text:
Prospect Avenue - Downtown Telluride
4 bedrooms, 3 bathrooms, sleeps 7 people
Sleeps: 8
Bedrooms: 4
Bathrooms: 3.5
Pets: No
Smoking: No
Aparcamiento gratuito en las instalaciones
Chimenea interior
Distribución de las camas
El barrio
Cosas que debes tener en cuenta
Normas de la casa
Guest please read through this carefully, initial each page, sign, date, scan and Email to:
(Email hidden by Airbnb)
Latitude 38 Vacation Rentals, LLC
THIS SHORT TERM RENTAL AGREEMENT ("Agreement"), executed/processed this
Today's Date: _____________________________________________________________________________
by and between Latitude 38 Vacation Rentals, LLC ("Rental Agent/Host") and
Guest First Name:_______________________________________________________________
Guest Last Name: ________________________________________________________________
("Guest") for the short term occupancy of the real property described herein:
Property Address or Property Code/ID:__________________________________________________
Telluride, Colorado ("Property");
Occupancy (Sleeps): ________________________________________________________________
Reservation # (Transaction ID/AirBnB Res#/ID):_________________________________________
1 (Website hidden by Airbnb) TERM. The Property shall only be occupied as a short term vacation domicile for the term commencing on:
Arrival Date:____________________________________________________________________________________
at 4:00 PM ("Commencement Date") and terminating on:
Departure Date:_____________________________________________________________________________________
at 10:00 AM ("Rental Period").
1.1 Check-In/Check-Out Time. Check-in time is 4:00 PM at the Property. Check-out time is 10:00 AM. Early or late arrivals and departures must be arranged with and approved in writing by the Agent in advance. Unless pre-approved by Agent, any check-outs between 1:00 PM and 6:00 PM will be charged a fee equal to 50% of one night's occupancy fee which shall be charged to the Guest's credit card. Check-outs after 6:00 PM will be deemed "hold-overs" and charged a fee equal to 150% of one night's occupancy fee which will be charged to the Guest's credit card. Unless pre-approved by Agent, early check-ins are deemed to be a trespass and may be subject to the cancelation of the reservation and forfeiture of all deposits paid hereunder and/or charged a fee equal to 200% of one night's occupancy fee which will be charged to the Guest's credit card.
2 (Website hidden by Airbnb) CANCELLATION. Guest may cancel this Agreement by sending written notice of cancellation to Agent at the address set forth herein. Guest acknowledges that by entering into this Agreement, the Agent and the owner of the Property have stopped marketing and advertising the Property for occupancy for the Occupancy Period that is the subject of this Agreement.
2.1 Liquidated Damages. Guest further acknowledges that Guest's termination of this Agreement will cause the Agent to incur substantial economic damages and losses of types and in amounts which are difficult to compute and ascertain with certainty as a basis for recovery by the Agent of actual damages, and that liquidated damages represent a fair, reasonable and appropriate estimate thereof. Accordingly, in lieu of actual damages for such delay, the Guest agrees that liquidated damages may be assessed and recovered by the Agent as against Guest, in the event of termination of this Agreement, and without the Agent being required to present any evidence of the amount or character of actual damages sustained by reason thereof. Therefore the Guest may be liable to the Agent for payment of liquidated damages in the amounts described in Section 3.2 and 3.3 below. Such liquidated damages are intended to represent estimated actual damages and are not intended as a penalty, and Guest shall pay them to Agent without limiting Agent`s right to terminate this agreement for default as provided elsewhere herein.
2.2 Termination Prior to Final Deposit Due Date. If Guest cancels this Agreement more than 61 days before the Commencement Date, the entire Initial Deposit shall be refunded to Guest, less an amount equal to $100 per bedroom in the Property.
2.3 Termination After Final Deposit Due Date. If Guest cancels this Agreement after the Final Deposit Due Date, GUEST SHALL NOT BE ENTITLED TO THE REFUND OF ANY PORTION OF ANY DEPOSITS PAID BY GUEST AND GUEST SHALL BE LIABLE FOR THE ENTIRE FINAL DEPOSIT WHETHER IT HAS BEEN RECEIVED BY AGENT OR NOT, IN WHICH EVENT THE AGENT SHALL BE AUTHORIZED TO CHARGE THE GUEST'S CREDIT CARD FOR THE ENTIRE FINAL DEPOSIT.
(Website hidden by Airbnb) DAMAGE/INSURANCE/LOST KEYS/LOST ITEMS. In lieu of a Security Deposit, Agent requires each Guest to pay a $ (Phone number hidden by Airbnb) fee for participation in Agent's Vacation Rental Damage Protection ("VRDP") plan.
(Website hidden by Airbnb) 3.1 VRDP Plan. The VRDP plan covers up to $1, (Phone number hidden by Airbnb) in certain damages to the interior of the Property and/or its contents that occurs during Guest`s stay, provided that such damage is reported to Agent prior to the Guest`s departure date. Damage in excess of $1, (Phone number hidden by Airbnb) will be charged to the credit card on file. In the event of such Property Damage, the VRDP plan will cover the lesser of the cost of the repair or the replacement cost of the property, up to a maximum of $1, (Phone number hidden by Airbnb) It is the Guest`s responsibility to promptly report any damage that is caused to the Property. The Plan does NOT cover damages arising from, or related to 1) damages deemed by Agent to be intentional, 2) theft, 3) damages in connection with violations of this Agreement, or 4) damages caused by gross negligence of the Guest or Guest`s invitees. The VRDP does not cover damages to any of the Guest`s personal effects, bodily harm, nor Guest related travel cost. The VRDP plan becomes effective upon check-in and terminates at departure or 10:00 A.M. on the last day of the reservation period, whichever occurs first. Any cost(s) related to damage, loss, etc., that Agent deems not covered by the VRDP plan shall remain the sole responsibility of the Guest.
(Website hidden by Airbnb) 3.2 Lost Keys/Parking Passes/Garage Door Openers. Guest shall be responsible for a fee in the amount equal to the cost of a replacement key, parking pass and/or garage door opener, plus 25%, for such items related to the Property that are not returned to the Agent. Guest's credit card may be charged for all such replacement fees and costs.
4. Cleaning
4.1 Mid-Stay Cleanings. If Guest wishes to schedule a mid-stay cleaning/cleanings of the Property, Guest must make those arrangements through the Agent with at least 48 hours advance notice. Additional cleaning is charged at an hourly rate determined by the housekeeper, but is currently $ (Phone number hidden by Airbnb) per hour. If Guest's occupancy is longer than 21 days, Guest must pay for an additional full cleaning of the Property, in addition to the cleaning fee included in the Total Fees, at the rate of $ (Phone number hidden by Airbnb) per hour.
4.2 Excess Cleaning. Guest shall leave the Property in a reasonably clean condition. If the Property is not left in a clean condition, normal wear and tear excepted, Guest's credit card will be charged for an excess cleaning fee in an amount equal to the actual excess charges incurred by Agent over and above the regular and customary cleaning fee that is part of the Total Fees, to have the Property properly cleaned and restored to the condition it was in as of the Commencement Date
5 (Website hidden by Airbnb) MAINTENANCE AND DAMAGE. Guest acknowledges that, unless the Agent is notified immediately upon occupancy, the Property including the furniture, furnishings and appliances shall be deemed to be in good working order, condition and repair. Guest shall keep the Property in a clean and sanitary condition, and shall immediately notify Agent of any damage to the Property or its contents, or any inoperable equipment or appliances. Guest shall not move, alter, or remove any furniture, fixtures, equipment or audio/visual systems from the Property. Guest shall surrender the Property, at termination, in as good condition as received, ordinary wear and tear excepted. Guest shall not commit any waste upon the Property or any nuisance or act which may disturb the quiet enjoyment of any neighboring occupants. Guest hereby acknowledges and agrees that insurance policies of the Agent and the Owner of the Property do not cover the Guest's personal property.
(Website hidden by Airbnb) 5.1 Damage from Ski Boots and/or Other Equipment. Please be advised that ski boots and other recreational equipment can cause substantial damage to the interior of the Property. Wearing ski boots inside of the Property is strictly prohibited, except in entryways, ski rooms, and mudrooms. Any damage to the Property caused by ski boots or other improper footwear to carpeting, hardwood, tile, and stone floors shall be the repaired by Agent at the cost of the Guest. Guests should refrain from wearing shoes inside the Property. Guests should bring slippers or other appropriate indoor footwear for use during your stay in the Property.
6 (Website hidden by Airbnb) OCCUPANCY.
(Website hidden by Airbnb) 6.1 The maximum overnight occupancy of the Property is set by the Agent and published online at (Website hidden by Airbnb) as the total number of people (adults and children) allowed in the property. Guest shall not allow more than the maximum overnight occupancy of the Property.
(Website hidden by Airbnb) 6.2 Guests may request blow-up mattresses for additional sleeping spaces by complying with the following requirements: (a) Guests must submit a written request to Agent for such blow-up mattresses not later than seven days prior to the Commencement Date; and (b) Guests must pay an additional charge of $75 per bed, per night in advance.
7 (Website hidden by Airbnb) HOLDING OVER. There will be no holding over or late departure without prior approval of the Agent. Any unauthorized holding over by Guest will be subject to a charge of 150% of the daily occupancy rate for the Property as published on the Agent's website at (Website hidden by Airbnb) plus any additional damages incurred such as the cost of alternate housing for guests displaced by Guests holding over which shall be billed to the Guest's credit card.
8 (Website hidden by Airbnb) NO SMOKING. No smoking of any kind is allowed inside the Property. Smoking inside of the Property is strictly prohibited at all times. The Guest shall be responsible for all damage caused by the smoking, including but not limited to, stains, burns, odor and removal of debris. In addition to Agent's other remedies upon a violation of this provision, Guests will be charged a minimum cleaning fee of $500 that will be billed to the Guest's credit card..
9 (Website hidden by Airbnb) PETS. Pets are not allowed in or on the Property or within property line of property, unless approved in writing by Latitude 38 Vacation Rentals, at the time of booking, and/or prior to your arrival. If approved, the Guest shall provide Latitude 38 Vacation Rentals with a valid credit card number for payment of an additional fee for the Pet (fee to be determined by Latitude 38) and credit card number shall be held on file for any possible damage remediation. If an unauthorized pet is in the Property, the Guest shall be responsible for all damage caused by pet; and can be made to vacate property without refund of any remaining deposits. In addition to Agent's other remedies upon a violation of this provision, Guest violating this policy will also be charged a cleaning fee in the minimum amount of $500 and the Guest's credit card shall be charged for all costs incurred by Agent for additional cleaning and to repair any damage to the Property caused by the pet.
If approved by Latitude 38, Guest will be required to complete an addendum Pet Waiver to this "Short Term Occupancy Agreement", provided by Latitude 38 Vacation Rentals (Host) accepting 100% responsibility for any damage and permitting the use of their credit card in the case of damage. Guest is required to provide: Breed, Weight and name of any/all pets which will accompany or visit property for any reason during the rental period.
10. ENTRY AND INSPECTION. Agent and Agent's employees, contractors and agents shall have the right to enter the Property at any time in case of emergency. Agent and Agent's employees, contractors and agents shall further have the right to enter the Property upon 24-hour notice go Guest (or such shorter time period as may be agreed to by Guest), to make necessary or agreed repairs, decorations, alterations, improvement, supply necessary or agreed services, and/or inspect the condition of the Property, or to show the Property to potential purchasers.
11. LAWS AND RULES AND REGULATIONS. Guest shall comply with all statutes, ordinances and requirements of all municipal, state and federal laws regarding the Property, including the use, possession, production or sale of illegal drugs. Guest further agrees to adhere to all rules and regulations set forth by the regulatory parties for the condominium complex or homeowners association in which the Property is located, including rules with respect to smoking, noise, odors, disposal of refuse, pets, parking and use of common areas. Guest acknowledges that it has received a copy of such rules from Agent.
12. PROPERTIES FOR SALE. If the Property is listed for sale, Agent shall have the right to enter the premises and to allow prospective or actual buyers, lenders or Guests to enter the Premises upon twenty-four (24) hours prior notice to Guest. A representative of Agent or the Owner of the Property may accompany prospective or actual buyers, lenders or Guests. Guest should inquire with the Agent regarding whether or not the Property is, or is not listed for sale.
13. HOT TUBS. The use of hot tubs, sauna, spas and steam rooms within the Property is at the Guest's own risk. The Property is located at a high elevation and Guests are urged to exercise caution when using these types of amenities. Proper precautions and acclimatization to altitude is recommended.
14. CONSTRUCTION ACTIVITIES. Telluride and Mountain Village are growing resort communities. There are various construction projects that may be ongoing during your stay that Agent has no control over. Agent shall use its best efforts to notify Guests of any construction projects in the vicinity of the Property that may impact the Property at the time of booking, however, Agent makes no representations or warranties as to the future status of construction projects that may impact Guests during their occupancy of the Property.
15. UNAVAILABILITY. If for any reason, the Property is unavailable, or becomes unavailable during the dates contracted for occupancy, Agent may either (i) cancel this Agreement, refunding to Guest all payments made hereunder by Guest, or (ii) undertake commercially reasonable efforts to work with Guest to locate and reserve suitable equivalent lodging (of equal or greater occupancy value) that is managed by Agent.
16. LIMITATION OF LIABILITY. In no event shall Agent be liable to Guests for incidental or consequential damages incurred by Guest as a result of the unavailability of the Property. In all circumstances, Agent's maximum liability to Guest shall be limited to the amount of the Total Fees paid by Guest under this Agreement.
17. EVENTS OF DEFAULT. In the event that Guest fails to abide by its obligations or breaches any of the representations made herein, in addition to any other remedies set forth in this Agreement, Agent shall have the option, in its absolute discretion, to declare Guest to be in breach of this Agreement. In such event, Agent shall be entitled to require all persons occupying the Property to immediately leave the Property or be removed from Property. Defaulting Guests shall automatically forfeit the right to a return of any unused Total Fees and shall be subject to a default charge of up to $ (Phone number hidden by Airbnb) . INDEMNIFICATION AND WAIVER. Guest shall indemnify, defend and hold harmless the owner of the Property and l Agent (the "Released Parties") from any and all liability for costs, expenses, claims, disputes, litigation, judgments, and attorney fees resulting from loss, damage, or injury to Guest, Guest's guests or licensees, or their personal property arising out of the Guest or the Guest's guests, invitees and licenses occupancy or use of the Property, except for injury or damage caused by the gross negligence or willful misconduct of the Released Parties. This waiver and release is intended to be a full and complete waiver and release of the Released Parties from any and all present or future claims.
19. INSURANCE. Guest acknowledges that the Released Parties' insurance does not cover any of Guest's or Guest's invitees` personal property, including vehicles, against loss or damage due to fire, theft, vandalism, rain, water, criminal or negligent acts of others, or any other cause. Guest is recommended to carry or obtain insurance to protect Guest, Guest's invitees, and their personal property from any loss or damage.
20. MEDIATION. Guest agrees to mediate any dispute or claim arising out of this Agreement, or any resulting transaction, as a condition precedent to the institution of any arbitration or litigation under this Agreement. Mediation fees, if any, shall be divided equally among the parties involved.
21. TIME. Time is of the essence of this Agreement.
22. ATTORNEYS FEES. In any action or proceeding involving a dispute between Agent and Guest arising out of this Agreement, the prevailing party will be entitled to reasonable attorneys' fees and any costs incurred in enforcing this Agreement.
23. NO WAIVER. Failure of Agent to enforce any provision of this Agreement shall not be deemed to be a waiver. The acceptance of any fees or deposits by Agent will not waive Agent's right to enforce any provision of this Agreement.
24. ENTIRE AGREEMENT. The foregoing, plus any attachments or addendums hereto, plus any electronic mail from Guest acknowledging and accepting the terms of this Agreement, if any, constitutes the entire agreement between the parties and may be modified only in writing signed by all parties. This Agreement and any modification, including any photocopy or facsimile, may be signed in one or more counterparts, each of which will be deemed an original and all of which taken together will constitute one and the same instrument. If there is more than one Guest, all Guests are jointly and severally liable under this Agreement.
25. NOTICES. All notices and documents to be delivered under this Agreement must be in writing, and delivery shall be effective when physically received by either party. As an alternative to physical delivery, any document, including a signed document or written notice, may be delivered in electronic form by electronic mail or facsimile. Unless otherwise provided, any notice which either party may give or is required to give, may be delivered to the addresses shown on the signature page or at such other places as may be designated by the parties from time to time. Notice will be deemed effective three days after physical mailing, or on personal delivery, or when receipt is acknowledged in writing.
26. CREDIT CARD AUTHORIZATION. Guest hereby authorizes Agent to charge all deposits, fees, costs and charges arising under this Agreement to the Guest's credit card provided to Agent. The reversal of any charges to Guest's credit card arising under this Agreement shall constitute a breach of this Agreement by Guest. In the case of any reversal of charge by Guest, this provision shall serve as express permission to Agent to recharge the Guest's credit card for payment or to collect such fees, costs and charges by any other legal means. ** Pt 26 does not apply to Airbnb guests.
27. COUNTERPARTS. This Agreement may be executed in any number of original counterparts, all of which evidence only one agreement, and only one of which need be produced for any purpose.
IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first written above.
Guest's Signature (Website hidden by Airbnb)
By: _____________________________________________________________________ (Website hidden by Airbnb)
Guest Name: ______________________________________________________________
Email: _____________________________________________________________________
Address: ___________________________________________________________________
Guest may alternatively sign and be bound by this document, by sending an electronic email to Agent, pursuant to which Guest agrees to be bound by the terms of this Agreement.
Rental Agent's Signature:
_________________________________________________________________ (Website hidden by Airbnb)
By:________________________________________________________ Latitude 38 Vacation Rentals, LLC
Guest, please read through this carefully, initial each page, sign, date, scan and Email to:
(Email hidden by Airbnb)
Latitude 38 Vacation Rentals, LLC
(Phone number hidden by Airbnb)
(Email hidden by Airbnb)
Mailing Address (USPS Only): PO Box 749
Shipping Address (UPS, FEDEX, DHL Only):
230 South Pine Street, Suite 100
Telluride, Colorado (Phone number hidden by Airbnb)


text:
Property Sale Through GPA Is Illegal
Through an order in 2011, the Supreme Court held that transferring property title through a general power of attorney was not valid. The top court directed municipal bodies not to register/mutate properties based on these documents. Following the order, states banned the registration of properties sold through GPA. The SC, however, said that genuine transactions carried out through GPA would be valid. In light of this, should you be entering property transactions that involve sale through power of attorney? Let us find out.

subset: commoncrawl


text:
CraftKitsandSupplies carries a large selection of Novelty Hats. It doesn't matter if you are going to a costume party, dressing up for the holidays, or just looking for a little attention, we have the fun novelty hat that you are looking for. Novelty Hats such as Cowboy Hats, Gangster Hats, Mardi Gras Hats, New Year's Eve Hats, Party Hats, Pirate Hats, Santa Hats, St. Patrick's Day Hats, Straw Hats, and many more other hat styles.
We also carry a complete line of Beads, Birdhouse Kits, Christmas Crafts, Craft Supplies, Kids Crafts, Misc Crafts, Wood Craft Kits, and much more.


text:
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
Integrating oral appliance therapy into the delivery of care for sleeprelated breathing disorders has been a challenge for dental and medical professionals alike. We review the difficulties that have been faced and propose a multidisciplinary care delivery model that integrates dental sleep medicine and sleep medicine under the same roof with educational and research components. The model promises to offer distinct advantages to improved patient care, continuity of treatment, and the central coordination of clinical and insurance-related benefits.
Sharma S; Essick G; Schwartz D; Aronsky AJ. Sleep medicine care under one roof: a proposed model for integrating dentistry and medicine. J Clin Sleep Med 2013;9(8):827-833.
Although sleep science has significantly advanced in the last decade, the delivery of care for sleeprelated breathing disorders remains fragmented. Oral appliances in particular have historically been underutilized. This article discusses some of the challenges we have faced and proposes a care delivery model that is designed to integrate the disciplines of dental sleep medicine and sleep medicine. While in the past there has been a natural tendency to build separate "shops" for each specialty (separateoffice model), the current emphasis on multidisciplinary care stresses the need to be able to play in the same "sandbox" (care-under-one-roof model). As will be discussed below, this model offers distinct advantages to improved patient care, continuity of treatment, and the central coordination of benefits, both insurance-related and clinical.
Reasons for the inability of dental sleep medicine to integrate fully with the delivery of sleep medicine care have been many. First, the growth of dental sleep medicine has not kept pace with the exponential growth of sleep medicine in the treatment of obstructive sleep apnea syndrome (OSA). Dentists who provide appliance therapy for sleeprelated breathing disorders are seemingly few in number. Although the American Academy of Dental Sleep Medicine (AADSM) website (http://www.aadsm.org/FindADentist.aspx) lists about 3,000 US dentists as members, only about 200 dentists have obtained diplomate status with the American Board of Dental Sleep Medicine (ABDSM) (http://www.abdsm.org/Diplomates.aspx), and only about a dozen dental practices have been accredited as dental sleep centers. (http://www.aadsm.org/PDFs/AccreditationStandards.pdf). Thus, with the possible exception of using these websites, the thousands of sleep disorders centers (both accredited and nonaccredited) in the United States have found no easy way to identify dental sleep medicine experts to whom patients can be referred for evaluation and treatment with oral appliances and for whom the specialized training and experience in oral appliance therapy can be assured.
Second, the lack of education in the specialized use of oral appliance therapy for sleep disordered breathing among dentists and sleep physicians has been a limiting factor.1 A survey of dentists found that 40% knew little or nothing about oral appliances for treatment of OSA.2 Moreover, 49 responding dental schools of the 58 US schools recently surveyed reported only 3 hours of total curriculum time devoted to sleep medicine.3 With the exception of short courses offered by the AADSM, dentists have relied on training from marketing groups often associated with specific appliances and products for sleep medicine. Knowledge of new materials, techniques, procedures, and continuing education has also been attained from dental journals, periodicals, and advertisements. Efforts are under way to formalize dental sleep medicine training in our dental schools. The University of North Carolina School of Dentistry is hosting a conference for dental educators across the United States and Canada to begin the process of developing predoctoral DDS and clinical residency programs.
Education to sleep physicians and technologists about oral appliances has been virtually nonexistent. Indeed, there have been recent efforts to train physicians to practice oral appliance therapy at professional meetings. Although this practice raises awareness of oral appliance therapy, it can undermine recognition of the training dental sleep experts undergo to properly evaluate the integrity of the teeth, the surrounding bone, and temporomandibular joints; to obtain accurate impressions and fit removable oral appliances (such as dentures and bite guards) to the teeth; and to minimize negative side effects of their presence.
Third, communications between sleep physicians and dentists have been suboptimal in most healthcare settings. Even in academic settings, interactions between medical and dental professionals have been limited by their separate and different clinics, patient record systems, administrative priorities, and business models. There has been little need to cotreat patients in the past; thus the infrastructure and administrative support to encourage good communication between medical and dental sleep providers are lacking.
Fourth, the cotreatment of patients with dental clinicians has been viewed as vaguely competitive to some physicians who provide CPAP as the primary treatment modality. This view has likely limited referral of patients for oral appliance therapy. However, a truly successful relationship between physicians and dentists will only be established by close communication and sharing the common goal of patientcentered treatment.
Fifth, referrals to dentists have been discouraged by the lack of, or limited reimbursement for, oral appliances by insurance carriers. Although the AASM recognized oral appliance therapy in 2005 as a potential first-line therapy for mild and moderate OSA and for patients with severe OSA who fail positive airway pressure therapy, many medical insurance carriers (including Medicare) are now only beginning to provide benefits for oral appliance therapy.4,5 Progress on this front has been slow and severely challenged by (i) claims processing centers that are not prepared administratively to negotiate contracts with, or process claims from, dentists who are treating a medical condition, (ii) dental practices that are unfamiliar with submission of medical insurance claims and the appeal process upon denial, and (iii) reduced reimbursement rates for appliances that may not meet the dentist's costs for high quality oral appliances and the chair time required for comprehensive followup care.
Sixth, post-intervention care with oral appliances has left much to be desired. Many patients are reluctant to return to the referring physician for followup evaluation of the efficacy of the oral appliance therapy, often citing the costs of another sleep study or its inconvenience as reasons for their reluctance. In one study, only 18% of patients receiving oral appliances underwent polysomnography after the initiation of therapy.6 For those patients who do return for a followup sleep study and for whom there is residual sleep disordered breathing, another sleep study with yet further costs and inconvenience may be indicated after the dentist or patient adjusts the appliance.
Seventh, outcome measures have not been well documented for oral appliance therapy. While some controlled trials have shown improvement in daytime sleepiness and blood pressure on a shortterm basis, the impact of oral appliances on cardiovascular disease on a longterm basis remains largely unknown.7–9 Such data on robust outcomes measures are needed to substantiate the long-term benefit of oral appliance therapy when compared to those of nightly use of positive airway pressure.
The future of sleep medicine will invariably be influenced by healthcare system reforms to focus more on prevention, multidisciplinary care, and longitudinal disease management in a patientcentered medical home concept. It is, therefore, in the best interest of sleep medicine that a dialogue on innovative improved models of care be reviewed, discussed, and implemented to address the abovementioned barriers to achieve comprehensive care. We feel that a strong partnership model, based at least initially in academic tertiary care centers, will be able to initiate and to build all aspects of the program including clinical, educational, and research components. Such an integrated model will be able to provide the much needed leadership and backbone that can then successfully form a blueprint for communitybased programs.
Our model is based on an integration of the academic center's sleep medicine program (American Academy of Sleep Medicine [AASM]-accredited sleep disorders center) and its dental school to form a partnership in clinical, educational, and research activities and to include the longitudinal collection and analysis of outcome measures. We believe that the unique scope of practice for physicians and dentists can be preserved and business success achieved. Implementation of the model across the country will require a significant and novel commitment of dental schools to educate students in the field of sleep medicine and to demonstrate how the dentist can play a significant role in the success of oral appliance therapy by working closely with sleep physician colleagues.1
Since fragmentation of care and limited communication have been major stumbling blocks to comprehensive care, we propose a care-under-one-roof ("one sandbox") concept allowing sleep physicians to be in face-to-face contact with dental sleep faculty for discussion of patient care issues pertaining to diagnosis, treatment, followup, and to provide the necessary dental care that must be delivered prior to rendering dental appliance treatment. We anticipate that cotreatment of patients in the same facility would raise expectations and clinical successes within the facility and improve patient care. Care-under-one-roof would effectively minimize patient travel from office to office. This would ensure that patients are treated, that patients receive followup care and posttreatment evaluation, and that all medical caregivers receive communication on the patient's treatment plan. This approach has been well validated in other disease models and has been shown to improve outcomes.10,11
A care-under-one-roof model also provides a ready venue for the practitioners to effectively collaborate. For example, the current AADSM-approved protocol for oral appliance therapy for sleep disordered breathing in adults (http://www.aadsm.org/PDFs/TreatmentProtocolOAT.pdf) includes the possibility of combining positive airway pressure and oral appliances for patients who have a subtherapeutic response to oral appliances alone.12–14 However this therapy is rarely offered to patients because of the lack of a setting in which the dental (oral appliance and its titration) and medical (PAP and its titration) components can be implemented together or the lack of business plan to bill insurance companies for the combined service. The care-under-one-roof model offers a means to overcome these limitations as well as the venue for the conduct of much needed clinical research on combination therapy.
Any integrative and collaborative model should adhere to accreditations standards set by the AASM. Sleep disorders centers should comply with AASM practice parameters including comprehensive assessment of patients by, or under the supervision of, a board certified sleep specialist (http://www.aasmnet.org/accred_centerstandards.aspx). The Medical Director of the center is ultimately responsible for maintaining the standards and assuring quality delivery of all aspects of care. We propose that a faculty member of the dental school who is a diplomate of the (ABDSM) serve as the dental sleep expert at the sleep disorders center. This individual would be expected to develop and streamline dental treatment and assessment while taking into consideration center-specific infrastructure and patient management procedures. However, unlike in the existing separate office model of care, the dental sleep expert would be available on a scheduled basis to consult with patients during their visits to the sleep disorders center and advise on their candidacy for oral appliance therapy. In addition, the dental sleep expert would participate in multidisciplinary staff conferences during which treatment plans for the more difficult-to-manage patients are generated (see 1 in Figure 1).
Research components are indicated by dashed lines (see 1R and 4R).
Schematic diagram of the proposed care-under-one-roof model for integrating dental sleep medicine and sleep medicine within the university-based sleep disorders centerResearch components are indicated by dashed lines (see 1R and 4R).
(more ...)
In accord with a patient centric model, the patient after diagnosis of obstructive sleep apnea would be counseled on different treatment options including oral appliances and patient preference taken into account. A study by Krucien et al., using a discrete choice experiment model revealed that patients preferred CPAP 60% and OA 36% of the time.15 However, the model assumed that oral appliances were effective 40% of the time compared to CPAP (100% of the time)—neither estimate of which is consistent with contemporary literature.16,17
Potential candidates for oral appliance therapy would complete a battery of questionnaires and receive a standardized orofacial and dental examination within the comprehensive sleep disorders center. Impressions and records would be taken for fabrication of the dental appliance (see 2 in Figure 1). In the nearby dental facility, dental radiographs would be taken as necessary to complete the evaluation.
The patient would return to the sleep disorders center for fitting of the appliance and postinsertion instructions on its use, cleaning, and titration. For the latter, the patient would increase the extent of jaw advancement on a set schedule until his symptoms were eliminated or wear of the appliance became uncomfortable. Titration protocols can be home based, in which titration is done based on patient and family feedback.18 This technique can take several weeks and has a potential of resulting in incomplete treatment of OA. Because elimination of symptoms does not necessarily guarantee normalization of the apneahypopnea index (AHI), out-of-center sleep testing (OCST) or inlab polysomnography may guide additional advancement of the jaw.17,19,20,21 OCST may be considered in patients for whom OCST is appropriate, as described by AASM practice parameters.22 The use of OCST is also recognized in the current AADSM approved protocol for oral appliance therapy for sleep disordered breathing in adults (http://www.aadsm.org/PDFs/TreatmentProtocolOAT.pdf). Thus, in the proposed model the patient would be scheduled for administration of OCST by the sleep disorders center or inlab polysomnography at the sleep disorders center, once adjustments in the appliance to eliminate the patient's symptoms had been made. Published studies have shown that a higher proportion of patients can be treated effectively if the custom-fabricated oral appliance is adjusted during an overnight sleep study.17,20,21
Patients who respond to OAT with AHI normalized as determined during OCST or polysomnography reevaluation, would be seen for routine followup in the sleep center in 6 months, 12 months, and yearly intervals thereafter in accordance to recommendations of the AASM practice parameters (see 3 in Figure 1).4 On the yearly visits, the patient would be seen by the dental team and the sleep center healthcare professional, who would evaluate compliance with therapy and assure continuity of medical care.
Patients whose sleep disordered breathing could not be corrected solely with an OAT would be reevaluated for CPAP or surgical procedures (see 4 in Figure 1) or undergo CPAP titration while wearing the dental appliance (see 4R in Figure 1). Because the jaw is stabilized in a forward and upward position, the effective pressure may be less than that required without an appliance, thereby decreasing pressure-related patient complaints.13,14 Moreover, support for nasal pillows or a mask can be obtained directly from the appliance, eliminating all straps and contact with the patient's face except for the nasal or perinasal region.
There are other advantages to patient care of an integrated care-under-one-roof delivery model. There is growing interest in determining which patients are good candidates for oral appliance therapy prior to treatment. Cephalometric measurements may help predict patients who may benefit from OA.23
Alternatively, inlab "prognostic" titration has been shown not only to produce rapid results but can also be helpful in predicting patient response.24–27 During the titration study, the teeth are engaged by upper and lower trays of impression material that can be slid apart manually or by remote control to advance the mandible. The goal is to determine if the patient's sleep disordered breathing can be alleviated by jaw advancement and to estimate the extent of advancement required. The procedure is anticipated to be particularly important in the assessment of patients who have failed CPAP repeatedly and who have been considered poor candidates for oral appliance therapy based on other factors such as a high BMI.28 The authors are already investigating this newly validated approach to patient care and have included it as a research component for select patients in the care-under-one-roof model (see 1R in Figure 1).
Patients may also be offered a trial of jaw advancement using a less expensive boil and bite appliance, before a custom-fabricated appliance is suggested.29 We feel that prognostic sleep studies and temporary oral appliances can be successfully used to determine the efficacy of jaw advancement and acceptance by a segment of patients before ordering a more expensive permanent appliance. For example, temporary appliances are indicated for patients who are undergoing dental treatments over an extended period of time. However, custom-fabricated appliances have been shown to be more efficacious and compliance is higher.29,30
Safety and compliance monitoring would be conducted every 4-6 weeks after an appliance is delivered until treatment efficacy and patient adherence have been established. In addition to compliance, patient adverse effects would be documented and addressed by the attending dental sleep expert. Noncompliance (compliance being defined as ≥ 4 h use for ≥ 70% the nights) or failure due to intolerance of oral appliance therapy would trigger an alternative treatment strategy in consultation with the sleep specialist. These might include hybrid therapy, PAP therapy, or surgical intervention in select cases. A sleep specialist would manage any concomitant sleep disorders, which a patient may have to avoid overlap of visits. Cardiovascular and cognitive markers would be recorded for outcome data analysis and quality control.
We recommend outcome measures form the backbone of the proposed model's care of patients with obstructive sleep apnea. Outcome measures would serve as benchmarks for quality assurance and improve our understanding of the natural history of the disease with different interventions. Several outcome measures would be evaluated for quality assurance including compliance (patient-reported until reliable lowcost objective measures can be obtained), post intervention reductions in the AHI and excessive daytime sleepiness (e.g., Epworth Sleepiness Scale) and improvements in scales of neurocognitive functioning (e.g., psychomotor vigilance testing). Recently, mouth temperature-sensing compliance-monitoring chips embedded in oral appliances have been shown to be useful in recording hours per night and nights per week of therapy.31 This technology will provide oral appliance data similar to compliance monitoring of positive airway pressure therapy. Longterm followup and monitoring of blood pressure, cardiac and cerebrovascular events, and mortality would be undertaken, so that the benefits of oral appliance and positive airway pressure therapies can be compared. A concomitant surveillance of adverse effects (both shortterm and longterm) would be documented.
The integrated care-under-one-roof model provides educational opportunities at all levels consistent with the mission of the medical and dental schools of the faculty working at the sleep disorders center. The weekly multidisciplinary conferences would provide a forum for crosstraining of medical and dental personnel as well as other healthcare professionals present (e.g., otorhinolaryngology and pulmonary medicine). Dental school residents (particularly those in general practice residency programs, advanced education in general dentistry programs, and orofacial pain residency programs) would be given the opportunity to rotate in the sleep disorders center to practice the dental sleep medicine skills taught at the dental school by both medical and dental faculty. Fellows at the sleep disorder center and the dental residents would present clinical cases during ground round presentations with literature reviews. It is anticipated that sleep medicine education would eventually be incorporated into the predoctoral M.D. and D.D.S. curricula. Opportunities would develop for continuing education of physician and dentists in private practice, as well as for sleep technologists and respiratory technicians providing CME, CDE, and CEU credits, as appropriate.
The establishment of a strong and productive integrated care-under-one-roof program would naturally motivate research activities. The collection and analysis of outcome measures for oral appliance therapy from shortterm efficacy to longterm compliance and impact on medical comorbidities of untreated OSA would be most vital. Clinical trials on combined oral appliance/positive airway pressure therapies are needed and would be made readily possible with a single healthcare visit. Depending on infrastructure and support, we suggest that research from outcome measures, prospective trials on combined therapies, and therapy compliance be a mission of the integrated care-under-oneroof program.
There are specific Medical and Dental Licensing Laws and Practice Acts, which dictate the scope of practice for physicians and dentists (http://www.aasmnet.org/resources/pdf/AADSMJointOSApolicy.pdf). As per individual state law, laws only a licensed physician can make a diagnosis and treatment plan for sleep disordered breathing. Similarly, a dentist's scope of practice includes evaluating the candidacy of patients for oral appliance therapy as well as construction and fitting of the appliances. The proposed "care-under-one-roof model" will be structured within the practice parameters established by the AASM.4 Updated practice parameters are currently being prepared by the AASM for publication.32
Responsibilities of sleep physician specialist:
Assess patients with sleeprelated complaints.
Order appropriate diagnostic tests and diagnose obstructive sleep apnea.
Discuss treatment options with the patient based on practice parameters and standard of care guidelines.
Counsel on behavioral therapy, sleep hygiene, weight loss, and driving precautions.
Manage concomitant sleep disorders which often accompany OSA, such as restless legs syndrome (RLS)/periodic limb movement disorder (PLMD), circadian rhythm disorders, and insomnia.
Follow and document comorbid conditions and impact of treatment on hypertension, diabetes, heart failure, arrhythmia, and neurocognitive function.
Engage in active consultation with staff dental sleep expert on treatment plan.
Participate in periodic multidisciplinary rounds and conferences.
Provide followup sleep testing after OSA therapy has been instituted.
Provide ongoing and routine followup patient care.
Responsibilities of staff dental sleep expert:
Evaluate patients for dental sleep medicine therapies.
Discuss treatment options (mandibular advancement splints, combination MAS/PAP therapy, tongue retaining device, maxillofacial surgery, etc.).
Manage coexistent dental disorders, such as bruxism.
Counsel on dental hygiene and daily maintenance of oral appliances.
Followup patients every 4-6 weeks until treatment efficacy and patient adherence to therapy have been established.
Review compliance and manage potential complications or adverse effects of therapy.
Maintain communication with sleep physician specialist for outcome measures monitoring.
Assess the need for change in treatment, or repeat PSG for either retitration or resolution of sleep disordered breathing.
Establish protocols at the sleep disorders center on oral device titration, technician training, consent procedure, offhour call coverage issues.
Provide ongoing and routine patient followup care.
Sustainability of the integrated care-under-one-roof model would depend on development of a business model that can successfully address the financial challenges faced by many dentists today who provide oral appliance therapy. Ideally, the sleep clinic administration would negotiate contracts with medical insurance companies for the dental providers in much the same way the physicians are enrolled to deliver contracted services and are credentialed as providers. The clinic office would ideally handle preauthorization and file insurance claims for the dental component of the patient's evaluation and treatment. A single, unified electronic medical record (EMR) system would be used by all providers. Financial sustainability would be made possible, in part, by the efficiency of care delivery and the quantity of care delivered. The dental sleep expert may be able to bill for his services provided to the patient at the sleep disorders center even if seen on the same day as the sleep specialist, as services provided are different and performed by two different specialists.
The care-under-one-roof model raises legal concerns that would need to be addressed to comply with individual state and federal laws. For example, dentists in some states are bound by a "corporate practice" doctrine, which prevents nondentists from owning any part of the dental practice. Moreover, compliance with the federal Stark laws also require that the referring physician have no financial interest in any business that provides positive airway pressure (CPAP provider) or oral appliance (dentist), as both are viewed as durable medical equipment (DME) providers by the Centers for Medicare and Medicaid Services. However, several large hospitals and institutions now have DME services and can provide integrated care-under-one-roof with appropriate safeguards. Due to these limitations, we believe that this model is best suited initially for use in an academic/institutional setting with a communitybased model evolving from the experience of these centers.
Although the above model is proposed with academic institutions in mind, this model can be adapted for nonacademic centers. We propose that this collaboration take place in AASM-accredited sleep disorders centers. Boardcertified sleep physicians at the center should form alliance with dedicated dental practitioners who have adequate training in sleep medicine and are motivated to serve this population. The dental expert should have scheduled clinic hours at the sleep center where a comprehensive dental evaluation may be performed. Dentist "chair" is a small investment which the sleep center or the dentist has to make (a refurbished chair can be obtained for around $3,000.00). The use of radiographs is essential to the treatment decision (http://www.aadsm.org/PDFs/TreatmentProtocolOAT.pdf), but these can be obtained from the patients' general dentists. Many dentists have digital offices and therefore are able to email the radiographs upon patients' permission. This will all be done in conjunction with a comprehensive dental exam, periodontal screening, muscle evaluation, TMJ evaluation, and review of medical history.
From a business perspective, the sleep center charges the dental sleep expert for renting space and equipment. The dental sleep expert, by his presence and expertise, determines which patients are good candidates for OA. The dentist utilizes the center's expertise to titrate patients either by OCST or inlab titration, and in longterm followup.
Oral appliances for OSA are considered durable medical equipment, so several models out in the real world can exist. Under one model, the sleep center provides DME, and the dentist is contracted to provide under the DME services of that group. This model allows the DME company to bill on behalf of the dentist for those services. Other models have the dentist with their own DME, then provide services and bill for their services. The advantage of the dentist contracting under the sleep center DME is that most of these DME companies already have insurance contracts in place to provide CPAP, another DME item. It is then easy for the contracts to be extended to oral appliances.
While the reimbursement for OA is varied, it is a covered benefit to most patients with private insurance. Medicare has also come on board in reimbursing for these appliances with fairly strict coverage and mandating delivery by a dentist.
We feel this model will not only improve patient care and comfort, but it is also financially viable and professionally satisfying.
Integrating oral appliance therapy into the delivery of care for obstructive sleep apnea syndrome has been a challenge and few effective models exist so far. It is imperative that the sleep medicine community develops a realistic and effective model of this underutilized but promising treatment modality. We believe that the best structure is to integrate dental sleep medicine with the sleep disorders program is via a care-under-one-roof concept. Training, communication, education, marketing, and evaluating outcome data are vital. Such centers of excellence at academic institutions are best suited to lay this foundation. These institutional centers can provide care in their community as well as serve as a model of integrated care delivery for sleep medicine throughout the country in nonacademically based sleep centers.
This was not an industry supported study. Dr. Sharma served on the Speaker Bureau of Actelion and Gilead pharmaceuticals and has a portable sleep device grant from Cadwell Industries. Dr. Essick has received devices for research on loan from SleepImage and from Airway Management, Inc. He has also received teaching materials at no charge from Airway Management, Inc. and serves as the chair of the Research and Ethics Committees of the American Academy of Dental Sleep Medicine. Dr. Schwartz is on the Academy Faculty of Somnomed. Dr. Aronsky serves on the Board of Directors of the American Academy of Sleep Medicine.
The content of this paper is the sole responsibility of its authors and is not meant to represent the opinion of the American Academy of Sleep Medicine. The authors thank Dr. Sam Fleishman for his helpful suggestions during preparation of the manuscript. Legal and financial models proposed are personal viewpoints of the authors and all entities are advised to consult their state/institutional regulatory bodies to seek expert counsel.
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Naismith SL, Winter VR, Hickie IB, Cistulli PA, authors. Effect of oral appliance therapy on neurobehavioral functioning in obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med. 2005;1:374–80. [PubMed]
Tan YK, L'Estrange PR, Luo YM, et al., authors. Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: a randomized crossover trial. Eur J Orthod. 2002;24:239–49. [PubMed]
Vanderveken OM, Boudewyns A, Ni Q, et al., authors. Cardiovascular implications in the treatment of obstructive sleep apnea. J Cardiovasc Transl Res. 2011;4:53–60. [PubMed]
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Antoline C, Kramer A, Roth M, authors. Implementation and methodology of a multidisciplinary disease-state-management program for comprehensive diabetes care. Perm J. 2011;15:43–8.
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Borel JC, Gakwaya S, Masse JF, Melo-Silva CA, Sériès F, authors. Impact of CPAP interface and mandibular advancement device on upper airway mechanical properties assessed with phrenic nerve stimulation in sleep apnea patients. Respir Physiol Neurobiol. 2012;183:170–6. [PubMed]
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Petelle B, Vincent G, Gagnadoux F, Rakotonanahary D, Meyer B, Fleury B, authors. One-night mandibular advancement titration for obstructive sleep apnea syndrome: a pilot study. Am J Respir Crit Care Med. 2002;165:1150–3. [PubMed]
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Fleishman S. Personal communication. 2013.


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Reporters: Before you report unconfirmed information—wait.
Bloggers: Before you assume motive in a senseless act—wait.
Tweeters: Before you retweet information or jump into a political debate—wait.
Believe me. I was right there believing every report that came in, right there feeling pissed at Sarah Palin for her crosshairs, right there considering a nasty blog post about the Tea Party. And while I still think those crosshairs are completely irresponsible, I'm glad I waited long enough to cool down, get a few more facts, and gain some perspective before venting online.
Yesterday's events were tragic, and it will take a long time for us to sort out what happened and what it means for us going forward. But that's how it's supposed to be. Grief is supposed to be processed over time, not in an instant.
So how did social media affect how you received and processed yesterday's news? Was it fair or unfair for tweeters to point to Sarah Palin's image of crosshairs over Gabrielle Giffords' district? Did you learn anything about waiting?
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It's my wedding day, and the idea that everything will be different from this point forward terrifies and excites me. Three years of dating had taught me a lot about Josh, but I knew marriage would be an entirely new experience.
Those years of dating were full of questions:
- Was he the one God had for me; the one I would spend my life with?
- Did we have similar ideas regarding marriage, family, finances and our futures?
- Would he make me happy?
- What if we got married — committed ourselves to one another — and then discovered some horrible secret or character flaw?
- What if I was wrong?
Talking out our fears and anxiety, we wrestled with each question together and privately. Praying, seeking God's direction, and believing that if we genuinely desired His will God would not steer us wrong.
So we arrived at our wedding day.
Curled, powdered and covered in satin, standing at the doorway to the chapel, I recognized the importance of that first step inside; there would be no turning back. Confidently walking forward, my arm looped through my dad's, I welcomed the commitment ahead.
Over ten years have passed since that day, and there have been surprises and trials for us to work our way through. Not all the surprises have been bad, and the trials have made us stronger and closer. Never once have we given ourselves the option of running away from our commitment or doubting the path God has led us on.
Normally these types of posts are written on wedding anniversaries or birthdays, but mine is prompted by the similarities I am experiencing on the brink of a new commitment.
Over the past few months Josh and I have been wondering what God was bringing us to Washington for, and where we would serve once we were up here. We felt pressure and anxiety to find a new church right away.
Like my dating experience, the questions in my mind regarding our decision were all about me:
- Do I like the worship, preaching style, decorations and children's programs?
- What kind of opportunities do they have for me to use my calling and giftings?
- Are they welcoming and friendly? Do I see people I'd like to get to know better?
- What if we start going here and it turns out bad? What if they just want to use us?
- What if we're wrong?
We believe we've found our church
Today, I recognized that once again I am standing at the door to a chapel. The time for fear and anxiety is past, and my questions need to change.
On the day of my marriage, the only thing I needed to ask was: "How can I be a godly wife for Josh? What can I do to serve him?" No longer could it be all about me, because I was now one with another.
In committing to a church, much like a marriage, the question needs to be: "How can I serve the leadership and congregation of this church?" No longer can it be about what they do to serve me or feed me. We are told to be more concerned about the needs of others than ourselves. That we will be known by our love for one another.
My marriage has lasted over ten years because of my commitment to Josh and to God, and trusting Him to work in my relationship. If I had based it on my feelings and personal ideas of happiness, there might have been a few times I would have chosen to bail out. Today I am wiser, happier and a better person because of the things Josh and I have been through together.
I believe the same thing can be true as I commit myself to the leadership and fellowship of a new church family.


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2016 CUDO (Common University Data Ontario)
CUDO provides detailed information about every Ontario university in a common format. It invites prospective students and the general public to explore, assess and compare various aspects of each university.
OCAD U is Canada's largest university of art and design, dedicated to applying the power of imagination to education, research and creative enterprise.
For last year's CUDO data visit the 2015 CUDO site.
Go to the Council of Ontario Universities site for similar information on other Ontario universities.


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At UAMS, we are specializing in you with personalized medicine. Trying to decide which doctor to see can be a difficult process, so we try to make it as easy as possible for you to find the right doctor.
You can search for your doctor by name, condition, disease, department or specialty. Ensuring that you will be able to find the right doctor for your individual needs is just one of the many ways that UAMS is committed to providing personalized care to you and your family.
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2013 NAIA Men?s Cross Country Runner of the Week - No. 2
By: Alan Grosbach, Manager of Communications and Sports Information
KANSAS CITY, Mo. — Sam Atkin of Lewis-Clark State (Idaho) has been named the NAIA Men's Cross Country National Runner of the Week, the national office announced Wednesday. Atkin was chosen for his performance during the week of Sept. 16 – 22 and was selected out of a pool of conference, independent and unaffiliated group award winners.
Atkin, a junior from Lincolnshire, England, cruised to an individual title at the Runners Soul Erik Anderson Invitational in Spokane, Wash., on Sept. 21. His time of 25:14 topped a field of 186 runners that included a pair of NCAA Division I members – Gonzaga (Wash.) and Lipscomb (Tenn.) – and two nationally ranked NCAA Division II schools – Simon Fraser (B.C.) and Cal Baptist. Atkin previously claimed an individual title at the Clash of the Inland Northwest on August 31.
For the complete player of the week calendar, click here.
Nominees: Michael McCulloch, Columbia (Mo.); Tim Williams, Missouri Baptist; Kaleb Wilson , William Woods (Mo.); Arnold Mutuse, Tennessee Wesleyan; Tanner Thomas , Truett-McConnell (Ga.); Danzel Jefferson, St. Andrews (N.C.); Kody Shriver, Eastern Oregon; Paul Adams, Oregon Tech; Eric Alldritt, Concordia (Ore.); Justin Holden, Corban (Ore.); Matt Hall, Taylor (Ind.); Tyler Herber, Huntington (Ind.); Mark Babbey, Marian (Ind.); Josh Richardson, Mount Vernon Nazarene (Ohio); J.j. Weimer, Grace (Ind.); Noah Kiprono, Rocky Mountain (Mont.); Sancho Ridesattthedoor, Carroll (Mont.); Marc Klimas, Great Falls (Mont.); Garret Ehlers, Morningside (Iowa); Ben Sievert, Concordia (Neb.); Kwame Jackson, Xavier (La.); Cris Renteria, Central Methodist (Mo.); Vincent Tadokoro, Baker (Kan.); Colton McNinch, Southwestern (Kan.); Hunter Stayton, Kansas Wesleyan; Jeo Mendez, Ottawa (Kan.); Jeremy Johnson, Berea (Ky.); Seth Prince, Indiana East; Brad Liston, Shawnee State (Ohio); John-Paul Williamson, Lindsey Wilson (Ky.); Jonathan Gears, Cumberlands (Ky.); Herbert Beyale, III, Haskell (Kan.); Tj Mosbach, Mount Mercy (Iowa); David Guillen, Texas at Brownsville; Patrick Mutai, Wiley (Texas); Kyle Wardwell, Oklahoma City; Robert Dupoint, Science & Arts (Okla.); Zach Sollie, Auburn Montgomery (Ala.); Jacob Alplund, Northwood (Fla.); Paul McKenna, Embry-Riddle (Fla.); Jonathan Nusbaum, Warner (Fla.); Trevor Coules, Ave Maria (Fla.); Kyler Kathman, Southeastern (Fla.); Jacob Towne, Aquinas (Mich.); Samuel Parlette, Siena Heights (Mich.).
2013 Men's Cross Country Composite Award Winners
Week 1 (September 18): Mike Blaszczyk, St. Francis (Ill.)
Week 2 (September 25): Sam Atkin, Lewis-Clark State (Idaho)


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Welcome to our skin care site dedicated to providing you with advice on how to remove blackheads and other great skin care tips for beautiful, clear skin.
We provide information on everything from effective but inexpensive home remedies, to product reviews of popular skincare products as well as information about the latest dermatologist treatments.
To find the information you are looking for, please make use of the 'site index' link at the top of the page to browse all the articles and product reviews.
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What Is The Best Way Of Treating Blackheads?
Blackheads are unsightly blemishes, caused by excess oil that has clogged a pore, tend to appear on the oily parts of the face, the nose, chin and forehead and look like tiny black plugs; the open pore exposes the trapped oil to the oxygen in the atmosphere, which is what turns it black.
There are different views on treating blackheads. Harsh squeezing of them is not recommended, but very gentle pressure applied to the surrounding area is thought to be the simplest, more effective method.
"Popping" releases the trapped oil, which relieves the pressure that is causing the damage to the skin. Care must be taken not to apply too much pressure, however, as this could cause scarring and make the skin look even worse.
The best method of blackhead removal is to use a very gentle facial scrub on damp skin to get rid of dead skin cells on the surface of the skin. Next, pat your face dry with a clean washcloth.
Wet the washcloth with warm water, wring it out and place it over your face for around 15 minutes. Relax and let the warmth soften the contents of the blocked pores, which should make them easier to remove.
Do this by first, patting the skin dry again, then take a piece of tissue and hold it over the blemish; use the tips of both index fingers to apply even pressure to either side . Try to apply the pressure from underneath the blemish. If it will not "pop" after a couple of attempts, leave it alone.
Focus on caring for your skin over the next few days, kep it free of heavy products and cosmetics as much as possible, and drink plenty of water to hydrate the skin. Use a very mild facial scrub every day.
Try the above method again a few days later, and you may have more success. The aim is to encourage the black 'plug' blocking the pore to come up to the surface of the skin and eventually ease it out completely. Continue reading


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The Morrison & Foerster Plant Intellectual Property Group is a cross-disciplinary practice group that handles a wide range of intellectual property issues related to plants and other agricultural products. The Group encompasses a unique combination of legal expertise in the patent, licensing, corporate, trademark, and litigation fields. The Plant Intellectual Property Group has extensive experience preparing and obtaining utility patents for new plant varieties, plant patents, and Plant Variety Protection (PVP) Certificates, advising and counseling clients regarding the handling of trademarks and variety denominations, and a strong litigation practice.
Additionally, the Group oversees and coordinates the filing and maintenance of plant patent, plant breeders rights (PBRs) and plant-related trademark rights overseas. The Group has significant related experience in numerous countries and regions outside the United States including the EU, Japan, Israel, Egypt, Turkey, Morocco, Chile, Argentina, Mexico, Brazil, Peru, South Africa, Australia, Canada and China. The Group also advises clients regarding the unique and complex issues related to the licensing of plant-related patents, PVPs and trademarks, both domestically and internationally.
Industry Trends
Selected Representative Clients
HeinzSeed is the world's leader in tomato breeding and production of ketchup from those tomatoes. We advise HeinzSeed on the protection of its tomato varieties worldwide and the development and implementation of its tomato intellectual property strategy.
The University of Minnesota is one of the world's leading developers of apple varieties. We advise the University of Minnesota on the development of its intellectual property strategy related to its apple breeding program. Such strategic advice includes the preparation and filing of plant patents and PBR applications worldwide, the development of a variety naming and trademark strategy and a related licensing strategy.
The California Table Grape Commission is an agency of the state of California that has been set up to promote the California Table Grape Industry. The California Table Grape Commission is the exclusive licensee of certain table grape varieties developed by the USDA. We advise the California Table Grape Commission on the development and implementation of its intellectual property strategy. Such strategic advice includes the preparation and filing of plant patents and plant breeders rights applications around the world, the development of a variety name and trademark strategy and a related licensing strategy. We have also coordinated worldwide enforcement efforts for the commission.
Arcadia Biosciences is working to establish the groundwork for a carbon-credit methodology in China and other countries applicable to nitrogen-efficient crops. We represented Arcadia Biosciences in the development and implementation of its intellectual property strategy including patents, trademarks, and trade secrets for its technologies and programs, and provide general corporate, financing, and mergers and acquisitions advice.
Catchlight Energy, LLC, is a joint venture between Chevron Corporation and Weyerhaeuser Company focused on developing the next generation of renewable transportation fuels from nonfood sources. Catchlight Energy will research and develop technology for converting cellulose-based biomass into economical biofuels. We represent Catchlight Energy in general corporate and intellectual property matters.
Energy Biosciences Institute ("EBI") is a new research and development organization that harnesses advanced knowledge in biology, the physical sciences, engineering, and environmental and social sciences to devise viable solutions to global energy challenges and reduce the impact of fossil fuels to global warming. EBI is the world's first research institution solely dedicated to the new field of energy bioscience. They are initially focusing on the development of next-generation biofuels, but will also look into various applications of biology to the energy sector. EBI is a unique collaboration between the University of California, Berkeley, the Lawrence Berkeley National Laboratory, the University of Illinois, and BP, which will support the Institute with a 10-year $500-million grant. We are assisting EBI with the development and implementation of an IP protection strategy.
Institute for Food and Agricultural Research and Technology ("IRTA"), Generalitat of Catalonia, is a research institute of the Catalan Government that focuses on scientific research and technology transfer in the areas of agriculture, aquaculture, and agrifood. We provide IRTA with advice regarding the development and implementation of its intellectual property strategy and technology transfers.
Progeny Advanced Genetics is one of the world's leading developers of new lettuce varieties. Progeny invented a hybrid lettuce breeding process that has led to the development of unique hybrid lettuce varieties. We manage Progeny's intellectual property program including the patenting of its lettuce varieties and hybrid lettuce production process. We also have managed Progeny's trademark program.
R&D Ag is the world's leader in development of heat tolerant broccoli. We developed R&D Ag's intellectual property program including obtaining a broad trait utility patent covering heat tolerant broccoli. We also handle R&D's IP licensing and patent enforcement program.
The University of California, Davis is one of the world's leading developers of new plant varieties. We have drafted and prosecuted numerous PVP, PBR, and plant patent applications to grant for UC Davis. Such applications were directed to new plant varieties including pistachios, potatoes, wheat, oats, peach and nectarine rootstock, grape rootstock, walnuts, and beans.
Stevia First Corporation is an early stage agribusiness focused on industrial scale production of an all-natural and zero-calorie sweetener from the Stevia plant. We represent Stevia First in general corporate and plant intellectual property matters.
Read the latest legal and business insights impacting the global life sciences community
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Top Items:
Michael A. Memoli / Los Angeles Times:
Boehner rules out impeachment, but Democrats cash in on the threat — Republicans hoped that by filing a lawsuit against President Obama — a move that is expected to win House endorsement Wednesday — they would mobilize conservatives eager for a confrontation with the White House.
Discussion: Independent Journal Review
Caroline Schaeffer / Independent Journal Review: Speaker Boehner Outs The DEM's 'Impeachment Talk' For What It Really Is
Bob Cusack / The Hill:
GOP lawmaker: No to Obama lawsuit — A Republican congressman opposes legislation that would authorize a lawsuit against President Obama for his executive actions. — Rep. Walter Jones (R-N.C.) told The Hill that the lawsuit, spearheaded by Speaker John Boehner (R-Ohio), is "theater, is a show."
Discussion: Talking Points Memo
Lisa Desjardins / CNN:
Surprise Senate highway vote near deadline
Surprise Senate highway vote near deadline
Discussion: Politico, Yahoo! News, Capitol Report and The Hill
Jonathan Topaz / Politico: Chuck Todd's impeachment tirade
Robert Schroeder / Capitol Report: Hillary Clinton: Washington Redskins should change their name
Mike Lillis / The Hill: Dem: Impeachment is GOP's 'final goal'
Washington Post:
President Obama's impeachment is a fantasy — for both parties
President Obama's impeachment is a fantasy — for both parties
Discussion: ThinkProgress, Hot Air, The Daily Caller, Daily Kos, National Review, msnbc.com, ABC News, Prairie Weather and CNN
Igor Volsky / ThinkProgress: House Republican Insists He's Not Considering Impeaching Obama, Then Admits He Is, All In Less Than 60 Seconds
Andrew C. McCarthy / National Review: Against Premature Impeachment
Dems warn GOP on border bill
Dems warn GOP on border bill
Jed Lewison / Daily Kos: Senate Dems suggest they'll link immigration reform to House bill on deporting refugee children
Juan Williams / The Hill: Shame of the GOP on border
Stephen Dinan / Washington Times:
Boehner rules out impeachment: 'Scam started by Democrats'
Boehner rules out impeachment: 'Scam started by Democrats'
Discussion: Daily Signal, The PJ Tatler and American Spectator
Genevieve Wood / Daily Signal: If Conservatives Try to Impeach Obama, He'll Have the Last Laugh
Sofia Resnick / RH Reality Check:
Hobby Lobby Allegedly Fired Employee Due to Pregnancy — When a very pregnant Felicia Allen applied for medical leave from her job at Hobby Lobby three years ago, one might think that the company best known for denying its employees insurance coverage of certain contraceptives …
Discussion: The Raw Story, Firedoglake and Lawyers, Guns & Money
Travis Gettys / The Raw Story: Contraception-denying Hobby Lobby fired Miss. woman for taking time off to have a baby
Erik Loomis / Lawyers, Guns & Money: That Pro-Life Hobby Lobby
Lexington Herald-Leader:
NATIONAL VIDEOS — Democratic U.S. Senate candidate Alison Lundergan Grimes kicked off a bus tour to this weekend's annual Fancy Farm picnic by opening her Fayette County headquarters with a few hundred cheering supporters. — A day after the Bluegrass Poll showed U.S. Senate Minority …
Discussion: RedState and National Review
Jim Geraghty / National Review: Never Ask Alison Lundergan Grimes for Defense Advice
Trip Gabriel / New York Times:
Ex-First Couple's Defense in Virginia: The State of Their Union — RICHMOND, Va. — Former Gov. Bob McDonnell of Virginia and his wife, Maureen, on trial for conspiring to use his office for personal enrichment, outlined an unexpected defense on Tuesday: Their marriage was so broken …
Discussion: The Daily Beast and Outside the Beltway
Mark Wilson / The Daily Beast: Ex-Virginia Gov's Wife Had Crush
Doug Mataconis / Outside the Beltway: Bob McDonnell Trial Opens On A Pathetic And Sordid Note
Emily Orley / BuzzFeed:
Paramount Deletes Controversial 9/11 "Teenage Mutant Ninja Turtles" Poster — Intentional or unintentional, the Australian poster juxtaposes an exploding building and a Sept. 11 release date. UPDATE: Paramount Pictures Australia has issued an apology to BuzzFeed.
Discussion: Mediaite and The Raw Story
Josh Feldman / Mediaite: Paramount Apologizes for Cringeworthy Teenage Mutant Ninja Turtles 9/11 Poster
Jordan Schachtel / BREITBART.COM:
THIRD ROCKET ARSENAL FOUND AT UN SCHOOL IN GAZA — The United Nations Relief & Works Agency For Palestine Refugees (UNRWA) announced Tuesday that another rocket stockpile has been found at one of its schools in Gaza. This instance marks the third time since the beginning of Operation Protective Edge …
Discussion: NewsBusters, Israel Matzav, Roger L. Simon, The Gateway Pundit, The Times of Israel and Algemeiner.com
Kyle Drennen / NewsBusters: NBC Touts Palestinian Teen Praising 'Justified' Hamas Terror Attacks on Israel
Roger L Simon / Roger L. Simon: Gaza Continued: What Do We Do About the UN?
Jim Hoft / The Gateway Pundit: WOW! Hillary Claims Hamas Fires Rockets From Schools Because "Gaza Is Small" (Video)
Asaf Romirowsky / Algemeiner.com: Are UN Agencies Fighting for Human Rights or Supporting Terrorism?
Wichita Eagle:
3-year-old boy dies after apparent accidental shooting (VIDEO) — A 3-year-old boy has died after what apparently was an accidental shooting in a home in the 500 block of East Lincoln on Tuesday afternoon, Wichita police said. — Police said they believe the mother and her boyfriend …
Discussion: Talking Points Memo and Associated Press
Where are California's Uninsured Now? Wave 2 of the Kaiser Family Foundation California Longitudinal Panel Survey — Bianca DiJulio and Jamie Firth and Larry Levitt and Gary Claxton and Rachel Garfield and Mollyann Brodie — Last summer, just before the first open enrollment period under …
Discussion: Wall Street Journal, ABC News and New York Times
Michael Falcone / ABC News: So Sue Him — NOTABLES — ANALYSIS — ABC's JEFF ZELENY …
Spencer S. Hsu / Washington Post:
Federal review stalled after finding forensic errors by FBI lab unit spanned two decades — Nearly every criminal case reviewed by the FBI and the Justice Department as part of a massive investigation started in 2012 of problems at the FBI lab has included flawed forensic testimony from the agency, government officials said.
Discussion: Hit & Run
Rukmini Callimachi / New York Times:
Paying Ransoms, Europe Bankrolls Qaeda Terror — BAMAKO, Mali — The cash filled three suitcases: 5 million euros. — The German official charged with delivering this cargo arrived here aboard a nearly empty military plane and was whisked away to a secret meeting with the president of Mali …
Discussion: Telegraph, Fox News, JustOneMinute and Unfogged
Damien McElroy / Telegraph: Europe 'funding al-Qaeda' as governments condemned for hypocrisy over ransom payments
Tom Maguire / JustOneMinute: Financing Al Qaeda
Greg Sargent / Washington Post:
Senate documents and interviews undercut 'bombshell' lawsuit against Obamacare — The most serious current legal challenge to the Affordable Care Act turns on the argument that the law did not actually make subsidies available to those obtaining coverage on the federal exchange.
Discussion: RedState, ACASignups.net, Patterico's Pontifications, The New Republic, Hot Air and Lawyers, Guns & Money
Leon H. Wolf / RedState: Greg Sargent's Own Goal Worse than Previously Believed
Charles Gaba / ACASignups.net: WaPo: Do Senate Docs/Interviews deflate Halbig balloon? (UPDATE: Or fill it up?)
Patterico's Pontifications: Liberal WaPo Blogger Inadvertently Strengthens Argument from Halbig Majority
Brian Beutler / The New Republic: Why Are Conservative Health Journalists Covering for Halbig Truthers?
Allahpundit / Hot Air: Halbig: Documents show either that Congress wanted federal exchange consumers to get subsidies or, er, the opposite
Molly K. Hooper / The Hill:
Will Speaker move bill on the pope? — A popular piece of legislation that seeks to honor Pope Francis is stuck in Congress. — With time running out on the Capitol Hill calendar, the lawmakers who crafted the bipartisan measure are getting impatient with Speaker John Boehner (R-Ohio).
Discussion: The Raw Story
Jonathan Chait / New York Magazine:
Why I Have Become Less Pro-Israel — A bad run for liberal Zionism. — A half-dozen years ago, I attended the first conference of J Street, a liberal pro-Israel organization, to debate the meaning of the term pro-Israel itself. Pitted against Matthew Yglesias, I maintained that …
Discussion: Lawyers, Guns & Money, The Dish and American Prospect
Andrew Sullivan / The Dish: The Best Of The Dish Today
Roger Cohen / New York Times: Zionism and Israel's War with Hamas in Gaza
Issie Lapowsky / Wired:
This Is What Tech's Ugly Gender Problem Really Looks Like — Shortly after Kathryn Tucker started RedRover, an app that showcases local events for kids, she pitched the idea to an angel investor at a New York tech event. But it didn't go over well. When she finished her pitch, the investor said he didn't invest in women.
Discussion: Guardian and Shakesville
Jess Zimmerman / Guardian: Twitter's real diversity problem isn't in Silicon Valley offices. It's ... on Twitter
Talk Business:
U.S. Senate Poll: Tom Cotton 44, Mark Pryor 42 — A new Talk Business & Politics-Hendrix College survey of 1,780 likely Arkansas voters shows Republican Cong. Tom Cotton with a 44-42% lead over two-term incumbent Democratic Sen. Mark Pryor. — The poll, which was conducted July 22-25 across …
Discussion: Daily Kos and Arkansas Blog, Arkansas Times
New York Times:
Coordinated Sanctions Aim at Russia's Ability to Tap Its Oil Reserves — WASHINGTON — The United States and Europe kicked off a joint effort on Tuesday intended to curb Russia's long-term ability to develop new oil resources, taking aim at the Kremlin's premier source of wealth and power in retaliation for its intervention in Ukraine.
Discussion: Outside the Beltway, Belmont Club, Daily Kos and Hinterland Gazette
Doug Mataconis / Outside the Beltway: New Sanctions Announced Against Russia, But It's Unclear Russia Will Care
Richard Fernandez / Belmont Club: An Ordinary Country Led By Someone From Chicago
Michael Shaw / BAGnewsNotes:
David Frum Accuses NYT and Reuters of Staging Gaza Hospital Photos (GRAPHIC) — Defending Israel with the objectivity and intensity of the Bush speech writer he once was, David Frum, the Senior Editor at the Atlantic, alleged to his 100k Twitter followers on Thursday (not once, but eight times) …
Discussion: Mediaite, Pressing Issues, New York Times, Mondoweiss and Poynter
Andrew Kirell / Mediaite: David Frum Accuses NY Times and Reuters of Staging Photos of Weeping Gazans; Gets Debunked
Greg Mitchell / Pressing Issues: David Frum Axes Evil (or So He Thought)
James Estrin / New York Times: Photographing on the Ground in Gaza
Philip Weiss / Mondoweiss: Israel advocates are in a battle with US media
Kristen Hare / Poynter: NYT says its Gaza photos are real
Washington Examiner:
Sandra Fluke's biggest donor is ... Sandra Fluke — BELTWAY CONFIDENTIAL CALIFORNIA CAMPAIGN FINANCE SANDRA FLUKE — Liberal darling and free-birth-control advocate Sandra Fluke is her own biggest donor in her state Senate race, according to official California campaign finance reports.
Discussion: Independent Journal Review, The Daily Caller, Rush Limbaugh and LifeNews.com
Kevin Boyd / Independent Journal Review: When You See Sandra Fluke's Biggest Campaign Donor, You'll Hope She's Not Writing Rubber Checks
Aaron Bandler / The Daily Caller: Guess Who Sandra Fluke's Biggest Donor Is?


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Gee – such an open ended question. A – which version of IEEE 802 are you trying to implement? B – What format of media are you using, Coax, UTP, proprietary? C – If we cut to the chase and presume 802.3 and TCP/IP and UTP (RJ45) connetions and 10MB half or full, then you need a crossover cable from device to PC. [No MAC then you cannot use a hub or switch!] At that point 'Google' Ethereal and WinCap to setup a workstation that can capture packets and display them on the PC [if using Linux instead of Windows you won't need WinCap].
Without a MAC address then DHCP and DNS won't work and forget going through switches or routers.
Register Hereor login if you are already a member


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Songbird Pebble wallpaper
A whimsical design featuring hand drawn songbirds nestling among sprigs of leaves. All of our prints were originally drawn by hand and developed in our own studio.
This wallpaper is printed with organic pigment ink, which is non-toxic, free of heavy metals and classed as non-carcinogenic.
This is a 'non-woven' type wallpaper, which is highly durable and easy to hang (as you can paste the wall). The wallpaper can be cleaned with a damp sponge or cloth. View our 'non-woven' hanging guide here.
FSC certified wallpaper.
Printed in the UK.


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Picture: The cast of 'Portobello Panto' The edgy Notting Hill pantomime version of The Wizard Of Oz, produced by Sarah Owen and Ruby Platts-Mills. Runs to...
Studio bosses at Warner Bros. are planning a huge $25 million (£16 million) extravaganza to celebrate the 75th anniversary of The Wizard of Oz.
The family favourite was released on 25 August 1939, and to mark its latest milestone, executives will release the movie in 3D next month (Sep13). It will actually become the first film to screen at the renovated Chinese Theatre in Hollywood.
The celebration will also include a line of Happy Meal figures at fast food giant MCDonald's throughout September and October, and special Dvd box sets will also hit the market.
The film, starring Judy Garland as a teenage farm girl who finds herself lost in the fantasy world of Oz, was nominated for six Oscars following its release.


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Turnverein Clubhouse and Grounds, Houston, Texas
Description: Color postcard depicting the Turnverein Clubhouse and grounds in Houston, Texas. Park benches and a gazebo sit outside the buildings of the clubhouse. Correspondence on the back reads, "Hello! Little Girl, After many adventures I arrived here. It is a beautiful place. But have been sleepy most of the time. Write me little girl, Maude" It is addressed to Miss Rosa Louise Dill, 517 High St., Oklahoma City, Okla. Postmark is from Houston, Texas on Jul 15, 1909.
Date: unknown
Partner: Private Collection of Joe E. Haynes