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MUSTANG GAMEDAY (Saturday at 4:30 p.m.)
SAN LUIS OBISPO, Calif. — Coming off its first victory of the 2017 season, Cal Poly (1-8, 1-5 Big Sky) continues Big Sky Conference play Saturday night with its final home game and Hats Off to Heroes contest against in-state rival Sacramento State (5-4, 4-2 Big Sky) inside Alex G. Spanos Stadium (11,075).
Kickoff is set for 6:05 p.m. PST and it will be Senior Night with 20 seniors to be honored in a pregame ceremony. The game will be broadcast live on ESPN Radio (1280 am) with Chris Sylvester (play-by-play) and Alex Clupper (analyst). Pregame show starts at 5:30 p.m. Links for audio and video streams as well as live stats are available on the football schedule page at www.GoPoly.com.
Cal Poly earned its fourth FCS playoff berth in 12 seasons last fall, finishing 7-5 and tied for fourth with Southern Utah in the Big Sky. UC Davis is still seeking its first FCS playoff berth after elevating its program from Division II to Division I in 2007.
The Mustangs have struggled in 2017, losing their first eight games for the first time since the 1964 squad went 0-10. The losing streak came to an end last week with a 35-28 Homecoming victory over Portland State.
Colgate shut out Cal Poly for three quarters, the first team to do that since Southern Utah in 2010, and held off the Mustangs in the final minutes for a 20-14 win in the season opener. An incomplete pass on fourth down at the Colgate 22 with 37 seconds remaining halted Cal Poly's late rally. San Jose State overcame an early 6-0 deficit and built a 20-6 lead before Cal Poly closed the gap to seven. It was still a seven-point margin with eight minutes left before the Spartans scored twice in a nine-second span to pull away for the 34-13 triumph.
Against Northern Iowa, Cal Poly scored two touchdowns in the final 2:05 of regulation to force overtime, but two illegal procedure penalties thwarted the Mustangs' drive after the Panthers scored. Northern Arizona led all the way in the Big Sky opener for both schools, pulling away with three consecutive touchdowns after Cal Poly closed the gap to 7-3 with a field goal. The loss to the Lumberjacks was Cal Poly's first in a conference home opener since 2007 when the Mustangs fell 31-28 to North Dakota State. Cal Poly was 5-0 in Big Sky home openers after winning its last four in the Great West.
The Mustangs erased an early 10-0 deficit at Idaho State with 17 second-quarter points but let a 14-point third-quarter lead slip away as the Bengals outscored Cal Poly 21-3 over the final 18 minutes for a 38-34 triumph. Cal Poly quarterback Khaleel Jenkins rushed for 202 yards and two touchdowns and also passed for two more scores. Three weeks ago, Cal Poly dropped a 20-14 decision at Southern Utah. The Thunderbirds scored 17 points in the first 18 minutes of the game and held on. Trailing 20-7, Cal Poly rallied with a five-yard touchdown run by Broc Mortensen with 4:46 to play and got the ball back with 2:51 to go, but after picking up a pair of first downs and moving the ball into Southern Utah territory, the Mustang drive stalled. Senior fullback Jared Mohamed set new career highs with 142 yards on 30 carries.
Three weeks ago, Weber State held Cal Poly to 106 rushing yards, the lowest total since 2009 when North Dakota allowed just 62 yards on the ground, in a 17-3 victory. Last time Cal Poly was held without a touchdown was in 2000 when Montana won 53-3. UC Davis scored 21 points in the first six minutes, 10 seconds, and held on for a 31-28 victory two weeks ago. Jared Mohamed earned his fifth career 100-yard game with career highs for rushes (35) and yards (143). Trailing by three points with 14 minutes to play, Cal Poly couldn't secure the go-ahead score in three final possessions. In the win over Portland State, Mohamed and Chuby Dunu each scored two touchdowns, Mohamed rushed for a career-high 194 yards and Mark Reza intercepted a Viking pass with 48 seconds to play to seal the verdict. The Mustangs rushed for 400 yards to offset Portland State's 433 yards passing.
Under fourth-year head coach Jody Sears, Sacramento State welcomed back 47 letter winners, including 20 starters (nine on offense, 11 on defense), to Fall Camp in early August. Heading the list of veterans are wide receiver Isiah Hennie (49 catches, 594 yards, five TDs, 10.7 punt return average, 18.3 kickoff return average), safety Manny Scott-Anderson (107 tackles, four pass breakups, two fumble recoveries) and defensive lineman Ben Sorenson (42 tackles, 11.0 tackles for lost yardage, 5.5 sacks).
Sacramento State dropped non-conference games to Idaho and Weber State, defeated Incarnate Word and has won Big Sky games against Southern Utah, Idaho State, North Dakota and Northern Colorado while falling to Eastern Washington and Northern Arizona. The Hornets, 2-9 a year ago, are 5-4 overall and 4-2 in Big Sky contests, just one game behind tri-leaders Southern Utah, Weber State and Northern Arizona, all 5-1.
The Hornets are No. No. 1 in the Football Championship Subdivision in third-down conversions defense, holding opponents to 23.3 percent efficiency (29 of 125). They also are No. 3 in sacks with 37 in nine games and No. 9 in turnover margin at plus 11. Sacramento State's defense has collected 13 interceptions, compared to just four a year ago, and have allowed only two 100-yard rushers this season (14 last year. The two are Trae Riek of Northern Colorado with 114 yards last week and Austin Duckworth of Idaho with 142 yards in the season opener.
Isiah Hennie, brother of Cal Poly's Kyle Lewis, is believed to be the first Hornet in program history to return both a kickoff and punt for touchdowns in a career. He has one kickoff return for a score and two via punt, including a 90-yarder against Cal Poly a year ago, and also has 132 career receptions.
The Hornets, 4-1 at home but 1-3 on the road, won their third straight home game last week with a 50-21 victory over Northern Colorado. Elijah Dotson rushed for 124 yards and two touchdowns while Roman Ale competed 13 of 21 passes for 137 yards and two more scores. Immanuel Anderson returned an interception 21 yards for a score and Devon Medeiros kicked two field goals. Sacramento State has won three consecutive home games (Southern Utah, Idaho State, Northern Colorado) for the first time since 2000.
Sacramento State returned just one rusher from the 2016 team and he was moved to safety in Fall Camp, leaving no experience in the backfield. Kevin Thomson has rushed for 422 yards and eight touchdowns, averaging 6.9 yards per carry, and Joseph Ajeigbe, the transfer from Duke, has added 412 yards and four touchdowns. Isaiah Gable, BJ Perkinson and Elijah Dotson all have over 300 yards as well as the Hornets average 217 yards per game on the ground.
Sacramento State has used four quarterbacks this season. Roman Ale has started the last three games, completing 31 of 56 passes (55 percent) for 491 yards and five scores. Top Hornet receivers are Hennie with 35 catches and Jaelin Ratliff with 20.
Defensive leaders are cornerback Dre Terrell with five interceptions, six pass breakups and 50 tackles and strong safety Mister Harriel with 72 tackles, two sacks and three interceptions. Defensive end Ben Sorensen has notched 10.5 tackles for lost yardage, including eight sacks while the other defensive end, George Orbinna has recorded 11.5 tackles for lost yardage, including 8.5 sacks.
Senior fullback Joe Protheroe headlined another strong group of ball carriers in Cal Poly's Spread Triple Option, but is sidelined the rest of the 2017 season with an injury. In becoming Cal Poly's 20th 1,000-yard rusher a year ago, Protheroe amassed 1,334 yards and 13 touchdowns on the ground and is No. 8 on the career rushing chart with 2,461 yards. Jared Mohamed, another senior, also returns after collecting 343 yards in 2016. The group of slot backs features all-purpose player Kyle Lewis (591 rushing yards and six TDs, team-leading 22 catches for 375 yards and four scores in 2016).
Quarterback Khaleel Jenkins started one game in 2015 against Portland State and appeared in four games last season with one incomplete pass and one carry for two yards. He completed nine of 16 passes for 238 yards and four touchdowns against Northern Iowa, the most passing yards by a Mustang quarterback since Tony Smith threw for 407 yards and six touchdowns against South Dakota in 2009, but is lost for the season as well with an injury.
Two of last year's five starting offensive linemen are back in junior left guard Harry Whitson and center Joey Kuperman -- the other three probable starters played all 12 games a year ago -- and the Mustangs' wide receiving corps is led by sophomores J.J. Koski (18 catches in 2016) and Jake Smeltzer (five). Protheroe and Kuperman landed on the 2017 All-Big Sky Preseason Team.
On defense, Cal Poly returned all four starters in the secondary, but three of the four linebackers and one of the linemen need to be replaced. The good news is that Charlie Davis and R.J. Mazolewski, both of whom played in the first three games of 2016 before suffering season-ending injuries, are back and healthy. Anders Turner and Jayson Lee, who combined for five starts a year ago, return as well, and Mason Montgomery and Darren Adjei each played at least 11 games last fall.
The secondary features safeties B.J. Nard, Kitu Humphrey, Carter Nichols and Aaron Johnson and cornerbacks Dominic Frasch, Jerek Rosales, Kevin Griffin and Kam Dennis. All played at least 11 games in 2016. Nickel back Aaryn Bouzos, who also played all 12 games with two interceptions, returns as well.
Starters Jack Ferguson and Augustino Elisaia anchor the defensive front as tackles and the end spot in the 3-4 formation features a battle between L.J. Mealancon and Miles Williams, both of whom played all 12 games in 2016.
The kicking game has both of last year's kickers back -- Casey Sublette and Alex Vega. Sublette handled most of the chores in 2016, averaging 36.8 yards over 29 punts and making 54 of 56 PATs and all six field goal attempts. Vega, who punted 10 times for a 40.7 average, is best known for his 49-yard field goal with four seconds remaining in a 20-19 win over Montana in the 2015 opener.
Coached by Tim Walsh (ninth season, 51-50, UC Riverside '77), Cal Poly began its 98th season of football in 2016 by winning six of its first eight games before losing three of its final four contests, including a 35-21 setback at the hands of San Diego in the opening round of the FCS playoffs, almost three months after a 38-16 triumph in Week Two.
Cal Poly was No. 1 in the FCS in rushing offense (309.1) in 2013, duplicated the feat in 2014 by averaging 351.8 yards on the ground, broke school and Big Sky records by averaging 387.3 rushing yards per game in 2015 and topped all 121 FCS teams during the regular season again last fall with a 343.5-yard average.
In the absence of Protheroe, senior fullback Jared Mohamed has produced 940 yards, including five 100-yard games. Redshirt freshman Jake Jeffrey has replaced Jenkins as the Mustangs' signal caller and has completed 30 of 69 passes for 471 yards and two scores. Both Mohamed and Jeffrey scored their first touchdowns of 2017 at UC Davis two weeks ago. Sophomore J.J. Koski is the top receiver with 18 catches for 349 yards and three scores. Senior Kyle Lewis has 16 receptions for 417 yards and five TDs along with 213 rushing yards and one score. Redshirt freshman Chuby Dunu scored his first two career touchdowns last week against Portland State and has 217 yards this season.
Defensive leaders for the Mustangs nine games into the season are senior linebacker Mason Montgomery (82 tackles, 17 against San Jose State, 14 at Northern Iowa and 10 at Southern Utah) and senior linebacker R.J. Mazolewski (61 tackles). Sophomore safety Kitu Humphrey and sophomore cornerback Mark Reza both have a pair of interceptions this season for Cal Poly, which has logged 54 tackles for lost yardage, including 20 sacks, five more than all of last season.
Cal Poly and Sacramento State are meeting for the 37th time in football this weekend and the Mustangs lead the series 20-16 after last year's 59-47 win inside Hornet Stadium. Dano Graves passed for three touchdowns while Joe Protheroe and Kori Garcia each surpassed the 100-yard mark on the ground as the Mustangs overcame a 21-17 halftime deficit for the win.
The series began in 1967 with a 17-7 Mustang victory in Sacramento. Cal Poly is 11-8 against Sacramento State at home and 9-8 against the Hornets in Sacramento. Tim Walsh is 17-2 against Sacramento State, including a 12-1 mark while he was head coach at Portland State, while Jody Sears is 0-5 against Cal Poly.
Sears (16-27 at Sacramento State (fourth season), 120-46 overall (sixth season), Washington State '91) was head coach at Weber State in both 2012 and 2013, compiling a 4-22 mark, and has served as defensive coordinator at Washington State (2008-11), Eastern Washington (2000-07) and St. Ambrose (1997). He also was an assistant at Army (1998-99) and Iowa State (1994-96). Sears was a two-year receiver at Washington State before earning his bachelor's degree in 1991 and obtained his master's degree at Iowa State in 1996.
Cal Poly, which captured the 2012 Big Sky title in its first year in the conference, was picked by head coaches and media this summer to finish fourth in the 13-team Big Sky. North Dakota and Eastern Washington shared the conference title in 2016 with 8-0 marks. North Dakota was ranked No. 1 by both the media and coaches to repeat this season, followed by Eastern Washington and Northern Arizona. Sacramento State was picked to finish 12th.
The Mustangs claimed four Great West Conference titles in the eight-year history of the league (2004, 2005, 2008, 2011) before moving to the Big Sky in 2012 and have earned NCAA Division I FCS playoff berths in 2005, 2008, 2012 and 2016.
The Mustangs have won 61 of their last 82 home contests (74 percent) and, overall, Cal Poly has won 99 of its last 170 games (58 percent) going back to the 2002 finale and has won 20 of its last 46 and 39 of 84 on the road while producing 12 winning seasons in the last 16 years.
Next week Cal Poly wraps up the 2017 season at Northern Colorado. Kickoff in Greeley, Colo., is set for 10:35 a.m. PST.
Photos of Broc Mortensen at top of page and Kam Dennis at left courtesy of Alexander Bohlen | Cal Poly Athletics


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Welcome to the Twitter customer engagement playbook, where you will learn how to build a basic chatbot using webhooks and REST API endpoints. In this playbook, you will learn everything that you need to know to create a working customer engagement application with the ability to use welcome messages, quick replies, custom profiles, media attachments, buttons and more.
A webhook is a way for a web app to communicate real-time information. Webhooks are different from streaming because they do not require an active connection in order to receive activities, and different from REST APIs because you do not need to poll.
Since Twitter's launch in 2006 it has been a world-changing messaging platform. Tweets are a way to deliver a public message to the entire world. Direct Messages are a way to have a conversation, privately. Over the last few years we've been making private messaging on Twitter better:
Now, we're making Direct Messages a better channel for developers to build messaging interactions that deliver personalized customer experiences at scale. We provide the ability to get Direct Messages in real-time via Webhooks, and the REST API to implement features that make conversations faster and easier.
In order to get the messages required to build great customer experiences you will need to:
In order to create experiences in Direct Messages by responding to the messages you receive and using new features you may want to:
As a developer, there are several steps that you will need to take in order to begin using the Direct Messages services.
After creating a Twitter app, the next step is applying for Account Activity API access.
To access the Sandbox or Paid Premium Account Activity API tiers, you need to set up a developer account. If you have not applied for a developer account yet, please do so at the following link:
Once you have a developer account, then you are ready to set up your access to the Premium Account Activity API. You will need a Twitter app to attach to your Account Activity API dev environment.
If you would like to use a script with a visual dashboard to get set up with your account activities, you should check out the Twitter Dev-supported Account Activity Dashboard.
In order to perform write actions (create Tweets or messages) on behalf of another account or to read private information from that account, you will need to obtain access tokens. Access tokens provide the user context when using the Twitter API.
At this point in the process, you should have all of the necessary information to set up an application in the developer portal, perform the initial Challenge Response Check to secure your endpoint, and obtain access tokens in order to publish content on both your own application and on behalf of others who have given explicit permission. Now let's take a look at the different endpoints we will be using in our app.
To make experiences conversational we provide Direct Message data in real time via webhooks which includes metadata about the features in that experience. Additionally, we have REST endpoints to create messages, get welcome messages and custom profile data, and manage these features. Understanding the basic flow below will help you set up your own app based on the sample app you cloned in step 3.
Below is a list of debugging tools you may find useful when building your application:
Now you've created a solution that allows you to access Direct Messages in real-time and create personalized experiences at scale on behalf of customers. You can start conversations with a welcome message for context. You can make messages that have quick reply options, buttons to open links, or engaging media attached to them. Those messages can have a custom profile to make it clear when a human or a chatbot is interacting. Ideally, it looks something like this example.
This feature lets developers add up to three calls-to-action or buttons to any Direct Message or Welcome Message POST request. Buttons can be used to open any https URL and the call-to-action shown to users in the Twitter app can be fully customized.
Buttons are intended to make it easier for users to complete actions outside of Direct Messages, whether in a webview or another part of the Twitter app. For instance, CTAs can be used to:
Technical information on Buttons can be found here.
Custom profiles allow a Direct Message author to present a different identity than that of the Twitter account being used. For example, brands may want customer service agents posting under a single Twitter account to use their own name and photo. A custom profile may also be used to attach a unique identity to a message authored by an automated application or chatbot so that users clearly understand they are talking to a chatbot.
Technical information on Custom Profiles can be found here.
Ready to build your solution?
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subset: commoncrawl


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Thursday, July 30, 2009
"Gone from our sight"
She had a profound influence on a rippling circle of individuals, most lately of course, the professionals who cared for her as her life waned away, but more inclusively, her family, and the friends who came to visit her in the last few weeks.
As we make "the arrangements", we come to realize that many of those she touched, perhaps all of them who are still alive themselves, have come to visit her and pay their respects for her life and her inspiration. Oh, there have been many tears, to be sure, but there has been far more joy and sense of honor just to know her.
She literally saved my life -- more than once -- and I am eternally grateful to her.
As far as we could tell, she went gently into that "other place" which she had visited before but where she had never been able to stay. We believe that her spirit left her body some time before her body shut down completely, but just when she completed her journey we can't know. She was at peace, though, when the end finally came. The serenity on her face and the easy appearance of her body as she lay in bed while we put up with all the bustling to and fro of the various people who came to certify and to pronounce and to call various others and to pray and to take her body away to the mortuary was a blessing; she was so beautiful through it all.
The friend who called yesterday called again about ten minutes after Betty died. His name appeared on the screen as the phone rang. I answered the phone, "So you know do you?" He said, "I knew yesterday." I told him that Betty had breathed her last just a few minutes before, and here he was calling... He said, "I drove by your house a few minutes ago, but something told me not to stop. I sensed I should go home and call instead." Yes, it was the right thing to do, and we talked for a while, remembering a mutual friend who had been through somewhat the same process of dying several years ago. I said, "You're still welcome to come over. Would it help you to see her one last time?" He said, "I'll be over, but first I'm going to get you all some burgers at the [Burger joint name redacted] and make sure you get some food in you." I thought OMG.
So we went through a whole raft of processes and procedures ending with our waiting with the priest for the nurse who would "pronounce" the death, when my friend arrived knocking on the door, and sure enough he'd brought big sacks of fresh-cooked hamburgers -- which smell wonderful -- and he and the priest, and we and Betty's granddaughter chat about what a wonderful person Betty had been, how much she'd touched our lives, etc, etc, and my friend went over to Betty, who was still very serene on her bed, and he gently took her hand, kissed it and stroked her head and turned away, tears streaming down his cheeks, and just whispered "Thank you." He left not long afterwards, reminding us that we'd better have those hamburgers, and we said we would.
And about an hour later, when all the hub bub was done, we did; we had a wonderful little wake, Betty's granddaughter and us, as we talked about Betty's life, listening to music she liked to hear, and making preps for the next step.
At this point, I don't think there's going to be a funeral as such. Betty's body will be cremated, and her ashes will be split. Her spirit will be honored, and her memory will be secured. I suspect a number of people will write about her -- I couldn't possibly be the only one who does so! Those words will be assembled and distributed to those whose lives she touched so profoundly.
Rest in peace, Betty. You may be gone from our sight, but you will always be in our hearts. It was a privilege just to know you.
3 comments:
And, it would appear that it was a privilege for her to know you, as well. This love was mutual.ReplyDelete
I'm sorry for your loss, Ché. May the warmth of her memory find a niche in your heart and travel with you forever.
Thanks again.ReplyDelete
We're "working through the grief" here; very interesting, very odd how and when the loss comes upon me, almost, but not quite at random.
No, something will trigger a memory of Betty, and I just lose any sense of composure. Have to let it out. But then there will be another memory of complete joy.
They say this is how grief works, and I guess they're right.
I'm sorry, Ché. It's a part of life, but it is some of the worst part of life. You sure seem to make the best of things, though. From reading your thoughtful and varied posts, I think Betty was blessed to have had you in her life.ReplyDelete


text: 10 of the Oddest Things Ever Left in an Uber How do you forget an elf cut-out? By Arden Dier, Newser Staff Posted Mar 30, 2017 11:03 AM CDT 12 comments Any lobsters in there? (AP Photo/Jeff Chiu, File) (Newser) – A cellphone? Sure. But a lobster? That's just one of the odd things left behind in an Uber—and there are plenty, according to the company's Lost and Found Index published Wednesday. It notes that small items like wallets, keys, and phones are among the most commonly forgotten items. But occasionally large and downright strange pieces also get left behind. Ten notable ones, per Time: Engagement ring Nordic walking poles Pool cue Vacuum Smoke machine Bulletproof vest Elf cut-out Money bag Valium Taser Click for the full list, which also includes musical instruments and a variety of food. (Read more Uber stories.) My Take on This Story Report a story error Show results | 56% Hilarious 17% Intriguing 4% Depressing 1% Brilliant 2% Scary 20% Ridiculous


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Patients with obstructive sleep apnea (OSA) on established positive airway pressure (PAP) treatment are often advised routine annual follow-up visits to assess ongoing effectiveness and address problems associated with therapy. This study evaluates the clinical utility of annual face-to-face follow-up visits.
We performed a retrospective chart review of OSA patients on PAP who had completed a routine annual follow-up visit. Demographics, polysomnography, PAP compliance, Epworth Sleepiness Scale (ESS), subjective complaints (efficacy and interface issues, equipment malfunction, prescription renewal), objective findings (efficacy or leak issues, equipment problems), and visit-specific interventions were recorded. We determined relationships between patient provided information and likelihood of therapeutic versus administrative interventions.
Academic sleep center.
Among 716 patients who met study criteria, we abstracted data on 180 randomly selected patients. On multivariate analyses, only subjective complaints or objective findings by providers were associated with a therapeutic intervention (p < 0.0001). Though most patients (55 of 63 patients, 87.3%) who required therapeutic interventions had objective findings, without subjective complaints, the odds of such findings were only 0.12 (95% CI = 0.06-0.24, p < 0.0001). Without subjective complaints, the likelihood of a therapeutic intervention was 0.07 (95% CI = 0.03-0.15, p < 0.001).
Our data suggests that in the absence of a subjective complaint, an annual follow-up is more likely to require administrative rather than face-to-face clinical intervention. Designing a clinic model to account for this might reduce resource utilization. However, the value and optimal timing of "routine" annual follow-up visits requires further evaluation.
Nannapaneni S, Morgenthaler TI, Ramar K. Assessing and predicting the likelihood of interventions during routine annual follow-up visits for management of obstructive sleep. J Clin Sleep Med 2014;10(8):919-924.
The most common treatment option for patients with obstructive sleep apnea (OSA) is the use of continuous positive airway pressure (CPAP). Occasionally, patients who are unable to tolerate CPAP may need a different form of positive airway pressure (PAP) to treat OSA such as bilevel positive airway pressure (BPAP).1 The short-term and long-term positive effects of PAP therapy in OSA patients are well established.2 Adherence to PAP therapy is important to obtain and maintain these expected positive benefits. However, studies have shown that the overall adherence is suboptimal.3–5 The suboptimal PAP adherence may be related to various factors such as nasal congestion, rhinorrhea, dryness, mask interface problems such as lack of fitting, mask leak issues, pressure related problems such as exhaling against high pressure, or PAP machine related symptoms.6–8 Close follow-up to monitor and address compliance issues in OSA patients is recommended to establish effective utilization patterns and remediate any problems related to the PAP or the mask, and thereby improve PAP adherence.9 This is especially important during the first few weeks of PAP use, as adherence to PAP therapy is more likely to be established within the first few months of PAP use.9,10 Accordingly, CMS and third party payers require an initial face-to-face follow-up visit with a physician to assess PAP adherence and benefits of PAP use between 31 and 90 days after the start of PAP therapy.11 Subsequently, patients on PAP therapy for OSA are frequently advised annual follow-up visits by trained health care providers in order to continue to troubleshoot and manage issues that may arise with the use of PAP devices and renew PAP prescriptions as requested by vendors.12 Changes in PAP may also be needed as the patient's weight changes or as new side effects related to therapy emerge, not to mention the possible occurrence of mechanical malfunctions of PAP equipment.10 Therefore, most sleep centers, based on the current guidelines advise OSA patients on PAP therapy, to return for an annual clinic follow up visit.9,10,12 Despite these reasonable considerations, the value of such annual routine visits has not been scrutinized.
Current Knowledge/Study Rationale: Though patients with obstructive sleep apnea (OSA) on positive airway pressure (PAP) are routinely advised annual follow-up visits to assess ongoing effectiveness and address problems related to PAP use, there is no available data to support the value of this practice, particularly in an era of decreasing costs of care and improving patient access with appropriate resource utilization.
Study Impact: Our study found that in the absence of subjective symptoms, OSA patients on CPAP are less likely to need an intervention during their annual follow-up face-to-face visit. Our findings suggest an opportunity for future studies to investigate screening tools that would assess predictive factors prospectively to determine the need for and timing of face-to-face follow-up visits for this patient population.
Our anecdotal observations suggest that significant changes to PAP therapy were made infrequently during routine annual follow-up visits. Often, it seemed that the appointments were mostly congratulatory on their CPAP use, and that only administrative tasks such as prescription refills that might be accomplished without a face-to-face visit were accomplished. In an era of increasing emphasis on appropriate resource utilization and efforts towards decreasing costs of care, we considered a review of our current clinical practice of utmost importance, particularly as it pertains to the requirement of these routine annual follow-up visits for all patients with OSA on PAP therapy. A literature search on this topic did not reveal any studies to date. The goal of this study was therefore to evaluate the clinical utility of routine annual face-to-face follow-up visits for OSA patients on PAP therapy and determine which clinical predictors are associated with a need for clinically significant interventions during such visits.
A retrospective chart review was conducted on patients 18 years and older seen at our center who had a clinical diagnosis of OSA (ICD-9 Code 327) and underwent a baseline polysomnography (PSG) in the year 2008. Of the 4,204 patients who had a PSG performed, 3,297 patients were confirmed to have a diagnosis of OSA (ICD-9 Code 327.23). Patients with central sleep apnea and complex sleep apnea were excluded from the study. Of the patients with OSA, we screened for patients who had at least one routine annual follow-up visit. We considered "routine follow up visits" as those that occurred 12-18 months after the initial PAP visit; the initial PAP visit usually occurred 2-12 weeks following PAP prescription to help with initial adaptation. Based on these criteria, 716 patients were eligible and included in the study group. Of the 716 patients, data were abstracted on 180 (20%) randomly selected patients (Figure 1).
Patient selection algorithm
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In addition to demographics, we gathered data on PAP compliance (device download), body mass index (BMI), Epworth Sleepiness Scale (ESS), subjective patient symptoms (such as problems related to treatment efficacy, interface issues, PAP equipment malfunction), objective clinical findings (such as lack of efficacy, leak issues around the PAP mask, nasal or mouth dryness despite adequate humidity settings on their PAP device or history of water reservoir emptying overnight during use), and visit-specific interventions. Dryness was evaluated not only by asking for these symptoms but was objectively evaluated by routinely asking patients about: (i) humidity settings on their PAP device and (ii) whether the water reservoir ran empty or had to be refilled in a given night. Additionally, data were gathered on coexisting chronic medical conditions such as diabetes mellitus, hypertension, dyslipidemia, chronic kidney disease, coronary artery disease, and current tobacco use. Data were also obtained on the presence of preexisting or concomitant diagnosis of restless legs syndrome (RLS) and insomnia. The visit-specific interventions were divided into "therapeutic interventions" (that required a licensed care provider for skilled troubleshooting, mask fitting, or patient education) and "administrative interventions" (clerical in nature that might be provided by non-licensed healthcare workers, or management of prescription refills for equipment or established medications that might be taken care of without a visit or on protocol). Therapeutic interventions included changes in mask interface, changes in PAP pressure or modality (e.g., from CPAP to BPAP), addition of oxygen, addition of new medications such as sleep hypnotics, change from PAP therapy (i.e., change from PAP to oral appliance or referral to surgery), or discontinuation of PAP therapy because of patient/clinical reasons. Administrative interventions included PAP prescription refills, established or routine medication refills, education on how to use their current mask and adjusting the straps, or education regarding care and operation of the PAP machine. PAP compliance was evaluated based on the Centers for Medicare and Medicaid services (CMS) definition of use: ≥ 4 h per night on 70% of nights during a consecutive 30-day period anytime between 31 and 90 days of initial use.
Patients at their annual follow-up visit were seen or supervised by sleep physicians, nurse practitioners (NPs)/physician assistants (PAs), or trained registered nurses (RNs). ESS was filled out and device downloads were obtained from the PAP machines before the patients' visit with the providers. During the visit, patients were asked about their subjective symptoms or complaints. Similarly, objective findings were evaluated during the visit and documented based on assessment of PAP devices and masks/straps for problems such as leak issues.
Data were analyzed using JMP statistical software (Version 9.0.1, SAS Institute, Cary, NC). Descriptive statistics were performed on baseline characteristics of patients. The t-test statistic was used for 2 group statistics with respect to continuous variables and the Pearson χ2 for categorical values. Nonparametric tests (Wilcoxon) were used to assess data with non-normal distribution. A sum risk factor score (RF score) was developed for each individual patient by adding the total number of cardiovascular risk factors, and an exponential score was generated by multiplying the sum score by itself to assess the additive effect of each clinical condition. From the list of predictors and potential confounders, simple logistic-regression analysis was performed to identify significant covariates that were correlated with intervention. Subsequently, we built multivariate logistic-regression models with therapeutic intervention as the dependent variable using significant covariates identified by simple logistic-regression analysis. Significance was defined with a p-value < 0.05. Next, we tried to determine if there was baseline or patient-provided information that related to the likelihood of specific intervention at the annual follow-up visit. Visit-specific interventions were categorized into higher or lower level interventions as explained above.
In addition, we divided the patients randomly into a derivation group (70%) and a validation group (30%). Recursive partitioning analysis was applied to the derivation group to select factors that predicted a clinically significant intervention at the annual follow-up visits.13 We then checked the performance of those factors in the validation group. We developed receiver operator curves (ROC) for these models.
The baseline patient demographics are shown in Table 1. The BMI (Mean ± SD) did not significantly change from baseline to annual follow up visit (35.6 ± 7.7 to 35.5 ± 7.9, p = 0.28). However, there was a significant decrease in ESS from baseline (Mean ± SD) 10.1 ± 5.0 to 6.8 ± 4.1 at follow-up (p = 0.001). At the annual follow-up visit, PAP compliance in the overall study population was 74%. Therapeutic interventions at the annual follow-up were provided to 63 patients (35% of the patients), as listed in Table 2. Information regarding those requiring therapeutic interventions vs not requiring therapeutic interventions is provided in Table 3. The factors that were significantly associated with a therapeutic intervention were the presence of subjective symptoms (interface, efficacy) and objective findings (leak, efficacy, equipment problems, and dryness) (Table 3). Though not statistically significant, univariate analysis demonstrated that patients who were compliant with PAP therapy were less likely to require therapeutic intervention (78.6%, p = 0.08). Also, univariate and multivariate analysis of each individual chronic disease condition did not appear to predict the need for therapeutic interventions at the time of follow-up visit (Table 4). Preexisting sleep related conditions such as RLS and insomnia also did not appear to increase the likelihood of need for therapeutic interventions at the follow-up visit (Pearson χ2 1.48, p = 0.22, and 1.97, p = 0.16, respectively). Duration (in months) from baseline PSG to annual follow-up visit on patients who were on CPAP did not correlate with the need for therapeutic intervention. Further analysis to evaluate for predictive effect of the RF score did not appear significant with either univariate or multivariate analysis.
Baseline patient characteristics
Interventions at annual follow-up of 180 patients
Characteristics of patients at annual follow-up
Univariate analysis of chronic medical conditions and need for intervention
Of the 65 patients (36%) who presented with subjective complaints, therapeutic interventions were performed in 47 (72.3%). Additionally, when health care providers identified a problem (objective findings; Table 3) such as efficacy problems with PAP (evidenced by high ESS or downloaded AHI estimates), leak issues, or dryness (61 patients, 34%), 55 (90.2%) had a therapeutic intervention performed during their visit (change in interface, change in PAP pressure/modality, addition of oxygen, addition of medications or change from PAP therapy—change from PAP to oral appliance, or referral to surgery, or discontinuation of PAP therapy because of patient/clinical reasons). Of the 115 patients without subjective complaints, only 16 (13.9%) had therapeutic interventions (8 had change in mask interface, 7 had change in PAP type, and 1 had a medication change). In patients without subjective complaints, the likelihood of a needing a therapeutic intervention was 0.07 (95% CI = 0.03-0.15, p < 0.001). If the patient had no subjective complaint, the odds of finding an objective problem at the follow-up visit was 0.12 (95% CI = 0.06-0.24, p < 0.0001). On multivariate logistic regression, the only significant predictors of patients needing clinical intervention during the follow-up visit was the presence of subjective symptoms (found in 36% of the total) or the finding of objective problems (33.9% of patients) by their providers (Table 5).
Predictors of need for therapeutic intervention
In addition to the multivariate analysis, we sought thresh olds for predictors of therapeutic intervention using recursive partitioning analysis, which revealed that the most significant predictors of the need for therapeutic intervention were the presence of a subjective complaint, AHI > 12, age > 55, and BMI < 40.
The findings of this study clearly demonstrate that OSA patients on PAP therapy are less likely to need an intervention during their routine annual face-to-face follow-up visit in the absence of subjective symptoms. Therapeutic interventions during prescheduled routine annual visits occurred only in 36% of patients, and the likelihood for an intervention in the absence of a subjective complaint was very low at 0.07 (95% CI = 0.03-0.15, p < 0.001). The presence of subjective complaints, baseline AHI above 12, age older than 55, and a BMI less than 40, were identified as factors predictive for the need of therapeutic intervention. In the era of reducing costs of health care delivery and improving resource utilization, our study provides evidence that select patients such as those with subjective complaints may benefit from face-to-face follow-up visits due to their need for clinical intervention, while the majority might possibly be adequately served in some other manner, such as follow-up via electronic, telephonic, or correspondence methods. However, these findings should not be misconstrued as a guideline or recommendation to follow until future prospective studies at other sleep centers can validate our findings.
From our analysis we were also able to show that the presence of chronic medical conditions and sleep related disorders such as RLS and insomnia were not predictive of a need for therapeutic intervention at the time of a routine annual follow-up visit. This again suggests that the only factors that remain strongly predictive of the higher likelihood of need for interventions at the time of follow-up visits are the presence of a subjective complaint or finding of an objective problem.
Fifty percent of the patients did not require any clinical intervention whatsoever at their annual follow-up visit. In another 15% of cases, patients required an administrative renewal of PAP prescription, refill of routine or established medications, or education regarding proper use of existing equipment. It is likely that many of these latter transactions could be delivered by sleep technologists or performed via telephone or primary care providers, obviating the need for a sleep center intervention. On the other hand, only 15.4% of patients who had subjective complaints did not require therapeutic interventions, such as changes in type of mask interface, changes in PAP modality/ pressure/oxygen, new medication prescription such as a sleep hypnotic, or a change from PAP therapy to different mode such as oral appliance or surgery—all therapeutic changes requiring a licensed provider. Thus, the presence of specific subjective complaints increased the likelihood of a necessary clinical intervention at the follow-up visit (OR 16.1 95% CI 7.6-34.5 p ≤ 0.001).
This is perhaps not a surprising conclusion. However, what about those patients who have no subjective complaints? We inspect their equipment and download compliance reports at all follow-up visits. Our data indicate that these objective findings contribute relatively rarely to the need for intervention in the absence of subjective complaints. Of the 115 patients without subjective complaints, only 20 (17.4%) were found to have objective findings, and 16 of those required therapeutic interventions. None of the 95 patients out of the total 180 without subjective symptoms or objective findings required therapeutic interventions. These data clearly show the importance of eliciting subjective symptoms, and that the needs of patient without symptoms may not require specialist intervention.
How do we assess for subjective complaints before the patient presents for their annual visit? With no other studies to address this issue, this is a prime area for research. Potential options include a pre-visit questionnaire via phone, internet patient portal, or mail. Recursive partitioning with retrospective validation identified age > 55 years, BMI < 40, and AHI > 12, along with subjective complaints as predictors for clinical intervention at the annual follow-up visit. However, whether these variables can be part of a predictive model to assess the need for clinical intervention and thereby assess the need for an annual follow-up visit will need to be studied prospectively and validated before it can be applied in clinical practice. Higher age and severity of OSA may be associated with comorbidities that can likely increase the need for interventions at annual follow-up visits. For example, it is unclear why a BMI < 40 should be predictive of therapeutic interventions.
At annual follow-up inclusive of compliance downloads and equipment inspection, our overall compliance was 74%, which is slightly higher than other studies.14,15 It is likely that our total patient compliance is much lower than the 74%, since we only included patients who kept routine annual follow-up visits. This may be related to closer monitoring within the first few weeks of PAP use that includes education by our trained nurses, addressing issues related to mask fitting and problems related to PAP. It is therefore possible that the higher adherence overall may have resulted in fewer clinical interventions in the annual follow-up visit, as most issues and problems may have been addressed in the first few weeks of PAP use.
There are several limitations to our retrospective study. Our findings, like all retrospective studies, are likely biased by sample selection. Patients included in the study data were abstracted through a process based on ICD-9 coding. In spite of selecting patients with ICD-9 code 327.23, during chart review we discovered patients with complex sleep apnea in our data set. These patients were secondarily excluded. Additionally, only 22% of the patients (n = 716) with confirmed diagnosis of OSA by PSG were found to have an annual follow up-visit. The likely explanation for the attrition in the number of annual follow up visits are: (a) patients may not have been scheduled for their follow up appointments within the time frame specified by our study parameters (8-18 months), (b) patients may have missed their scheduled appointments, (c) some of our patients who travel long distances probably had their annual follow-up visits closer to home with their physicians, (d) patients may have stopped using their PAP, or non-adherent to the recommendation, (e) patients may not have received recommendation/prescription for the annual visit. The higher than usual compliance rate with PAP therapy at the annual follow-up visit may also be related to the biased sample of patients returning to the clinic for follow-up, which may also affect the actual number of patients requiring a clinical intervention at the annual follow-up visit. Since the likelihood of a therapeutic intervention was not influenced by the years of experience using PAP, it may be that we predominantly were examining established PAP users rather than those who had struggled more to use PAP. The selection bias problems can only be addressed by a prospective study. Additionally, our study population is over 90% Caucasian. Future studies based on patient samples drawn from a more representative sample of the US population could help improve validity.
Our findings may not be generalizable to other sleep centers as this is a single center study that was conducted in an academic sleep center and consisted of highly selected patients who kept their annual scheduled follow-up visits. We classified our interventions as "therapeutic" and "administrative"; this distinction was based on our resources and expertise available at our center and may not necessarily apply to other centers. We chose "administrative" to cover transactions that in our setting were predominantly clerical or that required little or no medical decision-making, and "therapeutic" to describe those transactions that would likely require assessment and medical decision-making. Finally, this study does not allow assessment of the impact of reassurance and minimal education that may have taken place during predominantly administrative visits on long-term adherence. Such factors as patient-doctor relationship, re-emphasis of the importance of managing OSA in the broader clinical picture, and other intangibles are not represented in retrospective assessments and could conceivably be significant in establishing long-term PAP adherence. Despite these limitations, our data show an opportunity to better select which patients would most benefit from routine face-to-face follow up.
OSA is a chronic condition that requires ongoing follow-up. However, PAP follow-up may not require face-to-face visits in all cases. Future studies looking at screening tools to assess predictive factors prospectively on this group of OSA patients will help to determine the need for and timing of face-to-face follow-up visits. Avoiding unnecessary while ensuring appropriate annual clinic visits will improve resource utilization and result in increased value of care.
This was not an industry supported study. This study was partially supported by Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The authors have indicated no financial conflicts of interest.
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Fleury B, Rakotonanahary D, Tehindrazanarivelo AD, Hausser-Hauw C, Lebeau B, authors. Long-term compliance to continuous positive airway pressure therapy (nCPAP) set up during a split-night polysomnography. Sleep. 1994;17:512–5. [PubMed]
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Nino-Murcia G, McCann CC, Bliwise DL, Guilleminault C, Dement WC, authors. Compliance and side effects in sleep apnea patients treated with nasal continuous positive airway pressure. West J Med. 1989;150:165–9. [PubMed Central][PubMed]
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Kushida CA, Littner MR, Hirshkowitz M, et al., authors. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep. 2006;29:375–80. [PubMed]
Gay P, Weaver T, Loube D, Iber C, authors. Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep. 2006;29:381–401. [PubMed]
Positive Airway Pressure (PAP) devices. Complying with documentation and coverage requirements. Centers for Medicare and Medicaid Services. Accessed December, 2010. http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/PAP_DocCvg_Factsheet_ICN905064.pdf.
Epstein LJ, Kristo D, Strollo PJ Jr.; et al., authors. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263–76. [PubMed Central][PubMed]
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Kohler M, Smith D, Tippett V, Stradling JR, authors. Predictors of long-term compliance with continuous positive airway pressure. Thorax. 2010;65:829–32. [PubMed]


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Taipei, Jan. 7 (CNA) President Tsai Ing-wen (蔡英文) began her second overseas visit since taking office in May 2016, a trip that will take her to four of Taiwan's Central American allies, as well as two U.S. cities, where she will have stopovers.The goal of the trip, according to Tsai, is to consolidate diplomatic relations with the allies Honduras, Nicaragua, Guatemala and El Salvador and deepen trade exchanges with those countries.But what will be closely watched by the international community is her transit stops in the U.S. cities of Houston and San Francisco. Tsai's administration has refused to divulge whether she will meet with any U.S. officials, U.S. President-elect Donald Trump or any members of his incoming administration.Speaking at the Taiwan Taoyuan International Airport before departing for Honduras, Tsai reaffirmed her administration's efforts to improve Taiwan's foreign relations based on "steadfast diplomacy," which aims to create mutually beneficial relations with Taiwan's diplomatic allies.Through the visit, the president said she hopes to consolidate Taiwan's relations with the four allies, which she said all have long-standing friendships with the Republic of China (Taiwan's official name).She said she will not only meet with the presidents of the four countries but will also seize the opportunity to interact with leaders from other countries.The second goal of her visit is to deepen bilateral cooperation, she said, noting that there may be many opportunities in Central America.It is important to strengthen trade relations with the four countries, according to Tsai.Meanwhile, she will meet with Taiwanese diplomats stationed there to boost their morale and see Taiwanese expatriates there.During the nine-day visit, Tsai will also be able to meet with heads of state from other countries who will attend the inauguration of Nicaraguan President Daniel Ortega.Tsai and her entourage are traveling on an EVA Air-chartered flight. Prior to arriving in Honduras on Jan. 8 on the first leg of trip, she will make a stopover in Houston on Jan. 7, according to the itinerary.Her office has not released details about who she will meet with in Houston, besides Taiwanese expatriates. She will also visit the technology industry there.On Jan. 8 after arriving in Honduras, she will inspect a bilateral cooperative project between Taiwan and that country. On Jan. 9, she will meet with President Juan Orlando Hernandez before departing for Nicaragua.Tsai will attend Nicaraguan President Ortega's inauguration ceremony on Jan. 10, after meeting with Taiwanese businesspeople based in Nicaragua earlier that day.On Jan. 11, Tsai will arrive in Guatemala, where she will hold discussions with President Jimmy Morales. She will head to El Salvador the next day, and will meet with El Salvadoran President Salvador Sanchez Ceren, according to the itinerary.On her way back from Central America, she will make a transit stop in San Francisco on Jan. 13 -- during which she will meet with Taiwanese expatriates and visit the innovation industry there.She is scheduled to return to Taiwan on Jan. 15.The visit comes after Taiwan lost one diplomatic ally in December, amid strained cross-Taiwan Strait ties. Taiwan severed official ties with Sao Tome and Principe, after the African country decided to break its ties with Taiwan, mainly due to Taipei's refusal to meet its demand for financial aid.Sao Tome and Principe resumed diplomatic ties with China later that month.There are growing concerns that Taiwan may lose more diplomatic allies if relations with China continue to deteriorate and that Beijing may be trying to woo away Taiwan's allies to put pressure on Tsai for not accepting the "1992 consensus" that Taiwan and mainland China are part of one China as the sole political foundation for the development of cross-strait exchanges. (By Elaine Hou, Sophia Yeh and Chiu Chun-chin)ENDITEM/cs
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The U.S. Army Corps of Engineers and four researchers from SEFS—including Professors Josh Lawler (PI) and Aaron Wirsing, Affiliate Professor Peter Dunwiddie and postdoc Michael Case—have teamed up on a new research project, "Evaluating Flora and Fauna Diversity in the John Day/Willow Creek Project for Special Status Species Protection."
With $284,968 in funding, the project in northwest Oregon aims to:
1) Inventory and identify terrestrial animal and plant species and their habitats. This comprehensive inventory will include native and non-native and invasive, threatened and endangered, noxious and nuisance plants and wildlife on 13,600 acres of project lands;
2) Delineate and identify dominant ecological communities, including abiotic components;
3) Assess the status, health and viability of resident wildlife and plant populations and their habitats, including special status species, as well as biological diversity and environmental health of ecological communities;
4) Provide qualitative and quantitative information about the identity, location and abundance of state and federal classified invasive and noxious species within dominant ecological communities;
5) Develop an integrated pest management plan.
The relevant data will be entered into a GIS database and generate a series of maps to show a detailed, scaled overview of ecological communities, species habitats, and general habitat conditions.
Funding for the project is made available through a cooperative agreement (W912HZ-16-2-0031) under the Pacific Northwest Cooperative Ecosystem Studies Unit (PNW CESU), a partnership for research, technical assistance and education to enhance understanding and management of natural and cultural resources.


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Tuesday, July 29, 2014
Happening at Last!
After months of eager anticipation, everyone's patience (and contributions to a Kickstarter campaign) are finally going to be rewarded. The word is out that the Upstreet Market, the midweek farmers' market taking place in the Public Square (a.k.a. Seventh Street Park), will happen for the first time tomorrow, Wednesday, July 30. The market will be open from 4 to 7 p.m.
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DOJ: Rummy Took 9/11 Rubble
The Justice Department investigation that criticized FBI agents for taking souvenirs from the World Trade Center site also found that Defense Secretary Donald H. Rumsfeld and a high-ranking FBI official kept items from the Sept. 11 attack scenes.
The final investigatory report said the Justice Department inspector general confirmed Rumsfeld "has a piece of the airplane that flew into the Pentagon." The Associated Press obtained a copy of the report Friday.
Pentagon spokesman Lawrence Di Rita said Friday night that Rumsfeld has a shard of metal from the jetliner that struck the Pentagon on a table in his office and shows it to people as a reminder of the tragedy Pentagon workers shared on Sept. 11, 2001.
"He doesn't consider it his own," Di Rita said, adding the piece is on display for the Pentagon. "We are mindful of the fact that if somebody has an evidentiary requirement to have this shard of metal, we will provide it to them."
The Justice Department investigation also collected testimony that Pasquale D'Amuro, FBI Director Robert Mueller's executive assistant director for terrorism until last summer, asked a supervisory agent to "obtain a half dozen items from the WTC debris so the items could be given to dignitaries."
Six items none needed as evidence were gathered and sent to D'Amuro, the report said.
D'Amuro, now the head of the FBI's New York office, told investigators that "he asked for a piece of the building as a memento" and that he was aware that agents had taken such items from other terrorist crime scenes over the years.
He said he got a piece of the building in June 2003 but denied asking for items for dignitaries. D'Amuro left the following month from FBI headquarters as Mueller's top terrorism official to become an assistant director in charge of the New York office.
Joe Valiquette, a spokesman for the New York FBI office, declined to comment Friday.
The report also divulged that FBI agents' removal of items like a Tiffany crystal globe from the World Trade Center rubble gutted a criminal case the bureau was building against a Minnesota contractor that had taken a fire truck door from the same rubble.
Prosecutors told the FBI they "might not indict the crime regarding the fire truck door due to government misconduct involving the Tiffany globe," the report said.
Surviving family members were surprised by the latest news.
"Unbelievable," said William Doyle, whose son was killed in the World Trade Center.
"Everybody has things that they probably should not have from the World Trade Center site," added Sally Regenhard, whose firefighter son died in the towers. "I'm sure there's probably all kinds of people that have all kinds of artifacts."
The Justice Department's report has not been officially released, but heavily deleted versions of the report began circulating around Washington last month showing 13 FBI agents had taken rubble, debris and items such as flags and a Tiffany crystal globe paperweight.
The bureau announced it was banning agents from taking items from crimes scenes, but no agents were being charged with crimes because the bureau did not have such a policy during the Sept. 11 investigation.
The full report obtained by the AP divulges some senior FBI managers were among those cited for having authorized or asked for mementos from the World Trade Center site.
In addition to D'Amuro, the report stated the now-retired head of the New York FBI office, Barry Mawn, asked and received an American flag and a piece of marble from the debris before his retirement.
The report also states the special agent in charge of the FBI's office in Knoxville, Tenn., Joe Clark, contacted FBI officials in New York requesting a piece of debris to display in an exhibit dealing with hate crimes. A 100-pound piece of steel was sent to Clark, the report said.
The report stated FBI agents who worked in New York repeatedly expressed their disgust that visiting agents and supervisors would seek souvenirs from the terrorist attacks.
Many interviewed regarded the debris as sacred, the reported stated, "and were disgusted by the fact that anyone would want to take items, including pieces of the building which were contaminated with blood and human body parts."
The report discloses that among the items taken, agents had cut World Trade Center security patches from the sleeves of shirt pieces found in the rubble.
One New York agent who worked on the evidence recovery team "stated it was a ghoulish prospect that anyone would want things from a crime scene where people have died," the report said.
Two senior FBI lawyers from New York told the investigators they were never consulted by FBI managers about the propriety of taking items, and they would have objected.
The FBI New York office's ethics officer, Steven Carolotto, "emphatically stated FBI agents could not profit from working any location" and the "calamity of the event was inconsistent with the taking of items for personal use."
Investigators also stated that they found evidence that the agent who ran the recovery effort at the landfill, Richard Marx of Philadelphia, gave "inconsistent" answers during the investigation after several colleagues claimed he had given them permission to take items.
Last summer, Marx was subjected to a lie detector test in which he said he did not recall giving items to Mawn, did not recall giving permission for evidence recovery agents to take items and insisted he was completely true when he gave an affidavit to the investigation.
"The results of the examination indicated that Marx was deceptive in his responses to all three questions," the Justice report said. FBI officials declined to comment about Marx's conduct.
(c)MMIV, The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed


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You're surely familiar with myriad American cultural giants associated with the land to our west, Oak Park.
Ernest Hemingway.
Frank Lloyd Wright.
Betty White. (Okay, so we looked that one up.)
Now let's talk about its non-American cultural giants. One just set up shop in Chicago.
Meet New Rebozo, a Chicago incarnation of the beloved suburban mole mecca, now open in the Gold Coast.
This occupies a tiny garden-level spot that recently belonged to another Mexican joint, Cantina 46. It's still pretty tiny, but it's been revived with sleek new furniture, bright-red walls and a tasteful amount of Frida Kahlo artwork. Amazing what a little Kahlo can do to a place.
There's a pretty handy little front patio just rearing to host your next after-work margarita party. Or if the weather's bad, just grab a stool at that diminutive six-person bar.
But mostly, remember this place for cozy little dates. There's a whitewashed fireplace lit with white candles instead of logs. A silver shaker full of margarita (it's conveniently big enough for two, mixed tableside). And some of the best pumpkin-seed mole, pollo encacahuatado (chicken with roasted chile de árbol and peanuts) and tacos chetumal (steak tacos with bacon) you've had in a long time.
No one knows how to make good pollo encacahuatado anymore.


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We had lunch/dinner at Little Caesars Pizza and it was fabulous!
Honey Mustard Bacon Wings
Such a sweet and tangy flavor going on that melted in our mouths.
Parmesan Garlic Wings
The garlic aroma filled the air and then the blend of Parmesan Cheese made these wings wake up our taste buds and we could not get enough of them.
Soft Pretzel Crust Pizza & Pepperoni Cheese Bread
Is it a pizza or a pretzel?
Every bite gave us a different taste, with the four-cheese gourmet blend of Asiago, Fontina, Parmesan and White Cheddar cheeses the bite leaned towards a pizza but then when the Creamy Cheddar Cheese sauce was in the bite it was a pretzel. Either way it is a uniquely different taste that we would highly recommend and we are going to have many more in our future. Especially for only $6!
As for the Pepperoni Cheese Bread is was flavorful and the crunchiness of the burnt ends really made it taste even better.


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After visiting Kangaroo Island last September – we knew it would not be long before we were back.
On Saturday the 11th of May – the alarm went off at 4.15 – time to get up get dressed for the 4.30 Taxi to Brisbane airport.
A bit cool but not too bad and before long we were on the plane.
A glorious view out the window on the flight to Adelaide.
Uneventful and fast trip – possibility because I snoozed a fair portion of it.
Into Adelaide – and on time for our transfer with Rex airlines across to Kangaroo Island
The planes are getting smaller ( photo by my partner Tammy)
Weather forecast not great – but luckily not raining as we got on the plane and patches of Blue sky on our flight across.
Landing safely at Kingscote Airport – time to pick up the Hire Car – went with Budget – unhelpful and unfriendly staff – would not use them again.
Off to Kingscote for some supplies from the IGA to get us through the few days we will be on the Island, and lunch at the Aurora Hotel ( fabulous meal) – watching what we thought was a lonely New Zealand Fur Seal playing in the bay out the front while we ate.
After lunch we went for a walk with camera – here we found the Seal was not alone.
They were quite placid – we still did exercise caution when we were close to them – and this is as close as we got – (my partner Tammy getting one of her shots)
Lots of birds at Kingscote too
After this we headed off to our accommodation – and that will be a post for another day.
Cheers Dave


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Shibata to Nagao (2013)
- Studio: Independent
- Release: January 26, 2013
- Director: Yang Ik-June
- Writer: Yang Ik-June
- Cast: Masato Aragaki, Yumiko Kashihara, Asami Kawamura, Yoi Kojima, Takuma Nagao, Chihiro Shibata
Video archive for the film Shibata to Nagao, which has a domestic theatrical release in the year of 2013. There is currently one video available for the film, of which one and only one is a trailer, as listed below. Happy viewing!
Featured Movie Star Wars: The Rise of Skywalker


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On today's date in 2004, Canada Post honoured former Governor General Ramon John Hnatyshyn on a domestic-rate commemorative stamp.
Canada's 24th governor general, Hnatyshyn served in that role from 1990-95 before being featured on a 49-cent stamp (Scott #2024) designed by Susan Mavor. Based on a photograph by Paul Chiasson, the stamp symbolizes Hnatyshyn's joyful, human qualities with a photograph that's likely familiar to some Canadians.
Taken on the day Hnatyshyn assumed the office of governor-general, the photo appeared again when his death was announced in December 2002. The photograph's strong vertical lines and wide borders enhance the stamp's vertical orientation.
"The cropping is unusual, too," said Alain Leduc, stamp design manager at Canada Post. "Parts of the photograph reach outside the frame, into the margins, emphasizing the sense of movement, and of individuality."
The stamp was issued on what would have been Hnatyshyn's 70th birthday.
An official first-day cover was also cancelled in Ottawa.
Hnatyshyn is famously remembered for re-opening the grounds of Rideau Hall to the public. He supported the arts and education, establishing several awards and scholarships. In 1992, he organized what aired on television as His Excellency's Most Excellent Rock Concert.
"Virtually each day I have the great honour to experience a deep sense of pride in the excellence of our people and the magnificence of our country," Hnatyshyn said in a 1991 speech.
The lawyer and politician was the son of a senator and grandson of Ukrainian immigrants. He was a Progressive Conservative member of the House of Commons from 1974-88, serving as energy minister as well as justice minister before being appointed governor general in 1990.
He died on Dec. 18, 2002, at the age of 68.
- Denomination: 49 cents
- Design: Susan Mavor
- Dimensions: 24 mm by 38 mm (vertical)
- Gum type: P.V.A.
- Paper yype: Tullis Russell Coatings
- Perforations: 13+
- Photography: CP/PC (Paul Chiasson)
- Printer: Lowe-Martin
- Printing Process: Lithography in four colours plus two special metallic
- Tagging: General, all sides
- Quantity: 2,500,000


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Manoa Falls is probably the most popular waterfall hike on Oahu. Most popular being code for "lots of tourist." Indeed, you're almost guaranteed to cross paths with copious amounts of tourists, some of whom will be ill-prepared and wearing slippers (flip-flops for the non-locals). Those on the ecotours will be walking around with awkward and bulky wooden walking sticks (probably a selling point for the tour operators). Don't let that deter you, though, Manoa Falls is also a popular trail with locals. You'll often find students from the neighboring University of Hawaii at Manoa exploring this waterfall trail. Manoa Falls has something for everyone. It can be a simple waterfall hike or it can be the starting point to even more exciting exciting trails. Some even believe that Manoa Falls is one of the paths that Night Marchers, the ghosts of ancient Hawaiian warriors, often march.
Manoa Falls is a short hike. You should be able to complete it within 45 minutes. The trail is well defined and easy to follow. However, Manoa Falls is located within Manoa Valley and therefore this area is often very wet and muddy. If it's been raining (and when does it not rain in Manoa) then be prepared for slippery rock.
LOST fans might be interested to know that a few scenes from the series was shot at Manoa Falls [2]. In fact, the tropic feel of the Manoa Falls trail keeps Hollywood coming back for more. On the day that I did this trail, there crew from Hawaii Hawaii Five-0 was filming. Unfortunately for me, I did not spot Steve McGarrett, however, I did hear rumors that both Chin Ho Kelly and Danno were on set [3].
If you visit Manoa Falls on the right day then you'll be treated to a wonderful waterfall. Since this is the most visited waterfall on the island, there is a chain surrounding the perimeter of the falls. If you really want to experience the falls, hop the chain and get close to the falls (at your own discretion of course). You might even want to take a dip in the shallow waterhole beneath the falls [1].
On the day that I visited Manoa Falls, there was a backlog of people around the left perimeter of the falls. In fact, once I got close to the falls, traffic became somewhat unbearable. In any case, I hopped the chain and had the waterfall all to myself. The toursits thought I was crazy. I heard whispers of, "oh my, he's going in" and "he's nuts." In fact, their concerns were not without reason. In 2002 a major landslide occurred Manoa Falls causing 30 tons of material to fall nearly 600 feet. With that said, be nice and stay behind the chain. Of course, the waterfall is 100 times more beautiful when the crowd is out of the picture.
If you'd like to extend this hike then you can jump on the Aihualama trail. The trailhead to the Aihualama trail is located just before the waterfall. You'll see a sign indicating the start of this trail, you can't miss it. Once on the Aihualama, you can connect to various trails such as the Pauoa Flats Trail. If connecting to the Pauoa Flats Trail you can then connect to the Manoa Cliff Trail and end up at the top of Tantalus. From the Manoa Cliff Trail you'll be able to peek into Manoa Valley and see upper Manoa Falls from a distance. This is just one of the connector options. You can even use the Manoa Falls Trail to access the upper Manoa Falls (dangerous) or even use Manoa Falls as an exit route when doing Konahuanui.
So you've made up your mind and you want to visit Manoa Falls, huh. Keep in mind the ancient Hawaiian spirits that is said to linger on this trail. There are many stories and legends associated with Manoa Falls. A banyan tree at the Manoa Falls trailhead is said to be in the direct path of the Night Marchers. It's also said that you can hear a spectre or banshee screaming while walking along this path.
"Night marchers (huaka'i pō) are ghosts of ancient Hawaiian warriors. While the characteristics of night marchers in ancient Hawaiian belief vary depending on the sources describing these spirit processions which march on specific nights of the month, all sources agree on one major point: don't get in their path and don't look at them. According to legend, if someone comes across a procession of the night marchers, it is important that that person crouch low to the ground, resting on their stomachs and to avoid making eye contact. Doing so is said to prevent harm to that person. While some night marchers may prod and poke a person lying on the ground to instigate them to look up, night marchers are known to stick to their destination and not deviate in their aim to haunt humans."
"For the last ninety years or so published and unpublished accounts have surfaced of people encountering the marching apparitions of chiefs, chiefesses, dead relatives, gods, goddesses, and their retinues on roads they had once ceremonially traveled to attend to customary affairs inextricably combining secular and sacred elements. Hawaiians call the phantom parade either huaka'i po (huaka'i, procession; po, night) or, less often, 'oi'o (derivation unknown)." (Luomala, 1983).
Former University of Hawaii at Manoa student, Katharine Luomala, published an excellent article titled Phantom Night Marchers in the Hawaiian Islands. The paper includes stories obtained by Luomala and by student collectors in her folklore classes (1983) at the University of Hawaii at Manoa.
There's indeed something for everyone at Manoa Falls. Novice hikers will enjoy the short and safe trip to the falls. Extreme hikers might use the Manoa Falls trail as the starting point to trails with more action. Ghost hunters will definitely be intrigued by the potential of seeing a Night Marcher or hearing the screams of a banshee. Manoa Falls has something for everyone so don't let its popularity prevent you from visiting.
Explorers: Coty Gonzales
Total Time: Give yourself about 1.5 hours for the roundtrip.
Manoa Falls Trail Tips:
- The Manoa Falls trail is often very muddy so be prepared for mud! A nice pair of hiking shoes or boots would be nice. Sneakers will get destroyed by the mud on this hike.
- As with the other Manoa trails, bring mosquito repellant!
- To extend the hike, continue on the Aihualama Trail.
- To avoid the $5 parking charge, park in the residential area before entering Paradise Park.
- Before jumping into the pool of water, be warned that it may contain leptospirosis. "Leptospirosis is a bacterial disease that is primarily carried by rats and mice, although dogs, pigs, cattle and horses can also become infected. The disease is generally transmitted to humans by exposure to fresh water that is contaminated with urine from infected animals. Infection can take place when contaminated water enters the body through the mouth, nose, eyes or open wounds." Fortunately, locals are said to be more resistant to leptospirosis.
Directions to Manoa Falls Trail: If heading east on H1, you will take the Exit 23 (Punahou) or if heading west on H1 you will take the Exit 24 (Wilder). Continue on Wilder to the third light and take a right on Punahou. Continue up Punahou, toward the mountains. Punahou turns in Manoa road by staying left at the fork in the road. You will soon come to a five way intersection. Stay on Manoa road. Manoa Road continues into the back of Manoa Valley and ends at Paradise Park. Follow the road and park in the Manoa Falls parking lot. The parking charge is $5. Follow the road, on foot, uphill and to your right. You'll reach a fork in the road, to the left will be the entrance to the Lyon Arboretum and straight ahead will be a gate indicating the start of the Manoa Falls Trail.
1. You should always keep in mind that waterfalls can be very dangerous. Rock slides do happen and can be very deadly.
2. A couple of LOST scenes were filmed here including Episode 1×11 "All the Best Cowboys Have Daddy Issues" Jungle scenes and the banyan tree Charlie was hanging from and Episode 2×15 "Maternity Leave" Jungle scenes with Claire and Ethan.
3. This was confirmed once I saw the actual episode.


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When I was 13, I would have killed for a pair of Jordache jeans. I remember a particular meltdown Christmas fest cause I couldn't open my Christmas gift, which I just knew were Jordache jeans cause that's the only thing I asked for that year. I would go to middle school and switch out my yucky jeans for skinny minny redhead's jeans in the bathroom before the first bell rang.
This curvy gal has been reunited. And it feels so good. And who doesn't love a 40% off sale on jewel-covered sweatshirts? I first noticed this bedazzled specimen in August on my business trip to NYC. But like all things at J. Crew, eventually it all goes on sale. I like to wait about 6 weeks til it's 40% off. It may not be "in season" but what is that for this Floridian? Over the last few days there's been a slight dip in the temps, which means only one thing - well maybe two - you can wear long sleeve shirts without looking like a freaknut and better hair and the camera doesn't fog up. Okay that's three. I can pretty much wear jeans any day at work. However, it has to be with a company shirt, except Fridays where it's a free-for-all. Since I had sister time Friday night at Mugs N Jugs (they have great boneless wings), I thought this would be a good outfit. Probably a little overdressed, but hey - the cooler temps have arrived! I gotta fit in whatever I can before it shoots up into the 90s again.


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Is there such thing as "Clintonism"?
I think there is such a thing as Clintonism. And I think it's one of the main reasons why the Republican Party, back in the 1990s, were very determined to crush Bill Clinton – either before he became president, or to destroy his credibility in office. They thought he was taking their ideas and packaging them as progressive politics.
We look back now, and this idea of the Third Way, as it becomes known, is so synonymous in the UK with Tony Blair, and because of how that all came to an end, it seems rather inglorious. But one need not be too much of a fantasist to see how that approach to politics could have continued quite successfully – had Florida gone the other way in 2000 and Al Gore been elected president, as a New Democrat, as Bill Clinton positioned himself.
At heart, Hillary is a cautious, small-c conservative who in the UK would be quite at home in the centre ground of British politics.
Bill Clinton's great hope was to distinguish himself from Democrats of the past, people like Jimmy Carter and Ted Kennedy, and position himself as a proponent of a moderate, reforming centre-left around which traditional Democrats could coalesce – but which also what used to be referred to as Reagan Democrats could come home to. It was a system of government which, in Clinton's own words, gave opportunity to all, but asked for responsibility from all. So, a reduced role for the federal government, but not an end to government involvement. Reform for welfare, not the end of welfare. And no fear of using US military power as and when necessary, but not as a first resort.
If we look at Hillary Clinton's campaign in 2016, it's very different from 2008. That's because of the presence of Bernie Sanders. He has certainly drawn Hillary further left than she wanted to run. At heart, she's a cautious, small-c conservative who in the UK would be quite at home in the centre ground of British politics. She's no great radical, and neither was her husband, so there is an overlap – but we're talking about politics 25 years on, so there has been some movement from those early policies of Bill Clinton.


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FHA Certification and Your HOA
Bob Gourley is a former President of the Board of Directors of the Connecticut Chapter of the Community Associations Institute (CAI-CT). He operates an incredibly informational condominium site called MyEZCondo and runs a Q&A page on the CAI-CT website called "Ask Mister Condo." He is also one of the top contributors to a website dedicated to condominium associations called Association-Life.
Long story short (too late!)...the guy knows condos.
One of his articles from today is titled "FHA Certification and Your Community". Given his background and knowledge of community associations, I was excited to read this article.
In the article, he writes:
"My advice is to get in front of it and get your condominium on the FHA approval list now, before you find yourself defending your lack of approval, or worse, defending the fact that the condominium never even sought approval."
I spoke with a property manager just yesterday who was remarking to me that of the HOAs that he manages, only the ones that are on the FHA approved condos list have been able to sell units. He said that in one of his communities that is not FHA-approved, there have been 7 units on the market for nearly 6 months. [Average selling time for condos in the area is 3-4 months.] He chuckled as he said "they don't want to get FHA approved and can't figure out why their units aren't selling! Hello??"
By not being on the FHA Approved Condominiums list, these projects are needlessly eliminating buyers due to misunderstanding for whom FHA loans are truly designed.
Thank you very much, Mister Condo! If you continue to spread the word, so will we!
Image courtesy of grant_cochrane/freedigitalphotos.net
The Condominium Project Approval Team at ReadySetLoan is dedicated to helping condominium projects across the nation to obtain their approvals with FHA and the VA or become recertified with FHA. We have assisted nearly 200 condominiums and we can help your association.
ReadySetLoan is an active member of the Connecticut and New England chapters of the Community Associations Institute (CAI) and is a frequent contributor to Common Interest Magazine as an expert in FHA/VA condominium project approvals.
Please contact us with any questions regarding FHA or VA condominium project approvals. You can email me at email@example.com or call me at 404-433-4565. I will be happy to answer any of your questions.
FHA/VA Condo Approval Specialist
404-433-4565 Cell Phone
860-644-3772 Fax Phone
Check out our article in Common Interest magazine on page 19!