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To determine whether pretreatment with zaleplon immediately before CPAP titration improves 1-month CPAP adherence in subjects newly diagnosed with OSA.
Prospective, randomized, double-blinded, placebo-controlled trial of a single dose of zaleplon 10 mg or matching placebo at the start of CPAP titration during laboratory-based, split-night polysomnography (PSG). Baseline sleep symptoms were assessed with the Functional Outcomes of Sleep Questionnaire (FOSQ) and Epworth Sleepiness Scale (ESS). CPAP usage and change in symptom questionnaire responses were assessed at 1-month follow-up.
One hundred thirty-four newly diagnosed OSA patients undergoing their initial split-night PSG (49.8 ± 11.3 years old with an apnea-hypopnea index of 16.5 (7, 32) [median (interquartile range)] were randomized to zaleplon (n = 73) or placebo (n = 63). Complete follow-up data were available in 83 subjects (44 zaleplon group; 39 placebo group). CPAP was used for 6.5 (5, 7) h/day with zaleplon versus 6.5 (5, 8) h/ day with placebo (p = 0.64). Improvements in FOSQ and ESS scores did not differ between the two groups.
A single dose of zaleplon at the start of a split-night CPAP titration does not result in superior CPAP adherence or improvement in symptoms at 1-month compared to placebo. Our data show that zaleplon is safe and is associated with shorter sleep latency during CPAP titration, but it does not translate into improved short-term CPAP adherence.
Park JG; Olson EJ; Morgenthaler TI. Impact of zaleplon on continuous positive airway pressure therapy compliance. J Clin Sleep Med 2013;9(5):439-444.
Obstructive sleep apnea (OSA), is a chronic disease that affects at least 2% to 4% of middle aged adults1 and is associated with significant morbidity and mortality.2–7 Among medical, surgical, and appliance options for treating OSA, continuous positive airway pressure (CPAP) is the treatment of choice for most patients.8 Increasing CPAP use is associated with dose-dependent improvements in several clinical outcomes.9 However, a significant number of patients struggle to consistently adhere to CPAP therapy.10
Drake et al. reported that individuals whose sleep improved during the CPAP titration demonstrated two hours of increased nightly compliance, even after correcting for disease severity at initial polysomnography.11 Several investigators examined whether a short course of hypnotic therapy coincident with the start of CPAP therapy would improve compliance, but they found conflicting results. Bradshaw et al. reported that zolpidem after titration, but commencing with the first 14 days of CPAP did not improve compliance compared to placebo or standardized therapy.12 In contrast, Lettieri et al. found that eszopiclone for the first 14 nights of CPAP was associated with greater long-term compliance than placebo.13 Their group, in a retrospective study, also found an association between hypnotic (mostly zolpidem, and to lesser extent eszopiclone) use during CPAP titration and improved compliance at 4-6 weeks.14
Although encouraging, we felt that the conflicting outcomes of the prospective studies and the retrospective nature of the latter study needed further clarification. Thus, we report on a prospective, randomized, double-blinded, placebo-controlled investigation to determine whether administration of a single dose of hypnotic during the CPAP titration in the sleep laboratory would improve CPAP compliance at 1 month. We hypothesized the hypnotic would improve the initial CPAP experience, and thus CPAP adherence would be greater. The hypnotic employed in this study was zaleplon, a short-acting nonbenzodiazepine hypnotic that is a benzodiazepine receptor agonist.
Current Knowledge/Study Rationale: Compliance with continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea remains suboptimal, and usage patterns appear heavily influenced by early CPAP experience. We hoped to improve compliance by improving the very first night's sleep on CPAP by using zaleplon during the titration study.
Study Impact: Our study did not show improvement in CPAP compliance with the use of zaleplon during CPAP titration. A very high level of compliance in our control group and similar quality of sleep during CPAP titration between the zaleplon and control group suggests that other factors are more important in determining CPAP compliance.
After approval by our institutional review board, subjects referred to our multidisciplinary accredited sleep facility for suspected OSA between October 2004 and March 2006 were approached for enrollment. Inclusion and exclusion criteria are listed in Table 1. All subjects underwent an evaluation by a board-certified sleep specialist, were thought to likely have OSA, and were tested via a laboratory-based, technologist-attended polysomnogram (PSG). Prior to PSG, each subject viewed an educational video describing OSA, PSG, and CPAP, followed by a personalized CPAP interface sizing session with a polysomnographic technologist. Subjects were allowed to try on different interfaces with CPAP at 5 cm H2O. Participants completed the Functional Outcomes of Sleep Questionnaire (FOSQ),15 a 30-item questionnaire designed to assess 5 areas of functional outcomes affected by sleep disorders: general productivity, social outcomes, activity level, vigilance, and intimate relationships.
Inclusion and exclusion criteria for study participants
(more ...)
PSGs were performed using a digital polygraph (NCI Lamont Medical, Inc., Madison, WI, or Bio-Logic Systems Corp., Mundelein, IL). The following parameters were recorded: electroencephalography (Fz-Cz; Cz-Oz; C4-M1 or C3-M2); electrooculography (right outer canthus-Fpz; Left outer canthus-Fpz); submental and anterior tibialis electromyography; snoring by laryngeal microphone; electrocardiography; pulse oximetry; and respiratory effort (thoracic, abdominal, and summated inductive plethysmography). Airflow was analyzed by nasal pressure transducer (standard at the time of this study). Obstructive apnea was defined as cessation of airflow ≥ 10 sec despite respiratory effort. Hypopnea was defined by ≥ 30% reduction in airflow ≥ 10 sec accompanied by ≥ 4% drop in oxyhemoglobin saturation. Sleep stages and arousals were manually scored by registered polysomnographic technologists using contemporary standards at the time of the study.16,17 OSA was defined by an apnea-hypopnea index (AHI) ≥ 5.
All PSGs were performed in a split-night fashion. The initial (i.e., diagnostic) phase was continued until a minimum total sleep time of 120 min occurred and REM sleep was noted. If REM did not occur, diagnostic portion was stopped at 02:30 if the total sleep time was a minimum of 120 minutes. Subjects with OSA were randomized (using nQuery Advisor 4.0 software) to receive zaleplon 10 mg or an identical-appearing placebo, followed immediately by commencement of the CPAP titration during the second portion of the PSG. CPAP was started at 5 cm H2O (4 cm H2O if the subject was uncomfortable with the initial CPAP setting) through an interface of the subject's choosing and gradually increased in increments of 1 cm H2O until disordered breathing events were eliminated. At the conclusion of the polysomnogram, subjects used a visual analog scale to rate their initial experience with the PSG and CPAP.
A board-certified sleep specialist reviewed all PSGs. For those prescribed CPAP, a standardized education packet regarding the use and care of CPAP equipment supplemented the sleep specialists' education regarding CPAP use, and follow-up visit was scheduled. The follow-up visit target was 1 month, but varied because of differences in time necessary to secure CPAP (CPAP was obtained by subjects through a durable medical equipment vendor of their choosing) and travel distance to our center. All subjects were also encouraged to call our sleep center nurse phone line if they experienced any CPAP problems. At the follow-up visit, CPAP use information was downloaded from their device and subjects completed a second FOSQ. If subjects missed their return appointment, they were contacted by telephone to rescheduled a visit or were sent a mail package asking them to return a second FOSQ and their downloaded CPAP information (via their local vendor) using an enclosed self-stamped envelope. All patients, physicians, technologists, and nurses remained blinded with respect to zaleplon vs. placebo pretreatment throughout the study.
A retrospective analysis of 274 OSA patients treated with CPAP in our sleep facility and who had downloaded compliance data revealed a mean CPAP use of 5.6 h (± 1.9) per night (non-published data gathered as part of our center's database). Assuming the same standard deviation in our study groups and using α = 0.05, we calculated that 63 patients per study group would provide 80% power to detect a difference in nightly average CPAP use of 60 min (18% improvement) (nQuery Advisor 4.0 software) between groups. We used an intention-to-treat analysis for the pre- and post-CPAP data using a nonparametric analysis of variance (ANOVA). Similarly, nonparametric ANOVA was used to analyze the difference between groups at the time of follow-up regarding compliance and FOSQ. Non-normally distributed data are expressed as median and interquartile range (IQR), 25th and 75th percentiles. Where noted, mean ± standard deviation is used for some parametric data.
One hundred seventy-six eligible subjects were enrolled and randomly assigned to receive either placebo or zaleplon during split-night PSG (Figure 1). After enrollment, 42 subjects (27 in the placebo group, 15 in the zaleplon group) did not receive the assigned treatment for various reasons (Figure 1). As a result, 61 subjects comprised the placebo group and 73 subjects the zaleplon group.
Subject flow diagram
Table 2 provides data on baseline demographics and the diagnostic portion of PSG for the 2 groups. Placebo group had slightly greater percentage of women and was slightly younger. There were no significant differences in body mass index, Epworth Sleepiness Scale (ESS) score, or FOSQ scores. There were no significant differences in various diagnostic PSG parameters, including AHI and minimum oxyhemoglobin saturation (Table 2).
Baseline characteristics of study subject and diagnostic polysomnogram data
During CPAP titration, zaleplon use was associated with shorter initial sleep latency and decreased REM sleep compared to placebo (Table 3). There were no differences in the effective CPAP pressures, AHI for the entire titration, or the arousal index. Furthermore, there was no difference in overall subject satisfaction with the PSG and CPAP as determined by their responses on the visual analog scale (Table 3). All studies were completed without any adverse events and all CPAP titrations were considered "adequate" or greater per published clinical guidelines for CPAP titration.18
Effect of zaleplon on polysomnogram values during CPAP titration
CPAP was not prescribed in 10 subjects (4 in the placebo group, 6 in the zaleplon group), because of the very mild nature of their OSA (mean AHI 5.9 ± 5.6 in these 10 subjects). An additional 20 subjects (7 in the placebo group, 13 in zaleplon group) refused CPAP therapy. Those who declined therapy were younger (median age of 41 vs 51 [p = 0.019]) and had lower BMI (median BMI of 31.5 vs 35.7 [p = 0.009]), but did not differ in ESS, FOSQ, VAS, or AHI (data not shown). Nine subjects (4 in the placebo group; 5 in the zaleplon group) did not return for follow-up; they were not available by telephone and did not return a mail request for follow-up information (Figure 1). There were no significant differences in the age, BMI, FOSQ, ESS, or AHI between those who did and did not return for follow up (data not shown).
Ultimately, follow-up information was available in 46 subjects in the placebo group and 49 subjects in the zaleplon group, with 39 placebo group patients and 44 zaleplon group patients having CPAP devices with downloadable compliance capability (Table 4). Among these groups, no subjects discontinued CPAP therapy during the follow-up period. Using an intention-to-treat analysis, CPAP compliance and symptomatic improvements were not statistically different between the two groups (Table 4). ESS and FOSQ scores improved similarly in both groups (Table 5).
Intention-to-treat analysis
Outcome variables at follow-up
Overall, ESS score, AHI during the diagnostic test, and sleep efficiency during the CPAP titration was not associated with daily CPAP usage at follow-up (p = 1.0, 0.85, and 0.84, respectively).
Our study demonstrated that zaleplon administered just before CPAP titration during split-night PSG improved initial sleep latency without affecting minimum oxygen saturation or resultant CPAP pressure. Contrary to our hypothesis, use of zaleplon did not result improvement in sleep efficiency or arousal indices, and thus perception of sleep quality during the PSG did not differ between the two groups. Although CPAP adherence was relatively high in both groups, use of zaleplon did not result in increased compliance. Improvements in OSA-related symptoms as measured by FOSQ and ESS were also similar in the zaleplon and placebo groups.
Our data conflict with Lettieri's work involving the use of a hypnotic during CPAP titration. A retrospective assessment of 400 consecutive patients prescribed CPAP for OSA showed that of multiple parameters assessed, only age and use of a hypnotic (typically zolpidem) during the CPAP titration were associated with better short-term CPAP compliance.14 This association was significant for patients less than 50 years old, but not with older patients. The retrospective nature of their study did not allow control for selection bias (they only included patients who returned for follow-up; patients using hypnotic-sedative medications prior to PSG were excluded) or medication effects (they could not identify which patients received which hypnotic and could not verify use or non-use in 15% of their patients). In a prospective study, Lettieri and his colleagues also demonstrated that pre-treatment with eszopiclone prior to full-night attended polysomnography for CPAP titration improved CPAP compliance for those patients returning for follow-up.21 However, about one-sixth of their patients did not return, and the improvement in compliance was not demonstrated using an intention-to-treat analysis.
There are several potential explanations for the conflicting results. Twenty-nine percent of successfully randomized patients did not complete the study (77% of these subjects were not prescribed or declined CPAP), leaving our study potentially underpowered to detect a difference in CPAP compliance with zaleplon. In addition, the average rating of the initial CPAP experience in both groups was "very good" ("4" on a 5-point scale with "5" being "very satisfied"), making it challenging to discern an additive contribution of zaleplon when the control group was highly satisfied.
We also used a different hypnotic. Zaleplon is a pyrazolopyrimidine hypnotic/sedative that is unrelated to benzodiazepines but acts on the same GABA-A receptor site as the benzodiazepines. Zaleplon also possesses some anxiolytic effects.22,23 We opted for use zaleplon because of its short-acting hypnotic effect in an effort to mitigate any morning hangover that might result from administration in the middle of split-night PSG. Other studies have used related but longer acting nonbenzodiazepine, benzodiazepine receptor agonists, zolpidem, and eszoplicone. Multiple regression analysis of Drake's study correlated improved CPAP compliance only with objective improvement in sleep efficiency, not with participants' subjective improvement in their sleep quality.11 In our study, zaleplon improved initial sleep latency but did not affect other sleep parameters. This lack of objective improvement in sleep efficiency may also account for lack of improvement in CPAP compliance.
It is probably also important to note that the improvement in CPAP compliance in Drake's study was from 4.09 to 6.12 hours per night.11 Lettieri's prospective study using eszopiclone at the beginning of CPAP titration showed improvement from 3.9 to 4.8 hours per night of CPAP use.21 A prospective use of short-term eszopiclone use improved CPAP use from 2.4 to 3.6 hours.13 Other interventions that improved CPAP compliance were in cases where baseline or placebo group use was under 5 hours (Table 6). Our placebo group's average compliance was already 6.5 h/night. These results imply that the benefit of adding hypnotic in improving CPAP compliance may be limited to those whose compliance is less than 5 hours. Thus, the benefit of adding zolpidem or eszopiclone for full-night CPAP titration studies may hinge on baseline CPAP compliance of the patient population. For example, if CPAP compliance of patients with certain risk factors might be predicted to be less than 5 hours, adding hypnotic such as zolpidem or ezopiclone prior to CPAP titration may result in improved CPAP compliance at follow-up.
Review of interventions' impact on CPAP compliance
Our study may have been limited by the split-night format of our PSG. It is possible that approximately 4 hours of CPAP titration may have been insufficient for our subjects to fully subjectively experience the benefit of CPAP, especially considering some of that time was spent in less than optimum CPAP pressure. With a full-night CPAP titration study, more of the night may be spent at adequate CPAP pressure that may further improve subjective rating. However, given that our subjects felt the titration portion was at least "very good" (rating of 4 on 5-point scale), the split-night format seems less likely to be a major contributing factor. Furthermore, there were several studies looking at the impact of split-night studies that did not find any negative impact on CPAP compliance.24
In our double-blinded, placebo-controlled, randomized study, the use of zaleplon at the beginning of CPAP titration during split-night study improved initial sleep latency, but did not yield improvements in CPAP compliance. While there was a trend towards improved sleep efficiency, it did not reach statistical significance. Our study showed that use of zaleplon did not result in systematic changes to AHI, oxygenation, or CPAP titration pressures, and it may therefore be used safely in patients without contraindications during attended polysomnography, and because of shorter sleep latency, might allow for longer PSG recordings. However, benefit for CPAP treatment adherence may only accrue to patients in whom anticipated CPAP adherence is low.
This was not an industry supported study. Dr. Morgenthaler has received research support from ResMed Corporation. Dr. Park has received research support from Dymedix Corporation and lecture fees from the American Physician Institute. The other author has indicated no financial conflicts of interest.
The authors acknowledge Ross A. Dierkhising for his statistical support. We also thank Terri Weaver for giving us the permission to use FOSQ in our research.
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Marin JM, Carrizo SJ, Vicente E, Agusti AG, authors. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365:1046–53. [PubMed]
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The Duke and I find ourselves a little late to the love-in that is/was/continues to be the blog awards season, though to be fair I've been tied up lately (literally, and am still applying salve to the Vicar-ious wrists and ankles), and the Duke has been vacationing in sunny Uzbekistan and only recently returned to rescue me. (Note to all mad scientist-cum-dominatrices with delusions of world conquest and an army of lucha-masked dwarf henchmen--Do. Not. Fuck. With. The. Duke. That sword-cane with the Gilded Gonads of Gilgamesh handle is NOT just for decoration!) As a result, we've thus far neglected to acknowledge our friends and colleagues who have seen fit to grace our humble offerings with laurels and accolades. It's an oversight we aim to rectify, toot sweet.
Our first thank-you goes to Ms. Horror Blogosphere 2009 herself, BJ-C of Day of the Woman, who awarded us the prestigious Zombie Chicken Award. According to the by-laws, The blogger who receives this award believes in the Tao of the zombie chicken – excellence, grace and persistence in all situations, even in the midst of a zombie apocalypse. These amazing bloggers regularly produce content so remarkable that their readers would brave a raving pack of zombie chickens just to be able to read their inspiring words. Which may be the nicest thing anyone's said to me since the great-granddaughter of Maria Ouspenskaya assured me that her Mee-maw "would totally have done you, Vicar." Thanks, BJ-C, for the much appreciated recognition!
Our second shout-out goes to the honorable Al Bruno III, who declared Mad Mad Mad Mad Movies "One Lovely Blog," and gave us an award to that effect. If you aren't following Al's twitter feed, you're missing out on his awesome and entertaining "5-Second Fictions," 140 character or less narratives that have more stylistic punch than anything Hemingway could put to paper--especially since the old man's been dead for so long. Thanks, Al! You're rather fetching yourself! Check out The Wit and Weirdness of Al Bruno III here.
And finally, we'd like to nod our heads in humble gratitude to the gentleman scholar and anthropomorphized symbol of all that is great in American and World Cinema, Samuel Wilson of Mondo 70: A Wild World of Cinema, a blog that every Mad Movie fan should have on his or her blogroll. The esteemed Mr. Wilson awarded us the Kreativ Blogger Award. Bask in its wire-frame CG goodness:
Because the Duke and I took so long to get round to displaying these prizes on our ornately carved marble mantels, most people in the blogosphere have already received awards for their excellence; and of those who remain, we really hate to play favorites and risk leaving anyone out. Therefore we have decided to pass all three of these awards on to every single person in the blogosphere who has ever watched a crazy Eurotrash or American Grindhouse sleazefest and been moved to grasp tightly their quills and shake out a glee-sticky review. You hear that, people? YOU'RE ALL WINNERS IN OUR BOOK!
But since we know our parishioners and subjects have thirst for knowledge about the enigmatic figures behind these blogs, we've decided to abide by half the Kreativ Award rules by sharing "Seven Interesting Things" about ourselves. And because he's much more the cultural historian than I am, I now turn this blog entry over to The Duke of DVD, who had forgotten more about us than I'll ever know. Take it away, Duke!
*At this point, the Duke comes staggering through the door, simultaneously fondling a busty Hooters waitress with one hand and trying to take the trousers off of a diminutive Indonesian teen boy with the other. Shoving them both away in sudden disgust, he drunkenly denounces all involved with the preparation of food at the Denny's corporation, and then sinks down on a lounge chair which is covered in silk peacocks.*
Ok, thank you Vicar. Instead of sounding our collective barbaric yawps across the rooftops of the world by doing 7 Interesting Things for both of us, I'll instead cull the list down to just 7 Things total, thus saving you all from priapism and self-loathing.
#6 - The Duke won a local Romanian wenching contest 3 years in a row during the late 80's by bedding the most wenches in a 12 hour period. His record still stands at 537 wenches.
#5 - Both The Duke and The Vicar are ordained priests in a splinter sect of Gaulish Druidism focusing on metempsychosis and the bedding of horny nuns.
#4 - The Vicar has a tattoo of Paul Naschy seeing bitches in chains across his back. He also has a tattoo of 50 Cent holding a 9mm handgun etched into his coin purse.
#3 - Every year during Saturnalia, The Duke drops a 14" golden phallus into the Salvation Army donation tub located outside Macy's.
#2 - The Vicar once consumed twice his own body weight in Peeps(tm).
#1 - Both The Duke and The Vicar absolutely love the job of bringing you, our loyal readers, to the very edge of MADness with our reviews, beckoning you with a smile to look over the edge, whereupon we rudely kick you into the abyss, your soul then being slowly devoured over eons by those from beyond time.

subset: commoncrawl


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Keira earrings
Keira earrings in golden brass
Product details
100% brass - Pierced earrings - Long pendant earrings - Each earring is unique - Mix of square & round studs - 4 different leaves on each side - Chloé engraved on the clasp Comes with a box Unique size Length: 13.5 cm Avoid any impact or fall Avoid contact with water or any source of humidity Store it carefully in the original pouch when not in use, after having it wiped with a soft duster cloth Colour: golden brass Item code: 2E0623-CB7-095
Each of the Keira long pendant earrings is unique, fastened with a mix of square and round studs for the carefree Chloé girl. Four different leaves dangle from the flowing chains of each earring, adding graceful movement while catching the light.
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After two years of begging and pleading to Jay (and then about five minutes of searching the web), The Bojon Gourmet now has a 'print friendly' button at the bottom of each individual post (not the main page with all the posts – to go to an individual post, click the recipe title). The happy, green button is located at the very end of the post, after the recipe and final photo. When you click it, you can delete anything you don't want printed – just hover over the photo or paragraph and click. To remove all the images, click the 'remove images' box at the top.
And what better recipe to print out than this easy, gluten-free, vegan, one-pot meal?
This is the dish we've been enjoying regularly for the past couple of months. It was inspired by a meal I enjoyed at Spice Monkey, an adorable cafe in Oakland with an eclectic menu inspired by foods from around the globe. As we partook of their excellent beer and wine selection served up by friendly staff, I reveled in a steaming bowl of fragrant coconut milk broth teaming with vibrant vegetables and slippery noodles. When we left, I knew I would either have to re-create the recipe or begin spending more time in the East Bay. (Like, every night.)
Luckily for Jay and my bank account, I found a recipe in Heidi Swanson's Super Natural Cooking for a 'slurp and slop bowl of noodles' that looked like a winning springboard recipe. I omitted the tofu, doubled the broth, and added in a jumble of vegetables.
The result is a messy bowl of spiced broth, stained yellow with turmeric and Thai red chile paste, creamy from light and full-fat coconut milks, tangy from a generous dose of lime. The ample vegetables cook right in the broth until crisp-tender, and noodles added to the bowl just before serving stay chewy-soft. The curry is light and nourishing all at once, leaving you satisfied yet energized.
While my favorite version uses colorful carrots, broccoli, savoy cabbage and cauliflower (which turns bright gold from the turmeric), I also made a tasty version with bok choy, romanesco and baby turnips – pesky vegetables from our CSA that I previously never knew how to use.
If you have a case of the winter vegetable blahs and find yourself pining for the asparagus and peas which are not yet in season, the bright flavors in this lively curry may assuage your longing.
And you don't even have to cross the bridge (or copy and paste) to enjoy it.
Oodles of noodles:
Creamy Sesame Soba Noodles
Mac and Cheese with Winter Squash, Bacon and Collard Greens
Pasta Alla Carbonara
One year ago:
Butterscotch Pudding (I just made this the other night with a shot of bourbon stirred in at the end – highly recommended!)
Two years ago:
Winter Vegetable Curry with Rice Noodles
Inspired by Super Natural Cooking
My curry paste wasn't very spicy, and this curry turned out completely mild; taste yours to determine how much spice you want in your curry, and add extra chile, or a bit of Sriracha hot sauce, for more heat if you like. Feel free to add 8 – 12 ounces of extra-firm tofu along with the vegetables. And speaking of vegetables, try any combination you like, taking cooking times into consideration – I've successfully used bok choy, thinly sliced baby turnips and romanesco in place of the ones suggested below.
This curry keeps well for several days, but don't add the noodles until just before serving; otherwise, they will drink up all the broth, and then disintegrate before making it into your mouth. Thai red curry paste and coconut milk can be found in the Asian section of most grocery stores.
Makes 6 – 8 servings
2 tablespoons extra-virgin coconut oil or sunflower oil
1 large yellow onion, peeled, halved and thinly sliced
4 cloves garlic, peeled and finely chopped
1 tablespoon plus 1 teaspoon Thai red curry paste
1/2 pound carrots, scrubbed and thinly sliced diagonally
1/2 pound broccoli, in bite-sized florets
1/2 pound cauliflower, in bite-sized florets
1/2 pound green cabbage (preferably savoy or napa)
1 can light coconut milk
1 can regular coconut milk
4 cups vegetable stock (I use 2 cubes of Rapunzel bouillon and 4 cups water)
1 tablespoon plus 1 teaspoon ground turmeric
2 tablespoons sugar
tamari or soy sauce to taste
juice of 1-2 limes
8 ounces Asian-style rice noodles
a bit of vegetable oil for tossing the noodles (such as sunflower)
a big handful of cilantro, washed well and chopped
In a large wok or dutch oven, heat the oil over a medium flame. Add the onion and garlic, and saute for a few minutes until translucent and softened. Add the curry paste and cook for a few more minutes, stirring constantly, until fragrant. Add the vegetables and give them a turn to coat them in oil. Add the coconut milks, stock, turmeric and sugar. (It will seem like not enough liquid, but the vegetables will shrink and release water as they cook.) Increase the heat to bring the curry to a simmer, then lower the heat to maintain a simmer and cook until the vegetables are crisp-tender, about 10 minutes. Add tamari and lime juice to taste.
Cook the noodles according to the package instructions, drain, rinse with cool water to prevent stickage, and toss with a bit of vegetable oil.
To serve, place a nest of noodles in a bowl and top with the curry and broth, and a sprinkling of cilantro. Serve with extra lime wedges and Sriracha, if desired, and both chopsticks and soup spoons for easy eating.


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(3 coats)
This was one of the nail community's glitter-floating-in-jelly faves many moons ago. I can see why! It's really pretty and it's one of the few older Zoya's that dries well.
This is three coats but I just put on the third to refresh the mani before I took a pic. It was good in two.
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SNPwatch gives you the latest news about research linking various traits and conditions to individual genetic variations. These studies are exciting because they offer a glimpse into how genetics may affect our bodies and health; but in most cases, more work is needed before this research can provide information of value to individuals. For that reason it is important to remember that like all information we provide, the studies we describe in SNPwatch are for research and educational purposes only. SNPwatch is not intended to be a substitute for professional medical advice; you should always seek the advice of your physician or other appropriate healthcare professional with any questions you may have regarding diagnosis, cure, treatment or prevention of any disease or other medical condition.
Three studies published Monday in Nature Genetics report new associations between SNPs and common diseases. Two of the studies find new SNP associations for colorectal cancer, while the third addresses Type 2 Diabetes.
All three studies relied upon very large sample sizes, which increased the chances that the researchers would find SNPs that individually have a very modest effect on the risk of disease, but in the right combinations may greatly increase the odds a person would be affected.
Colorectal Cancer
Colorectal cancer is the third most common cancer (excluding skin cancers) and the second leading cause of cancer-related deaths in the United States. The average lifetime risk of developing colorectal cancer is about 5% in Western European and North American populations.
In Tomlinson et al, researchers from several large consortiums used a multi-phase approach to narrow in on SNPs significantly associated with colorectal cancer. Using three phases that examined about 18,800 people with colorectal cancer and 18,400 controls (all of European ancestry) the scientists identified two new SNPs associated with colorectal cancer — rs10795668 and rs16892766.
When the researchers split the individuals with colorectal cancer into more specific groups, they found some evidence that the riskier version of rs10795668 increased the odds of developing rectal cancer more compared to the odds of developing colon cancer. The effect of rs16892766 was significantly stronger in cases of colorectal cancer that arose before the age of 60.
The second study, by Tenesa et al, also took a multi-phase approach for finding SNPs associated with colorectal cancer. In four phases of testing that examined about 17,500 people with colorectal cancer and 16,400 controls (all of European ancestry except for one group from Japan) they found one new SNP associated with colorectal cancer and replicated two other associations that had been found in previous studies.
In people with European ancestry, the C version of SNP rs3802842 increased the odds of colorectal cancer. In the Japanese population, however, the SNP was not significantly related to the odds of developing colorectal cancer.
But if the researchers took into account whether a patient had rectal or colon cancer (instead of combining the two types of cancer into one category), they found that the C version of rs3802842 did increase the risk for developing rectal cancer in the Japanese population.
The A version rs7014346 and the C version rs4939827 were also found to be associated with an increased risk for colorectal cancer. These two SNPs had been found in previous studies. The riskier versions of both of these SNPs increased the risk for colorectal cancer in both the Japanese and European populations.
Tenesa et al calculated that a person with two copies of the riskier version for each of the three SNPs (rs3802842, rs7014346, and rs4939827) — a situation only expected to happen in 0.5% of the population — would have 2.6 times the odds of developing colorectal cancer as someone with two copies of the less risky version at all three SNPS.
Summary of New Colorectal Cancer Data:
23andMe customers can check out their data at each of the SNPs newly associated with colorectal cancer in the Genome Explorer (now called Browse Raw Data).
In the chart below, each SNP's rsid number is followed by the version of the SNP that is less prevalent in the population. The two columns labeled "effect" show the change in odds for developing colorectal cancer when either one or two copies of the less prevalent version of the SNP are present compared with the odds of developing the disease when two copies of the other version of the SNP are present. The data in this chart only apply to people with European ancestry.
(Note that for rs10795668, the less prevalent version actually protects against colorectal cancer — that's why the change in odds is less than one. For rs4939827 the two versions are about equal in European populations.)
Type 2 Diabetes
Type 2 Diabetes occurs when chronically high blood sugar levels cause a breakdown of the body's natural response to sugar. It can result in kidney failure, blindness, and circulatory problems that increase the risk of heart attack or stroke. In the United States, almost 21 million children and adults have diabetes, but the rate of new diagnoses is increasing.
Several SNPs have already been associated with Type 2 Diabetes (check out the Gene Journal (now called Health and Traits) article), but the established associations only explain a small proportion of the genetic component of the disease. Studies done to date may have been too small to find SNPs with very modest effects. SNPs with small effects, however, may be key to capturing the contribution that genes make to Type 2 Diabetes and many other common diseases.
Zeggini et al pooled the data from three large studies that previously examined SNPs and Type 2 Diabetes (more than 10,000 people total). The researchers then followed up on their findings in another 57,000 people (about 14,000 with Type 2 Diabetes).
The research replicated several SNPs that were found to be associated with Type 2 Diabetes in previous, smaller studies. But this new study also found six new associations. Two of these are available to 23andMe customers through the Genome Explorer (Browse Raw Data): rs7578597 and rs10923931, which is not included in the 23andMe Personal Genome Service but is equivalent to rs2793831, which is.
In the chart, each SNP's rsid number is followed by the version of the SNP that is less prevalent in the population. The two columns labeled "effect" show the change in odds for developing Type 2 Diabetes when either one or two copies of the less prevalent version of the SNP are present compared with the odds of developing the disease when two copies of the other version of the SNP are present. So far these data apply only to people of European ancestry.


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Globe photos of the week June 28, 2013
Globe photos of the week June 28, 2013
Judy Sclarsky and Lyralen Kaye shared a moment in front of Cambridge City Hall, where they were married in 2004, as they celebrated the US Supreme Court's decision overturning the Defense of Marriage Act.
Ava Bowman, 5, and her father, Brooks, of Los Angeles, paid their respects at the Boston Marathon bombing memorial in Copley Square a few days before the items placed there were moved to the City Archives.
The Boston Symphony Orchestra's new conductor, Andris Nelson, appeared at Faneuil Hall where he received a proclamation of "Andris Nelson's Day" and conducted a group of brass players.
Family and friends of Melissa Hardy reacted in grief during the arraignment of her accused killer, Martin Jiminez, at South Boston District Court. Hardy's body was discovered by Boston police in a South Boston halfway house.
City archivist John McColgan bagged items for removal from the Boston Marathom bombing memorial in Copley Square.
Despite frequent showers, Christopher DeSimon, 5, fished with his uncle, Arthur Giannetti of Medford, not pictured, at Horn Pond in Woburn.
Sunlight was reflected through hazy morning clouds at sunrise at Nantasket Beach.
Republican senatorial candidate Gabriel Gomez voted at Cohasset Town Hall, with his family, from left, Antonia, Zander, wife Sarah, Max, and Olivia.
Second-grader Sara Lieb enjoyed a popsicle with hot classmates in their classroom at the Beethoven School in West Roxbury.
Former Red Sox pitcher Pedro Martinez showed his good humor as he wore some big glasses given to him by a fan as he gave out Good Humor ice cream near the Copley T station as part of the team's "Share the Love" campaign.
Colorado Rockies first-base coach Rene Lachemann gave a young fan a souvenir baseball between innings of a game hosted by the Red Sox at Fenway Park.
Boston Breakers forward Sydney Leroux (2) battled Seattle Reign midfielder Kaylyn Kyle (6) during a game at Dilboy Stadium in Somerville.
Dustin Pedroia leaped over Blue Jays runner Jose Bautista at second base as he fired to first base to complete a double play in the fourth inning against Toronto at Fenway Park.
Dustin Pedroia was congratulated by his teammates at the Red Sox dugout after hitting a two-run homer in the second inning against the Toronto Blue Jays.
From the Bruins bench, Shawn Thornton reacted as Chicago's Bryan Bickell slammed Zdeno Chara to the ice from behind during Game 5 of the Stanley Cup Finals at the United Center.
Bruins goalie Tuukka Rask and his teammates watched the Chicago Blackhawks celebrate their Stanley Cup victory at TD Garden immediately after Game 6 of the Stanley Cup Finals.


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Funding for Kuklin Pool restored, and three Police Officers added
Mayor Don Wesely today proposed adjustments to his recommended city budget for 2001-2002, which include the restoration of funding for Kuklin Pool and the addition of three new Police Officers. The changes will be presented to the City Council Monday, July 16, when a tentative vote is scheduled. The public hearing and final vote are scheduled the week of August 6.
When the Mayor released his proposed budget in June, the final revenue and expense projections were not available. Some budget additions were possible because personnel costs were slightly less than projected. The City Council's approval of Councilman Glenn Friendt's amendment to increase the city's share of the administrative fee for parking tickets will generate an additional $61,500.
Mayor Wesely said that in reviewing the Departments' budget proposals, he looked first for areas to reduce costs -- programs that were not cost effective and were under-utilized.
"In that context, it made sense to close Kuklin Pool, a facility with low use, in need of expensive repairs, in close proximity to Wood Pool and slated for future displacement by the Antelope Valley Project," Wesely said. "What we have seen since proposing the cut is an enormous amount of support for keeping the pool open. We also have received information that some cultural differences may also be factors in the low attendance. Parks and Recreation Director Lynn Johnson has met with members of the community who are willing to help create a program to get more neighborhood residents to use and be active in the pool program."
The Mayor emphasized that the $36,900 funding (cost of $48,800 minus revenue of $11,900) will keep the pool open for this year, but he said the success of the efforts to increase neighborhood usage of the pool is vital to its continued operation.
The addition of three new Police Officers was possible with $92,000 in additional city funding combined with $75,000 from the Federal COPS program. The federal program provides $25,000 for each new officer each year for three years. After three years the city is required to absorb all costs.
Another addition to the Mayor's proposed budget is about $17,000 to fund the city's portion of the Weed Control Program.
The city was recently informed that it will receive an additional $278,829 in state aid. Mayor Wesely emphasized that due to the declining sales tax receipts, the funding will be used to lower projected sales tax receipts. "It is only prudent for the city to be conservative in projecting our sales tax receipts if the economy continues to slow and sale tax receipts decline," Wesely said.
The Mayor stressed that this the 2001-2002 budget is an austere one and that the proposed increase in the occupation tax is essential to avoid severe service cuts, open several new major facilities, address the need for more traffic staff to accommodate the growth of the city and avoid any increase in the property tax rate.
Media Release


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February 2014
25 February 2014
We're well known for our crocs and koalas, but did you know we also have amazing turtles on display at Australia Zoo, as well as recovering in the Australia Zoo Wildlife Hospital?
Our hospital sees hundreds of aquatic patients each year, with around 186 turtles having been treated in the past 12 months. One of the most common conditions is "floating", a build-up of gas in the gastrointestinal tract of a turtle. Usually caused by a parasitic fluke infestation, a "floating" turtle is unable to submerge itself in water to swim. Our incredible vets rehabilitate numerous "floating" turtles through a two-week treatment process, followed by a bit of extra recovery time before releasing them back into the wild.
One hospital patient made a break-through this week when she finally submerged herself underwater after five months of recovery in the Wildlife Hospital. Gemma the green sea turtle weighs a whopping 90 kgs, and has impressed our vet team with her recent progress. She is joined by other much smaller "floating" turtles Angel and Taryn, both of whom are starting to submerge and are on the road to recovery.
While you wouldn't see our turtle patients on a hospital visit (they live behind-the-scenes so they can recover properly), Australia Zoo has plenty of healthy freshwater turtles on display to the public, including saw shells, Brisbane river turtles, and broadshell turtles. Make sure you say hi next time you're here - There are some great, cheeky personalities in the group, and they are sure to brighten smiles!
Some more friendly inhabitants of Australia Zoo are our four Aldabran tortoises. Coconut and Jarvis live on their own paradise island, so be sure to keep an eye out for them when walking to Africa! Meanwhile, Igloo and Goliath are our two brothers that can be seen within the zoo. In their late 30's, these guys are just in the early stages of their life, with Aldabran tortoises often living well over one hundred years of age. You can book in for our awesome tortoise encounter to meet Igloo and Goliath, join in their feeding time, and have your photo taken with them.
We look forward to welcoming you at Australia Zoo soon to enjoy all our aquatic and land animal action!
1 Zoo Comment
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Strangelove wrote:How does that contradict what I said about Schneids AND Luongo getting traded?
I know you THINK I have a problem saying I'm wrong so I'm gonna prove you wrong now.
I was wrrrrrr.... ahem... okay I was wrrrrrrrrrr....
A humble Doc doesn't sit well with me. It's like the blue sky all of a sudden becoming Green.


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Divorce diaries
Hilarious outing. Thursday night, I finish work and pick up my constantly-in-a-divorce-state friend to go out for dinner. He starts complaining about his wife, and describes this long fight with his mother-in-law that ended in a demand for divorce. I think this is like the 70th time or something. His usual dilemma; he'd like to divorce her yesterday before tomorrow, but he'd also like to keep the little girl. Which ofcourse he knows that it will most likely not happen.
Another friend of mine calls me while I'm listening to the latest divorce story. I told her, hey, I'm bringing my friend and coming over to meet you. Both are cool friends, so they were okay in meeting for the first time. Although she was abit worried about meeting a constantly-in-a-divorce-state guy who will probably be depressed, and turn it into a lousy outing, but I knew it would be fun. I only urged my friend to watch his mouth and avoid any foul language infront of the lady.
So we all meet at this Pizza place, which I find nothing good about and don't know why everyone thinks so highly of (both the food and the seating are bad)! I order a large pizza to finish it on my own, and my friend who had a quick dinner at home, orders a medium one. The femme just goes for tonic water. A beauty and two beasts basically. Then they roll. He tells his endless stories about his marriage, and how his wife cannot sleep at night without having a good fight. And she, analyzes him and his parents and his wife and her parents. As long as she's agreeing with him on how his wife is wrong, then he's enjoying it, and as long as she's tough on him, he wants to tell more stories to prove how much of an angel he is. So I had to intervene (considering that I'm always siding with his wife, and he's always hating me for it), and tell the story when he was flirting with a girl and telling her that she was sexy through an SMS, and when his wife saw it and was fuming he told her that the SMS was to me! I also had to tell about his meeting with his other girlfriend in Italy when he was engaged to his wife. So then he had to tell some of my stories to prove I was crazy, like when I jumped off his car because he wouldn't let me out, and when I was fighting with them in the house in Agamy and went running out of the house with two brooms in my hand, a pj pants and a torn t-shirt and came back an hour later, and how I get off my car to curse the guys who throw flyers in your car while you're driving. I think my poor lady friend didn't know all this was coming. The guy said everything, and just stopped short of telling his intimate stories with his wife (thanks God he stopped there).
We're laughing so much, but their eyes start tearing from all the onion chopping going on in the kitchen, so we continue over at the cafe next door. Now that was comfortable, so we get more divorce stories, and our lady friend starts to think that this outing can't be real, and she must be dreaming. She asks my friend jokinly, "so how long have we known each other for?". Then he says there's one more thing she doesn't know about him, "my underwear is size 6", and we all crack. Man, even I didn't know that!
Three hours of constant fun and laughter, and he was actually truly depressed about his marriage, but totally helpless (or so he believes). Two years of a failed marriage, nothing they do works because they're not really trying hard enough and they don't trust one another anymore. He's a stubborn child and a dumb control freak, and she's selfish and insecure who always puts herself ahead of the relationship, that she'll never do what will satisfy him.
We separate at midnight, Cinderella heads home, I drop my friend at the 'ahwa to continue his night, and I head to bed. As my friend is getting out to the 'ahwa he tells me that he had lots of fun, and asks me why her and I are not together!


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Latest News
- First Released
- March 20, 2012
- Platforms
- ps3, xbox-360
- Genre
- Action
- Rating
- Rated "T" for Mild Language, Suggestive Themes, Use of Alcohol and Tobacco, Violence
- Summary
- Warriors Orochi 3 combines the much loved heroes of the Dynasty Warriors and Samurai Warriors series in an all new story that for the first time also features characters from Ninja Gaiden, Warriors: Legends of Troy, Bladestorm, Trinity: Souls of Zill O'll and Dead or Alive! The game also introduces the bond system, where the bonds between characters can be increased by interaction in banquets, fighting together as allies, rescuing struggling allies, and accepting then clearing missions in battles. Players can also customize existing scenarios and then share them online for all to enjoy, as well as rate those created by others. Years after the battle against Orochi, the Serpent King, the heroes of the Three Kingdoms and the Warring States struggle to seize control of the new universe they were thrown into when a new threat arises. A terrible and colossal monster casts its shadow across the land and defeats most of the brave warriors. The ones that survived, assisted by the mysterious Kaguya, travel back through time to save fallen warriors and forge new alliances, collect powerful weapons and build an army so they can have a chance to defeat the terrible Hydra! But that is not all the help they'll get this time, as the vortex created by Orochi drags a few more allies to their universe. Dragon Ninja Ryu Hayabusa, Achilles, Jeanne d'Arc, Nemea and Ayane are only a few of the new additions to the 120+ playable character roster.


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A Long Line of Godly Men Book Collectionby Various Authors
From Spurgeon to Luther, certain lives throughout church history are remembered as special testaments of God's faithfulness. Through preaching, teaching, hymnody, and their courageous choices, they illustrate what God's grace can accomplish through a life submitted to His purposes. With …read more
The Masculine Mandate: God's Calling to Men
The Masculine Mandate: God's Calling to Menby Rev. Richard Phillips
What Does It Mean to Be a Christian Man?
In this book, Richard D. Phillips cuts through the cultural confusion, highlights God's mandate for men, and encourages readers to join him on a journey of repentance and renewal. Phillips begins …read more
Reformation Trust Children's Book Collection
Reformation Trust Children's Book Collectionby Various Authors
In these delightfully illustrated children's books, Dr. R.C. Sproul applies his talent for explaining the things of God to children, communicating essential elements of the gospel through allegorical stories that reflect biblical truth. Adults and children alike have found these …read more
The Passionate Preaching of Martyn Lloyd-Jones
The Passionate Preaching of Martyn Lloyd-Jonesby Dr. Steven Lawson
From the pulpit at Westminster Chapel in London, Dr. Martyn Lloyd-Jones set a new standard for faithful and passionate preaching, a standard that continues to be relevant today. Lloyd-Jones was a physician by training and had begun a promising career …read more
The Reformation Study Bible (NKJV)
The Reformation Study Bible (NKJV)by
The Bible is not like any other book because its ultimate Author is God. As the psalmist prayed in Psalm 119:18, "Open my eyes, that I may see wondrous things from Your law," the new Reformation Study Bible emphasizes the …read more
The Knight's Map
The Knight's Mapby Dr. R.C. Sproul
In this allegorical tale, theologian, pastor, and author Dr. R.C. Sproul continues his life's work of making deep biblical truths clear and understandable to students of all ages. The Knight's Map is the story of a knight who undertakes a …read more
Can I Lose My Salvation?
Can I Lose My Salvation?by Dr. R.C. Sproul
Whether you can lose your salvation is one of the most pressing issues you can face as a Christian. In an uncertain world, painfully aware of the continued reality of their sin, and confronted by the Bible's warnings about falling …read more
What Is the Great Commission?
What Is the Great Commission?by Dr. R.C. Sproul
After His resurrection, Jesus gave His disciples a mission: to go to all the nations and make disciples, baptizing and teaching them. That remains the continuing mission of the church today.
In this book, Dr. R.C. Sproul explores the Great …read more
The Expositor's Kit
The Expositor's Kitby Various
"The Expositor's Kit" provides seven trustworthy resources from Ligonier Ministries and Reformation Trust Publishing. These resources have been handpicked by Dr. Steven J. Lawson, the president and founder of OnePassion Ministries and a teaching fellow for Ligonier.
This kit includes …read more
The Reformation Study Bible (ESV)
The Reformation Study Bible (ESV)by
The Bible is not like any other book because its ultimate Author is God. As the psalmist prayed in Psalm 119:18, "Open my eyes, that I may behold wondrous things out of your law," the new Reformation Study Bible …read more
Economy Paperback (ESV)
Economy Paperback (ESV)by
- The Bible is not like any other book because its ultimate Author is God. As the psalmist prayed in Psalm 119:18, "Open my eyes, that I may behold wondrous things out of your law," the new Reformation Study …read more
- The Bible is not like any other book because its ultimate Author is God. As the psalmist prayed in Psalm 119:18, "Open my eyes, that I may behold wondrous things out of your law," the new Reformation Study …read more
The Daring Mission of William Tyndale
The Daring Mission of William Tyndaleby Dr. Steven Lawson
Early in the sixteenth century, legislative decree in England controlled people's access to Scripture and prohibited an English Bible. But theologian and linguist, William Tyndale, was determined to provide his fellow countrymen with Scripture they could read.
In The Daring …read more
The Trinitarian Devotion of John Owen
The Trinitarian Devotion of John Owenby Dr. Sinclair Ferguson
The writing and teaching of John Owen, a 17th century pastor and theologian, continues to serve the church. Daily communion with God characterized his life and equipped him for both ministry and persecution.
In The Trinitarian Devotion of John Owen, …read more
What Is Repentance?
What Is Repentance?by Dr. R.C. Sproul
"Repent and believe in the gospel." From the beginning of His ministry, Jesus called people to repentance. Peter and Paul urged people to repent as well. The concept of repentance is central to the Christian life. But what does it …read more
What Is the Relationship between Church and State?
What Is the Relationship between Church and State?by Dr. R.C. Sproul
From the very beginning of Christianity, the relationship between the church and the state has been a matter of great concern. The issue remains confusing and contentious for many Christians today, as issues of political activism, religious freedom, and civil …read more
Are These the Last Days?
Are These the Last Days?by Dr. R.C. Sproul
Toward the end of his earthly ministry, Jesus predicted the destruction of the Jewish temple in Jerusalem. His shocked disciples asked when it would happen. Jesus' response, a lengthy monologue about coming chaos and tribulation, forms the Olivet Discourse, an …read more
Everyone's a Theologian
Everyone's a Theologianby Dr. R.C. Sproul
Many people react negatively to the word theology, believing that it involves dry, fruitless arguments about minute points of doctrine. Yet as Dr. R.C. Sproul argues, everyone is a theologian. Any time we think about a teaching of the Bible …read more
The Evangelistic Zeal of George Whitefield
The Evangelistic Zeal of George Whitefieldby Dr. Steven Lawson
England in the seventeenth and early eighteenth centuries was in the midst of spiritual decline, marked by lifeless sermons, strife, persecution, and malaise. Into this dark time, George Whitefield burst forth as one of the greatest preachers the church had …read more
Peace: Classic Readings for Christmas
Peace: Classic Readings for Christmasby Dr. Stephen Nichols
The celebration of Christmas in the twenty-first century is wrapped in nostalgia and infused with hopes and dreams. The sweetest of these dreams is peace—peace between nations, peace between family members, and peace with ourselves.
But Christmas is often …read more
The Poetic Wonder of Isaac Watts
The Poetic Wonder of Isaac Wattsby Douglas Bond
In an age of simplistic and repetitive choruses, many churches are rediscovering the blessing of theologically rich and biblically informed songs. In The Poetic Wonder of Isaac Watts, Douglas Bond introduces us to "the father of English hymnody." Douglas Bond …read more
What Is the Lord's Supper?
What Is the Lord's Supper?by Dr. R.C. Sproul
The evangelical church is deeply confused over the sacrament of the Lord's Supper, with many believers being unclear as to what happens at the Lord's Table. In some churches, it is practiced infrequently or irreverently.
In this booklet, Dr. R. …read more
What Is the Church?
What Is the Church?by Dr. R.C. Sproul
When the word church is mentioned, many people tend to think of a formal building with a steeple and stained-glass windows. For others, the word brings to mind the idea of a denomination. But the church is much more.
In …read more
How Can I Develop a Christian Conscience?
How Can I Develop a Christian Conscience?by Dr. R.C. Sproul
In Walt Disney's classic animated movie Pinocchio, Jiminy Cricket sings, "Always let your conscience be your guide." The Bible confirms that the human conscience is real and important, but it also shows that the conscience is not always a reliable …read more
The Heroic Boldness of Martin Luther
The Heroic Boldness of Martin Lutherby Dr. Steven Lawson
During the Protestant Reformation of the sixteenth century, the Reformers' most effective tool was the pulpit, and all of the Reformers were gifted preachers. This was especially true of Martin Luther, the man regarded as the father of the Reformation.…read more
Blood Work: How the Blood of Christ Accomplishes Our Salvation
Blood Work: How the Blood of Christ Accomplishes Our Salvationby Rev. Anthony Carter
Evangelical Christians often sing and preach about the blessed blood of Christ and the wonderful things it accomplishes for believers. To the uninformed ear, such language can convey the idea that Jesus' blood had semi-magical qualities. Actually, Jesus' blood was …read more
Can I Have Joy in My Life?
Can I Have Joy in My Life?by Dr. R.C. Sproul
Joy is a popular topic in Western culture today. Books explain how to find joy in a wide variety of activities. We speak of "joyous" occasions such as weddings and births. We sing about "Joy to the World" at Christmas. …read more
Does God Control Everything?
Does God Control Everything?by Dr. R.C. Sproul
Most people today believe that we live in a closed, mechanistic universe, that is, a universe that functions from day to day according to certain physical forces and causes. Classical Christianity has taken a very different view, teaching that God …read more
Who Is the Holy Spirit?
Who Is the Holy Spirit?by Dr. R.C. Sproul
The topic of the Holy Spirit sparks much interest these days, but also much confusion. Thanks to extra-biblical assertions about the Spirit's person and work, ideas abound as to who the Spirit truly is, how He operates in time and …read more
Are We Together? A Protestant Analyzes Roman Catholicism
Are We Together? A Protestant Analyzes Roman Catholicismby Dr. R.C. Sproul
In recent years, some evangelical Protestant leaders have signed statements pledging themselves to joint social action with Roman Catholics. Others have refused to participate, declaring that, in their view, the statements went too far, touching on the gospel, which remains …read more
God in Our Midst: The Tabernacle and Our Relationship with God
God in Our Midst: The Tabernacle and Our Relationship with Godby Rev. Daniel Hyde
Christians often wonder whether it is worth their time to read and study the seemingly odd narratives about God's instructions for the tabernacle in the second half of the book of Exodus. The answer, according to Daniel R. Hyde, is …read more
The Donkey Who Carried a King
The Donkey Who Carried a Kingby Dr. R.C. Sproul
The biblical teaching that Jesus was the Suffering Servant who carried the sins of His people when He went to the cross is vividly brought home to children in The Donkey Who Carried a King, the latest children's book from …read more
The Gospel Focus of Charles Spurgeon
The Gospel Focus of Charles Spurgeonby Dr. Steven Lawson
Charles Spurgeon, the great Baptist preacher of nineteenth-century London, is remembered today as "the prince of preachers." However, the strength of Spurgeon's ministry went far beyond simple rhetorical skill. In The Gospel Focus of Charles Spurgeon, Steven J. Lawson shows …read more
Markby Dr. R.C. Sproul
Mark presents the fruits of Dr. R.C. Sproul's lifetime of biblical study as expressed in his most recent calling. After a long and distinguished ministry as a teacher in various settings, Dr. Sproul accepted a call in 1997 to preach …read more
Parenting by God's Promises: How to Raise Children in the Covenant of Grace
Parenting by God's Promises: How to Raise Children in the Covenant of Graceby Dr. Joel Beeke
Parents are unable to give their children what they need most—new hearts that trust in Christ for forgiveness of sins. All belief is a work of God alone. But parents must not "hinder" their children from coming to Christ, as …read more
What Is Baptism?
What Is Baptism?by Dr. R.C. Sproul
Baptism is taught in the Bible and has been practiced for centuries, but understanding of its meaning and respect for its importance is at a low ebb today. Confusion reigns over questions about its mode and its place in the …read more
What Can I Do with My Guilt?
What Can I Do with My Guilt?by Dr. R.C. Sproul
Dr. R.C. Sproul has often asked unbelievers who deny their need for a Savior, "What do you do with your guilt?" The question often breaks through sinful complacency, because feelings of guilt over sin are common. Unbelievers may ignore their …read more
What Is the Trinity?
What Is the Trinity?by Dr. R.C. Sproul
The Trinity is truly a mystery. This doctrine teaches that the God of Christianity is one in His essence but three in His persons—the Father, the Son, and the Holy Spirit. Though the word Trinity is not found in the …read more
The Mighty Weakness of John Knox
The Mighty Weakness of John Knoxby Douglas Bond
John Knox, the great Reformer of Scotland, is often remembered as something akin to a biblical prophet born out of time—strong and brash, thundering in righteous might. In truth, he was "low in stature, and of a weakly constitution," a …read more
How the Gospel Brings Us All the Way Home
How the Gospel Brings Us All the Way Homeby Dr. Derek Thomas
In How the Gospel Brings Us All the Way Home, Dr. Derek W. H. Thomas explores Romans 8, which he calls "the best chapter in the Bible." Here he finds an exposition of the steps through which God leads His …read more
The Priest with Dirty Clothes
The Priest with Dirty Clothesby Dr. R.C. Sproul
In this classic story Dr. R.C. Sproul continues his project of illustrating theological concepts for children. The Priest with Dirty Clothes teaches the concept of imputation, which lies at the heart of the important biblical doctrine of justification.
Using the …read more
Abortionby Dr. R.C. Sproul
In this book, Dr. R.C. Sproul employs his unique perspective as a highly experienced pastor-theologian and a trained philosopher to provide well-considered and compassionate answers to the difficult questions that attend termination of pregnancy. Dr. Sproul strives for a factual, …read more
What Is Faith?
What Is Faith?by Dr. R.C. Sproul
The word faith is heard often these days, but it is given many different meanings. Sometimes it is used in the sense of trust. Other times, it has more to do with hope. Perhaps most often, it is used to …read more
What Does It Mean to Be Born Again?
What Does It Mean to Be Born Again?by Dr. R.C. Sproul
When Jesus explained the necessity of the new birth, the Jewish leader Nicodemus asked in astonishment, "How can these things be?" Some two thousand years later, much confusion still surrounds the term "born again," though more people than ever claim …read more
Can I Be Sure I'm Saved?
Can I Be Sure I'm Saved?by Dr. R.C. Sproul
Many people in the church today are plagued by doubts about their salvation. Satan whispers that it is impossible that sinners such as they could be in a state of grace, and some churches compound the problem by teaching that …read more
Holy, Holy, Holy: Proclaiming the Perfections of God
Holy, Holy, Holy: Proclaiming the Perfections of Godby Rev. Thabiti Anyabwile
The angels in Isaiah's vision of God's heavenly temple (Isa. 6) used threefold repetition to praise His holiness, the superlative form of emphasis in the Hebrew language. Their cry tells us that nothing is as significant as the holiness of …read more
Welcome to a Reformed Church
Welcome to a Reformed Churchby Rev. Daniel Hyde
"Who are these guys?" That was the question the teenage Daniel R. Hyde posed to his father when he first encountered "Reformed" believers. With their unique beliefs and practices, these Christians didn't fit any of the categories in his mind. …read more
By Grace Alone: How the Grace of God Amazes Me
By Grace Alone: How the Grace of God Amazes Meby Dr. Sinclair Ferguson
Are you truly amazed by God's grace? Or have you grown accustomed to it? Yes, we sing of God's "Amazing Grace," but do you truly understand what you as a Christian have experienced in receiving the grace of God? Or …read more
Surprised by Suffering
Surprised by Sufferingby Dr. R.C. Sproul
Suffering often seems to catch us by surprise. One day we are healthy, comfortable, and happy. The next we find ourselves ill or injured, struggling, and distraught. The pain that invades our lives may come from our own suffering or …read more
Johnby Dr. R.C. Sproul
In John, the second volume in the St. Andrew's Expositional Commentary series, Dr. Sproul deals with major themes in his easily understandable style. Readers will find invaluable insights into the goals John had in writing his Gospel, the background for …read more
Sola Scriptura: The Protestant Position on the Bible
Sola Scriptura: The Protestant Position on the Bibleby Dr. Joel Beeke
Sola Scriptura, the formal principle of the Protestant Reformation, is essential to genuine Christianity, for it declares that the Bible is the inspired word of God, the church's only rule of faith and practice. Yet this doctrine is under assault …read more
How Should I Live in This World?
How Should I Live in This World?by Dr. R.C. Sproul
Christians want to "do the right thing." But it can be tough to know what the right thing is. Plus, it's not just the big questions with which we must wrestle—ethical dilemmas confront us each day in every aspect of …read more
Does Prayer Change Things?
Does Prayer Change Things?by Dr. R.C. Sproul
Does prayer make any difference? Does it really change anything? Yes, says Dr. R.C. Sproul in this Crucial Questions booklet. Though we cannot hope that our prayers will change God's mind, prevailing upon Him to act against His will, we …read more
Can I Know God's Will?
Can I Know God's Will?by Dr. R.C. Sproul
As human beings, we long to know that our lives will unfold in ways that we will find pleasant and rewarding. As Christians, we have a different focus—we want our lives to be pleasing to God. Thus, we ponder His …read more
The Christian Lover
The Christian Loverby Dr. Michael Haykin
Marriage is under siege in our time, and Christian unions are not going unscathed. Dr. Michael A. G. Haykin believes that love letters written by Christian husbands and wives of the past can help strengthen the ties that bind believing …read more
Sammy and His Shepherd
Sammy and His Shepherdby Susan Hunt
In Sammy and His Shepherd, veteran children's writer Susan Hunt takes youngsters on a delightful trip through Psalm 23 from the point of view of a sheep named Sammy.
Sammy lives happily under the care of his faithful shepherd. But …read more
The Unwavering Resolve of Jonathan Edwards
The Unwavering Resolve of Jonathan Edwardsby Dr. Steven Lawson
Jonathan Edwards is well known as perhaps the greatest theologian the United States has ever produced. He is equally noted for his preaching and writing. But in The Unwavering Resolve of Jonathan Edwards, Dr. Steven J. Lawson considers the unique …read more
Feed My Sheep: A Passionate Plea for Preaching
Feed My Sheep: A Passionate Plea for Preachingby Various Authors
The apostle Paul declared that "what we preach" was "folly" in the eyes of many in his time (1 Cor. 1:21). Such is always the world's response to the gospel. But in our day, it seems that the method behind …read more
John Calvin: A Heart for Devotion, Doctrine, & Doxology
John Calvin: A Heart for Devotion, Doctrine, & Doxologyby Dr. Burk Parsons
In celebration of the five hundredth anniversary of John Calvin's birth (2009), Burk Parsons, editor of Tabletalk magazine and associate minister at St. Andrew's in Sanford, Fla., has brought together an impressive group of pastors and scholars to reconsider Calvin's …read more
The Prince's Poison Cup
The Prince's Poison Cupby Dr. R.C. Sproul
With The Prince's Poison Cup, Dr. R.C. Sproul continues his series of books designed to present deep biblical truths to children on their own level. In this work, he focuses in on the atonement to show that Jesus had to …read more
Living for God's Glory: An Introduction to Calvinism
Living for God's Glory: An Introduction to Calvinismby Dr. Joel Beeke
The theological system known as Calvinism is often caricatured as harsh, dour, and illogical. But as Dr. Joel R. Beeke argues in this important new book, this image could not be further from the truth. Beeke, a pastor, educator, editor, …read more
Five Things Every Christian Needs to Grow
Five Things Every Christian Needs to Growby Dr. R.C. Sproul
People need to maintain a diet of nutritious foods if their bodies are to grow and thrive. But what do the people of God need in order to grow and thrive in the Christian faith? In this book, noted theologian …read more
In Christ Alone: Living the Gospel-Centered Life
In Christ Alone: Living the Gospel-Centered Lifeby Dr. Sinclair Ferguson
Noted theologian, pastor, and educator Dr. Sinclair B. Ferguson explores aspects of the person and work of Jesus in his latest book, In Christ Alone: Living the Gospel-Centered Life. This collection of articles, published earlier in Tabletalk magazine and Eternity …read more
Jesus the Evangelist
Jesus the Evangelistby Rev. Richard Phillips
Rev. Richard D. Phillips digs into the early chapters of the Gospel of John to discover principles you can use for Christian outreach that were modeled by witnesses for Jesus and by Jesus Himself. Phillips unfolds biblical principles for evangelism …read more
The Truth of the Cross
The Truth of the Crossby Dr. R.C. Sproul
In this book, Dr. R.C. Sproul surveys the great work accomplished by Jesus Christ through His crucifixion — the redemption of God's people. Dr. Sproul considers the atonement from numerous angles and shows conclusively that the cross was absolutely necessary …read more
The Expository Genius of John Calvin
The Expository Genius of John Calvinby Dr. Steven Lawson
"The aim of this book is to raise the bar for a new generation of expositors." —Dr. Steven J. Lawson
Looking to the past for outstanding Bible-based, Christ-centered, and life-changing preaching, Dr. Steven J. Lawson focuses on sixteenth-century Geneva, Switzerland. …read more
The Lightlings
The Lightlingsby Dr. R.C. Sproul
In The Lightlings, Dr. R.C. Sproul weaves an allegorical tale that captures the essence of the biblical story of redemption in a manner that will fascinate and delight children. A race of tiny beings known as lightlings are a picture …read more
Foundations of Grace, 2006 Edition
Foundations of Grace, 2006 Editionby Dr. Steven Lawson
Understanding the doctrines of grace will give you a clearer picture of God's sovereignty. From the lawgiver Moses to the apostle John, and from the early church fathers to modern defenders of the faith, there has marched onto the stage …read more


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The Republican elite are skilled at snatching defeat from the jaws of victory.
Their arrogance in dealing with social conservatives, libertarians, and the Tea Party underscores the continued rejection of the "big tent philosophy" they allegedly promote. If you don't adopt D.C.'s version of big-government conservatism and war-machine foreign policy, you can expect open opposition.
The worst perpetrator of this jihad on unconventional Republicans is Karl Rove (and his minions at the Crossroads committee).
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And now, Rove and the rest of the D.C. consultants controlling the GOP are going to lose their best chance to win the U.S. Senate majority in a decade. How? Well, it starts with Alaska, where the GOP's misguided Puritanism has created astounding resentment.
In Alaska, the GOP elite are concerned with two things: helping the companies that they run to get federal contracts and keeping control of a Tammany Hall-type patronage system in state jobs.
TRENDING: Schumer Furious That Republicans Are Granting Green New Deal a Senate Vote
On top of that, the consultants in D.C. smack their chops at a race in Alaska because their favorite campaign tactic – saturating the market with TV ads – costs chump change in Alaska compared to many other media markets.
But this thinking has inspired a series of stiff-armed moves that have laid waste to the Alaskan GOP. Six years ago, for example, Mark Begich – a generally unaccomplished unknown – was able to snatch the U.S. Senate seat away from long-term Republican Ted Stevens.
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This election cycle, Begich is vulnerable… but the GOP elite would rather play blood sports to stop Tea Party leader Joe Miller than simply beat Begich.
In the end, either Joe Miller will win or Alaska will re-elect Begich.
A Vicious GOP Backstabbing
How can I be so sure?
I've watched Alaskan politics closely since I agreed to speak at their Lincoln Day Dinners in Juneau and Fairbanks over a decade ago. And to understand why either Miller or Begich will win, you need to know what happened in 2010, in Miller's last race, as it left a residual distaste for Republican elite tactics.
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You see, Miller is typical of the candidates whom D.C. consultants dislike: He's too smart, too pro-life, too anti-government, and too anti-establishment. He's also a decorated war veteran and a former Judge who cut his political teeth challenging the Alaskan GOP establishment owned by the Murkowski family. Alaska's senior Senator, for example, is Lisa Murkowski, whom Miller challenged – and beat – in the 2010 Republican primary.
When Murkowski lost the GOP primary, the D.C. establishment circled the wagons, helping Murkowski run an independent race as a write-in. The Republican leader, Mitch McConnell, didn't remove her from leadership even when she decided to launch her bid against the legitimate Republican nominee.
Meanwhile, the National Republican Senatorial Committee (NRSC) manipulated the very grassroots, fresh-faced Miller campaign and used his name to raise money… then subsequently spent the money helping Murkowski win her race.
Time to Widen the Circle
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But the plan has backfired this election cycle. Emotions run deep because of the viciousness of the Murkowski campaign against Miller. And this time, he's the only GOP candidate who can win the general election. Polling shows that if anyone else wins the primary, scores of general election voters (in the double-digit percentages) intend to write in Miller as a protest against the aggressive backstabbing in 2010.
Miller's opponent in the primary is a Karl Rove favorite, Dan Sullivan… a Bush administration appointee and member of the Council on Foreign Relations and the World Economic Forum's "World Agenda Council." Sullivan is committed to aggressive War Party policies in Syria and elsewhere. Yet Miller, a veteran tank commander who has seen bloody conflict, is much more wary of American intervention abroad.
Frankly, Miller cares more about America than he does the Republican Party, and many of his supporters are encouraging him to just skip the GOP primary and run an unconventional campaign as an independent. Even if he went this route, it would still be disastrous for the GOP's hopes of recapturing the U.S. Senate.
With recent polling showing Miller's candidacy beginning to surge in a matchup against Begich, the GOP's best hope for picking up the seat is to embrace Miller as the Party nominee. The question is, will the Republican elite do their best to snatch defeat from victory again, or will they lengthen the tent cords enough to stand with a true conservative from Alaska?
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This commentary appeared at CapitolHillDaily.com and is reported here with permission.
The views expressed in this opinion article are those of their author and are not necessarily either shared or endorsed by the owners of this website.
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text:
"The iPad takeover of public education isn't just confined to the mainstream classroom: Special needs educators, too, are finding that iPads can be a vital tool to support independence. What sets the iPad apart from other devices is the simple and visually robust user interface that can be used by almost everyone. It's also a highly customizable device that can be set up with applications and assistive features to support a variety of special needs."
Via John Evans