text:
No. 18 Baseball Travels To Washington State For Crucial Three-Game Pac-10 Series
April 21, 2004
ASU Baseball Links:
Career Summary:
College Baseball Links:
Apr. 23 at Washington State, 3 p.m. PSTASU - Jason Urquidez, RHP (8-2, 2.97 ERA)WSU - Aaron McKenzie, RHP (5-3, 4.14 ERA)
Apr. 24 at Washington State, 1 p.m. PSTASU - Jeff Mousser, RHP (2-3, 3.86 ERA)WSU - Aaron Trolia, RHP (4-3, 5.21 ERA)
Apr. 25 at Washington State, 12 p.m. PSTASU - TBAWSU - Garrett Alwert, LHP (3-1, 4.50 ERA)
The All-Time Series:All-Time Record vs. WSU:.....26-5Last Year:...................ASU sweeps series (21-0, 5-3, 25-0)
The National Rankings:
National Polls (April 19, 2004)
Arizona State (26-12) is ranked No. 18 in the recent ESPN/Sports Weekly coaches poll. It marks the 90th straight week the Sun Devils have been ranked dating back to the start of the 2000 season. ASU dropped out of each the Baseball America and Collegiate Baseball polls for the first time since the end of the 2002 season. WSU (22-13) is not ranked.
Media Exposure:
All three games of the WSU series will be broadcast on the radio or internet with Tim Healey and Bob Eger calling all the action from Bailey-Brayton Field. Friday's game will be carried on the internet only, while the Saturday and Sunday games will be on 1440 AM. All games are also available on www.TheSunDevils.com. Every game during the 2004 season will also have the statistical GameTracker on www.TheSunDevils.com.
Did You Know?
ASU ranks second in the Pac-10 and 28th in the NCAA with a .319 batting average... Dustin Pedroia is coming off another solid week, going 9-for-16 (.563) in the last four games... Pedroia leads the Pac-10 and is 28th in the NCAA batting .419... the Devils are 5-1 all-time in Pullman against the Cougars... with three more new starting lineups last weekend, ASU now has used 33 different batting lineups this season... of ASU's 38 games, 23 have come against opponents that have been ranked at one time this season... ASU is 11-3 against ranked teams.
What's On Tap:
The Sun Devil Baseball team (26-12, 5-7 Pac-10) continues an eight-game road swing this weekend with a three-game Pac-10 series against the Washington State Cougars in Pullman, Wash. ASU is coming off a series victory on the road at UCLA and is currently in eighth place in the Pac-10 with a 5-7 record. The Devils are part of a tightly-bunched league race, only 1.5 games back of three teams tied for second place. ASU will play three of their last four conference series on the road, returning home to face Oregon State (May 14-16) and then take back to the road to face Arizona and Stanford. Following the trip to the Palouse, the Devils will travel to Wichita, Kan., for a two-game, non-conference set at Wichita State (Apr. 27-28). ASU plays 13 of their final 18 games on the road, including a regular season-ending eight-game road trip.
Recapping Last Week:
The Sun Devils won three of four games last week and ended a four-game series skid by defeating UCLA in two of three Pac-10 contests. The Devils started the successful week wtih a 9-5 win over Arizona, then took the first two games against the Bruins. ASU's bid for a fourth straight win and the series sweep ended with a 11-10 UCLA victory on Sunday. The Devils averaged 8.75 runs per game last week while hitting at a .328 clip. Junior shortstop Dustin Pedroia led Devils hitting .563 (9-for-16) with five walks and four runs scored. In two appearances on the mound, sophomore lefty Erik Averill had a 1.23 ERA giving up one run and four hits in 7.1 IP.
Quick Hits:
- Of ASU's 38 games this season, 23 have been played against teams that have been ranked or are currently ranked.- Junior shortstop Dustin Pedroia has hits in 32 of ASU's 38 games and leads the Pac-10 hitting .419 with 18 2B.- The Devils have used 33 different starting batting lineups and 25 different positional lineups this season.- Travis Buck is second in the Pac-10 with 45 RBI and is hitting .343 (47-for-137) with seven HR and seven SB.- Pedroia is sixth in the ASU record books with 267 career hits and a .388 career batting average (267-for-688).- Jason Urquidez is tied for the Pac-10 lead and is sixth in the NCAA with eight wins. He is 8-2 with a 2.97 ERA.- The Devils have been ranked in 90 consecutive national polls dating back to the start of the 2000 season.- The Sun Devils feature three players on the roster from the state of Washington (Buck, Curtis, Webb).- Senior 2B Nick Walsh is hitting .476 (20-for-42) in his last 10 games. He is hitting .410 in Pac-10 games.- ASU is going through a bit of a home run draught, hitting only one in the last eight games and 0 in last five.
Pedroia For National Player of the Year:
Junior shortstop Dustin Pedroia is a leading candidate for Pac-10 and National Player of the Year honors. Through 38 games, Pedroia leads Pac-10 in hitting at .419 (65-for-155) with 48 runs scored, 18 doubles, five home runs and 33 RBI. He has hits in 32 of ASU's 38 games, including 18 multi-hit affairs and four games with two or more doubles. Pedroia also leads the Pac-10 in runs scored (48), hits (65), doubles (18), total bases (98), on-base percentage (.521) and is third with a .632 slugging percentage. As a sophomore, Pedroia hit .404 (120-for-297) and was named the Pac-10 Co-Player of the Year. He led the NCAA with 34 doubles, setting the ASU and Pac-10 single-season record and tied for third all-time in the NCAA record books. With 18 doubles this season, Pedroia now has 65 in his career, ranking fourth in the ASU career record books. He also has recorded 267 hits to rank 6th and his career .388 batting average (267-for-688) ranks sixth in the ASU record books. He has played and started all 164 games of his Sun Devil career and has recorded at least one hit in 139 games (85%). He has also recorded 86 career multi-hit games and is a .392 career hitter in 60 Pac-10 games (104-for-265). Additionally, the 2003 Collegiate Baseball Defensive Player of the Year has made only 19 errors in 725 total chances in the field for a career .974 FLD%. He was a two-year starter for the USA Baseball National Team and was named to the all-tournament team in the 2003 Pan American Games in Santo Domingo, Dominican Republic. Here is a look at Pedroia's season/career highlights and statistics:
- Among the league leaders in hitting (.419, 1st), hits (65, T-1st), runs (48, 1st), doubles (18, 1st) and total bases (98, 1st).- Hit .563 (9-for-16) with four runs, five walks and one double in four games last week against Arizona and UCLA.- Has a pair of 10-game hitting streaks this season and seven career streaks of 10 or more games.- Broke a rare 0-for-10 streak by going 4-for-4 with a home run and a career-high five RBI against No. 11 Tulane (3/13).- Second on the team with five home runs and has 10 in his career. Entered the season with only five career homers.- Has recorded 18 multi-hit games this season and 86 in his career. Has four three-hit games and four, four-hit contests in 2004.- Rated as the No. 28 overall position player by Baseball America for the 2004 MLB Draft.- A career .388 (267-for-688) hitter to rank sixth in hits (267) and sixth in batting average in the ASU career record books.- Has recorded at least one hit in 139 of 164 career games (85%) and has started every game of his career.- Has hit 65 career doubles, ranking fourth in the ASU career record books. Needs five more doubles to reach third place.- Set the ASU and Pac-10 single-season record with 34 doubles in 2003. Old ASU record was 30 by Chris Bando in 1978.- Named the 2003 Pac-10 Co-Player of the Year with Stanford's Ryan Garko and was a first-team All-American.- Played for the USA Baseball National Team in 2002 and 2003, leading Team USA to a bronze medal in the Pan Am Games.
Year Avg GP-GS AB R H 2B 3B HR RBI BB SO SB-ATT2002.... .347 58-58 236 51 82 13 2 1 45 24 19 5-92003.... .404 68-68 297 83 120 34 3 4 52 36 13 3-72004.... .419 38-38 155 48 65 18 0 5 33 31 9 5-10TOTAL... .388 164-164 688 182 267 65 5 10 130 91 41 13-26
Pedroia Times Two:
Junior shortstop Dustin Pedroia is a doubles machine. Through ASU's first 38 games, Pedroia has 18 doubles to lead the Pac-10. He has picked up right where he left off in 2003, setting an ASU and Pac-10 record while leading the NCAA with 34 doubles. In 161 career games, the Woodland, Calif., native has 65 doubles to rank fourth in the ASU record books. He ranks 13th in the NCAA with 0.47 doubles per game this season.
Pedroia Ranks Sixth With 267 Career Hits:
With 267 career hits, junior shortstop Dustin Pedroia is approaching the career top five in ASU history. He recently passed Barry Bonds (1983-85), who had 247 during his three years in Tempe. After recording nine hits in the last four games, Pedroia moved into sixth place, passing ASU legends Bob Horner and Antone Williamson. The all-time school record is 322 set by Clay Westlake from 1973-76.
Devils Ranked For 90th Straight Week:
After going 3-1 last week against Arizona and UCLA, Arizona State (26-12) moved up in the ESPN/Sports Weekly Coaches poll. ASU dropped completely out of the Baseball America and Collegiate Baseball polls in recent weeks, marking the first time since 2002 that ASU has not appeared in both. The Devils moved up three spots from No. 21 to No. 18 in the coaches poll, extending a streak of 90 consecutive weeks in the national rankings dating back to the start of the 2000 season. ASU entered the 2004 season ranked in all four of the national preseason polls (#7 CB, #10 SW, #11 NCBWA, #18 BA). ASU finished the 2003 season with a 54-14 record and earned a consensus top 10 ranking in all four national polls.
Buck Providing Power and Production:
Sophomore right fielder Travis Buck leads ASU in two of the three Triple Crown categories with seven home runs and 45 RBI. He is also second in the Pac-10 in RBI and leads the conference with 37 walks. He is also amongst the league leaders in runs scored (39, 9th), doubles (12, 9th), total bases (80, 10th), slugging percentage (.584, 10th), on-base percentage (.497, 25th) and home runs (7, t-8th). Buck is hitting .343 (47-for-137) with 12 multi-hit games and leads the Devils with 11 multi-RBI contests. He also leads the team with five outfield assists and is 7-for-9 stealing bases. He was named Pac-10 Player of the Week and the Collegiate Baseball/Louisville Slugger National Player of the Week after going 10-for-12 (.833) with 13 RBI in the three-game series against UConn (2/27-29). The sophomore outfielder is a career .332 (125-for-376) hitter with 11 home runs, 98 runs scored and 91 RBI.
Buck Repeats As Pac-10 Player of the Week:
After going 5-for-10 with home runs in all three games against East Carolina, Travis Buck earned his second consecutive Pac-10 Player of the Week award. With his third career Pac-10 POW award, he became the 16th conference player to repeat and first since 1998 when Cal's Xavier Nady earned the award in consecutive weeks in 1998 (Apr. 27, May 4). He is the first Sun Devil since Oddibe McDowell in 1984 to earn back-to-back conference honors.
Five Times The Fun:
Travis Buck had a string of hitting a home run in five straight games dating back to the series-sweeping victory over Connecticut (2/29). He is the first Sun Devil to hit homers in five straight since single-season home run record holder Mitch Jones cleared the fences in five straight games during 2000 season against Florida State (2/6), Duke (2/11-13) and LSU (2/18).
A Triple Play For The Ages:
Leading 10-1 in the seventh inning in the series opener at UCLA (4/16), the Sun Devils completed a baseball oddity when they turned the first triple play in recorded school history. With no outs and runners on second and third, Bruin catcher Chris Denove hit what appeared to be a three-run home run over the right field fence. But, ASU sophomore outfielder Travis Buck leaped over the fence and pulled the ball back into play to record the out. He then relayed the ball to the infield where Dustin Pedroia and Seth Dhaenens recorded outs to complete the triple play. Instead of three runs, it was three outs.
Solid Defense Leads Devils To Series Victory Over UCLA:
The Sun Devils did not make an error in the three-game series at UCLA while winning the series, two-games to one. The trio of errorless games runs the 2004 total to 13 errorless games and marks the first time since the beginning of the 2003 season that the Devils have gone three straight games without an error. ASU's .970 fielding percentage ranks fourth in the Pac-10 and 28th in the nation. ASU also had no errors in the field and no walks on the mound in Saturday's 4-3 win.
Averill and Zinicola Go 15 Up, 15 Down:
In one of the most important games this season for the Sun Devils, the bullpen came to the rescue to give ASU a 4-3 victory over UCLA on April 17. Down 3-0 in the game with ace pitcher Jason Urquidez out of the game, the offense rallied to tie the game at 3-3, but more importantly, sophomore Erik Averill and freshman Zechry Zinicola kept the Bruins off the basepaths. Averill retired all 11 batters he faced in 3.2 perfect innings and Zinicola completed the come-from-behind win with 1.1 perfect innings (2 K's). In addition, Zinicola hit the game-winning sacrifice fly in the top of the ninth to put ASU up 4-3.
Urquidez Returns To Dominating On The Mound:
Junior right-handed pitcher Jason Urquidez is tied for the Pac-10 lead with eight wins, ranking sixth in the NCAA. The junior college transfer from Central Arizona College is 8-2 with a team-leading 2.97 ERA in 11 starts this season. In addition to leading the league in wins, he is also fourth in ERA (2.97), ninth in strikeouts (54) and fifth in opponents batting average (.244). Here is a look at Urquidez's game-by-game breakdown:
Date Opponent GS IP H R ER BB SO 2B 3B HR WP BK HBP DP IBB Score W-L SV ERAFeb 08, 2004 Florida State * 5.0 6 1 1 3 9 0 0 0 0 0 0 0 0 12-6 1-0 0 1.80Feb 14, 2004 vs Utah * 6.0 3 0 0 2 7 0 0 0 0 0 0 0 0 11-0 2-0 0 0.82Feb 22, 2004 at Rice * 9.0 3 1 1 2 7 0 0 0 0 0 0 0 0 3-1 3-0 0 0.90Feb 29, 2004 Connecticut * 3.0 3 1 1 1 1 1 0 1 0 0 0 0 0 18-11 4-0 0 1.17Mar 06, 2004 East Carolina * 7.0 5 4 3 3 4 0 0 2 0 0 1 0 0 6-4 5-0 0 1.80Mar 13, 2004 Tulane * 5.2 4 1 1 5 5 1 0 0 0 0 0 0 0 11-3 6-0 0 1.77Mar 20, 2004 California * 1.1 4 3 3 2 0 0 0 1 1 0 0 0 0 8-20 6-1 0 2.43Mar 26, 2004 Washington * 4.1 5 5 3 4 6 3 0 1 0 0 0 0 0 1-11 6-2 0 2.83Apr 02, 2004 USC * 8.1 7 3 3 6 7 1 1 0 0 0 0 0 0 10-3 7-2 0 2.90Apr 09, 2004 Oral Roberts * 7.0 5 1 1 2 6 2 0 0 1 0 1 0 0 5-1 8-2 0 2.70Apr 17, 2004 at UCLA * 4.0 8 3 3 0 2 1 1 1 0 0 0 0 0 4-3 8-2 0 2.97Totals 11 60.2 53 23 20 30 54 9 2 6 2 0 2 0 0 89-63 8-2 0 2.97
A Washington Homecoming:
Three Sun Devils will have a homecoming of sorts this weekend when ASU travels to the Palouse for a three-game series against the Washington State Cougars. Freshman Colin Curtis (Issaquah, Wash.) is from the western side of the state, but will still have tons of family and friends make the trek across the Evergreen State to watch him play. Sophomore Travis Buck hails from Richland, Wash., about two hours south of Pullman. He was high school teammates with WSU slugger Grant Richardson and played summer baseball for former WSU skipper Steve Farrington. Freshman left-hander Travis Webb has the strongest ties to Cougar country, as both his mother and father attended WSU. Webb's father, Stan, played baseball for WSU in the early 1980's for legendary head coach Chuck 'Bobo' Brayton. His uncle, former NBA guard Craig Ehlo, also attended WSU and played basketball.
The All-Time Series Against Washington State:
The Sun Devils and Cougars meet on the Diamond for the sixth straight year. ASU carries an all-time 25-6 record into the series and owns a 5-1 record at Bailey-Brayton Field. The Sun Devils and Cougars renewed the rivalry with a three-game series in 1998 at Packard Stadium that served as a primer to Pac-10 North and Six-Pac (Pac-10 South) joining in 1999. ASU and WSU had previously last met in the 1990 NCAA Regional in which ASU won 8-6 in 10 innings.
Last Year Against The Cougars:
The Sun Devils had a record-breaking weekend against Washington State last year, sweeping the three-game Pac-10 series in Tempe by a combined score of 51-3. ASU opened with a 21-0 shutout and then battled for a 5-3 victory in 10 innings the following night. Slugger Jeremy West hit a walk-off home run in the bottom of the 10th to give ASU the victory. ASU then finished off WSU with a staggering 25-0 shutout on Sunday, including a 10-run first inning. Nick Walsh had a career weekend, going 8-for-14 (.571), including going 6-for-6 with three doubles and six run-scoring hits in Sunday's 25-0 victory. West, who is currently a minor leaguer with the Boston Red Sox, hit five home runs and drove home 13 runs in the series. ASU hit .437 in the series and pitched for an impressive 0.96 ERA.
Mousser Dominates Cougars... as a Cougar:
Senior right-handed pitcher Jeff Mousser will get a second look at a familiar opponent. Last year as a BYU Cougar, Mousser beat the WSU Cougars in a complete-game, five-hit shutout in the Banana Belt Classic at Harris Field in Lewiston, Idaho (home of the NAIA World Series champs, Lewis-Clark State). Mousser struck out five and walked one en route to earning Mountain West Pitcher of the Week honors. The Tempe native is 2-3 on the season with a 3.86 ERA. He is coming off a strong outing against UCLA last weekend when he gave up only five hits and one run in a season-high tying seven innings. The win broke a personal three-game losing streak.
**For complete relese, download the PDF version**
TODAY | 12:00pm PTLive
Airing on:
- Pac-12 Network
- Pac-12 Arizona
TODAY | 2:00pm PTLive
Airing on:
- Pac-12 Network
- Pac-12 Bay Area
- Pac-12 Mountain
Pac-12 PlaylistTODAY | 4:00pm PTLive


text:
just wondering what other metals may be leached from the can into the tuna, esp. since it's cooked in the can. I so wish it was packed in glass jars. I'm very sensitive to many foods, & tuna is one food I seem to tolerate. But now I'm concerned abt. eating it every day bec. of mercury building up over time. thanks for your site:=) Dorothy
Review: Safe Catch, The First 100% Mercury Tested Albacore Tuna. The New Whole Foods of the Sea.
I was just sent a can of Safe Catch 100% Mercury Tested Wild Albacore Tuna to sample and write about. Like many of you, I didn't know much about mercury problems in canned tuna. Nor did I know that there were FDA and EPA rules around acceptable mercury levels in canned tuna. I didn't know that one can of tuna could be totally safe to eat, but the next can could have 9 times the amount of mercury levels than what the EPA recommends as safe to consume in one day. I also didn't know that this was a concern for pregnant women and nursing mothers. I was completely oblivious of any of these issues, and ate my tuna fish sandwiches and my tuna salads without any thought of concern. But upon receiving my Safe Catch sample, I started doing a little research on the issue. Here's what Consumer Reports had to say:
"Canned tuna, Americans' favorite fish, is the most common source of mercury in our diet. New tests of 42 samples from cans and pouches of tuna bought primarily in the New York metropolitan area and online confirm that white (albacore) tuna usually contains far more mercury than light tuna.
Children and women of childbearing age can easily consume more mercury than the Environmental Protection Agency considers advisable simply by eating one serving of canned white tuna or two servings of light tuna per week. A serving is about 2.5 ounces. Expect a 5-ounce can to contain about 4 ounces of tuna plus liquid.
Results from our tuna tests, conducted at an outside lab, underscore the longheld concern for those people. We found:
- Every sample contained measurable levels of mercury, ranging from 0.018 to 0.774 parts per million. The Food and Drug Administration can take legal action to pull products containing 1 ppm or more from the market. (It never has, according to an FDA spokesman.) The EPA compiles fish advisories when state and local governments have found high contaminant levels in certain locally caught fish.
- Samples of white tuna had 0.217 to 0.774 ppm of mercury and averaged 0.427 ppm. By eating 2.5 ounces of any of the tested samples, a woman of childbearing age would exceed the daily mercury intake that the EPA considers safe.
- Samples of light tuna had 0.018 to 0.176 ppm and averaged 0.071 ppm. At that average, a woman of childbearing age eating 2.5 ounces would get less than the EPA's limit, but for about half the tested samples, eating 5 ounces would exceed the limit.
In 2006 we scrutinized the results of the FDA's tests in 2002 to 2004 of mercury levels in hundreds of samples of canned tuna. The agency's white-tuna samples averaged 0.353 ppm; light tuna, 0.118 ppm. But we found that as much as 6 percent of the FDA's light-tuna samples had at least as much mercury as the average in white tuna—in some cases more than twice as much.
Given the uncertainties about the impact of occasional fetal exposure to such high levels, we urged the FDA to warn consumers about occasional spikes in mercury levels in canned light tuna."
That's some pretty freaky stuff, and is all because man-made mercury pollution has tripled the mercury presence in our oceans. Have I been killing myself, my wife, and our unborn child by occasionally serving tuna sandwiches? I usually use light tuna (Skipjack) for sandwiches and white tuna (Albacore) for pastas and salads. So our unborn baby girl may be OK by her mother eating a few tuna sandwiches during gestation, but dang this is messed up stuff!
So maybe Safe Catch is onto something here. Safe Catch claims to be the only brand to establish purity levels that are stricter than the Consumer Report's 'Low Mercury' criteria limit and average set in 2014 for pregnant moms and children (Safe Catch's Skipjack tuna has a mercury content of less than 0.1 part per million, 1/10th the FDA limit). They have developed a proprietary technology that allows them to quickly test every single tuna fish they get their hands on to verify its mercury levels, allowing them to only process the low-level fish for their brand. Safe Catch's Albacore tuna mercury level requirements are 70% stricter than the FDA's. Is Safe Catch the new "Whole Foods" of the ocean?
Safe Catch Tuna Has Higher Omega 3′s and No GMO's
In addition to Safe Catch's low mercury level claims, they are also marketing their tuna to have 5 times the Omega 3′s than other big brand tuna. Really? 5 times? How could that be? It's all the same fish after all. I was confused by this claim, so I had to do a bit of research on how tuna is traditionally caught and processed. After watching the following videos, I get it.
With the conventional tuna processing you just watched, up to 80% of Omega 3s are lost during the precooking process. Not only that, that tuna is often rehydrated with pyrophosphates, GMO vegetable broth, soy, water, oil, or other fillers.
In contrast, Safe Catch raw packs its tuna, sealing in all of the nutrients, and then cooks it in a proprietary process that yields an amazing taste (more on that below). Safe Catch tuna is free of additives, non-GMO (due to not using any vegetable broth in the can), BPA-free, and sustainably caught. It is not packed in oil or water. Liquids in the can are natural juices from the tuna. It's just raw fish, sealed in a can, and cooked to preservation temperatures. That sure seems to make a lot of sense to me!
Safe Catch Gives You More Tuna in Each Can!
Being that Safe Catch doesn't add any broth or liquid to their cans, I was curious to see what the difference in content weight was from regular brands. For my comparison, I used a can of Safe Catch Albacore Tuna and a can of Chicken of the Sea Albacore Tuna. The contrast was startling.
First off all, the two products look completely different once opened. Where Chicken of the Sea was full of liquid, Safe Catch was nearly a solid mass of fish in the can; so much so that it was somewhat difficult to get it out of the can without breaking it up first.
But once I broke the Safe Catch up a bit, it easily came out with a quick shake of the can. Surprisingly, there was nothing left clinging to the bottom of the can.
Compare that to the Chicken of the Sea tuna, and you quickly get an idea of the quality difference going on. The regular Chicken of the Sea was a mushy mess on the bottom of the can.
I strained each can, reserving the juices, and weighed each product. Very interesting results. Safe Catch weighed in at .75 ounces more meat! That's quite substantial when we're only talking about a 5 ounce can!
Not only did Safe Catch give more tuna, it was a significantly better textured product as well. It was very flaky and firm, whereas the Chicken of the Sea was a bit mushy and easily fell apart. Safe catch literally looked like a cooked tuna steak. I could actually see the protein fibers in the flakes! The flakes were densely packed and together, much like a pan fried tuna steak. It was beautiful for a canned fish product.
In contrast, Chicken of the Sea was soggy and mushy. All the flakes were unraveled. Nothing held together.
As if that wasn't a big enough difference, the liquid in Safe Catch was a vastly smaller amount than Chicken of the Sea. Safe Catch only had 5 teaspoons of liquid in their 5 ounce can, whereas Chicken of the Sea had 10.5 teaspoons of liquid in theirs! Over twice as much liquid in Chicken of the Sea! That is liquid you pay for in order to just dump down the sink!
Safe Catch Tuna Tastes Much Better!
OK, so Safe Catch is a safer product, safe Catch is a healthier product with more Omega 3′s, Safe Catch provides more fish per can, and Safe Catch is a higher quality canned product with more dense fish flakes. But how does it taste? Does it taste any different than regular canned tuna? YES!!!
I started by tasting the liquid/broth of each product.
- Safe Catch's liquid was very clean tasting. It was savory, fishy (but clean rather than bottom of the ocean fishy), and perfectly salty. It tasted like very good fish broth, and I found myself wanting to eat it.
- Chicken of the Sea actually tasted bad in comparison. It was bitter, too salty, and tasted fake. I had never noticed it before over the years, but the broth actually tasted like bad vegetable broth. It was actually rather disgusting. No wonder I just dump that crap down the sink!
Next up was the tuna. I tasted each product several times for a good comparison. Just a chunk of tuna straight in my mouth. No additions, no accompaniments, no anything other than tuna straight from the can.
- Chicken of the Sea tasted fairly fishy (as in bottom of the ocean). It actually tasted quite bad by itself. No wonder we typically smother it in mayonnaise and spices. Texturally, it was very flaky but very dry. I could taste the vegetable broth in each bite of fish. Compared to Safe Catch, my can of Chicken of the Sea was a terrible product.
- Safe Catch tasted VERY clean. It tasted just like cooked fish. There wasn't any odd after taste or any other funk. Additionally, it felt lite on my tongue but had a nice denseness to it. It had a dry texture, like all cooked tuna, but was still moist in the mouth. It was clean cooked fish right out of a can. Amazing!
How Much Does Safe Catch Tuna Cost to Buy?
With this type of superior quality product, you need to expect to pay more for it. But how much more? about twice as much. Safe Catch can be purchased from Amazon for $4.50 per can for albacore, or $3.50 per can for chunk lite skipjack. Compare that to typical grocery store prices of roughly $2.00 per can for albacore that is full of mercury that will jack you and your babies up, and that extra price doesn't seem to be that big of a deal (yes I know that with coupons and sales you can buy albacore for less, but it's still worth the extra price). But even if mercury wasn't an issue, the additional price of Safe Catch is completely justified in my mind for the better tasting, better quality, better health, more meat in every can product.
If you are skeptical, I encourage you to do a taste comparison yourself and let me know what you think.
Thank you Safe Catch for sending me a review sample of your product. I will be filling my pantry with your goods now.
The Bald Gourmet reviews and highly recommends Safe Catch brand tuna.
19 Comments + Add Comment
I recently purchased a 6 pack from Safe Catch's website. Their tuna is good. My only concern is that on the box it says its custom packed in Thailand. Comes from California but custom packed in Thailand?
It is from Thailand. You can see the country of origin printed on each can.
Saw safe catch on Shark tank!
Could you reveiw the organic products in Green chef? I just subscribed im on my 3rd box.I just ate a barlet pear from them "organic" yet it had NO SEEDS.Also my raw yellow fin Tuna "product of Thailand and has "carbon monoxide to retain color" is this "ORGANIC"??
What about radiation content ? any tests there ? ……
American Tuna is amazing also and packed here in the USA
My local organic grocer sells tuna caught in Italy packaged in a glass jar. Tastes very good. It's costly though, $9. So I limit consumption by half.
Would you kindly address the questions regarding from where this tuna is obtained? I noticed this question appears more than once and has gone unanswered. I too would like to know the origin of their tuna product. Thanks so much.
I just stumbled upon this amazing product at the Grocery Outlet in the Bay Area, CA Dfor only $1.99/can! I grabbed nearly every can from the shelf I couldn't believe it! Just wondering does it come from Thailand? I know it says packed in Thailand but distributed from Sausalito.
I was wondering where the fish come from? And also where the tuna is canned? US?
thanks so much,
I agree with the taste and texture of Safe Catch tuna. Now that is real food!
Thanks for the really useful info, Jothan and in light of the post from Rhet, congratulations. Without knowing about the safety issues and just based on taste, I switched to Genova light tuna packed in olive oil a long time ago. It has none of that nasty stuff in broth either. After getting your email I checked it out and found out that is packaged by one of the big boys but it is yellow fin, not the bland albacore. Costco and all the super markets seem to carry it. I don't know if the liquid to solid ratio is as good as yours but it tastes pretty good and it's nice to know that light tuna is relatively safer.
Thanks for the great info. And congrats on having a baby girl on the way.
Leave a comment to Sheila Ward
Recent Comments
- The Bald Gourmet on Recipe: Best Home Canned Thick and Chunky Salsa
- The Bald Gourmet on Recipe: Best Home Canned Thick and Chunky Salsa
- Matt on Recipe: Best Home Canned Thick and Chunky Salsa
- jeannine m walatka on Angel Wings Mushroom
- The Bald Gourmet on Recipe: Tagliatelle with Lamb Mergeza Sausage

subset: commoncrawl


text:
Trainsongs.com, in conjunction with Blue Vision Music, is here to help you with your railroad entertainment needs. Along with offering information and services regarding our own products by award-winningsinger/ songwriter James Coffey, we hope to provide information about any subject pretaining to trains including traditional song information, other railroad song artists, videos as well as fun and games for everyone!
All Aboard!


text:
Istanbul Exhibition
By personal invite from Turkish Prime Minister Recep Tayyip Erdoğan, 1001 Inventions launched the block-buster exhibition at the historic Sultanahmet Square in Istanbul on 18th August 2010.
Hot on the heels of the record-breaking residency at the London Science Museum, the global tour began with Istanbul the ideal first host city as the exhibition formed part of the 'Capital of Culture' programme. The 1001 Inventions exhibition was entitled '1001 ICAT BILIM VE TEKNOLOJININ 1000 YILLIK SERUVENI' and given an iconic position in Sultanahmet Square, nestled in between the Hagia Sophia and the Great Blue Mosque, two of Istanbul's most famous landmarks.
The exhibition was officially opened by the Turkish Prime Minister Recep Tayyip Erdoğan in a blaze of media attention during a gala opening ceremony. The 1001 Inventions exhibition, in partnership with the Prime Ministry and sponsored by ALJ Community Initiatives, ran until the 5th of October 2010 and achieved a staggering 400,000 global visitors during its short 7 week residency.
Official Launch Event
Gala Event
TV Coverage
Library of Secrets Movie
Related Links
VIP Visitors
In the Press
More Photos
Please click the images to enlarge:
In the Press
|11/08/10 Hür Haber
|11/08/10 Hurriyet.com.tr
|11/08/10 Milliyet Cadde
|11/08/10 Haber Türk
|11/08/10 HaberTurk.com
|11/08/10 Taraf
|11/08/10 Takvim
|11/08/10 Samanyolu Haber
|11/08/10 Sabah
|11/08/10 Radikal
|11/08/10 İstanbul Net
|10/08/10 Hürriyet
|10/08/10 Risale Haber
|10/08/10 Istanbul.com
|10/08/10 Takvim Online
|10/08/10 Zaman Online
|10/08/10 Zaman
|10/08/10 Dünya Bülteni
Online Press Coverage:
|30/08/10 Muslim Voice
|27/08/10 Muslim Heritage
|26/08/10 San Francisco Chronicle
|26/08/10 Hindustan Times
|26/08/10 Today's Zaman
|25/08/10 Washington Post
|17/08/10 Sabah English
|17/08/10 Middle East Online
|17/08/10 Nature Blog
|16/08/10 SE Times
|16/08/10 On Islam
|11/08/10 Balkan Travellers
|11/08/10 World Bulletin
|11/08/10 Today's Zaman
|10/08/10 Republic of Turkey
Click here for more press coverage
TV Broadcast Coverage: Selected Videos
TRT English Broadcast
Channel 7 Turkish Broadcast
CNN Turk Broadcast
Click here for more TV Broadcast Coverage


text:
Looks like you are using an old version of Internet Explorer - Please update your browser
Biblical truth should not be just a starting point—our whole philosophy and worldview should be submitted to the acid test of biblical authority. That includes our interpretation of scientific data.PDF Download
No results found in .
Answers in Genesis is an apologetics ministry, dedicated to helping Christians defend their faith and proclaim the gospel of Jesus Christ.


text:
Pharmaceutical and Device Companies
Pharmaceutical and medical device companies have an ongoing challenge reaching and educating providers and patients. In the world of diabetes, developments in the field - including new therapies, clinical approaches, and education interventions - are constantly changing. This dynamic environment requires companies to connect with its stakeholders with the highest quality information and most effective communication approaches in order to succeed.
For over 100 years, Joslin has pioneered diabetes research, care and education, and has created programs that inform providers and patients using the highest quality content and methods. With access to the world's leading diabetes clinicians, researchers and educators as a Harvard Medical Affiliate, Joslin develops education programs that generate measurable impact with providers and patients. Through continuing medical education, to value-added programs, to clinical trial services, Joslin is actively working with companies to offer their target audiences the best information and education for diabetes and its co-morbidities.
Contact Information
For more information on how Joslin can provide health solutions for your company - from the world's leading diabetes CME programs to other innovative services - please contact
Matthew Verlinden
Healthcare Services
or email
Matthew Verlinden
Related Links
Page last updated: October 14, 2019


text:
Free Shipping on Orders Over $39
Zincflyte Travel Solutions
Going any place with children means you need baby gear and parenting essentials in order to keep the show on the road. Whether your travels take you to the supermarket or around the globe, thoughtfully designed baby gear and travel solutions can make the journey easier. Lighten the load with kids backpacks ÃÂ if theyÃÂre old enough, put them in charge of carrying some of their own stuff so you can focus on the important things. No trip is complete without a travel potty and baby wipes, especially when you travel with a toddler. Smaller children and tired parents know the benefits of a baby travel bassinet ÃÂ letting little ones drift off to sleep in a quiet place can help to give everyone a break. Browse our comprehensive selection of baby travel accessories to find portable booster chairs, travel bottle and food warmers, snack packs, wet/dry bags, car seat travel totes, stroller bags, bottle bags and more. Get going!


text:
In Chicago now
The first part of the trip is over (ok the easiest part!); I'm in Chicago on a few hour layover now. I'd post a picture but, you know… it's just an airport.
I stayed up all night last night packing and generally getting ready. And working on that Pelican case, which unfortunately didn't come together quite like I planned – but I'm getting what I need out of it. Here's a picture of the lid, where I've either epoxied or velcro'd everything in place. On the right are four Lexar FireWire readers, mounted sideways. These are glued in place. On the left are three firewire drives; the top one is a backup drive for the OS and applications, so I can recover on the road if needed (all personal files are backed up on systems back home and I don't need recovery on the road for those if I lose them). The lower two drives are the G-RAID MINI's, as primary and backup. All master files to go to the one then are backed up to the other. In the middle you see the MacBook Pro power supply velcro'd to the lide, and under that the little white box is a Belkin FireWire hub. The coil of cables underneath are the two FireWire cables coming off the Lexar readers (for the FW400 port) and off the drives/hub (FW400 to 800 for the 800 port). The computer is living in the protective sleeve that came with the case, and the sunshade sits under that. I couldn't figure out a way of incorporating the shade into the lid with all the other stuff there, so I compromised and put a small velcro tab on the lid of my MacBook Pro to hold it when I want to use it. Not thrilled with the idea but at least it works.
So now to recharge the iPod and have a snack before the 8 hour flight to Brussels! I have a three hour layover there, so may try to go to the other side of customs to see the big Tintin rocket. I grew up on Tintin, and my friend Steve just sent me this picture from the airport there. Gotta see it ;-)


text:
TaylorMade Salutes Side-Hustle
Tonight, October 23rd, TaylorMade Media salutes African American part-time entrepreneurs with the best side hustle. The riveting event will be held at 10 E. 33rd Street, 10th Floor (between Madison and Fifth Avenues), in New York City, from 6:30pm - 9:30pm.
TaylorMade Media returns to host the networking event of the season saluting African American part-time entrepreneurs during an" Evening of Empowerment, Refreshments & Conversation" on Tuesday, October 23rd, 2007, at 10 E. 33rd Street, 10th Floor (between 5th & Madison Avenue), New York, NY from 6:30pm - 9:30pm.
Karen Taylor Bass, CEO & Founder of TaylorMade Media, an award-winning professional empowerment agency will host the upscale networking soiree. Special guest, Rodney Lofton, author of The Day I Stopped Being Pretty will share how he went from having multiple jobs as a mail carrier and HIV/AIDS Prevention Counselor to securing a book deal with Simon & Schuster. In addition to networking, attendees will have an opportunity to pitch their business, products, and/or ideas to win $100. Fellow side hustlers will judge and pick two side hustlers with the best 15-second pitch to walk away with $100 each.
In today's forever changing global corporate environments, African Americans are increasingly opting to launch their own businesses that embrace their creative freedom and allow permanent flexibility. "A Salute to African American Female Part-Time Entrepreneurs with the Best Side Hustle" will once again bring together talented full-time, part-time and aspiring entrepreneurs to enjoy a valuable evening of connections, networking, and conversation.
The event is open to the public. Registration is $20.00 per person, which includes empowerment, lite fare provided by Cynthia Hankerson of Cynful Treasures and spirits by sponsor, Moet Hennessy. Space is limited. To register please visit: www.taylormademediapr.com or call 516-285-4999.
About TaylorMade Media – TaylorMade Media LLC is an award-winning professional empowerment agency. Our company's goal is to help individuals achieve success while utilizing the principles and education of Public Relations, Branding and Empowerment. Each client is mentored, motivated and coached for success.
For additional information, please visit www.taylormademediapr.com.
To subscribe to or advertise in New York's leading Pan African weekly investigative newspaper, please call (212) 481-7745 or send a note to firstname.lastname@example.com
"Speaking Truth To Empower."
Latest comments
- Ann GarrisonFebruary 22,2018 @ 08:03 PM
I think you have "Filtered HTML" turned on here. If you switch to "Full HTML," it will probably...
googletag.pubads().definePassback('6785150/BENN/BlackStarNews', [[300,250]]).setTargeting('fold',['BTF']).display();


text:
MODERATION: By popular demand, this discussion is now closed for comments.
Hi All,
I recently responded to the "I'm Not a Christian Anymore" thread. As a philosophical Christian Theist, I hate to see people reject Christ due to misconceptions. I offered some thoughts.
I was challenged on God's existence and nature so I'll offer some thoughts for anyone who would like to discuss. I find it's always necessary to dispel straw men and define terms first.
Motivation. I am interested in civil dialogue on what I think is the most important issue of all time. I think there are more distractions keeping people from the knowledge of God than at any time in history. Yet, I think there are more reasons to believe Theism is true than at any time! It's too important to just view these discussions as a contest - to win the debate at all costs.
No matter how one feels about the "Religious Right", an obnoxiously religious family member, or atrocities done in the name of God, etc. Theism just may be true.
Humility is required in the quest for truth. Respect is required for those on the quest. I hope to offer both.
Worldview. It all comes down to which worldview best explains the data of the universe. If Naturalism is true, then atheism follows. If Theism is true, I think Christianity is the best theistic option.
Classical (or Christian) Theism. Something is ontologically ultimate and therefore eternal and necessary. It is either something of the order of matter, or something of the order of mind. Theism holds to the latter and a conceptual analysis leads to God who is the personal Creator, is powerful, transcendent, and distinct from "his" creation yet active in it.
Christianity. The view that God revealed himself in the person and work of Jesus Christ. Christ's claims concerning himself are true and he is authoritative in everything he taught or affirmed.
Faith. Broadly, faith is the assent, or trust, or affirmation that a proposition is true. It has been defined on a scale from "blind faith" (fideism) to reasonable (or informed, supported) faith. I hold to the latter.
Faith is not a way of "knowing something", it is the application of what you know (or think you know). Some form of faith is a component of virtually everything in life - from the scientific method to personal relationships. But faith is only as good as the object in which it is placed. All the faith in the world will not make something true.
One ought to place one's faith where the evidence points, even if one cannot prove the proposition 100% or does not have exhaustive data.
Proof. While it is difficult to prove something 100%, one can nevertheless offer and consider proofs (reasons or evidence). 100% certainty is not necessary for a view to be justified or considered knowledge. I offer proofs for Christian Theism not "100% proof".
A cumulative case is also often necessary. I think various arguments combine to show Theism is true.
Burden of Proof. When debating a question, (e.g. does God exist?) anyone offering answers to the question bears the burden of proof. All views make truth claims. All truth claims bear the burden of proof. Whether one defends Naturalism or Theism one ought to offer reasons why.
God of the Gaps. Theists need not argue from what we don't know. Arguments for God can be based on what we do know from science or philosophy.
Further, God can employ Secondary Causation, wherein initial conditions or systems produce perpetual effects (e.g. weather systems produce lightning).
God and Science. An eternal, transcendent Creator does not preclude us from rigorously exploring the universe and discovering how it works.
(You may be interested that I reject "Young Earth Creationism". I don't think it's the best biblical explanation and it certainly is at odds with known science. "Yom" in Genesis can denote long periods of time).
Thank you for reading this far. If anyone is interested I can sketch out some arguments for God for discussion.
Kevin H
Views: 535
Replies are closed for this discussion.
It would surely strengthen the case if the miracle occurred within a given context, i.e it was predicted, verified a claim, or vindicated a particular proclamation, etc. And we must avoid ruling out an explanation a priori.
Indeed, holding a view due to one's birthplace may explain why one holds the view but does not make it true or false (Genetic Fallacy).
I think one true God would entail one true "religion". But, given freewill, humankind certainly can fail to be united in it. If Quantum Mechanics is true, why are there disagreements and about ten different interpretations of it?
Am I the only one bothered by his seeming implications that a multitude of different belief systems concerning the nature of God, or even the many denominations of just Christianity, is okay concerning the "truth" of God's existence but that disagreements over Quantum Mechanics means that it is not true?
With science, we can only interpret the data, and scientists will come to different conclusions. But at least we CAN get data. We can't get data on gods. And better data, instruments, technology and measurements lead to better conclusions until they all start to look the same. If the existence of a god is true, and god lies within the realms of science, then it can be studied through the scientific method and either affirmed or denied.
"Because science is all about provisional truths, about fitting the data as best we can until new data forces us to reinterpret and re-analyze, and if necessary, build new models".
I don't disagree. What I pointed out was even if people disagree on the truth of a proposition does not mean the proposition is not true.
"It is very important to analyze the historical, psychological, and cultural origins of specific religious beliefs, and I dare to say that once we analyze these foundations when it comes to Christianity, there are very good reasons (lack of evidence being one of them, but the historical context is another good reason as well) to think that these beliefs are false, as false as those of other very important world religions".
"The unexamined life is not worth living" and I think the unexamined faith is not work believing. And I certainly think the historical, psychological, and cultural grounds are very solid supporting the claims of Christ.
Because he's "an X" not "Y or Z", therefore as "an X" "X is true" and "Y and Z" are false. It makes perfect sense.
But he said it himself. "and I think the unexamined faith is not work(sic) believing." And when I asked him if that makes Islam, Hinduism, or Wicca worth anything because they've been examined, he states "I don't think there are good grounds for holding to those views."
Backpedaling hypocrite. Ever asked members of these religions what makes these faiths worthwhile and true to them versus all the others and specifically yours?
"'Ive always hared that idea of "True to me." Things are either true or untrue. There might be an elaboration behind a truth or untruth, but "true to me" is simply silly."
It IS silly!
Free will? What free will? There is no free will in religion, given the problem of exclusivity. And since there IS not one religion but that they ALL claim to be true, the two most likely conclusions are ALL the gods are real or ALL the gods are not.
Or. Third scenario. There is one god but all the religions ever created describing it are STILL false. A true religion would imply a true god. A true god doesn't imply a true religion.
But seeing as how mankind's imagination has allowed it to create a wealth of different belief systems and fantastical stories, all varying and often contradictory, where is this all-powerful god's ability to instill universal truth in his supposed followers and let himself be known?
Everbody knows 2+2 = 4. It doesn't matter what you call the numbers, that computation is a universal truth. Mankind's myriad beliefs and fantasies and confusion indicates to me that neither gods nor religions are universal truths.
"Religion" is rather broad. However, there is the concept of free will in Christianity.
God's "ability" to reveal himself to his followers is a question of how God reveals himself rather than whether God exists.


text:
A Christmas Carol (Children's Classics)
by Charles Dickens
- 4 Ratings
- 24 Want to read
- 7 Currently reading
- 9 Have read
December 1999
Viking Penguin
Written in English.
In library, Ghost stories, Readers, Ebenzer Scrooge (Fictitious character), Accessible book, open_syllabus_project, Cartoons and comics, Promptbooks, Christmas stories, French language books, Poor families, Navidad, Esperanto, Sick children, French language, Repentance, Criticism and interpretation, Facsimiles, Christmas, English Manuscripts, English Christmas stories, Large type books, Fiction,, Poor, Empathy, Animals, Adaptations, Recluses, French language edition, Translations into Portuguese, Comic books, strips, Recitations, Generosity, Literary collections, Cuentos de fantasmas, London(England), Children's stories, Ficción, Manners and customs, Fiction, Short stories, Misers, History, Ebenezer Scrooge (Fictitious character), Social life and customs, Trials (Breach of promise), England, Vida social y costumbres, Juvenile fiction, Fantasmas, Bible stories, Texts, Cuentos de Navidad, Scrooge, Ebenezer (Personaje literario), Protected DAISY, Social conditions, Ghosts, Internet Archive Wishlist, Juvenile literature, Scrooge, Ebenezer (Fictitious character), High interest-low vocabulary books, Pictorial works
About the Book
An allegorical novella descibing the rehabilitation of bitter, miserly businessman Ebenezer Scrooge. The reader is witness to his transformation as Scrooge is shown the error of his ways by the ghost of former partner Jacob Marley and the spirits of Christmas past, present and future. The first of the Christmas books (Dickens released one a year from 1843–1847) it became an instant hit.
- Created April 30, 2008
- 13 revisions
|September 10, 2014
|Edited by Jessamyn West
|undo merge authors
|September 10, 2014
|Edited by Jessamyn West
|undo merge authors
|November 16, 2012
|Edited by BETHANY J COOPER
|merge authors
|November 16, 2012
|Edited by BETHANY J COOPER
|merge authors
|April 30, 2008
|Created by an anonymous user
|Inital record created, from an amazon.com record.


text:
On Sunday October 20th, 2019 from 5:00 am cst to 8:00 am cst there will be approximately 3 hours of scheduled downtime while we make upgrades to our servers. During this time-window the JCSM website will be unavailable. Thank you for your patience.
If you are a subscriber to the JCSM (including members of the AASM), please login to access the journal.
Click here to Subscribe:
$75/volume year for individuals or $140/volume year for institutions to access all current articles and archives published in JCSM.
Click Here to DOWNLOAD the article*:
$20 to access a PDF version of a specific article from the current issue of JCSM.
*Purchase of an electronic download of JCSM provides permission to access and print the issue/article for personal scholarly, research and educational use. Please note: access to the article is from the computer on which the article is purchased ONLY. Purchase of the article does not permit distribution, electronic or otherwise, of the article without the written permission of the AASM. Further, purchase does not permit the posting of article text on an online forum or website.
Subscribers can download and print full articles from current and past issues of the JCSM
Login to JCSM
Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership
To examine the impact of gender in narcoleptic patients on timeliness of diagnosis, symptomology, and health and lifestyle impairment
This is a cross-sectional study of 109 consecutive patients (68 women) with newly diagnosed narcolepsy with and without cataplexy, from a University sleep disorders center. Consecutive patients were administered an 8-page questionnaire at the time of their diagnosis regarding sleep habits, medications, and medical conditions, lifestyle impairments, as well as details regarding narcolepsy-related symptoms.
Men and women presented with remarkably similar narcolepsy related symptoms, yet women were more likely to be delayed in diagnosis; 85% of men were likely to be diagnosed by 16 years after symptom onset, compared to 28 years in women. More women were likely to remain undiagnosed at any given time point after symptom onset (hazard ratio for diagnosis of men compared to women 1.53; 95% CI 1.01-2.32; p = 0.04). Men and women reported similar degree of subjective sleepiness as measured by the Epworth Sleepiness Scale (mean 16.2 ± 4.5; p = 0.18), though women demonstrated significantly more severe objective sleepiness on multiple sleep latency testing (MSLT) (mean sleep latency in women = 5.4 min (± 4.1), in men 7.4 min (± 3.5); p = 0.03). Despite being more objectively sleepy, women were less likely to report lifestyle impairments in the areas of personal relationships (71% men, 44% women, p = 0.01) and physical activity (36% men, 16% women, p = 0.02), but were also more likely to self-medicate with caffeine (63.4% men, 82.4% women; p = 0.03).
Narcolepsy impacts men and women's health and lifestyle differently, and may cause delays diagnosis for women.
Won C; Mahmoudi M; Qin L; Purvis T; Mathur A; Mohsenin V. The impact of gender on timeliness of narcolepsy diagnosis. J Clin Sleep Med 2014;10(1):89-95.
Sleep disorders affect women and men differently. This is well described, for example, in sleep disordered breathing, insomnia, and restless leg syndrome. In these common sleep disorders, there are notable sex differences in disease prevalence, manifestation, health effects, and social consequences,1–9 as well as sex-related discrepancies in diagnosis and health care delivery.10 There is some evidence from animal models and genetic studies to suggest sex differences in the susceptibility and manifestation of narcolepsy.11–13 However, sex differences in narcolepsy remain understudied in humans, and there is little scientific information regarding the clinical significance and consequences of the diagnosis of narcolepsy in women. Therefore, this study aimed to compare clinical presentations of narcolepsy in men and women from an academic sleep center, and to identify potential sex differences affecting recognition, diagnosis, and treatment of this disorder. This is the first study dedicated to addressing clinical gender differences in narcolepsy.
One-hundred twenty-five consecutive patients with newly diagnosed narcolepsy from 2007 to 2010 were identified from the Yale Center of Sleep Medicine. All patients completed polysomnography (PSG) and multiple sleep latency test (MSLT), and a structured interview by an independent sleep specialist. Patients were administered a standardized 8-page questionnaire within 4 weeks of their narcolepsy diagnosis. Sixteen patients did not complete the questionnaire or had missing data, and were excluded. The study was approved by the Yale Institutional Review Board.
Current Knowledge/Study Rationale: There have been descriptions of sex differences in several sleep disorders such as obstructive sleep apnea and restless leg syndrome, however, the impact of sex in narcolepsy has not been previously explored. This study was performed to assess whether narcolepsy clinically presents and affects women differently than men.
Study Impact: This study suggests there are critical differences between men and women in the clinical care and outcomes of patients with narcolepsy. This study supports the necessity for consideration of sex in narcolepsy research.
The standardized questionnaire, in addition to other sleep disorder symptoms, sleep history and habits, current medications, and social, psychological, psychiatric, surgical, and medical conditions, contained detailed questions about sleepiness, the Epworth Sleepiness Scale (ESS), naps, cataplexy, hypnogogic and hypnopompic hallucinations, sleep paralysis, and disrupted nocturnal sleep. The cataplexy section of the questionnaire explored the following conditions: sudden episodes of loss of muscle function in response to emotion, ranging from slight weakness (such as sagging of the jaw and facial muscles, nodding of the head, closure of the eyes, double vision, buckling of the knees, dropping of the arms, weakness of the hands, and loss of speech or slurred speech) to complete body collapse. With regard to hypnogogic or hypnopompic hallucinations, patients were asked whether they have ever experienced vivid dream-like scenes, or tactile, auditory or visual hallucinations upon awakening or falling sleep. For sleep paralysis the questionnaire asked for transient inability to move partially or completely upon awakening from nocturnal sleep or naps.
The questionnaire asked binary questions, followed by open-ended questions regarding the impact of narcolepsy in the following areas: (1) work or school, (2) social activities, (3) personal relationships, and (4) exercise and physical activity. Questionnaire responses were scored and recorded by a single blinded researcher.
Nocturnal PSG and MSLT were performed after a sleep diary confirmed a patient's regular sleep habits with ≥ 6 h of nocturnal sleep per night during the 2 weeks preceding the evaluation. Patients discontinued any wake-promoting medications 2 weeks before the sleep study. Antidepressants were tapered off 2 weeks prior to the sleep study in subjects who were considered psychiatrically stable and who were willing to come off these medications. For those with obstructive sleep apnea, MSLT was performed after a night on therapeutic positive airway pressure therapy and apnea-hypopnea index (AHI) was < 5 events per hour. PSG and MSLT were standardized, and performed and scored according to American Academy of Sleep Medicine guidelines.14,15
All tests of significance were two-sided. For univariate analysis, continuous variables were reported as means and standard deviations (SD) if they were normally distributed, and student's t-tests were used to do comparisons between two groups. Otherwise they were reported as medians and 25% to 75% quartiles (Q) and were analyzed using nonparametric Wilcoxon method. For categorical variables, frequencies and percentages were reported. Chi-square tests or Fisher exact tests were used to compare differences in proportions of patients as appropriate. Logistic regression was performed to obtain the odds ratios (ORs) of cataplexy with sleep paralysis as the predictor. Association between time to diagnosis and age at symptom onset was assessed by Spearman correlation coefficient. Cox proportional hazards regression survival model were performed by gender with time to diagnosis from symptom onset as the independent variable of interest, and initial ESS, BMI, presence of cataplexy, and age at symptom onset as predictors. Hazard ratio (HRs) and 95% CIs for the incidence of diagnosis were calculated. Cumulative incidence of diagnosis for each gender group was estimated using the Kaplan-Meier method and compared with the log-rank test for patients with age at symptom onset < 15 years old. Analyses were carried out with the use of SAS software (SAS Institute Inc, Cary, NC). P values of less than 0.05 were considered to indicate statistical significance.
Among 109 patients with narcolepsy, 68 (62.4%) of participants were women. The patients in this study were predominantly younger (mean [SD] = 30.4 [10.9] years), and their ages ranged between 14 and 62 years. The characteristics of the patients are shown in Table 1. Obesity (BMI ≥ 30 kg/m2) was common, affecting 27.8% of patients, with no gender differences observed. There was a bimodal pattern of age distribution in symptom onset (Figure 1). A peak in symptom presentation occurred during the age period of 10-15 years with diminishing frequency with increasing age and a second slight increase in presentation between the ages of 35-40 years. We did not observe a gender difference in the bimodal character of age at which symptoms presented. Twenty-four percent of men and 22% of women (p = 0.78) associated the onset of hypersomnia with a discreet event. The most common events described by women included head trauma (n = 5), infection (e.g., Lyme disease, mononucleosis, viral infection) (n = 4), and childbirth (n = 2). The most common preceding event reported by men was infection (e.g., Lyme disease, mononucleosis, encephalitis) (n = 5).
Characteristics of narcolepsy patients by gender
(more ...)
(A) Age of symptom onset of narcolepsy for all subjects. (B) Age of symptom onset by gender. In both genders, there was a peak of onset between the ages of 10-15 years, with decreasing frequency with age and a slight increase in onset during the ages of 35-40 years.
Age of symptom onset. (A) Age of symptom onset of narcolepsy for all subjects. (B) Age of symptom onset by gender. In both genders, there was a peak of onset between the ages of 10-15 years, with decreasing frequency with age and a slight increase in onset during the ages of...
There was a high prevalence of self-reported anxiety (32.1%) and depression (56.0%) in both men and women, and greater than 40% of men and women were taking psychiatric medications at the time of diagnosis. As shown in Table 2, the prevalence of attention deficit hyperactive disorder ([ADHD]; in men, 19.5%, in women, 2.9%; p = 0.006) and autoimmune disorders (in men, 0%, in women, 10.3%; p = 0.03) differed in similar gender trends as those observed in the general population.16 Autoimmune disorders included 4 women with rheumatoid arthritis, 2 women with lupus and/or antiphospholipid syndrome, and one woman with Hashimoto thyroiditis. Neurologic conditions were reported more frequently in women (men, 14.6% vs. women, 42.6%; p = 0.002), with the most common condition being headaches or migraines (82%). The prevalence of cardiovascular disease was similar for both men and women (17%), and consisted mostly of hypertension (67%). Other cardiovascular diagnoses included arrhythmias (reported by 3 men) and a patent foramen ovale reported by one woman.
Comorbid disorders
Objective sleepiness as measured by mean sleep latency on MSLT was more severe in women (women 5.7 [4.1]; men 7.4 [3.5] min; p = 0.03) despite significantly longer total sleep time and sleep efficiency, and fewer respiratory events during the preceding night's sleep (Table 3). The mean sleep latency was not affected by cataplexy status: 5.7 (4.6) min in women with cataplexy vs 5.8 (3.3) min in women without cataplexy, (p = 0.9), compared to 6.6 (3.2) min in men with cataplexy vs. 7.8 (3.6) min in men without cataplexy, (p = 0.3).
Polysomnographic features
There were 17 women and 11 men diagnosed with narcolepsy despite lack of initial MSLT findings of mean sleep latency (MSL) < 8 min and ≥ 2 SOREMPs. For 7 of these women and 9 of these men, narcolepsy was diagnosed despite negative MSLT findings, based on a history of clear-cut cataplexy. For 14 women and 8 men diagnosed with narcolepsy (there was overlap with the cataplectic group mentioned above), the lack of ≥ 2 SOREMPs on their initial MSLT was attributed to active selective serotonin reuptake inhibitor or other antidepressant use at the time of the study.
Gender differences were not apparent in the subgroups of narcoleptics with and without cataplexy, with two notable exceptions. Those with cataplexy were more overweight than their non-cataplectic counterparts (BMI 28.0 [6.7] kg/m2vs 25.7 [4.7] kg/m2, respectively; p = 0.04), and those with cataplexy were more likely to use nicotine than those without cataplexy (32.1% vs 7.1%; p = 0.001). ESS were similar in those with and without cataplexy (16.0 [5.0] vs. 16.5 [4.0]; p = 0.5).
Multivariable Cox proportional hazards model showed men were diagnosed earlier than women, and more women remained undiagnosed at any given time point after symptom onset (male hazards ratio [HR] 1.53; 95% CI 1.01-2.32; p = 0.04). Among men, 85% were likely to be diagnosed by 16 years after symptom onset, compared to 28 years in women. Patients achieved a sooner diagnosis if their symptoms started at an older age (HR 1.06; 95% CI 1.04-1.08; p < 0.0001). Patients with greater BMI also experienced sooner time to diagnosis (HR 1.05; 95% CI 1.01-1.09; p = 0.02). The presence of cataplexy did not impact timing of diagnosis (HR 0.70; 95% CI 0.47-1.04; p = 0.08; Table 4).
Results of multivariable Cox proportional hazard model for time to narcolepsy diagnosis from symptom onset for all patients
The majority of men and women (90%) reported having trouble at work and/or school due to narcolepsy, and specifically due to excessive sleepiness (Figure 2). More men reported their narcolepsy-related symptoms negatively affected their personal relationships, with the main reason being excessive sleepiness and not cataplexy or other REM-intrusive symptoms. More men were also likely to reduce their physical activity and exercise due to symptoms associated with narcolepsy. Up to a third of both men and women reported having to reduce their social activities due to excessive sleepiness. Patients generally reported oversleeping or feeling too tired to engage in social activities, and 2 patients reported cutting back on social activity because of concerns about driving. Seven patients ascribed drug abuse to sleep problems, with 4 patients abusing stimulants such as amphetamines and cocaine, and the remaining 3 using alcohol to assist with sleep. More than 40% of narcoleptic men and women reported at least one incident of falling asleep while driving.
Values represent percentages of men or women who attribute the listed impairments directly to symptoms of narcolepsy. *p-value < 0.05
Lifestyle impairments attributed to narcolepsy. Values represent percentages of men or women who attribute the listed impairments directly to symptoms of narcolepsy. *p-value
Gender differences in the presentation and manifestation of common sleep disorders are well recognized. However, aside from few animal and genetic data, there is a paucity of data regarding potential gender differences in the clinical presentation and manifestation of narcolepsy. Given the relevance of sex hormones and/or gender roles on other sleep disorders such as sleep disordered breathing and restless leg syndrome, the potential for gender differences in narcolepsy—a disease commonly emergent during adolescence and young adulthood17,18—necessitates further investigation.
It has been reported that a diagnosis of narcolepsy is commonly delayed on the order of 10 years19,20, and it is important to understand the impact of gender on these delays since narcolepsy may be associated with significant morbidity. Patients in this study were also delayed in their diagnosis by a median of 8 years (25% to 75%Q 2-15 years) from the time of symptom onset. Gender seemed to impact the timeliness of diagnosis with women being more likely to be delayed despite women reporting more occurrences of cataplexy and having greater objective sleepiness on MSLT. This held true even after considering age of symptom presentation, presence of cataplexy, and ESS.
Interestingly, we observed a bimodal pattern of age distribution in symptom onset, similar to that that has been described in previous studies.21,22 We observed a peak in symptom presentation during the age period of 10-15 years with diminishing frequency with age and a second slight increase in presentation between the ages of 35 and 40 years. We did not observe a gender difference in the bimodal character of age at which symptoms presented, and therefore could not explain its contribution to the observed gender difference in time to diagnosis.
We were able to ascertain occupational history and found at the time of diagnosis, three women were homemakers, 17 were students (ranging from undergraduate to graduate or professional students), and the remainder were employed. Examples of female occupations include teachers, research assistants, waitresses, secretaries, nurses, and financial consultants. Two men did not work due to retirement and disability, 19 were students, and the remainder were employed. Men also varied widely in their occupations, and examples include teachers, auto mechanics, bankers, and engineers. There were significantly more male students compared to female students (46% vs 25%, respectively, p = 0.02). However, student status was not found to contribute to gender differences in the delay to diagnosis. Our cohort may represent a greater proportion of adult students compared to those seen at other sleep centers, and likely reflects the association of this sleep center to a large university.
Narcolepsy is a relatively rare disorder and presents with nonspecific complaint of daytime sleepiness, and therefore requires a high index of suspicion for the diagnosis. The diagnosis is often readily made by sleep specialists, and we assume a delay in referral to a sleep specialist likely contributes to the delay in diagnosis. This delay in referral may reflect either delay in recognition by the referring provider or delay in seeking medical help by the patient. When looking at referral patterns, 53% of women and 58% of men were referred to the sleep center by their primary care providers. The next most common referring provider was a neurologist (n = 13) then a psychiatrist (n = 8) for women, and a neurologist (n = 6) and an ENT (n = 4) for men. Geriatricians, pediatricians, endocrinologists, rheumatologists, and pulmonologists referred fewer than 3 patients each of men or women. We did not observe differences in time to diagnosis between the referring provider specialties; however, there were small numbers in each group.
We suggest one possible reason for the gender difference in time to diagnosis may be that women are less forthcoming with their symptoms, opting to self-medicate, or because they are less affected in their daily lives than men. Although men and women had similar ESS scores and similar narcolepsy related symptoms, men were more likely to report problems with personal relationships and more likely to experience a negative impact on their physical activity. Interestingly, greater impairments were reported by men even while women had more severe findings on MSLT. It is possible that women are delayed in their diagnosis due to underestimating their subjective sleepiness on the Epworth Sleepiness Scale and/or underestimating their degree of impairments. Alternatively, women may cope with narcolepsy symptoms differently allowing for different lifestyle implications. For example, women demonstrated more self-medicating behavior with greater proportion of women reporting use of daily caffeinated beverages. We ascertained daily caffeine use by asking subjects on average the number of cups of caffeinated coffee consumed per day, number of caffeinated sodas consumed per day, and number of power drinks consumed per day. We analyzed the percentage of subjects reporting daily caffeine use rather than comparing amount of caffeine intake because we assumed the former was more indicative of self-medicating behavior while the amount of caffeine per day is more reflective of caffeine response. Our study also showed greater percentage of women using over-the-counter stimulants and nicotine; however, these were not statistically significant. It should be noted that in both men and women, the vast majority reported impairments in work/school, social, and intimate relationships, confirming narcolepsy is a debilitating disease for the majority of patients. These discrepancies may not be specific to narcolepsy per se, and may represent a general pattern of gender effect on chronic disease. It is important to understand these implications in narcolepsy, however, because current treatments are directed at symptom management and improving quality of life. Understanding the impact of narcolepsy on lifestyle allows us to interpret treatment efficacy and affect important outcomes such as depression and obesity.
Obesity predicted a sooner narcolepsy diagnosis, and it may have been that obese individuals were more likely to be referred to sleep specialists for concerns of the more commonly recognized sleep disorder, sleep apnea, and in this process were diagnosed with narcolepsy. Patients whose symptoms started in childhood (age < 15 years old) were more likely to be delayed in their diagnosis (ρ = -0.61, p < 0.001); gender differences were apparent in this group as well. The median time for women with childhood onset symptoms (n = 23) was 15 years (13-23; 25% to 75%Q) compared to men (n = 15) who had a median time of 11 years (9-13; 25% to 75%Q; p = 0.04). Those with childhood narcolepsy were also more likely to have acquired psychiatric diagnoses (p = 0.045), suggesting that children with narcolepsy may have been more likely to be misdiagnosed with a psychiatric disorder, or that they are at greater risk for psychiatric comorbidities. It should be noted that these patients were from an adult sleep clinic, and therefore reflect adult patients who escaped diagnosis as children and are distinct from children with narcolepsy who are diagnosed accurately during childhood.
There were remarkably very little differences in the clinical presentation of men and women with narcolepsy, with the exception of a trend toward greater cataplexy in women. We suspect because of the elusive nature of cataplexy, the observed difference reflects a complex gender-influenced interaction between the patient's ability to recognize and communicate cataplexy symptoms, and the clinician's ability to diagnose cataplexy. Epidemiologic studies on narcolepsy have not consistently found a gender difference, and prevalence and incidence rates in both men and women differ by ethnicities and with changing narcolepsy definitions.23–26 Hypocretin deficiency, which is tightly associated with cataplexy,27–31 has not been described to be influenced by gender, although studies addressing this specific question have not been rigorously performed. The possibility of a true gender difference, however, should not be discounted. For example, greater rates of HLA DQB1 genotype has been described in Mexican women compared to men,32 suggesting greater susceptibility for cataplexy in women in this specific ethnic group.
The lack of a gender difference in the prevalence of cardiovascular disease and obstructive sleep apnea (defined as AHI ≥ 5)—diseases otherwise typified by male predominance—were unexpected, and raised the question of whether narcolepsy could be a risk factor for these diseases in women. We found an overall high prevalence of OSA in narcolepsy (> 20%) akin to that described by Sansa et al. (28% for AHI ≥ 10).33 While obesity was predictive of OSA in women with narcolepsy, women were not more likely to be obese than men. This suggests perhaps being female is not protective for OSA in patients with narcolepsy. Hypocretin-deficient mouse models such as the preprohypocretin knockout and orexin/ ataxin-3 transgenic mice have shown greater levels of serum leptin and greater leptin resistance in female than male mice.13 Leptin is known to be a ventilatory stimulant whose levels are elevated in OSA and decrease with CPAP use,34–38 and thus leptin has been hypothesized to be partially pathogenic in OSA.
Being female was also not protective of cardiovascular disease in this predominantly premenopausal sample of narcoleptics. In this group of patients, the occurrence of cardiovascular disease was independent of OSA status. Cardiovascular risk factors such as obesity and insulin resistance have been described in narcolepsy.42–44 Metabolic derangements are hypothesized to arise from perturbations in feeding and energy expenditure as well as sleep fragmentation, and hypocretin and leptin have been shown to directly impact cardiovascular function.45 It has been suggested that estrogen provides women cardiovascular protection through a hypocretin-mediated pathway,46,47 and our findings are supportive of the hypothesis that hypocretin-deficiency may reduce a woman's protective advantage against cardiovascular disease.48
There were 17 women and 11 men diagnosed with narcolepsy despite lack of initial MSLT findings of MSL < 8 minutes and 2 or more SOREMPs. These patients were diagnosed with narcolepsy based on highly suggestive clinical features such as cataplexy, and their MSLTs interpreted within their clinical context. For 14 women and 8 men, the lack of 2 or more SOREMPs on initial MSLT was attributed to REM suppressing medication use at the time of the study. Our MSLT positivity findings are consistent with the Aldrich study,49 in which they describe 2 or more SOREMPs occurring in approximately 80% of narcoleptic subjects during an initial diagnostic MSLT. They also reported 93% of those with cataplexy and 97% of narcoleptics without cataplexy had MSL < 8 minutes, a finding similar to our cohort. They concluded that while the MSLT is highly sensitive and specific for narcolepsy when narcolepsy is clinically suspected, exclusive reliance on MSLT for the diagnosis of narcolepsy may lead to misdiagnosis or non-diagnosis. It is recommended if there is a high clinical suspicion for narcolepsy without cataplexy that MSLT be repeated when initial results are non-diagnostic. Unfortunately in many of our cases it was felt unsafe or patients refused to be discontinued off confounding medications for a repeat MSLT. Because we do not have repeat MSLT data, we concede it is possible that up to 27% of our study group may represent alternative diagnoses such as idiopathic hypersomnia. However, there were no clinical or demographic differences between those that did and did not meet strict International Classification of Sleep Disorders 2nd edition criteria for narcolepsy.
The results of this study represent a cohort of patients from a single academic adult sleep center, and thus its application to narcoleptics from other centers is limited. Hypocretin levels were not measured thus the role of hypocretin deficiency was speculative. While hypocretin deficiency is ubiquitous in cataplexy, its role in narcolepsy without cataplexy is heterogeneous and unpredictable.50,51 Sixteen patients otherwise qualifying for the study were not included in the analysis due to pertinent missing data. Thirteen of these 16 patients were women. While selection bias may have affected results, we were reassured by similar demographic and polysomnographic findings in this excluded group. Finally, since many of the symptoms and disease history depended on self-reporting, we are not able to exclude gender-influenced recall bias.
This is the first study dedicated to addressing gender differences in the clinical presentation of narcolepsy, and to investigate the impact of the diagnosis in women. There are many studies to suggest gender impacts disease differently across a spectrum of common sleep conditions. Likewise, we have shown that men and women with narcolepsy despite similar symptom severity and profile have important differences in health care, health risks, and lifestyle impairments. This study substantiates the need for further research on the influence of gender on narcolepsy, and emphasizes the importance of thoughtfulness to gender in future research on narcolepsy.
This was not an industry supported study. The authors have indicated no financial conflicts of interest.
Phillips BA, Collop NA, Drake C, Consens F, Vgontzas AN, Weaver TE, authors. Sleep disorders and medical conditions in women. In: J Womens Health (Larchmt). 2008. 17. Proceedings of the Women & Sleep Workshop, National Sleep Foundation; March 5-6, 2007; Washington, DC. p. 1191–9.
Valipour A, Lothaller H, Rauscher H, Zwick H, Burghuber OC, Lavie P, authors. Gender-related differences in symptoms of patients with suspected breathing disorders in sleep: a clinical population study using the sleep disorders questionnaire. Sleep. 2007;30:312–9. [PubMed]
Redline S, Kump K, Tishler PV, Browner I, Ferrette V, authors. Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med. 1994;149:722–6. [PubMed]
Berger K, Luedemann J, Trenkwalder C, John U, Kessler C, authors. Sex and the risk of restless legs syndrome in the general population. Arch Intern Med. 2004;164:196–202. [PubMed]
Bixler EO, Vgontzas AN, Lin HM, et al., authors. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163:608–13. [PubMed]
Kapsimalis F, Kryger MH, authors. Gender and obstructive sleep apnea syndrome, part 1: clinical features. Sleep. 2002;25:412–9. [PubMed]
Kapsimalis F, Kryger MH, authors. Gender and obstructive sleep apnea syndrome, part 2: mechanisms. Sleep. 2002;25:499–506. [PubMed]
Shepertycky MR, Banno K, Kryger MH, authors. Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep. 2005;28:309–14. [PubMed]
Zhang B, Wing YK, authors. Sex differences in insomnia: a meta-analysis. Sleep. 2006;29:85–93. [PubMed]
Greenberg-Dotan S, Reuveni H, Simon-Tuval T, Oksenberg A, Tarasiuk A, authors. Gender differences in morbidity and health care utilization among adult obstructive sleep apnea patients. Sleep. 2007;30:1173–80. [PubMed]
Hayduk R, Flodman P, Spence MA, Erman MK, Mitler MM, authors. HLA haplotypes, polysomnography, and pedigrees in a case series of patients with narcolepsy. Sleep. 1997;20:850–7. [PubMed Central][PubMed]
Dauvilliers Y, Neidhart E, Lecendreux M, Billiard M, Tafti M, authors. MAO-A and COMT polymorphisms and gene effects in narcolepsy. Mol Psychiatry. 2001;6:367–72. [PubMed]
Fujiki N, Yoshida Y, Zhang S, Sakurai T, Yanagisawa M, Nishino S, authors. Sex difference in body weight gain and leptin signaling in hypocretin/orexin deficient mouse models. Peptides. 2006;27:2326–31. [PubMed Central][PubMed]
Littner MR, Kushida C, Wise M, et al., authors. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep. 2005;28:113–21. [PubMed]
Littner M, Hirshkowitz M, Kramer M, et al., authors. Practice parameters for using polysomnography to evaluate insomnia: an update. Sleep. 2003;26:754–60. [PubMed]
Walsh SJ, Rau LM, authors. Autoimmune diseases: a leading cause of death among young and middle-aged women in the United States. Am J Public Health. 2000;90:1463–6. [PubMed]
Longstreth WT Jr.; Koepsell TD, Ton TG, Hendrickson AF, van Belle G, authors. The epidemiology of narcolepsy. Sleep. 2007;30:13–26. [PubMed]
Silber MH, Krahn LE, Olson EJ, Pankratz VS, authors. The epidemiology of narcolepsy in Olmsted County, Minnesota: a population-based study. Sleep. 2002;25:197–202. [PubMed]
Hayes D Jr, author. Narcolepsy with cataplexy in early childhood. Clin Pediatr (Phila). 2006;45:361–3. [PubMed]
Kryger MH, Walid R, Manfreda J, authors. Diagnoses received by narcolepsy patients in the year prior to diagnosis by a sleep specialist. Sleep. 2002;25:36–41. [PubMed]
Dauvilliers Y, Montplaisir J, Molinari N, et al., authors. Age at onset of narcolepsy in two large populations of patients in France and Quebec. Neurology. 2001;57:2029–33. [PubMed]
Wing YK, Chen L, Fong SY, et al., authors. Narcolepsy in Southern Chinese patients: clinical characteristics, HLA typing and seasonality of birth. J Neurol Neurosurg Psychiatry. 2008;79:1262–7. [PubMed]
Ohayon MM, Priest RG, Zulley J, Smirne S, Paiva T, authors. Prevalence of narcolepsy symptomatology and diagnosis in the European general population. Neurology. 2002;58:1826–33. [PubMed]
Lavie P, Peled R, authors. Narcolepsy is a rare disease in Israel. Sleep. 1987;10:608–9. [PubMed]
Wing YK, Li RH, Lam CW, Ho CK, Fong SY, Leung T, authors. The prevalence of narcolepsy among Chinese in Hong Kong. Ann Neurol. 2002;51:578–84. [PubMed]
Hublin C, Kaprio J, Partinen M, et al., authors. The prevalence of narcolepsy: an epidemiological study of the Finnish Twin Cohort. Ann Neurol. 1994;35:709–16. [PubMed]
Hara J, Beuckmann CT, Nambu T, et al., authors. Genetic ablation of orexin neurons in mice results in narcolepsy, hypophagia, and obesity. Neuron. 2001;30:345–54. [PubMed]
Blouin AM, Thannickal TC, Worley PF, Baraban JM, Reti IM, Siegel JM, authors. Narp immunostaining of human hypocretin (orexin) neurons: loss in narcolepsy. Neurology. 2005;65:1189–92. [PubMed]
Thannickal TC, Moore RY, Nienhuis R, et al., authors. Reduced number of hypocretin neurons in human narcolepsy. Neuron. 2000;27:469–74. [PubMed]
Nishino S, Ripley B, Overeem S, Lammers GJ, Mignot E, authors. Hypocretin (orexin) deficiency in human narcolepsy. Lancet. 2000;355:39–40. [PubMed]
Peyron C, Faraco J, Rogers W, et al., authors. A mutation in a case of early onset narcolepsy and a generalized absence of hypocretin peptides in human narcoleptic brains. Nat Med. 2000;6:991–7. [PubMed]
Alaez C, Lin L, Flores AH, et al., authors. Association of narcolepsy-cataplexy with HLADRB1 and DQB1 in Mexican patients: a relationship between HLA and gender is suggested. BMC Med Genet. 2008;9:79. [PubMed Central][PubMed]
Sansa G, Iranzo A, Santamaria J, authors. Obstructive sleep apnea in narcolepsy. Sleep Med. 2010;11:93–5. [PubMed]
Shimura R, Tatsumi K, Nakamura A, et al., authors. Fat accumulation, leptin, and hypercapnia in obstructive sleep apnea-hypopnea syndrome. Chest. 2005;127:543–9. [PubMed]
Cuhadaroglu C, Utkusavas A, Ozturk L, Salman S, Ece T, authors. Effects of nasal CPAP treatment on insulin resistance, lipid profile, and plasma leptin in sleep apnea. Lung. 2009;187:75–81. [PubMed]
Tokuda F, Sando Y, Matsui H, Koike H, Yokoyama T, authors. Serum levels of adipocytokines, adiponectin and leptin, in patients with obstructive sleep apnea syndrome. Intern Med. 2008;47:1843–9. [PubMed]
Ozturk L, Unal M, Tamer L, Celikoglu F, authors. The association of the severity of obstructive sleep apnea with plasma leptin levels. Arch Otolaryngol Head Neck Surg. 2003;129:538–40. [PubMed]
Ip MS, Lam KS, Ho C, Tsang KW, Lam W, authors. Serum leptin and vascular risk factors in obstructive sleep apnea. Chest. 2000;118:580–6. [PubMed]
Plazzi G, Ferri R, Antelmi E, et al., authors. Restless legs syndrome is frequent in narcolepsy with cataplexy patients. Sleep. 2010;33:689–94. [PubMed]
Ferri R, Zucconi M, Manconi M, et al., authors. Different periodicity and time structure of leg movements during sleep in narcolepsy/cataplexy and restless legs syndrome. Sleep. 2006;29:1587–94. [PubMed]
Billiard M, author. REM sleep behavior disorder and narcolepsy. CNS Neurol Disord Drug Targets. 2009;8:264–70. [PubMed]
Nowak KW, Mackowiak P, Switonska MM, Fabis M, Malendowicz LK, authors. Acute orexin effects on insulin secretion in the rat: in vivo and in vitro studies. Life Sci. 2000;66:449–54. [PubMed]
Schuld A, Hebebrand J, Geller F, Pollmacher T, authors. Increased body-mass index in patients with narcolepsy. Lancet. 2000;355:1274–5. [PubMed]
Honda Y, Doi Y, Ninomiya R, Ninomiya C, authors. Increased frequency of non-insulin-dependent diabetes mellitus among narcoleptic patients. Sleep. 1986;9:254–9. [PubMed]
Shirasaka T, Takasaki M, Kannan H, authors. Cardiovascular effects of leptin and orexins. Am J Physiol Regul Integr Comp Physiol. 2003;284:R639–51. [PubMed]
Russell SH, Small CJ, Kennedy AR, et al., authors. Orexin A interactions in the hypothalamo-pituitary gonadal axis. Endocrinology. 2001;142:5294–302. [PubMed]
Campbell RE, Grove KL, Smith MS, authors. Gonadotropin-releasing hormone neurons coexpress orexin 1 receptor immunoreactivity and receive direct contacts by orexin fibers. Endocrinology. 2003;144:1542–8. [PubMed]
El-Sedeek M, Korish AA, Deef MM, authors. Plasma orexin-A levels in postmenopausal women: possible interaction with estrogen and correlation with cardiovascular risk status. BJOG. 2010;117:488–92. [PubMed]
Bassetti C, Aldrich MS, Quint DJ, authors. MRI findings in narcolepsy. Sleep. 1997;20:630–1. [PubMed]
Oka Y, Inoue Y, Kanbayashi T, et al., authors. Narcolepsy without cataplexy: 2 subtypes based on CSF hypocretin-1/orexin-A findings. Sleep. 2006;29:1439–43. [PubMed]
Thannickal TC, Nienhuis R, Siegel JM, authors. Localized loss of hypocretin (orexin) cells in narcolepsy without cataplexy. Sleep. 2009;32:993–8. [PubMed]


text:
La Purisima Mission State Park
Founded in 1787, the La Purisima Mission land holdings once covered nearly 470 square miles. Bordered by the Santa Maria River in the North and the Gaviota coastline in the South, the land was home to the Chumash people and Spanish settlers. The mission was best known for its hides and blankets, and at its peak inhabitants herded as many as 24,000 cattle and sheep.
Today, history lives at La Purisima. The most extensively restored mission in the state, La Purisima hosts over 200,000 visitors each year for recreation and a chance to explore California's heritage.
We are open nearly every day for self-guided tours, and frequently the park provides a re-creation of life here during the 1820's, when the residents engaged in weaving, pottery making, candle making, blacksmithing, livestock production, and leatherwork.
In addition to the restored original buildings, the nearly 2,000 acre park is home to 25 miles of hiking trails, a modern Visitor Center and Exhibit Hall, and livestock.
This website is presented by Prelado de los Tesoros de la Purisima. Our name, loosely translated, means "Keepers of the Treasures of La Purisima."
We invite you to explore the website's three main areas: Visit, Learn, and Join. The Visit menu explains how best to experience the mission for yourself, including driving directions, building maps, and an extensive photo gallery. The audience for the Learn menu is students and teachers. Each year we are a destination for thousands of children as part of our Student Learning History Days program. The Join menu explains how you can become part of the Mission experience.
Prelado is a non-profit, volunteer organization that assists the staff at La Purisima Mission State Historic Park preserve history and provide quality educational programs for park visitors.
Mision La Purisima Concepcion de Maria Santisima was founded on December 8, 1787 by Franciscan Padre Presidente Fermin Francisco Lasuen. La Purisima was the eleventh mission of the twenty-one Spanish Missions established in what later became the state of California.
A Place in Time: The Story of La Misión de la Purisima Concepcion
(with subtitles)


text:
Escort of the Week
Featured Escort
Featured Escort
Featured Mistress
Experience exciting hours for two with a lovely escort from Sweet Passion Escort. Whether as a high-quality entertainment for business events, as attractive company at a concert or as a pleasurable playmate in the hotel room - our escort ladies from Sweet Passion Escort pamper you in every possible way. Visit our website and be inspired by our escorts.
All logos and trademarks in this site are property of their respective owner. The comments are property of their posters, all the rest © Punterlink 2000 - 2019.
Punterlink is an information resource, and as such has no connection or liability with any of the sites mentioned herein.
Unauthorized use of Punterlink by commercial organizations will be prosecuted...


text:
The California budget debate is about children as abstractions -- how will we fund their schools and the health and social services programs upon which they depend.
A new report from the Public Policy Institute of California puts a face on California's poor children -- who are nearly one in four of all California children.
Poor children in California are more likely to be from the Central Valley (where the major counties have high poverty rates) or Los Angeles. (The five Bay Area counties have child poverty rates below 13 percent, compared to 23 percent statewide).
The child poverty rates for Latinos, African Americans, and kids with single parents are much higher than the statewide average.
The report dispels some myths about California and its children.
Child poverty is not at some record high today -- the poverty rate was higher during the big early '90s recession. California isn't some sort of national leader in child poverty -- our rate is only slightly higher than the national average.
Most poor children aren't from other countries -- they were born here.
Most distressingly, the child poverty rate is on the rise -- up from 16 percent, a record low in this measurement, in 2001.
Let us know what you think. Comment below, send us your thoughts via Twitter @PropZero or add your


text:
NORWICH � Two days after a standoff with police, Anthony Lafemina told a judge that the police and the media made the incident seem much worse than it actually was.
Lafemina was arraigned Thursday in Norwich Superior Court on charges of third-degree assault and second-degree breach of peace.
Both charges are misdemeanors. The assault charge carries a penalty of up to a year in prison. The breach of peace charge carries a penalty of up to six months in prison.
Neither charge relates to the standoff, which began about 2 a.m. Tuesday and ended shortly after 10:30 a.m., when Lafemina agreed to leave his Great Plain Road home and was put under arrest.
More than a dozen officers, many wearing helmets and protective armor and carrying assault rifles and shields, surrounded Lafemina�s home during the standoff. Police were called there after getting a report of a domestic disturbance. Police said Lafemina refused to come out or let officers into the house, which led to lengthy negotiations before he changed his mind.
Lafemina did not have a weapon, and no one was hurt, police said.
Judge Thomas Moukawsher issued a protective order and asked that Lafemina be evaluated for substance abuse and mental health problems.
Lafemina protested the order to Moukawsher. �I don�t feel I�m a threat to the public,� he said. �I had a night out. I was drinking. � I�m asking you to reconsider.�
A woman sitting in the courtroom whom authorities identified as the victim in Lafemina�s domestic violence case joined him in asking the judge not to issue the order, saying Lafemina was not a violent person. The Bulletin does not identify victims or potential victims of domestic violence.
Moukawsher declined to change his order, but said it could be modified when Lafemina returns to court Jan. 6.
�You made threats. You made comments that had everyone concerned,� Moukawsher said. �You have to understand what happened here is not a minor matter. � Without some examination, I�m not going to take that risk.�
Lafemina also asked Moukawsher to stop a Bulletin photographer from taking his picture during the arraignment, saying he already had received too much publicity as a result of the incident.
�Yes, I was put on the front page of the newspaper, I was all over the news,� he said. �I don�t feel I did something that bad that they need to keep reporting on it.�
�I don�t mean to add to your burdens,� Moukawsher told Lafemina, but the judge denied his request, saying policy required courts to be public except in a few circumstances.


text:
Chuong Vo Tennis Coaching
- 0402 22####
Blair Athol SA 5084Click to view map
- Send email
About Us
View similar businesses near: Blair Athol SA
Tennis Coaches
There are no reviews for this business
Squash Centre Thornleigh
"I was attending a gym for many years but it got boring so I wanted to try something new, I walked in never played squash before and the staff were so helpful, they showed me how to play and even gave me a free mini lesson to improve my game. I now play every week twice a week and feel so good after the workout that Squash provides."
Squash Centre Thornleigh
"Lovely atmosphere! I felt welcomed as soon as I walked through the door. Courts are very well maintained, and service was friendly! I was very happy to play at Thornleigh Squash Courts, would much recommend a visit anytime!!"
Squash Centre Thornleigh
"The competitions are well organised and new players can get off to a great start even if they have never played before due to the staff being well experienced and helpful"
McDonald School of Tennis, ACT
"Matt Mcdonald at McDonalds School of tennis is a fanastic coach. He is patient and makes playing tennis fun. His teaching techniques work across all ages from my 6 year son to my 13 year old girl. i have even had lessons. I highly recommend him. Kate"
Alan Frost Tennis School
"Alan Frost, funniest man and awesome tennis coach!!!!!!! 1 000 000 stars!"
Alan Frost Tennis School
"Love it. Have been learning from Alan Frost for allmost ten years and it is exclent. Great Coaches and Great Service. Definately Recomend it."
Emma Clayton on 29th Apr 2014
Matthew Bridle on 17th Apr 2014
Anthony Thomas on 11th Apr 2014
Kate on 25th May 2012
1234bang on 10th Nov 2010
tennisgirl on 21st Feb 2010