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Adolescents with obstructive sleep apnea syndrome (OSAS) represent an important but understudied subgroup of long-term continuous positive airway pressure (CPAP) users. The purpose of this qualitative study was to identify factors related to adherence from the perspective of adolescents and their caregivers.
Individual open-ended, semi-structured interviews were conducted with adolescents (n = 21) and caregivers (n = 20). Objective adherence data from the adolescents' CPAP machines during the previous month was obtained. Adolescents with different adherence levels and their caregivers were asked their views on CPAP. Using a modified grounded theory approach, we identified themes and developed theories that explained the adolescents' adherence patterns.
Adolescent participants (n = 21) were aged 12-18 years, predominantly male (n = 15), African American (n = 16), users of CPAP for at least one month. Caregivers were mainly mothers (n = 17). Seven adolescents had high use (mean use 381 ± 80 min per night), 7 had low use (mean use 30 ± 24 min per night), and 7 had no use during the month prior to being interviewed. Degree of structure in the home, social reactions, mode of communication among family members, and perception of benefits were issues that played a role in CPAP adherence.
Understanding the adolescent and family experience of using CPAP may be key to increasing adolescent CPAP adherence. As a result of our findings, we speculate that health education, peer support groups, and developmentally appropriate individualized support strategies may be important in promoting adherence. Future studies should examine these theories of CPAP adherence.
Prashad PS; Marcus CL; Maggs J; Stettler N; Cornaglia MA; Costa P; Puzino K; Xanthopoulos M; Bradford R; Barg FK. Investigating reasons for CPAP adherence in adolescents: a qualitative approach. J Clin Sleep Med 2013;9(12):1303-1313.
Obstructive sleep apnea syndrome (OSAS) affects approximately 2% of children and adolescents.1 OSAS in children may result in severe complications if left untreated, such as growth failure, pulmonary hypertension, neurocognitive deficits, behavioral problems, and attention deficit hyperactivity disorder.2–6
In young children, OSAS can often be treated with adenotonsillectomy. However, in adolescents, adenotonsillectomy may not be effective, as adenoids and tonsils involute with age7,8 and obesity is more likely to be present. While weight loss may be an effective treatment for OSAS in this age group, it is difficult to achieve and maintain, particularly for those with severe obesity. Therefore, continuous positive airway pressure (CPAP) has become the mainstay of treatment of OSAS in adolescents.
CPAP is an effective treatment for OSAS in adolescents, but adherence remains a challenge.9–12 CPAP adherence patterns of adolescents have not been extensively studied, but studies of medication adherence in other adolescent groups, such as asthmatics, epileptics, and diabetics have demonstrated poor adherence.13,14 Poor adherence in adolescents may be related to not understanding or not perceiving the benefits of the treatment, wanting to conform to peers, and rebelling against authority.15 In addition, adolescents may have little parental supervision of CPAP use. Because of a lack of published literature, we performed an exploratory study from the perspective of adolescents and their caregivers. To our knowledge, this is the first study focused on the adolescent age group.
Current Knowledge/Study Rationale: Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea syndrome (OSAS) in adolescents, when used, but adherence is a challenge. The purpose of the current study was to identify and explore factors that influenced adolescent CPAP use.
Study Impact: This is one of the first studies to provide information about reasons for continuous positive airway pressure (CPAP) adherence and nonadherence in adolescents, a growing group of CPAP users who have been understudied.
The purpose of the study was to identify and explore factors that influenced adolescent CPAP use, using a modified grounded theory approach.16 Grounded theory is a qualitative method that seeks to generate theories from the data, to offer explanations for the phenomenon being explored.
This exploratory study consisted of qualitative semi-structured interviews and a download of the adolescent's adherence data from his or her CPAP machine during the previous month. As experienced physicians in pediatric sleep medicine, it was impossible to set aside our preconceived notions regarding CPAP adherence. As a consequence, we acknowledged these notions and used them to generate a tentative framework from which we developed the initial interview questions. This framework led us to explore issues of stress, parenting style, family structure and organization, behavior and emotional problems, knowledge about OSAS, and the purpose and benefits of treatment with CPAP. We used these notions to identify and explore factors that may act as barriers and facilitators of CPAP use.
Details of the study participants are shown in Table 1. Each participant had been diagnosed with OSAS by polysomnography. All participants had been prescribed CPAP therapy as part of their usual care for at least one month prior to recruitment. Details of how long the study participants had been prescribed CPAP are shown in Table 1. Participants were purposively recruited across the spectrum of adherence. We also included a caregiver for each adolescent in the study, defined as a parent, relative, or other adult with the responsibility of caring for the adolescent. Exclusion criteria included non-English speakers, developmental delays, and the presence of another severe chronic medical condition.
Details of the study participants
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Approval was obtained from the Children's Hospital of Philadelphia Institutional Review Board. Parental/guardian informed consent was obtained, as well as child assent for those younger than 18 years of age. Participants were provided reimbursement for their time.
Each individual semi-structured interview was conducted by one of three interviewers conversant with qualitative methodology and interviewing techniques. The approach used was to ask questions exploring the issues within the framework developed for the study. The semi-structured nature of the interview was piloted with a related caregiver and adolescent. Their feedback helped us identify appropriate language and phrases that would be understood by the participants. Examples of the type of questions used to explore these issues are shown in Table 2. By using a semi-structured approach, we ensured that the same topics were explored with each family; however, the interviewers had the scope to be responsive to the issues that arose during the interview and to ask more probing questions. Most interviews were audio recorded, transcribed verbatim, and reviewed by the interviewer for accuracy. Three interviewees refused to have their interviews audio recorded, so notes were taken instead. In addition, the interviewers took field notes and noted general impressions for each interview, which were used in the analysis process. The mean time for interviews was 30 minutes.
Examples of semi-structured interview questions for adolescents
The decision to use modified grounded theory for the analysis16 was made because the framework was created using the researchers' experience and the analysis was inevitably influenced by this experience. Five of the authors read the transcribed text and looked for the factors that had been previously identified as being potentially relevant to CPAP use, as well as allowing other factors to emerge. The authors were conscious of a need to understand the meaning of the responses within the context provided by the participants. In order to facilitate this understanding, interim analyses were informally conducted by the lead investigator and the interviewers after each interview which allowed for the identification of themes to explore in depth in subsequent interviews. We decided to invite for interview all eligible families who attended the sleep center during the study period until we reached saturation (where no new themes were emerging). In order that all the coders had a shared understanding of the concept and context that underpinned each code, we developed what we termed a "codebook" to help insure the integrity and reliability of the coding. Each transcript was independently coded by the 5 authors using NVivo 9.0 software (Doncaster, Victoria), and 85% agreement was found among the coders. Remaining differences in coding were discussed and resolved among the coders. Two authors then refined the factors and categories and created themes and theories (Table 3). These revised themes and theories were reviewed and validated by one of the 5 original coders. Records were kept that demonstrate an audit trail of the data processing and reveal how the theories emerged from the data.
Development of coding, themes, and theories from the initial theories
Objective adherence data from the previous month was obtained from the adolescents' CPAP machines using Encore Pro2 software (Phillips Respironics, Murraysville, PA). In order to explore potential differences between adolescent users, participants were divided into those with high use, low use, and no use based on tertiles of number of minutes used per night. The adherence data was downloaded at the end of the interview and independently reviewed with the adolescent and caregiver, and used to further explore adherence.
Using the departmental CPAP database, 36 families with adolescents who met the eligibility criteria during the study period were approached. 28 (78%) agreed to participate. Seven of these did not come to their study appointments, and thus, 21 adolescents (including one set of twins) were enrolled along with 20 caregivers. Mean CPAP use was 381 ± 80 (SD) (range 213-468) min/night for adolescents with high use (n = 7), 30 ± 24 (range 8-65) min/night for adolescents with low use (n = 7), and zero min/night for adolescents with no use (n = 7).
By comparing adolescents with high, low, and no use, we identified factors associated with CPAP adherence that differentiated use in the groups. This led us to create 4 theories of CPAP use. We postulate that each of the following factors has an effect on CPAP adherence: (1) The extent and nature of structure in the home and family, (2) style of communication between care-givers and adolescents, (3) social reactions and attitudes, and (4) adolescent perception of benefits. Exemplar quotes for each theme can be found in Tables 4–7.
Relationship between quotes, themes and theory: the extent and nature of structure in the home/family affects CPAP adherence
Relationship between quotes, themes and theory: the style of communication between caregivers and adolescents affects CPAP adherence
Relationship between quotes, themes and theory: social reactions and attitudes affect CPAP adherence
Relationship between quotes, themes and theory: adolescent perception of benefits affects motivation for CPAP adherence
Adolescents with high use described having a stable family structure. Their caregivers were able to organize routines that incorporated CPAP use into their daily lives. When problems occurred, the caregivers were able to identify the issues and work to resolve them, sometimes in creative ways. For example, one participant described how family meetings were used to address concerns.
Adolescents with low and no use described a lack of stability in their family life, and unsuccessful attempts by their caregivers to incorporate CPAP use into their daily lives. For example, a caregiver felt challenged to create a better nighttime routine to enable her daughter to use her CPAP machine.
Adolescents with high use demonstrated an awareness or knowledge of what is needed for nightly CPAP use. Clearly, having CPAP incorporated into nighttime routines means it is less likely to be forgotten. Adolescents with low or no use described not wanting to use their CPAP machines and deliberately forgetting to use them at night.
Communication methods about CPAP differed between adolescents with high versus low and no use and their care-givers. Adolescents with high use were not disquieted by their caregivers' reminders to use CPAP. These reminders were appreciated by them and found to be helpful. Consistency was identified as being important by participant 11, who divided her time between different parental homes.
Adolescents with low and no use described that yelling by their caregivers would decrease their motivation for use. They felt that this showed that their caregivers did not understand how difficult it was for the adolescents to use CPAP.
The caregivers of adolescents with high use described an authoritative parenting style, e.g. explaining why it was important to use CPAP and then giving their adolescents the choice whether to use it or not. Four of 7 of the adolescents with high use have been using the device since they were much younger, less than 10 years old, and are currently using it and cleaning it largely without parental supervision (Table 1).
By contrast, the caregivers of the adolescents with low and no use exemplified an authoritarian parenting style. The quote from the mother of participant 1 typifies this style in her response to asking about strategies used to encourage adherence. Since 13/14 of these adolescents were prescribed CPAP at an older age (> age 10; Table 1), they were initially trusted to use CPAP independently. When caregivers discovered that they had not been using it, caregivers tried to facilitate use by punishment and threats. These scenarios rarely resulted in the adolescent exhibiting the desired behaviors. Indeed, these punishments and threats appeared to have the opposite effect.
Within the theme of social reactions and attitudes that affect CPAP adherence, was a sub-theme of desire to please which seemed closely linked to the notion of self-respect. Adolescents with high use revealed an awareness of their caregivers' concerns about their health and the consequences of having sleep apnea. They expressed a desire to alleviate their care-givers' anxiety by using CPAP.
Rebellious attitudes were noted by the caregivers of the participants with low or no use. Parental promotion of CPAP use can become an issue of contention. Within our participants, we found that teenagers who described rebellious attitudes tended to be lower users. Adolescents with low and no use were influenced by their peers' knowledge of them having a CPAP machine. These users appeared to be ashamed about having to use CPAP and expressed wanting to be like peers. Their desire to conform to peer norms was also noted by caregivers.
Some participants did not express any need to use CPAP. A sub-theme of invulnerability was related to the theme of adolescent perception of benefits affects motivation. This feeling of invulnerability in the adolescents was recognized by their care-givers too.
Stress within a family was linked to CPAP use. High use appeared to decrease stress. While adolescents with low and no use did not perceive lack of CPAP adherence to be an issue related to stress, adolescents' lack of use was seen as a factor in increasing the stress in the lives of the caregivers.
Adolescents with high use seemed to be motivated by fear of the consequences of not using CPAP. Adolescents with low and no use appeared indifferent to the knowledge of the consequences of not using CPAP. They expressed indifference about their lack of use being detrimental to their health.
Adolescents with high use consistently described receiving benefits from CPAP use. They appeared to be untroubled by the adverse side effects they suffered. However, adolescents with low and no use were more variable in noticing benefits from CPAP, which may have been due to inconsistent use. They complained about discomfort and saw this as a reason for disuse.
In adolescents with low and no use, being shown evidence of their lack of use provoked surprise. The low use participants were especially astonished about their lack of use. Their expressions showed a belief that they thought they had been using their CPAP machines more. Participant 12 said, "I like I had the machine set up …So I guess I was using it and I take it off when I was asleep." Participant 15 said, "I usually would think that I would have it on long, but then I see it don't look like I have it on that long at all."
Caregivers expressed surprise and concern when presented with the evidence of low or no use. The mother of participant 13 responded that she thought her daughter was using her CPAP machine most nights. After seeing the download of her daughter's CPAP use during the past month, she said "She has to use it more, …I'm gonna stay on top of it."
Little is known about the perspectives of adolescent CPAP users and their caregivers. This is important as adherence in this age group is often poor. Gaining these insights may be of benefit to clinicians in identifying factors to explore with adolescent patients and their families to facilitate optimal use.
Adolescents may have difficulty adhering to treatment regimens devised by health professionals and parents because of poorly developed abstract thinking. This problem may manifest as a poor ability to plan and prepare for different situations using abstract concepts17; therefore, family organization is key. Bender found in a quantitative study that non-adherence, to β-agonists and corticosteroids in 24 asthmatic children, increased with the level of disorganization or dysfunction within the family.18 Our qualitative results support this conclusion with CPAP adherence: for families of adolescents with high use, CPAP use was considered an important family priority by both the caregivers and the adolescents. Also, households with an adolescent with high use maintained an organized structure for managing CPAP use, e.g., caregiver present at bedtime and facilitating the adolescents using CPAP away from home.
Youth with behavior problems are especially at risk for poor adherence. According to family process theories, behaviorally disordered youth tend to lack routines in their lives, which is hypothesized to compromise their compliance with a daily, multifaceted treatment regimen.19 Greening found it is important that clinicians help families recognize the critical aspects of the child's medical regimen and to integrate the treatment plan into the child's and family's current routine activities.20 If a routine does not exist, it may be beneficial for the clinical team to facilitate the development of a routine with the family that incorporates CPAP.
Starting in early adolescence, parents and adolescents begin to have less interactions and spend less time together outside the home than they did previously and children's conformity to their peers peaks, reflecting the importance of social acceptance.21 This distancing in parent-adolescent relations has a functional value for adolescents in that it fosters their independence, prompts them to try more things on their own, and develops their sense of efficacy.22 Caregivers may view their adolescents as emerging adults and may expect their adolescent to use CPAP independently without support and supervision. Of note, most high users initiated CPAP during childhood rather than adolescence, when their parents may have played a more active role.
Parenting style can contribute to adolescent adherence patterns. Family environments that encourage autonomy and the early adolescent's role in family decision making are associated with self-esteem, self-reliance, satisfaction with school and student-teacher relations, positive school adjustment, and advanced moral reasoning.23 Recognizing the emerging adult autonomy of an adolescent is a factor that can contribute to optimal use by encouraging a sense of self-respect and self-discipline and fostering mature and responsible health decision-making. Conversely, a parenting style that is coercive, authoritarian, and not attuned to the adolescent's need for autonomy and input is associated with self-consciousness and lowered self-esteem which can have negative implications for CPAP adherence.24
Research from several investigators25–27 suggests that adolescents' relationships with their parents can be also be stressful during early and middle adolescence due to developmental changes. This stress is often focused on issues of control and autonomy within the family, which are renegotiated during this developmental period. Ideally, the renegotiation process would be a smooth transition for both adolescents and parents, but as children mature and take more responsibility for their own lives; it is not easy for parents to determine the optimal level of autonomy versus control. According to the stage-environment fit perspective, one would predict strained relationships wherever there is a poor fit between the child's desire for increasing autonomy and the opportunities for independence and autonomy provided by the child's parents.28
Monaghan found that an authoritative parenting style was associated with significantly less parenting stress than authoritarian or permissive parenting styles.29 In our study, an authoritative parenting style was more common among caregivers of adolescents with high use and an authoritarian style was more likely to be demonstrated by caregivers of no and low use adolescents. Our findings were consistent with studies of other treatment regimens which found that caregivers with an authoritative parenting style were associated with improved treatment adherence.30–32 For adolescents with low and no use, there were some caregivers who would try to assist with using CPAP, but their authoritarian parenting style led them to have expectations that were unrealistic resulting in little or no CPAP use. This phenomenon has described in the literature as "Miscarried Helping."33 DiMatteo also found that social support from caring family members, family cohesiveness, and positive family interaction patterns strongly affect adherence. Conversely, family conflict and negative feelings in the family can serve as powerful factors related to non-adherence, as well as by being upsetting and stressful.34 Effective communication is important in the parental promotion of CPAP adherence.
Offering occasional reminders and checking on adolescents at bedtime as a means of encouraging the establishment of CPAP into their routines seems to promote adherence. Berating or nagging appeared to have the opposite effect than intended.
There was a difference in the age CPAP was prescribed between the high users and low and no users (Table 1). We believe this shows the difficulty of introducing CPAP in the adolescent age group. Introducing CPAP prior to adolescence, when children's behaviors are more malleable and parents have greater influence and control,28 is likely to be less challenging, although can still take time for the child to become accustomed to using the mask and machine. When CPAP is prescribed at a younger age, there is a longer opportunity for it to become a routine part of the adolescent's life and the patient may have a better sense of the benefits of use. Introducing CPAP use during adolescence may be especially challenging because of rebellion and emerging autonomy, as discussed below.
Concerns about health contributed to stress levels in participants' families. Although high stress levels in the families of low and no users may not have been entirely attributable to poor adherence, poor CPAP use was a cause of stress for the caregivers. Becoming aware of family stressors is important so that the health care providers consider the social situation of the families to begin the conversation that despite having other stresses how can they best support the family in using CPAP and making its use a priority. The way CPAP is initiated may be important to facilitate adherence. Adding CPAP to a family that is already coping with significant stressors may only magnify stress in the household and impede actual use of CPAP.
Some high users attributed the reasons for their regular use of CPAP to a desire to please their caregivers. They expressed concern about their parents' anxiety about their OSAS and did not want to upset them. They seemed to have a greater sense of self-worth than the low and no users and had a sense of responsibility for their own and their parents' well-being. Encouraging self-respect and fostering a sense of responsibility would appear to be a helpful strategy for increasing adherence.
The participant-caregiver relationship also appeared to play a role in adherence. Within the high users, most participants described cohesive family relationships. Although a close relationship with the parent facilitates adherence in young adolescents, if the parent is overprotective, it may prove challenging for the adolescent to achieve autonomy and assume responsibility for their CPAP use. Overprotection has been shown to cause social isolation and interfere with the development of individual ability for self-care.35
A normal facet of adolescence is to rebel against authority and to challenge limits set by family caregivers. One of the main tasks of adolescence is to become an autonomous individual. The drive for autonomy stems from biological processes marking the transition to a more adult role (puberty and increasing cognitive maturity) and from shifts in social roles and expectations. As adolescents become physically mature, they begin to question family rules and roles, leading to conflicts.21 CPAP use provides an opportunity for rebellion. While adolescents may rebel against parental and adult societal expectations, they want to conform to peer norms.
Another aspect of the developmental process is a feeling of invulnerability. Adolescents possess little ability to appreciate consequences of current life style decisions and actions. They see themselves as being invulnerable, a notion that has been described in the literature as being "bullet proof."17 This notion is linked to the adolescent perceptions of the benefits of CPAP.
Less daytime sleepiness, sleeping better, having more energy, improved school performance, and decrease in enuresis were some of the benefits associated with adolescent CPAP adherence. Caregivers and adolescents of the low and no CPAP use groups reported more subtle benefits from using CPAP than their high use counterparts. Some of the adolescents with high use described having a physical or psychological need for using CPAP, e.g., believing it was what made them fall asleep or reporting they would wake up choking and gasping if they fell asleep without using it. Having an understanding of the importance of using CPAP was associated with high use, which highlights the need for healthcare providers to educate CPAP users and their families as fully as possible about the purpose and benefits of CPAP, as well as the physical and neurobehavioral consequences of untreated OSAS.
Discomfort with using CPAP was described by all the adolescents, but only adolescents in the low and no use groups described this as a significant barrier to adherence. Nasal congestion, skin irritation, a poor mask fit, and intolerance to air pressure are all well-known side effects of CPAP use that were mentioned by all the adolescents. As part of the educational initiation processes for CPAP, it is essential to provide anticipatory guidance about the potential complications of CPAP. Further, it is important for clinicians to explain that potential remedies exist for these complications and that the family should contact the medical team if the adolescent experiences any of the side effects. While some of these complications may improve with increased use of CPAP, others may be addressed by the health care team (e.g., mask fit, chronic nasal congestion, skin irritation). Identifying potential barriers and providing support to problem solve barriers may facilitate adherence.
As previously discussed, some adolescents are non-adherent because of a feeling of invulnerability; however, the adolescents with high use described fear as a motivator for adherence. They expressed being afraid of the consequences of not using CPAP (e.g. death, not being able to breathe, adverse effects on their hearts). Bond et al.'s Health Belief Model predicted that the benefits-costs and cues constructs were related to compliance if benefits were high and costs were low. The greatest compliance was achieved with low perceived threat and high perceived benefits-costs. Our findings fit this model. High use adolescents expressed knowledge of fear of consequences, or high threat, for lack of use and had a perception of high benefits and low cost regarding their CPAP use. Adolescents with low or no use perceived low benefit, high cost, and high threat, but the level of threat was not adequate motivation to overcome the high cost of use which may be linked to the adolescent perception of invulnerability.36
This was a small study and as is the case with qualitative research, the findings do not presume to be generalizable. Rather, we have generated grounded theories that we offer for further exploration and evaluation. Nonetheless, we feel that these theories merit consideration by clinicians in helping families develop strategies that will promote CPAP use. Despite purposively sampling across the spectrum of adherence, we do recognize it was not demographically representative, and the population was primarily inner city families. Following the analysis, it became apparent there was a difference in the age at which CPAP was prescribed for the high users (Table 1); ideally, we should have also purposively recruited more high users who started CPAP during adolescence and additional low and no users who were prescribed CPAP at a younger age in order to represent a broader range of experience using CPAP in adolescence. Another potential weakness that is common to all studies involving interviewing was self-selection of participants, which could create volunteer bias in our sample. There is a risk that participants will offer responses that they feel are desired by the interviewer. We attempted to minimize this risk by carrying out the interviews in a non-judgmental and open way and by emphasizing that there were no right or wrong answers and that the interviewer was genuinely interested in the participants' experiences and opinions.
Our findings were strengthened by the use of objective adherence data facilitating an open discussion about actual use. Objective measurement of adherence is less prone to bias, owing to the tendency of parents and children to overestimate adherence on self-report.37
Adherence to medical regimens in adolescents has long been recognized as problematic. For sleep clinicians, CPAP adherence in adolescents has been a concern that is likely to grow due to the current obesity epidemic and an increase in referrals to sleep specialists of adolescents with OSAS. Understanding the adolescent and family experience of using CPAP may be the key to developing more effective mechanisms to promote adherence. Issues that need to be considered are parenting style, family dynamics, and communication. Health education, combined with family involvement in developing strategies that facilitate CPAP use within their family context, are important components of promoting adherence. Since many adolescents appear reluctant to make their peers aware of their CPAP use, peer support groups may help promote adherence. All support strategies need to take into account the developmental process of adolescence and should be tailored to the individual and his or her family.
This was not an industry supported study. Carole Marcus, Jill Maggs, Mary Anne Cornaglia, and Ruth Bradford have research support in the form of loaned equipment from Philips Respironics and Ventus, not related to the current study. Nicolas Stettler works at a scientific consulting firm that does work for various companies. None of his work has been related to the topic of this study or devices described in it. The other authors have indicated no financial conflicts of interest. Financial Support: NIH T32-HL007713-19 & R01HL58585
We would like to thank Dr. Reneé H. Moore from the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania for her assistance with the study design and mentorship; Shimrit Keddem and Katie Kellom from the Mixed-Methods Research Laboratory at the University of Pennsylvania for their expertise with NVivo 9.0 software; and the patients and their families for their participation in the study. Financial Support: NIH T32-HL007713-19 & R01HL58585
Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G, authors. Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med. 1999;159:1527–32. [PubMed]
Marcus CL, Carroll JL, Koerner CB, Hamer A, Lutz J, Loughlin GM, authors. Determinants of growth in children with the obstructive sleep apnea syndrome. J Pediatr. 1994;125:556–62. [PubMed]
Guilleminault C, Eldridge FL, Simmons FB, Dement WC, authors. Sleep apnea in eight children. Pediatrics. 1976;58:23–30. [PubMed]
Somers VK, White DP, Amin R, et al., authors. Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). J Am Coll Cardiol. 2008;52:686–717. [PubMed]
Beebe DW, Byars KC, authors. Adolescents with obstructive sleep apnea adhere poorly to positive airway pressure (PAP), but PAP users show improved attention and school performance. PLoS One. 6:e16924. [PubMed Central][PubMed]
Beebe DW, Ris MD, Kramer ME, Long E, Amin R, authors. The association between sleep disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood. Sleep. 2010;33:1447–56. [PubMed Central][PubMed]
Kliegman RM, Behrman RE, Jenson HB, Stanton BF, authors. Nelson textbook of pediatrics. 2007. 18th ed. Philadelphia: Saunders.
Zitelli BJ, Davis HW, authors. Atlas of pediatric physical diagnosis. 2007. 5th ed. Philadelphia: Mosby/Elsevier.
Marcus CL, Rosen G, Ward SL, et al., authors. Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics. 2006;117:e442–51. [PubMed]
Marcus CL, Beck SE, Traylor J, et al., authors. Randomized, double-blind clinical trial of two different modes of positive airway pressure therapy on adherence and efficacy in children. J Clin Sleep Med. 2012;8:37–42. [PubMed Central][PubMed]
Sawyer AM, Deatrick JA, Kuna ST, Weaver TE, authors. Differences in perceptions of the diagnosis and treatment of obstructive sleep apnea and continuous positive airway pressure therapy among adherers and nonadherers. Qual Health Res. 2010;20:873–92. [PubMed Central][PubMed]
Simon SL, Duncan CL, Janicke DM, Wagner MH, authors. Barriers to treatment of paediatric obstructive sleep apnoea: Development of the adherence barriers to continuous positive airway pressure (CPAP) questionnaire. Sleep Med. 2012;13:172–7. [PubMed]
Orrell-Valente JK, Jarlsberg LG, Hill LG, Cabana MD, authors. At what age do children start taking daily asthma medicines on their own? Pediatrics. 2008;122:e1186–92. [PubMed]
Chigier E, author. Compliance in adolescents with epilepsy or diabetes. J Adolesc Health. 1992;13:375–9. [PubMed]
Difeo N, Meltzer LJ, Beck SE, et al., authors. Predictors of positive airway pressure therapy adherence in children: a prospective study. J Clin Sleep Med. 2012;8:279–86. [PubMed Central][PubMed]
Charmaz K, author; Denzin NK, Lincoln YS, editors. Grounded theory: objectivist and constructivist methods. The handbook of qualitative research. 2000. 2nd ed. Thousand Oaks, CA: Sage Publications; p. 509–35.
Suris JC, Michaud PA, Viner R, authors. The adolescent with a chronic condition. Part I: developmental issues. Arch Dis Child. 2004;89:938–42. [PubMed Central][PubMed]
Bender B, Milgrom H, Rand C, Ackerson L, authors. Psychological factors associated with medication nonadherence in asthmatic children. J Asthma. 1998;35:347–53. [PubMed]
Fiese BH, Tomcho TJ, Douglas M, Josephs K, Poltrock S, Baker T, authors. A review of 50 years of research on naturally occurring family routines and rituals: Cause for celebration? J Fam Psychol. 2002;16:381–90. [PubMed]
Greening L, Stoppelbein L, Konishi C, Jordan SS, Moll G, authors. Child routines and youths' adherence to treatment for type 1 diabetes. J Pediatr Psychol. 2007;32:437–47. [PubMed]
Eccles JS, author. The development of children ages 6 to 14. Future Child. 1999;9:30–44. [PubMed]
Collins WA, author; Montemayor R, Adams GR, Gullotta TP, editors. Parent-child relationships in the transition to adolescence: Continuity and change in interaction, affect, and cognition. From childhood to adolescence: A transitional period? 1990. Beverly Hills, CA: Sage Publications; p. 85–106.
Eccles JS, Lord S, Buchanan CM, authors; Graber JA, Brooks-Gunn J, Petersen AC, editors. School transitions in early adolescence: What are we doing to our young people? Transitions through adolescence: Interpersonal domains and context. 1996. Hillsdale, NJ: Lawrence Erlbaum Associates; p. 251–84.
Leahy RL, author. Parental practices and the development of moral judgment and self-image disparity during adolescence. Dev Psychol. 1981;17:580–94.
Buchanan CM, Eccles JS, Becker JB, authors. Are adolescents the victims of raging hormones? Evidence for activational effects of hormones on moods and behavior at adolescence. Psychol Bull. 1992;111:62–107. [PubMed]
Paikoff RL, Brooks-Gunn J, authors. Do parent-child relationships change during puberty? Psychol Bull. 1991;110:47–66. [PubMed]
Steinberg L, author; Feldman SS, Elliott GR, editors. Interdependence in the family: Autonomy, conflict, and harmony in the parent-adolescent relationship. At the threshold: The developing adolescent. 1990. Cambridge, MA: Harvard University Press; p. 255–76.
Eccles JS, Midgley C, Wigfield A, et al., authors. Development during adolescence: The impact of stage-environment fit on young adolescents' experiences in schools and in families. Am Psychol. 1993;48:90–101. [PubMed]
Monaghan M, Horn I, Alvarez V, Cogen F, Streisand R, authors. Authoritative parenting, parenting stress, and self-care in pre-adolescents with type 1 diabetes. J Clin Psychol Medical Settings. 2012;19:255–61. [PubMed]
Rhee H, Wenzel J, Steeves RH, authors. Adolescents' psychosocial experiences living with asthma: a focus group study. J Pediatr Health Care. 2007;21:99–107. [PubMed]
George M, Rand-Giovannetti D, Eakin MN, Borrelli B, Zettler M, Riekert KA, authors. Perceptions of barriers and facilitators: Self-management decisions by older adolescents and adults with CF. J Cyst Fibros. 2010;9:425–32. [PubMed Central][PubMed]
Guilfoyle SM, Goebel JW, Pai ALH, authors. Efficacy and flexibility impact perceived adherence barriers in pediatric kidney post-transplantation. Fam Syst Health. 2011;29:44–54. [PubMed]
Carden SR, author. Working with Families of Adolescents with Diabetes, CME Disclosures. In: Presented at the 60th Scientific Sessions of the American Diabetes Association 2000; San Antonio, TX.
DiMatteo MR, author. The role of effective communication with children and their families in fostering adherence to pediatric regimens. Patient Educ Couns. 2004;55:339–44. [PubMed]
Wysocki T, author. Diabetes mellitus in the transition to adulthood: adjustment, self-care, and health status. J Dev Behav Pediatr. 1992;13:194–201. [PubMed]
Bond GG, Aiken LS, Somerville SC, authors. The health belief model and adolescents with insulin-dependent diabetes mellitus. Health Psychol. 1992;11:190–8. [PubMed]
Bender BG, Bartlett SJ, Rand CS, Turner C, Wamboldt FS, Zhang L, authors. Impact of interview mode on accuracy of child and parent report of adherence with asthma-controller medication. Pediatrics. 2007;120:e471–7. [PubMed]


text:
James Kavanaugh, a former Catholic priest who came to fame in 1967 with his controversial bestseller calling for reform in the church and later wrote bestselling books of poetry and other works, has died. He was 81.
Kavanaugh, who underwent surgery for an aortic aneurysm in July, died Dec. 29 in a hospice in Kalamazoo, Mich., said his wife, Cathy.
Ordained in 1954, Kavanaugh served as a parish priest in Lansing and Flint, Mich., and earned a doctorate at the Catholic University of America in Washington, D.C., before the publication of "A Modern Priest Looks at His Outdated Church" in 1967.
The book, in which he called for church reforms on issues such as birth control, divorce, premarital sex and celibacy for priests, quickly became a national bestseller.
A New York Times reviewer called it "a personal cry of anguish that goes to the heart of the troubles plaguing the Catholic Church."
"I was naive enough to think that 'Modern Priest' would turn things around in the church and that I could still stay in the priesthood," Kavanaugh told the San Diego Union-Tribune in 1984. "I had no idea the book would have the impact it did."
Look magazine purchased the serial rights, and Kavanaugh made the rounds of talk shows, including Johnny Carson's "Tonight Show." He also was in great demand to speak on college campuses around the country.
The book followed up an article Kavanaugh had written for the Saturday Evening Post's "Speaking Out" page. Written under the pseudonym Father Stephen Nash, it was titled "I am a Priest and I Want to Marry."
The article reportedly generated "Speaking Out's" heaviest reader response, and the magazine forwarded the missives to Kavanaugh.
"He got so many thousands of letters, it filled up half my garage," recalled his brother, Dr. Philip Kavanaugh.
The vast majority of the letters were positive, he said, "the most notable" being one from "Dear Abby" advice columnist Abigail Van Buren.
"She wrote a brief letter saying, 'I've received hundreds of thousands of letters, but this is the first fan letter I've ever written,' " he said.
For both the clergy and the laity, Philip Kavanaugh said, "Jim was a spiritual permission-giver to question authority and to trust their own instincts and beliefs. It had been suppressed previously in the church."
Kavanaugh left the priesthood several months after his book's publication.
"He resigned formally on the stage at Notre Dame University," where he was delivering a speech to a large audience made up mostly of priests and nuns, said Philip Kavanaugh. At one point, "he ripped off his collar, threw it on the ground, stamped on it and said, 'I will never wear this again!' "
In a 1985 interview with The Times, James Kavanaugh explained that midway through his talk at Notre Dame, "I got carried away. . . . The church had done a lot of damage to people's personal lives, and I felt compelled to say so."
In the early '70s, Kavanaugh published his first book of poetry, the bestselling "There Are Men Too Gentle to Live Among Wolves."
"I am one of the searchers," he wrote in the prologue. "There are, I believe, millions of us. We are not unhappy, but neither are we really content. We continue to explore life, hoping to uncover its ultimate secret."
Kavanaugh's spiritual journey began in Kalamazoo, Mich., where he was born Sept. 17, 1928.
The fourth of seven sons of an Irish Catholic family, he entered St. Joseph's Seminary in Grand Rapids at age 15. (His brother, Robert, also became a priest, and they both left the priesthood within a month of each other).
Kavanaugh published more than two dozen books, including works of poetry, nonfiction and allegories ("Celebrate the Sun: A Love Story" and "A Village Called Harmony -- A Fable") and two novels ("A Coward for Them All" and "The Celibates").
Kavanaugh, who suffered bouts of depression over the years, was not a big fan of self-help books.
"I burn all self-help books or tapes in which hyped heroes tell me how easy it is to put one's life together," he wrote in the newsletter of the James Kavanaugh Institute, which was launched in the early '80s to promote his inspirational book "Search: A Guide for Those Who Dare to Ask of Life Everything Good and Beautiful" and associated workshops.
"I need those who are still wading through pain, who must struggle at times just to hang on," he wrote. "I don't believe in quick fixes and I'm outraged when anyone promises one."
In addition to his wife and brother Philip, the twice-divorced Kavanaugh is survived by a stepdaughter, Katherine Markel; a stepson from a previous marriage, Chris Grove; and brothers Dr. Thomas Kavanaugh and Dr. Daniel Kavanaugh.
A virtual memorial service is online at james-kavanaugh.memory-of.com.

subset: commoncrawl


text:
Visit our main website at www.StDavids.com
Rick Alan
Measles is an infection that spreads easily. It causes fever, cough, and a rash. It was once a common childhood illness, but it is now less common in the United States due to the use of the
measles vaccine.
Copyright © Nucleus Medical Media, Inc.
Measles is caused by a virus. The virus is spread by:
Measles can be spread:
Factors that may increase your risk of measles include:
Measles symptoms generally appear 8-12 days following exposure. They include:
Full recovery, without scarring, generally takes 7-10 days from the onset of the rash.
You will be asked about your symptoms and medical history. A physical exam will be done. Diagnosis is made from the symptoms and the rash. Lab tests are usually not needed.
Measles is caused by a virus. It cannot be treated with antibiotics. The focus is on relieving symptoms with rest and comfort measures such as:
In most cases, complications are rare. You may need to be hospitalized if you have a severe case. Complications may include:
Getting vaccinated is the best way to prevent measles. The vaccine contains live viruses that can no longer cause disease.
There is a single vaccine to prevent measles. It is also available in combination with:
The regular schedule for giving the vaccine is at age 12-15 months and again at age 4-6 years. If you or your child has never been vaccinated against the measles, talk to the doctor.
In some cases, the MMR vaccine is given within 3 days after exposure. This can prevent or reduce symptoms. Immune globulin is given to certain unvaccinated people within 6 days of exposure. This is usually for infants and pregnant women.
If you or someone in your family gets measles, family members may need to be vaccinated or given immune globulin.
If you are not vaccinated, avoid contact with someone who has measles. Recent outbreaks of measles have occurred in Europe and the United States. They may have been caused by increasing numbers of children who are not vaccinated. Discuss the benefits of vaccination with your doctor.
Centers for Disease Control and Prevention
National Foundation for Infectious Diseases
Caring for Kids—Canadian Paediatric Society
Public Health Agency of Canada
Bellini WJ, Rota JS, Lowe LE, et al.
Subacute sclerosing panencephalitis: more cases of this fatal disease are
prevented by measles immunization than was previously recognized.
J Infect Dis. 2005;192(10):1686-1693.
Kassianos G. Vaccination for tomorrow: the need to improve immunization rates.
J Fam Health Care. 2010;20(1):13-6.
Measles. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 8, 2015. Accessed June 9, 2015.
Measles (rubeola). Centers for Disease Control and Prevention website. Available at:
http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/measles-rubeola.htm. Updated December 13, 2013. Accessed June 9, 2015.
Peter G, Gardner P.
Standards for immunization practice for vaccines in children and adults.
Infect Dis Clin North Am. 2001;15:9-19.
5/27/2011 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Measles—United States, January—May 20, 2011.
MMWR Morb Mortal Wkly Rep.
Last reviewed June 2015 by Fabienne Daguilh, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.
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text:
The use of Colour Therapy is a truly holistic therapy which dates back thousands of years.
It is the Colour energy from light that is used as Colour Therapy.
Colour can have a profound and healing effect on us as humans as well as the animals we share this world with.
UK Based Colour Therapy Workshops
We hold regular workshops that are ideal for those who wish to learn more about Colour Therapy, Colour, and how colour is used by Colour Therapists.
UK Based Colour Therapy Diploma Course
We also provide a qualifying Diploma Course for those who wish to progress further and practice Colour Therapy on a professional level.
What is colour
Colour is simply light of varying wavelengths and frequencies, as we see or feel it,
Visible colour plays a very important part in all of our lives; from colour in work, to adverts and design.
As an energy Colour forms just a small part of the Electromagnetic spectrum.
Colour properties
Each colour has its own unique properties, from wavelengths and frequency's to how it can be used as colour therapy.
more about... Colour properties


text:
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The LinkedIn profile of Chris Green, "Person of interest at Valve Software," says Valve is looking for senior Linux and Mac engineers. Actually he says they are: "REALLY looking for senior Linux + Mac engineers." Thanks superannuation, who are setting themselves up for potential disappointment in hoping this means to expect Steam for MacOS.
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text:
This Positive Life: An Interview With Evelyn Hernandez
September 15, 2011
"I share my story, so that communities can see that this can happen to anyone. It impacts everyone. It has no borders," says HIV advocate and long-term HIV survivor Evelyn Hernandez. In 1993, instead of enjoying the honeymoon stage of being a newlywed, Evelyn was dealing with not only her husband's HIV-positive diagnosis, but her own as well. Evelyn speaks to us about loss, overcoming stigma, finding love again and the importance of giving back to other HIV-positive Latinos like herself.
This is Bonnie Goldman reporting for TheBody.com. Welcome Evelyn, to This Positive Life.
Thank you very much. Hopefully, my experience can help many other women who are living with HIV in various communities.
Let's start from the beginning. How did you find out that you are HIV positive?
I found out back in 1993. I was recently married. My husband found out about 2 weeks after our wedding day.
What made him get tested?
Prior to our wedding day, he had not been feeling well for some time. Losing weight, feeling fatigued, he just did not have the energy he was accustomed to having. And I pretty much encouraged him to go and have a physical done, because the last time he had one he was a teenager. He worked in construction and worked out several times a week. Then he just started losing a lot of his muscle mass, and began to feel fatigued.
How old was he at the time?
He was 33 years old.
And how old were you?
I was 29.
This was in New York?
Yes, in upstate New York. I grew up in New York City, born and raised. I lived there the majority of my life. Then I moved to upstate New York and lived there for about 10 years. That's where my husband and I had met.
How long were you married when he started getting sick?
Two weeks after our wedding day.
Wow, so you were spun into a new world.
Absolutely. When you're planning a marriage with someone you love, you think you're beginning the rest of your life -- the second part of your life, I should say. I was looking forward to starting a family, being a wife and spending the rest of my life with someone who I cared for very, very deeply. Just as quickly as he was diagnosed, this curve ball was thrown at us.
At that time, what did you know about HIV?
All that I really knew was what was on the news and in the paper -- it was primarily a gay and an IV [intravenous] drug user disease. We just didn't seem to fit the perceived profile.
Did your husband know how he got infected?
He experimented with steroids at the gym. He worked out three or four times a week. He needed to be physically fit for his job in construction.
So he shared needles with other guys?
That's what we suspect. He used to get his steroids and syringes at the gym. So, where did that come from? We don't know.
As soon as you found out that he had HIV, were you worried about your own health?
Absolutely. Immediately, the doctor that had diagnosed my husband wanted me to come in and get tested. The ironic thing is that I was feeling fine. I was working a full-time job and had no symptoms at all. About two weeks after I was tested, I received a call from my husband. He had just returned from a doctor's appointment and wanted me to come home right away. I thought he received some really bad news at his doctor's appointment. But when I arrived home -- this was back in November of '93 -- that's when he told me that I had tested positive as well.
What was the first thing that you did?
I was in shock. I just couldn't believe it. I did not know what to do. I didn't know who to turn to. I just kept pacing our living room floor. We had barely been married for a month; this is not what you would expect to happen.
In 1993, the only medicines available were Retrovir [zidovudine, AZT] and Videx [didanosine, ddI], so it was a still a fatal time.
It was. It was thought to be pretty fatal and those were the images that we were seeing on the news. People were dying of AIDS -- lying in bed and withering away. We thought, "This can happen to us, or we can both fight it together."
I have a lot of faith and I'm a fighter by nature. So, because I had been feeling well, I thought, "Okay, let's just do what we need to do and embrace the fact that we are living with this illness, and that we are not going to die immediately."
Was your husband as brave as you?
Unfortunately, no. By nature, he was such an outgoing person and enjoyed life, but his whole demeanor just changed, literally overnight. He became very reclusive. He just, pretty much, would sit in his chair. I tried my very best to help get him out of that space, but it didn't work.
Who did you tell in your family about your diagnosis?
Well, interestingly enough, the first person I called was my father. My parents were both living in New York City, in the projects of the Lower East Side of Manhattan. I called my father at work. The reason I did that was because my mom had had open heart surgery, and I knew she was home alone. I did not want to give her the news knowing that she was alone. So I thought the stronger person at this point would be my dad.
And surprisingly, he became extremely emotional. He cried. I'm the youngest of four and as you can imagine, no parent would want this to happen to any one of their children, let alone their youngest, their baby. He had a really, really difficult time just dealing with it.
Did they blame your husband?
No, and that's one of the things that Greg and I said from the very beginning, that HIV already had control over our lives. We were not going to allow it to take any more control by getting us to bicker back and forth: "I got this from you," or "You gave me this." We did not want to go there, because we knew it was not a healthy place to go. We couldn't change the fact that we were both HIV positive. We just had to be strong and work together as a family, as newlyweds, and try to get through this as best as we could.
So, did your husband immediately go to the doctor and try to get treatment?
We both went in together and we saw a very good doctor in upstate New York who was pretty much on the cutting edge in treating people with HIV. And, my husband comes from a family of nurses, so they were a great resource for us. They had recommended a doctor who was recommended to them. We went and we sought treatment; we took AZT and Zerit [stavudine, d4T]. They were the only two medications available to us.
This article was provided by TheBody.
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text:
Coronet Peak
Just an easy 20 minute drive from the heart of Queenstown, Coronet Peak has modern lifts, restaurants, world-class grooming and computerized snowmaking that cover the entire mountain. But more than that, there's a feeling that this is as good as it gets.
Mind blowing views, awesome roller coaster terrain and incredible back bowls to throw down a challenge to the very best. It's no wonder why some of the best ski racers in the world use Coronet Peak on their international training circuit. As New Zealand's best known ski area, it is a must do activity for any Queenstown visitor and a firm favourite amongst locals.
From gentle learners' slopes to night skiing under the stars on the weekend, there really is something for everyone. And, with a fully sealed road right to the ski area, it's so close and easy. This is winter fun, Queenstown Style!
- Varied terrain - perfect for all abilities
- Easy 20 min self-drive or coach from Queenstown on a sealed road
- Night Skiing & First Tracks combined makes it NZ's longest mountain resort opening hours
- Quick and easy on mountain rental system
- High-speed quad chairlift & four surface conveyor lifts to beginners terrain
- High-speed quad & six-seater chairlifts to general terrain
- All day supervised kids' programmes for 3 months upwards
- Free day lift passes for children aged 6 years & under
Scheduled season dates: 2017 TBA
280 acres
25% (includes the back bowls)
1 high speed six seater
2 high speed quads
1 T-bar
4 surface conveyor lifts
M1 – 2.4km
Kids 'Fun Zone' and Park after Dark freestyle trail during Night Ski
Fully licensed restaurant, bar and café
Sub Station on the sun deck
Ice Bar at the top of Greengates
Guest Services & Ticketing
Snowsports School
Rental - skis and snowboards, boots and poles, ski & snowboard repairs, ski & snowboard storage
Retail outlet - ski accessories and clothing
First aid and emergency services
Licensed Early Learning Centre and all day dedicated children's programmes
Air Bag operating weekends and night skiing hours
Children aged 6 and under ski for free and youngsters aged three months to five years can be enrolled in the fully-licensed Early Learning Centre, while the older ones get to enjoy daily lessons in the Kea Club. Children six and under enjoy free day lift passes every day of the season.
* Scheduled season dates are indicative only and dependant on weather and snow conditions.


text:
Only hotels in Middle River are listed below. Explore our guide for inexpensive and discount hotel/motel rates in or near Middle River, MD for your business or personal leisure travel. Discover the best Middle River Maryland hotel rooms. Review the Middle River hotel list below to find the perfect lodging. We also have a map of the Middle River hotels. Group booking? Search Middle River Group Hotel Discounts
The Middle River center point is around 1 mile east of Middle River, BWI Airport Station and 8 miles northeast of Cruise Maryland Terminal.
How should we direct your call?


text:
CrashPlan stands out from the competition in terms of the variety of options it offers users. To begin with, its client is available for a wide variety of computers, from Macs and Windows PCs to Linux and Solaris systems. There are also apps for accessing stored data for Apple iOS and Android devices, but not for BlackBerry phones.
There are also a number of different plans. The free version actually doesn't offer online backup, but instead allows you to back up to other computers, for example, a system belonging to a friend, or a system at work. It's an interesting twist that can lessen the chances that your data will disappear, but might put it in too many hands. I'm not sure I'd want my data sitting on someone else's computer, although CrashPlan does encrypt it.
The paid versions allow you to back up your data to CrashPlan's online servers. The CrashPlan+ service that I used offers unlimited storage for $50 (£30) a year; there's also a plan that limits capacity to 10GB for half as much, but both are limited to a single computer.
The unlimited family package gives you backup for up to 10 computers for $120 a year. The company offers a full-featured trial for 30 days.
CrashPlan has a central interface that shows the status of your backups and how many files are queued up. It also has places to click for restoring files, for determining where the backups will be stored and for making configuration changes. CrashPlan doesn't visually mark files for backing up as Mozy and Carbonite do. The software does have an excellent log that shows all tasks performed.
By default, the software gathers up key personal files like music, video and desktop files for backing up, but ignores Windows and system files. However, you can manually add any file type to the backup, including system files.
After its initial backup, CrashPlan continually looks for changes in your system's files and adds those that it finds to its next backup. CrashPlan does this behind the scenes as you use your computer; I didn't notice any slowdown of my system as a result. By default, the system will send backups every 15 minutes, but that interval can be changed; you can do an incremental backup at any time as well.
CrashPlan has a screen that shows a progress bar with an estimate of how long it will take to finish (except, of course, when it is working in the background). The service can also back up the contents of an external hard drive.
CrashPlan uses 448-bit key Blowfish encryption (the free version uses 128-bit Blowfish encryption). Unlike the other applications reviewed here, which have deadlines after which deleted files are removed, files backed up to CrashPlan and then deleted from your hard drive are never removed unless you do it manually, according to the company.
CrashPlan colocates its servers at several data centres throughout the US, but doesn't mirror backups.
Test results
Uploading backup data to CrashPlan's servers was slow, it stopped several times during the process, once for a little over an hour. As a result, it took 4 hours and 7 minutes to save 321MB during the initial backup.
Archiving the entire C: drive took four days, 20 hours and five minutes, four times longer than the next closest service, Norton Online Backup.
I was able to back up the system's C: drive to a 250GB Western Digital external drive in 2 hours and 6 minutes, midway between Norton Online Backup and Mozy.
The service's ability to perform a 25MB incremental backup took just 1 minute and 3 seconds, the fastest of this gang of five. Like the others, CrashPlan searched for a lost file quickly, at 2.3 seconds, and restored it 35.6 seconds.
CrashPlan offers some innovative services and the ability to save your backups on other computers. However, uploading backups to CrashPlan is slow, which can be a problem.


text: Johannesburg - Proteas limited overs captain AB de Villiers has expressed his support for a new-look T20 side ahead of the three-match series against New Zealand. The national squad for the series, which starts next week, was set to be be named in Cape Town on Thursday and De Villiers expected fresh faces after South Africa's disappointing ICC World T20 exit before the semi-final stage. "You've got to keep the T20 team fresh and exciting and it's a great vehicle to get youngsters through into international cricket," De Villiers said on Wednesday. "We want to try fresh faces and there will definitely be a few new names because there are youngsters who have really performed at domestic level and we need to give them a chance. "These new players will bring different talents and skills, which is exciting." The general trend in international cricket has been for countries to use T20 specialists rather than relying on their Test players and De Villiers said it was clear South Africa would have to go further down that route. "The Test players have played a big part in the T20 side, but that might change in future and you'll probably see a team with a whole different look." Fresh off his thrilling hundred in the series-clinching Test victory over Australia in Perth, De Villiers returned to limited-overs action at the weekend with a century for the Titans, albeit in a losing cause against the Cape Cobras in their One-Day Cup eliminator. "That was one of my better hundreds because it was against a really good attack. "You can tell the standard of domestic cricket is very good from that match and I like to play domestic cricket when it's like international cricket." New Zealand have had two major blows with the loss of injured spinner Dan Vettori and the unavailability of former captain Ross Taylor, and De Villiers conceded that the hosts should beat the Black Caps if they play to their full potential. "New Zealand are always a dangerous side. They beat us in the World Cup and they're really tough to beat when they get things right. "But we know we're the favourites and if we play good cricket, then we should win. "We have a mental advantage over them because we beat them over there at the beginning of the year." However, even if fresh faces such as Aaron Phangiso, Hardus Viljoen, Chris Morris, Roelof van der Merwe, Vaughn van Jaarsveld and Andrew Birch are included, the skipper insisted that South Africa's T20 strategies were not going to undergo any dramatic change. "We may have new players, but we'll use the same strategy and follow the same game plan."


text:
Priscillano "Pres" Romanillos, the animator who brought to life the athletic Native American Little Creek in DreamWorks' "Spirit: Stallion of the Cimarron" and the evil Shan-Yu in Disney's "Mulan," has died. He was 47.
For the record: An obituary of animator Priscillano "Pres" Romanillos in Wednesday's LATExtra section misspelled his wife Jeannine's name as Jeanine.
Romanillos died at his home in Tujunga on Saturday, surrounded by his family, friends and pets. The cause of death was complications from leukemia.
During his 21-year career, Romanillos earned the respect of his fellow artists for his exceptional drawing ability and his enthusiasm for the art of animation.
"I first met Pres during production on 'The Little Mermaid,' when he was an animation trainee, straight out of art school," said Disney supervising animator Ruben Aquino. "From the very beginning, I was impressed by his beautiful draftsmanship, but even more by his incredible passion for animation."
Born in Zamboanga in the Philippines on Jan. 11, 1963, Romanillos came to the United States with his family in 1971 and grew up in the Queens borough of New York City. When he was 9, his older brother Bob started a correspondence course in art but lost interest in it. Romanillos began doing the assignments and later attended the School of Visual Arts in Manhattan.
After graduating, he came to Walt Disney Studios in 1989 as an animation trainee on "The Little Mermaid." He served as an assistant animator on "The Rescuers Down Under," "Beauty and the Beast" and "Aladdin," and was promoted to animator on the 1995 film " Pocahontas," working on the title character.
"Pres was a man who loved to draw," said Glen Keane, who served as a mentor to Romanillos.
"When he came to the edge of his paper, his pencil didn't stop; he continued to draw characters onto the wood of his animation desk." That desk now sits in the Disney Animation Research Library.
"When the time came to do 'Pocahontas,' Pres was up for promotion," said Eric Goldberg, who directed the film with Mike Gabriel. "His first test scene was of Pocahontas' dainty foot dipping into the water at the start of the song 'Just Around the Riverbend.' It was so beautiful, Mike and I glanced at each other briefly and said, 'Yep, you're an animator.'"
At Disney's Florida studio, Romanillos created his most memorable character, Shan-Yu, the brutal leader of the Hun army. Richard Corliss wrote in Time magazine: "The villain, a crazed, WWF-style hulkster named Shan-Yu, has no comic irony softening his brute trapezoidal lines. He's just an evil machine with vampire teeth. The Wall, the vast plains and hills, the Forbidden City itself, all cringe at his shadow."
"Mulan" co-director Barry Cook said Romanillos "was such a gentle soul, it was amazing to see that villain come out of him as an animator and a performer. Shan-Yu had no comedic elements. He was a straight villain who needed to feel like a real threat to our heroine. Pres pulled that off in an amazing way."
In an interview at the film's opening in 1998, Romanillos described the character.
"The challenge in animating him was to convey his weight and gravity: He's like a force of impending doom," he said. "Unconsciously, I would scowl all day while I was drawing him. When I worked on Pocahontas, I would go home feeling sexy; with Shan-Yu, my wife was always asking, 'Why are you so angry?'"
After "Mulan," Romanillos moved to DreamWorks, where he animated various characters for "The Road to El Dorado" (2000), "Sinbad: Legend of the Seven Seas" (2003), "Shrek 2" (2004) and "Madagascar" (2005). One of his most memorable characters was in 2002's "Spirit": Little Creek, the clever, mischievous Lakota Indian who befriends Spirit.
In 2006, Romanillos began drawing "Life as a Pickle," a blog about the cats, dogs, rabbits and other pets he and his wife rescued from animal shelters. The main character was Pickle, a cartoon based on their chubby, aging rat terrier. Romanillos used his canine alter-ego to offer a slightly befuddled dog's-eye view of the world.
Romanillos and fellow animation artist Scott Johnston went to Salamanca, Spain, in 2007 to help establish the Enne animation studio and train artists. Romanillos directed "The Old Chair," a short film featuring drawn and computer-generated versions of Pickle and other characters from the blog.
During production, he was diagnosed with leukemia and returned to the United States. Following a bone marrow transplant, he did his final animation work, for Disney's "The Princess and the Frog" and for DreamWorks' "Shrek Forever After."
"Pres was one of the most respected and beloved artists at our studio," said DreamWorks Animation chief executive Jeffrey Katzenberg. "All of us in the animation community deeply mourn the loss of Pres ... though his memory and legacy will forever exist in the characters he brought to life through his art."
Romanillos is survived by Jeanine, his wife of 14 years. Plans for a life celebration are pending.


text:
Thursday, 17 May 2012 11:21
Another Pro-War Resolution Hits the House Floor
On Tuesday afternoon, the U.S. House of Representatives debated H.Res. 568, an AIPAC-sponsored bill designed to outlaw diplomacy with Iran and take the United States Congress one step closer to authorizing an illegal, unprovoked and premeditated military attack on Iran.
Debunking statements about Iran made by House Representatives and Senators on the floor of Congress is tedious and boring. Most of the statements are inarticulate readings of AIPAC-drafted talking points and boilerplate hasbara. M.J. Rosenberg has already excellently addressed the point of this legislation and there is no need to repeat, ad nauseum, why most of what's in the bill is wrong, how 13,000 AIPAC operatives were dispatched through the halls of Congress to garner sponsorship and support for the bill, how shameful it is for elected officials to spout pure propaganda about silly cartoon drawings and absurd assassination plots, and how - despite the many repetitions of the same infamous and long-debunked claim (which has literally appeared in over 50 Congressional resolutions since 2005) - even Israeli Minister of Intelligence and Atomic Energy Dan Meridor admitted on Al Jazeera that Iran has never threatened to "wipe Israel off the map."
No, this time around it's best to simply look at how statements made during Tuesday's floor debate compare to statements made a decade ago (and longer). After so much deceit, destruction and death, how can anyone take this stuff seriously?
Ileana Ros-Lehtinen (R-FL), October 9, 2002:
Saddam Hussein is not far from developing and acquiring the means to strike the United States, our friends and our allies with weapons of mass destruction. Thus, if we do not act now, when?
Ileana Ros-Lehtinen (R-FL), May 15, 2012:
The Iranian regime continues to pose an immediate and growing threat to the United States, to our allies, and to the Iranian people. We are running out of time to stop the nightmare of a nuclear weapons-capable Iran from becoming a reality...We must meet our responsibility to the American people and protect the security of our Nation, our allies, and the world from this threat of a nuclear capable Iran.
Madeleine Albright, February 18, 1998:
[T]hat the leaders of a rogue state will use nuclear, chemical or biological weapons against us or our allies is the greatest security threat we face.
Rush Holt (D-NJ), May 15, 2012:
The threat of nuclear proliferation is the greatest threat to world peace. A nuclear Iran would destabilize the region and threaten the United States and our allies.
Howard Berman (D-CA), October 10, 2002:
But under today's circumstances, the best way to give peace a chance and to save the most lives, American and Iraqi, is for America to stand united and for Congress to authorize the President to use force if Saddam does not give up his weapons of mass destruction. Confront Saddam now, or pay a much heavier price later.
Howard Berman (D-CA), May 15, 2012:
What better time for this body to send an unambiguous message that Iran must never be allowed to achieve a nuclear weapons capability and that its nuclear weapons program must end once and for all?
George W. Bush, January 29, 2002:
By seeking weapons of mass destruction, these regimes pose a grave and growing danger...[T]ime is not on our side. I will not wait on events, while dangers gather. I will not stand by, as peril draws closer and closer. The United States of America will not permit the world's most dangerous regimes to threaten us with the world's most destructive weapons.
Gene Green (D-TX), May 15, 2012:
Iran is developing the capability to quickly produce a nuclear weapon at a time of its choosing. Iran's acquisition of such a capability would create a significant new regional danger and be an immediate threat to America's interest and allies in the Middle East.
John McCain (R-AZ), Jesse Helms (R-NC), Henry Hyde (R-IL), Richard Shelby (R-AL), Harold Ford (D-TN), Jr., Joe Lieberman (D-CT), Trent Lott (R-MS), Ben Gilman (R-NY) and Sam Brownback (R-KS), December 5, 2001:
The threat from Iraq is real, and it cannot be permanently contained...We have no doubt that these deadly weapons are intended for use against the United States and its allies. Consequently, we believe we must directly confront Saddam, sooner rather than later.
Howard Berman (D-CA), May 15, 2012:
And so, as the window is closing, we send a clear message that the House is aligned with the administration in thoroughly rejecting containment...In fact, we have no choice but to stop Iran's nuclear weapons program before it ever reaches that point.
Steny Hoyer, (D-MD), October 9, 2002:
[Saddam Hussein] continues his efforts to develop and acquire weapons of mass destruction, and he sponsors international terrorism. Saddam Hussein continues to be an unacceptable threat whose duplicity requires action, action now.
Steny Hoyer (D-MD), May 15, 2012:
The most significant threat to peace, regional security, and American interests in the Middle East is Iran's nuclear program...Iran continues to be a sponsor of groups committed to the destruction of our ally Israel and of groups that threaten Americans throughout the world.
John Edwards (D-NC), October 7, 2002:
Saddam Hussein's regime is a grave threat to America and our allies, including our vital ally, Israel... Every day he gets closer to his longtime goal of nuclear capability. We must not allow him to get nuclear weapons.
Eni Faleomavaega (D-American Samoa), May 15, 2012:
[I]t is imperative that the United States and the international community understand that a nuclear-capable Iran is a global threat and a danger to the United States and, just as important, to the State of Israel...This is a direct threat to our closest ally in the Middle East.
George W. Bush, March 19, 2003:
The people of the United States and our friends and allies will not live at the mercy of an outlaw regime that threatens the peace with weapons of mass murder.
Ileana Ros-Lehtinen, May 15, 2012:
For the Iranian regime, the possession of the capability to produce a nuclear weapon would be almost as useful as actually having one...Tehran would be in the driver's seat, and the security of the United States, Israel, and our many other allies would be in their hands.
George W. Bush, March 13, 2002:
First of all, we've got all options on the table, because we want to make it very clear to nations that you will not threaten the United States or use weapons of mass destruction against us, or our allies or friends...[Saddam Hussein] is a problem, and we're going to deal with him. But the first stage is to consult with our allies and friends, and that's exactly what we're doing.
Rob Andrews (D-NJ), May 15, 2012:
[W]e are negotiating with a country that has conceived its nuclear weapons program in secret, that has brandished its nuclear weapons program with the rhetoric of hostility, and for whom the attainment of a nuclear weapon would be fraught with peril for free people everywhere...[O]ur position must be that we will not support or stand for an Iran with nuclear weapons.
George W. Bush, August 13, 2005:
As I say, all options are on the table. The use of force is the last option for any president and you know, we've used force in the recent past to secure our country...In all these instances we want diplomacy to work and so we're working feverishly on the diplomatic route and we'll see if we're successful or not.
Barack Obama, January 24, 2012:
Let there be no doubt: America is determined to prevent Iran from getting a nuclear weapon, and I will take no options off the table to achieve that goal. But a peaceful resolution of this issue is still possible, and far better, and if Iran changes course and meets its obligations, it can rejoin the community of nations.
Howard Berman (D-CA), May 15, 2012:
The urgent nature of the Iranian nuclear threat demands that the United States work with our allies to do everything possible diplomatically, politically, and economically to prevent Iran from acquiring a nuclear weapons capability. No option, as the President has said, can be taken off the table.
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text:
|Small Greeting Card
|Large Greeting Card
|4" x 6"
|5" x 7.5"
|4" x 6"
by Karin Taylor
Searching for sea-glass
seashells & marine debri
Flotsam and jetsam
Floating in from the sea
Give me the sun and the sand
Leave me to ponder
the perfection of this land
Creamy foam on waves of turtle green
Blue crystal walls, Whisper my name
Ebbing flow of oceans deep
Sing my soul, at last to sleep
Like lullabies and twinkling stars
Your soothing simple tempo beats
The pure melodies of nature
And nothing else competes.
Traditional pencil drawing on paper with layers of digital painting to complete. An especially popular piece which I think is so, because of it's deep personal meaning to me. This small painting became bigger than I could ever have imagined, because it spoke of something that I knew nothing of, except that which was in my subconscious mind. An example of how creativity is often able to bring to the fore, the things that are smouldering away deep in our souls, the things that no amount of conscious thinking can heal or repair. Sometimes, it's only the magic of dipping into the creative consciousness and being brave enough to wander in there with no or little expectations of oneself, that brings about a revelation that is not only your own truth, but speaks somehow to others also.
One of my most popular designs, and I'm so very grateful for all my customers and all the support of redbubble members, who constantly uplift and offer encouragement, my gratitude is unending, thank you!*
Beachcombers Sunrise (alternative vintage version)
*Beachcombers has just been featured on pages 12 and13 in Australian Homespun Magazine (The Summertime Issue) – thank you to Catherine Sanchez (Editor) and all the team, it is a great honour and privilege Complete Craft.com.au
contact Redbubble | Known problems | redbubble@twitter | help something is broken | enhance your profile tutorial by karin | creating links & clickable images for beginners | text & image links simplified
a little drawing I created by hand a few weeks ago, I've just completed painting this one digitally, in time for Mother's Day in Australia which falls on May 10 (just happens to be my birthday too :)
Here's the before shot:
Karin (myself) and Sal (my mum) at Yamba on holiday in 1968
art, beach, beachcombers, children, drawing, gifts, girls, illustration, karin taylor, painting, art, canvas, prints, greeting, cards, mothers day, special occasions, mother, daughter, blue, waves, birthday


text:
JD Supra Corporate Brief: BYOD Policies, Conflict Minerals, Cyber Crime, Class Actions
Go ahead, sign up for email delivery of the JD Supra Corporate Brief. It is Friday, after all… Unfortunately for employers, there is no boilerplate BYOD policy that will work for all situations… (Michelle Keogh at Snell & Wilmer) What if the key to overturning the SEC conflict minerals rule were the First Amendment? (Frank… Read more »


text:
Produce professional-quality colour and easily print, scan and copy, using HP's smallest colour laser MFP. Print from mobile devices, using HP ePrint[1] or WiFi Direct printing[2], and get quick-and-easy setup so you can start printing faster.
Make an impact with professional-quality colour from HP's smallest colour MFP
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Easily enhance the quality of your copied images, text and graphics with automatic copy optimisation.
Print professional colour: HP ImageREt 2400 delivers crisp detail and consistent colour. Use Original HP cartridges with HP ColorSphere toner to maximise the impact of marketing and business documents.
Print black text affordably - at the same cost per page as a black-and-white HP LaserJet printer[3].
Mobile printing with HP ePrint[1], WiFi Direct [2], wireless printing [4], and quick, easy set-up.
Stay productive on the go using HP ePrint[1], and print from wireless-enabled mobile devices directly to your printer[2].
Install your MFP in only a few minutes using HP Smart Install[5], and easily print and share with built-in wireless and Ethernet connectivity[6].
Easily produce one-sided copies of two-sided IDs using ID copy. Scan instantly to a PC, email and more.
Confirm your cartridge is Original HP to ensure superior performance and reliability, using HP Toner Cartridge Authentication[7].
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Print on a wide range of paper sizes from 3.5 x 5 ins (8.9 x 12.7 cm) to 8.5 x 14 ins (21.6 x 35.6 cm).
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Reduce energy use with Instant-on Technology and Instant-on Copy[9].
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Save space and reduce packaging waste compared with larger-sized products - use a compact colour laser MFP.
[1] HP ePrint requires an internet connection to the printer. Feature works with any internet- and email-capable device. Print times may vary. Available on the HP LaserJet Pro 100 color MFP M175nw only. For a list of supported documents and image types, see www.hp.com/go/eprintcenter.
[2] Available as of September 2011. WiFi Direct printing requires a wireless capable device or mobile device and is available on the HP LaserJet Pro 100 color MFP M175nw only. Mobile device must be wireless-enabled and within wireless range of the printer. Feature may require the download of driver or apps to mobile device, available at www.hp.com/go/eprintercenter.
[3] Compared with HP LaserJet Pro P1566/ P1606dn printer (single function) and HP LaserJet Pro M1536dnf MFP. Assuming customer is printing at least 30 percent of total pages in colour with content similar to the colour ISO/IEC 19798 test suite (www.iso.org/jtc1/sc28) and overall average job length of three pages. Yields established using ISO/IEC test standards. Actual yields and costs vary considerably depending on images printed, number of colour pages printed, and other factors.
[4] Built-in wireless is available on the HP LaserJet Pro 100 color MFP M175nw only. Wireless performance is dependent upon physical environment and distance from access point, and may be limited during active VPN connections.
[5] HP Smart Install works with Windows only.
[6] Built-in Ethernet networking and wireless and Internet connectivity are available on the HP LaserJet Pro 100 color MFP M175nw only.
[7] Compatible with a range of HP LaserJet printers and MFPs. For more information, see, www.hp.com/go/learnaboutsupplies.
[8] HP Auto-Off capabilities subject to printer settings. Compares energy consumption of HP LaserJets with HP Auto-Off Technology to top competing models based on market share as of September 2010. Energy consumption based on HP internal testing using the ENERGY STAR® programme's Typical Electricity Consumption (TEC) method or TEC value found at energystar.gov./eu-energystar.org using greatest TEC value reported. Actual power usage may vary.
[9] Compared with products that use traditional fusing and cold cathode fluorescent lamp (CCFL) copying.
[10] Programme availability varies. HP print cartridge return and recycling is currently available in more than 50 countries and territories around the world through the HP Planet Partners programme. For more information, or to request return envelopes and bulk collection boxes, visit www.hp.com/recycle


text:
Data science is one of today's hottest fields and one that is rife with competition. Projections indicate that employer demand requires that the United States increase the number of graduates with skills handling large amounts of data by as much as 60 percent. The federal government is one of the organizations most in need of data scientists, but hiring freezes, slashed training budgets and a lack of qualified candidates have all hampered the ability to recruit these types of professionals. Faced with such obstacles, agencies have been developing creative solutions to fill the hiring gap.
Download this Government Business Council issue brief to learn:
- Why government needs more analytic capacity
- Which new data mandates are putting pressure on federal agencies
- Why government has difficulty hiring data scientists
- How self-service data tools can bridge the hiring gap