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Rhapsodio 10BA
"Introduction Rhapsodio is a little boutique company based in Hong Kong, that recently celebrated their 3 year anniversary. The two owners Sammy and Sam are passionate about their craft, constantly experimenting with new innovative designs and improving their products. Rhapsodio was the first company for instance to introduce a hybrid design encorporating two dynamic drivers, a while back...." --flinkenick
Rhapsodio RDB+ Hybrid (2BA + Dynamic driver)
"Before writing this review, I would like to thank Charles for generously sending out multiple IEMs and amplifiers for us to try and review. Charles is also one of the friendliest and most responsive guys that I have met in the audio world and often responds to emails in a few minutes. This is something that I take into account when buying any product, especially one at this price. I am in no..." --lin0003
Rhapsodio RD3 Hi-Fi Grade Dynamic In-Ear Monitor
" Synopsis: The RD3 is part of the next generation of earphones from Rhapsodio. Powered by a single high-end dynamic driver, it has a warm sound and a hearty bass response. The RD3's design includes detachable cables and a strong metal housing. For $400, its sound and build quality make the RD3 a serious contender in the mid-level price range. Please note that this review was..." --Kunlun
Rhapsodio RTi2
"A short while back Rhapsodio launched two new flagships: the 10 BA, 5 way crossover Solar which I recently reviewed here, and more recently the RTi2; successor to their former flagship, the RTi1. "RTi" standing for 'Reference Titanium', referring to the 8mm titanium dynamic driver developed in-house by Rhapsodio. The '2' however not only indicates it's the sequel of the Rti1; it also sports a..." --flinkenick
Rhapsodio RDB+ 2v1
"Who/what? I'd like to thank Rhapsodio for sending the 2v1 our way for a tour, along with the Shozy amp. Australia isn't exactly a hot electronics place First off - Rhapsodio is a young IEM company from HK. They sell Custom and Universal IEMs and lots of cables, and some DIY amps. You can read more on their site and Facebook While I haven't bought their products yet and only tried their..." --svyr
Visang VS-K1
VS-K1 is a tri-band silver-line balanced-ear ,cavity use all-metal cutting process excellent resolving power, high elongation, low-frequency elastic density superb, Naiting sound is a highthe quality of the HI-FI headphones.It is suitable for all kinds of music to listen and popular vocal jazz rock.
ViSang VS-R02 InEar Hi-fi Noise Isolation Ear-Buds Earphones
Visang R02 is an earphone with equilibration. The high, medium, and low frequency distribution is average. It works well and grabbed a frequency and not to influence another frequency. The sound is up, good clean and fresh. This earphone sound great for the price. Their sound quality easily compares with products costing 2-3 times as much. Isolation and comfort levels are also very good. A...
Visang ro1
In ear monitor headphones.
Visang RO3
The R03 is an up-market professional-level earphone from well-known Chinese manufacturer ViSang. With quality materials used all-around, the build of the R03 is as venerable as the sound. Metal shells and a Cu-Ag alloy cable ensure longevity while the 10.7mm dynamic driver delivers crisp, powerful, and engaging sound. A uniquely patterned cable sheath provides flexibility and reduces cable...


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Show-Stealing Side Dishes: 20 of the Best Slow Cooker Side Dish Recipes
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Ham, Green Beans and Potatoes
By: Stockpiling Moms
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If you're in search of a simple, slow cooker side dish recipe, this recipe for Ham, Green Beans and Potatoes is easy to make and oh so tasty. It's made with cubed ham, green beans, potatoes, onion, pepper and water. That's it! Let it cook all day. And when you get home, you'll have a flavorful side for whatever main dish is planned.
Cooking Time: 8 hr
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Paul Wall, Jamie Kennedy and "Mattress Mack" Pimp Some Furniture
Since the days of Houston Wrestling late weekend nights on Channel 39, Houstonians have known there's absolutely nothing Jim "Mattress Mac" McIngvale won't do to "Save... You... Money!" And as Mac's Gallery Furniture empire has grown, so has his willingness to go to any lengths necessary to keep feeding the beast. As Exhibit A, I offer this 2006 spot of Mac, Paul Wall and special guest Jamie Kennedy pimpin' that Tempurpedic. Go ahead, I dare you to look away:
An extended version of "Mattress Mack" appeared on Kennedy's 2006 album, Blowin' Up, the soundtrack to his eight-episode "comedic reality show" the "success" of Malibu's Most Wanted convinced MTV to green-light. Trash-culture scholars may remember one more song from the record: "Rollin' With Saget," Kennedy's salute to the foulmouthed Full House star:
Curious, I entered "Gallery Furniture" into YouTube's search engine to see what else would turn up. Results after the jump, including a "Gallery Furniture Saved My Marriage" spot and special guest endorsement by He Who Never Cries. - Chris Gray
Look, it's Chuck Norris!
"Gallery Furniture Saved My Marriage"
"That's No Bull"
The "Mini Mac" commercial contest, from earlier this year:
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- [2015-03-26]The Renderings of Venizea Ceramic in 117th China Import and Export Fair
- [2014-10-14]The Renderings of Venizea Ceramic in 116th China Import and Export Fair
- [2014-03-12]2014 Mosbuild Fair Moscow Russian Federation
- [2014-03-05]The Renderings of Venizea Ceramic in 115th China Import and Export Fair
- [2013-10-11]114th CHINA IMPORT AND EXPORT FAIR (CANTON FAIR)
- [2013-06-17]Guangdong Hongwei Ceramic Jingdezhen Ceramic Institute of Materials Science and renewal scholarships
- [2013-06-14]Venizea celebrate the new member of the family
ABOUT USVenizea Ceramics has been established since 2000, is owned by Guangdong HOMEWAY Ceramics Co.,Ltd which is an enterprise participate in development of China national standards. Venizea Ceramics is an integrated enterprise professional in developing, producing and marketing of the finest tile. And it have been proudly recognized as GUANGDONG FAMOUS TRADEMARK and BRAND-NAME products in Guangdong Province. Besides, Venizea has been granted 119 patents, including 16 invention patents and 17 scientific innovatio......【MORE】


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Rockland Luggage 4 Piece Expandable Rolling Luggage SetItem # HN-FXL073
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Tag archives: fluids
The July 2015 issue of Physics World is now out
By Matin Durrani
Sometimes, nature does something unexpected – something so rare, transient or remote that only a lucky few of us get to see it in our lifetimes. In the July issue of Physics World, we reveal the physics behind our pick of the weirdest natural phenomena on our planet, from dramatic rogue waves up to 30 m tall, to volcanic lightning that can be heard "whistling" from the other side of the world, and even giant stones that move while no-one is watching. We also tackle tidal bores on rivers and the odd "green flash" that is sometimes seen at sunset.
Plus, we've got six fabulous full-page images of a range of weird phenomena, including salt-flat mirrors, firenadoes, "ice towers", beautifully coloured nacreous clouds, mysterious ice bubbles of gas trapped in columns, as well as my favourite – the delicately wonderful "frost flowers" seen very occasionally on plants.
The biophysics of Godzilla, skipping stones, Schrödinger in the morning and more
By Hamish Johnston
I'm a bit of a connoisseur of the art of stone skipping. That's because I grew up a stone's throw from the western end of Lake Ontario, which thanks to its shale shoreline has the best skipping stones in the world. As a result, I was fascinated to read a piece on the Figure One blog about entitled "Frisbee meets fluid: Skipping stones takes spin and skill".
View all posts by this author | View this author's profile
Honey at the asymptotic limit
By Hamish Johnston
What's the buzz in physics this week? Forget dark matter, it's honey – or rather the strange properties of this tasty fluid.
If you have a sweet tooth (or an interest in the Rayleigh–Plateau instability) check out this paper in Physical Review Letters.
View all posts by this author | View this author's profile


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BLOOMINGTON, Ind. -- There's an infatuation with recruiting rankings that can obscure the realities of a college football team.
Sometimes players don't develop to justify the hype they acquired in high school. Sometimes they just aren't ready as freshmen.
But in the case of Aaron Burbridge, Michigan State's 31-27 comeback win at Indiana made it clear -- the freshman receiver's glowing recruiting profile was accurate, and he can help this team right now. ...


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Twin Towns is the largest Services Club in Australia, occupying almost 5 square kilometres of property spread across its four sites - the main club, Twin Towns Services Club, Club Banora at Banora Point, Outrigger Twin Towns Resort (which adjoins Twin Towns by an overhead walkway) and Twin Towns Juniors.
Hello my name is Akmal and I'm a comedian, although the term comedian is open to interpretation and highly subjective. Believe it or not, many people...
Enjoy a fun-filled evening of singing, drumming and dancing as the African Children's Choir spreads its message of hope.
Enjoy a fun-filled morning of singing, drumming and dancing as the African Children's Choir spreads its message of hope.
"The most surprising and inspiring read I have had in years" - Russell Crowe "Tác phẩm tạo nhiều ngạc nhiên và gây cảm hứng nhất mà tôi đã đọc trong nhiều...
Back by popular demand for a third year, Apia are proud to present the 2015 Apia Good Times Tour - back, bigger and better than ever! This year's lineup...


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Warm Summer Rain
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Director:Joe GaytonActors:Kelly Lynch, Barry Tubb, Ron Sloan, Larry Poindexter, Lupe Amador(View All)
Description: Watch Warm Summer Rain full movie online for free directed by Joe Gayton produced in 1989. Genres are Drama, Romance.
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I have been accused of having a fevered and at times twisted imagination. Without offering a plea one way or the other, let me note that we can encounter real life situations so surreal, it's all you can do to remember The Bard of Stratford-on-Avon, "There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy." And I was never even a fan of CSI: Miami.�
I also would never be confused with a philosophic man though I've discovered that from a distance jaded looks surprisingly similar to thoughtful especially to people who have no idea what they are looking at. Guess how far from the Madding Crowd I never wander. I never even knew Frank and Joe had a brother, much less a writer; he could've really helped himself out, career-wise.�
I should have a less snarky attitude and even lesser prurient interest in this possibly-precedent setting legal case except, it's just so tawdry (without the Hepburn).�
This is the kind of court case you know the bailiff just wants to power wash the entire chamber after a day of deliberations. And being a life long (so far) resident of the Northeast, you know I'm looking at the slugline on the story and going "Kentucky."�Except that attitude is both elitist and in this case, fehl am platz.�
Sarah Jones makes me feel better about my life, no matter how bad it is and no matter who I am. She needs to be fitted for a bright orange blazer with lettering visible from space, "I Am A Cautionary Tale." From what I've read she gets it from her mother, though the account also makes it clear she gets it any way she can.�
Pardon my callousness and casual contempt but being raised by Cheryl Jones sounds like a childhood Romulus and Remus might better understand. No one we know wants to keep up with these Jones' and even though I've never met any of the framers of the Constitution, I'm pretty sure this was never envisioned by any of them to be a test of the First Amendment-not even among those who had a reputation for hitting the opium (yeah, TJ, takin' 'bout chew).�
Regardless of how the jurists decide, I'm sure I'm not alone in wishing the happy couple (or however many are in the relationship such as it is this week) all the best and hope I can be forgiven for looking forward to the day when Sarah's son or daughter provides us with as much mirth and merriment as Mommy Dearest. Because with a genetic inheritance like this, it absolutely has to happen.�
-bill kenny


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Houston Rockets v Dallas Mavericks
Darren Collison of the Dallas Mavericks handles the ball against... Nieuwsfoto'sAmerican Airlines Center,Bal,Basketbal,Basketbal - NBA Pro,Dallas,Dallas Mavericks,Darren Collison,Gulf Coast States,Hendel,Horizontaal,Houston Rockets - Basketbalteam,Patrick Beverley,Sport,Texas,Verenigde StatenPhotographer Glenn JamesCollection: National Basketball Association 2013 NBAEDALLAS, TX - JANUARY 16: Darren Collison #4 of the Dallas Mavericks handles the ball against Patrick Beverly #12 of the Houston Rockets on January 16, 2013 at the American Airlines Center in Dallas, Texas. NOTE TO USER: User expressly acknowledges and agrees that, by downloading and or using this photograph, User is consenting to the terms and conditions of the Getty Images License Agreement. Mandatory Copyright Notice: Copyright 2013 NBAE (Photo by Glenn James/NBAE via Getty Images)


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Julie Manundo
95 posts and
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since Feb 2012
i'm really glad how this cake turned out! chocolate cake covered with modeling chocolate.
Feb 2012
1,052 views
... Feb 2012
great job!
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Introducing Heroku DX: The New Heroku Developer Experience
Posted by Jesper
One of our core beliefs at Heroku is that developers do their best work when the development process is as simple, elegant, and conducive to focus and flow as possible. We are grateful for how well many of our contributions to that cause have been received, and today we are making generally available a new set of features that have been inspired by those values.
Collectively, we call these new features Heroku DX—the next evolution in Heroku's developer experience. Our goal with these new features—Heroku Button, Heroku Dashboard + Metrics and Heroku Postgres DbX—is to make it faster than ever for developers to build, launch and scale applications.Read more →


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Stars Photos
Who's in, who's out? Recapping the Stars' busy off-season
Photo: Keith Srakocic/ASSOCIATED PRESS
IN: Sergei Gonchar -- The veteran Russian defenseman was acquired after stints in Washington, Pittsburgh and Ottawa to bolster the Dallas blue line on June 8. He is one of many additions with Stanley Cup experience, having won a title in Pittsburgh.
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Mobile web version stopped working on my Z10
Hi, I have been using the web mobile version on my BB Z10 for a while, but all of a sudden it has stopped working and I am getting a blank screen with the TD logo at the top and logout at the bottom right. If I switch to the full web version it works fine. Have tried reloading the page etc, but no joy.
All responses
Sorry for the inconvenience, we're looking into this issue now.
This issue has now been fixed and the /m site is now available.
Great thanks.
md000001, have you tried running the Android app on your Z10? Just curious.
Have not tried the Android app. How do you install that on a Z10.
I had used the ToDoIst App from BlackBerry World on the Z10, and it had worked great, but had to remove it and when I went to reinstall found that it was no longer available for some reason.
Thanks for fixing this guys. It is my Windows Phone connection to Todoist while I wait for the official app. ;-)
@md000001, if you're running BlackBerry 10.2.1, download the Amazon Appstore, then get Todoist!
Are you sure that it's fixed? I am getting the same blank screen.
P.S. Why doesn't your POST button work?
Hello Jim,
It seems that the todoist.com/m site is currently working correctly. Please try to clear your mobile browser's cache and see if it helps.
Hi Guys, have just upgraded to the latest version of BB10 and the problem is back, same as before the mobile website now only shows the logo etc at the top of the screen and logout at the bottom, no tasks are displayed.
We Martin,
Sorry about that! We are no longer fully supporting todoist.com/m
As a workaround, you could try to access this link https://todoist.com/m/forceRegular
it should bring you to the full Todoist site. Sorry for the inconvenience!
That's a shame, Todoist is a great tool, and the mobile version worked well for those of us that were not able to use one of the App options.
Will try the regular version on my BB10.
The Android app works fine on BB10 on my old Z10. Check my postings on this thread https://todoist.com/Support/show/74135/ for more details including a link to the instructions to patch Todoist to not give Google Play Services warning when launched.
Unfortunately it's a locked down work device, so cannot use the Android app.


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This week's podcast is the first one Tom and I have recorded in almost a month. So after a bit of catching up, we talked about David Bellos's new translation of Simenon's Pietr the Latvian, the difficulties of translating "I love you" and all the swears into Japanese, and this list of "The 20 Best Books in Translation You've Never Read." As necessary, we also talked about the baseball playoffs and this cute flowchart.
Since Tom can't post here, I just want to have the final word on our discussion of the list of translations that Stephen Sparks and I put together. First off, we didn't give it this bombastic of a title, but whatever. We did put some time into coming up with twenty books that we love and that readers of international literature may not have heard of. As readers of heaploads of translated books, we had hundreds of titles to choose from. Every list is incomplete and flawed, but Tom's accusation that this is "intentionally esoteric" is totally off-point. It is a symptom of today's culture though, where if someone knows more about some topic that someone else, they are dismissed. Not to get all J-Franz about the kids these days and their Twitterversing, but there's a reason why stupid websites like Flavorwire are popular—they replace genuine knowledge with listicles that make the common reader feel good about themselves. "Hey, I've read 20 of the 25 lists on the "Greatest List of Lists Created by Flavorwire" list! I'm gonna tweet this." Sorry, Tom and whomever, for trying to share a bit of the lifelong research I've done on international literature. Next time someone wants to know about translated books, I'll just search the "translationsIreadinHighSchool" hashtag and call it a day.
This week's music is Rolling Waves by The Naked and Famous.
As always you can subscribe to the podcast in iTunes by clicking here. To subscribe with other podcast downloading software, such as Google's Listen, copy the following link.
César Aira dishes up an imaginative parable on how identity shapes our sense of belonging with Dinner, his latest release in English. Aira's narrator (who, appropriately, remains nameless) is a self-pitying, bitter man—in his late fifties, living again with. . .
Originally published in French in 2007, We're Not Here to Disappear (On n'est pas là pour disparaître) won the Prix Wepler-Fondation La Poste and the Prix Pierre Simon Ethique et Réflexion. The work has been recently translated by Béatrice Mousli. . .
Even though the latest from Jean Echenoz is only a thin volume containing seven of what he calls "little literary objects," it is packed with surprises. In these pieces, things happen below the surface, sometimes both literally and figuratively. As. . .
Who is this woman? This is the question that opens Xiao Bai's French Concession, a novel of colonial-era Shanghai's spies and revolutionaries, police and smugglers, who scoot between doorways, walk nonchalantly down avenues, smoke cigars in police bureaus, and lounge. . .
For the past 140 years, Anna Karenina has been loved by millions of readers all over the world. It's easy to see why: the novel's two main plots revolve around characters who are just trying to find happiness through love.. . .
Linn Ullmann's The Cold Song, her fifth novel, is built much like the house about which its story orbits: Mailund, a stately white mansion set in the Norwegian countryside a few hours drive from Oslo. The house, nestled into the. . .
Karel Schoeman's Afrikaans novel, This Life, translated by Else Silke, falls into a genre maybe only noticed by the type of reader who tends toward Wittgenstein-type family resemblances. The essential resemblance is an elderly narrator, usually alone—or with one other. . .
In Joris-Karl Hyusmans's most popular novel, À rebours (Against Nature or Against the Grain, depending on the which translated edition you're reading), there is a famous scene where the protagonist, the decadent Jean des Esseintes, starts setting gemstones on the. . .
There are books that can only wisely be recommended to specific types of readers, where it is easy to know who the respective book won't appeal to, and Kristiina Ehin's Walker on Water is one these. What makes this neither. . .
Imagine the most baroque excesses of Goethe, Shakespeare, and Poe, blended together and poured into a single book: That is The Nightwatches of Bonaventura. Ophelia and Hamlet fall in love in a madhouse, suicidal young men deliver mournful and heartfelt. . .


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HOUSTON (AP) — Seattle's victory in the Super Bowl has cost Houston furniture store mogul Jim McIngvale some $7 million.
McIngvale is the owner of one of the nation's largest independent furniture stores, Gallery Furniture. He promised customers who spent at least $6,000 in the past two weeks and took delivery before Sunday's game that he'd refund their purchase cost if Seattle won.


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CDAC MTech Admissions 2015-16 – Electronics Design and Technology (http://cdac.in/) MTech in Electronics Design and Technology – Center for development of Advance Computing Notification has been released by Center for development of Advance Computing, for admission into MTech courses (Electronics Design and Technology). This admissions are jointly conducted by C-DAC Hyderabad, NIELIT Chennai and SCSVMV … Read more
Search Results for : punjabi university mtech ece syllabus for 2013 2014
Lecturer syllabus 2015 – Rajasthan Public Service Commission (www.rpsc.rajasthan.gov.in) Rajasthan Public Service Commission – Lecturer Syllabus have been issued for the exam/Assessment for the year -2015/2016 Rajasthan Public Service Commission Syllabus: April 2015 Post: Lecturer (Tech. Edu. Dept.) Syllabus Website: http://rpsc.rajasthan.gov.in/ http://www.rpsc.rajasthan.gov.in/rpsc_Syllabus.aspx http://www.rpsc.rajasthan.gov.in/Syllabus/SYLL_LEC_ELECROENG_29_09_2014.pdf http://www.rpsc.rajasthan.gov.in/Syllabus/SYLL_LEC_COMPUTERENG_29_09_2014.pdf http://www.rpsc.rajasthan.gov.in/Syllabus/SYLL_LEC_COSTUME_29_09_2014.pdf http://www.rpsc.rajasthan.gov.in/Syllabus/SYLL_LEC_TEXT_29_09_2014.pdf Company/Organization – Profile: Rajasthan Public Service Commission Rajasthan Public … Read more
UKPSC Junior Engineer Exam Syllabus 2015 (http://ukpsc.gov.in) Uttarakhand public service commission Junior Engineer Exam Syllabus Syllabus has been declared for Uttarakhand public service commission Junior Engineer Exam; please go through the link mentioned below Exam Date: May 2015 Official Website: http://ukpsc.gov.in/pages/display/83-syllabus http://ukpsc.gov.in/files/JE_Adv.pdf Uttarakhand public service commission: The State of Uttarakhand came into existence on 09 … Read more
TN TRB TET Exam 2015 – Syllabus, Question papers and Exam Pattern (http://trb.tn.nic.in/) Tamil Nadu State Teachers Recruitment Board Examination 2015 – Latest Syllabus, Question Papers and Exam Pattern. TN TET Examination will be conducted by Tamil Nadu State Teachers Recruitment Board, which is divided into two papers. TNTET (paper-1) – Secondary Grade Teachers for … Read more
Shadan College MTech and Pharmacy Admissions 2015-16 (www.shadan.org) MTech, B Pharmacy and M Pharmacy Admissions 2015-16 – Shadan Group of Institutions Official Website: http://www.scet.in/pcmbNoti2015.pdf http://www.shadan.org/ Notification for admissions into M.Tech / M.Pharmacy courses has been released in the official website by Shadan Group of Institutions. All the interested candidates (Muslim Minority) can apply for these … Read more
Probationary officer Exam Syllabus 2015 at State Bank of India (www.sbi.co.in) State Bank of India Probationary officer Exam Syllabus 2015 Syllabus has been declared for State Bank of India; please go through the link mentioned below Exam Syllabus – State Bank of India Category: Probationary officer (PO) Sector: Banking Total Vacancies: 2062 Job Posting/Place: Throughout … Read more
G Narayanamma Institute MTech Admissions Notification 2015-16 (www.gnits.ac.in) MTech Admissions Notification 2015-16 – G Narayanamma Institute of Technology and Science Notification – http://www.gnits.ac.in/catb-admissions Application Form – https://drive.google.com/file/d/0B3LFVaoM8zAGV1k4VG5vaVVvQ1ZLeEQ0Y1RvRzB5akxTZHJB/view?usp=sharing Admission Notification has been released for M.Tech B.Category seats (Management Quota) on its official website by G Narayanamma Institute of Technology and Science. These admissions are applicable for … Read more
Applications are invited for its M.Tech. (Industrial Safety Engineering) programme for the academic year 2013-14 at Annamalai University, Annamalainagar: Eligibility for Admission: BE/ B.Tech. in any branch of Engineering. Last date for issue and submission of filled up Application: 18/08/2013 More details click here
Applications are invited for admission into its new programmes for the academic year 2013-2014. Central University of Punjab: New Programmes M.A. (Hons.): Punjabi and Comparative Literature M.Sc.: Physics (Nanophysics), Computational Sciences, Molecular Genetics M.Tech.: Cyber Security M.Phil.: Physics PG Diploma: Translational Biomedical Research Museology, Archaeology and Conservation Selection Process: Selection of the candidates will be done on the basis of entrance … Read more
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Europe for the Right Reasons: A Conversation with Stanley Hoffmann
Michal Matlak
It requires a certain amount of chutzpah for somebody like Obama to be president because he knows there are a number of people who will never forgive him for being half-black. And for the time being America is ungovernable. The Constitution—and all the additions that have been grafted on it—make effective government almost impossible.


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De Pere offers first look at Riverwalk's 'crowning jewel'
Viewing pier is second phase of the project
11:41 AM, Jan. 1, 2013
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De Pere offers first look at Riverwalk's 'crowning jewel'
The city debuted the newly completed Riverwalk's wildlife viewing pier on Monday, the second phase of the project that is expected to annually see 200,000 visitors and help generate $1.9 million.
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Determining the population of scientists and engineers in the U.S. can be dramatically affected by the criteria used to define this group. Educational degree levels and fields, occupational categories, or a combination of these factors may all be taken into account. To better define and understand this population, the National Science Foundation (NSF) developed the Scientists and Engineers Statistical Data System, or SESTAT ('SEE-stat').
SESTAT was designed in response to recommendations of the National Research Council's Committee on National Statistics (CNSTAT). The committee, with support from NSF, was asked in the late 1980s to conduct a comprehensive review of the NSF's surveys and data on scientists and engineers and to propose methods and procedures for increasing the quality and usefulness of the data in the 1990s. As NSF was expecting to draw a new sample of experienced scientists and engineers from the 1990 decennial census, the opportunity was provided to examine the design and operation of NSF's S&E data system. The committee's analyses and recommendations for the data system were presented in their 1989 report Surveying the Nation's Scientists and Engineers: A Data System for the 1990s. As one of its principal proposals, CNSTAT stated:
"We strongly urge that the NSF personnel data system for the 1990s strive to provide information that will permit users to apply their own definitions of the science and engineering population to suit their particular research and analysis purposes within a framework that facilitates cross-comparisons with other widely used data sources. Specifically, we believe that the system should support analysis of the science and engineering community from each of two major perspectives... from the perspective of occupational employment or jobs and from the perspective of academic training or careers."
The NSF has strongly endorsed this recommendation and it has served as the guiding principle in the design and development of SESTAT.
SESTAT is a comprehensive and integrated system of information about the employment, educational, and demographic characteristics of scientists and engineers in the United States. It comprises data collected through three national sample surveys supported by NSF: the National Survey of College Graduates (NSCG), the National Survey of Recent College Graduates (NSRCG), and the Survey of Doctorate Recipients (SDR). These surveys are conducted biennially; each is administered to a different sample population of bachelor's and above college degree holders. Although there are individuals in the U.S. who have earned science and engineering related degrees at the associate's degree level or who do not have bachelor's degrees but are working in science and engineering occupations, these individuals are not included in the sampling frames for the three SESTAT surveys.
The National Survey of College Graduates
The NSCG was first administered in 1993 and biennially thereafter to a nationally representative sample of all college degree holders who were identified through the 1990 decennial census. The target population for this survey includes individuals in the United States as of April 1990 with a bachelor's degree or higher in any field, not just the sciences or engineering. Besides capturing people with degrees earned at U.S. institutions, the NSCG also includes college degree holders who earned their degrees outside of the United States but who were residing here in 1990. In 1993, two selected groups from the NSCG were incorporated into the SESTAT database: those with science or engineering degrees, and those without such degrees but working in S&E occupations. These two populations are collectively referred to as the NSCG S&E panel.[1] In 1995 and subsequent rounds of the survey, these same two groups were followed.
The National Survey of Recent College Graduates
A second survey, the NSRCG -- which has been administered biennially since the early 1970s to recent S&E bachelor's and master's degree recipients -- is used to incorporate new U.S. S&E degree earners in the 1990s. In 1993, the NSRCG consisted of a sample of individuals who earned new S&E bachelor's and master's degrees in the 1990, 1991, and 1992 academic years. In 1995, these 1993 sample cases were moved into the NSCG sample frame; the 1995 NSRCG includes only recent U.S. S&E bachelor's and master's degree earners from the 1993 and 1994 academic years. The 1995 NSRCG sample was passed to the NSCG for the 1997 survey round; the 1997 NSRCG includes new U.S. S&E bachelor's and master's degree earners from the 1995 and 1996 academic years.
The Survey of Doctorate Recipients
A third survey, the Survey of Doctorate Recipients, has been sponsored by the National Science Foundation and other federal agencies since the early 1970s. In this survey, a sample of holders of S&E doctorates earned at U.S. institutions are followed throughout their careers from year of degree award until age 75. Every 2 years, a sample of new S&E doctoral degree earners is added to the SDR from another NSF-sponsored survey, the Survey of Earned Doctorates. In 1993, the SDR sample frame included all U.S.-earned S&E doctorates through academic year 1992; the 1995 sample frame includes doctorates earned through the 1994 academic year; the 1997 sample frame includes doctorates earned through the 1996 academic year.
The SESTAT Integrated Database
The SESTAT database was created by the integration of the S&E Panel of the NSCG, the NSRCG, and the SDR. Table 1 is a summary of the populations included in these three component surveys of the SESTAT integrated database. Because after 1993 the SESTAT surveys identify individuals for inclusion only at the point of earning a new S&E degree from a U.S. institution, two subpopulations of scientists and engineers in the United States are underrepresented in the SESTAT integrated database in 1995 and subsequent survey years: (1) new immigrants with S&E degrees earned outside the U.S. who entered the U.S. after 1990, and (2) people with no S&E degrees working in S&E occupations after 1990.
The SESTAT integrated database captures that part of the science and engineering population who either received a college degree (bachelor's or higher) in an S&E field or those who work in an S&E occupation with a bachelor's degree or higher in any field. This is a broad designation that includes many fields of study, as well as many occupations. The dashed oval on Figure 1 shows the groups of individuals included in the SESTAT integrated database. There are other groups in the U.S. population that can be considered part of the population of scientists and engineers, for example persons in technical occupations without college degrees, who are not included in the SESTAT integrated database. The SESTAT system was developed to provide information on the bachelor's and above population of scientists and engineers, with emphasis placed on those trained at U.S. institutions.
The 1993 SESTAT integrated database represents 11,615,200 individuals. This included 11,021,500 persons with S&E degrees, and 593,600 persons without such degrees but working in S&E occupations (table 2).
The 1995 SESTAT integrated database represents 12,036,200 individuals: 11,456,600 with S&E degrees; 334,100 persons without such degrees but working in S&E occupations, and 245,400 persons without S&E degrees or jobs.[2]
Approximately 84 percent of the individuals in the 1993 and 1995 SESTAT integrated databases (9,793,500 and 10,114,500, respectively) were employed. Among this group, about one-third were employed in science or engineering occupations (3,303,400 in 1993 and 3,185,600 in 1995). Individuals in this group are often referred to as those working in S&E. The remaining individuals were either unemployed, but seeking work (322,200 in 1993 and 249,300 in 1995) or were not in the labor force (1,499,500 in 1993 and 1,672,400 in 1995).
Many of the individuals in the 1993 and 1995 integrated databases hold either multiple S&E degrees or have degrees in both S&E and non-S&E fields. There were 11,021,500 individuals in 1993 who were educated in S&E; that number had risen to 11,456,600 by 1995. Approximately three-fourths of these individuals reported that their highest degree was in an S&E field (8,571,000 in 1993 and 8,908,000 in 1995).[3]
Many workers educated in S&E routinely find occupations in non-S&E fields. Roughly 70% of all S&E-educated individuals in the labor force were employed in non-S&E occupations (6,490,100 in 1993 and 6,718,600 in 1995). Conversely, but to a lesser extent, non-S&E educated individuals are employed in S&E occupations. In 1993, there were 593,600 non-S&E educated persons working in S&E occupations. In 1995, the SESTAT integrated database included only 334,100 persons in this category.[4]
There is a wide range of information on scientists and engineers contained in SESTAT. Listed here are examples of the variables found in the SESTAT integrated database.
Labor Force Information
For the employed:
For the unemployed and those not in the labor force:
Other Work-Related Information
Other Information
Special modules
1993: Labor force status in 1988
1995 (SDR only): Post-doctoral experience
1995 (NSCG and SDR only): Patent and publication activity
1997: Alternative or temporary work experience
SESTAT is useful not only for describing the characteristics of the U.S. scientists and engineers, but also for answering questions about this group. For example, it can be used to describe the educational background of engineers or social scientists. Analysts can use the system to show what occupations people with physics degrees hold. It can also be used to answer questions such as how age or gender are related to salary distributions for scientists or engineers working in different fields or with different degrees. SESTAT is intended to support this type of research, for both policy analysis and general information.
The Division of Science Resources Studies has produced a variety of analyses that show the capability of SESTAT for analyzing characteristics and issues about the U.S. population of scientists and engineers, including the following examples:
The concepts used to develop the SESTAT integrated database are broad and general in order to provide the capability for flexible and customized analyses. As such, SESTAT users may tailor their inquiries and research to address a variety of issues about the population of scientists and engineers.
The SESTAT system is available to the public on the World Wide Web at http://sestat.nsf.gov. This site contains public use versions of the SESTAT integrated databases for 1993 and 1995, as well as a public use version of the 1993 NSCG database. The 1997 integrated database will be available in Spring 1999. The National Science Foundation ensures the confidentiality of all of the data collected and available in the SESTAT system.
[1] For 1993, the full NSCG file (which includes all college degree holders, both S&E and non-S&E) is available for analysis. This file can be obtained on CD-ROM, or accessed through the SESTAT web site.
[2] The 245,400 persons without S&E degrees or jobs in the 1995 integrated database represent individuals who had S&E jobs in 1993, but by 1995 had moved to non-S&E jobs, become unemployed, or had moved out of the labor force. Although these cases are shown in the SESTAT integrated database, they no longer fit the population of individuals either educated in S&E or working in S&E. These individuals, along with the 334,100 persons in the 1995 integrated database without S&E degrees but still working in S&E jobs are part of a panel of individuals that are being followed throughout the 1990s. The latter group is described in figure 1 as "Box M", and is underrepresented in the SESTAT database after 1993 because the SESTAT surveys do not capture new persons entering S&E occupations who are not educated in S&E fields in this decade.
[3] For individuals with two or more degrees at the same highest degree level (bachelor's, master's, doctorate, professional), the field of the most recently earned degree is considered the highest degree field.
[4] See footnote 2.


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Charleston Aquarium
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A Day Trip to Lexington, Va.
... was the Stonewall Jackson House. We got there a few minutes late for the 1:00 tour so had to wait until the 1:30 tour. We wandered around the town for a few minutes and then headed on back. At exactly 1:30 we started the tour which began with a video. After the video had been going for just a couple of minutes Gary called with information about the river house so we kind lost the gist of the video. ...


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You are here: Home Uncategorised Healthgrades
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|From the Well4Life Blog
One of Healthgrades America's 100 Best Hospitals for Cardiac Care™ for two years in a row (2014-2015)
One of Healthgrades America's 100 Best Hospitals for Orthopedic Surgery™ in 2015
One of Healthgrades America's 100 Best Hospitals for Joint Replacement™ in 2015
America's 100 Best Hospitals is one of Healthgrades' highest distinctions, recognizing hospitals that exhibit exceptional, comprehensive and consistent quality year over year. Even more impressive, we were the only hospital in New Jersey to receive these three.
We're thrilled to be honored with such high praise, and happy knowing our patients can believe in our care more than ever.
If that's not enough, we've received even more recognitions from Healthgrades — many of which are for consecutive years! Take a look at the well-deserved honors for our acclaimed Orthopedic and Cardiology teams.


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Page 1
Diagnosis and Initial Management of Obstructive Sleep Apnea without
A Randomized Validation Study
Alan T. Mulgrew, MB; Nurit Fox, MSc, CCRP; Najib T. Ayas, MD, MPH; and C. Frank Ryan, MB
Background: Polysomnography (PSG), despite limited availability
and high cost, is currently recommended for diagnosis of obstruc-
tive sleep apnea and titration of effective continuous positive airway
pressure (CPAP).
Objective: To test the utility of a diagnostic algorithm in conjunc-
tion with ambulatory CPAP titration in initial management of ob-
structive sleep apnea.
Design: A randomized, controlled, open-label trial that compared
standard PSG with ambulatory CPAP titration in high-risk patients
identified by a diagnostic algorithm.
Setting: A tertiary referral sleep disorders program in Vancouver,
British Columbia, Canada.
Patients: 68 patients with a high pretest probability of moderate to
severe obstructive sleep apnea (apnea–hypopnea index [AHI] ?15
episodes/h) identified by sequential application of the Epworth
Sleepiness Scale (ESS) score, Sleep Apnea Clinical Score, and over-
night oximetry.
Intervention: Patients were randomly assigned to PSG or ambula-
tory titration by using a combination of auto-CPAP and overnight
oximetry. They were observed for 3 months.
Measurements: Apnea–hypopnea index on CPAP, ESS score, qual-
ity of life, and CPAP adherence.
Results: The PSG and ambulatory groups had similar median BMI
(38 kg/m2), age (55 years), ESS score (14 points), and respiratory
disturbance index (31 episodes of respiratory disturbance/h). Each
episode is determined by a computer algorithm based on analysis
of oxygen saturation measured by pulse oximetry. After 3 months,
there were no differences in the primary outcome, AHI on CPAP
(median, 3.2 vs. 2.5; difference, 0.8/h [95% CI, ?0.9 to 2.3]) (P ?
0.31), between the PSG and ambulatory groups, or in the second-
ary outcomes, ESS score, Sleep Apnea Quality of Life Index, and
CPAP. Adherence to CPAP therapy was better in the ambulatory
group than in the PSG group (median, 5.4 vs. 6.0; difference,
?1.12 h/night [CI, ?2.0 to 0.2]) (P ? 0.021).
Conclusions: In the initial management of patients with a high
probability of obstructive sleep apnea, PSG confers no advantage
over the ambulatory approach in terms of diagnosis and CPAP
titration. The ambulatory approach may improve adherence to
treatment. When access to PSG is inadequate, the ambulatory
approach can be used to expedite management of patients most in
need of treatment.
Ann Intern Med. 2007;146:157-166.
For author affiliations, see end of text.
ClinicalTrials.gov identifier: NCT00254059.
in 2% of women (1). Patients with obstructive sleep apnea
have considerable comorbid conditions, including excessive
daytime sleepiness; concentration difficulties; and an in-
creased risk for motor vehicle accidents, hypertension (2),
coronary artery disease, and strokes. Obstructive sleep ap-
nea may result in a systemic inflammatory state that pre-
disposes the patient to cardiac and cerebrovascular condi-
tions (3). Continuous positive airway pressure (CPAP) is
an effective treatment that is commonly prescribed for
symptomatic patients with obstructive sleep apnea: It is
cost-effective (4) and reduces daytime sleepiness, rates of
motor vehicle accidents, and blood pressure.
The American Thoracic Society (5) and the American
Academy of Sleep Medicine (6) recommend supervised
polysomnography (PSG) in the sleep laboratory over 2
nights for diagnosis of obstructive sleep apnea and initia-
tion of CPAP. This approach to a highly prevalent condi-
tion results in inevitable discrepancies between the demand
for services and the current capacity of sleep laboratories
(7). Various strategies have been proposed to expedite di-
agnosis and treatment for obstructive sleep apnea (8). Pre-
ymptomatic obstructive sleep apnea is a common, un-
derdiagnosed condition that occurs in 4% of men and
dictive algorithms (9–15) and widespread use of overnight
home monitoring, such as oximetry, have improved access
to diagnostic testing (16–22). Several algorithms have been
used to determine optimal CPAP (23, 24). Ambulatory use
of autotitrating CPAP machines is effective in determining
therapeutic CPAP (25) and as a treatment method.
To our knowledge, this is the first study to examine a
combined ambulatory diagnostic and treatment algorithm
without PSG in initial management of obstructive sleep
apnea. To do so, we performed 2 parallel validation stud-
ies: 1) a cross-sectional study in patients screened by the
See also:
Editors' Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Appendix Tables
Appendix Figures
Conversion of figures and tables into slides
Annals of Internal Medicine
© 2007 American College of Physicians 157
Page 2
diagnostic algorithm to test its use in identifying high-
probability patients using PSG as the gold standard, and 2)
a randomized trial of PSG versus ambulatory CPAP titra-
tion in high-probability patients identified by the diagnos-
tic algorithm. Our study asked whether the conventional
PSG approach was superior to the ambulatory approach in
terms of controlling obstructive sleep apnea as measured by
the apnea–hypopnea index (AHI) on CPAP after 3
months of treatment. We also wanted to determine
whether there was any difference between the 2 manage-
ment strategies in terms of sleepiness, quality of life, treat-
ment adherence, and CPAP after 3 months of treatment.
Study Design
We designed a randomized, controlled, open-label
clinical trial to compare PSG with an ambulatory algo-
rithm for titration of effective CPAP in patients with a
high probability of moderate to severe obstructive sleep
Patient Selection
Participants were recruited from among adult patients
referred from the catchment area of the Sleep Disorders
Program at University of British Columbia Hospital, Van-
couver, British Columbia, Canada, between May 2004 and
November 2005, for assessment of suspected obstructive
sleep apnea. Consecutive patients who, on the basis of a
routine clinical evaluation by their sleep physician, were
suspected of having moderate to severe obstructive sleep
apnea, met the inclusion criteria, and were referred for
possible participation in the trial, were considered for re-
cruitment. Eligible patients had a high pretest probability
of moderate to severe obstructive sleep apnea, were medi-
cally stable, and were not taking any sedative medications.
We excluded patients who were pregnant or who had ab-
normal results on spirometry (predicted forced vital capac-
ity or FEV1?70%); a known cause of daytime sleepiness;
a major psychiatric disorder; a life-threatening comorbid
illness, such as unstable coronary artery disease or chronic
lung disease; a motor vehicle accident attributable to hy-
persomnolence in the preceding 5 years; previous treat-
ment for obstructive sleep apnea; a contraindication to na-
sal CPAP therapy; or the inability to provide informed
consent. Each eligible patient provided written informed
consent, and our institutional ethics review committees ap-
proved the protocol. Patients were enrolled by the research
coordinator who collected the baseline data.
Determining Pretest Probability
High-probability patients were identified by sequential
application of the Epworth Sleepiness Scale (ESS), Sleep
Apnea Clinical Score (SACS) (11), and overnight oximetry
in the home. The range of possible scores on the ESS is 0
to 24. In a retrospective case series of all patients (n ? 798)
referred to our sleep clinic with suspected obstructive sleep
apnea who had a full diagnostic overnight PSG between 1
January 2001 and 31 December 2001 (26), the prevalence
of moderate to severe obstructive sleep apnea (AHI ?15/h)
was 49% among patients with an ESS score of 10 or
greater. The SACS is a screening tool based on snoring,
witnessed episodes of apnea, neck circumference, and sys-
temic hypertension that can be used to calculate likelihood
ratios for the presence of obstructive sleep apnea (11). A
score of 15 or greater gives a likelihood ratio of 4.45 of
having moderate to severe sleep apnea (11). The Remmers
Sleep Recorder (SagaTech Electronics Inc., Calgary, Al-
berta, Canada) is an easy-to-use, multichannel portable de-
vice that measures oxygen saturation, respiratory effort, air-
flow, snoring, and leg movements. This device calculates a
respiratory disturbance index (RDI) on the basis of oxygen
desaturation events. An RDI of 15/h or greater measured
by the Remmers Sleep Recorder has a sensitivity of 98%
and a specificity of 88% for diagnosis of moderate to severe
obstructive sleep apnea, giving a likelihood ratio of 8.1
(18). Starting with pretest odds of approximately 1:1 on
the basis of an ESS score of 10 or greater, we used Bayes
theorem and assumed no interaction between components
of the algorithm. The combined likelihood ratio condi-
tional on a SACS of 15 or greater and an oximetry RDI of
15/h or greater yielded an estimated pretest probability of
moderate to severe obstructive sleep apnea greater than 95%.
Before randomization, all recruited patients completed
the Sleep Apnea Quality of Life Index (SAQLI)—a com-
prehensive survey with a high degree of internal consis-
tency, face validity, and construct validity designed to mea-
Overnight polysomnography in a sleep laboratory is nor-
mal practice for diagnosing obstructive sleep apnea (OSA)
but it is expensive and can delay diagnosis.
The authors combined standard clinical scales and over-
night home oximetry to ensure a pretest probability of
OSA of 90% or greater. Sixty-eight patients were ran-
domly assigned to usual care (polysomnography obtained
before continuous positive airway pressure [CPAP]) or am-
bulatory management (start CPAP without doing polysom-
nography). After 3 months, the 2 groups had the same
results on overnight polysomnography.
The study was done in a single tertiary care center.
Most patients with a probability of OSA of 90% or
greater do not require polysomnography before starting
—The Editors
Diagnosis and Initial Management of Obstructive Sleep Apnea without Polysomnography
158 6 February 2007 Annals of Internal Medicine Volume 146 • Number 3
Page 3
sure outcomes of clinical trials in sleep apnea (27, 28). All
patients received a one-on-one orientation and education
session from a dedicated CPAP coordinator who provided
information in a standardized fashion regarding nasal
CPAP therapy. This session included mask fitting and a
trial of CPAP while the patient was awake to ensure that he
or she could tolerate the device (Appendix, available at
The CPAP coordinator randomly assigned patients to
standard PSG or the ambulatory algorithm (Figure 1), us-
ing a stratified block randomization with a block size of 20.
The stratification factors were an ESS score less than 15
versus an ESS score 15 or greater and oximetry RDI less
than 30 episodes per hour versus RDI 30 episodes per hour
or greater. Four large envelopes were prepared, 1 for each
block. There were 20 folded cards in each envelope, 10 for
the PSG group and 10 for the ambulatory group. Patients
who consented to participate were assigned to a block ac-
cording to their ESS and RDI scores. Each patient picked
1 card from the designated envelope; the CPAP coordina-
tor noted the treatment allocation and destroyed the card.
Blinding patients to their treatment allocation was not pos-
sible, but all patients were treated in an identical manner,
including follow-up, aside from the interventions being
studied. The ResMed AutoSet Spirit (ResMed Inc., Syd-
ney, Australia) autotitrating CPAP machine was used in all
patients. Together with the ResMed Autoscan software,
this device is capable of storing and downloading data on
compliance; mask leak; and CPAP, including the 95th per-
centile pressure (29)—the pressure at or below which the
patient spent 95% of the time. Final CPAP was determined
according to treatment group.
Polysomnography Group
A trained technologist supervised PSG. Obstructive
sleep apnea was confirmed during a regularly scheduled
overnight PSG in the sleep laboratory at our hospital. Final
CPAP was determined according to a standard protocol
during a CPAP titration PSG performed on the following
night (Appendix, available at www.annals.org). There was
no subsequent adjustment to the fixed CPAP in the PSG
Ambulatory Group
The AutoSet Spirit was set to autotitrate at pressures
between 4 and 20 cm H2O. After being used for 1 week,
the ResMed Autoscan software was interrogated for effi-
cacy data, including CPAP, mask leak, residual respiratory
events, and use. The 95th percentile pressure was taken as
the initial effective pressure if no residual sleep-disordered
breathing was identified. The patient continued treatment
at this pressure in fixed CPAP mode for another week. On
days 6 and 13, overnight oximetry using a single-channel
device (Ohmeda Biox 3400, Ohmeda, Milan, Italy) was
performed. The following day, patients returned to the
clinic where ResMed Autoscan interrogation was per-
formed. If residual respiratory events or oxygen desatura-
Figure 1. Design of the clinical study.
CPAP ? continuous positive airway pressure; ESS ? Epworth Sleepiness Scale; PSG ? polysomnography; SAQLI ? Sleep Apnea Quality of Life Index.
Diagnosis and Initial Management of Obstructive Sleep Apnea without Polysomnography
6 February 2007 Annals of Internal Medicine Volume 146 • Number 3 159
Page 4
tion was observed during either night, the initial 95th per-
centile pressure or the fixed CPAP was increased by 1 to 2
cm H2O as tolerated. The final pressure was set on day 14
by the CPAP coordinator in consultation with the study
physician; this was deemed to be the effective pressure and
was not changed for the remainder of the study. The study
physician was responsible for monitoring adverse events
and ensuring patient safety (Appendix, available at www
Baseline measurements on all patients included the
SACS and RDI by using the Remmers Sleep Recorder.
Baseline diagnostic PSG was performed only in the PSG
group. At baseline and after 3 months of therapy, all pa-
tients completed the ESS (a decreasing score reflected less
sleepiness) and were administered the SAQLI question-
naire (an increasing score reflected improved quality of
life). After 3 months of treatment, the CPAP machines
were interrogated for the patient's adherence and CPAP.
All patients then had overnight PSG to measure the pri-
mary outcome: AHI while CPAP was used at the effective
pressure. The primary outcome was, therefore, a measure
of the efficacy of the chosen CPAP in eliminating sleep-
disordered breathing. Secondary outcomes were ESS and
SAQLI after 3 months of treatment, adherence to CPAP
averaged over 3 months, and final CPAP.
Sample Size and Statistical Analyses
The primary outcome of interest was AHI on CPAP
after 3 months of treatment. We calculated that a sample
size of 30 patients in each group would be needed to detect
a clinically important minimum between-group difference
of 5/h or more in AHI on treatment (AHI ?5/h was con-
sidered normal [30]), at the 0.05 level (2-sided) with 95%
power, assuming a standard deviation for AHI of 5 on the
basis of previously published data (24, 31–34). This sam-
ple size provided 85% power to detect a clinically impor-
tant minimum difference of 1 in the SAQLI. All analyses
were performed by using GraphPad Prism, version 4
(GraphPad Software Inc., San Diego, California) and
Stata, version 9.2 (Stata Corporation, College Station,
Texas). We expressed normally distributed baseline data as
means (SD) and nonnormally distributed baseline data as
medians (interquartile range). Most outcomes (AHI, ESS
score, SAQLI, and CPAP adherence) had floor and ceiling
effects, which resulted in moderately to severely skewed
distributions. We used the Wilcoxon rank-sum test to
compare the 2 treatment groups for these outcomes; point
and interval estimates for the difference between medians
were calculated using the Hodges–Lehmann method. We
used the 2-sample t-test to compare CPAP, and point and
interval estimates were calculated for the average difference
between groups. The primary outcome was AHI on CPAP
after 3 months of treatment. We used a complete case
analysis for primary and secondary outcomes and per-
formed additional sensitivity analyses using worst-case and
best-case scenarios to address the impact of missing data.
We used Fisher exact test to assess the performance of the
diagnostic algorithm. We collected baseline data before
randomization and analyzed outcome data with the treat-
ment allocation concealed.
Role of Funding Sources
The funding sources played no role in the conception
or design of the study, in analysis or interpretation of the
data, in writing of this report, or in the decision to submit
the manuscript for publication.
Figure 2 shows the details of study enrollment and
outcomes. The baseline characteristics of patients who were
not enrolled were similar to those who were randomly as-
signed (Appendix Table 1, available at www.annals.org).
Baseline characteristics of the patients who were randomly
assigned were comparable between the 2 groups (Table 1).
In general, patients were middle-aged, predominantly
male, moderately obese, and hypersomnolent and had
moderate to severe obstructive sleep apnea.
Performance of the Diagnostic Algorithm
Of 79 patients screened by the diagnostic algorithm, 2
declined enrollment, 9 were ineligible because of an RDI
less than 15/h, and 68 were eligible for randomization. Of
these 68 patients, 35 were assigned to the PSG group (Fig-
ure 2). Of the patients who were screened, 41 had a base-
line diagnostic PSG: 34 patients were part of the random-
ized trial and 7 ineligible patients as part of routine care. In
these patients, the PSG served as the gold standard for
assessment of performance of the diagnostic algorithm. Of
the 36 patients with an ESS score of 10 or greater, SACS
15 or greater, and RDI 15/h or greater who had a baseline
PSG, 34 had an AHI greater than 15 h/night. Thus, the
probability of moderate to severe obstructive sleep apnea
was 0.94 (95% CI, 0.81 to 0.99), conditional on an ESS
score of 10 or greater, a SACS of 15 or greater, and an RDI
of 15/h or greater.
Apnea–Hypopnea Index
After 3 months of treatment, there was no difference
in AHI on CPAP therapy between the groups (Figure 3).
The median difference in AHI was 0.8/h (CI, ?0.9 to 2.3)
(Table 2). One patient in the PSG group who had mixed
central and obstructive sleep apnea and an AHI of 90/h on
baseline PSG had a residual AHI greater than 30/h but had
a good clinical response to CPAP.
One patient in the ambulatory group with Cheyne-
Stokes respiration and a baseline RDI of 43/h had a resid-
ual AHI of 27/h. He remained symptomatic and had poor
adherence to CPAP therapy throughout the study.
Epworth Sleepiness Scale and Sleep Apnea Quality of
Life Index
The changes from baseline did not differ between the
groups for ESS score (1 [range, ?1 to 4]) (P ? 0.26) or
SAQLI (0.17 [range, ?0.6 to 0.9]) (P ? 0.69) (Table 2).
Diagnosis and Initial Management of Obstructive Sleep Apnea without Polysomnography
160 6 February 2007 Annals of Internal Medicine Volume 146 • Number 3
Page 5
After 3 months of treatment, there was no difference be-
tween groups in ESS score (0.0 [range, ?2.0 to 2.0]) (P ?
0.86) or SAQLI (?0.19 [range, ?0.7 to 0.3]) (P ? 0.41)
(Figure 4). Scores on the ESS and SAQLI improved in all
patients who completed the study, except for the person
with Cheyne-Stokes respiration.
Adherence and Continuous Positive Airway Pressure
Overall compliance was good. Compliance was better
in the ambulatory group (median, 6.0 [interquartile range,
5.1 to 7.1] h/night) than in the PSG group (median, 5.4
[interquartile range, 3.7 to 6.4] h/night): The difference
between the PSG and ambulatory groups (?1.12 [CI,
Figure 2. Study flow diagram.
CPAP ? continuous positive airway pressure; ESS ? Epworth Sleepiness Scale; OSA ? obstructive sleep apnea; PSG ? polysomnography; RDI ?
respiratory disturbance index; SACS ? Sleep Apnea Clinical Score. *Baseline PSG was used to assess the performance of the diagnostic algorithm.
Diagnosis and Initial Management of Obstructive Sleep Apnea without Polysomnography
6 February 2007 Annals of Internal Medicine Volume 146 • Number 3 161


text:
|Blog Posts
11/19/2013 by Sandy Spencer 1 Comment
Many readers have asked about the various Medic-Alert Systems available right now. Making a good choice for you can be confusing with so many offering this service.
But if you have a loved one who is still living at home alone, this extra measure of safety may be a necessity. What if they fall and can't get up! as we hear so often on television. This can and does happen everyday. Which system would you choose? Prices quoted are from time of review and may have changed recently. Check with a dealer for current prices.
The American Medical Alert Corp (AMAC) monitors Walgreens Ready Response, a medical monitoring service started by this drugstore giant in 2007. This well-known home medical alert system monitoring center supports various systems throughout the country.
Walgreens Ready Response is simple to set up. After you receive your console, you just plug the console into a phone line and a power outlet. Press the help button to alert the monitoring center that the system works and then you're ready for service. An activation fee is required to start up, but the good news is that no lonq-terrn contract is required.
In addition to the smartly designed console, the help pendant comes with three different attachment options: necklace, belt clip and wristband. The pendant has a 4·year battery life, but to ensure protection, it will send a signal to the monitoring center when the battery is low. Walgreens Ready Response will also notify your family and health care providers in case of an emergency.
To ease your pocketbook worries, Walgreens provides a lifetime warranty on all equipment.
·Walgreens Ready Response offers toll-free, 24-hour customer service. You'll find FAQs and an email address on their website for further questions. You can also submit a
Like its home security systems, ADT Companion Service offers professional installation. This is not required, but the company suggests it, just to make certain everything is working properly. The company also charges an activation fee to turn on the home emergency alert system. The start-up costs are steep compared to other services we reviewed.
Furthermore, before you buy ADT Companion Service, you must be absolutely sure this is the service for you, because ADT lacks a cancel-at-any-time policy. This means that if you are dissatisfied with the service, you must wait until your yearlong contract is complete before you can switch to another service.
A two-way communication console and waterproof pendant are included with ADT Companion Service, and the monitoring center provides 24/7 support. Theconsole-to-pendant range is 300 feet, and the console has 12-20 hours of backup battery power. The console includes high and low temperature sensors that can send an alert to ADT if it detects unsafe temperatures in your home.
ADT Companion Service offers a monthly check-in service. Operators from the monitoring center make sure to call once a month to verify that the system is fully functional. Additional pendants, which are needed when a second person uses ADT Companion Service or if a pendant is lost and needs to be replaced, can be purchased on ADT's website. Receiving help regarding your ADT Companion Service account is incredibly easy. A toll-free phone number for support and an email form to request a call back are both listed on ADT's website. For quick answers to commonly asked questions regarding the system, FAQs are listed on the site. A downloadable brochure is available on their site as well.
A home medical alert system offers more than added safety and security; it gives seniors and their caregivers the freedom of independence as well as peace of mind. With the ADT Companion Service® Emergency Response System, you will have access to help at just the push of a button, 24 hours a day, from anywhere in your home. And since living alone should never mean being alone, ADT offers wireless home health security and personal emergency response systems so you can live life on your terms.——————————————————–
Life Alert's method is simple. The person being monitored wears medical alert jewelry, such as a wrist band or neck pendant. The jewelry features an emergency or panic button that the wearer can push in the case of an emergency. The pendant then communicates with the console connected to the customer's phone line that contacts Life Alert's monitoring center, which in turn contacts first responders or other emergency contacts.
A Life Alert technician professionally installs each system. This is a great feature for those with family who live too far away to help. However, the company charges an activation fee for its service. There is no long-term contract required to use Life Alert, but a cancellation fee applies if you cancel without 30 days' notice.
The core feature of the Life Alert medical alert system is the console that enables two-way communication with the company's reputable monitoring center. The operational range between the console and pendant is 150 feet, making the system best suited for small homes. Life Alert provides either a necklace pendant or a pendant hidden in a standard men's watch. A lifetime warranty is included on all products.
While Life Alert doesn't offer popular additional monitoring products like a voice extender and lockbox, it does include a 911 phone (a phone that is exclusively designed to contact emergency services directly) as part of its monitoring repertoire. The Life Alert Mobile service allows you or your monitored loved ones to leave the confines of their home – and the limited 150-foot range of the console – to enjoy the freedom of coverage everywhere. Simply press any button on the phone to connect to Life Alert's monitoring center.
Life Alert is a Personal Emergency Response and Home Medical Alert System company that saves lives from catastrophic outcomes, using a unique technology to provide superior home audio monitoring protection. Founded in 1987, Life Alert provides its service to members nationwide. The company employs over 600 people, all in the United States.
The company's service solves a major home security issue. Life Alert's protection helps people to live at home with independence and comfort, living their lives the way they want to, with a feeling of safety and peace of mind. Life Alert handles over two million calls a year, and on average saves at least one life from a catastrophic outcome every 17 minutes (over 31,000 in 2010). In Life Alert's Monitoring Center, the size of its emergency staff per member is 200% greater than a traditional security company.
Thanks to a greater sense of security, a 2004 ACNielsen study showed that 87% of Life Alert members stated that Life Alert's protection is a main or important factor in their decision to keep on living alone at home. For safety, security and emergency protection, Life Alert is the choice for all ages.
The LifeStation console enables two-way communication with LifeStation care specialists. This is the heart of the LifeStation medical alert system. The pendant is the legs, giving you the ability to signal LifeStation from anywhere in your home, as long as you are within 400 feet of the console.
Monitoring Services:
When you press the Help button on your console or pendant, LifeStation care specialists will answer your call in 30 seconds or less. The lightweight pendant is waterproof. If needed, additional pendants are available for a monthly charge. LifeStation also makes it a cinch to move your system to a new location, if necessary. Simply call LifeStation using your Help button a few days before you move, and they'll set everything up.
LifeStation will fix or replace all equipment free of charge thanks to its outstanding product warranty. The company also performs weekly check-ins. When an actual emergency does occur, LifeStation will contact 911 services and anyone you've indicated on your emergency contact list, from a doctor to your family, friends and neighbors.
LifeStation provides a variety of extra products that help keep you protected. A lockbox is available to keep a key in so that emergency personnel can get into your home if you can't reach thedoor, The company also sells a bathroom/llallway Help button in case of a fall when a.pendant or console isn't in reach. For those.lookinq.for.the ultimate in protection, LifeStation offers Activity Assurance. This service has a LifeStation care specialist check in with you on a daily basis.
Contracts & Fees:
Help & Support:.
A very basic service as far as medical alert systems goes; this is a good thing. A simple service means a fast response time which is crucial when an emergency occurs.
When a representative is reached, he or she determines the best course of action. Options include contacting emergency responders or the customer's selected contact. In either case, a quick response to a medical emergency can mean the difference between life, serious lasting injury or even death.
This is all pretty standard stuff in this industry. There is a fatal flaw in this method. That is it only works if the customer is within the range of the console and has a landline telephone connection attached to it. Unfortunately, more and more Americans are moving away from landlines in favor of mobile devices such as smart phones and VOIP services to provide their telephony needs. Medical Guardian recognizes this flaw.
To compensate for today's changing technological, Medical Guardian now provides a service plan that works with mobile devices. Cutting the cord to a landline telephone connection moved this service into the top half of our side-by-side comparison chart. This service knocks on the door of the award winning products in this category.
When we contacted Medical Guardian's customer service support, we were pleased to find that their representatives are informed, patient and helpful. They answered all our questions promptly and were truly interested in the best interest of their customers. Too often, we find that call center staff for medical alert providers are apathetic or crass, this leads to a lesser quality of care. Frankly, these are not qualities you look for when picking such an important service. Medical Guardian takes great care when picking their employees, you should have no trouble trusting that your call will be handled with the professionalism and urgency such a service demands.
For Years, Medical Guardian has been a leading provider of personal emergency response systems, utilizing the latest technologies to provide the best possible home medical alert system for seniors, while remaining committed to providing all of our customers with personalized care and attention. Doctors, hospitals, home health care providers, social workers and pharmacies nationwide frequently recommend our services. We are honored to have been recommended as a top home medical alert system in a comprehensive study by Good Housekeeping Magazine. Our services are also reccmmended by CVS Pharmacies, Reader's Digest, U.S. News and World Report, and have been featured on NBC News.
We offer service and support 24 hours a day, 7 days a week. Our systems are offered nationwide, monitored by medically trained personnel, and never outsourced outside of
We look forward to helping you regain your independence and start enjoying an independent life at home, free from fear. Our representatives are always available and delighted
Top Ten REVIEWS Silver Award for medical monitoring services. LifeFone earned this honor by providing a thorough medical monitoring service. Among the features we look for is a solid emergency contact plan that is set in place upon activation of the service. Receptive and courteous response center operators are also necessary for services in this industry. LifeFone's Emergency Care Plan offers all this and more, including a personalized profile with medical history, medications, allergies, physicians, family members, neighbors and preferred hospitals.
Monitoring Services:
Medical monitoring services have come a long way over the years. Many now offer additional products to use in conjunction with the console and pendant. LifeFone's Long
Range Help Button allows the emergency call center to hear you even if you're not by the console, extending the reach of the console up to 1,000 feet. A removable belt and pocket clip are included with each long-range button to help adhere it to your person securely. For further protection, LifeFone sells the highly popular Help Button, which is a large Velcro-mounted help button to place in hallways, by the nightstand and in other areas of the home to provide extra security in case the pendant isn't accessible.
To let emergency responders into your home if you can't unlock the door, you can get a hanging lockbox or a wall-mounted lockbox. Simply store a spare house key in the box and place it outside your main door. LifeFone will share the lockbox password with emergency personnel if they need to gain entry to your home.
A monitoring feature of LifeFone that you won't find with any other medical alert system is its Worldwide Protection service. Every LifeFone client receives a LifeFone Emergency Response Card to keep in a wallet or purse at all times. This card gives health care providers instant access to your Personalized Profile via the LifeFone Emergency Response Network. This provides invaluable extra protection while you're traveling, since emergency personnel will have access to everything they'll need to know to give you or your loved one the best possible care.
To ensure that you're protected in the bathroom, the place where the greatest number of falls occur, the pendant is fully waterproof and will continue working no matter how soaked it gets. Additionally, the entire system, from the console to the pendant, is UL approved. Each console has an operating range of 1,000 feet. Moreover, the console will recognize the pendant from both inside and outside the home.
Contracts & Fees:
Help & Support:
Bay Alarm Medical can provide assistance 24 hours a day, 365 days a year at the touch of a button. Additionally, this service puts customers first by providing no-hassle pricing, the best combination of hardware, and fast, courteous service in 170 languages. This system works in most living areas of your home and can even detect if you push the button while you're outside, as long as you're within range of the receiver. This first-rate medical alert system wins our Top Ten REVIEWS Gold Award for its overall value, ideal combination of features and great customer service.
Monitoring Services:
Bay Alarm also offers monitoring for fire, smoke and carbon dioxide leaks. These additional monitoring services give you more peace of mind, especially if you or your loved one is elderly and cannot swiftly fiee the home or contact emergency services.
The pendant for this senior alert system is petite and waterproof. You can wear the small, lightweight pendant as a necklace or wristband, or clipped on a belt. Additionally, it
Emergency workers use whatever means necessary to get to you. That includes breaking down the door if you are incapacitated and cannot let them in the house. This is the scenario Bay Alarm Medical alert system helps you avoid with its lockbox feature. In an emergency, operators can give ambulance and fire personnel a code for your lockbox.
The lock box works just like the ones realtors use. Responders can open the box with the code and get the house key is inside. That way you don't end up with costly repairs.
We wish the lockbox were included in the basic price, but it is not. You pay a one-time set-up fee that we think is worth it for most people. You can order extra pendants to monitor another loved one with the same main console. You pay extra for the additional pendant, but there's no additional monthly fee to add a person. For an added monthly cost, you can configure the home medical alert system to work with detection equipment from Bay Alarm for smoke and carbon monoxide. If the system detects either of those, it will alert customer service representatives, who will then call the fire department and anyone else you designate. Bay Alarm Medical does not
Contracts & Fees:
This senior alert system can come with you on vacation or easily move to another state. As long as you have a land line and power, you can plug in the Bay Alarm Medical
Help & Support:
There are plenty of support options online and over the phone if you need help with installation. Additionally, Bay Alarm Medical has a FAQs page on its website. This is the only medical alert system we reviewed that offers live chat support. Chat is not an essential feature for every customer, but we don't see why this is not an option with more home medical alert system providers, especially since they have workers ready to respond around the clock anyway. It's convenient to be able to go to the website and get answers within seconds.
The emergency pendants are designed to be lightweight for comfort throughout the day and are 100% waterproof so that they're able to be worn while bathing. After all, 80% of falls happen in the bathroom. The pendants are shipped with a lanyard, wristband and belt clip and can be interchanged. Easy to Use. Even Easier to Install. Installing BayMed Basic is as easy as 1-2-3. Just plug in the power, plug in the phone line and test the system by hitting the Emergency Button. That's it! You'll be set up in minutes.
Personal Protection Plan
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Report: Jude Law dating movie wardrobe assistant
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British actor Jude Law is reportedly dating the wardrobe assistant from his new movie "Dom Hemingway."
RELATED: Stars who fall for average Joes and Janes
The "Sherlock Holmes" star, who was previously married to Sadie Frost and engaged to Sienna Miller, has grown close to Ellen Crawshaw since they began working on the film in October, according to Britain's Mail On Sunday.
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A source tells the publication, "Jude and Ellen's romance is the talk of the set. It started last month when we were filming in France.
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"There was an instant connection and they'd been flirting but it didn't turn physical until the night we all went out for a cast and crew party just outside St Tropez.
"Since then they have been inseparable. They are making no attempt to hide their feelings for each other and both of them look so happy. They clearly get on fantastically well. He's single and so is she, so there's nothing to hide. They are just two people in love having a great time together."
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text:
Left 4 Dead
Version and / or Patch Used: Latest Steam Update
Timedemo or Level Used: Custom Timedemo
Developer Homepage: http://www.valvesoftware.com/
Product Homepage: http://www.l4d.com/
Left 4 Dead uses the latest version of Valve's Source engine, with improvements such as multi-core processor support and physics-based animation to more realistically portray hair and clothing, and to improve physics interaction with enemies when shot or shoved in different body parts. Animation was also improved to allow characters to lean realistically when moving in curved paths.
Rendering and artificial intelligence were scaled up to allow for greater number of enemies who can navigate the world in better ways, such as climbing, jumping or breaking obstacles. Lighting has been enhanced with new self-shadowing normal mapping and advanced shadow rendering that is important to convey information about the environment and player actions.
Like we've seen all along, we have some good gains here thanks to the extra MHz on offer.
PRICING: You can find products similar to this one for sale below.
United States: Find other tech and computer products like this over at Amazon's website.
United Kingdom: Find other tech and computer products like this over at Amazon UK's website.
Canada: Find other tech and computer products like this over at Amazon Canada's website.
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Bio: Forging a path in the East Coast U.S. rock scene and beyond, Shryne drives pop rock to new heights with their energetic recorded sound and infectious live shows.
The award winning quintet has just completed work on their newest release, "Here and Now".
The new record features 11 original genre...See Full Bio
Vocals, Keyboard, Percussion
Keyboard, Vocals, Violin/Viola
Guitar, Vocals
Andrew Sharp
Kevin Pereira
"First off, the dual main vocalists were strong. Unlike most local acts, this band did not have that "fishbowl" sound to them and you could actually hear the words. Also, the playing ability of this band really shocked me. At one point during the cover of "Carry on My Wayward Son," the guitarist, Mattera, hit the solos so perfectly it was mind blowing. I figured it may just be the fact that it was a cover, but the ability continued through the set. One final note is the band drew the largest crowd reaction. Everyone in the crowd was dancing and packing up front. In all, due to the reaction and the pure talent, this band placed first on my list."


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