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CPAP is used as the first-line treatment for patients with severe OSA, but this machine is not always feasible to use on the long term. We performed a clinical trial to determine whether patients with OSA could use a mandibular advancement splint (MAS) as a short-term treatment alternative to CPAP.
Twenty-two patients adherent with CPAP therapy were recruited to the study. Each patient used the MAS for approximately 4 months. The transition between CPAP to MAS was gradual, and patients were asked to start using MAS together with CPAP during the MAS titration until subjective improvement or maximum mandibular advancement was achieved. Sleepiness (ESS), quality of life (SAQLI), and polysomnography were recorded prior to and after MAS titration. Patients recorded CPAP or MAS usage for the following 3 months.
Seven women and 12 men with a mean age of 53.8 (± 12.1) years and mean body mass index of 28.1 (± 4.8) kg/m2 completed the clinical trial. Prior to MAS, CPAP adherence was 5.8 h/night. AHI decreased significantly with MAS use compared to baseline (30.7 ± 23.1 vs 13.2 ± 11; p < 0.01). Fourteen patients (74%) had > 50% decrease in their AHI, while 2 patients had an increase in their AHI. There were no significant differences in SAQLI between MAS and CPAP treatment, while ESS decreased significantly on MAS. MAS self-reported usage was correlated with treatment efficacy (r = 0.52; p < 0.05). Seventy-five percent of the patients reported being sufficiently satisfied with MAS to continue to use it as an alternative short-term therapy.
MAS partially or completely reduced sleep disordered breathing in the majority of selected, successfully CPAP-treated severe OSA patients. Many patients can probably effectively use MAS as a short-term treatment alternative to CPAP.
ClinicalTrials.gov registration number NCT00358605.
A commentary on this article appears in this issue on page 325.
Almeida FR; Mulgrew A; Ayas N; Tsuda H; Lowe AA; Fox N; Harrison S; Fleetham JA. Mandibular advancement splint as short-term alternative treatment in patients with obstructive sleep apnea already effectively treated with continuous positive airway pressure. J Clin Sleep Med 2013;9(4):319-324.
Obstructive sleep apnea (OSA) is a common syndrome that is characterized by recurrent episodes of partial or complete upper airway obstruction during sleep. OSA is associated with reduced quality of life, decreased cardiovascular health and increased healthcare utilization, car crashes, and mortality.1,2 There are a variety of treatment options currently available for OSA including lifestyle modifications, continuous positive airway pressure (CPAP), mandibular advancement splints (MAS), and corrective upper airway surgery. CPAP is the most efficient treatment for OSA and has been demonstrated to improve daytime symptoms and reduce cardiovascular disease and car crashes.3,4 Despite improvements in the portability of CPAP machines, many patients find this treatment not feasible when away from home. CPAP machines require access to a reliable electrical source while asleep. This can sometimes be provided by a battery, but is quite cumbersome and needs periodic recharging. Many patients faced with short-term difficulties complying with CPAP during periods of travel or vacation stop treatment in these circumstances. MAS are now widely used for the treatment of OSA both as a primary therapy and as an alternative for patients with severe OSA who are unwilling or unable to tolerate CPAP.5 MAS are a simple, reversible, quiet, and cost effective therapy for selected patients with OSA.
Current Knowledge/Study Rationale: Many patients with OSA who are under CPAP treatment will experience temporary circumstances during which CPAP is not convenient, and therefore adherence is compromised. There is a lack of studies evaluating the combination of CPAP and OA where patients can alternate between the two therapies.
Study Impact: This study may impact clinical treatment recommendations with a patient-centered treatment approach. Patients can express treatment preferences; deliberate the options; and agree on a treatment plan implementing both devices (CPAP and OA). This combination of therapies allows greater flexibility of treatment and opportunity for ongoing adherence during those temporary circumstances in which CPAP cannot be used.
In randomized controlled trials comparing both modalities of treatment, CPAP therapy is consistently more effective in reducing sleep disordered breathing events.6–9 While CPAP and MAS have similar subjective and cardiovascular outcomes, patients tolerate MAS better.8–11 The superior patient satisfaction associated with the use of MAS reflects the relative simplicity and convenience of this form of treatment. Patients are offered one or the other treatment, but the combination of these two specific therapies warrants further investigation. To our knowledge, there has only been one previous study12 that has attempted the combination of these two therapies, with the disadvantage of using a non-titratable device without a follow-up by a dentist for adjustments. The objective of this study was to determine the feasibility of using MAS as an alternative treatment in patients previously established on CPAP. This combination of treatments would permit greater flexibility and improved treatment adherence in circumstances where CPAP cannot be tolerated.
Patients with symptomatic OSA and an apnea-hypopnea index (AHI) > 10 events/h adherent with CPAP (> 4 h/night) for a minimum period of 3 months were recruited to the study. Patients were excluded if they had any comorbid diseases, had a safety-critical occupation, were looking for an alternative treatment to stop CPAP treatment, or had dental contraindications to MAS treatment, (< 8 teeth per arch or severe periodontal disease).13 This study was approved by the UBC Human Ethics Committee, and all patients signed a consent form prior to inclusion in the study.
All patients had baseline diagnostic polysomnography (PSG) prior to initiation of CPAP treatment. The laboratory PSG was performed according to practice parameters published by the American Sleep Disorders Association Standards of Practice Committee.14 Standard measurements included electroencephalography (EEG), electrooculography (EOG), submental and tibial electromyography (EMG), electrocardiography (ECG), chest and abdominal respiratory impedance plethysmography (Respitrace; Ambulatory Monitoring Systems, Ardsley, NY), arterial oxygen saturation was recorded using a pulse oximeter (Model N-100; Nellcor Inc., Hayward, CA, USA), and nasal airflow was recorded using nasal cannulae connected to a pressure transducer (Ultima Airflow Pressure Sensor; Braebon Medical Corp., Carp, Ontario, Canada). PSG data were analyzed manually according to AASM criteria by a certified polysomnographic technologist. All patients were prescribed CPAP and had used it consistently for a minimum of 3 months. CPAP adherence was objectively measured prior to recruitment.
Patients completed an Epworth Sleepiness Scale (ESS)15 and quality of life and side effects (SAQLI) questionnaires16 at recruitment while on CPAP. ESS and SAQLI were repeated after MAS titration and while on MAS for ≥ 2 weeks. Patients were then informed of the results of the PSG and were instructed to use either the MAS or CPAP at their discretion for the following 3 months. They were instructed to keep a 3-month diary where they tracked which treatment was used each night. After this 3-month period, patient and partner satisfaction were assessed using visual analog scales. At the end of the study, patients were asked whether they were sufficiently satisfied with MAS to continue with it as a short-term treatment alternative and/or purchase it at a similar cost to CPAP.
Patients were fitted with a titratable MAS (Klearway).17 To ensure safety and adherence, the transition between CPAP to MAS was gradual, and patients were asked to start using MAS together with CPAP. Patients were instructed to advance the MAS 0.5 mm per week. Patients were then advised to stop using the CPAP for 1 or 2 nights to evaluate the efficacy of the MAS once a month. CPAP pressure was not adjusted during treatment, since after titration patients would use only one treatment at a time. Patients were evaluated by the dentist once a month, and further titration was recommended based on the patient's subjective evaluation. Once patients felt that the MAS had either successfully reduced the snoring and sleepiness or if the maximum mandibular advancement had been achieved, patients underwent PSG with the MAS and also repeated the ESS and SAQLI questionnaires. Treatment success was defined as AHI ≤ 10; suboptimal treatment if 20 ≤ AHI > 10; or treatment failure if AHI > 20 or ESS > 9 or ESS > 4 CPAP value. Treatment efficacy was also described as a decrease in the AHI greater than 50%, a decrease of less than 50%, or increase of the AHI compared to the baseline AHI. The clinical trial was registered as ClinicalTrials.gov registration number NCT00358605.
The study design included the patient's diagnostic PSG and the assurance that patients were adherent to CPAP for a minimum of a 3-month period. Once patients were included in the study, they answered the ESS and SAQLI while on CPAP. All patients received a custom-made adjustable MAS. After the adjustment period, all patients underwent a repeat PSG, ESS, and SAQLI while on MAS treatment alone. After MAS outcomes disclosure, patients were followed for 3 months with a treatment use diary where they could use CPAP or MAS at their will. A schematic flow chart of the study design is shown in Figure 1.
Schematic flow chart of the study design
(more ...)
Statistical analyses were performed using SPSS version 15.0 (SPSS Inc., Chicago, Illinois, USA). Descriptive data were presented by percentage, mean, and standard deviation. Comparisons between baseline and follow-up for AHI, ESS, SAQLI, and treatment usage were analyzed using paired Student t-tests, and Pearson correlation tests were applied to determine the correlation between MAS AHI and days per month of MAS usage. A p value of 0.5 was considered statistically significant.
Nineteen of 22 patients recruited for the study completed the trial. One patient could not tolerate the MAS due to excessive salivation, and 2 patients were unable to attend the follow-up PSG. Seven women and 12 men completed the clinical trial with a mean age of 53.8 (± 12.1) years and a mean body mass index (BMI) of 28.1 (± 4.8) kg/m2. CPAP adherence was 5.8 (± 0.8) h per night prior to the study. Baseline demographic data is provided in Table 1.
Demographic data for 19 sleep apnea patients who completed the study
Baseline AHI compared to AHI while on MAS treatment decreased significantly from 30.7 ± 23.1 to 13.2 ± 11.0 events/h (p < 0.01). Patient baseline and follow-up (MAS) AHI data are shown in Figure 2. The MAS successfully treated 47% of the patients, while 21% reached suboptimal results and 32% were considered treatment failures. Fourteen of 19 patients (74%) showed a reduction ≥ 50% in the AHI. Further changes in the AHI expressed as percentage are shown in Figure 3. In the evaluation of sleep quality, MAS treatment did not change sleep architecture (as percentages of sleep stage N1, N2, N3, or REM) and did not significantly improve the mean oxygen saturation.
Significant reduction of the apnea and hypopnea index when comparing no treatment to MAS treatment (p
Distribution of the number of patients with their respective percentage of change in the AHI
In the 3-month follow-up period, MAS usage reflected treatment efficacy, with a significant negative correlation between days per month of MAS use and MAS AHI (r = -0.45 p < 0.05; Figure 4). There were two exceptions, one patient in whom the MAS was highly effective but used it infrequently, and one patient used the MAS exclusively despite MAS treatment AHI > 20/h.
Significant correlation between AHI when wearing a MAS (MAS-AHI) and days per month of MAS usage (r = -0.454; p = 0.05)
While on CPAP treatment, patients reported a mean ESS of 8.5 and a SAQLI score of 4.8. There was significant improvement in ESS while on MAS compared to CPAP (5.5 ± 3.0 vs 8.5 ± 4.3) and no difference in SAQLI while on MAS compared to CPAP (5.5 ± 0.9 vs 4.8 ± 0.7). There was no significant difference in reported side effects with MAS compared to CPAP, but MAS side effects (salivation and jaw discomfort) were more common in patients who were infrequent users of MAS. Six patients (31%) used MAS exclusively during the first month of follow-up. There was no significant difference between treatment nights per month (16.1 ± 12.1 nights on CPAP and 15.0 ± 11.4 nights on MAS). Sixteen patients (84%) reported wearing MAS while on vacation or traveling, and 11 (58%) reported using it at home. Sixteen patients completed a follow-up questionnaire. Patient preference between treatments did not show a statistical significant difference, as 56% of the patients preferred the MAS, 31% preferred CPAP, and 13% responded that they had no preference. In terms of patient perception of treatment efficacy, 19% of the patients felt that the MAS was more effective than CPAP, 44% felt both treatments were equally effective, and 37% felt that CPAP was more effective than MAS, which was not significantly different. When bed partners were asked about treatment preference, a significantly higher number of patients preferred MAS treatment (88%), while 6% preferred CPAP and 6% showed no preference (Figure 5). At the end of the trial, 85% of the patients reported using MAS, and 75% of them said they would purchase the MAS at a similar cost to the CPAP.
Data presented as percentage of patients. *CPAP and No preference significantly different than MAS preference, p < 0.05.
Subjective evaluation of treatmentData presented as percentage of patients. *CPAP and No preference significantly different than MAS preference, p
We have demonstrated that patients with OSA established on CPAP can use MAS as an alternative treatment. MAS was effective in reducing sleep disordered breathing in the majority of patients. With the exception of one patient, all subjects found MAS useful and have subsequently alternated between CPAP and MAS at home or used it solely for traveling. For patients adherent to CPAP treatment, this modality is well accepted and not inconvenient, although many patients may not use it while traveling. We have demonstrated that MAS is useful as an alternative therapy and patients will tend to use MAS while traveling instead of avoiding treatment in these circumstances. This is the first study to use titratable MAS on patients compliant to CPAP that investigates the applicability of having an alternate treatment for traveling.
Treatment preference outcomes, with a higher percentage of patients preferring MAS over CPAP, were similar to previous studies,9,10 although this is the first report to evaluate and describe a significantly higher preference in favor of MAS by the bed partner. The opportunity for an easier treatment approach was well received by most patients and bed partners, and we further hypothesize that these patients will have a tendency to spend fewer days without the use of any treatment modality. The treatment approach to OSA should always be individualized; a patient-tailored therapy requires patient involvement in planning and decision-making in their treatment. Patient lifestyle, including consistent access to a reliable electrical source while asleep, should be evaluated; patients may be frustrated if their needs are not taken into account.18
For the evaluation of the treatment effects on sleepiness and quality of life, previous studies have shown that patients with OSA present with a significant impairment in daytime sleepiness, quality of life, and neurocognitive function, which can be improved with CPAP and MAS therapy.6–9,19 Randomized control trials have shown no significant differences in subjective sleepiness and quality of life when comparing CPAP to MAS.8,20,21 Our study showed an interesting and important finding in terms of daytime sleepiness. When compared to sleepiness on CPAP, patients showed a significant decrease in their ESS score when using MAS. One could hypothesize that patients were less likely to occasionally drop treatment, and therefore the long-term effects on sleepiness were further consolidated.
The level of CPAP compliance effects on sleepiness has been widely studied. The assumption of good CPAP compliance use is commonly described as a 4 h per night on 70% of nights.22 Antic and colleagues,23 though, identified a treatment dose effect for subjective sleepiness, where a greater percentage of patients achieved normal functioning with longer use of CPAP. Based on our results, we hypothesize that combination therapy may be similar to higher hours to CPAP use, and combination therapy might be superior to CPAP alone in terms of the subjective sleepiness outcomes.
Quality of life is often measured in comparative studies. Similar to the present trial, previous studies found similar efficacy in MAS and CPAP when assessed by FOSQ, SF-36, anxiety and depression scales, or Nothingham health profiles.8,9,20 In contrast, there are two studies showing a greater impact of CPAP compared to MAS in quality of life.21,24 The appliance used in these studies was not titratable and thus likely did not achieve ideal mandibular protrusion with less efficacy than a titratable MAS. According to Lettieri and collaborators,25 adjustable devices are superior to single jaw position appliances and produce a greater reduction in the AHI, especially in moderate to severe OSA.
With regards to the type of MAS treatment, titratable MAS have higher efficacy rates,25 and a careful follow-up by the dentist is recommended by the American Academy of Sleep Medicine.26 We are aware of one previous study which addressed the feasibility of using MAS as an adjunct treatment in patients previously established on CPAP.12 The study used a non-adjustable MAS at 75% of mandibular advancement. Some patients had the appliance mailed to them, and there was minimal dental follow-up. The study measured CPAP and MAS efficacy with a portable monitor rather than detailed polysomnography. Without the refined adjustments and progressive titration of the MAS conducted by a dentist, of the 50 patients in that study who were fitted for MAS, only 9 were able to complete the study and 31 patients withdrew due to side effects from the MAS. The authors speculate that "insecurities" related to withdrawal from CPAP therapy as well as the use of a relatively simple MAS may have been contributory factors to the low acceptance rate. The current study also reinforces that a specialized dentist in the field should be responsible for insertion of the device and follow-up of the patients and that gradual titration of the mandible is extremely important to improve MAS efficacy. Despite the use of titration, according to our study protocol, patients were not asked to further adjust their appliances after the follow-up PSG. It is common in clinical practice to continue mandibular advancement if residual apneas are seen and further protrusion is possible. Therefore, an even higher success rate may have been achieved. Titration procedures are extremely important and are clearly related to MAS adherence and efficacy.27
The effect of treatment in the reduction of apneas is very important. Our study raises one issue in that some of our patients effectively treated with CPAP and provided with short-term MAS treatment subsequently discontinued their CPAP treatment in favor of MAS. It is imperative that the patients are aware of the efficacy of MAS. In the present study we found a positive correlation between the reduction in the AHI and MAS usage, showing that the allowance for patients to utilize both therapies is safe. In this regard, a follow-up sleep assessment should always be considered as part of a treatment protocol and in every patient with OSA treated with MAS. Despite the presence of residual apneas and the inferior efficacy of MAS compared to CPAP, it is interesting that some studies have shown that with a higher adherence to MAS, patients have similar health outcomes related to blood pressure8 and endothelial function.28 In a recent study, Lam and collaborators29 evaluated a group of severe OSA patients with recent diagnosed hypertension or on hypertensive drugs and found that despite the partial reduction in the AHI (67 to 25/h), there was significant improvement in the systolic and diastolic blood pressure measurements after one year of treatment.
This study has some clear limitations. Patients recruited to the study were biased to those who were willing to try another therapy because of lifestyle issues. It is possible that these patients, despite good initial reported CPAP adherence, were not as compliant to treatment on the long-term. Objective MAS adherence could not be obtained, as there was no readily available MAS adherence monitor in the market at the time of this study. Subjective treatment adherence reporting generally overestimates actual objective treatment adherence. This is a short-term study; the evaluation of usage of these treatments over a one-year period would have been ideal.
Despite the short-term evaluation, we believe this study reflects some patient behavior in daily life, such as changing treatment for relief of side effects or for convenience during travel. A different treatment option is likely useful when patients are experiencing specific side effects or discomfort, which could be relieved with the other form of therapy or while away from home.
The present study suggests that the mandibular advancement splint is a safe short-term alternative treatment approach for CPAP compliant patients. Since patient involvement in treatment choices may increase adherence with treatment; patient involvement would tend to increase overall adherence in the long term and decrease subjective sleepiness. Patient-tailored treatment is synonymous with good medicine, and life-long therapies are dependent on the patient's cooperation and adherence. We believe that it is important to include patients in decisions about their treatment and to offer more than one type of therapy for OSA patients who are potentially good candidates for MAS therapy.
A majority of patients with OSA already successfully treated with CPAP can effectively be treated with MAS as a short-term alternative treatment when travelling, when an electrical supply is not available, or on days that patients are not willing to use CPAP and tend to forgo treatment. A combination of therapies allows greater flexibility of treatment and opportunity for ongoing adherence in circumstances where CPAP cannot be used.
This was not an industry supported study. The authors have indicated no financial conflicts of interest.
This study was performed at the University of British Columbia, approved by the UBC Human Ethics Committee and all patients signed a consent form prior to inclusion in the study. This study was supported by the BC Lung Foundation, a non-profit organization.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S, authors. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5. [PubMed]
Flemons WW, author. Clinical practice. Obstructive sleep apnea. N Engl J Med. 2002;347:498–504. [PubMed]
George CF, author. Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax. 2001;56:508–12. [PubMed Central][PubMed]
Levy P, Pepin JL, McNicholas WT, authors. Should all sleep apnoea patients be treated? Yes. Sleep Med Rev. 2002;6:17–26; discussion 7. [PubMed]
Kushida CA, Morgenthaler TI, Littner MR, et al., authors. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep. 2006;29:240–3. [PubMed]
Aarab G, Lobbezoo F, Heymans MW, Hamburger HL, Naeije M, authors. Long-term follow-up of a randomized controlled trial of oral appliance therapy in obstructive sleep apnea. Respiration. 2011;82:162–8. [PubMed]
Aarab G, Lobbezoo F, Hamburger HL, Naeije M, authors. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial. Respiration. 2011;81:411–9. [PubMed]
Barnes M, McEvoy RD, Banks S, et al., authors. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med. 2004;170:656–64. [PubMed]
Gagnadoux F, Fleury B, Vielle B, et al., authors. Titrated mandibular advancement versus positive airway pressure for sleep apnoea. Eur Respir J. 2009;34:914–20. [PubMed]
Ferguson KA, Ono T, Lowe AA, Keenan SP, Fleetham JA, authors. A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest. 1996;109:1269–75. [PubMed]
Trzepizur W, Gagnadoux F, Abraham P, et al., authors. Microvascular endothelial function in obstructive sleep apnea: Impact of continuous positive airway pressure and mandibular advancement. Sleep Med. 2009;10:746–52. [PubMed]
Smith DM, Stradling JR, authors. Can mandibular advancement devices be a satisfactory substitute for short term use in patients on nasal continuous positive airway pressure? Thorax. 2002;57:305–8. [PubMed Central][PubMed]
Almeida FR, Lowe AA, authors. Principles of oral appliance therapy for the management of snoring and sleep disordered breathing. Oral Maxillofac Surg Clin North Am. 2009;21:413–20. [PubMed]
Chesson AL Jr.; Ferber RA, Fry JM, et al., authors. The indications for polysomnography and related procedures. Sleep. 1997;20:423–87. [PubMed]
Johns MW, author. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5. [PubMed]
Flemons WW, Reimer MA, authors. Development of a disease-specific health-related quality of life questionnaire for sleep apnea. Am J Respir Crit Care Med. 1998;158:494–503. [PubMed]
de Almeida FR, Lowe AA, Tsuiki S, et al., authors. Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome. J Clin Sleep Med. 2005;1:143–52. [PubMed]
Sabaté E, author; WHO Adherence to Long Term Therapies Project., Global Adherence Interdisciplinary Network., World Health Organization. Dept. of Management of Noncommunicable Diseases.. Adherence to long-term therapies: evidence for action. 2003. Geneva: World Health Organization;
Gotsopoulos H, Kelly JJ, Cistulli PA, authors. Oral appliance therapy reduces blood pressure in obstructive sleep apnea: a randomized, controlled trial. Sleep. 2004;27:934–41. [PubMed]
Hoekema A, Voors AA, Wijkstra PJ, et al., authors. Effects of oral appliances and CPAP on the left ventricle and natriuretic peptides. Int J Cardiol. 2008;128:232–9. [PubMed]
Lam B, Sam K, Mok WY, et al., authors. Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. Thorax. 2007;62:354–9. [PubMed Central][PubMed]
Weaver TE, Maislin G, Dinges DF, et al., authors. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep. 2007;30:711–9. [PubMed Central][PubMed]
Antic NA, Catcheside P, Buchan C, et al., authors. The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. Sleep. 2011;34:111–9. [PubMed Central][PubMed]
Engleman HM, McDonald JP, Graham D, et al., authors. Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am J Respir Crit Care Med. 2002;166:855–9. [PubMed]
Lettieri CJ, Paolino N, Eliasson AH, Shah AA, Holley AB, authors. Comparison of adjustable and fixed oral appliances for the treatment of obstructive sleep apnea. J Clin Sleep Med. 2011;7:439–45. [PubMed Central][PubMed]
Vanderveken OM, Devolder A, Marklund M, et al., authors. Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea. Am J Respir Crit Care Med. 2008;178:197–202. [PubMed]
de Almeida FR, author. Complexity and efficacy of mandibular advancement splints: understanding their mode of action. J Clin Sleep Med. 2011;7:447–8. [PubMed Central][PubMed]
Itzhaki S, Dorchin H, Clark G, Lavie L, Lavie P, Pillar G, authors. The effects of 1-year treatment with a herbst mandibular advancement splint on obstructive sleep apnea, oxidative stress, and endothelial function. Chest. 2007;131:740–9. [PubMed]
Lam B, Sam K, Lam JC, Lai AY, Lam CL, Ip MS, authors. The efficacy of oral appliances in the treatment of severe obstructive sleep apnea. Sleep Breath. 2011;15:195–201. [PubMed]


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Local artists represented: Craig Rubadoux, Robert Baxter, William Jerdon, James Griffin, Beatrice del Perugia, Thyra Wexler, Richard Hager, Sarah Costello, Nancy Turner, Corinne Fallacaro and Nat Krate
The gallery's hottest new artist: Nancy Turner, eloquent and compelling printmaker; Nat Krate, dramatic, luminous oils; and Corinne Fallacaro, richly pigmented pastels
The gallery's most established artist: Rubadoux, who has paintings in the Guggenheim Museum, Atlanta's High Museum, the American Embassy collection, in Madrid, and The John and Mable Ringling Museum of Art.
What the gallery looks for in an artist: "Professional integrity coupled with unique high-quality artwork that emotionally engages collectors at all levels," says gallery owner David Dabbert.
The kind of art found in their own home: "We have a modest collection of original fine art and crafts, many of which we acquired as trades with other artists," says gallery owner Pat Dabbert.
Why they're cut out for this business: "Prior to opening the gallery, we successfully made our living for 35 years selling our own artwork," says Pat Dabbert, who taught art and art-history classes for 14 years after receiving her master's degree in art.
What makes their job fulfilling: "As the artists' representative, we have the privilege of helping exceptional artists exhibit and sell their work," says David Dabbert. "As the gallery/art dealer, we bring together a high-quality original collection of artwork that attracts a diverse group of collectors. We also have the everyday joy of being surrounded by exhilarating color, compelling imagery and creative brilliance that is shared with enthusiastic viewers."
Current show: "Summer Showcase" runs through Sept. 30. The exhibit features a diverse award-winning group of artists from Vero Beach, Calif., Sydney, Prince Edward Island, Canada, Quebec, Canada, and 11 Sarasota artists.
Owners: David and Patricia Dabbert
Location: 76 S. Palm Ave., Sarasota
Year established: 2004
Phone: 955-1315
Website: www.dabbertgallery.com
Summer Hours: 11 a.m. to 5 p.m. Tuesday through Saturday

subset: commoncrawl


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Run! Celebrities Who Tried To Run From The Cops
- By Bossip Staff
10 of 10
Celebrities Who Ran From The Police
Being arrested sucks. Dealing with cops sucks. No one wants to get arrested, but it's best to just take your medicine. These celebrities didn't want to get arrested so they tried to run from the police…and usually they failed.
They tried their hardest to avoid arrest by any means. And it didn't end well.
Katt Williams – He got in a car chase away from the cops while hopped up on whatever he was hopped up on.
Robert Downey, Jr. – Downey had a crazy traipse against the police in the 90s in the middle of one of his crazy binges.
Too Short – A video recently came out on TMZ showing Short Dog trying to run from the police and getting nowhere.


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Best Online Calendars For the New Year
If you hope to be more organized this year I suggest you spend some time selecting an online calendar that can easily sync with your gadgetry and life.
- Though relatively unknown Famundo has received a lot of attention lately for being a great option for families. They call themselves a "family hub" and hope to replace your wall calendar, address book, filing cabinet, fridge magnets and yellow sticky notes. Famundo offers Outlook synchronization, a list maker and even a family library for storing your documents, photos, bookmarks and other personal information.
- You all know I am a die hard fan of the free shareable Google calendar, which makes it easy to keep track of birthdays, schedules, dates and appointments. I couldn't live without its invitations feature, which allows you to send invites to friends and family.
- Real Simple recently sang the praises of Which Time so I checked it out and am pretty impressed with its set up. It seems like a simpler version of Google Cal or Famundo and takes style points from iCal. The calendars can be downloaded or accessed from the web.


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Do you love the show Super Why!? I know my kids do. I love that the kids are having fun and learning at the same time. I think there's a great balance between the two. Well, whether you and your kids are big fans or no, I have to say that this is a pretty cool costume, all made from scratch, with no sewing involved. I know, it's hard to believe, but check out the video below. It's really pretty easy, and I think you and your kids will have a lot of fun like I did with mine! So go ahead, and try to make a no-sew Super Why costume and transform into your favorite PBS KIDS superhero for Halloween. Even if your kids end up hounding you at the local costume pop-up shop and you cave, it's still a lot of fun and a great way to spend some creative time with your little ones. Enjoy!
Check out the 2 min video:
For more on the hit PBS KIDS' show, Super Why, click here: http://www.pbs.org/parents/superwhy/
Subscribe for new videos every Wednesday: http://www.youtube.com/subscription_center?add_user=pbsparentspicks
Crafts for Kids is a weekly series that encourages parents and kids to spend time together making fun and simple projects. Brought to you by PBS Parents and Salsa Pie's Caroline Urdaneta. Music provided by Freeplay.
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Sisters of Charity Hospital
Home » Hospitals & Locations » Hospitals » Sisters of Charity Hospital
Access Your Medical Records Online
Patients can access their medical records by logging into our patient portal.
Emergency Care: 24 hours a day, 7 days a week
CT Scanning: Monday - Friday: 7:30 a.m. to 3:30 p.m.
MRI: Monday - Friday: 7:30 a.m. to 3:30 p.m.
Nuclear Medicine: Monday - Friday: 7 a.m. to 3:30 p.m., Saturday: 7:30 a.m. to 11:30 a.m.
Ultrasound: Monday - Friday: 8 a.m. to 4 p.m., Saturday: 9 a.m. to 10 a.m.
X-Ray: Monday - Friday: 8 a.m. to 5 p.m., Saturday: 8 a.m. to 1 p.m.
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Your nursing staff was spot on.
Being a nurse myself, I understand how difficult it can be caring for a nurse who is also a patient.
Each of your staff was kind, compasionate, empathetic and very knowledgeable. Although she is a new nurse and was still working under a preceptor, one nurse stood out. Lindsey was amazing. Your facility is fortunate to have her on staff. She has a bright future in nursing.
Thank you all for making my stay the best it could be. You really do nursing the right way.
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text:
Nexus Centre boss believes enterprise zone location will pay dividends for the Gorleston facility
PUBLISHED: 18:38 14 December 2012
Archant Norfolk Photographic © 2012
Bosses of the new Nexus Centre in Gorleston said its enterprise zone location would help it save costs and plough more cash into the facility aimed at giving youngsters the skills needed to work in engineering.
The £1m faciliy on Beacon Park, part of the Great Yarmouth and Waveney enterprise zone features an energy and renewables laboratory, IT suites, an advanced manufacturing workshop, and 3D computer aided design (CAD) machinery.
Nexus Centre manager Keith Loveys, said: "Moving to the new building will create wide-ranging opportunities for us. We are surrounded by engineering and energy sector businesses, schools, and colleges, which can benefit from what we have to offer.
"Being based in the enterprise zone enables us to have business rates relief," he added. "We will make significant cost savings which we can plough back into Nexus year after year. Also are premises are easily accessible by car or by local transport from both Suffolk and Norfolk, which is useful for trainees and staff.
Norfolk County Council and Great Yarmouth borough council provided the start-up funding to get Nexus off the ground, while equipment was provided by the Hethel Engineering Centre.
Ann Steward, the county council's cabinet member for economic development, said moving the equipment from Hethel to the new facility was the right thing to do.
"If you look at the opportunities that this area has got, it means that having the equipment here it will be used as much as possible, whereas when it was at Hethel it wasn't utilised as much as it could have been," she said. "It makes perfect sense when you think about the energy and engineering opportunties which will be happening in Great Yarmouth.
Andy Wood, chairman of New Anglia local enterprise partnership, which developed the enterprise zone, said the centre would play a pivotal role in understanding and delivering the skills needed by the engineering and energy industries.
Unveiling the new facility at an official opening ceremony, Great Yarmouth MP Brandon Lewis, said: "It's great to see organisations and people coming together to make this facility.
"We have got so many opportunities in energy and engineering and for this to come together so quickly is fantastic."


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CHAINMAILLEKID 4 years ago#1
There is this test that I posted before here PRIOR to the release of Con2, and I thought that now would be a good time to post it again.
Its a really pretty dang cool kinda personality test, that discovers what game elements you play for.
Being familiar with the community, and with many peoples fighting styles, it would be really awesome to see who all is what type.
It would also be really interesting to compare how Con2 players as a whole compare to the gaming population as a whole.
Anyway, the test is here:
Its around 5 years old, so maybe some of you have seen it before.
My Class is a Daredevil Mastermind, which represents only 0.9% of the gaming population tested.
You like rushing around at heights or high speed while you are still in control as well as solving puzzles and devising strategies.
I last took it late 2009, before the launch of Conduit 2.
Then my results where:
Daredevil: 19
Mastermind: 18
Seeker: 12
Achiever: 10
Socialiser: 6
Survivor: 5
Between then an now, the BIGGEST influence on my gaming has been Conduit 2
And taking the test again today, my results are now:
Daredevil: 19
Mastermind: 18
Seeker: 15
Conqueror: 12
Achiever: 8
Socialiser: 7
Survivor: 2
I actually play less to win now than I did then.
Discovering new things and exploring has become a renewed interest.
And... I've become even less of a fan of Not being in control.
Which, really, is at the core of my complaints and frustrations, aside from just being lulzy.
Very interesting, 2Chainz!
I like Conduit 2 because of our community and how I can play for real at times, but there are always people there to mess around when I don't feel like playing seriously.
Here are my results:
Socialiser: 19
Mastermind: 13
Conqueror: 11
Daredevil: 10
Survivor: 9
Seeker: 8
Achiever: 6
Khmer & Drift's Funniest Gaming Moments! http://www.youtube.com/watch?v=1jOzJnX6oww
KhmerGirl posted...
Very interesting, 2Chainz!
What a loser
We need Dinos
Mastermind: 20
Conqueror: 18
Seeker: 15
Survivor: 13
Daredevil: 8
Achiever: 7
Socialiser: 5
You like solving puzzles and devising strategies as well as defeating impossibly difficult foes, struggling until you eventually achieve victory, and beating other players. This is why I use the dark star ... except eventually beating others ... yet.
If it's yellow, leave it for the next fellow. If it's brown, flush it down.
B05S_Brennan 4 years ago#5
Mine was "Conqueror-Socialiser".
Conqueror: 20
Socialiser: 16
Seeker: 15
Daredevil: 12
Achiever: 9
Mastermind: 8
Survivor: 2
"God put obvious limitations on our intelligence, but none whatsoever on our stupidity". -Fr.John Corapi
Derppopotamus 4 years ago#6
Wow, that pretty cool.
Socialiser: 19
Seeker: 17
Survivor: 15
Mastermind: 10
Conqueror: 10
Daredevil: 7
Achiever: 5
Uhm, I guess I should look forward to a co-op Metroid then.
I'm Derpitimus. I forgot my password, and got locked out of my account.
stardust121 4 years ago#7
Pretty interesting little quiz thing, actually.
Your BrainHex Class is Conqueror.
your BrainHex Sub-Class is Conqueror-Seeker.
Conqueror: 19
Seeker: 17
Socialiser: 12
Achiever: 12
Survivor: 9
Daredevil: 6
Mastermind: 0
I don't like thinking haha
You like defeating impossibly difficult foes, struggling until you eventually achieve victory, and beating other players as well as finding strange and wonderful things or finding familiar things.
Which I guess explains why i specifically target the more dangerous opponent even in larger groups..
» No Problems: You dislike being asked to solve puzzles or work out solutions without clear instructions.
Which explains so, so much.
Conduit 2: 0862-8647-6484(Ricky)
- - - (Shadice)
Derppopotamus 4 years ago#8
CHAINMAILLEKID posted...
Between then an now, the BIGGEST influence on my gaming has been Conduit 2
I'm guessing I would have been Seeker-Survivor back then. And Social would have been much much lower.
I'm Derpitimus. I forgot my password, and got locked out of my account.
My scores for each of the classes in that test were as follows:
Conqueror: 16
Achiever: 15
Seeker: 11
Mastermind: 8
Daredevil: 6
Socialiser: 4
Survivor: 1
Between conquerer and achiever. I do like exploring through the game and achieving.
TCon-{AISP FC: 3954-8764-7672}
Con2-{AISP FC: 4083-8526-7529 HC-AISP FC: 4642-7312-4915}
I think seeker and mastermind should be switched, though.
TCon-{AISP FC: 3954-8764-7672}
Con2-{AISP FC: 4083-8526-7529 HC-AISP FC: 4642-7312-4915}
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2010 Ford Fusion vs. Honda Accord and Toyota Camry
Not to mention the price of those truts! I replaced them once on my Grand Cherokee, then when they went bad again, they got replaced with a 2x4...
I also experience a surge/touchy throttle on my 2010 camry when the engine is cold and the rpms are higher than normal at idle..as the engine warms up, idle engine rpm drops and the surge is no longer a problem..it is a bit disconcerting the first few times you drive it until you get used to it..
Was yours a Hybrid? Mine was fully warmed up, well it should have been after 5 miles at 60 MPH. :P The Hybrid motor shuts down when you come to a stop, normally once you hit about 20 MPH and slowing the motor drops offline, but in my case it revved up instead.
Now a Prius had a stuck throttle, although I am skeptical that the dude just got caught speeding and used it as an excuse.
no, mine is a 4cyl le version..yea, I'm also a bit suspicious of that runaway prius claim..not to say that it really couldn't/didn't happen but with toyota's recent bad publicity and very "deep pockets", it wouldn't surprise me if there are not at least a few folks out there making bogus acceleration claims to make a quick buck...
I don't think the guy was using it as an excuse. The officer said when he saw the car the brake lights were on and he could smell the brakes!
More information came out after I posted, and sure enough, this looks legit. Burning up brakes is very hard to do, you need both feet pushing down on the brake to do that, so unless the guy has 3 feet, it does look like his ran away with him. There are three ways to get the car into neutral, first move the shift lever to the right and hold for a few seconds, or push the park button while in motion, there is a failsafe that prevents the park pawl from engaging at anytime when the speed is above 3 MPH, so it puts it in neutral, the 3rd is to press and hold the power button for 3-5 seconds. If he did the first two and nothing happens, that is a genuine software glitch!
"bogus acceleration claims to make a quick buck"
Did you see the guy on the news? He looked to me like he was shaken up. How is he going to make a buck? The first thing the court will ask is what is your loss? I have never seen so many people defend a company over a recall than this Toyota deal, what the heck is going on? Are people brain washed?
The reports also state the cop who helped him saw him lift out of the seat trying to apply the brakes. Is the cop in on it too? So far everything is pointing to a software problem on this one, if anything the NTSB will find the cause.
dissmember Posts: 1"With the improvement in the 2010 model year, Ford narrowed the gap with leading Asian automakers, including Toyota."
Fusion is a Japanese car. Built on Mazda's GG chassis with a Mazda engine, it is a Mazda 6 that is re-branded to fooling American in thinking it is an American made car. In fact the Mazda 6 is more American built then the Fusion. While Mazda6 sold in the USA are assembled in Flat Rock, Michigan, the Fusions are assembled in Mexico with only 20% of the parts coming from USA/Canada. Japanese Cars sold in the USA like Camrys and Accords had more USA/Canada parts then the Fusion and assembled in the USA.
dissmember: Here are the real facts:
So US manufacturers assemble some cars in Mexico. Well so do Toyota, VW, Nissan, Honda, BMW, and Mercedes Benz. And even with some US-based manufacturers assembling cars in Mexico, the vast majority are still built in the USA. By the the domestic content of a Mexican-built Ford Fusion is still 30% versus the Japanese built Toyota Prius at 0%.
And GM alone employs more Americans than all foreign automakers combined; 40 percent of GM's worldwide workforce is in the United States, compared to only 11 percent of Toyota's.
Chrysler employs about 83 workers for every 2,500 vehicles sold, Ford employs 80 and General Motors 71, according to the Washington-based Level Field Institute. By comparison, Toyota employs 33 American workers for every 2,500 cars sold.
Everyone: I started this thread in 2009 before the Fusion made car of the year. I did trade in my 2008 Accord and purchased the Fusion SEL 2.5L We have had the car 1 year 18,000 miles and it has been a wonderful car. No rattles,noises or shakes. we average 28 MPG which is 4 MPG better than the 4cly Accord that we owned. I took a lot of heat from the die hard Accord fans but it has been worth it.
mtnman1 Central OhioPosts: 431I have to second your opinion about the Fusion. I purchased a 2009 Fusion SEL V6 in late October 2008. I have about 27,000 miles on it. It has been the best vehicle I have ever owned in my 54 years on this planet. I have commented to my wife frequently that this car has no rattles or squeeks and rides so smoothly. Everything from the seat comfort, Audiophile stereo system, auto climate control, to the great engine has been flawless. The car is as good as the first day I drove it off the lot. I have been running about 19 Mpg City and 26 to 27 Highway.2012 Highlander Limited AWD V6 and 2015 Ford Fusion Hybrid SE
tgozdalski1 Posts: 34Last summer I rented Fusion for a week while vacationing in virginia. Overall I liked the car; it was I believe se 4 cyl automatic. It felt solid, handled well. For a week I averaged 26 MPG with about 70% hwy trying to maximize fuel economy. The MPG based on car display info. I expected a little better. The one think I did not care about was plastic aluminium like trim around edges of controls. Small think but looked quite cheap in the car. I looked into few options but in the end I bought certified 2007 accord lx sedan 5 speed manual with 34,500 on odometer for 14,100 PTD in Dallas area. I've been averaging about 32.7 MPG with about 85% hwy. My old 2000 accord lx manual as well is driven daily by my son. This one has close to 250,000 miles and gets about 28 MPG. Comparing 2010 Fusion to 2007 accord I would give a slight edge to accord but this is just my perception. Ford came a long way since ford tempo
If you go according to the display for fuel MPG, you can get widely different readings. The only true method is hand calculating per tank, and average out over several tanks to get the correct FE. I have an 1999 F350 that according to the display gets 32 MPG. It really only gets half that. When I had Hybrids, I kept a little black book, marked down every tank, how many miles, and how many gallons, and after a year averaged it out, and it was not even close to the displays. My Fusion Sport reads 23 it gets 26, so I stopped using it.
yepmaybe Posts: 3your back brake pads are probably worn because of the new accord braking system, "EBD" electronic brake distribution, so while your nose diving each time you hit the brakes in your fusion, the accord comes to alot more comfortable of a stop..... just sayin
Say what you what you want but when the back brakes on my 08 Accord were wore out at 19,000 miles and my front brakes still had 80% left on them I would say that it was poor design and for Honda to say it was "normal wear" well they lost 1 customer for life. Oh by the way my Fusion does not nose dive "just saying"
This is normal for the rears to wear out faster, first, they are smaller pads and second they do most of the stopping. Just about all cars with rear disks will apply more braking pressure to the rear of the car, especially in a FWD car, than to the front. The harder you brake the more the fronts will brake until they are doing the most work. It isnt just the Honda's that do that. My Fusions rear pads were worn long before the fronts were.
cannon3 Posts: 296For the Fusion out of these 3. I have a 2006 Fusion SEL V6, very first year. I now have over 72,000 trouble free, squeak free, rattle free miles. As far as improvements to the Fusion, Yes, Ford listened to consumers and made improvements. I test drove a 2010 Fusion SEL 2.5 and the improvements are noticible. Interior is improved, ergonomics improved, the newer car seemed a bit more quiet, handling also more confident with good feel. Break light moved to trunk area for better visibility. Head rests for back seat passengers, just to name a few more.
akirby Posts: 8,040Have to disagree on that my friend. The front brakes do most of the work in regular stopping - that's why so many vehicles came with disc fronts but drum rears or smaller rear discs. When you brake it shifts the weight to the front.
This seems to be a recent development (rear brake wear) that has something to do with new parking brake designs and/or stability control.
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Hi guys,I'm trying to read and absorb as much as I can on these boards, been working on bettering my pizza making for probably 18 months now.Over christmas I recieved a wonderful gift that I'm deathly afraid of. A sourdough starter kit.Don't ask me why, it just scares me. I am only just now manning up and trying to tackle starter. The sourdough starter is King Arthur, does anyone have any feedback on the quality of the starter?I've been following the directions that came with the starter, but I've noticed that the directions are always calling for discarding 1/2 the mixture, then feeding with 1/2 cup of water and 1 cup of flour. My starters consistency is like a very thick batter right now. Kinda difficult actually to scoop and measure and whatnot.You can easily modify the consistency by whatever you like. My starters are a 50/50 by weight.I'm still in the early stages with this starter, I literally just did my first discard and feeding to bring the acidity to a proper level. But is starter always supposed to be so thick?If you are looking for a sponge culture then yes, there really is no "right" consistency, it's what you prefer. For example, my preference is a liquid culture for pizza dough & a sponge culture for bread dough.Also I'm concerned slightly with storage. It came with a small crock that looks nice aesthetically, but just doesn't seem very large. What sort of container do you folks recommend? I use a 1 quart Cambro Container; a 1L widemouth mason jar works just as good. Is airtight okay or am I going to slaughter my culture doing that?No you will not harm the culture, you may however blow the lid off if you have a very strong culture. The advantage of a mason jar is that you can leave the lid loose.I'd really like to know how everyone feels the King Arthur's culture compares to some of the more popular starters here (I believe Camoldi and ischia, both given to Ed Wood by pizzanapoletana if I recall correctly).I use Camoldoli & Ischia, not sure about the KA starters. I'm sure their fine. If my starter is mediocre in comparison perhaps I should consider it my training wheels to learn the basics of starter maintenance.Sorry to be longwinded folks, I'm reading most of the threads in this section, but starter makes me very uneasy.[/quote
Ahh Matthew, it seems you're coming to my rescue quite often these days. Oven troubles, high heat cooking, starters, etc. You're a man with many hats, I truly appreciate your help. I think my preference when this is said and done will be to have a more liquid culture. The King Arthur instructions call for me to do one more discard and feeding (with a 2-4 hour wait) before it is considered ready for use. At that point perhaps I'll experiment with making the starter more liquidy so that its a bit easier for handling and measuring. Being stored loosely, will I have to worry at all about my starter absorbing any refridgerator funk smell or is absorbtion something that simply won't happen?Also, how feasible is it to have a starter just kept at room temperature rather than refridgerated? If I'm correct the starter would be pretty active and probably require alot more maintenance, so I'm not sure if that would be more trouble than what its worth.


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Second, this is the preview of the Vampire Weekend track from the Eclipse Soundtrack - aaah!
Via TeamTwilight
- Lorabell
Oh I love vampire weekend so much, I saw them in concert a few weeks ago and they were amazing! This song is a bit different to their usual stuff, but I really like it!ReplyDelete
Wow, that "preview" was practically the whole song. It sounded pretty good too!ReplyDelete
@Tess- You are so lucky!!!!
I think I'm more psyched for this sountrack more than the others. Vampire Weekend is one of my favorite groups. Their quirky and inovative.
I think I like it. Not sure where it would go in the film, though.ReplyDelete


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man this so makes me feel....
like i'm 12 again, and all hiding under the duvet at my mates house watching banned video nasties. BBFC Ban it...I sooooooo want to play it now!!!!!
Gory game Manhunt 2 can legally be sold to UK consumers as a download, despite the refusal of the British Board of Film Classification (BBFC) to grant the title a certificate for sale as a physical product in shops. Manhunt2 Download this... legally The latest twist to the tale of the controversial title is the result of …
like i'm 12 again, and all hiding under the duvet at my mates house watching banned video nasties. BBFC Ban it...I sooooooo want to play it now!!!!!
'only covers physical products.'
yet make a copy and its theft.
Bunch of hypocritical idiots.
or maybe if its a copy of a download???
It's a feature and needs to be safeguarded.
The BBFC should stick to the function implied in their title - Classification. not ban, restrict, censor or attempt to control.
( classification as unsuitable is not allowed )
Reg - where's the download link ?
Surely, since this game could teach a person how to commit a crime or, worse, make them contemplate one, it's illegal to link to it or own it?
Heck, if you were to download a "stolen" copy of this you could expect to be sent down for 25 years, couldn't you?
Does the Obscene Publications Act cover digital media?
If so this can be used to restrict its ownership in England and Wales; it's the Civic Government (Scotland) Act (1982), for those who live north of the border.
"he claimed the company may choose not to exploit the opportunity because the likes of Sony and Nintendo are likely only to allow onto their consoles games that carry a BBFC rating."
Well, that and the fact that there's no way of downloading games and playing them on the PS2 or Wii without using mod chips etc
...that it doesn't have any hidden sex scenes. Wouldn't want to damage impressionable minds.
Seems like a perfect opportunity to sell it on Valve's game delivery system, aka Steam.
I don't see why the BBFC is saying that selling games physically is more profitable. Valve went down the Steam online game delivery route because they were so pissed about losing all their money by using a publisher to sell it physically.
Get it on Steam, surely that's more profitable than not selling it at all.
I doubt that I'll ever play the game, but if the Nanny State wants to keep me from having it, I damn well *WILL* go buy it now.
I didn't spend 23 years in the Army (11 of them in the Mech Infantry) to be told that I am not permitted to view gore and violence.
Bugger the censors (preferably with a hedgehog on a stick)!
and if it has scenes of Paris Hilton nude, I definitely won't play it. But I will DAMN sure own a copy!
Funny really. In England it's fisticuffs and in the US it's nekkidness.
And yet in each country, the opposite bugbear is celebrated.
For the US readers, imagine the Superbowl with a full frontal streaker running onto the pitch during a live broadcast. Now consider the scandal if the TV cameras actually zoomed in and made sure you got every detail permanently burnt into your retinas, ignoring the game completely for a good 10-15 minutes. That's British tv for you - with a healthy sprinkling of sarcasm and anti-political correctness. But should even the title of the show include a violent word, say Ninja, then it would have to be renamed forthwith.
For the UK imagine a world where no matter what the violent content, nobody raised an eyebrow until a naked toon having sex entered the equation. Then the matter would be elevated to Parliament, a debate in the House of Lords and the Prime Minister promising something would be done to make sure our children were protected from cartoons having sex. The best way forward would probably be a campaign that advocates celibacy targeted at everyone under the age of 33.
What truly puzzles me is everyone is fully aware that hyping the violence or nudity of a product will escalate sales a million fold, so why would they be so stupid as to do it?
If you were a game publisher, sunk millions into a mediocre piece of shite, and desperately needed a winner to boost stock prices - what would this sort of reaction teach you? I would cheerfully expect all future releases from these guys to include unadulterated violence, and if they're wise enough to want to cash in on the US market - a liberal sprinking of toon sex whereever possible.
I remember when they tried to ban Grand Theft Auto thinking that people will start highkjacking cars, drive-by shootings, running people over and hiring prostitutes then killing them to get your money back.
GTA is still going strong and where are the bleeding hearts now? Picking on another computer game.
Violence in video games make people violent in real life. We know this to be a fact because there was absolutely no record of any violence at all anywhere in the world before the first video game was invented.
>Bugger the censors (preferably with a hedgehog on a stick)!
Now there's a scene to bring both side of the Atlantic.
And to top it off, you get the cruelty to animals hysteria into it as well.
I just wanted to add my comment on this matter.
I feel that this country is too soft and left wing...
If a company make a game that is for 18+, then what is the problem? 99% of 18 year old + members of society wouldn't even think twice about it and certainly wouldn't go around mindlessly killing people because they saw it on a game or even a film.
If the BBFC are concerned about teenagers being infulenced by such games, then why aren't they actually prosecuting the parents of those teenagers for allowing their child to play such a game (and most likely would have bought it for them). the same should go for alcohol and other things. (but it doesn't)
And seriously - if a teenager is going around with a gun, why wouldn't the parents be responsible??? Oh no - surely the developers are to blame for their out-of-control kid and should be punished. How dare they push the boundaries....on a game!!! It's just a game dudes!!
Also - I wasn't intereted in this game until all this cafuffal (however it's spelt) but now I seriously want it - I bet it's fantastic "Fantasy" game play!
is that we actually have a legally enforced ratings system here in the UK. That means if its rated 18 shops can't legally sell it to anyone under that age. So why not just give it an 18 rating and be done with it? Every safeguard is already in place to prevents kids getting hold of it.
Although the game looks pretty crappy and i wouldn't bother with it. i still don't think the BBFC should be dictating what sort of games can and can't be played by adults. They should stick to dictating what games can and can't be played by children without their parents consent. (if a parent buys an 18 game for a child it should be assumed by the law that they have fully reviewed it and decided it is suitable for their child - one well publicised slap down of an outraged parent using this would stop them all calling for 'murder simulators' to be banned)
>> I didn't spend 23 years in the Army
> Me neither.
Now lets all grab our axes and go chop someone up like the picture in the article is obviously making us want to do...
"Surely, since this game could teach a person how to commit a crime or, worse, make them contemplate one, it's illegal to link to it or own it?"
Does reading Harry Potter teach you to cast spells too?
Did watching Hotel Rwanda teach you how to and make you consider committing genocide?
No, thought not.
I know the PS2 wouldn't be able to download it, but I thought the Wii had the capability to download games through Wii's online network thingemy? If not, could be a shift to an upscaled PS2 version for 360 / PS3 at a budget price through the PSN & Xbox-Live. Plus, the PSP version could be downloaded through the PSN on your PS3 too.
"I remember when they tried to ban Grand Theft Auto thinking that people will start highkjacking cars"
"...drive-by shootings",
"...running people over"
"hiring prostitutes then killing them to get your money back."
At least with the traffic nowerdays there are no town centres that you can scream round at high speed...
ROFL!! Nice Neil!
You really are the number one person today to make me spit out my drink.
I think i'll fish out my copy of GTA Vice City now :/
"I didn't spend 23 years in the Army (11 of them in the Mech Infantry) to be told that I am not permitted to view gore and violence."
One would think that after 23 years in the army you had seen enough gore and violence.
Neil I can find meaningless correlations too.
For instance people called Neil are nasty, here is the evidence.:


text: I used to have a practice partner. She went back to work and is rarely available anymore. I used to do weekly clinics with a pro with a rotating group of 4.0 women. This was terrific practice and instruction. Two of the women are rarely available, another is often injured. We just disbanded the clinic, which has existed in some form since 2006. I used to do weekly private lessons. I could still do this, but I am not getting anywhere (to be expected given lack of practice opportunities). It is hard to make progress on 60 minutes of instruction a week. That leaves me doing little but playing matches. This, too, has cratered. I'm losing and losing, my consistency is dropping, my confidence has evaporated. Just a month ago, I was winning against tough opponents, and now I can't put a ball in the court. I need to reboot. How does one turn it around against such headwinds?


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Pitching on Epstein's mind as Deadline nears
If Cubs do make trades, team hopes to replenish system with hurlers
By Carrie Muskat and Rowan Kavner / MLB.com
Cubs president of baseball operations Theo Epstein said calls have picked up as the Deadline approaches.
"You can express a preference for pitching," Epstein said, "but if we're dealing with a club that has better position player prospects or we feel position players in a certain system are a safer bet or offer a higher upside, I don't think it's fair to pigeon hole yourself to one situation.
"As a whole, not specifically regarding these potential deals that are upcoming, we need to add a lot of pitching to the system. It's not enough to have a handful. We need to have waves and waves coming into the system. We don't have that. We hardly have one wave. We need to build a lot of pitching depth."
Dempster, who will be a free agent at the end of the season, is reportedly drawing interest from several teams, including the Dodgers. He has 10 years in the Major Leagues and five with one team, so he can veto any deal. Epstein would not reveal which teams Dempster favored.
Garza, on the other hand, would be under a team's control through 2013. Right now, the Cubs are looking to the future.
"It's an opportunity," Epstein said of the Trade Deadline. "We want to make the most of it. We wish we were looking to add, and hopefully in the years going forward, we'll play better in the first three, four months of the season and be in a position to add going into the playoffs."
Cancer survivors Rizzo, Campana visit kids hospital
CHICAGO -- Anthony Rizzo and Tony Campana, both cancer survivors, did their best Wednesday to help patients at a children's hospital smile.
The two Cubs players visited patients at the Ann & Robert H. Lurie Children's Hospital in Chicago for about two hours.
Both Rizzo, 22, and Campana, 26, have overcome Hodgkin's lymphoma, and they tried to show kids that cancer can be beat.
"Sometimes, we'd go into a room and just say hi, cheer them up," Rizzo said. "Other times, we'd talk to them a little more and tell them Tony and I are both survivors and what we went through, and we know it's not fun. Kids were sitting there getting chemotherapy as we're talking to them. We just tell them to have fun."
Rizzo has visited children in hospitals before, but this was his first in Chicago since being promoted to the big league team June 26.
"They were awesome," Rizzo said of the young patients. "This was definitely the coolest [visit], just because everyone was a big Cubs fan. I met a lot of cool kids, inspiring kids."
Campana and Rizzo took their girlfriends on the visit, and Rizzo said some of the kids preferred to talk to them rather than the players. No problem, he said, laughing. They still got their message across.
"The situation I'm in now, I have a chance to go out and show kids that, hey, there's a light at the end of the tunnel and keep fighting no matter what and always have fun," he said.
Pair of Cubs Minor League pitchers suspended
CHICAGO -- Cubs Minor Leaguers Juancito De La Cruz and Antonio Encarnacion were suspended for violating the Minor League Drug Prevention and Treatment Program, the Office of the Commissioner of Baseball announced Wednesday.
Both are right-handed pitchers. They have each been suspended for 50 games without pay after testing positive for metabolites of Stanozolol.
The suspensions of De La Cruz and Encarnacion, who are currently on the roster of the Dominican Summer League Cubs, are effective immediately.
Ferrell, Galifianakis savor first pitches at Wrigley
CHICAGO -- Uncommon pregame festivities are inevitable when Will Ferrell and Zach Galifianakis throw out the first pitch and announce the lineups at a Cubs game.
Ferrell and Galifianakis changed out of their suits and into Cubs uniforms Wednesday before taking the mound. After Galifianakis, donning a yellow visor and sunglasses, threw his pitch to Ryan Dempster, a deep dish pizza was delivered to the mound for Ferrell, who threw a hard enough rope to Dempster to draw applause from the entertained crowd at Wrigley Field.
Galifianakis and Ferrell, who portrayed famed Cubs broadcaster Harry Caray for multiple sketches on Saturday Night Live, proceeded to read their own renditions of the Cubs lineup on the field.
"I'm sure I'll mess something up," Galifianakis joked before.
It's hard to tell if anything was butchered.
"Batting fifth, and playing right field, he loves playing the banjo and doing tricks with his pet dog, Chachee, No. 6, Bryan LaHair," Ferrell said.
"Batting sixth, and playing catcher, in his spare time he's an accountant at a styrofoam cooling company, No. 18, Geovany Soto," Galifianakis said.
The comedic duo, who will star in the upcoming movie, "The Campaign," scheduled to open Aug. 10, had fun with the entire lineup.
"It was great," Ferrell said. "I was a little nervous."
Extra bases
Cubs shortstop Starlin Castro entered Wednesday's game 3-for-17 in his last four games, and his average has dipped to .285, but Sveum sees good signs.
"[Castro] is a guy who is going to be as good as he wants to be, and adjustments are still part of his game, as well," Sveum said Wednesday. "Sometimes you have kids like that, and they may never have gone through any adversity on the offensive part. Sometimes guys learn how to pitch to you, so you have to make those adjustments, or you have to make adjustments in your hitting style to get better and not be content with being OK with a .720 OPS or whatever it is. Adjustments are how you do that sometimes."
In his last 12 games, Castro, one of the Cubs' two All-Stars, was batting .196 (9-for-46).
Backup catcher Steve Clevenger was batting .449 at home, and .127 away, which would make one think that the catcher should be in the lineup for every Cubs game at Wrigley Field.
"[Geovany] Soto is swinging the bat pretty good, and as good as he has all year," Sveum said. "He's gotten quality at-bats and doing a good job. They're going to share time in the long run."
Soto was batting .191 overall, but .267 in his last eight games.
Clevenger subbed at third base on Tuesday for the first time in the big leagues. He also has filled in at first.
"He brings a lot with that bat, and I think he's only going to get better and better as he sees more and more big league pitching," Sveum said.
Ryan Dempster, scheduled to start Friday against the Cardinals, is the sixth pitcher since 1900 to win five straight starts in one season and not give up a run in those games. He joins Doc White (1904 White Sox), Don Drysdale (six straight starts for the 1968 Dodgers), Bob Gibson (1968 Cardinals), Orel Hershiser (1988 Dodgers) and Brandon Webb (2007 D-backs).
Jorge Soler, the Cuban outfielder who signed a nine-year, $30 million deal with the Cubs earlier this month, will make his pro debut in an Arizona Rookie League game on Thursday. Soler was expected to be the designated hitter for the Mesa Cubs.
Albert Almora, the Cubs' No. 1 Draft pick, also has been working out in Mesa, but has yet to get into a game.
Pitcher Randy Wells, who was 1-2 in 12 games, including four starts, with the Cubs, then designated for assignment in June and outrighted to Triple-A Iowa, has been placed on the disabled list with a right elbow strain.
Carrie Muskat is a reporter for MLB.com. She writes a blog, Muskat Ramblings, and you can follow her on Twitter@CarrieMuskat. Rowan Kavner is an associate reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.


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How to Tie Dye: 10 Tie Dye Instructions & Techniques
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"Just had a grandson born Jan. 11 and was looking for a blanket to crochet for him. Found it! Love the Grayson blanket and it's his middle name to boot! Thank you for the pattern."
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"I realize that this is months later.. But what they probably mean is, when they say 4 tbs. of each, 4 of food coloring and 4 of glue, since the direction is on the same line."
"You know, the Mod Podge is a really cool thing. You can transform just about anything in the house. I particularly love serving trays, small rectangular containers for jewelry, keys, and coins, and even the plain wooden stools you can find at big box stores. A black and white check looks nice for a modern take on the farm house."
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Puffy Tie Dye Flowers
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Some people remember how to make paper flowers with tissue paper from their youth, but the rest of us need a little reminder. This Puffy Tie Dye Flower tutorial by Lauri Eaton for I Love to Create is perfect for an afternoon of home decor crafting with the kids. With cute little pom poms and wacky colors, these homemade paper flowers will brighten up your home in no time.
- Tulip® SuperBIG™ One-Step Tie-Dye Kit™
- Aleene's® Fabric Fusion® Peel and Stick Tape™
- Tulip® Dye Zip Ties™
- Tulip® Surface Cover™
- Wire cutters
- (4) Assorted black and white cotton printed fabrics – ½ yard length each
- Heavy-gauge floral wire – straight lengths (for stems)
- 24-gauge floral wire for wrapping pompoms
- PattieWack PomPom Tool http://pattiewack.com/shop/pompom-tool/
- Scissors
- Plastic tablecloth
- Washer/dryer
- Masking tape
- Pastry racks (optional)
- Wash fabrics and leave damp. Tear each piece lengthwise into two equal pieces, for a total of eight pieces.
- Randomly combine different printed fabrics into three pairs, leaving the last two separate.
- Pleat, fold or scrunch each pair and secure with zip ties.
- Cover work surface with a plastic tablecloth and place pastry racks on top (if using). Lay damp fabrics on pastry cooling racks or directly on plastic tablecloth. Tip: Placing fabrics on pastry cooling racks before dyeing helps prevent fabric from sitting in pools of dye and spreading dye colors to unwanted sections.
- Mix One-Step Dyes according to package instructions. Colors used for this project: Yellow, Orange, Lime, Turquoise, Fuchsia, Red, and Purple.
- Use Yellow and Orange dye on first fabric set (one color per panel).
- Use Lime and Turquoise on second set, and Red and Fuchsia on third set.
- Apply Lime only on one of the single panels; this panel will be used for flower stems. Apply Purple on the other single panel.
- Allow dye to set for time recommended in package instructions, or overnight.
- Rinse fabrics under warm running water to remove excess dye, remove zip ties and dry in dryer.
- Tear all fabrics into ¼" strips, except stem fabric.
- Use PomPom Tool and 24-gauge floral wire to make poms from each color set, following instructions included with PomPom Tool and leaving a generous 6" to 8" wire tail on each.
- Tear stem fabric into 1" lengths and reserve.
- Twist two heavy-gauge floral wire lengths together for stem.
- Wrap wire tail of one pom tightly around wire stem, and continue wrapping pom wire down stem until wire is completely wrapped around stem.
- Secure at top with masking tape, and wrap tape all the way down stem.
- Lay out flat a strip of stem fabric. Remove liner from one side of Peel & Stick Tape and press exposed side of tape down the whole length of fabric strip.
- Remove remaining protective liner from tape on fabric strip. Starting at the base of PomPom, wrap fabric (adhesive side down) around wire stem, working downward until entire stem is covered.
- Repeat steps 14-18 with remaining pompoms.
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2007 Ford F150 - Stealth
All Black And Under The Radar
When we first caught sight of Blake Parker's '07 F-150, it looked more like a tactical bomb-squad transporter rather than a daily driver filled with audio. "I got a little out of hand with the black," Blake tells us at the photo shoot and we just laughed and agreed. It started out like so many projects, just a little bit here and little bit there and then it happened. A year after the first part was purchased, a custom truck was built just the way he wanted it: black.
Working as a salesman at Appearance Car Audio in Birmingham, Alabama, Blake was tired of seeing cars being fixed up with tons of chrome. New to the truck world, he picked up an '07 Ford F-150 and decided to add just a couple of things. After the custom truck snowball had fully engulfed him, he ordered a Belltech lowering kit. Up front drop spindles and coils bring the front down 4 inches and out back, a flip kit lowers everything 5 inches. Belltech Nitro Drop shocks keep the ride smooth and Blake tells us it's his favorite mod he's done. American Racing 24-inch wheels were ordered, in black of course, and mounted inside Hankook 295/35R24 rubber up front and 305/35R24 tires in the rear. With the lowering kit installed and the new wheels bolted on, the F-150 began to take on a sinister look. Rather than fight the feeling, Blake went with it.
On went a black Grillcraft mesh grille, the headlights were smoked, and the taillights were also blacked-out. Each Ford emblem was painted black and the windows received a serious coat of tint. Under the hood, the 5.4L received a K&N intake and MagnaFlow exhaust. The rumble was nice, but Blake wanted a different kind of rumble, the kind that can be felt and heard.
Committing to the truck, Appearance Car Audio began by looking at the room they had to work with and the product Blake already ordered. Each Kicker box was opened and the crew at Appearance got to work. Raising the rear bench seat up 3 inches, a sub box was built and installed. Housing four 8-inch Kicker L5 square subs the enclosure also features an etched Plexiglass cutout with the Appearance logo. Mounted behind the front seats is another enclosure with two Kicker amps and component crossovers. A Kicker 350.4 powers the Kicker RS-series components in the front doors and the Kicker center channel, while a Kicker 200.2 powers the rear door Kicker components. Sending huge wattage to the square subs are two Kicker 1000.1 amps. An Alpine double-DIN DVD head unit controls the monster system. All that was left to do was cover the cloth seats in black leather with red stitching and paint the dash matte black. Above all of the audio lies a suede-covered headliner with an etched Plexiglass piece featuring a menacing skull.
Appearance Car Audio proves too much audio is never a bad thing and Blake helps prove that an all-black truck can get into a magazine.


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LaToya Baldwin, a representative from Parent Advocates for Student Success, criticized the board, asking why the district hasn't made more progress with disadvantaged students.
"I'm still trying to understand this idea that we should celebrate what we've done," she said. "The honest truth is that Palo Alto is still doing really poorly by especially black students, Hispanic students and low socioeconomic-status students."
Within the world of API, the magic number is 800, which is the state's standard for proficiency. Four subgroups within the Palo Alto school district have yet to hit that mark: African American students (761), Hispanic or Latino (795), socioeconomically disadvantaged (768) and students with disabilities (734).
All of those subgroups' scores did improve from last year. Students with disabilities had the greatest uptick — 31 points.
Asian and white students came out well above 800. Asian students' score is 976 and white students' 941.
The district's overall API score for 2013 is 932, down one point from last year. The number comes from 9,247 second through 11th graders who were tested. Santa Clara County was also down one point and the state, two.
Though Palo Alto ranked fifth out of the top 10 unified school districts in California, its subgroup scores are not high across the board as in other districts.
At Manhattan Beach Unified School District, ranked third out of the top 10, African American students score at 839, Asian at 968, Hispanic or Latino at 901, white at 938, socioeconomically disadvantaged at 859 and students with disabilities at 778. Palo Alto is the only district in the top five with four subgroups below the 800 mark.
Demographic data was also presented, showing that Palo Alto Unified has higher percentages of some of these subgroups than other higher performing districts. Nine percent of Palo Alto students are socioeconomically disadvantaged; none of the top four districts break 4 percent.
Baldwin countered the idea that having a greater percentage of disadvantaged students than other districts makes it more difficult to raise each group's scores.
"We're still really talking about small numbers of kids," she said. "So 9 percent of whatever's in Palo Alto versus 3 percent of whatever's in another district; it's not really that big of a difference."
She also argued that districts with fewer disadvantaged kids might actually have a harder time reaching them and providing them with necessary services.
Board members were quick to concede that there's still much progress to be made but emphasized that the improvement by these subgroups — however slow — should not go ignored.
"I don't want anyone out there to think that the people sitting here don't care about students who aren't performing as well as they could because the aides in this district, the teachers in this district, the administrators in this district and the school board all want to see better learning and boost the learning of all of our struggling students," school board President Dana Tom said.
"And that's why it's been a part of the last Strategic Plans; that's why it's been a part of every annual focused goals — because we know we want to do better."
He also said the achievement gap has indeed closed in the past five years. Between 2008 and 2013, the gap was reduced 55 points for African American students, 47 points for Latino students and 55 points for socioeconomically disadvantaged students, he said.
The board's discussion of the API scores included suggestions for how to do better: bring in teachers, parents and students for focus groups to understand what's going on; look to other higher performing districts to see what they're doing that Palo Alto isn't; analyze more nuanced issues such as transportation challenges that keep students from attending after-school programs or the unique issues that transfer students face.
We Can Do Better Palo Alto founder Ken Dauber also spoke at the meeting, further analyzing the API data. He looked at the scores through a larger statewide prism, noting that Palo Alto's Asian and white students' API scores rank second in the state but the district's other groups fall significantly behind. African American students are 62nd in the state, Hispanic students 55th and socioeconomically disadvantaged students, 112th, he said.
"Other top-ranked districts, it's important to note, don't match this pattern," Dauber said.
But, he said, comparing Palo Alto to other districts should not be about rankings but rather recognizing opportunity for change.
"The point of this comparison isn't to castigate the district. It's to say actually that what these other high-ranking districts show is that it is possible to be high ranking not just for advantaged students, but also for disadvantaged students. And that that possibility is one that we should investigate."
Superintendent Kevin Skelly responded that Dauber's analysis is accurate.
"I think that all of us are dedicated to getting these numbers up and want to see higher scores," he said. "We do take some pleasure in the fact that the results are going in the right direction, yet we've got a long way to go."
In other business, the school board also briefly discussed its budget on Tuesday evening.
The 2013-14 budget, officially adopted in June, counts on a 2 percent increase in property-tax revenue over 2012-13.
The Santa Clara County Controller estimates the actual 2013-14 property tax revenue will come in at $126.5 million — 6.56 percent higher than last year. (Property taxes for the 2012-13 year ended about $190,600 lower than expected, closing out at approximately $118.8 million.) The final property tax revenue for the 2013-14 year will not be determined until July 2014, after the fiscal year has ended.
The budget update also touched on the district's reserves, which totaled about $24 million at the end of the 2012-13 school year, or 13.9 percent of the general-fund budget. Reserves include the reserve for economic uncertainties, the unrestricted and undesignated balance, and the basic-aid reserve.
Because revenue exceeded expenditures last year by more than 3 percent, the board agreed to add a minimum of $1.6 million to the basic-aid reserve, according to its policy, upping that reserve's projected balance to $11.3 million (including budgeted interest income).
The basic-aid reserve is used only to fund non-recurring district expenses, such as instructional materials, and capital outlay projects, such as the revamping or expansion of facilities, deferred maintenance, property acquisition and the purchase of equipment and furniture, according to the school district.
The board will hear and discuss more information about the basic-aid reserve, Common Core expenditure plan, proposed program additions and staffing formula in November.
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My Zone Alarm Pro will not allow my Outlook Express to complete it's connectionp; and thus receive and send. When I shut down Zone Alarm, Outlook Express works fine.
Outlook Express is among my "trusted" programs... so that is not the problem.
Please advise. Thank you.
Operating System:
Windows XP Home Edition
Software Version:
Product Name:
ZoneAlarm Pro
Message Edited by fullrun on 07-11-2007 07:17 PM


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Oklahoma has lost a legend... Vespa Guru, Creston Coates has passed.
He bought his first motorcycle a Whizzer Sportsman when he was 12 years old with his own hard earned money from mowing lawns and such. Told his mother he wouldn't leave the street and when she was gone he rode wild all around Bethany Oklahoma!
He was most know in the vintage motorcycle, BMW and Vespa scooter world but owned and rode hundreds of two wheel bikes all over this country.
He will be missed...
Creston L. Coates
November 16, 1942 - February 2, 2013
creston motorcycle.jpg


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You'd have to read the Uncyclopedia to see why.
And I'm pretty sure since no one's posted about it that no one knows, but there's a new fan vid coming out today called "The Hunt For Gollum" and it actually promises to be pretty good.
I'm watching it right now.