text:
|Land Matters Discussion Area Discussion Relating to Your Land/Legislative Issues
|Thread Tools
|Display Modes
Forest Service Planning Rule
Dear Stakeholder,
Thank you for your comments on the Forest Service Planning Rule Notice of Intent (NOI). Your comments provide valuable insight for us as we move forward on preparing the draft environmental impact statement and the Proposed Rule. We hope that you will continue to engage with us throughout the process.
We would like to invite your continued participation in the collaborative process for the development of the new National Forest planning rule. The collaborative process provides numerous avenues for contributing meaningful input for the agencys decision-making process and allows diverse interests to come together to explore critical issues. The input will be used by the USDA Forest Service rule writing team in the development of the draft environmental impact statement and proposed rule.
The process includes a Science Forum, national and regional roundtables, Tribal collaboration and consultation, and an electronic discussion forum at Planning Rule Blog to engage, educate, encourage meaningful dialogue, and gain as much input as possible from interested stakeholders. The Science Forum and all roundtables will be open, public forums. Notes from the various roundtables will be synthesized and posted for further feedback opportunities. The national roundtables will include a webcast component for participation by those unable to attend the events in person; webcasting may also be available for some of the regional roundtables. The NOI and additional information about all the different ways to participate is available at the Forest Service Planning Rule Website. Pre-registration for the in-person events is strongly requested as far in advance as possible preferably one week prior to any meeting(s) you plan to attend.
SCIENCE FORUM: March 29 30, 2010, in Washington DC, is being convened by the USDA Forest Service with support from Booz Allen Hamilton. Panels of scientists will present the latest science on topics relevant to the development of the planning rule. The key themes from the Science Forum will help frame the collaborative discussions at the regional and national roundtables that will follow. Please pre-register here: www.fsnationalmeetings.eventbrite.com. If you have questions concerning special needs or to request sign language interpretation, contact Kathryn Hite at 703-412-7494 or by email at email@example.com by March 22, 2010.
Three NATIONAL ROUNDTABLES are being convened by the Forest Service with support from the US Institute for Environmental Conflict Resolution (USIECR) and the Meridian Institute. Your attendance at all three meetings is encouraged! Please pre-register here: www.fsnationalmeetings.eventbrite.com. If you have questions concerning special needs or to request sign language interpretation, contact Danielle Youngblood at (202) 354-6451 or email@example.com at least a week before the scheduled roundtable.
First National Roundtable - April 1-2, 2010, at the Omni Shoreham Hotel in Washington DC. This meeting will engage attendees in dialogue about the planning rule and will solicit focused input on how the planning rule should address restoration, climate change, watershed health and biodiversity (NOI substance principles 1-4).
Second National Roundtable - April 20-21, 2010, in Washington DC (specific location TBD). This meeting will engage attendees in dialogue about the planning rule and to solicit focused input on how the planning rule should address the social, economic and cultural contribution of NFS lands to surrounding communities; provide for effective collaboration; consider the relationship between national forests and surrounding lands; and use the latest in planning science (NOI substance principle 5 and process principles 1-3).
Third National Roundtable - May 11-12, 2010 in Washington DC (specific location TBD). This meeting will allow stakeholders to discuss and build upon the synthesized results from the Science Forum and the preceding national and regional roundtables.
To encourage broad participation, the Forest Service, through the National Forest Foundation, is offering the opportunity to apply for travel support (flight and/or ground transportation and/or hotel) to attend the science forum and national roundtables. These are limited funds targeted toward individuals who would not be able to attend without such assistance. This assistance will help ensure that multiple stakeholder perspectives are represented in the planning rule dialogue. Additional information and an application are available at http://www.nationalforests.org/conse...vel-assistance.
REGIONAL ROUNDTABLES are being conducted throughout April in locations around the country. The roundtables will engage stakeholders in dialogue about the planning rule, and provide opportunities for stakeholders to explore issues of particular relevance in each Forest Service region. Dates, locations, and registration links are available at the Forest Planning Rule Website.
Secretary Vilsacks charge to the Forest Service gives all stakeholders a unique opportunity to play a vital role in the development of a new national forest planning rule that draws on the best elements of previous rulemaking efforts, while considering new scientific knowledge and the evolving values and priorities for forest and ecosystem management.
Please join in this exciting endeavor. Thank you!
************************************************** ******************
Barbara Timberlake
USDA Forest Service
on detail to Ecosystem Management Coordination Staff
Phone: 202-205-0917 Fax: 202-205-1012
************************************************** *******************
Dave Walters
Tri-Cities Peak Putters
Land Use Coordinator
WOHVA Board member
It's a Scout thing
Blue Mtn plan revision is working on the old, old rule from way back. (like 1982 as ammended in 2000) We heard they were working on a new one that might stand up in court.
We are kind of watching this, since our RAC is chartered to work with four Forests in our area. We will probably be discussing it at our next meeting in late April
1981 Cherokee W/T, 360, T-18, Warn 8274 in custom bumper/deer strainer (tested and approved)
1988 Cherokee 4 door, 3" Rancho lift, custom sliders/steps, custom roof rack, custom camo paint, custom camo headliner, custom bumpers and Warn 9500 HS, 31-10.50's
Only 31's, but can drag self with either rig
BLM John Day/Snake RAC-OHV/Recreation Representative
Wolfpack 4x4's - Region 5 - "Cave Lupum"
Pres.- Outcast Land Use Review Team
Forest Service Planning Rule (Portland Oregon)
Thank you Grumpy for the thread.
The U.S. Forest Service is proposing a new Planning Rule and is seeking public input to help create a new rule that is effective and endures over time. The upcoming Roundtable Meeting in Portland on April 6, hosted by the Pacific Northwest Region of the U.S. Forest Service, is part of this collaborative effort. We look forward to seeing you there.
The meeting will include three interactive sessions, beginning at 9 am, 1 pm and 6 pm. You are welcome to participate in any or all of these sessions. Each session will open with a plenary presentation, followed by facilitated roundtable discussions highlighting specific issues relevant to the proposed Planning Rule. Discussions will focus on areas of agreement and disagreement, as well as possible alternatives. Interested participants may engage in more than one roundtable. Sessions will conclude with report-outs from each roundtable to all attendees. Summaries of these sessions will become part of the public record and will be utilized in the rule-writing process.
Roundtable discussion topics will be drawn from the "Process (3) and Substantive (5) Principles for a New Rule" published in the Federal Register on December 18, 2009 (http://edocket.access.gpo.gov/2009/pdf/E9-30174.pdf). We will provide you with an agenda and discussion guide prior to April 6.
You may also be interested in reviewing or contributing to ongoing online discussions on the Forest Service Planning Rule blog at http://blogs.usda.gov/usdablogs/planningrule.
If you have not already done so, please reply by email to firstname.lastname@example.com with your name, address and organizational affiliation to let us know if you plan to attend. Your response is not required to participate, but is extremely helpful for planning purposes and very much appreciated.
The event will be held in the Multnomah Room at the Doubletree-Lloyd Center in Portland. Participants are eligible for a $94 room rate (April 5th and/or April 6th), which includes overnight parking. To receive this rate, guests should make reservations before March 22 either online at www.doubletree.com using the group/convention code SVC or by calling the Doubletree at 800.996.0510 or 503.281.6111. The government per diem rate is $120 and includes parking, breakfast and in-room wireless service.
Open house hours are from noon to 1pm and from 5pm to 6pm. Come-and-go participants may pick up handouts and contribute comments individually, if they so choose.
We look forward to seeing you -- and hearing from you -- in Portland.
NOTICE: The Forest Service is committed to providing equal access to this meeting for all participants. For questions about accessibility or to request alternative formats or other reasonable accommodation, please email email@example.com or call 206.408.7129. Advance notice of two weeks (by March 22) will allow us to provide seamless access.
Randy Drake
Region 6 member
Deschutes County 4 Wheeler
(Trails Development Committee)
Harney County High Desert Wheeler
Last edited by high desert 4x4; 03-19-2010 at 02:04 PM. Reason: USFS udated information
BRC Nationwide Land Use Advisory - National Forest Planning Rule Collaborative Meetings AnnouncedMarch 26th, 2010
Dear BRC Action Alert Subscriber,
Executive Summary:
Below is an update on the U.S. Forest Service revision of its rules and regulations for amending Forest Plans. The agency has said it is committed to a open collaborative approach, and has announced several national and regional meetings.
After reviewing the agendas for the meetings, BRC believes there is good reason for the recreating public to be concerned about the direction the agency is proceeding. We discuss these concerns below, as well as provide information and links to the meetings.
This issue is of sufficient importance that we hope you will take some time to review the information, but if you want to skip it, or leave it for later, and go straight to the action item click here.
As always, please call or email if you have any concerns or questions.
Brian Hawthorne
Public Lands Policy Director, BlueRibbon Coalition
208-237-1008 ext 102
We're collaboratin' now!
The U.S. Forest Service (FS) is beginning the process of revising their regulations that govern how the agency prepares Forest Plans. Known as the "Planning Rule." These regulations will be the driving force behind how the agency develops, amends and revises their Land Use Plans. The FS has recently closed a formal comment period on a proposed action that includes several so-called "Principles" that will guide the new regulations.
The FS partnered with the US Institute for Environmental Conflict Resolution, and they have been working to develop a collaboration strategy for the ongoing development of the new planning rule. As part of that effort, Chief Tom Tidwell recently announced a series of events to provide additional opportunities for public discussion. Events include a series of meetings, including a national science forum, three national roundtables and nine regional roundtables.
In a news release, the agency stated:
"The Forest Service is committed to developing a new planning rule that endures over time. We believe a transparent and participatory method is the best way to accomplish this. Well be working hard to gather input collaboratively throughout the development of a new planning rule."
Now, I think that is an excellent statement, and I would wholeheartedly support a true collaborative approach. But the science forum and the current agendas for the regional roundtables evoke concern.
The Little Principles that WILL
During the recently closed formal comment period, the UFSF stated:
The Department [of Agriculture] has not made any decisions as to the content of a new rule. We intend this process to be collaborative, transparent, and participatory. Issuing an NOI [Notice of Intent] ensures that the public is involved at the ground level.
To begin the conversation, the Forest Service has included in the NOI a set of potential principles that could guide development of a new planning rule. We are seeking public input on the potential principles and on specific associated questions. We are also asking for input on possible principles or issues not mentioned in the NOI.
Many interested parties, including BRC, believe the set of potential principles that could were significantly flawed and didn't solve any of problems with the current Planning Rule. Some of the principles that could, such as this all lands concept, where the USFS would attempt to influence activities on privately owned land, were vehemently opposed by many key stakeholders.
Many concerned stakeholders believe the agency needs to re-evaluate its process. BRC believes the existing principles threaten to create new, undefined goals and criteria which will exacerbate, not resolve, the planning gridlock accelerating through the agency. It is sadly ironic that the Planning Rule is supposedly designed to reduce such gridlock.
BRC was among many urging the FS to steer this effort back to its necessary focus: (1) to fill the current regulatory void; and (2) to redouble proper focus on the primary goals of efficiency and expediency in the Forest planning process.
Those comments have been received by the agency and are supposedly being analyzed, but upon review of the science forum and roundtable agendas, it doesn't look like our message has gotten through.
I would love to give these folks the benefit of the doubt, but it looks like the principles that could are trying to be the principles that WILL.
If you put me in another breakout group my head will explode!
Here is a quick low-down on the agency's meetings and agendas.
The Science Forum is scheduled for March 29 and 30, 2010, in Washington, DC. According to the FS website, the Science Forum is:
Panels of scientists will present the latest science on topics relevant to the development of the planning rule. The key themes from the science forum will help frame the collaborative discussions at the regional and national roundtables that will follow.
If you've read the agenda, you might agree with me that a much more colorful description could be used!!
Don't get me wrong. This stuff is important and could meaningfully impact FS planning. But it is reasonable to assume that most of this will result in further movement away from the agency's multiple use/sustained yield mission, and probably a whole lot more 'analysis paralysis.' BRC's Concern-O-Meter is at a fairly high level at this point, so at least one BRC staff member and/or contractor will be at the forums. Ditto for the national and many of the regional roundtables as well. (Your membership makes that possible, by the way... thanks!)
There are three National Roundtables scheduled, April 1 - 2, April 20 - 21, and May 11 - 12, 2010, in Washington, DC. The stated purpose for the first is to solicit focused input on how the planning rule should address restoration, climate change, watershed health and biodiversity, which are the agency's priorities identified in the NOI. The second meeting purportedly will discuss social, economic and cultural contribution of National Forest System lands to surrounding communities; provide for effective collaboration; consider the relationship between national forests and surrounding lands; and use the latest in planning science.
I'm going to assume the second meeting will provide an opportunity to discuss the need to re-evaluate this process, the trend away from multiple use and how the agency intends to address this key issue in the rulemaking process, not to mention the need for a focus on recreation. The third meeting will allow stakeholders to discuss and build upon the synthesized results from the Science Forum and the preceding national and regional roundtables.
Based on conversations with the outfit running the national roundtable, I think my assumption about the second meeting above is safe. Not all collaborative planning facilitators are bad, and to the FS's credit, they have contracted with a group that is on the National Roster of ECR Practitioners.
Some will then say that I'm being overly paranoid by express concern. Before you pronounce me guilty, lets look at the agendas for the regional roundtables.
The agenda for Region 5's roundtables (California) is of particular concern. As of this writing, the agenda is one sentence long: Discuss Planning Rule Principles and Concerns to Submit to the National Planning Rule Revision Team.
The agenda for Region 10 (Alaska) is even worse. They have a detailed agenda, but, like Region 5, the focus is exclusively on the agency's principles. Things might change, but it doesn't look like there will be any opportunity to discuss other issues. That's collaboratin', Forest Service style!
The roundtable for Region 1 (N. Idaho and Montana) will allow some discussion on what is working well and what isn't [with the current Rule], and they will touch on a topic called Plan Content that, while wasn't a principle the agency identified, was discussed in background information and alluded to in the NOI. (Plan Content is defined by the agency as the kind of information that should be included in plans and whether or not to include standards and guidelines.)
The agendas for Region 2 (Colorado, Nebraska, Wyoming and both Dakota's) and Region 4 (S Idaho and Utah) looks a bit more interesting, and these meetings look a lot more open to recieving actual public input. Also, Regions 2 and 4 will have a Brief panel by a diversity of participants on what they hope to see and not see in the new draft rule for planning.
Region 8's (Southern US, from Texas eastward) meetings looks positively trendy. According to their agenda, they will break everyone into groups and begin with a small group dialog allowing each participant to state the 1 most important thing they'd like to see in the new rule. Then, after lunch, they will... well, I'll just quote the agenda here:
Using world café discussion format, participants rotate in small groups among 4 stations every 25 minutes; each station elicits input on subset of NOI planning principles; additional, unstaffed station accepts written suggestions all day on anything else related to planning principles. Groups will continue to rotate through stations every 20-25 minutes until all participants have had a chance to provide comments at each station. Current plan is that principles will be allocated across stations as follows: (1) Ecosystem Restoration; Climate Change; Watersheds Station; (2) Species Diversity; (3) Vibrant Rural Economies; (4) Process Principles. Focal question is, How, if at all, should new planning rule reflect this / these principles?
Now, I should admit that I'm a fan of true collaborative planning, and I will also admit that is somewhat of a character flaw (I'm working on it), but even I know a sham collaboration when I see it.
I bet Region 8 provides the best lunch though!
As of this writing, no agendas have been made available for Region 3 (Arizona and New Mexico), Region 6 (Washington State and Oregon) and Region 9 (Eastern US). (The full meeting schedule is available here.)
What you need to do
The regional roundtables will provide the best opportunity for recreationists to influence the process. We encourage our members to register and attend, and I'll raise that to a strongly encourage for any land use officers or others that are active in FS planning and management.
I need to give the disclaimer that much of this information appears to be in flux. I began writing this update on Tuesday, and the information, agendas and meeting locations on the FS website have been changing on almost a daily basis. We strongly recommend checking the FS websites often for changes and updated agenda's. (See links below.)
You do have to register for the roundtables, which appears to be relatively easy. The agency's websites are a bit hard to navigate, but they are updated often and they should be able to get it all together before long. You can register for Region 2 and 4's roundtables here. For other regions click the View other USDA Forest Service events link on the right to find out how to register for the other Regions.
If you decide to go to the roundtables, BRC strongly recommends reviewing our formal comments. Our comments will give you some ideas on what points you might make during discussion of the principles, as well as additional concerns you might want to raise (if that is possible). We posted them on a webpage for easy viewing. Please feel free to cut, paste and/or link to these comments as you see fit.
We will have more comments and plan to have additional info on the meetings as they draw near. So stay tuned.
I don't want my head to explode, but I want to help. What can I do?
We also have an ACTION ITEM prepared for those who can't make it to the meetings and still want to do something to help.
It involves contacting your Congressional Representatives, and I know you think that's all I ever ask our members to do, and I also know that some of our political representatives aren't listening on these land use issues, but Congress has a very important oversight role to play, and they need to hear from YOU!
This is very important for members in Alabama, Alaska, Arkansas, Arizona, California, Colorado, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin and Wyoming. That's because you have representatives that are on the committees overseeing the Department of Agriculture and the FS. They need to know your concerns now before the process gets really moving.
Dates, links and a LOT more info is below. As always, call or email if questions.
Brian Hawthorne
Public Lands Policy Director, BlueRibbon Coalition
208-237-1008 ext 102
PS. I need to mention that memberships and donations from individual OHV enthusiasts give us the resources needed to represent your interests in this important planning process. Everyone at BRC is profoundly grateful to our members and supporters. Membership is our lifeblood!
Meeting schedules:
National Science Forum March 29 and 30, 2010, in Washington, DC.
National roundtables April 1 and 2, April 20 and 21, and May 11 and 12, 2010, in Washington, DC.
Nine regional roundtables in the following locations:
Pacific Northwest Region (Region 6), Portland, OR, on April 6, 2010;
Pacific Southwest Region (Region 5),Sacramento, CA, on April 6, 2010;
Intermountain Region (Region 4), Salt Lake City, UT, on April 8, 2010;
Rocky Mountain Region, (Region 2), Lakewood, CO, on April 12, 2010;
Northern Region (Region 1), Missoula, MT, on April 13, 2010;
Alaska Region (Region 10), Juneau, AK, on April 13, 2010;
Southern Region (Region 8), Atlanta, GA, during the week of April 12, 2010 (exact date to be determined);
Eastern Region (Region 9), Chicago, IL, during the week of April 28 (exact date to be determined); and
Southwestern Region (Region 3), Albuquerque, NM, on April 28, 2010.
Region 2 will host additional meetings on April 14 in Cheyenne, WY, and on April 21 meeting in Rapid City, SD.
More Info on the Web:
BRCs Latest Action Alert
BRC's comments on Planning Rule: Click here.
USFS Planning Rule Homepage
Complete list of meetings:
Map and links to USFS Regional offices:
Forest Service collaborative planning and public involvement portal.
Another FS collaborative planning and public involvement portal (mostly the same info, but some additional stuff)
Science panel agenda:
Register for all but Region 3, 6 and 9's Regional Roundtables here.
Webcasting may also be available for selected meetings; please check the planning rule website, at http://www.fs.usda.gov/planningrule, for the most up-to-date information.
FS Planning Rule Blog
To encourage widespread participation the Forest Service is using new media tools in conjunction with the public meetings. Please visit http://blogs.usda.gov/usdablogs/planningrule to participate in the Forest Service web-based planning rule blog.
Our advice? Skip the FS blog.
Another blog has interesting and useful discussion, and it also has the bios posted for those participating on the Science Forum. See:
A New Century of Forest Planning
A New Century of Forest Planning - Bios for Science Panel
Note: This is NOT the official FS blog for the new planning rule. A New Century of Forest Planning is a collaborative effort between the University of Montana and the Forest Service. The intent is to provide a forum where different academic communities (social, physical and biological disciplines, law, policy), practitioners of planning, and participants in planning processes can come together to share perspectives on forest planning. The opinions expressed by those providing comments are theirs alone, and do not reflect the opinions of the University of Montana nor the U.S. Forest Service.
Dave Walters
Tri-Cities Peak Putters
Land Use Coordinator
WOHVA Board member
It's a Scout thing
Thank You Dave for the information. You must have spent lots of time on that post. I will go to the Portland meeting at 1:00pm to input what I can. If anyone can go at a different time that will be very good also. I and Mona have signed up to speak not sure what we will be allowed to say; but the agenda is coming and information is online if anyone wants to sign up you will know as much as I. Once again thank you for the information. Randy
Randy Drake
Region 6 member
Deschutes County 4 Wheeler
(Trails Development Committee)
Harney County High Desert Wheeler
Last edited by high desert 4x4; 03-28-2010 at 08:41 PM.
Just attempting to do what little I can. Just hope it helps...
Dave Walters
Tri-Cities Peak Putters
Land Use Coordinator
WOHVA Board member
It's a Scout thing
planning rule 2010
my letter and my input for April 6th meeting
letterhead and etc...
April 6, 2010
United States Forest Service-Pacific Northwest Region
Attention: Forest Service Planning Rule
Dear Managers of our Public Lands,
We applaud the Forest Services attempts and efforts as they try to follow directives from Washington DC and incorporate management of our natural resources into these efforts. Collaboration in developing a new Planning Rule to manage 193 million acres of the publics holdings will be a monumental task. Special interest groups are more often than not well funded, well armed and well prepared and therefore receive the most attention, a perfect example of the squeaky wheel getting the most grease.
The United States Forest Service is just now finishing up on a Travel Management Plan that was a collaborative exercise as this new plan proposes. The Travel Management Plan was used by special interest groups to close many areas of recreation to the public that utilized their historic camps, trails and areas.
The Travel Management Plan summary states the objective: designating trails, roads and ways for all classes of vehicles, to eliminate cross country travel. The special interest anti access groups utilized the collaborative system to force closures of trails, roads and ways. Closing areas where no resource damage had occurred. Class II vehicles, the 4x4s were completely overlooked. Old jeep trails were obliterated which had been used for decades by families for recreations of all types.
Collaboration is not effective when bullies with agendas contrary to the good of the whole carry larger weapons and larger coffers.
"Our National Forests and Grasslands are great natural treasures that we must conserve and restore for the benefit of future generations," said Agriculture Secretary Tom Vilsack. "Developing a new planning rule provides the opportunity to manage national forests and grasslands for the benefit of water resources, the climate and local communities." Local communities are made of a wide variety of individuals and families. These families and individuals cannot hire attorneys to keep their favorite trails and camping spots open. The US National Forest Service did a great disservice to many by allowing closures of their historic trails in the Travel Management Planning Sessions of late.
The US Forest Services collaborative input statement reflects the by-words public input and public comment. Of late the USFS does as whatever special interest groups litigation threatens. The recent Travel Management Plans were highly ineffective with their Public Meetings and Public Comments. Meetings held during the comment periods were scheduled during work hours and publicized by the USFS ineffectively. The public did not understand the implications, the overall effect or magnitude their comments may or may not have influenced to the managers of their forests. The USFS must facilitate effective information dissemination to effect fair public anything. The USFS fell short and neglectful in the recent Travel Management Planning concerning the publics wishes. When decisions were made in favor of Class II vehicles anti-access groups quickly threatened legal actions and forest managers readily rethought their decisions.
The US FS could list of principles and process is misleading and in-genuine to the public. In truth the USFS could utilize much of the public in restoration, conservation, and monitoring, maintaining and the general health of all forests. The USFS is a failure at education, information sharing/gathering, implementation of facts and truths of the forests they are stewards of. The rural public cares for its forests; the rural public knows its forests. The USFS has never published adequate mapping, adequate resource concerns or even adequate historical and biological facts on any of its forests. When a family entered a forest they were exploring, the roads marked are often mismarked. The United States forests are a foot print of an historic record yet as you traverse the trails there are rarely any kiosks or explanations of the forests history recorded. Let alone the individual forests health or well being.
The USFS should involve the public. Education of the truths on all aspects, forest fires kill healthy forests and its habitats. Healthy forests are not what old growth proponents proclaim. Old trees are dying trees and should be removed for the younger and healthier trees to survive and flourish the forest. Trail density may be an issue but a total roadless area inhibits forest health also as fire suppression etc is curtailed. Forests become infested with harmful insects, noxious weeds and over run with dangerous levels of flammable fuels from lack of care. Preventive health care of forests may mean utilizing herbicides, brush thinning or insecticides.
Climate change is not an exact science. Climate change effects are as old as the world. Climate change has been a constant since the worlds inception, creation or when the world came into existence, however you believe it happened. The USFS reaction and especially over reaction to any change in the forests climate should be from experience not special interest group consensus. Reacting to a publics fears on climate change dramatically exhibits the USFSs own Faith Based Religion.
Sustainable means to create and maintain conditions, under which humans and nature can exist in productive harmony, that permit fulfilling the social, economic, and other requirements of present and future generations of Americans. Executive Order 13423Strengthening Federal Environmental, Energy, and Transportation Management. January 26, 2007. The above statement is a lofty goal, I feel the USFS has failed in its recent Plan stopping cross country travel. The agency allowed itself to be used by special interest groups to curtail the harmony mentioned. I fear this present Plan an extension of the later. Forests unmanaged by designation into Wilderness or forests left to rot and not harvested after forest fire upon forest fire is not a harmonious picture, but devastation, a travesty of neglect.
USFS publication: Montreal Process Criteria for the conservation and sustainable management of temperate and boreal forests
1) Conservation of biological diversity
2) Maintenance of productive capacity of forest ecosystems
3) Maintenance of forest ecosystem health and vitality
4) Conservation and maintenance of soil and water resources
5) Maintenance of forest contribution to global carbon cycles
6) Maintenance and enhancement of long-term multiple socio-economic benefits to meet the needs of societies
7) Legal, policy, and institutional framework
Our actions in the coming five yearsto help define the paths forward for adapting forests to climate changes and using them to mitigate greenhouse gas emissions; to help shape the role of forest biomass in offsetting increased use petroleum; and to help stem the loss of forests and the ecosystem services they providehave the potential to shape for future generations the forests they will have to manage, conserve, protect, and use. Will future foresters and citizens 130 years from now be able to look back at this point in time and say, well done! Will forest historians and policy makers then be able to point to actions taken now as turning points in the sustainable management of the Nations forests? We hope so. But it will take brisk action from all of us.
Historically the forests have been utilized by the civilization of the era. Will my children be permitted use of the forests as I have? Sightseeing from touring vehicles, hunting and fishing, gathering fire wood? Closing gates to the forests entrance and claiming management is but an offensive exclusivist action. Managing forests will require much of the stewards who claim the responsibly, partnership in education, policing and maintenance. Litigation should not be the winner.
Forest Service Planning must embrace motorized vehicle travel fairly. Since wheels had motors attached the public has accessed the forests boundaries. The USFS has not designated trails for 4x4 travel adequately. The USFS must understand and incorporate motorized recreation in each venue and arena of the forest. Do not assess an environmental issue without including motorized recreation. The forests sustainability, rehabilitation, and health stems on the utilization factor of the public. Education prevents most resource damage. Rehabilitation and education will sustain the publics right to motorized recreation throughout the nations forests. Do not be negligent in this new plan. Address motorized recreation the fastest growing sport. If you do not embrace the issue of 4x4 travel and designate areas and trails for the public, by default the public will.
Mona Drake
Mona Drake
Deschutes County 4 Wheeler
(Trails Development Committee)
Harney County High Desert Wheeler
Region 6 PNW4WDA Secretary
BlueRibbon Coalition Board Memeber
WOW! That is fantastic...Mona, may I add that to our thread on this subject on the Putters' site?
Dave Walters
Tri-Cities Peak Putters
Land Use Coordinator
WOHVA Board member
It's a Scout thing
I agree, well put. But I fear that with this "project", such a comment, even though showing the pitfalls and failures of what they are doing, will get classified as a TMP comment and therefore "outside the scope of this document". Just be prepared for that kind of a response from them.
Since the RAC I serve on is chartered to work with both the USFS and BLM, and we are involved in the Blue Mtn, Plan Revision, we get a little closer feel and comments from the feds than some others do. The general feeling here is that the team doing the planning rule is not only being driven by court decisions, but also has the marching orders from the very top, and it will be very "resource "friendly"". They are moving toward more protection and restoration than as a sustainable, multiple use resource for the public good.
1981 Cherokee W/T, 360, T-18, Warn 8274 in custom bumper/deer strainer (tested and approved)
1988 Cherokee 4 door, 3" Rancho lift, custom sliders/steps, custom roof rack, custom camo paint, custom camo headliner, custom bumpers and Warn 9500 HS, 31-10.50's
Only 31's, but can drag self with either rig
BLM John Day/Snake RAC-OHV/Recreation Representative
Wolfpack 4x4's - Region 5 - "Cave Lupum"
Pres.- Outcast Land Use Review Team
Last edited by Art Waugh; 04-06-2010 at 05:24 PM.
Art, that was a horrendously negative, defeatist and condescending response to a very well researched and well written letter. If we adopted your attitude, then we should all just sell our rigs and stay home. Fortunately, there are many who feel otherwise. There were numerous members of the PNW board, both from Oregon and Washington, in attendance at the Forest Service meeting who believe their input and their participation could bring about positive change.
You may not realize it, but you are not the only PNW member who serves on a RAC. And your "closer feel" is much different than other RACs and much different than some Forest Service personnel "from the very top.". In addition, some of our PNW representatives are working personally with those very same FS personnel "from the very top" to promote and protect our access to our public lands. We have found that our personal meetings with those in charge of the Forest Service at the Regional level and higher are very beneficial.
I am not sure just why the FS and the BLM in the remote eastern part of Oregon feel that multiple use will not be important, but fortunately, others from across this great country feel differently. You are entitled to your opinion, but we encourage everyone to write to the Forest Service and express your desires. Don't take no for an answer. Don't roll over and play dead. Don't accept closure as the only option. If you think those in charge of your local forest are not listening to you, keep writing, keep calling. Find out who their supervisors are and write to them also. Meet with them, talk to them and speak your right. If you have to continue to do this until you reach those from "the very top" then so be it.
I want to personally thank each of our PNW members who took the time to attend these meetings and to thank each member who wrote a comment. I also want to thank each member who provides positive and constructive support to the PNW land use volunteers. Your words of kindness, your calls of support and your prayers for our success are always appreciated and always welcome. Condescending negativity is not productive.
Patti Pyland
Deschutes County 4-Wheelers
Oregon Executive Director Staff
PNW Forum Leader Team Member
Region 6 Delegate
Bend, Oregon
|Thread Tools
|Display Modes
Linear Mode


text:
Many times I've seen videos of people talking while presenting their slides. How is that done on a Mac?
I know that I can do a screen recording with Quicktime, and I notice there are two options New Screen Recording and New Audio Recording.
But there is no New Screen+Audio Recording.
Thanks for any help.

subset: commoncrawl


text:
1970: Steve McQueen stars in the race film classic Le Mans
2014: Patrick Dempsey takes the relay…
In real
Le Mans, 11 June 2014 — TAG Heuer and Patrick Dempsey signed a long-term partnership this week-end during the 24 Hours of Le Mans. More than 40 years after Steve McQueen starred in the race classic Le Mans with a Monaco chronograph on his wrist, the asphalt once again belongs to TAG Heuer and Hollywood.
It is asphalt that TAG Heuer never really quit: in 1973, Scuderia Ferrari proudly bore the TAG Heuer logo on its 312PB prototypes; and in 2009, with Peugeot Sport, and then 2010-2013 with Audi Sport, the brand won 5 titles.
This year, the pioneering Swiss brand has decided to enter the world's most prestigious endurance race in support of Patrick Dempsey that – in partnership with Proton Competition – is competing in this year's race with team drivers Patrick Dempsey, Joe Foster and Patrick Long.
Dempsey, a Grey's Anatomy leading man and popular Hollywood actor, is also a top-tier international sports car racing driver and team owner. A long and fruitful partnership between his Patrick Dempsey team and the world chronograph leader is now underway, TAG Heuer will promote the team's achievements in its new advertising campaign, and its iconic shield will be visible on the car and the drivers' racing suits in every race.
Beyond a passion for speed, TAG Heuer and Patrick Dempsey share values of performance, courage and the spirit of freedom: "This new partnership opens up great new perspectives for me," Dempsey said. "It's exciting but does comes with a bit pressure to succeed. Becoming part of TAG Heuer's living legacy that goes back to Jo Siffert, Ayrton Senna and Alain Prost makes me humble. I will have to give my best and, as the famous TAG Heuer slogan goes, never crack under pressure."
"Pressure is manageable," said Jean-Claude Biver, Head of Watchmaking Division at Moët Henessy - Louis Vuitton (LVMH). "You have to believe, keep moving ahead, and put your heart into it. If you are willing to give your all, the world is yours."
Through this new partnership, TAG Heuer once again puts itself at the very heart of motor racing history. Many champions have worn the brand's colors all the way to the top. Very few have done so with true Hollywood panache. Patrick Dempsey and TAG Heuer represent an exciting new expression of sporting passion and glamour.
INSPIRED TIMEPIECESmobile_title_border
RELATED NEWSmobile_title_border
Hollywood and Patrick Dempsey
Patrick Dempsey visits TAG Heuer
- Watches
- Often searched for
- You may also like


text:
Slips easily onto the Reformer's frame. Available in regular, sandwich, and old wood style.
Gratz Pilates has teamed up with one of the premier equipment financing lenders in the market today, Marlin Equipment Finance! Since 1997, Marlin has provided customized equipment financing solutions to over 300,000 small businesses allowing them to replace obsolete equipment, secure their business capital and grow their businesses. No matter the size of your Pilates studio, effectively managing cash flow is crucial for long term success. By using equipment financing, you can procure the right Pilates equipment through a financing plan that fits your budget, rather than with the capital or cash currently available to you.
With financing, you determine the term and the monthly payment. Our financing program through Marlin is simple. Visit our financing page here, click "Apply Today." Complete and submit the credit application. Marlin will process the application and provide a decision within 2-4 hours. Once approved, MARLIN provides the documentation for you to sign with the agreed upon monthly payment and term. It really is that easy!
This product is shipped standard freight and delivered curbed side to the first dry area outside your location.
Special Delivery Options (Available for an additional charge)
Track Your Shipment
We will provide you with a tracking number via e-mail as soon as order leaves the Gratz Industries warehouse which you can use to track your order.
Important: The shippers are NOT licensed Pilates technicians and they are not qualified to assemble your new Gratz apparatus.
Please contact our sales representative to make special delivery arrangements.


text:
The well-known phrase "Man's best friend" is, in fact, a rather anemic way to describe the utterly unique relationship that has evolved over thousands of years between dogs and humans. Whether as hunting companions, workmates, helpers or saviors (is there anything cooler than a rescue dog?), the multitude of domesticated canine varieties speaks to an interspecies bond that, for more than a few people, is closer than any connection they might have with their own kind.
And then there are show dogs. Primped, pampered and trained with the same dedication and diligence that world-class coaches bring to the prepping of elite athletes, show dogs are superstars. Granted, they're superstars to a relatively small group of obsessed aficionados — but the same might be said, in relative terms, of professional tennis stars, or Formula 1 race car drivers. Within their respective sports, and to the fanatics who follow them, pro athletes are demigods; to the rest of us (even those of us who enjoy watching and following sports) they're overpaid jocks.
But when the Westminster Kennel Club Dog Show descends on New York's Madison Square Garden, it seems that everybody — even cat people! — are, for a few days at least , dog devotees. We might not understand or appreciate why the television commentator is positively rhapsodic about what looks to us like a perfectly average Sealyham Terrier, or why a Swedish Vallhund has the audience of thousands at the Garden applauding like mad folk, but there is something both arcane and comforting about watching dogs run around and obey commands with a huge, prestigious prize on the line. Most dogs, after all, just want to please. And it's hard not to root for that kind of heart.


text:
ANAHEIM -- Players young and old took up video game controllers Sunday evening at Downtown Disney in Disneyland Resort to play for the first time Disney's much-anticipated Infinity gaming system.
Nintendo Wii U controllers in hand, players locked plastic figurines of Disney characters, such as Captain Jack Sparrow, onto a pad wired into the gaming consol and watched as virtual versions of the characters sprang to life on television screens.
"I liked the fact that you can just enter into the movie," said Jack Cummings, 21 of Anaheim. "It's what I always wanted to do as a kid, and now you can do it right here with this game."
Disney employees stood by and helped the players as they explored a character's world -- or a world of the player's own design -- for about 10 minutes during the promotional event.
"You just kind of jump in there, and it's anything you want it to be," said Zachary Reeves, a Disney Interactive Studios Inc., employee who demonstrated the gaming system and fielded users' questions during the event.
The Downtown Disney stop was the first on Disney's multicity "Summer of Endless Fun" tour to promote the entertainment giant's most ambitious gaming project to date.
The tour offers fans an opportunity to try out -- and preorder -- Disney Infinity before its Aug. 18 launch. Infinity works with a variety of game systems, including Xbox 360, Nintendo 3DS and PlayStation 3, and the starter kit costs about $75.
Other players praised various aspects of the game. None said they were disappointed.
"I liked that you can jump and do whatever you want to do," said Alex Sypowicz, 8, of Eastvale, a suburb north of Corona.
For Karey Kusuhara, 54, of Northridge, the coolest part about the game was the freedom to create.
"To me the whole attraction is that you can keep adding and manipulating and putting your character in different situations," Kusuhara said.


text:
Thank you for your outstanding customer service.
Joan M. - Clayton, California
Our goal is for QuiltHome.com to become one of your valued sources of quality quilting supplies, information, and inspiration. We welcome your comments, suggestions, observations, and bug reports.
Please leave your Comments HERE.
It's the end of the bolt...or is it? What do we do with these orphaned pieces? We wrap up these little treasures for you, of course! Our Surprise Endings™ remnant packs consist of special selections from our most popular prints, all packaged beautifully by our own Angels. Each pack is filled with surprises that are sure to turn into inspiration as soon as they enter your hands! Whether stash building or small projects, quilt tops or that perfect trim, these ends are sure to surprise and delight you with their endless possibilities. Every pack is unique, no two alike! Cuts range from 3″-17″, by width of fabric, the perfect size to add a little pizzazz to that special project! And each pack holds a great variety of both colors and prints... so there is sure to be something for everyone!
This pack contains Home Dec fabrics from Joel Dewberry's very popular Ginseng Home Dec collection.
0 items


text:
Students' work preserves high school
on photos below to enlarge.]
[November 17, 2012]
Send a link to a friend
It takes a village to built
a yearbook. If you don't believe that, check out the group of kids
who are diligently working on the LCHS yearbook for the 2012-13
school year.
According to Mrs. Jennifer
Gouin, the yearbook sponsor, putting together a nice publication is
a lot easier today then it was when she worked on her first book 16
years ago. Today, technology and the Internet make it easy for the
kids to do their own layouts and ship them off to the publisher. Gouin remembered that when she began doing this, layouts were done
on paper and mailed to the publisher. Then the students had to wait
for proofs to be mailed back. Once the proofs arrived, they were
checked for errors, and if there were errors, the process was
repeated until it was finally perfect.
the school year, the yearbook staff divides into teams. Each
team has specific organizations or athletic teams that they
follow throughout the year or season, documenting the very best
moments at LCHS for the book.
Yearbooks are a long-standing tradition in high schools and colleges. They serve as a means of preserving students' history in school and
give them something they can keep with them for the rest of their
Pictures by Karen
Hargis and Jennifer Gouin
2012-2013 LCHS yearbook staff members: (front row) Annalee Baxter and
Janessa Merritt; (standing) Shakia Dawson, Megan Brown, Dalanie Schleder, India
Ballew, Loren Smith, Kristin Leake, Serena Cunningham, Jenna
Meister, Elijah Cox, Cheyenne Roher, Alisha Snyder, Skylar Morgan,
Rhiniqua Carter, and the yearbook sponsor, Mrs. Jennifer Gouin.
Ballew, Elijah Cox and Serna Cunningham are working on the layout
pages for the football and volleyball teams that will be part of
this year's
2012-2013 yearbook.
Dalanie Schleder and Lauren Smith are working on the design and
layout of
the spirit group for dress-up days. All staff members are assigned
to teams
that "snapshot" an event or some portion of student life.
Annalee Baxter and Janessa Merritt are the sales team for the
They go out and sell ads to businesses in the community, scan the
cards into the system and lay out the pages to go into the yearbook.
Yearbook is an extracurricular activity, so
the book has to be paid for with dollars brought in through
advertising sales.
Back to top
News |
Sports | Business |
Rural Review |
Teaching & Learning
Home and Family |
| Obituaries
Community |
Law & Courts |
Leisure Time
Spiritual Life |
Health & Fitness |
Teen Scene
Letters to the Editor


text:
|Monroe, CT
|High School:
#10 Steve Zazuri - Career Stats
Career Game-by-Game Stats: 2011-12 | 2010-11 | 2009-10 | 2008-09
2010-11: Played in all 29 games...Averaged 12.1 minutes per game in a back-up point guard role...Averaged 1.1 rebounds and 1.2 assists per game...Had 12 steals on the year...Scored four points with three assists at home vs. FDU...Grabbed a career-high five rebounds in home loss to Mount St. Mary's...Tied his career-high of five assists at Long Island.
2009-10: Appeared in 26 games as a sophomore, earning a pair of starts...Played 14.3 minutes per game...Finished the season with 23 points, 37 rebounds, 53 assists and 18 steals...Averaged 1.8 assists and 1.4 rebounds per game...Had four points and two assists at Holy Cross...Scored four points with four assists and three rebounds at Wagner...Dished a career-high five assists at home vs. Quinnipiac.
2008-09: Played in 14 games his freshman season, averaging 7.7 minutes per game...Started first two games of college career, playing 24 minutes in opener at Holy Cross...Finished the season with five points, 11 assists and 10 rebounds.
High School: Attended Masuk High School where he played basketball for four years for coach John DeGennaro. Was team captain his senior year and was also named team Most Valuable Player. Was named MVP and All-State by the Connecticut Post and Hartford Courant. Was a two-time all-area and all-league selection. Scored 49 points in a game twice his senior year and finished his career with over 1,000 points.
Personal: Son of Stephen and Nancy Zazuri. Has five siblings - Meghan, Kelly, Mikey, John and Julia. His father is Sacred Heart's all-time leader in assists, averaging 7.7 per game from 1980-84. Undecided on a major. Favorite sports teams are the New York Yankees and LA Lakers. Favorite athletes are Derek Jeter and Kobe Bryant. Favorite movie is Goodfellas and favorite TV show is Entourage. Favorite food is pizza. Favorite hobby is playing poker. Would like to have dinner with Derek Jeter "because he has been my favorite player since he's been playing."


text:
Login to change or cancel your reservation
This depends on the chosen rate. The Best Available (Flexible) Price only needs to be settled in the hotel. Special rates such as early booking discounts, last-minute campaigns or non-refundable rates for which no reimbursement is possible, should be settled prior to your stay.
We?d be delighted to help you!


text:
If you are a subscriber to the JCSM (including members of the AASM), please login to access the journal.
Click here to Subscribe:
$75/volume year for individuals or $140/volume year for institutions to access all current articles and archives published in JCSM.
Click Here to DOWNLOAD the article*:
$20 to access a PDF version of a specific article from the current issue of JCSM.
*Purchase of an electronic download of JCSM provides permission to access and print the issue/article for personal scholarly, research and educational use. Please note: access to the article is from the computer on which the article is purchased ONLY. Purchase of the article does not permit distribution, electronic or otherwise, of the article without the written permission of the AASM. Further, purchase does not permit the posting of article text on an online forum or website.
Subscribers can download and print full articles from current and past issues of the JCSM
Login to JCSM
Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership
Stepped care models for chronic insomnia are in their infancy. This study evaluated predictors of movement in a stepped care pathway using a sample of 50 adult outpatients with chronic insomnia.
At assessment periods, participants completed daily sleep diaries, the Insomnia Severity Index, the Multi-Dimensional Fatigue Inventory (MFI), and the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-10). Following this, data were collected regarding whether the individual went on to receive more intensive services (i.e., individual consultation, group or individual therapy). Data were analyzed using multi-nomial logistic regression.
Results showed that age, employment status, and sleep (quality, latency) predicted use of more intensive services. Results showed that psychiatric and sleep comorbidity, sleep attitudes, and insomnia severity did not.
Implications of these findings are that stepped care resulted in a 69% improvement in efficiency, and that low-intensity treatment delivered in step 1 may have been particularly sufficient for the young and employed, and for those with better sleep.
Vincent N; Walsh K. Stepped care for insomnia: an evaluation of implementation in routine practice. J Clin Sleep Med 2013;9(3):227-234.
Insomnia is a chronic condition for 10% of the adult population1 and has been described as an international public health problem.2 Far from being just a nuisance, individuals with insomnia disorder are at increased risk for stroke,3 diabetes,4 obesity,5 alcohol abuse,6 depressive episodes,7 automobile accidents,8 and workplace absenteeism.9,10 Given the scope of the insomnia problem, several researchers have discussed the utility of providing stepped care to meet the massive population need.2,11 One of these papers described a proposal for a stepped care model,2 which will now be reviewed, following which an alternative model currently in use will be outlined.
Espie proposed a 5-level, stepped care model for insomnia.2 The levels differed in terms of provider (e.g., graduate student, psychologist, nonspecific therapist) and cost, but not content. In Espie's proposed model, the lowest intensity intervention was self-administered cognitive behavioral therapy (CBT), either by booklet, CD/DVD, or internet. The next step in this model was a small group manualized brief CBT delivered by a trained therapist, following which individual or small group CBT delivered by a graduate psychologist would be offered. The next step up Espie's proposed hierarchy was the opportunity to receive individual CBT by a clinical psychologist. The final step was to receive "expert CBT" by a behavioral sleep medicine specialist. Espie proposes that there be iterative assessment and review to ensure that progression through steps and the decision of where to begin in the stepped care model be appropriate. An important commentary on this model challenged the sleep community to identify features that might match individuals to a particular entry step (e.g., comorbid sleep, medical, or psychiatric conditions, low levels of sleep self-efficacy, cognitive deficits).11
Current Knowledge/Study Rationale: This study sought to examine whether the introduction of a stepped care model improves the efficiency of care for those with insomnia. A second purpose was to determine predictors of "stepping up" and "stepping down" in such a model.
Study Impact: Results of this study show that stepped care is viable in the treatment of chronic insomnia and produces significant improvements in efficiency. Results show that the presence of comorbid conditions is not associated with more intensive service receipt.
The model under study which has been in use since 2009 contains 4 levels (see Figure 1). It has been employed in a behavioral medicine sleep clinic, in a mid-sized urban center with a population of 700,000. Although not depicted in the figure, the first intervention for most patients with chronic insomnia is the provision of hypnotic medication, which is the standard response to an insomnia complaint when patients are in the office of a family physician. The next step up the hierarchy is a 6-week, computerized treatment (return2sleep.com) that patients access from their homes, one of the first of its kind in North America.12 This program employs cognitive behavioral strategies for managing insomnia, includes homework exercises, determines an appropriate bedtime for the individual through use of a sleep calculator, and provides feedback to users to maximize self-management of the condition. Upon completion of return2sleep.com, or when the individual indicates that they no longer wish to continue using it, patients have the option of an on-site single session consultation with a staff psychologist or psychological associate (graduate student in clinical psychology; step 2). If after the consultation, more intensive intervention is required, patients have the option of a 6-week cognitive behavioral group treatment run by a staff psychologist or a psychological associate (step 3). The components of the group intervention are identical to that of the computerized treatment; however, patients receive more individualized feedback, the opportunity to hear about how others are coping with similar problems, and more attention. Following completion of the group, if individuals are continuing to require care, they are provided with individual treatment with a staff psychologist who specializes in behavioral sleep medicine (step 4).
Stepped care model
(more ...)
A review of the stepped care literature echoes the words of Edinger11 and illustrates that little is known about providing more or less intensive service to those with chronic sleep problems. Past research has tended to focus on the decision to seek consultation with a healthcare provider, typically a family physician or a general practitioner. Some of this research shows that increased consultation with a general practitioner regarding sleep is associated with increased sleep onset latency, time awake at night, daytime fatigue/sleepiness, and reduced total sleep time.1,13,14 Other research has shown that consultations were positively associated with perceived severity of insomnia,1,15 presence of comorbid medical conditions,16 increasing age and unemployment,1 and a perception that insomnia is due to poor sleep habits.15
Based on a review of the literature, the following hypotheses were made: (a) those who are older and unemployed will be more likely to step up the stepped care plan; (b) Those with less favorable sleep onset latency, time awake at night, and sleep quality will be more likely to step up the stepped care plan; (c) those with comorbid psychiatric conditions or symptoms suggestive of alternative sleep disorders will be more likely to step up the stepped care plan.
These data represents a consecutive series of patients who participated in a stepped care model within an outpatient behavioral medicine sleep clinic. As such, this is a non-controlled design.
Participants were 50 adults referred by physicians to a behavioral sleep clinic. Demographic and sleep features of the sample are listed in Tables 1 and 2 and illustrate that the sample was typical of help-seeking adults with chronic insomnia with regard to disturbed sleep. Inclusion criteria for the study were access to high speed internet and a home computer, a disturbance of sleep consisting of delay in sleep onset, return to sleep, or early-morning awakening > 30 min, the report of at least one symptom of daytime impairment (e.g., fatigue, lack of concentration), and a duration ≥ 6 months, occurring ≥ 4 nights per week. There was no maximum allowable total sleep time ([TST] e.g., 6.5 h) for inclusion in the study. The inclusion criteria were consistent with the general research diagnostic criteria for insomnia disorder.17 If a comorbid sleep or psychiatric disorder was present, treatment of this condition was stable at the time of entry into the study based on patient self-report. We did not require that medications be stable; many of the participants had not responded successfully to sleep medication. Exclusion criteria for the study were the presence of shift work, head injury, acute suicidality, current mania, schizophrenia, current or past cognitive behavioral treatment of insomnia, or elevated substance use. Elevated substance use was defined as consuming > 14 alcoholic beverages per week for males or and > 12 alcoholic beverages per week for females.
Descriptive features of sample
Sample characteristics
A standard sleep diary18 collected information pertaining to sleep quality (SQ), wake after sleep onset (WASO), sleep-onset latency (SOL), and medication use (both psychiatric and sleeping agents). Although sleep diaries also measure TST, number of awakenings (NOW), and sleep efficiency (SE), these variables were not explicitly studied for reasons of parsimony. Sleep diary measures were scored for each night and then averaged across the recording period. Although not perfectly correlated, sleep diary ratings have been shown to correlate significantly with results obtained using polysomnographic monitoring.19,20 Sleep diaries tend to provide overestimates of SOL and WASO, and underestimates of TST, relative to PSG21–24; however, they are one of the most widely used measures of insomnia.
The Insomnia Severity Index (ISI)18 measured the degree of dissatisfaction and daytime impairment associated with insomnia. The ISI has been found to have acceptable reliability and construct validity.25,26 Scores can range from 0 to 28, with higher scores indicating more impairment. Scores > 14 are thought to indicate the presence of clinical insomnia.25
The general fatigue subscale of the Multi-Dimensional Fatigue Inventory (MFI)27 measured general levels of fatigue. The general fatigue subscale has been found to have good internal consistency (ranging from 0.83-0.90), and scores have been shown to positively and significantly correlate with other self-report measures of fatigue.27 Scores on the subscale can range from 4 to 20, with higher scores indicating greater fatigue.
The Dysfunctional Beliefs and Attitudes about Sleep Scale-revised version (DBAS-10)28 is a 10-item self-report measure of maladaptive beliefs about sleep (e.g., beliefs about the immediate and long-term negative consequences of insomnia, beliefs about the need for control over insomnia). Although developed as an analogue scale, it was transformed into a Likert-type scale, with responses ranging from 1 (strongly disagree) to 6 (strongly agree). Thus, total scores could range from 10 to 60, with higher scores indicating more maladaptive cognitions regarding sleep. The DBAS-10 has moderate reliability and validity.29
Age, employment status, and gender were collected in a telephone screening interview. Sleep disorder symptom comorbidity was assessed using the Insomnia Interview Schedule18 as well as using chart information regarding physician-diagnosed sleep disorder available at the time of screening. Participants were asked about whether they experienced any of the following: snoring, pauses in breathing at night (apnea symptoms); leg twitching or jerking during night, awakening with cramps in legs (periodic limb movement symptoms); crawling or aching feelings in the calves, inability to keep legs still (restless legs symptoms); and nightmares, night terrors, sleepwalking/talking, teeth grinding (parasomnia symptoms). If participants endorsed any of these problems, sleep disorder symptom self-report comorbidity was scored as 1 = present. Support for the validity of the method was previously documented.30 With established reliability and validity, the Mini-International Neuropsychiatric Interview,31 a structured clinical interview for the Diagnostic and Statistical Manual for Mental Disorders axis I disorders, was administered by the study coordinator and used to assess psychiatric comorbidity. We also administered the Clinical Global Improvement Scale (CGI) at the end of step 1 to measure perceptions of change in sleep. The Clinical Global Improvement Scale-self-report version (CGI)32 assessed patients' perceived global improvement. The CGI asked patients to report the overall change in their sleep and in sleep-related effects as a result of participation in their treatment. Participants are asked to rate the change in their sleep and not in any other problem such as chronic pain, depression, or anxiety. Response choices ranged from very much improved (1) to very much worse (7). Evidence of the construct validity of the CGI-self-report version comes from the demonstration that CGI scores are significantly and positively associated with treatment-related changes in sleep parameters (e.g., TST, SE).33 Lastly, the Client Satisfaction Questionnaire (CSQ)34 was administered at the end of Step 1 and measured global satisfaction with service.
Upon physician referral to a teaching hospital behavioral medicine sleep clinic, potential participants received written information describing the services in the clinic and a followup telephone call from a clinic coordinator. Potential participants were told that the sleep clinic has a number of services including computerized treatment, on-site single-session consultation, on-site group treatment, and on-site individual treatment. All participants were told that receiving initial computerized treatment for insomnia did not remove the individual from the in-person waitlist or prioritize placement on that waiting list in any way. Participants were next asked whether they would be interested in receiving initial computerized treatment for insomnia. If interested, individuals were phone-screened to determine whether they met inclusion and exclusion criteria for the study and whether they were interested in participating. Informed consent was obtained at this time. Next, information was collected by telephone regarding symptoms of sleep disorders, as well as medical history and current medications (for sleep and any other problem). Additionally, the Mini-International Neuropsychiatric Interview (MINI)31 was administered by the study coordinator. All participants completed a computerized baseline questionnaire package consisting of 7 days worth of sleep diaries, the MFI, ISI, and DBAS-10.
Once complete, participants entered Step 1. A description of the steps follows:
A 6-week computerized treatment, return2sleep.com, served as the initial step. Components were psychoeducation (week 1), relaxation training (week 2), stimulus control and sleep restriction (week 3), cognitive therapy (week 4), sleep hygiene education (week 5), and mindfulness meditation (week 6). Participants logged onto the website from their homes, completed homework, and received automated feedback about their progress.
The step 2 intervention consisted of an on-site single-session consultation with a staff psychologist or psychological associate in the clinic. During this appointment, progress was reviewed and ideas regarding further cognitive behavioral intervention were generated.
The step 3 intervention consisted of a manualized 6-week on-site cognitive behavioral group treatment program. Groups met weekly for 90-min sessions, and were led by a clinical psychologist or psychological associate. There were 5 to 6 members per group. Treatment components were identical in content and sequence to the computerized program.
The step 4 intervention consisted of individual psychotherapy conducted by a clinical psychologist, resident, or psychological associate in the clinic. Intervention was uniquely tailored to the patient.
After the beginning of step 1, a brief e-mail was sent at week 3 inquiring into whether they were having any difficulties with the site, and then again at week 6 and week 10 to prompt them to re-do the questionnaire measures and the sleep diaries. At week 6, participants completed the CGI and CSQ. After week 10, there was no further contact with participants until their name came to the top of the clinic in-person waiting list. At this time, participants were contacted by telephone by a receptionist or staff psychologist to inquire about the need for and interest in having a one-session on-site consultation (step 2). Interested individuals had appointments scheduled and disinclined individuals were asked about reasons for declining. At the end of the on-site consultation meeting, interest in and need for further treatment of insomnia were reviewed with the participant, and a description of the group treatment program (step 3) was provided. Interested individuals began group treatment. At the end of the group treatment program, interest in and need for further individual treatment of insomnia (step 4) was discussed. Interested individuals were assigned a therapist. Sleep diaries were administered at the beginning of steps 1, 2, and 3, but not step 4. The ISI, DBAS-10, and MFI were administered at the beginning of steps 1 and 2 but not the remaining steps. The lack of standardization of test administration reflected that the primary intent of the study was to assess service uptake rather than outcomes at the various steps. The study was approved by the ethics review board at the University of Manitoba.
Results were analyzed using multinomial logistic regression. The criterion variable was final step (1 = return2sleep.com, 2 = single session consultation, 3 = group treatment, 4 = individual treatment). Prior to analysis, all assumptions of the approach were evaluated. Preliminary inspection of missing data revealed that there were complete questionnaire and sleep diary data at step 1, that 20% of questionnaire data and 36.8% of sleep diary data were missing at step 2, and that 36.4% of sleep diary data were missing at step 3. As a result, missing values analysis was conducted using SPSS v. 18, and missing values were imputed.
Of the initial set of participants, results in Figure 1 illustrate that 35% (19/50) moved up to step 2, 22% (11/50) moved up to step 3, and 6% (3/50) moved up to step 4. For comparison purposes, existing volume data from this clinic showed that, in the 8 years prior to the introduction of the stepped care model, 71% of referred patients received group treatment (what we are referring to as step 3).
To conduct the logistic regression analysis, we removed 3 individuals (those in receipt of step 4) due to insufficient numbers in cells. This resulted in a final sample size of n = 47 for the regression analyses. Results from examination of hypothesis one are presented in Table 3, and illustrate that age and employment status but not gender affected movement up the care pathway. For each one unit change in age (from younger to older), the odds of receiving the step 3 intervention increased by 85.7%. For each one unit change in employment status (from employed to unemployed), the odds of receiving the step 3 intervention increased by 95%. There was no significant impact of demographic variables predicting receipt of the step 2 intervention.
Impact of demographic variables on group treatment for insomnia (n = 47)
Results from examination of hypothesis two are presented in Table 4 and show that SQ at step 1 (return2sleep.com) significantly predicted movement up the stepped care pathway. For each one unit improvement in SQ, the odds of receiving the step 3 intervention decreased by 91%. Alternatively put, less favorable SQ was associated with more intensive service receipt. There was no significant impact of SOL or WASO at step 1 on movement up the stepped care pathway. There was no signifi-cant impact of SQ, SOL, or WASO at step 1, or change in these variables predicting the odds of receiving the step 2 intervention. Thus, response to treatment did not affect receipt of more intensive services.
Impact of sleep at step 1 on movement up to group therapy (n = 47)
Results in Table 5 illustrate that SOL at step 2 significantly predicted movement up the stepped care pathway. For each one unit change in SOL, the odds of receiving the step 3 intervention increased by 22-fold. Less favorable SOL predicted receipt of the step 3 intervention. Neither SQ nor WASO at step 2 predicted movement up the steps, nor did change in these variables from step 1 to step 2. Thus, response to treatment did not affect receipt of more intensive services.
Impact of sleep at step 2 on movement up to group therapy (n = 47)
Results showed that scores on the MFI-20, DBAS-10, and ISI at step 1 (or step 2) did not significantly predict movement up the steps. Results from examination of hypothesis three showed that neither psychiatric nor sleep symptom comorbidity significantly increased the odds of moving up the stepped care pathway. Among those with psychiatric comorbidity, those who did not proceed to step 2 reported no change in the frequency of nights of medication use (M = 0); those who proceeded to step 2 had fewer nights of medication usage (M = 33.33% SD = 57.7); and those proceeding to step 3 had no change in frequency of medication use (M = 0). Thus, for those with psychiatric comorbidity, it seems unlikely that increased medication use was responsible for the lack of receipt of more intensive services. A similar pattern of findings was observed for sleep symptom comorbidity.
Of this series of patients, 3 requested access to the step 1 treatment (return2sleep.com) after the conclusion of the step 3 intervention (group therapy). When examined, we noted that none of these individuals re-accessed the online program despite receiving a new username and password. Results in Table 6 illustrate the average sleep diary scores for data that was available at steps 1 (n = 50/50), 2 (n = 12/19), and 3 (n = 7/11). Both data from completers and multiply imputed data are presented. As a group, those in receipt of the step 3 intervention have experienced improvements in sleep compared to baseline (prior to step 1). Next, we examined perceived improvement and satisfaction with step 1. Of those who did not proceed from step 1 to step 2, 81.8% reported improvement in sleep on the Clinical Global Improvement Scale (CGI). On the Client Satisfaction Questionnaire (CSQ), and of those who did not proceed from step 1 to step 2, 83.3% rated the quality of step 1 service as good to excellent, 75% indicated that they had received the service that they wanted (in step 1), 66.7% reported that most of their needs had been met in step 1, 83.3% reported that if a friend were in need of similar type of help, that they would recommend step 1, and 75% reported that services received in step 1 helped them to more effectively manage their problem. Of those who did not proceed from step 1 to step 2, 45.5% had sleep efficiency > 85%, and 45.0% had scores on the Insomnia Severity Index which fell below a clinical cutoff suggestive of insomnia (i.e., 13.0). These results indicate that approximately half the sample that completed step 1 had sleep in the normative range, but that a larger number were satisfied with the changes and felt themselves to be improved.
Sleep at different steps
This was a case series study of 50 adults presenting for psychological treatment of chronic insomnia and proceeding through a stepped care model. As such, it represents one of the first illustrations of the use of stepped care for insomnia in a public health setting. An important finding of the study was that fewer participants accessed the more intensive steps (e.g., group and individual therapy) when provided with an initial low-intensity intervention (return2sleep.com). Although not a controlled investigation, prior to the advent of this stepped care model, 71% of referred patients were receiving more intensive services (group treatment) at this site, compared to the rate of 22% noted in this case series study. Stepped care approaches, where non-responders to a less intensive therapy receive a more intensive intervention, aim to only provide intensive assistance to those who need it, thereby allocating therapeutic resources more efficiently. From a stepped care perspective, this particular model increased service efficiency by 69%. One way of envisioning how stepped care might work to treat the thousands of people with insomnia is to provide steps 1-3 in primary care, and step 4 at a specialty sleep clinic.
A second main finding of the study was that belonging to particular demographic groups (being older, unemployed) and having poor sleep (quality and latency) predicted receipt of more intensive services for insomnia. This is consistent with results from other research examining consultation patterns for those with insomnia.1,13,14 These authors reported that increasing age, more severe insomnia, and greater unemployment predicted patient consultation for the problem of insomnia. Practical considerations such as increased time available for treatment may explain why the older and unemployed were more likely to receive on-site services. In the current study, the converse finding was that younger individuals were less likely to pursue more intensive services. Other researchers have shown that younger individuals may be more receptive to technology and may have better outcomes in self-administered treatments.35 Of course other explanations are also possible and are discussed below. Available sleep diary and perceived improvement data suggest that the number of participants who became normal sleepers in step 1 was modest but perhaps typical of CBT-I self-help interventions for insomnia. A review of the effectiveness of self-help CBT-I showed that normative sleep at the end of treatment programs is typically in the range of 18% to 50%.36 In this study, an even larger number of patients detected an improvement in their sleep and were satisfied with the step 1 intervention. After receipt of step 1, approximately 50% were sleeping optimally, but the group as a whole may have had a renewed sense of hopefulness or perhaps a greater feeling of mastery associated with having some improvement in a challenging and chronic health problem. The finding that satisfaction ratings outstrip sleep status has also been found with in-person programs.
A third main finding of the study was that neither psychiatric nor sleep disorder symptom comorbidity predicted receipt of more intensive services. This is noteworthy, given that 60% of the sample met DSM-IV criteria for an axis I disorder, and approximately 22% had symptoms suggestive of alternative sleep disorders. These results suggest that individuals with comorbidity may not perceive greater need for more intensive services, may be satisfied with briefer interventions, may have received additional treatments (e.g., psychiatric medications) during the course of stepped care, may have been demoralized by a poor outcome with low-intensity treatments, and/or may feel that more intensive behavioral intervention for sleep will not address a significant part of their sleep problem. A recent investigation in our laboratory showed that return2sleep.com was largely robust to psychiatric and sleep symptom comorbidity, suggesting that these groups were not disadvantaged in terms of clinical improvements associated with a low-intensity treatment (our step 1).30 Thus, both lack of significant improvement at step 1 with consequent low morale is probably an unlikely explanation for why individuals with comorbidities did not receive more intensive services in this stepped care model. Additionally, we did not find that those with comorbidities were more likely to be receiving extra medication treatments such as antidepressants or sleeping agents. Anecdotal information provided by participants in this study suggested that there was reduced need for service after completion of a low-intensity step 1 intervention. The current investigation also found that daytime fatigue, and less/more dysfunctional beliefs about sleep did not predict movement up the stepped care pathway. Fatigue in particular may not be a sufficient impediment to receiving more intensive services for insomnia.
A fourth ancillary finding of this study is that very few patients actually "stepped down" in this pathway. At the conclusion of group treatment, only 3 patients requested renewed access to return2sleep.com, and none of the patients who received individual therapy requested to rejoin a group treatment. Examination of web usage patterns reveals that these individuals did not actually revisit the site. Instead it seems that access to the website served as a reassuring aid, much like having a bottle of sleeping medicine that is rarely used near the bedside.
This study involving the use of stepped care for insomnia in routine clinical practice had a number of limitations. Some of these include the use of a single publicly funded site and a single model to obtain this data, lack of complete outcome data for each of the steps in the model owing to the emphasis on service receipt rather than outcomes, and small sample size. Using this model at other sites might produce differing results owing to contextual factors. Upon referral, patients access health services such as this one at no charge after providing their healthcare number. Our staff are equally comfortable with providing low- and high-intensity treatments, and there was no perceived threat associated with providing self-administered treatments. This might not be the same in other contexts where low remuneration for behavioral sleep services is the norm. Additionally, the decision to step up in this stepped care model is mutually agreed upon between staff and patients, and there is/was a lack of standardized criteria to make this decision. It is possible that bias was introduced at these points. Future studies will determine whether patient and provider decision-making is inferior or superior to numerical decision aides regarding stepping up or down in stepped care pathways. Lastly, this was an uncontrolled study, so it is possible that other factors (e.g., spontaneous remission, regression to the mean, treatment seeking outside of the study) explained movement up the steps.
There are a number of plausible factors that may drive movement up a care pathway, some of which pertain to individual level variables and others to contextual level variables.37 Individual variables may include perceived need, convenience, belief in the importance of working with a professional to solve health problems, and degree of social support. Contextual factors may include advice from others to seek care for insomnia and policies which facilitate or impede access to care for insomnia. Although this investigation focused on individual-level variables, more examination of contextual factors would be an important future area of study. For example, a study that compared a publicly funded stepped care model with a privately funded one would provide an interesting examination of context in the use of stepped care. Future investigations should compare outcomes in stepped care models for insomnia and contrast this with treatment as usual. The efficiency produced by stepped care models is only as good as the outcomes that the models produce. In the absence of data showing that the outcomes are at least as good as treatment as usual, stepped care is not a viable future opportunity in this area. More qualitative study of why individuals choose to proceed to more intensive services may prove to be very fruitful in this area.
This was not an industry supported study. The authors have indicated no financial conflicts of interest.
Morin CM, LeBlanc M, Daley M, Gregoire JP, Merette C, authors. Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med. 2006;7:123–30. [PubMed]
Espie CA, author. "Stepped care": a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment. Sleep. 2009;32:1549–58. [PubMed Central][PubMed]
Elwood P, Hack M, Pickering J, Hughes J, Gallacher J, authors. Sleep disturbance, stroke, and heart disease events: evidence from Caerphilly cohort. J Epidemiol Community Health. 2006;60:69–73. [PubMed Central][PubMed]
Cappuccio FP, D'Elia L, Strazzullo P, Miller MA, authors. Quantity and quality of sleep and incidence of type 2 diabetes. Diabetes Care. 2010;33:414–20. [PubMed Central][PubMed]
Gangwisch JE, Malaspina D, Boden-Albala B, Heymsfield SB, authors. Inadequate sleep as a risk factor for obesity: analyses of the NHANES I. Sleep. 2005;28:1289–96. [PubMed]
Crum RM, Storr CL, Chan Y-F, Ford DE, authors. Sleep disturbance and risk for alcohol-related problems. Am J Psychiatry. 2004;61:1197–203
Breslau N, Roth T, Rosenthal L, Andreski P, authors. Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry. 1996;39:411–8. [PubMed]
Balter MB, Uhlenhuth EH, authors. New epidemiologic findings about insomnia and its treatment. J Clin Psychiatry. 1992;53 Suppl:34–42. [PubMed]
Daley M, Morin CM, Leblanc M, Gregoire JP, Savard J, Baillargeon L, authors. Insomnia and its relationship to health-care utilization, work absenteeism, productivity and accidents. Sleep Med. 2009;10:427–38. [PubMed]
Godet-Cayré V, Pelletier-Fleury N, Le Vaillant M, Dinet J, Massuel M-A, Léger D, authors. Insomnia and absenteeism at work. Who pays the cost? Sleep. 2006;29:179–84. [PubMed]
Edinger JD, Olsen MK, Stechuchak KM, et al., authors. Cognitive behavioural therapy for patients with primary insomnia or insomnia associated predominantly with mixed psychiatric disorders: a randomized clinical trial. Sleep. 2009;32:499–510. [PubMed Central][PubMed]
Vincent N, Lewycky S, authors. Logging on for better sleep: RCT of the effectiveness of online treatment for insomnia. Sleep. 2009;32:807–15. [PubMed Central][PubMed]
Bartlett DJ, Marshall NS, Williams A, Grunstein RR, authors. Predictors of primary medical care consultation for sleep disorders. Sleep Med. 2008;9:857–64. [PubMed]
Hayward R, Jordan KP, Croft P, authors. Healthcare use in adults with insomnia: a longitudinal study. Br J Gen Pract. 2010;60:334–40. [PubMed Central][PubMed]
Cahn SC, Langenbucher JW, Friedman MA, Reavey P, Falco T, Pallay RM, authors. Predictors of interest in psychological treatment for insomnia among older primary care patients with disturbed sleep. Behav Sleep Med. 2005;3:87–98. [PubMed]
Aikens JE, Rouse ME, authors. Help-seeking for insomnia among adult patients in primary care. J Am Board Fam Med. 2005;18:257–61
Edinger JD, Bonnet MH, Bootzin RR, et al., authors. Derivation of research diagnostic criteria for insomnia: report of an American academy of sleep medicine work group. Sleep. 2004;27:1567–96. [PubMed]
Morin CM, author. Insomnia: psychological assessment and management. 1993. New York: Guilford Press;
Coates TJ, Killen JD, George J, Marchine E, Silverman S, Thoresen C, authors. Estimating sleep parameters: a multitrait-multimethod analysis. J Consult Clin Psychol. 1982;50:345–52. [PubMed]
Spielman AJ, Saskin P, Thorpy MJ, authors. Treatment of chronic insomnia by restriction of time in bed. Sleep. 1987;10:45–56. [PubMed]
Monk TH, Reynolds CF, Kupfer DJ, et al., authors. The Pittsburgh sleep diary. J Sleep Res. 1994;3:111–20
Sateia MJ, author; Lee-Chiong TL, Sateia MJ, Carskadon MA, editors. Epidemiology, consequences, and evaluation of insomnia. Sleep medicine. 2002. Philadelphia: Hanley and Belfus; p. 151–60. [PubMed]
Spielman AJ, Glovinsky PB, authors; Pressman MR, Orr WC, editors. The diagnostic interview and differential diagnosis for complaints of insomnia. Understanding sleep: the evaluation and treatment of sleep disorders. 1997. Washington, DC: American Psychological Association; p. 125–60
Wohlgemuth WK, Edinger JD, authors; Lichstein KL, Morin CM, editors. Sleep restriction therapy. Treatment of late-life insomnia. 2000. Thousand Oaks, CA: Sage; p. 147–84
Bastien CH, Vallieres A, Morin CM, authors. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2:297–307. [PubMed]
Morin CM, Azrin NH, authors. Behavioral and cognitive treatments of geriatric insomnia. J Consult Clin Psychol. 1998;56:748–53
Smets EM, Garssen B, Bonke B, De Haes JC, authors. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 39:315–25. 195. [PubMed]
Espie CA, Inglis SJ, Harvey L, Tessier S, authors. Insomniacs' attributions: psychometric properties of the dysfunctional beliefs and attitudes about sleep scale and the sleep disturbance questionnaire. J Psychosom Res. 2000;48:141–8. [PubMed]
Edinger JD, Wohlegemuth WK, Radtke RA, Marsh GR, Quillian RE, authors. Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial. JAMA. 2001;285:1856–64. [PubMed]
Vincent N, Walsh K, Lewycky S, authors. Determinants of success for computerized CBT: examination of an insomnia program. Behav Sleep Med. 2012 7 18. [Epub ahead of print] http://dx.doi.org/10.1080/15402002.2012.700662.
Sheehan DV, Lecrubier Y, Sheehan K, et al., authors. The Mini International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview. J Clin Psychiatry. 1998;59 Suppl 1:22–3
Guy W, author. Clinical global impressions: ECDEU assessment manual for psycho-pharmacology. 1976. Bethesda, MD: National Institute of Mental Health. Revised.
Vincent N, Penner S, Lewycky S, authors. What predicts patients' perceptions of improvement in insomnia? J. Sleep Res. 2006;15:301–8
Larsen DL, Attkisson CC, Hargreaves WA, Nguyen TD, authors. Assessment of client/patient satisfaction: Development of a general scale. Eval Program Plann. 1979;2:197–207. [PubMed]
Newman MG, Erickson T, Przeworski A, Dzus E, authors. Self-help and minimal contact therapies for anxiety disorders: is human contact necessary for therapeutic efficacy. J Clin Psychol. 2003;59:251–74. [PubMed]
Morin CM, Bastien C, Savard J, authors; Perlis ML, Lichstein KL, editors. Current status of cognitive-be havior therapy for insomnia: evidence for treatment effectiveness and feasibility. Treating sleep disorders: principles and practice of behavioral sleep medicine. 2003. Toronto: John Wiley & Sons Canada; p. 262–85
Andersen RM, author. National health surveys and the behavioural model of health services use. Med Care. 2008;46:647–53. [PubMed]


text:
BeBop's Forte Wireless Data Glove - Lets you Get-a-Grip "Virtually"
So I was very pleased to see the BeBop Sensors Forte Wireless Data Glove system, a fully featured affordable data glove to incorporate haptics and super accurate, rapid sensing for gaming and AR/VR environments for a more realistic VR experience. The hand tracking system tracks fingers and fingertips with haptics, the Forte Glove is an ultra-comfortable one-size-fits-all glove, conducive to lengthy Augmented Reality and Virtual Reality sessions due to its light weight and open airy design. Light and simple looking, it also can be worn inside a glove, for example. Sensing speed and accurately sensing finger movements are key features along with tactile feedback to the fingertips.
The glove provides Super Accurate Rapid Sensing with data rates at 150 frames per second. With lag time eliminated, triggering has near instantaneous response times -- perfect for the most demanding Applications and Games.
Raven Connected Car - IoT, IoMe, IoCar + Secure Connectivity & Artificial Intelligence all disguised as a Dash Cam!
Contextual technology gathered up and situational relevance and intelligence added. To call this security conscious "vehicle-to (and from)-everything" platform a Dash Cam is a bit of an injustice to the scope of this connected car ecosystem. Connects directly to the car's OBD port so know's what's going on internal to the vehicle systems and puts that into the contexts of info, location plus driver and family to deliver valuable set of person centric capabilities. The feature list is long, but the Raven, with cameras looking out and in and all knowing connectivity delivers peace of mind while driving. Not just for driver and passangers, but for family as well. This caught my eye because of what the overall technology combination delivers when the IoCar intelligently intersects with access to information, the IoT and IoMe and mine.
So many stated features. Here's what they say. (my comments in parenthesis)
Raven gives cars the intelligence and voice needed to proactively communicate with drivers and their families, making them smarter, safer and more connected while on the road.
At home, at work or a thousand miles away, Raven's always-on and always-connected system gives family members and car lovers unprecedented peace of mind with:
* Live streaming camera views, both road-facing and in-cabin
* Security alerts (car broken into?)
* Departure and arrival notifications (mapping)
* Driving reports (even capture time lapse synopsis of journey)
* Gesture controls (and voice commands coming soon)
* Next-turn navigation
* Weather condition updates
* Vehicle diagnostics
* Wi-Fi hotspot
Raven unmasks the sophistication and intelligence locked under the hood in today's vehicles and makes it readily accessible to drivers.
Raven has been designed and engineered from the ground up by a highly accomplished team passionate about best in-class performance and user experiences.
(The connectivity to the web and to a defined group of friends and family is a real value proposition understated here) Worth a visit to the Raven Website for more details on use cases and how it works.
HEARTGUIDE Wrist Watch - Blood Pressure on the Go, on the Couch, even while you Sleep. Cardiology Department on your Wrist?
I am always seeking what I call "technology enabled, consumer driven change".
There is growing evidence that health conscious consumers will instigate much of the rapid change in healthcare, rather than organically in the healthcare industry itself. This is effectively where personal emphasis on wellness and preventative healthcare will emerge rather than from the reactive nature of your relationship with your healthcare provider.
So here is one more personal item that could change the dynamics of heart health not just in terms of monitoring vitals, but also in building a very valuable contextual database of clinical data specific to the wearer! Normal Looking, and according to Omron, "Clinically Validated & Accurate"
The HEARTGUIDE Wrist Watch works with a smartphone App and has a long list of vital sign monitoring sensors, but now Omron adds one measurement that has been missing from wrist wearables to date - a Blood Pressure Monitor.
It syncs with the Omron app to track and share vital data about your heart health and keeps track of physical activity and sleep as well.
Currently undergoing FDA testing, available later this year for about the same price as an Apple Watch.
But the real bonus for me came from a discussion I had with Dr. David Albert, MD, Founder & Chief Scientific Officer of AliveCor - an affiliate company to Omron Healthcare who I met with on the Omron booth. It is likely that the EKG Atrial Fibrillation sensing and recording of Alivecor's Kardia Band device will also be incorporated in future versions. Kardia Band is an available product, a clinical grade wearable EKG which is already FDA-cleared and replaces your original Apple Watch® band. It provides access, analysis and data storage of a 30-second EKG anytime, anywhere.
Add that to your personal heart health Database!
A Cardiology Department on your Wrist!