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Assess the association between REM predominant obstructive sleep apnea (OSA), sleepiness, and quality of life in a community-based cohort of men ≥ 65 years-old.
A cross-sectional analysis of 2,765 subjects from the Outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study was performed to identify subjects with an apnea hypopnea index (AHI) < 15 (n = 2,044). Subjects were divided into groups based on the AHI in REM sleep (< 5 [referent group], 5 to < 15, 15 to < 30, and ≥ 30). Daytime somnolence, sleep-related quality of life, sleep disturbance, general quality of life, depressive symptoms, and health status were quantified using Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Pittsburgh Sleep Quality Index (PSQI), Short Form-12 (SF-12), Geriatric Depression Scale-15 (GDS), and self-perceived health status, respectively.
Prevalence of REM-predominant OSA (AHI-REM ≥ 5) was 42.8% if OSA was defined as AHI ≥ 15 and 14.4% if OSA was defined as AHI ≥ 5. Higher AHI-REM was associated with polysomnographic indices of poorer sleep architecture (reduced total sleep time, sleep efficiency, REM sleep duration and proportion). Adjusting for age, BMI, and study site, higher AHI-REM was not associated with subjective sleep measures (ESS, FOSQ, PSQI), lower quality of life (SF-12), or greater depressive symptoms (GDS).
In a community-based sample of older adult men ≥ 65 years-old, REM-predominant OSA was highly prevalent and was associated with objective indices of poorer sleep quality on polysomnography but not with subjective measures of daytime sleepiness or quality of life.
Khan A; Harrison SL; Kezirian EJ; Ancoli-Israel S; O'Hearn D; Orwoll E; Redline S; Ensrud K; Stone KL. Obstructive sleep apnea during rapid eye movement sleep, daytime sleepiness, and quality of life in older men in osteoporotic fractures in men (MrOS) sleep study. J Clin Sleep Med 2013;9(3):191-198.
Obstructive sleep apnea (OSA), as defined by an apnea hypopnea index (AHI) ≥ 5, is present in 24% to 62% of community dwelling elderly (age ≥ 65 years), and moderate to severe OSA with an AHI ≥ 15 has been noted in 19% to 44%.1–3 OSA has been associated with excessive daytime sleepiness, decreased quality of life, impaired cognition, hypertension, stroke, diastolic dysfunction, left atrial enlargement, and insulin resistance.4–13 Little is known about OSA confined only to REM sleep (REM-predominant OSA).14–17 This is of particular interest, given that disordered breathing events in REM sleep are often of longer duration and associated with a greater degree of oxygen desaturation than NREM sleep.18,19
REM-predominant OSA also poses a difficult dilemma for the practicing clinician. There is lack of data regarding the association between REM-predominant OSA and quality of life as well as cardiovascular and metabolic outcomes. It is not clear if isolated REM-only OSA needs to be treated or if during continuous positive airway pressure (CPAP) titration, pressure should be increased for REM events if the overall AHI is in the normal range. The prevalence and impact of REM-predominant OSA is not clear due to differences in sample size and patient populations of various studies and the adjustments used in various studies to compensate for the effect of AHI in NREM (AHI-NREM) on AHI in REM (AHI-REM) sleep.14–17,20 This is further confounded by REM-predominant OSA being more prominent in women and relatively younger population and less common in individuals with severe OSA.14–17,20,21
Current Knowledge/Study Rationale: It is not known if REM-predominant obstructive sleep apnea (OSA) affects quality of life and sleepiness and if isolated REM-only OSA needs to be treated.
Study Impact: In a community-based sample of older adult men ≥ 65 years-old, REM-predominant OSA was highly prevalent and was associated with objective indices of poorer sleep quality on polysomnography but not with subjective measures of daytime sleepiness or quality of life.
The prevalence and impact of REM-predominant OSA in individuals older than 65 years is not known. The average age of the subjects in most studies of OSA has been between 49-65 years, and individuals older than 65 have been excluded in most studies.17,22–24 In some studies REM related OSA was more common in the younger population,15,16 while in other studies such as the Sleep Heart Health Study, subjects with more severe REM-predominant OSA were older.22 Our primary objective was to define the prevalence of REM-predominant OSA in the Osteoporotic Fractures in Men Sleep study (MrOS Sleep Study) cohort and determine whether REM-predominant OSA was associated with sleepiness and quality of life in older male adults. Our secondary objective was to describe the demographic and polysomnography (PSG) characteristics of older men with REM-predominant OSA.
From March 2000 through April 2002, 5,994 men aged 65 years and older were recruited for participation in the prospective Osteoporotic Fractures in Men (MrOS) Study from population-based listings in 6 areas of the United States: Birmingham, Alabama; Minneapolis, Minnesota; Palo Alto, California; Pittsburgh, Philadelphia; Portland, Oregon and San Diego, California.25,26 To be eligible for the study, men had to be able to walk without assistance, not have had bilateral hip replacement or a medical condition that (in the judgment of the investigator) would result in imminent death at the time of enrollment, and were willing to give informed consent and undergo the study procedures. There were no other exclusion criteria.25
In an ancillary study, from December 2003 through March 2005, subjects were invited to have in-home polysomnography (PSG) and actigraphy as part of Outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study.2 Of the 5,994 men enrolled in the MrOS Study, 3,135 (52.3%) were enrolled in the MrOS Sleep Study. All participants provided written informed consent, and the study protocols were approved by the institutional review boards at each respective study site and at the data coordinating center in San Francisco, California. The MrOS sleep visit was completed between December 2003 and March 2005. A total of 3,135 participants attended the sleep visit. Men were screened for use of mechanical devices during sleep including continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BPAP), mouthpiece for snoring or sleep apnea, or oxygen therapy. In general, those who reported nightly use of any of these devices were excluded from the MrOS Sleep Study; however, the study sample does include 11 men who reported use of one of these devices < 2 times per week. In the present analysis, data were analyzed from 2,765 subjects who took part in the MrOS Sleep Study and had adequate PSG signal quality available for ≥ 4 h, as well as adequate REM staging data (Figure 1).2
AHI, apnea hypopnea index; AHI-REM, apnea hypopnea index-rapid eye movement sleep; PSG, polysomnography. REM-predominant OSA was defined as AHI < 15 but AHI-REM ≥ 5.
Distribution of subjects in MrOS Sleep Study with AHI
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In-home sleep studies were performed using unattended PSG (Safiro, Compumedics, Inc., Melbourne, Australia). The recording montage consisted of 2 central (C3/A2 and C4/A1) electroencephalographic leads, bilateral electroculograms, a bipolar submental electromyogram, thoracic and abdominal respiratory inductance plethysmography, airflow (using nasal-oral thermocouple and nasal pressure cannula), finger pulse oximetry, electrocardiogram, body position (mercury switch sensor), and bilateral leg movements (piezoelectric sensors). Trained certified staff members performed home visits for setup of the sleep study units. After sensors were placed and calibrated, signal quality and impedance were checked, and sensors were repositioned as needed to improve signal quality, replacing electrodes if impedances were greater than 5 kΩ, using approaches similar to those used in the Sleep Heart Health Study.27–29 Staff returned the next morning to collect the equipment and download the data to the Central Sleep Reading Center (Cleveland, OH) for centralized scoring by trained technicians using standard criteria.27,29
Subjects included in the present analysis included MrOS Sleep Study participants who had PSG with adequate scoring of REM sleep based on availability of reliable staging data. Less than 1% of the subjects had ≤ 10 min of REM sleep; all subjects with any REM sleep were included in the analysis. Sleep stages (REM, stages 1-4 NREM) were scored using standard criteria.27,29 The reliability of indices of sleep architecture, determined by rescoring studies over time, indicates that the inter-scorer reliability (ICC) for the percent of sleep time spent in sleep stages 1, 2, slow wave sleep, and REM were 0.60, 0.91, 0.96, and 0.94, respectively.2,30 AHI was calculated as the total number of apneas and hypopneas per hour of sleep. The inter-scorer reliability for AHI was high (ICC = 0.99).30
Apneas were identified if the amplitude of the airflow signal was flat or nearly flat for > 10 seconds. Obstructive apneas were scored if persistence of effort on abdominal or thoracic inductance plethysmography was noted, and central apneas were scored if there was no evident effort on either the abdominal and thoracic plethysmography bands. Hypopneas were scored using Sleep Heart Health Study criteria (requiring a "discernible" [> 30%] reduction in amplitude of respiratory effort or airflow) and, in secondary analyses, using the American Academy of Sleep Medicine (AASM) criteria (> 50% reduction in amplitude of signals), considered according to the following hierarchy: summed inductance plethysmography channel, abdominal or thoracic inductance plethysmography, nasal pressure, or thermistor.28 For the current study, apneas and hypopneas associated with ≥ 4% oxygen desaturation were included, and the Sleep Heart Health Study definition was used for primary analyses.30 The total AHI, as well as AHI-REM and AHI-NREM were computed as the number of apneas plus hypopneas per hour of total, REM, and NREM sleep, respectively.
OSA was defined as AHI ≥ 15 during the entire sleep period. REM-predominant OSA was defined as AHI < 15, but AHIREM ≥ 5 (Figure 1). From the entire population of MrOS study participants, men were first classified on the basis of OSA: AHI < 15 (absence of moderate to severe OSA group) and AHI ≥ 15 (OSA group). The 2,015 men with AHI < 15 (analytical cohort) were further subdivided based upon the AHI-REM sleep: AHIREM < 5 (referent group) and AHI-REM 5 to < 15, AHI-REM 15 to < 30, and AHI-REM ≥ 30 (Figure 1). Baseline characteristics of men in the analytical cohort were compared across category of AHI-REM sleep (Figure 1, Table 1). The analysis was repeated defining OSA as AHI ≥ 5/h during the entire sleep period and REM-only OSA as AHI < 5/h and AHI-REM ≥ 5/h (supplemental material Figure S1, Table S1).
Baseline subject characteristics based on AHI and AHI-REM sleep of subjects in MrOS Sleep Study
Subjective sleepiness was measured using the Epworth Sleepiness Score (ESS), a self-administered questionnaire which provides a measurement of the subject's general level of daytime sleepiness.12 Individuals rate the chances that they would doze off or fall asleep when in 8 different situations commonly encountered in daily life on a 0- to 3-point scale. Possible scores range from 0 to 24. An ESS score > 10 is considered sleepy and correlates with sleep latency measured during the multiple sleep latency test and during overnight PSG.12
Sleep-related quality of life was measured using the Functional Outcomes of Sleep Questionnaire (FOSQ).31,32 FOSQ is a 30-item disease specific self-reported measure designed to assess the impact of disorders of excessive sleepiness on multiple activities of everyday living.31,32 Mean-weighted item scores are used to generate 5 subscales (activity level, vigilance, intimacy and sexual relationships, general productivity, and social outcome) that together produce a composite score.31 The total score ranges from 5 to 20, and lower scores indicate greater dysfunction. FOSQ can successfully discriminate between normal subjects and those who should seek medical attention for a sleep problem.
Subjective sleep symptoms, disturbance, and patterns were assessed using the Pittsburgh Sleep Quality Index (PSQI).33–35 PSQI is a self-reported questionnaire that assesses sleep quality and disturbances over a 1-month time interval.33 Nineteen individual items generate 7 component scores (subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction), the sum of which yields a global score. The total global score ranges from 0 to 21; greater scores indicate higher levels of sleep symptoms. A global PSQI score > 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% in distinguishing good and poor sleepers.33
General quality of life was measured using Short Form 12 (SF-12), a generic 12-question survey which is weighted and summed to provide interpretable scales for physical and mental health.36 The physical and mental health composite summary scores are computed using the scores of the 12 questions and range from 0 to 100, where a 0 score indicates the lowest level of health measured by the scales and 100 indicates the highest level of health. SF-12 does not target a specific age or disease group and the physical and mental summary scores tend to vary over the life span and for different age groups.
Depressive symptoms were assessed using the Geriatric Depression Scale (GDS).37–39 GDS is a brief questionnaire in which participants are asked to respond to either 15 or 30 questions by answering yes or no in reference to how they felt on the day of administration.37,38 GDS-15 was used in this study, and scores ≥ 6 on this scale indicates depression.37,39
Self-reported health status was scaled as excellent, good, fair, poor, or very poor; the responses were collapsed into 2 categories excellent/good health and fair/poor/very poor health.40
Study participants completed an anthropometric evaluation and questionnaire assessment of medical history including self-reported provider–diagnosed disease which included hypertension, diabetes mellitus, cardiovascular disease (CVD), heart attack, respiratory illness, and stroke. All prescription and over-the-counter medications taken 30 days prior to the last visit were recorded by the clinics and stored in an electronic medications inventory database (San Francisco Coordinating Center, San Francisco, CA). Each medication was matched to its ingredient(s) based on the Iowa Drug Information Service (IDIS) Drug Vocabulary (College of Pharmacy, University of Iowa, Iowa City, IA).41 Clinic visit examination and questionnaire measurements included age (years), body mass index (BMI = kg/m2), race, neck and waist circumference (cm), tobacco smoking, and alcohol use status. Physical activity was assessed using Physical Activity Scale for the Elderly (PASE), a research instrument that measures the level of physical activity in individuals aged 65 years or older.42
Participant characteristics were examined across AHI-REM categories. For categorical data, χ2 test was used. Analysis of variance (ANOVA) was used for normally distributed continuous data and Kruskal-Wallis test for continuous data that were skewed. Similarly, sleep related variables were also explored across AHIREM categories where p-value for trend was calculated.
Least square means linear regression was used to examine the relationship between continuous outcomes, such as sleepiness and quality of life, and AHI-REM categories. Logistic regression was used to assess the relationship between AHI-REM categories and similar dichotomized outcomes. All models were initially adjusted for age and study site. Since OSA has been associated with obesity43 and weight loss has been associated with improvement in BMI, anthropometric measures, and OSA,44 further adjustment was done for either BMI or waist and neck circumference. All analyses were performed using SAS software, version 9.1 (SAS Institute, Cary, NC).
Polysomnography data quality were excellent, with a failure rate < 4% and more than 70% of studies graded as being of excellent or outstanding quality using standardized criteria. Of the 2,765 men with technically adequate PSG data (Figure 1), 2,044 subjects had AHI < 15 (analytical cohort), while 721 subjects had AHI ≥ 15. Three hundred seventy subjects were excluded due to inadequate unreliable REM/NREM data or no PSG data. There were 858 subjects with AHI-REM < 5 who served as the referent group; there were 644 subjects with AHIREM 5 to < 15, 409 subjects with AHI-REM 15 to < 30, 133 subjects with AHI-REM ≥ 30, and 721 subjects with AHI > 15. The average time spent in REM sleep time was 70.3 ± 28.2 min and in NREM 286.3 ± 55.5 min. The prevalence of REM-predominant OSA was 42.8% if OSA was defined as AHI ≥ 15 and 14.4% if OSA was defined as AHI ≥ 5.
Among our cohort of 2,041 older men without moderate or severe OSA (AHI < 15), there were no significant differences by age or race across AHI-REM categories. A higher AHI-REM was associated with higher BMI, neck circumference, and waist circumference (p value < 0.001) (Table 1). Subject-reported histories of respiratory illness and snoring were also associated with a higher AHI-REM (p < 0.05). There were no significant associations between PASE score, benzodiazepine use, smoking status, alcohol use, physician diagnosed and self-reported diabetes, stroke, cardiovascular disease, and heart attack across categories of REM-predominant OSA (Table 1). Results were similar when AHI ≥ 5 was used to define the presence of OSA (supplemental material Table S1).
There was a significant trend in decreasing total sleep time, sleep efficiency, and minutes and percentage of time in REM sleep across AHI-REM categories (Table 2). A higher AHIREM was associated with a higher total and NREM AHI as well as a higher AHI-REM-to-AHI-NREM ratio and arousal index (Table 2). The trend was similar when AHI ≥ 5 was used as definition of OSA (supplemental material Table S2).
Polysomnography characteristics of subjects in MrOS Sleep Study
Adjusted for age, study site, and anthropometric measures, AHI-REM ≥ 30 was associated with worse self-perceived health status than AHI-REM ≤ 5 (Tables 3 and 4). After adjustment for age and site, there was no evidence that level of sleepiness or vitality (as measured by ESS, PSQI, and FOSQ) or quality of life (as assessed by SF-12 physical, mental summary scale, and GDS) varied across categories of REM-predominant OSA (Tables 3 and 4). Adjusting for BMI or neck or waist circumference did not change the results (data not shown). Results were not altered in analyses when OSA was defined as AHI ≥ 5 during the entire sleep period and REM-predominant OSA was defined as AHI < 5 with AHI-REM ≥ 5 (supplemental material Table S3 and S4).
Self-reported perceived health status, quality of life measures and sleepiness in subjects in MrOS Sleep Study
Adjusted* means (A) and odds ratios (B) (95%CI) of functional outcome measures by AHI categories
In a large, community-based sample of adults > 65 years old, we assessed the association between REM-predominant OSA, sleepiness and quality of life in subjects without OSA (using either AHI ≥ 15 or AHI ≥ 5 to define OSA). Our findings show that in this population of older men, an elevated AHI-REM sleep was highly prevalent even when the AHI was either low (< 5) or modest (< 15). Similar to what is known regarding total AHI levels, a higher AHI-REM was associated with a higher BMI, neck circumference, and waist circumference. Of note, even among those without an elevated AHI (overall AHI < 5 or < 15), a higher AHI-REM was associated with reduced total sleep time, sleep efficiency, and REM time and percentage. This suggests that even when the predominant number of respiratory disturbances occur in REM sleep, sleep architecture is disturbed. However, increasing REM-specific AHI levels were not linearly associated with increased sleepiness as determined by the ESS. In this elderly population, only adjusted AHI-REM ≥ 30 was associated with a decrease in self-perceived health status. There were no other associations between REM-predominant OSA and the behavioral measures studied.
Prior literature has provided conflicting reports regarding whether REM-predominant OSA is associated with excessive daytime sleepiness. Excessive daytime sleepiness can affect 10% to 33% of the elderly and has been associated with significant consequences, including an increased incidence of functional impairment, falls, cognitive deficits, and mortality.13,45–47 The presence of OSA has been shown to be an important risk factor for mortality from excessive daytime sleepiness in older adults.13,24 In our study, REM-predominant OSA was not associated with increased daytime sleepiness using the ESS. This is similar to two large studies which showed that OSA in NREM sleep was associated with excessive daytime sleepiness while patients with REM-predominant OSA did not have evidence of excessive daytime sleepiness.17,22
Similar to data from the Sleep Heart Health Study,22 our results show that after adjusting for age, BMI, and study site, in subjects with either AHI < 15 or < 5, REM-predominant OSA did not have a significant association with quality of life measures as measured by FOSQ, PSQI, SF-12 physical and mental summary scale, or GDS-15. Worse self-perceived health, however, was associated with REM-AHI ≥ 30 (Table 3 and 4). Similar to our results, the Sleep Heart Health Study showed that REM-predominant SDB was not independently associated with daytime sleepiness, impaired health-related quality of life, or self-reported sleep disruption.22 Self-perceived health status was not reported in the Sleep Heart Health Study.
We choose AHI ≥ 15 as the primary definition of OSA in our analysis because of the high prevalence of modestly elevated AHI levels in older adults that has no significant clinical consequences.1–3,48,49 Morbidity and mortality in the elderly with lower AHI levels have been shown to be similar to those without OSA.50,51 We further analyzed our data defining OSA as AHI ≥ 5 during the entire sleep period and defining REM-predominant OSA as AHI < 5 with AHI-REM ≥ 5 and the results were similar (supplemental material Tables S3 and S4).
In our cohort, the average time spent in REM sleep time was 70.3 ± 28.2 min and in NREM 286.3 ± 55.5 min. It is possible that some of the effects of REM-predominant OSA were mitigated by a decrease in time spent in REM sleep with increasing AHI-REM (Table 2). This could be due to increased events in REM sleep leading to arousals and decreasing the time in REM sleep. The total AHI in all subgroups of AHI-REM was low, with the highest being 10.8 ± 2.9 in the subgroup with AHIREM > 30. The total AHI in subjects with AHI ≥ 15 was 29.1 ± 12.9. This significant difference may have also been responsible for the lack of any effect of AHI-REM on sleepiness and quality of life measures.
AHI levels increase with age1,48; however, it has not been clear if REM-predominant OSA increases with age. The prevalence of REM-predominant OSA in our population was 42.8%, which is higher than the 14% in men ≥ 70 years old in another published trial with a similar definition of REM-predominant OSA.16 More severe REM-predominant OSA was associated with a higher BMI, neck and waist circumference, and an increased prevalence of snoring. It has been suggested that narrowing of the upper airway in REM sleep due to REM-associated atonia may lead to changes in airway closing pressure in REM sleep.52 It is possible that an increase in BMI or neck and waist circumference lead to an increased AHI-REM before any changes were observed in AHI-NREM which may explain some of our findings. The strength of our study is that we were able to evaluate the association of REM-predominant OSA with daytime sleepiness in a large, community-based sample of older adults, a population group that has not been evaluated before for the effects of REM-predominant OSA.
Our study has several limitations. This is an observational study and with associated limitations on inferences regarding causality. Our study population consists of community dwelling, ambulatory men aged 65 years or older with ability to walk without the assistance, who did not have either bilateral hip replacements or a medical condition that would result in imminent death at the time of enrollment.25 There were no other exclusion criteria. Another limitation is that more than 90% of our subjects were Caucasian. Our data should be taken with caution while generalizing it to other populations and racial groups. We only studied male subjects and although we used validated instruments to measure subjective indices of sleepiness, these instruments may have lower levels of discrimination in older subjects, who may also have other competing causes of sleepiness.53,54
In a cohort of community dwelling males, 67 years or older, REM-predominant OSA was associated with small differences in objectively measured sleep quality: decreased total sleep time, sleep efficiency, minutes and percentage of time in REM sleep. However, increasing AHI-REM levels were not linearly associated with subjective measures of excessive daytime sleepiness or quality of life. Severe REM-predominant OSA was associated with worse self-perceived health status.
This was not an industry supported study. Dr. Khan has received grant support from United Therapeutics. The other authors have indicated no financial conflicts of interest.
The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Institute on Aging (NIA), the National Center for Research Resources (NCRR), and NIH Roadmap for Medical Research under the following grant numbers: U01 AR45580, U01 AR45614, U01 AR45632, U01 AR45647, U01 AR45654, U01 AR45583, U01 AG18197, U01-AG027810, and UL1 RR024140. The National Heart, Lung, and Blood Institute (NHLBI) provided funding for the MrOS Sleep ancillary study "Outcomes of Sleep Disorders in Older Men" under the following grant numbers: R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. NIA R01 AG08415 for Sonia Ancoli-Israel. This publication was made possible with support from the Oregon Clinical and Translational Research Institute (OCTRI), grant number UL1 RR024140 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.
Author Contributions: Akram Khan and Katie Stone were involved in the conception, hypotheses delineation, and design and interpretation of the analysis. Stephanie L Harrison was involved in the analysis and interpretation of data. All authors were involved in the writing the article or substantial involvement in its revision prior to submission.
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Whitney CW, Gottlieb DJ, Redline S, et al., authors. Reliability of scoring respiratory disturbance indices and sleep staging. Sleep. 1998;21:749–57. [PubMed]
Weaver TE, Laizner AM, Evans LK, et al., authors. An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep. 1997;20:835–43. [PubMed]
Gooneratne NS, Weaver TE, Cater JR, et al., authors. Functional outcomes of excessive daytime sleepiness in older adults. J Am Geriatr Soc. 2003;51:642–9. [PubMed]
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Cole JC, Motivala SJ, Buysse DJ, Oxman MN, Levin MJ, Irwin MR, authors. Validation of a 3-factor scoring model for the Pittsburgh sleep quality index in older adults. Sleep. 2006;29:112–6. [PubMed]
Buysse DJ, Reynolds CF 3rd, Monk TH, Hoch CC, Yeager AL, Kupfer DJ, authors. Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index (PSQI). Sleep. 1991;14:331–8. [PubMed]
Ware J Jr.; Kosinski M, Keller SD, authors. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–33. [PubMed]
Sheikh JI, Yesavage J, authors. Geriatric depression scale (GDS): recent evidence and development of a shorter version. 1986. New York: The Haworth Press; [PubMed]
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Kezirian EJ, Harrison SL, Ancoli-Israel S, et al., authors. Behavioral correlates of sleep-disordered breathing in older men. Sleep. 2009;32:253–61. [PubMed Central][PubMed]
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AHI, apnea hypopnea index; AHI-REM, apnea hypopnea index REM sleep; PSG, polysomnography.
Distribution of patients in MrOS Sleep Study with AHI
Subject characteristics based on AHI and AHI-REM sleep in subjects with AHI < 5/h in MrOS Sleep Study
Subject characteristics based on AHI and AHI-REM sleep in subjects with AHI
Polysomnography Characteristics of subjects with AHI < 5/h in MrOS Sleep Study
Polysomnography Characteristics of subjects with AHI
Self-reported perceived health status, quality of life measures and sleepiness in subjects with the REM-only OSA vs. those with no OSA in patients with AHI < 5/h in MrOS Sleep Study
Self-reported perceived health status, quality of life measures and sleepiness in subjects with the REM-only OSA vs. those with no OSA in patients with AHI
Adjusted# means (A) and odds ratios (B) (95%CI) of functional outcome measures by AHI categories


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Applications are pouring in for a new scholarship program benefiting disabled students while a lawsuit seeking to invalidate the bill that created the program sits in a Leon County circuit court.
Applications are pouring in for a new scholarship program benefiting disabled students while a lawsuit seeking to invalidate the bill that created the program sits in a Leon County circuit court.
The Florida Personal Learning Scholarship Account is for students with significant learning disabilities in kindergarten through 12th grade.
Scholarships are worth about $10,000, and families are free to use the money for a variety of education options, including private school tuition, therapists, medical specialists, educational materials or a prepaid college fund.
The restrictions: A student can't receive both the PLSA and the McKay Scholarship for Students with Disabilities, and a student receiving the PLSA can't be enrolled in a publicly funded school.
"Not everybody who's applying for it will want to use it," said Patrick Gibbons, a spokesman for Step Up for Students, which is administering the scholarships.
Gibbons said that some of the families who have already applied for the PLSA are likely weighing their new options against the McKay Scholarships they may already receive, which may only be used to cover the cost of attending a different school.
Step Up for Students has already received nearly 1,200 applications in just under a week, Gibbons said.
The state set aside $18.4 million during the legislative session to fund the program through its first year, which will accommodate about 1,800 students.
The Florida Education Association's issue with the program is not that it increases aid to students with disabilities, but that the authors tacked on a provision to expand the corporate voucher program on the last day of the legislative session, which the FEA called unconstitutional.
The Florida Constitution contains restrictions to lawmaking that state a law may only address one issue, and the law that created the scholarship program, unfortunately, dealt with too many, said Alachua County Education Association President Karen McCann.
The FEA filed its lawsuit against Gov. Rick Scott and Education Commissioner Pam Stewart last week. There was no action on the suit as of Thursday evening.
Another issue McCann took with the program, she said, is that it takes children out of public schools and could put them, and the scholarship money, into private charter schools, a majority of which have a religious bent in Florida.
"The whole purpose appears to be that you can have this if your child isn't going to public school," she said. "It's another way of defunding public education."
PLSA was the idea of Sen. Andy Gardiner, R-Orlando, who has a son with Down syndrome. The program is modeled after an existing program in Arizona.
To be eligible for a PLSA, a student must be diagnosed with autism, cerebral palsy, Down syndrome, an intellectual disability causing severe cognitive impairment, Prader-Willi syndrome, spina bifida or Williams syndrome, or be entering kindergarten with developmental delays that cause the student to be designated "high risk."
In Alachua County, 5,386 public school children have disabilities, although not all would be eligible for the PLSA. In Marion County, there are 6,566 disabled students.
Resources for students with disabilities exist in both counties, like the Sidney Lanier Center in Gainesville that enrolls only disabled students, but 266 public school students in Alachua County and 150 in Marion County have received McKay scholarships to transfer schools.
For Barbara Misener, it was an inclusion issue.
Misener's 11-year-old son has Down syndrome and has attended St. Patrick Interparish School since third grade.
Misener said he'd been in public school before that, but she felt like he was too often separated from other kids.
If he receives a PLSA, Misener said she'll keep her son enrolled at St. Patrick, but she would be able to use any money left over from tuition for speech therapy, which isn't covered under the McKay scholarship the family already receives.
"Having that flexibility to use it for some other things is really huge," she said.

subset: commoncrawl


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About the Office of Advancement
The Office of Advancement represents a team of professionals dedicated to cultivating philanthropic partnerships on behalf of the University of Massachusetts Medical School and UMass Memorial. Garnering the support of private philanthropy is a crucial element of this team, enabling us to educate future physicians, nurses and pioneering researchers, support vital and innovative research, and provide patients access to the most comprehensive, leading-edge care.
Every leading academic health sciences system builds and sustains excellence with the commitment of generous benefactors. Each gift to UMass Medical School and UMass Memorial brings us closer to our goal of improving the health and well-being of all and provides hope for future generations. Together with your partnership, we can shape the future of medicine, transform lives - and make history.
We welcome your questions, comments or suggestions.


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Last night, Rachel Maddow sat down with David Letterman on "The Late Show" to talk Weinergate and political sex scandals.
When asked by Letterman if the scandal surrounding Rep. Anthony Weiner was "something," Maddow responded, "if he resigns, it is something," otherwise the story is "more gossip than news."
While Maddow notes that the scandal "does raise questions of judgment and recklessness" for Weiner, she was quick to point out the hypocrisy in the calls for resignation by fellow politicians.
Referencing other political sex scandals, Maddow pointed out Louisiana Senator David Vitter who has "admitted to using the service of prostitutes":
"Nobody from the Republican Party has ever called for him to resign, but yet they are calling for Anthony Weiner to resign, and that to me says a lot more about the Republican Party, than it does about Anthony Weiner. That sort of hypocrisy."
However, there is still the issue that Anthony Weiner lied before he confessed via press conference.
As a member of the press to whom Weiner directly lied when asked about the tweeted crotch shot, Maddow said, "He lied to my face when I asked him directly about this. So when he apologized for the lying, I felt like, yeah, I'm ready to hear that."
Watch the complete interview below.


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ME: I'll sing two more songs, and then you go night-night. Which song would you like?
HER: The ball song.
ME: The ball song?
HER: Okay.
ME: I don't know the ball song. How does it go?
HER: Ball ball ball ball…
ME: Okay.
So I had to make it up, you see. I call it "The Ball Song."
I had a red ball
It was very tall
I gave it a call
And it said, "Hey, y'all!"
I had a red ball
I had a red ball
I had a red ball
And it said, "Hey, y'all!"
Repeat with every other color (taking requests). The ball can be tall or small and can say, "Hey, y'all!" or "Don't fall!" or "Don't crawl!", etc., etc.


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SALISBURY, Md. – The No. 21 Salisbury University football team rushed for a season-high 559 yards and nine touchdowns and claimed the Empire 8 Athletic Conference's automatic qualification to the NCAA tournament with a 63-23 victory over Utica College at Sea Gull Stadium on Saturday.
Senior quarterback Dan Griffin ran for a game- and career-high five touchdowns with 137 yards and classmate superback Joe Benedetti added two scores and a game-best 153 yards on 19 carries on Senior Day.
The nine rushing TDs are the most for Salisbury (7-2, 5-1 Empire 8) since it matched the number in a 70-45 win at Utica last season. SU totaled 606 yards overall on the day; it was the first time Salisbury had over 600 yards of offense since the win against the Pioneers on Oct. 1, 2011.
Up, 7-3, on a with 3:01 left in the first quarter, Salisbury turned it on.
Griffin hit senior slot Ross Flanigan on a 47-yard pass play to the UC 10-yard line, and two plays later, sophomore slot Isaiah Taylor ran it in for a 6-yard touchdown with 1:42 left in the quarter.
After a three and out from the Pioneers, Griffin took the first snap of the second quarter 56 yards down the sideline for a 21-3 lead. Dakota Peel fumbled the ensuing kickoff to linebacker James White on the Utica 24, setting up a Benedetti 13-yard touchdown that made it 28-3 with 12:56 to play in the second.
Utica quarterback Andrew Benkwitt connected with Jeremy Meier on a 58-yard pass and a 9-yard TD strike later in the drive to Joseph Gerbino to cut into the SU lead to 28-10 with 11:46 left in the half, but the Gulls responded with 10-play 75-yard drive, chewing up five minutes, that ended with a 4-yard Griffin score.
Utica (6-3, 4-2) marched to the Salisbury 16 on its next possession but senior safety Chris Everett intercepted Benkwitt in the end zone with 3:31 left to keep the Pioneers off the board.
Leading, 42-10, early in the third junior slot Lonnie Liggins, a transfer for the United States Military Academy, scored a 9-yard touchdown for his first as a Sea Gull to make it 49-10 with 11:03 left in the quarter.
Griffin added two more touchdowns of 2 and 1 yard, respectively sandwiched by a 22-yard rushing TD by UC's Jesse Baldassare and a 15-yard fumble recovery for a score by James Lenahan for the final margin.
The 30 points scored by Griffin in the game move him into second place all-time on SU's points-scored list with 258, six behind Mike Coppa (1984-87). Griffin also has 2,325 passing yards, good for sixth in school history, and his 2,550 rushing yards are eighth best.
Benedetti and Griffin ran for 8.1 yards per carry while Flanigan also posted 81 yards on seven attempts (10.9-yard average). Taylor and Liggins chipped in with 70 and 54 yards, respectively.
Benkwitt was 26-for-37 for 225 yards, a touchdown and interception to lead Utica. Meier posted nine catches and 112 yards. Baldassare had 68 yards and a TD on 17 carries.
Greg Stanton and Sal Carfaro had seven tackles apiece for Salisbury with Stanton picking off his team-leading fifth pass of the season in the fourth quarter. Senior Paul Moore led a group of five with six stops each; he also had a tackle for loss, a fumble recovery and three breakups.
Luke Manolescu paced five Pioneers with double-digit tackles with 15. Lenahan recovered two fumbles for Utica.
Salisbury travels to Frostburg State University next Saturday for the 14th annual Regents Cup beginning at 1 p.m.


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Bold All Over
A young Florida designer revisists a house once designed by his father
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Andrew Howard is accustomed to nudging nervous clients into making strong design statements, but no coaxing was required for friend and client Jennifer Ward, who couldn't get enough glam. "I would characterize this design style as Mad Men meets Valentino and Jen," laughs Howard, a Jacksonville, Florida, interior designer who helped Jennifer and her husband, Peter Sleiman, update their home in Ponte Vedra Beach.
It's part Hollywood decadence (think Real Housewives of Beverly Hills), part comfort (the couple loves to entertain), and totally pet-friendly (they have one rescue dog and a cat who have free rein in the home). "Jen has a very modern aesthetic, and she's also a warm human being," Howard says. "This design reflects both.
"Before I took over, the house was big and spacious with great light and volume," says Howard, whose father, James Howard, designed the interiors, including the architectural detailing, when the house was built in 1995.
Jennifer and Peter took ownership of the residence several years ago and worked with James Howard to update the interiors. During that period, Jennifer got to know Andrew, and their design personalities clicked. So when she was recently ready to shift from florals and antiques to a modern aesthetic, she turned to Andrew.
Jennifer's bold instincts allowed the younger Howard to play with edgy materials and patterns he'd been longing to use. First up was the faux tortoiseshell wall covering he'd spotted in a New York design showroom. "I'd been dying to use it but had been hesitant to show it to anyone," he says. Jennifer loved it.
"Jen wanted to update the rooms and make the experiences in them feel more memorable," Howard says. The wall covering, printed on heavy artisan lokta paper—Nepalese handmade paper—does just that, giving the dining room an unforgettable, dramatic presence.
To top off the room, the designer painted the tray ceiling a deep blue trimmed with cocoa brown molding, and even Jennifer was surprised by this choice. "When I said blue for the ceiling, both the decorative painter and Jen gasped," Howard relates. "But in my opinion, blue was the most logical choice, as it gave some relief to all the warm colors.
"I lost a lot of sleep over that room," confesses the generally confident Howard. "The wall covering, the blue ceiling, trim color, yellow leopard rug, and ostrich chairs—it was bold. But I found the rooms you lose the most sleep over always come out the best."
Drama also played out in the nearly 30x20-foot living room, where the couple frequently entertains large groups. "This is the first room you see when you enter the home," Howard says. "It's the center of the house and has magnificent ocean views. It really needed to be a showstopper."
For the floor, Howard chose a 25x17-foot navy-and-cream wool rug he designed—an electrifying 21st-century version of a traditional Bargello needlework pattern. "I had to reshape and re-imagine typical Bargello patterns," he explains. "We rendered this in Photoshop about 10 different ways until the spacing of the lines was absolutely perfect." He lost some sleep over this space, too, he admits, but not as much as over the dining room. "It's bold, but the rug's electricity provides that needed juxtaposing element to all of the decoration."
The large-scale pattern of the rug opened up possibilities for fabric choices in a variety of pattern sizes. The chaise is covered in a medium-scale herringbone that stands up to but doesn't compete with the rug. Jennifer insisted that the fabrics had to please the cat, too, so Howard chose a snuggly cotton velvet for the chaise longue.
Seating was also selected with human entertaining in mind; the chaise and armless chairs make it easy for people to perch and share sitting spots. Howard designed a crescent-shaped sofa covered with blue velvet—a luscious color somewhere between cobalt and royal blue—that complements the backdrop of the Atlantic Ocean.
The room's silver-leafed, multi-armed chandelier remained in place by virtue of its size—nearly 5 feet wide and 6 feet tall. Howard had planned to replace it, but finding another fixture with the proper scale proved difficult and unnecessary. "Once the room was done, we loved it just the way it was."
Windows and French doors are draped in velvet panels with an ogee scallop on the leading edge. The velvet curtains, while admittedly not a typical fabric choice, drape beautifully and play nicely against the back of the blue velvet sofa, explains the designer.
The spacious foyer with its 12-foot-plus-high ceiling was updated as well, with a high-gloss white paint with a blue-gray tint on paneled walls and millwork. "Lacquered surfaces are so gorgeous and unexpected," says Howard. "They are the new wallpapers."
An antique Swedish daybed was spruced up with silk upholstery and paired with a chrome-based coffee table topped with petrified wood. These combinations of old and new—with fresh takes on traditional forms—are what make the spaces work, Howard says. A father and son story played out to stunning effect.
Photography by Jessie Preza and Colleen Duffley
Produced by Elizabeth Beeler
Interior designer: Andrew Howard, Andrew Howard Interior Design, 4128 Herschel St., Jacksonville, FL 32210; 904/389-5100, andrewjhoward.com.
Decorative painter: Steve McKnelly, 904/710-8793.
Wall, trim, and ceiling paint ("Stone White" #2120-70): Benjamin Moore & Co., 888/236-6667, benjaminmoore.com.
Floors: existing.
Area rug ("Kasane Rug," custom): Tai Ping Carpets, 404/233-4151, taipingcarpets.com.
Pedestal table; tables with leather doors by mantel: custom.
Mirrors over tables: Mirror Fair, 212/288-5050, mirrorfair.com.
Chaise ("Jupiter Chaise"): Holly Hunt Studio, 800/320-3145, hollyhunt.com.
Chaise fabric ("Marmont"/Fline #Z101/02, by Zinc, discontinued): Romo, 800/338-2783, zinctextile.com.
Side table ("Lincoln Large Sugar Pull-Up Table" #10555-STL): Mitchell Gold + Bob Williams, mgbwhome.com.
Art over mantel (Untitled #16, Dominican Moves Series, Pigment Print, 2006, by Mikhail Baryshnikov): J. Johnson Gallery, 904/435-3200, jjohnsongallery.com.
Roman shade fabric ("Ibana" #1010250991); Zimmer+ Rohde, 212/758-7925, zimmer-rohde.com.
Chandelier; sconces (by Lalique); piano: owner's collection.
Living Room Details
The living room is all about glamour, with luxurious fabrics and textures.
See more of this room on the following slides.
Embossed Cabinets
Cabinets flanking the fireplace are walnut with embossed leather fronts, and pull double-duty as bars during cocktail parties.
Table Vignette
Design books, stone obelisks, and other curiosities adorn the custom pedestal table.
Living Room
Andrew designed the living room's crescent-shaped sofa to tuck into the corner. It is covered in a deep cobalt-royal blue hue to complement the Atlantic Ocean outside.
Sofa: custom.
Sofa and drapery fabric ("Adamo & Eva"/Bleu de Prusse #1040/03): Dedar, 800/493-2209, dedar.com.
Sofa pillow fabric ("Bellisario"/Tungsten #Z225/01, by Zinc); sofa pillow fabric ("Skyline"/Tungsten #Z109/02, by Zinc): Romo, 800/338-2783, zinctextile.com.
Slipper chair ("Simpson Slipper Chair" #6720C, Barbara Barry Collection); cocktail table ("Oberon Cocktail Table" #3651, Barbara Barry Collection): Baker, 800/592-2537, bakerfurniture.com.
Slipper-chair fabric ("Labyrinth"/Storm #Z220/02, by Zinc): Romo, 800/338-2783, zinctextile.com.
Throw: owner's collection.
Black-and-white collage: Richard Giglio, 212/724-8118, richardgiglio.com.
Accent table/stool ("Mieke Teak Tooth Stool"): Made Goods, 626/333-1177, madegoods.com.
Floor lamp; end tables; small black sculptures: Mrs. Howard, 904/387-1202.
An antique Swedish daybed covered in a Zimmer + Rhode silk is paired with modern tables from the Mrs. Howard shop near Jacksonville.
Details on the following slides.
Wall, ceiling, and trim paint ("Stone White" #2120-70): Benjamin Moore & Co., 888/236-6667, benjaminmoore.com.
Floors: existing.
Swedish daybed; mirror behind daybed: owner's collection.
Daybed fabric ("Alluvia" #47804/104, by Zimmer + Rohde): Zimmer + Rohde, 212/758-7925, zimmer-rohde.com.
Daybed pillow ("Aramasa"/Shadow #Z186/04 by Zinc): Romo, 800/338-2783, zinctextile.com.
Lounge chair: owner's collection.
Lounge-chair fabric ("Saxby"/Flint #Z151/03, by Zinc); lounge-chair pillow ("Bellisario"/Tungsten #Z225/01, by Zinc): Romo, 800/338/2783, zinctextile.com.
End tables; cocktail table: Mrs. Howard, 904/387-1202.
Area rug ("Shuka Rug," custom colors): Tai Ping Carpets, 404/233-4151, taipingcarpets.com.
Ionic Columns
A cabinet was designed by Andrew to anchor the large wall. Four Ionic columns separate the living room from the spacious foyer, which features a Greek key-motif area rug from Tai Ping Carpet.
Armchairs ("Louis Ghost Chair" #17185): Design Within Reach, 800/944-2233, dwr.com.
Chandelier ("Lymington Chandelier," two-tier #CL88/2/N): Vaughan Designs, 212/319-7070, vaughandesigns.com.
Cabinet: custom.
Foyer Details
Wall, trim, and ceiling paint from Benjamin Moore is high-gloss for a contemporary look. "Lacquered surfaces are so gorgeous and unexpected," says Andrew. "They are the new wallpapers."
Andrew Howard grew up surrounded by design. Family vacations often were spent touring antiques shops and sites such as Biltmore with his father and stepmother, James and Phoebe Howard, Jacksonville, Florida, interior designers. Today, the Howards share offices in Jacksonville and have shops there and in Atlanta and Charlotte, North Carolina.
Dining Room
Designer Andrew Howard tamed the dining room's stronger features–like the chandelier made from slices of agate crystal from Ironies–with a dusk-blue ceiling.
Details on the following slide.
Wall covering ("Tortoise Shell"/Amber, handmade lokta paper by Cannon/Bullock): Cannon/Bullock, 360/221-2742, cannonbullock.com.
Ceiling paint: custom.
Floors: existing.
Area rug ("Leopard"/Kasanga #68046, color 44): Bellbridge Carpets, 800/227-3408, bellbridge.com.
Dining table: owner's collection.
Dining chairs ("Ritz Dining Chair" #7841, Thomas Pheasant Collection): Baker Furniture, 800/592-2537, bakerfurniture.com.
Chair fabric ("Ostriche"/Caramel #CA00765083, by Old World Weavers): Stark Carpet, 212/752-9000, starkcarpet.com.
Chandelier ("Jaeger Chandelier," 6-tier #526-04): Ironies, 510/644-2100, ironies.com.
Drapery ("Kaleidoscope"/Pineapple #180 838): Jim Thompson Fabrics, 800/262-0336, jimthompson.com.
Credenza ("Domicile Credenza"/Dark Oak #65015): Bolier & Co., 336/887-2815, bolierco.com.
Mirror: Mrs. Howard, 904/387-1202, mrshowardpersonalshopper.com.
Andrew had been waiting for the chance to use the tortoiseshell wall covering from Cannon/Bullock. Its rich colors and sheen needed strong pieces to coexist with it.
Onyx backsplashes and the hood facing are backlit for drama. Antique mirror and a high-gloss paint on the cabinets add a healthy dose of texture and shine.
All items: existing.
Countertops: onyx.
Oven-hood finish: antique mirror.
Stools: owner's collection.
The Ward-Sleiman house sits between the Florida Intracoastal Waterway and the Atlantic Ocean.
Homeowners Jennifer Ward and Peter Sleiman.
Master Bedroom
A faux bois (wood-look) wall covering from Nobilis gives the bedroom a restful and somewhat masculine feel, says Howard. The Roman shade fabric is "Tassara" from Pindler & Pindler. Howard added two tufted stools at the foot of the bed.
Details on the following slide.
Papier Bois wall covering ("Chene" #PBS32, Cote a Cote Collection): Nobilis, 800/464-6670, nobilis.fr.
Ceiling and trim paint: existing.
Bed; bedding; table lamp: owner's collection.
Bedside chests ("Niagara 3-Drawer Side Table"): Bungalow 5, 201/405-1800, bungalow5.com.
Roman shades ("Tassara"/Mushroom #P9034, discontinued): Pindler & Pindler, 805/531-9090, pindler.com.
Stools at end of bed: ("Marc Stool" #2318-30, by Thomas O'Brien); stool fabric: Hickory Chair, 800/349-4579, hickorychair.com.
Master Bedroom Details
"I found the rooms you lose the most sleep over always come out the best," says designer Andrew Howard.
Inspired by a David Hicks fabric design, Howard had the wood floor painted with a large-scale hexagonal pattern in shades of cream and gray. The mirror is from Oly Studio, and the box sconces are from are from Visual Comfort.
Floor (custom): by decorative painter: Steve McKnelly, 904/710-8793.
Sconces ("Mercer Box Light Sconce"/Polished Nickel #TOB2003PN, by Thomas O'Brien): Circa Lighting, 877/762-2323, circalighting.com.
Vanity; hanging lantern; faucet: existing.
Mirror ("Andre Mirror"/Small): Oly Studio, 775/336-2100. olystudio.com.
Wall paint: existing.


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WASHINGTON � The House last week overwhelmingly approved lifting Cold War-era trade restrictions with Russia now that it has joined the World Trade Organization.
WASHINGTON � The House last week overwhelmingly approved lifting Cold War-era trade restrictions with Russia now that it has joined the World Trade Organization.
Russia, which has 142 million consumers, joined the WTO in August and must now play by the same trade rules as other WTO members, including the United States.
The U.S. cannot take advantage of lowered tariffs and other trade-easing provisions that come with WTO membership until it grants Russia permanent normal trade relations.
Proponents claimed that exports to Russia would more than double over the next five years with the change in status. U.S. businesses exported $11 billion to Russia last year.
The bill, which was approved 365-43, gained unusually high support for a trade bill because it included strong human rights provisions. The bill would freeze assets and ban visas for Russian officials who engage in corruption and gross violations of human rights.
Rep. James McGovern, D-Mass., said he would have opposed the trade bill but for those provisions.
The measures, he said, send a �clear message to the Russian people that we support their fundamental human rights.�
The Senate is expected to take up the bill before the end of the year.
Reps. Rick Crawford, R-Jonesboro, Tim Griffin, R-Little Rock, Mike Ross, D-Prescott, and Steve Womack, R-Rogers, Tom Cole, R-Moore, James Lankford, R-Edmond, and Frank Lucas, R-Cheyenne, voted for the bill. Reps. Dan Boren, D-Muskogee, and John Sullivan, R-Tulsa, did not vote.
Senate Again Scuttles Cybersecurity Bill
Cybersecurity legislation that was supported by the White House was blocked in the Senate last week on a procedural vote.
Republicans largely stood in the way of fast tracking the bill, saying they wanted more opportunities for amendments. The bill had been blocked on a similar procedural motion in August.
Sen. Joe Lieberman, the Connecticut independent who sponsored the bill, said the Senate had been given a second chance to raise defenses against those who would steal industrial secrets or, worse yet, sabotage critical infrastructure.
�That is what this bill is about, creating standards for public-private cooperation to raise our defenses against cyber attack or cyber theft,� he said.
Sen. Charles Grassley, R-Iowa, said there is no debate over the need to enhance cybersecurity. But, he said, there are major problems with the bill, such as having the Department of Homeland Security in charge.
�I am baffled why the Senate would take an agency that has proven problems with overseeing critical infrastructure and give them chief responsibility for our country�s cybersecurity,� Grassley said.
In the absence of legislation, President Obama is expected to issue an executive order that would set cybersecurity standards for power plants, banks, telecommunications and other critical infrastructure.
The Senate voted 51-47 to proceed with the bill, falling nine votes shy of the 60-vote majority required. Sens. Mark Pryor, D-Ark., John Boozman, R-Ark., Tom Coburn, R-Okla., and James Inhofe, R-Okla., voted against it.


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Stirring Things Up for Immigrants
The attitude of the German mass media to foreigners living in Germany is much the same as their attitude to reporting on foreign countries – it is only done in exceptional circumstances, should be as spectacular as possible, and ideally have a touch of catastrophe thrown in for good measure.
There is a tendency to associate immigrants with chaos and crime: Mafia murders, gang robberies and asylum fraud. If it's true that "only bad news are good news," then, as far as the German press is concerned, one might say that only bad foreigners are good foreigners!
Journalists tend to judge immigrants according to two criteria: their use to Germany, or, more precisely, to the German economy, and their ethnic origin. Migration may be portrayed as a threat or as an advantage to the native population, but it is only seldom presented as the normality of a globalised world.
Whilst capital crosses borders in fractions of a second, immigrants, particularly those from poorer countries, remain undesirable – unless of course they are highly qualified or young families who are welcome to fill the role of demographic stopgaps.
Islamophobia as a consequence of 9/11
The attacks on the World Trade Centre and the Pentagon constituted a turning point for media coverage of the topic of immigration. Since then, in West Germany at least, the Arab or Turkish Muslim has replaced the southern European immigrant worker and the black asylum seeker as the country's favourite foreigner stereotype.
Since then a triple modification of the way in which migration is reported on has become discernible. Firstly, the migration and criminality discourses have now become even more closely interlinked than they were during the asylum debate of 1991/92.
Secondly, the discourse on criminality has become politically and ideologically charged, has intensified into a terrorism discourse and, through the mass dissemination of the "clash of cultures" metaphor, become a global discourse on war.
Thirdly, both the migration and the criminality discourses have been Islamicised. Plans for Turkish membership of the EU have played a crucial role in terms of foreign policy, as have Muslim headscarves, "honour" killings and forced marriages on the domestic policy front.
Now, the image of Islam in the German media is not simply becoming darker, the media is even joyfully subscribing to the unhappy revival of interpretations of world politics as a "clash of civilizations" (Samuel P. Huntington) or a "war of civilizations" (Bassam Tibi).
DIE ZEIT magazine, in a bout of uncharacteristic sensationalism, published an editorial on September 13, 2001. Its title, in red print, the headline announced that war had been declared on USA read: "The Target: Our Civilization. Total and Global Terror".
Symbols of the culture clash
In the wake of the 9/11 attacks, Osama bin Laden and Al Qaida became bywords for terror, symbols of a "clash of cultures" between Islam and the West. For much of the media, terrorism, fundamentalism and Islamism became omnipresent dangers to be robustly opposed in pugnacious solidarity with US President George W. Bush.
Prevailing liberal attitudes in migration policy fell casualty to the new bogeyman of the "sleeper" after 9/11. From now on, immigrants were to become even more strongly associated with criminality, irrationality, backwardness, religious fundamentalism and ideological fanaticism.
For a long time after the attacks, the German mass media was dominated by images of the burning twin towers, by military metaphors and martial language.
The Turks as domestic and foreign policy problem
One year after the terror attacks in New York, DIE ZEIT published an article by Hans-Ulrich Wehler on what he called "Das Türkenproblem" (The problem of the Turks). In the article, he claimed, "the West needs Turkey as a front-line state, a buffer against Iraq. But the Muslim country should never be allowed entry to the EU." The anti-Islamic thrust of the piece was already clear from the title.
Wehler identifies a clear "cultural frontier" between Europe and Turkey, and uses this to justify his claim that: "Muslim minorities all over Europe are proving resistant to assimilation, and are withdrawing into their own subculture. "Germany, too," he says, "as is well known, does not have a problem with foreigners, it has a problem with Turks."
When the bombers came to Europe, blowing up trains in Madrid on March 11, 2004, migration policy became an even hotter political potato. Following the murder of Dutch filmmaker Theo van Gogh on November 2, 2004, a new media term, "parallel society" entered the fray as a counterpoint to the notion of the "multicultural society".
Modernised bogeyman
The debate culminated in the article, "Die Schlacht um Europa" (The Battle for Europe) by Gilles Kepel in the Welt am Sonntag newspaper of November 21, 2004, and in the title page headline of Focus magazine on the following day: "Sinister Guests. Muslim Counterculture in Germany". The old Cold War bogeyman was being resurrected and modernised.
Media open season on Muslims had been declared. Dramatist Botho Strauss did his bit to nourish fears of an Islamisation of the West through his historical reminiscences on crusades, Turkish wars and the Reconquista (medieval expulsion of the Moors from the Iberian Peninsula) when, in Der Spiegel of February 13, 2006, he posed the question whether "looked at from today's point of view, the successful defences of Christian Europe against the onslaught of the Arab hordes had not all been in vain. With the Muslim populations of Amsterdam and other major cities moving towards a majority position, they will soon no longer be in need of our tolerance," he claimed.
Whilst it is certainly possible that immigrants could represent a majority of the population at some point in the distant future, they will certainly not all be of the same religion, nor is it very likely that they will all feel compelled to convert to Islam.
The mass coverage of topics such as "forced marriages" or "honour killings" was also replete with racist undertones. Muslim immigrants, Turks especially, were being stigmatised by a media that was reinforcing the impression of entrenched groups, walled off in their "parallel societies", oppressing their women, and generally not fitting in with "us", being more suited to the places they had originally come from.
Mosques, minarets and muezzins
In March 2007, a Frankfurt divorce court judge denied a battered wife the right to a quick divorce on the grounds that she should have been aware of her violent Moroccan husband's religiously given right to beat her. And though the media duly expressed their outrage, it was not the judge's inadequate and unhistorical interpretation of the Koran that raised their ire, but rather the fact that the judge had taken a foreign interpretation of law into consideration.
Christoph Butterwegge
© Christoph Butterwegge 2007
Translated from the German by Ron Walker
Professor Christoph Butterwegge teaches political science at the University of Cologne.
The "Clash of Civilizations" in the Media
Suspension of Reason
After a Frankfurt judge supported her ruling with a reference to Islamic law, the German media prophesied the infiltration of the legal system by the Sharia. In his biting commentary Robert Misik takes a look at the German media landscape and warns against overall hysteria
Islam in the Media
How Media Researchers Draw Hasty Conclusions
Many studies dealing with the representation of Islam in Western media come to the conclusion that there is a tendency to portray Islam in a negative way. Klemens Ludwig doubts whether they all adhere to scientific criteria
The Headscarf and the Media
A Symbol Which Has Been Instrumentalised
The Islamic headscarf is seen by the media as a symbol of the oppression of Muslim women. Sabine Schiffer argues that this perception is often linked to stereotypes, and that the media often try to read too much into the headscarf
Media Influence
The Framed World
In this age of global media, foreign countries and events are only viewed through a small frame that obscures everything else. Charlotte Wiedemann files this report about working as a foreign correspondent and the way we perceive the rest of the world


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Toy builder Jon English has come up with these incredible custom He-Man figures, some of the heavily modified interpretations on actual old toys, others entirely new characters.
My favourite is probably He-Bro up there, but Sintaur is equally awesome, both for the figure and the name.
MOTUC Customs [Jon English, via Super Punch]


text:
- Features
- News
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- Life
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- Scene
- Social
While Wisconsin's capital city, Madison, is often dismissed by conservatives, including the state's Republican governor, as a liberal bastion out-of-step with the rest of the state, the college town has provided the perfect atmosphere for out gay state Rep. Mark Pocan.
A 14-year member of the Wisconsin State Assembly, first elected in 1998 to fill the seat of former assemblywoman and current U.S. Rep. Tammy Baldwin (D), the first out gay non-incumbent elected to Congress, Pocan is now seeking Baldwin's seat in the U.S. House of Representatives, while she runs for U.S. Senate.
Mark Pocan
Photo by Todd Franson
In Wisconsin's heavily Democratic 2nd Congressional District, Pocan faces three other Democrats, including a fellow assemblymember, in an Aug. 14 primary that, barring an upset, will likely determine the outcome of the general election.
When asked what strengths he brings to the table relative to his competitors, Pocan first cites his 14 years in the Assembly and his leadership roles serving as the head of the Assembly Democratic Campaign Committee, which helped Democrats successfully gain control of the chamber in 2008 after 14 years in the minority, and as co-chair of the Joint Finance Committee for six years. He also has business experience, having owned and operated a printing company specializing in large-format graphics for 24 years.
On the policy front, Pocan's list of legislative accomplishment reads like a checklist of the major issues touted by left-leaning progressives, ranging from the extension of 41 rights of marriage to same-sex domestic partners, to partner benefits for state and university employees, to education, access to contraceptives and access to health care.
Appropriately, Pocan says the Congressional Progressive Caucus is a "natural place" for him to fit in if he is elected to Congress. He has been endorsed by one of the caucus's co-founders, U.S. Rep. George Miller (D-Calif.), in the race to succeed Baldwin.
And Pocan doesn't shy away from controversial issues, embracing the recently upheld federal health care law as an important first step in improving access to health care.


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Recently, I came across nice application called Floola. From the project home page:
Floola is a freeware application to efficiently manage your iPod or your Motorola mobile phone (any model supporting iTunes). It's a standalone application that can be run directly from your iPod and needs no installation under Linux, Mac OS X and Windows (Windows Vista is supported).
Floola supports all common used iPod features including artwork, podcasts and smart playlists! It's also able to convert audio or video incompatible with the iPod so that you can copy almost any file to it. It even allows adding youtube and myspace videos just entering the page url!
In other words it is cross-platform application that makes it easy to copy music and videos to and from your iPod from and to any computer.
Download Floola
=> Floola project home page [ 4.9Mb Linux version ]


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Doug Kass has long been bearish on the market—and that has long been the exact wrong call. But now, Kass says the market's moment of truth is finally upon us.
"I've certainly been wrong," Kass admitted. "But being wrong doesn't keep me from warning investors."
And warn investors he did, for Kass sees this as a particularly treacherous time. "I think when the searchlights of the investor are the dimmest, when the economic and market threats are the greatest, and when market participants are the most comfortable in their inattentiveness and ignorance, the risks are surging—and that's precisely where we are now."
So what exactly is making Kass so concerned about the market right now? The president of Seabreeze Partners Management laid out his reasons on Tuesday's "Futures Now."
1. Stagnating GDP will weigh on revenue
Kass noted that "projections for second-quarter GDP—real GDP—are now under 1 percent." Indeed, Barclays cut its Q2 GDP growth forecast to 0.5 percent on Monday, and Goldman Sachs reduced its estimate from 1.3 percent to 1 percent.
Kass believes this stagnant rate of growth will be a major constraint on corporate revenue. "You've got to see a sharp acceleration in the second half for companies to have any top-line growth whatsoever," Kass said.
2. UPS lowers expectations
On Friday, UPS gave Kass one reason why this "sharp acceleration" is unlikely to come to pass. "I can't see it," Kass said, "with UPS cautioning about domestic economic growth."
UPS shares dropped by 6 percent on Friday after the company reduced earnings guidance. And one of the reasons the global shipping company gave for cutting guidance was "a slowing U.S. industrial economy." This is in line with Kass' thinking about what the rest of the year will bring.
(Read more: Cramer: Has UPS called recovery into question?)
3. Coca-Cola's weak shipments
On Tuesday, Coca-Cola gave Kass another reason to be bearish. In an earnings report that CEO Muhtar Kent said he is "not happy" with, Coca-Cola reported that soda volume in North America fell 4 percent.
That said, Kent pointed to factors that were more meteorological than economic: "We experience an extremely wet and cold second quarter," he said on Tuesday's earnings call, and "this weather clearly impacted our industry's volume growth."
(Read more: Coca-Cola's earnings meet, but CEO's 'not happy')


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Hundreds of students and other activists yesterday marched through the streets of Banciao (板橋) in New Taipei City calling for the recall of the Chinese Nationalist Party's (KMT) "four major bandits."
The "four bandits" refer to four KMT lawmakers who the protesters believe have been following President Ma Ying-jeou's (馬英九) orders without hesitation — including KMT Central Policy Committee chief executive Lin Hung-chih (林鴻池), whose constituency is in Banciao.
Student leaders Lin Fei-fan (林飛帆) and Chen Wei-ting (陳為廷) announced yesterday morning that one of them would lead a group of people to Banciao to call on the electorate to exert pressure on Lin and ask him to listen to the people instead of Ma, who doubles as KMT chairman.
About 20 student representatives, including members of student group Democracy Kuroshio, nongovernmental organization workers and academics, gathered in Banciao at 2:30pm and were subsequently joined by hundreds of people.
Neither Lin Fei-fan nor Chen showed up, with the former saying from the legislative floor — which protesters have been occupying since March 18 — that they decided against going to avoid drawing media attention to them, which could have obscured the aim of the movement.
Chanting "Reject Ma's will and respect the people's will," "Lin Hung-chih come out and face us" and "Recall Lin Hung-chih," more than 500 people gathered in a park and marched through several streets before returning to the park to deliver short speeches.
At about 5pm, police, holding up a board that read: "[Your] behavior has violated the law," told the crowd that the gathering was in violation of the Assembly and Parade Act (集會遊行法).
Students retorted that they were just "passing by" — a reference to how Taipei police had described former gang leader Chang An-le's (張安樂) demonstration on Tuesday.
Commenting on the protest, Lin Hung-chih said he had done nothing wrong in reviewing the cross-strait service trade agreement.
He added that he was willing to apologize for the "social instability" caused by the "30-second incident and the students' subsequent occupation" of the legislature.
He was referring to a move by KMT Legislator Chang Ching-chung (張慶忠) to pass the service trade agreement through a legislative committee meeting in 30 seconds.
Chang, the second of the so-called "four bandits," called on everybody to calm down and to quickly put an end to the protests.
KMT Legislator Wu Yu-sheng (吳育昇), the third recall target, criticized the students, saying they represent no one and have no right to ask elected lawmakers to step down.
He compared the students' action to police being censured by robbers and said they are behaving like "red guards."
KMT Legislator Lin Te-fu (林德福), the last of the four, said the students had "gone overboard."
In other developments, the student protesters yesterday proposed a "civil parliament," saying they would implement what they described as "direct democracy" to review draft legislation to establish a mechanism to monitor cross-strait agreements in the legislature.
The meetings are to start today, with more than 1,500 people from 60 groups expected to attend, Lin Fei-fan said.
Lawmakers across party lines are welcome to join, he said, as he encouraged more KMT lawmakers to "stand with the people and respond to the students' demands."


text: Twilight Saga producers Mary Bowen and Wyck Godfrey continue to dream up new ways in which they can look at Taylor Lautner while also justifying their belief that he deserves to be a star, first dreaming up a retelling of David and Goliath with Lautner in the David role, and now signing Lautner to the only slightly less ancient tale of a young hotshot taking on an organized crime gang. Adding to the rich sense of history, the plot—entitled Tracers, in reference to how it was drawn—also revolves around the extreme sport of parkour that 2004 can't stop talking about: Lautner will play a "whiz" of a bike messenger in debt to some of New York's many organized criminals whose life changes after he crashes into a "sexy stranger," who introduces him to the exciting world of parkour that he's missed out on because he hasn't used the Internet in the past decade. Anyway, while the film seems like the usual mishmash of standard-issue action thriller contrivances—or a downgraded version of Joseph Gordon-Levitt's own upcoming bike messenger movie—awkwardly grafted onto a sports fad, the melding of Taylor Lautner with parkour is, of course, inspired, considering both are things involving solid surfaces that enjoyed peak popularity years ago.