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Visa information for for Libya nationals travelling to Congo, Democratic Republic Of on business
The following documents are required for a business visa for Libya nationals travelling to Congo, Democratic Republic Of.
All applications must be accompanied by an RLP Order Form.
Visa requirements
- Valid passport
- Yellow fever certificate
- UK business letter
- Official invitation
- Proof of accommodation
- Proof of flights
- Recent utility bill
- 2 passport photos
- UK visa permit
- 3 months bank statements
- Application form (download)
Additional information
- Takes 15 working days to process the visa.
- The Invitation must be in French and be certified by either the Ministry of Foreign Affairs in Kinshasa or an immigration office (DGM) along with the company stamp.
Embassy details
45-49 Great Portland Street
Phone: +44 (0) 20 7580 3931
View website →


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Comment wrote on the June 19, 2015
I bought a pair of your boots under the Havanna Joe name in 1999 Im thrilled to say, they are still going! Although they are aging gracefully, (just the occasional condition and polish) I cannot believe how these have held up! I paid almost $300 doll... +info

subset: commoncrawl


text: "Infectious disease condemns poor countries to an endless cycle of ill health and poverty. Now a powerful new model of the link between disease and economic growth has revealed why some escape plans work while others just make matters worse. The problem is that when workers suffer from poor health, economic output goes down. And if economic output goes down, there is less to spend on healthcare. And if spending on healthcare drops, workers become less healthy. And so on. So an obvious solution is for a country to spend more on healthcare. But the new model says governments must take care since the cost to a poor country can send the economy spiraling into long term decline. By contrast, an injection of capital from outside the country allows spending on healthcare to increase without any drop in economic output. 'We find that a large influx of capital is successful in escaping the poverty trap, but increasing health spending alone is not,' say the authors. And the amount required is relatively little. The model suggests that long-term investment needs only to be more than 15 per cent of the cost of healthcare. But anything less than this cannot prevent the vicious circle of decline."


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Nike is one of the world's leading and best-known sportswear brands. Nike Golf became a cornerstone to the industry since linking up with golfers of the calibre of Tiger Woods and Rory McIlroy.
With modern designs, updated silhouettes, and the iconic swoosh logo, the 2017 range offers everything in terms of performance, style, and comfort.
Nike's Dri-FIT technology, a high-performance fabric that moves perspiration away from the body, is used in a variety of their products.
Shop the TW Collection here


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A Massachusetts company has received approval to build a solar array on a field in the Vermont town of Charlotte.
The Vermont Public Service Board recently approved the request by Charlotte Solar.
The Burlington Free Press reports the project, which was fought by neighbors, will occupy about 12.6 acres with 26 rows of solar panels. The panels will be about 10 feet high.
Bill Ellis, an attorney representing the neighbors, indicated then that it seemed the project was "predestined to be approved from the get-go."
Public Service Board Hearing Officer Jake Marren found that the project was consistent with the town plan.


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Michel Belanger
July 12, 2013, KAZAN, Russia (Team Canada) (ISN) – In its first quarter-final appearance at the Summer Universiade since 2001, the Canadian women's volleyball team dropped a straight-set decision (25-17, 25-16, 26-24) against Thailand, Friday afternoon.
Canada now hopes to finish the biennial tournament in fifth place. The red and white gets back on the court Saturday at 3 p.m. local time (7 p.m. ET) against either host Russia or Taiwan. Regardless of the outcome the rest of the way, it will be the country's best result in women's volleyball at the FISU Games since an eighth-place finish in 2001 in Beijing.
Team Canada website: http://english.cis-sic.ca/universiade/summer/2013
Team Canada Twitter: @CDNUniversiade | #gocanada
Summer Universiade website: www.kazan2013.com/en
"Despite the loss, we're still motivated and we want to go as far as possible in the tournament. Reaching the quarters was already a good step for the team. Now, we want to finish as high as we can," said Canadian head coach Arnd Ludwig. "We blocked well today against a team that utilizes many different combinations. We committed a few errors in the first set and couldn't quite get back into the match before the third."
Thailand jumped out to a quick 8-5 lead in the opening set but Canada responded with four straight points to get in front, thanks in part to a huge block and a kill by Lucy Charuk of Tsawwassen, B.C. (University of Houston). The Canadians held on to the advantage until 16-15 but saw their rivals go on an 8-0 run after the break to take the first stanza.
The middle frame was all Thailand as the powerful Asian squad built a comfortable 13-4 lead and never looked back. Canada did pull to within five but never got closer, en route to a 25-16 loss.
Canada's best moments came in the third set. Kyla Richey of Roberts Creek, B.C. (UBC) was a force with five kills as her side built was seemed to be a commanding advantage at 18-12. However, their opponents, who have yet to drop a set in the tourney, never panicked and mounted a spectacular comeback to tie the affair at 22.
Led by outside hitter Ounma Sittirak, who had five kills in the second half of the decisive frame, the winners closed the deal on their second match point, at 26-24.
In the loss, Shanice Marcelle of Victoria (UBC) racked up seven kills, two blocks and 11 digs. Charuk finished with four blocks and two kills, while middle Alicia Perrin of Creston, B.C. (Trinity Western) had five kills and three blocks.
BOXSCORE: Canada vs Thailand


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|Head Coach
|Previous College:
|Maryland, '95
|Sixth Season
*Thank you for your interest in the UMBC Women's Soccer Program. In order for us to keep up with your schedule of events, please fill out the following questionnaire!*
Leslie Wray just completed her fifth season at the helm of the UMBC women's soccer program. Wray led the Retrievers to three America East Tournament appearances in back-to-back-to-back seasons from 2013-2015.
Wray was named the eighth head coach in the program's history in January of 2012 and helped the Retrievers' program celebrate its 25th season in her first year at the controls, completing the campaign with a program record five ties and leading UMBC to its first win in over a season.
In just her second season with the program, Wray guided the Retrievers to a Cinderella run. With a combined 14 wins in its prior six seasons, UMBC registered the third-biggest turnaround in Division I women's soccer in 2013 and the largest turnaround in America East history. Two years removed from a winless 2011 season, Wray helped the Retrievers to post a program-record 13 wins, a share of its first-ever regular-season title, a league crown and an NCAA Tournament appearance. UMBC put up a fight, battling College Cup semifinalist Virginia Tech in the opening round of the NCAA Tournament and finished the season ranked in the top-10 of the National Soccer Coaches Association of America (NSCAA) Northeast Region Poll.
The Retrievers became the first team to complete the worst-to-first turnaround during America East action, moving from a 0-5-3 conference record in 2012 to a 6-2-0 mark in 2013. Wray and her staff were honored by being named the America East Coaching Staff of the Year, the second staff in program history to receive the honor. Red-shirt junior Jessy Brown became the first UMBC women's soccer player to take home a major award from the America East, by being recognized as Co-Midfielder of the Year. The Retrievers would also have four players named to the All-Tournament Team, with Brown receiving the tournament's Most Outstanding Player award. Brown would also garner Eastern College Athletic Association (ECAC) All-Star Second Team honors and NSCAA All-Region Third Team recognition.
In addition to five players receiving All-Conference recognition, Brown and sophomore back Nikki Boretti proved that Wray's Retrievers can get things done in the classroom as well as the field. The duo became the third and fourth members of the program to earn spots on the league's All-Academic Team. Brown was also named to the NSCAA University Division Women's Scholar All-East Region Second Team.
The squad also did its part in the community, participating in Headers for Hope, which raised nearly 18 thousand dollars for the Ulman Cancer Fund for Young Adults, as well as selling shirts for the team's annual Fight in Pink game, with proceeds going to the Susan G. Komen fund.
In 2014, the Retrievers used their confidence from the 2013 campaign to post yet another successful campaign under Wray. UMBC recorded its lowest number of losses in program history en route to a second-place finish in the America East standings. The Retrievers earned eight conference honors at the end of the regular-season, with Brown highlighting the honors by becoming the first women's soccer player in league history to be named Midfielder of the Year in back-to-back seasons. Junior back Amira Walcott and junior goalkeeper Jen Nance earned America East All-Conference First Team and Second Team honors, respectively, after helping the Retrievers record the lowest number of goals allowed in program history, including a single-season program record of nine shutouts for Nance.
Wray saw the team and players earn recognition on a national level for their efforts both on the field and in the classroom in 2014. On the field, the Retrievers were ranked as high as No. 6 in the Northeast Region by the NSCAA. Off the field, the team was honored with the NSCAA Team Academic Award for a combined 3.0 GPA or higher. Individually, UMBC saw Brown be recognized as a nominee for the Senior CLASS Award, as a semifinalist for the coveted Wooden Citizenship Cup, as a NSCAA Scholar All-East Region Second Team honoree and as an NSCAA All-Northeast Region Second Team member. Boretti continued to be recognized for her work in the classroom, becoming the first player in program history to receive the nation's top academic distinction, earning a spot on the 2014 Capital One Academic All-America First Team. Rookie Lisa Nanov added in a pair of ECAC Rookie of the Week distinctions, as well as being ranked 83rd on Top Drawer Soccer's Midseason Top-100 Freshmen list.
Prior to UMBC, Wray served as the head coach at Towson University from 1999-2006 and recorded the most victories of any coach in that program's history. She resigned from her position after the 2006 season in order to stay at home with her young children.
In her second season at Towson, the 2000 Tigers tied a school record with 10 victories and reached the America East semifinals. Half of TU's losses came at the hands of teams that went to the NCAA Tournament, including 1-0 setbacks to No. 8 Hartford and No. 9 Maryland.
In 2005, her tenacious defense produced six shutouts and allowed only 21 goals in 18 games as Towson went 8-7-3 as members of the Colonial Athletic Association.
The former Leslie Kerhin was a first team all-state selection at Parkville High School and earned junior college All-America status at Essex Community College in 1992. She then started for three seasons at Maryland and finished her Terrapin career with six goals and 15 assists.
After graduation, Wray spent two years as an assistant coach at Towson (1996-97) and two seasons in the same capacity at the University of Missouri (1997-99). She earned her bachelor's degree in sociology at Maryland and her master's in education at Missouri.
In 2000, she married Sean Wray, also a 1995 Maryland graduate and soccer standout for the Terrapins. In July of 2006, the couple welcomed a son, Roman, and a daughter, Melena, and in 2007, Ashton, joined the family.
Wray played for the USWISL Maryland Pride team for three years and was a member of its National Championship Team. She served as a co-head coach for the Maryland Olympic Program from 2000-04 and guided the U-16 and U-17 squads to regional titles in 2003 and 2004, respectively.


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Site Outage Morning Of 1/18, affected oesf and elsix
Site Outage Morning Of 1/18, affected oesf and elsix
Jan 18 2005, 08:47 AM
Post #1
Group: Admin
Posts: 1,418
Joined: 18-May 03
From: St. Paul, MN
Member No.: 4
hello all - ibiblio upgraded their storage devices this morning, and changed the directory structure a little. Once we got the email that the upgrade was complete, I was able to change the config files with the correct paths...
As of now, I don't know of any other scheduled ibiblio outages, so we should be outage free for a while.
Thanks for your understanding and patience,
p.s. the storage upgrade was much needed... I kept getting out of space errors when trying to upload even small ipks to the elsix or forums. Now we shouldn't have space issues for a long time
|Lo-Fi Version
|Time is now: 14th December 2019 - 01:56 AM


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Help with Health Care Brochures
Who is this for?
If you're uninsured, this information will help you learn about resources where you can get access to health care in your community.
Helping Michigan residents obtain access to health care is an important part of the Blue Cross social mission.
Our Help with Health Care brochures list resources for the uninsured in Michigan, including:
- County health plans
- Dental and vision services
- Free and low-cost clinics
- Government programs such as Healthy Kids
- Mental health services
- Prescription assistance programs
View and download brochures
Use the table below to view and print the Help with Health Care brochure for your region.
Order brochures
To order free copies of these brochures, please call 1-800-658-6715. Please be ready to tell us your name, address and how many of each version you would like in your request (region and language). Sorry, we can't fill requests that don't provide all the required information.


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Grainger Hotel
Grainger Hotel is situated in Newcastle upon Tyne in the beautiful north east of England. With easy acces
NO SMOKING Policy throughout the property. Fix penalty for smoking within the premises. Free Wifi Access to guests and Secured Car Parking (£5.00 per car per night ) is provided along with FREE Continental Buffet Breakfast.
Availability & RatesTo view availability and prices please select dates and click 'Update Dates'
Hotel Facilities & Policies
- 24 Hour Reception
- Breakfast Not Included
- Credit Cards Accepted
- Elevator
- House Keeping
- No Curfew
- Parking
- Tea & Coffee Making Facilities
- Wheelchair Friendly
Cancellation PolicyThis property has a 2 day cancellation policy. Failure to cancel within this time will result in a cancellation charge equal to the first night of your stay.
Must-Read Hotel InfoThis property has specific Terms & Conditions.
Cancellation is 48 hours prior to arrival. late cancellation or now show will result in FULL BOOKING VALUE CHARGE.
DirectionsShow MapHide Map
Grainger Hotell is situated in the north section or Westgate Road and is close to all of the major
networks . Please find directions below:
By Road
Leave the A1 and join A186 (Westgate Road) towards the City Centre and continue for approximates 2 miles.
Grainger Hotel is on the left. You will see the Grainger Hotel sign .
Guests who prefer to use navigation system, once you enter Newcastle Please Enter DILSTON ROAD as your Destination as the post code may take you to wrong destination with some navigation systems. If by entering postcode it directs you to Lynwood Terrace then it's fine else please use the road as mentioned above.
From Newcastle Airport
Leave the airport and join the A696 towards Newcastle. Join the A1 heading south. Take the second exit and join
A186 (Westgate Road) towards the City Centre and continue for approximates 2 miles. Grainger Hotel is on the left. You will see the Grainger Hotel sign
From Railway Station
Leave the railway station and proceed left along Neville street towards Westmorland Road A6115).
From Westmorland Road turn right onto Blenheim Street/St. James Boulevard (A189). Then turn left onto Westgate
Road. Continue along Westgate road for about 3/4 of a mile and you have arrived at Grainger Hotel.
You will see the Grainger Hotel sign.
Local Busses
Main Routes 10 , 11 ,38 from Central Station and from St. James's Park Statdium 39 , 40 {Busses go directly to city centre , Central Station and Football Stadium Travel Time: Appx. 10 min}.
Located Near
::: Metro Radio Arena ::: appx. 1.5 miles.
.::: City Centre ::: appx 1 mile
. ::: Newcastle Train Station::: Appx 1 mile
::: St Jamses' Park ::: appx 1 mile.
:::MetroCentre::: ( Europe's one of the biggest shopping Mall ) appx 4 miles.
:::Quay Side::: appx 2.5 miles.
:::Carling Academy::: Appx 1 Mile
:::Newcastle General Hospital:::Appx 100 yards
:::Great North Run Starting Point:::appx 1 mile
:::Discovery Meuseum:::appx 1 Mile


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We can forgive the small things, but when they're as painful and inexplicably chronic as the 10 below, we've got to act in the only way we know how – by making a list. It wasn't hard to think of 10 things game developers constantly irk us with – we could have geeked on and on about 20, even 30, but we aren't trying to nitpick…well, yes we are…but we aren't trying to rub hydrochloric acid into gaping chest wounds. We're being constructive!
Does anyone think that running back and forth across an area looking for the exit is fun? These "puzzles" are not really puzzles at all. There's no figuring them out, only stumbling onto the right bit of the map. OH, we were supposed to crawl through that vent over there that was really hard to see. As great as it is, Half-Life 2 is full of "go through the vent" moments.
Sometimes they're even more obtuse than that. It isn't A + B = C, it's A + whatever the hell they felt like = turn left at the pickle. The games most commonly criticized for this kind of absurdity are classic point-and-click adventure games – but that was sort of part of their charm. We forgive them for that. But much like modern art, once it's done, it's not cool anymore.
Programming quirks aren't always considered aspects of "game design," but we interact with the final product, not the ideal inside of some luminary's head. The design not only includes how the game is supposed to work, but how it actually works.
And how do most game's AIs work? Like three-year-olds who just had spoonfuls of extra-drowsy cold medicine. NPCs never seem to have any idea what's going on around them, and it doesn't seem like anyone needs to revolutionize the art of AI programming to give them a just little more awareness.
How many times have you run circles around your supposed leader while he shuffles toward your next objective like a defective wind-up toy? Maybe it's not the developer's fault that we don't play along and creep around behind their zombie-like characters, but all they'd have to do is change one line of dialog and our suspension of disbelief would be maintained. "Follow me" becomes "Meet me there," and voila!
What's worse are NPCs with the attention spans of caffeine-addled Jack Russell Terriers. Take Fallout 3 for example: Shoot a neutral NPC in the face and he goes berserk, as he should, but then get close enough to talk to him, and he's all "Gee, how are ya?" WE JUST SHOT YOU IN THE FACE YOU STUPID SHIT. End the conversation and he goes straight back to whacking you with a pipe. Maybe, just maybe, dialog could be disabled when we're in the middle of killing someone.
With just a few exceptions, we don't like these, no matter how "cinematic" they make the game. In fact, if the word "cinematic" ever enters your head, you're probably doing it wrong. Reacting to button-prompts is fun in rhythm games, but when a big yellow 'Y' pops into the middle of our screen during a firefight, the last thing we're thinking is "Gee, how cinematic."


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Single Width Entry/Exit Brush Wallplate Cable
Here at BCE Direct we can offer bulk order discounts. Simply complete the form below and we'll get back to you as soon as we can with a tailored quote. We hold high quantities of the products we have on the website and can offer next day delivery on almost every single item. We can provide very competitive pricing so please feel free to get in touch. There are no minimum order quantities so even if you need a price on 5 items, we're sure we can do something to help.
Please feel free to give us a call on 01761 452997
Alternatively, please use the form below.
Standard Delivery:
Standard Delivery Starting from Just £0.89*
Express Shipping:
Royal Mail 24 (1-2 Days Delivery) This option is available on most small items and starts from £2.99*
Next Day:
Next day delivery is available on all of our items, only £7.99* We generally use APC for these or Royal Mail Tracked 24 for smaller items
International Delivery:
From £9.49* most items will be sent via Royal Mail fully Tracked, heavier items will be sent using the most cost effective services.
Bristol Communications and Electrical ltd accept returns on all items within 14 days. If there is no fault with the product, the buyer must pay the return postage costs, of which are non-refundable.
If we deem the items returned to be in an unsatisfactory condition we reserve the right to charge up to 40% of the final selling price. This cost will be decided upon receipt of goods. Within this percentage will be the costs to repair/refurbish/repackage items.
Items that are being returned due to buyer error will be refunded MINUS postage costs. Postage costs are set within many of our overall prices, postage costs will be deducted from final refund amounts.
If there was an error on our side, for example incorrect or damaged items we will except all responsibility for postage costs and a full refund will be given.
Please note: You have the right to cancel within 14 days of delivery, if this deadline has passed we will not accept the return request.


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People jumped from second floor windows to escape a fire in an apartment building in Hartford, Connecticut, Sunday morning.
Firefighters were called to 31 Gillett Street around 7:30 a.m. after heavy smoke filled the building, according to Fire Chief Michael Dempsey.
Blankets and sheets hung from the broken windows where people tried to escape the fire.
U.S. & World
"We opened the door. All the smoke was really really dark in the hallway," resident Juan Valez described.
"I was asleep. My daughter woke me up. Then I heard the alarm, then she told me the building was on fire and then we ran out," added another resident, Betty Kennedy who lives on the fourth floor.
Authorities believe the fire started in a 2nd floor apartment in the back of the building when a man fell asleep while cooking French fries on the stove.
"It's scary. You never know, especially when you live in a building like this," said Valez.
The fire sent smoke through all four floors, according to the Fire Department's Public Information Officer, Captain Raul Ortiz.
"There were people in the back screaming banging on the windows telling people to get out, so we just woke up and ran downstairs," recalled Zatanya Irving, who lives on the third floor.
Irving told us the smoke alarms go off so regularly in this building, most people ignore them. By the time some residents realized the fire was real, it was too late.
"We did know we had something serious happening once we saw people hanging out the windows," said Ortiz.
Valez's girlfriend was one of three people taken to the hospital.
"She's not feeling well. Her chest is kind of tight. They gave her some blood tests to see how much smoke she inhaled," he said.
Authorities said a dog also died in the fire.
After 90 minutes, residents were allowed back into all but three of the building's 64 units. Fire officials said the unit where the fire started was destroyed and two more were uninhabitable.


text:
This story has been updated.
A stretch of sunny, pleasant days will end midway through the weekend as rain and thunderstorms sweep through the region, marking a sharp change in the weather pattern.
Rain will move into the region early in the evening Saturday and continue into Sunday morning.
A windswept 1" to 2" of rain is likely, with higher amounts in areas where there are thunderstorms, according to the National Weather Service.
Winds will gust up to 30 mph with 40 mph gusts possible, especially along the coast, where they are likely to create rough surf and strong rip currents.
The gusty winds, combined with drenching rain, could cause sporadic power outages, especially if accompanied by thunderstorms. Flash flooding is possible.
A Wind Advisory is in effect from 8 p.m. Saturday through 6 a.m. Sunday for NYC, Hudson County, southern Westchester, southern Fairfield, and western and central Long Island.
Rain will arrive after 7 p.m. Saturday and become heavy overnight with downpours as thunderstorms move through.
The rain and storms will wrap up around 7 a.m. Sunday. The rest of the day will be mostly cloudy with a high temperature in the low-80s.
There will be a chance of showers and thunderstorms Sunday night, with showers and possible storms becoming likely overnight after 1 a.m. Monday.
Showers are likely during the daytime Monday with thunderstorms possible. The high temperature will again be in the low-80s.
There will be a chance for showers the rest of the workweek.
Check back to Daily Voice for updates.
Click here to sign up for Daily Voice's free daily emails and news alerts.


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So there is this great website called http://www.fancast.com
It has loads of different tv shows on it, and many with full episodes. And these aren't just current shows!
I found American Gothic, which only ran for one season but I loved it. Now I'm watching it from the beginning again. Good times!!!


text:
(Cinet)- Preserving and surviving their wedding customs with cultural characteristics have been developed by the San Chay ethnic minority in northeastern Bac Giang province.
(Cinet)- Each ethnic minority group has its own festivals, customs, beliefs and farming practice. Tet festival lasts about half a month, during which time many exciting cultural and community activities take place.
(Cinet)- The Lo Lo people are one of the many ethnic minorities in Vietnam, living for many generations in the Dong Van Rocky Plateau.
(Cinet)- The Tay in Lang Son are cheerfully celebrating the Lunar New Year festival, the most important event of the year. To the boisterous sounds of gongs and drums, the Tay prepare thoroughly to welcome a lion dance troupe to visit their home on the first days of the new year.
(Cinet) - Mong ethnic people in Meo Vac district, Ha Giang province celebrate their New Year or Tet one month earlier than Lunar New Year.


text:
Mississippi Delta farmers and ginners have made excellent progress in meeting requirements for hiring and housing migrant and seasonal workers, says Eric Nash, U.S. Department of Labor.
"Compliance has improved big-time" over the past several years, he said at the joint meeting of the Delta Council's Ginning and Cotton Quality Improvement Committee and the Southern Cotton Ginners Association.
Nash said agency investigators "will be out doing enforcement actions" during the harvest/ginning season and that employers need to continue to be vigilant about rules and regulations applying to migrant/seasonal workers.
These include salaries and bonuses, computing/payment of overtime, housing inspection, disclosure of working conditions, wage statements, and posting of notices and forms in proper places.
For housing inspections, there is a 97-item checklist that must be followed. Employers don't have to provide housing for these workers, Nash noted, "but if you do, you must comply with the standards."
Non-compliance for any of the DOL rules/regulations "can be costly," he said, "so it's better to take a proactive stance on these things."
Nash said Mississippi ag employers "are doing a fantastic job" on complying with child labor laws, with no violations recorded in a long while. (For gins, no one under 18 may be employed.)
In a bit of good news for Mississippi ginners, most of whom are facing drastically curtailed operations this fall as a result of cutbacks in cotton acreage, the Entergy Corp. has agreed to a one-time reduction in its facilities charge to gins.
Cheryl Comans, customer service manager for the electric utility, said based on a 45 percent reduction in the state's cotton acreage this year, gins that are Entergy customers will be granted a 65 cents per registered kilowatt hour credit on the facilities charge portion of their electric bills.
She emphasized that the credit will apply for this ginning season only.
"This is a significant reduction, and we very much appreciate them stepping forward to work with us on this," said Lexington, Miss., ginner James Killebrew, chairman of the Delta Council committee.
He said the council has also been working with rural electric associations to try and develop a similar arrangement.
e-mail: firstname.lastname@example.com


text:
Breville Smart Grill & Griddle Removable Plates
Easy, hassle-free returns online and in-store for eligible items.Learn More
Earn 2x Rewards4 That's 10% back in rewards when you use your Williams Sonoma Credit Card at Williams Sonoma 12/14 - 12/21.Apply Now Learn More
- Summary
Maximize the versatility of your Breville Smart Grill & Griddle with these compatible cooking plates, which instantly double your effective cooking area when the grill lid is open.
- Interchangeable grill and griddle plates create twice as much space for pancakes on the griddle or chicken breasts on the grill.
- Made of aluminum for superior heat conductivity.
- Nonstick finishes release food easily
- For use with the Breville Smart Griddle & Grill only.
- Dishwasher safe.
- 13" x 10" wide.
- Designed and engineered in Australia, Made in China.
- Use & Care
- Pans get very hot; use gloves or mitts when removing from grill.
- Dishwasher safe.
- Shipping
Shipping Information
UPS can deliver most in-stock items within 3–5 business days. UPS is unable to deliver to P.O. boxes.
Shipping Rates
The shipping rate varies depending on your order total and shipping destination. View Shipping Options and Charges.
Next Day Delivery
For an additional charge of $26 per address, we can expedite delivery to most destinations. This service is not available for some oversize items, items shipped directly from the supplier (including perishable and custom-manufactured items), out-of-stock items and items to be shipped outside the contiguous 48 states.
Orders received by 9:00 p.m. ET Monday through Thursday will arrive the next business day; orders placed Friday through Sunday will arrive on the following Tuesday.
Return Policy
At Williams Sonoma, we take great pride in the quality and craftsmanship of our products. Attention to design, materials, safety and construction are our priority. Upon receipt, please inspect your purchase and notify us of any damage; we will arrange for a prompt replacement.
If within 30 days, you are dissatisfied for any reason, you may return your purchase for a refund of the merchandise value. An original receipt or gift receipt is required for all returns and exchanges. Returns with a gift receipt will be refunded in the form of a Merchandise Credit for the amount indicated on the gift receipt. Returns with original receipt will be refunded in the original form of payment, cash and check refunds over $100 will be issued as a company check (may take 14 business days from time of request).
For all cutlery returns (knife sets, single knives, cutting boards, knife sharpeners and knife storage), please contact us at 888.922.4108 to initiate the return.
We cannot accept returns on monogrammed, personalized, special-order items, custom upholstery, food, items shipped direct from the vendor or on items damaged through normal wear and tear. Final sale items ending in .97 or .99 cannot be returned.
Made to Order and Final Sale Furniture items are non-returnable and cannot be cancelled once the order is placed.
For returns of items purchased from your Williams Sonoma Gift Registry, we will gladly provide a refund or exchange for the merchandise within 90 days of your event or within 90 days of purchase, whichever date is later. View Full Returns Policy.
- Price Match Guarantee
Williams Sonoma Price Match Guarantee
At Williams Sonoma, we're committed to bringing you the best quality at the best prices.
If you find a lower price on any of our products, we'll match it—guaranteed. Click here for details.
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Rated 5 out of 5 by gadgetjunky from Worth the purchase As stated in my Breville Smart Grill review, purchasing the extra plates makes sense. Just as you need a horse for the carriage, the plates make the grill more functional.Date published: 2013-09-29Rated 4 out of 5 by OhJenny from One Specialty Electric That Won't Get Dusty Grill is great, we use it quite a bit, from pancakes to grilled cheese, and with the optional grill plates for the world's best Panini. It's got a huge grill area, love that it opens flat, and the removable plates make cleanup a breeze - this is a deal maker! My issues with this grill: the 'optional' plates - which I think are practically necessary to take full advantage of the grill are quite overpriced. Also, since we're doing removable plates, where are the waffle plates, LOL? Overall, this is a great 'specialty' electric that unlike some others, won't sit unused at the back of the pantry.Date published: 2013-07-31Rated 5 out of 5 by naples91 from Simple and Fabulous! Connivence and simplicity makes this whole system fabulous. Cooks evenly have used both the griddle and the grill. Easy to switch plates, extremely easy to clean and stores easily. It has made feeding a family of 5 much more of a pleasure!Date published: 2013-05-28Rated 5 out of 5 by efgraphx from Great addition to great product! This adds to a great product, the Breville Panini Press/Grill. It's awesome.Date published: 2012-04-11
Does this includes pair of robes and flat plates?One ribbed and one flat plate are included.Date published: 2019-04-02


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are you travelling each year? Far? In the country you live or elsewhere? Are you travelling with children,little or bigger?
We went two years ago with our daughter when she was a baby to the Northsee,we rented a whole house,tellign ourselfes thats better with a baby.We stayed a week in the cosy De Haan,with no huge houses or skysceapers. Then the eyar after we wanted to go by bus to the Bretagne but there weren't enough trvallers and it got cancelled so I choose a hotel where Saskia could come and eat for free in teh Bourgogne in Macon?We had walks and one daytrip by train to Bourg en Bresse,very nice city nearby.All the years we visted my Mum in Hannover too by train.
This year we go for a week to the Ardennes,into a House from teh union,the price in intresting and the wood is nice to have air and walks,good to have one week rest and some exercise in the Wood.
What about you guys?


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Tahoe Donner hosts Ski for Light for visually and mobility impaired
Special to the Sun
TRUCKEE, Calif. – On Saturday, Feb. 9, Tahoe Donner Cross Country hosted a wonderful day of skiing, snowshoeing and learning on the trails for both visually and mobility impaired skiers and their volunteer guides. Ski for Light, Inc. (SFL) is an all-volunteer, nonprofit organization founded in 1975, modeled on a similar program in Beitostolen, Norway. The mission of SFL is to enhance the quality of life and independence of visually or mobility impaired adults through a program of cross-country skiing.


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A chinstrap is potentially useful to reduce unintentional air leak by preventing mouth opening during PAP treatment. This study examines whether the addition of a chinstrap to PAP therapy has any effect on adherence, nightly duration of use, air leak, and residual AHI.
This was a retrospective study performed at an AASM-accredited VAMC sleep center. Clinical sleep data of veterans (n = 124) prescribed PAP therapy for sleep apnea was evaluated, and the effect of chinstrap use vs non-use on the above parameters was assessed.
Chinstrap users had significantly greater PAP adherence, longer nightly duration of PAP use, lower residual AHI and lower leak compared to chinstrap non-users at first follow up visit.
The addition of a chin strap to PAP therapy is a simple and inexpensive method of increasing PAP adherence.
Knowles SR; O'Brien DT; Zhang S; Devara A; Rowley JA. Effect of addition of chin strap on PAP compliance, nightly duration of use, and other factors. J Clin Sleep Med 2014;10(4):377-383.
Sleep apnea is associated with increased risk for cardiovascular disease, hypertension, heart attack, and stroke. Positive airway pressure (PAP) therapy has been shown to reduce this risk.1–3 Due to the significant health consequences of untreated sleep apnea, it is desirable to achieve high PAP compliance. PAP is usually initiated during a PAP "titration" (incremental adjustment of PAP pressure) during polysomnography in the sleep lab. PAP treatment is a closed system for treatment of sleep apnea that delivers pressurized air to the site of obstruction in the pharynx. The pressurized air splints the airway open and relieves the obstruction. Unintentional air leak in the system results in development of an open circuit that may reduce the pressure of air delivered to the site of obstruction, with associated recurrence of respiratory events (including apneas, hypopneas, RERAs, flow limitation and snoring). Mouth opening during PAP treatment is a source of air leak. A chin strap may be useful to reduce this leak by preventing mouth opening during PAP treatment, and may be applied during PAP titration or later in the course of PAP clinical follow-up. The chin strap supports the mandible with sufficient tension to reduce mouth opening during sleep (Figure 1). Chin strap application may also reduce complaints of dry mouth and arousals associated with air leak.30 American Academy of Sleep Medicine (AASM) Best Clinical Practices for PAP titration recommends addition of chin strap (or switch to full-face mask) to reduce leak.29 After in-lab PAP titration, the patient then uses PAP during sleep at home and is seen in follow-up in sleep clinic to assess compliance and response to therapy. Overall reported PAP compliance rates vary widely and range between 30% and 84%.4,6,10 Literature review reveals many studies examining factors potentially affecting compliance, such as heated humidity, patient education, mask type, and type of PAP machine used and its properties (CPAP vs BPAP, auto-PAP vs fixed PAP, expiratory pressure relief settings, etc.).5–13,28 Unresolved air leak has been associated with persistence of sleep apnea in PAP-treated patients, and also with reduced PAP compliance,14,15 but there are few studies evaluating whether chin strap use has any effect on leak, residual AHI, or compliance.
Example of wide white chin strap application
Chin strap front and side views. Example of wide white chin strap application
(more ...)
Current Knowledge/Study Rationale: Achieving good positive airway pressure (PAP) adherence in OSA patients is a challenge. The purpose of the current study was to identify whether addition of a chin strap to PAP therapy may be beneficial in increasing PAP adherence.
Study Impact: This is the first outpatient study to specifically demonstrate the positive impact of chin strap use on leak and adherence to PAP therapy. The findings suggest that a chin strap should be routinely prescribed as part of PAP therapy, to improve adherence.
The primary purpose of this study is to determine whether the addition of a chin strap alone improves PAP compliance and nightly duration of use as measured by download of PAP smart card data, reduces residual apnea-hypopnea index (AHI) and/or leak, and improves daytime function as measured by the Epworth Sleepiness Scale (ESS) score.
This was a retrospective analysis of existing data previously collected during routine sleep clinic follow-up visits. The study was approved by the Wayne State University and John D. Dingell VAMC Institutional Review Boards, and all records held in strictest confidentiality. The study was done at the John D. Dingell VAMC, an AASM-accredited Sleep Center. Computerized records of veterans who had had follow-up at the VAMC sleep clinic, already prescribed PAP for sleep apnea were reviewed. Sleep clinic follow-up data between August 2008 and May 2011, where 2 "smart card" 30-day downloads were available, were evaluated. Records for which it could not be determined whether a chin strap had been prescribed or used, or were missing compliance, residual AHI, or leak information for first follow-up visit, or for which the course of treatment was not adequately documented were excluded. Typically patients had been clinically evaluated 1 month after PAP was initially dispensed, then again 3 to 6 months later. The most recent 30-days compliance was evaluated for the 2 visits (in a few cases first follow-up download was done at 60 days). Most records did not meet criteria, because the smart card did not report AHI/leak data (older PAP machines), there was not a second compliance download, or the download period exceeded 60 days (during which multiple undocumented interventions may have been made to treatment, which might affect results). A total of 124 records met criteria to be included in the study. All 124 subjects were treated with a fixed positive airway pressure (PAP) for their sleep apnea, which had been identified as effective via in-lab polysomnography with PAP titration. In our lab, autoPAP is not used as a final treatment for sleep apnea. AutoPAP records were also excluded from the analysis due to reports of variance in leak rates with variable pressures,25 which may have led to confounding of variables under analysis. Inclusion and exclusion criteria are listed in Table 1.
Inclusion and exclusion criteria
Data were extracted from the electronic medical record and Respironics Encore-Pro and Encore-Pro 2 software, which was used for smart card downloads. Only Respironics download data was included for standardization purposes (to avoid discrepancies in units of measurement, i.e., with reported leak). Variables analyzed included patient age, sex, BMI (body mass index), baseline AHI (apnea-hypopnea index), ESS (Epworth sleepiness score), 1st and 2nd smart card download % compliance (percentage of nights used), % compliance ≥ 4 h, average duration of usage on nights used (min), residual AHI and leak (min/ night), whether chin strap was prescribed and whether chin strap was used (the latter determined by clinical interview), and ESS at the follow-ups. Baseline AHI was obtained from in-lab polysomnography and is defined as per 2007 AASM scoring criteria.16
We evaluated data from chin strap users vs. non-users, and data from non-users who became chin strap users after their first clinic visit. SAS version 9.3 (SAS Corporation, Cary, NC) was used for statistical analysis including frequency distributions, t-test and general linear regression procedures. Paired t-test was used for within-subjects analysis.
Demographic data are presented in Table 2, which shows BMI, age, sex, baseline AHI, neck circumference, Mallampati score, initial PAP pressure, and baseline ESS were not statistically different between chin strap users and non-users. There were more men than women in the sample, consistent with a VAMC general sleep clinic setting (117 males, 7 females). Sixty-one of 124 patients (49%) were prescribed a chin strap after initial in-lab PAP titration.
Baseline characteristics of subjects
At the first sleep clinic follow-up visit, most patients were not using a chin strap (38 chin strap users vs. 86 chin strap non-users [31% vs 69%, respectively]); Reasons for chin strap non-use included personal choice, patient did not understand the reason for the chin strap, patient lost the chin strap, chin strap was not initially prescribed, or patient had not received the chin strap as prescribed. Two patients for whom no chin-strap prescription could be found were using chin strap at first follow-up.
In all subjects at first follow-up, with PAP treatment AHI was reduced by 92% compared to baseline AHI (4.2 ± 3.6 vs 50.4 ± 35.7, p < 0.0001) and the ESS was reduced by a mean of 2.4 points in all subjects compared to their baseline ESS (8.9 ± 6.0 vs 11.3 ± 5.54, p = 0.0108).
When chin strap users were compared to non-users, at the first follow-up visit there was significantly greater PAP adherence, longer nightly duration of use, greater reduction in air leak, and lower residual AHI in chin strap users compared to non-users (Figure 2). Compliance was 9% higher in chin strap users compared to non-users, and chin strap users had 53 min/night longer duration of PAP use compared to non-users (Figure 2A and 2B). Chin strap users had a significantly lower mean residual AHI than non-users (Figure 2D). Chin strap users also had lower leak/night compared to non-users (Figure 2E). Percent compliance ≥ 4 h/night was 10% greater in the chin strap user group (Figure 2C), but it was not statistically signifi-cant. Chin strap users also had lower ESS than non-users at first follow-up, but it was not statistically significant.
Data from first sleep clinic follow up visit after PSG with in-lab CPAP titration. Chin strap users N = 38, non-users N = 86. Compliance %, percentage of nights PAP used; used duration, nightly duration of PAP use in minutes; PCT ≥ 4 h, percentage of nights used greater than or equal to 4 hours duration; leak is in minutes/ night; ESS, Epworth Sleepiness Score. Residual AHI, apnea-hypopnea index from PAP machine smart card. Results from t-test, * = statistically significant.
Effect of chin strap use at first follow up visit. Data from first sleep clinic follow up visit after PSG with in-lab CPAP titration. Chin strap users N = 38, non-users N = 86. Compliance %, percentage of nights PAP used; used duration, nightly duration of PAP use in minutes; PCT...
The compliance parameters were corrected for age, gender, and BMI, and the resulting regression analyses are shown in Tables 3A, 3B, 3C, 3D, and 3E. PAP percent compliance was reduced in chin strap non-users compared to users (Table 3A) and was not influenced by age, gender, or BMI. Both chin strap use and increasing age were positively associated with longer nightly duration of PAP use at first follow-up visit (Table 3B). Age was the only determinant of percent compliance ≥ 4 h/ night; chin strap showed only a trend (Table 3C). Residual AHI at first follow up was higher in chin strap non-users at first follow up (Table 3D), with a higher residual AHI also associated with increasing age. Chin strap non-users had higher air leak/night which approached significance. Age was associated with greater leak, which was significant (Table 3E).
AHI, apnea-hypopnea index; BMI, body mass index; SE, standard error. Results from general linear regression, * = significant. (A) Percent compliance at
first follow up for chin strap non-users vs users, adjusted for age, gender, baseline AHI and BMI. Chin strap non-users had 9.51% lower compliance than chin
strap users, which was significant. (B) Comparison of nightly duration of PAP use in minutes at first follow up, adjusted for age, gender, baseline AHI and BMI.
Chin strap non-users had almost an hour less PAP use per night compared to chin strap users, which was significant. Age was also a factor influencing PAP
nightly duration of use. (C) Comparison of percent compliance = 4 h at first follow up for chin strap non-users vs users, adjusted for age, gender, baseline
AHI, and BMI. (D) Comparison of residual AHI at first follow up for chin strap non-users vs users, adjusted for age, gender, baseline AHI and BMI. Chin strap
non-users had 1.62/h greater residual AHI compared to chin strap users, which was significant. Increasing age was also positively associated with residual
AHI at first follow up. (E) Comparison of air leak in minutes/night at first follow up for chin strap non-users vs users, adjusted for age, gender, baseline AHI,
and BMI. Chin strap non-users had 10.84 minutes additional leak/night compared to chin strap users, which approached significance. Age was associated
with greater leak, and was significant.
Data were separately analyzed for patients who initially did not use a chin strap but were then prescribed one at first follow-up and began using it. Reasons for chin strap prescription included complaints of dry mouth, continued unrefreshing sleep despite adequate PAP pressure, elevated leak on smart card download, or reported arousals due to mouth leak. For patients who had a second download containing the required data, there were 31 chin strap non-users who became chin strap users ("converters"): The data for these patients are presented in Table 4. Patients who converted from chin strap non-use to chin strap use at second follow-up visit had 10.4% higher compliance and slept with PAP for 59 min longer/night compared to the period without a chin strap. Leak was 19 min/ night less with chin strap use compared to non-use. ESS scores were reduced an additional 2.8 points with chin strap use, and residual AHI at second follow-up was reduced an additional 1.2 events/h compared to without chin strap. Percentage use > 4 h/ night was not significantly different.
Converters: comparison of means between first and second follow-up visits, with addition of chin strap, expressed as (N) mean ± SD
This study shows that addition of chin strap to PAP was associated with improved PAP adherence, nightly duration of PAP use, residual AHI, and leak compared to without chin strap. In patients whose PAP use is suboptimal, addition of a chin strap may increase adherence.
In 1999, Teschler et al.17 found that air leak reduced nasal bilevel PAP effectiveness and that taping the mouth closed during BPAP treatment significantly reduced leak, arousal index, and improved BPAP effectiveness as measured by reduction in PaCO2 in hypercapnic patients. Taping the mouth closed was also associated with a significant increase in percentage of REM sleep in that study. Similarly, Gonzalez et al. reported reduction in both air leak and hypercapnia with addition of chin strap in five noninvasively ventilated patients, as compared to without chin strap.32 Two studies by Bachour et al. in 2004 indicated that mouth breathing reduces nasal PAP compliance and that addition of a chin strap reduces air leak.18,19 The latter study (N = 15) was performed with in-lab polysomnography where chin strap was added to PAP therapy, and the arousal index positively correlated with mouth leak. A more recent outpatient PAP mask analysis by Bachour et al. reported subjective patient comfort and leak differences between different brands/types of masks, but the PAP smart card download data were not reported and there was no mention of chin strap usage.20 Sopkova et al. found that mask leak was the single biggest predictor of PAP adherence,21 and Valentin et al.22 demonstrated that air leak and elevated residual AHI is associated with poor compliance to autoPAP therapy; in both of these studies, chin strap use was not specifically examined.
Two recent PAP mask-analysis studies were performed: A study by Bakker et al.23 concluded that full face masks resulted in increased leak and residual AHI and that nasal masks were associated with lower leak; use of chin strap was not reported. Teo et al.24 also reported higher leak with full face masks. In that study, a chin strap was used with nasal masks, but sub-analysis on chin strap and leak was not reported.
Reduction of OSA with use of chin strap alone, confirmed with polysomnography and nasopharyngolaryngoscopy, has also been reported.31 In our study, the addition of a chin strap to PAP therapy was associated with an increased percentage of nights used, with almost one hour longer PAP use at night and greater reduction of AHI. In addition to chin strap use, age was also associated with increased duration of nightly PAP usage, but also with higher residual AHI on PAP therapy. The latter may be due to higher leak in older patients.
When evaluating the effect of chin strap on leak, in our study chin strap users had lower leak than non-users; this lost a degree of significance on regression, and the effect of age on leak was found to be a stronger modifier. Age has been associated with air leak in other studies.37,38 This may represent changes in facial morphology with aging due to loss of teeth, removal of dentures for sleep, changes in skin elasticity or subcutaneous fat, or other etiologies. Older patients may have reduced dexterity due to arthritis or other factors, which may impair ability to adjust the mask and reduce leak.
Results of this study are consistent with others suggesting air leak is a significant factor in PAP compliance. However, this is the first outpatient study to specifically demonstrate the beneficial impact of chin strap use on leak and compliance with therapy.
One difference between this and preceding related studies is that autoPAP was not used. Fixed PAP was used in all patients. Since fixed PAP was used, there is no confounding by variations in leak with varying pressures or variable machine efficacy over certain leakage rates, which has been ascribed to some autoPAP devices.25 The combination of chin strap with autoPAP has not been specifically studied. In contrast to Bachour's in-lab study on addition of chin strap, this was an outpatient study which relied on machine-reported variables.
Antic et al. demonstrated that longer nightly duration of PAP use was associated with normalization of ESS, especially in patients using PAP for at least 7 h/night.26 In a meta-analysis, Weaver and Sawyer noted improvements in mean sleep latency (on multiple sleep latency testing) and Functional Outcomes of Sleep Questionnaire with 6 hours/night and 7.5 hours/night of PAP use, respectively.4 Thus addition of chin strap may reduce daytime sleepiness and improve daytime function by increasing nightly hours of PAP use. In this study, there was a significant reduction in ESS in patients who adopted use of chin strap between first and second follow-up visits (within-subjects analysis). However, for all patients at first follow-up visit, while EDS was reduced compared to baseline, there was no significant difference between chin strap users and non-users in between-subjects analysis. The mean nightly usage in both groups was at least 5.5 hours/night. The initial magnitude of the reduction in AHI in both groups with associated sleep improvement may have masked quantitative differences in ESS. ESS is not always a sensitive indicator of residual sleepiness. Patient estimate of arousals/night or nocturia (see Pressman et al.27) might be a better choice to determine subjective response to differences in treatment.
This study was designed to explore the influence of chin strap use and was not designed to explore the effects of other demographic and social factors on compliance. There are numerous other variables that may influence PAP adherence which were not addressed in this study, including but not limited to marital status, living/sleeping arrangements, employment, race, and socioeconomic status.33–36 However, in performing the regression analyses, we did find that age was a significant independent factor in predicting compliance, with increasing age associated with small increases in the percentage of nights used > 4 hours and nightly hours of use. In most studies on CPAP adherence, age has not been shown to be a predictor of compliance39–42; however, in one study analyzing use in a large cohort, increasing age was associated with increased number of days of use and hours used per night.37
Another weakness of this study is small sample size due to missing data on review of the databases, which may have impacted results where a nonsignificant result was found despite obvious differences in the means. Use of a structured PAP follow-up template including the variables to be analyzed might resolve this issue. Because the study was retrospective and only data on patients who presented for follow-up were analyzed, there may be some bias toward patients who are motivated to improve their health and would have higher compliance in general.
This study shows that the addition of a chin strap was associated with improved patient PAP compliance, nightly duration of use, residual AHI, and leak in patients with sleep apnea. The improved compliance and duration of use is most likely due to reduction of leak and associated micro-arousals. The addition of a chin strap during home PAP use is a simple and inexpensive method for improving PAP adherence, and because of this has potential to affect the morbidity and mortality from sleep apnea and potentially reduce associated health care costs from this disease. Further studies with larger numbers of patients need to be done in this area.
This was not an industry supported study. The authors have indicated no financial conflicts of interest.
Special thanks to Ms. Aneesa Shaik, who assisted with formatting of tables and figures. Also thanks to Dr. John Flack, MD (Chair, WSU Department of Internal Medicine) for advice and Dr. John K. Fink, MD (Professor of Neurology, University of Michigan) for advice.
Martinez-Garcia MA, Campos-Rodriguez F, Catalán-Serra P, et al., authors. Cardiovascular mortality in obstructive sleep apnea in the elderly. Role of long-term CPAP treatment: a prospective observational trial. Am J Respir Crit Care Med. 2012;186:909–16. [PubMed]
Martínez-García MA, Soler-Cataluña JJ, Ejarque-Martínez L, et al., authors. Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med. 2009;180:36–41. [PubMed]
Marin JM, Carrizo SJ, Vicente E, Agusti AG, authors. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365:1046–53. [PubMed]
Weaver TE, Sawyer AM, authors. Adherence to continuous positive airway pressure treatment for obstructive sleep apnea: implications for future interventions. Indian J Med Res. 2010;131:245–58. [PubMed Central][PubMed]
Beecroft J, Zanon S, Lukic D, Hanly P, authors. Oral continuous positive airway pressure for sleep apnea: effectiveness, patient preference, and adherence. Chest. 2003;124:2200–8. [PubMed]
Smith I, Nadig V, Lasserson TJ, authors. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines for adults with obstructive sleep apnoea. Cochrane Database Syst Rev. 2009;CD007736. [PubMed]
Chai CL, Pathinathan A, Smith B, authors. Continuous positive airway pressure delivery interfaces for obstructive sleep apnoea. Cochrane Database Syst Rev. 2006;CD005308. [PubMed]
Nilius G, Happel A, Domanski U, Ruhle KH, authors. Pressure-relief continuous positive airway pressure vs constant continuous positive airway pressure: a comparison of efficacy and compliance. Chest. 2006;130:1018–24. [PubMed]
Ballard RD, Gay PC, Strollo PJ, authors. Interventions to improve compliance in sleep apnea patients previously non-compliant with continuous positive airway pressure. J Clin Sleep Med. 2007;3:706–12. [PubMed Central][PubMed]
Sin DD, Mayers I, Man GC, Pawluk L, authors. Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest. 2002;121:430–5. [PubMed]
Mortimore IL, Whittle AT, Douglas NJ, authors. Comparison of nose and face mask CPAP therapy for sleep apnoea. Thorax. 1998;53:290–2. [PubMed Central][PubMed]
Haniffa M, Lasserson TJ, Smith I, authors. Interventions to improve compliance with continuous positive airway pressure for obstructive sleep apnea. Cochrane Database Syst Rev. 2004;CD003531. [PubMed]
Kushida CA, Berry RB, Blau A, et al., authors. Positive airway pressure initiation: a randomized controlled trial to assess the impact of therapy mode and titration process on efficacy, adherence, and outcomes. Sleep. 2011;34:1083–92. [PubMed Central][PubMed]
Baltzan MA, Elkholi O, Wolkove N, authors. Evidence of interrelated side effects with reduced compliance in patients treated with nasal continuous positive airway pressure. Sleep Med. 2009;10:198–205. [PubMed]
Baltzan MA, Kassissia I, Elkholi O, Palayew M, Dabrusin R, Wolkove N, authors. Prevalence of persistent sleep apnea in patients treated with continuous positive airway pressure. Sleep. 2006;29:557–63. [PubMed]
American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Westchester, IL: American Academy of Sleep Medicine, 2007.
Teschler H, Stampa J, Ragette R, Konietzko N, Berthon-Jones M, authors. Effect of mouth leak on effectiveness of nasal bilevel ventilator assistance and sleep architecture. Eur Respir J. 1999;14:1251–57. [PubMed]
Bachour A, Maasilta P, authors. Mouth breathing compromises adherence to nasal continuous positive airway pressure therapy. Chest. 2004;126:1248–54. [PubMed]
Bachour A, Hurmerinta K, Maasilta P, authors. Mouth closing device (chinstrap) reduces mouth leak during nasal CPAP. Sleep Med. 2004;5:261–7. [PubMed]
Bachour A, Vitikainen P, Virkkula P, Maasilta P, authors. CPAP interface: satisfaction and side effects. Sleep Breath. 2013;17:667–72. [PubMed]
Sopkova Z, Dorkova Z, Tkacova R, authors. Predictors of compliance with continuous positive airway pressure treatment in patients with obstructive sleep apnea and metabolic syndrome. Wien Klin Wochenschr. 2009;121:398–404. [PubMed]
Valentin A, Subramanian S, Quan S, Berry R, Parthasarathy S, authors. Air leak is associated with poor adherence to autoPAP therapy. Sleep. 2011;34:801–6. [PubMed Central][PubMed]
Bakker JP, Neill AM, Campbell AJ, authors. Nasal versus oronasal continuous positive airway pressure masks for obstructive sleep apnea: a pilot investigation of pressure requirement, residual disease, and leak. Sleep Breath. 2012;16:709–16. [PubMed]
Teo M, Amis T, Lee S, Falland K, Lambert S, Wheatley J, authors. Equivalence of nasal and oronasal masks during initial CPAP titration for obstructive sleep apnea syndrome. Sleep. 2011;34:951–5. [PubMed Central][PubMed]
Coller D, Stanley D, Parthasarathy S, authors. Effect of air leak on the performance of auto-PAP devices: a bench study. Sleep Breath. 2005;9:167–75. [PubMed]
Antic NA, Catcheside P, Buchan C, et al., authors. The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. Sleep. 2011;34:111–9. [PubMed Central][PubMed]
Pressman MR, Figueroa WG, Kendrick-Mohamed J, Greenspon LW, Peterson DD, authors. Nocturia. A rarely recognized symptom of sleep apnea and other occult sleep disorders. Arch Intern Med. 1996;156:545–50. [PubMed]
Gentina T, Fortin F, Douay B, et al., authors. Auto-bilevel with pressure relief during exhalation as a rescue therapy for optimally treated obstructive sleep apnoea patients with poor compliance to continuous positive airways pressure therapy-a pilot study. Sleep Breath. 2011;15:21–7. [PubMed]
Berry RB, Chediak A, Brown LK, et al., authors; NPPV Titration Task Force of the American Academy of Sleep Medicine. Best clinical practices for the sleep center adjustment of noninvasive positive pressure ventilation (NPPV) in stable chronic alveolar hypoventilation syndromes. J Clin Sleep Med. 2010;6:491–509. [PubMed Central][PubMed]
Meyer TJ, Pressman MR, Benditt J, McCool FD, Millman RP, Natarajan R, Hill NS, authors. Air leaking through the mouth during nocturnal nasal ventilation: effect on sleep quality. Sleep. 1997;20:561–9. [PubMed]
Vorona RD, Ware JC, Sinacori JT, Ford ML 3rd, Cross JP, authors. Treatment of severe obstructive sleep apnea syndrome with a chinstrap. J Clin Sleep Med. 2007;3:729–30. [PubMed Central][PubMed]
Gonzalez J, Sharshar T, Hart N, Chadda K, Raphael JC, Lofaso F, authors. Air leaks during mechanical ventilation as a cause of persistent hypercapnia in neuromuscular disorders. Intensive Care Med. 2003;29:596–602. [PubMed]
Gagnadoux F, Le Vaillant M, Goupil F, et al., authors; IRSR sleep cohort group. Influence of marital status and employment status on long-term adherence with continuous positive airway pressure in sleep apnea patients. PLoS One. 2011;6:e22503. [PubMed Central][PubMed]
Cartwright R, author. Sleeping together: a pilot study of the effects of shared sleeping on adherence to CPAP treatment in obstructive sleep apnea. J Clin Sleep Med. 2008;4:123–7. [PubMed Central][PubMed]
Simon-Tuval T, Reuveni H, Greenberg-Dotan S, Oksenberg A, Tal A, Tarasiuk A, authors. Low socioeconomic status is a risk factor for CPAP acceptance among adult OSAS patients requiring treatment. Sleep. 2009;32:545–52. [PubMed Central][PubMed]
Billings ME, Auckley D, Benca R, et al., authors. Race and residential socioeconomics as predictors of CPAP adherence. Sleep. 2011;34:1653–8. [PubMed Central][PubMed]
Woehrle H, Graml A, Weinreich G, authors. Age- and gender-dependent adherence with continuous positive airway pressure therapy. Sleep Med. 2011;12:1034–36. [PubMed]
Amfilochiou A, Tsara V, Kolilekas L, et al., authors. Determinants of continuous positive airway pressure compliance in a group of Greek patients with obstructive sleep apnea. Eur J Intern Med. 2009;20:645–50. [PubMed]
Kohler M, Smith D, Tippett V, Stradling JR, authors. Predictors of long-term compliance with continuous positive airway pressure. Thorax. 2010;65:829–32. [PubMed]
Yetkin O, Kunter E, Gunen H, authors. CPAP compliance in patients with obstructive sleep apnea syndrome. Sleep Breath. 2008;12:365–67. [PubMed]
Popescu G, Latham M, Allgar V, Elliott MW, authors. Continuous positive airway pressure for sleep apnoea/hypopnoea syndrome: usefulness of a 2 week trial to identify factors associated with long term use. Thorax. 2001;56:727–33. [PubMed Central][PubMed]
Pelletier-Fleury N, Rakotonanahary D, Fleury B, authors. The age and other factors in the evaluation of compliance with nasal continuous positive airway pressure for obstructive sleep apnea syndrome. A Cox's proportional hazard analysis. Sleep Med. 2001;2:225–32. [PubMed]


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Teacher resources and professional development across the curriculum
Teacher professional development and classroom resources across the curriculum
This workshop explores the power and importance of America's first "bestseller," Thomas Paine's Common Sense. Using the language of ordinary folk, Paine called for revolution and challenged many commonly held assumptions about government and the colonies' relationship to England. By looking at Common Sense,comparing it with the local declarations of independence, and then comparing it with the Declaration of Independence, you can explore the growing support for American independence in the 1770s.
Workshop 2: Introduction | Before You Watch | Lectures & Activities | Classroom Applications | Resources
© Annenberg Foundation 2017. All rights reserved. Legal Policy


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The Armageddon Blade II
|The Armageddon Blade II
Drowned Pass
In the Drowned Pass, look directly across the way from the Vulgrim location. You can use the Abyssal Chain to cross to a Chest (Drowned Pass Chest 6/6) with a Lifestone Shard (Lifestone Shard 13) inside. Note: There is another chest marked on your map under the Armageddon Sword Shard, but, if you followed our guide, you actually already collected this chest (Drowned Pass 3/5) the first time you visited the area. Unfortunately, a glitch seems to make the chest appear on your map at this point.
The Shard you seek is on top of the building in the middle of the area. To reach this building you need to don the Mask of Shadows. This reveal a grapple point which you can reach by climbing the stairs as high as you can on the southern building. Grapple up to the rooftops and cross to the Armageddon Blade Shard (Armageddon Blade Shard 4/7).
The only other thing of note in the Drowned Pass is a Special K appearance in the southeast. Travel through the sewer pipe to take on this strange skeleton once again for 2,000 Souls. Head back to Vulgrim and warp to the Broken Stair.
The Broken Stair
The Broken Stair is overrun with Angel Soldiers. Use Chaos Form to take out large clumps of them on your way to the far east side of the map. Ascend the building above the Vulgrim location and use the Geyser just outside the upper window to reach the highway. Follow the highway all the way to the building in the east. Climb to the roof for the Armageddon Blade Shard (Armageddon Blade Shard 5/7).
Head back to Vulgrim when you have the shard and head to the Twilight Cathedral.
Twilight Cathedral (Serpent Hole)
In the Serpent Hole between the Broken Stair and Twilight Cathedral, activate the Mask of Shadows and head down the forming path. You'll soon come to a yellow Geyser you can use to access a secret area of the Serpent Hole. Follow this long path to another Geyser and use that to float to the Chest (Serpent Hole 3/3) with a Lifestone Shard (Lifestone Shard 14) inside. Exit the Serpent Hole and then warp to the Choking Grounds.
Choking Grounds
In the Choking Grounds you can encounter Special K once again in the crypt to the southwest of the Vulgrim Location. Defeat him to win 2,000 Souls.
Now head to the tall building in the northeast corner that you've probably looted several times (you've certainly been back here for the Treasure Roundup portions of our guide if you've been following it closely). Climb to the very top floor and activate the Mask of Shadows.
You'll see a yellow Geyser appear. Hop into it and float up to the rooftop to find the Armageddon Blade Shard (Armageddon Blade Shard 6/7).
Before leaving the Choking Grounds, head to the northeast corner and enter the Broken Stair Access Tunnel. Run to the place with two blue Geysers in the large tunnel. Between these you'll find a clump of blue crystals. Destroy these with the Tremor Gauntlet to score a Champion Artifact (Champion Artifact 6). Now, return to Vulgrim and warp to the Crossroads.


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Sam Raimi, Director of all movies in the Spiderman franchise, spoke in the latest issue of Empire magazine and told them who he'd like to be the featured nemesis of Peter Parker's alter ego in Spider-Man 4.
"I like it in the Marvel comics when Spider-Man fights Morbius," said Raimi. "He's really cool. A vampire! I like that combination of superhero plus supernatural."
After Spider-Man 3, it was assumed by many that The Lizard would play a major role if there was to be another sequel as he was featured as an important secondary character in the movie playing a mentor-type role to Peter Parker in that film.
It would make sense to see The Lizard and Morbius as the two villains as they would work well together in the same film having had quite a bit of history together in the Spider-Man comics. On top of that, they share obvious similarities: Both are/were doctors, both work with different animals for their experiments and both achieved power from the same method.
Dr. Curt Connors (The Lizard) had his arm amputated due to an injury sustained by a blast while being a military surgeon. Later in life he studied the limb-regenerative capabilities of lizards and long story short, he turned into a humanoid-lizard hybrid.
Dr. Michael Morbius on the other hand, was a Nobel Prize-winning biochemist who suffered from a rare blood disease. Using experiments involving vampire bats and electroshock therapy, he ended up with super strength some side-effects similar to that of Vampirism and now he must drink blood from his victims.
I think this is a great idea for the next Spider-Man movie and if done right, can make up for the mess that was Spider-Man 3. This time they can focus on two characters and the film can be darker-themed with the nature of the characters involved. That being said, I'm getting a little tired of all of the Spidey villains partly redeeming themselves at the end and not being truly bad. That applies for both of these characters who are not entirely bad guys.
We should also not forget that Vampirism is definitely a current hot topic with the success of the Twilight books and movie which is turning into a series of films as well as the True Blood HBO series which is pre-production for a second season.
What do you think of The Lizard and Morbius making their big screen debuts?
Spider-Man 4 brings together Tobey Maguire and Sam Raimi yet again, and is expected to hit theatres in 2011.
Source: /Film


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Number of first-time homeless from Greenwich is growing
GREENWICH -- The car was the first to go. The job search led to one rejection after another. The situation at home grew toxic.
Jane, 44, had returned to Greenwich after two decades living in Florida to care for her sick mother.
"The plan was to stay with her," she said. "I began looking for job, thinking that if I could get a job, I'd be able to move out, but everything got backlogged."
With the two crammed in a one-room apartment, her presence could do little to prevent her mother from slipping further into illness and dementia. Funds grew tighter and tighter. And Jane -- who spoke with Hearst Connecticut Newspapers under the condition her name be changed to maintain her anonymity -- overwhelmed with stress and fear, reached the breaking point.
In December 2012, she joined one of lower Fairfield County's fastest growing, yet least visible groups: the homeless.
"The problem isn't what you see," says Jason Shaplen, CEO of Inspirica, a Stamford-based nonprofit aiding and housing homeless men, women and children from throughout the region. "It's what you don't see. What you don't see is the homelessness problem we do have."
In fact, the economic downturn coupled with one of the most expensive housing markets in the country, has accelerated homelessness in the Greenwich-Stamford area at a startling rate.
Between 2012 and 2013 alone, the number of homeless people in shelters and out on a single January night jumped 45 percent, from 280 to 405. Head counts found 53 people living on the streets in the Greenwich-Stamford area in 2011. And that's counting just those who were seen. Shaplen suspects the real number could be even higher.
Apart from snapshot statistics provided by counts, Shaplen and others fighting a growing tide know that, over the course of 2011, area shelters served over 900 different persons, according to the Connecticut Coalition to End Homelessness.
Since then, the problem has only grown worse.
"This summer, the shelters have been basically full every night," said Shaplen, noting that capacity in the past usually peaked as the nights grew colder and ebbed with the warmer weather. "There's just no longer any seasonality."
While homelessness is not a word often associated with Greenwich, the town Department of Social Services suggests a sizeable portion of those packing the Stamford shelters come from our town.
As many as 15 percent of those served in Stamford shelters are from Greenwich, according to the department. Greenwich has no shelters of its own, but opts to fund Stamford-based programs with federal Community Development Block Grant funds.
Reflected in the raw increase in numbers is a phenomenon that has been growing ever since the economy crashed in 2008: people who never thought it possible that they'd be on the street are finding themselves there; others are a skipped paycheck or one more hardship away.
According to Shaplen, 87 percent of the people served in Inspirica in 2012 were experiencing homelessness for the first time.
Jerome Roberts, associate director of Stamford-based Shelter for the Homeless, which provides shelter for homeless men from Greenwich and Stamford as well as New Canaan and Darien, said that for many of the people he serves, like Jane, bouncing back after a lost job is becoming more and more difficult.
"Of late, it's the economy," he said. "With people losing their jobs, they can no longer afford their homes. They exhaust all their resources, both the tangible and intangibles. " With rents being what they are, people are living marginally."
The loss of a job could mean the loss of a house, and a drop deep into homelessness in a matter of weeks.
Alan Barry, commissioner of the Greenwich Department of Social Services, says the cost of living in the region stands as one of the central causes of homelessness and steepest impediments to people getting back up on their feet.
"The number one need is housing -- It's a tremendous challenge," he said. "The housing stock is getting more and more limited and more and more expensive."
But in well-to-do Greenwich and Stamford's rapidly gentrifying downtown, where housing costs are increasing at their fastest rates, the problem seems to go unseen.
"Many of (the homeless people we work with) are sleeping in cars, or living with friends or relatives," said Barry. "It's hard to see, but it's definitely there. You just don't know where it could be. People literally fall through the cracks.
While the sidewalks are clean, regional shelters are packed to the brim with people with nowhere else to stay. Despite being less visible, homelessness has far from disappeared.
"It's only the people who are also homeless that know I'm homeless," said Israel, 51.
Like so many others in area shelters, Israel came to Inspirica after he was blind-sided by the 2008 financial crisis. The bottom dropped out when he lost his job driving for Pfizer, leaving him and his young son with few places to turn. For the single father, options were uncertain.
"That's scary part, not knowing what the next day holds," said Israel. "I'm resourceful, but it's different when it's just you and when you have a 10-year-old kid with you."
An odd job taken almost a decade earlier doing custodial work at a Stamford nonprofit called St. Luke's Lifeworks, now called Inspirica, would prove to be more valuable than he had known. Israel knew where to go, and returned to there, this time not as an employee but as a client. At the shelter, Israel received more than just a place to rest his head. He also got job training, educational programs for his son and a community supporting him.
"Everybody is looking to help each other," said Israel. "We're all in the same predicament, and we're all looking to get out."
"Our services aren't just a cot and a hot meal anymore," Shaplen said. "We're trying to break the cycle of homelessness. In-house, we're trying to provide everything a person needs to get out of homelessness."
For many of those facing homelessness for the first time, it's easier said than done. Pricey housing, a flagging job market, and low wages for entry-level work don't present a path to solvency.
"I got to the shelter, said I can't stay here, this isn't me," said Jane, who recently found work in Norwalk and an apartment in Bridgeport. "But a day turned to a week, that turned to a month, and that turned to eight months to get back on my feet."
Jane moved out of Inspirica housing last week. She says, like many of the people facing similar struggles, much of those eight months were spent reeling with shock.
"I left Florida with a full time job, a car, and a two-bedroom apartment, and it's taken me a lot of time to say that I lost it, that I am homeless," she said. "I've seen people come in puppy-eyed crying, saying that they couldn't even imagine their life would be like this. But for many people who come through here, it's not anyone's fault."


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Original Trinity Hymnal, #162
Hark, the glad sound! the Saviour comes,
The Saviour promised long:
Let every heart prepare a throne,
And every voice a song.
On him the spirit, largely poured,
Exerts his sacred fire;
Wisdom and might, and zeal and love,
His holy breast inspire.
He comes, the pris'ners to release,
In Satan's bondage held;
The gates of brass before him burst,
The iron fetters yield.
He comes, the broken heart to bind,
The bleeding soul to cure;
And with the treasures of his grace
To enrich the humble poor.
Our glad hosannas, Prince of Peace,
Thy welcome shall proclaim;
And heav'n's eternal arches ring
With thy beloved Name.
Page number: Blue 162, Right-Click Here to Download MIDI File
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