text:
If you are a subscriber to the JCSM (including members of the AASM), please login to access the journal.
Click here to Subscribe:
$75/volume year for individuals or $140/volume year for institutions to access all current articles and archives published in JCSM.
Click Here to DOWNLOAD the article*:
$20 to access a PDF version of a specific article from the current issue of JCSM.
*Purchase of an electronic download of JCSM provides permission to access and print the issue/article for personal scholarly, research and educational use. Please note: access to the article is from the computer on which the article is purchased ONLY. Purchase of the article does not permit distribution, electronic or otherwise, of the article without the written permission of the AASM. Further, purchase does not permit the posting of article text on an online forum or website.
Subscribers can download and print full articles from current and past issues of the JCSM
Login to JCSM
Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership
The extant literature on predictors of treatment response to behavioral treatments for insomnia is equivocal and limited in scope. The current study examined demographic, clinical, and sleep characteristics as predictors of clinically significant treatment response to brief behavioral treatment of insomnia (BBTI) in older adults with insomnia.
Thirty-nine older adults with insomnia (67% females, mean age: 72.54 years) were randomized to BBTI treatment. Treatment outcomes were defined according to 2 criteria: (1) "response," defined as change in Pittsburgh Sleep Quality Index (PSQI) score ≥ 3 points or increase in sleep diary sleep efficiency ≥ 10%); or (2) remission, defined as absence of a clinical diagnosis of insomnia according to standard diagnostic criteria. Logistic regression examined whether baseline demographic, clinical, or sleep characteristics predicted treatment outcomes at 1 month follow-up.
Demographic variables did not predict treatment outcomes for either criterion. Higher anxiety, depression, poorer sleep quality, and longer polysomnography (PSG)-assessed sleep latency predicted greater likelihood of response at follow-up (p < 0.05). Longer sleep duration at baseline (measured by sleep diary and PSG) predicted greater likelihood of the remission at follow-up (p < 0.05).
Patients with insomnia who have greater distress at baseline or prolonged sleep latency are more likely to show positive response to BBTI. In contrast, short sleepers at baseline are less likely to have resolution of insomnia diagnosis following BBTI, perhaps due to the sleep restriction component of the treatment. Identifying the characteristics that predict positive BBTI treatment outcomes can facilitate personalized behavioral treatments to improve outcomes.
Troxel WM; Conrad TS; Germain A; Buysse DJ. Predictors of treatment response to brief behavioral treatment of insomnia (BBTI) in older adults. J Clin Sleep Med 2013;9(12):1281-1289.
Insomnia is a chronic and persistent sleep disorder which affects approximately 10% of the adult population, and up to 20% in geriatric populations.1,2 Over the past 20 years, robust and consistent evidence has demonstrated that behavioral interventions (under the umbrella of cognitive behavioral therapy for insomnia; CBTI) are comparably efficacious and perhaps more enduring than pharmacologic interventions.3 Despite the well-documented benefits of CBTI, pharmacotherapy remains the front-line treatment for insomnia in many primary care settings, in part due to the lack of trained CBTI clinicians. To address this challenge, our group recently demonstrated the efficacy of a variant of CBTI, called brief behavioral treatment of insomnia (BBTI),4 in a sample of older adults with insomnia. BBTI is shorter in duration than traditional CBTI and designed to be delivered by a nurse with limited training in sleep medicine. The improvements seen with BBTI (effect sizes ranging from 0.62-0.96 for quantitative sleep parameters) were comparable in magnitude to those reported in a meta-analysis of CBTI and other behavioral interventions for insomnia in older adults.5 As with traditional CBTI, however, there was considerable variability in treatment response to BBTI. In other words, though treatment was efficacious overall, not all patients demonstrated significant improvement. Identifying characteristics of individuals who are more or less likely to benefit from a given treatment is of critical clinical importance in order to maximize patient benefits and cost-effectiveness, and minimize side effects. Therefore, the purpose of the present study is to identify predictors of treatment response to BBTI.
Current Knowledge/Study Rationale: Research on predictors of treatment response following behavioral treatment of insomnia is equivocal and limited in scope. The current study includes a broad assessment of demographic, clinical, and sleep characteristics as predictors of treatment response to brief behavioral treatment of insomnia (BBTI) in a sample of older adults with insomnia.
Study Impact: Identifying patient characteristics that predict favorable treatment outcomes to behavioral treatment of insomnia is critical to tailor treatment efforts and optimize treatment outcomes. The current study demonstrated that higher levels of depression and anxiety predicted better treatment response to BBTI, whereas shorter sleep latency and shorter total sleep time predicted poorer treatment outcomes.
Although this is the first study to examine predictors of response to BBTI, previous research has examined the influence of several demographic, clinical, and psychiatric variables on treatment response to CBTI. For the most part, however, prior results are equivocal, perhaps due to methodological differences across studies. For instance, age has not been consistently related to treatment response, with a handful of studies reporting older age being related to poorer outcome6–8 and other studies showing no influence of age on treatment response,9–11 perhaps due to differences in study eligibility criteria (including a varying range of ages for "older" or "younger" participants) or statistical control for medical comorbidities, which are particularly common in older adults. Indeed, once screened for medical comorbidities, older patients have been shown to respond similarly to their younger counterparts.12 These findings suggest that older age does not portend poorer treatment response; however, comorbidities associated with increasing age may account for age differences in treatment outcome.
Differences in eligibility criteria may also account for equivocal findings with regard to baseline clinical characteristics. For instance, in a clinical effectiveness trial, which included patients representative of those presenting in clinical practice, Espie and colleagues found that higher levels of baseline depression and anxiety and initial insomnia severity predicted greater treatment response.13 In contrast, the majority of clinical trials of CBTI, which have been conducted in highly controlled research trials with more stringent eligibility criteria, have shown higher severity and longer duration of insomnia associated with poorer response,8 while still other studies have shown no relation to treatment response.7,14 Thus, given the conflicting nature of these results and that the vast majority of insomnia patients can be characterized as comorbid cases (particularly among older adults), further investigation of predictors of treatment response in samples more characteristic of the general insomnia population is warranted.
Aside from patient characteristics, the operational definition of treatment response varies widely and may influence the clinical significance of treatment response.15 To date, most studies assess treatment response via change in clinically relevant quantitative sleep parameters (e.g., sleep latency, wakefulness after sleep onset, sleep efficiency) measured via sleep diaries and/or actigraphy.7,16 Although these quantitative criteria have the utility of being well recognized and relatively well standardized in terms of research diagnostic criteria,17 their clinical utility is somewhat limited as current clinical diagnostic criteria are based on the clinical complaint of insomnia with daytime impairment, and do not specify quantitative parameters (e.g., sleep latency > 30 min). Moreover, quantitative criteria may not adequately reflect the patient's experience of clinically significant improvement. For instance, Currie and colleagues demonstrated that 57% of patients met treatment response criteria based on significant reductions in Pittsburgh Sleep Quality Index (PSQI) scores after 7 weeks of treatment; however, only 18% were considered fully recovered from their sleep problems, based on reliable change in PSQI scores and clinical criteria for normative values on diary-assessed quantitative sleep parameters (e.g., total sleep time, sleep efficiency) and PSQI scores < 5.18 Reimann and Perlis have also recently advocated for outcome data that can be interpreted in terms of clinical relevance, such as percentages of responders/nonresponders or those meeting/not-meeting insomnia diagnostic criteria at follow-up.19
Finally, few previous investigations have examined physiological predictors of treatment response. In a sample of middle-aged adults with insomnia, Krystal and Edinger found that lower peak delta and a more gradual decline of delta across NREM periods prior to treatment predicted a greater subjective response to CBTI.20 Given age-related changes in sleep architecture and micro-architecture, particularly with regard to the levels and slope of decline in delta activity and the putative role of homeostatic sleep pressure as a mechanism of change in behavioral insomnia treatments, examination of the role of delta activity as a predictor of treatment response in older adults may provide useful insights into how to further improve or refine behavioral insomnia treatments.
In summary, prior research on predictors of treatment response to CBTI have not identified a reliable set of predictors to treatment response, and no prior study has examined predictors of response to BBTI. Several methodological characteristics of the BBTI clinical trial offer unique opportunities to address unresolved issues in the extant literature on predictors of treatment response to CBTI. In particular, the BBTI trial includes older adults recruited from the community and ranging in age from 62 to 88 years, which offers the opportunity to examine predictors of treatment response in an older adult population. In addition, to maximize generalizability of the results and in contrast to most prior clinical trials of behavioral treatments of insomnia, the BBTI trial did not exclude based on the presence of other co-occurring medical or psychiatric conditions, which more accurately reflects the vast majority of insomnia cases. The current study incorporates a broader assessment of demographic, clinical, and physiological predictors of treatment response than has been considered in prior research. Finally, the current study includes treatment response criteria that are intended to more closely reflect clinically relevant domains of improvement.
These data were collected as part of a study of older adults with chronic insomnia (symptoms present ≥ 1 month) and their response to a brief behavioral treatment for insomnia (BBTI; AG 20677; Buysse, PI). Detailed study procedures have been published previously.4,21 Briefly, participants were recruited from a single primary care practice in the Pittsburgh area or from community advertisements. Following screening and baseline assessments, participants were randomly assigned to an active treatment condition (BBTI) or information-control condition. Given the current study focus on predictors of BBTI treatment outcome, participants included in the present analyses (n = 39) were insomnia patients who were randomized to BBTI treatment. Predictors of treatment outcome were collected at the baseline assessment and included demographic and clinical characteristics assessed by questionnaires, and sleep characteristics assessed by sleep diaries, actigraphy, and polysomnography. Treatment response was determined after 4 weeks of treatment. The University of Pittsburgh Biomedical Institutional Review Board approved this study. All participants provided written informed consent.
Eligibility criteria required that participants be at least 60 years of age and meet the general criteria for insomnia in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR)22 and the International Classification of Sleep Disorders, 2nd Edition (ICSD-2),23 A structured clinical interview was used to determine eligibility, i.e., the presence/absence of insomnia disorder and other sleep disorders. As part of the interview, we administered an insomnia symptom checklist (see supplemental material, Figure S3) to specifically examine DSM-IV and ICSD-2 criteria. Specifically, insomnia criteria included: presence of a sleep complaint lasting for at least one month (median duration of symptoms was 351 weeks; minimum = 35 weeks; maximum = 2,860 weeks); adequate opportunity and circumstances for sleep; and evidence of significant distress or daytime impairment. The checklist was administered at both time points and was used to determine the presence/absence of insomnia post-treatment.
To optimize the clinical relevance and generalizability of the study, participants were eligible if they had stable, co-occurring medical or psychiatric disorders. Therefore, most of our participants had comorbid insomnia. The following exclusion criteria were applied: presence of dementia (identified by history or a score < 25 on the Folstein Mini Mental Status Exam)24 or delirium; previously undiagnosed and untreated depressive, anxiety, psychotic, or substance use disorders (those with stably treated depressive and anxiety disorders were not excluded); untreated severe obstructive sleep apnea syndrome (apneahypopnea index [AHI] > 20), restless legs syndrome or other sleep disorders (those with stably-treated sleep disorders were not excluded); hospitalization within the past 2 weeks; ongoing chemotherapy or other cancer treatment; and terminal illness with life expectancy less than 6 months.
Detailed descriptions of BBTI efficacy data and therapeutic guidelines have been previously reported.4,21 The manualized intervention consists of a single 45- to 60-min in-person, individual session, followed by a 30-min follow-up session 2 weeks later, and 20-min phone sessions after 1 and 3 weeks of treatment. All sessions were conducted by a master's level mental health nurse. BBTI shares many features of standard CBTI; however, it is distinct in its explicit behavioral focus (i.e., primary treatments are stimulus control and sleep restriction), its relatively short duration including 2 phone call sessions, its delivery by a nurse without prior training in behavioral sleep medicine, and the provision of a hard-copy workbook which includes the treatment rationale and specific written instructions for prescribed sleep behaviors. All intervention sessions were audiotaped. An independent evaluator randomly rated 33% of the audio-tapes using a checklist of the 4 treatment elements specified in the treatment manual to rate treatment fidelity. BBTI sessions contained 97% (SD = 3.2) of intended BBTI treatment elements.
Baseline predictors of treatment outcome were assessed prior to treatment initiation and included data from interviews and questionnaires, sleep diaries, wrist actigraphy, and polysomnography (individual methods described below).
Demographic characteristics including age, sex, marital status, race/ethnicity, and education were assessed by self-report.
Depressive symptoms were assessed with the 17-item Hamilton Rating Scale for Depression (HRSD).25 The HRSD is a clinician-administered interview scale that assesses the presence and severity of 17 symptoms of depression experienced in the past week using a varied response format ranging from 0-2 to 0-4 (with higher scores indicating greater depression severity), and exhibits well-documented reliability and validity.26 Anxiety symptoms were assessed using the Hamilton Anxiety Rating Scale (HRSA),27 a widely used and well-validated interview scale that assesses 14 symptoms of anxiety.28 Three items on the HRSD and 1 item on the HRSA pertaining to sleep disturbance were removed from all subsequent analyses to avoid confounding with the outcomes. Given research suggesting that people's beliefs and expectations with respect to behavioral treatments play a crucial role in shaping their experiences and outcomes of that treatment, we administered a modified, 4-item version of the Credibility and Expectancy Questionnaire (CEQ)29 to all participants prior to their first treatment session, but after a brief description of each treatment condition (BBTI or information-control was provided). Example items were: "How sensible/logical does this intervention seem?" and "how much improvement in your sleep do you think will occur because of this type of treatment?" The 4 items were standardized and summed, yielding a total score with excellent internal consistency (α = 0.85).
Medical comorbidities were evaluated with a comorbidity questionnaire developed at the Center for Research on Chronic Disorders at the University of Pittsburgh School of Nursing. This measure is adapted from the Charlson Comorbidity Index30 but includes a wider range of conditions, which were grouped into 17 categories (e.g., arthritis, cancer, coronary heart disease, diabetes).
Information regarding participants' use of medications known to affect sleep or wake functions (benzodiazepines, hypnotics, antidepressants, antipsychotics, anxiolytics, stimulants, antihistamines, decongestants, corticosteroids, diuretics) was collected via self-report and included as a potential predictor of treatment outcome.
The Pittsburgh Sleep Quality Index (PSQI)31 was used as a measure of global sleep quality. The PSQI is a widely-used, well-validated, self-report scale, used to assess sleep quality in the past month. Global PSQI score was utilized, with a total possible range from 0 (good sleep quality) to 21 (poor sleep quality). In the current sample, PSQI scores ranged from 6-16; (skewness = 0.34; kurtosis -0.61).
The Pittsburgh Sleep Diary (PghSD)32 is a prospective self-report measure of daytime activities, sleep behaviors, and sleep parameters. Previous research has demonstrated that the PghSD is sensitive to differences between sleep disorder patients and good sleeper controls, and to behavioral treatment effects in insomnia patients.32,33 The PghSD was administered via paper and pencil and collected for 2 weeks (mean = 13 days, SD = 1.49) at baseline. Baseline sleep diary sleep latency (SL), wakefulness after sleep onset (WASO), and total sleep time (TST), averaged over 2 weeks of baseline data collection, were evaluated as predictors of treatment outcome. Sleep diary sleep efficiency (SE; calculated as the ratio of time spent asleep/time in bed) collected after treatment was utilized in the definition of treatment response (as defined below).
Wrist actigraphy was measured with the Minimitter Acti-watch-64 device (Respironics, Inc., Murrysville, PA), which was worn concurrently with the collection of sleep diary data (mean = 13.86 days; SD = 1.49). Actigraphs are wrist-watch-sized, motion-sensitive monitors worn on the participant's nondominant arm that can be used to provide a behavioral measure of sleep-wake patterns. Actigraphy data were collected in 1-min epochs and analyzed with the validated Actiware Version 5.04 software program. Actigraphy variables evaluated as predictors of treatment outcome included SL, WASO, and TST (expressed in minutes). We used definitions provided by the Actiware software for these variables, which rely on values for bedtime and rise time from the sleep diary.
Visually scored and Quantitative EEG Sleep. Polysomnography (PSG) was conducted in participants' homes at their habitual sleep times using Compumedics Siesta units (Compumedics Limited, Abbotsford, Victoria, Australia). One screening PSG night was used to rule out severe obstructive sleep apnea or periodic limb movements (i.e., participants with apneahypopnea index [AHI] > 20 or periodic limb movement arousal index [PLMA-I] > 20, [according to American Academy of Sleep Medicine Task Force standards] were excluded). Visual sleep stage scoring was conducted in 20-sec epochs by trained PSG sleep technologists with established reliability, using standard scoring criteria34; this study was conducted prior to the AASM 2007 scoring rules. Visually scored PSG measures evaluated as predictors of treatment outcome were averaged over nights 2 and 3 and included SL, WASO, TST, AHI, and PLMA-I. In addition, quantitative EEG analysis35 was performed to quantify average power in the delta (0.05-4.0 Hz) range and slope of delta activity across the night, given previous associations between visually scored delta activity and treatment response.20 Modified periodograms were computed using the fast Fourier transform (FFT) of non-overlapping 4-sec epochs of the sleep EEG. NREM EEGs were binned into 5-min averages across each NREM period. Any 5 min epoch that had > 4 min of artifact was removed, as well as one peak epoch from each NREM period. The one peak epoch was removed since we often saw extreme blips at beginning or end of NREM period that we believed to be artifact due to sleep staging. The peak and average delta in each NREM period was calculated from the remaining epochs. A mixed effects repeated measures analysis of variance was use to model peak and average delta across NREM periods using random intercept and slope. A natural log transformation was used on both peak and average delta in the analyses. Models were run using whole group and each subject's model-based estimate of their intercept and slope as predictors in a logistic regression.
There are no universally accepted criteria for assessing response or remission in insomnia treatment studies.36 For the current study, outcomes were chosen because they met the following criteria which are thought to be indicative of clinically significant change: (1) outcomes correspond to approximately 1 standard deviation of the pretreatment values (i.e., a "large effect" according to Cohen's D of approximately 1.0); (2) outcomes are consistent with mean change values in published clinical trials; and (3) outcomes correspond to a change score of approximately -8 on the Insomnia Severity Index.37 Specifically, for the current study we focused on 2 binary treatment outcomes: (1) response/remission versus partial response or nonresponse; and (2) clinical remission, defined as the participant no longer meeting DSM-IV-TR and ICSD-2 criteria for insomnia disorder after treatment using a structured interview and checklist (described above). As reported in the BBTI efficacy study,4 the response/remission category consisted of those participants who had a change in PSQI score ≥ 3 points or increase in diary SE ≥ 10% (response) or remission defined as response criterion plus final PSQI score of < 5 and sleep diary SE of > 85%, corresponding to "good sleep" values.31 The partial response or nonresponse category consisted of those who showed improvement in PSQI or SE but worsening in the other measure or change in PSQI < 3 points and increase in sleep diary SE < 10%, respectively. For the current study, we refer to these categories as "response" (inclusive of response or remission) versus "non-response" (inclusive of partial or nonresponse).
Sleep variables with non-normal distributions (i.e., sleep latency across all methods and diary-assessed WASO) were normalized using logarithmic transformations prior to analyses. Logistic regression models regressed each of the individual baseline variables on response or clinical remission criteria. Statistical analyses were conducted using IBM SPSS software, version 19. Statistical significance was set at a p-value of p < 0.05.
Table 1 describes sample characteristics for the 39 participants randomized to BBTI. As reported in Buysse et al., 67% of those randomized to BBTI met criteria for response/remission after 4 weeks of treatment, and 55% no longer met diagnostic criteria for insomnia after treatment.4
Baseline demographic and clinical characteristics of samplea
(more ...)
Logistic regression models which regressed baseline demographic, clinical, or sleep characteristics on response criteria are reported in Table 2. Higher levels of depression and anxiety were associated with higher likelihood of treatment response (as shown in Figures 1 and 2, respectively). In addition, poorer quality sleep at baseline, as indicated by higher PSQI scores, was associated with greater likelihood of treatment response. For visual purposes, Figure 3 displays mean baseline PSQI values for responders versus non-responders. There was also a significant association between PSG-assessed sleep latency and treatment response, such that patients with longer sleep latency at baseline were more likely to respond to BBTI. None of the demographic, sleep diary, actigraphy, or remaining PSG or clinical measures predicted treatment response.
Bivariate logistic regression predicting the odds of treatment response after brief behavioral treatment for insomnia (BBTI; N = 39)
Mean Hamilton Rating Scale for Depression score according to responder status
Mean Hamilton Rating Scale for Anxiety score according to responder status
Mean PSQI score according to responder status
As shown in Table 3, the only significant predictors of clinical remission were total sleep time as assessed by sleep diary and in-home PSG. As shown in Figure 4, participants with longer PSG-assessed TST or longer diary-assessed TST at baseline were more likely to meet clinical remission criteria at post-treatment. Follow-up analyses which used the cutoff of ≤ 6 h of sleep (i.e., short sleepers) versus those with > 6 h of sleep, showed an increased odds of non-remission, among those defined as short sleepers by PSG (OR = 4.8; CI: 1.04-21.79) or diary (OR = 8.05; CI: 1.70-38.1). However, these analyses should be interpreted with caution due to the relatively small cell sizes for this categorical definition of short sleepers (n = 20 and n = 17, respectively, for PSG and diary), and the wide confidence interval.
Bivariate logistic regression predicting the odds of remission after brief behavioral treatment for insomnia (BBTI; N = 39)
Diary or PSG-assessed total sleep time according to remission status
Despite the well-documented efficacy of CBT for insomnia, behavioral treatments remain under-utilized, in part due to the lack of specialty trained clinicians. Such challenges to dissemination have motivated considerable efforts to develop variants of CBTI that can be more easily disseminated to broader clinical practice.38 BBTI has been shown to be efficacious for the treatment of older adults, most of whom have other comorbid medical or psychiatric conditions, with effect sizes comparable to those of CBTI. Although BBTI has been shown to be efficacious overall, this is the first study to examine a wide range of potential predictors of treatment response to BBTI.
Consistent with prior research on predictors of response to CBTI, we found no reliable evidence for differential treatment response according to demographic characteristics. However, these results may be due to the fact that the sample was restricted in terms of age and composed primarily of educated, Caucasian older adults. Although a handful of previous studies6–8,14 have indicated poorer treatment response among older adults versus younger adults, these findings may be more indicative of higher rates of co-occurring medical or psychiatric conditions in older adults. A strength of the current study was that to maximize generalizability of the findings to older adults with insomnia, we did not exclude participants with stable or treated co-occurring medical or psychiatric conditions or mild to moderate OSA or PLMs. The presence of such comorbidities also did not predict treatment response in this sample. In contrast, consistent with Espie effectiveness trial,13 higher clinical distress at pre-treatment, as indicated by higher depression and anxiety scores and poorer sleep quality, were associated with greater likelihood of meeting the response criteria at follow-up. Importantly, these distress characteristics were only associated with the more subjectively defined response criteria, but not by the insomnia criteria defined by structured interview, whereas PSG- or diary-assessed short sleep duration predicted the clinician-assessed outcome of remission. The fact that distress measures predicted better treatment response may reflect regression to the mean (i.e., greater opportunity for improvement with higher baseline values) or perhaps greater motivation among this subset who is most distressed by their insomnia. However, supplemental analyses conducted in the control condition demonstrated that among patients in the information-control condition, higher PSQI scores at baseline were associated with poorer treatment response (see Figure S2), which argues against regression to the mean. We also found that PSG-assessed prolonged sleep latency at baseline predicted higher likelihood of treatment response in the BBTI group, perhaps again due to greater motivation to change as well as opportunity for improvement, given that behavioral techniques including sleep compression are particularly effective at reducing sleep latency.
These findings are in contrast, to findings for the remission criteria, based on clinician-assessed diagnostic criteria, which showed that longer sleep diary and PSG-assessed total sleep time predicted greater likelihood of remission. Actigraphy-assessed sleep duration showed a similar pattern of results for remission, but did not reach statistical significance. Actigraphy or diary-assessed sleep latency and WASO were not associated with response or remission. These findings regarding short sleep duration have important clinical implications because they suggest that the possibility that individuals with shorter sleep durations may benefit less from behavioral sleep treatments (including BBTI), which utilize sleep restriction as a primary component of treatment. For safety reasons, including increased risk of falls associated with short sleep duration in older adults,39 the BBTI protocol did not restrict time in bed less than 6 hours per night, even if pretreatment total sleep time is estimated at 6 hours. Thus, given these safety constraints, the strength of the sleep restriction component may be diminished in these patients. Recent evidence from Vgontzas' laboratory suggests that there may be a synergistic effect of insomnia with short sleep duration on a wide variety of adverse outcomes, including poorer cognitive functioning and mortality.40,41 Thus, insomnia patients presenting with short sleep durations present a specific clinical challenge, given that they may fail to benefit as much from behavioral treatments of insomnia and are at greater risk for associated morbidities. On the other hand, the short duration of follow-up in this study (4 weeks) may have contributed to the finding linking short sleep duration with poor treatment outcome. For these patients, longer follow-up periods may be necessary to allow sufficient time for the benefits of sleep restriction to be realized. In contrast to the findings of Krystal and Edinger,20 we did not find evidence for an effect of overall delta activity or slope of delta activity across the night on treatment outcomes. Several methodological differences may account for the discrepancy in results. In particular, Krystal's findings were based on a smaller sample (N = 16) of primarily middle-aged adults (mean age = 56), whereas the current findings were based on a sample of 39 older adults all over the age of 60 (mean age = 72). Given age-related declines in peak delta activity and blunted delta dynamics (i.e., lesser slope) throughout the night, our findings which were restricted to older adults may reflect a lack of range in delta activity and subsequent reduction in power. In addition, the two studies used similar, but not identical, methods for calculating delta EEG activity. Nevertheless, given the putative role of homeostatic sleep pressure as a mechanism of change in behavioral sleep treatments, future research is needed to examine the impact of sleep micro-architecture and dynamics in broader clinical samples.
These findings must be interpreted within the context of study limitations. First, findings may not generalize beyond older, predominantly Caucasian adults with insomnia, who were recruited from the community or a primary care practice, and who volunteered to participate in research. Second, although the relatively inclusive recruitment strategy is a strength of the study, the enhanced generalizability of results also introduces greater heterogeneity and potential confounds, such as the inclusion of patients with mild to moderate levels of sleep disordered breathing or periodic leg movements, which may have influenced the results. Although, the study characterized a wide range of pretreatment demographic, clinical, sleep, and neurophysiologic indicators of treatment response, we did not measure all potentially informative treatment predictors, such as motivation for change (although we did assess treatment expectancies, which was not related to outcome). As previously mentioned, the relatively short follow-up (4 weeks) may have implications for the results, particularly with regard to the sleep duration finding. There are limitations with regard to the definition criteria for treatment response. Specifically, treatment response was based, in part, on change in PSQI scores, which is a general measure of sleep quality, rather than a measure specific to insomnia severity, such as the Insomnia Severity Index (ISI).37 However, only a subset of the sample (N = 17) completed the ISI. Finally, the magnitude of observed effects may be partially attributable to the use of a single clinician. Whether similar effects would be observed across different clinicians, with different professional backgrounds and varying levels of experiences cannot be ascertained. On the other hand, delivery by a single therapist has the advantage of minimizing inter-therapist variability.
These limitations notwithstanding, the current findings contribute to our understanding of in whom behavioral treatments for insomnia are most likely to benefit. This question is absolutely critical as there continues to be a substantial gap between the solid evidence base supporting behavioral treatments for insomnia and the actual use of such treatments in clinical practice. Our findings also suggest that even complex insomnia cases, including those with comorbid mood or sleep disorders or medical conditions may benefit from a brief behavioral treatment delivered by a mental health nurse without prior training in sleep medicine, rather than a doctoral-level clinical psychologist. These findings also provide convergent evidence from sleep diaries and PSG to suggest that insomnia patients with short sleep duration or with short sleep latency may be a specific subset of the patient population that requires different treatment approaches, with more extended follow-up, such as adjunctive pharmacotherapy or multi-component behavioral strategies which rely more on cognitive techniques (e.g., thought restructuring) or other behavioral techniques (e.g., relaxation or mindfulness-based approaches). Alternatively, it is possible that these patients would benefit from the sleep restriction component of BBTI if limits regarding the minimum time in bed (set at 6 hours for this protocol) were removed; however, safety issues are a concern. In summary, identifying predictors of treatment response to behavioral treatments for insomnia is critical in order to refine treatment algorithms to optimize treatment response, improve patient adherence and satisfaction, most efficiently allocate resources (including specialty trained clinicians), and ultimately reduce the economic and public health burden of insomnia.
This was not an industry supported study. Funding for this research was provided by National Institutes of Health grants AG020677 (PI: Timothy Monk, Ph.D., D.Sc.), MH024652 (PI: Daniel Buysse, M.D.), RR024153 (PI: Daniel Buysse, M.D.), and K23HL093220 (PI: Wendy M. Troxel, Ph.D.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Buysse serves as a paid consultant for Merck, Philips, and Transcept Pharmaceuticals, Inc., and he has been paid for lectures at international, non-CME educational meetings supported by Servier and Astellas. The other authors have indicated no financial conflicts of interest.
American Academy of Sleep Medicine
apnea-hypopnea index
brief behavioral treatment of insomnia
cognitive behavioral therapy for insomnia
Charlson Comorbidity Index
Credibility and Expectancy Questionnaire
Diagnostic and Statistical Manual of Mental Disorders 4th Edition Text Revision
fast Fourier transformation
Hamilton Rating Scale for Anxiety
Hamilton Rating Scale for Depression
International Classification of Sleep Disorders 2nd Edition
Insomnia Severity Index
non-rapid eye movement
Pittsburgh Sleep Diary
periodic leg movement with arousal index
Pittsburgh Sleep Quality Index
sleep efficiency
sleep latency
total sleep time
wakefulness after sleep onset
Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer DG, authors. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep. 1995;18:425–32. [PubMed]
Ford DE, Kamerow DB, authors. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA. 1989;262:1479–84. [PubMed]
Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL, authors. Psychological and behavioral treatment of insomnia: An update of recent evidence (1998-2004). Sleep. 2006;29:1398–414. [PubMed]
Buysse DJ, Germain A, Moul DE, et al., authors. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med. 2011;171:887–95. [PubMed Central][PubMed]
Irwin MR, Cole JC, Nicassio PM, authors. Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychol. 2006;25:3–14. [PubMed]
Alperson J, Biglan A, authors. Self administered treatment of sleep onset insomnia and the importance of age. Behav Ther. 1979;10:337–46.
Edinger JD, Stout AL, Hoelscher TJ, authors. Cluster analysis of insomniacs' MMPI profiles: relation of subtypes to sleep history and treatment outcome. Psychosom Med. 1988;50:77–87. [PubMed]
Gagne A, Morin CM, authors. Predicting treatment response in older adults with insomnia. J Clin Geropsychol. 2001;7:131–43.
Chambers MJ, Alexander SD, authors. Assessment and prediction of outcome for a brief behavioral insomnia treatment program. J Behav Ther Exp Psychiatry. 1992;23:289–97. [PubMed]
Espie CA, Inglis SJ, Tessier S, Harvey L, authors. The clinical effectiveness of cognitive behaviour therapy for chronic insomnia: Implementation and evaluation of a sleep clinic in general medical practice. Behav Res Ther. 2001;39:45–60. [PubMed]
Van Houdenhove L, Buyse B, Gabriels L, Van den Bergh O, authors. Treating primary insomnia: Clinical effectiveness and predictors of outcomes on sleep, daytime function and health-related quality of life. J Clin Psychol Med Settings. 2011;18:312–21. [PubMed]
Morin CM, Kowatch RA, Barry T, Walton E, authors. Cognitive-behavior therapy for late-life insomnia. J Consult Clin Psychol. 1993;61:137–46. [PubMed]
Espie CA, Inglis SJ, Harvey L, authors. Predicting clinically significant response to cognitive behavior therapy for chronic insomnia in general motor practice: Analyses of outcome data at 12 months posttreatment. J Consult Clin Psychol. 2001;69:58–66. [PubMed]
Lacks P, Powlishta K, authors. Improvement following behavioral treatment for insomnia: Clinical significance, long-term maintenance, and predictors of outcome. Behav Ther. 1989;20:117–34.
Vincent N, Penner S, Lewycky S, authors. What predicts patients' perceptions of improvement in insomnia? J Sleep Res. 2006;15:301–8. [PubMed]
Bliwise DL, Friedman L, Nekich JC, Yesavage JA, authors. Prediction of outcome in behaviorally based insomnia treatments. J Behav Ther Exp Psychiatry. 1995;26:17–23. [PubMed]
Lichstein KL, Durrence HH, Taylor DJ, Bush AJ, Riedel BW, authors. Quantitative criteria for insomnia. Behav Res Ther. 2003;41:427–45. [PubMed]
Currie SR, Wilson KG, Curran D, authors. Clinical significance and predictors of treatment response to cognitive-behavior therapy for insomnia secondary to chronic pain. J Behav Med. 2002;25:135–53. [PubMed]
Riemann D, Perlis ML, authors. The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Med Rev. 2009;13:205–14. [PubMed]
Krystal AD, Edinger JD, authors. Sleep EEG predictors and correlates of the response to cognitive behavioral therapy for insomnia. Sleep. 2010;33:669–77. [PubMed Central][PubMed]
Troxel WM, Germain A, Buysse DJ, authors. Clinical management of insomnia with Brief Behavioral Treatment (BBTI). Behav Sleep Med. 2012;10:266–79. [PubMed Central][PubMed]
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV-TR). fourth edition, text revision. 2000. Washington, DC: American Psychiatric Association.
American Academy of Sleep Medicine. International classification of sleep disorders, second edition (ICSD-2): diagnostic and coding manual. 2005. Westchester, IL: American Academy of Sleep Medicine.
Folstein MF, Folstein SW, McHugh PR, authors. Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98. [PubMed]
Hamilton M, author. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62. [PubMed Central][PubMed]
Prien RF, Carpenter LL, Kupfer DJ, authors. The definition and operational criteria for treatment outcome of major depressive disorder: A review of the current research literature. Arch Gen Psychiatry. 1991;48:796–800. [PubMed]
Hamilton M, author. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32:50–5. [PubMed]
Shear MK, Vander Bilt J, Rucci P, et al., authors. Reliability and validity of a structured interview guide for the Hamilton Anxiety Rating Scale. Depress Anxiety. 2001;13:166–78. [PubMed]
Borkovec TD, Nau SD, authors. Credibility of analogue therapy rationales. J Behav Ther Exp Psychiatry. 1972;3:257–60.
Charlson ME, Pompei P, Ales KL, MacKenzie CR, authors. A new method of classifying prognostic comorbidity in longitudinal studies. J Chron Dis. 1987;40:373–83. [PubMed]
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ, authors. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213. [PubMed]
Monk TH, Reynolds CF, Kupfer DJ, et al., authors. The Pittsburgh Sleep Diary. J Sleep Res. 1994;3:111–20. [PubMed]
Germain A, Moul DE, Franzen PL, et al., authors. Effects of a brief behavioral treatment for late-life insomnia: Preliminary findings. J Clin Sleep Med. 2006;2:403–6. [PubMed]
Rechtschaffen A, Kales A, authors. A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. 1968. Washington DC: US Government Printing Office.
Brunner DP, Vasko RC, Detka CS, Monahan JP, Reynolds CF, Kupfer DJ, authors. Muscle artifacts in the sleep EEG: Automated detection and effect on all-night EEG power spectra. J Sleep Res. 1996;5:155–64. [PubMed]
Buysse DJ, Ancoli-Israel S, Edinger JD, Lichstein KL, Morin CM, authors. Recommendations for a standard research assessment of insomnia. Sleep. 2006;29:1155–73. [PubMed]
Yang M, Morin CM, Schaefer K, Wallenstein GV, authors. Interpreting score differences in the Insomnia Severity Index: using health-related outcomes to define the minimally important difference. Curr Med Res Opin. 2009;25:2487–94. [PubMed]
Perlis ML, Smith MT, authors. How can we make CBTI and other BSM services widely available? J Clin Sleep Med. 2008;4:11–3. [PubMed Central][PubMed]
Stone KL, Ancoli-Israel S, Blackwell T, et al., authors. Actigraphy-measured sleep characteristics and risk of falls in older women. Arch Intern Med. 2008;168:1768–75. [PubMed]
Fernandez-Mendoza J, Calhoun S, Bixler EO, et al., authors. Insomnia with objective short sleep duration is associated with deficits in neuropsychological performance: a general population study. Sleep. 2010;33:459–65. [PubMed Central][PubMed]
Vgontzas AN, Liao D, Pejovic S, et al., authors. Insomnia with short sleep duration and mortality: the Penn State cohort. Sleep. 2010;33:1159–64. [PubMed Central][PubMed]
Primary analyses focused on predictors of treatment response to the active treatment group (i.e., BBTI); however, we conducted supplemental analyses in the group randomized to IC in order to determine whether the same factors that predicted treatment response or remission in the active treatment condition (i.e., depression, anxiety, PSQI, PSG assessed sleep latency, or diary or PSG-assessed sleep duration) also contributed to improvements in the IC condition. There were no significant predictors of the response definition in the IC condition. The only significant predictor of remission in the IC group was PSQI (OR = 2.60; CI: 1.20, 5.63). However, in contrast to the BBTI condition, in the IC condition higher levels of PSQI scores at baseline were associated with lesser likelihood of meeting remission criteria post-treatment (see Figure S2).
We examined the absolute difference in PSG and diary-reported SL, WASO, and TST as predictors of response or remission in the BBTI group. As shown in Table S1 and Table S2, none of the discrepancy scores predicted either outcome.
Objective-Subjective Discrepancies in Sleep as Predictors of Treatment Response after BBTI
Objective-Subjective Discrepancies in Sleep as Predictors of Remission after BBTI
Participants reported whether or not they took nap(s) in their daily diaries. We calculated the average number of naps over the dairy recording period by dividing the number of naps by the number of days of diary collection; values ranged from 0 to 1.15, with 24% of the sample reporting no naps over the diary recording period. Average number of naps was not associated with treatment response [OR = 0.25; CI; 0.03, 2.21] or remission [OR = 2.08; CI; 0.26, 16.9]. In addition, we examined whether napping accounted for the relationship between short sleep duration and treatment remission, by adding average number of naps to the logistic regression models with diary or PSG-sleep duration as the predictor of remission. Controlling for napping did not attenuate either of these significant results reported in Table 2 of the manuscript).
Distribution of PSQI scores in the BBTI group
Baseline PSQI Scores and Remission in Information-Control Condition (N = 40)
Insomnia symptom checklist


text:
Even though she's got just less than a week left in her highly publicized jail stint, Lindsay Lohan is already concerned about her upcoming three month stay in rehab.
"She's a little upset right now," said her lawyer, Shawn Chapman Holley, in an interview with People. "She'd like to spend some time with her family, and there's at least some question as to whether or not she'll have to do directly to rehab."
Presently, LiLo will have a day from the time of her release to make personal arrangements before heading to rehab, though Holley says the concern now is that the troubled star will go straight to a rehab facility.
"I think it would only be fair for her to spend some time with her family and that's what she'd like me to emphasize to the judge," Holley said.
Lohan started a 90-day jail sentence at a women's facility in Lynnwood, Calif., on July 20 for violating probation in a DUI case. She is scheduled for early release on Sunday or Monday due to overcrowding.

subset: commoncrawl


text:
Pearl Cotton Special Hardanger #12
DMC Pearl Cotton is a highly mercerised, non-divisible, lustrous 100% cotton thread on a twisted skein. During the manufacturing process, the thread is combed, singed by flame and then double mercerised. It is this double mercerising which gives it its beautiful pearlised sheen. The thread is soft, silky, does not fluff or kink, and is 100% colourfast. Pearl Cotton is a supple thread that provides wonderful volume and dimension to your embroidery. Made in France.


text:
Just because the Washington Times fired their entire sports section, Mark Zuckerman isn't going to stop doing his job. For someone to cover the Nationals voluntarily, I'm not sure it's going too far to call him a modern day Jesus.
Page 2 had a nice profile yesterday of Zuckerman, who's down at Spring Training with the team and writing about it on his own blog, Nats Insider. In other, equally shocking news, Page 2 is still extant.
With the Post replacing their beat writer, there weren't many, if any experienced reporters covering the team. So Zuckerman figured, why not keep doing it? There's not much that goes on in the offseason that requires more than a phone call, something any blogger could do. So he launched Nats Insider last month, and it exploded in popularity (as much as a blog about the Nationals can, anyway).
But with Spring Training rolling around, he got the itch.
I didn't want to just be a guy with a blog who is riffing and relying on other media outlets to cover the team for me," Zuckerman says. "I figured I would drive down and stay for a few days on my own dime."
He figured he could cover the team in Viera, Fla., for $5000, if he did it on the cheap. To help defray costs, he put up a post asking for fans to donate. The next day, he had blown past the $5000 mark.
We give the Nats a lot of shit around here, but it's hard to imagine another fanbase being so generous when it comes to increasing their media presence. (It's also hard to imagine another team's Spring Training being covered by a rookie beat writer, and no one else.) So good on ya, Nats fans, and good on ya Mark for giving bloggers a good name.
Nats Insider
Covering the Nationals on behalf of fans [ESPN.com]


text:
Orlando Bloom has already fought for the rights of humans, elves and dwarves in the "Lord of The Rings" trilogy – and now the actor is fighting for the rights of children around the world as a UNICEF Goodwill Ambassador.
"Advocacy from UNICEF Goodwill Ambassadors helps build momentum to improve the lives of children around the world," UNICEF Executive Director, Ann M. Veneman said in statement released to Access Hollywood. "We are proud to have Orlando Bloom as one of the strong voices for vulnerable children."
VIEW THE PHOTOS: The Brit Pack: Hot Shots Of Stars From The U.K.!
The 32-year-old actor – whose ambassador role was announced on Monday – has already witnessed the efforts of UNICEF in Nepal, Russia, and Sarajevo.
"UNICEF doesn't just deliver humanitarian aid, which is what they are known for all over the world. They also educate and provide tools which help women and children face challenges specific to their own lives," he said in a statement. "I responded to how UNICEF works as much as I did to the work itself. I look forward to learning more and to supporting UNICEF any way I can."
VIEW THE PHOTOS: Orlando Bloom
Orlando joins a distinguished list of celebrities including Angelina Jolie, Nicole Kidman Audrey Hepburn, Danny Kaye, Shakira, Selena Gomez, Sir Roger Moore, David Beckham, Jackie Chan, Mia Farrow and Vanessa Redgrave who have worked as UNICEF Goodwill Ambassadors.
Related Content from AccessHollywood.com:
VIEW THE PHOTOS: Celebs Who Give Back
PLAY IT NOW: Access Archives: Orlando Bloom
PLAY IT NOW: Orlando Bloom On Breaking His Back
MORE ACCESS ON THESE TOPICS: Orlando Bloom - Charities - Movies - David Beckham - Nicole Kidman


text:
Just Arrived
- Exclusive Deals
- Health & Beauty
- Jewelry
- Kids & Toys
- Men
- Sports & Fitness
- Women
10pcs Professional ...
Special Price AED59.00 Regular Price AED149.00
Best Sellers
- Health & Beauty
- Jewelry
- Kids & Toys
- Luggage & Travel
- Sports & Fitness
- Women
Best Deals
Best Deals in Dubai
ZAgifts.com is the ultimate online shopping destination in UAE. We offers best deals in dubai and uae including daily deals, gifts for shopping, jewelry, fashion, perfumes, electronics and coupons for restaurants. Enjoy online shopping in uae with ZAgifts.com.
Our daily discounts for online shopping includes fashion, perfumes, bags, kids, health and beauty, jewelry, electronics and home products.
Buy your favorite stuff with discount prices and we will ship your products, gifts at your door steps anywhere in Dubai, Abu Dhabi, Sharjah, Ajman, Al Ain and Fujerah. Our shipment is not limited to UAE. We also offer worldwide delivery subjected to terms mentioned on every product page.


text:
The Strong Woman
Encouraging Women in their pursuit to get STRONG spiritually & physically through fitness, nutrition & supplementation so we can impact our world and leave a legacy!
Books List
Your Routine vs Your Schedule
Sara Oliver
Thursday, July 21, 2016
More Posts
28 Jul, 2016
Let me introduce you to someone...
YOU! Imagine yourself 20 years from now. Go ahead-close your eyes and see who you've become. What do you look like? What clothes are you wearing? What are your priorities? What do you like to do in your free time? Who are you with? What do you do for a living? Now, let that future self mentor you today. What would she tell you to do today? What would your future self tell you to eat TODAY? Would she recommend you go for a walk? Exercise? Go to bed earlier? Eat healthier? Go after your dream
26 Jul, 2016
You will or you won't
There's just a big difference between the words: "I will" and "I won't" So which is it for you when it comes to making your fitness, health & nutrition a priority in your life? It's one or the other! It's either "I won't make it a priority!" (not, "I'll start tomorrow", or, "I know I should but it's so hard"....whaaaaa!!) Nope, if you have that mind set then you are saying "I won't today!" I won't eat healthy. I won't workout. I won't sleep at least 7 hours. I won't take my vitamins. I won't
22 Jul, 2016
What to Focus on
Focus on the PROCESS not the end result or goal. Figuring out what you want, what goal you want to achieve, is the first step. But once you've decided, now you have to focus on the process to get you there. You want to lose 50 pounds? You can't get down and negative thinking, "This will take a whole year! I'll never make it!" NO! You gotta put those thoughts out of your head! You have to break down into baby steps the ACTION steps you need and must take DAILY to reach your goal! Here the


text:
Contributor Page
Carlton Fields
Contact DetailsTel: +1 305 530 0050
Fax: +1 305 530 0055
Miami Tower
100 S.E. Second Street
Suite 4200
United States
100 S.E. Second Street
Suite 4200
United States
By Gary Pappas, Ryan P. Forrest
The Southern District of California certified a food labeling class against Ocean Spray Cranberries, Inc. based in part upon a price premium damages model developed ...
United States: Court Enforces Policy's Crumbling Foundation Plain Language In Dismissing Claims Against Insurers {Dec 2018}
By Brendan N. Gooley
A federal judge in Connecticut recently dismissed claims against insurers related to their denial of a claim by two homeowners whose home's foundation was crumbling.
By Thomas C. Lauerman
Rule amendments proposed in October by the SEC could impact insurers whose obligations under certain types of annuity contracts have been guaranteed by the insurers' affiliates.
By Thomas C. Lauerman
Like most ETFs, the buffer ETFs are registered with the SEC on Form N-1A as "open-end" investment companies, and they issue and redeem their shares at net asset value (NAV
By Gary Cohen
The SEC staff now says that mutual fund directors can rely on chief compliance officer certifications in determining compliance with board procedures required by SEC exemptive Rules 10f-3, 17a-7,
By Edmund J. Zaharewicz
The SEC has long refused to allow companies to go public with bylaws or other governing documents that would require shareholders to arbitrate federal securities law claims against the company.
By Jeanne Kohler
A California district court recently denied a motion to vacate an arbitration award which had denied a plaintiff's claims brought before the Financial Industry Regulatory Authority ("FINRA").
By Ann Began Furman
For many years, insurance company issuers of non-variable products that are registered with the SEC on Forms S-1 or S-3 have been required to disclose compensation information about highly-compensated executive officers of the issuer.
United States: Fourth Circuit Reverses Dismissal, Finding Federal Question Jurisdiction For Review Of Arbitral Award {Dec 2018}
By John Pitblado
The Fourth Circuit Court of Appeals reversed a Virginia federal court's dismissal of a challenge to an arbitration award.
By Carlton Fields
U.S. Eleventh Circuit Court of Appeals.
United States: When A Nightclub Is Forced To Say Goodnight: California Appellate Court Applies Broad Reading Of "Loss Of Use" Provision {Dec 2018}
By Christopher Freeman
The frustration property owners must feel when the actions of another cause them to no longer be able to use their property as originally intended is certainly palpable ...
United States: U.S. Immigration Policy And Procedural Changes Impacting Foreign Students (Video) {Dec 2018}
By Maria Mejia-Opaciuch
This presentation is a three-part series on the procedural and policy changes issued by the various U.S. agencies governing legal immigration ...
United States: Court Declines To Reconsider Summary Judgment Decision In Latest Development In Ongoing Asbestos Liability Reinsurance Litigation {Dec 2018}
By Thaddeus Ewald
The Northern District of New York declined to reconsider a September 2018 decision on competing motions for partial summary judgment ...
United States: Illinois Legislation Revises Laws Applicable To Captive Insurance Companies {Dec 2018}
By Jason R. Brost
Illinois has adopted a bill that includes a number of revisions to its laws regarding captive insurance companies.
United States: D.C. Federal Court Permits Insured To Amend Complaint In Reinsurance Dispute Related To Credit Insurance Policy {Dec 2018}
By Thaddeus Ewald
A District of Columbia federal court partially granted and partially denied a reinsured's motion to amend its complaint in a dispute over a reinsurance agreement for a credit insurance policy.
Contributor's Topics


text:
If there's one cop car that says, "hey, criminals, I'm gonna arrest the living crap out of you," it's the Charger. Maybe it's fitting that this all-black cop Dodge gets a Decepticon badge on the hood, and not one from Autobots.
The car was found by Jalopnik reader UW Huskies in Winnemucca, NV.
Now, if we were going to make a police cruiser to scare the living daylights out of criminals/other road users/giant robots from space, we'd start with a Crown Vic. Then we'd model it after this totally awesome Zombie-proof armored custom.
Still, we'd stay out of this Charger's way.
(Hat tip to UW Huskies!)


text:
Login to my Lennar
Forgot Your Password?
Enter the email address that was
used to create your account. If found
in our system, password reset url will be
emailed to this account.
Thank You!
An email has been sent to your account with password reset url. Please follow the instruction to update your password.
To comply with real estate laws in some states, we require your state of residency before we can respond to your request.
Thank you for your interest in Lennar homes in San Francisco / Bay Area, CA. Your request has been submitted and a Lennar Associate will contact you shortly.
Lennar is proud to welcome CalAtlantic to our family of companies.
Silicon Valley
AT&T Park - Home of the SF Giants
Gilroy Vineyards
Fremont City View
Cable Car, San Francisco
View byGridList
Sort byPriceAlphabeticalLocation
First PagePreviousNextLast Page
Bay Area Team888-216-2330
We're here to help.
Want to meet your Internet New Home Consultant? Select the desired location of your new home:
Meet your personal Internet New Home Consultant.
Bay Area Team
Meet your INHC
Let's talk
Enter your phone number and we'll immediately call you to talk about all things Lennar.
Our communities are centrally located to spectacular destinations including San Francisco, Wine Country in Sonoma and Napa Valley, Mount Diablo State Park, Monterey, Lake Tahoe and Yosemite National Park. Tour Alcatraz Island, enjoy a day of family fun at Oracle Park watching the 2014 World Series Champions the San Francisco Giants, or Levi's Stadium watching the San Francisco 49ers.
Lennar offers new single-family homes and townhomes in some of the most desired real estate locations in the San Francisco Bay Area such as the East Bay, the Peninsula and Alameda, San Mateo, San Joaquin, and Santa Clara counties. Lennar currently builds in the cities of San Francisco, Foster City, Dublin and San Jose.
They offer their Everything's Included® package with the most popular upgrades included as standard. Among the most noteworthy of these features are granite slab countertops, upgraded cabinetry, gourmet GE® stainless steel appliances and much more. Buyers will also enjoy several hi-tech energy-efficient features such as tankless water heaters, low VOC paint and radiant barrier roof sheathing. There's no need for buyers to compromise when purchasing a new Lennar home.
University of San Francisco
Lake Elizabeth, Fremont, California
The Golden Gate Bridge
Highway 1, Big Sur
Fishermans Wharf, San Francisco
Port of San Francisco
San Jose Museum of Art
Are you beginning your home buying journey? Consider the opportunities that come with buying a brand new home. From modern design to quality features, you'll discover an array of benefits when you buy new!
You're ready to buy a home. What now? myLennar is where you'll find all the info you need to manage the personal process of shopping, buying, owning and enjoying your Lennar home. So whether you're taking the first steps to purchase a home or learning how to care for the one you already own – you can find it all at myLennar.
Learn more
Save your favorite Lennar homes and communities. Create a scrapbook of your home coming to life. Manage your home contacts and documents all in one place.
Thanks for your interest
Lennar doesn't currently build homes in this area.View everywhere we build.
Use your current location or View everywhere we build
in San Francisco Bay Area


text:
Another day, another blown call that changed a game's outcome in Nashville as third-seeded Florida State escaped with a win over St. Bonaventure due to referees missing this violation (hint: when inbounding the ball you have to stay out of bounds) that would have handed the Bonnies the ball under their basket and a chance to tie or take the lead. [CBS]
Update (6:50 p.m.): While Seth Davis suggests that after speaking with officiating coordinator John Adams he believes the correct call to be made, it appears to me both feet cross the line. YOU MAKE THE CALL.
Update 2 (11:33 p.m.): Turns out that Seth Davis tweet was about something else entirely. We've heard from reader T.E. (who is a basketball referee) that our original interpretation is correct.


text:
Click to enter...
A Fresh Country Market. Gourmet Food Destination.
Seasonal. Artisanal. Cheese. Bakery.
European Pastries. Local Cafe. Roasted Coffee.
Exclusive Farm-to-Table Dining. Ten Course Tasting Menu.
Secret Kitchen Table. Custom Catering.
Open 7 days a week
7am - 7pm
Farm to Table Restaurant.
Elegant. Urban. Garden Seating.
Delicious Dinners. Sunday Brunch.
Beautiful Bars. Cocktails.
Fresh and Natural.
Wine and Cheese Galore.
Exciting Seasonal Menu.
Impeccable Service.
Sunday Brunch: 10am - 2pm
Sunday - Thursday: 5pm - 10pm
Friday - Saturday: 5pm - 11pm


text: The extreme gardeners who compete at the annual Cooperstown Weigh Off have one obsessive goal -- to raise the biggest giant pumpkin in the world. These gurus of the gourd nurture their fruits through harsh weather, floods, animal attacks and even sabotage to produce glorious pumpkins of gigantic proportion. This program follows Joe Pukos and his fellow competitors through the final harrowing days of harvest and the journey across New York State with the bulging behemoths strapped into the backs of their pick-ups. Joe is a real contender -- at least until last minute rumors circulate that another grower may be set to smash the world record.


text:
Mayor's Office
The public is invited to a workshop the evening of Monday, October 25 to help create a vision for the proposed downtown civic plaza on the northeast corner of 13th and "P" streets. The meeting is from 6 to 9 p.m. at Chez Hay, 210 N. 14th St. The workshop, facilitated by the internationally-recognized, non-profit planning organization Project for Public Spaces, will include a visit to the site.
The civic plaza was identified in the 2005 Lincoln Downtown Master Plan as one of seven "catalyst" projects for downtown. "The plaza has been envisioned as downtown's future 'living room' — an attractive place that anchors and supports downtown and the entire community," said City Urban Development Director Dave Landis. "The workshop will be a fun, fast-paced exercise to encourage us to start thinking about the possibilities for this key location."
Refreshments will be served. Those who plan to attend are asked to contact Kristi Nydahl in Urban Development by October 21 at 441-8206 or email@example.com. More information on the Downtown Master Plan is available at downtownlincoln.org.
Since its formation in 1975, Project for Public Spaces has helped build, transform and revitalize thousands of parks, plazas, streets, markets, libraries and other community gathering spaces in hundreds of cities across America and around the world. More information is available at www.pps.org.


text:
Voodoo Doughnut Denver update: Awaiting permits, hoping to open between Halloween and Thanksgiving
The first Voodoo Doughnut location outside of Oregon, in Denver at 1520 E. Colfax Ave., will open "absolutely in 2013," says co-founder Kenneth "Cat Daddy" Pogson.
I checked in with the dough mogul to see how construction on the 2,800-square-foot store is going. He is a little hesitant to announce an opening date, partly because you never know with construction projects, and partly because Voodoo fans can be, shall we say, avid in their anticipation.
The last time they opened a new Voodoo Doughnut shop (in Eugene, Ore., in 2010), people gathered outside, chanting "WHEN WHEN WHEN," says Pogson. "There was one guy who walked by every day and banged on the door, "Where's my cream doughnut?!'"
Read more…


text:
Welcome to Watch List, where we identify five things on TV to watch while you stay at home, think about going to see "Robin Hood," then read the reviews and decide to save $10 and watch "Gladiator" on DVD for the 90th time instead. AM I NOT MERCIFUL?!! LET'S GO!
KITCHEN NIGHTMARES – 9:00PM Friday (FOX)Gordon Ramsay is back to taste your restaurant's food and tell you it's terrible. My favorite part is the kitchen inspection. If you've got mold, Gordo is gonna find it. IT'S BLOODY ROTTEN! Tonight, Gordon helps a down and out sushi restaurant. And man, if there is one kind of food you do not want handled by someone sloppy and passionless, it's your raw blowfish. ANTICIPATION: YELLING!
WIFE SWAP – 8:00PM Friday (ABC) According to my guide, "A free-spirited mom trades places with a mom who caters to her husband and son's every whim." Oh snap. Where can I get that second mom? She sounds cool. ANTICIPATION: CRUMMY PARENTING!
20/20 – 9:00PM Friday (ABC) An adopted woman learns her birth mother was convicted of shooting her kids. Whew! Bullet dodged! ANTICIPATION: EVEN CRUMMIER PARENTING!
SURVIVOR: HEROES AND VILLAINS – 8:00PM Sunday (CBS) It's the season finale, and it's two hours long, with a one-hour reunion special airing immediately afterwards. Followed by a preview of SURVIVOR: DAVE AND BUSTER'S, in which parents must outlast one another at a birthday party held at Chuck E. Cheese's evil older brother restaurant. ANTICIPATION: RICH DIRTY PEOPLE!
MISS USA PAGEANT – 7:00PM Sunday (NBC)Curtis Stone and Natalie Morales host, and I really do not know who either of those people are. Natalie Morales is the lead singer of 10,000 Maniacs, right? No? Well good, because I hate that band. Anyway, tune in to see who wins, then gets stripped of her title for denouncing gay marriage and appearing in an amateur porn vid. ANTICIPATION: HOT GALS!


text:
Cannella School of Hair Design 4217 W North Ave Chicago, IL 60639 Phone: (773) 278-4477
General Information About Cannella School of Hair Design
The mission of the Cannella Schools is to provide outstanding basic training in cosmetology instruction to qualified students and to assist them in achieving licensure and entry-level placement in the beauty industry. We strive to enhance not only technical skills but also self-confidence, resourcefulness, and personal growth.
Institutional statistical data was gathered from the U.S. Department of Education - Institute of Education Sciences, National Center for Education Statistics, 2009-2010.
Institution Type
- 2-year, Private for-profit
Special Learning Opportunities
- Teacher certification
Student Services
- Academic/career counseling service
- Placement services for completers
Credit Accepted
- Institution does not accept dual, credit for life, or AP credits
Religious Affiliation
- Not applicable
Federal Aid
- Eligible students may receive Pell Grants and other federal aid (e.g. Direct Loans).
Degrees/Certificates offered
- 1-2 years certificate
Campus Setting
- City: Large
Disability Services Student
- 3% or Less
Admission Total Applicants Full Time Retention Rate 86%
Student Demographics Total Enrolled 117 Native American 0.0 Asian 0.0 African American 38.0 Hispanic 79.0 Enrolled FullTime Undergraduates 17 Enrolled FullTime Graduates


text:
Oh boy, I can't believe that I'm actually submitting a tutorial on "how to draw a shrimp", step by step. To me this is actually a pretty ridiculous critter to be making a lesson out of, but I guess someone will find a use for this tutorial. Anyways you all know that shrimp are both fresh and salt water crustaceans that can be found almost anywhere in the world. Like a lot of water dwelling animals, shrimp tend to live in schools, and when they become adults, they stay close to the bottom of the sea because they are what you call filter, or bottom feeders. One of the most common things that shrimp are popular for is consumption. One of the major reasons why I am uploading this tutorial is because I thought that a lesson on drawing a shrimp would be cool because summer is here is this is the season that people tend to feast on lots of seafood, which includes shrimp, prawns, crabs, lobster, and all sorts of fish and other shellfish. One of the things I sometimes wonder is how their curled or arched bodies are able to swim through water. The fact is, shrimp swim, and they can swim pretty fast in a backwards motion. No matter if you eat shrimp or not this is an interesting lesson showing you "how to draw shrimp". Thanks for joining me today guys, and remember to keep those pencils moving. Adios mi amigos and good day!
DragoArt members upload artwork and drawing tutorials! They are also allowed to leave comments on tutorials, profiles, etc. Many more features, as well; it's way better than just being a boring guest! Register Now!


text:
Bdw_inc needed a new wordpress theme design and created a contest on 99designs.
A winner was selected from 11 designs submitted by 3 freelance designers.
The Bridge Securities LTD
The Nigerian Stock Market is a Securities market not unlike the NASDAQ. Everyday, the market trades stocks in excess of hundreds of millions of dollars. Not the size of the NASDAQ ofcourse but is among the top in Africa.
The Bridge Securities LTD is a successful stock broking firm based in Nigeria. See existing website:
The Bridge is the top stock broking firm in Nigeria. It has hundreds of thousands of wealthy clients. What we are looking to do here is build a site that will match Bridge's reputation.
Target audience is made up of the following:
1. Middle-class to wealthy individuals in Nigeria who have funds to invest in the Nigerian Stock Market
2. Nigerian Citizens living outside of Nigeria who want to invest in the Nigerian Stock market
Here is the existing site
The problem with this site is that it is horrible design.
I came up with the following newer, silly design instead. Here, pay attention to the content on the home page. The stock ticker list and news information is dynamic.
Goals for new design:
-Would use the same logo, but should be more crisp and perhaps use better font
-should have the colors of the logo, perhaps in different shades
-must be very classy, needs to make me fall in love with it at first sight
-Should have room for dynamic content and use that room very efficiently
-The current (newer ) design wastes too much space with graphics. let's do less of that here, but instead use nice icons to signify the different products/services that bridge offers
-there doesn't need to be a banner at the top (as in newer site design), I prefer to have more marketing messaging
-make the design with 2 kinds of pages in mind: the home page and an inner page
-along with the dynamic content, there should be room for a graph showing the market index, similar to the one that shows up on finance.google.com
please submit a layered PSD file as final deliverable
-----More comments to help with your design:
-if you use a banner, please use something like a bridge in your stock photos, or something more akin to tickets, graphs, or mathematical imagery
-please supply a design for an inner page, without the right side that has all the boxes. Instead, the inner pages should have a secondary nav
3. waste as little space as possible on the top (the less white space up there the better)
-please copy as little as possible from the old site I hate everything about it
- try to use nice fonts on the logo. the existing fonts are pretty crappy


text:
InnoDB uses simulated asynchronous disk I/O:
InnoDB creates a number of threads to take care
of I/O operations, such as read-ahead.
There are two read-ahead heuristics in
In sequential read-ahead, if
InnoDB notices
that the access pattern to a segment in the tablespace is
sequential, it posts in advance a batch of reads of database
pages to the I/O system.
In random read-ahead, if
InnoDB notices
that some area in a tablespace seems to be in the process of
being fully read into the buffer pool, it posts the remaining
reads to the I/O system.
InnoDB uses a novel file flush technique
involving a structure called the
doublewrite buffer,
which is enabled by default
innodb_doublewrite=ON). It adds
safety to recovery following a crash or power outage, and improves
performance on most varieties of Unix by reducing the need for
fsync() operations.
Doublewrite means that before writing pages to a data file,
InnoDB first writes them to a contiguous
tablespace area called the doublewrite buffer. Only after the
write and the flush to the doublewrite buffer has completed does
InnoDB write the pages to their proper
positions in the data file. If there is an operating system,
storage subsystem, or mysqld process crash in
the middle of a page write (causing a
torn page condition),
InnoDB can later find a good copy of the page
from the doublewrite buffer during recovery.


text:
91 Front Street S.
Friday Harbor, WA 98250
The Seattle terminal and ferry dock is currently under major construction until 2023, and could affect your travel plans. The passenger terminal is much smaller, and the entrance for drive-on customers is located south of the main dock. Learn more about construction.
Approximate Drive-Up Spaces Available on First-Come BasisThe estimated drive-up spaces is based on the number of vehicle reservations made for that sailing. We are unable to calculate the estimated drive-up spaces based on the number of vehicles at the terminal in real time due to vehicles not purchasing a fare for their travel.
Please view cameras to make more informed travel decisions.
Space Availability Legend
91 Front Street S.
Friday Harbor, WA 98250
WSF has implemented a U.S. Coast Guard approved security plan, for more information please check Security.
There is no parking at the Friday Harbor terminal. There is limited short term on street parking available.
While motorcycles are not, by Washington Administrative Code (WAC 468-300-700), a preferential loading category of users, they are often loaded prior to automobiles for operational and staging purposes. Arrival at the dock after vehicle load has commenced requires motorcycles to wait until all cars have been loaded for the next motorcycle loading opportunity. Motorcycles should proceed, while on the dock, at no more than 10 mph. Use caution when car decks are wet. The following information details specific staging for this terminal:
Motorcycle Fare Purchase/Redemption
Tickets are required for International travel to Sidney, B.C. Canada.
Motorcycle Entry/Staging
Motorcycles are staged on the yellow curb lane in front of Cannery Landing.
Motorcycle Loading
Loading order: bicycles, motorcycles, vehicles, late arriving motorcycles as space permits.
Motorcycle Special Communication
Recommended arrival time is 20 minutes prior to scheduled sailing time.
On high traffic sailings, vessel overloads may occur for travel to Anacortes. To avoid missing a desired sailing, motorcyclists should arrive an hour prior to scheduled sailing.
Inter-island tickets may be used between any two islands, they are not destination specific and fare payment is required traveling westbound only. Motorcyclists travel free eastbound.
WSF requires trucks with a gross vehicle weight of over 80,000 lbs and/or over 8'6" wide to have "travel approval" before crossing any of our routes. Vessels on this route have a limited height clearance and trucks may be loaded out of sequence.Trucks that have a gross vehicle weight of over 80,000 lbs but are hauling less than 80,000 lbs will need to provide a weight slip.
Please fill out our Oversized/Overweight Vehicle Travel Request Form by downloading a pdf version of the form and fax it to us at (206)515-3773. Please allow three business days for completion and approval. You can contact us at anytime for status updates at (206)464-6400 (Seattle).
Bicyclists load through the passenger terminal and should bypass the vehicle holding lanes. Bicyclists should arrive 20 minutes prior to departure time to be loaded at the beginning of vehicle loading. If a bicyclist arrives after vehicle loading has begun, they will be loaded at the end of the load. The terminal has bicycle racks near the terminal along Front Street. Bicyclists are asked to walk on and walk off the vessel. The Agent will notify bicyclists when they may ride while offloading.
We offer seniors (65+), persons with disabilities and passengers with a Medicare card, or other eligibility verification, travel at half the regular passenger fare rate. We offer special rates for youth ages 6 to 18. Children ages 5 and under travel free.
Multi-ride cards are good for 90 days from the date of purchase and are non-refundable.For more information check Fares.
Lost and found items on this route are turned in to the Anacortes ferry terminal. Due to storage limitations, found items are held for 10 days from the date they were found. Our Information Agents can assist you with lost and found inquiries from 7:00 am to 5:30 pm (daily) at (206) 464-6400 or 1-888-808-7977.


text:
When I email/send URL links to documents to Mac users such as
and the user clicks on the link the file is downloaded to the local drive. From wich the user can open it. They are now working on the local copy not the centrally managed document.
But On windows it actually opens up in Excel and the user can then Check out the file and work on it, Check it in etc.
How can I configure a Mac and Sharepoint so that referenec files are opened in the client app. I would have thought that I'd be able to specifiy the MIME application in the browser but my Mac guy does not seem to think that this will help.
Any thoughts on how I can get a Mac to open files in SharePoint.


text:
Columbia man arrested in string of burglaries
Howard County police investigate possible involvement in more cases
Howard County police said they arrested a Columbia man in connection with a series of burglaries throughout the county.
Police said Robert Stone, 43, was arrested and charged with first-, third- and fourth-degree burglary, destruction of property, auto theft, and resisting arrest in multiple cases.
On Nov. 22, police investigating a stolen vehicle located the car parked in front of a home in the 11000 block of Ridermark Row in Columbia. The officers saw Stone walking near the house dressed in dark clothing, wearing a mask and gloves. When police approached, Stone ran to the vehicle and attempted to drive away, but was captured and detained by officers. Police determined a nearby home had been burglarized and the rear door was smashed with a rock. Stone was arrested at the scene, police said.
Police said they conducted a search and seizure warrant at Stone's home and additional evidence linking him to other burglaries in the county, including one on July 14 in the 6800 block of Creekside Road in Clarksville. In that case, police said the robber made entry into a home by going through an unlocked front window. Once inside, he stole a safe which contained a green coin purse of foreign currency, jewelry, a house deed and other documents. During the search warrant conducted at Stone's home, police said they found a green coin purse with foreign currency and it was identified by the resident as belonging to her.
While police were executing the search warrant and applying for the additional Creekside Road burglary charges for Stone, he was released on bail from his initial arrest. A new warrant was issued for his arrest and he was immediately picked up by police in Baltimore City, where he is being held at this time.
Police said an additional warrant was issued, charging Stone in connection with a third incident Aug. 31 in the 5900 block of Bright Flow Mews in Columbia, where a man told police he awoke at 3:40 a.m. to see a man in his bedroom looking over his dresser. The victim yelled for the suspect to leave, which he did, police said. Further investigation revealed a sheer, gold bag containing several gift cards was stolen from the home, and police said during the Nov. 22 search warrant at Stone's home those items were found.
Detectives are investigating whether Stone may be linked to other burglaries. Anyone with information can call 410-313-STOP or text anonymously through a new smartphone app, "iWatchHowardCounty," on iPhone, Android, Blackberry or on a computer at www.iWatchHowardCounty.com.


text:
General prevailing wage apprentice schedules: 2006-1 apprentice schedules
General prevailing wage determinations
made by the director of industrial relations
Pursuant to California Labor Code part 7,
chapter 1, article 2, sections 1770, 1773, and 1773.1
To locate a particular apprentice craft or classification's prevailing wage schedule, please follow the six steps in the table below:
Step one
First examine if your craft's apprentice schedule is among the basic trades that apply to most counties in California.
Step two (A)
If you have not found your craft in step one, check this area to see if your craft's apprentice schedule is one of Northern California's basic trades.
Step two (B)
If you have not found your craft in step one, check this area to see if your craft's apprentice schedule is one of Southern California's basic trades.
Step three
After following steps one and two (B), examine this area if your project is in San Diego County.
Step four
If you have not found your craft in steps 1, 2, or 3, choose the county where work is being performed to examine the subtrades. Download all counties (ZIP 615 KB). HTML format.
Step five
Check the Important Notices to see if any corrections, interims, or modifications have been issued that may apply to your determination.
To ensure that you are able to view all current prevailing wage
determinations and current holiday, scope of work, and travel and subsistence
provisions, you must have a copy of Adobe Acrobat and a copy of Microsoft Excel
. If you do not have the programs necessary to open these
files, you can obtain the free Reader and Viewer programs below:
Excel Spreadsheet File Viewer - Follow this link to download the Microsoft Excel Viewer program.
If you cannot find a job classification needed to execute a contract in the Director's general prevailing wage determinations, please contact the Division of Labor Statistics and Research, Prevailing Wage Unit, P.O. Box 420603, San Francisco, CA 94142, (415) 703-4774. Because it may necessitate a wage survey, you should allow 45 days prior to the bid advertisement date for such request. Include in your request the project name or bid number, the classifications needed, job description if available, the bid advertisement date, and location of the project(s).


text:
Blue Chip 225
Bryant College, RI
It is the premier recruiting camp for high school lacrosse players in the Northeast. You can expect to be coached during the week in both practice and game situations by college coaches, and to be observed by other college coaches who attend camp as observers and evaluators. You can expect to learn about the college recruiting process from the people who do it. What are the recruiting rules; who to talk to; what to expect on visits, how to communicate with coaches and a whole lot more.
"This camp is the best of its kind in the Northeast. If you aren't going to Jake Reed's Blue Chip and you want to play up North, you better be going to this Blue Chip."
Our Take:
It is on point to say that this is the best recruiting camp in the Northeast. Coach Spencer does a great job drawing top talent to the camp along with loads of D1, D2 and D3 coaches. This year, he joined forces with Coach Pressler to host the camp at Bryant. The new location secures its spot as a Northeast destination. Blue Chip 225 is one of the best options for players who do not attend Jake Reed's camps and want to attend college in the north.
Elite 180 Lacrosse Camp
Keene State, NH
As the Head Coach of the Amherst College Lacrosse team, Coach Tom Carmean found it to be ineffective to travel to each and every recruiting venue looking for that small faction of student/athlete who could meet the academic and athletic demands of the Northeast's most prestigious colleges. In turn, Elite 180 seeks to bring together the nation's best student/athletes with the some of the nation's best colleges.
"We found that your camp allowed our players to get that early look from these highly competitive schools that they might not gotten elsewhere. This exposure no doubt, allowed our players to get a better handle on the recruiting process as it relates to these schools." Ken Miller, Owner Long Island Sting
Our Take:
Elite 180 focuses on exactly what Coach Carmean set out in his camp's mission statement. Giving players the opportunity to be seen by coaches from high level academic schools (Ivy, NESCAC, Patriot) in a competitive atmosphere. Unlike some of the larger camps, like 205 or Peak 200, Elite 180 keeps their limit of campers low. If you visit their website, they provide a unique list of camp alumni, schools where players move on include, Kenyon, Dartmouth, Haverford, Bucknell, Providence, etc.
Jake Reed's Blue Chip
It is the premier recruiting camp for high school lacrosse players. 2009 will be the first year of Jake Reed's Nike Blue Chip camp for rising Sophomores. Just like the Junior and Senior camps, the rising Sophomore camp will be held at UMBC. Invites are sent by the camp in the fall to players that pass a strict referral process. Acceptances are due by November 22nd, 2008. There is a 120-player limit for each session of the camp. If the invites are not accepted, additional invitations will be sent to alternates. All current invitees accept by November 22nd.
"If you think your son or player is good enough to play at the highest level, do everything you can to get them at this camp. Be proactive, try to get as many respected coaches as possible to lobby for your son's spot at this camp."
Our Take:
If you get an invitation to this camp… go. It is that simple, if you want to play at the highest level of college lacrosse, this camp is your best opportunity to impress top tier coaches by showcasing your skills against the highest level of competition. The number of total players is kept to a manageable level, so coaches are able to get a good look at each player.
New England Top 150 Lacrosse
Portsmouth Abbey, NH
The New England Lacrosse Camp Top 150 provides the experienced high school player with excellent competition and advanced coaching techniques. Each player will have the opportunity to improve their individual techniques and tactical knowledge and to compete against strong competition. Over 50 Colleges are in attendance providing student/athletes an opportunity to meet college coaches.
"The camp has the best corral of Ivy and NESCAC coaches out there. They aren't just scouting, they are getting players better. And you will see lots of high level, intelligent lacrosse players."
Our Take:
Coach Brown puts together one of the best camps in the country for players who want to improve their game and compete at a high level. This is one of the rare recruiting camps that teach players how to become better. It also boasts a full roster of coaches from the top programs in the Northeast. Every level, D1 to D3. From UMASS, Yale, Tufts, Providence, Bryant, Vermont, Middlebury, Bates, to name a few. The coaching staff is excellent, and they care about the players and helping their game. The experience is more personal than most camps out there.
Peak 200
Springfield, MA
The Peak 200 Lacrosse Camp is a focused, competitive program designed to provide the best possible advanced coaching and playing experience for the nation's most exceptional secondary school players. Each player will be on a team with its own complete coaching staff and will be exposed to individual, position and team training. Emphasis will be placed on advanced techniques, tactics and strategies from some of the top coaches in the country.
"It is a fun camp that has good competition, good numbers and a number of scouts."
Our Take:
Having a college coach as the coach of your team at Peak 200 gives you an opportunity to be exposed to great coaching for the entire week. Not only are you getting better, but as you play all the other teams at the camp, it also gives you the opportunity to play in front of a lot of coaches. Peak 200 also has a great "College Fair" night where each school in attendance sets up a booth and you are given time to speak with all the coaches.
Showtime Recruiting: National Recruiting Showcase
160 of the top rising sophomores (Class 2012) and juniors (Class of 2011) with college lacrosse aspirations will compete from July 13th – July 16th, 2009 at Western Connecticut State University, in Danbury (Fairfield County), CT. Participants will have the opportunity to showcase their skills while being individually assessed during position specific instruction and game sessions. CT. Many top DI, DII, and DIII coaching staffs will be in attendance. In 2008, some of the nation's top coaching staffs were in attendance, headlined by Johns Hopkins and Syracuse.
"The camp is still in its second year, so if you can go to Blue Chip, Top 205 or Blue Chip 225, you may be better off there. But Paul, Joe and Mike have lots of coaching connections and will be able to build their camp into a first choice camp for upcoming players."
Our Take:
This camp is run by former Syracuse standouts, Paul Carcaterra, Joe Ceglia and Mike Springer. They offer invite only spots to rising Sophomores and Juniors. The camp is in its 2nd year at Western Connecticut State University. Last year's camp drew a wide range of top-notch players from throughout the country. The lowdown on this camp is that it is a great place to be seen by some big time programs. Word is that Syracuse found 4 or 5 players who are high on their recruiting lists for the upcoming season. As mentioned above, Hopkins was also patrolling the sidelines. The camp also drew a number of D1 and top D3 programs in the tri-state area. Since the camp is only open to rising sophomores and juniors, this camp is for top players that want to play at the highest level.
Texas 99
The camp covers the Top 99 players in the state selected by the HS coaches. Over 50 colleges were represented. Top 20 D1 schools like Harvard, Notre Dame, Yale, Towson, Ohio State, Navy, Army, Air Force, Maryland, Dartmouth and Penn State as well as developing programs like Hartford, Bellarmine and Manhattan College. Additionally, top D2 and D3 programs like Washington and Lee, Salisbury State, Merrimack College, Bates College, Bowdoin, Limestone, etc attended.
Our Take:
Coach Byrne from ND runs a very well attended camp. You can see by the schools that they list above on their website. The camp is a lifeline for strong high school players from Texas who might not have the opportunity to attend camps on the East Coast.
Top 205
College Park, MD/Towson, MD
The original recruiting camp. It is still regarded as one of the best opportunities to be seen by the top-level coaches. They offer three sessions for players, rising juniors and two open Top 205 camp sessions. The 4 days provide players with the opportunity to go from unknown to on the tip of the coaching communities tongues with an impressive couple of days of play.
"Do not expect to get much individual instruction, this camp is almost all playing, but coaches are camped out on the sidelines."
Our Take:
The camp is known as a stronghold for colleges from the South. The opportunities are there to be seen. It is the best alternative to Jake Reed's Blue Chip camp. If you make the All Star team you are guaranteed looks from top 10 Division 1 programs.


text:
Parent Directory | Revision Log
|Links to HEAD:
|(view) (download) (annotate)
Default clutter license is LGPL-2.1 or later.
dev-util/pkgconfig -> virtual/pkgconfig
fix random bugs in eclass documentation, and convert to new @AUTHOR tag
Convert every instance of hasq to has.
Add a variable to remove all .la files if requested
clutter.eclass: Update LICENSE, allow it to be overriden per-package
Add clutter.eclass. Discussion for addition was finished with no objections on Jan 1 2010
This form allows you to request diffs between any two revisions of this file. For each of the two "sides" of the diff, select a symbolic revision name using the selection box, or choose 'Use Text Field' and enter a numeric revision.
|ViewVC Help
|Powered by ViewVC 1.1.20