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Time estimation is a complex cognitive task that is especially challenging when the time period includes sleep. To determine the accuracy of sleep duration perception, we investigated 44 healthy subjects participating in multi-day inpatient sleep protocols during which they had extended nighttime and short daytime sleep opportunities but no time cues or knowledge of time of day.
The first sleep opportunity was at habitual sleep time and duration. The subsequent 3, 4, or 11 days had 12-h nighttime sleep opportunities and 4-h daytime nap opportunities, potentially creating an experimentally induced "insomnia" with substantial time awake during scheduled sleep.
Subjective sleep duration estimates were accurate for the first (habitual) sleep opportunity. The subjective reports following nighttime 12-h sleep opportunities significantly underestimated objective sleep duration, while those following daytime 4-h sleep opportunities significantly overestimated objective sleep duration. Misperception errors were not explained by poor sleep efficiency, which was lower during 4-h (~39%) than 12-h opportunities (~71%). Subjective sleep estimates after 4-h opportunities correlated with the percentage of REM and N3 sleep. Subjective sleep estimates following 12-h opportunities were, unexpectedly, negatively correlated with NREM stage 2 sleep.
The estimation of sleep duration in the absence of time cues may depend on length of sleep opportunity and/or time of day. The results have implications for understanding sleep state misperception, which is an important consideration in patients with insomnia.
Bianchi MT; Wang W; Klerman EB. Sleep misperception in healthy adults: implications for insomnia diagnosis. J Clin Sleep Med 2012;8(5):547-554.
The clinical diagnosis and management of insomnia rests largely upon the subjective self-report of patients describing difficulty with sleep onset or sleep maintenance.1 It has long been recognized, however, that subjective reports may differ from objective measurements of sleep using physiological criteria.2–6 In particular, patients with insomnia may underestimate their actual sleep times and overestimate their wake times. This mismatch has implications for both diagnosis and treatment of patients with insomnia.
Perception of time as it relates to sleep is a particularly challenging topic. The subjective experience of wake may differ for the time elapsed preceding sleep onset compared to the time elapsed during mid-sleep awakenings. Also, mid-sleep awakenings may be associated with variable levels of alertness, which may affect perception. These issues become clinically important when considering the manifold forms of insomnia, and how the fragmentation of sleep and neurophysiological hyperarousal7,8 may affect time estimation. Current theories of insomnia pathophysiology include the issue of hyperarousal, as evidenced by increased high-frequency EEG activity as well as increased metabolism.7–9 The extent to which hyperarousal contributes to the failure to register what appears to be sleep by physiological criteria is an area of ongoing investigation.10 Because the diagnosis and management of insomnia each rely profoundly on patient self-report, it is critical that physicians and patients improve their understanding of subjective-objective mismatch in sleep duration, or sleep misperception.
Current Knowledge/Study Rationale: Sleep misperception remains an important yet poorly understood phenomenon in sleep medicine. We investigated misperception in healthy individuals with nighttime and daytime extended sleep opportunities expected to elicit isomnia in an experimental setting.
Study Impact: We found that healthy individuals with normal sleep perception at baseline exhibit misperception under inpatient experimental conditions that elicit insomnia. The extent to which insomnia patients with sleep misperception exhibit state or trait features warrants further exploration.
The extent to which sleep misperception may be a "trait" present in certain patients with sleep disorders, or a "state" that varies night to night, remains uncertain. In this study, we investigated self-reported sleep-wake estimates in healthy adults undergoing multiple days of inpatient assessments. Subjects had no time cues during the protocol, including not knowing the scheduled length of their sleep or wake opportunities, and had extended sleep opportunities during the day and at night, which caused an experimental form of insomnia due to excess time in bed. We hypothesized that the perception of sleep duration would be altered in this setting, and would relate to the degree of sleep fragmentation.
Healthy younger and older adults were pre-screened to rule out sleep and circadian disorders and prescription or elicit drug use. Subjects were healthy based on history, physical examination, electrocardiogram, routine blood and urine screens, and a polysomnogram to exclude those with sleep apnea and periodic limb movements.11,12 None had performed night shift work within 3 years or crossed more than one time zone in the previous 3 months. The age of the population was bi-modal, with a "younger" cohort (ages 18-32 years; n = 32) and an older cohort (ages 60-76; n = 12). Chronotype was assessed by the Horne and Ostberg method,13 described here as the Owl-Lark score.
The protocol was approved by the Partners Healthcare Institutional Review Board. Actigraphy and diary monitoring for 3 weeks at home during habitual sleep behavior was followed immediately by the inpatient portion of study. During the home and inpatient portions, subjects abstained from medications, supplements, caffeine, tobacco, and alcohol. Subjects then spent 10-13 days and nights in the Brigham and Women's Hospital General Clinical Research Center, in single occupancy suites with no windows and no information about time. Subjects were not informed of the exact length of their scheduled sleep or wake opportunities; the consent documents stated "You will be assigned to one of four groups which have different patterns of sleep and wake times." The inpatient portion of the protocol was designed to evaluate the response to sleep deprivation for a separate study; some data from this protocol have been previously reported.11,12 The inpatient portion began with an initial sleep opportunity at each subject's habitual sleep time and duration, followed by 3-8 consecutive days with 12-h nocturnal sleep opportunities (centered at the same time as habitual sleep) and 4-h daytime nap opportunities (centered 12 h opposite the 12-h nocturnal sleep period). For some subjects, a sleep deprivation occurred after these 3-8 days (random assignment stratified by age and sex); only the data from before the sleep deprivation and the final 8-h sleep period of the inpatient protocol after three 24-h days of recovery from the sleep deprivation are used for these analyses. The last sleep period was 8 h in duration, centered at the same time as the 12-h sleep period. This last period was not included in most of the Results analysis, unless specifically stated. During waking periods, subjects were not allowed to lie in bed. During sleep opportunities, which occurred in darkness, subjects were required to remain inactive in bed.
Sleep was recorded on Vitaport digital recorders (Temec, The Netherlands) using standard EEG, EMG, and EOG montage, and scored in 30-sec increments according to Rechtschaffen and Kales criteria14 by experienced technicians. For this report, NREM stages 3 and 4 were analyzed separately and as a combined stage to yield stage N3, to align with recent changes in scoring criteria. After each sleep opportunity, subjects were asked to record their estimate of sleep latency, total sleep time (TST), and number of awakenings for the prior sleep period. The errors in these estimates were calculated as "subjective – objective," such that negative values represent underestimation errors. Latency to persistent sleep (LPS) was defined as latency until the start of 20 consecutive epochs (10 min) of any stage of sleep. Wake after persistent sleep onset (WAPSO) was defined as the amount of wake occurring between the end of 20 consecutive epochs of sleep (LPS) and the final awakening. Objective criteria for number of awakenings was pre-specified to be ≥ 2 consecutive epochs (1 min) scored as wake after persistent sleep (as defined above) was achieved.
Group comparisons for basic demographics, TST errors, and sleep efficiency were performed with either ANOVA with Bonferroni correction for multiple comparisons, or, in cases of non-Gaussian distributions, with nonparametric Kruskal-Wallis testing (with Dunn multiple comparisons test). Correlation analysis was conducted using the Spearman nonparametric method. For 12-h and 4-h sleep opportunities, each subject contributed multiple data points, and the number was not the same for all subjects due to the protocol (see supplemental material, Figure S1). Group analysis and correlation analysis were conducted by first taking the median of all 12-h or 4-h blocks for each subject, so that each subject contributed only one data point to the analysis.
Table 1 contains the baseline characteristics of this population (n = 44), divided into older and younger groups. There were approximately equal numbers of males and females. The average habitual sleep durations overall were 8.4 ± 0.9 h (mean ± SD; range of 6.1 to 10.3 h). The habitual sleep durations were not statistically different between age groups, while the chronotype scores were different (ANOVA, p < 0.05), with older groups having more early-morning tendency.
Subject characteristics
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The first inpatient night began at each individual's habitual bedtime and lasted for their habitual sleep duration. We label this first night sleep period as "FNH." The baseline sleep stage findings on this first night are shown in Table 2. The results with subgrouping by age or sex are reported in the supplemental material. Similar sleep time estimation patterns were observed for males and females. Although misperception showed a trend toward being more evident in younger than in older subjects, the differences were not significant. Thus, for the remaining analyses below, all 44 subjects were analyzed as a group.
Sleep characteristics on the first night of habitual time and duration
As expected, sleep efficiency was highest (> 90%) during the FNH night of the experimental protocol. Sleep efficiency was significantly decreased for the enforced nighttime 12-h sleep opportunities (Figure 1A); this is not surprising, given the excess time in bed compared with habitual sleep durations, which averaged ~8 h. Efficiency was lowest for the 4-h opportunities (Figure 1A) that occurred during the daytime. The distribution of sleep stages during the different sleep opportunities differed in the percentage of REM sleep (smaller in 4-h compared to FNH and 12-h), and in the percentage of NREM stage 1 sleep (larger in 4-h compared to FNH and 12-h) (Figure 1B). The temporal pattern of sleep efficiency demonstrates 2 tendencies: (i) gradually decreasing efficiency over successive days in the protocol, and (ii) systematically lower efficiency in the 4-h compared to the 12-h sleep opportunities (Figure 1C). The final sleep opportunity (8-h sleep opportunity) showed partial return towards the sleep efficiency of FNH.
(A) Overall sleep efficiency in the different sleep opportunity durations. Brackets indicate significant differences with p < 0.05 by Kruskal-Wallis test with Dunn post-test. The median sleep efficiency value within individuals was used, such that each subject contributed one point for each sleep period. The first (FNH) opportunity and subsequent 12-h and 4-h opportunities are shown (B) Sleep stage composition in FNH, 4-h, and 12-h conditions. In each group, the values were averaged within subject for 12-h and 4-h periods, such that each subject contributes one point to the group data for each sleep period. *Significant difference from FNH and 12-h (p < 0.05; ANOVA with Bonferroni post-test). (C) Sleep efficiency across each sleep period of the protocol; brackets indicate significant differences (p < 0.05; ANOVA with Bonferroni post-test). Note that (i) SP1 is the first, habitual night (FNH, variable length), SP2 (and subsequent even numbers) are 12-h nocturnal sleep periods; SP3 (and subsequent odd numbers) are 4-h daytime nap periods. The final opportunity, SP17, is an 8-h sleep period centered at habitual time; (ii) the number of subjects contributing values to each sleep period decreased after SP8 due to the protocol design (n = 39-42 for SP 1-7, n = 32 for SP 8, n = 26 for SP 9, n = 11-12 for SP 10-16, and n = 12 for SP17). (D) Subjective TST estimate values according to the duration of sleep opportunity. In the box-and-whisker plots, the boxes show the median as well as 25% and 75% boundaries, while the whiskers show the 90% confidence range (5% to 95%). The "+" symbols indicate the mean value. Brackets indicate significant differences (p < 0.05; Kruskal-Wallis test, with Dunn post-test). In each group, the median value was taken across 12-h and 4-h periods, such that each subject contributes one point to the group data. (E) Objective TST values according to the duration of sleep opportunity. Box-and-whisker plots as in panel D. Brackets indicate significant differences (p < 0.05; Kruskal-Wallis test, with Dunn post-test).
Sleep stages and relation to total sleep time errors(A) Overall sleep efficiency in the different sleep opportunity durations. Brackets indicate significant differences with p
Figure 1D shows that the subjective estimates following 12-h opportunities were significantly lower than those for the habitual duration, and that estimates for 4-h opportunities were significantly lower than those for either 12-h or FNH opportunities (p < 0.05, Kruskal-Wallis). Figure 1E shows for comparison the objective TST values for the FNH, 12-h, and 4-h sleep opportunities; the objective TST for 4-h periods was significantly smaller than the other periods (p < 0.05, Kruskal-Wallis).
Subjective TST estimates were accurate for FNH, with a median error of −9.1 min (quartiles of -43.5 to 51.3 min), not significantly different from zero error (Figure 2A). Negative values indicate underestimation (subjective minus objective TST minutes). Subjects significantly underestimated their TST for 12-h sleep opportunities, and overestimated their TST for 4-h sleep opportunities (Figure 2A). The median TST error was -109.4 min (quartiles of: -227.2 to -47.4) after 12-h opportunities and 58.3 min (quartiles of: −0.2 to +142.4) after 4-h opportunities (Figure 2A).
Errors in estimating the total sleep time (A), sleep latency (B) and number of awakenings (C) are shown according to the sleep opportunity: first night habitual (FNH), 4-h and 12-h durations. In the box-and-whisker plots, the boxes show the median as well as 25% and 75% boundaries, while the whiskers show the 90% confidence range (5% to 95%). The "+" symbols indicate the mean value. In each group, the median value within each subject was used for 12-h and 4-h periods, such that each subject contributes one point to the group data. The error metric is derived from subtracting the objective value from the subjective value, such that negative values represent subjective underestimation. Brackets indicate significant differences by Kruskal-Wallis (in panel B and C, with Dunn post-test; p < 0.05). (D) The distribution of TST errors is shown over successive sleep periods. SP1 is the first, habitual night (FNH, variable length), SP2 (and subsequent even numbers) are 12-h nocturnal sleep periods; SP3 (and subsequent odd numbers) are 4-h daytime nap periods. SP17 is an 8-h sleep period centered at habitual time. Note that (i) SP1 is the first, habitual night (FNH, variable length) SP2 (and subsequent even numbers) are 12-h nocturnal sleep periods; n = 39-42 for SP 1-7, n = 32 for SP 8, n = 26 for SP 9, n = 11-12 for SP 10-16, and n = 12 for SP17. Brackets indicate significant differences between adjacent sleep periods (p < 0.05; ANOVA with Bonferroni correction).
Accuracy of self-reported sleep latency, total sleep time, and awakeningsErrors in estimating the total sleep time (A), sleep latency (B) and number of awakenings (C) are shown according to the sleep opportunity: first night habitual (FNH), 4-h and 12-h durations. In the box-and-whisker plots, the boxes show the median as...
Sleep latency estimations were accurate for FNH and 4-h sleep opportunities, but were slightly but significantly underestimated for 12-h sleep opportunities (Figure 2B). The number of reported awakenings within sleep was significantly underestimated compared to objective criteria for FNH and 12-h sleep opportunities, while the number reported for 4-h opportunities was accurate (Figure 2C).
To illustrate the temporal stability of the systematic under- and overestimations of TST, Figure 2D shows the errors for each sleep period: the alternating pattern for 12-h and 4-h sleep periods of errors persists throughout the protocol. The final sleep opportunity (SP17) was an 8-h opportunity at the habitual sleep time and shows resumed accuracy, although the variance was larger than on the first night. Similar patterns were observed when we compared male versus female subjects, and old versus young subjects (Figure S2).
We next conducted correlation analysis to determine whether the degree of TST error was related to sleep consolidation in the prior sleep period. There were no significant correlations between the TST error for a given 12-h or 4-h sleep opportunity and the sleep efficiency of the preceding 4-h or 12-h sleep opportunity, respectively (data not shown). We also conducted correlation analysis between the subjective TST estimates and sleep stage metrics (Table 3). No significant correlations were observed between sleep stages and TST estimates during FNH (data not shown), a condition in which TST estimates were highly accurate (see Figure 2A). We had predicted that TST estimates should have inverse correlations only with generally accepted metrics of sleep fragmentation, such as WASO, N1 sleep, and number of awakenings. These metrics were not significantly correlated with subjective TST estimations, however. Surprisingly, TST estimates were negatively correlated with the percentage of NREM stage 2 sleep.
Correlation with TST estimate
For the 4-h sleep periods, TST estimates were positively correlated with the percentage of stages N3 and REM sleep (Table 3). Similar correlations were found for individual NREM stages 3 and 4 sleep, when considered separately (data not shown).
The above analysis considered the subjective estimation of TST, regardless of accuracy. We finally turn to investigation of correlations with the magnitude of the error in TST estimation (Table 4). Given that our calculation of TST error yields negative values for underestimation, positive correlation means "the higher the value of variable X, the less the TST underestimation." Regarding 4-h sleep opportunities, we found no significant correlations between sleep-wake stage percentages, efficiency, or number of awakenings and the TST error (Table 4), including when NREM stages 3 and 4 were analyzed separately (not shown).
Correlation with TST error
Of note, the objective TST was not significantly correlated with the subjective estimate of TST during 12-h sleep opportunities (r = 0.26; p > 0.05). Objective TST during 12-h sleep opportunities was, however, positively correlated with REM% (r = 0.30; p < 0.05), and inversely correlated with WAPSO% (r = −0.76; p < 3x10-9) and the number of awakenings (r = −0.32; p < 0.03) (Table 5). Objective TST during 4-h sleep opportunities was correlated positively with the subjective TST estimate (r = 0.31; p < 0.04), as well as the REM% (r = −0.72; p < 3x10-7), while it was inversely correlated with LPS (r = −0.33; p < 0.03), NREM stage 1% (r = −0.38; p < 0.01), and WAPSO% (r = −0.55; p < 0.0001). Unexpectedly, the objective TST was positively correlated with the number of awakenings during 4-h sleep opportunities (r = −0.56; p < 9×10-5), (Table 5).
Correlation with objective TST
Regarding 12-h opportunities, TST errors were not correlated with sleep latency errors, arguing against a "general" error of time perception. This suggested that retrospective self-report of sleep onset and total sleep time involve distinct cognitive processes. Contrary to expectations, TST error was positively correlated with WAPSO (lower WAPSO correlated with greater underestimation) and negatively correlated with the proportion of NREM stage 2 sleep (higher N2% correlated with greater underestimation). The direction of these relationships was unexpected, given the working hypothesis that errors are increased by sleep fragmentation. Two potential explanations were entertained. One is that larger errors are theoretically possible when more objective sleep (and less WAPSO) occurs and N2 comprises the majority of objective TST. The other possibility relates to the fact that the TST error is calculated directly from the objective TST, which is itself positively correlated with time spent in NREM stage 2 sleep and negatively correlated with time spent awake. To evaluate the potential for spurious correlations of TST error with sleep stage percentages due to this "embedded" correlation, we undertook additional analysis (supplemental material). This analysis shows how sleep architecture associations with TST error are confounded by the fact that the objective TST is both used in the calculation of the error and itself has correlations with sleep architecture components. This embedded correlation may lead to incorrect conclusions about TST error in relation to sleep stage percentages.
The main finding of this study is that healthy adults without evidence of sleep misperception on the baseline habitual night of sleep within an inpatient experimental facility exhibit substantial sleep misperception under subsequent conditions of (i) absence of time cues and (ii) extended time in bed per 24 hours. The inpatient extended sleep opportunity resulted in decreased sleep efficiency and thus a form of experimental insomnia. The misperception of sleep duration was bi-directional: overestimation of sleep following 4-h daytime nap opportunities, and underestimation of sleep following 12-h nocturnal sleep opportunities. Contrary to our working hypothesis, neither the subjective TST estimates nor the extent of their accuracy was correlated with commonly accepted indices of sleep fragmentation, such as NREM stage 1 sleep or the number of awakenings.
Retrospectively estimating sleep duration involves, among other things, time cues common to daily life, such as looking at the time just before bed, natural sunlight variations, and waking to an alarm in the morning. Systematic removal of time cues may compromise accuracy in retrospective time estimation. The use of auxiliary cues is not surprising, since sleep is a state of altered consciousness, and presumably an individual cannot directly assess a sense of time passage while asleep. For patients with insomnia, the existing data do not support the hypothesis that general time perception is abnormal. For example, in one study, time perception during wakefulness was intact in patients with insomnia,15,16 and in another study showing mild overestimations of short time periods (< 3 min), there were no differences between those with insomnia and controls.17
Errors in TST underestimation are most clinically relevant for insomnia patients, who often demonstrate a component of sleep misperception.2 Underestimation errors were observed specifically for 12-h nighttime sleep opportunities, whereas overestimation was observed for 4-h daytime sleep opportunities. TST errors were related to NREM stage 2 sleep in an unexpected direction: the less of this stage, the higher the subjective TST estimate. The basis of this finding is uncertain, though it is worth mentioning that the percent of NREM stage 2 sleep was inversely related to the percentage of REM and N3 sleep. Thus the apparent correlation may be spurious (see supplemental material) and reflect its relation to these other stages of sleep, which themselves did not reach significance in correlations with TST estimates, possibly due to greater variance compared to the dominant NREM stage 2 sleep percentages. Similarly, the apparent correlation of TST error with the percentage of WAPSO was likely related to the strong inverse correlation of WAPSO with objective TST (see Table 5).
Regarding the potential importance of sleep stages, there is literature supporting the restorative and cognitive roles of REM and slow wave sleep,18,19 although a variety of opinions on the role of particular sleep stages exist.20–22 Here, REM and slow wave sleep only showed significant correlations with TST estimates following 4-h sleep opportunities. The relationship is clearly complex, since TST was overestimated for 4-h sleep opportunities, despite less REM sleep in these daytime naps.
Although we expected that the degree of fragmentation evidenced by increased WAPSO% would influence the perception of sleep, clearly this is not a simple causal relationship, as the TST errors following 12-h periods were larger when WAPSO% was smaller, and there was no correlation of WAPSO% with errors following 4-h periods. In addition, TST errors for 4-h periods were overestimated despite the markedly decreased sleep efficiency. One might predict that this overestimation was in fact related to sleep inertia when awakening from slow wave sleep. Despite a correlation of TST estimate following 4-h sleep opportunities with the N3%, there was no correlation of TST error for 4-h sleep periods with the absolute or relative amount of slow wave sleep whether it was considered as NREM stages 3 and 4 sleep separately or combined as stage N3 sleep. In fact, the magnitude of TST error for 4-h periods was not correlated with any other sleep-wake metrics. Therefore, misperception is not strictly related to the degree of fragmentation or WAPSO. The difference between subjective estimates and the extent to which they are incorrect (i.e., the TST error) suggest that the subjective experience of sleep has complex dependencies, only a portion of which relates to the sleep-wake stage content of the sleep opportunity.
In summary, subjective sleep estimates demonstrated correlation with sleep stage amounts. The magnitude of misperception errors, however, showed no clear mechanistic link to the amounts of individual sleep stages. The potential roles for circadian phase in sleep perception could not be assessed in these protocols, but could represent an important factor in how we process time perception. We also cannot address whether subjects inferred either the time of day or the expected sleep duration based on the repeating alternation of 12-h and 4-h sleep opportunities, despite not being informed of this pattern. The extent of misperception was nevertheless substantial, even if unaccounted for heuristics were involved.
Despite the extensive literature documenting the occurrence of misperception in various sleep disorders,2–6,23,24 the issue of perception is not typically addressed in epidemiological studies that depend on self-reported sleep.25 Many reports utilize subjective reports of latency, efficiency, and total sleep time in insomnia interventions.26 Although the patient's subjective perception is a justifiable endpoint for assessing the effectiveness of interventions, from a mechanistic standpoint and from the perspective of possible feedback to re-align subjective-objective mismatch, understanding the degree to which this phenomenon occurs in insomnia patients remains an important goal.
Clearly the misperception of sleep times was a "state" rather than a "trait" phenomenon in this study of healthy adults. Patients with insomnia could, in principle, demonstrate a trait of misperception, independent of the sleep stage amounts on a particular night, in which case pharmacological management takes on a perspective other than increasing the amount of sleep obtained. Other patients may demonstrate fluctuations in their sleep stage amounts and consolidation from night to night, and thus their degree of misperception may also fluctuate as a reversible state. Determining where on this spectrum a particular patient resides may have important implications for insomnia management.
This study has several limitations. First, the experimental setting was highly controlled, and thus may not have external validity with respect to the sleep-wake patterns of patients with insomnia. Although excess time in bed is a maladaptive behavior adopted by some patients with insomnia, absence of time cues and other experimental restrictions on activity do not occur clinically. The variance in misperception among individuals with insomnia accounted for by excess time in bed is unknown. Moreover, the habit of clock-watching may actually exacerbate insomnia. Second, the form of insomnia observed here is entirely attributed to excess time in bed, whereas clinical insomnia is often multifactorial. Third, healthy subjects presumably do not have the hyperarousal that is hypothesized to be a major pathophysiological aspect of chronic insomnia. The extent to which hyperarousal contributes to misperception is incompletely understood, but cortical hyperarousal is a plausible (and testable) potential etiology.10 Finally, we cannot distinguish possible contributions of circadian factors (i.e., time of day or night) or sleep opportunity duration (4-h or 12-h) as potential causes of the differences in misperception between the two types of sleep period using these data.
This was not an industry supported study. Dr. Bianchi has a patent pending on a home sleep monitoring device that may be used in the future for insomnia patients. Dr. Klerman has received support from Respironics and Sony Corporations. The other author has indicated no financial conflicts of interest.
The authors thank Drs. Andrew Phillips and Catherine Chu-Shore for valuable discussions. Funding: Department of Neurology, Massachusetts General Hospital, Center for Integration of Medicine and Innovative Technology, and the Clinical Investigator Training Program: Harvard/MIT Health Sciences and Technology – Beth Israel Deaconess Medical Center, in collaboration with Pfizer, Inc. and Merck &Co. (MTB); NIH P01-AG009975, NSBRI HFP01603, NIH RC2-HL101340, K02-HD045459, and NIH K24-HL105664 (EBK); and NCRR-GCRC-M01-RR02635 to the BWH GCRC.
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To evaluate the potential for spurious correlations between TST error and sleep architecture components, we performed a simulation experiment. Fifty "subjects" were simulated to have normally distributed variance of stage percentages with the following means: 5% wake, 5% N1, 50% N2, 20% N3, and 20% REM. These values were chosen to approximate typical amounts seen in laboratory polysomnogram data. We assumed a fixed time of 8 h total time in bed. We then simulated subjective TST values as random numbers from 180 to 480 min, to mimic the majority of the experimentally observed subjective sleep times. These simulated estimates had no correlation, by definition, with the simulated objective TST values (mean 95% efficiency, or ~456 min). These values allowed us to test the hypothesis that TST errors could be spuriously correlated to sleep stage percentages simply because stage percentages are correlated with the objective TST, and TST enters into the calculation of TST error.
The simulated objective TST values showed the following significant correlation coefficients: wake, 1.0; N2, 0.77; N3, 0.21; REM 0.17 (p < 0.05). This demonstrates, as expected, that the objective TST is correlated to varying degrees with sleep-wake stages. The exact inverse correlation with wake is due to the fact that TST is calculated by subtracting wake from the time in bed.
We then measured correlations between the TST errors and the simulated sleep stages. Figure S3, A1 shows that the percentage of N2 sleep was correlated with the TST error, with r = 0.42 (p < 0.002). Thus, even though the simulated subjective sleep times were randomly assigned, the TST error can show "significant" sleep stage correlations, because the objective TST was itself strongly correlated with stages, in particular, here, with stage N2 sleep. Figure S3, A2 shows the observed data from our experimental subjects, demonstrating that the correlation of TST error with stage N2 sleep was similar to that seen in our simulations.
Although these simulations were compelling, they included assumptions about stage percentages and subjective estimates. Therefore, we next turned to our experimental data to explore the potential for spurious correlations. To this end, we randomized the experimental TST error values by reassigning the subjective estimates randomly, and repeated this scrambling process 100 times, to generate a distribution of possible correlation coefficients. We performed this analysis with the WAPSO percent (Figure S3, B) and the N2 percentage (not shown). Note that the strong correlation with WAPSO in the experimental data (~0.4) is well within the range expected by pure chance, using this scrambling protocol. Thus, by these complementary methods, we conclude that sleep-wake stage percentage correlations with TST error are inherently confounded by the "embedded" correlations with TST itself.
The protocol for the study is shown in double raster format. Clock time is on the X-axis, and day on the Y-axis. Black bars represent sleep opportunities. For some subjects (random assignment), a sleep deprivation occurred after 3 (n = 12) or 4 (n = 20) days of this 12+4 schedule; 12 subjects continued on this schedule without sleep deprivation for 8 days (as shown in figure). Data after this sleep deprivation were not included in these analyses, except for the final 8-h sleep episode, in certain analyses. Actual protocol times were adjusted for each subject. The dashes indicate that multiple sleep latency testing was performed. Total n = 44.
The error in TST (defined as subjective – objective values, in minutes) is given according to sleep period (SP#). The means and SD values are shown for subgroups as follows: males (A), females (B), younger (C), and older (D). Brackets indicate significant differences between adjacent sleep periods (ANOVA with Bonferroni correction; p < 0.05). For the male group, n = 19-23 for SP 1-7, n = 16 for SP 8, n = 15 for SP 9, n = 5-6 for SP 10-16, and n = 13 for SP17. For the female group, n = 17-21 for SP 1-7, n = 16 for SP 8, n = 11 for SP 9, n = 5-6 for SP 10-16, and n = 11 for SP17. For the younger group, n = 28-31 for SP 1-7, n = 24 for SP 8, n = 20 for SP 9, n = 7-8 for SP 10-16, and n = 16 for SP17. For the older group, n = 10-12 for SP 1-7, n = 8 for SP 8, n = 6 for SP 9, n = 3-4 for SP 10-16, and n = 8 for SP17. The reason for variation in particular sleep periods relates to infrequent missing data, as well as differences in when the sleep deprivation occurred (i.e., whether after sleep period 8 or 9).
Sleep-wake stage percentages were simulated as Gaussian distributions (± 20% standard deviation) centered at these mean values: 5% wake, 5% N1, 50% N2, 20% N3, and 20% REM. Four of the 5 stages were simulated, and the final stage adjusted to yield 100% (with approximately equal proportion of each stage being the "adjusted" one); negative values were not allowed. TST was calculated by subtracting the % wake from the fixed time in bed of 8 hours. Random subjective TST values, in a uniform distribution between 180 min and 480 min were used to calculate TST error values. Panel A1 shows the correlation of TST error with the NREM stage 2 percentage (linear regression and 95% confidence interval), with r = 0.42 (p < 0.002). Panel A2 shows the same analysis applied to the observed data from our experimental subjects. Panel B shows the distribution of correlation coefficients between WAPSO % and the TST error obtained over 100 trials of random scrambling of the experimental TST error values. The observed correlation is shown (left column) for comparison. In the box-and-whisker plots, the boxes show the median as well as 25% and 75% boundaries, while the whiskers show the 90% confidence range (5% to 95%); outliers are shown as filled circles.


text: Find this wine Find this wine Cupcake Vineyard Chardonnay 2011 Recommended Delicious Pin It Tweet 6 years ago by TwoPaddlers More posts Cupcake Vineyards Chardonnay 2011 Ok 6 years ago by Cathijohnson1 Cupcake Vineyards Chardonnay Light tasting, fruity, low strength Central Coast 2011 6 years ago by Katie T. Cupcake Vineyards Chardonnay 2011 from Randy - decadent flavors of butter cream, bright citrus and vanilla melt into a balance of oak and subtle spice. 6 years ago by canoe52 Cupcake Vineyards Chardonnay 2011 A little sweet, fruity 6 years ago by Jessica L Cupcake Vineyard Chardonnay 2011 Lees in Mesquite 1/5/13. Total wine $7.97 2/8/13 6 years ago by Mrssatch

subset: commoncrawl


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Britta Jaschinski
Britta Jaschinski is a German photographer based in London. Her work has been published and exhibited worldwide and received numerous awards. In 2017 she was named the GDT European Wildlife Photographer of the Year, and won the BigPicture Natural World Competition Grand Prize. She is the co-founder of the group Photographers Against Wildlife Crime, together with editor and writer Keith Wilson.


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This website uses cookies to function and to improve your experience. By continuing to use our site, you agree to our use of cookies.
COMSOL, Inc. is seeking a computational physicist with a specialty in optics to join the development team in its Burlington, MA office. We are seeking an individual with a strong background in numerical simulations, particularly ray tracing simulations, although a background in finite element methods is also desirable, as well as any experience in multiphysics analysis or design of optical systems.
COMSOL is an Affirmative Action/Equal Opportunity Employer.
Has COMSOL been identified to you as a source of potential employment by
any employment recruiter or placement agency at any time?*
Name of employment recruiter or placement agency*
COMSOL is an Affirmative Action/Equal Opportunity Employer. Any information you
volunteer below is for compliance with government regulations and guidelines only.


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Two people have been convicted of an elaborate housing fraud scheme that operated out of a vacant South Florida coin laundry.
A federal jury last week convicted Darryl Burke and Vicki Garland of Delray Beach on conspiracy, bank fraud and wire fraud charges. They face sentencing April 18.
Testimony showed the pair used the coin laundry address for a variety of fake companies. Evidence showed they falsified documents to obtain bank loans to invest in low-income neighborhoods. Then they enrolled the properties in U.S. Housing and Urban Development low-income programs to receive money from government vouchers.
Testimony also showed Burke and Garland falsely claimed to be disabled veterans to avoid property taxes.
Prosecutors say the pair had a waterfront residence, luxury cars and courtside tickets to Miami Heat games.


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(Phoenix, AZ–August 12, 2003) Arizona Attorney General Terry Goddard is warning Arizona residents of several advertisements that are appearing in valley newspapers offering high yield "FDIC Insured Bank CDs." Several consumers have filed complaints with the Attorney General's Office in response to such advertisements and being sold products that were not individual certificates of deposit, but rather group certificates.
These group certificates, sometimes known as "pooled certificates" have different features and protections than individual certificates of deposit. In some cases, pooling of monies into a group certificate can limit the individual investor's ability to cash out their contribution prior to the certificate's maturity, often a period of many years.
With interest rates so low, consumers are always on the lookout for the highest return on their investments. However, in some cases unscrupulous salespeople are selling pooled certificates without disclosing the differences between those and individual certificates.
In a related issue, some advertisements are creating the appearance of offering a higher return rate by calculating into the return rate some form of "bonus" consumers are paid up front. For example, if a consumer is "paid" $50.00 for moving a certificate of deposit from one investment company to another, that $50.00 is then calculated into the return rate advertised by the company and artificially raises the rate.


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Explore Our Hotel
Welcome to our Airport Hotel in Austin, TX
Allow this unique city to show you what it means to, Keep Austin Weird, as its motto insists. Seemingly misplaced in the land of honky tonk, this art influenced, distinctly different city boasts the title of "Live Music Capital of the World." Whether you are in town for business or leisure, the all suite Holiday Inn Express & Suites Austin Airport hotel offers a welcoming and comfortable atmosphere to call home during your stay. Families find their Texas travel can be stress-free with our Complimentary Shuttle to nearby Austin Bergstrom Airport. Hotel guests benefit from our convenient location just minutes from downtown Austin and the University of Texas. Our all-suite hotel offers larger, more comfortable rooms and Happy Hour every Monday to Thursday, from 5:30PM to 7PM. Business travelers looking for an airport hotel in Austin, TX need look no further than our Austin, Texas hotel. We are located just a minutes from companies like Ercot, AMD, Freescale, IBM, Helio Volt, LCRA, and the MetCenter Business Park.
Free high-speed wireless Internet access is provided to keep you connected. Use our 24-hours business center. Our outdoor pool, and whirlpool will keep you cool from the Texas heat. Take advantage of our 24-hours fitness center. Our Hotel guests can Stay Smart when they stay with us.
- Crib Available
- Iron/Ironing Board
- Separate Hanging Closet
- In-Room Heating and A/C Controls
- Extra Bedding Available
- Sofa Bed/Sleeper Couch
Bathroom/Personal Care
- Private Bathroom
- Bathroom Amenities Available
- Hair Dryer
- Bathtub
In-Room Features
- Mini Refrigerator
- Microwave
- Coffee Maker
- Flat-screen TV
- DVD Player
- Work Desk with Lamp
- Free Local Calls
- Cable/Satellite
- Premium Channels
- Stereo/Radio
- Direct-dial Phone
- Two-line Phone
- Phone with Voicemail
- Complimentary Morning Newspaper
- Windows Open by Guest
Added Value
- Connecting Rooms Available
- Separate Living Room
- Complimentary Coffee/Tea Supplies
- Full Breakfast Included
- Breakfast Buffet Included
- Continental Breakfast Included
- Complimentary Coffee in Lobby
- Off-site Restaurant Delivery Available
Business Services
- 1 Meeting Room(s) Available
- On-Site Business Center
- Printer
- Copier
Internet Access
- Free High-Speed Internet in all Rooms
- Wireless Internet service is free for all IHG® Rewards Club members
Entertainment & Recreation
- Outdoor Pool
- Outdoor Whirlpool
- Outdoor Pool Hours of Operation: 10:00 AM - 10:00 PM
Health & Fitness
Complimentary Fitness Center
Our Complimentary Fitness Center offers a treadmill, stationary bike, elliptical, and weight training machine for all your cardio and weight-training needs.
Hours of Operation: 12:00 AM to 11:59 PM
Fitness Center Type: LIMITED
Fitness Center Equipment:
- Treadmill
- Elliptical Machines
- Free Weights
- Stationary Bicycle
Last Renovation of Fitness Center Equipment: 2018
Housekeeping & Laundry
- Daily Housekeeping
- On-site Guest Self-Laundry Facilities
- Hours of Operation: 12:00 AM - 11:59 PM
Added Value
- Concierge Services
- Language Interpretation
- Wake Up Calls
- ATM/Cash Machine
- Ice Machine
Hotel Details
7601 East Ben White Boulevard
Austin, Texas 78741
United States
Check In: 3:00 PM
Check Out: 12:00 PM
Check-in Age: 21
Parking + -
- Complimentary Self Parking Available
Shuttle + -
- Complimentary Airport Shuttle Service Available For :Austin-Bergstrom international Airport.
Accessibility + -
- Public Entrance
- Guest Rooms
- Elevators
- Public Restrooms
- Registration Desk
- Exercise Facility
- Business Center
- Number of Accessible Meeting Rooms: 1
Accessible Hotel Areas
- Registration Area
- Accessible Guest Rooms
- Business Center
- Meeting Room
- Pool
Hotel Areas with Accessible Routes from Accessible Public Entrance
- Accessible Self Parking
- Van Accessible Self Parking
- Ramp Access
- Closed Caption TVs
- Telephone with TDD
- Visual Alarm/Alert in Guest Rooms
- Visual Alarm/Alert in Public Spaces
- Communication Kits with Visual Alarms
Provided by Hotel
Pet Policy + -
- Service Animals Allowed
- Pets are not allowed. Service animals are always welcome.
Facility + -
- Smoke-Free Facility
- Number of Floors: 4
- Total Number of Rooms: 80
- Number of Suites: 80
- Number of Non-Smoking Rooms: 80
- Number of Accessible Rooms: 6
- Connecting Rooms Available
- Public Spaces Renovated in: 2016
- Guest Rooms Renovated in: 2016
Languages + -
Languages Spoken by Staff
- English
- French
- Korean
- Spanish
Credit Cards + -
- American Express
- Visa
- MasterCard
- Diners Club
- Carte Blanche
- Discover


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The Alexandria Handmade Briefcase
The Grove Lane line of handmade briefcases and messenger bags provide you with a professional-looking bag that is as versatile as they come. These briefcases and bags provide you with all the utility you need, making them great for business meetings, travel, and for cyclists alike. We've tested these bags to make sure they work for your daily routine.
Length: 37cm;
Height: 26cm;
Width: 10cm;
Shoulder Strap(Adjustable): 140cm
Color: Dark Brown


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Friday, August 16, 2013
Patient quote of the day
16 comments:
- ER's Mom said...
Are we sharing patients again?
- August 16, 2013 at 6:24 AM
- Your Doctor's Wife said...
Glad to see they have their priorities in order.
- August 16, 2013 at 11:23 AM
I hope they don't live in NJ. Worst state to get divorced in. Better to just live together.
- August 16, 2013 at 11:38 AM
"They told us that if we didn't break off, they'd kick us out of the church."
- August 16, 2013 at 1:35 PM
- thethingspatientssay said...
This would be a better story if they were a male gay couple.
- August 16, 2013 at 2:03 PM
Ok? I'm not seeing the issue. Planning a wedding can be very stressful and time consuming, hence the break from attempted baby-making. Does that not make sense to anyone else? Or are people taking issue with trying to have a baby prior to getting married? Because if that's the issue, I have to wonder what century you folks are living in.
- August 16, 2013 at 2:42 PM
Anonymous 2:42 pm: I don't think it's the premarital sex that people are commenting on. It's that the patient makes it sound like she/he is having sex 24/7
- August 16, 2013 at 6:44 PM
- A Doc 2 Be said...
Wonder if these are the same folks who wanted the cell phones last November...
- August 16, 2013 at 11:19 PM
Hey, maybe they married at one of those abstinence/commitment churches.
Some pastors will only preform the ceremony if the couple sign up to a period of abstinence before the wedding. It's supposed to test their commitment, and make the marriage ceremony more meaningful for them.
Could be worse - my cousin's church won't marry couples who've had pre-marital sex at all. And the relationship has to have lasted a minimum of two years of abstinence, church attendance and bible studies.
- August 17, 2013 at 4:15 AM
Anon 6:44, I don't think she does make it sound like they're having sex 24/7. She makes it sound like they put the baby-making on the back burner and just weren't trying for a while, which is perfectly reasonable. "Planning a wedding can be very stressful and time consuming, hence the break from attempted baby-making."
There's nothing weird or stupid about what she said. I think sometimes people want to see stupidity where there is none just so they can feel superior.
- August 17, 2013 at 8:04 PM
If people think having and raising a child is easier to handle unmarried then they are obviously not ready to be parents. Yes, even if it is the 21st century, it is still the wrong order in which to proceed.
- August 18, 2013 at 6:38 PM
anonymous 2:42, since even in the 21st century, children born to unmarried parents tend to do worse in life (more likely to end up on welfare, more likely to end up in jail, more likely to drop out of school, you get the picture), the order very much matters.
- August 19, 2013 at 12:45 PM
does anyone else recall the old joke about wedding cake and contraception??
- August 19, 2013 at 1:53 PM
Anonymous at 12:45, I would like to know where you got these splendid statistics from.
- August 21, 2013 at 5:37 PM
Anon 8:04 PM, are you saying the entire post is stupid because you didn't read into the comment they way others did? If so, then aren't you the one with the superiority complex?
- August 22, 2013 at 7:41 AM
And on the day they were married, the non-stop sex stopped...cold.
Tell me I'm wrong.
- August 26, 2013 at 12:17 PM


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The 30th Annual Hot Rod Reunion hosted by Shades of the Past keeps getting better
The Hot Rod Reunion, hosted by the Shades of the Past, celebrated its 30th annual event and even a little rain couldn't keep 2,791 entrants and nearly 20,000 spectators from enjoying plenty of "sunny" southern hospitality. Getting comfy in its new home at Dollywood's Splash Country Water Adventure Park, the "Shades", as it's likely to be called, continues to grow and offer a wide breath of hot rods to view. And it will continue to get better as the available area for the event will be expanded again in 2013.
This year marked the second time that the STREET RODDER/Painless Performance Products Top 100 joined with Shades to make this event one of the coveted 10 events, but it was the first time the selected 10 cars were displayed with the Shades Top 25. (The Top 25 is a prestigious award, recognized by rodders everywhere.) Added to this mix was Ford Racing Performance/STREET RODDER's Best Ford in a Ford pick as well as the second time the AMSOIL/STREET RODDER Road Tour has joined this event as one of the eight weeklong legs. All three keynote themes will be back in 2013. In fact, rumor has it that the Vintage Air leg of the Road Tour will head out from San Antonio, stopping at the 31st Hot Rod Reunion in Pigeon Forge, Tennessee. Now that's a road trip worth taking.
The Hot Rod Reunion is well known for a number of happenings within the main attraction, like the winner of the giveaway PPG blue '32 Ford highboy roadster that was built at Alloway's Hot Rod Shop (Bobby Alloway is a member of the club). All of the products used in the build of this car were donated by many companies from within our industry. The club gives away a car each year and plans are already in the works for next year's giveaway. (See the Feb. '12 issue of SR for a listing of all the cars given away since the club's inception.) With 2013 representing the 32nd anniversary of the event it wouldn't be fair if we tipped the club's hand on what the car will be, but we're sure every hot rodder would thoroughly enjoy driving this one home.
Speaking of driving home—this year's little blue Deuce highboy roadster was won by Sharon Frady (No. 1535) of Cleveland, Tennessee. To say she was both happy and stunned wouldn't do justice to the look on her face when the winning ticket was selected and her number read aloud. Several hours later we watched her drive off and there was still the "deer in the headlights" look of disbelief. Well Frady, believe it. You are driving home in an Alloway-built hot rod, and that's something to make anyone's weekend special.
There can be no denying winning a car, especially a custom-built hot rod, is something very special, but Shades has plenty more to share with rodders. If you are an early registrant you are placed in a drawing for $10,000 and that should get everybody's attention. It sure woke up Red Lamoreaux (No. 1675) of Trenton, New Jersey, when he heard his ticket number coming out of the PA system. We suspect that his drive home to Jersey was a great deal more pleasant than the drive down! Although it was pretty good as he did it in his hot rod.
Another East Coaster is Richard Jones (No. 1804) of Severna Park, Maryland, and was he pleasantly surprised to find out that he had won the 50/50 raffle. The total was $43,226 and 50 percent of it went home in his hot rod. The club wasn't done sharing the 50/50 proceeds as the Empty Pantry Fund and Toys for Blount County received $4,000; the Dollywood Company received $2,500 for its Share It Forward program; The Ronald McDonald House of Knoxville, Tennessee, received $2,500; and several local churches as well as other charities benefitting senior citizens come Christmas time will find a welcome present.
The Shades event is well known for its number of awards and also for the strict judging guidelines when selecting the Top 25. But the toughest judges of all are the car owners of the Top 25 who vote and they alone select the car and owner to receive Winner's Choice Best in Show. No complaining here about the judging! There's also the Fab Five taken from the Top 25 as well as the Best Street Rod, Best Street Machine, and Best Street Cruiser. The cars that make the Top 25 are as good as any hot rod found anywhere in the country and that's what makes this event so special. It really does draw the best of the best.
Top vote getter at this year's event was Frank Tetro (No. 229) for his black RM-painted '55 Ford Sunliner. Tetro worked off the design efforts of Eric Brockmeyer while Alloway's Hot Rod shop mocked up the car, establishing just the correct stance. From here Tetro and his crew of Jason Magnum, Randy Hadwiggen, Will Tetro, Clay Deenan, and Frank Jr. brought the car to its completion.
The Ford sits on an Art Morrison chassis with a Winters rearend housing filled with a 9-inch centersection and Strange axles and coilover shocks. You can see the Alloway wheels (built by Boyd Coddington back in the day) that are wrapped with BFGoodrich rubber. Motorvating this hot rod is an original '66 Ford 427 SOHC (cammer) V-8. (If you want to learn more about this spectacular hot rod then you will have to wait several months for this car to appear as a full feature in SR.)
Other top vote getters form the Fab Five, made up of Frank Tetro also Best of Show, Larry Olson for his black and flamed '40 Ford coupe (STREET RODDER feature car) and Best Street Rod, Johnny Edmundson for his brilliant red '55 Chevy (SRP Winter '13 feature car), William Shores' '32 Ford highboy roadster (will be featured in a future issue of SR), and the Peter Datino for his '32 Ford three-window coupe. Other coveted awards went to Nathan Powell for his '66 Nova as Top 25, Best Street Machine, and the Billet Specialties award, and Josh Dennison for his '55 Caddy as a Top 25 and Best Street Cruiser.
A handful of the other numerous awards include the PPG award for Best Paint presented to George Keel for his red '55 Chevy that also took home one of the Painless/STREET RODDER Top 100 awards; the BFGoodrich pick went to Barry Ewing for his '33 Ford; Jack Stirnemine, for his beautiful black '34 Ford coupe, took home the Pete & Jake's award; the Vintage Air award went to Kevin Bolwing for his '68 Pontiac Firebird; Classic Instruments awarded John Gilbert for his '33 Ford; and the Chrome Specialty Insurance award went to Brad Cline for his '50 Ford coupe, also a Top 100 pick.
You want to have a good weekend with your street rod then the Hot Rod Reunion held at Dollywood's Splash Country is a great place. In fact, the town of Pigeon Forge has ample entertainment for the entire family. See you next year in early September.


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Add QR codes to FrameMaker documents. Edit embedded QR codes and preview them in real time. Use them on popular iOS or Android QR reader apps. Generate QR codes in different sizes.
Next-generation Responsive HTML5 layouts
Deliver personalised content experiences with new frameless Responsive HTML5 layouts that have best-in-class search and navigation. Enjoy a richer viewing experience as layout icons have been optimised for HD displays. Show or hide widgets, such as glossary and TOC.
Search faster with autocomplete
Deliver a best-in-class search experience to end-users with first-of-its-kind search autocomplete and more contextual search results. Provide users with automatic suggestions as they type, displaying the frequency of occurrence for each alongside.
Customisable Basic HTML5 output
Generate lightweight, easily sharable Basic HTML5 code with no layouts and JavaScript, which can then be customised via CSS for a unique look and feel.
Effortlessly publish to Adobe Experience Manager
Easily publish DITA content to Adobe Experience Manager Sites from FrameMaker by using XML Documentation Add-on for Adobe Experience Manager.
Out-of-the-box multi-channel, multi-device publishing
Deliver content to any device from within FrameMaker. Publish as Responsive HTML5, EPUB, Kindle, PDF, CHM and Adobe Experience Manager Mobile. Create content-centric mobile apps with a single click. Define settings once and share them organisation-wide.
Leaner HTML5 output
Ensure content loads faster for users with the default HTML5 output that cleans itself up to exclude any extra files, resulting in as much as a 50% reduction in loading time.
Text search within SVG images
Give end-users a more comprehensive search experience with the added ability to search text within SVG images, that also shows up in search results.
SVG support in HTML5 output
Effortlessly ensure that your images always look good regardless of the screen size of the device on which they are being viewed, because FrameMaker (2015 release) embeds the entire SVG code in the final HTML5 output.
Content personalisation for DITA content
Now directly use DITA attributes for content as criteria in Dynamic Content Filters, making it even easier to create personalised content experiences for your end-users.
Add favourites within new Responsive HTML5 layouts
Provide users the option to mark topics as favourites within the new Responsive HTML5 layouts, saving them time and effort when accessing content again.
Greater content accessibility with 508 compliance
Now accommodate your users' special needs by generating HTML5 layouts that meet 508 compliance, making content compatible with assistive technologies.
Bi-directional language publishing
Publish documents with bi-directional content, including XML/DITA content, from within FrameMaker (2017 release) as PDF, Responsive HTML5, CHM, EPUB, Kindle and Mobile App. Optionally flip the HTML5 layout so that the navigation pane appears on the right for RTL content.
Personalisation with Dynamic Content Filters
Give end-users a more personalised content experience with improved Dynamic Content Filters that now support indexes. Users can select appropriate filters to view relevant content.
Customised fonts in EPUB files
Embed customised fonts in your EPUB files and ensure that your users see text exactly as you intended, whether or not they have the font installed on their device.
Note: You must have distribution rights for the embedded font.
Note: You must have distribution rights for the embedded font.
HTML page template support
Configure mini-TOCs, breadcrumbs and headers and footers just once and apply your settings easily to all outputs using the new HTML page template support.
Do more with advanced XML/DITA capabilities
Revamped DITA authoring templates
Author with ease using the revamped DITA authoring templates, for DITA 1.3 and 1.2. Work more easily with the improved look and feel.
Optimised DITA cross-reference
Insert and manage DITA cross-references more optimally with multiple usability enhancements. Easily access it through the new 'cross-reference' option in the insert menu. Now also search by element type, ID or text in the improved pod interface.
Improved Keyspace Manager
Use the improved, resizable Keyspace Manager to search and reference documents. Search for just the first few characters of the key to locate a keyspace or select from a drop-down list of keyspaces added from any open DITA map in the current session. Access a common keyspace for all open DITA maps or choose to set a different keyspace for any document.
Enhanced structure view
Work more easily with your XML structure. Show or hide text based on your convenience and need. Enjoy a larger work area by collapsing elements and attributes for entire sub-trees. Get a visual indication of the element in focus and validity of a drop.
New status bar with element path
Use the brand-new status bar to keep track of the exact path of your current element while authoring DITA content in your structured document. Easily navigate using your cursor keys, eliminating the need to go back and forth to the structured view.
DITA 1.3 support
Now get out-of-the-box support for DITA 1.3 topic types, including topic, task, concept, reference, glossentry, glossgroup, DITA and the new troubleshooting learningObjectMap and learningGroupMap.
Optimised file opening experience
Open files faster with FrameMaker due to optimised cross-referencing of linked files.
Smart Paste
Author structured content faster. Convert content to a structured format with Smart paste. Easily bring in a variety of content, including paragraphs, tables and lists, from a variety of sources, such as Microsoft Word and Excel and HTML web pages. Note: This feature is included for DITA, but you can also build it for other XML schemas.
Improved support for inline MathML equations
Easily create inline MathML equations within FrameMaker (2017 release) thanks to native integration with MathFlow Structure and Style editors from Design Science. Equations inherit paragraph properties, such as fonts and background colour and are now exported as high-quality vector graphics in the published output.
Simplified XML authoring
Now subject matter experts and casual authors can create valid XML, without worrying about XML complexities. Work faster with a simplified user interface, a form-like easy-to-fill authoring experience and the ability to insert objects easily using Quick Element toolbar or by importing from other sources such as Word and HTML pages, even for DITA 1.3 documents.
Faster EDD customisation process
Reduce EDD customisation time from hours to minutes by using the script included with FrameMaker (2017 release), which automatically changes the element definition in all the relevant places in the DITA 1.2 EDD hierarchy.
DITA maps preview, including nested maps
Now easily preview content in DITA maps, including nested DITA maps, by opening topics individually or all at once. Edit the topic by double-clicking the expanded topic content.
DITAVAL support in DITA-OT publishing
Leverage out-of-the-box support for DITA OT to seamlessly publish content in various formats, including PDF, HTML, Microsoft HTML Help (.CHM) and Java Help. Use the free OASIS DITA-OT plug-in to carry out DITAVAL-based filtering while publishing.
Comprehensive DTD support
Author and validate XML content using standard DTDs, such as DITA and DocBook, as well as customised DTDs. Easily import a DTD and create an EDD with a single click. Alternatively, point to the DTD in the XML source and validate that against the DTD.
XPath 2.0 support
Eliminate the need to browse through long XML code. Use the XPath pod to find elements and automatically apply functions to them. Customise your query builder, get suggestions, define the scope of queries, use the history drop-down menu and save search results for greater productivity.
XSLT 2.0 support
Create a variety of transformation scenarios by applying predefined or customised XSLT to XML files and execute them using a range of JAXP-compliant processors. Define the scope of the transformation—a file, all files in a folder, DITA map or all children of a book.
Publishing DITA maps to books
Easily publish DITA content to professional-looking output. Generate nested books and books with flat components. Create attractive book content from DITA maps by automatically generating titles and TOCs, applying number properties and page rounding.


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Bliss Candy Wrapper
Communion Candy Bar Wrappers
Bliss Candy Wrapper, Item# CB1400CM
Note: Sparkles are simulated and will not light up.
Bliss Candy Wrapper, Item# CB1400CM
Note: Sparkles are simulated and will not light up.
Bliss Thank You Card
What would sweeten your special occasion more than a customized Candy Bar Wrapper with a delicious chocolate bar inside? Recipients will be thrilled with this unique favor!
"Bliss" features a beautiful little girl smiling peacefully while clutching a bouquet of white flowers to her face. She is wearing a gorgeous white satin dress and has a white berry ornament in her hair.
Wrappers come unassembled, however we will email you assembly instructions.
The wrapper is designed to fit a 1.55 oz. Hershey's® Candy Bar. Note: foil is not included. Our wrappers fit directly over the Hershey's® Candy Bar Wrapper.
Due to the hot summer months and the chance of chocolate melting while in transit, we temporarily do not offer the Hershey's Chocolate Bars with the wrappers.
You will be able to select the typestyle and ink colors to use for your personalized text during the design process. Start by clicking on the green 'Personalize and Continue' button. We recommend using the default typestyle and ink colors.
|Item Type:
|Candy Bar Wrapper
|Candy Bar Wrapper Dimensions:
|5.50 X 5.60 (W x H)
|Printing Process:
|Digital Press
|Coated Wrapperstock
|Typestyle Shown:
|Shelley Volante
|Matching Ink Color:


text: Chromalox cartridge heaters are most frequently used for heating metal parts by insertion into drilled holes. The SST Split Sheath industrial heater is designed especially for platen, die or mold commercial heating applications where the holes are poorly drilled or worn through age. Independent expansion of each section of the SST when energized, creates intimate contact with the wall of the hole.


text:
Parent Directory | Revision Log
|Links to HEAD:
|(view) (download) (annotate)
Add support for newer vala slot
Add support for vala 0.26
0.20 is our new lower version
Fix repoman warnings (#521980 by Arfrever Frehtes Taifersar Arahesis)
Update VALA_MAX_API_VERSION (bug #509222, thanks to Arfrever) and modernize VALA_MIN_API_VERSION too.
Prepare for vala-0.22
Update VALA_MAX_API_VERSION
making vala_src_prepare() into a no-op in the common situation where vala is in IUSE and USE=-vala as discussed with the team via mail. Thanks a lot to Alexandre Rostovtsev for the work.
VALA_{MIN,MAX}_API_VERSION are not unset by default.
Small stylistic fix.
Typo: s/VALA_API_VERSION/version/
New eclass.
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


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Over 60 percent of the roof is vegetated. The building's 12,000-square-foot living green roof is created with layers of insulation, roof membrane, drainage fabric, and a four-inch granular composition supporting the planting of nine different species of sedum ground cover. About nine inches thick, the roof offers more effective insulation than traditional roofs and expands and contracts with seasonal changes. It is expected to last about 40 years, more than twice the lifespan of traditional materials.
The green roof also controls and reduces water runoff. With normal rainfall, about 60 percent of the water will be absorbed by the roof while the remainder drains into a 10,000-gallon cistern to be used as "gray" water for flushing toilets and the irrigation of the campus quadrangle. A system of weirs, tile fields (composed of material made of volcanic ash), and long-rooted grasses and trees will prevent 60 percent of the rainwater that falls on the adjacent campus quadrangle from running into the Rouge River as part of a regional effort to control storm water drainage and improve the water quality and biodiversity of this portion of the Rouge watershed. This bioswale of vegetation will naturally purify the water by filtering out pollutants commonly found in snow and rain.
The most complex and sustainable aspect of the Taubman Center cannot be seen: a field of 120 geothermal wells sunk 300 feet (about as deep as the Town Center buildings across Northwestern Hwy. are high) through five geological layers under the campus quad. A system of polyethylene tubing, pumps, and fans connected to the wells utilizes water to heat and cool the building, which has no boiler, furnace, or even a gas meter. Water never leaves the tubes in the closed loop system, which transfers heat to and from the earth as needed to meet the building's cooling or heating needs. The heating, ventilating, and air conditioning systems contain no CFC-based refrigerants, HCFC's, or Halons.
Lighting in the Taubman Center is controlled by sensors and astronomically-syncronized timers that adjust three minutes a day to accommodate seasonal lighting needs. The heating and cooling system is controlled by a York state-of-the-art Direct Digital Control system, which continually monitors approximately 1,700 points throughout the building and sends signals to various valves and dampers that adjust to the demands within the building. Many of the heating, ventilation, and air conditioning controls and mechanisms are visible for study by students. The concrete flooring tiles throughout the building are elevated 18 inches, making all wiring and piping easily accessible by lifting panels of the completely modular floor.


text:
Find us on:
The National Institute of Mental Health (NIMH), a component of the National Institutes of Health, seeks to reduce the burden of mental illness and behavioral disorders through research on the mind, brain, and behavior. NIMH provides a wide range of information based on that research. Publications are available through the NIMH Web site or by calling the NIMH information center for information and to order publications.
Review Date: Wednesday, July 01, 2015
List reviewed web resources
The Depression and Bipolar Support Alliance (DBSA) is a non-profit, patient-directed organization founded to provide personal support and direct services to patients with depression or manic depression and their families. DBSA offers a toll-free information and referral line, has more than 1,000 patient-run support groups throughout th U.S. and Canada, and reaches nearly five million people through educational materials and programs, exhibit materials, and media activities. An annual conference is held to provide for communication between local chapters, general members, and the DBSA.
Review Date: Monday, October 05, 2015
Mental Health America (formerly known as the National Mental Health Association) is the country's leading nonprofit dedicated to helping all people live mentally healthier lives. With our more than 320 affiliates nationwide, we represent a growing movement of Americans who promote mental wellness for the health and well-being of the nation – everyday and in times of crisis.
Review Date: Monday, June 13, 2011
Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®.
Language Assistance Available


text:
Skip to Main Content
Resident Services
Doing Business
Your Government
Explore La Mesa
How Do I...
Your Government
Finance Department
The Purchasing Officer is responsible for the procurement of city goods and services and for the
disposal of city surplus
equipment and vehicles.
Register to be a Vendor
You may
register your business
using the PlanetBids System to be a potential vendor for the City.
Public Works Construction
All licensed contractors are invited to
for the city's List of Qualified Bidders for Public Works Construction by following these
. All public works construction bids will now be posted on
Please note: The City has changed the registration process this year to include specific categories of work for public works construction. In order to be included on the List of Qualified Bidders, contractors must select at least one of the Public Works Construction categories (99902-99922) on
Bid Opportunities & Results By Type Of Product
The city routinely issues online Invitations for Bids and Requests for Proposals or Qualifications through PlanetBids for Public Works Construction, Goods, Services and Professional Contracts. View
Current Bids and Bid Results
Regional Opportunities
For regional bid opportunities, visit the
County of San Diego Purchasing
Small Business Assistance / Disadvantaged Business Enterprise (DBE)
As a recipient of federal funds administered by Caltrans, the City of La Mesa encourages vendors to take advantage of outreach programs.
U.S. Small Business Administration
offers resources to assist small and DBE businesses.
Vendor Registration
Bid Opportunities
Surplus Disposal/Auction
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text:
Jessica Perlove
Music and Media Library Desk Coordinator
Colin Bragg
Reserves Coordinator
James Steffen
Film Studies & Media Librarian
Using Videos in Class
Emory University Instructors are encouraged to use films and videos from the Heilbrun Music and Media Library collection in their Emory University classes. We recommend booking these items in advance in order to avoid the possibility that the item is already being used by someone else.
Although VHS is an aging format and many classrooms on campus no longer have VHS players installed, there are a few steps you can take to ensure that the content you need for your teaching is still usable and accessible.
If your classroom does not have a VHS player installed, you may arrange for VHS playback by placing a request with Classroom Technologies. A two-day notice is recommended, but they will be most flexible during this transition period. Call 404.727.6853 or email email@example.com.
Another option for classroom VHS viewing is the Group Viewing Room in the Music and Media Library. The room can seat up to 20 people and can handle a large variety of media formats. For more information, see Facilities and Computing on this page, or call the Music and Media Library at (404) 727-1777.
For VHS tapes in the library collection, contact your subject librarian to see whether a DVD version is available for purchase by the library, or if there are other options the library can pursue. If you are using personal or departmental tapes, the library can also see whether a DVD is available for purchase to add to the library's collection.
The Emory Center for Digital Scholarship (ECDS), located on the third floor of the Woodruff Library, may be able to help you create a DVD of clips for teaching purposes. Call 404.727.6886 or email email@example.com.
Booking Videos for a Class
To show videos and DVDs from the library in your class, there are three steps.
1) Reserve a room (unless you are using your regularly scheduled classroom)
* For Weekday reservations: Registrar's office (404) 727-6042
* For Evening & weekend reservations: Meeting Services Office (404) 727-5355
* For Heilbrun Library's Group Viewing Room: (404) 727-1777
2) Arrange for Technical Support
* Contact Classroom Technologies (404) 727-6853
3) Book the video in advance through DiscoverE.
This function enables you to create a booking request for the item (available only for authorized users).
Booking Instructions
Faculty get seven days for all visual media except items on course reserve. Grad students get three days for DVD-LEND titles and three hours for all other media types.
Note: If you choose a range that extends beyond the loan period, the booking will not be placed.
4) Book the video in advance with the Media Booking Form
*If the film you want to book is currently on reserve, you can either fill out a paper form at the Music & Media Library circulation desk or download either the pdf or word document version:
Media Booking Form (PDF)
Media Booking Form (Word)
Please, limit your requests to one item booking per form. Email completed forms to our email at:
Allow at least one business day (M-F) for processing. For same-day or next-day service, or as an alternative to online booking, come in or call us at 404-727-1777 whenever the Heilbrun library is open. We do not accept booking requests via e-mail with less than 48 hours notice.
Booking Library Films for Public Viewing
To book a film, video, or DVD held by the Music and Media Library for a campus film festival or other public event on campus, you will need to obtain permission to show the material. Some items at Music and Media may already have viewing permissions - contact us at 404-727-1777 with questions.
Confirmations/CancellationsYour booking will be confirmed via e-mail within one business day of receipt. Should you fail to receive a confirmation or notice of unavailability, please call us at (404) 727-1777. You may also call in any cancellations.
We will hold your booked media at the Heilbrun Library for pickup at the service desk on the specified date. If you send an assistant to pick up your material, that person must officially registered as your proxy for library transactions.
Film Rental ServiceThe library provides film rental services for support of course offerings in Emory College and the Graduate School of Arts and Sciences. Showings must take place in White Hall or at other campus locations served by the Classroom Technologies unit of University Technology Services (UTS). Departments wishing to sponsor showings which are not intended for a particular class should make their own rental arrangements. The library's Media Coordinator will provide information about vendors and procedures, if desired.
Please note that the library can only rent films currently in commercial distribution in the US.
Charges: For each title, the library pays up to $100 of the rental fee. The sponsoring department pays any additional amount.
The rental will be arranged at the public-performance rate whenever the public and/or the Emory community is invited to the showing, in order to comply with copyright law and licensing requirements. The instructor will be informed in advance of the cost. A showing for which the instructor is present and the audience is limited to members of the class qualifies for an educational rate.
No admission fees may be charged, nor donations collected, for any film showing arranged by the library.
Submit a request at least four weeks in advance of the screening date. Please hand deliver the form. You will receive notification of the film's availability. For further information, contact James Steffen at firstname.lastname@example.com | 404.727.8107 or Kevin Miller at firstname.lastname@example.com | 404.727.0924.
Film Rental Request Form
How to Arrange a Rental-Film Showing at Emory* Reserve a room unless using your regularly-scheduled classroom. Contact the Registrar's Office at 404-727-6042 for weekday reservations. For evening and weekend showings call the Meeting Services Office at 404-727-5355.
* Arrange for technical support by contacting Classroom Technologies at (404) 727-6853.
* Film Delivery and Projection: A media technician from Classroom Technologies will deliver the film to the classroom, operate the equipment during the screening, and return the film to Heilbrun Library. Instructors may not remove rented films from the classroom.


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Hiroki Kuroda, Yankees roughed up in loss to Blue Jays
TORONTO >> Edwin Encarnacion hit a two-run home run, rookie Todd Redmond snapped a seven-start winless streak and the Toronto Blue Jays beat the New York Yankees 7-2 on Wednesday night.
The Blue Jays took two out of three from the Yankees after losing 12 of their first 13 meetings this season. They're 3-3 against New York at home and 0-10 on the road.
Redmond (2-2) left to a standing ovation after striking out Alfonso Soriano and Alex Rodriguez to begin the sixth inning. He allowed two runs and three hits, walked four and struck out seven for his first victory since beating Minnesota on July 7.
Aaron Loup worked 1 1-3 innings, Sergio Santos pitched the eighth and Darren Oliver finished for the Blue Jays.
New York's Hiroki Kuroda (11-10) lost for the fourth time in five starts and gave up seven runs for the second straight outing, matching his career high for the seventh time. Five of the seven runs off Kuroda were earned. He allowed nine hits, walked one and struck out four.
Kuroda came in 4-0 with a 1.60 ERA over his previous five starts against the Blue Jays, but couldn't bring an end to his recent road struggles, falling to 0-4 with a 6.94 ERA in his past four starts away from home.
Yankees second baseman Robinson Cano was held out of the lineup, one day after being hit by a pitch on the left hand. Manager Joe Girardi said Cano was still dealing with pain and swelling, but said he hoped to have the five-time All-Star back for Friday night's game against Baltimore. The Yankees are off Thursday.
New York's Eduardo Nunez, who left Tuesday's game with a sore right knee, was scratched from the lineup after he felt sore during batting practice. Mark Reynolds made his first career start at second.
Toronto took advantage of a throwing error by Yankees catcher Chris Stewart in a four-run, two out rally in the first. Brett Lawrie hit a two-run double and Rajai Davis was hit by a pitch before J.P. Arencibia reached on a two-strike passed ball. Lawrie and Davis both scored when Stewart's errant throw to first rolled into foul territory down the right field line.
The Blue Jays made it 6-0 when Encarnacion clubbed his 34th home run in the second, a towering two-run shot to left. A seventh run scored on Jose Reyes' sacrifice fly in the third.
New York broke through against Redmond in the fourth, when Rodriguez hit an RBI single. One out later, Reynolds hit an RBI double, but Rodriguez was thrown out at the plate trying to score from first.
Rodriguez finished 1 for 4 with three strikeouts.
NOTES: The Yankees struck out 13 times, one shy of their season high for a nine-inning game. ... Girardi said RHP Phil Hughes remains on track to make his next scheduled start Sunday. Hughes is winless in his past nine outings. ... Toronto RHP Steve Delabar (shoulder) threw one perfect inning for the Gulf Coast Blue Jays on Wednesday, his first rehab appearance.