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Mechanistic and observational studies support an independent increase in risk of hypertension and abnormal glucose metabolism associated with obstructive sleep apnea (OSA). However, the specific populations and outcomes that improve with treatment of OSA in clinical practice are not established. We examined the effectiveness of OSA treatment on clinical blood pressure and diabetes control measures in men with preexisting systemic hypertension or type 2 diabetes.
A retrospective cohort of veterans (n = 221) with a new diagnosis of OSA and initiation of positive airway pressure treatment was identified using administrative databases and clinical records.
Outcomes were changes in blood pressure (BP; mean of 3 highest recordings; systolic and diastolic) and glycemic control (mean of 3 highest fasting glucose and hemoglobinA1C values) at 3-6 months (T1) and 9-12 months (T2) following treatment compared to pretreatment. A generalized estimating equation model was used with adjustment for potential confounders: demographics, body mass index (BMI), OSA severity, Charlson comorbidity index, and pharmacologic treatment for hypertension and diabetes. Sustained independent effects of OSA treatment (mean change [95% CI]) were noted in both systolic BP (T1; −7.44 [-10.41 to −4.47] and T2; −6.81 [-9.94 to −3.67]) and diastolic BP (T1; −3.14, [-4.99 to −1.29] and T2; −3.69, [-5.53 to −1.85]). Diabetes control measures did not change with OSA treatment.
Treatment of OSA improves office blood pressure in hypertensive men. Prospective studies are necessary to better characterize specific populations with OSA that benefit from treatment with respect to progression of hypertension and type 2 diabetes.
Prasad B; Carley DW; Krishnan JA; Weaver TE; Weaver FM. Effects of positive airway pressure treatment on clinical measures of hypertension and type 2 diabetes. J Clin Sleep Med 2012;8(5):481-487.
Considerable evidence from observational studies implicates obstructive sleep apnea (OSA) as an independent risk factor for systemic hypertension1 and abnormal glucose metabolism.2 The results of experimental studies evaluating effects of OSA treatment in hypertension reveal modest benefits,3,4 and the data regarding improvement in glucose homeostasis in type 2 diabetics from small clinical trials are inconsistent.5,6 This discrepancy is partly due to the size and type of cohorts examined or the specific outcomes assessed.7 Several studies examined populations with differential baseline characteristics (presence or absence of preexisting hypertension/diabetes) or variable OSA disease severity.7–12 Additional sources of variability relate to duration of follow-up and levels of treatment adherence.13 However, frequently the outcomes examined are not routinely available in clinical practice, and the applicability of these findings to usual care settings is unclear.
The objective of this study was to examine the effectiveness of treatment of OSA on routine clinical measures of hypertension and diabetes control in a primary care practice setting. We examined the long-term effects of OSA treatment on diurnal office BP, fasting glucose, and hemoglobin A1C (HbA1C) in veterans with newly diagnosed OSA and comorbid systemic hypertension and/or type 2 diabetes.
Current Knowledge/Study Rationale: Clinical trials indicate management of sleep apnea maybe efficacious in improving cardiometabolic outcomes. We examined whether the management of sleep apnea improves these outcomes in clinical practice.
Study Impact: CPAP treatment effectively reduces blood pressure, in clinical practice, in men with hypertension. Future studies that identify treatment responsive populations with respect to key clinical outcomes are needed to guide healthcare providers and to optimize healthcare delivery for sleep apnea.
We reviewed national Veterans Health Administration databases and clinical records at 2 Veterans Affairs Medical Centers (VAMC1 and VAMC2, IL) for fiscal years 2005-2006 and identified a cohort with new diagnosis and treatment of OSA (Figure 1). Individuals were included in the analysis if they met the following 2 criteria: (1) new diagnosis and treatment of OSA; and (2) presence of preexisting hypertension or diabetes, identified by ICD9 codes. New diagnosis of OSA with initiation of treatment was defined as: (1) a CPT code for a diagnostic sleep procedure (polysomnography; PSG or unattended level 3 portable monitoring, Stardust II, Philips-Respironics; PM) followed by an ICD-9 code for OSA within 3 months; (2) prosthetics records indicating CPAP or APAP device provision within 6 weeks of the diagnostic procedure; (3) no OSA ICD-9 code in administrative and clinical records for 6 months prior to the diagnostic procedure date. The exclusion criterion was CPT codes for or history of surgical or dental device treatment for OSA. Subjects received either laboratory titrated fixed-CPAP treatment (Remstar Pro, Philips-Respironics, Inc; Murrysville, PA, USA) or APAP device treatment set at 4 to 20 cm H2O upon initiation (Remstar Auto with C-Flex, Philips-Respironics). The veterans with both fixed CPAP and APAP treatments had similar outpatient follow-up with sleep medicine physicians, and the APAP device pressure was adjusted to ≥ 90th percentile after treatment initiation at the treating physician's discretion. This study was approved by the institutional review board at both participating facilities.
Cohort Identification
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The index date for the study was the date of CPAP or APAP device distribution. Three months preceding the index date was defined as the baseline period (T0), 3-6 months following the index date as T1 (first follow-up), and 9-12 months following the index date as T2 (second follow-up). The outcomes assessed (final cohort, n = 221) at T1 and T2 were: (1) Outpatient office visit systolic and diastolic BP (from the same recordings) in the subjects diagnosed with hypertension. For conservative treatment-related effect estimates, an average of the highest 3 values was taken to represent the systolic and diastolic BP within each time interval. (2) Outpatient fasting glucose values extracted from clinical records. If multiple values were noted, the last value within each time interval (T0, T1, and T2) was recorded. If the lab did not specifically indicate fasting glucose in the remarks, an outpatient blood draw that occurred between 07:00 to 08:30 was considered a fasting sample. (3) Outpatient hemoglobin A1C (HbA1C) extracted from clinical records. If multiple values were noted, the last value within each time interval (T0, T1, and T2) was recorded.
Several potential confounders were assessed, including: demographic data (age, race, BMI), concurrent medical illnesses per ICD9 codes, drug treatment of hypertension and diabetes, objective OSA treatment adherence (SmartCard download to EncorePro software), and self-reported daytime sleepiness documented in clinician notes. Demographic, comorbid medical disorders, and pharmacy data were extracted from administrative records. Data regarding vital signs, OSA disease severity, OSA treatment adherence, and symptom of sleepiness were extracted from clinical records. OSA disease severity was defined by the apnea hypopnea index (AHI) per published criteria for PSG.14 For both PSG and PM, the criterion for hypopnea was ≥ 50% airflow reduction and ≥ 3% desaturation (or associated arousal for PSG). The Charlson comorbidity index (CCI) was calculated and used to indicate general health status.15 The pharmacy data provided the total number and dosage of medications used for treatment of hypertension and diabetes. Three pharmacologic treatment measures were considered as covariates: changes in number of drugs, changes in dose of drugs, and adherence to drugs. Adherence to medications for hypertension and diabetes was defined by the medication possession ratio (MPR).16 MPR calculation results in a ratio < 1.0 if there are lapses in prescription refilling. The MPR was truncated at the maximum value of 1.0 (indicating potentially perfect adherence). An MPR was calculated for each 90-day interval (T1 and T2) and for each drug. The mean MPR for each drug class (antihypertensive and oral plus injectable hypoglycemics) within T1 and T2 individually were used as a measure of adherence to pharmacologic treatment. Total number of antihypertensive and antihyperglycemic medications as well as dose changes was recorded. Change in total number of medications during each follow up interval compared to baseline was coded as −3 to +3 (0 being no change in number of medications). Change of medications within the same class (e.g., ACE inhibitors) and replacement of one drug with another was not considered. Dose changes of individual medications was recorded categorically: none (0), increase (+1), and decrease (-1).
Comparisons of sociodemographic characters of the final cohort to those lost to follow-up (Figure 1) were performed with χ2 or t-tests. Primary outcomes were examined for treatment-related changes in outcomes at T1 and T2 using the generalized estimating equation (GEE) model, where the final model was adjusted for time and the potential covariates described above. OSA disease severity was treated as a categorical variable with 2 levels: mild (AHI or RDI 5-15) and moderate to severe (AHI or RDI > 15). Daytime sleepiness symptom was coded as a categorical variable (yes/no/missing). Multicollinearity amongst the covariates was checked with variance inflation factor (VIF, < 5 accepted). In the stratified analyses (by type of treatment; CPAP vs. APAP and by race; European Americans vs. African Americans), similar adjusted GEE model was used with added variables of groups as defined above and time-group interaction terms. Adherence to OSA device treatment (CPAP or APAP) was treated as a continuous variable (average nightly use in hours and minutes). Due to significant missing data, adherence to OSA treatment was excluded as a covariate in the final GEE model. The effect of adherence to OSA treatment on individual outcomes was separately examined with general linear regression. All analyses were performed using SAS 9.2, and a p-value ≤ 0.05 was considered significant.
As total of 650 veterans were diagnosed with OSA, but only 302 were identified as receiving treatment (CPAP or APAP device) within 6 weeks of diagnosis. Veterans who did vs. did not receive treatment were not different by race (p = 0.81), marital status (p = 0.54), or age (p = 0.57).
Ninety-four percent of participants had a diagnosis of hypertension, while 40% had type 2 diabetes. Approximately one-fourth had mild sleep apnea, and more than half reported no daytime sleepiness. A third of the subjects were treated with APAP long-term in the autoadjusting mode. Compared to those treated with CPAP, the APAP treated subjects had higher BMI (33.9 ± 6.3 vs. 35.9 ± 5.7, p = 0.02) and were more frequently ethnic minorities (28% vs. 68%, p < 0.0001). The preponderance of African Americans veterans among those treated with APAP reflects the practice patterns at the 2 study sites (i.e., the urban VAMC utilizes APAP more frequently). Due to this difference of treatment modality with regards to race, we examined the effect of race on baseline characteristics of the cohort. African Americans (AA) compared to European Americans (EA) and Hispanics/other were not different in OSA disease severity, self-reported sleepiness, or the prevalence of hypertension or diabetes at baseline. However, AA veterans were younger (59.5 ± 10.9 vs. 64.7 ± 10.5, p = 0.007), more obese (BMI 36.5 ± 5.9 vs. 33.9 ± 6.3, p = 0.004), and had lower adherence to pharmacologic treatment (MPR) for hypertension (0.96 ± 0.09 vs. 0.98 ± 0.03, p = 0.01) and diabetes (0.93 ± 0.13 vs. 0.97 ± 0.05, p = 0.05).
Baseline characteristics of cohort (N = 221)
Both systolic and diastolic BP decreased significantly with initiation of OSA treatment at both T1 and T2. No significant change in fasting glucose or HbA1C was noted at either T1 or T2 after initiation of PAP treatment. Of the other factors (explanatory variables) considered in the model, age was significant with regard to BP outcomes. Specifically, increasing age was associated with a greater reduction in both systolic BP (p = 0.04) and diastolic BP (p < 0.0001). A second significant factor was change in dose of antihypertensive medications. An increase in dose of antihypertensive medications was related to less reduction in diastolic BP (p = 0.03; systolic not significant at p = 0.08), likely reflecting a response rather than a causal effect.
Changes in outcomes with OSA treatment at Time 1 and Time 2
For glucose control measures, OSA treatment had no independent effect on fasting glucose or HbA1C. Of the other predictors considered for fasting glucose, a greater reduction in fasting glucose was seen in older veterans (p = 0.05). Medical comorbidity (measured by CCI) was the only significant predictor of HbA1C, where a higher number of diagnosed medical conditions was associated with an increase in HbA1C over time (p = 0.001).
Notably, large standard deviations were noted for reductions in both systolic (-10.41 to −4.47 at T1) and diastolic BP (-9.94 to −3.67 at T1), indicating a heterogeneity of treatment effects (HTE) within the cohort. To examine potential explanatory variables for this HTE (Table 3), we examined changes in systolic and diastolic BP outcomes by type of treatment (CPAP vs. APAP) and by race (EA vs. AA). Systolic and diastolic BP improved in veterans with either CPAP or APAP. African Americans exhibited significant reductions in both systolic and diastolic BP, while among the European Americans, only systolic BP showed statistically significant change.
Changes in blood pressure with type of treatment and by race
As expected in a naturalistic dataset, we encountered missing data (39% at T1 and 54% at T2) with regards to OSA treatment adherence. Missing data for adherence to OSA treatment was not significantly different by age, race, OSA severity, or symptoms at T1. In the subset of the cohort where adherence to OSA treatment data was available, adherence was objectively assessed for each time interval (SmartCard reports extracted in average daily hours of use). The adherence was stable over time (T1; mean ± SD = 4.90 ± 1.59, T2; mean ± SD = 4.44 ± 1.57, p = 0.15). Adherence to OSA treatment did not correlate with adherence to pharmacologic treatment (MPR for hypertension; p = 0.77 or MPR for diabetes; p = 0.67). Examination of the effect of adherence to OSA treatment on primary outcomes at T1 with general linear regression showed results consistent with previous reports, i.e., adherence to OSA treatment was significantly associated with lower diastolic BP, HbA1C, and fasting glucose (Figures 2A-C).
(A) OSA Treatment Adherence and Diastolic Blood Pressure. (B) OSA Treatment Adherence and HemoglobinA1C. (C) OSA Treatment Adherence and Fasting Glucose.
This is the first study to our knowledge to examine the effectiveness of treatment of OSA on routine clinical measures of hypertension and diabetes control in a real-world setting. In this cohort of hypertensive men on drug therapy, we found OSA treatment was associated with improvement in diurnal office systolic and diastolic blood pressure up to 1 year after initiation of PAP treatment. The finding was not related to the type of device (CPAP and APAP) used for treatment. Despite their comparatively lower adherence to pharmacologic treatment, we noted significant reductions in both systolic and diastolic BP among African Americans, while among the European Americans, only systolic BP showed a statistically significant change. We failed to discern any independent effects of OSA treatment in veterans with type 2 diabetes on clinically utilized glucose homeostasis markers: fasting glucose and HbA1C.
Published evidence largely supports a causal association between OSA and elevated blood pressure,17,18 and OSA is recognized as a treatable cause of hypertension.19 Efficacy studies support modest beneficial effects of fixed-CPAP and APAP treatments on blood pressure.9,20 This effect may be more robust on 24-hour and nocturnal BP, which are better predictors of cardiovascular risk.21 Clinical trials and meta-analyses indicate that populations with higher levels of obesity (BMI) and severity of OSA22–24 with preexisting systemic hypertension, and those receiving antihypertensive pharmacologic therapy maybe more likely to benefit from CPAP treatment.25,26 The magnitude of systolic and diastolic BP reduction noted in this study is higher than has been previously reported with CPAP treatment.13,27 Studies that recruited participants without hypertension may have encountered floor effects. Other characteristics of this naturalistic cohort, which may explain these findings include; older men (mean age 61-63 years), with a high prevalence of moderate-severe OSA (60% to 80% with AHI/RDI > 15/h) and obesity, a large proportion with resistant hypertension28 (use of ≥ 3 antihypertensive medications; 59/209, 28%) and multiple cardiovascular comorbidities (more than half had at least one of the following: heart failure, atrial fibrillation, hypertensive heart disease). These population characteristics have individually been associated with higher therapeutic effects of CPAP on BP.4,20,29,30 Age and OSA interact as risk factors for hypertension31: the importance of age as an effect modifier of treatment response is illustrated in this study; that is, older men showed greater OSA treatment-related response in both systolic and diastolic BP. The effect size (Cohen's d for repeated measures) when considered by type of treatment and race varied from small to large, indicating that type of treatment and race may also be significant determinants of HTE. For systolic BP changes the effect size were; CPAP = 0.49, APAP = 0.56, European Americans = 0.39, and African Americans = 0.80. For changes in diastolic BP observed, the effect size were; CPAP = 0.28, APAP = 0.50, European Americans = 0.27, and African Americans = 0.67.
The duration of treatment effect of OSA on BP is unknown, with most studies examining outcomes at a few weeks.23 We noted a sustained response of BP in this cohort to OSA treatment up to 12 months of follow-up. These results are consistent with a recent randomized trial of CPAP in a population with coexistent OSA and systemic hypertension. Barbe et al., reported significant but comparatively modest therapeutic effects of CPAP on systolic (-1.89 mm Hg) and diastolic BP (-2.19 mm Hg).13 Less than half of the participants in this study were on any drug treatment and all were asymptomatic, while the average number of antihypertensive medications per subject in this cohort was 2.67, and 40% reported daytime sleepiness.
Small efficacy studies indicate the cardiovascular risk reduction with use of APAP devices for treatment may not be equivalent to fixed-CPAP treatment.32–34 Moreover, due to lack of data, the use of APAP therapy in populations with comorbid cardiorespiratory illnesses is not recommended.35 The current cohort included subjects with comorbid conditions—known chronic obstructive pulmonary disease (45/221; 20%), congestive heart failure (20/221; 9%), and stroke (12/221; 5%)—were included, a previously understudied group.35,36 Our results indicate reduction in systemic BP with both APAP and CPAP treatments. These data provide a rationale to prospectively test the effectiveness of APAP treatment for titration and long-term therapy in a broader population, particularly as this technology advances.
A third of this cohort was African American, a population that suffers a higher burden of hypertension37 and in whom treatment of OSA is recommended as adjunctive therapy.38 We found significant effects on both systolic and diastolic BP that are clinically highly significant. Such treatment-related effects, if prospectively confirmed in a similar population, would have a considerable impact on cardiovascular disease.39
Our data do not support the effectiveness of OSA treatment in improving clinical glycemic control indices in type 2 diabetes. This maybe related to sample size or inability to adequately control for adherence in this cohort. Despite the demonstrated independent detrimental effect of OSA on the full spectrum of abnormal glucose homeostasis,40–43 data from a single randomized sham-CPAP controlled trial of CPAP (mean CPAP adherence 3.6 h nightly) in subjects with OSA and diabetes are negative.6 In contrast, studies with a less robust design in a similar population demonstrate a therapeutic effect of CPAP on HbA1C at 3-4 months post-treatment, suggesting an important modification of effects of CPAP on glucose homeostasis by level of adherence.44,45
The impact of OSA treatment adherence on intermediate cardiovascular risk markers noted in this study is consistent with published reports.24,45–47 Nevertheless, sizable missing data on device treatment adherence limit conclusions in this study. Prospective examination of the effect modification of OSA treatment adherence on systemic BP and glucose metabolism by objective and unobtrusive measurement is crucial. A second limitation of this study pertains to selection bias (Figure 1), where the final cohort assessed for OSA treatment effects is about half of all eligible veterans. The veterans who did not follow-up at the study sites were not different with regard to available sociodemographic data, i.e. race, age, or marital status. However, there are other potential uncontrolled sources of bias that limit our results. In addition, the retrospective design imposed a burden of attrition of sample size due to missing data for key variables.
OSA treatment lowers blood pressure in a clinical population of men with hypertension. This study extends the known efficacy to real-world effectiveness of OSA management on hypertension. Prospective effectiveness research examining changes in cardiovascular outcomes with treatment interventions for OSA is necessary to confirm these findings, to identify traits associated with a positive therapeutic response, and to inform clinical practice.
Disclaimer: The findings of this research do not reflect the policy of the Department of Veterans Affairs. This was not an industry supported study. Dr. Terri Weaver has received equipment for research from Philips Respironics, Inc., grant support from Cephalon, Inc., and remuneration for consultation from Apnex Medical, Inc. She also has FOSQ license agreements with Nova Som, Apnex Medical, Inc., GlaxoSmithKline, Philips Respironics, Inc., Cephalon, Inc., and Innovaderm Research, Inc. The other authors have indicated no financial conflicts of interest.
The authors thank Dr. Samuel Kuna for his review and valuable advice during the preparation of this manuscript. Work for this study was performed at Center for Management of Complex Chronic Care, Hines, Edward J Hines Jr. VAMC and University of Illinois at Chicago. Funding was provided by Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital
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text:
Keeling over: Launching history the hard way
The Lewis & Clark Exploratory Center at Darden Towe Park invited everyone out Saturday, October 23, to a unique boat launching on the Rivanna River.
For an early leg of their historic journey, Lewis and Clark used a keelboat to help them traverse the American Midwest. With the help of master keelboat builder and Iowa native Butch Bouvier, Charlottesville now has a beautiful replica of the boat used by Lewis and Clark, this one christened Discovery Virginia.
Launching the 55-foot handcrafted wooden vehicle into the Rivanna was intense, to say the least.
Built high on the Center's grounds in an old barn at Darden Towe Park, the boat first had to journey several hundred yards across land. The path was complicated by a large tree.
To circumvent the tree, the boat had to be maneuvered downhill at an angle. Then, with a loud snap, the unbalanced boat broke through one of the wooden supports. To budge the boat from the slope, Bouvier and his crew of men and backhoes pushed, leveraged, and muscled for over two hours until, after a final heave, it reached the Rivanna. "It floated like a cork," Bouvier declared.
While the heavy lifting was going on, a gala of period music, arts and crafts, oxen rides, and an official U.S. Mint-sponsored nickel swap entertained park visitors. The new nickel, with the Lewis & Clark keelboat on the back, was available for purchase in $2 rolls.
The boat is open for tours during park hours. A nice little trail leads from Route 250 to this fascinating testimony to human ingenuity– and the power of elbow grease.
With a big push, Discovery Virginia Begins its journey down the ramp.
After the loss of a support beam, a backhoe helps push Discovery Virginia into the water.
After its big ordeal, Discovery Virginia relaxes on the banks of the Rivanna.
Butch Bouvier hatches a plot to get the boat off the bank.
A large crowd waits excitedly for the big splash.
A nickel with a boat and a boat in the river on the same day!

subset: commoncrawl


text:
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Quality Management System requirement documentation as per ISO 9001:2015 Standard means activity or process to document that contains sufficient information for effective implementation of processes and be retained to provide evidence that activities were performed.
The new ISO 9001:2015 standard includes three basic core concepts :
a.) process approach
b.) plan-do-check act methodology, and
c.) which is new in the 2015 version is risk based thinking
New structure of ISO 9001:2015 standard has aligned with the common 10-clause to ensure greater harmonization among its many different management system standards. The new revision to ISO 14001:2015will also adopt this same structure, which is built around the Plan-Do-Check-Act sequence. This will help organizations to integrate the requirements of more than one ISO Management System Standard.
ISO 9001:2015 version further require that organization 'determines' processes needed for quality management system and identify all the processes that include Actions to Address Risks and Opportunities.
Risk Based Thinking is a new and welcome addition to ISO
9001:2015 standard requirement
How will the organisation prevent, or reduce, undesired
effects? How will the organisation ensure that it can
achieve its intended outcomes and continual
One big plus is that preventive action does not now
appear. The assumption is that the risk management
process has features which creates inherent preventive
actions via the improvement cycle.
Highlights to ISO 9001:2015 free download are available on URS website, and 2015 version reference for issues that means 'an actual or potential threat' for effective implementation and control of activities that affect client's ability to supply products or services to meet customer requirements.
A structured approach to risk assessment for a quality management system requirement can describe a process, an actual or potential threats and decision on whether to accept, mitigate, eliminate or transfer the risk, and identify the controls needed to ensure the effectiveness of the processes. By including 'potential' threats, organization can put in place preventive actions.
Quality objective as per ISO 9001:2015 Certification are seen as those that have a direct impact on customer requirements, have a direct impact of the efficiency of the client's business, which means an improvement in the quality system processes. ISO 9001:2015 standard requires quality objectives to be measurable which means that targets have to be set.
The requirements around the ISO 9001:2015 objectives have
also been made more detailed. They are to be
consistent with the ISO 9001:2015 quality policy, measurable (if
practicable), monitored, communicated, and updated
as appropriate. They have to be established at relevant
functions and levels.
Now planning how to achieve its quality objectives is
introduced in the new version of ISO 9001:2015 standard.
The main differences in content between the old and new version of ISO 9001 standard?
The adoption of the high level structure as set out in Annex SL of ISO Directives Part 1
An explicit requirement for risk-based thinking to support and improve the understanding and application of the process approach
Fewer prescriptive requirements
More flexibility regarding documentation
Improved applicability for services
A requirement to define the boundaries of the QMS
Increased emphasis on organizational context
Increased leadership requirements
Greater emphasis on achieving desired process results to improve customer
Transition means extra paperwork?
No! New ISO 9001:2015 standard requires an organization to document a number of things but, these are
relatively less as compare to previous version of standard, new standard gives you flexibility to document
system (Except mandatory requirement) without unnecessary paperwork. You may refer clause by clause
changes in the below guidance note.
ISO 9001:2015 Standard further requires performance management - for more details email@example.com . URS is organizing Transition course for 2015 version of ISO 9001 Standard in India in all major cities- for schedule in your City of India, please visit the Calendar at www.ursindia.com/training.aspx.
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ISO 9001 Certification in sopur is issued by URS. This is applicable to all type of Organizations of all size, such as ISO 9001 for Hospital & Health Care in sopur, ISO 9001 for Trading in sopur, ISO 9001 for Manucaturing in sopur, ISO 9001 for Services Companies in sopur, ISO 9001 for Software Companies in sopur, ISO 9001 for Medical Devices in sopur, ISO 9001 for Construction in sopur can implement the system as per ISO 9001 and URS awards the UKAS accredited ISO 9001 Certification in sopur for various product
ISO 9001 Training Services in sopur
ISO 9001 Lead Auditor Training are delivered by URS in sopur. Lead Auditor Training Courses are designed such that the participants gains the subject knowledge and auditing skills, the auditors courses are accredited by IRCA, UK - International Register of Certificated Auditors, UK. Organization can apply to IRCA Accredited ISO 9001 Lead Auditor Trainings in sopur to URS at firstname.lastname@example.com
ISO 27001:2013 is revised version of
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Winners of the High Cotton awards sponsored by Farm Press Publications through a grant to The Cotton Foundation are quick to thank their wives, other family members and Extension agents and crop consultants who have helped them over the years.
Southeast winner Monty Rast did all of that, but he also made another observation during the breakfast honoring the award recipients at the 2007 Beltwide Cotton Conferences. "I am proud to be in the presence of all these wonderful farmers," said Rast, who farms in and around Cameron, S.C.
Rast's comments were in keeping with the name of the High Cotton awards, which were presented for the 13th year at the Beltwide, which is sponsored by the National Cotton Council, this year in New Orleans.
"High Cotton is a phrase that means standing in the presence of greatness," says Greg Frey, publisher of Southeast Farm Press, Delta Farm Press, Southwest Farm Press and Western Farm Press. "When you say someone's in 'High Cotton,' that means he's in a special group of people."
Rast; Justin Cariker, the Delta winner from Dundee, Miss.; Barry Evans, the Southwest winner from Kress, Texas; and Gil Replogle, the western winner from Visalia, Calif., all appear to be standing in High Cotton when it comes to environmental stewardship and conservation.
"We are very proud to present the 2007 winners of the High Cotton awards to you," said Frey. "Each is dedicated to taking care of his land and water and leaving his farm better than he found them."
Besides implementing conservation practices on his 1,400-acre farming operation, Rast also devotes time to helping improve the environmental image of farmers where it counts — among South Carolina lawmakers.
"Monty is also well-known for incorporating wildlife into his farming operation, adding value to the land he farms," said Paul Hollis, the editor of Southeast Farm Press who presented the Cotton Boll award to Rast. "He also is a frequent host to legislative groups to keep them aware of the challenges farmers face."
"I know it is important to spread the news about what farmers do to protect the environment," says Rast. "I get my legislator down to our farm to let him know how important farming is to our economy and to the environment."
Cariker, who farms 4,000 acres of cotton that run from the casinos of Robinsonville to Dundee in Mississippi, also thanked his wife, Shelby, and his crop consultant, Bobby Basse, Tunica, Miss., for their contributions to the success of their farming operation.
"It is such an honor to be in this program," said Cariker, who has been a participant in DuPont's Cotton Leadership program and FMC's Producer Information Exchange. He has also been a member of the National Cotton Council's Policy Education Program.
Besides working on developing "branded" cotton through his involvement in Signia Cotton Cooperative, Cariker has been employing a stale seedbed approach to cotton production, trying to improve his bottom line from both directions. He's also experimenting with no-till on a buckshot, irrigated farm, growing yields of 900 pounds per acre with reduced input costs.
Barry Evans, a producer who returned to the farm after spending several years working as a commodity broker, said the example set by his father, helped instill the environmental ethic he practices on his farm in him.
"When I left the farm to go to work in Amarillo, I told myself I was never coming back," he said. "But I came to realize working with my Dad that I do love the farm, and I wanted to come back."
To be honored as a High Cotton award recipient was a "very humbling experience," he told those attending the awards breakfast in New Orleans. "But being able to bring sustainability to your farming operation and making it work is a great message to send that people need to know."
Far West winner Gil Replogle said he wanted to thank his wife, his parents and University of California farm advisor Steve Wright for helping him achieve success in farming and environmental stewardship.
"Steve Wright has a gift for getting right to the heart of the matter, and his humor helps," said Replogle, referring to information Wright has provided that has been helpful in his farming operation. "People like Steve, (UC cotton specialist) Bob Hutmacher, (Fresno State University's) Bruce Roberts and (gin manager) Larry Galyan provide a lot of common sense answers."
Replogle said he especially wanted to thank his father, Ray, for giving him the opportunity to farm and giving him encouragement when times were tough. "Many times I've walked away with a new spirit of encouragement, knowing he was with me all the way."
e-mail: firstname.lastname@example.com


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Have fun, stay legal targeting blue crab
As the local saltwater areas become warmer, some super fun outdoor activity picks up. We are fortunate to be in an area where the blue crabs are plentiful. Historically, the pursuit of these tasty crustaceans has been a family adventure. Cold weather means cold water, and the crabs don't move around much. With the type of winter that has just passed the water was chilled for quite a time. That trend has been changing and with the warmer water comes some really fine times to head out to the areas where the crab action is.
Blue crabs seem to be not only in saltwater, but also in nearby brackish water and even in freshwater that is near saltwater areas. So what type bait and equipment will most consistently produce good numbers of the big blue crabs? Crabs will feed upon any meat that is in their area. The use of chicken or turkey legs, wings or thighs is popular and an excellent choice. Perhaps chicken or turkey necks are even more popular than the other offerings. It is a good idea to remove the skin and fat from the bait so that it doesn't have a tendency to float. Baited crab lines must be on the bottom in order to be consistently productive.
The commercial crabbers will use all sorts of fish in their traps. Shad, the remains of cleaned larger fish, and such things will attract crabs. Fish heads do work well for sport crabbing, should there be some available. Again any type bait that contains meat will take crabs.
The bait should be tied to a simple piece of string. The cotton line that is available in all hardware stores for a couple of dollars is ideal.
Whenever you tie on the bait, if there is a current, I recommend the use of enough sinker to keep it on the bottom. Old nuts or bolts work well. Be sure to use enough line so that the crab can pull it out a little ways once he takes it. Too much pressure or resistance will sometimes cause him to release the bait.
Crab traps that are approved and tagged are legal for sports crabbers. The regulations for their use are published in the Texas Parks and Wildlife's Outdoor Annual. These are available whenever fishing license are sold and at the Texas Parks and Wildlife Department office on Eastex Freeway in Beaumont.
Only six crab traps per person may be fished by each non-commercial crabber. There are also a sunrise and sunset restrictions. These are all listed in the annual. Some anglers will set out some legal crab traps while they are going fishing. Then by checking them from time to time, it is possible to end the day with a big mess of some great table fare.
All of the aforementioned legal crabbing methods will produce crabs, but the string and bait technique is by far the most fun and more popular. When the crab takes the bait, all that is necessary is to slowly pull it toward you. Be sure to have a long handle dip net at hand. Better yet, allow someone else to net the crab while you slowly pull it in. Sudden jerks or pulling it in too fast may cause the crab to turn loose. It seems that for some reason, youngsters are more apt to get the crabs near enough to net. I have rarely come across a youngster that doesn't enjoy crabbing. There will be a lot of excitement and comment when they are experiencing some fast activity. Put out several baited lines for faster action.
Anglers who are required to possess a fishing license must have one when crabbing. A saltwater stamp is also necessary in most cases. Even if the adult only touches the string or container of live crabs, he or she must have the license and stamp.
Believe it or not, there is a size requirement for blue crabs. Blue crabs must be at least 5 inches at the widest point of the body. Five percent by number of undersize may be retained for bait, but they must be kept separately. It is illegal to retain egg bearing or sponge crabs or females with the apron removed. There is, however, no number limit for legal blue crabs.
Any place in the local bays, rivers, and bayous where there are rocks, bulkheads, shell or jettys are crab haunts. Boat ramps, fishing piers, weirs in the bayous are good crab catching areas. Bridges are also good spots, but don't block traffic or crab illegally from the bridge.In my opinion, the blue crab's flavor is second to no other seafood from our saltwater areas. If you would like to enjoy a family outing, go crabbing.
Tune in to KSET 1300 at 6 p.m. on Thursdays for Billy Halfin Outdoors and listen to The updates daily at 7:25 a.m., 12:25 p.m. and 6:25 p.m.


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Boris Johnson Eyes Parliament Vote on Brexit Before Christmas
United Kingdom Once Again Go to the Polls to Determine Brexit
Aung San Suu Kyi Denies Myanmar Genocide at World Court
Press Watchdog Reports China as Biggest Jailer of Journalists
Brazil's President Jair Bolsonaro Calls Greta Thunberg a "Litte Brat"
Ministry of Health Says Cancer the Number One Killer in Thailand
Study Found Thailand's Youth Addicted to Online Games
17 Year-Old Teen Gets 'Popcorn-Lung' Illness from Vaping
How Can Yoga and Meditation Change Your Brain?
Will You Get Dementia? Many Don't Understand the Risks
China Bans Broadcast of Arsenal Match Over Criticism of Uighur Muslims
Japan's Taki Masami Becomes Coach of Chiang Rai United
Former NBA Basketball Player Fined For Not Looking at China's Flag
Mourinho Era at Tottenham Begins with 3-2 Away Win at West Ham
Ideal Candidate to Replace Mauricio Pochettino as Tottenham's Manager
The Mekong River Dying a Slow But Most Certain Death
Hydro Electric Dams Starving Mekong River of Vital Sediment
Chiang Rai NGO Saves13-Year-Old Girl from Forced Marriage
Xayaburi Dam Opens in Laos Sparking Protests in Thailand
Convicted Human Traffickers Flout 99% of Court Orders
Top 5 Video Downloading Applications Avaliable for 2020
Finland Lends a Helping Hand to Thailand's Tech Sector
eSports isn't Just a Game its Become a Serious Business Thailand
Thailand's Navy Purchases Israeli Made Counter-Drone System
How is the New Twitch Store Going to Impact Gaming?
Military Conscription in Thailand Will Not Be Scrapped Anytime Soon
No Real Punches Landed In First British Election Debate
Thailand's Government Slowly Moving to Stifle Free Speech
Will a No-Deal Brexit Threaten the Global Economy?
Racist Asian's Bashing Unleashed Over New Zealand's Housing Crisis
CHIANG RAI – The 12 boys and coach of the Wild Boars Soccer were shocked and saddened when told of the death of a former Navy...


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Clinical Professor, Department of Pathology
Professor, Dominick P. Purpura Department of Neuroscience
Scientific Director of the Litwin-Zucker Center for the Study of Alzheimer's Disease and Memory Disorders, Feinstein Institute for Medical Research
Ramakrishnan P. Dickson DW. Davies P. Pin1 Co-Localization With Phosphorylated Tau In Alzheimer's Disease And Other Tauopathies. Neurobiol Disease, 14; 251-264, 2003.
Andorfer C. Kress Y. Espinoza M. de Silva R Tucker K. Barde Y-A. Duff K. Davies P. Hyperphosphorylation and Aggregation of Tau in Mice Expressing Six Normal Human Tau Isoforms J. Neurochem 86, 582-591, 2003.
Conrad C. Vianna C. Schultz C. Thal DR. Ghebremedhin E. Lenz J. Braak H. Davies P. Molecular Evolution and Genetics of the Saitohin Gene and tau haplotype in Alzheimer's Disease and Argyrophilic Grain Disease. J Neurochem, 89, 179-188, 2004.
Herskovits AZ. Davies P. Cloning and expression analysis of two novel pctaire 3 transcripts from human brain. Gene, 328, 59-67, 2004.
Bargorn S. Davies P. Mandelkow E. Tau paired helical filaments from Alzheimer's disease brain and assembled in vitro are based on beta-structure in the core domain. Biochemistry , 43, 1694-1703, 2004.
Material in this section is provided by individual faculty members who are solely responsible for its accuracy and content.


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Yoga for a Balanced Life
Name: Yoga for a Balanced Life
Date: September 20, 2019
Time: 10:30 AM - 11:45 AM EDT
Website: http://www.thestudiohillsborough.com
Event Description:
This alignment-based class focuses on the length, strength and integrated movement of the spine and core muscles. Each class is grounded on the theme of treating with opposites to achieve balance focusing on moving the body, breath, heart and mind in opposite ways to those encouraged by our everyday habits and external influences. All students are welcome whether new to yoga; suffering from shoulder, back or hip pain; dealing with the challenges of aging or injury; or those simply wishing to feel more comfortable, calm and balanced. Join Robin DeMent in The Studio at A Step To Health in Hillsborough for this weekly Friday class.


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Google Inc.'s popular map app got booted from the software bundled with Apple Inc.'s new iPhone 5 — the casualty of an escalating feud between the Silicon Valley heavyweights — but the search company is still throwing plenty of research and development muscle into the technology.
Apple replaced Google's app in its latest mobile operating system with its own (sharply criticized) Apple Maps. But Google reportedly plans to roll out a new app for Apple devices and continues to invest heavily in its mapping expertise because for hundreds of millions of users, Google Maps remains the go-to method to find their way.
So Google digital cartographers recognize it's imperative that their maps know which Paris you're talking about if they're going to tell you how to get there.
If someone is searching on Google Maps for "Paris," they're probably looking for the city in France. Unless that user happens to be in Texas, in which case they're probably looking for Paris, Texas, about 100 miles from Dallas. Or maybe they're standing on The Strip in Las Vegas, in which case they want the Paris Hotel.
"Can you give me directions to Paris" might be obvious to a human being, but it takes a great deal of sophistication for online mapping technologies to accurately determine where they are in the physical world.
Of course, understanding what the user is searching for is only half the battle for Google Maps. Once the service understands where the user wants to go, the next challenge is to find the easiest routes to get them there, whether by car, foot, or public transit.
So how does Google Maps figure out the best route for a user to take? How does it know which streets are marked 'one way' only, where there are left turn restrictions and which roads are separated by dividers or streetcar tracks?
The attempt to answer these questions led Brian McClendon, vice-president of Google Earth and Google Maps, and his team at the Mountain View, Calif.-based search titan, to launch Ground Truth in 2008, built on the back of the company's Street View project.
"In 2008, we were in a situation where we were licensing third-party data and organizing it with search as best we could, but we weren't able to do what we wanted with the data," Mr. McClendon said in an interview.
"So we made a fundamental decision to go out and make our own maps and have our own data and be able to improve it in terms of both quality and detail. This has been a huge investment for us, focusing on both the data and the search quality."
To create its digital maps, Google relies on all sorts of data from third-party providers, from satellite imagery and census data to bike trails from riding associations. With the Ground Truth project, Google has steadily been incorporating GPS data and images collected by its fleet of Street View cars, which have covered more than five million unique miles of roads in 3,000 cities in 40 countries.
With Ground Truth, Google has been busy teaching its computers to comb through its vast collection of Street View photos and has developed technology which enables them to recognize street signs, turn restrictions and the locations of businesses. Google combines that information with GPS data to help align the road information.
"It's actually good GPS data and we make it much better by using computer vision to connect different photos to each other," Mr. McClendon said. "We then run these computer vision algorithms to do extraction of street signs, speed limit signs, addresses and business logos, and then run these through automated recognition."
These data can be uploaded immediately to the company's road database, but if there's a discrepancy, Google will send a Street View car operator to confirm what's in the photos.
"The combination of heavy automation, with final human verification of the ambiguous pieces gives us a very high-quality data set that is derived from Street View imagery," Mr. McClendon said.


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1. A.J. Graves lays more pipe than you do. Butler's 6-1, 155 lb. Emo-bang wearing A.J. Graves lays pipe all summer long at his family's plumbing business in Switz City, Indiana. A.J. was all-state at White River Valley H.S. in 2004 and finished two votes behind North Central's A.J. Ratliff in voting for Indiana's Mr. Basketball. He wasn't recruited by any of the major programs and chose to follow his brothers Andrew and Matthew to Butler, choosing the Bulldogs over Indiana State, Xavier, Bradley and SIU. A.J. led Butler to the preseason NIT championship this year, beating Notre Dame, Indiana, Tennessee, and then, after shrooming the night before with Josh Heytvelt, beating Gonzaga in the final. At that time, Butler's R.P.I. was 1. Because A.J. is widely regarded as the best looking Graves brother, we could totally see him laying lots of pipe, even without the plumbing thing.
2. Greg Oden in a Butler uniform? But for the incompetence of the former Butler Athletic Director, it could have happened. Thad Matta, the current Ohio State coach, was the head coach at Butler in 2000-01. That year, Thad's team beat the crap out of Wake Forest in the first round of the NCAA tournament, 79-63 (Butler was actually up 43-10 at the half). After returning to Indianapolis, Thad, who was then on a three-year contract, met with then-AD John Parry about his contract. According to a reliable source, Thad didn't want any more money, just some job security, and asked for a 10-year contract. The genius John Parry refused. Several weeks later, after Skip Prosser left Xavier to take the Wake Forest job after Dave Odom went to South Carolina, Xavier came calling. It seems that the Xavier president had dinner in the same Kansas City restaurant as the Butler team during the NCAA opening round (XU was in the same regional) and was impressed with the way Thad's team handled themselves, so he told the Xavier A.D. to go hire Thad, which he did. Three years later, after Jim O'Brien starts shipping money to recruits, Thad ends up at Ohio State. It goes without saying that Thad is the reason that Oden went to Ohio State (what, do you think Dan Peters can recruit now that he no longer has access to Bob Huggins' checkbook?). So, given the NBA rule change that has Oden in college for one season, do you think Thad would have been able to talk him in to coming to Butler to play in historic Hinkle Field House in front of his hometown fans? I think yes. And but for the incompetence of one Butler A.D. in refusing to lock Thad up for 10 years, it could have happened.
3. Six Degrees of Kevin Bacon: Indiana hoops/Deadspin-style. Butler head coach Todd Lickliter played at Butler with Doug Mitchell, who is the head coach of
Illinois Indiana recruit (oops, sorry Will), Eric Gordon, who played AAU basketball with Duke's Josh McRoberts, who is the son of former Butler player Tim McRoberts, who was a Butler teammate of Chad Tucker, who was a Butler teammate of Thad Matta, who was a Butler teammate of Darin Archbold, who was in Blue Chips (filmed at Brandon Crone's high school in Frankfort, IN) with Robert Wuhl, who was in Bull Durham with Kevin Costner, who was in JFK with Kevin Bacon, who was in A Few Good Men with Tom Cruise, who was in Jerry Maguire with Cuba Gooding, Jr., who was in Coming to America with Eddie Murphy, who was in 48 Hours with Nick Nolte, who was in Blue Chips with Bob Knight, who coached Bowling Green coach Dan Dakich at Indiana, who went to Pierce Middle School in Merrilville, Ind. with ... Dee Mirich. Affirmed. — Bulldog Lounge


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Dr. William Bainbridge, Friday, 2-8-13 February 6, 2013Posted by The Space Show in Uncategorized.
Tags: CCI Games, citizen science, Dr. William Bainbridge, EVE Online, frontier development, Galaxy Zoo, gaming, JPL, NASA, NASA story telling, nuclear propulsion, pioneering, science fiction, Sean Smith (Vile Rat), space economic issues, Space Futures Space Survey, space industry knowledge and perceptions, space policy, The Committee for the Future, the next fifty years in space, The Syncon Process, U.S. space leadership, Vile Rat., virtual reality
1 comment so far
Dr. William Bainbridge, Friday, 2-8-13
Guest: Dr. William Bainbridge. Topics: The Space Futures Space Questionnaire about space exploration and the next fifty years. Please direct all comments and questions regarding Space Show programs/guest(s) to the Space Show blog, https://thespaceshow.wordpress.com. Comments and questions should be relevant to the specific Space Show program. Written Transcripts of Space Show programs are a violation of our copyright and are not permitted without prior written consent, even if for your own use. We do not permit the commercial use of Space Show programs or any part thereof, nor do we permit editing, YouTube clips, or clips placed on other private channels & websites. Space Show programs can be quoted, but the quote must be cited or referenced using the proper citation format. Contact The Space Show for further information.
We welcomed Dr. William Bainbridge to the program to discuss the Space Futures project which is to help define the future of space our space program for the next fifty years. Perceptions of informed, interested, and space conscious individuals are sought for the Space Futures space questionnaire. The questionnaire is based on years of prior research conducted by Dr. Bainbridge as well as other more recent surveys. You can read about the Space Future Questionnaires (different platforms are available for it) at http://convergentsystems.pbworks.com/w/page/16444389/FrontPage. If you use the Droid platform, click on the links that allow you download a free Droid APP which enables you to instantly transmit your survey responses to the survey data base. For everyone else, you can download the survey as a Word document which you can complete online and email to Dr. Bainbridge. The Word document questionnaire with 300 questions is at http://convergentsystems.pbworks.com/w/file/62227159/Space%20email%20survey.doc. Make sure you click on the DOWNLOAD tab in the upper left corner. There is a shorter 200 question Word document questionnaire on The Space Show blog. During our discussion, Dr. Bainbridge provided us with the history of this project, how the information has been and is now collected, processed, and used. We also talked about the importance of space aware people taking the time to complete the questionnaire. Lots of listeners asked Dr. Bainbridge questions about who should participate from Middle School students to those in the general population to people outside the U.S. All groups are welcome but as you will hear, it is very important to get the perceptions and opinions of those that have knowledge and expertise about space exploration and development. We talked about question groupings such as around topics including the Moon or Mars. We discussed changing trends overtime and current influences on our opinions such as today's economic problems. I brought up the decades old Syncon Process and how some attitudes and perceptions are even stronger today than they were decades ago with Syncon. For example, attitudes including space benefitting all of humanity and more. This topic took us toward the virtual world, gaming to help increase space awareness and expertise. I mentioned the recent discussion re the lunar space elevator program this past Monday regarding CCI Games in Iceland. This was our cliff hanger as we went to our break waiting for Dr. Bainbridge's comments about his being involved with CCI Games.
In our second segment of this 1 hr. 45 minute program, Dr. Bainbridge talked about his research with the CCI gaming product, EVE Online as he plays the game. He had much to say about the space awareness of this game and the team in Iceland that created it. He also said that Sean Smith, one of those slain in the terrorist attack in Benghazi, Libya was a player of EVE Online. His game name was "Vile Rat" and there is a huge outpouring of support and comments about him on the internet. Google Vile Rat to see these comments & news stories. We talked about other scientific games and new technologies for developing a space consciousness and expertise about space exploration. We talked about space and innovation along with frontier development, pioneering & what it means to both continue it or stop it for the future of a nation. John called to talk with Dr. Bainbridge about his surprise in taking the survey in finding out he was potentially more pessimistic about the future than he had thought he was because like so many others, he had expectations for more advancement in space exploration, development, even settlement than what exists with our present day reality. Dr. Bainbridge helped put these thoughts and realizations into context with our actual space exploration and development over the past decades. It's a fascinating discussion and analysis, don't miss it. Near the end of the program, a listener asked how to realize space as an investment rather than just another government expense item. We talked about better story telling by everyone concerned. Dr. Bainbridge also linked the survey questionnaires to this question because the results will help pinpoint our space insights along with the value stream. While there is a March 1 questionnaire due date, this is not a hard date and Dr. Bainbridge encouraged people to participate, even if later than March 1. Also, if someone wants hard copies of the questionnaire to distribute at a space conference or other event, perhaps even a Meetup, you can contact him for copies or you can download the questionnaire from the links provided above. Another idea is to make a simple flyer with the basic information and the URLs for space or related event distribution. I did the 300 questionnaire Word document and can't wait to see the analysis. I certainly plan on bringing Dr. Bainbridge back to the program to discuss the project findings.
Please post your comments/questions on the blog. If you do the questionnaire, share your thoughts with us on the blog. If you want to contact Dr. Bainbridge, you can do so through me at email@example.com.
The shorter 200 question survey is available for download here:


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Every week -- often with your help -- Food52's Senior Editor Kristen Miglore is unearthing recipes that are nothing short of genius.
Today: A no-cook, smooth, scoopable frozen treat without an ice cream maker -- in our new favorite flavor: salted butter.
This week's recipe solves a timeless, universal summer problem: how to make a soft, scoopable ice cream without a fancy machine. Just like that. Solved!
It also takes care of another serious issue, one we didn't know we had: the issue being that we didn't know salted butter was a flavor. It's impossible to say which will be the more lasting improvement to humanity.
More: Another improvement to humanity? S'mores Ice Cream.
Our tale begins when chef Brad Spence was visiting the Jersey Shore with his wife, eating Springer's ice cream, as he had all his life. The butter pecan got him thinking.
Back in his restaurant Amis in Philadelphia, Spence wanted to recreate the not-so-sweet butter ice cream -- but the kitchen didn't (and still doesn't) have an ice cream or gelato machine. So he developed the recipe without fancy equipment, using a method any home cook with a whisk and a few bowls could pull off.
"It was one of those things -- I put it on the menu and I can't take it off," Spence told me. Now he serves it year-round, on blueberry tarts and in hot fudge sundaes in summer, over spiced pound cake in winter. Scoops melt over yeasted waffles and collapse into maple milkshakes.
And you have every reason to make it at home -- because all you have to do is whisk and fold. If you have some light machinery to help you, it will take no more than 20 minutes to assemble. (If you're riding on the strength of your whisking arm, maybe a little longer.)
Here's how it works:
Cream egg yolks and sugar until they curl up, pale and buoyant.
Pour in melted (but cooled) butter and salt.
Fold in whipped cream, then whipped egg whites. (No, the eggs aren't cooked. Just buy them from a trustworthy source -- Spence's come from Green Meadow Farm in Gap, PA -- or you can use pasteurized eggs.)
Once this airy yellow fluff has a chance to freeze for several hours, unattended, it's semifreddo.
It tastes a little like butter pecan or French vanilla (without the pecans, or the vanilla) and perhaps even more like a well-salted sugar cookie dough. It's astonishingly creamy and smooth for what little attention you've given it. Maybe it's all the air you whipped in, or the power of yolks and cream -- but I'd like to think it's the butter.
As our Managing Editor Brette Warshaw pointed out when she hunted down this recipe, this is an anytime, any season pantry frozen treat. You have butter, eggs, sugar, and salt, don't you? Cream, maybe? And ... a freezer?
If you answered yes to all of the above, then you don't need to go to the store, or pre-freeze any component parts, or even stop to flick on the stove. There's nothing stopping you. Nothing.
Brad Spence's Salted Butter Semifreddo
Adapted from Amis Restaurant in Philadelphia, PA
Serves 6 to 8
8 egg yolks + 4 egg whites, divided (reserve remaining 4 egg whites for another use) 3/4 cup + 2 tablespoons sugar (175 grams)1 stick + 2 tablespoons unsalted butter1 teaspoon kosher salt1 cup heavy cream
See the full recipe (and save and print it) here.
Photo of Brad Spence from Vetri Family website, all other photos by James Ransom
Got a genius recipe to share -- from a classic cookbook, an online source, or anywhere, really? Please send it my way (and tell me what's so smart about it) at [email protected].
The Genius Desserts cookbook is here! With more than 100 of the most beloved and talked-about desserts of our time (and the hidden gems soon to join their ranks) this book will make you a local legend, and a smarter baker to boot.
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Well, Alastair,
I went onto the egypt mahjong, played it, but it kind of decides "for you" when you're finished with the game. Hard to explain, but also the persia mahjong is the same. You play along, go through one field, then get another, and evidently there's a timer on...that you do not know about. Suddenly, you come to a page which states something like you're all done. If you put your name in the opening, then go onto our Arcade page, you'll see your name cited as having won that certain game & the score. IF you have a high score! I have seen this many times, however, it's frustrating to think you're really going good on passing through so many fields, clearing them out, to be told that it's all over, & you must post your name "here". Unless one plays these two mahjongs, one doesn't really understand what happens. Just my two cents. Joan
PS: it is also trying to get you to click on "more mahjong games"...which takes you to another site.


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The recent WIRED article entitled "New Wi-Fi Standard Promises Blazing Fast Data Speeds" finally clears up a few of the unknowns of the 802.11n standard that has been in development for the last five years.
This technology will allow for increases in speed, range and number of simultaneous users on a network. Wireless N, as it is mostly commonly called is also backward compatible; meaning that a new 802.11n router will still support connections from devices using the older 802.11b and 802.11g chipsets.
Even though wireless n devices have been available to consumers for some time, they have been based on the draft of the N standard. The September release of the finalized standard by the IEEE, brings with it some interesting modifications to the draft, which the current products are based on. These improvements include: the addition of a extra send and receive channel, increasing both the range (to approx. 4000 square feet) and throughput by an additional 33 percent.
These improvements will benefit both the home wireless network user and the hotspot provider, allowing for greater coverage, higher speed and better concurrency. Unfortunately depending on the Internet gateway services available, end users may not receive the full benefit of the equipment improvements because the service itself is not capable of supporting it. This could mean slow adoption rates for hotspot providers like us at Vex.
Once the ISPs can support the technology, browsing and downloading content will become a significantly better experience. This is one of the first instances where wireless technology has outpaced the wired service (internet gateway) and will lead to innovations and lower bandwidth costs in the ISP market.


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I think this will be the last Pokemon species I will be uploading today and for a while. I just wanted to get a lot of the requested Pokemons uploaded because I know how many fans there are of the series. Every once in a while I will come a cross a species that is incredibly adorable. That is the case with this character from the series. Today I will teach you "how to draw Lillipup", step by step, which is one of the cutest Pokemon I have seen in a while. It is from the Generation V species being a normal type, falling in the Puppy Pokemon specie category. Lillipup will evolve into Herdier once it reaches level sixteen and then once again into Stoutland at level thirty two. Lillipup looks very much like a dog, especially the types that have faces full of hair. The entire front part of the face is covered with a plate of fur as well as the ankles of the legs above the paws. Like most dogs in real life, Lillipup will stand up to opponents stronger they thee, but it almost always walks away from fights it knows it won't win. There really isn't too much more information on this Pokemon which is why I have to cut this description short. I will return with more fun things to draw in a bit but for now enjoy learning "how to draw Lillipup" first. Thanks guys and be sure to stay tuned in for more drawing fun.
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!


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« Return to Inventory List
Year: 2003
Make: Ford
Model: Ranger
Trim: XL Short Bed 2WD - 311A
Mileage: 85,301
Vin: 1FTYR10D23PB61723
Stock #: 2304
Engine: 2.3L L4 SOHC 8V
Color: Silver Frost Metallic
Drive Train: RWD
Type: Truck
State: OK
Estimated By E.P.A.
Actual Mileage May Vary
Visit Oklahoma Patriot Auto Sales online at www.oklahomapatriotautosales.com to see more pictures of this vehicle or call us at 405-285-5080 today to schedule your test drive.
I hereby consent to receive text messages from or on behalf of dealer at the mobile phone number I provided above. I understand that I am opting in to receive text messages from dealer or their employees. I include consent to receive phone calls at the mobile phone number I provided. I understand that message and data rates may apply.


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AMVETS, DeVry Offer Vets Scholarships
American Forces Press Service
WASHINGTON, Feb. 8, 2008 - Veterans pursuing higher education through DeVry University may be eligible for scholarships up to $1,000, but the deadline to apply is quickly approaching.
Applications for 2008 AMVETS/DeVry University scholarships are due Feb. 15. Veterans and their family members are encouraged to apply for one of 10 scholarships being offered for 2008 spring semester.
The scholarships of up to $1,000 may be applied to undergraduate and graduate programs at both DeVry and its Keller Graduate School of Management for online and on-site programs, AMVETS officials said in a recent news release. Applicants are eligible for scholarships every semester of enrollment, up to $9,000 throughout the course of a degree plan.
Those wishing to apply must submit an essay, a copy of a valid DD 214, a resume, a letter of recommendation and their most recent completed tax return. A full listing of eligibility rules and an application form can be found on the AMVETS Web site, www.amvets.org.
AMVETS partnered with DeVry and its school of management last year to provide up to 30 scholarships per year at a value of up to $1,000 each.
DeVry, which offers programs in 25 states and Canada, as well as online, started the program as a way to honor veterans and their families, officials said.
AMVETS is a supporter of America Supports You, a Defense Department program connecting citizens and companies with servicemembers and their families serving at home and abroad. The service organization is a longtime proponent of higher education, offering a variety of scholarship programs to veterans and their family members.
(From an AMVETS news release.)
*Related Sites:*
AMVETS [ http://www.amvets.org/ ]
AMVETS, DeVry Offer Vets Scholarships [ http://www.defenselink.mil/news/newsarticle.aspx?id=48909 ]


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Relations with the northern part of Cyprus
The purpose of this communication is to put forward measures promoting economic development in the northern part of Cyprus and bringing it closer to the European Union.
Communication from the Commission to the Council, the European Parliament, the Economic and Social Committee and the Committee of the Regions of 3 June 2003, "Ways of promoting economic development in the northern part of Cyprus and bringing it closer to the Union" [COM (2003) 325 final – Not published in the Official Journal].
In the absence of an overall settlement to the de facto partition of Cyprus, this communication proposes measures to promote the economy of the northern section of the island and bring it closer to the Union. Two types of measure are identified: financial assistance and trade.
Financial aid
In 2003, EUR 9 million in financial aid to promote economic development is to go to the following projects:
In 2003 the Commission will step up its information work to bring Northern Cyprus closer to the Union; EUR 3 million will be allocated to the following activities:
The communication proposes adoption of a system enabling products from Northern Cyprus to be exported under a preferential tariff system pursuant to the Association Agreement signed between Cyprus and the Union. Since 1994, non-acceptance of certificates issued by the Turkish Republic of Northern Cyprus has prevented exports from this part of the island from benefiting from the preferential customs treatment granted to the rest of Cyprus under the Association Agreement. Under the new system, the Cypriot Chamber of Commerce will be responsible for issuing certificates for the movement of goods produced or obtained in the northern part of the island.
Communication from the Commission to the European Parliament and the Council - Annual Report 2006-2007 on the implementation of Community assistance under Council Regulation (EC) No 389/2006 of 27 February 2006 establishing an instrument of financial support for encouraging the economic development of the Turkish Cypriot community [COM(2007) 0536 final – Not published in the Official Journal]. This report follows the first year of the implementation of the economic assistance programme for the Turkish Cypriot community. The report is positive, in particular due to the strengthening of the administrative capacity. However, the programme duration was reduced from five years (2005-2009) to three years (2007-2009). The overall reduction in planning also means a reduction in the deadlines for awarding contracts.
Council Regulation (EC) No 389/2006 of 27 February 2006 establishing an instrument of financial support for encouraging the economic development of the Turkish Cypriot community and amending Council Regulation (EC) No 2667/2000 on the European Agency for Reconstruction [Official Journal L 65 of 07.03.2006].
Communication from the Commission of 27 August 2008 - Annual Report on the implementation of Council Regulation (EC) 866/2004 of 29 April 2004 and the situation resulting from its application [COM(2008) 529 final – Not published in the Official Journal]. The Commission considers that Regulation (EC) No 389/2006 constitutes an adapted legal framework. The number of people crossing the line doubled between 1 May 2007 and 30 April 2008, reaching the highest level since the green line was established. However, illegal immigration is still increasing. The flow of goods has increased by a third during the reporting period, despite the continuing obstacles to trade, particularly for goods originating in the northern part of the island, which is not under effective government control. The Regulation was amended on 16 June 2008, in order to facilitate trade between the two areas. The Commission shall continue to monitor the implementation of the Regulation.
Commission Decision 2007/330/EC of 4 May 2007 lifting prohibitions on the movement of certain animal products on the island of Cyprus under Council Regulation (EC) No 866/2004 and laying down conditions for the movement of those products (notified under document number C(2007) 1911) (Text with EEA relevance) [Official Journal L 123 of 12.5.2007].
Council Regulation (EC) No 866/2004 of 29 April 2004 on a regime under Article 2 of Protocol No 10 of the 2003 Act of Accession [Official Journal L 161 of 30.4.2004]. The areas where the Government of the Republic of Cyprus exercises effective control and those where they do not have effective control are separated by a line.
This line does not constitute an external border of the EU. This Regulation establishes the conditions under which checks on persons, goods and services crossing the line will be carried out.
Last updated: 07.09.2009


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2012 Hot Rod Power Tour Feature Sponsors
Lucas Oil / E3 Dyno Challenge
Royal Purple Driving Experience
Royal Purple is proud to announce several planned activities and events around the 2012 Hot Rod Magazine Power Tour (R). The Royal Purple High Performance Experience will include the Autocross and Drag Race that will take place at the Muskegon and St. Louis tour stops respectively. In addition, Royal Purple will give away a unique swag item and award a daily prize at each stop on the tour and a Longhauler gift at tour's end.
Long Hauler Ugly Luggage Contest
Do you have luggage that has seen better days of travel? Are you holding your suitcase together with duct tape or intricately woven rubber bands? If you are a victim of these luggage faux pas or you are just too lazy to buy new luggage, Royal Purple wants to trade your old bags for a set of new Royal Purple Ogio luggage.
Long Haulers on the 2012 Hot Rod Magazine Power Tour will have the opportunity to bring their ugly (or well-traveled) luggage to the Royal Purple booth at the Miami, OK stop at the Buffalo Run Casino, Wednesday, June 6 from 1 3 p.m. Royal Purple will snap a photo of the luggage and post it to their Royal Purple Inc. Facebook fan page (www.facebook.com/officialroyalpurple ) and let the fans vote. The luggage that receives the most votes for "ugliest" will be announced at the Stillwater, OK stop of the tour at Kicker Headquarters. Royal Purple will swap the "ugly" luggage for a Royal Purple Ogio Layover bag, backpack and gym bag.
In addition to the Ugly Luggage contest, Royal Purple is the featured sponsor of the Driving Experience events on the 2012 Hot Rod Tour. Those include Autocross at Muskegon, MI on June 3, Drag Racing at Madison, IL on June 5 and a Burn-Out Contest at Arlington, TX June 7.
Main Stage
Vision Screen
HOT ROD and Edelbrock, each celebrating their respective 65th and 75th anniversaries are proud to announce at the 2012 HOT ROD Magazine Power Tour, the "Racing to the Presses" Essay Contest to celebrate the next generation car enthusiast.
By sharing passion for hot rodding and educating America's youth, the essay contest provides an opportunity with three age-appropriate essay prompts.
For ages 9-13, the qualifying essay will answer the question "My favorite car is..."
Those 14-18 years old will answer the question, "My dream career with cars is..."
For technical college and 18-to-25-year-old participants, the prompt asks, "I want to innovate the automotive industry by..."
Here are the rules in short form:
Each qualifying essay will include 500-1500 words written in grammatically correct English.
Every entry must be handwritten in black ink on college ruled notebook paper single spaced.
Judging will be conducted by the staff of HOT ROD Magazine, Edelbrock Corp., and other aftermarket performance industry members including the staff of Ohio Technical College's Edelbrock Performance Academy.
Winners of this prestigious writing contest will be invited to Southern California for tours of both Edelbrock and HOT ROD's offices in May 2013 for next year's Rev'ved Up For Kids Charity Car Show. A host of prizes will also be available from Edelbrock, HOT ROD, and the entire performance aftermarket industry.
Sign up now at by clicking on the link on this page or look for entry forms during the 2012 Power Tour. We'll send via e-mail the rules package and instructions for submission on August 1. Look for updates and announcements in Hot Rod Magazine starting August 10 with the final essays postmarked no later than January 31, 2013.
For more information about the contest, the prizes and entering, visit Edelbrock.com. Announcements will also be available right here at HOTROD.com.
Photo Contest


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NBC's "Today" franchise is getting a new head coach.
Jamie Horowitz, a programming executive at ESPN, has been tapped as senior vice president and general manager of "Today." In that role he will be in charge of all four hours of the morning show and will report to Deborah Turness, the president of NBC News.
"Jamie has the skills, the talent and the experience to lead the 'Today' brand into the future," Turness said in a statement. In an internal memo to staff, Turness said besides oversight of the over-the-air content of "Today," Horowitz will also look to expand the show's reach on digital platforms and elsewhere.
Don Nash, the executive producer of "Today" will report to Horowitz.
At ESPN since 2006, Horowitz is currently a vice president of original programming and production. Shows Horowitz has had a hand in running include "First Take," Olbermann" and "SportsNation." Prior to joining ESPN, Horowitz was at NBC Sports, where he worked on the network's Olympics coverage.
Once the king of morning television, NBC's "Today" now trails ABC's "Good Morning America" in the ratings. Returning the show to first place is a top priority for Turness and NBC.
Follow Joe Flint on Twitter @JBFlint.


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1.Maritime Directory (5)
How to start promote my company
2. Internet Solutions (76)
About Domain names and Hosting Plans
3. My Account (1)
About using your account and other utilities
Roules & Regulations (2)
Roules & Regulations for .GR Domains
Cele mai populare articole
How can I add my Company profile to Maritime Directory ?
In order to add your company to our directory follow the bellow steps :1) You must Login first...How can I start promote my business profile in Maritime Directory?
Service: Premium Add URL in Maritime directoryCost €25.00 Annually. From top menu BUY NOW select...Why Infomarine On-Line ?
- Infomarine On-Line is a Worldwide Maritime Directory with more than 2000 visitors per day. -...How I can access Cpanel?
Because Infomarine On-Line is LIVE connected with the Domain Registry the Domain Name will be...What is CPanel?
CPanel is an extremely powerful, web based control panel. Cpanel provides a point and click...


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Apple's Diversity Data: Workforce Mirrors Other Tech Giants
Apple said its U.S. workforce is largely male, white and Asian, mirroring its Silicon Valley peers.
Apple said 30% of its U.S. workforce is female, in line with the gender breakdown at Google and Yahoo. Separately, it said 55% of its U.S. staff is white and 15% is Asian, with Hispanics and blacks accounting for 11% and 7%, respectively.


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Miller Lite Adopts Christmas Lights Show
Miller has capitalized on the viral power of Carson Williams' Christmas lights video with a television advertisement for Miller Lite.
A double-story house is emblazoned with Christmas lights including a beaming star, moving Christmas trees and a peace symbol. Across the top floor is a display reading, "Happy Holidays". Viewers are encouraged to 'Enjoy the Lites" and are presented with a six-pack of Miller Lite beer.
Click on the image below to play the video.
Original Christmas Lights video
See the original Christmas lights video that hit the viral charts…
Click on the image below to play the video.
Carson Williams
Carson Williams is an electrical engineer in Mason, Ohio, who used Light-O-Rama software and 88 channels to control 16,000 Christmas lights in 2004 and over 25,000 lights this year. Residents were able to view the lights synchronized with a a Frosty song, 'God bless the USA' and 'Wizards of Winter'. Williams broadcast the 12 minute soundtrack on FM from a low-power transmitter in his computer.
Unfortunately local traffic conditions deteriorated and police had to ask Williams to turn off the display after a car accident. However the 'Wizards in Winter' section of the show is hosted on numerous internet sites. The music is from Trans-Siberian Orchestra's The Lost Christmas Eve album.
See the article at podcast of WDMG.com Dan's interview with Carlson Williams. Snopes has a reference to TV and radio interviews.
Carson Williams has posted instructions for creating the Wizards of Winter animation at Wonderland Christmas, courtesy of Don, a Christmas lighting peer in Texas.
Wizards of Winter
The Miller Lite Christmas Lights commercial was created by The Martin Agency, Richmond, Virginia.
The Wizards in Winter clip is available to view at Metacafe set to the sounds of Barbara Streisand singing Jingle Bells.
Download the 'Wizard in Winter' track from iTunes with the link below.
Trans-Siberian Orchestra Lost Christmas Eve Album at Amazon.com
Note: The Miller Lite Christmas Lights advertisement has in some cases been mistakenly attributed to Budweiser.
Filed under: Christmas, Commercials, Miller
Tagged: Carson Williams, The Martin Agency
Location: USA


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LinkedIn sent me an email on Monday that said my profile was in the top 5% of viewed profiles in 2012!
Check me out yeah I'm a social media mogul.
Then I realised I have no idea what that number means so I did a few calculations. It seems LinkedIn have surpassed 200 Million users and they are having a party. I couldn't find any stats on how many of the 200 million are active. It looks like they don't make that information available but no doubt there are at least some duplicates in that figure and no doubt that at least some of those users are not active on LinkedIn.
So I managed to quickly burst my social media mogul bubble by doing some calculations
Lets assume that all 200 Million users are active, Being in the top 5% means that my profile view numbers are in the top 10 Million users. Suddenly I don't feel so special any more.
If we assume that 100 Million or 50% of the 200 Million members are active then my profile is in the top 5 Million active users. Slightly better but still not top 10 material.
So if you read my blog and you are not connected to me on LinkedIn then send me a connection request and I'll happily accept. Maybe I can get in the top 1% of viewed profiles in 2013
Did you get an email too? Where were you ranked?