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A high prevalence of obstructive sleep apnea (OSA) occurs in children with Prader-Willi syndrome (PWS). Yet, due in part to the relatively small samples previously used, the prevalence of OSA has varied greatly across studies. It is also unclear if factors such as age, gender, body mass index (BMI), or type of genetic imprinting are associated with increased risk for OSA among children with PWS.
To evaluate the (a) prevalence of OSA, as well as narcolepsy, in pediatric populations diagnosed with PWS; (b) effects of age, gender, body mass index, and genetic imprinting on OSA severity; and (c) efficacy of adenotonsillectomy (AT) for decreasing OSA severity in this population.
All studies assessing OSA among children with PWS through August 2013 were identified using the PubMed/Medline, Psych Info, Cochrane library, and Google Scholar data bases.
Fourteen studies of children diagnosed with PWS and who were assessed for OSA using polysomnography (PSG) met inclusion criteria (n = 224 children). The prevalence of OSA across studies was 79.91% (n = 179/224). Among youths with OSA, 53.07% had mild OSA, 22.35% moderate OSA, and 24.58% severe OSA. Narcolepsy was found to occur in 35.71% of children with PWS. Adenotonsillectomy was associated with improvement in OSA for most children with PWS. However, residual OSA was present in the majority of cases post-surgery.
This study confirms the high prevalence of OSA and narcolepsy among children with PWS. Screening for OSA and narcolepsy among children with PWS is recommended. In addition, while adenotonsillectomy was effective in reducing OSA for some children, alternative treatments may need to be considered, given the only moderate response rate.
Sedky K; Bennett DS; Pumariega A. Prader Willi syndrome and obstructive sleep apnea: co-occurrence in the pediatric population. J Clin Sleep Med 2014;10(4):403-409.
Prader-Willi syndrome (PWS) is a genetic disorder affecting chromosome 15q11-q13. It has a prevalence of 1:10,000-25,000 live children and occurs secondary to paternal chromosomal deletion in 70% to 75% of cases, or with maternal disomy occurring in 20% to 25% of cases.1 In addition, there is abnormal methylation of chromosome 15 in 2% to 5% of cases.2 Children presenting with this disorder are characterized by severe hypotonia and feeding difficulties leading to failure to thrive in infancy. By the second year of life, however, excessive eating secondary to hypothalamic dysfunction can lead to morbid obesity. Other associated symptoms include delays in motor and language development, and low intelligence. Hypogonadism in both males and females, short stature, scoliosis, and strabismus are also associated symptoms.3 It is important to note that hypothyroidism, a comorbid disorder sometimes present in children with PWS, has been associated with obstructive sleep apnea (OSA).2
Current Knowledge/Study Rationale: Prevalence rates of OSA are high among children with PWS, but vary greatly across studies. It is unknown if factors such as age, gender, body mass index, or type of genetic imprinting are related to OSA risk among children with PWS. It is not clear if AT has the same curative effects in children with PWS as compared to the general population. Thus, this study assessed changes in the prevalence of OSA following AT. Controversies about the prevalence of narcolepsy also exist in this population.
Study Impact: Since there is a high prevalence of OSA among PWS patients, routine screening for OSA by PSG is essential for early detection and treatment of this disorder. Although AT is often a curative treatment for children with OSA, it might not be as effective for children with PWS. Thus, post-AT PSG is essential to assess the OSA severity and to consider additional treatment if required. Screening for narcolepsy in this population is also essential after resolution of OSA since there is a high prevalence.
Angelman syndrome (AS) is very closely associated with PWS, as both syndromes are characterized by deficiency in expression of the long arm of chromosome 15.4 However, in PWS, the genes are deleted or unexpressed on paternal chromosomes, whereas the maternal gene is deleted or inactive in AS. Behavioral and endocrinal abnormalities (e.g., irritability with outbursts and hypothalamic insufficiency) are more severe in PWS patients, possibly suggesting a higher incidence of narcolepsy in this population. In AS, cognitive and neurological consequences (e.g., severe mental retardation, ataxia, and seizures) are more pronounced and severe.4 AS is believed to occur at about the same prevalence as PWS; however, in contrast to PWS which has three distinct types, AS has four: deletions, paternal disomy, methylation mutation, and single gene mutation (UBE3A).5 In AS, OSA occurs at a higher rate than in the general population, but probably with lower prevalence than among PWS patients. In a study involving ten children with AS, 30% were found to have OSA, diagnosed by an AHI cutoff of 5 per hour.15
OSA occurs in 2% to 3% of children and/or adolescents in general community samples.6 In contrast, rates of OSA among children with PWS range from 44% to 100%.7–13 The increase in viscosity of secretions, craniofacial abnormalities causing small airways, and hypotonia leading to airway collapsibility all contribute to the higher prevalence of OSA in this population. Secondary alveolar hypoventilation can also occur among children with PWS. Thus, baseline polysomnography (PSG) has been recommended in this population as infants and in early childhood to screen for any breathing problems.14 Aside from high rates of OSA, children with PWS also have a higher prevalence of short sleep onset latency and REM latency, and sleep onset REM (SOREM) due to central hypothalamic dysfunction.2 Thus, a higher prevalence of narcolepsy also has been suggested among youths with PWS.2
Although the prevalence of OSA in PWS patients is known to be high, it varies considerably across studies. Accordingly, one purpose of the current study was to examine several potential moderators of OSA prevalence among children with PWS, including child age. Some studies have found a higher incidence of OSA in the first two years of life.14 This might be secondary to the presence of central apnea that occurs more often at this age. However, there is also reason to believe that children with PWS might be less likely to have OSA during infancy because their overeating and obesity, a risk factor for OSA, does not tend to occur until after the first two years of life.16 Thus, it remains unclear whether the prevalence of OSA varies with age.
Gender is a second potential moderator of OSA prevalence. Gender differences are found among adults with OSA in community samples without PWS, as men exhibit higher rates of OSA,17 although most studies of children suggest an equal prevalence of OSA in gender.18 With puberty, a gradual increase in prevalence occurs in males due to hormonal changes and/or possessing a longer upper airway leading to higher risk of airway collapse during sleep.18 An increase in OSA occurs in post-menopausal women, suggesting a hormonal protective role.19 However, patients with PWS have associated hypogonadism; thus, it is expected that gender differences would not be seen following puberty, due to the lack of hormonal production in females. A third potential moderator is BMI, as obesity, a common sign among children with PWS, has been related to worsening OSA in children without a genetic abnormality.20 However, it remains unclear as to whether this plays a significant factor in increasing risk of OSA among children with PWS. Finally, genetic imprinting has not been examined for its potential effect on OSA in prior research of children with PWS. Thus, age, gender, BMI, and genetic imprinting were examined as potential moderators of differences in prevalence rates of OSA among children with PWS.
Untreated OSA in children has been associated with a diversity of health problems. Lower cognitive function has been detected in children with untreated OSA compared to controls in non-genetically abnormal children.21 Later in life, OSA is associated with cardiovascular complications including high blood pressure, heart disease, and even strokes.22,23 Attention problems, hyperactivity and other psychiatric problems such as increased depressive symptoms are also more common among children with OSA.24–26 Thus, effective treatment of OSA may prevent negative long-term consequences. Adenotonsillectomy (AT) has been the main treatment in non-genetically impaired children with OSA, and has been found to cure OSA in up to 60% to 85% of children with OSA.27 Other treatments for OSA can include use of a dental device or continuous pressure ventilation, and in rare cases, tracheotomy. The effectiveness of AT in treating OSA among children with PWS is largely unknown, as AT treatment studies have generally excluded patients with genetic abnormalities or those with facial dysmorphism. In children with PWS, however, the causes of upper airway narrowing include hypotonia affecting upper airway muscles, facial dysmorphism and mid facial hypoplasia, restriction in lung volume secondary to obesity and scoliosis, and the hypothalamic abnormalities leading to central apneas. Thus, AT would be expected to help but not necessarily cure the OSA. We analyzed the limited published data on the effectiveness of AT to treat OSA among children with PWS.
The goals of the current quantitative review are to (a) examine the overall prevalence of OSA and narcolepsy among children with PSW given the variable prevalence rates across studies; (b) explore whether OSA appears to vary as a function of age, gender, BMI, and genotype among children with PSW; and (c) examine the efficacy of adenotonsillectomy in treating OSA in children with PSW.
The PubMed/Medline, PsychInfo, Cochrane library, and Google Scholar data bases were searched using the terms "Prader Willi syndrome" crossed by "sleep disordered breathing," "SDB," "obstructive sleep apnea," or "OSA" and further crossed by "child," "children," or "adolescents." English-language studies through August 2013 were examined.
Published studies including children less than 18 years of age diagnosed with PWS were included. However, a small number of studies included adult subjects and were included for comparison purposes. Selection and coding of information was conducted by the first author and included sample size, age, gender, BMI, and apnea-hypopnea index (AHI) or respiratory measure.
To assess the incidence and severity of OSA, only studies including PSG were included since it is the gold standard diagnostic test.28 Seventeen published studies were initially identified.1,7–14,29–36 Four studies did not report the use of individual AHI scores for patients.1,10,29,31 Attempts were made to contact authors to obtain individual level data, which one author provided10; the other 3 studies were excluded from the review. An additional study was partially included, but only to assess the prevalence of OSA in patients with PWS11 as it did not report individual AHI scores but did reports the percentage of OSA in their population. Thus, 14 studies satisfied the inclusion criteria (Table 1).7–11,12–14,30,32–36 To minimize publication bias, we searched for unpublished data, including dissertations. No unpublished dissertations were found to have PSG screening in the PWS population. When examining potential moderators, all studies included the age of each participant, but only 9 studies included the gender of each participant. Across studies, we divided participant age into the following 4 groups: age 2 years or younger since some studies suggest a higher prevalence of OSA in this age group14; 2.1 to 7.0 years (since this is the age when adenoidal and tonsillar enlargement occur most frequently); 7.1 to 14.0 years of age; and a final group from 14.1 to 18 years old.
Demographics and characterization of children included in this analysis
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Of note, 4 of the included studies focused on children with PWS undergoing growth hormone treatment who were recruited from pediatric clinics,9,11,13,30 and 2 others consisted of children with PWS who were randomly chosen from pediatric clinics.7,8 Four other studies consisted of children with PWS who presented to sleep clinics with sleep disorders,12,32,35,36 possibly inflating the prevalence of OSA, while 2 others included children who were randomly selected from the community and referred to the sleep clinic.10,33 The remaining 2 studies consisted of children with PWS who were selected from a sleep laboratory referral and thus also might have inflated the prevalence of OSA.14,34 We further analyzed the prevalence of OSA in the following 4 groups to see if referral source was associated with OSA prevalence: those randomly selected from pediatric clinic7,8 (2 studies), those referred from pediatric clinic undergoing growth hormone administration9,11,13,30 (4 studies), those randomly selected from a sleep center10,33 (2 studies), and lastly those referred to a sleep center with possible OSA or excessive daytime sleepiness suggesting narcolepsy12,32,35,36 (4 studies).
Narcolepsy is subdivided into cases with cataplexy (cataplexy by itself is sufficient to diagnose the disorder), without cataplexy (daytime sleepiness in addition to ≥ 2 sleep onset REM periods in 4 or 5 naps on the mean sleep latency test [MSLT]), and those secondary to a medical condition. Since most of the studies included in our analysis did not screen for other narcolepsy symptoms, diagnoses depended mainly on the presence of ≥ 2 sleep onset REM periods. To assess the incidence of narcolepsy in this population, studies were screened for children with PWS who were assessed using the mean sleep latency test. There was one study that documented cataplexy symptoms, and children were included even if their MSLT was negative.
Among the 14 included studies of 224 children and/or adolescents diagnosed with PWS, the prevalence of OSA was 79.91% (179/224; Table 1). Mild sleep apnea (apnea-hypopnea index [AHI] between 1 and 5/h) was diagnosed in 53.07 of cases, moderate sleep apnea (AHI 5-10/h) in 22.35%, and severe cases (AHI > 10/h) in 24.58%.
To test whether the site of referral was associated with differences in the prevalence of OSA, we divided studies into the following 4 referral groups: children referred from pediatric clinics who were randomly chosen showed an OSA prevalence of 91.89% (34/37), while those from pediatric clinics who were undergoing growth hormone treatment had a prevalence of 77.05% (94/122). Children with PWS referred to sleep clinics who were randomly chosen had a prevalence of 91.67% (11/12), while those referred to a sleep clinic due to suspected OSA or narcolepsy actually had a relatively low prevalence rate of 73.91% (34/46). However, there was one study assessing narcolepsy that biased this last group in that they had a high number of children with PWS who did not have OSA (87.5% did not have OSA).35 When excluding this study, the prevalence of OSA in this population was 86.84%. Examining the 4 original groups, referral source was not significantly related to OSA prevalence (χ2 (3) = 5.95, p = 0.11)
Among the 9 studies that included gender (n = 87 children), 85.06% were diagnosed with OSA as detected by PSG (74/87). Of the 74 positive cases, 43 were male and 31 female, with all 4 negative cases being female (χ2 (1) = 3.10, p = 0.08). Examining severity of OSA, mild OSA was diagnosed in 33.78% of boys (n = 25) vs. 16.22% of girls (n = 12), moderate OSA in 12.16% of boys (9) vs. 16.22% of girls (12), and severe OSA in 12.16% of boys (9) vs. 9.46% of girls (7).
When analyzing the 4 age groups across the 12 studies that provided individual age data (after excluding two studies that only had the average age11,30), 88.89% (32/36) of children aged 2 or younger had OSA. This is compared to 88.89% (32/36) in the > 2 to ≤ 7-year age group, 86.49 (32/37) in the > 7 to ≤ 14-year age group, and 76.19% (16/21) in the > 14 to ≤ 18-year age group. Thus, age did not affect the prevalence of OSA among children with PWS (χ2 (3) = 2.20, p = 0.53). In addition, 25 adults (age 19 to 46 years) with PWS from 9 studies were compared to the children with PWS. A lower prevalence of OSA was observed among the adults (60.0%; 15/25) than children (χ2 (1) = 5.18, p = 0.02). Examining OSA severity as assessed by AHI scores (mild, moderate and severe) as a function of children's age indicated greater severity with younger age (r = -0.34, p = 0.0018; see Figure 1). This finding of decreasing prevalence with age is suggestive of possible improvement over time among both males (n = 39 children, r = -0.34, p = 0.03) and females (n = 45, r = -0.32, p = 0.03).
Scatterplot of the relation between apnea
Six studies included genetic chromosomal abnormality information for children (n = 102). Deletion of parental chromosome abnormality was present in 66.67% of the population (68/102), with maternal disomy diagnosed in 28.43% (29/102) and imprinting center mutation in 4.90% (5/102). Rates of OSA were highly similar between the deletion of parental chromosome abnormality and maternal disomy groups (χ2(1) = 0.08, p = 0.77). Examining OSA severity levels in parental chromosome abnormality children compared to maternal disomy, 14.71% vs. 17.24% in the respective groups had no OSA; 41.18% vs. 37.93% had mild OSA; 17.65% vs. 17.24% had moderate OSA; and 26.47% vs. 27.59% had severe OSA, respectively. The rate of OSA among the imprinting center mutation group was 80% (4/5).
Z-scores for BMI, which were normed for age and gender, were assessed in 3 studies involving 47 children. OSA did increase with greater BMI (r = 0.34, p = 0.018). BMI percentage, again normed for age and gender, was assessed in 19 children across 3 studies. As was the case for BMI z-scores, OSA was also associated with greater BMI percentiles (r = 0.49, p = 0.035).
Six studies assessed children with PWS (n = 42) using MSLT and/or screening for cataplexy symptoms. The prevalence of signs/symptoms suggestive of narcolepsy was 35.71% (15/42).
Since adenotonsillectomy is generally the treatment of choice for children with OSA, the effect of AT was assessed in children with PWS. Pre-surgery data including children with PWS undergoing AT to treat their OSA was compared with post-AT AHI levels. Four studies were included in the analysis totaling 17 children with OSA, whose follow-up period ranged from 3 to 43 months post-AT surgery. There were 4 studies included in this analysis.37–40 Seven children had a normal AHI level after AT (41.18%; 2 were normal at baseline). Six children had mild OSA (35.29%), one had moderate OSA (5.88%), and 3 had severe OSA (17.65%) following surgery. It is important to note that 2 cases had worsening of their OSA (one of each gender), while one had the same severity level of AHI (female).
Obstructive sleep apnea prevalence rates range between 44% and 100% in the published reports. Our quantitative review suggests an overall prevalence rate of 79.91%, equally distributed between the two genders. This rate is substantially higher than the typical prevalence of OSA among community samples of children, which range around 2% to 3%.6 Several risk factors may help to explain this relationship, however, including obesity leading to fatty deposition around the neck and subsequent airway narrowing. Both obesity and scoliosis can limit lung capacity as well.3 Reduced respiratory response to hypoxia and hypercapnia are prevalent in this population, independent of obesity risk.41 Fifty-three percent of children with PWS had mild forms of OSA, while 22% and 25% were for moderate or severe OSA, respectively. The Clinical Advisory Board of the PWS Association recommends a PSG study in all PWS children with interpretation by a sleep specialist.42 They also recommend expediting the PSG in cases of severe obesity, chronic respiratory infection, asthma, snoring or witnessed apnea, or EDS before AT or other surgeries that require sedation and prior to initiating GH.
Our study has found comparable rates across all age groups (86% to 89% for 3 age groups < 14 years of age). Although it is expected that adenotonsillar enlargement occurs in the 2- to 7-year age group, this group did not show a higher prevalence of OSA compared to those older or younger. However, when using AHI severity as the measure of OSA, a significant correlation was found, such that younger age was associated with higher AHI scores for both genders.
Analyses of the published data on adult individuals with PWS have yielded a much lower incidence of OSA (60% vs. the 80% we found for children). This might be explained by either the presence of a wider airway present among adults or that some adults had AT which in turn improved their OSA. However, grading difference in OSA in adults compared to children also might have played a role, as there is a 5 apnea/ hypopnea per hour grading difference when assessing OSA in children vs. adults. Another methodological difference is that OSA is considered present for children following two or more missed breaths, whereas OSA is considered present for adults when the respiratory event lasts at least ten seconds.43 Thus, scoring differences can lead to the detection of more OSA events in children compared to adults.
Children suffering from OSA have been found to have increased rates of behavioral problems (e.g., inattention, hyperactivity, and irritability).24,26 These studies have excluded children with severe neurological or genetic disorders. Controversy exists, however, as to whether specific genetic subtypes are related to behavioral and psychiatric problems among children with PWS.44 Some authors suggest worse behavioral problems and greater comorbidity with the maternal disomy, while others suggest higher severity in the paternal deletion type.44 Examining OSA rather than behavioral problems, our analysis did not yield a relationship between the genetic type and OSA.
Since AT was the treatment of choice for children with OSA, we examined its efficacy in improving OSA among patients with PWS. Several studies have found either partial or a complete lack of response to AT.1,37–39 In addition, one study suggests weight gain after AT, a major correlate to worsening of OSA.45 In our review, 46.67% of children with PWS had normal AHI after the surgery (including two children who had normal AHI scores before surgery). The literature suggests that 60% to 85% of children without facial dysmorphism or genetic abnormalities who have OSA have normal AHI after AT.46,47 Thus, this study highlights that while many children with PWS exhibit improved OSA following AT and that their response rate is substantial, it is still less than that of children without PWS. Our findings confirm the need to screen children with PWS after surgery for OSA (even in asymptomatic cases). There are several studies suggesting the effectiveness of intranasal steroids and leukotriene antagonists to be effective in treating OSA cases.47 Antibiotics can treat any associated adenotonsillar infections but usually do not lead to cure of OSA. In moderate to severe residual OSA, continuous pressure ventilation is an appropriate option. Compliance with this latter treatment is improved when combined with behavioral interventions. Dental devices have also been used; however, compliance issues and lack of research on their long-term effects limit their use.47 Adenoidal enlargement also can reoccur, requiring further surgeries. Supplemental oxygen has sometimes been used in individuals presenting with frequent oxygen desaturations. Weight loss can lead to improvement of OSA in some patients. However, since there are other etiologies causing OSA (e.g., hypotonia), it is rarely the cure. In the obese adolescent population, bariatric surgery has shown improvements in OSA.48 However, this treatment modality is usually reserved for those who are morbidly obese and have failed dietary adjustment. Other surgery alternatives include nasal reconstruction (for septal deviation or turbinate enlargement), rapid maxillary expansion, and mandibular advancement surgeries49; however, these treatment options are not well studied in children. Tracheostomy, while previously used to treat severe cases, is rarely used due to its complications.50
Narcolepsy is a neurological disorder characterized by cataplexy, excessive daytime sleepiness, hypnogogic and hypnopompic hallucinations, and sleep paralysis. Although it is a clinical diagnosis, MSLT is used to confirm the diagnosis in atypical cases. A high prevalence of narcolepsy has been previously suggested among children with PWS, partly due to the hypothalamic abnormalities associated with the syndrome. In our analysis, 35.71% of individuals had two or more SOREMs. However, a positive MSLT might have been secondary to OSA leading to interrupted sleep and delayed REM periods. There is also a population that would be categorized as having narcolepsy with cataplexy based on the presence of cataplexy alone; this was not screened for in most of the included studies.
Several factors might have affected the results of this study. There are limited published studies involving PWS, partly due to its low prevalence. Even in the published cases, the number of included individuals was often modest; thus, many studies used the median AHI score for analysis. Second, it is possible that referral source could have affected OSA prevalence rates across studies. However, examining prevalence rates by referral source (e.g., whether from a pediatric clinic versus a sleep clinic), we did not find evidence of differences due to referral source. Third, there is the possibility of selection bias, even in the randomized studies. We tried to minimize this by including any unpublished data. However, we could not find any unpublished data that met our inclusion criteria.
The current review highlights the high prevalence of OSA in children with PWS compared to general community samples of children. Since untreated OSA can lead to a diversity of medical, cognitive, and/or psychiatric complications, routine screening of this population is essential. PSG is the gold standard screening tool, especially given the lack of reliable correlations between symptomatic complaints and the presence of OSA. Since AT can improve, but does not usually cure the OSA of children with PWS, post-AT PSG is essential, especially in those with severe OSA. Other treatment methods should be considered if necessary (e.g., continuous pressure ventilation, or dental device) in children with residual OSA. Due to the high rate of narcolepsy prevalent in this population, causes of excessive daytime sleepiness also should be ruled out. Stimulant medications (e.g., modafinil, methylphenidate or mixed amphetamine salts) have been indicated to improve excessive daytime sleepiness in individuals with narcolepsy.51
This was not an industry supported study. Dr. Pumariega has received honoraria from consultation from both Concordia Behavioral Health for managed care consultation and AmeriHealth of NJ for serving on their Quality Committee. The other authors have indicated no financial conflicts of interest.
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Vandenbussche N, de Groen J, authors. Analysis of sleep- and wake disorders in Prader Willi Syndrome. NSWO. 2007;18:123–6.
Harris JC, Allen RP, authors. Is excessive daytime sleepiness characteristic of Prader-Willi syndrome? The effects of weight change. Arch Pediatr Adolesc Med. 1996;150:1288–93. [PubMed]
Hiroe Y, Inoue Y, Higami S, Suto Y, Kawahara R, authors. Relationship between hypersomnia and respiratory disorder during sleep in Prader-Willi syndrome. Psychiatry Clin Neurosci. 2000;54:323–5. [PubMed]
De Cock VC, Diene G, Molinas C, et al., authors. Efficacy of modafinil on excessive daytime sleepiness in Prader-Willi syndrome. Am J Med Genet. 2011;155:1552–7.
Nevsimalova S, Vankova J, Stepanova I, Seemanova E, Mignot E, Nishino S, authors. Hypocretin deficiency in Prader-Willi syndrome. Eur J Neurol. 2005;12:70–2. [PubMed]
Pavone M, Paglietti MG, Petrone A, Crino A, De Vincentiis GC, Cutrera R, authors. Adenotonsillectomy for obstructive sleep apnea in children with Prader-Willi syndrome. Pediatr Pulmonol. 2006;41:74–9. [PubMed]
Meyer SL, Splaingard M, Repaske DR, Zipf W, Atkins J, Jatana K, authors. Outcomes of adenotonsillectomy in patients with prader-willi syndrome. Arch Otolaryngol Head Neck Surg. 2012;138:1047–51. [PubMed]
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Clinical Advisory Board of the PWS Association, USA. Last accessed on October 3, 2013. http://www.pwsausa.org/syndrome/recevalsleepapnea.htm.
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Spendelow JS, author. Assessment of behavioral and psychiatric problems in people with Prader-Willi Syndrome: a review of the literature. J Policy Pract Intellect Disabil. 2011;8:104–12.
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Friedman M, Wilson M, Lin H-C, Chang H-W, authors. Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2009;140:800–8. [PubMed]
Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D, authors. Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc. 2008;5:274–82. [PubMed Central][PubMed]
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On World Press Freedom DayENEMIES OF THE PRESS 1999
New York, May 3, 2000 --The Committee to Protect Journalists (CPJ) released its annual list of the Ten Worst Enemies of the Press today, calling to account those whose actions make them personally responsible for the abysmal press conditions of their countries. Sierra Leone's Foday Sankoh, Iran's Ayatollah Ali Khamenei and Yugoslavia's Slobodan Milosevic head this year's list.
Sankoh is leader of the Revolutionary United Front (RUF) a rebel movement that targeted journalists for murder during his country's civil war. Khamenei, as supreme leader of Iran, has fostered an anti-reform climate that culminated in the dramatic closings of 16 publications over the past week. Milosevic returns to the list for a second year, as he continues his concerted campaign to destroy his country's independent media.
CPJ also placed Kazakhstan president Nursultan Nazarbayev and Angolan president José Eduardo dos Santos among the ranks of the world's worst press enemies. They join Alberto K. Fujimori of Peru, and Mahathir Mohamad of Malaysia, who are each listed for a second year, as well as repeat offenders President Zine al-Abdine Ben Ali of Tunisia (three years), President Jiang Zemin of China (four years) and President Fidel Castro of Cuba (six years).
"These enemies of the press use methods that range from outright torture and murder to more subtle techniques aimed at keeping uncomfortable truths from being told," said Ann Cooper, CPJ's executive director. "In Yugoslavia and Iran, threats are so severe that independent media are in grave danger of becoming extinct in the near future. Elsewhere, in China and Cuba, opposition voices have used new technology to circumvent restrictions, prompting new reprisals from leaders determined to control information."
Foday Sankoh, leader of the Revolutionary United Front, Sierra Leone.
Sankoh's rebel RUF force, along with allies from the Armed Forces Revolutionary Council (AFRC,) targeted journalists as "enemies" during the civil strife that ravaged Sierra Leone for eight years. During a bloody three-week occupation of the capital, Freetown, in January 1999, rebel forces executed at least eight journalists, some together with their families, before being ousted by the Nigerian-led West African peacekeeping force. In all, ten journalists were killed in Sierra Leone in 1999 because of their work. Despite his faction's long record of human-rights violations and atrocities, Sankoh was made part of the government in last year's UN-brokered peace agreement. As chairman of the Management of Strategic Mineral Resources Committee, he answers only to President Ahmad Tejan Kabbah. Chances are slim that Sankoh and his organization will ever face charges for their deadly campaign against journalists.
| Ayatollah Ali Khamenei, supreme leader of Iran.
In Iran's theocracy, where Khamenei exercises tremendous influence over key institutions, particularly the judiciary, the hard-line ruler has been presiding over the relentless repression of a burgeoning pro-reform press. In the past two years, courts have tried and imprisoned outspoken journalists at a dizzying pace. This April, following an inflammatory speech by Khamenei, Iran's judiciary banned 16 publications in less than a week, decimating the reformist press. In his speech, Khamenei charged: "[T]here are newspapers whose only aim is to create tension and make people cynical of the regime... It seems that 10 to 15 newspapers are guided from one center; they write similar headlines ... They insult official institutions..." Within days, these publications were banned.
Slobodan Milosevic, president of Yugoslavia.
Authorities intensified their crackdown on the independent Serb media with an almost daily barrage of attacks on press freedoms in the first few months of 2000. An unprecedented wave of attacks on newspapers and broadcast stations throughout the country followed vitriolic remarks against the press made by Serbian deputy prime minister Vojislav Seselj in February. Radio and television stations were closed and equipment destroyed or damaged. Newsrooms were raided, and newspaper publishers prosecuted and fined huge sums. Several independent and opposition media organizations were shut down under Serbia's notorious Information Law. Many more face closure as a result of Milosevic's ongoing effort to silence all opposition voices.
Jiang Zemin, president of China.
China's abysmal press freedom record is getting worse. The government maintains total control over all domestic media and disregards international norms of free expression. At the start of the year, 18 Chinese journalists were in jail, six of them convicted in 1999 because of their use of the Internet. Now, even as Jiang edges China toward fuller participation in the global high-tech economy, he continues to use his country's secret police to monitor the Internet. Under new regulations issued this year, anyone found guilty of transmitting ill-defined "state secrets" online can be jailed.
Zine al-Abdine Ben Ali, president of Tunisia.
Nursultan Nazarbayev, president of Kazakhstan.
| Fidel Castro, president of Cuba.
Castro's government continues its attacks on independent journalism by interrogating and detaining reporters, monitoring and interrupting their telephone calls, refusing to let them travel freely, and routinely putting them under house arrest to prevent coverage of political or religious events. After the Ibero-American Summit in Havana last November, when independent reporters received widespread international attention, Castro's government clamped down even more harshly against local journalists, who are now fleeing Cuba in unprecedented numbers. Four independent journalists remain behind bars, convicted of such vaguely-defined crimes as "dangerousness" for reporting that is critical of the Cuban system.
José Eduardo dos Santos, president of Angola.
Press freedom is virtually non-existent in war-torn Angola, where a crackdown on independent journalism goes hand-in-hand with government-sponsored disinformation campaigns. Under the country's notorious Law 7/78, dos Santos has effectively made any public mention of the UNITA rebel organization, or of the war that has now gone on for 25 years, a crime against state security. Self-censorship is common, and the few journalists who dare call dos Santos a dictator are systematically harassed, both legally and physically. Those arrested for "press crimes" may be detained on no further evidence than "suspicion," and then tried in secrecy. Journalists are often beaten by pro-government thugs or sentenced to prison and hit with enormous fines for defaming government officials.
Alberto K. Fujimori, president of Peru.
Fujimori has thrown all the resources at his disposal, including his near-total control of the legislative and judicial branches of government, into decimating what was, just five years ago, a thriving and vigorous press. His arsenal includes surveillance, smear tactics, and trumped-up charges against journalists and publications. Fujimori's systematic campaign to destroy independent television journalism gave his re-election bid an overwhelming amount of broadcast coverage, while tabloids and a Web site controlled by people close to the president's inner circle featured character assassinations of journalists who reported critically on the president.
Mahathir Mohamad, prime minister of Malaysia.

subset: commoncrawl


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Follow RFF News on your cell phone. Text follow rff to 40404 you will receive txt messages with RFF News
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I still don't get it.
Quote from: georgiapeach on June 05, 2011, 10:14:55 AMI still don't get it. What I interpret him as saying is, that there is no reason for them to be wearing cold weather gear so these must be images from one of the European episodes shown prematurely
is there anywhere that i can watch this online?
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Gang of 8 introduces 'border surge'
Two Republican senators unveiled an amendment on Thursday to strengthen the border security provisions of the Gang of Eight's bipartisan immigration bill. The amendment will help bring aboard swing senators and removes a major impediment to passing the Senate's immigration reform bill before the July 4th recess.
Sens. John Hoeven (N.D.) and Bob Corker's (Tenn.) amendment will require that border security be toughened before 11 million undocumented immigrants can pursue green card status, a key requirement of some Republicans.
Story Continued Below
Requirements in the amendment include completing 700 miles of fencing along the U.S.-Mexico border, adding 20,000 border patrol agents, adding an entry-exit and implementing an E-verify program to prevent illegal immigrants from getting jobs, the senators said.
( PHOTOS: 10 wild immigration quotes)
"Some people have described this as a border surge, and the fact is we are investing resources in the border that have never been invested before," Corker said. "The American people have asked us, if we pass an immigration bill on the Senate floor, that we do everything we can to secure the border."
The bill will be introduced Thursday afternoon, Hoeven said, and co-sponsored by Gang of Eight Republicans John McCain (R-Ariz.), Lindsey Graham (R-S.C.), Jeff Flake (R-Ariz.) and Marco Rubio (R-Fla.) as well as Kelly Ayotte (R-N.H.) and Dean Heller (R-Nev.).
Senators hope that the amendment can bring as many 15 Republican votes in support of the immigration bill, which would mean the support for the bill would approach 70 votes in favor.
In pitching the amendment to his colleagues, Graham compared the surge in troops on the border to the surge in Iraq.
( Also on POLITICO: House GOP on immigration tightrope)
"This is a border surge," Graham said. "I can look anybody in the eye and tell them that if you put 20,000 Border Patrol agents on the border in addition to 20,000 we've got … that's one every 1,000 feet. That will work. And if you buy technology that helped us fight and create success in Iraq when we did that surge, that will help the Border Patrol agents."
The Senate tabled an amendment from Sen. John Cornyn (R-Texas) on Thursday, 54-43, which would have required a hard trigger on border security along the pathway to citizenship but also would have added 5,000 border security agents and security technology on the border. Cornyn asked the deal-making senators how they could criticize his amendment as "budget-busting" when their own amendment went even further.
"We built on the foundation you laid," Hoeven told Cornyn on the Senate floor. "You asked for 5,000, we gave you 20,000."
Cornyn also wondered how they would pay for the $30 billion in additional border security that they were pitching. Hoeven responded that the CBO score delivered earlier this week that showed hundreds of billions in deficit reduction would more than pay for more boots on the ground.
"We use about $30 billion to make darn sure the border is secure," Hoeven said.
Strengthening border security had long been the major impediment to attracting conservative votes, and a compromise that resolves the issue would significantly improve chances for passage of the overall bill.


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Buffer, a social media manger, opened the Buffer API last week beyond its internal apps. According to co-founder, Leo Wildrich, the decision sprung from its single purpose as a company: "How can we make sharing links, videos and images to your social networks easier and more powerful?" Unlike its main competitors, Hootsuite and Sprout Social, Buffer "focus[es] on non-original content sharing, especially photos, videos and articles" states Tech Crunch. As Buffer launches its API, and attempts to make sharing easier, Wildrich stressed that Buffer aims "to build a new sharing standard...across the web."
Buffer's API has already accomplished some success with "15 integrations done and dozens more in the pipeline." Buffer further differentiates itself from competitors by focusing on all social media users; not simply offering a dashboard to companies wishing to manage social media. Its focus on non-original content ensures users can provide the best content when and where they want to share the content.
The Buffer API uses REST protocol and JSON data format for responses. Sharing content is simple. As Wildrich describes the process: "Drop [content] into your Buffer and that's it, we take care of the rest." The content is then distributed where and when the developer wants it (e.g. scheduled or non-scheduled sharing across multiple social networks at the instruction of the developer."
Social media management is already a crowded market. The threat of a social media giant (e.g. Facebook) acquiring or overturning a successful social media manager always remains. However, with an open API, forward-thinkers like Buffer could establish a widespread user-base that could set itself apart from competitors and give it legs to stand strong on its own.


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I have set $A=\{1, 2, 3\}$. $M$ is set of all relations on $A$.
$t:M \to M$ is function that returns the transitive closure for each $R \in M$.
I need to decide if the function $t$ is injective and/or surjective and prove it. the question is how should I do it. I don't even know where to begin because all examples I saw before was for functions like $f(x) = 2x + 3$, etc...
Thank you.


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Orders are processed and fulfilled daily with the exception of weekends and public holidays.
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A judge on Thursday granted a request for release from a suburban Chicago teenager accused of trying to join an al-Qaida-affiliated group.
Abdella Tounisi will await trial outside jail under home confinement and electronic monitoring, the judge said. Tounisi's father must be his third-party custodian.
After announcing his surprise ruling, the otherwise soft-spoken U.S. magistrate judge leaned forward on his bench Thursday and raised his voice, telling the teenager he should take the allegations seriously.
"This is no game, Mr. Tounisi. OK?" Judge Daniel Martin told him.
The slight, short Tounisi stood before the judge in orange jail garb and slippers, flanked by U.S. marshals. Some 30 friends and relatives sat on spectator benches; several cried after the judge ruled.
After ruling, the judge stayed his own order for 24 hours to give prosecutors a chance to appeal, which they announced later Friday they would do. A hearing in the matter was set for Friday.
Prosecutor William Ridgway had argued that Tounisi posed a threat to the community, saying he sought to hook up with the al-Qaida-linked group in Syria even after his friend Daoud's arrest.
"One would think that would be a wake-up call," Ridgway said about the arrest. "But it didn't deter him."
Tounisi persisted even as family and friends warned him not to get involved with extremists, Ridgway said. He quoted a friend as saying about Tounisi in a wiretap, "He will not die a martyr. He will die like road kill."
The prosecutor said Tounisi also is a flight risk, noting how he had managed to secure a U.S. passport on short notice and to scrape together money for a plane ticket.
"He's very resourceful," Ridgway told the judge.
But Tounisi's attorney, Molly Armour, said Tounisi came from a caring home and had no prior criminal record. She also said a terrorist-related charge shouldn't automatically deny release.
"The word 'terrorism' is a word that tends to taint everything," she told the court.
She also gestured to the back of the courtroom, where dozens of members of his community sat, assuring the judge they would also watch over Tounisi and see that he stays out of trouble.
"They are committed to being part of his life," she said. "That offers a backstop to the family."
Judge Martin said repeatedly that his decision to grant Tounisi release was a close call. He told Tounisi's father, Ahmad Tounisi, that a landline must be installed in the Aurora family home before his son could be released — to comply with home confinement and electronic monitoring.
The judge told Tounisi's father that he will be obliged to contact authorities immediately if his son takes "one step out of the house." The elder Tounisi said he understood and would comply.
Federal authorities said Tounisi is a threat and should remain behind bars, but the 18-year-old's family has said they believe he is innocent.
Tounisi faces one count of attempting to provide material support to a foreign terrorist organization, a felony. He is accused of planning to join an al-Qaida group in Syria and was living with his family in Aurora when he was arrested last month at O'Hare International Airport.
According to the FBI, Tounisi was discovered through a sham website claiming to connect users with extremist groups. Prosecutors also allege he is friends with Adel Daoud, charged with trying to detonate what he thought was a bomb outside a Chicago bar last year.
Speaking with Tounisi's father after the arrest, he said he believes his son was looking for an escape and wouldn't hurt anyone.
Tounisi has yet to enter a plea. He faces up to 15 years in prison if convicted.
The Associated Press' Michael Tarm contributed to this report.


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Let's say that I put together a Shapefile and all the features have their vertices shifted by a constant amount. What's the easiest way of shifting all the features (hence the (x,y) position of their vertices) by an arbitrary shift? I have lots of files that I would apply this correction to, so a Bash/OGR answer would be preferred :)
Finally, I ended up using Spatialite for this, as it has the nice function
ShiftCoords. However, the thread was very informative! Thanks all!


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Mariners Pointe in Little River
RE/MAX Southern Shores sells condos at Mariners Pointe in Little River
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Mariners Pointe amenities include an outdoor pool, hot tub, tennis court, clubhouse with lounge, a private dock and boat slips for the Intracoastal Waterway. Two bedroom units begin in the mid $100s with prices increasing depending upon the floor and location.
RE/MAX Southern Shores knows the Mariners Pointe condo market
As the #1 selling real estate agency along the Grand Strand, RE/MAX Southern Shores agents can assist you with purchasing a condo or investment property at Mariners Pointe that is suited to your needs. RE/MAX Southern Shores invites you to access listings for condos by using the search features on the left of this website. Then call a RE/MAX Southern Shores agent at 843-839-0200 for personal attention to find the housing option that is just right for YOU!
It is no wonder that so many buyers choose Mariners Pointe condos as the location of their new home. All one has to do is take a drive through the community to see all Little River has to offer. RE/MAX Southern Shores real estate agents are very familiar with the area, and we would be happy to take you on a tour of this complex as well as any Little River community. Simply give us a call at 843-839-0200 to schedule some time to make your real estate dreams come true!
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What types of cc work on the diffusion adds? Are they fearable? Rootable? Or just able to be stunned?
What types of cc work on the diffusion adds? Are they fearable? Rootable? Or just able to be stunned?
Aerzara, Discipline Priest
<Modest> 14/14H - US 2nd 10m Guild
they're rootable and stunnable, might be silencable. void tendrils are very good if people pay attention
Brewmaster Icy-Veins Guide Writer
http://oce.op.gg/summoner/userName=dw+soul+roc in oceanic now Lol
5172-1206-0622 pokemon FC Lets Battle!!
We're running:
Lock, Lock, Ret, Mage, Ele, Rog (sometimes a DK subs in)
We're shutting down (powering up?) static shock first. We've tried 3/3/2/2 and 1/3/3/3, and seem to be slaves to RNG or otherwise unable to be fully consistent in the first transition. More often than not, we lose 1 due to some combination of helm/shock RNG. Been rolling with the 1/3/3/3 strat recently and have me (protpal) solo, with the rest grouped up (changes throughout the night). Is there some better setup we can try to prune out some bad RNG?
When we do move to phase 2, it's usually pretty clean. We start off at bolts, go CCW to overcharge, then end up at chains (and stay there til end). We have our ranged splitting up to try and bait fewer chain adds, then a soft collapes for balls. Holy wrath/leg sweep stun adds seems to work well. We then go to 2/2/6 for the next trans, which is Protpal/rog, BrM/Mage, rest of group. We've yet to get through this successfully. Any suggestions or moves we should make?
We really are hoping to get practice on p3, as that is apparently the worst phase...which is a little disheartening given our struggles in transitions. We have phase1 on cruise control (no big feat), then everything either goes well, or goes to pot in the first trans. Phase 2 itself is also very clean, followed by a make-or-break (usually break) transition phase again.
We used the same transition setup, 1/3/3/3 and 2/2/6, can you paste your platform assignments here ? Think that could make quiet a difference.
What i'd suggest for the first transition would be the Monk Tank alone, then Group up the Disc, Elemental shaman and prot pala in a platform next to that off the solo monktank. (the prot pala can then help soak a double bouncing on the monks platform if his platform doesn't have helm of command / static shock and the monk has a easy time dealing with helm while still soaking 1 bouncing.).
Then the Mistweaver Rogue and a lock , and a Lock Ret and Mage. This last one is gonna have the hardest time due to lack of healing, the monk healer should be prepared to fly over to help heal and the ret should not be afraid to blow sacs , loh's etc. (i'd also swap the ret with a deathknight if they are both geared enough and got a brain).
Second transition i'd make it Brm/Ret instead of mage so that you can force difussion chain on to the platform of 6 and melt the add fast, if the ret gets static shock just have him rush to the platform of 6 get gripped and group soak it, then as that is occuring have the mage swap to his platform due to a incoming overcharge (the ret can't make it back intime).
Last edited by Nuckels; 2013-05-29 at 01:46 PM.
Ah, well perhaps there is hope; reading some other folks saying "it took us 100 wipes in p3 for a kill" made us all a bit disheartened.
Hmm, perhaps the monk and I can swap. I use Speed of Light (pally sprint) for the fight and it makes dealing with helms pretty trivial for me as well, but sometimes it's impossible to catch the bolt while helmed (or if there are 2). I can't recall 100% our assignments, but here goes:
Protpal (N) /BrM, MW, Lock (W) /Lock, Rog, Mage (S)/ Ret, Ele, Disc (E)
Prot, Rog (E) / BrM, Mage (W) / Rest in (S)
I think, anyway. But we did rotate around a few times to try and curb bad RNG or "I cant heal/soak/immune X" moments. Any suggestions for changes are surely welcomed.
DK can sub in for Ret, but our Ret has put in ~50+ more attempts than DK and is very competitive on DMG (plus another Devo, LOH/Sac, and offhealer for platforms). We'll be down a lock tonight and have the DK in instead.
In 25 man, the shock hits for 1.3M baseline. AMZ only absorbs about 150-200K damage, even with +535 item level. Even if you added AMS on top of this (and I don't know if they stack now, but back in start of Cata I know they didn't), you'd be less than halfway there. That is why DK's have a hard time surviving in 25 man. In the last phase, the shock's hitting for 3.6M .
Is there a way to minimize the number of ball lightnings that spawn? How does that mechanic work exactly? Can we have a set number of ranged stand out, and the rest stand in, or does it not work that way? Also what is the diameter of the ball lightning splash damage?
3yard aoe splash, and you need 3 people out for it to only spawn in range (so you only get 3 balls) we ran with 4 melee (2 tanks 2 dps) so 6 ranged, so what we did in p3 was tank the boss in teh middle of 2 platforms, then split up the ranged in 3 sides each, and the side that got thunderstruck would clump on the boss, balls would spawn, and they would move back out. Worked quite well for p3.
Its about timing though, if you drop AMZ too early and the Absorb cap is reached before the ability you were trying to soak, you'll just think it didn't work or that its useless.
We are starting out first night on this later tonight. It seems there are two main conduit strategies: bouncing bolts/diffusion or static shock/diffusion. What are the pros and cons of each of these? Our group has only 2 people who cannot solo a static shock. Would we be better suited to do static/diffusion?
Aerzara, Discipline Priest
<Modest> 14/14H - US 2nd 10m Guild
Myself, disc priest, and an elemental shaman.
Aerzara, Discipline Priest
<Modest> 14/14H - US 2nd 10m Guild
I've a question about Lei Shen and his thunderstruck, is it possible, with a log or something, to know on who he casted it ? And is it possible that he casted thunderstruck on a melee/tank during p3 or is one of my rangedps/healers lying ?
No, it's a ranged player only that's targetable by Thunderstruck. Chances are you had a ranged or healer on the boss.
Thank you, that's what I thought...
Nuckels, we tried what you said about phase3, is it possible that sometimes thunderstruck comes after the static shock explosion ? What should we do then ? Static shock was on me during p3 but I just blocked it (gg mage), didnt take a look at the timer to see if everything fits correctly.
Edit: Watched the video, it is possible for thunderstruck to go out, and then him to cast static straight after, and 10seconds AFTER static has actually exploded he will cast thunderstruck at one point during the fight, but in both scenarios you got tons of time to make it out / in. So unless you survived for so long that I never experienced the overlap, its not possible.
Last edited by Nuckels; 2013-06-04 at 12:24 AM.


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- Magazine2011 Storage Products of the Year
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- MagazineHelluva lot of data
- MagazinePoor performance? Maybe it's the app and not the storage
- MagazineDoes cloud-based file syncing qualify as backup?
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Does cloud-based file syncing qualify as backup?
Mobile device use is growing, and companies need to take steps to support access to corporate data on-premises and in the cloud.
Mobile device use is growing, and companies need to take steps to support access to corporate data on-premises and in the cloud.
My IT guy sent out a corporate-wide email reminding employees to copy files to their Dropbox folder. In addition to Dropbox serving as a collaboration tool and enabling accessibility to files from any endpoint device, our IT group sees Dropbox as a form of endpoint file protection. We're not alone. In a 2011 Cloud Adoption Trends survey of more than 300 IT professionals, Enterprise Strategy Group (ESG) found collaboration and file sharing ranked third in use or planned use of Software-as-a-Service (SaaS) applications, behind customer resource management (CRM) and email, and ahead of fifth-ranked backup/recovery. That prompts an interesting question for storage decision makers: Do new cloud-based file syncing tools qualify as backup? Let's investigate the possible answers.
File synchronization vs. file backup
As backup SaaS, file synchronization, sharing and collaboration services take hold, the proverbial lines are beginning to blur. Backup SaaS vendors like Mozy offer capabilities to access files stored in the Mozy cloud from multiple types of endpoint devices, enabling syncing. File sharing and collaboration services, such as Insync, SugarSync and Syncplicity (among others), also promote their backup capabilities.
Backup is any process or technology that automatically makes a secondary copy of data, and makes it available for recovery in the event the primary copy of data is lost. Typically, backup solutions provide versioning (automatically retaining multiple versions of any file), allowing data to be recovered from multiple, previous points in time.
Using file synchronization and collaboration solutions involves setting up a cloud-based folder and copying files into that folder. The files are immediately available for access via a Web interface from any Internet-connected device. In some solutions, like SugarSync, a user's sync workspace on one device is automatically synchronized with sync folders on other devices.
Back to the question of what qualifies as backup. Using the aforementioned backup definition, file syncing could be considered backup. If the primary copy of the file is lost or corrupted, the copy maintained in the cloud-based sync folder can be retrieved. From a versioning perspective, Dropbox actually does create copies of the files saved to a cloud folder, including deleted and prior versions of files, and saves them for a 30-day period or longer with advanced features. Solutions like Box and SugarSync have a similar versioning feature with the ability to restore previous versions of files stored in the cloud repository. However, not all cloud-based collaboration tools have automation for backup. However, a few do have automated synchronization where new and changed files are automatically synchronized with cloud folders.
The other side of the cloud
We haven't even talked about the biggest challenge in relying on these synchronization tools as backup. While leveraging file syncing solutions as a form of backup takes care of one pesky problem for IT, making endpoint users happy and productive, it presents another. In many cases, it allows employees to adopt consumer-grade file syncing solutions haphazardly, leaving organizations more susceptible to risk.
Consider this: Endpoint devices have typically been the most underprotected business asset. In a 2010 survey of more than 500 IT professionals, ESG research found that less than 50% of respondents back up 100% of desktops, less than 40% of organizations back up 100% of laptops, and less than 25% of those surveyed back up 100% of handhelds. Today, there are several forces at work in elevating file syncing and backup to the fore: increased worker mobility, growing interest in and use of cloud services, and the consumerization of IT. Today, IT professionals are challenged to embrace certain consumer technologies in the workplace while maintaining IT standards to minimize risk and meet corporate and/or regulatory requirements. Clearly, enabling file synchronization for both personal and professional mobile devices with centralized IT services and cloud storage services will be a high priority to facilitate user productivity.
Many cloud-based file synchronization and backup services have a "free-mium" business model that offers some cloud storage capacity at no charge. This has created a "Wild West" scenario, with corporate endpoint users subscribing to cloud-based services and copying files -- both personal and corporate -- to cloud repositories without regard for privacy, regulatory or corporate policies.
The lack of awareness of cloud-based corporate data copies creates vulnerability for IT, and the absence of administration features for the centralized IT function creates management headaches.
On-premises endpoint backup and backup SaaS
It's very clear that the landscape of endpoint backup solutions is evolving. On-premises, purpose-built endpoint backup/recovery solutions are catering to the needs of both the endpoint user (nondisruptive and enables self-service recovery) and IT administrator (automated, optimized and centrally controlled), and starting to eclipse more traditional client/server backup approaches. Solutions like those from Copiun and Druva are mobile worker-friendly, supporting different endpoint device types, as well as file access from endpoint devices like smartphones and tablets. They also ensure data privacy with features such as role-based access control and encryption, and optimized data transfer with features like block-level incremental backups, deduplication and compression that minimize the impact of data transfer on the network and reduce storage capacity requirements. The solutions enable self-service recovery and don't interfere with endpoint user productivity. They also centralize administration of policies (retention, deletion), scheduling, alert conditions and error handling.
Corporate cloud-based backup services, such as those from Axcient, EVault, Hewlett-Packard (which acquired Iron Mountain's backup services portfolio via its Autonomy acquisition) and Symantec, have furnished companies with commercial-grade backup SaaS solutions; however, not all have met the requirements of the mobile and alternative endpoint device user by supporting nontraditional devices or file access/synchronization capabilities. On the other hand, solutions from Carbonite, Code 42 Software (CrashPlan), EMC (Mozy) and KineticD, which have traditionally catered to consumer and small business audiences, are appealing for corporate customers who need to support mobile workforce and/or file sharing and syncing requirements.
Headed into 2012
H.G. Wells' call to "adapt or perish" is apropos when it comes to the megatrends of mobility, cloud and consumerization. Taking proactive steps to support access to corporate data -- retained on-premises or in the cloud -- on a myriad of devices should be a top priority for IT organizations. Otherwise, companies risk employees "going rogue" and making the company susceptible to privacy/security breaches or noncompliance fines. If endpoint backup is in place, pressuring vendors to provide file sharing and synchronization features (especially from handheld devices) may make sense. For organizations already using a file sharing/synchronization solution, instituting policies and guidelines for backup/recovery (based on what's available with your chosen vendor) should be a priority for 2012.
BIO: Lauren Whitehouse is a senior analyst focusing on backup and recovery software and replication solutions at Enterprise Strategy Group, Milford, Mass.
Related Resources
- 3 Common Cloud Challenges Eradicated with Hybrid Cloud –SearchStorage.com
- Cloud Storage for Primary or Nearline Data –SearchStorage.com
- Cloud Backup and Cloud Disaster Recovery Essential Guide –SearchStorage.com
- CW Europe – September 2018: Costs stack up for Dutch government IT projects –ComputerWeekly.com


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KzooEnrique…back in Kalamazoo
After having lived in Oklahoma City for three years, and Ann Arbor for one, I am back again in Kalamazoo, MI where I was born and raised. Once again starting a new chapter in my life, both personally and professionally, this blog will serve as a way to keep old friends up to date on what is new, and new friends educated on where I got my start.
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These games teach valuable skills and have a high fun and educational rating.
Your child watches a surprising science experiment about a leak proof bag based on the properties of the plastic.
Your child watches a surprising science experiment in which the properties of an egg shell change when mixed with vinegar.
Your child watches a science experiment and learns how to make invisible ink.
Your child develops an understanding of gravity by placing objects in water to find out if they will sink or float.
Your child watches a fun science experiment and learns how to make plastic from milk and vinegar.
Your child learns about colors and objects they typically embody by watching this video with black and white drawings, and guessing which colors should fill in the objects.
Your child watches a clip from Earth to Luna in which she learns about bubbles and why they are round.
Your child will learn why tears have salty taste while watching this video.
Your child watches a surprising, easy to do science experiment based on water dissolving the candies sugar coating.
Your child learns about the floating and sinking by categorizing different objects based on whether they float or sink in water.
Zoodles 11.8.7 Copyright (c) 2014 Inquisitive Minds, Inc. All rights reserved.


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Python 3.1.1 Release
Python 3.1.1
Python 3.1.1 has been superseded by 3.1.2. You can download 3.1.2.
Python 3.1.1 was released on August 17th, 2009.
Python 3.1 is a continuation of the work started by Python 3.0, the new backwards-incompatible series of Python. Improvements in this release include:
- An ordered dictionary type
- Various optimizations to the int type
- New unittest features including test skipping and new assert methods.
- A much faster io module
- Tile support for Tkinter
- A pure Python reference implementation of the import statement
- New syntax for nested with statements
See these resources for further information:
- What's New in 3.1?
- What's new in Python 3000
- Python 3.1.1 Change Log
- Online Documentation
- Conversion tool for Python 2.x code: 2to3
- Report bugs at http://bugs.python.org.
Help fund Python and its community by donating to the Python Software Foundation.
This is a production release.
We currently support these formats for download:
- Gzipped source tar ball (3.1.1) (sig)
- Bzipped source tar ball (3.1.1) (sig)
- Windows x86 MSI Installer (3.1.1) (sig)
- Windows X86-64 MSI Installer (3.1.1) [1] (sig)
- Mac Installer disk image (3.1.1) (sig)
The source tarballs are signed with Benjamin Peterson's key (fingerprint: 12EF 3DC3 8047 DA38 2D18 A5B9 99CD EA9D A413 5B38). The Windows installers are signed with Martin von Löwis' public key which has a key id of 7D9DC8D2. The public keys are located on the download page.
MD5 checksums and sizes of the released files:
f1317dbb2398374d6691edd5bff1b91d 11525876 python-3.1.1.tgz d1ddd9f16e3c6a51c7208f33518cd674 9510105 python-3.1.1.tar.bz2 d31e3e91c2ddd3e5ea7c40abe436917e 14130176 python-3.1.1.amd64.msi e05a6134b920ae86f0e33b8a43a801b3 13737984 python-3.1.1.msi 9c7f85cc7fb5a2fa533d338c88229633 17148746 python-3.1.1.dmg
|The binaries for AMD64 will also work on processors that implement the Intel 64 architecture (formerly EM64T), i.e. the architecture that Microsoft calls x64, and AMD called x86-64 before calling it AMD64. They will not work on Intel Itanium Processors (formerly IA-64).


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In football, it's the Super Bowl. In dog shows, it's the Westminster Kennel Club Dog Show at Madison Square Garden.
And on Tuesday night, an underdog from Virginia took top honors.
The audience roared with delight when Foxcliffe Hickory Wind, a 5-year-old Scottish Deerhound from Warrenton, Va., was named Best In Show. She represented the hound group and beat out the top dogs from each of the other six breed categories. It was a surprise win, as those of the betting persuasion had their money on the Pekingese or fox terrier.
This is the first time a Scottish deerhound has ever won Best in Show at the Westminster Dog Show. Her handler, Angela Lloyd, beamed and hugged Hickory in front of the television audience. Her human owners are Sally Sweatt, Cecilia Dove and R. Scott Dove.
Hickory, apparently, isn't one for the city life. She loves to chase deer and rabbits on a 50-acre farm in Warrenton much more than hailing a cab in New York City.
"She's not used to lights, camera and noise," Lloyd said.
For her efforts, Hickory will get a couple of Manhattan treats on Wednesday -- steak at famed Sardi's restaurant and a trip to the top of the Empire State Building, according to the Associated Press.
More than 170 breeds and 2,500 dogs entered the competition, which ran two days. This was the 135th year for the Westminster Dog Show.


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Does Strategy Matter? Ask IT
By Richard Hunter and Dorothy Yu
Strategy is a touchy subject for many enterprises. Every executive knows that strategy matters, or at least that it's supposed to matter. But strategy is not easy, requiring plenty of effort and creativity to complete and execute. Further, some businesses appear quite successful without a clear strategy.
So why bother with a strategy? Recent research from Gartner offers one answer: the effectiveness of an IT organization depends on it.
IT spending accounts for about 3.5% of enterprise revenue, on average, but that spending produces a majority of enterprise productivity gains. In other words, effective IT is key to increasing enterprise effectiveness—and according to our research, IT effectiveness is lower in enterprises where strategy is unclear or inconsistently executed.
Gartner recently surveyed executives inside and outside IT to explore the relationship between strategy and IT effectiveness. Each respondent was asked to rate the overall effectiveness of the IT organization, followed by questions on key enterprise activities: making and executing strategy, identifying needs and opportunities for investment, making investment decisions, bringing those decisions to fruition, and measuring initiative outcomes.
The survey results show clear differences between the top 40% of respondents (in terms of perceived IT effectiveness) and the bottom 60%. The most important correlation to perceived IT effectiveness in our data for the top 40% is execution of their initiatives for change; for the bottom 60%, the strongest correlation is to strategy and investment decision making. We believe that the difference results from the ability of the leaders to articulate and execute against strategy.
When strategy is clear and consistently applied to investment decisions, executives have confidence in the quality of their decisions, and so see capable execution as the most important leading indicator for success. When strategy is weakly articulated and managed, executives have little confidence in investment decisions, and by extension in the projects IT supports.
The lack of confidence is justified. In any enterprise, demand for resources in support of change is greater than supply. Given that almost any change in enterprise operations requires a corresponding change in IT systems and support, everyone's demand eventually increases demand for IT. In the absence of clearly articulated strategy, not only does demand exceed supply, but there is no rational way to determine which demand is most important. In this situation, two things are certain: 1) IT will face overwhelming and increasing demand, and 2) executives will be dissatisfied with investment decisions and IT's role in those investments.
Absence of strategy implies significant waste. Here's a rough formula for calculating waste. The typical enterprise succeeds in about 60% of its IT-supported initiatives. Take the total IT spend and multiple by 35%, the average percentage of IT spending that's devoted to change initiatives. Now take 40% of that figure. That's how much waste is involved for IT alone; in a typical enterprise that spends $100 million per year on IT, $14 million is wasted.
The typical IT-supported initiative involves at least one to two additional, non-IT personnel for every IT person on the project; so double or triple the amount of IT waste to get the full amount.
It may come as a surprise to many executives that lack of clarity in their strategies produces so much waste outside IT, because too many executives think of any change in the enterprise that involves IT as an "IT project." This attitude is a major contributor to failure; when a project is an "IT project," executives outside IT feel free to ignore it, leading to shortages of resources like executive sponsors and subject matter experts. This produces delay if not failure.
Our research points to a way out. CIOs don't control enterprise strategy, but can exert influence to move the enterprise in a better direction.
For enterprises in the bottom 60% of our survey, strategy comes first. The first step is to improve the executive team's ability to create a workable strategy — one that includes a realistic diagnosis, policies to address the circumstances and opportunities exposed by the diagnosis, and an action plan.
Whether or not the CIO has the responsibility to manage strategic planning in their enterprises, he or she can influence the executive team to improve strategy making and execution. Many CIOs have taken action by studying executive and enterprise communications to create an explicit, if tentative, statement of strategy for validation or correction by senior leaders. In doing so, they emphasized the importance of strategy to IT's plans, encouraging other executives to take enterprise strategy more seriously as well.
The second step is improving IT governance which means focusing governance on increasing yields for enterprise investments in change, incorporating strategy into every investment decision, and ensuring that all necessary resources for an initiative, not just IT professionals, are allocated and available when needed—or that the associated initiatives are cancelled before waste cascades further.
For enterprises in the top 40%, CIOs have the benefit of clear strategy to guide them in choosing and executing initiatives. Here the goal should be to increase yields from investments in change even further. Given that a very low percentage of all enterprises actually measure the yields from their IT-supported initiatives, the logical next step is to measure yields and use that data to identify opportunities for smarter investments.
Like the enterprise, IT potentially can do anything, but it can't do everything. A clear strategy helps everyone involved to make the best possible choices about where IT and other resources can be deployed to greatest effect. Without a strategy, the enterprise has no compass. Without coherent action in support of the strategy, the compass is useless.
Richard Hunter is a vice president and research fellow at Gartner and the author of several books including "Real Business of IT" published by Harvard Business Press. Dorothy Yu is a managing vice president in consulting at Gartner specializing in the alignment and application of technology for increased business performance.


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i read a ton.
Come for the read. Stay for the food.
A Unique Coffee & Food Experience
The cave of a cat-alien that chats about books, otaku and Asian cultures, and mental health wellness.
You're bound to find something ......
Exploring The World In The Footsteps of The Artists and Writers Who Came Before
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Thresher sharks are large lamniform sharks of the family Alopiidae found in all temperate and tropical oceans of the world; the family contains three species, all within the genus Alopias.
The three extant thresher shark species are all in the genus Alopias. The possible existence of a hitherto unrecognized fourth species was revealed during the course of a 1995 allozyme analysis by Blaise Eitner. This species is apparently found in the eastern Pacific off Baja California, and has before been misidentified as the bigeye thresher. Thus far, it is only known from muscle samples and no aspect of its morphology has been documented.
Alopias pelagicus H. Nakamura, 1935 (pelagic thresher)
Alopias superciliosus R. T. Lowe, 1841 (bigeye thresher)
Alopias vulpinus (Bonnaterre, 1788) (common thresher)
Phylogeny and evolution
Based on cytochrome b genes, Martin and Naylor (1997) concluded the thresher sharks form a monophyletic sister group to the clade containing the families Cetorhinidae (basking shark) and Lamnidae (mackerel sharks). The megamouth shark (Megachasma pelagios) was placed as the next-closest relative to these taxa, though the phylogenetic position of that species has yet to be resolved with confidence. Cladistic analyses by Compagno (1991) based on morphological characters, and Shimada (2005) based on dentition, have both corroborated this interpretation.
Within the family, an analysis of allozyme variation by Eitner (1995) found the common thresher is the most basal member, with a sister relationship to a group containing the unrecognized fourth Alopias species and a clade comprising the bigeye and pelagic threshers. However, the position of the undescribed fourth species was only based on a single synapomorphy (derived group-defining character) in one specimen, so some uncertainty in its placement remains.
Distribution and habitat
Although occasionally sighted in shallow, inshore waters, thresher sharks are primarily pelagic; they prefer the open ocean, venturing no deeper than 500 metres (1,600 ft). Common threshers tend to be more common in coastal waters over continental shelves. Common thresher sharks are found along the continental shelves of North America and Asia of the North Pacific, but are rare in the Central and Western Pacific. In the warmer waters of the Central and Western Pacific, bigeye and pelagic thresher sharks are more common. A thresher shark was seen on the live video feed from one of the ROVs monitoring BP's Macondo oil well blowout in the Gulf of Mexico. This is significantly deeper than the 500m previously thought to be their limit.
Anatomy and appearance
Named for and easily recognised by their exceptionally long, thresher-like tail or caudal fins (which can be as long as the total body length), thresher sharks are active predators; the tail is actually used as a weapon to stun prey. The thresher shark has a short head and a cone shaped nose. The mouth is generally small, and the teeth range in size from small to large. By far the largest of the three species is the common thresher, Alopias vulpinus, which may reach a length of 6.1 metres (20 ft) and a weight of over 500 kilograms (1,100 lb). The bigeye thresher, Alopias superciliosus, is next in size, reaching a length of 4.9 m (16 ft); at just 3 m (10 ft), the pelagic thresher, Alopias pelagicus, is the smallest.
Thresher sharks are fairly slender, with small dorsal fins and large, recurved pectoral fins. With the exception of the bigeye thresher, these sharks have relatively small eyes positioned to the forward of the head. Coloration ranges from brownish, bluish or purplish gray dorsally with lighter shades ventrally. The three species can be roughly distinguished by the main color of the dorsal surface of the body. Common threshers are dark green, bigeye threshers are brown and pelagic threshers are generally blue. Lighting conditions and water clarity can affect how any one shark appears to an observer, but the color test is generally supported when other features are examined.
Pelagic schooling fish (such as bluefish, juvenile tuna, and mackerel), squid and cuttlefish are the primary food items of the thresher sharks. They are known to follow large schools of fish into shallow waters. Crustaceans and the odd seabird are also taken.
Thresher sharks are solitary creatures which keep to themselves. It is known that thresher populations of the Indian Ocean are separated by depth and space according to gender. All species are noted for their highly migratory or oceanodromous habits. When hunting schooling fish, thresher sharks are known to "slap" the water, herding and stunning prey. The elongated tail is used to swat smaller fish, stunning them before feeding. Thresher sharks are one of the few shark species known to jump fully out of the water, making turns like dolphins, this behaviour is called breaching.
Two species of the thresher have been identified as having a modified circulatory system that acts as a counter-current heat exchanger, which allows them to retain metabolic heat. The mackerel sharks (Lamnidae family) have a similar homologous structure to this which is more extensively developed. This structure is a strip of red muscle along each of its flanks, which has a tight network of blood vessels that transfer metabolic heat inward towards the core of the shark, allowing it to maintain and regulate its body heat.
No distinct breeding season is observed by thresher sharks. Fertilization and embryonic development occur internally; this ovoviviparous or live-bearing mode of reproduction results in a small litter (usually two to four) of large well-developed pups, up to 150 cm at birth in thintail threshers. The young fish exhaust their yolk sacs while still inside the mother, at which time they begin feeding on the mother's unfertilized eggs; this is known as oophagy.
Thresher sharks are slow to mature; males reach sexual maturity between seven and 13 years of age and females between eight and 14 years in bigeye threshers. They may live for 20 years or more.
Importance to humans
Threshers have a low fecundity, like all large sharks, and are highly vulnerable to overfishing. Besides being hunted for its meat, threshers are also hunted for their liver oil, skin (for leather), and their fins, for use in shark-fin soup.
They do not appear to be a threat to humans, although some divers have been hit with the upper tail lobe. A dubious account of a fisherman being decapitated by a tail swipe as the shark breached has been reported.
Thresher sharks are classified as prized game fish in the United States and South Africa. Common thresher sharks are the target of a popular recreational fishery off Baja, Mexico. Thresher sharks are managed in some areas for their value as both a recreational sport fish and commercial species.
Scientific classification Kingdom: Animalia Phylum: Chordata Class: Chondrichthyes Subclass: Elasmobranchii Order: Lamniformes Family: Alopiidae Bonaparte, 1838 Genus: Alopias Rafinesque, 1810 Type species Alopias macrourus Rafinesque, 1810 Synonyms Alopecias Müller and Henle, 1837 Alopius Swainson, 1838 Vulpecula Jarocki, 1822


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88 HASKINS & SELLS November Additions to the Library American Academy of Political and Social Science. Some Aspects of the Present International Situation. (Philadelphia, American Academy of Political and Social Science, July, 1928. 204 p. The Annals, v. 138.) Badger, Ralph Eastman. Badger on Investment Principles and Practices. (New York, Prentice-Hall, 1928. 915 p.) Cushing, Harry Alonzo. Voting Trusts. (New York, The Macmillan Company, 1927. 257 p.) Empire Trust Company. Illustrative Forms of Life Insurance Trusts. (New York, Empire Trust Company, 1928. 56 p.) Empire Trust Company. Memorandum of Terms of Insurance Trusts. (New York, Empire Trust Company, 1928. 28 p.) Galston, Arthur. Security Syndicate Operations, Organization, Management and Accounting. (New York, The Ronald Press Company, 1925. 95 p. Ronograph Library, No. 33.) Harrison, G. Charter. Cost Accounting to Aid Production. (New York, The Engineering Magazine Company, 1924. 234 p.) Kansas City, Missouri, Council. License Ordinance No. 54814; an ordinance amending ordinance No. 38141, entitled "An Ordinance Providing for the Regulation and Licensing of Occupations, Callings and Trades . . . " (Kansas City, July, 1928.) Mills, Joseph E. Garage Management and Control. (Chicago, A. W. Shaw Company, 1928. 286 p.) National Canners Association. Classification of Accounts for the Canning Industry. (Washington, D. C., National Canners Association, May, 1927. 31 p. Bulletin No. 3, revised.) Perine, Edward Ten Broeck. The Story of Trust Companies. (New York, G. P. Putnam's Sons, 1916. 327 p.) Rorem, C. Rufus. Accounting Method. (Chicago, The University of Chicago Press, c1928. 596 p.) Secrist, Horace. Banking Standards Under The Federal Reserve System. (Chicago, A. W. Shaw Company, 1928. 420 p.) Tejada, J. DeD. A Spanish-English and English-Spanish Dictionary of Sugar House Terms. . . . (Havana, 1927. 145 p.) United States. Treasury Department. Bureau of. Internal Revenue. Internal Revenue Laws in Force April 1, 1927. . . . (Washington, Government Printing Office, 1928. 1630 p.) Virginia. State Board of Accountancy. Virginia C. P. A. Law. (Richmond, State Board of Accountancy, August 15, 1928. 14 p.) Wildman, John Raymond, and Powell, Weldon. Capital Stock Without Par Value. (Chicago, A. W. Shaw Company, 1928. 553 p.) News Items Mr. W. L. Green, of the Executive Offices, and Mr. M . A. Finnen, of the New York 39th Street office, are now lecture-members of the faculty of St. John's College, School of Accountancy, Commerce, and Finance. Mr. Finney, of our Chicago office, has revised both Volumes I and II of his Principles of Accounting. Mr. Wildman has been granted a certificate of the State of Illinois, to practice as a public accountant, under the act effective October 1, 1927. PRESS OF WILLIAM GREEN, NEW YORK
Object Description
Additions to the Library
News items
|Personal Name
Green, Wilmer Lewis
Finney, H. A. (Harry Anson), 1886-
Wildman, John Raymond, 1878-1938
Finnen, Malachi A.
Haskins & Sells. Library
Haskins & Sells. Executive Offices
Haskins & Sells. New York Office
Haskins & Sells. Chicago Office
Haskins & Sells Bulletin, Vol. 11, no. 11 (1928 November), p. 88
|Originally published by: Haskins & Sells
|Deloitte Digital Collection
|Digital Publisher
|University of Mississippi Libraries. Accounting Collection
|Date-Digitally Created
|HS Bulletin 11-p88