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at Sodexo in CASTINE, Maine, United States
Job Description
Position Summary
The Cook I will accurately and efficiently prepare, portion, cook, and present a variety of hot and/or cold food items for various meal periods: to include Breakfast, Lunch, Dinner, and Special/Catered Events.The general responsibilities of the position include those listed below, but Sodexo may identify other responsibilities of the position. These responsibilities may differ among accounts, depending on business necessities and client requirements.
General Responsibilities :
+ Prepares and cooks to order foods that may require short preparation time.
+ May prepare food and serve customers at an a la carte and may operate a grill station.
+ Prepares food in accordance with current applicable federal, state and corporate standards, guidelines and regulations to ensure high-quality food service is provided.
+ Reads food order or receives verbal instructions on food required by patron, and prepares and cooks food according to instructions.
+ Provides the highest quality of service to customers at all times.
+ Follows basic recipes and/or product directions for preparing, seasoning, cooking, tasting, carving and serving soups, meats, vegetables, desserts and other foodstuffs for consumption in eating establishments.
+ Prepares foods under direct supervision or instruction by operating a variety of kitchen equipment to measure and mix ingredients, washing, peeling, cutting and shredding fruits and vegetables, and trimming and cutting meat, poultry or fish for culinary use.
+ Tastes products, reads menus, estimates food requirements, checks production, and keeps records in order to accurately plan production requirements and requisition supplies and equipment.
+ May clean and sanitize work stations and equipment and must follow all Sodexo, client and regulatory rules and procedures.
+ Attends all allergy and foodborne illness in-service training.
+ Complies with all Sodexo HACCP policies and procedures.
+ Reports all accidents and injuries in a timely manner.
+ Complies with all company safety and risk management policies and procedures.
+ Participates in regular safety meetings, safety training and hazard assessments.
+ Attends training programs (classroom and virtual) as designated.
+ May receive inventory, move and lift foodstuffs and supplies and prepare meals for customers requiring special diets.
+ May produce some batch goods using basic cooking techniques.
+ May perform other duties and responsibilities as assigned.
Qualifications & Requirements
+ Willingness to be open to learning and growing.
+ Maturity of judgment and behavior.
+ Maintains high standards for work areas and appearance.
+ Maintains a positive attitude.
+ Ability to work a flexible schedule helpful.
+ Must comply with any dress code requirements.
+ Must be able to work nights, weekends and some holidays.
+ Attends work and shows up for scheduled shift on time with satisfactory regularity.
+ High School diploma, GED or equivalent.
+ 0 to 2 years of related work experience.
+ Knowledge of basic operation of equipment and cash-handling procedures preferred.
+ Presents self in a highly professional manner to others and understands that honesty and ethics are essential.
+ Ability to maintain a positive attitude.
+ Ability to communicate with co-workers and other departments with professionalism and respect.
+ Maintains a professional relationship with all coworkers, vendor representatives, supervisors, managers, customers, and client representatives.
+ Ability to use a computer.
+ Good working knowledge of food preparation.
+ Requires familiarity of kitchen equipment.
+ Must be able to read and follow a recipe unsupervised
Physical Requirements:
+ Close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus, with or without corrective lenses.
+ Significant walking or other means of mobility.
+ Ability to work in a standing position for long periods of time (up to 8 hours).
+ Ability to reach, bend, stoop, push and/or pull, and frequently lift up to 35 pounds and occasionally lift/move 40 pounds.
Working Conditions (may add additional conditions specific to defined work location):
+ Generally in an indoor setting; however, may supervise outside activities and events.
+ Varying schedule to include evenings, holidays, weekends and extended hours as business dictates.
+ While performing the duties of this job, the employee is primarily in a controlled, temperate environment; however, may be exposed to heat/cold during support of outside activities.
+ The noise level in the work environment is usually moderate to loud.
Sodexo is an EEO/AA/Minority/Female/Disability/Veteran employer.
Location US-ME-CASTINE
System ID 964377
Category Food Service
Employment Status Full-Time


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Bostitch BTFP3KIT 3-Piece Nailer and 0.8 HP 6 Gallon Oil-Free Pancake Air Compressor Combo KitBostitch Model: bstnbtfp3kit
- 6 Gallon 150 PSI Oil-Free Compressor
- 18-Gauge 2 in Brad Nailer
- 16-Gauge Straight Finish Nailer
- Heavy Duty 18-Gauge 3/8 in Crown Stapler
In Stock
Product Details & specs :
Reviews :
Stanley Fastening Systems, L.P. 7 Year Limited Warranty (1 Year for Reconditioned Products) - U.S. and Canada Only
Effective December 1, 2005 Bostitch, L.P. warrants to the original retail purchaser that the product purchased is free from defects in material and workmanship, and agrees to repair or replace, at Bostitch's option, any defective Bostitch branded pneumatic stapler or nailer for a period of seven (7) years from date of purchase (one (1) year from the date of purchase for reconditioned pneumatic staplers or nailers and for new and reconditioned compressors and tools used in production applications). Warranty is not transferable. Proof of purchase date required. This warranty covers only damage resulting from defects in material or workmanship; it does not cover conditions or malfunctions resulting from normal wear, neglect, abuse, accident or repairs attempted or made by other than our national repair center or authorized warranty service centers. Driver blades, bumpers, o-rings, pistons and piston rings are considered normally wearing parts. For optimal performance of your Bostitch tool always use genuine Bostitch fasteners and replacement parts.
This warranty IS IN LIEU OF ALL OTHER EXPRESS WARRANTIES AND with respect to compressors and tools used in production applications, limits to a period of one (1) year from the date of purchase all implied warranties INCLUDING, BUT NOT LIMITED TO, IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. BOSTITCH SHALL NOT BE LIABLE FOR ANY INCIDENTAL OR CONSEQUENTIAL DAMAGES.
Some states and countries do not allow the exclusion or limitation of incidental or consequential damages, so the above limitations or exclusions may not apply to you. This warranty gives you specific legal rights, and you may also have other rights which vary from state to state and country to country.

subset: commoncrawl


text: Seller: xlr8-imports ✉ (36,927) 100%, Location: Grand Saline, Texas, US, Ships to: US & many other countries, Item: 231644081747 12 Cast Iron BROWN MISSION STYLE Coat Hooks Hat Hook Rack Hall Tree Restoration. Here's a great wholesale lot of 12 cast iron coat hooks. Made just like the hooks of the past. These have the same look of the antiques, but at a much lower price! Measure approx. 5" tall top to bottom, 3 3/4" from the wall to the front. Each hook has 2 holes for easy hanging. These do not include screws! Great item for re-sale or for those restoration projects. This item was manufactured to look antique, expect some built in imperfections. Satisfaction Guaranteed Color: Brown, Material: Cast Iron


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North American family organically grown whole grain rye, gas fire roasted and rolled into versatile flakes. Hot cereal in minutes. Ideal for granola, muesli, creamy soups, stews, desserts, pie crusts, and baked goods. Mix them into your oatmeal. The muscle building grain. 100% whole grain. High in manganese, and a good source of fiber, thiamin B1, riboflavin B2, magnesium, and zinc. Packed in a reclosable, protective, standing pouch.
Eden Organic Rye Flakes are North American family organically grown whole grain rye, gas fire roasted and rolled into delicious golden flakes. Hot cereal in minutes. 100% whole grain.
Eden Organic Rye Flakes are roasted and rolled. Whole grain rye is sprayed with water and gas flame roasted in a ceramic kiln. Immediately after roasting the grain is rolled into flakes. The flakes are packaged at Eden's AIB 'Superior' rated facility in one pound nitrogen flushed, reclosable, standing pouches.
Rye Secale cereale is a relative of wheat, but not a wheat. A rich, robust grain with a dark brown slender kernel, rye emerged as a wild seed bearing grass and was first cultivated as a cereal grain around 1,000 B.C. It is believed to have originated somewhere between the Austrian Alps and the Caspian Sea. For centuries rye was the staple bread making grain of northern Europe and western Asia and remains so today in the rugged northern climates. Rye is one of the unique grains that offers 'complete' protein containing all of the amino acids, including all of the essential ones.
Nutrition Facts
Scientists at the USDA Human Nutrition Research Center at Tufts University say, "Whole grain helps regulate blood sugar by slowing down the conversion of complex carbohydrates into sugar. In fact, low-glycemic index food such as whole grain reduces hunger and can help to control weight." Scientists at the Agriculture Research Service completed a study of more than 2,000 people concluding, "at least three or more servings of whole grain everyday could reduce the chances of developing metabolic syndrome - a condition marked by a combination of abdominal obesity, high blood pressure, poor blood sugar control, low HDL 'good' cholesterol and high blood fats."
According to the FDA, "Diets rich in whole grain and other plant foods, and low in total fat, saturated fat, and cholesterol may reduce the risk of heart disease and some cancers." Also, "Low fat diets rich in fiber-containing grain products, fruits, and vegetables may reduce the risk of some types of cancer, a disease associated with many factors." Eden Rye Flakes are low fat, saturated fat and cholesterol free, and sodium free. They are an excellent source of manganese, and a good source of fiber, thiamin B1, riboflavin B2, magnesium, and zinc.
Eden Organic Rye Flakes are perfect for quick hot cereal in just minutes. Ideal for granola, muesli, creamy soups, stews, desserts, pie crusts, and baked goods. They are ideal for hardy soups, and even for making wholesome entrées. Eden Rye Flakes are great for making quick whole grain salad as they hold their shape well and remain light and fluffy. Check out 'Rye & Vegetable Salad' in the recipe section for a great dish using Eden Organic Rye Flakes.


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By David Crane defrev (at) gmail (dot) com March 23, 2010 One of the reasons why it's so dangerous to mess with the United States militarily is that, while we Americans value hard work–which makes us formidable, in itself,–we've always exhibited and enjoyed a very healthy combination of inherent creativity/inventiveness and laziness, in the sense that if there's a way …Read More »
Tag Archives: g36 rifle for sale
Czech Republic CZ S805 Assault Rifle/Carbine: FN MK16 SCAR-L Meets HK G36. Civilian-Legal, Semi-Auto Version on the Way? And, if so, is it worth getting excited about?
By David Crane defrev (at) gmail (dot) com December 31, 2009 Since we just published a heads-up piece on the CzechPoint/CZ vz. 58 7.62x39mm Russian caliber semi-auto tactical rifle/carbine for the civilian tactical shooting market, we might as well touch on the next-gen Czech Republic army's assault rifle/carbine–and the military (select-fire/full-auto) vz. 58's replacement–the CZ S805 assault rifle/carbine, which was …Read More »
Heckler and Koch's G36C Mini-Assault Rifle: TREXPO East
Heckler & Koch has just introduced their new G36C mini-assault rifle, which incorporates an 8 ½ inch barrel and is even more compact than their G36K model. Mini-assault rifles are currently the biggest trend in tactical and special operations weaponry, as they provide much better performance(i.e. penetration) against both hard targets and body armor than submachine guns. The new gun …Read More »


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Novo Communications, LLC
Louisiana Contractors try to get all available information about Novo Communications, LLC, that is based in and around New Orleans.
This Information about Novo Communications, LLC is made to help you to find the right Professional from New Orleans for the job.
Please, check reviews under our Business listing to make sure this is the right Company for you.
Company name: Novo Communications, LLC
Activity: Telecommunications
Attn: Emile John Tiblier III
1215 Prytania St. Suite 431
New Orleans, Louisiana
Parish: Orleans
ZIP Code: 70130
Phone number: (504) 237-0392
Fax number: (504) 617-6005
e-mail: Not found
About Novo Communications, LLC:
We are working hard to provide maximum information about Novo Communications, LLC and other Contractors in New Orleans. If you have any updates or additional information about Novo Communications, LLC to expand this listing and help other readers, not only from Orleans, leave the note under this Louisiana Business Profile. All changes will be added after review by one of our editors. If you have already used Novo Communications, LLC that is based in and around New Orleans, Louisiana (LA), please write a review and let us know what do you think about Novo Communications, LLC.
Novo Communications, LLC – Uncensored Customer Reviews:
Louisiana Contractors Information:
Louisiana Contractors Directory is leading Directory not only in New Orleans or in Orleans Parish (LA), we cover the entire Louisiana State. If Novo Communications, LLC in New Orleans, LA is your Business or you are representative of Novo Communications, LLC, please update its Business Information and the Company Profile. It won't cost you anything. Yes It's Free and it can give you even more new customers. Just leave the info under this listing and all additions or changes will be added straight after review by one of our editors.


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Flock of Flying Geese - A Finished Quilt
absolutely riveting! GORGEOUS!ReplyDelete
Love this one Rita!!
Awesome. Sure they should fly north. I'm in Canada, tell the Geese they can come to my house!!ReplyDelete
I love how this is turning out. It looks great without sashing, and I'm glad the rainbow doesn't start or end on either edge. My favorite thing is using the unlikely gray crosshatch print as your neutral. It works brilliantly!ReplyDelete
Rita could you please tell me the name of the grey background fabric.
quilt looks fantastic
that is just beautiful. i love the colours & that they are flying 'north' i agree they look amazing without the sashing.ReplyDelete
I seem to have a recurring comment for your creations Rita - 'I love it!'ReplyDelete
very awesome!! i would've never thought of that. gr8 colors!!ReplyDelete
That is really eye catching! Love it!ReplyDelete
wow, your lines are all so straight and stuff! LOL I just put up in progress pictures of my second ever quilt,and my joins are not nearly so pretty!ReplyDelete
It's gorgeous, Rita!ReplyDelete
Wonderful! I love it without sashing.ReplyDelete
It's fabulous Rita, I love it. xoReplyDelete
Perfect Rita!ReplyDelete
Love it! Very cool :)ReplyDelete
Holy Mole spicy guacamole!!! This is just crazy insane cool!!!!!!ReplyDelete
Love love love! :) Thanks for sharing! :)ReplyDelete
It reminds me of a Native American blanket with a little twist. Love it!ReplyDelete
Beautiful and inspiring!ReplyDelete
What a striking quilt!ReplyDelete
Rita you have done a fabulous job as always! This design is so punchy in visual impact, I LOVE it. I love how perfectly pieced it all is too. Can't wait to see how you quilt and bind it :-)
You've been busy today. I really like this quilt you are working on; the"gray" fabric really sets off those triangles. (Yes, I know it's not gray, but it just reads that way.) Bravo!
I've been working too--I'm on to the next Lollypop Tree block.
This is really beautiful, but oddly enough I see the gray 'geese' when I look at it, so they are headed in the opposite direction. Isn't it funny how we can look at the same top and see it differently?ReplyDelete
I think you made a wise choice without sashing- I like how everything plays well together. And flying north vs. flying south? It's amazing how the eye plays tricks on the brain.
I'm excited to see the final product.
stunning, seriously beautiful. Can't wait to see what you come up with for the borders.ReplyDelete
Binding? If it were mine I would stick to the background fabric.
This one is great Rita!
I actually see geese flying north in both pictures. In one, they are colorful; in the other, they are gray. Very interesting.
And very lovely.
double WOWsie! This make me, first time, to put flying geese on my bucket list!
I, too, see the "gray" geese going one way and the colour going the other way.
Wow, Rita! It looks sensational!ReplyDelete
I love it....as usual.ReplyDelete
Gorgeous. I'm wondering how you pressed your seam allowances?ReplyDelete
Seriously gorgeous.ReplyDelete
Totally fantastic and I want to make one NOW! (a little more HST practice first methinks!!)ReplyDelete
WOW! I love it. Colourfull but not too much, a 'simple' design but not at all dull, it's just perfect! And the grey is perfect too... Wish I had one like this in my room... Well done!ReplyDelete
so clever!, and my eyes are drawn to the "other" geese flying south :)ReplyDelete
Perfect piecing - every point present and accounted for and wonderful colour too!ReplyDelete
It looks great! My eyes are funny, once you've turned the quilt around, I see the grey/blue geese and not the coloured ones anymore. So for me, they are still going north.ReplyDelete
Amazing as always!ReplyDelete
It's looking great. Can't wait to see it quilted. JacintaReplyDelete
That is just beautiful - I love how they stand out with your choice of Alexander Henry's Heath. Sew creative on the placement too. A real show stopper!ReplyDelete
Love. Love. Love!!!
I actually see the geese in the black and white too. I live in one of the largest wild goose stopover areas in the country, so my brain is wired to see them in B&W, I think. :)
Great geese!
Beautiful Quilt! So, it is a spring/fall quilt with the geese direction going with the weather.
Ready to try my own. Truly a nice quilt.
Love the quilt! Very modern, makes the eye move about, and makes you want to figure out what is going on in the quilt. Wonderful!
Have a super great sewing and stitching day!
They're gorgeous! The colors work beautifully.ReplyDelete
This is beautiful! It might inspire a copycat crime!!ReplyDelete
One of my favorites this week!!ReplyDelete
Just fantastic. Hope you and everyone you know is sharing champagne over this one! A beauty.ReplyDelete
wow the overall effect is something else, well done RitaReplyDelete
Absolutely stunning. What a very colourful quilt!ReplyDelete
Absolutely stunning! Flying geese are one of my favourite patterns, and the colour & simplicity of this makes them stand out on their own. Gorgeous! JxoReplyDelete
Beautiful! I'm inspired :o)ReplyDelete
LOVE & inspiration. THANK YOU!ReplyDelete
It is sew beautiful. Love your colors....ReplyDelete
Not surprised it sold, a unique bright Rita quilt. It was lovely and I'm sure the buyer will love it.ReplyDelete
Rita, I love reading your blog. You always deliver on color, and I love gazing at color! Seeing some of the things you've made has given me the courage to try new color schemes and to mix fabrics that I'm not sure about at first. Thanks for sharing all about what you do. :)ReplyDelete
Thank you for stopping by and leaving a comment! I really appreciate it.
Comments are published after review.
Feel free to ask questions and I will answer either here or by email, as is appropriate.


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Epworth sleepiness scale scores range from 0 to 24, with the higher values representing increasing sleepiness. The vertical dashed line represents the cut off for excessive sleepiness. Positive sleep disorder screening result was defined as meeting criteria for any of the sleep disorders assessed. A screening result negative for a sleeping disorder was defined as not meeting criteria for any of the sleep disorders assessed.
Customize your JAMA Network experience by selecting one or more topics from the list below.
Rajaratnam SMW, Barger LK, Lockley SW, et al. Sleep Disorders, Health, and Safety in Police Officers. JAMA. 2011;306(23):2567–2578. doi:10.1001/jama.2011.1851
© 2023
Author Affiliations: Division of Sleep Medicine (Drs Rajaratnam, Barger, Lockley, Shea, Wang, Landrigan, Cade, Epstein, White, and Czeisler and Messrs O'Brien, Qadri, and Sullivan), and Channing Laboratory (Dr Wang), Department of Medicine, Brigham and Women's Hospital, and Division of General Pediatrics, Department of Medicine, Children's Hospital Boston (Dr Landrigan), and Division of Sleep Medicine (Drs Rajaratnam, Barger, Lockley, Shea, Wang, Landri gan, Epstein, White, and Czeisler), Harvard Medical School; and Sleep HealthCenters (Drs Shea, Epstein, and White), Boston, Massachusetts; and School of Psychology and Psychiatry, Monash University, Clayton, Victoria, Australia (Dr Rajaratnam).
Context Sleep disorders often remain undiagnosed. Untreated sleep disorders among police officers may adversely affect their health and safety and pose a risk to the public.
Objective To quantify associations between sleep disorder risk and self-reported health, safety, and performance outcomes in police officers.
Design, Setting, and Participants Cross-sectional and prospective cohort study of North American police officers participating in either an online or an on-site screening (n=4957) and monthly follow-up surveys (n=3545 officers representing 15 735 person-months) between July 2005 and December 2007. A total of 3693 officers in the United States and Canada participated in the online screening survey, and 1264 officers from a municipal police department and a state police department participated in the on-site survey.
Main Outcome Measures Comorbid health conditions (cross-sectional); performance and safety outcomes (prospective).
Results Of the 4957 participants, 40.4% screened positive for at least 1 sleep disorder, most of whom had not been diagnosed previously. Of the total cohort, 1666 (33.6%) screened positive for obstructive sleep apnea, 281 (6.5%) for moderate to severe insomnia, 269 (5.4%) for shift work disorder (14.5% of those who worked the night shift). Of the 4608 participants who completed the sleepiness scale, 1312 (28.5%) reported excessive sleepiness. Of the total cohort, 1294 (26.1%) reported falling asleep while driving at least 1 time a month. Respondents who screened positive for obstructive sleep apnea or any sleep disorder had an increased prevalence of reported physical and mental health conditions, including diabetes, depression, and cardiovascular disease. An analysis of up to 2 years of monthly follow-up surveys showed that those respondents who screened positive for a sleep disorder vs those who did not had a higher rate of reporting that they had made a serious administrative error (17.9% vs 12.7%; adjusted odds ratio [OR], 1.43 [95% CI, 1.23-1.67]); of falling asleep while driving (14.4% vs 9.2%; adjusted OR, 1.51 [95% CI, 1.20-1.90]); of making an error or safety violation attributed to fatigue (23.7% vs 15.5%; adjusted OR, 1.63 [95% CI, 1.43-1.85]); and of exhibiting other adverse work-related outcomes including uncontrolled anger toward suspects (34.1% vs 28.5%; adjusted OR, 1.25 [95% CI, 1.09-1.43]), absenteeism (26.0% vs 20.9%; adjusted OR, 1.23 [95% CI, 1.08-1.40]), and falling asleep during meetings (14.1% vs 7.0%; adjusted OR, 1.95 [95% CI, 1.52-2.52]).
Conclusion Among a group of North American police officers, sleep disorders were common and were significantly associated with increased risk of self-reported adverse health, performance, and safety outcomes.
Sleep disorders affect 50 to 70 million US residents.1 Most are undiagnosed and remain untreated, resulting in adverse health, safety, and performance outcomes that have important economic ramifications.1 Obstructive sleep apnea (OSA)2 is associated with hypertension,3,4 cardiovascular disease,3,5,6 cognitive impairment,7 and increased risk of motor vehicle crashes.8 Insomnia is a risk factor for depression9 and hypertension10 and causes daytime functional impairments3 leading to absenteeism and productivity losses.11 Shift work disorder, affecting approximately 10% of night and rotating shift workers,12 is associated with social disturbances and higher rates of ulcers, unintentional injury, absenteeism, and depression.12 Untreated sleep disorders and chronic sleep deficiency1 increase the risk of unintential motor vehicle crashes and injuries.3 These problems are exacerbated in shift workers, who experience circadian rhythm disruption and chronic sleep deficiency due to their work schedules.13
Police officers frequently work extended shifts and long work weeks,14 which in other occupations are associated with increased risk of errors, unintended injuries, and motor vehicle crashes.15 According to data through the year 2003, more officers are killed by unintended adverse events than during the commission of felonies.14 It has been hypothesized that fatigue—likely due to reduced duration and quality of sleep16 and untreated sleep disorders17—may play an important role in police officer unintentional injuries and fatalities.14 To date, the effect of sleep disorders on police officer health, safety, and performance has not been systematically investigated.
We examined, among North American police officers, the risk of major sleep disorders, including those described above as well as restless legs syndrome and narcolepsy.2 This prospective cohort study examined the association between screening positive for a sleep disorder and self-reported adverse health, safety, and performance outcomes.
A total of 4957 sworn police officers in North America (United States 97%, Canada 3%) volunteered to participate in either the online or on-site study component (Figure 1). The on-site portion of the study included intense investigations of a municipal police department serving 1 of the 10 largest US cities and a state police department serving 1 of the 10 most densely populated states. The participating police departments were not from the same state. The on-site cohort was included to achieve a high cooperation rate within those departments and to compare characteristics of responders and nonresponders (in the municipal police department). The online cohort was included to provide a comparison group of police officers from across North America. Both cohorts included monthly follow-up surveys.
To recruit for the online cohort, we corresponded with large law enforcement agencies across North America to solicit participation and placed advertisements in police magazines and newsletters and on police-focused Web sites. For the on-site cohorts, we solicited participation from several municipal and state police departments. Ultimately a municipal department and a state department were selected and agreed to participate in the study protocol. Of the 3329 potential attendees from the departments participating in the on-site study, 2004 participated in informational sessions. In addition, 4018 registered for the online study (Figure 1). Of these police officers, 4957 completed the baseline survey, which included a sleep disorders screening: 1264 (63.1%, cooperation rate18) in the on-site cohort and 3693 (91.9%, participation rate18) in the online cohort, which made them eligible for the cross-sectional analyses.18 In both cohorts, the 3545 officers who had completed at least 1 of the monthly follow-up surveys were eligible for the prospective analyses: 1264 in the on-site and 2281 in the online cohort. This represents a 63.1% cooperation rate and 56.8% participation rate, respectively; these were deemed the prospective study cohort.
The study protocol was approved by the Partners Human Research Committee and was conducted between July 2005 and December 2007. Participants provided written or electronic informed consent and were not informed about study hypotheses. For reporting purposes to the human research committee and to funding agencies, participants were required to self-report race and ethnicity using prespecified categories (Table 1). Participants selected for polysomnography studies received up to $440, and survey participants were eligible for a prize drawing valued at up to $1000.
In a cross-sectional baseline survey, we assessed demographics, physical and mental health status, and the risk of sleep disorders. For up to 2 years following the baseline screening, each month we sent all participants an e-mail with a link to a short online survey assessing work-related performance, work hours, and safety. Reminder e-mails were sent to those who did not immediately complete the survey. (The baseline screening questions and follow-up surveys are available from the authors.)
The sleep disorders screening questionnaire used validated, self-report screening tools for OSA (Berlin Questionnaire; sensitivity 0.86, specificity 0.77),19 moderate to severe insomnia (Athens Insomnia Scale: sensitivity 0.93, specificity 0.85),20 restless legs syndrome (RLS Epidemiology, Symptoms, and Treatment questionnaire: sensitivity 0.82, specificity 0.90),21 and narcolepsy with cataplexy (Cataplexy Questionnaire: sensitivity 0.92, specificity 0.9522 and Epworth Sleepiness Scale [ESS]23). For shift work disorder, we created a screening tool based on the International Classification of Sleep Disorders, Second Edition (ICSD-2) diagnostic criteria2 (criteria are provided in the eMethods). The municipal police department allowed that only the OSA risk could be assessed for its 659 participants. Excessive sleepiness was assessed using the ESS (sensitivity 0.94, specificity 1.00)23 to examine prevalence of this symptom and to compare across positive and negative sleep disorder groups.
In the baseline survey, participants reported current health status (poor to excellent); previous diagnoses of sleep and other medical disorders (eg, diabetes, cardiovascular disease, gastrointestinal tract disorder, depression, anxiety); likelihood of falling asleep while driving after work; and use of sleeping medications (never or nearly never to nearly every day), caffeine (0->8 servings/d), and alcohol (0- >14 servings/wk). The Maslach Burnout Inventory was used to assess 2 subscales of burnout: emotional exhaustion and depersonalization.24
In the monthly surveys, participants were asked about work and sleep hours, likelihood of falling asleep in various situations and outcome measures of work performance, such as administrative errors, injuries, uncontrolled anger toward suspects or citizens, absenteeism, citizen complaints, and safety violations. The work-hours instrument was previously validated against daily work diaries (for monthly work hours, r = 0.76; for extended shifts, r = 0.94; P < .001),25 which in themselves were validated by direct observation (r = 0.98, P < .001).26
To compare questionnaire OSA screening outcome with polysomnography, full, attended polysomnography studies were performed for 126 participants from the state police department. Of these, 63 had screened positive on the Berlin questionnaire and were the first from the overall study to agree to have sleep studies performed and agree to provide the investigators with access to relevant medical records; 61 had screened negative on the Berlin questionnaire and were selected randomly from the group of participants who screened negative; and 2 had invalid Berlin screening outcomes. Obstructive sleep apnea severity was classified by a sleep specialist, blind to questionnaire outcome, and was made on the basis of both the respiratory disturbance index and the minimal arterial oxyhemoglobin saturation level associated with respiratory disturbances (eMethods).
Multiple logistic regression models were used for cross-sectional analysis of the associations between health outcomes at baseline and sleep disorder screening outcomes (for positive screening for any sleep disorder, or positive OSA screening). For the prospective analysis, the generalized estimating equations (GEE) method27 was used to assess performance and attentional failures in those who screened positive and those who did not screen positive for any of the sleep disorders because these outcomes were measured monthly over the course of this study and hence likely to be correlated. For performance and attentional failures, we used a logit link in the GEE model for dichotomized outcomes (1 for any number of the performance and attentional failures and 0 for no performance and attentional failures). Supplemental analysis was conducted on the continuous version of each outcome, assuming that the actual number of events follow a Poisson distribution and using a log link in the GEE model.
For the cross-sectional analysis, we adjusted for the potentially confounding effects of age, sex, body mass index (BMI), hypertension, cigarette smoking, alcohol consumption, primary police activity, second job, usual shift length, night shift work, and shift rotation. For the prospective analysis, we adjusted for age, sex, BMI, primary police activity, second job, night shift work, shift rotation, mean total work hours per week, and monthly sleep time. We tested these confounders individually and only included those that were significant (P < .10) in the initial multivariable models. We then applied a backward elimination method to remove those that were not significant in the final model. Only significant variables of P < .05 were left in the final model. Because there were some missing data for some of the confounders, we repeated the analysis using the missing-indicator method.28 Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals are reported for the complete-case analysis, and adjusted ORs are reported when the missing-indicator method was applied.
For the cross-sectional analysis, we deemed the following primary outcomes: diabetes, depression, burnout (emotional exhaustion), and falling asleep while driving. For the prospective analysis, we deemed the following as the primary outcomes: falling asleep while driving, making a serious administrative error, making fatigue-related errors or safety violations, and having an occupational injury. P < .0125 was considered statistically significant for the 4 primary outcomes of interest in each analysis with Bonferroni adjustment. P < .05 was considered statistically significant in all secondary analyses. Statistical analyses were conducted using SAS for Windows (version 9.2, SAS Institute Inc).
Sample size and power calculations are based on our previous studies examining the effects of extended duration shifts on performance and attentional failures. A similar magnitude of difference was expected in the present study because both sleep disorders and extended durations of wakefulness have been reported to induce neurobehavioral performance impairments comparable with that of alcohol intoxication.3 For the sample size and power calculation, we considered 3 outcomes: falling asleep while driving, having an occupational injury, and making an error or committing a safety violation attributed to fatigue. Assuming that one-third of our sample would screen positive for a sleep disorder, with 15 000 person-months of data, we estimated 90% power to detect the following differences from those who had screened negative vs those who had screened positive for a sleep disorder: rate of falling asleep while driving, 0.06625 vs 0.083 (OR, 1.28); rate of occupational injury, 0.01029 vs 0.017 (OR, 1.71); and rate of error or safety violation due to fatigue, 0.03830 vs 0.051 (OR, 1.36), with a 2-sided z test at P <.05/3 = .0167.
A total of 4957 police officers (mean [SD] age: 38.5 [8.3] years; years of police service: 12.7 [8.1]) completed the baseline survey. All participants reported being 18 years or older and sworn police officers. A total of 3930 officers (79.3%) were overweight or obese and 1663 (33.5%) were obese (Table 1). In 256 participants who attended a follow-up clinic visit, BMI was measured and found to be highly correlated with self-reported BMI (R = 0.912, P < .001).
As is the case nationally, white males made up the majority of officers. Based on the national average, women were slightly overrepresented in our sample (17.4% [95% CI, 16.3%-18.4%] vs 13.7% nationwide) whereas racial/ethnic minorities were somewhat underrepresented (7.9% [95% CI, 7.2-8.7] vs 12.7% for black officers nationwide; 5.9% [95% CI, 5.2-6.5] vs 9.1% for Hispanic officers nationwide31; Table 1). Our sample of onsite participants from the municipal police department (responders) was generally consistent in age, sex, and rank to characteristics of the entire police department, although the responders were slightly younger and had fewer high-ranking officers (eTable 1).
A total of 15 735 monthly surveys were completed during the 2-year follow-up, with a mean (SD) of 684.2 (254.1) completed monthly. Each participant completed a mean of 4.4 (5.2) surveys (median [interquartile range], 2 [1-6]). Officers who participated in the follow-up survey were similar to those who did not in terms of demographics and risk of sleep disorders (eTable 2).
A total of 2003 of 4957 participants (40.4%) screened positive for at least 1 sleep disorder (eTable 3 for demographic comparisons). One thousand six hundred sixty-six participants (33.6%) screened positive for OSA, the most common disorder, followed by 281 (6.5%) with moderate to severe insomnia; 269 (5.4%) with shift work disorder—those reporting excessive wake time sleepiness and insomnia associated with night work—representing 14.5% of those who work night shifts in the cohort; 70 (1.6%) with restless legs syndrome; and 16 (0.4%) with narcolepsy with cataplexy (Table 2). Applying the ICSD-22 criteria for shift work disorder, (ie, excessive wake time sleepiness or insomnia), 1004 (53.9%) of the police officers who work night shifts screened positive. Considering only those who showed both insomnia and night work–associated drowsiness (defined as a moderate to high chance of falling asleep while driving after working nights compared with never or a slight chance during days off, and moderate to high chance of falling asleep during night shift compared with never or slight chance during day shift), 47 (2.5%) on the night shift screened positive. To examine associations between positive sleep disorder screening and health and safety outcomes, the last definition of shift work disorder was used.
Higher proportions of participants in the online and in the on-site municipal police department cohorts screened positive for OSA than in the onsite state police department cohort: 36.0% (95% CI, 34.5%-37.6%) for the online cohort, 32.2% (95% CI, 28.6%-35.7%) for the municipal police cohort vs 20.3% (95% CI, 17.1%-23.5%) for the state police cohort. The state police cohort also reported a significantly lower mean (SD) BMI of 27.7 (3.6) than the municipal police cohort of 28.9 (4.6; P <.001) and the online cohort of 28.8 (4.8; P <.001). (BMI is calculated as weight in kilograms divided by height in meters squared.) Most participants who screened positive did not report a current diagnosis of the disorder (Table 2).
Positive screening for any sleep disorder was associated with increased risk of reported health- and safety-related outcomes: 203 (10.7%) of those who tested positive for a sleep disorder reported having depression vs 37 (4.4%) of those who did not screen positive (adjusted OR, 2.20; 95% CI [1.52-3.19]); 399 (34.1%) of the positive-screen group reported burnout (emotional exhaustion) vs 89 (17.9%) in the negative-screen group (adjusted OR, 2.85 [95% CI, 2.16-3.77]), and 388 (20.0%) in the positive-screen group reported falling asleep while driving vs 66 (7.7%) in the negative-screen group (adjusted OR, 3.79 [95% CI, 2.79-5.14]). Several of the secondary outcomes were also significantly associated with positive screening for sleep disorder, specifically gastrointestinal tract disorder, anxiety disorder, pharmacotherapy for insomnia, health status, and burnout (depersonalization) (Table 3 and eTable 4).
Because OSA was the most prevalent disorder reported, we examined associations between positive OSA screening results and risk of reported health- and safety-related outcomes. In addition to the risks observed with positive screening results for any sleep disorder, positive OSA screening was also associated with a diagnosis of diabetes, 84 (5.3%) of the positive-screen group vs 46 (1.5%) in the negative-screen group (adjusted OR, 1.61 [95% CI, 1.05-2.47]; of cardiovascular disease: 54 participants (3.4%) vs 30 (1.0%; adjusted OR, 1.95 [95% CI, 1.20-3.18]); and high caffeine consumption: 141 (12.6%) vs 164 (7.3%; adjusted OR, 1.94 [95% CI, 1.32-2.85]) (Table 4). All of these outcomes were statistically significant when adjusted for potential confounders; however, when adjusted for missing values using the missing indicator method, the significance level for diabetes (P = .03) fell short of statistical significance when accounting for multiple comparisons (P =.0125).
At baseline, 1312 of 4608 participants (28.5%) who completed the ESS had scores of 11 or higher, which means that they experienced excessive sleepiness.23 Of the total 4957 baseline survey respondents, 2276 (45.9%) reported having nodded off or fallen asleep while driving; 1294 of these (56.9%, 26.1% of the total cohort) reported falling asleep while driving at least 1 to 2 times a month; and 307 (13.5%, representing 6.2% of the total cohort) reported falling asleep while driving at least 1 to 2 times a week.
Those who screened positive for a sleep disorder also had a higher mean (SD) ESS score than those who did not (9.65 [4.25] vs 7.63 [3.80]; P < .001, Figure 2). Furthermore, 38.6% (95% CI, 36.4%-40.8%) of those who screened positive for any sleep disorder had an ESS score of 11 or higher vs 21.5% (95% CI, 19.9%-23.0%; P < .001) of those who did not.
During the 2-year follow-up, 15 735 monthly surveys were collected, 6587 person-months with positive screens for sleep disorders and 9148 with negative screens for a sleep disorder. Of the participants who screened positive for any sleep disorder and responded to the question, 17.9% reported making important administrative errors vs 12.7% of those who screened negative (adjusted OR, 1.43; 95% CI, 1.23-1.67), 14.4% vs 9.2% reported falling asleep while driving (adjusted OR, 1.51; 95% CI, 1.20-1.90), and 23.7% vs 15.5% reported making errors or committing safety violations due to fatigue (adjusted OR, 1.63; 95% CI, 1.43-1.85; Table 5 and eTable 5). Similarly, 34.1% vs 28.5% reported having uncontrolled anger toward a citizen or suspect (adjusted OR, 1.25; 95% CI, 1.09-1.43), 11.2% vs 9.4% incurring citizen complaints (adjusted OR 1.35; 95% CI, 1.13-1.61), 26.0% vs 20.9% absenteeism (adjusted OR, 1.23; 95% CI, 1.08-1.40), and 14.1% vs 7.0% falling asleep during meetings (OR, 1.95; 95% CI, 1.52-2.52). When these outcomes were analyzed as continuous variables rather than as dichotomized outcomes), the results were similar (eTable 6 and eTable 7).
To address possible reporting bias, we calculated these ratios for the 459 police officers who completed at least 1 year of monthly surveys (5508 person-months; eTable 8). The results were comparable, although falling asleep while driving and occupational injury did not reach statistical significance in the smaller sample.
Two hundred eighty-seven participants reported being in a motor vehicle crash during the follow-up period. Motor vehicle crashes were more likely to be reported by those who reported falling asleep while driving (29 of 180 person-months) than by those who did not (1132 of 9980 person-months; risk ratio [RR], 1.49 [95% CI, 1.01-2.20]; P < .05) or by those who reported falling asleep while stopped in traffic (25 of 177 person-months) than by those who did not (872 of 9898 person-months; RR, 1.68 [95% CI, 1.11-2.55], P = .01).
Of the 126 completed polysomnograph studies, 116 had complete data available. Forty-four of 54 participants who underwent polysomnography assessment and who screened positive for OSA on the survey (positive predictive value, 81.5%) were classified by the assessment as having mild to moderate, moderate to severe, or severe OSA compared with 28 of 60 (46.7%) of those who screened negative. Eleven of 60 (18.3%) of those who screened negative were found to have moderate to severe or severe OSA (eTable 9). We found that 35 of 44 (positive predictive value, 79.5%) of participants with a BMI of 30 or higher and 11 of 12 (positive predictive value, 91.6%) of participants with BMI of 35 or higher had mild to moderate, moderate to severe, or severe OSA (eTable 9).
Sleep disorders are common and are largely undiagnosed and untreated in North American police officers. Our comprehensive sleep disorders screening program found that 40.4% of police officers reported symptoms consistent with at least 1 sleep disorder. The majority reported not having been diagnosed in the past or not taking regular treatment. Obstructive sleep apnea was the most prevalent disorder, with one-third of officers screening positive. Given that obesity is a major risk factor for OSA3 and that one-third of our sample had a BMI of 30 or higher, the high prevalence of OSA could be anticipated but is nevertheless a concern. There are several factors that might account for the lower prevalence of OSA in the state police department cohort, including their lower reported BMI and the department's physical fitness program, which provides fitness facilities and the opportunity to exercise at all stations during paid work time and job performance standards associated with physical ability.
The OSA prevalence in our sample is comparable with recent reports,32,33 but higher than reported 2 decades ago.34 Although only a subset of patients with OSA report excessive sleepiness, many describe related symptoms (eg, fatigue, nonrestorative sleep, inattention). The prevalence of OSA without a complaint of excessive sleepiness, even in 1993, was 24% in men and 9% in women.34 Today, it is likely even higher, given that the prevalence of some of the major risk factors for OSA (eg, aging and obesity) is increasing. In 2009, self-reported obesity prevalence in the United States was 26.7%, up from 19.8% in 2000.35 In addition, recent improvements in diagnostic technology would likely yield higher apnea prevalence estimates.
Although in-the-line-of-duty death rates in police have decreased by almost half since 1972, the proportion of deaths due to unintentional injury have shown little change and in 2003 were greater than the rate of felonious deaths.14 Across 2009-2010, more than one-third of in-the-line-of-duty deaths were due to motor vehicle crashes.36 Driver sleepiness is a major cause of motor vehicle crashes,3 and excessively sleepy individuals have an increased risk of having more crashes and more serious crashes.37 Obstructive sleep apnea exposes individuals to increased sleepiness and a 2- to 3-fold higher risk of motor vehicle crashes.8 We found that excessive sleepiness is common in police officers, with almost half reporting having fallen asleep while driving and about one-quarter reporting that this occurs 1 to 2 times per month. This is despite police officers apparently recognizing the dangers associated with drowsy driving; in a survey of North American police officers, almost 90% regarded drowsy driving to be as dangerous as drunk driving.38
Police officers who screened positive for a sleep disorder were likely to report more actual and near-miss administrative errors and safety violations. The loss of even 2 hours of nightly sleep for 1 week is associated with decrements in performance comparable with those seen after 24 hours of continuous wakefulness.3 Sleep disorders resulting in chronic sleep deficiency may therefore adversely affect on-the-job performance. Because long work hours are also associated with decrements in performance and attentional failures,13,14 we adjusted for mean work hours in our analysis (eTable 5).
There may be a biological basis to our finding that those who screened positive for a sleep disorder were significantly more likely to report displaying uncontrolled anger toward a citizen or suspect. Yoo et al39 studied changes in the amygdala with functional magnetic resonance imaging and reported that those in a sleep deprived state were unable to appropriately govern behavioral responses to negative emotional stimuli. This may also explain the self-reported increased number of citizen complaints filed against those officers who screened positive for a sleep disorder, although further studies are required to test this potential mechanism.
Cardiovascular disease–related morbidity and mortality and vascular markers associated with these are increased in police officers, and these increases are not fully explained by traditional risk factors.40,41 We found significantly increased risk of diagnosed cardiovascular disease and diabetes in those who screened positive for OSA, which is recognized as a major risk factor for cardiovascular disease, diabetes, hypertension, and stroke, independent of obesity.3,6,42,43 Untreated OSA may therefore contribute to the increased prevalence of cardiovascular disease and diabetes in police. Furthermore, sleep loss is associated with metabolic abnormalities and may be the pathway contributing to sleep-related increases in the risk of obesity and diabetes.3 Many police officers are at an even greater risk of these outcomes because they are often required to work overnight, on rotating shifts, or both. Impaired cardiometabolic responses are observed in healthy volunteers scheduled to eat and sleep out of phase from their habitual times,44,45 and night work greatly increases the risk of progression to diabetes.46 These findings may at least in part explain the increased risk of cardiovascular disease and diabetes in shift workers,47 in particular police officers.48 We note, however, that although we adjusted our analysis for many of the possible variables that influence cardiovascular disease risk, behavioral factors such as physical activity and diet were not assessed and may also account for the observed increased risk.
Our finding of increased risk of adverse mental health outcomes (diagnosed depression and risk of burnout) with positive screening for sleep disorders has significant implications, given the reported increased risk for suicide in police officers.49 Obstructive sleep apnea, in particular the excessive sleepiness symptoms, and insomnia are associated with depression.9 Research has also demonstrated relationships between sleep loss and mental health problems. Resident physicians, who work protracted hours as do police in many municipalities,14 have been found to have rates of depression and burnout roughly double those in the general population.50 Depression and burnout typically develop over the first several months of residency as sleep loss increases51 and are associated with making more errors.50 By analogy, officers who are burned out may be at increased risk of making mistakes on the job, which could compromise public safety; however, further studies will be needed to determine whether this is in fact the case.
This study had several limitations. By collecting data on a monthly basis, we attempted to reduce, but could not eliminate, the effect of recall bias. Performance outcomes and attentional failures were self-reported and therefore may be overreported or underreported. Although participants were assured of confidentiality, underreporting of work-related outcomes may have occurred, possibly due to the stigma associated with these. Additionally, reporting bias could have confounded the results if participants preferentially completed monthly surveys after having had a negative health or safety outcome. However, analysis of a subgroup that completed a full year of monthly surveys yielded a similar pattern of results. Because response rate could not be determined for this study, it is possible that those who participated may not be representative of all North American police officers, although demographic characteristics in municipal police department responders were similar to the entire department. The magnitude of difference in absolute risk of some of the outcomes we assessed was relatively small, and the clinical significance of such differences is unknown. Although we observed a positive relationship between sleep disorders screening result and health and safety outcomes (Table 3), the cross-sectional analysis cannot determine causality. Hypertension and BMI are used in the Berlin questionnaire to identify those at high risk of OSA, which could have contributed to the observed association between OSA risk and cardiovascular disease, even though we adjusted for these variables in our analyses. Finally, the shift work disorder questionnaire remains to be validated.
Questionnaire screening instruments are inherently less precise than objective tests. Although the Berlin questionnaire had a positive predictive value of 81.5% for detecting mild to moderate, moderate to severe, or severe OSA, and negative predictive value of 81.7% for those with moderate to severe or severe OSA, its performance in predicting OSA in our study did not match that reported initially.19 Several factors likely account for this difference. First, the initial validation of the Berlin quesionnaire was conducted among individuals preselected with high pretest probability for OSA, such as sleep clinic populations.19 Second, the techniques we used to record breathing abnormalities are much more sensitive than those used in many previous studies on the prevalence of sleep apnea,34,52 including the initial studies used to validate the Berlin questionnaire in a sleep clinic population.19 Third, different criteria are now used for the definition of hypopnea,53 influencing respiratory disturbance index values.54 As a result of these increases in sensitivity, sleep apnea would now be detected in many individuals who were classified as not having sleep apnea in the initial validation studies for the Berlin questionnaire.19 This may explain why in our study the positive predictive value remained high for all levels of sleep apnea severity, whereas the negative predictive value was high only for those with more severe illness. Moreover, excessive sleepiness is a criterion for positive screening on the Berlin questionnaire, and given that our sample had high incidences of night shift work and chronic sleep loss, it is possible that excessive sleepiness associated with behaviorally induced insufficient sleep syndrome,55 shift work disorder, or OSA were being detected. The utility of the Berlin questionnaire in predicting outcomes in our study may thus have been due in part to the clinical consequences of all 3 of these sleep disorders; for this reason, we extended our prospective analysis to all sleep disorders, rather than to OSA alone. Research to develop more specific diagnostic questionnaires that distinguish OSA from behaviorally induced insufficient sleep syndrome and shift work disorder would be useful because the therapeutic interventions differ.
In conclusion, a large proportion of police officers in our sample showed a positive sleep disorder screening result, which was associated with adverse health, safety, and performance outcomes. Further research is needed to determine whether sleep disorder prevention, screening, and treatment programs in occupational settings will reduce these risks.
Corresponding Author: Charles A. Czeisler, PhD, MD, Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston MA 02115 (email@example.com).
Author Contributions: Drs Rajaratnam and Barger had full access to all of the data and take responsibility for integrity of the data and the accuracy of the data analysis. Drs Rajaratnam and Barger as co-first authors contributed equally to this article.
Study concept and design: Rajaratnam, Barger, Lockley, Landrigan, O'Brien, Cade, White, Czeisler.
Acquisition of data: Rajaratnam, Barger, Lockley, Landrigan, O'Brien, Qadri, Sullivan, Cade, Czeisler.
Analysis and interpretation of data: Rajaratnam, Barger, Shea, Wang, Landrigan, Qadri, Sullivan, Epstein, Czeisler.
Drafting of the manuscript: Rajaratnam, Barger, Shea, Wang, O'Brien, Qadri, Czeisler.
Critical revision of the manuscript for important intellectual content: Rajaratnam, Barger, Lockley, Shea, Landrigan, Sullivan, Cade, Epstein, White, Czeisler.
Statistical analysis: Rajaratnam, Barger, Wang, Landrigan, Qadri, Sullivan.
Obtained funding: Rajaratnam, Lockley, Landrigan, Czeisler.
Administrative, technical, or material support: Rajaratnam, Barger, Shea, Landrigan, O'Brien, Qadri, Cade, Epstein, Czeisler.
Study supervision: Rajaratnam, Landrigan, O'Brien, Epstein, White, Czeisler.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Rajaratnam reported that he has served as a consultant through his institution to Vanda Pharmaceuticals, Philips Respironics, EdanSafe, the Australian Workers' Union, and National Transport Commission, and has through his institution received research grants and unrestricted educational grants from Vanda Pharmaceuticals, Takeda Pharmaceuticals North America, Philips Lighting, Philips Respironics, Cephalon, and ResMed Foundation, and reimbursements for conference travel expenses from Vanda Pharmaceuticals. His institution has received equipment donations or other support from Optalert, Compumedics, and Tyco Healthcare. He has also served as an expert witness and consultant to shift work organizations. Dr Barger reported receiving a research grant through her institution from Cephalon, receiving payment for lectures from Vital Issues in Medicine and National Sleep Foundation, and serving as a consultant for Alertness Solutions. Dr Lockley reported that he received 2 investigator-initiated research grants from the ResMed Foundation and an unrestricted equipment gift from ResMed Inc, in support of the studies described in this article; receiving consulting fees from Apollo Lighting, Naturebright, Sound Oasis, and Wyle Integrated Science and Engineering, and federally funded projects at Brigham and Women's Hospital, Thomas Jefferson University, and Warwick Medical School; lecture fees from Takeda Pharmaceuticals North America, I Slept Great/Euforma, LLC, and Emergency Social Services Association Conference, UK; unrestricted equipment gifts from Philips Lighting and Bionetics Corporation; an unrestricted monetary gift to support research from Swinburne University of Technology, Australia; a fellowship gift from Optalert, Pty Ltd, Melbourne, Australia; advance author payment and royalties from Oxford University Press, and honoraria from Servier Inc for writing an article for Dialogues in Clinical Neuroscience and from AMO Inc, for writing an educational monograph, neither of which refer to the companies' products; honoraria or travel and accommodation support for invited seminars, conference presentations or teaching from the Second International Symposium on the Design of Artificial Environments, Eighth International Conference on Managing Fatigue, American Academy of Sleep Medicine, American Society for Photobiology, Apollo Lighting, Bar Harbor Chamber of Commerce, Bassett Research Institute, Canadian Sleep Society, Committee of Interns and Residents, Coney Island Hospital, FASEB, Harvard University, Illinois Coalition for Responsible Outdoor Lighting, International Graduate School of Neuroscience, Japan National Institute of Occupational Safety and Health, Lightfair, National Research Council Canada, New York Academy of Sciences, North East Sleep Society, Ontario Association of Fire Chiefs, Philips Lighting, Thomas Jefferson University, University of Montreal, University of Tsukuba, University of Vermont College of Medicine, Utica College, Vanda Pharmaceuticals, Velux, Warwick Medical School, Woolcock Institute of Medical Research, and Wyle Integrated Science and Engineering (NASA); investigator-initiated research grants from Respironics Inc, Philips Lighting, Apollo Lighting, and Alcon Inc; and a service agreement and sponsor-initiated research contract from Vanda Pharmaceuticals. Dr Lockley also holds a process patent for the use of short-wavelength light for resetting the human circadian pacemaker and improving alertness and performance which is assigned to the Brigham and Women's Hospital per Hospital policy and has received revenue from a patent on the use of short-wavelength light, which is assigned to the University of Surrey. Dr Lockley has also served as a paid expert witness on behalf of 2 public bodies on arbitration panels related to sleep, circadian rhythms, and work hours. Dr Shea reported receiving fees for interpretation of polysomnographic sleep studies of participants in this study from Sleep HealthCenters, a sleep medicine specialty practice group; receiving fees for attendance at directors meeting of the American Academy of Sleep Medicine; and lecture fees from Tufts University School of Dental Medicine. Dr Landrigan reported serving as a consultant for Vital Issues in Medicine, developing an educational course for physicians on Shift Work Disorder (supported by an unrestricted educational grant from Cephalon Inc to Vital Issues in Medicine); and AXDev, to assist in the development of a study of Shift Work Disorder (supported by an unrestricted research grant from Cephalon Inc to AXDev). Dr Landrigan also reported receiving monetary awards, honoraria, and travel reimbursement from multiple academic and professional organizations for delivering lectures on sleep deprivation and safety. Mr O'Brien reported receiving support for travel to meetings for the study or other purposes from National Institute of Justice and Centers for Disease Control and Prevention. Dr Cade reported receiving a monetary award from the World Sleep Federation. Dr Epstein reported being employed by Sleep HealthCenters, a sleep medicine specialty practice group. Dr White reported being employed as the chief medical officer for Philips Respironics, for which he owns stock. Dr Czeisler reported that he has received consulting fees from or served as a paid member of scientific advisory boards for: Actelion Ltd; Bombardier Inc; Boston Celtics, Celedon Trucking, Cephalon, Inc, Delta Airlines, Eli Lilly and Co, Garda Síochána Inspectorate, Gerson Lehrman Group, Global Ground Support, Johnson & Johnson, Koninklijke Philips Electronics, NV, Minnesota Timberwolves, Norfolk Southern, Novartis, Portland Trail Blazers, Philips, Respironics Inc, sanofi-aventis Group, Sepracor Inc, Sleep Multimedia Inc, Somnus Therapeutics Inc, Vanda Pharmaceuticals, Inc, and Zeo Inc. Dr Czeisler reported that he owns an equity interest in Lifetrac Inc, Somnus Therapeutics Inc, Vanda Pharmaceuticals Inc, and Zeo Inc; that he has received royalties from the Massachusetts Medical Society/ New England Journal of Medicine, McGraw Hill, the New York Times, Penguin Press, and Philips Respironics Inc. Dr Czeisler reported receiving lecture fees from the Accreditation Council of Graduate Medical Education, Alliance for Epilepsy Research, American Academy of Sleep Medicine, Cephalon Inc, Duke University School of Medicine, Harvard School of Public Health, Hokkaido University Graduate School of Medicine, Japan Aerospace Exploration Agency (JAXA), LOTTE Health Products, Mount Sinai School of Medicine, National Academy of Sciences, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK/NIH), National Sleep Foundation, New England College of Occupational and Environmental Medicine (NECOEM), North East Sleep Society, Office of Rare Diseases Resarch (NIH), Rockpointe, sanofi-aventis Inc, Sleep Research Society, Society for Obstetric Anesthesia and Perinatology (SOAP), St Lukes Roosevelt Hospital, University of Chicago, University of Colorado, University of Pittsburgh, University of Virginia Medical School, University of Washington Medical Center, University of Wisconsin Medical School, and the World Federation of Sleep Research and Sleep Medicine Societies. Dr Czeisler reported that he has received research prizes with monetary awards from the American Academy of Sleep Medicine and Sleep Research Society, a clinical trial research contract from Cephalon Inc, and an investigator-initiated research grant from Cephalon Inc and that his research laboratory at the Brigham and Women's Hospital has received unrestricted research and education funds and support for research expenses from Cephalon Inc, Koninklijke Philips Electronics NV, ResMed, and the Committee for Interns and Residents and the Brigham and Women's Hospital. The Harvard Medical School Division of Sleep Medicine (HMS/DSM), which Dr Czeisler directs, has received unrestricted research and educational gifts and endowment funds from Boehringer Ingelheim Pharmaceuticals Inc, Cephalon Inc, George H. Kidder Esq, Gerald McGinnis, GlaxoSmithKline, Herbert Lee, Hypnion, Jazz Pharmaceuticals, Jordan's Furniture, Merck & Co Inc, Peter C. Farrell, PhD, Pfizer, ResMed, Respironics Inc, sanofi-aventis Inc, Sealy Inc, Sepracor Inc, Simmons, Sleep Health Centers LLC, Spring Aire, Takeda Pharmaceuticals, and Tempur-Pedic. The HMS/DSM has received gifts from many outside organizations and individuals including: Brigham and Women's Hospital (Development Office), Catalyst Group, Cephalon Inc, Committee for Interns and Residents, Eisai Inc, Farrell Family Foundation, Fisher & Paykel Healthcare Corp, Jordan's Furniture, Lilly USA, LLC, Neurocare Center for Sleep, Philips-Respironics Inc, Praxair US Homecare, sanofi-aventis Inc, Select Comfort Corp, Sepracor Inc, Sleep HealthCenters LLC, Somaxon Pharmaceuticals, Synchrony Healthcare Communications, Vanda Pharmaceuticals Inc, Wake Up Narcolepsy Inc, Watermark Medical, and Zeo Inc. The HMS/DSM Sleep and Health Education Program has received Educational Grant funding from Cephalon Inc, Takeda Pharmaceuticals, sanofi-aventis Inc, and Sepracor Inc. Dr Czeisler is the incumbent of an endowed professorship provided to Harvard University by Cephalon Inc and holds a number of process patents in the field of sleep and circadian rhythms (eg, photic resetting of the human circadian pacemaker). Since 1985, Dr Czeisler has also served as an expert witness on various legal cases related to sleep, circadian rhythms, or both.
Funding/Support: This study was supported by grant 2004-FS-BX-0001 and grant 2010C-10002 from the National Institute of Justice, Office of Justice Programs, US Department of Justice; grants R01 OH008496 and R01 OH009403 from the Centers for Disease Control and Prevention; and grants from the ResMed Foundation.
Role of the Sponsor: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.
Disclaimer: Points of view in this document are those of the authors and do not necessarily represent the official position or policies of the US Department of Justice.
Online-Only Material: The Author Video Interview is available here.
Additional Contributions: We thank Richard Coleman, PhD, and Frank Speizer, MD, for study design; Jeffrey Ellenbogen, MD, MMSc, for clinical investigations; and Mary Kay Landon, PhD, Sarah Edwards, MD, Marissa Moritz, PA-C, Erin Flynn-Evans, PhD, Jeff Tarpy, ALM, Amy Hallal, and Sean Bendix for Study coordination and assistance, all of which was performed as part of of their regular duties at the Division of Sleep Medicine, Brigham and Women's Hospital. We thank Richard Allen, PhD, Johns Hopkins University, Murray Johns, PhD, Optalert Ltd, Emmanuel Mignot, MD, PhD, Stanford School of Medicine, and Kingman Strohl, MD, Case Western Reserve University, for their advice about the selection of sleep disorder screening questionnaires, and Peter Brown, Brigham and Women's Hospital, and Chief Inspector Kathleen M. O'Toole, Garda Siochana Inspectorate, for assistance in recruitment of participating police department, all without compenstion from the study sponsor. We also thank the police departments, and police unions for their participation.
This article was corrected for errors on December 20, 2011.


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Routing numbers are also referred to as "Check Routing Numbers", "ABA Numbers", or "Routing Transit Numbers" (RTN). The ABA routing number is a 9-digit identification number assigned to financial institutions by The American Bankers Association (ABA). This number identifies the financial institution upon which a payment is drawn. Routing numbers may differ depending on where your account was opened and the type of transaction made. Each routing number is unique to a particular bank, large banks may have more than one routing number for different area.
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ACH Routing Number:
ACH Routing Number stands for Automated Clearing House (ACH). This routing number is used for electronic financial transactions in the United States. ACH helps to improves payment processing efficiency and reduce expenses. Banks offer ACH services for businesses who want to collect funds and make payments electronically in batches through the national ACH network.
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Fedwire Routing Number:
Fedwire Transfer service is the most expedient method for transferring funds between business account and other bank accounts. It is used for domestic or international transactions in which no cash or check exchange is involved, but the account balance is directly debited electronically and the funds are transferred to another account in real time.
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Routingbank 2016


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I just asked Maria what Kirstie Alley is selling and why she's pimping herself all over Barbara Walters, forgetting that she's on that Dancing Stars show and must not be eliminated yet. This, apparently, is how she's trying to secure votes: by telling people that John Travolta isn't gay...?
During her interview with Walters, Kirstie reveals that she fell in love with him on the set of Look Who's Talking and that they could have been together forever and forever except that...
She was married at the time.
Like, that's the ONLY REASON they never hooked up.
Otherwise, there'd be NO OTHER REASON for them to have been apart.
John Travolta is the "greatest love of" Kirstie Alley's life:
"I know John with all my heart and soul; he's not gay," Alley tells Walters of her Look Who's Talking costar. I think in some weird way, in Hollywood, if someone gets big enough and famous enough, and they're not out doing drugs and they're not womanizing, what do you say about them? It took everything I had inside, outside, whatever, to not run off and marry John and be with John for the rest of my life . . .I feel like when you marry someone, you're supposed to work hard at it and you're supposed to make it work."
It's been a rough year for the Church of Scientology as scandal surrounded two of its most high profile members. Travolta allegedly groped a masseur in every city with a spa and Tom Cruise's wife decided she didn't want a babysitter anymore. I'd been wondering why Church disciples weren't mobilising more to defend their religion and their poster boys. Looking back I guess they didn't want to jeopardise Alley's opportunity to return to Dancing. And now that she's advanced in the competition, now that there's an established fanbase supporting her, well, I guess she got the call from Xenu, the executive order to leverage her popularity in service of another Scientologist...
If not for cruel fate then, Kirstie could have been JT's co-pilot. Kirstie and John would have been the Brange of Scientology.


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DENVER — The man accused in the deadly Colorado theater shootings wants to change his plea to not guilty by reason of insanity, his lawyers said Tuesday, despite their fears that the plea could severely hamper his ability to mount a defense against the death penalty.
James Holmes is charged with more than 160 counts of murder and attempted murder in the July 20 assault on a packed Aurora movie theater that killed 12 and injured 70. Prosecutors announced last month they would seek the death penalty.
Holmes was widely expected to plead insanity given the compelling evidence against him, but his attorneys put it off for weeks, saying state laws on the death penalty and insanity overlap in ways that violate his constitutional rights and his ability to mount an effective defense.
One of their worries: If Holmes doesn't cooperate with doctors who will evaluate his sanity at the state mental hospital, he could be barred from calling witnesses to testify about his mental condition during sentencing. That would make it nearly impossible for his lawyers to use his mental state as an argument against the death penalty.
"If you don't cooperate during the evaluation phase, you lose the right to call witnesses in your own behalf who could help convince a jury that your life should be spared," said Karen Steinhauser, an adjunct law professor and former prosecutor.
Two judges previously refused to address the constitutionality question, saying Holmes couldn't challenge the insanity law unless he entered an insanity plea first. That gave his lawyers little choice but to enter the plea and then try to make their case against the law.
Their filing Tuesday made it clear they are not giving up their right to challenge the laws, Steinhauser said.
Holmes was supposed to enter a plea March 12, but his lawyers said he refused to do so because the constitutional questions prevented them from giving him good advice. The judge in charge at the time, William Sylvester, entered a standard not guilty plea for him.
Sylvester withdrew from the case April 1, saying his administrative duties as chief judge of the district wouldn't allow him enough time. Sylvester assigned District Judge Carlos Samour to take over.
Samour must approve the new plea before Holmes is allowed to enter it, and he already has said he would require an explanation before he does so. Steinhauser said she doesn't think that will be an issue.
Samour said he would hear arguments from the defense and prosecutors about the new plea at a hearing Monday.
If the judge does accept the plea, Holmes would be sent to the state mental hospital, where doctors would determine whether he was sane at the time of the shootings. If the doctors do determine Holmes was insane, a jury could still find him guilty.
Holmes' attorneys repeatedly have said in court hearings and documents that Holmes is mentally ill. He was being seen by a psychiatrist before the attack.
Holmes had sent the psychiatrist a notebook that media reports said included crude drawings of violence. Prosecutors might renew their request to see the notebook, because state law gives them access to some medical records of defendants who plead not guilty by reason of insanity.
Prosecutors backed off their previous attempt to see the notebook when Holmes' lawyers said it was protected by doctor-patient privilege.
It's unclear how long the mental evaluation would take, but it would further delay the proceedings, which already have taken nearly 10 months. The trial is not scheduled to start until Feb. 3, and even that likely would be pushed back by the mental evaluation.
Tom Sullivan, whose son Alex was killed in the attack, said prosecutors have warned victims that an insanity plea would delay the case.
"We're just mortified that this is the process that we're going through, and we still have a long way to go," Sullivan said Tuesday. "I know justice will win out in the end."
Prosecutors declined to comment.
Colorado law defines insanity as the inability to distinguish right from wrong, caused by a diseased or defective mind. The law specifically excludes depravity, "moral obliquity" and passion caused by anger, hatred or other emotions from being considered insanity.
Prosecutors say Holmes, 25, spent months buying guns and thousands of rounds of ammunition, donned police-style body armor and opened fire during a midnight screening of the latest Batman movie.
Last month, prosecutors filed a court document listing aggravating factors they plan to raise in a possible death penalty phase of the trial. The factors included the death of 6-year-old Veronica Moser-Sullivan, the youngest of dead.
Prosecutors also said in the filing that the slayings were "especially heinous, cruel or depraved."
Associated Press Nicholas Riccardi and Catherine Tsai contributed to this report.
Follow Dan Elliott at http://twitter.com/DanElliottAP
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8613 Seminole Blvd, Seminole, FL 33772
Local: 727-392-1000
The FTD® Yellow Rose BouquetS38-4307
The FTD® Yellow Rose Bouquet is a spectacular way to offer hope and warmth to those facing the loss of a loved one. Sunlit yellow roses are arranged with seeded eucalyptus in a clear glass vase to create the perfect gift of caring kindness that expresses your deepest sympathies
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2030 is only 8 years away, by making very modest assumptions about economic growth it is possible to project forward economic data to 2030.
Click the charts or button below to see more charts showing the world economy of today and how it could look in 2030.
Download all data featured on World Economics in a simple and consiatant format.
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Find out how good a country could be if it upgraded it's GDP data.
Real GDP in Malaysia is estimated to be $371 Billion US dollars at the end of 2022.
The economy of Malaysia has grown at an average annual growth rate of 0.7% in the last four years and is ranked the 13th largest economy in Asia-Pacific, ahead of Taiwan.


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Gender predictor | List Of Demon Names
Unique baby names have become very popular in the recent years. On our site, we have selected cool and unique baby names that parents are searching for. There are some advantages to giving your kids uncommon unique baby names. Your child will probably be the only one in his or her class with that unique name which will make your kid feel even more special. When your babies grow up and start to build their career, they are more likely to catch the employer's eye on the resume if they have unusual baby names.
Unique names will make your kids stand out from the crowd. Girls with cute baby names are most likely to meet their prince in a white Mercedes or on a horse, depending on where you live. Boys with rare baby names will not need to come up with a special pick up line to meet the girls. It will be enough just to say, "Hi my name is Alexander". But on a more serious note, uncommon baby names can be an advantage for both boys and girls. Some people search for weird baby names and different baby names. In any case, whether you prefer popular baby names or unique baby names, your baby will be one of a kind! Enjoy your browsing!
1 - 9 of 9
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Choosing Unique Names has never been easier. Narrow your search by choosing one of our baby names categories such as celebrity, flower, vampire, fruit names and more.
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Browse celebrity baby names that celebrities give to their babies. Many celebrities like to give their children Cool and Unusual baby names. Here you might find some great ideas for your baby name.
Do you like exotic baby names that are beautiful and unique? It is very trendy now to give exotic baby names. Parents want to encourage individuality and uniqueness in their children, that's why they choose exotic baby names. Some people love the sound of exotic baby names which for them associate with beauty, nature and mystery. Use your imagination, and find some inspiration for exotic baby names in flowers, colors or famous people! It also became popular to make old fashioned baby names more unique by changing the spelling. Just make sure the name is not too hard to pronounce or spell when looking through exotic names. Remember, your baby will have his or her name for the rest of the life, so spend some time and choose exotic names wisely.
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Baby Names tool bar is an Instant access to our baby names database at all times no matter where you are on the web. Not only you will be able to search the baby names but tool bar will also display your pregnancy progress and much more.


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L.L.Bean Pathfinder Sleeping Pad Short
Upgrade your zzzzz's with this luxe and versatile system.
Brand: L.L. Bean
Model: Pathfinder Sleeping Pad Short
"This is the only sleeping pad I'll ever need—for my ounce-counting backpacking trips and my weight-be-damned, luxe car camps," says one tester. That's because the Astro combo is a pad system that allows you to strip it down or amp it up, depending on the trip. At its heart is a 2.5-inch, full-length mattress that's insulated with open-cell foam and packs down to about eight by four inches. Alone, it's as comfortable and warm (down to at least 15°F) as any pad we've tried, with a rugged, 75-denier polyester shell that fended off abrasion even on sandpapery slickrock.
The Astro takes some lung power—and three to four minutes—to inflate, but the handy push/pull valve let's you easily cap it for a breather. (You can also opt for the foot-powered Disco Pad Pump, which weighs 2.2 ounces and costs $40.) For trailhead throw-downs, basecamps, and drive-up campgrounds, slide the Astro into its Pillowtop sleeve. Made of open-cell polyurethane foam, it adds a pound and a half, a few inches of girth when packed, and an entirely new level of comfort.
The combo is like a portable mattress, a full 3.25 inches thick. "It turned our lumpy, rock-strewn trailhead campsite in Capitol Reef into a featherbed," says one tester. And the price? It looks high, but consider this: If you were to buy a lightweight backpacking pad and a decadent car-camping mattress, you could easily spend more and not sleep as well. Astro: $100; 1 lb. 8 oz.; 20x72x2.5"; Pillowtop: $80; 1 lb. 9 oz.; nemoequipment.com
Self-inflating sleeping pad offered at a great value. Designed for backpackers, canoe/kayak campers, and family campers. New push-in valve for locking valve open or closed. Stuff sack included.


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Escrow Agencies operating in the State of Idaho are required under Section 30-901 of the Idaho Code to execute an Idaho Escrow Agency Bond to ensure compliance with licensure.
A surety bond protects the party requesting the bond, the Obligee, against any financial losses as a result of poor financial decisions, damages, unethical decisions, or a failure to follow state and local laws on the part of you, the Principal. The Idaho Escrow Agency Bond holds you accountable for your business decisions. By possessing an Idaho Escrow Agency Bond, you are telling your Obligee that you can be trusted as a Principal and that you stand behind your business decisions.
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Bond approvals, like loans, are based upon several factors: personal credit and financial strength of the owner(s), liens or judgments, bankruptcies, length of time in business, bond amount and type of bond. The more information you provide the better chance you have of getting the lowest available price and a faster approval.
Complete our fast and easy online application by clicking the link below. Most will receive a free quote within 1 hour.


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Hip Hop - Future Ringtone
File Size: 0.44 Mb
Uploaded by: qweasdzxc
Ringtone Format: MP3 for Android & M4R for iPhone
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