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Tradition is part of the business plan at F. Wardynski & Sons, the Peckham Street sausage maker.
Its customers' devotion to Wardynski's Polish kielbasa and natural casing hot dogs helped the company survive as regional competitors went under, unable to compete in a marketplace dominated by billion-dollar brands like Johnsonville and Hillshire Farms.
In their spare time, though, Raymond "Skip" Wardynski and his partners were working on a secret sausage. One aimed straight at the American heartland.
What does your average American love to eat? Meat and potatoes.
Meet Duetts, the precooked pork sausage with chunks of real potato, available at Tops Markets in six flavors from Parmesan garlic to spicy Cajun.
With potatoes in the mix, the sausage delivers 40 percent less fat than leading brands of precooked pork sausage. It debuted on Memorial Day weekend, a minor part of Wardynski's output with the potential to make it to the sausage big leagues.
"This is the first item ever that has given us national attention in a big way," Wardynski said. "We're dealing with 20 different companies that are thinking about slotting this item. We've never had that."
The dream is that Duetts could do for Wardynski's what its kielbasa never could. "It gives us a chance at a national presence," the sausage maker said. "It gives us a chance."
Polish sausage alone isn't enough to keep his 45 employees working. Wardynski's makes about 150 different meat products, from jalapeno cheese dogs to liverwurst. It also makes custom sausages for other companies, like the venison and boar sausages it makes for a Canadian customer. His firm has become a distribution company too, Wardynski said, with half its business devoted to delivering products the company didn't make.
Last year Americans bought about $3 billion in refrigerated dinner sausage, according to industry site www.meatpoultry.com. Skip Wardynski and his partners want a slice of that market. But the power of the Wardynski brand wanes with every mile a sausage travels from the Peckham Street factory.
Thus it was that Dean O'Brien, the Wardynski's vice president in charge of product development, among other things, crossed the border and headed to Niagara-on-the-Lake in November 2011.
He was there to brainstorm sausages with Joseph Lopez, a product development consultant with experience in food processing.
Inventing a truly new sausage is harder than you would think. Since at least the time of ancient Greece, cooks have used arcane methods and spices to transform animals into single-serving meals. Adept sausage makers can use just about anything, and they have.
From his strolls about town, O'Brien noted that bangers and mash, the English sausage of finely ground pork and bread crumbs, served alongside mashed potatoes, seemed quite popular.
O'Brien recalled that Lopez said it was too bad they couldn't figure out how to put the potatoes and the sausage together. Everybody likes meat and potatoes.
"I said, 'Give me some time, I can figure it out,' " O'Brien said. "I can get potatoes in there."
Research turned up a Swedish Christmas potato sausage called korv that includes shredded potatoes. O'Brien went to work, turning out 25-pound test batches: mashed potato, potato flakes, shredded potato.
"The potatoes disappeared," O'Brien said. He wanted more potato character, chunks of potato. That was the vision.
He found that the pork wouldn't bond with the potato pieces. That left voids, pockets that would fill with liquid fat as the sausage cooked, an unappetizing condition known, in industry lingo, as "greasing out."
O'Brien countered by tinkering with his potatoes. "We froze the potato first, then thawed it down till there was still a thin coat of ice and it was firm, then we blended it with the meat. We found that there were no voids, it broke down to smaller chunks in the stuffing machine, and the sausage held together. Just fantastic."
That's the short version. O'Brien did week after week of test batches, 150 or more, their variables and outcomes tracked on his office whiteboard. The Duetts operation has invested about $40,000 in development costs before selling a single sausage, O'Brien said. "We're taking a chance."
Repeated tests were necessary to fine-tune the fat content, a critical "balancing act," he added. "You want just enough fat for cooking, but not enough to feel 'fatty.' "
After being cooked at the plant, then cooked at home, the sausage shrinks by 10 percent. "When you cook, you're losing moisture and fat," O'Brien said. "With the potato, it binds so well that it holds moisture and fat in there."
Once he became familiar with potato as a sausage ingredient, O'Brien began to note other benefits. Its starch allowed him to leave out binders like soy protein, egg or milk products commonly used in competing sausages.
The sausages all tasted good, but that's not the hard part. The true test of its national marketability would be its numbers, what the nutrition panel on the label would say.
After the USDA analyzed the Duetts recipe and sent back the federally approved numbers, Wardynski, O'Brien and Lopez, the Duetts partners, were thrilled. Duetts could state that it has 40 percent less fat than leading competitors.
Forty percent. That's a sausage you can sell.
So Lopez went to work lining up potential customers. Duetts delivers pork sausage flavor for about the same amount of fat as the chicken sausages newly popular to health-conscious consumers, he said.
"You can have that same eating experience with more than a third less fat than anything that's out there," the marketer said. "That's huge."
Tops Markets was the first to say yes. So far Lopez has arranged official sampling evaluations with 14 more regional and national supermarket chains and distributors, with more to come. A "large retailer" is considering adding Duetts for tailgating season, Lopez said. "That could give us 150 to 200 more stores."
If Duetts catches on, the partners will have to hire another plant to make it; Wardynski's doesn't have the room. "If our business fluctuates 10 or 20 percent, we have enough staff to handle that," Wardynski said. "We might have to find a co-packer closer to source for transport that can follow our guidelines. Without expanding we can only make so much."
Or they could decide to sell or license the sausage's most attractive feature: its patented process.
"Whether we make it ourselves or someone takes it and makes it, we have a chance, and it's our job to explore all those possibilities," Wardynski said. "We got a chance because this is unique."
email: email@example.com


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USDA food commodities available next week
Commodities from the U.S. Department of Agriculture will arrive at county senior centers May 7, with distribution beginning May 8.
Sites may not distribute commodities on the same day. Patrons are encouraged to contact their local site for scheduling.
Commodities are available to those who are income eligible. The maximum gross income for a household of one to qualify is $1,265, with an additional $440 for each family member.
If there are no commodities left at a local site, call the Department on Aging at (620) 382-3580 to find where they are available.

subset: commoncrawl


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We had a fun trip. I had insisted on driving down to Arkansas, as flying with little kids stresses me out. We packed 5 people and too much junk into our aging minivan (the "busboos") and drove south.
Arkansas is beautiful! Who knew? I guess I knew about the Ozarks, but still. Coming from brown Wisocnsin to green Arkansas in March is definitely cool. We drove up to the race headquarters at Blanchard Springs on Thursday night to check in. The campground is surrounded by little mountains in all directions and trails shoot off in all directions.
Since most people come here via the Girl's blog, they know that I ran the 50K and the 20K and did come in first in both. Now, there were plenty people signed up to run just those two races (ie. skip the middle 50 miler) but they tended to be the less serious runners.
The 50K was fun. I ran the first half with Nick Lewis, the eventual overall winner and Brad Bishop, who ended up taking 5th overall (I think; the results are not up yet). Every time I run an ultra, I am surprised by how everyone has a similar frame of reference. Only first names are spoken, and you are expected to know who they are talking about (as in, "Hal really shouldn't have sold Tony those short-shorts in a women's small"). It turned out Nick Lewis had taken second at Leadville (that race probably has a real name, but one should never call it anything else than Leadville in ultra circles). He more or less floated both up and down hills, making me feel old and stiff.
After halfway, Nick slowed down a little and told me to go ahead. I did, and essentially spent the next two hours worried about getting lost. The course markings were so sparse that I ran miles without seeing any ribbons. I wouldn't say the course was not well-marked, because each intersection was marked adequately. But I am the type who needs to see a ribbon at least every half mile or so. If not, I start playing head games, and several times I did turn around to wait for Nick to show up in the distance. I ran the 50K in 4:13.
The Girl ran the 50K in some good time I can't remember. She took second, which was surprising to both of us.
I got to watch the 50 miler from the sidelies, which was fun. The Girl dug very deep, as she got passed at the end and tried to keep up. Everyone now knows how she passed out in the shower. She lay in bed for an hour and was so sick that I had to keep it a secret from her mom. Her mom would have called 911 immediately, had she seen how pale the Girl looked. I was really worried: not about the Girl, but since we have no health insurance, I was freaking out about the ambulance bill.
Amazingly, she bounced back and took second among the overall contenders on day 3.
Having "only" run a 50K on Friday, I was able to win the 20K. A few days ago, I would consider that to be some serious recovery, but everything is relative.
Of course, I felt pretty good in my skin. My training has been going well, and things are clicking. Next up is a 5K in two weeks and then maybe the Mad City 50K.
Tuesday, March 13, 2012
3 Days of Syllamo
Posted by Fast Bastard - World's Fastest Hematologist at 10:19 PM
2 comments:
- SteveQ said...
I once had an uninsured ambulance ride. $950, in I think 2000.
I'm currently working on 3 Days of Cilantro.
Oh, and congrats on the wins.
- March 14, 2012 at 8:22 AM
- Olga said...
Hal really shouldn't have sold those shorts to Tony, that much is true. As well as that Nick is a young and coming, more power to him. You surely had a couple of good runs for a self-proclaimed short-distance lover. As for passing out - been there, no ambulance bills, drink lots.
btw, came here from Danni
- March 14, 2012 at 2:02 PM
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Home/Melissa Egan
Dress Rehearsal
Edition of 30
Archival Pigment on Archival Hahnemuhle Paper
Image Size 61 x 51cm
Paper Size 83 x 71cm
Using animals as metaphors Melissa's much celebrated body of work resulted from the development of her close relationship with an internationally renowned symphony orchestra. At the beginning of this series, Melissa hosted several members of this orchestra at her home and their lives became entrenched.
Here in the works you see the concert master and first violinist as a rabbit, the double bass player as a bear, and Malcolm the horn player – tall and lean as a hare.


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Seeding Thaw
with local artists Carlo Ripaldi, Carla Sullivan, Matt Pidgeon, Ambitious Eva and Gary Destramp, along with music from the Scott Barnett Band, Russell Hill and Chuck Anastasiou
When: Sunday, March 27, at 5 p.m. (Gallery 5-6 p.m., live music and artist spotlight 6-10 p.m.)
Where: Fody's Tavern, 9 Clinton St., Nashua
Tickets: $7 at the door
Info: www.nhlamppost.com
While Brian Melanson was earning a computer science degree at Bryant College, he frequently found himself turning from his technical studies toward his creative side. He began attending story and poetry readings. Eventually, a group led by Rhode Island School of Design poetry professor Tom Chandler helped Melanson to find his voice.
"My original works were more emotional, but I've kind of grown out of that," he says. "I'm influenced by nature and a lot of it's about New Hampshire and Main Street."
Recently, Melanson seized on a way to blend his business and creative impulses by organizing a collaborative event at Fody's Tavern in downtown Nashua: Seeding Thaw, which presents the work of five local artists combined with live music performances and poetry.
Musical guests include the rootsy Scott Barnett Band, singer-songwriter Russell Hill and guitarist Chuck Anastasiou. Among those exhibiting their art are abstract acrylic painters Carlo Ripaldi and Matt Pidgeon; Gary Destramp, whose watercolor cityscapes of his hometown of Lowell have drawn positive notices, Manchester tattoo artist/painter Ambitious Eva and Nashua glass artist Carla Sullivan.
The idea for Seeding Thaw came after an artist approached Melanson about painting an impression of a poem he'd written.
"I learned that there was a lot of local interest in cross-media collaborations,' Melanson says.
"That's when the first few steps were made to make this event happen."
The effort is the first in a series planned by Melanson.
"I'm trying to represent small businesses, individual entities, and host events that bring them out into the mainstream," he says. The festivities begin with a gallery in Fody's downstairs function room, where patrons can peruse and make purchases. Wine and hors d'oeuvres will be served.
"There's a typical art gallery audience and they're different from music audiences," he says. "So the first hour is to give them what they are used to."
After the gallery, the action moves upstairs into Fody's main room. Each artist is allotted a half-hour segment to discuss his or her work and show some favorite pieces. Each discussion is followed by music. Scott Barnett, says Melanson, has a gravelly voice reminiscent of Eddie Vedder's and his band has a loose jamming vibe that will appeal to fans of Dave Matthews. Hill's songs owe a bit to Jackson Browne, while Anastasiou specializes in atmospheric instrumentals.
At the end of each segment, Melanson will read from his collection of poems, The Lamppost. That's also the name of his recently launched marketing company, and the evening will also feature slide presentations from local businesses he's recruited as sponsors.
"I think there's a need for enlightening everybody and highlighting resources in the area that we might not know about," he says. The 35-year-old Melanson, who currently works for the medical website WebMD.com and spent several years as a computer analyst for Fidelity, hopes to build a web portal focused on local talent. "Rather than going to Google and finding a pair of slippers some lady made in Alaska, you could look local first and then branch out."
Holding the event at Fody's was a natural move, says Melanson. "I moved to Nashua the same year it opened, so I've been coming there for a long time," he says. Noting that open-mike events and comedy shows have occasionally been accompanied by artist displays, he added, "I found them open to having a collaboration between music and the arts."
City Room Café is the main sponsor of the event, which will also include a local business raffle and $4 burger specials. All proceeds will benefit Big Brothers and Big Sisters of Nashua.


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Tewksbury Fast Ethernet for Business | Fast-E in Tewksbury, MA
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2012 Girls' Tennis All-Scholastics
Meet the standout performers who earned All-Scholastic honors for their work this spring.
Lauren Bamel Newton South, Senior
Bamel, who paired with freshman Mei Kasif on first doubles, was named a DCL All-Star for the second consecutive season. The doubles pair finished 15-3 and advanced to the North finals of the individual tournament. Bamel will attend Tulane University.
Julia Cancio Concord-Carlisle, Sophomore
Cancio finished the season a perfect 18-0, capped with a victory over Denny LaMachia to win the North singles individual championship. The DCL All-Star and honors student also enjoys running, art, and playing the piano. Cancio also plays in USTA tournaments.
Emma Davis Cohasset, Freshman
Davis finished the regular season undefeated in singles play, and helped her team capture the Division 3 South title. Cohasset finished 21-3 and won the South Shore League title. Davis, an honor roll student, also plays in USTA New England and National tournaments.
Marie Fleming Brookline, Senior
Fleming established an impressive four-year career, going 70-6 in singles matches. The four-time All-Scholastic will play for Pomona-Pitzer College (Calif.). Fleming, who was named Brookline's Athlete of the Year, also plays basketball and volleyball.
Hailey Hoffman Concord-Carlisle, Freshman
Hoffman played first doubles with classmate Isabella Stone to go a perfect 18-0 en route to winning the North doubles title in the individual tournament. The DCL All-Star also plays USTA tournaments.
Mei Kasif Newton South, Freshman
Kasif, who was named a DCL All-Star as a freshman, played first doubles with Lauren Bamel and advanced to the North finals of the individual tournament. The duo finished with a 15-3 record. Kasif, who hopes to attend BU, enjoys playing the piano.
Madeline King Concord-Carlisle, Senior
King, who played first singles as a freshman and sophomore, was 18-0 her senior season at second singles. The four-time DCL All-Star reached the semifinals of the North singles tournament, and will play tennis at New York University in the fall.
Dennison LaMachia Hopkinton, Junior
LaMachia made it to the North final in the state individual tournament for the first time this season. A repeat All-Scholastic, she was undefeated in the Tri-Valley League for the third straight season and was named TVL MVP. She led her team to the Division 2 EMass final.
Erika Nannery Canton, Sophomore
Nannery, a sophomore singles player, reached the semifinals in the South individuals tournament. With a personal record of 18-3, the Hockomock League All-Star ranks 20th in the 16-and-under New England division by the USTA.
Kaila Nelson Lincoln-Sudbury, Junior
Nelson has a near-perfect record her first three seasons with the Warriors, going 40-4 in singles matches. The two-time Globe All-Scholastic and Dual County League All-Star reached the North semifinals in this year's individual tournament.
Maggie Pedicini Barnstable, Sophomore
Pedicini, who plays doubles with Gabrielle Riley, finished with a 16-0 record and the pair won the South championship in the individual tournament. Pedicini, who has a 3.80 GPA, also helped her team with the Division 1 South title. She hopes to play at Boston College.
Alana Prinos Foxborough, Senior
Prinos advanced to the South championship match in the MIAA individual tournament. She lifted her team to the Division 2 South final and an 18-0 regular season record. A repeat All-Scholastic, the senior was named the Hockomock League MVP for the third time.
Gabrielle Riley Barnstable, Sophomore
Riley teamed up with classmate Maggie Pedicini to go 16-0 and win the South doubles championship in the individual tournament. Riley, who also enjoys running, horseback riding, and skiing, helped Barnstable to a 16-0 record and the Division 1 South championship.
Isabella Stone Concord-Carlisle, Freshman
In her first year with Patriots, Stone and doubles partner Hailey Hoffman assembled a perfect 18-0 record. The pair defeated Lauren Bamel and Mei Kasif of Newton South to win the North doubles title in the individual tournament. Stone also plays ice hockey.
Meghan Talerman Barnstable, Senior
The two-time team captain played first doubles with eighth-grader Katie Tynan, and the pair advanced to the finals of the South individual tournament. Talerman, who was a Globe All-Scholastic in 2010, will play field hockey at Bentley University.
Katie Tynan Barnstable
Tynan played first doubles with Meghan Talerman, and the pair advanced to South finals where they lost to teammates Gabrielle Riley and Maggie Pedicini. Only an eighth-grader, Tynan also plays volleyball.
Coaches of the Year:
Coach of the year: Monika Drabkova Bedford
In her first season as head coach, Drabkova led the Buccaneers to a 15-7 regular season record and their first state championship. "This whole season has been a complete team effort," she said. "I am very proud of the girls."
Coach of the year: Cornelius Driscoll Braintree
Driscoll, who was named the 1995 Stonehill Football Coach of the Year, turned a team that was 1-17 five years ago into a tournament contender. The Wamps finished 13-5 this season, and made their second straight tournament appearance. Driscoll also teaches special education.
Coach of the year: Robert Furey Concord-Carlisle
Furey led the Patriots to the Division 2 state championship title after finishing the season with an undefeated record. His coaching career with the Patriots is extensive, having coached tennis for 25 years, freshmen boys soccer for 34, and cross-country and alpine skiing for 42.
League All-Stars:
Atlantic Coast — Falmouth: Caroline Cobb, Gwen Koontz, Sarah Monteiro, Katie O' Sullivan. Marshfield: Erin Kane. Nauset: Emma Gubbins, Tori Paolino. Plymouth North: Amanda Strickland. Plymouth South: Jazz Hicks. Sandwich: Shannon Beloin, Brie Campbell, Jaclyn Higgins.
Bay State — Brookline: Marie Fleming.
Big Three — Durfee: Courtney Bailey, Grace Borden, Marlene Costa, Kaci Furtado, Sopane Khek, Jennifer Lord, Jessie Lord.
Cape Ann — Ipswich: Megan Frieberger, Lexi Lopez, Hannah Lynch, Ashley Sulkin. Manchester Essex: Molly Carlson, Rachel Daley, Michelle Fuca. Masconomet: Danielle Dunn, Mia Farnham. Pentucket: Rachel Downey.
Catholic Central — Archbishop Williams: Ashley Dallaire, Jessica Muscato, Patty Scott, Elaine Wang. Arlington Catholic: Stephanie Gervais, Nicole Herendeen, Becky Warner. Austin Prep: Diana Carlson, Nicole Casper, Marisa DeLuca, Marie Noga, Madison Shaw. Bishop Fenwick: Jessica Griffin, Sara Kanarkiewicz, Megan McCarthy, Demi Veloinis. Cardinal Spellman: Laura Hill, Murielle Renfort, Sammi Zina. Lowell Catholic: Melinda Mora, Katherine Rindo, Katie Smolko. Matignon: Sara Berndt, Mellissa Collins. Pope John: Iris Dunn, Kim Tran. St. Mary's: Emily Hatchouel, Cathleen Troisi.
Dual County — Acton-Boxborough: Diana Du. Bedford: Sydney Arsenault, Maya Biswas, Sarah Cowles. Concord-Carlisle: Julia Cancio, Hailey Hoffman, Madeline King, Carly McCarthy, Isabella Stone. Lincoln-Sudbury: Kaila Nelson. Newton South: Lauren Bamel, Katie Freer, Mei Kasif. Wayland: Drew Canavan, Allison Wei. Westford: Sydney Diamond.
Eastern Athletic — Bishop Feehan: Rebecca Liliberte, Kathryn McCourt. Coyle & Cassidy: Kristin Carbone, Savannah Costa. Somerset Berkley: Kelsey Duff, Bojana Roman, Alison Vautrin.
EIL — Beaver Country Day: Gabriela Marks.
Greater Boston — Cambridge: Emma Doyle, Mei Lin Pratt. Everett: Cecellia Tran. Latin Academy: Diandrea Galloway, Mina Le, Terry Voong. Malden: Hahn Pham, Louisa Tse, Wendy Tse. Medford: Stephanie Collozzo, Bailey Lee, Michelle Nguyen. Somerville: Tenzin Loma, Kheyla Orival, Loveleen Sceini.
Hockomock — Attleboro: Katherine Barlow. Canton: Erica Nannery, Erika Nannery, Michaela Nannery. Foxborough: Alana Prinos, Emma Prinos, Hallie Young. Mansfield: Emma Yeransian. North Attleborough: Jamie Grinavic, Ali McHugh, Sarabeth Parent, Amanda Rose. Sharon: Melissa Yuan.
ISL — Brooks: Nicole Zohdi. BB&N: Rebecca Epstein, Isabel Goldfine. Groton: Zandra Ho, Anita Xu. Middlesex: Olivia Dewey. Milton Academy: Ilvey Bayturk, Abigail Lebovitz. St. Paul's: Isabella Turchetta. Thayer: Olivia DiLaratti, Caroline Finnegan, Audrey Fitzpatrick.
Mayflower — Bishop Connolly: Mary Cate Maher. Sacred Heart: MaryAnn Aaron. West Bridgewater: Melisa Larose. Westport: Morgan Levesque, Morgan Nicholas, Katie Rego, Zoe Shea, Emma Wilkinson.
Middlesex (Large) — Belmont: Juliet Barker, Choah Kim. Lexington: Sophie Dulberg, Michelle Katzelnik, Sophie Meyers, Natalia Pronchick. Reading: Hannah Conroy, Lily Drescher, Meghan Ziegler. Winchester: Karen McKeough, Janie Weber, Sarah Wheeler. Woburn: Svetoslava Vodenicharska.
Middlesex (Small) — Burlington: Nadia Eshraghi, Catherine Gianino, Molly Gilpin, Jenna Perlmutter, Eleni Pesiridis, Maya Russell, Stephanie Swiszcz. Wakefield: Meghan Chapman, Alison Doherty, Shira Faigel, Nicole Wu.
NEPSAC — Boston Trinity: Semi Oloko. Brimmer & May: Maria Aguilar Moreno. Gann Academy: Marielle Marcus, Shoshana Preuss, Sarah Waxman. Landmark: Margaret Alevizos, Katie Dirico. New Mission: Joyce Guada, Jandayia Lubin, Camly Pham.
Northeastern — Marblehead: Tory Booth, Lindsay Cohen, Megan Gabel, Kelly Mealey, Annie Ryan, Mary Lindsay Ryan, Megan Stanojev. Peabody: Rachel Gillis, Kayli Lehman, Alaina Warren. Revere: Devin Colon. Swampscott: Alicia Coyle, Tatum Pederson, Rita Tsokanis, Dancia Villanueva.
Old Colony — Barnstable: Kristen Donnelly, Jasmine Opie, Maggie Pedicini, Lauren Persson, Gabrielle Riley, Meghan Talerman, Katie Tynan. Bridgewater-Raynham: Leah Johnson. Dartmouth: Courtlyn Long. Taunton: Emily Donaldson, Jess Khang, Chrissy Maze, Mollie Mcaffrey, Maggie McAndrews, Alisha Silva.
South Coast — Martha's Vineyard: Alyssa Adler, Dylan Brockmeyer, Annie Burton, Sam Potter.
South Shore — Cohasset: Emma Davis.
Tri-Valley — Dover-Sherborn: Alex Blizard, Sarah Egener, Olivia Tedesco. Holliston: Kristen Ydoate. Hopkinton: Dennison LaMachia, Abby Normandeau, Vanessa Prathab, Bevy Reynolds. Medfield: Gabi Bergonzi, Lexi Nasraway, Hunter Stahl. Medway: Ashley Keller. Westwood: Abby Groton, Terrence Harris-Hughes, Jing-Juan Li, Joanne Nasr, Mary Kate Norton


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Adding Speed And Style By Sculpting A Dash And Door Tops
Infusing style into an early post-war-styled hot rod is as easy as opening a dusty "lil' book" and peering deep to see what's pressed between the pages. Inspired metal fabrication can instill the feeling of speed into any hot rod.
The interior dash and door area of a Ford Model A are pretty basic, leaving plenty of opportunity to artistically alter its original configuration. To add just a dash of speed and style to the area, the team at the Rolling Bones Hot Rod Shop in Greenfield Center, New York, set out to blend the dash and door tops together with the sleek look reminiscent of those seen in '33-36 Ford roadsters. Working with a Brookville Roadster '29, the team began by adding plenty of momentum to its persona by installing a Sellers Equipped windshield and Brookville '32 Ford dash. This prior work included the removal of the stock eyebrow section of the body, which was reworked to accommodate the new windshield as well as peak to the back of the cowl being pie-cut and laid back.
Getting started, team member Matt Schmidt prepared the area to the side of the dash where he would create a mold for the first transition of rolling the dash into the door top. Using 2-inch masking tape, he covered the work area, since the tape would act as a perfect release agent for the mold once completed. After preparing a small amount of plastic body filler, he began to apply it to the area in gradual stages, allowing plenty of drying time between the layers. This step allowed Schmidt to fill the area and build it up in just the right places. Once the plastic had hardened, he followed with a combination flat and half-round file to sculpt the gradual transition from the dash to the beginning of the door top. When satisfied with the mold, it was carefully pried from its place and used as a visual guide to create the panel from steel. Schmidt proceeded with 22-gauge flat stock, cold rolled mild steel to fashion a filler piece. Using a pair of metal shears, he cut out the piece, making sure it was larger than required to allow for needed trimming in obtaining the exact shape. To add a graceful bend to the steel, Schmidt worked with a sandbag and a curved dolly while test-fitting the piece to the dash numerous times till the exact transition was found. With the basic shape attained, he trimmed the piece for a better fit using metal shears and continued with a number of body hammers to establish the correct contours to the end of the dash.
Schmidt forged on to stretch the steel to create some needed compound curves using a homespun anvil anchored in a bench vise while working the filler piece with a blunt point and finishing hammer. Once satisfied with the piece, he used his Millermatic MIG welder to anchor the piece. Wearing eye protection, the welds were then ground smooth using an air-driven disc grinder topped with a 50-grit disc followed by a die grinder.
With the transition piece from the dash completed, Schmidt focused on the gradual sweeping flow needed to bridge this area to the door top. Working in the same fashion used to create the initial dash end mold, he proceeded with tape and plastic filler to design the transition atop the door. Using this as a guide, he selected a 4-foot section of 1-3/4-inch steel exhaust pipe to act as a solid base. After bending the pipe to match the factory curve of the door top, he marked it for trimming and where it needed to be split open to begin the shaping process. While anchored in a bench vise, he used an air-driven cutoff wheel to make the initial incision to split the pipe section open. Using an anchored flat dolly, Schmidt proceeded to open up the pipe by hammering both of the separated sides flat with a rubber hammer from front to back. This prevented the pipe section from becoming dented during the process. To open the pipe even further, he used a pair of duck-billed Vise-Grips parallel to each other to additionally stretch the section open. As the pipe changed its shape, Schmidt checked the section to the door top numerous times to ensure the curve to the top of the pipe did not become distorted. This is a gradual process that takes plenty of time to get right.
Once comfortable with the fit to the door top, it was time to begin forming the forward end (which will meet the dash filler piece) to add the needed graceful curves and form the transition. For this step, Schmidt used various anchored dollies to gradually stretch the steel while adding curves and depth through the use of a number of body hammers with different ends. Again, this is a process that takes time, working the steel and placing the filler piece atop the door countless times to aid in its shaping to create just the right contour.
Once satisfied with the overall shape, Schmidt first reinstalled the Sellers Equipped windshield and then marked the exterior of the new door top with masking tape to show a delicate sweep from fore to aft. He cut the excess metal off using a plasma cutter and ground the edges smooth with a small disc grinder. Wanting to achieve the correct contour for the inside curve of the door, a relief-cut was made using a disc grinder to the inner top edge and it was rolled inboard. Focusing on the inner portion of the door top, a masking tape line was run from the end of the dash filler piece rearward to follow a gradual tapered line. The door top was then removed, trimmed with a plasma cutter, and its edge ground smooth with a disc grinder. Knowing that interior panels would need an anchoring point, Schmidt marked a "fold-line" on the door top, which would need to be bent inward toward the door. Since this was a compound curve, to accomplish the bend a number of relief cuts were marked and carefully cut using an air-driven cutoff wheel with the piece in a bench vise. With the curve intact, Schmidt used a flat anvil secured in a bench vise to bend the tabs over to the correct angle. After test-fitting the door top in place, it was again removed for the tabs to be MIG welded together. It's imperative to allow ample cooling between the welds so as to not distort the steel. A disc grinder was used to smooth out all of the finished welds. Once a few remaining filler pieces were fashioned and added to the front inside top hinge area of the door, the new door top was welded into place and all welds were ground smooth with a disc grinder topped with a 50-grit disc. The completed job added newfound personality to the interior of the Model A by incorporating plenty of sleek styling with the flow of the '32 Ford dash into the door tops.


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It is difficult to objectively review Fast & Furious 6 since its star, Paul Walker, died so suddenly on November 30. I grew up with these films. I was the target audience for The Fast and the Furious back in 2001, and I remain a fan of the franchise. By all accounts, Walker was a great friend to his co-stars, generous with his time and money, and an all-around decent human being. Walker never got to act in the prestige projects that we normally associate with acting greatness, but he brought an easy, natural charisma to all his roles. His career was on an upturn of late, and I expected to see the actor in many more roles. Sadly, a violent car wreck ended his career, but The Fast and the Furious series certainly benefitted from the actor's contributions. Walker's Brian O'Conner is not the main focus of Fast & Furious 6, the fourth entry directed by Justin Lin, which sees Walker, Vin Diesel, Dwayne Johnson, Michelle Rodriguez and company fighting an international criminal in London. Furious 6 isn't quite as tightly plotted as Fast Five and some of the action is borderline ridiculous, but Lin again crafts an exciting action picture buoyed by his charismatic, likeable supporting cast.
A stinger scene during the credits of Fast Five revealed that Letty Ortiz, Dominic Toretto's (Diesel) former girlfriend, apparently survived an explosion in Fast & Furious and is now working for criminal Owen Shaw (Luke Evans). Agent Luke Hobbs (Johnson) approaches Dominic and Bryan with an offer they can't refuse: Re-assemble their crew, including Roman Pearce (Tyrese Gibson), Tej Parker (Chris Bridges); and Han Seoul-Oh (Sung Kang), to track down and capture Shaw and receive full pardons for their laundry list of international offenses. Dominic refuses to abandon Letty, and Brian, now married to Mia Toretto (Jordana Brewster) and the father of a baby boy, wants to return home to Los Angeles to raise his family. The team flies to London, where they discover Shaw wants to sell on the black market a device that can cripple a country's military operations.
Somewhere between 2 Fast 2 Furious and The Fast and the Furious: Tokyo Drift, this series became more than just exotic locations and fast cars. When the core cast returned for Fast & Furious, criminal enterprising began to take a back seat to Dominic, Bryan and company's Robin Hood morality; saving the good guys from international drug dealers and thieves. Furious 6 serves up more of this recipe, giving the audience heaping helpings of the diverse cast that has carried this series to six installments and counting. From its humble beginnings on the L.A. street racing circuit to more recent action by the beaches of Rio de Janeiro, the series has defied expectations of its quality and performance.
Lin gets a lot of credit for rejuvenating the series, and Furious 6 caps his trilogy that takes place after the events of 2 Fast 2 Furious but before Tokyo Drift. Furious 6 has plenty of action: An early car chase on the streets of London is lean and mean, and an extended highway chase involving multiple vehicles, a tank, and a flying Vin Diesel is ludicrously entertaining. The climax, which takes place on and around an accelerating Antonov cargo jet, is anything but realistic. There are a number of funny Internet memes about the sequence, and I've seen calculations putting the runway length at 27 miles. These gaps in logic matter little in a film that stages elaborate fight sequences and car chases aboard an airplane. Furious 6 may be silly at times, but it's also incredibly fun. Lin's direction is technically proficient, and the film is quite slick looking. If you hated previous entries then I suppose Furious 6 won't change your mind about the series, but everyone else should find a lot to like here.
The chemistry between the core cast members has always been the series' greatest asset. From original cast members Diesel, Walker, Rodriguez and Brewster, to later additions Johnson, Gibson and Bridges, few action series can claim such a likeable cast. There are plenty of scenes for each supporting character, and MMA fighter Gina Carano joins Brewster, Rodriguez, Gal Gadot and Elsa Pataky's crew of beautiful, badass Furious women. Walker gets less screen time this go-round, but he has some entertaining solo scenes where Bryan pretends to be a federal prisoner in order to confront Arturo Braga (John Ortiz), Shaw's former henchman who Bryan sent to prison while working for the FBI. Furious 6 is not looking to win an Oscar, but it earns its audience's respect. As the sixth entry in the series, Furious 6 remembers to bring things both new and old to the table, and the film is not satisfied to coast by on the fumes of past success. The future of the series is uncertain without Walker, but whatever happens, it's been a hell of a ride.
Universal provides an expectedly excellent 2.35:1/1080p/AVC-encoded transfer for Fast & Furious 6. Detail is abundant and impressive, and each frame benefits from beautifully realistic texture and stunning clarity. Backgrounds stretch for miles without a hint of compression artifacts, and close-ups reveal minute, intimate facial details. Colors and contrast are perfect; boldly saturated when required but never bleeding. The candy paint jobs of the street racers and the cold metal interior of the Antonov are equally stunning. Edge enhancement and digital manipulation are completely absent. Black levels are strong, with only the slightest hint of crush.
The 5.1 DTS-HD Master Audio soundtrack is boisterous, and places viewers amid the action with perfect separation and range. All elements - dialogue, effects and score - work together like a finely tuned engine. Car chases make great use of the surround speakers and subwoofer. There is always something going on in the rear speakers or in the front extremities, and all of these elements are mixed perfectly. If you're looking to impress guests with your home theater's audio system, this is the disc to use. 5.1 DTS French and Spanish mixes and a 2.0 English descriptive mix are included, as are English SDH, French and Spanish subtitles.
This combo pack includes the Blu-ray, a DVD copy of the film, and both UltraViolet and iTunes digital copies. The main artwork matches the colorful designs used for the Blu-rays of the previous films, but the outer slipcover features different artwork with light embossing. The disc includes both the 130-minute theatrical cut and a 131-minute extended cut. Differences are minimal and consist of a few minor additions to the subway fight, Bryan and Dominic's interrogation of a Shaw henchman, and the final action scene. On the main menu you can access the Fast and Furious 7 First Look (1:54/HD), and there are a number of additional extras on the disc:
This sixth entry in the Fast and the Furious series rekindles the joyous energy and camaraderie of previous films, with cast members Vin Diesel, Paul Walker, Tyrese Gibson, Chris Bridges, Michelle Rodriguez, Jordana Brewster and Dwayne Johnson all returning for this blockbuster outing. The crew goes to London to track an international criminal in hopes of earning their freedom, and the action is over-the-top exciting. The late Walker again provides easy charisma, and Furious 6 is fine action entertainment. Highly Recommended.
William lives in Burlington, North Carolina, and looks forward to a Friday-afternoon matinee.


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It's now official: Pon Holdings has today announced that it has acquired Cervélo Cycles, after successfully concluding negotiations that began last December.
"Cervélo is a unique brand that we are very pleased to bring into Pon Bicycle Group (PBG). The Canadian based company's state of the art technology and passion for pushing the limits of engineering has captured the imagination of cyclists around the globe," said Janus Smalbraak, CEO of Pon Holdings.
"With Cervélo we believe there is great potential for growth and we are looking forward to working with them to achieve these goals."
Cervélo will continue to operate independently, retaining its unique identity, innovation and premium brand positioning. This is the same strategy Pon employs with its other Pon Bicycle Group (PBG) properties, Royal Dutch Gazelle and the German manufacturer Derby Cycle where Pon is a major shareholder.
Cervélo co-founders Phil White and Gerard Vroomen both remain with Pon Bicycle Group. White will continue in his present role as Cervélo CEO. Vroomen will assume a (part-time) role as Business Development Manager within PBG, focusing on special projects for the group.
"The opportunity for Cervélo within Pon Bicycle Group, is tremendous," said Phil White, CEO and co-founder at Cervélo. "The combination of Pon's considerable resources and expertise and Cervélo's cutting edge technology will make us stronger and more competitive as we continue to engineer the best bikes on the planet."
Pon, one of the Netherlands' largest family companies, is an international trading and services organisation involved in a varied range of activities. Pon employs almost 11,000 people, spread across 250 establishments in 20 countries.
Phil White and Gérard Vroomen founded Cervélo in 1995 when their design for a new time trial bicycle failed to garner interest from traditional bicycle manufacturers. Today, Cervélo is the largest triathlon bike manufacturer in the world and partner with the world's most established and successful triathlon team, Team TBB and one of the world's top pro road cycling teams, Team Garmin-Barracuda.
Cervélo is recognized internationally as one of the most innovative and fastest growing bike manufacturers. Readers of VeloNews, CycleSport, Inside Triathlon and Slowtwitch (all publications for serious cyclists and triathletes) all voted Cervélo as the #1 brand they intended to purchase in 2011.


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In 2005, the City began a process to look at open space opportunities for dogs and their owners while also considering the wider community's open space needs; field conditions and maintenance; school and athletic use; historically sensitive areas; potential rules and regulations; and examples from other similar cities. Both shared use options as well as opportunities for dedicated off leash spaces in Cambridge were explored. Open spaces were considered that:
• Were relatively underutilized at the time
• Met certain size requirements
• Not a part of school grounds
• Not heavily used and scheduled athletic facilities
• Contributed to achieving geographic distribution of off leash opportunities throughout the City
Today there are three types of off leash spaces in Cambridge open to dogs with current licenses:
• Dedicated Off Leash Areas
• Shared Use Off Leash Areas
• Shared Use Hours
Dedicated Off Leash Areas: These areas are fenced in and intended exclusively for use by off leash dogs and their owners.
• Pacific Street Park - located at the corner of Pacific Street and Sidney Street has a fenced in area with mutt mitt dispenser and trash barrels available.
• Danehy Park - located at 99 Sherman Street near Garden and New Street has a leash free zone with mutt mitt dispensers and trash barrels available.
• Pemberton Street Dog Run - located on Pemberton Street
Shared Use Off Leash Areas: These are areas where dogs are allowed off leash, but that are not fully fenced in or separated from other uses and activities.
• Fresh Pond Reservation – dogs can run off leash (not on mowed grassy areas) with some restrictions. There are mutt mitt dispensers and trash barrels throughout the area.
• Fort Washington - located on 101 Waverly Street between Erie Street and Putnam Avenue with a mutt mitt dispenser and trash barrels outside the park. Check signs at the park for hours of operation.
Shared Use Hours: Areas where dogs are allowed to be off lease during designated hours, are not fenced in, and outside of shared use hours, dogs must be on a leash in these locations.
• Raymond Park - located on Raymond Street. 6:00 am to 9:00 am
• Hoyt Field - located off Western Avenue from Gilmore Street or Montague Street. 6:00 am to 9:00 am
• Green-Rose Heritage Park - located on Harvard Street between Windsor Street and Moore Street. 6:00 am to 9:00 am
• Gold Star Mother's Park - located on Gore Street. 6:00 am to 9:00 am
• Joan Lorentz Park - located in front the Cambridge Public Library on Broadway between Felton Street and Ellery Street. 8:00 am to 10:00 am
See the Off Leash Dog Guide and the map for new designated areas in Cambridge where dogs are allowed to run without a leash:
Please check with the management of these sites for more information. Learn more about the City's Shared Use possibilities. At all other parks, the City ordinance on leash control applies. And of course, dog walkers are required to pick up dog waste at all sites.
Learn more about rules and etiquette related to dogs in parks. Learn more about proper waste disposal in our brochure, After Your Pet Goes, Where Does it Go?
Irresponsible dog owners:
Contact the Animal Commission at (617) 349-4376. Although the number of Animal Control Officers is limited, they may be able to place special patrol emphasis at certain parks as needed, in an effort to educate people on existing regulations.
Cambridge citizen requests, now online & on the go! Report issues here.
Have a question?Find the answer in our extensiveFrequently Asked Questions
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Questionnaires have been validated as screening tools in adult populations at risk for obstructive sleep apnea (OSA). Portable monitors (PM) have gained acceptance for confirmation of OSA in some patients with a high pretest probability of the disorder. We evaluated the combined diagnostic utility of 3 validated questionnaires and a Level III PM in the diagnosis and exclusion of OSA, as compared with in-laboratory polysomnography (PSG) derived apnea hypopnea index (AHI).
Consecutive patients referred to the Sleep Disorders Clinic completed 3 testing components: (1) 3 questionnaires (Berlin, STOP-Bang, and Sleep Apnea Clinical Score [SACS]); (2) Level III at-home PM (MediByte) study; and (3) Level I in-laboratory PSG. The utility of individual questionnaires, the Level III device alone, and the combination of questionnaires and the Level III device were compared with the PSG.
One hundred twenty-eight patients participated in the study (84M, 44F), mean ± SD age 50 ± 12.3years, BMI 31 ± 6.6 kg/m2. At a PSG threshold AHI = 10, the PM derived respiratory disturbance index (RDI) had a sensitivity and specificity of 79% and 86%, respectively. The sensitivity and specificity for the other screening tools were: Berlin 88%, 25%; STOP-Bang 90%, 25%; SACS 33%, 75%. The sensitivity and specificity at a PSG AHI = 15 were: PM 77%, 95%; Berlin 91%, 28%; STOP-Bang 93%, 28%; SACS 35%, 78%.
Questionnaires alone, possibly given a reliance on sleepiness as a symptom, cannot reliably rule out the presence of OSA. Objective physiological measurement is critical for the diagnosis and exclusion of OSA.
Pereira EJ; Driver HS; Stewart SC; Fitzpatrick MF. Comparing a combination of validated questionnaires and level III portable monitor with polysomnography to diagnose and exclude sleep apnea. J Clin Sleep Med 2013;9(12):1259-1266.
Obstructive sleep apnea (OSA) affects 24% of adult men and 9% adult women in North America.1–3 A questionnaire-based survey in 2009 by the Public Health Agency of Canada (PHAC) estimated that 22% (5.4 million) of adult Canadians report either being diagnosed with sleep apnea (3%) or are at high risk for OSA (19%).4 Untreated OSA has been associated with serious long-term medical and neurocognitive complications, including premature death.5–7
The recommended diagnostic test for OSA includes an overnight in-laboratory technologist-attended sleep study (Level 1 polysomnography [PSG]).8 In addition to monitoring sleep stage by electroencephalography, electro-oculography, and chin electromyography, PSG includes monitoring of electro-cardiography, respiratory effort, airflow (nasal pressure and oronasal thermal sensor) and snoring, oxygen saturation, leg movements via electromyography on the anterior tibialis muscles, and body position. This procedure is time- and labor-intensive, and costly. Given the large number of individuals in the population likely to be suffering from OSA, it is not surprising that a great majority remain undiagnosed.9 It is clear that the challenge of providing a diagnosis of OSA to those suffering from the disorder cannot rely on in-laboratory polysomnography alone, and that simpler and less expensive diagnostic tests are needed. Several such tests for diagnosing OSA, including questionnaires and at-home portable sleep monitors (PM), have been investigated.10–13
Current Knowledge/Study Rationale: Several validated questionnaires are available for screening for obstructive sleep apnea but none has sufficient sensitivity or specificity to mitigate the need for further clinical assessment and testing. Level III portable monitors, while tending to underestimate sleep apnea severity, provide an objective assessment of sleep apnea severity that is often adequate for clinical decision-making. This study evaluated whether one or more previously validated questionnaires, or a combination of these questionnaires with the results from a Level III study, could mitigate the need for polysomnography in patients referred to a sleep disorders clinic.
Study Impact: The results demonstrate that the questionnaires were inferior to the Level III study in determining the presence or absence of sleep apnea, and when combined with the information from the Level III study, did not enhance its discriminant ability. These finding strongly suggest that objective physiological monitoring is critically important in the diagnosis and exclusion of obstructive sleep apnea, and cannot be supplanted by questionnaire data.
Several questionnaires have been validated to assist in the stratification of patients as high risk or low risk for OSA based on clinical symptoms and anthropomorphic risk factors.12–17 Portable monitors that include the recording of oximetry, respiration, heart rate and rhythm, and body position have gained increasing acceptance as a diagnostic tool for sleep apnea. The complexity of physiological measures included range from the equivalent of a full PSG at home without the continuous attendance of a technologist (Level II polysomnography) to overnight pulse oximetry alone (Level IV).18–20 In a previous report, we demonstrated a high level of agreement for OSA between a Level III portable device and in-laboratory PSG for the diagnosis of OSA, particularly at a threshold AHI of 15 (moderate OSA).19 Hence, we were curious whether we could harness the screening power of validated questionnaires and the objective physiological measures provided by a Level III device to optimize out-of-laboratory diagnosis of OSA, and potentially obviate the need for PSGs in non-selected referrals to the sleep clinic. We evaluated the combined use of three previously validated questionnaires and a home-based Level III portable monitoring study compared with in-laboratory PSG, for the diagnosis of OSA in consecutive referrals to the sleep clinic.
Consecutive referrals to the Sleep Disorders Clinic at Kingston General Hospital, Kingston, ON, were invited to participate in the study. All patients were informed that their participation was completely voluntary, and they received nominal compensation for incurred expenses only. The study was approved by Queen's University Health Sciences and the affiliated teaching hospital's research ethics board. Inclusion criteria included the ability to apply the Level III monitoring equipment without supervision (after brief initial training) and a primary residence within 100 miles of the sleep clinic (for returning the PM equipment). Exclusion criteria included known COPD, congestive heart failure, or uncontrolled asthma.
The study was prospective, involving patients referred to the Kingston General Hospital Sleep Clinic. Study participants were recruited and interviewed by the Research Assistant (EJP), and consenting individuals completed 3 questionnaires: (1) Berlin Questionnaire,13 (2) Sleep Apnea Clinical Score (SACS),14 and (3) STOP-Bang.12 Common features of the questionnaires include physical symptoms of snoring, witnessed episodes of apnea, and hypertension. Based on the Berlin and STOP-Bang questionnaires, respondents were categorized as low or high probability for OSA, while the SACS categorized low (likelihood ratio of AHI < 5 = 0.25), intermediate (ratio of AHI < 15 = 2.03), or high probability (ratio of AHI > 15 = 5.17) of having the disorder.
Upon completion of the questionnaires, participants were shown how to set up the portable monitor. They were asked to wear the Level III portable monitoring device (MediByte; Braebon Medical Corporation, Ottawa, ON) for 2 consecutive nights at home. The first night of recording was used in the analysis, with the second night as a back-up if recording from the first night did not provide sufficient data. The PM device consists of 2 inductance bands for thoracic and abdomen measurement, a nasal cannula pressure transducer airflow signal, finger pulse oximetry, and a body position sensor. The typical at-home set-up is shown in Figure 1. Patients were given the option to either manually turn on the device before switching off the lights at night and turn off the device once awake in the morning, or to have the device start and stop automatically at predetermined times.
Full set-up for the at-home portable monitoring device
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Following completion of home testing, patients attended the Sleep Disorders Laboratory at Kingston General Hospital for a full overnight PSG. Recordings were conducted using Sandman Elite SD32+ digital sleep recording system (Natus [Embla]; Ottawa, ON), and included 4 EEG channels (C4-A1, C3-A2, O2-A1, F3-A2), 2 EOG channels (ROC-A1, LOC-A2), submental EMG, intercostal (diaphragmatic surface) EMG, bilateral anterior tibialis EMG, ECG, respiratory piezo bands (chest and abdomen), finger pulse oximetry, a vibration snore sensor, nasal pressure airflow, and oronasal thermocouple. PSG recordings were conducted as either a diagnostic study or, in the event of severe OSA, a split-night study. For split-night studies, the initial diagnostic period was followed by the introduction of treatment during the night, and only the diagnostic part of the recording was used for comparison.
Data from the questionnaires and portable monitoring device were manually scored by an experienced scorer (EJP) who was blinded to the results of the in-lab polysomnography. The PSGs were manually scored using standard criteria by registered polysomnographic technologists, who in turn were blinded to results of the questionnaires and the PM device.20–23 Sixty-four percent of the scored PM data were reviewed by an experienced technologist (HSD) (the concordance between the 2 scorers, EJP and HSD, was 99.2%), and all the PSG studies were reviewed by a sleep specialist. For both PSG and PM data, apneas were scored as a cessation of airflow ≥ 50% for ≥ 10 sec, and hypopneas were scored as a reduction in pressure-derived airflow of 50% to 90% from baseline for ≥ 10 sec followed by ≥ 3% oxygen desaturation.20,22 For the PSG, the definition of hypopnea also included ≥ 50% reduction in pressure-derived airflow amplitude associated with arousal, in the absence of a desaturation ≥ 3% (alternative criteria).22 The outcome measure for the PSG data was the apnea-hypopnea index (AHI), which was defined as the number of apneas and hypopneas per hour of sleep, and the outcome measure for the PM data was the respiratory-disturbance index (RDI), defined as the number of apneas and hypopneas per hour of recording time.
A dot plot comparison was conducted for the probability rating of sleep apnea based on each questionnaire (Berlin and STOP-Bang as low-high; SACS as low-intermediate-high) as compared to the PSG derived AHI (events/h). Measurement agreement and correlation analysis of the RDI and AHI values based on the PM and PSG, respectively, were obtained and a Bland-Altman plot of agreement was constructed.24 Multilevel, mixed-effects Poisson regression analysis was used to investigate possible sources of differences between the recording methods, including gender and obesity (BMI ≥ 30 kg/m2), while accounting for differences in recording time. The outcome measurement was the observed counts of respiratory events, with the observations nested in individuals—individuals were considered random effects, while recording method, gender, obesity, and their interactions were considered to be fixed effects.
The agreement of each of the 4 screening tools was assessed, compared with PSG, at different threshold AHI threshold values (5, 10, 15, and 30). For each AHI threshold, PM and questionnaire data were rated as true-positive (TP), false-positive (FP), true-negative (TN), or false-negative (FN), allowing for a measure of the sensitivity and specificity for each of the diagnostic screening methods.25 Receiver operating characteristic (ROC) curves were also plotted to assess the trade-off between false-negatives and false-positives in order to evaluate the area under the curve (AUC), which provides a measure of the diagnostic utility of the screening tools. Likelihood ratios (LR) were calculated to determine the practical significance of the screening measures.
To evaluate the effectiveness of a combination of questionnaires and PM, 2 separate analyses were conducted: (i) the presence of OSA was defined as scoring high on ≥ 2 questionnaires along with a PM RDI ≥ 10 events/h, and (ii) the absence of OSA was defined as scoring low on ≥ 2 questionnaires along with a PM RDI < 10 events/h. ROC curves, AUC, and LR were also calculated for the combination of screening measures by severity groups based on AHI thresholds 5, 10, 15, and 30 to assess for significance. A stepwise multiple linear regression was used to model the relationship between the various screening tools and the PSG AHI in order to determine the best combination of questionnaires and PM at each AHI threshold value; the PSG AHI was used as the dependent variable, and the questionnaire scores (Berlin and STOP-Bang scored as 0, 1, and SACS scored as 0, 1, 2) and RDI based on the PM as the independent variables.
One hundred twenty-eight patients were recruited into the study (84 M, 44 F; mean ± SD: age 50 ± 12.3 years, BMI 31 ± 6.6 kg/m2, neck circumference 41 ± 4.4 cm). On average, patients reported that they snored (3-5 times a week), felt fatigued (3-4 times a week), and had witnessed apnea (1-2 times a month). The PM data for 13 participants (10%) were analyzed from the second night rather than the first due to unusable or lost data resulting in insufficient (< 2 h) recording time on the first night.
The mean AHI, derived from PSG, for the OSA risk categories determined by the questionnaires is shown in Table 1. Dot plots for each questionnaire compared to the PSG AHI are displayed in Figure 2; they illustrate a significant overlap and a wide range in the AHI between the different categorical probability ratings for each questionnaire. The mean PSG AHI for each of the questionnaire ratings are provided in Table 1.
Apnea-hypopnea index (AHI) based on polysomnography (PSG) for questionnaire data for 128 patients
Dot plots for each questionnaire rating compared to the polysomnographically (PSG) derived apnea-hypopnea index (AHI) for 128 patients
Objectively recorded data for the PM and PSG are summarized in Table 2. The total recording time on PM was longer by approximately 30 min (438 ± 89 min) as compared to the PSG (405 ± 103 min). There was a positive correlation between the PM derived RDI and PSG derived AHI (r = 0.69, r2 = 48%; Figure 3).
Portable monitoring (PM) screening measures and polysomnography (PSG) data for 128 patients
Correlation plot for the PM respiratory-disturbance index (RDI) and the PSG apnea-hypopnea index (AHI) for 128 patients
The Bland-Altman plot (Figure 4) shows the mean difference between the PM-RDI and the PSG-AHI, with an under-reporting by the PM of -11.2 ± 19.2 events/h, with limits of agreement (± 2 SD) at +29 and -51. The mean percent difference between the 2 measures was -40%, with limits of agreement at +90% and -170%. The PM-based RDI under-reported the rate of respiratory events for women and non-obese men by 27% (women: p < 0.001, IRR = 0.73, 95% CI: 0.70, 0.75; non-obese men: p < 0.001, IRR = 0.73, 95% CI: 0.70, 0.76), and for obese men by 38% (p < 0.001, IRR = 0.62, 95% CI: 0.60, 0.64).
The solid line delimits the mean difference (-11), and the dotted lines represent the limits of agreement ± 2 SDs (29 and -51).
Bland-Altman plot examining the difference between the PM RDI and PSG AHI against the mean of the RDI and AHI for 128 patients. The solid line delimits the mean difference (-11), and the dotted lines represent the limits of agreement ± 2 SDs (29 and -51).
The sensitivity and specificity of each screening tool at various PSG-AHI thresholds is displayed in Table 3. For a threshold AHI of 10 events/h, the Berlin, SACS, and STOP-Bang questionnaires had sensitivities of 88%, 33%, and 90%, respectively, and specificity of 25%, 75%, and 25%, respectively. The positive (PPV) and negative (NPV) predictive values were 81%-83% and 24%-41%, respectively. In comparison, the PM had a sensitivity of 79% and specificity of 86% (PPV 95%, NPV 53%). Based on the ROC curve for an AHI threshold of 10 (Figure 5), the AUC for the PM at 0.82 was higher than that for any of the 3 questionnaires (≤ 0.58). For a PSG-derived AHI diagnostic threshold of 15 events/h (moderate OSA), the sensitivity and specificity for each measure was: Berlin 91%, 28%; SACS 35%, 78%; STOP-Bang 93%, 28%; PM 77%, 95% (Table 3).
Sensitivity (Sen; %), specificity (Spec; %), positive predictive value (PPV; %), and negative predictive value (NPV; %) for the individual and combination of questionnaires and portable monitoring device based on the polysomnography (PSG) apnea-hypopnea index (AHI) threshold points for 128 patients
Area under the curve (AUC): Berlin = 0.565; SACS = 0.540; STOP-Bang = 0.575; PM = 0.824.
Receiver operating characteristic (ROC) curves for each of the three questionnaires and the PM at a PSG AHI cutoff of 10 events/h. Area under the curve (AUC): Berlin = 0.565; SACS = 0.540; STOP-Bang = 0.575; PM = 0.824.
Sensitivity and specificity were also calculated for a combination of the screening tools (presence of OSA = high risk for ≥ 2 questionnaires and PM RDI ≥ 10 events/h; absence of OSA = low risk for ≥ 2 questionnaires and PM RDI < 10 events/h) and are provided in Table 3. For an AHI threshold of 10 events/h, the combination of questionnaires and PM had a sensitivity of 71% and specificity of 89% for the presence of OSA (PPV = 96%, NPV = 46%), and a sensitivity of 94% and specificity of 25% for excluding OSA (PPV = 82%, NPV = 54%). The AUC for the combination of questionnaires and portable monitor was 0.80 (Figure 6) for the presence of OSA and 0.59 (Figure 7) for the absence of OSA. Positive and negative likelihood ratios for each individual screening tool along with the combination of the questionnaires and portable monitor are displayed in Table 4.
Likelihood ratio positive (LR+) and likelihood ratio negative (LR-) for the individual and combination of questionnaires and portable monitoring device based on the polysomnography (PSG) apnea-hypopnea index (AHI) threshold points for 128 patients
Area under the curve (AUC): AHI 5 = 0.773; AHI 10 = 0.801; AHI 15 = 0.811; AHI 30 = 0.716.
Receiver operating characteristic (ROC) curves for identifying OSA at various PSG AHI cutoffs based on the combination of ≥ 2 high-scoring questionnaires and a PM RDI ≥ 10 events/h. Area under the curve (AUC): AHI 5 = 0.773; AHI 10 = 0.801; AHI 15 = 0.811; AHI 30 = 0.716.
Area under the curve (AUC): AHI 5 = 0.674; AHI 10 = 0.595; AHI 15 = 0.608; AHI 30 = 0.590.
Receiver operating characteristic (ROC) curves for excluding OSA at various PSG AHI cutoffs based on the combination of ≥ 2 low-scoring questionnaires and a PM RDI
Stepwise multiple regression analyses were used to examine the relationship between the PSG AHI and the various screening tools. A model using all 3 questionnaires and the portable monitor produced an R2 = 0.487, F4,123 = 29.22, p < 0.001. Of all 4 screening tools, the portable monitor was the only screening device with a statistically significant regression coefficient, b = 0.91, ß = 0.658, p < 0.001. In fact, none of the questionnaires contributed significantly to the multiple regression model, p-values > 0.35; combined, the questionnaires accounted for less than 1% of the variation of the regression.
Our analysis is estimated to have had 90% power (1 – ß error probability) of detecting a Cohen's effect size f2 of 0.1 (medium effect size), given a sample size of 128 patients and α error probability of 0.05.
This study demonstrated that in a consecutive series of patients referred to a hospital-based sleep clinic, questionnaires that have been previously well-validated in other populations were not accurate in determining the presence or absence of OSA. None of the three questionnaires used had adequate sensitivity (proportion of patients with OSA who screen positive) and specificity (proportion without OSA who screen negative) to render them sufficiently reliable in a clinical setting to rule in or to rule out OSA—two of the questionnaires (Berlin and STOP-Bang) were found to have a high sensitivity for OSA but low specificity, while the SACS had higher specificity but low sensitivity for OSA. Overall, the portable monitor was found to perform significantly better in the identification as well as the exclusion of OSA than any of the individual questionnaires or combination of questionnaires with portable monitoring.
The accuracy and reliability of questionnaires used to screen for OSA appears to vary depending on the patient population studied and the diagnostic AHI threshold used.14,16,27 In contrast to the present study of patients referred to a sleep clinic, in community screening the Berlin questionnaire had a high sensitivity (85%) and specificity (95%) at an AHI threshold of 5 events/h.27 However, Netzer reported that when the AHI threshold for the diagnosis of OSA was raised to 15 events/h, sensitivity levels were reduced to 54%.13 A decrease in specificity with increasing AHI was mirrored in the STOP-Bang questionnaire, where specificity dropped from 56% to 43% with a change in AHI from 5 to 15 events/h, respectively.12 Compared to questionnaire responses, portable monitors have shown a consistently high degree of sensitivity and specificity even at higher AHI thresholds with a bias of underreporting the OSA severity.19,28,29 Our findings also showed a low negative predictive value for the portable monitor, both with and without the addition of the questionnaires, suggesting that the monitor may be able to establish a diagnosis of OSA with a high degree of certainty, but that it may not be able to conclusively rule out OSA. Guidelines from the Canadian Thoracic Society and Canadian Sleep Society have suggested that portable monitors be used in patients with a high pretest probability of OSA, and previous research has shown these devices to have a moderately high negative predictive value (71% to 100%) for patients with a high likelihood of having the disorder.20,29,31 It had been our belief that the NPV of this objective diagnostic method would be increased with the addition of subjective questionnaires, but it appears that the portable monitor alone still outperformed the combination of the portable monitor and questionnaires in negative predictive value.
A potential contributing factor to the underreporting of OSA severity with the PM as compared with PSG is that the denominator is total sleep time for PSG and total recording time for the PM. By recalculating the PSG scored apnea and hypopnea index in the present study using total recording time rather than total sleep time as the denominator, there was an improvement in the performance of the PM such that the PM underreported the rate of respiratory events for women by only 5% (p = 0.001, IRR = 0.95, 95% CI: 0.91, 0.98), for obese men by 14% (p < 0.001, IRR = 0.86, 95% CI: 0.83, 0.88), and did not underestimate the AHI for non-obese men (p = 0.42, IRR = 0.99, 95% CI: 0.95, 1.02).
Different scoring rules for hypopneas have been found to affect the resultant AHI.32 The highest AHI was based on 1999 ("Chicago") scoring criteria (hypopnea based on ≥ 50% decrease in airflow or < 50% reduction in airflow associated with a 3% oxygen desaturation and/or arousal), followed by the alternative criteria that was used in this study (≥ 50% pressure-derived airflow reduction and ≥ 3% desaturation or arousal) and lowest using recommended criteria for hypopneas (≥ 30% pressure-derived airflow reduction and ≥ 4% desaturation).21,22 The authors suggested that the AHI cutoff of 5 events/h using AASM recommended criteria is approximately equivalent to an AHI of 15 events/h using the 1999 hypopnea definition and 10 events/h using the alternative AASM definition.32 Scoring of hypopneas in our study was based on the AASM alternative criteria, but without the option of identifying arousals on the PM, which contributed to underreporting by this screening tool.
We have demonstrated that objective data from a portable monitor was superior to questionnaires in the identification and exclusion of OSA. Recently the Centers for Medicare and Medicaid Services and a position statement from the Canadian Thoracic Society and Canadian Sleep Society have endorsed the use of portable monitors as a means of providing sufficient evidence for the diagnosis of OSA, under defined circumstances and with specific patient populations.31 These rulings, and the results of the current study, support the judicious use of portable monitors in the diagnosis of OSA, in association with appropriate clinical assessment.
Many patients with OSA are only minimally symptomatic. In the Sleep Heart Health Study, the average Epworth Sleepiness Scale (ESS) score of patients with severe OSA (AHI > 30) was within normal limits.32 Indeed two-thirds of patients with severe OSA had an ESS within normal limits, while 21% with an AHI < 5 (normal) had an ESS score that was higher than normal.32 Hence, the reliance of sleepiness as a symptom to determine the presence or absence of OSA is fraught with uncertainty. In addition, although obesity increases the propensity to OSA for simple anatomical reasons, many patients with OSA are not overweight.33 It is our belief that the overlap in symptom profile and anthropomorphic features between individuals with OSA and those without underpins the weak discriminant ability of screening questionnaires for OSA (as demonstrated in the current study), even when anthropomorphic data is added. A critical factor here is the current uncertainty as to whether asymptomatic or minimally symptomatic OSA carries similar cardiovascular consequences to symptomatic patients with the OSA syndrome; if not, then the detection of clinically important OSA—based on symptoms—may prove to be adequate.34
It is important to acknowledge the limitations of the current study. Although our patient group was recruited from a series of consecutive referrals to the sleep clinic, our data did not come from a community-based random sample, and as such, our results may not be generalizable to the general population. Further research would be required to determine whether or not the sensitivity and specificity of the portable monitor would be maintained when testing more heterogeneous groups. It is also possible that our findings are specific to the particular brand of portable monitor used for the study (MediByte; Braebon Medical Corporation) and may not be as generalizable to other Level III devices. As such, it would be important to test patients without a high pretest probability of OSA on other portable monitors to further validate our findings. In addition, although the portable monitor and PSG had a moderately positive correlation for AHI, there were significant outliers in our data—which could potentially relate to the presence of other sleep disorders, particularly movement disorders and periodic limb movements. There are potential advantages of the use of at-home PM studies over in-lab PSG; for example, home sleep testing may better represent habitual sleep habits, including posture, as compared to in-laboratory testing, where patients are likely to spend more time sleeping supine.35 In-laboratory testing may also underrepresent habitual alcohol consumption at night, because of the need to drive to the sleep laboratory. Hence, the systematic underestimation of the RDI by PM, that does not include instrumentation for measurement of the sleep-wake state, may be balanced to some extent by the less than perfect reflection of true sleep-related habits provided by the "gold standard" PSG.
In conclusion, the current study demonstrated poor discriminant ability for OSA among previously validated questionnaires, and emphasizes the need for objective physiological monitoring in the identification and exclusion of OSA. Furthermore, in the current study, the use of questionnaire data did not further enhance the diagnostic utility of a Level III portable monitor for the diagnosis and exclusion of OSA.
This was not an industry supported study. This research was conducted at the Sleep Disorders Laboratory, Kingston General Hospital, Kingston, ON, and has been funded by the Innovation Fund, the Ontario Ministry of Health and the William M. Spear Foundation from Queen's University. The authors have indicated no financial conflicts of interest. There was no off-label or investigational use.
The authors thank BRAEBON Medical Corporation for providing MediByte units for the purposes of the study, and the technologists at Kingston General Hospital Sleep Disorders Laboratory for assistance.
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text: Thailand Videos To see over 400 Thailand videos click the image above, or the link below: ThaiPulse Video Channel at Youtube Author: Vern I'm an American expat living in Thailand. I like to write informative pieces about life in, living in Thailand, including topics like: Thai People, Thai Culture, Nightlife, Technology, and I have published a lot of photographs, videos, and even books on Thailand that you can find at ThailandeBooks.com. There are many photographs of Thailand here - feel free to share with attribution (a link back to the home page). All written content on this site by Vern Lovic. Contact me at Google+. View all posts by Vern


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[Via Foodbeast]