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Spot macaws in the jungle and caimans on the riverbanks, sail the waters of Lake Titicaca, delight in the smells of markets and explore ancient ruins—including a trek along the Inca Trail. As we operate our own treks, our quality equipment and the expertise of our porters and CEOs will ensure that your first glimpse of Machu Picchu will leave you in awe. Whether you're scanning the canopy for wildlife from the comfort of our intimate and exclusive G Lodge Amazon or following in the footsteps of the Incas, this fast-paced adventure provides a sweeping view of this diverse country.
Arrive at any time.
Fly to Juliaca and transfer to Puno. Take it easy in the afternoon, wandering the markets and exploring the city.
Fly to Juliaca then take a short bus ride to Puno, on the shores of Lake Titicaca. Titicaca is also the largest lake in the world above 2000m, and the views from its Islands are stunning.
Enjoy a guided tour of Lake Titicaca and a homestay in a small village.
Head out by boat across Lake Titicaca. Visit the community on the Taquile Islands and enjoy a local lunch with spectacular views.
Afterwards, cruise to the another village (this can vary based on community availability) for an overnight homestay on the shores of the lake. This experience provides an opportunity to learn more about rural life in the Peruvian highlands and to participate in local traditions. Eat with the family, learn some Quechua and Spanish language skills, try on traditional costumes, and help out with daily chores around the village.
Visit the floating islands of Uros before returning to Puno. Opt to visit to Sillustani burial site.
Leave the homestay families late morning and visit the Uros Islands on the way back to Puno. A popular optional activity in Puno is a visit to the spectacular chullpas (funerary towers) of Sillustani, a pre-Inca archaeological site only a short drive away.
Hop on the bus for a full day's drive to Cusco.
The trip from Puno to Cusco takes the better part of the day, with stark, beautiful scenery en route as you travel through the high Altiplano region. Check out a bit of Cusco, find a spot for dinner or get prepared to head into the Sacred Valley.
Enjoy a full-day guided tour of the Sacred Valley. Stop at the G Adventures-supported women's weaving co-op before visiting a local pottery making community. Break for lunch at the G Adventures-supported Parwa community restaurant in Huchuy Qosco. After lunch, opt to head out on a hike to the Ollantaytambo storehouses and look out over the ruins. Or, wander around the cobblestone streets and visit a local Chicheria (corn beer bar).
Travel through the stunning Sacred Valley of the Incas, visiting a G Adventures-supported women's weaving co-op. Meet the women and learn about traditional weaving and dyeing. Opt to pick up some handmade souvenirs and textiles directly from the women who made them.
Have lunch at the G Adventures-supported Parwa community restaurant. Learn about the G Adventures for Good project and eat a delicious buffet-style lunch. Proceeds of this meal go directly back to the remote community.
Return to the Sacred Valley with your CEO to explore the sites of the Maras Salt Mines and the ancient Incan agricultural terraces of Moray. Continue on a scenic drive through small villages and stunning views of the Andean countryside. Stop for a picnic lunch at Piuray Lagoon and opt to explore by kayak or stand-up paddleboard. Return to Cusco for the evening.
Leave the hikers to start their trek and head out to explore Moray and Maras ancient Incan ruins. Enjoy a scenic drive through Andean farmland on the way to Piuray Lagoon.
Enjoy a free day to explore the city or take advantage of the many optional activities available.
Travel by van to Ollantaytambo to catch the scenic train to Aguas Calientes.
Enjoy a guided tour of Machu Picchu. Opt to visit the Inca Bridge before returning to Cusco in the evening.
Rise early to catch the first bus up to Machu Picchu with the guide. Enjoy a guided visit of the ruins followed by free time to explore. When ready, head back down by bus to Aguas Calientes to meet up with the rest of the group and take a train back to Cusco.
Enjoy a free day to explore Cusco or relax. Choose to pre-book the Cusco Cooking Class. Opt to go whitewater rafting, horseback riding, or mountain biking.
Fly to Puerto Maldonado and continue by motorized boat to our comfortable and intimate G Lodge Amazon.
Fly to Puerto Maldonado, deep in the lowlands of the Amazon Jungle.
After a brief stop in town to store large luggage, drive to the pier and travel by covered motorized boat to the jungle lodge. En route, spot bird species typical to the river and forest edge. The Tambopata Rainforest area holds the world record for the most bird sightings in one area.
Local community members make up the majority of lodge staff, including multilingual naturalist guides. Take the opportunity to learn about the area's rich flora and fauna and locals' extensive use of medicinal plants and other forest plant resources through traditional techniques for building, fishing, and hunting.
Enjoy guided excursions led by expert naturalists to spot wildlife at nearby oxbow lakes and along jungle trails. Spend some time relaxing in a hammock, enjoying the local swimming hole, or visiting a nearby plantation. Go on a caiman spotting cruise after dinner.
Head out early to catch the jungle at its wildest (and coolest). Walk slowly through the forest searching for wildlife before heading out on an oxbow lake by canoe. Search for anaconda, the elusive giant river otter, or black caiman. Even if you don't spot these shy creatures, there are plenty of other birds, interesting plants, and other animals about.
Fly back to Lima for an optional final dinner and night out.
Enjoy a delicious Amazonian breakfast before heading back to the airport by motorized boat and van. Fly to Lima and opt for a final night out for dinner or Pisco Sours.
Depart at any time.
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I had an absolute ball. High points were the wonderful people we had in our group and of course trekking the inca trail.Overall Rating
It was an incredible trip. Our tour leader was excellent. Peru is a beautiful country. The Inca trail really pushes you to your limits.Overall Rating
The trip was very well organised and ran smoothy. It was our first pre-organised tour and made things stress free but adding the element of adventure and indivuality to enjoy it. Our tour leader was very helpful and always went above and beyond to help.Overall Rating
Terry was an excellent guide. Very attentive. Full of great advice and coordinating our travel connections. Machu Picchu was awesome and the highlight of our trip. No downsided to report. Accomodations were always good. Lake Titicaca homestay was also a highlight.Overall Rating
This G Adventures tour exceeded my expectations. The places we visited were outside the usual holiday experiences and they certainly lived up to the brochures descriptions. The logistics of traveling were eased by connections at airports. The travel arrangements were being handled smoothly and efficiently by Jorges. He kept the whole group informed and well advised at all times and was great fun to be with. The Lares Trek was superb amazing landscapes and Javier was a wonderful guide full of information and encouragement over the very high passes.Meeting only local people away from other tourists made these couple of days feel really unique and gave me a real sense of the place and people who live there. The support team were amazing at looking after us and were very gracious as hosts. All I had to do was sit back and enjoy the spectacular landscape. The home stay with Olga on Lake Titicaca was just lovely. Olga and her family were so welcoming and shared their home most generously. We had great chats and exchanged stories songs and helped prepare the delicious evening meal. Percy our guide on Lake Tititcaca really deserves a special mention he is full of passion about his home. He was so charming humorous and full of fun he made the trip really well rounded. The swim in Lake Titicaca was amazing refreshing and something I would recommend. The Amazon Lodge was simply wonderful and the staff and food outstanding. Seeing monkeys, magaws, vultures, cayman and amazing butterlfiesOverall Rating
very interesting, well organized, nice hotelsOverall Rating
Amazing Trip. Well coordinated and a lot of fun despite the busy shedule! Inca Trail definite highlight but the rest was a close secondOverall Rating
Peru is just simply brilliant???.. I just got back from the Peru Panaroma adventure. There was so much to do -- exploring the cities, nightlife, sightseeing, etc??The highlight of the trip was the Inca Trail hike which was just unbelievable. There are really no words to describe it. Gladys, our G Adventures leader and Hamilton and Elvi, the United Mice local guides made the trip so enjoyable and safe -- we had lots of fun -- laughing and talking the whole hike through. My utmost gratitude to all the porters and the cooks in our group who took care of us so well. It's amazing the work they did for us. When you finally reach the top of each mountain and especially, Machu Picchu -- talk about absolute, untainted pure beauty. Awesome does not even begin to describe the sight from the mountain top to the valleys below. The best part of the trip is the people you meet and I was fortunate to forge lifetime friendships. I couldn't have asked for better fellow group members. We had such a great time together. Also, the Peruvian people are some of the most generous and gracious people I have ever met. As a single female traveling, G Adventures provided the safety and security I was looking for??..I didn't have to worry about anything except for showing up -- Gladys took care of the everything. I encourage everyone to consider G Adventures for their next travel and I look forward to my next G Adventure.Overall Rating
The tour leader Gladys will forever hold a dear place in my heart. A true sweetheart willing to give you the shirt on her back if you need it. The tour itself had zero low points, even waking up at 4 in the morning was great with our group. The mix in the group made for a fantastic time. we are all life long friends and are planning to get together for a reunion soon. I will recommend both Percy and Galdys to all my friends on their way to Peru. I am not used to touring the world with a group, but G Adventures certainly opended my eyes to the sheer fun and feeling of family that quickly forms when you are all going through the same awesome experience. I will travel G Adventures again!!!Overall Rating
Far exceeded our overall expectations of what group travel would be like. This was our first tour (we have always traveled independently) and we really had a great time.Overall Rating
Trip Name: Peru Panorama
Duration: 15 Days
From Price: $2,759
Supplier Tour ID: PPP.F/201812
We will be in touch shortly
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For more than 130 years, the RSC has been bringing together scholars and researchers from diverse disciplines to conduct expert, multi-disciplinary investigations on matters of public importance. Beginning in the 1980s, the RSC formalized one aspect of this endeavor by launching Expert Panels operating on the model pioneered by the US National Academy of Sciences. These Expert Panels, struck as a public service to Canadians, have provided insight, advice and recommendations to Canadian governments, industry and NGOs on public policy matters ranging from the health effects of asbestos to early childhood education. The work of the RSC's Expert Panels ensures that there is independent, comprehensive, and evidenced-based input into the public policy development process in Canada.
For additional information on the RSC's Expert Panel process please view the reference materials below.
Peer Review Process - January 18, 2010
Development of the Expert Panel Process in Canada
Manual of Procedural Guidelines

subset: commoncrawl


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Beirut has been undergoing an architectural renaissance, with Herzog & de Meuron, Norman Foster, Steven Holl, and Zaha Hadid among the starchitects making their mark on the Lebanese capital. Zuhair Murad, who is based there, saw the potential for a Couture collection built from geometry—particularly Hadid's extreme forms.
Wednesday, November 19, 2014
Zuhair Murad Fall 2014 Couture
The Author
Posted by Vilcan Ioana at 5:26 AM
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More detailed scientific evidence is expected throughout the day Wednesday in the Anthony Sowell trial.
First on the stand was the Coroner's Trace Evidence Supervisor Curtiss Jones. Prosecutors peppered Jones with questions about evidence he collected from the accused serial killer's home.
Because the testimony is just about the collection of evidence, and not the DNA testing, jurors are hearing no conclusions on what was found.
After this phase, DNA experts will be questioned about what they found on the evidence forwarded to them by Coroner's trace evidence techs.
Prosecutors displayed a photograph of an apparently used condom that was found with one of the victim's bodies. DNA testing not yet introduced could tie Sowell to at least one of the victim's and could be explosive evidence against him.
Sowell faces the death penalty if convicted of murdering eleven women. The bodies of the victims were found in and around Sowell's Imperial Avenue home in late 2009.
Copyright 2011 WOIO. All rights reserved.


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|CGSSA Shoots, Meets and Range Stories Set up and organize shoots and meets and share your shooting range stories.
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A Place To Shoot- Firecracker 5 Stand Fun Shoot
Listen Up everyone!
A Place To Shoot is holding a fun shoot on our Firecracker 5 Stand Sporting Clay's on the Last of Sunday of the month!
We are now changing the day of the 5 Stand Match to the last Sunday of the month instead of the last Saturday!.
$25 gets you in to the range and two rounds of Firecracker 5 Stand Sporting Clays match. We will be awarding the top 3 shooters with cool prizes like Official A Place To Shoot hats or shirts; or you could win free passes to the range or free 5 Stand Rounds.
Please come and enjoy the company of other shooters like yourself, all there just to play and have good time.
Firecracker 5 Stand Sporting Clays is a fun clay bird game that best simulates real bird flight. This shotgun game is a twist between trap,
skeet and hunting where the birds are coming from the left to right going out; from right to left going up; birds coming out from the center; there are even birds going straight up in the air as well as over the head!
This game keeps you on your toes and is designed to give you a good time!
For more information please call A Place To Shoot at (661)296-5552 or visit our web site at http://www.aplacetoshoot.net Or https://www.facebook.com/events/143056259216928/
33951 San Francisquito Canyon Road
Saugus, CA 91350
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Sunday, October 18, 2009
Letting it All Out – While Retaining Everything
6 comments:
- Old MD Girl said...
Well, we probably ought to *try* to be composed in front of the patients..... What I was talking about is this idea that we should appear composed at ALL times. As it stands now, our degree of composure is measured only by time spent NOT in front of patients. Because, of course, my peers/supervisors don't see all/any of my actual patient interactions, rather only time spent *outside* their rooms.
If you have these debriefing sessions, I'd advise keeping the mouth shut even if you really really don't want to. If you can (sometimes I can't). HR tends to take notes from meetings like these, and this kind of information can and will get used against people they would like to terminate in the future.
I am very cynical.
But yes, taking time away from breaks SUCKS. So do meetings.
- October 18, 2009 at 9:57 AM
- TorontoEmerg said...
I'm with you... I mean who wants to start disclosing all sorts of personal and/or professional frustrations to people you don't really trust or even like. The thought makes my skin crawl, a little, even if they are acting in good faith.
My hospital tried to substitute the lunch break for similar meetings, which backfired badly when we still took our lunches afterwards.
- October 20, 2009 at 10:26 AM
- Richard said...
Given the popularity and prevalence of twitter, I put together a list of 50 different nurses on Twitter that you can follow to potentially get some insight on their medical lives. If you wouldn't mind, could you share my list with your readers?
Here's the post:
Many thanks!
- October 22, 2009 at 4:54 PM
- Guzzo said...
Maybe asking employees to "stir the pot" is their way of attempting to reduce overhead through employee attrition?
- October 23, 2009 at 3:08 PM
- Maha said...
OMDG - I wasn't referring to maintaining a calm composure (which frankly is half the battle sometimes) but rather being forced to participate in activities that are relaxing, like meditating with a group. I'd much rather be alone with a good book and maintain some distance from work when I feel overwhelmed.
Blogging also helps to vent out frustrations so remaining calm is an incentive - get all the juicy details for blogging!
When my idiotic meetings start, I do not plan on saying anything beyond the standard crap about loving where I work. *shudders*
- October 23, 2009 at 10:03 PM
- Old MD Girl said...
Yep. Mandatory meditation sessions would suck.
Anyway, I know you know to keep your mouth shut at these meetings. Consider it an admonition to MYSELF more than anything else. Meetings like that make me cranky.
- October 25, 2009 at 8:13 AM


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Node.js® Enterprise Support
New comprehensive plans availableLearn More
February 7, 2013Meetup: The Art of Email Explained Scientifically by joyentirene
SF Meetup, Wednesday, 2/27: The Art of Email Explained Scientifically: What Developers, Operations and Marketing are Required by Law to Know.
February 7, 2013Nodejitsu and Joyent: We Feel the Need for Speed by rachelbalik
In the past year, journalists, enterprise organizations and forward-thinking developers everywhere are realizing that Node.js is more than just a passing fad: It's ready for the big time. But long before some of the world's biggest and fastest growing companies were building in Node, Nodejitsu was providing a platform for developers to deploy and host their Node apps.
February 5, 2013Cloud Performance Counts - ReelSurfer the Viral Video Site by joyentirene
Video is now the king of content. However, there's not enough time to watch a video. 4-minute videos can make us squirm in our chairs or reach for our smartphone to check email. Even if you have not heard of ReelSurfer, you probably have watched a mash-up or one of its viral videos. ReelSurfer is a free online service that lets anyone clip and share any video from any website.
February 4, 2013The Client-Server Model and the Internet of Things by rachelbalik
Engineering often requires a heads down focus on very small, detailed problems. But innovation often requires thinking very, very big - sometimes bigger than we even realize we need to think.
January 31, 2013Exams + Homework = Fun studying application from Quizlet by joyentirene
Making studying fun is almost impossible, partially because everyone learns differently. Despite the odds, Quizlet has done it. How? They've taken the simple concept of a "Study set," which can be input onto flashcards, and created a vibrant community that shares and learns these sets in various study modes and competitive games.
January 23, 2013Joyent and Hadoop: Making Big Data Better by rachelbalik
What? You haven't? Well perhaps that's because it's not quite famous yet, but once word gets out about the new Apache Hadoop-based solution we launched today, we expect this phrase to be top-of-mind for companies who are looking for better performance from Hadoop and have ambitious goals when it comes to managing big data.
January 17, 2013One of Our Favorite Kingmakers Sheds Light on Nerd Power! by rachelbalik
Our partners and friends at New Relic just sponsored a very insightful book titled, "The New Kingmakers. How Developers Conquered the World," by Stephen O'Grady, Redmonk analyst. The book discusses the way that today's economy is shaped by technology and the developers. New Relic offers a simple, elegant app performance management solution. Since its inception, it's always been a big advocate for the developer community.
January 14, 2013Linux Users, Got Three Cents? We've Got Something for You by Jasun Wurster
We've just updated Ubuntu 12.04 and Debian 6.0.6 to make Joyent an even sweeter ride for Linux users. Highlights of Joyent's version 2.3.1 include Joyent GPG signed Debian and Ubuntu repos that offer secure Joyent updates and being able to set hostnames via CloudAPI using Mdata.
January 3, 2013Code Forward: Meet the Developers Behind President Obama's 2012 Re-Election by joyentlindsay
Meet the Obama for America tech team in NYC, SF or Chicago, sponsored by our partner NewRelic
December 20, 2012Xeround - database-as-a-service boasts more than 40,000 users. Have you tried it? by joyentirene
Razi Sharir, CEO of Xeround recently shot a video at Joyent talking about why customers have selected Xeround's cloud database solution.
December 5, 2012And the Academy Award Goes to... by Len Shneyder
Message Bus and Joyent partner to deliver cloud-native messaging across email, mobile and social channels.
November 28, 2012Skookum Digital Works & Joyent: A Match Made in Tech Heaven by Pat Morrell
Skookum Digital Works kicks off this Joyent-SDW partnership by cohosting the second installment of Joyent's "DIYvAAS" webinar series.
October 26, 2012NodeStack Online Conference Recap by Nuno Job, Chief Commercial Officer at Nodejitsu
NodeStack joined some of the market leaders exploring the advantages of Node.js, MongoDB, and SmartOS as a stack.
October 22, 2012New Relic Launches Key Transactions and Unveils New UI by Guest Post by Bill Hodak, Director of Product Marketing at New Relic
Joyent Partner New Relic Launches Key Transactions and Unveils New UI
October 18, 2012Nodestack Online Conference a Great Success! by Graham Neray, Product Marketing Manager at 10gen
NodeStack is uniquely suited to address the increasing demands of modern application development. NodeStack 2012 was an overwhelming success.


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9:00 pm
America's Test Kitchen from Cook's Illustrated "A Slow and Easy Thanksgiving" Test cook Becky Hays uncovers the secrets to a slow and easy Thanksgiving with Braised Turkey and makes Bread Stuffing for a crowd. And finally, equipment expert Adam Ried reviews oven thermometers in the Equipment Corner. D
9:30 pm
Coastal Cooking with John Shields "Ready, Set, Party" To feed a coastal party crowd, think Shrimp Feed with guest "Paw Paw" George Davis. Other recipes include Gloucester Lobster Salad, and Firefly Farms Goat Cheese Cheesecake with Caramel Sauce. The Kitchen Goddess show viewer how to set up the perfect coastal buffet. D
10:00 pm
Joanne Weir's Cooking Confidence "I'm Inspired" Joanne is often asked where her inspirations come from and begins by composing an inspired salad with roasted beets, and then gives her student Charlie some pointers for making honey glazed pork chops and a roasted squash puree. Recipes: Bibb Lettuce Salad with Roasted Beet, Grapefruit and Pecans, Honey Glazed Pork Chops with Orange and Cardamom, and a Roasted Squash and Ginger Puree. Student: Charlie Baldwin, City Gardener. D
10:30 pm
Rick Steves' Europe "Italy's Amalfi Coast" Rick visits the trendy resort of Positano on the Amalfi coastline, south of Naples. He also takes in the charms of Sorrento, the ancient Greek temples of Paestum, and the iridescent Blue Grotto beneath the Isle of Capri.G
11:00 pm
Great Conversations "General Wesley Clark and Joe Klein" In a 2001 interview, Wesley Clark, Five Star General, former Commander NATO European Forces and NATO Air Campaign Kosovo and author, talks with Joe Klein, The New Yorker Correspondent, Politics and Defense, and author. D


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Brandi Grissom
Brandi Grissom is The Texas Tribune's managing editor and joined the staff when the online publication launched in 2009. In addition to editing duties, Grissom leads the Tribune's coverage of criminal justice issues. During her tenure at the Tribune, she was chosen as a 2012 City University of New York Center on Media, Crime and Justice/H.F. Guggenheim Journalism Fellow and was a fellow at the 2012 Journalist Law School at Loyola Law School, Los Angeles. Grissom, along with Tribune multimedia producer Justin Dehn, received a 2012 regional Edward R. Murrow Award for investigative reporting for work on the case of Megan Winfrey, who was acquitted of murder in February 2013 after the Trib's coverage brought statewide attention the case. Grissom joined the Tribune after four years at the El Paso Times, where she acted as a one-woman Capitol bureau. Grissom won the Associated Press Managing Editors First-Place Award in 2007 for using the Freedom of Information Act to report stories on a variety of government programs and entities, and the ACLU of Texas named her legislative reporter of the year in 2007 for her immigration reporting. She previously served as managing editor at The Daily Texan and has worked for the Alliance Times-Herald, the Taylor Daily Press, the New Braunfels Herald-Zeitung and The Associated Press. A native of Alliance, Neb., she has a degree in history from the University of Texas.


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What can you do with a pocket watch, except bring it out when you want to know what time it is? Why, take its insides out and create one of the awesomest steampunked versions of Iron Man's arc reactor! That's what Adi Simion did and it looks out he succeeded in creating a piece that Tony Stark himself would be proud to own.
You won't be able to read the time off of the pocket watch anymore, since its face has been taken out to make room for Iron Man's reactor, but who needs a watch when you can have Iron Man's source of power, right in your very own pocket?
VIA [ Obvious Winner ]


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The Etobicoke Event Calendar lists all the major events taking place in our great city. If you want your event listed in our calendar and promoted to thousands of Etobicoke residents that visit 365Etobicoke every day please send us your event details and we'll add your event right away!
December 1, 2018 –
Unzipped, an iconic exhibition celebrating artistry and city-building:
Luxury development firm and emerging culture company, Westbank, and Danish architecture firm, Bjarke Ingels Group (BIG), have reconstructed the iconic 2016 Serpentine Pavilion in downtown Toronto, at King and Brant Streets. In Toronto, the Pavilion — made of 1802 stacked fibreglass 'bricks' and which stands 14 metres (46 feet) tall at its apex, 27 metres (88.5 feet) long and 12 metres (39 feet) wide — will play host to Unzipped, Westbank's newest exhibition.
Unzipped will showcase an intimate collaboration between developer and architect, where every element of design is considered in relation to its site, environment and the city in which it will stand. Experience the iconic architectural commission at no cost at 533 King Street West for a limited time between 9 a.m. and 5 p.m. from September 15, 2018 to November 30, 2018.
Submit an Event!
Please enter the following details to get your event added to the Etobicoke Event Calendar. Your event will be reviewed and once approved, will be added to the calendar (typically between 24-48 hours). Please click the Submit button only once!
Note: If you are unsure how to enter a recurring event, leave as "does not reoccur", and be sure to add as much detail to the Description field below as possible and we'll take care of the rest!


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Lakers 105, Thunder 96 (final)
The Lakers won their second consecutive game by defeating the Oklahoma City Thunder, 105-96, on Sunday afternoon at Staples Center.
Coming in with the best record in the NBA, the Thunder are now 34-11, trailing the San Antonio Spurs for the league's top spot, after getting outscored by the Lakers, 30-21, in the final quarter.
Kobe Bryant had one of his best games of the season with 21 points, 14 assists and nine rebounds. It's the second game in a row that Bryant finished one rebound short of a triple-double and one assist short of tying his career high.
Bryant also spent most of the game guarding Thunder All-Star point guard Russell Westbrook. Although Westbrook was also one rebound short of a triple double with 17 points, 13 assists and nine boards, he made only six of 22 shots from the field.


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About Gamcare
Free Support and Counselling
GamCare is the leading national provider of information, advice, support and free counselling for the prevention and treatment of problem gambling. Our expert services are confidential and non-judgemental.
GamCare offer moderated chatrooms every day. You can live chat with others affected by problem gambling. Both gamblers and those affected by someone else's gambling are welcome.
GamCare offers free, impartial and confidential advice and support about a gambling problem. Our advisers are available to talk from 8am to midnight every day of the year. Whether you are struggling with the effects of gambling issues of your own, or of someone close to you, we are here for you.
One of the most common results of a gambling problem is debt, and yet debt is also used by many gamblers as a reason for their continued gambling. It plays a complex and contradictory role at the heart of the gambling experience for many of the people that we speak to. If debt has become a problem for you as a result of your gambling.
GamCare counselling provides a safe, confidential way for you to talk about your situation. It offers an opportunity to explore the causes of your gambling behaviour and the effects gambling has on your life, and helps put it in context of your life experiences. GamCare face to face counselling is available in many locations throughout the UK


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NOM Denies Marriage Equality Has Come To California
The National Organization for Marriage hate group has dropped to a worrisome level of unreality in which it is in total denial about marriage equality returning to California.
In a comment thread attached to a Wednesday message in which Brian Brown claims that there are 38 states that ban same-sex marriage (California's addition has lessened it to 37), a commenter asks about the typo.
"Your article states that there are 38 states that define marriage as being only between a man and a woman. With the latest supreme court ruling, hasn't that dropped to 37 since CA now allows gay marriage?" the concerned commenter asks.
Thomas Peters, a NOM member and blogger, replied, "Prop 8 remains the law in CA. Clerks have been ordered to ignore it."
That's some fuzzy math!


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Men Raise $20,000 for Charity With Goofy Webcast
In a heartwarming and wacky video sure to bring you some Christmas spirit, two Pittsburgh, Pennsylvania, men acted like buffoons for 24 hours, and in exchange the world gave them money. It's like you want to make fun of them, but then they raised $20,000 for Toys for Tots.
The pair wore ugly sweaters, shook taxidermy animals at the camera for some reason and danced around for charity. Oh, and they let people get a chance to control a gigantic claw machine to decorate a tree, and as we all know, nobody can resist a claw machine. In keeping with their general aesthetic, they donated the money in the form of a garish giant check. But we can't hate, because charity and Christmas spirit. So we begrudgingly say good work, guys.


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Tag Archives: MR-14EX
Learning to slow down and starting to really see
Posted on 06. Sep, 2011 by Paul Burwell.
But it wasn't until this summer that I finally started to take a good look around what's been hiding in plain site, just outside my office. You see, I got married last fall (finally! hurray!) and I've moved into the house that my was living in. It's a fantastic little house built during the war in the 1940's and one of its fantastic features is a very large back yard (at least by city standards). My wife is a fantastic gardener and in addition to a few vegetable crops we have tremendous wildflower and sunflower gardens.
This summer I managed to slow myself down a little more and now I'm seeing all these little critters who I previously…


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Predators blank Blackhawks behind Rinne's 29 savesby Brian Hedger
CHICAGO -- The Nashville Predators did what they do best Sunday at United Center.
They delivered another gut-wrenching loss to the Chicago Blackhawks, who were shut out 2-0 by Nashville thanks to a dominant 29 saves by goaltender Pekka Rinne. Chicago failed to keep pace with the St. Louis Blues in the race for first place in the Central Division.
It was the Predators' third win in four games this season against Chicago (41-16-15), which dropped to 10-12-3 against Central Division opponents, its worst record against any division in the NHL.
"They have a really good team, but we seem to match up against them pretty well," Rinne said after his first shutout of the season. "We have to play a defensive style of hockey against them. They have a lot of individuals who can change the momentum and change the game, but that team seems to get the best out of us."
The Blackhawks, who outshot the Predators 29-17, were missing two key players due to injury: right wing Patrick Kane (lower body) and left wing Bryan Bickell (upper body).
Rinne, a towering 6-foot-5, 204-pound Finnish goalie, looked like he did prior to hip surgery last spring that led to an infection that kept him out 51 games this season. He swallowed up most of the shots that were on target, played the puck well, and withstood a furious few minutes toward the end of the game to keep the Blackhawks scoreless.
Nashville finished 2-2-0 on a tough four-game road trip that tested Rinne with some atypical outings.
"Personally, I've struggled the last couple games on this road trip, and it's been tough for me, so it for sure feels good after tonight's win," Rinne said. "The guys played extremely hard. Against a top team like that, it's going to get the best out of you, and I think we showed that as a team tonight."
Mike Fisher and Gabriel Bourque scored for the Predators (31-31-10), who are still alive in the chase for a spot in the Stanley Cup Playoffs. Nashville did get some bad news when rookie defenseman Seth Jones couldn't play the second or third periods because of concussion-like symptoms.
Jones took a hit along the boards from Chicago forward Andrew Shaw 6:37 into the game and didn't return for the second. He logged 5:48 of ice time on eight shifts.
Corey Crawford made 15 saves for Chicago, which is six points behind St. Louis following the Blues' 1-0 win against the Pittsburgh Penguins on Sunday. The Blackhawks went 0-for-4 on the power play and have failed to score on nine man-advantage opportunities in the past two games without Kane.
"Obviously, we know points are at stake," Chicago defenseman Duncan Keith said. "We want to keep getting those points and we left two on the table tonight, but for whatever reason we've had trouble against these guys. I can't pinpoint what it is. We've played good games the last little while and we've played good team games, so I don't know. It's tough when you don't score a goal to win the game."
Nashville took a 1-0 lead on Fisher's 18th goal, which he scored with 1:22 to go in the first by tipping a slap pass from Ryan Ellis past Crawford at the side of the crease. The goal negated a solid start by the Blackhawks, who were out for revenge following a 3-2 loss to the Predators on March 14 and led in shots 11-4 after 20 minutes.
"We had a good start and we had a couple of great looks at the net," Blackhawks coach Joel Quenneville said. "[We] missed the net, missed the opportunities there, and they scored first. What happened after was exactly what happened [March 14]. They get the lead and they go into a check-fest and they check well."
The second period mirrored the first.
Aided by three power plays, the Blackhawks ran their advantage in shots to 20-11 after 40 minutes but trailed 2-0 thanks to Bourque's goal at 17:35. His seventh goal capped a 2-on-1 rush created when he took a short pass from rookie Calle Jarnkrok and headed up ice.
Jarnkrok, who got his second assist in as many NHL games, used a burst of speed to beat Blackhawks defenseman Brent Seabrook in the neutral zone and charged toward the net. Bourque zipped a wrister from the left circle that sailed over Crawford's left shoulder into the right corner of the net, deflating the Blackhawks going into the locker room yet again.
"That was big," Bourque said of Jarnkrok's effort. "He gave me more space and made the goalie on edge. Crawford didn't know if I'd pass or not, so that was a really good job. He's fast and uses his speed."
Rinne took it from there, dazzling in the third period by stopping nine Chicago shots, including an intense goalmouth scramble with 50 seconds left. It was one of several times the Blackhawks skated away shaking their heads.
"It was a good bounce-back game for him," Nashville coach Barry Trotz said. "You saw tonight exactly what Pekka Rinne can do for you. I thought we spent a lot of time in our zone, but I thought we kept them to the outside for the most part. They didn't get those second and third looks that sometimes they can."


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Wanna know more how to mix and match all the lovely pieces of jewlery we feature each day on FairyBlingMother? Here you have some fabulous fashionastas that will show you how you can use jewelry in a million ways. If you have any ideas feel free to leave them in the comment section down bellow. Which is your favorite outfit from this post?
Home » streetstyle » FairyBlingMother Street Style Jewelry


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Continuous positive airway pressure (CPAP) improves sleep and quality of life for both patients with obstructive sleep apnea (OSA) and their spouses. However, few studies have investigated spousal involvement in treatment adherence. Aims of this observational study were to assess perceptions of spousal involvement and evaluate associations between involvement and adherence.
Spousal involvement in CPAP adherence was assessed in 23 married male OSA patients after the first week of treatment. At 3 months, 16 participants completed a second assessment of spousal involvement. Types of involvement assessed included positive (e.g., encouraging), negative (e.g., blaming), collaboration (e.g., working together), and one-sided (e.g., asking). An interpersonal measure of supportive behaviors was also administered at 3 months to evaluate the interpersonal qualities of spousal involvement types. Objective CPAP adherence data were available for 14 participants.
Average frequency of spousal involvement ratings were low for each involvement type and only negative spousal involvement frequency decreased at 3 month follow-up (p = 0.003). Perceptions of collaborative spousal involvement were associated with higher CPAP adherence at 3 months (r = 0.75, p = 0.002). Positive, negative and one-sided involvement were not associated with adherence. Collaborative spousal involvement was associated with moderately warm and controlling interpersonal behaviors (affiliation, r = 0.55, p = 0.03, dominance r = 0.47, p = 0.07).
Patients reported low frequency but consistent and diverse perceptions of spousal involvement in CPAP over the first 3 months of treatment. Perceptions of collaborative spousal involvement were the only type associated with adherence and represent moderately warm and controlling interpersonal behavior. Interventions to increase spousal collaboration in CPAP may improve adherence.
Baron KG; Gunn HE; Czajkowski LA; Smith TW; Jones CR. Spousal involvement in CPAP: does pressure help? J Clin Sleep Med 2012;8(2):147-153.
Obstructive sleep apnea (OSA) is present in 2% to 4% of middle-aged adults and causes intermittent hypoxia, sleep fragmentation, and changes in sleep architecture.1 Continuous positive airway pressure (CPAP) is the recommended treatment for the majority of patients with OSA and has been shown to improve daytime sleepiness2 and mood,3 and reduce risk for coronary events in patients with obstructive sleep apnea (OSA).4,5 In addition to improving health and quality of life for patients, spouses of OSA patients also report benefits from the patient using CPAP, including decreased sleepiness and improved sleep quality and relationship satisfaction.6–9 Despite these benefits, 46% to 83% of patients do not adhere to CPAP treatment, which means studying factors associated with adherence to CPAP are a necessary and important task.10,11
Frequently, patients report the spouse is a main factor in their decision to seek treatment for OSA.12,13 However, only a handful of studies have evaluated the process of spousal involvement in CPAP adherence and whether such involvement is beneficial. Of those that have examined spousal involvement in CPAP adherence, the findings are mixed. Some studies have reported that spousal involvement is associated with better adherence and others have reported possible negative effects of spousal involvement. Sharing a bed with a spouse or partner has been associated with higher adherence in two studies.8,14 However, higher marital conflict and seeking treatment because of a spouse (rather than self-referral) have been associated with poorer adherence.15,16
Current Knowledge/Study Rationale: Patients often report spousal influence on treatment-seeking in OSA but few studies have systematically evaluated spousal involvement in treatment. The goal of this study was to evaluate how spouses are involved in CPAP treatment and the effects of percieved involvement on adherence to continuous positive airway pressure.
Study Impact: This study will inform sleep professionals about the ways spouses are involved in treatment and results suggest that increasing collaborative spousal involvement in CPAP use may improve adherence.
The discrepancy in these findings may be due to the specific nature of spousal interactions with respect to CPAP use. In other words, the type of involvement may be integral to CPAP adherence. At this point, no study has systematically evaluated spousal involvement in CPAP. Elsewhere in the health literature, spousal involvement has been related to improvements in a range of health behaviors, including diet, exercise, and visiting the doctor, particularly when the involvement is viewed as positive and collaborative.17–21 The most effective types of spousal involvement include providing encouragement or helping make changes to facilitate the behavior. On the other hand, negative types of involvement, such as criticism, have been associated with psychological distress or ignoring the spouses' request for behavior change.18,22–25 In one study, feeling supported by the spouse has been associated with higher CPAP adherence during the subsequent night in patients with more severe OSA.26 However, the methodology used in the study (daily questionnaires) limited the number of spousal behaviors assessed, and it was not clear what type of supportive behavior was most beneficial. Further research to describe and understand how spouses are involved in improving CPAP treatment is vital to the design of couples-based interventions, as well as for providing evidence-based recommendations to OSA patients and their spouses.
The goal of this observational longitudinal study was to evaluate the frequency and nature of spousal behaviors aimed at influencing CPAP adherence over the first 3 months of treatment. The second aim was to determine if perceptions of spousal involvement are associated with adherence. We hypothesized that more frequent perceptions of positive and collaborative spousal involvement aimed at CPAP adherence would be associated with higher adherence and that more frequent perceptions of negative involvement would predict poorer adherence.
Participants were recruited from patients undergoing overnight diagnostic polysomnograms at an academic sleep disorders center. Eligibility criteria included the following: age 18-65 years, male gender, diagnosis of OSA, married or living with a romantic partner ? 1 year, and CPAP naive. Exclusionary criteria included the following: spousal use of CPAP, chronic obstructive pulmonary disease, oxygen therapy, congestive heart failure, cardiomyopathy, psychosis, and use of other concurrent treatments for OSA (bariatric surgery, upper airway surgery, and oral appliance). Patients with comorbid sleep disorders (insomnia n = 2, periodic limb movements and/or restless leg syndrome n = 8) were not excluded. The protocol was approved by the University of Utah institutional review board, and all patients completed written informed consent.
All patients underwent 2 overnight polysomnograms: a diagnostic study and a CPAP titration. Patients were enrolled in the study after the diagnostic study confirmed an OSA diagnosis. All patients attended a physician's appointment for education and treatment planning as well as an individual 30-min mask fitting and education session with a sleep technician prior to the CPAP titration. The type of CPAP mask was determined by the patient preference and assessment of fit by the technician. Brand of CPAP machine, use of heated humidification, and settings were determined by the sleep physician. Patients completed baseline questionnaires (demographics, relationship quality) on the evening of their CPAP titration. Spousal involvement was measured using a questionnaire administered by mail 7-10 days after starting CPAP to assess spousal involvement in the first week of CPAP use. At 3 months, patients were contacted again to complete follow-up measures (spousal involvement and interpersonal behavior associated with CPAP). CPAP adherence data were downloaded by the patients' home care company at 3 months. Multiple attempts were made by the home care company and research team to contact patients missing adherence reports and arrange to retrieve the adherence data by mail or in person.
Demographics were collected prior to treatment initiation including self-reported age, marital status, income, and employment status.
Relationship quality was measured by the support and conflict subscales of the Quality of Relationship Inventory (QRI).27 The support subscale contains items related to emotional support in the marriage, such as "To what extent could you count on your spouse for help with a problem?" and "To what extent could you count on this person to listen to you when you are very angry at someone else?" The conflict subscale contains items related to the frequency and extent of marital conflict, such as, "How angry does your spouse make you feel?" and "How often do you have to work hard to avoid conflict with your spouse?" Subscales were scored as the average of the 7 support items and average of the 12 conflict items. Cronbach's α for the support and conflict subscales ranged from the 0.70s to 0.90s, indicating adequate internal consistency; test-retest reliability correlations ranged from 0.48 to 0.79.28,29
Perceptions of spousal involvement in CPAP was measured using an adapted version of a 25-item measure of strategies couples use to influence each other's health behavior.30,31 The original measure was developed using existing power/control measures as well as focus groups of couples discussing influencing each other's health, then subscales were assigned by 6 independent raters. In this study, we excluded 3 items from this measure because these items were not relevant to CPAP treatment (e.g., offering to change with the patient, making the change for the patient). Then, we adapted the remaining items in the scale to specifically reference perceptions of spousal efforts to influence CPAP use. Patients rated how often their spouse used each strategy over the past week. Response options ranged from 1 (never) to 5 (often, several times per day). We also re-named the subscale titles for easier interpretation (without changing the scoring of the measure). Subscales included collaborative (e.g., changed something at home, discussed CPAP), one-sided (e.g., gave space, dropped hints), positive (e.g., told me she was happy), and negative (e.g., tried to evoke negative emotion, withdrew). Some behaviors were combinations of these categories. For example, helping make changes at home to get the participant to use CPAP is considered positive and collaborative, whereas making the patient scared of the consequences of not using CPAP is considered negative and one-sided. Therefore, categories were not mutually exclusive and many items were coded in two categories. Cronbach's α for this scale (in the original form) has been reported as adequate (0.72 to 0.78.)30 In our sample, the Cronbach's α for the 4 scales was similar (0.72-0.80). The adapted measure was administered 7-10 days after initiation of CPAP treatment and at 3-month follow-up.
Patients completed an adapted version of the Support Actions Scale-C32 at 3-month follow-up as a measure of interpersonal qualities of behaviors associated with CPAP use. This measure was included to provide more specific information on the nature of interpersonal behaviors that were occurring between spouses in regards to CPAP. Based on the interpersonal circumplex, the measure included items that measure supportive behavior based on the 2 main axes of interpersonal behavior: affiliation and control.33 Thirty-two items of the 64-item measure were selected for use in this study. Items were selected by factor loadings on the octant scores and their relevance to transactions regarding CPAP. The instructions for this measure were adapted to interactions regarding CPAP use. Responses ranged from A (very unlikely) to E (very likely). Two dimension (affiliation and control) scores were computed. Excellent structural integrity and construct validity of the original 64-item measure with other measures of social support and circumplex measures of interpersonal behavior have been reported.32
Adherence to CPAP was measured using a memory card located in the CPAP apparatus which recorded the number of minutes per night the CPAP machine was turned on with the mask in place. Adherence downloads were ordered by the clinic's CPAP follow-up technician approximately 90 days after patients began treatment. Downloads were conducted by mail or in person by the patients' durable medical equipment company. Adherence was defined as average hours of CPAP use per night.
Data were analyzed using SPSS (v. 19). Descriptive statistics were computed to describe the sample characteristics, frequency and intensity of spousal involvement subscales. Change in spousal involvement from week 1 to 3-month follow-up was evaluated using paired t-tests. Correlations between spousal involvement week 1 and adherence at follow-up were calculated using Pearson correlation coefficients. Significance was defined as p values < 0.05 on two tailed tests.
Twenty-three patients initially completed questionnaires before starting CPAP and the spousal involvement measure 7-10 days after beginning CPAP treatment. Of those 23 patients, 16 responded to a request to complete a second spousal involvement measure 3 months after starting CPAP. Participant characteristics at week 1 are listed in Table 1. Average age was 47.3 years (SD 11.8) and average disease severity measured by the apnea hypopnea Index (AHI) was 36.5 (SD 26.4). All were married and except one participant (who was engaged and living with his fiancée), and all were white. There were no differences in age, AHI, adherence, relationship quality, or level of spousal involvement over the first week of treatment between patients who responded at 3 months and those who did not complete the second assessment (Table 2). Objective CPAP adherence data at 3 months was available for 14 patients (n = 12 patients who completed baseline and follow-up spousal involvement measures, and n = 2 patients with only baseline spousal involvement measures). Average adherence was 5.6 h (SD 1.3), and average number of days recorded was 88.4 (SD 45.9). Missing adherence data were due to inability to contact the participant to arrange a download of adherence data (n = 5), lack of placement of adherence card (n = 2), lack of adherence recording capabilities in the CPAP machine (n = 1), and moving out of state (n = 1).
Baseline participant characteristics, N = 23
* Objective adherence data were available for 14 patients with baseline data.
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Participant characteristics according to follow-up
{ label (or @symbol) needed for fn } p values are > 0.20 for all variables.
* One participant did not respond to this question.
** Objective adherence data were available for 12 of 16 patients in the group with both time points and 2 of 7 patients with baseline spousal involvement measures only.
*** Notes from follow-up with a sleep physician were available for 16 of 16 participants with both time points and 6 of 7 participants with baseline only.
Ratings of perceived spousal involvement from week 1 are listed in Table 3. Results demonstrate a range of commonly endorsed items from all subscales. Of the 25 items on the spousal involvement scale, the most commonly rated items were from the positive scale, such as "Changed something at work or home to get me to use CPAP," reported by 83% of patients with an average rating of 2.3 (approximately 1-2 times in the past week), and "Told me she was happy I was using CPAP," reported by 65% of patients with an average rating of 2.2 (approximately 1-2 times in the past week). However, negative items were also endorsed by many patients. "Tried to make me scared of the consequences of not using CPAP" was reported by 57% of patients and had an average rating of 1.9 (approximately 1-2 times in the past week).
Spousal involvement items and ratings week 1, N = 23
Average perceived spousal involvement scores total scores and subscores at 1 week and 3 months are presented in Figure 1. Average rating of within each subscore was low, in the range of less than 1-2 times per week. Perceived spousal involvement frequency at 3-month follow-up was only different for the negative subscore, which was lower at 3 months (p = 0.003). When perceived spousal involvement types were scored as either present or absent over the previous week, patients endorsed 5.75 items on the spousal involvement scale over the first week, and 4 items on the spousal involvement scale at 3-month follow-up (p = 0.07).
Change in average spousal involvement from one week to three months (N = 16)
*p < 0. 01
Perceived collaborative spousal involvement was positively correlated with adherence at 3 months (r = 0.75, p = 0.002, Figure 2). Total spousal involvement scores, positive, negative, and one-sided involvement were not associated with adherence.
Correlation between collaborative spousal involvement and adherence at three months (N = 14)
There was a trend for an association between perceived collaborative spousal involvement and ratings of relationship support (r = 0.388, p = 0.07), but this score was not associated with relationship conflict. With respect to interpersonal support behaviors (Support Actions Scale-C, adapted to focus on CPAP use), perceived collaborative spousal involvement was positively correlated with the affiliation scale (r = 0.55, p = 0.03) and demonstrated a trend with the dominance scale (r = 0.47, p = 0.07). This suggests the interpersonal quality of collaborative spousal involvement is warm yet has some degree of control. Total perceived spousal involvement score and other subscales (positive, negative, and one-sided) were not associated with relationship support, conflict, or interpersonal ratings.
The goals of this study were to systematically evaluate spousal involvement in CPAP treatment and the effects of such involvement on adherence. We found that perceived spousal involvement was present in the majority of male OSA patients at low but consistent levels between 1 week and 3 months after initiation of CPAP therapy. Patients reported their spouse was involved in CPAP approximately 4-6 different ways occurring 1-2 times per week. Despite this low level, patients reported experiencing a variety of involvement types from their spouse. For example, the majority of patients reported positive and collaborative involvement, such as changing things at home to facilitate adherence. However, over half of the sample also reported their spouse used negative types of involvement at least once during the week, such as trying to evoke fear over the consequences of not using CPAP. We predicted that both the positive and collaborative involvement types would be associated with adherence. Consistent with this hypothesis, we found that patients with higher perceptions of collaborative involvement in week 1 had higher CPAP adherence at 3-month follow-up. We did not find an association between those involvement types that were positive, (including collaborative and one-sided items), negative, or one-sided.
In addition to the spousal involvement measure, we also used a measure of interpersonal behavior to more precisely define the qualities of collaborative involvement. Results of this analysis demonstrated that collaborative spousal involvement is associated with the perception of warm and controlling interpersonal behaviors (e.g., helping in a friendly manner). Using an interpersonal framework allows for comparisons between our results with other previously reported studies of spousal interactions using different measures and in different populations, including measures of social support. In this case, we found that collaborative spousal involvement has similar interpersonal qualities as instrumental social support, which has been associated with adherence behaviors in other illnesses such as end stage renal disease and diabetes.34 The benefits of collaborative involvement appear to be two-fold. In addition to providing support and encouragement, collaborative involvement provides opportunities for spousal involvement problem solving, which can lead to better outcomes in problem solving tasks.35,36 Dealing with initial problems is a common occurrence in CPAP use, with up to two-thirds of CPAP users reporting initial problems with this treatment. These problems often require adjusting the equipment or learning strategies to get used to sleeping with the machine.37 Therefore, collaborative involvement from the spouse may provide both support and structure needed to overcome these initial problems in early CPAP use.
The longitudinal nature of our study allowed for evaluation of spousal involvement over several months. We found that most of the spousal involvement types remained consistent between 1 week and 3 months of CPAP treatment. The only type of spousal involvement that decreased was negative spousal involvement. One of the reasons this may have occurred is that negative spousal involvement may have been ineffective at motivating adherence or possibly caused annoyance or frustration. Previous studies have found that criticism tends to be unrelated to adherence or related to poorer adherence and emotional distress.26,38,39
Interpretation of results of our study are limited by a small sample size and attrition at 3-month follow-up. Furthermore, the high levels of adherence in our sample (average adherence > 5 hours) suggest there is a possibility of selection bias for those who entered the study and/or bias in the results due to attrition. Although not statistically significant, participants who dropped out of the study were less likely to share a bed every night, had higher AHIs and were less likely to have objective adherence reported. However, in notes from follow-up visits with a sleep medicine physician, there was no different between groups in whether the physician noted the patient self-reported having adequate or good adherence. In addition, the responses in this study are limited to the patient's report of the spouse's behavior. It is possible that patient observations may over or underestimate the frequency of spousal involvement. Indeed, one study of couples motivation and attitudes about health behaviors found spouse but not patient perceptions of spousal involvement to be related to behavior change efforts.30 Spousal involvement in CPAP adherence is likely an interaction between the patient and spouse's perception. Therefore, future research should consider the perspectives of both patient and spouse. Another consideration is that the findings of the current study are not necessarily generalizable to women with OSA. Due to significant gender differences in both the provision of and reactions to spousal involvement, it should not be assumed that results from male patients can be generalized to female patients.30,40–42
Future studies of spousal involvement should consider involving qualitative methods to gain more knowledge about the intricacies of spousal involvement in CPAP. The spousal involvement measure used in this study was developed in healthy couples discussing a range of health behaviors and did not take into account specific ways that spouses can be involved in CPAP usage (e.g., assisting with refilling the water reservoir or cleaning the machine). Many of the items administered in this study were rated with very low frequency. Not only could this have limited statistical power for the study due to restricted range, it may have not assessed potentially important behaviors because it was not developed with CPAP users. The measure also did not take into account individual differences in perceptions spousal involvement. For example, repeated reminders may be helpful for some patients and irritating to others. Therefore, investigation into both the specific types of involvement in CPAP treatment and also individual differences in perceptions of involvement should be taken into account in future research, particularly in the design of interventions.
In conclusion, this study demonstrates that the majority of married OSA male patients report that their spouse is involved in CPAP treatment in a variety of ways over the first three months of treatment. However, only collaborative spousal involvement was associated with higher adherence. Encouragement of collaborative involvement may lead to improvements in CPAP adherence through a blend of both support and structure for patients.
This was not an industry supported study. The authors have indicated no financial conflicts of interest.
This study was supported by an APA Division 38 Health Psychology graduate student research award, the University of Utah Sleep Wake Center, Grants 5K12 HD055884, and 1K23HL109110-01.
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Looking at waste
Hood River has a great recycling system with reusable opportunities for most of the stuff we tend to claim as garbage.
The district of Hood River has various recycling stations for our waste giving us the opportunity to reduce, reuse and recycle. The gorge of Hood River consists of many animal farms, orchards and vineyards that grow delicious fruits, which can all be affected if we don't recycle responsibly.
We are lucky to have a strong community that is willing to help us recycle, free of cost. By reducing the toxic waste we can increase the quality of our fruits and we can help our animals breathe fresh air and give them a cleaner environment.
Toxic waste affects the quality of our fruits in the Gorge because it is poisonous and dangerously chemically reactive. Toxic waste is often found in chemicals that often discard gases and create huge amounts of air pollution and land degradation to our fields. A way we can help decrease the toxic waste that goes into our environment is by taking the hazardous waste to our local garbage service area and there they can dispose of the toxic waste properly.
Hood River is a small community that consists of about 7,000 people. It is important for Hood River to produce less garbage because Hood River has many tourist attractions such as great railroads, the Columbia River, Mount Hood and many award-winning vineyards. Through the year there are many activities that go on, from our strong Gorge winds to our cold mountain and the beautiful blossom time.
Together we can all help save energy and take care of our environment by creating less garbage because we want to keep our Gorge in healthy conditions for our visitors, our children and ourselves.
It is important to save energy because the increase of carbon dioxide in our environment changes our climate locally. We can all help to save energy by choosing energy efficient products.
Using the recycling system can benefit all of us and is a great way to give back to the community by preventing toxic waste, and creating less garbage. The recycling system in Hood River is a practice that I challenge all of us to take part in and together we can build a strong and healthy community for our farms, orchards, vineyards, tourists and our children.
Cecy Castro
Hood River
We'll soon
have it all
In the April 20 Hood River News, Myles Green was kind enough to let us know that his recent move to Waltham, Mass., had uncovered an extremely well-stocked public library, a "delight" he only hoped we might also enjoy some day. Realistically, I doubt that we'll be able to.
You see, according to the 2000 Census, Waltham is home to two great universities (Brandeis and Bentley), a population almost 10 times Hood River's and a median family income 82 percent higher! That allows their $2 million library budget.
But, having been raised in the Boston area myself, I can attest that we've got the better scenery, more space in our backyards and relaxed, varied lifestyles which usually makes for happier people.
And, a beautiful library building that's reopening soon!
Dave Dockham
Hood River
Everyone uses oil
Concerned about the oil production protestors: Most drove to the protest; wear clothes that used oil to make; eat food that used oil to make. Cook that food using appliances that used oil to make and ship. Live in houses that use oil, etc.
Oil production has been shut down here in the U.S. so we depend on oil produced elsewhere. Even the wind generators use oil to make and transport to many sites.
What do the many wind techs use to get to the many sites? Electric cars that go 40 miles then spend 10 hours to recharge? Using batteries that used oil to make and transport, or the bikes that use oil to make or transport?
What is the answer? Then we could support them.
Paul Nevin
Hood River
Earth Day
It bothers me that I am writing this from a negative point of view, but I feel quite strongly about the concepts of Earth Day and conservation in general. I am not sure if our intentions always match our actions.
My son came home from school with a beautiful green water bottle yesterday. It is silk-screened with an OSU Extension Service label as well as a statement that it was paid in part by Oregon SNAP. I believe SNAP stands for State Nutritional Action Program.
It was just a month ago that my wife and I recycled several plastic water bottles we had accrued over the past several years from the various job fairs, health fairs and school-related activities and educational opportunities one or more of us attended. All the while we were deciding how many bottles to get rid of, I thought long and hard about the energy wasted to fabricate and print the bottles, ship then to a destination and haul away and recycle the packing material necessary to deliver those bottles.
We all have short memories, so memories on water bottles may help to remind us why we should recycle. I wonder how that works for stacks of bottles in the back of a cabinet? We can't be the only family with a collection of bottles.
We don't bring drugs to school to show kids what they should not do and we don't bring a gun to teach them not to shoot anyone. Why must we repeatedly give our children plastic water bottles in our schools and at health fairs to show them what a water receptacle looks like?
I hope anyone reading this with the authority to turn down water bottles as a nice "give away" with a polite explanation will do so if given the chance. These people will be heroes to me because they are making a global change through the foresight in their decision.
I think of those who organize the local Thursday Farmers Market and local restaurants who feature local goods as heroes as well because of the large positive impact they have on the environment in which we live and breathe.
Thank you for reading and thinking about this.
Steve Kaplan
Hood River
the positive
This is in reference to your letter written on Wednesday, April 20, Mr. Garry W. Koop:
It's too bad that you felt like it was your responsibility to bring more attention to the two incidences that occurred in Hood River, or as you said "Top story?" Isn't it bad enough that innocent people had to live and deal with the issues stated? I really wonder how you would have felt if either one of those would have happened to you?
There is so much negativity going on in the world today; appreciate the positive that gets printed in the Hood River News.
Cathy Fisher
Hood River
Still working
for change
Regarding Mr. Albiston's letter to the editor in Saturday's paper ("Why the silence?" April 23) and his accusation of hypocrisy, I think that many of us who protested for eight long years are no longer out there regularly because we now see the dysfunction in our political system.
We voted for change. As Mr. Albiston points out, Obama has continued the Bush policies of endless war, funneling money to the rich and pandering to the corporations who really control our country. If voting in someone who claimed to have different goals only brought more of the same, then obviously the political machine is worthless.
I find it more hypocritical to hear complaints from those who strongly supported Bush as he drastically increased our deficit and helped crash the economy. Why complain as Obama continues this work?
For those who were looking for change, many of us now work on the local level. We bring speakers to our communities to educate people on where our money is going. We stand up for union members who are being targeted as the cause of our economic problems. We speak in support of schools and libraries, local food, and our local economy. We're still out there, still working.
Theresa North
Hood River
Keep trails open
There was a trail that was closed in Post Canyon. It was a popular trail for many mountain bikers. It was closed pending the sale of the land to a timber company. I ask, is that fair? I love to mountain bike and understand the frustration of these people when a favorite riding spot gets blocked for something not all that critical.
This lumber company is going to buy the land, take the trees and leave it bare, until they can replant some trees. But what is the point? By the time the trees that were replanted are grown they will be gone and replaced by another round of trees.
Why can't the lumber companies just buy their own plots of land without interfering with recreational trails, and then plant trees and harvest them and continue to do so in a cycle?
I think that lumber companies should not be permitted to buy land on property that serves a recreational purpose so then the land can remain pleasant for the bikers, hikers and runners. After all, we only have a few of our natural forest left, like the redwoods and sequoias in California; so shouldn't we preserve as much as we can?
Ana Lenoir
White Salmon, Wash.
Superstore would help
Walmart has recently been approved for a 30,000-square-foot expansion, allowing more retail space. Expanding Walmart is great, but what about building a Super Walmart in Hood River?
I think residents in our area, and most likely residents from surrounding areas, would benefit from a super center. If a one-shop store opened in Hood River it would provide job openings to many unemployed. Along with a job offer, employees would be eligible for benefits, such as medical insurance.
As good as it might sound, I'm aware that not everybody approves it. The main concern about a Super Walmart in the area is the negative effect on small business. Rather than being threatened by Walmart's "everyday low prices," local business should get competitive. Lower prices would actually benefit us, the shopper.
I know there is a lot that needs to be taken into consideration in order for a new store to be built in the area, but I certainly think a super center in Hood River would benefit the community.
Marcela Castro
Hood River
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You are cordially invited to the FIRST EVER Slowdance Night in LONDON, ONTARIO!
With a lending library of designated dancers for all you wallflowers, and a dancecard-booklet to set up dances in advance (should you choose to), Slowdance Night has all slow songs, all night long! (Except for the occasional intermission when we play the fastest songs we can find!)
It's high school with a happy ending, and it's queer, straight, and senior-friendly too. Come and experience why slow is beautiful, and why love is not ironic.
PS. Fantastic and inspired attire, while desired, is not required. But would be AWESOME.
Brennan's Beer & Bistro (www.brennansbeerbistro.ca)
347 Clarence St.
London, Ontario
Saturday, January 29th, 2011
Doors at 8:30, Dance from 9 PM - 2 AM.
$8 admission includes your Dancecard-Booklet!
RSVP on the Facebook Event Page!
(Warning about the event page - in recent weeks, Facebook has been weird about event pages. Sometimes they just don't show up. If this is the case, just ignore the link. All the info you need about this event is here on this page!)
"Relive the prom without the angst." - the Canadian Press
"In an age where physical contact is a scarce commodity, an event that brings strangers safely together is long overdue." - The Montreal Gazette
"I really like hugging people, and this is like, a five-minute hug." - Telyn Kusalik, one of our guests
For more info, please join our facebook group,
"Slowdancers of the World Unite & Dance Slow"
or go to our blog: http://www.slowdancenight.
A NOTE ABOUT INCLUSIVENESS: This will be a queer, straight and trans-friendly event! You may be asked to dance by someone of the same, opposite, or indeterminate gender! We are delighted by this and we hope you are too. If, however, that prospect scares you, then it is probably a good idea for you to stay home. Assholes, and assholishness, will NOT BE TOLERATED. Our entire aim is to create a safe and welcoming place for everyone to ask anyone they like to dance.
A NOTE ABOUT THE DANCE CARDS: The dancecards are these little booklets that contain a setlist of every song that will be played that evening. The idea is that during the course of the evening, you can "book" certain songs with certain people, and vice versa. So when your charming hosts announce a particular song, you can look on your dancecard and see who it is you're going to dance with next. There is a little space after every song where people can write their names. How filled your dancecard gets depends on you, of course. Ask someone to dance! Or give someone meaningful looks! Look for the Dancecard-Signing Station located somewhere on the premises, usually near a light, where small pencils are available. The dancecards also - thoughtfully - have lots of empty places where you can write down the names and numbers of charming people whom you may have danced with that night. Use of the dancecards, is, of course, optional, and completely up to you. Proceed at your comfort level.
A NOTE ABOUT THE RULES OF ENGAGEMENT: The Rules essentially state that as someone coming to Slow Dance Night, you have the right to ask anyone you want to dance. But whoever it is you asked has the right to refuse your request, and not have to give any reason why. But wonderfully, you have this right as well. This is done because slowdancing with someone is rather an intimate sort of enterprise, and a minor commitment, and you should have the right to back out anytime you wish. Slow Dance Night is about consensual respect and enjoyment. Just because you may have danced with someone for most of the song, if at any point you are feeling unsafe or uncomfortable, you can simply walk away. If whoever it is persists in their attention, locate one of the organizers, and they will be ejected from the premises. And fucked-up. Anyone who refuses to comply by the rules will be fucked-up.
A NOTE ABOUT THE DESIGNATED DANCERS: On any particular night there will be a handful of our Designated Dancers available to dance with you for the first half of the evening - so arrive early! They will be wearing shiny powder blue sashes, and these Designated Dancers are warm, charming, and safe people to ask to dance. Of course, the same Rules of Engagement apply, and they, as free agents, can decide for themselves who they want to dance with, and for how long, but in all likelihood, they would be very open to dancing with you. Please think of them as a warm taxi light in the middle of a blizzard; the cast of a lighthouse, when you are too far from shore and shrouded in fog; a glimmer of hope after a lifetime of desolation. Well, actually, that might be pushing it. Please think of them as a temporary safe harbour. They will also be looking for you, and asking you to dance, trying in their way to turn wallflowers into perennials. Finally, we are always looking for designated dancers for our evenings. If you are outgoing, warm, and willing to undertake the very serious duty and responsibility of inviting wallflowers out onto the dancefloor - if in fact, such a prospect gives you great joy - then please contact the organizers at email@example.com


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Passing the Testby Anthony SanFilippo / Philadelphia Flyers
GLENS FALLS, N.Y. – Mike Testwuide has been patient. He's had no other choice.
A healthy scratch in six of the previous seven games, and having not dressed since December 1, the Phantoms power forward has been searching for an individual identity in coach Terry Murray's system, trying to reclaim a regular spot that was his in the Phantom's lineup in each of the previous two seasons.
It's been a pretty tough road to hoe for the 25-year-old.
After a successful four-year run at Colorado College, the Flyers signed him to a free agent contract in March, 2010.
The Flyers were excited about his potential because of his size and his knack for scoring goals.
In his first professional season, Testwuide started to show glimpses of that promise, potting 18 goals and finishing with 39 points in 76 games for the Phantoms in 2010-11.
But then his production dipped in 2011-12. His goal total went down to 12. His point total dropped to 29. And, although it's not always a great indicator of on-ice performance, his plus/minus rating waned considerably, going from a plus-12 in his first season to a minus-5 in his second.
This year, he's played fewer games than any active Phantoms forward except Jason Akeson, who has only been with the team for 11 games.
And when he's played, his ice time has been limited to mostly fourth line duty with scant – if any – special teams time.
The knock on Testwuide was that he wasn't thinking the game correctly. It wasn't that he wasn't trying, or that his effort was missing, it's just that the effort and energy was a little misguided and didn't always fit within the structure of Murray's system.
Murray had hoped that Testwuide would figure it out on his own, but no matter how many times he struck flint to steel, while he would get the occasional spark, the tinder would not ignite.
So, Murray decided to give him a push.
Saturday, Testwuide was back in the lineup, but when he saw his number on the board it was in a foreign location.
"When I looked at it he had me at center," Testwuide said. "I've never played center in my life."
The move was a shrewd one by the wily coach. Put a player who needs to focus more on details in a brand new position, so he has no choice but to focus and play within the confines of the game plan.
For one night, it was a resounding success. Although the Phantoms still lost a good hockey game 3-2 to Manchester, Testwuide was excellent.
He scored one goal, probably scored the second, although he said he wouldn't request a scoring change, and all told, played his best game of the season under Murray.
"We need some balance here," Murray said. "We've been relying a lot on (Sean) Couturier and (Brayden) Schenn and it's nice to see (Testwuide) step up. He's been doing a lot of hard work and doing a lot of skating when he was out of the lineup. He got an opportunity and came up big time."
His goal came when he took a nice drop pass from Jeff Dimmen and sniped a wrister to the top shelf far side. It was just his second goal – and point – of the season.
The second goal – which ultimately goes into the annals as belonging to Tyler Brown after it hit his skate on a shot by Danny Syvret – was probably batted in by Testwuide – he said he got his stick on it, even if the replay officials beg to differ – but the play was made possible by Testwuide skating hard to the net and looking to make something happen, rather than just lingering on the outskirts of the play.
"(Murray) kind of threw a curveball at me when I came in and looked at the lineup and I was a centerman," Testwuide said. "Sometimes shaking up things like that you have to think about positioning – I've never been in those positions, I've never really been a centerman. It was kind of cool to feel the puck a little bit more and get some opportunities with the puck.
"Coming into the lineup, I just wanted to contribute, get some energy for the guys, take some minutes away from the guys who are logging 20-plus minutes," he said. "If we can get a couple minutes away from them I think they'll stay fresher. I think it paid off."
And Murray took notice of it, which means Testwuide should get yet another chance when the Phantoms take on St. John's Wednesday at the Glens Falls Civic Center.
" It wasn't just him scoring," Murray said. "There was good energy and he used his size and strength and moved the puck well. He held onto the puck and carried it. I liked what he gave us."
The next step is to continue to give that effort to the team whether it's at center, or somewhere else.
"I wouldn't say I'm the new center for the team," Testwuide. "I wouldn't say that at all. But I liked the new look and I liked having the puck on my stick, but I'm not going to change my tires – I'm a right winger for sure."
Erik Gustafsson missed his first game of the season Saturday with a right foot injury after blocking a shot in the third period of Friday's game.
The good news for the Phantoms is that x-rays came back negative, which means Gustafsson should be back expeditiously.
"I'd be really disappointed in myself if I couldn't play Wednesday," Gustafsson said. "But to be honest, it still hurts a lot, but I'm pretty sure I'll be O.K."
Gustafsson is considered the Phantoms top defenseman and is third on the team in scoring with 14 points.
To contact Anthony SanFilippo, email firstname.lastname@example.com or follow him on Twitter @AnthonySan37