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2014 Rules Package Published for Comment
The Tennessee Supreme Court today published the annual package of recommendations from the Advisory Commission on Rules of Procedure and Evidence. Proposals include new authority for appellate courts to suspend rules; requirements for electronic copies of transcripts; specification of the color of applications; responses and amici in TRAP 9 and 11 matters; and refinement of criminal contempt provisions. Four TBA sections -- Appellate Practice, Litigation, Tort and Insurance Law and Criminal Justice -- will be asked to review the recommendations and propose comments on behalf of the association. Comments on the proposals are due Nov. 27.
|Amendments to TN Rules of Procedure & Evidence-Comment Order_09112013.pdf


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LYNBROOK - A police officer from Long Island who survived Sept. 11 was honored at LaGuardia Airport Thursday afternoon as he retired.
Port Authority K-9 Lt. David Lim, of Lynbrook, was the first Asian K-9 officer in the Port Authority and had served for 34 years. Co-workers describe him as a hard worker who served as a mentor and role model to younger officers.
Lim was one of only 14 people inside the World Trade Center who survived the collapse in 2001. He was on the fourth floor with six firefighters, helping rescue an older woman in a stairwell when the building collapsed. Lim was pulled from the rubble 5 1/2 hours later.
Lim says he decided to stay on the force after Sept. 11 because he felt he had more to learn and more to give.


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The wavelength dependent transmission performance of adaptively modulated optical OFDM (AMOOFDM) signals is investigated, for the first time, over optical amplification- and chromatic dispersion compensation-free IMDD SMF systems using semiconductor optical amplifiers (SOAs) as intensity modulators. A theoretical SOA model describing both optical gain saturation and gain spectral dynamics is developed, based on which optimum SOA operating conditions are identified for various wavelengths varying in a broad range of 1510nm–1590nm. Results show that, SOA intensity modulators operating at the identified optimum conditions enable the realization of colourless AMOOFDM transmitters within the aforementioned wavelength window. Such transmitters are capable of supporting >30Gb/s signal transmission over 60km SMFs.
© 2009 Optical Society of AmericaFull Article | PDF Article


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Donald Douglas: Providing health care for the uninsured
For nearly 40 years gastroenterologist Donald Douglas of Lewisburg, Pennsylvania practiced medicine in the traditional way. He worked in comfortable medical suites and hospitals with access to the best equipment that technology offered. Most of his patients had insurance coverage that allowed them to pursue the treatment they needed.
He could have retired from his profession, never stepping outside his comfort zone.


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The Rap Map
Hing Hay Park
From "Talk Story" by Blue Scholars
LyricsSo I was walking around Hing Hay Park, right / Sun was goin down, we gettin off of work late
A small, quarter-block, tree-lined brick clearing with a small pagoda in the center. Literally translates to "Park for Pleasurable Gatherings". Neighbors all around Chinatown kick it in the park from dawn 'till dusk.
The park is on the route home for Geo. Admittedly, it takes about 10 seconds to walk from one end to another.


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Note: Supplemental materials are not guaranteed with Rental or Used book purchases.
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What is included with this book?
Note: This is the bound book only and does not include access to the Enhanced Pearson eText. To order the Enhanced Pearson eText packaged with a bound book, use ISBN 0133830888.
This widely popular text uses a management approach organized around the processes and procedures necessary for implementing effective human resources administration to give students a comprehensive, user-friendly look at the fundamentals. It presents the human resources function within the context of public school districts; covers the eight essential dimensions of the human resources function: human resources planning, recruitment, selection, placement and induction, staff development, performance evaluation, compensation, and collective negotiations; and looks at the legal, ethical, and policy aspects of human resources administration.
Now available as an affordable e-book, Ronald Rebore's Human Resources Administration in Education weaves the language of technology throughout; includes more stories and personal examples; poses reflective questions on the focus scenarios; includes a section on value added performance evaluation and more information on win-win collective negotiations; and includes updating throughout. The Enhanced Pearson eText features assessments and internet resources.
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Ronald W. Rebore has 22 years of experience as a central office administrator: nine year as the Assistant Superintendent for Business and Finance with the Lindbergh School District; five years as the Superintendent of Schools for the Valley Park School District; and eight years as the Superintendent of Schools for the Special School District of Saint Louis County. He is currently a Professor in the College of Education and Public Service at Saint Louis University.
He was the Missouri State President of the Association of School Business Officials in addition to serving on various committees of the Association of School Business Officials International. He has also served as an evaluator for the North Central Association of Colleges and Secondary Schools. During his professional career, Professor Rebore has conducted numerous workshops and seminars on educational leadership and has served as a consultant to many school districts. He received a Bachelor of Arts Degree in philosophy, a Master of Education Degree in counseling and guidance, and a Doctor of Philosophy Degree in educational leadership from Saint Louis University.
Ronald Rebore's 46 publications include twelve books. Two of the books have been published in multiple editions. Human Resources Administration has ten editions and two of his books have been translated into Chinese. Over the years, his research has become focused on the human rather than the technical dimensions of educational leadership.
1 Organizational Dimensions
2 Human Resources Planning
3 Recruitment
4 Selection
5 Placement and Induction
6 Staff Development
7 Performance Evaluation
8 Compensation
9 Collective Negotiations
10 Legal, Ethical, and Policy Issues in the Administration of Human Resources


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The best control and display strategy will do the same as a qualified human therapist—it will assist the patient's movement only as much as necessary. Future projects and studies will focus on socalled patient-cooperative or subject-centered 342 Special Populations Figure 23.5. The Zurich arm rehabilitation robot ARMin.
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FUNCTIONAL NEUROANATOMY AND CORRESPONDING VASCULAR SUPPLY To make sense of the signs and symptoms of strokes affecting the frontal lobes and frontal lobe function, it is necessary to understand the vascular supply of the frontal–subcortical networks kamagra sildenafil citrate oral jelly. Kumral, Bayulkem, Evyapan, & Yunten, 2003). The frontal lobes themselves are supplied by the ACA and MCA, whereas the distributed components of frontal lobe networks may be nourished by small branches from the ACA, MCA, and PCA.
We switch to an anatomical approach, for smaller arteries. We use a vascular ap- 448 N E U R O LO G I A L D I S E A S E S proach, for larger arteries. • The mesial, superior frontal, and cingulate gyri, and the mesial extension of the precentral gyrus, the paracentral lobule, and orbital sectors are supplied by the anterior branches of the ACA (orbitofrontal, anterior and middle, posterior internal frontal, and paracentral branches) (H.
F. S., et al. Benson, D. M., Friston, K.
Neuropsychologia, 31, 997–932. J., Paulesu, E., Frackowiak, R. Investigations of the functional anatomy of attention using the Stroop test.
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When the Manchester City players wheeled away in delight after winning the Capital One Cup final penalty shootout against Liverpool, one man held back.
City captain Vincent Kompany 's first instinct was to console the Liverpool players before taking part in his side's celebrations.
TV cameras caught Kompany walking back to talk to the dejected Reds before joining his victorious team-mates who understandably raced towards their fans at Wembley.
Class from @VincentKompany - consoling the #LFC players before joining City celebrations pic.twitter.com/LQ0duTmjtE— Liverpool FC News (@LivEchoLFC) February 28, 2016
Misses from Lucas Leiva, Philippe Coutinho and Adam Lallana cost Jurgen Klopp's side dearly in a shootout in which they had held the advantage following Fernandinho's miss for City. Willy Caballero, the backup goalkeeper, was City's hero with three saves as his team ran out 3-1 winners on penalties.
Earlier, Fernandinho had given City the lead early in the second half before Coutinho equalised late on to take the game to extra time.
Reaction to Kompany's gesture:
Absolute class from Vincent Kompany, who went to console #LFC players before joining #MCFC's celebrations.— Melissa Reddy (@MelissaReddy_) February 28, 2016
Touch of class from Kompany going to console #LFC players after the shootout before joining the City celebrations— James Pearce (@JamesPearceEcho) February 28, 2016
Classy by Kompany at the end. Consoling #lfc players as City team-mates celebrate— Mark Ogden (@MarkOgden_) February 28, 2016
Kompany went straight to the Liverpool players to console them instead of celebrating— Jay (@JAM_LFC) February 28, 2016
The game in pictures:


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Effects of Prestorage vs Poststorage Leukoreduction on the Rate of Febrile Nonhemolytic Transfusion Reactions to Platelets
The purpose of this study was to assess the incidence of febrile nonhemolytic transfusion reactions (FNHTRs) to concurrent transfusions of prestorage-leukoreduced (PreSLR) pooled platelets, poststorage-leukoreduced (PostSLR) pooled platelets, nonleukoreduced (NonLR) pooled platelets, and apheresis single-donor platelets (SDPs) to compare the rates of FNHTRs to PreSLR vs PostSLR pooled platelets. Reported transfusion reactions to platelets at 15 hospitals for a period of 45 months were retrospectively reviewed. Reaction rates to different types of platelet products were calculated and compared. During the study period, 70,015 platelet transfusions were administered. Among these, 152 (0.22%) FNHTRs and 111 (0.16%) allergic transfusion reactions were seen. Reported rates of FNHTRs were 0.07% (SDP), 0.16% (PreSLR), 0.30% (PostSLR), and 0.20% (NonLR) (P < .05 for PreSLR vs PostSLR). Rates of allergic reactions were 0.16% (SDP), 0.17% (PreSLR), 0.18% (PostSLR), and 0.11% (NonLR) (P > .05). The rates of reported FNHTRs were low for all types of platelet transfusions. SDPs and PreSLR pooled platelets were associated with a slightly lower rate of FNHTR compared with PostSLR pooled platelets.
- Transfusion reactions
- Leukoreduction
- Platelets
Febrile nonhemolytic transfusion reactions (FNHTRs) are characterized by fever (≥1°C elevation) that may be accompanied by chills, rigors, hypertension, tachycardia, and dyspnea without another clinical explanation.1 Leukocytes and cytokines released by leukocytes in the transfused allogeneic blood components are important causes of FNHTRs,1,2 but other mediators such as platelet-derived soluble CD154 (CD40 ligand) are also likely involved in its etiology.3,4 Leukoreduction removes leukocytes from cellular blood components and has been shown to reduce the rate of FNHTRs to RBC and platelet transfusion.1,5–8 Leukoreduction of pooled whole blood platelet concentrates can be performed at any point during their storage. Prestorage leukoreduction (PreSLR) refers to removal of WBCs soon after component preparation (ie, before storage) whereas poststorage leuko-reduction (PostSLR) usually occurs just before the products are issued for transfusion. Single donor platelets (SDPs) are typically leukoreduced at the time of apheresis collection. Leukoreduction, especially when performed at the time of issue from the blood bank, has limited efficacy in reducing the rate and severity of FNHTRs to platelets because the level of cytokines in the platelet concentrates is correlated with the age of the platelets.9–11 Therefore, to effectively prevent or decrease the frequency of FNHTRs to platelet transfusion, leukoreduction should ideally be performed at the time of collection or shortly thereafter. Leukoreduction would not reduce the amount of CD154 elaborated by the platelets themselves, thus it is unlikely that leukocyte filtration by itself can completely eliminate the risk of FNHTRs.
Although PostSLR has been the mainstay of leukoreduction in our transfusion service, in July 2008 we began using a device approved by the US Food and Drug Administration which permits prestorage pooling, leukoreduction, and bacterial detection of whole blood platelets (Acrodose, Pall Medical, East Hills, NY). This study was performed to test the hypothesis that the rate of FNHTRs to PostSLR pooled platelets was higher than that to PreSLR pooled platelets or SDPs.
Materials and Methods
Patients and Clinical Data
The centralized transfusion service (CTS) provides blood components and transfusion medicine clinical services to 15 local hospitals in the greater Pittsburgh (PA) area. Selective leukoreduction is used for patients with clinical indications for leukoreduced blood components. The most common indications are organ or stem cell transplantation, hematologic or solid organ malignancy, cardiac surgery, or a history of FNHTR. All patients at the local children's hospital receive leukoreduced blood components. SDPs are primarily reserved for patients who require human leukocyte antigen (HLA)–matched platelets. All other patients receive nonleukoreduced (NonLR) blood components. For this study, data were collected on all platelet transfusions between August 2007 and February 2010 at 15 hospitals served by CTS.
Suspected transfusion reactions were reported to the hospital's blood bank by the clinical team who used a standard form across all hospitals; the form includes pertinent patient information as well as signs and symptoms observed during the reaction. Investigation for hemolysis included clerical check, visual inspection for free plasma hemoglobin, and direct antiglobulin test (DAT). Transfusion reactions were evaluated by a single team of transfusion medicine physicians who reviewed the patient's clinical and laboratory data and rendered an interpretation. For this report, transfusion reactions were classified as acute hemolytic, delayed hemolytic, febrile nonhemolytic, allergic (mild, moderate, and anaphylactic), septic, unrelated to transfusion, or caused by the patient's underlying disease according to established criteria.1 Allergic transfusion reactions to the different platelet types, which are caused by a mechanism distinct from FNHTR and are not affected by the timing of leukoreduction, were also enumerated to serve as a control for any potential reporting bias between the different platelet types. Reaction rates were calculated by dividing the number of reactions to each type of platelet component by the total number of platelets of that type transfused during the study period. The protocol was approved by the University of Pittsburgh Medical Center's Total Quality Council.
Platelet Components
SDPs were collected through apheresis and leukoreduced at the time of collection (Trima, CoridianBCT, Lakewood, CO). PreSLR pooled platelets (Acrodose) were manufactured from whole blood platelets within 36 to 48 hours after the donation. PostSLR pooled whole blood platelets were leukoreduced using the PXL8c filter (Pall Medical) in the blood bank immediately before issue. Patients with an indication for leukoreduced pooled platelets received exclusively PostSLR pooled platelets before July 2008. In July 2008, the transfusion service added PreSLR pooled platelets to its inventory and they have been used interchangeably with PostSLR platelets for patients with indications for leukoreduced blood components. The standard issuing practice was to use the oldest platelets first. The standard pool size for PreSLR, PostSLR, and NonLR platelet doses was 5 whole blood platelet units. Transfusion of a 5-unit platelet pool or 1 SDP was considered 1 transfusion episode.
Statistical Analysis
The rates of FNHTRs to the different types of platelet products were compared using the χ2 test. The ages of the platelets associated with transfusion reactions were compared with the ages of platelets that were not associated with reactions using 1-way analysis of variance. A P value of less than .05 was considered significant.
During the study period spanning 45 consecutive months, 70,015 platelet doses were transfused Table 1. There were 152 (0.22%) FNHTRs and 111 (0.16%) allergic transfusion reactions reported. The rates of FNHTR to SDPs, PreSLR, PostSLR, and NonLR pooled platelets were 0.07%, 0.16%, 0.30%, and 0.20%, respectively (Table 1). The rate of FNHTRs to SDPs and PreSLR pooled platelets was significantly lower than that to PostSLR pooled platelets Figure 1. The rate of FNHTRs to NonLR platelets was also lower (P = .045) than that to PostSLR platelets (Figure 1). No significant differences were found in the rates of allergic reactions among the different types of platelet products (P > .05 between any groups) (Table 1).
For PostSLR and NonLR platelets, the average age of platelets associated with FNHTRs were older than that of platelets not associated with reactions Figure 2. The average age of the SDP, PreSLR, PostSLR, and NonLR platelets that were implicated in FNHTR was 4.1, 4.6, 4.3, and 4.4 days, respectively. The proportion of older (4- to 5-day-old) platelets in pools associated with FNHTRs was significantly higher than that of pools not associated with FNHTRs for the PostSLR and nonLR pooled platelets Figure 3.
We analyzed more than 70,000 platelet transfusions, making this study one of the largest platelet transfusion data sets on FNHTRs to date. Four types of platelets (SDP, Pre-SLR, PostSLR, and NonLR) were concurrently available and used during the 45-month study period. The study showed that the rates of FNHTRs to all platelet components were low. The rates of FNHTRs to SDPs and PreSLR platelets were similar to those seen in 2 previously published studies6,7 and lower than one recently published study.12 A 2-fold increase was observed in the rate of FNHTRs to PreSLR pooled platelets (0.16%) compared with SDPs (0.07%), but the difference was not statistically significant (P = .067) because of the small number of reactions. This may be because the PreSLR platelets underwent leukoreduction between 36 and 48 hours after donation, which, even in that short interval, permits the accumulation of pyrogenic cytokines.9 A recent study revealed that some cytokines start accumulating in the donated whole blood within hours after donation.13
This study demonstrated a nearly doubled rate of FNHTRs between PreSLR and PostSLR pooled platelets but both rates are quite low. Previous studies have shown that Pre-SLR apheresis and whole blood–derived platelets were more effective in decreasing the frequency of FNHTRs to platelet transfusion than plasma removal, which was in turn more effective than poststorage leukoreduction.10,14 This study revealed a clear temporal correlation between the timing of leukoreduction and the rates of FNHTRs SDPs that underwent leukoreduction at the time of collection had the lowest rates of FNHTRs, PreSLR that underwent leukoreduction 36 to 48 hours after collection had more than twice the rate of FNHTRs compared with SDPs, and PostSLR that underwent leukoreduction at the time of product issue had the highest rates of FNHTRs (Table 1 and Figure 1). Furthermore, Post-SLR and NonLR pooled platelets associated with FNHTRs were on average older compared with the same type of platelet product that was not associated with FNHTRs. These findings are also consistent with previous studies that demonstrated an increased rate of FNHTRs to platelets that had been stored for at least 3 days.11,15–17
A selective leukoreduction strategy was practiced at all CTS hospitals. In this study, patients were given transfusions with either leukoreduced or NonLR blood products exclusively. The patients who received NonLR platelets were general medical and surgical patients who usually do not require long-term transfusion support. Although the rates of FNHTR to NonLR pooled platelets were similar to that of PreSLR (P = .382) pooled platelets and lower than that of PostSLR (P = .045) pooled platelets, we do not believe any clinically meaningful conclusions can be drawn from these numbers because of the inherent differences in the patient populations given transfusions. It should also be emphasized that leukoreduction provides other important benefits such as minimizing HLA alloimmunization and reducing the risk of transfusion-transmitted infections (such as cytomegalovirus) to specific patient populations, in addition to reducing the incidence of FNHTRs.1
This study had several limitations. Because reaction rates were calculated from a retrospective review of passively reported reactions, underreporting of reactions could have led to lower calculated rates of reactions. To assess whether there was a bias in reporting reactions to one type of platelet component vs another, we analyzed the rates of allergic reactions. No significant differences were seen in the reported rates of allergic reactions among the 4 platelet types, which suggests that a reaction reporting bias for patients receiving different types of blood products was not present. Because this was a retrospective review, we did not have the opportunity to measure the levels of pyrogenic cytokines in the platelets involved in the transfusion reactions. CTS hospitals do not have a universal premedication policy, and the premedication status of the patients receiving transfusions was unknown. However, a recent study has shown that premedication is ineffective in preventing FNHTRs; thus the reduction in FNHTRs caused by premedication is probably minimal.18
In summary, we demonstrated increasing rates of FNHTRs to transfusions of SDPs, PreSLR pooled platelets, and PostSLR pooled platelets. PostSLR and NonLR platelet concentrates associated with FNHTR were on average older than the same type of products not associated with FNHTR. Our study supports and expands on previously published data9,10 demonstrating that the timing of leukocyte removal during platelet storage likely influences the amount of accumulated cytokines in the transfused platelet products and plays an important role in the pathogenesis of FNHTR to platelet transfusion.
We thank Ronald Radocay at The Institute for Transfusion Medicine for his support in platelet data collection and Mark Yazer, MD, for his valuable comments on the manuscript.
- © American Society for Clinical Pathology


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License & Identifications
A medical license is required for a doctor to practice medicine in a particular state. Requirements vary by state but most require, at a minimum, post-graduate training in the doctor's specific specialty. An NPI number is a national identifier unique to an individual health care provider and is managed by the Center for Medicare & Medicaid Services (CMS).
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Photos: Oct. 20 storm damage
Washington is the county seat of Washington County, home to 15,000 people. The area can trace its history back to the mid 1700s.
It's a city that can trace its roots back to the days of the American Revolution. Take a tour back in time with us as we look at the early days of Washington, Pennsylvania.


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The Argyle Sweater by Scott Hilburn
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Comments (23) (Please sign in to comment)
Who knew?
It's a half-baked plan at best.
Cutting edge of mugging, Does the star make him law enforcement?
Don't be a hero, Cookie…
just do what he says!
His heart is empty….
he can't even see his own good points.
He believes he's got nothing to lose….
So when the chips are down, he's perfectly willing to cut you!
Careful, those might be some tough cookies!
I wonder if that's the thief that cut Reeses to Pieces??
He might have taken on more than he bargained for. Those cookies look kind of chippy to me.
They're probably relatives of these.
Chocolate Chip Cookies
A family favourite.
1/2 cup shortening (lard or vegetable)
1/4 cup white sugar
1/2 cup brown sugar (light or dark, it doesn't matter)
1/2 teaspoon vanilla extract (real only, or the taste will be off)
1 egg, well beaten ( a medium works well, but a large works best)
1/2 cup nuts, chopped (optional) Mum never put in nuts, and I never have either.
1 cup semi-sweet chocolate chips
1 cup plus 1 tablespoon all-purpose flour (sift the flour before measuring, and always sift about 1/2 cup more than the recipe calls for. This makes it easier to measure and you just put the extra back in the bag.
1/2 teaspoon salt
1/2 teaspoon baking soda (not baking powder)
Maraschino Cherries
Cream shortening, brown sugar, white sugar, and vanilla together.
Add egg, beat till fluffy.
Add chocolate chips all at once, and beat until evenly distributed.
Set aside for the moment.
Sift together the flour, salt, and baking soda and stir with a spoon so they're evenly distributed.
Divide the flour mixture into three.
Add them one at a time to the shortening/sugar mixture, blending each one in well.
Put the bowl in the fridge for an hour.
Cut enough Maraschino Cherries so you have 30 pieces.
When the dough has finished chilling, drop by rounded tablespoonsful (you'll get +/- 2 dozen cookies) onto well greased cookie sheets.
Put a piece of Maraschino Cherry on top of each cookie and lightly push it in.
Bake in a fully preheated moderate oven ( 350°F) for 12 to 15 minutes. Keep a close eye on the cookies after the ten minute mark so they do not burn.
Once out of the oven, slide them onto a cake rack to cool.
Just another Hollywood con artist; telling them he can make them into stars.
I don't knead your wallet, just your dough.
If they catch him he'll do time in the Toll House.
There's nothing worse than a Christmas cookie cutter gone bad. He was once the Star of Bethlehem, got pretensions, was kicked out by the angel cutter. Got in a bad batch of marijuana brownies, then to worse things. That white stuff he's dusted with is not flour!
chip in you two, don't give me a raisin to show you how the cookie crumbles.
comprehensive chuckle
That's what you get for taking the alley to avoid the Toll House.
…oh my god, those sound good…
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From the Department of Clinical Neurophysiology (Dr. Hagander), Karolinska Hospital, Stockholm, Sweden; Fysiologlab in Stockholm (Dr. Harlid), Stockholm, Sweden; and the Department of Clinical Neurophysiology (Dr. Svanborg), University Hospital, Linköping, Sweden.
Eva Svanborg, MD, PhD, Department of Clinical Neurophysiology, University Hospital, 58223 Linköping, Sweden; e-mail: firstname.lastname@example.com
This study was supported by grants from the Swedish Society of Medicine, the Swedish Heart and Lung Fund, the Swedish Sleep Research Society, and the research funds of Karolinska Institute.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).
© 2009 American College of Chest Physicians
It is not fully understood why habitual snoring frequently progresses to obstructive sleep apnea syndrome (OSAS). Vibrations per se may cause peripheral nerve lesions. Therefore, snoring vibrations could cause nervous lesions, leading to impaired reflex activation of dilating muscles at inspiration. In this study, the methodology for quantitative sensory testing in the oropharynx was developed, and the presence of sensory nerve lesions in patients with OSAS and snoring was evaluated.
Vibration detection thresholds (VDTs) and/or cold detection thresholds (CDTs) were tested at the tonsillar pillars, tongue, lip, and finger in 23 nonsnoring individuals, 13 habitual snorers (apnea-hypopnea index [AHI] < 10), and 31 patients with OSAS (AHI > 20).
At tonsillar pillars, there were significant gender differences in both VDT and CDT, with women having lower thresholds. VDT showed no significant differences between any of the three groups when men only were tested. Two nonsnoring control subjects could not detect vibrations at all. When both genders were tested, there was significant difference only between nonsnorers and patients with OSAS (p = 0.003). CDT showed significant differences between nonsnorers and snorers (p = 0.001) and also between nonsnorers and patients with OSAS (p < 0.001), but not between snorers and patients with OSAS. CDT was easier to test than VDT with low variability in nonsnorers.
CDT gave more discriminative results than VDT. Signs of sensory nervous lesions were present in the oropharynx of most patients with OSAS and some snorers, supporting the hypothesis of a progressive oropharyngeal nervous lesion. CDT testing could be a useful clinical method to evaluate the degree of oropharyngeal nervous lesions in patients who snore and in those with OSAS.
During obstructive sleep apnea (OSA), the upper airway dilating muscle activity is insufficient to overcome the negative inspiratory pressure. Sensory nervous lesions, causing impaired reflexes, could give rise to such upper airway collapse. Some previous studies have demonstrated signs of sensory impairment in patients with OSA syndrome (OSAS). Reduced sensibility regarding thermal stimuli,1 vibration,2 and two-point discrimination has been reported,3 as well as impaired mucosal sensory function at multiple upper airway sites.4
OSAS/rhoncopathia is in many cases a progressive disorder.5 The reason for this development is not fully understood. In many cases, there is a correlation between the impairment of obstructive respiration and weight increase, but not always. In one study,6 there was no certain correlation between increases in apnea-hypopnea index (AHI) and body weight, and in another study,7 marked worsening of obstructive breathing was found in some patients despite weight loss. Some other factor could, therefore, also be responsible for disease progression.
A majority of patients have reported8 that they have been habitual snorers for years before apneas become apparent. Snoring implies vibrations of the tissues that produce the sound. It is well known from occupational medicine that long-term use of hand-held vibrating tools may induce local peripheral nerve lesions in the hands.9 We, therefore, hypothesize that snoring-induced vibration may cause local peripheral nerve lesions in the oropharynx, contributing to OSA development.
Quantitative sensory testing (QST), evaluating vibration detection thresholds (VDTs) as well as thermal thresholds, is increasingly used in clinical routine and research for the assessment of peripheral neuropathies. The VDT evaluates the function of large myelinated sensory neurons, and thermal thresholds evaluate the function of thin myelinated and unmyelinated fibers. Under standardized conditions, QST in the extremities is reliable and reproducible.10–12 Impaired vibration and thermal thresholds may be an early sign of subclinical or mild peripheral neuropathy.13 Impaired vibration and thermal thresholds may, therefore, be early signs of subclinical OSAS (ie, snoring without significant apneas).
Our aims for this study were to develop methods for QST of thermal and vibration sensitivity in the oropharynx, and to use this to compare oropharyngeal sensitivity in patients with OSAS, habitual snorers, and nonsnoring subjects.
Thirty-one patients with OSAS, 13 habitual snorers, and 23 nonsnoring control subjects were included in the study. Subject characteristics are summarized in Table 1. The exclusion criteria were as follows: previous treatment for OSAS or snoring; neurologic illness or medical condition that might cause peripheral neuropathy; smoking; previous upper airway surgery; and recent upper respiratory tract infection.
Values are given as the mean (maximum-minimum), unless otherwise indicated. For "Years Snoring," 20 years is the maximum estimated time if the patient reported that snoring had been present since youth.
All patients were referred because of habitual snoring and suspicion of OSAS. The patients and the nonsnoring control subjects underwent whole-night sleep respiratory recordings including respiratory movements, airflow, snoring, body position, and pulse oximetry (Embletta; ResMed; Trollhättan, Sweden) the night before sensory testing. The QST investigator (L.H.) was unaware of the results of these recordings. OSA diagnosis was defined as an AHI ≥ 20 events per hour. Habitual snorers were included if their AHI was < 10 and if they snored during > 50% of their estimated sleeping time. Control subjects were included if sleep respiratory recordings showed < 20% snoring time and an AHI < 5 events per hour, and if cohabiting persons denied habitual snoring. All patients estimated the number of years that they had snored habitually before testing (Table 1).
VDTs were examined on both anterior tonsillar pillars, on the lower lip, and over the index finger pulp of the nondominant hand. A tool (Vibrameter Type IV; Somedic Inc; Sollentuna, Sweden) producing 100-Hz vibrations was used, with a custom-made intraoral probe, consisting of a 10-cm long vibrating pin with a stimulating surface area of 6 mm2 in diameter (Fig 1). When testing the lower lip or the pharyngeal mucosa, a constant application pressure was visually ensured by the investigator. VDT was determined by the method of limits.10 The stimulus intensity was increased from zero to the point where vibration was first detected. Five stimuli were given at each site, and the mean was calculated as the threshold. If vibrations were not perceived, a value of 70 μm was used for the statistical analysis.
Thermal thresholds were measured by using a thermal sensory analyzer (Medoc 2000 TSA; Medoc Inc; Ramat Yishai, Israel) with a custom-made intraoral probe (Fig 2) having a circular stimulating surface diameter of 9 mm2. A constant application pressure was visually ensured by the investigator.
Cold detection thresholds (CDTs) and warm detection thresholds were tested separately on both anterior tonsillar pillars, on the tip of the tongue, and on the lower lip. Thermal thresholds were determined by the method of levels.10 The starting (adaptation) temperature was 32°C when testing the lower lip, 34°C at the tip of the tongue, and 36°C at the tonsillar pillars. The rate of temperature change was 1°C/s in all thermal tests. The first search step was 3°C and the final search step was 0.1°C. Random dummy stimuli were used. Thermal thresholds were expressed as the calculated difference between detection temperature and adaptation temperature. If no sensation of cold was perceived, a temperature of 15°C was used for the statistical analysis.
The Mann-Whitney U test was used for the statistical comparison analysis among the three subject groups. Average values of the thresholds from both tonsillar pillars were used for each subject. Statistical significance was set at p < 0.05. Regression analysis was performed to compare the matched data.
Ethical consent to conduct the study was given by the ethics committees at Karolinska Institute, Stockholm, and the Linköping University Hospital. All patients and control subjects gave informed consent.
The mean vibration threshold at the lip was 3.5 μm (range, 0.4 to 9.6 μm; 95% confidence interval [CI], 2.3 to 4.7 μm), and at the index finger it was 1.3 μm (range, 0.5 to 7.4 μm; 95% CI, 0.6 to 2.0 μm). CDTs were expressed as the difference between the threshold and the adaptation temperature. The mean CDT at the tip of the tongue was 1.2°C (range, 0.4 to 3.0°C; 95% CI, 1.0 to 1.6°C), and at the lower lip it was 0.6°C (range, 0.1 to 1.2°C; 95% CI, 0.5 to 0.8°C). There were no significant group differences at any of these sites.
Warmth detection testing was not performed in any patient, since seven consecutive healthy subjects did not experience the sensation of warmth at the tonsillar pillars, despite testing at the maximal temperature level (50°C). One healthy subject and two patients with OSAS could not go through with any of the tests in the upper airway because of strong gag reflexes. VDT was not possible in one additional patient with OSAS due to a large tongue. Due to technical reasons, CDT could not be performed in 4 subjects, nor could VDT be performed in 10 subjects (ie, 16 nonsnorers underwent both tests and another 3 patients underwent either CDT or VDT only). Eleven snorers underwent both tests, and another two snorers underwent CDT only. Twenty-two patients with OSAS underwent both tests; another five patients underwent CDT only, and one patient underwent VDT only.
There were gender differences in VDT and CDT at the tonsillar pillars. Such differences were not found in the other tested sites. Both oropharyngeal VDT and CDT were significantly higher in nonsnoring men compared with nonsnoring women (p = 0.006 and p = 0.02, respectively) [Fig 3]. All women except one were premenopausal. There were no significant age differences (mean age for women, 42 years; mean age for men, 36 years).
The results of VDT testing at the tonsillar pillars for both men and women in all groups are given in Figure 4, A. VDT differed significantly between nonsnoring subjects and patients with OSAS (p = 0.003), but not between nonsnoring subjects and snorers or between snorers and patients with OSAS. However, there was a larger percentage of women in the control group than in the other two groups. When the results for men only were compared, there were no significant differences in VDT among any of the groups (Fig 4, B). The variability in the control group especially was large; two nonsnoring men did not experience any sense of vibration at all, despite maximal output of the equipment. Neither did one snorer and two patients with OSAS. Altogether 5 of 19 nonsnorers (26%), 7 of 11 snorers (64%) and 20 of 23 patients with OSAS (87%) had VDT values exceeding the upper 75th percentile (> 15.8 μm) for nonsnoring subjects.
CDT showed a low variability among the nonsnoring control subjects. None of the patients had a threshold for cold sensation below 31.8°C. CDT differed significantly between nonsnoring control subjects and patients with OSAS (p < 0.001), and also between nonsnoring subjects and habitual snorers (p = 0.001) [Fig 5, A]. There was no significant difference between snorers and patients with OSAS. Six patients with OSAS and one snorer did not perceive cold at the lowest tested temperature (15°C). When men only were examined, almost the same results were obtained (Fig 5, B). The significance for difference between control subjects and snorers was p = 0.005, and between control subjects and OSAS patients it was p = 0.001. There was no significant difference between snorers and patients with OSAS (Fig 5, B). Five of 9 snorers and 19 of 28 patients with OSAS had values exceeding maximum threshold values for nonsnoring control subjects. Six patients with OSAS and one snorer did not perceive the sensation of cold at the lowest tested temperature (15°C).
There was no significant correlation between the degree of sensory impairment in terms of CDT or VDT vs the measures of apnea severity. Neither were there any correlations between CDT and VDT and the number of snoring-years, as reported by the patients, or VDT and CDT vs age in nonsnoring subjects.
A new finding in this study was the gender difference in oropharyngeal sensitivity, with significantly higher thresholds for sensations of both vibration and cold in nonsnoring men. Gender differences were not found in any other tested site, which is in agreement with the findings of previous studies.14,15 One reason for our finding could be that healthy men are more likely to snore occasionally than healthy women. Also, greater intrathoracic negative inspiratory pressures usually develop in men than in women during sleep, which may harm their receptor structures. On the other hand, lower oropharyngeal sensitivity in men might be one explanation for why they are more prone to snoring than women.
There was significantly reduced oropharyngeal sensitivity for both vibration and cold in patients with OSAS compared with the nonsnoring subjects, but not concerning vibration when men only were tested. In snorers, such a difference was present for cold but not vibration. The snorers showed less pathology in all tests, however, with greater variability. One reason for test results deviating from those of the control subjects in the snorers group could be that some of them actually experienced sleep apnea. In mild cases, the night-to-night variability can be considerable, and we only have data from one night of sleep respiratory recording. There were no statistically significant differences between snorers and patients with OSAS in VDT or CDT, but there was a trend, as seen in Figures 4 and 5. In most patients with OSAS, there was a good concordance between VDT and CDT. However, in habitual snorers, most subjects had discordant results. CDT was more commonly affected in those who underwent one pathologic test, both concerning patients with OSAS and snorers. Thus, CDT gave more discriminative results.
Our findings regarding the sensory function in the oropharynx confirm the results of previous studies. Kimoff et al2 measured vibratory sensation and two-point discrimination at the tonsillar pillars and found significantly increased thresholds in patients with OSAS and snorers vs nonsnoring control subjects. Guilleminault et al3 reported reduced sensitivity to two-point discrimination in the upper airways in patients with OSAS and snorers compared with nonsnoring individuals, but there were no significant differences between patients with upper airway resistance syndrome (who may or may not snore) and nonsnoring control subjects.3,16 Nguyen et al4 reported reduced sensitivity to the touch of air pulses at different sites in airways. The "air-jet" technique has the advantage over the techniques we employed in that it may be applied to a much wider area in the upper and lower airways; but, it cannot discriminate between different sensory modalities, since it will stimulate pressure, cold, and touch receptors.
Larsson et al1 tested oropharyngeal thresholds for warmth and cold in patients with OSAS and nonsnoring control subjects, and found significant differences. Most tested subjects experienced the sensation of warmth at the anterior tonsillar pillar. In the present study, no nonsnoring subject experienced warmth at this site despite testing at 50°C. The reasons for this discrepancy could be different probe size, type of equipment, or testing algorithm. Larsson et al1 employed custom made equipment with a smaller probe. Testing was performed according to the Marstock method,17 with alternating cold and warm stimuli. In the present study, the method of levels10 was employed, in which testing of cold and warmth was done separately. The Marstock method has been criticized, since cooling will influence the ensuing warm perception and vice versa.18
CDT and especially VDT were much higher at the tonsillar pillars than at any other site. Variability was much greater for VDT than for CDT in the nonsnoring group. Two control subjects did not experience vibration at this site at all. Some control subjects and patients had difficulties in defining the sensation as vibration; more like touch, pressure, or pain. In clinical routine, VDT is usually performed with application of the probe against skin closely overlying bone. If application is made against soft tissue, the thresholds will be higher and the sensation will have a different quality.19 Therefore, VDT is a less suitable test method in the soft palate.
VDTs in the extremities are increased with age,20 while this is not as pronounced concerning CDT.14,21,22 Fowler et al23 found no effect of age on CDT in the face. In the present study, there were no age-related changes concerning either CDT or VDT in the nonsnoring control subjects. However, it cannot be ruled out that this was due to the small number of investigated subjects in different age groups.
The findings in the present study support the previously formed hypothesis24 that the inability of the dilating upper airway muscles to maintain airway patency during sleep is due to peripheral nerve lesions, causing partial paresis and/or impaired dilating reflexes at inspiration, worsening over time. Snoring vibrations, repeated every night for several years, might cause progressive, local nervous lesions in the oropharynx as part of the pathogenesis of OSAS. In the present study, there were no signs of impaired sensitivity in any other location than the tonsillar pillars in the patient groups. The habitual snorers showed less pronounced pathology in both VDT and CDT than the patients with OSAS. However, there was no significant correlation between the degrees of sensory impairment vs the measures of apnea severity.
An exposure-effect relationship for vibration-induced neuropathy has been shown in humans.25 In animals, it has been shown26 that both unmyelinated and myelinated fibers in the hind leg are damaged after vibration exposure. Another possible reason for impaired oropharyngeal sensitivity could be excessive pharyngeal pressure swings and violent muscle contractions against the occluded airway, causing inflammation and edema. Inflammatory cell infiltration has been found in the mucosa as well as the musculature of the upper airways in patients with OSAS.27–30 However, it has been demonstrated by Puig et al31 that vibration per se, simulating snoring, of the bronchial epithelial cells triggers inflammation, which is seen as a release of interleukin-8.
There are also data indicating a local motor neuropathy in the oropharynx. Muscle biopsy studies27,28,32 of pharyngeal muscles have shown signs of denervation in patients with OSAS. Friberg et al33 found indications of progressive nervous lesions in histologic studies of palatopharyngeus muscles from heavy snorers and patients with OSAS.
In occupational medicine, the avoidance of further vibration exposure is a critical part of treatment due to the dose-response relationship of vibration exposure and local neuropathy.34 In the study by Lundborg et al,26 the neuronal changes were reversible after 4 weeks without vibration exposure. We speculate that the early treatment of snoring in predisposed individuals could prevent OSAS. The elevated sensory thresholds in some snorers probably indicate an early sensory nervous lesion, and these patients may, therefore, be especially at risk for the development of OSAS. If this is the case, oropharyngeal CDT testing might, in the future, become a clinical routine test to find those snorers in whom active treatment is warranted.
apnea-hypopnea index
cold detection threshold
confidence interval
obstructive sleep apnea
obstructive sleep apnea syndrome
quantitative sensory testing
vibration detection threshold
Dr. Hagander performed all the quantitative sensory tests and participated in the writing of the article. Dr. Harlid recruited most of the patients and participated in the writing of the article. Dr. Svanborg was the scientific mentor of Dr. Hagander, performed the statistical analysis, and participated in the writing of the article.
The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
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Guys, I've been buying here.
Little nibbles, I sense desperation out there.
They are trying to make us believe that the USD is healthy.
Give me silver and gold as money, then I believe that things are under control.
Each successive trillion has had a lesser impact, now even a few hundred billion is meaningless.
You're right. The positive impact of more and more new fiat has evaporated, but it allows them to maintain their positions of power and that's what they are doing. In fact, I recall reading about a study a couple of months ago that indicated that we have crossed over the threshold and are at the point to where these new infusions of money now have a seriously detrimental impact on the economy, probably as the result of further value depreciation, but with a mental degradation component as well.
When (and if, frankly) the dust settles insofar as the "cliff" is concerned, we would be foolhardy to expect anything like fiscal responsibility and ought to be prepared to deal with further monetary expansion. It really is the only arrow left in their quiver.
The only people that like the current situation regarding the metals is JPM. They may be able to salvage that losing position they've built if the pricing can be manipulated low enough. Then I would expect them to become the engine to accelerate the price of the metals to the upside.
But you should also be mindful of the upcoming further attack on your gun rights. It may be a tangentially related aspect of the upcoming economic default. Hint, Hint.
Yeah James Turk is right, why didn't they send some serious auditors in to that vault in London?
And why is all that Gold "flying" out of Afghanistan? All the low hanging fruit has been picked already and rehypothecated over and over. China and India are going to keep finding and digging for what's left for a long long time, one way or another.
I wonder what will the be the thing that flips the metals into mania mode. Perception is the false reality right now. Behind the scenes there much preparation taking place for a huge bid on the metals IMO.


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Voices of Peace From Ground Zero, Democracy Now! and WBAI Broadcast Around the World On Pacifica Radio, Community Radio Stations, Public Access Cable Television, Dishnetwork Channel 9415 , Free Speech
This is viewer supported newsDonate
Considered the "Queen of American Folk Music," Odetta has introduced audiences worldwide to American roots music andespecially African-American folk, blues and gospel. As a major voice in the American Civil Rights Movement, shemarched with Dr. Martin Luther King, Jr. in Selma, sang for the masses in Washington in 1963, and performed forPresident John F. Kennedy at a civil rights presentation on national television.
She has shared the stage with Paul Robeson, Nina Simone, Pete Seeger, Joan Baez, Bob Dylan, and many others. HarryBelafonte once said, "Odetta is a vast influence on our cultural life."
On September 29, 1999, President Bill Clinton presented Odetta with the National Endowment for the Arts' Medal of theArts.
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- 4 total posts
- 2 reviews
- 2 comments
Reviews by janeasch
Minoxidil - Las Vegas, NV
Minoxidil works! Within 3 months my hair got thicker and after 6 months the new growth got long enough to cover all thinning spots on the top of my head. I wouldn't be without it even though it causes my blonde hair to have a reddish cast. I just use Shimmer Light shampoo to tone down the... READ MORE
Corrective Surgery to my Lips - Las Vegas, NV
Dr. Parker is an artist surgeon. For 15 years I lived with lip implants (skin from another part of my body) that were too large. My smile was distorted and you couldn't see my teeth. Not one of the 20+ surgeons I consulted, in four different states, would help me, stating they did not want to... READ MORE
Recent comments from janeasch
Get a stretchy band and exercise your arms, also use deep penetrating skin cream on them. READ COMMENT
I also got dizzy from Botox in the forehead and it has been a week and I am still dizzy. It's lessened a little though. I hate vertigo. Never getting Botox again. READ COMMENT


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The first 2 entries for the 2017 edition of the Another Dam 50K have been received. On line registration will open on November 1. Mail in is available any time.
Come check out the Englewood MetroPark.
It will be a pleasant day at the park!
For race information click here.
For an entry form in text format click here.
For an entry form in WORD format click here.
For a location and course map click here. It's pretty big so be patient.
To confirm your entry click here.
For the race results click here.
For race photos click here.
To see a list of everyone who has finished the Another Dam 50K click here.
|Open (39 and under)
|David Riddle (3:30:34)
|Alice Essinger (4:32:45)
|Master (40-49)
|Eric Hunziker (3:39:02)
|Terri Lemke (4:25:36)
|Grand Master (50-59)
|Craig Wheeler (4:17:34)
|Linda Barhorst (5:03:17)
|Senior (60+)
|Kenneth Sirois (5:13:25)
|Ingrid Honzak (6:21:54)


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Leaving no doubt
Mike Trout's historic rookie season has led exactly where everyone expected.
The Angels outfielder won the American League Rookie of the Year Award on Monday, taking the honor without a dissenting vote. He became the eighth player to unanimously win the AL award, the 18th overall. Trout is the first Angels player to win the Rookie of the Year since 1993, when Tim Salmon won, also unanimously.
Trout, who learned of the award on a live MLB Network broadcast, said it was an "incredible honor."
Trout finished ahead of Oakland Athletics outfielder Yoenis Cespedes and Texas Rangers pitcher Yu Darvish, who were second and third, respectively, but it was really no contest.
All 28 voters, two members of the BBWAA representing each city in the AL, put Trout in the top spot on their ballots.
Starting the season at age 20, Trout became the first rookie to combine 30 homers and 40 steals. He led all rookies in average (.326), homers (30), RBIs (83), stolen bases (49), on-base percentage (.399) and slugging (.564).
Trout also played spectacular defense in center.
Of all the lines on his resume, Trout said he was most proud of his run total, but most surprised by the home runs.
"I knew my power was there," Trout said. "I didn't know it would come so quick."
The only drama is now to look ahead. On Thursday, the BBWAA will reveal the MVP results, and Trout is one of the five finalists, although he's expected to finish behind Triple Crown winner Miguel Cabrera.
"At the end of the year to be in the talk of MVP, with the big guys like Miguel Cabrera, who won the Triple Crown, is an incredible feeling," Trout said. "It's a hard one to explain."
Once the MVP announcement passes, though, Trout's focus will be fully on 2013.
First, he's most likely going to be without his mentor, Torii Hunter. Hunter is expected to sign with a new team within a couple of weeks.
Trout is also likely to be learning a new position next year. As good as he was in center, the Angels believe Peter Bourjos is better at that spot. Barring any more player movement among the outfielders, Trout is expected to move to left to make room for Bourjos in center.
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CityPASS Home » City Traveler Blog » Play the Tampa Bay Trivia Scavenger Hunt!City Traveler Blog
Play the Tampa Bay Trivia Scavenger Hunt!
Today's a BIG day for Tampa Bay! It marks the official start date of Tampa Bay CityPASS. To celebrate, we thought it would be fun to host a little contest on Facebook. For a chance to win 2 Tampa Bay CityPASS booklets, simply play our Tampa Bay Scavenger Hunt. You can enter once per day through May 31.
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Wspaniałe i spokój Apartament
Maks. liczba gości5
Rozmiar55 m²
- Przyjazny dla rodziny/dzieci
- Kuchnia
- Pralka/suszarka
- Ręczniki
- Zmywarka
- Zwierzęta dozwolone
- Internet
|Chemin des Courrèges, 33290 Parempuyre, Francja
|Rodzaj nieruchomości
|Kod referencyjny
One of the bedrooms have two single beds and the other one has a double bed. Of course all of the three beds are comfortable to ensure that you will be well rested during your vacation. Also, the sofa in the livingroom can be converted into a sofa bed, providing this accommondation with the capacity of 6 people.
Staying here will make you experience the real French country side, have som nice wine and just enjoy your days.
If you have any questions please feel free to contact me. I am an experienced host who take great pride in giving my guests an amazing experience. I hope to hear from you soon!
|Opłata tygodniowa dla maksymalnie 4 gości
|3187 zł
|Opłata miesięczna za maksymalnie 4 gości
|9059 zł
|Cena za >4 gości
|159 zł opłata dodatkowa od gościa/nocy
|Zameldowanie po
|Do ustalenia
|Zameldowanie przed
|Do ustalenia
|Wymeldowanie przed
|Do ustalenia
|Zasady Anulowania Rezerwacji
The apartment matched the photos exactly. It was well equipped and clean. The majority of the space consists of a large glass sunroom. It was somewhat chilly in the dead of winter. A nice surprise was the adjustable bed which was very comfortable. The heaters kept the bed and bath plenty warm.
We had a bit of difficulty communicating on arrival because we have almost no French and Eliane has very little English. However, she cleverly telephoned a friend to act as an interpreter and we solved that problem.
The location is a bit hidden away and feels rural even though it is only a few blocks from a shopping center with a McDonald's.
The wireless internet connection was weak and slow but we were able to check email as needed.
- Gwarancja jakości zakwaterowania
- Każdy gospodarz jest weryfikowany telefonicznie
- Bezpieczna płatność za pomocą szyfrowania SSL


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Newegg.com - A great place to buy computers, computer parts, electronics, software, accessories, and DVDs online. With great prices, fast shipping, and top-rated customer service - once you know, you Newegg.
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Showing Results: Most Recent
This review is from: Mushkin Enhanced Stealth 16GB (2 x 8GB) 240-Pin DDR3 SDRAM DDR3 1600 (PC3 12800) Desktop Memory Model 997069S
Pros: - Like any RAM worth its salt, you plug em in, system recognizes them, and they just work
- No errors in any memory benchmarks to speak of yet
Cons: - They didn't open the case and install themselves.
Other Thoughts: Purchased these to be able to load planets in Space Engineers - I had nowhere near enough RAM+VRAM to play at faster than powerpoint speeds. These were listed at a great price so I ordered them.
I've never had a problem with any Mushkin products that I've bought, including this kit.
They work flawlessly, which makes me very happy.
I can actually defend my base from space bugs successfully now. Thanks Mushkin.
This review is from: ARCTIC F12 PWM Fluid Dynamic Bearing Case Fan, 120mm PWM Speed Control, 74CFM at 22dBA
Pros: - More quiet than most other fans at this CFM
- Well designed
- Hydro bearing
- 4-pin PWN or 3pin w/ molex adapter
- This particular model allows for daisy-chaining, which to me is a huge plus
Cons: - Cannot prepare me bacon and eggs for breakfast.
Other Thoughts: The daisy-chaining feature is really great for smaller builds that have motherboards with only one system fan header. I purchased three of these to help cool a now RMA'd r9 390 card, and they do a fantastic job especially at their comparatively low noise level.
I've been using Arctic fans for around 6 years now, from case fans to HSF units and I've yet to find anything to really complain about. I do a lot of computer builds and have tried all sorts of case fans, but always keep an eye out for this brand if the budget allows.
No, these are not completely silent, but neither are the exponentially more expensive Noctua, and these look a lot better to me anyway. At eight bucks they're really reasonable, especially with the daisy-chaining feature. There are cheaper fans out there, true, but for how well these perform the price is right. Will definitely buy more when I do another build.
This review is from: ASUS Radeon R9 390 DirectX 12 STRIX-R9390-DC3OC-8GD5-GAMING 8GB 512-Bit GDDR5 PCI Express 3.0 HDCP Ready Video Card
Pros: The price/performance ratio is very good. I game at 1440p, and in benchmarks and actual game test, the 390 outperforms the competition by a good amount. I am usually on Team Green, but I took a calculated risk and went with this card.
Newegg's shipping was good, as usual.
I don't regret my purchase . . .
Cons: . . . Except I think I do.
Unfortunately I think I got a bad card. The card itself would get very hot in sudden intervals. It would spin up the fans immediately, and cool them down again just as suddenly, even when in normal web browsing.
This is especially strange as I have a great case with good cooling and airflow. The card would still idle around the 70s, and under load, it would actually reach its thermal threshold around 95 and throttle itself. Very very disappointing.
Even more disappointing is that these tantrums eventually led to one of the fans breaking. One sudden spin up caused one of these fans to break a blade. Now when this fan reaches over 50-ish percent, it makes a very very loud rattling sound, which I assume is caused by the now unbalanced fan. Normally I'd be okay with a rattling fan, but the noise is severe enough to shake my workspace and it makes me fear that prolonged usage will cause further, potentially fatal damage no just to the card, but the other components in the case.
To clarify, this card was the only expansion card installed in this particular build, so no possible obstructions could have made contact with the fan as there are no cables or other components remotely near the spinning fans. I have over 10 years experience putting together custom systems and I have never experienced this sort of problem before.
As it stands, I cannot honestly give this card more than two eggs, and even considered giving it one.
However, I have to be as fair as possible, despite my negative experiences. When the card wasn't throttling itself, it was absolutely wonderful with most games that I threw at it in 1440p and maximum settings. Modded Skyrim with ENBs and 2k textures, Warframe, MechWarrior Online, Witcher 3 all easily reached 60FPS and greater even with my low-ish end FX8320.
But it didn't stay this way for very long, and would routinely thermal throttle itself, underperforming the 760 it replaced by a sizable amount.
So to conclude, either I got a lemon, or the heatsink+fan design on this model is very poor for how hot the 390 itself gets. Even more disturbing is that this is a high-end card, so one would think that the HSF solution would also be quality.
Other Thoughts: For most people, I'm sure Newegg would come through. It always has for me - with this one exception.
Due to a technicality, Newegg could not take back the card themselves for replacement and asked me to deal with ASUS directly.
I have contacted ASUS support already and am shipping it back under warranty for possible repairs. The gentleman told me that it is up to the repair technician whether or not this repair actually falls under warranty. If not, who knows what the cost of repair will be to replace a cheap fan? This is my first purchase from Asus so I really don't know.
On top of this worry, it's going to cost a significant amount to ship it to their service center, but even more sad is that what was supposed to be a gift will not be around until well after the holidays. Disappointment doesn't even BEGIN to express what I feel right now and I can't imagine what my intended recipient will feel when I have to tell them that their gift is still in the mail. I don't look forward to this encounter at all.
At the end of the day, this card will end up costing me far more than the sticker price and sour Christmas this year.
I am happy that many reviewers are having a good experience with their cards, but my experiences have been very poor overall.
I'll definitely update this review once the RMA process has matured.
I really hope Asus will remedy this situation.


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Love this Blue and Gold Eye #Makeup Look With an Egyptian Influence ❤'d by http://makeupartistrycairns.com.au/
Acho que fui Cleópatra na outra vida! Amo! Más
The Cleopatra look | Elizabeth Taylor
Egyptian makeup... Okay not for really wearing out but reminds me of a late sunset in Egypt
Elizabeth Taylor in 'Cleopatra', 1963. Queen of the Nile? She looks like a goddess of the universe.
Picture of Kristin Kreuk #egyptomania
halloween makeup? hair-makeup -why didn't I think of this last year when Jessi was Cleopatra?
Cleopatra makeup. …
Gold Metal Asp Snake ARM BAND Cleopatra egyptian greek goddess queen
Cleopatra makeup More


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Alpaca Teddy Bears
Alpaca Teddy Bears are made of soft and gentle natural alpaca fur. These teddies have a lovable look and a delightful feel and they are available in several colours and fur types. Alpaca Teddy Bears have an ultimate cute factor that is appreciated by both children and grown-ups!
Alpaca Teddy Bears are made of the best quality alpaca fur to ensure a silky and delicate finish. The fur is processed in the traditional way so that you can feel the difference in the luxury, richness and soul of these teddies with every touch. Each of them is handmade to the highest quality standards and no two teddies are identical. Alpaca Teddy Bears will bring the warmest of hugs to everybody!
Alpaca Fur Key Points
Alpaca fur has very soft and lustruous fibres that makes it ideal for luxurious high-quality products. It comes in various natural shades, therefore no two alpaca fur items are the same. Alpaca fur contains no lanolin and is naturally hypoallergenic, therefore it is excellent for people with sensitive skin.


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Gregory J. Wood, Chartered Professional Accountant
Serving Kitchener, ON
Call 519-804-9847 or Request an Appointment
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This 50 watt halogen light bulb by Sylvania is 30-percent more energy efficient than comparable bulbs thanks to a special reflective coating.
50 watt IR 12 Volt Sylvania Tungsten Halogen Tru-Aim MR16IR. Has a UV-Stop Capsule that greatly reduces any potential for fading of merchandise or decor. Bi-Pin Base. SYLVANIA IR halogen lamps feature a special infrared-reflective coating on their inner capsules that makes them up to 30 percent more energy efficient. One bulb per pack. Price is for one bulb.
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This was a "doggy" cake made for a dog's birthday party. The person cake looked like a dog bone. I found a dog friendly recipe, which was a big dog hit. I and a few other people guests tried it, and it was quiet tasty, like carrot cake.
CakeCentral.com is the world's largest cake community for cake decorating professionals and enthusiasts.
(if this is a private computer)
Yes please, register now!


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Researches at GIGA – CRC (Cyclotron Research Center) in vivo imaging range from radiopharmaceutical production to in vivo imaging with positron emission tomography and also with magnetic resonance imaging and electrophysiology. Studies are conducted in small animals for brain, cancer or cardiology preclinical researches and for drug development, and in humans for understanding biological processes underlying sleep, mood, addiction, cognition (memory, attention, executive functions), movements, consciousness and their disorders (dementia, Parkinson, impaired consciousness, epilepsy…).
|Principal Investigators
A GIGA team, in collaboration with Italian, English and americans researchers, showed that the responsiveness of neurons control was one of the means used by the body clock to maintain our cognitive functioning. This discovery, published this week in Nature Communications, shows that even the simplest aspects of brain function are affected by our circadian clock, with moments of lesser reactivity or exacerbated reactivity of neurons.


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Charlie Weis knows better than to trust Tom Zbikowski.
Herring turns in trustworthy start
Premium Content
Subscribe today to read the full article and get everything Rivals has to offer.
- Member-only message boards
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Master of Monsters
|This article needs additional citations for verification. (March 2007) (Learn how and when to remove this template message)
|Master of Monsters
PC-9801 cover art
|Hayato Matsuo
|MSX, PC-8801, Sharp X1, PC Engine, PC-9801, Sega Genesis, Sega Saturn, PlayStation, Microsoft Windows
|Release date(s)
|Turn-based strategy game
Master of Monsters is a turn-based strategy game developed by System Soft for the MSX and NEC PC8801. It was later ported to a variety of consoles and PCs including the PC Engine, NEC PC9801, Sega Mega Drive (Genesis), Sega Saturn and PlayStation. While it never garnered the same success as its System Soft stablemate Daisenryaku, the game garnered a loyal following. Its success in the North American market on the Sega Genesis proved sufficient for a sequel on the Sega Saturn, and an anime art-style enhanced PlayStation version titled Disciples of Gaia with a Japanese role-playing game feel.
Gameplay engages players by permitting them to summon and move monsters around a board in an effort to capture towers and to eventually defeat the opponents (which are controlled either by other humans or by the computer program). Moves are based on a hexagonal board structure, such that every tile on the board is adjacent to six other tiles. Other notable features were the large variety of monsters, upgrading ("leveling up") of veteran units and control of a "Master" character who, if killed, can end the game for that player.
The focus of the game is strategic, despite the fantasy-type characters that might imply an RPG element. Other than the existence of the Master character and magic in the game, the gameplay is very similar to System Soft's more hardcore modern warfare strategic wargame series Daisenryaku, with the exception that some versions of the Master of Monsters (such as Master of Monsters – Final) series allow equippable items, weapons and armor.
The game Lords of Chaos by Julian Gollop of Mythos Games predates Master of Monsters by one year, shares many of the same elements of summoning and tactics, and may be an inspiration, along with the earlier title Chaos from 1985. David White, creator of the open source turn-based strategy game Battle for Wesnoth, cited Master of Monsters as an inspiration.[1] Master of Monsters was also compared to later games such as the role-playing video game series Pokémon (which also revolves around commanding monsters) and the real-time strategy game Starcraft.[2]
System Soft Alpha returned the game to its strategy-based roots, and the two entries in the Master of Monsters series as originally popularized on the NEC 9801 PC were updated by System Soft Alpha with new graphics and gameplay features. Two more sequels were made for Japanese Windows and hark back to the deep strategic gameplay of the NEC PC9801 versions (as opposed to the more casual Genesis and PlayStation versions). Available for Japanese language Windows-based systems, the remakes include マスターオブモンスターズIII Special Edition, マスターオブモンスターズ4 ~光と闇の争覇~, Master of Monsters Value Edition (the original game, updated and with expansion packs added in), and 真・マスターオブモンスターズ Final. A spin-off of the game targeted towards the younger audience was titled Masumon Kids. A mobile version of the game is available in Japan.[3]
- ^ WesnothPhilosophy – Wesnoth
- ^ Buchanan, Levi (17 June 2008). "Top 10 Renovation Games". IGN. Retrieved 12 August 2016.
- ^ webmaster. "Vi". Retrieved 16 January 2015.


text: ×Close Product Image 1 of 2 Eyeshield 21, Vol. 17 See all 2 images Eyeshield 21, Vol. 17 (Book #17 of Eyeshield 21) By Riichiro Inagaki Edited by: Andy Nakatani / Illustrated by: Yusuke Murata With their former kicker back on the team, the Devil Bats have a real shot at closing the gap against the Seibu Wild Gunmen. But Seibu is still a major threat. Can the Devil Bats hold on for the victory? × Added to Cart List Price $7.99 Your Cart ( items) Cart total Continue Shopping CHECKOUT NOW Choose a format: 1st Edition Trade Paperback Format: 1st Edition Trade Paperback VIZ Media LLC | 200 pages | ISBN 9781421511665 | December 2007 Add to Cart List Price $7.99 In Stock: Usually ships within 1 business day Browse Related Books Comics & Graphic Novels > Graphic Novels > Manga > Media Tie-InComics & Graphic Novels > Graphic Novels > Manga > Sports Buy from another retailer Amazon Barnes & Noble Books-a-Million IndieBound see more retailers see more retailers Get a FREE eBook when you join our mailing list. Plus, receive updates on new releases, recommended reads and more from Simon & Schuster. Email Address Free eBook available to NEW subscribers only. Offer redeemable at Simon & Schuster's ebook fulfillment partner.Offer expires in three months, unless otherwise indicated.See full terms and conditions and this month's choices. More Books from this Author Eyeshield 21, Vol. 37 Eyeshield 21, Vol. 37 By Riichiro InagakiBy Riichiro Inagaki Eyeshield 21, Vol. 36 Eyeshield 21, Vol. 36 By Riichiro InagakiBy Riichiro Inagaki Eyeshield 21, Vol. 35 Eyeshield 21, Vol. 35 By Riichiro InagakiBy Riichiro Inagaki Eyeshield 21, Vol. 34 Eyeshield 21, Vol. 34 By Riichiro InagakiBy Riichiro Inagaki See more by Riichiro Inagaki About the Author Riichiro Inagaki BECOME A FAN BOOKS


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The CAAT Advisory Board was established in 1981 to provide oversight and direction to CAAT staff. Representing industry, academia, the U.S. and European regulatory communities, and the animal welfare community, its members meet annually to review recent progress and discuss future initiatives. Once every three years, the Advisory Board gathers at a board retreat to map long-range plans for the Center. In addition, CAAT board members from academic institutions are responsible for reviewing applications submitted annually to the CAAT grant program and selecting recipients.
CAAT always welcomes new organizations to the board. Please contact us if you are interested in details. (firstname.lastname@example.com).
(Updated October 18, 2012)
Melvin Andersen (ScitoVation)
Anne Marie Api (RIFM)
Tara Barton-Maclaren (Health Canada)
Rebecca Bascom (Penn State University)
Kim Boekelheide (Brown University)
Leon Bruner (GMA)
Warren Casey (NIH/NIEHS)
Katy Champ (Bernice Barbour Foundation)
Shannon Cooksey (GMA)
Rodger Curren (IIVS)
David Dix (EPA)
Suzanne Fitzpatrick (FDA)
Jack Fowle (Science to Inform, LLC)
James Freeman (ExxonMobil)
Dianne Garnes (Novartis)
Tony Gaspari (University of Maryland)
Michelle Glidden (Society for Science & the Public)
Wally Hayes (Harvard)
Eric Hutchinson (NIH)
Daland Juberg (Dow)
Andy Klingenstein (Klingenstein Foundation)
Daniel Krewski (University of Ottawa)
Carolina Livi (Agilent Technologies, Inc.)
Anna Lowit (EPA)
Jorge Naciff (Procter & Gamble)
Monicah Otieno (Johnson & Johnson)
Kelly Pate (JHMI)
Stefan Pfuhler (Procter & Gamble)
Bernard Robaire (McGill University)
Andrew Rowan (Humane Society of the US)
Pamela Spencer (Dow)
David Steup (Shell)
Danilo Tagle (NCATS)
Gihan Tennekoon (University of Pennsylvania)
Nathalie Alepee (L'Oréal
Bas Blaauboer (Utrecht University)
Karin Blumer (Novartis)
Alexander Burkle (University of Konstanz)
François Busquet (University of Konstanz)
Francesca Caloni (University of Milan)
Mardas Daneshian (CAAT-Europe)
Urlich Deschl (Boehringer-Ingelheim)
Daniel Dietrich (University of Konstanz)
Franz Gruber (Doerenkamp-Zbinden Foundation)
Sebastian Hoffmann (seh consulting + services)
Joanna Jaworska (Procter & Gamble, Eurocor)
Lisbeth Knudsen (ecopa)
Roman Kolar (German Animal Welfare Federation)
Harald Krug (EMPA)
Manfred Liebsch (firstname.lastname@example.com)
Walter Pfaller (Innsbruck Medical University)
Donald Prater (FDA Europe)
Kristy Reid (Eurogroup)
Wolfram Riedel (BioService)
Adrian Roth (Roche)
Michael Schwarz (Universitat Tubingen)
Troy Seidle (HIS)
Andrea Seiler (ZEBET)
Thomas Singer (Roche)
Pierre Sivac (IFRA)
Bennard van Ravenzwaay (BASF)
Didier Verloo (EFSA)
Mattias Vey (IFRA)
Sonja von Aulock (ALTEX)
Eckhard von Keutz (Bayer)
Kristina Wagner (German Animal Welfare Federation)
Carl Westmoreland (Unilever)
Martin Winter (CETICS)
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