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Characterize disrupted nighttime sleep (DNS) in narcolepsy, an important symptom of narcolepsy.
A panel of international narcolepsy experts was convened in 2011 to build a consensus characterization of DNS in patients with narcolepsy. A literature search of the Medline (1965 to date), Medline In-Process (latest weeks), Embase (1974 to date), Embase Alert (latest 8 weeks), and Biosis (1965 to date) databases was conducted using the following search terms: narcolepsy and disrupted nighttime sleep, disturbed nighttime sleep, fragmented sleep, consolidated sleep, sleep disruption, and narcolepsy questionnaire. The purpose of the literature search was to identify publications characterizing the nighttime sleep of patients with narcolepsy. The panel reviewed the literature. Nocturnal sleep can also be disturbed by REM sleep abnormalities such as vivid dreaming and REM sleep behavior disorder; however, these were not reviewed in the current paper, as we were evaluating for idiopathic sleep disturbances.
The literature reviewed provide a consistent characterization of nighttime sleep in patients with narcolepsy as fragmented, with reports of frequent, brief nightly awakenings with difficulties returning to sleep and associated reports of poor sleep quality. Polysomnographic studies consistently report frequent awakenings/arousals after sleep onset, more stage 1 (S1) sleep, and more frequent shifts to S1 sleep or wake from deeper stages of sleep. The consensus of the International Experts' Panel on Narcolepsy was that DNS can be distressing for patients with narcolepsy and that treatment of DNS warrants consideration.
Clinicians involved in the management of patients with narcolepsy should investigate patients' quality of nighttime sleep, give weight and consideration to patient reports of nighttime sleep experience, and consider DNS a target for treatment.
Roth T; Dauvilliers Y; Mignot E; Montplaisir J; Paul J; Swick T; Zee P. Disrupted nighttime sleep in narcolepsy. J Clin Sleep Med 2013;9(9):955-965.
Narcolepsy is a chronic neurologic disorder defined by a tetrad of symptoms: excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, and sleep paralysis.1 It affects approximately 0.05% of the general population, with variation according to geography and ethnicity.2 Narcolepsy is associated with substantial morbidity and an impaired health-related quality of life (QOL).3–7
EDS is the most common presenting symptom and is necessary for a diagnosis (Table 1),8 although EDS is not specific to narcolepsy.9–11 Cataplexy is the most specific symptom of narcolepsy. It is defined as a sudden, transient partial or total loss of muscle tone triggered by strong emotions, most typically laughing or joking. Although specific, it is not universal, occurring in approximately 75% of patients with narcolepsy as defined by the ICSD-2.2,10,11 Estimates of the prevalence of hypnagogic hallucinations range from one-third to 80% of patients, whereas sleep paralysis affects 25% to 50% of patients.2 Only a minority of patients (10% to 25%) suffer from the complete tetrad of symptoms.2,12
ICSD-2 criteria for the diagnosis of narcolepsy with and without cataplexy.8
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Among patients with narcolepsy, disrupted nighttime sleep (DNS) is a common complaint and frequent finding on polysomnographic (PSG) testing, and it is referred to in the contemporary literature as a disease-related symptom. Patients typically report that DNS is more of a problem than are sleep paralysis and hypnagogic hallucinations, and it appears to be more common, with prevalence estimates ranging from approximately 30% to 95%, depending on the definition and sleep assay used.13–15 Thus, DNS may represent an additional characteristic of narcolepsy to be considered as part of a pentad of symptoms rather than EDS and the triad of auxiliary symptoms.
Despite the widespread reference to DNS in narcolepsy, there are few systematic patient-report and PSG data describing specific patterns of DNS or its clinical or QOL impact. Finally, there is no consensus characterization of DNS in narcolepsy that distinguishes it from disturbed sleep in other sleep disorder populations, especially primary insomnia, or that differentiates DNS associated with other sleep disorders commonly seen in patients with narcolepsy (e.g., vivid dreaming, periodic leg movements, rapid eye movement [REM] behavior disorder, and sleep apnea) from DNS as a stand-alone symptom. This is an important distinction: DNS may be secondary to a comorbid sleep disorder including insomnia or sleep apnea, or it may affect patients with narcolepsy independently from such conditions. Many patients with narcolepsy appear to experience DNS as a stand-alone and specific symptom that is not associated with other sleep disorders.1,15–18
To better characterize the most commonly patient-reported and PSG-determined disruptions to nighttime sleep and to distinguish DNS as a consistent and frequently observed feature of narcolepsy—one that is distinct from insomnia and other sleep-related comorbidities—as well as a possible target for treatment, this article reviews the available literature on DNS in narcolepsy. In this review, we focused on sleep disruptions and PSG findings, not ancillary symptoms.
Another approach to characterizing DNS in narcolepsy is to build a consensus among experts that incorporates both clinical experience as well as the published literature. Toward this end, the International Experts' Panel on Narcolepsy was held on June 9-10, 2011, in Minneapolis, Minnesota, to review and discuss the literature on DNS in patients with narcolepsy and their own extensive clinical expertise to clarify the characterization of sleep disturbance in narcolepsy.
The meeting was sponsored by Jazz Pharmaceuticals, Inc., Palo Alto, California. Participants attending the International Experts' Panel on Narcolepsy are listed in the appendix, and portions of the panel's proceedings have been incorporated into this characterization of DNS.
We reviewed and included studies that provided objectively and subjectively collected data on nighttime sleep in patients with narcolepsy. These studies were of variable size, design, and scientific rigor, but each provided data on characteristics of night sleep in patients with narcolepsy such as the number and frequency of PSG-recorded and patient-reported arousals and awakenings, the duration of sleep stages and wake time after sleep onset (WASO), patient-reported sleep quality, and other parameters. The literature included comparisons between patients with narcolepsy and normal controls, patients with and without sleep-related comorbidities, and patients receiving and not receiving narcolepsy-specific medications. Overall, the patient report and PSG studies indicate a nighttime sleep pattern characterized by frequent arousals and brief awakenings that occur independent of other sleep disorders and treatments.
A search of the Medline (1965 to date), Medline In-Process (latest weeks), Embase (1974 to date), Embase Alert (latest 8 weeks), and Biosis (1965 to date) databases was conducted using the following search terms: narcolepsy and disrupted nighttime sleep, disturbed nighttime sleep, fragmented sleep, consolidated sleep, sleep disruption, and narcolepsy questionnaire. There were no date limits on the search.
The purpose of the literature search was to identify publications characterizing the nighttime sleep of patients with narcolepsy. Search results were reviewed by the lead author, with other authors consulted as needed to provide consensus on questions or issues arising during the review process. Studies providing specific PSG and/or patient-reported characterizations of nighttime sleep were selected for inclusion in the current article. Review articles and articles describing sleep-related comorbidities, such as periodic leg movements, obstructive sleep apnea, REM behavior disorder, and nightmares, were excluded so as to be able to identify the nature of disturbed sleep in narcolepsy per se without the contamination of other sleep disorders.
A total of 642 English-language citations were returned and reviewed for characterizations of nighttime sleep in patients with narcolepsy. When inclusion criteria could not be identified through an abstract, full-text articles were reviewed. As shown in the flow of citations through the review process (Figure 1), of the 642 citations, 20 relevant studies were identified: 12 reported PSG characteristics of nighttime sleep in patients with narcolepsy, 4 reported patient-reported outcomes, and 4 reported both PSG and patient-reported characterizations of sleeping patterns. Baseline data from a randomized clinical trial evaluating the effect of sodium oxybate on nighttime sleep in patients with narcolepsy was also included (another trial was excluded because it did not provide baseline PSG data on patients' nocturnal sleep). Thus, a total of 21 studies met the inclusion criteria (Table 2).14,19–38
Flow of citations during the review process
Publications characterizing the nighttime sleep of patients with narcolepsy
Nighttime sleep in patients with narcolepsy is characterized by a short sleep latency and a sleep-onset REM period in approximately 50% of cases.10,13,39 Aside from the short sleep latency, it is also characterized by an inability to stay asleep.13,22,23,26,31,33,35 Patients with narcolepsy experience frequent awakenings during sleep. The database characterizing such sleep patterns is limited but consistent, with patients reporting frequent awakenings after sleep onset and poor sleep quality,22,31,33–35,38 although only 3 studies provided a quantitative comparison of nocturnal awakenings (Table 3).22,31,33
The number of nightly awakenings reported by patients with narcolepsy and by comparator groups
The literature search identified 4 studies that reported on DNS from the patient perspective and 4 studies that included the patient perspective in addition to PSG. Patient reports and sleep diaries from these studies indicate that between 33% and 81% of patients with narcolepsy awaken multiple times throughout the night.23,38 Zachariev and colleagues reported that 16 of 22 (72.7%) consecutive patients with narcolepsy reported DNS, and 36.4% of these patients described the disturbances as frequent awakenings.38 Rosenthal and colleagues, using a 22-item questionnaire, surveyed 237 consecutive adult patients diagnosed with narcolepsy and found that 81.1% of the 119 responders experienced nocturnal sleep disturbances, also characterized as frequent brief awakenings.33 The prevalence of DNS was comparable to the prevalence of patient-reported cataplexy (79.3%), but significantly higher than the prevalence of hypnagogic hallucinations, sleep paralysis, and memory problems (67%, 64.2%, and 46.3%, respectively; p < 0.001 vs. DNS).
In the Rosenthal study, patients with narcolepsy and disturbed sleep had significantly less total sleep time (6 vs. 7 h, respectively; p < 0.001) and reported more frequent nocturnal awakenings (4.6 vs. 1.3 per night, respectively; p < 0.001) than did patients who reported no trouble sleeping. PSG data, recorded 7 days after discontinuation of stimulant medications, confirmed these patient reports. Patients were stratified according to whether they reported the presence or absence of difficulty maintaining nocturnal sleep. According to the PSG studies, patients who reported suffering DNS experienced 13.0 awakenings per night vs. 10.5 among those who did not self-report DNS. PSG also demonstrated that patients with DNS had significantly more stage 1 (S1) sleep (23.0% vs. 17.4%, respectively; p < 0.05), significantly less stage 2 (S2) sleep (49.1% vs. 53.5%, respectively; p < 0.05), and significantly more wake time during sleep (72.5 vs. 45.4 min, respectively; p < 0.01), all characteristics of DNS independent of other sleep-related comorbidities.33
Parkes et al. reported data on the sleep-wake habits of 183 patients with narcolepsy, 62 patients with idiopathic hypersomnia (IH), and 10 patients with obstructive sleep apnea.31 Responses were compared with 188 controls with normal sleep-wake habits and no complaints of EDS or insomnia. Patients with narcolepsy reported a mean 4.5 nightly awakenings versus 1.4 among controls (p < 0.01) and poor sleep quality, measured using a visual analog insomnia score (43.1 vs. 27.6, respectively; p < 0.01).
Sturzenegger and Bassetti compared 40 normal controls with no history of sleep disorders, EDS, or use of sleeping pills with 57 patients with narcolepsy with cataplexy and 56 patients with "nonnarcoleptic hypersomnia," defined by the presence of subjective EDS and an Epworth Sleepiness Score (ESS) ≥ 10 and other sleep disorders.35 Almost 95% of patients with narcolepsy reported falling asleep rapidly, with sleep latency < 20 minutes. Importantly, patient-reported inability to sleep without awakening was significantly more common among patients with narcolepsy than among normal controls (71% vs. 25%, p value not reported), as were early morning awakenings (83% vs. 43%, respectively; p < 0.001). Among patients with nonnarcoleptic hypersomnia, frequent nocturnal awakenings and early morning awakenings were reported by 67% and 71%, respectively. Among normal controls, these rates were 25% and 43%, respectively (p < 0.001 vs. normal controls for both comparisons).35
As compared to normal control groups, patients with narcolepsy consistently report disturbed and fragmented nocturnal sleep. This experience is distinct from the nocturnal sleep patterns reported by patients with other sleep disorders. For example, Bruck and Parkes compared the sleep-wake behaviors of 18 patients with IH and 50 patients with narcolepsy with cataplexy using questionnaires and sleep diaries.22 Patients with narcolepsy reported a mean 3.3 awakenings per night, for an average total wake time of 34.4 minutes. By comparison, patients with IH reported only 1.3 nocturnal awakenings (p < 0.005 vs. narcolepsy), with an average total wake time of 7.7 minutes (p < 0.05 vs. narcolepsy).
These patient-report studies present a consistent characterization of fragmented, disrupted, and unsatisfactory sleep in patients with narcolepsy. It is clear that nighttime sleep in patients with narcolepsy has its own patterns distinct from those in normal controls and from those with insomnia. Although DNS is important and may be potentially troublesome for patients, there is a paucity of patient-reported data regarding the consequences of DNS. The fact that narcolepsy is associated with a diminished QOL is well established, but how DNS in patients with narcolepsy affects QOL is not well understood.3,5–7,10 In one study using the World Health Organization QOL (WHOQOLBREF) instrument, Rovere et al. compared QOL among 40 patients with narcolepsy and 40 normal controls with fixed daytime work schedules and no history of chronic diseases or sleep disorders.34 Dissatisfaction with sleep was common among patients with narcolepsy, with 22.5% being very unsatisfied and 45.0% unsatisfied. Among normal controls, the rates were 2.5% and 10.0%, respectively (p < 0.001). The rates of regular, satisfied, and very satisfied sleep among patients with narcolepsy were 17.5%, 15.0%, and 0.0%, respectively. Among normal controls, these were 22.5%, 50.0%, and 15.0%, respectively (p < 0.001 for comparisons). The results of this study do not address the QOL impact or other consequences of DNS in narcolepsy. The study does, however, confirm the PSG and sleep questionnaire data indicating high rates of overall dissatisfaction with sleep among patients with narcolepsy.
Objective data from the 12 PSG-specific studies,14,19,20,23,25–30,36,37 the 4 with PSG in addition to patient reports,32,33,35,38 and the 1 randomized clinical trial21 confirm the patient-reported data that nighttime sleep in patients with narcolepsy is generally disrupted and fragmented. PSG comparisons between patients with narcolepsy and normal controls with no history of sleep disorders consistently find that patients with narcolepsy experience frequent brief awakenings and arousals (e.g., excessive shifts to S1 sleep or wake from deeper sleep stages), therefore having more time spent in S1 sleep, an elevated WASO, and reduced sleep efficiency relative to normal controls (Table 4 and Figure 2).20,23,24,26–30,32
Polysomnographically identified arousals and wake time after sleep onset (WASO) among untreated patients with narcolepsy and normal controls
S1, stage 1; S2, stage 2; S3, stage 3; S4, stage 4; SWS, slow wave sleep. Frauscher et al.,23 Jiménez-Correa et al.,26 Mukai et al.30
Comparison of the stages of sleep between patients with narcolepsy and normal controlsS1, stage 1; S2, stage 2; S3, stage 3; S4, stage 4; SWS, slow wave sleep. Frauscher et al.,23 Jiménez-Correa et al.,26 Mukai et al.
These nighttime sleep patterns are present whether or not patients are receiving stimulant medications,20,22,32 including in drug-naïve patients with narcolepsy,30 albeit in a small sample (N = 8), as well as when compared with other sleep disorders.32,36 These observations provide further support for an association between narcolepsy and DNS that is also independent of stimulant use, and although the studies do not identify underlying causes of DNS, several suggest an abnormality in non-REM (NREM) sleep as a possible mediator. However, no studies have directly compared DNS in patients with narcolepsy who are on and off stimulants. This lack of objective data on the effects of stimulants on DNS suggests the need for studies addressing this issue.
The largest study to characterize PSG-assayed sleep in patients with narcolepsy is a 530-patient database created for a clinical trial of modafinil (US Modafinil in Narcolepsy Multicenter Study Group, 1998).24 All prescription and over-the-counter stimulant- and sedative-containing medications were discontinued 2 weeks prior to patients undergoing 2 consecutive baseline PSG measurements. On both nights, patients displayed evidence of nocturnal sleep disruption, characterized by an arousal index of 12 and an awakening index of 3.8. Analyses of smaller patient groups with narcolepsy in Asia and Eastern Europe have reported similar DNS arousal rates.14,38
Comparisons between patients and normal controls confirm the conclusion that these sleep parameters are deviations from normal sleep. Mukai and colleagues compared PSG data between 8 drug-naïve patients with narcolepsy and 8 healthy normal controls with no history of sleep disorders.30 Patients with narcolepsy had significantly more S1 sleep (17.2% vs. 8.9%, respectively; p < 0.01), more stage shifts (mean, 352.6 vs. 251.8, respectively; p < 0.05), and a higher percentage of WASO (3.9% vs. 1.0%, respectively; p < 0.05) than did normal controls. These investigators suggest that DNS is linked to the higher REM densities seen in patients with narcolepsy.
In several studies, DNS in patients with narcolepsy has been differentially associated with NREM sleep. Frauscher and colleagues, using nocturnal video-PSG studies, compared motor events during REM and NREM sleep in 6 stimulant-free patients with narcolepsy/cataplexy with 6 sex- and age-matched normal controls with no history of sleep disorders, ESS < 10, and no central nervous system-active medication at the time of investigation.23 PSG was performed on 2 consecutive nights and video monitoring for 1 night. All visible movements were defined as a motor event and classified according to topography, number of involved body parts, duration, and its association with arousal.
Patients with narcolepsy with cataplexy had more fragmented sleep with more S1 sleep (20.0 vs. 9.1 min, respectively; p = 0.071) and less S2 sleep (35.5 vs. 51.5 min, respectively; p = 0.022) than did normal controls. The mean motor activity index, defined as movement episodes per hour of sleep excluding electromyographic-related muscle activity in the chin or tibialis anterior channels, was 59.9/h of sleep in patients with narcolepsy with cataplexy versus 15.4/h of sleep among controls (p = 0.004). Motor event indices were similar between REM and NREM sleep periods in the narcolepsy with cataplexy group, whereas motor event indices were higher during REM sleep periods in controls (p = 0.028). Motor events affected significantly more body parts in patients with narcolepsy with cataplexy than controls, and events lasting > 1 second were significantly more common (p = 0.011 and p < 0.001, respectively). The total arousal index among patients and controls was 21.6 versus 8.7, respectively (p = 0.004), and the motor activity-related index was 17.6/h of sleep versus 5.9/h, respectively (p = 0.002). The investigators hypothesized that motor disturbances during NREM sleep in patients with narcolepsy with cataplexy exacerbate DNS in patients with narcolepsy with cataplexy and may be an underlying cause.23
Khatami et al. reported that patients with narcolepsy with cataplexy have decreased NREM sleep intensity and suggested that this may mediate DNS.27 Their analysis compared PSG findings between 11 treatment-naïve patients with narcolepsy with cataplexy with 11 matched controls. As in other studies, patients with narcolepsy with cataplexy exhibited more S1 sleep, lower sleep efficiency, and more frequent awakenings/ arousals than did controls. Patients with narcolepsy exhibited longer NREM-REM cycles than did controls and a more dramatic decline in slow wave sleep across successive NREMREM cycles. This was evidenced by less slow wave activity during the second NREM sleep episode among patients. In parallel, during this second NREM sleep episode, patients with narcolepsy with cataplexy experienced more wake episodes than did controls (p = 0.01).27
Based on the hypothesis that insufficient NREM intensity is associated with sleep disruptions, Khatami et al. compared 6 drug-free patients with narcolepsy with cataplexy and 6 matched controls after 40 hours of wakefulness.28 Prior to sleep deprivation, slow wave activity decreased in both groups across successive NREM-REM sleep cycles, but, as in the previous study, slow wave activity was smaller among patients with narcolepsy during the second NREM-REM cycle (p = 0.02). During recovery sleep, initial slow wave activity increased in both groups, and there were no sustained differences between groups across sequential NREM episodes. That is, during recovery sleep, there were fewer awakenings during the first and second NREM sleep episodes (p = 0.01 and p = 0.02, respectively) than at baseline, suggesting that increased NREM intensity associated with sleep deprivation reduces disruptions to nocturnal sleep among patients with narcolepsy with cataplexy.
These studies provide a consistent characterization of fragmented nighttime sleep in drug-free patients with narcolepsy. Similar results have also been observed in patients receiving active treatments. One study compared normal controls (n = 50) with patients with narcolepsy with cataplexy (n = 50), 36 of whom were being treated for narcolepsy at the time of the study.20 Patients with narcolepsy had significantly greater WASO (92.7 vs. 51.1 min, respectively; p < 0.01), more total wake time (104.9 vs. 77.3 min, respectively; p < 0.01), and a greater percentage of S1 sleep (12.4% vs. 7.8%, respectively; p < 0.01).
Rogers et al. compared PSG and sleep diary data from 25 treated patients with narcolepsy with gender-matched controls.32 All patients were receiving stimulants, and 5 patients were also taking REM-suppressant medication. Treatment response was considered satisfactory by both the patient and the patient's physician. The controls had no history of sleep, neurologic, or psychiatric disorders, alcoholism, use of drugs affecting the central nervous system, or shift work. Patients recorded sleep-wake patterns, activities, and medication use in the diaries and underwent PSG assessment. Total sleep time was comparable between patients and controls, but patients with narcolepsy had more WASO (57.5 vs. 34.5 min, respectively; p ≤ 0.05), S1 sleep (15.3% vs. 10.1%, respectively; p ≤ 0.05), and more frequent awakenings, although this parameter failed to reach statistical significance.
Finally, studies have compared the nighttime sleep of patients with narcolepsy with the nighttime sleep of patients with other sleep disorders.19,36 Baker et al. found that patients with narcolepsy had more DNS than did patients with IH, characterized by more S1 sleep, greater WASO, and lower sleep efficiency.19 More recently, Takei and colleagues reported PSG findings among patients with narcolepsy both with and without cataplexy (n = 52 and n = 62, respectively) and patients with IH without long sleep times (n = 50).36 Patients with narcolepsy with cataplexy experienced more arousals per hour than did those without cataplexy and those with IH (17.1 vs. 11.7 vs. 10.1, respectively; p < 0.01). There was no statistically significant difference in the number of arousals between patients with narcolepsy without cataplexy and those with IH. Patients with cataplexy also had a greater percentage of S1 sleep than did those without cataplexy and those with IH (15.6% vs. 9.2% vs. 10.8%, respectively; p < 0.01). Sleep efficiency was lowest (p < 0.05) and WASO highest (p < 0.01) among patients with cataplexy. The data suggest that DNS occurs more frequently among patients with narcolepsy with cataplexy than without.36
Nighttime sleep in narcolepsy, as defined by PSG, parallels that of patient reports of fragmented sleep, with the preponderance and consistency of data suggesting that DNS is a characteristic of narcolepsy per se, not a comorbid condition. Interestingly, DNS may be related to lower drive for sleep as evidenced by a greater decline across the night in slow wave sleep among patients with narcolepsy. This is especially true for patients with narcolepsy with cataplexy. However, this is not a consistent finding.27,28,40,41
Despite the consistency of reports of DNS in narcolepsy, few studies have attempted to correlate DNS with narcolepsy's daytime symptoms.24,26 Those that have, produced inconsistent results or found suggestive, but not completely persuasive, correlations between DNS and EDS.
In the US Modafinil in Narcolepsy Multicenter Study, there was a significant, albeit modest, relation between DNS and daytime sleepiness evaluated with the multiple sleep latency test (MSLT), maintenance of wakefulness test, and ESS. Thus they concluded that whereas DNS may exacerbate EDS, DNS is not the primary cause of EDS in narcolepsy.24
Jiménez-Correa and colleagues compared patients with narcolepsy and healthy matched controls with no history of sleep disorders (n = 23 in each group) and found that patients with narcolepsy had a greater percent of S1 sleep (16.60% vs. 10.57%, respectively; p < 0.05) and S2 sleep (58.36% vs. 52.09%, respectively; p < 0.05), a significantly greater number of arousals (78.38 vs. 29.13, respectively; p < 0.05), and more awakenings lasting < 3 minutes (mean, 35.15 vs. 3.77, respectively; p < 0.05).26 Using measures of daytime sleepiness (ESS, MSLT, subjective sleep quality) and other tools, investigators reported moderate correlations between EDS and DNS. Daytime sleepiness was associated with WASO and frequency of awakenings, and lower total sleep time, sleep efficacy, and percent of slow wave sleep.26
Although fragmented sleep has generally been associated with EDS, the limited number of studies on the role of DNS in producing daytime sleepiness in patients with narcolepsy, and their contrasting results, do not present a clear picture of this relationship. Consequently, further studies are warranted for clarifying this relationship, and addressing the question of whether directly treating DNS has an impact on EDS. Furthermore, since there are interrelationships among disturbed sleep, inflammation, and chronic conditions such as cardiovascular disease and diabetes,42,43 the potential impact of DNS on other health outcomes would also be of interest.
It is important to recognize that patient reports and PSG characterizations of DNS in narcolepsy are part of narcolepsy per se and distinguishable from the sleep disturbances seen in insomnia. Insomnia is defined by a patient report of difficulty falling asleep or staying asleep, or the presence of nonrestorative sleep.44–46 There is obviously overlap in descriptions of insomnia and DNS with narcolepsy, but patients with narcolepsy have no difficulty falling asleep, and the difficulties in sleep maintenance experienced by individuals with insomnia are different from those experienced by patients with narcolepsy. Insomnia is characterized by prolonged periods of wakefulness such as long sleep latency and difficulty falling back to sleep after nocturnal awakenings.43,44 In contrast, patients with narcolepsy fall asleep rapidly and experience frequent arousals but not prolonged wakefulness (Table 5).10,26–30,33,47
Differences in sleep parameters between patients with narcolepsy with and without cataplexy and insomnia
Based on patient-reported and PSG data reviewed and discussed by the panel, the following consensus characterization of DNS in patients with narcolepsy was formulated:
Patients report poor sleep quality and frequent nocturnal awakenings
PSG findings document sleep fragmentation as evidenced by frequent transitions to lighter stages of sleep (S1 and wake)
To evaluate patients with narcolepsy for DNS, the panel recommended consideration of patient reports of the number of awakenings, duration of awake time in bed, and sleep quality. Patient reports should be considered alongside PSG data, including the frequency of shifts from deeper stages of sleep to waking or S1 sleep, frequency of brief awakenings/arousals, sleep efficiency, WASO, and sleep stage distribution, especially times spent in S1 and slow wave sleep and latency to REM sleep.
Contemporary guidelines for the treatment of narcolepsy are available from the American Academy of Sleep Medicine (AASM) and European Federation of Neurological Society (EFNS), and numerous reviews have been published in the last decade describing available therapeutic options.7,9,11,48–50 An in-depth review of available therapies is beyond the purview of this article. However, it is worthwhile to note that some available pharmacologic treatments have been associated with improvements in nighttime sleep in narcolepsy.21,52,53 In 2 randomized clinical trials, treatment with sodium oxybate increased slow wave sleep, decreased S1 sleep, and produced dose-dependent reductions in the number of nocturnal awakenings experienced by patients with narcolepsy.21,52 A randomized controlled trial by Mayer and colleagues of ritanserin in patients with narcolepsy found that ritanserin increased nocturnal slow wave sleep and improved patients' perception of feeling refreshed after awakening, although investigators did not see a significant effect in the primary efficacy parameters.53 These findings support the hypotheses that insufficient slow wave activity mediates DNS of narcolepsy. Nevertheless, DNS remains a symptom that typically goes untreated.7,9,11,13
Current guidelines from the AASM endorse "control[ling] nocturnal symptoms of disrupted sleep…when present and troublesome in patients with narcolepsy,"7 whereas guidelines from the EFNS note that improvements in DNS are achievable, but the guidelines do not provide a specific treatment recommendation.9 Therefore, studies are needed that evaluate objective and patient-reported effects of various therapies on the treatment of DNS.
DNS is a common aspect of narcolepsy that appears to differ from DNS in other sleep disorders including insomnia. DNS in narcolepsy is characterized by patient reports of frequent brief awakenings and by PSG findings of frequent arousals, higher WASO, frequent shifts to wake or increased S1 sleep with reduction in stage 3/stage 4, and overall decreased sleep efficiency. Several studies using PSG suggest that decreased NREM and slow wave activity are possible mediators of the fragmented sleep. Some pharmacologic therapies are associated with improvements in nighttime sleep in narcolepsy. These distinctions further endorse DNS as part of a narcolepsy symptom pentad.
The AASM recommends controlling troublesome nocturnal symptoms of disrupted sleep in patients with narcolepsy but makes no specific treatment recommendations. It is unclear that improving nocturnal sleep leads to improvement in daytime functioning. However, this symptom is potentially troublesome for patients, and treatment may be warranted when patients report its presence and impact on their daily lives.
The International Experts' Panel on Narcolepsy meeting and the development of this article were supported by funding from Jazz Pharmaceuticals PLC, Palo Alto, California. Dr. Tom Roth has served as a consultant for Abbot, Accadia, Acogolix, Acorda, Actelion, Addrenex, Alchemers, Alza, Ancel, Arena, AstraZeneca, Aventis, AVER, Bayer, BMS, BTG, Cephalon, Cypress, Dove, Eisai, Elan, Eli Lilly, Evotec, Forest, Glaxo Smith Kline, Hypnion, Impax, Intec, Intra-Cellular, Jazz, Johnson and Johnson, King, Lundbeck, McNeil, MedicNova, Merck, Neurim, Neurocrine, Neurogen, Novartis, Orexo, Organon, Otsuka, Prestwick, Proctor and Gamble, Pfizer, Purdue, Resteva, Roche, Sanofi, Schering Plough, Sepracor, Servier, Shire, Somaxon, Syrex, Takeda, TransOral, Yanda, Vivometrics, Wyeth, Yamanuchi, and Xenoport. He has served on speakers bureau for Purdue and Sepracor. He has received research support from Apnex, Aventis, Cephalon, Glaxo Smith Kline, Merck, Neurocrine, Pfizer, Sanofi, Schering Plough, Sepracor, Somaxon, Syrex, Takeda, Transcept, Wyeth, and Xenoport. Prof. Y Dauvilliers has received speaker's honoraria and funding for travel to conferences from UCB Pharma, JAZZ, Cephalon, Novartis, and Bioprojet. Prof. Dauvilliers has participated in advisory boards of UCB pharma, JAZZ and Bioprojet. Dr. Emmanuel Mignot has received research support from Glaxo Smith Kline, Jazz Pharmaceuticals, and Novo Nordisk. He has received an educational gift from Jazz Pharmaceuticals to the Stanford Center for Sleep Sciences. Dr. Jacques Montplaisir received honoraria for speaking engagements from Valeant Pharmaceuticals and Otsuka Pharmaceuticals. He has served as an advisor for Sanofi, Servier, Merck, Jazz, Valeant Pharmaceuticals, and Impax. He has received research grants/support from Merck and Glaxo Smith Kline. Josh Paul has no conflicts of interest to disclose. Dr. Todd Swick has received funding as a principle investigator for: Jazz Pharmaceuticals/Orphan Medical (SXB-6, SXB-7, SXB-15, SXB-19, SXB-22, SXB-26, H-16368, Jazz 06-008, Jazz 06-009, and Jazz 06-010), Takeda Pharmaceuticals, Merck, Cephalon, Sanofi-Aventis, Pfizer, Somaxon, GlaxoSmithKline, and Epix Pharmaceuticals. He has received funding as a consultant to Jazz Pharmaceuticals, Aerial Pharmaceuticals and Concert Pharmaceuticals and Boehringer Ingelheim. He is on the Speakers' Bureau of Glaxo Smith Kline, Sepracor, Jazz Pharmaceuticals, Sanofi-Aventis, and Boehringer-Ingelheim. Dr. Phyllis Zee has received a research educational gift from Philips Respironics to Northwestern University. She is a consultant for Takeda Pharmaceutical, UCB, Merck, Jazz, Purdue, and Ferring. She has stock options from Zeo.
American Academy of Sleep Medicine
disrupted nighttime sleep
excessive daytime sleepiness
European Federation of Neurological Society
Epworth Sleepiness Score
International Classification of Sleep Disorders
idiopathic hypersomnia
long sleep time
multiple sleep latency test
narcolepsy with cataplexy
obstructive sleep apnea
periodic leg movements
quality of life
rapid eye movement
stage 1
stage 2
sleep-onset rapid eye movement period
wake time after sleep onset
The authors thank Josh Paul, M.A. for his editorial and writing assistance.
Benca RM, author. Narcolepsy and excessive daytime sleepiness: diagnostic considerations, epidemiology, and comorbidities. J Clin Psychiatry. 2007;68(suppl 13):5–8.
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Black J, Pardi D, Hornfeldt CS, Inhaber N, authors. The nightly administration of sodium oxybate results in significant reduction in the nocturnal sleep disruption of patients with narcolepsy. Sleep Med. 2009;10:829–35. [PubMed]
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Rogers AE, Aldrich MS, Caruso CC, authors. Patterns of sleep and wakefulness in treated narcoleptic subjects. Sleep. 1994;17:590–7. [PubMed]
Rosenthal LD, Merlotti L, Young DK, et al., authors. Subjective and polysomnographic characteristics of patients diagnosed with narcolepsy. Gen Hosp Psychiatry. 1990;12:191–7. [PubMed]
Rovere H, Rossini S, Reimão R, authors. Quality of life in patients with narcolepsy. A WHOQOL-Bref study. Arq Neuropsiquiatr. 2008;66:163–7. [PubMed]
Sturzenegger C, Bassetti CL, authors. The clinical spectrum of narcolepsy with cataplexy: a reappraisal. J Sleep Res. 2004;13:395–406. [PubMed]
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Tafti M, Rondouin G, Besset A, Billiard M, authors. Sleep deprivation in narcoleptic subjects: effect on sleep stages and EEG power density. Electroencephalogr Clin Neurophysiol. 1992;83:339–49. [PubMed]
Mullington JM, Haack M, Toth M, Serrador JM, Meier-Ewert HK, authors. Cardiovascular, inflammatory, and metabolic consequences of sleep deprivation. Prog Cardiovasc Dis. 2009;51:294–302. [PubMed Central][PubMed]
Miller MA, author. Association of inflammatory markers with cardiovascular risk and sleepiness. J Clin Sleep Med. 2011;7(5 Suppl):S31–3. [PubMed Central][PubMed]
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Emmanuel Mignot, M.D., Ph.D.
Stanford Center for Sleep Sciences
Professor of Psychiatry and Behavioral Sciences
Stanford University
Palo Alto, California
Thomas Roth, Ph.D.
Sleep Disorders and Research Center
Henry Ford Hospital
University of Michigan College of Medicine
Ann Arbor, Michigan
Claudio Bassetti, M.D.
Neurocenter of Southern Switzerland
Chairman of the Neurology Department
Ospedale Civico
Lugano, Switzerland
Professor of Neurology
University Hospital
Zürich, Switzerland
Jacques Montplaisir, M.D., Ph.D.
Center for Advanced Studies in Sleep Medicine
Hôpital de Sacré-Cœur de Montréal
Centre d'étude du sommeil
Montréal, Québec, Canada
Jed Black, M.D.
Consulting Professor
Stanford Sleep Medicine Center
Todd Swick, M.D.
Medical Director
The Houston Sleep Center
Assistant Clinical Professor of Neurology
University of Texas-Houston School of Medicine
Houston, Texas
Yves Dauvilliers, M.D.
Director of Sleep Unit
Montpellier, France
University Hospital, Gui de Chauliac
Phyllis Zee, M.D., Ph.D.
Professor and Director
Sleep Disorders Center
Northwestern University
Chicago, Illinois
Cynthia McCormick, M.D.
McCormick Consultation, LLC
Bethesda, Maryland


text:
mvh needed a new web page design and created a contest on 99designs.
A winner was selected from 35 designs submitted by 13 freelance designers.
We are in the process of porting our website to drupal 6.5, but our current website design doesn't accommodate the typical elements of a drupal site. We need a design that can be turned into a drupal theme easily.
Edia is a company specialising in e-learning and educational software. Our primary market is higher education. We're looking for a fresh design that should include our current logo but otherwise all options are open. Above all, the design should work on a drupal website.
This screenshot of our new website shows the general layout of the site and the main menu items. It also shows our inability to design ;-)
For reference, this is our current website.
If you have the skills to code the design as a drupal theme, let me know.
- Three columns design
- Two menu levels
- Ability to switch between languages on every page
- Design that can be converted to a drupal theme
- Pages will include a latest news and latest blog entries
- Pages will include a search and a login block
- Pages will include phone numbers and links to the contacts page.
A K12 website or lots of references to primary education. We do secondary and higher education.

subset: commoncrawl


text:
Skip to comments.Cats' ears (vanity)
Posted on 12/14/2012 7:47:50 PM PST by NowApproachingMidnight
I just published an invention on Quirky, and would like to get some up votes, and other positive thoughts from the FR community.
Thanks in advance, FRiends.
That is such an awesome picture. Where did you find that?
I googled "Earhorn".
Show off.
"Can you hear me now?"
I was looking for this one:
Prior art from the 1880's...
Early hi-fi stereo?
Hi-fi be one ear cupped, stereo be hi-ten...
Designed by God.
Yeah.... That's what I was thinking.
There are a few museums with hearing aid collections...
you might be amused by the vast numbers of prior art.
Uploaded on Feb 15, 2010
This is a short video advertising The Kenneth Berger Hearing Aid Museum and Archives. It is located on Kent State University in Kent, Ohio.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.


text:
Happy!I'm proud of me guys, today i did the highest cum on the wall. For me it's record.
P.S. you can find video with that show in my profile :)
Casper James has setup a wish list at our authorized sex toystore. If you purchase an item from the wishlist it will be sent discreetly to Casper James!
Your personal information (name, address, etc.) will not be visible to the performer; nor will you be able to access the performer's information.
I like to have a lot of friends to see new places, i love music and lot of partydance, also i like to dance with somebody. Just ask me about what i like and i tell you.
My first fantasies is to have some fun on Eiffel Tower and on Statue of Liberty, is only one my fantasies but i am open mind and i wish to know which is your crazy fantasies.
dad, teacher, slave, boss, wild sex
I like to make jokes, to make people smile and laugh with me. I am a funny boy and always i like to win a bet. I like comedy and action movies and The Rock is my new favourites actor. My favourites food is Romanian food "sarmale" and grilled minced meat rolls.
In my opinion i don't have special information about me because i am a simply guy and i enjoy in evry day of each day and people from my life, but if you want to ask me something special i answer at your question with big pleasure.
Anal, Armpit, Feet, Muscle Worship, Nipple Biting, Nipple Play, Rimming, Smoking, Spanking, Wrestling
Boss / Secretary, Dirty Talk, Doctor / Nurse, Flight Attendant/Pilot, Gender Play, Master / Slave, Nun/Priest, Prisoner/Guard, Service Worker/Housewife, Student/Teacher


text:
|By Admin1 (admin) (ppp-70-245-109-220.dsl.okcyok.swbell.net - 22.214.171.124) on Saturday, April 05, 2008 - 5:25 pm: Edit Post
1970: Susan Simons Brandt served as a Peace Corps Volunteer in Thailand in Surin, Chiang Mai beginning in 1970
Returned Peace Corps Volunteer Susan Simons Brandt can be contacted at susanmbrandtayahoodcom
Country of Service: Thailand
Training Group: 33
Cities you served in: Surin, Chiang Mai
Arrival Year: 1970
Departure Year: 1972
Work Description:
TEFL at secondary school and at School for the Blind
Bring us up to date on your life after the peace corps:
Continued to live and work in South and Southeast Asia from Pakistan to Taiwan. Currently living in Kathmandu Nepal since 1994.
Any thoughts you have now looking back on peace corps days?:
Peace Corps was a pivotal point in my life
Anyone you are looking for or would like to hear from?:
Looking for Beth Ann Spain, Thailand and Gini and Tom Caudill,Thailand, Group 33.
Originally posted: April 5, 2008
Related Links:
Peace Corps Annual Report: 1970; Peace Corps Thailand; Directory of Thailand RPCVs; Messages and Announcements for Thailand RPCVs
Looking for another volunteer who served with this Group?
If you know this volunteer or someone from his or her group and are looking to reconnect with them,
leave a message above where it says "Create New Conversation."
If this is your profile, post any additions, updates or corrections to your profile below where it says "Add a Message."
RPCVs: To add your own RPCV profile click here.
| The Peace Corps Library
Peace Corps Online is proud to announce that the Peace Corps Library is now available online. With over 30,000 index entries in 500 categories, this is the largest collection of Peace Corps related stories in the world. From Acting to Zucchini, you can use the Main Index to find hundreds of stories about what RPCVs with your same interests or from your Country of Service are doing today.


text:
Juno the Beluga Whale and Staff Mystic Aquarium Join GoLocal LIVE During the Storm
Wednesday, March 15, 2017
Mystic Aquarium says while a storm might close the doors to the public, Mystic Aquarium never shuts down.
Richard says many of the animals love the cold weather, especially Juno, "he's right at home in these cold temperatures."
Juno, a male Beluga Whale, weighs just over 1,800 pounds, and Richard says he's still growing. Richard says they feed the soon-to-be 15 year old whale about 60 pounds of fish a day.
That's more than his female tank mate Kela. She's 35 years old and weighs about 1200 pounds. Richard says in the winter time Kela eats about 40-50 pounds of fish a day.
While the whales stayed in their Arctic Coast exhibit during the storm, the African penguins, as a warm climate species, who visited GoLocal LIVE in February,were moved inside to ensure their safety. Richard says the penguins were doing fine and working with their trainer.
The stingrays from the Ray Touch exhibit and Northern fur seal Ziggy Star were also moved indoors.
Related Slideshow: The 50 Greatest Living Rhode Islanders
Professor J. Michael Kosterlitz
Nobel Prize Winner
In October 2016, Brown University Professor J. Michael Kosterlitz was awarded the Nobel Prize in Physics. He has been at Brown since 1982.
The Royal Swedish Academy of Sciences announced that it awarded the Nobel Prize in Physics 2016 to three U.S. scientists, including Kosterlitz "for theoretical discoveries of topological phase transitions and topological phases of matter."
"They revealed the secrets of exotic matter," wrote the Academy in their October 4 release. "This year's Laureates opened the door on an unknown world where matter can assume strange states. They have used advanced mathematical methods to study unusual phases, or states, of matter, such as superconductors, superfluids or thin magnetic films. Thanks to their pioneering work, the hunt is now on for new and exotic phases of matter. Many people are hopeful of future applications in both materials science and electronics."
The Academy wrote:
The three Laureates' use of topological concepts in physics was decisive for their discoveries. Topology is a branch of mathematics that describes properties that only change step-wise. Using topology as a tool, they were able to astound the experts. In the early 1970s, Michael Kosterlitz and David Thouless overturned the then current theory that superconductivity or suprafluidity could not occur in thin layers. They demonstrated that superconductivity could occur at low temperatures and also explained the mechanism, phase transition, that makes superconductivity disappear at higher temperatures.
Barnaby Evans
Barnaby Evans is the creator of WaterFire, cited as one of America's most important pieces of public art. Friedrich St. Florian called WaterFire the "crown jewel of the Providence renaissance."
He has won numerous regional, national and global awards for his creation of WaterFire. The art and event has helped to transform Providence.
As his bio states, he "is also known for his photography which is included in the permanent collections of the Victoria and Albert Museum, London; the Bibliotheque National, Paris; the Musee' d'art et d'histoire, Fribourg, Switzerland; the Addison Gallery of American Art, Andover, Massachusetts; and the Museum of Art, Rhode Island School of Design among others."
Howard Ben Tré
Ben Tré is a world leader in innovating cast glass as a sculptural medium, and his work has been exhibited at more than 100 museum and public collections worldwide -- and his studio is located in Pawtucket, RI.
His works have been at the Metropolitan Museum of Art; the Museum of Fine Arts, Boston; the Philadelphia Museum of Art; the Albright-Knox Art Gallery, Buffalo, NY; the Hirshhorn Museum and Sculpture Garden; the Renwick Gallery of the Smithsonian Institution; the Los Angeles County Museum of Art; the Museum of Fine Art, Houston; the National Museum of Modern Art, Kyoto; and the Museum of Modern and Contemporary Art, Nice.
Bill Reynolds
Reynolds' books use sports as the framework, but are deeper examinations of poverty, race, and addiction.
His book "Fall River Dreams" defined him a leading American writer who uniquely captures the intersection of sports and culture.
"Bill Reynolds is one of the best writers around, and this book is the Friday Night Lights of high school basketball," said Dan Shaughnessy of the Boston Globe.
"Success is a Choice," which he co-wrote with Rick Pitino, is a business "how to" book that was a New York Times best-seller.
Reynolds has written 11 books and is a sports reporter for the Providence Journal.
John McCauley (Deer Tick)
McCauley has been a leading voice in the alternative, indie rock sphere for more than a decade. His work is a mix of rock with folk, blues, and country influences.
Along with his band, McCauley won Rock Artist of the Year at the Boston Music Awards (beating out Aerosmith) in 2013. He is married to fellow musician Vanessa Carlton -- Stevie Nicks officiated their wedding.
With Deer Tick he has produced five albums.
Ira Magaziner
Business Consultant
He created one of the most innovative university curriculums in America while he was an undergraduate at Brown, and went on to a Rhodes Scholarship at Oxford.
Magaziner founded a leading business consulting firm - Telesis -- and then sold it to Towers Perrin. He served as the policy point person in President Bill Clinton's Health Reform initiative that was led by Hillary Clinton. The effort failed and Magaziner was sued and fined — it ultimately was overturned
Today, he serves as the vice chairman and chief executive officer of the Clinton Health Access Initiative (CHAI). His son Seth is RI's General Treasurer.
Angus Davis
Few business innovators in America have had the success of native Rhode Islander Davis.
He co-founded Tellme, raised more than $200M in capital, and helped to lead the company to more than $100 million in sales and 300 employees. Tellme was acquired by Microsoft for nearly $1 billion.
Now, he is trying to do it again with Upserve, formerly Swipely. The company is "the smart management assistant serving up clear guidance that makes your restaurant thrive" - a tech firm that creates an information infrastructure for restaurants. He has raised upwards of $50 million for Upserve. Davis is a leading American business thinker -- all before the age of 40.
Terry "Mother" Moy
Navy SEAL
If the Navy SEALs are the best trained and most respected in the United State Armed Forces, Moy is the "Mother" of the SEALs.
The Newport native is the embodiment of military lore. He was a famous SEAL instructor and one of his most infamous trainees was Jesse "The Body" Venture - Seal, professional Wrestler and Governor of Minnesota.
While most SEAL activity is undisclosed, his effort to recover Apollo 17 was globally broadcast.
Phil West
Government Reformer
Once dubbed the Godfather of Ethics Reform, West has been the driving force in reforming governmental ethics for three decades in Rhode Island.
His successes include a then-record fine against Governor Ed DiPrete, Separation of Powers, downsizing and modernizing the legislature, and the requirement of electronic filing of bills and making hearings accessible to the public.
He was the head of Common Cause RI for eighteen years and retired in 2006, but still remains a guiding force in reform. Two years ago, the master lever was eliminated and this year major ethics reform is moving through the General Assembly — all under the watchful eye of West.
West has taken on the most powerful forces — sometimes alone — and made Rhode Island a better place as a result.
Richard Jenkins
Jenkins is the consummate American actor. His work ranges from everything from "The Witches of Eastwick" to "Hannah and Her Sisters" to HBO's "Six Feet Under" to his award winning role in "Olive Kitteridge"
His formative acting years took place at Trinity Repertory Company (now Trinity Rep). Jenkins then returned later in his career to help save the financially struggling theater.
He has starred and appeared in more than 80 movies and television series or movies. In 2014, Jenkins and his wife Sharon received the Pell Award for Lifetime Achievement from Trinity Repertory Company in Providence.
Alan Hassenfeld
The former CEO and Chairman of Hasbro was a driving force in transforming the company from a toy manufacturer to an entertainment company.
Michael Jackson and slews of others came to Rhode Island to tour the company and negotiate licensing deals.
In the early 1990's he became a force in initiating ethics reform in Rhode Island. More recently, he endowed the creation of the Hassenfeld Institute for Public Leadership at Bryant University.
The Rhode Island-based Hassenfeld Foundation gave out roughly $4.7 million in donations in the most recently reported year.
M. Therese Antone, RSM, Ed.D
Sister Antone was born in Central Falls, and educated at Salve Regina University, Villanova University, Harvard University and MIT Sloan School of Management.
Correspondingly, she has taught almost every level of education, rising to President of Salve Regina. There, she transformed the school, and Salve Regina's national rankings and student profile vastly improved under her leadership.
During her tenure, the University's endowment grew from $1 million to more than $50 million and the University invested $76 million on renovations and expansions and has received numerous awards for restoring the historic mansions, cottages, and gatehouses on its campus. She transformed the University and correspondingly has won countless awards for her service.
Umberto Crenca
Artist and Entrepreneur
Artist, visionary and business leader, Crenca took a crazy idea of developing a sustainable art cluster in Downtown Providence and made it the most unimaginable success, and has become a national model.
AS220 was founded in 1985 to "provide a local, unjuried, and uncensored home for the arts," and has grown to own and operate multiple facilities, currently providing fifty eight artist live and/or work spaces, four exhibition spaces, a print shop, a media lab including a black and white darkroom, a fabrication lab, a stage, a recording studio, a black box theater, a dance studio, and a bar and restaurant.
In 2016, Crenca was awarded Honorary Degrees from two different Rhode Island Universities.
Carolyn Rafaelian
In July, Forbes announced its "America's Richest Self-Made Women" list for 2018 and Rhode Island's Carolyn Rafaelian came in at #21 on the list.
The list includes Oprah Winfrey at #6, Sheryl Sandberg of Facebook at #12, Sara Blakely of Spanx tied with Rafaelian at #21, and Kylie Jenner at #27.
"Despite this crazy state, it's possible for a Rhode Island woman to reach this self-made list. For that I am proud," said Rafaelian, Founder and CEO of Alex and Ani in an interview with GoLocal.
"I am thrilled with my new team in place and we will continue to attract all the right people and continue to streamline the business and its efficiency. After all, we are the jewelry capital of the world!" she said.
In June, Alex and Ani hit a milestone that few companies could ever dream of achieving — it has surpassed the donation of $50 million to more than 50 non-profit partners through its Charity by Design program.
The program was created in 2011 to "spread the Alex and Ani ideal of sharing positive energy worldwide, igniting passion for the wellbeing of our planet, our communities, and our individual paths. Since 2011, Alex and Ani has donated $52.6M to organizations large and small," she said.
Louise Durfee
Environmentalist and Attorney
When one talks about trail blazers in Rhode Island, Louise Durfee's image should be the first thing that comes to mind. She was the first female partner at a major Providence law firm at a time when most law firms did not employ women attorneys. She was one of a small group of Tiverton residents who joined together in the early 1970's to oppose a proposal to build a major oil refinery.
The fight was so profound that it was featured in 1971 in Life Magazine and resulted in the founding of an organization that ultimately became Save the Bay. Again, Durfee the trail blazer.
In the 1980's she helped to clean up the aftermath at Rhode Housing after widespread corruption was found. In 1991, Governor Bruce Sundlun named her Director of the Department of Environmental Management and just three years later, he fired her.
So she ran against him in the Democratic primary for Governor.
Ron Machtley
Politician and University President
Rhode Islanders were first introduced to Ron Machtley in 1988 when he traveled around Rhode Island with a pig named Lester "Less" Pork to point out the wasteful spending of then-Congressman Fred St. Germain.
Machtley upset the 28-year veteran and Chairman of the House Banking Committee to take the Congressional seat. In 1994, he was the odds-on-favorite to win the Governorship, but was upset in the GOP primary by Lincoln Almond, who went on to serve eight years as Governor.
After his defeat, he was the surprise choice to serve as President of then-Bryant College. At first appearances it was a strange choice, but Machtley could not have turned out to be a better selection.
Under his leadership, the college transformed to a University, with massive improvements in the University's campus, an elevation to Division I Sports, and an overall improvement in Bryant's academic position.
When he assumed office Bryant had a $1.7 million operating deficit and a tiny endowment. Today, the University's endowment is nearing $200 million. Over the past 20 years, Bryant has become one of the most improved higher education institutions in America.
U.S. Senator Jack Reed
If this list of greatest living Rhode Islanders had been developed twenty years ago, it might have been rich with elected officials - the likes of Senators Claiborne Pell and John Chafee, the retired John O. Pastore and Bruce Sundlun, but today there are few with the gravitas of achievement of those politicians.
However, there is the now-senior Senator from Rhode Island, who has a national reputation as an expert on issues of national defense and is a constantly rumored to serve as the Secretary of Defense.
The former Army ranger worked his way up the political ladder as a State legislator and Congressman before winning the Senate seat of the retiring Pell.
In a time of great diverseness, he is a rare member that has conversations across the aisle.
Trudy Coxe
Environmentalist and Historic Preservationist
Coxe has now headed three of the most most important preservation organizations in New England. As the long-time Executive Director of Save the Bay in the 1980's and 1990's, she was a powerful force in driving the preservation of Rhode Island's open space and improvements to Narragansett Bay.
Coxe lost a close race for Congress against Jack Reed, but was later appointed head of the largest Environmental Agency in New England when then-Governor Bill Weld named her head of the Massachusetts environmental agency - the Department of Environmental Protection.
After a multi-year stint in the Commonwealth, she came back to Rhode Island to lead and transform the Preservation Society of Newport. In that role she has helped to recpaitalize and modernize the non-profit that stewards the mansions and other assets in Newport and across Aquidneck Island.
Ken Read
No one on this list may be more accomplished in their individual field than Ken Read is to sailing. Twice the Rolex United States Yachtsman of the Year, three times leading America's Cup yachts, and dominant in the Volvo Ocean Races for decades.
One could argue Read may be the most accomplished sailor in the world. He was a three-time college All-American at Boston University.
Today, he sails leading privately owned yachts and has been involved with the North Sail company.
Michael Littman
There are few computer science professors that get tapped for their celebrity for a national television commercial (see below), but Brown University's Littman is an academic rock star. After ten years at Rutgers he left to join the faculty at Brown
He leads an effort called Humanity-Centered Robotics Initiative (HCRI) in which Brown University aims to become a global leader in the field of creating robots that benefit, learn from, teach, support, and collaborate with people.
One of his recent journal articles he co-wrote was titled, "Learning behaviors via human-delivered discrete feedback: modeling implicit feedback strategies to speed up learning."
His commercial was easier to understand -- it has been viewed 550,000 times.
Johanne Killeen
For decades the nicest restaurant in Providence might have been the old Rusty Scupper, but in the 1980's, Johanne Killeen and George Germon not only transformed the restaurant scene in Providence, but also proved that small cities with brilliant chefs could compete.
Food & Wine honored Al Forno for launching 'a new era of ambitious cooking in Providence [in 1980] with their thin-crusted grilled pizzas topped with superfresh ingredients.' The editors singled out Al Forno's Margarita Pizza (with house-made pomodoro, fresh herbs, two cheeses and extra virgin olive oil) as the signature item.
John Mariani, the food writer for Esquire put the new restaurant, Al Forno, on the national map by naming it the best new restaurant in America. Other food and travel magazines followed and the recognition transformed Providence, and as a result other mid-sized cities.
Al Forno put Providence on the food map and sparked many other creative and smart chefs. George Germon passed away in October of 2015.
Terry Murray
It has been a number of years since Terry Murray ran one of the biggest banks in America. In 2004, Fleet Bank was acquired by Bank of America. Even today, Bank of America is headed up by a former Fleet executive -- Brian Moynihan.
In the 1990's, Fleet was a superstar financial service firm — it gobbled up bank after bank in the U.S. and in 1999 Murray and Fleet made the biggest buy - acquiring BankBoston. The new FleetBoston was a megabank.
FleetBoston was the seventh-largest bank in the United States, as measured by assets (US$197 billion in 2003). It employed over 50,000, served more than 20 million customers globally, and revenues of $12 billion per year.
Murray grew Fleet from a small RI community bank to a global player.
Farrelly Brothers
Movie Producers
The Cumberland brothers - Peter and Bobby - are two of the most prolific comedic movie makers in Hollywood. They created a genre of politically incorrect, slapstick humor that has generated billions in box office sales.
Their movies include Kingpin, There's Something About Mary and Dumb and Dumber -- to name a few of their 15 movies.
The Farrelly Brothers also co-wrote one of the all-time great Seinfeld episodes -- titled "The Virgin."
Ojetta Rogeriee Thompson
In 1965 Thompson came to Providence from South Carolina to attend Brown University and never went home. Today, she serves on the 1st Circuit Court of Appeals - one of the highest federal courts in America.
She was elevated to the seat previously held by Judge Bruce Selya. Before serving on the court she served on the District and Superior Courts in the Rhode Island Courts.
Today, she serves on the Brown Corporation, the Board for College Unbound and Save the Bay.
Sid Abruzzi (Johnny Morocco)
Abruzzi is known as the "godfather of the New England surf/skate mafia."
"With a face that launched a thousand spliffs, 'The Package' has skated, surfed, and partied over the last 50 years with no end in sight. After reaching rockstar status with Big World in the mid '80s, Sid's infamous Water Bros. Surf shop brought vert skating to the beaches of Newport, RI," wrote Jim Murphy in Juice Magazine.
Before ESPN's X Games (Extreme Games) or the Gravity Games were envisioned, Abruzzi was an innovator helping to create a movement and industry that was primarily a West Coast phenomenon.
Duke Robillard
The blues guitarist and Woonsocket native is well-known locally for co-founding Roomful of Blues, but his presence on the national stage, performing with The Fabulous Thunderbirds and recording with the likes of Bob Dylan and Tom Waits has helped make Robillard a bona fide star in American music.
He is a two-time Grammy nominee, won the W.C. Handy Award in 2000 and 2001 for Best Blues Guitarist, and in 2007 received a Rhode Island Pell Award for Excellence in the Arts. But don't take our word for it — Tom Clarke with Elmore Magazine extolled Robillard's virtues when he reviewed "The Acoustic Blues & Roots of Duke Robillard" in 2015."
"A jazz man, a front porch pickin' blues man and one-time guitarist for Dylan. A string band, jug band, ragtime, delta, Louisiana, Appalachian folk and Jimmie Rodgers-country aficionado. A backwards traveler, but forward thinker. A writer and singer with distinct style, and a studio owner and in-demand producer. Did I miss anything? Duke Robillard may wear a handsome, if nondescript, lid lounging on the cover of The Acoustic Blues,but he almost literally wears a hundred hats—all of them damn well. It's hard to believe any one man can be as prolific as this Rhode Island Duke of the blues," wrote Clarke.
John Ghiorse
Ghiorse may be Rhode Island's most trusted and beloved television and digital news personality of all time. The Air Force Veteran and Harvard educated weatherman studied Meteorology at Penn State. He transformed weather reporting in Rhode Island and created his own branded measure — the Ghiorse Factor.
He first joined WJAR-10 in 1968, then moved to Channel 6 for nearly a decade and then back to WJAR. He retired from Channel 10 in 2009 and joined GoLocal and helped the digital media company launch its first site in 2010. He has delivered the daily Ghiorse Factor to GoLocal for the past five plus years.
Ghiorse continues to be one of Southeastern New England's most beloved news personalities.
Eugene Lee
Set Designer
If you have watched Saturday Night Live, the Tonight Show with Jimmy Fallon or many a production of A Christmas Carol at Trinity Rep, you have seen the work of Eugene Lee. He is one of America's most creative and accomplished set designers.
The Providence resident has won three Tonys for Wicked, Sweeney Todd, and Candide. He has won multiple Drama Desk Awards for Outstanding Set Design and has won an Emmy for the design of the set for Saturday Night Live.
He is a member of the American Theater Hall of Fame.
Claire Andrade Watkins
Rhode Island has always been one of the top destinations for Cape Verde emigres — and next month, Emerson College Professor and Brown University Fellow Andrade-Watkins, who grew up in Fox Point, will have a thirty year retrospective of her work at the Museum of Fine Arts in Boston.
The subject? "Our Rhode: 30 Years of Cinema by and About Cape Verdian Rhode Islanders."
Andrade-Watkins, a PhD, is Professor of Africana and Postcolonial Media Studies at Emerson, and is a Fellow at the Swearer Center for Public Service at Brown (as well as a visiting scholar). She is the Director of the Fox Point Cape Verdean Project, President, SPIA Media Productions, Inc., and a pioneer of global, intercultural media, marketing and distribution. Her CV of work and accomplishments is 17 pages long.
In 2006 Dr. Andrade-Watkins released "Some Kind of Funny Porto Rican?" A Cape Verdean American Story" (SKFPR), the "popular and critically acclaimed feature documentary about the Cape Verdean community in the Fox Point section of Providence, RI, and the first in a trilogy of documentaries about this unique and important community of the Africana Diaspora," states her Emerson bio.
She's won numerous awards including the 2008 Community Service Award from Fox Point Boys & Girls Club Alumni Association.
Freidrich St. Florian
St. Florian is one of the most accomplished and varied architects in America. At one extreme he was the architect of the critically acclaimed World War II memorial in Washington, DC and on the other he designed the Providence Place Mall.
St.Florian has won numerous awards for his architectural achievements. He is a Fellow of the American Institute of Architects and a Fellow of the American Academy in Rome. His drawings are in the permanent collection of the Museum of Modern Art in New York and the Georges Pompidou Centre in Paris. In 2006 he was an awarded an honorary degree from Brown University.
Brad Read
Over the past few decades, Brad Read has built Sail Newport into a leading world class sailing education organization. Their programs vary from a partnership with the MET school that introduces urban children to sailing to running world class sailing events.
In 2015, Read was the driving force to bringing the Volvo Ocean Race to Rhode Island and then followed it up by leading the state's effort to successfully bring the Volvo race back in 2017.
Read is a leading sailor, educator, facilitator, organizer and leader. His impact on Newport — and Rhode Island — has been remarkable.
Gordon Wood
In a scene in the movie Good Will Hunting, Matt Damon humiliates a Harvard grad student by picking apart the student's thesis regarding Wood's "pre-revolutionary utopia." (see scene below)
Matt Damon aside, Wood is one of America's most accomplished scholars on the American Revolution — he won the 1993 Pulitzer Prize for History for his work The Radicalism of the American Revolution. In 2010 he was awarded the National Humanities Medal.
He is the Alva O. Way University Professor and Professor of History Emeritus at Brown University. His list of academic awards over the past 50 years is unmatched - he is the leading Revolutionary era historian.
Barrett Hazeltine
Business Mentor
For the past 60 years Hazeltine has been one of the most important educators at Brown University. While Brown does not have a traditional B-School like Penn's Wharton, it does have one of the top American business mentors. According to many of the top business leaders in America, Hazeltine was a guiding influence on their careers.
A 2000 article in Brown Alumni Monthly unveiled in 2000 that 10% of the freshman class at Brown University took his "Engin. 9" class — short for Engineering 9.
Entrepreneurs as diverse as "Tom and Tom" (First and Scott, who met at Brown), Founders of Nantucket Nectars to John Koudounis, the CEO of Calamos Investment to Marques Coleman at Carlyle Group all identify Hazeltine as being a driving force in their business careers.
John Donoghue
Brain Scientist
Donoghue is one of the leading brain science researchers and entrepreneurs in the world. At Brown, he led the enhancement and growth of the Brain Science Center and his work to develop BrainGate, a mind-to-movement system developed in Donoghue's lab.
Donoghue has published over 80 scientific articles in leading journals including Nature and Science. His work was featured on 60 Minutes and he has served on advisory panels for the National Institutes of Health, the National Science Foundation and NASA.
On October 2, 2018, he got another accolade that might just change the course of humanity -- "Brown scientist wins $1.5 million innovator award for new approach to decoding brain signals."
James Woods
The Warwick native is a two-time Academy Award nominee and winner of a Golden Globe, and three-time Emmy Award winner. His acting career ranges from The Onion Field to Casino and Nixon.
More recently his voice work has been featured on The Simpsons, Family Guy, and Stuart Little 2.
Between TV, voiceover work and movies he has played roles in more than 100 productions.
Once dubbed as a genius by Business Insider for his attendance at MIT and his reported near-perfect SAT score and IQ of 184.
Today he is a Republican activist and supported Ted Cruz for President. He has also been the center of controversy.
Arlene Violet
Violet was one of a group of pioneering women who changed the face of politics in Rhode Island.
Claudine Schneider had been elected to the U.S. House of Representatives in 1980 in the 2nd Congressional District. Susan Farmer won the Secretary of State post two years later in 1982. Violet was the first female Attorney General in the United States when she was elected by Rhode Island voters in 1984. The new decade had ushered in a new era in Rhode Island politics. All three were Republicans.
It was her work and the work of other women that set the stage for Governor Gina Raimondo to be elected Rhode Island's first woman Governor in 2014.
Violet was defeated in her re-election bid in 1986, but her political presence continued in the state.
She was a talk radio host.
She penned two books, Convictions: My Journey from the Convent to the Courtroom and Me and the Mob, a book about the witness protection program. Violet was inducted into the Rhode Island Heritage Hall of Fame in 1996.
Meredith Viera
A native Rhode Islander, TV-journalist Vieira is one of the leading Portuguese Americans in the United States. She attended Lincoln School and Tufts before landing her first job in Worcester in radio and on television as a reporter at WJAR-TV in Providence.
Her hard news journalism bona fides were earned while working on the CBS news magazine West 57th, then as an investigative report for 60 Minutes.
Then in the late 1990s she shifted to more entertainment focused broadcast as a co-host to The View, hosting the game show "Who Wants To Be A Millionaire," co-hosting the Today Show and Dateline NBC. She hosted her own show, The Meredith Viera Show for two years.
More recently she has been involved with a range of event and initiatives in Rhode Island including speaking at RIC regarding her heritage — all four of her grandparents were born in the Azores. Last year, URI's Harrington School of Communication traveled down to Viera's show at NBC Universal.
Leon Cooper
Brown University's Leon Cooper held the distinction as Rhode Island's only Nobel Prize winner -- until colleague J. Michael Kosterlitz earned the honor in 2016.
Cooper won the Nobel Prize in 1972 for Physics (along with J. Bardeen and J.R. Schrieffer) for his studies on the theory of superconductivity. The winning work was completed while still in his 20s.
He has received seven honorary degrees from leading academic institutions from across the globe.
In the past few years, his work at Brown has focused on neural and cognitive sciences and has been "working towards an understanding of memory and other brain functions, and thus formulating a scientific model of how the human mind works."
Ernie DiGregorio
There are certain athletes who transcend the game and elevate it from sports to a higher level of entertainment. Ernie D. was one of those rare athletes. He was am epic story, the 6 foot guard from North Providence who helped to take the beloved Providence College Friars to the final four. His skills and showmanship helped to transform the game from fundamentals to entertainment along with players like Connie Hawkins, Pistol Pete Maravich, Dr. J, and then Larry Bird, Magic Johnson and Michael Jordan. They all may have had better and longer careers, but none of them put on any better a show.
His NBA career was cut short due to injury but in his first year in the league he dazzled and won the NBA Rookie of the year. He was the third pick in the NBA draft.
For Rhode Islanders at the time his achievements were mythical. He teamed with fellow local boy Marvin Barnes and put little Providence College in the same sentence with powerhouse programs like UCLA.
Elizabeth Beisel
Arguably the best swimmer to come out of Rhode Island, the Saunderstown native and North Kingstown high school grad first competed in the 2007 World Championships at the tender age of 14, placing 12th in the world in the 200 meter backstroke after advancing to the semi-finals.
Beisel was the youngest member of the U.S. swim team at the 2008 Olympics in Beijing, finishing just out of medal contention with a fourth place in the 400-meter individual medley and fifth in the 200 meter backstroke. Four years later in London, Beisel made it to the Olympic podium with a silver in the 400 meter individual relay and a bronze in the 200 meter backstroke.
The SEC Female Swimmer of the Year in 2012, Beisel won two individual national titles and was an eighteen-time All-American at the University of Florida, and a first-team Academic All-American. According to her USA Swimming bio, the college communications major had dreams as a child of being an actress, but now has professional aspirations of being a news anchor. As someone accustomed to being in the headlines, it's not hard to imagine we'll be seeing more from Beisel in the future.
George Wein
The Newport Jazz and Folk Festivals would not be among the top American music festivals were it not for Wein, who celebrated his 90th birthday last year.
Trained as a jazz pianist, Wein might be Boston-born and educated, but it was the Newport Lorillards who invited Wein down in 1954 to the City by the Sea to establish the first outdoor jazz festival in the country. Wein went on to form Festival Productions to promote large-scale jazz events, and has been well-lauded for his efforts — both nationally, and internationally.
In 1995, Wein received the Patron of the Arts Award from the Studio Museum of Harlem, and in 2004 given an Impact Award from the AARP. He was decorated with France's Légion d'honneur and appointed a Commandeur de L'Ordre des Arts et Lettres (Commander of the Order of Arts and Literature) by the French government, and has been honored at the White House twice, by Jimmy Carter in 1978 and Bill Clinton in 1993. In 2005 he was named a "Jazz Master" by the National Endowment for the Arts. He has received honorary degrees from the Berklee College of Music and Rhode Island College of Music.
GoLocal's Ken Abrams sat down with Wein for a one-on-one last summer — read more here.
Jeffrey Osborne
Grammy Award-winning Osborne, born and raised in Providence, came from musical lineage. His father, Clarence "Legs" Osborne was a trumpeter who played with the likes of Duke Ellington and Count Basie. And the Osborne roots are firmly planted here — in 2012, the city named a portion of Olney Street "Jeffrey Osborne Way," to honor him.
Osborne's biggest hits include "On the Wings of Love" and a duet with Dionne Warwick, "Love Power." He wrote the lyrics for Whitney Houston's "All at Once," appeared in the fundraising "We Are the World" video in 1985, and has sung the national anthem at multiple World Series and NBA finals games.
While Osborne is an international legend in his own right, his star status continues to grow and impact the community here through his charity work. He's done golf and softball classics, comedy nights, celebrity basketball games. And he brings in the big names, from Magic Johnson to Smokey Robinson to Kareem Abdul Jabbar — the list is extensive. Osborne is the epitome of a "greatest Rhode Islander" — one who's gone on to make the state proud, and keeps coming back to help use his celebrity to benefit the community.
Tom Ryan
Ryan helped to build one of America's Fortune 500 top 10 companies, as CVS is a leading retail and healthcare force in America.
More recently, the URI pharmacy grad has been involved with two of the biggest initiatives in Rhode Island in the past few years.
He and his wife Anne donated $15 million to fund the George and Anne Ryan Center on Neuroscience at URI. The effort is one of the key elements in bringing together major educational and health organizations in a broad-based neuroscience initiative in Rhode Island.
Ryan's neuroscience gift coupled with his fundraising leadership and donations to build the Ryan Center have made him the single biggest individual donor to URI.
Ann Hood
Born in West Warwick and a URI grad, Hood is a best-selling novelist and short story writer; and the author of fifteen books, with her latest, The Book That Matters the Most, due out this August.
Hood has won two Pushcart Prizes, two Best American Food Writing Awards, Best American Spiritual Writing and Travel Writing Awards, and a Boston Public Library Literary Light Award. Her essays and short stories have appeared in The Paris Review, Ploughshares, and Tin House. Hood is a regular contributor to The New York Times' Op-Ed page, and is a faculty member in the MFA in Creative Writing program at The New School in New York City. Hood's "An Italian Wife" was recently featured as a play at the Contemporary Theater Company in South Kingstown.
Of Hood's The Knitting Circle, The Washington Post wrote, "A wondrously simple book about something complicated: the nearly unendurable process of enduring a great loss." Fellow best-selling writer Jodi Picoult even asked if anyone could top Hood. "Is there anyone who can write about the connections of ordinary people better than Ann Hood?" posed Picoult.
While her reach is worldwide, Hood lives in Providence and is a fixture in the Rhode Island community.
Bob Ballard
Ballard found the Titanic. And yes, he was a URI undergrad and now serves multiple leading roles at URI as a Professor of Oceanography; Director, Center for Ocean Exploration; and head of the Institute for Archaeological Oceanography.
Today, the Archeological Oceanography, which he started in 2003 is a unique institute "combines the disciplines of oceanography, ocean engineering, maritime history, anthropology and archeology into one academic program." The institute involves a broad cross section of URI faculty and includes faculty from Harvard University, the University of Pennsylvania, Florida State University, MIT and Woods Hole.
He is the rockstar face of oceanography in the world.
Jonathan Nelson
Nelson is one of America's leading investors. In an era of Wall Street mega firms, Rhode Islander Nelson has built in Downtown Providence a $40 billion private equity fund Providence Equity Group.
Once the golden boys of private equity and lauded for putting together "the biggest deal in the world," he and the firm have had a series of set backs.
The highest profile bump was the firm's loss of nearly $800 million in the firm, Altegrity, that was contracted to review federal contractors like Edward Snowden.
As GoLocal previously reported, the domino effect of Snowden's absconding with federal data bases exposed the deficiencies of Altegrity's vetting process.
He has become more active as a philanthropist and is listed by Forbes richest in Rhode Island.
Dennis Littky
Littky is a rebel, a disruptor, an innovator, a trouble maker, and an educator. They made a movie about him, Newsweek has featured his schools, President Obama talks about his schools and Bill and Melinda Gates gave him millions to grow, refine and scale is model of disruption.
In 2009, Littky defied all and created an alternative college and by 2015 the Rhode Island Council on Postsecondary Education approved College Unbound as a degree-granting postsecondary option in the state.
In Rhode Island, The Met School celebrated its 20th Anniversary this past week. Thousands of students who would not have finished high school have graduated and moved on to college, business and beyond.
There may be no more accomplished innovator than Littky.
Bill and David Belisle
Bill and David Belisle may be the best high school and youth coaches in history. Going by the statistics, the record of twenty-six consecutive state hockey championship (1978 to 2003) and a total of 32 may be a record never to be matched. Bill Belisle (the father) has coached at Mount for 42 years and his son David has been his assistant for years.
The younger Belisle made national headlines with his post-game speech to the Little League team he was coaching was defeated in the Little League World Series.
Twice their players have been selected #1 in the NHL Draft, countless others played in the NHL, and dozens played college hockey. There are movies and books on the exploits of Mount Hockey under the Belisles.
Photo courtesy of Dave Belisle
Nick Benson
There are few people in the world that are recognized as the very best in their craft, but Nick Benson of the John Stevens Shop in Newport is globally recognized as the best stone cutter in the world.
Founded in 1705, The John Stevens Shop specializes in the design and execution of one-of-a-kind inscriptions in stone — the MLK Memorial, FDR's Four Freedoms Park, and the inscription for the John F. Kennedy Memorial in Arlington National Cemetery, to name a few.
Benson won a Genius Fellowship from the MacArthur Foundation, and was recently featured on CBS news. The John Stevens Shop is one of America's longest continuously running businesses.
Viola Davis
Davis is one of the most accomplished actors in the United States. She is the winner of two Tony awards, an Emmy and a SAG award as well as being nominated for an Oscar. With regards to her Emmy, she became the first African-American to win the Award for Outstanding Lead Actress in a Drama Series in 2015. Amazingly, she did not earn her SAG card until she was 30 years old.
Davis self-describes that she grew up in abject poverty in Central Falls and worked her way to Rhode Island College and now beyond but has been a constant force in helping Central Falls to recover from its bankruptcy and rebuilding its spirit.
She is a leading fundraiser for a range of Rhode Island causes. Davis is the embodiment of the Rhode Island spirit and a model of how to overcome the greatest challenges to reach greatness.
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Walking Dead Episode 1 Available for Free on XBLA
Telltale Games has made the first episode of the critically acclaimed Walking Dead video game available for free to anyone on Xbox Live.
For a limited time, Xbox 360 owners who have yet to download one of 2012's best games can now get the first installment of the episodic adventure game for the low, low price of free.
IGN is reporting Telltale confirmed it will be a limited offer, and will only last until Dec. 31st. To make the deal even better, for one day only starting Dec. 28th, the remaining four episodes will be part of the Xbox Live Countdown to 2013 sale.
Now you not only get to play the game everyone's been talking about, you get to do it on the cheap too.


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Errors & Omissions
Travel has its risks. Running a travel agency shouldn't.
Romance. Relaxation. Adventure. As a travel agent, you're in the business of selling all this and more. But what happens when a travel experience includes some misadventure? An incorrect departure date. The wrong itinerary. A forgotten passport. Or worse, a "slip and fall" or other type of physical injury to your client while traveling. It only takes a client who believes you have erred to file a case against you, whether or not the facts actually support their allegations.
Professional Liability Insurance provides valuable coverage for owners and employees of travel agencies and tour operators in the event of any errors and omissions claims. While you cannot completely eliminate the likelihood of a claim, how you choose to manage risks makes a difference as an agency manager.
Errors & Omissions Professional Liability Coverage is comprehensive and affordable. It includes:
- Errors and Omissions claims against you, your agency or its employees that may involve either actual or perceived errors.
- Bodily injury and property damage liability coverage that protects against catastrophic losses involving injury or death to your clients while traveling.
- Personal injury coverage that protects against charges of libel, slander, false arrest, detention or imprisonment. For example, this situation could arise if your clients do not possess proper passports or travel visas.
- Unlimited legal defense expenses are integrated into the policy limits. Legal costs can skyrocket even in cases where travel agents are deemed not to be liable.
- First dollar defense, another policy feature, means that there is no out of pocket expense for legal costs. The deductible applies only to paid claims.
- Worldwide coverage means that no matter where your clients travel or where the claim is made, you're protected.
For more product information or a participation agreement, call 1-800-523-8020 or email email@example.com.