text:
A free storage tool for Microsoft Azure
- Manage all your Microsoft Azure blobs in one place
- Reliably upload and download blobs with a responsive UI
- Transfer blobs between your storage accounts
- Easily search and filter your blobs
Chrome Extension for Dynamics CRM/365 power users
Download: https://github.com/rajyraman/Levelup-for-Dynamics-CRM
Firefox extension for Dynamics CRM/365 power users
Download: https://github.com/rajyraman/Level-up-for-Dynamics-CRM-365-Firefox
Edge extension for Dynamics CRM/365 power users
Download: https://github.com/rajyraman/Level-up-for-Dynamics-CRM-365-Edge-Browser
Free multi-platform database tool for developers, SQL programmers, database administrators and analysts. Supports all popular databases: MySQL, PostgreSQL, MariaDB, SQLite, Oracle, DB2, SQL Server, Sybase, MS Access, Teradata, Firebird, Derby, etc.
Community Edition 5.0.2
Released on April 2, 2018 (Milestones).
It is free and open source (license).
Also you can get it from the GitHub mirror.
WSO2 Integration brings digital transformation into a single package for connecting enterprise systems and data.
WSO2 Enterprise Integrator 6 is a powerful, 100% open source integration platform connecting to, and transforming data between legacy systems, SaaS applications, services, and APIs. Enterprise Integrator 6 provides the fundamental capabilities of a connected SOA architecture. The Enterprise Integrator 6 package includes runtimes for data and service integration, messaging, business process execution, microservices, and analytics.
This release brings together functionality previously encapsulated in the WSO2 Enterprise Service Bus (WSO2 ESB), WSO2 Message Broker (WSO2 MB), WSO2 Data Services Server (WSO2 DSS) and WSO2 Business Process Server (WSO2 BPS).
Android Studio provides the fastest tools for building apps on every type of Android device.
World-class code editing, debugging, performance tooling, a flexible build system, and an instant build/deploy system all allow you to focus on building unique and high quality apps.
If you want to project your phone screen to an external display but are unable to connect to a wireless device, you can use a USB cable to connect to a Windows device. Note: To project your phone screen with a USB connection, you'll need to install the Project My Screen app on your Windows device (a Windows PC, laptop, or select tablet). Once you've installed the Project My Screen app, do the following: 1. Use a USB cable to connect your phone to your Windows device. 2. Start the Project My Screen app on your Windows device. 3. On your phone, tap Yes when prompted to allow screen projection. Notes: • You can't use a USB connection to project content that's protected by Digital Rights Management (DRM) – for example, Xbox Video. • Projecting your phone screen with a USB connection is video only. You can still manage audio through your phone.
Almost 11 years after we created CodePlex, it's time to say goodbye. We launched CodePlex in 2006 because we, like others in the industry, saw a need for a great place to share software. Over the years, we've seen a lot of amazing options come and go but at this point, GitHub is the de facto place for open source sharing and most open source projects have migrated there.
We migrated too. As many of you know, Microsoft has invested in Visual Studio Team Services as our "One Engineering System" for proprietary projects, and we've exposed many of our key open source projects on GitHub (Visual Studio Code, TypeScript, .NET, the Cognitive Toolkit, and more). In fact, our GitHub organization now has more than 16,000 open source contributors – more than any other organization – and we're proud to partner closely with GitHub to promote open source.
Over the past few years, we've watched many CodePlex projects migrate. During the same period, we've had to address several issues, including a spam epidemic over several months in 2015, as spammers sought to take advantage of the CodePlex.com domain to boost their illicit activities. We've also seen a substantial decrease in usage: as of this writing, less than 350 projects saw a source code commit in the last 30 days.
The shutdown plan
So, it's time to say goodbye to CodePlex. As of this post, we've disabled the ability to create new CodePlex projects. In October, we'll set CodePlex to read-only, before shutting it down completely on December 15th, 2017.
The CodePlex archive
We'll take a final, complete backup of the site before shutting down and decommissioning the existing CodePlex site and servers.
At that time, CodePlex.com will start serving a read-only lightweight archive that will allow you to browse through all published projects – their source code, downloads, documentation, license, and issues – as they looked when CodePlex went read-only. You'll also be able to download an archive file with your project contents, all in common, transferrable formats like Markdown and JSON. Where possible, we'll put in place redirects so that existing URLs work, or at least redirect you to the project's new homepage on the archive. And, the archive will respect your "I've moved" setting, if you used it, to direct users to the current home of your project.
There isn't currently any plan to have an end date for the archive.
Migrating your data
We're providing two first-class ways to get your data out of CodePlex. First, we've partnered with GitHub to provide a streamlined import experience to help you bring your CodePlex source code, license, and documentation to GitHub. A migration tool for issues is also in the works and will be available soon – we'll update this blog post with more details when it's available. And, we've added a new option to your project to set an "I've moved" banner on your project that will direct your users to your new home. There's a walkthrough on the CodePlex wiki to help you through the migration process.
Second, the CodePlex Archive will allow you to download an archive file, as described above.
If you'd like to migrate just your source code, you have a variety of options depending on your source control type. For Git users, many Git hosting services, including Visual Studio Team Services and BitBucket, offer an easy import flow to help you migrate. Bitbucket also offers import for Mercurial users.
We're here to help
As you use these tools, CodePlex support is standing by to help via email. GitHub is also ready to help if you encounter any issues with the import experience.
Field Service for Microsoft Dynamics CRM 2016 is a powerful tool to help support the activities of field based engineers.
Neil Parkhurst have been blogging on this subject for a few months!
Here I will give a collection of links to Neil Parkhurst various posts on Field Service for Microsoft Dynamics CRM. Collectively these posts should provide you with a detailed user guide, you could think of this post as a "book" on Field Service.
Introduction / Theory
|Last Updated
|An overview of the capabilities of Field Service
|August 2016
|Work Order Theory
|A description of what a work order is, its lifecycle and how it relates to other Field Service entities
|August 2016
|Video Demo
|A video demo of Field Service and notes on how to create the demo.
|October 2016
|Last Updated
|Step by step guide to creating a Field Service trial solution and installing the mobile application.
|August 2016
General Set-up
|Last Updated
|User Setup
|Field Service users, security roles and field security profiles explained.
|August 2016
|Reference data
|There are many reference data fields to define including work order types, pay types, work order sub-statuses etc. I describe them all here.
|August 2016
|Skill Types (Characteristics)
|How to create skill types and use them to ensure the right engineers are used.
|August 2016
|Configuring the Schedule Board
|In this post I describe how to configure the schedule board including adding new tabs and changing views.
|September 2016
|Service and Billing Accounts
|A description of the additional fields on service and billing accounts in Field Service. Plus, how to Geo Code accounts.
|August 2016
|Price Lists
|How to create price lists for Field Service including using Field Service Price List Items to apply minimum call out charges etc.
|August 2016
|Product and Services
|How to create the products and services to be included on work orders
|August 2016
|Incident Types
|Incident types are used to speed the creation of work orders. In this post I explain what is involved in creating an incident type.
|August 2016
|How to create resources, define their working hours and associate them with territories.
|August 2016
Using Field Service
|Last Updated
|Calculating Engineer Pay
|A description of how pay types and resource information is used to derive payment values for each booking
|September 2016
|Manual Scheduling (Schedule Board)
|An explanation of how to manually schedule work orders on the schedule board and also review driving direction / routes.
|September 2016
|Scheduling Assistant
|Using the scheduling assistant to use the semi-automatic scheduling capabilities of Field Service.
|September 2016
|Time Groups
|A description of how to define timeslots and then how you can use them in the scheduling assisstant.
|September 2016
|Customer Assets / Equipment
|How to create and see customer assets
|September 2016
|Agreements are used to automatically create regular work orders based on a "contract". Ideal for a preventative maintenance schedule. This post describes on how to create agreements and their associated booking and invoice setups.
|September 2016
|Time Off Requests
|This post explains what happens when the engineers request time off from the mobile application.
|August 2016
|Purchasing and Inventory
|An overview of the purchasing and inventory options in Field Service
|September 2016
|Inventory Quantities
|An explanation of when stock quantities and allocated values change. Plus unit groups explained.
|September 2016
Customizing Field Service
|Last Updated
|Field Service and Voice of the Customer
|Example workflow to send out a survey after completion of a work order. You may also find this post on how to create a survey useful.
|September 2016
|Download Resco CrmMobile Woodford
|You will need to download the client if you wish to customize the mobile application.
|September 2016
|Risky Situations
|A description of a simple change to warn if your field agent is working on something risky.
|September 2016
|Show Entity Images
|A example of how to improve the mobile app by adding images.
|September 2016
Chntpw (also known as Offline NT Password & Registry Editor) is a small Windows password removal utility that can run from a CD or USB drive. The latest version is 140201. Please download the Bootable CD image or the USB version for your own purpose:
You can also download chntpw for ALT Linux, Arch Linux, CentOS / RHEL, Debian, Fedora, Mageia, ROSA, Slackware, Ubuntu distributions from this link.
If you need to download the old version, please visit Offline NT Password & Registry Editor's official website.
After you've downloaded it, you then need to burn chntpw to CD/USB drive in order to get it to work.


text: Glenview, Ill. 150837651 150837651 en 1970 A new and enl. ed. / 1970 Reexamines earlier editions and re-words, re-arranges, and supplements where necessary. First complete revision since 1915. Rules of order newly revised Robert's rules of order, newly revised 2018-11-22 Congresses Robert Henry M. Henry Martyn Henry Martyn Robert 1837 1923 Parliamentary practice ilu Scott, Foresman

subset: commoncrawl


text:
The Difference in Throwing Mechanics of Pitchers to Position Players
MLB Promotes Olympic Lifting for All Baseball Players
america today, badass, college baseball, conventional wisdom, corporate america, explosive, fast twitch muscle, fastball, four months, heavy loads, hester, legal performance, lsu, massive strength, minor league baseball, Olympic Lifting Pitching, olympic lifts, performance enhancer, pitchers, rotator cuff, throwing a baseball, USA Weightlifting, weight training
Athleticism Defines the Pitching Mechanism
Pitching Study Proves Late Trunk Rotation Increases Arm Speed
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text:
In 2018, average daily viewing time for television stood at 2 hours and 55 minutes, according to Eurodata TV Worldwide's One TV Year in the World report.
That figure (based on analysis of 94 countries) was one minute shorter than in 2017, suggesting remarkable stability for the medium. However Eurodata says the headline figure does conceal some disparities between the different regions of the world. For example, viewing times in North America were significantly down (-9 mins), but Asia saw growth of three minutes year on year (up 2 hours and 28 minutes, +3 mins).
Frédéric Vaulpré, Eurodata TV Worldwide Director said: "TV is in good health and is benefitting from new consumer practices. Over the last 25 years, daily viewing time has been stable in North America and even increased in South America and Europe."
Adding detail, Eurodata said catch-up accounted for 8.3% of global TV viewing time – though the figure rises to 18% in Switzerland and 23% of the TV viewing time among young adults in Portugal. It also identified a trend towards pre-broadcasting – ie the launch of shows online before their official linear debut. In the UK, "pre-broadcast" accounted for 21% of the total audience for content offering this viewing option.
Among more than 10,000 new series launched in 2018 around the world, 43% were factual, 41% fiction and 16% entertainment genres. In terms of audience figures, new scripted series topped the annual charts in three quarters of the countries studied. Eurodata noted that 80% of them were local productions.
According to Eurodata TV, one trend emerging in 2019 is the factual TV portrayal of medical operations and health-related interventions. In the fiction genre, political drama series are on a roll while co-productions will continue to grow.
Enter the Advanced TV Service of the Year category if you've delivered something new and compelling to the market t… twitter.com/i/web/status/1…
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19th June 2019


text:
These days, every celebrity (and her stylist) dreams of a gasp-worthy red carpet moment almost as much as a win at the awards show that follows. The canniest, most reliable performers follow a few unwritten rules and often rely on their jewelry to take the pre-show crown. So we tapped a trio of three major gem-world talents — call them our rock stars — to offer some insider advice on how regular women can tap styling tricks used by red-carpet regulars.
Mismatch to win
According to Lucrezia Buccellati, of the Italian namesake jewelry house, the key to selecting a flattering earring is mismatching. In other words, soft, round faces gain definition, and a hint of cheekbone, from angular jewelry with sharper corners and heavier settings. "Smooth the angles of a more geometric face with an openwork texture," she suggests, much as Jaime Ray Newman did with the emerald and diamond statement Buccellati earrings she wore to this year's Oscars.
Come to play
Don't assume there's no place for playfulness amid the formality; quirky jewelry can add a shot of stylish sass. See how Alessandra Ambrosio wore this de Grisogono emerald sautoir backwards on the red carpet in Cannes, France, last year. "Jewelry is to be enjoyed, so get creative," says the firm's CEO, Céline Assimon, "Oftentimes, I mix and match my earrings, pairing a long drop in one ear and a small stud in the other."
Pony up
If in doubt, err toward simpler hairstyles, especially sleek buns or glossy ponytails. "It's the first thing people will notice with eye-catching jewelry pieces, so the key is keeping it simple," says Valérie Messika, who runs Messika Paris. She cites Charlize Theron's restrained elegance at this year's Critics' Choice Awards as a perfect example. Keep hair tamed, smooth and mostly away from the face, allowing jewelry to sparkle; makeup should be minimal, too.
Call them excess-ories
Red-carpet dressing doesn't shy away from maximalism: When the paparazzi are watching, too much is never enough. "Small and delicate jewelry doesn't stand out in photos, but larger, more prominent pieces will," says Buccellati, who recommends focusing on one jewelry category to avoid tipping from exuberance into tackiness. Doubling down on rings? Downplay the necklace and ear studs. Loading your arms with bangles? Then leave the 6-carat solitaire [add: ring?? finger bling??] on your dresser.
The rock is the foundation
De Grisogono's Assimon suggests inverting the usual rule, and consider the gown, dress and shoes as the accessories. Start instead with the jewelry and plan backwards. It's a trick stylists regularly employ, she confides. "They might come across an amazing, bold statement earring, then hunt for the perfect outfit to complement it. Jewelry can make or break a look." The perfect example, per Assimon: the intricate bodice of Naomi Campbell's 2018 Cannes Film Festival gown, which draws inspiration from her emerald earrings.
From Charlize Theron to Rihanna: Jewelry style hacks straight from the red carpet
The drop
After seasons of chandeliers, elegant drop earrings are making a comeback. Michelle Yeoh parades her dazzling diamond Chopard pair at the 2019 Oscars.
Arm party
Rihanna could give a master class in bracelet stacking, mixing cuffs from David Yurman,
Buccellati, Chopard and more.
Mod lobes
Stars like Amber Heard (pictured flaunting Marco Bicego at this year's Golden Globes) and Diane Kruger (pictured dotted in Messika Paris) are mixing diamond ear cuffs, cartilage jewelry and single danglers — taking the multiple-piercings look to the next level.
From rainbow rocks to romantic rubies — the 2019 jewelry trends you need to try
View Slideshow
White hot
The best way to show off major bling? On the clean slate of an all-white ensemble, as French model Cindy Bruna shows, wearing a de Grisogono necklace in Cannes, France.
Wrap stars
Whether it's multiple glittering strands — as on Lily Aldrige (pictured wearing Bulgari at the 2018 Met Gala) and Taraji P. Henson (pictured rocking Roberto Coin at January's Golden Globes) — or one major piece swirled around an otherwise modest neckline (Charlize Theron in Bulgari at this year's Oscars), red-carpet necklaces are layering up.
From rainbow rocks to romantic rubies — the 2019 jewelry trends you need to try
View Slideshow


text:
Nationwide Insurance: Stephen M Shipe
[33.3915858589414, -82.1097871467192] nationwid, insur, stephen, m, shipe, auto, agent, broker
(706) 790-9416 (706) 790-3192 (706) 798-9565 2920 Tobacco Rd, Hephzibah, GA 30815 M-F 9:30am-6pm, Sa-Su Closed Official site
Categories: Insurance, Auto Insurance
The Hype
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The Shipe Agency has a combined 48 years of insurance experience to analyze your insurance needs and to provide our clients with superior customer service. We offer Auto, Home, Business and Life Insurance.
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text:
Color Block Scarf
Wrap it under a coat
Product variations
Color: Khaki
Size: PLEASE SELECT
Extra wide and seriously soft, this color block scarf is bound to keep you from feeling the chill. It's really easy to dress up or down depending on what you're up to; keep it close when it's cold.
Product code: 928856
- 71 x 15" / 180 x 38cm
Care Instructions
- 100% acrylic
- Machine washable
Returns Information
Need to send something back? We now offer FREE returns!
Returns Policy
We really hope you like your purchase, but if you need to send anything back, just email firstname.lastname@example.com with your order number beginning USF and we'll send you a pre-paid returns label. We are happy for you to return items to us within 30 days from receipt for full price items and 15 days for items bought during the sale.
- bvseo_sdk, dw_cartridge, 16.1.1, p_sdk_3.2.0
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- reviews, product
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text:
Psychometric Evaluation of the Insomnia Symptom Questionnaire: a Self-report Measure to Identify Chronic Insomnia
Michele L. Okun, Ph.D.1; Howard M. Kravitz, D.O., M.P.H.2; Mary Fran Sowers, Ph.D.3; Douglas E. Moul, M.D.1; Daniel J. Buysse, M.D.1; Martica Hall, Ph.D.1
University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA; 2Rush University Medical Center, Department of Psychiatry and Department of Preventive Medicine, Chicago, IL; 3University of Michigan Center for Integrated Approaches to Complex Diseases, Ann Arbor, MI
Study Objectives: The objective was to psychometrically evaluate the Insomnia Symptom Questionnaire (ISQ), a self-report instrument designed to establish a clinically relevant case definition of insomnia consistent with widely used insomnia classification criteria, using methods from classical test theory and item response theory (IRT). Methods: The ISQ was evaluated using IRT algorithms in a cohort of 362 pre-, peri- and post-menopausal women recruited for the SWAN (Study of Womens Health Across the Nation) Sleep Study. This yielded a dichotomous outcome consistent with the presence/absence of insomnia. The internal consistency and criterion validity of the dichotomized ISQ were compared to traditional measures of sleep from sleep diaries, polysomnography, and the Pittsburgh Sleep Quality Index using kappa statistics, and indices of sensitivity, specificity, positive and negative predictive value (PPV), and likelihood ratio tests (LRs). Results: The ISQ identified 9.8% of the sample as meeting insomnia, consistent with established diagnostic criteria. Reliability was established with Cronbach ( = 0.89). The ISQ had high specificity
(> 90%), but sensitivity, PPV, NPV, and LRs varied according to which sleep measure was used. Concurrent validity was not confirmed with any of the traditional sleep summary measures (kappas < 0.30). Conclusions: The ISQ captures the multidimensionality of insomnia better than traditional sleep measures as it ascertains symptoms of insomnia that are based on DSM-IV and RDC criteria. The high specificities suggest that the ISQ has a high probability of correctly identifying those without insomnia and would be a cost-effective tool in large observational studies in which the prevalence of insomnia is likely to be about 10%. Further evaluation of the ISQ, including validation against clinical interviews, is warranted. Keywords: Insomnia; questionnaire; sleep; menopausal transition; validity Citation: Okun ML; Kravitz HM; Sowers MF; Moul DE; Buysse DJ; Hall M. Psychometric evaluation of the insomnia symptom questionnaire: a self-report measure to identify chronic insomnia. J Clin Sleep Med 2009;5(1):41-51. or daily functioning.9,10 Although these criteria do not include frequency of occurrence, a frequency criterion of 3 nights per week is commonly used.11 Clinical interviews conducted by trained clinicians are used to establish a clinical diagnosis of insomnia, but the use of a fully structured interview12 is often impractical in large epidemiological studies because it is timeconsuming and costly.13,14 Cost-effective metrics for assessing insomnia are needed. Various symptom severity questionnaires have incorporated diagnostic criteria for chronic insomnia.15 Several of these correspond directly to specific established diagnostic criteria by assessing sleep complaints, duration and/or daytime consequences. These include the Insomnia Severity Index (ISI),16 the Medical Outcomes Study (MOS) Sleep measure,17 the Womens Health Initiative Insomnia Rating Scale (WHIIRS),18 the Athens Insomnia Scale,19 and the Short Insomnia Questionnaire (SDQ).20 However, none of these instruments establishes a case definition of insomnia that would be an appropriate analog of clinical interviews for epidemiological studies, and none provides a dichotomous outcome based on a case definition that would allow a clinician or researcher to confidently categorize participants.15 Other sleep instruments assess specific sleep characteristics or quality, but were not designed to identify insomnia per se. For instance, the Pittsburgh Sleep Quality Index (PSQI)21 is a
nsomnia is a major public health problem affecting millions of individuals, along with their families and communities.1 Insomnia is defined as difficulty initiating or maintaining sleep, or unrefreshing sleep despite adequate opportunity for sleep. It is the most commonly reported sleep disturbance, affecting up to 30% of the adult population.2-4 Women are 1.4 times as likely as men to complain of insomnia symptoms,5 and this number significantly increases with the transition into the menopausal period.3,6-8 Recent epidemiological data indicate that approximately 40% of women between the ages of 40 and 55 years report recent sleep difficulties that resemble symptoms of insomnia.6 Diagnostic criteria for insomnia from the American Academy of Sleep Medicine and the American Psychiatric Association include: (1) a complaint of problems initiating or maintaining sleep, and/or that sleep is nonrestorative or poor in quality; (2) the duration of the sleep complaint is at least 1 month; and (3) complaints of significant impairment in social, occupational
Submitted for publication February, 2008 Submitted in final revised form August, 2008 Accepted for publication August, 2008 Address correspondence to: Martica Hall, Ph.D. University of Pittsburgh, WPIC, 3811 OHara St E1119, Pittsburgh, PA 15213; E-mail: email@example.com
Journal of Clinical Sleep Medicine, Vol.5, No. 1, 2009
questionnaire with established reliability and validity that is frequently used for measuring sleep quality and identifying good and bad sleepers. However, it was not designed to assess insomnia based on diagnostic criteria. The PSQIs reliability and validity for identifying people who have difficulty initiating or maintaining sleep, a necessary symptom of insomnia, may be improved by using a more stringent cutoff score (> 10).20-22 Nevertheless, the PSQI does not ascertain frequency of sleep symptoms nor specific information on daytime consequences. Based on the above, we identified the need for a self-report questionnaire guided by established diagnostic criteria that could be used to identify insomnia in large epidemiological or health services research studies. We administered the 13-item Insomnia Symptom Questionnaire (ISQ) (Appendix 1) to pre-, peri-, and post-menopausal women in a large observational study and compared the reports of symptoms from this instrument to other measures of sleep including the PSQI, sleep diaries, and nocturnal polysomnography (PSG) data. There was no true gold standard for diagnosing insomnia in our sample as we had no clinical interview. Rather, the available sleep measures were used to suggest the presence of a sleep disorder. Therefore, the analyses focused on the internal consistency and criterion (i.e., concurrent) validity of the ISQ. The aims of the present analyses were (1) to describe the development of a scoring algorithm using item response theory (IRT) that yielded a clinically relevant case definition of insomnia, and (2) to present the psychometric properties of the ISQ. METHOD Participants Participants were 370 mid-life women who took part in a cross-sectional study of sleep during the menopausal transition. They were recruited from 4 (Chicago, IL; Detroit area, MI; Oakland, CA; and Pittsburgh, PA) of 7 study sites participating in the Study of Womens Health Across the Nation (SWAN), a longitudinal study of menopause and aging. The recruitment methods and study design for the Core SWAN Study have been described.23 All Core SWAN participants participating in the year 5, 6, or 7 annual follow-up visits (20032005) were approached for SWAN Sleep Study participation. Exclusions for Sleep Study participation were hormone therapy (HT) use; active chemotherapy or radiation; oral corticosteroid use; regular participation in shiftwork; regular consumption of > 4 alcoholic drinks/day; and noncompliance with Core SWAN study procedures (missed > 50% of annual visits, refused annual visit blood draw). During the final year of the sleep study, postmenopausal women were also included to provide evaluations of sleep across the full spectrum of menopausal transition stages. Eight women had incomplete or missing data for the ISQ, leaving an analyzable sample of 362 women. Informed consent was obtained in accordance with institutional review board-approved protocols at each SWAN site. Procedure Sleep data collection included PSG, daily sleep diaries, and self-report sleep symptom questionnaires (ISQ, PSQI). PSG
Journal of Clinical Sleep Medicine, Vol.5, No. 1, 2009 42
sleep studies were conducted in participants homes during the first 3 days of the protocol which spanned a full menstrual cycle or up to 35 days, whichever was shorter. Participants were scheduled for the SWAN Sleep Study protocol based upon the timing of their menstrual cycle. Each woman began the sleep protocol at the initiation of menstrual bleeding (between days 3-6 of the early follicular phase) to allow greater comparability in considering cycle effects on sleep. If the participant had been without menses or was not regularly cycling for at least 4 months she was considered peri- or late-peri-menopausal and the study was scheduled at her convenience. Throughout the protocol, participants completed daily sleep-wake diaries at bedtime and upon awakening. The ISQ and the PSQI data used in this report were completed on Day 4 of the protocol. Measures The Insomnia Symptom Questionnaire (ISQ) (Appendix 1) is a 13-item self-report instrument designed to identify insomnia. ISQ questions were based on the American Psychiatric Associations fourth edition of the Diagnostic and Statistical Manual (DSM-IV) criteria for primary insomnia10 and are consistent with the American Academy of Sleep Medicines (AASM) Research Diagnostic Criteria (RDC).24 However, the ISQ does not assess whether the sleep disturbance occurs exclusive of another sleep disorder, mental disorder, or substance or general medical condition (criteria C-E in DSM-IV for primary insomnia); nor does it ask if the participant has adequate opportunity to sleep (RDC criteria). Questions on the ISQ follow a stepped approach: (1) ascertaining the presence of a complaint of difficulty initiating or maintaining sleep, or feeling that the sleep was nonrestorative or unrefreshing; (2) determining the frequency of complaints (questions 1-5) and duration of these symptoms; and (3) evaluating the severity of daytime correlates of the sleep complaint(s) (questions 6-13). The ISQ items contain multiple choices on an ordinal scale to assess the presence, frequency and/or severity of the complaint. For example, the During the past month have you had difficulty falling asleep? item includes choices ranging from 0 = never to 5 = always (5-7 days per week), and a follow-up contingency question asks about the problems duration with open-ended responses for weeks, months, or years. Similarly, questions 6-13 assess the extent to which the individuals endorsed sleep complaints affect daytime activities, with response choices ranging from 0 = not at all to 4 = extremely. The Pittsburgh Sleep Quality Index (PSQI) 21 is a 19-item questionnaire used to measure sleep quality complaints. Seven component scores assess habitual duration of sleep, nocturnal sleep disturbances, sleep latency, sleep quality, daytime dysfunction, sleep medication usage, and sleep efficiency. The 7 components (range 0-3) are summed to yield a measure of global sleep quality with a range of 0 (good sleep quality) to 21 (poor sleep quality). The PSQI and its psychometric properties have been characterized in various populations, including patients with insomnia and depression and in healthy good sleeper controls.21,22 These reports have documented adequate sensitivity and specificity using a cutoff score > 5 to identify those with poor sleep quality in depressed and normal sleepers, and a cutoff score > 10 to identify poor sleep quality among people with insomnia.
Self-reported and PSG assessed sleep variables. Three pathognomic symptoms of insomnia are difficulty falling asleep, difficulty staying asleep, and unrefreshing sleep. Sleep onset latency, wake after sleep onset, and sleep efficiency are 3 derived sleep variables used to quantify the first 2 of these symptoms. Unrefreshing sleep is defined from a subjective perspective. Sleep onset latency (SOL) is defined as the time one time tried to go to sleep to sleep onset. Wake after sleep onset (WASO) is defined as the total number of minutes spent awake following sleep onset. Time in bed (TIB) is defined as the total amount of time from reported time tried to go to sleep to the time of the reported final awakening from sleep. Total sleep time (TST) is defined as minutes of time spent asleep. Sleep efficiency (SE) is defined as the ratio of TST to TIB multiplied by 100. Sleep diaries25 were used to capture daily measures of selfreported sleep parameters at both a morning and evening recording time. Variables included mean values for SOL, WASO, TST, TIB, and SE calculated from all available sleep diary data. Ambulatory polysomnography (PSG) studies were conducted in participants homes. Recordings included bilateral central referential EEG (C3 and C4, referenced to A1 + A2), bilateral electro-oculograms (EOG), submentalis electromyogram (EMG), a modified V2 lead electrocardiogram (EKG), and inductance plethysmography abdominal and thoracic belts. On Night 1, additional data (nasal pressure monitoring, oral-nasal thermistors, and fingertip oximetry, and bilateral anterior tibialis EMG leads) were collected to assess sleep disordered breathing and periodic leg movements. Sleep was visually scored in 20-s epochs using standard scoring criteria,26 supplemented by apnea-hypopnea criteria derived from American Academy of Sleep Medicine recommendations,27 and standard rules for scoring periodic limb movements.28 Summary PSG variables (averaged over Nights 2 and 3) included SOL, WASO, TST, TIB, and SE. Psychometric and Statistical Analyses Item response theory (IRT) was used to determine the optimal cutoffs for individual questions and yield a dichotomous outcome (insomnia or no insomnia) that most closely reflects established diagnostic criteria for insomnia. Conceptual guidelines and established psychometric techniques, including internal consistency and criterion validity measures, were used to evaluate validity between the dichotomized ISQ and traditional sleep measures. In order to restrict our analyses to individuals without clinically significant sleep disordered breathing, women with an AHI 15 were excluded from all analyses. The final sample for the psychometric analyses included 266 women, 73.5% of the initial cohort. Item Analysis and Development of Scoring Algorithm In IRT, logistic regression equations are used to model a persons odds of a response choice from questionnaire items based upon that respondents location along a latent dimension of an ability or trait (here insomnia). This modeling locates a response along the overall dimension based upon the respondents total scale-score and, based upon this estimate, it also approximated each items location (item threshold) and relevance (discrimination) of reporting along a severity dimension theta.29
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Simultaneously, the standard error of location of a response on the latent trait was estimated.30 The collection of item parameters comprised the representation of the overall severity of the latent dimension of insomnia. We used a 2-parameter model. The first parameter represented discrimination, namely, how decisive the question was, compared to other questions. The second parameter represented thresholds, namely where the item information was located along the spectrum severity. IRT was also used to identify the questions that uniquely contributed the most useful information to an ISQ insomnia definition (item-category reduction). Item-category reduction assists in reducing redundancy of questions. It is also desirable for the questionnaire to be unidimensional. We used scree plot and eigenvalues when modeling across all item categories (with the item being considered a testlet) conjointly estimating every item information curve (IIC) in the collection of items. The information curve data then allow one to justify where the number of item-categories could be reduced and compared the relative information provided by each item. We began the itemcategory reduction process by heuristically evaluating the itemcategory probability curves or item characteristic curves (ICC) for each item, which shows the predicted logistic function probability of responding in the item choice category, given where the respondent is estimated to be on the trait spectrum.31 This process was completed iteratively until a dichotomous outcome could be determined for each item and for the entire ISQ. Statistical Analyses Descriptive statistics were used to characterize the subjective (questionnaires and diary) and PSG sleep measures for the sample. Traditional psychometric characteristics including content and face validity, internal validity, and criterion (concurrent) validity were then examined. Internal reliability was characterized using Cronbach statistic.32 In the absence of a gold standard, concurrent validity and indicators of diagnostic accuracy (e.g., sensitivity, specificity, and predictive value) were estimated by comparing the dichotomized ISQ to widely used indicators of insomnia (e.g., PSG- and diary-assessed indicators of difficulty falling and staying asleep).33 Lastly, likelihood ratios (LR) were used to evaluate how adequately the ISQ performed as a diagnostic test. This approach has the advantage of being less likely to change with the prevalence of the disorder in different samples as compared to estimates of sensitivity and specificity.34 LR positive indicates how much more likely it would be to find a positive ISQ in those with insomnia compared to those without insomnia. Generally, LR values > 10 suggest a strongly positive result, 5-10 indicate a moderate result, 2-5 is a small result, and LR values of 1-2 suggest the questionnaire is non-informative.34 Insomnia estimates used to evaluate the validity of the ISQ were derived from three sources: PSQI, sleep diaries, and PSG. We dichotomized the PSQI global score at 2 cutoffs (> 5 and > 10) reflecting the values used in previous mixed-subjects samples 21 and samples of insomnia subjects.20-22 The decision to use comparison values for SOL ( 31 minutes), WASO ( 31 minutes), and SE (< 85%) from the sleep diaries and PSG was based on various reports and recommendations for quantitative insomnia criteria.24,11,35 For the sleep diary data, the frequency of the sleep complaint was also assessed in accordance with the RDC.24
Figure 1a
Item Characteristic Curve: Q5 Feeling that sleep is unrefreshing? 1.0 Graded Response Model 4 Item Information Curve: Q5: Feeling that sleep is unrefreshing?
0.8 1
0.4 3 0.2 4 6 5
Figure 1b
1.0 Item Characteristic Curve: Q5 Feeling that sleep is unrefreshing? Graded Response Model 1 Item Information Curve: Q5 Feeling that sleep is unrefreshing? 12
0.4 4
0 Scale Score
Category legends
1= < 3x/Week 2 = 3+X/Week 3 = Missing
Figure 1Item Characteristic Curve (ICC) and Item Information Curve (IIC) Illustration. These graphs display parent polytomous and child dichotomous item characteristic curves obtained as a part of deriving dichotomous cutpoints for the ISQ questions. For each ICC curve, the inflection point represents the location of item thresholds along the spectrum of responding (Theta) where near-neighbor responders were 50% likely to endorse a more severe or less severe item category. The IIC curve depicts the information location and strength provided by the item, compared to other questionnaire items, along the same spectrum, based upon the information provided by each ICC curve. In the ICC graphs for the polytomous responses concerning the frequency of difficulty falling asleep, it can be appreciated that the item thresholds are comparatively aggregated in the region of Theta = +1. In the corresponding IIC graphs, the information provided by the summation of the item categories can be noted. The IIC item evaluation points to where the item provides its overall information. In the dichotomous simplification of this item, where the responses are dichotomized, the binomial IIC is located in the approximate location where the thresholds are located in the parent polytomous item. The IIC for the binomial child item illustrates that the dichotomization of the parent polytomous item has preserved the information profile of the parent item in the approximate region where the case:control separation could be plausibly drawn. The decision of cutpoint was made after several data runs, as the number of polytomous categories was sequentially reduced. Journal of Clinical Sleep Medicine, Vol.5, No. 1, 2009 44
ISQ: Psychometric Evaluation Table 1Subjective and Polysomnographic Sleep Characteristics for Women Who Meet the Case Definition (Insomnia) and Women Who do not Meet the Case Definition (No Insomnia) No Insomnia Insomnia N = 320 N = 38 (89.4%) (10.6%) PSQI global score 6.4 2.3 9.5 3.2 Diary Data Sleep Onset Latency 14.6 10.7 24.9 18.6 (minutes) Wake after Sleep 14.0 13.8 24.5 16.5 Onset (minutes) Total Sleep Time 401.8 47.9 379.1 77.4 (minutes) Time in Bed (minutes) 492.7 70.1 518.1 118.4 Sleep Efficiency (%) 93.2 4.6 87.5 7.2 Polysomnography Data AHI (events per hour) 9.6 13.4 16.6 23.2 Sleep Onset Latency 21.3 20.1 24.6 26.7 (minutes) Wake after Sleep 52.0 30.2 67.9 43.2 Onset (minutes) Total Sleep Time 376.0 53.6 351.5 69.8 (minutes) Time in Bed 449.0 58.8 444.1 65.0 (minutes) Sleep Efficiency (%) 83.8 7.7 79.1 10.2 Table 2aCross-Tabulations Between PSQI Global Score (Cutoff of >5 and >10) and ISQ Classifications of Subjects Who do not Meet the Case Definition (No Insomnia) and those Who do Meet the Case Definition (Insomnia) PSQI Total Global Score 5 >5 ISQ No Insomnia 93 137 230 Insomnia 2 24 26 Total 95 161 256 PSQI Total Global Score 10 >0 207 15 222 23 11 34 230 26 256 t-test t = 16.6, df = 345, p < 0.001 t = 3.4, df = 352, p = 0.002 t = 4.4, df = 352, p < 0.001 t = 1.8, df = 352, p > 0.05 t = 1.3, 352, p > 0.05 t = 4.7, df = 352, p < 0.001 t = 1.8, df = 356, p > 0.05 t = 0.94, df = 356, p > 0.05 t = 8.5, df = 356, p = 0.03 t = 3.6, df = 356, p < 0.05 t = 0.50, df = 356, p > 0.05 t = 7.1, df = 356, p = 0.009
agreement between findings from the proposed classification from the ISQ in relation to other sleep measures whose results had been dichotomized. These analyses were conducted with the use of SPSS Version 14.0.36 A 2-sided probability of < 0.05 was designated as a statistically significant association. RESULTS IRT Analyses Through a heuristic examination of ICC graphs, we identified a nocturnal sleep symptom frequency 3 times per week as the most discriminating cutpoint; this value also corresponds with established case definitions of insomnia10,24(Figure 1a and 1b). For daytime symptoms, ICC graphs (not shown) indicated that being bothered quite a bit or extremely for any of the daytime consequences optimally distinguished this DSM-IV specific criterion among those believed to have insomnia from those without insomnia. Our selection of the cutpoint locations for the individual items was based on our visual inspection of the locations of the threshold parameters and the graphs of the information functions. IRT analyses of the ISQ culminated in a scoring algorithm that identified insomnia based on the following responses: (1) presence of at least one of 3 sleep symptoms: difficulty initiating sleep, difficulty maintaining sleep, or unrefreshing sleep; (2) the symptom(s) occur with a minimum frequency of 3 times per week; (3) duration of the sleep symptom is 4 weeks; and (4) at least one aspect of daily life (e.g., difficulties at work
Additional composite variables were created to facilitate more similar comparisons between measures. The first new variable created a composite score from the sleep diaries which considered the presence or absence of a complaint and the frequency of the complaint (< 3 or 3 per week) for one month. This composite score yielded a categorical score that more closely resembled the score from the ISQ. Since PSG only provides quantitative information for 3 days, a composite was not created from PSG. The ISQ does not differentiate individuals who have 1, 2, or 3 sleep symptoms. Moreover, the three variables used to identify a sleep symptom are highly collinear. So, we conducted a principal components analysis (PCA) on SOL, WASO, and SE (from diaries and PSG) to create a single factor devoid of units and overlap. A participant was identified as positive for insomnia if minimum quantitative criteria were met for SOL, WASO, or SE. Kappa statistics were used to test
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ML Okun, HM Kravitz, MF Sowers et al Table 2bCross-Tabulations Between SOL from Sleep Diary ( 31 minutes) and PSG (cutoff 31 minutes) and ISQ Classifications of Subjects Who do not Meet the Case Definition (No Insomnia) and Those Who do Meet the Case Definition (Insomnia) SOL (sleep diary) Total SOL (PSG) < 31 min or 31 min & < 31 min 31 min 31 min but 3x/week# < 3x/week ISQ No Insomnia 236 1 237 203 37 Insomnia 24 2 26 20 6 Total 260 3 263 223 42 Total
240 26 266
# Data from sleep diaries were assessed for sleep complaint of 31 minutes and frequency of 3x/week to identify parameters more closely resembling DSM-IV and RDC diagnostic criteria. Table 2cCross-Tabulations Between WASO from Sleep Diary ( 31 minutes) and PSG (cutoff 31 minutes) and ISQ Classifications of Subjects Who do not Meet the Case Definition (No Insomnia) and Those Who do Meet the Case Definition (Insomnia) WASO (sleep diary) Total WASO (PSG) < 31 min or 31 min & <31 min 31 min 31 min but 3x/week# < 3x/week ISQ No Insomnia 232 3 235 55 185 Insomnia 23 3 26 5 21 Total 255 6 261 60 206 Total
240 26 266
# Data from sleep diaries were assessed for sleep complaint of 31 minutes and frequency of 3x/week to identify parameters more closely resembling DSM-IV and RDC diagnostic criteria. Table 2dCross-Tabulations Between Sleep Efficiency from Sleep Diary and PSG (cutoff of < 85%) and ISQ Classifications of Subjects Who do not Meet the Case Definition (No Insomnia) and Those Who do Meet the Case Definition (Insomnia) Sleep Efficiency Total Sleep Efficiency (sleep diary) (PSG) 85% or < 85% & 85% < 85% < 85% but 3x/week < 3x/week ISQ No Insomnia 232 5 237 142 98 Insomnia 25 1 26 10 16 Total 257 6 263 152 114 Total
240 26 266
Table 2eCross-Tabulations Between any Sleep Symptom and ISQ Classifications of Subjects Who do not Meet the Case Definition (No Insomnia) and Those Who do Meet the Case Definition (Insomnia) Any Sleep Symptom and Total Any Sleep Symptom Frequency 3x/week (PSG) (sleep diary) No Yes No Yes ISQ No Insomnia 230 7 237 47 193 Insomnia 21 5 26 4 22 Total 251 12 263 51 215 Total
240 26 266
or in social life) is affected quite a bit or extremely by endorsed sleep symptoms (Appendix 2). As a validity and sensitivity check, we considered additional frequency cutoffs with respect to each sleep complaint and daytime consequence to explore for variability in the sensitivity of the ISQ. Changing the cutpoint modestly affected, but did not improve, the sensitivity of the ISQ in the number of women identified as having insomnia (data not shown).
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Sleep Characteristics In the present sample, 38 (10.6%) women met diagnostic criteria for insomnia as defined by the ISQ. The subjective and PSG sleep measures for participants by ISQ insomnia criteria are reported in Table 1. Among participants without clinically significant sleep disordered breathing (AHI < 15), 26 (9.8%) of the cohort met ISQ-derived criteria for insomnia, indicat-
ISQ: Psychometric Evaluation Table 3Evaluation of the Insomnia Symptom Questionnaire as a Diagnostic Screening Tool Concurrent Confirmation Measure Sensitivity PSQI (> 5) 14.9% PSQI (> 10) 32.4% SOL diary ( 31 minutes) & >3x/week 66.7% WASO diary ( 31 minutes) & >3x/week 50.0% SE diary(< 85%) & >3x/week 16.7% Any sleep symptom &> 3x/week (Diary) 41.7% SOL PSG ( 31 minutes) 14.3% WASO PSG ( 31 minutes) 10.2% SE PSG(< 85%) 14.0% Specificity 97.9% 93.2% 90.8% 91.0% 90.3% 91.6% 91.0% 91.7% 93.4% PPV 92.3% 42.3% 7.7% 11.5% 3.8% 19.2% 23.1% 80.8% 61.5% NPV 40.4% 90.0% 99.6% 98.7% 97.9% 97.0% 84.6% 22.9% 59.2% Kappa 0.10 0.28 0.12 0.16 0.03 0.21 0.05 0.01 0.08 LR 1.55 4.23 3.44 9.01 1.82 6.52 1.38 1.04 1.51
PPV = Positive predictive value; NPV = Negative predictive value; LR = Likelihood ratio for a positive test; PSQI = Pittsburgh Sleep Quality Index; SOL = Sleep onset latency; WASO = Wake after sleep onset; SE = Sleep Efficiency; PSG = Polysomnography; Any sleep complaint = endorsement of SOL 31min OR WASO 31 min OR SE < 85%
ing symptom overlap between symptoms of insomnia and sleep apnea. Women who were identified as having insomnia on the ISQ had more sleep symptoms (SOL 31 minutes or WASO 31 minutes or SE < 85%) indicating greater sleep disturbance, as measured by sleep diary (F (261) = 8.3, p = 0.001) and PSG measures (F (264) = 12.2, p = 0.02), than did women who were not identified as having insomnia on the ISQ. Psychometric and Test Characteristics Content and face validity were considered excellent since the ISQ questions were derived directly from widely accepted and published criteria from DSM-IV10 and RDC.24 The 13-item ISQ had an overall reliability coefficient (Cronbach ) of 0.89, indicating a high degree of internal consistency.32 The criterion validity of the ISQ was assessed by examining the diagnostic accuracy of ISQ outcomes referenced to dichotomized PSQI scores and dichotomized estimates of SOL, WASO, and SE, and subsequent composites, from sleep diary and PSG (Table 2a-e). Tables 2b and 2c indicate that comparing the ISQ to a composite measure derived from the sleep diary consisting of SOL or WASO 31 minutes or SE < 85% and frequency of 3 times per week results in more true negatives than quantitative data from PSG alone. The highest sensitivities (66.7% and 50.0%), and specificities (90.8% and 91.0%), with respect to SOL or WASO, were from the sleep diary (Table 3). When comparing the dichotomized ISQ to other sleep measures, specificities were quite high (all > 90%), indicating that the ISQ identifies those without insomnia in a manner consistent with sleep parameters from the sleep diaries, PSG, and PSQI. Sensitivities (10.1% to 66.7%) were much more variable, indicating that the ISQ insomnia definition was not sensitive to the manner in which those sleep measures characterize insomnia. The wide range of PPV similarly indicates that traditional sleep measures and methodologies differentially identified false positives. Similarly, NPV was highest when composite measures were assessed (90% to 99%). With respect to the composite variables, the sleep diary composite variable (which includes any sleep symptom and minimum frequency 3 times per week) most closely resembled the ISQ definition as it considers 2 of the 4 criteria used to diagnose insomnia. PSG, on the other hand, can only capture one criterion, i.e., the presence of sleep disturbances, and it compared poorly with the ISQ. As seen in Table 3, the kappa values between dichotomized ISQ scores and PSQI scores, as well as cutoffs derived from the
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sleep diary and PSG variables (SOL 31 minutes, WASO 31 minutes, and SE < 85%), indicate no agreement when compared to reference values proposed by Landis.37 The LRs indicate that the ISQ is more similar to the composite measure from the sleep diary that includes WASO and frequency 3 times per week in its ability to identify who has insomnia (LR > 6). The single diary SE measure and all PSG data do not provide useful measures of validity (LRs 1-2) (Table 3). DISCUSSION There is a growing need for an easily administered and scored self-report measure that provides a clinically relevant case-definition of insomnia guided by established diagnostic criteria, such as the DSM-IV10 and the AASMs RDC.24 The ISQ was developed to provide such a tool. We used IRT analysis to evaluate which ISQ items provided the most information regarding symptoms of insomnia and which cutoff on those items would support the specification of a simple scoring algorithm with a dichotomous outcome of insomnia (present or absent) that is suitable for use in large scale research studies. Our preliminary evaluation suggests that the ISQ effectively identifies insomnia caseness based on DSM-IV10 and RDC24 criteria. In contrast to other self-report measures, the ISQ contributes additional information for complaint criteria of 3 times per week and at least one month duration, respectively, in the diagnosis process. The case definition of insomnia includes an aggregate of symptoms together with severity.10,24 In epidemiological or health services research, and in research settings where trained sleep medicine specialists are not available, the use of a structured clinical interview is impractical and costly.38 Since few current retrospective instruments assess all recommended criteria,10,24 particularly frequency or daytime consequences, the use of multiple complementary, reliable methods, including retrospective and prospective estimates, is typically suggested to adequately capture all the different dimensions.11,38 In the context of a research study, when clinical interviews are not an option, a combination of other proxies, such as patient history, physical exam, sleep diaries, and questionnaires, can generate a reliable estimate of insomnia caseness.38,33,11,39 That the ISQ captures a defined set of insomnia symptoms enhances its interpretability in research studies when a clinical interview is not feasible. Insomnia is a multidimensional disorder.38-41 Since the ISQ assesses the recommended criteria, while traditional sleep mea-
sures assess one or two criteria, it is not necessarily surprising that there was low agreement for the diagnosis of insomnia between the ISQ and the other measures of sleep using kappa statistics.42 Likewise, the low LRs and variable PPV suggest that if a symptom cluster more closely approximates the DSMIV10 or RDC24 diagnosis, then the gold standard should include symptom frequency criteria. The ISQ appears superior to current methods since it assesses the multidimensionality of the insomnia disorder better than traditional methods. Sleep diaries are commonly used to provide a detailed, prospective account about quantitative sleep disturbances and their variability.38 However, quantitative information alone is insufficient to diagnose insomnia. To allow a more reliable comparison between the sleep diary and the ISQ, we utilized the recommended cutoff of 31 minutes in conjunction with an associated frequency. We are not aware of any other published reports that have measured frequency of a sleep complaint when using sleep diaries as comparison measures.16 This cutoff as compared with 30 minutes or 60 minutes appears to provide a more meaningful estimate and one that better reflects an unpleasant sleep experience.11 Validating an insomnia questionnaire like the ISQ is best served in a population that experiences high rates of insomnia so that there are a sufficient number of true positives. Using the SWAN Sleep Study to validate the ISQ was ideal since many women going through the menopausal transition report symptoms of insomnia.6,7,43,44 The ISQ identified an insomnia diagnosis prevalence of 9.8% in this cohort of pre-, peri, and postmenopausal women, excluding those with an AHI 15. This prevalence rate is consistent with the prevalence rates reported by Ohayon (2002) which were 6% for the general population, corresponding to a decision-making diagnosis using DSM-IV classifications of criteria for insomnia, and 9% to 15% when the diagnosis was based on insomnia symptoms and daytime consequences.45 Our prevalence estimate is also similar to a 14.3% prevalence in a previous reported among menopausal Korean women who were asked about difficulty initiating or maintaining sleep or early morning awakenings.46 A limitation of the current study is the absence of a clinical diagnosis as a gold standard for validation. Future studies are needed to compare the ISQ to clinical interviews, evaluate the ISQs test-retest reliability, and assess other measures of validity. Consistent with information gleaned during diagnostic interviews, it might prove useful to include question(s) regarding opportunity/ circumstances for sleep as the ISQ undergoes further refinement. Inclusion of this item may improve its sensitivity since it is a criterion that is specific for the diagnosis of insomnia. The ISQ does not assess insomnia due to another medical or mental condition and since comorbidity was not evaluated in this report, it is possible that some of the women may have insomnia due to another medical or mental condition. A follow-up evaluation of the ISQ might take into account comorbid conditions such as depression or anxiety. Lastly, sleep symptom reporting and prevalence rates for insomnia differ between men and women, thus a limitation is that this sample was all women. A distinctive quality of the ISQ is that it is not only a severity measure for insomnia, but it is an instrument that appears to provide an accurate case definition of insomnia. Following further psychometric evaluations, we believe that the ISQ is likely to
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emerge as a cost-effective self-report instrument with high utility for use in large observational studies as a screening instrument. ACKNOWLEDGMENTS The Study of Womens Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Womens Health (ORWH) (Grants NR004061; AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, AG012495). The content of this article manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH or the NIH. Funding for the SWAN Sleep Study is from the National Institute on Aging (Grants AG019360, AG019361, AG019362, AG019363). Clinical Centers: University of Michigan, Ann Arbor - MaryFran Sowers, PI; Massachusetts General Hospital, Boston, MA - Robert Neer, PI 1994 - 1999; Joel Finkelstein, PI 1999- present; Rush University, Rush University Medical Center, Chicago, IL - Lynda Powell, PI; University of California, Davis/ Kaiser - Ellen Gold, PI; University of California, Los Angeles - Gail Greendale, PI; University of Medicine and Dentistry New Jersey Medical School, Newark Gerson Weiss, PI 1994 2004; Nanette Santoro, PI 2004 present; and the University of Pittsburgh, Pittsburgh, PA - Karen Matthews, PI. NIH Program Office: National Institute on Aging, Bethesda, MD - Marcia Ory 1994 2001; Sherry Sherman 1994 present; National Institute of Nursing Research, Bethesda, MD Program Officers. Central Laboratory: University of Michigan, Ann Arbor Daniel McConnell (Central Ligand Assay Satellite Services). Coordinating Center: New England Research Institutes, Watertown, MA - Sonja McKinlay, PI 1995 2001; University of Pittsburgh, Pittsburgh, PA Kim Sutton-Tyrrell, PI 2001 present. Steering Committee: Chris Gallagher, Chair, Susan Johnson, Chair N-CTRC grant RR024153 for support of the conduct sleep studies including scoring, reliability assessments, and processing of sleep data. Dr. Mouls time is supported by grants MH 24652-29,1 U01 AR052155-01, and 5 P01 AG20677-02. Dr. Okuns time is supported by NR010813. Disclosure Statement This is not an industry supported study. Dr. Buysse has consulted for Actelion, Arena, Cephalon, Eli Lilly, GlaxoSmithKline, Merck, Neurocrine, Neurogen, Pfizer, Respironics, Sanofi-Aventis, Sepracor, Servier, Stress Eraser, Takeda, and Transcept Pharmaceuticals, Inc. The other authors have indicated no financial conflicts of interest. REFERENCES
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Diagnostic and statistical manual of mental disorders (DSM-IV-TR). 4th ed. Text Revision ed. Washington, DC: American Psychiatric Association; 2000. Lichstein KL, Durrence HH, Taylor DJ, Bush AJ, Riedel BW. Quantitative criteria for insomnia. Behav Res Ther 2003;41:427-45. Schramm E, Hohagen F, Grasshoff U, et al. Test-retest reliability and validity of the Structured Interview for Sleep Disorders According to DSM-III-R. Am J Psychiatry 1993;150:867-72. Edinger JD. Classifying insomnia in a clinically useful way. J Clin Psychiatry 2004;65 Suppl 8:36-43. Reite M, Buysse D, Reynolds C, Mendelson W. The use of polysomnography in the evaluation of insomnia. Sleep 1995;18:58-70. Moul DE, Hall M, Pilkonis PA, Buysse DJ. Self-report measures of insomnia in adults: rationales, choices, and needs. Sleep Med Rev 2004;8:177-98. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2001;2:297-307. Hays RD, Martin SA, Sesti AM, Spritzer KL. Psychometric properties of the Medical Outcomes Study Sleep measure. Sleep Med 2005;6:41-4. Levine DW, Kripke DF, Kaplan RM, et al. Reliability and validity of the Womens Health Initiative Insomnia Rating Scale. Psychol Assess 2003;15:137-48. Soldatos CR, Dikeos DG, Paparrigopoulos TJ. Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria. J Psychosom Res 2000;48:555-60. Violani C, Devoto A, Lucidi F, Lombardo C, Russo PM. Validity of a short insomnia questionnaire: the SDQ. Brain Res Bull 2004;63:415-21. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213. Backhaus J, Jughanns K, Broocks A, Riemann D, Hohagen F. Testretest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res 2002;53(3):737-40. Sowers MF, Crawford SL, Sternfeld B, et al. SWAN: A multicenter, multiethnic, community-based cohort study of women and the menopausal transition. Menopause: biology and pathobiology. Academic Press; 2000. p. 175-88. Edinger JD, Bonnet MH, Bootzin RR, et al. Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group. Sleep 2004;27:1567-96. Monk TH, Reynolds CF, Kupfer DJ, et al. The Pittsburgh Sleep Diary. J Sleep Res 1994;3:111-20. 26. Rechtschaffen A, Kales A. A Manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. NIH Publication 204. Washington, DC: U.S. Government Printing Office, Department of Health Education and Welfare; 1968. 27. American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667-89. 28. American Sleep Disorders Association Atlas Task Force. Recording and scoring leg movements. Sleep 1993;16:749-59. 29. Baker F. The Basics of Item Response Theory. College Park: ERIC Clearinghouse on Assessment and Evaluation; 2001. 30. Hays RD, Morales LS, Reise SP. Item response theory and health outcomes measurement in the 21st century. Med Care 2000;38:II28-II42. 31. MULTILOG users guide: multiple categorical item analysis and test scoring using item response theory. [computer program]. Version 7.0 Scientific Software International; 2003. 32. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1951;16:297-309. 33. Faraone SV, Tsuang MT. Measuring diagnostic accuracy in the absence of a gold standard. Am J Psychiatry 1994;151:650-7. 34. Flemons WW, Whitelaw WA, Brant R, Remmers JE. Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med 1994;150:1279-85. 35. Lineberger MD, Carney CE, Edinger JD, Means MK. Defining insomnia: quantitative criteria for insomnia severity and frequency. Sleep 2006;29:479-85. 36. SPSS 14.0 for Windows [computer program]. Chicago: SPSS; 2006. 37. Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 1977;33:363-74. 38. Buysse DJ, Ancoli-Israel S, Edinger JD, Lichstein KL, Morin CM. Recommendations for a standard research assessment of insomnia. Sleep 2006;29:1155-73. 39. Summers MO, Crisostomo MI, Stepanski EJ. Recent developments in the classification, evaluation, and treatment of insomnia. Chest 2006;130:276-86. 40. Chesson A Jr, Hartse K, Anderson WM, et al. Practice parameters for the evaluation of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep 2000;23:237-41. 41. Sateia MJ, Doghramji K, Hauri PJ, Morin CM. Evaluation of chronic insomnia. An American Academy of Sleep Medicine review. Sleep 2000 15;23:243-308. 42. Gordis L. Assessing the validity and reliability of diagnostic and screening tests. Epidemiology. 2nd ed. Philadelphia: W.B. Saunders; 2000:63-81. 43. Chung KF, Tang MK. Subjective sleep disturbance and its correlates in middle-aged Hong Kong Chinese women. Maturitas 2006 20;53:396-404. 44. Young T, Rabago D, Zgierska A, Austin D, Laurel F. Objective and subjective sleep quality in premenopausal, perimenopausal, and postmenopausal women in the Wisconsin Sleep Cohort Study. Sleep 2003;26:667-72. 45. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 2002;6:97-111. 46. Shin C, Lee S, Lee T, et al. Prevalence of insomnia and its relationship to menopausal status in middle-aged Korean women. Psychiatry Clin Neurosci 2005;59:395-402.
7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.
24. 25.
Instructions: If you have experienced any sleep symptoms during the past month please circle the appropriate number to let us know how your sleep is affecting your daily life.
During the past month did you have 1. Difficulty falling asleep?
Never 0
Do not know 1
How long has the symptom lasted? (# of weeks, months or years) wks mos _____ yrs wks mos _____ yrs wks mos _____ yrs wks mos _____ yrs wks mos _____ yrs
Difficulty staying asleep? Frequent awakenings from sleep? Feeling that your sleep is not sound? Feeling that your sleep is unrefreshing?
Instructions: If you have experienced any sleep symptoms during the past month please circle the appropriate number to let us know how your sleep is affecting your daily life
During the past month 6. 7. 8. 9. How much do your sleep problems bother you? Have your sleep difficulties affected your work? Have your sleep difficulties affected your social life? Have your sleep difficulties affected other important parts of your life? Not at all 0 0 0 0 0 0 0 0 A little bit 1 1 1 1 1 1 1 1 Moderately 2 2 2 2 2 2 2 2 Quite a bit 3 3 3 3 3 3 3 3 Extremely 4 4 4 4 4 4 4 4
10. Have your sleep difficulties made you feel irritable? 11. Have your sleep problems caused you to have trouble concentrating? 12. Have your sleep difficulties made you feel fatigued? 13. How sleepy do you feel during the day?
The Insomnia Symptom Questionnaire (ISQ) has 13 self-rated questions. Only questions 1,2 or 5 are used to determine the presence, frequency AND duration of sleep symptom criteria. Questions 6-13 are used to identify significant daytime consequences of the sleep complaint. Please answer the following questions based on the participants responses to determine if they meet the case definition of insomnia. Scoring proceeds as follows: Yes No Sleep symptom criterion Is the answer to at least one of Questions 1, 2, or 5 Frequently or Always? Duration criterion Is the answer to at least one of Questions 1, 2, or 5 > 4 weeks? Daytime impairment criterion Is the answer to at least one of Questions 6 -13 Quite a bit or Always? If the answer to each question above is Yes, assign a diagnosis of insomnia disorder. Insomnia disorder If the answer to one or more of the questions above is No, do not assign a diagnosis of insomnia disorder. No insomnia disorder


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Search Results for (204) 222-4085
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- Welling, S L
22 Sarcee Cove, Winnipeg, MB R3W 0B1, CanadaHistory
2 older records found on this number.Last found
February 2015Other Formats
2042224085 / 222-4085 / 222-4085 / (204) 222-4085 / +612042224085
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January 15, 2003 -- Volume 4, No. 3
This week's NEWS
AWWA and EPA provide interesting reviews of 2002 and ASDWA gets a new leader.......from EPA! Perchlorate still rattling cages, as the main supplier of that stuff to Lake Mead points a finger. Security issues come home to roost in smaller water utilities as well as those not in the USA. Water utilities are going to have to notify customers "in advance" of finding out about contamination if the trend continues. Crypto outbreaks in Scotland lead to new guidance. If source control is part of the answer, look Down Under for dung beetle doings. Simple applied research on cholera could be a boon for countries where the sari is worn. There's a little bit of everything this week: arsenic, MTBE, aluminum, radium, POU, legal stuff and............a big ozone WTP gets up and going soon.
New Opportunities at Job Reservoir!
Senior Engineer (Newport Beach, CA)
Water Quality Technician III (Carson, CA)
Wasterwater Engineer (Beltsville, MD)
Senior Engineer (San Jose, CA)
Water Meter Reader (Cerritos, CA)
Water Treatment Plant Operator (Paso Robles Area, CA)
Your Job Here!
-- Now sent to more than
** Many more jobs and resumes on the Job Reservoir website **
National Update
USEPA has 2002 water factoids
available.......how many?
(PDF file, 13 pages)
National water statistics must always be taken with a grain of salt because of the lack of uniformity in how different states address and consider violations (i.e., the "funding" and vigor of the state programs, the totality of reporting, etc.), but a review of the data is interesting. Explanations for 31% of Nebraska's Community Water Systems (all sizes) having "health-based" violations and for violation rates in the double-digits for a handful of additional states can likely be found by careful reading of those states' annual reports for 2002, which are not yet available. (Hopefully, EPA's choice of the term "factoid" is inappropriate since the OED says a factoid is a "simulated or imagined fact.")
The Association of State Drinking Water Administrators' new Executive Director brings a strong EPA background
(Best wishes, Vanessa!)
State Updates
Florida is adopting a new arsenic MCL
(PDF file, 3 pages),
approving Best Available Treatment technologies for arsenic and radionuclides
(PDF file, 5 pages)
monitoring rules for arsenic and radionuclides
(PDF file, 46 pages)
Florida goes directly to the 0.010 mg/l MCL AND effectively grants all utilities the maximum time-extensions allowed by EPA for coming into compliance by making their MCL effective on 1-1-05 with compliance required 3 full years later.
Maine's latest edition of the "
Service Connection"
covers a SWAP demo, "bulk water hauling" and other updates
Alabama will hold a public hearing on February 5 to amend their rules on radionuclides, arsenic and filter backwash recycling to conform to federal requirements
Microbiological Issues
Scotland's drinking water authority issues new guidance on
following the release of
two government reports on recent waterborne incidents
Independent review indicates need for new lab prioritization procedures
(Scotsman, January 11)
Cattle farmer provides agriculture's point-of-view on Walkerton contamination
(Owen Sound Sun Times, January 13)
E. coli
detection in church well serves as case example in Connecticut area under sewering order
(Norwich Bulletin, January 11)
Water Security
"Unfunded mandates" issue raised by Pennsylvania town which supports water security but....where's the beef?
(Kennett Paper, January 9)
The required Vulnerability Assessments and emergency response plans mandated by recent national security legislation were not accompanied by any funding, at least not for systems serving less than 100,000 persons. SRF loans will likely be available for implementing physical aspects of response plans.
States set up new drinking water security websites:
Media fuels speculation that Scottish water system was told by national intelligence service to fence reservoir....no one's talking
(BBC News, January 13)
Break-in at Florida town's WTP prompts "do not use the water" advisory
Chemical company wants federal government to pick up cost of Nevada perchlorate clean-up
(Reno Gazette-Journal, January 11)
It's "Midnight at the Oasis," CA as residents are wary about perchlorate after it is found in adjacent Indian reservation wells
(Desert Sun, January 10)
Perchlorate among the contaminants found in Los Alamos, NM area monitoring well
(Santa Fe New Mexican, January 11)
PRP (potentially responsible party) offers "money for freedom" from lawsuits (and enforcement?) re: perchlorate clean-up in Southern California
(San Bernardino County Sun, January 10)
Wonder how a business that has just agreed to spend $4 million to avoid litigation for 2 years feels about being "rolled", in the vernacular of an opposing attorney? The deal still needs approval by several agency boards.
Water Treatment Residuals: From Troublesome Sludge to Desirable Commodity
McGuire Environmental Consultants, Inc. (MEC) offers specialty services to assist utilities in managing water treatment residuals (WTRs). We can assist utilities with recycle audits, Filter Backwash Recycle Rule (FBRR) compliance, arsenic residuals management, selection of innovative dewatering methods, and optimization of existing WTR facilities. Most importantly, we can help utilities determine the unique chemical and physical characteristics of their WTR, evaluate and recommend options, and establish a viable beneficial use program.
For more information on these services, please contact Jim DeWolfe at
or visit
Water Contamination Issues
Indiana city finds PCE in well
(Indianapolis Star, January 7)
but city officials are criticized for
delaying public notification while confirmation samples taken
(Indianapolis Star, January 9)
The criticism seems to be much ado about nothing by people who don't understand that (a) false positive lab findings do occur; (b) false-alarm public notices are damaging to everyone; and (c) exposure to water containing 8.5 ppb of PCE for a few weeks is not a public health crisis!
South Dakota city notifies customers of "ancient" turbidity problem
(Aberdeen News, January 13)
but the "non-problem" posed no risk and is being resolved by new project
(Aberdeen News, January 14)
Corps of Engineers works on GAC plant to clean up Kansas TCE plume
(Topeka Capital-Journal, January 13)
TCE contamination forces private school to relocate
(Union Leader, January 14)
Water Epidemiology
Investigation of link between colon cancers and caused hydrazine contamination due to a
initiated at Michigan industrial plant
(Times Herald, January 12)
Good luck to any epidemiologist who tries to determine linkage of cancer occurrence in workers when the suspect contamination occurred 14-20 years earlier, no one knows when or how much...
Source Water Protection
Research suggests that dung beetles may help decrease
in cow manure
(The Australian, December 27)
Aussie school kids get "hands-on" experience in quantifying these helpful guys
And, definitely in the category of all you ever wanted to know (and more) about dung beetles, see
Part 1
Part 2
(Thanks to Brian McRae of the Australian Water Association for help with this item.)
New York watershed group provides education program for private well owners
(The Ithaca Journal, January 14)
Water-related Research
Practical research indicates "sari" cloth filtration may be good solution against cholera
(Nature, January 14)
UK simulation study assesses "exposure measurement error" re: effects of chloroform on pregnant women
(Environmental Health Perspectives, January 9, abstract, PDF file, 3 pages)
Water Treatment
Waste disposal restrictions impact RO treatment plants in Florida
(South Florida Sun-Sentinel, January 12)
Hookup/start up of ozone facility at Southern California wholesaler's WTP spurs temporary request for cutback in water use
(Press Enterprise, January 13 - free site registration required)
Texas water system raises rates to comply with arsenic rule and build a desalination plant
(Houston Chronicle, January 9)
Water Aesthetics
Southern California
city says hospital shouldn't expect to get clear drinking water
(Press Enterprise, January 9 - free site registration required)
Oklahoma officials ponder aesthetic concerns of clearing up lake
(Oklahoman, January 13)
Radium level increases baffle water officials in
South Carolina
(The State, January 8)
and in
(Times-Press, January 9)
Battle of the Eagles: Town vs Village! Attempt to solve radium problem ends up in Wisconsin court
(Milwaukee Journal-Sentinel, January 9)
Water Legalities
North Battleford residents seeking legal settlement with Saskatchewan government over
(Saskatchewan News Network, January 11)
Decade-old class action lawsuit over TCE contamination about to be settled
(Arizona Daily Republic, January 13)
National Ground Water Association's Chairman has interesting comments on arsenic test kits
(NGWA Newszine, January 2003)
Arsenic findings puts Wisconsin plan for aquifer storage in doubt
(Green Bay Press Gazette, January 10)
Rhode Island officials make significant progress on massive MTBE cleanup
(Woonsocket Call, January 8)
Bioreactor using
bacteria may be part of the solution
(Woonsocket Call, January 10)
New Jersey private well owners find MTBE and benzene
(Express Times, January 10)
Chevron joins its competitors in removing MTBE from California gasoline before ban goes into effect
(San Luis Obispo Tribune, January 9)
California's fluoridation law to be tested by city's initiative
(Mercury News, January 9)
South Africa delays fluoridation plans for demonstration projects
(The Mercury, January 8)
Irish EPA releases its annual report on drinking water quality compliance
The report is titled:
"Quality of Drinking Water in Ireland"
(PDF file, 141 pages)
Exceedances of the Irish guideline of 0.2 mg/l for aluminum are noted and are attributed to overdosing of alum at water treatment plants.
New South Wales, AU acts to counter "nightclub" efforts to increase bottled water sales by not providing free tap drinking water
(Border Mail, January 10)
New Zealand treatment plant upgrade may be fast-tracked to address taste and odor issues
(Waikato Times, January 11)
NSF is hosting a conference on POU and POE treatment technologies for public water system compliance February 13 and 14 in Orlando, Florida
Please visit our partner
National Groundwater Association
The mission of NGWA is to enhance the skills and credibility of all ground water professionals, develop and exchange industry knowledge and promote the ground water industry and understanding of ground water resources.
You can visit the NGWA website at:
Daily Water Resource Newsletters
For those readers who have an interest in water resources
, we recommend that you subscribe to Ken Harlow's
SoCal Water Resources News
. Its focus is mainly on Southern California but it also covers state-wide issues and sometimes a bit beyond.
For free subscription to this or other regional newsletters from Brown and Caldwell, please visit the following website:
Relevant Links
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Main Content
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2023 21 Av Sw, Calgary
MLS® # C4249026 - 3 Beds, 3 Baths, 1,669 Sf
This almost 1,800 SQFT 2-Storey home sits on a 42 x 125 FT R-C2 LOT on ONE OF THE BEST STREETS IN RICHMOND, with a TRIPLE DETACHED HEATED GARAGE with a 4-POST HOIST & 15 foot ceilings. This 3 BEDROOM 2.5 BATHROOM HOME was EXTENDED, and CONVERTED INTO A LARGE FULLY UPDATED 2-STOREY HOUSE in 2001. This SPACIOUS property features an office just off the living room, HUGE KITCHEN, seperate formal dining room, a bright front living room, a beautiful west facing back yard, and an additional parking pad beside the triple garage, perfect for an RV. The Master bedroom features a walk in closet and an in-progress master ensuite that awaits your finishing touch. Other upgrades include newer windows, furnace, electrical, & plumbing. **ATTENTION BUILDERS: THE PROPERTY NEXT DOOR CAN ALSO BE PURCHASED for a COMBINED SIZE OF 84 x 125 FT, which MAY ALLOW FOR 3 DETACHED HOMES TO BE BUILT ON 3 x 28FT LOTS EACH.**
View more real estate listings in Richmond, Calgary
Insulated, Heated, Parking Pad Cement or Paved, Triple Garage Detached, RV Parking
Back Lane, Fenced, Landscaped, Shopping Nearby
View More Richmond Move Up Homes for Sale in Calgary
MLS® # C4249026 - 3 Beds, 3 Baths, 1,669 Sf
MLS® # C4248311 - 2 Beds, 2 Baths, 963 Sf
MLS® # C4244160 - 3 Beds, 2 Baths, 883 Sf
Disclaimer: Information herein deemed reliable but not guaranteed by CREB®.
Listing information last updated on June 18th, 2019 at 4:30pm MDT.


text:
"The Love Nest" Tranquil Peace For Couples Or Solo Travellers
- Apartment
- People: 2
- Bedrooms: 1
- Bathrooms: 1
- Min. Stay: 4 nights
Apartment in Tijola, Orgiva,Alpujarras, Andalucia, Country Apartment With Pool
- Languages:
- English, Spanish
About Mandy
We moved to Spain to bring our children up in a safe and friendly culture. Ralph is a successful sculptor and an ingenious practical fixer of anything from strimmers to computers. Mandy is an English teacher locally but has been both a psychiatric nurse and belly dancer. Flexibility is the key to life in the Alpujarras! We both speak good Spanish.
Mandy purchased this Apartment in 1996
Why Mandy chose Órgiva
Our rambling farmhouse is located in Tijola, 2.5 kilometres away from the lively mountain town of Orgiva. The abundance of flowers and woodland and its proximity to the river make Tijola the most desirable location in the area. The previous Spanish owner made wine in a "bodega" in an unused room next to the stables, treading the grapes with a new pair of wellies each year! Unable to continue the tradition ourselves, we converted the wine room into a smart and comfortable apartment for couples or solo travelers. The location is wonderful and in easy reach of Granada, the white mountain villages and the coast. As we avoid pesticides and maintain a variety of habitats on our land we have abundant and interesting bird life ranging from common British garden birds to more exotic species like Shrikes, Hoopoes and Golden oriels .
What makes this Apartment unique
Many guests love to cook using the fantastic fresh produce available locally. There's no scrabbling around for enough plates here. Nor will you be frustrated by the lack of a cheese grater or potato masher. Guests have repeatedly praised the kitchen. And there is a dishwasher. Of course, every cook wants a night or two off and Orgiva has a great range of restaurants and bars where you can eat out. Comments in our visitors' book describe us as the "perfect hosts" (gosh!) because we are both available and discreet. If you need help or advice during your stay we are here for you but if you want to be left alone in peace then we won't intrude. Come and stay and have a great holiday!
- Heater
- Internet
- Parking
- Swimming pool
- 1 Bathroom
House Rules
Cancellation Policy
100% refund for cancellations more than 60 days before check-in date. 50% refund for cancellations more than 30 days before check-in date.
18 Reviews
Peaceful idyllic and very spanisj
Very friendly and accommodating owners, I was delau d almost 5 hours and they didn't seem to mind. The accommodation had everything you'd need spectacular views secluded pool, bravery needed it's freezing! I would definitely return
Thanks Lee. We are glad you had a peaceful stay. The pool was indeed cool due to an unusually late spring this year.
Hope to see you again some day! Mandy and Ralph
Lovely place to stay!!
The love nest is a lovely place to stay. The owners, Mandy and Ralph are superb hosts, and always there if you need them. Ralph is a very knowledgeable guy, and very interesting to talk to. Also recommended is horse riding, which can be arranged by Ralph. The local scenery is beautiful, and Orgiva is a bustling little town with some nice places to eat and drink. We were sad to leave!
Very nice cosy apartment with great views, garden and swimming pool
Mandy and Ralph were very welcoming, and discreet, only there if needed. The property is in a stunning location, and it was great to have a pool to cool off given the temperature!
It has all you need and the location is good to visit places such as Granada, about a 50 mins drive.
If you want to switch off, this is a good place to do it, many thanks
Peace & quiet in rural Spain
A cosy, comfortable apartment for two people in a peaceful location with stunning views of the mountains and countryside. Despite being attached to the owner's property the apartment is completely private and secluded.
A lovely property with a gorgeous garden and fantastic views.
A super stay in the quiet area near to the town with a beautiful garden. The property was great for two with everything we needed and the nearby town had nice shops, restaurants and an interesting market. A wonderful area of Spain.
Just lovely: quiet, relaxing and very comfortable.
We loved the place. Wendy and Ralph were helpful and unobtrusive: just there if we needed them. It was clean,well maintained and equipped with everything we could possibly have needed. We had some great food out, but also enjoyed cooking for ourselves. Would definitely recommend to friends and family.
Thanks so much. Predictive text has changed my name from Mandy to Wendy!!
Special interest holidays:
Pony trecks can be arranged
The beaches on the Costa Tropical are 40 minutes by car. There are many to choose from within an hour's drive and none are as crowded and busy as those on the Costa del Sol nearer Malaga.
Granada airport is our nearest airport at one hours drive away. Malaga airport is 1hr 50 mins away. Car hire is available at both airports. Alternatively you can pre-book your car in the UK and pick it up on arrival. If you prefer not to drive whilst on your holiday then we can arrange a taxi to and from the airport at an extra cost. Órgiva town has a Taxi service. Please enquire at the time of booking.
Nearest Town - Órgiva 30 mins walk - 2.5 KM
Beaches. Nearest - 40 minutes drive. Nicest 50 minutes
"White Villages" Pampaneira. The nearest - 20 minutes drive, the rest a little longer.
Further Details:
There are a variety of things to do in the area such as walking, skiing, diving, horse-riding, paragliding, visiting traditional white mountain villages and the Alhambra palace in Granada (50 mins away). Some visitors find it difficult to leave the relaxing surroundings of the apartment and do anything at all! In this case we can arrange a soothing massage or reflexology session if you fancy pampering yourselves. Otherwise, forget everything, take another sip of wine, or gaze at the stars in the black night sky and just concentrate on being with your loved one in Andalucia!