text:
Sleep Related Infant Deaths
Tulsa County 2004 – 2009
Table of Contents
Introduction — 1
Summary Recommendations and Findings — 4
Data and Statistics — 6
Modifiable Risk Factors for Sleep Related Infant Deaths — 9
Home Interviews — 13
Case Review Team — 15
Appendix I: Top Ten Safe Sleep — 17
Appendix II: Healthy People 2020 Goals — 19
Appendix III: Resources — 20
Appendix IV: Works Cited — 22
The idea that not all babies leave the hospital to live happy and healthy lives is
difficult to hear; however, many families in our community have suffered the loss
of an infant. The nature of a preventable infant death makes this an even more
difficult discussion.
Over the last decade, there have been periods of time when Tulsa County
mothers have experienced infant mortality rates higher than other mothers in the
state. Over that same decade, Oklahoma as a whole has consistently exceeded
national infant mortality rates. The purpose of this report is to bring attention to
the role sleep related deaths play in infant mortality. Sleep related deaths account
for 19% of all Tulsa County infant deaths and are typically identified in one of
three categories: Sudden Infant Death Syndrome (SIDS), Asphyxia, or Unknown
Cause. Nationally, SIDS is the leading cause of death among infants aged 1
month to 12 months and is the third leading cause overall of infant mortality in
the United States (Sudden Unexpected Infant Death and Sudden Infant Death
Syndrome). On average, every year in Tulsa County there are 14 sleep related
infant deaths. The five year rate, from 2005 – 2009, illustrates a 13.2% increase
from the previous 5 year rate.
Table 1: Sleep Related Deaths:
Tulsa County and Oklahoma State
Tulsa County Oklahoma State
Number of
Rate per 1000
live births
Number of
Rate per 1000
live births
2000 15 1.61 81 1.63
2001 11 1.18 62 1.24
2002 16 1.72 77 1.53
2003 13 1.39 90 1.77
2004 11 1.20 68 1.33
2005 10 1.08 71 1.37
2006 20 2.05 89 1.65
2007 17 1.74 89 1.62
2008* 13 1.39 93 1.70
2009* 19 1.95 95 1.79
Total 145 1.54 815 1.57
*Preliminary Data (6/22/11)
Source OK2Share, Oklahoma State Department of Health
There are a variety of modifiable and non-modifiable risk factors that influence
an infant's sleep environment and impact mortality. Non-modifiable risk factors
such as gender, time of year, race/ethnicity, premature birth, mother's age, and
family history are beyond our scope of influence. Modifiable risk factors such as
bedsharing*, sleep surface, sleep position, loose bedding or other objects in the
sleep area, exposure to environmental tobacco smoke, overheating, and maternal
alcohol and illegal drug use can and should be addressed. Figure 1 summarizes
these risk factors.
The goal of the Tulsa Fetal and Infant Mortality Review Project (TFIMR) is to
work with the community to reduce infant mortality rates through targeted systems
changes and improvements. Working with others in the community, specifically
those who play a part in the delivery of maternal and child health services, is a
requirement if we expect to meaningfully address this important issue.
* Bedsharing also known as co-sleeping, is defined as sharing a sleep
surface with one or more individuals
Figure 1: Summary of Selected Risk Factors
• 88.6% (62) of the sleep related deaths were considered to be in a non-safe
sleep environment.
• 70% (42) of sleep related infant deaths were categorized as unknown or
• 61.4% (43) of the infants were sharing a sleep surface with at least one other
• When sleep position was known, 56.3% (18) of infants were placed in the
prone or face down position.
• 63% of sleep related infant deaths occurred to mother reporting tobacco use.
Targeted Education Regarding Protective Measures
Certain factors are considered protective against SIDS. A significant reduction
in the risk for SIDS has been demonstrated with pacifier use, particularly
during sleep (Hauck, 2011). Breastfeeding has also been found to be protective
against SIDS and the recommendation is to include breastfeeding with
other SIDS risk reduction messages, such as "Back to Sleep" campaigns and
encouraging roomsharing (Hauck Fern R., 2005). Education should be provided
by practitioners throughout pregnancy and at birth and well child visits on a
consistent basis.
Promote accurate and consistent death scene investigation
Using the Sudden Unexplained Infant Death Investigation reporting forms
developed by the Centers for Disease Control (CDC) would ensure consistent
death scene investigations and provide the medical examiner additional
information for assigning a cause of death. Forms and information can be
accessed at the following website: www.cdc.gov/sids/SUIDRF.htm
Intensify public awareness
campaigns on all aspects of safe sleep
This includes providing information on all Safe Sleep Top 10 recommendations
and modifiable risk factors. Focus should include reduction in modifiable risk
factors surrounding sleep related infant deaths and communication between
mothers and their providers. Practitioners have the most consistent contact
through prenatal appointments and should be provided tools and technical
assistance to convey the importance of safe sleep practices and risk exposure for
both mother and baby.
6 infant deaths
5 infant deaths
4 infant deaths
3 infant deaths
2 infant deaths
1 infant death
None reviewed
74135 74145
74114 74129
74104 74128
Sleep Related Deaths 2004 – 2009 | Tulsa County
Case Selection Criteria and Case Definition
Sleep related infant deaths occurring from 2004 – 2009 that meet TFIMR's
case selection criteria and case definition were included in this report. In order
to qualify as a sleep related death, available documentation (hospital records,
autopsy reports, death certificates and/or police reports) must have indicated an
unsafe sleep environment.
Death Certificates
Death certificate data include the manner and cause of death. Several
individuals are responsible for completing the relevant information. Primarily,
the medical examiner or pathologist is responsible for completing the death
certificate. Occasionally, the funeral director will also provide information.
The death certificate also contains data revealing additional significant medical
conditions when applicable.
Infant Deaths 2004 – 2009
From 2004 – 2009, there were a total of 457 Tulsa County resident infant
deaths. Of these, TFIMR has abstracted data for 411 infant deaths, representing
404 pregnancies.
Year of
N Infant
(Data Abstracted)
Sleep Related
Deaths Reviewed
by TFIMR
Asyphyxia SIDS Undetermined
2004 46 6 1 3 2
2005 68 7 1 2 4
2006 79 19 3 8 8
2007 86 16 2 3 11
2008 66 10 1 0 9
2009 66 12 1 3 8
411 70 9 19 42
Table 2: TFIMR Infant Deaths by Year of Death and
Cause of Death
Summary of all Infant Deaths, Tulsa County, 2004 – 2009
Of the total infant deaths from 2004 – 2009, 70 were considered sleep related.
For those cases reviewed by TFIMR, the causes of death were listed as:
• 27.1% Sudden Infant Death Syndrome (SIDS)
• 60.0% Undetermined/Unknown
• 12.9% Asphyxia
Table 3 illustrates actual numbers and underlying or additional causes of death.
Table 3: Summary of Sleep Related Deaths by
Manner of Death (2004 – 2009)
Sleep Surface and Environment
For the 70 sleep related deaths, the most common sleep surface identified was
an adult size bed (55.1%). The chart to the right identifies by percent the surface
associated with sleep related infant deaths.
Sleep Surface
Table 4: Sleep Surface & Bed Sharing Status by
Cause of Death (2004 – 2009)
Sleep Surface
Sharing Sleep Surface Asphyxia SIDS Undetermined Total
Bassinet 0 0 0 0
Crib 0 2 0 2
Couch 4 1 3 8
Adult bed 3 0 29 32
Swing 0 0 0 0
Unknown 0 0 1 1
Total 7 3 33 43
Not Sharing Sleep Surface
Bassinet 0 2 2 4
Crib 0 12 3 15
Couch 0 1 0 1
Adult bed 2 1 3 6
Swing 0 0 1 1
Unknown 0 0 0 0
Total 2 16 9 27
Table 4 illustrates cause of death by type of sleep surface and presence of
bedsharing. For sleep related SIDS deaths, 73.7% (14) occurred in a crib or
bassinet and non-bedsharing environments. Asphyxia and Undetermined causes
of death combined for 97.5% (38) of sleep related deaths when a shared surface
includes a couch or adult bed, with adult beds accounting for 84.2% (32) of
those deaths.
Sleep Position
The American Academy of Pediatrics recommends infants be placed on their
backs to sleep to reduce the risk of SIDS and infants are provided with "Tummy
Time" during the day for exercise. The risk of SIDS is lowest for infants placed
on their back (supine) to sleep and increases when placed on their stomach
(prone) to sleep. Infants who are unaccustomed to sleeping on their stomach and
are placed on their stomach to sleep are at much higher risk for SIDS (Centers
for Disease Control). Out of 70 infant deaths that were reviewed, sleep position
was unknown for 38 infants. Of the 32 infant deaths where sleep position was
known, 18 (56.3%) were placed or found prone or face down
0 10 20 30 40
Sitting up
Number of Infant Deaths
Sleep Position
Access to Prenatal Care
Recommendations from this report identified prenatal care appointments as
a feasible option to provide targeted safe sleep messages to mothers and other
caregivers. Table 3 illustrates that of known access to prenatal care, only 10.1%
of mothers delayed prenatal care until the 3rd trimester and only 4.3% received
no prenatal care. The majority of mothers accessed prenatal care prior to the
end of the first trimester and a combined 85.5% accessed prenatal care prior to
the end of the second trimester.
Table 5: PNC by Infant Cause of Death
PNC During Pregnancy Asphyxia SIDS Undetermined Total
Week PNC Started
<14 2 14 20 36
14 – 24 5 4 14 23
25+ 2 0 5 7
None 0 1 2 3
Unknown 0 0 1 1
Total 9 19 42 70
3 9 8
8 3
2004 2005 2006 2007 2008 2009
Year of death
D eaths by Ye ar and C ause
Triple Risk Model for SIDS
The Triple Risk Model (Administration, Sudden Unexpected Infant Death and
Sudden Infant Death Syndrome) includes three factors: a vulnerable infant, a
critical developmental time period in an infant's life, and an external stressor.
When these three elements come together SIDS can occur. In order to reduce the
number of sleep related infant deaths, we must be able to identify and educate the
public about the risk factors associated with these types of infant deaths.
TFIMR Home Interviews
Home or phone interviews were conducted on 36 (51.4%) of the 70 sleep related
infant deaths. Some of the general observations made during home interviews
have been:
Most of the families appreciate the opportunity to discuss the life of their baby.
It is always difficult to hear about a child death but there seems to be a sense of
relief when someone wants to hear the details, see the pictures, and watch the
videos. Whether the baby lived for a minute, a year, or even died in utero, all of
our parents recognize this as a life and want those around them to recognize it as
such and give it the same value that is given to any life.
Most families do not understand why their baby died, but they want to
understand. There is a frustration that arises when a baby's death is listed as
"undetermined." Families believe all sorts of things contributed to the death of
their baby, but very few understand exactly what happened. Overall when we ask
"What do you think happened to your baby?" the answer is "I don't know."
Families do not have a sleep plan. Although all of our families, in one way or
another, describe preparations they made for their baby, no family we have
spoken with considered how they were going to put their baby to sleep before the
baby was born. Many mothers have expressed being overwhelmingly tired and
having little support to help them care for the baby.
Resources are available in Tulsa County. Almost all of our families had a crib
or bassinette when the baby came home from the hospital. Because of our area
social service agencies and their generosity, safe sleep resources are available in
our county.
The Safe Sleep message is incomplete and misunderstood. Although most of
our families say they have heard a safe sleep message at one time or another, the
message is incomplete or misunderstood. Families are familiar with "Back to
Sleep" but still fear their baby may choke in this position. Families generally have
not heard of the dangers of suffocation that accompany co-sleeping or securing
the baby with pillows.
Finally, most of our families are doing okay. Almost all of our families are
emotional during the interview; they tear up or express some anger at a situation
that cannot be changed. However, with just a handful of exceptions, they are
experiencing appropriate grief and have had normal reactions to an incredibly
difficult situation. They are able to get up in the morning and take care of their
family, go to work, have contact with friends and family, and are able to smile
and laugh. The pain is still evident, but they are moving forward.
Case Review Team (CRT) Review
The case review team reviews the de-identified information collected in interviews
and medical data abstractions. The CRT then summarizes findings and creates
recommendations to improve the community's service delivery systems and
resources. The CRT reviewed 87.1% of the sleep related infant deaths.
Recommendations made by the CRT:
A strong Safe Sleep "information card" should be developed and given to
women residing in TFIMR Counties, at delivery and preferably during early
prenatal care. It should include TFIMR sleep related statistics.
• Prepare an opinion column for local media with the sleep environment statistics
• Have sleep environment topic presented at local hospital grand rounds.
• Social Service agencies require Safe Sleep video viewing before receiving a crib.
• Promote looping Safe Sleep video in waiting rooms ("I Sleep Alone")
• Promote morning TV time slots with 1st responder and/or physician
discussing safe sleep issue
• Have a safe sleep presence at State Fair and Just Between Friends
• Partner with Emergency Infant Services and Women, Infant and Children to
promote safe sleep
• Prepare statistics and a statement on sleep related deaths
• Have someone available to interpret autopsy reports to families, particularly
sleep environment deaths.
Appendi x I: Safe Slep Top 10
1. Always place your baby on his or her back to sleep, for naps and at night.
The back sleep position is the safest, and every sleep time counts.
2. Place your baby on a firm sleep surface, such as on a safety-approved crib
mattress, covered by a fitted sheet. Never place your baby to sleep on pillows,
quilts, sheepskins, and other soft surfaces.
3. Keep soft objects, toys, and loose bedding out of your baby's sleep area.
Don't use pillows, blankets, quilts, sheepskins, and pillow-like crib bumpers in
your baby's sleep area, and keep any other items away from your baby's face.
4. Do not allow smoking around your baby. Don't smoke before or after the
birth of your baby, and don't let others smoke around your baby.
5. Keep your baby's sleep area close to, but separate from, where you and others
sleep. Your baby should not sleep in a bed or on a couch or armchair with
adults or other children, but he or she can sleep in the same room as you. If
you bring your baby in bed with you to breastfeed, put him or her back in
a separate sleep area, such as a bassinet, crib, cradle, or a bedside cosleeper
(infant bed that attaches to an adult bed) when finished.
6. Think about using a clean, dry pacifier when placing the infant down to
sleep, but don't force the baby to take it. (If you are breastfeeding your baby,
wait until your child is 1 month old or is used to breastfeeding before using a
7. Do not let your baby overheat during sleep. Dress your baby in light sleep
clothing and keep the room at a temperature that is comfortable for an adult.
8. Avoid products that claim to reduce the risk of SIDS because most have not
been tested for effectiveness or safety.
9. Do not use home monitors to reduce the risk of SIDS. If you have questions
about using monitors for other conditions talk to your health care provider
10. Reduce the chance that flat spots will develop on your baby's head: provide
"Tummy Time" when your baby is awake and someone is watching; change
the direction that your baby lies in the crib from one week to the next; and
avoid too much time in car seats, carriers, and bouncers.
Source: Eunice Kennedy Shriver, National Institute of Child Health and Human Development.
Safe Sleep Top 10.
Retrieved from http://www.nichd.nih.gov/publications/pubs/safe_sleep_gen.cfm#risk
Appendi x II: Healthy People
2020 Goals
Healthy People 2020 goals are the nation's 10-year goals and objectives for health
promotion and disease prevention. For 30 years, Healthy People has established
benchmarks and monitored progress over time to encourage collaborations across
sectors, guide individuals toward making informed health decisions and measure
the impact of prevention activities. Healthy People 2020 goals for reducing infant
deaths from SIDS, SUID, and increasing Back to Sleep are:
• Reduce the number of infant deaths from SIDS from 0.55 per 1,000 live
births to 0.50 deaths per 1,000 live births.
• Reduce the number of infant deaths from sudden unexpected
infant deaths (includes SIDS, Unknown Cause, Accidental Suffocation and
Strangulation in Bed) from 0.93 infant deaths per 1,000 live births to 0.84
infant deaths per 1,000 live births.
• Increase the percentage of infants who are put to sleep on their backs from
69% to 75.9%.
Source: Healthy People 2020.
Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.
Appendi x III: Available
Resources and Training
Free, confidential call for health and social services information. Dial 211 from
any phone.
Comprehensive, long-term counseling to assist the bereaved in the wake of their
loss, located at 3930 E. 31st Street, Tulsa, OK 74135
http://www.fcsok.org/ | Family and Children's Services
Provides an array of family services and comprehensive mental health services
for adults and children.
Free 24/7 telephone and mobile psychiatric crisis intervention for children,
adolescents, and adults in Tulsa County.
650 South Peoria Avenue, Tulsa, OK 74120-4429
utilizes mobile medical units to offer free, quality medical care directly to the
poor and under-served in the greater Tulsa area.
http://www.ppaeo.org | Planned Parenthood
Sexual and reproductive health care provider offering services such as birth
control, std testing & treatment, emergency contraception, abortion referrals and
women's health services.
CDC website on pregnancy. If you are pregnant or planning to get pregnant
there are steps you can take for a healthy pregnancy and a healthy baby. Visit
this website for more information.
Oklahoma State Department of Health website. We all want Oklahoma's babies
to be safe and healthy. Many things can help and everyone can play a role. View
this website for information on keeping babies safe and healthy.
The mission of the Robert Wood Johnson Foundation is to improve the health
and health care of all Americans. Their goal is to help our society transform
itself for the better.
Annie E Casey Foundation. Helping vulnerable kids and families
succeed. Explore hundreds of measures of well-being for kids across the nation,
or in your state, city, or community.
The Center for Disease Control and Prevention's website for information on
Sudden Unexpected Infant Death (SUID) and Sudden Infant Death Syndrome
(SIDS). The site offers information about their SUID Initiative as well as
materials for training.
First Candle is one of the nation's leading nonprofit organizations dedicated to
safe pregnancies and the survival of babies through the first years of life. Our
current priority is to eliminate Stillbirth, Sudden Infant Death Syndrome (SIDS)
and other Sudden Unexpected Infant Deaths (SUID) with programs of research,
education and advocacy.
A non-profit organization whose mission is to improve the health of babies by
preventing birth defects, prematurity and infant mortality. The site provides
information for women planning a pregnancy or who are pregnant as well as
research information and educational materials for professionals.
Appendi x IV: References
Health Resources and Services Administration (n.d.). SIDS/ID Program
Manual. Centers for Disease Control.
Centers for Disease Control. (n.d.). Sudden Unexplained Infant Death
Investigation. A Systematic Training Program for the Professional Infant Death
Investigation Specialist.
Hauck Fern R., O. O. (2005). Do Pacifiers Reduce the Risk of Sudden Infant
Death Syndrome: A meta-analysis. Pediatrics. Vol. 116, No. 5, pp. e716 – e723.
Hauck, F. R. (2011). Breastfeeding and Reduction Risk of Sudden Infant Death
Syndrome: A Meta-analysis. Pediatrics. Originally published online at: http://
pediatrics.aappublications.org/content/early/2011/06/08/peds.2010 – 3000
Sudden Unexpected Infant Death and Sudden Infant Death Sundrome. (n.d.).
Retrieved June 15, 2011, from Centers for Disease Control: http:www.cdc.gov/
This report was produced with data from 2004 – 2009 and distributed in 2011 by
the Tulsa Fetal and Infant Mortality Review Project (TFIMR) as a collaborative
effort including data and information collected through the data abstraction
process, home interviews, and the CRT and CAT processes. Members of
CRT and CAT represent practitioners and community members dedicated to
reducing infant mortality for Tulsa County through systems changes. To learn
more about TFIMR or to request additional copies of this report, please send
an e-mail to firstname.lastname@example.com, call 918.595.4441, or visit our website at
The Fetal and Infant Mortality Review process model was developed in collaboration
between the American College of Obstetrics and Gynecology (ACOG) and the
Maternal and Child health Bureau. For over 25 years, FIMR projects across the
United States have been working to understand infant mortality and develop local,
systems-oriented solutions.
The Tulsa Fetal and Infant Mortality Review Project is supported by the
Maternal and Child Health Services Title V Block Grant, Department of
Health and Human Services, Health Resources and Services Administration,
Maternal and Child Health Bureau, administered by the Oklahoma State
Department of Health, Maternal and Child Health.
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Posts Tagged 'Muffins'
All right, did anyone actually READ the article noted below, because what it really says, beyond the sensationalizing headline is: exercise won't necessarily make you thin – because – when you exercise you get hungry and think it's okay to PIG OUT afterward, or to drink sugary beverages while you exercise, giving you a net calorie loss of zip, zilch, zero.
Here's the real truth according to what I've lived, learned and observed:
Most people lie about what they really eat and how much exercise they get, to everyone who asks AND, more importantly, to themselves. Have you ever done a food diary and figured out what you're actually eating, and just how close you are (or are not) to consuming the number of calories you need to merely maintain your current weight? My lord, you'll be shocked, truly shocked at how many calories you're really consuming. I pride myself on eating well and being fairly active, and I'm nowhere close to burning off the number of calories I take in, NO WHERE CLOSE. I'm consuming a lot of calories, absolutely shed-loads of calories; way more calories than I need to fuel my body's basic activities, like breathing and pumping my blood, or propelling me from car to my chair at work and from my work chair back to my car and from car to couch.
From what I've seen, a lot of people just don't work hard enough when they do exercise to achieve substantial calorie burn; compounding the problem, they do a lackluster workout where they don't push themselves and barely break a sweat, that burns say 150 calories tops, then reward themselves with 500 calories of wine and dessert because they "worked out." Have you ever computed how long you'd have to work out walking on a treadmill to offset the calories from a piece of cheesecake? Okay people, go use those internet calculators to do the math and you'll see why exercising isn't making you lose weight – because you EAT MORE CALORIES than you can possibly burn off with those tepid attempts to move your sorry carcass around.
Deep down inside we all know it. We know that the "science" of our forebears, or the "science" of "brown fat" doesn't really factor in if we sit all day in front a computer, then retire to the sofa for a night of television, bending over twice in twenty-four hours, once to feed our porcine pets, then again to lift our pants up around our bulging waists.
Hey, my jeans are so tight they leave an impression of each and every seam and stitch on my doughy belly fat; I love to suck down sugary Gatorade while I coast my bike down a hill; I don't work out that hard because it makes me feel like I'm going to barf up the nachos I had for lunch; and I sit all day and all night on my ever-expanding behind. And I know precisely why I don't lose weight: because I'm eating more calories than I'm burning off, day in and day out, which makes weight creep on ever so s-l-o-w-l-y, slow enough that I can pretend I didn't have anything to do with it, and that it's my brown fat's fault, or my genes, or my ancestors, and that, uhuh, yup, exercise is a sham.
All of our self delusions aside, the point of exercise is to maintain cardiovascular health (so you don't faint if you have carry your niece past a scary dog); improve strength (so you can push your own couch around when you need to feng shui your living room) and flexibility (so you don't pull a muscle when you try to bend down and pick up the 940-calorie plastic-wrapped Costco muffin that rolled under your car seat).
We're a sad, frustrated, angry lot of nearly immobile people constantly exposed to the siren song of more. It's time to tell "science" to shove it and move for the joy of moving. Move because you can. Move in any way you can. Get up, get up, get up, get up! Just don't head straight for the refrigerator

subset: commoncrawl


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Back to Search Results | Start New Search
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text:
How the Queen's Speech got my goat
Oh dear. The Queen's Speech has already got my goat. Let me explain.
I reported this morning that the Gracious Speech is written on vellum with ink that takes three days to dry so it cannot be amended at the last minute. True... until recently but, apologies, I now learn it is not any more. I regret to have to report that the goat has fallen victim to the age of austerity. This year's speech will be written on plain - or, in truth, rather posh - paper.
"Going goat" is still a phrase used in Whitehall to describe the moment when the Queen's Speech has to be finalised and sent to the Palace for Her Majesty's approval. That is several days before it is delivered.
This year that meant it was completed before not after the local elections which, as I reported, meant that the measures announced could not be a response to UKIP's triumph at the polls.
Analysis right. Fact wrong. Sorry.
PS I blame Fergie trauma for my error...
UPDATE 2pm: When is a goat not a goat? When does a mea culpa become not so culpa after all?
Just when you thought Goatgate had been cleared up, along comes the official line: It is not on vellum anymore. It is on "goatskin parchment paper" but confusingly it's not actually goatskin. However it is very high quality, thick paper, which is why the ink takes several days to dry, and it then needs to be bound into a booklet, before being sent on to Her Majesty for signing. So it did have to go to the printers last week. And the paper does have the watermark of a goat....
That's enough goats - Ed


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All About Kaanapali Beach Hotel
Officially recognized as the 'Most Hawaiian Hotel' by the Waiaha Foundation and 'Hawaii's Best Value Hotel' by Travel and Leisure Magazine, this low-rise property is an oasis amongst its high-rise neighbors. Guestrooms beckon guests to enjoy gentle tradewinds and a view of our lush, tropical gardens. From Hawaiian quilt-designed bedspreads, island furnishings and original artwork, you will never feel like you're in a pre-packaged chain hotel. A signature interactive cultural program is the foundation for award-winning service. Our complimentary children's program, nightly hula show, and daily cultural activities make a stay at Kaanapali Beach Hotel a fun-filled, value-packed Hawaiian experience.


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I recall Ida telling how disappointed she and Agnes were when they couldn't continue their schooling as their father needed their help at the lumber camps. Ida was always self-conscious about her perceived lack of education and penmanship.
Ida's father, Johannes Hoefferle was born in Austria and her mother, born in Grundy county, Illinois, was a first generation American. John Hoefferle immigrated to northern Wisconsin with his siblings and married Rose Schaper in 1907.
Ida's family Prussian heritage and that of her German husband insured that many of their children's comfort foods would lean towards pork, sauerkraut, pickles and fruit desserts.
Late summer traditionally was a busy time for Ida; "putting" up jars of pickles, including pickled beets; jars of fruit to be used for pies during the winter months and choke cherry syrup. Of all the comfort foods that Al recalls from his childhood, the one he has missed the most are his mother's homemade pickles. It has been a number of years since I have done any preserving but the sight of pickling cucumbers and fresh picked dill at the local Farmers Market found me returning home with ingredients for a batch of Ida's Russian Dill pickles.
While I didn't realize it at the time, I have a family treasure of having Ida's handwritten instructions for her pickles. I don't recall how it came to be that we were given the recipes but they have laid in my recipe box for years until recently. I know that they were written during "pickle season" as I recall her saying that she would measure out the ingredients and write them down since she rarely measure anything on the dishes that were her family favorites. When I pulled the recipes out of the box I was dismayed to read the instructions "...with dill and a little alum and pickling spice in each jar." Ida was not known for her portion size - her idea of a little was always generous to say the least. After searching other pickle recipes, I settled on a 1/2 tsp of pickling spice and an 1/8 tsp of alum.
It seems that alum has gone out of favor with many pickle recipes and I debated on whether or not to use it but in the end decided Ida used it for a reason and was true to her recipe.
I made a small batch of the Russian Dills, in the event I needed to adjust the ingredients. It was a very long week's wait before we opened the first jar: Ida must have been guiding my hands as the sweet dill taste with the crisp crunch was exactly as he remembered.
We now have a number of jars of Russian Dills along with garlic dill and pickled green and yellow beans in our downstairs to carry us through the winter and I understand Ida's satisfaction of seeing the jars filled with the green and white spears resting on a head of dill with spices working their magic. Bread & Butter Refrigerator Pickles with red peppers are being enjoyed as well.
Another recipe handed down from Ida are Cherry Dill pickles; for the past two weeks chunks of cucumbers, dill and choke cherry leaves have been marinating in a brine of salt water. Later this week I'll follow her instructions for making the brine and pack the pickles in jars with additional dill and leaves. Let's hope they are as successful as the Russian Dills.
Copyright (c) 2011 Cindy Bergeron Scherwinski


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The most astounding feature of the political fray as the 2012 election comes into view is that not a single Republican other than Congressman Ron Paul is stepping forward to brand as his or her own the issue of honest money. The whole party is into the negotiation with the president over the budget, and the underlying issue--the failure of our fiat currency--is up for grabs.
It is true that there's plenty of blame to go around on the dollar. It had a value of 265th of an ounce of gold on the day that George W. Bush acceded to the presidency and was worth less than an 853rd of an ounce of gold on the day he left office. The New York Sun, which supported Mr. Bush in 2000 and 2004 elections, issued in December of 2005 an editorial called "The Bush Dollar," warning of the collapse of the greenback. It had just sunk below a 500th of an ounce of gold.
Today, of course, it is worth barely more than 1,500th of an ounce of gold. The giddiness of the plunge of the dollar really started to be felt in the years after the Democrats acceded to the leadership of the House.
At the time the Sun called for renaming the dollar "The Pelosi." The collapse has been so dramatic that the Europeans, the United Nations and even the Chinese communists are talking about the need to create a new international reserve currency. Yet not a single Republican has stepped onto the national stage and declared a run for the presidency on a platform containing the strong dollar as a major plank.
Now that the Republicans are back in control of the House they are in a perfect position to press this issue.
Congressman Paul has been on the issue at least since the early 1980s, when he, with Lewis Lehrman, issued his dissent to the final report of the United States Gold Commission. The commission had been established in 1981, a decade after the collapse of the Bretton Woods system. It ultimately endorsed a continuation of fiat money. It's hard to think of a longer, more faithful adherence to constitutional principle than that which has been maintained by the physician turned legislator in the 30 years since. But Dr. Paul has yet to announce his run for president.
Neither has Sarah Palin. The alert Alaskan--as the Sun likes to call her--has made it clear she's watching the issue. In November, as the Group of 20 was preparing for its doleful meeting at Seoul, she leaked to National Review a speech she was about to make at Phoenix, confronting Chairman Bernanke over his program of quantitative easing. The demarche ignited quite a tumult for a few days (and an editorial salute from TheWall Street Journal), but Palin, too has hung back from a campaign.
A number of other Republican governors--current ones like Mitch Daniels and Tim Pawlenty and former ones, like Mitt Romney--would seem to adhere to the principles of political economy that would put a premium on sound money. But none is preparing to make campaign on sound money. Nor is Paul Ryan. He clearly sees the issue out there. It was he who elicited from Mr. Bernanke the famous reply, "I don't fully understand the movements in the gold price." But Mr. Ryan is focused on the details of the budget.
The conservative intelligentsia is waiting for a champion on the issue. The Wall Street Journal editorial page has been pressing the issue in op-ed pieces and editorials. So has Forbes. Lawrence Kudlow of CNBC has been calling for a return to "King Dollar." James Grant is illuminating the issue in his Interest Rate Observer (and TheNew York Times).
Even a group of our greatest federal judges is asking the Supreme Court to hear their plea for a ruling that Congress must reinstate the automatic inflation adjustment in their salaries that the legislature had suspended--a suspension that was, the judges contend, in violation of the constitutional prohibition of diminishing the pay of a judge while he continues in office.
And then there are the states. The other week Utah became the first to take advantage of an opening left to the states by Article One, Section 10 of the Constitution to make gold and silver coins legal tender. The Constitution prohibits states from coining their own money and/or making anything other than gold or silver coins a tender in payment of debts. Now, spurred by the American Principles Project, at least a dozen states are at least tentatively exploring doing just that.
In Utah's case, what it has done is not only make gold and silver coins legal tender but remove the state capital gains tax on any gain persons in Utah might get from holding gold and silver coins. There are those who set down the gesture as irrelevant and even flaky. But if several other states actually pass laws similar to what Utah has done it will add up to a remarkable vote of no confidence in the system that has been creating the money that we call dollars.
Could value start to return to the dollar without any candidate seizing the issue? No doubt it's possible. The bad-cop, good-cop team of Paul Volcker and Ronald Reagan used the combination of the chairman's tight money and the president's supply-side fiscal and regulatory reforms to achieve just such a turnaround during the 1980s. But can one expect the same from a combination of Chairman Bernanke and President Obama?
The fact is that the ground is so ripe for a candidate to seize the lead on monetary reform that one has to wonder why no one is stepping up. Is there what might be called the William Jennings Bryan effect? In 1896 he made the most famous attempt to run for the presidency on a monetary campaign. It produced his speech against crucifying mankind on a cross of gold. He lost. But then his campaign--a call for debasing the dollar--was the opposite of the opportunity that is beckoning the Republicans today, which is a campaign for a return to sound money. So let it be a lesson.


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In Savannah, heading northwest then northeast up to Richmond.
Miles driven: 3782
Bookstores visited: 142
Books signed: 1059
States traversed: 7
Days on the road: 17
Nights in hotels: 6
Gas cost: $364
Hotel cost: $401
Other costs include food, parking, and tools, which I'll add up later.
So far, bookseller reaction has been overwhelmingly positive, and I'm getting to meet a lot of cool people. I had to fly home for the Reaching Forward library conference, and signed and sold a lot of books and had a great time.
When this tour ends, the total cost for everything should be under $2000, and I'll have signed well over 2000 books and visited well over 200 bookstores.
Is it worth the time and money?
Well, it sure beats sitting on my butt whining about my sales. :)
Latest stores visited include:
Borders Orlando Airport FL
Borders Philly Airport PA
BN 213 Dale Mabry Tampa FL
Borders 909 Dale Mabry Tampa FL
Walden West Shore Tampa FL
Walden University Tampa FL
Borders Clearwater FL
BN 11802 Dale Mabry Tampa FL
Borders 12500 Dale Mabry Tampa FL
BN Clearwater FL
Walden Citrus Park Tampa FL
BN Merrit Island FL
BAM Merrit Island FL
BN Daytona FL
BN St. Augustine FL
Borders Jacksonville FL
BN San Jose Jacksonville FL
BN Midtown Jacksonville FL
BN Savannah GA
On to the Carolinas and Virginia...
Sunday, May 03, 2009
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7 Things Worth Knowing
November 27, 2012
1. We love to work hard.
Whether students arrive looking to explore the big questions or to pursue something more specific, we provide abundant options and personal support. Our nationally recognized professors teach small classes and collaborate with students on cutting-edge research. Integrating coursework, research, internships and volunteer projects, and leadership experiences, students leave Lewis & Clark ready for a world of opportunities.
2. We love to have fun.
From river-rafting expeditions to swing dancing, varsity athletics to a cappella performances, students at Lewis & Clark enjoy their free time.
3. It's beautiful here.
It's no surprise to us when Lewis & Clark is ranked among the nation's most beautiful campuses. Every day we delight in our idyllic, parklike setting, our view of Mount Hood framed by towering trees, our historic architecture, and our innovative facilities utilizing the best of modern sustainable design.
4. Portland is our backyard.
A short shuttle ride away, students can enjoy all the concerts, food carts, bookstores, galleries, and performances of Portland. In addition to countless entertainment and recreation options, the city also offers internships, job opportunities, and access to an impressive network of alumni.
5. We're everywhere.
More than half of our students participate in overseas and off-campus programs. Our student body represents 66 countries and all 50 states plus D.C. While we physically occupy a small corner of the world, our community spans the globe.
6. Our alumni go on to great things.
We're proud to be a top producer of Fulbright award winners and Peace Corps volunteers, and we're just as happy to report that our young alumni are succeeding as graduate students and entrepreneurs.
7. We want you to join us!
If Lewis & Clark sounds like the right fit for you, we encourage you to apply before our regular decision deadline, January 15.


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In the year 2021 several illegal experiments have been taking place under Crow City, an experiment with an artifact found on space triggered several portals to another dimensions leaking all kind of ferocious creatures. A special team of highly trained combat experts has been send to clean the area from these creatures, seal the portals and retrieve the artifact. Due to the extremely violent creatures and the mess they leave when they devour their victims, the portals have been codenamed "carnage frontiers" or CF for short.
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Dropbox, Google Docs, and Evernote – A Balancing Act
A recent question on www.Quora.com, "What is the best way to balance the use of Dropbox, Google Docs, and Evernote" inspired us to create a post describing how we support these services from within LifeTopix so that our users can easily place and track relevant pieces of information in their proper context regardless of its source. These three services (Evernote, Dropbox, and Google Docs) are the choice within their category for our users, and most users use a combination of all three based on their needs.
We're constantly talking to our users about how they use top notes services (Evernote), top file storage services (Dropbox), and top collaborative document services (Google Docs). This has influenced us to support these services from within LifeTopix, and also helped us to understand how users want to track relevant pieces of information in their proper context regardless of its source.
This post will explore how you might use these services when planning a trip — to perhaps, Maui.
Evernote: Real note taking happens in Evernote. As a platform for notes, Evernote gives you access to your serious notes that build over time from anywhere. When planning your trip to Maui, you might want to jot down a few tourist attractions and places you want to visit by using Evernote. You can get to your notes from most devices using either the Evernote app or via a browser on your Mac or PC, making it very easy to manage the content of these long-term reusable notes. Within a LifeTopix trip, you have access to an Evernote entry used during trip planning. After syncing your notes in All Online Notes and associating the notes with a topic item, you can view your notes within the context of your trip as we show you below.
Dropbox: By making it very easy to store files from the desktop as well as from apps, Dropbox has become the file storage service of choice for our users. Again, we chose not to replicate this, but rather to allow our users to attach files from Dropbox into items within LifeTopix. For example, if you are planning a trip with a group of friends, you might want to upload travel itineraries, brochures, photos, or other files that are necessary for your trip. After adding your Dropbox file folder to LifeTopix via Notes + Files, the file becomes available for viewing in context of the Maui trip. Notice the notification on the Files icons below. Clicking that icon allows you to view and edit these files.
Google Docs: For online collaboration, personal documents, and spreadsheets, Google Docs has the most traction within our user base. Again, we allow LifeTopix items to easily associate spreadsheets and other documents that are authored, edited, and managed on Google Docs. For example, during your Maui trip, you might want to track shared expenses with your friends. Collaborating in a Google Docs spreadsheet and viewing it within the context of the Maui trip is a great way to keep everyone on track with their trip expenses.
Personal and collaborative notes, documents, and files will continue to be a heterogeneous approach based on what we have seen over the last few years. As a vendor of the most complete life organization and productivity app, we have embraced the concept of getting more value from users' notes, files, and documents by allowing these items to be used in context.


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Burnett Heads is nestled along the Coral Coast and is most readily identifiable by the two historic lighthouses that dot its coastline.
Oaks Beach is a 200 metre long stretch of beach safe for surfing and swimming with many choosing to fish off the rocks and groyne at The Oaks which are the best places to reach deep water.
Burnett Heads is also home to the Port of Bundaberg, which boasts fresh, off the trawler, local seafood and lovely waterfront dining as well as many visitors berthing their vessels there for short stays and international yachties converging.
There are a variety of accommodation options and Burnett Heads is conveniently located close to the Mon Repos Conservation Park.
Note: Information on listed products and services are provided by the operator and were correct at the time of publishing. Rates are indicative based on the minimum and maximum available prices of products and services. Please visit the operator's website for further information. All prices quoted are in Australian dollars (AUD).


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The World's largest Hula Festival in Hilo
30 minutes from Hale Moana Bed & Breakfast in Hilo the famous annual Merrie Monarch Hula Competition will take place from April 20 - April 27. This year will be the festival's 51th Anniversary. Many dignitaries of the Hula world will attend and many special events will take place commemorating this long history of Hawaiian culture.
It is a magical time, when all of Hilo town is in a festive ambiance celebrating the art of Hula and the Hawaiian Culture. It is a community event with everybody involved from the Keiki (children) to the Kupuna (Elders): Hula performances in parks, public places and all around town, fabulous arts and crafts shows, the smell of fresh flowers everywhere, beautiful leis, everybody out in their finest Aloha wear, cheerful and happy. It is one of the most wonderful times here on the East side of the Island and as a visitor this magic is contagious and carries over to all open to be taken in by it. What makes this event so special is the fact, that it is not put on as a festival for visitors. It is genuine and authentic. It is the perfect time to experience Hawaii, its cultural richness and overabundant beauty. It's also a time to closely experience some of Hawaii's most famous performers, entertainers and musicians: Keali'i Reichel, Robert Kazimero, members of the Beamer family, Sonny Ching, Kekuhi Kanahele & the Kanakaole Ohana, and many other kumu hula and their halau from around the world.
The event starts on Wednesday night (April 23) with the Ho'ike Performance, a free exhibition night of hula, international performers and music. Thursday night (April 24) features the Miss Aloha Hula competition of individual women for the title of Miss Aloha Hula. Contestants perform hula kahiko (ancient hula), hula 'auana (modern hula) and oli (chanting). On Friday night (April 25) groups of women and men perform Hula Kahiko. Saturday (April 26) night, the final evening, presents women and men groups dancing the modern style hula ('auana). At the end of this evening the overall winners of both group hula nights are celebrated.
The week-long event finds its finale in the Saturday parade (April 26th) through downtown Hilo as one of the festival's most entertaining and fun parts for the whole family.
Tickets are mostly pre-sold, but may still be available at the door of the Edith Kanakaole Tennis Stadium on the evenings of the competition events. More information is also available on the official Merrie Monarch website www.merriemonarch.com.
Activities are available all over Hilo and in the area. Here are some links:
Basically Books in Hilo:
'Imiloa Astronomy Center in Hilo:
Hawaii Volcanoes National Park: