text:
Tired of opening and closing the world map to pick up quests at the Hermit's House, in Cloudland or Sanctuary, or turning in a Lock Pick quest in Port Blackwood, then popping back to the Flux?
Introducing a new and helpful way for you to get around Bushwhackia! The Commons' Teleporter Hub!
If you've built Brock's Masonry shop (to the west of the Town Hall) and are level 100 or higher, you can start building your Teleporter Network by talking to Eunice, the Port-Co representative in the Commons.
When you've completed the first teleporter station in the Commons, you will be able to seek out Eunice's friends around the world, in Quest Hubs and all the Fluxes, so that you can set up a chain of Teleporters to help out in your daily routines. Only one teleporter quest will be available to work on at a time, so it will take a few days to get it fully set up.
One of Eunice's fellow Port Co. employees, out in the wild world (well, just the Hermit's House.)
When you reach level 200, a second teleporter pad can be built in the Commons, and at level 300 you can build your 3rd pad. So depending on what quests you want to do that day, or how you want to get around, you can set a different destination for each of the Commons teleporter pads.
Plus, we've added 6 achievements relating to the Teleporters for you to achieve!
We welcome your comments and feedback on the forums.


text:
Travel in the correct car
Some Intercity trains may be longer than the platform.
Plan your trip to choose the correct car for your destination.
- Commuter car park
- Wheelchair accessible car space
- Toilets
- Wheelchair accessible toilet
- Baby change table
- Emergency help point
- Payphone
- No Opal card top up or single trip ticket sales
- This location is Independent Access
- Wheelchair ramp boarding assistance
- Hearing loop
- PA system for announcements
- Platform edge tactiles
Opal fare peak times
When you travel outside of peak times with an Opal card you will receive a 30% discount. Off peak fares apply on metro/train, bus and light rail service . The off-peak discount does not apply to Opal single tickets.
The peak times from Monday to Friday for this station are:
Stop information
Station Rd, Berry

subset: commoncrawl


text:
WASHINGTON, D.C. — White House press secretary Sarah Sanders will be leaving the Trump administration at the end of the month.
President Donald Trump announced the news on Twitter Wednesday.
He says Sanders will be returning to her home state of Arkansas and has not immediately named a successor.
Sanders is one of the president's closest and most trusted White House aides and one of the few remaining who worked on his campaign.
Her tenure was marked by a breakdown in regular White House press briefings and questions about the administration's credibility.
Special counsel Robert Mueller's revealed that Sanders admitted to investigators that she had made an unfounded claim that "countless" FBI agents had reached out to express support for Trump's decision to fire FBI Director James Comey in May 2017.
After 3 1/2 years, our wonderful Sarah Huckabee Sanders will be leaving the White House at the end of the month and going home to the Great State of Arkansas....— Donald J. Trump (@realDonaldTrump) June 13, 2019


text:
A woman who bought a baby shower gift at a Florida Goodwill store was shocked when the father-to-be opened the box and found a loaded semi-automatic rifle inside.
Veronica Alvarez-Rodriguez told the Northwest Florida Daily News that she and her husband stopped by the store in Valparaiso on Sunday as they were heading to a friend's baby shower. She found a Baby Einstein's bouncer that was unopened and appeared to be brand new for $9.99.
''It was like the perfect gift for the baby shower," Alvarez-Rodriguez said.
The father-to-be thought so too.
He shouted, ''You guys got me a gun!" Alvarez-Rodriguez said.
While some of the guests laughed, Alvarez-Rodriguez said she and her husband were shocked. They called the Crestview Police Department.
Officers came to the party and checked the couple's identifications to make sure they weren't convicted felons, police spokesman Maj. Andrew Schneider said.
The responding officer initially allowed the father-to-be to keep the gun, which is a Mossberg 715T semi-automatic rifle. The next day police asked him to turn it over to the department.
The incident remains under investigation. There were no details on how the gun got into the box, which appeared unopened.
An employee at the Goodwill store said she couldn't comment.
''Goodwill has the best treasures for $9.99," Alvarez-Rodriguez said.


text:
Ginger June Candle Co
YOU'RE A STONE COLD FOX • Conversational Soy Candle
made using only vegan + cruelty free, sustainable ingredients. clean burning wax made from American grown soybeans. Non-toxic, paraben & phthalate free fragrances. standard jar burn time is approx 50+ hours. large jar burn time is approx. 100+ hours Scent Guide: VACATION: sea spray, salt, jasmine & mandarin SUNSHINE: fresh, bright blend of blue sage & lemongrass MOONSHINE: balsamic woods, sandalwood, patchouli + vanilla. HAVANA warm tobacco leaf, honey, citrus and spice


text:
Apparel Accessories
Wholesale Party Accessories
Wholesale party accessories at first may seem like an unnecessary add on in both costumes and fashion, however as anybody who take these things seriously will tell you, they most certainly are not. Cheap party accessories can add so much to an outfit and often times can even make or break them. Image a pirate outfit without an eyepatch or how about an princess outfit without a tiara. Without these essential pieces to the puzzle most of these costumes would look uninspired and out of place. You can either buy our cheap party accessories in bulk or individually.
However shopping for wholesale party apparel and fedora hats accessories does not just pertain to costumes. Fashion is another area that choosing proper wholesale apparel accessories can make or break your look. In many places around the world it is unthinkable to go outside during winter without a coat. However by adding something as simple as a scarf you are not only increasing your protection against the elements but you are updating your look as well. If you really wanted to get fancy you may want to check out a houndstooth scarf which is fast becoming one of the more fashionable garments to wear.
Cheap party accessories are not just for looking good though, in fact many people who would scoff at wasting their money on fancy items are already wearing them. Belts, suspenders and bandanas are all examples of wholesale party accessories that might not put you on top of the fashion world, but provide a very functional purpose.
However it is important to remember that as much as cheap party accessories and halloween costumes can make a look they can also break it. If you don't put any thought into what kind of accessories you are matching with your outfit you could end up looking like a fool. For example, if your showing up to a party dressed as a lady soldier but are wearing some cute earrings you may have just undermined yourself. As cute as they may be they simply don't fit the outfit. Have you ever seen someone wearing sunglasses at night and wondered why? Well most likely that person understands that sunglasses are cool, but does not understand they need to be in context. In order to use party accessories and rave outfits to take your look to the next level you really need to be aware of how they fit into your outfit and the situation that you are in.
If you keep these tips in mind you can take any look good or bad and turn it into something spectacular. Remember, you can buy our cheap party accessories in bulk at wholesale prices or individually at still very low prices!


text:
Premier League Playback: 2013-14 season review
As Vincent Kompany held the Premier League title aloft on the final day of the Premier League campaign, you couldn't help but marvel that after 382 PL games the title winners would be decided in the final 90 minutes. As we all know by now, Manchester City prevailed as their attacking prowess and experience of winning the PL crown two years ago made the difference.
Yet while the City slickers celebrated way into the night and around Manchester city center on Monday, it is easy to forget that they were only at the top of the PL standings for 14 days the entire season. That's right.
FULL COVERAGE: Premier League Season Review
This season was one of the most exhilarating PL title races we've ever seen. On the final weekend we knew the likely destination for the PL trophy would be the Etihad Stadium after Liverpool's incredible collapse, but during the course of the campaign the Premier League lead changed 25 times. To put that into context, last season it only changed four times. 25 is the highest figure since a PL-record of 29 in 2001-02, plus it was just the seventh time in 22 seasons that the PL crown had been decided on the final day.
All of that, coupled with the rise of Liverpool, Arsenal and Everton, coupled with demise of perennial powerhouse Manchester United, made the battle at the top the most intriguing I have ever seen. Here are some stats, courtesy of our mates at Opta, on why it was the most incredible campaign in PL history:
- This is the first Premier League season to feature two teams scoring over 100 goals (Man City on 102, Liverpool on 101). Chelsea (103) in 2009/10 are the only other Premier League team to score 100 in a single season.
- Sunderland have become only the second PL team to be bottom at Christmas and avoid relegation, after WBA in 2004-05. They secured survival with a win over West Brom.
- Manchester United finished outside the top six in the top-flight for the first time since 1989-90 (13th).
- Jose Mourinho lost his first home league game as Chelsea manager, in his 78th PL match at Stamford Bridge (1-2 v Sunderland in April).
- Asmir Begovic became the fifth goalkeeper to score in Premier League history. The Stoke goalkeeper was also one of three players to score after 13 seconds this season (also Jesus Navas and Jay Rodriguez).
- 2013/14 is the first season in Premier League history to see 10 managers leave a club before the final day.
Premier League Schedule - Week 38
|Recap & Highlights
|Cardiff City 1-2 Chelsea
|Recap and watch here
|Fulham 2-2 Crystal Palace
|Recap and watch here
|Hull City 0-2 Everton
|Recap and watch here
|Liverpool 2-1 Newcastle
|Recap and watch here
|Man City 2-0 West Ham
|Recap and watch here
|Norwich City 0-2 Arsenal
|Recap and watch here
|Southampton 1-1 Man United
|Recap and watch here
|Sunderland 1-3 Swansea
|Recap and watch here
|Tottenham 3-0 Aston Villa
|Recap and watch here
|West Brom 1-2 Stoke City
|Recap and watch here
RISE OF SILKY SOCCER - Liverpool, Everton, Saints, Man City
Liverpool, Everton, Manchester City, Southampton... all of those teams have injected a new lease of life into the PL this season, as their flamboyant passing, high-pressing style and clever endeavor has enabled them all to surpass their goals at the start of the season.
MORE: Final Premier League Standings
Okay, City perhaps had the title in their mind, but apart from them Saints had their best-ever finish of eighth place, Everton finished fifth with a record points tally and Liverpool came so close to winning the damn thing but came up just short in second. They all did this with a possession based style which wore down the opposition and put them under relentless pressure from the first whistle. The pleasing thing for English soccer is that Liverpool, Everton and Southampton achieved their success by using young English players and provided a template that can be replicated by other PL teams willing to invest in youth and chuck them in at the deep end.
The PL has always been known as direct, fast-paced and rambunctious but this season we saw more depth to the play of teams, more thought, more intellect. The league's core product of athletic prowess and breathtaking counter-attacks still remains but intertwined into those powerful teams is an enhances soccer IQ. We've seen that this season and it will only get more widespread. That's something to look forward to.
City were deserved champions for the second time in three years as Manuel Pellegrini (known as 'the Engineer') added a solid foundation to City's swashbuckling soccer. As they showed on the final day of the season, they were ruthlessly efficient and peaked at the right time. Below is a video which tells the story of their season, as City scored 102 goals (one shy of the record) and had the second best defense in the league. Quite simply, they were the most balanced side and over the course of the campaign the deserved to lift the crown.
It has been a mixed bag for the U.S. players in the PL, as the likes of Geoff Cameron and Tim Howard have excelled with Stoke and Everton respectively, while Jozy Altidore and Brad Guzan had a season of struggle against the dreaded drop.
Heading into the World Cup in Brazil this summer, the U.S. national players plying their trade in the PL were under intense scrutiny from fans back home who watched their every move intently and prayed for their full fitness. Cameron has been the big success story as he's become one of the most consistent right backs in the league and is truly Mr. Dependable. His Stoke side finished in ninth, their highest-ever position, while Howard led Everton to their highest-ever points tally and a fifth place finish.
As you can see in this photo, Cameron is loving life in the PL and from the end of season stats pack he ranked ninth in the PL in total tackles made with 108. As for Howard, he has kept the second highest number of clean sheets in the league (15) and has made the fifth most saves (111).
We all know about Altidore's struggles in front of goal but you have to say that playing for Sunderland for most of the season meant his chances to score were extremely limited. That said, 1 league goal in 31 league appearances tells its own story. Guzan has battled on all season as Villa just beat the drop once again, with the former MLSer ranking seventh in saves made (110) and his impressive distribution helping to set up plenty of goals.
All in all, a decent season for the four USMNT stars who played regularly in the PL. Other such as Brek Shea and Cody Cropper failed to make an impact, while Maurice Adu moved back to MLS.
Read more here on how the U.S. quarter marked out of 10, here.
After 382 matches, it is hard to pick out a few... but I have given it a go complete with a link to the recaps so you can watch the highlights in amazement. You're welcome.
- RECAP: Everton 3-3 Liverpool, November 23, 2013 - A pulsating match at Goodison Park saw a fantastic Merseyside derby ebb and flow. The Toffees looked to have snatched a famous win following a rousing comeback but Daniel Sturridge popped up late on to seal a draw. What. A. Game.
- RECAP: Liverpool 3-2 Manchester City, April 20, 2014 - Liverpool raced into a 2-0 lead at Anfield in what was dubbed as the title-decider and the Kop was in dreamland. Then a David Silva inspired City came roaring back to make it 2-2 in the second half but a late Philippe Coutinho goal gave Liverpool the win as Anfield erupted.
- RECAP: Manchester City 4-1 Manchester United, September 22, 2013 - Sergio Aguero, Samir Nasri and Jesus Navas tore United apart at the Etihad as City embarrassed their neighbors. It was derby day delight for the home team and they really could have scored double figures. This win was symbolic of United's shambolic season to come.
- RECAP: Crystal Palace 3-3 Liverpool, May 5 2014 - Liverpool needed to win and win big against Palace to keep the pressure on Man City going into the final weekend. Brendan Rodgers' men were leading 3-0 with 11 minutes to go... then imploded as they went all-out attack to try and chip away at City's superior goal difference. Palace's comeback at a raucous Selhurst Park was something else.
- RECAP: Manchester City 6-3 Arsenal, December 14, 2013 - At the time this was a top of the table clash as Arsenal's superb early season form carried into the festive period. However their trip to the Etihad would bring them back to earth with a bump. It wasn't as if the Gunners played too badly, City were sensational in front of goal and so clinical. Even late on Arsenal hit the woodwork and had goals wrongly disallowed as this match really could have ended up 8-8. A terrific advert for the PL.
The demise of United came courtesy of David Moyes' mismanagement, poor transfer policies, a change at the top which saw Ed Woodward take over from long-term Chief Executive David Gil and, most importantly, an aging squad that was past it.
Moyes was given his marching orders four games before the end of the season and he simply didn't fit in at United. The players didn't work for him, his tactics didn't please the fans and the man Sir Alex Ferguson chose to succeed him lasted less than 10 months at the helm. The superb video above takes you on Moyes' ill-fated journey as he was doomed from the start at Old Trafford. Ryan Giggs came in to try and steady the ship but the new man in charge from next season is rumored to be Louis van Gaal.
Regardless, United's title defense was pathetic as they finished outside the top four for the first-time in PL history and failed to qualify for a European competition for the first time since 1990. It was a record-breaking season at Old Trafford... but none were of the good kind.
This season in the Premier League a record number of managers were dismissed during the campaign. The price of success at the top has made soccer a cut-throat industry, we saw that this season more than ever. The stat below (which we used earlier, as it is so fitting) from our friends at Opta says it all.
- 2013/14 is the first season in Premier League history to see 10 managers leave a club before the final day.
Why were owners so ruthless this season? Money. It's always about money with them, isn't it?
That, sadly, is the way it should be in the modern PL and that is why so many clubs chopped and changed their managers to try and avoid relegation. I wrote about this during the season, but the pitfalls of dropping down to the second-tier of English soccer don't bear thinking about. Norwich City, Cardiff City and Fulham all changed their gaffers to try and alter their downward trajectory. It almost worked for all three but ultimately stability, not quick fix solutions, paid dividends in the PL. Crystal Palace replaced Ian Holloway with Tony Pulis and that worked wonders, West Brom's decision to sack Steve Clarke and bring in Pepe Mel worked to keep them up... but now he is gone. Elsewhere Sunderland where the only other team who got their managerial switch spot on as the eccentric Paolo Di Canio went out and Gus Poyet came in to guide his team to safety after stating he needed "a miracle." They got it.
Whatever way you look at it, the shelf life of a PL manager decreased significantly this season.
Let's finish the last Playback of the season in style with a montage of 10 wonderful goals. Below are the best strikes of the season as the incredibly quality on show week in, week out in the PL is there for all to see.
Premier League Playback takes an alternative look at all the weekend's action from the PL, it comes out every week.


text:
It's been a week of big decisions in our nation's capital. The Supreme Court's 5-4 verdict on Obamacare was the biggest story for politicians, pundits and the so-called mainstream media.
That the justices reaffirmed the constitutional authority of Congress to levy taxes — even when the tax is called a "mandate" — should not have surprised anyone. The second-place decision of the week was the unprecedented 255-67 vote in the U.S. House of Representatives to hold Attorney General Eric Holder in contempt of Congress for his unwillingness to respond to congressional subpoenas for information on the Obama administration's notorious "Fast and Furious" gunrunning scheme.
Both of those decisions will provide countless hours of debate, commentary and fuel for political fundraising over the next four months. Though neither matter will be completely resolved until after Americans go to the polls Nov. 6, at least the Supreme Court and the House of Representatives have proved that they can make decisions — and we know how they were made.
Though the Supremes always debate in private, their determination is explained in depth — and by reading their decision, we know the thinking of each member of the court. The House debate and vote on holding Holder in contempt was conducted in the open for all to see.
The American people now can weigh where they stand on those decisions and decide for themselves whether they agree and, in the case of Congress, whether they want to return or replace their representatives. But we still don't know how decisions are made at 1600 Pennsylvania Ave. — and it has been that way since the O-Team arrived in Washington, particularly on matters of national security.
This is, after all, the administration that came to office promising "transparency," a "responsible end to Bush's wars," to "shut down Gitmo" and to "try terrorists in civilian courts." Now, better than three years on, none of that has happened — other than the precipitous withdrawal of U.S. and NATO troops from Iraq.
Other than with a tidal wave of leaks — all designed to portray a dithering administration in disarray as bold and decisive — the White House never has explained the "what, why and how" for the decisions it has made (or has failed to make) on issues affecting our security.
Worse, the damage done by publicly disclosing highly classified national security information has put Americans at risk, jeopardized our ability to collect important intelligence and seriously damaged vital relationships with our allies. The Obama White House now says the leakers "must be held accountable." That's about as likely as the sun rising in the west tomorrow morning.
This week's domestic policy decisions on Capitol Hill obscure the sanguinary consequences of attention-deficit disorder at the White House. In his June 4, 2009, Cairo speech, Obama famously expressed his "commitment" to "governments that reflect the will of the people" and specified, "You must maintain your power through consent, not coercion; you must respect the rights of minorities and participate with a spirit of tolerance and compromise; you must place the interests of your people and the legitimate workings of the political process above your party."
Yet just two weeks later, when the ayatollahs ruling in Iran brutally crushed a popular challenge to a fraudulent presidential election, the O-Team decided to do nothing. Four months later, he was named a Nobel Prize winner.
Last year, as Arab Spring revolutions began sweeping dictators from power in Tunisia, Egypt and Libya, the White House announced a new doctrine: the "responsibility to protect" innocent civilians from despots — and let the United Nations and NATO "take the lead."
Now, for the Syrian people caught in the crossfire of a civil war, the lack of American leadership is nothing short of catastrophic. Human rights groups estimate that the 15-month rebellion against the Assad regime in Damascus has cost more than 14,000 lives and at least 25,000 wounded — most of them innocent civilians.
On June 28, as the White House focused on Supreme Court and congressional decisions in Washington, Turkish troops were moving into position along their border with Syria. In Ankara, Prime Minister Recep Tayyip Erdogan said that his army regards Syrian military units approaching Turkey as a threat.
At the same time, Russian President Vladimir Putin has dispatched more naval infantry to protect the Russian naval base at Tartus — and presumably the underground joint Syrian-Russian command center in Damascus. The Obama administration, distracted by events in Washington, issued a response from Secretary of State Hillary Clinton in Helsinki, Finland: "We have great hope" that a meeting this weekend in Geneva hosted by U.N. special emissary Kofi Annan will be "a critical turning point."
The operative word is "hope." Hope is not a course of action. A course of action necessitates making decisions. Decisions require paying attention to what's happening. That's just one more reason we need to hire a commander in chief with an attention span greater than that of a fruit fly.


text:
Clemson Hangs On To Beat Georgia Tech, 56-53
ATLANTA (AP) — K.J. McDaniels scored 14 points and Milton Jennings blocked a potentially tying 3-pointer at the buzzer, preserving Clemson's 56-53 victory over Georgia Tech on Thursday night. The Tigers (13-11, 5-7 Atlantic Coast Conference) extended their domination of the Yellow Jackets (13-10, 3-8), sweeping the season series and winning their seventh in a row overall. Georgia Tech rallied from a 12-point deficit in the second half and had a couple of chances to force overtime. Chris Bolden missed badly on a drive with about 10 seconds to go, but the Yellow Jackets got another chance after Jennings made only 1 of 2 free throws. Mfon Udofia took off down the court, looking to get off a 3, and he appeared to have an open look when Daniel Miller delivered a pick to free up his teammate. But Jennings came up from behind to strip it away, and the Tigers celebrated. Marcus Georges-Hunt led Georgia Tech with 11 points. The Yellow Jackets nearly pulled out an improbable win after shooting just 17 percent from the field in the first half. Clemson appeared to be firmly in control when Damarcus Harrison made an open 3 with 7:51 left, pushing the Tigers to their biggest lead of the night, 47-35. But Georgia Tech ripped off a 12-4 run to make a game of it. Miller helped finish off the spurt when he blocked Devin Booker from behind on what appeared to be a clear drive to the basket, and the Yellow Jackets took off the other way. Bolden missed on a drive, but Robert Carter Jr. tipped it in to cut Clemson's lead to 51-47 with 3:27 left, forcing the Tigers to take a timeout. The home team couldn't complete the comeback. With just over a minute to go and the shot clock running down, McDaniels drove into the lane and tried to pass to a teammate under the basket. The Yellow Jackets got a hand on it, but the ball went right back to McDaniels. He flipped up a quick shot, just ahead of the 35-second buzzer, to give Clemson a 55-50 lead with 1:02 remaining. The Yellow Jackets didn't think McDaniels should've even been in position to make the fortuitous basket. Rod Hall threw the ball out of bounds after bumping with Carter, but the officials ruled that the Georgia Tech player deflected it. He protested vehemently, but Clemson kept possession — and took advantage of it. The teams slogged through a first half of brutal offensive basketball, filled with airballs, blocked shots (Clemson had six), clunkers from close range, and open 3-pointers that wouldn't fall. Georgia Tech went nearly 8 minutes without making a field goal, made just 5 of 29 from the field — and still trailed only 20-15 at the break. That's because Clemson wasn't much better. The Tigers hit only 8 of 29 (28 percent), failing to pull away even when the Yellow Jackets couldn't make a thing. In the end, the last of nine blocks by Clemson preserved the win, adding to a 63-60 triumph over the Yellow Jackets last month. Copyright by STATS LLC and The Associated Press


text:
- 1 cup sugar
- 1 cup water
- sprig of mint
- 1 cup fresh lime juice or a bit more if your like me and you want it extra tart
- 2 cups ice
- 2 cups water
- lime slices and mint leaves for garnish
Monday, March 12, 2012
14 comments:
Hehe looks lovely.ReplyDelete
Also when juicing any citrus fruit instead of having to put it in your mouth you can put the prongs of a fork into the open side and wiggle them about whilst squeezing the fruit with the other hand. Works a treat...
mmmmmmmmmm! thanks for sharing! that looks wonderful!ReplyDelete
drop by allister bee soon!
consider it pinned, girl. can't wait to make it!ReplyDelete
love, rach.
Ooooh, that is on the list for this weekend. I love love love your colors!!ReplyDelete
Wow!! I want to drink it!!That baby looks so sweet!! :)ReplyDelete
Oooo this looks D-LISH!ReplyDelete
Mmm....My mouth is watering!!!ReplyDelete
Your baby girl has your same beautiful eyes!!
Haha the gif is hilarious! What a cutie. The perfect Spring/St Pattys day drink =)ReplyDelete
- Sarah
So refreshing! Love lime and mint!ReplyDelete
what a simply recipe...love the juicing between the teeth tip!ReplyDelete
aarean your blog never ceases to amaze me!! love it!ReplyDelete
Yum! I just need to pop down to the store to get some mint and lime before I can try this!ReplyDelete
Et tu, tutu?


text:
This beautiful quilt was designed by Amish-Mennonite woman Ann Lapp and hand quilted by Mrs. Mose Miller using 355 yards of thread. The dimensions are 98×111 so you would have a 19 inch drop on either side of your queen bed. Plus our quilts are made long enough so you can have a pillow tuck at the top and won't need shams!
There are no reviews yet.
Only logged in customers who have purchased this product may leave a review.


text:
Microsoft has launched a campaign in the U.S. that targets Google's alleged practice of going through the contents of all Gmail messages to sell and target advertisements, raising again an old issue the Redmond, Washington, software giant has with the free email service.
The company late Wednesday cited a study which showed that 70 percent of consumers don't know that major email providers routinely engage in the practice of reading through their personal email to sell ads.
[Tools for the paranoid: 5 free security tools to protect your data and What Google's Transparency Report doesn't tell us]
88 percent of people disapprove of the practice once they are informed, according to a GfK Roper study commissioned by Microsoft.
Unlike Gmail, Microsoft's Outlook.com doesn't go through the content of users' emails to show ads, it said.
The "Don't Get Scroogled by Gmail" campaign on Microsoft's Scroogled.com promotes Outlook.com as an alternative to Gmail. Microsoft previewed Outlook.com in July and said it would eventually replace its Hotmail email service.
Advertising keeps Google and many of the websites and services the company offers free of charge, Google said in an emailed statement on Wednesday. "No humans read your email or Google Account information in order to show you advertisements or related information. An automated algorithm -- similar to that used for features like Priority Inbox or spam filtering -- determines which ads are shown," it added.
Outlook.com is also calling on consumers to join a petition drive on Scroogled.com to tell Google to stop going through their users' email to sell ads, Microsoft said.
Microsoft sponsored Don't Get Scroogled activities will appear online and offline, demonstrating why consumers should be concerned, and helping them take action, Microsoft said. "This campaign is as much about protecting Outlook.com users from Gmail as it is about making sure Gmail users know what Google's doing," said Stefan Weitz, senior director of online services at Microsoft, in a statement.
The company has been critical of a settlement in January between the U.S. Federal Trade Commission and Google over the search giant's business practices and access to its standards-essential patents, calling it a "missed opportunity."
John Ribeiro covers outsourcing and general technology breaking news from India for The IDG News Service. Follow John on Twitter at @Johnribeiro. John's e-mail address is firstname.lastname@example.com


text:
No need to search the world over for your other puppy half. Doggelgänger uses facial recognition software to pair you up with the puppy that already shares your handsome features!
The website, which was created in New Zealand, is pretty self explanatory. Upload a picture of yourself, and find out what you look like in dog form:
Pedigree's New Zealand branch hired design agency Colenso BBDO to come up with a new way to get the word out on pup adoptions. Using the idea that dog owners tend to look like their pets, Colenso teamed up with NEC to develop Doggelgänger, "Human to canine pairing software, designed to connect real homeless dogs to their human doubles.
Here's another good match. Naturally, I was matched up with Terminator Dog, because I am part robot.
[via Pawesome]


text:
49°12' / 21°39'
Translation of Seyfer Zichron Stropkov
Written by: Avraham Avish Weinstein
Published in Brooklyn, N Y, 1968
Project Coordinator
Melody Amsel-Arieli
Moshe Pernick
Note: The original book can be seen online at the NY Public Library site: Stropkov (1968a)
JewishGen, Inc. makes no representations regarding the accuracy of
the translation. The reader may wish to refer to the original material
for verification.
JewishGen is not responsible for inaccuracies or omissions in the original work and cannot rewrite or edit the text to correct inaccuracies and/or omissions.
Our mission is to produce a translation of the original work and we cannot verify the accuracy of statements or alter facts cited.
|The History of Stropkov
|Expulsion From Stropkov
|The Rabbis of Stropkov
|The Reb Wolf, of Sainted Memory
|The Dayan Rabbi Mordechai Yitschak Samet
|Stropkov -- A Cosmopolitan City
|Every House in Stropkov a Guest House
|Harav Rabbi Yitschak Hersh Amsel
|A Miricle by the Rabbi of Stropkov, Rabbi Sholom of Sacred Memory
|The Lay Leadership of Stropkov
|The Chevra Shas - (Talmud Study Group)
|The Teachers of Stropkov
|The Shamosim (Sextons) of Stropkov
|The Various Societies
|The Worshippers of the Synagogue
|The Craftsmen A baal Melacha (Including various trades)
|A Fire in Stropkov
|An Interesting Episode
|The Honest People of the Past
|Sh'mini Atseres (last day of Sukkos) with Rabbi Yitschak Hersh Amsel of Blessed Memory
|The Yahrtzeit dates of the Rabbis of Stropkov
Yizkor Book Project JewishGen Home Page Stropkov, at Kehilalinks
Copyright © 1999-2023 by JewishGen, Inc.
Updated 26 Jun 2020 by OR


text:
A "Commemorative" Bill of Rights
Lesson At A Glance
The students will understand the revolutionary and evolutionary aspect of the creation of the United States, through writing about and artistically interpreting the rights and freedoms granted in the Bill of Rights, and how they affect people's lives to the current day.
See how this lesson fits into the context of a full unit, and prior knowledge students should have before doing this lesson.
- Students will have a deeper understanding of what rights and freedoms the people in our country are given, of the limits of governmental power, and why our government is often described as "We, the People".
- Students will have a deeper understanding that the Constitution is timeless, yet also a "living document".
Standards Addressed: History Social Science
5.7.3 Understand the fundamental principles of American Constitutional democracy, including how the government derives its power from the people and the primacy of individual liberty
5.7.5 Discuss the meaning of the American creed that calls on citizens to safeguard the liberty of individual Americans within a unified nation, to respect the rule of law, and to preserve the Constitution
Standards Addressed: Language Arts
2.2 Analyze text that is organized in sequential and chronological order
2.4 Make inferences, conclusions, or generalizations about text and support them with textual evidence and prior knowledge
2.2 Write responses to literature; demonstrate understanding of a literary work; support judgments through references to the text and to prior knowledge; develop interpretations that exhibit careful reading and understanding
Visual Arts: Artistic Expression
2.7 Communicate opinions, values or personal insights through an original work of art
Common Core State Standards for ENGLISH LANGUAGE ARTS & Literacy in History/Social Studies, Science, and Technical Subjects K-5
College and Career Readiness Anchor Standards for Reading K-5
Key Ideas and Details
1. Read closely to determine what the text says explicitly and to make logical inferences from it; cite specific textual evidence when writing or speaking to support conclusions drawn from the text.
2. Determine central ideas or themes of a text and analyze their development; summarize the key supporting details and ideas.
Craft and Structure
3. Interpret words and phrases as they are used in a text, including determining technical, connotative, and figurative meanings, and analyze how specific word choices shape meaning or tone.
Integration of Knowledge and Ideas
7. Integrate and evaluate content presented in diverse media and formats, including visually and quantitatively, as well as in words.*
Range of Reading and Level of Text Complexity
10. Read and comprehend complex literary and informational texts independently and proficiently.
Big Ideas:
1. The United States Constitution is the foundation of the American democratic republic, and at its inception, distinguished the United States from the rest of the world.
2. The Constitution is timeless, durable, and binding to all Americans.
3. The Constitution is a living document.
Essential Questions/Issues/Higher Order Thinking Questions:
1. Why are the rights given to us in the Bill of Rights important for maintaining a democratic republic? (Analysis, Evaluation)
2. How would our country be today if we didn't have free speech, religious freedom, freedom of the press, the right to a lawyer and a jury trial, the right against unreasonable searches and seizures (without a warrant), the right to have fair punishment if convicted of a crime, etc.? (Analysis, Eval.)
3. How would our country be today if our government was a monarchy (ruled by kings and queens), instead of a democratic republic? (Analysis, Eval.)
4. What rights do we have in school and at home? What responsibilities do we have at school and at home? Can a person have rights without responsibilities? Why or why not? (Analysis, Synthesis, Evaluation)
5. What would a "Bill of Rights" for a school be like? (Synthesis, Evaluation)
6. Is freedom "free", or is it very costly? Explain. (Analysis, Evaluation)
7. Why did the Constitution need additional amendments, such as for the abolition of slavery, and women's right to vote? (Analysis, Evaluation)
8. If you were chosen to add a new amendment to the Constitution, what would you write? Why? (Synthesis, Evaluation)
9. How would Anne Frank's life have been different, had her family escaped to the United States, instead of living in German-occupied Holland during World War Two? (Analysis, Eval.)
Students will be evaluated through teacher observation and during class discussions, informal checking for understanding, writing assignments, quality of artwork (understanding of ideas and creativity), and formal assessments.
Click here to download assessment tools
Activity Steps:
Students will read, discuss, and write their interpretation of one of the various amendments in the Bill of Rights in a three paragraph essay.
Students will design an original work of art--a commemorative stamp-- representing a key right or freedom granted in the Bill of Rights, and describe in writing how their stamp represents or symbolizes that right or freedom.
Based on the book "Number the Stars" by Lois Lawry (set during WWII) students will write a persuasive letter to Ellen Rosen, trying to convince her why her family should move to the United States from German-occupied Denmark. The letter should specify why they would have more freedom (specific to their chosen freedom) in the U.S under our Constitution than under the Germans, and how their lives might be different.
These series of classroom lessons and activities focus on fifth grade standards in History/Social Science. The students will analyze and interpret historical primary documents, namely the Constitution's Bill of Rights. Students will understand the Founders' intent on securing individual liberties and limiting governmental power. Students will be able to compare and contrast the monarchies of Europe (chiefly, England) of the 1770's and modern dictatorships with the democratic republic of the United States.
Prior Knowledge/Prior Lessons
Students have studied the Declaration of Independence and the Preamble to the Constitution. Students read "Can't You Make Them Behave, King George?" by Jean Fritz. They wrote a Class Constitution at the beginning of the school year, wrote a class Preamble, and performed the song "We the People".
Class Preamble (Rewritten by students):
"We the Students of Room 61, in order to form a more perfect classroom, establish fairness, ensure educational tranquility, provide for everyone's safety, promote the general harmony, and secure the blessings of learning, to ourselves and our future, do ordain and establish this Constitution for the United Students of Room 61."
With the help of thinking maps (Double Bubbles), students compared and contrasted undemocratic societies (from stories they read ie. "Number the Stars") with the United States. The reasons for the Revolutionary War were also discussed in class. The concepts of "democracy" and "dictatorship" were discussed. Students understand the Founding Fathers' intents on distinguishing the American democratic system from the British monarchy circa late 1700's.


text:
National Geographic Simply Beautiful Photographs by Annie Griffiths
National Geographic Simply Beautiful Photographs by Annie Griffiths
Now in mini format: National Geographic Simply Beautiful Photographs takes readers on a spectacular visual journey through some of the most stunning photographs to be found in National Geographic's famed Image Collection. Award-winning photographer Annie Griffiths culled the images to reflect the many variations on the universal theme of beauty. Chapters are organized around the aesthetic concepts that create beauty in a photograph: Light, Composition, Moment (Gesture and Emotion), Motion, Palette, and Wonder.
Beyond the introduction and brief essays about each featured concept, the text is light. The photographs speak for themselves, enhanced by lyrical quotes from scholars and poets. In the chapter on Light, for example, we read these words of whimsical wisdom from songwriter Leonard Cohen: "Ring the bells that still can ring. Forget your perfect offering. There is a crack in everything. That's how the lights get in." And then the images flow, of light entering scenes through windows, clouds, and spotlights, from above, alongside, and behind, casting radiance upon young ballerinas and weathered men, into groves of autumn trees and island-dotted seas, revealing everything it touches to be beautiful beyond expectation.
To illuminate the theme of Wonder, Griffiths chose a wish from Andre Bazin: "If I had influence with the good fairy...I should ask that her gift to each child in the world be a sense of wonder so indestructible that it would last throughout life." This thought is juxtaposed with an exquisite vision in white, a frame filled with the snowy-pure dots and rays of a bird's fan tail. And on it goes, picture after tantalizing picture, alive with wondrous beauty.
When she created National Geographic Simply Beautiful Photographs, Annie Griffiths set two goals: to maximize visual delight, and to create a book unique in the world of publishing—one in which many of the photographs could be purchased as prints. She has succeeded on both counts. Many of these stunning images are available for order, and there can be no doubt as to the visual delight. You must open this book for yourself, and take in its radiant beauty.
Share the details of your shipping policy.
Share the details of your return policy.
Image with text
Pair text with an image
Pair text with an image to focus on your chosen product, collection, or artist. Add details on availability, style, or even provide a review.
Image with text
Pair text with an image to provide extra information about your brand or collections.


text:
Afghan Survivors of Errant US Drone Strike Seek Probe
KABUL, Afghanistan (AP) -- A survivor of an errant U.S. drone strike that killed 10 members of his family demanded Saturday that those responsible be punished and said Washington's apology was not enough.
The family also seeks financial compensation and relocation to the United States or another country deemed safe, said Emal Ahmadi, whose 3-year-old daughter Malika was among those killed in the Aug. 29 strike.
On that day, a U.S. hellfire missile struck the car that Ahmadi's brother Zemerai had just pulled into the driveway of the Ahmadi family compound as children ran to greet him. In all, 10 members of the family, including seven children, were killed in the strike.
On Friday, U.S. Marine Gen. Frank McKenzie, head of U.S. Central Command, called the strike a "tragic mistake" and said that innocent civilians were indeed killed in the attack.
The U.S. military initially defended the strike, saying it had targeted an Islamic State group's "facilitator" and disrupted the militants' ability to carry out attacks during the chaotic final stage of the withdrawal of U.S. and NATO troops from Afghanistan late last month.
Discrepancies between the military's portrayal of the strike and findings on the ground quickly emerged. The Associated Press and other news organizations reported that the driver of the targeted vehicle was a longtime employee at a U.S. humanitarian organization. There were no signs of a large secondary blast, despite the Pentagon's assertion that the vehicle contained explosives.
The drone strike followed a devastating suicide bombing by IS -- a rival of the Taliban -- that killed 169 Afghans and 13 U.S. military personnel at one of the gates to the Kabul airport in late August. At that time, large numbers of Afghans, desperate to flee the Taliban, had crowded the airport gates in hopes of getting on to evacuation flights.
McKenzie apologized for the error and said the United States is considering making reparation payments to the family of the victims.
Emal Ahmadi told the AP on Saturday that he wants the U.S. to investigate who fired the drone and punish those responsible.
"That is not enough for us to say sorry," said Ahmadi who heard of the U.S. apology from friends in America. "The U.S.A. should find the person who did this."
Ahmadi said he was relieved that an apology was offered and the family members he lost were recognized as innocent victims, but that this won't bring them back. He said that he was frustrated that the family never received a call from U.S. officials, despite repeated requests.
He looked exhausted as he sat in front of the charred ruins of his brother's car.
In the days before the Pentagon's apology, accounts from the family, documents from colleagues seen by the AP and the scene at the family home -- where Zemerai's car was struck by the missile -- all sharply contradicted the accounts by the U.S. military.
Instead, they painted the picture of a family that had worked for Americans and were trying to gain visas to the U.S., fearing for their lives under the Taliban.
Zemerai Ahmadi was the family's breadwinner and had looked after his three brothers, including Emal, and their children.
"Now I am then one who is responsible for all my family and I am jobless," said Emal Ahmadi. The situation "is not good," said Ahmadi of life under the Taliban.
International aid groups and the United Nations have warned of a looming humanitarian crisis that could drive most Afghans below the poverty level.
McKenzie said the decision to strike a white Toyota Corolla sedan, after having tracked it for about eight hours, was made in an "earnest belief" -- based on a standard of "reasonable certainty" -- that it posed an imminent threat to American forces at the Kabul airport. The car was believed to have been carrying explosives in its trunk, he said.
But Ahmadi wondered how the family's home could have been mistaken for an Islamic State hideout.
"The U.S.A. can see from everywhere," he said of U.S. drone capabilities. "They can see that there were innocent children near the car and in the car. Whoever did this should be punished."
"It isn't right," he added.


text:
Josie Duckett, special to wtop.com
BETHESDA, Md. – Step inside the doors at Washington Waldorf School and you'll find woodwork, cross-stitch and sculpture classes — but you won't find web design, graphics or film classes. As schools race to the top, innovation here looks basic, artsy and unplugged.
With 120 Waldorf schools in North America and 1,000 Waldorf schools across 60 countries, the self-proclaimed "fastest growing education movement" keeps attracting students despite the digital revolution in American culture and classrooms.
Waldorf's approach caters to paying attention to learning, instincts and the world — tough skills to teach in the distracted era of texting, friending and tweeting. The classes are small — with only 264 students in the entire school — and teachers use hands-on learning in lieu of computing.
Washington Waldorf Faculty Chair Natalie Adams says the seminar teaching format with frequent adult interaction benefits students.
"They're comfortable in their own skin — in real interactions with people as opposed to what you see with teenagers today interacting with the device versus each other, which is sad," Adams says.
Two November reports by the Pew Research Center and non-profit Common Sense Media found teachers overwhelmingly believe digital technology is curtailing attention spans and critical thinking skills.
In the Pew survey, 87 percent of 2,000 middle and high school teachers said the Internet and digital technology have caused an "easily distracted generation with short attention spans." Common Sense Media researchers found that 71 percent of 685 K-12 teachers surveyed say the media – including TV shows, music, video games and the Internet — interferes with attention span, followed by concerns for writing skills, homework preparation and face-to-face communication skills.
Jack Petrash, a Waldorf teacher of 40 years and author of "Understanding Waldorf Education: Teaching from the Inside Out," says he believes the absence of technology in classrooms encourages students to pay attention.
"It's not that a Waldorf school doesn't believe in technology – (kids) will be in a technology society — but with the younger children, we deemphasize technology because we want their whole participation," Petrash says.
Gordiya Khademian, 17, switched from a large class at Bethesda-Chevy Chase High School to a graduating class of eight at Waldorf.
"It's free of distraction. It's a good place for learning. I felt that way the moment I walked into the school," Khademian says.
She adds that she likes the smaller classes and problem solving.
"Instead of telling us this is how you do something, they let us figure it out," she says. "It may take a little longer, but it ensures we know what's going on."
Washington Waldorf costs $20,750 a year for elementary school students, $22,000 for middle school students and $23,200 for high school students.
At Waldorf, students don't take any standardized state tests, so the best measure of their learning is college placement and SAT scores. Adams says the average SAT score at Washington Waldorf for 2012 was 1,926 on a scale of 2,400. In comparison, the national SAT average was 1,500, according to the Princeton Review.
In addition to good testing scores, the school has a high matriculation rate. The Research Institute for Waldorf Education found that 94 percent of Waldorf graduates attended college and 88 percent completed college from 1943 to 2005. While the numbers look good on paper, critics say students may be at a disadvantage when they encounter technologies after leaving Waldorf.
Natalie Milman, director of the Education Technology Leadership Program at George Washington University, says she thinks students could benefit from integrating more electronics in their curriculum, especially in a world saturated with technology.
"It is everywhere you go. The grocery store, you text payment for parking — it's everywhere," she says. "The reality is that we are immersed in a technology culture."
But being free of devices during the school day, students including Khademian say they feel focused at Waldorf.
"You have every opportunity to learn what you want," she says. "There is nothing stopping you."
Follow @WTOP on Twitter.
(Copyright 2013 by WTOP. All Rights Reserved.)


text:
Free blueprints
Get a
Custom Spring
Quote Instantly!
Southern Shenzhen Spring Manufacturer
China Spring Products Corp has been a leading manufacturer of quality coil springs for over 25 years. We are known as trusted spring manufacturers for several industries including automotive, goverment, electronic, medical, construction, general engineering, etc.
At China Spring Products Corp we strive to have the best quality in both products and service which is why, we attend every one of your projects in a specialized manner to give you the best attention and resolve any issue you may have. Whether it is help on achieving a successful spring design or finding a stock spring, our engineering and sales team will be at your disposal.
Innovating the spring industry. You will find several tools that'll help you both design your springs effectively and acquire them quickly. These are Spring Creator which is the fastest, most user-friendly spring calculator on the web, our Custom Spring Instant Quote where you can generate instant quotes for custom springs, and our Search Stock Spring which searches for stock springs amongst our vast stock spring catalogs.
"China Spring Products Corp has been amazing from the beginning to the end! Alfonso and Ashley helped us throughout the process and we now are shipping our products daily because of the help we received from you. Thanks and we look forward to ordering many more springs from you in the very near future!"
The I.S. Team
"Ashley, I wanted to thank you for jumping on our order and getting springs out to our company so quickly. We definitely have a need that is urgent and deadlines for project completion, and you are helping us achieve those deadlines. Kudos to you and your team, we really appreciate it! All The Best"
John S., R&D Director
"China Spring Products Corp is great at providing engineering solutions when we develop new products. China Spring Products Corp meets their delivery deadlines and is honest about lead times. We are never left expecting product they cannot deliver. Great staff, easy and friendly to work with."
Matt M., RDL, CA
"Wanted to let you know that I finally had a chance to look at your spring order I received about 10 days ago and wanted to thank you for producing pieces exactly as designed, they look and work perfectly. I will be ordering again soon. Thank you."
Blue H.A. Co.
"My experiences at China Spring Products Corp have been great. I've been working with Ashley she has been of great help. I always get my email responses right back. I'm happy with the services at China Spring Products Corp."


text:
NOTE: This form should not be used to make a claim for an administrative expense arising after the commencement of the case. A "request" for payment of an administrative expense may be filed pursuant to 11 U.S.C. § 503.
Recent security enhancements require Internet Explorer 8 or the latest Chrome/Firefox web browser
Installed Version: 7.2


text: PVA filament is used as support material for PLA as it bonds well with PLA and is water soluble. It prints at 200 degrees and is translucent-brownish. For printing it behaves rather like PLA actually. If you put it in warm water for a while the material will slowly dissolve leaving you with only PLA. The material is rather expensive though, making it only applied in situations where you cannot go without support.


text:
The aim of this study was to evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening and diagnosis of postpartum depression. Three months after delivery, EPDS was administered to 378 mothers from the 2004 Pelotas Birth Cohort Study, Rio Grande do Sul State, Brazil. Up to 15 days later, mothers were re-interviewed by mental health care professionals using a semi-structured interview based on ICD-10 (gold standard). We calculated the sensitivity and specificity of each cutoff point, and values were plotted as a receiver operator characteristic curve. The best cutoff point for screening postpartum depression was > 10, with 82.6% (75.3-89.9%) sensitivity and 65.4% (59.8-71.1%) specificity. For screening moderate and severe cases, the best cutoff point was > 11, with 83.8% (73.4-91.3%) sensitivity and 74.7% (69.4-79.5%) specificity. For diagnosis, EPDS was valid only for prevalence of postpartum depression in the 20-25% range, with 60% PPV for the > 13 cutoff point (59.5% sensitivity; 88.4% specificity). The specificities and PPVs for all cutoff points were below those reported by other authors. Small numbers and the calculation of PPV in samples with overrepresentation of cases in the majority of studies appear to account for these differences.
Postpartum Depression; Validation Studies; Questionnaires
Avaliar a validade da Escala de Depressão Pós-natal de Edimburgo (EPDS) para rastreamento e diagnóstico de depressão pós-parto. Três meses pós-parto, a EPDS foi aplicada a 378 mães da Coorte de Nascimentos de Pelotas, Rio Grande do Sul, Brasil, em 2004. Até 15 dias após, as mães foram reentrevistadas por profissionais de saúde mental utilizando-se questionário semi-estruturado baseado na CID-10 (padrão-ouro). Calculamos sensibilidade e especificidade de cada ponto de corte e construiu-se curva ROC. Melhor ponto de corte para rastreamento foi > 10 (sensibilidade 82,6%, 75,3%-89,9%; especificidade 65,4%, 59,8%-71,1%). Para rastrear casos moderados e graves, melhor ponto de corte foi > 11, com sensibilidade 83,8% (73,4%-91,3%) e especificidade 74,7% (69,4%-79,5%). Para diagnóstico, a EDPS foi válida somente para prevalências em torno de 20%-25%, com valor preditivo positivo de 60% para o ponto de corte > 13 (sensibilidade 59,5%; especificidade 88,4%). As especificidades e valores preditivos positivos de todos os pontos de corte foram inferiores aos relatados na literatura. Possivelmente, o uso de amostras pequenas e o cálculo de valores preditivos positivos em amostras com super-representação de casos, sejam responsáveis por essas diferenças.
Depressão Pós-Parto; Estudos de Validação; Questionários
Validation of the Edinburgh Postnatal Depression Scale (EPDS) in a sample of mothers from the 2004 Pelotas Birth Cohort Study
Validação da Escala de Depressão Pós-natal de Edinburgo (EPDS) em uma amostra de mães da Coorte de Nascimento de Pelotas, 2004
Iná S. SantosI; Alicia MatijasevichI; Beatriz Franck TavaresI; Aluísio J. D. BarrosI; Iara Picinini BotelhoI; Catherine LapolliI; Pedro Vieira da Silva MagalhãesII; Ana Paula Pereira Neto BarbosaI; Fernando C. BarrosIII
IFaculdade de Medicina, Universidade Federal de Pelotas, Pelotas, Brasil
IIMestrado em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brasil
IIICentro Latinoamericano de Perinatología y Desarrollo Humano, Organización Panamericana de la Salud/Organización Mundial de la Salud, Montevideo, Uruguay
Correspondence Correspondence: A. Matijasevich Faculdade de Medicina Universidade Federal de Pelotas Av. Duque de Caxias 250 Pelotas, RS 96030-002, Brasil email@example.com
The aim of this study was to evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening and diagnosis of postpartum depression. Three months after delivery, EPDS was administered to 378 mothers from the 2004 Pelotas Birth Cohort Study, Rio Grande do Sul State, Brazil. Up to 15 days later, mothers were re-interviewed by mental health care professionals using a semi-structured interview based on ICD-10 (gold standard). We calculated the sensitivity and specificity of each cutoff point, and values were plotted as a receiver operator characteristic curve. The best cutoff point for screening postpartum depression was > 10, with 82.6% (75.3-89.9%) sensitivity and 65.4% (59.8-71.1%) specificity. For screening moderate and severe cases, the best cutoff point was > 11, with 83.8% (73.4-91.3%) sensitivity and 74.7% (69.4-79.5%) specificity. For diagnosis, EPDS was valid only for prevalence of postpartum depression in the 20-25% range, with 60% PPV for the > 13 cutoff point (59.5% sensitivity; 88.4% specificity). The specificities and PPVs for all cutoff points were below those reported by other authors. Small numbers and the calculation of PPV in samples with overrepresentation of cases in the majority of studies appear to account for these differences.
Postpartum Depression; Validation Studies; Questionnaires
Avaliar a validade da Escala de Depressão Pós-natal de Edimburgo (EPDS) para rastreamento e diagnóstico de depressão pós-parto. Três meses pós-parto, a EPDS foi aplicada a 378 mães da Coorte de Nascimentos de Pelotas, Rio Grande do Sul, Brasil, em 2004. Até 15 dias após, as mães foram reentrevistadas por profissionais de saúde mental utilizando-se questionário semi-estruturado baseado na CID-10 (padrão-ouro). Calculamos sensibilidade e especificidade de cada ponto de corte e construiu-se curva ROC. Melhor ponto de corte para rastreamento foi > 10 (sensibilidade 82,6%, 75,3%-89,9%; especificidade 65,4%, 59,8%-71,1%). Para rastrear casos moderados e graves, melhor ponto de corte foi > 11, com sensibilidade 83,8% (73,4%-91,3%) e especificidade 74,7% (69,4%-79,5%). Para diagnóstico, a EDPS foi válida somente para prevalências em torno de 20%-25%, com valor preditivo positivo de 60% para o ponto de corte > 13 (sensibilidade 59,5%; especificidade 88,4%). As especificidades e valores preditivos positivos de todos os pontos de corte foram inferiores aos relatados na literatura. Possivelmente, o uso de amostras pequenas e o cálculo de valores preditivos positivos em amostras com super-representação de casos, sejam responsáveis por essas diferenças.
Depressão Pós-Parto; Estudos de Validação; Questionários
Postpartum depression is one of the conditions that can affect childbearing women. Puerperal mothers are more vulnerable to symptoms of depression and to depressive episodes per se 1. In the phenomenological sense, postpartum depression is similar to depression during any other period of life. However, postpartum depression can be more serious, since depression in this period can have a negative effect on the health of both the mother and the newborn 2,3,4,5, affecting the mother-child bond, infant development, and even family organization 6,7 and the child's interpersonal relations. The onset of postpartum depression happens early, between the first week and first month after delivery. Postpartum depression can compromise breastfeeding and consequently the infant's health. In extreme cases postpartum depression can even lead to infanticide. In 50% of cases postpartum depression can persist throughout the first year after delivery and become recurrent 8,9.
According to previous studies, prevalence of postpartum depression from one month to one year after delivery in the United States and Canada ranges from 8% to 26%, 8,10,11,12,13,14 and depressive symptoms can affect up to 80% of women in the postnatal period 15.
Postpartum depression is a matter of increasing concern in several countries; investments in early detection are being made for the development of health policies for its clinical management. In 1987, Cox et al. 16 developed the Edinburgh Postnatal Depression Scale (EPDS) for the identification of postpartum depression, for use in clinical and research settings. EPDS is a self-administered, 10-item scale based on previously available scales (Irritability, Depression, and Anxiety Scale IDA; Hospital Anxiety and Depression Scale HAD; and Anxiety and Depression Scale) and on items devised by the authors themselves. The scale was initially compared to the Research Diagnostic Criteria (RDC). The use of EPDS is favored because of the ease and speed of its administration. This has led to its use by health care professionals in community studies, especially for the investigation of potential cases of depression. The clinical and epidemiological value of the scale have been confirmed by several validation studies carried out in different countries, with both sensitivity and specificity in the 70-85% range, depending on the cutoff point.
The present study aimed to evaluate the validity of EPDS for the diagnosis of postpartum depression three months after delivery in a sample of mothers from the 2004 Pelotas Birth Cohort Study.
A cross-sectional study was carried out during the three-month follow-up of a birth cohort in the city of Pelotas, southern Brazil, which included all births in that city in 2004 17. Briefly, the Pelotas 2004 birth cohort is a population-based study including all children born in the city's five hospitals. Newborns were examined and mothers interviewed during their stay in the hospital (perinatal study). At age three months, infants were visited at home for another examination. At this point mothers were re-interviewed and the EPDS questionnaire was administered.
In order to ensure the scale's adequacy, the ten questions were initially translated into Portuguese by one of the authors (I.S.S.). Questions were then back-translated into English by an English teacher born in the United Kingdom and living in the city of Pelotas. The instrument was administered as an interview to a small number of mothers of infants up to three months of (n = 50), who did not participate in the validation study. The original version of the test and the final version of the scale in Portuguese are presented in Table 1.
In contrast to the original, self-administered format, questions were posed to mothers by a trained interviewer, as a single block and in the same order as in the original instrument, within the cohort's regular three-month follow-up interview. The decision to pose the questions to mothers verbally was based on the fact that many mothers of newborns from the cohort had little schooling and were not familiar with self-administered data collection instruments. The administration of EPDS as an interview is accepted by the instrument's authors 16 and has been used previously 18.
The present validation study was designed to detect sensitivity and specificity > 80%, with a standard error of ±5, significant to the 5% level. The three-month follow-up did not include mothers whose infants died before three months. We interviewed mothers whose infants reached age three months between January 1 and March 31, 2005 (thus born from October 1 to December 31, 2004), who responded to the EPDS questionnaire at home or at the medical school, according to the cohort's three-month follow-up procedures. This sample, which included about one-fourth of all births, consisted of 886 mothers.
We used two sample selection strategies. First, all mothers scoring at least 9 points on the 30-point EPDS were included in the study. Based on the results of previous studies, we expected to find 10-15% of mothers with positive scores (about 100-150 mothers with EPDS > 9). Then, a systematic 20% sample of mothers scoring < 9 was obtained by recruiting every fifth mother. All mothers selected to participate in the validation study underwent a diagnostic interview (gold standard).
For the diagnostic interview, mothers were re-interviewed at home by a mental health professional (psychiatrist, psychologist, or psychiatry resident), previously trained for the administration of the semi-structured interview. The diagnostic interview aimed to detect current or recent (previous 15 days) depressive episodes. The gold standard interview was planned to be administered 15 days after EPDS at the latest and was based on ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) diagnostic criteria 19. According to the result of this interview, mothers were classified as "normal" or "positive", the latter including those with mild, moderate, or severe episodes of depression. Mental health professionals were blinded as to mothers' EPDS scores.
Data analysis
For each EPDS cutoff point, we calculated the sensitivity (proportion of depressed mothers according to ICD-10 criteria that were correctly identified by EPDS), specificity (proportion of non-depressed mothers correctly identified as such by EPDS), and accuracy (proportion of results correctly identified by the scale). 95% confidence intervals were determined for each of the measures. The EPDS point showing simultaneously the highest sensitivity and specificity was determined using a receiver operator characteristic (ROC) curve. Based on the sensitivity and specificity obtained for the EPDS at the cutoff points most commonly used internationally 20, the positive predictive value (proportion of true positives among all positives identified by EPDS) in simulations for populations with different postpartum depression prevalence rates was calculated.
In order to explore the performance of EPDS in a sample of high-risk mothers, a sub-sample of mothers was selected. These mothers answered positively when inquired, during the perinatal interview, about the presence of symptoms of depression, treated or untreated, or about feeling sad or depressed, always or most of the time, during the index pregnancy. The perinatal questions were formulated as follows: During pregnancy, did you feel depressed or have any nervous condition? (No, Yes, treated, and Yes, untreated) and During the three last months of pregnancy, did you feel sad or depressed? (Never, sometimes, most of the time, and always). Mothers who answered positively to both questions were considered at high risk of postpartum depression, and the validity of EPDS was tested specifically in this group.
Also investigated was the effect on EPDS performance of a change in case definition criteria, by excluding mothers with mild episodes of postpartum depression according to the gold standard. Stata 9.1 software (Stata Corp., College Station, U.S.A.) was used for all analyses.
Ethical aspects
The research protocol was approved by the Research Ethics Committee of the University of Pelotas Medical School. Since this was a nested study within the 2004 cohort and this sub-study did not involve any additional risk to the mother, the informed consent obtained was the same as requested for participation in the cohort.
Only nine mothers refused to participate in the three-month follow-up, and the EPDS was administered to 886 mothers. Of these, 378 also answered the diagnostic interview (219 with score > 9 and 159 with score < 9). According to the gold standard, 105 mothers showed mild, moderate, or severe episodes of depression.
Table 2 presents the characteristics of mothers included in the study. The vast majority (83.6%) had family incomes of up to three minimum wages. About 67% were aged 20-34 years, and over one-fifth (22.2%) were adolescents. Only two mothers had never attended school, whereas 15% had 1-4 years of schooling and 40% had 9 or more years. The majority of the women were white (70.9%), and 81.2% lived with a husband or partner. Slightly more than one-third (38.4%) worked outside home during pregnancy. The majority of the pregnancies were unplanned (67.2%). The prevalence of low birth weight (< 2,500 grams) and preterm births (< 37 gestational weeks) (10,8% and 16.4%, respectively), as well as the frequency of all maternal characteristics examined in the sample, with the exception of smoking during pregnancy, were statistically similar to those of the 2004 cohort as a whole (n = 4,287). The prevalence of maternal smoking was higher in the validation sample (33.6% versus 25.1%; p < 0.001).
Table 3 shows the sensitivity and specificity, with the respective 95% confidence intervals, for each of the EPDS cutoff points. As expected, sensitivity decreased progressively as the cutoff point increased, with a more pronounced decrease between the > 9 and > 10 cutoff points (from 91.3% to 82.6%). In contrast, specificity between these two cutoff points increased from 54.9% to 65.4%. According to the ROC curve (Figure 1), the > 10 cutoff point was best for this population. The 95% confidence intervals for this cutoff point were 75.3% to 89.9% for sensitivity and 59.8% to 71.1% for specificity.
We analyzed the effect of changes in maternal postpartum depression risk profile on EPDS performance. During the perinatal interview, a total of 247 mothers reported depression, treated or untreated, or feeling sad or depressed, always or most of the time, during the index pregnancy. These women were considered as a higher risk group for postpartum depression. Of these, the gold standard identified 89 mothers (36%) with diagnosis of postpartum depression. As in the sample from the general population of mothers, the balance between sensitivity and specificity confirmed the adequacy of the > 10 cutoff point, with 79.8% sensitivity (69.9-87.6%) and 53.2% specificity (45.1-61.1%), which ratified these levels as stable characteristics of the test, regardless of the disease prevalence.
The effect of changes in the prevalence of postpartum depression in the study population was observed in the predictive value of EPDS. Table 4 shows the positive predictive values for EPDS cutoff points between 10 and 14 in simulations for populations with different postpartum depression prevalence rates. Thus, for instance, if EPDS was administered as a diagnostic test with a cutoff point of > 11 in a population with a postpartum depression prevalence of about 20%, the positive predictive value would be 45%. In this case, the majority of women identified by EPDS as suffering from postpartum depression would actually be false-positives. Likewise, in populations with a postpartum depression prevalence of 15%, the use of EPDS at this same cutoff point would yield a positive predictive value of only 36.6%. As expected, lower cutoff points, such as > 10, when used in a population with 15% prevalence of postpartum depression, would lead to 42% of the tested population being diagnosed as suffering from postpartum depression and to a positive predictive value of 29.6%, even lower than the previous one.
The effect of changes in postpartum depression definition criteria was tested by considering as positive only mothers classified by the gold standard as showing moderate or severe episodes of depression (75 out of 378 mothers in the general population). In this scenario, the ROC curve identified > 11 as the best cutoff point, with 83.8% (73.4-91,3%) sensitivity, 74.7% (69.4-79.5%) specificity, and 76.5% accuracy. Among high-risk mothers (n = 247), the gold standard identified 63 as showing moderate or severe postpartum depression. As expected, analyses within this group confirmed the > 11 cutoff point, with 81% (69.1-89.8%) sensitivity, 66.3% (59-73.1%) specificity, and 70% accuracy.
EPDS is the scale most widely used worldwide for the study of postpartum depression. It has been translated into several languages and validated in different countries. Before the present investigation, two other studies evaluated the performance of EPDS in Brazil, one in Pernambuco, in the Northeast 18 and one in the Federal District, in the Central West of the country 21. The Pernambuco study included 218 women and aimed to measure the prevalence of pre- and postpartum depression in a sample of low-income mothers. EPDS sensitivity and specificity were evaluated only for the antenatal period, using as a gold standard the interviewers' impressions (medical and nursing students) based on the IDC-10 diagnostic criteria. Using the > 13 cutoff point, EPDS showed 73% sensitivity and 90.5% specificity for diagnosing depression during the third month of pregnancy.
The validation study conducted in the Federal District included 69 predominantly middle-class working women with a mean of 10.2 weeks postpartum. According to the authors, the best cutoff point for the scale was > 11, with 84% sensitivity and 82% specificity. The authors provided no information on the risk profile of the sample, but the working definition of postpartum depression included only moderate or severe episodes. This cutoff point coincides with that found by the present study when cases were defined according to the same criteria.
EPDS was originally constructed as a screening instrument for postpartum depression, but the scale's authors and others propose that, using > 13 as the cutoff point, the scale has high positive predictive value for diagnosing postpartum depression. In general, EPDS validation studies report high sensitivity and specificity, as well as high positive predictive value, both as a screening instrument and as a diagnostic test. In the present study, the sensitivity of EPDS was consistent with the findings of other authors using the same cutoff points. On the other hand, specificity and positive predictive value were generally below those reported in the literature at all cutoff points investigated. The high rate of false-positives and the corresponding low specificity were largely responsible for the differences found in terms of positive predictive values.
The comparison between the results of different validation studies for a same test requires caution. In addition to the quality of the instrument used, several methodological aspects may interfere with the results obtained. These include the prevalence of the disease in the sample, the case definition employed by the gold standard, the design of the validation study, and the study population's socio-cultural characteristics. As initially described by its authors 16, EPDS was developed to screen for postpartum depression among mothers considered potentially depressed according to attending health professionals. Therefore, women with depression were over-represented in the sample. This was also the case in the present study, in which we included all mothers with EPDS > 9 and 20% of those with EPDS < 9. This type of sampling design leads to a higher prevalence of postpartum depression than that observed among the general population of mothers. This methodological aspect has an effect on the test's predictive value, while sensitivity and specificity remain unchanged. A test's positive predictive value increases in populations where prevalence of the disease is greater, while sensitivity and specificity remain relatively constant. Validation studies that estimated predictive value based on samples in which mothers with postpartum depression were over-represented obtained better results than studies that corrected values according to the actual prevalence of postpartum depression. Indeed, a review of EPDS validation studies by Eberhard-Gran 20 identified positive predictive values from 37% to 78%, which, when corrected using a more realistic prevalence of 13%, were usually smaller, ranging from 22% to 79%. After correction, the positive predictive values of these studies were closer to those found in the present study for corresponding cutoff points and prevalence rates.
There are two ways of increasing a test's positive predictive value: increasing the prevalence of disease in the screened population and altering the cutoff point so as to increase the specificity. Indeed, the present study's findings indicate a higher positive predictive value when EPDS is applied to high-risk mothers. When the > 10 cutoff was used to screen postpartum depression among a group of mothers with 25% pre-test prevalence of the disease, the positive predictive value increased from 29.6% (in the general population of mothers, with an approximate prevalence of 15%) to 44.3%. Although only two of every five mothers identified by the test as at risk of postpartum depression will actually be diagnosed with the disease when interviewed by health professionals, this is an acceptable level for screening instruments. Due to the generally low prevalence of diseases, screening tests usually have low positive predictive values, even when specificity is high 22. On the other hand, at the > 10 cutoff point, the positive predictive value of the test was too low for the scale to be recommended as a diagnostic test, even in a population with a high prevalence of postpartum depression. Despite the almost twofold increase between the pre-test (25%) and post-test (44.3%) probability of postpartum depression, the discriminating capacity of EPDS was still weak. A positive predictive value below 50% is weaker than that obtained when tossing a coin. Furthermore, the area under the ROC curve for high-risk mothers was lower than that obtained for the entire group of mothers (0.76 and 0.84, respectively), indicating lower accuracy among high-risk mothers than among the entire group.
The second alternative to improve the predictive value of EPDS would be to choose a cutoff point with higher specificity. For instance, by increasing the cutoff point from > 10 to > 11, the specificity increased from 65.3% to 77.3%. This increase, however, was accompanied by a reduction in sensitivity from 82.6% to 74%. A screening test that fails to identify more than one-fourth of mothers with postpartum depression is unacceptable. A good screening test must have high sensitivity in order not to miss the few cases of the disease, and high specificity, in order to reduce the number of false-positives that will have to undergo further evaluation.
For diagnostic purposes, the best performances were found for cutoff points > 13 and > 14 when the test was applied to high-risk mothers, with postpartum depression prevalence between 20% and 25%. For these mothers, the positive predictive value was more than 60%.
The second methodological aspect that may interfere with the results of validation studies is the case definition used by the gold standard. In the current study, we defined postpartum depression as occurring in mothers presenting depressive episodes with any level of severity. In general, studies that include mild cases of the disease report lower sensitivity for a same cutoff point 23,24. The current study's findings also provide evidence of this phenomenon. The sensitivity of the > 10 cutoff point in the sample including all mothers with depressive episodes was 82.6%, whereas among mothers with moderate and severe episodes only, sensitivity for the > 10 cutoff point increased to 87.8% (78.2-94.3%).
An alternative would be to use the > 11 cutoff point to diagnose moderate or severe postpartum depression, a scenario yielding greater specificity for EPDS when compared to the diagnosis of any type of postpartum depression. Assuming 10% prevalence of moderate or severe postpartum depression, the positive predictive value for EPDS > 11 would be 26.7%. For 15% prevalence, the positive predictive value would increase to 36.9%. Although a positive result in these situations would imply a probability of disease about three and two times greater, respectively, than the pre-test probability, such a finding indicates that, in the first case, only slightly more than one-fourth of mothers selected by EPDS would have moderate or severe postpartum depression confirmed after evaluation by health professionals. In the second scenario, even with a 50% increase in prevalence as compared to the previous example, only a little more than one-third of mothers would be correctly identified by EPDS. These findings indicate that a cutoff point of > 11 would be adequate for screening, but not for diagnosing mothers with moderate or intense postpartum depression. For diagnostic purposes, the most adequate cutoff point would be > 15, which has 47.3% (35.6-59.3%) sensitivity and 92.4% (88.9-95.1%) specificity among mothers with 20% prevalence of moderate or severe postpartum depression. A major difficulty would be to work with a sample of mothers with such high pre-test prevalence of moderate and severe postpartum depression. The accuracy (area under the ROC curve) for the diagnosis of moderate and severe cases was 0.86, thus higher than the area for the screening and diagnosis of PPD among both the general population and high-risk mothers.
Finally, study design plays an important role in the evaluation of a test's attributes. As a screening test, the aim of EPDS is to detect postpartum depression during its pre-symptomatic phase or as close as possible to the threshold of clinically detectable symptoms. When conducting a cross-sectional comparison of performance by EPDS and the psychiatric interview, the scale is actually being tested as a diagnostic test for postpartum depression rather than as a screening instrument. The sensitivity of a screening test is given by the ratio between the number of true-positives and the sum of true-positives and subjects that will develop the disease within a given follow-up period 22, meaning that the disease was present but the test was not able to identify it. Ideally, therefore, a study of the validity of EPDS as a screening test should evaluate the scale's performance in the early identification of symptoms that would later evolve to postpartum depression. A study with this aim should have a prospective design and include (as a selection criterion) only mothers tested after the first 7-10 days post-delivery, the period in which 30-70% of mothers show symptoms of melancholy, sadness, and emotional instability, which are self-limited in the majority of cases 25. Two measurements at different time points would be necessary: one during the selection of mothers, in which EPDS would be administered, and another between four weeks and three months post-delivery, the peak of postpartum depression incidence 26, when only the gold standard for the diagnosis of postpartum depression would be administered. Mothers with positive EPDS scores at the beginning of postpartum and that developed postpartum depression during the follow-up period would be considered true-positives. Only thus could the sensitivity of EPDS as a screening instrument be defined. Specificity, on the other hand, would be determined as the proportion of mothers with negative EPDS scores confirmed by the gold standard. Therefore, the low predictive value for EPDS found in the present study may be due to the design used for its validation. We found no studies in the literature that evaluated EPDS as a screening instrument using this methodology. The available results thus express the performance of EPDS more as a diagnostic test than as a screening instrument for postpartum depression.
The above-mentioned aspects may explain the differences detected between this and other studies with respect to the positive predictive value of EPDS. The reason for the differences in specificity and false-negative rates, on the other hand, appear to be due to other methodological aspects, especially sample size. Wide confidence intervals such as those reported by the majority of EPDS validation studies in terms of both sensitivity and specificity are due to the small samples investigated. Low specificity and the corresponding high false-positive rates found in the present study indicate that mothers answered positively to EPDS without these answers having the depressive connotation that the scale aims to detect. This characteristic is not concentrated only in a few questions; rather, it is seen in most of the test's questions. Although the translation of EPDS into Portuguese and the subsequent back-translation into English were considered adequate given the settings in which the scale would be used, it is possible that cultural factors may have interfered with the interpretation of the content of certain items and consequently with the expected values for the answers provided. Thus, before using this scale for the general population of Brazilian mothers, it would be recommendable to test the validity of the content of these items in relation to the other variables in the scale, using further studies.
Other characteristics of the study population, such as the health status of children and the mother's perception of her child's health, were not explored in the present study and may have limited the results' validity. Although the 2004 birth cohort recorded the number of hospital admissions and medical appointments during the first three months of the infant's life, the mother's perception regarding the child's health was not evaluated. However, events leading to hospitalization were infrequent in this sample. Only 20 children were hospitalized at least once before the interview date. According to the gold standard, ten of these mothers showed depressive episodes, versus 95 among the others (p = 0.02). Likewise, the mother's actual or self-perceived health status was not evaluated. Mothers with unfavorable self-perceived health status may show greater prevalence of postpartum depression than those who considered themselves healthy. It is plausible that mothers with clinical intercurrences due to (or increased by) pregnancy show greater prevalence of postpartum depression.
Strengths of the current study include the fact that both EPDS and the gold standard interview were standardized and blinded as to each other's results. Administration of the scale as an interview by a trained interviewer, rather than as a self-administered instrument, as originally planned and as done in the majority of studies, was appropriate for the social and educational characteristics of a population-based sample of mothers. Moreover, this was the first validation study for EPDS in Brazil to rely on a population-based sample.
In short, the present study has shown that the validity of EPDS should be interpreted in light of the use for which it is intended. EPDS is adequate as a screening instrument using the > 10 cutoff point, especially among selected populations of mothers at high risk of postpartum depression. For diagnosis, the > 13 cutoff point will be adequate only if used among high-risk populations. In the general population of mothers, the scale shows low validity for the diagnosis of postpartum depression. It should be noted, however, that there is still a gap to be filled in the validation of EPDS as a screening instrument for postpartum depression, given that with the design used by the present study and other studies identified in the literature, such performance remains to be formally tested.
I. S. Santos and A. Matijasevich designed the study, conducted the data analysis, and wrote the draft and final version of the article. B. F. Tavares coordinated the fieldwork. I. P. Botelho, C. Lapolli, P. V. S. Magalhães, and A. P. P. N. Barbosa participated in the fieldwork. A. J. D. Barros and F. C. Barros helped develop various concepts and interpret the findings. All authors reviewed the draft and contributed to the final version of the article.
The authors wish to thank the funding agencies, the mothers of all newborns in the cohort, the hospitals of the city of Pelotas, the Municipal Secretariat of Health and Welfare, and all those who collaborated in the various stages of this study. The study was funded by the World Health Organization (HQ/04/072979), the Brazilian National Research Council (CNPq grant nº. 476727/2003-0), and the Children's Mission (Pastoral da Criança).
Submitted on 04/May/2006
Final version resubmitted on 07/Feb/2007
Approved on 14/Feb/2007
- 1. Buist AE, Barnett BE, Milgrom J, Pope S, Condon JT, Ellwood DA, et al. To screen or not to screen that is the question in perinatal depression. Med J Aust 2002; 177 Suppl:S101-5.
- 2. Beck CT. Teetering on the edge: a substantive theory of postpartum depression. Nurs Res 1993; 42: 42-8.
- 3. Beck CT. The effects of postpartum depression on maternal-infant interaction: a meta-analysis. Nurs Res 1995; 44:298-304.
- 4. Cogil SR, Caplan HL, Alexandra H, Robson KM, Kumar R. Impact of maternal postnatal depression on cognitive development of young children. BMJ 1986; 292:1165-7.
- 5. Holden JM. Postnatal depression: its nature, effects, and identification using the Edinburgh Postnatal Depression Scale. Birth 1991; 18:211-21.
- 6. Murray J. The impact of postnatal depression on infant development. J Child Psychol Psychiatr 1992; 33:543-61.
- 7. Stein A, Gath D, Bucher J, Bond A, Day A. The relationship between post-natal depression and mother-child interactions. Br J Psychiatry 1992; 158:46-52.
- 8. Cox JL, Murray D, Chapman G. A controlled study of the onset, duration, and prevalence of postnatal depression. Br J Psychiatry 1993; 163:27-31.
- 9. Garcia-Esteve L, Ascaso C, Ojuel J, Navarro P. Validation of the Edinburgh Postnatal Depression Scale (EPDS) in Spanish mothers. J Affect Disord 2003; 75:71-6.
- 10. Sword W, Watt S, Krueger PD, Sheehan DD, Lee KS, Roberts J, et al. New mothers identify information needs: actions for postpartum community care providers. Public Health and Epidemiology Report Ontario 2000; 11:38-44.
- 11. Gotlib IH, Whiffen VE, Mount JH, Milne K, Cordy NI. Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. J Consult Clin Psychol 1989; 57:269-74.
- 12. O'Hara MW, Zekoski EM, Philips LH, Wright EJ. Controlled prospective study of mood disorders: comparison of childbearing and nonchildbearing women. J Abnorm Psychol 1990; 99:3-15.
- 13. Warner R, Appleby L, Whitton A, Faragher B. Demographic and obstetric risk factors for postnatal psychiatric morbidity. Br J Psychiatry 1996; 168:607-11.
- 14. Watt S, Sword W, Krueger P, Sheehan D; Ontario Mother & Infant Survey. A cross-sectional study of early identification of postpartum depression: implications for primary care providers from The Ontario Mother & Infant Survey. BMC Fam Pract 2002; 11:3-5.
- 15. Uwakwe R, Okonkwo JE. Affective (depressive) morbidity in puerperal Nigerian women: validation of the Edinburgh Postnatal Depression Scale. Acta Psychiatr Scand 2003; 107:251-9.
- 16. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987; 150:782-6.
- 17. Barros FC, Victora CG, Barros AJD, Santos IS, Albernaz E, Matijasevich A, et al. The challenge of reducing neonatal mortality in middle-income countries: findings from three Brazilian birth cohorts in 1982, 1993, and 2004. Lancet 2005; 365:847-54.
- 18. Da Silva VA, Moraes-Santos AR, Carvalho MS, Martins MLP, Teixeira NA. Prenatal and postnatal depression among low-income Brazilian women. Braz J Med Biol Res 1998; 31:799-804.
19Organização Mundial da Saúde. Classificação de Transtornos Mentais e de Comportamento da CID-10. Critérios diagnósticos para pesquisa. Porto Alegre: Editora Artes Médicas; 1998.
- 20. Eberhard-Gran M, Eskild A, Tambs K, Opjordsmoen S, Samuelsen SO. Review of validation studies of the Edinburgh Postnatal Depression Scale. Acta Psychiatr Scand 2001; 104:243-9.
- 21. Santos MFS, Martins FC, Pasquali L. Escala de auto-avaliação de depressão pós-parto: estudo no Brasil. Rev Psiquiatr Clin 1999; 26:90-5.
- 22. Fletcher RH, Fletcher SW, Wagner EH. Epidemiologia clínica: elementos essenciais. Porto Alegre: Editora Artes Médicas; 1996.
- 23. Lijmer JG, Mol BW, Heisterkamp S, Bonsel GJ, Prins MH, van der Meulen JHP, et al. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA 1999; 282:1061-6.
- 24. Rutjes AW, Reitsma JB, Di Nisio M, Smidt N, van Rijn JC, Bossuyt PM. Evidence of bias and variation in diagnostic accuracy studies. CMAJ 2006; 174:469-76.
- 25. World Health Organization. Postpartum care of the mother and newborn: a practical guide. http://www.who.int/reproductive-health/publications/msm_98_3/msm_98_3_14.html (accessed on 29/Mar/2007).
- 26. Blenning CE, Paladine H. An approach to the postpartum office visit. Am Fam Physician 2005; 72:2491-6.
Publication Dates
Publication in this collection
18 Oct 2007
Date of issue
Nov 2007
04 May 2006
07 Feb 2007
14 Feb 2007