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Webb RT, Wicks S, Dalman C, et al. Influence of Environmental Factors in Higher Risk of Sudden Infant Death Syndrome Linked With Parental Mental Illness. Arch Gen Psychiatry. 2010;67(1):69–77. doi:10.1001/archgenpsychiatry.2009.172
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Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010
Since national risk reduction campaigns have been conducted, sudden infant death syndrome (SIDS) has become increasingly concentrated among disadvantaged families, including those affected by mental illness. However, causal mechanisms specific to this group are poorly understood.
To estimate relative risk and compare risk factor prevalence in infants with and without parental psychiatric inpatient history, and to explore effect modification after the 1992 Swedish risk reduction campaign.
National birth cohort. Parental psychiatric admissions, maternal prenatal smoking, obstetric and social risk factors, and cause-specific infant death were ascertained via linkage between national registers.
The Swedish population, 1978 through 2004.
All singleton live births (N = 2.5 million).
Main Outcome Measure
Incidence of SIDS.
Risk of SIDS was higher with a history of parental inpatient care, especially if both parents were admitted with any mental illness (odds ratio, 6.8; 95% confidence interval, 4.7-10.0), or if the mother (6.5; 4.9-8.7) or both parents (9.5; 5.5-16.4) had an alcohol/drug disorder. A 2-fold higher risk was also seen if the mother or father was admitted with any psychiatric illness other than alcohol or other drug disorders. Elevated risk persisted even if the last maternal inpatient episode had occurred 5 or more years before the infant's birth. After the national campaign, risk factor prevalence (especially maternal antenatal smoking) remained high in this population, and relative risks therefore increased. During 1992 through 2004, smoking and individual social adversity measures jointly accounted for approximately half the excess risk linked with maternal psychiatric inpatient history, whereas the confounding effects of obstetric factors were minimal.
Tailored approaches are needed to ensure that standard safety advice is effectively communicated to these vulnerable families. In particular, mentally ill pregnant women should be encouraged and better supported to stop smoking. Families with 2 affected parents require particularly strong support. A clearer understanding is needed as to why high risk factor prevalence persists among these parents.
Sudden infant death syndrome (SIDS) designates a death during the first year of life that remains unexplained after autopsy, death scene investigation, and medical history review.1 Despite substantial reductions in rates of SIDS during recent decades, it remains the leading cause of infant death beyond the perinatal period in developed countries. Known modifiable risk factors include parental smoking and the infant's sleeping position,2,3 and national risk reduction campaigns have successfully targeted these factors in the general population. Recent evidence from the United Kingdom indicates that SIDS has become highly concentrated among socially disadvantaged groups, so that up to three-quarters of all cases now occur among the 15% to 20% of poorest families.1 The phenomenon is also associated with parental mental illness, but few studies have specifically examined these effects.4-8 Higher risk has been reported with maternal prenatal4 and postnatal5,6 depression, maternal schizophrenia,7 and severe parental mental illness per se; a recent Danish study reported a 7-fold elevation in risk if both parents had been admitted for psychiatric treatment.8 However, the causes of this excess risk are poorly understood. Adjustments for clinical factors (eg, smoking, previous pregnancies, gestational age)4-7 and social factors (eg, marital status, deprivation, ethnicity)5,6 have been made, but with arguably too few exposed cases to support comprehensive multivariate analyses: n = 7,4 n = 10,7 n = 13,6 and n = 15.5
National cohort studies are limited by a lack of detailed prospectively collected data concerning the antecedents and circumstances of these deaths. Nonetheless, linked Swedish registers enabled us to study SIDS risk with parental mental illness in the context of important clinical and social risk factors, such as maternal smoking, obstetric factors, and social adversity, using a larger and richer data set than previously available. We aimed to (1) replicate Danish findings of elevated risk with any maternal or paternal admission, particularly if both parents had been admitted for any psychiatric reason or the mother was diagnosed as having an alcohol/drug disorder8; (2) assess effects of time since last maternal inpatient episode before childbirth; (3) compare SIDS risk factor distributions among infants with and without parental admission history; (4) explore potential effect modification by period (1992-2004 vs 1978-1991); and (5) undertake multivariate adjustment for clinical and social risk factors.
We hypothesized that risk factors (particularly maternal smoking and social adversity) would be more common in this group, and that they would partly explain higher risks associated with parental mental illness. We predicted relative risks to be higher in the later years of the study period, in line with falling rates overall and an increasing concentration of risk factors and cases among disadvantaged families.1 Finally, we expected higher risks among infants whose mothers had last received inpatient psychiatric care in the year preceding birth (indicating serious ongoing illness) rather than at some earlier time.
We obtained prior approval from the research ethics committees of the Karolinska Institutet, Stockholm, Sweden, and the University of Manchester, Manchester, England. The following national registers and databases, held by the National Board of Health and Welfare and Statistics Sweden, were linked by means of unique registration numbers: (1) Multigeneration Register and Population Register: dates of birth, death, immigration, and emigration, and infant-to-parent linkage; (2) Medical Birth Register: maternal prenatal smoking and obstetric factors for all births since 1973, and singleton vs multiple birth status; (3) National Patient Register: hospital discharges by diagnosis, with virtually complete national coverage of all public inpatient psychiatric care from 1973 (Swedish private inpatient psychiatric care is rare); (4) Cause of Death Register; and (5) Population and Housing Census (every 5 years, 1960-1990), Total Income Register (1985, 1990, 1995, and 2000), and longitudinal integration database for health insurance and labor market studies (1995 and 2000); these last two sources provided our social adversity measures.
Initially, we derived a cohort of all live births from January 1, 1978, through December 31, 2004 (N = 2.69 million). Linkage to the Medical Birth Register was 99.4% complete and, as in other studies,7-10 we excluded multiple births (2.5%) because of lack of statistical independence among these sets. Infants who did not complete a full year of follow-up because of emigration (0.3%) were excluded to avoid survival-time bias in our logistic regression models. We excluded infants whose mother or father did not reside in Sweden during the entire 5-year period before December 31, 1977 (4.5%), to ensure that we had complete recent psychiatric inpatient histories for all parents. This approach, as opposed to excluding infants whose parent or parents were born abroad, meant that immigrants were retained in the analyses to a representative degree. We conducted our final analyses on 2 480 320 live births.
Psychiatric illnesses and cause-specific infant deaths were classified by means of the 8th, 9th, or 10th revision of the International Classification of Diseases: ICD-8 (1969-1986),11ICD-9 (1987-1996),12 and ICD-10 (1997-2005).13 On the basis of primary or secondary diagnoses entered in the National Patient Register, which also records physical diseases, the following codes were used to delineate psychiatric illnesses: (1) any psychiatric diagnosis: ICD-8 codes 290 to 315, ICD-9 codes 290 to 319, and ICD-10 codes F00 to F99; (2) nonaffective psychoses: ICD-8 codes 295, 297, 298.20 to 298.99, and 299.99, ICD-9 codes 295, 297, and 298C-Z, and ICD-10 codes F20 to F29; (3) affective psychoses: ICD-8 codes 296.10 to 296.88, ICD-9 codes 296C to 296W, and ICD-10 codes F30.2, F31, F32.3, and F33.3; and (4) alcohol/drug disorders: ICD-8 codes 291, 294.30, 303, and 304, ICD-9 codes 291, 292, 303, 304, 305A, and 305X, and ICD-10 codes F10 to F16 and F18 to F19.
We generated 2 broad mutually exclusive categories among the affected parents (history of admission with alcohol/drug disorders vs any psychiatric illness other than alcohol/drug disorders) to assess the extent to which any observed excess risk linked with parental admission could be explained by alcohol/drug disorders.
Follow-up was for 1 year from birth (up to December 31, 2005, for infants born on December 31, 2004, the final day of the cohort). We included only cases with an assigned underlying cause of death of SIDS10,14,15 by means of ICD-8 code 795, ICD-9 code 798.0, and ICD-10 code R95. A small percentage (0.6%) of all births had no registered father. Paternal identity is automatically registered when Swedish married women give birth, but not so with unmarried mothers. The degree of missing paternal identity was much greater among SIDS cases (10.5%) and other infant deaths (18.0%) than among surviving infants.
We categorized the 27-year birth cohort into 2 almost-equal periods, 1978 through 1991 vs 1992 through 2004, in line with the 1992 Swedish SIDS risk reduction campaign.16,17 Time period was assessed both as a potential confounder and as an effect modifier. Smoking at antenatal booking was recorded in the Medical Birth Register from 1983 as nonsmoker, 1 to 9 cigarettes per day, or 10 or more cigarettes per day, with 93.9% completeness. We had no measure of maternal smoking postpartum or of paternal smoking at any time. We also adjusted for obstetric factors recorded in this register: maternal age (<20, 20-24, or ≥25 years), parity (1, 2, or ≥3), premature birth (<37 weeks), low birth weight (<2500 g), small for gestational age (<2 SDs18), small head circumference (<32 cm19), and low Apgar score at 1 or 5 minutes (0-6 vs ≥7). Each was 99% to 100% complete during 1978 through 2004, except for small head circumference (96.4% complete).
Sociodemographic variables were also assessed. From the Medical Birth Register we obtained an almost 100% complete measure of birth place (3 largest urban centers [Stockholm, Gothenburg, and Malmö] vs elsewhere) and parental noncohabitation at antenatal booking (93.7% complete, from 1983). Parents' country of birth (Sweden vs abroad) was taken from the Multigeneration Register (99%-100% complete). Low socioeconomic position was measured as an adult in the household receiving social welfare payment and by the mother's educational attainment, given at 5-year intervals from the Population and Housing Census, the longitudinal integration database, and the Total Income Register. To eliminate potential reverse causality bias,20 we extracted these data according to the earliest available measurement year before the infant's birth, and we derived variables only for mothers who reached 20 years of age in that year to ensure their complete eligibility for the measure. Social welfare data were applied to births from January 1, 1986, onward (96.8% complete), and maternal educational data were applied to births from January 1, 1992 (93.9% complete), with a low level defined as failure to complete upper secondary schooling. In the early 1990s, approximately 70% of the Swedish population completed this level (reaching 80% by 2000).
Statistical analyses were performed with Stata software, version 10 (StataCorp, College Station, Texas). Exposure was defined stringently so that first maternal/paternal admission must have occurred before the infant's birth. Risks were calculated as number of deaths at 0 to 364 days by number of live births per 1000. We fitted unconditional logistic regression models because, with rare outcomes, the odds ratios derived are equivalent to relative risk estimates.21 Multiple SIDS events per family were very rare (0.5% of all cases in the cohort). Nonetheless, standard errors were corrected for any sibship-clustering effects by means of the Huber-White estimator.22 For effect estimates calculated with sparse data (≤10 exposed deaths), we applied conservative exact confidence intervals.
From 1978 through 2004, the prevalence of parental psychiatric admission before the infant's birth was 2.8% for mothers, 2.6% for fathers, 4.8% for 1 parent only, and 0.3% for both parents. Among the 69 995 mothers with admission histories, 21.0% received diagnoses of alcohol/drug disorders; 8.3%, nonaffective psychoses; and 3.2%, affective psychoses. The equivalent percentages among the 65 092 admitted fathers were 47.7%, 8.4%, and 3.1%, respectively. The other diagnoses resulting in parental admission consisted mostly of nonpsychotic depression, neurotic and stress-related conditions, childhood psychoses, autism, behavioral (and other developmental) disorders, and personality (and related) disorders.
A total of 1531 SIDS cases occurred in the whole cohort at a rate of 0.6 per 1000 live births. In 11.2% of all cases there had been at least 1 parental psychiatric inpatient admission before the birth (with almost half of this group having been admitted for alcohol/drug disorders). There were 118 cases (1.7 per 1000 live births) with maternal admission histories and 82 cases (1.3 per 1000 live births) with paternal admission histories. Our analyses excluded the few cases in which first parental admission occurred between the infant's birth and death (maternal, 6 cases; paternal, 3 cases).
Table 1 shows relative risks of SIDS estimated as odds ratios. An elevated risk was seen for maternal and for paternal admission with any psychiatric diagnosis, and there was an approximate 7-fold increase if both parents were admitted. Table 1 also presents relative risks linked with specific parental diagnostic groups. There was no significant evidence of higher risk with maternal or paternal nonaffective psychoses. We also examined parental affective psychoses (results not presented), but there were too few SIDS cases for relative risk estimation (maternal, 2 cases; paternal, 1 case). Significantly higher risks were seen with parental alcohol/drug disorders (with a 6.5-fold higher risk linked to maternal admission). The greatest risk (4.8 per 1000 live births) was seen if both parents were admitted with alcohol/drug disorders: a 9.5-fold increase vs the general population. There was also a 2-fold elevated risk among infants with mothers or fathers admitted for any psychiatric diagnosis other than alcohol/drug disorders. If both parents had admission histories without alcohol/drug disorders, a more than 5-fold higher risk was seen.
Among infants with mothers admitted for any psychiatric diagnosis, an elevated risk of 1.8 per 1000 live births was found with last maternal episode within a year and 1 to 4 years of the infant's birth, with risk falling only slightly to 1.6 per 1000 live births if the last episode was 5 or more years before the birth (Table 2). With adjustment for period effects, the relative risk was at least 3 in each time stratum. Categorizing maternal admissions into 2 broad diagnostic groups (alcohol/drug disorders vs all other psychiatric illnesses) produced divergent trends in relative risk by timing of the last episode. For infants whose mothers were admitted with alcohol/drug disorders, risk was highest if the last episode was within a year of the birth and lowest if it was 5 years or more previously, and vice versa among infants whose mothers had been admitted with other types of psychiatric illness. Although neither diagnostic group–specific test was significant, the interaction term indicated differential trends in risk over time since last episode between these groups (P = .05).
Table 3 shows prevalence across the study period (or for all years with available data). Risk of SIDS was no higher among infants whose mothers or fathers were born abroad, or for those born in the 3 largest cities, and so these variables were discounted as risk factors in this cohort. There was a somewhat higher prevalence of obstetric risk factors with parental mental illness compared with the general population. The prevalence of having at least 1 obstetric risk factor was 21.8% in infants with mothers admitted for any psychiatric reason and 24.8% in those with 2 admitted parents, compared with 15.9% among infants with neither parent admitted. There was a markedly higher prevalence of maternal smoking at antenatal booking and of social adversity, especially with both parents admitted (or with maternal alcohol/drug disorder). We also assessed maternal smoking rates at booking among infants whose fathers had been admitted (results not shown in Table 3); maternal smoking was almost as prevalent in this group (38.6%) as in the all maternal admissions group (41.1%). Among infants with 2 admitted parents (and with mothers admitted for alcohol/drug disorders), smoking at booking was approximately 3 times more common than in the general population, and prevalence of adverse social circumstances (parents not cohabiting at booking, low maternal educational attainment, social welfare receipt) was between 4 and 7 times higher. With such a large sample size, the prevalence was significantly higher (P < .001) among the exposed groups (mother admitted or both parents admitted) than the unexposed groups (mother not admitted or neither parent admitted) for each of the risk factors shown in Table 3, with the exception of male infant sex.
The prevalence of risk factors declined after the national risk reduction campaign. The maternal smoking rate at antenatal booking fell by almost half in the general population, whereas in the exposed groups, even from higher baseline rates, there was a smaller percentage reduction. The highest-risk groups saw the smallest percentage reductions between periods: for example, both parents admitted (18.5% reduction) compared with neither parent admitted (49.0%). Rates of maternal smoking and social adversity were high during both periods if 2 parents were admitted or if the mother was treated for an alcohol/drug disorder. Thus, in the period after the campaign, more than half of the mothers in these 2 high-risk groups reported smoking at booking.
Table 4 shows strong effect modification by period of birth. Among infants with any parental psychiatric admission history (mother, father, or both parents), the relative risk increased significantly after the campaign. Maternal and paternal effects showed a more than 4-fold higher risk in the later period. In the earlier period there had been a parental admission before the birth in 8.0% of all SIDS cases, whereas after the campaign this figure rose to 20.1%. The increase in relative risk was especially marked if both parents were admitted (with the odds ratio increasing from 3.9 to 14.8).
Parental mental illness and greater maternal burden may interact to produce even higher risk. For example, SIDS risk could be especially elevated with mentally ill single mothers or with those caring for more than 1 child. We therefore tested for effect modification (of the maternal admission effect) by parity greater than 1 and by parents not cohabiting, but in both cases the interaction term was not close to being significant (P = .91 and P = .76, respectively).
We assessed the obstetric factors separately, and each one had minimal confounding effect. However, maternal smoking at antenatal booking had a considerable confounding influence, and the strength of this effect was greater during 1992 through 2004 than during 1983 through 1991. The results presented in Table 5 relate to maternal admissions only, but, during 1992 through 2004 and with both parents admitted, the adjustment for maternal smoking was stronger still: from an odds ratio of 14.1 to 5.6. Social adversity also had some additional confounding effect. We adjusted for maternal smoking plus 1 social adversity measure (parents not cohabiting, social welfare receipt, or low educational attainment) in the same model. In each case these combined adjustments reduced the odds ratio with maternal admission by around a half, from an approximate 4-fold to a 2-fold increase in risk. Additional multivariate analyses were fitted with combined adjustment for smoking, multiple social adversity measures, and low birth weight or at least 1 obstetric risk factor. These were flawed because of multiple zero cell counts with sparse event data, and sizeable proportions of missing data when several incomplete covariates were combined, and so they are not presented herein. However, as with the more robust models shown in Table 5, they suggest an adjusted odds ratio of approximately 2 in each case. Thus, even with multiple confounder adjustment, a considerable degree of residual confounding by unmeasured factors was indicated.
In a 27-year national birth cohort, we found significantly higher SIDS risks among infants whose mothers or fathers had received psychiatric inpatient care. A particularly high risk was seen if both parents had been admitted for any psychiatric reason or if the mother, or both parents, had been diagnosed as having an alcohol/drug disorder. Additional analyses (not presented herein) showed that maternal, but not paternal, alcohol/drug disorders were also linked with elevated risk of infant death owing to all other natural causes, and of unnatural-cause death, albeit with smaller effect sizes. Furthermore, a 2-fold elevation in SIDS risk with parental psychiatric admission with illnesses other than alcohol/drug disorders was also indicated. Thus, there was no evidence of specificity in the association between parental alcohol/drug disorders and higher SIDS risk. We found no evidence of higher risk with parental affective or nonaffective psychoses, perhaps because of a lack of power to detect modest effect sizes in these groups. In relation to all admitted mothers, a consistent 3-fold increase in risk was seen irrespective of whether the last inpatient episode had occurred within a year of the birth or some years previously.
As in other developed countries, Swedish national SIDS rates have declined in recent decades, but the relative risks linked with parental mental illness increased after the 1992 risk reduction campaign. In approximately a fifth of all cases after the campaign, at least 1 parent was admitted with psychiatric illness before the infant's birth, and this proportion is likely to have been substantially higher if we had been able to include community-treated mental illnesses. During 1992 through 2004, with 3.4% of mothers having been admitted before the infant's birth and an odds ratio of 4.4, a population-attributable fraction of approximately 10% is indicated from our results. Therefore, the population impact of maternal mental illness on SIDS risk may be considerable. Inclusion of more common forms of mental illness, occurring before and after the infant's birth, suggests a much greater population impact. For example, a prospective study in New Zealand5 reported an odds ratio of 4 linked with postnatal depression (prevalence, 16%), indicating a population-attributable fraction of more than 30%. However, causality cannot be established from these study designs, and so these estimates should be treated cautiously.23
Known SIDS risk factors in the general population, particularly maternal smoking in early pregnancy and social adversity measures, continued to cluster strongly in families with parental mental illness after the Swedish national campaign. Thus, rates of maternal smoking fell in all groups, but to a far lesser extent with maternal or paternal admission, and smoking prevalence remained high if both parents had been admitted or if the mother had an alcohol/drug disorder. In the later period, maternal smoking in early pregnancy and individual social adversity measures jointly accounted for approximately half the excess risk associated with maternal psychiatric admission. The confounding effects of obstetric risk factors, however, remained marginal throughout the study period. Our multivariate adjustments did not account for important unmeasured confounders, but there may also have been some overadjustment if worsening social adversity and failure to quit smoking lie directly on a causal pathway between mental illness and higher SIDS risk.
These findings are only partially consistent with previous evidence. A national Danish study also reported higher risk with parental admission,8 and in both Denmark and Sweden there was a 7-fold elevation in risk if both parents had been admitted or the mother had an alcohol/drug disorder. Denmark implemented its own national risk reduction campaign in 1991,24 but, unlike in Sweden, there was no evidence of a subsequent change in relative risk with parental mental illness.8 This difference in results between neighboring countries may have occurred because maternal smoking rates remained generally high in Denmark after the campaign.24,25
Our study gives new insight into possible reasons for higher SIDS risk among infants with mentally ill parents. Our measures of social adversity, including single parenthood, low levels of educational attainment, and social welfare receipt, had some confounding influence. Consistent with our findings, a recent systematic review found that low socioeconomic position is an independent predictor of SIDS risk.26 Our results show that relative social differences have an important confounding effect, even in an affluent country like Sweden.17 Socioeconomic position could act as a marker for unmeasured causal mechanisms in 2 ways. First, key health promotion messages may currently be communicated in such a way that they mainly reach better-educated parents.27 Second, psychosocial stress may prevent parents from acting on key safety messages. For example, highly stressed parents may have difficulty coping if their infant's sleeping pattern becomes disrupted when placed in the supine position,28,29 and they may also find it harder to stop smoking. We assessed 2 potential markers of heightened maternal burden (caring for more than 1 child and single parenthood), but neither modified the effect of maternal admission in this cohort. Even if the last maternal psychiatric admission had been 5 or more years before the birth of the infant, we found that risk remained significantly elevated. This could mean that severe mental illnesses had not remitted among affected mothers experiencing long periods without inpatient care before the birth, or it could reflect more general psychosocial adversities encountered by these families. Thus, intractable social problems, rather than effects directly linked with acute psychopathologic factors around the time of childbirth, might underpin much of the elevated risk.
With widespread adoption of the supine sleeping position for infants, maternal antenatal smoking is now the major SIDS risk factor in the general population.25,30,31 It had a major influence throughout our study period, although its confounding effect became stronger after the national risk reduction campaign. The campaign emphasized the importance of smoking cessation as well as sleeping position, but more than a third of women with psychiatric histories reported smoking in 1992 through 2004 (and the prevalence was higher still if both parents had been admitted or if the mother had an alcohol/drug disorder). Our only smoking measure was based on maternal self-report at antenatal booking. One study reported that only 30% of Swedish women stop smoking after their first antenatal visit,32 and so the increased prevalence we report may apply throughout pregnancy and infancy (albeit at a somewhat lower level). It is difficult to disentangle prenatal vs postpartum smoking effects because most infants are exposed during both periods. The Nordic Epidemiological SIDS Study indicated that the effect is specific to maternal smoking in pregnancy, and that infants' exposure to parental smoking after birth is unlikely to have a major influence.25 Infants in that study had a 4-fold higher risk with prenatal or postpartum exposure to maternal smoking, but there was no effect of paternal smoking postpartum without maternal smoking in pregnancy (odds ratio, 0.8). Several mechanisms could explain the prenatal smoking effect, including reduced oxygen and nutrient availability to the fetus, altered ventilatory and awakening responses to hypoxia, decreased lung volume and compliance, poorer development of the neonatal airway, impairment of the immune system, and greater susceptibility to airway infections and other diseases.2,25,33 An estimated one-third of all SIDS cases might be prevented if in utero smoking exposure was eliminated.34
Important strengths of our study include record linkage between multiple national registers, a large sample size for investigation of rare exposures and outcomes, absence of information or recall bias, and complete follow-up. In particular, the Swedish registers combined vital statistics data (births, deaths, and parent-infant linkage) with clinical data (obstetric and psychiatric) and sociodemographic measures. Assessment of all types of admitted parental psychiatric illnesses enabled us to conduct a comprehensive investigation of this rare outcome, compared with previous Swedish studies that have focused on parental schizophrenia but have lacked power to investigate SIDS as a specific cause of death.9,35
The study had 2 main limitations. First, we were unable to measure some key modifiable risk factors, especially prone infant sleeping position36 and infant bed sharing with parents who smoke or who are intoxicated with alcohol.37 Important contextual factors like these are commonly missing from registry studies.38 However, our findings concerning prenatal maternal smoking and social adversity suggest that the prevalence of the unmeasured risk factors may also be higher in these parents. Second, our measures were imperfect. We used a broad definition of parental mental illness (all inpatient admissions) including alcohol/drug disorders, but our results cannot be generalized to the far larger community-treated psychiatric population. Equivalent information is not available in Sweden, but a Danish validation study indicated that alcohol/drug disorders are significantly underdiagnosed in their national psychiatric register.39 The social adversity covariates were measured at 5-year intervals only, and their confounding effects may therefore be underestimated. A greater concern is potential misclassification of cause of death40 without retrospective verification. However, Swedish classification is comparatively accurate because virtually all infants dying outside of hospitals undergo forensic autopsy.28 A previous national study reported that autopsies were performed on 97% of all babies with a SIDS diagnosis during 1983 through 1990,10 whereas data for 1997 through 2004 (from the National Board of Health and Welfare) show a mean autopsy rate of 98%. In the United States41 and the United Kingdom,42 there is evidence of a growing reluctance to diagnose SIDS where co-sleeping with a parent is discovered. During 1997 through 2004 we also compared numbers of SIDS cases (ICD-10 code R95) against "other ill-defined and unspecified causes" (code R99.0). Only 10 infants were assigned that code (vs 215 SIDS cases), indicating no evidence of a similar trend in Sweden.
Standard SIDS risk reduction messages appear to be ineffective in reaching the most vulnerable families, including those with serious parental mental illness and especially those with alcohol/drug disorders. We recommend the delivery of tailored health education messages to mentally ill parents and parents-to-be, using client-focused approaches by trained staff. Professionals working in mental health, child health, and primary care should strive to provide continuing support to affected parents to help them take advantage of this advice. In particular, parents should be strongly encouraged and supported to stop smoking at antenatal booking and afterward. Families with 2 mentally ill parents will require particularly high levels of ongoing support. Smaller, but more detailed, retrospective case-control studies should be conducted to investigate the specific circumstances of death in families with parental mental illness, to further advance the findings from our large cohort study. Qualitative research is also needed to understand why risk factor prevalence remains so high among these parents.
Correspondence: Roger T. Webb, PhD, Centre for Women's Mental Health and Health Methodology Research Group, University of Manchester, Room 2.311, University Place, Oxford Road, Manchester M13 9PL, England (email@example.com).
Submitted for Publication: January 9, 2009; final revision received March 4, 2009; accepted April 21, 2009.
Author Contributions: Dr Webb and Ms Wicks had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Financial Disclosure: None reported.
Funding/Support: This project was funded by grant 073935 from the Wellcome Trust and grant 232/11.1 from the Foundation for the Study of Infant Deaths.
Role of the Sponsor: The funding sources had no role in the design or conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript.
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- Austrian GP - Race
Pit stop delays frustrate Hamilton
Lewis Hamilton says his slower pit stops made the tough task of beating Nico Rosberg even more difficult after battling from ninth on the grid to second in Austria.
A stunning first lap, in which he jumped to fourth, brought Hamilton into contention for victory, but he lost valuable time relative to Rosberg during both pit stops - with the gap between both in the box roughly 1.9s in the German's favour. That eventually accounted for the final gap between the two and Hamilton said he needs to work out the problem and concedes he may in fact be the culprit.
"They haven't yet," Hamilton said when asked if the team had explained his pit stop delays. "I didn't know it was that much time, but they didn't feel that fast. Obviously it's frustrating when you lose time, because you are constantly doing everything you can to gain a tenth here, a tenth there, so when you lose a chunk, like two seconds over the pit stops, it's tough.
"I have to have a look at the feedback, just see what the team say about the stops. Maybe my positioning is not right, in that situation you are just pushing. At least we haven't made any mistakes, let's step back and look at it like that, to get so many one-two's has been incredible this year. I'm hoping in the future I won't have those problems."
Hamilton's start off the line saw him jump between Kimi Raikkonen and Daniil Kvyat, before peeling past the likes of Fernando Alonso to cross the line looking at Rosberg's gearbox in fourth, leaving him wondering what might have been after his costly spin in qualifying saw him start ninth.
"It was a good start, we've been working very hard on our start throughout the years. It's probably one of the best starts I've ever had really. I was positioning the car in the right places. If I'd started where I should have started [it would have been better] but it was damage limitations, to get from ninth to second and ending up pressuring Nico shows the pace I had this weekend."

subset: commoncrawl


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vincentp wrote:thanks marc. I read my post again and I see I totally forgot to mention my actual location which is... France.
I know that import duty is very low in both the US and canada, unfortunately, anything coming from outside of the EU will be highly taxed for anything above $300 (ish). As they count the shipping cost in the total bill, an estimate of 25% import duty (> VAT) is what you have to pay. Stiff, isn't it ?
(but if you could fax me that machine, I'll take it for sure :lol: )
thanks again !
nobody with experience on the mechatronika 10V ?
This might be more than you're looking for, but it's at least located in France :)


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Thanks to everyone for coming out. As I mentioned at the dinner, we will skip December due to the holidays. We will start up in January again. Topic and date TBD. Here's the deck I used today: Keep an eye out for the hidden slides. There are quite a few more slides than I actually…
SQL Azure and SSMS: happy together
SQL Server Management Studio Support for SQL Azure http://blogs.msdn.com/ssds/archive/2009/11/10/9920168.aspx More details: http://msdn.microsoft.com/en-us/library/ee621784.aspx One of the things they don't mention in the post is that all this works in SQL Server Management Studio Express! Go get it: http://www.microsoft.com/downloads/details.aspx?displaylang=en&FamilyID=c772467d-e45b-43e1-9208-2c7b663d7ad1 Happy SSMSing with SQL Azure!!!
Going to PDC?
I am looking to connect with my customers at PDC. So if you work or are doing work (as contractor, consultant, etc.) for a US Government organization, then drop me a line here. I'd love to connect at PDC.
Simple, short videos on the Windows Azure Platform
Windows Azure Platform Windows Azure SQL Azure .NET Services Short, sweet, clear. Brilliant!


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Before the introduction of online
DDL, it was common practice to combine many DDL operations into a single
ALTER TABLE statement. Because each
ALTER TABLE statement involved copying and rebuilding the table, it was more
efficient to make several changes to the same table at once, since those changes could all be done with a single
rebuild operation for the table. The downside was that SQL code involving DDL operations was harder to maintain
and to reuse in different scripts. If the specific changes were different each time, you might have to construct
a new complex
ALTER TABLE for each slightly different scenario.
For DDL operations that can be done in-place, as shown in Table
5.8, "Summary of Online Status for DDL Operations", now you can separate them into individual
TABLE statements for easier scripting and maintenance, without sacrificing efficiency. For example,
you might take a complicated statement such as:
alter table t1 add index i1(c1), add unique index i2(c2), change c4_old_name c4_new_name integer unsigned;
and break it down into simpler parts that can be tested and performed independently, such as:
alter table t1 add index i1(c1);alter table t1 add unique index i2(c2);alter table t1 change c4_old_name c4_new_name integer unsigned not null;
You might still use multi-part
TABLE statements for:
Operations that must be performed in a specific sequence, such as creating an index followed by a foreign key constraint that uses that index.
Operations all using the same specific
LOCK clause,
that you want to either succeed or fail as a group.
Operations that cannot be performed in-place, that is, that still copy and rebuild the table.
Operations for which you specify
ALGORITHM=COPY or
old_alter_table=1, to force the table-copying behavior if needed for
precise backward-compatibility in specialized scenarios.


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Now that Max Payne 3's out, maybe you figured you'd catch up with Max Payne's drug-addled life by playing through the character's previous games. A great thought!
But reports are coming in that users aren't able to fully download and play the Xbox Live version of Max Payne 2 after purchasing it. The problem for some seems to be a download that gets stuck at 99%. Here at Kotaku headquarters, several attempts to download the full game went exceptionally slowly despite a very robust internet connection. Apparently, Microsoft are refunding the purchases for dissatisfied customers if they contact customer support over the phone.
Now, you don't really need to play Max Payne 2 to fully enjoy Max Payne 3. But if you want to do so on Xbox, it seems you're out of luck right now. Kotaku has reached out to Microsoft for comment and will update this story as needed.
After nearly an hour of download time, our attempted download of Max Payne 2 has stalled at 99% just like other users, confirming for us that there's a problem here.
[Thanks, tipster Thomas]


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Download and podcast this program here:
In this week's program, we take a closer look at how high stakes testing is impacting what happens in classrooms, how teachers see students, how students see themselves, and the kinds of society we are building through how young people are being educated. The impact of high stakes tests is both broadly social and intimately personal. Socially, high stakes testing re-segregates our schools, marginalizes black and brown children, young people who live in poverty and children who do not learn in traditional ways. High stakes testing tells us who we will value, and who we will not value, and makes room for us to criminalize youth, especially black and brown youth, opening the path to the school to prison pipeline. It operates within and builds on white supremacy, and exploits long standing privileges and oppressions. And, as with any dominant discourse, high stakes testing enters our consciousness and begins to structure how we see ourselves, each other, and the kind of world we want to build.
We speak with Linda Christensen, Director of the Oregon Writing Project at Lewis and Clark College, author of Reading, Writing and Rising Up among other books, and editorial board member for Rethinking Schools about how, entering the classroom, even with a curriculum designed to access student voices and knowledge, she discovered that the testing came to stand between her and the students, and her work with students to reclaim their knowledge and stories.
|Wayne Au
|Linda Christensen
Wayne Au, assistant professor of education at University of Washington Bothell, and author of Unequal by Design: High stakes testing and the standardization of inequality, talks about how high stakes testing locks some students out of the curriculum and begins a process of devaluing - that changes how students know themselves, how teachers know students, and how society sees young people, especially young people of color.
|Joan Grim
|Edward Brockenbrough
|Erica Meiners (with Tim Scott)


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ExpertGroup needed a new print or packaging design and created a contest on 99designs.
A winner was selected from 88 designs submitted by 13 freelance designers.
Expert Performers - http://www.ExpertPerformers.com
We are an entertainment agency that specializes in providing entertainment (singers, musicians, comedians, magicians, jugglers, mentalists, hypnotists) to upscale venues and events.
Corporations, Cruise Lines, and Performing Arts Theaters. Our audience is upscale, affluent and sophisticated.
We are seeking a presentation folder that generates a "wow" response from our clients without any design elements that include embossing, foil, stamping, spot UV, etc.
Colors: The logo color cannot be changed. Aside from that, no white background.
The front of the folder will include the following:
Our logo icon: Letter "e" in circle (provided in link below)
The slogan "Unforgettable Performances Start Here!"
** WE HAVE INCLUDED 3 DIFFERENT GRAPHIC IMAGES THAT WE THOUGHT WOULD BE UTILIZED - AFTER VIEWING ALL SUBMISSIONS WITH THE IMAGES (Mic, Audience) I HAVE DECIDED TO HAVE ALL SUBMISSIONS BE WITHOUT THE IMAGES ** We would like to see something more conservative and sophisticated.
Graphics or Artwork: We have provide idea graphics. Retro style microphone, audience applauding, audience w/standing ovation (see samples in link below)
The back of the folder will include the following:
Our logo either stacked or horizontal (provided in link below)
Our URL ExpertPerformers.com
Graphics or Artwork
A template is provided from our vendor in the link below. This folder has a CD/DVD slit on the left pocket and a biz card cut on the right.
This is the third time we have used this service and have been pleased with the results. We are very easy to work with - We leave frequent and detailed feedback (check it out, 80%).
- We have additional projects that we will give to the winner of this contest.
We look forward to some fantastic designs!


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Hi,I have heard Vegetables loose its Vitamins and Minerals if you cook it really well. Is that true? Should we cook it to "Al dente"?
Yes, it is true that the way vegetables are cooked can be important in avoiding unnecessary nutrient loss. Steaming causes the least amount of vitamin and mineral loss because the vegetable is surrounded in steam rather than submersed in water since many vitamins in vegetables are water-soluble. Also, the longer the food is exposed to heat and moisture, the greater percentage of nutrient loss will be experienced. However, with most cooking techniques, nutrient loss is small. You will receive the nutritional benefits of vegetables whether you eat them raw or cooked!


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Cosmetic dentistry is the process of improving the appearance of a person's teeth, gums and smile.
Although the American Dental Association (ADA) does not recognize cosmetic dentistry as a formal specialty most cosmetic dentists are held in high regard because of their extensive education, training, and experience in improving the esthetics of a person's oral appearance.
Cosmetic dentistry procedures differ from general dentistry or restorative dentistry procedures in that they are elected as opposed to required.
Cosmetic dentistry has the added dimension of art as well as combining the oral health benefits of general and restorative dentistry to give patients the smile they have dreamed of.
The latest advancements in dental technology have allowed cosmetic dentists to utilize materials that are both durable and esthetically pleasing.
The amount of additional training cosmetic dentists undergo allows them to blend both art and science into smiles that are healthy and beautiful.
Materials such as porcelain or composite materials are closely matched to resemble the look and feel of your original teeth, giving a natural appearance of your teeth and smile that enhance one's oral appearance.
Cosmetic dentistry has also taken leaps in utilizing less invasive techniques that conserve as much natural tooth as possible.
These practices combined with advancements in natural-looking, tooth-colored dental materials make today's cosmetic dental treatments more durable and predictable than in years past.
In addition to these advancements, many cosmetic dentists are available to perform many procedures in-office that used to require referrals to other specialists.
The need for patients to see multiple dental care providers and experience multiple trips has been replaced by more convenient and advanced procedures and has reduced recovery time.
Cosmetic Dental Procedures
Dental Implants
A dental implant is a form of cosmetic dentistry used to replace missing teeth for a look and feel that is natural. Dental implants are long-term replacements that your cosmetic dentist or oral and maxillofacial surgeon surgically places in the jawbone. With the exception of children, dental implants can be a healthy solution for people of all ages and are a good alternative to dentures or partials.
Dental Bonding
Tooth bonding is the application of a tooth-colored resin material using adhesives and ahigh-intensity curing light. Bonding is typically used for cosmetic purposes to improve the appearance of a discolored or chipped tooth, close spaces between teeth, to make teeth look longer or to change the shape or color of teeth. It is also used as an alternative to amalgam fillings, or to protect a portion of the tooth's root that has been exposed when gums recede.
Dentures are used to replace missing teeth that can be taken out and put back into your mouth. There are generally two types of dentures available: complete dentures and partial dentures. Dentures are used so that patients who suffer from tooth loss don't have to suffer the negative effects of not having teeth. They are free to eat and drink most foods and don't suffer from the sagging facial appearance that occurs with missing teeth.
Invisalign is the most popular alternative to orthodontic appliances such as braces because they employ a clear tooth aligner that is invisible to the eye. Users are attracted to this product because it allows them to straighten their teeth while maintaining a professional appearance. The aligners fit comfortably over the teeth and gradually straighten them the same way braces do.
Teeth Whitening
Tooth whitening is the most common cosmetic dentistry procedure because it can significantly improve the appearance of your teeth at much less cost and inconvenience than other techniques. There are various types of teeth whitening treatments available ranging from in-office bleaching to take-home kits that take a few weeks. Each method has its pros and cons and you can learn more about them here.
Braces are an orthodontic corrective appliance used most commonly to properly align teeth. Often times a cosmetic dentist may recommend braces before other cosmetic procedures because a misaligned mouth can lead to various dental health problems. A bad bite can make maintaining teeth more difficult and can lead to oral health problems that would have been much cheaper and easier to prevent than to fix.
Dental veneers are custom-made ultra-thin shells of tooth-colored materials designed to cover the front surface of teeth to improve your appearance. They can remedy the look of teeth that are chipped, discolored, misaligned, uneven, worn down, or abnormally spaced. The result of a dental veneer treatment is teeth that are bright and beautifully aligned and look and feel completely natural.
Cosmetic dentistry offers many opportunities to restore and enhance teeth that may suffer the effects of aging, trauma, poor genetics, or general wear-and-tear.
If you wish to improve your smile and appearance consult with an experienced cosmetic dentist that is affiliated with the ACE network to ensure the best in patient care and dedication to excellence.
Cosmetic Dentistry Materials
Modern advancements in dentistry have replaced the materials of dental fillings and other tooth restorations that were made of gold, amalgam, and other metals.
Modern materials more closely resemble the look and feel of natural teeth with materials like porcelain or resin composite.
The difference is that these materials are more natural in appearance and closely resemble the durability of real teeth. These materials are bonded to the underlying tooth structure with resin adhesives and crafted by your cosmetic dentist to resemble your natural tooth.
The consideration of materials may prove to be an important factor in your cosmetic dentistry treatment as some materials may differ in cost and in appearance.
For example, dental ceramics that contain predominantly glass best mimic the optical characteristics of enamel and dentin, and your dentist may consult with you regarding these types of characteristics as related to cost as your individual tooth characteristics such as opalescence, color, and opacity will be taken into account when selecting an appropriate material.
Learn more:


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Spring Revival Dublin Mills Community Church, 2700 Dublin Mills Road, Hustontown, will hold spring revival meetings with Bro. Bill Wollett from March 17-24. The meetings will begin at 10 a.m. on Sunday, March 17, and be held each evening at 7 p.m. through Sunday, March 24, at 7 p.m. The meetings will include a variety of special music, inspirational worship, fellowship and the challenging word. Visitors are invited to attend. Please call 814-685-3910 for more information.
Special Services Starting February 20, Warfordsburg Presbyterian Church will hold "24 Hours That Changed The World" every Wednesday. Join in as steps are retraced of Jesus on his final day in this powerful several weeks of study. Weekly program schedule is "The Last Supper," "The Garden of Gethsamane," "Condemned by the Righteous," "Jesus, Barabbas and Pilate," The Torture and Humiliation of the King," "The Crucifixion," and "Christ The Victor." Starts promptly at 6:30 p.m. with a free fellowship meal followed by an hour study from 7 p.m. to 8 p.m. More information may be obtained by calling 717-294-3028.
Benefit Auction A benefit auction will be held at Chambersburg Mennonite Church, Friday, February 22 (snow date February 23). Food will be available at 5 p.m. and auction begins at 5:30 p.m. New items available along with gift certificates, handmade items and collectibles.
Auction/Dance Ashlyn's Angels will hold a benefit auction/ dance March 23, 2013, at McConnellsburg American Legion. Doors open at 3 p.m. and auction starts at 5 p.m. Admission tickets are $5 each and on sale now. Anyone wishing to purchase or help sell tickets or make a donation to be auctioned off, please contact Nancy Bivens at 717-799-7343 or Patti Mills at 717-294-3676. Proceeds benefit Jeff Evertts, who is battling lung cancer.
Mic And Jam Night McConnellsburg Alumni & Friends Association will sponsor a Mic and Jam night in the alumni community gym Saturday , March 16, 2013, starting at 5 p.m. Kitchen will open at 4 p.m. and the museums will be open. All ages are invited to come and listen, dance, eat and enjoy a night out. Anyone wishing to perform on March 16, 2013, please contact John Hendershot at 328-2899.
Card PartyAn old-fashioned, free card party will be held Saturday, February 23, at 6 p.m. in the alumni community building. Everyone is invited to attend and asked to bring a covered dish that all can enjoy. Any questions, please call Kathy Kendall at 485-0221 or 377-3643.
Little League Registration Reminder Time is running out for the Farm League registration (7- and 8-year-olds) and for Little League registration (9-, 10-, 11- and 12-year-olds). Forms can be obtained from Greg Strait or Loy Garber.
Pony League Registration Fulton County Pony League registration will be held for ages 13-14 as of April 30. Registrations will be held Friday, February 22, from 6 p.m. to 8 p.m.; Saturday, February 23, from 9 a.m. to noon; Friday, March 1, from 6 p.m. to 8 p.m.; and Saturday, March 2, from 9 a.m. to noon. Registration will be held at the Ray Koontz Memorial Little League field in the upstairs pressbox located above the concession stand. Cost is $30 nonrefundable, to be paid upon registration. This fee includes shirt and hat. Checks may be made to Fulton County Pony Baseball. Please bring a copy of child's birth certificate to registration. More information may be obtained by calling Steve at 717-404-0054 or Garry at 717-552-1222.
Snow Tubing Better Days Animal League invites all to join us for Whitetail Adventure Snow Tubing Wednesday, February 27, from 4 p.m. to 10 p.m. Tubing rates are $18/1 hour; $21/2 hours with 20 percent of proceeds going toward providing the best possible care for the many dogs and cats in adoption centers.
Dodgeball Tournament A benefit dodgeball tournament will be held Sunday, February 24, at the alumni building in Mc- Connellsburg. Registration begins at 1 p.m. and tournament starts at 1:30 p.m. Cost is $10 per player and $3 per spectator. Teams of any number of players, teams and ages can come. A concession stand and bake sale will also be held. Proceeds benefit Tristan Douglas and Cody Trail who are both fighting cancer. More information may be obtained by calling 717-485-4209.
Yard/Bake Sale A two-day indoor yard and bake sale will be held at Needmore Bible Church Family Life Center on Friday, February 22, from 8 a.m. to 4 p.m. and Saturday, February 23, from 8 a.m. to noon. A food stand will also be available with hot dogs, steamers, homemade soups, pie, chips and drinks. All proceeds benefit the NBC missions trip to Brazil.
WAYS Sign-up Warfordsburg Ara Youth Soccer (WAYS) will hold spring sign-up on Saturday, March 2, at Dott Store, from 10 a.m. to noon. More information may be obtained by calling Lauren Mosemann at email@example.com or 717-573-2524.
Gold Game At SFHS A Gold game will be held at Southern Fulton High School February 23, 2013. Come watch the alumni basketball players and cheerleaders. Games start at 6 p.m. Concession stand available. Admission is $3 for adults $2 for students. Proceeds benefit Tristan Douglas who is fighting a battle with cancer.
Open Stage An open stage, sponsored by Hustontown Area Volunteer Fire Co., will be held Saturday, February 23, at 6 p.m. The kitchen opens at 5 p.m. with free admission.
Bus Trip To Sight And Sound The Knobsville United Methodist Church is taking a bus to Sight and Sound theatre in Lancaster Saturday, April 27, for the production of "Noah." There are a few remaining seats available on the bus. Please call Joann at 717-987-3164 for more information.
Walk, Run, Play Walk, run and play at the alumni community gym free every Monday, Wednesday and Friday from 11 a.m. to 1 p.m. Questions? Please call Kathy Kendall at 485- 0221 / 377-3643.
Hall Walking Hall walking will be held Tuesday and Thursday evenings during the months of February and March, from 5 p.m. to 7 p.m. at McConnellsburg High School.
Fitness Classes Reaching Wellness Presents Work It Out fitness classes for women. All fitness levels welcome. Every Tuesday and Thursday in February at 5:30 p.m. For more information, email:email@example.com. or call Catherine Washabaugh at 717-816-4331.
Community Wellness/Silver Sneakers/Prime Community Wellness/Silver Sneakers/Prime will be held Monday, Tuesday and Thursday, from 6 a.m. to 7 a.m. and 1 p.m. to 6:30 p.m. and Wednesday and Friday, 7 a.m. to 3:30 p.m., at Fulton County Medical Center cardiopulmonary rehab gym. The cost is based on insurance. Call Kim or Patti at 717-485- 6149 to see if insurance provider is accepted. Community Wellness is $40/month/person or $70/month/couple.
Free Dental Screenings Free dental screenings for ages birth to 18 will be held at Fulton County Partnership Dental Clinic (Overly-Raker building) February 15 from 9 a.m. to noon. No appointment is necessary. Cancelled in the event of bad weather. More information may be obtained by calling 717-485-3079, Ext. 207.
Zumba Classes Zumba classes will be offered at Mc- Connellsburg Firehall Wednesday evenings at 7:15 p.m. More information may be obtained by contacting Sarah at 814-259- 3667.
Yoga Classes Reaching Wellness yoga classes will be held for all ages every Wednesday, 4:30 p.m. and 6:30 p.m., at Community State Bank. Call for cost and to register at 717-485- 4492.
AA Meetings AA meetings will be held every Monday beginning April 1 at 11 a.m., at Fulton County Medical Center, Second Floor, Pearl Room. More information may be obtained by calling 485-6115.
Zumba Fitness Reaching Wellness Zumba fitness class will be held for all ages every Friday at 6 p.m., at McConnellsburg Alumni & Friends building. More information may be obtained by calling 717-253-7599 or at email@example.com.
SF Kindergarten Registration Southern Fulton School District will hold kindergarten registration March 7 and March 8, 2013. Anyone having children who will be 5 years old before September 1, 2013, please call the elementary school at 717-294-3400 to schedule an appointment.
Girl Scout Cookie Sale Fulton County Girl Scouts will be selling Girl Scout cookies on Wednesday, February 27, at Lincoln Way Pizza in McConnellsburg. In addition, Lincoln Way Pizza will be donating 10 percent of their dine-in meal proceeds that day back to the Girl Scouts.
Benefit Book Sale More than 60,000 new and used books of all types, plus CDs, maps, sheet music, magazines, videotapes and artwork, will be offered for sale at bargain prices at the 29th annual Friends of Legal Services Book Sale at Laird Hall on the Wilson College campus in Chambersburg May 10-12. Hours are 9 a.m. to 9 p.m. on Friday, May 10; 9 a.m. to 5 p.m. on Saturday, May 11; and noon to 4 p.m. on Sunday, May 12. Additional information may be obtained by calling 717-262-2326.
PIAA Softball Umpires Clinic A PIAA softball umpires clinic will be held Sunday, March 17, at 10 a.m., at Bedford Middle School. This clinic is open to all current and potential softball umpires. Registration is from 9:30 a.m. to 10 a.m. Clinic starts at 10 a.m. To register call Audrey Hall at 717-377- 3707. Checks should be made payable to Bedford County Softball Officials. Cost is $20. Mail check and registration to Audrey Hall, 114 South Third Street, McConnellsburg.
Conservation District Tree Sale Fulton County Conservation District is currently taking orders for its annual tree sale. A large variety of fruit, nut, ornamental and forestation trees are available. Also available are strawberries, blueberries, grapes, rhubarb and asparagus. Deadline for orders is March 8. An order form can be obtained by calling 717-485- 3547, Ext. 116, or by e-mail at firstname.lastname@example.com, or by visiting http://fultoncountyconservationdistrict.org/tree-sale. Profits are used to support environmental education efforts within Fulton County.
VFW Nominations Nominations being accepted for vacancies on the board of directors for VFW. Must be a VFW member.
Help FR Fight World Hunger Forbes Road FFA is attempting to raise $2,000 to send livestock to third world countries. The donation deadline is March 8. This will bring agricultural knowledge, bring back economic opportunity and feed those who are hungry. Anyone wishing to make a donation can contact the FFA advisor at 814-685-3866, Ext. 1118, or Alexis Clippinger at 717-491-9323.
CF Registration Central Fulton School District will hold registration for the 2013-2014 school year Thursday, Friday, Monday and Tuesday, March 21, 22, 25 and 26. Children who will be age 4 on or before August 19 are eligible for the 4K program, and children who will be age 5 on or before August 19, 2013, are eligible for the 5K (kindergarten) program. Please note that students who are currently enrolled in the 4K program do not need to re-register for 5K. Please contact Stacy Morton at 485-7072 to schedule an appointment.
Community Victory Garden The Fulton County Master Gardeners would like to invite the public to participate in the second-year community Victory Garden within McConnellsburg Borough held Wednesdays from April to September, from 9 a.m. to 11 a.m. The gardens will be at Second Street behind the McConnellsburg Firehall. There will be a small fee associated with this program: $20 per person or $30 family to defray material costs for the 2013 season. A meeting of those interested will be held to discuss the program. Anyone interested should contact the Fulton County Extension Office and speak with Donna E. Shasserre at 717-485-4111.
Workshop on Planting Seeds A workshop on planting seeds will be held Saturday, March 9, fom 9 a.m. to 1 a.m., at the first floor of McConnellsburg Firehall. Cost is $10 per person. To reserve a seat call 485-4111. Program presented by Fulton County Master Gardeners.
Pancake Supper A pancake and sausage will be served March 2 at Asbury United Methodist Church, 7404 Lincoln Highway, Harrisonville, from 4 p.m. to 7 p.m. Donations to support UMW mission project.
Free Pasta Dinner A free pasta dinner will be served March 12 at Asbury United Methodist Church, 7404 Lincoln Highway, Harrisonville, from 4:30 p.m. to 7 p.m. Everyone is welcome.
Free Meal A free meal will be served the second Tuesday of each month at St. Paul Lutheran Church, 220 North Third Street. Please join in for good fellowship.
Italian Dinner Fulton County Community Christian School will hold an Italian dinner February 23, from 4 p.m. to 7 p.m. Menu will be lasagna, stuffed shells, spaghetti, garlic bread, salad bar, dessert and beverage. Donations will be accepted. More information may be obtained by calling 717-573-4400.
Pancake Supper Whips Cove Church will hold a pancake supper Saturday, March 2, at 5 p.m. Served will be buttermilk pancakes, old-fashioned buckwheat cakes, eggs, pork puddin, sausage, ham, sausage gravy, coffee, hot chocolate and juice. Donations accepted. The church is located at 5044 Moss Road, Warfordsburg.
Lincoln Day Dinner The Lincoln Day dinner will be hosted by Fulton County Republican Committee on Saturday, February 23, at 6 p.m., at McConnellsburg Firehall. Tickets are $13 for adults; $6.50 for children 6-12; children 5 and under eat for free. Please contcat a council member for tickets or Jackie Yates at 717-573-2571.
Breezewood Bingo Cancelled Bingo at Breezewood Fire Co. will be cancelled for the month of February.
Cemetery Assoc. Meeting Jerusalem Cemetery Association will hold its annual business meeting Saturday, March 2, at 7 p.m. at the Jerusalem Christian Church.


text: Stylish Tunic for everyday wear. It is very comfortable, made with 100% rayon fabric. You can wear this Tunic according to your style from a skinny jeans to a palazzo pant and still look Modestly awesome! It has two convenient side pockets for handy use! Actual color may vary slightly from the pictures due to different light effect.


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Our apologies for not posting this sooner, but at least you'll be able to root through the archives after the Tour concludes, and relive your favorite moments. One of the best daily blogs to follow and analyze the race is Blazin' Saddles, which appears via Yahoo! Eurosport. Pappillon strongly recommends it. Excerpt:
"Stage 17 prediction: After the rest day both Contador and Schleck are going to be caught napping as they continue their discussion on the pros and cons of Tour protocols. Menchov will show the world just why he's called 'The Silent Assassin' by knifing them both in the back before powering up the Tourmalet. Despite falling twice on the ascent, the Russian will ghost into the yellow jersey, with Sanchez moving into second. Fabian Cancellara will complain via a video on YouTube. Andy will get very angry once again, but then forget all about it and hug Alberto."
In Saddles' own words:
"Ever since he was bullied by his brothers into watching the Tour de France as an eight-year-old, Blazin' Saddles has been a cycling fanatic. As persistent as Voigt, as fast as Abdoujaparov, as voracious as Ullrich and as accurate as a Festina watch, Blazin' Saddles offers a lighter take on the oft-grave world of professional cycling. The self-styled best cycling-blog pedlar in the business, BS refutes sullied claims of doping levelled by his rivals: these nuggets are powered on Gerolsteiner fizzy water alone. Just ask BS's friend Bernhard Kohl for a reference."
Wednesday, July 21, 2010
Recommended Reading
at 2:22 PM
Labels: Blazin' Saddles, Denis Menchov, Tour de France
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Hsbc Bank Cheque Drop Box
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Metal is a chemical element that is a good conductor of both electricity and heat. Used in a wide range of industries, metal has been a material of choice for demanding parts that require high strength, durability, and high cavity to cavity repeatability.
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Making Strides with Magnesium Injection Molding
Download PDF


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Tuesday, December 13, 2011
Ben Francisco Is...Something?
The Jays acquired outfielder Ben Francisco from the Phillies yesterday afternoon for pitcher Frank Gailey. (And seriously, who on Earth is Frank Gailey?) Before we'd even made it through 50 characters of the tweet officially announcing the transaction, we were short of breath, dizzy with the possibilities of what the next move in the sequence might be. Was this Travis Snider's final moments in our laundry? Was Gio Gonzalez on his way to walk 90 batters in a Blue Jays uniform next season?
By the time 5 pm rolled around and Alex Anthopoulos' conference call comments began getting tweeted out, and it was clear that there were no subsequent moves to come, we were more than a little confused. So, Ben Francisco is really here to stay?
In trying to wrap our heads around the move, we thought for a moment about Earl Weaver, and his notion that a team needn't have more than nine pitchers, including four starters. That's a tough sell now, but having six position players on the bench so that you can work platoon advantages in your favour is not the worst idea we could think of. Sure, you might wish that Travis Snider would learn to hit lefties, but let's pretend that a pool of rabid gators is going to be let loose on your meaty posterior unless the Jays win 94 games: Would you run Francisco out against left-handed pitchers? Yer darn tootin' you would!
(Setting aside, of course, the bizarrely even platoon splits that Francisco himself has, he would be a better option against the southpaws than Snider, Thames, or maybe even Rasmus.)
Not that we think that any of this actually happens. We're still doubtful that Francisco - supposing he even makes the team - plays as often as Corey Patterson did last year, and we're still assuming that John Farrell would prefer more choice in the bullpen than on the bench. But the notion that the team might work in some regular platoons at first, second and in left appeals to us. If that's where this outfield pileup nets out, we'll be happy to see it.
Scrap Heap Dreaming
There were 29 men set loose and left untendered at the deadline to...um, tender. It's an inauspicious list, though if we had to pore through it (and why wouldn't we?), here are a few notable names that we might consider.
-Hong-Chih Kuo: Sky high walk rates (7.0/9) and injury derailed him in 2011, but for a modest contract (something under the $2.75 million he made last year), we'd think he'd be a decent fit towards the back of the Jays' pen.
-Ryan Spilborghs: Because who couldn't use one extra outfielder in the mix? We like the .360 OBP in 2010, and wouldn't mind him as a bench player.
-Eli Whiteside: Not so much for his bat or his ability to handle pitchers. But he couldn't be that much worse than Jeff Mathis, and he has the most awesome surname-to-hair relationship in the Majors. He could be a Bond villain.
-Joe Saunders: Or as we'll affectionately refer to him, "Joe-Joe Saunders". (Incidentally, Jo-Jo Reyes IS available. But let's not go there.) Saunders is a classic innings-eater, and wouldn't be much more than a fifth starter, but he wouldn't be a bad option to have around given the questions around Kyle Drabek, Jesse Litsch and Dustin McGowan going into the season.
-Jeremy Hermida: We'll always advocate for Jeremy Hermida. We always add him in deep fantasy leagues and on video games, and we'll always remember the year he hit 84 homers for us in a season of 2K baseball. Sign him up, because we can't quit Hermida.
8 comments:
- Ty said...
Kuo wasn't derailed by injury, it was an anxiety disorder... I'd love to pick him up but I think if he does end up pitching again, it'll be with the Dodgers. The only reason they non-tendered him was because he's apparently unsure if he still wants to pitch, but I'd assume under the circumstances that L.A. would be the first choice if he does decide to come back.
- December 13, 2011 at 4:22 PM
- Tao of Stieb said...
Didn't realize that. I probably could have found that information had I looked. I just remembered him being DL'ed last year.
- December 13, 2011 at 4:46 PM
jojo reyes is available!
I dont think thames or snider will be moved. I think fransico is to compete with davis who may or may not be healthy yet.
- December 13, 2011 at 4:51 PM
the Jays haven't had a good LF since Jorge Bell
- December 13, 2011 at 6:20 PM
- Ty said...
The thing about Francisco is, even if one of Snider or Thames is moved, the overcrowded outfield situation doesn't change at all because the current projected roster already assumes one of them will be spending the ear at AAA. I can't see both Francisco and Davis starting the year on the team.
- December 13, 2011 at 7:06 PM
Hey Tao,
Can you have a post about Yu Darvish? Is he a real deal or it's all hype?
- December 14, 2011 at 2:12 PM
Came here to read about Darvish and nothing?
- December 16, 2011 at 1:22 PM
Looking to make excuses for those cheap fucks at Rogers trying to block the Yankees, Tao?
- December 16, 2011 at 4:02 PM


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- Multi channel hull for ultimate tracking and stability
- Adjustable back rest and comfortable seat cushion
- Adjustable Step Lock footrest system
- 10" x 18" rear storage hatch
- Front and rear bungees
- Deck plate with cup holder and side compartments
- Bow and stern carry handles
- Integrated drain plugs
- Molded-in cup holder
- Blowmolded
|Tandem or Single?
|124 in - 315 cm
|32 in - 81 cm
|11.5 in - 29 cm
|300 lbs - 136 kg
|45 lbs - 20.5 kg
|38.5 in x 20.5 in - 98 cm x 52 cm
Customer Reviews (4)
- You're never to old.Review by Wheels
- Love itReview by WaterRat
- Awesome boat but....Review by UltraFlyGuy
- Excellent kayak Review by Wolf359
Write Your Own Review
Q1: Can I buy a spray skirt for my Kayak? If so, where?
A1: Only sit-in kayaks can accept spray skirts, but not all of them do. It all depends on the size of the cockpit and the shape of the lip. Some cockpit dimensions are shown on the product detail page. If you don't see your cockpit dimensions, you can use a tape measure and check the width and length of your cockpit including the lip. To purchase spray skirts, please visit www.sealsskirts.com.
Q2: Regarding the «weight capacity» to a specific kayak, is there a general rule that applies whether it should suit me or not?
A2: The weight capacity stated on the kayak documentation represent the maximum weight the kayak can hold to be fully usable. For a more comfortable ride, always look for a kayak that has a weight capacity approximately 30 to 40lbs above your actual weight. It's even more important for sit-on top kayaks as the closer you are to the weight limit, the deeper will the line of floatation be, resulting in more water coming into the kayak from the scupper holes.
Q3: Where do I find the Serial/Warranty #?
A3: Your kayak's serial number is located behind the seat or on the rear left hand side (when looking at your kayak from the front). Please use this number in order to register your kayak on the Registration section of our website.
Q4: What is the best way to store my kayak?
A4: The ideal way to store a kayak is to sit it on a flat surface. If your kayak remains outdoors, you should keep it covered and out of direct sunlight. Do not leave any straps tightly clinched around your kayak for long periods, especially in warm weather. This could distort the shape of the kayak. For an easy storage and access to your kayak, we recommend to take a look at the different options in the Accessories section of our website.
Q5: I would like to put a rudder system on my kayak, is it possible?
A5: None of our kayaks comes with a rudder system. Even if there are third party rudder system available on the market, we do not recommend the use of any specific one. The installation of a rudder system is done at your own risk. Please note that any permanent alteration of your kayak hull will result in the cancellation of the warranty.


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35395, Children's Songbook, The Savior, Picture a Christmas, 50-51
1. Picture a stable in Judea.
Picture a sacred, silent night.
And can you hear
The angels near
And see the star so bright?
Picture the little baby Jesus.
Think of his life and words so dear.
Sing praise to him;
Remember him,
As you picture Christmas this year.
2. Picture the kind and gentle Joseph.
Picture the mother, Mary, fair.
And can you see
So rev'rently
The shepherds kneeling there?
Words and music: Patricia Kelsey Graham, b. 1940. © 1983 IRI
Luke 2:4-16
Matthew 2:1-2


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Cornell Raiders Girls Basketball: View the Guestbook.
1. - Posted February 13, 2010 11:34AM
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*Only the original Tahitian Noni Juice increases endurance 21%. Human Clinical Trial:


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'Twilight' Reboot Already in the Works?
Sometimes, you hear news that makes the hair on the back of your neck stand up. Your rational mind denies it. You remind yourself that no one could possibly be that greedy. No one could possibly be that stupid. No film studio could loathe their audience that much. This is a Rumor with a capital "R," so grab your fistful of salt, but Bloody Disgusting is reporting that the folks at Lionsgate (who recently acquired Summit Entertainment) are already discussing a reboot of the 'Twilight' franchise.
Of course, this rumor was almost immediately denied by Lionsgate honcho Rob Friedman, who told Deadline: "We are not remaking Twilight. We will happily support Stephanie Meyer if she decides to proceed in any way. But this will be the last one unless that should change." But what does that mean? If Stephanie Meyer decided there should be a 'Twilight' remake (and she's publicly pondered the thought in the past) not even five years after the first one hit theaters, would Lionsgate follow her? Well, um, yeah. This franchise had made hundreds of millions of dollars and since movie studios have this nasty little habit of thinking with their wallets first, they'd follow Meyer and her sparkling vampires right off a cliff.
This is a disheartening rumor, not necessarily because just as many people loathe these films as those that love them, but because it's pure naked greed. 'Batman Begins,' 'The Incredible Hulk' and the upcoming 'The Man of Steel' are reboots, yes, but their franchises were rebooted following disastrous films that had done seemingly permanent damage to their names. A 'Twilight' reboot is just a plan to drag the franchise's audience back into the theater for the same 'ol thing, expecting them to pony up the cash like sheep. It's just plain icky.
But let's face the facts: this sounds outlandish and it's a Rumor and a Rumor alone. Blood Disgusting may be convinced that this is going to happen, but we're not so sure. In fact, until we hear hard evidence, we think it's all just bogus. We wouldn't be surprised to see Lionsgate whip up some non-literary sequels to 'Twilight' or craft more adventures in the series' universe, but a reboot? Don't count on it.
Please let us be right about this one.


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Toca Percussion 4711SEC
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