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Republican presidential candidate Mitt Romney has described his disparaging remarks about the 47 percent of Americans who don't pay federal income taxes as "not elegantly stated." Now he's calling them "just completely wrong."
Romney had contended that nearly half of Americans consider themselves "victims" and are dependent on government.
In an interview Thursday night with Fox News, Romney was asked what he would have said had the "47 percent" comments come up during his debate the night before with President Barack Obama.
Romney responded that sometimes in campaigning something doesn't come out right and that, quote, "In this case, I said something that's just completely wrong."
The "47 percent" comments came to light in mid-September after the release of a secretly recorded video from a May fundraiser.


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Torches in hand and hounds at their side, the bond vigilantes at Wednesday's Spanish bond auction imposed a heavy price on the Spanish government's most recent issuance of debt, reviving fears of European debt contagion spreading.
With weak demand, the yield reached a high of 5.81% in Thursday trading. Bill Gross, the world's biggest bond manager, put the matter in perspective on Twitter. "Greece was a zit, Portugal is a boil, Spain is a tumor. You can't fix a debt crisis w/ austerity & more debt," the Pimco manager tweeted.
Indeed, Spain renewed its commitment to austerity in the 2012 budget its government presented on Friday. Combined budget cuts and tax increases worth 27 billion euros are aimed at bringing the budget deficit down to 5.3% of GDP from 8.5% currently.
So, was the bond market unmoved by the Spanish government's cuts? Or, as Gross implies, might the cuts be contributing to a sense that the Spanish economy will be sliding further downhill?
Dow Jones quotes the London-based sovereign debt analyst Nicholas Spiro saying, ""Bond market credibility in Southern Europe is now at least as much about growth as about lower deficits."
Spiro's comment succinctly state's the bond market's case against Spain, and Gross' tumor comment suggests the malignancy affects many other players on the economic stage as well. That austerity measures must form part of Spain's approach to international bond investors seems beyond dispute. It must do something to assure creditors it is gaining control of its finances.
Mike Shedlock's Global Economic Analysis blog reveals that nearly 57% of Spain's budget is devoted to pensions, unemployment benefits and interest at a time when unemployment is pushing 24% and the economy is sliding into recession. Understandably, bond investors would be reluctant to lend to a sovereign like that absent high rates and assurances it has an economic future.
So what can Spain do if it is stuck between a rock and a hard place—between the need to cut, which stifles growth, and the need to grow? New research by two economists on the question of austerity may provide an answer to this seeming paradox.
Alberto Alesina of Harvard and Francesco Giavazzi of Italy's Bocconi University, in a paper published this week called The Austerity Question: 'How' is as Important as 'How Much,' argue that the way fiscal stability is achieved makes the critical difference. Specifically, they say "the accumulated evidence from over 40 years of fiscal adjustments across the OECD speaks loud and clear" that cutting spending has less of a recessionary impact than tax increases, and that spending cuts combined with easy money, labor-market and other structural reforms can stabilize if not reduce debt-to-GDP ratios.
Tax hikes aimed at increasing revenue do not succeed in arresting the rise in debt-to-GDP ratios, the authors say. "When these fiscal packages are announced entrepreneurs' confidence falls sharply, and this is reflected in a fall in output." This is all the more the case in the European context where tax revenues are close to 50% of GDP, they add. Moreover, spending cuts do not depress entrepreneurialism and often lead to an increase in GDP within a year, they say.
Indeed, the U.K. Treasury in February—in the first test of a new wealth tax introduced last year—received 509 million pounds less in revenue for the month of January compared with the previous year. The Treasury had projected that monthly revenues would actually increase by more than 1 billion pounds.
Alesina and Giavazzi criticize the new fiscal compact European leaders are expected to ratify soon. That agreement calls for fiscal austerity but ignores the critical question of the composition (i.e. how versus how much) of proposed fiscal packages.
Deficit reduction remains a key issue in this year's U.S. presidential election as well, and the question of how deficit reduction is to be achieved will likely take a prominent place in the debate.

subset: commoncrawl


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A farmer in Milani, Kenya, measures fertilizer with a One Acre Fund planting scoop and pours the microdose of fertilizer into holes his group members have dug for his maize.
Photo by Hailey Tucker, courtesy of the One Acre Fund blog. One Acre Fund supplies smallholder farmers with the tools and financing they need to grow their way out of hunger and poverty.
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Amanda Todd's mother, Carol Todd, doesn't want other children to suffer as her daughter did — stalked and harassed by bullies in cyberspace and in the schoolyard, by people she knew and by stalkers many miles away.
Amanda told her story in the heart-wrenching video that chronicled her nightmare: the taunts, the beating, the cyber-stalker who tracked her down whenever she tried to start afresh at a new school — firing off images that captured her showing off her young body, flattered by online attention from someone she thought was a kid just like her.
Amanda killed herself this week, one month shy of her 16th birthday and one month after telling the world through a YouTube video of bullying that left her depressed and despairing.
If you or someone you know is experiencing suicidal thoughts, click here for ways to get help
Now Carol wants to tell her story. It is a story no mother wants to tell.
"Amanda was a very caring individual. She would help others who needed help," Carol told The Vancouver Sun during an exclusive interview Friday at her home, where she was surrounded by friends and family. "One of Amanda's goals was to get her message out there and have it used as a learning tool for others."
As a teacher in the Coquitlam school district and a specialist in assistive technologies, Carol is comfortable around computers and knows well the dangers the online world can hold. Still, she wasn't able to protect her child.
"I have lost one child, but know she wanted her story to save 1,000 more."
Amanda was 12 years old when she made a mistake that would haunt her until her death three years later.
Her ordeal started while she was fooling around online with friends. She probably didn't think it was risky behaviour when she lifted her top to flash the person who was flattering her at the other end of the webcam.
Amanda's moment of indiscretion was not unusual for someone her age: Sexting and using webcams to share sexual photos is a growing trend among children, some so young they are still in grade school.
"The Internet stalker she flashed kept stalking her," said Carol. "Every time she moved schools he would go undercover and become a Facebook friend. What the guy did was he went online to the kids who went to (the new school) and said that he was going to be a new student — that he was starting school the following week and that he wanted some friends and could they friend him on Facebook."
"He eventually gathered people's names and sent Amanda's video to her new school."
The video and photos went to teachers, to parents, to Facebook friends, which lead to repeated taunts: "Oh, there's the porn star."
"It increased her anxiety and she couldn't go to class," Carol said.
In putting together her video, which Amanda did on her own, Carol said her daughter wanted to help other young people who are being bullied and to bring attention and education to the problem in the hope of seeing it eradicated.
"Amanda wanted to tell her story to help other kids. I want to tell my story to help parents, so they can be aware, so they can teach their kids what is right and wrong and how to be safe online," she said. "Kids have iPads, they have smartphones, technology is much more accessible than it was even five years ago — that is the dangerous factor."
When Amanda's story and video went viral this week, the outpouring of grief from local teens left Carol unable to distinguish Amanda's true friends from those who may have helped drive her to suicide.
Carol has launched a trust fund in Amanda's memory to raise money for anti-bullying awareness education and for support programs for youth with mental health issues.
Amanda was the victim of unrelenting blackmail. And the cyberspace stalker was aided by people in Amanda's real-world life — kids who would share the photos on their cellphones, kids who would gang up to hurl first verbal abuse and then fists at her.
"Everything she said in the video happened over the past two years," said Carol. "It was horrendous. I think about it now and I think, 'Oh my God. How did she survive this long with the pain?' "
The end, when it came, was a shock. Despite Amanda's earlier suicide attempts, Carol said in recent days and weeks she was getting much better. She spent time in hospital in September, getting treatment and counselling.
Her life was starting to return to normal, which it hadn't been since grade 8.
"She felt like a normal teenager, she was so proud of herself," said Carol. "She went out with friends, she went to the mall, she said to me, 'Mom, this is the first time that I feel normal again. I have had the best day ever.'"
Carol doesn't know what caused her daughter's setback, but Amanda may have given Carol an answer in a private video.
"She left me a video message on her phone. I'm not ready to look at it yet," said Carol.
"The coroner has told me it will provide closure for me but I can't look at it yet."
Carol doesn't know what happened, but sometime earlier this week — before Amanda killed herself late Wednesday afternoon — something happened to shatter that fragile recovery.
The police have been unable to track her stalker down. "The police investigated and investigated, it got traced to somebody in the United States," said Carol. "But they never found him. Those people are very good at hiding their tracks." The suspected pedophile threatened that if she didn't do a show for him, he would circulate her pictures again. Amanda wouldn't bow to the pressure and he carried out his threat.
Finger-pointing at schools for not stopping bullying only angers Carol. She said Amanda, who had learning problems, had excellent support in the Coquitlam school district, where Amanda spent most of her school time.
Since March, she was a student at CABE, Coquitlam Alternate Basic Education secondary school, which is a haven for youth who, for whatever reason, need the alternative learning situation.
It was there that Amanda made friends, among both the students and staff.
"She had a good support network there," said Carol. Among the teachers Amanda especially liked was former Olympic track and field star Leah Pells, who teaches physical education at the school. "She and Amanda clicked and Amanda trusted her," said Carol.
Carol is much more tech savvy than the average parent.
But Amanda's victimization at the hands of the stalker led Carol to learn more about the horrifying world of child pornography, where some victims don't even know their images are being shown on porn sites.
"You'll see pornography and the girls are so young," she said.
"I don't know if the girls are doing this for kicks, if their parents are monitoring it or if they even know about it.
The Amanda Todd trust fund is being held at the Royal Bank of Canada, which will be accepting donations in Amanda's name at all its branches.
If you or someone you know is experiencing suicidal thoughts, click here for ways to get help


text:
Our TOR address is
How to use TOR?
- Tor is free to use. Simply download and install the browser, which is a modified version of Firefox available for Windows, Mac OS X, and Linux.
- Open an URL http://zlibraryexau2g3p.onion in the TOR browser.
- Enjoy!
- More books available to download!


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A decade and a half ago a sublime blend of Eastern role-playing and Wild Western adventure was released in Japan. Today the talented folks at OC Remix celebrate that release with a free album featuring more than four hours of expertly twisted tunes from the soundtrack of the original Wild Arms.
While I wouldn't call the Wild Arms series of role-playing games revolutionary, it was powerful enough for the 53 artists featured on OC Remix's 31st album, Wild Arms: Armed and Dangerous, to create 58 astounding musical mix-ups. They've managed to fix everything on here: Hip-hop, reggae, trance, jazz, and much more, all sprinkled with Wild Arms' distinctive Old West flavor. I imagine it's quite tangy and smoky.
And free. Nothing tastes quite as good as free. Got take a bite and see for yourself.
Wild Arms: Armed and Dangerous [OC Remix]


text:
Rates of preterm birth are rising worldwide. Studies from the United States and Latin America suggest that much of this rise relates to increased rates of medically indicated preterm birth. In contrast, European and Australian data suggest that increases in spontaneous preterm labour also play a role. We aimed, in a population-based database of 5 million people, to determine the temporal trends and obstetric antecedents of singleton preterm birth and its associated neonatal mortality and morbidity for the period 1980–2004.
Methods and Findings
There were 1.49 million births in Scotland over the study period, of which 5.8% were preterm. We found a percentage increase in crude rates of both spontaneous preterm birth per 1,000 singleton births (10.7%, p<0.01) and medically indicated preterm births (41.2%, p<0.01), which persisted when adjusted for maternal age at delivery. The greater proportion of spontaneous preterm births meant that the absolute increase in rates of preterm birth in each category were similar. Of specific maternal complications, essential and pregnancy-induced hypertension, pre-eclampsia, and placenta praevia played a decreasing role in preterm birth over the study period, with gestational and pre-existing diabetes playing an increasing role. There was a decline in stillbirth, neonatal, and extended perinatal mortality associated with preterm birth at all gestation over the study period but an increase in the rate of prolonged hospital stay for the neonate. Neonatal mortality improved in all subgroups, regardless of obstetric antecedent of preterm birth or gestational age. In the 28 wk and greater gestational groups we found a reduction in stillbirths and extended perinatal mortality for medically induced but not spontaneous preterm births (in the absence of maternal complications) although at the expense of a longer stay in neonatal intensive care. This improvement in stillbirth and neonatal mortality supports the decision making behind the 34% increase in elective/induced preterm birth in these women. Although improvements in neonatal outcomes overall are welcome, preterm birth still accounts for over 66% of singleton stillbirths, 65% of singleton neonatal deaths, and 67% of infants whose stay in the neonatal unit is "prolonged," suggesting this condition remains a significant contributor to perinatal mortality and morbidity.
In our population, increases in spontaneous and medically induced preterm births have made equal contributions to the rising rate of preterm birth. Despite improvements in related perinatal mortality, preterm birth remains a major obstetric and neonatal problem, and its frequency is increasing.
Citation: Norman JE, Morris C, Chalmers J (2009) The Effect of Changing Patterns of Obstetric Care in Scotland (1980–2004) on Rates of Preterm Birth and Its Neonatal Consequences: Perinatal Database Study. PLoS Med 6(9): e1000153. https://doi.org/10.1371/journal.pmed.1000153
Academic Editor: Peter Brocklehurst, University of Oxford, United Kingdom
Received: November 21, 2008; Accepted: August 17, 2009; Published: September 22, 2009
Copyright: © 2009 Norman et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This project was funded by grant no CZG/2/285 from the Chief Scientist Office, Scottish Government (http://www.sehd.scot.nhs.uk/cso) and the baby charity, Tommy's (http://www.tommys.org). The funders had no role in study design, data collection or analysis, decision to publish, or preparation of the manuscript.
Competing interests: JN has received grants from government (Medical Research Council, UK; Chief Scientist's Office, Scottish Executive) and charitable organisations for research into understanding the mechanism of term and preterm labour and investigating treatments (charities currently include Tommy's, Piggy Bank Kids, and Action Medical Research, and formerly include Wellbeing of Women), has acted as a consultant to a small drug company (Preglem, Geneva) that was considering developing treatments for preterm labour, and is named as an inventor on patent applications for a compound (a prokineticin antagonist) potentially useful in preterm labour prevention. CM and JC have read this journal's policy and have no competing interests.
Abbreviations: GROS, General Register Office for Scotland; pPROM, preterm premature membrane rupture; SBR, Scottish Birth Record; SGA, small for gestational age; SMR02, Scottish Morbidity Records 2
Editors' Summary
Most pregnancies last about 40 weeks but increasing numbers of babies are being born preterm, before they reach 37 weeks of gestation (gestation is the period during which a baby develops in its mother). Nowadays in the US, for example, more than half a million babies arrive earlier than expected every year (1 in 8 babies). Although improvements in the care of newborn babies (neonatal care) mean that preterm babies are more likely to survive than in the past, preterm birth remains the single biggest cause of infant death in many developed countries, and many preterm babies who survive have long-term health problems and disabilities, particularly those born before 32 weeks of gestation. Preterm births can be spontaneous or medically induced. At present, it impossible to predict which mothers will spontaneously deliver early and there is no effective way to prevent these preterm births; medically induced early labor is undertaken when either the unborn baby or mother would be at risk if the pregnancy continued to full term.
Why Was This Study Done?
Preterm birth rates need to be reduced, but before this can be done it is important to know how the causes of preterm birth, the numbers of preterm stillbirths, and the numbers of preterm babies who die at birth (neonatal deaths) or soon after (perinatal deaths) are changing with time. If, for example, the rise in preterm births is mainly due to an increase in medically induced labor and if this change in practice has reduced neonatal deaths, it would be unwise to try to reduce the preterm birth rate by discouraging medically induced preterm births. So far, data from the US and Latin America suggest that the increase in preterm births in these countries is solely due to increased rates of medically induced preterm births. However, in Europe and Australia, the rate of spontaneous preterm births also seems to be increasing. In this study, the researchers examine the trends over time and causes of preterm birth and of neonatal death and illness in Scotland over a 25-year period.
What Did the Researchers Do and Find?
By searching a Scottish database of linked maternity records and infant health and death records, the researchers identified 1.49 million singleton births that occurred between 1980 and 2004 of which nearly 90,000 were preterm births. Over the study period, the rates of spontaneous and of medically induced preterm births per 1,000 births increased by 10.7% and 41.2%, respectively, but because there were more spontaneous preterm births than medically induced preterm births, the absolute increase in the rates of each type of birth was similar. Several maternal complications including preeclampsia (a condition that causes high blood pressure) and placenta previa (covering of the opening of the cervix by the placenta) played a decreasing role in preterm births over the study period, whereas gestational and preexisting diabetes played an increasing role. Finally, there was a decline in stillbirths and in neonatal and perinatal deaths among preterm babies, although more babies remained in the hospital longer than 7 days after birth. More specifically, after 28 weeks of gestation, stillbirths and perinatal deaths decreased among medically induced preterm births but not among spontaneous preterm births.
What Do These Findings Mean?
These findings indicate that in Scotland between 1980 and 2004, increases in spontaneous and medically induced preterm births contributed equally to the rising rate of preterm births. Importantly, they also show that the increase in induced preterm births helped to reduce stillbirths and neonatal and perinatal deaths, a finding that supports the criteria that clinicians currently use to decide whether to induce an early birth. Nevertheless, preterm births still account for two-thirds of all stillbirths, neonatal deaths, and extended neonatal stays in hospital and thus cause considerable suffering and greatly increase the workload in neonatal units. The rates of such births consequently need to be reduced and, for Scotland at least, ways will have to be found to reduce the rates of both spontaneous and induced preterm births to achieve this goal while continuing to identify those sick babies who need to be delivered early to give them the best chance of survival.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000153
- Tommys is a nonprofit organization that funds research and provides information on the causes and prevention of miscarriage, premature birth, and stillbirth
- The March of Dimes, a nonprofit organization for pregnancy and baby health, provides information on preterm birth (in English and Spanish)
- The Nemours Foundation, another nonprofit organization for child health, also provides information on premature babies (in English and Spanish)
- The US Centers for Disease Control and Prevention provides information on maternal and infant health (in English and Spanish)
- The US National Women's Health Information Center has detailed information about pregnancy, including a section on pregnancy complications
- MedlinePlus provides links to other information on premature babies and to information on pregnancy (in English and Spanish)
Preterm birth is the pre-eminent problem facing perinatologists in developed countries and has been defined as a major public health problem whose magnitude is increasing [1]. Although the secular trend is of an improvement in gestation specific outcomes (at least in terms of mortality) [2],[3], absolute rates of preterm birth are increasing in both the US [2] and in European countries such as the UK [4],[5] and Denmark [6]. Thus prematurity arising from preterm birth remains the biggest single cause of perinatal mortality and morbidity in most developed countries [7]. Governments and health care providers are increasingly concerned about this issue, and there have been calls for action from many bodies [1],[8].
Preterm birth may result from induced labour or operative delivery (medically induced preterm birth) in either the fetal or maternal interest (e.g., in the presence of intrauterine growth retardation or pre-eclampsia) or it may follow spontaneous preterm labour with or without preterm premature ruptured membranes [9]. If rates of preterm birth are to be reduced, a detailed understanding of both the temporal trends in the causes (obstetric antecedents) of preterm birth, and the neonatal morbidity and mortality associated with each of these causes is essential. Additionally, this information will determine the likely impact of treatment strategies (including novel therapies such as progesterone for the prevention of preterm birth), assist in service planning and in determining priorities for research and treatment, and last, but by no means least, help obstetricians, neonatologists, and the public in decision making around indicated preterm birth in high risk pregnancies. For example, an effective tocolytic or preterm preventive agent will help to reduce preterm birth occurring as a consequence of idiopathic preterm labour, but will not reduce elective/induced preterm delivery rates. Additionally, if the hypothesis that preterm birth rates are rising largely due to an increase in medically indicated preterm birth is correct, and that this increase in medically indicated preterm birth is associated with a decrease in perinatal mortality and morbidity, then extensive efforts to reduce elective preterm birth rates might be unwarranted or harmful.
Recent reports from the US have suggested that much of the increase in singleton preterm birth rates has resulted from rising rates of medically indicated preterm birth, and that spontaneous preterm birth rates are static or falling, especially amongst high risk ethnic groups [10],[11]. A fall in perinatal mortality in parallel with this rise in medically indicated preterm birth has been interpreted to mean that the rise in medically indicated preterm birth is appropriate and beneficial, and that this rise has (in part) caused the reduction in perinatal mortality [10]. In contrast, emerging data from Europe and Australia show that spontaneous preterm birth may also play a role [5],[6],[12].
The aim of this study was to determine the temporal trends in obstetric antecedents of preterm birth, and the temporal trends in neonatal mortality and morbidity associated with each of these antecedents during the period 1980 to 2004, using Scotland's comprehensive perinatal database [13]. We hypothesised that, in contrast to reports from the US and Latin America (which highlight an increase in elective delivery), increased rates of idiopathic spontaneous labour (with or without preterm premature membrane rupture [pPROM]) would be a major contributor to the increase in preterm birth rates observed in Scotland, even when adjusting for a change in maternal age over the study period. Additionally, we hypothesised that neonatal outcomes of preterm birth would show a progressive improvement over the time period studied. If our hypotheses are correct, then a major drive to reduce spontaneous preterm labour would be appropriate and would have the biggest impact in averting the adverse neonatal consequences of preterm birth.
We explored the SMR02/SMR11/SBR/SSBID/GROS Birth Database ("The Linked Maternity and Neonatal Database"). This database contains linked maternity, neonatal, and stillbirth/infant death records, with records pertaining to mother and baby held together. The SMR02 (Scottish Morbidity Records 2) return is completed at the time of discharge of any patient from a Scottish maternity hospital and the level of completeness over the period studied is estimated to be in excess of 98%. There is also a facility for the data to be returned in the case of home births but this is thought to be less complete. However, home births in Scotland during this period comprised less than 1% of all births, so this is unlikely to be a source of significant error. SMR11 (now replaced by Scottish Birth Record, or SBR) are routine neonatal returns. SSBID is a record relating to Stillbirths and Infant Deaths, based on stillbirths and infant deaths that are registered with the General Register Office for Scotland (GROS). For each SSBID event, further information is sought from the relevant hospital. Because the data are based on registered events, it is unlikely that any cases are missed.
We examined records on singleton births between 1975 and 2004. Although we initially planned to report on data throughout this period, after an initial review we opted to confine our analysis to the period 1980–2004, excluding data from 1975–1979. The rationale for this was 2-fold: firstly, the coding changed from ICD8 to ICD9 in 1979 and many of the relevant codes do not map satisfactorily between these two systems, and secondly, the overall data quality in the early years of SMR02 appeared not to be adequate enough for this study, with problems such as augmentation with oxytocin probably being erroneously recorded as induction in a number of records.
We calculated the number and percentage of all singleton preterm births (live and stillbirths before 37 completed wk of gestation) and the number and percentage of singleton preterm births between 24 and 27 wk, 28 and 31 wk, and 32 and 36 wk. Gestational age at birth (as recorded on SMR02) is based on the clinician's best "guess" of estimated date of delivery, based largely on last menstrual period and ultrasound findings. The latter will have been used for confirmation in the majority of women—since the early 1990s, more than 95% of pregnant women in the UK (including Scotland) have had ultrasound in the first half of their pregnancy [14] (Professors Martin Whittle [Chair of the UK National Screening Committee] and Professor Andrew Calder [Professor of Obstetrics and Gynaecology, University of Edinburgh 1987–2009], personal communication). Any records missing the gestational age have been excluded from the analysis.
Thereafter, we calculated outcomes for 5 calendar year periods starting in 1980; i.e., from the period 1980–1984 up to 2000–2004. Initially preterm birth was classified according to its obstetric antecedents (see below for definition). These antecedents were used to subdivide preterm birth numbers and percentages. Outcomes were then further analysed by gestation at delivery (24–27 wk, 28–31 wk, 32–36 wk gestation).
The obstetric antecedents of preterm birth were defined as follows: spontaneous preterm labour with maternal complications, spontaneous preterm labour without maternal complications, pPROM with maternal complications, pPROM without maternal complications, indicated preterm delivery (labour induction or elective caesarean delivery) with maternal complications, and indicated preterm delivery without maternal complications. These antecedents are similar to those used by other investigators in this field [3]. We used the ICD codes for pPROM (658.1, 658.2 [ICD 9], O42 [ICD10]): with ICD 10 defining pPROM as preterm membrane rupture, which occurs more than 1 h prior to the onset of labour. Other ICD codes were used for maternal complications as follows: essential hypertension: 6420–6423 (ICD9) O10 (ICD 10); pregnancy induced hypertension: 6424, 6425, 6427, and 6429 (ICD 9) O11, O13, and O14 (ICD 10); eclampsia: 6246 (ICD 9),O15 (ICD 10); placenta praevia: 6410, 6411, 6635 (ICD 9), O44, O694 (ICD 10); abruption: 6412,6413,6418,6419 (ICD 9), O45,O441 (ICD 10); pre-existing diabetes: 250, 6480 (ICD 9) E10-14, O240-1, O243 (ICD 10); gestational diabetes: 6488 (ICD 9) O244, O249 (ICD 10). Any other maternal disease was classified as any other diagnosis code excluding delivery records containing those above and the following: 630–678, 760–779, all V codes (factors influencing health status and contact with health services [ICD 9]), O00–O99, all Z codes (factors influencing health status and contact with health services [ICD 10]).
We calculated secular trends in rates of preterm birth associated with these maternal complications. The relative contribution of each of the maternal complications to preterm birth was calculated for the 10-y period 1995–2004. Additionally we determined the following neonatal outcomes associated with preterm birth: birthweight, stillbirth, neonatal death, extended perinatal mortality (the rate of stillbirths and deaths within the first month of life per 1,000 live births), and the incidence of prolonged stay in the neonatal unit (defined as more than 7 d) [15]. The secular trend in incidence of these neonatal outcomes was calculated for all singleton preterm births, and then further subdivided by gestation at delivery (24–27 wk, 28–31 wk, 32–36 wk). Given the known change in 1992 in gestation used to define stillbirth, we analysed secular trends in stillbirth and extended perinatal mortality from 1995–1999 to 2000–2004, whereas secular trends in neonatal mortality were analysed over the whole of the study period, from 1980–1984 to 2000–2004. We looked at aggregate data from 1995–2004 to define the contribution of the obstetric antecedents of preterm birth to adverse neonatal outcomes, and calculated the contribution of the specific maternal complications.
Permission for record linkage and analysis of data for the purpose of this study was obtained from the Privacy Advisory Committee of NHS National Services Scotland.
Statistical Analysis
Mantel-Haenszel chi-square (linear by linear association) test for trend was performed on temporal trends for the obstetric antecedents and subdivided by gestation groups to examine whether there was a linear relationship over the time period.
Univariate analysis was initially carried out to examine each individual confounding factor in relation to the outcomes of preterm birth, stillbirth, low birthweight, neonatal death, and prolonged stay in neonatal care. Thereafter, we used multivariate logistic regression modelling to examine the relationship between preterm birth, neonatal outcomes, and the six obstetric antecedents. All confounding factors including birth cohort period, deprivation, parity, smoking status (only recorded since 1993), health board of residence, age, and gestation at delivery (where appropriate) were entered into the model. The outcomes were considered as dichotomous variables and the covariates above categorised. The p values for all hypothesis tests were two-sided, and we set the significance at p<0.05. The goodness of fit of the logistic regression models was assessed using the Hosmer and Lemeshow test. We used SPSS 13.0 software package to conduct all the statistical analyses.
Causes of Preterm Birth
There were 1,490,074 births over the study period, of which 86,723 (5.8%) were preterm (before 37 completed wk gestation). As previously shown, rates of preterm birth per 1,000 singleton births increased over the time period studied from 5.4% singleton live births in the 5-y period beginning 1980 to 6.3% in the 5-y period beginning 2000 [5]. This increase in preterm birth rates applied to each of the three gestation subgroups (24–27 wk, 28–31 wk, and 32–36 wk) although the greatest proportionate increase was in the 24–27 wk subgroup. When preterm birth was divided into spontaneous and medically induced, we noted a modest rise in the crude rates of spontaneous preterm birth per 1,000 singleton births (10.73%, p<0.01) but greater percentage increase in medically indicated preterm birth rates (41.47%, p<0.01, chi-squared test for linear trend) over the study period (Table 1). The increase in spontaneous preterm birth largely relates to an increase in preterm birth associated with pPROM (189.17%, p<0.01, chi-squared test for linear trend). Looking at gestational age subgroups, the rise in the rate of spontaneous preterm birth held for all gestation subgroups, whereas the relative increase in rates of elective/induced preterm delivery was greatest in the 24–27 wk gestation subgroup. There was a modest increase in rates of induced/elective preterm birth in the 32–36 wk gestation subgroup but a 22% decline in the 28–31 wk gestation subgroup. However, given the much larger contribution of the 32–36 wk gestation subgroup to overall numbers, there was a net increase of 34% in induced/elective deliveries in babies of gestational age 28–36 wk over the study period (Table 2).
In view of the increase in maternal age of first pregnancy over the study period (Figure 1) [16],[17] and the known effects of maternal age on preterm birth rates, we calculated age standardised preterm birth rates and looked at their changes over time.
Maternal age standardised rates of spontaneous deliveries (preterm and term) and induced deliveries (preterm and term) for the period 1980 to 2004 are shown in Figures 2 and 3. There was a small (2.3%) decline in maternal age adjusted spontaneous preterm birth rate on a background of a greater decline (17.1%) in maternal age adjusted spontaneous birth at term (Figure 2). There was a modest (10.5%) increase in maternal age adjusted induced/elective preterm birth rate, which contrasted with a 23.4% reduction in age adjusted induced/elective term birth rate (Figure 3).
Maternal complications were present in 24.3% of preterm births. Essential and pregnancy induced hypertension, pre-eclampsia, and placenta praevia played a decreasing role in preterm birth over the study period (p<0.01, chi-squared test for linear trend). In contrast, there was over a 7-fold increase in preterm birth associated with pre-existing diabetes, and a 4-fold increase in preterm birth associated with gestational diabetes (p<0.01) (Table 3).
Given the smaller numbers of preterm births associated with maternal complications, data from the 10-y period (1995–2004) were aggregated to examine the obstetric conditions relevant to preterm birth within each gestational cohort. Overall, pregnancy induced hypertension was the commonest obstetric antecedent of preterm births, being present in nearly 13% of preterm births. The second commonest obstetric antecedent was abruption, being present in 9% of preterm births. However, there was a clear difference in the leading obstetric antecedent at each gestation: abruption was the commonest obstetric antecedent of preterm birth in the shortest gestation cohort (associated with 17.7% of preterm births at 24–27 wk gestation), with pregnancy induced hypertension being the commonest obstetric antecedent of preterm birth at the longer two gestation periods (16.7% at 28–31 wk gestation, and 12.5% at 32–36 wk gestation). Abruption and/or pregnancy induced hypertension combined were associated with 25.1% of singleton preterm births, compared with 12.6% of all singleton births.
The adjusted odds of preterm birth in association with specific maternal complications (both unadjusted and after adjusting for deprivation, parity, smoking, health board of residence, and maternal age and birth cohort period), in comparison with having no maternal complications, are shown in Table 4. The odds of preterm birth are increased in association with all maternal disease, and were greatest in association with eclampsia (adjusted OR 8.94 [95% CI 6.93–11.54]), placenta praevia (adjusted OR 8.42 [95% CI 7.81–9.08]), and pre-existing diabetes (adjusted OR 6.67 [95% CI 6.03–7.37]). These maternal antecedents increased the risk of both spontaneous preterm labour and induced/elective preterm birth.
Neonatal Outcomes
Stillbirth and neonatal death.
The OR for stillbirth, both unadjusted and after adjustment for parity, smoking, deprivation, birth cohort period, and health board of residence is shown in Table 5. Over 90% of these stillbirths were antepartum events. Unadjusted ORs for stillbirth were greater in babies born at earlier gestations (OR of 15.71 at 32–36 wk, 77.15 at 28–31 wk, and 101.88 at 24–28 wk compared with term babies [95% CI 15.00–16.46, 72.94–81.59, and 94.28–110.09, respectively]), to women with low or high parity (ORs least in those who were para 1: 0.69 [95% CI 0.66–0.72] compared with nulliparous women), to women who smoked (OR 1.54 [95% CI 1.45–1.64] compared with non-smokers), and to women from a higher deprivation quintile (OR 1.62 [95% CI 1.51–1.72] in the most deprived compared with the least deprived quintile). The majority of stillbirths occurred in association with spontaneous preterm labour in the absence of maternal complications and without pPROM; although the OR of stillbirth was greatest in association with induced/elective preterm delivery.
Unadjusted ORs for neonatal death were also greater in babies born at earlier gestations, to nulliparous women, to smokers, and to women of a high deprivation quintile. In contrast to the association between elective preterm delivery and stillbirth, the risk of neonatal death was lower in babies born preterm following elective/induced delivery, compared to those born after spontaneous preterm labour (Table 5).
Looking at secular trends over the study period, there was only a modest reduction in preterm birth associated stillbirth (prevalence ratio 0.9 in 2000–2004 compared with 1995–1999) but a greater decline in preterm birth associated neonatal death (prevalence ratio 0.43 in 2000–2004 compared with 1980–1984) (Table 6). Looking at obstetric causes of preterm birth, in the absence of maternal complications, we found a reduction in stillbirth and extended perinatal mortality for medically induced but not spontaneous preterm births at gestations of 28 wk and above although at the expense of a longer stay in neonatal intensive care.
Prolonged stay in hospital.
Smoking, deprivation, and extremes of parity had similar adverse effects on prolonged stay in hospital as they did on stillbirth (unpublished data). Adjusted OR showed that, after adjustment for deprivation, parity, smoking, birth cohort period, and health board of residence, and in the absence of maternal complications, prolonged stay was less common in babies born preterm following elective/induced delivery compared with babies born preterm following spontaneous preterm labour (adjusted OR 0.68 [95% CI 0.62–0.75]) (Table 5).
Looking at secular trends, there was an increase in the incidence of prolonged stay in hospital in the period 1995–1999 compared with 1980–1984 (Table 6). This is consistently true for preterm births up to 32 wk gestation following all obstetric antecedents (with the minor exception of induced/elective preterm delivery with maternal complications).
Growth restriction.
Babies who were small for gestational age (SGA) (z score<2) were more common amongst preterm compared with term births (proportions 2.18% and 1.82%, respectively) (unadjusted OR 1.11 [95% CI 1.06–1.16], p<0.01). The adverse effects of deprivation, smoking, and nulliparity on the incidence of SGA were similar to their effects on stillbirth and prolonged hospital stay. After adjustment for parity, deprivation, smoking, birth cohort period, and health board of residence, preterm birth was paradoxically associated with a reduction in odds of SGA. Looking at obstetric antecedents, in the absence of maternal complications, babies born as a result of induced/elective preterm birth were at an increased risk of being SGA after adjustment whereas those born preterm following pPROM were at reduced risk (Table 7).
Contribution of categories of obstetric antecedents of preterm birth to adverse neonatal outcomes.
The contribution of the categories of each of the obstetric antecedents of preterm birth to adverse neonatal outcomes, together with their overall contribution in terms of percentages of preterm birth, is shown in Table 8.
At the outset of this study, we hypothesised that, in contrast to reports from the US and Latin America (which highlight an increase in elective delivery), increased rates of idiopathic spontaneous labour (with or without pPROM) would be a major contributor to the increase in preterm birth rates observed in Scotland. Our hypotheses were partially correct—although the percentage increase in preterm birth rates was greatest in the elective/induced category (a 41% increase over the study period), rates of preterm birth were also rising in the spontaneous preterm birth category (a 10% rise over the study period). These changes persist when adjusted for maternal age: a progressive rise in the proportion of preterm births (in both the elective and spontaneous category) would have occurred even if there had been no change in maternal age over the study period. Although the percentage rise in elective/induced preterm births is greater than that in spontaneous preterm births (with and without pPROM), the absolute increase in the rate of preterm births is similar in each group (4.24 compared with 4.71 per 1,000 singleton births, respectively [Table 1]). Thus, in our population, increases in spontaneous and elective/induced preterm births are making equal contributions to the rise in the rate of preterm births. Our results showing an increase in both elective/induced and spontaneous preterm birth rates contrast with those of Ananth and colleagues, who showed a 50% increase in the rate of medically indicated preterm birth in the US from 1989 to 2001, but a 5%–25% decline in spontaneous preterm birth (with and without pPROM) [10], and those of Barros and Velez Mdel, who showed a 80% increase in medically indicated preterm birth in Latin America between 1985 and 2000 due to elective induction/delivery but again a decline in spontaneous preterm birth and that associated with pPROM [3]. The discrepancy with the Barros paper may in part relate to the fact that we included women with gestational or pre-existing diabetes in contrast to Barros and Velez Mdel, who excluded them, especially since the contribution of both of these complications to preterm birth (in our population) increased significantly over the study period. Our results are in keeping with those of Langoff Roos et al. [6] and Tracy et al. [12], who showed a rise in spontaneous preterm deliveries over a 10-y period in both populations as a whole, and in specially constructed "standard" populations of low risk women.
The findings that pregnancy induced hypertension and abruption are the commonest maternal complications preceding preterm birth are not unexpected. However, the decline in rates of preterm birth in association with essential hypertension, pregnancy induced hypertension, eclampsia, and placenta praevia over the study period was not anticipated. It could imply either better obstetric management of these conditions (in that their severity is reduced, and the need for elective preterm delivery or the triggering of spontaneous preterm labour is lower), it could imply a greater willingness of obstetricians to manage these conditions conservatively, or it could be an artefact of varying completeness of coding. In contrast, we observed a 4- to 7-fold increase in preterm deliveries associated with pre-existing and gestational diabetes. The reasons for the increased contribution of diabetes to preterm delivery are likely to be multifactorial: greater numbers of women with pre-existing (both Type I and Type II) diabetes may be getting pregnant, ascertainment of gestational diabetes may be getting better, and the true incidence of gestational diabetes may be rising as obesity rates rise in pregnancy. The fact that gestational diabetes increased the odds of spontaneous preterm labour was somewhat of a surprise, and has not (to our knowledge) been highlighted in previous studies. Whatever the reason for the association between pre-existing and gestational diabetes and preterm birth, it suggests that treatment and management of diabetes during pregnancy will be a key issue in inhibiting any further rise in preterm birth rates, particularly given that the maternal condition associated with the greatest odds of preterm birth is pre-existing diabetes.
The reason for the increase in rates of induced/elective preterm birth in the absence of maternal complications is unclear. Induced/elective preterm delivery in this scenario implies detection of a fetal complication. However, there have been no new methods of fetal surveillance over this time period: indeed the current recommended tools for surveillance of the small-for-dates fetus are umbilical Doppler ultrasound and fetal biometry—both of which tools have been available for the majority of the study period [18]. There has been no change in prevalence of small-for-dates fetuses in the Scottish population over the study period [19], so it appears that obstetricians have had a lower threshold to act on information from surveillance strategies and to electively deliver the baby. This increased enthusiasm for induced/elective preterm may be in part due to the known improvement in neonatal mortality in all gestation subgroups over the study period.
In terms of spontaneous preterm labour in the absence of maternal complications, again there has been no systematic change in practice over the time period of the study that is likely to contribute to the increase in rates. Current UK guidelines suggest that it is reasonable not to use tocolytic agents given their lack of effect on outcomes or preterm delivery rates overall [20], but given their inefficacy, it is unlikely that any change in tocolytic use will have affected spontaneous preterm delivery rates.
A caveat to any study of this type has to be that we are relying on routinely collected data for our analysis, with issues of data quality and of other confounders that we were unable to measure. Although we did not formally examine SMR2 data quality for the purposes of this project, previous studies have confirmed that it is adequate for analyses of the type reported here. For example, an evaluation over a 6-mo period in 1996–1997 compared a 5% sample of paper records with the database. This showed that most fields had less than 2% errors. However, there was a 5.6% error rate in the estimated gestation, 6.4% error in induction of labour, 13.5% error in duration of labour, and a 10%–20% error rate in the recording of the main ICD diagnostic codes [21]. For these minor errors to have contributed to the secular trends seen, they would have to have caused systematic bias, which seems unlikely. A potential confounder that has been raised in many population studies of preterm birth rates is the increasing use of early ultrasound to more accurately date gestational age. We do not believe that this will have had an effect here: the trends observed have been consistent over time, and there will have been very little change in the proportion of pregnancies dated using first trimester ultrasound over the last 15-y period of this study. Another potential confounder that we were unable to address is ethnic origin: this is potentially important given the increased rates of preterm birth in African American compared with white American women. Again, we do not believe this to be relevant to our study: in the 2001 census nearly 98% of the population of Scotland was white, so it is unlikely that any potential increases in the small proportion of nonwhite inhabitants in the period 1980–2004 will have impacted on preterm delivery rates.
The results of our study show that to reverse the rising trend of preterm birth in Scotland, policies and research strategies should be focussed on both spontaneous and elective/induced preterm deliveries: different approaches will be required, but both are important. They also emphasise an emerging theme in the epidemiology of preterm birth in that although preterm birth rates are rising in all developed countries, the rise appears to be driven largely by rises in elective/induced preterm birth in the US and South America, but by an increase in both elective/induced and spontaneous preterm births in Europe and Australia.
The data supported our second hypothesis: that neonatal outcomes of preterm birth would show a progressive improvement over the time period studied. There was a 55% reduction in risk of neonatal death and a 10% reduction in risk of both stillbirth and extended perinatal death over the study period. However, these improved outcomes come at a cost to the health service with a 57% increase in the risk of prolonged stay in hospital for the neonate over the study period. These data are in keeping with those from other groups, showing improved perinatal outcomes in association with preterm birth over the time period of our study. The improvement in stillbirth neonatal mortality in the elective/induced preterm birth group at gestations of 28 wk and greater does support the decision making behind the rising trend of elective/induced preterm birth. It implies that sick babies are being appropriately identified, and rather than being stillborn or dying shortly after birth as they were in earlier time cohorts, they are delivered and survive. Whatever the specific indication for the elective/induced preterm delivery, the fact that elective/induced preterm babies are more likely than those delivered spontaneously to be SGA suggests that their in utero environment is compromised and has restricted their growth. However, once delivered alive, somewhat surprisingly these babies do better than those delivered spontaneously (in the absence of maternal complications in both groups) in terms of lower neonatal mortality and a lower incidence of prolonged hospital stay.
Our data showing lower neonatal mortality in electively delivered babies are somewhat different to those of Barros and Velez Mdel, who showed that babies born following medically indicated preterm birth, even in the absence of maternal complications, had higher neonatal mortality than those delivered following spontaneous preterm labour [3], and to those of Villar and colleagues, who showed that babies delivered electively preterm were more likely to have a prolonged stay in the neonatal unit [15]. This difference is even more surprising given that our population included women with diabetes whereas Barros and Villar excluded them. In contrast our data showing that the presence of maternal complications significantly increased the risk of neonatal mortality is in agreement with others in the literature [3],[15].
The rationale for poorer neonatal outcomes following spontaneous rather than elective preterm delivery may be that intrauterine infection, which often triggers spontaneous preterm labour, continues to have an adverse effect on the neonate after delivery. This likely lower neonatal mortality in electively delivered babies compared with those delivering spontaneously should be taken into account by obstetricians and paediatricians making decisions about elective preterm delivery of individual babies (especially those where delivery is indicated in the fetal interest and where there is no maternal compromise).
To summarise the neonatal outcomes of this study, the secular trend is of a reduction in mortality associated with preterm birth, supporting the decision making behind elective/induced preterm delivery, particularly at gestations of 28 wk and above. Although babies born electively (and alive) tend to be smaller than those delivering spontaneously, their outcomes tend to be at least as good. In contrast, the rising tide of antepartum stillbirth, which increasingly appears to be a factor in triggering elective preterm birth (in the absence of maternal complications), has been noted elsewhere, suggesting that research into this issue is needed. Lastly, a common theme throughout our data was that smoking and social deprivation both continue to play a significant role in the aetiology of preterm birth and are major risk factors for adverse neonatal outcomes.
We are grateful to Gordon Murray, Professor of Medical Statistics, University of Edinburgh, for his advice on some of the statistical issues arising from this manuscript, and to Mr. Ronnie Grant, University of Edinburgh, for help in preparation of the figures.
Author Contributions
ICMJE criteria for authorship read and met: JEN CM JC. Agree with the manuscript's results and conclusions: JEN CM JC. Designed the experiments/the study: JEN JC. Analyzed the data: JEN CM. Wrote the first draft of the paper: JEN. Contributed to the writing of the paper: JEN CM JC.
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Institute of Medicine of the National Academies (2007) Preterm birth: causes consequences and prevention. Washington, DC: Institute of Medicine.
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Chalmers J (2006) Preterm deliveries in Scotland. BMJ.com Available: http://www.bmj.com/cgi/eletters/322/7547/937#132366. Accessed: 26.8.09.
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- 10. Ananth CV, Joseph KS, Oyelese Y, Demissie K, Vintzileos AM (2005) Trends in preterm birth and perinatal mortality among singletons: United States, 1989 through 2000. Obstet Gynecol 105: 1084–1091.
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Photojournalist Fadi Arouri released the video footage and photographs of the attack which shows an Israeli soldier pepper spraying paramedics from the Palestine Red Crescent Society after they were prevented from attending to an injured Palestinian protester who had been violently run over by an Israeli jeep.
Journalists documenting the attack were then kicked, slapped and pepper sprayed by soldiers.
In some cases Israeli police pulled journalists' gas masks from their face so that the pepper gas could be sprayed directly into their eyes.
All of the journalists were clearly identified as members of the press and were standing away from the clashes.
Palestinian press can be heard shouting that they are journalists and questioning why they are being attacked as border policemen shout "get back" and "move," despite that the journalists clearly pose no threat.
The Foreign Press Association (FPA) yesterday released a statement condemning Friday's attack
"This sort of behaviour by the border police is both abusive and a gross violation of press freedom, and yet it has become all too common, raising serious concerns about senior officers' ability to control their actions of forces under their command."
They added that the Border Police or the Defence Ministry have been unresponsive to FPA's attempts to meet with commanders to discuss the IDF's treatment of the press.
Israeli police's disregard for the neutrality of journalists and paramedics is not unprecedented.
In September, at least ten journalists were prevented from covering the clashes in and around the plaza in front of East Jerusalem's Al-Aqsa Mosque. Israeli police targeted and beat journalists and damaged their equipment.
Earlier this month, the PRCS released a statement criticising Israeli forces for intentionally targeting their medical staff and ambulances. Between Oct. 3 and Oct.11, PRCS documented 53 attacks against its teams and ambulances in which 37 emergency medical technicians were wounded and around 20 ambulances damaged.
"Everyone is at risk from the Israeli occupation forces. Soldiers usually directly target paramedics and medical teams. They do not differentiate between medical staff and demonstrators," Murad, 22, a paramedic with PMRS, told the Palestine Monitor during clashes at Beit El on Oct 13.
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Following August's upcoming UFC 133 broadcast, "UFC 134: Silva vs. Okami" will be the next pay-per-view event to get a "UFC Prelims" special on Spike TV.
Officials recently confirmed the broadcast plans with MMAjunkie.com (www.mmajunkie.com).
The two bouts set for the one-hour special include Spencer Fisher vs. Thiago Tavares and David Mitchell vs. Paulo Thiago.
"UFC 134: Silva vs. Okami" takes place Aug. 27 at HSBC Arena in Rio de Janeiro. The pay-per-view headliner sees pound-for-pound kingpin Anderson Silva defend his UFC middleweight title against perennial contender Yushin Okami.
The UFC 133 "UFC Prelims" special will be Spike TV's eights of 12 scheduled for 2011 (UFC 126, UFC 128, UFC 129, UFC 130, UFC 131, UFC 132 also got them, and August's UFC 133 event will also feature a special). ION Television also has aired specials when Spike TV hasn't, such as with UFC 127.
Despite being armed with a penchant for crowd-pleasing brawls, Fisher (24-7 MMA, 9-6 UFC) has struggled to a 1-3 mark in his pst four outings. Nevertheless, the nine-year veteran is known to bring the fight to opponents and will surely do the same against Tavares.
Meanwhile, Tavares (15-4-1 MMA, 5-4-1 UFC) looks to rebound from a March knockout loss to Shane Roller. The loss was the Brazilian's first in four trips to the cage. A Brazilian native who has also fought in the U.S., England and Holland, Tavares is a three-time UFC "Fight of the Night" winner.
Once of the UFC's most promising 170-pounders, Thiago (13-3 MMA, 3-3 UFC) now finds himself in a must-win situation. After opening his career with a 10-0 record and signing with the UFC, the Brazilian won three of his first four bouts, including high-profile victories over UFC contenders Josh Koscheck and Mike Swick. But he since has dropped decisions to Martin Kampmann and Diego Sanchez and looks to avoid a three-fight losing streak.
The Brazilian special-forces police officer was slated to fight Johny Hendricks in March but pulled out of the bout due to an elbow injury. He now meets Mitchell (11-1 MMA, 0-1 UFC), a California-based fighter and Tachi Palace Fights veteran who opened his career with an 11-0 mark to earn a UFC contract. But in his UFC debut back in September, he suffered a decision loss to T.J. Waldburger at UFC Fight Night 22. Mitchell had been slated to fight Swick in January at UFC Fight Night 23, but both fighters pulled out of the event due to injuries.
The remaining preliminary contests could stream on Facebook, but the UFC has yet to announce any official plans.
The UFC first offered a PPV teaser broadcast for UFC 103 in 2009, when the UFC went head-to-head with a boxing PPV broadcast featuring Floyd Mayweather vs. Juan Manuel Marquez. The Spike TV specials proved effective enough at generating last-minute PPV buys that officials from the UFC and the organization's longtime cable partner decided to make them a regular offering.
The latest UFC 134 card includes:
- Champ Anderson Silva vs. Yushin Okami (for middleweight title)
- Forrest Griffin vs. Mauricio "Shogun" Rua
- Antonio Rodrigo Nogueira vs. Brendan Schaub
- Edson Barboza vs. Ross Pearson
- Luiz Cane vs. Stanislav Nedkov
PRELIMINARY CARD (Spike TV)
- Spencer Fisher vs. Thiago Tavares
- David Mitchell vs. Paulo Thiago
- Erick Silva vs. Mike Swick
- Yuri Alcantara vs. Antonio Carvalho
- Yves Jabouin vs. Ian Loveland
- Alexandre "Cacareco" Ferreira vs. Rousimar Palhares*
* – Not officially announced
For the latest on the UFC 134 card, stay tuned to the UFC Rumors section of MMAjunkie.com.
(Pictured: Spencer Fisher)


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I'll add more photos as they become available but wanted to get this article off asap. Here's Nicole Kidman, with Ang Lee, at the Palais in Cannes tonight. That dress looked familiar to me. I thought it might be Valentino Haute Couture. It sure looks like it. And it sure looks like the one Anne Hathaway was supposed to wear to the Oscars before her last-minute change into the pink Prada to avoid clashing with Amanda Seyfried, you remember? Click here for a refresher.
But she can wear a dress, can't she? God she can wear a dress, Nicole Kidman. She can elevate a lesser dress. When it's an exquisite dress, on her, it's truly art.
Kidman was last on the carpet with an exhausted Keith Urban who'd come in to spend a few days with her after Idol. He's gone now, back to the US to work on the new album. Her duties run until at least Sunday when the jury awards the Palme d'Or.


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The R-C Morning Report
Streamflow forecasts are calling for the rest of February to have well below average snowpack this spring and summer unless we get some snow. In a report issued by the National Weather Service and Natural Resource Conservation Service, water users are warned to keep a close eye on the weather as the winter unfolds.
Fort Churchill Park Ranger Kim Clawson is the speaker at tonight's historical lecture at the Carson Valley Museum & Cultural Center in Gardnerville. Clawson is speaking at 7 p.m. Admission is $3 for nonmembers.
It will be sunny and warm on this Valentine's Day with temperatures in the mid-50s and the wind clam in the morning then picking up to 5 mph. It still looks like we're not going to get any precipitation before Tuesday.


text:
Beautiful Photos of China
Photographer: Feng Jiang
Little about China from Wikipedia:
China is one of the world's oldest continuous civilizations and for most of the last two millennia was one of the largest and most advanced civilizations in the world, until the 1850s when it missed the industrial revolution. Subsequently, imperialism, wars and civil wars damaged the country and its economy up to the end of the civil war in 1949. In the 1950s, change to economic policies in the Republic of China (Taiwan) transformed the island into a technology-oriented industrialized developed economy. It became known as one of the Four Asian Tigers along with Hong Kong, South Korea and Singapore. In mainland China, in the 1970s, reforms known as the Four Modernizations modernized the agriculture, industry, technology and defense, eventually making the PRC one of the major powers. China is viewed as the source of many major inventions. It has also one of the world's oldest written language systems.
95 Comments:
- February 24, 2010 at 2:06 PM
What's with the photoshopping of the mom and her child in the bath tub?
- February 24, 2010 at 5:49 PM
How do you know all these pictures aren't Photoshopped? You can't believe any images anymore. Welcome to the Brave New World.
- February 25, 2010 at 3:23 PM
Thats some really cool pics but I agree the photoshopping could have been left out !!!
- February 25, 2010 at 7:56 PM
- Nepal Travel said...
wow whats a really really nice picture.after seeing your picture blog it make me to start journey to china.but in my view if you add "The great wall of china" picture it would be more nice
best wisher
Nepal travel
- February 26, 2010 at 5:39 AM
this is truly breathe taken
- February 26, 2010 at 3:45 PM
- Everest expedition said...
first of all i m agree with nepal travel because The great wall of china is a proud of china. if you dont include the great wall of china then your blog not sufficent. second the photo grapher is very very profesnal because normal person can't take like this picture. these above picture are really really nice. thank you very much for sharing
- February 26, 2010 at 10:03 PM
- Pres said...
China is a country of supreme natural beauty as these wonderful photos reveal. Even more powerful is its cultural, intellectual, and spiritual beauty. There is great wisdom that we all can gain if we study the great thinkers of every civilization.
- February 27, 2010 at 4:50 PM
- Emilie Watson said...
Gorgeous photos, I love the photography.
China is a beautiful place!
- February 27, 2010 at 9:47 PM
- Lauren said...
Absolutely awe inspiring. I want to travel to China now!
- February 28, 2010 at 6:21 PM
Unfortunately as beautiful as China might be I would never visit whilst it subjects animals to such horrific torture.
- March 1, 2010 at 11:54 AM
- MB said...
ok, is here anybody who can tell me where is this places on google maps ?
i want be there right now.
- March 1, 2010 at 4:00 PM
You obviously have no understanding of what happens in China. Go ask any Chinese person and see whether they think they are "animals of horrific torture."
- March 1, 2010 at 7:44 PM
the person above me's isn't the brightest. The person said that they subject animals to horrific torture, not that Chinese people are animals of horrific torture. I don't know if that's really the case but I've heard that they do eat a whole lot of different animals so who know. ANYWAY. the pictures are gorgeous. Looks Like an absolutely beautiful place. Photography at its best.
- March 3, 2010 at 2:44 AM
These are some of the most gorgeous pictures I have ever seen.
- March 3, 2010 at 5:49 PM
- Aglolink said...
I swear, that's wonderful farm I've ever seen! I like your shot!
- March 5, 2010 at 12:21 AM
- Adam G said...
Love this set of pics. Thank you!
- March 8, 2010 at 6:46 AM
Please stop trying to figure out if it's real or not Just except what the author presented and enjoy the view! Learn to except
- March 15, 2010 at 7:03 AM
Awesome pics..wants to visit China again:)
- March 19, 2010 at 4:54 AM
Are a lot of these from Guilin? These types of mountains are the hallmark of that area (as you can see on the 20 RMB bill). God, how this makes me wish I was back there. And to answer the anonymous wondering about the food: coming from the U.S. some of the food did seem pretty outlandish, including things like dog, donkey, and many of the organs americans don't eat. You get over it surprisingly quickly though!
- March 22, 2010 at 4:26 PM
Come on People!!! I am the last person to call a picture on an edit... most photographs these days are edited in some form or another. But these are incredibly fake! Added hills, increased color, and that isn't even mentioning the tub scene.
This is manufactured in photoshop and not what the actual scene would loo like. I am sure that these areas are still quite nice, just not the beautiful oasis they look like in these pictures. Get a grip on reality, goofs.
- March 25, 2010 at 8:59 PM
I have been to a lot of these place and they are just as beautiful as in the pictures. If you you dont believe then save up and take a trip :)
- March 27, 2010 at 5:10 AM
- putu said...
Wow... amazing! What a nice panoramic photos.
- March 28, 2010 at 6:31 AM
A quick search will show you that these are not photoshopped to the extent two posts above would like to think...
But although the picts are great.. i have a hard time being inspired by landscapes that are EXTREMELY altered by man. (The terracing is not natural)
- March 28, 2010 at 4:34 PM
Is this sincerely China or includes other areas like Tibet? Just to point it out, I think I seen some of those somewhere and was told it was from Tibet...
- March 29, 2010 at 7:34 PM
- SunCar said...
Photos are really GREAT! This is an amazing place... I would like to see it in real!
- March 31, 2010 at 5:32 AM
beautiful photos, very talented!!!
- April 1, 2010 at 9:22 AM
West China is much more beautiful than this
- April 11, 2010 at 11:16 PM
I noticed that there the sky was foggy in almost every one of these photos. I thought it was beautiful until I realized it's all smog and air pollution.
- April 19, 2010 at 3:34 PM
- Shailesh Chauhan said...
very nice photo collection
- May 11, 2010 at 8:24 AM
Its really amazing. Thank you for your posting.
Weekend breaks Europe
- May 19, 2010 at 3:09 AM
- Fran said...
Beautiful images.
- June 15, 2010 at 11:16 AM
- Bargain Holidays said...
Fantastic landscapes! Great photo's.
Thank you,
Bargain Holidays
- June 16, 2010 at 1:28 AM
- Jan1985 said...
Beautiful photo's!!!
Thank you for sharing.
- June 16, 2010 at 11:03 AM
- Richard said...
China is known to be having many sources of inventions. And Now china known for its beautiful scenery.. Thank for sharing this nature pieces..Love to see this everyday if i could.. :)
- June 24, 2010 at 5:39 AM
what happened with the woman in the bath tub?
- June 29, 2010 at 7:23 AM
- Nepal Tour Packages said...
Stunning Photography
- July 15, 2010 at 5:14 AM
- rigoberto said...
This is an amazing place... I would like to see it in real!
great posting, thank you
- July 28, 2010 at 2:05 PM
Why are people fussing about the great wall of China not being included. You know the wall, you have seen it. It is not the main way China identifies itself. Westerners focus on it way more than the people or government of China does. It shows that men can lay bricks. This blog on the otherhand shows the landscape and many natural wonders of china that are often overlooked by people flying in to take their cliche cheesy shots standing on the wall. Even the first sentence on this page says "Forget everything you think you know about China and take a couple minutes to ponder these photos."
- August 1, 2010 at 2:15 PM
Amazing photos, I just came back from an amazing week in Shanghai.
Anyway I can get these in larger size/quality for desktop wallpaper?
- August 2, 2010 at 10:26 AM
Wow.. these are quite nice. I just came back from a 3 month photo expedition throughout China for a travel mag.
You can tell from the mountains that most of these photos are of Guilin. The other ones are most likely from the southeastern part of China, Guangxi, Guangdong, etc.
To the commenters saying the weird hills are BS, the terraces actually look like that, they are man-made rice paddies. And that woman with the child bathing is of the Zhuang minority nationality (which you can tell from the hanging clothing and her headdress). The Zhuang people are a prominent nationality southern provinces.
- August 4, 2010 at 4:41 PM
- Soendoro Soetanto said...
China is breathtakingly beautiful. Great posting.
Soendoro Soetanto
- August 6, 2010 at 5:37 PM
- William K Wallace said...
Some parts of China are amazingly beautiful...but those huge traffic jams which they are having at the moment that last for days aint quite so beautiful!
- August 26, 2010 at 2:34 PM
- Jenny said...
Amazing Photography!
- September 1, 2010 at 2:29 PM
- Kashmir Tour Packages said...
China has a amazing beauty in nature.Wonderful photographs
- September 2, 2010 at 11:04 PM
I want to go to China now.
- September 15, 2010 at 12:02 AM
they are pictures of guilin , and the terraces are from Guilin Longsheng
- September 25, 2010 at 6:03 AM
- zablon said...
your photos are awesome, i have never seen such beautiful photos before
- October 22, 2010 at 11:31 PM
ATTENTION! The second picture is NOT China, its plitvice lakes Croatia!!
Now I dobut some of the others are China either.
Trust the Chinese to lie
- October 23, 2010 at 12:35 PM
- mata said...
Plitivice? lol, it's similiar, but look hills behind, thats not Croatia dude!
- October 24, 2010 at 3:53 AM
- Caz Makepeace said...
Absolutely stunning photos
- October 25, 2010 at 1:47 AM
the second picture should be Detian Waterfall, the second largest transnational waterfall in the world, its on the border of China and Vietnam,
- October 25, 2010 at 11:47 PM
- Photos from China said...
Great collection of photos. For sure those terrassed fields provide wonderful photo opportunities. Thanks for sharing
- November 8, 2010 at 1:47 PM
- Vrnjacka Banja Sobe said...
great pics,great idea
- November 10, 2010 at 4:13 AM
- xiomaracafe said...
mmm the human mind.... Why can't you guys just admire beauty ? nag nag and nag...
Relax! breath !!! enjoy life, and if you do not like the way of life in
China, just be grateful not to be where you do not want to be at !
i think the pics are just beautiful......
Best wihes to all for inner peace ( hold on to your axel! or... get one! The best one is your maker.
- November 22, 2010 at 8:52 AM
- fajas colombianas said...
This makes me feel like going to china
- December 28, 2010 at 10:07 AM
- greg urbano said...
crazy good photos
- January 6, 2011 at 4:10 PM
- Mark Lester A. Iragana said...
Good stuff. I like your content.
- January 18, 2011 at 6:56 PM
- Krishna said...
Beautiful china
- January 25, 2011 at 10:35 PM
- klAnA said...
v beautiful scenery (^o^)v
- January 26, 2011 at 10:49 PM
- online nepal tours said...
wow all above images are incredible and interesting to view. I think it's a talent of photo taker i respect that person for giving us golden chance to view.
thank you..
- January 30, 2011 at 1:32 AM
- iqbalnk said...
Beautiful photography........nice....i like it.
- March 3, 2011 at 9:25 AM
- Donna said...
Woww just unbelievable. So beautiful places wish to be there right now http://www.smokersworld.info/
- March 23, 2011 at 8:23 AM
- Unknown said...
very beautiful & sizzling pictures...
- April 8, 2011 at 12:10 PM
- Falmouth Photos said...
These are some beautiful, breathtaking photos of China. Feng Jiang is a very talented photographer.
- April 12, 2011 at 4:26 PM
- The Epic Adventurer said...
I just wish I knew what specific places these photographs are of!
- April 24, 2011 at 4:50 PM
- Aldo DiCioccio said...
am in absolute awe right now.
- May 2, 2011 at 9:30 PM
I would love to know where specifically the second photo of the waterfalls is from because it's absolutely beautiful and would definitely be a hopeful destination spot for me!
- May 26, 2011 at 10:29 PM
- trekking in nepal said...
Very beautiful and amazing pictures of China. I really enjoyed looking those pictures.
- June 2, 2011 at 12:33 AM
- Islandvacations said...
Awe-inspiring pictures of China. Cannot wait visiting the places.
- June 13, 2011 at 9:18 AM
- TrendBuzz said...
Its really amazing. Fantastic landscapes! Great photo's.
- June 23, 2011 at 8:58 AM
- Singapore Tourism said...
Beautiful images lol. There is lot more places in china than above
- July 13, 2011 at 2:43 AM
- Mauritius Travel Guide said...
Stunning China is has Awesome Scenery
- August 27, 2011 at 11:33 PM
- Dambar Khadka said...
Lovely short,Like it.
- September 27, 2011 at 1:15 AM
- Malaysia Tourism said...
This images shows a picturesque view of china's tourist sopts
- September 30, 2011 at 12:16 AM
- Frivolous 11(b)1 said...
Beautiful pictures. Do you know who I could talk to about using them? I want to share, but I'm afraid of copyright issues. Is there a way to get in touch with Feng Jian?
- May 15, 2012 at 9:01 PM
- Nepal Expeditions said...
Magnificent snaps and likes this blogs..so much fun to read it..and see all the lovely photographs..
- September 18, 2012 at 11:26 PM
- Nepal Expeditions said...
Magnificent photographs!!! So much fun so see all the snaps. It must have taken a lots of hard work to collect all the photos. Love to read more..
Well Wisher
Nepal Expedition
- September 18, 2012 at 11:29 PM
- Expedition in nepal said...
Nice landscapes and really nice views...Great posts
- September 22, 2012 at 9:36 PM
- johan said...
Makes me want to go and visit. Catchy images. It's always surprised and disapponted me that with a country as large and diverse as China that there's not more photography coming out of there.
- March 12, 2013 at 5:31 AM
- Mountain Expedition Nepal said...
Amazing pictures, really heart touching. The professional capture of every shoot is so beautiful. The rare pictures gave me deep joy in my heart.
- September 24, 2013 at 4:52 AM
- hKN said...
Amazing.. really amazing.. thnks for this great pictures dude..
- March 24, 2014 at 3:31 PM
- Creative Clipping Path said...
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- April 14, 2015 at 2:31 PM
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- May 23, 2015 at 1:34 AM
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- June 10, 2015 at 3:54 AM
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First of all appreciate your photography and then thanks for sharing it.
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- July 5, 2015 at 4:39 AM
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- November 24, 2015 at 9:43 AM
- Unknown said...
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- July 4, 2016 at 11:09 AM
- Unknown said...
Amazing Photos. I'm like all of them.
- July 15, 2016 at 11:29 AM
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- November 15, 2016 at 11:59 PM
- GoNandini said...
China is really beautiful... and these pictures prove that...
Thanks for sharing...
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- September 22, 2017 at 12:13 AM
- Unknown said...
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- October 31, 2017 at 3:28 AM


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Rich and famous people seek out publicity, and publicity seeks them out—often in detrimental ways.
"Individuals with wealth and notoriety are prime targets for having their assets disclosed by the media," Jim Duggan, a wealth and estate planning attorney at Duggan Bertsch LLC in Chicago, said in a statement.
Duggan says that rather than use their own names when titling their assets, high-profile people should camouflage them with bland, ambiguous names.
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Duggan suggests five pre-emptive planning techniques public figures should consider in order to maintain confidentiality and creditor protection and to avoid probate.
1. Revocable Living Trusts
When the value, assets and inheritors of a public figure's estate become public knowledge, the estate planning process has failed, Duggan says. This is because assets owned in an individual's name at the time of death must go through the probate process, the details of which are fully available to the public.
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"Spendthrift trusts" or asset protection trusts provide protection and confidentiality for assets placed within the trust. Individuals can create an APT for a third party (gift trusts) or themselves (self-settled) to protect wealth during their lifetime.
Properly structured, Duggan says, the assets in an APT are fully protected from outside attack or inquiry. An APT is also a way to isolate separate property, ensuring it is protected from spouses in the event of a divorce. 4. Establishment of LLCs
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Rather than investing directly, Duggan says, an individual puts the funds into the private placement contract as premium, and the issuing insurance company invests the funds in its name for the benefit of the client.
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