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This all-embracing exploration of South America visits Rio de Janeiro, Iguassu, Buenos Aires and Santiago.
"The experience was superb"
Three wonderful cities on a laid-back holiday: Rio de Janeiro, Buenos Aires and Santiago come together with the mighty Iguassu Falls, on this relaxed exploration into South America.
You'll enjoy Insider moments like… being charmed by a vibrant young Buenos Aires family as they wine, dine and entertain you in their home. Lina and Gaspar let you in on the secrets of making delicious bread and how the Tango should be danced.
Trip type: At Leisure i
Trip code: LBSA
11 full breakfasts.
5 dinners (including Be My Guest).
1 lunch.
No further information available
Best of South America
1. Arrive Rio de Janeiro (4 Nights)
Bemvindo ao Rio de Janeiro. Upon arrival at the airport, you will be met by a local host and taken to your lovely oceanfront hotel. Relax, get settled and enjoy your hotel's superb location overlooking Copacabana Beach.
2. Rio de Janeiro Sightseeing
Enjoy a leisurely morning before joining your Travel Director for an exploration of the cidade maravilhosa (marvellous city) and its many contrasts, from the 18th century aqueduct and colonial Candelaria Church to the 20th century opera house, Sambodromo, and city cathedral. Ascend Sugarloaf Mountain via cable car for astounding bay and city views followed by a festive Welcome Reception with your Travel Director and fellow travellers.
3. Rio de Janeiro Sightseeing At Leisure
Journey by cogwheel train to the summit of majestic Corcovado, site of the iconic Christ the Redeemer statue, one of the Seven Wonders of the World. Back down the mountain, see the song-inspiring Copacabana and Ipanema beaches. The rest of the day is at leisure. This evening, learn to mix the national cocktail, the caipirinha, and indulge in a traditional Regional Meal barbecue at a local churrascaria.
4. Rio de Janeiro At Leisure
Enjoy a full day to explore the wonders of Rio on your own. Optional activities include a tour into the nearby favelas, a sailboat cruise and a helicopter flight over Copacabana Beach.
5. Rio de Janeiro – Iguassu Falls (2 Nights)
Relax and enjoy a free morning for independent activities. This afternoon, visit a Samba school, a Cultural Insight, to see how the school operates and prepares for Carnival week. See Carnival props and should you desire, join a Samba dance lesson. Afterward, head to the airport for the short flight to Iguassu Falls. These 275 separate falls cover nearly two miles along the Iguassu River. This evening, enjoy a convivial dinner with your companions at the hotel.
6. Iguassu Falls Sightseeing and At Leisure
Enter Iguassu National Park, a UNESCO World Heritage Site, and meet your Local Specialist to explore the Brazilian side of Iguassu, including a scenic walk through the rainforest to the base of the falls. After lunch at a restaurant overlooking the falls, return to your hotel for a leisurely afternoon at your resort. You may wish to join an optional activity such as a jetboat ride to the base of the falls or a helicopter flightseeing tour.
7. Iguassu Falls – Buenos Aires (3 Nights)
Cross the border into Argentina and board the open air ecological jungle train for a different perspective of the cascades. Walk along a scenic catwalk, with a Local Specialist, to see the thunderous Devil's Throat Falls. Then fly to Buenos Aires, a city renowned for its boutiques, fine dining and museums.
8. Buenos Aires Sightseeing and At Leisure
Embark on an in-depth tour with a Local Specialist to see the Casa Rosada, Metropolitan Cathedral and other government buildings; the colourful neighbourhood of La Boca and San Telmo. Stare in awe at the famous Teatro Colon, a landmark in Buenos Aires. Lastly, visit the Recoleta Cemetery where Argentina's former First Lady, Eva Peron (Evita), is buried. This evening, get ready for a festive Regional Meal and a chance to savour renowned Argentinian beef followed by a sensual Tango performance and Cultural Insight.
9. Buenos Aires At Leisure
A full day at leisure to explore on your own or perhaps take an optional trip to a traditional estancia (ranch) and learn about the life of a gaucho (cowboy) while enjoying a barbecue lunch and equestrian show. This evening, enjoy an exclusive Be My Guest experience in Palermo Soho. You will be welcomed by a local family and long-time residents of this now-trendy neighbourhood. Be delighted, as they wine and dine you with homemade family recipes in the kitchen. Discover the secrets of kneading country bread and watch as they demonstrate the art of typical Argentinian crafts. Spending time with this lively family will be a memory you won't soon forget.
10. Buenos Aires – Santiago (2 Nights)
Bid "Adios" to Buenos Aires and say "Hola" to Santiago as you fly west across the Andes to the Chilean capital. Meet your Local Specialist and embark on a tour of this vibrant city, travelling by Club Hipico-the regal racetrack-and sprawling Parque O'Higgins. Drive along Alameda Avenue past the University of Chile on your way to the dynamic Plaza de Armas with its fountains and sculptures. Head up San Cristobal Hill for panoramic views of the city and the snowcapped Andes. Later, settle into your hotel, situated in the heart of one of Santiago's most beautiful neighbourhoods, and a prime location close to charming boutiques, bars and restaurants. This evening is at leisure.
11. Valparaiso and Winery Excursion
Today, set out on a tour of Valparaiso city, formerly a major stopover for ships travelling between the Atlantic and Pacific Oceans. This afternoon, visit a Chilean winery and sample a variety of wines from this now famous region before returning to Santiago. This evening, gather with your travel companions for a festive Farewell Dinner.
12. Depart Santiago
Say hasta luego to Chile and transfer to the airport for your onward travel arrangements. Choose to extend your stay at the InterContinental Santiago or with an exciting optional extension.
Guest Service Rating from 4 Reviews
Excellent. Gio was superb.
Service rating : The whole tour was enjoyed by the two of us. Beverley had an accident and Rodrego's care was marvellous.Product : The pace of the day tours and departures suited everyone. Rodrego's skills and contacts made airport and departures so smooth.
Things worked out pretty well especially since we had a lot of airline flights
Service rating : Argentina and Brazil were fabulous, the tour manager there was a 12 out of 10. Chile let you down, the tour guide there de the absolute minimum that he could get away with.Product : Argentina and Brazil were wonderful, whoever made the decision to cut the trip from 3 nights in
Be My Guest
Dine at the home of a local family in the Palermo Soho neighbourhood.
Cultural Insights
Learn about the Tango at a performance in Buenos Aires. Visit a Samba school and see how they prepare for Carnival.
Hidden Treasures
Enjoy at least one surprise Hidden Treasure.
Local Specialists
For sightseeing in Iguassu, Buenos Aires and Santiago.
Find out what makes Trafalgar different.
Because you looked at Best of South America
Our best deals and offers
from our brochure
What's Included
City tour in Rio de Janeiro, Buenos Aires and Santiago
See the Church of San Francisco, Copacabana and Devil's Throat Falls
Visit the Christ the Redeemer statue, Sugarloaf Mountain, Corcovado, Recoleta Cemetery, Iguassu Falls and Valparaiso
What's Included
Audio Headsets for flexible sightseeing
Daily breakfast and an average of 50% of evening meals
Luxury air-conditioned coach with WiFi in most countries or alternative transportation (such as rail journeys)
A Trafalgar bonus - all Intra-Air Flights: Rio de Janeiro to Iguassu, Iguassu to Buenos Aires and Buenos Aires to Santiago, including porter service at all airports
Cherry-picked hotels, all tried and trusted
Hand-picked Insider Experiences
Optional Experiences and free time
Porterage and local charges included
Must-see sightseeing and surprise extras
An expert Travel Director and separate Driver
All hotel tips, charges and local taxes
Airport transfers on the first and last day of your guided holiday
VIP entry to many sights
Airport Transfers
Specific transfer information can be found on the airport transfers page
Why Trafalgar?
Enjoy the wonder of travel, crisscrossing the globe through the seasons. On effortless adventures in breathtaking new horizons, forge lifelong friendships and memories. Our lovingly crafted itineraries are a fascinating mosaic of cultures, flavours, festivals and local stories. We're with you all the way, guiding you and ensuring you experience the real thing: the sheer love of travel, entirely hassle-free.
"Is simply the best way to position what our guests love to experience and what we love to deliver" - Gavin Tollman CEO
Meet warm-hearted locals and like-minded travellers. Along your journey of discovery, stop to share stories and flavours with local farmers, chefs and winemakers. Pause to admire the handicrafts and rich traditions of amazing artisans. Explore the essence of Europe through captivating accounts shared by expert historians and savvy local guides.
Travelling with your tastebuds, treating them to new flavours, spices and textures along the way. From the very first breakfast to the last nightcap, travelling through Europe indulges your palate, with every meal an opportunity to discover regional fare. Savour each new flavour, try the local tipple and take home fresh culinary inspiration. Let us share our love for food and hospitality with you.
Once you've packed your suitcase, we take care of the rest, removing all your concerns so that you can be secure in the knowledge that an award-winning global company with an impeccable reputation has taken care of every little detail. We arrange everything you'll need along your journey - meals, accommodation and travel logistics, because we are with you all the way. Travel the world with peace of mind, knowing you're in the hands of Trafalgar.
12 days, 3 cities
Any questions? If so, call one of our agents or contact us via our enquiry form0808 281 1126
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Santiago, Chile
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La La La...Everything!Like so many of us, the love of Zelda is why I am 24 and still playing video games (and why I am STILL trying to stop the damn moon from falling in just three short days - I'll get you someday Majora, I swear!) Kingdom Hearts gives me hope that I'll never grow up - and at the same time, appreciative that I have. Katamari keeps me open minded and balanced - I can roll up anything, even you! Nintendogs keeps me girly.
And my naturally geeky tendencies tie everything together with a nice, neat bow.
P.S. Mr. Pokeylope is the best soul-talking turtle EVER!
My Games
Comments (0)

subset: commoncrawl


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The dog days of summer are in full swing. Sunshine! Humidity! Thunderstorms! The intense desire to avoid wearing pants!
No? Is that just me?
As we settle into the heat of August there is nothing more unpleasant than putting on anything tight when the air around you already feels like a thick, woolen hug. 764 more words


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Parsons' Master of Fine Arts in Industrial Design program offers an innovative two-year, 60-credit full-time graduate curriculum that prepares students to negotiate the seemingly contradictory forces at play in the growing product design industry. Students explore the way goods can be produced in both localized contexts (a "making in place" approach, which relies on regionalized needs and constraints) and globalized contexts (employing design principles focusing on universal needs). Parsons' School of Constructed Environments includes graduate students in Architecture, Interior Design, and Lighting Design, creating a unique learning community.
This program is part of Parsons' School of Constructed Environments (SCE). Learn about the
SCE community and explore our
blog to see what students, faculty, and alumni are doing in NYC and around the world.
New York City boasts the country's largest number of creative-sector jobs and attracts top design talent. Local industry events and collaborations with commercial and nonprofit partners deepen connections to the field. In the MFA Industrial Design program, students combine advanced making skills with critical inquiry to design for production at all scales, from low volume to high volume, employing methods ranging from desktop manufacturing to systems involving global supply chains. Students develop their knowledge and skills at the university's state-of-the-art product prototyping and testing facilities.
The MFA Industrial Design curriculum balances competing interests such as economical production and sustainability, consumerism, social and environmental improvement, and global and local production, investigating ways to integrate and reconcile these forces as a whole. In their second semester, MFA students explore limited-run making in New York City, and in the third semester they can investigate large-scale global production through virtual collaborations or study abroad at sites including Parsons Paris. A specialized thesis project offers opportunities to develop designs that advance — or challenge — industrial design theory and practice.
The faculty of design practitioners aims to develop a community of designers committed to improving industry, protecting the environment, and promoting the quality of life. The MFA Industrial Design program attracts motivated, reflective students with experience in product design but also accepts candidates from other design professions and disciplines such as engineering, fine-art, management, and anthropology,. An innovation-focused university with programs in the social sciences, business and management, media studies, and the performing arts, The New School offers complementary courses that enrich design practice.
Students graduate equipped with the ability to integrate the many considerations involved in product design and to lead as socially aware makers, strategists, and industry specialists. Graduates emerge prepared to design innovative products and lead the industries that produce them as well. Career paths include industrial design, product development, manufacturing, furniture design, humanitarian and service design, toy design, design management, and architectural building systems.
The Master of Fine Arts degree is awarded for completion of 60 credits. A maximum of nine credits of graduate-level coursework may be transferred from another institution. Students must maintain a 3.0 cumulative grade point average and fulfill all requirements in a timely manner.
Students engage form giving as a means to strengthen discourse around beauty, desire, context, audience, and function. Thematic assignments build on analytical and prototyping skills developed in Advanced Modeling Methods and Form Analysis. Students will be
challenged to evolve their prototypes into refined, innovative physical forms with strong conceptual underpinnings.
Students develop a critical future-oriented understanding of the history of product and industrial design through many lenses, including socio-technological innovation, economics, business, ethics, gender, scale of production, efficiency, labor, human-centered design,
systems thinking, ecological impact, engineering, science, and cultural expression. Readings and lectures expose students to multiple perspectives and encourage them to challenge historical assumptions.
Students apply testing to create designed outcomes and explore advanced means to communicate ideas to multiple audiences through application of product semantics, distinguishing between self-perception and how others read design artifacts. Principles and analytic
vocabulary are introduced through lectures, weekly readings, discussions, and exercises. Project-based work will challenge students to work individually, as well as collaboratively with external parties.
Students develop approaches that not only improve work product, but the working environment. The course is integrated with Design Studio 1 with various project touch points. Focus is on hands-on full-scale and scaled making. Students explore how varying degrees of
intent, audience, and fidelity influence a project's timeframe, final finish, and conceptual purpose.
This course investigates opportunities for product design, production, and distribution in localized contexts, with emphasis on low-volume self-production and the use of appropriate making strategies utilizing both CNC technology and manual labor. Using a
satellite location for testing and short-run trial implementation, students complete hands-on project-based work in an iterative process and with a strong engagement with manufacturing.
This course employs user-centered design methods and push-pull participatory practice to optimize creative problem solving. Need-finding exercises challenge students to assess and substantiate compatibility with input from market, community, business, and
manufacturing. Students will conduct advanced usability research, applying testing to create designed outcomes. Heavy emphasis on data visualization and diagramming will complement scenario, simulation, interactive, and interface design.
This course surveys processes commonly used by industrial designers at various scales of production and provides advanced methodologies for developing and constructing more sustainable and long-lasting products. Students are challenged to choose appropriate
manufacturing methods and deploy strategies for creating intentional by-products, co-products, and scenarios of zero waste production.
Students should explore their elective options with their
advisors to create a coherent study plan.
This studio explores extended supply chains and proposes designs that could be implemented across national boundaries and cultures. Students will have access to a case-study international locale either through travel, virtually, or a combination. Projects explore
"universal" product typologies and how industrial design can transcend cultures.
This course builds upon Materials, Manufacturing, and Assembly by developing rudimentary engineering skills and capacities. The course leverages project-based exercises in advanced supply-chain mapping, process tree diagramming, carbon footprint, toxicity, recycling, etc.
Students are introduced to concurrent engineering and integrated product development via digital simulation and testing.
This is the first part of a two-semester thesis project. Students begin research, analysis, and developing design ideas in this semester and then follow through with project closure in their last term. Students work closely with faculty to identify an appropriately
complex and forward-thinking inquiry that may positively expand the field and advance knowledge.
This seminar draws upon various colleges of the university (
Parsons) in navigating seemingly contradictory dichotomous worldviews and the possibility of a more integrated future. The course considers appropriate scale as well as parsing values between market-driven and humanitarian initiatives. The course has a
special emphasis on cooperation, collaboration, and illustrates numerous case studies of corporate as well as nongovernmental organizations driving design-led social change. Guests will include leading practitioners, design historians, theorists and futurists.
This is a self-directed studio in which students synthesize theoretical ideas and conceptual underpinnings developed in Thesis Preparation. Students will work closely with a primary thesis advisor, and select professors and professionals inside and outside the Parsons
faculty will serve as secondary advisors and guest critics. Students will present a specific focus in creating designs that challenge or innovate the field. Reconciling multiple stakeholders and audiences, students must shape their work as a form of social engagement, with a particular focus on
user-centered design and innovation.
This course supports Design Studio 4 and builds upon Thesis Preparation. Students learn to articulate their hypothesis and supporting arguments, while testing it against evidence from their own design-led inquiry and others' research. The paper will focus on students'
own primary source material, as well as secondary sources and precedence. Beyond the thesis paper, the course also acts as a repository for collecting students' full body of work around their selected project. Students will combine their thesis essay, final project, and supporting body of
work into a compelling media document, such as a digital book.
This course provides an overview of design services and principal structures for product/industrial designers including in-house, consultancy, freelance, and self-production. Fundamentals in business, entrepreneurship, and external funding models will be
covered. Other areas include project planning and interfacing with various stakeholders. Students will be introduced to corporate, public, and nonprofit realms. Emphasis is placed on understanding liability and indemnification as well as intellectual property rights and responsibilities.
Learn more about what Parsons students, faculty, and alumni are doing throughout the city and around the world.
Explore the SCE Community
Application Deadline:
The application deadline is January 1. To be most competitive for admission and merit scholarship consideration, please apply before the deadline. We will continue to review applications submitted after the January 1 priority deadline pending space availability in the program. The Admission Committee will make a decision on your application only after all the required materials have been received. Spring term admission is not offered for this program.
The fall term readmission deadline is August 1 (review
readmission information below).
Financial Aid Deadline:
All applicants selected for admission into our program are considered for a merit scholarship award that is determined by the strength of their application. Scholarship award notification is communicated at the same time as the admission decision. International students are eligible only for merit scholarships. If you are a U.S. citizen or eligible noncitizen, we encourage you to complete the Free Application for Federal Student Aid (FAFSA), which can be found on the Web at
www.fafsa.gov. The FAFSA is available each year on October 1. You do not need to wait for an admission decision to apply for federal aid; we recommend submitting by our FAFSA priority deadline of Februrary 1 for fall applicants. (The New School's federal school code is 002780.)
All applicants are required to apply online. Save your work frequently and print a copy for your records. You must complete all required fields and uploads prior to submission.
Any additional supporting documents that need to be sent by mail must include an
Application Materials Cover Sheet. All supporting materials must be received before your application can be reviewed.
See below for additional information regarding submission of transcripts and recommendations.
Some of your required materials will be submitted through
The New School does not require TOEFL, IELTS, or PTE scores for applicants:
Students may be invited for an interview in-person or by phone
Application for Readmission (PDF) should be completed by students who wish to return after an absence of four semesters (fall and spring). Students must reapply to the program to which they were originally admitted. Readmission is only available for current New School programs. If you are looking to transfer 24 or more semester-based credits, you should apply for admission as a transfer student according to the instructions outlined above. The following materials are required of applicants seeking readmission:
Rama Chorpash, Program Director
Parsons Wide
SCE Wide


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Sheer silky blouse from Sister Jane, with edgy detailing. Features intricate silver metal collar detailing.
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Display Ads
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Mail: Acts of kindness
Groene at the Legislature: State budget looks better, Kintner scandal, vaccine
More opinion
McCook company catches NUs eye
Nebraska sheep, goat producers to meet in Broken Bow
More Ag News
It is a late December day. Its 60 degrees. Warm breeze today. Its time to stand by the boats. Its time to ponder summer things. As I look around my neighborhood, I see another man standing by his boat. Its what we do.
Some of us are old. We are not sure if and when summer comes we will be able to do summer things. On days like this, we will stand by the boats. We have a faraway look in our eyes, as we stand by the boats.
City councilman Jim Carman, North Platte
Flatrock Publishing, Inc.
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Top Definition
Someone who's known to fuck bitches with hairbrushes. They are also known to quit a lot then rejoin and afk.
OMFG he's such an ashveen
av idunurmumma 9 februari 2013
Trending Now
Can you define these popular missing words?
Someone who basically sleeps for more than 18 hours a day, wakes up, eats and goes back to sleeping.
Don't be such an ashveen. Get your butt out of bed and help your mum with the dishes, will you?
av daddy's girl 09 26 juli 2016


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Speaker's Blog
President Obama has failed our military and veteransSeptember 28, 2016
Tonight, President Obama is participating in a CNN Townhall to tout his record on supporting the military and our veterans. But don't be fooled—he's failed miserably on both fronts. Read More
The Real Obama Liberal Legacy: 'If You Like Your Plan, You Can Keep It.'September 28, 2016
"If you like your plan, you can keep it." As Obamacare continues to unravel, we look back at one of its biggest broken promises. Read More
House Tackles Water Infrastructure ChallengesSeptember 28, 2016
Today, the House is set to take up the Water Resources Development Act of 2016 (WRDA), which addresses the needs of America's harbors, locks, dams, flood protection and other water-related infrastructure. Here are five things you need to know about this legislation: Read More
Statement on the Passing of Shimon PeresSeptember 27, 2016
"The world has lost a true legend and statesman." Read More
Speaker Ryan: Clean Power Plan Would Cost People Jobs, Send Electricity Bills SkyrocketingSeptember 27, 2016
"Whether you are a consumer, a worker, or a small business owner, our regulatory system should work for you, and even with you, but never against you." Read More


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Top Definition
The act of defecating a very watery type of fecal matter all over the head of ones mate and/or friend.
Randyl is into some weird stuff. Yesterday night, she wanted me to Native Shower her.
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Thank you Graham Norton
How businesses can win talent war with mobile apps, HR data analytics and cloud technology
Latest articles on HR best practices: mobile apps disrupting the annual staff appraisals; reasons for and against open-source software; and Rolls-Royce case study.
By submitting your email address, you agree to receive emails regarding relevant topic offers from TechTarget and its partners. You can withdraw your consent at any time. Contact TechTarget at 275 Grove Street, Newton, MA.
You also agree that your personal information may be transferred and processed in the United States, and that you have read and agree to the Terms of Use and the Privacy Policy.
Graham's site of the week is http://myparentsjoinedfacebook.com or 'Oh Crap. My Parents Joined Facebook'. Very funny and well worth a look !


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Top Definition
Something that is just plain fuckin awesome, best of da best.
Dood, i watched Blade Trinity last night, it was da shit, u gotta see it!
door ken-dawg 18 december 2004
Trending Now
Can you define these popular missing words?
Meanign the best of the best, nothing is better.
that girls ass is da shit
door Ben 16 december 2004
great or amazing
P dizzle is DA Shit
door Sparky13 26 maart 2009
1. Slang for "diarrhea". Usually associated with (but not limited to) eating poorly prepared foods. See also Montezuma's Revenge.
2. The shortest review of "The Da Vinci Code".
2. The shortest review of "The Da Vinci Code".
1. "I knew I shouldn't have had that raw steak with eggs. Now I got Da Shits."
2. The Da Vinci Code was Da Shits
2. The Da Vinci Code was Da Shits
door Brainiac 9 januari 2005
When one can't stop shitting
Man I got Da Shits
door The Man 23 juli 2001


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Life—fluid, invisible, inaudible…
LIFE—fluid, invisible, inaudible… is simple yet deep in its fundamental concepts, important in its themes, and excellent in its realization.
LIFE—fluid, invisible, inaudible… is simple yet deep in its fundamental concepts, important in its themes, and excellent in its realization.
Composers obsess on strange things. For me, it's the gender role stereotypes and sexuality surrounding any given instrument.
Desperately seeking orchestra music that is new in every regard.
Can a private institution control its artistic agenda in a way that a public one cannot?
While one can argue about the importance of remaining true to one's ideals, when writing music for a large ensemble such as an orchestra, what is practical is ultimately what will get done.
New music has been experiencing a surge of popularity over the past couple decades, but, at least in the orchestral world, it still plays the role of underdog. But even if new music does become standard in orchestral concerts across the nation, the music will always be of its time and by definition will always be new; and so it will always be fun to root for.
Remarkable as Elliott Carter's productive longevity is, he is far from the only composer who has given the lie to the Mozartean mythology that composing genius traces an early trajectory.
Overheard on 57th St.: I just played Carnegie Hall; I'm going to take a cab!
A rundown of the 2007 Minnesota Orchestra's Composer Institute.
More music and seminar action from the Minnesota Orchestra's Composer Institute.


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Kernel Bug Tracker – Bug 15446
sysctl(2) can return EACCES without sufficient permissions
Last modified: 2012-12-21 20:31:19 UTC
After a semi-lengthy discussion, it turns out that EACCES can and would be set in cases where a sysctl(2) isn't available [in the old model, pending a bug in test_perm] or the file isn't accessible [in the new model].
This currently isn't documented as such in the manpage.
It would probably be prudent to add the following to the manpage:
EACCES The requested access to the sysctl is not allowed.
More testing will need to be performed to ensure that other unexpected errors don't pop up with sysctl(2), if possible time-wise.
Credit goes to Shi Weihua for finding the documentation bug, and Eric W. Biederman for noting the bug in the original sysctl(2) implementation.
Would someone please look into patching the manpage for this requirement?
(In reply to comment #1)
> Would someone please look into patching the manpage for this requirement?
Garret, could you provide a pointer to the discussion that you mentioned in the report?
Sorry -- I canceled my Yahoo email account. Here's a link to this discussion: https://lkml.org/lkml/2010/3/4/309 .
Garrett, I've applied a different patch from what you suggest, essentially just
making EACCES a synonym of EPERM.
index bb2d9a5..b1772d5 100644
--- a/man2/sysctl.2
+++ b/man2/sysctl.2
@@ -78,6 +78,7 @@ Otherwise, a value of \-1 is returned and
is set to indicate the error.
The invocation asked for the previous value by setting
.I oldval
@@ -88,7 +89,7 @@ non-NULL, but allowed zero room in
.I name
was not found.
No search permission for one of the encountered "directories",
or no read permission where
.I oldval
lines 1-21/21 (END)
LGTM. Thanks!


text:
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Never or curtailed lactation has been associated with an increased risk for incident hypertension, but the effect of exclusive breastfeeding is unknown. The authors conducted an observational cohort study of 55,636 parous women in the US Nurses' Health Study II. From 1991 to 2005, participants reported 8,861 cases of incident hypertension during 660,880 person-years of follow-up. Never or curtailed lactation was associated with an increased risk of incident hypertension. Compared with women who breastfed their first child for ≥12 months, women who did not breastfeed were more likely to develop hypertension (hazard ratio (HR) = 1.27, 95% confidence interval (CI): 1.18, 1.36), adjusting for family history and lifestyle covariates. Women who never breastfed were more likely to develop hypertension than women who exclusively breastfed their first child for ≥6 months (HR = 1.29, 95% CI: 1.20, 1.40). The authors found similar results for women who had never breastfed compared with those who had breastfed each child for an average of ≥12 months (HR = 1.22, 95% CI: 1.13, 1.32). In conclusion, never or curtailed lactation was associated with an increased risk of incident maternal hypertension, compared with the recommended ≥6 months of exclusive or ≥12 months of total lactation per child, in a large cohort of parous women.
Primary prevention of hypertension is a major public health priority. Although pharmacologic treatment can reduce the burden of this disease, compliance is poor, and adverse effects of treatment are common (1). Thus, hypertension remains a leading preventable cause of death for women (2).
Multiple lifestyle factors have been associated with increased incident hypertension (3). In addition, parous women who never breastfed (4) or only briefly lactated (5) may also have an increased risk of developing hypertension, compared with women who lactate for longer periods of time. Absent or premature discontinuation of lactation has also been associated with increased risks for diabetes (5–8), hyperlipidemia (5, 9), the metabolic syndrome (10, 11), and cardiovascular disease (5, 12, 13).
The mechanisms underlying these associations are not known. Lactation is associated with weight loss in some, but not all, studies, and we have previously hypothesized that lactation may "reset" maternal metabolism after pregnancy, reducing risk of obesity-related disease (14). Lactation also activates central neuroendocrine pathways, including oxytocin and prolactin, and these hormones have been associated with blood pressure regulation (15) and incident hypertension risk (16).
However, unmeasured confounding is a major concern in studies of lactation and health outcomes, because mothers who breastfeed are more likely to engage in other health-promoting behaviors (17, 18). Such confounding is a potential limitation of the 3 prior studies that have measured the association between lactation and hypertension. One study assessed incident disease in a population without data on dietary intake other than alcohol (4), and 2 studies measured prevalent hypertension, adjusting only for concurrent health behaviors (5, 11). No prior study has included information on pregnancy complications, such as preeclampsia or preterm birth, which may affect both breastfeeding success and maternal hypertensive disease risk. Moreover, previous studies have not considered the timing of introduction of foods other than breast milk, which is a measure of breastfeeding intensity.
To address these limitations in the existing literature, we measured the association between duration and exclusivity of lactation and incident maternal hypertension in the second Nurses' Health Study. This large, prospective cohort includes data on duration of exclusive lactation for each child, as well as hypertensive pregnancy complications and preterm birth. Moreover, the study design allowed us to adjust our analyses for multiple lifestyle factors previously associated with risk of incident hypertension in women (3). We further conducted a sensitivity analysis to quantify the degree of unmeasured confounding that would explain observed associations between lactation and incident hypertension.
The Nurses' Health Study II began in 1989, enrolling 116,608 women from 14 US states. Participants were between 25 and 42 years of age at baseline. Each woman completed detailed questionnaires every 2 years. We limited the current analyses to data collected since 1991, the first year for which dietary data were available. We limited our analysis to women who could be "exposed" to breastfeeding, by excluding women who were nulliparous (n = 22,590), as well as those with missing data on breastfeeding (n = 19,605). Compared with women for whom breastfeeding data were available, women missing data on breastfeeding were less likely to self-identify as Caucasian (90% vs. 94%) or to be currently using oral contraceptives (60% vs. 73%) and were more likely to be current smokers (13% vs. 9%) and to be missing data on other health behaviors. However, the 2 groups were similar in age (assessed in 1991), year of first birth, body mass index (BMI) at age 18 years, and family history of hypertension.
We further excluded women who reported a diagnosis of hypertension prior to 1991 (n = 4,583) or who in 1989 reported elevated blood pressure (median systolic blood pressure >120 mm Hg or diastolic blood pressure >80 mm Hg, n = 7,038) or antihypertensive medications (n = 1,640). We further excluded women with self-reported physician-diagnosed diabetes (n = 215), cardiovascular diseases (n = 153), hyperlipidemia (n = 4,538), or cancer (n = 328) (Figure 1).
At baseline in 1989 and on each biennial questionnaire, women reported their number of pregnancies lasting ≥6 months. In 1997, participants completed a detailed questionnaire on breastfeeding for each of their first 4 children, including timing of introducing formula and solid foods. Women with births after 1997 completed a similar questionnaire in 2003.
At baseline and on biennial follow-up questionnaires, participants were asked to report whether they had ever had a physician diagnosis of high blood pressure, excluding during pregnancy. If so, they were asked what year they received this diagnosis. Self-reported hypertension has been previously validated in our population by review of medical records for a randomly selected sample of 147 participants (19). The sensitivity of self-reported hypertension was 94%, and the specificity of reporting no diagnosis of hypertension was 85%. At baseline in 1989, participants were also asked to report their usual blood pressure when checked within the last 2 years.
We included the following time-fixed covariates in our covariate-adjusted models: year of first birth, body mass index at age 18 years, family history of hypertension, self-classified race, and history of pregnancy complications. Parental history of hypertension and self-reported race were assessed on the 1989 questionnaire. Pregnancy complications, including gestational diabetes, preeclampsia, gestational hypertension, gestational diabetes, preterm birth, late miscarriage or stillbirth, and low birth weight, were self-reported on a supplemental questionnaire in 2001.
Time-varying covariate data were collected on multiple questionnaires. On each questionnaire, women reported current weight, use of nonnarcotic analgesics, and oral contraceptive use. Women reported height in 1989. We used current weight and self-reported height to calculate BMI (weight (kg)/height (m)2) at each follow-up time. Women reported alcohol consumption in 1991, 1995, 1999, and 2003 and physical activity in 1989, 1991, 1997, and 1999 (20). We calculated a Dietary Approaches to Stop Hypertension (DASH) diet score for each participant on the basis of validated food frequency questionnaires collected every 4 years (3).
The hazard ratio of incident hypertension by lactation history was assessed with a Cox proportional hazards model. Women contributed person-years from 1991 until diagnosis of hypertension, death, or study end date of June 2005. Because lactation duration was reported categorically, we modeled our primary analysis using categories. Two-sided P values are reported for trends, and 95% confidence intervals are reported for hazard ratio estimates.
As lactation is highly correlated with other health behaviors, both residual confounding and unmeasured confounding are major concerns. To address this problem, we used 2 different approaches. For our primary analysis, we used propensity scores with inverse probability weights (IPWs) to model the association between duration of lactation for the first child and incident hypertension. We then performed a sensitivity analysis to determine the degree of unmeasured confounding that would be needed to explain observed associations. In a secondary analysis, we measured the association between mean duration per child and incident hypertension, using multivariable regression.
All major medical organizations in the United States recommend ≥6 months of exclusive and ≥12 months of total breastfeeding for each child (21–23). We therefore used these durations as referent categories. We defined optimal breastfeeding as having occurred when a mother reported both ≥12 months of total breastfeeding and ≥6 months of exclusive breastfeeding for her first child.
To account for differences in other risk factors for hypertension, we created propensity scores for breastfeeding duration categories (24, 25). We used multinomial regression to model probability of each duration category as a function of covariates at study baseline in 1991, or, for women whose first birth occurred after 1993, at the cycle immediately preceding her first birth. We included in this propensity score body mass index at age 18 years and year of first birth (linear and quadratic), self-reported history of pregnancy complications (ever/never history of each condition: preeclampsia, gestational hypertension, gestational diabetes, preterm birth, low birth weight infant, or stillbirth), smoking status (current, past, missing), vigorous physical activity (<30, 30–59, 60–119, 120–209, ≥210 minutes/week), alcohol consumption (<1, 1–4, 5–9, 10–14, 15–29, ≥30 g/day), DASH diet score quintile, family history of hypertension, current oral contraceptive use, current nonnarcotic analgesic use (none, <2, ≥2 days/week), and self-reported race (white, Hispanic, black, Asian, other).
We constructed weights for each participant using the inverse probability of the duration category she reported (26). We used these normalized IPWs in our Cox proportional hazards models. All models were adjusted for the woman's age and follow-up time in months. To test whether BMI was an intermediate between lactation duration and incident hypertension, we added BMI to our IPW models, using 3-knot quadratic splines (27) to allow for nonlinear associations. We then performed a sensitivity analysis (28, 29) to determine the degree of unobserved confounding that would explain observed associations.
Many of the women in our cohort gave birth prior to the start of study follow-up in 1991, so we could not adjust for concurrent behaviors. In an additional sensitivity analysis, we limited our population to women with a first birth after 1989. For propensity weights, we further included pregravid BMI, defined as the BMI in the cycle prior to the first birth.
We further estimated the population-attributable risk of suboptimal lactation, which is the hypothetical proportion of hypertension cases that would be avoided if all individuals in the study lactated exclusively for ≥6 months and continued for ≥12 months. We used a previously published statistical approach (30) for this calculation, which assumes that there is an independent, causal association between lactation and incident hypertension.
To determine whether our results were sensitive to our modeling approach, we further measured the association between mean duration of lactation per child and incident hypertension, using Cox proportional hazards regression. We derived 2 variables, mean total duration per child and mean exclusive duration per child, which were updated during follow-up, as were lifestyle covariates. To test whether pregnancy complications confounded the association between lactation duration and incident hypertension, we quantified changes in parameter estimates for each duration category in age-adjusted models and in models adjusting for each pregnancy complication. To test whether a history of gestational hypertension, preeclampsia, or both modified associations between lactation and incident hypertension, we tested for effect modification using an interaction term.
All analyses were performed by using SAS, version 9.1, software (SAS Institute, Inc., Cary, North Carolina). The Institutional Review Board of Partners Healthcare approved the study. All P values were 2 tailed, and values of less than 0.05 were considered statistically significant.
There were 55,636 parous women who were eligible for our analysis, of whom 80.6% had breastfed their first child, 16.8% had breastfed their first child for ≥12 months, and 14.6% had exclusively breastfed their first child for ≥6 months. Longer lactation duration for the first child was associated with higher parity (Table 1), as well as lower BMI during follow-up, less family history of hypertension, less frequent smoking, and oral contractive use, higher DASH diet score, more frequent vigorous exercise, and more analgesic use.
Both total duration and exclusive duration of lactation for the first child were correlated with subsequent parity (Mantel-Haenszel chi-square test for trend, P < 0.0001), and lactation durations among siblings were highly correlated (Pearson's r = 0.46–0.81) (P < 0.0001). Thus, parity may be a "collider," and adjustment for parity may produce false associations between lactation duration and outcome (31). For our primary analysis, we therefore analyzed the association between lactation duration for the first child (not all children) and incident hypertension.
We ascertained 8,861 cases of incident hypertension during 660,880 person-years of follow-up. We found a dose-response association between never or curtailed breastfeeding and incident hypertension risk. In IPW-adjusted models, mothers who had never breastfed had a 1.27-fold risk of incident hypertension (95% confidence interval (CI): 1.18, 1.36) (across breastfeeding duration categories, Ptrend < 0.001) compared with mothers who lactated for ≥12 months after their first birth (Figure 2; Table 2). To test whether BMI mediated this association, we further adjusted for BMI during follow-up, which modestly attenuated the association (for never vs. ≥12 months of lactation for the first child, BMI-adjusted hazard ratio (HR) = 1.22, 95% CI: 1.13, 1.31) (across breastfeeding duration categories, Ptrend < 0.001). When we measured the association between duration of exclusive lactation and incident hypertension, we found that women who did not lactate had an IPW-adjusted 1.29-fold risk of incident hypertension (95% CI: 1.20, 1.40) (across breastfeeding duration categories, Ptrend < 0.001) compared with having exclusively lactated for ≥6 months after the first birth (Table 2). Again, this association was somewhat attenuated in models adjusting for BMI during follow-up (for never vs. ≥6 months of exclusive lactation for the first child, BMI-adjusted HR = 1.22, 95% CI: 1.13, 1.31) (across breastfeeding duration categories, Ptrend < 0.001). All associations were materially unchanged with adjustment for lifetime parity.
We then considered the degree of unobserved confounding that would explain our results. Assuming an unobserved binary confounding factor perfectly correlated with lactation in the longest duration category, we found that unmeasured confounders with effect sizes of 0.85 for ≥12 months' total and 0.83 for ≥6 months' exclusive lactation for the first child would be needed to explain the observed difference in incident hypertension among women in these groups versus those who had never breastfed. These effect sizes are similar in magnitude to the associations between 7 days/week of vigorous physical activity versus <1 day/week of vigorous activity (HR = 0.87, 95% CI: 0.81, 0.93) or a DASH diet score in the highest versus lowest quintile (HR = 0.82, 95% CI: 0.77, 0.87) in prior studies (3).
To determine whether measuring health behaviors at the time of the first birth affected our results, we limited our population to 8,318 women with a first birth after 1989. In IPW-adjusted models, we found a hazard ratio = 1.31 (95% CI: 1.00, 1.71) for women who never lactated and 1.40 (95% CI: 1.07, 1.82) for women who lactated for >0–3 months compared with women who lactated for ≥12 months. Adjustment for BMI during follow-up modestly attenuated these associations (never vs. ≥12 months, HR = 1.22, 95% CI: 0.93, 1.60; >0–3 vs. ≥12 months, HR = 1.22, 95% CI: 0.93, 1.59).
We then estimated the population-attributable risk due to suboptimal lactation, defined as <6 months' exclusive lactation and/or <12 months' total lactation, and incident hypertension. If this association is causal, we estimate that 12% (95% CI: 4.9, 19) of incident hypertension in our population could be attributed to suboptimal lactation.
In a secondary analysis, we measured the association between mean lactation duration per child and incident hypertension in the full study cohort (Table 3). With adjustment for lifestyle covariates and hypertension risk factors, we found a 1.22-fold risk (95% CI: 1.13, 1.32) (across breastfeeding duration categories, Ptrend < 0.001), comparing women who had never breastfed versus those who lactated ≥12 months per child. Curtailed lactation was also associated with increased risk: compared with ≥12 months per child, women with >0–3 or >3–<6 months per child had a 1.21-fold (95% CI: 1.12, 1.30) and a 1.19-fold (95% CI: 1.11, 1.28) increased risk of incident hypertension in covariate-adjusted models. We similarly found an increased risk of incident hypertension with never or curtailed exclusive lactation (Table 3). With adjustment for covariates, we found a 1.16-fold risk (95% CI: 1.05, 1.27) (across breastfeeding duration categories, Ptrend < 0.001) for women who had never breastfed compared with a mean exclusive duration of 6 months or more. These results were materially unchanged with adjustment for current BMI and parity.
We found that adjustment for ever-history of preeclampsia slightly attenuated associations between lactation duration and incident hypertension. Our results were materially unchanged with adjustment for other pregnancy complications. We found no evidence for an interaction between ever-history of gestational hypertension or preeclampsia, lactation duration, and incident hypertension (for log likelihood ratio test, all P > 0.15).
We found a direct association between never or curtailed lactation and incident hypertension in a large, prospective cohort of parous women. We found an increased risk of hypertension among women who breastfed each child for <9 months compared with women who breastfed each child for ≥12 months, as well as among women who never breastfed exclusively, compared with women who breastfed exclusively for ≥6 months per child. This association persisted after adjustment for multiple hypertension risk factors by using 2 modeling approaches. In addition, we quantified the degree of unmeasured confounding that would explain observed associations. Our results strengthen the evidence for a causal association between never or curtailed breastfeeding and maternal hypertension.
Our findings confirm and extend earlier work linking lactation with blood pressure regulation. Light et al. (32) reported higher maternal blood pressure among formula-feeding mothers versus lactating mothers after infant feeding. Others have described increased autonomic and hypothalamic-pituitary-adrenal axis stress response to stressors among formula-feeding versus breastfeeding women (33, 34).
Authors have also previously reported differences in hypertension associated with lifetime lactation (Table 4). Lee et al. (4) assessed incident hypertension among 177,749 parous women in the Korean Women's Cohort Study and found the lowest risk among women with 1–6 months of lifetime lactation (vs. never having lactated, relative risk = 0.90, 95% CI: 0.87, 0.93). Lactation duration was associated with lower hypertension prevalence among women in the Study of Women's Health Across the Nation (SWAN) (n = 2,516) (per year of lifetime lactation, odds ratio = 0.90, 95% CI: 0.81, 0.996) (11). Schwarz et al. (5) assessed prevalent hypertension in the Women's Health Initiative (n = 139,681) and found a dose-dependent inverse association (for ≥24 months' lactation vs. never, odds ratio = 0.87, 95% CI: 0.82, 0.93) (Ptrend < 0.001). This association persisted with adjustment for maternal BMI.
We similarly found that adjustment for BMI did not fully explain associations between curtailed lactation and hypertension risk. We speculate that differences may be mediated, in part, by the neuropeptide oxytocin, working centrally and/or peripherally. Oxytocin is released during lactation to facilitate milk let-down, and converging evidence supports a regulatory role for oxytocin on autonomic cardiac control. Animal studies show that oxytocin administration causes changes in blood pressure regulation that persist for at least 3 weeks after discontinuation (15). Moreover, central oxytocinergic fibers inhibit sympathetic and promote parasympathetic activity to the heart (35, 36). In the periphery, oxytocin binding to cardiac and vascular endothelial receptors reduces the heart rate and enhances vasodilation (37, 38). Postpartum oxytocin levels are associated with reduced stress-induced vasoconstriction and norepinephrine, a biomarker of sympathetic activation (39). We speculate that lactation leads to changes in central oxytocin release and/or peripheral receptor expression that persist after weaning, thereby diminishing blood pressure in later life. Prolactin may also play a role. Zhang et al. (16) recently reported a direct association between serum prolactin and incident hypertension in the Nurses' Health Study. Never breastfeeding was associated with higher prolactin in 1 prospective cohort study (40), although not in the Nurses' Health Study cohort (41).
Our findings must be interpreted in the context of the study design. Both obesity and insulin resistance are associated with lactation difficulties, suggesting that curtailed lactation could be a marker for metabolic risk (42, 43). These associations may explain the slightly higher risk of incident hypertension among women with >0–3 months of lactation for their first child compared with those who never breastfed. Moreover, pregnancy complications, such as preeclampsia or preterm birth, may interfere with lactation, and these conditions are risk factors for later cardiovascular disease. A key strength of our study was our inclusion of BMI at age 18 years and pregnancy complications in our adjusted models. Our results do not support our hypothesis that pregnancy complications confound associations between breastfeeding and maternal health. Nevertheless, we cannot exclude the possibility that optimal lactation duration may be a marker for health, rather than a mechanism to prevent subsequent disease.
Unmeasured confounders are another concern. A woman whose circumstances allow optimal lactation may experience less chronic stress and thus face a lower risk of hypertension (44). However, when we performed a sensitivity analysis, we found that our results were robust. We found that unmeasured confounders would have to be as strongly associated with hypertension as 30 minutes per day of vigorous physical activity versus no physical activity or DASH diet score in the highest versus lowest quintile to explain our findings.
Of note, all participants in our study are registered nurses, and 94% are Caucasian, so confounding by race or socioeconomic status is less likely than in a more diverse cohort. Nevertheless, if the choice of nursing as an occupation is correlated with unobserved determinants of health, then conditioning on occupation could affect observed associations (45). In this case, nursing as an occupation would serve as a collider, potentially biasing our results.
Missing data are another concern. We found that women missing data on breastfeeding were more likely to be nonwhite, to be smokers, and to be missing other health behavior data, suggesting that women who were included in our analysis may be more health conscious, potentially biasing our results. Finally, misclassification is also a potential concern. Promislow et al. (46) compared recalled lactation with prospective menstrual diaries and found overall correlation of 0.55, with a mean difference between recorded and recalled duration of 0 (standard deviation, 2.7) months, indicating no overall recall bias. If such misclassification occurred in our cohort, it would likely bias our results toward the null; thus, our observed association may underestimate the true association.
In conclusion, we found that never or curtailed lactation is associated with increased incident hypertension among parous women, independent of BMI. If this association is causal, 12% of incident hypertension cases among parous women can be attributed to suboptimal breastfeeding. Policies that increase support for breastfeeding mothers (47) may decrease the burden of hypertensive disease among parous women.
Author affiliations: Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina (Alison M. Stuebe); Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, North Carolina (Karen Grewen); Department of Maternal-Child Health, Gillings Global School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Alison M. Stuebe, E. Michael Foster); Department of Health Policy and Administration, Gillings Global School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (E. Michael Foster); Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania (Eleanor B. Schwarz); Department of Epidemiology, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania (Eleanor B. Schwarz); Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania (Eleanor B. Schwarz); Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts (Janet W. Rich-Edwards, Karen B. Michels, Gary Curhan); Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts (Karen B. Michels); Division of Women's Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Janet W. Rich-Edwards); Department of Obstetrics, Gynecology, and Reproductive Biology, Obstetrics and Gynecology Epidemiology Center, Harvard Medical School, Boston, Massachusetts (Karin B. Michels); and Renal Division and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Gary Curhan, John Forman).
This study was funded by the American Heart Association (grant 0535401T) and by the National Institutes of Health (grants HL079929-01A2, CA50385, and 5K12HD050113-04 to A. M. S.).
The authors thank Eileen Hibert for technical support.
Preliminary findings were presented at the 57th Annual Meeting of the Society for Gynecological Investigation, Orlando, Florida, March 24–27, 2010.
Dr. Foster has received grant support from the Mead Johnson Center for Clinical Excellence. The other authors have no conflicts of interest to disclose.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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