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In the 1700s, Benjamin Franklin quipped: "Nothing is certain except death and taxes."
Today he'd have to add: and annual Pennsylvania turnpike toll increases.
Drivers on the Pennsylvania toll road system are shelling out more starting today as the latest rate increases kick in - largely because of mandated quarterly payments to PennDOT.
And prices are almost certain to continue to rise in the years ahead.
Those who pay with cash are shelling out the most. Cash fares rose 10 percent across the turnpike system as the clock struck 12:01 this morning.
Those using E-ZPass transponders to pay their tolls will only see a 2 percent fare increase as part of a continuing effort by the Turnpike Commission to encourage drivers to adopt the electronic payment system.
The fifth annual toll increase means drivers paying cash are shelling out about 70 percent more than they did in 2008, the Pittsburgh Post-Gazette reports. E-ZPass users are paying about 35 percent more.
In a press release, the commission noted that E-ZPass customers now pay about 25 percent less than those paying with cash. The commission plans to switch to an all-electronic tolling system, which will eliminate the need for human toll takers and reduce pollution from vehicles slowing down or stopping to pay tolls.
But even electronic tolling isn't likely to stop the annual increases, largely stemming from Act 44 of 2007. That law now requires the Turnpike Commission to make payments of $450 million a year to PennDOT to support mass transit and road and bridge repairs. Because the payments originally were double the current rate, the commission has sent $3.6 billion to PennDOT since 2007.
The commission is borrowing money to make those payments, greatly increasing its debt. That's an issue outgoing state Auditor General Jack Wagner has highlighted in the past year.
The commission's debt has grown from $2.5 billion in 2007 to $7.8 billion in 2012, Wagner told state lawmakers in November.
And that debt is expected to continue to grow to $20 billion because under Act 44 the commission has to make the annual payments to PennDOT until 2057. As that debt grows, so will turnpike tolls.
To put the size of the payments to PennDOT in perspective, the commission's operating revenue in the last fiscal year was $803 million, according to its annual report. It cost $387 million that year to operate the toll roads and $368 million was spent on bonds and interests. With other costs and depreciation, the commission went $560 million in the hole in that year alone.
Paying that off will take many more years of toll increases. In fact the 2012 annual report states: "The Commission plans to continue to increase toll rates annually and to issue debt for the foreseeable future to finance these payments" to PennDOT.
Finding a way to wean PennDOT off relying on the $450 million in annual payments will be difficult, but for the longtime financial stability of the commission and the chance to break the string of annual toll increases, lawmakers need to try.
Otherwise, drivers will be digging deeper and deeper into their pockets each year.


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The Upshur County school system was recently awarded a $1 million grant by the state's School Building Authority.
The county is one of only two counties to receive $1 million, and one of only seven counties awarded with just more than $6 million in available funds. Upshur County schools also received the same grant last year, Superintendent Scott Lampinen said.
"It's pretty impressive in that regard," Director of Facilities Keith Moran said.
The grant money, matched by some funds from the school board, will help with Phase II of the Major Improvement Project Plan for the county, allowing the upgrade of heating, ventilation and air-conditioning systems at French Creek, Rock Cave and Tennerton elementary schools.
Lampinen said that he was notified Monday about the grant.
"That's great news, very pleased with that," Lampinen said.
Moran said there would be an update to the school board on how to approach the project.
"This is a bigger project than just putting up some lights and some ceiling tile, and that type of thing," Moran said. "This is an impact that will go a long way and hopefully last 30, 40 years down the road."

subset: commoncrawl


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Systemwide Events Calendar
Manoa Jazz & Heritage FestivalOctober 26, 7:30pm - 10:00pm
Manoa Campus, Orvis Auditorium
Nnenna Freelon is a six-time GRAMMY Award-nominee. She sings with what the Los Angeles Times described as "... exquisite musicality and an unerring sense of swing." In addition to six Grammy nominations, Freelon made her feature film debut in the Mel Gibson hit, What Women Want and sang a remake of Sinatra`s classic, `Fly Me To The Moon` for The Visit starring Billy Dee Williams. She has twice been nominated for the "Lady of Soul" Soul Train Award. In addition Freelon has performed and toured with a veritable who`s who in jazz, from Ray Charles and Ellis Marsalis to Al Jarreau and George Benson. An accomplished singer, composer, producer, and arranger (as well as budding actress), Freelon has dedicated herself to educating young people, both musicians and non-musicians. Her messages reach into the very soul of the person listening, encouraging and motivating them toward constructive change and the creation of positive energy. A University of Hawaii at Manoa Outreach College production. Part of a Performing Arts Presenters of Hawaii tour.
Event Sponsor
UHM Outreach College Community Services, Manoa Campus
More Information
956-8246, http://www.outreach.hawaii.edu/community/default.asp
|Saturday, October 26
|The Wellness Center - Fitness Class Schedule
Maui Campus, Pilina Bldg., Wellness Center
|Indigo Blues Workshop
Manoa Campus, 3860 Manoa Rd.
|Plein Air Watercolor Painting Workshop
Manoa Campus, Lyon Arboretum, 3860 Manoa Rd.
|Making the Graphic Novel
Manoa Campus, Krauss Hall
|2013 SOEST Open House
Manoa Campus, POST / HIG / MSB
|Social Media Summit & Expo
Neal S. Blaisdell Center
|Manoa Maniacs Student Tailgate
Manoa Campus, Aloha Stadium
|Manoa Jazz & Heritage Festival
Manoa Campus, Orvis Auditorium
- Highlighted dates have scheduled events.
- Select the date to view all events for that day.
Ongoing Events
- The Wonder of Learning: the Hundred Languages of Children Exhibit
- Waikiki Parc Features Nicole Naone
- Course Reserves Deadlines and Information
- Red Hat System Administration I
- EWC Arts Exhibition: Bollywood & Beyond: Costume in Indian Film
- Kalaupapa -- A Source of Light, Constant and Never-Fading
- Trip Around the Island
- Convergence: Glitch_Click_Thunk, Featuring Mark Amerika
- Trip Around the Island exhibit
- Conflict Resolution Day Book Displays
- UHM Costume Museum Exihibition
- The Wild Party


text:
As the Black Swan Research Initiative™ team moves from its launch phase to its research phase, we will update this page frequently with new information. Be sure to check back often in the coming months.
Where do I sign up? I've had 2 tplants and am currently on rev maintenance.
My good friend is from Sweden and has had this for three years now. He has had the xplant and in remission, yet on such pain killers that he can barley function. Any help finding him some help beyond Sweden's horrible health care system would be immensely appreciated.
Dear Dr. Durie,
My mom was diagnosed with myeloma four years ago. She was given Revlimid and Dexamethasone. A few months later, she had a stem cell transplant (auto, not allo). A few months after that, still taking the Revlimid and Dexamethasone, she was declared to be in remission, although not complete remission. She is still taking Revlimid. Her doctor told her to stop taking Dex. Soon she will also stop taking Revlimid (doctor's orders).
Can you help my mom to somehow get into complete remission? Her myeloma has remained stable since she was declared to be in near-complete-remission. She is willing to take part in trials.
Thank you,
San Francisco, CA.
My uncle has has been treated on multiple myelom in 2012. He underwent 2 bone marrow transplanations with no success, the MM still progresses. He is also willing to participate on research, since he hasonly one more chance of bone marrow transplatation. New treatment is his only help. Is there a chance for him to become a part of the program?


text:
Anthony Jasenski, Chair of the County Legislature | Kathleen Rooney, County Manager
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Welcome to the Homepage of the Schenectady County Clerk
Dear Schenectady County Resident:
The Office of County Clerk serves almost every citizen of Schenectady County, and although the office doesn't often make headlines, it touches and affects your life in many ways. County Clerks wear many different hats; Clerk of the Supreme and County Courts; Register of Deeds; County Commissioner of Motor Vehicles; County Filing Officer; Chief Notary and elected County Officer. We provide services that involve the Federal, State and Local government.
The Office of County Clerk is one that is steeped in history and tradition and yet, an office prepared to face the future challenges of government. Established by the New York State Constitution, its heritage dates back to medieval England. The Clerk was appointed by the King to travel with the circuit judge. The Clerk was responsible for maintaining court files, documenting land transactions, and representing the crown at local occasions. Over 850 years has passed and the clerk is still responsible for land and court records along with a wide array of duties ranging from recording deeds to swearing in new American citizens.
My goal is to provide responsive service to the people of Schenectady County. If you have any suggestions or comments, or if I may be a personal assistance, please do not hesitate to call me at (518) 388-4220. County Clerk office hours are Monday - Friday 8:30am - 4:30pm. Motor Vehicles is open Monday - Friday 8am - 3:45pm. County Clerk Office, July and August hours are 9am - 4pm.
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. Please call 388-4225.
My e-mail address is
. Our mailing address is 620 State Street, Schenectady, NY 12305.
I'd also like to remind many of our DMV customers that you can process some transactions 24/7 at www.dmv.ny.gov--and skip the trip to the DMV!
Thank you for visiting our webpage.
--JOHN J. WOODWARD, Schenectady County Clerk
Deputy County Clerks:
Maryellen Brehm, Cynthia Reedy, Cara Jasenski, and Jeffrey Morrette
How do I get a copy of my Birth Certificate
The Schenectady County Clerk's Office does not handle Birth Certificates. Birth certificates can be obtained at the City/Town/Village Clerk in the location where the birth took place. For example, if you were born at Ellis Hospital or St. Clare's, the CITY Clerk would have your birth certificate, if you were born at Belleview Hospital, the NISKAYUNA Town Clerk would have it. For births in New York State, but outside of New York City, they can also be obtained by calling (518) 474-3077. For births in NYC call (212) 788-4520.
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John J. Woodward - Biography
Schenectady County Clerk JOHN J. WOODWARD has over 35 years experience in state and local government. Woodward was first elected to public office in May 1975 winning a seat on the Mohonasen School Board. He was 18 years old at the time–making him one of the youngest school board members ever elected in New York State.
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Schenectady County Pistol Safety Course
In order to be considered for a Pistol Permit, you must submit proof that you have successfully completed one of seven approved handgun safety training programs within one (1) year prior to the date of submission of the application.
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Schenectady County office of the New York State Department of Motor Vehicles
The Schenectady County office of the New York State Department of Motor Vehicles is administered by the Schenectady County Clerk. Through our website you can find valuable links to online services which help you avoid lines, and are available 24 hours a day, from the comfort of your home.
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text:
Remember that Walden's Title IV Code is 025042.
Call us now toll-free on1-866-492-5336 or
Do you live outside the US?
Call us now using these toll-free numbers or visit our International Students area.
How well do you communicate? Walden faculty member Dr. Annie Shibata suggests questions to ask yourself to evaluate your effectiveness as a communicator.
Spotlight on Walden is a collection of stories and insights from our students, alumni, faculty, and staff. Get to know the Walden community and see how they are making a difference. Share your story at firstname.lastname@example.com.
Click here to see all posts.
Or call 1-866-492-5336 to speak to an advisor
© 2016 Walden University


text:
LISBON - Tired of separating cardboard and other paper products from cans and bottles when disposing of them at one of the drop-off recycling sites in Columbiana County?
Starting Feb. 1, all recyclable materials can be mixed together when disposed of at one of the drop-off sites in the county because of a change in policy being implemented by the Solid Waste District that represents Columbiana, Carroll and Harrison counties.
"We're going with what we call a single stream" system, said district Director Chris Jacobs. "You won't need to separate your recyclables anymore."
The change is being made for two reasons. First, it is more work for the company that operates the disposal sites for the district to have the recyclable materials disposed of in separate containers, and eliminating the practice is supposed to reduce the number of trips the company must make to the sites to empty the containers.
Jacobs said they hope making all containers available to accept any materials will greatly reduce the problem of overflowing bins and the practice of leaving excess materials on the ground next to full containers.
In addition of going to a single-stream policy, Jacobs said the district board purchased new and larger containers for the four heaviest-used sites -located in Salem, Columbiana, East Palestine and Lisbon - to reduce the overflow problems at those sites. In addition to being larger, the containers at these sites will have sliding side doors to gain easier access.
Jacobs reminded the public to flatten cardboard boxes prior to disposal to save space in the containers. "All it takes is about 10 unflattened boxes to fill a container to the point where no one else can use it," he said.
The district's voluntary recycling program consists of 30 permanent disposal sites spread around the county. Approximately 6.4 million pounds of recyclable materials were disposed at these sites in 2012 - a 21 percent increase over the 5.3 million pound collected the year before.
The increase from 2010 to 2011 was only 2 percent. Jacobs attributed the huge jump in 2012 to increased advertising and public education about the availability of the disposal sites, plus continued expansion of the types of materials that are being accepted.
For more information about the recycling program go to www.RecyclingMakesSense.org or call Jacobs at 330-627-7311.


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7 Tips to Prepare for Your Job Interview
You've sent in the cover letter with your resume and you received a call asking you to come for an interview. The employer sounds impressed with what you sent them on paper and now they want to meet you in person.
Job interviews are your second step to the first impression a company has of you. In the beginning they think they know you on paper but you have to make them comfortable with you as a potential employee.
Whether you are a new graduate or an older worker if you can put your best foot forward in an interview you can grab the job you want. Here are some tips to help you prepare:
1.Brush up on your speaking skills — if you are a person who doesn't speak well in front of people, it may be a good idea to practice speaking in front of a group. Many job interviews today are group interviews instead of personal ones. In fact, many interviews today have a group discussion as part of the interview process. The more confident you are speaking to a group, the more your personality will get across.
2.Check your appearance — no matter what job you are going towards make sure that you have appropriate dress for the interview. Look business, look professional.
3.Piercings, Tattoos and other personal statements — in most interviews, it is inappropriate to show piercings and tattoos. Of course this depends on the job interview, but you want to put your best foot forward. Take out piercings and hide tattoos if you can for now.
4.Keep extra copies of resumes — even though the employer has your resume, you will want to take several copies with you. There may be other people in the room who also need to see your qualifications. Don't rely on the employer to do this for you.
5.Promote you — when you are in the interview keep your comments specific to the job for which you are applying. Show them how you did similar things in your last job (accomplishments) and create a positive image of who you are in work.
6.Do the job interview with confidence — employers like to see confident job seekers. Watch your body language and make sure you are always showing openness to the process. Give a firm handshake in the beginning.
7.Make sure you are comfortable — wear comfortable shows, dress comfortably but business like and make sure that you are comfortably seated when you get to the interview. This will add to your self-confidence.
A job interview is really a kind of game that we play that allows an employer to look us over before they choose to buy. If you are appalled at that idea think about it more. It is a system where employers ask questions and you are there with the ready answers. How well you answer the questions is how you will obtain the job. If you see it as a game you may relax a little and prepare easier.
So, take heed of these tips and prepare well for your interview. Good luck!
Sharon Alexander – Claim That Job
For more information on how to manage your career successfully, and to get a free job hunting report, visit Claim That Job at http://www.claimthatjob.com .


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Select Sires Offers Breed-Leading Sires
Select Sires Offers Breed-Leading Sires
Select Sires' lineup continues to offer numerous breed leaders in a wide variety of traits to meet the needs of every dairy producer. Select Sires' highlights include the No. 1 sire in the breed for type, the breed leader for milk, the No. 1 sire for Lifetime Profit Index (LPI) in Canada and the breed leader for Total Performance IndexSM (TPISM) with 97% Reliability.
7HO9165 Regancrest S BRAXTON
7HO9441 Stouder JAYVEN
Ranking No. 1 for GLPI in Canada at +2638 GLPI is 7HO9264 Lirr Drew DEMPSEY
7HO8081 Ensenada Taboo PLANET
To view Select Sires' new graduates and the complete Holstein lineup, visit www.selectsires.com
Based in Plain City, Ohio, Select Sires Inc. is North America's largest A.I. organization and is comprised of 10 farmer-owned and -controlled cooperatives. As the industry leader, it provides highly fertile semen as well as excellence in service and programs to achieve its basic objective of supplying dairy and beef producers with North America's best genetics at a reasonable price.


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Flu season is in full swing in Central Oregon, but it's still not too late to get your shots, a local health official said Wednesday.
Health specialists say usually, flu season doesn't peak until February. This year it started a bit earlier.
Although flu shots aren't 100 percent effective, doctors say they are still your best defense.
They say getting a shot will greatly reduce your chance of getting sick, and even if you do get sick, your symptoms will be milder.
"We are seeing an increase from previous years, meaning we are seeing flu hit earlier here," said Heather Kaisner, a public health communications specialist with Deschutes County Health Services. "So there's definitely been more flu cases this last month in December than we've seen in previous years."
Adults and youth as young as 11 are highly encouraged to be vaccinated. Vaccines are still available at local pharmacies and the health department.
For more information on how to avoid getting the flu and who should be vaccinated, visiting the county's Website at http://www.deschutes.org/Media-Releases/Flu-Season-Prevention-Information.aspx
Flu cases on the rise nationally, in C.O.
Flu season is in full swing in Central Oregon, but it's still not too late to get your shots, a local health official said Wednesday.
Copyright 2013 KTVZ. All rights reserved. This material may not be published, broadcast, rewritten or redistributed
The views expressed are not those of this company or its affiliated companies. Please note by clicking on "Post" you acknowledge that you have read the Terms of Service and the comment you are posting is in compliance with such terms.


text:
Top Definition
When you bend a girl over and finger blast her pussy from behind while you jerk yourself off
"You need to invite over the Crowd Pleaser because my boy is ready for action and has no condoms."
av Kmaddogmiller 1 november 2013
Trending Now
Can you define these popular missing words?
A large weapon that has great fire-power, think shotgun or better. More likely a rocket launcher or RPG. Given the name as it's immense destruction with certainly please any crowd.
"Yo Mack hand me the crowd pleaser, need to show this coward what's up..."
av The Crowd Pleaser 12 oktober 2009
unusual or noteworthy stool which one feels an urge to show to someone before flushing.
After a heavy night i produced a fine log which i had to show my collegues at work, they seemed impressed. What a " crowd pleaser"
av prince30 31 juli 2009
Originally named for the larger sets of fireworks that gave particularly large displays of flash and bang, a crowd pleaser is any weapon, usually a gun or missile, that is above average in its devastation.
Soldier 1: What's that bomber packin, B-53s?
Soldier 2: Nah, B-90 Bettys.
Soldier 3: Ooo, crowd pleasers.
Soldier 2: Nah, B-90 Bettys.
Soldier 3: Ooo, crowd pleasers.
av Mister Boo 13 september 2009
Noun: A perfect pair of womens breasts. Size: C-cup on up. Usually paired with a banging booty. Often displayed in bars, restaurants, parties, malls, and in situations where a female wants something from a man (such as a large tip at a restaurant, a free drink or when something needs fixed). Sparks high spirits & enthusiasm among men. Evokes jealousy among bitter/insecure women (usually bitchy girlfriends who catch you "gocking"). Commonly referred to as bad jokers, bazongas, cantelopes, fun bags, globes, hooters, jugs, knockers, melons, ta-tas, tig 'ol bittys, and whoppers among many others.
Oh Shit. Did you see the crowd pleasers on that girl?
Chase got no nooky tonight because his girlfriend caught him staring at the waitress's crowd pleasers.
Chase got no nooky tonight because his girlfriend caught him staring at the waitress's crowd pleasers.
av spook85 9 oktober 2006
Someone who pleases crowds with their exceptionally long penis. Also someone, whom other people believe to have a long penis, who is frequently the target of loving male banter or sexual harassment. Or just someone's exceptionally long-serving member.
"Hey hey, the crowdpleaser has come out"; "Put the crowdpleaser away"
av oliver lw 25 juni 2009
A person that has sexual relations with many different people.
Ifty: Man, that girl hops on every guy she meets.
Evan: Damn, what a crowd pleaser.
Evan: Damn, what a crowd pleaser.
av randyn 16 januari 2008


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"Arise and take our stand for freedom as in the olden time." Winston Churchill
"Proclaim Liberty throughout All the land unto All the Inhabitants Thereof." Inscription on the Liberty Bell
Vice presidential debate
Abiding Biden
I've been wondering since the vice presidential candidates' debate this past Thursday night: how can Democrats have been pleased by Joe Biden's performance? His behavior was almost beyond belief. But for his excellent articulation, one might have taken him for a loudmouth drunk — until he shifted his dynamics into the stage whisper of the last half hour. As many have observed, his behavior was rude, boorish, bordering on the »
Joe Biden Democrats square off
During today's episode of the Hinderaker-Ward experience, Brian Ward made a great point about Joe Biden's debate performance. Biden, said Brian, was behaving like a Democrat. Not all Democrats, of course, but certainly a great many of those one encounters on the internet. Like Biden, they are rude, eager to prevent the other side from talking, and prone to attack arguments they don't like with bad behavior rather than reasoning. »
The Hug family take on the debate
Procter Hug III is the son of prominent Ninth Circuit Judge Procter Hug, Jr., and a long-time reader. His messages always catch my attention because of his name; I have been reading his father's opinions for many years. Procter Hug IV has now joined Mr. Hug in his Reno law practice, so they are keeping the family tradition alive. Mr. Hug wrote yesterday with kind words for our commentary on »
The VP debate — not 2004, more like 1976
Some on the left want to compare last night's debate to the 2004 mismatch between Vice President Cheney and John Edwards. As I noted before the debate, there is a superficial similarity. In both instances an elderly, highly experienced incumbent vice president squared off against a fresh face. And now that the debate has occurred, I can point to another similarity — like Cheney, I believe that Biden rallied a »
Biden's Libya dodges
Whatever else one might say about Martha Raddatz's moderating of the VP debate, she did Paul Ryan a favor by starting the debate with a question about Libya. Joe Biden tried to change the subject to Afghanistan and Iraq, but the diversion failed because Ryan stayed after him on the issue (I wish Ryan had done so more consistently). Biden tried to minimize the damage through dishonesty. When Ryan pointed »
Thoughts on the vice-presidential debate
Joe Biden was always going to be an attack dog tonight. After the presidential debate, the Democrats needed him aggressively to promote their post-debate excuse that Romney is all smoke and mirrors. Moreover, Biden is well suited for the attack dog role. I didn't expect, however, that Biden's demeanor would be so off-putting. The ridiculous toothy smile didn't come as a shock. But the smirking, mocking, laughter, constant interruptions of »
ABC News' version of a proper debate moderator
Tomorrow's vice presidential debate will be moderated by Martha Raddatz. The Daily Caller has reported that in 1991, Barack Obama attended Raddatz's wedding to the future president's law school classmate and fellow Harvard Law Review member Julius Genachowski. If that name sounds familiar, it's because Obama appointed Genachowski to head the Federal Communications Commission. Raddatz and Gemachowski divorced in 1997. But they have a son together. So the father of »
Previewing the vice presidential debate, Biden's mission
The Obama campaign has responded to the defeat of its man in the first debate by accusing Romney of lying his way to victory. It thus becomes incumbent on Team Obama to make this assertion stick in a forum where the other side gets to participate. This task falls to Joe Biden in tomorrow's vice presidential debate. His mission is not generally to reassure Americans that the country is in »
Previewing the Vice Presidential debate, Part One
"Big stakes for Biden and Ryan in VP debate." So reads the Washington Post's headline to this story by Dan Balz. Actually, the debate of vice presidential candidates is almost always inconsequential in the end. The odds are that this will be the case once again. Vice presidential debates seem to take on a heightened importance when an incumbent president loses the first debate. In that event, the party in »


text:
modern living + innovative design + inspiring ideas
Possini Felicity Modern Chrome Pendant Light
"Sleek and modern, yet not minimalistic."
- BOMD, Carlsbad, CA
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Top Definition
The act of joining a group and then trying to get as many items as possible, without regard for the well-being of the rest of the group.
(from WoW)
I'm a little ninja, short and stout
I take all the loot and I hearthstone out
All the guys on teamspeak scream and shout
I'm the warrior in full devout.
(from WoW)
I'm a little ninja, short and stout
I take all the loot and I hearthstone out
All the guys on teamspeak scream and shout
I'm the warrior in full devout.
In World of Warcraft, it's customary in many groups to pass on an item when it's being rolled, in order to decide who needs it the most, and then roll again (/random 1-100). A ninja looter will roll on the item, instead of passing, and then may plead ignorance, or may declare that he needs it more than anyone else. Such behavior often results in ejection from the group and blacklisting.
Beküldő: Ugluk 2005. augusztus 23.
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1) (n) (MMORPG) A player who loots and/or attempts to loot items (usually of significant rarity and value) without the permission of the group, especially one who loots items designed for other classes or one who loots all items of value immediately prior to leaving the group/raid/guild.
2) (n) (World of Warcraft) See Hunter
2) (n) (World of Warcraft) See Hunter
Felstriker? Obviously a Hunter weapon.
Beküldő: Danin 2005. június 26.
Someone who grabs loot which he/she has not won during a raid.
Doup won the loot, but that bastard Kerb ninja looted it.
Beküldő: Martin 2005. január 28.
-A player in an MMORPG who attempts to loot every monster killed in a group as quickly as possible
"Dude, we killed 4 Krayt Dragons, but some ninja looter ganked all the drops!"
Beküldő: Knight of the Hub 2004. február 7.


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Top Definition
Town in Massachusetts known by the court for its massive "weed problem" but most kids are proud of this fact since Hopkinton is otherwise boring. The small town lets people know things that happen really fast so you can catch up on drama really easily.
Hopkinton, MA is lame but most people there are chill. And I love thier weed
po Anonym0us person Октобар 18, 2011
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Please enter a city, state, or zip code
It's a Clinique first. And it will change your skin for the better.
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All allergy tested, 100% fragrance free. Find your regimen now.
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allergy-tested fragrances.
You're unique—and so is your skin. These quick, easy tools guide you to customized skin care and makeup solutions.
Curated roundups of Clinique's latest and greatest—by theme, colour, category and more.
Can one change make a difference? Yes.
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I am conducting research to assess my new methodology for website design "Participative Methodology for Marketing Websites". This Methodology was developed during my PhD research. Your assistance in this research would be greatly appreciated and would assist in the success of its findings. My Post-Doctoral Survey will take up to 25 minutes to complete.
To complete the survey please click on http://curtinbusiness.qualtrics.com/SE/?SID=SV_00Ld8CYpppPbQHy


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|The Tennessee Historical Society is a non-profit, membership organization headquartered in Nashville, Tennessee. Established in 1849, the Society's purpose is to "promote interest in and preservation of all matters relating to the history of Tennessee."
Activities undertaken to support this purpose include publication of the Tennessee Historical Quarterly, public programs and lecture series, special projects such as publication of The Tennessee Encyclopedia of History and Culture, and active collection of artifacts and documents important to the history of Tennessee.
Have questions about Tennessee History? Visit the Tennessee Encyclopedia of History and Culture.
To receive all the latest news from the Tennessee Historical Society, click here to join our email list.


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Copier and Printing Services
Printing from computers, photocopiers, and microform readers requires a copy card. Students with Bevo Bucks accounts may also use two printing stations on the second floor of the PCL and one printing station in the Fine Arts Library along with a photocopier located in PCL 2.400.
Laptop Printing is also available:
How will printing from laptops work?
- a client for both PCs and Macs is available for download on the Computing Facilities page;
- this client is easy to download and doesn't require wireless access (which means users from wired workstations elsewhere on campus and at home may use the client to send print jobs to the UT Libraries network print system);
- print jobs will remain in the print queue for 120 minutes;
- all B&W network print stations across the UT Libraries will receive each print job, making access for users as convenient as possible.
Photocopiers, readers, and printers will not accept coins or currency.
Fax Machine: 512-495-4296; this is the number for people who want to fax a question to Reference Information Services.
Library Copier Services offers full service copying and other specialty services. Library Copier Services is located on the first floor of the Perry-Castañeda Library, PCL 1.102, phone (512) 495-4239. Hours of operation are available online as well as posted at the entrance to the room.


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Do you want to end up with a 40-year-old that you pick up after physically and emotionally? read more
Page 31 of 127
Why Do Spouses Sometimes Remember Things Differently?
The details of some of your stories seem to have two versions. Here's how you should handle it. read more
How to Make Big Deposits Into Your Spouse's Emotional Bank Account
Doing this has a great deal of value for your marriage. read more
5 Bad Child Behaviors You Need to Break Early
If left unchecked, these can grow into major problems down the line. read more
God Uses This Type of Man
These are the types of men whose fingerprints remain long after they have died. read more
10 Things to Pray For and With Your Child
Prayer is vital to all of our lives. How do you pray for your children? read more
3 Reasons Married Sex Is Better
No matter what the world is telling you, here's some great advice to listen to. read more
10 Texts to Send to Your Husband in the Next 10 Days
Now, it's the wives' turn. Here's how you can make your husband's day. read more
What Parents Can Learn from 'Inside Out' About Children's Emotions
Here's why telling your child how to feel is a disaster waiting to happen. read more
The Jesus Agenda: Redeeming Families One Father at a Time
Men, are you living and taking care of your family the way Jesus commanded? read more


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- Admissions
- Academics
- Campus Life
- Athletics
- Cost & Aid
- News & Events
- About Plattsburgh
At home you may have your own room, but at college, your room becomes your home! Here is a list of suggested items you might want to bring with you to college. If you forget something, don't worry; we have a College Store (on campus), Wal-Mart, K-Mart, Staples, and Target.
For more information or questions about Student Orientation at SUNY Plattsburgh, please contact:
New Student Orientation
Office: Kehoe 602
Phone: (518) 564-3282
Email: email@example.com


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Barbara Kingsolver's first novel in nine years is an engrossing story of
revolution, art, searching for one's place, all wrapped up in the
atmosphere of 1930s Mexico topped with a tasty dollop of political
machinations. Harrison William Shepherd spends his formative years in
the household of Frida Kahlo and Diego Rivera. It's there that he meets
Leon Trotsky, becoming enmeshed in an unlikely group of bodyguards and
politicos and seduced by this exotic and dangerous life. The story is
told through narrative, letters, journal entries and articles as we
follow Shepherd from Mexico back to the states, looking and yearning for
a place to belong. This quiet man's story is as colorful, textured and
intriguing as a Kahlo painting.
A Hudson Best Book of 2009
"Moving from a setting in Mexico (in the company of Frida Kahlo, Diego Rivera, and Trotsky) to the 1950s America of Red Scares and McCarthyism, The Lacuna tells the very personal and human story of young novelist Harrison Shepherd. Kingsolver does a masterful job creating a story with both scope and intimacy while also raising potent questions about freedom of expression and belief. Bravo!"
— Sheryl Cotleur, Book Passage, Corte Madera, CA
"Kingsolver's first novel in nine years has a compelling, provocative storyline that takes place between Mexico City and the United States in the period from the 1930s to the 1950s. A young Mexican-American man finds himself caught up in the creative and political household of Diego Rivera and Frida Kahlo. He mixes plaster for the muralist, types letters for Leon Trotsky, and befriends Frida. The Lacuna is a solid example of Kingsolver's expertise in combining politics and fiction. The philosophy of Communism and the innate need for freedom of expression raise their demanding fists in this young man's story, and they won't let the reader go."
— Dianne Patrick, Snowbound Books, Marquette, MI
In The Lacuna, her first novel in nine years, Barbara Kingsolver, the acclaimed New York Times bestselling author of The Poisonwood Bible and Animal, Vegetable, Miracle: A Year of Food Life, tells the story of Harrison William Shepherd, a man caught between two worlds an unforgettable protagonist whose search for identity will take readers to the heart of the twentieth century's most tumultuous events.
"Rich…impassioned…engrossing…Politics and art dominate the novel, and their overt, unapologetic connection is refreshing."
-Chicago Tribune
"Masterful…a reader receives the great gift of entering not one but several worlds…The final pages haunt me still."
-San Francisco Chronicle Book Review
"Compelling…Kingsolver's descriptions of life in Mexico City burst with sensory detail—thick sweet breads, vividly painted walls, the lovely white feet of an unattainable love."
-The New Yorker
"A work that is often close to magic.... Much research underlies this complex weaving...but the work is lofted by lyric prose."
-Denver Post
"Shepherd's story in Kingsolver's accomplished literary hands is so seductive, the prose so elegant, the architecture of the novel so imaginative, it becomes hard to peel away from the book"
-Pittsburgh Post-Gazette
"[Kingsolver's] playful pastiche brings to vivid life the culture wars of an earlier era..."
"...True and riveting...Barbara Kingsolver has invented a wondrous filling here, sweeter and thicker than pan dulce, spicy as the hottest Mexican chiles, paranoid as the American government hunting Communists "
-Philadelphia Inquirer
"A sweeping mural of sensory delights and stimulating ideas about art, government, identity and history…Readers will feel the sting of connection between then and now."
-Seattle Times
"A sweeping narrative of utopian dreams and political reality…A stirring novel…intimate and pitch-perfect."
-San Diego Union-Tribune
"Kingsolver deftly combines real history and the life of the fictional protagonist…A sweeping tale."
-Atlanta Journal-Constitution
"The most mature and ambitious [novel] she's written…An absorbing portrayal of American life…A rich novel [with] a large, colorful canvas…A tender story about a thoughtful man."
-Washington Post
"A lavishly gifted writer... Kingsolver [has a] wonderful ear for the quirks of human repartee. The Lacuna is richly spiked with period language... This book grabs at the heartstrings..."
-Los Angeles Times
"Breathtaking...dazzling...The Lacuna can be enjoyed sheerly for the music of its passages on nature, archaeology, food and friendship; or for its portraits of real and invented people...But the fuller value...lies in its call to conscience and connection."
-New York Times Book Review
"The novel achieves a rare dramatic power...Kingsolver masterfully resurrects a dark period in American history with the assured hand of a true literary artist."
-Publishers Weekly (starred review)
"[Kingsolver] hasn't lost her touch...she delivers her signature blend of exotic locale, political backdrop and immediately engaging story line...teems with dark beauty."
"[Kingsolver] stirs the real with the imagined to produce a breathtakingly ambitious book, bold and rich…hopeful, political and artistic. The Lacuna fills a lacuna with powerfully imagined social history
-Kansas City Star


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The Future of RuneScape
It's almost time for the fourth and final Q&A in our first series of live streams and this week we're looking to the future. This Sunday September 30th at 21:00 GMT, join Mod MMG and Mod Cloughie to talk about the future of RuneScape and what we can expect to see in the coming years!
Remember you can send in your questions on the RuneScape forums, Facebook, Twitter, Google+ and Reddit.
RuneScape 3 anybody?
Ozan Gets Quizzical
This week welcomed two brand new adventures into the game starring everybody's favourite charming rogue, Ozan, and now it's time to test your knowledge in this week's community event!
With prizes aplenty up for grabs, you'll want to keep a close eye on your surroundings this week as you tackle RuneScape's two latest quests: Stolen Hearts and Diamond in the Rough.
Mad Scientist Beta Event: Slayer
Prepare those abilities and get ready to jump into the Evolution of Combat beta for another Mad Scientist outfit unlock weekend.
This weekend we're focusing on the Slayer skill – receive and complete one Slayer task in full this weekend and you'll have nabbed yourself another credit towards unlocking the upcoming wacky Mad Scientist outfit!
Fansite News
This week we bring you another chance to win some awesome RuneScape prizes (and more!) from Czech Republic-based fansite, RSKO. Head on over to their forums to find out more about how to win some great prizes! On a similar note, RSKO's owner visited Jagex HQ this week so look out for his report on that in the near future!
Ever been told you've got a voice for the radio? Maybe you could be the new voice of the Zybez20 RuneScape podcast! Head on over to the Zybez forum to find out more information on how to get involved!
Player Fanart
Check out this terrifyingly awesome fan submission of the gruesome Ripper from One Piercing Note, created by the incredibly talented LeadWeaver over on deviantART.
Follow RuneScape!
Did you know that there are lots of ways to stay in-touch with what's happening in Gielinor while on the move?
Follow RuneScape on Twitter, Facebook, Google+ and YouTube for all the latest news, teasers and competitions!
RuneScape Community Team
Discuss this here
Sep 27, 2012 - Community Round-Up: 27/09/2012
Posted 28 September 2012 - 04:42 AM
Posted 01 November 2012 - 02:27 AM
- the question you are asking has been answered,
- you may have posted in the wrong forum,
- the topic could be degenerating into/has already started a flame war,
- the posts were straying too far from the original topic.
This list of reasons that your topic may have been closed is given instead of a specific reason because moderators have the option to close multiple topics at once, with this standard reply added to the topic. This is much faster than closing multiple topics manually, and gives us more time for our other work.
If you have any further questions as to why this topic was closed, let me encourage you to check the FAQs, and to PM me if you do not find the answer there.
Have a nice RuneHQ day.


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Gainesville, Fla. -- The Hatters may be in unfamiliar terriority, but they will be facing a familiar opponent.
After a solid week of practice, the Stetson University softball team boarded its charter bus Thursday and made the short trip to Gainesville in preparation for this weekend's NCAA Regional at the Univerisity of Florida.
Making their second appearance in NCAA postseason play, the Hatters (38-12) will open the Gainesville Regional at 3:30 p.m. Friday afternoon against the UCF Knights (41-16), an opponent Stetson faced twice during the regular season. The winner will play the winner of the Florida-Florida A&M game at 1 p.m. Saturday afernoon. The four-team, double-elimination regional continues through Sunday. All games will be broadcast for free on GatorVision.tv.
"I am real happy with opening against UCF," Stetson head coach Frank Griffin said. "They are a friendly rival. I have known Renee (Luers-Gillispie) a long time now; she has has a good team, and they are well coached. They have a lot of good talent. We played with them for two ball games and came ahead of them in one of them, and I think it is a good draw for us."
The Hatters will look for a strong effort from their pitching and defense, just as they have had all season long. Stetson enters the weekend ranked 11th in the nation in ERA (1.77) and 14th in fielding percentage (.973). The Hatters have committed just six errors in their last 15 games, good for a .987 clip. Third baseman Brittany Hawn has played errorless ball over the last 30 games.
In the circle, Meredith Owen enters the regional with a 26-7 overall record and a 0.84 ERA. That mark ranks second in the NCAA and is tops among pitchers with at least 100 innings pitched. The Atlantic Sun Championship Most Valuable Player was 4-0 with a 0.50 ERA in 28 innings for the Hatters last week.
At the plate, Stetson maintains a .298 batting average with 44 home runs. The team is having its best season of all-time in terms of slugging percentage (.462) and on-base average (.382). The Hatters are also averaging 5.3 runs per game, although they averaged just 2.8 runs during the Atlantic Sun tournament.
"We need to hit," Griffin said. "Don't attempt to hit, go to the plate and hit, and we'll fare well."
In Stetson's first NCAA appearance in 2007, the Hatters played as the regional's No. 4 seed and lost to Florida 7-0 and Texas 2-0.
This year the Hatters are the No. 3 seed, and they hope the experience of playing four tightly-contested, low-scoring games in last week's A-Sun tournament will serve as a winning formula this week.
"We had to be on our game through all seven innings every single game," junior Amanda Grimaldo said. "I think that really prepared us a lot."
The winner of the Gainesville Regional will advance to face the winner of the Seattle Regional in a best-of-three Super Regional, May 22-25. The teams in the Seattle Regional are Washington, Northwestern, BYU, and Iona.
What will it take for the Hatters to be successful?
"We have to play a balanced ball game with defense, pitching, and offense," Griffin said. "There are going to be a lot of fans there, and we have to ignore all that and not have any distractions. We have to try to keep the anxiety down, stay focused, and just play our game."
Ticket information, as well as free live video and live stats can be found on the University of Florida website. The Stetson softball twitter feed and the Hat-Alerts text messaging system will provde in-game updates as well.
Notes: Frank Griffin has coach 999 games at Stetson. He is 611-388 in 18 seasons ... Stetson is one home run shy of tying the school record of 45, set last year ... Stetson did not face Florida or Florida A&M this season, but did defeat Florida A&M 11-0 last season.


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on February 22, 2013 - 8:31 PM
, updated February 23, 2013 at 2:35 PM
William "Bill" Gethoefer and Sharon Parucki initially wanted to have a destination wedding – the second for both – on an exotic island, but they couldn't make it happen.
Then they thought about doing it in Florida, but that didn't work out, either,
So the lovebirds decided, why not the mall? That's where it all started, after all.
The couple tied the knot Friday morning in the food court at the Eastern Hills Mall.
"You are amazing," Bill gushed to his bride.
The Gethoefers met three years ago in the Clarence mall, where they both work. He's a security guard, and she has worked at Vitamin World for the past 13 years.
Her engagement ring and both of their wedding bands came from Kay Jewelers in the mall.
Her dress was purchased at one of the dress stores there, and his tuxedo came from a store in the shopping center.
And his best man also is a security guard at the mall.
"We're a big, happy family," said Karen Garrow, marketing manager for Eastern Hills. Garrow helped organize the nuptials, which coincided with the mall's 10th annual Summer in February event that features a sand box – which is where the vows were exchanged – and "fun in the sun" games for children.
In addition to their Feb. 22 wedding date, Bill and Sharon have another special date in common – July 23. That's when each was born, he in 1942 and she in 1943.
Bill delivered his proposal to his bride last July, when he walked out of Kay Jewelers and into Vitamin World and got down on one knee to propose.
"I was surprised and shocked," Sharon said.
It was her "sparkly eyes and beautiful smile" that first impressed Bill.
For Sharon, it was his "good looks."
"He was handsome and witty," she said.
As time went on, their romance continued to blossom.
"As I got to know you better, I realized that beauty was not only skin deep but it went to your heart and soul," Bill said in his vows.
"Baby, you rock my world," he said.
Their mall romance began when Bill mentioned to Sharon how good the macaroni and cheese was at LaRosa NY Pizzeria in the food court.
"Then I bought a bowl for her, and she kissed me on the cheek," he said.
"To say thank you," Sharon added.
A retired state trooper and former investigator with the federal public defender's office, Bill has three children. His son is a sergeant with the Las Vegas police department. One of his daughters is a district manager for Lancome Cosmetics, and the other works as a speech pathologist.
Sharon's oldest son, Glenn Parucki, is a New York State trooper. He gave her away.
"I'm happy for them," he said.
Sharon's two other sons, Eric and Troy, also attended the wedding and were just as delighted for the couple.
"As long as my mom's happy, I'm happy," said Eric, who works for the Department of Homeland Security.
"He seems like a real nice guy," Eric said of Bill.
"Everybody deserves to be happy. That's what it's all about," said Troy, who also is a state trooper.
Fellow security guard Thomas Owen was Bill's best man. The two men have known each other for three years, and when Bill told his friend of his intent to marry Sharon, Owen thought it was a "good idea."
"I don't know a better couple that was more suited," Owen said.
Erie County Family Court Judge Kevin Carter officiated at the ceremony. Bill and Carter taught criminal justice together at Erie Community College in the 1990s and remained friends.
While Carter has done many weddings in his career, this one was very different and the most memorable for two reasons, he said.
"This one was personal, and it's the first wedding I've done at 9 a.m. on a Friday or any other weekday in the mall on the beach in February in Buffalo," he joked.
Other than the unusual location, the wedding was fairly traditional.
She wore white. They were surrounded by dozens of family and friends – even if some of them were mall walkers and store managers. And, of course, there was the customary smashing of the wedding cake in each other's face. But Sharon didn't mind at all.
"I can't tell you how happy I am," she beamed. "He is my true love."
email: email@example.com


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Brad Pitt & Angelina Jolie Beach Party in Malibu
Regan Stephens
| May 31, 2010 - 7:08 pm
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Toronto, ON (Sports Network) - Jordan Staal and Patrick Dwyer each recorded a goal and assist, while Cam Ward stopped 41 shots as the Carolina Hurricanes topped Toronto, 4-1, at Air Canada Centre.
Eric Staal and Justin Faulk also tallied, while Jeff Skinner posted three assists for the Hurricanes, who have won four of their last six.
Matt Frattin supplied the only offense for the Maple Leafs, losers in two straight and four of six. James Reimer made 35 saves in defeat.
The Sports Network


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Lucky Number Three With Chris McDonald
NAME: Chris McDonald
HOMETOWN: Austin, Texas
NEWTON SHOE YOU WEAR WHEN RACING: MV3 or Olympic racer
RACE: Ironman Louisville, Louisville, KY; August 25, 2013
DOES THIS RACE HOLD ANY SIGNIFICANCE TO YOU? The race means a lot to me, as it was where I won my first IM.
HOW DID YOU FEEL GOING INTO THE RACE? I felt calm and content going into the race, which is always a good sign for me. After having problems that were out of my control in my last two Ironman races, I was just hoping for a smooth day.
WHAT DID YOU THINK OF THE COURSE? The course in Louisville is very challenging! It is a warm non-wetsuit swim with a bike course that has relentless rolling hills, and a run that is in the wide-open streets with temps in the 90s. I am a believer that it is very much a strong man's course.
CAN YOU GIVE US SOME HIGHLIGHTS FROM THE RACE? It's funny that when a race goes well, there is often not much to talk about. The swim went great for me and I was able to get some good feet and stay pretty close to the front. I think I was about 30 seconds down exiting the transition, but was able to take the lead by mile one of the bike.
Then it was out onto the bike and the only thing to report was I lost my spare tire at about mile 4—the rest of the ride was very uneventful! I felt good and was having fun. Out onto the run, I really had no idea of my lead until the turn around at roughly mile 7. So I did run the first half marathon pretty strong. Once I saw I had a solid lead and Pat (2nd place guy) was giving me the "It's your day wave," I tried to dial it back a little and save something for the upcoming races.
WHAT DO YOU THINK WAS THE KEY TO YOUR SUCCESS? Consistency! If you can't get up and train day after day, I think you have over done the day before.
ARE YOU DOING ANYTHING DIFFERENT IN 2013 VERSUS 2012 OR 2011? Nope, just consistent training and always looking to improve, even on my strengths.
DO YOU HAVE ANY SPORTS NUTRITION TIPS YOU COULD SHARE? Keep it simple!!! You are putting your body under an amazing amount of duress during an Ironman and the last thing you want to do is upset your stomach or eat something that takes a lot of digestion.
HOW DO YOU MANAGE FAMILY AND TRAINING? I put family first! If they are happy I am happy and training is easy. I like to swim early so I can be home for breakfast and I like to start my last training session before school ends. I also try to include them, nothing better than some company while you are out running long.
DO YOU EVER TAKE DOWN TIME? IF SO, WHAT DOES IT LOOK LIKE? I do take down time! I like to pretty much take December off. At the start of January I hate myself, but by mid March I am very happy I did it. It always leaves me motivated and pumped up for the year ahead.
WHAT'S NEXT? IM Tahoe [Lake Tahoe, CA; September 22, 2013].
DO YOU HAVE ANY WORDS OF INSPIRATION FOR FELLOW RACERS? "If you do push your limits, you set your limits." And keep it fun! We like to do things that are fun.


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Raised Bed Corners, Set of 2
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Exclusive | Gardener's Supply Raised Bed Corners: the Fast, Foolproof Way To Build a Raised Bed
- Made in Vermont by Gardener's Supply
- Choose from 6 heights, each sized to fit standard 2 x 6, 2 x 8, 2 x 10 and 2 x 12 lumber
- Set of 2 - buy two sets to build a complete bed
The hardest part of building a raised bed is constructing corners that are square, strong and trim-looking. Our ingenious Gardener's Supply Raised Bed Corners are brackets that cut building time and result in a handsome, sturdy raised bed every time.
Product Details
- Powder-coated aluminum with plastic caps to keep out water
- Six heights, all designed to fit standard 2 x milled lumber
- Philips screws included
- Gardener's Supply Exclusive
There are no special shipping restrictions or charges associated with this item. For detailed information about our delivery methods and charges, click here.
We're proud of the fact that this item is shipped to you directly from our warehouse in Vermont, by one of our 250 employee-owners. In-stock items are packed with care and shipped within the next business day to ensure prompt delivery to your home and garden!


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quote: The only people in the Microsoft universe who are getting their A$$e$ kicked are their investors. And this has been going on for a very long time.
quote: ROFLMAO, talk about clueless posts... :DYou mean those investors who get [b]regular dividents
quote: enjoy stable growth ever since the company was founded?


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de Pete61 18 Iulie 2006


text:
Author Affiliations: Division of Adolescent Medicine, Department of Pediatrics, Cooper University Hospital, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, Camden (Dr Feldman-Winter); Division of Neonatal-Perinatal Medicine, Schneider Children's Hospital at North Shore University Hospital, Manhasset, and Albert Einstein College of Medicine, Bronx (Dr Schanler), and Departments of Pediatrics and Obstetrics and Gynecology, University of Rochester School of Medicine, Rochester (Dr Lawrence), New York; and Division of Health Services Research, American Academy of Pediatrics, Elk Grove Village, Illinois (Ms O'Connor).
This article was corrected | View correction
To survey pediatricians on their breastfeeding knowledge, attitudes, and practices and to compare these results with those of a 1995 study.
Cross-sectional follow-up survey.
The Periodic Survey of Fellows survey conducted by the American Academy of Pediatrics.
The survey was completed by 875 pediatrician members of the American Academy of Pediatrics from November 1, 2003, through May 21, 2004.
Main Outcome Measures
Pediatricians' recommendations on management, opinions about the benefits and promotion of breastfeeding, and relationship to personal breastfeeding experience were compared with the results of the 1995 survey.
Compared with the results of the 1995 survey, in 2004, pediatricians were less likely to believe that the benefits of breastfeeding outweigh the difficulties or inconvenience (adjusted odds ratio, 0.60; 95% confidence interval, 0.47-0.76), and fewer believed that almost all mothers are able to succeed. More pediatricians in 2004 reported reasons to recommend against breastfeeding. Pediatricians in 2004 were more likely to recommend exclusive breastfeeding (adjusted odds ratio, 1.55; 95% confidence interval, 1.23-1.94) and follow supportive hospital policies. Respondents with personal breastfeeding experience were 2.3 times more likely to recommend supportive policies (adjusted odds ratio, 2.3; 95% confidence interval,1.74-3.08) in 2004 than in 1995. Those with no personal breastfeeding experience were also slightly more likely in 2004 to recommend these policies (adjusted odds ratio, 1.49; 95% confidence interval, 1.09-2.03).
Although pediatricians seem better prepared to support breastfeeding, their attitudes and commitment have deteriorated. Personal experience mitigates poor attitudes and seems to enhance breastfeeding practices among those surveyed.
The American Academy of Pediatrics (AAP) has affirmed breastfeeding as the preferred method of infant feeding, providing ideal nutrition and optimal health outcomes.1 In 1995, a survey of pediatrician's attitudes and practices related to breastfeeding was conducted and the results were analyzed.2 Since then, pediatricians have seen an explosion of research further delineating health benefits related to breastfeeding and exploring methods of breastfeeding promotion and support. During this period, overall breastfeeding rates in the United States have risen at the time of delivery from 59% in 1995 to 74% in 2004 and at 6 months from 22% in 1995 to 42% in 2004.3,4 Nevertheless, few US mothers follow recommendations to exclusively breastfeed; in 2004, 51% exclusively breastfed at 7 days and only 14% exclusively breastfed for 6 months.4
Key changes have occurred during the decade since 1995, resulting in increased awareness and promotion of breastfeeding by the AAP, the US government, and multiple organizations throughout the world.5- 7 The AAP Section on Breastfeeding has organized programs for physicians to enhance office-based promotion of breastfeeding, the Breastfeeding Promotion in Pediatricians' Office Practices Program I and the Breastfeeding Promotion in Physicians' Office Practices Programs II and III, funded by the Health Resources and Services Administration Maternal and Child Health Bureau. These initiatives have a central goal to increase the knowledge, attitudes, and practices of physicians to promote and manage breastfeeding. The more recent initiatives include goals to enhance culturally competent breastfeeding care and to introduce breastfeeding education and training in pediatric, obstetrics and gynecology, and family medicine residency programs.8
Given the increased programs devoted to breastfeeding in the last decade and the increase in overall rate of breastfeeding in the United States, we expected to find improvements in pediatricians' promotion and support of breastfeeding. This study examined changes in pediatricians' opinions and counseling practices related to breastfeeding, recommendations for breastfeeding practice, and self-disclosed breastfeeding management. In addition, the influence of personal breastfeeding experience on opinions and management of breastfeeding was examined.
This study is based on data gathered using the AAP Periodic Survey of Fellows. Since 1987, the Periodic Survey of Fellows has been conducted 3 or 4 times annually on current topics in pediatrics. Each survey is sent to a unique random sample of nonretired members of the AAP who reside in the United States; those selected to participate in a Periodic Survey of Fellows are not selected again for at least 4 years. The AAP presently has about 60 000 members representing an estimated 80% of US board-certified pediatricians.
Both the Periodic Survey of Fellows conducted in 2004 and that conducted in 1995 were 8-page, self-administered, forced-choice questionnaires developed by the AAP Department of Research working with the leadership team of the AAP Section on Breastfeeding. The 2004 survey was mailed to 1640 members, and 5 follow-up mailings were conducted to recontact nonrespondents from November 1, 2003, through May 21, 2004. A total of 875 questionnaires were received, for a response rate of 53.4%. The 1995 survey was mailed to 1602 members and followed by 4 follow-up mailings between July 1, 1995, and November 29, 1995. A total of 1132 questionnaires were received, for a response rate of 70.7%. Each questionnaire was accompanied by an introductory letter from the Executive Director of the AAP and a business reply return envelope. The AAP institutional review board approved both surveys.
Questions on pediatricians' breastfeeding recommendations to mothers, counseling and management practices, opinions on issues about breastfeeding benefits and promotion, and hospital breastfeeding policies asked on the 1995 survey were replicated on the 2004 survey, enabling trends in these areas to be examined. In addition, the 2004 survey included questions directed to aspects of breastfeeding care, with the inclusion of questions related to cultural beliefs, diet, and use of herbal agents.9 On both surveys, questions about hospital breastfeeding policies and demographic data were to be answered by all survey recipients. Demographic data included age, sex, resident training status, practice location (self-defined by respondents as urban inner city, urban not inner city, suburban, or rural), practice setting (defined as solo or 2-person practice, group practice, or staff model health maintenance organization, and hospital or clinic practice or medical school), time spent in general pediatrics (defined as <50% of time spent in a subspecialty area), and geographic region (Northeast, Midwest, South, and West, classifications used by the National Center for Health Statistics). Both surveys also included personal questions about number of children and personal experience (self or spouse) with breastfeeding. Breastfeeding counseling, recommendations, and opinion questions were directed only to respondents who indicated that they provided primary care to children from birth to 2 years (675 pediatrician respondents in 2004 and 832 pediatrician respondents in 1995).
Data are presented as percentage of respondents or mean percentage. For analysis of selected questions, pediatricians were subdivided on the basis of whether any of their own children were breastfed exclusively or were given formula supplements (breastfeeding experience) and whether their children were never breastfed or whether they had never had children (no breastfeeding experience). Odds ratios (ORs) were used to compare differences in response by survey years for pediatrician characteristics and selected breastfeeding recommendations. Multivariate logistic regression was used to examine the likelihood of supporting selected breastfeeding promotion and benefit statements in 2004 and 1995 after controlling for breastfeeding experience and to compare differences in response by survey year after controlling for sex, time spent in general pediatrics, total hours worked per week, and percentage of patients aged birth to 2 years. For all analyses, confidence intervals (95% CIs) are given.
In 2004, 875 of 1640 pediatricians surveyed responded, compared with 1133 of 1602 respondents in 1995. To assess how well the samples represented AAP membership at the time of the surveys, respondent characteristics of these surveys were compared with those of the 6 periodic surveys conducted just before each Periodic Survey of Fellows. The 53.4% response rate was comparable to that for other more recent surveys. Many more pediatricians with experience in breastfeeding, either themselves or their spouses, participated in the 2004 survey (Table 1).
Pediatricians in both 2004 and 1995 reported a low rate of prenatal visits for their patients younger than 2 years; the mean percentage of parents seen during a prenatal visit was 10%. Although most of the pediatricians in both years reported discussing breastfeeding if parents were seen during the prenatal visit, the percentage decreased to 86.6% in 2004 from 93.2% in 1995 (OR, 0.97; 95% CI, 0.96-0.99).
Both surveys questioned pediatricians about reasons for recommending against breastfeeding or discontinuing breastfeeding (Table 2). A higher percentage of pediatricians in 2004 vs 1995 recommended that mothers discontinue breastfeeding for conditions compatible with breastfeeding. For example, pediatricians in 2004 were more than 5 times more likely to recommend against breastfeeding for mothers who were considered too immature or because of the time required and demands of breastfeeding.
Pediatricians' recommendations were compared with several recommendations in the AAP policy statement on breastfeeding and human milk available at the time of the 2004 survey10 (Table 3). In general, more pediatricians in 2004 than in 1995 gave recommendations that were consistent with AAP policy. Only 38% of pediatricians reported scheduling the first postnatal office visit for breastfed infants within the first 5 days after birth. The most common period of follow-up for a breastfed neonate was 7 days after delivery (35% of respondents), followed by 14 days (10% of respondents). Significantly more pediatricians delayed follow-up for formula-fed neonates; 23% reported scheduling within the first 5 days, 32% scheduled at 7 days, and 23% scheduled at 14 days; the remaining 22% scheduled the first follow-up visits after 14 days. Half of the pediatricians surveyed in 2004 routinely recommended vitamin D for breastfeeding infants, and one-fifth of pediatricians never recommended vitamin D for breastfeeding infants.
More pediatricians in 2004 than 1995 believed they worked in hospitals that applied to become a baby-friendly hospital, even though only 12% of respondents were familiar with the "Ten Steps to Successful Breastfeeding" guidelines.12 Pediatrician compliance with the "Ten Steps to Successful Breastfeeding" guidelines was determined for 8 of the 10 steps in which comparisons could be made, and data were analyzed to compare the results of the 2004 and 1995 surveys (Table 4).
More pediatricians in 2004 than in 1995 reported receiving education about the management of breastfeeding while in medical school or during residency (67.6% vs 57.9%; OR, 1.02; 95% CI, 1.01-1.02). Fewer than half (44% in both survey years) of the pediatricians surveyed have attended continuing education programs or grand rounds on breastfeeding topics, whereas most pediatricians have read articles about the management of breastfeeding (88% in 2004 and 90% in 1995). Most pediatricians were interested in receiving more education focused on the management of breastfeeding; however, interest has declined since 1995 (79.7% vs 85.9%; OR, 0.98; 95% CI, 0.97-0.99).
Despite acknowledging the need for additional education and training, pediatricians reported high levels of confidence in managing common breastfeeding problems. Furthermore, 87% of pediatricians in 2004 reported confidence in addressing parents' questions about breastfeeding. In contrast, only 37% of the respondents reported teaching mothers breastfeeding techniques at least 5 times during the previous year. Most pediatricians in 2004 reported counseling mothers about lactation problems (56%), observing breastfeeding in the hospital or clinic (61%), and counseling mothers about infant feeding choices (81%) at least 5 times during the previous year. Although most pediatricians reported answering telephone inquiries about breastfeeding (76%), many pediatricians deferred breastfeeding questions to office staff members or other health care professionals. Significantly more pediatricians in 2004 than 1995 reported not knowing how their staff members were trained in breastfeeding management (22.1% vs 13.0%; OR, 1.02; 95% CI,1.01-1.04), and fewer pediatricians in 2004 participated in training their staff (57.4% vs 63.7%; 0.99; 0.98-0.10).
In 2004 compared with 1995, fewer pediatricians thought the benefits of breastfeeding outweigh any difficulties or inconvenience (58.0% vs 68.2%; adjusted OR [AOR], 0.60; 95% CI, 0.47-0.76), and fewer believed that almost all mothers are able to be successful (Table 5). In contrast, fewer pediatricians in 2004 than in 1995 thought formula-fed babies were just as healthy as breastfed babies.
Compared with 1995, in 2004, almost twice as many pediatricians had personal experience with exclusive breastfeeding (Table 1). Among pediatricians who cared for children younger than 2 years, 64% had some breastfeeding experience. Pediatricians with any personal experience with breastfeeding, either themselves or their spouses, were much more likely to counsel new mothers about infant feeding choices and teach new mothers breastfeeding techniques such as latching on and positioning the infant at the breast (Table 6).
Personal experience had less effect on pediatricians' attitudes about breastfeeding. Those with experience were more likely to disagree that formula feeding and breastfeeding are equally acceptable methods of feeding. Nevertheless, even among respondents with breastfeeding experience, compared with 1995, fewer reported in 2004 that almost any mother can be successful at breastfeeding and that the benefits of breastfeeding outweigh the difficulties or inconvenience.
Pediatricians' recommendations regarding the "Ten Steps to Successful Breastfeeding" guidelines were analyzed after controlling for personal experience with breastfeeding. Overall, 66% of pediatricians in 2004 recommended at least 4 of the 8 steps queried compared with 49% of those in 1995 (AOR, 2.03; 95% CI, 1.66-2.49). Among respondents with personal breastfeeding experience, 71.1% in 2004 vs 51.5% in 1995 recommended at least 4 steps (AOR, 2.3; 95% CI, 1.74-3.08). Those with no breastfeeding experience were also slightly more likely in 2004 to recommend at least 4 steps (AOR, 1.49; 95% CI, 1.09-2.03).
Despite improvement in some areas, more pediatricians in 2004 than in 1995 were likely to have negative opinions and attitudes about breastfeeding. Although knowledge about optimal duration of exclusive and overall breastfeeding improved during the period studied, more pediatricians recommended that mothers of full-term infants not breastfeed or that they discontinue breastfeeding for unnecessary reasons. Even more pediatricians in 2004 than in 1995 reported issues such as immaturity of the mother, inconvenience, low milk supply, and infected nipples as reasons to recommend against breastfeeding. Fewer pediatricians in 2004 believed that the benefits of breastfeeding outweighed the difficulties or inconvenience. These trends reflect pediatricians' ambivalence about whether breastfeeding goals can be met and a readiness to recommend formula feeding over breastfeeding.13 The decline in attitudes may reflect poor knowledge about how to overcome barriers and challenges or may simply reflect the opinion that the risks of not breastfeeding are outweighed by any concerns about the sustainability of breastfeeding. The AAP activities aimed to enhance office-based promotion of breastfeeding resulted in improvement in pediatrician knowledge and practices but were ineffective in changing attitudes. These activities may have used the wrong model or strategy to change attitudes and commitment to breastfeeding. Our results suggest that pediatricians may be less likely to provide effective breastfeeding promotion despite improved knowledge. These data are particularly concerning because respondents in 2004 had more personal breastfeeding experience, a factor known to be associated with increased breastfeeding attitudes and practices.
Evidence is good that educating mothers about how to breastfeed and enhancing their knowledge and skills will increase the likelihood of breastfeeding.14 Our data show that few pediatricians had the opportunity to promote breastfeeding in the prenatal period; however, there may be missed opportunities in the immediate postpartum setting as well. Many pediatricians do not function in the role of the person educating mothers about breastfeeding and have little experience in the clinical setting with breastfeeding management.15 There is evidence that a short training program for practicing physicians followed by breastfeeding support through an early, routine, preventive visit might contribute to improving breastfeeding outcomes.16 However, many pediatricians in 2004 did not follow the AAP recommendation for a 3- to 5-day follow-up visit for breastfeeding neonates. Given that only 38% of pediatricians surveyed in 2004 scheduled early postpartum visits, education and management of breastfeeding during this critical period would be missed. If education of primary care practitioners is to be successful, early postnatal follow-up visits must be scheduled.
Personal experience continues to have a tremendous effect on the advice to breastfeed and the clinical experience with breastfeeding management.2,17 Having personal breastfeeding experience in 2004, even more than in 1995, was associated with more optimal breastfeeding management. Given the changing demographics of pediatricians and new work hours for pediatric residents, more pediatricians may be starting families early in their careers and attending to the needs of their children.18,19 Providing worksite accommodations for residents and young pediatricians to facilitate a positive experience with breastfeeding may be one method to enhance future attitudes and skills about breastfeeding. Pediatricians may also serve as role models for mothers contemplating infant feeding decisions.
Pediatricians' opinions about breastfeeding promotion have deteriorated since 1995, but having personal experience is an attenuating factor. Poor attitudes about whether mothers can be successful in breastfeeding are in conflict with pediatricians' recommendations for exclusive breastfeeding. Mothers may hear messages such as "Exclusive breastfeeding is best, but if you can't . . . " and assume that they will be unable to meet their infant's needs. Competing demands make it difficult for many mothers to exclusively breastfeed. The cultural norm in the United States continues to be breastfeeding in combination with formula feeding, with fewer than 1 in 6 infants being exclusively breastfed at 6 months.4 Given that only 37% of pediatricians in 2004 had children who were breastfed exclusively for the first 6 months, it is not surprising that many of the pediatricians surveyed doubted that mothers could be successful if they tried. Therefore, knowing the AAP recommendation for exclusive breastfeeding is only the first step in being able to support mothers to breastfeed according to AAP policy. Creative strategies need to be developed to enable more pediatricians, regardless of personal experience, to adopt practice behaviors that support exclusive breastfeeding.
Pediatricians need to become comfortable promoting and supporting breastfeeding in many cultural groups.9 In our study, respondents reported that about one-fifth of their patients younger than 2 years are black and one-fourth include Hispanics and Asians. These data indicate even more diversity than reported in the 2000 US census, in which 64% of the pediatric population were white, 15% were black, 16% were Hispanic, 4% were Asian, and 1% of other race/ethnicity.20 Despite this diversity, our data indicate that pediatricians rarely consider the cultural beliefs of mothers when observing and evaluating breastfeeding. The rate of breastfeeding among the US black population is lower than overall US rates.3,4 More recent studies suggest that foreign-born mothers have higher rates of breastfeeding compared with overall rates in the United States.21,22 On closer examination, these groups are most likely in the United States to supplement breastfeeding their first child but exclusively breastfeed subsequent children.22 Thus, acculturation has an immediate negative effect on breastfeeding; however, there is opportunity to restore the cultural norm to exclusively breastfeed. Cultural competency is important to provide optimal breastfeeding care and may attenuate the negative effects of acculturation.23
Certain limitations in this comparison of surveys should be mentioned. Although more than half of the pediatricians surveyed in 2004 completed the survey, this was substantially lower than the 71% response rate in 1995. Despite the lower response rate, we believe there is a lack of bias based on the comparisons with other Periodic Surveys of Fellows conducted at about the same time. Although the effect of nonresponse bias is unknown, a recent analysis of AAP surveys suggests that such bias is minimal.24 There is also the limitation of not knowing how pediatricians support breastfeeding in practice beyond what is self-reported in this survey. Many of the pediatricians surveyed provide direct patient care less than 40 hours per week and may have limited contact with families and mothers who may be breastfeeding. Despite these limitations, the comparison of surveys can aid organizations in developing future educational programs and policies on breastfeeding. This study reaffirms the need to continue efforts to enhance pediatricians' knowledge, skills, and, in particular, attitudes to promote and support breastfeeding and may provide evidence that new strategies need to be developed.
Since the 2004 survey was conducted, additional resources and educational materials have been developed to aid physician support for breastfeeding, including the Breastfeeding Handbook for Physicians, a joint publication by the AAP and the American College of Obstetricians and Gynecologists.25 Multiple educational sessions were offered at national meetings of the AAP, American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and other organizations. In addition, there were 2 large national campaigns to promote breastfeeding targeted to low-income and black mothers, groups that continue to have the lowest breastfeeding initiation and continuation rates.26 After the 2004 survey, a multispecialty breastfeeding residency curriculum was implemented as a component of the final phase of the Breastfeeding Promotion in Physicians' Office Practices Program III.8 Future studies may be able to demonstrate whether these activities affected pediatricians' knowledge, attitudes, and practices. Pediatricians may be more likely to effectively promote and support breastfeeding if they are surrounded by a culture in which breastfeeding is the norm and they are affected early in their training years with knowledge, skills, and personal support. With continued educational efforts by organizations that promote and support breastfeeding, we anticipate enhanced attitudes and skills among pediatricians in the future.
This study provides evidence for the need to continually enhance pediatricians' knowledge, attitudes, and practices about breastfeeding. Practical solutions must be developed to improve pediatricians' beliefs so that mothers can successfully meet their breastfeeding goals.
Correspondence: Lori B. Feldman-Winter, MD, MPH, Division of Adolescent Medicine, Department of Pediatrics, Cooper University Hospital, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, Education and Research Bldg, Third Floor, 401 Haddon Ave, Camden, NJ 08103 (email@example.com).
Accepted for Publication: April 22, 2008.
Author Contributions: Dr Feldman-Winter had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Feldman-Winter, Schanler, and Lawrence. Acquisition of data: Feldman-Winter and O'Connor. Analysis and interpretation of data: Feldman-Winter, Schanler, and O'Connor. Drafting of the manuscript: Feldman-Winter, Schanler, and Lawrence. Critical revision of the manuscript for important intellectual content: Feldman-Winter, Schanler, O'Connor, and Lawrence. Statistical analysis: O'Connor. Administrative, technical, and material support: Feldman-Winter and O'Connor. Study supervision: Feldman-Winter, Schanler, O'Connor, and Lawrence.
Financial Disclosure: Ms O'Connor is an employee of the American Academy of Pediatrics.
Funding/Support: This study was supported in part by the American Academy of Pediatrics (Ms O'Connor).
Role of the Sponsor: The American Academy of Pediatrics had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.
Disclaimer: The Periodic Survey is a program of the American Academy of Pediatrics; however, the opinions expressed in the article are those of the authors and do not necessarily represent the view of the American Academy of Pediatrics.
Additional Contributions: Sanford Sharp, BS, assisted with the data analysis; Lauren Barone, MPH, assisted with preparation of the manuscript and managing of the American Academy of Pediatrics breastfeeding initiatives including coordination of the Periodic Survey of Fellows on Breastfeeding and Breastfeeding Promotion in Pediatricians' Office Practice and the Breastfeeding Promotion in Physicians' Office Practices programs.
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