Preheat the oven to 170°C/325°F/gas 3. Grease a 19cm x 23cm (7 1/2in x 9 1/2in) shallow cake tin and line with baking parchment.
Place the plain chocolate and butter in a bowl set over a pan of simmering water and leave until melted. Remove from the heat and beat in the sugar, eggs and vanilla essence, then fold in the flour.
Pour the mixture into the cake tin. Spoon the melted white chocolate over the mixture. Use a skewer to swirl the white chocolate into the mixture, to create a marbled effect.
Bake for 30-35 mins until just firm to the touch. Leave to cool in the tin before cutting into squares.


Happy Friday! What colors make you feel happy? I really enjoy bright colors, they automatically let me in a good mood! The outfit of the day is very romantic, full of joy and special (you can see me included in this set, yay!). Also it's a previous inspiration for the Valentine's Day: a vintage 1950's floral dress; mary jane pumps; handbag and delicate jewelry. Sincerely, I feel like this look came from a classic movie and I would love to wear it! Have everyone a blessed week!
Feliz sexta-feira! Quais as cores que te deixam feliz? Eu realmente gosto de cores brilhantes, elas me deixam automaticamente em um bom humor! O look do dia é muito romântico, cheio de alegria e especial (você pode me ver incluída neste set, yeah!). Também é uma inspiração prévia para o Dia dos Namorados: um vestido vintage 1950 com estampa floral; sapatos mary jane; bolsa e joias delicadas. Sinceramente, sinto que este look veio de um filme clássico e amaria vesti-lo! Tenha todos uma semana abençoada por Deus!
I love the dress and the yellow touch:).
I'm in love with this floral dress, I would wear it any day!
That dress is so pretty! I love it!
Beautiful floral print and colors!
Great inspiration board! Love the dress and the yellow accessories. This is so perfect for spring!
Lindíssimo esse vestido combinou perfeitamente com o sapato e a bolsa!!
i am following you now, you can also follow me back please !
Também adoro vestir cores fortes, elas deixam o dia mais animado mesmo!
Can I please have that bag?! That floral pattern is beautiful! I love the pick of the yellow accessories, so fun! You have such a good eye for fashion!
That dress is stunning! Love it!
I literally saw that photo and said 'wow!' That is such a lovely outfit, the colours are perfect together and I absolutely love a bit of vintage, so flattering and classy!
I love also bright colours and the dress you show here!
Oh, that dress is so gorgeous!!
Yellow definitely makes me happy and this post makes me want spring to come little sooner. Have a great weekend!
Sorteio la no blog vai la..
I love the print of this beautiful midi dress! So chic!
Have an amazing weekend Jessica!
Love how you paired yellow shoes with this dress. So fun!!
A cor que me deixa feliz é rosa, mas esse vestido é maravilhoso.
Beautiful! These are definitely happy colors!
This dress is so stunning! I love the vintage vibe!
Lovely dress ♡♥ all the colors make me happy !
O vestido é muito fofo!
Hi Jessica! Thanks for the lovely words on my post. The pictures are from Ilhabela and Buzios, the other ones from Ilha Grande and Rio do Janeiro will be up soon in the second part and I have more on Instagram.
i love fit & flare dresses! so girly!
The dress is stunning. Amazing post & can you please click on the sheinside links in my latest post. It would mean the world to me!
I love the color of those shoes! Cute.
I am in love with that floral dress!
Such a lovely and romantic outfit, love that flower dress!
Love the happy colors of the dress!
Menina que escolha maravilhosa! O vestido é perfeito e realmente super colorido e lindooo! Amei os acessórios que escolheu pra compor com o vestido!
OMG!!!! que coisa tão lindaaaa!! Super Amei!
Love the florals and burst of colors!
Lovely dress! flower print is one of my fav for ever and ever.
Beautiful dress, i love all of this!
Yellow is definitely one of them! :) The floral dress is very pretty!
Que lindo *o* adorei o look, a combinação ficou ótima!
Just discovered your wonderful blog after you left a comment on mine. Stunning outfit! I LOVE the floral dress!
Following you on GFC & Bloglovin.
It sure is a color of happiness! One look and it's a perk me up. You pick really good things.
Tb gosto de cores brilhantes!
achei a estampa do vestido mt amor!!
Look bem delicado, ficou bonito.
Babando e querendo demais este vestido! Perfeito!
The dress is stunning!!! Love It combined with the yellow color for the shoes and bag!
That dress paired with the yellow is amazing! It reminds me of a friendly Alice in Wonderland (not Tim Burton).


text:
PAKISTAN: Baloch Activists Punished for Dissent
A Statement by the Asian Human Rights Commission
Since inception, Pakistan has been at war with its own citizens; time and again the State has indulged in gross human rights violation to muzzle voices of dissent. Ethnic Balochis have especially suffered discrimination and stigmatization, by successive military and civil governments. Due to State negligence, Baluchistan remains the least developed province even though its natural resources fuel 60% of the nation's economy. The call for equal rights for Balochis is viewed as rebellion by the State and "strategic tactics" of disappearances and extrajudicial killings are employed to silence the voices of conscience.
In the latest, the Pakistan military has conducted an operation on January 30 in Mastung, Balochistan. In this operation, five persons have been killed in a house, wherein, according to the Balochistan Times, Baloch separatists were hiding.
Earlier, on January 16, the Frontier Corp (FC) raided a house and killed Dr. Manan Baloch and four other persons by shooting directly at their heads. The FC and the Balochistan Interior Minister said that those killed were militants and that they died in a gun battle with security forces in Mastung District.
Dr. Manan, 48, was a physician by profession and a senior leader of the proscribed Baloch Liberation Front (BLF). He joined BLF after he began having to confront many dead bodies of those who had earlier been disappeared; these bodies had torture marks on them. He was a committed nationalists and he joined the movement for the independence of Balochistan.
Similarly, eight years ago, on 3 April 2009, the ex-President of the Baloch National Movement (BNM), Ghulam Muhammad Baloch, along with two other Baloch political activits, were abducted from their lawyer's office at Turbat, at gunpoint by security officials. Six days later their mutilated and smashed bodies were found at Murghaab, 35 km from Turbat. The killing of this Baloch leader drew international condemnation.
Dr. Manan was widely respected for his tireless work for those internally displaced as a result of military and paramilitary operations in Balochistan. According to media reports, more than 178,000 persons from the Dera Bugti area – which has substantial deposits of natural gas, known as Sui gas – who were displaced as result of military action in 2005, are still not allowed to return home by the Frontier Corp. And, this is in direct violation of a Supreme Court order.
A 20 September 2015 press statement from the Interior Ministry of Balochistan states that law enforcement agencies have killed approximately 204 "militants" in operations, and 29 have been injured. However, the State has remained tight-lipped about the identity of these militants which law enforcement agency has undertaken the killings and arrests.
In the press conference, the Minister also stated that 8,363 Balochis were arrested over the span of 9 months, and 1,800 targeted operations were conducted in the Province between December 2014 and September 2015.
Next, in a 31 January 2016 press statement, the Interior Ministry of Balochistan notes that security forces conducted 239 intelligence-based operations in Balochistan over the past two months, in which 22 militants were killed and 14 others injured.
Dr. Manan was killed a day after a was meeting held between Sanaullah Zehri, the pro-Islamabad Chief Minister of Balochistan and Lieutenant General Amir Riaz, the highest official of the Pakistan Army designated in Balochistan. Both of them vowed to "chase the terrorists". The Chief Minister urged security forces to work as a team and said, "I'll be your captain." The next day, the vocal Baloch leader was murdered in what officials describe as an "operation against the terrorists".
Since 1948, when the Khan of Kalat refused annexation to the State of Pakistan, five military operations have taken place in the province. However, these operations have proved futile in curbing insurgency, because the government has continued with its discriminatory policies. The Federal government's militarized approach has further eroded peace and stability in the region. The Army is itself accused of prejudice against Balochis; a majority of Baloch leadership accuses the Army of being dominated by Punjabis and to be safeguarding the provincial political interests of Punjab.
The Federal government is viewed unfavourably by proponents of Baloch liberation, who state that perpetrators of gross human rights violation are promoted to the highest echelons of administrative affairs, which further hurts the feelings of the Balochistan people and gives rise to discontent amongst the masses. For instance, the Commander, Southern Command, Lieutenant General Nasir Khan Janjua, who was said to be the de facto head of the Balochistan government – despite the civil leadership of the Chief Minister of Balochistan, Abdul Malik Baloch – was appointed the National Security Advisor. It was during the tenure of General Nasir Khan that the Kalat Mass grave scandal broke out; General Nasir actively deflected all charges of the agency's involvement before the enquiry commission.
The China Pakistan Economic Corridor (CPEC) has compelled the State to expedite Baloch ethnic cleansing. The state didn't bother to take the Baloch administrative government into confidence before launching the project. Dr. Abdul Malik Baloch, who was deposed from chief minister-ship, according to a formula with the Federal government, in a recent statement said that he was not even taken into confidence about CPEC. The effect on the Baloch population is not even regarded by the Federal government as worthy of consideration. How can the State expect nationalist sentiments from a population that is completely disillusioned with the State?
The CPEC project has again provoked the Federal government to commence a new phase of military operations in far-flung areas of Balochistan, where there is a general feeling that with the start of CPEC, the Balochi people will become a minority in their own province.
In the past, the Baloch wanted greater autonomy and increased royalties from natural resources for provincial revenue. But due to repressive state policies, a peaceful movement has turned into an insurgency for separation. Suppression of dissenting voices will not serve any good to the province or the country. The use of force is only fuelling the conflict, while the solution clearly lies in the political way.
Dr. Manan was the General Secretary of the Baloch National Movement, a political group seeking independence from Pakistan. Although the BNM claims its struggle is peaceful, the Pakistan military has killed dozens of its leaders and activists, including its Founding President, Ghulam Mohammed Baloch, due to their separatist demand.

redpajama_set_name: RedPajamaCommonCrawl


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text:
Fire breaks out at refugee camp on Greece's Samos island
by ANI
Samos [Greece], November 2 (ANI/Xinhua): A fire broke out at a refugee camp on the Greek island of Samos, which also recently suffered from a powerful earthquake, the country's Migration and Asylum Ministry said on Monday.
The fire is said to have started at approximately 02:00 GMT in the reception and identification centre, which shelters over 4,200 people.
"Fifteen tents burned down. The residents were evacuated immediately, there have been no reports about casualties," the ministry said in a statement, adding that the fire was small and its cause is still unknown.
This is not the first time a fire has broken out in a Greek refugee camp, as the Moria refugee camp on the Lesbos island experienced several fires in March and September.
On Friday, a strong earthquake occurred in the Aegean Sea, affecting several Greek islands and a part of western Turkey. On Samos, two people died and 20 were injured. (ANI/Xinhua)
Disclaimer: The views expressed in the article above are those of the authors' and do not necessarily represent or reflect the views of this publishing house. Unless otherwise noted, the author is writing in his/her personal capacity. They are not intended and should not be thought to represent official ideas, attitudes, or policies of any agency or institution.
greece Samos fire refugee camps Migration and Asylum Ministry earthquake
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Music sales: Digital = Physical for the first time!
…I have to get serious and talk about sales as it pertains to music!
So the IFPI (International Federation of the Phonographic Industry) just released their Global Digital Music Report which revealed that global digital music sales equaled global physical music sales for the very first time!
So the report states that 2014 is the very first year that digital sales equalled physical sales which is quite impressive if you ask me! Digital revenues grew 6.9% since 2013 to $6.9 billion USD which is equal to the same as physical CD & vinyl sales!
The cool thing about this is that digital sales still happen, for one, which is largely because of iTunes and how great it is to have instant/non-Wi-Fi access to your favorite artists, bands, songs, and albums AND the fact that streaming revenue is growing means that record labels cannot ignore them any longer and need to negotiate higher rates per stream.
Ignorance isn't quite what I think is happening because everybody including me knows that there are millions of users on SoundCloud and Spotify, but the fact that the rates are extremely low and what I find to be unnegotiated…it seems to me that it's high time that the rates were raised to equal or to come significantly close to the mechanical rate (9.1 cents per song) in order to compensate songwriters and producers properly!
The rate per stream is not really publicized that I know of, but from what I remember it's something like .000000001. Seriously! That's why when the public information of income from Pharrell's "Happy" and John Legend's "All Of Me" was released a few months prior, everyone's mouth started to drop. I don't remember precisely but I know that each song made less than $5,000 in streaming income and they were played MILLIONS of times!!
Regardless, the only constant in life is change and that couldn't be more true of the music industry too. There are many things in flux and flow, but perhaps that's what makes it exciting, challenging, and rewarding to be a part of.
Come back tomorrow for some laughs HAHA & thanks IFPI for your report!
Florence Welch broke her foot during Coachella!


text:
You are at:Home»Agencies»Postal Service»Postal Service: Accelerated mail processing plant downsizing not linked to new board directive
Postal Service: Accelerated mail processing plant downsizing not linked to new board directive
By on	 January 19, 2013 Postal Service
On Monday, the Postal Service announces that its governing board has given orders to accelerate cost-cutting measures. On Thursday, the Postal Service notifies the National Postal Mail Handlers Union that it is speeding up the shutdown of mail processing operations at 18 plants.
Contrary to what some might assume, though, "the decision is not part of the package directed by the USPS Board of Governors," postal spokeswoman Sue Brennan said in an email. "But because we have had the flexibility to consolidate operations in the past—when we could do so—we're following through now as the opportunity exists."
For employees at the affected plants—which include facilities in Florida, Texas and Wyoming—that may be a distinction without a difference. Under the Postal Service's three-year plan to halve the size of its processing network, the 18 were supposed to be axed next year. Under the new timetable, they'll join 82 other facilities set for consolidation between this month and July. In an interview, John Hegarty, president of the mail handlers union, was hopeful that the departure of thousands of workers under two early-out programs in the last year will lessen the number of employees who will have to move to keep working for the Postal Service. In any case, he said, the union will continue to stress that dislocation be kept to a minimum.
For anyone who's wondering, incidentally, postal officials still aren't saying exactly what they will be doing in response to the Board of Governors directive. Information on that score will come "as soon as possible," another spokesman said.
Postal Service announcing 1Q financials tomorrow
With stamp prices set to rise, legal challenges filed
Postal Service, mailers poised to challenge exigent rate decision
twoguns on January 20, 2013 8:03 pm
Simple business. Charge enough to cover your cost plus profit margin. USPS can't do that. Congress under GOP control morphed PRC (Postal Regulatory Commission) into master agency above Postal board of Governors & Postmaster General. PRC has blocked rate increases to cover Congress mandated business costs. GOP solution. Create additional layers bureaucracy over USPS operations. Never mind that USPS actually has never fired anyone for agency losing money. That managers in national management have been in place for sometimes 40+ years. This will take President Obama declaring an emergency & issuing Executive order(s) changing USPS operating standards. Then GOP can complain that Obama is over reaching (again).
truthteller on January 20, 2013 11:10 pm
why is the USPS still failing? the answer to that in a nutshell is that the management of the united states postal service is saturated with incompetence, waste, fraud, and corruption. the office of the inspector general of the USPS brags that their
role is to maintain the integrity and bring accountability to the united states postal service. if the office of the inspector general was doing its job, the levels of waste, incompetence, fraud, and corruption would be significantly lower within the management of the USPS. case in point, the office of the inspector general recently announced that they discovered that postal management paid out over $600,000 in 'questionable bonuses' in 2011 and 2012 to (2) ad agencies!
furthermore, the OIG reported $2.3 million paid by USPS management but with improperly certified invoices. all told, the OIG claimed there were $7 million dollars of 'questioned' costs paid by the united states postal service
in just this one instance relating to USPS's advertising. what did the office of the inspector general do about all these questionable costs and improperly documented payments and 'suspect' bonus payments? well, the OIG put out a press release of course! why wasn't anyone fired or charged with a crime? why does the office of the inspector general even bother to investigate anything if they don't intend to do ANYTHING ABOUT IT? postal management is littered with incompetence, waste, fraud, and corruption BECAUSE THE OFFICE OF THE INSPECTOR GENERAL IS A MISERABLE FAILURE AND ALLOWS IT TO CONTINUE.
KaRi from 90809 on January 21, 2013 2:39 pm
ww.facbook.com/TPSradio Please listen to my ideas by calling (562)804-5625 and view my PROJECTS area on LinkedIn.
This includes Same Dy Delivery Service which is being tested RIGHT NOW and employing our honorably discharged military Veterans – more than 22%.
Frd on January 22, 2013 11:54 am
Twoguns is right in that mailers have to pay their share. If you go to USPS.com find the standard mail calculator and input numbers. Large mailers pay as little as 12 cents a letter! The post master general refused to tell congress how much mailers that have contracts pay. Is this because the amount is even less? In the past there was more first class mail than junk mail, now it is the other way around. Standard mail is sill growing, while 1st class is shrinking. These large mailers make donations to congress every year in attempt to privatize the postal service. What they really mean is cut the workers pay and allow the new owners to make millions! A private corporation also would not have price controls. Critics of the P.O. say that prices would drop, but we only have to look at Japan and Germany that have already privatized. They pay a lot more for postage than here in the U.S.


text:
Hello, paris
Few cities match the iconic status that Paris boasts in the imagination of travellers. In fashion, gastronomy, and the arts, she is queen. As you visit the different quartiers of the City of Light, her moods shift from gritty to sophisticated, from Haute Couture to punk. There is always something new to discover in Paris beyond the legendary sights and museums we all know so well. This fabled city has a way of getting under your skin and feeling instantly familiar to all who wander her hypnotic streets and linger at her inviting cafes.
Writers, travellers, artists, photographers, and filmmakers have tried to capture the magic of the French capital for hundreds of years. Time and time again, they have failed. It may be possible to understand and admire the magnificence of its architectural splendours, the appeal of its long tree-lined boulevards, and the draw of its vast, green parks, but that unique feeling of strolling through this open-air museum on a clear night cannot be reproduced by any medium. Paris is a city that must be experienced first-hand. Instantly recognisable for its iconic architecture, the City of Light is a vibrant metropolis in constant change. Though perennial monuments like the Eiffel Tower, Arc de Triomphe, and Notre Dame Cathedral are a must, as are world-renowned museums such as the Louvre and Musée d'Orsay, there are wonders to be found on every corner. From the trendy bars, boutiques, and galleries of Marais to the artsy and bohemian feel of Montmartre to the grandiose elegance along the Seine – there is plenty for all tastes, a full range extending from earthy grit to over-the-top sophistication, but always with an emphatic and inimitable Parisian flavour. A pioneer in design of all kinds, Paris is consistently at the forefront of innovation in everything from the arts and culture to fashion and gastronomy. Be it for shopping, dining, or sightseeing, it is hard to find a better place than this, the world's most visited city. Explore the city like a local and discover the top things to do and see in Paris, as well as the best restaurants, bars, nightclubs, cafes, and hotels the City of Light has to offer, with our comprehensive, up-to-date, and free Paris travel guide.
Homely studio near the Jussieu metro
Large studio near the Gare de Lyon transport station
Enchanting studio with balcony close to Vaugirard metro station
Pleasant 2-bedroom apartment near the Goncourt metro
Spacious studio flat near Arts et Métiers metro station
Fancy 2-bedroom apartment near Place des Vosges
Lovely studio in 11e -Bastille-République
1-Bedroom apartment in Courbevoie
Bright double bedroom in a 6-Bedroom apartment close to ESPE University
Cute double bedroom in a 6-Bedroom apartment, close to Porte d'Auteuil metro station


text:
Q: Larave 6 l "Creating default object from empty value" Here, I have setuo CRUD table with laravel, vuetify and vue . I could successfull create and read data from the database. But, for some reason my update and delete are not working. I am getting error like:
{message: "Creating default object from empty value", exception: "ErrorException",…}
exception: "ErrorException"
file: "C:\WinNMP\WWW\chillibiz\app\Sys\Http\Controllers\StageController.php"
line: 53
message: "Creating default object from empty value"
trace: [{file: "C:\WinNMP\WWW\chillibiz\app\Sys\Http\Controllers\StageController.php", line: 53,…},…]
My code are here:
StageController.php
<?php

namespace App\Sys\Http\Controllers;

use App\Http\Controllers\Controller;

use Illuminate\Http\Request;

use Illuminate\Support\Str;

use App\Sys\Model\Stage;

class StageController extends Controller
{

    public function index(Request $request)
    {
        $per_page = $request->per_page ? $request->per_page : 5;
        $sort_by = $request->sort_by;
        $order_by = $request->order_by;
        return response()->json(['stages' => Stage::orderBy($sort_by, $order_by)->paginate($per_page)],200);
    }

    public function store(Request $request)
    {
        $uuid = Str::uuid()->toString();
        $stage= Stage::create([
            'id' => $uuid,
            'code' =>$request->code,
            'name' =>$request->name,
            'description' =>$request->description,
        ]);
        return response()->json(['stage'=>$stage],200);
    }

    public function show($id)
    {
        $stages = Stage::where('code','LIKE', "%$id%")->orWhere('name','LIKE', "%$id%")->orWhere('description', 'LIKE', "%$id%")->paginate();
        return response()->json(['stages' => $stages],200);
    }

    public function update(Request $request, $id)
    {

       $stage = Stage::find($id);

       $stage->code  = $request->code; //line 53
       $stage->name  = $request->name;
       $stage->description  = $request->description;

       $stage->save();
       return response()->json(['stage'=>$stage], 200);
    }

    public function destroy($id)
    {
        $stage = Stage::where('id', $id)->delete();
        return  response()->json(['stage'=> $stage],200);
    }

    public function deleteAll(Request $request){
        Stage::whereIn('id', $request->stages)->delete();
        return response()->json(['message', 'Records Deleted Successfully'], 200);
    }
}

Stage.php
<?php

namespace App\Sys\Model;

use Illuminate\Database\Eloquent\Model;

class Stage extends Model
{
    protected $guarded = [];
}

A: I just found they you are using uuid as id not increment. that why you get error like that:
to solve your problem you need to add the field to your model;
<?php

namespace App\Sys\Model;

use Illuminate\Database\Eloquent\Model;

class Stage extends Model
{
    public $incrementing = false;
    protected $keyType = 'string';
    protected $guarded = [];

}

I hope this time you can solve your problem. happy coding.
Edit you can read docs for more info

redpajama_set_name: RedPajamaStackExchange


text:
Study Design and Sample
Follow-up Time
Articles| November 01 2021
Update on Phototherapy and Childhood Cancer in a Northern California Cohort
Jean C. Digitale, MPH, RN;
Jean C. Digitale, MPH, RN
aDepartment of Epidemiology and Biostatistics
Address correspondence to Jean C. Digitale, MPH, RN, Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th St, 2nd Floor, San Francisco, CA 94158. E-mail: jean.digitale@ucsf.edu
Mi-Ok Kim, PhD;
Mi-Ok Kim, PhD
cHelen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
Michael W. Kuzniewicz, MD, MPH;
Michael W. Kuzniewicz, MD, MPH
bPediatrics
dDivision of Research, Kaiser Permanente Northern California, Oakland, California
Thomas B. Newman, MD, MPH
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Jean C. Digitale, Mi-Ok Kim, Michael W. Kuzniewicz, Thomas B. Newman; Update on Phototherapy and Childhood Cancer in a Northern California Cohort. Pediatrics November 2021; 148 (5): e2021051033. 10.1542/peds.2021-051033
Video Abstract
We aimed to reassess the relationship between phototherapy and cancer in an extended version of a previous cohort and to replicate a report from Quebec of increased cancer risk after phototherapy beginning at age 4 years.
This cohort study included 139 100 children born at ≥35 weeks' gestation from 1995 to 2017, followed through March 16, 2019, in Kaiser Permanente Northern California hospitals who had a qualifying bilirubin level from −3 mg/dL to +4.9 mg/dL from the American Academy of Pediatrics phototherapy threshold; an additional 40 780 children and 5 years of follow-up from our previous report. The exposure was inpatient phototherapy (yes or no), and the outcomes were various types of childhood cancer. We used Cox proportional hazard models, controlling for propensity-score quintiles, and allowed for time-dependent exposure effects to assess for the risk of cancer after a latent period.
Over a mean (SD) follow-up of 8.2 (5.7) years, the crude incidence of cancer per 100 000 person-years was 25.1 among those exposed to phototherapy and 19.2 among those not exposed (233 cases of cancer). After propensity adjustment, phototherapy was not associated with any cancer (hazard ratio [HR]: 1.13, 95% confidence interval [CI]: 0.83–1.54), hematopoietic cancer (HR: 1.17, 95% CI: 0.74–1.83), or solid tumors (HR: 1.01, 95% CI: 0.65–1.58). We also found no association with cancer diagnoses at age ≥4 years.
We did not confirm previous, concerning associations between phototherapy and adjusted risk of any cancer, nonlymphocytic leukemia, or brain and/or central nervous systems tumors in later childhood.
Cancer/Neoplastic, Fetus/Newborn Infant, Hyperbilirubinemia
cancer, childhood cancer, phototherapy, leukemia, solid tumors, hematologic neoplasms
There is conflicting evidence as to whether phototherapy given to jaundiced newborns may have a carcinogenic effect. A recent study from Quebec suggested phototherapy could increase the risk of solid tumors but only after a latent period of several years.
In an extended version of a large Northern California cohort, we did not replicate previous, concerning associations of neonatal phototherapy with increased risk of any cancer, nonlymphocytic leukemia, or brain and/or central nervous systems tumors after 4 years of age.
Phototherapy is commonly used to treat hyperbilirubinemia in newborns. Although it has been widely considered safe, it can damage DNA,1–4 potentially leading to cancer. There is conflicting evidence of a carcinogenic effect. Multiple studies in Europe found no association with leukemia.5–7 One Swedish study found an elevated risk for myeloid leukemia, but it was attenuated after excluding cases with Down syndrome (none of the controls had Down syndrome).8 In a California study, researchers using a large, administrative data set found a slight increased risk for overall cancer, myeloid leukemia, and kidney cancer before age 1 among those who received phototherapy.9
Newman et al10 previously reported on the association of phototherapy and cancer using data from a large cohort of children born from 1995 to 2011 at Kaiser Permanente Northern California (KPNC) hospitals followed through March 2014. The study reported that phototherapy was associated with higher rates of any type of leukemia and nonlymphocytic leukemia in unadjusted models. In propensity-adjusted analyses, however, excess risks were attenuated and no longer statistically significant.
Recently, Auger et al11–13 reported on the association between phototherapy and childhood cancer using administrative data from the province of Quebec. Their hypothesis was unique compared with previous studies in that they looked for evidence of excess cancers only after a latent period of several years after phototherapy. They found an increased risk particularly for late-onset solid tumors, such as brain and central nervous system (CNS) cancers, between ages 4 and 11 years.
In this report, we update the investigation by Newman et al with an additional 6 years of the birth cohort (now through 2017) and 5 additional years of follow-up (now through March 2019). In addition, we assess whether there is evidence to support the findings by Auger et al of increased risk of later-onset childhood cancer, which was not previously investigated in this population.
We assembled a cohort of 751 170 children born at ≥35 weeks' gestation from 1995 to 2017 at KPNC hospitals. We excluded infants who died during their birth hospitalization (n = 463; 0.1%), were transferred to facilities outside of KPNC (n = 1112; 0.2%), had follow-up in KPNC for <60 days (n = 38 442; 5.1%), or were diagnosed with cancer before 60 days or only had a secondary cancer diagnosis (n = 28; <0.01%). An additional 3582 infants (0.5%) were excluded because the last encounter date was missing and another 4901 (0.7%) because of missing covariate data. We categorized these 702 646 children into neurotoxicity risk groups on the basis of gestational age (dichotomized at 38 weeks) and direct antiglobulin test (positive or not) and compared all of their total serum bilirubin (TSB) levels to the relevant phototherapy thresholds in the 2004 American Academy of Pediatrics (AAP) phototherapy guidelines.14 We then restricted the sample to those with a qualifying bilirubin level, defined (as in previous studies10,15 ) as a TSB −3 mg/dL to +4.9 mg/dL from the relevant AAP threshold. A final analytic sample of 139 100 children remained. This is 40 780 more children than included in the models restricted to this TSB range in the previous analysis by Newman et al.10
The institutional review boards for the protection of human subjects at the University of California, San Francisco, (no. 10-04918) and KPNC (no. 1270417-19) approved the study.
The exposure of interest was a binary indicator of receiving any phototherapy during birth hospitalization or readmission. For infants born before the implementation of HealthConnect (the Kaiser Permanente version of EPIC, the electronic health record), phototherapy use was ascertained from inpatient procedure codes. For infants born after the implementation of HealthConnect, phototherapy use was determined on the basis of documentation in a phototherapy nursing flowsheet or both a procedure code and an order for phototherapy.
We obtained data on hypothesized confounders from medical records: sex, race and/or ethnicity (White, Asian American, Black, Hispanic, and other or unknown), gestational age (weeks), delivery mode (normal spontaneous vaginal, assisted vaginal, and cesarean), facility of birth, year of birth, maternal age (<25, 25–34, and ≥35 years), multiple birth, birth weight (grams), Down syndrome, presence of congenital anomalies, chromosomal abnormalities other than Down syndrome, early hyperbilirubinemia (an indicator for a TSB level within 3 mg/dL of the phototherapy threshold before 24 hours of age), and TSB level in relation to the phototherapy threshold categorized in 1.0-mg/dL increments.10,15 Race and/or ethnicity was included because Asian American infants are more likely to be diagnosed with jaundice and more likely to require phototherapy than white infants.16 Furthermore, there are known racial and/or ethnic disparities in cancer incidence.17–19
We converted International Classification of Diseases, 10th Revision codes to International Classification of Diseases, Ninth Revision, (ICD-9), if needed, and classified subjects as having congenital anomalies or chromosomal abnormalities based the presence of at least 2 ICD-9 codes from inpatient or outpatient encounters from unique departments or dates: Down syndrome (ICD-9: 758.0), other chromosomal abnormalities (758.1–758.9), and congenital anomalies (740–759.9, except 743.65 [nasolacrimal passage anomaly]).
Childhood cancer was captured via diagnosis codes from all inpatient and outpatient encounters. We required at least 2 diagnoses of cancer from different departments or different dates to reduce false-positive diagnoses because of coding errors. The modal cancer ICD-9 code (recorded at the highest number of encounters) was the diagnosis used for this study. Age at event time was defined as age at the first diagnosis of cancer. We excluded cancers occurring before 60 days of age to allow for a minimum latent period between phototherapy and the development of cancer.9–11
We classified cancer into hematopoietic cancers: (1) acute lymphocytic leukemia (ICD-9: 204.X), (2) nonlymphocytic leukemia (205.0–208.X), and (3) lymphoma and other hematopoietic cancers (200.0–202.X); solid tumors: (1) brain and CNS tumors (190.5, 191.0–192.X) and (2) other solid tumors (140.0–165.X, 170.0–171.X, 174.0–189.X, 190.9, and 193.0–196.X); and other cancers (172.0–173.X and 199.0).
Time at risk in primary analyses was defined as starting at age 60 days and ending at the age of first cancer diagnosis or censored at the age of the last encounter date at a KPNC facility through March 16, 2019. This resulted in a total of 1 112 520 person-years (453 786 more than the original cohort).
Our logistic models for propensity for inpatient phototherapy included sex, race, gestational age, delivery mode, facility of birth, year of birth, maternal age, multiple birth, birth weight (as restricted cubic splines), chromosomal abnormalities (other than Down syndrome), early hyperbilirubinemia, and bilirubin levels in relation to guidelines. Because those with Down syndrome are at greatly increased risk for hematopoietic cancers, we did not include Down syndrome in the propensity model we used for all cancer and hematopoietic cancer and instead included it separately in the outcome model to ensure adequate control of confounding. We included Down syndrome in the propensity model for solid tumors.
We calculated crude incidence rate ratios for cancer among those who did and did not receive phototherapy. We then used Cox proportional hazard regression to estimate the effect of phototherapy on the hazards of each type of cancer controlling for quintiles of propensity to receive phototherapy. We tested the proportional hazards assumption on the basis of Schoenfeld residuals. In all models, we controlled for congenital abnormalities and, in models for any cancer and hematopoietic cancers, for Down syndrome as well. As a sensitivity analysis, we estimated the same models with time 0 beginning at 1 year of age, rather than 60 days, to further preclude the possibility of reverse causation.
To assess whether there was a higher risk for late-onset cancers, we used the same Cox models but allowed time-varying exposure effects. To facilitate comparisons with the results of Auger et al,11 we added an interaction term, with age dichotomized at 4 years. We conducted a sensitivity analysis in which we added an interaction term, with age dichotomized at 6 years instead. We also used the propensity scores to create stabilized inverse probability weights and re-estimated all models as weighted analyses.
Finally, we restricted our exposure to birth hospitalization phototherapy (excluding those who were readmitted for phototherapy) to assess if this had any impact on the results of the primary analyses.
A description of the cohort is included in Table 1. Of the 139 100 newborns with qualifying bilirubin levels included in the study, 42 266 (30.4%) received phototherapy. Infants who did and did not receive phototherapy differed in the expected ways.
Description of Analytic Cohort
Inpatient Phototherapy .
No Inpatient Phototherapy .
n 42 266 96 834 —
Male sex, n (%) 23 519 (55.6) 51 913 (53.6) <.001
Race and/or ethnicity, n (%) <.001
White 13 871 (32.8) 35 383 (36.5) —
Asian American 13 182 (31.2) 26 127 (27.0) —
Black 2116 (5.0) 4510 (4.7) —
Hispanic 9823 (23.2) 22 381 (23.1) —
Other or unknown 3274 (7.7) 8433 (8.7) —
Early hyperbilirubinemia: TSB level within 3 mg/dL of AAP phototherapy threshold at <24 h, n (%) 12 585 (29.8) 18 519 (19.1) <.001
Gestational age, wk, n (%) <.001
35 3939 (9.3) 3167 (3.3) —
36 4870 (11.5) 7318 (7.6) —
37 6547 (15.5) 16 415 (17.0) —
≥41 3061 (7.2) 8634 (8.9) —
Birth wt, kg, mean (SD) 3.3 (0.6) 3.3 (0.5) <.001
Delivery mode, n (%) <.001
Normal spontaneous vaginal 10 941 (25.9) 20 091 (20.7) —
Cesarean 26 987 (63.9) 68 104 (70.3) —
Assisted vaginal 4338 (10.3) 8639 (8.9) —
Maternal age, y, n (%) <.001
<25 6682 (15.8) 16 603 (17.1) —
25–34 25 226 (59.7) 58 244 (60.1) —
35+ 10 358 (24.5) 21 987 (22.7) —
Multiple birth, n (%) 1241 (2.9) 2617 (2.7) .015
Trisomy 21, n (%) 262 (0.6) 205 (0.2) <.001
Other chromosomal anomaly, n (%) 169 (0.4) 219 (0.2) <.001
Other congenital anomaly, n (%) 5347 (12.7) 9949 (10.3) <.001
Included in previous cohort,a n (%) 30 716 (72.7) 66 494 (68.7) <.001
Follow-up time, y, mean (SD) 7.8 (5.3) 8.1 (5.9) <.001
There are 41 890 children included in the present cohort who were not included in the previous publication by Newman et al.10 This resulted in a total of 40 780 more children in this cohort because the eligibility criteria for our study differed slightly from those in the previous one (required to have nonmissing values for the variables in our propensity score), excluding 1110 children included in the previous cohort. —, not applicable.
Cancer incidence rates and crude incidence rate ratios (IRRs) are presented in Table 2. Graphs of the crude cumulative incidence for each type of cancer are included as Supplemental Figs 1–10. In unadjusted analyses, any cancer (IRR: 1.31, 95% confidence interval [CI]: 0.99–1.72), any hematopoietic cancer (IRR: 1.65, 95% CI: 1.10–2.47), and acute lymphocytic leukemia (IRR: 1.72, 95% CI: 1.03–2.84) were associated with phototherapy. Only 9 children diagnosed with nonlymphocytic leukemia received phototherapy: reclassification of leukemia cases based on the modal rather than the first cancer diagnosis led to a net decrease of 2 cases exposed to phototherapy compared with what was previously reported for the 1995–2011 cohort. Restricting to those eligible for this study, the percentage of those with nonlymphocytic leukemia exposed to phototherapy decreased from 64.7% in the 1995–2011 cohort to 42.9% in the present cohort.
Crude Cancer Incidence Rates and Rate Ratios for Inpatient Phototherapy
Cancer .
Phototherapy .
No Phototherapy .
Unadjusted Incidence Rate Ratio (95% CI) .
No. Cancers .
Incidence of Cancer per 100 000 Person-Years (95% CI) .
Any cancer 83 25.12 (20.26–31.15) 150 19.18 (16.34–22.51) 1.31 (0.99–1.72) .05
Any hematopoietic cancer 44 13.32 (9.91–17.89) 63 8.06 (6.29–10.31) 1.65 (1.10–2.47) .01
Acute lymphocytic leukemia 29 8.78 (6.10–12.63) 40 5.11 (3.75–6.97) 1.72 (1.03–2.84) .03
Other hematopoietic cancers 15 4.54 (2.74–7.53) 23 2.94 (1.95–4.43) 1.54 (0.75–3.09) .20
Nonlymphocytic leukemia 9 2.72 (1.42–5.23) 12 1.53 (0.87–2.70) 1.78 (0.66–4.59) .20
Lymphoma and other hematopoietic cancers 6 1.82 (0.82–4.04) 11 1.41 (0.78–2.54) 1.29 (0.39–3.81) .61
Any solid tumor 36 10.90 (7.86–15.10) 83 10.61 (8.56–13.16) 1.03 (0.67–1.54) .89
Brain and CNS tumors 14 4.24 (2.51–7.15) 35 4.48 (3.21–6.23) 0.95 (0.47–1.80) .88
Other solid tumors 22 6.66 (4.38–10.11) 48 6.14 (4.63–8.14) 1.08 (0.62–1.83) .74
Other cancera 3 0.91 (0.29–2.82) 4 0.51 (0.19–1.36) 1.78 (0.26–10.49) .47
Skin cancer (n = 6) and unspecified cancer (n = 1).
After adjustment for confounding variables using propensity-score quintiles, none of these associations remained statistically significant (Table 3). The association between phototherapy and any cancer (hazard ratio [HR]: 1.13, 95% CI: 0.83–1.54), as well as any hematopoietic cancer (HR: 1.17; 95% CI: 0.74–1.83), was attenuated. The point estimate for the adjusted HR for nonlymphocytic leukemia decreased to 0.72 (95% CI: 0.26–1.95). Of note, major contributors to the difference between this adjusted HR and the crude IRR (1.78) were Down syndrome and early hyperbilirubinemia. Omitting the propensity-score quintiles and including only these 2 variables brought the adjusted HR down to 0.98 (95% CI: 0.40–2.39). HRs for all categories of solid tumors were close to 1. There was no evidence to reject the proportional hazards assumption. Estimates from models with a latent period of 1 year (instead of 60 days) were similar (Supplemental Table 5).
Association of Phototherapy and Childhood Cancer in KPNC and Quebec
KPNC (1995–2017) .
Quebec (2006–2016) .
Adjusted HR (95% CI) .
Any cancer 233 1.13 (0.83–1.54) 183 1.11 (0.80–1.54)
Any hematopoietic cancer 107 1.17 (0.74–1.83) 61 1.19 (0.70–2.03)
Acute lymphocytic leukemia 69 1.37 (0.78–2.39) 36 1.66 (0.86–3.21)
Other hematopoietic cancers 38 0.89 (0.42–1.89) <30 0.60 (0.24–1.53)
Nonlymphocytic leukemia 21 0.72 (0.26–1.95) — —
Lymphoma and other hematopoietic cancers 17 1.17 (0.37–3.69) — —
Any solid tumor 119 1.01 (0.65–1.58) 123 1.05 (0.70–1.60)
Brain and CNS tumors 49 0.94 (0.46–1.93) 50 1.26 (0.70–2.28)
Other solid tumors 70 1.06 (0.60–1.86) 74 0.89 (0.49–1.59)
Other cancer 7 4.13 (0.88–19.43) — —
Results from this cohort (KPNC born in 1995–2017, N = 139 100) are compared with Quebec (born 2006–2016, N = 124 169)11 phototherapy versus untreated jaundice results. All propensity models included sex, race, gestational age, delivery mode, facility of birth, year of birth, maternal age, multiple birth, birth weight, chromosomal abnormalities, early jaundice, and bilirubin. Down syndrome was included in the propensity model for solid tumors. We estimated all Cox proportional hazard models, controlling for propensity-score quintiles and congenital abnormalities, with time at risk beginning at 60 d of age. In models for any cancer and hematopoietic cancers, we also controlled for Down syndrome. —, not applicable.
In models that allowed for time-varying hazards (Table 4), we similarly found no evidence for increased risk of cancer, either before or after 4 years of age. Dividing the follow-up period at age 6 years similarly revealed no evidence for increased cancer related to phototherapy (Supplemental Table 6).
Association of Phototherapy and Childhood Cancer in KPNC and Quebec, Allowing Hazards to Vary at Age 4 Years to Assess for Latent Cancer
Quebec (2006–2016): 4–11 y, Adjusted HR (95% CI) .
0–4 y .
4+ years .
Any cancer 122 1.08 (0.72–1.61) 111 1.19 (0.78–1.80) 2.21 (1.31–3.69)
Any hematopoietic cancer 54 1.13 (0.63–2.05) 53 1.20 (0.66–2.18) 2.07 (0.90–4.74)
Acute lymphocytic leukemia 33 1.22 (0.58–2.61) 36 1.51 (0.73–3.10) 2.19 (0.82–5.90)
Other hematopoietic cancers 21 0.98 (0.38–2.52) 17 0.79 (0.27–2.29) 1.14 (0.27–4.69)
Nonlymphocytic leukemia 18 0.74 (0.26–2.14) 3 0.58 (0.05–6.68) —
Lymphoma and other hematopoietic cancers 3 1.01 (0.09–11.97) 14 1.20 (0.35–4.15) —
Any solid tumor 66 0.97 (0.55–1.71) 53 1.07 (0.57–2.00) 2.21 (1.15–4.26)
Brain and CNS tumors 22 1.06 (0.40–2.80) 27 0.85 (0.33–2.16) 2.48 (1.04–5.92)
Other solid tumors 44 0.92 (0.46–1.85) 26 1.34 (0.57–3.13) 1.81 (0.67–4.87)
Other cancer 2 5.57 (0.34–91.63) 5 3.65 (0.58–22.83) —
Results from this cohort (KPNC born in 1995–2017) are compared with Quebec11 (born 2006–2016) phototherapy versus untreated jaundice results. All propensity models included sex, race, gestational age, delivery mode, facility of birth, year of birth, maternal age, multiple birth, birth weight, chromosomal abnormalities, early jaundice, and bilirubin. Down syndrome was included in the propensity model for solid tumors. We estimated all Cox proportional hazard models, controlling for propensity-score quintiles and congenital abnormalities, allowing hazards to vary at 4 y of age. In models for any cancer and hematopoietic cancers, we also controlled for Down syndrome. —, not applicable.
Models adjusting for phototherapy propensity using inverse probability weighting rather than indicator variables for quintiles of phototherapy propensity yielded similar results, although generally with wider CIs (Supplemental Tables 7–10). Changing the exposure to birth hospitalization phototherapy alone also did not appreciably affect the results (results not shown).
In this study, we assessed the effect of phototherapy on childhood cancer, with a particular focus on possible delayed or latent effects. We found no evidence for an increased risk of cancer due to phototherapy. All crude associations between phototherapy and cancer were attenuated after controlling for confounding, similar to the original results by Newman et al.10 Their results were particularly concerning for nonlymphocytic leukemia; in this analysis, with more patients, extended follow-up time, and use of the modal rather than the first cancer diagnosis, we did not replicate this result. Using the modal diagnosis likely reduced misclassification because patients' initial cancer diagnoses may change or become more specific after biopsies or other tests are completed. We also found no increased risk for any hematopoietic cancer (any leukemia in the earlier paper).
We did not confirm the main results by Auger et al11 of increased risk of late-onset childhood cancer at older ages in Quebec. Our goal was to attempt to replicate their results by using a target trial emulation20,21 approach with inclusion criteria that restricted to infants who ever had an eligible TSB, as defined above. The subset of the infants in this analytic sample who received phototherapy corresponds to the sample of infants in the study by Auger et al who received phototherapy, and the subset who did not receive phototherapy is comparable to the Auger et al sample of untreated infants with jaundice. KPNC incidence of any type of cancer among those who received phototherapy (25.1 per 100 000 person-years) matched Quebec's (25.1 per 100 000 person-years). The incidence rate of any cancer among those with jaundice who did not receive phototherapy was 19.2 per 100 000 person-years at KPNC versus 23.0 per 100 000 person-years in Quebec.
Point estimates and CIs from our primary models controlling for confounding were, in general, similar to those of Auger et al.11 However, our point estimates for cancer after 4 years of age were consistently lower than the estimates by Auger et al. For their most concerning results, which indicated increased risk of both solid tumors and brain and/or CNS tumors, our estimated 95% CIs for ages 4 and older excluded their point estimates. In some cases, our point estimates for the hazard of cancer associated with phototherapy from 0 to 4 years differed from 4+ years. For example, for acute lymphocytic leukemia, the HR was 1.22 (0.58–2.61) from 0 to 4 years and 1.51 (0.73–3.10) for 4+ years of age. This could be chance variation or a true increase in risk that we did not have enough power to detect.
We replicated the methods by Auger et al as closely as possible. Our propensity models included all of the same variables, with the exception of place of residence (rural <10 000 inhabitants, urban, and unspecified) and socioeconomic deprivation in their analyses and early hyperbilirubinemia and bilirubin levels in our analyses, which they did not have access to in their data set. Although we controlled for propensity-score quintiles in our primary analyses, based on the previous analysis by Newman et al,10 we also estimated models with stabilized inverse probability weights to ensure that did not explain any observed differences with Auger et al. Our results from the weighted models were qualitatively similar to our results from primary analyses. Both the Quebec study and our own controlled for congenital anomalies directly in the outcome models; however, we also decided to control for confounding by Down syndrome directly in the outcome models for hematopoietic cancers because it is a strong risk factor. Our results likely differ not because of our methodologic choices but rather because the associations they detected in their cohort were not present in ours.
Childhood cancer is a rare disease, and there are a small number of cases of cancer, although the cohort was large. We hypothesized that given the increased sample size and additional years of follow-up of the extended data set that we would be able to achieve more precise estimates, but wide CIs continued to preclude the ability to fully rule out a small effect of phototherapy on cancer risk. Additionally, the data set lacks information on dosage and intensity of phototherapy. In addition, fluorescent and incandescent light was used in much of the phototherapy provided during the study, whereas LED light is primarily used in modern phototherapy. The measurement of cancer incidence is also undoubtedly imperfect, although its specificity (by requiring 2 diagnoses of cancer) is likely to be high. In addition, this measurement error is unlikely to be worse than that of Auger et al, so this does not explain the discrepancy in results. We did not have information on morphology, which is a particular limitation for the interpretation of estimates of the association between phototherapy and specific solid tumors. It is possible, for example, that the HRs for brain and CNS tumors were slightly attenuated if some brain metastases were erroneously coded as primary brain tumors. However, because we used only the modal diagnosis of cancer, we expect this misclassification and its effects on our HRs to be minimal. We also did not have data on other causes of cancer (eg, cancer predisposition syndromes, prenatal exposures to radiation, cytomegalovirus, or pesticides). However, to account for our null findings, factors that increase cancer risk would have to be reasonably common and to decrease the use of phototherapy. Given that treatment decisions about phototherapy are mostly based on the variables included in our models and that these syndromes and exposures are rare, generally diagnosed well after birth, and unlikely to decrease phototherapy use, significant confounding from such factors is unlikely. Finally, we do not know whether those who left KPNC developed childhood cancer, but there is no reason to believe the association between phototherapy and cancer rates would be different among this group.
In a large cohort of children in Northern California, we found no evidence for increased risk of cancer due to phototherapy. In addition, we did not replicate previous, concerning findings of increased risk of nonlymphocytic leukemia10 or of brain and/or CNS tumors in later childhood.11 Although a small causal effect is possible, we believe current evidence suggests that the decision to treat with phototherapy should be based on other, more compelling considerations.
We thank Sherian Li and Eileen Walsh for their assistance in compiling and auditing the data for this article.
Ms Digitale conceptualized and designed the study, analyzed the data, drafted the initial manuscript, and reviewed and revised the manuscript; Dr Kim conceptualized and designed the study, advised on the statistical analysis plan, and reviewed and revised the manuscript; Dr Kuzniewicz was responsible for data acquisition and reviewed and revised the manuscript; Dr Newman conceptualized and designed the study, advised on the statistical analysis plan, reviewed all analyses, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted.
Deidentified individual participant data will not be made available.
FUNDING: No external funding.
American Academy of Pediatrics
International Classification of Diseases, Ninth Revision
KPNC
Kaiser Permanente Northern California
total serum bilirubin
Kahveci
Tastekin
Ikbal
Phototherapy causes a transient DNA damage in jaundiced newborns
Drug Chem Toxicol
Aycicek
Kocyigit
Erel
Senturk
Phototherapy causes DNA damage in peripheral mononuclear leukocytes in term infants
J Pediatr (Rio J)
Minnet
Karadag
Phototherapy increases DNA damage in lymphocytes of hyperbilirubinemic neonates
Mutat Res
Yesilyurt
Unal
A chromosomal-effect study of intensive phototherapy versus conventional phototherapy in newborns with jaundice
Leukaemia and non-Hodgkin's lymphoma in children and young adults: are prenatal and neonatal factors important determinants of disease?
Br J Cancer
Kjaer
Mellemkjaer
Boice
Childhood leukemia following phototherapy for neonatal hyperbilirubinemia (Denmark)
Cnattingius
Ekbom
Prenatal and neonatal risk factors for childhood lymphatic leukemia
Gunnarskog
Linet
Prenatal and neonatal risk factors for childhood myeloid leukemia
Cancer Epidemiol Biomarkers Prev
Wickremasinghe
Kuzniewicz
Neonatal phototherapy and infantile cancer
Retrospective cohort study of phototherapy and childhood cancer in Northern California
Laverdière
Neonatal phototherapy and future risk of childhood cancer
Int J Cancer
Healy-Profitós
Reply to: phototherapy and childhood cancer: shared risk factors?
Calkins
Phototherapy and childhood cancer: shared risk factors
American Academy of Pediatrics Subcommittee on Hyperbilirubinemia
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation
Liljestrand
Numbers needed to treat with phototherapy according to American Academy of Pediatrics guidelines
Villaveces
Dhillon
Neonatal jaundice in Asian, white, and mixed-race infants
Oksuzyan
Cockburn
Mezei
Vergara
Kheifets
Race/ethnicity and the risk of childhood leukaemia: a case-control study in California
J Epidemiol Community Health
Cancer incidence rates and trends among children and adolescents in the United States, 2001-2009
Available at: www.pediatrics.org/cgi/content/full/134/4/e945
Linabery
Trends in childhood cancer incidence in the U.S. (1992-2004)
Hernán
Using big data to emulate a target trial when a randomized trial is not available
Am J Epidemiol
Hernández-Díaz
Shrier
Specifying a target trial prevents immortal time bias and other self-inflicted injuries in observational analyses


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The Space Book Revised And Updated From The Beginning To The End Of Time 250 Milestones In The History Of Space Astronomy
Title : The Space Book Revised And Updated From The Beginning To The End Of Time 250 Milestones In The History Of Space Astronomy
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Hepatitis C in Developing Countries: Current and Future Challenges explores the current state of HCV in several countries, including Africa, Asia and South America. It maintains a dedicated focus on the epidemiology, clinical patterns, virologic diversity, coinfections, natural history and progression, complications, and response to standard of care (SOC) pegylated interferon and ribavirin therapy of HCV with recommendations specific to middle and low income countries. Readers will find detailed information on the burden of HCV infection from a global health and economic perspective, along with data from multicenter trials on DAAs that have enrolled patients infected with HCV non-genotype 1.
Professor Sanaa Kamal works at the Department of Gastroenterology and Hepatology within in the Ain Shams Faculuty of Medicine. She is a leading authority on the treatment and stidy of hepatitis C.


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By rob | May 3, 2017 | Analysis, Contractors, Energy Efficiency, Heating & Cooling, Insulation, Maintenance, Saving Money, Tips and Techniques, Ventilation, Water & Moisture |


The debt of the federal government has now increased by more than $8,000,000,000,000 during the time President Barack Obama has been in office, according to the official debt numbers published by the U.S. Treasury.
The total federal debt, which was $18,722,746,583,118.03 at the close of business on Monday, now equals about $159,007 per household.
It has increased approximately $68,756 per household during Obama's presidency.


I have played several of the ball buster games and this is one of the best.It gives you many chances to add lives while throwing new characters at you to end your lives.
I think this game got a bum rap, and I strongly suspect that this happened for two reasons. Firstly, there's a very tough puzzle right at the beginning of the game.. tough not because of hard thinking, but because the game controls for the wooden inlay puzzle aren't as good as they could be. The developers could have made it behave more like a 3-D puzzle with the pieces snapping to align with the nearest edge, rather than acting like a 2-D paper puzzle that you have to align to the pixel with shaky hands. I gave the game the benefit of the doubt, despite poor reviews and this challenge within the first hour, because as a Nancy Drew game fan, I know there's often just one puzzle that will drive me nuts within an otherwise fun game (and this one was it), and I'm glad I did buy it and complete the game. Second reason for the poor reviews, I think, is the loss of the 'to do' list. This game does encourage you to think for yourself when deciding what to do, but for those who are really stuck, you can call Bess and George. They'll tell you what you need to do. Get past those two items, and I think most mystery gamers would find this game very entertaining and challenging, with a great story line!


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CARLA VIVIANE INCULATA
It has no flow. She is pregnant and out of the business. She is pregnant and out of the business. I still like Adrianne Palicki and Emmanuelle Chriqui together. Carla Gugino starts out fine but goes downhill. It tries to be campy with Joseph Gordon-Levitt.
Its quirkiness is not actually funny. I'm willing to go with this weirdness for another Sebastian Gutierrez episode. It has no flow. However it becomes rambling messy story. I still like Adrianne Palicki and Emmanuelle Chriqui together. In return, Cora wants her to seduce her fiancée Ben Justin Kirk to even the score. Cora gives her songs written by Nick about her. She is famous for a porn with herself as twins but she actually has a twin in prison for real.
This is the sequel to 'Women in Trouble'. Carla Gugino starts out fine but goes downhill. She tries to accommodate but he wrongly mistakes robber Dellwood Butterworth Timothy Olyphant for him.
Was this review helpful to you? She is famous for a porn with herself as twins but she actually has a twin in prison for real. I'm willing to go with this weirdness for another Sebastian Gutierrez episode. I'm willing to go with this weirdness for another Sebastian Gutierrez episode. The first movie has a certain charm which this one seems to struggle to maintain.
Was this review helpful to you? The first movie has a certain charm which this one seems to struggle to maintain. It tries to be campy with Joseph Gordon-Levitt. It has no flow. I still like Adrianne Palicki and Emmanuelle Chriqui together. However it becomes rambling messy story.
The first movie has a certain charm which this one seems to struggle to maintain. The first movie has a certain charm which this one seems to struggle to maintain. However it becomes rambling messy story. She tries to accommodate but he wrongly mistakes robber Dellwood Butterworth Timothy Olyphant for him. Cora Marley Shelton admits killing her baby daddy Nick while having sex with him.
infieles - Bienvenida Carla (completo)(Exclusivo)
She tries to accommodate but he wrongly mistakes robber Dellwood Butterworth Timothy Olyphant for him. She is famous for a porn with herself as twins but she actually has a twin in prison for real. It tries to be campy with Joseph Gordon-Levitt. Joseph Gordon-Levitt is too broad and I grow to hate his part of the movie. This is the sequel to 'Women in Trouble'. Its quirkiness is not actually funny. Was this review helpful to you?
Trans Olbia Tempio Transex Trav E ...
Oggi Ricevo Per Tutto Il Giorno
Lei Bsx Cerca Coppia Pari Requisit...
jerome6230 09.02.2018 : 15:15 :
Che bella frase


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Sen. Lamar Alexander, the moderate Republican from Tennessee, outraged conservatives colleagues by supporting a bill that would put Kyoto-style caps on carbon dioxide emissions.
Lamar Alexander Backs Kyoto-Style Carbon Caps
Sen. Lamar Alexander (R-Tenn.) enraged Senate conservatives last week by supporting environmental legislation that will devastate the nation's coal industry and dramatically increase electricity prices.
In a break with most of his Republican colleagues, Alexander is backing the Clean Air Planning Act (S. 843), sponsored by Sen. Tom Carper (D-Del.), and cosponsored by liberal GOP Sen. Lincoln Chafee (R.I.). The bill includes a Kyoto-style cap on carbon dioxide emissions, and highly unrealistic reductions in mercury emissions-provisions that could shut down some coal-fired electric utilities, especially in the Midwest. According to Senate sources, Alexander snubbed President Bush (whom he ran against in 2000) by making his announcement without informing the White House.
Supporting Carper-Chafee puts Alexander in opposition to Bush's top environmental initiative, the Clear Skies Act, announced during the State of the Union Address. Clear Skies, which caps only emissions of mercury, sulfur dioxide, and nitrogen oxides, would institute a market-based emissions trading system, allowing companies to plan for reductions over time, keeping costs down. Environmental groups vigorously oppose it, while it enjoys fairly broad support from the energy industry.
Industry sources believe Alexander's decision could be politically damaging to him because over 60% of the electricity in Tennessee is generated from coal. "Does he know what the Carper bill will do to his state?" asked one industry source. "Coal just won't be viable under Carper, which means most utilities will switch to natural gas. But where do we get it? Maybe Lamar forgot that we are in the midst of a natural gas crisis in this country."
During a July 10 Senate Energy and Natural Resources Committee hearing, Alexander seemed quite aware of how skyrocketing natural gas prices are destroying jobs in Tennessee. "It seems at a time when our greatest challenge for our country, longer term," he said, "is how we keep our manufacturing jobs from moving overseas, and we know that a big part of that is to try to keep unexpected costs low for those manufacturers so they won't move to Mexico or China or somewhere, these energy policies that we fail to adopt here are having a direct impact on everyday jobs."
The Carper bill amounts to a massive transfer of wealth to the Northeast. Under it, emissions allowances (or, the right of a utility to emit a ton of a specified pollutant) would be distributed to nuclear and natural gas generators, which have few if any emissions. As a result, coal-fired utilities, which already face highly burdensome compliance costs, would be forced to buy these allowances predominantly from generators in Connecticut, Massachusetts, New Jersey, New Hampshire, New York, and Rhode Island, where electricity is fueled mostly by natural gas and nuclear power.
"These six states," found a study by Generators for Clean Air (a group of electrical utilities), "would receive a financial windfall of approximately $719 million per year in excess allowances, whereas three states (Ohio, Indiana, and Kentucky) would be penalized $775 million annually because of allowance shortfalls."
"Lamar's writing a check to Carper and Chafee," said an energy industry source.
The Carper bill also implicitly concedes a frequent liberal charge: that emissions from power plants are causing global warming, which is why it regulates carbon dioxide, a greenhouse gas. There is, however, no compelling scientific evidence to support that view.
"Alexander has essentially bought into the green myth that soccer moms and their SUVs and the coal industry are causing catastrophic heating of the Earth," said one Senate source. "That's just completely bogus. Lamar's support for Carper is fulfilling the greens' dream of imposing energy suppression on the American people."
Senate EPW Committee Responds to Columnist's Faulty Claims
Capital Briefs — Week of July 21


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Item Color: Black, Blue, Green, Purple, Yellow or Red grip.
Just wanted to drop you a line and let you know how great the Central Pens worked out for our company! My wife and I love them, and so do all of our employees! It's been a real challenge to say the least starting up a new company, but these have really helped us get the word out there! Thanks again to you and your team for helping us out with our order, and we will definitely be placing a new order as soon as we get low on these!


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It appears that writing down a plan online makes me pull my finger out and get things done. As planned, I used the first ball of cotton to work out that I could comfortably get 10 hexagons out of each 50g ball, giving me 50 hexagons in total.
50 hexagons would give a nice layout for the blanket but it would be quite small. It looks like it would be the perfect size for a pram or a car seat but I was hoping for a blanket that the new baby Collins would be able to use for a little longer.
I made a quick trip back to Hobbycraft and bought a second ball of each colour and set off crocheting again. I think I'll go for 19 hexagons of each colour for the main body of the blanket making it double the size of the first plan.
I've also figured out a half hexagon to fill in along the top and bottom but I couldn't work out how to fill in the sides. I used photoshop to mock up the layout so that I could get an even distribution of colours when I sew them together. Now that I see it, I think the little points will be cute.
All I need to do now is keep adding to my stack of blocks. 77 down, 18 to go!


When was the last time you had an update?
Not your cell or computer; I'm talking about your mindset!
Your mindset is everything, and if it isn't up to date, you could be missing out on your full potential.
This week's episode is a great reminder of how you can be #Fearless and take action to achieve success!


Published at Monday, February 25th, 2019 - 21:20:53 PM. Pergola Ideas. By Adalwolfa Wolf.
But, don't be mistaken. There is no need to cover ourselves completely. The key is in using slats or lattice for a roof that will diffuse the sun's rays when they are at their peak. Two by two inch slats that are spaced a few inches apart are ideal for reducing the glare and the direct sunlight your patio will receive. The first essential before starting any pergola project is to carefully consider the location. You want to construct your structure in a way that takes into account the direction it is facing and how it will be affected by the daily sun and shade patterns of your yard.


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Buckle up! This 'ultimate bear chart' signals a pivotal moment for investors
By Shawn Langlois
Published: Feb 5, 2018 12:03 p.m. ET
Critical information for the U.S. trading day
Fasten those seat belts, folks.
ShawnLanglois
Social-media editor
As if all the recent action in the reeling stock market, just on its bloodied face, isn't troubling enough, there's another reason to be worried.
Sven Henrich of the Northman Trader blog rolled out what he describes as "the ultimate bear chart". That serves to back up former Federal Reserve Chair Alan Greenspan's thoughts from last week, which went: "There are two bubbles: We have a stock market bubble, and we have a bond market bubble."
In that spirit, here's our chart of the day:
After last week's breakout in the 10-year Treasury TMUBMUSD10Y, +0.51% above its 30-year trend line, stocks took — and appear to be taking — a beating. That prompted Henrich to take a harder look at that chart, which illustrates the ratio between the 10-year yield TNX, +0.34% and the S&P 500 SPX, -0.23% .
"The correlation is stunning to me from a technical perspective," he writes. "Indeed, if Greenspan is right, this chart could have enormous implications for the next few years. This chart suggests a massive multiyear bear market could emerge."
The ratio got hit last week, with stocks dropping and yields rising. For the trend to reverse, yields have to fall and stock rise. If it doesn't happen, Henrich warns, the "massive multiyear head-and-shoulders" pattern could become even more alarming.
"Basically what this implies is that the entire rally since the early 2016 lows will turn out to have been a blow-off top," he explained. "I'm not calling for an immediate collapse here, but I'm pointing to a possibly huge structural relationship between bonds and stocks, one that will likely take years to play out. But the signs of trouble are already in that chart."
So, to avoid this scenario, he says that yields need to drop soon "or this market party may come to an abrupt end with deep reaching consequences."
But before you look at today's premarket action and get too panicky, fund manager Chris Ciovacco offers some words of wisdom:
100% of the 5% corrections in stock market history were followed by a higher high.
100% of the 10% corrections in stock market history were followed by a higher high.
If that was not the case, we would not call them corrections. #Perspective
— Chris Ciovacco (@CiovaccoCapital) February 4, 2018
Key market gauges
The bleeding's not done yet. The Dow DJIA, -0.42% the S&P 500 SPX, -0.23% and the Nasdaq COMP, -0.45% are all off session lows but are still getting hit. Crude US:CLH8 is down, while gold US:GCH8 is up. Europe SXXP, -0.15% is feeling the risk-off vibe, as is Asia ADOW, -0.50% which closed mostly lower. Bitcoin BTCUSD, +6.92% is down again, falling under the $8,000 mark amid a broad crypto retreat.
"Bull markets don't die from old age," says Guggenheim Partners CIO Scott Minerd. "They typically get shot in the head."
We covered Minerd in this space a couple of weeks ago, when he said Davos might just be a flashing contrarian indicator and that investors should consider the positive message from the gilded boondoggle as a potential reason to sell. Turns out it would have been a pretty good move.
So, now what?
"I'm a bull for the next year or so," he told Barron's. "There is another 15% of upside in the stock market from 2017's close, but after a 300% run [from the 2009 lows], the question is how to time the exit. What are the signs?"
He explained that he doesn't think all the pieces are in place for a bear market just yet, though the parabolic nature of stocks right now is a bit unsettling.
"Now, individual investors aren't in the market yet, and that's why I'm still bullish," Minerd said, adding that he's looking for a flat yield curve in the first quarter of 2019 to signal the end of the bull run.
"Historically, once the yield curve goes flat, stock returns for the next 12 months approximate zero," he says. "Then, a year later, you get the recession and bear market."
"On the S&P 500 index, the current level [2819] is roughly where we could be a decade from now. Elevated stock valuations portend weaker returns over the next decade, and retaining some dry powder in the final year of expansion will allow equity and credit investors to take advantage of more attractive valuations," he says.
Eagles Win! pic.twitter.com/MMfB5u7W1P
— Matthew A. Cherry 🏁 (@MatthewACherry) February 5, 2018
Philadelphia IS the buzz this morning. Quarterback Nick Foles led the underdog Eagles to their first-ever Super Bowl victory, and, more important for the rest of us, kept the Patriots and Tom Brady from winning another.
Hopefully it was worth it for this guy, who cashed in his 401(k) to attend. While Philly fans celebrate, don't expect the same from bookmakers as the heavy betting was reportedly on the Eagles to win.
Check out: Super Bowl ad blackout — NBC denies glitch cost it millions
OK, enough, back to markets.
We could be looking at the biggest tech deal in history if Broadcom AVGO, -0.35% and Qualcomm QCOM, -1.31% ultimately tie the knot. Reports say Broadcom plans to raise its hostile bid to buy its rival chipmaker to about $120 billion.
As Spotify's IPO nears, Apple AAPL, +0.29% Music is on track to surpass it and become the No. 1 music streaming service in the U.S.
Wells Fargo WFC, +0.67% says the sanctions that have followed its customer-account scandals could cut its profit this year by as much as $400 million.
"Us little guys working our butts off, we can't get ahead. This is a once-in-a-lifetime opportunity to change my life" — Cedric Knight, one of many Kentuckians looking for bitcoin to fund their retirement. What could possibly go wrong?
The stat
500% — That's how much Virgil Capital, a hedge fund specializing in crypto arbitrage, returned in 2017. Meet Stefan Qin, a 21-year-old Australian based in California who runs the $23.5 million fund. He tells the Wall Street Journal that he expects to keep posting positive returns, even if bitcoin keeps sliding.
If there are any more market fireworks to be had in the coming week, it probably won't be due to any notable data points. We'll get the ISM nonmanufacturing index for January at 10 a.m. Eastern this morning, and the latest U.S. trade deficit Tuesday. Other than that, it should be fairly quiet out there.
Read: Jobs, jobs, jobs!
Random reads
How bots and Trump fans made #ReleaseTheMemo go viral.
Inside the twisted world of Hollywood and why Uma's really angry.
Meanwhile, a curveball from Harper's: "I think 'believe all women' is silly. Women are unreliable narrators also."
Then there are some men making a crypto utopia in Puerto Rico.
Why Justin Trudeau isn't the leader he's cracked up to be.
China's surveillance state should scare EVERYONE.
Need to Know starts early and is updated until the opening bell, but sign up here to get it delivered once to your email box. Be sure to check the Need to Know item. The emailed version will be sent out at about 7:30 a.m. Eastern.
Follow MarketWatch on Twitter, Instagram, Facebook.
AT&T CEO says Trump's handling of Acosta appears to violate free-press protections as CNN sues White House
Aurora stock falls as earnings show cannabis company's investments are still the big earners
Shawn Langlois
Shawn Langlois is an editor and writer for MarketWatch in Los Angeles. Follow him on Twitter @slangwise.
TMUBMUSD10Y
SXXP
ADOW
AVGO
U.S. 10 Year Treasury Note Tullet Prebon: TMUBMUSD10Y
Open 2.05%
High 2.07%
Low 2.04%
CBOE 10 Year Treasury Note Yield Index FactSet Prices: TNX
STOXX Europe 600 Index STOXX: SXXP
High 388.08
Low 385.02
The Asia Dow Index USD Dow Jones Indices: ADOW
Broadcom Inc. U.S.: Nasdaq: AVGO
Apple Inc. U.S.: Nasdaq: AAPL
Wells Fargo & Co. U.S.: NYSE: WFC


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D'ERLANGER's Shocking Switch to Major International Label Warner Music!
Posted by SYNC MUSIC JAPAN on Thursday, March 28, 2013 ·
D'ERLANGER: the legendary band that, since their major debut in 1990, have had enormous influence on later visual kei rock bands, and who characterize their unique, avant-garde sounds and visual styles as "Sadistical Punk."
For their first act since switching to Warner Music, this band, which is also considered to be a pioneer among visual kei rock bands, has at long last completed their sixth album, "#Sixx," which will be the band's first new album in nearly four years. After suddenly announcing their breakup on December 24, 1990, just 10 months after their major debut, they rocked the music scene by miraculously reuniting in 2007 after 17 years. And now, this shocking new album will be the first they have unleashed in the nearly four years since the release of their fifth album, "D'ERLANGER," in 2009.
Coming into 2013, the band's reason for choosing to move to internationally-known label Warner Music has been to expand their global reach. Since getting back together, they have had success with concerts in the Asian region, and also performed at the Ho-Hai-Yan Gongliao Rock Festival in Taiwan, which drew 300,000 attendees. While establishing a base in Asia, they also have ambitions to go even further overseas.
With expansion into America and Europe entering their sights, they made a sudden contract with international label Warner Music. Be sure to keep an eye on D'ERLANGER and their upcoming activities.
Official Website: http://www.derlanger.jp/
Facebook: https://www.facebook.com/derlangerofficial
Myspace: http://www.myspace.com/derlangerlive
D'ERLANGER
Filed under FEATURE, ROCK, TOP · Tagged with D'ERLANGER


When packing for a road trip, I know from experience that it's the inside of the car that can get all messy, dirty and disorganized while traveling- and that makes me crazy! That's why I've created a system to keep things neat and organized so the kids can find what they are looking for and have a great time during all those hours that we are spending in the car on a family road trip!
Here is what you need to organize the inside of your car when packing for a road trip!
These kids car organizers This is an affiliate link: MomOf6 earns a commission if you purchase, at no additional cost to you. are totally awesome- they have lots of compartments inside so one bin can easily be shared between two siblings. Keep in mind that you will need to have an extra seat between the two kids in order to use these bins. They are secured using the seat belt for that middle seat which means the bins won't move around or fall off of the seat. Each bin has two cup holders, and the bin also comes with a lid that can be flipped over and used as a food tray, which is a really nice feature.
Don't have space between the seats? This hanging car organizer This is an affiliate link: MomOf6 earns a commission if you purchase, at no additional cost to you. keeps the back seat organized too!
Now I know this won't work for every type of car, but underneath each child's seat we use a plastic storage bin This is an affiliate link: MomOf6 earns a commission if you purchase, at no additional cost to you. to hold additional travel gear such as a nice cozy fleece blanket This is an affiliate link: MomOf6 earns a commission if you purchase, at no additional cost to you. that they can snuggle up with in the car, a pair of sunglasses, a sweatshirt, and it's where they can also store their shoes (which they love to take off when they get into the car) as well as the extra pair of shoes that they have with them on the trip.
This bin keeps all of this clutter off of the floor and makes it just so much neater on the floor of the car.
Planning a family road trip?
Then be sure to check out this list of Road Trip Must Haves This is an affiliate link: MomOf6 earns a commission if you purchase, at no additional cost to you. over on my Amazon influencer page This is an affiliate link: MomOf6 earns a commission if you purchase, at no additional cost to you. !
I love these over-the-headrest, velcro-strapped DVD player holder This is an affiliate link: MomOf6 earns a commission if you purchase, at no additional cost to you. . It is easy to shift the location of the DVD player if I want to move it from the driver's headrest to the passenger's headrest, and when sitting in the passenger seat, the smooth strap doesn't bother my head. And the design of the holder also makes it easy for the kids to access the DVD player and switch out movies on their own.
Or you can download Netflix titles to your iPad for the car ride- and then you might want an iPad headrest mount This is an affiliate link: MomOf6 earns a commission if you purchase, at no additional cost to you. for your car to hold it in place.
Now the other issue you might run into- is having the ability to keep everything charged and humming along! In our car with 6 kids each having a phone as well as a DVD player- we need to be able to charge a whole lot of things! So we use this power inverter This is an affiliate link: MomOf6 earns a commission if you purchase, at no additional cost to you. and a couple of extension cords that snake under the seat to keep everyone happy!
Looking for some travel games to entertain the kids in the car? Then check out this post on 10 Great Travel games for Kids!
Each row has its own garbage bag- it's just a plastic shopping bag from the grocery store- and this really helps keep the car neat. I love that the kids don't keep passing their garbage up to me to throw away for them- they can take care of it themselves!
When we arrive at our destination in the evening, they can pick up any little wrappers or anything that's on the floor around them and put it in a garbage bag and then dispose of the bag as we walk into the hotel, making the car nice and neat to start the next day.
Want something sturdier and a little more leak-proof than a grocery store plastic bag? We love this XL leak-proof bin This is an affiliate link: MomOf6 earns a commission if you purchase, at no additional cost to you. !
Each row also has a backpack that we keep underneath the seat, and when we arrive at the hotel for the evening, each child can pick up their own electronics, their chargers, their headphones, and anything else that they want to carry into the hotel into their backpack. Easy peasy.
The next morning when it's time to check out of the hotel, they are responsible for finding their own electronics, headphones, and chargers, and putting all of it back into the backpack to return the items to the blue bins once we get back into the car.
Want to See Road Trip Organization in Action?
Packing for a road trip?
8 Must-Have Road Trip Essentials!
« 10 Summer Ideas To Make This Your Family's Best Summer Ever!
Nice post!!It takes planning and a sense of humor to make road trips fun with kids.You have shared nice tips and tricks on how to pack wisely.thanks!
I used your tips on our recent road trip to florida (from new jersey) and they really helped keep me sane and organized.
I really like that the straps in to the seat, I worry about things sliding or flying around if we had an accident. We keep a small trash can tucked in between the seats with extra bags inside, each gas station stop we pull out that days trash and voila a clean bag ready for the next leg of the trip. I'm really enjoying your road trip diaries and look forward to the next report.
Thanks so much for all of your comments Beth! Having a garbage bag for each row of kids is a lifesaver for me, and really helps to keep the car neat!


You've purchased the perfect Purrfect Post® and gotten it home. Now how can you get your cat to use it? Below are several helpful, easy ways to help your cat love her new scratching post.
The initial placement of your Purrfect Post may affect how quickly your cat adapts to its use. At first, place the post in a prominent location in your home or (if your kitty has already started scratching furniture) place it as close to that furniture as possible. Once good scratching habits have been established, you can gradually move the post to a less conspicuous location.
Encourage your kitty to use her post with clever enticements. If possible, play with her and feed her near the post. Rub dried catnip leaves or powder into it or use catnip spray; reward her with a favorite treat when she uses it. Make interactions surrounding the post pleasurable. Have her chase a string or a toy around the post, attach toys to it, or place a favorite toy on top of it, which will result in her digging her claws into the post. Eventually she will learn to love it and claim it as her own.
Cats like to scratch when they awaken, especially in the morning and the middle of the night, so it's also a good idea to put a post where your kitty sleeps. If space permits, a scratching post in every room of the house would be any cat's dream.
If at first your kitty is reluctant to give up her old scratching spots, there are ways to discourage undesirable behavior. Cats like to scratch for several reasons (See: "Why Cats Scratch"), but a major one is to leave their scent. Applying a pet odor remover to the old scratching locations may reduce the appeal for your cat.
Covering the area with aluminum foil or double-sided tape can be a great deterrent. These surfaces don't have a texture that feels good to scratch. Also, cats have an aversion to citrus odors. Use lemon-scented sprays or a potpourri of lemon and orange peels to make her former scratching sites less agreeable to her.
If your kitty still persists in scratching the furniture, try squirting her with a water gun or a spray bottle set on stream. Another option is a loud whistle or other noisemaker. You must "catch her in the act" for the deterrent to be effective; it will not work if it is a moment too late. Care should also be taken with this or any form of negative reinforcement such as yelling or chasing because it can result in stress for your cat that can lead to more negative behaviors.
If you are starting with a kitten, you're in luck! It's even easier to initiate good behavior patterns in kittens than to correct undesirable ones in adult felines.
From the beginning, teach your kitten the appropriate place to scratch. Use the methods described above, especially playing near the scratching post to capture her interest. Take advantage of your kitten's desire to play and attach toys to the post. She will soon "dig in" to catch her toy and discover how good it feels to scratch this surface.
Do not take her paws and "make" her scratch the post. This is a major turn-off and will only inspire a bratty "you can't make me" attitude. Even at an early age, cats refuse to be coerced into doing what they don't want to do.
If she starts to scratch an inappropriate object, immediately place your cat in front of her scratching post and begin petting her. Some cats will begin kneading when petted, thus digging their claws into the desired surface and establishing this as a fine place to scratch.
Cats are creatures of habit. Start them off with good ones.
You can get more tips in our informative article, "How to Train Your Cat or Kitten to Use a Scratching Post."