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Commercial mortgage lenders of non-owner occupied property need to be adept at reviewing leases to protect themselves from risk. Although the rent roll is a useful tool, some lenders learned during the economic downturn that it was a mistake to rely solely on the rent roll for a picture of the future income stream of a commercial property. Lease agreements of retail space, in particular, carry some unique terms that could impact the lender in ways a typical office or industrial lease may not. A thorough review of the lease agreements not only helps to protect the lender from risks in the borrower's ability to meet its debt service, but also can help identify provisions that might negatively impact the lender in the event of a default. A lender should be wary of the following:
Self-Help and Off-Set Rights. When a landlord fails to make certain repairs to a property, self-help and off-set rights allow the tenant to make the repairs and off-set its costs against the rent. Self-help and off-set rights interfere with the predictability of the property's income stream. This affects the borrower's ability to pay under the loan and the value of the lender's security. Property maintenance and upkeep can also become a problem when properties go into foreclosure or become the subject of a distressed sale. As such, it is a prime time for tenants to exercise self-help and off-set rights. A tenant's exercise of self-help rights while property is in foreclosure or receivership can become a burden on a receiver in foreclosure proceedings. Lenders should be wary of any self-help or off-set rights and may want to consider requiring the borrower to enter into a lease amendment with the tenant, removing those rights from the lease.
Co-Tenancies. Some tenants, such as those in retail shopping centers, would prefer to condition their lease upon the operation of another tenant in the center or upon certain occupancy thresholds. But when a key tenant leaves or the occupancy threshold isn't met, like dominoes, tenants with co-tenancy agreements or lease provisions can leave in succession without breaching their lease agreements. Unfortunately, this occurred during the economic downturn, leaving many landlords with empty shopping centers, no recourse against vacating tenants, and no new tenants to fill the vacancies. With no income stream, landlords defaulted on their loans and lenders inherited empty centers. A co-tenancy agreement may entice a desirable tenant to move into a center, but it can also be a precursor to a rapid decline of the property. All co-tenancies should be considered in underwriting risk analyses.
Kick-out Clauses. Under a kick-out clause, if a retail tenant fails to meet a certain minimum sales threshold over a period of time, the tenant has the option to terminate the lease. The early termination could interfere with the income stream of the property and make it more challenging for the landlord to meet its debt service.
Seasonal or Temporary Leases. In the economic downturn, owners of shopping centers and office buildings were willing to take on seasonal and temporary tenants to fill space that had previously been filled by more reliable tenants. Seasonal and temporary tenancies can be deceiving to lenders looking primarily at vacancy rates. They are also less likely to be renewed and could be an indication that the borrower is having difficult filling the space. Lenders may not miss a "Halloween Store" but less obvious seasonal or temporary tenants could be missed if the leases are not carefully reviewed. A lender should protect itself by reviewing the entire lease term of each lease, rather than just the termination dates of the leases, in connection with the overall vacancy rate of the building.
Best practice calls for a full review of all existing leases so that lending institutions can factor these and other lease provisions into their underwriting decisions.
See more »
DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.
© Rogers Towers
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Pronunciation: clavo de olor
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The Global FlyFisher - The Largest and Best Place to go for Online Fly Fishing and Fly Tying
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New SEC coaches play catch-up in recruiting
The Southeastern Conference football programs with new head coaches have been easy to spot in the league recruiting rankings this winter. They're toward the bottom.
Before Tennessee's Butch Jones, Auburn's Gus Malzahn, Arkansas' Bret Bielema and Kentucky's Mark Stoops can turn around the autumn fortunes at their respective schools, they must assemble their inaugural signing classes. Recent history has shown that coaches do what they can in their first few weeks and then make the most of their second batch of signees.
"I think for Bielema and Butch Jones and Stoops, this class is going to be the hardest," said longtime recruiting analyst Jamie Newberg, who is now with Scout.com. "It's a short recruiting window, and recruiting is about relationships. Let's face it, Stoops has never been a head coach before, and Butch and Bielema have been at Midwestern teams but are now coaching in the SEC.
Continue reading at The Chattanooga Times Free Press.
(For the latest on Tennessee recruiting, please see govols247.)


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Geoff Calkins' Take 5: On the Grizzlies and Tigers and a big night of sports
Five quick thoughts on the Griz, the Tigers and a big night in Memphis sports:
1. Nice of the Clippers to go out and demonstrate that an NBA season cannot be judged by one game, eh? Whoever imagined they'd drop their first game to the Lakers? This bit of perspective may be helpful for Griz fans after tonight's opener at San Antonio. It'll be a hard one to win.
2. Griz coach Dave Joerger tends to shrug off talk of pressure, but when I asked him about the responsibility that goes with coaching the city's one major-league team, he opened up. "It's something I take very, very seriously, because it's awesome," he said. "It's probably the same for Josh (Pastner). You know, to take over the program of a city's team. There's not three or four major league teams here. I don't take it lightly at all. I take it so seriously that I try not to think about it and let it bury me. I don't want to let anybody down."
3. Tough year for Memphis football. The team is plainly better, but hasn't been able to put away a number of close games. Now the Tigers have a game on ESPN2 and it just happens to be opposite the Grizzlies opener and a potentially historic World Series game at Fenway Park? Yikes.
4. The Tigers are giving out black rally towels to the first 10,000 in the Liberty Bowl. They'll be wearing their black uniforms for the first time since the win over Arkansas State.
5. Oh, and in honor of the return of the NBA, here's something completely ridiculous. The Dallas Mavericks perform "What do the Mavs Say?"
Subscribe to The Commercial Appeal
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Marshall Headphones - 'Major' Over Ear (Black)
" This is actually the first "over-head" headphone i ever bought, but compared to my philips and LG tone+ this one is a lot more for 70$, i mainly use it on my gaming rig with sound card installed. i listen to rock mostly, bass heavy stuff and some r&b, alternatives.. i just listen to anything that sounds good basically. anyways, i had some issues with the fit when i..." --Kordz
Stanton Dynaphase Sixty
"a tad muddy, but it can be easily fixed with abit of equalizing they're louder then stadium speakers with duel drivers there is a woofer and tweeter in each can, so that= loads of bass and tremble bass tons of bass to go around treble it has it, but that about all I can say sound they favor highs over mids, but 'they're still well balanced sound stage love it deep and rich Comfort fine..." --voodoo do-er
Stanton Dynaphase Fifty
" What can I say, vintage. Honestly well worth the $30 I payed for these. They have a nice sound to them in the $30 price range, not Hi-Fi by any means, but fun to wear around. " --GrandZechs
Polk Audio AM5109-A In-ear Headphones
Polk Nue Voe In-Ear Headphones Authentic sound, personal style. Nue Voe headphones, part of the Polk Heritage Series, combine serious audiophile performance with stand-out style, for headphones that make a statement about what's personally important to you. Because audio performance is our benchmark, Polk has re-engineered what a headphone can do. We've expanded the limits of the...
Polk Audio UltraFocus 6000 Noise-canceling Headphones w/ Free Pair of Polk UltraFit 500 (Black/Red) Headphones
With the UltraFocus 6000, Polk called upon their decades of speaker engineering know-how to create headphones with a smart, ultra-portable design. High-quality components reproduce your music with impressive clarity and detail, while active noise-canceling technology isolates you from noisy surroundings. Just insert these earbuds and press "play" to turn a hectic commute into a...
Polk Audio UltraFit 3000 Headphones - Black (ULTRAFIT 3000BLK)
Polk Audio's new UltraFit Sports Headphone Series is a rethinking from the ground up of performance, comfort and durability - the three characteristics serious athletes need most in a pair of headphones. Serious music lovers too will value the UltraFit Series because of its undeniably impressive sonic performance. The UltraFit 3000 is an in-ear canal design that offers the highest sonic...
Stanton Dynaphase Sixty-A Headphones
I've been looking for someone that has these or has seen them before, I have a pair and have looked in many places but can't find these headphones ANYWHERE. No info, no pics, nothing...If anyone knows of these headphones or at least seen them in the past, please contact me ASAP. They were my dad's when he was younger. THESE ARE NOT STANTON DYNAPHASE SIXTY HEADPHONES, THEY ARE...
Aluratek Bluetooth Headphone w/Mic ABH02F
Bluetooth Headphone w/Mic
Aluratek ABH01F Bluetooth Stereo Headset with Built In Mic - Retail Packaging - Black
The Aluratek Bluetooth Wireless Stereo Headphones delivers hands-free convenience and superb hi-fidelity stereo sound wirelessly. Stream your favorite tunes and listen to audio from your Smartphone, Tablet, PC or Mac laptop. Connect with friends and colleagues thru Skype, Yahoo Messenger, Windows Live Messenger, Gmail and AIM with the integrated microphone. Easily switch between phone calls and...
Polk Audio UltraFocus 8000
The engineers at Polk Audio know great sound. They should, they've been building high-performance home and car speakers for demanding listeners for decades. Now they've taken that experience and expertise and created a headphone designed from the ground up to match the clarity and detail of their famous speakers. The Polk UltraFocus 8000 with active noise-canceling technology...


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BSO, Courtesy
October 8, 2009
Teacher Herbert Roach was accused in 2007 of having sex with a female student in a closet at Parkway Middle School in Fort Lauderdale. The student said she had sex three to four times a week with Roach for several months when she was 14 and 15. Prosecutors dropped criminal charges against Roach in October. The girl admitted she lied to police about a prior sexual relationship. In December, Roach, 35, resigned before the School Board was to vote on whether to fire him, saying, "circumstances are beyond my control."
Search This Weekend's Events
CTnow.com, 285 Broad St., Hartford, CT 06115
A Hartford Courant website


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Page Showing 1-20 of 24 Results
You can't go wrong with an Ocean Suit
Roseann B.
from Sioux Falls, SD
on 11/4/2013
This suit fits perfectly and the print is beautiful. The fabric holds up beautifully. This is my 4th Ocean suit and it's predecessors have each lasted more than a year each with 4-5 day per week swimming in the pool.
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great bathing suit
from Chicago,IL
on 6/19/2013
I intend to use this bathing suit just like the previous Ocean brand I've been enjoying - swimming in a pool 3 times a week. It looks good and holds up well to the chlorine and frequent usage. No sagging or stretching. I wish it came in more colors.
Good Suit
from Chicago, IL
on 4/23/2013
I use this suit for lap swim and water exercise classes. Lasts about 2 years. I like the style, color, and pattern. One negative is that the sizing is a tad too small. The width is fine, but the length is a little too short. If you have a long torso, be careful with the sizing. Otherwise, this is a great suit.
Very pretty suit - great for Aqua Aerobics
from Kansas City, MO
on 2/27/2013
I'm using this suit for aqua aerobics and it functions very well for that purpose. It fits pretty well and is very comfortable during my workouts. And, the pink/lavendar color is really very pretty!
great suit for water aerobics
myrna goldman
from mountain view,ca.
on 2/14/2013
I love polyester. It hold its shape and dries quickly. Great for water aerobics
from LA County, CA
on 2/14/2013
This suit (any Ocean moderate suit) is perfect for frequent exercise in a chlorinated pool (especially if it is heated to 85 or so degrees or you go into a hot tub with it on). The suit feels snug because it's polyester and doesn't have spandex that springs loose after a dozen wears. (I bought an endurance sppedo that lasted through 9 uses!) I have worn this suit for a year, at least 3x per week. The color is still strong, but most importantly, the fabric has held up in chlorine. Polyester (which can feels tight and is harder to get on and off) is a must if you exercise or swim frequently. So go ahead and buy a size up. You won't be sorry.
Ocean Flora Swimsuit
from Fort Myers, FL
on 2/12/2013
- great fit and colour
It looks good
from Portland, OR
on 1/31/2013
I use this suit for Aqua Exercise 3 x a week. I have no problem with slipping straps or other non-fitting problems. I expect it will hold up well considering its material type.
Great suit for chlorine pool!
from Fayetteville, PA
on 1/27/2013
Slightly short in body length
Ocean Flora Moderate Scoop Back
from Mooresville, NC
on 1/19/2013
I ordered the one size extra and the body of the suit fits well tho it is snug through the bust. Perhaps should have ordered the D cup or it could be meant to fit this way. I like that it is not too low cut. I wear it two times a week for water exercises. I have discarded four suits due to stretch and fading but I hear polyester is the answer.
Not true to size
from Mountain View, CA
on 1/18/2013
I loved everything about the suit and was sorry to have to return it. I had read the reviews and felt the size I ordered was correct. I agree with one of the reviews, it seem a little short in the torso. That being said, It was just too small.
Joyce J.
from Grosse Pointe Woods, MI
on 1/14/2013
this suit is very short in the body and runs small overall.
scoop back suit
from Ames, Iowa
on 1/13/2013
Great color and fit. I use it for daily exercising and swimming in a pool that seems to have a lot of chemicals.
Great Swimsuit
Water Baby
from Indianapolis, IN
on 1/10/2013
I wear this suit for water aerobics. I am at the top end of the size range and had to exchange (very easy process) for a size larger than usual because the suit is short in the body. Otherwise, it has great support, is easy to get into and out of, and is comfortable for all kinds of water activities. The fabric is beautiful, colorfast, holds its shape, and fully lined. It has a modest cut front and back. I'll be back for more in a size smaller the next time!
Not quite true to size.
from Battlefield, MO
on 1/5/2013
It seems a little short in the torso. I'm not pleased with the bra type used. I like the style & design/color. I like that it is chlorine resistant, & the price was right.
from Brighton, MI
on 12/27/2012
The "Ocean" suits have always fit me perfectly and have lasted over 2 years. I participate in deep water aerobics 3 times per week in a chlorine pool. The suit looks as vibrant after 2 years as it does on day 1. I now have some stretching of my older suits, so that is why I bought a new one. But, after 2 years, I'm not complaining.
Great long lasting fitness suit
from Sioux Falls, SD
on 11/22/2012
This is my third Ocean 100% polyester bathing suit and I will not buy any other brand for doing aqua aerobics at our fitness center. These suits wear like iron and stand up to the pool chemicals. I get at least a year's wear out of each suit and that is wearing them 5 days a week, rinsing them in the shower and hanging them up to dry. They are true to size but I do recommend ordering one size larger than you usually wear because the 100% polyester does not stretch like a suit containing Lycra does. If I could change anything about this suit it would be that I would like to have it cut a little higher in the neckline. I am large busted and wish I had a bit more coverage and a little less cleavage showing for an exercise suit. Other than that, this is a perfect bathing suit and you can't go wrong ordering it.
Great for water aerobics
from Philadelphia
on 10/23/2012
This is my second Ocean bathing suit (clorine resistant.) The first one lasted an amazing 2 years (going 2 to 3 classes a week.!) I would recommend going up a size from what you usually wear. Comfortable to exercise in, nice inset bra, and nice colors.
Fits Great
from Cincinnati, OH
on 9/26/2012
I workout in a therapy pool daily. This suit is true to size and very comfortable. I would buy it again.
I'm enjoying my Ocean Flora swimsuit.
Nancy M.
from Chelsea, MI
on 6/18/2012
I wear this swimsuit for water aerobics twice a week. I ordered a size larger than I normally wear because I need a longer torso. The swimsuit fits well, is holding up nicely in the pool, and I've received several compliments on it.


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You are hereHome › Chris Sabga › Weapons of Mass Destruction Found in the Middle East
Weapons of Mass Destruction Found in the Middle East
Destructive viruses that no longer affect most of the world are still lingering in the Middle East, according to one of the world's leading antivirus vendor, Symantec.
The ancient Nimda, Jeefo and Redlof viruses are still wreaking havoc in the region because the majority of computers there lack critical security and anti-virus patches. The Nimda virus, considered a worldwide threat in 2001, is the second most common virus in the Middle East despite no longer being listed in the top ten anywhere else.
Richard Archdeacon, a director at Symantec, believes that these viruses "are not particularly serious" but they could be "used to spread more dangerous ones." (Source: itp.net)
However, antivirus company Trend Micro takes these threats more seriously:
The Virus Encyclopedia on Trend Micro's Web site lists "high" damage potential for several variations of Redlof. Jeefo is classified as a milder threat, ranking at "medium." And Nimda is more unpredictable, with some strains being given a "high" damage rating while others are considered "low" risk. (Source: trendmicro.com)
Archdeacon's solution is an all-too-obvious one: "There's still a lot of patching which has to be done." (Source: itp.net)
What is really needed is education.
Computer users in the Middle East must be taught the benefits of downloading and installing important security and virus updates. It's a lesson the rest of the world would be wise to remember too.
What Can You Do to Protect Yourself?
The most effective approach to ensure your computer protected against email worms, Trojans, and similar exploits is to update your PC regularly by visiting the Windows Update Web Site and by installing the latest Service Pack. For Windows XP, the current Service Pack is version 2.


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Dear President Obama: Please Invite Madonna to the White House
Madonna really, really wants to meet President Obama. She'll even become one of Beyoncé's sister-wives to do it.
Beyonce Recorded an Unreleased Fela Kuti-Inspired Album
Will it ever be released? That remains to be seen.
Does Beyoncé Deserve a Spot on Mount Rushmore?
Yes, according to her frequent collaborators Tricky Stewart and The-Dream.
See the 'Poverty Is Sexist' Letter Signed By Beyonce, Lady Gaga, More
"Put simply, poverty is sexist, and we won't end it unless we face up to the fact that girls and women get a raw deal."
Beyoncé, Ed Sheeran, Ariana Grande Honor Stevie Wonder at GRAMMYs Tribute
After a quick tribute during the GRAMMYs telecast, Stevie Wonder got an all-star salute.
Every Song on the 'Fifty Shades of Grey' Soundtrack, Ranked by Sexiness
From Beyoncé to Sinatra, we take a closer look at the movie's soundtrack to figure out who is the sexiest of them all. Curious to know who tops the list?
Producer Says a Beyoncé & Jay Z Joint Album Is Happening This Year
A Beyoncé and Jay Z collaborative album could come as early as this year.
How Ferguson Came to the GRAMMYs
Pharrell, Beyonce, John Legend and Common got in on the protest.
Beyoncé Surpasses Aretha Franklin as Woman with Second-Most GRAMMY Awards
She's already the most nominated female in GRAMMY history—and on Sunday, Beyoncé came one step closer to doing the same in the winners category, too.
Behind 'Take My Hand, Precious Lord,' the Gospel Song Beyoncé's Singing at the GRAMMYs
Here's a rundown on "Take My Hand," and why it's part of the GRAMMYs program.


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You can now invite anyone to meet at your favorite Starbucks.
Limited-time feature
35 year old woman | Burbank, CA, USA | Seeking men 30-40 within 10 miles
I'm often described as being level headed and grounded. I'm looking for someone that is kind, funny, smart, witty, and motivated.
I'm an easy going person that is looking for someone to spend time with. I appreciate hard workers, humor, and wit. I have great friends and am happy with my life, however I'd love to meet someone to share that with. I moved to LA roughly a year ago from NC and am originally a Midwestern gal. Things I do for fun: Love sports (Go Bears), I joined a kickball team last year and had a blast (was surprisingly good), I'm in a bookclub with a great group of women (currently reading Faulkner the Sound and the Fury), hiking up to the Observatory and enjoying an avocado sandwich at Trails post hike, Barnsdall wine nights and Shakespeare in the Park were fun this summer, going to movies, musuems, or sporting events (Santa Anita racetrack is a great time), working out with my trainer (it's torture but I love how I feel after a great workout), relaxing by the pool with a good book, finding good restaraunts (found a deep dish pizza place that is pretty close to the real deal), drinking wine (red over white and am by no means a wine snob), and hanging with my dog Payton. I'd love to meet someone who is comfortable going out or staying, someone who is not afraid to try new things or is willing to share their passions with me. Things that make me smile are dancing to good music, eating a delicious meal, a glass of wine, dry humor, my dog, fresh flowers, clean sheets, having someone to come home to or vice versa, my family, my friends, catching a fish (if I don't have to touch it), reading a good book, horseback riding, seeing dolphins in the wild, summer bbqs, being out on the water...I love boats! I'm grateful for my family. My parents have been married for 43 years and are the best. They have always provided for me, supported me, and encouraged me my whole life. I am so blessed. I also love having great relationships with my siblings. I have fantastic friends who are like family to me. I'm very lucky to have such a great group of people in my life.
Camping , Coffee and conversation , Cooking , Dining out , Fishing/Hunting , Movies/Videos , Museums and art , Music and concerts , Exploring new areas , Nightclubs/Dancing , Performing arts , Playing sports , Shopping/Antiques , Travel/Sightseeing , Volunteering , Watching sports , Wine tasting
Baseball, Billiards / Pool, Bowling, Dancing, Football, Hockey, Other types of exercise, Running, Soccer, VolleyBall, Walking / Hiking, Weights / Machines, Yoga
I exercise 3-4 times per week.
Don't display my sign
I have Dogs
I like Horses
I grew up with horses, but sadly havn't ridden in awhile. I'd love to get back into it though.
Middle of the Road
St. Lucia, anywhere out on the Intercoastal or water in general, getting an avodcado sandwich at Trails post hike, a glass of wine or cup of coffee at Olive & Thyme
Music-anything but hardcore rap or heavy metal...favorties would be Sam Cooke/Otis Redding/Beatles. Movies-not into horror but will give anything else a chance Foods-will try about anything...not a food snob TV shows-Downton Abbey, Breaking Bad
BBQ's with friends, hanging out by the pool, reading, hiking up to the Observatory, Shakespeare in the Park, watching the races at Santa Anita, live sporting events, movies, etc.
Currently reading Henry & June for bookclub and next month's pick is Cutting For Stone
Z{{Cta}} {{#if HasMoreInfo}} ?{{CtaSecondary}} {{/if}}
|What she is looking for
|5'2" (157cms)
|5'8" (172cms) to 6'5" (195cms)
|Body type:
|Athletic and toned
|No preference
|Dark brown
|No preference
|No Way
|No Way
|Social Drinker
|Social Drinker
|Nonprofit / Volunteer / Activist
|No preference
I was a public high school teacher in NC for the past five years and am currently working as the office admin. for the Child Development Center of the YMCA.
|I'll tell you later
|No preference
|Never Married
|Never Married
|Have kids:
|Wants kids:
|White / Caucasian
|White / Caucasian
|Christian / Catholic
|Christian / Catholic
I grew up attending CCD and going to Catholic High School, but am not a practicing Catholic. I would say I'm spiritual more than religious but I have a nostalgia for the Church music I grew up with.
|Bachelors degree
|Bachelors degree
I have a Bachelors Degree in Sociology from Arizona State and was certified in Secondary Education from the University of North Carolina Wilmington.


text:
Do mLabs Make a Difference?
This report is an assessment of the overall effects of infoDev's mobile application labs (mLabs). mLabs are specialized mobile business incubation and acceleration facilities offering physical workspace, mentoring and coaching, devices for mobile application testing, training, and startup competitions.
Creating Your Own Angel Investor Group
infoDev's new Guide for Creating Your Own Angel Investor Group aims to educate entrepreneurs and angels from around the globe. It offers hands-on examples, such as financial worksheets, application forms, term sheets, contracts, and checklists that may be used as templates. The publication is a substantial update of the original Kauffman Foundation's 2004 guidebook, which targeted a U.S. audience. This international edition is written specifically for newcomers to angel investing, and highlights the successes and challenges of angel groups in emerging and frontier markets.
VentureOut Challenge down to 24 semifinalists
The VentureOut Challenge—a campaign by infoDev and CRDF Global to help mobile apps go international—announced today the 24 competitors with the most potential and preparation to enter new international markets.
6.4 Trillion Reasons to Fight Climate Change
The infoDev study "Building Competitive Green Industries" estimates that over the next decade $6.4 trillion will be invested to develop clean technologies in developing countries. Business incubation specialist Michael Ehst explains why 6.4 represents the key to a greener and more prosperous future for all of us.
How do climate-tech startups take ideas from mind to market?
Wondering how climate tech entrepreneurs in developing countries are taking their ideas from mind to market? Watch this animation and see how infoDev's Climate Technology Program supports the growth of small and medium-sized businesses that are creating jobs while building resilience to climate change. To learn more, subscribe to our YouTube channel and watch more videos on climate technology entrepreneurs!
Mobile Innovation Roadshow - A Step-by-Step Guide
How Agribusiness Innovation Centers Contribute to Africa's Agribusiness Sector
As rapid urbanization will soon cause more than 50% of Africans to live in cities, the World Bank estimates that continent's food market will be worth $1 trillion by 2030. Over the next decade, agribusiness in Africa could hence become the engine that drives dynamic, unprecedented economic growth and development.


text:
1872 $1 Dollar, Judd-1210, Pollock-1350, R.8, PR65 Brown NGC....
2009 January Orlando, FL FUN Auction #1121
|Sold for:
|Sign-in or Join (free & quick)
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|Auction Ended On:
|Jan 7, 2009
|Item Activity:
6 Internet/mail/phone bidders
551 page views
Orange County Convention Center
Extremely Rare 1872 Copper Dollar1872 $1 Dollar, Judd-1210, Pollock-1350, R.8, PR65 Brown NGC.
Judd-1210, Regular Dies, PR65 Brown
Judd-1210, Regular Dies, PR65 Brown
Design. The regular Seated Liberty With Motto design, the motto boldly doubled as seen on regular issue proofs dated 1872 and 1873. Struck in copper with a reeded edge.
Commentary. The 1872 copper dollars from the regular dies were not trial pieces as often recorded, but instead were part of off-metal coinage sets that the Mint marketed to contemporary collectors. The off-metal pattern sets were coined in both copper and aluminum (Judd-1211).
The complete coinage set in copper contained the cent (Judd-1179), two cent (Judd-1183), coronet three cent (Judd-1185), trime (Judd-1187), five cent (Judd-1189), half dime (Judd-1191), dime (Judd-1193), quarter (Judd-1198), half dollar (Judd-1203), dollar (Judd-1210), gold dollar (Judd-1227), quarter eagle (Judd-1233), three dollar (Judd-1238), half eagle (Judd-1243), eagle (Judd-1248), and double eagle (Judd-1253).
It is doubtful that many sets were actually purchased by collectors, as only two or three examples of the copper dollar are known today. We are aware of only five auction appearances over the past 54 years, and representing at the most only three different coins.
In addition to the Heritage and Stack's auctions where this specimen appeared, either the same or another example was offered in Bolender's 11/1959 sale, reappearing in Merkin's 9/1968 sale, and an example appeared in the King Farouk sale in 1954.
Physical Description. This glittering, boldly defined proof has fully mirrored fields around modestly lustrous devices. Both sides are medium to dark brown, with considerable orange mint color remaining beneath the iridescent toning. NGC Census: This is the only Judd-1210 certified in any grade or designation. PCGS Population: A single coin grading PR64 Brown (12/08).
Provenance. Ex: Heritage (12/1988), lot 1896; Stack's (9/1992), lot 751.
From The Lemus Collection, Queller Family Collection Part Two. (PCGS# 61481)
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text: Hallettsville sweetheart, beau Dec. 13, 2012 at 6:13 a.m.Hallettsville High School band members voted Janine Smajstrla their sweetheart and Phillip Hlavac their beau. Janine and Phillip are seniors. Janine is the daughter of Tyan Schulze and Victor Smajstrla, of Hallettsville. Phillip is the son of Phillip and Kimberley Hlavac, of Hallettsville.SHAREComments


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well the most important key to sucess is motivation....Being self motivated isnt always that easy! 1 big poster in my room to remind me of my ultimate goal and 356 pictures in a box...each morning while drinking my coffee I pick a card where the motivational picture and quote of the day will guide me through the 24 hours ....have fun choosing the pictures and printing them....
i have SEEN one of the BEST motivational posters on JODIANN421's spark page--CHECK IT OUT--SPARK IT!!!
The secret for loosing weight and keeping with it for me is motivational posters. I will read the motivational quotes and when I am feeling low I will go to pinterest and look up fitness motivation or weight loss. The pictures and words lift me up and give me the determination to succeed. I feel seeing others who have gone the distance give me the push I need. I know I can do it to and so can you.
Picturing yourself at goal weight can actually backfire, because our minds are fascinatingly weird, but having a rival (even if unspoken)...now that's motivational.


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Dewi Morris: Battle of the No 8's will decide the outcome of England v Wales
Dewi Morris says that Ben Morgan has to become a demolition man if England are to beat Wales.
By Dewi Morris
Last Updated: 06/03/14 9:01am
Billy Vunipola is a huge loss for England but one man's loss is another man's game and this could be the defining game for Ben Morgan.
He has a huge job though - in this campaign all England's go forward has come from Billy Vunipola and Morgan really has to match that - if not do more against a very physical Welsh side. Vunipola's work has allowed Danny Care to really sparkle and Care has been a breath of fresh air to England's attacking play.
Morgan has come off the bench very well and he has to step up and take on the mantle of England's one-man wrecking ball. I am sure England's front five will get parity and their lineout will go well too, so for me it will be down to who carries the ball the best - Wales No.8 Taulupe Faletau or Ben Morgan!
Class is permanent
Wales also have Jonathan Davies back and that is a huge plus for them. You make exceptions for certain players and Davies is one of those players that you want straight back into your side.
He would not be in the side if he was not fit and raring to go. He adds just so much to the Welsh backline and certainly adds a bit more spice in the midfield. You have the experience of him and Jamie Roberts against two youngsters in Luther Burrell and Billy Twelvetrees. Wales will certainly come to attack right up the middle - England know where the threats are coming from but can they stop them?
George North moves back to the win and him and Alex Cuthbert are two very strong and powerful runners. England's back three will be sorely tested but i have been impressed by them - especially by Mike Brown who will play a key role on Sunday. England's back three are not scared to have a go and Brown will not only lead that, but also make sure they are strong in defence.
In the back of England's mind will be the drubbing the got - and deserved - in Cardiff last year. They have to right a wrong and I think that will add an extra bit of spice to this game. That defeat will have certainly stoked the fires within England and there is definitely a bit of revenge in mind. Wales have had the sign over England of late but it is up to Stuart Lancaster - who I have been immeasurably impressed with - to get his team past that. Under him this team are going places and I think they are going to develop into a very good side and while I don't think they will be quite ready for the World Cup in 2015, watch out for them in 2019.
So who do I think is going to win on Sunday? Well I can't split them so I am going for a draw! They are so well and evenly balanced that I just cannot call it. We shall see what happens.
Friday action
Before Sunday we have the U20s game on Friday night which should be a cracking game. If it is anything like the junior world cup final then it is well worth tuning in to Sky Sports to catch it. Jack Nowell was part of that England Under-20 team that defeated Wales 23-15 in the final and look where he is now. It is such a fantastic competition and is the next step up from your club before hitting the Saxons. It will be a real fire and brimstone game and will certainly whet the appetite for Sunday's action!


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Business & Information Technologies
The Division of Business and Information Technologies is where creative entrepreneurship meets artistic technology. Here is where you'll learn the skills you need to push the envelope on the technology of the future and be prepared to enter the business world.
Our Associate of Applied Science (AAS) degree programs are designed to provide students with the skills necessary to succeed in today's competitive, highly skilled workplace. Our graduates have a 94% placement rate. Programs include: Accounting, Graphic Design, Information Systems, Media Technology, Management, Networking, and Paralegal.
Click a program below for additional information.
- Accounting A.A.S.
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Journalism students will acquire the skills needed to meet the demands of the modern journalistic profession. The program focuses on current trends in converged media and social media.
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Graduates leave proficient in PC trouble shooting, computer forensics, designing, configuring and implementing computer networks along with Microsoft 2003 and 2008 file servers.
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The paralegal studies program offers a two-year, full-time curriculum that allows a student to graduate and enter the paralegal profession under the supervision of an attorney in the private or public sector with an associate of applied science degree.
Web Design
Web design is the process of developing and creating a website using text, images and interactive elements to produce the page seen on the web browser.
Faculty Spotlight
Dr. Chris Willis – Media Technology
Friday, January 23, 2015 - 10:12am
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Wednesday, March 26, 2014 - 8:03am
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Wednesday, October 23, 2013 - 1:45pm
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BIT News
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Hospitality and Tourism Careers Start Here
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The Fifth Tiffany Aching Novel Announced
August 11th, 2014
At the UK Discworld Convention this weekend, Rob Wilkins announced the book that Terry Pratchett is currently working on is the fifth novel in the Tiffany Aching series.
Drumroll please…… The book will be called: The Shepherd's Crown!
More news will be published here as soon as we have it. In the meantime, have a look at I Shall Wear Midnight if you'd like to mentally prepare yourself.
Comments for: The Fifth Tiffany Aching Novel Announced
I am re-reading I Shall Wear Midnight now and I was thrilled to hear there is to be another in the series.
His understanding of people rivals Shakespears and all women who aspire to be witches should note what the job entails. We should all try to be more like them.
Thrilled–just absolutely thrilled to hear that a fifth novel will be published. Am currently re-reading (for about the 10th time) the series & am always sad when I finish "I Shall Wear Midnight."
You're absolutely right, Ros. Sir Terry's understanding of the human situation *does* rival Shakespeare.


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An internship with Amarillo Magazine presents students with an outstanding, real-world opportunity for hands-on experience in magazine publishing. From brainstorming and planning to writing, editing and participating in photo shoots, eligible candidates will be exposed to every facet of producing a monthly publication.
Students will take part in editorial meetings and assist with visual concepts, story boards, developing content ideas and coordinating a variety of photo shoots. In addition, interns will have the opportunity to research and write features for both the printed and online versions of the magazine, providing much-needed clips for print and digital portfolios.
Qualified candidates must be a junior or senior college student and have maintained an overall GPA of 3.0. Candidates must be able to communicate effectively, have excellent writing abilities and be comfortable working on a deadline. Interns will be expected to handle themselves in a professional manner as representatives of Amarillo Magazine, execute interviews with clients and brainstorm with a creative team. Individuals will also need to possess time-management and customer-service skills, superior knowledge of the English language and AP Style, and the ability to use a computer system for editing and updating Amarillo Magazine's social media.
Students must be working toward a journalism, public relations, mass communications or English degree. Personal transportation is required, as some days involve shopping, going on location to photo shoots and interviews, running errands and researching features. The Amarillo Globe-News will pay mileage for interns when they are on duty.
Now that we've told you what we expect, you might wonder what you'll receive in return. As a part of Amarillo Magazine's internship program, interns will gain experience working with a close-knit staff and be an important part of the AM team. Translation: you won't be picking up dry cleaning or getting us coffee; you'll be involved in the day-to-day operation and be a part of the details other interns miss out on.
The two major projects each month, our cover stories and fashion shoots, provide the most hands-on experience for interns. Imagine yourself being able to work closely with talented photographers, stylists and designers while we bring to life the beautiful images you see on our pages each month.
After your time with Amarillo Magazine, you will walk away with:
To apply, submit an up-to-date resume, original writing samples and a letter of recommendation via email to firstname.lastname@example.com.
Deadline for Spring 2013 is December 1
Deadline for Summer 2013 is March 1
Deadline for Fall/Winter 2013 is July 1
The First Sign of Spring
Susan Gibson shares the meaning behind her song, "First Sign of Spring"
The Dogie Club
Directed by Matthew "Bones" Hooks, the Dogie Club took boys on camping trips, gave them ...
Invisible Ink
Across Amarillo and throughout the United States, more people are wearing – and possibly hiding ...
Fresh and Fascinating Found Flowers
Parie Donaldson of Parie Designs, says arrangements of found flowers may not have the polished ...


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The Pill, the welfare check, the earned income Tax Credit—all the work of Satan, propagated by the party of Satan.
Today's earned income Tax Credit is its successor, and it is available only to those already committed to work.
He favors the earned income Tax Credit, which gives wage supplements to the working poor.


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Trip Reports
A decent bone
From: Morne Steyn · maggie·at·myconnection.co.za Link
Submitted February 16th 2009
Marvellous, but is there anywhere that I can buy a Waldron Reel. I have phoned Lawry Waldron but he unfortunately do not make them anymore. Can someone please help me! Regards Morne Steyn
Part of the theme:


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Five diseases are currently screened on dried blood spots in France through the national newborn screening programme. Tandem mass spectrometry (MS/MS) is a technology that is increasingly used to screen newborns for an increasing number of hereditary metabolic diseases. Medium chain acyl-CoA dehydrogenase deficiency (MCADD) is among these diseases. We sought to evaluate the cost-effectiveness of introducing MCADD screening in France.
We developed a decision model to evaluate, from a societal perspective and a lifetime horizon, the cost-effectiveness of expanding the French newborn screening programme to include MCADD. Published and, where available, routine data sources were used. Both costs and health consequences were discounted at an annual rate of 4%. The model was applied to a French birth cohort. One-way sensitivity analyses and worst-case scenario simulation were performed.
We estimate that MCADD newborn screening in France would prevent each year five deaths and the occurrence of neurological sequelae in two children under 5 years, resulting in a gain of 128 life years or 138 quality-adjusted life years (QALY). The incremental cost per year is estimated at €2.5 million, down to €1 million if this expansion is combined with a replacement of the technology currently used for phenylketonuria screening by MS/MS. The resulting incremental cost-effectiveness ratio (ICER) is estimated at €7 580/QALY. Sensitivity analyses indicate that while the results are robust to variations in the parameters, the model is most sensitive to the cost of neurological sequelae, MCADD prevalence, screening effectiveness and screening test cost. The worst-case scenario suggests an ICER of €72 000/QALY gained.
Although France has not defined any threshold for judging whether the implementation of a health intervention is an efficient allocation of public resources, we conclude that the expansion of the French newborn screening programme to MCADD would appear to be cost-effective. The results of this analysis have been used to produce recommendations for the introduction of universal newborn screening for MCADD in France.
Keywords:Medium-chain Acyl-CoA dehydrogenase deficiency; Cost effectiveness; Neonatal screening; Health policy; Tandem mass spectrometry; France
Medium chain acyl-CoA dehydrogenase deficiency (MCADD) is a hereditary metabolic disease characterised by decreased ability of the body to use fat as a source of energy during periods of fasting or increased metabolic need. It is due to a deficit of the medium chain acyl-CoA dehydrogenase enzyme and is transmitted through an autosomal recessive mode. Affected individuals may present with hypoketotic hypoglycaemia, which may lead to coma or death. If individuals are detected before a life-threatening episode, the complications of MCADD are, however, preventable by avoiding fasting stress and providing regular feeds in the first years of life.
The prevalence of MCADD at birth among Caucasian populations ranges between 1/10 000 and 1/27 000 [1-8]. In France, while epidemiological studies of a sufficient sample size have not been conducted, it is nevertheless likely that the prevalence lies within the range of the extreme values found in the neighbouring countries.
Universal newborn screening based on a dried blood spot test is a well-established, government-funded programme in France. It is currently organised through a network of 22 regional labs and its coverage is over 99.99%. It includes five diseases – phenylketonuria (PKU), congenital hypothyroidism, congenital adrenal hyperplasia, cystic fibrosis, and, among high-risk populations, sickle cell disease.
The development of tandem mass spectrometry (MS/MS) in the early 1990s led to a substantial increase in the number of potentially detectable hereditary metabolic diseases. This technology is being used to screen newborns for an increasing number of diseases in an increasing number of countries in Europe [9] and elsewhere.
The French National Authority for Health (HAS) was asked by the Ministry of Health to evaluate options and to produce public health recommendations concerning the expansion of the national newborn screening programme for inborn errors of metabolisms using MS/MS. Based on a preliminary literature review, it was agreed to start by evaluating the expansion of newborn screening to MCADD, a disease for which there is ample evidence to suggest that newborn screening is an effective and cost-effective intervention [10-22]. Cost-effectiveness was considered by the French health authorities to be an important element to inform policy decision even though France has not defined any incremental cost-effectiveness ratio (ICER) threshold for the implementation of new public health interventions.
Several economic analyses of MCADD newborn screening have been performed in Europe [10,13-15] and North America [18-23], and several reviews of such economic analyses have been published [10,13,24,25]. Estimates of cost-effectiveness of MCADD screening varied widely, depending on the modelling assumptions [25].
One Canadian study estimated an ICER of 253 161 Canadian dollars (about €200 000) per life year (LY) [22], assuming systematic lifetime supplementation of carnitine. If, however, it was assumed that supplements were provided up to the age of 5 years only, MCADD screening became cost-saving. In another Canadian study [21], where no carnitine supplementation was assumed, the ICER was estimated to be 2 676 Canadian dollars (about €2 000) per quality-adjusted life year (QALY). As highlighted in a recent review, more data are needed to reduce the uncertainty surrounding a number of parameters, particularly the proportion of MCADD cases who die in the first few days of life and will thus never be detected by screening, the effectiveness of screening in preventing MCADD deaths, the quality of life attached to the different health states, and the costs of diagnosis and treatment in the absence of screening [25]. Because of health system specificities and limitations in transposing health care costs from one country to another, it was felt important to carry out a cost-effectiveness analysis of MCADD newborn screening, taking into account the French setting and, where available, using local data.
Model structure, data sources and sensitivity analyses
We developed a decision model to evaluate the cost-effectiveness of the expansion of newborn screening for MCADD in France. We used the decision analysis software TreeAge Pro 2009 Healthcare (TreeAge Software Inc, Williamstown, MA, USA). The model was structured according to the economic evaluation methodological choices defined by HAS [26]. We used a societal perspective and a lifetime analytic time horizon, expressed the health consequences in QALY, and used an annual discounting rate of 4% for both costs and health effects.
Because PKU, but not the other conditions currently screened for in France, can be detected by MS/MS, the expansion of newborn screening to MCADD was evaluated alongside a concurrent switch in the technology used for PKU screening, from the current fluorometric method, to MS/MS. The economic modelling was performed in two steps.
In the first step, we evaluated the consequences of expanding the existing newborn screening program to include MCADD screening (Figure1), which implies the introduction of the MS/MS technology. Second, we evaluated the consequences of replacing the fluorometric method currently used for PKU with MS/MS. In this second step, we assumed, conservatively, that the performances of the PKU screening test were identical for both technologies, which implies that the health outcomes were also identical, regardless of the screening technology used. As the cost of MS/MS screening remains virtually unchanged irrespective of the number of conditions being screened, the consequences of this second step only pertain to the incremental cost of the MS/MS screening test over and above the cost (no longer incurred) of performing fluorometry for PKU.
Figure 1. Decision tree: Expansion of newborn screening to include MCADDvs.current newborn screening. The square represents a decision node, circles chance nodes, and triangles terminal nodes. The branch of the decision node "MCADD screening" is compared to "No MCADD screening" which is the current situation. Probabilities, costs, and QALY are calculated at each terminal node according to the parameters described in Table 1. To evaluate the concurrent cost-effectiveness of switching to MS/MS for PKU screening, the cost of the current technology to screen for PKU was subtracted from the cost of the MCADD screening test as described in the text.
Health effects were expressed in LY and in QALY gained. We calculated, for a French birth cohort (821 000 live births), the incremental cost/saving of screening and early identification of MCADD (step 1) and of using MS/MS for PKU screening (step 2); the incremental health effect in terms of additional LY gained and corresponding QALY gained; and the ICER, expressed in € per LY and per QALY gained.
Parameter values were based on published and routine data sources, where available; otherwise, expert judgment was used (Table 1). Systematic reviews of the literature were conducted using various electronic searches (MEDLINE, EMBASE), government reports, and hand searching journals and reference lists on the following topics: MCADD screening tests, diagnosis, outcome, treatment, effectiveness, cost, and cost-effectiveness. We used French administrative databases to estimate costs of MCADD sequelae. We used the national health insurance 2010 official rate for specialized medical consultation (€ 23 per consultation). Costs of MCADD tests were estimated based on 2010 commercial prices of equipment and reagents, and salaries, in consultation with the national screening programme. Details on the search strategies and on the values and plausible ranges for the model's parameters and the calculations performed are available (in French) at http://www.has-sante.fr/portail/upload/docs/application/pdf/2011-07/argu_depistage_neonatal_vf.pdf [27].
Table 1. Value of the parameters used in the MCADD newborn screening cost-effectiveness analysis model
One-way sensitivity analyses were conducted on most parameters, which were varied over a range of plausible values to estimate the impact of uncertainty in the data and the robustness of results. A worst-case scenario, where all the parameters that were varied in the one-way sensitivity analyses were set at their most unfavourable values, was also simulated. We also conducted sensitivity analyses on the discount rate for the following values: 0%, 3%, and 6%.
MCADD prevalence
In the absence of any relevant epidemiological study, the prevalence of MCADD in France was assumed to be within the range of extreme values estimated in neighbouring countries. A value of 1 in 15 000 live births was assumed, with a range of plausible values between 1 in 10 000 and 1 in 25 000 [1-8].
Screening test performance
MS/MS is the only available method to screen for MCADD. Its specificity, which has been evaluated in a number of studies, ranges from 99.97% to 100% [2,4,29-36]. We used a median value of 99.98%. Its sensitivity is considered to be 100% [28].
The current method used in France to screen for PKU is fluorometry. Its specificity has been estimated to be 99.97% and its sensitivity to be 99.3% [48]. Compared to fluorometry, MS/MS appears to have a greater specificity and sensitivity [49-51]. We made the conservative assumption that these measures were identical for the two methods.
Probability of MCADD complications
The probability of dying within 24 hours of life, i.e. before screening could be performed or its results be available, was estimated at 2%. This estimate was based on the results from an Australian study where the proportion of deaths before 24 hours was 2% (1/41) among screened children and 8% (3/30) among unscreened children [52] and from a study in New England where no early neonatal death was observed among 47 children detected with MCADD by screening [35].
In the absence of screening, two thirds to three quarters of individuals with MCADD will develop a metabolic crisis [17,37]. We used a conservative value of two-thirds (67%) for this parameter. The risk of death following a metabolic crisis was estimated at 20% by pooling data from available studies [17,38-44]. Based on available literature, the probability of developing severe and the probability of developing mild neurological complications after a metabolic crisis were both estimated to be 5% [38-41,43-45].
Effectiveness of MCADD screening
In a large Australian cohort study on MCADD screening [17], the cumulative relative risk of death or severe metabolic decompensation by age 2 years was estimated to be 0.26 (which would correspond to an effectiveness to prevent adverse outcomes of 74%), with more liberal and more conservative estimates of 0.19 and 0.44, respectively. On this basis, the effectiveness of MCADD screening to prevent a metabolic crisis was assumed to be 75% with a plausible lower-bound at 50%.
Life expectancies
We assumed that the life expectancy (LE) at birth of a child with MCADD who will not develop neurological sequelae (or otherwise die from MCADD) is the same as that of an average person, i.e. 81 years (the mean between male and female LE in France in 2009) [53]. The LE of a child who will die from an MCADD metabolic crisis was assumed to be 1.2 years [46]. Likewise, the age at which a metabolic crisis occurs was assumed to be 1.2 years.
No data on LE of patients with MCADD and neurological sequelae were identified. Estimates were therefore derived from a population-based study using data from the state of California [47], which calculated a LE of 65 years for children with mild or moderate mental retardation who did not have Down syndrome, and of 51 years for those with severe mental retardation. These figures correspond to reductions of 11 years and 25 years respectively with respect to the average LE of 76 years in the 1992 US life tables used in the Californian study. For the purpose of our model, we subtracted these same figures from the current French LE of 81 years, giving estimated LE of 70 and 56 years, which we used for mild and for severe neurological sequelae, respectively.
Health-related qualities of life
Quality of life was estimated by a utility score ranging from 0 (death) to 1 (perfect health). We assumed that the utility score of persons with MCADD who did not develop neurological sequelae was the same as that of persons without MCADD and that it was equal to 1. We used a value of 0.9 in the sensitivity analysis to take into account the fact that these persons may suffer from other types of disease or impairment.
We did not reduce the utility score in case of a false-positive screening result, which is defined as an abnormal screening test followed by a repeat screening test or further investigation that does not indicate an MCADD diagnosis. Indeed, a US study suggests that parents have a high tolerance to false positive newborn screening results [54] and the incorporation of the loss in quality of life associated with false positive test results did not noticeably increase the ICER [23].
For the quality of life related to neurological sequelae, only one study, conducted in Finland and based on a multi-attribute utility instrument, estimated utility scores for neurological sequelae due to MCADD, which were 0.89 and 0.76 for mild and severe neurological sequelae, respectively [14].
Cost of screening test and of diagnostic test
The collection and transportation of dried blood spots are part of the current newborn screening programme. Therefore these costs could be excluded from the cost- effectiveness analysis. Furthermore, any potential changes in the lab location (see below) would have no impact on transportation costs as dried blood spots are sent by post with charges that are uniform across France.
Therefore, the cost of the MCADD screening test used in the model was limited to lab costs including capital equipment, consumables and personnel. Costs of equipment, including maintenance and consumables, were provided by screening lab experts and also obtained from suppliers. Personnel inputs required to operate MS/MS in a newborn screening lab were estimated in consultation with the national newborn screening programme. The cost of a MS/MS machine represents a high initial capital spending. It constitutes a fixed cost regardless of the number of specimens screened, at least for a large range of number of specimens up to the maximum capacity of the machine.
The introduction of MS/MS will most likely imply a reduction in the number of labs that are performing newborn screening tests, in order to guarantee the quality of the technical expertise and to achieve efficiency. On the basis of 50 000 specimens tested per machine per year and a machine lifespan of 5 years, and using a 4% annual discount rate, the cost of MCADD screening was estimated to be €3.75 per test. The estimated cost of the screening test decreased at a decreasing rate with the number of specimens tested per machine (and hence per lab, assuming one machine per lab) per year, from €5.85 for 25 000 specimens to €2.67 for 100 000 specimens per machine per year.
The cost of the diagnostic test to confirm a positive screening test depends on the screening algorithm used. It was estimated in consultation with the national screening programme to be €500, which includes the costs of contacting the child, of a medical consultation and of additional lab tests. It was assumed, conservatively, that both the cost of further investigation in case of a false positive screening test result and the cost of diagnosing a case of MCADD, in the absence of screening, would also be €500.
Based on the fee paid by the national health insurance scheme to the screening labs [55], the cost of the existing technology for PKU screening (fluorometry) was estimated at €1.76 per test.
Cost of uncomplicated MCADD
The management of uncomplicated MCADD consists in dietary management to preventing fasting stress. It was assumed, based on expert opinion, that persons diagnosed with MCADD have on average two medical consultations (at €23 each) per year until the age of 6 years, then one consultation per year for the rest of their life. In a sensitivity analysis, the number of medical consultations was varied from two to five per year during the first 6 years of life. Regarding L-carnitine supplementation, there is no good quality study nor expert consensus on its effectiveness [10,56], data on prescription habits in France are lacking, and its use in other countries is heterogeneous. Therefore, in the base-case analysis, it was assumed that 50% of children diagnosed with MCAD receive a supplementation in L-carnitine until the age of 18 years, after which the supplementation is stopped. Two alternative scenarios were evaluated in the sensitivity analysis where, respectively, no children and all diagnosed children receive L-carnitine until the age of 18 years. Costs were estimated on the basis of the recommended posology and mean weights for age according to French growth charts. In the reference scenario, the discounted cost, for a population LE of 81 years, was estimated at €5 831 (€888 for the medical consultations plus €4 942 for L-carnitine supplementation).
Cost of MCADD complications and sequelae
The cost of a metabolic crisis was estimated using the hospital administrative database "Programme de médicalisation des systèmes d'information" (PMSI) by computing the weighted average fee of the disease related groups corresponding to the International Classification of Disease (ICD) 10 code "disorders of fatty-acid metabolism". The cost amounted to €2 770.
There are no specific data available on the costs of managing neurological sequelae of metabolic diseases in France. Using a French claim database ("Echantillon généraliste des bénéficiaires"), we analysed the annual management cost for patients with long-term illnesses diagnosed with mental retardation (ICD-10: F70–79), as a proxy for severe MCADD neurological sequelae, and for patients with behavioural and emotional disorders with onset in childhood and adolescence (ICD-10: F90–98) as proxy for mild sequelae. These costs, which are covered by the national health insurance scheme, include health care costs as well as other expenses such as special education, residential care, and transportation. They were highly variable, with a median of €21 352 (99% confidence interval [CI]: €17 074–€25 540) and a mean of €125 106 (99% CI: €101 450–€148 171) for mental retardation and a median of €6 306 (99% CI: €4 822–€8 703) and a mean of €77 581 (99% CI: €46 910–€118 558) for behavioural and emotional disorders. We used the median costs in the base-case analysis and the lower bound of the median and upper bound of the mean as extreme values in the sensitivity analysis. We computed lifetime discounted costs based on the estimated LE for neurological sequelae.
Base-case analysis
The model projected that the introduction of MCADD screening into the French newborn screening programme would, every year, prevent five child deaths and the occurrence of severe neurological sequelae in one child and mild neurological sequelae in one other child under five years, which results in a gain of 128 LY or 138 QALY (Table 2). The cost of the tests (including screening and confirmation tests) was estimated at €3.2 million. When the costs of treatment and care were taken into account, the net incremental cost of introducing MCADD screening was lower – estimated at €2.5 million – because of the MCADD complications prevented. The resulting ICER was €19 478 per LY or €18 033 per QALY gained.
Table 2. Cost-effectiveness of the introduction of MCADD newborn screening in France
When the introduction of MCADD screening was combined with a switch in technology for PKU screening from fluorometry to MS/MS, the health gains remained the same as in the above strategy because the performances of MS/MS and of fluorometry for PKU screening were assumed to be similar. However, the incremental cost of the screening programme was lower because of the savings from no longer having to perform the current PKU test. The annual cost of the tests was estimated at €1.7 million and the annual net incremental cost of the screening programme at €1.0 million. The resulting ICER was estimated at €8 189 per LY or €7 851 per QALY gained. As expected, this strategy clearly dominated that of solely introducing MCADD screening.
Sensitivity analyses
One-way sensitivity analyses showed the influence of variations, within plausible ranges, of different parameters on the results of the model (Table 3 and Figure2). The parameters that had the largest influence include the costs of neurological sequelae, for which estimates were highly uncertain; the MCADD prevalence; the cost of the MCADD screening test, which is dependent on the number of tests per lab per year and ultimately on the number of labs performing screening tests; the risk of death following a metabolic crisis; and the effectiveness of MCADD screening. For example, the ICER varied from €3 444 to €15 856 per QALY gained when the MCADD prevalence varied from 1/1000 to 1/25 000. Likewise, the ICER rose to €15 655 per QALY if the cost per test was increased to €5.16 (which would correspond to 30 000 tests per lab per year). When the annual costs of managing neurological sequelae exceeded €50 000 for severe sequelae or €40 000 for mild sequelae, the programme became cost-saving.
Table 3. One-way sensitivity analyses of the cost-effectiveness of introducing MCADD screening and of switching to MS/MS technology for PKU screening
Figure 2. Sensitivity analyses: Expansion of newborn screening to include MCADDvs.current newborn screening. The width of the bar indicates the variation in the incremental cost-effectiveness ratio associated with alternative parameter values for that input. The numbers on the right side, next to the parameters, indicate the lower- and upper-bounds of the ranges used in sensitivity analyses.
The worst-case scenario indicated that the ICER of introducing MCADD screening and of switching to MS/MS for PKU screening would be, at worst, equal to €72 115 per QALY gained.
The objective of this cost-effectiveness analysis was to inform policy makers and help them decide whether or not to introduce MCADD screening in France.
The predicted ICER of MCADD screening in France – €7 580 per QALY gained – is within the range of those obtained by others [10,13-15,18-23]. While there is no defined threshold in France for judging whether the implementation of a health intervention is an efficient allocation of public resources, this analysis suggests, in view of efficiency thresholds defined in other European countries, that the introduction of MCADD screening in France is cost-effective. In England, interventions with an ICER of less than £20 000 to £30 000 (around €24 000 to €36 000) per QALY gained are considered to be cost-effective [57]. In Sweden, the threshold to decide whether a drug provides value for money and to determine coverage status is €45 000 per QALY [58] and in the Netherlands, this threshold may be as high as €80 000 per QALY for severe conditions [59]. The World Health Organisation considers that health intervention are very cost-effective if they cost less than the average per capita gross domestic product (GDP) per disability adjusted life year averted (DALY) for a given country or region. Interventions that costs up to three times the average per capita GDP per DALY averted are still considered cost-effective, while those that exceed this threshold are considered not cost-effective [60]. For France, these thresholds would correspond to about €30 000 and €90 000 per DALY averted, respectively.
The results of the model were relatively robust to the variations of parameters applied in the one-way sensitivity analyses, whereby the ICER remains below €16 000 per QALY gained. The model was, however, more sensitive to some parameters, some of which are subject to a large degree of variability (notably the cost of neurological sequelae) or uncertainty (e.g. MCADD prevalence, cost of MCADD screening test). The production of empirical data generated by the implementation of MCADD screening in France would improve the estimates of some of these parameters.
The costs used in this analysis did not include the start-up costs for launching the programme, such as the costs of staff training and of producing information and education materials. While the use of MS/MS technology for newborn screening implies that the number of labs performing screening tests be reduced, the intangible costs related to potential disruption of the current newborn screening programme incurred by such reorganisation have not been taken into account either. We did not incorporate the potential loss of quality of life associated with lifelong dietary recommendations for treating MCADD in patients who may in the absence of screening not have experienced any MCADD related problems. Yet, such adjustments may counterbalance some of the health gains from newborn screening [23].
The budget impact for the national health insurance scheme of the expansion of the newborn screening programme to MCADD and of the replacement of existing technology for PKU screening was estimated at €1.7 million per year for the tests alone and at €1 million when the savings from preventing MCADD sequelae were taken into account. This amount represents an increase of 11% in the annual cost (currently estimated at €9 million) of the newborn screening programme.
This analysis suggests that implementing MCADD newborn screening in France would be an efficient use of resources. These results were used by HAS as supporting evidence to recommend the expansion of newborn screening to include MCADD. The French Ministry of Health is currently making plans to put these public health recommendations into practice.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
FFH conceived and designed the study and wrote the paper. CRP contributed to the conception of the study and provided overall advice. Both authors read and approved the final manuscript.
We thank the members of the HAS Working Group on the expansion of newborn screening in France who provided numerous inputs used in this analysis: Ségolène Aymé, Claude Burlet, Brigitte Chabrol, David Cheillan, François Feillet, Roselyne Garnotel, Didier Lacombe, Pascale Lévy, Gerard Loeber, Cécile Loup, Anne Noëlle Machu, Valérie Seror, Florence Suzan, Nathalie Triclin, Patrick Truffert, Toni Torresani, Cécile Vaugelade. We acknowledge Annie Rudnichi for her analysis of the EGB database and Sophie Despeyroux for assisting with literature search and retrieval. We are grateful to Scott Grosse for his comments on an earlier version of the manuscript. These data were presented in part previously at the Health Technology Assessment International Meeting in June 2010 (Dublin), and published as abstract in the proceedings (poster M2-43).
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Pre-publication history
The pre-publication history for this paper can be accessed here:


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About This Video
A clip/trailer of The Wine of SummerTags : The Wine of Summer
Type : Movie Trailer
Views : 725
This Movie Info
Release Date :September 21, 2013 Douro Film Festival
Studio :Public Media Works
Director :Maria Matteoli
Starring :Elsa Pataky, Sonia Braga, Ethan Peck, Marcia Gay Harden
"The Wine of Summer" is a story of love, both lost and found, of timeless beauty and the brightness of youth. James (Ethan Peck), at the age of 27, quits his law career in pursuit of his childhood dream of becoming an actor. While studying acting under the tutelage of Shelley (Marcia Gay Harden), he becomes engrossed in Carlo Lucchesi's play, Tinto de Verano, which is set in Spain. James' girlfriend Brit (Kelsey Chow) leaves him, and he spontaneously flies to Spain, where he encounters the misanthropic playwright Lucchesi (Bob E. Wells) at a bookstore in Barcelona. Lucchesi is in a relationship with a much younger woman, Veronica (Elsa Pataky), but still nurtures an old love for his long lost muse, Eliza (Sonia Braga), a novelist, who happens to be visiting her son, Nico (Nicholas Dominic Talvola) a trumpet player who also lives in Barcelona. In the golden backdrop of Spain, these characters find their fates intertwined.


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Did Kim Kardashian Confirm That She Is Having A Girl On Instagram? (Photos)
She might have not made it quite official yet, but it looks like Kim Kardashian might have already let the cat out of the bag!
The pregnant celebrity mama-to-be has neither confirmed or denied the rumors that she is having a baby girl, but could the reality television star let it slip that she's thinking pink on Instagram? We think so! Kimmy Cakes recently shared a photo of all of the flowers that were sent to her by her friends and family after her miscarriage scare this week and with all the pink roses we're seeing we can't help but wonder… is she really expecting a little Kimye with a cute Etsy bow on top in that bump of hers??
Check out all of our fun photos below and let us know what you think! We've also added a few new photos from her Instagram account, including one of her hiding her bump once again. Kim, let it out! You should be wearing that bump both loud and proud!
Flowers 1 of 5Kim is surely feeling the love from her family and friends. But does all of the pink flowers here mean she's having a girl??
Source via Instagram
LOL of the Day 2 of 5It's good to see that Kim Kardashian has a good sense of humor as she reposted this from a fan.
Source via Instagram
Sister Love 3 of 5Talk about four very gorgeous sisters! Khloe looks exceptionally HOT here.
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Duck Face 4 of 5Because no week is complete without posting at least one duck face selfie of yourself on Instagram, right? LOL.
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Where's The Bump? 5 of 5The photo's cute, but I can't help but wonder... why does Kim always insist on hiding her baby bump?
Source via Instagram


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This Week
Hinchingbrooke celebrates 450 years in 2015!
Did you attend Hinchingbrooke School? Sign up to our Alumni page, a safe secure site administered by 'Future First' allowing us to keep in touch. https://networks.futurefirst.org.uk/former-student/hinchingbrooke
Week Commencing 29th June 2015 – Week A
In a continuation from last week's message, I am thrilled to report that we had two wins at the secondary film festival! Hinchingbrooke students managed to come 1st and 3rd in the KS4 category (despite being in KS5!). The winner was the psychological thriller '282' created by Sabrina Hunt, Kristine Flores and Hannah Brace. The nightmarish 'Trapper' coming in a respectable third, made by Josh Craig, Ashton Matthews and Emma Cole. Well done to all - a great result.
The Sicily Trip seems to have been a fantastic experience for the fortunate Year 9 students who went along. One of the students, Emily Eacott made a great video to summarise the experience (click on the hyperlink below) and here are a few choice photos to evidence the beauty and fun had by all. http://www.hinchingbrookeschool.co.uk/tripvideo/sicily/
Last Friday evening, although a little damp and humid was a great time was had by all. As the photos below suggest, the students all made a real effort and looked absolutely amazing - well OK Mr Pape and Mrs Woolhouse did! The students really scrubbed up well and all looked amazing too! The transport to and from the Year 11 prom was also pretty special. Let's hope there will be as many smiling faces this summer. A massive thanks to Mrs Woolhouse, Mr Pape and Miss Winter for all their hard work to pull this amazing event together. I have no doubt the Sixth Form Prom (this Friday) will be an equally exciting event for all involved.
This week we have a number of trips. On Monday a number of our 'Eco Warriors' have gone across to St Ivo to talk about the environmentally friendly schemes we have introduced. On Tuesday 54 Year 9 students are off to Bletchley Park – no doubt to try and see if they can break a few codes. The Geography Department are off again – only this time it's to Shropshire on an enrichment trip for Year 10 students and the Art Department are off to Hatfield with Year 10 on Saturday 4th July. So lots to keep the students occupied outside of the classroom. A huge thanks to all the staff who give so freely of their time for all these trips.
On Wednesday it's Sports Day and it is set to be a scorcher! Please can you ensure that your son/daughter has a sun hat and sun cream. If any of you out there have gazebos you could lend us for the day please let the PE Department know as this will increase the amount of shade available for students. Water is provided so we will be making sure they keep hydrated.
Don't forget that Friday is a staff training day – so no students (unless they are on the Geography trip or have been invited in specifically by a member of staff). For the majority not in school here is the perfect time to sit in the garden and catch up on your reading. The Interhouse Reading Challenge continues, although time is running out fast.
The theme for this week is RESPECT. It's all about the respect you have for yourself, others and the school as a whole. The rules of the school can be encapsulated in this one phrase.
Have a great week.
Anna Nightingale
Vice Principal