text:
Download AutoForm^Plus R7 Windows/Linux 64bit full crack 100% working
AutoFormPlus R7 Windows Linux 64bit full software
working with AutoFormPlus R7 Windows Linux 64bit
AutoForm offers software for manufacturers of dies and stamping. Using AutoForm software improves reliability in planning, reduces the number of adjustment cycles stamps and setup time. The result is improved quality components and design tools, which can be produced with maximum confidence. In addition, significantly reduced downtime and production of defective products.
Based on practical, industrial know-how and experience in sheet metal stamping, AutoForm software solutions are complete, integrated system with highly specialized functions, the ability to analyze, review and optimize every phase of the process.
AutoForm provides solutions all stages of stamping process. A set of solutions ranging from stand-alone modules for small and medium-sized companies to complete, integrated multi-module systems for large companies.
Extras. information:
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Thanks all
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Speaking up about sexual abuse or exploitation can be upsetting and scary. We understand that you want the abuse to stop. We also understand that you might be worried about what might happen after you tell somebody. This is normal and it's okay to feel like this.
If you've got a problem or are worried about someone you know, it can be hard to know what to do to make the situation better. This page will give you the information about services and people that are there to help.
Are you worried about:
Are you afraid to talk to anyone about your worries because you:
It can be very hard to talk about your feelings, but some problems won't go away if you ignore them. Talking to someone can make you feel better and help you to find a solution.
Could you talk to:
If you want to speak to someone else please see the helpline numbers in the orange box at the right hand side of this page.
If you are concerned about another child or young person, follow this link: Referring a safeguarding concern to Children's Social Care
Helpful organisations:
Childline for advice and support to children and young people. Phone 0800 1111 or visit the Childline website.
Connexions Direct - information and advice for 13-19 year olds. Phone 080 800 13 2 19 or visit the Connexions Direct website.
Kidscape is a Children's charitythat gives practical advice to young people about bullying and keeping safe. Visit the Kidscape website
The Samaritans confidential helpline for young people experiencing feelings of distress or despair – tel: 08457 90 90 90. Visit The Samaritans website
Youth Access – Tel: 020 8772 9900. This organisation will put you in touch with local services that offer information, advice and counselling
The Hideout - for young people affected by domestic abuse. Visit The Hideout website.

subset: commoncrawl


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For July we have designed a General Message Prezi Template. When you are creating a Prezi, you will find that many of the templates available are too 'themed' and don't support your message.
This template gives you a great base for your story, with three colourways to choose from. You can mix and match the elements, or copy the whole straight into Prezi. Once your individual assets are in Prezi, you can size and rotate them to create endless variations. Add them to 'My Collection' in Prezi for easy access in the future.
Remember, when you are using the circle areas for content, avoid circular frames as they limit the space available to use on your screen. For more information, read our blog post: Prezi Frames – should you use circles?
All our templates are designed with the 3 Act Speech Structure in mind, to help you create a well organised, structured and memorable presentation. Here you could use the banner for a title; a section at each end for the Introduction and Conclusion and three sections in the middle for your three acts.
In the demo below, I have created a Prezi using our free Prezi Template and free assets available on Prezi; total cost – just your time!
Download your Prezi Templates Here


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Unity3D library for importing and exporting GLTF 2.0 assets. The library will be modularized such that it can be extended to support additional capabilities in Unity or support additional extensions to the glTF specification. The library is designed to work with Unity 5.6 and above.https://github.com/KhronosGroup/UnityGLTF
|unity3d gltf
This is the offical Khronos Blender glTF 2.0 exporter. This repository mainly contains Python scripts to export the internal Blender data structure to glTF 2.0. Node groups are also provided, to simulate glTF Physically-Based Rendering (PBR) materials using the Cycles renderer. Finally, several Blender scenes are provided demonstrating each feature individually. The Khronos glTF 2.0 exporter is not available in the Add-ons tab by default, and must be installed manually by copying the scripts/addons/io_scene_gltf2 folder into the scripts/addons/ directory of the Blender installation, then enabling it under the Add-ons tab. Read detailed installation instructions here.
glTF™ (GL Transmission Format) is a royalty-free specification for the efficient transmission and loading of 3D scenes and models by applications. glTF minimizes both the size of 3D assets, and the runtime processing needed to unpack and use those assets. glTF defines an extensible, common publishing format for 3D content tools and services that streamlines authoring workflows and enables interoperable use of content across the industry. Please provide spec feedback and community updates by submitting issues. For quick questions, use gitter.
See the README.md in each model's directory for usage restrictions. Sample models help the glTF ecosystem, if you are able to contribute a model, see the contributing section below.
This is a raw WebGL demo application for the introduction of physically-based materials to the core glTF 2.0 spec. This project is meant to be a barebones reference for developers looking to explore the widespread and robust capabilities of these materials within a WebGL project that isn't tied to any external graphics libraries. For a DirectX sample please head over to this repo instead. If you would like to see this in action, view the live demo.
A library to deserialize Unity3D Assets and AssetBundles files (*.unity3d). Most extractors for Unity3D files (such as Disunity) deal with the format as a "file store", treating it as one would treat a zip. This is not how the format actually works.unity3d disunity unity3d-format unity
This is a command line tool for converting 3D model assets on Autodesk's venerable FBX format to glTF 2.0, a modern runtime asset delivery format. Precompiled binaries releases for Windows, Mac OS X and Linux may be found here.
:boat: 关于炫酷的Unity3D Shader | About Cool Unity3D Shadersshader unity-shader shaderlab unity3d-shader unity graphics-programming posteffect awesome
The project is the socket.io client for unity3d, written in C#. It's based on socketio4net.Client (http://socketio4net.codeplex.com/). However, socketio4net.Client only provides a .NET 4.0 C# client, and does compatible with unity3d. We've done a lot of works on supporting unity3d. The project was initially designed for unity client of pomelo framework, which is a powerful, scalable game server framework.
Unity3D AssetBundle 打包与管理系统assetbundle unity3d unity3d-plugin
This repository contains formal documentation of the Vulkan API. This includes the Specification of the Vulkan API, including extensions; the reference ("man") pages; the XML API Registry; header files; and related tools and scripts. The authoritative public repository is located at https://github.com/KhronosGroup/Vulkan-Docs/ . Issues, proposed fixes for issues, and other suggested changes should be created using Github.
This project provides vktrace capture/replay tool, the Layer Factory, and other layer tools and driver tests. Branches within this repository include the Vulkan loader, validation layers, header files, and associated tests. These pieces are mirrored from this Github repository: https://github.com/KhronosGroup/Vulkan-ValidationLayers These pieces are required to enable this repository to be built standalone; that is without having to clone the Vulkan-ValidationLayers repository.
Game prototype made in Unity3D. Game codename: Butterflies Programmer: Luciano José(me) GD/LD: Frank Malcher Similar game: http://helicoptergame.net/ Unity3D version: 3.4 Language: C# Feel free to send me any question or suggestion. -- My blog: http://lucjose.wo...
Unity3D Utilities provides additional functionality to Unity3D (3.0+) via extensions, utilities, mini-frameworks, etc.
C# wrapper around XInput, works with any Mono or .NET application (eg. Unity3D).XInput is a DirectX API to manage the controllers connected to a PC (the same API is also used on Xbox 360). It allows an Xbox 360 controller to be used on a Windows PC.xinput c-sharp unity3d xbox-controller
A productive VR Toolkit for rapidly building VR solutions in Unity3d. The API documentation for the project can be found within this repository in API.md which includes the up to date documentation for this GitHub repository.unity3d vrtk steamvr-plugin steamvr virtual-reality vr oculus-rift vr-solutions
A .NET, Mono and Unity3d compatible(*) library for reading/writing INI data from IO streams, file streams, and strings written in C#. Also implements merging operations, both for complete ini files, sections, or even just a subset of the keys contained by the files.c-sharp unity3d ini mono cli configuration config configuration-management configuration-file config-management iniparser ini-parser unity-scripts unity3d-games nuget monodevelop
A slippy map implementation written in C# for Unity3D. It aims at helping developpers create 2D/3D maps working with a variety of online tile providers (OpenStreetMap, VirtualEarth/Bing Maps, ...) and offline sources (DBMap, MBTiles, ...) like Route-me (iOS) or Leaflet (HTML5), on every platform supported by Unity3D. Google Maps won't be supported (see Google Maps tiles terms of service). Yahoo! Maps neither since it was closed on September 13, 2011. Nokia Maps (now called Here) provides a REST API designed for static maps. They could be used as tiles but would get a 'Nokia' watermark on each one of them. Also Nokia and Microsoft are now teaming up so supporting both might be redundant.
If you have ever wanted to transmit data from Arduino to Unity3D the main issue is INSANE LATENCY. We didn't find any free, optimized, and customizable solutions to tackle this problem. So I built wrmhl. You can now connect any Arduino interface to Unity3D. You can use the default protocol, or implement your own without having to deal with thread just by changing wrmhl/Assets/WRMHL/Scripts/Thread/wrmhlThread_Lines.cs.arduino unity hardware-libraries hardware threading threadsafe iot iot-framework
Unity3D Client And C# Server Frameworkc-sharp game-development server unity3d-framework netcore netcore2 game-engine
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Berlin highlights – personal and individual
Explore the German capital! Even if an entire lifetime is not enough to explore every corner of the city, there are a few highlights that it is certainly well worth visiting. The list of the top things to do in Berlin will of course always be very personal. Beside the countless standard attractions, there is also no end of insiders' tips and locations that might not immediately come to mind when you think of Berlin. Read about some absolute highlights of this very special city here.
Enjoy a fabulous brunch at the House of Small Wonder
While the concept is originally from Brooklyn/USA, the food comes from all around the globe. The menu features a multicultural array of delectable dishes, ranging from matcha latte through home-made croissants and American sandwiches to exquisite Japanese specialities. The atmosphere is also utterly charming – with lots of plants, plenty of wood and cosy furnishings.
Impressive art in a bunker
Just a short distance away, further along Reinhardtstraße, is a converted bunker that is simply brimming with contemporary art. In the 1990s, the bunker was home to one of the most renowned techno clubs in the world. Today, works by artists of the likes of Ai Weiwei, Dirk Bell, Awst & Walther and Wolfgang Tillmans can be viewed in this impressive building. The Boros Collection is the private collection of media mogul, Christian Boros. He had the idea for the artistic transformation of the former bunker. For safety reasons, it is only possible to visit the bunker as part of a guided tour. Enjoy an entirely different museum experience!
Street Food Thursday in Neun Market Hall
In Berlin on a Thursday? Then why not head for Neun Market Hall for Street Food Thursday. Every Thursday between 5 p.m. and 10 p.m., young gastronomes and lovers of good food offer a delectable array of dishes. All kinds of specialities can be sampled here – from Mexican tacos and Thai tapioca dumplings to Allgäu cheese noodles. An exquisite taste experience!
Shop and dine in Bikini Berlin
Bikini Berlin is an extremely unique, state-of-the-art shopping centre. A great deal of individuality and very few mainstream, off-the-peg wares are available here. Beside charming cafés and restaurants, the concept mall is home to countless one-of-a kind designer stores offering selected products. A fantastic roof terrace affording views over Berlin's zoological gardens is the perfect place to kick back and relax. It is possible to enjoy a coffee here whilst observing the monkeys at play. The perfect opportunities to satisfy any hunger or thirst can be found directly next door, in the 25hours hotel with Restaurant NENI and the Monkey Bar.
Flea markets – with bargains guaranteed
Berlin is a self-confessed flea market mecca! From spring through to autumn, there are countless flea markets to browse. For Berlin locals, a visit to a flea market is a particularly popular ritual on a Sunday. We suggest a visit to the flea market on Maybachufer (every first and third Sunday of the month), the year-round flea market in Mauerpark, the antique market at the Bode Museum (also on Saturdays) or the Sunday flea market at Boxhagener Platz.
Simply stunning shows
The Friedrichstadt-Palast is the most visited theatre in Berlin. The huge show stage featuring state-of-the-art technology and the unique Grand Shows attract 700,000 people to the theatre every year. These lavish revue performances are produced in-house. Guests are able to experience world-class acrobatics, elaborate choreographies and fantastical costumes by renowned fashion designers. Critics rave about the Palast as the "Las Vegas in Berlin"; it is simply perfect for fans of exquisite show experiences.
The new show at the Palast is starting at 27 September. VIVID is a declaration of love to life. Featuring more than 100 stunning artists on the world's biggest theater stage. A production budget of 12 million euros for spectacular costumes and stage sets of unparalleled dimensions. A kaleidoscope of physical perfection and outstanding artistic performances that may prompt tears of joy. Despite all the glamour, ticket prices start at just €19.80!
Enjoy a walk at Tempelhof Airport
When the weather is fine, half of Berlin heads for Tempelhof airfield – be it to jog, skate, go for a walk or fly a kite. The former Tempelhof Airport offers an urban recreation area comprising green spaces, smooth (decommissioned!) runways and cafés. The inhabitants of Berlin have essentially made this space their own.
The Store x Soho House
While still very new, this concept store is already attracting the masses. Located on the ground floor of Soho House, "The Store" is an adventure playground for aesthetes. Furniture, flowers, books, fashion, music, art and an organic restaurant can be found here. Occupying a space covering 2,800 m², "The Store" will leave shopping enthusiasts' hearts beating a little faster with its pleasant, relaxed atmosphere.
Explore Berlin – from the water!
Because the River Spree flows right through the centre of Berlin, it is also possible to explore a great many of the city's sights and highlights from the water. A whole series of boat trips depart from locations throughout the city several times a day, offered by companies such as Stern und Kreisschifffahrt GmbH. Among others, these tours pass the TV tower, Pergamon Museum, Reichstag, Alte Nationalgalerie and Berlin cathedral.
We wish you a fantastic time exploring and experiencing your very own Berlin highlights!
Sammlung Boros | Photo: NOSHE
Bikinihaus | Credits: Bayrische Hausbau, Photo: Franz Brück
The Store at Soho House | Photo: Flickr / currystrumpet (CC BY-SA 2.0)


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Dr. Diane K. Smith, DC, CCSP
Doctor of Chiropractic
Certified Chiropractic Sports Physician
Chiropractic Acupuncture
Dr. Smith is a graduate of Northwestern Health Sciences University and holds a Bachelor's of Science degree from St. Cloud State University. She is a Certified Chiropractic Sports Physician (CCSP) specializing in sports-related injuries including swimming, biking, running, hockey and gymnastics related injuries. She is also a chiropractic acupuncturist, has a certificate in Sports Nutrition, is a certified Graston Technique provider and is a certified RockDoc (Rock Tape provider).
Dr. Smith appreciates the importance of patient education in empowering them to make lifestyle changes to stay active, healthy and to avoid injuries. As a marathon runner, ultramarathon runner and triathlete herself, Dr. Smith's passion is in working with athletes to overcome overuse injuries and helping them achieve a full and quick recovery. She has extensive post-graduate training in sports nutrition and Functional Medicine as well. She is a member of the American Chiropractic Board of Sports Physicians (ACBSP) and the American Chiropractic Association (ACA).
In her free time, Dr. Smith enjoys spending time with her husband, family, friends, training for the next marathon or triathlon, playing hockey, officiating high school and NCAA hockey, and playing golf. You may also find Dr. Smith playing drums with a local band on the weekends.


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This set includes a Nike Dry Fit XL polo and Nike Featherlight hat.
Special Instructions
Please bid carefully as all net auction proceeds will fund the Arkansas Alumni Association Scholarship Program. The Arkansas Alumni Association accepts your bid as a promise to pay. No Refunds, No Exchanges - No Exceptions.
Important: All winning bidders will receive an email notification of a winning bid immediately following the closing of the auction. You will then receive a follow up email indicating your payment options and instructions. Receipt of your item(s) will be handled by:
� Items are available for pick up at the Janelle Y. Hembree Alumni house no earlier than November 3 and no later than November 17.
� Shipping is NOT included in the final bidding price. If shipment of your item is required, please contact the Alumni Association for shipping costs at 479-575-2801.
� All shipments will be sent by November 17.
* Due to the current circumstances, a final decision about pick up & mailing options will be communicated in the email informing you of your winning bid and/or payment options.


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I wish to complain about Riva Poker for their ABSOLUTE UNACCEPTABLE service, which is 100% NON RESPONSE FROM this site.
I am joining Riva Poker after my friend strong recommendation saying that Riva Poker is offering a 100% free risk offer up to 40 Pounds. During the registration process, the live chat is prompted and the customer service offers me to deposit now and get up to 40 Pounds. If losing the deposit within 7 days, the initial deposit up to 40 Pounds claimed from them by email to [email protected] with subject title "100% refund".
Since the offer is so attractive, I immediately deposit via the Neteller method for the sum of 40 Pounds.
Fortunate enough, I managed to win some money at poker table. After a few hours, I cashout a total of 70 Pounds, making a little winnings of 30 Pounds.
I also receive the auto response from Riva Poker that my cashout been registered and updated within the next 96 hours. I feel quite weird as 96 hours for cashout is really a long time. But I am Ok, since I won some money there.
After a day, I wishes to go back to the poker game and try to login into the software. I got a message that my account is temporaily locked for security reason and requested me to contact their support which I also immediately email to them.
Since there, I got 100% no response from them. I have counted myself that I have emailed them for more than 15 times to all the email which I could find at www.rivapoker.com which is as follows:
a) cashie[email protected]ivapoker.com
b) suppor[email protected]ivapoker.com
c) [email protected]
d) feedba[email protected]rivapoker.com
e) [email protected]
I sincerely hope that askgamblers.com would be able to find the reason what is going on with this site.
I am ready to sent out my ID and bank statement but since there is no reply at all, I also do nothing.
This is totally unacceptable practice because they have ignored email and now I am really worrying what would happen to my intial deposit of 40 Pounds.
Since this site is so terrible and irresponsble at all, I don't put a hope to get the winnings but I really want to take back my intial deposit which they have no right to confiscate without any communication.
By the way, I am taking opportunity to warn any players who wish to play there, please don't do that. Otherwise, you not only fail to get any of your winnings but your own deposit also "missing" without any reasons.
Thank you and looking forward to hear from you soon.


text: Home > News Senate urged to probe 'irresponsible' military, Chinese-linked telco deal ABS-CBN News Posted at Sep 17 2019 01:42 PM Share Facebook Twitter LinkedIn MANILA - Opposition Sen. Risa Hontiveros on Tuesday filed a resolution urging the Senate to probe an agreement between the Armed Forces and Chinese-linked telco firm Dito Telecommunity Corp. to construct facilities inside military camps. AFP inks deal allowing presence of Chinese-linked 3rd telco in military bases Hontiveros filed Senate Resolution No. 137, saying there was "an urgent need" to determine if the agreement complied with the law. She said deal allowed lease of portions of military bases, which would violate Section 88 of the Public Land Act that states, "military reservations cannot be subject to lease, occupation, entry, sale, or other disposition, until declared alienable by provisions of the Act or by proclamation by the President." The senator also cited the Armed Forces of the Philippines (AFP) Modernization Act, which stated that any "sale, lease or joint development of military reservations must be authorized by Congress." "Sa isang panahon na patuloy ang panghihimasok ng Tsina sa West Philippine Sea, napaka-iresponsable na pumasok tayo sa mga kasunduan sa kanila na hindi sinusuri ang epekto nito sa ating pambansang seguridad at kaligtasan," she said in a statement. (At a time when China continues to intrude in the West Philippine Sea, it is extremely irresponsible to enter into an agreement with them without scrutinizing its effects on our national security.) Malacañang earlier said the Department of Defense would look into the deal after Defense Secretary Delfin Lorenzana said he was unaware of the agreement. Defense dept to probe PH military, Chinese telco deal: Palace Hontiveros hit the government for keeping the defense chief out of the loop, who she said was also unaware of the reported Chinese development of three key Philippine islands. Creeping annexation? Lorenzana checking on Chinese investment in key PH isles "Is there now a 'sign first, worry about security later' policy under this administration?" she said. "Ito na ang pangalawang beses na hindi nakonsulta ang defense secretary tungkol sa mga diumanong Chinese deals na pinapasok ng ating pamahalaan na may seryosong implikasyon sa ating pambansang seguridad," Hontiveros said. (This was the second time that the defense secretary was not consulted regarding Chinese deals our government entered into which has serious implications in our national security.) Sen. Francis Pangilinan earlier said he would raise the matter during Senate deliberations on the DND and AFP's budget. Senate to probe deal between Chinese-linked telco, PH military during budget hearing Share Facebook Share on Twitter LinkedIn Risa Hontiveros, AFP, military, DND, Dito Telecommunity Corp, Delfin Lorenzana Read More: Risa Hontiveros AFP military DND Dito Telecommunity Corp Delfin Lorenzana


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Criminal Justice - Statewide
Criminal Justice
Locations: Big Rapids, Grand Rapids, Alpena, Auburn Hills, Benton Harbor, Clinton Township, Dowagiac, Flint, Gaylord, Harper Woods, Jackson*, Kalamazoo, Lansing, Livonia, Midland/Bay/Saginaw, Muskegon, Petoskey, Port Huron, Scottville, Sidney, Traverse City
The Excellence You Expect, The Flexibility You Need
Ferris State University's Criminal Justice program is amongst the most respected in the nation, and with our locations across Michigan, your degree is within reach wherever you are. Whether you're a seasoned professional or you're interested in entering the field, our Statewide Criminal Justice programs will provide the flexibility you need to earn your degree and take the next step forward in your career.
Schedule a free appointment with a local Ferris advisor to get started.
Already finished your bachelor's degree? Check out our Master's of Criminal Justice Administration program.
*Note that our Jackson-based program focuses on the Law Enforcement track.
Expanded Options: With your degree in Criminal Justice, you'll find opportunities in youth services, addiction treatment, offender aftercare and treatment, victim advocacy, law enforcement and many other areas of the criminal justice field. Your Criminal Justice degree is also excellent preparation for law school.
Save Thousands: Thanks to our partnerships with community colleges across Michigan, earning your Ferris State University degree at an off-campus location can save you thousands of dollars. Take many of your courses at your local community college's inexpensive tuition rate and apply them directly to your Ferris degree. Check our transfer guides for details.
Keep Your Schedule: Night and weekend classes are available in many locations, so you can keep your current career while you get ready for the next step. Check out our accelerated 8-week courses to earn your degree even faster.
Get to Work: Earn your degree in your community and begin building the local professional network you'll need to launch your career.
This program has been designed as a degree completion program. You will need a minimum number of credit hours to enter this program. Contact a local or online advisor for all of the details.
Our transfer process and community college partnerships will help you maximize the number of credits you bring to Ferris, saving you time and money. Check out our transfer guides to get an idea of what your transfer to Ferris might look like.
Alpena Community College
Delta College
Grand Rapids Community College
Jackson College
Lake Michigan College
Lansing Community College
Macomb Community College
Montcalm Community College
Mott Community College
Muskegon Community College
North Central Michigan College
Northwestern Michigan College
Oakland Community College
Schoolcraft College
Southwestern Michigan College
Saint Clair County Community College
Wayne County Community College
West Shore Community College
More Transfer Options


text:
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Mazda service merges speed and quality to offer you even greater value and convenience. Our precision service system expedites the maintenance process, providing a seamless experience that allows you and your vehicle to get back on the road as quickly as possible.
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14720 Buck Hill Rd • Burnsville, MN 55306Get Directions
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text: The practice Young lawyers Surviving law school How to succeed and stay sane — one challenge at a time. BY Katya Hodge 5 Sep 2014 Rachel Lehman. Photo by/par Robert Karpa, Venturi+Karpa Share: Facebook Twitter Linkedin Email So you've made it to law school. Now all you have to do is survive the heavy course load, the massive amounts of reading on a daily basis, the exhausting exams and the stress of being graded on a forced curve. Each year of study brings its own unique and arduous challenges. As they say, the first year they scare you to death, the second year they work you to death, and the third year they bore you to death. Four students share their strategies for surviving law school and avoiding the law school blues. Surviving 1L Rachel Lehman University of British Columbia I wish I had a magic strategy, but the truth is that first year of law school is challenging for everyone. However, I do have a few tips that I can share based on what worked for me this past year. First, whenever you take breaks from studying, try to do things that you really enjoy. For me that was taking walks with friends or enjoying new restaurants. I tried to completely relax while I wasn't studying, and I think that helped me to be much more focused when it was time to hit the books. My second tip is to use the resources that your law school provides. My school offers academic success workshops throughout the year and a peer tutor program, both of which I found to be very helpful. My last tip is to identify people in your life who you can get support from, and talk to them when you're feeling overwhelmed. Family members, friends, and significant others are great, but people you meet while in law school can be just as helpful too. I received a mentor (a practising lawyer in Vancouver) when I joined the Canadian Bar Association Mentorship Program, and I found him to be extremely helpful throughout the year because he understood the unique challenges that law school presents. What superhero would you want to represent and why? Batman! As I'm interested in corporate law, I'd love to represent a huge company like Wayne Enterprises. Surviving 2L Johnny Maskine Schulich School of Law at Dalhousie University My secret weapon is a schedule. I think it's important to physically write out a manageable timetable and work with that. I try to balance leisure, extracurricular and school-related commitments. It helps to embrace all of law school's joyful activities. Law school is challenging and can be as demanding as you allow. It is important to set boundaries and allow yourself to enjoy other things in life. This will help to keep you balanced, focused, and sane. What superhero would you want to represent and why? I would love to represent Batman because, firstly and most importantly, he's the coolest superhero. Bruce Wayne is a successful businessman and philanthropist. He would be a great person to work with. Also, Batman's entire motive is to fight criminals, such as those who killed his parents, to promote justice. Although he may cause a lot of mess in achieving his ends, his objective is admirable. Surviving 3L Kathryn Kitchen University of Calgary I had always intended to return to Saskatchewan for articles because that was where my fiancé and my family are. In this regard, I never felt the pressures of the competitive Calgary job market and the corresponding pressure of having marks that would catch the eye of a firm. I got to set personal goals that ultimately led me to an amazing firm where I have spent the last two summers and where I will be spending my articles. The biggest challenge I faced during law school was managing my time and knowing my limits. There are only so many hours in the day and making sure you balance schoolwork, extracurricular involvement and your social life can be a real struggle. There are so many different organizations and opportunities that present themselves in law school and sometimes it's difficult to fight the urge to join them all. Each will offer a unique opportunity or skill development that will certainly make them appealing. What superhero would you want to represent and why? Ironman. [He's] a very intelligent superhero and when faced with the opportunity to use his technology for evil, he opted to use it for good. I certainly think that integrity is worth defending. In addition, there would probably be some pretty interesting intellectual property law to deal with as well as some great client referrals as a result of his work with the Avengers team. Surviving articles Devan Marr University of Ottawa; Articling at Nelligan O'Brien Payne I've done everything from relatively mundane things like file documents at court to drafting factums, preparing affidavits, meeting with clients, giving submissions at express motions, and having pretty much independent carriage of our own small claims files… The firm gives us a lot of substantive work and a lot of independence to seek out interesting assignments. It's always gratifying when you look at the factum a lawyer has sent in and it's your research and arguments that win the day. I think the key to surviving is to just have at least one thing that's not law-related in your life and not letting work consume your every waking thought. I have a strict policy of not checking my work e-mail on Saturdays unless I actually have something I need to work on. To keep sane I go to weekly trivia nights with my non-law friends; another student goes to the gym six days a week; and another has a monthly outing with her friends outside the firm. What superhero would you like to represent? One of the other articling students immediately said Tony Stark, because you know he can pay the bills. I think I have to go with Green Lantern. Do superheroes owe a duty of care for the property damage they do? What if that damage is caused by the power of your imagination? That's going to make for some interesting work. Share: Facebook Twitter Linkedin Email Katya Hodge is managing editor of National.


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Background: Screening reduces colorectal cancer mortality, but many persons remain unscreened. Screening with a blood test could improve screening rates. We estimated the comparative effectiveness and cost-effectiveness of colorectal cancer screening with emerging biomarkers, illustrated by a methylated Septin 9 DNA plasma assay (mSEPT9), versus established strategies.
Methods: We conducted a cost-utility analysis using a validated decision analytic model comparing mSEPT9, fecal occult blood testing (FOBT), fecal immunochemical testing (FIT), sigmoidoscopy, and colonoscopy, projecting lifetime benefits and costs.
Results: In the base case, mSEPT9 decreased colorectal cancer incidence by 35% to 41% and colorectal cancer mortality by 53% to 61% at costs of $8,400 to $11,500/quality-adjusted life year gained versus no screening. All established screening strategies were more effective than mSEPT9. FIT was cost saving, dominated mSEPT9, and was preferred among all the alternatives. Screening uptake and longitudinal adherence rates over time strongly influenced the comparisons between strategies. At the population level, mSEPT9 yielded incremental benefit at acceptable costs when it increased the fraction of the population screened more than it was substituted for other strategies.
Conclusions: mSEPT9 seems to be effective and cost-effective compared with no screening. To be cost-effective compared with established strategies, mSEPT9 or blood-based biomarkers with similar test performance characteristics would need to achieve substantially higher uptake and adherence rates than the alternatives. It remains to be proven whether colorectal cancer screening with a blood test can improve screening uptake or long-term adherence compared with established strategies.
Impact: Our study offers insights into the potential role of colorectal cancer screening with blood-based biomarkers. Cancer Epidemiol Biomarkers Prev; 22(9); 1567–76. ©2013 AACR.
Colorectal cancer is the third most common cancer globally and the second most common cancer in industrialized countries (1–3). Screening can decrease colorectal cancer-related mortality through removal of precancerous lesions and detection of early-stage cancers (4–8). The United States Preventive Services Task Force (USPSTF) recommends guaiac or immunochemical fecal occult blood tests (FOBT, FIT), sigmoidoscopy, or colonoscopy for colorectal cancer screening starting at age 50 years (grade A recommendation; ref. 9).
Despite the established benefits of colorectal cancer screening, approximately 40% of eligible Americans do not undergo colorectal cancer screening (10). Moreover, adherence to screening over time is suboptimal (10–19). Barriers to screening at the system, practice, and individual level can substantially reduce the effectiveness of screening programs (20). Several promising blood-based biomarkers of colorectal cancer are under investigation and development (21, 22). An easily conducted blood-based screening test might be accepted by persons not currently participating in screening and may improve adherence over time, and a highly accurate blood test could even replace current tests if it proved more acceptable to most people.
Plasma methylated Septin 9 DNA is a marker of colorectal cancer (23–25). In a recent large prospective study in average-risk persons undergoing screening colonoscopy in the United States and Germany, a 2-well plasma Septin 9 DNA methylation assay showed an overall sensitivity of 48% for colorectal cancer and a specificity of 92%, with sensitivities of 35% for stage I colorectal cancer, 63% for stage II colorectal cancer, 46% for stage III colorectal cancer, and 11.2% for advanced adenoma (26). This sensitivity is superior to that of FOBT, but inferior to that of FIT. It cannot yet be compared with that of other promising blood-based biomarkers (21, 22) because these other markers have not yet been evaluated in large prospective studies. A commercial assay for this biomarker is available in Europe.
We used our published decision analytic model of colorectal cancer screening, which is validated against randomized controlled trials of FOBT and sigmoidoscopy (27, 28), to address key questions pertaining to the potential use of a blood-based biomarker in a screening program, illustrated by methylated Septin 9 DNA, including the appropriate screening interval, comparative effectiveness and cost-effectiveness in relation to established strategies, and the potential impact at the population level accounting for differential patterns of uptake and adherence among screening strategies over time.
Materials and Methods
Decision analytic model
Our published decision analytic model, its validation (27, 28) against the Minnesota Colon Cancer Control Study (4, 5), the United Kingdom Flexible Sigmoidoscopy Trial (8), the SCORE Trial (29), and the PLCO Cancer Screening Trial (30), the data sources used, and a model schematic are presented in the Supplementary Appendix. We modeled the contemporary population in the United States at average risk for colorectal cancer, with age-specific all-cause mortality based on U.S. Life Tables from 2003.
The PRESEPT study and methylated Septin 9 DNA assays
PRESEPT, a prospective multicenter study in the United States and Germany, examined the performance for colorectal cancer detection of a polymerase chain reaction-based assay for methylated Septin 9 DNA in plasma of average risk persons undergoing screening colonoscopy (26). Two plasma aliquots per person were initially tested (2-well assay), and a third aliquot of remaining DNA was tested later post hoc to emulate a 3-well assay (26). Based on these results, we modeled both assays, with the 3-well assay having higher sensitivities but slightly lower specificity than the 2-well assay.
Screening strategies and surveillance
Because there is value in illustrating different sets of test performance characteristics for blood-based biomarkers, we compared screening using 2-well or 3-well methylated Septin 9 DNA assays (mSEPT9-2well and mSEPT9-3well) with established strategies recommended by the USPSTF: annual FOBT, annual FIT, sigmoidoscopy every 5 years, and colonoscopy every 10 years (9), and the combinations sigmoidoscopy/FOBT and sigmoidoscopy/FIT. We recognize that the 3-well assay model inputs are based on an emulation and not a prospective evaluation.
Screening was superimposed on the Natural History module. Screening and surveillance were offered to persons at average risk of colorectal cancer from ages 50 to 80 years. If a screening test was positive, then colonoscopy was offered. If colonoscopy was normal after a positive screening test, the screening test was assumed to be a false-positive and screening resumed in 10 years with the primary screening strategy. With colonoscopy, polyps were removed and colorectal cancers were biopsied if detected. In all strategies, surveillance colonoscopy was carried out on average every 5 years after adenoma detection to reflect guidelines that suggest surveillance at 3, 5, or 5 to 10 years depending on adenoma number and size (31), and within 1 year of diagnosis, 3 years, and then every 5 years after colorectal cancer diagnosis (31).
Assumptions about test performance characteristics, uptake, and adherence are crucial in our analyses. Test sensitivities and specificities are presented in the Supplementary Appendix, Supplementary Table S1. In the base case, we modeled perfect uptake and adherence, and we considered multiple levels of imperfect uptake and adherence in sensitivity analyses.
Septin 9–based screening: testing performance and interval
Our model is calibrated to SEER data on stage distribution by localized, regional, and disseminated colorectal cancer. SEER coding guidelines consider stage IIA as localized and IIB as regional disease. We used the reported population-adjusted sensitivities of mSEPT9-2well and mSEPT9-3well (26) to estimate the assay's sensitivities for localized, regional, and disseminated colorectal cancer.
In the PRESEPT study, only one-time screening was carried out. Before a mSEPT9-2well or mSEPT9-3well screening program could be compared with alternatives, a testing interval had to be selected. We examined screening with mSEPT9-2well and mSEPT9-3well at progressively shorter intervals, as we have described previously (32), and selected 2 years as a screening interval consistent with the common willingness to pay threshold of $50,000/life-year gained (see Results).
Cost inputs
The derivation of cost inputs in year 2010 dollars is described in the Supplementary Appendix. The cost of mSEPT9-2well and mSEPT9-3well in the United States is not yet determined. We used $150 in the base case (range $100–200) based on anticipated costs (C. Lofton-Day, personal communication).
Clinical and economic outcomes
The principal model outputs were quality-adjusted life-years (QALY) and costs per/person (33, 34). Future QALYs and costs were discounted by 3% annually (35). Reported health state utilities for colorectal cancer by stage were used to calculate QALYs by applying these for 5 years after colorectal cancer diagnosis. For each strategy, we estimated colorectal cancer cases by stage and deaths in a cohort of 100,000 persons. The effects on colorectal cancer mortality for mSEPT9-based screening are unknown. Estimates of effectiveness were produced by the model for these and all strategies based on the assumptions about natural history, uptake, adherence, and test-performance characteristics.
Cost-effectiveness analyses
Analyses from the perspective of an insurer such as Medicare were conducted in TreeAge Pro (TreeAge Software, Inc.) and in Excel 2003 (Microsoft Corporation). Incremental cost-effectiveness ratios were calculated (33, 34).
One-way sensitivity analyses were conducted on all model inputs. Threshold analyses were conducted on influential variables. To estimate the uncertainty of our projections, a Monte Carlo simulation with 1,000 trials was carried out. We used beta distributions for probabilities derived from means, SD, and ranges in the literature (36). Costs of screening were varied by a common factor within a range of 20% of the base case value, and costs of care by a different common factor within the same range.
We conducted analyses reflecting persons who take up and adhere with screening and follow-up colonoscopy after abnormal screening (maximum efficacy), as well as scenarios reflecting imperfect uptake, per-cycle adherence, and follow-up (potential effectiveness). We addressed the potential impact of mSEPT9 at the population level by contrasting scenarios with increased overall uptake of screening as a consequence of acceptance of mSEPT9 by some of those currently unscreened, versus partial substitution by mSEPT9 for current strategies (10–19).
Testing interval for strategies based on mSEPT9
The incremental cost/QALY gained with mSEPT9-3well increased from $5,900 to $16,400 as the testing interval decreased from every 5 years to every 2 years, and rose sharply to $49,200 for annual testing, assuming a test cost of $150. This accelerating cost/QALY gained as the testing interval moved to yearly was also observed with mSEPT9-2well, and at mSEPT9 costs of $100 and $200. Annual testing at a test cost of $200 had incremental costs/QALY gained of $64,600 formSEPT9-3well and $52,500 for mSEPT9-2well. mSEPT9-3well and mSEPT9-2well with annual testing were less effective and more costly than annual FIT. Thus, a base case testing interval of 2 years was selected for mSEPT9-based screening.
Base case: effectiveness and cost-effectiveness with perfect uptake, adherence, and follow-up
Assuming perfect uptake, adherence, and follow-up after abnormal screening, the greatest reductions in colorectal cancer incidence and mortality compared with no screening were observed with sigmoidoscopy/FIT, and the reductions with mSEPT9-3well and mSEPT9-2well were lower than with the alternatives (Table 1).
All strategies yielded substantial gains in life expectancy, and some but not all were cost-saving (Fig. 1, Table 1). mSEPT9-3well and mSEPT9-2well gained fewer QALYs than the other strategies, and incurred the highest costs (Fig. 1, Table 1).
Compared with no screening, mSEPT9-2well and mSEPT9-3well yielded costs/QALY gained of $11,500 and $8,400, respectively (Table 1). In comparison, sigmoidoscopy/FIT, sigmoidoscopy/FOBT, and colonoscopy yielded costs/QALY gained under $3,000, and FOBT, sigmoidoscopy, and FIT were more effective and less costly (i.e., cost-saving) compared with no screening (Table 1).
While all strategies yielded substantial gains in life expectancy compared with no screening, and the differences in effectiveness between strategies were comparatively small, annual FIT was preferred in incremental comparisons between strategies. It was more effective and less costly than mSEPT9-2well, mSEPT9-3well, FOBT, sigmoidoscopy, and colonoscopy (Table 1).
Sensitivity analyses assuming perfect uptake, adherence, and follow-up
Comparisons between strategies were affected by key attributes of the screening tests. Assuming a best-case scenario for mSEPT9 based on the CIs for reported sensitivities and specificities, mSEPT9-2well and mSEPT9-3well became more effective than FOBT but not FIT. With these assumptions, mSEPT9-3well would have to be carried out yearly at a test cost of less than $10 to approximate but still not match the effectiveness and costs with FIT. At the lower bound of reported sensitivities for FIT, mSEPT9-3well with base case assumptions carried out yearly was nearly as effective as FIT, but mSEPT9-3well cost would have to be less than $5 in order for costs to be similar with the 2 strategies. Compared with no screening, mSEPT9-2well and mSEPT9-3well every 2 years were cost-saving at a cost of $50.
The costs of colonoscopy and colorectal cancer care, and the underlying risk of colorectal cancer in the population affected the results for all strategies (Table 2). For instance, if colonoscopy costs increased by 70% to $1,097 and $1,722 with biopsy, to illustrate costs for commercial insurance instead of Medicare, then FIT was no longer cost-saving, but it was still dominant over the mSEPT9 strategies. Other variables did not significantly affect the results, ranking of strategies, or conclusions (Table 2).
Monte Carlo simulation assuming perfect uptake, adherence, and follow-up
FIT remained more effective and less costly than mSEPT9-2well and mSEPT9-3well in all iterations. Cost-effectiveness acceptability curves are shown Fig. 2. Compared with no screening, the strategies' median costs/QALY gained and the 95% CIs were $11,600 ($8,200–$16,300) for mSEPT9-2well, and $8,500 ($5,800–$11,600) for mSEPT9-3well. By comparison, the values were $600 (cost saving to $2,900) for sigmoidoscopy/FIT; $570 (cost saving to $2,900) for sigmoidoscopy/FOBT; $2,700 ($300–$5,300) for colonoscopy; and cost-saving in all iterations for FIT, FOBT, and sigmoidoscopy.
Imperfect screening uptake and adherence
Differential screening uptake affected the comparisons between strategies. FIT was no longer more effective than mSEPT9-2well when the FIT uptake rate fell below 70% relative to that of mSEPT9-2well, and it was no longer more effective than mSEPT9-3well when the FIT uptake rate fell below 85% relative to that of mSEPT9-3well. For FOBT, the analogous thresholds were 85% and 95%, respectively. The thresholds at which mSEPT9-3well yielded incremental costs/QALY gained less than $50,000 compared with FIT and FOBT were relative uptake rates of 60% with FIT and 70% with FOBT (Fig. 3).
Differential rates of per-cycle adherence among persons taking up screening also affected the comparisons between strategies. To illustrate, assuming 75% per-cycle adherence with mSEPT9-based screening, mSEPT9-3well yielded incremental costs/QALY gained of less than $50,000 compared with FIT when the per-cycle adherence with FIT was less than 20% (Fig. 4), and compared with FOBT when the per-cycle adherence rate with FOBT was less than 40%.
Projected impact at the population level with imperfect uptake, adherence, and follow-up
Table 2 shows the estimated reductions in colorectal cancer incidence and mortality in a population cohort reflecting current rates of screening uptake and adherence for the currently accepted tests, and colonoscopy follow-up after an abnormal screening test in the United States. If the mSEPT9 blood test were then introduced into the population and it induced some of those who are currently not screened to undergo screening, then this yielded incremental reductions in colorectal cancer incidence and mortality at very reasonable costs/QALY gained (Table 3). However, when mSEPT9-based screening was substituted for other alternatives among some of those currently screened, effectiveness decreased and costs increased, as illustrated for FIT, FOBT, and colonoscopy (Table 3). For every 10 persons switching from the current strategies (in proportion to current use; Table 3) to mSEPT9-3well, more than 6 additional persons would need to switch from no screening to mSEPT9-3well to effect a net gain in QALYs, and a total of more than 13 additional persons would need to switch from no screening to mSEPT9-3well in order for this gain to incur costs of less than $50,000/QALY gained. This shows how the net impact of an emerging screening test at the population level is likely to depend on the degree to which it induces nonscreened persons to undergo screening, and the degree to which it changes the fractions of the population taking up each specific strategy.
Our health economic evaluation of mSEPT9-based colorectal cancer screening compared with established screening strategies offer insights into the potential role of screening with a blood-based biomarker at the population level, and highlights principles applicable to colorectal cancer screening in general. In our analyses, mSEPT9-based screening was effective and cost-effective by traditional standards compared with no screening. However, with current test performance characteristics, screening every 2 years with mSEPT9 was estimated to be less effective and more costly than existing alternatives. At the most favorable extremes of the reported CIs for mSEPT9-3well test performance characteristics (26), which serves to illustrate any emerging blood-based biomarker, mSEPT9-3well screening would need to be carried out yearly at a cost less than $10 to be preferred over FIT by traditional standards, assuming comparable levels of uptake and adherence.
The potential role of screening based on mSEPT9 or comparable biomarkers depends on the setting in which it is offered, and population rates of screening uptake, adherence per screening cycle, and follow-up colonoscopy after an abnormal screening test. From the point of view of a health care system seeking to choose a single testing strategy, FIT emerged as the preferred alternative assuming perfect uptake, adherence and follow-up. Population studies suggest, however, that uptake, adherence and follow-up rates for fecal-based tests are disappointing (10–19). In organized programs, uptake rates have been up to 60% to 80% (37, 38). It is hypothesized that a blood-based test could lead to improved colorectal cancer screening uptake or adherence rates, but this remains to be proven in clinical studies.
In a health care system that accepts multiple colorectal cancer screening strategies, the potential effect of screening based on mSEPT9 or comparable biomarkers depends on the extent to which it increases overall screening uptake as opposed to being substituted for current alternatives, and the relative rates of adherence and follow-up compared with current alternatives. For example, if mSEPT9-based screening were taken up only by persons who are currently not screened at all, then net clinical benefits would be realized at acceptable costs. Alternatively, if a test such as mSEPT9-3well with current test performance characteristics were simply substituted for current alternatives without improvements in adherence or follow-up, then overall effectiveness would decrease and costs would increase. The real effect of screening with mSEPT9 or comparable biomarkers is likely to lie between these extremes.
In most previous modeling studies by us (27, 32) and others (39), colorectal cancer screening strategies have been estimated to be highly cost-effective, but usually not cost-saving. As the cost of colorectal cancer treatment continues to rise (40, 41), certain strategies may actually be cost-saving (42–44). In recent years in the United States, the costs of colorectal cancer care have been increasing (40, 41, 45), whereas Medicare reimbursement rates for screening tests including colonoscopy have been decreasing (46). These opposing trends in colorectal cancer care costs and screening costs are the principal factors behind our and other recent study results that FIT, FOBT, and sigmoidoscopy may be cost-saving in the United States. With this in mind, it is possible that screening with a relatively inexpensive blood-based biomarker could be cost-saving compared with no screening, but its cost-effectiveness against other screening alternatives will depend on the relative test performance characteristics, uptake, adherence, and cost.
Our study has several strengths. Our model is validated against prospective, randomized clinical trials of screening with FOBT (4, 5) and sigmoidoscopy (8, 29, 30), which provides us with some confidence in our model's predictions. The test performance characteristics for mSEPT9-based screening were obtained from a prospective study, and the CIs serve to illustrate a range of potential performance by emerging biomarkers. We examined in detail the effects of imperfect screening uptake, adherence, and follow-up, factors that others have also emphasized recently (47). Our results with perfect uptake, adherence and follow-up represent estimated efficacy under ideal circumstances, whereas our results with imperfect uptake, adherence, and follow-up represent estimated effectiveness under current clinical realities.
Our study has some limitations. The degree of independence between individual tests in a given strategy is not known, and our model assumes independence. For instance, although improvements in mSEPT9 test-performance with 3 wells compared with 2 wells suggest that additional testing provides incremental yield, the true degree of independence between tests from year to year is not known. However, the effect of assuming independence is likely to be most pronounced for strategies with yearly testing, including FOBT, which was the subject of one of our encouraging validation exercises (Supplementary Appendix). We did not model adenoma multiplicity or location, and the number of people with adenomas and colorectal cancer detected by size and stage were not validated in the same way that colorectal cancer incidence and mortality reduction were validated (Supplementary Appendix). Disutilities associated with screening are not included; considering modest disutilities for 1 to 2 days every 1 to 10 years does not affect the results substantially (results not shown). In the real world, screening uptake, adherence, and follow-up are complex at the population and individual level. Instead of pure subpopulations, there is likely a distribution of screening behaviors that may vary over time. The data to inform a model with such complex attributes are not currently available.
In conclusion, colorectal cancer screening with a blood-based biomarker such mSEPT9 is likely to be cost-effective compared with no screening, but with test performance characteristics and costs such as those of the current mSEPT9 tests, established alternatives are likely to be preferred under idealized circumstances of uptake and adherence. Screening uptake, adherence, and follow-up are as influential determinants of the real-world effectiveness and cost-effectiveness of colorectal cancer screening strategies as are the performance characteristics and costs of screening tests themselves. Colorectal cancer screening with blood-based biomarkers offers potential benefits over current methods, but to realize their full potential, blood-based biomarkers will need to achieve a level of performance that is acceptable to clinicians and patients relative to current technologies. As blood-based biomarkers become available clinically, the decision over whether to adopt them will require weighing their costs and possibly lower performance but higher adherence rates, against the alternative of investing in efforts to improve uptake of current strategies.
Disclosure of Potential Conflicts of Interest
U. Ladabaum has a commercial research grant from Epigenomics. S.D. Ramsey has expert testimony in Epigenomics. No potential conflicts of interest were disclosed by the other authors.
The sponsor had no role in the conduct of this study. No future research funding by the sponsor is pending for any author.
Authors' Contributions
Conception and design: U. Ladabaum, M. Wandell, S.D. Ramsey
Development of methodology: U. Ladabaum, M. Wandell, S.D. Ramsey
Acquisition of data (provided animals, acquired and managed patients, provided facilities, etc.): U. Ladabaum, M. Wandell
Analysis and interpretation of data (e.g., statistical analysis, biostatistics, computational analysis): U. Ladabaum, M. Wandell, S.D. Ramsey
Writing, review, and/or revision of the manuscript: U. Ladabaum, J. Allen, S.D. Ramsey
Administrative, technical, or material support (i.e., reporting or organizing data, constructing databases): U. Ladabaum
Study supervision: U. Ladabaum, M. Wandell
Grant Support
This work was supported by an unrestricted research grant from Epigenomics (to U. Ladabaum).
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).
- Received March 1, 2013.
- Revision received May 24, 2013.
- Accepted May 30, 2013.
- ©2013 American Association for Cancer Research.


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SINGAPORE - When a parent often cannot pay his child's pre-school fees, that could indicate that the family faces some problems. But even if the pre-school is aware of this, it may not know how to follow up.
Having a coordinated system in which such warning signs are flagged earlier could help authorities intervene earlier.
The Ministry of Social and Family Development (MSF) is looking into this, to better help vulnerable groups - one of three key priorities that MSF will focus on.
Mr Tan Chuan-Jin, the former Manpower Minister who took over MSF on April 9, said the other two areas are building stronger families and promoting volunteerism.
In his first sit-down interview on Monday in his new capacity, he said MSF is working with the Health and Education Ministries to get data, find patterns to identify vulnerable children and intervene earlier.
This is to "bring them on an even footing... so that they're not disadvantaged because of circumstances", he said.
"Upstream work could mean a world of difference to the possibilities. Not doing some of this will not mean that every child (in such circumstances) therefore is destined to fair poorly, but the probabilities are there. For some, it will be a lifetime of social challenges."
He acknowledged that some may disagree with this approach of early intervention.
"Do you become over-zealous... too much of a nanny state to intervene when perhaps you really shouldn't? But that's where we need to determine how we view these issues. Perhaps by taking steps earlier, could I actually prevent the situation from deteriorating? We're talking about lives here."
While he did not say when these plans would be implemented, he said: "Work is already ongoing and rather than wait till everything is fully cooked... we may want to perhaps push it out faster, and then experiment and learn as we go along."
He also hopes to see better coordination among the different groups that provide help.
He said: "One of the things that gets in the way is actually confidentiality... We protect individuals' data quite seriously and sometimes, there are challenges getting data from different ministries. But when you can't share, it means you may not be as effective as you should be."
Families are changing, he noted. For instance, more one-person households of childless, divorced or widowed individuals are emerging.
So, for some policies which limit the definition of family to immediate family members, "we may need to redefine some of these parameters", to make it easier for people to support their relatives, he said.
"Where does family start and where does it end, especially when these (family) structures unravel? I'm not sure it's something for the Government to pronounce. Society needs to grapple with these issues because it reflects our sense of values and it has ramifications for policies ."
He also wants to have more people involved in volunteering. Some are reluctant to do so as they feel that they are not trained or cannot commit their time, he said.
So one way to get them involved could be creating avenues in which they can volunteer "in a fairly straightforward manner, because there's a lot of work done that actually doesn't need trained personnel to do", such as befriending the elderly.
And helping others benefits the volunteers themselves too, he said.
He recalled how meaningful his soldiers found working with prison inmates to pack goodie bags for National Day celebrations in 2009, which he helped organise.
Referring to a recent viral video of elderly abuse, he encouraged people to report such cases to the authorities.
"If in doubt, err on the side of being a bit more kiasu... Step forward. When you identify individuals who seem to need help, talk to them.
"If you can get details and if you feel that it sounds like this individual needs help, let us know. That's really important because we will follow up on every of these cases."


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The base Sierra 1500 Regular Cab is fairly sparse, with only manual windows and mirrors and a four-speaker radio as standard. In higher trims, you may find features like dual-zone automatic climate control, GMC's IntelliLink touch-screen infotainment system, an upgraded Bose stereo system, navigation, five USB ports, and satellite radio. The IntelliLink system is well-regarded for its ease of use.
Read more about Sierra 1500 interior »
The price of a used 2014 GMC Sierra 1500 ranges from about $17,800 for the base two-wheel-drive Regular Cab with a 78-inch box to around $31,500 for the four-wheel-drive Double Cab SLT trim. Prices vary depending on the vehicle's condition, mileage, features, and location.
Our used car rankings and reviews are not based on our own opinions. Instead, we collect and analyze information like safety and reliability reports, total costs of ownership, and the views of the automotive press. We reviewed 12 professional reviews for this 2014 GMC Sierra 1500 overview to help you make a buying decision.
U.S. News & World Report has been ranking cars, trucks, and SUVs for a decade, and our Best Cars team has more than 75 years of combined experience in the automotive industry. To ensure our impartiality, we don't accept expensive gifts or trips from carmakers or dealers, and an outside team handles our site's advertising.
The 2014 GMC Sierra 1500 has a reliability score of 3.5 out of five. That's above average for the industry as a whole.
Read more about Sierra 1500 reliability »
The National Highway Traffic Safety Administration awarded the 2014 Sierra five out of five stars overall and four stars in the rollover crash test. The Insurance Institute for Highway Safety gave the Sierra the highest rating of Good in all four crash tests conducted.
Trailer sway control is a standard active safety feature. Available features include a rearview camera, front and rear parking assist, forward collision warning, lane departure warning, and a safety alert seat that tells you when you are drifting outside your lane or if a vehicle is in your blind spot.
See Sierra 1500 safety scores »
The 2014 GMC Sierra 1500 is the first model year of the third generation. It was newly redesigned. The 2015 model will cost a bit more, but you may want to consider it to get Siri Eyes Free and an available 4G LTE hot spot.
Compare the 2014 and 2015 Sierra 1500 »
The 2014 GMC Sierra 1500 comes in four trim levels (Sierra, SLE, SLT, and Denali), three cab sizes (Regular, Crew, and Double), and three bed lengths (68, 78, and 96 inches). The base Sierra 1500 features a locking tailgate, rear bumper corner steps, a 3.5-inch driver information display, a 4.2-inch radio display with a USB port, and a six-speaker sound system. The GMC Sierra 1500 SLE trim adds a 4.2-inch driver info center, OnStar, satellite radio, an easy-opening tailgate, pickup bed lighting, a rearview camera, and lockable under-seat storage. The SLT has 10-way power, heated leather seats; a standard V8 engine; a 110-volt power outlet; remote start; and manual tilt and telescoping steering. The top-of-the-line Denali trim has a standard 8-inch customizable instrument panel and an 8-inch touch screen with navigation, which is the main hub for Bluetooth phone and audio. The Sierra Denali also has five standard USB ports. You'll find the SLE trim meets most of your needs, unless you need the standard SLT's V8 power for more towing capacity.
Even with the Sierra's above-average reliability, you might want to consider a certified pre-owned model. For all of its certified pre-owned models, GMC extends its original new-car limited powertrain warranty to six years or 100,000 miles and provides a one-year/12,000-mile bumper-to-bumper limited warranty. GMC CPO vehicles must pass a 172-point inspection. Additional benefits like towing and roadside assistance may be available, so read GMC's warranty page carefully.
Read more about certified pre-owned vehicles »
Read more about the GMC certified pre-owned program »
The 2014 Chevrolet Silverado 1500, like the GMC Sierra 1500, was a fully redesigned model. The same engines are offered in the GMC and the Chevy, but the Silverado's suspension is better tuned when towing heavy weights, and it has a more composed highway ride. The GMC, however, is the more upscale of the two, with a quieter interior and first-rate cabin materials.
The 2014 Ram 1500 and GMC Sierra 1500 are closely matched. The few key differences will help make your decision. Both vehicles offer quiet, upscale materials and powerful engines, but the Ram is the only full-size truck with an available diesel. The Sierra can tow and haul more, and it outclasses the Ram in crash tests. Rams tend to cost a little less, so it may be a better choice if your budget is tight. But if you need lots of towing and hauling capacity and are concerned about crash test scores, the Sierra's the way to go.
Use our tools to calculate monthly payments or figure out which cars you can afford.Calculate 2014 GMC Sierra 1500 Monthly Payment Calculate 2014 GMC Sierra 1500 Monthly Lease Payment Which Cars You Can Afford?
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Twenty tech entrepreneurs have been chosen for a new accelerator program run by PwC and backed by some of Australia's largest corporates that aims to rapidly scale Australia's most promising science, technology, engineering and maths (STEM) education initiatives.
"The quantity and quality of applications received proves overwhelming that, not only is there a need for support to get STEM education initiatives off the ground, but that there is depth of innovative talent out there. The business community just needs to nurture and support that talent," PwC Managing Partner Tony Peake said.
"That's why PwC is collaborating with businesses and investing over $2.5m in cash and in-kind services in our 21st Century Minds Accelerator program over the next 18 months. I'm tremendously excited by our winners. Any one of them can help to lift STEM education nationally and internationally."
Australia's Chief Scientist Dr Alan Finkel welcomed investment in the workforce of the future.
"Thousands of Australian students can be entrepreneurs if we open their minds and nurture their talent," Dr Finkel said.
One initiative of those selected is an easy-to-use 3D design software and complete 3D printing program for K-8 classrooms, which recently won government support through the first round of Accelerating Commercialisation grants awarded by the Department of Industry last year.
"Government support has really helped us to expand a lot faster than we'd anticipated, and the 21 Century Minds Accelerator will help us go the next step. We're very excited about the opportunity to work with PwC and Education Change Makers to help us get a better foothold in the NSW and Victorian market. The connections and credibility the program brings will be an enormous help to Makers Empire," Jonathan Soong said.
3D printing is a gateway for more females to study STEM subjects Soong adds. "More girls go into design than coding and 3D printing is a bridge between the two."
Other winning initiatives are targeted at primary school children to university graduates and include an app that turns playgrounds into STEM exploration spaces, robotics and coding workshops, virtual learning environments, and initiatives that incorporate a focus on improving outcomes for under-represented groups, including females, Indigenous Australians and students from low socio-economic backgrounds.
Support for finalists in 2016 will include:
Melodie Potts Rosevear, Founder and CEO of Teach For Australia, who are supporting the program, said: "We are honoured and excited to be taking part in the PwC's 21st Century Mind's Accelerator Program and have high hopes for this unprecedented and important initiative to collectively harness the potential of young Australians to become the next generation of STEM leaders."
The accelerator program is being supported by the Office of the Chief Scientist, Google, Microsoft, NAB, BP, GE, Monash University, Social Ventures Australia, AI Group and CPA Australia and Chartered Accountants ANZ.
Read more about the 21st Century Minds Accelerator program.
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At PwC Australia our purpose is to build trust in society and solve important problems. We're a network of firms in 157 countries with more than 208,000 people who are committed to delivering quality in assurance, advisory and tax services. Find out more and tell us what matters to you by visiting us at www.pwc.com.
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About Us
Welcome to Bristol's newest space for events! Spread over 5 rooms, "The Tea Room", "The Pantry", "The Parlour", " The Cabinet" & "The Carousel" including 2 bars, dining rooms, and plenty of space to put on a great party.
The Cloak and Dagger is a brand new cafe bar and grassroots event venue in the heart of Bristol's Independent District. We are still relatively new and in our incubation months.
Over the past five years we have seen many venues close in Bristol due to high rates and also to make way for student accommodation. There is a demand for smaller venues to arise- we are one of those!
We are a small ambitious team with decades of experience in the industry who are working on utilizing the building to its maximum potential. We have programmed a calendar packed with weekly events and activities and have generated appeal and customer base from successful past events and serving good quality food and drinks.
Regular events include- weekly magic shows, therapy drop ins, gigs & club nights, markets, workshops and social activities such as private parties, baby showers and hen dos. The majority of our events are free to enter.
The venue is a beautiful, versatile and eccentric space, spread across 2 floors. The Cloak rooms are ideal for dining, cinema and daytime events and the Dagger rooms are designed for partying into the early hours.We are also very proud of our weekly menu which is thoughtfully prepared by Masterchef finalist Sebastian Merry, who is passionate about serving fine dining, that is affordable as well as sustain-ably sourced.


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Refrigerator Repair Basics
Affordable Refrigerator repair folks are available, and they're just one click away. Refrigerator repair is just one of the responsibilities you have when you own this kind of appliance. What you have first to do should you wish to do a DIY refrigerator repair is to check for the outer regions of the large kitchen appliance.
Choosing Good Refrigerator Repair
Refrigerators are among the largest appliances in your house, and their complexity makes them prone to any range of malfunctions. Excellent refrigerator or fridge repair companies monitor their services very carefully so they can mitigate any shortcomings in their expert services.
The pricier the refrigerator, the costlier the repair will be. Therefore, the refrigerator repair can address the typical problems very fast and efficiently. Refrigerator repair in this U.S Appliance Repair company is famous for the bit of service we provide. We are widely known for our trust, in addition to the reliability of service.
Your refrigerator isn't an exception. Refrigerators store food, beverages, and eatables, so they have to stay fresh for a long duration of time. In case the refrigerator has stopped working, it could be better to get hold of a certified repairman to look into the origin of the issue. A noisy refrigerator is not only annoying but also embarrassing when guests come over. Refrigerators are important portions of our life.
Details of Refrigerator Repair
The Quality of Refrigeration Repair
Your refrigerator is just one of the appliances in your house that you depend on the most. In both the residential and business markets, your refrigerators will probably be among the most significant factors in your kitchen. They are probably essential kitchen equipment. In reality, your refrigerator is going to be repaired within the day, and that means you will be back to storing food soon. For instance, if you've got a high-end Sub-Zero refrigerator, it might be advisable to have one of our seasoned service technicians that are directly connected to Sub-Zero refrigerators.
Out of the entire appliance to break down, the refrigerator is easily the most inconvenient. Refrigerators are among the important kitchen change. Your refrigerator is just one of the most significant appliances in your residence. On the flip side, if the refrigerator does not have sufficient cold temperature, do not neglect to appear first at the setting. Without regard to the path you take, you'll wind up with a functioning refrigerator which lets you get your domestic routines back on course.
Refrigerators will stay cool inside for several hours. So, whenever your refrigerator isn't cooling correctly, that is hugely problematic. Refrigerators help civilized men in distinct ways. Then see if a specific portion of the fridge is damaged physically. Repairing a refrigerator demands technical wisdom and expertise. Whenever your refrigerator is not functioning, it can pose as a costly problem as it might result in food to spoil. Frequently the whole refrigerator will want to get emptied to make sure everything is correctly dried.
Why Choose A+?
• Same Day Efficient Service and Next Day Repairs
• Absolute Professionalism committed to Customer Service Excellence
• No hidden fees or bait & switch - put it all on paper
• Best customer loyalty service programs
• Most competitive local rates serving Broward and Palm Beach County
• We Work nights and weekends
• Every make and model appliance serviced & repaired
• On Time and On Budget Service - We value you too
• 100 % Satisfaction Guaranteed Service & Repairs - no fine prints
Contact A+ Appliance Repairs when you are in need of appliance service or appliance repair! We have skills above the rest and our technicians are here to make you at ease. Troubleshooting problems and quickly identifying the problem is the A+ way. We are the full service Appliance Repair Company for you!
Proudly serving Broward County:
Fort Lauderdale, Sunrise, Pompano Beach, Hallandale Beach,
Coral Springs, Hollywood, Miramar, Pembroke Pines, Davie, Southwest Ranches, Cooper City, Deerfield Beach, Margate, Weston, Lauderhill, Tamarac, North Lauderdale, Plantation, Dania Beach, Wilton Manors, Lauderdale by the Sea, Lauderdale Lakes, West Park, Pembroke Park, Lighthouse Point, Sea Ranch Lakes, Broadway Park, Lazy Lake, Sunshine Acres, Roosevelt Gardens, Boulevard Gardens, Franklin Park, Washington Park, Hillsboro Pines, Hillsboro Beach, Pine Island Ridge
Proudly serving Palm Beach County:
Palm Beach, West Palm Beach, Boca Raton, Palm Beach Gardens, Delray Beach, Jupiter, Boynton Beach, Lake Worth, Wellington, North Palm Beach, Royal Palm Beach, Riviera Beach, Palm Springs, Belle Glade, Lantana, Greenacres, Juno Beach, Manalapan, Tequesta, Pahokee, Palm Beach Shores, Highland Beach, Lake Park, South Palm Beach, South Bay, Gulf Stream, Loxahatchee Groves, Ocean Ridge, Briny Breezes, Jupiter Inlet Colony, Hypoluxo, Lake Clarke Shores, Mangonia Park, Westgate-Belevdere, Golf, Limestone Creek, Canal Point, Cloud Lake, Royal Palm Estates, Lake Belvedere Estates, Schall Circle, Stacey Street, Juno Ridge, Kings Point, Lake Harbor, Atlantis, Aberdeen, Haverhill, Dunes Road, Glen Ridge


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Excommunication is a 15 letter word which starts with the letter E and ends with the letter N for which we found 1 definitions.
|(n.) The act of communicating or ejecting; esp. an ecclesiastical censure whereby the person against whom it is pronounced is for the time cast out of the communication of the church; exclusion from fellowship in things spiritual.


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Every woman has an essential piece of makeup that she never leaves the house without. And although we admire the few ladies that are brave enough to go out au naturale, we're still not ready to take that bold step. Sadly, that means we put all these products on our face every day to give us a little confidence boost and we're slowly, but surely, doing harm to the skin which we try so hard to keep looking beautiful. To help remedy that, we rounded up a few homemade makeup recipes that you can make at home, so you'll know exactly which ingredients are used and make sure you keep yourself healthy.
Crayon Lipstick
If you've ever had trouble finding just the right shade that greatly flatters you, it might be easier to try and make your own lipstick. There are crayons in a huge variety of colors, and with this common household item, you can mix the perfect color for you. Go crazy and have fun with unusual colors you won't find on the market!
Natural Eyeliner
This recipe is wonderful easy and you'll need only two ingredients. To achieve a glamorous look, smokey eyes or the classic cat eye look without irritating your eyes, use this natural version of the popular eyeliner.
Cream Pigment Eyeshadow
Again, you have the freedom to choose any shade that best complements your eye color. Try this pigment eyeshadow that's rich in color, but goes on smooth like a cream eyeshadow.
Natural Blush
Although sometimes you might think you can skip this product because you see no drastic changes to your face when you apply it, that is a huge mistake. Blush really freshens up your face and it's an essential part of your look. Get your own, natural blush by following this recipe.
Homemade Makeup Natural Mascara
The most important product in your makeup bag. You put mascara on your eyes, which is a very sensitive area, so if you decide to make any natural makeup product, this is the one to go with. This mascara not only darkens the lashes, but also adds a bit of fullness.
Use this bronzer to contour your face, enhance your bone structure and give your skin a golden glow. Follow these instructions and you'll be able to have a warm, sun-kissed complexion in no time.
Kool-Aid Lip Gloss
Well, this is a great idea. As with the eyeliner you'll only need two ingredients for this recipe, and using Kool-Aid for making lip gloss is really simple and also makes it smell great.


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Several structural barriers make it difficult for government officials and academic researchers to engage collaboratively in evidence-based policymaking. These include a lack of common language for discussing programs, limited methodological strategies for establishing causation without randomized control trials (RCTs), and data-sharing restrictions. The Causal Inference for Social Impact Lab (CISIL) finds solutions to these barriers and enhances academic-government collaboration.
The Lab is led by 2018-19 CASBS fellow Jake Bowers, 2017-18 CASBS fellow Carrie Cihak, and CASBS program director Betsy Rajala.
CISIL has received funding from SAGE Publishing, the Knight Foundation, and the Alfred P. Sloan Foundation.
For more information, please contact CASBS program director Betsy Rajala (firstname.lastname@example.com).
CISIL Overview
75 Alta Road
Stanford CA, 94305 USA
+1 (650) email@example.com
Webcast SeriesPodcastFeatured StoriesNewslettersBrochuresDirections to CASBSMember Site
© Stanford University, Stanford, California 94305.


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Students in Stephanie Natale-Boianelli's Composition I classes this fall read essays from the This I Believe project (www.thisibelieve.org) and examined what they revealed about effective writing. Students then wrote their own This I Believe essays. Atlantic Cape CommuniCator will share some of the best essays. This essay comes from Sara France, a Nursing major and online Composition I student:
Mastiffs Are the Perfect Family Dog
I believe dogs are an important part of the family. I have had the pleasure of being owned by several Mastiffs ranging in size from one hundred-ten pounds to a monstrous one hundred and eighty-five pounds. Their size and intimidating looking features tend to mislead people into thinking they are dangerous. The sad look found in their eyes can be confused with being unhappy or angry; however nothing could be further from the truth.
To put their size into perspective, imagine one of my Mastiff's named Kovu, an enormous dog with a square-shaped head. He had big, droopy jowls, and a very muscular body. He could scare the living daylights out of any mailman with his fierce looks, but those who were familiar with him knew he was actually a big baby. He would tower over my three year old daughter while gazing down on her as though she was his reason for living. He was there to protect her.
Guarding their family is a natural instinct for this breed. These dogs are lovable and loyal. Gigantic as they may be in size, the love they give their family is just as abundant. My life has been enriched by their devoted companionship. Another Mastiff I have named Holly comes to the bus stop with me to pick up my children. She sits by my side, no leash required. She waits contently and greets my kids as though she hasn't seen them in weeks. She enjoys giving hugs and to do that she must stand on her hind legs placing her massive paws on one's shoulders.
Though they were bred to be guard dogs, they often tend to be couch potatoes. Sleeping is one of their favorite pastimes. Holly can often be found snuggled next to me snoring comfortably on her soft royal orthopedic bed. When Holly isn't getting her beauty sleep, she likes to eat from her elegantly raised serving dishes. Her consistent devotion to my family earns her nobility in my house. Her majestic and stately demeanor earns her the best food and veterinary care.
One of my favorite things about Mastiffs is that they are always ready to cuddle. All I have to do is mumble cute phrases to them, and they flip on their backs inviting an old fashioned belly rub. When not relishing in a belly rub, Mastiff's enjoy going for short walks. I am used to seeing heads turn and then hear, "Hey, do you use a saddle for that thing?" I laugh and smile. I love it.
Mastiffs love to be included in family events. My dogs have camped, gone on vacations, visited dog parks, and even ran through the waves at the beach with my kids. They are very calm, and nothing bothers this breed. They rarely bark and require little exercise. They can adapt to any type of living arrangement. They are well-behaved and dignified. I am proud to share my home with one of these gentle giants.
Simply put, I believe that an enormous Mastiff can be the perfect family dog.


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The Asian Cities Climate Change Resilience Network (ACCCRN), funded by the Rockefeller Foundation and technically managed and coordinated by the Institute for Social and Environmental Transition (ISET), officially started working in Vietnam in 2008 with the engagement of three medium-sized cities Can Tho, Da Nang, and Quy Nhon (Binh Dinh province), with intervention projects starting in 2010.
These are highlights of some results and achievements of ACCCRN implementation in these three cities in infographic. To read full article, please go to this link.
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Inside Scoop
Product Description
Derik Girdwood weaves a serpentine and suspenseful tale in his revised novel as he exposes the twisted theological teachings of some popular televangelists and churches as they try to portray man with the divine nature that the true Gospel reserves only for God. Christina, aged eighteen, has been admitted to a Bible college and intends to become a mighty servant and warrior for God. Christina s college roommate, Becky, is dating the pastor s son and becomes pregnant. A few weeks later the college announces that Becky has committed suicide. A no-nonsense detective informs Christina that Becky was murdered and Christina is a suspect in Becky s brutal death. Christina s journey is fraught with twists and turns, but she eventually succumbs to the Jezebel spirit only to find that it almost destroys her. The novel culminates in a mission to Haiti, where nothing is what it seems, and a scandal develops that involves the highest levels of the megachurch. The Church of Jezebel cites appropriate scripture and examines the Jezebel spirit, false prophets, word-faith doctrine, faith healing, Christ-consciousness, and other beliefs that are so heavily promoted today by many popular and emerging televangelists and churches. A must-read for every Christian.
More Product Information
- Publisher: Outskirts Press
- Release Date: November 11, 2010
- Pages: 244
- Language: English
- Binding: Paperback
- Height: 0.55 inches
- Width: 5.98 inches
- Length: 9.02 inches
- Weight: 0.80 pounds


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Little Steamers
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Relive the Golden Age of Toy Trains
Relive the Golden Age of Toy Trains
Little Steamers in Monona, Iowa is here to bring back the glory of toy trains. Allow us to take you for a ride as we show you some of the 1946-1966 A.C. Gilbert Company American Flyer trains we have in store. We also have new, used, and reproduction parts to rebuild and complete your train set. Buckle up and enjoy a blast from the past!


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Fun, Playful, Exciting or Peaceful…
Decorative wallpaper for your kids is an ideal way to make your child's room the perfect play-place. We have a wide range of decorative kids wallpapers to choose from and there is something for everyone. Pirates, mermaids, Dots and stripes – where you would like to start? Stripes are fabulous for creating space and they create a classic feel which will never date. Ditch the plain painted walls and add some character to your child's walls. Kids Wallpaper is extremely fashionable and here to stay.
Select a pattern you like — playful, fun or dotty and let your imagination run wild. Boring playroom walls can be transformed into beautiful feature pieces and gloomy areas are brought back to life with the right choice of wallpaper. Unique Impressions are reputable wallpaper suppliers, contact us today!
"Only children believe they are capable of everything." – Paulo Coelho
Décor Kids Wallpaper is manufactured from an eco-friendly base and applied with eco-friendly, water-based adhesive. Our products are manufactured using the latest European technology and material.
Areas where this wallpaper can be used: