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J Cancer 2017; 8(9):1665-1672. doi:10.7150/jca.19197
Evaluation of 7th Edition of AJCC Staging System for Nasopharyngeal Carcinoma
YuFeng Ren1*, Huizhi Qiu2*, Yujie Yuan3, Jinning Ye3, Yunhong Tian2, Bixiu Wen1, Weijun Zhang2, Qun Li4, 5
1. Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P.R.China;
2. Department of Radiotherapy, cancer center of Guangzhou medical university, Guangzhou 510080, P.R.China;
3. Center of Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P.R.China;
4. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R.China;
5. Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, P. R. China.
* These authors contributed equally to this work.
This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) license (https://creativecommons.org/licenses/by-nc/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Ren Y, Qiu H, Yuan Y, Ye J, Tian Y, Wen B, Zhang W, Li Q. Evaluation of 7th Edition of AJCC Staging System for Nasopharyngeal Carcinoma. J Cancer 2017; 8(9):1665-1672. doi:10.7150/jca.19197. Available from http://www.jcancer.org/v08p1665.htm
Purpose: To evaluate and improve the 7th edition International Union against Cancer/American Joint Committee on Cancer staging system for nasopharyngeal carcinoma.
Methods: A retrospective review of the data from 905 patients with biopsy-proven non-disseminated nasopharyngeal carcinoma was performed. All the patients were examined by magnetic resonance imaging (MRI) and received radiotherapy.
Results: Satisfied distributions among the stages were observed in the 7th edition staging systems. LRFS only differed in classifications betweenT1 and T3, T1 and T4 (P=0.022 and P=0.016, respectively). Significant differences were observed between patients without and with masticator space involvement for OS, DMFS and PFS (p<0.05). No statistically significant differences in LRFS were observed among different groups with anatomical masticator space involvement. The DMFS between N2 and N3b, N3a and N3b were lack of significance (P=0.060 and P=0.59). The T category and N category were independent prognostic factors for the major endpoints in the Cox multivariate regression analysis (P<0.01).
Conclusion: This study confirmed the prognostic value of the 7th edition UICC/AJCC staging system, the revisions of the 7th edition staging system are acceptable. However, our study also revealed limitations in the current staging system and suggested some potential modifications in future revision.
Keywords: Nasopharyngeal carcinoma, American Joint Committee on Cancer, Staging system, prognosis.
Nasopharyngeal carcinoma (NPC) is one of the most prevalent malignancies of head and neck in Southeast Asia and southern China, with a high incidence of about 25-50/105 individuals per year [1-2]. Distant metastasis and recurrence occur frequently in NPC after treatment [3-5]. The nasopharyngeal carcinoma TNM staging system is crucial for evaluating the prognosis, guiding treatment strategy for different risk groups and facilitating exchanging experiences between multiple treatment centers [6]. However, there was no worldwide accepted staging system for NPC until the merge of the International Union against Cancer (UICC) and the American Joint Committee on Cancer (AJCC). UICC/AJCC staging system, amalgamating both Western and Eastern experiences and advocating the staging system, was widely used in the past several decades. The stage assignment and disease prognosis are affected by the improvement of diagnostic and therapeutic technology [7]. Revision is a factor that makes the TNM system the most clinically useful staging system and accounts for its worldwide use [2]. Thus, the UICC and AJCC periodically modify the TNM system in response to newly acquired clinical data and prognostic factors [6].
The most recently advocated 7th edition of UICC/AJCC for nasopharyngeal carcinoma is a common set of recommendations from the revision of the previous 6th edition. Several recommendations that derived from the 6th edition [8-9] have been advocated. Patients with oropharynx and nasal fossa involvement, which were T2a category in the 6th edition, are reclassified to T1. Anatomic masticator space involvement is categorized into T4. In the 6th edition UICC/AJCC staging system, the term ''masticator space'', defined as extension beyond the anterior surface of the lateral pterygoid muscle or beyond the posterolateral wall of the maxillary antrum and/or the pterygomaxillary fissure, was a synonym of infratemporal fossa. Compared with the 6th edition, the 7th edition adopted the description "primarily the muscles of mastication (the medial and lateral pterygoid, masseter and temporalis) enclosed by the superficial layer of the deep cervical fascia", as defined in classical radiological textbooks. Retropharyngeal lymph node is also clarified in the 7th edition staging system. Retropharyngeal lymph node invasion, regardless of unilateral or bilateral location, is staged as N1.
Several studies have confirmed that the current 7th edition staging system for NPC is acceptable, though there are limitations that need further modification [10-11]. However, the follow-up periods of these studies were relatively short. In this retrospective study, we aimed to assess the prognostic value of the 7th edition staging systems in nasopharyngeal carcinoma with a long-term follow-up.
Patients' characteristics
Between October 2004 and December 2005, 905 patients with newly diagnosed, untreated, non-disseminated NPC were included in this study. All patients underwent a pretreatment evaluation that includes a complete patient history, physical and neurological examinations, hematologic and biochemistry profiles, and MRI of the nasopharynx and neck, chest radiography and abdominal ultrasonography. Medical records and imaging studies were analyzed retrospectively, and the NPC stages of all patients were classified according to the 7th edition of the UICC/AJCC staging system.
Among these 905 patients, 520 (57.5%) patients underwent conventional two-dimensional radiation therapy, 246 (27.2%) patients underwent three-dimensional conformal radiation therapy (3D-CRT), and 139 (15.4%) patients underwent intensity-modulated radiation therapy (IMRT). The techniques of thermoplastic mask, low melting-point lead block, multi-leaf collimator (MLC) and source axis distance (SAD) were applied to radiotherapy. 6-8 MV supervoltage X rays generated by a linear accelerator were used for external irradiation. During the two-dimensional conformal radiotherapy, conventional fraction was given, and the dose for the primary lesion in the nasopharynx was 66 ~ 76 Gy/33 ~ 38 F. The dose for the cervical lymphatic drainage area was 50 ~66 Gy/25 ~ 33 F. supervoltage X rays added beta-rays were used to compensate the dose in consideration of skin and subcutaneous tissues in the neck. The prescribed radiation dosage of 3D-CRT were defined as follows: GTVnx (nasopharynx gross tumor volume): 65-70 Gy; GTVnd (positive neck lymph nodes volume): 60-70 Gy; CTV60 (clinical target volume 60): 60 Gy; CTVnx50 (nasopharynx clinical target volume 50): 50 Gy; CTVnd50 (neck nodal clinical target volume): 50 Gy. The prescribed radiation dosage of IMRT was defined as follows: 68 Gy in 30 fractions to the planning target volume (PTV) of the primary gross tumor volume (GTV-P), 60 to 64 Gy to the PTV of nodal gross tumor volume (GTV-N), 60 Gy to the PTV of CTV-1, and 54 Gy to the PTV of CTV-2 and CTV-N. In case of residual tumor confined in the nasopharyngeal cavity after external irradiation, afterloading irradiation was given at the dosage of 10-15Gy by 2-3 fraction. A total of 655 (72.4%) patients received chemotherapy, including various regimens of concurrent chemotherapy in combination with either neoadjuvant chemotherapy or adjuvant chemotherapy. Neoadjuvant or adjuvant chemotherapy consisted of two cycles of cisplatin with 5-fluorouracil or cisplatin with taxanes for every 3 weeks. Concomitant chemotherapy consisted of cisplatin given on weeks 1, 4, and 7during the radiotherapy (RT) process, or cisplatin given weekly (Table 1). Salvage treatments (including intracavitary brachytherapy, surgery, and chemotherapy) were provided in the events of documented relapse or persistent disease when necessary. Details of the radiation therapeutic techniques used at the Cancer Center of Sun Yat-sen University have been previously described [12-14].
Characteristics of 905 patients
N=905
male 698 (77.2%)
female 207 (22.8%)
Age(Y)
Median age 46
range 16-78
ECOG PS
0-1 886 (97.9%)
2 19 (2.1%)
Histological type
Who Ⅰ 38 (4.2%)
Who Ⅱ/Ⅲ 867 (95.8%)
Two-dimension radiotherapy 520 (57.5%)
Three- dimension radiotherapy 246 (27.2%)
IMRT 139 15.3%)
RT dose (Gy)
nasopharynx 70 (66-76)
lymphonode 60 (50-66)
no 250 (27.7%)
induction 280 (30.9%)
induction +CCRT 128 (14.2%)
induction +CCRT +adjuvant 19 (2.1%)
induction + adjuvant 12 (1.3%)
CCRT 191 (21.2%)
CCRT +adjuvant 21 (2.3%)
adjuvant 3 (0.3%)
Follow-up and Statistical analysis
The follow-up duration was calculated from the first day of treatment to either the day of death or the day of the last follow-up. Patients were examined at least every 3 months during the first 2 years; thereafter, a follow-up examination was performed every 6 months for up to 5 years or until death. The time of last follow-up was January, 2015 and the median follow-up period was 86.4 months (range, 1.4-120.4 months).
All events were measured from the date of commencement of treatment. The following end points (time to the first defining event) were assessed: OS, LRFS, DMFS, and PFS. Local recurrence was confirmed by fiberoptic endoscopy and biopsy or only MRI. Distant metastases were diagnosed on the basis of clinical symptoms, physical examination, and imaging, including chest radiography, bone scanning, MRI, and abdominal sonography.
All statistical analyses were conducted with Statistical Package for the Social Sciences (SPSS) 16.0 software (SPSS Inc., Chicago, IL). The survival rates were calculated by the Kaplan-Meier method, and survival differences were compared by the log-rank test. Multivariate analyses with the Cox proportional hazards model were used to calculate the hazard ratio (HR) and test independent significance by backward elimination of insignificant explanatory variables. Host factors (age and sex) were included as covariates in all tests. The criterion for statistical significance was set at p<0.05, 2-tailed T-test.
Patient characteristics and treatment toxicity
According to the 7th edition of UICC/AJCC staging system, balanced distributions could be achieved among different stages. The distribution of the stage groups for the whole series was 6.0% for stage I, 22.1% for stage Ⅱ, 35.7% for stage Ⅲ, 30.9% for stage Ⅳa, and 5.3% for stage Ⅳb. That is, 28.1% of patients were classified as early-stage (stage Ⅰ and stage Ⅱ), and 71.9% of patients were classified as advanced-stage (stage Ⅲ and Ⅳ). Table 2 lists the T and N distribution data. Among the 905 patients, the 10-year OS, LRFS, DMFS and PFS were68%, 87%, 85% and 75%, respectively. Altogether 256 patients died before the end of the study, 91 patients experienced recurrence, 125 patients experienced distant metastases, and 12 patients experienced both locoregional recurrence and distant metastases. Late toxicities of cervical subcutaneous fibrosis, xerostomia, trismus, otologic toxicities and radiation encephalopathy could be evaluated in 832, 507, 72, 660 and 63 patients, respectively.
Distribution of T categories and N categories of the 7th edition UICC/AJCC NPC staging system
UICC2009T
UICC2009 N 0 54 (6) 30 (3.3) 47 (5.2) 50 (5.5) 181 (20)
1 75 (8.3) 96 (10.6) 141 (15.6) 165 (18.2) 477 (52.7)
2 28 (3.1) 41 (4.5) 65 (7.2) 65 (7.2) 199 (22)
3a 1 (0.1) 3 (0.3) 9 (1.0) 5 (0.6) 18 (2)
3b 7 (0.8) 8 (0.9) 10 (1.1) 5 (0.6) 30 (3.3)
Total 165 (18.2) 178 (19.7) 272 (30.1) 290 (32.0) 905 (100)
Prognostic value of T classification
According to the 7th edition staging system, there were significant differences of OS between classifications T1 and T3, classifications T1 and T4, classifications T2 and T3, and classifications T2 and T4 (P<0.001 for all models, details shown in figure 1a). However, LRFS only differed between classifications T1 and T3, T1 and T4 (P=0.022 and P=0.016, respectively). A marginal difference of LRFS was observed between classifications T2 and T3, T2 and T4 (P=0.051 and P=0.047, respectively, details shown in figure 1b).
(a) Overall survival and (b)Local relapse-free survival by T-category in 905 non-disseminated patients
The T classification was an independent prognostic factor of local treatment failure and overall treatment failure in COX multivariate regression analysis (P<0.01). Hazard ratio of T categories by multivariate analysis was showed in Table 3.
Hazard ratio of T categories by multivariate analysis
T category
Disease failure
HR (95%CI)
Local failure
T1 1 1
T2 1.266(0.707-2.268) 1.151(0.516-2.569)
Significant differences were observed between patients without and with masticator space involvement for overall survival (72% vs. 52%, p<0.01), distant metastasis-free survival (87% vs. 81%, p=0.032) and progress-free survival (77% vs. 70%, p=0.018). There were no differences observed for local relapse-free survival (88% vs. 86%, respectively; p=0.474). In addition, in order to investigate the prognostic significance and various classifications for anatomic masticator space involvement (MSI), patients with anatomic masticator space invasion were divided into two groups: Group 1, with medial and/or lateral pterygoid muscle involvement; Group 2, with infratemporal fossa involvement. There were no statistically significant differences between those groups in LRFS, DMFS and PFS (P=0.234, P=0.075 and P=0.062, respectively), except OS (p=0.002). To verify the effect of different MSI classification on patients, patients treated with 3D-CRT/IMRT and patients treated with 2D-CRT were analyzed separately. There were 385 cases in 3D-CRT/IMRT population, 73 with medial and/or lateral pterygoid muscle involvement and 14 with infratemporal fossa involvement. The result showed no statistical significances among LRFS (p=0.904), DMFS (p=0.158) and PFS (p=0.233), while a marginal significant difference in OS (p=0.046) was observed. However, in the 2D-CRT group, significant differences in LRFS (p=0.036) and OS (p=0.015) were observed.
Prognostic value of N classification
The long-term DMFS and PFS show well segregation between N classifications. The N3a has a lower OS and DMFS than N3b. However, the reliability of these results might be limited because of the small number of patients within these subgroups.
According to the 7th edition staging system, significant differences of OS were achieved between N subsets except for those of classifications N1 and N2, classifications N3a and N3b (P=0.069 and P =0.903, details shown in figure 2a), and significant differences of DMFS were achieved except for those of classifications N2 and N3b, classifications N3a and N3b (P=0.060 and P =0.590, details were shown in figure 2b). Hazard ratio of N categories by multivariate analysis was showed in Table 4.
The N classification was an independent prognostic factor for distant and overall failure in COX multivariate regression (P<0.001).
Hazard ratio of N categories by multivariate analysis
Ncategory
Distant failure
N0 1 1
N1 2.030 (1.282-3.215) 3.647 (1.668-7.973)
N2 2.792 (1.704-4.572) 5.980 (2.674-13.373)
N3a 6.249 (2.873-13.592) 16.203 (5.866-44.756)
N3b 4.886 (2.416-9.883) 11.943 (4.542-31.405)
(a)Overall survival and (b)distant metastasis-free survival by N-category in 905 non-disseminated patients
(a) Overall survival and (b)disease-free survival by stage groups in 905 non-disseminated patients
Prognostic value of stage grouping
The OS and PFS curves for clinical stage are shown in figure 3a to 3b. No deaths occurred in stage Ⅰ patients. The 10-year overall survival rates of stage Ⅰ-Ⅳb patients were 100%, 87%,65%, 54%, 40%, respectively. Significant differences of OS for clinical stage were achieved (P<0.05 for all models), but there were no significant differences of PFS between stages Ⅰ and Ⅱ, stages Ⅲ and Ⅳa (P=0.110 and P=0.492).
The Cox proportion hazard model for multivariate analysis: age (≤46 years vs. >46 years), gender (female vs. male), T categories, N categories, chemotherapy (no vs. yes), and radiation techniques (2D-CRT vs. 3D-CRT/IMRT). The results showed that T categories were independent prognostic factors for OS, LRFS, DMFS and PFS in the Cox multivariate regression analysis (P<0.005). Moreover, N categories were independent prognostic factors for OS, DMFS and PFS. However, N categories were not independent prognostic factors for LRFS. The results of the multivariate analysis were shown in Table 5.
Summary of multivariate analysis of prognostic factors for the 7th edition UICC/AJCC NPC staging system
Exp(B)
Exp(B)95%CI
OS age -0.367 0.023 0.693 0.504-0.952
sex 0.032 0.000 1.033 1.022-1.044
T category 0.518 0.000 1.679 1.472-1.916
N category 0.461 0.000 1.586 1.405-1.790
LRFS sex -0.502 0.075 0.605 0.348-1.053
DMFS Age 0.019 0.015 1.019 1.004-1.034
DFS sex -0.305 0.088 0.737 0.519-1.046
age 0.014 0.019 1.014 1.002-1.027
A reasonable staging system should offer balanced distributions, obvious hazard discriminations, reasonable hazard predictions and good outcome predictions. Previous retrospective studies have showed that the current 7th edition of the UICC/AJCC staging system for NPC is useful in prognosis, and its superiority over the 6th edition staging system has been reported[10-11]. Our data confirmed that it is an acceptable system for most of our studies. However, some unsatisfactory aspects were revealed, especially due to lack of separation for the major endpoints among the T categories and lack of hazardous discrimination for DMFS between N3a and N3b.
For T categories, our data has showed that patients with oropharynx/nasal cavity erosion had better prognosis than patients with parapharyngeal space involvement. Previous studies reported lack of significant differences in LRFS among T stages according to the 6th edition system [15-16]. When using the 6th edition staging system, the LRFS curves of T1 and T2a showed a trend toward overlap, while better separation was observed between T1 and T2 in the 7th edition. However, no significant differences of LRFS were observed between classifications T1 and T2 according to the 7th edition. T2a patients had similar recurrent rates with T1 patients, according to the 6th edition system. Therefore, a reclassified the previous T2a to T1 would be more reasonable.
The criteria for defining masticator space were disputed before the 7th edition was published. Anatomically, the masticator space contains the medial and lateral pterygoid muscles, the masseter muscle and the temporalis muscle, as described in radiology textbooks [17-18]. However, masticator space in the 6th edition was defined asextension beyond the anterior surface of the lateral pterygoid muscle or beyond the posterolateral wall of the maxillary antrum and/or the pterygo-maxillary fissure [19]. The study of Tang et al. showed anatomic masticator space involvement affected the overall survival and local relapse-free survival of NPC, and the authors recommended the anatomic masticator space involvement be categorized as classification T4. Similar conclusion was drawn from our study. Our data showed that anatomic masticator space involvement was identified as an independent prognostic factor for overall survival and progress free survival. As IMRT can provide more accurate dose distribution for targets and protection for important tissues, patients with infratemporal fossa involvement could get excellent radiotherapy efficacy. We proposed that anatomic masticator space should be taken into the staging system as a whole in the area of IMRT.
In our study, LRFS curves of classifications T3 and T4 in the 7th edition staging system had a trend of mergence. It also revealed a lack of hazard discrimination for LRFS between classifications T1 and T2, T3 and T4, and a borderline significance for LRFS between T2 and T3(p=0.051). It is considered that the application of advanced diagnostic and therapeutic facilities and concurrent chemotherapy plus radiotherapy have contributed to this result. MRI can accurately indicate the primary tumor extension of NPC. Three-dimensional conformal radiotherapy and intensity-modulated radiotherapy have remarkable advantages in ensuring adequate dosage delivered to tumor and avoiding damages of tissues. The combination of 3D-CRT/IMRT with chemotherapy has increased the local control of NPC. As a result, T stage would have less effect on prognosis [21-22], thus, it would be necessary to simplify the staging system in the future. We trailed to merge T1 and T2 into T1 (hence T3 and T4 would become T2 and T3), T3 and T4 into T3 respectively, and analyzed survivals of these proposed staging system. A better separation of LRFS curves and hazard discrimination were observed when stages T1 and T2 were merged into T1. It seemed that it was more reasonable to classify the current T2 to T1.
For N categories, retropharyngeal lymph node (RLN), as the first nodal station for regional spread of NPC, has a high metastatic frequency [23]. RLN invasion, regardless of unilateral or bilateral location, is categorized as N1 by MRI in the 7th edition staging system. But the prognostic value of RLN metastasis in patients with NPC is controversial. Ma, Pan and Tham et al. [24-26] demonstrated that RLN metastasis affects the DMFS rates of patients with NPC. The study of Tang [27] showed that no significant difference was observed between patients with and without RLN metastasis. In our study, the frequency of retropharyngeal lymph node metastasis was 56.1%. Significant differences of DMFS between classifications N0 and N1, classifications N1 and N2 were obtained. However, multivariate analysis showed RLN metastasis only had influence on OS, but no effect on DMFS and PFS. We supposed the main reason was RLN could probably get relatively high dosage, due to its location which was adjacent to the primary nasopharyngeal tumor, especially using IMRT. The use of combined chemotherapy also reversed the effect of RLN metastasis on DMFS. The proportion of N3a and N3b in our data were 18(2%) and 30(3.3%), respectively. These groups had worse prognosis than other N categories, but there was no significance between N3a and N3b for distant failure (P=0.59), which is similar to lee's study [11]. Data from Yue[28] also showed that patients with classifications N3a and N3b had similar prognosis. We propose that it is not necessary to subdivide N3a and N3b subgroups. Modification to merge N3a and N3b is reasonable to simplify the current staging system.
Our study comprised data from one center between 2004 and 2005, with a relative long follow-up. However, due to unavoidable economic limitations at that time, only 144 (15.9%) patients in our cohort underwent 3D-CRT/IMRT, and it might have a negative influence on evaluating the staging system accuracy when IMRT is the main radiation modality for NPC worldwide. Plenty of prognostic factors, such as EBV-DNA levels, tumor volume, biological and genetic factors are being studied presently. These factors and more relevant additional prognostic factors should be identified and validated to refine the present TNM system. As a retrospective study, our conclusions need to be confirmed by prospective studies with a relatively large cohort.
In summary, the 7th edition staging system is better at predicting prognosis. It has an even distribution and good separation of survival curves among different stages. T classifications and N classifications were independent prognostic factors for most of the endpoints.
We thank WeiHan HU (Department of Radiation Oncology, Sun Yat-sen University Cancer Centre) for contributing patients to the study, assistance with the data management, and logistic support. We thank the Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Centre, for data management, and statistical assistance. We thank our patients and their families for their willingness in this study.
This study was funded by the Science and Technology Department of Guangdong Province (grant number: A2015112).
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Corresponding author: Qun Li., M.D., Ph.D; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, P. R. China; Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510060, P.R.China. E-mail: liqunorg.cn


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03/08/17 – 3:48 a.m. – Fort Madison police responded to a report of larceny/theft in the 1500 block of Avenue F.
03/06/17 – 11:56 a.m. – Lee County Sheriff's deputies responded to two-vehicle accident on 270th Avenue. A vehicle driven by Richard Daniel Moore, 33, of Keokuk, swerved to miss a vehicle parked by John Carl Patterson, 55, of Keokuk in the roadway. Moore's vehicle entered the ditch and sustained damage to the drivers and passenger side. No injuries were sustained and no citations were listed on the report.
03/07/17 – 1:46 p.m. – Lee County Sheriff's deputies responded to a two-vehicle accident in the 3000 block of Hwy 61. A vehicle driven by Torie Renee Waetzig, 21 of Keokuk, struck a vehicle driven by Larry Bradley Miller, 53 of Keokuk. Miller was traveling northbound on Hwy 61 and was struck when Waetzig's vehicle tried to cross the highway at an intersection. Both vehicle sustained severe damage. Waetzig had be extricated from the vehicle and had severe injures. Two infants in the vehicle appeared to be uninjured. No citations were issued on the reports.
03/07/17 – 5:06 p.m. – Lee County Sheriff's deputies arrested Adam Andrew Nolz, 30, of Keokuk, at the Lee County Jail in Montrose on two warrants for 5th degree theft. He was taken to the Lee County Correctional Center and jailed, but was later released on bond.
03/07/17 – 7:25 p.m. – Lee County Sheriff's deputies arrested Michael Austin Vaughn, 23, of Keokuk, on a warrant for voluntary absence. He was taken to the Lee County Correctional Center and jailed.
03/07/17 – 9:37 p.m. – Lee County Sheriff's deputies arrested Bryce Jakobi Wilsey, 21, of Keokuk, in Keokuk, on a charge of driving while barred. He was taken to the Lee County Correctional Center and jailed.


The new blockbuster movie, American Sniper, features the true story of Navy SEAL Chris Kyle, whose friend, Marc Lee, was the first Navy SEAL killed in Iraq.
Several years ago I had the opportunity to interview Marc Lee's mother, Debbie, for my co-authored book, Stories of Faith and Courage from the War in Iraq and Afghanistan (Battlefields and Blessings Series, AMG, Jane Hampton Cook, Jocelyn Green, John Croushorn).
Below I've excerpted Debbie's story from this book, which is a collection of 365 devotional stories through first-hand accounts from members of the military or their families. Her heart, faith, and love for America, have inspired millions.
It was a warm August evening in Surprise, Arizona and my Bible study was gathered, as we celebrated my birthday. One of my friends had given me one of the Willow Tree Angels named "Courage." She told me that it reminded her of me. To her I was a "Woman of Courage." None of us knew at that moment just how much courage would be required for me to survive what was about to happen that would change my life forever.
As we were finishing cake and ice cream I received what would be the most devastating phone call of my life. My oldest son, Kristofer, called asking where I was and how long it would take me to get home. When I questioned why he said, "You just need to come home." I had a sick feeling in my stomach, and I knew what faced me ahead. I knew that when I arrived home I would be informed that my youngest son Marc had died— being the first Navy SEAL killed in Iraq.
Something inside of me knew when Marc left my home in March of 2006 that he wouldn't be returning and that would be the last time I would see him. I'm not a fearful, worrisome type of person, and I didn't dwell on that while he was deployed, but somehow I knew. I immediately left and asked my friends to pray. As I drove home a song came to me.
"I put my hope in you, Oh Lord, trusting you I will not be shaken, knowing that you will see me through I put my hope in you." I sang it over and over as I drove home. I expected to see a black sedan sitting in front of my house, but there wasn't one. I guess I've seen too many movies. Instead I saw Kris pacing in the street.
"Mom, the Navy's here," he said, confirming the news—Marc was dead.
My friends, prayed, cried, and comforted me. God provided friends that night and insights on courage to prepare me knowing how much I would need to trust him to face the days ahead.
Prayer: Thank you for the gift of courage.
Through this passage, God confirmed to me Marc wasn't afraid. I learned more about Marc's final act of courage in the following days. On August 2, 2006, in Ramadi in 120 degree temperature, Marc carried the additional weight of a 150 pound M60 without a sling. His teammates were absolutely amazed at his strength.
It was the biggest battle since the war began. They had been in a firefight for two hours when Marc single-handedly stood in the direct line of fire and shot off more than 100 rounds of ammunition. Three times that day Marc would stand in the direct line of fire to defend his buddies, for you, for me, and for this nation.
Marc was a young man who selflessly gave his life because he valued other lives as more important than his own. That evening God comforted me with Psalm 27 and I knew I needed to read it at Marc's funeral to encourage others and give them hope.
"Lord, how can I do that? I'm sure I'll be weeping and who knows, I might faint." Again I felt God nudging me.
I read Psalms 27 at Marc's funeral without crying or breaking down. God gave me amazing strength as I applied each verse to our hearts. I had no clue where God would "deploy me" in the days to come, but I had hope and was confident he would see me through.
Prayer: Thank you for providing strength during extraordinary circumstances. Thank you for the courage of Marc Alan Lee and others who have sacrificed their lives for me.
At the beginning stages of grief, I was numb. I couldn't even write a letter to my best friend, yet alone the President of the United States. I had stayed in Hood River to repair an empty rental. I had no computer and no paper. I had found Marc's writing tablet the day before under the house. As I wrote the date September 11, memories from 2001 flooded my heart. I had two sons and a son-in-law serving in the military. I knew then this was going to be a personal war, but I had no idea just how personal.
The letter that followed was inspired by God! Hours after the President received my letter he hand-wrote me an amazing letter saying he would be honored to meet me. Arrangements were made to meet in October.
He held my hand and said, "How you doing mama? You're going to need to rely on the Lord." He was sincere, so compassionate. I knew he had a plane to catch, a bill to sign, yet people would have thought I was the only person in the world for that thirty-five minutes.
God's creativity never ceases to amaze me—those he uses, his timing, and the tools he provides. His favor fell on me in my greatest time of need, and he provided me an opportunity to meet President Bush.
Prayer: Thank you for using ordinary things to orchestrate your favor and blessings in life.
I envision every morning in heaven a briefing between God and Marc, "Okay, where are we going to put mom today?" Iraq. Eighteen months after my son's death.
My third tour with "Move America Forward" ended with the news I would be able to deliver 226,000 Christmas Cards to the troops in Iraq.
It took courage to decide to travel to the war zone where my son gave his life— courage God gave me.
Courage was my companion the night I boarded the C–130 bound for Baghdad. My flight made the craziest cork-screw landing that I could imagine to avoid being shot down by terrorists. Courage dressed me in body armor and Kevlar to go out on patrol in Baghdad and walk the streets with the 1-4 Cavalry. Courage to board the Blackhawk in the middle of the night on a secret flight to Camp Marc Lee, the base in western Iraq named in my son's memory. Courage to walk where Marc walked his last steps, spent his last night, to smell what he smelled, and embrace what he embraced.
Yet that night at Camp Marc Lee I was reminded of what real courage is. Real courage is what our troops, my heroes face every day. Real courage is being willing to give up your right to everything you want for your future to make a better place for others. Real courage is facing the enemy and being willing to pay the ultimate price with your life because you value others' lives more than your own. Real courage is using your voice and actions to make a difference in the world. Real courage is selfless, noble, true, humble, right, and honorable. That is the description of our men and women serving in Iraq. I witnessed it firsthand.
My Angel of Courage sits on my desk, her arms lifted high and fists clenched in victory, as if to say, YES! As a nation founded on God's principles we need to raise our hands high and thank the one who created us and blessed us to be born in America.
Prayer: Thank you for this amazing nation. Thank you for the courage you have given the members of the military. May I show courage to themy saying thank you with my voice, pocketbook, and voting.
This entry was posted in Book, Miltary and tagged American Sniper, Bradley Cooper, Chris Kyle, Debbie Lee, Marc Lee, Navy SEAL. Bookmark the permalink.
It was an honor to know Marc and to teach him as fairly hyper fourth and fifth grader. It is an honor to know his mom, Debbie, even though she now resides miles away. God bless you, Debbie, and thank you for your and Marc's ultimate sacrifice.


In today's word, more and more consumers are turning to the internet to find the products and services that they need. Therefore, online marketing is an integral part of running a business. Important aspects of online marketing include SEO, social media marketing, and web design. Studies show that when consumers utilize an internet search engine they typically click on the first link that meets their criteria and are unlikely to scroll through pages and pages of results. Therefore, the higher a website appears in search engine results pages, the more likely a consumer is to visit that website. Search Engine Optimization, or SEO, which raises a website's ranking in search engine results, is thus a crucial part of effective online marketing. According to SEMPO, the North American search engine marketing industry will be valued at nearly $23B by the end of 2012. Social media marketing and web design are also crucial components of online marketing, however. More than 250 million tweets and 800 million Facebook status updates are now made every single day and consumers frequently rely on social media to get information about and recommendations for various products and services. Furthermore, a quality, well designed, professional web site is the cornerstone of any effective online marketing. A website should be visually appealing as well as highly informative.
Providing these online marketing services are great business opportunities; 36 percent of small businesses pay for publishing and analytics tools. However, if you don't have the time of the talent to provide these services in house you might look into reselling options, such as SEO resellers, a social media reseller, or a website reseller. If you're interested in outsource SEO you might want to look into different private label SEOs, such as White Label SEO, which offer various options for an Seo reseller program. A company that offers an outsource Seo program can offer you expert guidance and advice, so that you can provide your clients with the best possible service. Similarly a website reseller can offer website design templates, while a social media reseller can offer plans and strategies for social media marketing. Ultimately, outsource or reseller programs, such as outsource seo, can be great business opportunities. Look into a outsource SEO for your company or business.
This entry was posted	on Friday, January 11th, 2013 at 12:41 pm	and is filed under Conversion tracking, Online marketing reseller, Seo reseller. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.


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Reverso One Duetto
https://www.tourneau.com/watches/jaeger-lecoultre/reverso-one-duetto-q3348420-JLC0213136.html
Reference#: Q3348420, 20 mm x 40 mm, Stainless Steel JLC0213136 Q3348420
This timepiece owes its name to the Duetto concept, which reveals its two faces and double set of hands, animated by one and the same movement, with the touch of a finger. Crafted from blue and stainless steel, the new Reverso One Duetto is also characterized by two rows of brilliant-cut diamonds nestled on the front and reverse of the watch. A new, bright blue leather strap completes this beautiful, Art Deco-inspired model.
Originally founded in 1833, Jaeger-LeCoultre has earned a unique renown in the Swiss watchmaking industry due to its distinctive aptitude and constantly evolving sense of innovation. Its watches demonstrate an elite sense of precision and reliability, as every step of creation is completed within its own Grande Maison. Each timepiece crafted by a Jaeger-LeCoultre watchmaker is imparted with a level of technical perfection that is rivaled only by its impeccable design standards.
One of the most distinctive timepieces from Jaeger-LeCoultre, the Reverso is the result of a legendary origin story involving British Army Officers' need for a watch that can withstand a challenge. The name of this timepiece comes from its innovative reversing case, which the Grande Maison created in the 1930s to offer the British Army Officers a watch that was at the same time elegant and durable. When turned, the case either reveals an alternative watch face or a beautiful, protective cover. The Reverso has since evolved into an icon of both style and watchmaking ingenuity.
Manufacturer Reference # Q3348420
Case Size: 20 mm x 40 mm
Item Number: JLC0213136
Features: Power Reserve
Collection: Reverso
Case Shape: Rectangle
Movement Caliber: 844

redpajama_set_name: RedPajamaCommonCrawl


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Workplace conflict consultancy The Pacificus Group launches in Toronto
21 April 2021 Consulting.ca 2 min. read
The Pacificus Group, a boutique consulting firm focusing on workplace conflict, has launched in Toronto.
Workplace conflict costs Canadian businesses more than $2 billion annually, according to research from HR consultancy Morneau Shepell. Conflict between coworkers and between staff and management, as well as aggressive or abusive behaviour by various parties can negatively impact a workplace's productivity. It can also lead to costs stemming from litigation.
Apart from financial costs, workplace conflict also negatively impacts the mental and emotional wellbeing of employees – an organization's most valuable resource.
The Pacificus Group will help clients limit these costs by preventing, identifying, and resolving conflict in the workplace. The company's leaders bring decades of expertise in conflict resolution, cultivated by experience in the armed forces, litigation, social work, and psychotherapy.
Pacificus' executive team is composed of lawyer Daniel Sommers (president); psychiatrist Frank Sommers (chief development officer); and psychotherapist Laval Martin (chief executive officer). Daniel Sommers has been practicing alternative dispute resolution, civil litigation, and criminal defence for over 10 years. Sommers was previously an infantry and armoured officer in the Canadian Army, and is currently an officer in the Canadian Forces Reserves. He holds a JD from St. Thomas University School of Law and a bachelor's degree from the University of Toronto.
Frank Sommers, MD, is a member of the department of psychiatry at the University of Toronto. Sommers has practiced psychiatry for more than four decades. He is also a military veteran and was deployed as a civilian psychiatrist to the Canadian Armed Forces contingent in Afghanistan.
Laval Martin has worked in social services for 15 years, with expertise in crisis intervention and conflict resolution. He has also delivered psychotherapy for more than five years. Martin holds a master's degree in social work from the University of Toronto.
"Our teams' work in psychotherapy, military service, and law has shown us the depth of that cost and given us the experience to deal with it, and teaching conflict resolution skills is the best way to reduce conflict, saving businesses money and improving the wellbeing of their employees," Daniel Sommers said. "We already have interest from companies in the United Kingdom, United States, and across Canada, showing just how serious the problem of workplace conflict is."
Pacificus will deliver courses, coaching, consulting, and mediation and arbitration services to private and public sector organizations. The firm's consulting offering includes workplace conflict-related audits, assessments, reviews, and investigations.
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Executive search firm Massey Henry launches in Canada Massey Henry, a Toronto-headquartered executive search and board advisory firm, has opened its doors.


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Tracking the facts: Experts to monitor the spread of fake and real coronavirus news on social media to see which is getting the most attention
Researchers will compare the spread of fake news to those from real sources
This could then be used to let policymakers known which rumours are spreading
They could then create alerts on Twitter and Reddit to warn users of fake posts
It could even provide people about to post fake news with a warning to check the source of their planned post before they get to share it
Here's how to help people impacted by Covid-19
By Ryan Morrison and Ian Randall For Mailonline
Published: 08:10 EST, 2 April 2020 | Updated: 12:21 EST, 2 April 2020
The spread of fake and real coronavirus information is being tracked by scientists to see which stories are getting the most attention on social media.
Researchers from the Open University will compare COVID-19 posts on Twitter, Facebook and Reddit against fact-checked articles from verified sources.
It comes as the UK government announced a spike in false and misleading narratives about the deadly virus that has put much of the world in lockdown.
Professor Harith Alani from the OU said his research could help governments, scientists and health organisations better stop the spread of dangerous rumours.
He said they would also look at ways to directly alert people on Twitter and Reddit if a post they are sharing is from a fake source or contains misinformation.
Coronavirus 'deniers' are using Facebook, WhatsApp and YouTube to spread conspiracy theories and misinformation about the deadly disease
Social media giants have said they are actively working to monitor and remove misinformation about COVID-19 and are promoting official information sources.
OU researchers will look to debunk myths, such as COVID-19 is a man-made virus, that you can tell if you have the virus by holding your breath for 20 seconds and that taking a hot bath will prevent you from catching the coronavirus.
Researchers say misinformation and 'fake advice'' can be dangerous because it can lead to people 'taking greater risks' than if they were following official guidance.
Alani said they will provide information to policymakers and health officials about the spread of fake news on the coronavirus.
It would also then be used to alert social media users about the extent to which they are spreading false information - with possible warnings about a fake post.
Scientists advise people to check official sources of information such as the NHS, World Health Organisation or the CDC. Alani and his team will check fake news against fact checking websites and articles to monitor the spread of fake news
They will extend existing tools and algorithms already in use for monitoring generic fake news as part of a project called CO-INFORM.
This project provides a dashboard and information that lets journalists, policymakers and others track fake news.
'We will extend and use such algorithms to find the claims that are being made about COVID-19,' said Alani, a professor of web science at the OU.
He said they would 'check them against facts from trusted and authoritative sources, and produce knowledge and graphs for policymakers and health influencers'.
'We will collect those articles (the misinforming ones and the corrective ones from the fact-checkers) and track their spread on social media, to understand which ones are spreading more than others,' added Alani.
He said they would look at which geographic areas, by what age and cultural groups, etc the articles are most quickly spread.
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WHAT FAKE INFORMATION IS BEING SHARED AND WHAT DO SCIENTISTS SAY?
1. 'Drink water to wash the virus away'
Paul Hunter, a professor in medicine at University of East Anglia said: 'Absolutely b****cks. There is no evidence for that whatsoever. Even if the water did wash it off your throat. Viruses bind onto cells in the body very strongly and are taken in. So just washing water over it won't do anything.'
2. 'Hold your breath for 10 seconds to check for the disease'
Professor Hunter said: 'That's rubbish because a lot of people who are incubating the infection won't necessarily have any effects on their lungs at all. I've never heard that.'
3. 'The virus hates the sun'
Professor Hunter said: 'Heat does kill viruses. If you heat something up to about 60°F (15.5°C), it's likely to die in minutes. Similarly UV light will inactivate the virus and we do know if you look at the survival of these viruses on surfaces, the death increase as temperate increases.
'But you can't rely on that to protect you. Your lungs are about 37°C degrees, and with a temperature it's a little higher. If the virus was killed by heat, we wouldn't get ill.'
4. 'If you have a runny nose, it's only a common cold'
Professor Hunter said: 'The symptoms [of COVID-19] that are far more common are fever and a cough leading to shortness of breath. Those are the classic symptoms.'
5. 'Gargle salt water as prevention'
Dr Head said: 'There's no evidence at all that salt water will protect yourself from coronavirus infection, so do not rely on this approach.'
6. 'It lasts on the hands for 5-10 minutes'
Dr Head said: ' We know that the virus can last on some hard surfaces for a few days, and it is likely the virus can survive for at least a few hours on a person's hands. This is why regular and thorough hand-washing is so important.'
<!- - ad: https://mads.dailymail.co.uk/v8/us/sciencetech/none/article/other/mpu_factbox.html?id=mpu_factbox_1 - ->
'This could hopefully help governments, scientists, media, and health organisations to get a better understanding of what misinformation needs to be addressed more urgently, and how effective fact-checking and other campaigns have been in halting the spread of particular rumours online.'
This would show which rumours are spreading more than others, where, and when.
The team will also investigate the most effective way to alert users on Twitter and Reddit of the extent to which they are spreading false information in their posts.
'We know that we can use this information to show individuals how much false information they have been circulating on social media,' said Alani.
'We need to look at how to correct people's beliefs in a more effective and personalised fashion.
'Although we are seeing that this misinformation is spreading, we don't yet know the effect of this on this type of crisis.'
The Department of Health and Social Care urged people to watch out for false guidance about coronavirus online.
It pointed towards nhs.uk/coronavirus for official advice on the outbreak.
A cross-Government counter-disinformation unit was set up in a bid to deal with the potential extent, scope and impact of misleading and false details.
The Department for Digital, Culture, Media and Sport-led team will engage with social media companies to monitor interference with the aim of limiting the spread coronavirus-related fake news.
Official NHS guidance is now being displayed at the top of internet search results as part of a crackdown.
Health Secretary Matt Hancock said: 'These changes will ensure the latest trusted NHS guidance sits at the very top of Google search lists, so people can be reassured they are reading official, up-to-date Government advice.'
A wide range of fake posts have been shared across social media since the start of the outbreak, which scientists say risk making the pandemic worse.
However, the Department of Health says there is no basis for this claim; you should instead consult nhs.uk/coronavirus for official advice on the outbreak.
A more recent piece of misinformation is that it can't spread in warmer climates.
Messages range from those suggesting that the risk of coronavirus has been exaggerated to the idea that the virus was man-made — either as a weapon, or to sell more vaccines, or as a smokescreen to hide the actions of a cabal of CEOs
The CCDH has today launched a '#Don't Spread The Virus' campaign, which encourages social media users not to engage with or share coronavirus misinformation online, but to report it to social media platforms instead
The World Health Organisation says all evidence suggests it can be transmitted anywhere including places with hot and humid weather.
It's also not true that Vitamin C can prevent you from catching the virus, cancer, heart disease and other illnesses - as claimed by Nobel prize winner Linus Pauling.
Recent research suggests taking an average dose of 200mg of vitamin C does reduce the duration of a cold in the general population, according to a review of several dozen studies in 2013 cited by independent fact-checking charity fullfact.org.
However, there was no evidence it could prevent the common cold. Similarly, there's no evidence it can prevent Covid-19.
The UK-based charity the Center for Countering Digital Hate has been tracking 50 social media accounts that are peddling health-related misinformation.
These forums promote fake cures, question the risk from the current pandemic and peddle conspiracies suggesting that the virus was man-made for nefarious ends.
Funding for the three year long Open University project came in part from a €393,000 EU emergency fund grant.
HAND DRYERS, GARLIC AND SESAME OIL ALSO WON'T PREVENT THE VIRUS
Debunking circulating myths, the World Health Organisation said hand dryers alone cannot kill coronavirus bacteria.
Rumours have claimed using the hot air from the dryer for 30 seconds will rid any trace of the virus on your hands, China Daily report.
Above all, people should focus on keeping their hands clean.
'To protect yourself against the new coronavirus, you should frequently clean your hands with an alcohol-based hand rub or wash them with soap and water,' the WHO said.
'Once your hands are cleaned, you should dry them thoroughly by using paper towels or a warm air dryer.'
Garlic is a healthy food that may have some antimicrobial properties, the WHO said.
However, there is no evidence from the current outbreak that eating garlic has protected people from the new coronavirus.
An online post went viral after claiming a bowl of boiled garlic water can cure the 2019 novel coronavirus.
Facebook has since blocked the post because 'the primary claims in the information are factually inaccurate.'
Sesame oil is a staple in Asian cooking. But that's about all it's good for.
Contrary to rife rumours, rubbing sesame oil onto the skin won't block coronavirus from entering the body.
The WHO said, 'No. Sesame oil does not kill the new coronavirus.'
This is because transmission is believed to occur when an infected person sneezes, and droplets land in a person's mouth or nose, or they inhale it from the air.
Close contact with someone infected also raises the risk. According to the Centre of Disease Control and Prevention, spread from person-to-person can happen from six feet apart.
You can see the full list of myths here.
Experts to monitor the spread of fake and real coronavirus news
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text:
Weekend Intensive
T-Group Weekend Intensive for Executive Leaders
Audience: Tech & Media Executives, Venture Investors, & Other Senior Leaders
Cost: $5250
This is an intensive residential immersion for a diverse cohort of 12 hand-selected senior leaders. The 3.5-day extended weekend program is based on the same learning format as the legendary Interpersonal Dynamics ("Touchy Feely") class — the most popular elective course at the Stanford Graduate School of Business and will be led by two experienced trainers including Carole Robin, the long-time lead instructor of the Stanford course and Tony Levitan, who has facilitated the course with Carole for many years. This is an experiential learning program focused on discovering when and how you are most influential; how others really think and feel about how you act; and how you lead. Many former participants have described the experience as profoundly benefitting their personal and professional lives.
Short Overview Video with Carole
Stanford Interpersonal Dynamics Exec Ed Website
T-Group Weekend For Startup Leaders Website (Different participants, different faculty, similar program format)
Carole Robin, Ph.D. – Carole Robin is an executive coach and personal consultant to numerous senior leaders across industries. She has recently moved on from the Stanford Graduate School of Business where she was Director of the Interpersonal Dynamics for High Performance Executives (IDHPE) Program, Director of the Arbuckle Leadership Fellows Program and Dorothy J. King Lecturer in Leadership. Carole won both the MBA Distinguished Teaching Award and the Silver Apple Alumni Association Award. Her MBA courses included: Interpersonal Dynamics, Leadership Fellows, High Performance Leadership, Leadership Coaching and Mentoring and Taking Stock and Moving Forward. She has also taught numerous custom programs to executives through the Stanford GSB's Executive Education in addition to being the director of IDHPE. Prior to Stanford, Carole was a line sales and marketing manager in the high tech industry and partner/principal in an international consulting firm.
Tony Levitan – Tony Levitan is Chief People Officer at ServiceRocket, where he is responsible for all aspects of the company's efforts to create strategic advantage through its people. Previously SVP, People at Proteus Digital Health and a three-time company founder — including co-founder of Internet pioneer, Egreetings Network (IPO, acquisition) —Tony has been building people-centric organizations for over 25 years. He is a leadership facilitator in Interpersonal Dynamics at the Stanford University Graduate School of Business in both its MBA and Executive Education programs and has served as a Lecturer in Entrepreneurship at the Haas School of Business at the University of California, Berkeley.
2018 Dates TBD
I've learned about a whole new aspect of communication that I believe will be invaluable in my personal and professional success. It's something I want to send all my friends and colleagues to and am privileged to have been a part of.
- Pulkit Agrawal, Co-Founder & CEO, Chameleon
The learnings about myself were much more intense and deep than anything I could have imagined. I'm really grateful for this life changing experience.
- Nicolas Dessaigne, Co-Founder & CEO, Algolia
I recommend this weekend intensive to experience transformation, not just talk about it.
- Sonali Kothari, COO, Kiva
Their are so few ways to really feel the impact and experience true learning with it comes to interpersonal skills. This InnerSpace intensive weekend have given me exactly that.
- Craig Dos Santos, Co-Founder, The Run Experience
Hour for hour, the most valuable personal and professional growth experience of my life.
- Jeff Barrett, CTO StitchFix
The InnerSpace Intensive Weekend will amplify your emotional capacity and leadership presence by an order of magnitude or more. Every startup founder needs to do this.
- Chris Tsai, Founder & CEO Celery
The T-Group Weekend Intensive was probably the highest ROI way I could have spent 3.5 days: for the health of my company, the happiness of the amazing individuals who work here, and for my own ability to create and sustain meaningful relationships.
- KJ Erickson, Founder & CEO Simbi
I can't overstate how much I wish this could be a more broadly accessible experience.
- Jess Hui, Exponent
At the risk of it sounding cliched, I came back cleansed and more mentally prepped to tackle real problems in the real world!! I can hands down say every startup leader needs such a weekend.
- Heejae Lim, Founder & CEO TalkingPoints
I believe I will achieve 10x more because of this weekend. I became aware of and learned how to overcome major interpersonal stumbling blocks that have been severely holding back my professional and personal relationships.
- Ben Sand, Cofounder & CEO, Meta
Wow. Eye opening. I loved it.
- Ben Mckean, Founder & CEO, HungryRoot
I don't often endorse stuff but, based on personal experience, here's one that I gladly will. The folks at Innerspace have found a way to replicate the experience of the Stanford [Interpersonal Dynamics] class in a Weekend Intensive. I've been through it and it changed my worldview. If you're in a leadership position at any level, you should try it too.
- Bharat Vasan, President & COO, August
Note: Testimonials from previous weekends with startup leaders.
Join the InnerSpace Community
SF Bay Area NYC Boston Seattle LA Denver/Boulder Austin Other
What events are you interested in attending?
Founder Circles
Cofounder Coaching Program
Whom did you hear about us from?
We'll be in touch soon :)


We have 1 answer for the clue Italian opera center. See the results below.
Where to see "The Last Supper"
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Local Coordinator Program
Virtual Reading Groups
Group Activism Grants
Group Network Kits
Peace, Love, Liberty
Donor Hub
Guest Author, United States
Lauren Hall is associate professor of political science at Rochester Institute of Technology. Her recent book, Family and the Politics of Moderation, came out with Baylor University Press in April 2014 and she edited a volume on the political philosophy of French political thinker, Chantal Delsol. She has written extensively on the classical liberal tradition, including articles on Edmund Burke, Adam Smith, and Montesquieu. She serves on the editorial board of the interdisciplinary journal Cosmos+Taxis, which publishes on spontaneous orders in the social and political worlds. She serves as the faculty advisor for the RIT College Libertarians. Her current research is on the politics of women and the family in classical liberalism, and she also writes on related areas in evolutionary theory and bioethics.
Articles by Lauren Hall
Feminism is about choice
Why new mothers usually don't sue doctors who violate their rights
Remembering the forgotten women, victims of government
Women work for equality - but these 3 policy ideas don't


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JOHN JACOBS Jr.
JACOBS, Jr., John E.
Age 63, of Huber Heights, passed away Thursday, January 7, 2021, at his residence. John worked in the Parks & Recreation Dept. at City of Dayton for 15 years and was the Marketing Director for Five Rivers Metro Parks for 15 years. He was a member of Grace Community Church, where he served as a worship leader. John is survived by his loving wife, Pamela L., sons & daughter-in-law, Bryan & Deanne Jacobs of FL, Michael Jacobs of Beavercreek and Nicholas Jacobs of Dayton; grandson, Sebastian; sisters, Ava Laws of TN, Dixie Archer of Kettering; and many other relatives & friends. A private funeral service will be held at Grace Community Church with Pastor Bob Foote officiating. Interment Woodland Cemetery. At a later date, after the current health crisis lessens, a larger memorial service will be scheduled at which extended family, loved ones, and friends may come and pay their respects and celebrate John's life. If desired, memorial contributions may be made to Compassion International or Samaritans Purse.
Published in Dayton Daily News on Jan. 10, 2021.
My wife Ann and I had the pleasure of working with John at Five Rivers MetroParks. I used to kid him about the photos he had of his children which i had mistaken as current but then learned they were from years earlier when they were young. Later, I did the same thing with my children's photos in the office. I had lots of questions for John about his hot tub and how to take care of it when i was considering getting one. John had good advice. I loved hearing about his family trips to Hawaii. I remember visiting John in the FRMP Main Office on Siebenthaler Ave. John, Bernadette Harawa and Kevin Kepler shared the space and they often joined in the conversation. John had to get our MetroParkways published and round up all the articles from folks who often changed items at the last second or procrastinated. John was patient. After he retired from FRMP, John went on some birding hikes with Lynn Modic, Sue Smith and my wife Ann. I think i joined one or two of them. I remember John's smile and conversations about music and recording it. John had a presence of happiness and kindness. His big heart will be missed. I hope you all have a chance to be in beautiful natural places to remember him and celebrate his life.
Douglas Horvat
Hello Pam and family,
Carmen and I were so sorry to hear about John's passing, he was a wonderful person, a great neighbor and a bright light in the lives everyone who knew him.
Please accept our deepest sympathies and know that you are in our prayers.
Pete and Carmen O'Brien
Pete O'Brien
PJJ, You are in my thoughts and prayers. Know that you are loved beyond measure.
Audrey Miller
John will be missed. Always quick with a smile and a kind word. My condolences to his family.
Nathan Cox
Dear Pam, Bryan, Michael and Nick, We are so very sorry that for the loss of your wonderful husband and father. John always had a smile on his face, a song in his heart, a kind word on his lips - he was so full of life! We will cherish our beach memories of him and all of you.
Sharon, Joe, Blake and Sean Loftus
John was a genuinely kind, caring and compassionate individual. Shared a number of good times at MetroParks and appreciate everything he did in service to his community. He is missed. Our condolences to Pam and rest of his family.
Charlie Shoemaker
John was fun to work with; he worked hard to make sure the community knew when the nature walks would be, among many of his other responsibilities, and because of him, we were one of the first park districts to have a web page at the beginning of the 'internet'! I will miss his kind smile, and his enthusiasm for his work.
Joshua York
Cluster of 50 Memorial Trees
Sympathy Gift courtesy of
Douglas Scholz
Oh how heartbreaking. John was so dear. He always made me laugh and was always ready to see how he could help. He was so kind hearted. I can't say enough good about him. He will be missed I'm sure. Prayers for the family for comfort at this time.
Kelly Kingery
My heart breaks for you all. He was an inspiration. A genuine Christian man whom will be missed
Dear Pam: So very sorry to hear of John's passing. John was a great guy and I will always remember many great times with both of you.
Michael Burris
Enjoyed working with John, he always had a smile on his face. Keeping his family in my prayers.
Robert Makley
I remember John very well from working with him at Five Rivers MetroParks. Always an inspiring and engaging man.
Shane Conley
John was a very kind and charismatic man. He brought joy to a lot of people. He will be greatly missed by many.
Teresa Britton


You can DQ him on the basis that nobody uses a hybrid RT/raster pipeline today either. You're both losers! Cheaper that way.
Though if I were him, I'd claim that Cyril Crassin's cone tracing is close enough to qualify. Not in any games yet but has been demo'd in UE4.
This is a great post. I like it very much. Thanks a lot.


At the end of November 2016, Pinterest introduced the new feature for a Pinterest business accounts called Showcase. In this post, you'll learn what is a Pinterest Showcase, why you should create a showcase for your brand, what to put on the Showcase and How to create a Pinterest Showcase for Your Blog & Business. If you still hesitate to switch to the business account, click over to read 5 benefits of having a Pinterest business account. Not to mention, it's mandatory to have a business account if you're using it for business purposes.
When I first saw the big slider on my Pinterest account, I instantly thought "it's a great alternative to cover photo like on Facebook or Twitter". Not to mention, it's a great way to highlight board with your content when you're a blogger displaying your articles, service provider showcasing your portfolio or shop owner presenting your products.
It's a rotating slider with hand-picked boards (or buyable pins) which helps your highlight your best content and make a great first impression. You can add up to five boards to the showcase and edit it as much as you like on the desktop web. The showcase is located below the profile information and above the boards, so it's the second thing pinners see when they visit your profile.
As I've mentioned, you should see the Pinterest showcase as a cover image for your brand on Pinterest. With Showcase, you have a chance to enhance your brand experience further, besides pinnable images for your blog posts or custom board covers.
Again, the showcase is a great way to highlight boards with your own content. If you haven't created a board JUST with your own content, do it now. It should be your first board in the Showcase and on your profile.
Pinterest Showcase comes in handy for those of you who have a lot of boards like 50-100+, again you can highlight the most important boards there. It can help pinners decide whether they want to look through your profile and boards or if the content you're posting is not relevant to them. That's why it's important to curate the boards and pins you're sharing, so they can "help" you make a killer first impression, rather than scare away your viewers.
If you're thinking what do add to the board with your own content think of pins like portfolio pieces, pins introducing your services, product pins, blog posts etc. just remember, only pins you've created. Why should you highlight the board with your own content? Well, to get traffic to your website, to get your products or services in front of your audience, to grow your email list and showcase your brand on Pinterest.
If you're lifestyle, seasonal or similar blogger, you can attract your potential readers by showcasing the boards with seasonal content like gift guides, DIY tutorials, home décor and more.
It can also work for entrepreneurs who sell digital products, so when there's a "season" (the launch week/month) for their product they can put the board with the content relevant to their product.
If you don't like the Showcase feature on Pinterest, you don't have to use it. Simply don't add any boards to the slots.
Have you created a Pinterest Showcase for your blog and business yet? What board did you put there? I'd love to see it in the comments.
I have a business account but I'm not getting the show case option? Has it gone away all ready?
Hm, that's weird. I went to your Pinterest account and I can see the showcase there.
Love this! I was wondering how to best use this feature!


The DAC‐51 Digital to Analog Audio Decoder uses 24‐bit audio DSP and 192KHz DACs to convert virtually any type of digital audio input to stereo output.
It supports uncompressed two‐channel PCM as well as compressed multi‐channel bit‐stream audio (such as 5.1 channel audio) and provides two channels of analog outputs both on RCA as well as 3.5mm headphone jack. When the input is multi‐channel, the device down‐mixes (using downmixing or fold‐down algorithm) the digital channels to 2‐channel stereo for easy connection to entertainment devices. When the input audio is multichannel the unit intelligently combines Left Front, Left Rear, Right Front, Right Rear, Center, and Subwoofer (LFE) in a way to create two channel stereo output.


text:
![Too Many Steps](img/ClassicFlow.png "Too many steps to get started")

note:
    The time it takes from idea to
    execution is way too long.

redpajama_set_name: RedPajamaGithub


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Argyle Street Pharmacy joined our Mission to help provide access to "Clean Water for All by 2030". This Mission was initiated by the United Nations.
A big thank you to Argyle Street Pharmacy's team and customers for joining this extremely important mission on 22 November 2017.
Peter Panos (B. Pharm M.P.S) is a highly experienced, trusted and caring Pharmacist having worked in the Parramatta area for 48 years. His training began at Rohini Street Pharmacy in Turramurra in 1965, then working with Martin Pye at the historic Pye's Pharmacy. He has since gone on to make a mark on pharmacy in Parramatta Westfield over the past 42 year and is in fact the longest serving private leasee in Westfield Parramatta.


Photographs are a wonderful way to commemorate your visit to the Nicholas Conservatory & Gardens. We encourage guests to take casual photographs for their own personal use within the guidelines of the facility. A permit is required for those using the Nicholas Conservatory & Gardens for posed photography, such as wedding, engagement, and family photos, or commercial photography.
Please silence cell phones and refrain from loud conversations so that all may enjoy the peace and serenity of the gardens.
For the safety of plants and visitors, please refrain from walking in planting beds.
Please use caution when walking on the conservatory pathways, surfaces may be wet. It is recommended to wear rubber-soled shoes.
If you are visiting with children, for their safety, please keep them within sight. No children under the age of 13 are allowed in the gardens without adult supervision.
No outside food or beverages allowed in the Nicholas Conservatory. Food and beverages are available for purchase from our in-house café.
Feeding fish and other wildlife is prohibited. For the health of the wildlife, please do not throw coins or wade in the water features.
Smoking is prohibited within 50 feet of garden structures and facilities.
Rockford Park District and Nicholas Conservatory & Gardens are not responsible for lost or stolen items.


Public Transport in Chihuahua has been evolving in the past years. With the implementation of the new system "Vive Bus" all the routes have had significant changes and now the users suffer from inefficiency of times thanks to the bad organization and lack of information.
The current system doesn't inform in a simple way complicating the users. As a result, people don't know the arrival times of the busses.
Create, develop and implement on each station ( where the Vive bus stop), a system that provides information to a centralized database, that subsequently shows that information on screens located on the station.


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The Waverly Hotel & Residences draws its inspiration from the rich heritage of Whitefield, which is often forgotten in the midst of the area's transformation into the silicon valley of India. The Waverly pays tribute to Whitefield's rich historical "British" connection through a 'colonial meets contemporary' concept.
The Whitefield we know today began in 1882, when in a generous moment, the then maharaja of Mysore, Charmaraja Wodeyar, granted 3,900 acres towards the creation of a settlement for the Anglo-Indian community of the area. As such, Whitefield was born, named after David White who conceptualized the idea of this settlement and also resided here. Over time, Whitefield developed into a homely Anglo-Indian village that attracted people from Bangalore City and those who were a part of the historic Kolar Gold Fields. It was one of the very few formally planned Anglo-Indian settlements in India, boasting of a relaxing lifestyle, colonial style architecture, quaint bungalows, sprawling orchards and farms as well as delightfully named cottages.
In 1896, a young British army officer by the name of Winston Churchill arrived in Bangalore and, as narrated by the ex-prime minister himself, fell in love with the weather, flowers and butterflies the city had to offer. In fact, the historic Bangalore Club proudly claims this butterfly obsessed officer still owes the club 13 Rupees from an unpaid bill during one of his visits. The young Lieutenant was a frequent visitor of the Waverly Inn at Whitefield, where he is believed to have also stayed on occasion. Rumour has it that during his visits, Churchill courted Rose Hamilton, the daughter of James Hamilton, who was the then owner of the Inn. The Waverly Inn still stands today, though it is now a private residence.
The history of Whitefield and its surrounding areas are imbibed in the The Waverly Hotel & Residences through our 54 spacious rooms, modern British pub, hotel veranda, and the living room; providing a modern experience with historical notes Churchill would have appreciated. The Waverly Hotel & Residences experience can be summed up as old world charm in a modern setting.


Students use creative tools in the Seesaw app or website to complete classroom activities like "Mixed Number Subtrac…"
1. Use the tool to draw your picture and solve the problem. 2. Record your thinking as you solved the problem.


How to be sure our customers will really use the new online service? Which user experience scenario would users prefer? How to make a complicated system pleasant to use?
Whatever goals and requirements did you set for your website design it helps to get the basic right.
These days, anyone with an entrepreneurial spirit can start an online business. After all, everything you need to launch a startup – free resources, flexible eCommerce and blogging platforms, and communities willing to share their tips – is at your fingertips.
In ecommerce, speed is important; there's nothing new about that. As a rule of thumb, you should not keep the user waiting for more than 3 secs, otherwise, there is a good chance she will move on to a more responsive competitor.
Not all online shoppers are created alike. Different people have different expectations and goals when it comes to shopping. Designing tailored experiences for various user types on data-based evidence will help you win their trust and boost conversions.
The new IBM Websphere Commerce Suite 8 (IBM WCS) supports many check-out scenarios. However, modifying submitted orders via 3rd party software and presenting the results to the customer on the shop storefront require a tailored interaction between Order Management and IBM WCS.
According to grocery sales statistics fresh foods can account for up to 40 percent of the revenue. This fact plays a major role in e-groceries as well. The retailers should encourage their online customers to shop for fresh food in order to increase the average order value. However, according to the article by Elaine Watson+, Online grocery shoppers are upping their spending online, but remain wary of buying fresh produce.
Have you ever bought your groceries online? If you have, then you're one of the rare weblovers who make sure (nearly) one per cent of grocery retailing in Europe takes place on the Internet. That doesn't seem like much, I know. But this might change very soon.
It is important for any business to understand developments on consumer markets, our rivals' activities and the technological facilities developed for us by various logisticians and IT companies, from smart phones and tablets to modern applications. If we know why, we will also know how to make use of our competitive qualities.