Last month we told you about Fantastic Fest's plan to let a select few people watch the Ryan Reynolds-helmed Buried while actually being buried. Called "Buried with BURIED: Rolling Roadshow of One", four people were picked up, blindfolded, then stuffed into coffins to watch the film. The winners get to meet Reynolds and walk the red carpet. We now have photos from the event, which you can see after the break.


A+: Classic comic book material. Belongs next to your copy of The Notebook and The Joy of Cooking.
B: Enjoyable read. Fans of the genre or characters will especially like.
C: Non-essential read. Can be enjoyable for fans of the genre or characters, but likely for only one or two events in the books.
D: Unenjoyable book. Read at your own risk. Might find satisfaction if major flaws are overlooked.
F: Please don't buy this book. Donate your money to a local comic book writer's workshop instead to inspire future generations to write something better than this trash.
That about wraps it up for our reviews this week! Look for next week's previews coming soon. Any comic books you didn't see reviewed that you want reviewed? Any grades you didn't agree on? Let us know in the comments!
All images taken credited to their respective publishers and creators; thanks to all the for putting out great books!


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That is why all GovTribe free trial accounts allow you to collaborate with up to 10 users. So you can assess the value of real-time, in context collaboration on federal business development.


text:
By Ronan Khalsa on June 20, 2019
It is too bad that most people on the Hilltop don't care much about Bradley sports. Since my freshman year I've been a fan and the Braves have been trending up since I arrived in Peoria.
Bradley has a rich history and usually leads the Missouri Valley Conference in men's basketball home attendance. But when I got on campus in August 2016, the athletic department only had one successful program: men's and women's cross country. We weren't particularly competitive in any other sport and that was abundantly clear.
On March 17, 2015 Chris Reynolds was hired as the athletic director. As a young man from Vermont who knew nothing of Bradley before enrolling, I now have discovered that the day he was hired was an important one for the university and city. The Bradley administrators and the NCAA surely agreed as his title is now vice president for intercollegiate athletics.
Since his return to his childhood city of Peoria each program has improved. Reynolds hired four new head coaches that he claims to be really good thinkers with cutting edge ideas who are smarter than himself.
I commend his decision-making when it comes to hiring volleyball coach Carol Price-Torok, women's golf interim head coach Grant Escue, men's basketball's Brian Wardle, women's basketball coach Andrea Gorski and cross country and track coach Darren Gauson.
This past academic year, the Braves were impressive on the fields, courts and courses. Looking back to my freshman year, I cannot believe the positive change.
Men's basketball went from five wins in 2015-16 to giving No. 2 seed Michigan State a run for its money in the NCAA Tournament. Women's basketball finished with a winning record in the Valley for the first time since 2009-10.
I came to Bradley a huge baseball fan, but in 2016 they finished 6-14 in the MVC. This year, they won 11 and were near the top of the conference standings the entire spring. Softball "shocked the Valley" and earn a double-bye in the conference tournament after finishing 15-10.
In the fall of 2016 I went to the homecoming soccer game, Bradley lost 2-0 to Evansville. That season the team finished with two wins. This past season the team did not suffer a loss until its 10th game. Plus we tied with Gonzaga, Wisconsin and Cincinnati.
The most remarkable improvement for Bradley's programs is volleyball. The team reached a postseason tournament this fall and increased its MVC play win total by 12 since Price-Torok was hired for the 2015 season.
Bradley's less followed programs impress me even more. For the last four years, men's cross country has won the MVC Championship. This fall they placed second in the Midwest Regional meet, eventually finishing 24th at the NCAA Championship.
Women's cross country has been dominant in the Valley as well and has finished 15th, sixth and ninth in the regionals the past three seasons.
Both men's and women's golf have been improving. In 2018 the men won the MVC Championship for the first time in school history, just a year after finishing seventh of nine.
The women lacked a full-time women's golf only coach; however, it hasn't held them back from placing in the top four the last three years. This past April, the women were predicted to win the MVC Championship, and although they finished third, I have to commend the effort.
Lastly, tennis set a program record with 16 dual match victories. They went 4-1 in conference, improving from 2-5 in 2016-17.
There you have it. I still can't believe the turnaround. Simply outstanding. Here's to hoping the Braves continue to brighten spirits on the Hilltop.
Go out and support; we don't suck. Sports lead to camaraderie and that's what Bradley needs. I doubt the success across the board will carry over to next year due to many key athletes graduating, but we'll see if the youth can meet the challenge.
The men's basketball season slogan of #TheArrival can expand to the entire department. The Braves as a whole did just that. Here's why Bradley was successful; they were consistent, tenacious, and above all, Brave.
More from OpinionMore posts in Opinion »
Editorial: Presidential search is crucial to Bradley's future
Editorial: 2018-19 assessment
Column: It's finally over
Bradley Running Club takes on the Illinois Marathon Weekend
Softball falls to Drake, ending first winning season since 2007

redpajama_set_name: RedPajamaCommonCrawl


Hoi hoi, we're in Munich right now! So today you get a potato quality cell phone picture of my sketch book instead of a comic. It's really wet here, but at least not quite the apocalypse the weather forecast announced. Next update will be something analog again. I hope you don't mind and enjoy the update nonetheless.


text:
Coinbase's stock deserves to fall
Colehill Cricket Club: the latest NIMBY victim
by Greta Aurora
Wednesday, 11
The latest reason to change gender: child custody
A father in Ecuador is identifying as a woman to see his kids
René Salinas Ramos. Source: La Voz del Tomebamba.
An Ecuadorian father recently legally changed his gender to female to improve his chances of gaining custody of his children. René Salinas Ramos doesn't consider himself transgender, but instead made this decision in order to circumvent his country's custody laws.
According to Ramos, his two daughters have been forced to live with their allegedly abusive mother, and that he hasn't been able to see them for five months. Speaking to local media, he explained that fathers are "punished" in the country, and that he is "only seen as a provider". Given that in Ecuador, as in many other nations, judges are significantly more likely to rule in favour of women in custody battles, he may have a point.
Diane Rodriguez, a notable trans activist in Ecuador, asserted that Salinas Ramos's legal change wasn't in "the spirit of the law" but, in reality, his bid to be recognised as a woman exposes loopholes in the policy of self-ID.
Feminists concerned about self-ID laws tend to focus on the dangers of biological males entering women's single-sex spaces and competing in women's sports. They argue that gender recognition laws like the one recently passed in Scotland make it easier for men with malicious intentions or severe mental health conditions to attack or disturb women and girls at places where they are at their most vulnerable.
But this case shows that there are other ways in which the self-ID system can be exploited. As Salinas Ramos's case shows, criminal intent is not the only reason biological men may choose to misuse an easily accessible 'woman' label.
It's not just in the courtroom where biological males can benefit from the system either. Identifying as female could also grant biological males access to advantages in education and employment. EU countries allowing self-ID may see a rise in men identifying as women once employers start implementing the gender quota law recently passed by the European Parliament. The new directive will require 40% of non-executive board positions and 33% of executive seats to be filled by women in the bloc's 27 countries. The earlier female retirement age may also appeal to many men. Will other biological males transition to advance their own careers?
Ultimately, the archetype of the damsel in distress and her ability to invoke chivalry has no male equivalent. Thanks to self-ID this uniquely feminine power, stemming from women's perceived weakness, may now be available to men as well. In a culture that labels masculinity as toxic and sends mixed messages to men about how they should behave, living as a woman may seem like an easier way out. The peculiar example of René Salinas Ramos's custody battle demonstrates that Ecuador's law, and gender legislature more widely, may well need a rethink.
Steve Murray
Brilliant! Anything that highlights the idiocy of trans activism is to be welcomed, although the plight of fathers in custody battles where their partner is clearly less fit to care for their children is another issue.
Whilst vehemently opposing the right of biological males to invade what should be women-only spaces, i welcome this use of transgenderism. I look forward to this particular father – obviously male and given the assumption that the mother in this case shouldn't be granted preferential status – winning his case, and then continuing to live as a male in every respect, i.e. no changes to his physical appearance. I guess his self-ID might help him when his two daughters need to visit a public loo; he'll be able to accompany them.
Reply to Steve Murray
Agreed. And I look forward to hundreds of divorcing fathers in Scotland claiming to change their gender in order to get fairer custody for their children too.
Warren Trees
How can a society prevent the intrusion into women-only spaces when it cannot provide a definition of "woman"? I don't like sitting by and watching this debacle play out, and loathe what it is doing to the biological females of our world.
Last edited 16 days ago by Warren T
Alison Wren
Reply to Warren Trees
Oh dear. The word female is a precisely defined biological term meaning producer of large immobile gametes. We really shouldn't be forced to use the adjective in order for the meaning to be clear!
Linda Hutchinson
Whilst I do sympathise with the man (at least from what he has said) this shows how the whole concept of self-identification can be used for any reason, whether it be nefarious or not.
Galvatron Stephens
There was a guy in Argentina who transitioned to get his pension five years early.
Last edited 17 days ago by Galvatron Stephens
CHARLES STANHOPE
Reply to Galvatron Stephens
Did he have to castrate himself?
Last edited 17 days ago by stanhopecharles344
Jim R
Isn't this basically the plot of "Mrs. Doubtfire"?
Gerald Arcuri
Insanity is as insanity does. Is any further proof of the idiocy of gender fluidity really needed? The proponents have painted themselves into a predictable legal corner, highlighting the underlying illogic of the whole movement.
Robert Cocco
I've always wondered if a male small business owner could identify as female in order to get preferential US Government contracts as a woman-owned business.
Isabel Ward
Highly entertaining- I hope he wins what appears to be a justifiable case.
"Feminists concerned about self-ID laws tend to focus on the dangers of biological males entering women's single-sex spaces and competing in women's sports."
Must one be a feminist to be concerned about this lunacy?
Douglas McNeish
"Uniquely feminine power, stemming from women's perceived weakness." Weakness is indeed power in our current nanny state era, so long as its claimant can point to a recognised oppressor – and of course any "privileged" male will do.
Reply to Douglas McNeish
Weakness, and victimhood, become claims for power in inverse proportion to having rights. Why emphasize group disadvantage in order to justify resource demands? Because people, as such, are not held to have rights to education, housing, jobs, medicine, old age security, and so forth.
The question is: can a biological male have the title 'mother'?
Reply to Chris W
If a biological male can self identify as a woman, for legal reasons, calling him a "mother" seems like a very minor step in the process. Heck, call him a vegemite sandwich, what difference does it make at this point?
I hesitate to be controversial on this site, but he were going to call himself anything it would be a Marmite sandwich, if you please.
Why, you mother . . . 😉


With threats to roll-back environmental regulations and international climate programs, we've been taking strength from the films and filmmakers in our SF Green Film Festival archive.
Each week we're going to provide you with a film suggestion to arm you with the knowledge, ideas, and inspiration to resist Trump's environmental agenda.
Together we'll watch and learn from the people taking on the climate deniers, standing up to power and offering up new solutions.
Here are the film suggestions so far and some coming up in Green Film Fest 2017, April 20-26.
And what better place to start than with the You've Been Trumped Trilogy from director Anthony Baxter for Inauguration Day, on January 20.
The second film A Dangerous Game (SFGFF 2014), charts the eco-impact of luxury golf resorts around the world.
San Francisco Green Film Festival will host an Inauguration Day screening of You've Been Trumped Too (dir. Anthony Baxter, 2016), following the ongoing battle of a feisty 92-year-old Scottish widow and her family to get Trump to give them back their access to water.
Merchants of Doubt, February 21, 7pm, Roxie Theater - Buy Tickets.
To mark the first month, there will be a public screening of Merchants of Doubt (dir. Robert Kenner, 2014) with special guests. The film exposes the spin tactics learned in the tobacco industry and now being used against the environmental movement.
The First 100 Days: Green Film Guide will culminate with new films at Green Film Fest 2017, April 20 - 26. Full schedule announced March 22, 2017.


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Report: J.Crew to Open Lower-Priced Chain, Mercantile
The name has already been trademarked.
Earlier this year, there were reports that J.Crew was planning to lower prices -- only to be quashed (how sad!) by the retailer's in-house PR. Well now it seems that more affordable J.Crew may soon be a reality: According to the Wall Street Journal, the company is planning to open a new, more budget-conscious chain called J.Crew Mercantile.
J.Crew has indeed registered the trademark J.Crew Mercantile, a filing in the United States Patent and Trademark Office reveals. The filing was made in November of last year to cover such goods and services as bags, wallets, umbrellas, footwear, jewelry and apparel. A rep for J.Crew would not confirm whether the name is being used for a new chain, but sources tell WSJ that the retailer is developing a new store format under the name which will sell merchandise in line with what you might find at J.Crew Factory, at a comparable price point. This, however, would not have the same "outlet" association -- it would be its own brand with its own full-price merchandise and discounts.
While fashion people fall more in love with J.Crew each season for its Jenna Lyons-fueled, high-end, fashion-forward items and its fancy collaborations with the likes of Sophia Webster, the retailer's elevated aesthetic and prices haven't completely caught on with its more budget-conscious customers.
The WSJ points out that the move is similar to Mickey Drexler's decision to open Old Navy during his tenure at Gap -- designed to sell lower-priced versions of Gap's easy basics. The risk for J.Crew, as it was for Gap, is cannibalizing its own business.
Ziwe Walked Mugler Fall 2023, and the Runway May Never Recover
Poppy Store Is Hiring An ECommerce Associate In California
Must Read: The RealReal Announces New CEO, June Ambrose Launches Collection for Puma
It's also worth noting that there have been many reports that J.Crew plans to stage an IPO soon. Perhaps that's why the company is looking to diversify across multiple price categories.
J.Crew Mercantile
J.Crew Says There Are No Plans for 'Mercantile' Brand Yet
Don't get your hopes up for that lower-priced J.Crew store. At least, not yet.
By Dhani Mau May 7, 2014
J.Crew to Open Fourth London Store... Surrounded by Bees
Don't worry, the bees are temporary.
Sorry Guys, J.Crew Is Not Really Lowering Prices
False alarm.
J.Crew Launches Lower-Priced Swimwear Line Aimed at Millennials
The retailer's latest move appeals to a younger customer.
By Dhani Mau Feb 1, 2018


Described as the birdwatcher's Glastonbury, Birdfair encompasses the whole spectrum of the birdwatching industry whilst at the same time supporting global bird conservation. This is the event of the year if you're into birds and wildlife. There are hundreds of stands selling the latest products for wildlife enthusiasts. You'll find everything, from scopes to sculptures, binoculars to bird food, eGuides to eco-holidays!
Every day a packed programme of events is offered. Three separate timetables boast a fantastic variety of lectures. The Events Marquee hosts quiz shows, question and answer sessions, exclusive book launches and family-based entertainment. The Birdfair Auction offers you the chance to bid for a whole host of lots, donated by our exhibitors, ranging from holidays, to artwork, to unique one-off experiences, with all the monies raised going directly to this year's Birdfair project.


Ideal for stippling, buffing, and blending with ease. This soft, synthetic, duet-fiber brush gently picks up products for a smooth, gentle application onto the face. The delicate angle will guide your hand as the brush glides over your skin for beautiful coverage.


If mold is a problem in your home, clean up the mold and get rid of the excess water or moisture. Fix leaky plumbing or other sources of water. Wash mold off hard surfaces with detergent and water, and dry completely. Absorbent materials (such as ceiling tiles & carpet) that become moldy may have to be replaced. Learn more.
What are molds and where are they found?
Molds are fungi found both indoors and out, almost everywhere in the environment. They can grow all year long and grow best in warm, damp and humid conditions. Molds spread by making spores that can survive harsh environmental conditions that normally do not support mold growth.
In the home, mold is almost always present in the air and grows best in damp areas with high humidity levels, like bathrooms and basements. While there are perhaps thousands of species of mold, most common indoor molds include Cladosporium, Penicillium, Alternaria and Aspergillus.


text:
Q: How to run camel components in parallel I have a camel route (main-route), which calls a soap web service and stores the result returned from soap service into database. My camel context is as below.
<route id="HttpRoute">
    <from uri="jetty:http://127.0.0.1:8889/Getdata"/>
    <to uri="direct:start"/>
</route>

<route id="TimerRoute">
    <from uri="timer://getdata?period=10000"/>
    <to uri="direct:start"/>
</route>

<route id="main-route">
    <from uri="direct:start"/>
    <process ref="soapRequestGenerator" />
    <marshal>
        <jaxb contextPath="org.sample.camel" fragment="true" namespacePrefixRef="namespacePrefixMap"/>
    </marshal>
    <convertBodyTo type="java.lang.String"/>
    <to uri="velocity:soapRequest.vm"/>
    <setHeader headerName="operationName">
        <constant>soapOperationName</constant>
    </setHeader>
    <to uri="cxf:bean:soapServiceEndpoint"/>
    <convertBodyTo type="java.lang.String"/>
    <process ref="soapResponseProcessor" />     //task-0
    <setBody>
        <simple>
            insert into table(Id,col1,col2) values(:?id,:?val1,:?val2);
        </simple>
    </setBody>
    <to uri="jdbc:dataSource?useHeadersAsParameters=true"/>     //task-1
    <to uri="velocity:soapResponse.vm"/>                        //task-2
</route>

Now there are two options to call main-route.
1) via timer(TimerRoute) which executes periodically and call the main-route to store data into database.
2)via http (REST) call which requires the returned response from soap service to be stored into db and returned to caller (REST).
Now i want to execute task-1 and task-2 of main-route in parallel when invoked via HttpRoute because they are independent. Data required by these two task can be prepared and stored into headers at task-0, but i don' know how to do this. Moreover i don't want to execute task-2 when main-route is invoke'd via TimerRoute. How to do that ?
I also want to check in to database before inserting the records received from soap service to avoid duplicate records into database. This check can be performed into parallel to soap service call (to increase throughput) and based on that need to decide weather records will be inserted or updated.

A: Enumerating the questions you've asked here

*

*To follow different flows based on source route, you can set a header in the source route and use it in the main-route with Router or Choice

*To run Task-1 and Task-2 in parallel, use Multicast

*To run the Database check, use a DB processor. You can use Multicast to fire the calls in parallel

redpajama_set_name: RedPajamaStackExchange


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SADcars has been a fantastic company to deal with. The customer service, pricing, and car couldn't possibly have been better.
I made quite a lot of changes to my reservation since I initially reserved a car last November and the whole team--especially Signy--were fantastic. They were patient with all of my requests, explained everything completely, and always responded within 24 hours. Pick-up and drop-off of the car was quick and easy.
Pricing is obviously unbeatable, and as I believe they've introduced a new policy regarding the maximum age of the vehicles in their fleet, I see no reason not to book with this company over other, more expensive competitors. They offer several different insurance packages, and I opted for the Platinum (most comprehensive) so I had peace of mind that I was covered for whatever happened throughout the trip.
I plan to visit Iceland again in the future to travel the northern half of the island, and will 100% book with SADcars again.
The booking was easy and informative. Returning the vehicle was simple and quick. The staff were understanding and helpful.
- Renter from United States. Rented Suzuki Grand Vitara | Auto.
Easy and smooth car rental process. Cheapest in Iceland! Great experience will be renting from SARcars again!
- Renter from United States. Rented VW Polo | Manual.
The rental procedure was effortless. The people at Sad Cars are very helpful and responsive. The Platinum insurance allowed me to rent a car with a debit card.
I totally recommend SAD Cars.
- Renter from Romania. Rented Dacia Dokker Camper.
I emailed a few questions prior to rental they were answered quickly and politely and left me feeling happy with my choices.
We requested a Toyota Rav 4 Auto on arrival this was changed to a Ford Kuga auto.
No complaints it was a year old, top spec and faultless. We had 4 days of hassle free pleasant and really comfortably driving.
We took out the platinum insurance so on return the car just needed a quick few minutes check and off we went to the airport.
The rental office was easy to get to via the shuttle bus, we had no wait either at pick up or return and were offered lovely coffee both times. All staff were friendly and lovely to deal with.
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- Renter from United Kingdom. Rented Toyota Rav4 4wd | Auto.
The renting process was smooth and the staff was professional! We were very pleased although at first our navigator was in a non roman letter -language and we had to ask for some extra amenities that we had already paid for.
- Renter from Finland. Rented Dacia Duster | Manual.
Спасибо за хороший сервис. Машина была полностью исправна, отлично прослужила нам 7 дней. При приёме машины советую максимально внимательно осмотреть ее, мы нашли несколько недочетов, не указанных в документе.
- Renter from Russia. Rented Dacia Duster.
I had a really pleasant and hassle free experience with Sad Cars. Will use them again as soon as I'm back in Iceland!
- Renter from Poland. Rented Toyota Rav.
Wir waren sehr zufrieden mit unserem Auto und dem Service. Der Flughafen Shuttle war super und wir hatten eine schöne Zeit auf der Ringstraße. Sehr gutes Preis Leistungsverhältnis. Wir werden wiederkommen!!!
- Renter from Germany. Rented Nissan Qaqshqai.
The benefit to cost ratio with these guys is high. I was able to have a great 5 day rental at much less than any other rental company. The cars are a bit older and show some wear, but still worked just fine for what I needed. Would use again.


text:
Sequencing Verb Tenses
Regular and Irregular Verbs Card Deck
by Rynette Kjesbo, M.S., CCC-SLP - Grades K and Up
#605 Developmental Milestones – Four to Five Years 12/20/2019
#604 Developmental Milestones – Three to Four Years 11/19/2019
#603 Meta-Memory Strategies 11/12/2019
#601 No-Prep Therapy Activity: Halloween Lotto! 10/29/2019
#598 No-Prep Therapy Activity: Guess My Monster! 10/8/2019
#596 Developmental Milestones – Two to Three Years 9/24/2019
#595 Twice-Exceptional Students 9/18/2019
#592 No-Prep Therapy Activity: A Chip Off the Ol' Ice Breaker! 8/27/2019
#587 No-Prep Therapy Activity: Back-to-School Barrier Game 7/23/2019
#584 American Sign Language 7/2/2019
#583 Developmental Milestones – Birth to One Year 6/25/2019
#577 Hearing Loss 5/14/2019
#576 No-Prep Therapy Activity: May Flowers 5/7/2019
#575 Rule Breakers: Irregular Verbs and Irregular Plural Nouns 4/30/2019
#573 No-Prep Therapy Activity: April Showers 4/16/2019
#561 Brown's Stages 1/22/2019
#560 No-Prep Therapy Activity: Guess My Snowman 1/15/2019
#557 Travel with Communication 12/25/2018
#549 Fall Fun 10/30/2018
#548 Aging Out of Developmental Delay 10/23/2018
#546 Naming Attributes 10/9/2018
#544 Further Flashcard Fun! 9/25/2018
#541 More About Graphic Organizers 8/21/2018
#537 A Picture is Worth a Thousand Words: The Value of Picture Books 7/24/2018
#534 Airborne Allergies 6/13/2018
#532 Seeing Red (Or Not Seeing It): What Is Color Blindness? 5/29/2018
#528 Poetry and Language 4/24/2018
#520 Cyberslang… :) or :( ? 2/13/2018
#511 What's Happening? Talking to Children about Current Events 12/5/2017
#504 Alzheimer's 10/17/2017
#498 Encouraging Good Communication with Children 8/23/2017
#497 What is higher-order thinking? Why is it important? 8/16/2017
#496 First Words 8/8/2017
#495 Adjectives & Adverbs 8/1/2017
#492 Visual Schedules for Daily Routines 7/19/2017
#476 Literacy Milestones: Should My Child Be Reading? 3/14/2017
#475 Important Qualities When Working with Children 3/7/2017
#469 Working Memory 1/24/2017
#467 Why Are Frogs Green? How to Handle Your Child's Nonstop Questions 1/12/2017
#462 More Flashcard Fun! 12/6/2016
#455 Flashcard Fun! 10/18/2016
#450 Minding the Gap Part Two: English Language Learners 9/13/2016
#449 Back to School Basics 9/6/2016
#442 I Screen, You Screen, We All Screen For… What? 7/19/2016
#440 Save it for a Rainy Day: Ideas to Beat Summer Boredom 7/5/2016
#435 Anomia 5/31/2016
#429 Webber HearBuilder® Collection 4/19/2016
#427 What is Academic Vocabulary? Why is it important? 4/5/2016
#426 Making Learning an Equal-Access Activity 3/29/2016
#414 Beating the Winter Blahs: Ten Boredom Busting Family Activities 12/22/2015
#407 Read with Me, Talk with Me: Helping Your Child Build Skills for Future Reading Success 6/2/2015
#402 Practicing Language Skills in the Car 9/2/2014
#401 How Can I Help My Students Perform Well on Standardized Tests? 1/14/2014
#382 Mainstreaming English Language Learners into the Regular Classroom 5/15/2013
#381 My Child Can Read – But Won't! 4/3/2013
#380 Help Students Develop Strong Vocabulary Skills 3/19/2013
#378 Six Early Literacy Skills Predict Reading and Writing Success 2/19/2013
#377 Building Early Literacy Skills through Speaking and Listening 2/5/2013
#376 Word Recognition Strategies for the Struggling Reader 1/22/2013
#371 Are My Child's Language Skills Developing Normally 11/8/2012
#361 Using Calendar Activities to Extend Classroom Learning 6/19/2012
#354 Present, Past, and Future Tense Verbs 3/13/2012
#353 Rebus Activities for Articulation 2/28/2012
#352 Language Lab: Response to Intervention (RTI) Program for Teaching Grammar, Vocabulary, and Storytelling 2/14/2012
#350 Narrative Stages 1/18/2012
#349 Narratives – From Oral to Written Language 1/13/2012
#339 Sentence-Building Activities 11/4/2011
#338 Sentence Structure 10/28/2011
#337 Types of Poetry 10/21/2011
#336 Types of Figurative Language 10/14/2011
#334 Teaching Time Management at Home 9/30/2011
#333 Teaching Time Management at School 9/23/2011
#332 Building Vocabulary Using Homonyms 9/16/2011
#331 Helpful Strategies for Auditory Memory 9/9/2011
#330 Journal Writing Activities 9/2/2011
#329 Journal Writing Across the Curriculum 8/26/2011
#328 Using the Technique of Brainstorming in the Writing Process 8/19/2011
#327 Fun Ways to Practice Fact vs. Opinion 8/12/2011
#326 Helping Students Understand and Distinguish Fact vs. Opinion 8/8/2011
#325 Ways to Teach Opposites 7/29/2011
#324 The Thesaurus—A Writer's "Best Friend" 7/22/2011
#323 A Thesaurus Is Not a Dinosaur! 7/15/2011
#322 Ways to Teach Dictionary Skills 7/8/2011
#321 Why Teach Dictionary Skills in the 21st Century? 7/1/2011
#320 Fun Ways to Practice Main Idea at Home 6/24/2011
#319 What's the Big Idea? Finding and Understanding the Main Idea 6/16/2011
#318 Teaching Prepositions 6/10/2011
#316 Gifted Students 5/27/2011
#311 Teaching Negation Should Not Cause Frustration! 4/22/2011
#295 What Makes a Story…a Story? 12/30/2010
#294 Parts of Speech 12/23/2010
#287 Understanding Metaphors…It's a Breeze! 11/5/2010
#286 Look, Listen…and Sequence! 10/29/2010
#285 Sequencing and Executive Functions 10/22/2010
#272 Context Clues—Can You Figure It Out? 7/23/2010
#268 Planning a Trip Helps Children Practice Many Skills! 6/25/2010
#259 Comparatives and Superlatives 4/23/2010
#257 Conjunctions "Join" Thoughts and Ideas 4/9/2010
#254 Cooking – A Recipe for Learning Success! 3/19/2010
#233 Teaching the Fundamentals of Grammar and Syntax at Home 10/23/2009
#228 Barrier Games—"Do You See What I See?" 9/18/2009
#227 Language Expansion vs. Language Extension—What's the Difference? 9/11/2009
#218 All About Analogies 7/9/2009
#212 Idioms—"As Easy as ABC" 5/29/2009
#200 Sight Words 3/6/2009
#185 Understanding Word-Retrieval Problems 11/21/2008
#182 Three Tiers of Vocabulary and Education 10/31/2008
#173 Teaching Pronouns in the Classroom 8/29/2008
#167 The Importance of Teaching Sequencing to Young Children 5/30/2008
#149 Vocabulary Development 1/30/2008
#129 Are Teachers Asking the Right Questions? 3/15/2007
#112 What is the Writing Process? 6/30/2006
#110 How to Help Your Child Understand and Produce "WH" Questions 5/30/2006
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"Blood Brothers" is the first book from Palestinian Israeli Elias Chacour. Elias is a Christian priest and community leader in Galilee, Israel. He lives and serves his community of Palestinian Christians in a village of Muslim, Druze and Christian villagers. This book is the personal story of his youth, the expulsion of him and his family from his home village of Biram, his training as a Melkite priest, and his eventual work in the ministry of bringing hope to a broken and terrified group of alienated Arabs in Jewish Israel. Unlike his other book We Belong to the Land, Chacour focuses more poignantly in Blood Brothers on his personal and family life. Most profoundly, he explores the character of his father who serves as an arch-type for both God and the image of what good men can be. Elias Chacour treasures and follows this image into a lifetime of seeking reconciliation, hope and love for the Palestinian people of the village of Ibillin.
"But How do we know the soldiers won't harm us?" Rudah pressed him.
This image turns out to be misinformed, though hopeful premonition to the tragedy that would ensure. After taking over the land of Palestine, the Jews of Israel began to programmatically terrorise the people of the rural villages such as Biram. Demolishing their homes and farms and confiscating the land became the program of the Zionist Jews. Even thought Chacour's father has his land taken from him and his home destroyed, his connection to the land and its plants shows a level of care foreign to us.
Father's other response to the sale of his land was more of a wonder to me. In a few weeks we heard that the new owner of our property wanted to hire several men to come each day and dress the fig trees, tending them right through till harvest. Immediately, Father went to apply for the job, taking my three oldest brothers with him. They were hired and granted special work passes, the only way they could enter our own property.
Now I determined to find out how a peaceful movement that had begun with a seemingly good purpose-to end the persecution of the Jewish people-had become such a destructive, oppressive force. Along with that determination, I was driven by a respect for history that Father had planted in me. Did the seeds of our future hope lie buried in our past, as he had so often said?
Elias is brilliant to turn to the teaching of his father to recall the thought that history can teach us and, perhaps if heard, can lead us back together. Blood Brothers tries to convince the reader that Zionist Israel is the major obstacle to reconciliation with the Palestinians, though he is against violence of all sort, including from the Palestinian people. He outright rejects the military efforts of the PLO and looks instead for a reconciled Israel in which Jews and Arabs can live together.


Following an epic New York Comic Con panel, we've got two new The Last Witch Hunter clips to keep the excitement coming. "Wake Up" is action-packed and features the immortal Kaulder (Vin Diesel) in a spell sequence between the past and present, while battling an evil warlock enemy. In "Trouble," Kaulder performs a spell to reveal hidden dark magic to Dolan 37 (Elijah Wood), and a new Sizzle features Ciara's cover of The Rolling Stones' "Paint It, Black."
The Last Witch Hunter hits theaters on October 23, which is shaping up to be one huge weekend at the box office. This action-thriller will go up against The Weinstein Company's comedy Burnt, Universal's Jem and the Holograms, Paramount's Paranormal Activity: The Ghost Dimension and Open Road Films' Rock the Kasbah. Will Vin Diesel be the savior of the fall movie season? Take a look at 90 seconds from this breathtaking fantasy adventure, along with two thrilling new scenes. Then be sure to mark your calendar for October 23. We only have a few days left until Vin Diesel returns to save mankind once again.


Pinpointe is excited to announce a new system update, Release 29, which makes creating beautiful emails easier. The main goal of this update is to streamline the email creation process, making it more intuitive and user-friendly.
Getting Acquainted with Pinpointe's Toolbox from Pinpointe on Vimeo.
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text:
Public Health Agency of Canada reports and publications
Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice
Vol 33, No 4, September 2013 - Chronic Diseases and Injuries in Canada (CDIC)
Improved estimation of the health and economic burden of chronic disease risk factors in Manitoba - CDIC: Vol 33, No 4, September 2013
Volume 33 · Number 4 · September 2013
Chronic Diseases and Injuries in Canada
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About CDIC
Improved estimation of the health and economic burden of chronic disease risk factors in Manitoba
H. Krueger, PhD (1, 2); D. Williams, MSc (2); A. E. Ready, PhD (3); L. Trenaman, BSc (2); D. Turner, PhD (4, 5)
Author references:
School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
H. Krueger & Associates Inc., Delta, British Columbia, Canada
Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
CancerCare Manitoba, Winnipeg, Manitoba, Canada
Correspondence: Hans Krueger, H. Krueger & Associates Inc., 4554 48B Street, Delta, BC V4K 2R8; Tel.: 604-946-5464; Email: hans@krueger.ca
Introduction: There are analytic challenges involved with estimating the aggregate burden of multiple risk factors (RFs) in a population. We describe a methodology to account for overlapping RFs in some sub-populations, a phenomenon that leads to ''double-counting'' the diseases and economic burden generated by those factors.
Methods: Our method uses an efficient approach to accurately analyze the aggregate economic burden of chronic disease across a multifactorial system. In addition, it involves considering the effect of body weight as a continuous or polytomous exposure that ranges from no excess weight through overweight to obesity. We then apply this method to smoking, physical inactivity and overweight/obesity in Manitoba, a province of Canada.
Results: The annual aggregate economic burden of the RFs in Manitoba in 2008 is about $1.6 billion ($557 million for smoking, $299 million for physical inactivity and $747 million for overweight/obesity). The total burden represents a 12.6% downward adjustment to account for the effect of multiple RFs in some individuals in the population.
Conclusion: An improved estimate of the aggregate economic burden of multiple RFs in a given population can assist in prioritizing and gaining support for primary prevention initiatives.
Keywords: population attributable fraction, risk factors, obesity, physical inactivity, tobacco smoking, chronic disease
Health care planners have long been concerned with the ''epidemiologic transition,'' the process whereby chronic illnesses displace pandemics of infection as the primary source of morbidity and mortality in the world.Endnote 1 The latest phase of this transition is marked by increased prevalence of overweight/obesity and physical inactivity in many countries.Endnote 2 Excess body weight and/or physical inactivity have been implicated in chronic diseases such as cardiovascular disease, stroke, type 2 diabetes, chronic kidney Endnote 3, Endnote 4, Endnote 5, Endnote 6, Endnote 7, Endnote 8, Endnote 9, Endnote 10, Endnote 11, Endnote 12disease, osteoarthritis and certain cancers. Consequently, these riskEndnote 13 factors (RFs) have joined tobacco smoking as key prevention targets.
Estimations of the economic burden generated by such RFs have been undertakenEndnote 14 in many jurisdictions in the world, including Canada as a wholeEndnote 15, Endnote 16, Endnote 17, Endnote 18, Endnote 19 and a few Canadian provinces.Endnote 20, Endnote 21 In addition to understanding the costs related to a single RF such as tobacco smoking, estimating the aggregate economic burden generated by two or more RFs in a population is often of interest. This information can inform prevention strategies aimed at more than one RF, for example, public health programs that address both physical inactivity and overweight/obesity. There are, however, analytical challenges involved with the estimation of the aggregate burden of multiple RFs in a population.Endnote 22 Certain costs (such as those generated by incident disease or by death) are by definition accrued only once. Thus, it is important to account for the confounding effect of multiple RFs in the same individual, and specifically to adjust for any increase in the calculated economic burden due to double-counting cases and costs.
Population attributable fraction (PAF) offers a powerful way to interpret causation in the practical terms of prevention. In short, PAF is that proportion of disease incidence (or costs) that will be removed if exposure to the causative RF is removed. The approach, however, becomes more complicated when the aim is to assess the combined effect of multiple RFs.
A number of innovative approaches have been developed to quantify the effects of multiple RFs in specific cohorts.Endnote 23 The World Cancer Research Fund, for example, used a process that could be described as ''sequential prevention,'' explained as follows:Endnote 24p149
Because no individual case of cancer can be prevented more than once, this calculation was done in a way that avoided the possibility of ''double counting.'' The PAF for the first exposure was subtracted from 100 per cent and the PAF for the second exposure was applied to the remainder. This process was performed sequentially for all relevant exposures, resulting in an estimated PAF for all exposures combined.
While it makes sense as a goal, the work of disentangling the impact of overlapping RFs is often omitted from estimations of the related economic burden. A case in point is the series of papers published from 2005 to 2009 by a British Heart Foundation group on the burden of ill health in the United Kingdom due to physical inactivity,Endnote 25 overweight/obesity,Endnote 26 tobacco smokingEndnote 27 and other RFs.Endnote 28, Endnote 29 In a summary paper, the authors acknowledge that ''the possible overlap between risk factors (such as overweight and obesity) was not addressed here but should be considered when calculating the total economic burden of these risk factors.''Endnote 30,p534
To address this challenge, we describe a methodology to account for overlapping RFs when estimating the aggregate economic burden of associated chronic illnesses. The approach involves four steps:
consideration of the function of body weight as a continuous or ''polytomous'' exposure ranging from no excess weight through overweight to obesity;
estimating an aggregate burden of chronic disease across a multifactorial system in a manner that adjusts for the effect of more than one RF;
estimating the aggregate economic burden adjusted for multiple RFs occurring in some individuals; and
disaggregating the total burden to provide an estimate of the economic cost notionally attached to each RF.
To our knowledge, this is the first published attempt to address the issue of double-counting costs due to overlapping RFs in some individuals when addressing the economic burden of multiple RFs.
As a demonstration of the utility of this approach, the economic burden of diseases attributable to tobacco smoking, physical inactivity, and overweight/obesity are estimated for the Canadian province of Manitoba. Manitoba has a population of about 1.2 million.Endnote 31 Although the province is marked by a strong agriculture and resource-based economy, some 60% of Manitobans reside in Winnipeg, the provincial capital. There is also a large First Nations presence in Manitoba (about 11% of the provincial population).Endnote 32
We used an approach based on PAF to estimate the economic burden associated with the various RFs. At its simplest, the PAF statistic refers to the proportion of disease incidence generated in a population by a particular RF.Endnote 33 The results we report in this paper required calculating a Manitoba-specific PAF for each of the diseases related to the RFs of interest and then combining that information with the estimates of Manitoba-specific costs associated with both disease treatment and the indirect impacts of mortality/morbidity.
PAF is a statistic that combines two facets of an RF and its impact on disease: relative risk (RR) of the RF in reference to a particular disease, and the prevalence of exposure to the RF in the population of interest.
Relative risk
The source for the RRs associated with physical inactivity is the meta-analyses by Katzmarzyk and Janssen.Endnote 16 The majority of the studies incorporated in the Katzmarzyk and JanssenEndnote 16 review include an index of obesity in the analysis so that the effects of physical activity on disease risk can be considered to be independent of obesity. The source for the RRs associated with overweight and obesity is the meta-analyses by Guh et al.Endnote 34 The authors did not include physical inactivity as a potentially confounding RF as ''physical inactivity is often poorly reported and requiring its inclusion would have reduced the number of included studies.''Endnote 34, p15
We consulted two sources to assemble RRs for diseases attributable to tobacco smoking. A 2008 paper by Gandini et al.Endnote 35 offers a detailed meta-analysis specific to smoking-related cancers, including RRs adjusted for known confounding factors (esophageal and upper digestive tract cancers for alcohol consumption, stomach cancer for diet, liver cancer for infection with hepatitis B or C, cervical cancer for infection with the human papillomavirus and kidney cancer for body mass index).Endnote 35 Note that tobacco smoking is no longer a significant RF for liver or cervical cancers after these adjustments. The RR of cardiovascular and respiratory diseases were taken from a publication by Thun et al.Endnote 36 Thun et al.Endnote 36 adjusted all RRs for age, race, education, marital status, employment, consumption of vegetables and fruits, aspirin use, alcohol consumption, body mass index (BMI), physical activity and consumption of fatty foods. In addition, the RR for pneumonia, influenza, bronchitis and emphysema were adjusted for occupational asbestos exposure.
Most sources, with the exception of those dealing with physical inactivity, offered RR data by sex. An additional review of research for sex variations associated with physical inactivity supported the assumption that there is no significant difference in RR between males and females for this RF.Endnote 37, Endnote 38, Endnote 39
The point estimates of the RRs are used for calculations in the base model with the upper and lower bounds of the 95% confidence intervals (CIs) assessed in a sensitivity analysis.
Risk factor exposure
The other half of a PAF calculation depends on high-quality RF prevalence data.Endnote 40 The analysis of Manitoba's population exposure to tobacco smoking, physical inactivity and overweight/obesity began with information drawn from the 2008 Canadian Community Health Survey (CCHS). Tobacco smoking included all ''current smokers'' (daily and occasional smokers); overweight and obesity included individuals with a calculated BMI of between 25 kg/m2 and 30 kg/m2 for overweight and of 30 kg/m2 and greater for obesity (based on self-reported height and weight); and physical inactivity included individuals categorized in the CCHS as ''inactive.''
We made several adjustments to the base CCHS data to address acknowledged weaknesses. First, we used data from the Manitoba Youth Health Survey (MYHS) to adjust for youth smoking and physical inactivity.Endnote 41 Data from the CCHS suggested that about 10% of Manitoba youth aged 12 to 19 years were current smokers in 2008 versus 21.2% of youth in Grades 6 to 12 in the MYHS. On the other hand, the prevalence of physically inactive youth was reduced from 32% (in CCHS) to 19.3% (in MYHS).
Second, we estimated rates of physical inactivity for children aged under 12 years based on rates in the MYHS (16.4% for males and 22.1% in females). Rates of overweight and obesity for children and youth aged under 18 years were estimated based on Manitoba-specific CCHS rates for ages 20 to 34 years (34.5%/36.6% overweight in males/females andEndnote 4215.6%/14.7% obesity in males/females). While CCHS provides an estimate of overweight and obesity combined for ages 12 to 19 years, the results have a high coefficient of variation and are to be used with caution.Endnote 42 Furthermore, obesity-related behaviours including physical (in)activity and diet tend to track from childhood into adulthood.Endnote 43
Third, the CCHS does not include individuals living on First Nation reserves, whichEndnote 44 represents about 55 000 Manitobans. We used results from the 2002/03 Manitoba First Nations Regional Health Survey to identify and then adjust for the high prevalence of smoking (62%) and overweight/obesity (75%) among adults aged 18 years and over in the on-reserve population.Endnote 45
A final adjustmentEndnote 18 was guided by the work of Anis et al., who used the prevalence of waist circumference rather than BMI for specific disease categories including ischemic heart disease, hypertension, type 2 diabetes and gallbladder disease.
Multiple exposure levels
The most basic version of a PAF calculation, derived from the prevalence of a single RF and the RR of a related disease, uses the formula (E(RR21)) / (E(RR21)+ 1), where E is the proportion of the population exposed to the factor of interest and RR is the relative risk of disease developing in the group exposed to the factor.
However, more sophisticated approaches are required to calculate PAF when a polytomous RF is involved, that is, one that is made up of many parts. This is the case for overweight and obesity. These two biological categories lie on a continuum. As such, it is not algebraically accurate to calculate basic PAFs for each of overweight and obesity, and then simply sum the two figures to derive an overall PAF for exposure to excess weight. Instead, overweight and obesity should be conceived as a trichotomous exposure to excess body weight; that is, three categories of exposure are involved:
no excess weight,
intermediate excess, or overweight (prevalence EOW),
more extreme excess, or obesity (prevalence EOB).
The PAF calculation is as follows:Endnote 46
EOW(RROW–1)+EOB(RROB–1)/EOW(RROW–1)+EOB(RROB–1)+1
Multiple risk factors
When complete information is known about both the exposure to multiple RFs (i.e. smoking and overweight/obesity in the same individual) and about the RR related to each set of causes, then it is straightforward to calculate the PAF for a combined system. However, when information on the RF overlap is lacking, as is often the case, it is once again important to avoid simply adding the basic PAFs for each RF in order to obtain a combined PAF for the multifactorial system. A more accurate approximation of PAF of the system is obtained using the equationEndnote 47
1–[(1–PAF1)(1–PAF2)(1–PAF3)]
where the notation PAF1 stands for the PAF related to the first RF, and so on.
This equation is most accurate when two conditions apply:
the RFs involved are statistically independent (i.e. experiencing one makes an individual no more or less likely to experience the other, or the clustering of RFs is limited), and
their joint effects are multiplicative (i.e. synergistic).
These two conditions can be shown to apply very well to a system involving obesity and smoking,Endnote 48, Endnote 49 and reasonably well to obesity and physical inactivity.Endnote 50, Endnote 51 Equivalent investigations of smoking combined with inactivity are scarce.
This adjustment equation can be extended to additional RFs. It can also be applied to aspects of disease development beyond basic incidence, including rates of mortality, disability, etc. In this analysis, we used the adjustment equation to generate a more accurate PAF of the direct costs of disease.
We estimated the economic burden (direct and indirect costs) associated with the RFs in Manitoba using a prevalence-based cost-of-illness approachEndnote 52 and reported this in 2008 Canadian dollars.
We began calculating direct costs using the approach adopted by Anis et al.Endnote 18 In short, direct costs including hospital care, physician services, other health care professionals (but excluding dental services), drugs, health research, and ''other'' health care expenditures were extracted from the National Health Expenditure Database for Manitoba.Endnote 53 All costs, with the exception of hospital care, were allocated to each of the comorbidity categories based on weights published in the Economic Burden of Illness in Canada (EBIC) for 1998.Endnote 54 Hospital costs were allocated to each comorbidity based on the proportion of total patient bed-days (based on data from the Canadian Institute for Health Information Hospital Morbidity Database 2000/2001Endnote 55) used in treating patients in Manitoba with that comorbidity. Estimated total direct costs were distributed between males and females based on the proportion of hospital bed-days in 2000/2001 utilized by males and females for each of the comorbidities. Finally, the Manitoba sex-specific costs by comorbidity were multiplied by the calculated sex- and comorbidity-specific PAF.
Adjusting direct costs in a multifactorial system
We then applied the formula introduced earlier for calculating the combined PAF in a multifactorial system to the calculated crude direct costs attributable to each of tobacco smoking, overweight/obesity and physical inactivity. Crude direct costs for each RF were inserted into the adjustment formula (i.e. PAF1 = crude PAF of cost for tobacco smoking, etc.) in order to generate an adjusted PAF of direct costs for the multifactorial system. This approach reduced combined direct costs by 12.6% (from $560.8 to $490.3 million per year).
Having determined as accurately as possible the combined population impact of multiple RFs, it is still useful for the purposes of high-level prevention prioritization, public educational messages, etc., to have a sense of the approximate impact of a particular RF. Thus we applied a disaggregation step at the end of the direct costing process to notionally assign an economic burden to each RF. We did this by returning to the crude costs for each RF, dividing each of these figures by their sum (i.e. the crude total cost for the combined system) and thereby generating a ratio. This ratio was then applied to the adjusted total direct costs, yielding a disaggregated, adjusted economic burden by disease that is notionally attributable to each RF.
We calculated indirect costs (premature mortality, short- and long-term disability) following the method used in EBIC, 1998 (a modified human-capital approach).Endnote 54
Specifically, the steps involved in estimating indirect costs were as follows:
Six diagnostic categories within EBIC, 1998 were identified that cover the comorbidities/diseases of interest; the direct and indirect costs for these six categories were extracted.
This information was used to determine a ratio between direct and indirect costs for each of the diagnostic categories, stratified by the specific category of indirect cost. For example, the indirect costs associated with cancer are 4.6 times (459%) higher than direct costs, largely driven by premature mortality. On the other hand, indirect costs associated with musculoskeletal diseases are 5.2 times (519%) higher than direct costs; in this instance, however, the majority of the higher costs are associated with long-term disability rather than premature death (see Table 1).
The pertinent ratios (by diagnostic category and specific indirect cost category) were then applied to the previously identified direct costs attributable to each RF and adjusted for a multifactorial system in order to generate the equivalent indirect cost data.
Economic burden of illness in Canada by diagnostic category
Diagnostic category
Indirect costs as percentage of direct costs, Canada, 1998
Mortality, %
Long-term disability, %
Short-term disability, %
Total indirect cost, %
415 38 7 459
Endocrine and related diseases
64 51 3 119
Musculoskeletal diseases
A detailed description of the steps taken in this analysis, with examples, is available on request.
Table 2 shows the fully adjusted prevalence of RF exposure, the statistically significant RR data by sex and the calculated PAF of disease incidence related to each RF. The PAF for all comorbidities, with the obvious exception of gynecological and breast cancers, vary by sex. For example, 38.8% of type 2 diabetes in Manitoba is attributable to obesity in males versus 48.2% in females. This is despite the higher prevalence of obesity in Manitoba males (19.8%) than in females (18.7%). The higher overall PAF in females is due to a much higher RR (12.41) than in males (6.74) for type 2 diabetes. This type of detailed analysis has important implications in determining direct and indirect costs.
Relative risk, prevalence of risk factors, and population attributable fraction in Manitoba, 2008
Prevalence of risk factor in Manitoba in 2008
ICD-9 code
PAF, %
Abbreviations: ICD, International Classification of Disease; PAF, population attributable fraction; RR, relative risk; y, years.
Note: Blank cells indicate that there is no significant relationship between the risk factor and the disease.
Trachea, bronchus, lung
162 8.96 66.7 8.96 62.1
Lip, oral cavity, pharynx
140–149 4.03 43.2 4.03 38.4
150 3.00 33.4 3.00 29.1 1.13 4.9
Kidney, other urinary
189 1.69 14.8 1.69 12.4 1.40 11.9 1.82 16.4 1.82 12.3 2.64 19.3
157 1.70 15.0 1.70 12.6 2.29 20.3 1.60 10.1
179, 181, 182 1.53 11.7 3.22 24.8
183 1.18 4.9 1.28 4.7
174, 175 1.31 11.6
Postmenopausal breast cancer
174, 175 1.08 2.3 1.13 2.3
153, 154 1.41 13.7 1.41 14.8 1.51 14.4 1.45 10.7 1.95 13.6 1.66 9.9
415.1 1.91 20.4 1.91 17.2 3.51 25.7 3.51 25.5
Ischemic heart disease
410–414 1.45 14.9 1.45 16.0 1.29 5.2 1.80 10.8 1.72 10.4 3.10 24.1
Aged 35–64 y
2.60 28.7 3.20 31.1
Aged ≥ 65 y
Other heart disease
390–398, 415–417 1.80 16.7 1.50 12.6
Stroke / cerebrovascular disease
430–438 1.60 18.9 1.60 20.3 1.23 7.6 1.15 4.1 1.51 8.4 1.49 7.9
Other arterial disease
401–405 1.30 10.4 1.30 11.3 1.28 5.1 1.65 9.3 1.84 11.8 2.42 18.5
493 1.20 6.8 1.25 6.5 1.43 7.3 1.78 11.7
Bronchitis, emphysema
490–492 10.80 71.1 9.90 69.9
Chronic airway obstruction
496 10.80 71.1 9.90 69.9
Pneumonia, influenza
250.x0, 250.x2 1.50 16.2 1.50 17.5 2.40 17.4 3.92 24.5 6.74 38.8 12.41 48.2
574, 575 1.44 6.7 1.43 7.0 2.32 17.9
720–724 1.59 15.5 1.59 12.8 2.81 21.7 2.81 21.3
Table 3 includes a summary of the adjusted estimates of the prevalence of the chronic disease RFs, the absolute numbers of Manitobans with each RF, and the fully adjusted results from the economic burden analysis. The total direct costs in Manitoba in 2008 attributable to the health effects of smoking, physical inactivity and excess weight are estimated at $490.3 million, while the indirect costs are estimated at $1113.8 million, yielding a total annual economic burden of $1604.2 million.
Estimated prevalence of risk factors, total economic burden for multifactorial system and disaggregated costs by risk factor, Manitoba, 2008, by sexTable 3 - Footnote a
Percentage of population with RF, %
Number of individuals with RF
Direct cost per individual with RF, $
Indirect cost per individual with RF, $
Total cost per individual with RF, $
Total direct cost of RF, million $
Total indirect cost of RF, million $
Total cost of RF, million $
Abbreviations: CCHS, Canadian Community Health Survey; RF, risk factor.
aAdjusted for selected CCHS data limitations and multiple risk factors in one individual.
25.1 148 460 690.3 1461.9 2152.2 102.5 217.0 319.5
38.8 229 124 180.2 388.2 568.4 41.3 88.9 130.2
19.8 116 970 498.6 1207.1 1705.8 58.3 141.2 199.5
42.3 257 429 194.2 463.6 657.7 50.0 119.3 169.3
Both sexes
490.3 1113.8 1604.2
This aggregate RF burden is somewhat higher for females ($824.9 million) than males ($779.3 million). The costs associated with smoking are higher in males than females ($319.5 million versus $237.9 million); whereas the economic burden associated with excess weight ($417.7 million versus $329.5 million in males) and physical inactivity ($169.3 million versus $130.2 million in males) is higher in females.
Figure 1 represents the RF-specific burden graphically, with additional information on the components that constitute the indirect costs of disease. The indirect burden related to premature mortality dominates as an outcome of tobacco smoking ($241.8 million, or 64.4% of $375.4 million in total indirect costs for that RF), and it is also marginally higher than disability in the case of physical inactivity. The reverse is true for overweight/obesity, where the economic burden of short- and long-disability related to disease ($311.5 million) outstrips the costs of premature mortality ($218.6 million).
Estimated Direct and Indirect Economic Burden of Smoking, Physical Inactivity and Overweight/Obesity, Manitoba, 2008Footnote a
[FIGURE 1, Text Equivalent]
Chronic Diseases and Injuries in Canada - Volume 33, no. 4, September 2013
Estimated Direct and Indirect Economic Burden of Smoking, Physical Inactivity and Overweight/Obesity, Manitoba, 2008
This analysis indicates that the notionally disaggregated economic burden for excess weight is larger than the economic burden related to smoking. Thus, the economic burden for the combination of overweight and obesity in Manitoba was $283.7 plus $463.5 million (or $747.2 million) in 2008, exceeding the economic burden associated with tobacco smoking (at $557.4 million) by 34%.
Adjusted for selected CCHS data limitations and multiple risk factors in one individual
The point estimates for RR are used in the base model results presented above. Some degree of uncertainty is attached to these point estimates as reflected by the 95% CI. To assess the effect of this uncertainty on the results, we used the lower and upper bounds of the 95% CI for the RR associated with each RF and disease in a sensitivity analysis. Using the lower bounds resulted in a decrease in the total economic burden from $1,604.2 million to $1,251.5 million (or 222.0%) while applying the upper bounds increased the total economic burden to $1,927.7 million (or +20.2%) (see Table 4).
Estimated total economic burden for multifactorial system and disaggregated costs by risk factor, Manitoba, 2008, by sex: sensitivity analysis
Best estimate of RR
Low estimate of RR
High estimate of RR
Abbreviations: RF, risk factor; RR, relative risk.
319.5 266.3 -16.7 363.0 13.6
130.0 95.2 -26.8 159.0 22.3
824.9 640.1 -22.4 1000.2 21.3
1604.2 1251.5 -22.0 1927.7 20.2
The analytic approach outlined in this document begins to address the issue of double-counting costs when estimating the aggregate economic burden of chronic illnesses associated with multiple RFs in one individual. Applied to the province of Manitoba, the approach suggests a reduction of 12.6% in the aggregate economic burden over the total that would be generated by crude summation of costs generated by each of the key RFs.
This analysis used an extension of the basic PAF formula to produce a more accurate result, including addressing both complications in assessing PAF when a polytomous RF is involved (i.e. overweight and obesity) and accounting for the possibility of multiple RFs in any given individual.
The analysis of the economic burden related to the RF system and (notionally) the individual RFs of smoking, physical inactivity and overweight/obesity is the first phase of any attempt to project the potential economic impact of applying known primary prevention initiatives.
Using the methods outlined in this paper, we estimated the total annual economic burden of the RFs in Manitoba in 2008 to be $1.6 billion ($490 million in direct costs and $1,114 million in indirect costs).
Another important result, generated by having access to sex-specific RF prevalence and RR data, was the difference between males and females in contributing to the total economic burden. The costs associated with tobacco smoking are higher in males, which is partly a reflection of the continuing higher prevalence of tobacco smoking among men. On the other hand, the economic burden associated with excess weight is higher in females, a result that appears to be anomalous since the prevalence of obesity and (especially) overweight is in fact higher in males. In addition to the burden in women that is specific to gynecological cancers, an explanation for the anomaly leans on the fact that the RR related to excess weight is higher in females for several costly conditions, including renal cancer, ischemic heart disease, hypertension and type 2 diabetes (see Table 2). The resulting overall sex-specific distribution for the burden of key modifiable RFs has important implications for prevention planning and public health messaging.
The current analysis also confirmed the emergence of overweight/obesity as a public health concern, a phenomenon that has also been noted in other jurisdictions.Endnote 56, Endnote 57 In fact, the estimated 2008 economic burden associated with excess weight in Manitoba ($747.2 million) is greater than that associated with tobacco use ($557.4 million). Even though the economic burden associated with smoking still exceeds that of obesity strictly defined, once the health effects of overweight are included, the area as a whole moves into the forefront. The United Kingdom project introduced earlier in this paper found similar results with direct costs due to overweight/obesity exceeding the total related to tobacco smoking (UK £5 billion vs. UK £3.3 billion) by a differential similar in proportion to that found in the current analysis for Manitoba.Endnote 26 However, the point at which overweight is associated with a significant increase in health effects is likely higher than a BMI of 25 kg/m2 in the North American population though it may also be lower in certain ethnic groups.Endnote 58
The quality of the results derived from a PAF analysis is inevitably limited by the quality of the inputs, specifically RR and prevalence data. The effect of any potential inaccuracies in this project was first mitigated by correcting known gaps in the RF exposure information obtained through routine Canadian population surveys. Variation in regional PAF estimates often reflects uncertainty in the degree of exposure to the RF being analyzed.Endnote 33 Thus, it is vital to refine prevalence information as much as possible.
A consistent dependence on meta-ana-lyses, which were adjusted for known confounding factors whenever possible, was used in estimating RRs. A sensitivity analysis using the 95% CI associated with each RR indicates the importance of using robust and accurate RR estimates.
Does a 12.6% adjustment (reduction) for overlapping RFs in certain individuals have face validity? Figure 2 summarizes the degree of potentially confounding RF overlaps in Canadians, based on CCHS data from 2000.Endnote 59 Summing across the pertinent sub-categories, 10.2% of the population is exposed both to smoking and overweight/obesity, 26.6% to overweight/obesity and physical inactivity and 14.0% to physical inactivity and smoking. While the overlap related to elevated BMI and physical inactivity is relatively high, the required correction (to avoid double-counting disease incidence) was, in fact, used here for RR data for physical inactivity adjusted for overweight/obesity.Endnote 16 When compared to the proportions of the population with multiple RF exposures, the 12.6% adjustment to the Manitoba economic burden appears to have face validity.
Overlap of risk factor exposure in Canada, Canadian Community Health Survey, Cycle 1.1 (2000)
Figure 2 summarizes the degree of potentially confounding RF overlaps in Canadians, based on CCHS data from 2000.Endnote 59 Summing across the pertinent sub-categories, 10.2% of the population is exposed both to smoking and overweight/obesity, 26.6% to overweight/obesity and physical inactivity and 14.0% to physical inactivity and smoking. While the overlap related to elevated BMI and physical inactivity is relatively high, the required correction (to avoid double-counting disease incidence) was, in fact, used here for RR data for physical inactivity adjusted for overweight/obesity.Endnote 16
Source: Klein-Geltink et al., Chronic Diseases in Canada, 2006.Endnote 59
Abbreviation: BMI, body mass index.
*BMI ≥ 25 kg/m2.
Despite the attempts to optimize the accuracy of the estimated economic burden, some limitations remain, partly related to the assumptions required to creatively integrate several data sources compiled at different points of time. For instance, a key assumption of using older CIHI and EBIC data was acknowledged by Anis et al.,Endnote 18 namely that ''the distribution of costs for each cost category did not change significantly from 1998 to 2006.''Endnote 18, p34 Similarly, the method of scaling up from direct costs to indirect costs depends on the assumption that the ratios of costs between different comorbidities are the same for direct and indirect costs. Furthermore, the RRs for tobacco smoking are based on a comparison of current versus never-smokers and do not take into account smoking intensity. Potential changes (reductions) over time in smoking intensity would modify the RRs.
Health care planners in many jurisdictions in the world share an interest in having a reasonable estimation of the economic burden of disease generated by modifiable RFs. Such information is vital to prioritizing and gaining support for primary prevention programs. Indeed, understanding the baseline economic burden associated with specific RFs is a prerequisite for developing a persuasive business case for prevention. The current findings, for example, have been a catalyst for action in Manitoba, supporting development of a Primary Prevention Syndicate, a risk factor reduction challenge to provincial politicians, and creation of Heart and Stroke Foundation Challenge Grants and a Research Chair in primary prevention.
Funded by the Heart and Stroke Foundation of Manitoba, CancerCare Manitoba, Alliance for the Prevention of Chronic Disease, and Health in Common.
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Though they did not retreat from the Vision, they did not see deep enough, into the Heart of the matter, into Themselves (to see that they were the stuff of the universe, and at the core, what held it all together).
Confronted with their End, they stopped asking questions and moved on to solving the Problem, as they saw it ~ of Time and Death. They planted a seed within their minds and created another world in which to live, a self-contained, alternative timeline in which to exist, unharmed by the Laws of Nature.
Deep in the heart of the Draco Constellation, a Great Star went nova, and the Eon race was left homeless, wandering the galaxies, knowing too well that all, at some point, would be brought before the face of the Black Deep ~ the Eye of Life. As Timekeepers, the Eon had witnessed the births and deaths of many systems and knew of the Cycle of things ~ but their numbers were now few, and although they lived beyond the measure of most things, even they had an end….They wandered space, searching for a planet to call home, but finding no planets capable of sustaining life such as theirs, they constructed one from the dust of the universe.
They chose to build in a binary star system with a bright and yellow sun they called Ras, and its dull blue companion, Rios ~ both stars born of the ultraviolet giant that shattered long ago, from the very Great Star that had ended the Eon world and set them on their journey…. The Eon called this ancient star Lubis, and for them, its death was only the beginning, the resurrection of its light foretold by means of a prophecy. It was by the conjunction of two Beings that the Great Star was first Created ~ and so was to be re-Created ~ as it was also by their love and ultimate union that the body of Lubis came to be scattered throughout time and space, its luminescent dust giving birth to mist and nebulae and to the Eon themselves.
With the ancient prophecy of yet another Cycle turning, the Eon waited for the time to come when the essence of the Two would converge once more, to give rise to a new Great Star ~ a new Lubis…. But in the meantime, despite their far-seeing eyes, the Eon feared their own extinction (their own re-turning) and began their experiments. Using their own DNA, they sought to isolate and capture the pure, eternal Essence of Being in order to extend their existence. After many failed attempts, they managed to contain this Essence within a stable living form, the Ebo. But there was a consequence.
While the Ebo embodied the Essence of Creation, they were as children, sensitive and defenceless against their inevitable counterpart, the Siron. In splitting the whole, the Eon created not one, but two living forms, and to their dismay they found that One could not live without the Other. While the Ebo acted as the dormant seeds of life, the Siron were unpredictable catalysts ~ active, adaptive, but often uncontrollable and destructive…. It was then that the Eon came to an unspoken realization and stopped their experiments.
Krysalis and Corben came out of a life-long search for meaning and purpose. Compelled by life's big questions (where did we come from? what is the meaning of existence?…) I sought the answers in many places ~ in orthodox and mystical religions; mythology and folklore; biology, cosmology, and quantum mechanics; in spiritual, new age and occult movements; and in clinical, transpersonal and Jungian psychology. Although I found many worthwhile things, I was still dissatisfied with the answers I came across.
I also looked for existential insight in other people's stories and worlds, in narrative and cinema (the 1982 filmThe Dark Crystal, in particular, was a formative seed influence of this series…) but it wasn't until much later when I decided to stop searching 'out there' for answers and to create my own instead ~ my own story.
Krysalis and Corben is a narrative-based art series that came out of an inner search for meaning and purpose, and was shaped by the ideas, forms, and limits of the outer world. Through this work, I seek to explore the underlying human need for love, connection and belonging… may it inspire others who are seeking their own answers….
The origins myth of Krysalis and Corben was created by the Canadian-based artist, Kat Vedah.
Hi Kat Vedah. I get the story and the art working together, but I'm sure glad creation didn't happen this way. Much too twisty, windy, and whimsical.
Brenda, how can you be sure – and if you are, how did it happen in your opinion?
I liked Kat's creative story and her illustrations.
Hi John. It might take awhile, but when you get to know the Spirit of God, you find out that God is very structured and ordered. That's not to say He doesn't have fluidity, but rhythm and order are what He's built on, and since He created the universe, so is everything He made.
Why are you looking for life from idols? We are the creators of the light and the sparks. We are in the garden. Even if there wasn't a Brother sun or Sistermoon planet out their we could create the warmth and the light with brother hood and sisterhood amongst ourselves right here where we are. Love one another with a pure thought of immeasurable love. Just do it.
Seriously you guys have much learning really fascinating don't take more than your worth but enjoy any way okay.


WATERSIDE - A wonderful and rare opportunity to acquire a detached property situated on an enviable riverside plot in one of the most ideal North Kingston locations. The grand hallway leads to a reception/bedroom with en suite to one side and a fully fitted kitchen on the other. Towards the back of the property are two further reception rooms leading into a full width rear extension in turn opening on to the 134ft. private rear garden. The beautifully mature lawned garden leads to a spectacular and unique view of the River Thames. Upstairs is the family bathroom and four bedrooms, one of which is en suite. The rear bedrooms have access to a sizeable west facing roof terrace again with beautiful views of the River Thames. The property also has plenty of off-street parking to the front and a separate studio room in the garden with clockroom.
Albany Park Road is in the heart of North Kingston with excellent schools as well as easy access to Kingston town centre, the River Thames and Richmond Park. The nearest station is Kingston.


Heart and stripe t-shirt from Sonia by Sonia Rykiel. Crafted in a cotton and wool blend woven jersey fabric. Featuring a round neckline with a reinforced trim, short sleeve styling, a heart print with embellished sunglasses and an applique grosgrain bow trim, and contrast stripes from the waist.


Explanation from from Dr Trever Bivona on Youtube.
A growing number of cancer practices are sequencing the DNA of tumors to uncover their genetic abnormalities. The aim: to pair a drug with the specific mutation fueling a patient's disease. University of California's San Francisco's Dr. Trever Bivona discusses how this technology is influencing cancer treatment.