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Canadian Anglican Michael Ingham on Rowan Williams
Stephen Crittenden: Welcome to The Religion Report, and the second part of our two-part series on homosexuality and the churches.
This week, we're focusing on the worldwide Anglican communion, which has been teetering on the edge of schism, as liberals and conservatives battle over issues like the blessing of same-sex unions and the ordination of gay priests.
We'll hear from a Canadian bishop whose own position on the issue has dramatically shifted. He's moved from being a conservative right to the head of the liberal camp.
It's with the voice of Rowan Williams that we begin.
Rowan Williams: Once we recognise God's great secret that we are all meant to be God's sons and daughters, we can't avoid the call the see one another differently. No-one can be written off; no group, no nation, no minority can just be a scapegoat to resolve our fears and uncertainties. And this is what unsettles our loyalties, conservative or liberal: we have to learn to be human, alongside all sorts of others, living in Jesus' company. I have to live in a community that is more than just the gathering of those who happen to agree with me, because I need also to be surprised and challenged. If all we have to offer is a Jesus who makes sense to me and people like me, we have no saving truth to give.
Stephen Crittenden: Rowan Williams, the 104th Archbishop of Canterbury preaching at his enthronement service in Canterbury Cathedral last week.
Even before his enthronement, conservative evangelical groups were calling on Rowan Williams to resign, because he had ordained a gay man living in a relationship. In the mainstream media he's been described as a liberal, a moderniser, and even as a heretic, and there have been suggestions that around 150 parishes in Britain might break away, looking to the oversight of another, more conservative bishop - someone like Sydney's Archbishop Dr Peter Jensen, perhaps. Dr Jensen has just returned from a speaking tour in Britain, during which he visited some of those parishes.
Meanwhile, Rowan Williams has repeatedly indicated that he will accept the orthodox Anglican position on homosexuality, so perhaps he's more of a traditionalist than he has been painted.
In Canada, meanwhile, the Anglican Bishop of New Westminster in Vancouver, Michael Ingham, found himself at the centre of an international storm last year, when he agreed to bless same-sex unions after his synod repeatedly voted in favour of the idea.
Michael Ingham spoke to me from his home in Vancouver, and I began by asking why homosexuality has suddenly become the maypole around which all the mainline churches are dancing.
Michael Ingham: I don't know really why this has become such a do-or-die issue for some people in the church, and I think I would want to emphasise that it's not for everyone. It seems to be a sort of tip-of-the-iceberg issue, behind which there are a whole lot of other things, perhaps, battles won and lost but not yet conceded throughout the 20th century. In the last century we had a number of issues that were controversial and divisive: the ordination of women being the most recent. But before that, we had the remarriage of divorced persons. We've also had quite substantial discussions around the admission of children to communion who are baptised but not yet confirmed, which has provoked a whole lot of reflection on our theology of baptism. So there've actually been a lot of questions, and conservative and progressive camps have formed around them, and at least in this context for most of the last sixty years, the conservative position has not won the day. And now I think what we're seeing is the internationalisation of conservative movements within the church, which are largely funded by people who've lost the argument in their own churches in the West.
Stephen Crittenden: In all of those issues that you cited there, you were really talking about issues that divide liberals and conservatives within the churches. What about developments in the wider society?
Michael Ingham: Well in Canada, for example, homosexuality was decriminalised over thirty years ago, and so we've seen actually since the Second World War in this country, the emergence of gay and lesbian people into the mainstream of society - and in fact the churches are about the last institutions from which they are in any sense prohibited. Within the Canadian church, the Anglican Church of Canada, there's been study and discussion and commissions and papers and debates and so on for over twenty-five years. So one cannot say, actually, that the church here has rushed headlong into anything. In Vancouver, where I live, there's a significant gay and lesbian population, it's a part of North America to which people migrate, or immigrate from across North America, or from other parts of the world. And some of the people who've come to live here are gay and lesbian people, and significant numbers are members of our churches. And they have come to seek a better life for themselves, to find acceptance and welcome in the Christian church, and many of them are fleeing religious bigotry and persecution that they've experienced in other places.
Stephen Crittenden: I wonder whether, if you take the line of a conservative evangelical group like Reform - which is strongly opposed to liberalisation, and which says any act of homosexual activity at all for Christians is contrary to the word of God - whether in places in the world like Vancouver or Sydney, that a message like that is just not going to go over with the wider community any more.
Michael Ingham: Well, if something is condemned by God, and if it is against God's word, then of course they're absolutely right, the church in Vancouver shouldn't be doing that, or the church anywhere else. In that sense, the word of God is not culturally limited. But therein lies the argument. There are many people, people of good conscience in my diocese, who hold to that point of view, and we respect that point of view - it is certainly the one held by the greater majority of Anglicans throughout the world. But in our biblical and theological studies here, we have come to a different position. We do not believe this is, in fact, condemned by God or by Scripture. And so when one's theological conviction around that fundamental point beings to dissolve, then the rest of the argument loses its force.
Stephen Crittenden: Bishop Ingham, I've never really understood whether blessing same-sex unions was something that you were personally in favour of doing, something you were driving in your diocese, or something that you were pushed into over time, perhaps a little reluctantly, pushed into by your synod. Because there was a delay of - was it five years?
Michael Ingham: Yes, that's right. I had been on my own journey on this question. I will confess openly that my position through most of my life has been quite conservative and traditional. But I've been ordained now for almost thirty years, and in my pastoral ministry, of course, I've had to deal with all sorts and conditions of people. And I have, in ministering to and among gay and lesbian people, begun to lose my own fears and anxieties about them as a community and individuals, and they have witnessed to me of their deep and abiding love for God through Jesus Christ in a way that has caused me to question my own convictions on this. The diocese here has really approached this question primarily as a pastoral one, not as a doctrinal one. We do not see any doctrine of the church at stake here, certainly no central or core doctrine of the church. We're really asking ourselves: how do we minister with the compassion of God to these people in our midst? They are given the choice, mostly by the church, of promiscuity or loneliness throughout their lives. Their denial of their loves and their relationships and their intimacies leaves most gay and lesbian people in an impossible position of Hobson's Choice - between promiscuity or loneliness - and I think what we see ourselves doing here is a moral thing, of encouraging and supporting permanent faithful and lifelong commitment among people who will have the same obligations, and all of the same challenges, that heterosexual people have in their relationships. And I do support that. I think it is appropriate, and a moral thing to do.
Stephen Crittenden: It's estimated there are issues about the inclusiveness of the Gospel, ultimately about whether Christ died for everybody, also possibly you know there's the great speech about the Grand Inquisitor in The Brothers Karamazov, the great religious novel of the 19th century, that really raises the question of whether the Gospel, in the end, is a nasty joke on people - you know, that this freedom that's been won for us is actually possibly all far too difficult for most people.
Michael Ingham: I think I have a real problem with some doctrines of creation that I hear from some people in the church, which are narrow and exclusivist, and appear in fact not to be full doctrines of creation. They appear to exclude rather large numbers of humanity, and I cannot myself believe in a God who creates all human beings in the divine image, and then offers salvation only to heterosexuals. My understanding of Scripture is that it witnesses to a sovereign lord of all creation who loves all unconditionally, and I believe in a saviour who died for all, and the sacrifice of Our Lord on the cross is not simply for heterosexual people, it is for homosexual people.
Stephen Crittenden: See Michael, if I can just pick up on this: I'm interested in the possibility that the issue of homosexuality, as it's emerged in the last few years in the churches, is actually a cover for a whole lot of other things, and that one of the things that it might be a cover for is an argument about whether Christ died for the whole world, or whether he just died for some - and even an argument, in the end, about whether possibly the secret message of the Gospels is that we're all saved.
Michael Ingham: I certainly think that it's God's will that we are all saved, and that that salvation is offered to everyone, regardless of their cultural or ethnic or gender background. I've spent a lot of time listening to people who are feeling left behind by this decision here, and I have a lot of sympathy for people who have difficulty with what we're proposing to do. There are a lot of issues behind us, and one gets the impression it's not simply about homosexuality. There are people who want to read Scripture in a highly prescriptive way, in a way that almost treats it as a kind of fax from heaven, a recipe book to be followed. And there are others, and I think this is really the greater part of the Christian tradition which sees Scripture as a revelation of God's word through Jesus Christ, a living word more than a written text. I mean, there's a watershed theological question there. There are other things, too: how generous can you stand God to be? Jesus stood in the tradition of enormous inclusivity, to the point where he caused great scandal among the religiously orthodox of his day. And I think we're fighting the same kind of concern here, and discerning a rise in Anglicanism throughout the world almost of what you might call Puritanism. It seems to me Puritanism breaks out in the Anglican tradition from time to time, and it's here again.
Stephen Crittenden: We haven't mentioned Rowan Williams yet. The outgoing Archbishop of Canterbury, George Carey, was a conservative on this issue. Is Rowan Williams likely to be able to lead the church through this crisis, perhaps even break new ground - or, because his position's different, are we now more likely in fact to see fragmentation?
Michael Ingham: I think Rowan's position is an extremely difficult one. He's inherited a church which has been deliberately divided by geopolitical forces that I've mentioned. And when you walk into a position like that, the options are very limited. My hope for the Anglican communion is that Rowan will be given time, perhaps by both his supporters and his opponents, to deepen and broaden this discussion and raise the level of debate from the sort of political mudslinging which so often it's become, to a much higher level of principle.
Stephen Crittenden: Could what you do in Vancouver influence whether that's going to happen?
Michael Ingham: He has come into his office at a point where we have reached a decision in which he could play no part, and I personally feel very badly for him around that, because I think the whole situation in the Anglican communion might have been different if Rowan had been around a little bit earlier.
Stephen Crittenden: In other words, you're going to proceed?
Michael Ingham: We are going to proceed, yes, I've already given my consent.
Stephen Crittenden: Well, what about the role of someone like our own Sydney Archbishop, Peter Jensen, who's been on a speaking tour in Britain over the last few weeks? He may well have in fact encountered no special mood in favour of his kind of hardline Bible-inspired position in Britain, perhaps because Britain's a First World nation, which leads to the question of the strong support for the hardline Bible position amongst Anglican bishops in Asia and Africa. I wonder whether the real culture war isn't a culture war between North and South, between First World and Third World, that the culture war in the West is already lost.
Michael Ingham: Well, I've heard that theory, it's popular in certain academic circles that this is a North-South split. I don't actually subscribe to that, for a number of reasons. One is that of course you have a vigorous debate going on in the North - in the so-called North - to start with, and there is also a similar debate going on in the global South. The position, for example, of the Anglican Church in South Africa would be quite different from the position -
Stephen Crittenden: In Kenya, or Uganda.
Michael Ingham: Kenya or Uganda particularly. And I've been involved, for some years now, in the international councils of communion, and everywhere I go people from so-called developing nations, global-style churches, come to me and say "we're quietly supportive, we support you privately, it's difficult for us to support you publicly". So I don't myself buy the north-south split thing. I think there is another interesting dimension. A number of the bishops around the world have had what you might call a formal theological education, but many have had what you would call a Bible College education. The two steams of education are quite different, and I'm not being judgmental here at all -
Stephen Crittenden: How are they different?
Michael Ingham: They're different in the sense that Bible Colleges tend to focus primarily on Biblical exegesis. And theological education is broader, in the sense that it looks at systematic questions, it looks at the relationship of systems of ideas to others; it looks much more closely at historical theology and how the church has developed its understanding of doctrine through this century. One can find conservatives and liberals, of course, in both schools, though again it's not the simple black-and-white issue there. But how the debate is continued, how it's carried on, is quite different in the two schools.
Stephen Crittenden: What's your view of the Peter Jensen idea of floating bishops who come in and say to conservatives in, say, the diocese of New Westminster, or conservatives in Britain, "I'm willing to be your flying bishop, you don't have to give your allegiance to this liberal bishop that you don't agree with or find that you can't agree with".
Michael Ingham: The Canadian House of Bishops almost uniformly is opposed to flying bishops. We don't see the issue of homosexuality as an issue to divide the church, or one on which to stake the historic episcopate. Flying bishops, especially if they're kind of intrusively inserted into other dioceses without permission, end up undermining the role of bishops throughout the world.
Stephen Crittenden: But in the case of someone like Peter Jensen, you've got somebody who, although he is a bishop, is quite open about saying that he doesn't really hold with the Episcopal structures of the church.
Michael Ingham: Right. And that I think is illustrative of the fact that the debate now seems to have moved from faith to order. It's moved from issues of sexuality to issues of the order and governance of the church. I think what is being proposed, in terms of flying bishops who would gather like-minded congregations under their wing, irrespective of geographic territory, is far more of an innovation, and far more radically destructive of the church, than anything that's been proposed around gay and lesbian people and their pastoral care. Because what you end up doing, is creating a bishop for every theological party.
Stephen Crittenden: A bishop for every theological issue.
Michael Ingham: And for every issue. So you'd almost have to have a website called Rentabishop.com, which people could sign up for the bishop of their choice on every issue, from hymn books to liturgies to the blessing of pets and animals. You'd also have to have one, I suppose, for people who are opposed to flying bishops. It becomes absurd, and if you follow it right through the structure of the church, it would mean that for every group in every parish who didn't agree with the Rector, or the incumbent, you'd have to have an alternate incumbent, a Rector, to cater to that particular group. And so you begin to see the kind of nonsense of this fragmentation. Anglicanism has always historically tolerated a fairly high level of diversity on theological and doctrinal issues. We've not forced one another into narrow confessional stances, but we have said that the order of the church is important to us, and this shift of the kind of political focus from sexuality to flying bishops, signals a much more disturbing development, I think.
Stephen Crittenden: Thank you for joining us on The Religion Report, it's been great talking to you.
Michael Ingham: You're very welcome, Stephen - and greetings from the northern hemisphere to the south.
Stephen Crittenden: Bishop Michael Ingham, the Anglican Bishop of New Westminster in Vancouver in Canada. And I should also say there that Peter Jensen has repeatedly said that he's not offering alternative or "flying bishop" episcopal oversight.
- Michael Ingham
- Anglican Bishop of New Westminster, Canada
- Title
- Theology and Sexuality: Classic and Contemporary Readings
- Author
- Eugene F. Rogers
- Publisher
- Blackwell (London 2002)
- Description
- Title
- Sexuality and the Christian Body: Their Way into the Triune God
- Author
- Eugene F. Rogers
- Publisher
- Blackwell (London 1999)
- Description


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If you are a busy man and don't have time to go through the entire WWDC Keynote address, then this video is just for you. The team at Mahalo has done a wonderful work of cutting down the entire address to just 60 seconds. It has all the major announcements which you wanted to hear. Enjoy….
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Victoria Oil & Gas's wholly owned subsidiary Gaz du Cameroun S.A. (GDC) has signed a legally binding term sheet with ENEO Cameroon S.A (ENEO), Cameroon's integrated utility Company, to supply gas to two power stations located in the city of Douala (The Agreement).
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Standing in the middle of Wellesley Books, it's hard not to notice the inviting, bright cover of Ethan Daniels' book, Under Cape Cod Waters, popping out from the regalia of titles on display as part of the bookstore's "Hot Summer, Cool Books" series. We're always happy knowing that our books are being sold in local bookstores, but we're ecstatic to see this title getting such great placement! To see Under Cape Cod Waters on display for yourself (among many other great titles), be sure to stop by Wellesley Books today.
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Empirical evidence of the continuing improvement in cost efficiency of an endoscopic surveillance programme for gastric cancer in Singapore from 2004 to 2010
Utilization, expenditure, economics and financing systems
Endoscopic surveillance has been proven effective in prolonging the survival of gastric cancer (GC) patients. However, there is limited evidence on the cost efficiency of delivering this intervention, especially on a national level in spite of cost efficiency being a major determinant of the actual cost-effectiveness of a cancer prevention programme. The Singapore Gastric Cancer Epidemiology Clinical and Genetic Programme (GCEP) is a demonstration project offering scheduled endoscopy to the Chinese population aged 50 years or older in Singapore. By assessing the cost efficiency of the GCEP, this study aimed to provide empirical evidence on the cost structure and mechanisms underlying cost generation in conducting GC surveillance, thus informing resource allocation and programme budgeting for the Singapore government.
From a societal perspective, we reported on the direct cost (resource consumption) of conducting endoscopic surveillance through the GCEP network. We retrospectively collected individual-level data of 216 subjects recruited at the National University Hospital, Singapore from 01/04/2004 to 31/10/2010. The Overall Cost, Clinical Cost, GCEP Cost and Personal Cost incurred in serving one subject was computed and discounted as 2004 US dollar (US$) per capita for every year. The Generalized Estimation Equation (GEE) was used to model the data.
All cost indices continuously declined over the 6.5-year costing period. For the total sample, Overall Cost, Clinical Cost, GCEP Cost and Personal Cost declined by 42.3%, 54.1%, 30% and 25.7% respectively. This downward trend existed for age and gender subgroups and the high risk group only with cost reductions varying between 3.5% and 58.4%. The GEE models confirmed statistical significance of the downward trend and of its association with risk profile, where the moderate risk group had cost indices at most 77% of the high risk group.
Our study offered empirical evidence of improved cost efficiency of a surveillance programme for GC in the early phase of programme implementation. Mechanisms such as economies of scale and self-learning were found to be involved in the cost reduction. Our findings highlighted the importance of assessing the cost efficiency and offered valuable insights for future programme budgeting and policy making.
In the global campaign to eradicate gastric cancer (GC), which claims over 700,000 lives every year
The Gastric Cancer Epidemiology Clinical and Genetic Programme (GCEP) is an endoscopic surveillance programme targeted at the Chinese population aged 50 years or above in Singapore, a country with an intermediate risk of GC
Cancer prevention programmes are costly undertakings and are featured by many years or even decades of time-lag between investment and the desired outcome. This then raises an important issue of cost efficiency - whether the programme is producing the service at the least cost, i.e., the lowest price per unit of service. Cost efficiency is one of major determinants of actual cost-effectiveness delivered by a specific programme
With the above considerations, a trial programme such as the GCEP is the ideal vehicle to empirically explore and evaluate the cost efficiency of GC surveillance. Evaluating the GCEP would be very informative for a future cost-effectiveness analysis of GC surveillance in Singapore and would have direct relevance to government budgeting. This will prevent incomplete information from affecting optimal resource allocation decisions. Thus, we designed this study with the aims of 1) informing resource allocation and programme budgeting in the planning of national surveillance of GC in Singapore; 2) providing a comprehensive cost structure for full economic evaluation of GC surveillance both locally and worldwide; 3) elucidating the mechanisms underlying cost generation of cancer surveillance programmes. This information will be of value to health administrators and planners in planning similar programmes, as well as providing a framework for health policy researchers to undertake similar studies in different jurisdictions.
General approach
The GCEP is an ongoing trial surveillance programme with the aim of eventually becoming a government-organized GC surveillance programme. The most pertinent concern about establishing such a programme is the financial impact on society by the programme. Therefore, this study was conducted from a societal perspective, whereby the direct costs on GCEP (the healthcare provider) and the patients (the beneficiaries) in undertaking GCEP surveillance were measured by a bottom-up approach and reported as US dollars per person served
Service mix of the GCEP programme
According to the GCEP Protocol Version 7, once a subject was recruited, the 5-year annual follow-up would be customized to the individual's risk of developing GC assessed at baseline. Those fulfilling any of five criteria, namely (1) dysplasia, (2) intestinal metaplasia, (3) atrophic gastritis, (4) GC family history, and (5) presence of
Study site, period & sample
The GCEP consists of a decentralized service network involving the National University Hospital (NUH), Tan Tock Seng Hospital, Singapore General Hospital and Changi General Hospital in Singapore. This study used data from the NUH only, as it is a tertiary medical institution as well as the programme initiator. The GCEP can be divided into three distinctive phases: Start-up, Full-Implementation and Closeout
Additional file 1
Phases and time frame of the GCEP. (TIFF 46 kb)
Click here for file
Resource quantification and costing
A task force funded solely by the GCEP grant was established at the NUH to exclusively operate the programme. The GCEP as the service provider paid the NUH for clinical, logistic and financial services. A co-payment system was also applied for clinical services whereby the GCEP provided free follow-up endoscopy, histology/biopsy and urease testing and patients were liable for baseline endoscopy, medication, consultation and diagnostic tests prescribed at follow-ups (Additional file
Additional file 2
Cost structure of the GCEP. (TIFF 44 kb)
Click here for file
From the NUH GCEP database, we retrospectively identified and quantified the resources consumed by a single subject at baseline and subsequent follow-ups by reviewing clinical casenotes and GCEP financial statements. Data sources of cost information included the Land Transportation Authority, Ministry of Manpower and the NUH financial office. The costs of each GCEP service were estimated by multiplying the quantities of various resources with the best-available unit cost for that resource. The cost components and estimation methods are summarized in Table
As this study was conducted in 2010, the unit costs of clinical items were based on actual hospital charges at that time. Although hospital charges may not truly represent the cost of the services provided, these were the only data available. Considering that NUH is a not-for-profit public healthcare institution with most charges being set based on the principle of cost recovery, the use of charges in this instance would be a reasonable reflection of actual costs.
Non-clinical GCEP resources included capital, overhead costs, consumables and manpower, of which only yearly total expenditures were available. Equipment, particularly computers, was the major capital outlay for the GCEP. Therefore the 5-year useful life of a computer was used to calculate the annual equivalent of capital cost
All individual items were categorized into four components, from which primary outcomes originated for this study (Table
Statistical analysis
All four cost indices were computed for each subject in every financial year within the costing period. The Student's
The study sample adequately represented the NUH GCEP cohort (Table
The cost efficiency of the GCEP improved over time. As shown in Figure
Figure 1
Temporal trends (2004–2010) of cost indices for the whole sample.
Temporal trends (2004–2010) of cost indices for the whole sample. Individual points represent the means of cost indices in each follow-up year.
As age and gender are critical for defining the target population for GC surveillance, the downward trends of the cost indices were further investigated in the age (50–59 year vs. ≥ 60 year) and gender (male vs. female) subgroups. In Figures
Figure 2
Temporal trends (2004–2010) of mean cost indices for the age subgroups.
Temporal trends (2004–2010) of mean cost indices for the age subgroups. Individual points represent the means of cost indices in each follow-up year.
Figure 3
Temporal trends (2004–2010) of mean cost indices for the gender subgroups.
Temporal trends (2004–2010) of mean cost indices for the gender subgroups. Individual points represent the means of cost indices in each follow-up year.
As per protocol, risk assessment at baseline determines the number of OGD which a GCEP subject will take during follow-up and is an important modifiable factor for resource allocation. As expected, the risk profile had a big impact on cost indices for the two risk groups. In Figure
Figure 4
Temporal trends (2004–2010) of cost indices for the risk subgroups.
Temporal trends (2004–2010) of cost indices for the risk subgroups. Individual points represent the means of cost indices in each follow-up year.
Risk profile also affected the downward trend pattern. The temporal trends were not universally downward for the three pairs of risk groups or for all cost indices (Figure
The GEE models fitting the temporal trends of cost indices and the comparison of the trends between the three pairs of subgroups of age, gender and risk profile are presented in Table
To the best of our knowledge, studies about continuous cost generation of cancer prevention programmes have not been previously reported despite that many studies have acknowledged the limitations of cross-sectional cost estimates. Our study attempts to fill this gap. The gradual and continuous decline of cost indices in our study strongly indicated the ever-improving cost efficiency of endoscopic surveillance for GC through the GCEP during the observation period. This study as a free standing cost analysis, despite its inability to compute the cost-effectiveness ratio, provided important empirical evidence for programme management and ultimately for value-for-money decision making. Cost studies of long-term GC surveillance have long been anticipated worldwide given that research already illustrated the benefit of GC surveillance
Economy of scale is considered the main reason for the cost reduction, especially for the Overall Cost and the GCEP Cost
More efficient utilization of the resources within the GCEP system was another factor driving the GCEP Cost down. It is well known that public health programmes can improve operational efficiency through self-learning
The decline in Clinical Cost indicated that subjects consumed less of the clinical services, which consist of follow-up OGD, specialist consultations, diagnostic tests and medications (Table
A further reason for the Personal Cost reduction was the declining price of patient time estimated by the human capital approach
Subgroup analysis was conducted to explore the cost generation in subgroups categorized by age and gender, which are relevant to the diagnostic yield of a screening programme
As the cost-effectiveness of screening is sensitive to disease incidence in target populations
Compared to other published cost-analyses of cancer screening programmes, our study was unique in four ways, in that we 1) analyzed long-term continuous cost generation; 2) collected individual-level data; 3) identified and quantified all possible resources; and 4) studied multiple indices simultaneously. The advantages of these are discussed as follows.
Given that long-term or life-long follow-up is required in a cancer surveillance programme we studied a prospective cohort, the GCEP, with 6.5-year follow-up data and reported on the temporal trends of cost indices, in addition to the point estimates which are the sole outcomes in cross-sectional studies
Regarding the quality of data, our study collected individual-level data based on the NUH GCEP database. The quality of our data afforded statistical advantages over aggregate data analyzed in other studies
In addition, we used the original documents of patient casenotes and the GCEP financial statements to identify clinical and non-clinical items directly associated with programme operation. A bottom-up approach was adopted to quantify resources consumed and to estimate their monetary value
A major contribution of our study was that we simultaneously investigated multiple cost indices, each of which has been a focus in separate previous studies
We acknowledge several limitations with our study. As a pure cost analysis, this study is inherently unable to inform the value-for-money decision which is of utmost importance yet requires a full economic evaluation. In addition, service underutilization which is negatively associated with programme effectiveness, cannot be ruled out as a mechanism driving down the cost in our study. The co-payment system whereby patients are committed to a certain amount of money could impede some patients from using GCEP services, especially those from low-income families
Our study highlighted the importance of assessing the cost efficiency of a pilot project for future economic evaluation and government planning. The downward trends in cost indices and the factors contributing towards them offered valuable insights for future programme budgeting and policy making. It is crucial for health administrators and planners to identify these factors and to further maximize their effect on cost efficiency in order for their programmes to succeed. Furthermore, our study illustrated the distinct pattern of resource consumption and its temporal variation in individual subgroups classified by variables defining the target population. These findings call for accurate classification of the target population and for the computation of a population specific cost-effectiveness ratio.
GC: Gastric cancer; GCEP: Gastric cancer epidemiology clinical and genetic programme; OGD: Oesophago-gastro-duodenoscopy; NUH: National university hospital; GEE: Generalized estimation equation; LTA: Land transportation authority; MOM: Ministry of Manpower.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
HJZ designed the study, collected, verified and analyzed the data, drafted and revised the manuscript. SCL critically revised the manuscript, improved the quality of data interpretation and results report, and instructed the discussion. NN critically revised the manuscript, refined the study report, and provided ideas for discussion. FZ coordinated the project and revised manuscript. KGY is the principal investigator. He initiated, funded and approved the study, supervised and monitored the study process and critically revised the manuscript. All authors read and approved the final manuscript.
The authors would like to thank contributors from the Singapor0065 Gastric Cancer Epidemiology, Clinical & Genetic Programme for their help in collecting data. We greatly appreciate Prof. Lee Hin peng for the guidance throughout the study. We are indebted to Ministry of Manpower, Ministry of Health, Land Transportation Authority for offering relevant cost information.
Global cancer statistics
Screening for gastric cancer in Asia: current evidence and practice
Declining cost-effectiveness of screening for disease. The case of gastric cancer in Japan
Gastric cancer: global pattern of the disease and an overview of environmental risk factors
The long term results of endoscopic surveillance of premalignant gastric lesions
Feasibility and cost-effectiveness of using magnification chromoendoscopy and pepsinogen serum levels for the follow-up of patients with atrophic chronic gastritis and intestinal metaplasia
Acceptance of repeat esophagogastroduodenoscopy to detect gastric cancer in a Chinese immigrant cohort
Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities
Epidemiology of Helicobacter pylori infection and gastric cancer in Asia
Singapore cancer registry report
Endoscopic screening for gastric cancer
Optimizing resource allocation for HIV/AIDS prevention programmes: an analytical framework
Cost analysis of the national breast and cervical cancer early detection program: selected states, 2003 to 2004
Biases in cost measurement for economic evaluation studies in health care
Direct measurement of health care costs
Variation in average costs among federally sponsored state-organized cancer detection programs: economies of scale?
Clinical and programmatic costs of implementing colorectal cancer screening: Evaluation of five programs
Mammography screening: how important is cost as a barrier to use?
Participation in transvaginal ovarian cancer screening: compliance, correlation factors, and costs
Estimating time and travel costs incurred in clinic based screening: flexible sigmoidoscopy screening for colorectal cancer
Cost of quality management and information provision for screening: colorectal cancer screening
Programme costs in the economic evaluation of health interventions
Recommendations of the panel on cost-effectiveness in health and medicine
The use of the bootstrap statistical method for the pharmacoeconomic cost analysis of skewed data
Cost-effectiveness of endoscopic surveillance for gastric intestinal metaplasia
Gastric cancer surveillance in a high-risk population in tuscany (Central Italy): preliminary results
The price of mammography in the united states: data from the national survey of mammography facilities
Mammographic screening: how to operate successfully at low cost
Cost evaluation in a colorectal cancer screening programme by faecal occult blood test in the district of florence
Estimating personal costs incurred by a woman participating in mammography screening in the national breast and cervical cancer early detection program
Age-related cancer detection rate and costs for one cancer detected in one screening by immunochemical fecal occult blood test
Short term outcomes of the first round of a pilot colorectal cancer screening programme with guaiac based faecal occult blood test
Cost-effectiveness of upper gastrointestinal endoscopy according to the appropriateness of the indication
Identifying and controlling for program-level differences in comparative cost analysis: lessons from the economic evaluation of the national breast and cervical cancer early detection program
Cost-effectiveness of screening for colorectal cancer: evidence from the nottingham faecal occult blood trial
Screening for cervical cancer in India: How much will it cost? A trial based analysis of the cost per case detected
Cost and cost-effectiveness guidelines: which ones to use?
Screening for breast cancer: time, travel, and out-of-pocket expenses
The scope of costs in alcohol studies: cost-of-illness studies differ from economic evaluations
Breast cancer screening by mammography: utilization and associated factors
Nonmedical costs of colorectal cancer screening with the fecal occult blood test and colonoscopy
Cost as a barrier to screening mammography among underserved women
Client-directed interventions to increase community access to breast, cervical, and colorectal cancer screening a systematic review
Pre-publication history
The pre-publication history for this paper can be accessed here:


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Home > Product Categories > Pro-Audio > Live Sound > DJ Lighting > E-190WW
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Lyons Signs With Denver Broncos
May 4, 2010
LEXINGTON, Ky. – Wide receiver Dicky Lyons, Jr., has signed a National Football League free-agent contract with the Denver Broncos.
Lyons played for the Wildcats in 2004 and 2006-08. He ranks fifth in school history in pass receptions (141), fourth in receiving yardage (1,752) and third in touchdown catches (18). Career highs included 12 catches vs. Middle Tennessee as a senior, along with a 124-yard, three-touchdown game vs. Florida during his junior season. He was the first player in school history to catch two TD passes in three consecutive games, which he accomplished at the opening of his '06 sophomore campaign.
Lyons' senior season was cut short because of a knee injury and subsequent surgery. Recovery from the injury limited his professional chances in 2009 but he has continued to gain speed and strength, leading to his current opportunity with the Broncos.
Lyons has been added to a Denver roster that includes two other former Wildcats, linebackers Wesley Woodyard and Braxton Kelley.


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My journey
Sometimes the wrong thing is the best thing for you.
Make sure you have a good time you take that time in and not just let that good time go.
Don't let anyone tell you how to live your life.
Don't look back on your past because it is in your past and not in you future.
My past
Life is like a pass, its not always perfect
To be a better player, you have to do something you have never done before.
Yes some people may make fun of them, but we should give them more credit because they are putting their lives in each other hands
Some people want it to happen, some people wish it would happen, others make it happen.
My present
Volleyball isn't just a sport, its LIFE.
Beyond allergy there's more to life than the allergy symptoms.
FFA motto - Learning to do, doing to learn, earning to live, living to serve.
I don't wear bows, I just shot
My future
I hope to be an OB/GYN Nurse when I grow up. An OB/GYN Nurse helps the mothers that just had a baby. So basically they are the mommy's mommy.
I want to go to Ball State and get my degree. I will go to school for 4 years to get my degree.
I have to have my diploma from high, associate's degree, bachelor's degree
I plane to have a future with my boyfriend, Robert.


text:
|Message view
|« Date » · « Thread »
|« Date » · « Thread »
|A non-apropriate question?
|Mon, 07 May 2001 16:11:54 GMT
Hello again: about my last e-mail to this list... "It's possible to use jikes as default compiler for jsp files in Tomcat? (instead of javac). I've been looking for any place in $tomcat_home/conf/build.xml where configure this option but i haven't found anything. " perhaps, Is it a non apropriate question to this group? or, due to my bad english it hasn't been understood... So, is possible to use 'jikes' as the default jsp compiler with Tomcat? Thanks again, and excuse me to be so impatient ;-) __________________________________________ Jaume Soriano Sivera <email@example.com> Tel: 965040000 -ext. 44744 Fax: 965040047 Portal y servicios multimedia - Nuevas tecnologias W a n a d o o E s p a n a - http://www.wanadoo.es __________________________________________
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September 29th, 2015 by superhdfx
Birthday wallpaper
Birthday wallpaper
Birthday wallpaper, Birthday wishes, Birthday greetings, Birthday images, Birthday pictures, HD wallpaper, Birthday special, Birthday HD wallpaper.
A birthday is an occasion when a person or institution celebrates the anniversary of their birth. Birthdays are celebrated in numerous cultures, often with a gift, party or rite of passage.


text:
2016 (10) TMI 654 - CESTAT MUMBAI - 2016 (43) S.T.R. 437 (Tri. - Mumbai) - Refund claim of service tax paid - classification of services - Business Support Service or Business Auxiliary Service - whether the appellant justified in claiming refund of tax paid under the head Business Support Service as now he believes the service to be classified under the head Business Auxiliary Service? - the decision in the case of Pagariya Auto Centre Vs. Commissioner of Central Excise, Aurangabad [201 .....
Extract - Part text onlyClick here to Access Full Contents
the tax liability arised on the commission, cannot be disputed. Claiming a refund of the amount paid as tax as per their understanding of law cannot be disputed now - refund claim rejected - appeal dismissed - decided against appellant. - ST/465 & 466/11 - A/85990-85991/16/STB - Dated:- 3-2-2016 - Mr. M.V. Ravindran, Member (Judicial) and Mr. C.J. Mathew, Member (Technical) Shri R.S. Indani, Advocate for Appellant Shri R.K. Das, Dy. Commr. (A.R.) for Respondent ORDER These appeals are directed a .....
rial period under the category Business Auxiliary Service . The appellant had discharged Service Tax under Business Support Service on receipt of show-cause notice appellant assessee filed refund claim, of the amount paid by them under Business Support Service . The lower authorities held that the Service Tax demand under Business Support Service is correct accordingly refund filed by the appellant needs to be rejected. 4. From the records, we find during the period in question, appellant themse .....
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text:
The Wharton School
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United States
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University of Pennsylvania - Finance Department
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Mutual fund, performance evaluation
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Value, Growth, duration, habit formation
Value, growth, duration, habit formation
Rare disasters, Peso problem, Excess volatility
implied volatilities, consumption disasters, jump-diffusions
disaster risk, financial crisis, collateralized debt obligations
rare events, recursive utility, factor models
Expected Default, Bond Issuance, Business Cycles, Disaster Risk
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Rolling Stones-Far Away Eyes MP3
I was driving home early Sunday morning through Bakersfield Listening to gospel music on the colored radio station And the preacher said, "You know you ...
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hide your kids, hide your wife...GV and Joe are singing some stones.
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album: Action Jackson Motion Picture Soundtrack All Rights Go To Warner Bros.
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Todd Snider covering the Rolling Stones' "Faraway Eyes" at the Winnipeg Folk Festival. Among the artists at the "Cover Tunes USA" workshop are Ollabelle and ...
Gorky's Zygotic Mynci - Faraway Eyes MP3
Please support this artist and buy their music.
Rolling Stones Far Away Eyes - Deluxe Edition of Some Girls cd LYRICS: I was driving home early Sunday morning through Bakersfield Listening to gospel ...
Warrant/Jani Lane: Faraway Eyes MP3
This song is off of a compiled collection of unreleased and various demos by the band, Warrant. This song can be bought and purchased on Erik Turner's solo ...
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Adrenalin. Faraway eyes. Track 5 from "Road of the Gypsy" album (1986). With sax. Subscribe for new AOR & Melodic rock videos: http://goo.gl/F83ggx AOR ...
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Vanity performs "Faraway Eyes" on the Italian variety show "Fantastico 8" 1987. Credit and special thanks goes to youtube user r2gh2s.
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1978 Somes Girls Tour.
Faraway Eyes ---Rolling stone cover song MP3
Faraway Eyes . Artist - The Handsome Family . Not as good as the Rolling Stones, but I like the lyrics. If you down on your Luck, and the World don't give a F**ck; ...
Vanity -Faraway Eyes MP3
From the 1988 movie "Action Jackson" starring Carl Weathers and Vanity .
Adrenalin on Kelly and Company (December, '85) feat "Faraway Eyes" MP3
Adrenalin appearance on Channel 7's Kelly and Company in late 1985. A brief interview and performances of 'Faraway Eyes' and some 'Road of the Gypsy'.
Erik Turner - Faraway Eyes (feat. Jani Lane) MP3
(P) 1998 E.T. Music / Perris Records - Una voz que personalmente extrañaré sobremanera... RIP Jani Lane!
Barbara Clear - Faraway Eyes MP3
2004 spielte Barbara Clear als erste Musikerin in Eigenregie in der Olympiahalle München vor über 8000 Menschen - eine Sensation. Aus diesem Konzert: ...
Gorky's Zygotic Mynci - Faraway Eyes MP3
Vanity - Faraway Eyes [smooth R&B] MP3
SONG: Faraway Eyes ARTIST: Vanity CREDIT: "Action Jackson" Motion Picture Soundtrack, Atlantic Recording Corp 1988 Nataly's Corner takes you back to the ...
Faraway Eyes MP3
Provided to YouTube by The Orchard Enterprises Faraway Eyes · Handsome Family Paint It Black: An Alt Country Tribute To The Rolling Stones ℗ 2011 ...
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Just fill'n the time in.
Rolling stones-Faraway eyes. MP3
Jani Lane & Bobbie Brown MP3
Musica : Warrant - Far Away Eyes Promovam a pagina : https://www.facebook.com/HardRockNRoll Rest In Peace Jani Lane !
Bill Ryder-Jones-Faraway Eyes (Gorky's Zygotic Mynci Cover) MP3
Rolling Stones - Faraway Eyes MP3
I was driving home early Sunday morning through Bakersfield Listening to gospel music on the colored radio station And the preacher said, "You know you ...
The Rolling Stones Faraway eyes Nashville 2015 full song v1 MP3
Faraway Eyes (Live At The Beacon Theatre, New York / 2006) MP3
Provided to YouTube by Universal Music Group International Faraway Eyes (Live At The Beacon Theatre, New York / 2006) · The Rolling Stones Shine A Light ...
Faraway Eyes Smoking Stones y Aurelio Morata Porta Ferrada 12 07 2012 MP3
Smoking Stones celebrando el 50 aniversario de sus Satanicas Majestades con los invitados de su disco "50 años de Satisfacción". Carlos Segarra,Chiqui Martí ...
Gorky's Zygotic Mynci - Faraway Eyes (live in Italy 1999) MP3
live in Italia 2 ottobre 1999.


text:
HTC thinks phone users spend too long staring at the screen to film music performances and sports events - and the answer is the RE, a small HD video camera.
Announced at a media event in New York today, the RE is a plastic, L-shaped device not dissimilar in size and shape to a door handle. The RE has a 16-megapixel sensor for shooting stills or Full HD 1080p video, which sits behind a wide-angle, 146-degree lens.
That HD footage is stored on 8GB of internal memory, although this can be increased by up to 128GB thanks to a microSD card slot.
Using the RE camera couldn't be simpler; there is just a single chrome button on the back of the device which sits comfortably under your thumb. A single press takes a photo, while a press for one second starts a video recording, which is stopped by a second long press. There's no on or off switch; instead, the RE uses an accelerometer to automatically switch itself on when you pick it up.
As well as regular 30 frames-per-second HD video, the RE can also shoot 120 fps slow-motion and timelapse footage of between one frame per second and one frame per minute. Changing between settings is done through a companion smartphone application, available for devices on Android 4.3 and later, and iOS devices running iOS 7 or later.
The RE connects via Bluetooth, but then uses a Wi-Fi direct connection to stream live video to your device, and through that connection content on the RE can be viewed and transferred. Underneath the RE there's access to the SD card slot, microUSB charging port, and a standard screw mount for connecting it to a tripod. The RE has an IP67 waterproof rating, meaning it can be submerged in up to one meter of fresh water for up to 30 minutes; this can be boosted by adding a waterproof case, sold separately.
Battery life is claimed to offer one hour and 40 minutes of continuous HD video recording, while a future software update will bring live video streaming to YouTube.
Although a price and release date have yet to be announced, HTC expects the RE to go on sale in the UK in late October or early November. We expect the RE to be priced at around £165.


text:
Scotty finished his junior season with over 4,500 passing yards and 65 touchdowns and was named to Texas' all-state second team.
LSU, Oklahoma, Texas, Texas A&M, SMU, Baylor, and Kansas have all been talking with Young on a regular basis, and Texas Tech has extended an offer to him. The Red Raiders are Young's early favorite.
Junior Year Highlights-


text:
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text: 1. As of noon trading, Lululemon Athletica ( LULU) is down $2.78 (-5.2%) to $50.13 on average volume. Thus far, 2.9 million shares of Lululemon Athletica exchanged hands as compared to its average daily volume of 4.2 million shares. The stock has ranged in price between $50.09-$51.88 after having opened the day at $51.52 as compared to the previous trading day's close of $52.91. lululemon athletica inc., together with its subsidiaries, designs, manufactures, and distributes athletic apparel and accessories for women, men, and female youth. It operates in three segments: Corporate-Owned Stores, Direct To Consumer, and Other. Lululemon Athletica has a market cap of $6.0 billion and is part of the consumer non-durables industry. Shares are down 10.4% year-to-date as of the close of trading on Thursday. Currently there are 11 analysts that rate Lululemon Athletica a buy, 3 analysts rate it a sell, and 10 rate it a hold. TheStreet Ratings rates Lululemon Athletica as a hold. The company's strengths can be seen in multiple areas, such as its robust revenue growth, largely solid financial position with reasonable debt levels by most measures and impressive record of earnings per share growth. However, as a counter to these strengths, we also find weaknesses including a generally disappointing performance in the stock itself and weak operating cash flow. Get the full Lululemon Athletica Ratings Report now. STOCKS TO BUY: TheStreet Quant Ratings has identified a handful of stocks that can potentially TRIPLE in the next 12 months. Learn more. If you are interested in one of these 3 stocks, ETFs may be of interest. Investors who are bullish on the consumer goods sector could consider iShares Dow Jones US Cons Goods ( IYK) while those bearish on the consumer goods sector could consider ProShares Ultra Sht Consumer Goods ( SZK).


text:
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Running Time: 106 minutes
Released: 04/2016
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William E Artist/Painter
R H Y SModel Male Sydney, New South Wales, Australia
My Website: FaceBookMy MM URL: http://www.modelmayhem.com/RHYS
Mayhem # 1183451
About Me
Hi I'm Rhys, I'm 29 and have been performing for as long as I can remember. Have worked as a Singer, Actor, Dancer, Host, Performance/MakeUp Artist, Model, and Choreographer in every state in Australia and also internationally. Always looking for new ways to challenge myself creatively and will never stop trying to reach my full potential as a performer/artist.
I am a very creative person and jump at the opportunity to work with like minded folks to create things of beauty and wonder.
Check out my Make-Up work here..
http://www.facebook.com/album.php?aid=3 … =707120421
I don't check MM too regularly so feel free to hit me up on FaceBook.
Afraid I'm only doing paid work at the moment. Times are tough and I gots to pay the bills. Unless the project both benefits you and I.
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text:
NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 2008 -- (Senate - September 27, 2007)
Mr. GRAHAM. Mr. President, before my colleague from Oregon leaves, I don't think there is anybody in this body who is more respected than Senator Gordon Smith. He is a very sincere, thoughtful guy who tries to personalize issues that affect people throughout this country. I know he is motivated by all the right reasons, but somebody needs to talk about the politics.
This legislation has been placed on the Defense authorization bill in the past. It never made it out of conference because we knew, with the makeup of the conference, the amendment would fall. Given the makeup of this conference, the amendment will be part of the bill and it is going to be vetoed. That is the politics. Whether one agrees with President Bush, he said he is going to veto this bill, and if I were him, I would as Commander in Chief. I would not buy into this way of legislating.
Another reason for this amendment, if you think there is a gap in military law that without this kind of amendment the military is not going to prosecute people who act on their prejudices, you are wrong. If someone in uniform commits a crime against a civilian or another person in uniform, I don't care why they did it; if they beat somebody up, hurt somebody, they are going to get prosecuted. That is the way the military law works.
We are not doing the military a favor by passing this legislation because there is no problem in the military in terms of how justice is administered. Whatever motivates you to hurt someone or to take the law in your own hands or act on your prejudices, you are going to be dealt with because we cannot have good order and discipline in the military when people can hurt someone based on their individual prejudice because the whole unit falls apart. This is nothing the military needs. They are going to take care of violence in the ranks based on the law they already have.
I can assure my colleagues that no one in the military gets a pass because of the status of their victim. If you engage in violent conduct, inappropriate behavior, illegal behavior, the law is going to come down on your head because we need good order and discipline.
The politics of this amendment is that this bill will get vetoed. The President is not going to agree to this social legislation on the Defense authorization bill, and we have to take responsibility for that action. Whether one agrees with him or not, we are going to put in jeopardy items the military does need. They don't need a hate crimes bill to make it an effective fighting force. We already have disciplinary tools to discipline people. They need pay raises and MRAP protection, and this bill provides those items.
Members of this body have different views about hate crimes legislation. We can argue those differences any time, anywhere, on any other piece of legislation. It can be brought up as a freestanding bill. But to put it on this bill is going to put in jeopardy items our men and women who are in combat and being shot at need. When I go to Iraq, I don't have a lot of people coming up to me saying we need to pass a hate crimes bill. They do need better body armor. They do need pay raises. They do need better MRAPs.
I think this is a very poor use of the legislative process knowing the end game. The end game is, we are going to hijack the Defense authorization bill by legislation not needed in the military, that is contentious, and that has an opportunity to be debated somewhere else. I hope reason prevails eventually.
I yield the floor.
Source: http://thomas.loc.gov


text:
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Amazing Pickle Juice Ranch Dressing
Recipe by fatefellshort0626
I love Chili's ranch dressing. I use this ranch recipe with everything. :) Sometimes I put smoked paprika in it for an extra kick. :)
Top Review by johoba83
I just ate a Chili's today, and our waitress told us how Chili's make their delish rand dressing.
1gal. mayo
1gal. buttermilk
then they add their "own" spices.
i think you could probably get a packet of hidden valley buttermilk ranch mix and of course downsize the gallon size and you would have chili's ranch
Ingredients Nutrition
- 1⁄4 cup mayonnaise
- 1⁄4 cup sour cream
- 2 tablespoons pickle juice, dill (I use Claussens)
- 1 tablespoon buttermilk
- 1⁄8 teaspoon salt
- 1⁄4 teaspoon dried parsley
- 1⁄4 teaspoon onion powder
- 1⁄8 teaspoon garlic powder
- 1 dash pepper
Directions See How It's Made
- Combine mayonnaise, sour cream and dill pickle juice in a medium sized bowl.
- Add in buttermilk.
- Stir in the rest of the ingredients.
- Chill for about 30 minutes.
- Enjoy.


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Broadcom Corporation (Nasdaq: BRCM), a global leader in semiconductors for wired and wireless communications, announced that it is offering its BroadVoice family of voice codecs royalty-free and without any licensing fees. As a direct response to customer demand for advanced, high-quality voice solutions and development tools, Broadcom is releasing its wideband and narrowband BroadVoice codecs in both floating-point and fixed-point C code as open source software under the GNU Lesser General Public License (LGPL), version 2.1, as published by the Free Software Foundation.
By eliminating the royalties and licensing fees (required by competitive solutions), Broadcom is driving a cost effective transition to HD voice-over IP (VoIP) applications by enhancing the quality of voice transmissions enabling a higher quality audio experience. The availability of BroadVoice source code, under an open source software license, provides the industry with maximum flexibility in how it can be deployed and has the potential of addressing a wide range of next generation voice-related applications.
Highlights/Key Facts
- Broadcom developed the BroadVoice family of voice codecs with two variants including a 32 kb/s version called BroadVoice32 for wideband (HD) speech sampled at 16 kHz, and a 16 kb/s version called BroadVoice16 for narrowband telephone-bandwidth speech sampled at 8 kHz.
- BroadVoice advanced voice codecs reduce the latency, complexity and bandwidth usage on a wide range of wideband and narrowband voice applications including voice-over-cable, voice-over-DSL, Ethernet IP phones, Wi-Fi VoIP phones and software-based VoIP client solutions. Additionally, for VoIP applications, distortion and echo are also reduced.
- BroadVoice is available on Broadcom's cable, DSL and VoIP system-on-a-chip (SoC) solutions enabling manufacturers and service providers to improve the customer's audio experience.
- When standardized by SCTE and ANSI, the BroadVoice16 and BroadVoice32 codecs are called BV16 and BV32, respectively. BV16 is a standard codec in PacketCable(TM) 1.5, PacketCable 2.0, ANSI/SCTE 24-21 2006, and ITU-T Recommendation J.161 specifications. BV32 is a standard codec in PacketCable 2.0, ANSI/SCTE 24-23 2007, and ITU-T Recommendation J.361 specifications.
- The real-time transport protocol (RTP) payload formats for BroadVoice16 and BroadVoice32 are specified in RFC4298.
- BroadVoice16 and BroadVoice32 have very similar codec structures. Both variants share most of the algorithm modules so when implemented together, substantial code sharing and memory reduction can be achieved.
- Broadcom is providing both the floating-point and fixed-point C source code of BroadVoice16 and BroadVoice 32 under an open source license (LGPL version 2.1) and on a royalty-free basis.
About Broadcom
Broadcom Corporation is a major technology innovator and global leader in semiconductors for wired and wireless communications. Broadcom products enable the delivery of voice, video, data and multimedia to and throughout the home, the office and the mobile environment. We provide the industry's broadest portfolio of state-of-the-art system-on-a-chip and software solutions to manufacturers of computing and networking equipment, digital entertainment and broadband access products, and mobile devices. These solutions support our core mission: Connecting everything. Broadcom is one of the world's largest fabless semiconductor companies, with 2008 revenue of $4.66 billion, and holds over 3,650 U.S. and over 1,450 foreign patents, more than 7,750 additional pending patent applications, and one of the broadest intellectual property portfolios addressing both wired and wireless transmission of voice, video, data and multimedia. A FORTUNE 500 company, Broadcom is headquartered in Irvine, Calif., and has offices and research facilities in North America, Asia and Europe. Broadcom may be contacted at +1.949.926.5000.


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Martine Garland is a former member of the Canadian national women's hockey team. Her only appearance with the Canadian senior team came in a gold medal effort at the 2007 Four Nations Cup. From 2003-08, she was also a defender with the New Hampshire Wildcats women's ice hockey program.
Playing careerEdit
Competing for head coach Brian McCloskey at UNH, she served as team captain in her junior season. During her junior season, her 23 assists tied for the team lead while her scoring average of 0.94 points per game ranked tenth in the NCAA in defenseman scoring. In addition, she was a Top 10 finalist for the 2007 Patty Kazmaier Memorial Memorial Award, making her the seventh top 10 finalist in program history.
Hockey CanadaEdit
From 2003-06, Garland suited up for the Canadian Under-22 national women's team. In 2007, she would earn a spot on the national senior team, earning a gold medal at the 2007 Four Nations Cup. During the round robin, she would score a goal against Finland.
In the 2010 CWHL Draft, Garland was selected by the Toronto Furies.
Awards and honorsEdit
- 2006 RBK Hockey All-America First Team selection
- Top 10 finalist for the 2007 Patty Kazmaier Memorial Memorial Award


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The Business Development Institute is an online business development training course that provides legal marketers with the knowledge, confidence, and resources that drive successful BD initiatives. The upcoming semester will show participants how to coach lawyers to become more effective business developers with their existing clients.
Over 95% of our past participants recommend this program as a professional development resource for legal marketers.
Business Development Training for Legal Marketers
Learn how to coach lawyers more effectively
According to BTI Consulting, it is 10 times easier to acquire a new matter from an existing client than from a new prospect. And yet, most lawyers struggle to realize the full cross-sell and up-sell potential of their client base.
This semester of BDI will show participants how they can become better coaches to the lawyers who struggle with this client development opportunity.
BDI will actively engage in a series of five webinars covering a range of topics on coaching lawyers to develop new business from existing clients. The program also includes an optional networking event that offers all BDI participants and graduates the opportunity to develop a peer network and take advantage of a discussion forum for sharing best practices. The program will impart actionable insights on the following topics:
- Client Team Plans
- Productive Conversations with Key Clients
- Motivating the Lawyer: Inspiring Buy-in in a Change-Resistant Environment
- The Sales Cycle: Mastering the Conversation from Introduction to Close
Enrollment in BDI entitles participants to the following:
- Access to all 4 webinars, the final capstone session, and an invitation to the annual Alumni Event
- Access to select training tutorials from Practice Boomers, the award-winning business development training curriculum
- An official certificate of completion that can be added to participants' resumes and LinkedIn profiles
- Access to the alumni directory for ongoing peer networking and idea exchange
The cost of the program is $750.
Who should attend?
This program is ideal for early-to-mid level marketing or business development professionals. Our business development training focuses on imparting BD tools and strategies that are relevant to any professional tasked with overseeing business development initiatives or training lawyers in business development. Each session incorporates feedback and engagement, so BDI participants will come away from the program equipped with personalized strategies that are relevant and actionable at their respective firms.
Program Curriculum
Sessions 1, 2, 3, and 5 are available recorded and on-demand. Sessions 4 takes place on February 15th from 10-11am PST/1-2pm EST. Details for the Alumni Networking Event will be provided soon.
The program is designed to accommodate a busy schedule so if you can not attend all of the sessions recordings will be made available for your review. All of the assignments are reasonable in scope and we provide ample time between sessions to complete them. Assignments typically include:
- Watching video lessons from the Practice Boomers curriculum
- Working independently or with a lawyer at your firm to implement sample components of a BD plan
- Completing short writing assignments related to the session subject matter
- Coming to each session prepared to discuss the BD initiatives at your firm
- Completing a final assessment questionnaire at the end of the program
David Ackert, MA, is the President of The Ackert Advisory and a mentor to high-achieving professionals in the legal, corporate, finance, and accounting sectors. David has advised hundreds of lawyers, CEOs and professional-services executives on overcoming business development and marketing challenges.
He has developed and implemented business development programs for countless firms, from AmLaw 100s to local boutiques. Widely recognized as an e-learning pioneer in the legal field, David is the founder of Practice Boomers, a business development e-learning program and two-time winner of the Legal Marketing Associations "Your Honor Award." He is also the founder of Practice Pipeline, a pipeline management software platform that incorporates business development coaching. The combination of technology and coaching has become a hallmark of his programs.
Darryl Cross, MBA, is the Vice President of Performance Coaching and Development at LexisNexis and Senior Advisor at the Ackert Advisory. He is responsible for sales training, developing coaches and creating high performers for a 1500 person, international sales force generating $1.5 billion in annual sales from the legal, corporate, government and academic sectors. Darryl is a highly sought after inspirational speaker on high performance, coaching and maximizing profitability. He has spoken to over 10,000 fee earners and business executives from over 100 countries. Darryl has served as a TEDx speaker coach and helps others create lasting impact on audiences. Darryl's direct experience in professional service organizations includes his service as the Chief Marketing Officer and member of the Executive Committee of a law firm. During his tenure, he was awarded the Marketing Partner Forum's Excellence in Marketing Award, for "Creating a Sales Culture at a Law Firm." He was also a finalist for the 2003 U.S. Marketing Director of the Year and 2004 Marketing Initiative of the Year.
Darryl is a member of the international Board of Directors for the Legal Marketing Association (LMA). He has also served on the Board of Directors for the Virginia, Chicago and Mid-Atlantic chapters.
He is an internationally known author on the subjects of marketing, competitive intelligence, CRM, social media, high stakes sales and sustained high performance.
Jeanne Hammerstrom is the Chief Marketing Officer at Benesch and brings 27 years of legal marketing experience to her post. Jeanne has firm wide responsibility for marketing, communications, practice development, and oversees a staff of business development, public relations, advertising, event planning and other professionals. She also participates in the firm's Executive Committee, Strategic Growth Committee and Client Service Committee.
Under Jeanne's leadership, Benesch was ranked the highest of any non-AmLaw 200 firm in the country by Marketing the Law Firm's 2012 national ranking list, "The Eighth Annual MLF 50: The Top 50 Law Firms in Marketing and Business Development." Benesch ranked fourth overall and was the only non-AmLaw 200 firm in the top five.* In 2015 Benesch received a first place award in Practice Management for its Client Onboarding Program and a second place award for its Data Privacy & Security collateral at the Legal Marketing Association (LMA) Annual Conference. Additionally, the marketing/business development team has received a number of awards at the Annual LMA Conference including Interactive Media, Competitive Intelligence and for its Shale Initiative. Benesch also has been the recipient of the Communicators Award of Excellence for Law and Legal Services for the Benesch website www.beneschlaw.com.
Active in the legal industry, Jeanne is a Fellow of the College of Law Practice Management. She is a former President of the International Legal Marketing Association (LMA), Chair of LMA's 2009 Annual Conference and a past-President of LMA's Pittsburgh Chapter. She is a frequent speaker and writer for the legal marketing industry.
Terence (Terry) D. Williams is the Global Director of Strategic Pricing at Hogan Lovells. He joined the firm in December 2015 as Managing Pricing Director of the Americas before assuming his current role in November 2016. Prior to joining Hogan Lovells, he was with AIG where served as Vice President and Deputy Director of Legal Strategies in their Legal Operations Center. In this role, Terry was responsible for the design and implementation of global legal strategies focused on legal process, cost efficiency, and qualitative outcomes. He additionally served as Staff Counsel Executive and Chief Counsel during his time at AIG.
Previously, Terry worked as a Managing Attorney at Shur, McDuffie, Williams & Morgan and as a Partner at Crim & Bassler in Atlanta. Terry holds a J.D. from Emory University School of Law and B.A. from McGill University.
Read the biographies of our Faculty Emeritus
BDI Certification
The Ackert Advisory offers professionals the opportunity to expand their professional development credentials by becoming a certified BDI graduate. This certification can be added to their resume and LinkedIn page, demonstrating their mastery of the core principles of training and strategy essential to effective performance in a business development role. Certification is valid for two years.
Over 100 AmLaw firms have enrolled their marketers in the Business Development Institute.
Bespoke Programs
We offer bespoke programs that can be customized as a series of webinars, a full-day retreat onsite at your firm, or various other formats.
Contact us if you would like to discuss a bespoke program for the marketers at your firm.
BDI FAQ's
- What does it cost? $750 per registrant for the entire 3 month program. Group discounts are available.
- What if I can't attend all parts of BDI? All sessions will be offered to participants on-demand.
- If I can't attend all parts of BDI, will I still obtain certification? All BDI offerings are recorded and posted on secure pages which can be accessed in case you are unable to attend a session. You may earn your certificate by reviewing the recordings, completing the assignments and completing the final assessment.
- How long will my certification be valid? Because the legal landscape is rapidly changing, BDI certifications will be valid for 2 years. After 2 years they may be re-instated by enrolling in BDI again at a special alumni discount.
Register for BDI
Membership in the Business Development Institute is limited to ensure that each session is are engaging, relevant and high-value. If you feel that you or someone at your firm would benefit from participating in BDI, click the link below to reserve your seat. The total cost of the program is $750.
Have questions? Contact Olivia Cowenhoven (firstname.lastname@example.com) to discuss how BDI can benefit you and your firm.


text: Lipsy High Waist Button Shorts June 28, 2012 By Outblush Back in the '80s, denim shorts were the tattered remnants of our favorite pairs of worn-to-pieces jeans, which we lovingly paired with high top sneakers and "I ♥ Axl" t-shirts. Today's fashion calls for a somewhat more tailored look, like the double-breasted style of these Lipsy High Waist Button Shorts ($55). Classic denim, yes. Sneak peaks at our knickers, not so much.


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E.T. The Extra Terrestrial 2-Disc Limited Collector's Edition
October 23, 2002 - As a result, the 2002 reissue didn't fare nearly as well as most people had hoped.
Original E.T. Confirmed on All DVDs
October 17, 2002 - Today, Universal Home Video officially confirmed that the original 1982 edition of E.T. The Extra Terrestrial would be included on all versions of Tuesday's DVD release, and not just the $70 Collector's Edition as originally announced.
E.T. The Extra Terrestrial
September 16, 2002 - What many consider to be Steven Spielberg's best film arrives on DVD on October 22, but only for a short while. E.T. The Extra Terrestrial will only be available on the format for ten weeks. After that, the title will be taken out of print.
E.T. Makes a Short Visit to DVD
June 6, 2002 - "E.T. Limited Collector's Edition DVD" will be $22.95 and include the 20th Anniversary edition along with an exclusive interview with Spielberg as well as footage of John Williams conducting the score at the E.T. 20 premiere, and more.


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I'm seeing a lot of posts lately about these two issues and since they are closely related i'll make a little guide *FROM MY OWN RESEARCH AND OBSERVATIONS*
Ethos: I am currently rank 20+ as conjurer and have spent time detailing Optimal Rank with exact numbers.
At 1 Durability, Skill gain is cut by 50%
Below 50%, Accuracy and Damage are reduced.
Below 50%, Damage Reduction is reduced.
Optimal Rank
On weapons, Optimal affects Accuracy and damage which in turn affects skill gains.
I tested both rank 11 elm cane vs rank 22 willow wand.
At rank 13, the willow wand was 12 points worse in each stat(damage & accuracy). There was also a hidden accuracy debuff that I am theorizing because I noticed a much higher miss rate. I tested this with the weathered cane level 1 which had worse accuracy than the rank 11 elm cane, but I hit more with the weathered cane than i did with willow wand at level 13.
At level 14, the willow wand did not increase, but at level 15 it gained +3 points in damage and accuracy, and continued to do so until level 18. At level 18, rank 11 elm cane and rank 22 willow wand were equal, but I still experienced a diminished accuracy AS WELL AS a higher rate of durability loss. At level 19, the willow wand had higher stats, but lower accuracy still, at 20, I noticed that the accuracy was normal and at 22 I hit the full stats.
EXP Implications:
The exact variables changed as I increased in level obviously, but I did write down that at level 14 against Aldegoat Nannys, I was averaging 45 skill per attack. I also only tested exp with spirit dart since spells have such random exp. After my weapon was broken, I was averaging 20-25 skill per attack. Same held true at level 18 against cassiopeia's. Averaging 50 or so with pine crook and when it reached one durability, was dropped to 20-25 range again.
My sample size was large enough to know it was not a fluke. I probably killed 20 or so mobs to make sure before going off to repair.
Using below optimal rank reduces the amount of stats provided and the damage reduction offered. The penalty seems to be less than weapons, but your durability will decrease faster.
Try to equip weapons the closest to your level. It really doesn't benefit you to equip a shiny high rank weapon, and it will be detrimental. Armor has a little bit more wiggle room than weapons, but Durability is lost faster so keep that in mind if you're out for a long grinding session.
I'll put this at the bottom as well because I know the reading habits of people on this forum - all of my information comes from:
Edited, Oct 5th 2010 11:51pm by xGaelx


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2010 Buick Lucerne Problems
RepairPal has identified the most common problems with the 2010 Buick Lucerne based on complaints from actual vehicle owners. We'll tell you what the problem is and what it'll take to fix it.
An engine oil leak may develop from the front crankshaft seal. Our technicians tell us a revised front crankshaft seal is available to correct this concern.
The fuel pump may fail causing the engine to stall and not restart.
The 2006-2011 Buick Lucerne is known to have issues with the EVAP system, a part of your emission control system.
The EVAP canister vent valve or valve solenoid wiring may fail causing illumination of the check engine light, setting code P0446, and problems filling the tank with fuel.
To correct the issue, the EVAP canister vent valve, solenoid, and wiring must be inspected. The most common fix is replacement of the wiring connector or replacement of the vent valve assembly.
The spark plugs should be replaced every 100,000 miles. Our technicians recommend replacing the spark plug wires also at this time.
Our technicians recommend flushing the brake fluid every 60,000 miles. Brake fluid that is dirty may cause problems in the brake system.
A Loose or worn gas cap may cause Check Engine Light to illuminate.
You may be able to prevent transmission problems by servicing the transmission and inspecting the fluid every 30,000 miles. If the fluid is dark or burned then the transmission system should be completely flushed.
The engine may develop an oil leak from the lower crankcase portion of the engine block. Our technicians tell us that the engine must be removed from the vehicle to properly repair this oil leak.


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Giddy Up…
Now this is a key holder. It's made from out of oiled horsehide leather. It's brown leather is going to age beautifully. If you are still rocking lanyard keychains… it's time for you to grow-up. Little details like this key chain tell those around you… that you are not a little kid anymore. This horsehide key holder matches with everything, you won't feel stupid pulling this out dressed in your finest tailored suit nor will it look over the top when your wearing your favorite jeans.
Pick this one up… the ladies will notice your horsehide key holder and the fellas will be wondering where you got something so unique.
Incoming Search Terms:
- Horsehide Key Holder