text: I have finally figured out how to get the Vanilla MMS app ported for us 2.1 leakers that can't root. Thanks to jonasl over at XDA for helping me figure this out. Took some time. Problems that I have with it: -Every time someone sends you a message, it sends 2. It only notifies you of one, but two show in the thread. I'm trying to fix it. That's it so far, let me know of any you come across and I'll see what I can do. Screens: Download: Mmz.apk Please DONATE if you love this.


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All the information you need in one place! Each Study Brief is a summary of one specific subject; facts, figures, and explanations to help you learn faster.
List price: $35.95Copyright year: 2007Publisher: RoutledgePublication date: 11/30/2007Binding: PaperbackPages: 190Size: 6.25" wide x 9.00" long x 0.50" tall Weight: 0.682Language: English
Peter N. Stearnsis a professor of history at George Mason University, where he is currently provost (since January 1, 2000) with almost 40 years of experience as a teacher and administrator. Stearns was the chair of the Department of History at Carnegie Mellon University and also served as the dean of the College of Humanities and Social Sciences. In addition, he founded andnbsp;continues to editnbsp;theJournal of Social History. Also while at Carnegie Mellon he developed a pioneering approach to teaching world history to undergraduates in addition to mentoring hundreds of graduate students. Besides his long career as a historian, he is active in historical groups such as the American Historical Society, the Society of French Historical Studies, the Social Science History Association and the International Society for Research on Emotion. He attended Harvard College and later received his Ph.D. from Harvard University. In his prolific career as an author and editor, he has written or edited over 110 works of literature. Stearns currently serves as chair of the Advanced Placement World History committee. nbsp; Stephen S. Goschis a professor emeritus of history at the University of Wisconsin-Eau Claire. Gosch began by teaching western civilization courses at UW-Eau Claire, but his scholarship evolved over the years to a broader comparative scholarship in world history, which he introduced to UW-Eau Claire classrooms in 1982. He also taught courses in the history of Japan, 19th and 20th century Europe and Marco Polo's world, as well as a popular team-taught interdisciplinary course on the Vietnam War, which he developed with a colleague in political science. He has published numerous articles and co-authored several books, including the recentPre-modern Travel in World History. Gosch earned his bachelor's degree from Boston University and his master's and doctoral degrees from Rutgers University. nbsp; Erwin P. Grieshabercurrently teaches world history, history of Latin America and history of 20 th century war and peace at Minnesota State University. He received his Ph.D. from the University of North Carolina in 1977. nbsp; Allison Scardino Belzerteaches a wide variety of courses at Armstrong Atlantic State University in Savannah, Georgia. In teaching both halves of world civilization, she focuses on assigning texts that spark a positive response in students ndash; texts that offer concrete knowledge while also inspiring questions. She developed her interest in history at Vassar College and received her Ph.D at Emory University. Her bookWomen and the Great War: Femininity Under Fire in Italy(2010) reflects her research interest in gender and cultural history and the history of war.
Mehran Kamravais Interim Dean of Georgetown University's School of Foreign Service in Qatar and also the Director of the School's Center for International and Regional Studies. He is the author ofThe Modern Middle East: A Political History since the First World War(second edition, UC Press) andIran's Intellectual Revolution.He has also editedThe New Voices of Islam: Rethinking Politics and Modernity(UC Press).
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Robies Heating & Cooling
[41.662012, -70.27489] robi, heat, cool, hvac, gener, contractor, air, qualiti, measur, servic, inspect, condit, clean, repair, forc, ac, pump, furnac, central, filter, carrier, generac, sanyo, mitsubishi, aprilair, guaridanair
(508) 775-3083 279 Yarmouth Rd, Hyannis, MA 02601 M-F 7:30am-4:30pm, Sa-Su ClosedOfficial site
Categories: Hvac, Generators, Hvac Contractors, Air Quality Measuring Service
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Robies is a full-service heating, air conditioning, and generator company serving Cape Cod. We repair and install gas furnaces, boilers, and radiant heat systems, as well as central cooling and ductless cooling systems. Robies also installs and services Generac automatic emergency stand-by generators. We are specialists in air quality and purification systems. All Robies technicians are factory-trained and NATE-certified. We serve both homes and businesses.
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Potential problems using software for RCA
Software can be helpful in a root cause analysis plan, but it also can lead to potential problems.
Root cause analysis (RCA) is a way of thinking, not a software application. However, there are sites that spend thousands of dollars and hundreds of hours learning about software instead of solving problems. Software is not necessarily bad, but also a sports car is not necessary to learn how to drive. Here are some potential problems of using software in an RCA plan:
- Software can limit team involvement: the facilitator is head down in the computer rather than up. This can hinder responses from the team.
- Software can slow the flow of ideas: creating or moving causes and links can be a slow process. Time required to create or edit means other are waiting and forgetting points and causes.
- Software can complicate reporting: for most sites the simplest and most effective reporting is the A3 style RCA report.
Computers create barriers between facilitators and the RCA team. If information has to be collected directly to the software, then a scribe or facilitator and a recorder should be considered. If information can be captured after the analysis, or problems can be solved without software, then a software-free RCA should be considered.
Some helpful tools while using a software-free RCA include sticky notes, a big blank wall, or a white board. These tools enable group involvement by allowing them to write and share or verbally share information to capture the causes. It also gives two streams of causes in two different communication styles. If two people share the same or similar causes, the responses can be stacked, and both participants will know they were heard. This can be key to good facilitation.
A benefit of using sticky notes is the ability to understand the sequence of events and include any time stamped data from PLCs, cameras, etc. Once the key event, also known as forcing functions, is identified, fault and logic tree can be transitioned with ease. This will provide a better understanding of the systemic and latent causes of the key event.
The sticky method allows causal chains to be reorganized and new causes to be added without huge disruptions to the flow of ideas. By taking a picture of the analysis, results can be shared with others electronically after it is pasted into a chosen report format. All things considered, software is not bad. It is simply not required to get started and make substantial improvements to a facility. Many students save thousands of dollars by using nothing more than sticky notes and a sound root cause methodology. Once root cause is a part of business culture, information can be captured, cataloged, and shared more effectively. Software can help, but not allowing it get in the way from the start is the key.
- Jon Bailey is a creative director at Eruditio. This article originally appeared on Eruditio's Blog. Eruditio is a CFE Media content partner.
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Annual Salary Survey
Before the calendar turned, 2016 already had the makings of a pivotal year for manufacturing, and for the world.
There were the big events for the year, including the United States as Partner Country at Hannover Messe in April and the 2016 International Manufacturing Technology Show in Chicago in September. There's also the matter of the U.S. presidential elections in November, which promise to shape policy in manufacturing for years to come.
But the year started with global economic turmoil, as a slowdown in Chinese manufacturing triggered a worldwide stock hiccup that sent values plummeting. The continued plunge in world oil prices has resulted in a slowdown in exploration and, by extension, the manufacture of exploration equipment.
Read more: 2015 Salary Survey


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Ronald Reagan Quotes About RevolutionQuotes about: Revolution
If you analyze it I believe the very heart and soul of conservatism is libertarianism. I think conservatism is really a misnomer just as liberalism is a misnomer for the liberals — if we were back in the days of the Revolution, so-called conservatives today would be the Liberals and the liberals would be the Tories. The basis of conservatism is a desire for less government interference or less centralized authority or more individual freedom and this is a pretty general description also of what libertarianism is.
Freedom is the right to question and change the established way of doing things. It is the continuing revolution of the marketplace. It is the understanding that allows us to recognize shortcomings and seek solutions. It is the right to put forth an idea, scoffed at by the experts, and watch it catch fire among the people. It is the right to follow your dream, or stick to your conscience even if you're the only one in a sea of doubters.
I think it's time we ask ourselves if we still know the freedoms that were intended for us by the Founding Fathers... Whether we believe in our capacity for self-government or whether we abandon the American Revolution and confess that a little intellectual elite in a far-distant capital can plan our lives for us better than we can plan them for ourselves.
Ours was the first revolution in the history of mankind that truly reversed the course of government, and with three little words: 'We the people.' 'We the people' tell the government what to do, it doesn't tell us. 'We the people' are the driver, the government is the car. And we decide where it should go, and by what route, and how fast. Almost all the world's constitutions are documents in which governments tell the people what their privileges are. Our Constitution is a document in which 'We the people' tell the government what it is allowed to do. 'We the people' are free.
There are no words to express the extraordinary strength and character of this breed of people we call American. They are the kind of men and women Tom Paine had in mind when he wrote, during the darkest days of the American Revolution, we have it in our power to begin the world over again.
During my first press conference as president, in answer to a direct question, I pointed out that, as good Marxist-Leninists, the Soviet leaders have openly and publicly declared that the only morality they recognize is that which will further their cause, which is world revolution.
We have not inherited an easy world. If developments like the Industrial revolution, which began in England, and the gifts of science and technology have made life much easier for us, they have also made it more dangerous. There are threats now to our freedom, indeed to our very existence, that other generations could never even have imagined. There is first the threat of global war. No president, no Congress, no prime minister, no parliament can spend a day entirely free of this threat. If history teaches anything, it teaches self-delusion in the face of unpleasant facts is folly.
Ronald Reagan
- Born: February 6, 1911
- Died: June 5, 2004
- Occupation: 40th U.S. President
- Cite this Page: Citation


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Stop Elephant Poaching
Elephants are in serious jeopardy of extinction. We must stop this terrible trend.
Elephants are in serious jeopardy of extinction. We must stop this terrible trend.
Don't let Congress deny your right to know: Oppose the DARK act
97% of Americans support tough new anti-corruption laws. Together, we can and will force our government to Represent Us!
US Fish & Wildlife Service is issuing an import permit for a hunted down endangered Black Rhino, a dangerous precedent.
Facebook Fails to Protect Human Rights
Killing these wild animals for a so-called "sport" does not help and give benefits anyone
Build a advanced Culture of Compassion and Empathy for Humans,Nonhumans,Earth and
Facebook is a household name for millions of people around the world who use it to make friends, share pictures, and
We ask to stop the terrible practice of eating dog meat and tortures to which the dogs are subjected in China.
For 150 years, the Canadian government has allowed the cruel seal hunt to go on. It's time to end it.
Ask the Senate to block Rex Tillerson's nomination today!
Google has taken Palestine off of their maps. 137 countries and the UN recognize Palestine as a state.
Millions of animals are being abused and killed for their skins, fur, wool, or feathers. You can help stop this.
The Cincinnati Zoo unnecessarily killed a gorilla after a child fell in the animal's cage. There's a more humane way!
Visitors to our national parks often put wildlife and themselves in danger. The Park service must have tighter laws.
Congress has attached a dangerous rider to the annual funding bill that would weaken efforts to end illegal ivory.
The Obama administration has drafted regulations to ban ivory sales in the U.S. We need to drum up support for the ban.
The poaching of Zimbabwe's "Cecil the Lion" that these lions are under constant threat and nearer to extinction
CISPA gives legal immunity to companies that share data with the government and justifies warrantless surveillance
Imagine living in a country where you have no right to be who you are and are not able to show love for whom you love!
A bill to Fast Track the TPP and other secret trade deals was officially introduced in Congress on April 16, 2015
Climate change denial is factually and morally wrong!
Choosing organic, sustainable, and humanely-raised products is both a healthful and environmentally-friendly decision.
Did Florida ban environmental regulators from using the term "climate change?" Call for an investigation to find out.
Destructive tuna fishing kills turtles, sharks and more
Nosey is showing signs of crippling arthritis, yet the USDA has refused to take her off the road.
Moby knows we've got to stop the use of bee-killing pesticides before it's too late.
Google and Facebook just dropped their support on ALEC (American Legislation Exchange Council) now Yahoo and Ebay must!
The Internet should remain free and open to all, not manipulated by governments and corporate monopolies
America's biggest brands say they want action on climate change, but spend millions to keep climate deniers in Congress
#KeystoneXL has been stalled for 6 years. We're out of time and out of excuses. It's #Time2Build.
Monarch butterflies are the canaries in the corn field, threatened by pesticides, GMOs and loss of habitat.
12/08/2014: Minister E.Molewa confirmed that 500 rhinos will be sold (private parks and hunting lodges) for R80m profit!
The best thing that you can do for sheep is refuse to buy wool! It's easy to check the label when you're shopping.
It's time to demand meaningful action from President Obama to protect our pollinators!!
The EPA just proposed a rule that will keep water safe for river otters -- make sure it passes! Raise your voice today!
What do Monsanto and Coke have in common? They've both spent millions of dollars to keep you in the dark.
The Fish and Wildlife Service is ignoring its own scientists and declining to protect wolverines. Take action today!
The US has a fiscal crisis because the government constantly spends more than it takes in. We must stop this trend.
There are alternatives to animal testing -- make sure tobacco companies use them!
ALEC writes legislation attacking clean energy and animals for corporations like Exxon. So why is Google funding them?
This legendary law saved the bald eagle. Now black-footed ferrets need it, too. Tell Congress: Hands off the ESA!
Big Oil claims its tar sands pipeline spills are actually "good" for local economies. This is ridiculous!
The U.S. is attacking India's solar policy at a time when we need to be fighting for more renewable energy.
Products sold at Walgreens have been linked to cancer and asthma. Target took steps to fix this - Walgreens can too!
Oklahoma is attacking solar energy and the homeowners who install it! We should encourage clean energy, not fight it!
Speak up for wild animals now by urging Animal Planet to cancel 'Wild West Alaska'!
The Federal government is allowing seismic air gun blasting that could injure and kill more than 138,000 marine mammals
When Fox News - the nation's most-watched cable news channel - covers climate change, they get it wrong 72% of the time!
GE salmon threaten the environment, public health, and wild salmon.
SURPLUS - Giraffe KILLED on Sunday Feb 9th 2014!
Chevron is using an obscure U.S. law to attack anyone who speaks out against its pollution of the Ecuadorian Amazon.
Dow Chemical's "Agent Orange" crops are bad for farmers, consumers, communities, and the environment
Please contact Groupon right away and urge it to cancel this SeaWorld deal.
America currently has NO national limits on carbon pollution from power plants--help us change that.
Carnival has the worst impact on our oceans of any other cruise line.
The NRA's support of toxic lead in bullets is endangering millions of wild birds every year.
You may have seen the disturbing stories
Aderonke is a Nigerian activist seeking refugee status in the UK.
We have less than one month remaining to moblize public support for the continued protection of America's gray wolves.
I realise this is a little late into the current season, but as a recent 'victim' to some anti-canadian hate based
Wolf hunting is not needed in Michigan! With less than 700 wolves across the span of 96,720 sq miles, how could anyone
If you live in Wisconsin - contact your legislators and urge them to support Senator Fred Risser's bill to ban
South Africa have been shocked by the savage rape, disembowelment and murder of 17-year old Anene Booysen by 4 men on
per far capire all'amministrazione che i cittadini si preoccupano della salute degli animali
To change the course of our future to TRUE SUSTAINABILTY .. support clean energy with out the combustion of fossil
Il diritto d'iniziativa dei cittadini europei consente ad un milione di cittadini europei di prendere direttamente parte
We need your signature! This petition will be sent to the Israeli, Palestinian, USA and European leaders, calling them
A poco più di un anno di distanza dallo straordinario risultato referendario che nel giugno scorso ha sancito la
We believe that Facebook needs to remove their animal hate pages and needs to stop their animal cruelty pages.


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Heather Joy - Raunchy raven is overcome with passion
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For frizzy, dry hair.
Don't just envy that sleek, shiny look — make it yours! Garnier Fructis Sleek & Shine Shampoo is infused with Moroccan Argan Oil and apricot to soak deep into hair and smooth each strand. Its lovely light, transparent texture leaves your tresses tamed and nourished — not weighed down. It's the kinder, gentler way to get the sleek and shiny look you love.
1. Conditions deeply to stay sleek with frizz control
2. Smoothes the surface for hair that is so much shinier
Hair is 10X smoother
Stays sleek for 3 days
Resistent even in 97% humidity
Frizz control & shine
Frizz control & shine
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The Garnier team
33 years old
I have been searching for YEARS to find a shampoo/conditioner (any cost) for my what I like to call "combination hair." Its greasy, yet it's frizzy, it's straight, except where it curls, i say it does everything that curly hair does but curl. This worked
61 years old
Thank you so much for sending the sleek and shine samples It made my hair easier to manage and not so fly away...... I love the Garnier products they always smell so good and they come in eye catching bottles to !


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Happy New YearFriday, January 01, 2016
Hello Lovelies
Happy New Year!!
I hope you all had a lovely new years eve however you celebrated it, for us new years eve means spending time together at home, we have some party type buffet food and play board games and I judge dance offs on the wii "just dance" game and other wii games, it's quiet but lots of fun. Years ago I always held a huge new years eve party and we had lots of friends and family to join us but it costs such a lot of money to hold a party like that and it got too much too in all honesty, someone I knew took over the role of host but then stopped for the same reasons I did so we started to stay in, having children means we haven't ever gone out to pubs etc but I can't say I have ever wanted to, we love the girls and they're our life so when the clock strikes midnight theres nowhere I'd rather be than with them and Simon.
New year new start and all that and I do have a kind of "goals" post coming up shortly for you but I wanted to ask what you would like to see/read on Mammafulzo in 2016? What are your favourite posts? What do you love to read? I do have my annual Christmas Day post coming with photographs and also my "what I got for Christmas" post too which I'm afraid are later than I'd hoped because we were without internet connection for 48 hours from Boxing day to Tuesday evening which as a blogger is an absolute nightmare and it set me back rather a lot, grrrrr! But those posts aside I'd love to know which posts you love and want to see more of and also if you have any requests I'd love to know, request posts are one of my favourite posts to write because they have been asked for especially. You can leave your favourite posts and requests in the comments below, or please feel free to contact me via any of my social media platforms or via email if you'd prefer.
Anyway I won't take up too much of your time, I just wanted to wish you a Happy New Year and also say a huge thank you for all your support and kindness in 2015 not just with my blog but personally too, it really does mean to world to me, thank you.
Thank you for reading, much love as always
Zoe x


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When it comes to shopping in the holiday season, most people tend to wait till the last moment when the holiday is upon them, to shop for different goodies. And that can be a mistake because they don't really know what deals features and they are not really sure what products to buy, which ends up wasting time and money saving opportunities.
Another mistake people make is not shop from cashback websites. They end up going to other popular e-stores, which do offer deals and discounts, but people seldom end up saving money on their shopping. This is completely the opposite of shopping from a cashback website where you end up making money on your purchase.
Cashback websites have become incredibly popular these days. Having been launched in the early 90's, the concept and the websites have come a long way in providing customers a satisfactory shopping experience over the decades. Cashback websites offer customers a percentage of cash on their purchases. Basically, they make commissions by becoming affiliate marketers for dozens of online retailers. So, it is important to understand the fact that cashback websites are not e-stores, they are affiliate websites.
And like any other online affiliate, they market the brand names of different stores and help attract visitors from over the globe. The retailers on the list of any cashback website pay the website a commission based on the how much business the site brought them. The commission the site earns isn't fixed per se and can considerably vary depending on the amount of business and transactions conducted. Nevertheless, cashback websites share the commissions with you, the shopper. And this is what makes them an ideal portal to shop from.
However, having said that it is important that you always stick to shopping from a well-reputed and authentic cashback website. There are a lot of websites out there, but a big chunk of them are fraudulent. So, look for a good cashback website that offers a free membership. This is one of the signs that the site is authentic. There are many sites that charge people a specific amount of fee for subscribing, and then they suddenly shut down. And that can be a problem.
Subscribing for a cashback website is very easy, all you need to do is provide the site with relevant information as to what you email is. Then you create a password, accept the terms and conditions and voila, you are a member. It is easy to begin shopping from a cashback website and earn huge cash rewards on your first purchases.
Earning Big Cashbacks before Shopping for Christmas
Earning Big Cashbacks before Shopping for Christmas
Most people look forward to shopping for Christmas neglecting other holidays that can help them earn bigger rewards and deals on different products. There is no doubt that a majority of online retailers and cashback websites now provide their customers with all the accommodation in the world to comfortably shop online and come back for more. Plus, it is also true that many people end up in debt when the impulsively shop for things during the Christmas season, adding to their financial woes in January. That is why it is important bust the myth that Christmas is the only holiday season to shop and win rewards.
Holidays to Look Forwards to Shop
Christmas is no longer the holiday season to shop in. Black Friday is considered to be the biggest shopping holiday worldwide. And Cyber Monday too has become a very good day to buy different products, save money and earn money in the process.
Online retailers provide special deals and discounts on cashback websites on Black Friday and Cyber Monday that most traditional online stores don't. This makes it important for you to shop compulsively on these holidays rather than missing out your opportunity and shopping impulsively on Boxing Day. Cyber Monday falls after the Thanksgiving weekend, and a majority of people are of the notion that Cyber Monday is far better to shop for different products compared to the Christmas season.
And you can capitalize on your shopping, especially if you plan your budget and your shopping list well in advance. Plus, the same items you can buy on a Cyber Monday will be available on Boxing Day, so why wait when you can buy something on a far better discount and earn money on it as well. You can't say for sure whether the discount offer provided is not going to be better than that on Christmas.
You can even choose to shop on Black Friday and although people go out for shopping on Black Friday, good cashback websites have plenty of retailers that offer very attractive prices on things like kitchen appliances, electronic appliances and gadgets. If you want to buy a new smartphone or a tablet or a laptop you can get just as well get a 50% discount on your purchase and a cashback as well.
of Not Waiting until Christmas to Start Shopping
Benefits of Not Waiting until Christmas to Start Shopping
There are a couple of great benefits in not waiting until Christmas to begin your holiday shopping. Well for starters you won't have to wait that long to buy your favorite products. For example, you won't have to wait to buy your favorite phone, when you can easily buy it online via a cashback website on a Black Friday or a Cyber Monday. And with the money you can make in cashback rewards you can buy even more things on Christmas.
Cashback websites provided customers with different cashback percentages depending on the amount of things they buy and the consistently and frequency of their shopping. That is mainly why there is a certain threshold on when you and how you can make a big cashback. The website primarily has a points system in which you have to collect a certain number of points before you can be eligible for your cashback. And scoring those points can be very easy if you are smart about your shopping and smart on all the right Holidays.
When you reach the threshold outlined by the website you can directly receive your payment via PayPal into your account within 3-5 business days. So, if you don't have a PayPal account it is necessary that you subscribe for one if you want to reap cashback rewards.
Another benefit of starting your shopping earlier in the holiday season is to steer clear off debts. This way you will not have to start your New Year worrying about paying for your big TV screen you just bought on credit. You could have bought the TV on a Black Friday at half the cost, which could have been a much more reasonable and affordable option.
Furthermore, Christmas is not merely to give and receive gifts as there are parties to host and attend, which can be a bit costly to say the least. And you will need the money to throw a big Christmas bash at your house. Shopping impulsively on Christmas can strip you off any cash you hoped to save. Although there are deals and discounts given, there are nowhere close to the type of discounts provided on Cyber Monday and Black Friday.
Another very good benefit of not waiting until Christmas is to be able to plan a good budget for your expenses. You can make a list of things you wish to buy in advance and compare prices when a holiday like Black Friday is upon you. So you can compare prices, save money and enjoy your cashback rewards. Plus, on Boxing Day, people are always in the rush to buy things, they are in such a hurry that most neglect to checkout deals and discounts and buy the product on first glance. This could end up becoming a very regrettable decision as you could have save a lot of money had you been patient and looked for discount coupon.
Buying on different holiday before Christmas also gives you time to save a bit more money to buy presents for your family and friends. And because of the fact that there are discounts given on everything on Christmas you can buy a handful of present like perfumes, makeup and other things for loved ones or friends.
All in all, to sum it all up, it is will be a wise decision on your part if you decide to the bulk of your shopping on holidays such as Black Friday and Cyber Monday. Plus, there you can take your time to shop online, carefully look for discounts and coupons offered to make informed decision as to what to buy and what leave for Christmas. And you can also end up making a lot in cashback rewards till Christmas, which is going to leave you with more options in regards to your shopping on Christmas.
So, shop for your favorite deals today, avail the discounts and don't wait for Christmas to come because you can never be sure how much money you actually would be able to save on Christmas shopping.


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Alex Smith hit Vernon Davis with a 14-yard touchdown with nine seconds left as San Francisco shocked New Orleans 36-32 in the NFC Divisional playoffs Saturday at Candiestick Park in San Francisco.
Davis' second touchdown of the day answered Jimmy Graham's 66-yard touchdown from Drew Brees with 1:48 left, giving the Saints a 32-29 lead.
There were four lead changes in the fourth quarter after the Saints rallied back from an early 17-0 deficit that could be largely blamed on five Saints turnovers.
Smith completed 24 of 42 passes for 299 yards and three touchdowns. He ran for another score. Davis caught seven passes for 180 yards and a score.
That was enough to outduel Drew Brees, who passed for 458 yards, four touchdowns, but also two early interceptions. Brees completed 39 of 62 passes.
Smith's 28-yard touchdown run, the longest of his career, came after he threw a 35-yard pass to Vernon Davis, who earlier had a 49-yard touchdown pass from Smith.
Graham's touchdown came after Smith had given the 49ers the lead with a 28-yard touchdown run. Before that, New Orleans had taken a 24-23 lead, its first of the game, when Brees found Darren Sproles for a 44-yard touchdown out of the backfield
New Orleans turned the ball over times in the first half, leading to a a 17-0 lead for the 49ers.
A 49-yard touchdown from Smith to Davis got the 49ers on the scoreboard, then a short pass from Smith to Crabtree after a Saints fumble upped the lead to 17-0.
But the Saints cut it to 17-14 at halftime after Brees threw touchdown passes of 14 and 25 yards to Jimmy Graham and Marques Colston, respectively.


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Vitamin E Skincare Collection
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Apply Cream Cleanser to the face and neck with fingertips. Wipe away with a cotton pad or muslin cloth. Apply a few drops of Overnight Serum-In-Oil to the face and the neck with a gentle patting motion. Using fingertips, massage in Mositure Cream in small circular movements over forehead, cheeks, around mouth and chin area.
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Fast forward to 1996 when we opened Wild About Harry's on Knox Street in Dallas. From the start, Texans ate up our unique blend of food and fun. They fell in love with our winning combination: my mom's delicious, old-fashioned frozen custard, our scrumptious, award-winning hot dogs and our relaxed Key West-casual atmosphere.
Today, our restaurant is a gathering place for every generation – from tiny tots to senior citizens. In fact, our food is so fantastic and our restaurant so special, we've won countless awards, been featured in dozens of publications and visited by celebrities. I'm proud to tell you that everybody is, well, wild about Wild About Harry's!
As you can see, my dream actually came true, and now I'd like to share that dream with you. Are you looking for a tasty opportunity?
I'm inviting you to join our Wild About Harry's family by becoming a franchise owner. Imagine, you could be in the business of making people happy, just like me.
All the best,
Harry Coley
Founder, Wild About Harry's


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Women in Business 2017
Women in Business: Krissi Williford - Xcite Fitness
The key to lifelong health and fitness isn't fad diets or intense workout programs, trainer Krissi Williford says. It's in slow, steady lifestyle changes that add up to something great. more
Jan 10, 2017 10:43 AM Women in Business 2017
Women in Business: Dr. Diana Wood & Dr. Melanie Spooner - Wood & Spooner Cosmetic and General Dentistry
In addition to regular checkups, Wood and Spooner provide a variety of services to create a healthy, beautiful mouth, including sedation dentistry, whitening, cosmetic enhancements, TMJ treatment, reconstructive dentistry, dental implants, sports and more
Jan 10, 2017 10:42 AM Women in Business 2017
Women in Business: Dr. Anne England - Vestridge Animal Clinic
Dr. England's combined love of animals & medicine led her into the veterinary field. She purchased Vestridge Animal Clinic from the original owner, Dr. S. Allen Price, in 2005. more
Jan 10, 2017 10:39 AM Women in Business 2017
Women in Business: Kim Nguyen - Uptown Nail Spa
Kim Nguyen brings 24 years of experience to her business, Uptown Nails, which opened three years ago. The popular nail salon provides clients with excellent service in a comfortable environment. more
Jan 10, 2017 10:36 AM Women in Business 2017
Women in Business: Lauren Conklin Trim - Sentry Heating and Air
"We really place our value as a family on our customers," said CIO Lauren Conklin Trim. more
Jan 10, 2017 10:33 AM Women in Business 2017


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A popular and affordable telephone, the 210 from AT and T is designed for those who don't want hassles or frills, just a basic phone that's reliable and easy to use. You can place the base on a convenient surface or easily mount it on the wall, saving on counter space. Simple corded operation means you never have worry about misplacing a cordless handset, and the phone's sturdy construction means it's designed to last.
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- What's in the box: telephone handset, telephone base, 7 ft. line cord, coiled handset cord, user's manual and warranty information


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Stacey N. Doan, Phd
Scientist, Writer, Mommy
Dr. Doan is an assistant professor at Claremont Mckenna College, and Director of the Applied Mind and Health Laboratory.
Link to Dr. Doan's selected publications.
Dr. Stacey N. Doan is a health psychologist with an interest in understanding how psychosocial factors like family, poverty, and cultural practices "get underneath the skin" to influence physical health and psychological well-being. She is also interested in the role of emotions, self-control, and social relationships and how they influence physical health and psychological well-being. Her research has been published in the top developmental and health journals.
Dr. Doan has also serve as a consultant for companies interested in designing products to improve the health and well-being of children. She is particularly interested in working with start-ups to evaluate the effectiveness of their products, and to generate insights for new innovations. On occasion, she does some life-coaching. She is a frequent speaker at colleges, universities, local, national and international conferences.
February, 2017. Dr. Doan is the recipient of the Western Psychological Association Early Career Award and the Society for Research on Child Development - Asian Caucus.
September, 2016. Dr Doan gave a lecture at Pomona College, "Maternal shaping of the stress response."
July, 2016: Lab members presented their latest research at the International Society for Behavioral Development conference in Vilnius, Lithuania!
May, 2016. Lab research assistant Isabel Mendiola won the Fletcher Jones Research Award!
April, 2016. Dr. Doan was awarded an NIDA grant!


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Earlier today, Dr. Rima Khalaf, Director of the United Nations Economic and Social Commission for Western Asia (ESCWA), resigned from her post following pressure from the US and Israel over a report issued this week by ESCWA documenting Israel's apartheid policies towards the Palestinian people and encouraging support for the grassroots boycott, divestment and sanctions (BDS) movement for Palestinian rights and freedom. Dr. Khalaf explained her decision stating: "I resigned because it is my duty not to conceal a clear crime, and I stand by all the conclusions of the report. The crimes that Israel continues to commit against the Palestinian people and in Lebanon amount to war crimes against humanity," she said.
— source bdsmovement.net


text: I was wondering what got everyone turned on to model railroading or rails in general. For me, it's in the blood. Both my grandfather and step-grandfather worked for the railroad. My step grandpa worked in a depot in Falmouth KY on the L&N and then later became a dispatcher. My grandpa worked for the C&O in Ashland KY but had too many jobs to count. He finished his career in the Raceland KY carshops and both grandfathers retired after their roads had been merged into CSX. So needless to say, I saw a lot of trains through them. But the model railraoding bug didn't bite me until 1994 when i saw a copy of Great Model Railroads in a hobby shop. In that issue I saw Gary Hovver's Missouri Kansas and Quincy and I was hooked. Form then on I've been into model railroading and now I've switched to N scale and having lots of fun. So, who or what inspired you?


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Our Message: You Can Solve Your Problems & Change Your Life by Escaping America for a Better Life and Love Overseas! Discover Friendlier Foreign Women, Authentic People and Saner Cultures, Lower Cost Living, Healthier Food, Greater Freedoms and More!
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Discuss culture, living, traveling, relocating, dating or anything related to Russia, Ukraine, or the former Soviet Republics.
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Check out this website!
Check out this website regarding Russian women! It's the truth regarding Russian women from an American man who lives there. Once you go Russian you never go back to an American women! http://russianwomen.wordpress.com/
Last edited by jamesbond on February 3rd, 2011, 7:58 am, edited 1 time in total.
Check out our Dating Sites and HA International Romance Tours!
Its a good site. Being happily married to a lady from St Petes for almost 2 years now I can testify that Russian women are awesome. Brains, beauty and personality plus.
Q. Why does Winston like to play his video's of his whore exploits backwards?
A. Because he likes to see the whore's giving him money.
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The Droll Yankees B - Tray Connector (BC) is a metal connector with a dimension of 3.5 x 2 x 5. This connects a UN Tray to a Droll Yankees B-series classic feeder.
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The previous list was deleted and now we are trying to gather up all the challenge cards that earn you neopoints. So sorry this happened. IF ANYONE HAS ANY LINK TO CONTRIBUTE, PLEASE LET US KNOW!!!!! Thanks to IVY and SCOTT for finding the following links.
Here is the link to the Neopets Cards:
SCNH Staff
*Click to start the game and then click end game. Then send a card.
*You are limited up to about 9-10 games to send a card but it doesn't hurt to try for more.


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The content of Jel Ena's Sanctum Infernum immediately signals conflict through uniting the diverging ideas of the sacred and infernal. We know we are going to be experiencing works that are going to try to challenge our boundaries of morals, ethics, comforts, and beliefs. Usually this experience is horrifying and grotesque; but it is the balance of the sacred and profane, not just in theory, but in the visual execution of these graphite drawings that make this show inviting.
Artwork that challenges our comfort zones usually weighs heavier on grotesque physical depictions, such as monsters in literature and film. But Jel Ena's realism of human form dispersing into ethereal gloom is a subtle depiction that introduces a feminine approach to a horror narrative.
The women in each of the works are transitioning into the infernal mental from the sacred physical that is bridged by melancholy. In film and literature in order to create compelling drama that moves the plot forward, the protagonist is faced with physical opposition in the form of an antagonist. In Sanctum Infernum these projections of internal processes are manifested through wild hair, protruding horns, decaying flora and fauna, and the female nude.
The protagonist and antagonist being one person makes for a circular narrative rather than a linear narrative. There is no state of being that these women are attaining. Like the Tai Chi taijitu symbol, these elements of the sacred and profane engender one another just as they are the dissolution of one another. And when the sacred and profane are seen as circular rather than polar opposites, the division between them becomes indecipherable. By providing this model of good and evil as one, Sanctum Infernum challenges the audience.
Jel Ena was born and raised in Belgrade, Serbia in Eastern Europe. With both parents as artists—her father a professor at the Academy of Applied Arts at the University of Belgrade—she was immersed in art at an early age. Though she graduated from the Academy of Fine Arts at University of Belgrade with a major in painting, she credits her art education to both her parents.
[pull_quote_center]What I learned from them in such depth about drawing, painting, technology, art history, business of art, and more, no art school in Europe was offering at the time.[/pull_quote_center]
On top of having professional artists for parents and attending the Academy of Fine Arts, Jel had the fortune to live and travel throughout Europe, home of many artists and works that most of us will only read about in textbooks or see in online galleries. The most impressionable travelling to her career, however, was an opportunity to visit the United States to complete several commissions. During her stay in the States, civil war broke out in Yugoslavia and her family urged her to remain abroad until the end of the war.
Jel has worked as a freelance artist, an illustrator in animation for film and television, and video games. Following the footsteps of her father, she worked several years as an art teacher, and in 2009 she began working as a full-time artist.
Now in 2015 Jel Ena has teamed together with Stephen Romano to produce Sanctum Infernum, which opened at Stephen Romano Gallery Brooklyn, NY October 29th and will be running until December 15th. This series of drawings is particularly intimate to Jel as it deals with many of her personal demons and darkness. In the interview below Jel gives us some insight into what inspired her to study the interplay between the sacred and the profane.
Dirge Magazine: What led you to work on the spectrum of good and evil?
Jel Ena: The idea for the show sprouted from conversations with Stephen Romano about one of my older pieces titled The Devil in Love. That particular piece was created in 2012 and was used for the poster for a play in London. The play was an adaptation of the novel The Devil in Love by Jacques Cazotte (1772). In a nutshell, the devil, after being summoned by the main character, appears in female form, falls in love with him and, of course, tries to seduce him. What made a lasting impression on me was the adaptation itself, made by play director Venus Raven.
The demon/devil appearing in female form was particularly of interest to me. I was interested in exploring the power and control demon women have (something that in real life is only possible to obtain by men, still).
How do you personally relate to the content of Sanctum Infernum?
In my vision, the ultimate symbols of power of these women are their horns. The symbol of strength is their hair, therefore big wild hair. Their idealized beauty symbolizes unlimited control they can obtain at will.
While researching this subject for the show, I wanted to go further and explore the vulnerability of these horned women, because I was going through a very difficult time. Since they are my own creations, and they do not really belong to any other mythologies or religions, nor stories, except maybe Medea, I view them as my own demons, my strengths but also weaknesses, my feelings and emotions, my dreams and my ideas. Salve Me and Requiem are the pieces that are addressing my deepest and darkest thoughts and dreams.
How would you define Sanctum Infernum as a concept for the show?
It's a dichotomy of terms; contradiction that is present in all of us, the conflict, and our neverending effort to balance them out. As much as they are contradicting they cannot exist without each other, just like light cannot exist without darkness, heaven without hell, sacred without profane/infernal.
I see these women are often placed in natural settings, however, the mood is dark, and even grotesque, or perhaps more appropriately, infernal. Is there a relationship that you are trying to portray between setting and the inner nature of female form? What also would you like to add in regard to your purposes for utilizing the female form in your work?
I believe that beauty can be reflected in pretty much any setting. My drawings are stripped of any specific environments other than a few symbols that emphasize loneliness, emptiness, including death and decay in some form, but also power and strength and immortality. I pay special attention to the selection of models for my work. Their features are of utmost importance as they are supposed to be contrasting the settings they are in.
Each of the women in your works has horns of some sort or another protruding from the heads. This could easily be associated with being a demon. Would this correlation be correct?
Horns have several meanings in this series. Firstly, they indicate that all of them are coming within the darkness/Infernum. Secondly, they are symbolic of their power. Thirdly, it is the outward expression of their primal urges.
These are realist depictions of women, yet the horns, the wild hair, and decaying animals floating amidst them are "surreal," and yet you draw them to appear naturally apart of their forms. How do these animals, plants, skulls, fit into the being of these women?
I think they are beyond that. Their forms are in some way idealized on purpose in order to juxtapose an overall dark and grotesque mood (that this body of work emanates). Their bodies are an epitome of light existing amidst the darkness. Their hair and animals carry certain symbols. The bigger the hair the more strength they possess, something like Samson.
Are there specific meanings behind the flowers that you chose?
Flowers in these works are dead. They are slowly decaying, or more likely their decaying processes will never end, as the moment of decay is frozen in time in my artwork. I think this can be applied to animals as well.
In drawing Stigmata there are two wounded pigeons. Is there a personal connection with loss represented by these two deaths?
Stigmata is the one with two doves. Those two doves are not wounded, those are Luzon bleeding-heart doves (Gallicolumba luzonica), also known as stigmata. There is a legend about them and Jesus on the cross where they flew and brushed themselves on Jesus' ribcage wound and forever kept his blood on their chests. But that legend has nothing to do with this piece, I just wanted to explain why they have those red spots.
What I was exploring in this piece and a few others is the idea of the possibility of redemption, or death as a salvation from eternal torment, which was never given to the devil or demons by god in Christianity. Why is that so? Would that be that if they are saved or let to die then heaven would have no meaning? Who will than take care of all the "bad guys"?
The way the carcasses are connected to human forms gives me the impression that there is something going on with the idea that death is not letting go. Perhaps there is something that isn't moving on after it has died.
Are they really dead or in a transitional place where they are waiting to be reincarnated?
"Death is not the end; death is the cessation of the connection between our mind and our body. Most people believe that death takes place when the heart stops beating; but this does not mean that the person has died, because his subtle mind may still remain in his body. Death occurs when the subtle consciousness finally leaves the body to go to the next life."
There is no specific atmosphere. No clear heaven or hell. Where does the infernal lie?
No, there is no clear heaven or hell, at least I don't see them like that. Infernal life exists within me, probably other people too but I can only speak for myself here. This inner torment, everyday struggle is to achieve balance and prevent the darkness from becoming one big swallowing hole.
Either these women are from darkness or they are entering darkness. What are these women discovering about themselves?
These women are coming from darkness, an infernal place, but they are discovering how strong and powerful they actually are.
The concept for these drawings is clearly dark, but I noticed that the pale bodies of these women are highlighted greatly with light. How does light emphasize darkness?
The very same way sanctum emphasizes infernum.
Commonly in stories when a character becomes dark they are described as 'surrendering' to darkness. I see surrender also in your works. Would you say surrender relates to darkness? Furthermore, how would you relate surrender to Sanctum Infernum?
In some of the pieces they are seeking salvation, not from darkness but within the darkness. It is their environment, it is the negative and positive energies, feelings, emotions they are battling to balance out. I don't believe in surrender. Darkness (infernal) is not necessarily bad, just like light (sacred) is not necessarily all good.
For more dark art, follow Stephen Romano Gallery on Facebook.
For more Jel Ena, follow her Facebook page.


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The protein encoded by FUT6 is a Golgi stack membrane protein that is involved in the creation of sialyl-Lewis X, an E-selectin ligand. Additionally we are shipping Fucosyltransferase 6 (Alpha (1,3) Fucosyltransferase) Kits (8) and Fucosyltransferase 6 (Alpha (1,3) Fucosyltransferase) Proteins (4) and many more products for this protein.
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characterisation of FUT4 and FUT6 alpha-(1 --> 2)-fucosyltransferases
FUT6 contributed to fucosylation of root arabinogalactan-proteins.
AtFUT4 and AtFUT6 are the first enzymes to be characterized for AGP glycosylation
ur results strongly showed that the low expression of FUT6 regulated by miR (show MLXIP Antibodies)-106b contributed to cell migration, invasion, and proliferation in human breast cancer.
There were significant differences between the type 2 diabetes mellitus patients and controls in the risk allele distributions of rs3792267 (CAPN10 (show CAPN10 Antibodies)) (P = 0.002), rs1501299 (APM1 (show ZBTB7C Antibodies)) (P = 0.017), and rs3760776 (FUT6) (P = 0.031).
The T allele of rs3760776 might repress the transcription of the FUT6 gene.
In normal colon samples a significant relationship between sLe(x) expression and the ratio between FUT6/B4GALNT2 (show B4GALNT2 Antibodies) activities exists, demonstrating for the first time a role for B4GALNT2 (show B4GALNT2 Antibodies) in sLe(x) inhibition in vivo
Results suggest that FUT4 (show FUT4 Antibodies)-, FUT6- or FUT8 (show FUT8 Antibodies)-mediated MDR in human HCC (show FAM126A Antibodies) is associated with the activation of the PI3K (show PIK3CA Antibodies)/Akt (show AKT1 Antibodies) pathway and the expression of MRP1 (show MDM4 Antibodies).
these results suggest that FUT6 plays an important role in hepatocellular carcinoma growth by regulating the PI3K (show PIK3CA Antibodies)/Akt (show AKT1 Antibodies) signaling pathway.
The biosynthesis of the selectin-ligand sialyl Lewis x (show FUT4 Antibodies) in colorectal cancer tissues is regulated by fucosyltransferase VI and can be inhibited by an RNA interference-based approach.
GALNT14 (show GALNT14 Antibodies) and FUT3 (show FUT3 Antibodies)/6 H-scores were significantly higher in non-small cell lung cancer cell lines sensitive to dulanermin and drozitumab versus resistant cell lines
endo-beta-galactosidase (show GLB1 Antibodies)-sensitive and mAb FH6-reactive carbohydrate chains are generated under the control of expression levels of FUT6 and involved in the adhesion of colon carcinoma cells to liver sections.
5'UT-exons A or C have higher expression of FUT8 (show FUT8 Antibodies) transcripts and higher alpha6-fucosyltransferase activity
The protein encoded by this gene is a Golgi stack membrane protein that is involved in the creation of sialyl-Lewis X, an E-selectin ligand. Mutations in this gene are a cause of fucosyltransferase-6 deficiency. Two transcript variants encoding the same protein have been found for this gene.
, fucosyltransferase 5
, fucosyltransferase 6 (alpha (1,3) fucosyltransferase)
, alpha-(1,3)-fucosyltransferase
, fucosyltransferase VI
, galactoside 3-L-fucosyltransferase


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Our Standard banners are made using vinyl banner material that is long lasting and durable consisting of heavy duty grommets placed throughout the banner. Vinyl Banners have many uses and applications. They can be seen in places such as billboards, building, street banners, stadium flags and more. You can hang these virtually anywhere!
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What a great reminder of our responsibility as parents! We know that God is in control and even now we trust him with our little boy. I'm sure there will be times when it's easy to forget that we can't make our kids be Godly. All we can do is pray and be an example to them of what it means to be a follower of Christ.
In some ways this takes the pressure off of us, but in other ways, it puts the responsibility right back on us. I know that kids watch everything you do and pick up on things you don't even realize you do. I'm sure we'll learn more from them than we can imagine!
And here's a Proverb that Adam and I will be committing to memory as we become parents:
"Point your kids in the right direction- when they're old they won't be lost."
Proverbs 22:6, The Message
If you missed the start of our 31 Days of Tips and Tricks you can find all the posts here.


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Finding the prices of the properties from the real estate agents Cooroy can be of benefit. These agents have been working in the region for many years. Cooroy real estate agents understand the property market with sufficient experience. Seeking advice would be prudent for house buyers.
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For many people, owning a home of their own is an exciting sojourn. They are happy that they now have a house of their own, which they can decorate as per their own accord and the feeling is quite satisfying. When people have their properties in the region of Sunshine Coast, there is surely an increased level of excitement because of the beautiful area that is found in these regions with greenery, suburban charms and locations close to the coast in Queensland. Among the different areas lying along the coast, Cooroy suburb is quite a preferred destination among the people, aiming to have their base down in the coast. These people find it easy to own a house or land in Cooroy, especially when they are planning through the Cooroy real estate agents.
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Network Hardware Suppliers Ltd
Network Hardware Suppliers was established in 2013 to deliver ICT products specifically for network systems - computers and accessories, printers, photocopying machines, PBX and PABX, projectors, screens and access control systems. Other products include electrical materials, generators, air conditioning units, two way radios, cables and connectors, tools, inverters, stabilisers, servers and fibre optic materials.
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Inpatient satisfaction, job satisfaction/stress of medical workers, and hospital profitability under the 7:1 nursing care system (in which 1 nurse cares for 7 patients at a time) were compared with those under the 10:1 system at a hospital with the diagnosis procedure combination (DPC) payment system.
A total of 202 inpatients discharged from the Departments of Cardiology and Metabolism completed an inpatient satisfaction questionnaire. A total of 108 medical workers were recruited to survey their job satisfaction/stress and to estimate the effects of the DPC. The profits for 10 cardiac and metabolic diseases in 2008 were compared with those in 2007.
Mean inpatient satisfaction scores were around 4 ("somewhat satisfied") under both the 10:1 and 7:1 systems, and increased significantly to 4.14–4.38 under the 7:1 system. Excluding workload of physicians, the other stresses of physicians/nurses remained unaltered, as did their low job satisfaction. They estimated their understanding of the DPC as insufficient but felt that introducing the DPC neither shortened length of stay nor improved "the quality of medical/nursing care," regardless of the system. Total percentage profit increased to 1.17% in 2008 from 0.73% in 2007, whereas 7 of 10 diseases showed deficits in 2008.
The 7:1 system was somewhat beneficial for inpatients but not always for medical worker quality of life (QOL) or for hospital income, which are important to maintain high quality of medical/nursing care. It is important to further explore factors increasing QOL of medical workers and hospital income.
The Japanese health care system features universal health insurance coverage, free access, medical allowance in kind, and the fee-for-service (FFS) payment system by treatment-related group/prospective payment system (PPS). Recently, increases in annual medical expenditure have caused financial stringency in Japan [1]. The FFS may be a major cause of the recent increase in medical costs, because of its weak incentive for cost containment. Moreover, the rapid aging of society, stagnant economy, and high medical expenses due to advances in medical technology and equipment are exacerbating the increasing medical costs.
To improve these conditions, the diagnosis procedure combination (DPC) was introduced in 2003 at 82 specific function hospitals (80 university hospitals, 1 national cancer center, and 1 national cardiovascular center) and their acute inpatient care services. This new system was planned based on the concept of diagnosis-related groups (DRG)/PPS in the USA [1]. The DRG/PPS is a per-case payment system, and displays effects of shortening length of hospital stay (LOS), reducing total medical costs, and standardizing medical care [2–4]. The DPC in Japan was planned to manage the total medical costs, and adopted as a per-day payment system but not as a per-case payment system [1, 4]. The hospitals' adjusted fee, examinations (excluding endoscopy, intravascular catheter, and biopsy), diagnostic imaging, medication, and treatment with lower than 1,000 points (one point being equivalent to 10 yen) are calculated according to LOS. Even under the DPC, several procedures such as surgical procedures, anesthesia, biopsy, etc., are calculated by the FFS. Thus, the DPC is also expected to at least reduce total medical costs and shorten LOS in Japan.
These DPC hospitals supply the highest level of medical care in Japan and deal with patients with extremely serious conditions. Nonetheless, these hospitals are required to improve efficiency and cut costs in each division, e.g., outsourcing of supply processing and distribution system of medical materials, provision of hospital meals, and office staff, to cut down on personnel expenses. In fact, a decrease in profits has already been reported by surgery departments [5–7]. Despite their efforts and the existence of such reports, the adjustment coefficient to subsidize the benefit loss of DPC hospitals was abolished in 2010, and financial difficulties are anticipated. Thus, further cost reductions are required and may lead to a decrease in patient satisfaction and an increase in workload for medical staff.
Although such effects of the DPC have not been examined in detail, the nursing care system was changed in many DPC hospitals in 2008 to reduce the possible disadvantages of the DPC for patients; that is, the 10:1 nursing care system (1 nurse cares for 10 patients at a time) was changed to the 7:1 nursing care system (1 nurse cares for 7 patients at a time). This alteration may increase patient satisfaction and reduce workload of nurses, and introduce extra subsidization to a hospital. However, it requires an increase in the number of nurses and forces the hospital to outlay further expenditure.
In the present study, the utility of the 7:1 system was evaluated in terms of satisfaction of inpatients and job satisfaction/stress of medical workers in comparison with the 10:1 system. Medical workers' estimation of the DPC's effects on medical/nursing care and the profitability of the hospital under both systems were also evaluated. This approach is important for implementing total quality management (TQM) [8] to maintain high quality of medical/nursing care in DPC hospitals.
This study was composed of three types of survey: (1) inpatient satisfaction and job satisfaction/stress of medical workers, (2) medical workers' estimation of the effects of the DPC with the 10:1 and 7:1 systems, and (3) profit analysis of DPC/FFS.
A total of 202 inpatients, who were discharged from the Departments of Cardiology and Metabolism of a specific function hospital from January to December 2008, gave their written informed consent and responded to a self-administered questionnaire. The 7:1 system was introduced in May 2008. These subjects were selected to be younger than 75 years old, were under nursing grade III and IV (i.e., not always serious), could read/write the questionnaire without any assistance, and were emotionally stable.
The survey was given twice to medical workers at a 50-bed ward for internal diseases. The first survey was in February 2008 under the 10:1 system. The second survey occurred after the introduction of the 7:1 system in October 2008. Under the 10:1 system, a total of 50 medical workers (36 physicians, 14 nurses) responded with a 68.5% (overall) response rate (70.6% physicians, 63.6% nurses). Under the 7:1 system, a total of 58 medical workers (33 physicians, 25 nurses) responded to this survey. The response rate was 74.4% (overall), being 67.4% for physicians and 86.2% for nurses. The purpose and procedure of this survey were explained to the subjects, and written informed consent was obtained from all subjects.
This study was approved by the ethics committee of the Kanazawa University School of Medicine.
The Japanese version of the Short-Form 36-Item Health Survey (SF-36) [9] was used to examine the quality of life (QOL) of inpatients before hospitalization. The scores of each item were calculated by the norm-based score (mean 50.0).
Thereafter, we analyzed the inpatient satisfaction questionnaire to examine the satisfaction level with medical care and nursing care simultaneously, using the same 7 items: Explanation, Easiness of Consultation, Dealing with Patients, Reliability, Coping with Patients' Pain/Indisposition, Coping with Patients' Anxiety/Mental Care, and Satisfaction. Each scale item had five response items on a Likert-type 5-point scale: (5) "very satisfied," (4) "somewhat satisfied," (3) "neither satisfied nor dissatisfied," (2) "somewhat dissatisfied," and (1) "very dissatisfied." These 7 items were selected and modified with reference to a nationwide survey where medical quality, safety, and patient satisfaction of university hospitals were investigated in 2003 just after introduction of the DPC [10]. Moreover, satisfaction with Physical and Mental Recovery and Overall Satisfaction during hospitalization were also addressed with the same five response scales. Satisfaction with regard to medical care and nursing care included 7 items, and the summed score was divided by 7 to facilitate comparison against scores for satisfaction with Physical and Mental Recovery and Overall Satisfaction.
A previous nationwide survey examined total job satisfaction alone [10]. However, to determine the effects of the 7:1 system, a questionnaire in terms of the physicians' and nurses' estimation of their Working Hours, Income, Number of Physicians in the Ward, and Number of Nurses in the Ward was utilized. Each scale item had five response items on a Likert-type 5-point scale: (5) "many," (4) "somewhat many," (3) "neither many nor few," (2) "somewhat few," and (1) "few."
We also applied the DPC-specific questionnaire consisting of 11 items regarding their estimation of the desired effects, efficiencies, and results after introducing the DPC (Fig. 1). Each scale item had five response items on a Likert-type 5-point scale: (5) "totally agree," (4) "somewhat agree," (3) "neither agree nor disagree," (2) "somewhat disagree," and (1) "disagree."
Levels of mental and physical stress were examined using the Simplified Job Stressor Questionnaire (SJSQ), which consisted of 57 questions with four response items on a Likert-type 4-point scale: (4) "totally agree," (3) "somewhat agree," (2) "somewhat disagree," and (1) "disagree" [11]. Stressors of work were judged with these subscales: Workload, Control, Personal Relations, Conformity, and Support by Coworkers/Supervisor and responses to stress with Mental Stress and Physical Stress. Those who required care due to high stress in each subscale were judged according to each scoring standard [11].
Profit data for 2007 and 2008 were obtained from the Division of Medical Information. We compared the DPC points and profits (DPC-FFS) of 10 cardiac and metabolic diseases in 2007 under the 10:1 system with those in 2008, the period after introduction of the 7:1 system. As the 7:1 system was introduced in May 2008, we directly compared profits for the corresponding 8-month period, i.e., May–December, in 2007 and 2008.
Characteristics of inpatients, SF-36, and satisfaction data were evaluated using Student's t test. Inpatient satisfaction was also analyzed by exploratory factor analysis using principal axis factoring with rotation by promax with Kaiser normalization and by multiple regression analysis. The characteristics of medical workers and the results of the survey regarding job satisfaction and the DPC-specific items were evaluated with either Student's t test or by one-way analysis of variance (ANOVA) following Scheffe's post hoc test. The results of the SJSQ were evaluated using Fisher's exact test.
The 202 inpatients in the study included almost twice as many men (n = 134) as women (n = 68) (Table 1). Mean age and LOS were not significantly different. All SF-36 scores before hospitalization were lower than the national mean (50), and scores were generally poorer for women than for men. Although the scores for General and Mental Health Perception and Social Functioning were not different between men and women, differences in Physical Functioning, Role-Physical, Body Pain, Vitality, and Role-Emotional were statistically significant. In summary scores, Physical Component Summary was also significantly lower for women than for men. Means of satisfaction scores were around 4 regardless of subscale, and there were no significant differences between men and women. Satisfaction level was almost the same as the nationwide survey, where more than 90% of patients scored more than 4 for Overall Satisfaction [10]. As expected, the group with LOS ≥15 had higher mean age and lower SF-36 scores than the LOS <15 group. It is also not surprising that the mean satisfaction for Physical and Mental Recovery of the LOS ≥15 group did not reach "somewhat satisfied" and was significantly lower than that of LOS <15 group. Comparing the 10:1 system inpatients with the 7:1 system inpatients, the 7:1 inpatients showed greater satisfaction in all subcategories, which ranged as high as 4.14–4.38. Differences between groups divided according to age using the mean age as cutoff were not always significant, as well as the differences between the Cardiology group and Metabolism group (data not shown).
Principal axis factoring extracted two factors related to patient satisfaction with high Cronbach's alpha coefficients of 0.95 and 0.94, respectively (Table 2). The first factor consisted mainly of Nursing Care, and Reliability and Satisfaction had extremely high factor scores (both 0.92), followed by Coping with Patients' Anxiety/Mental Care and Coping with Patients' Pain/Indisposition. The score for Dealing with Patients was lower than 0.80, and that for Easiness of Consultation was as low as 0.63. The second factor consisted of Medical Care. Dealing with Inpatients showed high factor scores (>0.9), as did Reliability, which was followed by Explanation, Coping with Patients' Anxiety/Mental Care, and Easiness of Consultation. The score for Satisfaction was only 0.68, and Coping with Inpatients' Pain/Indisposition had a low factor score. Multiple regression analysis extracted the formula: Overall Satisfaction = 0.36 × Nursing Care + 0.23 × Medical Care + 0.25 × Physical/Mental Recovery. All coefficients were statistically significant (P < 0.01), and the coefficient for Nursing Care was higher than the others.
Mean age of both physicians and nurses was around 30 years, which was due to this being a training hospital for interns (Table 3). This was also true for their generally short working years both after acquisition of their licenses and in this hospital. Young physicians were rotated specifically to several other hospitals, so that their working years were limited. Physicians under the 10:1 system worked for 67.2 ± 15.7 h/week, which was significantly longer than nurses regardless of the system. They were still working over 60 h/week under the 7:1 system, but the difference compared with nurses was not always statistically significant. Physicians required 3.9 ± 2.3 h/day for paperwork, which was significantly longer than that required by nurses (around twice as long under both systems). Aside from nurses who were working under the 3-shift system, physicians were required to perform night duty twice a month and to work at nearby hospitals for around 9 days/month. Physicians working for university hospitals are also responsible for maintaining community health, especially for hospitals in rural areas. This was similar to previous Japanese surveys [12–14].
Under the 10:1 system, nurses judged that their working hours were longer than physicians did, but this difference was not statistically significant (Fig. 1a). Both physicians and nurses under the 7:1 system judged that their working hours were significantly shorter than those under the 10:1 system; however, their real working hours were unaltered (Table 3). In fact, even in the 7:1 system, the SJSQ indicated that both physicians and nurses had stress problems, especially related to Workload. That is, under the 10:1 system, a high rate of physicians (83.3%) and nurses (92.9%) showed high level of stress for Workload and required care. A survey of approximately 25,000 workers indicated that around 10% of them are categorized as having high stress for Workload [11], and therefore these rates were extremely high. The rate of physicians with high stress for Workload was significantly reduced under the 7:1 system to 63.6%, but the rate for nurses was unaltered. Although the difference was not always significant, the rate of physicians with high stress for Control was almost twice that of nurses and more than 10 times as much as the survey [11] under the 10:1 system. Under the 7:1 system, it was reduced but was still higher than that for nurses. The rates for Personal Relations, Conformity, and Support by Coworkers/Supervisor were relatively low but were not altered from those under the 10:1 system. Approximately 20% of physicians and nurses had high Mental and Physical Stress under the 10:1 system. Under the 7:1 system, the rates for high Physical Stress for both physicians and nurses were slightly reduced, but these differences were not statistically significant, whereas that for high Mental Stress remained unchanged.
Satisfaction with income was generally low because they belonged to a National University Hospital (Fig. 1a). In the nationwide survey [10], more than 50% of both physicians and nurses scored total satisfaction lower than 3, and so the low levels of satisfaction with Income as well as with Working Hours observed here are not surprising. Both physicians and nurses recognized that Number of Nurses, but not Number of Physicians in the Ward, significantly increased under the 7:1 system compared with the 10:1 system. Of course, this is the effect of alteration from the 10:1 to 7:1 system. However, their recognition was still around 3, i.e., "neither many nor few."
When their understanding and estimation of the DPC was examined, the physicians' score for "having sufficient knowledge" was around 3, and that for nurses was lower than 2; the scores for nurses were significantly lower than those for physicians under both systems (Fig. 1b). Both physicians and nurses had a score for "Medical/nursing care was carried out efficiently" of <3. The scores for both "I changed the contents of medical/nursing care" and "I changed medicine/medical material" were higher than 3 for the physicians and lower than 2 for the nurses, regardless of the system. A similar tendency was observed for "I became aware of cost performance" and "Paperwork/data input increased." In fact, physicians spent approximately 4 h/day on paperwork/data input (Table 3). Both physicians and nurses scored "Paperwork/data input increased work load of medical/nursing care" higher than 3, regardless of the system; in fact, the physicians' score was as high as 3.9. The effect of the DPC on shortening the LOS was recognized as around 3 by both physicians and nurses, irrespective of the system. However, both physicians and nurses scored "Shortening of the LOS increased the work load of medical/nursing care" higher than 3, regardless of the system. There was no improvement in "the quality of medical/nursing care" or "the working environment" under the DPC, being scored by both physicians and nurses as around 2, even though the nurses' score in the 7:1 system was higher than that in the 10:1 system (Table 4).
When the profits of the hospital in 2007 under the 10:1 system and 2008 under the 7:1 system were compared, total percentage profit increased to 1.17% in 2008 from 0.73% in 2007 (Table 5). However, in 2007, deficits were observed only in acute myocardial infarction, valvular heart disease, and arteriosclerosis obliterans, whereas seven diseases showed deficits in 2008. These deficits were covered by the profits of the 3 other diseases, angina pectoris, heart failure, and hyperthyroidism, resulting in an increase in total percentage profits in 2008.
Introduction of the 7:1 system resulted in an increase in patient satisfaction and caused physicians and nurses to feel that their working hours had become shorter, whereas real working time was unaltered. In fact, the rate of physicians requiring care for Workload alone was significantly reduced under the 7:1 system, but the rates for other stressors were unaltered. The rates of nurses who required care were unaltered, and especially the rate of those requiring care for Workload remained higher than 90%. The 7:1 system is an incentive for hospitals with introduction of DPC, but its effect was not obvious in terms of hospital benefit.
After introducing a new system/program, it is important to examine the quality management and the validity of the system/program to improve its quality. The Deming cycle (Shewhart cycle), known as the plan–do–study–act (PDSA)/plan–do–check–act (PDCA) paradigm [15], has been widely adopted worldwide, including in medical research/studies to test the effects and performance before and after the introduction of a new system/program [16–18]. The DPC is newly introduced and, even though its study/check stage does not not yet seem to be sufficient, the new 7:1 system was introduced. It is necessary to study/check details from both inside and outside. Generally, worker satisfaction is related to inpatient satisfaction [8]. For TQM, it is important to maintain the balance of worker quality of life and profits [16–18]. Therefore, the present study was performed to evaluate inpatient satisfaction and job satisfaction/stress of medical workers simultaneously. Moreover, the effects of the introduction of the 7:1 system on medical workers' estimation of the DPC function and on hospital profits were examined.
As DPC hospitals deal with patients with extremely serious conditions, it is not surprising that all SF-36 scores before hospitalization were lower than the national mean. Regardless of whether the patient was healthy or sick, scores in women are usually lower than those in men [5]. This was also true in the present study. Low scores in Physical Functioning, Role-Physical, etc., led to significantly lower scores in the Physical Component Summary for women as compared with men, suggesting restriction of female mobility. There was no significant difference in the Mental Component Summary between men and women, but the significantly lower scores in Vitality and Role-Emotional for women suggests occult mental health risk among female patients. Nonetheless, Satisfaction scores reached "somewhat satisfied," and therefore medical/nursing care under the DPC seemed well organized. Higher scores in all satisfaction items examined under the 7:1 system than the 10:1 system showed that introduction of the 7:1 system was somewhat beneficial for inpatients. Low scores for Dealing with Patients and Easiness of Consultation in factor analysis confirmed that the 7:1 system increased the number and duration of nurses' rounds. A higher coefficient on multiple regression analysis for Nursing Care than for other types of care substantiated these findings. Physicians, who tended to be absent from the nurses' station, should be easily accessible and deal with and explain care to patients both reliably and sincerely. Although disease care was important, care by physicians was more important in terms of "mental" care than in terms of direct contact, such as Coping with Patients' Pain/Indisposition, which was usually considered to be Nursing Care rather than Medical Care.
In the 7:1 system, both physicians and nurses judged that their working hours had become significantly shorter than under the 10:1 system, although their real working hours were unaltered. The 7:1 system reduced the number of patients cared for by a single nurse at a time, whereas the time pressure due to shortened LOS continued, Therefore, the long working hours have not been improved for either physicians or nurses. Although the numbers of female physicians and male nurses are increasing, the majority of physicians and nurses are still male and female, respectively. Thus, nurses have heavier burdens at home than physicians, which may affect their estimation of Workload in a hospital/ward. However, more than 90% of nurses who required care in items of Workload in both systems showed no improvement in their workload in the 7:1 system. On the other hand, Personal Relations, Conformity, and Support by Coworkers/Supervisor for physicians and nurses were well administered regardless of the system, which may maintain a lower rate for those who required care for Mental and Physical Stress. This is a type of TQM performed by the workers themselves. However, the 7:1 system did not improve any of these qualities for either physicians or nurses. Moreover, the 7:1 system did not improve the Mental Stress of physicians or nurses, even though it slightly improved Physical Stress.
Understanding the DPC was categorized as "neither agree nor disagree" by the physicians and worse than "somewhat disagree" by the nurses, regardless of the nursing system. This was partly because some physicians and nurses only experienced the FFS at clinical training courses as a student, judging from their working years, and their knowledge about the differences between the FFS and DPC was limited. Even when they really did not know what type of system the DPC was, both physicians and nurses considered that introduction of the DPC could not always facilitate more efficient medical/nursing care, because all the scores were lower than "neither agree nor disagree." Under both systems, physicians had to spend almost 1/3 of their working hours on paperwork/data input, so that the mean working h/week of the physicians in this hospital was similar to in other Japanese surveys [12–14, 19] and higher than in Organization for Economic Co-operation and Development (OECD) countries [20–22]. One of the major purposes of the DPC [23] was to shorten LOS. Both physicians and nurses did not judge LOS to be shorter or see an improvement in quality of medical/nursing care or in the working environment. Nonetheless, physicians tried to change the contents of medical care and the medicine/medical material.
Introduction of the 7:1 system is an incentive for hospitals introducing DPC to increase hospital profit but also causes an increase in the number of nurses needed, probably resulting in a deficit. Total profit of this hospital in 2008 increased compared with that in 2007. However, the percentage profit of 7 of 10 diseases became negative, and therefore this increase was dependent on the profit from the patients with the other 3 diseases, i.e., angina pectoris, heart failure, and hyperthyroidism. If the number of patients with these 7 diseases exceeded that with the other 3 diseases, the hospital would suffer a financial loss. Unfortunately, the profits under the DPC could be compared only with those under the FFS in the present study. As the DPC is new, there have not been many studies and surveys, so it is very difficult to confirm the appropriateness of the setting of the DPC coefficients and points to calculate medical expenses. It is unclear whether the current administration of a hospital/ward and/or clinical pass are suitable to such settings. These points should be taken into consideration for further evaluation of the DPC setting.
The 7:1 system showed advantages with regard to patient satisfaction, but not always for the QOL of the medical staff or hospital benefit, which are very important to maintain high quality of medical/nursing care. Physicians and nurses did not always understand what type of system the DPC was, and what was expected from the DPC. It will be necessary to educate staff regarding the importance of DPC for efficient implementation of this system. It is also important to further explore factors that will increase the QOL of medical workers and hospital income.
An erratum to this article can be found at http://dx.doi.org/10.1007/s12199-011-0226-x
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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Discussion in 'General Discussion' started by cleveland, Apr 6, 2013.
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