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Elizabeth Goldman
Robert Jacobs
Ellen Scott
Bonnie Scott
At a Glance
Like weather forecasters, healthcare experts and providers are trying to predict the financial impact on the industry should Medicare's Recovery Audit Contractor (RAC) program begin using extrapolation in future audits. Their concerns are justified: The potential for the use of extrapolation in audits puts substantial money at risk and limits providers' ability to do anything about it.
Because extrapolation allows the RACs to calculate a total overpayment demand by applying overpayment findings from a sample of a provider's claims to all of a provider's claims, the process could transform an overpayment demand of a few thousand dollars into a demand of a few hundred thousand dollars or more. Worse, it could put some providers at risk for bankruptcy.
The rollout of the nationwide RAC program continues to bring significant anxiety to the healthcare industry. Providers are still uncertain about the extent of programmatic operations and audits. With many concerns, including the use of extrapolation, unanswered, providers are left questioning whether their organizations are completely prepared to comply with the program's demands.
There are several steps providers should take to protect their rights-and their finances.
Unfortunately, the current statutory and regulatory guidance for RAC extrapolation is hazy at best. The use of sample auditing by administrative entities is not a new concept. Chaves County Home Health Services v. Sullivan (931 F.2d 914, 923 [D.C. Cir. 1991]) shows the U.S. Department of Health and Human Services used the practice as early as 1972. And in 1986, the Centers for Medicare & Medicaid Services (CMS) issued CMS Ruling 86-1 to explain its authority to use statistical sampling, stating that claim-by-claim review is not feasible in cases involving a large amount of claims because of the administrative costs associated with record retrieval and review. Several federal courts have upheld CMS's authority on the issue.
Although RACs were authorized to use the extrapolation process during the three-year demonstration period for the RAC program, they did not. To use the process, Section 935 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 requires the secretary of the U.S. Department of Health and Human Services (HHS) to determine that there existed a "sustained or high level of payment error" or that "documented educational intervention has failed to correct the payment error."
Determination of a "sustained or high level of payment error" can be made based on error rate determinations by Medicare Review units, program safeguard contractors, zone program integrity contractors, probe samples, data analysis, provider history, the Office of Inspector General audits, as well as other means, according to the Medicare Program Integrity Manual (CMS, last modified June 29, 2011, www.cms.gov).
In addition, in determining whether to use statistical sampling instead of claim-by-claim review, a RAC can consider the total number of claims, the dollar amounts tied to those claims, available resources, and cost effectiveness of the sampling results.
What the guideline fails to explain is exactly what constitutes a "sustained or high level of payment error." Tracing the legislative history of the MMA also offers little insight into the meaning of these terms. Additionally, in 2009, CMS declined to define the phrase. In response to concerns about the vagueness of these terms, CMS explained that it did not specifically define them because it believed that "contractors need the administrative flexibility to determine whether an error rate is 'high level ... or sustained'" ("Termination of Non-Random Prepayment Complex Medical Review," Federal Register, Sept. 26, 2008). CMS further noted that a "variety of factors influence [their] determinations of such payment errors such as the scope of the problem, potential risk to the Trust Fund, the risk relative to other risks identified by contractor data analysis, and past history of the provider or supplier."
Despite CMS's apparent promotion of contractor flexibility, RACs cannot make the decision to extrapolate on their own. They must first receive CMS's approval through the new issue review process. Marie Casey, deputy director of CMS's Division of Recovery Audit Operations, told the Oklahoma Hospital Association during a question-and-answer session on RAC in 2009 that performing extrapolation is "actually a fairly difficult thing for RACs to do."
So far, CMS has not approved any issues that can use extrapolation, leaving the threshold for obtaining CMS's approval unclear.
It is clear, however, that once CMS does approve RAC extrapolation, it will be difficult for providers to challenge extrapolated demands. A major roadblock is the apparent inability to challenge the HHS secretary's determination of a "sustained or high level of payment error" on appeal. A recent Medicare Appeals Council decision, involving Lakeside Foot Clinic of Cornelius, N.C., highlights this issue.
In the Medicare Appeals Council (MAC) decision Lakeside Foot Clinic, a Medicare program safeguard contractor selected a random sample of 60 claims from a podiatry clinic (to represent a universe of 8,455 claims) and determined that 13 percent of the sample claims were not covered based on lack of medical necessity (www.hhs.gov/dab/divisions/medicareoperations/macdecisions/lakeside_footclinic.pdf ). This amounted to an overpayment of $319.02. The program safeguard contractor then extrapolated its findings to all of the claims, resulting in an overpayment demand of $23,656. On appeal, an administrative law judge reversed the overpayment finding, explaining that the program safeguard contractor failed to determine "a sustained or high level of payment error." However, the MAC vacated and remanded this decision, holding that the administrative law judge erred in invalidating the program safeguard contractor's sample. The MAC stated that neither the judge nor the MAC could review the HHS secretary's decision to undertake statistical sampling.
This decision suggests that a high-even absolute- level of deference will be given to the secretary's determination of a "sustained or high level of payment error." From a financial and legal perspective, this could place providers at a significant disadvantage. Not only do providers lack clear guidance on what defines a "sustained or high level of payment error," but they also appear to have no grounds to question it.
Furthermore, a case was filed earlier this year in the U.S. District Court for the District of Columbia challenging whether a Medicare contractor (in place of the HHS secretary) can determine whether there is a "sustained or high level of payment error" (see Gentiva Healthcare Corp. v. Sebelius, Civil Action No. 11-0438 [D.D.C.], filed Feb. 25, 2011). Here, a Medicare contractor used a subsample of 30 claims of a home health agency to extrapolate and calculate an overpayment. The home health agency filed for reconsideration and redetermination and then appealed to the administrative law judge, who upheld the contractor's use of sampling and extrapolation. The Medicare administrative contractor affirmed, holding that the HHS secretary delegated her authority to the Medicare contractor to make the determination that there was a "sustained or high level of payment error." The case is pending.
Losing this valuable appeal argument could potentially cause providers to feel that the battle has already been lost. Two defense strategies available to providers-challenging the statistical validity of the RAC's extrapolation methodology and disputing individual overpayment determinations from the sample claims-present difficulties.
First, mounting a statistical challenge requires that the provider hire a statistical expert, which can be expensive and time-consuming. It also does not address the basic cause for the appeal nor dispute the extrapolated error. In addition, this type of appeal may be difficult to win since the provider has the burden of showing that the contractor's sampling was invalid. Another complicating factor is that contractors are not strictly bound to using one type of sampling methodology. Although the Medicare Program Integrity Manual outlines specific sampling instructions, it states that a contractor's failure to comply with its instructions does not necessarily affect the validity of that contractor's sampling or its overpayment projection (Chapter 3, Sec. 184.108.40.206).
Second, disputing individual overpayment determinations also presents financial and logistical obstacles for providers. For example, the first obstacle in appealing the extrapolation demand from the Lakeside case on a claim-by-claim basis is cost. It may not be financially feasible for a provider to appeal each individual claim due to the low dollar-value of the claims (in Lakeside, about $40 per claim) in relation to the costs associated with record retrieval and review. It also may not be feasible if the records are no longer available or if there are not enough staff members to handle the paperwork.
RACs are not required to notify providers before starting reviews that could result in extrapolated overpayment demands, meaning providers may not even have enough time to plan and prepare appeal strategies.
So what is the forecast for RAC extrapolation? Although providers and healthcare professionals cannot precisely predict when RACs might implement this process, Casey suggested to the Oklahoma Hospital Association that it will not be implemented immediately: "We don't anticipate approving any issues in which the RAC would extrapolate on …at least initially. There would have to be some serious steps a RAC would have to take to even utilize extrapolation."
Nevertheless, as the RAC program develops and becomes more organized, it will probably follow the lead of other Medicare contractors and begin to use extrapolation-especially considering that RACs will receive their full contingency fee for extrapolated claims. To allow providers a better opportunity to protect their rights-and their finances-Congress or CMS needs to announce more clear-cut guidelines about the extrapolation process.
As we have seen in the RAC demonstration, interpretations of CMS regulations and the RAC Scope of Work potentially allow for flaws in contractor behavior and performance. RAC errors have been overturned on Medicare appeal (The Medicare Recovery Audit Contractor (RAC) Program: Update to the Evaluation of the 3-Year Demonstration, CMS, June 2010). Although only 12.7 percent of the RACs' overpayment determinations were appealed, 64.4 percent of those were favorable to the providers. In these appeals, multiple levels of safeguards were clearly defined and used by providers.
Moving forward, providers should not only understand the extrapolation forecast, but also be able to assess their extrapolation risk and their recourse through regulatory safeguards against contractor error.
Based on all of the open questions related to RAC extrapolation, we strongly recommend that providers be proactive. Providers should work with industry associations to get clarification from CMS on when extrapolation can be used and how a more meaningful appeal process can be established. They also should ask CMS to make the RAC financially liable if extrapolation is abused.
Finally, it is imperative that all providers aggressively appeal all incorrect RAC denials to minimize the potential impact of extrapolation. If providers follow this plan, perhaps RAC extrapolation can be minimized or at least be implemented without the potential for financial disaster for providers.
Elizabeth Goldman, JD, is counsel, Akin Gump Strauss Hauer & Feld LLP, Washington, D.C. (email@example.com).
Robert Jacobs is president, Health/ROI, Lake Success, N.Y., and a board member of HFMA's Metropolitan New York Chapter (email@example.com).
Ellen Scott, RN,is appeals clinical director, Health/ROI, Lake Success, N.Y., and a member of HFMA's Metropolitan New York Chapter (email@example.com).
Bonnie Scott is a legal intern, Health/ROI, Lake Success, N.Y., and a JD-MPH student at Emory University, Atlanta (firstname.lastname@example.com).
Publication Date: Thursday, September 01, 2011
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Scott Schmidt, vice president, Cerner RevWorks, LLC, shares insights on best practices for maximizing a revenue cycle management partnership.
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Dale Hockel, senior vice president of operations, and Jim Fanelli, CFO, TriMedx, share strategies for elevating clinical engineering through innovative management programs.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care's changing payment environment.
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Visit our campus this winter and Ski for FREE!
Now, when you attend one of these campus events you receive a FREE lift ticket to Purgatory - Durango Mountain Resort. And, up to four tour companions get ½ price lift tickets too!
(Free and half-price lift tickets need to be used within three days of visiting campus.)
While not as in-depth as our other events, our daily campus tours and information sessions give students and parents a good overall view of what Fort Lewis College has to offer. If you schedule your tour at least a week before your visit you can even sit in on a class and meet with a professor in your field of interest.
Campus tours occur every weekday at 9:30 a.m. and 1:30 p.m.
The Sneak Peeks are shorter visits that include a 30-minute information session,campus tour, lunch in our Student Union, and the opportunity to sit in on a class.
Our Sneak Peeks will be held on:
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Click here to learn more about all the fun winter opportunities you can find on and near our campus.

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Pediatric and Adolescent Gynecology, 5th Edition. S.J. Emans, Marc R. Laufer, Donald P. Goldstein. Evaluation of Dysuria in the Adolescent Girl. PP 449-452.
MedlinePlus. Urine Culture – clean catch. US Dept of Health and Human Services, National Institutes of Health, National Library of Medicie. Jan., 2010. Accessed May, 2011 from http://www.nlm.nih.gov/medlineplus/ency/article/003751.htm.
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DePaul's rally falls short in loss to St. John's
BY TONI GINNETTI email@example.com January 19, 2013 3:47PM
St. John's JaKarr Sampson (14) hits the floor fighting for the ball with DePaul's Donnavan Kirk (23) and Cleveland Melvin (12) during the first half at the Allstate Arena in Rosemont, Ill., on Saturday, January 19, 2013. | Andrew A. Nelles~Sun-Times Media
Article Extras
Updated: February 21, 2013 6:54AM
St. John's coach Steve Lavin called the Red Storm's 71-62 victory Saturday against DePaul ''a great learning experience'' for his young team, which hung on after its 17-point lead was cut to three.
But it was one more difficult lesson for the Blue Demons (10-8, 1-4 Big East), who lost their third in a row and fifth in the last six games.
''Everybody wants a lead at the beginning of the game, but it didn't go that way today,'' said sophomore Jamee Crockett, who led the Demons with 19 points and had four offensive rebounds, three assists and four steals.
The Red Storm (11-7, 3-3) built its 17-point lead with 7:37 left on a succession of turnovers and missed shots by DePaul.
''Our turnovers really hurt throughout the game, but especially in that stretch,'' coach Oliver Purnell said.
St. John's scored 24 points off 18 turnovers and another 16 fast-break points in transition.
''The other glaring area is our three-point shooting,'' Purnell said after the Demons went 5-for-25 from three-point range and shot 34.7 percent from the field (25-for-72). ''We took far too many and didn't hit enough.''
Crockett made two of them, but his greatest contribution was attacking the rim in the first half. The Crete-Monee product electrified the Allstate Arena crowd of 7,785 with back-to-back slams with less than three minutes left in the first half, giving the Blue Demons one of only two leads at 33-31.
''You want him to get to the rim, hit layups and slash and get to the offensive glass,'' Purnell said. ''That's what we want to see from him.''
But junior forward Cleveland Melvin was the only other Demon in double figures (16 points, eight rebounds). Junior guard Brandon Young had 10 rebounds but only six points and seven turnovers to three assists.
The Red Storm had four players in double figures, led by a career-high 18 points from sophomore guard Jamal Branch, who's averaging only 7.8 points.
Sophomore Sir'Dominic Pointer had a double-double of 14 points and 11 rebounds, sophomore guard D'Angelo Harrison added 15 points and freshman JaKarr Sampson had 10 points.
''As a coach, you're pleased when your team finds a way to close out a Big East game, especially on the road,'' said Lavin, whose team also held on after losing a 14-point lead to upset No. 20 Notre Dame 67-63 on Tuesday.
DePaul got as close as 65-62 with 2:26 left when junior Moses Morgan made a three-pointer, but the Red Storm made six of nine free throws at the end.
''DePaul is a feisty team that has a system, and they stay with it,'' Lavin said. ''That's why there's a razor-thin margin in this Big East. We still have a long way to go.''
That remains true for DePaul, which has only six victories in its last 71 conference games.
The Demons have lost two of their last four Big East games by five points or fewer.
''It can be discouraging, but you have to push through it,'' Purnell said.


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Ash-Shakoor: The Most Appreciative
Names of Allah Series: Part I | Part II | Part III | Part IV | Part V | Part VI | Part VII | Part VIII | Part IX | Part X | Part XI | Part XII | Part XIII | Part XIV | Part XV | Part XVI | Part XVII | Part XVIII | Part XIX | Part XX | Part XXI | Part XXII | Part XXIII |Part XXIV | Part XXV | Part XXVI | Part XXVII | Part XXVIII | Part XXXIV | Part XXXV
"Whosoever relieves from a believer some grief pertaining to this world, Allah will relieve from him some grief pertaining to the Hereafter. Whosoever alleviates the difficulties of a needy person who cannot pay his debt, Allah will alleviate his difficulties in both this world and the Hereafter. Whosoever conceals the faults of a Muslim, Allah will conceal his faults in this world and the Hereafter. Allah will aid a servant (of His) so long as the servant aids his brother." [Muslim]
Reading this hadith (saying of the Prophet ﷺ) always humbles me. We are given so much for doing things that we should be doing anyway, at the very least out of thanks because of all that we have been given. When we think of the concept of appreciation, what should immediately come to mind is that we should be appreciative and grateful for the blessings that Allah subhanahu wa ta`ala (exalted is He) has bestowed upon us—everything from the material, to our friends and family, to the spiritual.
But do we realize that Allah has given Himself the Name ash-Shakoor?
Shukr is defined as recognizing and appreciating when good is done. Shakoor in Arabic is also used to describe an animal that is given little food but gives back much. So it revolves around receiving something, even if small, and giving back much because of it.
Allah is ash-Shakoor, which we will translate here as the Most Appreciative. Al-Ghazali tells us that ash-Shakoor is "the one who rewards the practice of a few pious deeds many-fold, and in response to the action of a few days, gives limitless happiness in the life to come. The one who rewards a good deed many-fold is said to be grateful for that deed, while whoever commends the one who does a good deed is also said to be grateful. Yet if you consider the multiplication factor in reward, only God—great and glorious—is absolutely grateful because His multiplication of the reward is unrestricted and unlimited; for there is no end to the happiness of Paradise."
Allah (swt) says in the Qur'an:
لِيُوَفِّيَهُمْ أُجُورَهُمْ وَيَزِيدَهُم مِّن فَضْلِهِ إِنَّهُ غَفُورٌ شَكُورٌ
"That He may give them in full their rewards and increase for them of His bounty. Indeed, He is Forgiving and Appreciative." (Qur'an, 35:30)
We might think—what does Allah have to be appreciative for? Everything we have is from Him anyway! But that is why He, the Most High, is ash-Shakoor: The Most-Appreciative. In this form, it means He appreciates the smallest of deeds, He appreciates the deeds all the time, and His appreciation is unlimited.
وَمَنْ يَقْتَرِفْ حَسَنَةً نَزِدْ لَهُ فِيهَا حُسْنًا إِنَّ اللَّهَ غَفُورٌ شَكُورٌ
"…And whoever commits a good deed — We will increase for him good therein. Indeed, Allah is Forgiving and Appreciative." (Qur'an, 42:23)
The Prophet ﷺ urged us to do good deeds no matter how small, as he said that we should protect ourselves from the Fire by giving even half of a date in charity [Bukhari]. Now imagine if you give even more?
This is why the Prophet ﷺ reminds us, "Do not belittle any good deed, even meeting your brother with a cheerful face," [Muslim]. Allah appreciates the deeds that are done to all creatures, not simply humans. The Prophet ﷺ narrates to us a story of a man who was extremely thirsty, and found a well, which he climbed down to fetch water to quench his thirst. He then saw a dog which was panting out of thirst. Recognizing that the dog felt the exact same thing he was a few minutes ago, he climbed back down the well in order to give the dog some water. Allah appreciated his action (fashakara Allahu lahu) and forgave his sins [Bukhari and Muslim].
Simple acts like glorifying Allah (saying subhan'Allah – glory be to God) 100 times grants you 1000 good deeds.
Allah (swt) even appreciates our intention. The Prophet ﷺ describes two men: one man whom Allah has bestowed upon wealth and knowledge, and he acts upon that knowledge and gives from his wealth; and another man whom Allah has given knowledge but no wealth, and that man says, "If I had the wealth he had, I would do the same". The Prophet ﷺ said "And they are rewarded the same". [Ibn Majah]
Go out of your way to help someone, not expecting anything in return, and someone along the road will do that for you as a reward from Allah (swt). I remember someone telling my father and me about a time he was severely in debt. Only halfway through the month he was counting the little money that he had, not sure how he would feed his family for the next few weeks. He told us that as he was thinking about what he should do, a man who had borrowed money from him 10 years ago when he was a student called him and said he had the money to pay him back. Nothing we ever do is lost. Allah (swt) kept that money for him for when he needed it the most. And this man, may Allah bless him, had a habit of never asking for money back when he loaned it to people. It worked to his detriment sometimes, but Allah (swt) appreciated his selfless deed and returned the money to him when it was worth so much more. The Prophet ﷺ exemplified this and always gave people, so much that a Bedouin exclaimed, "O my people! Embrace Islam, for Muhammad gives away like the one who does not fear poverty." [Muslim]
Other names of Allah relating to Ash-Shakoor
The Qur'an is a book full of virtues and benefits. At the end of certain ayat (verses), Allah pairs two of His Names together – "Al-'aleem al-Hakeem (the All-knowing, the Wise)," for example. This is not random or by accident. Allah shows us the relationship between the two attributes. With ash-Shakoor this is particularly amazing. Amr Khaled explained the relationship between ash-Shakoor and the other Names it is paired with in the Qur'an:
When it comes to doing good, some of us are hesitant. 'I am such a sinner!' We may think, 'Will Allah really appreciate the pathetic deeds that I do when I commit such horribly bad deeds?' Allah (swt) says, "Surely our Lord is indeed Ever-Forgiving, Appreciative"(Qur'an, 35:34), and "He is most forgiving, most appreciative." (Qur'an, 35:30). This gives us the reassurance that even if we commit sinful deeds, we can return to Allah and He will, insha'Allah (God willing) forgive us, while rewarding us for the good.
Secondly, many of us crave recognition. We do good in secret and a part of us wishes that the person we have done good for knows. Or at other times, we may intend to do something good but everything goes wrong—and no one knew that your intention was to do good. To this effect, Allah (swt) tells us, "And ever is Allah Appreciative and Knowing," (Qur'an, 4:147). Allah (swt) rewards and appreciates the things that people may overlook.
Remember that with Allah (swt) the cycle is never ending. When we deal with human beings, you could give them a gift and they respond with a thanks or a gift in return, but it ends there. With Allah (swt), He tells us that when we thank, He gives us more. So it is a cycle of increase and encouragement for you to be grateful and constantly doing good.
Being aware of ash-Shakoor
Awareness of ash-Shakoor should inspire in us the following things:
- Give as much as you can, be there for people and help where you can. Treat people as you like Allah (swt) to treat you. The Prophet ﷺ said: "Walking with a brother in order to fulfill his needs is better for me than fasting and remaining in devotional seclusion in my mosque for a whole month." [Tabarani] Allah rewards for the tiniest things we do, so imagine if we start doing great things?
- Worship Allah (swt) in the best way that you can. Try to improve the devotion in your prayers, reflect over the Qur'an, fast voluntarily if you can—you will see the effect both in this life and the next insha'Allah! Also, adding a small amount that is continuous is better that doing so much and then burning out, so remember to do what you can bear.
- Sometimes Allah (swt) postpones the signs of His appreciation – and this is to build sincerity. Are you going to give up because you don't see the immediate fruits? Do it for Allah (swt), because you know He is ash-Shakoor in this life and the next, and ask Him to grant you beautiful patience. Remember that the Prophet ﷺ was kind and forbearing and was not treated with the same in Makkah, but Allah (swt) gave him great companions and finally refuge in Madina.
- Appreciate people. The Prophet ﷺ taught us that "The one who does not thank people had not thanked God." [Abu Dawud]
- Finally, be grateful for what you have been given by Allah (swt). Al-Ghazali states, "The best way of manifesting thankfulness for the blessings of God Most High is to make use of these blessings in obeying, and not disobeying, Him."
Allah (swt) says:
"Is the reward for good [anything] but good?
[Qur'an, 55:60]
May Allah enable us to be thankful and appreciative servants of the Most-Appreciative.
7 Comments
Creation is everything and everyone.
Subdivision is not to exclude but mere mathematics.
Algebra in Arabic al-jebr is defined as the reunion
of parts.
Allah gives us reflection to every part to guide
us as a union within creation undivided as creation
to an almighty creator.
Let us pause and pray for Syria ,subdivided by the spin
of inner turmoil and magnitude.
How sad within the glory of Islam that knowledge would become the sacrifice for resolve and annul the very essence of character within the whole of worship let alone the wholesomeness of Islam and the texts of ages!
Appropriately, I shall use the comment box for this article to thank Sr. Jinan, whose series here have taught me so much about who my Lord is through His Names. I never was one of those kids who could sing the popular song of His 99 names from memory. But today I remember many of those names, and more importantly I know what they mean, and what they mean to me. Thank you for sharing your knowledge and insight.
Mashallah, very eloquent and beautiful reminder!
Assalamualaikum Warahmatullahi Wabarakatuh Dearest Sister Jinan!!
JazakAllaahu Khair wa JazakAllaahu Jannatul Firdous bi ghayri hisaab!! :')
This names of Allah series is like the rain falling on parched ground.I know that is an analogy for the Qur'ran itself, in the sense that despite riches or quarrels or toothache or despondancy we can at least go someway beyond our own limitations by the simple choosing of doing some good where we can see it needs doing.This excellent article has helped me in the arduous task of clearing up the banks of a fishing pond here in Cheshire, England…you never saw so much detritus and fly-tipped rubbish…then I saw a pair of swifts swooping low over the pond, and I hope 'twasn't selfishness on my part to think someone has welcomed them from their long migration from Africa with a cleaner place to come to.Even all the comments on this article I have found uplifting and genuine in their thankfulness.Praise be to Allah,the beneficent,the merciful if I may add just two names from 'the seven of repeated verses' here.Brian Cokayne. Stockport, England,where work can be hard and not clean either.


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This illustration is from Liber Floridus, literally "Book of Flowers". The Liber is an encyclopedia compiled between 1090 and 1120 by Lambert of Saint-Omer, a French Benedictine monk. It was a summary of knowledge which covered Biblical subjects as well as natural history, astronomy, geography, and more.
In a moment, in the twinkling of an eye, at the last trump: for the trumpet shall sound, and the dead shall be raised incorruptible, and we shall be changed. 1 Corinthians 15:52


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Herbalife To Increase The Size Of Its Board Of Directors And Nominate Two Icahn Representatives For Election To Board
About Herbalife Ltd.
Herbalife Ltd. (NYSE:HLF) is a global nutrition company that sells weight-management, nutrition and personal care products intended to support a healthy lifestyle. Herbalife products are sold in more than 80 countries to and through a network of independent distributors. The company supports the Herbalife Family Foundation and its Casa Herbalife program to help bring good nutrition to children. Herbalife's website contains information about Herbalife, including financial and other information for investors at http://ir.Herbalife.com. The company encourages investors to visit its website from time to time, as information is updated and new information is posted.
Additional Information
The Company intends to promptly file a proxy statement with the Securities and Exchange Commission (the "SEC") in connection with the solicitation of proxies for the Annual Meeting (the "Proxy Statement"). Details concerning the nominees of the Company's Board of Directors for election at the Annual Meeting will be included in the Proxy Statement. This press release may be deemed to be solicitation material in respect of the Annual Meeting. In connection with the Annual Meeting the Company will file with, or furnish, to the SEC all additional relevant materials, including the Proxy Statement on Schedule 14A. BEFORE MAKING ANY VOTING DECISION, INVESTORS AND SHAREHOLDERS OF THE COMPANY ARE URGED TO READ ALL RELEVANT DOCUMENTS FILED WITH OR FURNISHED TO THE SEC, INCLUDING THE COMPANY'S DEFINITIVE PROXY STATEMENT, BECAUSE THEY WILL CONTAIN IMPORTANT INFORMATION. Investors and shareholders will be able to obtain a copy of the definitive proxy statement and other documents filed by the Company free of charge from the SEC's website, www.sec.gov. The Company's shareholders will also be able to obtain, without charge, a copy of the definitive Proxy Statement and other relevant documents by directing a request by mail to Herbalife International, 800 West Olympic Blvd., Suite 406, Los Angeles, CA 90015 Attn: Investor Relations or from the Company's website, http://ir.Herbalife.com.The Company and its directors and executive officers and certain other members of its management and employees and the Icahn Parties and their director nominees may be deemed to participate in the solicitation of proxies in respect of the Annual Meeting. Additional information regarding the interests of such potential participants will be included in the definitive Proxy Statement.
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Prep Time: 5 mins
Cook Time: 14 mins
Deliciously marinated with Southwest seasonings, these chicken breasts go well with Mexican rice.
(amount per serving)
Calories: 205
Sodium: 156mg
Fat: 13g
Carbohydrates: 1g
Cholesterol: 51mg
Protein: 21g
Fiber: 0g
For a lighter version, decrease olive oil to 2 tablespoons and ground red pepper to 1/8 teaspoon. This saves 40 calories and 5g fat per serving.
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Don't Miss It! 2014 Online Certifications Modules are LIVE!
If you have not started your modules, consider getting started now. Cigna HealthSpring is offering a 100% AHIP reimbursement incentive to those agents who complete training by September 10, 2013.
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Happy 4th of July from the Movies. »»
Behind all the President's men is a woman with an obsession. »»
A look at the cinematic redemption of Robert Downey Jr. in light of Lindsay Lohan in Playboy and Sherlock Holmes 2 ... plus a DVD review of American: The Bill Hicks Story »»
Conflicting storytelling approaches sink fractured portrait of complex man »»
Clooney to star in big-screen adaptation of the best seller. »»
Anybody who says 2010 wasn't a good year for film is in serious need of more trips to the theater or a Netflix account. »»
Life and love in reverse »»


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/// The Spot: Death by Cable
IDEA : Having cable inevitably leads to misery, self-destruction and personal degradation. You lose everything and shave your head for money. You get beat up and left in a roadside ditch. You run into Charlie Sheen and reenact scenes from Platoon with him. You fake your own death and attend your funeral in disguise. Grey's new DirecTV campaign (seven ads since January, with two more on the way) was initially meant to highlight features of the satellite-TV service that are superior to cable. But the creatives stumbled on a darkly comic structure for ads that seemed better suited to a broader attack—with each spot's hero having a cable problem that snowballs into bigger woes, leaving his life in tatters. "We thought, 'Hey, wouldn't it be funny if this annoying cable issue spiraled into a domino effect of events that turned into total awfulness for you?' " said Grey associate creative director Steven Fogel. Indeed, it has become, with the help of director Tom Kuntz, the funniest ad campaign of the year. COPYWRITING : The latest spot is narrated, like the others, by an earnest, serious voiceover that describes the scenes as they unfold. "When you wait forever for the cable guy, you get bored," he says
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Yom Kippur QuizIt's known as the holiest day of the year, so what's the deal with Yom Kippur?
Question 1. When reciting the list of sins, called the Viddui, it is customary for people to
Remain seated
To stand and stomp after each sin is read
Bow after each sin is read
To stand and beat their chests after each sin is read
Question 2. Tradtionally, to fast on Yom Kippur is to abstain from:
All food and drinks
All food and drinks except water
All food, but not drinks
All food that is not harvest directly from the ground
Question 3. One word you'll often hear on Yom Kippur is teshuvah, meaning:
Question 4. Traditionally, many people dress in what special way on Yom Kippur?
In all white or light colors, to symbolize purity
In all black or dark colors, to symbolize sin
In brand new clothes, to symbolize a fresh start
In leather, for no apparent reason
Question 5. True or false: Prayer services on Yom Kippur are longer than on any other day of the year.


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Latta – Latta, South Carolina
South Carolina | SC Picture Project | Dillon County Photos | Latta
Like Dillon, Latta was founded in 1888, when railroads were built all over South Carolina. It was named in honor of Robert J. Latta, who surveyed the right-of-way for the new railroad. Today, Latta is a delightful small town of around 1,500 in Dillon County, which borders North Carolina in the northeastern part of our state.
The below photo was taken of a cotton field west of Latta during the January, 2014 snowfall. Latta is situated in the Pee Dee region of the state, part of the inner coastal plain that still produces the most cotton in South Carolina. In the early nineteenth century South Carolina grew more than half of the nation's cotton. Two varieties made the state a leading producer: Sea Island cotton, which grew on the sea islands below Charleston, and upland cotton, which grew in the Piedmont and inner coastal plain.
Many factors led to the decline of South Carolina's staple industry: the end of the Civil War eliminated slave labor, the boll weevil invaded in the 1910s, and land lost valuable nutrients due to constant clearing. However, farmland eventually was renourished in the middle part of the state, and while much cotton production eventually traveled westward to other states, the inner coastal plain – including Dillon County – remains a heavy cotton producer.
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The purpose of the South Carolina Picture Project is to celebrate the beauty of the Palmetto State and create a permanent digital repository for our cultural landmarks and natural landscapes. We invite you to add additional pictures (paintings, photos, etc) of Latta, and we also invite you to add info, history, stories, and travel tips. Together, we hope to build one of the best and most loved SC resources in the world!
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The central objective of the thematic group is to estabish a sustainable discourse on risk and uncertainty in order to support theoretical developments as well as transnational empirical research.
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on our way
The first shots on our way to ArubaThis photo was shot on film. Taken by djramsay with a Lomo LC-A+ Russia Day (available in our Online Shop) loaded with Lomography X Tungsten (35mm) film (available in our Online Shop) in Aruba, Aruba. These tags describe this photo: europe, 35mm, bright, x-pro, plane, hotel, holiday, gatwick, fly, cloud, adventure, djramsay, carrie27, aruba, and flight. Date: 2012-09-08. Time: Afternoon. This photo can also be found in the album Gatwick and above....
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text: DFHK IntroductionThe Diamond Federation of Hong Kong, China (DFHK) is a non-profit organization aims to protect the integrity of diamond and consumer's interest by standardizing business practice. It is a joined force of two long-established associations in Hong Kong, namely the Diamond Importers Association (1959) and the Hong Kong Diamond Bourse(1985). Since January 2000, DFHK has undertaken their missions in maintaining Hong Kong's reputation as the diamond center in Asia and in promoting quality services and consumer rights. Consequently the Integrity Pledge Scheme was launched to ensure an ethnical and professional image of our members. Under the self-regulatory schemes for the diamond industry, members would mark on the sales invoice a true description of the diamond sold over 0.5 carat. Consumers therefore can shop with confidence and enjoyment.


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I didn't take his money, but I gave him an afternoon he won't soon forget. BREEDING MIKE O'NEILL is a video of what turned out to be almost a ritual.
We milk the cum out of a bunch of men in order to fill a glass with the white stuff.
We freeze all the fresh semen and use the "cum-cube" as a small dildo to start off Mike's breeding. As you may know, the term for using a big frozen wad of cum like this is "The Devil's Dick". Well, Mike gets started with a fuck from the Devil, resulting in a gut-full of cum that insures that no more lube will be needed for the rest of the day. Once Mike's hole is oozing and bubbling with the jizz of god-knows how many men, we bring in a troop of studs to give Mike a fuck-session that lasts all afternoon. Mega-Daddy Mark Magnos, stud-top Steve Parker, bulldog Joe Stack, hotstuff Tom Tomorrow, newcomers Perry, "Dick", Karl and other randy fuckers ... all of them take their turns using Mike, double-fucking him, shooting sperm up his ass once or twice, pumping loads down his throat.
And every time Mike feels another big raw cock sliding deep inside him, a huge grin spreads over his face. Here's a kid who now truly lives to serve cock, to be a receptacle for seed. By the end of the day, Mike's slutty butt-hole is gaping wide-open, protruding, red, raw - bred by the loads of a crowd of men.
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Upcoming Exhibition:
- Street Art Gallery, Dubai, UAE 26June till 31st July 2014.
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- ARTHEUM, Beirut Bloom, Beirut, Lebanon.
- Art Lounge Baiteddine , Maktoob , Baiteddine, Lebanon.
- US embassy of Lebanon, Calligraphy by Everitte Barbee, Awkar, Lebanon.
- Conway Hall, Firefly International, London, England.
- Scottish Poetry Library, Reel poetry festival, Edinburgh, Scotland.
- Glasgow Centre for Contemporary Arts, Reels poetry festival, Glasgow, Scotland.
- AXO Gallery, Save the Forest Art Auction, Lieth, Scotland.


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'Roman catholic Womenpriests' Attempts Ordination of Woman, Bishop Coyne Responds Comments
On Sunday April 15, 2012, the Feast of Divine Mercy, a 71 year old former nun named Maria Thornton McClain attempted to be ordained as a Catholic Priestess by the laying on of hands of Maria Regina Nicolosi, who pretends to be a Roman Catholic Bishop. The event took place at Friedens United Church of Christ on the south side of Indianapolis. Continue Reading
31 - 40 of 41 Comments
2 years ago
Thomas,as if you have not read what the Bishop said on the 12 Apostles of Jesus.
It`s only the men that Jesus had for the ministry.
People want to bring modernization in the church,and that can not happen in the catholic church.May be try it in other churches not in the catholic.
Those so called women priests will one time return back.We are seeing so many no-Catholics returning home.This is the work of the Holy Spirit that has been guiding the church since her inception.
May the Mary Mother of God pray for us.
2 years ago
Thomas..yes in the early ages of the church..priests were married..even some of the apostles were married.However it was decided that priests should sacrifice marriage for the Kingdom of God and to more closely immitate Christ..who Himself of course is celibate and High priest.See Mt 19:12,Lk 18:29,1Cor.7.There are two types of traditions within the Church..sacred tradition used with a capital T..which is the written word of God and has been passed down from Christ to the apostles..from the apostles to the church.It is found in the Creed,church council documents,writings of the popes and church fathers and doctors.These things that are contained cannot be changed..including the ordination of women to the priesthood.Then there is tradition with a small case t..these are more cultural traditions of the church such as praying the rosary..the use of relics etc..these things are good and helpful and within the teachings of the church but not necessary and can be changed.When Jesus formed His priesthood He called only men..the apostles.If He wanted to choose women to be priests don't you think He would have chosen His mother as the first?Mary is the supreme example for both men and women to imitate in order to follow her Son.She followed with humility and charity..obediance to the Will of God and with acceptance regardless of the consequence.These women are setting themselves up against God and do so at the peril of their souls.They are openly saying that they know better than God.If you have any questions about the Catholic faith..there is a great magazine called The Catholic Answere..they answere very clearly and concise any question about the faith that you may have.
2 years ago
Ick. It's quite....icky...when women pretend to be men.
2 years ago
Thank you, Deacon, for your edifying comments, and for Bishop Coyne's precise statement.
2 years ago
When the Bible states of woman not to teach nor to unsurp authority over the man but to silence & the very reason that which is stated "For Adam was not deceived, but the woman being DECEIVED was in the Transgression". Since the faith involves Spiritual matters, to which woman are asked to be obedient. These words apply in man's sinful state & as long as sin exists in man. Looking at History proves this, when of old, woman priests were basically temple Prostitutes among the pagans & of late in some of the Christian denominations like the Anglicans & its episcopals where Woman are used as a "tool to deceit" for the mind may be strong but the spirit is unwilling caught in the transgression, to the falling away of Churches from the Faith which again points to the garden by the devil putting the "I' into the woman & her tendency to rule over the man to which God put the correction on her desire to be to the man (not to satan by his ways) for she was made out of him & that the man shall rule over her & to which again God rightfully put the enmity between the Serpent & the Woman & between their seeds(spiritual in nature) & to the truth of this is seen in the above ordination as an act of rebellion, not to do with the faith or God in the Spirit but to the devil & his deceits & desires in its various forms & in this case will only lead to the falling away from the Faith as has been happening & to this The Catholic & Traditional Churches have the Truth making them as the inheritors off the Apostolic Faith.which is to Christ Jesus & The Father in the Spirit & truth of it., to the redemption of man & his kind, the very purpose of this life.
2 years ago
It is true that there were married priest in early times, particularly in the Celtic Church which had it's own rules and was not eager to bow to Rome. I have never heard of any validly ordained women priests. These nuns must be kin to this who sent me brochures inviting me to retreats to worship the goddess and the earth. Have not heard from them since the Pope ordered a Visitation of women Religious in America.
2 years ago
Thomas: NO. Women are not now, have never been nor will they ever exist in the Catholic Faith. Jesus ordained 12 men, no women. There were women disciples but never women priests. If a woman tells you she has been ordained and is a priest, she is not a valid priest and is only dilusional. Disciples back then, and presently, are men and women that follow Christ. Sooo, if you are a follower of Christ, you are a disciple. As Mary Magdalene was a disciple, nothing more. Married men have been ordained priests BUT unmarried priests cannot marry. The married men that are ordained are already ministers or pastors of a Protestant Christian denomination that have converted to Catholicism or a man that is single because his wife has died. God bless.
2 years ago
Thomas - The matter regarding priest marriage is a matter of discipline and not Church teaching. It has changed and may change again, though not likely. The matter of the priesthood being for men only is a teaching or doctrine that has always been and will always be, not subject to change.
2 years ago
All they are doing is"playing church". We did play church when I was a kid, and on one occasion I was ordained a Pope by another six year old kid. I forgot the name he gave me.
2 years ago
Is womenpriest's claim that woman priest did exist in early church right? If they have the explicit evidence so who is lying on this issue. Another issue that only unmarried men can be ordained as priest? The whole bible indicated that priests in early days did married. So who are lying on this issue. Please kindly answer my question.
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Arizona Index Climbs In January, Reports Comerica Bank's Arizona Economic Activity Index
DALLAS, March 28, 2013 /PRNewswire/ -- Comerica Bank's Arizona Economic Activity Index climbed in January, rising 1.9 percentage points to a level of 95.2. The January index reading is 24 points, or 34 percent, above the index cyclical low of 71.0. The index averaged 87 points for all of 2012, nine points above the average for full-year 2011. December's index reading was unrevised.
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"Our Arizona Index increased for the eighth straight month in January, now at its highest point since September 2008," said Robert Dye, Chief Economist at Comerica Bank. "Home prices notched their 16 th consecutive increase in the first month of 2013, up more than 21 percent year-over-year in January. Payroll employment dipped slightly in January, following strong gains in November and December. We expect to see further improvement to the Arizona economy in the months ahead."
The Arizona Economic Activity Index consists of seven variables, as follows: nonfarm payrolls, exports, sales tax revenues, hotel occupancy rates, continuing claims for unemployment insurance, building permits, and the Case-Shiller home price index. All data are seasonally adjusted, as necessary, and indexed to a base year of 2008. Nominal values have been converted to constant dollar values. Index levels are expressed in terms of three-month moving averages.Comerica operates 18 full-service banking centers throughout the Phoenix/ Scottsdale area. In addition to Arizona, Comerica locations can be found in its headquarters state of Texas, as well as in California, Florida and Michigan, with select businesses operating in several other states, as well as in Canada and Mexico. To find Comerica on Facebook, please visit www.facebook.com/ComericaCares. To receive this index directly to your email inbox, go to www.comerica.com/econsubscribe to subscribe. Follow us on Twitter @Comerica_Econ. SOURCE Comerica Bank
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Men's Carolina® 10" Lightweight Waterproof Composite Toe Wellington Work Boots, Brown
Item # WX2-227373
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This item is shipped directly from the factory. To see the expected shipping date, please add to your Shopping Cart. Sorry, no express shipping available. We are unable to ship factory direct items to Alaska, Hawaii, Puerto Rico or APO or FPO addresses.
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Carolina® 10" Lightweight Waterproof Composite Toe Wellington Work Boots The right stuff for taking on wet stuff.
When wet conditions and falling hazards threaten to sour your sunny disposition, Carolina® Work Boots to the rescue! These Work Boots pack a Scubaliner 100% waterproof membrane and lightweight composite toe so your feet stay dry and safe, comfort assured.Premium pull-ons:
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- Cement construction makes for a flexible, lightweight fit
- Slip-resistant rubber outsole will keep you on your feet, the perfect feature in your boots for work
- Each approx. 10" h., 28 ozs.
State Size and Width, as available in the Shopping Cart.
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Shows in trouble: who will kill 'whodunnit?' – yahoo! tv, "whodunnit?" is a reality-competition series on abc. modeled on classic murder mysteries, contestants are tasked with solving the murder at rue manor. contestants who.
Whodunnit? (tv series 2013– ) – imdb, Takes a lighter approach to the procedural with contestants vying to determine which one of them committed a fictional murder. the 13 would-be sleuths will follow the.
Whodunnit – abc reality show casting – 2013 auditions database, Whodunnit on abc is now casting for contestants on the reality tv show . abc is now holding auditions for their new murder mystery reality show whodunnit.
Whodunnit? (2013): the mole in small town x – competitive reality, Page 1 of 42 – whodunnit? (2013): the mole in small town x – posted in competitive reality shows: not to be confused with '70s game show. abc will be airing a new.
Abc sets summer line-up with bachelorette, whodunnit and motive, Abc sets summer line-up with 'bachelorette,' 'whodunnit' and 'motive' two new series wil be joining "celebrity wife swap" and "rookie blue" by liane bonin starr.
News from tvseriesfinale, Imdb, the world's most popular and authoritative source for movie, tv and celebrity content..
Cancelled tv shows | tv show spoilers and news, Cancelled tv shows: listing of cancelled tv shows, series, listing cancelled tv shows from fox, abc, nbc, cbs, cw, bbc and more. canceled tv shows, discontinued.
Abc's new murder mystery competition 'whodunnit?' premieres, Via press release: abc's new murder mystery competition, "whodunnit?," premieres sunday, june 23 names of the 13 guests vying for $250,000 prize revealed.
Sunday final ratings: no adjustments to 'whodunnit, There were no adjustments to sunday's three original programs, celebrity wife swap, whodunnit? and crossing lines among adults 18-49 versus sunday's.


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A recent CBC news article caught my attention, because of this staggering, sobering statistic: every hour, for the forseeable future, 20 people will be diagnosed with diabetes.
Whether you're concerned about preventing or managing diabetes, check out the Calgary Public Library's collections – both print and digital. Our cookery section has a huge range of books; our health and wellness section has information about the body, fitness, medications, and treatments. From home, access our e-library for a huge range of articles from encyclopedias, magazines, and authoritative medical journals.
Your doctor is not your only source of information! Empower yourself by making a trip to your local library!
At my favourite thrift store last year, I was beckoned by a T-Shirt featuring a shamrock and boldly declaring: "Kiss me, I'm Irish". I knew that I had to have it! I also knew that it would lay in wait for almost a year, until March 17th, whereupon I could unearth it and wear it proudly – if only for a few short hours.
But, what is the significance of the shamrock? Who is St. Patrick and why is he celebrated? For the answers to these questions, I turned to one of my favourite databases, World Folklore and Folklife Today.
Is there a custom, festival, mythological character, celebration or folktale that you'd like to know more about? Would you like to impress your friends with your extensive knowledge of Irish history and lore – (over a pint of green beer, of course)?
Use this wonderfully comprehensive database to find out more!
From our e-library, select Social Sciences and Education. From there, select World Folklore and Folklife Today. Browse by subject, geographical region or folktale and you'll find that you've got access to hundreds of full length books!
The Living Library works exactly like your local Calgary Public Library - readers can borrow a "book". The difference is, books in the Living Library are human beings: "living books", with whom the reader can have a conversation.
This unique program enables readers to ask the questions they have always wanted to ask; while books are given the opportunity to share stories about their personal experiences in a safe and welcoming environment. This enables individuals to actively contribute to building inclusive communities of understanding.
We are currently looking for Living Book Volunteers for our March 2010 programs and beyond.
As a Living Book, all you need is yourself - no more, no less. By being available to answer questions about your life will help readers understand you and your experiences better.
To find out more about the program, or to become a Living Book, please contact us by e-mail email@example.com or by phone at 403.221.2094.
For the vast majority of human history, the availability of light controlled our daily activities. Obviously, you can't chop wood in the dark! But with the advent of electricity, we've been able to stretch our days, and carry out our business on our time, rather than the Sun's. That progress is all well and good, until you consider how much electricity is used daily, just to keep lights on – even when they don't need to be. On March 27, at 8:30 PM, participate in Earth Hour and turn off your lights!
Earth Hour is celebrated all around the world! If you've never participated, let 2010 be your first year!
Check out the Earth Hour website, for more information.
Want to get an idea of just how much electricity you're using? Visit your local library branch and borrow a kill-a-watt meter.
Even though it's been thousands of years since he lived (or did he?), Jesus remains one of the most intriguing and influential - (dare I say "controversial"?) - figures in Western history. Nearly every aspect of his life has been debated – from whether he lived at all, to what his spiritual, moral, political and theological beliefs may have been. Is "gentle Jesus, meek and mild" really the case, or was Jesus more of a radical figure?
Browse our catalogue for books about Jesus. You don't need to have a devotional stance towards Jesus to find him fascinating. Read about Jesus because the art, architecture and icons created in his honour are simply beautiful. Read about him because the history of the Western world has been so strongly influenced by Christianity. Or, read for my favourite reason: because the story of a dying and rising god is as old as ancient Egypt!
There's a whole lot more to the Jesus story than loaf splitting! Check out our religion collection today!
Did you know that the Calgary Public Library offers Career Tours? Groups or individuals can come to the third floor of the Central Library and learn about the books, CDs, DVDs, databases and other tools we have, to assist in searching for jobs. Tours typically take between 75 and 90 minutes, and are in ever-increasing demand. Many people don't realize the wealth of information that can be found here. We have the city's largest collection of career-related materials, encompassing self-assessment tools, occupational profiles, business directories, and much more!
If you'd like to arrange for a Career Tour, please call (403) 260-2782 for more information. Additionally, why not check out our Careers and Employment Resources blog? Here you'll find information about upcoming programs and new career books.
Good luck in your search!


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To report a safety issue, please call (310) 289-5326 or toll free (800) 342-3457.
Safety Bulletins are researched, written, and distributed by the Industry-Wide Labor-Management Safety Committee for use by the motion picture and television industry. The Industry-Wide Labor-Management Safety Committee is composed of guild, union, and management representatives active in industry safety and health programs. These bulletins are posted on the Contract Services Administration Trust Fund website (www.csatf.org) and updated periodically.
To view the Safety Bulletins please click the button below:
Effective July 1, 2014, Assistant Directors, Unit Production Managers, Associate Directors and Stage Managers working in California must compete mandatory Safety Pass Training.
Members, click here for information on upcoming Safety Pass Training classes.


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Fibroid tumor treatment
Alternative Names
Treatment - fibroid tumors. Treatment - uterine leiomyoma
Fibroid tumors are noncancerous growths (tumors) in the uterus. In most cases, treatment is not needed at all. Treatment is only considered if the fibroid is growing rapidly or if you have symptoms such as:
- Abdominal enlargement
- Abdominal pain
- Excessive vaginal bleeding
- Pelvic pressure
- Pain with intercourse
In the past, most women who had fibroids with symptoms required surgery to correct the problem; recent research, however, has led to many new treatments that do not require surgery.
Medication: The following medicines are used to decrease the size of fibroids in preparation for surgery, or to decrease the symptoms caused by fibroids:
- GnRH agonists such as leuprolide (Lupron). These drugs stop the body from making the hormones that cause women to have their periods. As a result, fibroids shrink and symptoms decrease. GnRH agonists only shrink fibroids to 30-50% of their original size, and fibroids will regrow when women stop taking the medicine. For this reason, GnRH agonists are used only to help decrease bleeding as a woman prepares for surgery.
- Birth control pills can also decrease bleeding caused by fibroids. If a woman does not have risk factors that prevent her from taking hormones, this may be a good option for treating the symptoms caused by fibroids.
- NSAIDS are over-the-counter medicines that can decrease the amount of menstrual bleeding, as well as treat minor to moderate pain caused by fibroids.
Surgical Treatments
- Myomectomy: removal of the fibroid or fibroids that are causing symptoms. This can be done through an incision in the abdomen (abdominal myomectomy), or through the vagina without an incision (hysteroscopic myomectomy).
- Hysterectomy: partial or complete removal of the uterus. This can be done through an incision in the abdomen (abdominal hysterectomy), through the vagina (vaginal hysterectomy), or through instruments placed through several small incisions in the abdomen (laparoscopic hysterectomy)
- Endometrial Ablation: This treatment uses electrical energy or heat energy to destroy the lining of the uterus. It reduces the amount of bleeding a woman has with her periods.
Uterine Artery Embolization (UAE): UAE shrinks fibroids by cutting off their blood supply. A catheter is threaded from the groin up into the uterine artery. The blood vessels supplying the fibroids are identified and material is used to block blood flow to the tumor. This procedure is usually done in women who are not planning to get pregnant again.
Katsumori T, Kasahara T. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial). Am J Obstet Gynecol. 2006;195:1190.
Evans P, Brunsell S. Uterine fibroid tumors: diagnosis and treatment. Am Fam Physician. 2007;75:1452-1453.
Gupta JK, Sinha AS, Lumsten MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2006;25.
Lethaby A, Vollenhoven B. Fibroids (uterine myomatosis, leiomyomas). Clin Evid. 2005;14:2264-2282.
Reviewed By: Peter Chen, M.D., Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.


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Hour Detroit
Ozzie Winner: Best Use of Photography, Consumer Under 100,000 Circulation
"A magazine is like a Broadway show," says Hour Detroit editor Rebecca Powers. "The thrill when the curtains open on the stage of a production, you want your magazine to be that way. When someone opens it up, it should come alive—not the only words, which is equivalent to the script or dialogue, but the imagery. You want it to be this beautiful stage that becomes illuminated by stage lights. You want some drama there."
Powers says the magazine likes to ensure images have an editorial feel and equilibrium between photo spreads issue to issue.
"We work hard to make sure it doesn't feel like a catalog," she says. "In all of our editorial meetings we ask ourselves how we are balancing the meatier versus the light, frivolous and beautiful. We haven't shied away from grittier photo stories, but we also work very hard to include photo illustrations that make our stories more attractive to readers to draw them in."
As editor, Powers works to make sure the photographic mission of the publication touches its key demographics and important subject matter. The brand's art director works with photographers to determine the content of a photoshoot and story, though Powers gives directives and general guidelines of things the team should be looking and watching out for.
"If we've had a shoot that was darker, I want to make sure the next one is more upbeat and bright," she says. "I work to orchestrate the flow of our content from page to page and issue to issue."


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Definitions for fallow deer
This page provides all possible meanings and translations of the word fallow deer
Random House Webster's College Dictionary
fal′low deer′(n.)
a Eurasian deer, Dama dama, with a yellowish coat that is spotted in the summer.
Category: Mammals
Origin of fallow deer:
Princeton's WordNet
fallow deer, Dama dama(noun)
small Eurasian deer
fallow deer(Noun)
A ruminant mammal (Dama dama) belonging to the family Cervidae.
Webster Dictionary
Fallow deer
a European species of deer (Cervus dama), much smaller than the red deer. In summer both sexes are spotted with white. It is common in England, where it is often domesticated in the parks
Fallow deer
The fallow deer is a ruminant mammal belonging to the family Cervidae. This common species is native to western Eurasia, but has been introduced widely elsewhere. It often includes the rarer Persian fallow deer as a subspecies, while others treat it as an entirely different species.
Find a translation for the fallow deer definition in other languages:
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Discuss these fallow deer definitions with the community:
Use the citation below to add this definition to your bibliography:
"fallow deer." Definitions.net. STANDS4 LLC, 2014. Web. 17 Dec. 2014. <http://www.definitions.net/definition/fallow deer>.


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Shares of Cliffs Natural Resources (NYSE:CLF) opened today above their pivot of $22.03 and have already reached the first level of resistance at $22.36. Should the shares continue to rise, the resistance pivots of $22.65 and $23.27 will be of interest.
Cliffs Natural Resources share prices have moved between a 52-week high of $46.50 and a 52-week low of $15.41 and are now trading 45% above that low price at $22.38 per share. Over the last five market days, the 200-day moving average (MA) has gone down 0.8% while the 50-day MA has advanced 3.4%.
Based on a current price of $22.38, Cliffs Natural Resources is currently 13.2% above its average consensus analyst price target of $19.43. The stock should find resistance at its 200-day moving average (MA) of $24.36, as well as support at its 50-day MA of $20.52.
Cliffs Natural Resources Inc. is a diversified mining and natural resources company. The Company mines for iron ore and coal in locations across North America, South America, and Australia.


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Sing Solo Sacred
By Neil Jenkins
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Sing Solo Sacred composed by Neil Jenkins. For voice. Solo Voice. Sing Solo.... Other Collection. Part. 160 pages. Published by Oxford University Press (OU.9780193457843).
ISBN 9780193457843. Other Collection. 12 x 9 inches.
All the most popular sacred solos together in one volume. If you need to sing a solo at church this collection is all you need. Many of the pieces have been specially arranged for this book, and well-loved items traditionally viewed as only for higher voices are now available in the low voice volume in suitable keys.
- The Holy City Composed by Adams
- The Lord Is My Light Composed by Frances Allitsen
- Christians, on this day of gladness Composed by Johann Sebastian Bach
- Flocks in pastures green Composed by Johann Sebastian Bach
- If Thou Art Near Composed by Johann Sebastian Bach
- Jesu, Joy Of Man's Desiring Composed by Johann Sebastian Bach
- May the father's boundless love Composed by Johann Sebastian Bach
- Up, up my heart with gladness Composed by Johann Sebastian Bach
- Ave Maria Composed by Bach/Gounod
- The Old Rugged Cross Composed by Bennard
- Agnus Dei Composed by Georges Bizet
- Ave Verum Composed by Edward Elgar
- Pie Jesu Composed by Gabriel Faure
- Panis Angelicus Composed by Cesar Auguste Franck
- Come Unto Him Composed by George Frideric Handel
- I Know That My Redeemer Liveth Composed by George Frideric Handel
- Let The Bright Seraphim Composed by George Frideric Handel
- Lowly they kneel Composed by George Frideric Handel
- Merciful God Composed by George Frideric Handel
- The Lord's Prayer Composed by Head
- Abide with Me Composed by Liddle
- The Lord Is My Shepherd Composed by Liddle
- Brother James Air Composed by MacBeth Bain
- O For The Wings Of A Dove Composed by Felix Bartholdy Mendelssohn
- Alleluia Composed by Wolfgang Amadeus Mozart
- Laudate Dominum Composed by Wolfgang Amadeus Mozart
- Hark, the echoing air Composed by Henry Purcell
- Litany Composed by Franz Schubert
- God Shall Wipe Away All Tears Composed by Franz Schubert
- Refrain Thy Voice From Weeping Composed by Franz Schubert
- The Lost Chord Composed by Franz Schubert
- He that is down Composed by Ralph Vaughan Williams
- God Be In My Head Composed by Walford Davies
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Sing Solo Sacred
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- Critic & User
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& FAQs
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Videos & Screenshots
Game Details
- Release Date 10/20/2009
- Publisher D3P
- Platform PS2
- Genre Action Adventure
- Number of Players 2
Game Description
Astro Boy, star of the beloved anime series, gets the full-on hero treatment with this interactive game based on his adventures. President Stone and his evil robot army have taken over Metro City. Play as the longtime hero and free the city in signature Astro Boy style. Use all of Astro Boy's trademark weapons and skills, including Finger Lasers, Arm Cannons, Drill Attacks, and Butt Machine Guns as you battle robot enemies, gigantic bosses, and new, never-before-seen enemies. Hover in place, escape enemies, and dart away from danger with help from Astro's rocket boosters. Unlock special bonus content, including artwork, alternate versions of Astro Boy, and other exclusive collectibles.
Critic Reviews
GamesRadar Review (6.0 out of 10)
Astro Boy: The Video Game An anime icon from the past returns in retro style It seems Astro Boy returns every decade or so, and now American film makers have retooled the iconic character for another reboot. Albeit low budget looking and feeling, High Voltage Software p...more
User Reviews
Average Member Rating: 5.0 out of 10
Simple and Effective. (6 out of 10)
posted by pinkcubitt (SOUTHAVEN, MS) on Jan 31, 2010
Member since Mar 2009
Member since Mar 2009
Please keep in mind that this game is catered to players ages 5-8. This game is a shooter, with decent graphics and simple gameplay. My 5 year picked it up and played it with no learning curve. The two player coop feature was very nice to get him through the tougher foes. Over all the g...more
Specs & Requirements
Memory 95 kb
Controllers Analog Control, Vibration Function
Modes Story, Full Mission Single-Player, Full Mission Co-Op
Audio/Video In-Game Dolby Digital
Similar Games
- God of War IIIRelease 3/15/2010
- Call of Duty: World at War - Final FrontsRelease 11/12/2008
- Kirby's Return to DreamlandRelease 10/26/2011


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DMM - Nutbuster
Quick OverviewGet your gear out of the wall!
- Description
It may seem strange, considering its essential simplicity, but they are quite proud of this item because it embodies DMMs core values - it is very well made and works very, very well. The Nutbuster blade is laser cut in Sheffield from the finest stainless steel and then given a taper so that it can access narrow placements, but is still stiff enough to dislodge nuts that are welded in - simply compare the blade to anything else on the market and you will see the difference. The round hole in front of the rubber handle both reduces weight and helps accuracy so that you get nuts out faster without damaging their wires. The rubber handle makes the Nutbuster very easy to handle and allows wires to be hit hard without the blade digging into your hand. The rubber handle can be removed if you want to really hit the blade hard with a stone. The Nutbuster can be slung directly on a carabiner, but mountain rescue teams get fed up of digging nut keys out of bodies so it is always best to sling any nut key on a short piece of climbing cord. The danger of impalement in a fall is is also why we did not incorporate a gate into the Nutbuster - plus the mini, integral gates are a pain to use with cold fingers or with gloves.
- Specifications
Manufacturer DMM Weight 57 gm Color Silver Mfg Sku/Part Number C1251 Other Features Climbing gear retrieval tool
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What we do
What we work on; What we can offer
We are Multiplay; an online service provider and events company based on the sunny southern coast of England.
We work with a wide range of people in the industry, from high-level developers to the consumers who purchase their products, to deliver online services and events across the globe. With one of the biggest online gaming networks in the world at over 25,000 servers in 24 locations, we attract hundreds of thousands of gamers a night across more than 60 game titles.
Simultaneously, our business has an equally strong events management side: Over 20,000 gamers a year attending our gaming events, including the Insomnia Gaming Festival; the biggest gaming event in the UK. On top of our own events, we run third party events in a variety of arenas and disciplines, helping to extend our attention to detail and ability to get the job done to other companies.
To find out more about the distinct areas of our business, check out the For Industry and For Gamers sections of the site.
Who we work with
Organisations that trust us to deliver
Over the years we have established and grown relationships with some of the biggest names in the gaming and tech industry, and beyond. We've worked on everything from official online hosting, to fully branded and licensed events. Our client list currently includes Samsung, Mojang, EA, DICE, Trion Worlds, Paradox Interactive, Crytek and more!
We have worked on some of the highest profile projects in the industry, and have been trusted us to deliver when it really matters. Whether it be huge conventions, or thousands of ranked dedicated game servers hosted around the world, we have built up a reputation for delivering above and beyond the expectations of our clients.
Projects we work on
Constantly raising the bar
At Multiplay the work never stops: We have a constant flow of projects on both sides of the screen. We're always looking for the next challenge, and push ourselves to go above and beyond, to deliver on all fronts. Our customer page shows an example of major commercial partnership and business relationships and their associated projects, both past and present, a showcase that should prove to you why you should be the future.
How we can work with you
Overcoming your challenges
Our interest is in helping you to further your business, through tackling your problems and coming up with viable resolutions no matter the needs of the task. No project is too great or too small for our team of renowned industry professionals; from sales to servers, events through to marketing, we are the answer to any gaming service questions you have.
If your challenge is events or servers, hosting or web development, we want to help bring your ideas to life. Get in touch with the team today, and find out how we can help!


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The Spring Casino Night was another big success featuring Poker, Blackjack and Craps with dealers from local LGBT sports teams. Great fun with each team benefitting!
The 2014 Casino Night Series is sponsored by: J James Braeu Residential Specialist at Coldwell Banker (www.jamesbraeu.com). If you are looking for a place, contact James!
The Winners of the Raffle Prizes were:
- 8 Pack of Tickets to DC United vs. Montreal Impact – Greg Flannery
- Abstract Knife Block Set – Adam Miramon
- $75 Gift Card to Le Diplomate – Adrian Blue
- $50 Gift Card to City Sports and a new Racquetball Set – Joe Tresh
- $25 Gift Card to City Sports and a Tennis Prize Package – Matt Boemio
- Two tickets to an upcoming DC United soccer match – David Strobel
- Buffalo Billiards Prize Package – Alex Mastroyannis
- $50 Gift Card to Best Buy – Mark Hegeman
- Pride Run Package including Free Entry – Ken Regnier
- $50 Gift Card to Eatwell Restaurants – Jeremy Leffler
- 2 Chairback Seats to Washington Kastles Tennis Match – Ralf Meisenzahl
- 1 Year Membership to DC Triathlon Club – Tim Rosenberger
The next Casino Night will not be until Saturday, November 15. Until then, be sure to attend the Night OUT Series!