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Thomas Freeman
Stan Stephen
At a Glance
Hospitals should boost the revenue cycle performance of acquired physician practices by:
Many forces are driving the trend in hospital acquisition of physician groups, from the need to strengthen physician-hospital alignment to new payment systems that will cut fees and lower reimbursement. But simply acquiring a physician practice doesn't guarantee financial success for hospitals.
Achieving financial objectives requires effective management of the practice-based behaviors, processes, and tools that affect the revenue stream. But hospitals and health systems face several challenges in managing the revenue cycle performance of the physician groups they acquire. To begin with, hospitals and physician practices are separate entities with goals, practices, and standards that are often very different from each other. The challenges that result from such differences-such as differences in culture, policies, tools, and processes-can be alternately clear cut and hard to grasp. Without a solid understanding of what makes each entity "tick," achieving the financial targets a hospital sets for a physician practice can be an exercise in futility.
Improving the bottom line of hospital-acquired physician practices requires an understanding of these challenges and a plan to overcome them. Following are five strategies for enhancing revenue cycle performance of physician practices.
The challenge: Hospitals and physician practices operate in entirely different ways. In a hospital, for instance, decisions are made via committees and layers of authority, while in a physician practice, one or two key physician leaders may be calling the shots. Such differences can create an environment that is not conducive to setting-let alone meeting-goals. It is critical that hospital leaders invest time and effort into bridging this cultural gap and bringing the practice into the organization's fold.
Action Steps
Create an action-oriented culture through which an evidence-based improvement plan can be implemented. To promote accountability for such a plan within the practice, hospitals should establish a shared understanding with the physicians of the hospital's goals. Hospital leaders such as the CFO, COO, and clinical affairs director should work closely with key physician practice leaders and the practice administrator to explain the hospital's overall game plan-not just what the plan is for that particular specialty, but where financial resources are to be invested throughout the hospital and how quality and staffing will be improved. If physicians understand the hospital's strategic plan, they can better understand its financial decisions and be mindful of hospital interests in internal decision making.
Set clear practice performance expectations and establish organizationwide agreement on how to best assess the practice's performance in meeting those expectations. Examples of performance metrics include collection rate, days in accounts receivable, and payer mix. Realistic physician performance targets (such as for volume, procedures, and revenue) should be set based on current levels and industry norms, rather than solely on hospital goals. Physicians won't buy into unrealistic goals.
Develop and distribute a comprehensive reporting package to allow for ongoing comparison of performance outcomes against internal and external benchmarks. The practice administrator should be responsible for generating such reports and distributing them routinely to the hospital team, physicians, and revenue cycle staff to generate ideas for improvement from all levels.
Create revenue cycle teams to lead improvement by specialty. Team members should include the clinical department director for the hospital, a hospital finance manager, and the physician group practice administrator. The team should hold regular team meetings, led by the practice administrator, to track revenue cycle strengths and weaknesses within each specialty and identify issues that need to be addressed. Periodically, the teams should involve lower-level revenue cycle staff from both the hospital and physician practice to foster cultural alignment on the front lines, where processes and tools are used and implemented.
The challenge: Implementing plans for revenue cycle improvement within a physician practice requires a melding of resources between the hospital and the group practice for the plans to be effective. A practice's use of processes, policies, and tools that differ from those used by the hospital can hinder the practice's financial performance.
Standardize chargemasters to create efficiencies and avoid complications on the front and back ends of the revenue cycle. With input from physicians, who receive the brunt of patient complaints about charges, the revenue cycle team should ensure that hospitals and physician practices are charging the same amount for the same service, to avoid the appearance of misalignment.
Consider the provider-based issues associated with standardizing the chargemaster among both entities. Weigh the pros and cons of whether to charge services as hospital- or practice-based. In cardiology, for example, charges for ancillary services, such as echocardiograms and ultrasounds, are typically twice as high in a hospital setting as in a physician practice setting. And in a hospital setting, the patient receives two bills-one from the hospital and one from the physician who reviews the results-which can lead to confusion and anger over greater out-of-pocket costs. The patient may direct his or her anger toward the physician or even leave the practice altogether. Such negative ramifications should be considered when deciding how to charge for services.
Adopt a common charity policy and create an automated patient eligibility system for the policy. Because they often are personally familiar with patients, physicians are likely to write off charges in hardship cases. Yet this practice may run counter to the hospital's charity care policy. The hospital business office should develop the policy, but should include physicians in the decision making to ensure compliance. Physicians should be made to understand their role in following-not interpreting-the policy.
The challenge: Physician scheduling can have a major impact on a physician group's productivity. If the hospital has more physicians on staff than the patient count requires, the number of office visits by patients will be reduced, unnecessarily limiting the growth of the practice. Likewise, poor patient scheduling procedures can unnecessarily reduce the number of patients seen in physician offices, which will reduce the number of ancillary services ordered-and ultimately reduce the number of procedures performed at the hospital.
Review physician and patient scheduling options that can directly affect hospital and practice revenue. Hospital administrators, such as the vice president of clinical affairs and clinical department director, should work with physician practice leaders to consider various schedule-related questions, including the following:
Many decisions will be based on the practice's compensation system, whether it be a shared revenue structure or one in which each physician is compensated according to what he or she bills. If physicians share revenue, for example, it may not matter who should specifically make hospital rounds.
Avoid taking a top-down approach when developing scheduling policies. The hospital should gauge physician preferences, and then determine what options are appropriate. The importance of making the scheduling process as efficient as possible to accommodate new patients, who generate more ancillary services than established patients, should be underscored.
The challenge: Physician documentation directly affects the bottom line, yet is heavily prone to misinterpretation of rules and error. For example, documentation involves recording not only the type of services provided by the physician, but also the level of service provided. If a physician codes for a service one level lower than the level the documentation actually supports, the payment will be about 50 percent less than it would have been had the level of service been coded correctly. Another common problem is that hospital procedures for which the practice has billed patients may not accurately reflect the total number of procedures performed by physicians in the hospital.
Monitor the codes being billed by each physician and the supporting documentation to ensure compliance and uncover revenue charge capture opportunities. Even the smallest change in coding can have a major financial impact. For example, a level-five office visit requires a physical examination of eight organs. If the physician's documentation reports an exam of only seven organs, the level of service would drop from a level five to a level three, reducing the potential for payment by more than 50 percent. In turn, continual undercoding by a single physician can mean a loss of thousands of dollars in revenue. Internal anecdotal reports suggest, for example, that cardiologists may be losing as much as $45,000 a year individually due to undercoding. And the Centers for Medicare & Medicaid Services (CMS) estimates that undercoding costs practices $1 billion in fees annually (Improper Medicare FFS Payments Report, CMS, November 2009, www.cms.gov).
Periodically compare the number of hospital-based procedures billed by the practice with the number billed by the hospital. Discrepancies are common because physicians often inaccurately report to the practice's billing department the number of procedures they performed during weekend and night shifts. Not only do physicians often inadequately track the services they provide, but also coders may find physicians' handwritten logs difficult to decipher, adding further to an inaccurate count of procedures performed. For example, the practice's billing system may record 50 cardiac catheterizations performed during one month, while the hospital's system may record 54. Physician charges for those additional four tests would not be captured, resulting in lost revenue.
Conduct audits using an outside firm initially, then bring the function in-house once the hospital has gained the appropriate level of expertise. Practice administrators should regularly share the results of an audit with physicians. If a physician's error rate exceeds an established internal or external norm, a revenue cycle staffer with expertise in the physician's specialty should meet with the physician to explain the CMS rules and the financial impact of improper coding. The frequency of audits should increase for that physician until his or her error rate decreases.
The challenge: Many physician practices routinely write off bills that are denied by a payer, often because the practice has neither a clear understanding of payer rules nor a dedicated resource to handle payment issues. With appropriate effort, however, many of these denials can be easily appealed and overturned.
Track denials to determine what's being denied and why. The organization should maintain a separate log for each denial received that includes information related to the patient, payer, bill amount, and reason for the denial. Tracking the total amount of denials can help in determining the amount of resources that should be devoted to reducing and preventing denials. If a practice has $10,000 worth of denials annually, it doesn't make sense to invest $40,000 to reduce that amount. The potential savings should be able to justify the expense.
Dedicate a role within the practice to working on denials. If the dollar amount is substantial, the role should be full-time. An internal staff member, most likely a coder, who has a comprehensive understanding of payer rules and the appropriate negotiation skills, should be assigned to work with the payer on overturning denials. If someone with these skills is not available internally, the organization also could consider engaging an outside firm to handle denials for the practice or recruiting a person with these skills.
Determine the appropriate remedy for avoiding future denials. If the practice is successful in winning appeals, the payer will most likely deny fewer bills. If, however, a denial is caused by a physician error-such as failing to sign a document-the physician should be educated on proper coding/documentation. The employee charged with monitoring denials should either give a presentation at a medical staff meeting on this topic, work one-on-one with physicians who are the source of particular denials, or both.
Overall, the goal in managing the revenue cycle performance of a physician practice should be to avoid creating an "us versus them" mentality. The key-and the crucial element for success within each of these five strategies-is gaining that often-elusive physician buy-in, which can be accomplished by investing time in sharing organizationwide objectives with physicians and understanding their priorities. If physicians have a solid understanding of the hospital's or health system's goals, they are more likely to accept policies, processes, and tools that are directed toward reaching those goals.
Essentially, each side should understand what makes the other side "tick." The practice should understand how a hospital achieves financial success, while hospital leaders should understand what makes a practice successful. Achieving this shared understanding requires a solid hospital-practice alignment that continuously underscores what's important for both sides and dedicates time and resources to achieving bottom-line targets that will benefit both parties-and the entire organization.
Thomas Freeman is a vice president, Paragon Health, Southlake, Texas (email@example.com).
Stan Stephen is a senior consultant, Paragon Health, Southlake, Texas (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.
Amy Amick, president, revenue cycle management, and William Davis, vice president, revenue cycle advisory solutions, both with MedAssets, share insights on the industry and techniques to drive sustainable performance improvement.
Eric Ward, president and CEO, Parallon Revenue Cycle Services, discusses key trends in revenue cycle management and factors providers should consider when partnering to advance their revenue cycle performance.
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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text:
Saint Paul of Nicaea
Martyr. No other information has survived.
- at Nicaea, Turkey
- Book of Saints, by the Monks of Ramsgate
- Heiligen 3s
- Kirken i Norge
- Our Sunday Visitor's Encyclopedia of Saints
- "Saint Paul of Nicaea". Saints.SQPN.com. 23 October 2012. Web. 29 December 2014. <http://saints.sqpn.com/saint-paul-of-nicaea/>

subset: commoncrawl


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It's hard to understand how a President who says he believes in God would allow the Food and Drug Administration to play God. Right now, the FDA is starting its process to consider approval of a biological procedure to create genetically modified humans. As we speak, Mr. Obama has not issued an executive order to stop the mad scientists at the FDA.
The FDA calls the proposed procedure "Mitochondrial Manipulation Technology."


text:
Above, a 1934 plaque from the Big Apple Night Club at West 135th Street and Seventh Avenue in Harlem. Discarded as trash in 2006.
Recent entries:
• "Your mind is a garden, your thoughts are the seeds…" (12/19)
• "Never mix the grape and the grain" (drinking adage) (12/19)
• "My mother taught me about the science of osmosis—'Shut your mouth and eat your supper!'" (12/19)
• "Yo mama's so stupid, she asked for a price check at the 99-cent store" (12/18)
• "In a dog-eat-dog market, get yourself a big dog" (12/18)
More new entries...
Above, Big Apple Corner at 54th Street and Broadway in Manhattan.
Above, John J. Fitz Gerald, from the Oct. 17, 1931, Turf Play, p. 7.
Listen to Robert Emmerich introduce The Big Apple, a hit song from 1937. Music written by Bob and performed by Tommy Dorsey's Clambake Seven with Bob on piano. Lyrics written by Buddy Bernier and sung by Edythe Wright. Audio provided by Dorothy Emmerich.
This site is edited by Barry Popik. Technical matters are handled by Grant Barrett of Double-Tongued Word Wrester Dictionary.
The Big Apple. An etymological dictionary (over 11,000 entries) investigating the origins of American words, names, quotations and phrases, specializing in modern slang, neologisms, nicknames, slogans, proverbs, adages, idioms and aphorisms. There are regional dictionaries of New York City, Florida, Oregon and Texas. A web site by Barry Popik.
Above, the header from the 1924 newspaper column of John J. Fitz Gerald. Click to see a portion of the column which includes his use of "Big Apple." Part of a 1926 column is also available.
Above, a cartoon representing the idea of the "big apple" from the 1920s. Click to see the full version.


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Step 6...
In step 6 of the
bare foot trim
you will work on the outside of the foot (not the bottom-side of the foot). So start by setting the foot on the ground. (Now is a good time to take a breather and stretch your back muscles.) You're almost done!
If you have a hoof stand, pick the foot up slowly and give the horse time to stretch his leg out and rest his foot on the stand. If you don't have a stand you can accomplish this next part of the Mustang Roll by setting the horse's foot on your thigh.
Find the best angle for both you and the horse to get comfortable before moving on. Just like before, move slowly, smoothly and deliberately when trying to find the best position for you and your horse.
To finish off the Mustang Roll you will simply smooth and round the outer hoof wall in towards the work you've already completed from the bottom side of the foot. You can start with the rough side of the rasp and finish with the smooth side for a clean finish.
Most of the work needed in this step will take place in the toe area of the hoof wall. Rasp this area enough to create a very rounded toe. The more blunt and round the better. Just remember not to start the roll any higher than one inch up the the hoof wall. Any higher up the wall will just weaken the wall unnecessarily. The outside of the hoof wall is the strongest part and we do not want to remove any more then necessary to promote smooth breakover, strong coffin bone/hoof wall attachment and prevent chipping and/or cracking.
You're done! At least with one foot. The other feet, including the backs are bare foot trimmed the same way. How does it feel to have just helped your horse become stronger, healthier, happier and more athletic!
Stick with this bare foot trim and watch as your horse comes alive!
Do you want to watch a "how to video" for Step #6? If so, click this link.
" onclick="return FIX.track(this);">Finishing the Mustang Roll
The "how to" steps and methods you have just read or followed on the bare foot trim are designed to maintain or improve relatively healthy horse hooves. The steps as described were not necessary designed to rehabilitate or correct existing horse hoof problems (although they will correct many hoof problems). If you are specifically trying to correct hoof problems please (
click here
) to see specific treatment steps in healing, correcting or rehabilitating hooves.
Also, I would like to say that while I'm describing to the best of my ability my own personal recommendations and opinions based on my experience with horses both shoeing and trimming I freely admit that many of my recommendations are shaped from other people's work who have had a great influence on me. Including (Pete Ramey) who is well published (
I would certainly recommend reading his web site hoofrehab.com
), and other friends and coworkers who are not published but have certainly influenced my opinions, knowledge and recommendations.
This bare foot trim style has evolved (and still is) over time through my experience. I live in the Rocky Mountains of Idaho (read
About Us
for details) and am confident in saying, this trim style works very well in this area to produce "Fear No Rocks" horse hooves. My personal horses are able to travel comfortably over trailless areas and remain healthy, sound and athletic. Even more so than when I kept them shod. I feel confident that your horses will greatly benefit from the bare foot trim too!
Want to see one more video related to Step # 6? If you do, click on this link.
" onclick="return FIX.track(this);">Hind foot Mustang Roll & Flare Removal
Print these 6 steps of the bare foot trim and hang them "on your barn door" so when you need to refer to them while trimming, you'll have them handy. Best of luck to you and your horses!
Do you need to review?
click here to move back to Step 5.
What else can you do to strengthen your horse's feet, increase overall health, improve his mind and attitude? (
click here to find out
Back to
Bare Foot Trim. Step 1.
Back to Home (bare-foot-horses.com) page


text:
Take a look at my getting started series if you're new to the world of coupons. You may also be interested in my weekly menu plans and freezer cooking as a way to save time and money in the kitchen. Look around to find out how I can help you lower your monthly budget, so you can spend your hard-earned dollars on what is most important in your life.
I have been with my wonderful husband, Derrick, for 11 years. We have 2 energetic kids that keep me on my toes. Monkey is 6 and LuLu is 3. We live in the Hampton Roads area of Virginia. I welcome you to meet my family and learn about our spending habits.
After my son was born, my coupon usage became more of an obsession. I've always enjoyed finding a good bargain and watching my grocery spending become less each month. I have taken this further into frugal living by cooking more, wasting less, shopping for the best deals, and much more. I have found that I can put more money into things that are beneficial and enjoyable to my family by changing my spending habits.
Once we were debt free (except for our house), we continued saving money so I could stay home with our 2 children. We enjoy using our savings to spend time together as a family and create memories. We also love traveling and exploring the World – day trips camping or hiking, heading to Disney World or taking a Cruise. My husband and I have fond memories of family vacations growing up and we want to share those same experiences with our kids.
I love comments and getting to know my readers. Leave a comment or send me an email to say hi! I'm always looking to improve The Coupon Challenge, so let me know your thoughts, needs or questions.
Contact Me
Have a Question or Comment? Want to Share a Deal or Event?
I'd love to hear from you!
Email me
dana @ thecouponchallenge (dot) com
Meet the Coupon Challenge Team:
Melissa – Content Contributor and Farm Fresh Matchups
Hi! My name is Melissa. I grew up in Virginia Beach and now live in Hampton, Va. I'm a Navy Brat and moved to Virginia Beach when I was 7 years old so I proudly call Hampton Roads home. I am a mother of 3 wonderful kids, Danielle, Cole and Mikey. These days it is just John (the love of my life & best friend) and I at home with our kitty cat Kathy. John is an Army Veteran, Tanker, and I am a Disabled Navy Veteran and yes I miss it so very much! :o) I was an FMF (Combat) Corpsman, EMT/ EVOC, Pharmacy Technician and even served time with the Marines. HooRah!
I have always couponed, even as a child with my mom, but not the strategic way that I do now. I would make a list, find coupons for items that were on my list and then proceed to shop and spend way to much on groceries for the family. I came across "strategic" couponing a couple of years ago while I was in the hospital. I was flipping through the TV channels one night and came across "THAT" show. Yes, you know which one that I am talking about. :o) And no, I no longer watch "That" show. So anyway, I was discharged from the hospital and I went home and eagerly started researching on the internet everything that I could about this type of couponing. That is how I came upon "The Coupon Challenge" and fell in love instantly. Especially with the Farm Fresh Matchups! I was so happy to find a website that was local with deals specific to this area. Soon after, I quickly realized that the show was a farce, but yes you can save LOTS of money and even get items for free doing it the "right" way. I was hooked to couponing immediately! It became my obsession and a game of sorts. How much could I buy for the least amount of money?
Read more about Melissa here
Contact Melissa: [email protected]
Emily – Content Contributor and Giveaways
Hi! My name is Emily but most people just call me "Em" these days. I am married to the love of my life, Brock, and together we have the two best kids in the world, Jack and Lucy. Baby #3 is due in December 2013 and we couldn't be happier to become a party of five!
I started couponing when I quit my commercial interior design job to stay at home with my babies. It was a hard decision to make since I loved my career, but I knew it was the right choice for my family. Hubs is an public school elementary school teacher and together we've found ways to live (and enjoy!) a debt free life, except for our mortgage. I always say "we have everything we need and almost everything we want" . . . with the exception of historic house in the country and a decked out minivan and a few ponies, right? Just kidding.


text:
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Episode Two Title is up!
Also it looks liek the Botswana - Switzerland is one leg as opposed to Switzerland to Germany.
Bertram van Munster: "The helicopter starts in midair, hovers, and then they have to jump out. They know nothing in advance. They realize it once they're up there."
Episode three title is now up:
What a weak title.. "I Love Monkeys!" seriously?A cheerful female or Joey probably says it.


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Director of men's basketball operations named
Head men's basketball coach Saul Phillips announced the hiring of Josh Vaughan as director of operations on Wednesday, July 17. Vaughan replaces Jared Swanson, who resigned to pursue another job opportunity.
Vaughan was an assistant coach at Minnesota State University Moorhead the past two seasons under Chad Walthall. He was the director of operations for Wofford College in Spartanburg, S.C., for the 2010-11 season.
"Josh is a terrific addition to our staff," Phillips said. "He already had a leadership role with some of our players as a senior and is able to communicate well with players. He had terrific experience as the director of operations for an NCAA tournament team at Wofford."
Vaughan played four seasons at NDSU from 2006-10. He graduated with a bachelor's degree in sport and recreation studies in May 2010.
NDSU is recognized as one of the top 108 public and private universities by the Carnegie Commission on Higher Education.


text:
You are in: Home › Census › 2001 Census › Occasional papers › Scotland's Census 2001 - Statistics For Inhabited Islands ›
This paper present data from the 2001 Census of Population, as well as from earlier Censuses, on the inhabited islands of Scotland. It makes comparisons between individual islands groups and also compares the islands as a whole with Scotland.
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text:
Sustainability & CSR Jobs
Interested in a "green" job or one that promotes corporate social responsibility? Take a look at these job boards and networking sites to jump start your career search.
Networking Sites & Job Boards
- Net Impact
"A global network of leaders who are changing the world through business." Check out the website for UMass Amherst's Net Impact website for more information and for details on upcoming events.
- Idealist.org
"An interactive site where people and organizations can exchange resources and ideas, locate opportunities and supporters, and take steps toward building a world where all people can lead free and dignified lives."
- Experience Green
"Experience Green is an initiative to take collective action to protect our environment. As a member, you'll have a tree planted in your honor, PLUS exclusive access to green jobs, internships and many other unique opportunities and insight."
Job Boards
- Green Dream Jobs
"Service that specializes in connecting people with business skills with environmentally conscious employers."
- Ethical Jobs
"The latest ethical jobs from around the world."
- Sustainable Industries Jobs
Job board with opportunities in Green Building, Clean Energy, Technology, Food & Farms, Green Marketing, Finance, Transportation, and Recycled Materials.
- GreenBiz.com
"The leading online news and information resource on how to align environmental responsibility with business success."


text:
Tony and I met mutual friends, its that my best friend is engaged to his best friend sort of story. He said it was love at first sight and he knew i was the one he was looking for but i didnt know, he was a bit nerdy for me. I know a bit nerdy is a weird thing to say especially since when i asked her to fix me up i asked for a nerdy boy but he was like WOAH. His family jokes about star wars all the time. We saw each other for a few months before we actual dated because i had gotten out of a bad relationship a few months prior and had a kid so i wanted to be friends first. I finally agreed to go out with him after like the 8th time of him asking me out, he was persistent and it was cute and he is normally a bit antisocial so this surprised his family. Well when we finally started to go out he was awesome, like a true gentleman, i thought those didnt exist. After a year of dating and getting to know my super crazy family and my beautiful daughter he was still there, i was super surprised especially since he met my family. we were talking about marriage and all and i would want it in the future and we looked at rings but i thought it would be much further down the line and then one day he surprised me on break at work, not the most romantic but still romantic. he had just picked it up and said he couldnt wait to give to me and felt like a child at christmas, so there in the parking lot on one knee, and videotaped by a cell phone camera, i got my shiny pretty ring from my handsome nerd. Then all craziness ensued because not to long later i found out i was pregnant and not even pregnant, i was pregnant with TWINS, i asked the doctor to repeat it and he looked like a MAC truck ran all over him and then did some backing up. After all this, and our now family of five we are getting married and cannot wait to be husband and wife, or nerd and nerdette, and we cannot forget to mention the little nerds we had, which my daughter can name all superheroes and villains and loves star wars at age 4.
Wedding for five
By: jreilly08Subscribe Channel: Weddings Location: binghamton, ny
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StartUpHire is the place to find Workforce Scheduler jobs. Review the list of Workforce Scheduler career opportunities to the left. These Workforce Scheduler jobs represent some of the most rewarding careers available.
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Airbnb is looking for an experienced Workforce Supervisor to lead a scheduling and real time analysis team based in Portland and San Francisco. If you?re looking for a great work environment, where collaboration, adventure, travel and creativity are highly valued ? You should12/17/2014 Portland, OR Save This Job
Overview: The Project Manager?s role is to provide management of all projects including turnkey construction projects. The PM is the customer advocate to accurate and on-time delivery. The PM plays proactive role in problem identification and resolution by highlighting these11/17/2014 Houston, TX Save This Job


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Ingredients & DescriptionUltimate Flora Youth Formula is a high potency probiotic for adolescents and young adults between the ages of 10 and 21. Each capsule contains 10 carefully chosen strains of beneficial bacteria with a total of 8 billion active cultures, including 2 billion Bifidobacteria and 5.2 billion cultures of Lactobacillus and Lactococcus.
Ultimate Flora Youth Formula also contains 800 million active cultures of Streptococcus thermophilus, which has been shown in clinical studies to help alleviate the symptoms of lactose intolerance and promote gastrointestinal health.
Probiotics Support Intestinal Health, Bowel Regularity and Immunity


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Latest Articles
- nsnbc – from blog to daily newspaper next week. A letter from Christof Lehmann to nsnbc readers.
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Pro-Democracy Demonstrator Ahmed Aoun Must Be Provided Medical Treatment
Pro-Democracy Demonstrator Ahmed Aoun Must Be Provided Medical Treatment (BCHR – Copenhagen) – Mr. Ahmed Aoun is a seventeen year old student and demonstrator in Bahrain who has a metal pellet lodged in his eye which was fired from a … Continue reading
Posted in Middle East, News Tagged Arab Spring, Bahrain, Bahrain Center for Human Rights, Bahrain Protests, BCHR, Human Rights, Middle East, nsnbc, Police Violence


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Best Western1231 Lee StDes Plaines, IL 60018
The ASHI School features live home inspection classes that include more time on real field home inspections than any other home inspection school in the nation. Course focus is on starting and operating your own successful inspection career and business, as well as performing inspections in compliance with the ASHI Standards of Practice and Code of Ethics.
The courses are designed as an intelligent blend of pre-class study materials, live classroom lecture and actual in-field home inspection training. Some of the components that will be taught in class are electrical, plumbing, roofing, heating, exteriors, interiors,
Time: Class, which is held Monday through Friday for two weeks (10 business days), begins daily at 8:30 a.m. and ends at approximately 5:30 p.m. To accommodate students' questions and special needs, the class may begin earlier and extend after 5:30 p.m at the discretion of the instructor.
View and complete the above before you arrive: Your instructor will discuss pertinent pre-class material. We recommend that you print the on-line power point presentation and bring it to class. ON THE FIRST DAY OF CLASS PLEASE BRING ALL THE BOOKS YOU WERE SENT. If you did not receive books they will be provided the first day. You will need a pen, note pad and yellow highlighter. Try to complete your home study assignment (approximately 40 hours of work) prior to coming to class. This will enhance your comprehension of the classroom curriculum and assure you are not behind the rest of the class.
Classroom Location


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Created in 1880 by founder Louis-Alexandre Marnier Lapostolle, Grand Marnier® Cordon Rouge is a premium blend of Cognacs with wild tropical oranges from the Caribbean. Louis-Alexandre's vision of blending the essence of wild tropical oranges with fine Cognac from France was unconventional and truly the earliest form of spirits innovation of its time. Grand Marnier Cordon Rouge is a versatile spirit that can be enjoyed on the rocks or neat, yet exceptionally delicious in cocktails.See the History of the House of Marnier Lapostolle
Brilliant topaz tones with amber hues.
Pleasant orange notes with hints of candied peel, light aroma of vanilla fragrance from the Cognac.
Fragrant orange flavors enhanced by the Cognac with nuances of orange essence and hazelnuts.
Lingering and harmonious finish.
Neat, on the rocks or in cocktails.
How to make: Shake with ice then strain into shot glass.
How to make: Pour Grand Marnier over ice. Garnish with an orange peel.
How to make: IN A COCKTAIL MIXING GLASS ADD GRAND MARNIER, BULLEIT BOURBON AND SWEET VERMOUTH. ADD ICE AND STIR , THEN STRAIN INTO A CHILLED MARTINI GLASS. GARNISH WITH A BRANDIED CHERRY.
How to make: Muddle the orange disc. Add ice & stir. Strain over ice in an old fashioned glass and garnish with an orange rind and a maraschino cherry.


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Ciara in a Bikini and Other News
Ciara in Miami. (July 18, 2011)
Boing! Almost rinses away the soul-diminishing experience of the lady gaga photo.
Your mission, if you choose to accept it, is to be a single droplet of water sliding into uncharted territory. This message will self destruct, in a few seconds after my own explosion.
Sweet Jesus I believe!!!
This pic makes a strong case in favor of whatever subject you may try to convince me of.
That on my face. Fart.


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Football schedule changes
If you have the schedules that appeared in the Advocate on the same day as our prep football preview, or some of the other schedules distributed around our coverage area, you need to know of a few changes and corrections:
- Casey County: The Rebels' season opener against Trimble County in Henry County's bowl is Saturday night, not tonight.
- Garrard County: The school has announced that its Sept. 12 game against Jackson County has been moved to Lancaster because Jackson's field is still under construction. The school began football in 2006 and began building its field this spring. This could also affect Jackson's game against Casey on Sept. 26, which is also scheduled to be played in McKee, but there's no word on that yet.
- Lincoln County: The Patriots will play Tates Creek in the Governor's Bowl Sept. 6 at Woodford County. The date and time (5:30 p.m.) are unchanged, but the opponents changed after the schedule was originally set. Woodford will now play Bardstown. In addition, the schedule in weeks 3-5 was listed incorrectly on our flyer thanks to a typo by yours truly. Lincoln is open on Sept. 19, plays at Southwestern on Sept. 26 and host Rockcastle County on Oct. 3.
The corrected schedules are listed on the Advocate's prep football page, along with directions to road games.


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An Italian teen boy was given up by his adopted Italian family for being gay, it was reported today (18 March).
The boy, 14, was abandoned by his biological parents as a baby. Described as 'sweet, shy and insecure', other children bullied him because of his sexuality.
But instead of providing support, his unsympathetic adoptive parents disowned him and took him back to the adoption home as it created 'too many problems'.
The boy and the parents, from a small, unidentified Italian town, were given anonymity to protect the teen from further attacks and discrimination.
'It created too many problems – we can't handle it,' the parents were quoted as saying in Il Messaggero.
'At school his classmates don't accept it. Everyone says to us why do you bother?'
As a result, the boy was put up for adoption for the second time.
The story has caused an outrage in Italian media, with columnist Marida Lombardo Pijola describing the couple as 'undeserving of being parents'.
As translated by GSN, she writes: 'Being a parent isn't about having the necessary working parts.
'Being a parent is not giving it up if the child makes you look bad. Being a parent is fighting for them and protecting them from hate.'
She added: 'I dream of parents who are able to welcome you, love you, protect you, help you grow and recognize and accept each and every beautiful shade of your personality.
'I dream of a world without homophobia, and I dream nothing like this ever happens to any child again.'
But while homophobia is still rife in Italy, largely due to the strong Catholic influence in the country, there is evidence views on gay rights are changing.
In January this year, The Local reported how a court in Palermo allowed a gay couple to foster a 16-year-old, in a case thought to be the first of its kind in Sicily.
And last year, Rome's mayor Ignazio Marino said he was becoming more open to the idea of same-sex marriage.
SINK / DINK ??? Considering most of us in the LGBT "Community" are in the "Single / Double Income No Kid(s)" demographic, what is the possibility of us financially supporting Youth Homes for LGBTI Youths? Small, painless contribution$ from many could accomplish much. There are far brainier persons on this site than I, but with our collected knowledge and abilities we could do this - at least in some countries.
At the very least, this boy is too young to emancipate, though setting up a trust fund for him and his future is entirely do-able. Now, how do "we" do it?
No doubt the adoptive parents are proud of choosing bigotry, they might even think that an Invisible Sky Monster approves of their actions.
When are "Breeders" going to get it figured out that a $1 (US) Condom can prevent a pregnancy from occurring? Yeah, that's right: they're not just for reducing the spread of Sexually Transmitted Diseases (STD's.) I mean even sharp 12 year olds, like the Kid in the clip below, know that!
As for the 14yo subject of this article, so far, he has had 2 bad sets of "Straight/Heterosexual" parents. Let's hope Italy finds a nice Gay/Lesbian couple with whom he can live and thrive.


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Macintosh Terminal Pocket Guide
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Unlock the secrets of the Terminal and discover how this powerful tool solves problems the Finder can't handle. With this handy guide, you'll learn commands for a variety of tasks, such as killing programs that refuse to quit, renaming a large batch of files in seconds, or running jobs in the background while you do other work. Get started with an easy-to-understand overview of the Terminal and its partner, the shell. Then dive into commands neatly arranged into two dozen categories, including directory operations, file comparisons, and network connections.
On Dec 2 H. "Waldo" Grunenwald wrote: Handy Quick-Reference
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Shopping Guide: 20 Puffer Vests for Fall Layering
No matter how you wear it, this is one the most handy garments to have hanging in your closet. Herein, a few of our favorites all online now, at every price.
By Max Berlinger
The color-blocking gives this one a very-much '70s feel, and that's very much a good thing.
Retro gilet ($130) by Superdry, superdry.com


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Small and easy to grow, dwarf citrus trees are a great way to add fresh, tangy fruit into your life. Reaching a mature height between 3-8 feet tall, you can easily pot these citrus trees for patio and home growing. Citrus trees love warm, humid weather; but even if your winters are cold, it's a simple process to move a potted citrus tree indoors. Dwarf citrus trees can produce fruit year-round, making them a valuable and delightful addition to your household.
Enter your zip code to find your hardiness zone, see which trees and plants are best suited for your area, and learn your next ideal planting time.
Since 1816, Stark Bro's has promised to please customers with the very best fruit trees and landscaping products, no matter what. If for any reason you are not completely satisfied with your purchase, let us know within a year of delivery and we will send you a free one-time replacement or a refund of the full purchase price.
potted citrus trees, indoor citrus trees, patio citrus trees
Trees that are shipped without soil to ensure good contact with soil in your yard. When shipped, they are about 3-4' tall with 3/8" or larger trunk diameter. When they mature, they will be one of three sizes*:
Matures to be about 8-10' tall and wide. Provides an abundance of full-size fruit.
Matures to be about 12-15' tall and wide. Gives maximum fruit yield per square foot.
Matures to be about 15-25' tall and 20' wide. A multi-purpose fruit and shade tree.
Top-grade, bare-root trees that give you a head start on growing. When shipped, they are about 4-5' tall with 5/8" or larger trunk diameter.
Trees in bottomless pots that allow some roots to be air pruned, so that a dense mass of productive, feeder roots can grow within the pot to make transplanting easier. Mature sizes vary. When shipped, they are about 1-2' tall.
Top-grade, potted trees chosen to give you a head start on growing. When shipped to you, they are about 3-4' tall.
*Tree sizes may vary by variety. See our Growing Guide for details.


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Jesus Days: Photos of the World Through the Lens of a Closeted Young Gay Man by Greg Reynolds
Posted On Thursday, January 17, 2013 By Accidental Bear. Under Queer News Tags: Closeted, Gay Man, Greg Reynolds, Jesus Days, young
by Greg Reynolds Growing up Southern Baptist in the American South of the 1960s, I learned early that a good Christian refrains from smoking, drinking alcohol, dancing and having sex before marriage. Decades later, I still don't smoke. As a boy I loved ...
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Kickstarter Spotlights Young Transexuals And Drag Queens In Puerto Rico
Posted On Tuesday, April 3, 2012 By Accidental Bear. Under Queer News Tags: drag queens, kickstart, Puerto Rico, Transexuals, young
You remember when fierce actually meant FIRECE!? Take a peek at this kickstart page, it may remind you. ABOUT THIS PROJECT MALA MALA is a feature length documentary exploring the lives of young transsexuals & drag queens in Puerto Rico. Read about Mala Mala ...
9 Comments
"Gay. I'm gay." Announces Your 7-Year Old Boy to His Mom
Posted On Thursday, February 16, 2012 By Accidental Bear. Under Queer News Tags: coming out, I'm Gay, young
A blogger with The Huffington Post tells her story about her 7-year old son's revealing words, "Gay. I'm gay." What a refreshing and lovely story. Considering that my son has a longstanding crush on Glee's Blaine and regularly refers to him as "my ...
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Rare Photo of Young Ben Cohen & Father Who Was Killed Standing Up to Bullies (2000)
Posted On Wednesday, December 7, 2011 By Accidental Bear. Under Queer News Tags: Ben Cohen, Father, Standup Foundation, young
An amazing and joyful picture of Ben Cohen and his father Peter before his untimely passing. The father of the England international rugby player, Ben Cohen, died of serious head injuries from a nightclub attack when he stepped in to confront ...
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VSAConnect is VSA's alumni association for its returned volunteers and their accompanying partners. If you are not already a member but would like to join, register here
VSAConnect is VSA's alumni association for its returned volunteers and their accompanying partners. If you are not already a member but would like to join, register here
Published on 19th April 2012
The decisive result of the presidential election in Timor-Leste on Monday has cleared the way for VSA to continue with plans to extend its programme into rural areas of the country.
Taur Matan Ruak won 61 per cent of the vote in Monday's election – a result that commentators see as yet another indication of the growing stability in Timor-Leste.
Despite fears that the election could cause civil unrest similar to that which occurred during the 2007 elections, this year's presidential election took place in a peaceful and orderly manner.
VSA's international programme manager Peter Swain says the election result, and the peaceful way the election was conducted, has given VSA the confidence to continue pursuing development opportunities in areas outside the capital, Dili.
At present, VSA's six Timor-Leste volunteers are all based in Dili. However, the majority of people in Timor-Leste live a subsistence lifestyle in small villages in rural areas, and the country is one of the poorest in the Asia-Pacific region.
"A lot of VSA's most effective work is done with rural people, who have very few opportunities to gain the economic independence they need to build a more secure future," Dr Swain says. "Timor-Leste has gone through a period of some real difficulties in the last decade. This week's events have given us the confidence to continue with our plans to create better development opportunities in Timor-Leste."
Monday's election was the first of a series of key events in Timor-Leste this year. On 20 May, the country will celebrate 10 years of independence. On 7 July, voters will choose a new government in a general election, and at the end of the year the UN peacekeepers stationed in Timor-Leste since 1999 are scheduled to leave.
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eQ™ Air Handling Unit
The future of ventilation available today!
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eQ is our new flexible air handling unit, providing with new solutions that have not been on the market before. The smart casing design, the energy efficient components and the flexible design make the eQ air handling unit cost effective, and the possibility to combine single deck casing with a double deck casing makes the unit very flexible.
eQ is availble in 21 sizes with an air flow from 0.1 m3/s to 12.5 m3/s.
The range covers most imaginable requirements, from simple applications to integrated solutions. The length of the unit is determined by the components. The air handling unit is very easy to install and maintain. eQ is produced in factories that are quality approved by ISO 9001 and environmental apporoved according to ISO 14001. eQ is certified by Eurovent.
eQL Air Handling Unit
eQL (Large eQ) is availble in 8 sizes with an air flow from 8,0 m3/s to 30,2 m3/s.
- Casing The casing of Fläkt Woods new air handling unit eQ™ has a robust frame with high strength and a hygienic design.
- Dampers Fläkt Woods new air handling unit eQ™ is delivered with in-house manufactured dampers.
- Filters Fläkt Woods new air handling unit eQ™ is delivered with energy saving filters in several arrangements.
- Fans The fans in Fläkt Woods new air handling unit eQ™ are high performing and energy efficient.
- Heat exchangers For Fläkt Woods new air handling unit eQ™, there are several types of heat exchangers available; Rotary heat exchangers REGOTERM® or TURBOTERM®, plate heat exchangers RECUTERM® or eQ Plate™ and liquid-coupled heat exchangers ECOTERM® or ECONET®.
- Coils The coils in Fläkt Woods new air handling units are available in various arrangements.
- Controls The control equipment for Fläkt Woods new air handling unit eQ™ is a standardised control platform with modular construction that gives great flexibility. Communication as standard.
- Laboratory test Research and laboratory testings are performed at Fläkt Woods laboratories concerning all the main fields of air handling.
- eQ Hygiene® Even in its basic version, the air handling unit eQ unit meets very strict hygiene standards.


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Melzinha Bonekinha and Plumber
Cast: Melzinha Bonekinha
Genres: Transsexual, Hardcore, Anal
Sensual shemale sex by Melzinha Bonekinha, Simply The Most Realistic Sex In Transsexual
Format: Windows Media
Duration: 17:51
Video: 900x506, Windows Media Video 9, 2384kbps
Audio: 429kbps
File size: 359.6 MB
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Strictrestraint The Sultry LezDomme Pt II
Melissa remains quite defiant even after being worked over quite well by Sinn...she struggles around to break free with no give from the ropes...Sinn enters and removes the gag from Melissa's mouth...she shoves in four fingers as she explains what Melissa is going to do...Sinn expects oral pleasure and Melissa abides...after Sinn uses Melissa's face to cum and turns around to bury Melissa's lovely face deep into her perfect ass,
Format: mp4
Duration: 16:56
Video: 960x540, AVC (H.264), 975kbps
Audio: 46kbps
File size: 127.4 MB
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TGirl Fantasies #6
Release Year: 2005
Studio: Bob's TGirls
Cast: Alessandra Juliana (o) Sarah Sin Melissa Fabiola Celina (o)
Genres: Shemale, Transsexual, All Sex
Video language: English
A gorgeous European born tranny Sarah Sin joins the team in one of the hottest scenes Bob has shot to date. A couple of Brazilian cuties, Celina and Fabiola have some hardcore fun while Melissa poses solo and jerks off in bed wearing a seductive sex shop outfit. Finally a Brazilian shemale Juliana does the real girl Alessandra who shows much love for hard TGirl cock! Also featuring great "behind the scenes" footage and other extra material.
Format: avi
Duration: 1:35:18
Video: 640x480, xvid, 1732kbps
Audio: 250kbps
File size: 1.4 GB
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Strictrestraint Melissa jacobs
the defiance in Melissa drains away into anxious submission as Sinn takes control...she uses her hands to caress, spank and slap Melissa's entire bound body...Sinn is confident, controlling and sadistic but she pulls it off very gracefully...Melissa is then roped down to our spread bench...Sinn sucks and chews on Melissa's pussy...nipple clamps and a crop...then, Sinn straddles her bound slave and gets herself off by rubbing her pussy against Melissa's...I really like her style...
Format: mp4
Duration: 13:10
Video: 960x540, AVC (H.264), 975kbps
Audio: 46kbps
File size: 99.1 MB
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Melissa Goldeu
Melissa is such a nymphomaniac that she needs more than one cock to satisfy her lusts. She hooked up with six guys at once as they all stood in a circle and she sucked their cocks. Then Melissa rode on top of one guy as another guy penetrated her asshole for some deep double penetration. Melissa loved swallowing down their gallons of cum.
Format: Windows Media
Duration: 19:44
Video: 640x480, Windows Media Video 9, 3194kbps
Audio: 31kbps
File size: 383.9 MB
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Strictrestraint Lea lexis
This week we feature another new Domme to DungeonCorp, Mistress Melissa...Melissa has a perverted resume' that takes her all the way back to her formative years...a natural, like myself...someone who has fantasized about power from their very earliest fantasies...And, since Melissa has had fantasies of power, she has confronted and explored them...a real trooper, a true searcher...that's the lifestyle...Melissa lives it...it's great to watch Lea's face as Melissa describes her experience with BDSM...some real nervous energy to say the least...but excited energy for sure...Lea likes it real...she went on about how much she hates it when she can top from the bottom, using her emotions to manipulate the top...Of course she has a safeword...and I dont know if she used it...but I do know that thier session together was real...and consensual...that's what you get when you get two serious players together...
Format: Windows Media
Duration: 12:19
Video: 790x444, Windows Media Video 9, 973kbps
Audio: 62kbps
File size: 94.2 MB
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Sweet Melissa (2013)
Release Year: 2013
Cast: Melissa Jacobs
Genres: Fetish
Melissa's stocked and gagged and whining for freedom, but we have other plans...We've perched her atop the Sybian and there's only one way out. The blast of the Sybian is a forceful one and Melissa takes the brunt. Her moans increase in volume, no gag can deny her...She shudders and screams, her hands writhe...This dame is getting fucked Cumbots style!
Format: mp4
Duration: 6:11
Video: 1280x720, AVC (H.264), 1465kbps
Audio: 15kbps
File size: 67.2 MB
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Melissa Muscle Fetish Lynn McCrossin Domme, Melissa Dettwiller Submissive
Release Year: 2014
Studio: Muscle Elegance Productions
Genres: Muscle, muscule, body building, bodybuilding, lesbian, toys
Video language: English
Melissa Dettwiller's beauty is matched only by her willingness to submit! Twisted bodybuilder dominatrix Lynn McCrossin doesn't play nice , watch as she turns innocent Melissa into her submissive little slut. This scene is for fans of hard-core muscle domination as the action gets super intense when every one of Melissa's holes gets filled with a dildo. Pec Dancing, butt plugs and girl pony rides!
Format: mp4
Duration: 16:30
Video: 640x360, AVC (H.264), 4406kbps
Audio: 180kbps
File size: 554.6 MB
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Melissa Take it into your mouth
Video language: English
Take it into your mouth
You'll take Melissa's strapon into your mouth. It has be licked clean and that's why Melissa is spitting on it - let it go deep into your mouth - Melissa even helps you with it.
To make it even better for you you're kneeling in front of her so she can spit on the dildo and into your mouth before you can continue to suck it!
Format: Windows Media
Duration: 5:10
Video: 1280x720, Windows Media Video 9, 3906kbps
Audio: 156kbps
File size: 152.6 MB
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White Chocolate Shemale
Release Year: 2012
Studio: Shemax
Cast: Melissa
Genres: shemale
Video language: English
For those who prefer white chocolate we bring you Melissa to satisfy your sweet tooth for cock. With her big lips, booty and dick there is no mistaking this home tgirl but her silky smooth ivory skin gives away some white cock injections into her heritage. You could spend hours exploring her perfect hairless body with your mouth ending with your tongue rimming her succulent pink butt hole. Then she will jerk her long white dick into your waiting mouth and fill it with her creamy white frosting.
Format: Windows Media
Duration: 14:18
Video: 1280x720, Windows Media Video 9, 4194kbps
Audio: 366kbps
File size: 488.2 MB
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Melissa Muscle Fetish - Bit Clit Fucking Machine - Melissa Dettwiller
Release Year: 2014
Genres: Muscle, muscule, body building, bodybuilding, lesbian, toys
Video language: English
In Melissa's dream, scientists have created the ultimate porn stud replacements - Sex Machines! Just plug one end into the wall socket and the other end into a hot wet pussy. Melissa gets the ride of her life! Watch her multi-pierced pussy explode with orgasm after orgasm form multia angles and positions.
Format: mp4
Duration: 10:06
Video: 640x360, AVC (H.264), 4405kbps
Audio: 206kbps
File size: 341.6 MB
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Strictrestraint Just Getting Warmed up
Another way that Melissa reminds me of me is that she doesnt really care about making a slave cum or not...she cares more that the slave did not obey her, whatever her order may have been...Melissa doesnt seem to judge her job as a Domme on whether or not she pleasures her subject, but whether she had control or not...her answer to not cumming on command is to be punished...I like that...a lot...of course, Im speaking for Melissa here and have no idea of her thoughts on the matter...but she did what I would do...truly...making models cum is not my gig...our purpose at DungeonCorp is to put them through an experience of submission...orgasms may or may not be a part of that...here's the vibrator...NO? Ok, here come some clamps...After only two scenes, Lea's limber body has been put to the test...and Melissa is just getting warmed up.
Format: Windows Media
Duration: 13:33
Video: 790x444, Windows Media Video 9, 973kbps
Audio: 62kbps
File size: 103.7 MB
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Melissa Muscle Fetish - Naughty Nurse Nuriye Sener-Evans Gets Anal with Melissa Dettwiller
Release Year: 2013
Studio: Muscle Elegance Productions
Video language: English
Melissa reveals more of her dreams to her therapist : she's home, sick in bed waiting for her doctor, when a naughty nurse enters her room there's more than her temperature that's being taken - Nurse Nuriye administers a good colon cramming in Melissa's hole. This is nasty girl-on-girl action highlighted by intense orgasms and ultra-pierced pussy lips!
Format: flv
Duration: 15:38
Video: 640x360, VP6F, 1600kbps
Audio: 128kbps
File size: 205.8 MB
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Melissa Muscle Fetish - Swollen Clit Sucking Party - Angela Salvagno and Melissa
Release Year: 2014
Genres: Muscle, muscule, body building, bodybuilding, lesbian, toys
Video language: English
Angela Salvagno plays a sultry photographer who pops more than her strobes when blonde bombshell Melissa is in front of her camera. A sexy photo shoot becomes a non-stop girl/girl lick-fest as Angela and Melissa take turns sucking on one another's swollen-wet clits. Great camera angles and tight close-ups bring you into all of the hot action. Not to be missed!
Format: mp4
Duration: 15:36
Video: 640x360, AVC (H.264), 4393kbps
Audio: 192kbps
File size: 524.4 MB
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Strictrestraint Sinn Sage
she uses a vibrator on Melissa's tender clit until she is cumming and kicking...in the final scene Melissa is bent over and gagged...Sinn enters with a strap on...she fucks wildly...and she continues to fuck...Melissa screams as she cums through the hard pounding and Sinn is smiling and doing her best to hold on...you just can't go wrong with two beautiful and kinky women...enjoy!..
Format: mp4
Duration: 8:33
Video: 960x540, AVC (H.264), 974kbps
Audio: 46kbps
File size: 64.3 MB
read more / Download
Tension And Tempers
Studio: L. Scott Sales
Cast: Melissa, Chad
Genres: Wrestling
Video language: English
Melissa is an avid skilled wrestler and does not like to lose. In the first segment Chad really takes it to Melissa and has her struggling for the upper hand, while he manages to control her most of the match. Thankfully for her she manages to escape and apply some harsh breast smothers which make Chad tap out, and she manages to score to win. The second bout was not easy for Chad as Melissa is now enraged and really plows Chad down using every technique known, such as powerful facesits, , breast smothers, and many more, which leave Chad lying helpless on the mat. Awesome 2-part series here!!!
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Melissa Matthews
Release Year: 2014
Studio: takehereasy
Cast: Melissa Matthews
Melissa is a young, ripe slut who's hungry for some dick. Tattooed wild man, Evan, rips up her pussy with his huge cock.
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Red Pantyhose Clad Melissa in Action
Studio: TSPantyhose.com
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Exotic Melissa in her skintight red pantyhose drives this guy insane with need. He can't stop rubbing her red clad legs and licking her high heels. When he is naked she begins to give him a footjob in her covered toes as she plays with her own hard nylong clad cock.
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The Sultry LezDomme Pt II
Release Year: 2011
Genres: BDSM, Bondage, Humilation
Video language: English
Melissa remains quite defiant even after being worked over quite well by Sinn...she struggles around to break free with no give from the ropes...Sinn enters and removes the gag from Melissa's mouth...she shoves in four fingers as she explains what Melissa is going to do...
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HOT: Ass Spanked, Deeply Fucked and Machine Heaven all in The Same Girl
Release Year: 2011
Studio: Kink: Fucking Machines
Cast: Melissa Jacobs
We have a new favourite - Melissa Jacobs. She's just unreal - she squirts, she fucks for days and rocks the machines while tied up. She has a drill pull her hair while The Shockspot devours her pussy. We can't get enough of Melissa. She's unstoppable and the machines have crushes on her. This long update is a testament to her stamina.
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Dunham to lead HSBC GAM fixed income in London
HSBC Global Asset Management has appointed Guy Dunham as London head of fixed income.
Dunham will lead the London team managing over $7bn across fixed-income portfolios, including the £417m corporate bond, £98m gilt and fixed interest and £68m GIF global bond funds but will not manage any of the funds.
He was most recently head of portfolio management for the Bank of International Settlements in Basel, managing the team responsible for providing asset management services to central banks, monetary authorities and official institutions.
Dunham previously worked at JP Morgan Asset Management as head of UK and European rates strategy and at Lazard Asset Management as international portfolio manager.
UK chief investment officer Bill Maldonado says: "Our fixed-income team in London has been highly successful in attracting assets into several strategies. Guy's appointment further strengthens this team and under his leadership we expect continued good performance for clients and robust asset growth."
Concept Financial Planning managing director Paul Richardson says: "It is a tough market in fixed interest and will remain so with interest rates holding and rising inflation. HSBC understands that and wants to get the best people in."
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Is there a cure for chronic cough due to lisinopril/hydrochlorothiazide?
- Q: Is there a cure for chronic cough due to lisinopril/hydrochlorothiazide? I've been off the medicine for about 5 months, and it's worse than ever. What should I do?
- A: Cough is a well-known side effect of ACE inhibitors, including lisinopril. The medical literature varies in how often it occurs. Most prescribing information says that it can occur in anywhere from 1 to 12 percent of patients who take an ACE inhibitor. But some studies have estimated that it can occur in up to half of patients on ACE inhibitor therapy. According to the prescribing information for lisinopril, it was reported in 3.5 percent of patients participating in clinical trials. It is important to consult your doctor for proper evaluation of your cough to make sure it isn't being caused by something else. The cough is usually described as a dry, persistent, itchy or tickling cough. Some reports describe the cough as worse at night, leading to sleep problems and sore throat. The cough usually starts early in therapy, as early as one day after starting the medication. However, it can show up after almost a year of treatment. It is not totally clear how the cough happens or how to get rid of it. Traditional cough medicines do not seem to help. Sometimes, the cough will get better on its own after a few weeks of continued treatment with an ACE inhibitor. It generally does not help to change the dose or to change to a different ACE inhibitor, although sometimes these strategies can be successful. Some patients will find that they cannot tolerate the cough and will talk to their doctors about stopping the ACE inhibitor. The cough usually resolves in a few days to a few weeks after therapy is stopped. If your cough has not gotten better or has gotten worse, contact your doctor for proper evaluation and recommendations. For more specific information, consult with your doctor or local pharmacist for guidance based on your health status and current medications, particularly before taking any action. Sarah Lewis, PharmD
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What does ZIT stand for?
What does ZIT mean? This page is about the various possible meanings of the acronym, abbreviation, shorthand or slang term: ZIT.
We've found a total of 2 definitions for ZIT:
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Zeta Iota Tau fraternity
Zeta Iota Tau
What does ZIT mean?
- zit(n.)
- a pimple; skin blemish.
Still can't find the acronym definition you were looking for? Use our Power Search technology to look for more unique definitions from across the web!
"ZIT." Abbreviations.com. STANDS4 LLC, 2014. Web. 20 Dec. 2014. <http://www.abbreviations.com/ZIT>.


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The USDA estimate for combined 2012-13 Brazilian and Argentinean output is 136 million tonnes, up from last season's 107.5 million tonnes. Some analysts have suggested that farmers will go wild because of high prices that would leave them with extraordinary profits and have come up with a "leap frog" forecast of 150 million tonnes. Aside from the potential weather issue, it is doubtful that the infrastructure for planting, cultivating, and transporting that kind of volume exists in either Brazil or Argentina. Brazil has been working on modernizing its highway network, but that will certainly not be in place for moving the 2012-13 crop to market. The USDA estimate is much more realistic. Last year's crops were plagued with weather problems, but a year earlier the combined crop reached 124.5 million tonnes.
The other potential bullish factor is demand. Unlike many other commodities, sticker shock has not been a factor – yet. US export commitments stand at 21.4 million tonnes, well above last year at this time when sales were only 15 million tonnes. The USDA actually lowered its estimate for 2012-13 exports by 1.5 million tonnes, or 5%, from its August estimate, to 28.71 million tonnes. This compares with last year's final sales of 37.01 million tonnes. The USDA estimate is more of a reflection of how much the US can sell, rather than demand.
Global ending stocks for 2012-13 are currently forecast at 53.1 million tonnes, or 20.6% of usage. That's right on the border – anything lower than that has sparked multiyear bull markets in the past. To be sure, the US crop will still be significantly below the average of the past few years, even with the improved weather.
When prices approached $18 per bushel, however, the market was pricing a total disaster. Any further reduction in yield would have sent US ending stocks below 100 million bushels. With a more optimistic outlook for the crop, the market is now re-pricing the drought's impact on soybean supply. The size of South American crops is important and the extent of weather related problems is not yet known. In all likelihood, with the expansion of acreage, production should still be sufficient to compensate for the US crop – even with some weather problems.
Still, unexpected strong demand and the South American situation remain strong variables. Remain long. Maintain stops recommended on Aug. 31at $15.40, close only.


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Banbury mediterranean bronze two-handle high arc roman tub faucet
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to Astronomy
Understanding the Seasons
The reason that the weather is warmer in summer and colder in winter for the northern hemisphere is not due to the fact that the earth is nearer to the sun in summer and farther from the sun in winter. In fact, just the opposite is true. The seasons are the result of the differing amounts of solar energy which are received at the earth's surface. This changing insolation is a result of the 23 ½° inclination of the earth's axis to the perpendicular of the ecliptic, and the revolution of the earth around the sun. The earth's axis is the imaginary line about which the earth rotates. Expressed in another way, the ecliptic (path of the sun in the sky) is tilted to the plane of the celestial equator by 23 ½°. This causes the sun to not only move eastward as the earth revolves around this star, but to also move northward or southward with respect to the celestial equator. This change in the declination of the sun results in three yearly cycles which can be readily observed as the seasons progress:
In winter, the northern hemisphere is tilted away from the sun. The daily duration of sunshine is restricted, and the sun is lower at noon. The sun's energy strikes the ground at a shallower angle, and thus less energy is received per unit area. The temperature becomes colder. In summer, the northern hemisphere is tilted toward the sun. Not only is the daily duration of sunshine longer, but the sun also climbs to a higher altitude, so that its energy strikes our location more directly, and we receive more energy per unit area. It's time to party in the warmer weather.
The fact that the weather is warmer in the northern hemisphere in summer and colder in winter is NOT because the sun is nearer to us in summer and farther from us in winter. In actuality, the summer sun is three million miles farther from the earth than its winter distance. The two factors which produce the seasonal effects are (1) the duration of sunlit hours experienced during each season and (2) how directly the sun's rays strike the earth's surface. These two factors are in essence due to a single factor, namely the inclination of the plane of earth's equator with the plane of its orbit around the sun. Put another way, the axis of the earth is inclined 23 ˝° from the perpendicular to its orbit.
In summer, the northern half of the earth's
axis is tipped toward the sun. Not only is the duration of daylight
longest at any place in the northern hemisphere, but the sun transits
the meridian at a higher altitude, so that its rays are more nearly
vertical and more concentrated. In winter, the northern hemisphere of
the earth is tilted away from the sun. The duration of daylight is shorter
and the sun transits the meridian at a lower altitude. The sun's rays
strike the earth more obliquely and thus impart to the surface of earth
less energy per unit area.


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Calendar of Events
|Aug. 18, 2014
|8 a.m. - 1 p.m.
|Type of Event:
|Special Event
|Event Location:
|Carl and Emily Thompson Conference Center, Middletown Campus
Opening Activities - College-wide event
College-wide sessions will occur in the morning. Offices will remain open, but with reduced staffing. All full-time employees are expected to attend unless staffing offices. Full staffing will resume for Middletown offices at 1:00, and Fauquier offices at 2:00. Part-time employees are welcome, but not required to attend.
Faculty sessions will occur in the afternoon. All full-time faculty are expected to attend. Adjunct faculty members are welcome, but not required, to attend.
Workshops for adjunct faculty members will occur in the evening. All adjunct faculty are expected to attend at their respective campuses.
A continental breakfast and hot lunch will be provided.
|Invitation Only?
|No - Open to the public
|Cost of Admission:
|None, there is no cost to attend


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Why I became a nurse: Discovering my dream job.
- 13
This article will discuss my nursing story. I will discuss how I became a nurse, what type of work I did prior to nursing and how I combined my prior experience and discovered my dream job working in an ambulatory surgery center.Why did you become a nurse? This is a common question that is asked of nurses. Here is my story of why I became a nurse and how I discovered my dream job.
In 1995, I attended an educational course sponsored by the Ophthalmic Nurses Society (ASORN). At the time I was a certified ophthalmic assistant which is similar to a medical assistant, assisting eye surgeons in a clinic setting. It was at this educational course, that I realized I wanted to be a nurse. It was the ophthalmology aspect of it that intrigued me. I also enjoyed working with patients. I am a people person. Soon after taking the educational course, I enrolled in my local junior college and took one class at a time while working full time and raising a family.
Ten years later, in 2005 I quit my job to attend college full time. I completed my prerequisites, transferred to the local State University and completed my BSN in Nursing. My original plan was to go straight into ophthalmology but after three years of school I realized that there was much to learn about the body and about nursing. It is said that a new nurse should work on med-surg for at least one year. Three and a half years later I was still at the bedside. I was fortunate to have had a telemetry unit position as my first job. There was a med-surg component mixed with some specialty (cardiac).
Six months ago, I felt as though change was going to occur soon. I didnt know what type of change but I felt that it was time to leave telemetry for something else. I asked friends how they liked ICU, ER, L&D, etc. Nothing sounded like the right fit. I was looking for my niche. Dont get me wrong, I would have been more than happy to work in any of these areas. I didnt need to leave telemetry but if I was going to leave I wanted it to be a place I really wanted to stay in. I am a planter. I dont like to hop from job to job. I like to plant myself somewhere and stay there.
Then one night as I was driving home from work, it was like a light bulb turned on above my head. Why not go back into ophthalmology? I had experience in this field. It was something I truly was fascinated with and enjoyed. I started researching different eye clinics and the ophthalmic nurses (ASORN) website to see what it is that ophthalmic nurses do. It seemed the main thing was working in surgery centers or Universities. The closest Universities that would have this set up are at least one or two hours away so this was out. I found a few local eye centers that had their own surgery suites. I walked into a few of these eye centers wearing business attire and resume in hand and asked if they hired ophthalmic RNs. I did not say I was an ophthalmic RN. I was honest and told of my pre-nursing ophthalmology background and my three and a half years of nursing bedside experience. The third surgery center I walked into was the one that hired me. Today I completed my first week as an OR circulating nurse for three eye surgeons, and a few other surgeons (ENT and Urology). And I love it!
My advice to those who are trying to find your niche in nursing: really do your research. Talk to other nurses in different fields of nursing. See what they like most (and least) about their fields of nursing. Ask a seasoned nurse you work with what type of nursing they think would fit with your personality. If you have a good seasoned nurse mentor they may have an idea where you might like to work. Another question is if you have any previous background that you can use to your advantage. Can you use anything from your past to market yourself positively? This is what I did. None of the places I went to had a "help wanted" sign or listing of employment. I just went with a prayer, a professional, confident attitude, my previous experience and resume in tow. And now I am working at my dream job. I feel like I have found my niche and I am home.Last edit by Joe V on Sep 10, '12
About NF_eyenurse, BSN
OR circulator in an ambulatory surgery center. Previously worked as an RN for 3 1/2 years on a telemetry unit. I enjoy mentoring nursing students and new grad RNs. Prior experience as a certified opthalmic assistant and LASIK technician/assistant for 13 years.
NF_eyenurse has '6' year(s) of experience and specializes in 'Ambulatory Surgery, Ophthalmology, Tele'. From 'USA'; 42 Years Old; Joined Dec '08; Posts: 3,626; Likes: 5,528.1Sep 1, '12 by LPN-soon2beBeautiful story!3Sep 1, '12 by timmedicoVery inspiring! I really needed to hear this, as I am in nursing school. Thank you for sharing!2Sep 1, '12 by peanutsauceStories like this make me smile, and truly lighten up the at times bleak stories shared on AN. Thank you for sharing!1Sep 1, '12 by roseonyegreat story. thanks for posting1Sep 4, '12 by RosenhammerGreat story and thanks for sharing it with us!
Bookmarked!1Sep 4, '12 by RNitisThankyou for sharing your experience. I just encountered my first RN position in an LTC and it didn't end well. Felt a bit hopeless leaving there, but after a day and reading many posts, I realize it just wasn't the place to start and I'll find my place eventually!2Sep 4, '12 by NF_eyenurse, BSN GuideQuote from Really new RNThat's the beauty of nursing, there are many other things you can do. Check out the specialties tab on the yellow bar at the top of the page. There are SO many different things we can do in nursing. I hope you find your niche. Good luck.Thankyou for sharing your experience. I just encountered my first RN position in an LTC and it didn't end well. Felt a bit hopeless leaving there, but after a day and reading many posts, I realize it just wasn't the place to start and I'll find my place eventually!1Sep 10, '12 by gayetriwow.. thanx for sharing your experience. it was worth reading.


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New Here?
Wondering what to expect at Christ Church? We provide a casual atmosphere where you are free to experience God at your own pace. Our worship experience is designed with inspirational worship and relevant teaching to inspire you to live life to the fullest, as God intended it. We also have amazing children & student ministries, and great coffee!
We would love to have you come check out our church. Whatever your circumstances – single, married, single again, with or without children – and no matter where you've been or what you've done, you matter to God and you matter to us. We hope to see you this weekend! If you haven't been in a church in a while, it may not be what you're expecting.
We want your child to experience an engaging, life-changing message from God's Word in a way that they can understand, no matter what their age. Our Children's Ministry, CCKids, is designed specifically for birth to 5th grade and strives to be the best hour of your child's week. We would love for you to come check it out this Sunday!
The goal of our Student Ministry is to create an environment where teens can come to know God through immersive worship and engaging messages. ENGAGE student ministry is for 6th through 12th graders. Check out the Student Ministry page for details.


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Ranunculus 'Picotee'
'Picotee' is a Ranunculus variety in the Ranunculus genus with a scientific name of Ranunculus.
Bloom Colours are Pink, Rose/Mauve, Coral/Apricot, Gold, Bronze, Pale Yellow, and Cream/Tan.Picotee is known for growing to a height of approximately 25.0 cm (that's 9.75 inches in imperial). This variety tends to bloom in late spring.
Netherlands is believed to be where Picotee originates from.
This plant info is provided by the myfolia gardener's wiki. All details about Ranunculus 'Picotee' have been kindly provided by our members.
How to grow Ranunculus 'Picotee'
Growing Picotee from seed
Transplanting Picotee
Plant the claw-like tubers at a depth of 8cm with their claws pointing downw.Ensure that temperatures are mild and all chance of frost has passed before planting out, as Picotee is a half hardy plant.
Harvesting Picotee
Ranunculus 'Picotee' information
How long does Picotee take to grow?
These estimates for how long Ranunculus 'Picotee' takes to sprout, grow and harvest are from real observations from real gardeners, right around the world. Start logging and journaling your observations to participate!
Popular varieties of Ranunculus
- Bloomingdale mix
- Tecolote
- Double flowering
- Dark celebration blend
- Sunset mix
- Picasso
- Brazen hussey
- Picotee
Ranunculus Chat
A place to discuss anything relating to the plant that's so fun to say.1 members / 0 topics


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Saturday, December 20, 2014
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The last day for school for the Austin Independent School District is Wednesday, when high school graduation ceremonies are also set to begin. Eastside Memorial's ceremony starts at 2p.m. at the Frank Erwin Center, Reagan High School follows at 5 p.m. and Garza High School's graduation will be held at 8 p.m.
The graduation ceremonies continue through Saturday evening. They will also be webcasted live on the district's website at austinisd.org.
The district will provide shuttle service from Austin High School to the Frank Erwin Center two hours before the first graduation each day to run until the last ceremony ends. To get the full schedule of the ceremonies click here.
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|Buy Michigan Used Office Furniture from Arnolds Office Furniture and Save!
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