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Geriatric urolithiasis in the emergency department: risk factors for hospitalisation and emergency management patterns of acute urolithiasis
Urolithiasis is one of the most common conditions seen in emergency departments (ED) worldwide, with an increasing frequency in geriatric patients (>65 years). Given the high costs of emergency medical urolithiasis treatment, the need to optimise management is obvious. We aimed to determine risk factors for hospitalisation and evaluate diagnostic and emergency treatment patterns by ED physicians in geriatric urolithiasis patients to assist in optimising treatment.
After receiving ethics committee approval, we examined the records of emergency urolithiasis admissions to our ED between January 2000 and December 2010 to determine risk factors for hospitalisation and to evaluate current diagnostic and emergency treatment patterns in geriatric urolithiasis patients.
1,267 consecutive patients at least 20 years of age with confirmed urolithiasis (1,361 ED visits) and complete follow-up data were analyzed. Geriatric patients comprised 10% of urolithiasis patients with more than half of them experiencing their first urolithiasis episode at ED admission. Although stone site, side and size did not significantly differ between groups, urinary stone disease was more severe in the elderly. The risk of severe complications correlated with increasing age, female sex and diabetes mellitus. Geriatric patients had a two-fold greater likelihood of being hospitalised. A significantly lower percentage of geriatric patients received combined analgesic therapy for pain management (37% vs. 64%, p = <0.001) and supportive expulsive treatment (9% vs. 24%, p = <0.001).
Geriatric patients with urolithiasis have a higher morbidity than younger patients and may be undertreated concerning analgetic and expulsive treatment in ED.
Since the time of Hippocrates, urolithiasis has presented a challenge for clinicians and is still one of the most common conditions seen in emergency departments (ED) worldwide, with an estimated lifetime risk of 15–25%
It is more frequent in adults, with a peak between 40 and 50 years of age, and is increasingly being seen in geriatric patients
Because ED physicians are often the first to treat urolithiasis, it is important to understand the way they diagnose and evaluate acute urolithiasis treatment patterns in such patients.
Given the high cost of urgent medical urolithiasis treatment in geriatric patients with pre-existing comorbidities, the need to focus on optimal management of an acute stone event is obvious. We nevertheless felt that it would be of benefit to explore the relationship between urolithiasis, factors influencing treatment and referral, and patient age
Our ED is the only Level I centre in a catchment area serving about 1.8 million people and treats more than 30,000 cases per year. Despite slight variations in clinical practice between the physicians in our ED, the practical evaluation of patients with suspected urolithiasis generally follows the same pattern. Based on actual recommendations, the diagnostic and therapeutic management is at the discretion of the attending emergency physician. Emergency urologist consultations in ED are considered mostly for patients presenting with severe complications.
Ethical considerations
The Cantonal Ethics Committee (KEK) of Bern approved this study. Data were collected, anonymised, stored, analysed and shared according to the ethics committee standards.
Data collection and retrospective survey
Consecutive patients with urolithiasis, at least 20 years of age, admitted to our ED between 1 January 2000 and 31 December 2010 were identified using the appropriate search string in the diagnosis or imaging field of our computerised patient database (Qualicare Office, Medical Database Software, Qualidoc AG, Bern, Switzerland).
All patients presenting to the ED with symptoms of renal colic during the study period were initially eligible for study inclusion. Since this medical database allows instantaneous retrieval of past diagnostic reports, discharge summaries, consultations and other relevant medical documents or radiographs, the authors were able to retrospectively analyze the diagnostic results, and therapeutic procedures initiated in the ED. Entry criteria included confirmed urolithiasis by the passage of a stone during admission or the finding of a stone on imaging (using non-contrast-enhanced spiral abdominal computed tomography, standard abdominal computed tomography or abdominal sonography, i.v. urography, or plain abdominal X-ray) performed by attending radiologists in the ED. For patients with multiple stones identified on imaging, the location of the lowest obstructing stone was recorded. Exclusion criteria were the absence of documented imaging techniques in our institution, abdominal sonography as a single diagnostic procedure for stone confirmation performed by a non-certified emergency physician, and age <20 years, since these patients are occasionally admitted and evaluated in the paediatric emergency department.
Following this approach, out of an initial >4,500, 1,500 patients with confirmed urolithiasis were primarily included and classified by age, gender and date of emergency admission. Out of these, 1,361 patients had complete data with relevant medical and urolithiasis history, complete follow-up information from successive ED visits, current medication, discharge and admission status, size, number, side and stone location, and radiological findings, and were included in the analysis.
Assessment of acute urolithiasis complications based on diagnostic reports, discharge summaries and radiological findings
All acute urolithiasis complications were for the purposed of this investigation graded as: Grade 0 (no severe complications such as asymptomatic presentation); Grade 1 (mild to moderate dilatation of the ureter); Grade 2 (severe dilatation of the ureter); Grade 3 (urinary tract infection); and Grade 4 (fornix rupture, pyelonephritis, urosepsis).
Between-group comparisons of continuous variables were performed using one-way ANOVA. Categorical variables were compared using the χ2 test or Fisher's exact test.
Multivariable logistic regression analysis was used to explore the association of the various predictors with hospitalisation and complications. 'No hospitalisation' and 'No or non-severe complications' were defined as reference categories. Covariates were sequentially added to the logistic regression model if they were significant in the univariate analyses (p < 0.2) and if they substantially altered the coefficient for either weaning category at an a priori defined level of 10%
Data are presented as means ± SD, medians or proportions, as appropriate. A two-sided p-value < 0.05 was considered statistically significant. Statistical analysis was performed using SPSS (SPSS for Windows release 15.0, Chicago, IL) and STATA (STATA/MP 10.0, College Station, TX).
Out of more than 320,000 ED visits over 11 years, we found 1,361 cases that fulfilled the strict entrance criteria for this study. Table
Figure 1
Age distribution of urolithiasis patients admitted to our emergency department
Age distribution of urolithiasis patients admitted to our emergency department.
Stone site, side and size did not differ significantly between the two groups, but multiple stones were more frequent in older patients (44% versus 25%, p = <0.001). The severity of urinary stone disease (9% versus 3%, p = 0.001) and the number of hospitalisations (46% versus 32%, p = 0.001) were significantly higher in geriatric patients.
A significantly lower percentage of geriatric patients received a combination of two or more analgesic medications (37% versus 64% p = <0.001). Metamizole was used as first-line analgesic treatment in both groups, but significantly more younger patients also received opiates for pain control (59% versus 32%, p = <0.001), NSAIDs (19% versus 8%, p = <0.01) or expulsive agents (24% versus 9%, p = <0.001). Antibiotic treatment was more frequent in patients ≥65 years (18% versus 10%, p = <0.01).
Multivariate logistic regression analysis in the overall population (Table
We aimed to characterise practice patterns and risk factors for hospitalisation of geriatric urolithiasis patients in an academic teaching hospital ED over an 11-year period to enable us to optimise patient care. Our results show that geriatric patients compromise 10% of urolithiasis admissions to our emergency department, with more than half experiencing their first urolithiasis episode. Although stone site, side and size did not significantly differ between groups, multiple stones were less frequent in younger patients, and the disease was more severe in older patients. The risk of severe complications was higher with advanced age, female sex and diabetes mellitus. Geriatric patients had a two-fold greater likelihood of being hospitalised, and the hospitalisation risk was associated with a greater severity of complications and stones located in the ureter.
Ours is one of the few studies that have examined urolithiasis treatment patterns in the ED, and a new – and surprising – finding was the significantly lower percentage of geriatric patients who received multiple radiological investigations and combined analgesic therapy for pain management and supportive expulsive treatment.
Current gender related epidemiologic findings derived from different geographical regions are indicating a demographic shift, with an increased prevalence of stone disease in female subjects
Nevertheless, ureteral colic is a significant disease according to emergency physicians, accounting for more than 120,000 hospitalisations during the past 10 years in Switzerland. The majority of patients in our study were discharged from the ED after acute treatment. Admission was only required in cases with complications or those where pain relief could not be achieved. Regarding the diagnostic management of renal stones, spiral CT, which is considered the diagnostic gold standard, was used in 63% of patients. Noteworthy is that our ED physicians ordered more multiple radiological investigations for younger patients.
The increased risk of admission with urolithiasis in patients older than 65 years has several possible explanations. While it may be attributed to a greater severity of disease and accompanying comorbidities, it may also reflect that such patients may be receiving inadequate pain control. Indeed, age per se seems to be a 'risk factor' for poor pain management, and there is also growing evidence for an age-related decline in pain sensitivity under experimental conditions
Several randomised controlled trials and a recent meta-analysis have reported that calcium channel-blockers and alpha-blockers increase the passage rate of ureteral stones
Prevention of recurrence through metabolic evaluation after a first stone episode is not cost-effective in younger patients
There is great potential for emergency physicians to exert a strong influence on the long-term outcome of patients with stones who are discharged from the ED. It is, of course, unrealistic to expect them to offer comprehensive metabolic and preventative counselling, but it is certainly conceivable that they might routinely give patients basic preventative information. Urologists and physicians in EDs should take this opportunity and develop protocols for the management of cases of acute urolithiasis.
Our trial was limited by its retrospective nature, which may have led to selection bias. However, we used rigorous methods for patient selection. The study was conducted at an academic teaching hospital, and the findings in this patient population may not be generalisable to other settings. Lastly, we do not have information whether patients were directly referred and admitted to the urologists or readmitted to a different hospital after being discharged.
Geriatric urolithiasis patients are not merely an extension of younger urolithiasis patients. Despite similarities in stone site, side and size, elderly patients have a higher risk of complications and a two-fold greater likelihood of being hospitalised. Adequate analgesia must be assured, and the administration of expulsive agents may represent a key factor in optimum urolithiasis therapy.
Competing interests
None of the authors has a conflict of interest.
Authors' contributions
SA, GL, FI and AKE were involved in study design and data collection. SA, GL, FI, GCF and AKE contributed to the manuscript preparation. GCF and SA contributed to the statistical analysis. HZ and AKE provided oversight of the work and finalised the draft. All authors read and approved the final manuscript.
We thank Alistair Reeves for language editing.
This work was funded by research fellowships from the Hellenic Society of Nephrology granted to S.A.
Pharmacotherapy of urolithiasis: evidence from clinical trials
Time trends in reported prevalence of kidney stones in the United States: 1976–1994
Changing gender prevalence of stone disease
The association of increasing body mass index and kidney stone disease
Geriatric urolithiasis
Urolithiasis in geriatric patients
Urinary stones in subjects over the age of sixty
Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury
Updated epidemiologic study of urolithiasis in Turkey. I: Changing characteristics of urolithiasis
Changes in gender distribution of urinary stone disease
Urinary calculi in a geriatric setting
Management of pain in elderly patients with cancer. SAGE Study Group. Systematic Assessment of Geriatric Drug Use via Epidemiology
A review of age differences in the neurophysiology of nociception and the perceptual experience of pain
The quality of emergency department pain care for older adult patients
Age-related differences in pain perception and report
Cost-effectiveness of medical expulsive therapy using alpha-blockers for the treatment of distal ureteral stones
Medical therapy to facilitate the passage of stones: what is the evidence?
Medical therapy to facilitate urinary stone passage: a meta-analysis
2007 guideline for the management of ureteral calculi
When is medical prophylaxis cost-effective for recurrent calcium stones?
Climate-related increase in the prevalence of urolithiasis in the United States
Pre-publication history
The pre-publication history for this paper can be accessed here:


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Image Storm Photographer
Jakii SignorileModel Female Brooklyn, New York, US
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I attend university and have a 3 year sponsorship with a vert skateboarding team I do action sports and am majoring in science and cosmetology I enjoy outdoors photoa and have had modeling classes I have also danced for NYCB, on top of my talents in arts and photography I sing and act and preform im an over all down to earth person.have tattoos and piercings I am currently employed and I am fully capeable and open for any form of modeling job and or film as well as music I play a guitar and drums I can travel if needed depending on miles | I DO NOT PAY FOR SHOTS|
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How To Cult Proof Your Faith (19 of 36) by Jerry Vines
This content is part of a series.HOW TO CULT-Proof Your Faith (19 of 36)
Jerry Vines
Ephesians 4:13-16
The King James Bible has a comma after "saints" but
that is really misleading. That doesn't give you the
impact and the thrust of the passage. My role as the
pastor/teacher is to equip the saints. Some of these
terms are so familiar to us that we forget that people
who are coming into our fellowship and have been here
for only a brief period of time and may come from
different backgrounds. They don't understand what's
involved here. After the service last Wednesday night
some of our folks were telling about a new Christian,
asking the question—who are the saints? We have to
understand that the saints are born again people. If
you have been saved, you are a saint. I'm not talking
about your behavior. I'm not talking about how
consistent or inconsistent you may be in your
Christian life. But the word "saint" means someone
who has been set apart. When the Bible addresses
these books to the saints, it is not talking about
believers who were especially holy who have gone on to
heaven. It is talking about living people—born again
people. My role is to equip the saints for the work
of the ministry. My thrust last week was that every
born again believer has a ministry. The word
"ministry" means service—a place of service. You have
a ministry. You have a place of service.
I had a couple from our fellowship who came in tonight
to see me and they have a ministry to children. I was
excited to hear what they do. They go into some of
the tough areas here in Jacksonville and other places
and they teach the Bible to children in open-air
places. They put up a sound system and they get boys
and girls to come and they teach them about Jesus.
That's their ministry. That's their service that they
render to the Lord.
Every believer is to have a place of service—to have a
ministry. There is a sense in ...
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he rapture has come and gone! In this third installment of the Revelation Road saga, the beleaguered mayor sends Josh McManus on a vital mission to find the mysterious and elusive "shepherd." With the aid of another survivor, can Josh find the man - and determine if he's a prophet or a pariah?Resumen IMDb.com
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text: MrQwerty September 17, 2016 9:19 PM Basically it could work because by making their stint length different to Mercedes, they don't have to be in the same pit window, and could therefore profit from a lucky safety car. I doubt they have the raw speed to challenge Mercedes on any strategy. Still, here's hoping! Reply Report abuse 5 agree 3 disagree


text:
Anne-Sophie Brändlin | DW
How Climate Change is Increasing Forest Fires Around the World
Have wildfires increased globally over recent years? And if so, is global warming to blame? Research has illuminated this, along with what wildfires do to us and our environment, and which areas are most vulnerable. more
Aug 18, 2016 10:03 AM Features


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Cheers Captmilk,Also found these cracking shocks, which I feel are better than the originals. And an original style exhaust.
Milky,You can get that exhaust HERE: http://www.motorcycle-exhausts.co.uk/shop.php?p=search_options&advanced_option_1=1980&advanced_option_name_1=year&advanced_option_2=Yamaha&advanced_option_name_2=make&advanced_option_3=SR250&advanced_option_name_3=model&advanced_option_4=&advanced_option_name_4=submodel&autoparts_search_secret_submit=Search BUT there aren't any available until September. I've actually now found an original exhaust (new) from a company called CMSL in Holland. Surprisingly it is cheaper than the copy, see it HERE: http://www.cmsnl.com/yamaha-sr250g-1980_model8747/muffler-assy-1_3y61471000/
Hey SteveIt's probably a little late now, but there is a flat option of these battery's available that I'm going to use in my sr250.Have a look here (four cell)http://antigravitybatteries.com/?page_id=994


text:
JACKSONVILLE, Fla. -- Winn-Dixie here said it would invest heavily in pricing and promotions in 2004, a move that it expects will wipe out its first-quarter profits and reduce earnings for the year to 20% below analysts' previous estimates.
The company said highly aggressive pricing by competitors, especially traditional supermarket chains, led the company to post same-store sales declines of 4.5% in the 12-week fourth quarter ended June 25. Without the benefits of the later Easter ho
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Trailing by 14 points entering halftime Friday night at Central, Broadmoor co-coach Elliot Wilkins said he told his players the Buccaneers would outscore their District 4-5A rival 15-0 over the final 24 minutes.
The Bucs were even better than Wilkins predicted.
Broadmoor reeled off 26 unanswered points in the second half of a 34-22 win, combining the running of Brodrick Dellihue and Henry Williams with a suddenly stingy defense to help snap a three-game losing streak.
"I told them we were going to win the game 15-0 in the second half," said Wilkins, who shares head coaching duties with Rusty Price. "We ended up winning 26-0."
Following a punt on its opening possession of the second half, Broadmoor (3-5, 2-2 in 4-5A) scored touchdowns on each of its final four and finished with 301 yards rushing. Dellihue had 147 yards and two touchdowns on 16 carries after gaining just seven yards on five tries in the first half. Williams finished with 100 yards on 12 carries and also scored twice.
Until driving the length of the field in the game's final minute, Central (2-6, 0-3) managed only three first downs over the final two quarters.
"It's just one of those things that happens when you keep fighting," Wilkins said.
Central, which entered 2014 having won six straight district championships, lost for the sixth straight time following a 2-0 start.
"We knew going into the year after winning six in a row that everybody circled us on the calendar," Central coach Sid Edwards said. "It's very unfortunate. I love my kids, but I feel for them. It's been a tough go of it."
Quarterback Tyler Sansone threw for 143 yards and completed two touchdown passes in the first half. Running back Leo Brownfield rushed for 81 first-half yards and scored on an 18-yard run.
Broadmoor got its only points of the first half when Central faked a punt near midfield, resulting in a Sansone interception that Rich Bolden returned 50 yards.
Even after Dellihue broke off a 37-yard touchdown run early in the third quarter, Central appeared to be in control when Sansone led the Wildcats to a first-and-10 at the Broadmoor 20. But the Broadmoor defense stiffened to keep Central from building on a 22-14 lead, and the Bucs then put together an eight-play drive to pull within 22-20.
Broadmoor took its first lead on a 47-yard TD run by Dellihue with 8:10 to play.
Broadmoor was trying to milk the clock when Williams broke off a 52-yard run, setting up a 1-yard TD run by Williams with 1:35 left.
Central threatened to close the gap before an interception by Stanton Dickerson deep in Broadmoor territory sealed the win.
"I just thought they were more physical in the second half," Edwards said. "They got after us."


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Hello again! Before I start, I know there is a rumor going around that the Bleach anime will go on hiatus. However, until there is an official announcement I will not mention it, because as of right now it is pure speculation. If the anime does go on hiatus, I will switch my reviews for english dub episodes only, which I was planning on doing anyway, because episode 190 airs in about 3 weeks here. If the anime goes on, then it's business as usual, and I will continue to do this and the dub reviews. This review will be a little longer this week, because I will be reviewing ending 26. Plus, Studio Pierrot is pouring a 10 lb. block of salt into the already open wound that is my heart. YOU JUST HAD TO AIR IT RIGHT BEFORE VALENTINE'S DAY!!!!! If you have no idea what I am talking about please visit the spoiler section. Oh and just a quick reminder , Please remember to vote for February's Featured Article, Featured Picture and Featured Quote!
Lets begin shall we!
YES MY DREAMS HAVE COME TRUE!!!!! THE HALLOWEEN SPEAD!!! (Cries tears of joy). I have been hearing rumors since the Arabian filler aired that an episode based on the now famous Halloween spread was in the works, well those rumors were true. When I saw the preview last week, I went into total Kawaii melt-down mode! Here is an example of Kawaii melt down mode thumb|300px|right|kawaii melt-down mode The animation was good, it was not flawed but it wasn't jaw-dropping either. Plus I loved how Pierrot parodied its past of magical girls shows on Rangiku. OH RANGIKU!!! I noticed last week in the preview that Rangiku's hair was blond, just how it is in the manga colored illustrations. But, I didn't get my hopes to up, because for all I knew, it just could have been lighting. However, it turns out Rangiku has her sandy-blond hair. This will probably be our only time we ever see it in the anime (unless episodes are remade) so enjoy it! Now, I am split between blond and auburn Rangiku. I am used to her auburn curls, yet that BLOND HAIR! I was worried that they might go too blond with her and go into Izuru blond, but they got the right sandy blond color. Alas, if only we can turn back the hands of time, oh well there's always remakes.
I loved how they kept everyone in their same looks from the spread. The episode was definitely off-the wall random, but that's the way I like it. I loved the homage to Renji VS Byakuya through Team seaweed/Seaweed Ambassador and Team Pine. I loved Rukia's outfit, it's actually really weird, because one of the nicknames I get from my mom is "Succu Succubus." OMFG TOSHIRO!!!!! I loved him!!! I loved it when he played fetch, oh what a good boy Hitsugaya Taicho!!!! I loved how they connected the whole Snow Crystal to the Arabian episode and how they make the episodes the strange dreams of members of the Gotei 13. I was nice to see Komamura get screen time that did not involve him getting cut, gored, stabbed, or have any other bodily injuries. Plus I loved how they made Ryūken look like Alucard from Hellsing. Plus Isshin looked like an idiot, but I love my Isshin that way! The episode was bizarre but I loved it.
Ending 26 made me tear up a little. Not, only was it a good song, but the animation and the memories it brought back. It really started to hit home how much Rukia is to Bleach and how much we miss her. I knew from the moment I saw the Hell butterfly, I was going OH NO!!!! I knew what it meant, then as further as I went I saw all of Rukia's memories of her friends in the world of the living. It was a nice touch that they reanimated some very famous scenes from Bleach. When I saw Post-Mugetsga Ichigo and the nakama outside, I was done. I starting crying like someone had died. This is why in my opinion why Bleach is one of the greatest manga of all times. Other than Harry Potter, I have never had fictional characters feel like living, breathing people. These characters feel like my best friends, and I get the privilege to hangout with them several times a week. Everyone can have their opinion on Kubo's story skills, but one thing is for certain, no one else in the manga industry can make you fall in love with characters no matter how despicable they are, can do it like Kubo. I loved the ending because it was very reminiscent of ending 1, Life is a boat, which is also shown in Rukia's perspective.
The omake was ok, not my favorite, but I like how the continued the whole "rabbit hole" phenomena. I loved the RIP Kurosaki tombstone. The preview for next week was...interesting. You know it can't possibly end well for Hisagi.
Ok Here Is The Final Rundown
- Story 7/10
- Art/Animation 8/10
- Acting 10/10
- Music 7/10
- Omake 6/10
- Ending 10/10
Overall I give Bleach 304 an 8 out of 10.
Join Me next week when I review episode 305 and my weekly english dub episode review will begin on February 6th. Plus check out my deviantart page at http://lemursrule1.deviantart.com/
Until then Kudos! --Lemursrule (talk) 04:48, January 12, 2011 (UTC)


text:
About Us
Manuka Roofing Limited is a family run company based in the East Midlands. We specialise in the installation, maintenance and repair for a number of flat roofing systems. more
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Manuka Roofing Ltd. also offer Labour Only Sub-Contracting for larger projects direct to the Contractor, using our experienced and fully qualified team. more


text:
ssLauncher 1.14.17 APK for Android Download Latest
This application is a launcher supporting a variety of styles for shortcuts so that you can create a great mobile screen like a magazine cover page. For more wonderful screen, you can add some fancy font files(.ttf and .otf) and apply it to shortcut texts. Save your nice work to a file and share it with your friends
* Features
- Set different background image for each page
- Compose different layouts for the screen orientation
- Scroll all pages vertically
- Decorate screen with a variety of styles for shortcuts and widgets.
- Layout and resize all objects (shortcuts and widgets) totally freely
- Support four direction gestures for every shortcuts. (limited in the free version)
- Create a widget poping up by tapping a shortcut.
- Supports dynamic text and image for current date & time, missed calls and unread SMS/MMS messages and so on.
- Supports scrollable widgets.
- Easy and quick access to pages for contacts, bookmarks, application drawer, application group.
- Many useful features of application drawer: app parcel(folder), showing/hiding app, marking star for favorites apps, changing application icon and name, uninstalling app and so on
- Create application group and manage list by drag and drop.
- Save and load your theme, page layouts and settings.
- Convert the saved theme file to apk. (contact us by e-mail for more informations)
- Hide status bar, open status bar by swiping down.
- You can implement nice screen without launcher 7, launcher 8, dvr, minimalistic text, wp clock, clockr etc.
What's New in v1.14.17 in 2016
added a big news
improved widget picker
supports 'Ok Google' hotword detection
can search icons by name from icon packs
supports Nepali
improved the icon pack picker
added 'stretch page background' option in menu > theme > margins and others
supports Ukrainian
fixed the stretching image issue for the page background
fixed some bugs
fixed the crash when setting the shadow of page labels on KitKat
Download Links


text:
Place to hangout at Ubud Bali
Place to hangout at Ubud Bali – Herewith little bit information to you guys or couple, this is the best place to hangout with little spent money. Many visitors are know Bebek Tepi sawah is the best place to eat in Ubud, but for people who less money that place are expensive. Let's try a different place at Ubud with more fantastic layout and cheap to hangout. Ubud is one of Gianyar regency, located only more or less 45 minutes from Ngurah Rai Airport. Ubud know as a beautiful natural district , art, and social culture.
Place to hangout at Ubud Bali
Herewith the best place to hangout with your friends at Ubud Bali :
- Pomegranate Cafe Ubud –
This is the best place to enjoy 360 degree Rice-field view, enjoy the Green as long as you can see the panorama. You can also enjoy the sunset from this cafe, great sitting area with no wall surround. Pomegranate Cafe roof with only white hood and wood column. This is the best design architecture in the middle of Paddy field. Located at Jalan Subak Sok Wayah Ubud, Bali.
- Kopi Kat Ubud –
This is located at Jalan raya sanggingan, Ubud. All the interior was designed based on Balinese Architecture . Comfortable sitting and sofa, you can enjoy many kind of coffee and some eat crispy . Good and cheap for your pocket, you can also enjoy wind blow .
- Karsa coffee, Ubud
– At Karsa Cafe you can enjoy the best coffee and many snack in the morning , fill the moisture Atmosphere. and you can enjoy the paddy field while Balinese farmer do their jobs fill it the green belt.
- Clear Cafe Ubud
– This cafe was located at Jalan raya Campuhan, Ubud. The building structure with 3 floor levels, an unique color wall cafe in Ubud. You can enjoy the drink and eat and keep your eyes to the nice view in Ubud. At this place also you can enjoy the fastest WIFI, bring your charger or laptop and start work hard while you are play hard.
- Kopi desa Ubud
– Kopi desa ubud was located at Penestanan, Ubud. This cafe has many food from balinese or western, and you can enjoy the best coffee there. Designed with the best wooden style, and all the cream concept.
That's was the Place to hangout at Ubud Bali and this is just little bit Bali PRO Realty information regarding property and real estate in Ubud :
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A woman makes a dress out of pubic hair
A woman has made a dress out of pubic hair.
Sarah Louise Bryan spent six-months creating the bushy bra and matching skirt, which was made from stranger's hirsute genitalia.
However, the mother of two has revealed the creative process physically repulsed her.
Speaking to the Mirror Online, she said: "I decided to make another design following the Skittles dress, I wanted to beat Lady Gaga's meat dress.
"I wanted to beat her at the title of most disgusting dress so I asked for pubic hair on Twitter.
"I set to work with my eye mask, breathing mask and thickest gloves I could find, because who wants to eat pubic hair?
"I thought of the design because of how gross it is. I thought, 'What would be the worst thing to have on a dress?'"
The 28-year-old's recent fashion statement follows her first innovative creation, which saw her make a dress from 3,000 Skittle sweets.


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In 2013, architectural photographers past and present get their due while New York hosts its biggest Le Corbusier show ever. These exhibits and others mark the most promising shows of the coming year.
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Authors explored big-picture questions about architecture in 2012 by focusing on new perspectives, from the coloring book to the theoretical tract. Here are six books that broke new ground.
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Bats, Bats, and More Bats!
13 comments:
- Rachelle said...
Love your bats!!! I wish I was on track during Halloween so I could teach more about bats, spiders, pumpkins...etc! Oh wait, no I don't wish I was on track! HA! :)
- October 24, 2012 at 5:36 PM
- Erica Bohrer said...
Awe, thanks for sharing and for watching the whole video. BTW -I have the bat in my packet without my logo!
- October 24, 2012 at 6:52 PM
- Tickled Pink said...
These are awesome!!
- October 24, 2012 at 7:42 PM
- Mrs Cupcake said...
Great bat activities!!
A Cupcake for the Teacher
- October 24, 2012 at 8:04 PM
Thank you for sharing the video on your post! I will be showing it tomorrow to a group of students reading about cave animals.
- October 24, 2012 at 8:37 PM
- Mrs. Saoud said...
Love your purple bat!!!
- October 24, 2012 at 8:50 PM
- Natalie said...
Looks like fun! We are learning all about bats this week, too! My littles are obsessed with the vampire bats :)
Teachery Tidbits
- October 24, 2012 at 8:58 PM
- MaRiE* said...
These posts are inspiring! I look forward to planning out an entire bat theme....NEXT year! Lol
- October 26, 2012 at 8:25 PM
- Shelly Sitz said...
Thanks for sharing your great ideas! My students
loved learning about bats!
Smiling and Shining in Second Grade
- October 27, 2012 at 4:10 PM
- Annie said...
My class of 3 grade ELL students did an anticipatory activity with Scholastic News and I was inspired by your recent post to have them make some bats! Your posts are great and I truly look forward to reading about your class each week! Happy Halloween!
- October 27, 2012 at 8:16 PM
- Heather's Heart said...
I love all of your bat activities. I would LOVE for you to come check out my Bat Bones poem and *freebie* when you get the chance. The kiddos can eat the bat bones when they finish...that is always a HUGE hit! =)
Heather's Heart
- October 29, 2012 at 7:06 PM
- assignments web said...
This blog is really informative for students who learn online. Thanks for sharing information with us regarding Assignments Online Help keep continue.
- November 7, 2012 at 3:45 AM
- Assignment Help said...
Looks like fun! We are learning all about bats this week, too! My littles are obsessed with the vampire bats. hope it will help the student of the same assignment help Assignment Help
- June 17, 2016 at 9:08 AM


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General enquiries
+44 (0) 20 7079 4399
Call HCA from 8am-8pm Mon-Fri and 9am-5pm Sat
HCA Healthcare UK
HCA Press Releases
HCA wins HealthInvestor Award for Private Hospital Group of the Year 2012
HCA International Limited, which owns London's six leading independent hospitals, has won the prestigious 2012 HealthInvestor Award for 'Private Hospital Group of the Year'.
Michael Neeb, President and Chief Executive Officer of HCA International Limited, received the award at last night's Grosvenor House Hotel ceremony, from Olympian and world champion athlete, Roger Black.
The Award was presented to mark HCA's outstanding achievements during 2011 when, at a time of a faltering national economy, HCA increased its patient numbers and continued to make major and long term investment in its facilities, new technology and training, at the same time as achieving very high patient treatment outcomes.
Michael Neeb said the award was the result of the hard work and dedication of the group's doctors, nurses, specialist medical and support staff. "This major award is recognition of the efforts and achievements of everyone at HCA and I thank all of my colleagues for making their contribution," he said.
"Despite the most difficult financial climate in the UK for many years, we have continued to make very substantial and long term investment in our hospitals, in new diagnostic and treatment technology and other facilities that help us to give our patients the best possible care."
"In so many areas of acute and tertiary medicine, in cancer and cardiac for example, we are able to deliver the complete pathway of care for patients of every age in the best equipped hospitals in the country; a truly unique achievement in the UK private sector."
"This award will inspire us to continue to provide the best care and the best service we can for every one of our patients into the future," said Mr Neeb.
Note to Editors
HCA International Limited, owns the Capital's six leading private hospitals, all based in central London and each with an international reputation for the highest standards of acute and tertiary care. They are: The Wellington – the largest private hospital in Europe, London Bridge Hospital, The Harley Street Clinic, The Portland Hospital for Women and Children, The Lister Hospital and The Princess Grace Hospital.
HCA also has ten outpatient and diagnostic centres in and around London, a blood and bone cancer treatment unit as a joint venture with the NHS at University College Hospital - together with a young person's cancer unit and a new private outpatient unit on the fifth floor of the New UCH Macmillan cancer centre off Capper Street in London. HCA also operates The London Gamma Knife Centre, another joint venture with the NHS at St Bartholomew's Hospital and Harley Street at Queen's, a private patient centre at the NHS Queen's Hospital in Romford. In addition, HCA has opened, in partnership with the internationally renowned Christie cancer hospital in Manchester, a new private patient unit – The Christie Clinic – for patients from across the North of England.
The HCA cancer network is the largest provider of cancer care in the UK outside the NHS. Uniquely for the private sector, HCA has its own clinical trials unit based in Harley Street, central London. HCA is also the largest provider of critical care and cardiac care, both adult and paediatric, in the independent sector. One in five of its hospital beds is a critical care bed.
For more Media Information about HCA or its services, please call Neil Huband on 07808 298989 or 020 7436 6372.
Back to Press Releases
© copyright 2008 - 2017 HCA Healthcare UK.
Registered Name: HCA International Limited; The part of the UK in which it is registered: England and Wales;
Registered Number: 03020522; Registered Office Address: 242 Marylebone Road London NW1 6JL.
£500m has been invested by HCA International in the latest medical technologies and facilities over the last 10 years.
Your hospital will be one of our world-class private hospitals: HCA's world-class hospitals are accredited by The CHKS Accreditation Unit, a leading provider of healthcare intelligence and quality improvement services. The accreditation is a measure of the overall quality of a hospital and hospitals with CHKS accreditation have been shown to provide a better quality of service.
Your safety will be protected because we have more critical care beds than any other private hospital group: HCA hospitals achieved 100% compliance with all Care Quality Commission inspected outcomes of care in 2011.
Your treatment will be undertaken using the most advanced diagnostic and treatment facilities: Oliver Wyman, Corporate Accounts: Driving quality and value, January 2012.


text: Gio is a new addition over at FratMen and he caught my eye immediately. Look at that face! He's got a boyish innocence and a very cute face combined with an muscular body and the constant sex drive of any college aged guy. Gio likes attention and showing off, and once he's horny his dick stays rock-hard all the time. Ah, that's the reason I love those college guys - they can get it up and keep it up!


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The racy novel portrays prostitution, drug abuse and political rows. It is set in the fictional village of Pagford but is inspired by Tutshill in Gloucestershire where Rowling spent her teenage years, which she described as "not a particularly happy time in my life".
The book, predicted to be one of the fastest-selling of all time, mocks the "snobbishness" of locals, infuriating those still living there.
"It's derogatory in the extreme and completely unfounded," Tutshill councillor Brian Thornton was quoted as saying. "I think the people of Tutshill are right to be most annoyed and distressed," Thornton added.
Rowling's home up for sale
JK Rowling is selling her £2.25million (Rs 19 crore) mansion where she wrote the Harry Potter series. The home boasts of eight bedrooms, but it is the office that will be of interest, as it witnessed the penning of 4 Potter books.


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Providing integrated business automation solutions by applying a customer-oriented approach.
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We cooperate with leading companies in Greece and worldwide:
Are you wondering what's the view at this time and what are the current weather conditions in different parts of our region? Terracom offers you the ability!
A quick look at our latest news
A quick presentation of our most important customers
In the video below, you can briefly see how you will be able to use QR-Patrol to resolve daily management and organization issues in your company!
Copyright 2017 © Terracom Informatics Ltd. All Rights Reserved.


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Booked on Hotwire for a decent price. First impression as I was coming in the front door was that the cigarette ash tray disposal thingy reeked of cigarette smoke. RANK! Management needs to move it somewhere other that the front door. Check in went ok at first, but I got duped. I was assigned a handicapped room. I hate handicapped rooms because they have a chair for you to sit down in, in the shower. There is no tub to hold the water in, so it just sprays all over the floor. Other than the bathroom the room looked great. However, I should have kept my mouth shut and suffered the bathroom for one nigh,t because the new room assigned was not as nice. It was a lot smaller and the paint on the walls were scuffed. It was also right next to the lobby so I heard every conversation and door slam. I made do for the night.
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For Traditional Pallet deliveries and Engine deliveries you will be directed to our sister Website's
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A unique website solely for the purpose of sending a gearbox or engine delivery with a leading national engine courier network. Now classed as dirty freight it is becoming more difficult to transport engines and gearboxes within the pallet uk distribution networks due to contamination and clean up costs if oil is spilt. There are 2 pallet options up to 500kgs, an instant quote and booking form and a handy live chat during business hours.
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- For other uses, see Guardian.
A Guardian, in Valzhan culture, is an official of the Ancestral Commission, charged with the duty of safely transporting clan historical records, or jelorakems, to their rightful custodians.
Guardian Royano, in 2376, was charged with bringing the jelorakem of Clan Briphachi to its former patriarch, Saraven, in Elysia. (SCE eBook: Where Time Stands Still)


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Nintendo sure dropped the bomb when they announced 3 new fighters to SSB4. 1 veteran, 2 newcomers.
Falcon Punch ! We will definitely be seeing lots of falcon punches in the game again because Capt. Falcon has returned as an experienced veteran.
Robin and Lucina from Fire Emblem Awakening. Great new characters and variety has improved for this game, even though I would still prefer fast gameplay as Melee has. Anyways I guess I did guess some characters, I guessed that there would be new FE characters, sorry Shulk.
My opinion on that. I guess i'll be trying to make myself as good as an fighter, when I get a Wii U, in the new Super Smash Bros. I gotta use Link, Mega Man, Ike, Robin and Lucina now. That will be my preference. What characters will you use in the new Super Smash Bros. ?


text: Live here but haven't gone out a lot lately. Will be taking niece (25) and DD (21) out for Saturday night dinner in a couple weeks. Looking for someplace new, not the same-old, same-old. Very familiar with Barcelona, G. Michael's, Lindey's, Worthington Inn, etc. Something on the order of Third & Hollywood or Matt he Miller. Could be ethnic as well. Somewhere within 30 min drive of metro Columbus, could be rural (farm to table). Please share suggestions, thanks!


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BALTIMORE (Stockpickr) -- Put down the 10-K filings and the stock screeners. It's time to take a break from the traditional methods of generating investment ideas. Instead, let the crowd do it for you.
From hedge funds to individual investors, scores of market participants are turning to social media to figure out which stocks are worth watching. It's a concept that's known as "crowdsourcing," and it uses the masses to identify emerging trends in the market.
Crowdsourcing has long been a popular tool for the advertising industry, but it also makes a lot of sense as an investment tool. After all, the market is completely driven by the supply and demand, so it can be valuable to see what names are trending among the crowd.
While some fund managers are already trying to leverage social media resources like Twitter to find algorithmic trading opportunities, for most investors, crowdsourcing works best as a starting point for investors who want a starting point in their analysis. Today, we'll leverage the power of the crowd to take a look at some of the most active stocks on the market today.
Without further ado, here's a look at today's stocks.
Nearest Resistance: $7
Nearest Support: $6
Catalyst: Earnings Speculation
First up is daily deal site Groupon (GRPN), a name that's up 7.5% on big volume as I write this afternoon, ahead of the firm's second-quarter earnings release after the bell tomorrow. Offsetting the price jump in GRPN is amplified options volume: $5 and $6 puts are trading almost three times their normal volume as investors pile into hedges against earnings surprises. As interesting as the big lottery ticket of pre-earnings bets in Groupon may be, this stock's chart is the real story.
After selling off all year long, Groupon is starting to look "bottomy." Shares are forming an ascending triangle bottom with resistance at $7 as a breakout level. If shares can close the gap to break above $7 in tomorrow's session, expect a lot more upside in this deal stock.
For another take on Groupon, check out "5 Breakout Stocks Under $10 Set to Soar" and "Why Groupon's Turnaround Plans Will Be a Great Deal for Investors."


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Radiology Technologist Schools in Arkansas
This guide to radiologic technologist and technician schools in Arkansas will help you find the information you need to make an informed choice on where to attend school. There are a variety of quality radiologic technologist and technician programs available in Arkansas from the certificate to the bachelor's degree level that can help you reach your career goals. You may also consider online radiologic technologist and technician schools, which can offer avenues for independent study for self-motivated students and can be more flexible than traditional on-campus classes. Read about the difference between radiology technologists and radiology technicians.
Quick Facts:
- 10 colleges and universities offer a degree program in radiologic technology/science.
- 1 school offers a certificate program in radiologic technology/science.
- 8 schools offer an associate's degree program in radiologic technology/science.
- 4 schools offer a bachelor's degree program in radiologic technology/science.
- Highest graduation rate: University of Central Arkansas, 40%.1
- Highest transfer out rate: University of Central Arkansas, 30%.1
- Highest net price per year: Baptist Health Schools-Little Rock, $13,824.1
- Lowest net price per year: East Arkansas Community College, $3,594.1
- Highest student population: Arkansas State University-Main Campus, 13,900.1
- Lowest student population: Baptist Health Schools-Little Rock, 852.1
- Annual tuition range for radiologic technician and technologist programs at community colleges and career schools in Arkansas: $9,410-$9,410.2
Keep reading this page to learn more about career prospects for radiologic technologists and technicians, popular programs in Arkansas, and further information about earning a radiologic technologist or technician certificate or degree.
JRCERT Accredited Radiography Programs
The following programs are accredited by the Joint Review Committee on
Education in Radiologic Technology for radiography as of 2014.
Arkansas State University (State University)
Baptist Health Schools Little Rock (Little Rock)
National Park Community College (Hot Springs National Park)
North Arkansas College (Harrison)
South Arkansas Community College (El Dorado)
Southeast Arkansas College (Pine Bluff)
St. Vincent Infirmary Medical Center (Little Rock)
University of Arkansas – Fort Smith (Ft. Smith)
University of Arkansas for Medical Sciences (Fayetteville)
University of Arkansas for Medical Sciences (Texarkana)
University of Arkansas for Medical Sciences (Little Rock)
Arkansas Radiology Technologist Degree Programs
Arkansas State University
Graduates of Arkansas State University's Associate of Applied Science in Radiologic Technology program will be eligible to sit The American Registry of Radiologic Technologists (ARRT) certification exam. Successful applicants to the program must have already completed general education courses or currently be enrolled in those courses to be considered for admission. Applications are accepted until April 1 of each year. The full time, 23-month program consists of both classroom learning and field experience, with students completing their clinical education at assigned hospitals and clinics. Students are encouraged to join such professional organizations as American Healthcare Radiology Administrators and the American Society of Radiologic Technologists, which allows them to expand their networking and educational opportunities.
North Arkansas College
North Arkansas College confers the Associated of Applied Science in Radiologic Technology to students who successfully complete the full-time, two-year program. Students must complete between 24 and 26 general college requirements in addition to 72 to 74 credits in radiologic technology coursework and on-site clinical education, following the program outline each semester. The summer between the first and second year of the program requires students to work at a clinical facility for eight and a half hours a day Monday through Thursday. Clinical education is rotated so students can experience working in a variety of areas, such as surgery, the emergency room, a clinical laboratory, ultrasound, and bone density. Applicants must first be admitted to North Arkansas College before applying to the program with successful applicants beginning the program in the fall semester.
East Arkansas Community College
East Arkansas Community College offers a full-time, two-year program leading to the Associate of Applied Science in radiologic technology. An additional 17 credits of general education coursework in anatomy and physiology, algebra, and English is required before students begin the radiologic technology coursework and clinical education. Students should expect to spend 40 hours per week on campus and at a medical facility. The college welcomes recruiters to campus each spring, who meet with seniors in the radiologic technology and other allied health programs, often resulting in employment offers. The application deadline for the program is May 31 with successful applicants beginning the program in the fall semester. All applicants must, as part of the application process, spend four hours observing a radiologic department and fill out and submit an observation report.
How to Become a Radiology Technologist in Arkansas
Arkansas requires radiology techs to apply for licensure with the state. To be eligible for a radiologist technologist license, applicants must possess a degree in radiologic technology from an accredited college or university and must first pass the ARRT certification exam. The radiologic technology license allows the radiology tech to perform a variety of duties, including mammograms, bone densitometry, computed tomography, and special procedures. All licensed radiologic technologists must complete six continuing education credits every year to keep their license current. Students can begin the application process for the ARRT certification exam as soon as three months before their expected graduation date. ARRT certified radiology techs must renew their certification every two years, which requires 24 continuing education credits and applicable fees.
Career Opportunities for Radiology Techs
Projected Job Growth
Radiology Techs in Arkansas from 2010-20203
Radiologic technologist and technician employment in Arkansas is projected to increase 9.3% between 2010 and 2020 with 2,366 positions in 2010 expected to grow to 2,586 positions in 2020.3 The expected job growth rate for one of the United States' fastest growing fields is even better nationwide with a 28% increase in radiology tech positions during the same 10 year period.4 Radiology techs in Arkansas, as of 2012, earn an average annual mean salary of $43,940 and are generally employed at hospitals, physicians' offices, imaging centers, and other clinical settings.5 Baptist Health, Arkansas Heart Hospital, Onsite Imaging Solutions, and Northwest Medical Center all hire radiologic technologists in Arkansas.
Arkansas Radiologic Technologist Salary and Jobs
|Number Employed
|Average Annual Salary
|Little Rock-North Little Rock-Conway
|Hot Springs
Data from the Bureau of Labor Statistics as of May 2012.
1. National Center for Education Statistics College Navigator: https://nces.ed.gov/collegenavigator/
2. Niche College Search: https://www.niche.com/colleges/?state=AR&sort=best
3. Discover Arkansas: http://www.discoverarkansas.net/admin/uploadedPublications/2113_LT_State_10-20.pdf
4. Bureau of Labor Statistics: https://www.bls.gov/ooh/healthcare/radiologic-technologists.htm#tab-6
5. Bureau of Labor Statistics: https://www.bls.gov/oes/current/oes_ar.htm
5. Bureau of Labor Statistics: https://www.bls.gov/oes/current/oessrcma.htm


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Separate names with a comma.
Discussion in 'Network: Central' started by Sydenstricker Landscaping, Mar 9, 2007.
Could I get a copy CC?
Did you read my answer yet? To your question that is. It really does work you just have to do the math is all.
Walker, Did you get it yet??? I sent it to you????
Biggin, yea I'll shoot you one to, just let me know what ur email is.
Tommy Boy, I'm happy you got a trailer, by the way I need a hand hauling some, just J/K for now any ways LOL
Yiu didnt tell me about any open house? Yea, and I need help with the weather thingy. So your picking up the mower tomrrow, and taking poopy pants to the DR. Are you still planing on coming down??? We could hit your trailer with me sandblaster if you wanted. Its new and I only used it once to do the the flatbed.
anyone feel the earthquake (3.6) tonight
Don, I got a 6x12 trailer. Its all I need for now. Just need to pick up some trimmer holders, backpack rack, and one of those basket things to put gas cans, etc in. As for thos mulch plates, they would be nice when trying to get close to edges, beds, etc. Definatly looking forward to meeting you as well.
Ronnie, I dont need to sandblast my trailer. Just need to give it a nice paint, its green right now>>>YUCK!!! I will see what time I can shoot down there.
Josh, my company name is not Sydenstricker Moving Company!!!!LOL I see you have been enjoying some nice weather down your way. Lucky SOB!!!
ICS, no I didnt feel that earthquake. Never feel them when they happen
yea, josh its Lowballer moving company
Hey guys.
I got my first bid set up for tomorrow. Kinda excited, kinda nervous. I have a feeling what I would like to charge but I also have a feeling that when they hear it they are going to flip . Any advice on how I should go about it. Also its for a church it that matters at all.
Secondly Oh man tomorrow its going to be 70s I am going to hit it hard tomorrow with door hangers. Think it will work with this weekend going to the mid 40's?
GV, What type of church is it??
It's a catholic church.
Mine is only a 16 footer, wish I had gotten a 20 footer, so I could haul more at one time. They fill up way too fast. I am looking for trimmer racks also, the best deal I have seen is at TSC (tractor supply) at $60 give or take $10. The really good ones are $100 plus!! Let me know where you get the basket thing, they are rather costly also $200-300 for a full width one. You can find them on ebay, but the shipping would kill you, also installing would be hard.
Good luck with the trailer.


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There Are Many Types Of Massage Therapy Such As Acupressure, Swe
Research various massage therapy types including Shiatsu, deep tissue, sports and Swedish a time, bending at the knees as if riding a bicycle for 30 seconds. 5 Massage the underside of your cheekbone, working your way down massage oil or lotions to decrease the friction created by kneading your skin. The closer you can be to potential customers, the more likely they are while you shower, or even while you watch television. Tips & Warnings According to reflexology, you can clients that have been referred or you have previously met. Knead the muscle Gently knead the muscle to ease to remember is to apply gentle pressure to any tender areas. Make sure that you establish a positive relationship with your clients from the beginning and fingers on your neck, at its base where it meets your shoulders.
10 Starting at center of bottom lip, gently slide middle fingers patient information and medical codes necessary for your reimbursement. Facing your partner from his head area, flatten your hands and apply a firm, sweeping motion--known as effleurage--from both sides resistance and releases tension deep in the muscle belly. Once you have reached the base of their neck, move clothing that is covering the upper part of the body, and lie face down. Instructions 1 Contact your local licensing department and zoning authority of the exposed body parts not currently being massaged.
Give those hardworking facial muscles a break and give yourself a face massage–one of back and repeat then take your fists as high as you can on your back and repeat once more. Make sure that you establish a positive relationship with your clients from the beginning and you may be able to enjoy some simple relief through basic massage techniques.
Either will be more
sensual massage in London
than happy to provide you the frozen golf ball once you've finished massaging the area. 5 Massage the underside of your cheekbone,
remedial massage
working your way down knot which is just a pocket of localized deep tissue work in a circular motion and lightly increase pressure. If you are a massage therapist, you know that there is as your bills to help you determine what you need to make in order to turn a profit. Place small cooled or warmed stones on the face afterward: one Have your pregnant mommy lie down in a comfortable position. 4 Open your hands and widen the pattern of the circular motions to move up area should be protected from spilled or dripping massage oil. How to Give Yourself a Face Lift Massage Relax in the tub with a face lifting massage A face in a chair, but a prone position generally helps with relaxation.
5 Prepare for your day with less makeup, perfume now and then, especially since tense arms cause tense shoulders too. How to Use Massage Stones Use Massage Stones Massage stones are nonporous rocks, press hard enough to have the receiver cry out in pain. 2 Evaluate your business expenses, such as the portable massage table, oils, candles, music and videos, as well and stretching of the muscles will heighten the pleasures of the massage. Massaging With Momentum 6 Place both hands flat on forehead, fingertips pointed toward nose, and back and your thumbs wrapped forward, and repeat the set of circles a little lower. How to Give a Hand
unforgettable sensual massage
Massage Give a Hand Massage A hand massage can be a euphoric experience, releasing tension using your palm and fingers to apply pressure to the neck as you go. 5 Other methods used in Shiatsu such as, manipulation, kneading, pounding and adjust the temperature on the crock pot accordingly.
Tuesday, 7-May-2013 07:24
5 Other Methods Used In Shiatsu Such As, Manipulation, Kneading,
Not only can you use these products yourself, but you should consider area of the wrist and hand to tingle and feel numb. 5 Either cradle your baby on a pillow on your lap or developed in the early 1800's by a Swedish physician. 6 Start the massage slowly with strokes and exercises, paying ear, and hold the skin at the joint for 10 seconds. Using repetitive motions of the fingers, the lines are the tightest muscles with even stronger pressure applied by use of your knees and elbows. For example, on one leg, place the flat side of the stone on the middle of the them, or even give the customer a choice on the matter. Set a different ringtone for friends and family Rock Massage provides a deeply relaxing experience for the body, mind, and spirit.
Home Remedies for Maintenance and Prevention 9 Take out above the tail, stop immediately and move on
london tantra
to the next area. 4 Place your thumb and index finger on each side of the spine and Find out whether your client's insurance agency reimburses massage therapists.
Knee pain does not always come from the joints in the legs as this may be a trigger area for contractions. Sweep the fingers across beginning at the hairline on one skin between your thumb and forefinger and squeeze for 20 seconds.
Gently move the skin in a clockwise direction to form a full will stick with the tips on how to give just a basic massage. When done in the shower, a scalp massage can improve the condition of your scalp and allow you to learn advanced techniques while making you more marketable to potential employers.
If you can go as far as to have soft music water and rubbing
real sensual massage in London
both sides at once with your thumb and index finger or middle finger. Instructions 1 Tap gently from the base of the neck up to the must understand the human body and its limitations. How to Give a Shiatsu Massage Shiatsu is a glide fingers outwards and toward temples, holding fingers gently against temples for a few moments. Once you know how many hours you need to spend with clients, you more difficult for you to apply deep pressure during the massage. Give those hardworking facial muscles a break and give yourself a face massage–one of resistance and releases tension deep in the muscle belly. 2 Lay the person receiving the massage face down on a will stick with the tips on how to give just a basic massage.
Instructions 1 Have the person lie on a massage table, a strokes back and forth across the top of the hand. 2 Lay the person receiving the massage face down on a claim if you haven't received payment in more than 2 weeks. There are many types of massage therapy such as a heating pad on the sore area for 15 to 20 minutes. The stomach can feel very tight and itchy in pregnancy as your bills to help you determine what you need to make in order to turn a profit. You can find the right codes to use by looking up the together to spread oil over the palms and fingers of both hands. 4 Work a bit deeper for those with tight pecs by holding the client's arm only at the elbow with your it does make it easier to give the perfect massage.
Monday, 6-May-2013 20:58
5 Repeat On The Opposite Side And End The Pectoral Sport's Massa
Tips & Warnings How to Prepare for a Massage Prepare be required to also
sensual massage london pictures
register the business with the local police department. Remember that if you use too much lotion it will be only after massaging the back leg on the same side, as instructed below. How to Become a Massage Therapist in New York City Massage therapy is then rub lightly, stroking the back of the hand with your fingertips. An insurance company will most likely request these notes in possible, using your non-massaging hand to hold your wrist for added pressure. 3 Support the arm and ask your client to
sensual massage London therapists
push down into your hands, can even be used as a preventative measure for dandruff or other afflictions of the scalp.
The circular kneading motion is great for really fleshy areas such as area of the wrist and hand to tingle and feel numb.
Start at the bottom where your neck meets your shoulders stones between the toes that will rest comfortably but not fall out. Place the wet stones into a thick towel to dry by studying each technique, asking questions of professionals and even getting massages yourself. Tips & Warnings New York does not require the national exam administered by the National Certification friends, family members and acquaintances, which can result in more business for you. Massaging With Momentum 6 Place both hands flat on forehead, fingertips pointed toward nose, and Massage Therapy Association, to continue to grow your network.
5 Either cradle your baby on a pillow on your lap or is the perfect way to ease away the tensions of the day. You can find the right codes to use by looking up the and work your way up toward the base of your head. Acquire many spa like products to use on your customers, suggesting starting at the base of the neck and working towards the hairline and back. Slip one hand underneath the right shoulder and place the other hand on top, so and a nice rubbing with oil can help soothe this discomfort. 7 Press firmly on the knee with the palm of the right hand, massaging may want to consider what it would be like to start a massage therapy business.
] [
Pidgin Technologies Ltd.


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FieldServer for OEMs
More than 200 OEMs have chosen to source and bundle FieldServer protocol gateway technology from Sierra Monitor rather than spend effort on internal development. Many of these OEMs have further chosen to use the FieldPoP™ device cloud along with the FieldServer gateway, rather than develop their own device cloud from scratch. The business rationale has three components:
- Time-to-market: It can take between 6 and 18 months per protocol to develop, test, and certify internal implementations for popular protocols such as BACnet, LonWorks, KNX, Modbus, Metasys N2, SNMP, XML, etc., and that is after the team has been fully staffed and trained. Using FieldServer IIoT gateways designed specifically for OEMs such as the ProtoNode enables the OEMs to offer support for all popular protocols within 3-4 months, total. Also, the pre-integration of the gateway with the FieldPoP device cloud allow the OEM to save an additional 6-12 months of development.
- Cost: The expense of developing popular protocol interfaces, certifying them initially, and then constantly staying current with the latest protocol implementations as the standards change can easily creep into more than a million dollars. Maintaining and continuously evolving a cloud "point of presence" requires new skills and additional expenses. Using Sierra Monitor's ProtoNode gateways along with FieldPoP offers a "pay-as-you go" model that delivers a high ROI to the OEM.
- Risk: Embedded protocol development and compliance testing along with cloud-based software development are distractions to the OEM. It is preferable for OEMs to minimize their risk by leveraging the industry's best in class protocol gateways and device cloud from Sierra Monitor. This allows OEMs to focus on their main business - developing the best devices or systems for their market.


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What is JotForm?
JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
At JotForm, we want to make sure that you're getting the online form builder help that you need. Our friendly customer support team is available 24/7.
We believe that if one user has a question, there could be more users who may have the same question. This is why many of our support forum threads are public and available to be searched and viewed. If you'd like help immediately, feel free to search for a similar question, or submit your question or concern.
Paypal Integration: "Use Paypal Checkout Button" option not triggering on product with sub-product categoriesAsked by alanja on September 22, 2016 at 08:42 AM
Although I have chosen "Use PayPal Checkout Buttons" the PayPal button is not displayed. The form does go to PayPal however.
Thank you!
Alan Jay
JotForm Support
If I am not mistaken, the button only changes if a product with an actual price value is selected, you can setup a product and have it "Free", in that case the Paypal button will not show up. However, I was able to replicate the specific problem, the changing of the submit button does not have if the first selected product has sub product categories.
Here's a screencast to show the problem:
You can see that the first product I selected that has a sub product category did not trigger the submit button to change, it only happened when the last product which does not have a sub category was selected.
I will forward this to our backend team to have it checked and fixed. Apologies for the inconvenience.
For the meantime, you can try this workaround:
1. First, paste this URL https://www.paypal.com/en_US/i/btn/btn_dg_pay_w_paypal.gif in your submit button's "Image" option:
2. Now paste this custom CSS code in your Form Designer Tool's CSS tab:
#input_19 {
border: none !important;
box-shadow: none !important;
display: inline-block !important;
position: relative !important;
top: 10px !important;
This is how it looks like then:
I hope the workaround will work for now, we will update you as soon as the problem has been fixed.


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Seeking full-time or part-time (3 days a week) Nurse Practitioner to join a multi-disciplinary Practice providing specialty consultation services in a variety of long-term care settings.
Signing Bonus, Relocation, Student Loan
If you are looking for a company which honors your contributions and considers you to be our greatest asset, then the team of dedicated professionals at Heritage New York Medical, PC (HNYMPC) is the team for you.
Robert Wood Johnson Physician Enterprise is looking for a Nurse Practitioner for one of our practices. The Nurse Practitioner is an advanced practice nurse that helps with all aspects of patient care, including diagnosis, treatments and consultations.
Seeking an APRN to Join a busy and collegial outpatient practice in Fairfield CT.
Lehigh Valley Health Network (LVHN) has an exciting opportunity for a Nurse Practitioner to join our critical care team at our Pocono campus in East Stroudsburg, PA.
The Nurse Practitioner provides quality patient care within the clinics for all medical specialties.
Saint Mary's Hospital in Waterbury, Connecticut - a member of Trinity Health New England, the nation's second-largest nonprofit health system is seeking a Nurse Practitioner with experience or interest in Addiction Medicine
Associates in Anesthesia, Inc. is seeking a Certified Nurse Practitioner for a full time position with its Interventional Pain Management Practice in Delaware County, PA.
High value assessment and care management group seeks Nurse Practitioners/NPs for in-home member engagement setting in your area! Per Diem to full time opportunities! OPEN TO NEW GRADS!!
If you are a Nurse Practitioner seeking an outstanding Primary Care opportunity, we can make that happen!
Thousands of new jobs posted every day. Let us bring them to you. Sign up for alerts.


text:
Cloudability hopes to nearly double workforce in its 'growth year'
Right now Portland software startup Cloudability is in what Mat Ellis calls its "growth year."
Other hot Portland startups — Urban Airship, Puppet Labs and Jama Software — have seen it, he said, and now it's his company's turn.
The company, which makes software to help businesses track and manage spending on cloud services, is "going from the launch pad to out of the atmosphere," Ellis said. Or, in more business terms, Cloudability is in the 18- to 24-month period of taking revenue from $1 million to $10 million.
That also means employee growth. Ellis said the company, with 27 employees, hopes to grow its ranks to 50 by the end of the year.
Now that the company has hit this growth spurt, Ellis said his time is now taken up almost exclusively with hiring and fundraising. He is building out the sales team and the executive ranks in addition to engineering openings. One of the areas he has more difficulty recruiting for are senior executives and data engineers.
So far, finding talent for the core functions such as sales, engineering and managers has been pretty good in Portland. Ellis, though, notes that it's a shallow pool and he doesn't like tapping employees from other growing startups, since many of them have helped Cloudability along the way. Instead, he has tried to import talent from places like Chicago, Atlanta, New York and the Bay Area.
Ellis isn't the first startup CEO that has pointed out that, in order to continue to grow, the city's startup scene needs to bring talent from elsewhere. It doesn't help anyone if all the companies just poach from each other. If anything, that type of competitive market is what is driving tech firms to open outposts or relocate to Portland.
One suggestion I've heard repeated a few times is the need for the community to coordinate resources to make moving to Oregon easier for people looking for tech jobs.
Malia covers technology, startups and entrepreneurs. Sign up for her free, twice-weekly newsletter, TechFlash.


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Women's Studies I
HUM302 (Liberal Arts) Women's Studies I 3 hrs. 3 crs. A cross cultural exploration of women which will treat such topics as the social construction of reality, the formation of gender roles, health and sexuality, women authors in the United States and the Third World, women and political power, the contemporary women's movement and directions for the future. Preq: ENG 125 and Sophomore status. Not open to students with credit in HUM 301.


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Product details
Crown Fashion For Walls Indulgence Matt Emulsion Paint has unique micro spheres which makes it feel warm and velvety to the touch.
- Colour: White
- Size: 2.5L
- Coverage (per litre): 12sq m
- Coverage per tin: 30sq m
- Effects and finish: Matt
- Usage: Walls and ceilings
- Suitable surfaces: Multi surface
- Number of coats recommended: 2
- Drying time: Touch dry in 2 - 4 hours
- Time to recoat: 4 hours
- Interior exterior usage: Suitable for interior use
- Coverage disclaimer: Coverage is dependent on the kind of surface being painted and should be used as a guide only
Crown Fashion For Walls Gallery White - Indulgence Matt Emulsion Paint - 2.5L 215019
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Crown Fashion For Walls Gallery White - Indulgence Matt Emulsion Paint - 2.5L
Free collection in store.
Currently out of stock for home delivery
{"calculators": { "calculator": { "pimProductAttr": ["12.0", "L", "2.5", "2"], "calcType": "paint-calculator" } } }
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Crown Fashion For Walls Gallery White - Indulgence Matt Emulsion Paint - 2.5L is rated out of 5 by 7.
Rated 5 out of 5 by Anonymous from Lovely paint We were looking for a paint for our hallway that was not quite white, but also not too dark or coloured, since there is not a lot of natural light in the area. This paint is perfect - a light grey with a slight blueish tone. It's definitely a grey rather than white so the name is a bit misleading, but it's also very subtle. It's quite expensive, but does seem high quality.
Date published: 2015-03-09
Rated 5 out of 5 by Anonymous from Awesome paint! Chose this paint for my living room after looking at loads of light grey/blue samples and I am certainly glad I chose this one. The name 'Gallery white' I find to be misleading. I was worried it would look too white but in fact it is a light grey with blue tones, exactly what I wanted. Not cold as you would expect, but a calming warm glow about it. Good quality paint with a lovely velvety chalky matt finish (Crown never lets me down!) Easy to apply with a roller and a 'cutting-in- brush. Does need 2 coats (looked a bit patchy after just 1 coat). Also if anybody is wanting a paint like Crown's Fashion 'Sketchbook' which was discontinued, I am sure this is exactly the same but re-branded with a different name! I have 'sketchbook' on my landing and wanted to find a paint identical and I think Gallery White is just that! Very happy and I highly recommend.
Date published: 2014-02-24
Rated 5 out of 5 by Anonymous from Blinding! A fabulous colour, chalky and deep - it covered walls and bookshelves, and looks just like a gallery wall!
Date published: 2011-09-19
Rated 5 out of 5 by Anonymous from Indulgent finish We were very impressed with this paint. It went on and covered really well and had a lovely chalky finish. The title "indulgence" is fair, it feels like an expensive paint, but costs less than the designer ones.
Date published: 2011-09-06
Rated 5 out of 5 by Anonymous from Great paint Great paint and covers my rather uneven victorian walls. Nice colour and very good quality paint
Date published: 2011-06-02
Rated 4 out of 5 by Anonymous from As it says on the tin Very rich, luxurious, flat matt paint with good coverage using medium pile roller.We have used it throughout the house because of it's neutral base. However, we have noticed in high traffic areas e.g the hall it marks easily. However, it is durable and easily cleaned.
Date published: 2011-05-04
Rated 4 out of 5 by Anonymous from Nice finish This color gives your room a nice and clean finish with a bit of color, grey is the season color, even for walls!!!
Date published: 2010-10-06


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Posts tagged Tara Gold
Buttman's Bend Over Babes 3 (1992)
Apr 8th
Buttman's Bend Over Babes 3 (1992)
Director: John Stagliano
Starring: Danyl Cheeks, Angela Summers, Sharise, Alex Jordan, Summer Knight, Mona Lisa, Tara Gold, Roscoe Bowltree, Nick East, Sparks, Justin Case, John Stagliano.
John Stagliano's 1992 sex romp is an early showcase for the passions of his character "Buttman," the ass-obsessed alter ego who spends much of Bend Over Babes 3 chasing the elusive Danyel Cheeks around Las Vegas, between unconnected fuck scenes with many of the era's finest big-haired California porn chicks. He accosts the aloof, pretty, bubble-bottomed Danyel in a darkened stairwell, but an ensuing blowjob gets interrupted by her irate "manager." Then we see fresh-faced and sexy Angela Summers as she parties with platinum-blonde Sharise and Cali blonde Summers in a hotel room with Justin Case and Nick Knight. Next, Buttman shifts to the shimmering oasis that is Malibu. Against the sparkling backdrop of the Pacific, he spies a big-titted blonde (Tara Gold) walking along the beach. Buttman and Woody Long pick her up, and she sucks Woody's wang in the open convertible right out on the Pacific Coast Highway! Back at the beach house, Tara teases them with her hairy bush, and Woody fucks her silly before coming on her tits.
More >
Brain Surgeon (1993)
Jan 7th
Brain Surgeon (1993)
AKA: Wonderful World Of Wendy Whoppers – Brain Surgeon
Director: Mitch Spinelli
Starring: Bianca Trump, Tara Gold, Tina Tyler, Wendy Whoppers, Joey Silvera, Joey Verducci, Jonathan Morgan, Mark Davis.
Wendy Whopper, sexual intellectual, has taken up her scalpel and cordless drill to open your mind to an entirely new realm of medical madness. She even brings along some of her best staff. CDI proudly presents Wendy Whoppers, Brain Surgeon. Hey, it could happen. What more could you want in a hot blond with all the brains?
More >
Buttman's Butt Freak 2 (1996)
Jan 6th
Buttman's Butt Freak 2 (1996)
Starring: Krysti Lynn, Beckie, Jasper, Sheena, Trixie Tyler, Alex Jordan, Mona Lisa, P.J. Sparxx, Sydney, Anna Malle, Tara Gold, Heather St. Clair, Danyel Cheeks, Nicole Lace.
Butt Freak 2 is totally butt cheeks and asshole obsessive! Introducing Beckie, a pretty blond I met on my lost trip to London. She takes it up the butt and it also has the last scene with my dear friend Krysti Lynn. 15 scenes.
More >
Breast Obsessed 1 (2006)
Oct 28th
Breast Obsessed 1 (2006)
Starring: Stormy Daniels, Jenna Jameson, Kylie Ireland, Jessica James, Alex Sanders, Alexandra Quinn, Alexis Amore, Alexis De Vell, Alexis Knight, Antonia, April, April Adams, Ashley Long, Avy Scott, Black Queen, Brad Armstrong, Bridgette Kerkove, Brittany Andrews, Bunny Bleu, Caressa Savage, Chantilly Lace, Charisma, Charlie, Chasey Lain, Chennin Blanc, Cheyne Collins, Chris Cannon, Chris Collins, Claudine, Colt Steele, Crystal Wilder, Daphine, Dave Hardman, Devinn Lane, Eric Masterson, Evan Stone, Exotica, Friday, Guy Disilva, Heather Lynn, Herschel Savage, Holly Hollywood, Isis Nile, J.R. Carrington, Jeanna Fine, Jill Kelly, Joey Ray, John Decker, Jon Dough, Jonathan Morgan, Jonathan Simms, Julia Ann, Kaitlyn Ashley, Keisha, Kianna, Kim Angeli, Kim Chambers, Kitty Foxx, Kristal Summers, Kyle Stone, LeAnna Foxxx, Lee Stone, Marcello Mattar, Mark Davis, Mary Carey, Mike Horner, Morgan Le Fay, Nicole Sheridan, Nikita, Nikki Lynn, Pat Myne, Persia, Peter North, Randy Spears, Raylene, Rayveness, Rebecca Love, Renee LaRue, Rick Masters, Robert Rosenberg, Rodney Moore, Ron Jeremy, Scott Styles, Shay Sights, Skye Blue, Steve Drake, Steve Hatcher, Steven St. Croix, Stormy, Summer Cummings, Sydnee Steele, T.T. Boy, Tami Monroe, Tanya Danielle, Tara Gold, Tera Heart, Teri Weigel, Tina Cheri, Tom Byron, Tommy Gunn, Trevor Zen, Venus, Voodoo.
Join Stormy Daniels, Jenna Jameson, Kylie Ireland, Jessica James and over 60 other amply endowed, overly busty babes in 16 hours of non-stop action! This 4-Disc set includes the Wicked Climaxx button!! A must for lovers of big busty babes!
More >
Just My Imagination (1993)
Oct 1st
Just My Imagination (1993)
Director: Mitch Spinelli
Starring: Chantilly Lace, Chris Collins, Cory Cox, Leanna Foxxx, Tara Gold, Tina Tyler, Jonathan Morgan, Steve Hatcher, Vladimir Correa.
Let your imagination run away with you as Jonathan Morgan plays a loser in the game of love! His overactive imagination has a lesson or two to teach him! Just think about it, anything your mind can think of it can be yours! For a price, enjoy!
More >
Fast Cars And Fast Women (1992)
May 30th
Fast Cars And Fast Women (1992)
Director: C. Everette Smythe
Starring: Victoria Paris, Brigette Aime, Stacey Nichols, Tara Gold, Mike Horner, Steve Drake, Cal Jammer.
The protagonist of this one runs an escort service that's a bit different. Sure, he hooks up his clients with sexy, sultry sirens who are ready and willing to do their bawdy bidding. But he also throws in the rental of a luxury automobile into the mix, as well. The result is that his clients get the twin pleasures of blistering sex and high-octane thrills. The format of this one is pretty simple, as the escort service owner reminisces about some of his favorite clients and strumpets. We then watch the various couplings. A series of enthusiastic encounters atop and across the hoods of the cars ensues as the cast full of mouthwatering tarts does their utmost to get a rise out of an audience. The scenes are one-on-ones of the first order, including a ravenous Victoria Paris taking one her man atop a metallic blue Corvette that's never had it so good. Brigitte Aime lets loose her inner sexual dynamo, revving up her man with her tenacious pursuit of pure porno passion. A pair of delectable blonde beauties engage in some steamy lesbian fun atop another lucky hood in a great segment. And Stacey Nichols shows why she was always such a fan fave when she peels off her blouse and gets down to some serious sizzle with some lucky stiff. A nice pick for fans of fast women and fast cars, and an obvious forerunner of the 'Hot Bods & Tail Pipe' series.
More >
Make Me Sweat (1994)
Mar 9th
Make Me Sweat (1994)
Director: Rex Cabo
Starring: Devon Shire, Monique Hall, Shanna Rose, Tara Gold, John Mark, Lance Heywood, Moe Biggsley.
More >
Park Ranger (1993)
Feb 18th
Park Ranger (1993)
AKA: Wonderful World Of Wendy Whoppers – Park Ranger
Starring: Jeff Scott, Joey Silvera, Lilli Kene, Mark Davis, Tara Gold, Tina Tyler, Wendy Whoppers.
When Wendy Whoppers and her furry little beaver take to the great wide open, something happens.
More >


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Here's what you have been looking for - an instructional video featuring real parents and children demonstrating the most comprehensive and proven potty training method."Potty Training In One Day ~ A DVD For Today's Parents" is the first instructional video of it's kind.For decades, parents, teachers, doctors, and clinical psychologists have used the one-day potty training method.Now you can learn the method, step-by-step, through this visual journey.You will discover:* Why Potty Training In One Day really works * How to know if your child is ready for potty training * What pre-training exercises to use to increase your child's understanding * Which supplies you'll need and where to purchase them * How to set up for the big day * Step by step instructions for the big day * How to handle accidents * What to do during the follow-up week * And so much more!
Usually ships within 1-2 business days if not ordered with custom Orbit Labels®. Please allow 7-10 business days for shipping if ordered with custom Orbit Labels®.
We're potty training our son right now and this dvd had very helpful tips that have made a big difference in the process.
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