text:
They met as young women who arrived to Austin between 1963 and 1966, following husbands who were professors or in graduate school.
Suellen Mills, 75, Beverly Locklin, 77, Rachel Flake, 76, Barbara Lightsey, 77, Martha Fontaine Burns, 82, and Carol Kolsti, 75, all joined University Baptist Church and began friendships that will turn 50 next year.
"I still remember the day that you and Bob came" to Sunday school class, Lightsey says to Flake about her and her ex-husband.
"Really? I don't," Flake says with a laugh.
For the longest time, they called themselves simply "the Group," though at a recent lunch celebrating their birthdays, they decided on a more colorful name suggested by Kolsti's husband, John: "the Steel Bluebonnets."
Of course, their kids had some other names, including "The Six Bags Over Texas."
"The boys are pretty irreverent," Lightsey says.
The Group has been together through births and deaths, weddings and surgeries. Their lives have taken them in different directions, but they always come back together for the annual Christmas party and a birthday celebration or two.
As Kolsti once wrote to Flake: "Our 'Group' means more than words can convey — comfort, support, sharing talents, assisting in difficult times."
In good times and bad
They have always known when they were needed. Sometimes they sent the husbands home while they slept in chairs by a friend's hospital bedside.
Lightsey's youngest son, Jason, had to be hospitalized when he was 5 weeks old. She got a phone call from Burns: "She said, 'I heard what's happened. What can we do to help?'"
Four-year-old Jeffrey went to live at the Burns home for a week while the Lightseys took care of Jason.
When Lightsey's furnace went out when her sons were little, Kolsti took them in for the night.
"Beverly and Rachel helped when my grandmother died and there was a lot of family tension," Lightsey says. "I didn't want my 4-year-old to see it. I took him over to Beverly's and to Rachel's."
The friendships extended to their husbands as well as to their children.
Four of the friends were pregnant together and had sons months apart: Kolsti had Ken in August 1967; Burns had Michael in October 1967; and Lightsey had Jeffrey in November 1967. Mills finished the run with Scott in December 1967.
The boys were in Indian Guides together, with their fathers leading. When it came time for them to go to the 4-year-old class at Sunday school, University Baptist had to get a second teacher for that class because of their four boys.
The boys all went to different schools, but they remain close and attended Jeffrey Lightsey's wedding together.
Life kept them very busy. They took up volunteer positions. Mills has worked for Meals on Wheels and More for 40 years and started Mike's Place, a respite for people with Alzheimer's disease in honor of her late husband, Mike. Many of the other Steel Bluebonnets have delivered meals for Meals on Wheels. Locklin volunteered for the Daughters of the Republic of Texas and Girl Scouts and Cub Scouts.
Kolsti has spent 50 years volunteering with Church Women United. Lightsey volunteers with the Assistance League of Austin and Drive-A-Senior: West Austin. Flake served on the local Girl Scouts Council, overseeing Camp Texlake. She also got the other five women recycling in the late 1960s. Burns and Flake started the Friendship International program at Hyde Park Baptist Church, which paired American women with wives of foreign students at UT. All of the women are church deacons.
Even as their lives got busy, they held one day sacred every year: the annual Christmas party.
"We try to get together more often," Lightsey says. "Christmas dinner is not negotiable."
"It's all very exclusive," Flake says, though one time there was a minister who just moved to town and crashed the party.
They take turns hosting it, going in alphabetical order, though recently they're a bit off schedule because life's circumstances haven't always been so kind to the hostess. The hostess provides the main course and the others fill in the rest. Burns loves to make a pork tenderloin. Kolsti specializes in Swedish meatballs.
There's always a gift exchange, and each woman gets the other five the same thing. The husbands are invited, too, but don't want to bother with exchanging gifts.
One year, Kolsti gave mugs that said, "What happens with the girls, stays with the girls." Locklin tatted cross bookmarks for everyone, and Flake made Christmas pins. One year Flake and Kolsti got together and made sweatshirts that read "Hark the Texas Angel Sings." Another year Kolsti made cross-stitched hangings of "Friends Forever" with each of their names stitched in.
"We know we won't be able to top Carol," Flake says.
Shared stories
Whenever they do get together, they remember all those good times and the trips they took together. Twice they went to Round Top and one time broke out into a piano singalong with pianist James Dick.
They went to San Antonio and bought matching dresses and learned all the different ways to tie a scarf. They went to the Antlers Hotel in Kingsland and Mills made sangria. One New Year's Eve at Lightsey's house, they ran out of wine and drank cold duck.
"I drank it like it was water," Mills says.
"Sue got real happy," Lightsey says.
"It wasn't just me," Mills counters. "I have never drank any Cold Duck since."
After Flake had back surgery in 1995, she ended up in a coma. As she started to recover, all she wanted to do was go down to a beach house in Port Aransas.
"After the surgery, this group took me down there and drove me in a car down to the beach," Flake says.
They also remember the 75th birthdays of Locklin, Flake and Lightsey when they rented a limo and drove around town, including a stop at Green Pastures. "It was on my bucket list," Lightsey says.
Of course, they also remember how the limo driver got lost getting them home.
The trio also celebrated their 60th birthdays with a 1950s theme party. Not to be outdone, Mills and Kolsti celebrated their 60th birthdays with a party that was held at a secret location that ended up being Chuck E. Cheese.
New roles
They each have fallen into new roles in the group. Lightsey is the one you go to when you can't remember something like a name or a date.
Locklin is the transporter for Flake. "You are her Uber," Kolsti jokes to Locklin.
They always have a good laugh at themselves.
"You see a lot of Austin when you ride with Beverly," Flake says. "You see all the back streets."
"I like to stop at all the historical markers," Locklin explains.
Flake is the ideas woman, Kolsti is the artist/crafter/welder. "Carol is our very creative person," Lightsey says. "Rachel gets the ideas, but Carol follows through and does them."
"We're not creative are we?" Mills says to Burns.
"No, we're not," Burns replies.
"Rachel is the closest thing to a sister I ever had," Lightsey says. "But Martha was there when mother died."
At first when they would get together, they would talk about children. Now increasingly it's grandchildren and great-grandchildren. They also talk about health and worry about upcoming surgeries.
Lightsey and Burns have moved into senior residences. Flake knows that she will probably make that move as well.
Their annual Christmas dinners, originally a table for 12, is now only a table for nine.
Flake and her husband divorced in 1990. The friends saw her through it.
"It was a shock," Flake says.
"We were really fond of him," Lightsey says.
They remember spending a lot of time at the Flakes' house because they had a pool.
When Mills' husband died in 2013 from Alzheimer's disease, they helped her through that, as well as years of living with the disease.
"When Mike got so sick, we were supposed to have the Christmas party at my house," Mills says. "Rachel came to my home and decorated and helped Mike get into the bedroom."
Recently, Lightsey's husband, Louis, has not been well enough to attend.
Each of the friends have other friends they are close to, but the longevity and that they all get along is what's special about the Steel Bluebonnets.
"We're so grateful to see each other," Lightsey says. "When we are together, we don't get into weighty matters."
They are all very volunteer-minded. "We don't tend to talk about politics," Burns says.
Lightsey told Flake: "There's been a lot of love emanated from this small group of six women, benefiting not only our own families but many others in Greater Austin."


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subset: commoncrawl


text:
Jobs , Workers and Changes in Earnings Dispersion
@inproceedings{Burgess2001JobsW, title={Jobs , Workers and Changes in Earnings Dispersion}, author={Simon Burgess and Julia Ingrid Lane and David Stevens}, year={2001} }
- Published 2001
The 'fractal' nature of the rise in earnings dispersion is one of its key features and remains a puzzle. In this paper, we offer a new perspective on the causes of changes in earnings dispersion, focusing on the role of labour reallocation. Once we drop the assumption that all firms pay a given worker the same, the allocation of workers to firms matters for the dispersion of earnings. This perspective highlights two new factors that can affect the dispersion of earnings: rates of job and worker… CONTINUE READING
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text:
What makes a show dirty: The content or the language?
That question was put to the test Friday night at the Star Plaza Theatre in Merrillville, Ind. Tommy Davidson, George Wallace and D.L. Hughley performed 3 1/2 hours of comedy that was, for the most part, clean.
Or was it? Let's take a joke from Hughley, a solid, talented comedian who has a loyal following in the Chicago area:
"(O.J. Simpson's lawyer) Johnnie Cochran is a bad (dude). I get a parking ticket, I'm calling Johnnie. Johnnie talks so good, he makes me think (prosecutor) Marcia Clark did it."
Now, that's a biting, but basically inoffensive joke. Except Hughley didn't call Cochran a bad "dude." He used a common two-word street phrase that certainly couldn't be used in a family newspaper.
Take this one, where Hughley jokes that there's no way you'll find African-Americans living in a trailer park:
"You can't give no (black people) something to drive away in . . . not if you want your rent."
Again, there's nothing really wrong with that joke. In fact, it's a pretty nicely-written piece of material. Except that instead of saying "black people," Hughley referred to blacks in a very offensive slur.
Are those two jokes dirty? In comedy phrasing, a dirty joke is usually considered to be raunchy in nature, maybe having something to do with sex or some bodily function.
Both of those jokes certainly weren't sexual or anything else that would be considered blue. But you will never hear those jokes in their original context on "The Tonight Show."
Hughley and Davidson liberally sprinkled those and other harsh terms throughout their material. Wallace was also guilty of saying a few naughty words, but not as much as the other two.
The crowd at the Star Plaza certainly enjoyed themselves, for all three comics were talented, hilarious and entertaining.
A lot of African-American comedians get hammered, and deservedly so, for the type of material they do. A lot of it is scatological, and some can't even be considered a joke, because there isn't really a punchline. Some comics are just cursing for cursing's sake.
But if you took the dirty words out of a lot of what was heard Friday night, or changed the words to something less offensive, you'd have stuff suitable for network television.
Chances are the three comics used the words they used because that's the way they talk, not just to spice up their bits. And if you get into a conversation with Hughley, and you'll find the guy just can't help but curse, and he's the first to admit that. It doesn't detract from some very funny material.
What makes a show dirty? Ultimately, it's all in the presentation. Listen to what you're hearing. If you think the joke, without the naughty words, can be repeated in polite company, then it's not necessarily dirty.
But if the joke isn't funny unless it has the curse words for one, and doesn't have something resembling a punchline for another, then it goes beyond dirty. It's simply pointless.
There were very few pointless moments Friday night, which turned out to be something like a battle of the comics.
Both Wallace, another longtime favorite in the Chicago area, and Davidson, formerly of "In Living Color," were solid, each doing an hour material that audiences of all colors could relate.
But the winner? It had to be Hughley, a comic for close to eight years who formerly was host of BET's "Comicview" standup comedy show.
He gets the nod because unlike the other two, he only had about 40 minutes of stage time, and was outstanding throughout. His material ranged from growing up with strict mothers, religion and some not-too-harsh stuff on sex (let's lable the overall show PG-13 and leave it at that).


text:
Entire flat
Beachfront apartment in Punta: Amazing View& Bikes
Beachfront apartment in Punta: Amazing View& Bikes
6 guests
3 bedrooms
5 beds
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6 guests
3 bedrooms
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Great check-in experience100% of recent guests gave the check-in process a 5-star rating.
Sparkling clean2 recent guests said this place was sparkling clean.
Located In front of the calm beach Playa Pinares in Punta del Este. This beautiful and comfortable apartment has the best sunsets and is near all the attraction sites: Punta Ballena and la Península. 8 min away the international airport. Supermarket in the neighborhood. Wide, private terrace in front of the beach, another with barbecue and a 3rd in kitchen.
3 Bedrooms, 3 bathrooms, garage, FREE fast wifi, desk, 2 bikes, smart TV, AC full kitchen, beach service, building security. Welcome home!
Free parking on premises
Unavailable: Smoke detector
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The host hasn't reported smoke or carbon monoxide detectors on the property.
Sleeping arrangements
Bedroom 1
1 double bed
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Bedroom 3
2 single beds
House Rules
No pets
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Check-in is anytime after 4PM and check out by 10AM
Well-lit path to entrance
Step-free access to the bathroom
8 Reviews
Response rate: 100%
Response time: within an hour
Always communicate through AirbnbTo protect your payment, never transfer money or communicate outside of the Airbnb website or app.
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text:
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text:
Richard Balagur, of Thetford, tests the acceleration in the Tesla Model 3 owned by Julie Mullen, of Thetford, left, during Driver Ed: Driving into a Post-Fossil Fuel Era, a program organized by the Thetford Energy Committee in Thetford, Vt., Sunday, Sept. 30, 2018. Tesla claims the car is capable of going from 0-60 mph in 3.5 seconds. Mullen, who drove a 2005 Toyota Corolla before her Tesla was delivered a week ago, was one of several electric vehicle owners offering rides and test-drives to the program's participants. "Supposedly this is their economy model, even though it's more than I've ever paid for a car," said Mullen. The retail price of the base model of the car is $49,000. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to firstname.lastname@example.com.
Column: The real emergency is our trivial politics
Column: A love letter to the women of the Upper Valley
Hartford to tackle budget, TIF project
Valley News
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West Lebanon, NH 03784
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text:
Used 2011 Toyota Tacoma PreRunner in Dulles, VA
2011 Toyota Tacoma PreRunner in Richmond, Virginia 23114
2011 Toyota
Free Transfer to your store - VA to VA
Reviews for 2011 Toyota Tacoma
Overall Rating
2011 Toyota Tacoma PreRunner TRD
When looking for a truck, I knew the features I wanted before I went to the car lot. I had found this particular vehicle online and decided to take a test drive. I was very pleased with its handling, power, features, and gas mileage. The gas mileage has held true, actually even a little better, to it's claims, and it rides better than most trucks. To ensure I was making the right decision, I test drove other makes/models the same day, but kept coming back to the Toyota Tacoma. I've loaded the bed to over flowing with yard materials and hauled ZTRs with no problem. It's comfortable on the inside for 5 and the features are functional and convenient. I love my truck!
great car
Easy to drive quality vehicle good history I've owned Toyota before
Good to Go
Long before there was a Tocoma, I was a Toyota small truck fan. The Tacoma Pre-runners are like small trucks on steroids. They look great, work great and last forever. I bought the 4 cylinder specifically for improved gas mileage as I still needed a truck. If that was not an issue, I would absolutely go with a 6 cylinder but the 4 is a strong 2.7 litre. In my opinion, you can't go wrong with a Tocoma.
This price does not include tax, title, and tags. Additional fees may also apply depending on the state of purchase.


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When your tractor breaks or your cell phone stops working, hard disk(s) supported? Consider these scenarios: If you are upgrading your laptop or replacing a the motherboard, should be able to handle 2 terabyte drives. The whole system will fit in a size Windows XP SP3 will be a lot better with 1Gb or more, compared to 512mb.With great prices, fast shipping, and top-rated but are generally in the same 2.5" form factor.
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text:
The Senate Environment and Public Works (EPW) Committee passed a Senate climate bill on Thursday despite a Republican boycott.
Democrats voted 11-1 to approve the bill, with Sen. Max BaucusMax Sieben BaucusOvernight Defense: McCain honored in Capitol ceremony | Mattis extends border deployment | Trump to embark on four-country trip after midterms Congress gives McCain the highest honor Judge boots Green Party from Montana ballot in boost to Tester MORE of Montana the only "no" vote. Baucus said the legislation's timetable for emissions reductions was too aggressive, although bill supporters took heart in his pledge to work to craft a measure that could reach the 60-vote threshold in the Senate.
"I am committed to passing meaningful, balanced climate change legislation," Baucus said.
Republicans protested the markup, delaying a vote for two days. They wanted the Environmental Protection Agency to perform a more thorough cost analysis of the bill, an effort the EPA said would take another five weeks. EPW member Sen. George Voinovich (R-Ohio) has said he requested a full EPA analysis three months ago.
"I am deeply disappointed by Chairman Boxer's decision to violate the rules and longstanding precedent of the committee," ranking Republican Sen. James InhofeJames (Jim) Mountain InhofeAllies wary of Shanahan's assurances with looming presence of Trump On The Money: Trump to sign border deal, declare emergency to build wall | Senate passes funding bill, House to follow | Dems promise challenge to emergency declaration Trump to sign border deal, declare national emergency MORE of Oklahoma said in a statement.
Democrats said the analysis EPA has done was more than sufficient, given the likelihood the bill will change by the time it reaches the Senate floor. It projected a relatively modest cost impact for consumers.
There are five other committees that can claim some jurisdiction over climate and energy legislation. That includes Baucus's Senate Finance Committee, which is responsible for determining how valuable emissions allowances will be distributed.
The Senate bill, co-sponsored by Democratic Sens. John KerryJohn Forbes KerryWarren taps longtime aide as 2020 campaign manager In Virginia, due process should count more than blind team support Trump will give State of Union to sea of opponents MORE of Massachusetts and Barbara BoxerBarbara Levy BoxerHispanic civil rights icon endorses Harris for president California AG Becerra included in Bloomberg 50 list Climate debate comes full circle MORE of California, would reduce greenhouse gas emissions by 20 percent from 2005 levels by 2020, more than what is called for under the House climate bill.
Companies would be required to hold permits to cover their emissions. During the initial phase of the program, most of the permits would be distributed for free. Companies could buy additional permits in a market created by the legislation to meet their emissions targets as needed.
In a statement, Boxer, the chairwoman of the EPW panel, defended the decision to move forward with a vote without participation from committee Republicans.
"The committee and Senate rules that have been in place during Republican and Democratic majorities are there to be used when the majority feels it is in the best interest of their states and of the nation to act," Boxer said.
"A majority of the committee believes that S. 1733, and the efforts that will be built upon it, will move us away from foreign oil imports that cost Americans one billion dollars a day, it will protect our children from pollution, create millions of clean-energy jobs, and stimulate billions of dollars of private investment."
Scott Segal, an energy lobbyist at Bracewell & Giuliani, said a final bill will have to provide more protection against rising energy costs, set carbon reduction goals that are "realistic in light of the current state of technology and our energy mix" and improve provisions relating to the refining sector, which has complained the carbon cap will force many refiners out of business.
"In short, today's action marks another step along the path, but there is much further to go," Segal said.
Proponents argue the climate bill will not only lower pollution but create millions of new green jobs.
"The Senate Environment and Public Works Committee's passage of the Clean Energy Jobs and American Power Act is another critical step toward restoring American competitiveness and energy independence," said Daniel Weiss of the Center for American Progress.
Critics, though, say the measure will raise energy costs and drive jobs overseas. Oil refiners are among the fiercest critics of the legislation, claiming the bill will drive many out of business.
"The committee's total disregard for domestic refiners, petrochemical producers and their employees, the higher costs that consumers will bear and the threat to our national energy security that will result from this legislation is inconceivable and indefensible," said Charlie Drevna, president of the National Petrochemical and Refiners Association.


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By Jody GodoyLaw360, New York (February 8, 2017, 10:12 PM EST) -- The story of a D.C. lawyer accused of trying to sell access to a sealed False Claims Act complaint is certainly bizarre, but it demonstrates just how valuable that information would...
Bizarre Bid To Sell FCA Suit Shows Value Of Secrecy
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We like, and recommend, the Crankbrothers Speedier Lever. If you have to pick only one, go with the Pedro's, but if you want a backup or have some hard tires to unseat, Crankbrothers is a great choice. It's only one lever (as opposed to a set of two, like the Pedro's) and it's longer, so we didn't pick it over the Pedro's for portability reasons. But it's an excellent tool. It has a wide handle you can grip with your whole hand. Like the Pedro's, the tip is the right size and shape to prevent slipping and stay in place, and the shape of the handle happens to protect your knuckles if you do slip. Even in situations where I didn't need it, I liked having it because it made me feel like a pro.
We're Arizona's top rated and 5 times running "America's Best" Rated Bike Shop by the NBDA. From mountain bikes, kids, comfort, fitness and road bikes we sell and service them all! Are E-bikes your thing? Our Gilbert location Is our hub for electric bike sales and service. Swing by and see us... Family owned and operated by Brandee and Al since 2001.
Broadly speaking there are two major wheel sizes – 700c for road bikes and 26 inch off-road wheels. However there are a whole variety of older, less common wheel sizes and of course fold up bikes have much smaller wheels altogether. Repairing a puncture is not an emergency! It's a basic procedure that every cyclist should be able to to perform, but doing it correctly involves more steps than many people realise. Wheel building is often seen as the most artful skill in bicycle maintenance, and separates the professionals from the amateurs but that doesn't mean you should consider it out of reach. Truing a slightly misaligned wheel is a cycle maintenance job that almost any cyclist can perform.


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Connected devices that fuse health, technology and information.
InsureTech, Washington, DC, May 30, 2019
Silicon Valley Boomer Venture Summit, June 6, 2019
DC Longevity Summit, December, 2019
Growing life expectancy and shrinking assets limit options of older adults in late life, leaving those who may need care more likely to receive it at home. The biggest constraint for this industry is scarcity of willing workers. Although a greater role for technology is envisioned by many, the highly fragmented home care industry has made incremental progress in achieving it. As the industry matures, standard practices and tech-enablement have begun to take shape. Tech-enabled innovations can be categorized as helping firms source effectively, manage for retention and provide measurable value. The future of tech-enabled home care will present opportunities and challenges, both for new entrants and long-time players.


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To celebrate its soft opening, Waterway Point is giving away 500 pairs of FREE Shaw Theatres movie tickets daily from 18 to 20 January to the first 500 shoppers!
Come down to Waterway Point from 18 to 20 January 2016 and join Shaw Theatres in its soft opening celebrations! For three days only, Waterway Point will be giving away 500 pairs of FREE Shaw Theatres movie tickets daily (total of 1,500 pairs of tickets) to the first 500 shoppers each day*!
Simply redeem your free movie tickets at The Plaza, Level B1 East Wing from 10am onwards. See you there!
*See terms & conditions below
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Quarterly results round-up: Beckman still strong overall, as Gen-Probe misses expectations
This article was originally published in Clinica
Executive Summary
Beckman Coulter reported third-quarter revenue of $893.8m, which was up by around 9% compared to the same period last year. The growth was attributed, in part, to the acquired Olympus lab-based diagnostics division. The acquisition helped to considerably bulk up Beckman's chemistry and clinical automation business, which recorded 14% reported growth in sales, at $323.2m. This, in turn, helped to drive, clinical diagnostics revenue, which reached $787.6m (11% reported growth). Geographically, strong sales in Asia-Pacific and emerging markets helped to off-set softness in developed markets. Beckman's net income for the period was $67m, a significant improvement on Q3 2009 which was impacted by $79.2m in restructuring charges and reported earnings of $1.5m.
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Shopko to close more than 250 stores amid bankruptcy filing
Shopko will close almost 70 percent of its locations between now and mid-May as it attempts to reorganize and emerge from bankruptcy.
The company published a list this week that indicates it will close 251 stores, more than twice the number of stores Shopko identified for closing in mid-January.
The company currently operates about 360 stores in more than two dozen states. The list of closures would cut that to fewer than 110 stores.
Shopko originally announced plans to close 39 stores in December before expanding that list to more than 100 stores in January when it filed for bankruptcy protection from creditors. This week's expanded list added another 139 locations, Shopko spokeswoman Michelle Hansen said.
Hansen said the volume of store closures forced the company to issue a Worker Adjustment and Retraining Notification Act notice in Wisconsin and Illinois. She said the added closures were "difficult, but necessary."
"Through our conversations with the potential buyers, it has become clear that it is in our best interest to operate with a significantly smaller store footprint," Hansen said in a statement. "We remain hopeful that we will be able to emerge as a stronger company, and we believe that this is the best course of action to make ourselves more attractive to potential buyers and successfully emerge from Chapter 11."
The stores will be closed in phases between March 2 and May 12.
Shopko and its affiliate companies filed for bankruptcy protection from creditors on Jan. 16 in U.S. Bankruptcy Court in Nebraska, citing assets of less than $1 billion and debts between $1 billion and $10 billion.
The Wisconsin-based retailer announced plans to close stores, sell its pharmacy assets and spin off its optical centers into standalone locations. The changes were designed to enable the company to emerge from bankruptcy with the ability to continue operating with a slimmed-down, more profitable footprint across the Midwest and Northwest United States.
In December, the company sold pharmacy assets to dozens of locations to Kroger, CVS Pharmacy, Hy-Vee and other competitors. In late January, the company sold its remaining pharmacy assets for an estimated $52 million, well below its original projections, according to bankruptcy court documents. Walgreen's bought the bulk of the remaining pharmacy assets during the January sale.
Shopko pharmacy operations sold last month have already started to close this week.
Related video: These companies are thriving in the retail apocalypse (provided by GoBankingRates)
How Ocasio-Cortez and others pushed Amazon out of New YorkHere's how Rep. Alexandria Ocasio-Cortez (D-N.Y.) and other politicians influenced Amazon's Feb. 14 decision to cancel its plan for a second headquarters in New York.The Washington Post
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Quite often we forget to trust our intuition, and to ignore the warning signs or the Key Performance Indicators we have created as part of our reporting systems that we put in place to monitor our marketing. Sometimes we get a gut feel as to who it is that's about to call us? Sometimes we get a gut feel or an "Internal communication" that enables us to submit a proposal at a particular price point.
As we become more aware and more observant in the reality we live in, we can become more accustomed to trusting our intuition. Many people are quick to dismiss their intuitive nature, and prefer to look for evidence, or research data to aid them in their decision making process.
Some people rely too much on technology, instead of taking time out for reflection, and to better understand how to activate, or develop their intuitive side. Some people use meditation to quieten their mind and to explore their inner thoughts and feelings.
Perhaps you should try this too.
How do you apply your "intuition" to your marketing? When do you trust your "gut" or "instinct"? What are the signs that you know to look for to trigger your "intuition"?
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Authentic greek food is on the menu at Christos Mediterranean Grill in downtown Pittsburgh. The owner of Christos restaurant was once personal chef to Jacqueline Kennedy Onassis. Scandinavian food portland Gloria kent bellisio foods inc
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Entire townhouse
Portville Mactan Townhouse
Portville Mactan Townhouse
4 guests
2 bedrooms
2 beds
1 bath
4 guests
2 bedrooms
2 beds
1 bath
Self check-in
You can check in with the doorman.
Newly renovated 2-storey house which is ideal for couple, family, and group travelers. It is located within a guarded community right along the General Aviation Rd and with easy access to any resorts or restaurants in Lapu-Lapu City. More importantly, the house is at least 10 mins drive from the airport.
You can use the space at your own comfort. I look forward into welcoming you into my house!
Free parking on premises
Unavailable: Smoke detector
Unavailable: Carbon monoxide detector
The host hasn't reported smoke or carbon monoxide detectors on the property.
Sleeping arrangements
Bedroom 1
1 queen bed
Bedroom 2
1 queen bed
Common spaces
1 couch
House Rules
Not suitable for infants (under 2 years)
No smoking, parties, or events
Check-in is anytime after 2PM and check out by 12PM (noon)
Self check-in with building staff
Step-free access to the home's entrance
Flat path to front door
10 Reviews
Response rate: 100%
Response time: within an hour
Always communicate through AirbnbTo protect your payment, never transfer money or communicate outside of the Airbnb website or app.
The neighbourhood
Things to do near this home
Explore other options in and around Lapu-Lapu City
More places to stay in Lapu-Lapu City:


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Empire co-creator Lee Daniels condemned the racist attack against series star Jussie Smollett in an emotional social media video posted Tuesday.
"It's taken me a minute to come to social media about this because Jussie, you are my son," Daniels said in the video, before addressing specific details of the attack on Smollett, which occurred Tuesday morning and left the Empire actor, who is gay, hospitalized. "You didn't deserve, nor anybody deserves, to have a noose put around your neck, to have bleach thrown on you, to be called, 'die f-----, n-----, ' or whatever they said to you. You are better than that. We are better than that. America is better than that. It starts at home. It starts at home, yo. We have to love each other, regardless of what sexual orientation we are. Because it shows we are a united front. And no racist f--k can come in and do the things they did to you. Hold your head up, Jussie. I'm with you, I'll be there in a minute. It's just another f--king day in America."
Lee Daniels is breaking his silence about the racist and homophobic attack on Jussie Smollett: "You are better than that. We are better than that. America is better than that." pic.twitter.com/Z4IwhOEO5L— Entertainment Tonight (@etnow) January 29, 2019
TMZ first reported the news about Smollett's assault and the Chicago Police later released a statement confirming a cast member on the Fox drama was beaten and hospitalized. (Chicago police did not mention Smollett by name.)
According to the police statement, two men approached the 36-year-old and "gained his attention by yelling out racial and homophobic slurs toward him." Per the police, the two men beat Smollett, poured an "unknown chemical substance" on him (bleach, according to TMZ) and "wrapped a rope around the victim's neck."
The men, both of whom wore ski masks to cover their faces, allegedly shouted, "This is MAGA country," a reference to President Donald Trump's 2016 campaign slogan, "Make America Great Again." Police have not confirmed those specific details and a Chicago Police spokesperson told The Daily Beast there was "no report" of MAGA taunts from the attackers.
Representatives for the Chicago police department did not respond to requests for comment.
Statement on #ChicagoPolice hate crime investigation. We are taking these allegations very seriously and encourage anyone with information to report anonymously to https://t.co/yYAqzcVIfu pic.twitter.com/DxipALHXaz— Anthony Guglielmi (@AJGuglielmi) January 29, 2019
The incident occurred at 2 a.m. as the actor was getting food from a Subway sandwich location after arriving to Chicago from New York. The actor reportedly suffered a fractured rib and was transported to Northwestern Memorial for treatment before being released Tuesday morning. The assault follows the arrival of a threatening letter reportedly sent to Fox's Chicago studios last week which was addressed to Smollett and contained a threat to his life along with similar hateful slurs. Entertainment Tonight reports that as a result of the attack, Smollett and the rest of the Empire cast will have armed security as the production of the show continues.
In a statement posted to Twitter, the Chicago Police Department revealed that it is investigating the incident as a potential hate crime.
Chicago Police Department just sent out this statement re:— philip lewis (@Phil_Lewis_) January 29, 2019
Jussie Smollett pic.twitter.com/DxQswZn8xd
In addition to Daniels, fellow Empire co-creator and executive producer Danny Strong reacted to the news on Twitter, writing that he was "deeply horrified and saddened" by the attack and calling Smollett's assailants "hate-filled cowards."
I'm deeply horrified and saddened by the racist and homophobic attacks against @JussieSmollett. He is a kind and profoundly talented soul whom I respect with all my heart. The terror of racism and homophobia has no place in our society, it is the most indecent way to live...— Danny Strong (@Dannystrong) January 29, 2019
...whoever did this, do not forget that you are nothing but hate filled cowards while Jussie's talent and activism will continue to shine a bright light on to the world for decades to come.— Danny Strong (@Dannystrong) January 29, 2019
Twentieth Century Fox Television and Fox Entertainment, the studio behind Empire, reacted to the attack with the following statement, shared with TV Guide: "We are deeply saddened and outraged to learn that a member of our Empire family, Jussie Smollett, was viciously attacked last night. We send our love to Jussie, who is resilient and strong, and we will work with law enforcement to bring these perpetrators to justice. The entire studio, network and production stand united in the face of any despicable act of violence and hate — and especially against one of our own."
In a statement to The Hollywood Reporter, the Gay & Lesbian Alliance Against Defamation (GLAAD) said that they have reached out to Fox to and the actor's reps to offer the organization's support, adding, "Jussie is a true champion for LGBTQ people and is beloved by the community and allies around the world."
This story has been updated to include comments by Daniels, Strong, Fox and GLAAD.


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Renaissance:Status Meetings:2010-01-11-
From Apache OpenOffice Wiki
Quick Navigation
<< Back to Renaissance Status Minutes Page
Meeting Details
- IRC details: irc.freenode.net #ux.openoffice.org
In Attendance
- Frank Loehmann (IRC: frankl)
- Christoph Lukasiak (IRC:clu_sun)
- Raymond Baroux (IRC: ray007)
- Daniel Rhodes-Mumby (IRC: DanielRM)
- Round Table
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<frankl> Hi * clu_sun (n=cl114686@nat/sun/x-avhdupodjioxhfyt) hat #ux.openoffice.org betreten <frankl> It is time again for our weekly status meeting for Project Renaissance. <frankl> I want to give a short update on the 'Thinning Out Process for Impress' today. <frankl> The current status of this process can be found at the wiki: http://wiki.services.openoffice.org/wiki/Renaissance:Impress <frankl> I am currently working on a specification regarding 'Object Selection Positioning and Modification': http://specs.openoffice.org/renaissance/object_selection_positioning_and_modification.odt <frankl> This specification deals with the selecting, positioning and modificating objects (shapes) behavior in Impress/Draw. Feedback welcome! <frankl> Furthermore we had a discussions how to improve the current task pane implementation in Draw/Impress. <frankl> Problem of the current implementation is that each additional group cost vertical space due to its header. Space that is rare especially on small devices like netbooks. <frankl> Therefore the new task pane uses a vertical toolbar containing the group headers as buttons/tabs. Christian Lippka made a first implementation of the proposal. Please see the following video for details: http://www.youtube.com/watch?v=DPmfKN3JIqQ&fmt=22 <frankl> This concept will also work for menu buttons so that we can call task panes also also from horizontal toolbars. See the following video for details: http://www.youtube.com/watch?v=dIpXYtj4LMQ <frankl> Christoph Noack will blog about this proposal soon. OOo UX Planet: http://planet.services.openoffice.org/ux/ <frankl> That's all for today from my side. <frankl> Bye!


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Wat Xieng Thong
Luang Prabang's best-known and most visited monastery is centred on a 1560 sǐm that's considered a classic of local design. Its roofs sweep low...
Phongsali – a peaceful destination in Laos
Phongsali is the northernmost province of Laos which might meet your desire to run away the bustling life. If you're seeking for a peaceful and authentic destination to hide from hassle and bustle, Phongsali is perfect choice for you.
Wat Mai Suwannaphumaham
When you come Laos, don't forget to visit Wat Mai Suwannaphumaham - one the the most famost place in here. Beside the palace, Wat Mai is...
Wat Mai Temple
The impressive Wat Mai Temple is one of Luang Prabang's largest and most richly decorated temples.
Hua Phan and what to see
Hua Phan or Houaphanh is a charming province in the east of Laos, and also a friendly home to various ethnic groups. Traveling to this off-the-beaten-track destination, people feel like they're stepping into a new found world where ethnic culture meets with the natural beauty.
Haw Pha Bang – attactive monuments in Royal Palace
Haw Pha Bang is located on the grounds of the Royal Palace Museum which is one of the most attactive monuments in Luang Prabang.
Vang Vieng Laos
About Vang Vieng >>Arts and Ethnology Centre, Luang Phrabang >>Ban Hat Khai in Laos It is a small tourist-oriented town about 150km north of Vientiane capital, located in...
All Pakse Travel Guides
Pakse is the capital of Champasak Province, founded by French colonialists in 1905. It is an ideal place to explore the beauty of the region. For those who are going to travel Pakse or Champasak, here are some travel guides for you.
Bolaven Plateau Waterfall
Bolaven Plateau is famous tourist destination in Laos because of its great scenery, ethnic villages and unexplored corners.
Wat Mahathat in Luang Prabang
Wat Mahathat is one of the more ornate, attractive temples of Luang Prabang. The temple also known as Wat Phra Mahathat or Wat That is located near the Mekong river South West of Mount Phousi.


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Take good pictures. Some of the options below don't require you to actually take the picture and sell the product, but for the ones that do, make sure you take a clear picture that makes your product stand out from the others. If you're going to be taking a lot of pictures, set up a small "studio-like" area in your home with a backdrop and proper lighting to really make your pictures come across as professional. And of course, you'll want a good camera too.
Can someone help. I need a job or at least a hobbie to do at home, i need to make $400 in about 2 weeks. I'm 15 so i can't work yet. If anyone has any suggestions please e-mail me! ooh & btw i can't mow any lawns cause everyone who lives close by dosn't have any lawn at all. So if there is any suggestions whatsoever please feel free to e-mail me. thanks!
Donating plasma can actually work out better than selling your blood. It takes longer to donate plasma because they will put your red blood cells back in your system. The upside is that you can donate plasma as much as twice a week and you can make anywhere from $40-$60 per donation. You can make that $100 in less than a week if you can stomach the needle.
"The process is pretty straightforward: You fill out a questionnaire (either online or over the phone since sometimes they call you if they need to fill open slots) and if you qualify for the taste test you simply pick one of the available time slots," Chelsea says. "You never know which fast food/restaurant you're going to be tasting until you arrive and begin the taste test."
For example, you might take photos and have them available for a fee at sites such as shutterstock.com, smugmug.com, 500px.com, or istockphoto.com. Similarly, you can create and upload designs at sites such as zazzle.com and cafepress.com, where people can buy them imprinted on shirts, mugs, and so on. Similarly, you might write an e-book and sell it online, perhaps via Amazon.com's direct publishing service.
If you don't already have a job, you can try your luck with a day labor agency in your area such as Labor Works or People Ready. Generally, these jobs are of the low-skill, low-pay variety — construction helper, mover, retail or warehouse work. Arrive early in the morning, and if you're chosen for a job, you'll work that same day and receive payment at the end of your shift.
After you finish your first assignment, ask if they have any other projects for you to do, if they can provide a recommendation on LinkedIn or if they can refer you to someone else needing more work. Over time you could be making a full-time salary with your translation work. It's a great way to earn money online by putting your language skills to work.
How much will you make? I think my best month with Google AdSense was almost $5,000 over the last ten years. That amazing month blew my mind since it was actually near the beginning of my blogging journey. When you go from making zero to $5,000 in a month, that will rock your world. For me, it also got me even more excited because I knew there were other ways to monetize.
Rose and others looking for employment this summer: Retry the babysitting idea. Summer is a good time to babysit. Maybe volunteer a few times first and then use those families as references. Tell everyone you know that you are available to babysit. Use email, Facebook, fliers, word of mouth. Also try offering a set time every week, like Tuesday evenings form 5-9 pm in your home. Parents know they can drop off their children without calling ahead. They really appreciate that. It takes time and persistence to get the word out, butit can be done!
23. Affiliates – There are many affiliate networks, such as FlexOffers and CJ Affiliate that allow you to promote other people's products and services. You simply put a link or a banner on your page and then you get a percentage if someone clicks through and buys the product/service. You'll want to select products that are specifically within your blog's category.This is an effective way to earn money once you have the traffic coming to your blog.
Watch out for inflation chipping away at your assets. We've all heard an elderly person describe the purchasing power of a coin in their day. Inflation continues to make today's money worth less in the future. To win the race against time and inflation, learn to invest your money in the right places. A savings account might help you to keep up with inflation; however, to stay ahead of the game you'll want to invest in bonds, stocks, or some other investment that returns above the average rate of inflation (currently 3%-4%).
Websites like Survey Junkie will pay you a decent chunk of change for the low-maintenance, borderline mindless task of completing surveys. Companies want to understand consumers better, and one way they do that is by compensating survey-takers (a.k.a. you). Most surveys pay between $0.50 and $1.25, and many of them take less than 5 minutes to do. You can read our full Survey Junkie review for more info.


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What does Gilles read? Irving put her head on Farouk's shoulder. The house whose roof you see over there is my father's. She's completely incompetent. The tide normally leaves the beach walkers only a narrow strip of sand they can walk on without getting their feet wet. They cultivated the land.
Please give an example of usage. We promised. I understand him. This tie goes with your shirt. We watched TV for a while. You'll have to ask somebody else. That's what we need to do. We might regret this. That's impressive.
Ask around. Teflon griddles are nearly unusable. The land slopes gently toward the river. Think should technically be wearing safety goggles. You should be aware that too much time spent in front of the computer could damage your eyes. My investments earn about 10 percent a year.
How much did you pay for the labor on this? Jennifer has a stomachache. I could hear the voices of several other guests who had arrived and were already eating together in the main dinning room. Do you want to win or don't you? I don't believe they understood. Do you want those chocolates? Since Cristina had a little free time, he decided to go swimming.
We've been dating for three months now. I read the book in my second year of high school.
The sea is to fish what the sky is to birds. Liz wanted to talk to Lucius about something. For your bed itself cries out that you aren't letting yourself throw the nights away in vain. So it has come to this. Antonella got quite a few positive responses. He lives off campus.
Why are we going this way? He's a science teacher. Will this nightmare ever end? Even I would have helped you.
From the Moon, knowledge.
The children were left to fend for themselves. I can promise you that.
The exhibition is now open.
I think this is yours.
Knudsen stole your ring. I don't have to tell you what's at stake. Were you to take it back? I've always paid the rent. I can never predict anything. I cannot meet their demands. It makes little difference to me whether you believe it or not. Aren't you nervous? Do you often take business trips?
The hardest thing to do is watch the one you love, love somebody else. You can come back here anytime you want. Undoubtedly the most entertaining thing to do in winter is to search for your snow entombed car. Don't worry about Novo. He's studying hard so he can pass the entrance exam. I have an interest in cello and piano. You should be in a hospital. Understanding one another is important.
The sound of jets taking off gets on my nerves. Vernon is really close. Courtney announced he was retiring. For God sent not his Son into the world to condemn the world; but that the world through him might be saved. Above all, take care of yourself. I can buy one. Three years ago something like this never would have happened. The government lowered taxes for lower-income families.


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A New Year Resolution You Can Keep
by Carol Ann Donnelly The New Year is a time for resolutions—promises to one's self to eat clean, exercise regularly, lose weight and be healthy. But, what does healthy mean, and is there anything else we should do to ensure good health? There are things that can be done that do not involve emptying your … Read more


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Why Nurse Practitioners Are No Longer Primary Care Solutions
Robert C. Bowman, M.D. email@example.com
Nurse practitioners have contributed to primary care. Nurse practitioners will still contribute to primary care. There is nothing wrong with nurse practitioner primary care quality. But nurse practitioner graduates no longer are solutions for primary care shortages.
To solve massive primary care deficits, a health workforce source must remain in primary care, remain active, deliver 35 years of a health career, and deliver top volume.
Solutions for primary care require the following
· Must remain in primary care at 80% or greater levels – Only one-third of nurse practitioners remain in primary care and the level continues to fall with each class year and each year after graduation. Nursing is 80% hospital, 10% public health, 10% ambulatory and the hospital focus dominates, which is why 6% of NP and increasing is in cardiology and why NP percentages are double the physician percentages in four main IM subspecialty areas and in other specialties such as psychiatry. –
· Must have a maximal number of years in a career such as the 35 years from age 30 to age 65 – Nurses complete nursing school at age 31 and nurse practitioner training follows 8 years of nursing experience. The 27 years of a nurse practitioner career represents a loss of 23% of a workforce contribution before starting a primary care career. Extensions of training for graduate degrees, specialty training, and an additional 2 years for nurse doctor training will make primary care contributions worse in more than just the years lost.
· Must have 80% of graduates active – Nurses, nurse practitioners, and nurse midwives are about 55 – 65% active (your state may have higher due to inmigration for employment with higher percentages active, but nationwide the level is lower). Again with only about 60% active this is a substantial proportion of workforce lost. This is also why the nation will be 1 million short of basic nurses in 2020, the result of insufficient support of nursing, losses of nursing faculty to become nurse practitioners, and students that select nursing school that have 60% activity levels.
· Must deliver 80% or more of the volume of the most productive primary care forms, family physicians – Nurse practitioners deliver only 50 – 60% of the volume of a family physician. This could be higher, but again nurses are trained to be one on one detailed care givers in hospital settings. The requirements for health access recovery over the next 30 years demand more volume, activity, years, and primary care retention. Nursing leadership clings to the high quality-low volume-high satisfaction approach for nurse practitioners.
· Must remain in the broad generalist family practice role that multiplies rural, underserved, and all needed health access contributions – Nurse practitioners are leaving the family practice broad generalist role during training, at graduation, and each year after graduation. About 40 – 45% train as family nurse practitioners, but only 20 – 25% of nurse practitioners remain in this broad generalist family practice role.
Family physicians are permanent primary care sources that remain in primary care at 90 – 95% levels, remain 35 or more years in a career, remain active at 85% levels, and deliver the top volume of primary care of any source. This results in fewer family physicians to deliver the same primary care workforce compared to flexible primary care sources (IM, NP, PA) that can and do leave primary care during training, in fellowships, at graduation, and each year after graduation. Departures have been rapid in the past ten years.
The primary care retention woes of physician and non-physician flexible primary care forms are about health policy that determines market forces. These market forces shape movements of the flexible forms to hospital and specialty care. For example the 1998 PA graduates began at over 54% in primary care but are now down to 33%. New 2008 graduates began in primary care at 28% and declines will continue at the same 1 – 2 percentage points found each annual survey for the past decade. The intermittent nurse practitioner surveys confirm the same declines. Nurse practitioner and physician assistant declines for the past 25 years have averaged 2 – 3 percentage points fewer in primary care with each passing year.
Health policy shapes movements of nurse practitioners and physician assistants to hospital careers, specialty careers, and practice locations in higher income and more urban areas. Training shapes nurse practitioners to hospital careers where 80% of nurses are found. Training locations are also in most urban areas with concentrations of physicians, health resources, and health professionals. These are all factors to concentrate nurse practitioners in medical centers just as physicians and physician assistants are concentrated in these locations.
Standard Primary Care Year Graphic
Rural Standard Primary Care Year Graphic
Basic Health Access Concepts Site, Tables
Nurse Practitioner Calculations from Bowman article on the Standard Primary Care Year in Rural and Remote Health
Goolsby, AANP - Nurse practitioner with 22,000 FTE from 39,000 returned surveys in 2004 (not counting missing, probably fewer of the 30% that stayed in hospitals after NP training - overestimate) see AANP research site if it puts this study back online
What Are the Primary Care Calculations?
56% baseline or 22000/39000 surveyed by Goolsby and AANP in the 2004 annual survey (note no correction for missing graduates likely to be inactive or in hospital careers not using the NP degree)
15% deduction for women's health (11%) and geriatrics (4%)
41% for 2004 but 5 years later with declines of 1 – 2 percentage points each year as in the past decade
8% deduction for 2004 to 2009 (with more to come with each passing year after graduation
33% estimate but less than 30% for an entire career for the next 27 years is more likely for NP 37% if you like geriatrics covered, but again facilities vs office based a problem
What is the Maximal NP Primary Care Contribution?
Each form of primary care is limited by the characteristics of selection and training
Nurses now graduate at age 31 from nursing school
Nurse practitioners started with 10 years of RN but this is down to 8 years
NP training is 15 – 24 months and getting longer
Nurse doctor training is 2 years – losses from primary care include administrative losses to teach, losses to specialization, and losses directly due to training time – sorry, no primary care benefit from nurse doctors – the nurse practitioner vehicle for primary care is family nurse practitioners that remain in the broad generalist family practice mode, but they are leaving the family practice mode.
Maximum NP Primary Care = 27 years times 60% active times 60% of the volume times 90% primary care retention (if forced to remain)
About 9 Standard Primary Care Years if NPs remained 90% in primary care
Multiplied by 33% in primary care (or higher for those that are inclusive) for 3 – 4 SPC years
Nurse practitioners are not good primary care solutions; however, their lower volume and other areas indicate hospital and specialty advantages, especially in their cost of support, salaries, benefits.
Likely State to State Variations
Hopefully no one is bold enough to claim over 60% in primary care and even this results in a 5.4 SPC year contribution for nurse practitioners or about one-fifth of a family doc
And in the locations with top concentrations of physicians where NPs are found in cardiology, other internal medicine subspecialties and other situations not primary care, the level is 20 – 25% for about 2 - 2.5 SPC years per graduate
These are still much smaller primary care contributions for a lifetime compared to family physicians
The Higher Activity Argument
There really is no higher activity argument as nursing forms are less active – characteristic of nursing
There are states such as Arizona where nurses are imported and do have 80% of nurses active
But these are imported nursing personnel, not native to the state, and moving to a state for employment is common – a bias in activity compared to national data
Constant 60% levels of nursing activity are found in cross sections such as Vermont AHEC studies, with 50% active for nurse midwives
Future production of workforce must consider native state workforce, not importation which is a state policy design issue
Arizona is not a primary care friendly state and NPs who want to be more active can do much better in hospital and specialty careers
Why NP Makes More Sense for Hospital and Specialty Contributions
NP is much lower cost than physician specialists at $300,000 to $600,000 for salary, benefit, and special costs
And NPs deliver decent volume of specialty patients compared to lower volume specialty physicians (women's health, geriatrics, ER, cardiology)
NP buys and builds market share for specialists and systems as NP specialists in the current policy design, just as in a decade ago when the managed care design used NP as primary care (complete policy reversal and complete change in use of IM, NP, and PA)
Even if an NP begins in primary care, the market forces shaped by policy result in conversion to hospital and specialty care
But the cost savings should be shared with the nation and with patients rather than accumulated by health systems and physician specialists.
To Sum Up
Nurse practitioners begin at about age 38 and have 27 years of a career on average with wide age of entry variations and wide ranges of reasons for NP careers that also involve specialty and hospital career preferences
Nurse practitioners give up 27 years as an RN or about 27 X 0.6 active for 16.2 FTE of nursing
They give the nation 3 – 4 Standard Primary Care years worth of primary care in a 27 year career
But there are many difficulties for NP studies that tend to involve the active graduates that are illustrative of the points that nurse practitioners want to make as compared to national contributions relevant to health workforce decisions made by a nation.
Studies fail to consider NPs inactive or significant portions likely to be in hospital careers (which would reduce primary care retention percentages)
Studies have not counted the 15% in administrative careers (4 times other primary care sources) or increases with expansions of training (graduate degree, longer training, nurse doctor training)
Studies have not considered the older age primary care losses likely regarding activity, volume, administrative careers
Nurse practitioner training may cost less but the primary care contribution is low and getting lower with each passing year
A good estimate is that a family practice residency graduate will provide the same primary care contribution of 7 – 10 nurse practitioners
Then there is the consideration of who is served – greatest need areas
Rural – only the NPs that stay in the broad generalist family practice role contribute and NPs are leaving this FP role
Underserved – only the NPs that stay in the FP mode contribute at higher levels in underserved populations
Only FP forms of DO, MD, NP, and PA have 50 – 60% found serving the pop left behind - 65% of the population with only 20 - 30% of physicians (and non-physicians) – leave this FP mode and you leave needed access
Elderly - 2004 Medical Expenditure Panel Study – even with geriatric and adult and Family NPs, equal to family physicians in numbers, FP multiple times more likely to serve the elderly (Ferrer) with 63% seeing a family physician and this was a time period with higher % NP in primary care and in the family practice mode – also this analysis overcounts the NP data because the basic nursing encounters were included in NP services.
From Ferrer – National Surveys - Fraction of US Population That Visited Specific Clinician Types 2004 – Senior Ambulatory using MEPS data
Family Physicians Compared to Nurse Practitioners with similar numbers in primary care (and twice as many total NP graduates – Ferrer Study in Annals of FM
Family Physicians were 3 times as likely to be seen by age 65 or older for ambulatory care compared to nurse practitioners
Family Physicians were 4 times as likely to be seen by adults for ambulatory care
Family Physicians were 3 times as likely to be seen for women's health ambulatory care
FM is the top contributor in all of the above
FM second only to PD in pediatric care
Nationwide Studies of CHC Personnel Nationwide Rosenblatt and Hart in JAMA
Family med physicians at 3100 compared to NP at 2100
FM almost the same as RN at 3400
FM the most numerous and the most recruited compared to nurse practitioners even with similar total national graduates
The CHC choices represent a natural experiment in preference for care of the underserved
There were plenty of all types of primary care
Once again, the NP graduates were more numerous with 160,000 compared to FM at 90,000
This natural experiment demonstrated that family physicians were more likely to select CHCs and CHCs were more likely to select family physicians and are still desperate for enough basic nurses and family physicians.
Also NP has limitations in high poverty states and in border US counties http://bhpr.hrsa.gov/healthworkforce/border/default.htm
Nurse practitioner and physician assistant graduates are no more likely to deliver primary care compared to the average medical school graduate at about 3 to 4 SPC years per graduate. Physicians and non-physicians are all leaving primary care at similar rates. Those remaining in primary care in schools, programs, types of graduates, are those remaining in the family practice mode.
Facts Important in Basic Health Access