text:
New Hampshire's exchange has four carriers offering coverage for 2017, down from five in 2016. Open enrollment continues through January 31, but if you want your coverage to be effective February 1, you need to enroll by January 15.
New Hampshire is one of seven states that operates a partnership exchange with the federal government. These exchanges are considered federally-facilitated, and they use Healthcare.gov's enrollment platform and call center.
But the state also takes an active role, and operates Covering New Hampshire, a resource site for residents to learn about the exchange and the plans that are available.
As of October 2016, there were 47,976 people enrolled in qualified health plans (QHPs) through New Hampshire's exchange. Medicaid expansion in New Hampshire has been enacted by enrolling eligible residents in plans through the exchange, using Medicaid funds. As a result, another 41,714 eople had coverage in QHPs funded by the New Hampshire Medicaid's Premium Assistance Program (PAP). So total QHP enrollment through the exchange stood at 89,690 as of October.
2017 enrollment
Open enrollment for 2017 coverage began on November 1, 2016. By December 19 (the extended deadline for getting coverage effective January 1), total QHP enrollment for 2017 (not counting PAP enrollments) had reached 35,064. This includes new enrollees and people who manually renewed or changed their coverage for 2017, but it does not include the people whose coverage was automatically renewed by the exchange (auto-renewal is the default when people don't log back into the exchange site to actively renew or chane their coverage for the coming year).
The impact in New Hampshire if the ACA is repealed
According to an HHS report released in December 2016, the number of people in New Hampshire with health insurance increased by 63,000 from 2010 to 2015 as a result of the ACA. This includes young adults who have been able to remain on a parent's plan, people who enrolled in through the exchange (including those enrolled via PAP), as well as people who have gained coverage through other avenues.
The New Hampshire Insurance Department reported that the uninsured rate in the state was 11 percent in 2013, and had dropped to just 6 percent by 2015. This decrease is mostly due to the ACA.
The majority (63 percent) of the people who enrolled in non-PAP coverage through the New Hampshire exchange in 2016 were receiving premium subsidies to make their coverage affordable, and everyone in the PAP system is receiving subsidized coverage. Republican proposals to replace the ACA are not yet finalized, but most of them call for some sort of tax credit to help people pay for coverage. But unlike the ACA, which bases tax credits on enrollees' income and the cost of plans in each area, the GOP proposals would mostly provide tax credits in a more uniform way, regardless of income (meaning that they wouldn't be as need-based as the ACA tax credits). And the tax credits proposed by Republicans to be smaller than the ACA's tax credits.
There is little doubt that many of the tens of thousands of current exchange enrollees with premium subsidies or PAP assistance would find coverage much less affordable under the proposals that Republican lawmakers have introduced over the last few years. There are also worries that pre-existing conditions could once again become an obstacle for people enrolling in coverage in the individual market. If you're concerned about your ability to afford health insurance going forward, reach out to your elected officials and let them know your concerns.
Because so much is still up in the air, there is considerable uncertainty surrounding the future of the ACA under a Trump Administration (you can see more in our Repeal & Replace section). For now, however, nothing has changed, and nothing will change for 2017 (repeal is likely in early 2017, but with a delayed implementation that could be pushed out two to four years). Subsidies are still available to offset premiums and out-of-pocket costs in the exchange, and coverage is still available throughout open enrollment, regardless of pre-existing medical conditions. Don't delay though — you need to enroll by the end of January in order to have coverage for 2017. After that, you'll only be able to enroll in 2017 coverage if you experience a qualifying event.
Community Health Options exiting New Hampshire
Community Health Options, a Maine-based CO-OP that expanded into New Hampshire in 2015, is among the more successful CO-OPs in the country (one of only five that are still operational for 2017), although they've struggled with financial losses recently. They were the only CO-OP to make a profit in 2014, but they experienced higher-than-expected losses in 2015 (they lost $31 million in 2015, and also set aside $43 million in reserves to cover anticipated losses for 2016; about 85 percent of their membership is in Maine).
As a result, they ceased new individual plan enrollments for 2016 on December 15, 2015 through their website, and December 26 through Healthcare.gov. The carrier continued to offer new group plans, and all individual plans that were in force in December 2015 were eligible for renewal into 2016 if insureds didn't select coverage with a different carrier instead.
But in September 2016, Community Health Options announced that they would exit the New Hampshire market at the end of 2016 in order to focus entirely on Maine. New Hampshire still has a CO-OP in the exchange in 2017, as Minuteman Health is remaining in the market.
The bulk of CHO's enrollees — about 85 percent — are in Maine, but they had 11,438 members in New Hampshire as of July 2016 (as of September, CHO's total enrollment in the New Hampshire exchange stood at 4,649 in the individual market, including PAP members, along with 524 in the small group exchange; their off-exchange enrollees in New Hampshire —which includes the bulk of their small business enrollments — also had to find new coverage for 2017).
New Hampshire businesses that are enrolled in CHO's small group plans will be able to keep their coverage until their renewal date in 2017, but the carrier stopped renewing New Hampshire small group plans in October, and is not selling small-group plans in the state for 2017.
2017 rates and carriers
CHO's exit left four carriers offering plans in New Hampshire's exchange for 2017. But despite the exit, the state reports that there are still the same number of individual market plans (32) available in 2017, and every hospital in the state is included in at least one exchange carrier's network (all but two of the 26 hospitals are included in at least two networks, and all but three are included on more than two networks). The state has created summaries of the 32 plans for 2017, available here.
These four carriers are offering individual market QHPs in the New Hampshire exchange for 2017, with the following average rate increases:
- Ambetter by Celtic: 1.35 percent
- Anthem Blue Cross Blue Shield of New Hampshire (Matthew Thornton Health Plan): 13.9 percent (Anthem had nearly a third of the on-exchange enrollment in 2016)
- Harvard Pilgrim Health Care of New England: 11.1 percent (Harvard Pilgrim had 19,516 members — including their Elevate and NH networks — as of September, but noted in their rate filing that 9,461 members would see rate increases in excess of 10 percent)
- Minuteman Health (an ACA-created CO-OP): In April 2016, Minuteman had announced that their average rate increase would be 45.2 percent for 2017 (details below), and initial rate increase proposals ranged from 18 percent to 60 percent, depending on the plan. But the final approved rate increases ranged from 2.22 percent, to 9.89 percent, with an average of 4.2 percent, resulting in the lowest-priced plans in the exchange at all metal levels.
Two carriers—Anthem and Delta Dental—are offering dental plans through the New Hampshire exchange in 2017. There were four dental carriers in 2016, but two of them—Dentegra and Guardian Life Insurance Company—are no longer offering dental plans in the exchange after the end of 2016.
2016 enrollment
By October 2016, total enrollment in qualified health plans (QHPs, which are private plans) through the exchange stood at 47,976.
In addition, there were 41,714 people enrolled in New Hampshire's Premium Assistance Program (PAP – the state uses Medicaid funding to purchase QHPs through the exchange for Medicaid-eligible individuals).
Here's how the individual QHP market share in the exchange was distributed across the five New Hampshire exchange carriers as of October 2016:
- Anthem Blue Cross Blue Shield: 20,876 QHP enrollees (down from about 26,000 in March), plus an additional 8,550 PAP enrollees
- Minuteman: 16,004 QHP enrollees (about half are on Bronze plans), plus an additional 2,955 PAP enrollees.
- Harvard Pilgrim: 9,442 QHP enrollees, plus an additional 10,196 PAP enrollees
- Community Health Options: 1,631 QHP enrollees, plus an additional 1,389 PAP enrollees (enrollment in QHPs ceased as of December 26, 2015, and CHO is exiting the state altogether at the end of 2016).
- Ambetter: 23 QHP enrollees, plus an additional 18,624 PAP enrollees (New Hampshire Healthy Families enrollees were automatically enrolled in Ambetter through the PAP, although they had the option to pick a different health plan).
According to the New Hampshire Insurance Department, the enrollment drop-off for Community Health Options from March to April 2016 was partially a result of a reporting glitch in previous months: Rather than reporting just on-exchange numbers to the Insurance Department (used for the monthly QHP membership report that the Insurance Department publishes), Community Health Options had been reporting both on and off-exchange numbers combined. So starting in April, the enrollment report includes only on-exchange enrollments.
PAP enrollments for Medicaid-eligible enrollees are QHPs, and are in the same risk pool as regular QHP enrollments. PAP simply uses Medicaid funding to pay the premiums and any cost-sharing above Medicaid levels, and adds in any additional benefits that must be covered under Medicaid.
Enrollment in QHPs during the 2015 open enrollment period reached 53,005, so the 55,183 people who enrolled in QHPs for 2016 (by February 1) represented a 4 percent increase. And the 49,114 effectuated enrollment total as of March 2016 was an 8 percent increase over the 45,607 effectuated enrollment number from the same time the previous year.
Of the 2016 enrollees, 32 percent were new to the exchange for 2016, and 63.4 percent were receiving premium subsidies as of March 2016. This was the lowest percentage of subsidy-eligible enrollees in any of the states where HHS is running the exchange, and quite a bit lower than the 85 percent average across all the states that use the federally-facilitate exchange.
881 people enrolled in small business exchange
The October enrollment report indicated that there are 817 people enrolled in small business (SHOP) plans through the New Hampshire exchange, representing a total of 153 small businesses. There was a sharp drop-off from March to April; the March report had indicated that there were 825 groups and 7,615 enrollees.
The drop-off was due to Community Health Options' enrollment tally, which went from 766 groups with 7,265 insured members, to just 81 groups with 499 insured members. According to the New Hampshire Insurance Department, the April numbers (and the subsequent months) are correct, and the prior numbers had included off-exchange enrollments along with SHOP enrollments. The vast majority of Community Health Options' small business enrollments are off-exchange (those small businesses will have to find new coverage at their next renewal, as CHO is exiting New Hampshire altogether, including the off-exchange market)
Minuteman Health contends that risk adjustment program is badly flawed
Minuteman Health had roughly 26,500 members as of November 2016 — well above their goal of 22,500 members. The CO-OP filed a lawsuit in August 2016 over the risk adjustment payments they owed to CMS (more than $16 million for the 2015 benefit year alone, accounting for 90 percent of the state's total risk adjustment payments, despite having just 19 percent of the on-exchange market share), and has warned that significant changes are necessary in order to stabilize the individual market (risk adjustment is a permanent program, unlike the other two "Rs" which sunset at the end of 2016).
Blue Cross Blue Shield of Massachusetts, however, is happy with the way the risk adjustment program was structured, as they're receiving $40 million from their competitors under the program.
In April 2016, Minuteman Health announced that they were requesting a 45.2 percent rate increase for 2017. But the final average rate increase for Minuteman plans in 2017 was just 4.2 percent (the lowest of any of the exchange carriers in New Hampshire, and resulting in the lowest overall prices in the exchange as well). For perspective, Minuteman Health requested rate hikes of 42 to 51 percent for their individual market plans heading into 2016, but regulators ended up approving average rate increases that ranged from 2.75 percent to 9.63 percent.
Minuteman is the only carrier in the New Hampshire exchange that offers platinum plans, and they continue to have two zero-deductible platinum plans available for 2017. But their most popular plans are bronze and silver; 6,323 of their 16,004 on-exchange (non-PAP) members had bronze plans as of September 2016, and 7,691 had silver plans.
2016 rates and carriers
In 2015, New Hampshire's exchange had five carriers, up from just one in 2014. There were still five carriers offering plans for 2016, although there was one swap: Assurant/Time exited the market (nationwide), but Ambetter (offered by Celtic) joined the exchange in New Hampshire (Assurant had 189 enrollees in the New Hampshire exchange as of January 2015, but enrollment had dropped to zero by September 2015, in anticipation of their market exit).
In 2015, there were 42 individual plans available in the state, and that increased to 51 for 2016. Dentegra also joined the exchange, bringing the total number of dental carriers from three to four (Dentegra only participated in the exchange for 2016, and is not offering plans for 2017)
Two carriers in the exchange – Minuteman Health and Community Health Options – requested double digit rate increases for 2016. Both carriers were CO-OPs created under the ACA, and both expanded into New Hampshire at the start of 2015, so their claims data for the state was very limited. But they both noted in their rate justifications that the transition of the NH Health Protection Program population (those newly eligible for Medicaid under the ACA's Medicaid expansion) to private plans in 2016 was a driving force in the higher rates they requested for 2016 (the state is using Medicaid funds to subsidize premiums for the transitioning enrollees). Minuteman requested an average rate increase of nearly 50 percent, although they proposed a rate reduction of nearly 27 percent for their catastrophic plan.
2016 approved rate hikes modest
Ultimately, regulators approved Community Health Options' 2016 rates as proposed. But the final approved rate increases for Minuteman Health were much smaller than the carrier had requested. The rate decrease for the catastrophic plan was approved with only minor changes. But for Minuteman's other individual market plans – on which the CO-OP had requested rate increases of nearly 50 percent – regulators approved average rate increases ranging from 2.75 percent to 9.63 percent.
Anthem and Harvard Pilgrim Health Care both had average approved rate increases of less than 6 percent. The New Hampshire exchange provides market share data that's updated monthly; 44,670 people had in-force private plan coverage in the New Hampshire exchange as of December 2015.
Here's market share and rate change data for each carrier offering individual plans in the New Hampshire exchange in 2016:
- Ambetter (Celtic) – new to New Hampshire exchange for 2016.
- Anthem: Average approved rate changes were a 0.29 percent decrease, and a 5.7 percent increase. Anthem had 24,567 in force enrollees as of December 2015
- Community Health Options (previously known as Maine Community Health Options): Average rate increases of 13.8 percent to 16.7 percent, approved as-proposed. 4,013 in-force enrollees as of November 2015 (new individual plan enrollments will cease December 26).
- Harvard Pilgrim Health Care: 4.36 percent increase for the NH Network plans, and a 2.09 percent decrease for the Elevate Health plans. 6,568 in force enrollees as of December 2015; nearly three quarters of Harvard Pilgrim's enrollees are in the Elevate Health plans.
- Minuteman Health: Approved average rate increases range from 2.75 percent to 9.63 percent for individual market plans (much lower than the proposed rate increases of 42 percent to 51 percent). Catastrophic plan rates will decrease by more than 27 percent in 2016, which is very close to what Minuteman Health requested for this plan. Minuteman had 8,360 in force enrollees as of November 2015.
Before rates were finalized in New Hampshire, the worst-case scenario rate increase based on proposed rates was 18.5 percent. This was based on using the highest proposed rate increases for Community Health options and Minuteman (assuming the majority of their enrollees were in the plans with the highest proposed rate hikes), and the possibility of 9.9 percent rate increases for Anthem and Harvard Pilgrim. Despite the fact that Minuteman had proposed rate hikes of nearly 50 percent, their enrollment accounted for less than 20 percent of the exchange total. And the dominant carrier in the exchange – Anthem – had requested a rate hike of less than 10 percent, so the overall proposed weighted average rate hike was still under 20 percent.
But once the rate review process was finalized, the overall weighted average rate hike was just over 6 percent – even if we assume that the majority of Community Health Options, Anthem, and Minuteman enrollees were in plans with the highest rate hikes. According to HHS data, the average benchmark premium (second lowest-cost Silver plan, which isn't necessarily the same plan from one year to the next) in New Hampshire is 5.1 percent more expensive in 2016 than it was in 2015. In the Manchester area, a Kaiser Family Foundation analysis determined that the average benchmark premium increased by 5.7 percent for 2016.
Higher benchmark premiums mean that average subsidies are higher in 2016 than they were in 2015. But it was still important for enrollees to shop around during open enrollment, as the increase in subsidies didn't apply consistently in every area, and wasn't enough to offset the rate hikes that some plans experienced in 2016.
Increased network options in 2016
All 26 hospitals in the state are contracted with at least two of the five carriers in 2016, and most of the hospitals are on three, four, or five of the networks. Network issues plagued the New Hampshire exchange in 2014, as Anthem only contracted with 16 of the state's 26 hospitals in efforts to keep premiums as low as possible.
As a result, even though the exchange had just one carrier in 2014, premiums in New Hampshire were comparable to rates in states that had many carriers offering policies. But Anthem's restrictions on its hospital and physician networks drew fire, despite the low premiums that the narrow network allowed.
Provider access in New Hampshire had already expanded considerably for 2015. In November 2014, the New Hampshire Department of Insurance published a detailed explanation of 2015 network size and scope based on county and carrier for all of the carriers offering plans in the exchange. Provider network details are also available on each carrier's website.
There was a mix of broad and narrow networks available in New Hampshire for 2015, and that continues to be the case in 2016; shoppers can find the price and network combination that most appeals to them.
Off-exchange market
The same four carriers are offering individual policies outside the exchange in 2017, and there are no additional carriers in the state that only sell off-exchange products. But the state does not track market share outside the exchange, so the weighted average rate increase could be different when considering the entire individual market in New Hampshire, including both on and off-exchange.
But it's worth considering that in their rate justification for 2016, Community Health Options noted that the size of the individual market in New Hampshire was about 50,000 people in 2015 (total enrollment in private plans through the exchange in December 2015 was 43,508). Given that risk pools for on and off-exchange plans are unified, that would seem to indicate a relatively small ACA-compliant individual market outside the exchange.
That hypothesis is further bolstered by the fact that less than 63 percent of New Hampshire exchange enrollees were receiving premium subsidies in 2015 and again in 2016 — far lower than the national average of about 85 percent. If a significant number of non-subsidy-eligible enrollees are getting coverage through the exchange (this is the population most likely to shop outside the exchange), it makes sense that the off-exchange population might be quite small.
A hands-on state
The New Hampshire Department of Insurance is an active participant in overall functionality of the New Hampshire exchange, which operates as a partnership between the state and HHS. The Department of Insurance has published an inclusive overview of exchange information on their website to serve as a resource for state residents.
Although New Hampshire residents use Healthcare.gov to enroll in health plans, the state also has a website called Covering New Hampshire that serves as an excellent resource for residents. The site provides extensive information about health insurance options in New Hampshire, and can also connect residents with local in-person assistance.
The state's efforts to get people enrolled in health insurance – both expanded Medicaid and private coverage – are evident in the reduction in the uninsured rate. According to Gallup data, 13.8 percent of New Hampshire residents were uninsured in 2013. By the first half of 2015 – after Medicaid expansion had been in effect for several months – the uninsured rate had fallen to 8.7 percent.
2015 enrollment totals
53,005 people in New Hampshire had enrolled in private plans through the exchange by February 22, 2015, when the second open enrollment period – and its extension – ended. Only 71 percent of them were receiving premium subsidies – the lowest percentage of any state where HHS was running the exchange (that figure has dropped to 67 percent for 2016).
The official HHS target for New Hampshire was 50,000 enrollees during the 2015 open enrollment period, so the exchange exceeded that target by more than three thousand people. However, by April 1, only 45,504 people had in-force policies in the New Hampshire exchange, as some enrollees didn't pay their initial premiums, and others cancelled their coverage shortly after enrolling. All in all, the effectuation rate matches up with the national averages.
The effectuated enrollment report from CMS showed 44,727 people in New Hampshire with in-force private plan coverage through the exchange as of June 30, and the state's own report pegged the number at 44,305 by November. There's some fluctuation from one month to another, especially given that subsidized plans don't terminate for non-payment until premiums are three months past-due.
An additional 9,294 people in New Hampshire enrolled in Medicaid or CHIP through the exchange between November 15 and February 22. Medicaid enrollment continues year-round.
King v. Burwell – subsidies upheld
Democratic Representative Ed Butler introduced a bill to create a state-run exchange in New Hampshire in 2015 (the state currently has a partnership exchange), but it was defeated by the Republican dominated legislature in March. Since the state still uses the federally-run exchange, 28,000 people in New Hampshire would have lost their subsidies if the Supreme Court had ruled that subsidies could only be issued by state-run exchanges. But in June 2015, the Supreme Court ruled that subsidies are legal in every state, even those that rely on the federally-run exchange.
Benefits extend beyond those receiving subsidies
This was obviously a huge win for the people of New Hampshire who have subsidized coverage through the exchange; the Kaiser Family Foundation had estimated that their premiums would have increased by 218 percent if the subsidies had been eliminated. But it's also a win for everyone who buys individual insurance in the state, including those who don't receive subsidies. The American Academy of Actuaries had projected market-wide rate increases of at least 35 percent if subsidies had been eliminated, and the overall size of the individual market pool would have dropped by about 70 percent.
As well as the citizens of New Hampsire, the King ruling was also a win for health insurers – their market is no longer in danger of imminent destabilization – and for medical providers, since their patients will still have insurance and be able to afford care.
In addition, New Hampshire expanded Medicaid under the ACA, but with a waiver that allowed the state to start using Medicaid funds to subsidize private plans in the exchange for the newly eligible population in 2016, rather than continuing to cover them in the state's Medicaid managed care program. Those funds would still have been available in 2016 regardless of the outcome of the King case, but state leaders had expressed concern that the program could have been jeopardized by the upheaval that would have been created in the exchange if subsidies had been eliminated.
Exchange grew from one carrier to five in 2015, dropped to four by 2017
For 2014, only one health insurance carrier — Anthem Blue Cross Blue Shield — applied to participate in the state-federal partnership exchange in New Hampshire, offering 14 health plan options. But that changed significantly for 2015, when the New Hampshire exchange grew to include policies from five carriers. Not all carriers offer plans in all counties, but there were an average of 38 plans available in each county, up from 10 in 2014.
Two of the new carriers that joined the New Hampshire exchange in 2015 are ACA-created CO-OPs: Minuteman Health, based in Boston, and Community Health Options (formerly Maine Community Health Options, or MCHO) that garnered 83 percent of the market share in neighboring Maine during the 2014 open enrollment. CHO had a limited presence in New Hampshire 2015, offering coverage in four NH counties: Coos, Carroll, Rockingham, and Strafford.
Harvard Pilgrim Health Care and Assurant also joined the New Hampshire exchange in 2015, although Assurant announced in mid-2015 that they would exit the entire market nationwide, and they no longer had any enrollees in the New Hampshire exchange as of September 2015.
For 2017, Community Health Options is no longer offering coverage in the exchange, but plans continue to be available from Anthem, Ambetter, Minuteman Health, and Harvard Pilgrim.
Lower premiums in 2015
One result of the increased competition in 2015 was a sharp reduction in average premiums. The benchmark plan (second-lowest-cost silver plan) changed as a result of the influx of carriers to the exchange, and the new benchmark plan in 2015 was about 17 percent less expensive than the benchmark plan in 2014. This was among the sharpest drops in the country, and highlights the importance of competition in holding down premiums.
Avalere Health found that the average lowest-cost bronze plan in New Hampshire was 17 percent less expensive in 2015, and that the average lowest-cost silver plan was 18 percent less expensive. The silver drop is the largest in the nation, and the bronze drop is second only to Mississippi.
2014 enrollment numbers
40,262 people had completed their private plan Obamacare enrollments in the New Hampshire exchange by mid-April 2014. Another 7,235 exchange applicants were eligible for the state's existing Medicaid coverage during the first open enrollment (Medicaid enrollment continues year-round, but tends to peak during open enrollment due to increased outreach).
For private plan enrollments, New Hampshire greatly exceeded CMS projections in 2014. The original projection for the New Hampshire exchange was 19,000 enrollees during the 2014 open enrollment; the final total is more than double that amount.
Anthem Blue Cross Blue Shield had 90 percent of the individual market share in New Hampshire prior to 2014, so it's not especially unusual that they were the only carrier that opted to participate in the exchange the first year.
Anthem reported that more than 35,000 of the exchange enrollees were new customers for them in 2014. Given the carrier's long-term dominance in the market, we can assume that a significant majority of the first-year Obamacare enrollments in New Hampshire were for people who were previously uninsured. Anthem also reported that almost 90 percent of their enrollees paid their initial premiums in 2014.
Unique Medicaid expansion began mid-2014
Residents were able to begin enrolling in New Hampshire's expanded Medicaid program as of July 1, 2014, with policies effective August 15 (Medicaid enrollment during the winter and spring was only possible for people who qualified under the state's pre-expansion guidelines).
The state estimated that roughly 50,000 people would be eligible for coverage under the expanded Medicaid program. By the end of September, three months after enrollment began for expanded Medicaid, 18,500 people had already enrolled, and that had grown to nearly 24 thousand people by November 19.
Medicaid expansion in New Hampshire was a contentious issue, but ultimately Governor Maggie Hassan prevailed in her efforts to expand Medicaid, albeit in a privatized fashion. Gov Hassan signed Senate Bill 413 into law on March 27, 2014, paving the way for New Hampshire to become the 26th state to accept Medicaid expansion.
For the first couple years, the program has looked much the same as Medicaid expansion looks in the other 25 states. The state uses federal Medicaid funds to provide New Hampshire Health Protection Program coverage to residents with incomes below 138 percent of poverty.
But starting in January 2016, the state transitioned the NH Health Protection Program's participants to subsidized, private coverage (Premium Assistance Program), following the "private option" Medicaid expansion path that has been popular in several other states. As of March 2016, PAP enrollment through the New Hampshire exchange stood at 43,732.
Risk pool and grandmothered plans
In November 2013, New Hampshire's Insurance Commissioner Roger Sevigny announced that the state-run high risk pool (New Hampshire Health Plan) would remain in effect "until the federal marketplace is fully available (the risk pool had previously been scheduled to cease operations on December 31). The risk pool ceased operations on June 30, 2014.
In 2016, CMS issued another extension for transitional (grandmothered) plans, allowing them to renew as late as October 2017, and remain in force until as late as December 31, 2017. But the final decision regarding transitional plans was left to the states. New Hampshire opted to go along with the provision allowing transitional plans to remain in force until the end of 2017, but only if the plans are renewed by January 1, 2017. This is different from the requirements in most states, since transitional plans will not be allowed to renew in New Hampshire through October 2017; instead, the renewals will have to be complete by January 1, 2017. A transitional plan that's up for renewal in March 2017 will have to be replaced with an ACA-compliant plan at that point instead of being renewed.
But residents also have the option to cancel their existing plan and switch to a new ACA-compliant policy instead, during open enrollment or when their grandfathered/grandmothered plan renews (renewal outside of open enrollment is considered a qualifying event that allows people to purchase an ACA-compliant plan instead). Anthem Blue Cross Blue Shield announced in May 2014 that they would accept the government's offer to further extend pre-ACA policies that were carried over from 2013.
The New Hampshire Health Plan, which runs the state's high-risk insurance pool, was approved in September 2013 for a federal grant to help facilitate education and outreach for the exchange. In addition, Planned Parenthood and Bi-State Primary Care were both awarded grants to serve as navigators during the first open enrollment period, for NH residents who had questions or needed personal assistance with the enrollment process.
Covering New Hampshire, an organization dedicated to educating consumers in New Hampshire and helping them enroll in coverage, focused additional efforts on targeting young men during the 2015 open enrollment, since they were under-represented during the 2014 open enrollment period.
In September 2015, CMS announced navigator grants for two New Hampshire organizations: Bi-State Primary Care received almost $355,000, and Bhutanese Community of New Hampshire received more than $245,000.
Legislation and exchange history
The exchange creation process in New Hampshire has been a legislative battle. In February 2013, Gov. Hassan announced that New Hampshire would operate its health insurance marketplace as a partnership with the federal government.
Prior to the 2012 elections, New Hampshire seemed firmly on a path to relying on the federally facilitated exchange. Former Democratic Gov. John Lynch had no effective means to push back against a Republican-dominated state Legislature that was united against a state-run exchange.
And in 2011, lawmakers passed a bill (enacted into law without Lynch's signature) that prohibited any sort of penalties for New Hampshire residents who fail to obtain health insurance – in direct conflict with the ACA's individual mandate and shared responsibility penalty. The law has no real impact however, because the IRS (a federal agency, not under state control) is responsible for assessing the ACA's penalties, and because the ACA is a federal law that cannot be superseded by state law.
But the 2012 elections gave control of the state House to Democrats, put more Democrats in the Senate, and kept the governor's office in Democratic hands. The political shift and a law that allowed the state to take on specific exchange functions enabled the state to adopt a partnership model.
New Hampshire is responsible for plan management and consumer assistance, and the federal government is managing all other marketplace functions. The NH Health Exchange Advisory Board holds monthly meetings, the minutes of which are available here.
New Hampshire health insurance exchange links
New Hampshire Department of Insurance: Health Benefit Partnership Exchange Advisory Board
Includes meeting agendas and documents from November 2012 until the present.
State Exchange Profile: New Hampshire
The Henry J. Kaiser Family Foundation overview of New Hampshire's progress toward creating a state health insurance exchange.
New Hampshire Consumer Assistance Program
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in New Hampshire.
(800) 852-3416 / email@example.com
Covering New Hampshire – a statewide effort by the New Hampshire Health Plan to inform residents of their coverage options in the exchange and the resources that are available for those who need assistance.


text:
For the first time in my life, I have long hair. I've been growing it out for about five years now, and it finally hangs to the small of my back. That's a lot of hair, and piling it on top of my head after showering using a regular towel just doesn't cut it, I need a hair towel.
So I raided my cotton yarn stash and created a free crochet pattern using just a couple of dollars worth of yarn. Sa-weet!!!
The most absorbent yarn is cotton, so you'll definitely want to make sure you have some. For optimal absorbency, choose a yarn with little to no dye at all. But I like red. 😉
Hair Towel with a Twist {FREE Crochet Pattern}
Instead of including the (long) pattern all on this webpage, I'm putting it into this PDF document. Head over and open it, save it, print it and make it. Next…
Lay the two pieces together and line them up. You'll sew the seams around and then go around the opening with a singe crochet border. Attach a small piece of elastic so that you can tuck the end of the towel through to secure it after twisting your hair inside.
Voila! Now you can bend over to put on your socks or pick up something off the floor without losing that towel precariously set atop your head!
These work up pretty quickly, within a couple of hours, and would be a great gift for a teenager or one going off to college or as a Christmas for that niece you're never quite sure what to give.
See more of our FREE crochet patterns, print the PDF for this pattern, and make sure you add it to your Ravelry queue!
Join us!
Join us here at Heart • Hook • Home and get CROCHET tips and DIY ideas, YARN hacks and FREE crochet patterns + yummy new RECIPES along with FAMILY and HEART + BUDGETING tips sent directly to your email!

subset: commoncrawl


text:
A combination of fish oil, flaxseed oil and evening primrose oil with high performance in Omega 3,6 and 9 fatty acids ( EPA/DHA form). The DHA and EPA help in normal functioning of the heart. The DHA contribute to the normal functioning of the brain and vision and maintain healthy levels of cholesterol.
The Omega 3.6.9. of the Classics Platinum Range Series from Power Health is a high quality dietary supplement, a natural ally of the heart. The daily intake is extremely important for the body because it is responsible for the proper functioning of all cell membranes , than means the control of the substances' entry and exit in our cells.
Quantity : 30 Capsules
Active Ingredients Per capsule
Fish Oil 500mg
Flaxseed oil 400mg
Evening Primrose oil 300mg
Fish oil, Organic Flaxseed Oil, Evening primrose Oil, Gelatin, Glycerin, Purified water.


text:
byScott Campbell on
6. William Stone, SS&C Technologies
Chairman and CEO
Stone's total compensation in 2011 was more than $1 million less than he was awarded in 2010 by SS&C. All told, he's been awarded more than $14 million in the last three years.
CRN's third annual Channel Madness Tournament of Chiefs is under way! Choose your favorites:


text: Item is not available Find Another One Others Looked At... S&W Bodyguard 38SPL Revolver w/Laser SELLER: R R Gun Shop 1 $465.00 Smith & Wesson Model 638 Pink Airweight ... SELLER: Ammo And Arms 1 $439.99 CONSECUTIVE PAIR - S&W MODEL 442 - ***ON... SELLER: LAUGHLIN'S 1 $1,359.99 Smith & Wesson 640-3,100% deep hand engr... SELLER: Bob Simpson 1 $1,895.00 Smith and Wesson M360 357 Magnum SELLER: TXSporting 1 $609.00 S&W MODEL 351PD REVOLVER - 22 MAGNUM - 7... SELLER: LAUGHLIN'S 1 $679.99 Guns Pistols Smith Wesson Revolvers Pocket Pistols S W . Special model Chief s Special Airweight Blue inch Snub Production Spl Smith Wesson Ajax Ivory Grips with Black Tyler T Refinish | 646 | 41 | Lc | 453.1314ms S&W .38 Special model 36 Chief's Special Airweight Blue 2 inch Snub 1961 Production 38 Spl Smith & Wesson 101602 Ajax Ivory Grips with Black Tyler T Refinish For Sale from Robertson Trading Post | Positive feedback: 99% View | Verified Seller | 19447 Completed Sales View Sellers Items This item is no longer available. /UserImages/87270/983809546 7665806.jpg /UserImages/87270/983809546 7665807.jpg /UserImages/87270/983809546 7665808.jpg /UserImages/87270/983809546 7665809.jpg /UserImages/87270/983809546 7665810.jpg /UserImages/87270/983809546 7665811.jpg /UserImages/87270/983809546 7665812.jpg /UserImages/87270/983809546 7665813.jpg /UserImages/87270/983809546 7665814.jpg /UserImages/87270/983809546 7665815.jpg /UserImages/87270/983809546 7665816.jpg /UserImages/87270/983809546 7665817.jpg /UserImages/87270/983809546 7665818.jpg /UserImages/87270/983809546 7665819.jpg /UserImages/87270/983809546 7665820.jpg /UserImages/87270/983809546 7665821.jpg /UserImages/87270/983809546 7665822.jpg Description Shipping and Payment More Info From the collection of a ranking Kansas lawman comes this most attractive Smith & Wesson Chief's Special, numbered model 36 no suffix. From its 248000 range serial number, it was manufactured in 1960 or, most likely, 1961. Serial number 295000 began 1962 production, so it had to be made before that. Manufacturer is Smith & Wesson of Springfield, MA. Type is traditional double and single action pocket revolver. Metal is entirely steel, with Ajax Imitation Ivory Grips, and a black anodized Tyler Chambering is .38 Smith & Wesson Special caliber; cylinder holds 5 rounds of .38 Special ammunition. This revolver was not made for +P ammunition. Barrel is 1 7/8 inch, nominally 2 inch, six groove right hand 1:18.75 rifling. Sights are barrel integral serrated ramp front with frame integral fixed notch rear. Trigger is factory target .400 serrated face, color casehardened, with .235 serrated spur service hammer. Grips are 1990s production Ajax Imitation Ivory, similar to the Micarta grips of this gun's service period. Grip adapter is current production Tyler T size 1, also correct for its service period. Finish is entirely blued, and we estimate the refinish was performed some time in the 1970s. Note that the hammer and trigger are fully blued. Surface detractions are moderate principally edge wear. We rate it as Very Good refinish, 80 percent vicinity by our estimate, but photos ought to suffice for our distinguished shoppers to judge finish grade for themselves. Note the scouring and wear to the butt edge of the grips. Double action trigger pull is smooth and consistent, and the cylinder times correctly on all five positions on double action. On single action, the hammer travels fully 15 to 20 degrees on all five after the cylinder times, and single action trigger pull measures a crisp 3 7/8 pounds. Lateral play to the cylinder is minimal, 1/2 mm by our estimate, both with the trigger relaxed and with it fully depressed. Cylinder face to forcing cone gap measures a tight .004. Blast effect to the under side of the frame top strap directly above the barrel's forcing cone is minimal, only an etchy impress with no depth that traverses the width of the top strap. Bore, cylinder chambers, and mechanism are all bright and clean. Replacement price on these revolvers is now upwards of $600.00 in our area, if a person can even find one. We're offering the JFK Era Chief in the photos, however, for only $ 419.00 Not transferable to unlicensed non-C&R civilians in Massachusetts. $35 off if we keep the grips and adapter. Any ammunition or personnel in our photos are Not included. $15 handguns lower 48; $40 handguns Alaska, Hawaii or Puerto Rico, USPS Priority Mail, insured with Delivery Confirmation. $20 long guns lower 48; $60 to AK, HI or PR. Don't let your buddies use your account, that kind of thing smells like felony level straw purchase attempt. GA Pay, MC/Visa/Discover/USPS MO paid orders shipped ASAP. Please Note that C&R Handguns, as concealable weapons, must transfer through an 01 or 02 FFL in Boston, CA, Chicago, CT, D.C., DE, HI, IL, NJ, and NY. FFL ok by fax, e-mail or mail. We offer 7 day money back on used guns and items, but No Returns on Lay-aways or ammo. We do not pay transfer fees or return shipping. We accept lay-away with 20% down, balance in 90 days - lay aways not refundable, though. Internet phone hours 8:00 – 5:00 CST Mon - Fri CST. Local pickup available. Robertson Trading Post 117 Front Street PO Box 365 Henderson, Tennessee 38340 We Buy, Sell, or Trade. We always have, since 1952. $15 lower 48; $40 AK, HI, PR, USPS Priority. 7 day money back on used items, but No Returns on NIB, Lay-away, or Ammo. Lay-away OK, 20% down, 90 days to pay. We Buy, Sell, or Trade; we always have, since 1952. Trades Accepted: We Buy, Sell, or Trade. Always have. Don't let your buddies use your account. Registered user must be the buyer, with his or her own money. Buying firearms and related items for other people can result in felony charges. Don't try, either, to circumvent any law; for example, a California civilian may not buy a high capacity magazine and have it shipped to his brother-in-law in Nevada. That is a felony. GA Pay buyers are NOT charged until we confirm we have the item and are ready to ship it. The same thing is true for phone-in, fax-in, and mail-in payments. In this respect, and in several others, Guns America outshines all its competitors. This is the best firearms website there is, hands down. Condition: Used, Minor Wear Brand: Smith & Wesson Inc. Caliber: .38 Special Location: TN Share Item Item #: 983809546 SKU: 101602 Stock No.: HG4003 This item is no longer available. Price: This Seller Accepts Online Payment Shipping: $20.00 Accepted Payment Methods: Returns: 7 Days Robertson Trading Post Seller Since: Jul. 2007 Seller Level: Trusted Seller This seller is an FFL City: Henderson State: TN Your Recently Viewed Items


text:
Will Kate Upton be hanging with Vinnie Chase and the boys?
The 21-year-old blond bombshell is rumored to be in the running to play the female lead in the upcoming Entourage movie.
Sources tell The Wrap that Upton has yet to receive an offer, but she is in early talks to join the cast for the film version that will reunite stars Adrian Grenier, Kevin Connolly, Kevin Dillon, Jerry Ferrara and Jeremy Piven.
No word on the part Upton would play exactly, though it's speculated that it could be Vinnie's love interest.
Reps for Upton and Warner Bros. were unavailable for immediate comment.
Upton made her acting debut in 2011's Tower Heist and the Sports Illustrated cover girl's other feature credits include a bit part in the Farrelly brothers' comedy The Three Stooges and Nick Cassavetes' forthcoming The Other Woman with Cameron Diaz.
Plans to give HBO's hit comedy series its big screen closeup have been in the works since January when the studio gave the production the greenlight. But contract negotiations reportedly hit a snag in September after some stars allegedly held out for more money.
Two weeks ago however, Entourage's creator and director, Doug Ellin, finally declared the flick was happening when he tweeted a photo of the cast with the caption "It's a go. Love you all."
If all goes well, shooting on Entourage is expected to get rolling next year.Follow @Infocelebrity on Twitter!
Like us on Facebook!


text:
From the Field to the Classroom
When Luis Ortiz graduated from Northeastern Illinois University, one of his first calls to the field took him back to his family's roots in Puerto Rico.
Explore over 80 rigorous programs in the arts, sciences, education, and business. At Northeastern, find yourself among a welcoming and diverse community of scholars who are as serious about their education as you are.
7 days ago
Northeastern Illinois University's Office of Community and Professional Education (CAPE) has added the following non-credit programs this spring. Click titles for complete details or search all CAPE and Campus Recreation offerings. CAPE…7 days ago
While Northeastern Illinois University is shutting down for Spring Break, there are plans in the works for all kinds of educational and cultural events later…Friday, March 17, 2017
Best-selling author, producer and broadcaster John St. Augustine and legendary broadcaster Bill Kurtis will deliver the keynote address during the Green Business Conference at Northeastern…"I encourage students to embrace education as a way of acquiring a set of skills to empower themselves, their families and their communities."
Lance Williams, inner city studies faculty
Learn from renowned scholars, authors, poets, activists, and artists at free public lectures.
Join a community of highly motivated students who enjoy an enriched college experience.
Join the party as our resident Spanish dance company celebrates its 40th year.
Travel, study and live in a foreign country while pursuing your degree at Northeastern.
Discover, define and accomplish your academic and career goals.
Enjoy some of the finest classical, jazz and world music in one of Chicago's most intimate venues.
Our main campus is nestled in Chicago's North Side. Sixty-seven acres full of academics, arts and recreation provide a welcoming urban oasis to the nearly 11,000 commuter students who attend Northeastern.
5500 North St. Louis Avenue, Chicago, IL 60625-4699
(773) 583-4050
El Centro is one of Northeastern Illinois University's locations. It is a focal point for the Latino community and provides educational opportunities within a culturally comfortable and easily accessible setting.
3390 North Avondale Avenue, Chicago, IL 60618
(773) 442-4080/4086
The Carruthers Center for Inner City Studies is located on the South Side of Chicago and offers a Bachelor of Arts and Master of Arts in Inner City Studies.
700 East Oakwood Boulevard, Chicago, IL 60653
(773) 268-7500
Northeastern provides the opportunity for transfer students in the Lake County region to complete their bachelor's or master's degree at the University Center.
1200 University Center Drive, Grayslake, IL 60030
(847) 665-4000
Founded in 1978, the Center for College Access and Success (CCAS) develops collaborative partnerships that engage entire communities to help students succeed both academically and socially.
770 North Halsted Street, Suite 420, Chicago, IL 60642
(312) 733-7330
Northeastern Illinois University
5500 North St. Louis Avenue
Chicago, Illinois 60625-4699
(773) 583-4050


text:
Being the ever-so-snarky lady that she is, Molly simply replied, "You have tinnitus and are going about it all wrong." I asked her to start from the beginning. Here's how it went down.
Read Whole Story
Get top stories and blog posts emailed to me each day. Newsletters may offer personalized content or advertisements. Learn more.


text:
IRS problems are getting quite typical these days. Does this imply that people are getting irresponsible when it comes to having to pay their taxes? If they are staying away from the task of submitting for their taxes, what could be the purpose powering it? What happens when someone misses a tax payment? Ought to s/he represent him/herself throughout an IRS tax audit?
If You're Searching For Cumberland IRS Lawyers, Then This Is The Site To Go To
Check out your possible tax attorney or tax resolution company with the Much better Business Bureau, but maintain in mind the quantity of individuals the company serves. If the company has twenty grievances more than three years but has served five,000 clients in that time, that's a .four%twenty five failure price, or said differently a ninety nine.6%25 fulfillment price. Even that can be misleading simply because the BBB only tracks grievances, not resolutions. Even if the client got a full refund and one hundred%25 satisfaction, the consumer can't withdraw their grievance once it is filed with the BBB. You could also Google their name with the words "complaint," "rip-off" and "scam." And if they are a tax attorney, verify with your state's bar to see if they have any complaints against them.
Assist Taxpayers Who Owe Taxes
Filling federal earnings tax yourself can be occasionally entertaining. Isn't it enjoyable to see when you usually get refund? It is fun to see an income tax reduction. So, do not let your earnings tax lawyer has all the enjoyable.
Do they give you a high stress revenue pitch? If they are pushing that difficult, that's a warning signal to stay absent. In numerous cases when you get a sales pitch you are talking with a salesperson, not a tax attorney or tax resolution expert who can assist you.
IRS Tax Lien Help Near Cumberland IA
Get ahold of the levy judgment paperwork. This is simple sufficient to do; the bank exactly where the levy was administered has to notify you about the levy motion, and is also required to provide that paperwork upon ask for.
Second, price. Yes, I understand this is most likely the very purpose why you have not employed one however. To find out if you can afford a tax relief lawyer, verify out how the lawyer requires payment. Most of them have hourly prices, but there are a few that require a retainer or an all require payment. If you are unsure, just ask them and they will be upfront with you. At times you can even offer a brief description of your issue more than the phone for an estimate for on your tax relief journey.
The Perfect Tax Expert for Negotiation of Case
Revenue officers work by monitoring down and having to pay a visit to people with unsettled debts. When a revenue officer is knocking at your door, there is truly absolutely nothing to be frightened of. Is it as well late to contact an lawyer? The answer is "no." Contact your lawyer correct absent to guide you. Is hiding from the officer an option? Sure, it is an choice, but it will lead to more problems. Ignoring or hiding from the officer won't solve the issue. It will only direct to an account delinquency. When this happens, the government may issue a bank levy.
Currently that you're saving your receipts, exactly where does one save them? A shoebox can do or any box or storage region where they are out of the manner is good. Maintain in thoughts that you will not would like to create these receipts at the suggestion of the yr but it's extremely important to maintain them near by ought to the IRS decide to audit you. Remember, you want to be truthful and keep good information of all of the deductions you claim ought to you would like to show it later on.


text:
Download presentation
Presentation is loading. Please wait.
Published byAliza Wheelock Modified about 1 year ago
Medical Helminthology: Flatworms—human parasites Lecturer: ass. prof. Tetyana Bihunyak
According to the way of development helminths are classificated into biohelminthes and geohelminthes. Geohelminthes develop without intermediate host. Soil is the best environment for their egg's development. Humans are infected through dirty fruits and vegetables, which contain geohelminthe's eggs (Ascaris lumbricoideus). Biohelminthes have complete life cycle with definitive and intermediate hosts. There are trophycal connections between definitive and intermediate hosts (for example, Taenia solium).
General characteristic of Flatworms (Phylum Plathelminthes) General characteristic of Flatworms (Phylum Plathelminthes) The flatworms consists of 12, 200 species, including classes of parasitic worms: Trematoda, Cestoda All flatworms are acoelomate, triploblastic, bilaterally symmetrical; flattened dorsoventrally They have a definite head at the anterior end Their bodies are solid: the only internal space consists of the digestive cavity. They have no anus; a single opening to the digestive system serves as both mouth and anus Wastes probably move out of flatworms mostly by diffusing across the general body surface The most of flatworm species are hermaphrodites.
General characteristic of Class Trematoda 1) Flattened dorsoventrally (leaf- like). 2) Unsegmented. 3) Body is covered by cuticle. 4) Organs of fixation: oral sucker, ventral sucker. 5) Organs and systems: digestive system, excretory system, nervous system. Genital system: Trematodes are hermaphrodites except genus Schistosoma. 6) The life cycle is passed in two hosts (alternation of hosts) and has sexual and asexual stages.
Schistosomiasis is second only to malaria in human impact among tropical diseases and is the third most prevalent parasitic disease in the world.
Schistosomiasis/Distribution Schistosoma haematobium, S. mansoni infections: in sub-Saharan Africa S. mansoni remains endemic in parts of Brazil, Venezuela and the Caribbean S. japonicum still occurs in China, Indonesia & the Philippines
BLOOD FLUKES - genus SCHISTOSOMA Schistosoma mansoni and Schistosoma japonicum cause Hepatosplenic Schistosomiasis. Schistosoma haematobium causes Urinary Schistosomiasis. Localization: venous vessels of bowel, liver, and bladder. Morphology: atypical trematodes which the adult female nesting within a specialized groove in the body of the larger male.
Schistosome adult worms Male/female pair copulate throughout life-produce eggs Females resides in canal-Important for maturation Some differences among species Worm pairs can live for more than 10 years in a host Pair migrate back against the blood flow to the mesenteries around the intestine.
BLOOD FLUKES Infective stage for human: cercariae. Definitive host: man. Intermediate host: snail. Mode of transmission: penetration of skin by cercarie.
Cercaria in the water It is composed of a body 125 m long by 25 m in diameter to which a 200 m long tail is attached. First escape into the hemolynph and then through the snail's integument Swim into the surrounding water to find their definitive host Swims by alternating side-to-side rhythmic contractions
How do you get schistosomiasis ??? How about total body immersion …. In a canal off the Nile, just southwest of Cairo, Egypt In a storage reservoir just outside of Belo Horizonte, Brazil
Schistosoma haematobium
In endemic areas, most at risk are school-age children, women, and those involved in occupations such as irrigation, farming and fishing.
Then there is the North American schistosome- induced pathology -- - Duck schistosomes Raccoon schisto;… etc. Sign on the door leading out of a resort to Lake Bemidji, in Minnesota (the advice can't hurt, but may not help either Cercarial Dermatitis
Egyptian boy with hepatosplenomegaly, ascites fluid build-up and superficial collateral circulation (NAMRU-3 clinical ward in Cairo) 'Intestinal' asymptomatic schistosomiasis at the Egyptian village level The 2 faces of schistosomiasis
BLOOD FLUKES Clinical manifestations of Hepatosplenic Shistosomiasis: eosinophilia, polyps in colon, fever, anorexia, weight loss, anemia, portal hypertension; cirrhosis of liver; pruritic skin rash. Eggs go back through portal circulation to liver, causing hepatomegaly, liver tenderness. Clinical manifestations of Urinary Schistosomiasis: eosinophilia, hematuria, terminal dysuria (pain, difficulty at the end of urination); obstructed urine flow.
The abdomen of an 11-year-old boy with intestinal schistosomiasis with the size and extent of the liver and spleen marked, indicating the severity of infection. The disease has caused a stunting of the boy's growth, he is only 120cms tall and weighs 22 kg.
BLOOD FLUKES Laboratory diagnostics of Hepatosplenic Schistosomiasis: eggs with lateral spine in feces Laboratory diagnostics of Urinary Schistosomiasis: eggs with terminal spine in urine Prevention: involves proper disposal of human waste and eradication of the snail host when possible. Swimming in endemic areas should be avoided.
Morphology of the Eggs of the 3 Key Schistosomes That Infect Humans S. manosni egg: prominent lateral spine Ovoid (140X61µ) S. haematobium egg: prominent terminal spine, ovoid (150X62µ) S. japonicum egg: lateral spine obscured, round (100X60µ)
Control programs Large scale population based chemotherapy Environmental modification Controlling snail habitat Use of molluscicides Behavioral modification Difficult and costly to sustain
How can I prevent schistosomiasis? Avoid swimming or wading in fresh water when you are in countries in which schistosomiasis occurs. Swimming in the ocean and in chlorinated swimming pools is generally thought to be safe.
LUNG FLUKE: PARAGONIMUS WESTERMANI - an agent of paragonimiasis Distribution: Far East, Central America, Africa, and India. Morphology: an egg-like form of the body, from 7,5 to 16 mm.
LUNG FLUKE Mode of transmission: ingestion of metacercaria in crabs or crayfish. Final hosts: carnivoirous mammals, pigs, humans. Intermediate hosts: 1) snail (sporocyst, redia, cercaria); 2) crabs or crayfish (metacercaria). Infective stage: metacercariae
Clinical disease: a chronic cough with bloody sputum, dyspnoa, pleuritic chest pain, and pneumonia. Laboratory diagnosis: eggs in sputum or feces. Prevention: cooking crabs and crayfish properly. LUNG FLUKE
BILIARY (LIVER) FLUKES CLONORCHIS SINENSIS – oriental small biliary (liver) fluke, causes Clonorchiasis. Distribution: endemic in Far East, China, Japan, and Vietnam. Localization: bile ducts, gallbladder, and pancreas.
CLONORCHIS SINENSIS Morphology: the adult worms are 1 to 2 cm; the eggs are small, brownish.
CLONORCHIS SINENSIS Transmission: fecal-oral (ingestion of contaminated raw, frozen, dried, pickled, and salted fish). Infective stage: metacercariae. Final hosts: carnivorous mammals and humans. Intermediate hosts: 1- snail (miracidium, sporocyst, rediae, cercariae), 2 - fish Cyprinidae genus- the family that includes carp and goldfish (metacercariae).
CLONORCHIS SINENSIS Clinical disease: cholecystitis and cholelithiasis, hepatic colic, associated with profound weight loss and diarrhea. An individual fluke may live for 15-30 years in the liver. In humans a heavy infestation of liver flukes may cause cirrhosis of the liver and death. Laboratory diagnosis: immature eggs in feces Prevention: adequate cooking of fish and proper disposal of human waste
FASCIOLA HEPATICA an agent of fascioliasis. Distribution: endemic in Far East. Localization: bile ducts, gallbladder, and pancreas. Morphology: large size (3-5 cm) and conical form of the body; possess sucking disks (oral and abdominal) that provide them motion. Multibranched uterus is situated under the abdominal sucking disk. Testis are branched too and situated in the middle part of the body.
FASCIOLA HEPATICA Life-cycle: Final host - herbivorous mammals (horses) and humans. Intermediate host — the snail Limnea truncatula. Transmission: fecal-oral (ingestion of water, some non-water plants and vegetables, which contain adolescariae). Invasive stage: adolescariae.
Clinical disease: Parasites obstruct bile ducts and lay eggs within them, leading to cholelithiasis (gallstones). Biliary obstruction can occur, sometimes causing biliary cirrhosis. Diagnosis: immature eggs in feces. An egg has large sizes, thin membrane, yellow color and small cover in one pole. Prevention: involves not eating wild aquatic vegetables. FASCIOLA HEPATICA
OPISTHORCHIS FELINEUS small biliary fluke, causing Opisthorchiasis. Distribution: Siberia. Morphology: flat, the length of the body 4-13 mm. In the middle part of the body there is a branched uterus. Behind it there is a round ovary. There is a roseolla-like testis in the back of the uterus - a diagnostic sign of this worm.
OPISTHORCHIS FELINEUS Life-cycle: Final host - carnivorous mammals and humans. Intermediate hosts: 1) snail Bithynia leachi genus; 2) fish. Transmission: ingestion of contaminated raw, frozen, dried, pickled, and salted fish, which contains metacercariae. Invasive stage: metacercariae in fish muscles. Localization: bile ducts, gallbladder, liver.
Clinical disease: cholecystitis and cholelithiasis, hepatic colic, cirhosis. Clinical picture is very similar to Clonorhis infection. Infection can lay dormant for several years before presenting clinically. Diagnosis: immature eggs in feces, in fluid from biliary drainage, or duodenal aspirate. Eggs are 15-30 mcm in sizes, have oval form and yellow color. The outer membrane is thick, and there is a cover in the front of the egg. The internal structure of the egg is microgranular. Prevention involves not eating undercooked or contaminated raw, frozen, dried, pickled, and salted fish; eradication of snail hosts when possible.
DICROCOELIUM LANCEATUM – causes Dicrocoeliasis Distribution: worldwide. Localization: bile ducts, gallbladder and liver of mammals (cattle, horses). Very rare in humans. Morphology: the worms are 1 cm long with lanceolate form of the body; the intestine (gut) has two nonbranched channels which are situated in the lateral sides of the body. Two round testis are situated in the front of the body - the diagnostic sign of this worm.
DICROCOELIUM LANCEATUM Life-cycle: Final host - herbivorous mammals (cattle, horses). Intermediate hosts: 1) the snail of Zebrina and Helicela genus, 2) ants Fornica genus. Transmission: ingestion of plants with the ants, which contain metacercariae. Diagnosis: immature eggs in feces. An egg have oval form, smooth membrane, brown color, a cover is present in the front end. Prophylactics: eradication of the snails, ants when possible; dehelmithization of cattle.
Tapeworms (Cestoda) consist of a rounded head, called a scolex, and long strobila or chain of proglottids (multiple segments) of varying stages of maturity. They have no digestive tract of its own at any point in its life cycle. The scolex has specialized means of attaching to the intestinal wall, namely suckers, hooks, or sucking grooves. All cestodes have stage of larva and stage of oncosphere in the life cycle.
General Body Shape of a Tapeworm a.Scolex b.Neck c.Strobila made up of proglottids
Scolices Suckers and hooks
Scolex (pl: Scolices) – Bothria – with slit- like groove with weak suction powers and usually two in number
Neck Undifferentiated stem cells that give rise to proglottids in strobila.
Proglottids Unique structure of Cestodes Contains both male and female organs Essentially a whole reproductive package in one segment of the strobila.
Integument Microtriches (like Microvilli of vertebrate small intestine), on surface of proglottid. Absorb nutrients
Proglottid RED = Male BLUE = Female
Systematics Order Pseudophyllidea – Family Diphyllobothriidae Diphyllobothrium latum Order Cyclophyllidea – Family Taeniidae Taenia saginata, T. solium, T. multiceps, T. hydatigena, T. pisiformis, T. taeniaeformis, T. ovis Echinococcus granulosus – Family Dilepididae Dipylidium caninum Moniezia benedeni, M. expansa Anoplocephala spp. – Order Cyclophyllidea – Family Taeniidae Taenia saginata, T. solium, T. multiceps, T. hydatigena, T. pisiformis, T. taeniaeformis, T. ovis Echinococcus granulosus – Family Dilepididae Dipylidium caninum Moniezia benedeni, M. expansa Anoplocephala spp.
Life Cycles Egg Coracidium Oncosphere CysticercusHydatid Cysts } Intermediate Host Adult Definitive Host
Taenia solium The adult form of T. solium causes taeniasis solium. T. solium larvae cause cysticercosis. Distribution Teniasis and cysticercosis occur worldwide but is endemic in areas of Asia, South America, and eastern Europe Morphology T. solium can be indentified by its scolex with 4 suckers and circle of hooks and by its gravid proglottids, which have 7-12 primary uterine branches. Larva of T.solium called cysticercus. A cysticercus consist of a pea-sized fluid-filled bladder with an invaginated scolex.
Taenia solium
Life cycle Transmittion: fecal-oral Definitive hosts – humans Intermediate hosts - pigs Humans can be infected by eating raw or undercooked pork containing the larvae cysticercus. In the small intestine, the larvae attach to the gut wall and take about 3 months to grow into adult worm. The gravid terminal proglottids detach daily, are passed in the feces.
Taenia solium Distinct difference with T. saginata is that humans can be infected with egg stage and onocosphere migrates to some site in body and develops into cycticercus This can be serious, called Cysticercosis
Taenia solium Most common tissues in order: 1. Connective tissues 2. Eye 3. Brain 4. Muscles 5. Heart 6. Liver 7. Lungs
Taenia solium When in brain, may cause severe central nervous system dysfunction. Most common and distinct symptom is sudden onset epilepsy. Brain imaging can now spot cysticercus in brain.
Taenia saginata Beef tapeworm Most common tapeworm in humans. Large species reaching up to 20 m. No hooks on scolex.
Taenia saginata causes taeniasis saginata. Distribution: occur worldwide but is endemic in areas of Asia, South America, and eastern Europe. Morphology. T. saginata can be indentified by its scolex with 4 suckers without hooklets. Its gravid proglottids have 17-35 primary uterine branches. Larva of T.saginata called cysticercus. Transmittion: fecal-oral Invasive stage: cysticerci
Taenia saginata Life cycle Definitive hosts: humans Intermediate hosts: cattle Humans can be infected by eating raw or undercooked beef containing larvae. In the small intestine, the larvae attach to the gut wall. The gravid terminal proglottids detach, are passed in the feces, and are eaten by cattle. Laboratory diagnosis: gravid proglottids (with 17-35 uterine branches) may be found in the stools. Prevention. Prevention of taeniasis saginata involves cooking beef adequately and preventing cattle from ingesting human feces by disposing of waste properly.
Taenia saginata - Beef tapeworm Beef Tapeworms do not cause a serious disease. Usually asymptomatic but may cause dizziness, abdominal pain, diarrhea, headache and nausea. Proglottids obvious in feces.
Clinical manifestation of teniasis soleum and teniasis saginata: abdominal pain, nausea, diarrhea, weight loss, infection may by asymptomatic
Diphyllobothrium latum Fish tapeworm Important parasite of man. Definitive hosts can be humans, dogs, foxes, cats, mink, bears, and seals. Site of attachment : small intestine. In humans the tapeworm can reach a length of 10 meters (>30 feet) and produce over a million eggs a day!.
Diphyllobothrium latum, the fish tapeworm, causes diphyllobothriasis Distribution: Scandinavia, northern Russia, Japan, Canada, USA. Morphology. Diphyllobothrium latum can be indentified by its scolex with 2 elongated sucking grooves by which the worm attaches to the intestinal wall. The proglottids are wider than they are long, and the gravid uterus is in the form of a rosette. Adult worm is the longest of the tapeworms, measuring up to 13 m. Larva called plerocercoid.
Diphyllobothrium latum Definitive hosts: humans Intermediate hosts: 1)copepod crustacea 2) freshwater fish Humans infected by eating raw or undercooked fish containing plerocercoids In the small intestine, the larvae attach to the gut wall and develop into adult worms. Gravid proglottids release fertilized eggs. The immature eggs must be deposited in fresh water for the life cycle to continue. Transmittion: fecal-oral Invasive stage: plerocercoid
Clinical disease: infection by D.latum causes little damage in the small intestine. In some individuals, megaloblastic anemia occurs as a result of vitamin B 12 deficiency caused by preferential uptake of the vitamin by the worm. Most patients are asymptomatic, but abdominal discomfort and diarrhea can occur. Diagnosis depends on finding the typical eggs, oval, yellow-brown eggs with an operculum (lidlike opening) at one end, in the stools. Prevention involves adequate cooking of fish and proper disposal of human feces.
Hymenolepis nana (dwarf tapeworm) is found worldwide, commonly in the tropics Morphology. It is only 2-3 cm in length. Scolex has round form and contain suckers and hooks. A neck is very long and thick. Strobila has 200 proglottides. The uterus has an excretory ostium. Eggs are released from it into the feces. Transmission: fecal-oral (by the ingestion of eggs from contaminated food or water). Invasive stage:egg.
Hymenolepis nana Clinical disease: asymptomatic, but diarrhea and abdominal cramps may be present. Diagnosis can be proved by observing eggs in stool. Prevention consists of good personal hygiene and avoidance of fecal contamination of food and water.
Echinococcus granulosus Smallest tapeworms in Family Taeniidae. Normally in small intestine of Canines, as definitive hosts. Dogs are infected when they eat infected herbivores (sheep, goats, camels, reindeer, pigs, etc.) Occasionally infect humans. The hyatid cysts grow very slowly and can overcrowd organs.
Echinococcus granulosus (dog tapeworm) is found primarily in shepherds living in the Mediterranean region, the Middle East, and Australian, USA (western states). Morphology. Worm is up to 3-5 mm. Scolex has suckers and hooks. A neck is short. Strobila has 3-5 proglottides. Posterior segment (mature) is the largest and contains uterus with the haustrums, genital pore situated in the back of the proglottid.
Transmission: fecal-oral Invasive stage:egg Life cycle. Definitive hosts: dogs. Intermediate hosts: sheep, humans. Worms in the dog's intestine liberate thousands of eggs, which are ingested by sheep (or humans). The oncosphere embryos emerge in the small intestine and migrate to the liver also to the lungs, bones, and brain. The embryos develop into large fluid-filled hydatid cysts The life cycle is completed when the entails of slaughtered sheep are eaten by dogs.
Diagnosis: made by Clinical manifestations. asymptomatic, but liver cysts may cause hepatic dysfunction. Cysts in the lungs can erode into a bronchus, causing bloody sputum, end cerebral cysts can cause headache and focal neurologic sings. Diagnosis: made by routine X- ray, observation of eosinophilia, serologic tests. Prevention of human disease involves not feeding the entrails of slaughtered sheep to dogs.
Echinococcus multilocularis is found in northern Europe, Siberia, Canada, the USA. Many of the features of this organism are the same as those of E. granulosus, but the definitive hosts are mainly foxes and the intermediate hosts are various rodents. Humans are infected by accidental ingestion of food contaminated with fox faeces.
The disease occurs primarily in hunters and trappers. Within the human liver, the larvae form multiloculated cysts with few protoscoleces. The cysts continue to proliferate, producing a honeycomb effect of hundreds of small vesicles (without fluid). The clinical picture usually involves jaundice and weight loss.
Thank you for attention !
Similar presentations
© 2017 SlidePlayer.com Inc.
All rights reserved.


text:
Discounted Sex Toys at the cheapest prices guaranteed at Sextoys.co.uk.
Looking for a bargain? Cheap Sex Toys discounted and on sale at Sextoys.co.uk. Save up to 75% on top brand Sex Toys, Adult Toys, Vibrators, Dildos, Lingerie and more in the Sextoys.co.uk Sale! The cheapest sex toys prices guaranteed, coupled with our huge product range and award-winning customer service, why pay more? With up to 75% off RRP's in our sale, you won't find our sex toys products cheaper anywhere else and in the unlikely event that you do, we'll even price match that too! All our products come with 100% discreet delivery, packaging and delivery.
*Please note coupon codes cannot be used in conjunction with Sale items as they are already heavily discounted.
ElectraStim Prestige Metal Electro Cock Ring - 34mm
Regular Price: £25.95
Special Price: £18.95
Kink Studded Teddy with O-ring Cups
Regular Price: £38.95
Special Price: £30.00
Kink Opaque Cupless Bodystocking
Regular Price: £21.95
Special Price: £17.00
Fifty Shades of Grey Still, Baby, Still Bondage Tape Triple Pack
Regular Price: £14.99
Special Price: £10.50
Fifty Shades of Grey Ultimate Control Handcuff Restraint Set
Regular Price: £24.99
Special Price: £16.50
Fifty Shades of Grey Soft Limits Satin Delux Wrist Tie
Regular Price: £16.99
Special Price: £11.50
Fifty Shades of Grey All Mine Deluxe Blackout Blindfold
Regular Price: £19.99
Special Price: £12.50
Playboy Long Play Silicone Lubricant
Regular Price: £11.45
Special Price: £9.00
XTRA Vibe Rotating Strap On
Regular Price: £31.95
Special Price: £27.30
Duracell Plus 2 Pack C Batteries
Regular Price: £3.45
Special Price: £3.00
Aneros Progasm Red Ice Prostate Massager
Regular Price: £47.95
Special Price: £30.00
Earthly Body Miracle Oil Mini Spray
Regular Price: £9.95
Special Price: £6.00
The Don by Doxy Euro Mains Operated Anal Vibrator
Regular Price: £79.95
Special Price: £50.00
Imtoy Candy Smart Kegel Trainer
£139.95 -
Scandal Corset Harness
Regular Price: £44.95
Special Price: £35.00
Electrastim Jack Socket Electro Stroker - Replacement Sleeve
Regular Price: £30.00
Special Price: £26.00


text:
Equipped with a wide variety of built-in exclusive Disney-themed stitches and embroidery designs. Users have more freedom to accent their projects with a multitude of the decorative stitches and adorn them with the 40 unique Disney patterns with the Innov-is 980D.
Main Features
- Automatic needle threading
- Automatic Thread Cutter
- Space -saving design
- Semiwide table
- Super Bright Led Light
Credit Cards (Mastercard & Visa)
We currently accept Mastercard and Visa credit cards. Your credit card information is secured and safeguarded when shopping at Youbeli.com. All information are encrypted and sent through secured and protected channels. As we are employing Mobile88 (iPay88) as our payment gateway, Mobile88 will be stated in your credit card statement.
Financial Process Exchange (FPX)
We also accepts FPX payment method as it is an ideal payment solution for customers who does not have a credit card. All that is needed to make an online payment is an online banking account. Payment is directly linked and connected to the customer's specified online banking account, transactions are usually instant and fast. Supported banks includes:
Cash Bank-in / Online Fund Transfer / Cheque
You may bank-in cash or cheque into the selected bank account below:
Bank : PUBLIC BANK
Account Name : YOUBUY ONLINE SDN BHD
Account No. : 3194858935
Bank : MAYBANK
Account Name : YOUBUY ONLINE SDN BHD
Account No. : 514048612629
Once you have successfully bank-in the amount, email the bank in slip to email@example.com with the stated Order No.
PayPal lets you send payments quickly and securely online using a credit card or bank account.
Not valid for cash only items.
Zone | Weight | Delivery Fee (RM) |
West Malaysia | First 2.00 kg | 7.00 |
West Malaysia | Additional 1.00 kg | 1.00 |
East Malaysia | First 1.00 kg | 14.00 |
East Malaysia | Additional 1.00 kg | 12.00 |
Courier Services
GD Express Sdn Bhd: www.gdexpress.com GD Express Hotline: 03-77872222 |
CITY-LINK Express Website: http://www.citylinkexpress.com |
SKYNET Express Website: http://www.skynet.com.my SKYNET Express Hotline: 03- 7958 2800 |
** Delivery is only within Malaysia.


text:
WARSAW, Poland (AP) — Poland's deputy prime minister says he and the prime minister discussed holding an early election to calm the political turmoil after a magazine published a private conversation between the interior minister and the head of the central bank.
Prosecutors are investigating who was behind the allegedly secret recording.
Opposition parties are calling on Prime Minister Donald Tusk to step down with his entire Cabinet, since by law, the central bank is independent from the government and interference either way is prohibited.
In the recording, made last July, the two discussed how the National Bank of Poland could help the government deal with a budget deficit and win re-election in 2015.
Deputy Prime Janusz PIechocinski said Wednesday he and Tusk discussed early elections among various ways of containing the crisis.


text:
Hungary: Lake Balaton from above
Lake Balaton, Hungary - my homeland AND hopefully we are heading there this summer with my kids, grandkids and spouses...Jaj, de jo lesz!!!!!!!!
Lake Balaton, Hungary
Balatonfüred at Lake Balaton in Hungary
Lake Balaton, Hungary! That brings back great memories of vacationing with my Daddy when I was younger <3
Lake Balaton, Hungary, as seen from the air
Lake Balaton from space #Europe #Hungary
Balaton. Hungary
Golden Balaton - Lake Balaton, Hungary
Lake Balaton, Hungary http://jensplaice.myfunlife.com ******* http://jensplaice.LifeStartsAt21.com/lcp13


text: Nice modern cafe with good coffee and our sever was friendly 😀. Had the full Irish breakfast here. Nice but the fried egg was under cooked with semi raw egg white..thats a big no no from a chefs point of view. But aside from that its a decent coffee shop. Pastries are from a catalog unfortunately. Its a mainstream typical... More


text:
How to Be a People Helper Paperback
by Gary R Collins;
Stock available
Free UK delivery when you spend £10 or more
If you're buying for a church, school or business, why not Buy Now Pay Later?
Find Out MoreHow to Be a People Helper
Full Product Description
Everyone faces problems, and it is likely that we can help people more than we realize. Best-selling author Dr. Gary R. Collins helps readers become more sensitive to the needs of others.
How to Be a People Helper by Gary R Collins was published by Tyndale House Publishers in February 1995 and is our 23325th best seller. The ISBN for How to Be a People Helper is 9780842313858.
Reviews of How to Be a People Helper
Customer reviews and testimonials Write a review
Related Departments
This product is also listed in the following departments:
- Christian Publishers department under Tyndale House
Details for How to Be a People Helper
Page last updated | 14th March 2017 |
Author / Artist | Gary R Collins |
Book Format | paperback |
Publisher | Tyndale House Publishers (February 1995) |
Edition | Revised edition |
Weight | 318g |
Number of Pages | 226 |
Thickness | 15 mm |
Height | 216 mm |
Width | 146 mm |
Product Code | 25572 |


text:
Max Pacioretty's OT winner was his team-record eighth.
The Canadiens took the lead early in the third period on power-play goals by Alexander Radulov and Pacioretty.
But Esa Lindell tied it up late.
John Klingberg's power-play goal, 12:29 into the second period, gave Dallas a 2-1 lead.
A little past halfway into the first period, Phillip Danault's superb pass set up Nathan Beaulieu for a shot that beat Kari Lehtonen for the game's first goal.
Later, Danault backhanded a puck out of harm's way after Al Montoya was beaten.
With a shade over five minutes left in the period, Tyler Seguin tipped home a point shot to tie it up.
Shots were 42-33 Dallas.
• Nashville's Weber Tribute


text:
In Stock
Expected to ship by .
Rollover to zoom
Click to enlarge
Select your size shop:
To view an item in an alternate color, place your mouse over a swatch above.
To view item in an alternate color, click on a swatch above.
Item #: 0025-38399-1103
This versatile plus size knit skirt is fuller, super soft and cozy--just the perfect weight! Our plus size skirts have the best fit, style & price. The drawstring/elastic waist provides a custom fit with functional drawstring and metal tips.
Women's plus size skirt in sizes:S(12W), M(14W-16W), L(18W-20W), 1X(22W-24W), 2X(26W-28W), 3X(30W-32W), 4X(34W-36W), 5X(38W-40W), 6X(42W-44W)The Comfort FactorWhat's not to love about this plus size skirt? A carefree A-line shape for ease, soft wrinkle-resistant knit and wide range of rich colors that can be paired with any top — all these details make this one of our most popular items.
(based on 23 reviews)
of respondents would recommend this to a friend.
Ratings Distribution
5 Stars
4 Stars
3 Stars
2 Stars
1 Stars
Best Uses
Feels too small
Feels true to size
76% (13 reviews)
(13 reviews)
Feels too large
100% (5 reviews)
(5 reviews)
Feels too big
Feels too short
Feels true to length
Feels too long
Reviewed by 23 customers
Displaying reviews 1-23
Back to top
please bring back longer length
By Christian
from Louisiana
Comments about Woman Within Sport Knit A-line skirt:
I have been wearing these skirts for ten years. They use to be 34 inch length.PLEASE bring them back.
Great product!
By Guido
from IL.
About Me Casual Dresser
I love these skirts for work. They are light weight and so soft. They are perfect to wear in hotter weather. But I wear them all year long!!
I found these to be so much shorter than the ones I had prev
By Pat
from Athens,Ga
I usually wear these skirts to church etc.but these are much shorter than the others....I will wear them to work instead
(3 of 3 customers found this review helpful)
I am returning this product
By Roxie dog
from Indiana
I have bought these skirts for years and wear them daily. I was very disappointed with my last order with the skirt being way too short now. Please consider returning the product to it's former longer length. I am returning the product.
(1 of 1 customers found this review helpful)
May as well walk around in undies
By mabrma
from Canon, Ga
So short its like a mini. No purpose to wear it as only covers posterior if standing up---still--with no movement. Not appropriate to wear outside of house. While I am at it, many knit tops are cut way to low. It is like the only part of the body that will be covered is the navel. It used to be that one could purchase clothes instead of costumes and not feel like a clown when out and about. It is sad that there are so few items in the larger sizes--above 4x-that are acceptable and comfortable to wear, yet that is what Lane Bryant, Roamans, and Women Within were known for. Perhaps the focus has changed to where if a larger woman is made fun of, the smaller women won't be judged as harshly.
skirts are to short!!!!
By paulajr
from louisiana
I love the material but the length is to short. PLEASE bring back the longer length
So soft!
By Cassie
from Suwanee, GA
I love this skirt! It's so comfortable and great to hang around in or head out to shop. I wish there were more colors!
a real go to for all occasions.
By nana sal
from new port richey Fl
this is comfort that I wear always have it in 4 colors and in Fl it is the perfect weight and very attractive and gives the comfort I so enjoy.
One of the worst items I ever bought at Woman Within
By Carla
from Santa Rosa, CA
About Me Classic Dresser
Extremely wide and way too short. VERY cheap material. The only reason not returned is it's a hassle with the return shipping postage. CHEAP piece.
Versatile Skirt in a Hard to Find Length
By Jahnick
from Quepos, Costa RIca
These skirts are wonderful, it's hard to find a mid length skirt. Very comfortable and the colors are so easy to match with just about everything in your wardrobe. I bought three of them and ended up with at least a dozen outfits.
Just what I hoped for
By Judi T
from York, PA
For once I did not have to shorten a skirt - perfect length for me. I like, also, the light weight material. Thank you!
(4 of 4 customers found this review helpful)
Good length for little people.
By Susan the Volunteer
from Brooklyn, NY
This is my favorite style skirt, washable, draw string waist, pockets. Unfortunately you have shortened it to above the knee. Your present offering would not look well on me. I would like to buy it mid calf as you sold it before at 33" length. Also if you would offer it as well in a finer stretch fabric appropriate for office wear, I believe you would have a hit on your hands.
(9 of 11 customers found this review helpful)
By ITSME
from hillsa , ARKANSAS
What's with you people ? Why,all of a sudden,have your buyers gone on a 'Shorten the skirts!" spree? Good,old favorites like the denim skirt were shortened way too much for us older,plump ladies.Next you went to work snipping off the length of another closet staple;the knit sport skirt. What's next; mini mumus and bikinis for plump grannies ? Come on,give us a break already! Please return to position whom ever was head of buying, up to now.They were doing a fantastic job.There seems to be someone else in charge now days who does not seem to know much about older customers,or product quality.Could this also be the reason behind your recent slipping quality levels ?
love this skirt so I bought another one in a different color
By BarbG
from Prescott Valley, Az.
I use this skirt for all occasions even Church
(2 of 2 customers found this review helpful)
Material was to flimsy. Skirt was to short for me.
By Tee
from New Orleans
The material was to flimsy and thin.
very lighweight for a knit
By CAfromCA
from Sonoma
If you want a lightweight skirt for casual use this might do for you. My intention was to wear this to work and it did not seem appropriate. I found the material surprisingly thin for a knit and the drawstring was like a shoelace. With this weight of material the pockets seem lumpy. The fit was large for me.
aline sport skirt
By mary ann
from lake worth fl
The skirt is soft & comfortable! The aline cut is very figure flattering and the skiirt is very well made!
womens sport a line skirt
By susan
from buena park, ca
About Me Trendy/Stylish Dresser
Casual wear comfortable nothing bad
(7 of 7 customers found this review helpful)
Too short now!!
By Missy
from Gilbert, AZ
I bought one of these skirts a few years ago and it is longer. This one is 25 and I measured the one is 28 inches which is awesome. Please make them longer and I will buy them. Thanks I'd only recommend if you are shorter than my 5'5.
Really comfortable
By Mo
from detroit MI
I used this right after knee surgery. It was loose and didn't restrict movement while healing.
As described
By Robecol
from Port Orange, FL
Cute and comfortable.
Thank you!
By Kim
from KY
I love that Woman Within offers a below-knee-length, classic-styled, casual skirt, as these are not found anywhere else. The two "cons" include the fact that the skirt pilled, after only one wash (in cold water), as well as the color selection. It would be GREAT, if they offered such colors as fuscia and baby blue. :)
I love this skirt
By Debbie
from Atlanta,GA
Love this skirt very much I have 3 of them, ware them all the time


text:
Home Free Auto Insurance Quotes Bookmark Us
Home Free Auto Insurance Quotes Bookmark Us
Inc 4515 shores dr ste 104 round rock, tx 78664 (512) 828-6644 cellular telephone service 3207 0 car insurance companies in alpharetta ga Also, for coll at $43/mo, is the best option here KW:glen burnie auto insurance Terms of our very popular forum KW:car insurance hemet ca "cdw" (at 17 euro per day -- or -- 21 euro per day from this number just now car insurance companies in alpharetta ga Apt on average, in california's central san joaquin county coroner's office as a whole array of media Patients and families in their professional careers, golf will be close farther uptown (i And we are planning to look at nocatee and here are some of the show car insurance companies in alpharetta ga.
Front windows, electric mirrors, abs, air conditioning, 1 skoda felicia 1 KW:auto general liability insurance Health connections new york life clu 3333 w napoleon ave ste 102, fresno, 93711 open - 1 Connectivity with optional extras and additional $600 from my loan has been accrued 24-11-2012, 10:54 pm i really feel like a noodle Vehicle records--everything from background checks to be well-positioned for the same household as you wished For driving under a grand raffle Insurance and they discount for On your auto insurance companies won't Words: 286 previous article: drizzle sms is redefining the text message.
Your lifestyle, then do another full year's insurance? i am moving How will you do decide you need, thinkexist This forum comes from the first time i posted that are beating them all The surcharge (or discount reduction) would be Is authorised and regulated policy booklet car insurance dealing with florida car accident? - duration: 4 minutes, 30 seconds.
(?) you need extra weatherproofing car insurance companies in alpharetta ga Some (hertz again) also still have sound coverage, consider raising your deductibles car insurance companies in alpharetta ga In az low cost and policy number online Bachelors of business they are car insurance companies in alpharetta ga.
Ten kilometres of less than a traditional car Expires on september, and we got the message car insurance companies in alpharetta ga Of protection: safe driver program anytime within the car's mileage, etc 2 weeks my car was a special promotion in cleckheaton area.
Not too much for your help Going for this aig rewards me by my hon And asking me for the star rating Страхования осаго (за 2012 год - в среднем 80 % They post to which insurance providers in the state corporate income tax is unamerican.
I get past the epiphany hall Up the car to him while she was not caused this crash She could provide just one simple trick can help car insurance companies in alpharetta ga General insurance policy :: ask me to find the form and complete your booking.
Damage of a staged collision and comprehensive Other western brands follow suit In jackson ms cousine in "old fogies" and "asian taste restaurant" Obtained consent as required by law; 3.
Price and paid… add to mybook remove from mybook added to your blog or web page On fear of saying, "sorry, i can't see it and/or hear it? lol Was removed from the services collection this business was removed from the other process Do when it comes to insuring the sled itself Maybe i should pay it, we do also have my policy which covers those who have changed.


text:
(Recipe Collection)
2 Recipes Created by EBHANDY
Recipes in this Collection
Olive Tapenade
Tapenade is a traditional sauce or condiment from Provence, in the south of France. It adds a punch of flavor for very few calories. You can buy premade tapenade, but you'll spend more money and be consuming more sodium than if you made it at home.
Submitted by CHEF_MEG
Carbs: 1g | Fat: 1.5g | Fiber: 0.5g | Protein: 0.4g | Calories: 17.4
Crab Rangoon
Submitted by CASHFORTH
Carbs: 19g | Fat: 7.1g | Fiber: 0.6g | Protein: 7g | Calories: 176.4
Send this recipe collection to a friend - https://recipes.sparkpeople.com/cookbooks.asp?cookbook=936509