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Knowledge, Attitude and Factors Associated with Mental Illness amongNurses Working in Public Hospitals, Addis Ababa, Ethiopia | OMICS International
Journal of Mental Disorders and Treatment
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Research Article Open Access
Knowledge, Attitude and Factors Associated with Mental Illness amongNurses Working in Public Hospitals, Addis Ababa, Ethiopia
Mihiret G Mariam1, Bedaso A2*, Ayano G3 and Ebrahim J2
1Psychiatry Department, Dilchora Hospital, Diredawa, Ethiopia
2School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
3Department of Psychiatry, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
Bedaso A
School of Nursing, College of Medicine and Health Sciences
Hawassa University, Hawassa, Ethiopia
Received Date: May 14, 2016; Accepted Date: June 10, 2016; Published Date: June 17, 2016
Citation: Mariam MG, Bedaso A, Ayano G, Ebrahim J (2016) Knowledge, Attitude and Factors Associated with Mental Illness among Nurses Working in Public Hospitals, Addis Ababa, Ethiopia. J Ment Disord Treat 2:108. doi:10.4172/2471- 271X.1000108
Copyright: © 2016 Mariam MG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Background: Around 30-40% of patients who are attending primary care setting have emotional problems. The majority of these were often remaining unrecognized, misdiagnosed and inappropriately managed. Improving the knowledge and attitude of the health workers especially nurses is important to overcome this problem.
Objective: To assess knowledge, attitude and associated factors of nurses towards mental illness in Addis Ababa public hospitals, Ethiopia.
Methods: Institution based cross-sectional study was conducted from April 12 to May 12, 2014. The data was collected from 423 Nurses using structured Knowledge and attitude questionnaire for health workers, which is designed by National Institute of Mental Health and Neurosciences. Participants were selected by using systematic random sampling methods. Data was entered using Epi-info 7 and analysis was conducted using SPSS 20. Bivariate and Multivariate logistic regression analysis was performed to identify variables which have significant association with knowledge and attitude towards mental illness. The level of significance association was determined by AOR with 95% confidence interval and P-value ≤0.05.
Results: A total of 400 participants were participated with a response rate of 94.5%, 50% were females. The average age was 31 ± 6.6 years.50% and 44.2% of nurses have adequate knowledge and Favorable attitude towards mental illness respectively. There was significant association between knowledge and profession, working department and taking training. Also sex, educational status, profession, institute of graduation and work experience of respondents were significantly associated with attitude at p Conclusion and recommendation: About half of nurse's appear to have adequate knowledge and less than half of participant have favorable attitude. These unfavorable attitudes may cause certain problems like decrease in health care of person with mental illness. Practice based training at working areas regarding mental health problems need to be given for nurses.
Knowledge; Attitude; Mental illness; Nurse
About 450 million people suffer from mental or behavioral disorders worldwide today, mental disorder are widely recognized as a major contributor (14%) to the global burden of disease worldwide [1]. In India, prevalence rates of mental and behavioral disorders are `ranging from 9.54 to 370 per 1000 population [2]. 1 in 4 health services have at least one mental, neurological or behavioral disorder but most of these disorders are neither diagnosed nor treated. The majority of these were often remaining unrecognized, misdiagnosed, and inappropriately managed [3].
The National Institute of Mental Health (NIMH) at United States estimates that 1 in 5 people will experience some sort of mental illness in their lifetime and 1 in 4 people will know someone with mental illness. Mental illness is treatable and the symptoms of mental illness often can be controlled effectively through medication and/or psychotherapy. But sometimes the symptoms of mental illness may go into remission, and for some people it causes continuous episodes that require ongoing treatment. Untreated mental illness can disrupt an individual's personal, social, educational and work activities and in some cases it may lead to suicide. According to the World Health Organization the cost of not treating mental illness may be high both in personal and financial terms [3,4].
A further challenge that needs to be addressed worldwide is the massive gap between population needs for mental health and what is actually provided in mental health care. The treatment gap particularly pronounced in low and middle income countries (LAMICs), where commonly over 75% of people with mental disorders receive no treatment or care at all, and less than 2% of health budget is spent on mental health [5].
A study conducted in South Africa reported that, among the general public, knowledge of mental illness was low and stigma was high. Another example can be seen in Nigeria, where the first large-scale, community representative study of popular attitudes towards mentally ill, found stigma to be widespread, with most people indicating that they would not tolerate even basic social interactions with someone with a mental disorder [6].
Mental health problems are more common in developed world than in developing world [7]. However, Ethiopian people have suffered from mental health problem and it accounts 12.45% of burden of diseases. Substantial number of patients attending various health care settings suffers from psychiatric disturbance with figures ranging from 15%to 50%. A majority of these cases are handled by nonpsychiatric where majority of them go unrecognized and are subjected to unnecessary investigation leading to inconvenience and financial loss [7,8].
Misconceptions about psychiatric patients being under the control of evil spirits (and therefore being dangerous) are the main motivations behind the inglorious, long and persistent use of physical restraints and endorsing of segregating attitudes by society towards them and Health workers are not completely free from these abovementioned unfavorable beliefs and attitudes towards psychiatric patients [9].
Studies also demonstrate that health professionals have negative attitudes toward some aspects of mental illness and were less optimistic about prognosis and less positive about likely long-term outcomes when compared with the general public [10]. Health care providers have been known to stigmatize patients who use psychiatric medications or services by offering discouraging advice, disparaging remarks, and rejecting behavior. This form of discrimination may have a negative impact on patients' self-esteem and the way they seek help or adhere to prescribed medical treatments in addition, negative attitudes that manifest as apprehension or discomfort during patient interactions may lead to ineffective counseling or the lack of essential medical services [11].
Studies done so far in different countries of the world [11-19] have shown there was inadequate knowledge and unfavorable attitude of nurses towards mental illness. Also Knowledge and attitude of nurses were associated with variety of factors which were rooted with sociodemographic characteristics, type of training taken, institution of graduation, work experience and profession. Despite the increased burden of mental disorders, still there is information gap showing the knowledge and attitude of nurses towards mental illness.
Therefore the results of this study will be used as base line data for planning to improve the knowledge and attitude of nurses and for further studies on the subject area.
Study design and setting
Institution based cross sectional study was conducted among nurse working at public hospital under Addis Ababa health bureau from April 12 to May 12, 2014. Addis Ababa is a capital city of Ethiopia. It is located 2500 meter above sea level at 9.03N and 38.74E. It has a total population of 3,059,000. The city has a total of 608 health facilities (which include hospitals, health centers, health stations, health posts and private clinics). Addis Ababa is divided in to 10 sub cities and 116 woreda with an area of 540 Km2. According to the 2010 population Census, the total population of Addis Ababa is about 3,384,569. There are 6 public hospitals under administrative city, with a total of about 2466 nurses, of which about 859 nurses were working in public hospitals under the city administration.
All nurses who have been working in all Addis Ababa public health hospitals under the Addis Ababa health bureau were considered as source population. Nurse who were available during the study period and fulfilled inclusion criteria were included in the study. Psychiatry nurses and other nurses who were unable to communicate to respond for the interview were excluded from this study.
Operational definition
Adequate knowledge: if the respondents answer correctly greater than or equal to 11 out of 15 knowledge questions (If score more than 70% of knowledge questions).
Inadequate knowledge: if the respondents answers correctly less than 11 out of 15 knowledge questions (if score less than 70% of knowledge questions).
Favorable attitude: if the respondents answers correctly greater than or equal to 7 out of 10 attitude questions (if score more than 70% of attitude questions).
Unfavorable attitude: if the respondents answers correctly less than 7 out of 10 attitude questions (if score less than 70% of attitude questions
Sample size determination and sampling techniques
Single population proportion estimate was used to determine the sample size considering the following assumptions; confidence interval (CI)=95%=1.96, margin of sample error=5%. Since there was no published study conducted in Ethiopia, proportion of knowledge, attitude of nurses towards mental illness was taken as 50%. Considering 10% non-respondent the final sample size was 423. Systematic random sampling was used to select intended study subjects from hospitals with Kth value of 2.
List of nurses were taken from each hospital administration then the selection of 422 nurses was performed proportionally (Table 1).
No.of nurses
Selected Samples
Zewditu memorial hospital 142 71
Ras desta damtewu hospital 102 52
Dagmaw Minilik general hospital 172 80
Yekatit 12 referral hospital 193 96
Gandi memorial hospital 135 67
Terunesh Beijing hospital 115 57
Table 1: Number of Nurses who are proportionally allocated to be interviewed in each public hospitals of Addis Ababa administration, Addis Ababa, Ethiopia.
Structured, self-administering, Amharic version questionnaire was used to collect data. Modified version of Knowledge and attitude questionnaire for health workers which is designed by National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, department of psychiatry questions was modified and used for mental illness. Questions used to assess socio demographic data and other relevant information was designed by the investigator. A total of 43 questions were asked. Data was distributed and collected by six trained psychiatric nurses and 2 health officers were recruited to as supervisors and facilitators.
The questionnaire was designed and modified appropriately. The tool was translated to local language (Amharic) to be understood by all participants and translated back to English. Facilitators and supervisors were trained before data collection. The questionnaire was pre tested in 5% of nurses working in outpatient and inpatient department outside the selected hospitals and based on the findings from the pretest, the questionnaire was revised and adopted.
Data processing and analysis
Data entered using EPI info version 7, then exported to SPSS version 20 for analysis. Descriptive statistics was used to identify distributions of socio-demographic characteristics of study participants. Both bivariate and multivariable logistic regression analyses with 95% CI were used to see the association between each independent variables and outcome variables. Finally those variables which showed statistical significance at P<0.05 and 95% CI in the final model were reported as independently associated with Attitude and knowledge.
Ethical clearance was obtained from the Institutional Review Board (IRB) of college of medicine and health sciences, University of Gondar and from Addis Ababa administrative health bureau ethical committee. Formal permission was obtained from the medical director of each health facility and finally written consent was obtained from each participant during data collection. All participants were informed about the aims and purpose of the study, its contribution to the future development of health system; especially for mental health system in Addis Ababa as well as in the country. The right was given to the study participants to refuse or withdraw from the study at any time. For the purpose of anonymity participant's name was not used at the time of data collection and all other personnel information kept entirely confidential.
Socio-demographic characteristics
Out of 423 respondents intended to be included on the study, complete data were obtained from 400, making a response rate of 94.5%. Out of the total 400 respondents, 266 (66.5%) were females. The mean age of the respondents was 31 ± 6.6 years. Regarding marital status, 224 (56%) were never married and 154 (38.5%) were married. The major ethnic group was Amhara 179 (44.8%) followed by oromo103 (25.8%). A greater proportion of the respondents were Orthodox in religion 248 (62%) followed by Muslim 52(13%). Concerning the educational status of respondents 205 (51.2%) had first degree and 195 (48.8%) had diploma.
Work experience and area of graduation
Out of the total respondents, 159 (39.8%) had work experience of zero to five year and followed by 192 (48%) with work experience of greater than 15 years. Regarding their area of graduation 269 (67.2%) (Figure 1).
Figure 1: Work experience of respondents of Addis Ababa public hospitals, Addis Ababa, Ethiopia, 2014.
From the total respondents, 205(51.2%) ever took training about mental illness and the rest 195(48.8%) reported that they did not took training. Among respondents who took training, the dominant type of training reported to be theory only 36% (Figure 2).
Figure 2: Type of Training on mental illness taken by respondents of Addis Ababa public hospitals, Addis Ababa, Ethiopia, 2014.
Working department
As indicated by Table 2, from the total respondents, 301(75.2%) were working in adult outpatient department followed by 33(8.2%) were working in under five OPD (Figure 3).
,tbody>
Frequency(%)
Knowledge towards mentalillness Adequate knowledge 200(50%)
Inadequate knowledge 200(50%)
Attitude towards mentalillness Favorable attitude 177(44.2)
Unfavorable attitude 223(55.8)
Figure 3: Working department of respondents of Addis Ababa public hospitals, Addis Ababa, Ethiopia, 2014.
Table 2: knowledge and attitude of nurses towards mental illness in Addis Ababa public hospitals, Addis Ababa, Ethiopia.
Knowledge and attitude of nurses towards mental illness
Nurses' knowledge about mental illness was assessed by asking questions about cause, drug and manifestation of mental illness. In the same way, questions were asked to assess the presence of favorable (good) or unfavorable (bad) attitude among nurses towards mental illness. Then, the nurses were categorized as having "good" or "bad" attitude, "adequate" or "inadequate" knowledge about the issues under consideration based on their response to the questions and the definitions of the terms described under the heading 'operational definitions' in the thesis.
Based on this assessment 50% of nurses were having adequate Knowledge towards mental illness and 44.2% of the nurses were having favorable (good) attitude towards mental illness. In the contrary, 55.8% of the Nurses were having unfavorable (bad) attitude towards mental illness (Table 2).
Perceived treatment for mental illness
Of the total respondents, 81% of the respondents perceived that mental illness can be treated by modern medicine and followed by 26.5% perceived that mental illness can be treated by religious practice (Table 3).
Mental illness can be treated by
Traditional 23 5.8
Religious practices 106 26.5
Modern medicine 326 81.5
Others 23 5.8
Table 3: Perceived treatment of mental illness among nurses of Addis Ababa public hospital, Addis Ababa, Ethiopia, 2014 (multiple responses is possible).
Factors associated with knowledge of nurses
In this study, both bivariate and multivariate logistic regression analysis were done to show the factors associated with knowledge on mental illness among nurses in public hospitals in Addis Ababa.
Age of the respondents, profession, working department and ever taking training are statistically significant with knowledge on mental illness in bivariate logistic regression but age of the respondent was not significant in multiple logistic regressions (Table 4).
COR(95%CI)
(Crude OR)
AOR(95%CI)
(Adjusted OR)
18-22 4 1 0.36(0.04-3.33) 0.13(0.13-1.4)
23-27 47 68 2.06(1.17-3.65)* 1.40(0.74-2.6)
28-31 64 64 1.43(0.82-2.48) 1.11(0.59-2.1)
>37 (RC) 50 35 1 1
Male (RC) 71 63 1 1
Female 129 137 1.19(0.79-1.81) 1.72(0.89-3.3)
Never married (RC) 111 113 1 1
Married 78 76 0.96(0.64-1.44) 0.75(0.37-1.5)
Others (Divorced,widowed) 11 11 0.98(0.41-2.35) 0.41(0.97-1.7)
First degree (RC) 105 100 1 1
Diploma 95 100 1.11(0.75-1.63) 0.6(0.3-1.1)
Clinical nurse (RC) 18 173 1 1
Midwifery 15 27 1.92(0.96-3.85) 3.9(1.2-12.7)*
Institution of graduation
Government (RC) 135 134 1 1
Private 65 66 1.02(0.7-1.6) 1.04(0.53-2.1)
0-5year 75 84 1.13(0.7-1.7) 0.81(0.52-1.3)
5-10year 23 15 0.66(0.32-1.3) 0.59(0.28-1.2)
>10year (RC) 102 101 1:00 1:00
Adult OPD (RC) 158 143 1 1
Under-5 OPD 14 40 2.6(1.4-5.2)* 3.1(1.02-9.1)*
ART 16 10 0.69(0.30-1.57) 0.89(0.37-2.1)
ANC 6 5 0.92(0.27-3.08) 1.06(0.3-3.7)
Others 6 8 1.47(0.49-4.34) 1.16(0.38-3.5)
Have ever took training
Yes 121 84 0.45(0.3-0.7)* 2.1(1.4-3.1)*
No(RC) 79 116 1:00 1:00
Type of training
Theory only (RC) 84 60 1 1
Practice only 3 3 1.4(0.27-7.17) 1.59(0.25-9.9)
Theory and practice 34 21 0.86(0.45-1.63) 0.8(0.38-1.57)
*Significant association RC (1): reference category
Table 4: Bivariate and multiple logistic regression of factors associated with knowledge on mental illness among nurses in Addis Ababa public hospitals, Addis Ababa, Ethiopia, 2014.
Factors associated with attitude of nurses
This study also assessed attitude of the respondents towards mental illness. Professions, area of graduation, work experience, ever taking training and type of training on mental illness are significantly associated with attitude towards mental illness in bivariate logistic regression.
Profession, area of graduation, work experience and, ever took training are found to be significantly associated in multivariate logistic regression (Table 5).
COR (95%CI)
AOR (95%CI)
18-22 2 3 0.9(1.44-5.7) 0.7(0.9-4.5)
23-27 57 58 1.34(0.8-2.4) 1.3(0.8-2.5)
28-31 49 79 0.84(0.5-1.5) 0.8(0.4-1.44)
32-37 33 34 1.32(0.69-2.5) 1.2(0.6-2.3)
>37(RC) 36 49 1 1
Male 71 63 1 1
Female 129 137 1.5(0.96-2.24) 1.99(1.02-3.8)
Never married 96 128 1 1
Married 72 82 1.17(0.8-1.76) 0.7(0.4-1.34)
Others (Divorced, widowed) 9 13 0.92(0.38-2.3) 0.65(0.18-2.4)
Educationa lstatus
First degree (RC) 82 123 1 1
Diploma) 95 100 0.7(0.47-1.04) 0.32(0.1-0.9)*
clinica lnurse 153 207 1 1
Midwifery 24 18 1.71(0.87-3.4) 5.3(1.6-17)*
Government 105 164 1 1
Private 72 59 1.9(1.25-2.91)* 2.2(1.08-4.5)*
0-5year 69 90 1.07(0.7-1.64) 3.6(1.3-10.3)*
5-10year 23 15 2.14(1.05-4.4)* 0.3(0.19-4.6)
>10year 85 118 1 1
Adult OPD 133 168 1 1
U-5 OPD 24 24 1.05(5.1-2.2) 0.43(0.87-2.2)
ART 12 14 1.08(0.48-2.4) 0.96(0.36-2.6)
ANC 4 7 0.72(0.21-2.5) 0.56(0.97-3.2)
Others 4 10 0.51(0.15-1.6) 0.42(0.12-1.3)
Yes 80 125 1.55(1.04-2.3)* 1.50(0.9-2.2)
No (RC) 97 98 1 1
Theory only 61 83 1 1
Practice only 4 2 0.37(0.99-31.8) 0.70(0.4-15.3)
Theory and practice 15 40 1.96(0.88-3.2)* 1.51(0.3-1.86)
Table 5: Bivariate and multiple logistic regression of factors associated with attitude towards mental illness among nurses in Addis Ababa public hospitals, Addis Ababa, Ethiopia, 2014.
Two hundred (50%) health workers have inadequate knowledge and 223 (55.8%) have unfavorable attitude towards mental illness. This result has some variation from study done in Nepal, overall adequate knowledge and by and large a positive attitude [12]. Also show differences with the study done in Jimma zone about 89 of the respondents were knowledgeable about mental health problems [17]. The possible reason might be socio cultural difference, the sample size and profession difference which was 135 nurses were participated during the study done in Jimma zone.
In this study two hundred twelve (52.5%) have favorable attitude. Study done in Maldives the attitude toward the mentally ills among nurses are generally positive attitude even when the respondents took limited amount of training [13].
Concerning knowledge midwifery nurses are four times more likely to be knowledgeable than clinical nurses. Regarding working department, those who are working in under five OPD were four times more likely to be knowledgeable than those who are working in adult OPD.
Those nurses who have took training are two times more likely to be knowledgeable than those who do not took training. The study done Fiji showed that there were no difference seen between those who took further training and those who do not took further training. The variation might be due to the quality of training they took, the sample size and study technique.
Concerning attitude, female nurses were about 2 times more likely to have favorable attitude towards mental illness than males. This study show some variation from study done in chikador (18), in this study majority of the respondents were females with negative attitude. This variation may be due to socio cultural difference, exposure to the mental ill's.
Those nurses with first degree were about 70% less likely to have favorable attitude than diploma nurses.
Regarding profession Midwifery nurses were 5.3 times more likely to have favorable attitude towards mental illness than clinical nurses. This result may be due to they have enough training, exposed to department which help them to know better.
Those nurses graduated from private institution were two times more likely to have favorable attitude towards mental illness compared to those graduated from governmental institution.
Those nurse those with work experience 0-5 years were 3.6 more likely to have favorable attitude towards mental illness compare to those with work experience greater than 10 years. This result showed similarity from Zambia study which showed most of health care providers (81.1%) have been working for more than four year showed good attitude and experienced in dealing with mental ill persons.
Conclusion and Recommendation
About half of nurse's appear to have adequate knowledge and less than half of respondents had favorable attitude. Profession, current working department and ever took training were significantly associated with knowledge. Sex, educational status, profession, institution they graduated from and work experience were significantly associated with attitude.
Addis Ababa health bureau have to arrange short term and refreshment trainings for nurses working in the city. Future studies (interventional) should consider the effects of on knowledge and attitude of nurses.
I would like to thank University of Gondar and Amanuel mental specialized hospital for facilitating things for the success of the study and financial support. Also I would like to express my deepest gratitude for study Participants and data collectors for their unreserved contribution.
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text:
Young at art
Paddy McLaughlin says the opportunity to assess some of Cliftonville's young stars during pre-season could prove invaluable during the forthcoming campaign.
Inexperienced line-ups have recorded commanding victories over St James Swifts and Cookstown Youth in recent weeks, while a handful of underage talents featured in Saturday's defeat of Aquinas.
The Reds continue their preparations with tonight's friendly against Crumlin United at Mill Road (7.30pm) as McLaughlin and his coaching staff look to hone things ahead of next month's Danske Bank Premiership curtain-raiser with Coleraine.
"The future is always in youth," says the Manager.
"I was speaking to Brendan Lynch this week and we reckon we've handed debuts to 12 young players during pre-season so far and they have done very well. We had Saucy Brown on the scoresheet on Saturday at 15 years of age. It says a lot about the work that goes on in the Academy and all the coaching they do that we have a player who can come in at the age of 15 and do a job for us.
"It's going to be a long, hard, gruelling season, where the best teams play more than 50 matches. That can take its toll on players and nobody is going to play in every single one, so it's important to know the up-and-coming talents who are coming through.
"That's why these friendlies are so important. Obviously they're about fitness and sharpness for the senior players, but it's been great to get so many of the younger ones on the pitch and give them a chance to show what they're about."
Friendly, Pre-Season, Paddy McLaughlin
Scanned in
Pioneer spirit

redpajama_set_name: RedPajamaCommonCrawl


The driver is very vulnerable while sitting atop the loader, especially if the loader is leaning.
Brakes and stabilizers may not hold the truck in position if one or the other fails.
The driver does not have control of the truck in the loading position. If the truck slides or rolls, the driver may be thrown from the seat.
If the boom is extended and hydraulic pressure is lost, the boom will swing, following the slope, and possibly throwing the driver from the seat.
It is more difficult to climb up and down the loader (ladder) if it is on an angle. There will be an increased risk of slipping or falling.
This hazard can be minimized in several ways by both the harvesting and trucking contractors.
Where possible, avoid piling wood in a place that forces the truck driver to park and load on a steep slope.
Communicate with truck drivers to effectively manage inventory to avoid running out of room for certain products.
If drivers see forwarder operators piling wood in an unsafe location, let them know so they can pile in a safer location.
Communicate with operators to effectively manage inventory to avoid running out of room for certain products.
Trucks should be kept in safe working order.
If a driver must load on a slope, they should chock the wheels prior to climbing onto the loader.
Drivers should avoid loading on steep slopes when slippery conditions are present.
Drivers should wear their seat belt while sitting on the loader.
Tire chains should be used during icy conditions.
The best way to avoid this situation is to avoid piling wood in dangerous locations. This can be done through good communication and inventory management between harvesting crews and trucking fleets.


Please fill out the following information in as much detail as possible. Once received, expect a reply within 48 business hours.
All quotes will be reviewed, however not all projects can be accepted.
Please note: A full reference is required for all Partial and Fullsuit commissions. A front and back view is needed without clothes or any obstructions that could hide design details. Additionally, a close up on the head and any identifying marks (Tattoos, special markings, etc.) is needed as well. If such art cannot be provided, you will be required to receive a fursuit reference before your commission can be accepted. A list of artists can be provided to you upon request. Please be prepared for this additional cost if you are lacking proper reference art.
Please enter the name you commonly go by in the fandom. This does not have to be the name of the character you're requesting a quote for.
Please enter an email you check regularly. Email will be a main form of communication.
Are you prepared to place a deposit at this time?
Please select "Yes" if you are prepared to place a deposit for a commission from us at this time. Otherwise, if you are seeking a general quote, please select "No".
Describe your character in as much detail as possible, including color scheme, identifying marks, and other related design information. For fursuit part or harness gear commissions please detail the color, pattern, custom hardware, or other design details you would like.
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The undefeated Mounties team, under the leadership of Coach Don Null have clinched a second in a row Division I Center State Conference title in bowling.
Little Falls has had a bowling team for a very, very long time according to the coach. "The bowling alley opened in 1961 and I don't know if we had a team that year, but we did in the 60's," he said.
Last year was the first time that the team had won the sectional championship since that opening. "We were the very first smaller school to go to the state sectionals too and we ended up tied for fifth place," said the coach.
Both of the Cook boys are standouts on the team, as is T. J. Gottung and Dom Fazekas. "When Dom gets everything straightened out, he is a very, very good bowler. He seems to pick things up and once he does, he tears the pins apart," said Null.
Unfortunately, the entire varsity team will graduate this year, loosing those stars. "I have six seniors this year out of fourteen bowlers, and it's going to be a big hole to fill for next year," Null said.
The coach said he has two bowlers that he hopes will come out for the team next year who went out for different sports this year.
The team has one more game to play vs. Adirondack at RD`s Gorge View Lanes on February 4th at 3:15 pm, before their league tournament on February 12th at 11 am in Rome.


Kory Steed is a new M/M romance novelist who writes about real men in real relationships. Into his thirties, he realized he was attracted to men, but he has also loved women. With a naturally strong sense of empathy for all living things, he has been an astute observer of interpersonal relationship dynamics, the relationships between humans and animals, and the ensuing bonds that have developed between them.
He has extensive experience in trauma and emergency care and has worked as a medic for over twenty years while supporting his country, its citizens, and the military men and women in the armed forces in various capacities. Over the course of his career, he has seen more than his share of pain and suffering, not only from injuries and illness, but also from ignorance, discrimination, and prejudice. Now retired, his fictional writing draws on his life experiences to share the stories, personalities, strengths, and weaknesses of so many he has known and met along the way.
He hopes he does them justice.


This function is used internally to GStreamer to be able to determine which events and messages are "the same". For example, elements may set the seqnum on a segment-done message to be the same as that of the last seek event, to indicate that event and the message correspond to the same segment.
This function never returns SEQNUM_INVALID (which is 0).
A constantly incrementing 32-bit unsigned integer, which might overflow at some point. Use seqnum_compare to make sure you handle wraparound correctly.


National Reverse Mortgage Lenders Association (NRMLA) has announced that its board of directors has elected Reza Jahangiri of American Advisors Group and Scott Norman of Finance of America Reverse to serve as co-chairs of the association.
Jahangiri and Norman will serve until the association's 2019 annual meeting.
Jahangiri is the founder and CEO of AAG. He has served on the board since 2013 and was first elected co-chairman in 2014.
Norman is the vice president of field retail and government relations for FAR. He was first elected to the board of directors in 2012.
NRMLA also announced additions to its board for 2018 to 2019. The association added Harlan Accola from Fairway Independent Mortgage, Terry Connealy from Mutual of Omaha Bank, Scott Harmes from C2 Financial, Elly Johnson from United Northern Mortgage Bankers, and Jim Miller from Champion Mortgage.
In addition, the association announced the election of the following individuals as officers: Jason McNamara from Celink and Jim Cory from Live Well Financial as vice chairs, Mike Kent from Liberty Home Equity Solutions as secretary, Mike McCully from New View Advisors as treasurer, and Joe DeMarkey from Reverse Mortgage Funding as chairman of the executive committee.


The capital city of Western Australia. Perth offers an easy lifestyle, warm hospitality, diverse cultures and gay-popular beaches.
Great-value hotels in Perth for gay travellers. Save up to 75%.
Gay-popular, clothing-optional beaches near Perth.
A guide to Perth's gay party and clubbing scene.
Our roundup of the best gay bars in Perth.
Luxury choice. Great for sightseeing and gay scene.
Excellent value. Very central. Near the gay scene, shops and restaurants.
One of the biggest and most popular gay venues in Perth.


This course is aimed at individuals who have attained the ITIL Foundation certificate in Service Management and who wish to advance to higher level ITIL certifications. It will benefit delegates who require a deep understanding of Operational Support and Analysis processes and how they may be used to enhance the quality of IT service support.
The ITIL Intermediate Certificate in Operational Support and Analysis forms part of the Capability series of Intermediate certification modules, which can be taken as stand-alone qualifications or with a view to amassing sufficient credits to gain the ITIL Service Management Expert qualification. It will give candidates a deep level of understanding of the operational support processes and roles across the Service Lifecycle.
Individuals who may find this course of interest include IT professionals that are working within an organisation that has adopted and adapted ITIL and who need to be informed about and contribute to a service improvement programme, as well as operational staff involved in Event Management, Incident Management, Request Fulfilment, Problem Management, Access Management, Service Desk, Technical Management, IT Operations Management and Application Management, and who wish to enhance their role-based capabilities.


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Goals of the Program
UK Healthcare
Albert B. Chandler Hospital (Pavilions A&H)
Patients from the immediate metropolitan area and from surrounding communities present with a variety of both common and rare medical conditions requiring the latest in medical care in this 569-bed acute care hospital. The medical center serves Lexington and the surrounding areas of Central and Eastern Kentucky, capturing the care of much of the Commonwealth.
The clinical facilities at the University of Kentucky represent modern, attractive, state-of-the-art units all contiguously located on the University campus. Those components include an NIH-funded Clinical Research Center and a robust transplant center that includes heart, kidney, liver and lung transplant programs in the University Center.
For many of these patients, our internal medicine residents provide both primary as well as tertiary care. The University Center serves as one of the main hubs of the academic medical center inpatient wards experience for our residents.
UK HealthCare Good Samaritan Hospital is located less than a mile from UK Chandler Hospital.
The clinical experience at Good Samaritan Hospital includes a 180-bed acute care facility that allows our residents a broader experience in inpatient medicine. Good Samaritan is also conveniently connected to a 50,000 square-foot medical office building home to many subspecialty outpatient clinics.
By providing an opportunity to work in a hospitalist model in a medium-sized community hospital, residents can experience practicing medicine outside of the academic medical center.
The Gill Heart and Vascular Institute
The Gill Heart and Vascular Institute is connected to the University hospital.
The Gill Heart and Vascular Institute is home to a state-of-the-art cardiac care facility as well as world-renowned clinicians and researchers. The Gill building houses outpatient cardiac clinics, non-invasive echocardiography suites, a heart station, cardiac catheterization suites for inpatient and outpatient treatment, electrophysiology laboratories, a procedural recovery area as well as an advanced cardiovascular imaging center.
Our residents engage with cardiology faculty and fellows of The Gill Heart and Vascular Institute on inpatient services and outpatient clinics with opportunities to experience procedural and diagnostic cardiovascular evaluations.
The Markey Cancer Center Complex
The Markey Cancer Center Complex is integrated within the UK Hospital for patient care services and within the UK College of Medicine for academics and education, research, and service programs.
The Center encompasses four individual facilities containing a total of approximately 200,000 square feet of space, although its programs reach well beyond the University of Kentucky campus, extending through the Commonwealth of Kentucky and across twelve states of Appalachia and the Mid-South.
The Markey Cancer Center has developed a variety of specialized multidisciplinary teams to evaluate and treat the disease, which means that physicians and nurses from multiple specialties work together with each patient to develop the best treatment plan for their particular circumstances.
Our residents work alongside these multidisciplinary teams across all levels of care with exposure to a wide range of oncological pathology.
The Kentucky Clinic
Also connected to the University Hospital, the Kentucky Clinic is the primary outpatient facility for both primary care as well as over two dozen subspecialty consultative services. Annually, over 20,000 visits occur in General Internal Medicine or subspecialty clinics at the Kentucky Clinic.
Residents are paired with an attending in the Internal Medicine Group (IMG) Clinic or the Center for the Advancement of Women's Health for the duration of their residency. In this setting, residents see patients in their continuity clinics over the course of three years as well as in subspecialties during their elective rotations.
Turfland Clinic
While located a short drive from the University Hospital, Turfland Clinic is conveniently located and easy to access from many parts of Lexington.
Opened in 2015, this modern facility is home to several of UK Healthcare's primary care and specialty outpatient clinics including the Barnstable Brown Diabetes Center, UK Dentistry, UK Sports Medicine, UK Sports Rehabilitation and the Travel Clinic. This location also offers Urgent Care Services.
Residents in Internal Medicine see patients in several subspecialties here including a robust endocrinology department that includes a focus on diabetes management and sports medicine.
The Lexington VA Health System
The VA Medical Center and the UK Medical Center are connected and function effectively as a single hospitals from the perspective of both faculty and residents.
The VAMC is a 199-bed acute care facility which includes a general internal medicine service, acute psychiatry, intensive and progressive care units including a cardiac cath lab. Located inside the acute care facility are a variety of subspecialty clinics.
The VAMC is a staple for our internal medicine residents, allowing them to give back to our Veterans on their inpatient wards service and in multiple outpatient subspecialty clinics.
St. Claire Regional Medical Center
Morehead, a town of 8,300, is located 65 miles east of Lexington and serves the medical needs of a large area of eastern Kentucky.
The St. Claire Medical Center is a modern, attractive 159-bed acute care hospital in a picturesque part of Kentucky.
In their first year, residents spend a month working with the hospitalist group in Morehead caring for patients. They are accompanied by UK College of Medicine Rural Track medical students.
During the Morehead rotation residents have the opportunity to experience internal medicine as it is practiced in a rural community. While rotating at Morehead, residents and their families may live in Morehead in housing provided by St. Claire or commute from Lexington if they wish.
Explore Lexington
Why UK IM?
University of Kentucky Internal Medicine Residency Program
800 Rose Street Lexington, KY40506 | Tel. 859-218-2834
Designed by Megan Wolak, Sara Klinger, Chris Thomas and Neil Backer


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Home » Member State Monitor » Ireland's Housing Crisis Trundles On
Colored houses, Kinsale, Ireland
08/12/2019 - By Antoinette Tyrrell Member State Monitor
Ireland's Housing Crisis Trundles On
Last week saw Ireland's Minister for Housing, Eoghan Murphy, narrowly survive a motion of no-confidence, in the Irish Parliament.
It was the second motion of no-confidence in the Minister in less than 15 months.
As Ireland's political parties gear up for a general election, the country's housing crisis continues, seemingly unabated.
Ireland must go to the polls before April 10th 2021, but many feel that a general election will take place much sooner.
Uncertainty around Brexit has been one of the main factors in holding off on an election but with the UK general election taking place next week, political minds will be hoping for clarity to focus on what 2020 will bring for domestic Irish politics.
Housing in Ireland has been a thorn in the side of Government since the economic crash in 2008.
The property bubble that existed in Ireland, peaked in 2006, at the height of the country's Celtic Tiger. From 2007 onwards, house prices dropped and by 2010, had fallen by 35% compared with the second quarter of 2007.
The fall in Ireland's property prices was a major contributing factor to the 2008 Irish banking crisis.
House prices began to recover in 2013. This was followed by a prolonged period of property price increases, which has only begun to slow over the last year.
Earlier this year, typical house prices in Dublin were at nine times the average salary.
The price-income multiple, a standard measure of affordability worldwide, considers an affordable home for a worker to be three to four times their income.
Following the economic crash of 2008, the Central Bank of Ireland put in place limitations on borrowing. This means people cannot borrow more than 3½ times their income.
This protects the economy from the formation of a property bubble but leaves the majority of working people unable to afford a home.
Despite the recent slow-down, the cost of housing continues to price low and middle-income families out of the housing market.
In addition to this, homelessness figures in Ireland continue to rise while rental prices continue to spiral out of control.
Latest figures published by the Department of Housing, Planning and Local Government. show 6524 homeless adults in Ireland, and 1756 families without permanent accommodation.
In a country with a population of just 4.8 million, the figures are grim.
The obvious answer to this would be to build more houses to drive down property prices.
The Government pledged to do this as part of its Rebuilding Ireland programme.
Launched in 2016, the programme was set to tackle Ireland's housing crisis on five fronts – addressing homelessness, accelerating social housing, building more homes, improving the rental sector, and utilising existing housing.
Reactions to the results of the Programme have to date been mixed. Questions have been raised over clarity around the results while confusion has arisen around the terminology used by Government in relation to the programme.
Houses described as 'delivered' under the programme are not necessarily houses that have been 'built,' but rather houses that have become available from the private rental sector from landlords willing to rent houses as social housing.
There's a growing feeling among opposition parties and the public that lack of progress in the housing sector will drive the call for the next general election.
In a further criticism of how Government is handling the housing crisis, providing subsidies to bridge the price gap thereby sustaining the current model, instead of building more houses, opposition spokesperson on housing, Deputy Darragh O'Brien has accused them of 'an overreliance on the private sector, funnelling billions into landlords rather than building.'
Criticising Minister Murphy for the amount of money his Department plans to put into supporting rental payments for people on social welfare he said, 'We need to get Local Authorities back into direct build and shift away from pouring billions into the private sector. The Minister should take the shackles off Local Authorities and put bricks and mortar into the ground not billions into landlords' pockets.'
(Image by Mooncross via creativecommons.org)
Celtic Tiger Deputy Darragh O'Brien Housing Housing Crisis Ireland Minister Eoghan Murphy Property Bubble Property Crash
Antoinette Tyrrell
Antoinette Tyrrell is a writer and journalist who started her career in print and broadcast journalism in Ireland. An English and History graduate of the National University of Ireland, Maynooth, she worked for 11 years in corporate public relations for Irish Government bodies in the Foreign Direct Investment and Energy sectors.
She is the founder of GoWrite, a business writing and public relations consultancy. Her work has appeared in a range of national and international media and trade publications. She is also a traditionally published novelist of commercial fiction.
The sea rescuers of the "Sea-Watch 3" with 440 people on board had to wait for a week to be assigned a safe harbour. Now they are allowed to enter
In France, the number of new corona infections has increased significantly for days. While more than 100,000 new cases were reported for the first time on Christmas Day, the authorities
France seeks to pay nurses in intensive care units a monthly bonus of 100 euros from January. The bonus will be paid as early as January and contributes to the


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It's Okay To Say NO
TODAY I LEARNED: A glass bottle takes 1 million years to degrade.
It sounds like such a simple thing to do. When someone tells you that it's okay to say no, you think to yourself:
Oh of course I know that. Saying no is easy.
But when the time comes to say no to a friend, family member, stranger, coworker, or even yourself, something inside you locks up. You feel completely compelled to tell them yes, even though you want to scream NO!
Sometimes you do it to avoid confrontation or conflict. Other times you just don't have the energy to deal with the backlash that will come from saying "no". But whatever the reason for not saying it, I just want to say it is absolutely, completely 100% okay to say NO to someone.
It doesn't matter who it is. If you feel pressured to do something you don't want to do, say NO. If you're in a position that makes you uncomfortable, say NO. If the person you're hanging out with is making you feel unsafe, just say NO.
It is extremely hard to say no because most of us don't want to disappoint anyone. It's human to want to make sure someone is happy, but in this instant, it's just better to do what is best for yourself. I'm a firm believer in the power of saying NO. It sounds like such a simple thing, but it is so much more than a word. Not only are you taking back your own power, you aren't letting other people make decisions for you. Bask in the fact that you are your own person and you make your own decisions.
It takes a kind of assertiveness to say NO, and it's scary to do sometimes, but you must tell yourself you can push past the fear and do it. A lot of people try to brush it off and say that conjuring up the courage to say NO is not a big deal, but it is. Especially if you're a person who is extra sensitive to the world and all the energies that come with it. It's nerve racking and anxiety inducing. How you feel and how things affect you matters.
So, next time something is affecting you in a negative way, try your very best to say NO. If you don't, try again the next day. Find that freedom and courage that is resting with yourself. It's there, even if it's small, you can grow it. It's going to take time, but time is all we have, and it's going to tick by regardless. So, just do your best and the rest will come. I hope everyone has an amazing day today! 😊
#blogging, #inspire, #itsokay, #mental, #mentalhealth, #no, #notokay, #sayno, Advice, blessedbe, blog, blogger, Change, dailyblog, emotional, life, personal, witchywriter


The Diploma of Clinical Hypnotherapy and Psychotherapy* is Friday to Monday, one four day weekend each month, for five months followed by 3 days SEU. It is practical and requires attendance in person on every day. Numbers are limited, as the trainers only work with small groups of students at a time.
The next hypnotherapy course is due to begin in June 2019 and runs to October 2019, with the SEU following in December 2019. Course will be held on the Gold Coast, Queensland.
Fri – Mon 4 – 7 October.
Boardroom, Quality Inn, Mermaid Waters, Gold Coast, Queensland.
Early bird and payment plans available and discussed at required pre-enrolment information session.
If you want to know more, a personal information session will be arranged. At this session, questions about the course, its expected outcomes and suitability will be discussed. The early bird and payment plan can also be discussed at this session.
For more details on course content, click here.
To enquire about enrolling, click here or call Margaret Kelly on 07 5535 8462.
Although the Goulding Process – SleepTalk™ for Children is embedded into the APCCH courses, it also is a course in its own right. This course is accepted as by many Hypnotherapy Associations and Hypnobirthing as credits for continuing professional education (CPE). (We suggest you check with your organisation for its CPE eligibility).
2019 Queensland Accredited SleepTalk™ Consultant's Training will be held on the Gold Coast, hosted by Joane Goulding, (SleepTalk creator).
SEU training gives an extra three days of value to graduates of the Diploma of Clinical Hypnotherapy and Psychotherapy*. It only occurs two months after the initial training and graduation.
or call Margaret Kelly on 07 5535 8462.
2019 Clinical Hypnotherapy Course begins June.
For the 2019 Accredited SleepTalk™Consultant's Training, scroll down.


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Ford plans to nearly double production of its new all-electric F-150 Lightning pickup
DETROIT – Ford Motor on Tuesday said it plans to nearly double annual production capacity of its upcoming electric F-150 pickup to 150,000 vehicles per year by mid-2023, citing strong consumer demand.
The increase is a positive sign of demand for the F-150 Lightning as well as electric vehicles in general but also shows Ford significantly underestimated demand for the truck, causing it to now scramble to boost manufacturing of it. This is the second time Ford has said it plans to double production of the vehicle, which is due out in the spring. Initial output was set for about 40,000 units.
"The reception of this vehicle has been absolutely incredible," Kumar Galhotra, Ford president of the Americas & international markets, said Tuesday on CNBC's "Squawk Box."
Shares of Ford were up more than 7% in midmorning trading.
Ford's production plans come before the automaker starts taking orders for the vehicle on Thursday. The company received about 200,000 nonbinding reservations for the truck before it stopped taking the preorders last month.
At that time, Ford CEO Jim Farley told CNBC that the company was doing "whatever it takes" to double production capacity for the F-150 Lightning.
"We had to stop reservations, we got so many," Farley told CNBC's Jim Cramer. "We stopped at 200,000, and those are orders. Hard orders."
Ford said it will be implementing a "wave-by-wave reservation process," with reservation holders being asked to watch for an invitation via email from Ford or to log into their Ford.com account over the next few months to place an order for their vehicle.
This week is the final pre-build phase before transitioning into mass production of F-150 Lightning trucks for retail customers and F-150 Lightning Pro for commercial customers, the company said.
Ford's production plans come a day before General Motors is scheduled to reveal an electric version of its Chevrolet Silverado. The pickup is expected to compete more directly with the F-150 Lightning than its GMC Hummer EV, which recently started shipping to consumers. The Silverado isn't expected to go on sale until 2023.
Pricing for the F-150 Lightning, much like the traditional pickup, has a wide range. A work-oriented version of the truck will start at $39,974. More consumer-centric models will start at $52,974 and top out at around $90,000.
ISM(R) Manufacturing index Decreased to 58.7% in December


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July 25, 2016 December 26, 2017 by mvbookreviewer
ARC Review: The Good Fight by Julianna Keyes
ARC Review, Brooding Hero, Carina Press, Charming Hero, Contemporary, Emotions Wrencher, Endearing Hero, Great Read, Red Hot Reads, Toe Curler!!
Series: Time Served, #3
Publisher: Carina Press
Hero: Oscar Hall
Heroine: Dr. Susan Dufresne Jones
Date of Publication: July 25, 2016
Started On: May 22, 2016
Finished On: July 22, 2016
Book 3 in the Time Served series was a novel experience for me. This was my first time reading a book told in the first person totally from the hero's point of view.
34 year old Oscar Hall is the one who managed to get away from the shit hole that is pretty much Camden where he grew up. Years later, having had the success he had sought back then, Oscar returns, wanting to give back something to the community that is pretty much wasting away.
Oscar meets the formidable Dr. Susan Dufresne Jones by chance at the hospital where she works. The interest on Oscar's part is immediate, perhaps because Susan gives off the "nothing amuses me" vibe rather effortlessly. However, things don't work out as smoothly as Oscar envisions it for him and Susan. Though off to a rocky start, Susan and Oscar work things out by taking one day at a time, while at the same time Oscar sees to his dreams of building something that could give back to the people of Camden.
Miscommunication, the fact that both Oscar and Susan try to keep a lot of things bottled up, and most of all mistakes that both Susan and Oscar makes in the course of their relationship tests the strength of the bond that forges between them. A bond that is often seen to be rather fragile, but stands firm in many a storm it weathers through.
The Good Fight is not a story that just looks into the romance and the relationship that grows to life between Oscar and Susan. Rather, it focuses on Oscar's relationships with various other secondary characters, the ups and downs that he goes through while trying to build his dream into a reality that is sustainable and long-lasting, and his own shortcomings when it comes to trusting his ability to hold onto and be worthy of someone like Susan.
I loved the whole mess that was Oscar's life as it was portrayed through his inner thoughts. It was messy. It was real. That was what I connected with most and I wouldn't have had it any other way. I loved the friendship that was between Oscar and 24 year old Jade Romero, who puts up a false sense of bravado for the rest of the world to see. I would love to see whether Jade gets her own story, preferably with Wyatt, the man who does not get along at all with Jade, someone who is able to charm any man out of his pants and then some.
While I loved the novelty of the experience of reading a book solely told from the male lead's perspective, I felt that when it came to a character such as Susan, without knowing how she saw things through that logical and direct to the point sort of brain of hers, proved to be the reason why I failed to connect with her on an emotional level. Don't get me wrong, I loved the ending that took place a year after the story takes place, which gave me all warm fuzzies on the inside and showed to me that the bond between Oscar and Susan was one that was very real.
Susan I believe, was the character that got shortchanged because her story is the one that sits on the backburner, simmering and calling for attention where little if at all was given. I wanted to see Susan emerge out of that cold and logical shell of hers long enough to realize that there was more to life than being in a constant state of competition with ones own self to achieve more, to be better. That there was a daughter who required her love, understanding, empathy and kindness so that she might grow up and embody the same characteristics that Susan could teach her.
While there were bits and pieces of Susan's interactions and difficulties when it came to dealing with her 11 year old daughter, whom we met in the 2nd book of the series In Her Defense, I would have loved to see that take centrestage in the story, be it even for a little while so that readers would have been able to see a warmer side to Susan, a character who comes off cold at first and began to thaw towards the end of the book.
I would have thought that given that this novel was totally told from a male perspective, that there would be more sex scenes involved of the kind that would make for a panty melting read. But, contrary to that notion, I found that the sex scenes were more toned down than the previous two books in the series. Not that the ones that were included were any less hot or potent. But perhaps owing to the fact that I had some difficulties in connecting with Susan on an emotional level, I found myself a bit removed from what was happening in the bedroom until towards the latter part of the story where Susan broke out with a gut wrenching confession of the difficult times she had had with trying to make her previous marriage work, a marriage that had already been doomed to failure.
It is a testament to Julianna's talent that even with all the issues I had that I managed to enjoy the story that unfolded. Perhaps it was because through Oscar's life, the reader gets to experience a wide range of diverse characters, and get to see something fresh develop and burgeon to life right in front of your eyes. The whole concept of cultivating produce inside the confines of a building is an idea that is being explored quite fervently across the world, and to read about it and feel as if you were a part of the experience, that was one of the best aspects of this story.
Recommended for fans of stories that feature characters who are real enough to make mistakes and wise enough to own up and learn from them. Makes for great reading!
Final Verdict: Gritty, honest, hard hitting and real!
"Oh, Jesus, Oz, please," she begs some time later. "I can't—I need—just do something."
"I'm doing something," I tell her.
She whimpers and writhes, her body laid out like an offering, and I ease off and position myself on top of her, elbows on either side of her head. For the first time since I penetrated her I drag out my cock so just the tip is left inside, and dip my head so my lips brush against her ear. "Squeeze," I order.
She squeezes the head of my cock with her pussy and I shudder violently, unprepared for how amazing it feels.
Her lips and tongue feel like they're everywhere, tracing the shell of my ear, the pulse points over my throat, my collarbone. When she frees one hand to reach between us to undo the button at the top of my pants, I seize the opportunity to slip my own hand down the back of her shorts, sliding my fingers as low as I can until I find the damp heat between her thighs. I moan at the contact, then moan again when her fingers wrap around my cock, stroking like the pro she is. Pump, twist, fast, slow. It feels good, but it feels like a fucking textbook, too. Like she read the chapter, took notes and aced the test. I want messy and flawed. I want real. I want the scratched-out lines and the red ink and all the steps that come before you figure out what gets you off fastest.
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