![]() ![]() Further, CMS also works with State survey agencies to monitor nursing home compliance with Federal requirements, including those for staffing. The usefulness of this information to consumers depends on the extent to which it is complete and accurate. Specifically, consumers can search nursing homes on the basis of location and compare quality of care and staffing. Care Compare includes the same staffing information that had been found on Nursing Home Compare. In December 2020, CMS replaced Nursing Home Compare with a new website called Care Compare. In April 2018, CMS began updating staffing measures on Nursing Home Compare, a public website, with these staffing data. Since November 2016, CMS has required nursing homes to submit payroll-based staffing data, including data on nurses and non-nurses. (OIG) also noted recent CMS actions through December 2020. This review focuses on the Centers for Medicare & Medicaid Services’ (CMS’s) use of data on nursing home staffing from April 2018 through March 2019- before the COVID-19 pandemic. The above statements introduced the OIG Report (same title as the title of this blog) OEI-04-18-00451 (46 pages) that was posted March 9, 2021. CMS reported that the COVID-19 pandemic delayed its progress to implement these requirements.” Specifically, the staffing information that CMS provides on Care Compare could be more useful to consumers if it included data on nurse staff turnover and tenure, as required by Federal law. However, CMS has opportunities to better use the staffing information that nursing homes report. Additionally, CMS has implemented a robust process to ensure the reliability of this nurse staffing information. There, consumers can use Staffing Star Ratings to compare nurse staffing between nursing homes. CMS provides the public with some of this staffing information on the Care Compare website. “The Centers for Medicare and Medicaid Services (CMS) has taken important steps to build a new source for data on nursing home staffing and to use these data to better inform consumers and improve nursing home oversight.
0 Comments
![]() Upgrading the toilet at the public library is a nice way to finish Milestone II. "Rub a dub dub.three astrophysicists in a tub." The Wall Hanging and Bathtub give a nice return on your investment. If you have the Marketable reward, then you can earn a pretty penny and have some fun cranking out various sculptures and furniture on the Woodworking Table. Just hop on your John Deere microscope to continue leveling up Logic. Craft an object on the Woodworking Table (350).So, where are you hiding this awesome microscope we have heard about?" Welcome Wagon: "Welcome to the neighborhood, Sarah Bellum. The Microscope: a not so subtle way to tell the neighborhood you're a king-sized nerd and into all things Logic. Your main source of income for now is going to be selling crafted items from Woodworking so grab Marketable too. With the crazy amount of skilling in this Aspiration you're looking to get Morning Sim, Night Owl, and Savant as soon as possible. It's a great way to quickly acquire Satisfaction to purchase rewards to make your journey to finish Nerd Brain faster. If a Whim fires that cannot be completed quickly, then just cancel it and see if another replaces it that makes more sense. Try and remember to regularly check out your Sim's Whims. Then, you can then sell any prints that come up later. Buy a Microscope and start leveling Logic that way. Head to the library and read 3 books (make your first a Handiness book) to fulfill the initial Milestone. I tend to do the "bear in the woods" no building route for my Sims for simplicity and for saving money in the beginning, so I gave my Sim the Loves Outdoor trait. The other two traits are up in the air for you. If you look at the first screenshot you'll notice a lot of buffs going on - it does not take too much effort to push your Sim into Very Focused for even faster skilling. Genius Sims randomly get the Focused mood which is exactly the state you want to be in with all of your nerdy skilling that you will be doing. The most obvious trait to give your Sim in CAS is Genius. Carl's ( Logic Guide and Handiness Guide are excellent references for a player pursuing Nerd Brain. The good news is that Sims that choose a Knowledge Aspiration are automatically given the Quick Learner trait - Quick Learners learn all skills a little faster making it probably the best bonus trait in the game given how much time most Sims spend at skilling. Finally, your Sim needs to build a Rocket at the end, so leveling up Rocket Science is going to happen as well. The main focus is capping Logic, but your Sim will also dabble in Woodworking via the Handiness skill. There's a LOT of skilling in this Aspiration. Includes details on the handy and webmaster reward traits, which allow instant upgrade of objects, turking for money, and a research binge. The Sims 4 Super Nerd AspirationsĪ walkthrough of the Nerd Brain and Computer Whiz Aspirations in The Sims 4. The Sims 4 Nerd Brain Aspiration Milestones and The Handy Reward Trait by Tom "Metro" Schlueter Upgrading items via the Handiness skill is a key part of the Nerd Brain Aspiration. This email is from the Product Reviews app on Shopify. NRS offers a wide range of western cowboy hats from top brands including Resistol, Stetson, Rodeo King, American Hat Company, Charlie1 Horse, and JW Brooks. The embrace of this trend, both on the streets and on the runways, has shown theres no shortage of ways to wear this accessory. Find the perfect mens cowboy hats and western hats at NRS. American Hats are made by hand in Bowie, Texas and have been the ultimate standard since 1915. You can see how hats have begun to be top of mind for the fashion set again through more dramatic styles like balaclavas, cowboy hats, wide-brim fedoras, and oversize floppy hats. ![]() In the spirit of the wild west we offer a selection of summer and winter. but I can’t get anything done around here cause people keep asking me” Where did you get that hat?”……. The cowboy hat is the most iconic symbol of the western way of life in the world and only one hat can live up to the standard of style, quality, and durability required by such a beloved symbol. These high crown, wide brim cowboy hats were a signature style for the American cowboy. The goal is to create a bend that is 2 inches from the band of the cowboy hat. Using the fingers, gently bend the brim of the cowboy hat inward. This will allow for easy access to the brim of the hat, which is the part that will be shaped and folded. THE COW LOT is bringing country back with quality, style, and something that is lost in todays shopping world…… personalized service. The cowboy hat should be turned upside down, with the crown facing downward. You ain’t gotta be from Texas to wear the hat…. don’t fix it!!! The Cow Lot is your one and done store and the people are super sweet and nice. then we flew to Vegas to actually meet them at the Rodeo Finals and I was blown away! Bought two hats on the spot right there and numerous others in the past year because …. I bought my first hat after following them in social media and looking at a ton of other hat shapers on line as well…. Ya they got a steamer but they gotta blow the dust off of it and find it as it is usually under a pile of hats nobody bought anyways…… then I found The Cow Lot…. Prepare to embrace your inner drama queen because these hats will demand them to heed.Here’s the deal, I’m from northern Illinois and around here we have the pop up random western wear stores carrying the lower end hats and not real experts on shape, fit, and quality……. For example, most cowboy hats start with a Boss of the Plains. Cowboy hat shape is a bit easier to understand. While the Cattleman and the Gambler are both hat styles, the hat measurements (height of the crown, width of the brim) can differ pretty significantly. After your order is placed, you will be contacted to make sure we completely understand the shape you’ve chosen. Cowboy hat ‘style’ is a fairly generic term. Plus, I've identified the six hat styles that will be big this spring. Hat Shape Gallery The Cow Lot Need help determining your shape and size This page shows brim and crown shapes along with a sizing chart. So to chronicle that emergence, I've done a deep dive through recent runway collections and Instagram imagery to show how statement hats managed to catch our awareness again. The cowboy hat is the most iconic symbol of the western way of life in the world and only one hat can live up to the standard of style, quality, and durability required by such a beloved symbol. Cattleman cowboy hat shapes all feature three crown creases. It was, in a way, the greatest indication of the times-with so many things in the world fighting to be noticed, of course, the most attention-seeking accessory trend would emerge. Of all western hat crown styles, the Cattlemans crease cowboy hat is a classic cowboy hat shape. Across the board, over-the-top and often oversize hats that some might even describe as "frivolous" were spotted at various fashion houses. Nevertheless, as designers released their spring 2023 collections, it became evidently clear that this trend was demanding our attention. Of course, hats have been around for centuries, and every few seasons, we see a specific style surge in popularity again. These different styles evolved over time to help fit various purposes out in the West. And while I'm an ardent believer in the importance of staying informed, I have to admit that one trend is top of mind for me: statement hats. One of the biggest determiners of a cowboy hat’s shape is the crease in the crown. There are, after all, so many new trends that can feel "unnecessary" at a time when so much is happening in the world that requires our attention. While my own beliefs fall into the latter, I can sometimes understand why others may consider the matter of sartorial choices less than serious. Others see it as a pivotal part of the culture woven into society's fabric. ![]() Throughout time, there have been debates about the importance of fashion. ![]() We provide career-focused certificate programs for a fast route into the highly sought-after aviation and tourism sectors.We work hard to offer a friendly and efficient service because we think that everyone deserves to be treated with respect. were also hired by numerous airports around the nation. Following completion of the training course, candidates from Bhartiya Aviation Services. ![]() holds exams and training sessions to hire people for various positions and services. The aviation industry is making every effort to improve the balance between available jobs and people seeking them. providing any or all of the aforementioned services. For more than 30 years, we have been providing our clients with a wide range of exceptional services across India. For our staff, quality and client happiness are our guiding principles, supported by a solid sense of integrity. We have prepared and trained personnel working in airports across India, providing all types of services ranging from general airport supervision to ground handling, loaders/cleaners, guests and customer services, and airport services. Our goal is to become a recognised leader in the corporate and aviation industries as an innovative team of driven professionals. provides training and workforce to the aviation industry, serving 35 different clients at All Over Airport for jobs like passenger operations, ground staff, loaders and cleaners, customer sales executives, and guest service associates, among others. We offer solutions that are specifically crafted to meet the demands of clients, including everything from risk assessment and planning to requirements for integrated facility services and the supply and management of people. ![]() As a business, we assume all liabilities and provide prompt professional service. We are passionate about leading-edge innovation, and our operations centers are well-located in Delhi.Ī history of giving airports and airlines all throughout India the best services. With cutting-edge technologies, infrastructure, top-notch qualified and professional teachers, and a team of some of the most experienced workers in the aviation industry, it retains a competitive advantage in the sector. Through close collaboration with industry, our network of alumni and partners continues to achieve global success. Our students gain the technical skills, real-world experience, and problem-solving ability needed to embrace complexity and lead innovation in a rapidly changing workforce. We are proud to deliver an education that goes beyond textbooks and classrooms. We offer job oriented certificate courses for a quick way to highly desired Aviation & Tourism industry.Īirport Operations students at the Bhartiya aviation services receive broad training in foundational skills, aviation operations, aviation retail, emergency preparedness, and aviation airline management i.e Air India, Indigo, and many other airline operations. Candidates from Bhartiya Aviation Services has also got placed into various airport all over the country after successfully completing the training program. Bhartiya Aviation Services conduct training programs and exams for recruitment to various services and posts. The Aviation Industry is doing its best to bring about a better matching between the demand and the supply of work opportunities. Bhartiya Aviation servies is established in view of providing well trained staff for our customer for handling Passenger, Ramp and cargo activities in Indian, We deliver consistent and reliable service with particular focus on the specific requirements of our customer base. We train students for bright careers in the field of Aviation, Tourism & Hospitality. Bhartiya Aviation Services is an ISO 9001:2015 Certified company & professional team managed by professionals with a combined experience of more than 40 years in the Aviation industry. ![]() The discovery of the ultraviolet radiation with wavelengths below 200 nm, named "vacuum ultraviolet" because it is strongly absorbed by the oxygen in air, was made in 1893 by German physicist Victor Schumann. In 1960, the effect of ultraviolet radiation on DNA was established. By 1903, the most effective wavelengths were known to be around 250 nm. In 1878, the sterilizing effect of short-wavelength light by killing bacteria was discovered. The terms "chemical rays" and "heat rays" were eventually dropped in favor of ultraviolet and infrared radiation, respectively. The simpler term "chemical rays" was adopted soon afterwards, and remained popular throughout the 19th century, although some said that this radiation was entirely different from light (notably John William Draper, who named them "tithonic rays" ). He called them "(de-)oxidizing rays" ( German: de-oxidierende Strahlen) to emphasize chemical reactivity and to distinguish them from " heat rays", discovered the previous year at the other end of the visible spectrum. UV radiation was discovered in 1801 when the German physicist Johann Wilhelm Ritter observed that invisible rays just beyond the violet end of the visible spectrum darkened silver chloride-soaked paper more quickly than violet light itself. Ultraviolet has a higher frequency (thus a shorter wavelength) than violet light. "Ultraviolet" means "beyond violet" (from Latin ultra, "beyond"), violet being the color of the highest frequencies of visible light. Insects, birds, and some mammals can see near-UV (NUV) (i.e., slightly shorter wavelengths than what humans can see). The lower wavelength limit of human vision is conventionally taken as 400 nm, so ultraviolet rays are invisible to humans, although people can sometimes perceive light at shorter wavelengths than this. The UV spectrum, thus, has effects both beneficial and harmful to life. However, ultraviolet light (specifically, UVB) is also responsible for the formation of vitamin D in most land vertebrates, including humans. More energetic, shorter-wavelength "extreme" UV below 121 nm ionizes air so strongly that it is absorbed before it reaches the ground. The amount of UV light produced by the Sun means that the Earth would not be able to sustain life on dry land if most of that light were not filtered out by the atmosphere. For humans, suntan and sunburn are familiar effects of exposure of the skin to UV light, along with an increased risk of skin cancer. Short-wave ultraviolet light damages DNA and sterilizes surfaces with which it comes into contact. These interactions can involve absorption or adjusting energy states in molecules, but do not necessarily involve heating. ![]() Many practical applications, including chemical and biological effects, derive from the way that UV radiation can interact with organic molecules. Although long-wavelength ultraviolet is not considered an ionizing radiation because its photons lack the energy to ionize atoms, it can cause chemical reactions and causes many substances to glow or fluoresce. It is also produced by electric arcs, Cherenkov radiation, and specialized lights, such as mercury-vapor lamps, tanning lamps, and black lights. UV radiation is present in sunlight, and constitutes about 10% of the total electromagnetic radiation output from the Sun. Ultraviolet ( UV) is a form of electromagnetic radiation with wavelength shorter than that of visible light, but longer than X-rays. Arc welders must wear eye protection and cover their skin to prevent photokeratitis and serious sunburn. UV radiation is also produced by electric arcs. Here are some of the most frequent questions we get from consumers. When budgeting, remember to factor in additional expenses such as the price of underlayment, disposal fees, and transportation costs. We hope this article has answered your questions on the cost of installing plastic roof tiles. Fortunately, plastic tiles are an inexpensive option that is virtually indistinguishable from the real thing. ConclusionĬonventional tiles like clay, concrete, and slate can be quite expensive to buy and install. And that’s why no two installers will charge the same. They need to pay for advertising and promotions, training, fuel, insurance, taxes, and much more.Īll these expenses are what constitute operation costs. Contractor’s Operating CostĮach contractor spends money to keep the business afloat. Installers will undoubtedly charge higher for taking the risk. Also, it is more dangerous to work on a tall roof or steep slope. If it is complex, the project will take longer, thus increasing labor costs.įor instance, it will take longer to install tiles if there are facets at multiple angles and many hips and valleys. The style of the roof will also determine how long the installation process will take. ![]() Secondly, contractors will charge according to the size of the roof since this will have a bearing on the installation time. You can estimate how much you will pay for the materials by estimating the size of your roof. First, it will influence the amount of materials needed since manufacturers sell tiles in square footage. The size of the roof will affect the cost in two ways. Sizeable penetrations take longer to flash and will raise the installation costs significantly. That will result in added costs.Įxamples of penetrations include plumbing vents, chimneys, skylights, and bathroom vents. Therefore, they require flashing to remain waterproof. Penetrations on the roof are potential leakage spots. Additionally, the project could drag out if the distance from the building to the location of the materials is too long. The landscaping around the house could also be an obstruction. Tree branches and power lines are some of the things that could obstruct roof access. The installers will no doubt raise the cost to compensate for the lost time. But if they can’t access it with ease, the installation will take more time than expected. AccessibilityĪn easily accessible roof will make it easier for the contractors to do their job. For instance, you should expect to make frequent repairs if you live in an icy region. ![]() So, repair costs will vary depending on how extreme the weather conditions are. Moreover, the amount spent obtaining permits and licenses will be different in every state.Īdditionally, different regions will not experience the same climatic conditions. For one, labor costs will vary depending on where you live. ![]() The cost of installing a plastic tile roof will differ from one location to another. The prices outlined above may vary depending on a variety of factors. ![]() Factors That Affect the Cost of Plastic Roof Tiles Synthetic options are cheaper to repair, and they should cost you around $450 on average. On average, you should expect to pay $1,673. Tile repair costs will vary depending on the nature and extent of the damage. What is the Cost of Repairing a Plastic Tile Roof? You should expect to fork out between $2 and $3, depending on the type of material. Therefore, you should factor in the cost of installing it. Underlayment is a crucial component of the roof that you cannot afford to ignore. Sheriff of Nottingham is the first game in the Dice Tower Essentials Line from Arcane Wonders. The banker keeps the rest of the Gold close at hand so he can make change during the game. The banker gives each player (including himself) 50 Gold. The Sheriff must then determine who gets into the city with their goods, who gets inspected, and who may have their goods confiscated!ĭo you have what it takes to be seen as an honest merchant? Will you make a deal with the Sheriff to let you in? Or will you persuade the Sheriff to target another player while you quietly slip by the gate? Declare your goods, negotiate deals, and be on the lookout for the Sheriff of Nottingham! Choose one player to act as the 'banker'. ![]() Players declare goods they wish to bring into the city, goods that are secretly stored in their burlap sack. However, be aware that the volatility in this environment is high, so you should only anticipate. The Return to Player percentage of The Sheriff of Nottingham is 96, just in the middle of the range for online slot machines. The RTP of the slot is average 96, but the volatility is at a high level. In Sheriff of Nottingham, players will not only be able to experience Nottingham as a merchant of the city, but each turn one player will step into the shoes of the Sheriff himself. Sheriff of Nottingham RTP and Volatility. ![]() Should you play it safe with legal goods and make a profit, or risk it all by sneaking in illicit goods? Be mindful, though, as the Sheriff always has his eyes out for liars and tricksters and if he catches one, he very well may confiscate those goods for himself! ![]() However, players must first get their goods through the city gate, which is under the watch of the Sheriff of Nottingham. Prince John is coming to Nottingham! Players, in the role of merchants, see this as an opportunity to make quick profits by selling goods in the bustling city during the Prince's visit. ![]() In the downstairs second living room’s TV areaĭaytime’ and ice in single malt whiskey at nightĪnd things just aren’t built like they used to be Mother is juicing watermelons on the breakfast islandĪnd with frail hands she grips the NutriBullet She buys everything that glows gold in the kitchen larder I lose myself in the light of the TV, courtesy of her father She steams herself in marble rooms, courtesy of Big Pharma To the best new six-part Danish crime drama ![]() The lyrics are sometimes concerned with symbols of wealth or affluence but they are not written from a critical or even external position.” Listen above and check out the lyrics below.I had to include these!! “The song was intended to be highly inspirational. ![]() Speaking of the song front man Isaac Wood explained how, “It describes a series of events, loosely connected, all yet to happen,” says frontman Isaac Wood. Their second single was released on London label, Blank Editions and, in all of its dynamic glory, provides just under nine minutes of punchy, post-punk, post-rock, zany mayhem! Musically, Sunglasses protrudes with shape-shifting flair, ranging from gentle solace into disharmony as it grows and evolves into a song you wouldn’t quite anticipate judging by the way it starts! Lyrics are wild and engrossing, twists are unexpected and rousing, whilst the vocal delivery is utterly masterful and truly spirited! It’s a metamorphosis of sounds and the skilled transition over this nine minutes presents itself in a feast of compelling textures! Love this! I thought I had discovered a new band last night when I heard today’s song playing on the radio until I was told, “No, we were listening to this ages ago!”….so, apparently this band have been under my radar since last year, but I reconnected with them again last night!īlack Country, New Road are a 6-piece group who (mostly) originate from my neck of the woods:Cambridge,UK! Consisting of Charlie (Drums), Georgia (Violin), Isaac (Guitars / Vocals), Lewis (Saxophone), May (Synthesiser) and Tyler (Bass), this alt-rock collective have released two singles to date, but have an album on its way this Summer I believe! With influences including Shellac, Oxbow and Georgia’s experiences in Klezmer groups, the band created a buzz from the minute they released their debut single! Athens, France sold out of its pressing on Speedy Wunderground in just days and a lot of their early popularity is a direct result of their crazy live shows!! ![]() David Dodick, a neurologist at the Mayo Clinic in Scottsdale, Arizona and chairman of the American Migraine Foundation, echoing what other doctors around the country told Reuters about strong demand for the injection. “Patients are coming out of the woodwork now to get this new medication,” said Dr. After that, people with commercial insurance can get up to 12 months free while their coverage is sorted out. In the meantime, Amgen is trying to increase Aimovig prescriptions by giving all new patients two free 30-day samples. The FDA is slated to decide in September on new drug applications from Lilly and Teva. Headache specialists say the new therapy should help validate migraine - a predominantly female disorder - as a debilitating disease with biological causes.įour other companies - Eli Lilly & Co, Teva Pharmaceutical Industries, Allergan and Alder Biopharmaceuticals - are all working on potential rivals. In May, Amgen and Novartis were the first to win approval for the new type of migraine drug designed to interfere with a chemical involved in processes that kick off the severe headaches. Current migraine treatments are inexpensive generics or over-the-counter pills that might have side effects, or provide only partial relief for many patients. In the wake of public pressure from President Donald Trump, drugmakers including Pfizer Inc, Merck & Co Inc and Novartis have in recent weeks rolled back planned list price hikes, or pledged to refrain from raising prices.Īmgen, which will report quarterly results on Thursday, is relying on new medicines like Aimovig to offset declining sales of older products beginning to face competition from biosimilar versions.Īimovig has been shown to significantly reduce migraine frequency in about half of patients. ![]() New medicines are expected to triple the migraine market to $8 billion a year, mostly paid for by employers and the government. The migraine injection from Amgen, with partner Novartis AG, is the newest front in the battle by payors to control costs amid high patient demand for pricey new drugs. Kansas has none at all, although there are three in the Missouri side of Kansas City. Florida and Pennsylvania, for example, each have a couple dozen, mostly in or near cities. neurologists have such certification, and they are spread unevenly around the country. ![]() Plans including Blue Cross/Blue Shield in Florida, Pennsylvania and Kansas confirmed with Reuters that they will only cover prescriptions from - or in consultation with - a neurologist or headache specialist, and specifically a member of the United Council for Neurologic Subspecialties. Courtesy Amgen Inc./Handout via REUTERSīracing for a flood of costly prescription claims for the drug, Aimovig, large insurers such as Anthem Inc have set requirements for patients to document how they suffer from a defined number of headaches each month, and show that they have tried older migraine drugs first. Amgen Inc's headquarters building is seen in Thousand Oaks, California, U.S., in 2016 released July 24, 2018. A TSB might also be under warranty coverage, which means the vehicle manufacturer might indicate a specific period for its repair. TSBs are voluntary repairs and might not even apply to your vehicle if you haven't experienced the issue it covers. If any issue covered in a TSB turns out to be a safety concern, then the automaker will issue a full recall for the affected VINs. There can be multiple TSBs for the make and model of the vehicle throughout its lifetime if various issues arise. The solution might be a new part, a specific adjustment or other repair procedure. Once the issue is identified, a procedure will be developed to fix the problem. Recall issues might be discovered by NHTSA or by the automakers themselves.Īs service departments see a common issue with a specific make and model, they may report it to the automaker, who will then take a closer look. They can then take their vehicle into a branded dealership and have the problem fixed for free.Īny dealership that sells the brand affected by the recall must perform indicated repairs before selling the vehicles. In a recall situation, notices are arranged by the VIN and sent out to car owners alerting them of the problem. ![]() When a vehicle has been recalled, automakers are required by law to notify the current owner and the National Highway Traffic Safety Administration with a TSB, automakers must notify NHTSA but not car owners. In other words, these are problems that can lead to significant injury or death. The main difference is that a recall is issued by a vehicle manufacturer for issues that are safety-related, while a TSB covers components that may be malfunctioning but don't compromise the safety of the vehicle.įor example, an issue addressed in a recall might be related to things like engine fires, unintended acceleration or braking problems. Sometimes a TSB is confused with a recall. What's The Difference Between a TSB and a Recall? Sometimes there is more than one TSB for the same issue. Occasionally the bulletins are written by automotive OEM engineers, but more often they are written by the first repair tech to discover the repair procedure. ![]() Simply put, the TSB abbreviation relates to a diagnostic procedure for repairing a vehicle. It can be a shortened way to say "technical support branch," "total serum bilirubin," "targeted small business," or "Transportation Safety Board," or it might be a trending abbreviated internet slang term for "true story bro." But for all of the car enthusiasts reading today, TSB means, for our purposes at least, "technical service bulletin." This acronym refers to a bulletin issued by automakers when certain problems and defects are reported by repair shops or car owners. The meaning of TSB depends on the context in which it is used. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |