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Public is welcome to attend.
October 30, 2012 at 1:00 PM
Division of Rehabilitation Services Office 207 South Prospect Bloomington, IL
Present: Susan Keegan, Chairperson; Untress Quinn;Ginny Conlee;Cathy Contarino;Ed Baker; Thane Dykstra; Dan Dyslin; Robert Furniss; and Chris Milbrandt, Bill Diggins, Bureau Chief, (Rule SO) Central Investigations was present during the meeting
By the Quality Care Board members and Office of Inspector Generi:JI staff
Rule 5O focuses on state-operated facilities and facilities that are licensed, funded, or certified by DHS to provide Mental Health (MH) and Developmental Disability (DD) services. Rule 5O has been around since 1985. In 1987, various agencies were combined into DHS and we were the last major development. In 2001,our Domestic Abuse Program (DAP) was created. The bills were passed, the program was created, and existing OIG investigative staff was transferred into the DAP bureau to investigate allegations of abuse, neglect, and financial exploitation. The cases are generated by calls to our hotline. Our hotline investigators evaluate the information they are given. They ask questions to determine if the matter is reportable to OIG under Rule 5O. Most of the calls they receive are from staff or other people involved in the mental health industry because they are required reporters. They have an obligation to report abuse or neglect to OIG within four hours.
If the Hotline takes a case, it refers the matter to the appropriate geographical Rule 50 bureau. of which there are four: Northern, Southern, Central, and Metro. In addition to having cases assigned to OIG, there are situations in which the OIG will assign cases to certified agency investigators who have to go through our training and subscribe to our investigative protocol. However,they cannot investigate and reach a finding in cases of physical and sexual abuse or egregious neglect, though they can assist OIG with those matters During the last fiscal year, we accepted more than 2,300 Rule 5O cases, in addition to approximately 1,200 Rule 51 cases.
We have 19 Rule 50 investigators, including investigative team leaders. Each of the four bureaus is headed by a bureau chief, and the Northern and Metro bureaus have Investigative Team Leaders (ITLs). The ITL assigns and monitors cases, and also carries a caseload. We also have clinical coordinators who are registered nurses on staff. Two of them are OIG employees, with the others employed under contracts. One of them is primarily involved in site visits through our Bureau of Compliance and Evaluation (BCE). The other three consult and provide their medical expertise when such issues arise during an investigation.
The cases have three sets of findings: Unfounded: No credible evidence that something happened;Unsubstantiated- there is not a preponderance of evidence that supports that finding;Substantiated- there is a preponderance, basically 51%, of evidence. In other words, it is more likely than not that something occurred.
Definitions of various allegations were changed a couple of years ago to provide greater protection to individuals. Brief definitions of the allegations follow:
These last three categories involve more serious allegations. A substantiated finding in these cases will cause referral of a staff person's name to the Health Care Worker Registry, maintained by the Department of Public Health. There is an appeal process before the accused are placed on the registry. Once people are on the registry for a period of time they can file an appeal to have their names removed.
Response: Yes, it should. State-operated facilities and CILA providers should check the registry before hiring staff, but we seen paid caregivers hired into domestic settings who were on the registry. The Registry is on the IDPH website, and anyone can check it to see if a potential caregiver's name is on it.
Findings- Even when we do not substantiate a case, we can make recommendations to address issues uncovered during an investigation. We can recommend that the facility or agency address inappropriate staff conduct in some way. In an elopement case, we may find that the alarm system is inoperable or has been disarmed by staff, and will recommend repair.
Written Responses -An agency or facility has to file a written response to OIG's recommendation within 30 days that contains a plan to address the problem identified. OIG's Bureau of Compliance and Evaluation (BCE) does unannounced site visits at all state-operated facilities. Part of their review assesses how well facilities have carried out the written responses. The divisions take quite an active role of keeping in touch with the agencies and facilities to ensure timely filing of written responses and assess follow up measures.
Involvement of Law Enforcement -If,in the course of our investigation, we uncover credible evidence that a crime has been committed, we have to refer the matter to law enforcement within 24 hours. We have, in some cases, had situations in which individuals have been killed. When our Hotline receives credible evidence during an initial call,the staff will call law enforcement immediately. In most of these cases,the facility or agency has already involved the authorities. The Illinois State Police investigate crimes at the state-operated facilities, and local law enforcement entities would handle other criminal matters either uncovered by, or reported to,OIG. Sometimes there is interplay between these polices agencies.
Reconsideration Process- Can be initiated by a facility, agency, employee, or guardian of a person. If one of these parties takes issue with the outcome of an investigation, they can request reconsideration. They have to supply new information that was not provided during the initial investigation. We have an obligation to respond to these requests within a designated amount of time.
House Resolution 201- Contains statistics on agencies. These statistics are listed on the DD website.
In the course of our work, bureau chiefs or even an investigator will find themselves going to the same facility frequently or will have a number of similar events occur at the same place, (many incidents of bowel obstruction, for example). When OIG has concerns about a particular agency or troublesome trends, our staff will meet with BALC and BQM to discuss these issues. These meetings have led to meetings with providers. We are trying to keep track of these trends.
Non-reportables- Some of them are obviously non-reportable,such as an individual complaining that he did not get his cigarettes. The hotline will make a referral to the proper entity. These intakes end up as a report. They are also sent out to the bureaus on the off-chance the bureau chief may know this agency and detect a pattern that may merit an investigation. This is another check to ensure that OIG is looking into all matters that may concern us.
Response: We do not investigate matters involving DCFS, private hospitals, nursing homes, the elderly, assisted living facilities, or skilled nursing facilities. We have several agencies with niche services. The Governor's Office has recognized that there are several agencies dealing with protective services and is considering ways to consolidate them to provide a better service network.
Interplay with other agencies- Periodically IDPH will be involved in some of our investigations of a programmatic nature. They have a mandate to investigate complaints within five days, and OIG will stand down until they have completed their work. BALC and BQM receive our intakes and may contact us if the intakes relate programmatic problems, such as no heat or food at an agency. We coordinate efforts with these entities when appropriate.
A Community Integrated Living Arrangement (CILA) is a home containing up to eight beds that falls under DHS jurisdiction. Day training sites are also covered. An Intermediate Care Facility has over eight beds and falls under IDPH jurisdiction. Originally Rule SO's focus was on state-operated facilities. Now, any community provider of mental health and developmental disabilities services that is licensed,funded, or certified by Department of Human Services falls within our purview.
Response: If it is a CILA with eight beds or under, most likely yes.
Response: Yes, from IDPH, DCFS, Office of the Executive Inspector General. We have seen,over the past seven to eight years, an increase of 7- 10% in matters called into our Hotline. Also, the Department put our hotline number on the website, so we are experiencing an even greater increase of up to 30% this year. For example,Central Bureau averages about SO cases a month but handled 92 cases in October.
Response: No. People living in a private home falls under Rule 51.
Acting Inspector General (AIG) Dyslin wanted to clarify with regard to the reports. Deputy Inspector General (DIG) Furniss talked about findings within a report, which would be substantiated, unsubstantiated, unfounded, and then about the report containing recommendations. Recommendations can be made for a facility, whether it is state-operated, a CILA,or a provider regardless of the finding.
Response: Right. You have an individual with no injuries. Witnesses said nothing happened. Another example is an elopement case where we found that the alarm on the door wasn't working. Nobody did anything wrong here, but the systems are not working. OIG does not get involved in too many programmatic issues. Generally if we have a substantiated finding, there is going to be a recommendation.
OIG does not recommend disciplinary action, nor do we have any involvement with the disciplinary process or decisions to place employees on administrative leave. In response to a Department of Justice finding, the Department of Developmental Disabilities places all employees who are the alleged accused in OIG cases on leave or reassignment. This policy can cause problems for providers because a disgruntled individual can put off an entire shift of staff by calling in unfounded complaints against them. In such situations, and also when a particular client might call in ten to 12 times in a day, OIG will work with the facility to preliminarily assess the situation to put off as few staff as possible. We might also suggest telephone restrictions for such "frequent fliers."
Response: 2,300 cases were opened. Is it likely some didn't go anywhere? Probably.
Our substantiation rate varies between 10 -13%, about 900 cases per year. We have approximately 800 pending Rule 50 investigations right now and 200 open Rule 51investigations assigned to the five statewide investigators.
Agency Investigators- A small percentage of the agencies, 140 or about 15-20%, sign onto our investigative protocol to perform investigative tasks on OIG cases. Supervisory staff in the bureaus, either a bureau chief or an Investigative Team Leader (ITL), will assign cases to agency investigators and monitor the investigation. In some cases, an OIG investigator may act as a "buddy investigator" to assist. The Metro and Northern Bureaus feel they have to use agency investigators whenever they can due to the size of their caseloads, but the other bureaus call on agencies less frequently. Sometimes, an agency investigation may take longer because the investigator has other assigned duties at the agency.
OIG must complete Rule 5O cases within 60 working days, but given a burgeoning caseload,this is not always possible. Recently, OIG's average completion rate fell to 41%, but we have always felt that was the best possible mark. We have seen a steady climb since then as the caseload has increased, but we are still under 60 days. There are a lot of other pressures, too. Providers have staff on administrative leave that they want back at work. OIG saw a 15% increase in cases, and we anticipate the increase may reach 30%. At this point,the caseload averages 50 cases per investigator, with Metro investigators carrying 60-70 cases on average. Breaking this figure down by the time in an average work week, investigators have about ten minutes to devote to each case per day.
Rule 51 discussion- Please see the memorandum dated October 30, 2012 from Daniel Dyslin to Members of the Quality Care Board that was distributed at the meeting.
The Domestic Adults Protection program (DAP), created by Rule 51, is OIG's fifth bureau. Rule 51 differs from Rule 50 because the accused is a family member, neighbor, volunteer, or a stranger, rather than an employee of a DHS funded entity. Unlike Rule So, DAP investigates cases involving developmentally disabled or mentally adults between the ages of 18-59 years of age living in a private home. Cases involving people over that age limit fall under the Department on Aging, and those younger would be referred to DCFS.
Response: It is a challenge OIG faces almost daily. The Rule 51 staff are really performing assessments to determine if someone needs or wants services rather than investigating wrongdoing, which is the focus of Rule 5O. Because those involved are private citizens, they can refuse to participate in an assessment or receive any help. OIG terms such matters as "refused consents," which, outside of referrals we may make in some cases, ends our involvement. Also, OIG does not have the resources to circle back and check on every case that is called into the Hotline.
We have five investigators for the entire state, including one investigator for the entire Southern Bureau, which extends from south of Springfield to the southern tip of the state. The investigators drive their own vehicles, wait for six months for travel reimbursement, and work in often unsanitary and dangerous environments, and are still expected to provide service to those involved in the 1300 cases they take annually.
Recent articles in the Belleville News-Democrat led to an Executive Order requiring OIG to refer cases to law enforcement and the coroner when the subject dies before an assessment can be completed. These matters usually involve someone who dies within a few days,or even a few hours, of the Hotline call. Previously, OIG termed these cases as "ineligible" because the deceased could no longer benefit from any services the state could provide. As a practical matter,OIG can do nothing in these matters, but the articles pounced on the "ineligible" term and accused OIG of doing nothing to help a dying person. Many of those who criticized OIG on this basis mistakenly attributed police powers to us, and have suggested that we have the power to remove individuals from their homes on our own authority. Ironically, in nearly every case identified in the article, the coroner's offices and law enforcement were involved, and a lack of documentation allowed the newspaper's charge that OIG did nothing to stand. However, OIG has followed up on every one of the cases to ensure referrals were made.
However, most of the cases of Rule 50 neglect involve family members who are simply not up to the difficult task of caring for a disabled person. This can be true even if the victims have suffered serious deterioration in their conditions. We dispute the critics' notion that such matters involve criminal conduct, which begs the question of whether referrals to law enforcement are appropriate or would do any good. In any case,OIG will certainly be referring more of these matters. Proposed legislation would require OIG to inform law enforcement on every call to the Hotline, which seems completely excessive and unworkable. We believe that law enforcement agencies, which deflect our referrals in many cases, would strongly object to this misguided proposal.
Response: Yes, even in refused consent cases, OIG can refer matters to law enforcement, or other appropriate agencies such the fire department of building inspector. However, we believe that investigators have, on occasion, taken a refused consent too literally, so we have encouraged them to be more proactive in making referrals even in refused consent cases.
As DHS closes facilities, more individuals will transition to community agencies and private living arrangements. We believe that this will shift and increase the caseloads. Trinity and The Hope Institute are in the business of doing emergency crisis intervention. To be eligible for the crisis teams, a person must be funded by a Medicaid waiver, which would fall under Rule 50.
Response: We are using "reason to believe" to substantiate, which is essentially a probable cause standard. This means that, in Rule 51 cases, we would refer a substantiated case to law enforcement while in Rule 50, we would have to find credible evidence before making a referral.
The articles also asserted that coroners' offices claimed they had never heard from OIG. One of our investigators had attended two autopsies at the office of one of the coroners mentioned. In most cases, we would not even deal with the chief medical examiner, but a member of their staff. We suspect that, in the face of this reporter's badgering,the coroners found it expedient to deflect blame on OIG. Once again, lack of documentation allowed this inference to be made.
The Hotline investigators face a difficult task. They often are provided with very little information and may not even know the identity of the caller. After hours, an answering service takes the calls, so there may be even less information on the intake. Although all of the hotline intake staff are Internal Security Investigators, few if any of them have had experience in this kind of work, so they must learn on the job.
The Hotline intake staff must determine, among other things: (1) Is it in a state operated facility? (2) If it isn't in a state-op, do they provide DD or MH services? (3) Are the services licensed, funded, or certified by DHS? (4) What are the allegations? (5) Do they constitute abuse, neglect or financial exploitation? (6) Is it a community case in a domestic environment? (7) If it is a domestic case, is the person 18- 59 years of age living in a domestic environment? (8) To complicate things, does the person have a disability that prevents him/her from seeking help on their own?
On the domestic side, the investigators will visit any home that is involved in a case accepted for an assessment. Even in refused consent cases, there must be a face-to-face visit. For some of these people,this program might be the only chance they will have to get out of the situation they are in or receive the services they need. We receive calls from neighbors and, more frequently, calls from required reporters. We have even received calls from store employees who observe what they feel is abuse toward disabled people.
Response: If we have a suspicion,it is not unusual for us to call and request a well-being check. We have included,in certain situations, building inspectors, the fire department and law enforcement. In many cases, the police have already been involved, and we may have them accompany us in situation that may involve some danger.
Activity of the Board in the past- This is going to be a busy year because we are being faced with potentially sweeping changes. In the past,the Board has provided critical support and input when we have gone though the legislative or rulemaking process. We have also tried to keep the Board updated about any trends and problems we have seen with respect to agencies.
In the past, we have discussed open cases, which could be problematical as they concern confidential information. There are issues affecting the department that we felt the Board should know about such as potential litigation, closures or licensure issues. Information pertaining to potential litigation is an exception to required disclosure under the Open Meetings Act. The Board may go into closed session to discuss confidential information, such as open cases. If the Board chose to do so, you could motion to close the meeting. It is a quality control function. We will review the Open Meetings Act to ascertain what information or discussions could be addressed in closed sessions.
Response: Yes but some information, such as the identities or location of the people involved can still be ascertained.
We have tried to have presentations by various members of our staff about some of the things we are doing. We have had presentations on site visits, the process of seeking guardianship and other matters we considered to be of interest to the Board. We would welcome any topics the members suggest.
One word of caution on the licensure function. OIG has no licensure authority and cannot suspend or cancel licenses of programs or agencies, which is within BALe's purview. We can recommend sanctions against facilities and agencies to the Secretary, who would have the authority to impose them.
By-Laws of the Quality Care Board: Chairperson Keegan thinks that the Board needs to look at the duties and members should be mindful of them. The Board's responsibilities and mission are significant issues with which we have struggled in the past. Rita Burke, who is no longer with the Board, tried to get clarification of the duties from the Governor's Office and Attorney General's Office without success. The duties and responsibilities need clarification and may require revision.
The Board needs to see the policies and protocols of abuse and neglect, and the operations and regulations of the facilities for review. The members received the training calendar, and Rules 50 and 51are on line. Perhaps the members could observe various OIG functions to evaluate how staff are doing and offer suggestions for changes. At the January meeting,Chairperson Keegan would like to set up working groups and have the members identify issues related to the Board's functions. Chairperson Keegan is going to talk to the Governor's Office letting them know that this is a huge mandate for a small Board. We noted that, given the DHS legislative Committee's assumption that the Board was charged with expansive oversight powers,the Governor's office should be advised that this was not the case and a volunteer board of this size would have severe practical limitations in assuming such responsibilities. We reminded the Board that OIG staff are their guests, and the Board could decide to go into executive session or exclude them entirely from meeting.
Board members requested certain information and documents. We suggested that the documents are voluminous, such as directives and facility and agency policies. As a starting point, we will provide the members with the table of contents for the directives. Obviously, OIG staff would provide the members with any specific documents they request.
All of the Quality Care Board members turned in their Acknowledgement forms.
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Illinois Department of Human ServicesJB Pritzker, Governor · Dulce M. Quintero, Secretary Designate
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This combination medication is used to temporarily treat symptoms caused by the common cold, flu, allergies, or other breathing illnesses (such as sinusitis, bronchitis). Decongestants help relieve stuffy nose, sinus, and ear congestion symptoms. Acetaminophen (APAP) is a non-aspirin pain reliever and fever reducer. Antihistamines help relieve watery eyes, itchy eyes/nose/throat, runny nose, and sneezing.Cough-and-cold products have not been shown to be safe or effective in children younger than 6 years. Do not use this product to treat cold symptoms in children younger than 6 years unless specifically directed by the doctor. Some products (such as long-acting tablets/capsules) are not recommended for use in children younger than 12 years. Ask your doctor or pharmacist for more details about using your product safely.These products do not cure or shorten the length of the common cold and may cause serious side effects. To decrease the risk for serious side effects, carefully follow all dosage directions. Do not use this product to make a child sleepy. Do not give other cough-and-cold medication that might contain the same or similar ingredients (see also Drug Interactions section). Ask the doctor or pharmacist about other ways to relieve cough and cold symptoms (such as drinking enough fluids, using a humidifier or saline nose drops/spray).
How to use Actifed Plus Tablet
See also Warning section.
If you are taking the over-the-counter product, read and follow all directions on the package label. If your doctor has prescribed this medication for you, take as directed by your doctor. If you have any questions, consult your doctor or pharmacist.
Take this medication by mouth with or without food or as directed by your doctor. If stomach upset occurs, it may help to take this medication with food or milk. Drink plenty of fluids when you use this medication unless otherwise directed by your doctor. The fluid will help loosen the mucus in your lungs.
If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose. If your liquid form is a suspension, shake the bottle well before each dose.
If you are taking the extended-release capsules, swallow them whole. Do not crush or chew extended-release capsules or tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.
If you are taking the chewable form of this medication, chew it thoroughly before swallowing.
The dosage is based on your age, medical condition, and response to treatment. Do not increase your dose, take it more often, or use it for a longer time than directed. Do not give children medicines labeled only for adults.
Tell your doctor if your condition lasts for more than 1 week, if it gets worse, or if it occurs with headache that doesn't go away, rash, or fever lasting more than 3 days. These may be symptoms of a serious medical problem and should be checked by a doctor. Depending on the symptoms being treated, you may need to contact your doctor earlier than 1 week, if they last or get worse. Check your specific package label for when to contact your doctor.
Side Effects
See also Warning section.
Drowsiness, dizziness, blurred vision, upset stomach, nausea, nervousness, or dry mouth/nose/throat may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.
If your doctor has prescribed this medication, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as confusion, hallucinations), shaking, trouble urinating, fast/slow/irregular heartbeat, seizure.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US -
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
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One ingredient in this product is acetaminophen. Taking too much acetaminophen may cause serious (possibly fatal) liver disease. Adults should not take more than 4000 milligrams (4 grams) of acetaminophen a day. People with liver problems and children should take less acetaminophen. Ask your doctor or pharmacist how much acetaminophen is safe to take.
Do not use with any other drug containing acetaminophen without asking your doctor or pharmacist first. Acetaminophen is in many nonprescription and prescription medications (such as pain/fever drugs or cough-and-cold products). Check the labels on all your medicines to see if they contain acetaminophen, and ask your pharmacist if you are unsure.
Get medical help right away if you take too much acetaminophen (overdose), even if you feel well. Overdose symptoms may include nausea, vomiting, loss of appetite, sweating, stomach/abdominal pain, extreme tiredness, yellowing eyes/skin, and dark urine.
Daily alcohol use, especially when combined with acetaminophen, may damage your liver. Avoid alcohol.
See also Warning section.
Before taking this product, tell your doctor or pharmacist if you are allergic to any of its ingredients; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
If you have any of the following health problems, consult your doctor or pharmacist before using this medication: breathing problems (such as asthma, emphysema), diabetes, glaucoma, heart problems, high blood pressure, kidney problems, liver disease, seizures, stomach/intestinal problems (such as blockage, constipation, ulcers), overactive thyroid (hyperthyroidism), urination problems (such as trouble urinating due to enlarged prostate, urinary retention).
This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).
Some brands of this product may contain sugar, alcohol, or aspartame. Caution is advised if you have diabetes, alcohol dependence, liver disease, phenylketonuria (PKU), or any other condition that requires you to limit/avoid these substances in your diet. Ask your doctor or pharmacist about using this product safely.
Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
Children may be more sensitive to the side effects of this drug. In young children, antihistamines may cause agitation/excitement instead of drowsiness.
Older adults may be more sensitive to the side effects of this drug, especially dizziness, drowsiness, confusion, constipation, trouble urinating, fast/irregular heartbeat, or trouble sleeping. Dizziness, drowsiness, trouble sleeping, and confusion can increase the risk of falling.
During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.
This medication may pass into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breastfeeding.
See also Warning section.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Some products that may interact with this drug are: ketoconazole, levoketoconazole.
Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.
Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or other antihistamines (such as cetirizine, diphenhydramine).
The ingredients in this product are available in many prescription and nonprescription products. Check the labels on all your medicines (such as pain/fever drugs, diet aids, or cough-and-cold/allergy products) because they may contain the same or similar ingredients. Using these drugs along with this product could increase side effects (such as fast heartbeat, increased blood pressure, or drowsiness). Ask your pharmacist about using those products safely.
Do not use with any other antihistamines applied to the skin (such as diphenhydramine cream, ointment, spray) because increased side effects may occur.
This medication may interfere with certain lab tests (such as urine drug screening tests, urine 5-HIAA, allergy skin test), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.
If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call 1-800-222-1222. Canada residents can call 1-844-764-7669. Symptoms of overdose may include: nausea, vomiting, loss of appetite, sweating, stomach/abdominal pain, extreme tiredness, agitation, confusion, flushing, hallucinations, yellowing eyes/skin, dark urine, seizures. In children, excitement may occur first, and may be followed by: loss of coordination, drowsiness, loss of consciousness, seizures.
Keep all medical and lab appointments.
If you are taking this product on a regular schedule and miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
Store at room temperature away from light and moisture. Do not store in the bathroom. Do not freeze liquid forms of this medication. Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Have you ever purchased Actifed Plus Tablet?
This survey is being conducted by the WebMD marketing sciences department.
Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.


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Why is your oil change so important?
Oil changes may seem mundane, but if your car is maintained correctly you must change your oil as it is a crucial part of your vehicle and should always be part of your recurring maintenance. The fewer surprises your car throws at you the better and Covey's Car Care, Inc in Seaford, DE wants you to know just how important your oil changes are.
The oil in your engine is essentially its lifeline. It protects moving parts from rust, friction, and cleans your engine by absorbing carbon buildup and debris. When you neglect an oil change, that oil saturated with dirt, and debris begins to work against you. First, small particles in the oil wreak havoc on bearings and small oil journals. If neglected for too long, oil begins to break down or coagulate, inefficiently lubricating moving parts and clogging passageways. Old oil will destroy an engine, either through bearing and part wear or oil starvation, or both at the same time. Too much wear on internal engine parts will cause the engine to fatally malfunction, sooner rather than later.
What are the other benefits of a regular oil change?
- Improved engine performance: Clean oil and a fresh air filter will keep all the important parts of your engine clean and lubricated. This creates a smoother and quieter ride. A smooth running engine has a positive effect on multiple areas of your vehicle.
- Prevents debris build-up: Older oil will stick to engine parts. This can turn into debris, clog up areas, and create build up. Changing the oil and filter regularly remove and prevent this nasty build up. If you do the majority of your driving on dirt roads you will need more regular oil changes.
- MPG: As mentioned above, regular oil changes offer up improved lubrication. Newer, cleaner oil reduces friction that can slow your engine which means you'll end up paying more money for gas. New, clean oil also helps your engine run cooler. A cooler engine is more efficient. Anti-freeze and oil work together to cool your engine together. If one isn't working right it negatively affects the other one.
- Cleaner emissions: Older cars, trucks, RVs, and SUVs can burn old, dirty oil which increases emissions. Dirty oil allows hydrocarbons to build up in the crankcase. If the oil is dirty the emissions levels can raise. Brand new oil is much less likely to burn and can also absorb particles which means less pollution.
- Longer engine life: Whether you live in the city, suburbs, or country your engine will get dirt and debris stuck inside of it. If you change your oil there is less friction. With less friction, there is much less wear and tear. Less wear and tear means a much longer engine life. If you change your oil regularly, there is less carbon build-up. Altogether this will save you money in the long run. Replacing an engine can cost quite a bit of money.
- Other car parts: Clean, new oil doesn't only protect the engine. It also protects other car parts that are constantly in motion. Oil lubricates the crankshaft and the connection rods. This controls the pistons from going up and down when your engine is on. The cylinder walls allow the rings to build up better compression when lubricated. The camshaft is the valve train that opens and closes the engine tank and exhaust valves. The oil keeps this lubricated and moving efficiently as well.
- Other issues: If you get a regular oil change then the other parts of your vehicle will also get checked. We offer affordable oil changes and will also check for other issues while you are here.
- Warranty: Most terms of a warranty include regular oil changes. If you don't follow these terms it could void the contract.
Since it is a lot easier to keep an engine internally clean than it is to clean up a dirty one, and since proper lubrication is the most important aspect of engine longevity, you can see why proper oil maintenance is such a priority. Get your oil changed on time, and don't skip the oil filter replacement. The next time your car is ready for an oil change, or any other services from brake pads to major engine issues, let the experts at Covey's Car Care, Inc in Seaford, DE handle it. We'll keep your car maintained so you can avoid breakdowns and get the most out of your car, truck, or SUV.
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This job posting is no longer active.
Location: COLORADO SPRINGS, CO, United States
Category: Technicians/Patient Care Support
Job Type: Full Time
Job ID: 130717
Date Posted: Sep 13, 2023
Provides care for patients undergoing sleep studies and sleep disorder treatment.
Work Schedule: Full Time Nights
Prepares for the arrival of the patient by setting up and preparing the equipment for the ordered test. Interviews patient to determine sleep disorder issues and to explain testing procedures.
Performs testing and any additional testing required for sleep disorder that is noted.
Scores, interprets and reports results of sleep studies. Educates patients about test results, sleep disorders, community support groups, and available resources.
Prepares, calibrates, repairs, and maintains equipment required for testing. Determines and reports needed repairs and replacements.
Within scope of job, requires critical thinking skills, decisive judgement and the ability to work with minimal supervision. Must be able to work in a fast-paced environment and take appropriate action.
The pay range for this position is: $21.49 - $27.94 / hour. Pay is dependent on applicant's relevant experience.
UCHealth offers a Five Year Incentive Bonus to recognize employee's contributions to our success in quality, patient experience, organizational growth, financial goals, and tenure with UCHealth. The bonus accumulates annually each October and is paid out in October following completion of five years' employment.
UCHealth offers their employees a competitive and comprehensive total rewards package:
Loan Repayment:
UCHealth is a qualifying employer for the federal Public Service Loan Forgiveness (PSLF) program!UCHealth provides employees with free assistance navigating the PSLF program to submit their federal student loans for forgiveness through Savi.
At UCHealth, we do things differently
We believe in something different: a focus on the individuality of every person. In big ways and small, we exist to improve the extraordinary lives of all those we serve. As Colorado's largest and most innovative health care system, we as a team deliver on the commitment to provide the best possible experience for our patients and their families. We foster a true human connection and give people the freedom to live extraordinary lives. A career at UCHealth is more than a job, it's a passion.
Going beyond quality requires the perfect balance of talent, integrity, drive and intellectual curiosity. We are looking for individuals who recognize, like us, that the world of medicine is ever-changing and are motivated to do what is right, not what is easy. We support creativity and curiosity so that each of us can find the extraordinary qualities within ourselves. At UCHealth, we'll do everything in our power to make sure you grow and have a meaningful career. There's no limits to your potential here.
Be Extraordinary. Join Us Today!
UCHealth recognizes and appreciates the rich array of talents and perspectives that equal employment and diversity can offer our institution. As an affirmative action/equal opportunity employer, UCHealth is committed to making all employment decisions based on valid requirements. No applicant shall be discriminated against in any terms, conditions or privileges of employment or otherwise be discriminated against because of the individual's race, creed, color, religion, gender, national origin or ancestry, age, mental or physical disability, sexual orientation, gender identity, transgender status, genetic information or veteran status. UCHealth does not discriminate against any "qualified applicant with a disability" as defined under the Americans with Disabilities Act and will make reasonable accommodations, when they do not impose an undue hardship on the organization.


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Nursing Services Administrator Salary
Average Nursing Services Administrator Base Salary in the United States
Average Base Salary
$119,310 Per Year
Salary Range: $60,772 to $201,771
How Much Does a Nursing Services Administrator Make Per Year in the United States?
The national average salary for a Nursing Services Administrator is $119,310 per year in the United States. It can vary depending on the employer and the skills required for that position, but generally, it will be about $119,310 or more annually for a gross salary. Taxes impact salaries, so to get the net salary we've crunched the data and gotten the tax information on what the take-home pay would be after the effective income tax rates.
Jobs That are Similar to a Nursing Services Administrator
Technology Used
Microsoft Excel – Spreadsheet software
Microsoft PowerPoint – Presentation software
Microsoft Project – Project management software
Database software – Data base user interface and query software
Adobe Systems Adobe Acrobat – Document management software
Microsoft SharePoint – Cloud-based data access and sharing software
Microsoft Visio – Process mapping and design software
Facebook – Web page creation and editing software
Knowledge and Expertise
Administration and Management
Customer and Personal Service
Personnel and Human Resources
Computers and Electronics
Law and Government
Soft Skills
Critical Thinking
Reading Comprehension
Active Listening
What is the salary range of a Nursing Services Administrator?
Nursing Services Administrator salaries vary depending on the company you work for, your experience level, industry, education, and years of experience. The average annual salary is around $119,310 but a Nursing Services Administrator can earn a base salary anywhere from $60,772 to $201,771 per year with some companies paying more than others.
Pay ranges on average for a Nursing Services Administrator job title only vary a good amount, which may mean that there are many opportunities to earn more income in the future regardless of the employers or your location, industry, and experience.
A salary range that varies also means there is ability to move up within the company, as there may be as many opportunities for advancement or to change your job title. This opportunity for advancement can help with can increase their job satisfaction and motivation.
What are the Highest Salaries for a Nursing Services Administrator?
The highest Nursing Services Administrator salaries in the top 10% earn more than $201,771 per year. The salary range for the top 75% – 90% is between and $135,163 and $201,771 annually.
This salary data and salary estimates come from our Average Pay's salary database of carefully collected and detailed information about pay across many industries and categories, along with different types of labor data.
What are the Lowest Salaries for a Nursing Services Administrator?
The lowest Nursing Services Administrator salaries are in the bottom 10% of earners who make less than $60,772 per year. The salary range for the lowest 10% – 25% is between $60,772 and $77,259 annually.
This salary data and salary estimates come from our Average Pay's salary database of carefully collected and detailed information about pay across many industries and categories, along with different types of labor data.
What is a Good Salary for a Nursing Services Administrator?
If we only look at the data for Nursing Services Administrator salaries and we don't compare it to any other jobs, a good salary for a Nursing Services Administrator job would be over $119,310 per year. This is the average salary for this position in the United States. An excellent pay for a Nursing Services Administrator would be anything over the top 75%, which is $135,163 annually.
How Can I Increase My Salary as a Nursing Services Administrator?
There are a few ways you can increase your average salary for a profession as a Nursing Services Administrator. One way is to get promoted to a higher level and take on more duties within your employer. Another way is to gain more experience and skills in your career. You can also try negotiating higher compensation next performance review, when you are up for renewal or starting a new contract with a business.
Finally, you can look for a new job at a different employer that pays more. One thing not to overlook is companies often give their employees incentives and benefits outside of salaries. The total compensation, like healthcare, paid vacation days, 401k matches, bonuses, overtime, professional development, a career path in the company, and other benefits, need to be considered, which can add up to a lot more money than just a salary increase.
What are the Top Paying Industries for a Nursing Services Administrator?
The top paying industries for a Nursing Services Administrator job vary depending on the position's specific responsibilities, employers, and qualifications. However, some common reported high-paying industries for include the following:
- Professional, Scientific, and Technical Services
- Hospitals
- General Medical and Surgical Hospitals
- Ambulatory Health Care Services
- Federal, State, and Local Government
- Finance and Insurance
Related Jobs For a Nursing Services Administrator
Does a Nursing Services Administrator Have a Good Quality of Life?
Based on an average 2-bedroom apartment rental price, a Nursing Services Administrator would pay 15.63% of their monthly take-home pay towards rent. That's $1,310 per month or $15,720 yearly for a two-bedroom apartment.
The rent is less than 30% of the monthly take-home pay for an Nursing Services Administrator, which can helps lessen a financial burden and impact their quality of life.
This is because a high rent-to-income ratio would leave less money each month for other expenses, such as food, transportation, recreation, and activities. It can lead to financial stress, impacting overall job satisfaction and motivation.
Considering the cost of living in a city when considering whether to accept a job offer is essential. If the cost of living is too high, it might not be worth it, even if the salary is good.
Does a Nursing Services Administrator make good money?
In general, a Nursing Services Administrator can make a good salary. The national average salary is $52,632 annually which is less than the average Nursing Services Administrator salary, meaning most earn a livable wage. According to data and labor statistics from the Bureau of Labor Statistics, the average Nursing Services Administrator pay is above the median salary.
However, salaries can vary depending on the company you work for, what you are responsible for, education, college degree, work experience, job market, and your experience level. The highest-paid can earn upwards of 201,771 per year, while the lowest-paid income is less than 60,772 annually.
If you want to maximize your earnings as a Nursing Services Administrator, take on more responsibility, and gain more experience in related skills. Also, build interpersonal skills and strong leadership skills, get a certification in your field and then negotiate for a higher salary next performance review, when you are up for renewal or starting a new contract with a business.
The best thing you can do is develop yourself and gain knowledge. Many courses, additional training, and professional development opportunities in your area can help increase your skills and development in your job or related field.
You can also get your resume reviewed and look for a new employer that will hire and pay more or look for a career change that is hiring and may interest you more.
Salaries are also relative to the cost of living in different parts of the country. For example, the compensation for a Nursing Services Administrator will need to be higher if it is in or closer to larger cities like New York City or some states like California. The increase in pay in these areas is because of the higher than average cost of living and more interested applicants for employment versus someone living in a small town. With the cost of housing increasing and medical care premium costs, it is essential to ensure you are getting paid what you are worth.
How do I know I'm being paid fairly as a Nursing Services Administrator?
The easiest way is to see how close your current salary is to the average pay for your position in your state and city. If your income is below the estimated average wage in your area, you can try to negotiate for a raise.
You can use our research and tools to discover the average salary for a Nursing Services Administrator in your city or region to see if you are being compensated fairly. You may also compare your income to similar jobs and careers to determine whether you are underpaid or overpaid. Lastly, you can set up job alerts to see how the job market trends.
A few other ways you can research whether you're being paid fairly as a Nursing Services Administrator is to do a job search to look at job postings for similar positions and see the estimate for the listed salary range. You can also talk to people in your network who have similar jobs and ask them what they earn. Finally, you can try negotiating a higher pay when you are up for renewal, having a performance evaluation, or starting a new contract.
What Factors Determine the Salary of a Nursing Services Administrator?
The money a Nursing Services Administrator can make each year greatly depends on a few components that determine an average base salary.
The company you work for is one of the main factors that affect how much a Nursing Services Administrator earns.
The compensation will also depend on the location, as some states and cities have a higher cost of living than others. Other factors that affect compensation are the number of hours worked, company size, job type, level of experience in your career, and location.


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Cozzens Coat of Arms / Cozzens Family Crest
Click Here To View Our Cozzens Coat of Arms / Cozzens Family Crest Products
Thank You for visiting our Coat of Arms / Family Crest Gallery.
We specialize in Coat of Arms Glassware, Coat of Arms Plaques, Family Crest Rings, Family Crest Flags, and many other Coat of Arms / Family Crests Gifts.
We have Irish Coat of Arms, German Coat of Arms, French Coat of Arms, Spanish Coat of Arms, Italian Coat of Arms, and Coats of Arms from most every other European Country.
Please be aware that there is more than one coat of arms for this surname. If you would like this particular coat of arms, you must describe it on your order form. If you don't describe it on your order form, we will provide you with the oldest coat of arms on record for this surname, which may or may not be the one pictured above.
Please email me if you would like permission to use the Cozzens coat of arms on a website..


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Welcome back yet again to another Fight Back Friday! Today we are bringing together another collection of recipes, tips, anecdotes, and testimonies from members of the Real Food Revolution.
Who are they? Why, they're the Food Renegades. You know who you are — lovers of SOLE (Sustainable, Organic, Local, and Ethical) food, traditional food, primal food, REAL food, the list goes on. I believe that by joining together, our influence can grow, and we can change the way America (and the industrialized world) eats!
So, let's have some fun.
If you want to participate but aren't sure how, please read these guidelines for how Fight Back Fridays will work.
Please be courteous and use your BEST blog carnival manners! In the very least, that means remember the two most important things you can do:
- Share a relevant post from your blog with us using the McLinky Widget below (don't just link to your blog's home page).
- In your post, be sure to link back to this post (not the Food Renegade home page) so that your readers can have access to all the information and encouragement we'll be sharing.
Please also feel free to make use of any of the banners below by saving the image to your desktop then uploading it to your own server. (You don't have to use them, but they're there for you!)
If you don't have a blog but are interested in joining the conversation, you can leave your comments below!
I can't wait to see what you all share!
Fight Back Friday Banners


text: The HST New Housing Rebate program allows you to claim a rebate on part of the HST you pay on the purchase price of either a newly constructed home or cost of building the home. You can claim a rebate on a newly renovated home, a purchase of a new mobile home, or when your home is destroyed in a fire and is subsequently rebuilt. The purchase price of resale homes are exempted from the HST whereas the purchase price of newly constructed homes are subject to HST. New home buyers can apply for a 36% rebate on the federal portion of the HST of the purchase price to a maximum of $6,300 for homes costing $350,000 or less. For new homes priced at $350,000 to $450,000 the rebate will be reduced proportionately. Homes priced over $450,000 would not receive a rebate on the federal portion of the HST. For the provincial portion of the HST, new home buyers can apply for a 75% rebate applicable to the purchase price to a maximum of $24,000.


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This is the Hundred Years War. Each man must stand tall. Each man's mettle will be tested. But amongst all men there are leaders, there are those who will not be cowed. Can you be that leader? In this epic strategy RPG you will lead your army through the greatest of medieval wars and make history live again.
HISTORY™ Great Battles Medieval is a unique blend of Real-Time Strategy and Role-playing that allows you to develop your army; gaining experience, abilities and equipment to customise your troops. Success can never be guaranteed but to give you the best chance you must engage in careful preparation and be sure to equip your squads to meet every eventuality. In addition, an exciting Battle Card system will give you unique advantages which can turn the tide of battle if used at the right time!
In HISTORY™ Great Battles Medieval you take command as a general in control of English or French forces during the Hundred Years War. As the English you will fight under the Black Prince, Henry V and other heroic characters from history, and as the French you fight for the famous Joan of Arc and the King.


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To order call (323)882-8278 or email firstname.lastname@example.com WELCOME TO MARRIKA NAKK OFFICIAL WEBSITE WHERE YOU CAN SHOP FROM THE COMFORT OF YOUR HOME! Combining feminine western chic designs with a bohemian vintage appeal, Marrika Nakk captures beautiful western styles for women. From western bridal dresses to unique cowgirl styles, Marrika Nakk's designs have been seen on magazine covers, red carpets, and beautiful women around the world. Please call 323-882-8278 for pricing and ordering information.
Zorro Skirt


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Wooly Granola by Magnolia Fabric
Required Minimum Quantity Purchase: 2 yards
Book: -
Content: 100 POLY
Origin: CHINA
Performance: 25,000
Repeat: Horizontal: 0 and Vertical: 0
Width: 58
U.S. Shipping
Orders will be charged $25.00 per order to the contiguous USA. Please know that our average package price has doubled over the last couple of years. We pay about forty dollars per package and are absorbing the difference., We apologize for the higher shipping charges.
Items will ship via UPS, FEDEX, or USPS Priority Mail. There are a few premium brands that ship from the UK and bill at a higher fixed shipping rate and will not qualify for free shipping.
Shipping Time is estimated at 3-10 days. Our fabric warehouses normally take 1-2 business days to ship and then it will be another few days of transit time based on your final destination.
International Shipping
Orders shipping outside the United States will be shipped via USPS Priority Mail and shipping costs will be based on the weight of the items purchased.
We guarantee the quality of all of our items to be free from defects and they are all sold as FIRST QUALITY. In the rare event an item received is damaged we will replace it with the same item.
Fabric manufacturers produce many variations of the same fabrics. The size of the pattern, construction, and color lots may vary. Please be aware that fabric colors can vary from one computer to another and please don't buy any fabric based solely on an image in regard to color. The color, brightness and contrast settings of your monitor may vary.
If there are any questions, please ask before you place your purchase.


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Biweekly Mortgage Calculator
This calculator shows you possible savings by using an accelerated biweekly mortgage payment. Biweekly payments accelerate your mortgage payoff by paying 1/2 of your normal monthly payment every two weeks. By the end of each year, you will have paid the equivalent of 13 monthly payments instead of 12. This simple technique can shave years off your mortgage and save you thousands of dollars in interest. Click on the "View Report" button to see your savings!


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Whether you're 16 or 60, if you want to become a licensed driver in Kane, Illinois, taking an approved Driver's Ed class will get you one step closer to your goal. The course will teach you everything you need to know about legally operating a vehicle on the different roadways of Illinois. You'll also learn how to interpret and follow various road signs, including speed limit signs, yield signs, and many others.
Before obtaining your Illinois driver's license, you will need to pass both a written examination and a behind-the-wheel examination. Your driving instructor will provide you with the information you need to get one step closer to passing both examinations and earning your driver's license.
Completing a driver's education course will put you one step closer to meeting the requirements of your learner's permit and getting behind the wheel.
Even if you're an experienced driver or a parent getting ready to teach your teenager how to drive, a Driver's Ed course can help refresh you on topics including:
Driver's Ed, whether it's a requirement or not, can benefit all drivers.


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- Get $10 off your first order! Just use code WELCOME10 at checkout.
- Estimated between Mon, 29 July and Wed, 31 July to Australia
- Dark powder chrome platform
- 7 inches (17.8 cm) stiletto heels
- 2 3/4 inches (7 cm) platform
- Gold color
- Vegan material
- Medium width
- Inside zip closure
- Available sizes: US 5-11
- Inner: PVC
- Sole: Rubber
- Upper: Sequins
This product qualifies for 14 day free returns.
Find out more about our return policy.
Tags: Exotic Dancers / Pole Dancers / Burlesque / Showgirls / Platform
To get the perfect fit, here are some guidelines:
- Our footwear is shown in US sizes
- Order the same size you normally wear (size 9 US) if you are normally an Australian size 9, but sometimes fit in a smaller size (size 8 or 8.5 Australian)
- Order one size larger than you normally wear (size 10 US) if you are normally an Australian size 9, but sometimes fit in a larger size (size 9.5-10 Australian)
- If you would like to convert a man's size to a woman's size: take the man's size and increase it by two sizes. For example, man's size 9 would be a woman's size 11.
If you ordered the wrong size,
You followed all the instructions and still your shoe arrived and it is big or too small. Don't worry, we offer exchanges. No extra charges, No inventory refill fees, no extra shipping costs. You only have to ship the shoes back to us unworn and we will send you the bigger or smaller size. Please contact us on email@example.com
- Estimated between Mon, 29 July and Wed, 31 July to Australia
- 12-20 business days international shipping
- Free Shipping to Australia and New Zealand
Find out more about our SHIPPING & RETURN policy.
We want you to be 100% happy with your shopping experience at OtherWorld Shoes! If for any reason you aren't happy we make it easy to return your item to us.
This product qualifies for 14-days returns.
Find out more about our return policy.
- We are Australian owned and operated since 2018
- Our shoes are high quality, comfortable and stylish
- We are passionate about alternative fashion and shoes!
- We are a small, passionate team ready to help with any situation (Meet the team)
- We love making our customers happy (Over 200 positive reviews)
- We want you to feel your best all the time!
- As shoe lovers, we want you to have your new shoes as soon as possible for your next party or event


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A real estate agent is a professional in a field where most buyers and sellers are novices. This is very likely the largest single purchase you will ever make. After all, how often do you drop a quarter of a million dollars or more on a shopping spree? Home buying and selling is full of pitfalls that can be avoided with an agent to provide you with expert assistance, knowledge of the market and negotiation skills.
- Your agent is the unbiased voice of reason who brings objectivity to the table. An agent helps sellers see past their emotional connection to their home and helps buyers deal with a multiple bid situation.
- Your agent can recommend a good independent home inspector who can provide a list of repair needs. Then, the agent will help evaluate which repairs are reasonable and which are excessive as you get your home ready to sell. Your agent also has contacts with excellent contractors to make the necessary repairs.
- Determining the price of your home is difficult: you want to realize a maximum profit without scaring off potential buyers with sticker shock. With their experience in your market area, most real estate agents can set the price of a home very quickly.
- If you've ever bought or sold a house, you know that it involves a mountain of paperwork. Your agent can really save the day here because the possibility of missing something — such as initialing all the proper boxes — can drop substantially when you are working with a pro who knows all the paperwork nuances.
- Professional real estate agents are familiar with local zoning ordinances and codes to be able to know if you can add on a new bedroom or put up a privacy fence. The agent should be able to make sure the city will allow your changes.
- Licensed agents are required to keep a complete set of all your real estate transaction documents, making them a good resource for years after the deal has closed.
- Plenty of pitfalls are can appear in the final hours of a sale that might kill the deal. Your agent knows to watch for trouble before it's too late. Problems with the title or financing or timing are all things the agent knows to watch for and take steps to avoid. Agents are used to dealing with these kinds of issues and can work through nearly any challenge that might occur.
Nearly 90% of buyers purchase their home through a real estate agent, according to the National Association of REALTORS®. Your agent is an expert in sales, as well as marketing, social media and data analysis. Home sale rules are always changing and it's your agent's job to stay on top of the market and bring that expertise to you. Why wouldn't you choose to have a professional like that working for you as you make this momentous purchase?


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Used Subaru for Sale in Middletown, Connecticut
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Get the Best Duct Repair Clarinda with SK Duct Cleaning
Are you noticing dust and filth in the air? Is there a steep hike in your electricity bills?
Well, when was the last time that you repaired your ducts? Cannot remember?! Chances are high that you need to hire duct repairing services in Clarinda.
If your AC vent starts circulating stale air and if there is low or no cooling, and a steep hype in the electricity bills, know that your ducts are not functioning properly and need repair.
SK Duct Cleaning is a leading duct repair company in Clarinda because:
- We provide assured duct repair services in Clarinda
- We have a highly experienced and skilled team of in-house engineers
- All our work is 100% insured and guaranteed
- We are very economical and offer the best prices
- We provide duct repair services in all the remote corners of Clarinda
Duct Repair in Clarinda: Is it really necessary?
Apart from just helping the cooling system to work properly, the air ducts perform several other functions too, that make it an important part of a healthy home. Let us have a deeper look at the facts related to the importance of a clean and properly maintained air duct.
- The bacteria and dust accumulated inside the duct can cause serious health issues regarding the respiratory systems in home members.
- An unhealthy duct can severely damage your cooling system.
- It reduces the overall cleaning time of your home.
- It improves the air-quality of home.
SK Duct Cleaning: A Reliable Duct Cleaning Company in Clarinda That You Can Completely Trust
If you are looking for a reliable, experienced and affordable duct cleaning service that has the ability to provide you professional cleaning solutions, then one name that you can completely trust on is the SK Duct Cleaning.
We are a renowned name when it comes to duct repair Clarinda. We are the leading HVAC cleaning service in the area and have enough experience to deal with almost every kind of problem you can ever get while dealing with the duct system.
As a local and certified cleaner, we have enough knowledge of possible elements that could have clogged your air duct. We can easily suggest you the most effective tips to keep your duct clean, which will eventually help you reduce the electricity bills and improve the air quality inside your home.
So, instead of wasting your time to search for an ideal duct cleaning service provider and choose SK Duct Cleaning for impeccable services at extremely affordable rates.
What Makes Us The Best Duct Cleaning Company in Clarinda?
As said, several companies in Clarinda provide similar duct cleaning services to customers. However, there are a few points that have made us a better choice than most of the other companies operating in Clarinda. Let us have a look at the points that made SK Duct Cleaning the best in business:
- Customer satisfaction guaranteed
- 100% reliable and experienced staff
- We offer a free quote
- Extremely user-friendly cleaning
- We use completely natural cleaning agents that are safe for human, pets, and nature
- We have most advanced machinery that ensures perfect cleaning and maintenance of the air duct
- Carbon monoxide testing for air duct
- Prompt customer care services
- Our experts will help you to keep your duct clean by sharing some expert maintenance tips
So, if you were after a completely reliable and properly equipped company for your duct cleaning, then contact us. We will soon contact you and our official cleaning experts will be there for possible solutions.
Our Duct Cleaning Services in Clarinda
In addition to the duct cleaning services, you can literally rely on us for every single problem related to your duct. Whether you need it to be repaired, maintained or you are experiencing any other issue with your duct, just give us a call and we will send the experts for a free quote. Specifically, SK Duct Cleaning provides the following services to our customers in Clarinda.
- Professional duct cleaning
- Duct replacement
- Air vent cleaning
- Duct maintenance
- Duct unit repair
- Ceiling duct cleaning
- Duct inspection and repairing
- Ducted pipes repair
- Gas ducted heater replacement
- Floor duct cleaning
- Exhaust system cleaning
- Central heating system sanitization
- Central air conditioning system cleaning
- Duct maintenance
- Domestic duct heating cleaning
- Residential duct heating cleaning
- Commercial duct heating cleaning
- Duct unit servicing
Apart from the above-listed services, if you want some other services related to the air con vent or duct, then you can ask our duct cleaning and repair experts for that too.
We guarantee your satisfaction and know how to meet your expectations. We value your time and treat your work as our top-most priority. So, just inquire us for the services and we will contact you as early as possible.
Get Your Ducts Repaired with Our Duct Cleaning Services in Clarinda
Now, once you are aware of what services do we provide and how reliable we are, now it is time to know about the various ways through which you can contact us.
You can either contact us by filling the inquiry form on the website, or by leaving us an email regarding your problem. We will soon contact you with possible solutions. Also, if needed, we will send the experts to your lace for a free quote after inspection of your duct.
Another way to contact us is our phone number. You can always call us for the guidance and service request. Our customer care executives will give you proper guidance and support that you need from us. So, use any of the above-listed ways to contact us and we will be there to help you have a perfectly cleaned air duct.
You can be assured of getting a flawlessly cleaned and maintained duct by hiring us. So, what are you waiting for? Get in touch with our service executives and get your duct cleaned right through.
Dryer Duct Repair Clarinda
We at SK Duct Cleaning offer a range of duct repair services in Clarinda and dryer vent repair is one of them. Clogged and untreated dryer ducts are a major reason for the house fire. Thus, when it comes, to keep in your ducts and house safe, you must proper attention to duct repair and maintenance. There could be a number of factors leading to dryer vent damage, such as animal intrusion or poor and low quality work. But worry not, contact our professionals and get your ducts inspected on the same day of booking. With the help of advanced tools and skill deliver you the best results for dryer vent repair in Clarinda.
Local Duct Repair Clarinda Company
We are a well-established duct repair Clarinda company serving for more than years in the niche. Our technicians are fully trained and licensed and deliver you only the best services for duct repair. Our up-to-date equipment and advanced skills always bring you the best results. No matter what the type of your duct is, our experts can clean and repair it. Moreover, we can serve you even serve you on the same day of the appointment. Reach us today by calling or online for the duct inspection, to get a duct repair estimate.
Why Hire SK Duct Cleaning?
- 10 years of experience in duct repair.
- Industry's best tools and techniques
- All types of duct cleaning and duct repairing
- Complete duct care and maintenance
- Duct inspection and duct unit repair
- Affordable and high-quality services.
Best quality work
Location: Clarinda, VIC, Australia


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Hi! Just wanted to thank you for the speedy delivery of my fabric!! It arrived this morning, and it's wonderful- can't wait to start cutting and sewing!! Thanks again,
Vicki G, - Ontario, Canada
Our goal is for QuiltHome.com to become one of your valued sources of quality quilting supplies, information, and inspiration. We welcome your comments, suggestions, observations, and bug reports.
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Internet Speed Glossary
People frequently ask, "What is 'ping', 'download speed' or 'upload speed'? Or "What does Mbps mean?" and "What's the difference between Mbps and MB/s?" We have all those answers for you and more in this handy little glossary.
Once you've mastered these definitions, check out our FAQs for an even better understanding of internet speeds.
Download speed #
How quickly you can pull data from a server on the internet to your device. Most connections are designed to download much faster than they upload. This is because the majority of online activity, like loading web pages or streaming videos, consists of downloads. Download speed is measured in megabits per second (Mbps).
Upload speed #
How quickly you send data from your device to the internet. A fast upload speed is helpful when sending large files via email, or in using video-chat to talk to someone else online (since you have to send your video feed to them). Upload speed is measured in megabits per second (Mbps).
Latency (or Ping) #
Latency (or Ping) is the reaction time of your connection-how quickly your device gets a response after you've sent out a request. A low latency (fast ping) means a more responsive connection, especially in applications where timing is everything (like video games). Latency is measured in milliseconds (ms).
Packet loss #
Packet loss occurs when a packet of data being sent over the internet is not received or is incomplete. This is described in percentage of packets lost compared to packets sent. Packet loss in most cases is a result of poor signal/line quality.
Jitter #
Also called Packet Delay Variation (PDV), jitter frequency is a measure of the variability in ping over time. Jitter is not usually noticeable when reading text, but when streaming and gaming a high jitter can result in buffering and other interruptions. Technically, this is a measure of the average of the deviation from the mean.
Mbps #
Megabits per second. A megabit is 1 million bits of information. This is a standard measure of internet speed and 1 Mbps is 1,000 times faster than 1 Kbps. Not to be confused with megabytes (MB) which is a measure of size rather than bandwidth. Because a megabyte is larger than a megabit, and to avoid confusion, MB/s is not used to denote internet speeds.
Kbps #
Kilobits per second. A kilobit is 1,000 bits of information. This older measure of internet speed is only used when needed to describe slower connections. Not to be confused with kilobytes (KB) which is a measure of size rather than bandwidth. Because a kilobyte is larger than a kilobit, and to avoid confusion, KB/s is not used to denote internet speeds.


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We went through a number of ideas for names for the toy line and series. Mattel's focus group tests indicated that kids reacted positively to the words "wars" and "secret." Okay.
Mattel had a number of other requirements. Doctor Doom, they said, looked too medieval. His armor would have to be made more high-tech. So would Iron Man's, because their focus groups indicated that kids reacted positively…etc. Okay.
They also said there had to be new fortresses, vehicles and weapons because they wanted playsets, higher price point merchandise and additional play value. Okay.
When time came to actually do it, I realized that only I could write it. I was busy enough being Editor in Chief, I didn't need the additional burden and we didn't have a shortage of writers, but….
Marvel's writers at the time, some of the best in the business, were, to a person, very possessive about the characters they were writing. To some extent, that was a good thing, indicating a love for the characters that generally showed in their work. It also led to some intense rivalries and bitter arguments regarding crossovers and guest appearances.
For instance, once, writer "A," who shall remain nameless, wanted Doctor Doom to "guest-villain" in the series he wrote. I okayed it, over the snarling objections of writer "B," who wrote the series in which Doom usually appeared. I would not allow the Marvel Universe to be divided into fiefdoms. But then, writer "B" wrote a story "proving" that the Doom seen in writer "A's" series was a robot, the intimation being that the real Doctor Doom wouldn't behave so stupidly. Somehow, writer "B's" editor didn't realize what he was up to, and let it slip past. Writer "A" was furious…etc.
Allowing any one of the writers to handle pretty much everyone else's characters in Secret Wars, contemplated to be the biggest, most continuity-intensive crossover ever done, would have led to bloodshed in the hallowed halls.
So, I wrote it. As Editor in Chief, by definition, I was the company's designated Keeper of the Franchises, and the ordained Absolute Authority on the characters — all part of the job, at least back then. The writers could (and did) argue with me, and on some occasions talked me into their point of view regarding what Thor, Spider-Man or the X-Men would do or say in a given situation. But, ultimately, it was my call. That made things a little easier. And less bloody. And, because I had the best overview of what was going on in all the titles, working closely with the line editors and writers I was able to keep the continuity tight. And, with their help, I think we managed to work in the things Mattel asked for in ways that made sense and enhanced the story.
Secret Wars was the first mega-crossover. It was incredibly successful. Afterward, mega-crossovers became a staple of comic book publishing.
For me, it was one of the most difficult and yet enjoyable things I've ever done. To this day, when I go to conventions, I'm asked to sign many, many copies. Lots of people tell me that Secret Wars is what first got them into comics. Makes sense. The idea came from the fans. I'm proud to have been a part of it.


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Maxima Urbane Collection Analog Watch For Women 68514LMLI
Discover the timeless allure of MAXIMA watches, a flagship brand by P A Time Industries, now showcased on premier e-commerce platforms like Flipkart, Amazon, Paytm, Jabong, and Limeroad. With over 50 years of expertise in the wristwatch industry, P A Time Industries has crafted a legacy of excellence, introducing iconic brands such as Maxima, Ego, Max-Pro Smart Watches, and Premium Maxima Plus Watches.
Explore our extensive collection of MAXIMA timepieces, each meticulously designed to blend contemporary aesthetics with unwavering reliability. From metal analogue watches to plastic and fiber analogue watches, digital watches, analogue-digital watches, chronograph-multifunction series, and designer watches, MAXIMA offers an array of choices to suit every style and occasion.
Indulge in the convenience of seamless online shopping, where secure payment options and expedited delivery ensure a delightful experience. Rest assured, each MAXIMA watch is backed by a one-year product warranty and a 100% replacement guarantee on waterproof defects, reflecting our commitment to quality and customer satisfaction.
Experience the essence of MAXIMA watches today, available for purchase on your preferred e-commerce platforms. Elevate your style with a timepiece that exudes elegance, precision, and enduring charm.
Shipping is free across India on all our products.
P A Time Industries Unit-II offers 7 days replacement/return/refund guarantee for all products sold on smart.maximawatches.com. Customers may notify us of any damage or defect within 7 days from the date of delivery. P A Time Industries Unit-II will replace the defective product with a brand new product at no extra cost. P A Time Industries Unit-II will try to replace the specific product ordered. However, the company reserves the right to offer an alternate product in case the product is out of stock/ production. The 7 days return policy is valid only in cases of manufacturing defects and transport damages and is invalid in cases of damages due to normal wear & tear and negligence on part of the customer. Refunds are issued in the following two ways Product replacement - In case of damaged or incorrect items P A Time Industries Unit-II would replace it with a new one, upon receipt of the returned item In case you do not wish to receive the replacement, you may specify that in your communication with our customer service by phone or e-mail. You would receive maxima store credit of the equivalent amount. We do not provide cash refunds.


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Lana Wilson
Berkeley, California
Lana Wilson has given over 85 workshops on handbuilding and has taught in Canada, Israel, New Zealand and South Africa. She has written a column for Clay Times magazine since 1996. Her work has been in over 185 shows and appears in fourteen books including both volumes of The Best of Pottery and Kathy Triplett's Handbuilt Ceramics and several of Robin Hopper's books. She is the author of Ceramics: Shape and Surface, which includes extensive cone 6 and cone 04 electric glazes she has developed. A video "Soft Slab Techniques with Lana Wilson" has been produced on her working techniques and she was a featured demonstrator at 2003 NCECA where a DVD was also produced on her working process. After serving on the board of Craft Emergency Relief Fund for four terms, she is now on the board of Penland School of Crafts in North Carolina. She has appeared twice on Discovery Channel to extol the delights of working in clay while making a teapot.
I definitely love to make stuff. For two decades I have handbuilt with pieces of clay, arranging them in layers and making more parts and arranging them yet again. I work until I think I like it and then I might stop. I am greedy for complicated textures, movable doors and drawers, multiple stamped images and unusual glazes that I develop through obsessive testing. For years ethnic ritual objects have influenced me. With my abiding interests in unusual surfaces and ritual presence, I have made altars, teapots, tableware, multi-layered mosaics and tiles. .
Currently I am interested in functional ware. I paint three layers of colored slip on soft slabs. Sometimes I use newspaper to resist the colors, other times I spatter colors as a final step. I carve out bits, turn them upside-down and inlay them like fossils. The rich mix of colors, inlaying carved out colored pieces in new places give me painterly slabs of color to make into plates, bowls, cups, vases and teapots.
Previous phases in my work have included gas firing for thrown functional stoneware, metallic salts on porcelain, saggar firing with eggshells and kelp, electric fired lichen like surfaces, and glaze testing that produced unusual ceramic colors that were toxic, non-functional and undependable but very interesting. This present period is a change; the new functional work is microwave and dishwasher safe. Is this what happens when you become a grandmother?


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Michael holding a butterfly |
Three days before 20 year-old Adam Lanza killed his mother, then opened fire on a classroom full of Connecticut kindergartners, my 13-year old son Michael (name changed) missed his bus because he was wearing the wrong color pants.
This story was first published online by the Blue Review. Read more on current events at www.thebluereview.org


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Service Notice: EF 300mm f/2.8L IS II USM and EF 400mm f/2.8L IS II USM lens hood
Thank you for using Canon products.
It has been confirmed that, even when the lock screw for the lens hood on the Lenses is fastened, the lens hood may rotate when a certain amount of pressure is applied, but it will not detach from the lens. As a result, some specifications for the lens hood have been changed to address this phenomenon. For customers who may be inconvenienced by this phenomenon during shooting and would like to request a lens hood exchange, please contact the Canon Customer Support center in your region. The details are as follows.
Affected Products
Lens hoods for EF300mm f/2.8L IS II USM and EF400mm f/2.8L IS II USM interchangeable lenses for Digital SLR Cameras. Serial number: 7700XXXXXX through 8410XXXXXX
For customers who would like to request a lens hood, please contact your nearest Canon Customer Support center for a lens hood free of charge. This information is for residents of the United States and Puerto Rico only. If you do not reside in the USA or Puerto Rico, please contact the Canon Customer Support Center in your region. Please register your EF300mm f/2.8L IS II USM and register your EF400mm f/2.8L IS II USM. By registering, we will be able to notify you via email when future firmware updates become available for download. If you already registered, please ensure you are opted-in to receive the notification.
Thank you, Customer Support Operations Canon U.S.A., Inc.
Contact Information for Inquiries
Canon Customer Support Center
Phone: 1-800-OK-CANON
Email: firstname.lastname@example.com
Support options and hours of operation: www.usa.canon.com/support


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Tax Preparation Services inCallahan, FL
Services Available
Book your appointment
Our tax advance loans have ended this year, but our Tax Pros are ready to help you get your biggest refund!
Perfect for busy lives. Drop off your tax documents and a Tax Pro will take it from there, including a quick call to review your final return and convenient e-signing.
Whether you want to become a Tax Pro or you already are one, join us for tax preparation classes taught by some of the industry's best tax professionals.
A Refund Advance loan is a loan that is repaid with your tax refund. Sometimes the IRS can take weeks to send you your refund, so a Refund Advance loan gives you the opportunity to get money before your tax refund arrives.
Refund Advance is no longer available this year. Early Refund Advance was available at select locations December 11, 2023 until January 14, 2023. No Fee Refund Advance was available January 2, 2024, at most locations until February 11, 2024.
We offer appointments for in-person tax preparation, drop-off tax preparation, and help with IRS letters.
With Drop off and go tax preparation, you can drop off your tax documents to our 450096 S.R. 200 office. You don't have to come back. We'll contact you to share any additional documents, review your return, and e-Sign your return.
Refund Advance is no longer available this year.
We recommend booking an appointment online or calling us at (904) 507-4016 to reserve time with a Tax Pro. You may also walk in without an appointment at our 450096 S.R. 200 office.
Tax Pros at 450096 S.R. 200 Jackson Hewitt speak English.


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Garden Sheds in Aldwych
Welcome to Gorilla Garden Sheds, a leading manufacturer, supplier and fitter of garden sheds in Aldwych. We can provide a large range of garden sheds in Aldwych to suit a variety of purposes and they are built far beyond the standards that most companies build sheds to.
Our garden sheds are bespoke and handmade to your exact specification using only the highest quality materials available. The cladding used is 5th grade or better Scandinavian redwood pine. The frameworks we use on our garden sheds is either C16 or C24 grade with a smooth finish with rounded 4 corners. The floors on our garden sheds are either tongue or grooved or 18mm exterior plywood on our larger options. The roofing used on our garden sheds is not the cheap rag-based felt that is more commonly used by other shed companies. It is the hardwearing, polyester-based green mineral felt.
We are more than happy to deliver our garden sheds in Aldwych. Locations in South Essex or East London are delivered to completely free of charge, but if your location falls outside these areas, then a delivery cost will be calculated according to the specified postal code. We install our garden sheds in Aldwych upon delivery, and again, completely free of charge. All that we ask is for you to ensure good access for the delivery and that there is a suitable flat, firm base for the shed to be placed onto. The windows used in our garden sheds are made up of real glass and not plastic that tends to yellow over time. If safety is an issue then we can swap the standard horticultural glass to laminated glass at additional cost.
To protect our garden sheds from the elements, a basecoat treatment is applied as standard. This is also included in the price. However, you can have us treat your garden shed prior to delivery with a very high-quality spirit-based treatment that penetrates the timber and gives your shed the ultimate protective coating. This will ensure that your garden shed stands the test of time. If you would prefer to apply the treatment yourself after the shed has been installed then we can supply the treatment for you, at an additional cost.
Garden Sheds in Aldwych that are Built to Last
Gorilla Garden Sheds build only quality garden sheds that are built to last. Please feel free to browse our website and discover some wonderful options for garden sheds in Aldwych. If you would like to speak to an adviser, please get in touch today by calling on 01702 545243.