Background Naltrexone is an opioid receptor antagonist used in the treatment of alcohol and opioid dependency. Its efficacy has been demonstrated in a variety of studies. In the United States it is available as an oral or injectable medication but in the UK it is only available via the oral route.
Aims This manuscript evaluates the evidence supporting the use of naltrexone in addiction treatment. The aim is to assess the overall safety, efficacy and cost-effectiveness of naltrexone.
Results Overall, each modality of naltrexone showed superior treatment outcomes when compared to non-medication therapies. When used appropriately, naltrexone blocks the reinforcing effects of opioids, is not associated with tolerance, withdrawal, or abuse potential, and decreases the likelihood of relapse to opioid use.
Conclusions Naltrexone is a cost-effective treatment that promotes and supports the abstinence of opioid use across a wide range of demographics and severity characteristics. Further research is needed to generate more definitive, evidence-based conclusions.


Dentists around the world advise people to use fluoride free toothpaste for a proper oral hygiene. Including the dentists advises, many reputed toothpastes have an info written on them like fluoride free toothpaste. But the question is, what is fluoride free and why a teeth toothpaste should be fluoride free?
Fluoride is a mineral which is found mostly in water sources. The general advantages of a fluoride it helps prevent tooth cavities, it makes the teeth stronger and developing more acids resistant tooth activity. But recent research proved that fluoride in high quantities is causing irrevocable tooth cavity damages, like teeth surface stains.
Citing the above research, many dentists around the world have recommended a fluoride free toothpaste, most importantly if you have a child less than 2 years old, the parents should make the child use a fluoride free toothpaste like Theodent Kids – Whitening Chocolate Chip, research has proven that swallowing toothpaste which contains fluoride will cause poisoning and in extreme cases, even death, it is also proven that single fluoride toothpaste has enough fluoride to kill a child, and also it is proven that many children which brushing teeth swallow little amount of toothpaste if the toothpaste contains fluoride then it has harmful effects of teeth cavity of children.
Our fluoride free toothpaste for kids, Theodent kids toothpaste is also made with a chocolate taste as most kids like the chocolate taste. It is recommended for adults and children to brush your teeth with fluoride free toothpaste twice daily to be safe from bad breath and other harmful teeth infections.
Copyright © 2018 Theodentoralcare.co.uk. All rights resereved.


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Ralph Nader and Amy Goodman urge support for Pacifica network
December 21, 2014 December 21, 2014 by Save KPFA
Thanks to all who donated so generously to the station's winter fund drive, which ended today with $335,000 pledged. That's only $25,000 short of the goal. Please consider making an end-of-the-year, tax deductible gift to help put KPFA over the top. You can pledge securely online at KPFA.org, and while you are there, have a … Read more
Categories Amy Goodman, fund drives, KPFA, Pacifica, Ralph Nader Tags Amy Goodman, fundraising, KPFA, Pacifica, Ralph Nader
Pacifica board votes 11-5 to censure Gray and Uzzell for role in secret contract
September 14, 2014 August 16, 2014 by Save KPFA
The Pacifica National Board (PNB) voted 11-5 on August 14 to censure members Heather Gray (affiliates rep) and Richard Uzzell (KPFT) "for the illegal, unauthorized, and irresponsible act of signing a secret contract with the former Interim Executive Director Summer Reese, which they dated January 30, 2014 and in which they made promises that exceeded … Read more
Categories Heather Grey, KPFA, legal, Pacifica, Richard Uzzell, Summer Reese, United for Community Radio Tags Heather Grey, legal, Pacifica, Pacifica National Board, Richard Uzzell, Summer Reese
KPFA's new general manager: Quincy McCoy
July 1, 2014 June 25, 2014 by Save KPFA
After years of interim management, KPFA will finally have a permanent general manager: Quincy McCoy, a radio veteran with 30 years of experience in a diverse range of positions. Pacifica issued this press release with the news, noting that McCoy currently serves as executive director of the Museum of Children's Arts in Oakland, having previously worked as … Read more
Categories KPFA, Pacifica, Quincy McCoy Tags KPFA, Pacifica, Quincy McCoy
Pacifica moving forward, as injunction against fired executive issued
June 10, 2014 June 2, 2014 by Save KPFA
Pacifica's National Office next door to KPFA is functioning once again, three weeks after an Alameda County court granted the network a temporary injunction against former executive Summer Reese, who along with her mother and a small band of supporters, were obstructing the network's operations. UPDATE: The court issued a preliminary injunction reiterating its ruling … Read more
Categories legal, Summer Reese Tags legal, Pacifica, Summer Reese
Moving forward: new executive director for Pacifica
April 7, 2014 by Save KPFA
When Pacifica National Board chair (and SaveKPFA activist) Margy Wilkinson assumed executive powers after the termination of Summer Reese, she promised listeners and staff that she didn't want the job, wouldn't accept pay, and would work to get a qualified professional in as soon as possible. This week, she delivered. Pacifica has announced that KPFK … Read more
Categories Alan Minsky, Bernard Duncan, Pacifica, Pacifica National Board, Sonali Kolkathar Tags Alan Minsky, Bernard Duncan, KPFA, Pacifica, Sonali Kolkathar
Some still clinging to the past
April 9, 2014 April 7, 2014 by Save KPFA
[UPDATE 4/9/14 @10:05 am: The national board minority's attempt to get a Temporary Restraining Order to allow Reese to keep her job has been DENIED by the Alameda County Superior Court. More news as we have it.] Pacifica's former interim executive director, Summer Reese, remains barricaded in her former office, which she broke into with … Read more
Categories elections and governance, KPFA, KPFK, KPFT, Pacifica, Pacifica National Board, Summer Reese, WBAI, WPFW Tags KPFA, Pacifica, Pacifica National Board, Summer Reese
The truth about KPFA's financial records, from the station's treasurer
This is a statement released on 4/2/14 by KPFA's elected Local Station Board treasurer, Barbara Whipperman. "The business manager at KPFA is working on a complicated reconciliation of the KPFA financial records. The complications center around the records of income from credit card donations, many thousands of records. There are statements from credit card processing … Read more
Categories finances, KPFA, Pacifica audit, Summer Reese Tags budget, KPFA, Pacifica, Pacifica audit, Summer Reese
Listeners and staff to terminated executive: just leave!
April 2, 2014 March 28, 2014 by Save KPFA
"The Pacifica Radio network is as fragile as it is important — it cannot afford this protracted disruption," reads a petition launched by the network's listeners and staff, addressed to terminated executive Summer Reese, who has barricaded herself in the national office next door to KPFA with her mother and a handful of supporters. "Please respect the decision by the majority of … Read more
Categories elections and governance, KPFA, Margy Wilkinson, Pacifica, Pacifica National Board, Summer Reese, Summer Reese petition Tags KPFA, Pacifica, Pacifica National Board, Summer Reese, Summer Reese petition
Pacifica board takes action on election, WBAI crisis
February 15, 2014 February 15, 2014 by Save KPFA
In its new configuration, the board took several notable actions. It passed a motion that will put long-overdue board elections into motion. Pacifica's bylaws required it to hold elections in 2013, but Pacifica's executive director Summer Reese failed to hire anyone to run them, and that year's board ratified her inaction by voting to postpone … Read more
Categories budget, elections and governance, Free Speech Radio News, Pacifica, Pacifica National Board, Summer Reese, WBAI Tags budget, Pacifica, Pacifica National Board, WBAI
Pacifica in crisis: WBAI on the brink
August 16, 2013 August 16, 2013 by Save KPFA
This week, Pacifica management laid off two-thirds of the staff at KPFA's sister station WBAI in New York. The station will no longer have a local newscast; it's unclear whether it will have any paid programmers at all. Pacifica's interim executive director Summer Reese broke the news over WBAI's airwaves, reports the Pacifica Evening News (2 … Read more
Categories fund drives, KPFT, Pacifica, WBAI Tags fundraising, labor, layoffs, Pacifica, WBAI
DISCLAIMER: This is not an official Pacifica Foundation website nor an official website of any of the five Pacifica Radio Stations (KPFA Radio, KPFK Radio, KPFT Radio, WBAI Radio, WPFW Radio). Opinions and facts alleged on this site belong to the author(s) of the website only and should NOT be assumed to be true or to reflect the editorial stance or policy of the Pacifica Foundation, or any of the five Pacifica Radio Stations (KPFA Radio, KPFK Radio, KPFT Radio, WBAI Radio, WPFW Radio), or opinions of its management, Pacifica National Board, station staff or other listener members.
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text:
'N Sync's Joey Fatone Is Opening Up A Hot Dog And Italian Ice Shop
It's called Fat One's, natch.
'N Sync singer Joey Fatone is starting his second career—as mall hot dog shop owner. He announced today on Twitter he's opening a hot dog and Italian ice shop called Fat One's—a play on his last name which he has truly embraced.
yes this is happening,in the works for a bit and it's opening up in August in the Florida mall ,if your out here! pic.twitter.com/On0W1eCBtm
— Joey Fatone (@realjoeyfatone) June 27, 2016
The shop will open in August at the Florida Mall in Orlando, just minutes from Walt Disney World. The former teen idol tells Delish.com he chose these two foods, in particular, as an homage to his New York roots.
"Being from Brooklyn, hot dogs were a staple during my childhood, and we always ate Italian ices to cool off on hot summer nights," Fatone says. "Looking forward to bringing a piece of my childhood to Orlando."
The shop isn't Fatone's first foray into food—he hosted the Food Network show Rewrapped, a competition show revolving around snack foods.
Our 8 Favorite Gourmet Chocolate Shops
"Bulldog" Hot Dogs
Spiral Hot Dogs
Martha's Hot for Hot Dogs!
Chicago-Style Hot Dogs
Hot Dog Hash
50 States of Hot Dog Toppings


text:
EDINBURGH PRIDE TAKE 'LGBT EVENT OF THE YEAR' NOD AT CONTROVERSIAL DIVERSITY AWARDS
Organisers of the Scottish Diversity Awards have crowned Edinburgh Pride their 'LGBT Event of the Year' at a ceremony in Glasgow last night (Monday).
But the awards have been accused of profiteering from the cash-strapped voluntary sector, with some charity bosses urging the sector "to be cautious about taking part in award ceremonies … created with the sole purpose of making money."
The awards have been developed by a company who hit the headlines in recent weeks when they admitted the ceremony is set up to generate profit for the business. Joe Kahn, a spokesman for the business told TFN, "We are here to make money, let me make that absolutely clear. We are a private company. We identify new markets that we can target, we have the event to pay for, we have to make sure that everything is being done properly. That's out in the open, it's not something we hide behind. We run projects to make money."
Pride Edinburgh Chair, Brett Herriot, responded with the following statement:
"[I] attended the Scottish Diversity Awards on a complimentary guest ticket, also paying for my own travel. Creative Oceanic has not and will not receive any monies or funds from Pride Edinburgh in relation to the award ceremony or the award itself. We continue to be thankful for the award given to us for LGBT Group [sic] of the Year."
When asked about the lack of transparency on selection and judging, Brett continued, "I don't believe the company behind the awards were fully transparent, judging the credibility of the awards was difficult as this is the debut year, however the company have a wide resume of involvement with other awards around the UK and I took that at the value it was for. I had to call the organisers myself to find out exactly what the Awards were about and how they were to be judged and I was informed it was to celebrate diversity from across the third sector. The Awards were to be judged by a selected panel drawn from across the third sector. I was never informed who the judges were and what criteria they were using."
The company organise several award ceremonies across the UK and, according to their website, 'believe in the art of storytelling'. They also describe receiving 'thousands of nominations' across an exhaustive 28 award categories, including Charity of the Year, Body of the Year, Organisation of the Year and Third Sector CEO of the Year.
Scottish LGBT organisations such as LGBT Youth Scotland, Pride Glasgow, Stonewall Scotland and Equality Network were nominated, but most did not attend the event.
Monday night's ceremony was held at the Crowne Plaza Hotel in Glasgow and, although nominees were offered one free ticket, subsequent tickets were reportedly priced at £75 each. Organisers announced The Well Foundation to be the main beneficiary and a spokesperson told us £480 was raised on the night for the charity, which will go to Glasgow Hospital for Children.
When asked about the allegations of profiteering by the organisers, Brett added, "We do not have a comment to make on allegations of profiteering as Creative Oceanic did not receive any funds or money from Pride Edinburgh – the ticket used by the Chair was a complimentary guest ticket. Had we been asked to pay for the ticket we would not have been in attendance, as a charity that produces its own free event, we will not spend funds on award ceremonies."
The Scottish Diversity Awards were the top Twitter trend in Glasgow on Monday evening, although perhaps not for the reason organisers would have liked – a number of people commented on an apparent spelling mistake on each award, with the business named 'Creative Ocenic'.
Our investigations have uncovered a number of linked businesses to the organisers, which have either gone bankrupt or been dissolved, according to public records held at Companies House, including:
Creative Oceanic Scotland Limited (SC393644)
Creative Oceanic Ltd. (SC307052)
Oceanic Media Consulting Ltd. (SC295438)
Oceanic Retail Limited (SC358546)
Oceanic Consulting Scotland Ltd (SC251300)
Oceanic Group Ltd. (SC307051)
We approached Creative Oceanic for comment on the issues raised in this article but have not received a response.
pinksaltire December 12, 2017 December 13, 2017 Charity, Glasgow, LGBT Scotland, Pride Edinburgh, Scotland, Scottish Diversity Awards
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text:
Home Engineering Technical Reports Collection, Purdue University page 66
What Indiana is doing about floods and supplementation of stream flow
What Indiana Is Doing About
Floods And Supplementation
Of Stream Flow
Joseph I. Perrey, Chief Engineer
Indiana Flood Control and Water Resources Conference
Agitation for some positive action directed toward controlling
or protecting against floods has arisen after every major flood in
the state. Usually the cry for action has been directed to the governing body of some unit of government: a town board, the county
board of commissioners, the governor, or the legislature.
Following the disastrous flood of March 1913, the most widespread major flood in Indiana history, meetings were held, investigations conducted, reports written and recommendations made by
various groups throughout the state. All this activity and accompanying demand for protective works led Governor Ralston to
appoint the Indiana Flood Commission on April 20, 1914. The
commission was composed of one member for each congressional
district, 13 members in all.
This first commission was without funds but succeeded in
publishing, with help from Purdue University, one report summarizing flood data, regarding the 1913 flood. Thereafter, it apparently
died of financial starvation as no other records of its activities have
been found.
Following the flood of May 1943, perhaps second to the 1913
flood in magnitude of discharges and extent of area affected, the
urge to do something about floods led to the organization of the
Wabash Valley Association. This association realized that controlling floods on the larger streams was a problem beyond the abilities
of separate communities to solve and that some coordinated planning at state level was needed. It appealed to the governor with
the result that Governor Schricker appointed a new informal Flood
Control Commission in November 1944.
The most notable work of this commission was the drafting
of legislation for the creation of a permanent state agency to deal
with the problems of floods and water resources. By act of the
Title What Indiana is doing about floods and supplementation of stream flow
Author Perrey, Joseph I.
Conference Title Proceedings of the twelfth Industrial Waste Conference
Conference Front Matter (copy and paste) http://earchives.lib.purdue.edu/cdm4/document.php?CISOROOT=/engext&CISOPTR=5634&REC=3
Extent of Original p. 66-72
Transcript What Indiana Is Doing About Floods And Supplementation Of Stream Flow Joseph I. Perrey, Chief Engineer Indiana Flood Control and Water Resources Conference Indianapolis, Indiana Agitation for some positive action directed toward controlling or protecting against floods has arisen after every major flood in the state. Usually the cry for action has been directed to the governing body of some unit of government: a town board, the county board of commissioners, the governor, or the legislature. Following the disastrous flood of March 1913, the most widespread major flood in Indiana history, meetings were held, investigations conducted, reports written and recommendations made by various groups throughout the state. All this activity and accompanying demand for protective works led Governor Ralston to appoint the Indiana Flood Commission on April 20, 1914. The commission was composed of one member for each congressional district, 13 members in all. This first commission was without funds but succeeded in publishing, with help from Purdue University, one report summarizing flood data, regarding the 1913 flood. Thereafter, it apparently died of financial starvation as no other records of its activities have been found. Following the flood of May 1943, perhaps second to the 1913 flood in magnitude of discharges and extent of area affected, the urge to do something about floods led to the organization of the Wabash Valley Association. This association realized that controlling floods on the larger streams was a problem beyond the abilities of separate communities to solve and that some coordinated planning at state level was needed. It appealed to the governor with the result that Governor Schricker appointed a new informal Flood Control Commission in November 1944. The most notable work of this commission was the drafting of legislation for the creation of a permanent state agency to deal with the problems of floods and water resources. By act of the 66
What Indiana is doing about floods and supplementation of...


SAO PAULO (Reuters) - Sao Paulo lost Diego Souza to a red card in the first half and conceded an own goal early in the second but the Brazilian league leaders battled back to salvage a 1-1 draw at home to Fluminense on Sunday.
Former Brazil international Souza was sent off after 33 minutes for raising an arm in a challenge.
The award was controversial but Fluminense took advantage and went ahead eight minutes into the second period when Anderson Martins headed past his own keeper from 25 metres out.
However, the home side got the point they deserved when Colombian Santiago Trellez headed home a powerful cross from Regis after he had performed some nice skill on the right.
Sao Paulo remained top of the Serie A with 46 points from 22 games, four ahead of Internacional who have a game in hand. Fluminense sit in 11th spot with 27 points.


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Today I am ashamed to admit I saw "RoboCop," the 2014 model with all the fancy upgrades.
Belfort is driven by booze, drugs, hookers and, most of all, greed. Money is the juice that gets him going in the morning and his sole reason for living.
Irving cares what he looks like while just about everything about him is false. He's a small-time con artist who meets his match in Sydney (Amy Adams from "Man of Steel").
We are all Walter Mitty in some form. We are all ordinary people with big dreams of doing something extraordinary one day. Very few actually have the courage to take that leap of faith.


text:
Q: Attendance System marking student present/absent checkboxes, update Mysql PHP Scenario: I am making an attendance system for a college, however I have been stuck on updating mysql and using checkboxes to mark a student absent or present.
So currently I have managed to filter the data I want to be shown. this is student_id, fname, lname, present. Please see the code below
Class Register:

<?php

$test3= "SELECT * FROM course_attendance, students, courses, attendance WHERE course_attendance.course_id=courses.course_id AND course_attendance.week_id=attendance.week_number_id AND course_attendance.student_id= students.student_id AND courses.course_id='101' AND attendance.week_number_id='2' ";
$result = mysql_query($test3)  or die(mysql_error());

echo "

 Student ID	 First Name 	 Last Name	 Present
 ";

while($rows=mysql_fetch_array($result)){

    echo "
" .$rows['student_id'].
"	" .$rows['fname'].
"	" .$rows['lname'].
"	" .$rows['present'].
"
";
}
echo "
";
?>

So currently, this shows the data: student_id, fname, lname, present.
The field 'Present' in my MySQL is a unsigned tinyint, I want to be able to make this a checkbox, which would enable the user to either mark a student present or absent and then update to mysql. Also I dont want the students id, fname and lname enabled to be edited, just the present field.  Is this possible?
Thanks in advance if someone succesfully helps me , I will be forever grateful!

A: You can have a checkbox in a form for this:
<input type='checkbox' class='form' value='Yes' name='checkbox_attendance'/> Present?
Then you check for the value of that field and store it in the database:
if(isset($_POST['checkbox_attendance']) && $_POST['checkbox_attendance'] == 'Yes') {
    //Store the value of checkbox_attendance (Yes) into the database
} else {
    //Store 'No' into the database
}

student_id, fname, and lname won't be editable unless you make it.
There's a lot of information on PHP forms on the internet, take a look at those.

redpajama_set_name: RedPajamaStackExchange


Background The Care Quality Commission (CQC) is responsible for ensuring the quality of healthcare in England. To that end, CQC has developed statistical surveillance tools that periodically aggregate large numbers of quantitative performance measures to identify risks to the quality of care and prioritise its limited inspection resource. These tools have, however, failed to successfully identify poor-quality providers. Facing continued budget cuts, CQC is now further reliant on an 'intelligence-driven', risk-based approach to prioritising inspections and a new effective tool is required.
Objective To determine whether the near real-time, automated collection and aggregation of multiple sources of patient feedback can provide a collective judgement that effectively identifies risks to the quality of care, and hence can be used to help prioritise inspections.
Methods Our Patient Voice Tracking System combines patient feedback from NHS Choices, Patient Opinion, Facebook and Twitter to form a near real-time collective judgement score for acute hospitals and trusts on any given date. The predictive ability of the collective judgement score is evaluated through a logistic regression analysis of the relationship between the collective judgement score on the start date of 456 hospital and trust-level inspections, and the subsequent inspection outcomes.
Results Aggregating patient feedback increases the volume and diversity of patient-centred insights into the quality of care. There is a positive association between the resulting collective judgement score and subsequent inspection outcomes (OR for being rated 'Inadequate' compared with 'Requires improvement' 0.35 (95% CI 0.16 to 0.76), Requires improvement/Good OR 0.23 (95% CI 0.12 to 0.44), and Good/Outstanding OR 0.13 (95% CI 0.02 to 0.84), with p<0.05 for all).
Conclusions The collective judgement score can successfully identify a high-risk group of organisations for inspection, is available in near real time and is available at a more granular level than the majority of existing data sets. The collective judgement score could therefore be used to help prioritise inspections.
One widely supported solution to identifying risks to the quality of care is to make use of abundant patient feedback in the NHS.8 16–20 In addition to providing a different perspective on quality to traditional metrics, such as readmission rates and staffing levels,21 22 patient feedback from online rating pages NHS Choices and Patient Opinion, and via Twitter and Facebook, is available in a more timely manner (near real time), and at a more granular (hospital) level, than the data typically used by CQC. Patient feedback therefore has the potential to help address the perennial concerns over the timeliness and granularity of data used to identify risks to the quality of care.
Individual sources of patient feedback being biased towards certain demographics were identified as a barrier to the more effective measurement of quality in each of these studies. One possible way to overcome the bias of individual sources of patient feedback is to combine them. In the UK, Twitter has 15.8 million active users, 7.9 million (50%) of whom are aged below 35, predominantly of higher socioeconomic status. Facebook has 37.5 million active users, 21 million (56%) of whom are aged 35 or over, with users of a lower socioeconomic status over-represented.28 29 Demographics data are not available for NHS Choices; however, the wider site, which includes health information, received 583 million unique visits in 2015, nearly 10 visits for every member of the UK.30 Combining these high-volume, disparate sources of patient feedback in near real time is technically challenging however, and has yet to be successfully operationalised.
The aim of our study is to determine whether the near real-time, automated collection and aggregation of patient feedback can provide a collective judgement that effectively identifies risks to the quality of care, and hence can be used to help prioritise CQC inspections. This study furthers the existing research in a number of ways. Unlike previous research, this combines multiple sources of patient feedback, it looks at the more granular, hospital-level feedback, and it measures the association between patient feedback and other quality measures at hundreds of points over more than 3 years, rather than a fixed point in time. Moreover, the patient feedback used is contemporary having occurred within 90 days of the start of the inspection, and covers a greater volume and diversity of trusts and hospitals as a result of increased engagement with social media by the NHS.
Our analysis measures the statistical relationship between a time-limited collective judgement score (CJS) formed of patient feedback from multiple sources at the start of comprehensive CQC inspections, and the subsequent outcome of those inspections. The data sets and methods for this analysis are detailed below.
CQC then aggregates those service-level ratings using an unpublished, rules-based approach to assign hospital-level ratings, which, in turn, are further aggregated, using a similar rules-based approach, to generate an overall trust-level rating.
Up to 12 March 2017, CQC published 204 and 339 trust and hospital-level ratings, respectively. The majority of trusts and hospitals have been rated only once under the new inspection regime. Those inspected more than once were typically, although not always, rated poorly on their first inspection and have since been inspected again to check for improvements. A minority of inspections contained no overall rating. This occurred when CQC deemed there was insufficient evidence to produce a rating, or where the inspection team focused on a specific aspect of care and therefore could not judge the overall quality of care.
We obtained details of all NHS acute and specialist trusts and their hospitals, including the URL for their patient feedback submitted to NHS Choices, from the NHS Choices application programming interface (API) in February 2016. We then searched Google for each organisation's Twitter and Facebook details. Where no page was found, the organisation's own website was checked. The details for each data source and how they were combined are described below and in table 1.
NHS Choices is a government-run website that captures unsolicited feedback for all NHS trusts and hospitals. Users can leave free-text feedback and rate how likely they are to recommend the organisation to friends or family in need of similar care on a scale from 1 (extremely unlikely) to 5 (extremely likely) stars. Patient Opinion is a social enterprise which provides a similar function to NHS Choices including the ability to leave qualitative feedback and recommend the service on the same scale. Feedback posted to Patient Opinion is shared with, and appears on, the NHS Choices website. Comments left on either site are actively moderated before being displayed with references to individuals and speculation removed.33–35 All patient feedback posted between 1 January 2013 and 12 March 2017 inclusive was sourced via NHS Choices' API.
Facebook directly captures patient feedback in two ways. First, organisations can create official Facebook pages with a 'Reviews' section. Anyone accessing the page can leave a review, which must contain a rating from 1 to 5 stars with additional free-text feedback being optional. Second, organisations that users frequently search for automatically have an unofficial page generated that includes a similar review function to official pages. Comments for both page types are reactively moderated; once posted, comments cannot be amended and will only be removed if they breach Facebook's Community Standards.36 We sourced all reviews posted from 1 January 2013 to 12 March 2017 using a custom Python script.
Starting in February 2016, we queried the Twitter API at regular intervals of no more than 7 days to ensure complete coverage from the time and volume-limited data source. Unlike NHS Choices and Facebook data, not all comments related to the quality of care. To ensure only original feedback was included, and that the results were not biased by the popularity of users, all retweets and tweets generated by trusts or hospitals were removed.
After 6 months of data had been collected, a representative pilot data set of 1000 tweets was jointly coded by AG and MPL and the five classifications of tweet detailed in table 2 were agreed. Tweets that were clearly not original feedback from patients or their friends and family were classed as 'Not patient feedback concerning the quality of care' to prevent staff and promotional activities biasing the data set. A second representative sample comprising 10% (23 014) of all tweets, not retweeted or generated by the organisation in question, was then coded by AG, with just over 25% (5869) of AG's coding second-coded by MPL to check reliability. Inter-rater reliability was 'substantial' (κ=0.6–0.8) for all classifications except for the rarest, 'safety', where it was 'moderate' (κ=0.4–0.6).37 All differently coded tweets were then jointly reviewed and complete agreement was reached.
Tweets that were not classed as patient feedback concerning the quality of care were then excluded from the study and the sentiment of the remaining tweets was scored using the same 1 to 5-star scale as the NHS Choices and Facebook data. Initial attempts to use standard sentiment dictionaries such as SentiWordNet proved ineffective, likely due to the healthcare-specific lexicon and non-prose style of tweets. Instead, the same modelling approach used for classifying the tweets was used to identify sentiment. The chosen model predicted the 1 to 5-star rating of scored comments with 79% accuracy, rising to 91% accuracy when estimating the sentiment to within 1 star, and was used to assign a star rating to all care-quality related tweets. Further details of the modelling are available in the online supplementary technical appendix.
With a date and score ranging from 1 (lowest) to 5 (highest) stars associated with every item of patient feedback, a CJS could be calculated for all trusts and hospitals on any given date where sufficient patient feedback was available. A 90-day moving average was chosen as a balance between the CJS reflecting the more recent patient feedback, and being too volatile and overly influenced by a small number of recent items of patient feedback leading to unnecessary inspections being triggered. The 90-day CJS on the start date of each trust and hospital-level inspection was then paired with the overall rating from the inspection. Of the 543 trusts and locations rated by CQC, 87 were then removed from the data set as their 90-day CJS comprised fewer than 10 items of patient feedback. The majority of organisations removed were specialist units within a trust.
As trust-level ratings are an aggregation of hospital-level ratings they are not independent, and combining them for a single model would violate the assumptions of the regression model. The relationships between the 90-day CJS at the start of an inspection and the subsequent trust and hospital-level inspection ratings were therefore assessed using two distinct ordinal logistic regression models both of which used random intercepts and random coefficients.
Figure 1 shows the distribution of the 90-day CJS on the first day of hospital-level inspections grouped by the subsequent overall rating. For each improved inspection rating, the mean and median CJS increases, indicating that on average patient feedback is better for hospitals the CQC subsequently awards a higher rating. The better the patient feedback in the 90 days prior to a CQC inspection, the greater the likelihood of a more positive overall rating.
Box plot of collective judgement scores grouped by inspection rating.
The ordinal (cumulative) regression model detailed in table 3 describes the probability of a hospital being awarded a prescribed CQC rating given a particular CJS score and confirms the statistical significance of the association between increasing CJS and improved inspection ratings. The same significant relationship identified for hospitals is also present for trusts when considered in isolation. Further details about the regression model can be found in the online supplementary technical appendix.
The overlapping CJS across all four rating categories show that, despite the tendency for hospitals awarded a higher rating to have a higher 90-day CJS, it is not a perfect predictor of the outcome of inspections. A small number of 'Inadequate' hospitals have a high CJS, as do a greater number of 'Requires improvement' hospitals. Conversely, all 'Outstanding' hospitals have an above average CJS, suggesting patients are better collective judges of organisations performing well than they are of organisations performing poorly.
As of 12 March 2017, CQC had published 55 trust-level and 88 hospital-level inspection reports that contained an overall rating and where the inspection began in 2016. With CQC adopting a more targeted approach, and facing budget cuts, the number of inspections it conducts is likely to fall. Were CQC to prioritise the 50 trusts or 80 hospitals with the lowest CJS in the data set the outcome would be as described in table 4.
For hospitals, 70 out of the 80 inspections would result in a rating of 'Inadequate' or 'Requires improvement'. Moreover, only 10 of the 67 'Good' hospitals and none of the 6 'Outstanding' hospitals would be unnecessarily burdened with inspection. Similarly, 43 out of the 50 inspections of trusts would result in a rating of 'Inadequate' or 'Requires improvement' and only 7 of the 48 'Good' trusts and none of the 9 'Outstanding' trusts would be unnecessarily burdened with inspection. This represents a precision rate (the proportion of high-risk organisations that were subsequently rated as 'Inadequate' or 'Requires improvement') of 87.5% and 86% for hospitals and trusts, respectively. The issue for CQC is that, even with a tool that was 100% precise, the constrained number of inspections would still mean that 109 out of the 189 hospitals that were rated 'Requires improvement' or 'Inadequate' would not be inspected. In the unlikely event CQC's capacity for inspection were to double, the CJS would remain an effective tool with precision rates of 81% for both hospital and trust-level inspections. This is a meaningful improvement on the 72% and 71% that would be achieved at hospital and trust levels, respectively, by chance alone.
The study establishes that the near real-time, automated collection and aggregation of patient experiences from multiple sources, including social media, can provide a collective judgement that effectively identifies a high-risk group of organisations, and hence can be used to help prioritise inspections.
No combination of indicators, quantitative or qualitative, will ever perfectly predict the outcome of inspections. If they could, there would be little need for expensive inspections. Yet CQC does not have the resource to inspect each hospital every year. It therefore prioritises inspections as best it can with the data that are available. The CJS can support this data-driven approach in three ways.
First, while the collated patient feedback cannot perfectly identify poorly performing organisations, it can identify those organisations that are most likely to be performing poorly. Indeed, not a single organisation with a CJS below 2.95 was rated 'Good' or 'Outstanding'. Moreover, 89 out of 130 (68%) 'Good' or 'Outstanding' organisations had an above average CJS at the start of their inspection, compared with 147 out of 328 (44%) 'Requires improvement' or 'Inadequate' organisations. Second, much of the patient feedback is available at hospital level and can therefore be used to support more focused inspections than the trust-level data currently used.
Third, unlike CQC's statistical surveillance tools that comprised quarterly or annual performance measures that were slow to gather and process, and updated at most nine times a year, the CJS can be updated in near real time with up-to-date patient feedback. One advantage of the more timely data is the ability to spot rapid changes, such as the extreme examples of Ealing Hospital (R1K04) and Newham General Hospital (R1HNH) illustrated in figure 2. While some patients must experience poor care for the CJS to prompt action, the number may be far fewer than when care is monitored solely by large quarterly data collections.
The Loess-smoothed 90-day collective judgement score for six NHS (National Health Service) organisations over a 1-year period taken from the Patient Voice Tracker System developed by the authors.
The second question is how are patients, the vast majority of whom will have no clinical training, able to predict the outcome of comprehensive quality inspections? There are several possible non-exclusive explanations. A growing volume of research suggests that, in addition to the more service-orientated aspects of care such as dignity and respect, cleanliness and timeliness, patients are able to accurately assess some of the more clinical aspects of their care.45–47 This insight may be enhanced by the 'wisdom of crowds' phenomenon which states that, under the right circumstances, groups can be remarkably insightful, even if the majority of people within a group are not especially well informed.48 While individuals seldom have all the necessary facts to make an accurate assessment, and are subject to numerous heuristics and biases, when their assessments are aggregated in the right way, the collective assessment is often highly accurate. Combining multiple sources increases the likelihood that patients' collective judgement will be accurate as it increases both the volume and diversity of feedback. It may also be the case that aspects of care that are more easily assessed reflect accurately on those that are not. The poor management which results in impolite staff and poor timekeeping may also impact clinical effectiveness. Finally, another possibility is that CQC inspectors focus on the satisfaction of patients at the expense of clinical measures that patients may be less able to accurately assess for themselves.
Regardless of the reason for the agreement between the CJS and CQC inspection ratings, it is probable that its adoption will result in some unwelcome behaviour. First, some degree of 'gaming' is inevitable.49 While this cannot be eliminated entirely, the effects can be minimised: meta-data is available with all feedback and repeated comments from certain users, or multiple supposed patients at similar times or using similar language can be easily detected. Moreover, the sheer volume of comments means attempts by individuals to manually game the data will have minimal impact. Second, both organisations and patients may change their behaviour knowing the potential consequences of feedback. Some changes in behaviour, such as more courteous staff and better communicated appointments, may be positive; but there may also be a pressure to provide unnecessary or ineffective treatments to placate newly empowered patients. With the collection of patient feedback well established in the NHS, the effect on patients and organisations of formally collating additional feedback may be limited.
Our study has a number of strengths. First, it combines multiple sources of patient feedback to increase the volume and diversity of patient feedback. Second, it accurately classifies tweets excluding those that are not patient feedback related to the quality of care. Third, the inspection ratings used as an independent variable are comprehensive and reflect the quality of care throughout at multiple points over more than 3 years, rather than a snapshot provided by other quality measures such as annual surveys. Fourth, it made use of the more granular hospital-level feedback and ratings, and therefore suffers less from the overaggregation of information concerning large, complex organisations.
Further to the potential challenges of gaming detailed above, our study has four constraints. First, Twitter data were only available from February 2016 onwards and so have only been included for inspections starting after this point; this is due to the time-limited nature of Twitter's API. Second, the class imbalance in the data, with 61% (277) of all organisations in the study being rated as 'Requires improvement' and only 3% (14) being rated as 'Outstanding', makes drawing robust conclusions harder than would be the case were the ratings more evenly distributed. Third, feedback via social media may be influenced by current affairs. Fourth, while combining multiple sources of patient feedback has reduced representative bias, some patient groups have undoubtedly remained under-represented.
There is still a lot to be learnt about the use of aggregated patient feedback. It is possible that the predictive power of the CJS could be improved by weighting patient feedback by age or source, standardising for organisation type, shortening or lengthening the time period for the CJS, or adding additional data sources. Moreover, the quality of care is neither objective nor one dimensional.50 Future research should aim to identify what feedback is most strongly associated with specific dimensions of quality in order to better target interventions. Identifying how patient feedback can be best combined with quantitative data, such as mortality rates and waiting times, in order to identify risk should be a priority for CQC.
Aggregating patient feedback increases the volume and diversity of patient-centred insights into the quality of care. The resulting collective judgement can successfully identify a high-risk group of organisations for inspection, is available in near real time and is available at a more granular level than the majority of existing data sets. The near real-time, automated collection and aggregation of multiple sources of patient feedback should be used to help prioritise inspections.
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Contributors AG conceived the study, gathered the data and performed the analysis. MPL led on the safety aspects of the study and devised the systematic approach for coding the Twitter data. Both authors developed the argument of the study as it progressed and cowrote the article.
Funding We gratefully acknowledge the financial support provided for this project by the Economic and Social Research Council (Grant Ref: ES/N018869/1) under the Open Research Area Scheme (Project Title: QUAD — Quantification, Administrative Capacity and Democracy). The QUAD project is an international project co-funded by the Agence Nationale de la Recherche (ANR, France), DeutscheForschungsgemeinschaft (DFG, Germany), Economic and Social Research Council (ESRC, UK), and the Nederlands Organisatie voor Wetenschappelijk Onderzoek (NWO, Netherlands).
Data sharing statement The data are publicly available. Details of how to obtain the data are listed in the Technical Appendix.


text:
Finals 50m Pistol Men
"My goal is the Olympic title" says India's Jitu Rai in Bangkok, taking 50m Pistol Men Gold
ISSF World Cup Rifle / Pistol · Bangkok, THA
The Indian shooter beat two of the strongest members of the Chinese Olympic team, Pang Wei and Wang Zhiwei, to win the 50m Pistol Men final at the ISSF World Cup in Bangkok.
The 50m Pistol Men Final opened the day-2 of the 2016 ISSF Rifle and Pistol World Cup in Bangkok, Thailand.
The match turned into a stage of success for India's Jitu Rai, 28. The winner of the 2014 Asian Games, currently ranked 5th in the world in this event, shot consistently since the beginning of the round, and then peaked in the second half of the final, leaving few chances to his opponents.
Gaining points series after series, Rai entered into the last two shots with a 4.5-point advantage on his closest follower, the 2008 air pistol Olympic Champion Pang Wei of the People's Republic of China (29), and eventually sealed the victory with a sharp 10.0, finishing atop of the podium with a score of 191.3 points.
Pang, who had never made it to the podium in 2015, took Silver with 186.5 points, while his teammate Wang Zhiwei, 27 - the Olympic Bronze medallist of London 2012 - claimed Bronze with 165.8 points.
The 2013 European Champion, Giuseppe Giordano of Italy, 41, dueled head to head against Wang throughout the whole match, but lost the chance to step onto the podium as he fired a 7.8 on his 16th final shot, and eventually took the 4th place with 147.1 points. The 2010 World Champion Tomoyuki Matsuda, 40, followed him in 6th place with 128.9 points, being eliminated at the 14th shot as he nailed two disappointing shots (7.5 and an 8.4 points).
Today's victory, with such a large margin on those top-ranked finalists, places Jitu Rai atop of the favorites' list in the run-up of Rio 2016. The Indian shooter knows it, and makes no secret about his aims.
"The goal for the 2016 season is very clear: I want to win the Olympic Gold medal in Rio de Janeiro," he said right after the final.
"Given the amount of training and efforts I put in preparation of this competition, I was really confident before today's match," he added, commenting on the result, and showing a great self confidence.
Throughout the first part of the round, four athletes were eliminated. The 41-year old Vietnamese finalist Tran Quoc Cuong, competing in the second world cup final round of his career, dropped out of the final in 6th with 108.3 points, while Ukraine's Yuriy Popruzhnyy, 25, debuting in a world cup final, resisted right to the 10th shot, when he fired himself out of the final by scoring a frustrating 4.1. With a total score of 86.2 points, he secured the 7th place, his best world cup placement ever. Coming back into a world cup medal match for the first time after 12 years, it was Australia's 3-time Olympian Daniel Repacholi, 33, who placed in 8th with 72.5 points.
Bangkok's World Cup stage will continue this afternoon with the 25m Pistol Women final, scheduled at 1:30 PM (UTC+9). Watch the match live on www.issf-sports.org
RESULTS - 50m Pistol Men
1. RAI Jitu
2. PANG Wei
3. WANG Zhiwei
VIDEO - Finals 50m Pistol Men
PHOTOS - Finals 50m Pistol Men
BANGKOK - MARCH 4: (L-R) Silver medalist PANG Wei of the Peoples Republic of China, Gold medalist Jitu RAI of India and Bronze medalist WANG Zhiwei of the Peoples Republic of China pose with their medals after the 50m Pistol Men Finals at the National Shooting Sport Association of Thailand Shooting Range during Day 2 of the ISSF World Cup Rifle/Pistol on March 4, 2016 in Bangkok, Thailand. (Photo by Nicolo Zangirolami)
Marco Dalla Dea
Follow @ISSF_Shooting
New documents in the Tokyo 2020 section
A decision on Shooting Sports in the Commonwealth Games is imminent
The ISSF mission - We know how to protect our environment
Highlights of the 1st Golden Target Awards Ceremony
The ISSF and Eurosport will show the brightest moments of the pre-Olympic year 2019 on TV
A bright year for the ISSF on Eurosport
ISSF Extraordinary General Assembly
Munich, GER, 2019
Golden Target 2019 Award Ceremony
Golden Target 2019 Award Ceremony - Winners
Photos from the meeting
ISSF World Cup Final Rifle / Pistol
Putian, CHN, 2019
10m AIR PISTOL MIXED TEAM
10m AIR RIFLE MIXED TEAM
10m AIR RIFLE MEN FINAL
We save nature
SPORT TALK ISSF (EUROSPORT)
Winners of the Golden Target 2019 Award Ceremony
Golden Target 2019 - Ashley CARROLL (USA) - Trap Women


Using Used Toothbrushes For Cleaning: Yes Or No?
I had a debate with my wife about using used toothbrushes for cleaning. She's responsible for switching out our toothbrushes on a regular basis, and I asked that next time she switch them out, she give me the old ones so that I could use them for some of the deeper cleaning around the shower.
She suggested we use the 'free' ones that we get from the dentist, as we typically don't use these anyways. I was fine with that, but the thought still lingered whether using the old ones was common practice or if I really was gross for suggesting it.
What do you think, readers? Yes or no on using old tootbrushes as cleaning tools once they've been retired from tooth cleaning duties?
Do you spend a lot of your hard-earned cash on an assortment of expensive cleaning products? Consider making your own green cleaning supplies. You can find many of the ingredients in your cupboards at home. And while most commercial products only clean one surface type, natural ingredients serve multiple cleaning purposes, so you won't need to spend a bunch of money on an array of products.
In addition to saving you money, green cleaners keep dangerous toxins out of your home. Many commercial products contain volatile organic compounds (VOCs) like formaldehyde and harsh acids. Indoor exposure to such chemicals can cause a variety of illnesses according to the EPA. And the Children' Health Environmental Coalition (CHEC) notes that VOCs can cause cancer. In most situations, you can use milder chemicals to do the same jobs as VOCs.
You might think that making your own cleaning products will pose too big of a challenge. However, using just a handful of basic household ingredients, you can make your home safer for less money. In fact, you can accomplish most of your household cleaning using just ten items—white vinegar, baking soda, borax, hydrogen peroxide, club soda, lemon juice, liquid castile soap, corn meal, olive oil, and pure essential oils.
If you're concerned that natural, homemade cleaners won't kill household germs effectively, you're in for a big surprise. Researchers at Tufts New England Medical Center worry we're killing too many microorganisms with commercial cleaning products, and stress that disinfectants found in many household cleaners can contribute to drug-resistant strains of bacteria. If you prefer over-the-counter products to homemade cleaners, consider trying green cleaners made with natural ingredients.
In most cases, you can prevent the spread of germs by washing your hands frequently. You'll also want to launder your dish rags once a week and disinfect your sponges weekly, boiling them in water for three minutes then microwaving them for a minute or two.
Now that you've discovered all of the benefits of making your own cleaners, read on to get started. You may want to bookmark this page so you can revisit it in the future.
Carpet: Looking to clean and disinfect your carpets naturally? Simply blend a half cup of baking soda, one cup of borax, and one cup of cornmeal. Sprinkle the mixture over your carpet, rub with a cloth, and let it rest a few hours before vacuuming. The baking soda eliminates odors, the cornmeal soaks up excess moisture, and the borax acts as an antifungal agent, fighting off dirt and odors.
To remove stains from your carpets, mix one-quarter cup of liquid castile soap and one-third cup of water in a blender until foamy. Spread your concoction over the stain and let it soak for several minutes before scrubbing with a clean rag. If you need to remove an acidic stain—such as coffee, wine, or juice—club soda works pretty well. And if you're dealing with large spills, just pour some cornmeal on the spill, wait 15 minutes, and vacuum.
To remove candle wax from carpeting, lay newspaper down on top of the wax and set an iron to low. After the iron warms up, gently run it over the newspaper. As you iron, the wax will slowly start melting and attach to the newspaper, lifting off the carpet. After you've removed the large chunks of wax, you may need to do additional cleaning to remove some of the coloring from your carpet.
Hard Floors: To clean hard floors, combine one-quarter cup of liquid castile soap, a half cup of lemon juice or white vinegar, and two gallons of lukewarm water. Use a mop or soft cloth when cleaning. Liquid castile soap is a plant-based soap that makes a great antiseptic and grease cutter. White wine vinegar kills germs and bacteria, and lemon juice help remove stains and cut through grease.
Wood Floors: If you have sealed wood floors—which you probably do—start by placing a small amount of vinegar in a bucket of warm water. You should also wring out excess water before mopping. Once you've cleaned your floors, mix one part white vinegar with one part vegetable oil, then polish your floors for a healthy shine.
For natural unsealed wood floors, use linseed oil with a rag, allow it to soak in, and mop it up with a little more oil for good measure.
Bathroom Surfaces: To clean your bathroom, consider using the all-purpose solution mentioned later in this article. If your bathroom surfaces need a delicate touch, combine a half cup of baking soda with enough liquid castile soap to reach a frosting-like consistency. You can also add a few drops of essential oil for a fresh scent. If you need to scrub some of your bathroom surfaces, you can use baking soda or borax as a scouring powder. For plumbing fixtures, club soda makes an excellent polish.
Toilets: When you're ready to make your own toilet cleaner, simply combine a cup of borax with a quarter to a half cup of white vinegar or lemon juice. You should get a nice paste that you can spread inside your toilet bowl. After letting the paste sit for a while, come back and scrub it with a sponge or toilet brush.
Unclogging Drains & Shower Heads: Need to unclog your shower drain? You can accomplish this naturally without having to pour harsh chemicals down your drain. First, pour a three-quarter cup of baking soda down the drain. After the baking soda, pour down a half cup of white vinegar, making sure to cover the drain immediately after pouring. Because this concoction creates a foaming reaction that will push up and into your tub, you'll want to ensure your drain stays completely covered, keeping the foam down in your pipes. After roughly 30 minutes, remove the drain cover and slowly pour hot water down the drain. Your drain should flow smoothly.
To unclog your shower head, remove it from its fixture, find a bowl large enough to hold it, and sit it facedown in about an inch of vinegar. Let the shower head soak for an hour or so, then remove it from the bowl and rinse it for a few minutes in the sink. Put it back on your shower and enjoy the improved water pressure.
Coffee Makers: To clean your coffee maker, pour one cup of white vinegar into the water reservoir and fill it the rest of the way with hot water. Then, run the coffee maker as you normally would, but don't add any coffee beans. After the first cycle, run the coffee maker a couple more times using just plain water. This will help rinse out the vinegar and any build up left inside the machine. Lastly, enjoy your coffee.
Microwaves: For microwaves, mix a half cup of water with a few teaspoons of baking soda in a microwave safe bowl. Next, put the bowl in the microwave and run it for two minutes. Afterwards, remove the bowl and wipe your microwave clean. Any spots should come right off.
Ovens: Believe it or not, you can also create your own natural oven cleaner. First, you'll want to remove any caked-on material using wet steel wool. Next, cover the oven floor with baking soda and spray it lightly with water every few hours to keep it damp. Leave the baking soda in the oven overnight, and wipe it clean in the morning with a wet rag. The gunk in your oven should be loosened and ready to scrub right off.
Refrigerators: You can easily clean your refrigerator using a simple paste made from equal parts baking soda and water. Just scrub and wipe clean with a cloth.
Brass and Copper: Need a great brass and copper cleaner? Simply combine three tablespoons of lemon juice with one tablespoon of baking soda. This makes a great polish. For heavier polishing, you can soak your brass and copper in hot vinegar and table salt. As your items sit in this mixture, their finish will become shinier. Once you see the shine, take out your items and rinse them thoroughly. You can also rub some lemon on your brass and copper items when you need to clean inside any cracks or grooves. Always make sure to rinse and wipe your items after cleaning.
Chrome: You can clean chrome with a simple, natural solution. Just combine one tablespoon of ammonia with a pint of water. Rub your mixture on any chrome surface to remove dirt and grime.
Iron: When your iron cookware starts looking rusty, use a damp cloth and steel wool to get them clean. Simply wipe your iron object with the cloth, scrub with the steel wool, rinse, and dry. Once your item dries, you can rub in a little vegetable oil to prevent further rusting.
Pewter: When cleaning pewter, liquid castile soap usually does the trick. Just use warm soapy water, rinse, and polish with a cloth.
To clean your good silver, put some water in a pan with three tablespoons of washing soda and bring to a simmer. Then, throw a little piece of aluminum foil into the pan and dip your silver right into the mixture. Pull out your item, dry it off, and clean it with a rag. Voila—bright, shiny silver.
You can make a variety of scented air fresheners using water and essential oils. Simply take an empty spray bottle, pour in some water, and add several drops of essential oil. You'll find a large variety of essential oils with many different scents, such as lavender, lemongrass, thyme, eucalyptus, rosemary, rose, or clove. This lets you customize your air freshener according to your taste. You can also adjust the intensity of your air freshener by changing the amount of essential oil you add to your mixture.
You might also consider placing small boxes of baking soda around the house in places where odor is likely to strike, such as the cat's litter box or the refrigerator. And a nice vase of flowers can add a fresh scent to your house without leaving behind toxic residue like plug-ins and sprays.
All Purpose Cleaner: You can use all-purpose cleaners on most surfaces in your home. To make your own all-purpose cleaner, mix two tablespoons of white vinegar and one teaspoon of borax in a 16-ounce spray bottle. Fill the rest of the bottle with warm water and shake the solution until the borax dissolves completely. Once the borax dissolves, add a quarter cup of liquid castile soap and 10-15 drops of essential oil for a clean, fresh scent. Looking for an easier solution? Try cleaning with two cups of club soda in a spray bottle.
Disinfectant: When it comes to making your own disinfectant, start with tea tree oil. Add a teaspoon of tea tree oil to a gallon of water to disinfect windows, floors and toilets. Mix a few drops of tea tree oil with some water in a spray bottle to clean mold in your bathroom and disinfect your dirty floors. Tea tree oil also works great for disinfecting cuts and scrapes, and it makes a great bug repellant.
Glass Cleaner: For an eco-friendly glass cleaner, simply use a spray bottle filled with club soda. To give your mixture a little extra cleaning power, add a teaspoon of lemon juice. Terry-cloth cotton rags work best for cleaning glass.
Option 1—Mix two ounces of borax and a cup of white vinegar. Spray your mixture directly at the mold in your tub or shower. After spraying, let it sit 30-60 minutes before wiping the mold away.
Option 2—Mix a half cup of hydrogen peroxide with one cup of white vinegar. Spray your mixture on the mold without rinsing.
Option 3—For periodic maintenance, you can spray moldy areas with vinegar and let it soak in. Vinegar helps kill mold while preventing new mold growth.
Rust Remover: If you have salt and limes in your house, you could drink a margarita, remove some rust, or both. Yes, salt and lime juice work great on rust. Just sprinkle a little salt on the rusty area and put some lime juice right on top of it. Make sure you don't put so much lime juice on that the salt floats away. Leave the mixture on top of the rust for a few hours, then scrub. The rust should come off relatively easily.
Wood Polish: For a simple wood polish, just dab some olive oil on a soft cloth and massage gently into your wood furniture. If you're looking for a heavy-duty wood polish, take a spray bottle with three cups of water inside and add four tablespoons of olive oil and two tablespoons of distilled white vinegar. Shake the bottle up to mix the ingredients together and begin polishing. Before you begin, you might want to test your mixture on a small section of wood to make sure you have the correct mixture. Too much vinegar can be abrasive on wood surfaces.
 "The Natural Way to Clean Everything in Your House." The Good Human| Sustainability, Environment, Progressive Politics, Peak Oil, Being Green. Web. 14 July 2011..
 "Green America: Ten Simple Ways to Clean Green." Green America: Economic Action for a Just Planet. Web. 14 July 2011. .
 "Ten Cheap Ways to Clean Your House Organically." Sustainable Project Management. 10 May 2011. Web. 14 July 2011. .
This blog post was written by Check N Go.


I started dancing when I was eight years old, but it wasn't until college that I began to understand all of its many purposes. There I learned that it is 'by Him that we live, move, and exist' (Acts 17:28). It began to sink in that all of creation (His artistry) was indeed designed by Him and for Him. I learned that art is deeply relational. It is a unique, mysterious thing that happens as a result of interaction between creation and creator. Within this realization I found dance to become much more than just a series of positions. It is indeed a posture, but not solely one you take with your physical body. It is an emotional and mental place of receiving life from a completely different perspective. It is a bridge that will lead you toward discovery about God, self, and the world around you. It is my aim and passion to equip those, witnessing or partaking, to dive into this place of humbly learning, receiving, and experiencing the things of God through these simple gifts. To Him be the Glory.
We'll send an email to Mrs. Alison Fletcher with your contact information and your message below. Please explain below why you want to connect and what ministry topics you'd like to discuss. You will be contacted by Mrs. Alison Fletcher if they decide to connect. Coaches do not provide counseling, long-term mentoring, jobs or financial assistance. Violation of these terms may result in closing your login access.
We have sent an email to Mrs. Alison Fletcher requesting a connection.


text:
Dustin Michael Tokarski, född 16 september 1989, är en kanadensisk professionell ishockeymålvakt som är kontrakterad till NHL-organisationen New York Rangers och spelar för deras primära samarbetspartner Hartford Wolf Pack i AHL.

Anaheim Ducks i NHL. Han har tidigare spelat på NHL-nivå för Anaheim Ducks, Montreal Canadiens och Tampa Bay Lightning och på lägre nivåer för Lehigh Valley Phantoms, San Diego Gulls, St. John's Icecaps, Hamilton Bulldogs, Syracuse Crunch och Norfolk Admirals i AHL och Spokane Chiefs i WHL.

Tokarski draftades i femte rundan i 2008 års draft av Tampa Bay Lightning som 122:a spelare totalt.

Den 20 augusti 2018 skrev han på ett ettårskontrakt värt 650 000 dollar med New York Rangers.

Referenser

Externa länkar
Dustin Tokarski, Ducks – Stats – NHL.com
Dustin Tokarski NHL Statistics – Hockey-Reference.com
Dustin Tokarski hockey statistics and profile at hockeydb.com
Dustin Tokarski – Player profile at The Hockey News

Kanadensiska ishockeymålvakter
Spelare i Montreal Canadiens
Spelare i Tampa Bay Lightning
Spelare i Hamilton Bulldogs (1996–2015)
Spelare i Norfolk Admirals (2000–2015)
Spelare i St. John's Icecaps
Spelare i Spokane Chiefs
Kanadensiska idrottare under 2000-talet
Idrottare från Saskatchewan
Levande personer
Födda 1989
Män
Spelare i Syracuse Crunch
Spelare i San Diego Gulls (2015–)
Spelare i Lehigh Valley Phantoms
Spelare i Anaheim Ducks
Spelare i Hartford Wolf Pack
Spelare valda i NHL Entry Draft 2008
Personer från Humboldt, Saskatchewan
Spelare valda av Tampa Bay Lightning i NHL Entry Draft

redpajama_set_name: RedPajamaWikipedia


Our Surfers Paradise Family Accommodation is the perfect place to enjoy a quiet weekend. Perfect for families and friends, book your stay at our resort. Enjoy fully furnished apartments, fine guest facilities and the best location.
Our one bedroom apartment with study is ideal for couples and solo travelers. The apartment features a study area, a fully equipped kitchen, separate laundry facilities, air conditioning, a living area, master bedrooms, wireless internet access, complimentary pay TV, spacious balconies, and more. Take advantage of our WiFi access and stay connected to friends and family.
We also have one bedroom apartments, two bedroom apartments, and three bedroom apartments. Choose from our selection of apartments. Whether you are traveling on your own or with family and friends, enjoy your stay at our resort. Have a great time exploring the Gold Coast.
Aside from our beautifully appoointed apartments, we also have guest facilities such as a heated swimming pool, spa, sauna, gym, games room, theatre/conference room, barbecue facilities, wireless internet, and secure parking. Take a relaxing swim in the heated pool. Take a good long soak in the spa and feel refreshed. Use our barbecue facilities to create your own barbecue party.
Our resort is within walking distance from the beach. Laze on the golden sands and get a gorgeous tan. Race to the water and enjoy a refreshing swim. Be sure to visit Pacific Fair Shopping Centre, The Oasis, Marina Mirage, Harbour Town and many others all just minutes away from our resort. The Gold Coast is famous for its world class theme parks. Tick off the Gold Coast theme parks off your bucket list. Currumbin Wildlife Sanctuary features exotic and native animals that are truly fascinating. Sea World introduces you to the captivating wonders of the deep.


text:
James Howard Tupper (nascido em 4 de Agosto de 1965) é um ator canadense mais conhecido por seu papel como Jack Slattery na série da ABC Men in Trees e recentemente atuou como Dr. Chris Sands no drama médico da NBC Mercy (2009-2010), que foi cancelada em 2010.

Infância
Tupper nasceu em Dartmouth, Nova Escócia, Canadá. Ele estudou atuação na Concordia University, Montreal, e depois na Universidade Rutgers em Nova Jérsei, onde ele conseguiu seu Mestrado. Após isso, ele foi para a África Oriental para viver em uma plantação de café e para estudar suaíli.

Filmografia

Vida pessoal
Tupper se separou de sua esposa em Novembro de 2006 e foi morar com a atriz Anne Heche em Agosto de 2007.

No dia 5 de Dezembro de 2008 foi noticiado que Heche estava grávida de Tupper.

O filho, Atlas Heche Tupper nasceu no dia 7 de Março de 2009.

Em seu tempo livre, Tupper gosta de praticar carpintaria e observação de aves. Ele atuou em várias peças off-Broadway, incluindo An Actor Prepares e After the Rain. Tupper co-escreveu e apareceu em um filme indie de 2005, Loudmouth Soup, que foi filmado em uma única noite. Ele teve um papel recorrente na série Samantha Who?, como Owen.

Tupper atuou como Dr. Andrew Perkins, um conselheiro de traumas, na série da ABC Grey's Anatomy.

Ligações externas

Biografia de James Tupper

Atores do Canadá


"Here we have a Panzer IV medium tank. It's primary role is to support infantry and to rip you a new one."
— Official game quote The most common of all the tanks (Tiger Tank, Wespe and Flak Panzer). It is closest in resemblance to your tank and has a main 75 mm cannon and a MG34.
It's job is to pry-open your vehicles and structures with its main gun, while at the same time pinning your infantry with the MG34. If given the opportunity the panzer will turn into a Bunker Buster on you and make your day end badly.
It should be feared as it can seriously harm your infantry, but does not specialize in anything. A solid zook round will bang it up nastily.
Grenades can destroy the tank with a perfect hit.
Or mines and TNT will work too.


Prepare for a successful career in medical coding with comprehensive coverage from the most trusted source in the field! This easy-to-use resource guides you through each step of the medical coding and reimbursement process, introducing you to Current Procedural Terminology (CPT), providing in-depth explanations of various procedures and how to properly code them. Practice exercises reinforce important concepts and allow you to test your comprehension. With complete coverage of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), third-party reimbursement, 1995 and 1997 documentation guidelines for evaluation and management services, and Alpha II iCoder exercises, this revised and updated resource is your first step toward complete coding success.
In-text exercises throughout each chapter reinforce coding rules and concepts and emphasize the book's step-by-step organization.
Concrete real-life ; coding examples allow you to apply important coding principles and practices to actual scenarios from the field.
Medical procedure illustrations and discussions help you better understand the services being coded.
Three varieties of answer blanks test your understanding of correct coding practices.
Full-color presentation makes content visually stimulating.
Caution! notes warn users of common coding mistakes and reinforce the concept of coding as an exact science.
From the Trenches quotes provide valuable insights from instructors and professionals in the medical coding field.
Coders Index makes it easy to instantly locate specific codes.
Official Guidelines for Coding and Reporting boxes present the official guidelines alongside text discussions and visually indicate inpatient vs. outpatient use.
30-day trial access to Alpha II iCoder introduces you to professional coding software and acts as a supplement to the main text material.
Companion CD provides a variety of activities that reinforce material from the text.
Vibrant new design helps you find what you need quickly and easily.
Revised chapter on Third-Party Reimbursement Issues brings you up to date on Quality Improvement Organizations, Inpatient Prospective Payment System, and MS-DRG references.


Contact us at any of our offices by filling out this form.
Stinauer Family Dentistry is a family dental practice located in the towns of Havana, Lewistown, and Canton, IL. Dr. Bob and his two sons, Dr. Jesse and Dr. John are dedicated to general, family, and cosmetic dentistry with services including dental exams, dental makeovers, teeth whitening, veneers, crowns, x-rays, cleanings, and more.


The law firm Veirano Advogados and the Center for Arbitration and Mediation of the Chamber of Commerce Brazil-Canada are organizing in São Paulo, Brazil the Veirano CAM-CCBC Moot Training on 23-24 of February, 2013.
Veirano CAM-CCBC Moot Training is a pre-competition that aims to familiarize the students who are going to the 20th Willem C. Vis International Commercial Arbitration Moot with the oral rounds they will face in the real competition. It is a great opportunity to improve the oral arguments and to meet with students from a different legal background.
The Veirano CAM-CCBC Moot Training would like to invite the team from any university to participate of the pre-competition with a minimum of two students.


text:
Carlos "Botong" Francisco
Mike de Leon
Josefino Cenizal
Born on September 14, 1919, Josefino Cenizal grew up with immense mastery in music. His skill was greatly influenced by his mother, Rosario Ymson Cenizal, his first tutor in solfeggio and violin. Cenizal also studied cello, piano, and voice at the Conservatory of Music of the University of the Philippines.
With the talent that he had, Cenizal already experienced a lot in his younger days. He played the piano every night at Radio KZRM, performed at the Bay View Hotel and even in luxurious cruise lines. When he turned 17, he was able to conduct an orchestra and play at the US Army Navy Club.
Mowelfund 45th Anniversary
MOWELFUND 45th Anniversary Onward to Greater Change for the Movie Worker 45th Anniversary Celebration of the Movie Workers Welfare Foundation, Inc. Saturday, March 23, 2019,...
Movie Trivia: Panchito Alba
Movie Trivia: Panchito Alba By Boy Silverio Bago naging artista si Panchito sa pelikula, naging barker sa mga stage show sa mga pistahan sa lalawigan....


The online auction platform helps yacht owners expedite sales, Mahoney said, while charging no fees to the broker or owner to sell. "Broker commissions are always paid in full," he added.
Active Interest Media is the parent of Soundings Trade Only.
The recent sale of a 2006 Molokai Strait 75 proves that the process can quickly attract multiple qualified bidders, Mahoney said. After being listed on the brokerage market for more than a year, the expedition yacht sold within weeks, with five parties expressing strong interest.


Join us at the New Dawn Center for Social Innovation in Sydney for our March Conversation for the Common Good event!
Hear the Cape Breton Social Enterprise Table, Island Sandbox and others in the social enterprise community speak about their experience in using social enterprise to address social and economic goals.
Network with community leaders, learn about social enterprise, and learn how to get your idea off the ground!


text:
Confused About College
Find a College Major
How We Help You Choose a College
Career Test and Personality Test
• No Goals + No Passion =
Mediocre Performance
• Undeclared?
• The BIG Decision
• Understanding Personality Type
and Career Matching
• Are you seeking employment or
a career change?
Helping Your Son or Daughter Choose a College Major
If you are the parent of a college or high school student who is having difficulty deciding on a career path and choosing a college major, you are not alone. Students today are more confused than ever about the direction of their career and their education. The job market has changed significantly in the last 10 years and the general population has been unable to keep up with these changes.
College is expensive. Doesn't it make sense to know what you are investing in? In addition, the students feel lost. If they better understood their options, they would be more decisive, more driven, and more successful in their academic pursuits. Having a career choice gives a student a goal, even if that career path changes later. There are literally thousands of career choices and many are highly specialized. The first step toward success and happiness in one's career is to be able to work at something that fits well with his/her personality. There is no greater motivator.
Our methodology is driven by our experience as executive recruiters. Our team of professional recruiters has worked in the career industry for many years and we've interviewed thousands of people for hundreds of positions across a variety of industries. We know what companies look for in terms of skills and educational backgrounds. This is "real world" knowledge that students may not receive from their school's guidance department or from their freshman year experience in being "undeclared." We combine our knowledge of current trends in the job market with our experience in personality/career matching assessments to help students narrow their career options and choose a college major that will serve as a strong foundation for their future. This service has made a real difference in the lives of many people – both students and parents.
Home | Confused About College | Find A College Major | Undeclared | Career Test and Personality Test | Services and Pricing | How We Help You Choose A College
Seeking Employment or Career Change | Contact | About Us


text:
static volatile uint32_t *uart;

void init_uart() {
	uart = (volatile uint32_t*)SERIAL_BASE;
}

static inline bool buffer_full() {
	return *(uart + SERIAL_FLAG_REGISTER) & SERIAL_BUFFER_FULL;
}

char read_uart() {
	// TODO
	return 0;
}

void write_uart(char c) {
	while(buffer_full());

	*uart = c;

	while(buffer_full());
}

redpajama_set_name: RedPajamaGithub


Thank you for your interest in Noble Art Entertainment Dinner Theater. Noble Art occasionally sends out communication for deals, special offers and announcements for coming shows. If you would like to receive periodic e-mails, please sign up below.


text:
Of the estimated 390,000 Middle Tennesseans struggling with hunger, Second Harvest finds that there are disproportionate numbers of veterans, the elderly and children: of all of the hungry in middle Tennessee, 25 percent are children and 25 percent are seniors.
"We see a lot of veterans, who contributed to our country and struggle with agent orange, or other disabilities. Their Social Security is small and they cannot work," Day said. "They need help."
"We see hard-working men and women come through our doors everyday who have never needed help before," said Penny Anderson, at St. Luke's Community House where there is a Second Harvest Satellite food bank.
"They can usually take care of themselves. But sometimes the worst things happen and they just need a little help to make ends meet. It's normal to occasionally need a little help. It's why we are here."
So food stamps, how do they fit in?
The maximum monthly net income for a family of four to be eligible for food stamps is $2,050, or $1,005 for a single person. Plus many items that most of us would consider essential, like toilet paper, soap, and detergent, are not eligible for food stamp purchases.
"The food stamp program was not intended to be a permanent solution. It was always a supplemental program," said Paige Hopkins, SNAP Outreach counselor for Second Harvest. She also said that the criteria to be eligible for food stamps is stricter than most people might think, and that SNAP payments generally don't cover all of a household's food needs.
"A lot of the seniors are only getting $16 a month," she said. "And the DHS office is very strict on the income limit and even a dollar over the threshold for qualification could keep someone from getting the food stamp money," she said.
How many of us would be willing to stand in line in the rain to pick up a basket of groceries, like I saw more than 100 people do at a fresh produce mobile pantry last year?
Or who feels good going to a food pantry to ask for a food box and wait while they check to see how many times you've been there before?
And when you see what is in that Emergency Food Box, believe me it is not what most of us would pick up on our weekly grocery run.
Being hungry is definitely real— even here in the "IT" city. And our efforts to put an end to it — and to ease the paths of those who are trying to help themselves — are the right thing to do.
Reach Ms. Cheap at 615-259-8282 or mscheap@tennessean.com. Follow her on Facebook at facebook.com/mscheap, and at Tennessean.com/mscheap, and on Twitter @Ms_Cheap, and catch her every Thursday at 11 a.m. on WTVF-Channel 5's "Talk of the Town."
These hunger numbers may surprise you
Income and Poverty: An estimated 17 percent of households that are clients of Second Harvest have no income, 44 percent have annual incomes of $1 to $10,000, and 22 percent have annual incomes of $10,001 to $20,000. Taking into consideration household size, 80 percent of client households have incomes that fall at or below the federal poverty level.
Employment: An estimated 40 percent of client households have a household member who had worked for pay in the last 12 months; in 74 percent of households the most-employed person from the past 12 months is currently out of work.
Education: An estimated 71 percent of all clients have attained a high school degree or General Equivalency Diploma (GED) or more, and an estimated 23 percent of all clients have post-high school education (including license or certification, some college, or a four-year degree).
Source: Second Harvest and Feeding America
Most needed items: Peanut butter, canned meats, canned fruits and vegetables, rice and beans, macaroni and cheese, and cereal.


Raw and energetic fusion of various extreme metal influences to give a very Death/Crust-oriented Doom sound that veers between thrash attack and slow crawl. The band describe it as 'War Doom from Hell' - likeably blatant and enthusiastic, for those who enjoy a bit of over-the-border variety thrown in with their Doom-flavoured Death.
Act of Impalement / Forest of Tygers (Split) 2015 Acteon Records 7"


text:
Howard Lebow (* 1935 in New Jersey; † 1968 in Amherst, Massachusetts) war ein US-amerikanischer Pianist.

Leben
Lebow, ein Schüler Erich Itor Kahns und Eduard Steuermanns, studierte an der Juilliard School of Music in New York City (Master 1959) und wurde mit dem dortigen Morris Loeb Memorial Prize ausgezeichnet. Der Fulbright-Stipendiat besuchte die Staatliche Hochschule für Musik Hamburg und die Internationale Sommerakademie Mozarteum in Salzburg, während der Internationalen Ferienkurse für Neue Musik in Darmstadt wurde er zweimal mit dem Kranichsteiner Musikpreis geehrt: dritter Preis (1960) und zweiter Preis (1961). Dort besuchte er auch einen Kurs von Karlheinz Stockhausen. Nach seinem Debüt 1963 in Manhattan konzertierte er in fünfzehn Ländern. 1964 wurde er Assistant Professor für Klavier an der University of Massachusetts Amherst (UMass Amherst). Im Januar 1968 erlag er den Folgen eines Autounfalls. Das Department of Music der UMass Amherst richtete ihm zu Ehren ein Stipendium ein.

Diskographie
 2016: Darmstadt Aural Documents (Neos) mit Howard Lebow (Klavier) u. a. – Roger Sessions: From My Diary. Four Pieces

Weblinks
 Foto von Howard M. Lebow, ca. 1965 (Fotosammlung der UMass Amherst)

Einzelnachweise

Klassischer Pianist
Musiker (Vereinigte Staaten)
Hochschullehrer (University of Massachusetts Amherst)
US-Amerikaner
Geboren 1935
Gestorben 1968
Mann


This session will include panelists, Matt Bramble and Dennis O'Brien, both seasoned audience and product development veterans with years of experience using CDP's to grow audience and revenue. Matt and Dennis will talk about the various platforms they have worked with and strategies for leveraging CDP's to build your business. CDP's create a single view of the customer and enable companies to create personalized user experiences that drive engagement and ultimately revenue.


Read below for information on e-file, Free File, Telephone Excise Tax Refund, Earned Income Tax Refund, errors in filling out returns, electronic payments, extensions of time to file and pay and installment agreements. And check out 1040 Central, your one-stop shop for all of your tax filing and paying information needs.
WASHINGTON — With the April 17 tax return filing and tax payment deadline imminent, the Internal Revenue Service offers last-minute tips for those who haven't yet filed or paid.
Taxpayers can minimize any possible interest assessments and late filing or late payment penalties by filing and paying by the due date.
Filing electronically is fast, accurate and easy. The electronic filing program checks for errors and necessary information, increasing the accuracy of the return and reducing the need for correspondence with the IRS to clarify errors or omissions. The computer software leads the user step-by-step. Most people can usually file a state tax return at the same time they electronically file their federal return. Once the return is accepted for processing, the IRS electronically acknowledges receipt of the return. Generally, when someone files electronically, their refund will be issued in about half the time it would take if they had filed a paper return. Those who choose direct deposit will get their refund in even less time. More information on e-file is available on this Web site.
Nearly 20 companies are offering free electronic filing to taxpayers whose 2006 adjusted gross income was $52,000 or less. That means 70 percent of all taxpayers, 95 million individuals, can take advantage of the IRS-sponsored Free File program. Free File cannot be accessed through tax preparation Web sites that inaccurately say they are part of the Free File Alliance. The only way to access this program is through the IRS's own secure, official Web site, IRS.gov, where a link to Free File may be found on the home page.
Telephone Excise Tax Refund–– This is a one-time refund of long distance excise taxes available on 2006 income tax returns. The refund applies to charges billed from March 2003 through July 2006. The IRS offers a standard refund amount of $30 to $60, or taxpayers can calculate the actual tax paid. Even if the taxpayer does not normally have to file a return, Form 1040EZ-T can be used to request this refund. Businesses and exempt organizations can also request it. Taxpayers can find more information on this special payment on this Web site.
Earned Income Tax Credit–– Earned income of less than $39,000 in 2006 may qualify a taxpayer to claim the earned income tax credit. This credit could be worth up to $4,536. When the EITC exceeds the amount of taxes owed, it results in a tax refund to those who claim and qualify for the credit. To qualify, taxpayers must meet certain requirements and file a tax return, even if they did not earn enough money to be obligated to file a tax return. An electronic special "EITC Assistant" is available on IRS.gov to help taxpayers determine whether they are eligible. Taxpayers can access more information on this credit by clicking on "1040 Central" on the front page of this Web site.
Taxpayers who file electronically can e-file and e-pay in a single step by authorizing an electronic funds withdrawal or by credit card. Electronic payment options are convenient, safe and secure methods for paying taxes or user fees. Taxpayers can charge taxes on their American Express, MasterCard, Visa or Discover cards, using an IRS-authorized service provider listed on IRS.gov. The service providers charge a convenience fee based on the amount of tax the taxpayer is paying. Taxpayers should not add the convenience fee to their tax payment. A link to the "electronic IRS" is located on the front page of this Web site.
For those who can't file or pay on time, the IRS has alternative options.
If a taxpayer can't meet the filing deadline to file their tax return, they can get an automatic six month extension of time to file from the IRS, but they must submit the request by April 17. The extension gives taxpayers until October 15 to file the tax return. However, an extension of time to file does not give the taxpayer an extension of time to pay, which must be separately requested. Those who owe taxes can make a payment when they file the extension either by mailing a check made out to the U.S. Department of the Treasury or by several electronic payment methods, such as electronic funds withdrawals from bank accounts and credit card payments. Taxpayers can get an automatic six-month extension of time to file their tax returns by filing Form 4868, Automatic Extension of Time to File. Taxpayers can e-file the extension request from a home computer or through a tax professional who uses e-file. Taxpayers can e-file their extensions at no cost. Several companies offer free e-filing of extensions through the Free File Alliance; these companies are listed on this Web site.
Based on the circumstances, a taxpayer could qualify for an extension of time to pay. The IRS is willing to allow extensions of time to pay in order to assist in tax debt repayment. A taxpayer can request an extension from 30 to 120 days depending on the specific situation. Taxpayers qualifying for an extension of time to pay of 30 to 120 days generally will pay less in penalties and interest than if the debt were repaid through an installment agreement. Taxpayers can request an extension of time to pay using the Online Payment Agreement option available on this Web site.
The IRS may allow taxpayers to pay any remaining balance in monthly installments through an installment agreement. Taxpayers who owe $25,000 or less may apply for a payment plan electronically, using the Online Payment Agreement application. Alternatively, taxpayers may attach a Form 9465, Installment Agreement Request, to the front of their tax return. Taxpayers must show the amount of their proposed monthly payment and the date they wish to make their payment each month. The IRS charges a $105 fee for setting up an installment agreement. The fee is reduced to $52 for those who establish a direct debit installment agreement and $43 for those with an income below a certain level (more information is available on Form 13844). Taxpayers are required to pay interest plus a late payment penalty on the unpaid taxes for each month, or part of a month, after the due date that the tax is not paid. A taxpayer who does not file the return by the due date — including extensions — may have to pay a failure-to-file penalty. More information can be found on the "Payment Plans, Installment Agreements" page on this Web site.
For more information about filing and paying taxes on this Web site, choose "1040 Central" or refer to the Form 1040 instructions or IRS Publication 17, Your Federal Income Tax. Taxpayers can download forms and publications from this Web site or request a free copy by calling toll free 800-TAX-FORM (800-829-3676).