Mossberg 500 Shotgun Review #mossberg #500,shotgun,12 #guage,picture


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The Mossberg 500 Shotgun Review

Great Shotgun – Great Value

The Mossberg 500, 12 gauge pump shotgun provides us with something that matters to most real-world shooters: Value. Value means something that works well and costs less than it’s worth. And while some shot-gunners will read this and begin to rant and rave about “cheap” this and that; they can go ahead and use their “collector’s model”, artist engraved, sleek, precision. yada, yada, yada. $3000 guns. I’ll just keep blasting away with my $200 Mossberg. As will thousands of other shooters who have discovered this attractive, durable, and dependable pump shotgun.

The Mossberg 500 shotgun is a mil-spec manufactured shotgun, meaning that it is not your collector’s “finely tuned” gun. It means that it is produced to military specifications which emphasize generous tolerance, durability and dependability.

The 500 pump shotgun is one of the most versatile shotguns on the market with interchangeable barrels. That allows the owner to change from sporting clay, to turkey, to waterfowl to deer without having to buy a half dozen guns. Important to the average hunter and shooter that is not wealthy.

And the gun will keep on shooting due to the attention to the manufacturing particulars that matter.

My Mossberg 500 shotgun is the all purpose field model and sports a 28 inch ribbed and factory ported barrel. Stocks are wood.

My gun is chambered for 12 gauge shells up to 3″. I don’t hunt at this point, with my use of the gun being sporting clays, that I love to shoot.

And the light, fast pumping gun with front bead sight comes up and around quickly making even my average skills look more impressive than they are when busting lots of clays.

The gun sports a convenient safety on the top of the gun. It can be quickly accessed with your strong hand thumb while your hand is in the shooting position.

The Mossberg 500 pump shotgun has a capacity of 5 in the magazine and one in the chamber for a total of 6 rounds ready to shoot. Recoil with this shotgun is average for a 12 gauge which means that shooting a hundred or so rounds gives you a satisfyingly sore shoulder. As far as speed goes, the gun is as fast as any pump, and utterly dependable. It comes in the box with 3 chokes and a wooden dowel plug for states that restrict the capacity of a shotgun when bird hunting. The wooden plug is a nice piece to throw away. After market metal plugs are available and are desirable if you have the misfortune to live in a state that requires it.

BOTTOM LINE: The Mossberg 500 is a shotgun that is dependable and durable, manufactured by military specific standards. It is a fun, worry free gun that is a load of fun to shoot clays or hunt with. Mossberg makes a wide range of accessories including barrels that allow you to turn your gun into anything you want it to be. Those are the most important things. Then, you only have to pay about $200 for one new in the box. That means you have the added benefit of being able to throw it in the back of your truck, lay it down in the field, drop it, swat bugs with it or paddle a boat with it and not worry about hurting it. And that’s worth a lot.

Concealed carry just got simpler. Your shortcut to figuring it all out.


Picture of the Day: Open Water Roll Cloud – TwistedSifter #brazil, #clouds,


TwistedSifter

Picture of the Day: Open Water Roll Cloud

Photograph by Capt. Andreas M. van der Wurff via EPOD

This impressive (and seemingly endless) roll cloud was spotted from a ship en route from Paranagua, Brazil to Montevideo, Uruguay. The image was taken by Capt. Andreas M. van der Wurff and chosen as the Earth Science Picture of the Day for February 29, 2012.

A cloud feature like this isn t something you would want to run into on the open sea or on a crowded highway, but roll clouds (arcus cloud) aren t necessarily a presage of severe weather. They most often form along the leading edge of a mature thunderstorm in the relatively cool air associated with the storm s downdraft; however, they re detached from the storm itself and may be seen to roll or tumble along their horizontal axis.

This isn t the first time a roll cloud has been featured as a POTD (see here and here ) or in a standalone post. If you enjoy looking at various cloud formations, be sure to check out the clouds tag on the Sifter!


Are You (Still) Painting the Picture? Ensuring High Quality Documentation in Hospice

#hospice documentation guidelines

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It’s been almost twenty years since the Health Care Finance Administration (now the Centers for Medicare and Medicaid Services ) sent a memo to hospices announcing the first widespread, in-depth review of hospice medical records and patient eligibility. Focused Medical Review, as it was called in 1994, was just the beginning of the government’s search for fraud and waste in hospice.

Prior to this action, hospices that had largely avoided widespread regulatory scrutiny were suddenly being held accountable to a much higher documentation standard than ever before. During this audit, hospices struggled to demonstrate through their documentation that patients who had already died, often within days or weeks of admission, met eligibility requirements for hospice. In the days before Webinars or online education, hospices were challenged with the means to disseminate education to their staff to teach them to “paint the picture” of medical eligibility.

Today, hospices are once again facing intense scrutiny of their documentation as Medicare Administrative Contractors (MACs) are sending notices of Probe Edits and Additional Document Requests (ADRs). The burden on staff and financial resources to respond to these audits is taking a toll on hospices under review. Once again, many hospices are finding that they lack the documentation required to paint a picture of eligibility.

The criteria used to determine eligibility for the Hospice Medicare Benefit is specific to each MAC, and changes periodically based on new prognostication tools and research. Hospices should use the disease-specific criteria outlined in each MAC’s Local Coverage Determinations (LCDs) to determine if someone is or continues to be eligible for hospice under Medicare.

Documentation of disease-specific criteria, along with supporting information such as description of the patient’s illness trajectory, pertinent co-morbid and secondary conditions, severity of symptoms, declining functional, cognitive and nutritional status, and overall burden of illness are critical to depicting why this patient will probably die within six-months or less.

All hospice staff should be fully aware of and utilize their LCD guidelines and disease-specific criteria to document eligibility for each admission and every recertification.

Ask yourself the following questions to determine if your hospice team has the education and tools that they need to paint the picture of eligibility:

Are the LCDs easily accessible to all admission and IDT staff – either on their laptop, smartphone or in a handy printed resource?

Does your team refer to LCD criteria when discussing recertification during IDT meetings?

Does each patient’s medical record include documentation regarding his or her prognosis, both upon admission and in each recertification note?

Do your physician narratives contain key elements based upon LCD guidelines that lead the reader to the conclusion that the patient is terminally ill?

Do you conduct monthly chart audits to ensure that best practices for documenting medical eligibility are being followed?

Are ALL staff trained and regularly retrained on how to document to the LCDs, including documentation of co-morbid conditions to support medical eligibility?

If you answered “No” to any of the questions below, your hospice may be at risk for financial penalties in the event of an audit. Comprehensive documentation that paints the picture of initial and ongoing eligibility is paramount to the ongoing survival of your hospice. Training, along with ongoing chart reviews, is the best insurance you can have against future MAC audits, probes, and ADRs.

Looking for an efficient and cost-effective way to teach your entire team how to document to the LCDs? The Hospice Education Network’s Disease-Specific Hospice Eligibility Determination and Documentation Series is for you!

Do you need an objective review of your documentation or compliance system? Weatherbee Resources specializes in outsourced clinical record auditing and baseline compliance audits. The Weatherbee team can also create customized onsite staff training education or conduct webinars for your entire organization. Visit http://www.weatherbeeresources.com or call 508.778.0008 today!

Medicare Administrative Contractors MAC map

Review the Palmetto LCDs (be sure to select the hospice LCDs)

Posted by Terri Maxwell, PhD APRN Vice President, Strategic Initiatives, Weatherbee Resources, Inc. Hospice Education Network Inc.





The Abdomen (Human Anatomy) – Picture, Function, Parts, Definition, and More #abdomen,


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Picture of the Abdomen

The abdomen (commonly called the belly) is the body space between the thorax (chest) and pelvis. The diaphragm forms the upper surface of the abdomen. At the level of the pelvic bones, the abdomen ends and the pelvis begins.

The abdomen contains all the digestive organs, including the stomach, small and large intestines, pancreas, liver, and gallbladder. These organs are held together loosely by connecting tissues (mesentery) that allow them to expand and to slide against each other. The abdomen also contains the kidneys and spleen.

Many important blood vessels travel through the abdomen, including the aorta, inferior vena cava, and dozens of their smaller branches. In the front, the abdomen is protected by a thin, tough layer of tissue called fascia. In front of the fascia are the abdominal muscles and skin. In the rear of the abdomen are the back muscles and spine.

Abdomen Conditions

  • Peritonitis. Inflammation of the covering of the abdominal structures, causing rigidity and severe pain. Usually, this is due to a ruptured or infected abdominal organ.
  • Acute abdomen: A medical phrase doctors use to suggest that peritonitis or some other emergency is present and surgery is likely needed.
  • Appendicitis. Inflammation of the appendix, in the lower right colon. Usually, an inflamed appendix must be removed by surgery.
  • Cholecystitis. Inflammation of the gallbladder, causing severe right-sided abdominal pain. A gallstone blocking the duct exiting the gallbladder is usually responsible.
  • Dyspepsia. The feeling of an upset stomach or indigestion. Dyspepsia can result from benign or more serious conditions.
  • Constipation. Having fewer than three bowel movements per week. Diet and exercise may help but many people will need to see their health care providers.
  • Gastritis. Inflammation of the stomach, often causing nausea and/or pain. Gastritis can be caused by alcohol, NSAIDs, H. pylori infection, or other factors.
  • Peptic ulcer disease. Ulcers are erosions and peptic refers to acid. Peptic ulcers are ulcers in the stomach and duodenum (the first part of the small intestine). The usual cause is either an infection with H. pylori or taking anti-inflammatory medications like ibuprofen.
  • Intestinal obstruction. A single area of the small or large intestine can become blocked or the entire intestine may stop working. Vomiting and abdominal distension are symptoms.
  • Gastroparesis. The stomach empties slowly due to nerve damage from diabetes or other conditions. Nausea and vomiting are symptoms.
  • Pancreatitis. Inflammation of the pancreas. Alcohol and gallstones are the most common causes of pancreatitis. Other causes include drugs and trauma; about 10% to 15% of cases are from unknown causes.
  • Hepatitis. Inflammation of the liver, usually due to viral infection. Drugs, alcohol, or immune system problems can also cause hepatitis.
  • Cirrhosis. Scarring of the liver caused by chronic inflammation. Heavy drinking or chronic hepatitis are the most common causes.
  • Ascites. Abdominal fluid buildup often caused by cirrhosis. Ascites may cause the abdomen to protrude impressively.
  • Abdominal hernia. A weakening or gap in the abdominal fascia allows a section of the intestine to protrude.
  • Abdominal distension: Swelling of the abdomen, usually due to an increased amount of intestinal gas.
  • Abdominal aortic aneurysm. A weakening of the aorta’s wall creates a balloon-like expansion of the vessel that grows over years. If abdominal aortic aneurysms grow large enough, they may burst.

Continued

Abdomen Tests

  • Physical examination. By listening with a stethoscope, pressing, and tapping on the abdomen, a doctor gathers information that helps diagnose abdominal problems.
  • Upper endoscopy (esophagogastroduodenoscopy or EGD): A flexible tube with a camera on its end (endoscope) is inserted through the mouth. The endoscope allows examination of the stomach and duodenum (small intestine).
  • Lower endoscopy (colonoscopy): An endoscope is advanced through the anus into the rectum and colon. Colonoscopy can help identify problems in these areas, such as cancer or bleeding.
  • Abdominal X-ray. A plain X-ray of the abdomen can help see the organs and conditions in the belly including intestinal obstruction or perforation.
  • Computed tomography (CT scan ): A CT scanner uses X-rays and a computer to create images of the abdomen. CT scanning can help identify some abdominal conditions, such as appendicitis and cancer.
  • Magnetic resonance imaging (MRI scan ): Using radio waves in a magnetic field, a scanner creates highly detailed images of the abdomen. In the abdomen, MRI is usually used to check the liver, pancreas, and gallbladder, but a CT scan may also be used.
  • Abdominal ultrasound. A probe on the abdomen reflects high-frequency sound waves off the abdominal organs, creating images on a screen. Ultrasound can detect problems in most abdominal organs, such as the gallbladder, liver, and kidneys.
  • Endoscopic retrograde cholangiopancreatography (ERCP ): Using an endoscope advanced to the intestine, a tube is placed into the duct from the pancreas and a fluid that blocks X-rays is squirted into the tubes that serve the gall bladder, liver, and pancreas. Then an X-ray picture is taken to find problems with those organs.
  • pH testing. Using a tube through the nose or a capsule in the esophagus, acid levels in the esophagus can be monitored. This can help diagnose GERD or evaluate a treatment’s effectiveness.
  • Upper GI series (with small bowel follow-through): After swallowing a barium solution, X-ray films of the esophagus and stomach are taken. This can sometimes diagnose ulcers or other problems. In some cases they continue taking pictures as the barium courses through the small intestine.
  • Gastric emptying study: A test of how rapidly food passes through the stomach. The food is labeled with a radioactive substance and its movement viewed on a scanner.
  • Biopsy. A small piece of tissue is taken to help diagnose cancer, liver or other problems.

Continued

Abdomen Treatments

  • Abdominal surgery: Surgery is often necessary for serious abdominal conditions like cholecystitis, appendicitis, colon or stomach cancer, or an aneurysm. Surgery may be laparoscopic (several small incisions and using a camera and small tools) or open (one large incision, what most people think of as a typical surgery).
  • Histamine (H2) blockers. Histamine increases stomach acid secretion; blocking histamine can reduce acid production and GERD symptoms.
  • Proton pump inhibitors. These medicines directly inhibit the acid pumps in the stomach. They must be taken daily to be effective. There is, though, some concern about taking them for more than a few months.
  • Endoscopy. During upper or lower endoscopy, tools on the endoscope can sometimes treat problems (like bleeding or cancer) that are discovered.
  • Motility agents: Medicines can increase contraction of the stomach and intestines, improving symptoms of gastroparesis or constipation.
  • Antibiotics. H. pylori infection can be cured with antibiotics, which are taken with other medicines to help heal the stomach.
  • Laxatives. Various over-the-counter and prescription medicines can help relieve constipation.

WebMD Image Collection Reviewed by William Blahd, MD on March 04, 2016

Sources

http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/
http://www.medicinenet.com/proton-pump_inhibitors/article.htm
http://digestive.niddk.nih.gov/ddiseases/pubs/upperendoscopy/
http://digestive.niddk.nih.gov/ddiseases/pubs/colonoscopy/
http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/
http://www.medicinenet.com/gastroesophageal_reflux_disease_gerd/page5.htm
http://www.cancer.gov/cancertopics/types/colon-and-rectal
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/travelersdiarrhea_g.htm
http://www.cdc.gov/nczved/dfbmd/disease_listing/salmonellosis_gi.html
http://www.webmd.com/ibd-crohns-disease/default.htm
http://digestive.niddk.nih.gov/ddiseases/pubs/colonoscopy/
http://digestive.niddk.nih.gov/ddiseases/pubs/sigmoidoscopy/
http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/

© 2016 WebMD, LLC. All rights reserved.


Residential Electrician, Electrician #are #you #in #the #dark, #are #you #in #the


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Welcome to Our Site


We are strictly residential electricians. This means we know how to take care of your home in every way. We specialize in accent lighting, ceiling fans. kitchen remodels. bathroom lighting. can lighting, energy efficient lighting. attic fans. house wiring. and much more.

Our company cleans up like no other contractor you ve seen. We vacuum up any mess with our own vacuum! All our employees are cordial and trustworthy. We are a family company and we consider our customers to be our extended family. Your satisfaction with our service is our utmost priority. Our customers generally come to us through word of mouth and our phone rings constantly. Thank you for recommending us through the years and trusting us with your home.

We Provide Services to the Following Cities and Towns in CA:

  • Orange County, CA
  • Mission Viejo, CA
  • Irvine, CA
  • Woodbridge, CA
  • Turtle Rock, CA
  • Newport, CA
  • Newport Beach, CA
  • Big Canyon, CA
  • Balboa, CA
  • Monarch Beach, CA
  • Newport Coast, CA
  • Shady Canyon, CA
  • Laguna, CA
  • Laguna Beach, CA
  • Corona Del Mar, CA
  • Huntington Beach, CA
  • Seal Beach, CA
  • Long Beach, CA
  • Sunset Beach, CA
  • Los Alamitos, CA
  • Rossmoor, CA
  • Fountain Valley, CA
  • Costa Mesa, CA
  • Yorba Linda, CA
  • Orange, CA
  • Anaheim, CA
  • Anaheim Hills, CA
  • Tustin, CA
  • Tustin Ranch, CA
  • North Tustin, CA
  • Santa Ana, CA
  • Villa Park, CA
  • Rancho Santa Margarita, CA
  • Lake Forest, CA
  • Irvine Spectrum, CA
  • Foothill Ranch, CA
  • Coto De Caza, CA
  • Coto, CA
  • Dove Canyon, CA
  • Ladera Ranch, CA
  • Ladera, CA
  • Las Flores, CA
  • San Juan, CA
  • San Juan Capistrano, CA
  • Laguna Niguel, CA
  • Laguna Hills, CA
  • Trabuco Canyon, CA
  • Dana Point, CA
  • San Clemente, CA
  • Saddleback, CA
  • South Orange County, CA

Excellant work and very courteous. Thank you!

The team was very efficient and did a clean, professional job of installing our two ceiling fans. The did a great job of explaining the controls after installation. Great job!

Outstanding and professional service. will always recommend Armes Electric for any electrical work.

Jason and Juan did an absolutely flawless job installing can lights. They left no holes in the walls or marks on the ceiling – just two lights exactly where we asked that they be installed. Your workers always do an outstanding job.

Armes Electric provides you with these services, and More..

Kitchen/Bath Remodels
Recessed Can Lighting
Picture Lighting
Accent Lighting
Under cabinet Lighting
240 Spa Runs
Convenience/Holiday Outlets
Troubleshooting

We look forward to serving all of your electrical needs.

We are strictly residential electricians. This means we know how to take care of your home in every way. We specialize in accent lighting, ceiling fans, kitchen remodels, can lighting, attic fans, and much more. Our company cleans up like no other contractor you ve seen. We vacuum up any mess with our own vacuum! All our employees are cordial and trustworthy. We are a family company and we consider our customers to be our extended family. Your satisfaction with our service is our utmost priority. Our customers generally come to us through word of mouth and our phone rings constantly.


Spring Attendee Homepage – Atlanta Home Show – Georgia s Largest Home


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The 39th Annual Spring Atlanta Home Show – March 24-26, 2017 – Cobb Galleria Centre

The largest Home Show in Georgia! Hundreds of participating companies! For THREE days only March 24-26, the Cobb Galleria transforms into a one-stop-shop for all your home improvement needs! For 39 years the Spring Atlanta Home Show has been improving home lifestyles and adding value to your largest single investment, your home. We’re proud of our ability to produce a family friendly environment and welcome you to our home.

Experience exciting and interactive sessions that can inspire you in your yard, with your decor and save you a great deal of time and money on your next remodeling job. » Click here to read more.

This year’s grand prize is a 7 LED fixture outdoor lighting package provided by Outdoor Lighting Perspectives of Atlanta. No purchase necessary – read more for all the details. » Click here to read more.

Georgia Landscape presents the Red Hare Backyard Beer Garden! Come learn about landscape design, services and products ranging from grass to fire, flowers to water, patios to recreation areas. You can chat with area experts about local landscape and options for every type of backyard. This is an interactive, educational area designed to give you the information you need to turn your backyard into an outdoor living area to enjoy for years! If all that were not enough, for a $5 donation to Hope Atlanta – the programs of Travelers Aid you can taste your way through this feature. Marietta’s own Red Hare Brewing Company will have SIX of their handcrafted brews available for your approval! Cabot Creamery will also have a sampling of cheeses. So bring your friends, enjoy some great beer and help a worthy cause! » Click here to read more.

Thanks to PMC Building Materials, members of the home improvement trade receive FREE admission to the show on Friday March 24! » Click here to read more.


Are You (Still) Painting the Picture? Ensuring High Quality Documentation in Hospice

#hospice documentation guidelines

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It’s been almost twenty years since the Health Care Finance Administration (now the Centers for Medicare and Medicaid Services ) sent a memo to hospices announcing the first widespread, in-depth review of hospice medical records and patient eligibility. Focused Medical Review, as it was called in 1994, was just the beginning of the government’s search for fraud and waste in hospice.

Prior to this action, hospices that had largely avoided widespread regulatory scrutiny were suddenly being held accountable to a much higher documentation standard than ever before. During this audit, hospices struggled to demonstrate through their documentation that patients who had already died, often within days or weeks of admission, met eligibility requirements for hospice. In the days before Webinars or online education, hospices were challenged with the means to disseminate education to their staff to teach them to “paint the picture” of medical eligibility.

Today, hospices are once again facing intense scrutiny of their documentation as Medicare Administrative Contractors (MACs) are sending notices of Probe Edits and Additional Document Requests (ADRs). The burden on staff and financial resources to respond to these audits is taking a toll on hospices under review. Once again, many hospices are finding that they lack the documentation required to paint a picture of eligibility.

The criteria used to determine eligibility for the Hospice Medicare Benefit is specific to each MAC, and changes periodically based on new prognostication tools and research. Hospices should use the disease-specific criteria outlined in each MAC’s Local Coverage Determinations (LCDs) to determine if someone is or continues to be eligible for hospice under Medicare.

Documentation of disease-specific criteria, along with supporting information such as description of the patient’s illness trajectory, pertinent co-morbid and secondary conditions, severity of symptoms, declining functional, cognitive and nutritional status, and overall burden of illness are critical to depicting why this patient will probably die within six-months or less.

All hospice staff should be fully aware of and utilize their LCD guidelines and disease-specific criteria to document eligibility for each admission and every recertification.

Ask yourself the following questions to determine if your hospice team has the education and tools that they need to paint the picture of eligibility:

Are the LCDs easily accessible to all admission and IDT staff – either on their laptop, smartphone or in a handy printed resource?

Does your team refer to LCD criteria when discussing recertification during IDT meetings?

Does each patient’s medical record include documentation regarding his or her prognosis, both upon admission and in each recertification note?

Do your physician narratives contain key elements based upon LCD guidelines that lead the reader to the conclusion that the patient is terminally ill?

Do you conduct monthly chart audits to ensure that best practices for documenting medical eligibility are being followed?

Are ALL staff trained and regularly retrained on how to document to the LCDs, including documentation of co-morbid conditions to support medical eligibility?

If you answered “No” to any of the questions below, your hospice may be at risk for financial penalties in the event of an audit. Comprehensive documentation that paints the picture of initial and ongoing eligibility is paramount to the ongoing survival of your hospice. Training, along with ongoing chart reviews, is the best insurance you can have against future MAC audits, probes, and ADRs.

Looking for an efficient and cost-effective way to teach your entire team how to document to the LCDs? The Hospice Education Network’s Disease-Specific Hospice Eligibility Determination and Documentation Series is for you!

Do you need an objective review of your documentation or compliance system? Weatherbee Resources specializes in outsourced clinical record auditing and baseline compliance audits. The Weatherbee team can also create customized onsite staff training education or conduct webinars for your entire organization. Visit http://www.weatherbeeresources.com or call 508.778.0008 today!

Medicare Administrative Contractors MAC map

Review the Palmetto LCDs (be sure to select the hospice LCDs)

Posted by Terri Maxwell, PhD APRN Vice President, Strategic Initiatives, Weatherbee Resources, Inc. Hospice Education Network Inc.