text:
|Name: _________________________
|Period: ___________________
This test consists of 5 short answer questions, 10 short essay questions, and 1 (of 3) essay topics.
Short Answer Questions
1. Mawi's father took in a homeless man and helped him. What did the man give him in return when he departed in "God's Angels"?
2. What was the name of Mawi's half-sister who joined his family in immigrating to America?
3. What would bullies draw over Mehret's locker in "Playground Warfare"?
4. What is the name of the church that agreed to sponsor Mawi's family in "A New Life"?
5. What was Mawi's father's homeland?
Short Essay Questions
1. How does Mawi describe his memories of his family as refugees in "The Camp"?
2. What did Mawi's father teach his children about strangers in "God's Angels"?
3. How does Mawi describe his interactions with bullies in "The Camp"? Who came to his aid when he was attacked?
4. What example of foreshadowing does the author employ in "A New Life"? What did the family learn about American culture in this chapter?
5. How does the author describe the Sudanese rebels in "The Camp"? Where did the author's father want to go in order to find security?
6. What memories does the author describe of his childhood home in "Memories"? What does he question about the memories?
7. Where did Mawi's family live as refugees in "The Camp"? Where did his father work?
8. Who agreed to sponsor Mawi's family in "A New Life"? What did Mawi's family make of the sights of Chicago?
9. What incident does Mawi describe of being bullied terribly in "Playground Warfare"? Who saved him?
10. What deferred Mawi's family from leaving for America in 1982 in "Coming to America"?
Essay Topics
Write an essay for ONE of the following topics:
Essay Topic 1
Describe the settings of Chicago and Wheaton, Illinois. How do the settings of Chicago and Wheaton differ? What were the author's first impressions of each? In what year did Mawi's family arrive? How much English did the members of the family speak?
Essay Topic 2
Discuss Mawi's father's sense of morality and the morality he instilled in his sons. Was the story told by Mawi's father about the boy stealing realistic for the time and place in which it occurred? What punishment did the boys face for their actions after stealing the parking meter? Why did they fear their father more than the police officer?
Essay Topic 3
Describe and discuss the impact of Tewolde's death on the narrator. How was Tewolde killed? What foreshadowing refers to this incident early in the narrative? How does Mawi describe the aftermath of the accident? How was Tewolde remembered at his funeral?
This section contains 987 words
(approx. 4 pages at 300 words per page)


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|By PR Newswire
Article Rating:
|November 9, 2012 07:45 AM EST
MOUNTAIN VIEW, Calif., Nov. 9, 2012 /PRNewswire/ -- Recipients of the 2012 Excellence in Best Practices Awards joined Frost & Sullivan to receive their recognition at a dinner banquet held Nov. 8, 2012 at the Westin La Cantera Resort in San Antonio, Texas.
The Excellence in Best Practices Awards are presented each year to companies that are anticipated to impact significant growth in their industries, have identified emerging trends before they became the standard in the marketplace, and have created advanced technologies that will catalyze and transform industries in the near future.
Awarded companies include:
Anue Systems - 2012 Global Network Optimization and Visibility Customer Value Enhancement Award
BioCell Technology, LLC - 2012 North American Collagen Peptide in Personal Care New Product Innovation Award
Bio-Rad Laboratories, Inc. - 2012 North American Quantitative and Digital PCR Instrumentation Market Penetration Leadership Award
BRS Labs - 2012 North American Intelligent Video Analytics New Product Innovation Award
Cargill, Incorporated - 2012 North American Phytosterols Product Leadership Award
Cbeyond - 2012 North American VoIP Access and SIP Trunking Services Competitive Strategy Leadership Award
Centric Software - 2012 Global Retail, Fashion and Apparel PLM Product Differentiation Excellence Award
Cisco - 2012 Global Smart Grid Enabling Technology Award
Cisco Systems - 2012 Global Videoconferencing Infrastructure Market Share Leadership Award
Detection Innovations, Inc. - 2012 Global Machine to Machine Solutions Product Differentiation Excellence Award
Digium - 2012 Global SMB Communications Platforms Growth Leadership Award
Fallbrook Technologies Inc. - 2012 North American Powertrain Market Growth Capital Investment Opportunity Award
General Vision Inc. - 2012 North American Cognitive Computing Processors for Pattern Recognition New Product Innovation Award
Grote Industries - 2012 North American Commercial Vehicle Safety Lighting Technology Leadership Award
Humedica, Inc. - 2012 North American Health Data Analytics Customer Value Enhancement Award
Identive Group - 2012 Global Identification and Security Product Line Strategy Award
Intel-GE Care Innovations™ - 2012 North American Remote Patient Monitoring Competitive Strategy Leadership Award
KineMed, Inc. - 2012 North American Pathway Based Drug Discovery Enabling Technology Award
Level 3 Communications - 2012 United States MPLS/IP VPN Services Competitive Strategy Leadership Award
Liquid Robotics - 2012 North American Remote Operated Vehicles for the Oil and Gas Industry Enabling Technology Award
Navitas Solutions, Inc. - 2012 North American Battery Management Systems Technology Innovation Award
OnAsset - 2012 North American M2M Enabled Freight Intelligence Industry Customer Value Enhancement Award
Openwave Messaging, Inc. - 2012 North American Mobile Messaging Product Line Strategy Award
Proofpoint, Inc. - 2012 North American Email Content Security Product Differentiation Excellence Award
ShareThis - 2012 Global Social Analytics Technology Innovation Award
ShoreTel's Cloud Division - 2012 North American Hosted IP Telephony and UC Services Customer Value Enhancement Award
Sony Electronics - 2012 U.S. Consumers' Choice Award: Customer Contact Experience for PC Manufacturers
Subex - 2012 Global Communication Service Provider Financial Assurance Market Share Leadership Award
Sunshine Heart, Inc. - 2012 North American Heart Failure Treatment New Product Innovation Award
Teleperformance -
2012 North American Contact Center Outsourcing Customer Value Enhancement Award
2012 Latin American Contact Center Outsourcing Competitive Strategy Leadership Award
2012 Latin American Contact Center Outsourcing Green Excellence Award
Telogis - 2012 North American Light Commercial Vehicles Telematics Growth Leadership Award
TeraRecon, Inc. - 2012 North American Medical Imaging Informatics New Product Innovation Award
Time Warner Cable Business Class - 2012 United States Business Communications Executives' Choice of Primary Network Service Providers: Company with the Highest Loyalty Award
VanDyne SuperTurbo, Inc. - 2012 North American Automotive Powertrain New Product Innovation Award
Vertical Communications, Inc. - 2012 North American SMB Unified Communications Competitive Strategy Leadership Award
Volvo Trucks - 2012 North American Commercial Vehicle Repair & Maintenance Customer Value Enhancement Award
Webroot Inc. - 2012 North American Endpoint Security Products Product Differentiation Excellence Award
Windstream -
2012 North American VoIP Access and SIP Trunking Services Market Share Leadership Award
2012 United States Retail Carrier Ethernet Services Competitive Strategy Leadership Award
Xenex Healthcare Services - 2012 United States Hospital Safety and Prevention Technologies New Product Innovation Award
Frost & Sullivan's Best Practices Awards recognize companies in a variety of regional and global markets for demonstrating outstanding achievement and superior performance in areas such as leadership, technological innovation, customer service and strategic product development. Industry analysts compare market participants and measure performance through in-depth interviews, analysis and extensive secondary research to identify best practices.
For further information about the Awards Banquet, please contact [email protected] or a member of the Best Practices Team.
About Frost & Sullivan
Frost & Sullivan, the Growth Partnership Company, works in collaboration with clients to leverage visionary innovation that addresses the global challenges and related growth opportunities that will make or break today's market participants.
Our "Growth Partnership" supports clients by addressing these opportunities and incorporating two key elements driving visionary innovation: The Integrated Value Proposition and The Partnership Infrastructure.
- The Integrated Value Proposition provides support to our clients throughout all phases of their journey to visionary innovation including: research, analysis, strategy, vision, innovation and implementation.
- The Partnership Infrastructure is entirely unique as it constructs the foundation upon which visionary innovation becomes possible. This includes our 360 degree research, comprehensive industry coverage, career best practices as well as our global footprint of more than 40 offices.
For more than 50 years, we have been developing growth strategies for the global 1000, emerging businesses, the public sector and the investment community. Is your organization prepared for the next profound wave of industry convergence, disruptive technologies, increasing competitive intensity, Mega Trends, breakthrough best practices, changing customer dynamics and emerging economies?
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SOURCE Frost & Sullivan
It is one thing to build single industrial IoT applications, but what will it take to build the Smart Cities and truly society changing applications of the future? The technology won't be the problem, it will be the number of parties that need to work together and be aligned in their motivation to succeed. In his Day 2 Keynote at @ThingsExpo, Henrik Kenani Dahlgren, Portfolio Marketing Manager at Ericsson, discussed how to plan to cooperate, partner, and form lasting all-star teams to change t...
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Connected devices and the industrial internet are growing exponentially every year with Cisco expecting 50 billion devices to be in operation by 2020. In this period of growth, location-based insights are becoming invaluable to many businesses as they adopt new connected technologies. Knowing when and where these devices connect from is critical for a number of scenarios in supply chain management, disaster management, emergency response, M2M, location marketing and more. In his session at @Th...
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Jun. 24, 2016 04:15 PM EDT Reads: 1,057
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SYS-CON Events announced today that ReadyTalk, a leading provider of online conferencing and webinar services, has been named Vendor Presentation Sponsor at the 19th International Cloud Expo, which will take place on November 1–3, 2016, at the Santa Clara Convention Center in Santa Clara, CA. ReadyTalk delivers audio and web conferencing services that inspire collaboration and enable the Future of Work for today's increasingly digital and mobile workforce. By combining intuitive, innovative tec...
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Amazon has gradually rolled out parts of its IoT offerings, but these are just the tip of the iceberg. In addition to optimizing their backend AWS offerings, Amazon is laying the ground work to be a major force in IoT - especially in the connected home and office. In his session at @ThingsExpo, Chris Kocher, founder and managing director of Grey Heron, explained how Amazon is extending its reach to become a major force in IoT by building on its dominant cloud IoT platform, its Dash Button strat...
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The cloud market growth today is largely in public clouds. While there is a lot of spend in IT departments in virtualization, these aren't yet translating into a true "cloud" experience within the enterprise. What is stopping the growth of the "private cloud" market? In his general session at 18th Cloud Expo, Nara Rajagopalan, CEO of Accelerite, explored the challenges in deploying, managing, and getting adoption for a private cloud within an enterprise. What are the key differences between wh...
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19th Cloud Expo, taking place November 1-3, 2016, at the Santa Clara Convention Center in Santa Clara, CA, will feature technical sessions from a rock star conference faculty and the leading industry players in the world. Cloud computing is now being embraced by a majority of enterprises of all sizes. Yesterday's debate about public vs. private has transformed into the reality of hybrid cloud: a recent survey shows that 74% of enterprises have a hybrid cloud strategy. Meanwhile, 94% of enterpri...
Jun. 24, 2016 09:45 AM EDT Reads: 1,158
SYS-CON Events announced today that Bsquare has been named "Silver Sponsor" of SYS-CON's @ThingsExpo, which will take place on November 1–3, 2016, at the Santa Clara Convention Center in Santa Clara, CA. For more than two decades, Bsquare has helped its customers extract business value from a broad array of physical assets by making them intelligent, connecting them, and using the data they generate to optimize business processes.
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There are several IoTs: the Industrial Internet, Consumer Wearables, Wearables and Healthcare, Supply Chains, and the movement toward Smart Grids, Cities, Regions, and Nations. There are competing communications standards every step of the way, a bewildering array of sensors and devices, and an entire world of competing data analytics platforms. To some this appears to be chaos. In this power panel at @ThingsExpo, moderated by Conference Chair Roger Strukhoff, Bradley Holt, Developer Advocate a...
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There is little doubt that Big Data solutions will have an increasing role in the Enterprise IT mainstream over time. Big Data at Cloud Expo - to be held November 1-3, 2016, at the Santa Clara Convention Center in Santa Clara, CA - has announced its Call for Papers is open. Cloud computing is being adopted in one form or another by 94% of enterprises today. Tens of billions of new devices are being connected to The Internet of Things. And Big Data is driving this bus. An exponential increase is...
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industrial company for a multi-year contract initially valued at over $4.0 million. In addition to DataV software, Bsquare will also provide comprehensive systems integration, support and maintenance services. DataV leverages advanced data analytics, predictive reasoning, data-driven diagnostics, and automated orchestration of remediation actions in order to improve asset uptime while reducing service and warranty costs.
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The Practical Pig's Car Goon Twist attraction during repairs
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Recent Questions - Physical Fitness Stack Exchange most recent 30 from fitness.stackexchange.com 2016-06-25T03:22:36Z http://fitness.stackexchange.com/feeds http://www.creativecommons.org/licenses/by-sa/3.0/rdf http://fitness.stackexchange.com/q/31320 0 What is more important in fish oil supplements - concentration of EPA + DHA or just total volume? SuperR http://fitness.stackexchange.com/users/21767 2016-06-24T19:55:40Z 2016-06-24T19:55:40Z
There are all sorts of fish oils with different concentrations of EPA + DHA.

For example, one soft-gel may be 1000mg of fish oil but contain 180mg of EPA, 120mg of DHA and 700mg of "something else".

Another (more expensive) soft-gel may be a 1000mg in volume but contain 400mg of EPA, 500mg of DHA and 100mg of "something else".

That "something else" is still fish oil right? Is that stuff not beneficial in it's own right? Or is the only beneficial "stuff" the EPA and DHA?

The reason I ask is because there are more expensive concentrated brands of fish oil which are more expensive. However, if you do the math, you could get up to double the EPA+DHA concentration if you buy a large volume of fish oil soft-gels for the same price. The only downside is you would have to swallow 3x the pills (but who really cares).

If that "other stuff" inside the fish oil is beneficial as well, then boom, you are really getting a bang for your buck. But if it is harmful in some way, then going with the more expensive, higher concentrated oil would be better.
 http://fitness.stackexchange.com/q/31318 0 Is the "New Australian Method for Back Pain" scientific? tba http://fitness.stackexchange.com/users/10241 2016-06-24T18:05:35Z 2016-06-24T18:05:35Z
Jemmett's Spinal Stabilization book claims that a new "Australian method" to back pain developed by "Carolyn Richardson, Julie Hides, Paul Hodges and Gwen Jull" has revolutionized back PT.

Is there high-quality scientific evidence that this is true? I couldn't find any Google scholar results for "Australian method" "back pain".
 http://fitness.stackexchange.com/q/31316 0 How to make protein powder dissolve into liquid consistency everytime? [on hold] James http://fitness.stackexchange.com/users/21766 2016-06-24T11:07:23Z 2016-06-24T11:41:42Z
I have been using sunwarrior protein powder and mixing in glass with spoon. I noticed that sometimes it would dissolve quickly and give a awesome liquid like consistency. However at other times I noticed that it looked like liquid but when I drink it it contains grains of powder. I am only using the powder(sunwarrior) and water and don't want to add anything just yet.

Today I tried a blender bottle however although it creates the liquid look and foam on top, when drinking I could still taste little grains.

Wheather I use the glass or the blender when the solution is almost finish there is like half a teaspoon of powder which didn't fully dissolve which shows that it hasn't fully dissolved and hence the a bit grainy.

However on other occasaion and when using glass it becomes purely like water and no small amount of powder comes out at end. There must be something I'm doing when using the glass which on certain occasions causes it to liquidify quickly sometimes but not other times. The blender bottle didn't solve my problem. Does anybdoy know what I may be doing wrong and how I can get a liquid consistency(without slight grain taste) everytime? There are no clumps, it's just i taste little grains and I don't want that. I want near complete liquid where grains are not noticeable.

It's just speculation but sometimes it dissolves quickly while not others. Maybe there are some factors causing this.
 http://fitness.stackexchange.com/q/31311 0 Diabetes Destroyer Review? user21762 http://fitness.stackexchange.com/users/0 2016-06-23T22:03:02Z 2016-06-23T22:03:02Z
what about this review? any body bought it?Diabetes Destroyer Review
 http://fitness.stackexchange.com/q/31306 0 Is it healthy to eat cereal-like food instead of rice or pasta each meal five days a week? [on hold] Tim http://fitness.stackexchange.com/users/163 2016-06-23T11:33:55Z 2016-06-23T12:17:27Z
The pantry in my workplace has various kinds of cereal-like food, which might contain some dry berries or bran or ..., and look good. It doesn't offer beans, pasta or rice.

I know cereal-like food is usually eaten as breakfast. So I wonder if it is healthy to eat cereal-like food instead of beans, pasta or rice for three meals a day, for 5 days each week?

p.s. The pantry has no salad, but fresh carrot, celery, blueberry, black raspberry, strawberry, banana, apple, and orange. It also has eggs, yogurt, cheese, bars of mixed nuts. I base my three meals a day on the pantry.

Thanks.
 http://fitness.stackexchange.com/q/31303 1 Maitaining current form Herokiller http://fitness.stackexchange.com/users/12044 2016-06-23T06:17:20Z 2016-06-23T07:21:29Z
I'm interested in maintaining current physical form with minimal training time, including situations with forced breaks from training.

Usually I train 3 times a week for about 80-100 minutes, most 3-4 sets of 8-10 reps (last reps being around failure in base exercises)

Brief description:

day 1: chest + triceps, bench and inclined bench, dumbbell chest fly, weighted bars, isolated triceps day 2: back + biceps, weighted pull ups, lat pull down, cable row, weighted hyperextension, isolated biceps day 3: legs + shoulders, squats, leg press, seated and lying leg curls, shoulders

Suppose I stopped increasing weights at certain point, and routine and diet is fixed, will I keep my form? People often write that routine needs to be changed often.

How can this routine be changed in order to reduce overall time of training?

Also, now I'm taking a forced break from training due to wrist injury(it's going to be a month or two), I'm on a small caloric deficit and visually losing some fat and muscles.

What are best strategies to recover to the same form I had before break after I start exercising again?
 http://fitness.stackexchange.com/q/31300 3 Does SLOW reps have the same effect as high resistance Olav http://fitness.stackexchange.com/users/2094 2016-06-22T17:39:30Z 2016-06-23T07:37:12Z
If I do my reps slower, will it have a similar effect to increasing resistance?

With respect to building muscles for example?

Assume I go to failure / same level of fatigue in both cases.
 http://fitness.stackexchange.com/q/31298 1 What are the differences between a "Cutting Workout" and a "Bulking Workout"? JJosaur http://fitness.stackexchange.com/users/19738 2016-06-22T13:41:59Z 2016-06-23T15:34:30Z
Using the JFit categories here. The workouts fit into Bulking, Cutting, General, Sport. I understand that progression on a cut will be limited and you should assume that both the cut or bulk are clean (good macros) and accompanied with good sleep.

What (if any) are the key differences in terms of progression, exercises and volume of a program that is designed to be paired with a bulk (like German Volume 10x10) and those which are meant to be paired with a cut (ICF).
 http://fitness.stackexchange.com/q/31297 2 Runners advice for Night Trails User999999 http://fitness.stackexchange.com/users/18339 2016-06-22T11:31:36Z 2016-06-22T14:11:14Z
Next autumn & winter we would like to participate in some nighttime-trails. The distance is in no way a problem for us. But as we are unfamiliar with nighttime trailruns, I was wondering if someone here might help us along. If he (or she) might give us some tips,tricks,advices from personal experience. With regards to visibility, fighting sleepiness & fatiguee, handling the dropping temperature, avoiding unfriendly wildlife, faults you made on your first night trail,...

I know this question might be to broad. Therefor I apologize! I've read up on some internet posts but they seem extremely general. Some links I've found so far:

tips-for-trail-running-at-night

basic-tips-for-trail-running-at-night

tips-for-night-trail-running

Any advice would be dearly appreciated!
 http://fitness.stackexchange.com/q/31293 5 risks of running a marathon without adequate preparation Ale http://fitness.stackexchange.com/users/18245 2016-06-22T05:33:56Z 2016-06-22T16:22:57Z
I'm discovering the running and I like it.

I currently have race two 10km events (1 hour) and one 22km (2h 15') autonomy in a park.

During the 20km race I had very little bad knee, perhaps due to the fact that the path had many ascents and descents.

Currently I can train for 5/7km no more than once a week, but I would try to run a marathon.

More than this run I go to swim twice a month (about 1h+30') and 2/3 time cycling (about 4/5h each time).

I do not care the end time (the limit is 5 hours and I should be able to do it), but I want to finish it.

What risks could meet without adequate preparation?

 http://fitness.stackexchange.com/q/31289 0 Combining both LISS (or HIT) with HIIT for cardio and body strengthening [on hold] Avi http://fitness.stackexchange.com/users/19512 2016-06-21T16:31:45Z 2016-06-21T18:32:30Z
I would like to combine both LISS (Low-Intensity Sustained State) and HIIT (high intensity interval training) for strengthening my body and improve my cardio and aerobic for sparring in martial arts (I have no air after 3 rounds). I use the Body by Science method for LISS and Convict Conditioning for strengthening my body. I do HIIT twice a week in my martial arts lessons. I'm 43 years old and in quite good fitness but not good enough for intense sparring (and my body is not so strong, I'm quite thin). I do training one day on and one day off. In the days I do not train martial arts I do exercises at home in Body by Science like this and Convict Conditioning at home. What is the best way to integrate them. Both methods claim there is no need for further cardio training. In addition, Body by Science claim the body must rest for a week so do I ruin the method? What is the right and appropriate training for me?
 http://fitness.stackexchange.com/q/31285 12 What's the deal with those raw eggs eaten by Rocky before training DontVoteMeDown http://fitness.stackexchange.com/users/21728 2016-06-21T12:44:40Z 2016-06-23T22:06:57Z
I'm entering on this fitness life now, aged almost 30. I never used to care about it, but I realize I'm late on this as I have stopped all my sporting life and become sedentary. I've been in the gym for about 2 months and I'm learning about training and nutrition stuff. I realized how much feeding before training is important to provide energy so I can put in my best on the activities. I've started eating fruit just before the training and this just made a big difference to my training.

So I started wondering what's the deal with the eggs eaten by Rocky in the first movie, where he eats about 3 raw eggs before starting training.
 http://fitness.stackexchange.com/q/31284 0 Weight loss stopped (even gaining a bit weight) [on hold] Peter http://fitness.stackexchange.com/users/21726 2016-06-21T11:45:22Z 2016-06-21T14:07:32Z
I've started excercising and following diet to lose weight this January. I weigh 110 kilogramms now, and I was somewhere around 125 before. I've lost the first 10 kgs in one month, now nearly nothing, it totally stopped. I'm usually eating 60-80g of carbohydrates and 140g protein, which comes from chicken, fish, vegetables, and fruits. I take absolutely no sugar, and no wheat. I excercise 2-3 times a week, one hour of jumpy-runny kind of cardio (no more time for that).

I'm a little confused about a lot of things:

some articles say that I should take more carbs because my body is starving, but they are also calculating with more excercise, if I'd stick with 100-140 gramms, I'd literally eat the same meals like before I started

they also mention that I need at least one gramm of protein per 1kg of body weight, but some say that per lean body mass, which is about 60 gramms, considering that ~50% of my body is fat (if the measuring device is correct)

nearly every source states that 5-6 meals a day is the best for losing weight, but I'm not sure that then the glycogen breakdown even starts?

I've been thinking about following the ketogenic diet as well, but I'm not sure if the amount of fat it advises is good for me? I mean if I don't really count calories, only carbs, it's all right?

if not, how much calories should I take, and how is that broken down into carbs, protein, and fat?

Thank you really-really much in advance!
 http://fitness.stackexchange.com/q/31280 2 Missing mounting brackets for doorway pull bar. Alternatives? user52505 http://fitness.stackexchange.com/users/21721 2016-06-20T20:30:53Z 2016-06-21T19:41:09Z
I recently got a pull up bar from a friend, but he was missing the mounting brackets/cups to put it up in the doorway. Since I can't find the mounting brackets sold separately anywhere on the internet, I'm thinking of heading to the hardware store to find an alternative.

The pull up bar is similar to this: https://www.amazon.ca/Everlast-EX2405BK-Chinning-Sit-Black/dp/B00091RXLY/ref=sr_1_1?s=sports&ie=UTF8&qid=1466453777&sr=1-1&keywords=pull+up+bar

Plumbing flanges are unlikely to work because the molding on our doorways protrudes (inwards) and is exactly the same size as the diameter of the bar, so there is no space for the outer ring (though, I could only screw it in in 2 places — the top and the bottom)

I am considering trying a PVC cap, with holes drilled into the bottom, though I have concerns about it's ability to hold up my weight.

Any other ideas or suggestions? Do you know where I can get pull up bar mounting brackets? Do you think a PVC cap will hold?
 http://fitness.stackexchange.com/q/31269 0 I tried a new diet and I think my blood sugar is too low, do I need more carbs? newz2000 http://fitness.stackexchange.com/users/21713 2016-06-20T01:28:35Z 2016-06-21T05:48:02Z
My wife and I started the "whole 30" diet, which is a little more strict than paleo but for 30 days. My hope was that I would build better habits and identify some foods that may be causing problems. We eat a lot of fresh veggies, some fruit, eggs and a variety of meats.

After a week my energy level was low. I cut down on my workouts and I started drinking more caffeine. I was mentally exhausted by mid-afternoon and when I came home from work (4:00pm) I was pretty much useless. No conversation, no chores, no exercise.

I did a medium length bike ride (28 miles) on day 8. Day 9 I was a wreck. On day 10 I tried to go to spin class but had to walk out after 20 min. I came home, laid down on the couch and couldn't even lift my phone up to look at it.

I am 5'11 (1.8 meters) and 200lbs (91kg) with 23% body fat. On an ideal week I lift weights for an hour on Mon and Wed, do a 40 min walk 5-6 times and bike about 90 miles over 3 days (10 hours total exercise).

I weighed myself on day 10 and I was down to 198lbs (down 2lbs) but 25% body fat (up 2% points), which leads me to believe I've lost 2lbs of lean mass in 10 days. That is not good.

Last summer I lost 30lbs and my goal is to lose another 25lbs this summer.

I like the principle of the "whole 30" and paleo diets, but I have to make a change or it's not going to work.

Does this sound like a blood sugar problem, and if so, any suggestions on how to adjust my diet?

Note: After day 10 I made a concerted effort to boost my carbs. I started eating at least one serving of sweet potato a day, but tried to add additional quality carbs with green beans and some additional fruit. I'm on day 16 now and I'm not sure there's been much improvement.

Maybe I'm recouping lost energy, maybe I'm not eating enough carbs, or maybe that's not the right solution at all. I wish I knew.
 http://fitness.stackexchange.com/q/31263 5 Are there advantages to breaking up a workout? ThanksInAdvance http://fitness.stackexchange.com/users/21710 2016-06-19T18:34:10Z 2016-06-24T06:51:42Z
For instance, say you're doing an HST (Hypertrophy-Specific Training) routine, and you can choose between Routine 1 ad Routine 2. In Routine 1 you would be doing 3 full-body sessions per week, and in Routine 2 you would be doing 6 upper and lower body sessions per week. Assuming that each workout is done on a separate day at roughly the same time of day, are there any advantages to one routine over the other?

 Routine 1:

S M T W T F S F F F

 Routine 2:

S M T W T F S U L U L U L

Also, I do realize that there may be psychological and time advantages in both routines; however, I am asking strictly from a physiological/physical standpoint.
 http://fitness.stackexchange.com/q/31257 2 I am a track athlete, Does gymnastic help a track and field athlete, in terms of getting faster, pole vault and throwing? Vincent http://fitness.stackexchange.com/users/0 2016-06-18T04:33:44Z 2016-06-22T22:18:31Z
I do the decathlon and am very weak in the pole vault, do you guys think that gymnastic will aid in strength and help increase my athletic ability. Does it aid in speed also I want to really know
 http://fitness.stackexchange.com/q/31217 2 Can't run can't bike.. how do I maintain cardio? user1833028 http://fitness.stackexchange.com/users/19585 2016-06-16T13:53:54Z 2016-06-23T18:25:51Z
So, I am normally a bicycle commuter. Also, I am normally late, so I sprint through company property (occasionally being chastised) to get into position on time.

Sadly, I have been diagnosed with tendinitis (I imagine from the treadmill.) Therefore, I've been told I should try not to run or bike for two weeks!

Therefore, my question is: what can I do to maintain cardio? My access to a lap pool is limited, but it exists.

Edit: Looking, basically, for what cardio I can do that does NOT involve my lower legs supporting much weight or taking a beating. The nature of the restrictions are to rest my left Achilles, if possible.
 http://fitness.stackexchange.com/q/31109 9 How effective are standing desks? JJosaur http://fitness.stackexchange.com/users/19738 2016-06-07T14:59:28Z 2016-06-24T18:10:50Z
How effective at improving flexibility/posture/fitness/general health is using a standing desk instead of a sitting desk?
 http://fitness.stackexchange.com/q/29922 0 When to take Epsom salt baths / use Magnesium oil? Olav http://fitness.stackexchange.com/users/2094 2016-05-22T11:45:18Z 2016-06-22T21:37:52Z
During what period of time after a training session is it optimal to take an Epsom salt bath or use magnesium oil, when you expect DOMS/muscle soreness?
 http://fitness.stackexchange.com/q/29811 1 Getting back in shape after being bedridden for 4 months user4694 http://fitness.stackexchange.com/users/20326 2016-05-12T12:07:46Z 2016-06-22T08:13:36Z
Background:I have suffered a severe shoulder injury, and have therefore been completely bedridden the last four months. This has resulted in some extra kilos around my belly, enough to make me look like a stuffed sausage in some of my clothes. Under normal circumstances I would consider myself an athlete (I did an Ironman, a marathon and a few long bike races last year). I've never had problems getting in good shape fast, but this time everything goes much slower.

Current status: Due to the shoulder injury, there are a few exercises I can't do (for instance running, swimming and pushups).

Until now, (after the injury), I've been riding my bicycle trainer for 30-60 minutes (approx. 30 km/h, 180 rpm, 80% of max HR), followed by a three sets of 30 crunches, 60 sec plank, and 10 reps with the superman. In the end I do my mandatory shoulder exercises (resistance band for the rotator cuff, something like this).

The time I have available is 60 minutes three times and 90 minutes once a week.

Question: Is there something I can change, in order to loose some belly weight faster, not including dieting (I have found a lot of information about this already). I'm pretty much restricted to the exercises I mentioned above, so it's mainly a question of intensity, order, number of repetitions etc.

Would it be better to do intervals on the bike? Lower intensity? Or maybe mix it up: 10 minutes with high intensity on the trainer, then one set of core exercises, 10 minutes on the trainer etc.?

Note 1: I know it's not possible to reduce the fat percentage on one body part alone. However, my belly is the only place I have (visible) fat. My arms are skinny and my legs are well-trained.

Note 2: I have no problems with motivation.

Note 3: I do not have a gym membership.

Note 4: My BMI is exactly 25, so I'm not "overweight". The problem is that all the kilos are on my belly.
 http://fitness.stackexchange.com/q/29051 5 Relation between upper body workout and wrist size Torquemada http://fitness.stackexchange.com/users/19566 2016-02-28T16:54:15Z 2016-06-23T22:34:57Z
Does regular upper-body workout lead to an increase in the circumference of the wrist? I'm thinking of exercises like bench press, curls, etc.
 http://fitness.stackexchange.com/q/28057 2 Regain fitness for basketball after a long layoff Aseem Sharma http://fitness.stackexchange.com/users/18594 2015-11-22T08:05:15Z 2016-06-21T14:24:37Z
I am 23 years of age and played basketball professionally.

Back when I was in practice, I had dynamic and explosive fitness to move quickly with strength. After my 2 year layoff, I have put on some weight, and am now 5'7" and 76 kilos. I am on track to lose weight and reach my ideal weight that would be around 68-70 kilos.

I need to know how I can achieve my previous fitness since due to this layoff, as my lower body has gotten really weak. There is some kind of swelling between my lower knee joint between my calf muscles and hamstrings due to de-conditioning. I can barely jump like I use to previously.

Please suggest what kind of exercises I should include in my routine of losing weight so that I can achieve the fitness of a basketball player that I previously had.
 http://fitness.stackexchange.com/q/18817 3 How does Vo2max dieting differ from normal gym more endurance-training dieting? How much intake is enough? hhh http://fitness.stackexchange.com/users/6066 2014-09-02T00:37:34Z 2016-06-24T17:10:13Z
This is my second week of vo2max training where each week has 2 rest days. I train the whole body during the week. I need to eat a lot. If I am not eating enough, catabolism wakes me up. I already took 2 times more vitamins:

where minerals are Mg, Fe, Zn, Mangane, Copper, Selen, Crome.

than usually and doubled casein for the night -- after that muscles started to feel nice again. When I feel stiffness, taking more vitamins relaxes the body: it works, I don't know why. It is almost impossible to know which is enough: I train by feeling -- as large weights as possible, long pauses and as many times as possible. I train in gym.

Is there any guidelines how much more vitamins, nutrition etc should a healthy athletic person take during vo2max week?
 http://fitness.stackexchange.com/q/18484 1 Bizarre heart rate while running [on hold] half-pass http://fitness.stackexchange.com/users/10391 2014-08-05T05:40:02Z 2016-06-23T04:55:31Z
I went for a 4-mile run today and monitored my heart rate much more closely than usual. What I found was surprising. For the first 10-15 minutes of the run, which was gently uphill, my heart rate was only around 88-90 bpm. But, on the slightly downhill trip home (the last 10 min of the run), my heart rate was strangely high – in the mid-160s. Normally, my HR doesn't seem to break 170 even during bouts of intense cardio, such as HIIT on the stationary. Throughout the run, I maintained a pretty steady pace and perceived exertion (not intense, a bit faster than comfortable), averaging 7:45 min/mi.

I first suspected that the heart rate monitor was initially only picking up every other heartbeat, since the initial readings were roughly half the later readings. But I verified many of these readings by checking my pulse manually, so I know they're real.

Also, I've had something similar happen occasionally with other cardio activities. Once I manually took my pulse several times after challenging sets of burpees and was shocked to get languid pulses in the 50s given how hard I felt I was working.

If it's relevant, I am not a runner. I do steady-pace running only infrequently – say, 3-4X/month – although I am otherwise quite active. My resting pulse is around 45 bpm.
 http://fitness.stackexchange.com/q/16210 6 Running with bunions: technique, shoes, etc GoodWillHunter http://fitness.stackexchange.com/users/8434 2014-04-21T08:02:08Z 2016-06-23T01:44:31Z
Are there any other runners out there who have bunions on their feet? If so, has running led to any long-term or short-term health problems? Is it worthwhile to get a special pair of shoes to accommodate the bunions?

I've heard conflicting answers on this, from both professionals and well-meaning people who don't necessarily have bunions themselves. I don't think my bunions have affected my running, though I've been told that I walk on the outside of my feet, and when I run, my feet roll towards the inside, onto my bunions. I've also been told that my bunions raise the risk of hurting my arch, or cause me to run flat-footed. I was told this by a running-shoe salesman, however; in reality, how bad is it to be running flat-footed? Having read Born To Run, the jury's still out for me there.

My bunions are the type where the joint where my big toe meets my metatarsus (the inside edge of the balls of my feet) protrudes outwards significantly more than usual. The bones of my feet have just grown that way; it's not a case of chafing leading to calluses, as I originally thought bunions were.

(Also, for reference, I'm just an amateur runner; I don't work on any particular goals except for continuous running, and I usually just toss on my shoes and go without planning much beforehand.)
 http://fitness.stackexchange.com/q/4588 5 Push ups and (blood?) pressure? Chelonian http://fitness.stackexchange.com/users/1789 2011-11-13T05:05:16Z 2016-06-24T06:56:10Z
When I do push-ups, I notice pronounced pressure increases in my head, eyes, ears. I do 20, with what I hope is top form: slow (about up and down in 2 sec), chest and forehead touch floor each time, raised all the way up. I just did 20 and my ears feel sort of ringing. Note that I don't find doing 20 terribly hard--I feel I could push myself to do perhaps 25 or maybe 30 if I really strained. But even after about 15, I begin to feel that pressure. I do breathe in and out throughout the movements, though not in any particularly careful way.

I do not get this when I do bench press or any other weight lifting (preacher bench curls, pull ups, tricep press downs), even to near failure with high reps (15, 12, 10, 8), nor with jogging/running. Just push-ups.

Considering that at least one person has had eye capillaries rupture due to push ups, and 2 people have had aortic aneurysm dissections following push ups (or, of course, other intense weight lifts), this has me concerned. (Sure, of course, millions haven't had such things happen, too...just erring on the side of caution).

Push ups strike me as a simple and good exercise I can do at home easily, and a good measure of muscular endurance, but I am rather put off them every time I feel this unpleasant pressure.

How common is this? Is there a way to avoid it and do the push ups more safely? Or perhaps are push ups just not for all people (as if there are some systemic differences that happen during push ups in only some people)? I am willing to try altering my approach, but if I can't get around the "pressure problem", push ups are out of my repertoire.
 http://fitness.stackexchange.com/q/4142 2 How to avoid toe injury in martial arts? Joze http://fitness.stackexchange.com/users/2111 2011-10-07T09:51:02Z 2016-06-22T04:05:22Z
How do I prevent injuries in my toes while kickboxing? Specially the big toe and the small one?

I have heard about taping but is there a strengthening exercise to prevent injury or such? If you suggest taping I'd like to know specifically how.
 http://fitness.stackexchange.com/q/428 43 How do I properly breathe while swimming freestyle? KronoS http://fitness.stackexchange.com/users/30 2011-03-04T15:04:24Z 2016-06-22T18:14:18Z
While using the freestyle technique of swimming, what is the proper way to breathe? Is using the nose to breathe out while under better or is there any difference? Is there a specific number of 'strokes' that should be done before taking a breath? I've been told to alternate your breathing sides, and to always make them opposite of the arm raised out of the water, is this correct?
 http://fitness.stackexchange.com/q/21 54 Effect of protein intake on muscle recovery intuited http://fitness.stackexchange.com/users/39 2011-03-01T20:01:09Z 2016-06-23T22:04:43Z
"Protein shakes" and other high-protein dietary strategies are believed by some to improve muscle recovery times after workouts. However, there is some opinion to the contrary: that protein intake beyond a normal level does not result in quicker recovery times. Does ingesting huge amounts of protein actually help speed muscle recovery after workouts?


text:
Forever Drive
| |
Release Date: November 15, 2011
App Store Update: November 7
November 7, 2011 - Monkey Island, Forever Drive, Worms, Sword of Fargoal and more in today's App Store Update.
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text:
Practice Management
Chronic Care Management
Practice Management
Latest News
New Updates to Medical Marijuana Course Cover Conditional Use
The New York State Department of Health is pleased to announce updates to the 4-hour Department-approved online course for medical use of marijuana course developed by TheAnswerPage, an established online medical education provider.
The course has been updated to include additional information regarding the use of medical marijuana in each of the conditions covered in the Compassionate Care Act, based on available scientific evidence.
The cost to take the course is $249. Practitioners taking the course will earn 4.5 hours of CME credit upon successful completion of the course. The new material is also accessible through TheAnswerPage's website at no extra cost for those who have already taken the medical use of marijuana course.
The course may be accessed by clicking on the following link: https://www.theanswerpage.com/library.php?sid=9.
Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must complete this course. Please visit the Department's web page for more information about becoming a registered practitioner: http://www.health.ny.gov/regulations/medical_marijuana/practitioner/.
All Providers Must Take Action by July 1, 2016 to Avoid Medicare Payment Adjustments
The streamlined hardship applications reduce the amount of information that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must submit to apply for an exception. This new, streamlined application process is the result of Patient Access and Medicare Protection Act (PAMPA) , which established that the Secretary may consider hardship exceptions for "categories" of EPs, eligible hospitals, and CAHs. Hardship exception applications are due by July 1, 2016 for EPs, eligible hospitals, and CAHs.
Applications and Instructions
The Medicare EHR Incentive Program 2017 hardship exception instructions and application for EPs and eligible hospitals are available on the Payment Adjustments & Hardship Information webpage of the EHR Incentive Programs website. Please visit the EHR Incentive Programs. FAQs page for answers to specific hardship exception questions.
Please note: CAHs should use the form specific for the CAH hardship exceptions related to an EHR reporting period in 2015. CAHs that have already submitted a form for 2015 are not required to resubmit .
Guide to Help Primary Care Practices Integrate Behavioral Health Services
A new guide is offering primary care practices practical guidance and a flexible framework to increase their ability to serve patients with depression, anxiety, and other common mental health issues.
Produced by Montefiore Health System and United Hospital Fund, Advancing Integration of Behavioral Health into Primary Care: A Continuum-Based Framework delineates the specific steps to advancement: identifying preliminary, intermediate, and advanced stages of eight different components of behavioral health practice integration, and provides broader guidelines on getting started, including establishing priorities, articulation of goals, and determination of existing and potential resources.
As the guide explains, behavioral health disorders contribute to decreased quality of life and increased health care costs, yet they frequently go undiagnosed and untreated, with only 22 percent of adults with common mental health disorders receiving care. Even when conditions are identified by primary and specialty care providers, patient follow-up on referrals is low. These factors make increasing capacity for treatment of behavioral health conditions in primary care settings a core strategy for improving access to and quality of care.
"With so many alternative payment models being developed and the transition to value-based care, many physicians in practice, especially in primary care medicine, are eager for just this kind of guidance," said Linda Lambert, Executive Director of the New York Chapter of the American College of Physicians. "While the framework will undoubtedly have relevance for large provider groups, we are pleased that this paper and its recommendations were designed with the flexibility to work for smaller practices and physicians who operate independently. If integrating behavioral health care into primary care practices is going to work, it has to work for the smaller practices as well, which the authors clearly understood."
The work to create the guide was supported by a UHF grant with significant contribution from the NYACP. Advancing Integration of Behavioral Health into Primary Care: A Continuum-Based Framework is available from UHF's website at https://www.uhfnyc.org/publications/881131.
New York Kicks Butts Campaign: Encouraging New York City Residents to Quit Smoking
The New York Chapter ACP has joined with the American Cancer Society, the American Lung Association, and Tobacco Free Kids, as well as more than 50 other associated health organizations and media outlets to encourage New York City residents to quit smoking. The goal of the campaign is to encourage all New York City smokers to quit smoking with the aid of qualified health care professionals and to learn about the tools and support available to assist them during this week and beyond.
The New York Kicks Butts campaign will be held this week and physicians that practice in New York City are asked to discuss with patients smoking cessation treatment options. By offering medication and counseling, physicians can help patients to double their quit rates.
Helpful tools can be found on line at PlanMyQuit.com/NYC, by calling the New York State Smokers' Quit line at 1-866-NY-QUITS (697-8487) or by just dialing 311.
Physicians can find an information flyer here. Patient information can be found here.
There is also a new 5 Steps to Quit Smoking flier in both ENGLISH and SPANISH found on the resources page of nykicksbutts.org. You can also click here for additional information.
Medicare: 2016 PQRS GPRO Registration is Now Open
Physicians, nurse practitioners, physician assistants, clinical nurse specialists, and certified registered nurse anesthetists in groups of all sizes and those who are solo practitioners are subject to the Medicare Value Modifier in 2018, based on performance in 2016. These groups can register to participate in the 2016 Physician Quality Reporting System (PQRS) Group Reporting Option (GPRO) via the Physician Value - Physician Quality Reporting System (PV-PQRS) Registration System.
Avoiding the 2018 PQRS payment adjustment by satisfactorily reporting via a PQRS GPRO is one of the ways groups can avoid the automatic downward payment adjustment (-2.0% or -4.0% depending on the size and composition of the group) and qualify for adjustments based on performance under the Value Modifier in 2018.
More information is available on the PQRS Payment Adjustment Information web page.
Groups can participate in the PQRS program for the 2016 performance period by selecting one of the GPRO reporting mechanisms between April 1, 2016 and June 30, 2016 (11:59 pm EDT):
- Qualified PQRS Registry.
- Electronic Health Record (EHR) via Direct EHR using certified EHR technology (CEHRT) or CEHRT via Data Submission Vendor.
- Web Interface (for groups with 25 or more Eligible Providers [EPs] only).
- Qualified Clinical Data Registry (QCDR)
- Consumer Assessment of Health Providers and Systems (CAHPS) for PQRS Survey via a CMS-certified Survey Vendor (as a supplement to another GPRO reporting mechanism). See CAHPS for PQRS Made Simple for complete details.
Groups with 2 or more EPs that choose not to report via the PQRS GPRO in 2016 must ensure that the EPs in the group participate in the PQRS as individuals in 2016 and at least 50 percent of the EPs meet the criteria to avoid the 2018 PQRS payment adjustment in order for the group to avoid the automatic downward payment adjustment and qualify for adjustments based on performance under the Value Modifier in 2018.
The Registration System can be accessed using a valid Enterprise Identify Management (EIDM) account. Instructions for obtaining an EIDM account with the correct role are provided on the PQRS GPRO Registration web page. Instructions for registering to participate in the 2016 PQRS GPRO are provided in the 2016 PQRS GPRO Registration Guide.
The Mental Health Service Corps: New Initiative Aims to Close Gaps in Behavioral Health to Support Primary Care Practices
If your practice is in New York City - behavioral health support is available to your practice at no cost!
Funded by the NYC Department of Health (DOH), the Mental Health Service Corps (MHSC) is an initiative to close the gaps in behavioral health services and facilitate the integration of behavioral health services into primary care. Primary care practices, substance use programs, and mental health clinics in high-need communities throughout the New York City (the five burroughs) can receive full-time fully-funded masters or doctoral-level clinicians and physicians to support their practice.
The Corps is committed to working in high need communities that have experienced barriers to access to mental health care. Corps members will have experience and interest to work in diverse cultures (e.g., ability to speak languages specific to the patient population, oriented to ensure highest standard of social service) and will be trained, coached, and supported in the use of evidence-based therapeutic interventions to screen and treat patients for depression, anxiety, and substance use disorders.
To be eligible to receive a Corps member, a primary care practice must have:
- Clinical leaders at the site dedicated to collaborative care
- Exam room with table and chairs for Corps members and patients
- Electronic Health Record access for Corps members
- Panel size of at least 1,500 unique patients per site
- Be located in high-need area and/or serve a high percentage of medically underserved population
- Be willing to participate in site trainings offered by MHSC program to facilitate integration of Corps member services
This effort will give special consideration to small and solo primary care practices that meet the above requirements. Apply now to change how health care is delivered in New York City and participate in MHSC by completing an application, available here.
There are a limited number of Corps members, so submit your application early. Site selection for matching with Corp members begin May 1, 2016. Notification of Host Sites for placement of a Corps member will take place by June 1, 2016.
You can also access this FAQ about the Medical Service Corps.
For more information about MHSC, click here.
Get Smart Campaign from New York State DOH and CDC Highlights Antibiotic Resistance
The "Get Smart (Know When Antibiotics Work) Campaign" is a collaborative effort between the New York State Department of Health (NYSDOH) and the Centers for Disease Control and Prevention (CDC). CDC has provided grant funding to New York State in an effort to combat antibiotic resistance and the "superbugs" that arise from avoidable prescribing of antibiotics.
To get a handle on where New York stands, the "Get Smart Campaign" analyzed 2013 Medicaid claims data on prescribing for adult upper respiratory infections and found that in 11 counties in New York State, over 55 percent of provider visits resulted in antibiotics being prescribed for adults with upper respiratory infections (URIs). This map shows that data.
Some healthcare providers say they prescribe antibiotics even when they know they are not indicated because of pressure from patients for a post-office visit "takeaway". There is concern that they might get negative reviews on patient satisfaction forms if patients are denied antibiotics.
In addition, ACP has released a clinical guideline for Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults that coincides with these issues.
If you are interested in joining the "Get Smart" effort in New York State or becoming a "champion" of appropriate antibiotic prescribing (setting an example helps every community), please contact Mary Beth Wenger, Project Coordinator of the New York "Get Smart Campaign" at 518-474-1036 or email her at: email@example.com.
Reminder: Physicians and Teaching Hospitals Need to Complete Sunshine Act (Open Payments) System Registration in Order to Review and Dispute Data
The Sunshine Act, which is part of the Affordable Care Act (ACA), requires manufacturers of drugs, medical devices, and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals.
This system is known as Open Payments (or the Sunshine Act). The next review and dispute period for physicians and teaching hospitals is targeted to start in April 2016 for 2015 payment date. Registering in the Open Payments system is voluntary for physicians and teaching hospitals. However, registering is required if a physician or teaching hospital wants the opportunity to review and dispute data. Only information that has been submitted in the current program year is eligible for review and dispute.
The data is submitted by applicable manufacturers (e.g., Pharma companies) and applicable group purchasing organizations (GPOs) prior to public posting on June 30, 2016. If a physician or teaching hospital registered last year, they are not required to register again this year.
If it has been over 180 days since you have logged onto the Enterprise Identity Management System (EIDM), the account has been deactivated for security purposes. If an account has been deactivated, contact the Help Desk. The Help Desk hours are from 8:30 a.m. – 7:30 p.m. (EST). For new users, the quick reference guide on the EIDM system can be found here. In addition, the quick reference guides on teaching hospital registration can be found here, and the guide for physician registration can be found here.
CMS plans to publish the 2015 payment data and make any applicable updates to the 2013 and 2014 data in June 2016. More information about Open Payments is available at www.cms.gov/openpayments.
There are a number of useful educational materials available to help physicians and teaching hospitals learn more about the Open Payments registration process. These materials are available on the Resources page of the Open Payments website. You may want to begin by reviewing the 2015 Open Payments Program Overview and Enhancements – PDF .
The Resources page of the Open Payments website contains all of these materials.
Important Information on Zika Virus Testing from the New York State Department of Health
1. Talk to your patient about Zika: At this time, your patient can get tested if they:
- Are pregnant, and travelled to a place where Zika virus was being transmitted while the patient were pregnant
- Are a man or woman who become (or became) ill with symptoms of Zika virus within 4 weeks of travel to a place where Zika virus is being transmitted.
2. Patients can obtain a "Zika virus testing approval form" from Local Health Departments (LHDS): You can work with a patient to get this approval (Contact information for LHDs is available here). They MUST get approval from their LHD before they can get tested. The form can be emailed to you or the patient. The form could also be faxed.
3. Provide a Zika virus test prescription for your patients: In addition to getting LHD approval for testing, you can give your patients a prescription for the lab tests that are needed.
4. Provide your patient with collection site phone numbers if an appointment is needed: A list of hospitals and their laboratory telephone numbers is available to provide to your patient. (Health Commerce System Login is required).
5. Instruct the patient to go to the collection site: A patient will need to bring the approval form from the LHD and the prescription from you provided. The sample collection site is not able to provide any lab testing unless they are given both the health department approval form and the prescription you've provided.
At the collection site, blood and urine samples will be collected and sent to Wadsworth Center, the New York State public health laboratory, for Zika virus testing. There will be no charge to the patient for the blood and urine collection, shipping and testing. Inform the patient to wear short sleeves or sleeves that can easily be rolled up.
6. Results of the patient's tests: Testing for Zika virus infection is a two-step process. The first test results will be available within a few days of the sample collection. However, in most cases, additional testing is required to determine if a patient was infected; these results may take up to 21 days due to the complicated nature of the tests involved. Some people may need additional blood samples collected three weeks after the first samples. Test results will be sent to your office, and your patient can discuss their results with you and ask any questions they may have.
7. Questions? Patients can contact their Local Health Department or the New York State Department of Health at 1-888-364-4723. Instructions for Zika virus testing for NYC residents can be found here.
They can also read the Department of Health FAQ on the Zika virus here.
In addition, patients can call the Zika information line at (888)364-4723 from Monday - Friday, 9 am to 6 pm.
How to Avoid the 2017 Meaningful Use Penalty
Article courtesy of AMA
Prior to adjourning for the holidays, Congress passed the Patient Access and Medicare Protection Act (PAMPA), which directed the Centers for Medicare and Medicaid Services (CMS) to make AMA-supported changes to the Medicare EHR Incentive Program hardship exception process that allows physicians to avoid a Meaningful Use (MU) penalty in 2017.
NYACP encourages ALL physicians subject to the 2015 Medicare MU program to apply for the hardship. CMS has stated that it will broadly accept hardship exemptions because of the delayed publication of the program regulations. Applying for the hardship will not prevent a physician from earning an incentive. It simply protects a physician from receiving an MU penalty. Therefore, physicians who believe that they met the MU requirements for the 2015 reporting period should still apply for the hardship protection. Note that the program operates on a two-year look-back period, meaning that physicians who are granted an exception for the 2015 program will avoid a financial penalty for 2017.
Step-by-step instructions for completing the hardship exception application follow below:
- STEP 1: Access the instructions and download the application. You can type directly into the application on your computer if you plan to submit the application via email (more on this in Step Seven). Note that CMS "strongly recommends" submission via email, but if that is not possible, the application should be printed out and completed using blue or black ink. Do not use pencil.
- STEP 2: In Section 1.1, provide information for the person working on behalf of the physicians to apply for the hardship exception. Note that, for the first time, an individual may apply on behalf of a group of physicians. This individual may be the physician applicant him/herself or the individual filling out the information on behalf of a physician group (for example, a member of the group's administrative staff). This step is very important because CMS will provide notice of its hardship exception decisions – which are final and cannot be appealed – via the email address provided on the application.
- STEP 3: In Section 2, check the box beside the hardship exception reason that best applies to your circumstances. The AMA is encouraging physicians to apply for a hardship exemption under the "EHR Certification/Vendor Issues (CEHRT Issues)" category (Option 2.2.d in the application), even if they are uncertain whether they will meet the program requirements this year. Because of the delay in publication of the regulation, this category will apply to all physicians. Further, given the delay of the regulations and these updates to the hardship application, CMS has stated that they will refrain from auditing physicians who file under Option 2.2d. A physician who qualifies for more than one hardship exception category may select all of the options applicable to his or her practice; however, one category will suffice.
- STEP 4: Skip Section 3. This section only applies to hospitals.
- STEP 5: In Section 4, list the NPI, first name, and last name for each physician applicant. Again, multiple providers and provider types may apply as a group using a single submission. Failure to provide each physician's NPI will result in a delayed hardship exception decision by CMS. In addition to listing each physician's information on the application itself, CMS will accept physician identification contained in the following formats: Microsoft Excel (.xls or .xlsx), comma delimited (.csv), or text file (.txt).
- STEP 6: In Section 5, check the box marked "Confirm" and enter the date of application and the name of the individual completing the form.
- STEP 7: Submit the application to CMS. If you are submitting the application electronically, attach the application to an email addressed to email@example.com. If an electronic submission is not feasible, fax the application to 814-456-7132. If you have listed the required physician identification in a separate file as described in Step Five above, be sure to attach it to your email or include it with your fax. No additional documentation is required to be submitted to CMS; however, physicians should keep a copy of their application and any documentation supporting hardship exceptions claimed in addition to Option 2.2.d.
If granted, an exemption will prevent penalties for the 2017 payment year. This hardship exception application will not affect payment adjustments for 2016. The application must be received by CMS by 11:59PM ET on March 15, 2016. CMS has not said when applicants will be notified of CMS' decision.
Recruit-a-Colleague from ACP Rewards Members with Dues Credits
The American College of Physicians and the New York Chapter are asking members to help strengthen the organization by recommending ACP membership to colleagues. By joining the College, your colleagues will enrich their clinical knowledge and skills and have access to all of the ACP and Chapter member benefits that you enjoy.
To thank you for your dedication to our organization, ACP offers incentives to members and their chapters for recruiting new members through the Recruit-a-Colleague Chapter (RACC) Rewards Program.
The RACC Program rewards successful individual recruiters with dues credits for each new full Member or Physician Affiliate member recruited and a chance to win a trip to the annual Internal Medicine meeting. In addition, the RACC Program also provides rewards to the recruiter's chapter, and complimentary registrations to the annual Internal Medicine meeting.
The 2015-16 Recruit-a-Colleague Chapter Rewards Program runs until March 1, 2016.
To participate, simply forward a membership application found at www.acponline.org/racc to your colleagues. To qualify for the program, your name must be listed on the recruiter line of the application, and the form must include the code "RACC". We suggest you print the form and add that information to get credit!
Your help with membership recruitment, is a win-win for all!
Medicare / Medicaid
Chronic Care Management Resources
Chronic care management (CCM) is a unique physician fee schedule service designed to pay separately for non-face-to-face care coordination services furnished to part B Medicare beneficiaries with multiple chronic conditions. It applies to practices and patients that are not included in alternative payment models. The code (99490) fills a long-awaited void in treating patients with multiple chronic conditions and was included in the Centers for Medicare and Medicaid Services' final Physician Fee Schedule rule for 2015.
MLN Releases Chronic Care Management FAQ
MLN Matters® Special Edition Article #SE1516: "Chronic Care Management (CCM) Services FAQ" has been released to view and download. This article is designed to provide education on Medicare's requirement for 24/7 access by individuals furnishing CCM services to the electronic care plan, rather than the entire medical record. It includes FAQs regarding billing CCM services to the Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) under CPT code 99490.
Chronic Care Management Services Fact Sheet
The Chronic Care Management Services Fact Sheet (ICN 909188) was released and is available in downloadable format. This fact sheet is designed to provide background on the separately payable Chronic Care Management (CCM) Services for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions. it includes information on eligible providers and patients; Physician Fee Schedule billing requirements; and a table aligning the CCM Scope of Service Elements and billing requirements with the Certified Electronic Health Record or other electronic technology requirements.
Other CCM Resources
Practice Management Tools
End of Life Decision Making
Advance Care Decisions Materials Available from NYACP
Advance decision making and end-of-life care options are unfortunate but necessary conversations for patients to have with their physicians and families. New York Chapter ACP has gathered important resources to assist in making these difficult discussions a reality.
A recently released report from the Institute of Medicine of the National Academies entitled "Dying In America: Improving Quality and Honoring Individual Preferences Near the End of Life" details key findings and recommendations related to the realities of the clinician-patient relationship and how to effectively communicate and facilitate end of life wishes and directives. An excerpt of the recommendations:
"Most people nearing the end of life are not physically, mentally, or cognitively able to make their own decisions about care. The majority of these patients will receive acute hospital care from physicians who do not know them. Therefore, advance care planning is essential to ensure that patients receive care reflecting their values, goals, and preferences."
You can read the document in its entirety here.
In addition, the Department of Health for New York State has a website of resources including the Medical Orders for Life-Sustaining Treatment (MOLST) form.
The DOH has created a portal that contains a wealth of information on advance care decisions, including legal requirements checklists, frequently asked questions, and guidance documents for physicians and patients.
MOLST legal requirements checklists and general instructions for adult patients are:
- MOLST Adult General Instructions and Glossary (3/2012) (PDF, 114KB, 6pg.)
- MOLST Checklist 1 - adult with capacity any setting (5/1/13) (PDF, 49KB)
- MOLST Checklist 2 – adult with health care proxy any setting (5/1/13) (PDF, 91KB)
- MOLST Checklist 3 - adult with FHCDA surrogate (3/2012) (PDF, 95KB, 4pg.)
- MOLST Checklist 4 - adult without FHCDA surrogate (12/1/10) (PDF, 58KB, 4pg.)
- MOLST Checklist 5 - adult without capacity in the community (12/1/10) (PDF, 59KB, 4pg.)
The MOLST legal requirements checklist for minor patients is:
- MOLST Checklist for Minor Patients and Glossary (3/2012) (PDF, 120KB, 7pg.)
Frequently Asked Questions regarding MOLST:
Free Smoking Cessation Learning Module Available Online!
Tobacco use is leading cause of preventable death in the U.S., and as health care professionals we are in a prime position to help our patients successfully quit tobacco, while simultaneously lowering their risk of heart disease, stroke, COPD and other diseases.
Recently, the NYC Health Department has developed an excellent and free online learning module to assist physicians by enhancing your knowledge on how to effectively assess, counsel, and treat tobacco use, greatly improving patients' chances of successfully quitting. For medical residents, this module meets five of the six Accreditation Council for Graduate Medical Education core competencies and is able to be placed in your learning management system. For attending physicians, this module provides 1 CME credit.
Highlights of the module include:
- The "5 A's" model of treating tobacco use
- Provider/Patient communication techniques
- Treatment options and guidance, including combination therapy
- New York State Medicaid Benefits
- Billing information for smoking cessation counseling
Click here to access the online module and here to access additional provider resources.
Pri-Med Opioid Screening Online Course Now Available
With approximately 100 million adults in the U.S. suffering from chronic pain, the nonmedical use of prescription opioids has become a public health issue, and prompted the U.S. Food and Drug Administration to establish the Risk Evaluation and Mitigation Strategy (REMS) mandate. A total of 26 Continuing Medical Education (CME) and Continuing Education providers, including ACP, have created educational initiatives to help prescribers ensure that the benefits of a drug outweigh the risks for patients receiving extended release and long acting opioids.
ACP developed online training modules with Pri-Med to educate clinicians about best practices when prescribing opioids to patients and to help prescribers manage risk for abuse and inappropriate use. The REMS training modules provide comprehensive educational information for primary care clinicians, and can be completed for CME credit. Access the online modules for additional information.
A brief video from Steven Weinberger, MD, FACP, executive vice president and CEO of ACP, highlights the initiative's goal of reducing misuse, abuse and overdose deaths associated with prescription opioids.
Note: an ACP Username/password is required to login)
Managing Your Patients With Diabetes - Tools & Resources
Useful Links:
- ACP Smart Medicine
- ACP Quality Connect
- American Diabetes Association
- Bridges to Excellence Diabetes Care
- NCQA Diabetes Recognition Program
- ACP Diabetes Monthly
- Improving Diabetes Through Patient Engagement Webinar (password required)
Learn about NY's information network, Meaningful Use, e-Prescribing, privacy and security and best practices.
The following patient-related resources provide guidance in effectively maintaining and enhancing the doctor-patient relationship.


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Latest on 1954–55 Port Vale F.C. season »
M V Aida Aura, one of the luxury vessels of Aida Cruises called at New Mangalore Port on Wednesday with 1,145 cruise passengers and 411 crew on board. This is the 10th voyage of the vessel at New Mangalore Port and she is scheduled for six more calls
Leicester's mayor wants to rename the city's streets after Leicester City's players if they succeed in winning the Premier League title, he told Wednesday's edition of The Times.
Australian Richie Porte has confirmed he will leave Team Sky at the end of the season after four years as a domestique de luxe in the British outfit.
Shillong-based Royal Wahingdoh FC today put up a clinical display to beat Assam rivals Guwahati FC 4-0 in a zonal round of the U-18 I-League match at the JN Stadium here today.
The Cochin Port celebrated 'Port Day' on 26.05.2016 with a business meeting for the exporters and importers and agencies, among other programmes.
A small plane has crashed in northern Sao Paulo, killing seven people including the former chief executive officer of Brazilian mining giant Vale and his family. Reports said a pilot and six passengers, including Roger Agnelli, his wife and two child
Cruise vessel M V Insignia called at New Mangalore Port on Sunday with 625 cruise passengers and 400 crew on board.
Wondering what's in store for me, I look around the ship-container construction that makes up Fitness Positive and The Port Café (TPC), Chennai.
Rejecting the erstwhile Left Front government's proposal to develop a port near Rasulpur, the Mamata Banerjee government has come up with a new proposal to develop a minor port between Tajpur and Sankarpur - a three-kilometre stretch near Digha. Fina
Speed News
As part of ease of doing business and PM's Make in India project, JNPT, nation's biggest container cargo terminal has started direct port delivery (DPD) which will greatly cut the delivery time and also transportation cost
The much awaited railway track laying work from Jaigarh port in Ratnagiri to Digni railway station will start from April 16.
The minister favours external commercial borrowings (ECB) available at a cheaper rate and also for ports to earn in US dollars the vessel related charges that would enable them to make use of the dollar reserves as a hedge fund and also pay back the loan
JNPT has asked Ernst and Young consultant to prepare the detailed project report for the ambitious dry port project for which 185 hectares of land at a cost of around Rs 88 crore has been acquired at Jalana in Aurangabad district. Union road, transport and shipping minister, Nitin Gadkari flagged off the project Friday.
In terms of handling containers, the port registered a marginal increase of 0.5% growth over last year during the corresponding period that was good news in the backdrop of economic slowdown in the country.
JNPT notified influence area will be developed into a port city by Cidco
The fourth terminal is being developed by port of Singapore authority that the infra giant won in a global bid.
Bids for widening of NH 4 B, SH 54, Amre Marg, two inter change at Karal and Gavan Phata have been grouped into four packages
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Three reporters were beaten up on Sunday around 11.30 am when they went to cover an eviction of encroachers on Kolkata Port Trust land. KoPT officials alleged police inaction.
The state cabinet decided to go for an all-party meeting to reach to a consensus for awarding the Vizhinjam port project to Adani group. The all party meeting will be held on June 3.
Adani Ports bids for the Vizhinjam International Seaport Ltd (VISL) project for which the last date for submitting the tender was on Friday evening. Only one company has participated in the tender.
Chennai Port Trust has emerged overall champions in the 36th All India Major Ports Lawn Tennis Tournament organized by NMPT under the aegis of Major Ports Sports Control Board that concluded at NMPT Recreation Club on April 17. Kandla Port finished runners-up.
The New Mangalore Port Trust Sports Council and Major Ports Sports Control Board will be organising the 36th All-India Major Ports Lawn Tennis Tournament from April 15 to 17 at NMPT.
With a 25% growth during the just-concluded financial year, the Mormugao Port Trust has recorded the highest growth rate on a year on year basis among all the 12 major ports in India, MPT chairman Cyril C George announced here on Tuesday.