text:
We realize that medical science is constantly evolving and that ideas that seem to be irrefutable in one generation are dismissed out of hand in the next.
But the radical changes in the recommendations about screenings for cervical cancer and prostate cancer in recent weeks are truly baffling. And not a little worrisome to habitual skeptics of official medical truths.
First, the U.S. Preventive Services Task Force, an independent panel of federal advisers, declared that it was not necessary for men over 50 to get a PSA screening for prostate cancer as part of their overall regular medical exam each year.
That goes against the wisdom that has been inculcated in a couple of generations of American men.
Then, this week, the same panel announced that women need Pap smears to test for cervical cancer only every three years instead of annually. For years, women have been urged to get Pap smears every year.
In fact, until this stunning turnabout, men and women had been warned forcefully at every turn, through public service advertisements, celebrity advocacy and all kinds of events, as well as by their own doctors in many cases, that these annual tests are absolutely essential to protect their health.
Now, they're being told, in essence, "Never mind."
And don't forget that only a couple of years ago the same task force stirred up controversy when it declared that mammographies were not necessarily a good idea for younger women. (For good measure, the task force has also recommended against regular testing for human papilloma virus (HPV).)
What's going on here?
Americans and people in other developed nations have long been brainwashed to believe that getting these annual screenings was unquestionably the best way to protect themselves from the types of cancer they test for.
That recommendation certainly makes a lot of sense: If a cancer of the cervix or prostate can be detected in its earliest stages - within months after it begins to develop - it can be treated more effectively and with less radical methods.
But now, that advice goes out the window, more or less.
How come?
Sure, a mammogram is very uncomfortable for women and involves another dose of radiation and the fewer doses human beings get in their lifetimes, the better.
But the Pap smear and PSA test, by contrast, are simple, quick and easy screenings, with no side effects in the vast majority of cases. What's the harm in getting them done annually?
This is where the task force's primary "less-is-better" rationale gets a little sketchy.
According to the panel, more frequent tests could lead physicians, whenever cancer is detected at all, to recommend more aggressive treatment, such as surgery or radiation, although it may not be medically necessary. And naturally, patients spooked by the positive result will be more inclined to agree to that more aggressive treatment.
We understand the concern, but it seems to us that this is a problem caused by an inaccurate understanding about the screening's results on the part of the doctor and/or patient, and not a problem caused by these simple tests themselves.
Essentially, the panel seems to be recommending less vigilance about these diseases. It seems to be saying the patients can be kept in the dark to a greater extent about the possibility of their getting prostate or cervical cancer because it's likely that if they do have it, it can still be caught in time with three-year PSA and Pap screenings. At least most of the time.
And what of those whose cancers are not caught in time? Are they collateral damage in the service of this new scaled-back screening policy?
"It really throws a wrench into what we've been trying to do," Dr. R. Scott Owens of Urology of Central Pennsylvania told the Harrisburg (Pa.) Patriot News about the panel's surprising recommendation on PSA screenings. "It doesn't apply to what we're seeing in the clinical world."
Which leads to the question of where the impetus for this scaling back of prudent medical testing comes from. Is this really about improving health care?


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VINELAND - The very first election results have been reported in Cumberland County.
The results are from a Vineland voting precinct, which is no surprise because that is where county Democrats are gathered this evening.
Results from Deerfield Township have come in as well.
Tonetta, Focchi and Sheppard lead in the initial results out of Vineland, but there are many, many results yet to be reported.
According to online results, Democrats have the lead in 5 out of 92 precints reporting.

subset: commoncrawl


text:
Statement by
Melanie Bella
The Medicare-Medicaid Coordination Office
Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services (HHS)
Examining Medicare and Medicaid Coordination for Dual-Eligibles
Special Committee on Aging
United States Senate
Wednesday July 18, 2012
Ranking Member Corker, Chairman Kohl, and Members of the Committee, thank you for the invitation to discuss the Center for Medicare & Medicaid Services' (CMS) efforts to improve and integrate care for individuals who are enrolled in both the Medicare and Medicaid programs (Medicare-Medicaid enrollees). I appreciate the opportunity to be here today to update you on the many efforts underway at CMS to provide high quality, coordinated care for Medicare-Medicaid enrollees (commonly referred to as "dual eligibles").
The Medicare and Medicaid programs were originally established in 1965 as distinct programs with different purposes. Medicare provides health insurance for individuals over the age 65 and individuals with disabilities, while Medicaid provides coverage for low‐income families including children, pregnant women, parents, seniors and individuals with disabilities. Medicare and Medicaid are separate programs despite a growing number of people who depend on both programs for their care and the increasing need for the programs to work together to improve outcomes for these beneficiaries.
Medicare‐Medicaid enrollees receive benefits and services from both programs: Medicare provides primary coverage for health care services and prescription drugs, and Medicaid covers additional benefits, such as long‐term services and supports. Medicaid also provides help to pay Medicare premiums and cost sharing. Currently, the majority of Medicare-Medicaid enrollees must navigate three sets of rules and coverage requirements (Original Medicare, a Medicare Prescription Drug Plan, and Medicaid) and manage multiple identification cards, benefits, and plans. As a result of this lack of coordination, care often is fragmented or episodic, resulting in poor health outcomes for a population with complex needs. It also leads to misaligned incentives for both payers and providers, resulting in cost‐shifting, unnecessary spending and an inefficient system of care.
Today, more than 9 million Americans1 are enrolled in both the Medicare and Medicaid programs; nearly two‐thirds are low‐income elderly and one‐third are people who are under age 65 with disabilities.2
While pathways to becoming dually enrolled vary, Medicare-Medicaid enrollees either become eligible for Medicare first, e.g., when they turn 65 or qualify based on disability, and then later become eligible for Medicaid as a result of functional or financial decline; or become eligible for Medicaid initially, and then become eligible for Medicare based on age or disability. Medicare-Medicaid enrollees are among the most chronically ill and complex enrollees in both programs. Compared to non-dually eligible Medicare beneficiaries, Medicare-Medicaid enrollees:
- Include higher proportions of women and minorities;3
- Are more likely to have low-incomes; and
- Are three times more likely to have a disability, and overall have higher rates of diabetes, pulmonary disease, stroke, Alzheimer's disease, and mental illness.4
As a result of the complexity of their health care needs, costs for individuals within this population are nearly five times greater than other individuals with Medicare.5 Not surprisingly, Medicare-Medicaid enrollees are among the highest cost individuals within the Medicare and Medicaid programs. Total annual spending for their care exceeds $300 billion across both programs.6 In the Medicaid program, Medicare-Medicaid enrollees represent 15 percent of enrollees but 39 percent of all Medicaid expenditures.7 In Medicare, they represent 18 percent of enrollees and 31 percent of program expenditures.8
There are tremendous opportunities to strengthen the Medicare and Medicaid programs for Medicare‐Medicaid enrollees by addressing inefficiencies and misaligned incentives. A fully integrated system of care that ensures all their needs - primary, acute, long-term care, behavioral and social- are met could better serve this population in a high quality, cost effective manner. This is consistent with the Medicare Payment Advisory Commission's (MedPAC) June 2010 Report to Congress which states, "Integrated care has the potential to offer enrollees enhanced, patient‐centered, and coordinated services that target the unique needs of the dual eligible enrollees." There is also a growing awareness of the potential benefits that greater alignment across Medicare and Medicaid will provide not only to beneficiaries but also to providers, States, and the Federal Government in areas of improved quality of service, costs and program simplification.
Medicare-Medicaid Coordination Office
The Medicare-Medicaid Coordination Office was established by Congress through section 2602 of the Affordable Care Act to more effectively integrate the Medicare and Medicaid benefits and to improve the coordination between the Federal and State governments for individuals enrolled in both the Medicare and Medicaid programs.;
Improving Care for Beneficiaries
The Medicare-Medicaid Coordination Office seeks to increase access to seamless, quality and person-centered care programs for Medicare-Medicaid enrollees. As part of this mission within CMS, the Medicare-Medicaid Coordination Office works closely with the Center for Medicare, the Center for Medicaid and Children's Health Insurance Program (CHIP) Services, and the Center for Medicare and Medicaid Innovation (Innovation Center) within CMS to foster significant reforms across the health care delivery system designed to improve the coordination of care for all patients, including low-income beneficiaries, many of whom are Medicare-Medicaid enrollees.
A major focus is working to improve the beneficiary's care experience with both the Medicare and Medicaid programs. As part of this, CMS continually engages with many national and local advocacy organizations to incorporate their input and the beneficiary perspective in its work. In addition to meeting on a regular basis with these advocacy organizations, CMS partnered in 2011 with the States of California, New Mexico, New York, Oregon, Pennsylvania, and Wisconsin to conduct beneficiary focus groups to asses and raise awareness of the beneficiary's care experience and needs in both the Medicare and Medicaid programs. As we work to better coordinate services, CMS will continue to work with advocacy organizations and other partners to ensure the beneficiary perspective is always a part of our work.
The Need for Coordinated Care
In 2008 Medicare-Medicaid enrollees accounted for approximately $128.7 billion9 in combined Medicaid Federal and State spending– almost twice as much as Medicaid spent on all 29 million children it covered in that year.10 While spending on Medicare-Medicaid enrollees varies by State, it accounts for more than 40 percent of all combined Federal and State Medicaid spending in 27 States.11
These numbers demonstrate the critical need to build, sustain and strengthen Federal-State partnerships by better coordinating the benefits and services of the Medicare and Medicaid programs in a more efficient and cost-effective manner.
Medicaid is the major financing system for long-term services and supports (LTSS). In 2007, more than two-thirds (70 percent) of Medicaid expenditures for Medicare-Medicaid enrollees were for long-term services and supports (LTSS).12 The average Medicaid spending per Medicare-Medicaid enrollee was $16,087 in 2008,13 more than seven times higher than the comparable cost of a non-disabled adult covered by Medicaid ($2,296) in 2009.14
This spending mostly reflects the significant costs associated with a population that tends to have multiple chronic conditions, and, compared to other Medicare beneficiaries, is more likely to be hospitalized and in need of emergency room treatment and LTSS. However, there are opportunities for improved care coordination, simplification, and alignment of the Medicare and Medicaid programs to support and sustain a better health care delivery system.
The current system of financing care for Medicare-Medicaid enrollees often provides a financial incentive to push costs back and forth between the States and the Federal Government. For example, payment structures in Medicare and Medicaid may fail to adequately incentivize nursing facilities to intervene to reduce preventable hospital utilization. In particular, transferring Medicare-Medicaid enrollees receiving long-term care in nursing facilities to hospitals may be financially advantageous to facilities and States but raises Medicare spending. More information on this cost-shifting and CMS' work to address it can be found in the Initiative to Avoid Hospitalizations among Nursing Facility Residents section of this testimony. Partnerships to facilitate coordination of services between States and the Federal Government will work to eliminate these incentives and find real solutions that improve the experience and quality of care for beneficiaries while reducing costs.
As part of this ongoing partnership between the Federal Government and States, in July 2011, CMS established the Integrated Care Resource Center (ICRC). Through the ICRC, CMS is supporting States in developing integrated care programs and promoting best practices for serving Medicare‐Medicaid enrollees and other beneficiaries with chronic conditions. This center provides technical assistance to all States, including those that are implementing or improving programs for Medicare‐Medicaid enrollees using existing statutory vehicles in Medicaid and Medicare, as well as those planning new demonstration programs under new authority. States are able to contact the center with questions and support needs; the center then works with the States to answer questions, provides technical assistance, and works with CMS to meet the State's needs. To date, the ICRC has worked with nearly two‐thirds of the States to implement best practices for Medicare‐Medicaid enrollees, navigate use of new Medicare data, and support development of Medicaid health homes.15
Initiatives to Date
The Medicare-Medicaid Coordination Office has been working on a variety of initiatives to meet its Congressional charge and to further partner with States and other stakeholders to improve access, coordination, and cost of care for Medicare-Medicaid enrollees. Work falls into the following broad areas to support the overarching goals and mission of improving care, improving the health status of beneficiaries, and lowering costs:
- Program Alignment
- Data and Analytics
- Models and Demonstrations
Program Alignment
Although established at the same time in 1965, the Medicare and Medicaid programs were designed with distinct purposes, which often create barriers for beneficiaries eligible for both programs to receive coordinated quality care and also complicates the administration of a more cost-efficient system.
An example of this fragmentation occurs with behavioral health services. Medicare covers reasonable and necessary "partial hospitalizations" and traditional outpatient and inpatient visits to behavioral professionals and providers, while Medicaid can cover a broader range of behavioral health services including supports and services to keep beneficiaries in the community. For individuals with severe and persistent mental illness, the fragmented care delivery system can lead to poor follow‐up, especially for those individuals transitioning from inpatient care to a community setting. Lack of sufficient care coordination may increase the incidence of duplicative services, contraindicated therapies and drugs, inefficiencies in care, and cost-shifting.16 To the extent current systems create waste, confusion or poor care, CMS' mission is to reduce or eliminate their underlying sources, creating a more streamlined system that delivers appropriate, quality, cost‐effective care.17
To address such program inefficiencies, CMS launched the "Alignment Initiative" to facilitate development of a better, more cost-effective system of care that strengthens Medicare and Medicaid for beneficiaries, their caregivers, providers, States and the Federal Government.
As part of this effort, CMS compiled a wide-ranging list of opportunities for statutory, regulatory, and policy alignment and published it in the Federal Register to ensure public input in program development.18
CMS received 108 public comments in response to the Federal Register posting. Feedback ranged from large‐scale and broad reforms, to more issue‐specific proposals, such as altered timeframes for appeals and an aligned Medicare and Medicaid mental health provider credentialing process. A common theme among comments was the basic need for increased communication and coordination between Medicaid and Medicare, as well as with States and Federal Government, to assure that beneficiaries have a seamless care experience across the two programs.
Since its development, the Alignment Initiative has served as CMS' guide for streamlining Medicare and Medicaid program rules, requirements, and policies. Department and agency-wide Medicare-Medicaid enrollee policy workgroups have been formed to continually engage, coordinate, and build upon opportunities for alignment. For example, an area identified in the Alignment Initiative was the practice of balance billing19 Qualified Medicare Beneficiaries (QMBs)20, which is prohibited by law. Conversations within CMS and with external stakeholders such as beneficiary advocacy groups, providers, and others demonstrated a lack of awareness on this issue. In direct response, CMS issued both an Information Bulletin and Medicare Learning Network Article21 to better inform partners and provide best practices to address. Other areas of the Alignment Initiative have also informed CMS work, including but not limited to, consideration of potential opportunities to improve the Program of the All-Inclusive Care for the Elderly (PACE) as well as for alignment in the appeals process, both of which were identified in our FY 2011 Report to Congress. The Alignment Initiative has also informed the development of Medicare and Medicaid program policy areas within our demonstrations, which are discussed in the Models and Demonstrations section of this testimony.
Improved coordination of the Medicare and Medicaid program rules, requirements and policies could help to create a more seamless, quality, and cost-effective system of care. The Alignment Initiative has provided CMS with important public input on this effort and will continue to act as our guide to strengthening the programs to better serve this population.
Data and Analytics
Medicare Data to States Initiative
Another opportunity to support care coordination occurs in improved access to Medicare data, which has been a long‐standing barrier to States seeking to coordinate care for Medicare‐Medicaid enrollees. Lack of Medicare data on hospital, physician, and prescription drug use has prevented States from having a complete picture of the care being provided to this population. For example, without access to service utilization data, a State cannot identify unnecessary duplicative services that could be harmful to the individual and costly to both Medicare and Medicaid. States have asked CMS to expand access to timely Medicare data to help them better analyze, understand, and coordinate a beneficiary's care.
Through this initiative, CMS used existing regulatory and statutory authority to address these data challenges directly. Specifically, CMS established a new process for States22 to access Medicare data to support care coordination, while also protecting beneficiary privacy and confidentiality by assuring compliance with the Privacy Act and Health Insurance Portability and Accountability Act (HIPAA). CMS works with States throughout the entire process of requesting and receiving the data. Currently, 25 States have already received or are in the process of actively seeking Medicare Parts A and B data and 20 States are in the same position regarding Medicare Part D data.23 The process begins with a Data Use Agreement (DUA) that identifies and approves users to ensure data are used for care coordination purposes while requiring strict privacy and security safeguards. Medicare data will enable States to provide better, safer care based on the specific care needs of each Medicare‐Medicaid enrollee.
State access to Medicare data for Medicare‐Medicaid enrollees allows States to make more informed policy and program decisions. Nationally, States have varying levels of capacity to receive and analyze Medicare data but we are encouraged with the number of States that are working with CMS to actively seek Medicare data. We also plan to create opportunities for States to engage with and learn best practices from innovator States as they move forward on their respective data initiatives to improve coordination between Medicare and Medicaid. CMS will also continue to provide technical assistance to States seeking or newly using these data to coordinate care for Medicare‐Medicaid enrollees. States' efforts in this area directly support CMS' goals to improve care and reduce costs – including Federal costs –for this population.
Medicare-Medicaid Enrollee State Profiles
As part of our efforts to better coordinate the Medicare and Medicaid programs, in June, 2012 CMS released Medicare-Medicaid Enrollee State Profiles24
(State Profiles). CMS hopes these State Profiles will help provide policymakers, researchers, and other interested parties with a greater understanding and awareness of the population to foster program improvement. The information released includes a national summary and overview of data methodology underlying the analysis, along with individual profiles for each of the 50 States and the District of Columbia. State-level profiles contain demographic characteristics, utilization and the spending patterns of the Medicare-Medicaid enrollees and the State Medicaid programs that serve them while the national summary provides a composite sketch of Medicare-Medicaid enrollees including demographics, selected chronic conditions, service utilizations, expenditures and availability of integrated delivery programs. CMS expects to update the State Profiles annually and continually engage with States and other key stakeholders to improve the data to better inform policy.
Demonstrations and Models
The Medicare‐Medicaid Coordination Office, in coordination with CMS' program components, has created opportunities to develop, test, and rapidly deploy innovative and effective care models for Medicare‐Medicaid enrollees. In 2011 CMS announced several new opportunities and resources: State Design Contracts to Integrate Care for Medicare-Medicaid Enrollees, the Financial Alignment Initiative, and the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. These initiatives are designed to improve the overall beneficiary care experience and coordination of services while addressing inefficiencies in care delivery that may result in health care savings.
State Design Contracts to Integrate Care for Medicare-Medicaid Enrollees
As a first step to partnering with States to better integrate care, in April 2011 CMS awarded 15 States25 up to $1 million each to design person-centered approaches to coordinate care across primary, acute, behavioral health, prescription drugs, and LTSS for Medicare‐Medicaid enrollees.26
These States were selected to develop new ways to meet the often complex and costly needs of Medicare-Medicaid enrollees. Early work with these States confirmed that a key component of a fully integrated system would be testing new payment and service delivery models to promote better care and align the incentives for improving care with lowering costs for Medicare and Medicaid. Each of the 15 States has submitted a demonstration proposal to CMS, the majority of which are for one of the two models described in the Financial Alignment Initiative below.
Financial Alignment Initiatives
In July 2011, CMS announced the Financial Alignment Initiative, an opportunity for Medicare and Medicaid programs to test cost-effective integrated care and payment systems to better coordinate care for Medicare-Medicaid enrollees. The Initiative seeks to align the service delivery and financing of the programs to better align incentives for improving quality and costs between Medicare and Medicaid.
Medicare benefits focus primarily upon the acute medical care needs of beneficiaries, resulting in little incentives for State Medicaid programs to invest in care coordination for services for which Medicare is the primary payer. Financial savings gained through State‐led care improvement efforts, resulting in decreases in hospitalization, emergency department uses, and skilled nursing care, are believed to primarily accrue to the Medicare program. This financial misalignment between the two programs has been a major barrier to better serving Medicare‐Medicaid enrollees.
Through the Financial Alignment Initiative, CMS offered two models to test alignment of the payment and service delivery between the Medicare and Medicaid programs while preserving or enhancing the quality of care furnished to Medicare‐Medicaid enrollees.27
Twenty-six States,28 after extensive consultation with and public comment from a range of stakeholders (including providers, beneficiaries, and their advocates), submitted Financial Alignment Demonstration (Demonstration) proposals to CMS. Of these States, eighteen are pursuing the capitated model, six the MFFS model, and two are pursuing both models. State approaches to financial alignment vary by scope, population, and model of care coordination, among other key factors. In some instances, States are building and leveraging existing programs and resources, such as Medicaid health homes,29 to coordinate services for which Medicare is the primary payer (e.g., inpatient hospital stays and home health services). Other States are utilizing the demonstration to expand existing care management programs to serve Medicare‐Medicaid enrollees. The Demonstrations recognize the diversity of different States in serving the Medicare-Medicaid enrollee population, and afford an opportunity to test better coordination of services in a multitude of settings.
As part of this effort, States in the Demonstrations must establish a fully integrated delivery system that provides more easily navigable and seamless path to care for beneficiaries. Every Demonstration approach must have strong beneficiary protections and safeguards. To that end, on both January 25, 201230 and March 25, 201231
CMS released Demonstration Guidance to establish baseline program requirements for States and entities participating under the capitated model.
Demonstration Guidance released in January focused on payment principles and standards in key programmatic areas, such as appeals, enrollment, network adequacy, and other key programmatic standards. Guidance also provided States and potential participating plans with further information about the Demonstration approval process and timeline. These requirements establish the operational framework to be utilized in key Demonstration areas. Any variation from these standards will have to be equally or more robust from a beneficiary perspective. One such area is network adequacy standards, where the Demonstration requires aligning Medicare and Medicaid network standards to provide beneficiaries with more comprehensive access to necessary services by incorporating the strongest protections and aspects from both programs. Generally, State Medicaid standards will be used for LTSS, while Medicare standards will be used for Medicare prescription drugs and other services for which Medicare is primary. Where either program requires a more rigorous network adequacy standard than would otherwise apply (including time, distance, and/or minimum number of providers or facilities), the more rigorous standard will be used. In addition, for the prescription drug benefit, as noted in the guidance,32
States will be required to meet Medicare Part D requirements regarding beneficiary protections, protected classes, and network adequacy. No participating States will be permitted to alter standards in a manner that is less beneficiary-friendly or reduces access. In the March Guidance, CMS outlined the Medicare Plan Selection Requirements and other key Demonstration areas, such as Model of Care (MOC) requirements. As with the January Guidance, these standards guide the operations for indicated program areas under the Demonstration.
CMS is fully committed to an open and transparent process for the Financial Alignment Demonstrations. As a result, a robust public engagement process was required as part of the Demonstration proposal process. States held public forums, workgroups, focus groups, and other meetings to obtain public input on the development of their demonstration proposal. Each State was required to publicly post a draft demonstration proposal for a 30-day public comment period prior to submitting a proposal to CMS. After this 30-day period, States worked to address and incorporate public feedback in proposals before officially submitting their proposal to CMS. Once a State formally submitted its proposal to CMS, CMS then posted the proposal to the CMS website for a subsequent 30-day public comment period in order to solicit stakeholder feedback directly.
CMS will evaluate the care improvement resulting from these models, and implement rigorous Federal oversight and monitoring to assess the models' impact on beneficiary experience, quality and costs. CMS has contracted with an external independent evaluator to measure, monitor, and evaluate the overall impact of the Demonstrations including impacts on program expenditures and service utilization changes. The evaluator will design unique, State-specific evaluation plans for each individual State participating in the Demonstration, as well as an aggregate analysis that will look at the Demonstration overall including Demonstration interventions and impact on key subpopulations within each State. There will also be a CMS-State contract management team that will ensure access, quality, program integrity, and financial solvency under the capitated model, including reviewing and acting on data and reports, conducting studies, and taking quick corrective action when necessary. In addition, CMS will apply Part D requirements regarding oversight, monitoring, and program integrity to Demonstration plans in the same way they are currently applied for Part D for sponsors. CMS is working with individual States to develop a fully integrated oversight process, using the process currently employed in the Medicare Advantage and Part D programs as a starting point.
The overarching goal of the Demonstrations is to leverage the strengths of the Federal Government and States in a manner that incorporates the strongest aspects from each to best meet the needs of beneficiaries, their caregivers and providers.
Initiative to Reduce Preventable Hospitalization Among Nursing Facility Residents
Nursing facility residents are subject to frequent preventable inpatient hospitalizations. These hospitalizations are expensive, disruptive, disorienting, and often dangerous for frail elders and people with disabilities.33 Preventable hospitalizations among nursing facility residents stem from multiple system failures, including inadequate primary care, poor quality of care, poor communications, family preferences, lack of advance care planning, and other issues.34 Compounding these problems, nursing homes have little incentive to reduce preventable hospital utilization, improve quality of care, and better coordinate transitions of care between hospitals, nursing facilities and in‐home services.35
CMS research found that 27 percent of Medicare‐Medicaid enrollees were hospitalized at least once during the year, totaling 2.7 million hospitalizations. More than a quarter of these hospital admissions could have been avoided, either because the condition itself could have been prevented (e.g., a urinary tract infection), or the condition could have been treated in a less costly and more appropriate setting (e.g., chronic obstructive pulmonary disease). The study also found that skilled nursing facilities were by far the most frequent setting from which preventable hospitalizations occur.36 Furthermore, in 2011 alone, it was projected that the total costs for all potentially avoidable hospitalizations for Medicare‐Medicaid enrollees were $7‐8 billion, demonstrating opportunities for improvements in quality and costs.
To address these problems, CMS announced a new initiative to improve the quality of care for residents of nursing facilities by reducing preventable inpatient hospitalizations.37
Through this initiative, CMS will competitively select and partner with independent organizations that will provide enhanced clinical services to people in approximately 150 nursing facilities. Interventions will be targeted to nursing facilities with high hospitalization rates and a high concentration of residents who are Medicare‐Medicaid enrollees. Applications for this demonstration were due June 14, 2012. CMS received applications from organizations in 29 States, including health plans, hospitals, Area Agencies on Aging, hospice groups, and other types of care management organizations. CMS is currently reviewing those applications and intends to start these demonstrations before the end of the year.
Congress has provided a unique opportunity for undertaking a number of initiatives to create a more seamless and efficient delivery system for Medicare-Medicaid enrollees. These initiatives are designed to enhance care coordination and person-centered care programs, focus on increased access to needed services, promote keeping individuals in the home and community, support a much needed focus on improving the quality of care received by beneficiaries, and achieve health care savings for both States and the Federal Government through better care management. While exploring new models through Demonstrations are a part of this effort, CMS is also working to improve and enhance existing programs that serve Medicare-Medicaid enrollees. In addition, we seek to better understand the population to provide Congress and other policy makers with robust data about the care experience, quality, and spending for this population.
We thank the Committee for its interest in improving care for Medicare-Medicaid enrollees. With your continued support, we will keep working as partners with States and other stakeholders to advance high quality, coordinated care for these individuals.
1 Based on the Centers for Medicare & Medicaid Services (CMS) Enrollment Database, Provider Enrollment, Economic and Attributes Report, provided by CMS Office for Research, Development and Information, July 2010.
2 Kaiser Family Foundation, Medicaid's Role for Low‐Income Medicare Beneficiaries, May 2011 Report available athttp://www.kff.org/medicaid/upload/4091‐08.pdf hereinafter Kaiser, Medicaid's Role May 2011 Report; Kaiser Family Foundation.
3 Kaiser Family Foundation Program on Medicare Policy, The Role of Medicare for the People Dually Eligible for Medicare and Medicaid 3, January 2011 available athttp://www.kff.org/medicaid/upload/8081.pdf
4 Kaiser Family Foundation, Chronic Disease and Co-Morbidity among Dual Eligibles: Implications for Patterns of Medicaid and Medicare Service Use and Spending. Kaiser Commission on Medicaid and the Uninsured 1, July 2010 http://www.kff.org/medicaid/upload/8081.pdf.
5 Medicaid and Medicare Spending for Dual Eligible Beneficiaries 3, April 2009 available athttp://www.kff.org/medicaid/7895.cfm; Kaiser Report, Chronic Disease and Co-Morbidity among Dual Eligibles, http://www.kff.org/medicaid/upload/8081.pdf..supra note 4 at 1.
6 Based on the Centers for Medicare &Medicaid Services (CMS) Enrollment Database, Provider Enrollment, Economic and Attributes Report, provided by CMS Office for Research, Development and Information, July 2010. This number reflects both full benefit and partial benefit Medicare-Medicaid enrollees.
7 Kaiser, Role of Medicare for People Dually Eligible, January 2011 Report, at 1.
8 Medicare Payment Advisory Commission. A Data Book: Health Care Spending and the Medicare Program. June 2011.
9 Kaiser Family Foundation, Medicaid's Role for Dual Eligible Beneficiaries in 2012. http://www.kff.org/medicaid/upload/7846-03.pdf
10 Kaiser Family Foundation, Dual Eligibles: Medicaid Enrollment and Spending for Medicare Beneficiaries in 2007. December 2010. http://www.kff.org/medicaid/7846.cfm
11 Kaiser Family Foundation, Medicaid's Role for Dual Eligible Beneficiaries in 2012, at 11.
12 Kaiser Family Foundation, Dual Eligibles: Medicaid's Role for Low-Income Medicare Beneficiaries. May 2011. http://www.kff.org/medicaid/upload/4091-08.pdf
13 Kaiser Family Foundation, Medicaid's Role for Dual Eligible Beneficiaries. April 2012. http://www.kff.org/medicaid/upload/7846-03.pdf
14 Kaiser Family Foundation, State Health Facts. http://statehealthfacts.org/comparemaptable.jsp?ind=183&cat=4
15 CMS Integrate Care Resource Center: http://www.integratedcareresourcecenter.com/
16 MedPAC June 2010 Report. Coordinating the Care for Dual Eligibles, Chapter 5. http://www.medpac.gov/documents/jun10_entirereport.pdf; Kaiser Family Foundation, Health Reform Opportunities: Improving Policy for Dual Eligibles (August 2009). http://www.kff.org/medicaid/upload/7957.pdf
17 Section 2602 (c)(1)-(8) of the Affordable Care Act specifically delineates the goals.
19 Balance billing refers to a practice where providers bill beneficiaries the unpaid co-pay or cost-share from services received. Section 1902(n)(3)(B) of the Social Security Act (the Act), as modified by section 4714 of the Balanced Budget Act of 1997, prohibits Medicare providers from balance-billing QMBs for Medicare cost-sharing.
20 QMBs are persons who are entitled to Medicare Part A and are eligible for Medicare Part B; have incomes below 100 percent of the Federal Poverty Level; and have been determined to be eligible for QMB status by their State Medicaid Agency.
21 CMS, MLN Matters, https://www.cms.gov/MLNMattersArticles/downloads/SE1128.pdf; CMS, Informational Bulletin, Center for Medicare & Medicaid Services, Informational Bulletin, http://www.cms.gov/medicare‐medicaid‐coordination/11_MedicareMedicaidGeneralInformation.asp#TopOfPage.
23 Note: As of June 6, 2012, 20 States (Arkansas, California, Colorado, Connecticut, Iowa, Massachusetts, Michigan, North Carolina, New York, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, Washington, and Wisconsin) have been approved for Medicare A/B data. Twelve States (California, Connecticut, Massachusetts, North Carolina, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Vermont, Washington and Wisconsin) have been approved for Medicare Part D data. Other States continue to request access and are working with CMS to receive data use agreements.
25 CMS awarded contracts to the following 15 States: California, Colorado, Connecticut, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington, and Wisconsin.
28 These 26 States are: Arizona, California, Colorado, Connecticut, Hawaii, Idaho, Illinois, Iowa, Massachusetts, Michigan, Minnesota, Missouri, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Tennessee, Texas, Vermont, Virginia, Washington, and Wisconsin.
29 Note: The Affordable Care Act created a Medicaid State Plan option for states to establish Health Homes to coordinate care for people with Medicaid who have chronic conditions. CMS expects States' health home providers to operate under a "whole‐person" philosophy. Health home providers will integrate and coordinate all primary, acute, behavioral health, and long‐term services and supports to treat the whole person.
30 Guidance for Organizations Interested in Offering Capitated Financial Alignment Demonstration Plans. January 25, 2012. https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/FINALCMSCapitatedFinancialAlignmentModelplanguidance.pdf.
31 Additional Guidance on the Medicare Plan Selection Process for Organizations Interested in Offering Capitated Financial Alignment Demonstration Plans in 2013. March 25, 2012. https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MarchGuidanceDocumentforFinancialAlignmentDemo.pdf
32 January 25, 2012 Guidance, page 17.
33 Walsh, E., Freiman, M., Haber, S., Bragg, A., Ouslander, J., & Wiener, J. (2010). Cost Drivers for Dually Eligible Beneficiaries: Potentially Avoidable Hospitalizations from Nursing Facility, Skilled Nursing Facility, and Home and Community Based Services Waiver Programs. Washington, DC: CMS.
34See generally, Grabowski, D., Stewart, K., Broderick, S., & Coots, L. (2008). Predictors of Nursing Home Hospitalization: A Review of the Literature. Medical Care Research and Review, 65 (1), 3‐39.
35 Page 141 of June 2010 MedPAC Report; Intrator, O., Grabowski, D. C., Zinn, J., Schleintiz, M., Feng, Z., Miller, S., & Mor, V. (2007). Hospitalization of Nursing Home Residents: The Effects of States' Medicaid Payment and Bed‐Hold Policies. Health Services Research, 42(4), 1651‐71.
Last revised: June 18, 2013


text: A mysterious set of videos have began to surface online– mostly on YouTube and on this Tumblr page. Dubbed Brilliant Machines, this series, which seems to be updated almost daily, finds robots in all shapes and sizes and with varied abilities just going about daily life. Some are creepy while others are downright adorable. This one especially caught our eye. What would you do if you saw this going down?


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This is the organization that will cure the world's ills? Then we are terminal folks. It was not two days ago that Mallach Brown had the temerity to criticize American and British
diplomacy over Darfurhere. BOLTON RIPS UN DEPUTY OVER COMMENTS. The Democrats are against Bolton and for the UN?
(did you Blog for Bolton today?)
The ambassador John Bolton demanded Deputy U.N. Secretary-General Mark Malloch Brown apologize over comments that appeared in Friday's editions of the Independent newspaper in London. He criticized President Bush and British Prime Minister Tony Blair for threatening Sudan over its refusal to allow U.N. peacekeepers in Darfur.
Well, the clerk Brown has turned tail and ran the other way. I guess the Brown tool got his orders from bloodstained Kofi, eh? Whiplash! From today's Washington Post;
Critical U.N. aide now lauds U.S., U.K. on Darfur
A United Nations official who infuriated Washington by accusing the United States and Britain of "megaphone diplomacy" over Sudan changed tack on Monday, praising both countries for keeping the issue alive.
Deputy Secretary-General Mark Malloch Brown said on a visit to Brussels he was convinced President Bush and British Prime Minister Tony Blair were "on the right side" in seeking to end what he called an outrage in Darfur.
Ugh............. meanwhile hundreds of thousands suffer.


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Nice to see the sun out today and warmer (can't believe I said that - warm) temps. The icicles are melting and snow on roof tops sliding. The snow on my awning outside my front door, always gives us a chuckle. Wondering who will be the one to get "nailed" when it slides off, and just how long the "snow curl" will get before it falls off.
Honey, did you remember the mail?
By: observingnatureSubscribe Channel: Weather Location: Endicott NY
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text:
A Perry County man is out more than $1,300 after state police say someone stole his Visa debit card last week and ran up charges.
Troopers say the thief or thieves stole the card, owned by Mark Steininger, 50, of Shermans Dale, sometime between Wednesday and Friday. Steininger reported the fraudulent charges, totaling $1,387, on Saturday.
Anyone with information on the theft can call police at 717-567-3110.


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© — Star photo by Paul Hutchings
Ruby Reid donates to a Salvation Army kettle in a Deer Lake supermarket while Debbie Rowsell attends. Nationally the Salvation Army is reporting fewer donations over last year, but in Deer Lake numbers are up by $1,500.
DEER LAKE The Salvation Army is experiencing a downturn in donations through their annual kettle drive across the country, but local churches seem to be bucking the trend.
A Tuesday news release from the organization shows it's short by about $6 million nationwide and is at risk of not meeting its Christmas goals. So far they have collected about $13 million in approximately 2,000 kettles across Canada.
Deer Lake collectors have actually seen their numbers increase. Salvation Army spokesman Brian Snow said so far Deer Lakers have been more in the giving mood. He said the Deer Lake Sally Ann's donations are up by about $1,500 over this time last year.
"We collected about $19,000 last year and this year we could break $20,000," he said. "The economy, hard times, it all doesn't seem to matter, we are doing very well."
But Salvation Army officials in Corner Brook are seeing the same downward trend in their collections. Community and Family Services director Maj. Elaine Hibbs said they have seen donations drop, and they are down about $2,000 over where they were this time last year.
She said last year they raised approximately $68,000, beating their goal of $60,000 for 2010. They kept the same goal for this year but so far donations are not keeping pace.
"We're hoping and praying, we're trying to remain optimistic," said Hibbs. "The public usually goes above and beyond but some people may be finding it harder this year."
Hibbs said everyone has their own issues and some may be able to give one year and not be able to the next, depending on each individual circumstance. The last few days, she said, could help change the trend for the Corner Brook area.
"We're thankful to everyone who donated or will donate," she said. "Anything can happen at this point."
Maj. Roy Perry of the Salvation Army in Stephenville said donations in his region are on par with where they were last year.
"At this point in time I would say we're within where we were in 2010," he said. "We're not seeing any major downturn in this area right now."
He said it's always hard to judge at this point in the season but anything can happen in Stephenville as well.
"It seems fine now, but the last five days will determine whether we meet it or go over it," he said. "We're on par now but in five days we could be over or under, it's so hard to say."
Perry estimated that last year's campaign raised approximately $18,000 for the Stephenville area.
The kettles will be in place up to and including Dec. 23. Donations go to help with the Salvation Army's Christmas distribution and emergency assistance throughout the year.


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Ed Reed is moving on, agrees to two-year deal with Texans
Free-agent safety Ed Reed is moving on, agreeing to terms on a two-year contract with the Houston Texans Wednesday night, as first reported by Jason La Canfora of CBSSports.com.
Reed, one of the Ravens' cornerstone pieces for 11 seasons and one of the most decorated safeties in NFL history, visited the Texans last week but left last Friday without a deal.
While reports surfaced on Tuesday about Reed, 34, being offered a three-year deal in the range of $4 million annually, La Canfora noted that he wouldn't be surprised if Reed's deal is closer to $6 million per season.
Reed, whom the Ravens selected with 24th overall pick during the 2002 NFL draft, becomes the sixth defensive starter to depart Baltimore following last season's Super Bowl win and seventh overall.
His exit and the release of strong safety Bernard Pollard leaves the Ravens without their two starting safeties from last season. They did re-sign fifth-year veteran James Ihedigbo last week to a one-year deal, but the other safeties on the roster — including Omar Brown, Anthony Levine, Emanuel Cook and Christian Thompson — have no starting experience and weren't even on the active roster last season.
Reed's loss continues a movement that has seen the Ravens opt to go younger, cheaper and faster.
Center Matt Birk and middle linebacker Ray Lewis retired. Wide receiver Anquan Boldin was traded to the San Francisco 49ers in exchange for a sixth-round draft pick. Guard Bobbie Williams and Pollard were cut. Linebackers Paul Kruger and Dannell Ellerbe and cornerback Cary Williams all left via free agency, signing contracts with the Cleveland Browns, Miami Dolphins and Philadelphia Eagles, respectively.
Despite playing with a partially torn labrum in his right shoulder, Reed started every game this past season and finished tied for the team lead with four interceptions.
Reed, the Associated Press Defensive Player of the Year in 2004, is the Ravens' franchise leader in interceptions with 61 and has the most of any active player. The five-time first-team All-Pro selection is 10th on the all-time list, and his 1,541 return yards are an NFL record.
Reed has 14 touchdowns in his career, and he's the only player in league history to score on a punt return, a blocked punt, interception and fumble recovery.
With Reed moving on, the Ravens have scheduled a visit with Oakland Raiders free-agent safety Michael Huff.
For Ravens fans, the inevitable has become a harsh reality: they'll have come to terms that Lewis and Reed, the deans of one of the NFL's most feared defenses over the last decade, won't be dawning the purple and black anymore.


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Hi all!
Today was "Donuts with Dad" at my little girl's school. Donut and milk for the girl. Coffee and a halved banana for me. Coffee with the consistency and color of hot (spelled lukewarm) water dipped with a brown crayon. It needed another crayon!
Fun for the girl, she got a donut. Fun for me, I got some snuggles!
I got in some walking this week, so here's hoping for the weigh-in on Monday!
Client meeting on Tuesday, with dinner. Not planning on Paleo/Primal dinner that night, but hoping so!


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Two vie for council seat
In the single contested Poulsbo City Council race, voters have a choice between a former former councilman and Navy veteran, and a current councilwoman and business owner.
Kim Crowder, who is finishing her first term on the council, said growth should be watched, noting that Poulsbo may be growing too fast for its own good.
"We may be taking on more growth than is necessary at this time," she said,
Jim Henry, who was unseated in 2007 after two terms on the council, said growth is inevitable, and is the life-blood of city government.
"Nothing gets cheaper, nothing gets easier," he said.
Another difference mentioned by the candidates was what they see as their constituency, those living within the political boundaries of the city, or the North Kitsap community at large.
Henry said his primary responsibility was to Poulsbo residents.
"They come first," he said.
Crowder said perspective is valuable.
"Your hearts always has got the city first, but you also have to keep in mind we're in Kitsap County," she said.
The position lasts four years and pays $6,000.
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We work with brilliant, impassioned and serious entrepreneurs, and align them with market validation from strategic corporate partners that become customers, channel relationships or investors in the venture.
Tomorrow's successful tech startups won't look like they did in the past. They'll be willing to apply their vision to the real-world problems that face today's industry leaders, and work collaboratively on business solutions that get to markets and customers faster and more economically than ever before. Innovating isn't a lifestyle, it's work, just like successful businesses don't just raise money, they make it. We're looking for the select startups that think like we do… and want to engage seriously with our corporate clients and global ecosystem of innovators. If you're ready, we want to hear from you.
ESO Network Amplified by University Collaboration with Startups and Corporations
CHICAGO, IL – January 21, 2016 – TechNexus Venture Collaborative is expanding its core incubator facilities in Chicago, while simultaneously announcing plans to augment its Entrepreneurial Support Organization (ESO) Network with a new office at the University of Illinois in Champaign, and a collaboration with Purdue University in Lafayette, Indiana.
Launched in 2007 as the first Chicago startup incubator, TechNexus works withsecond-stage, enterprise-oriented startups through a collaborative venture development model with corporate partners around the country. TechNexus' proprietary, global ESO network of more than 500 universities, incubators, venture firms and key influencers plays is an important tool for sourcing and filtering ideas, talent and venture collaboration.
"We've leveraged the ESO network pretty effectively in the past year, but this expansion to…


text:
Saturday, 29 October, 2016
Daryl Joyce is a professional illustrator, based in the UK. ... Category: Visual Arts\Thematic
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See a Dalek in Bournemouth, Dorset. Category: Television\Programs
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Directory listing various Dalek-related resources. With news items and a ... Category: Television\Programs
A compilation of trailers for this series of audio dramas. Category: Television\Programs
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Official site for the TV channel broadcasting the new series ... Category: Television\Programs
Forum with images, fan fiction and games. Category: Television\Programs
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Canadian fanzine. Category: Television\Programs
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|Sub-Metropolitan City
Hill station
Dharan from hill sides
|Nickname(s): City of लाहुरे
|Motto: "To build an environmentally sound city, functioning as the centre of education, health, tourism and business with fully developed infrastructure".
|Coordinates: 26°49′0″N 87°17′0″E / 26.81667°N 87.28333°E
|Koshi Zone
|Sunsari District
|November 16, 1960
|• Body
|Dharan Sub-metropolitan city
|• Executive Officer
|Tika Datta Rai[1]
|• Total
|50.8 sq mi (131.6 km2)
|• Water
|1.7 sq mi (4.4 km2)
|Population (2011)
|• Total
|• Ethnicities (Majorities)
|Rai, Limbu, Khas (Chhetri, Brahmin), Newar
|• Ethnicities (Minorities)
|Magar, Gurung, Tamang, Madeshi
|• Official
|Time zone
|Postal Code
|56700 (Sunsari), 56702 (Mangalbare)
|Telephone code
Dharan (Devanāgarī: धरान) is one of the major cities, one of three Sub Metropolitan cities in eastern Nepal, in the Sunsari District, and is situated on the foothills of the Mahabharat Range in the north with its southern tip touching the edge of the Terai region at an altitude of 1148 ft (349m). It serves as a trading post between the hilly region and the plains of Terai region. It was once the location of a recruitment center for the Brigade of Gurkhas, opened in 1953. The recruitment center is closed and the campus is now the home of B.P. Koirala Institute of Health Sciences since 1993. Dharan Sub-metropolitan city organised a Golden Jubilee celebration of Dharan from January 28 to January 31, 2011 marking the 50th year of establishment of the municipality. It is the second-largest city of Eastern Nepal. It is also known as the soccer/footballer producing factory of Nepal.[2]
- History
- Etymology
- Local Government
- Entertainment/Sports facilities
- Culture
- Attractions in Dharan and nearby
- Geography and climate
- Media and communication
- Transportation
- Statistics
- Civic Administration
- Education
- Notable people
- References
Ancient history
The Ten Kings of Limbus came together to formally declare all the ten kingdoms between the Arun River and Teesta River to be called "Yakthung Laaje".
The ten rulers, their kingdoms and their forts:
- Samlupi Samba Hang, King of Tambar and his capital Tambar Yiok.
- Sisiyen Shering Hang, King of Mewa and Maiwa kingdoms and his capital Meringden Yiok.
- Thoktokso Angbo Hang, King of Athraya and his capital Pomajong.
- Thindolung Khokya Hang, King of Yangwarok and his capital Hastapojong Yiok
- Yengaso Papo Hang, King of Panthar and his capital at Yashok and Pheden (Phe meaning "plain", den meaning "place").
- Shengsengum Phedap Hang, King of Phedap and his capital at Poklabung.
- Mung Tai Chi Emay Hang, King of Ilam and his capital at Phakphok.
- Soiyak Ladho Hang Chemjong, King of Bodhey (Choubise) and his capital at Shanguri Yiok.
- Tappeso Perung Hang, King of Thala and his capital at Thala Yiok.
- Taklung Khewa Hang, King of Chethar and his capital at Chamling Chimling Yiok.
Rise of King Mawrong
After a brief period, King Mawrong Hang came to prominence and took over Terai lands of Chethar, Bodhey, Panthar and Ilam (present day Jhapa, Morang Sunsari and Dhankuta). He named his Kingdom Morang after his name and rose to power. He subdued all the Ten Limbu Kings of Limbuwan and became their overlord. He died without any male heir and King Uba Hang took over as supreme ruler of Limbuwan in 849 – 865 AD. He made many religious and social reforms in Limbuwan. Uba Hang's worthy son Mabo Hang succeeded him in 865 AD and ruled till 880 AD. Uba hang kept on with the reforms his father had started. Uba Hang was succeeded by his son Muda Hang. Muda Hang was a weak ruler so the local chiefs started ruling their areas independently. Muda Hang was succeeded by his son Wedo Hang, by this time Limbuwan was in chaos and every principality was ruling independently and fighting with each other. Wedo hang was murdered and his son Chemjonghang succeeded.
Rise of King Sirijonga
During this chaos and the waning phase of King Chemjong hang, King Sirijonga of Yangwarok kingdom rose to power. He subdued all the independent rulers and took over as the new supreme ruler of Limbuwan. He built two big forts in Phedap (present day Terhathum district) and Chainpur (present day Sankhuwasabha district). The remains of the structure still stand today. One of his legacies was that he brought all the Limbus under the same writing system in Kirat script. He also brought feudal reform in Limbuwan and divided Limbuwan into new boundaries and districts.
Eventually after the establishment of Namgyal dynasty in Sikkim and under the Lho-Mehn-Tsong Tsum, a treaty between the Bhutia, Lepcha and Limbu people of the Sikkim area, Limbuwan lost the area between Kunchenjunga range (present day eastern border of Nepal) and Teesta River to the Bhutia Kings of Sikkim. Since then Limbuwan comprises all the area between Arun River and Koshi River in the west to Kunchenjunga Mountains and Mechi River in the east.
In the beginning of the 15th century, the descendants of King Sirijonga became weak and Limbuwan again fell into chaos and anarchy. At the time Lowland Limbuwan Kingdom of Morang was ruled by King Sangla Ing. Sangla Ing declared independence and became the first independent ruler of Morang in a century. His son Pungla Ing adopted Hinduism and changed his name into Aamar Raya Ing. He was succeeded by his descendents, who also bore Hindu names. Kirti Narayan Raya Ing, Aap Narayan Raya Ing, Jarai Narayan Raya Ing, Ding Narayan Raya Ing, and Bijay Narayan Raya Ing.
King Bijay Narayan Raya Sanlga Ing built a new town in the middle of Varatappa and Shangori fort and named it Bijaypur after him. He had no issue and died without an heir.
Bijaypur town was founded in 1584 AD and is currently located next to Dharan, Sunsari District. Bijaypur town remained the capital of Morang Kingdom and Limbuwan region until the Gorkha Limbuwan War in 1774 AD.
It was the most powerful and influential of all the Kingdoms in Limbuwan region and was able to establish its hegemony among all the other Limbu rulers. But in 1609 AD Kirant King Lo hang Sen of Sen dynasty captured Morang and ruled it for seven generations.
King of Phedap Murray Hang was made the chief minister of Morong. He stayed in Bijaypur and the King of Morong made his post hereditary. Murray Hang was given a Hindu name and he became Bidya Chandra Raya . His descendents remained Chief Ministers of Morong until Buddhi Karna Raya . Buddhi Karna Raya succeeded the last Sen King of Morang Kama Datta sen and sat in the throne of Bijaypur Palace in 1769 AD.
Modern Era
Dharan started as a small trading settlement. Over the last couple of decades, the population of Dharan has increased and diversified to include people from various ethnicities like Nepali Maithils, Brahmins, Chhetris, Rai, Limbu, Gurung, Newar, etc.
Modern Dharan's foundation was laid in 1902 by prime minister Chandra Shamsher. He established a small village at the foot of Bijayapur hillock and named it Chandranagar (now Purano Bajar). The purpose was to supply timber to the East India Company, which in the 1890s had expanded its North Eastern territory and was laying railway tracks. The first government official to be appointed in this small village was Subba Ratna Prasad. The settlement grew steadily over the course of time. This growing settlement was named Juddha Nagar (now Naya Bazaar) after Prime minister Juddha Shamsher. It was declared a municipal town in 1960.[3]
The British Gurkha Recruit Center was established in 1953 and this increased the flow of people and expansion of the town. Recruits from all over Nepal flocked to join the British Gurkhas, thereby drastically altering the face of Dharan. There was a surge in population with recruits bringing their families, and others who came to seek employment and exploit business opportunities. As a result, Dharan emerged as one of the biggest towns in eastern Nepal. It is in a true sense a melting pot of different ethnic groups, languages, dialects and religions.
In 1962, Nepal was divided into 14 administrative zones and 75 districts and Dharan was made the zonal headquarters of Kosi Zone. Initially, the town was divided into eleven wards, but in 1980 Banjjhogara Gaon Panchayat at the east and Ghopa Gaon Panchayat at the west were added to Dharan Town Panchayat. This expansion led to the reformation of the wards. Now Dharan is divided into twenty-seven wards in 2014.
The name Dharan is Nepali, which literally means a place where you saw timber. A typical Dharan is constructed by digging a rectangular plot about 5 to 6 feet deep. This hole is large and deep enough for an adult to comfortably move about. A platform is constructed to cover half of the hole. A timber is placed on this platform and a two-man team, one standing on the platform and the other in the dug out proceed to saw timber with a huge saw blade. This is very labor-intensive and dangerous process.
Local Government
The local administration body is the Submetropolitan. Dharan Sub metropolitan city is headed by an elected mayor. There are 27 electoral wards in Dharan. A corporator is elected in each of the wards, and people of Dharan directly elect the mayor by majority vote.
Electricity is provided and distributed by Nepal Electricity Authority which is a state run company.
Entertainment/Sports facilities
Dharan has two cinema halls featuring Nepali, Hindi and English-language films. These are Ganesh Takeej and Shiv Cinema. The town used to have a public library. It exists no more.
From the very beginning Dharan has been an arena for games and sports. Many of its players have represented Nepal in international competitions. Till now Dharan is a force to reckon with in Football, Martial Arts and Cricket. The biggest and probably the best golf course of the country (18 holes) is in Dharan. Dharan Football Club with co-organization of Dharan Municipality, every year in August and September, the prestigious Budha Subba Gold Cup football tournament is held in which most teams of national repute participate. Dharan has also seen tremendous increase in popularity for bboying among the youths in the recent years and bboy/bgirl performances are now common in the major events of Dharan.
The sporting activities are mainly centered in the multipurpose stadium Dharan Rangasala. The popular sports are football, cricket, volleyball, Basketball etc. The Dharan Football Club is one of the most active organizations promoting football in the city and organizes a South Asian club-level annual tournament. Nearby Bhedetar hill has developed as a good attraction for adventure activities such as paragliding and Mountain biking. Adventure sports such as Cycling, paragliding, canyoning, etc. are targeted towards tourists. The musical events are quite often nowadays. The outsiders Band, The Gantabhya Band of Bishnu Memorial are the Main Bands.
Dharan is a melting pot of many cultures, representing a mix of diverse cultures of Nepal. There are many people from the surrounding district, Sankhuwasabha, Tehrathum, Ilam, Panchthar, Dhankuta, Bhojpur, Taplegung Khotang etc., who live in Dharan.
Different ethnic groups host their traditional cultural festivities all year around. The Dhan naach (Dance) and Chyabrung naach (Dance) of Limbus, Lakhe naach (Dance) and Gai Jatra of Newars, Sakela of Rai, Selo of Tamangs, Rodighar of Gurungs, Baalan and Sangini of Brahmin and Chhetris, all add to the cultural tradition of Dharan. Dharan also hosts a Sakela competition in Dharan every year. It starts from the Baisakh Sukla Purnima (full moon of day of the month of Baisakh) and lasts for 15 days.
Attractions in Dharan and nearby
Dharan is a tourist destination in its own right. Communication is mainly in Nepali and English. People who are English speakers should have no problem comprehending many signs and road maps in Nepal.
Beyond Bhedetar lies the eastern hilly district such as Dhankuta, Bhojpur, Phidim, Terathum. Dharan serves as a gateway to some of the remote tourist attractions like Kumbhakarna Himal, Kanchenjunga, Makalu Barun National Park, Arun Valley, Tinjure-Milke (Rhododendron Protection Area), Gupha Lake, Hyatrung Fall, and Sabha Pokhari. They are quite further and therefore require extended day trips.
On the south of Dharan is the city of Biratnagar and connecting towns, all within an hour's drive. Bhanuchowk is also known as the heart of Dharan. The towns of Tararah and Itahari are popular with the local population of Dharan.
Dharan, with its diverse population has numerous centers of worship i.e. temples, churches and a mosque. Bijaypur Hill is of a particular significance, as it has several temples of importance, such as Dantakali temple, Pindeshwar temple, Budha Subba Temple and Panch Kanya. These temples are of historical and archaeological importance as much as religious. These temples are centers for rituals, fairs and events.
In recent years the close proximity of the Tamur River has made Dharan a destination for the white water rafting enthusiasts, Which starts from Mulghat of Dhankuta district and finishes in Chatara Ghat.
Other potential tourism prospects include:
- Paragliding from surrounding hills and Bhedetar for the dare-devils.
- Development of Panchakanya, a Natural Park into a mini zoo.
- Protection and development of flora and fauna of Chaarkose forest.
- Cable car at Dharan-Bishnupaduka-Baraha Kshetra.
- Better advertisement of Babadham fair.
- Construction of an airport in Dharan.
Some measures taken by the Municipality of Dharan to promote tourism:
- Emphasis on the development infrastructures of the city.
- Support development and management of Pindeshwar Babadham fair, Baraha Kshetra fair and Bishnupaduka fair to promote religious tourism.
- Budha Subba Gold Cup Football Tournaments coordinated by the municipality every year.
- Annual publication of a brochure and city information of Dharan.
- Publication and distribution of postcards and photographs of Dharan and Bhedetar.
- Promote Dharan festivals. E.g. Dharan Mahotsav.
- Dharan clock tower (Ghantaghar).
- Development of the Saptarangi Park (Park of Seven Colours) and Panchakanya Natural Park.
- Financial and other assistance to the development of a privately-run Yalambar Park.
Geography and climate
- Surrounded by hills in three directions, Charkose Jhadi (forest) is to the south, to the east and west are Seuti and Shardhu rivers respectively.
- Temperate climate.
- Great change of altitude at a short distance (305 m to 700 m at a short distance of 4 km.)
- Sloped terrain.
- Midpoint between Hills and the Terai plains (Bhawar region), and a gateway to the hills.
Media and communication
- Newspapers: The people of Dharan are served by several daily local newspapers and national newspapers. There are 11 local newspapers in total. Among all of these, the most popular is The Blast Times and The Morning Times. National newspapers are also provided to the people of Dharan on a daily basis.
Some of the National newspapers are The Kathmandu Post, Kantipur, Annapurna Post,[4][5]Himalayan Times among others. Several monthly neighborhood papers serve the town.
- Radio: The state-owned Radio Nepal is broadcast on the medium wave on 648 kHz in the city. Similarly 5 private local FM stations is available. They are Star FM - 95.6 MHz, Vijayapur FM - 98.8 MHz, Dantakali FM - 88.5 MHz, Radio Dharan FM - 88.8 MHz. But Radio Ganatantra FM 95.1 MHz is a Community radio Station.
- Television: Nepal's state-owned television broadcaster, Nepal Television relay station is present near its border, which provides two free-to-air terrestrial channels. Beside that a mix of Nepali, Hindi, English, and other international channels are accessible via cable subscription and direct-broadcast satellite services. Kriti Television is a local Television channel that covers events in the city.
- Internet: Internet facilities are provided by Nepal Telecom, BroadLink, Lumbininet, WorldLink and Subisu, Nepal Telecom is leading internet facilities provider. Wi-Fi connectivity is available at many cafes.
One of the major highways, Koshi highway, passes through Dharan and links it with Dhankuta. Regular bus services and hired vehicles connect Dharan with Biratnagar and other neighbouring towns. Biratnagar Airport (40 km) is the nearest airport. Dharan is about 40 km from Biratnagar. It takes around 1 hour to reach Dharan from Biratnagar by road and costs about 60 rupees.
From Kathmandu, the capital of Nepal, tourist buses leave everyday at 3:30 pm from the Swayambhu bus park adjacent to the Swayambhunath Temple, arriving around 7 am the next morning. Tickets can be purchased for approximately 1100 rupees.
The local transport consists of taxis, local buses, microbuses, auto-rickshaws (or tuktuks), and rickshaws. Sharing a ride with other passengers on microbuses and auto-rickshaws is the most economical mode of transport.
- It is one of the largest cities of Nepal beside Kathmandu, Biratnagar, Pokhara and Birgunj
- Population: 95,332 (census 2001), of which male 55.514%, female 44.486%, census 2011 116,181, including 2 merged VDCs: 141,439.
Civic Administration
Dharan Submetropolitan looks after civic affairs in the town. The municipal area was previously divided into Nineteen wards. However, from May 8, 2014, as per the decision made by cabinet ministers, it is now divided into 27 wards with Panchakanya and Bishnupaduka V.D.C added to the existing area of Dharan. There was a proposal to upgrade it to a Sub-metropolitan after including neighbouring area under its jurisdiction which succeed in December 2014.
- Zone: Koshi
- District: Sunsari
- Number of Wards: 27
- Development Region: Eastern Development Region
Dharan has five public colleges and university (three under Tribhuvan University, one under Nepal Sanskrit University and one with deemed university status B.P. Koirala Institute of Health Sciences), several private colleges with affiliation with other national universities and more than 40 public and private secondary schools. Central Campus of Technology ( Locally also known as Hattisar Campus) is one of the constituent campus of Tribhuvan University Where Food Technology and Nutrition & Dietetics program are offered. Dharan also has 9 private and 1 public library and 3 special education centre. It has more than 5 technical school affiliated to Council for Technical Education and Vocational Training (CTEVT). Among them, Public Highschool & Sarada Balika Higher Secondary School are the most notable educational institution in the town of Dharan.
Academic institutions in Dharan include:
- Mahendra Multiple Campus - Tribhuvan University
—* Central Campus of Technology (Hattisar)° Dharan 14 - Tribhuvan Universityhttp://www.cctdharan.edu.np/[6]
- Purwanchal Campus - Tribhuvan University[7]
- Dharan College of Management - Affiliated to the Purbanchal University
- Birendra Memorial College - Affiliated to the Tribhuvan University
- Dharan Multiple Campus, Dharan-16, Affiliated to the Tribhuvan University[8]
- Alpine College, Dharan-10
- Dharan Model College, Dharan-4
- Bharavi Science
- City College, Dharan-12
- National Multiple College, Dharan-4
- Kaushiki Campus, Dharan-16
- Sagarmatha College
- Dharan Adarsha College[9]
- Pindeshwor Vidyapeeth - Affiliated to the Nepal Sanskrit University
- Sunsari Technical College, Dharan-4
High Schools:
- Children's Academy English Boarding School,(Pindeshowr Chowk) Dharan - 15
- Shree Sikchhya Sadan Uccha Ma.Vi Dharan - 15
- Carmel High School, Dharan-18
- Sainik Awasiya Mahavidyalaya (SAMV), Dharan-13
- Saraswati English Boarding School, Dharan-8
- Koshi Secondary English Boarding School,Dharan-8
- Gem Secondary Boarding School, Dharan 18
- National Academy of Applied Science and Technology (NAAST College), Dharan-16 NAAST College
- Dharan Higher Secondary school (DHSS), Dharan-04
- Shree Public Higher Secondary School (Phushre), Dharan-13
- Eureka Higher Secondary School, Dharan-04
- Navjyoti Catholic English School (recently upgraded = College), Dharan 15
- Shree Public Higher secondary school, Dharan 12
- Secondary Boarding School, Dharan 04
- Shree Sarada Balika Higher Secondary School, Dharan-16
- Summit higher Secondary Boarding School, Dharan-9
- Bishnu Memorial Higher Secondary School, Dharan 9(Best ranked in whole country)[10]
- Vijayapur Higher Secondary School, Dharan-14[11]
- Aims Academy
- Pravat Higher Secondary School, Dharan-12
- Shree Shikshya Niketan Higher Secondary School- Dharan-6
- Depot Higher Secondary School, Dharan 18 [12]
- Delhi Public School, Dharan-18
- Gyanodaya Secondary Boarding School, Dharan -15
- Gyanodaya Secondary High School, Dharan-11
- Sunakhari Academy, Dharan
- Shree Panchakanya Secondary School, Dharan-17
- Prithvi Cambridge English School, Dharan-19
Notable people
- Bivek Basnet, Professional SpeedCuber
- Malina Joshi, Miss Nepal 2011
- Subin Limbu, Miss Nepal 2014
- Namrata Shrestha, model and actress
- Deep Shrestha, singer and music composer
- Raju Kaji Shakya, former captain of Nepali football team
- Sabin Rai, singer
- Dibya Subba, singer
- The Outsider, band
- The Earth, former band
- Naren Subba, singer and director
- Sudip Gurung, singer
- Deep Shrestha, singer
Tanka Neupane
- ^ [www.dharan.gov.np]. Retrieved 18 March 2016. Missing or empty
- ^ [blog.dharan.gov.np]
- ^ Khanal, Binod. "Dharan | Nepal". Retrieved 2 July 2012.
- ^ [www.clickdharan.com]
- ^ [www.digieel.com]
- ^ [www.cctdharan.edu.np]
- ^ [www.ioe.edu.np]
- ^ [dmcampus.zxq.net]
- ^ [www.dharanadarsha.com]
- ^ [www.bishnumemorial.com.np]
- ^ [www.vijayapurhss.edu.npk]
- ^ [www.depotschool.com.np]


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February 25 morning skate quotes: Darryl Sutter
Darryl Sutter spoke with the media following Monday's morning skate before sharing his thoughts on the NHL's proposed realignment, which will be covered in a separate post this afternoon.
On whether he saw Anaheim's game versus Colorado:
"Every second."
On his thoughts of Anaheim:
"Good team. Not just their performance, their season performance to date. They have outstanding goaltending, good performances on a nightly basis out of their big players. They're experienced on the back end, and we've got to try and stick with them tonight."
On what he would like from L.A.'s forwards in a match-up where there's size on both sides:
"Play better than they did against them last time. Getzlaf, Perry; Kopitar, Carter. Go down the list. Lots of good match-ups. They're fun match-ups."
On Viktor Fasth:
"Experienced goalie. He doesn't give up bad goals. He's not a kid. He's a big guy that controls rebounds. [He's] 30 years old. He's got international experience. Good goalie."
On if Fasth's style is similar to Henrik Lundqvist's:
"I don't see Lundqvist enough. I see Fasth more than I see Lundqvist."
On Trevor Lewis' recent performance:
"When Lewis's on his game, he's using his speed on the forecheck. He's strong on the walls. He's a sound defensive guy. Hey, he cares. He cares about how he plays. One of the things I learned last year when he came here, there were a lot of critical opinions of Lewie. But I had a different view of him. I liked those things in his game, those parts of his games about the compete part of it, so it's a matter of getting some offense out of him, right? Because if he wants to play those minutes…if he's a teen-minute player, he has to be more than a penalty killer. We need some production, as we saw last spring, out of him, and right now we're getting that."
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We are asking our community to support the Avon Local School District.
Issue 11 will alleviate overcrowding in three separate school buildings. Each graduating class size continues to grow larger than the one before as the population of Avon increases. The middle school currently has classrooms at capacity. No space for larger incoming class size. When classes are dismissed the halls are overcrowded and at a standstill.
Issue 11 will allow for a new middle school building to be built for sixth-, seventh- and eighth-graders. Moving the sixth-graders to the proposed 1,200-person Avon Middle School would allow for more room at the Heritage Campus. Avon Village School would be retired and the kindergarten students would be moved to the current, one-floor middle school. This would cost each homeowner $38.29 per year or $3.19 per month per $100,000 of home valuation.
Issue 12 will not increase our taxes because it is a renewal of previously approved levies.
Support our Avon Local School District, our children and our home values. Vote yes for Issue 11 and Issue 12.
Bill and Angie Kitinoja


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Insane ramblings about internet dating, regular dating, and life. A single girl conducts experiments to see which get more response and obnoxiously judges those who cross her path.
Friday, February 8, 2013
One Thing at a Time
3 comments:
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Deadlifts are very form/set-up sensitive - at least at weight levels they are useful. You need to be near perfect everytime you pull. With reps, in the sense of bicep curl reps/sets scheme, you run a higher risk of injury.
It is dangerous to make a "work out" out of DL i.e. sweating, huffing and puffing and the feeling that you "exercised".


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Santa Claus is coming to Madison County to visit with boys and girls.
Santa's visit is scheduled for 9 a.m. to noon, Dec. 7, at the Madison County Office Building in Wampsville. Santa will be joined by one of his elves, Sarah, as they lead the audience in holiday songs.
The event is frree and open to the public.


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Crews respond to East Bremerton garage fire
Central Kitsap Fire & Rescue received a call at 9:02 a.m. this morning for a garage fire in the 3000 block of Viewcrest Drive NE.
Units from Navy Region Northwest and the Bremerton Fire Department were also dispatched. Crews from the Bremerton Fire Department were first on scene and confirmed it was a carport on fire and spreading to the garage. The call was upgraded to a second alarm.
The fire was quickly extinguished and was officially out at 9:22 a.m.
A neighbor called 911 after seeing the fire and reported it appeared to have started in a truck parked under the carport. The homeowners were not home at the time. An individual working on a retaining wall down the street broke through a door and rescued the family's chocolate lab.
There is smoke and fire damage to the truck, carport and front half of the garage. It did not extend into the main portion of the home.
Firefighters are conducting overhaul and the Kitsap County Fire Marshal is on scene to determine the cause.
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The ILLUSION OF LIFE: DISNEY ANIMATION [Hardcover]
An out-of-print collector's item since 1986, the definitive account of the development of Disney animation explains what made Disney's style unique and features original sketches and drawings revealing the origins of Mickey and the rest. National ad/promo.
Flag this deal
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|Asmera . nl
American Embassy - Zere Yacob Street 34 Asmara Eritrea.
To the south of Harnet Avenue you can see some of the best
examples of
Ambasciata d'Italia - P.O.Box 220 Asmara Eritrea
... Embassy of Yemen - Areza Street No. 27 Asmara Eritrea.
German Embassy and Lufthansa Office in Asmara
Swedish Embassy - Raza Building (4th Floor)
USAID Office - 19 Hiwot Street Asmara Eritrea.


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HUNTSVILLE, ALABAMA - Jeff Sandridge of Madison and his rock band Estoria have done fairly well on a local level since 2004, playing the club circuit and placing in some battles of the bands from time to time.
But now they've got a great national opportunity – the United States Automobile Association's Garage Band Playoff 2011 – and a chance for big-time exposure, maybe even a record deal.
And here's the ironic part – Estoria has outlasted more than 500 other bands and has gotten this far on the song "Drive," which they wrote, produced and sang in a few hours on a snow day when they were stuck inside without their lead singer, Courtney Stratton.
"The whole thing was thrown together," Sandridge said. "We didn't have our lead singer since we were snowed in and did it very last-minute. We didn't really expect it to get this far."
That's the music biz. If Estoria could win the Garage Band Playoff, it could be huge. The group won the first round matchup with "Drive" and is going head-to-head with seven other bands from Hawaii to Florida in a semifinal battle. The winner gets $4,000, a professional photo shoot and will be featured in a national magazine.
You can vote and try to send Estoria to the final through today at 1 p.m. at garagebandplayoff.com.
"Yeah, we hope being in the contest is going to help us," Sandridge said. "If we could win the contest, it could really open some doors for us. So far, it's getting us a lot of exposure because we've tried to advertise the contest online and tell everybody we know to vote.
"It's great to get this far and everybody seems to be enjoying the voting process. It's been exciting."
Sandridge and John Toelaer started the band back in 2004. They chose their name from the Latin word meaning a story or tale and describe their sound as "an extremely unique blend of rock and pop, lightly seasoned with, punk, metal and hip-hop influences, all baked into a delicious face-melting pie guaranteed to explode your musical taste buds."
Estoria added Raymond Gilstrap of Atlanta on bass and Brandon Parker of New York on drums, along with Stratton. Estoria played at the University of Alabama in Huntsville, local clubs like Crossroads and eventually out-of-town gigs in Nashville and Birmingham.
Estoria put out its debut CD, "Estoria: The Shattered Epic – The Prologue," in 2006 and recently released a self-titled EP. The group has been in the studio working on its next CD, "Introduction," which should be out July 4, including on iTunes. The band describes it as catchy and fun with an underlying Christian message.
The Madison band Estoria is in the United Services Automobile Association's Garage Band Playoff. You can vote for Estoria at garagebandplayoff.com through today at 1 p.m. The final is from May 6-12 and the winner will be crowned May 13.


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Auditions will be held at 7:30 to 9 p.m. on May 24 and 25 at First Baptist Church, 28 N. 10th St., for parts in two youth productions planned by the Take 2 Summer Youth Theater.
Roles will be available for children in grades 5 through 8 in Disney's "Peter Pan Jr." while students in high school and college will be up for roles available in "A Year with Frog & Toad."
Directed by Mary Jo Laupp, "A Year with Frog & Toad" will be performed July 17-19. The first children's musical to hit Broadway, the play and score were written by brothers Robert and Willie Reale who based it on the classic Frog and Toad children's stories written and illustrated by Arnold Lobel. The musical follows the woodland adventures of two amphibious friends, a worrywart toad and a perky frog. The songlist includes titles such as "I'm Coming Out of My Shell," "Toad to the Rescue" and "The Letter."
Directed by Esther Laupp, "Peter Pan Jr." will be performed July 31-Aug. 2. A spin of Walt Disney's animated classic about a boy who never grows up, this children's musical follows the adventures of Wendy and her brothers as they follow Peter Pan and with his sidekick, Tinkerbell, into Never Land. The musical score includes songs such as "You Can Fly, You Can Fly, You Can Fly" and "It's a Pirates Life for Me."
Take 2 Summer Youth Theater developed from an idea presented in 2010 by the Rev. Jim Laupp of First Baptist Church. He wanted to do something that was not a typical church program but that would still have a positive impact on the community. Two shows were produced in that first year, generating enthusiasm among the youth and inspiring the volunteers to continue the program the next year. Take 2 is now in its fourth season.


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It takes an especially soulful diva to get all four X Factor judges clapping - but 49-year-old Jennifer Phillips managed it.
The part-time carer, who has made it through to the "bootcamp" stage of the ITV talent show, but she will have to juggle rehearsing songs for Simon Cowell with performing with the London-based simchah band, Neshama.
He's the daddy of all things showbiz – and now Simon Cowell has fathered a baby boy with Jewish-American socialite Lauren Silverman.
The music mogul, 54, jetted from London to New York to be by Ms Silverman's side at the birth in the Lenox Hill Hospital in Manhattan last Friday - Valentine's Day - at 10 45pm.
"It has been a dramatic week for the band. Last Wednesday, we sang Mily Cyrus's song Wrecking Ball and thought we did well, but got put in the bottom two of the seven remaining acts.
"We thought that was it for us because we were up against two sisters who were amazing singers – everyone thought they would be in the final.
British teenager Adir Tov is competing as part of a boy band on the Israeli TV talent show
"We've been busy rehearsing all week for the first live show.
"At the beginning of the week, we had a serious talk with our mentor, Ivri Lider, who is a really big pop star in Israel.
Music mogul Simon Cowell has boosted the Israeli Army with a sizeable donation at a gala dinner in Los Angeles.
The X Factor chief gave a sum thought to be in the region of £150,000 at the annual fundraising event hosted by the American Friends of the IDF.
When pop star Harry Styles was filmed "twerking" at last Sunday's Teen Choice Awards, fans of his band One Direction ensured the video went viral on the internet.
But it was an earlier image from the awards ceremony that might have done more to catch the eye of JC readers.
The chairman of the Zionist Federation has said the organisation does not know why X Factor winner Alexandra Burke pulled out of tonight's Israel's 65 concert.
The singer, who performed at Jewish weddings with the Gilev Showband before her rise to fame in 2008, was due to perform at the Yom Ha'atzmaut event at Wembley Arena.
Former X Factor hopeful Dan Lipman of The Keys has said there is no bitterness after the judges decided to send singer Charlie Healy through to the live shows but axe the rest of the band.
The Jewish musician, 24 and from Hadley Wood, said he was "massively supportive" despite the collapse of the popular band.
A rapper from Hadley Wood is hoping to follow in the footsteps of Stacey Solomon and Katie Waissel after his band made it through to the next round of X Factor.
Dan Lipman, 24, is one-fifth of The Keys, a band dubbed "magnificent" by judge Gary Barlow during the auditions.


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Miracle of life
It is unfortunate, yet not unexpected, The Star-Ledger would be duped into publishing the op-ed piece by Michael Kinsley under the premise that he truly has a problem with the Catholic church beatification of Pope John Paul II ("A real miracle is needed," Jan. 21).
It was overly apparent that Kinsley's article was not about the process, but about his position on stem cell research and the use of fertilized embryos. "They are not fetuses; they are clumps of a few dozen cells" is luckily only one narrow-minded person's view of them.
Life begins at fertilization. It's not a few dozen cells, but the beginning of what will grow to be a beautiful person. The "famous test" Kinsley's puts forth for saving the test tubes smacks of sarcasm. It ridiculously tries to dumb down an issue important to many religious and secular people throughout the world.
Kinsley is angry about his disease, justifiably, but curing his disease at the expense of another life is simply wrong. And ultimately, it has nothing to do with what you perceive to be fake miracles.
Daniel Henn, New Providence
Reason for Roe v. Wade
I would like to inform our governor that those of us who support Roe v. Wade are not sanctioning abortion rights; we are trying to protect women's lives.
Before Roe v. Wade, illegal abortions were performed by "back-alley butchers," as they were then referred to, and women died. Roe v. Wade permitted legal abortions, performed by physicians under safe and legal circumstances.
I would remind the anti-abortion supporters that there will always be abortions — there always were, there always will be — but under Roe v. Wade, they are done in safe surroundings by licensed physicians.
Tobie C. Castelbaum, Toms River
Hiding their losses
Republicans and Democrats sitting together during the State of the Union address as a show of congressional civility was a canard.
People like to associate with a winner in politics. In the past, when the Democrats had control, the "winners" were readily apparent in the split audience. The majority was clearly delineated.
Now, when the Republicans have the higher numbers, the Democrats want to mix it up so the winners can't be clearly seen.
The new seating had nothing to do with a show of unity and civility. It had more to do with masking the low numbers of the Democrats, the losers in the last election.
Mike Barletto, Brookside
Free to chose
Your editorial demanding enforcement of the menu calorie-posting law ("Calories and the law count") "for the well-being of the state" sent shivers up my spine, as if the state is an entity whose "well-being" takes priority over the liberties and freedoms to choose of the citizens.
And if chain restaurant calorie-count labels fail to lower obesity levels, what next "for the good of the state"? Calorie quotas for food manufacturers? Produce consumption mandates for individuals? Tax penalties for the obese? Imprisonment for those who fry at home? Internment camps for those who refuse to bend to the state's well-being?
Mike Lyon, Boonton
Remembering a comrade
On Jan. 20, I attended the funeral of Lakewood police officer Christopher Matlosz, along with members of our department's honor guard detail.
Sadly, I know the overwhelming grief that his family, friends and fellow officers are dealing with, having experienced the line-of-duty death of one of our own officers.
We stood outside the church with thousands of other officers and state troopers from the tri-state area, listening to the Mass on a loudspeaker as Matlosz's fiancée, Kelly Walsifer, delivered a stoic and emotional farewell eulogy. Her poise and grace in sharing her memories of Chris left many glassy eyes on the hardened warriors who stood at parade rest in the street.
I will not give Matlosz's killer recognition by mentioning his name here. But as I looked out on a sea of blue, standing at attention and saluting the horse-drawn caisson carrying the flag-draped coffin of a young police officer, I can tell you we are stronger in our unity, spirit and strength of numbers than any criminal organization that would threaten the public that officer Matlosz gave his life to protect. He will not be forgotten.
Edward Patrick Donohue, police chief, Lower Township Police Department
Create jobs in Jersey
I couldn't resist writing after I read the story of Garry Giannone in "Blue breadwinners" (Jan. 16). How is it possible we are constantly led to believe the economy is getting better, yet we have a New Jersey resident with an an impressive résumé currently out of work for three years? I admire Garry for his efforts in continuing his job search and for traveling 250 miles round trip to Scranton, Pa., two times a week for a part-time position with Prudential, but unfortunately, my admiration will not help him secure a full-time job here in New Jersey.
Hopefully after this article ran, someone came to meet Garry and offer him employment. One can only hope so.
But for Garry and the thousands of other New Jerseyans who are currently unemployed, with no glimmer of hope in the job market, is the only answer to look outside of New Jersey for jobs?
Perhaps our government should start focusing more on creating jobs here rather than eliminating them.
Beth Iacullo, West Orange


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rebels v king of Africa (Mar 8, '11)Fly
me a Tuareg on time (Mar 8, '11) Libya
puts China in world stage spotlight (Mar 8, '11)
1. Libya puts China in world
stage spotlight2. Fly me a Tuareg on
time3. A to Z of silver
4. Wen acknowledges wealth
gap5. Payback time6. Cappuccino
rebels v king of Africa 7. Seoul reflects on nuclear
taboos8. Taiwan opens hi-tech to
mainland investors9. Old secretaries of defense never
die10. Danger signals in China's
high-speed graft(24 hours to 11:59pm ET, Mar
7, 2011)