Ski Mountaineering - An Introduction

Ski mountaineering is misunderstood by many people. Sometimes people will use 'ski mountaineering' and 'backcountry skiing' to describe the same thing. In fact they are very different.

Backcountry skiing is when you access downhill ski runs in the back country. The emphasis is always on finding the best way down the mountain. Ski mountaineering on the other hand has its emphasis on skis as a means of travel.

Ski mountaineering uses bindings which are hinged at the toe. This allows you to free your heels and climb. To gain traction on the snow when you are climbing you use 'skins'. These allow you to push forward with no resistance but grip when you exert a downward force. The combination of both the skis and skins make climbing snowy relatively easy.

When it comes to skiing downhill you are able to remove the skins and clip your heels down. Alternatively you can keep your heels free and 'telemark'. This type of skiing is very rewarding and will take you places that will seem a hundred miles away from the crowded pistes. It is important however to know the dangers.

The focus when you are ski mountaineering must be on moving safely. Sometimes this will involve making detours to avoid avalanche prone slopes and using other mountaineering methods which at times might be more appropriate than skis. If you are heading out into the mountains then you should have a lot of experience using all the mountaineering skills that you need in winter. You should be very competent at mountain navigation, understand how to use ropes to keep you and your companions safe and have a lot of experience using ice axes and crampons. If you are skiing on glaciated terrain you should also know how to rescues someone from a crevasse.

When you are doing anything in the mountains which is off the piste you should be very aware of the dangers that snow can cause. Every year hundreds of people are killed in avalanches. If you are going to be exploring on skis then it is very important that you know the risks and how to minimise them. For this the best recommendation I can make is to go on a course. Even just a 2 day course will increase your awareness and skills enough for you to make informed decisions in the mountains. This could be the difference between a good day out and tragedy, it is well worth it.

Treatment for MS Numbness - What Types of Treatment Are There?

For the person who has been diagnosed with multiple sclerosis, there are a number of different symptoms that they are likely to experience during the course of their lives. One of the most common and often longest lasting is numbness in one or more of their extremities. The severity of this varies from person to person, there is more than one treatment for MS numbness and while they work for some patients, they may not work for all.

Why Do I Have this Numb Feeling?

As most patients know, multiple sclerosis is a disease that affects the nerves. The damage is done to the myelin sheath that is designed to protect the nerves and keep them out of harm's way. Once the damage is done the way in which the nerves feed information to the brain is compromised. In some cases the nerves are completely shorted out. When this happens the result can be the numbness you are feeling. With proper treatment some or all of this numbness can be eliminated allowing you to feel again.

There are several medications that are being recommended as a treatment for MS numbness, however doctors do not usually prescribe them unless the patient presents in a relatively high level of pain associated with the numbness. Cortisone which is an anti-inflammatory is sometimes used especially in patients where the numbness has become severe enough to cause problems with their daily lives.

Alternative Treatment for MS Numbness

Rather than seeking a pharmaceutical cure for the numbness, you will find that seeking an alternative treatment for MS numbness is far more practical. The number one holistic treatment for the numbness that you are dealing with is to modify your diet if you are eating the standard western diet of heavily processed foods. Switch to a eating more whole foods, leafy green vegetables and seafood. This diet has been found to help with many of the symptoms of multiple sclerosis including numbness.

There are several herbal supplements that are thought to help such as Gingko Biloba and find someone that is willing to help you with a regular massage of your neck and shoulders. This can help to relieve stress and in turn increase blood flow to your extremities while relaxing your body. Gentle exercises such as yoga have also proven to be a good treatment for MS numbness instead of turning to medications that are likely to do more harm than good.

Memory and More

Ever lost anything? Ever heard a more ridiculous question?

If you are beyond the age of two, chances are you've lost plenty. And not just things. How about names, critical pieces of conversations, whole stories of books and films you once loved, key moments of childhood, life experiences or images of travels? What or how much would you like to retrieve and how much would you like to control your retrieving?

And when the memory comes... like when you stumble across those keys and find that, not only have you found the keys, but a rush of memories floods you and you are suddenly clear as to what caused the keys to be just where you found them? Or, has your memory been jolted by a smell, a single note of a song, an old photograph that literally transported you to some distant past with such clarity that other of your senses and emotions were strongly triggered? You're suddenly "in" the backseat of that car with a single note, "in" your gramma's kitchen with a single sugary scent, or find yourself laughing or crying with the intensity you had at the time of that photo. If we're old enough to have a past and if our senses are working, it's happened to us all. These memories are forever in your cells.

Experts say that unless we have some form of physical brain impairment, our memories can continue to get better as we age, not worse. An active mind that constantly is stimulated by new ideas, making decisions, in other words, paying attention, has very little to do with whether the person is 10 or 80 years of age. Attitude and involvement are the main ingredients. New finds regarding the elderly show that those engaged in word or number games (mental exercises) stay more alert and energized, slowing down the aging process.

Even the memory experts who teach association techniques acknowledge that the chief reasons for poor memory are 1) we never paid attention to that name or conversation in the first place because we were so busy thinking about what we were going to say next or, 2) we have told ourselves so often that we have a lousy memory, that this phrase became a self fulfilling prophecy. Words are powerful, whether positive or negative, and they shape our behaviors and attitudes and belief systems.

Want to improve your memory? Simple: Use these following ideas for a 30 days. You will have found something valuable and best, duplicatable. You have nothing to lose and everything to gain.

1) When meeting someone: Make simple, conscious effort.

o Get eye contact as they speak their name and repeat it out loud as you shake their hand. Give the topThe physical anchor of touch will help to imprint the name. o Associate the name with any visual thing about them. e.g. my name is Eisen, so you might get a mental picture of my eyes way back in my head. The picture, the more ridiculous the better, will be remembered long after the sound of the name has faded.

The key is PAY ATTENTION. People have everything you want: love, respect, opportunities, referrals, information, wisdom. Respect them with your attention. Be present by learning to be quiet and an active, attentive listener. The adage "Use your ears and mouth in direct proportion to that which God gave you" will help you retain more details from any given situation.

2) When reflecting on your memory: Always be positive. Avoid what my wife calls "the Neutral or Negative Game." That's the game where when we do something well, like remember something, we consider it small, "no big deal," unworthy of attention or reinforcement. Yet the same "small" memory if forgotten, somehow looms large in our judgmental inner voice both reminding us of, and reinforcing our frailty. The reality is that everyone forgets sometime and if viewed as a single event ("I have a great memory and I forgot something") rather than some impending disaster ("Senility is setting in fast"), the experience can remain AN experience instead of THE experience or state of being.

Most people don't pat themselves on the back when they remember a name, details of directions or complex processes easily done on a regular basis. Yet, when those same people forget some, even small thing, they often resort to personally directed anger, self deprecating frustration or humor. If you've fallen prey to this kind of limited thinking, it's easy to shift with a little practice. Here's how:

When you do remember, allow yourself to have a little internal celebration, "I DO have a great memory. Look at all I can handle and stream."

When you don't remember something:

o Let go of the need for sarcastic remarks like "I have the world's worst memory," and o Avoid self deprecating jokes such as "Oh, it's my memory: as you get older it's the second thing to go," or "If my head weren't attached to my shoulders, I'd lose it."

This easy access to sarcastic humor is usually a coping or defense mechanism. The intention may be to make light of a perceived failure or loss of control, yet in reality the sarcasm simply reinforces the the limitation. It may seem easier to make a joke and move on than to take an instant and say "I have a great memory."

Either way, WE GO WHERE WE LOOK... and if our gaze is on our perceived limitation as our identity or who we are in that arena, or if we focus on our strength and see the limitation or failing as momentary, as an aberration from our identity creates destination and our path. We will take the path of more bad memory with every lost thought as evidence of our weakness, or we walk the path of memory riches by allowing a lost memory to be just a simple bump in the road. The effect of our words by our own inner voice, the most powerful voice for us, creates a self fulfilling prophecy. There will be negative reinforcement and its collateral damage weakening memory or positive reinforcement, supporting our growth for future memories to be enhanced.

The key is IT'S NEVER WHAT HAPPENS THAT MATTERS, IT'S HOW WE VIEW IT THAT EMPOWERS US or DISENFRANCHISES US FROM OUR POWER.

3) When moving through your day: Play little awareness games. Pay attention to details that catch your eyes and ears and review them through the day to keep them fresh and available. It's obviously not the minutia that may matter. It is the willed attention that is strengthening the discipline of focus. Even beyond developing the discipline of learning how to focus and concentrate, you are creating little victories. Confidence comes from creating victories and the more confident you are the better you feel about your mastery of your focus and of your self. Ah, and this IS the stuff on which self esteem is built.

4) When you do focused relaxation and learning sessions like those which I teach in my classes or simply relax for a few minutes a time or two each day: Program your identity.

Take advantage of the greater suggestibility of your relaxed mind to program a thought such as "I use my photographic memory to retain and recall all information instantaneously and accurately at will." Imagine yourself in conversation, recalling information and fluidly communicating it to others. Throughout the day you will be prompted to show yourself what you can do rather than what you can't. Results develop gradually but surely. The common wisdom is that it takes two to four weeks to establish a true, positive and permanently set new habit. The time you invest is a small price to pay for the results you will get and have for the rest of your life.

Medicare NPI - Still Working Through Issues

When the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was passed, it mandated that a unique, shared identification number be issued to healthcare providers. The Centers for Medicare and Medicaid Services (CMS) began issuing National Provider Identifier (NPI) numbers in October 2006.

There are several legacy healthcare identifiers. Some of them include:

Online Survey Certification and Reporting (OSCAR) National Supplier Clearinghouse (NSC) Provider Identification Numbers (PINs) Unique Physician Identification Numbers (UPINs) One of the main goals of the NPI implementation was to simplify the identifiers used in healthcare claims. It has the added benefit of identifying providers on prescriptions, internal files, patient medical record systems and any other standard transaction. In short, replace all of the other identifiers with a single permanent number. This number could follow a provider regardless of job or geographical changes.

CMSs original date to force implementation was May 23, 2007. It subsequently extended that until May 23, 2008. Even with the extension, it seems CMS is vague about the penalties that may, or may not, be assessed for non-compliance.

NPI is a good idea and, in the long run, it is good for everyone. Any clinic, or software provider that services them, would rather use one number then navigate the maze of multiple numbers and trying to determine when to use what.

Let us not assume that just because there is only one number everyone is ready to gather around the NPI campfire singing Kum-Ba-Yah.

Not all of the other numbers are being replaced - NPI has just become one more field on the claim. Every number that was already there is often still required to be there for payment. While many of these numbers will eventually become obsolete, what motivations do the payors have? Changing the systems to only accommodate NPI is an expensive proposition on both sides.

Providers are not using their NPI - Practice Management software and clearinghouses report that their user communities are requesting features to allow claims from a single location or department to all use the same NPI number. The software providers see this but they are not exactly the NPI police and are doing what they can to services their clients.

Clearinghouses strip off / add on --Many clinics are seeing their claims go out the door with the NPI on them. Once the file gets to the clearinghouse, it is removed. Clearinghouses that are behind schedule in implementing NPI are creating a house of cards for their clients. Many might be able to replace this with actual NPI functionality, but this becomes a dangerous game, especially when the clinic is thinking they have implemented NPI.

Eventually NPI issues will be resolved and claims will process in a more efficient and expedited manner. Until we cross that bridge, healthcare clinics that accept Medicare will experience some payment and claim processing delays.

Are You Wasting Your Money on Diversity Training?

If you are planning to spend money on diversity training, WAIT!

You may be wasting your money if you haven't done any foundation building. If diversity and inclusion are not first integrated into your business strategy, very little will change just by holding one or two day training classes. Organizations in all sectors make this mistake and don't realize it until it is too late.

If you want to leverage the diversity you already have, increase the diversity of your organization, or prevent cultural misunderstandings you need to create a corporate culture that is inclusive at all levels, and in every system and process.

You can get everyone trained by a great trainer, with a great program, but when people leave your organization they take what they learned with them (if they still remember it) and your organization remains the same. Further, reaching resisters and naysayers of diversity efforts is unlikely only with training--a more multi-faceted approach is needed to help these individuals see the value of diversity in their organizations and to bring a greater number of people on board to the initiative.

Simma's Strategies for Creating an Inclusive Organization

Here are some of the steps that need to be taken in order to create an inclusive organization.

Start at the top. It must be championed and led by the CEO and other people in the executive team. Leadership of a diversity and inclusion initiative or culture change cannot be delegated. Other people can help drive it, but it must be viewed as coming from the top. That also means you need to start including it in conversations, discussions, newsletters and e-mail.

Assess your organization with surveys, focus groups and interviews in order to identify strengths, challenges and areas for improvement as it relates to diversity, inclusion and employee satisfaction in specific areas.

Create a cohesive vision and strategy that is agreed upon by members of the executive leadership team. Know where you are going.

Engage all levels of senior management. They need to be part of the vision and have a clear understanding of concepts, roles, business case and benefits, in order to help lead the change.

Develop a communication and information sharing strategy and process in order to share that vision throughout the organization. Send the message in such a way that you create middle manager and employee buy-in. Help them understand how the diversity and inclusion/culture change process will benefit them personally, professionally and as an organization, That will involve internal marketing at all levels.

Use the results of the survey to address specific areas for improvement, most commonly; recruitment, interviewing, hiring, retention, promotion and performance evaluation. Examine your present organizational culture, and identify ways in which your organization can create a more inclusive environment.

Define skills and behaviors that managers need in order to make the initiative/culture change a success and successfully lead a diverse workforce.

Conduct training for all levels of your organization in areas related to diversity and inclusion.

Set up a process for accountability at all levels, relating progress to compensation and evaluations.

Measure results, create the buzz and make it exciting (if its not fun, it won't be done)

The amount of time, order and the steps themselves depend on your organization and goals, but if you want to go beyond compliance, hear new ideas and best practices, reduce cultural misunderstanding and miscommunication, hire and retain the best of the best from everywhere, training alone won't do it. Before you spend your next dollar on diversity training, ask yourselves if you just want people to have a good day, learn and forget a few things or do you want ongoing change that will make you a benchmark organization and the employer of choice.

Important Terms for Computer Security

Due to the advancement of the technology it is easy to focus on the computer when it comes to transferring personal information. When you get permission from a patient to release information they have the right to know where their information is going. If they were seen by a doctor in their office then the patient can expect the billing office to review their information because they will need to bill their insurance company for reimbursement purposes. The first term you will learn is the acronym for the Health Insurance and Portability Accountability Act (HIPAA) and the next term in class will most likely be "Authorization" and this is gaining a formal approval before providing access. This makes sense, you are asking for permission before you look or take something from a person.

"Audit trails" are programs that record system activity and contain who accessed the system, when they accessed the system, and what was accessed in the system. It will also note if there were any additions, changes or deletes. Was it an accident or on purpose? This is something that you would have to investigate with the person. In HIPAA training you will hear about how important it is to have an "anti-virus" program on your computer system. Pay attention to this part of the training, you do not want your computer system open to virus that can damage and corrupt your data. An anti-virus system is the right thing to do to maintain continuity of protection to your computer system.

"Biometric" is another neat feature that has come a long way for people working with sensitive material and with computers. It is used as a form of recognition and authentication. You may use your fingerprints, voice recognition, or retinal and iris scans. About ten years ago it was something people kept saying was coming and it has been here at least five years. We see it in the movies but we have several places using the methods today in their facilities. Then an all time favorite is "Auto logoff" this is basically a timeout on the computer. If there is inactivity for a certain period of time with the computer it goes to a screen saver mode and logs off the user forcing them to log back in with their password. These are terms you will hear in HIPAA training.