Bangladesh Pharmaceutical Market Had a Valuation of US$700mn in 2007 and That a Compound Annual Growth Rate (CAGR) Of 18.79% Through To 2012 Can Be Expected

Research and Markets (http://www.researchandmarkets.com/research/bf1f27/bangladesh_pharmac) has announced the addition of the “Bangladesh Pharmaceuticals and Healthcare Report Q3 2008” report to their offering.

Bangladesh Pharmaceuticals and Healthcare Report provides independent forecasts and competitive intelligence on Bangladesh’s pharmaceuticals and healthcare industry.

The Bangladesh Pharmaceuticals & Healthcare Report Q308 is the most recent addition to BMI’s Industry Survey & Forecasts Series. It integrates data and narrative from market research firms, industry associations and company presentations to provide objective assessment of one of Asia Pacific’s most promising opportunities for drugmakers.

We calculate that the country’s pharmaceutical market had a valuation of US$700mn in 2007 and that a compound annual growth rate (CAGR) of 18.79% through to 2012 can be expected. This rapid market expansion is primarily due to greater uptake of medicine throughout this densely populated country, but also through appreciation of the data against the US dollar, population growth and increased government healthcare expenditure, among other factors.

2008 is proving a challenging year for drugmakers in Bangladesh. A round of price cuts is scheduled after a hiatus of two years. Sales forces of Bangladeshi drugmakers are growing exponentially, which results in significantly higher expenses. Meanwhile, the appreciation of both the Indian rupee and the Chinese yuan is boosting the cost of raw materials.

Eskayef was best performing company in Bangladesh during Q108, with sales up 21.12% on Q107, according to IMS Health. This compares favourably to the next fastest growing drugmakers: Renata (+16.19%), ACI (+16.17%) and Drug International (+13.79%), Incepta Pharma (+6.77%) and Square Pharma (+2.32%). Not all Bangladeshi pharmaceutical companies performed so well. Beximco Pharma witnessed a huge 42.04% drop in sales, while Acme recorded a 4.89% decrease.

The greatest challenge facing the industry is the end of the patent-free regime in 2016, when local pharmaceutical companies will have to cease the production, distribution and sale of medicine that have intellectual property protection elsewhere in the world. Forward thinking local drugmakers will have to adapt their product portfolio as necessary or suffer a steep drop-off in sales. However, the global ‘patent cliff’ in 2011 will mitigate this watershed.

Key Topics Covered:

Executive Summary

Bangladesh Pharmaceuticals And Healthcare Industry SW

Bangladesh Political SWOT

Bangladesh Economic SWOT

Bangladesh Business Environment SWOT

Pharmaceutical Business Environment Ratings

Table: Asia Pacific Pharmaceutical Business Environment Ratings For Q308

Limits To Potential Returns

Risks To Realisation Of Returns

Market Summary

Regulatory Regime

Table: Steps Required To Establish Pharmaceutical Manufacturing Unit And Obtain A Drug Manufacturing Licence (DML)

Counterfeit Drugs

Intellectual Property

Pricing And Reimbursement Regime

Industry Trends And Developments

Epidemiology

Healthcare Sector

Recent Activities By Foreign Companies

Contract Manufacturing

Research And Development

Table: Suggestions Made By University Of Dhaka’s Faculty Of Pharmacy To Improve Pharmaceutical Research Standards

Industry Forecast Scenario

Overall Market Forecast

Table: Bangladeshi Drug Market Expenditure, 2003-2012

Key Growth Factors – Industry

Key Growth Factors – Macroeconomic

Table: Bangladesh – Economic Activity

Prescription Drug Market Forecast

Table: Bangladeshi Prescription Drug Market – Data And Forecasts (BDTmn, unless otherwise stated)

Patented Drug Market Forecast

Table: Bangladeshi Patented Drug Market – Data And Forecasts

Generics Market Forecast

Table: Bangladeshi Generics Market – Data And Forecasts

OTC Drug Market Forecast

Table: Bangladeshi OTC Drug Market – Data And Forecasts (BDTmn, unless otherwise stated)

Pharmaceutical Export/Import Forecast

Table: Bangladeshi Pharmaceutical Export/Import – Data And Forecast (US$mn)

Other Healthcare Data Forecasts

Table: Other Healthcare Data And Forecasts

Key Risks To BMI’s Forecasts

Competitive Landscape

Company Profiles

Eskayef Bangladesh

Square Pharmaceuticals

Renata

Beximco Pharmaceuticals

BMI Forecast Modelling

How We Generate Our Pharmaceutical Industry Forecasts

Pharmaceutical Business Environment Ratings Methodolo

Ratings Overview

Table: Pharmaceutical Business Environment Indicators

Weighting

Table: Weighting Of Components

Companies Mentioned:

– Eskayef Bangladesh

– Square Pharmaceuticals

– Renata

– Beximco Pharmaceuticals

For more information visit http://www.researchandmarkets.com/research/bf1f27/bangladesh_pharmac

"Patsy" Teaches Parents How to Talk With Their Kids About Drugs

What would you do if your mom brought a drug-sniffing dog into your bedroom? It’s one of the off-the wall actions of “Patsy,” a well-intentioned, high-energy mother determined to go to any length to keep her kids from using drugs and alcohol. The character “Patsy” is the star of a series of home-video style television spots the Partnership for a Drug-Free America launches this week to steer parents toward the right way to talk to their kids about drugs. Hill Holliday New York, a top national communications agency, crafted the campaign and its impactful tagline: Don’t be a Patsy. Learn a better way at drugfree.org

In the spots and webisodes, Patsy not only uses a sniffing dog; she sneaks up on her teen son in the shower, drills him on drug facts, demonstrating a benevolent, police-style “Patsy pat-down.” Patsy also shows off her own method for preventing abuse of prescription medications – she removes the labels from every bottle in the medicine cabinet.

“Parents want help to prevent their kids from using drugs and alcohol, but most don’t know what to say or how often to talk about this important health issue,” said Steve Pasierb, President and CEO of the Partnership. “Our research shows that just like Patsy, many parents aren’t getting the real support or factual information they need to have a impact on the choices teens make. Hill Holliday’s great work is a lighthearted but important step to bring parents to drugfree.org for much-needed tools and advice.”

“By creating Patsy, a mom who gets it all wrong, we allow real moms to laugh at themselves and realize they don’t have all the answers,” says Alon Shoval, Hill Holliday’s executive creative director. “And by launching Patsy virally, the message is relatable, entertaining, and doesn’t come across as a lecture.” Recent research findings show an increased need for parents to find a way to talk with their kids.

— Partnership research shows that 1 in 5 teens has abused a prescription painkiller to get high. In fact, today’s teenagers are more likely to have abused prescription medications than illicit drugs like Ecstasy, meth, and heroin.

— According to data from the 2007 Partnership Attitude Tracking Study (PATS), half of all parents (51 percent), with kids in 6th-8th grade, feel they lack the tools and information to prevent drug and alcohol use

— According to the 2007 Partnership Attitude Tracking Study of teens, the number one reason teens see for using drugs is to deal with the pressures and stress of school. In this nationally projectable study (margin of error +/- 1.6 percent), 73 percent of teens reported that school stress is the primary reason for drug use.

The fully integrated “Patsy” campaign – the first of its kind for the Partnership – is a component of a greater Partnership effort to establish drugfree.org as the go-to resource for parents to find answers to their questions and get support and advice. Through television, print and Patsy’s own YouTube page at http://www.youtube.com/user/PatsyVideos, the Partnership and Hill Holliday hope Patsy will motivate parents to “learn a better way”, and get smarter about engaging with their own teens.

The “Patsy” campaign consists of four 30-second and two 15-second TV spots, five “webisodes” for YouTube, one radio spot and 2 print executions. Hill Holliday New York also developed Interactive banners, which link to the Partnership’s parent resources at www.drugfree.org/parent.

About the Partnership

The Partnership for a Drug-Free America is a nonprofit organization that unites parents, renowned scientists and communications professionals to help families raise healthy drug-free kids. Best known for its research-based national public education programs, the Partnership motivates and equips parents to prevent their children from using drugs and alcohol, and to find help and treatment for family and friends in trouble. Learn more at drugfree.org.

About Hill Holliday

Hill Holliday, owned by the Interpublic Group of Companies and headquartered in Boston with offices in New York, Miami and Greenville, S.C., is one of the top communication agencies in the nation. Hill Holliday has won every major award for advertising excellence and effectiveness and has among its roster of clients leading national and regional brands including Anheuser-Busch, AOL, Bank of America, Chili’s Grill & Bar, Cleveland Clinic, Covidien, CVS/pharmacy, Dunkin’ Donuts, Harvard Pilgrim Health Care, Liberty Mutual, The Massachusetts State Lottery, Novartis, Partners HealthCare, Procter & Gamble, the Rockport Company, TJX Companies, and Verizon Wireless. Hill Holliday can be found on the Web at www.hhcc.com.

Attorney Jamie Verdi Establishes Michigan Patient Advocacy Liaison, PLLC, to Serve Nursing Home Patients and Family Members

ROCHESTER, Mich., Oct. 3, 2008 (GLOBE NEWSWIRE) — Jamie M. Verdi, Esq., has established Michigan Patient Advocacy Liaison, PLLC or MI-PAL as a patient advocacy and legal consulting firm specializing in nursing home care, Medicaid/Medicare law, and elder law. The firm is located in Rochester, Michigan.

MI-PAL is dedicated to providing personalized legal services to patients in nursing homes and other long-term care facilities. MI-PAL works closely with its clients and their family members to identify and resolve problems that arise with quality of care. She also serves as a liaison between families and long-term care facility staff to resolve concerns and foster open communication. MI-PAL helps its clients develop strategies to maximize Medicare, Medicaid, and Veterans Affairs benefits.

In forming her company, Verdi said, “Too many of our elderly have no voice in the healthcare system. They and their families are often powerless to insist on the right care for themselves or their loved one. With my experience and expertise in healthcare law and a passion for justice for the elderly, I want to serve as their advocate. That’s what MI-PAL is in business to do!”

Prior to forming MI-PAL, Verdi was a healthcare attorney for a national healthcare company. She also served several years as a research attorney in the 48th District Judicial Court in Bloomfield Hills, Michigan.

Verdi holds a Master of Laws degree in Health Law from Loyola University Chicago School of Law; a Juris Doctorate degree from the New England School of Law; and a Bachelor of Science degree in business administration from the Boston University School of Management.

She is a member of the State Bar of Michigan’s Health Law Section; the American Health Lawyers Association; the National Academy of Elder Law Attorneys, Inc.; the National Citizens Coalition for Nursing Home Reform; the Michigan Society of Healthcare Risk Management and the Michigan Campaign for Quality Care.

Verdi speaks to groups of senior citizens and their families in the Metro Detroit area to educate them on their rights and how to find an advocate when they need one. She can be reached at 248-410-4945 or [email protected].

This news release was distributed by GlobeNewswire, www.globenewswire.com

 CONTACT:  Ahee Communications, Inc.           Renee Ahee            586-979-3801           [email protected]            MI-PAL           Jamie Verdi, Esq.           248-410-4945           [email protected] 

Additional Allegations Filed Against Elder Care Operator

SEATTLE, Oct. 3 /PRNewswire-USNewswire/ — A revised complaint with additional allegations in the class action lawsuit against skilled nursing facility Extendicare and its 16 facilities in the state of Washington [see list by city at end of release] was just filed (Case #2:08-cv-01332-JCC) in United States District Court, Western Washington Division, in Seattle.

The original complaint (Case #08-2-28645-2KNT), filed by The Garcia Law Firm of Long Beach, Calif., and Stritmatter, Kessler, Whelan, Coluccio of Seattle, Wash., in King County Superior Court in August 2008, alleges that Extendicare tells the public and prospective clients that it is operated in such a way that it meets the needs of its elderly and vulnerable adult residents by providing a certain standard of care. The complaint contends that in spite of the claims made on Extendicare’s websites and in its brochures and in other promotional materials, it is, in fact, cheating its residents and misrepresenting itself to prospective residents.

The suit was filed on behalf of Howard Steele as the personal representative for the estate of Lee Ann Steele and on behalf of all Washington citizens who resided in one of the company’s Washington facilities from July 1, 2004 through July 1, 2008.

“As people heard of the lawsuit, we started getting calls from family members and former Extendicare staff members, each with their own story of how bad their experience was with the company,” says plaintiff attorney Kevin Coluccio of Stritmatter, Kessler, Whelan, Coluccio. “These calls, combined with our own investigation, revealed a whole host of problems that we hadn’t even expected.”

New allegations include Extendicare’s “Green Flag Policy” or the “24/7 Extendicare Admission Policy.” This policy is comprised of three lists: “Green Flag,””Yellow Flag,” and “Red Flag.” Various medical conditions are attributed to each list.

The “Green Flag” list includes such serious medical conditions as tracheotomies, gastric tubes, nasal gastric tubes, Dobhoff tubes, wounds, VAC therapy, chest tubes for drainage, colostomies, ileostomies, ureotomies, IV therapy, Hepatitis B, HIV. It also includes patients who are in restraints, need physical occupational or speech rehabilitation, chemotherapy, radiation, traction, or are an elopement risk. Presenting with any of these conditions qualifies them for “Automatic Admission/Always Yes Immediately,” states the 24/7 Extendicare Admission Policy.

By law, a skilled nursing facility must be able to provide the care and treatment you need and be sure you are not a danger to other residents before it accepts you. These admitting policies were designed for all 16 Washington Extendicare facilities by the corporate office in Milwaukee, Wisc. A patient could only be DENIED admittance if the corporate vice president approved.

“I don’t believe a corporate vice president in Milwaukee could possibly know if the local facility was able to handle the needs of the patient or if the patient should be in a hospital or another acute care facility,” says Long Beach, Calif., plaintiff attorney Stephen M. Garcia of The Garcia Law Firm. “It seems to me that the emphasis is on increasing the census in order to increase the profits, regardless of whether the prospective patient needed care the facility couldn’t give or if he were a felon or even a sex offender.”

Coluccio and Garcia also found that the corporate-mandated Resident Rights form given to incoming patients, and which they had to sign, violates Washington law. Extendicare’s form makes patients sign away their right to bring legal action for any potential liability for personal injury or losses of personal property. Washington law (Section 388-97-051 WAC) says that the resident has the right not to be asked or required to sign any such contract or agreement.

In the revised complaint filed today, Extendicare Health Services, Inc. was added as a defendant to Howard Steele, as the Personal Representative for the Estate of Lee Anne Steele v. Extendicare Homes, Inc.; Fir Lane Terrace Convalescent Center, Inc.; and Does 1 through 250, inclusive.

Extendicare Homes, Inc. is a subsidiary of Extendicare Health Services, Inc. and is the licensee of a number of long-term nursing facilities. In the United States, Extendicare Health Services, Inc., (EHSI), based in Milwaukee, Wisc., is a wholly owned subsidiary of the Canadian company Extendicare Real Estate Investment Trust (Extendicare REIT). The company (symbol: ALC) is listed on the New York Stock Exchange.

Extendicare Health Services, Inc. operates, according to its website, 191 senior care facilities in the United States with approximately 19,200 beds.

Extendicare’s problems seem to range across the country. A July 27, 2008 article in the Milwaukee Journal-Sentinel reported that Extendicare owns 26 nursing homes in Wisconsin. Twenty of them have been cited for at least one serious care violation in the past three years. The article also reports that in 2005, Extendicare paid $2.3 million to Wisconsin in a civil settlement over serious nursing home violations arising from the 2003 death of a resident. Its Sun Prairie home, Willows Nursing & Rehabilitation, was cited for poor care after two residents died. Willows paid $198,045 in state and federal fines; it also is on the federal list of the worst homes in the country.

Nevertheless, Extendicare is expanding in Washington. A July 12, 2007 article in the Journal of Business reported that it had received preliminary state approval to build a 120-bed facility on the South Hill in Spokane. The article said that the facility is expected to open in July 2009.

For information about the class action suit, contact Stephen M. Garcia at The Garcia Law Firm, (800) 281.8515 or http://www.lawgarcia.com/.

Washington Facilities

The Washington statewide average of citations for deficiencies by the Washington Department of Social and Health Services in all years quoted below was nine.

   AUBURN   North Auburn Rehabilitation & Health Center dba Extendicare Homes, Inc.   2007:  38 notices of deficiencies   2006:  37 notices of deficiencies    BAINBRIDGE   Island Health & Rehabilitation dba for Extendicare Homes, Inc.    BREMERTON  

Bremerton Convalescent & Rehabilitation Center dba for Fir Lane Convalescent Center, Inc.

   2007:  16 notices of deficiencies   2006:  19 notices of deficiencies   

Forest Ridge Health & Rehabilitation Center dba for Fir Lane Terrace Convalescent Center, Inc.

   2006:  12 notices of deficiencies    CENTRALIA   Riverside Nursing & Rehabilitation Center dba  Extendicare Homes, Inc.   2007:  32 notices of deficiencies   2006:  11 notices of deficiencies    EDMONDS  

Aldercrest Health & Rehabilitation Center (dba for Extendicare Homes, Inc.)

   2007:  18 notices of deficiencies   2005:  19 notices of deficiencies    ELLENSBURG   Kittitas Valley Health & Rehabilitation Center dba Extendicare Homes, Inc.   2007: 13 notices of deficiencies    OLYMPIA   Evergreen Nursing & Rehabilitation Center dba for Extendicare Homes, Inc.   2007:  16 notices of deficiencies   2006:  14 notices of deficiencies    Puget Sound Healthcare Center dba Extendicare Homes, Inc.   2007:  27 notices of deficiencies   2006:  17 notices of deficiencies    PORT ANGELES  

Crestwood Convalescent Center dba for Fir Lane Terrace Convalescent Center, Inc.

   2007:  12 notices of deficiencies   2005:  18 notices of deficiencies   

Port Angeles Care Center dba for Fir Lane Terrace Convalescent Center, Inc.

   2007:  18 notices of deficiencies   2006:  10 notices of deficiencies    SHELTON  

Fir Lane Health & Rehabilitation Center dba for Fir Lane Terrace Convalescent Center, Inc.

   2007:  16 notices of deficiencies   2006:  29 notices of deficiencies    SPOKANE  

Franklin Hills Health & Rehabilitation Center dba for Extendicare Homes, Inc.

   2007:  35 notices of deficiencies   2006:  30 notices of deficiencies    The Gardens on University dba for Extendicare Homes, Inc.   2007:  20 notices of deficiencies   2006:  28 notices of deficiencies    VANCOUVER   Pacific Specialty & Rehabilitation Center dba Extendicare Homes, Inc.   2007:  17 notices of deficiencies   2004:  40 notices of deficiencies    - REVISED COMPLAINT, EXHIBITS & ATTORNEY INTERVIEW AVAILABLE -    CONTACT:  Geri Wilson, +1-626-403-6741, for The Garcia Law Firm  

The Garcia Law Firm

CONTACT: Geri Wilson, +1-626-403-6741, cell: +1-626-487-2235,[email protected], for The Garcia Law Firm

Web Site: http://www.lawgarcia.com/

Celldex Receives $10 Million Milestone Payment From Affiliate of PCH

Celldex Therapeutics, an integrated biopharmaceutical company, has received a milestone payment of $10 million from an affiliate of Paul Capital Healthcare.

The payment was triggered by the market launch of Rotarix in the US. Rotarix is marketed worldwide by GlaxoSmithKline.

John Leone, a partner at Paul Capital Healthcare, said: “In purchasing a portion of Celldex’s Rotarix royalty stream, Paul Capital Healthcare has helped Celldex to monetize a previously under-appreciated asset.

The US approval and launch of Rotarix validate our assessment of the product’s value and Celldex’s contribution to its development. Through our agreement with Celldex, we have provided the company with growth capital to advance and expand its development pipeline.”

Anthony Marucci, president and CEO of Celldex, said: “We are thrilled that GSK has successfully launched Rotarix in advance of the rotavirus season, enabling infants to receive this important vaccination in the coming months.

“We are also pleased to receive this final milestone payment from Paul Capital Healthcare (PCH) and will use the proceeds to advance our ongoing clinical programs and to support the creation of additional novel disease-specific drug candidates through our proprietary precision targeted immunotherapy platform.”

Acuo Technologies(R) Announces Image Distribution Contract With Michigan State University

ST. PAUL, Minn., Oct. 3 /PRNewswire/ — Acuo Technologies, developers of high-performance software for intelligent medical image management, data migration tools and services, today announced that its DICOM Services Grid(TM) is being used in the distribution of timely information monitoring the impact of malaria in Malawi, Africa by Michigan State University. Due to the fact that the vast majority of malaria patients are children, it is critical to use new technologies to quickly assess the damage malaria does to a child. Physicians now can diagnose and study the affect the disease has on an infected child’s brain, something that previously could only be done in an autopsy.

The plight of Malawi’s unfortunate children changed when General Electric’s new magnetic resonance imaging (MRI) unit was installed at the Queen Elizabeth Central Hospital in Blantyre, Malawi’s largest city. The MRI Scanner captured images and Acuo’s DICOM Services Grid rapidly transmitted them to Doctors at MSU over secure connections. The combined technology will let physicians assess the mystery of malaria and effectively deal with a wide range of illnesses before they are untreatable and affect the local population.

The Acuo DICOM Services Grid plays an important roll in receiving the images from the MRI by storing and rapidly sending them to the physicians across the Atlantic. Once received, radiologists evaluate images and provide critical input to the treating physicians. The DICOM Services Grid builds the foundation for a vendor neutral medical imaging grid environment allowing sharing and collaboration regardless of the proprietary systems producing, storing or viewing the images. Michigan State University will also be using the Acuo DICOM Assisted Migration (ADAM) to move and virtualize data between their existing proprietary archive with their new GE 3.0 Medical Imaging Environment. This new environment employs mirrored EMC CX-340 CLARiiONS providing an automated solution for business continuity.

The deployment of this new and exciting technology helps to attract and retain doctors in Malawi. Dr. Sam Kampondeni is a success story, trained as a guest radiologist in the MSU Department of Radiology in 2007, he returned to Malawi to treat patients. Dr. Kampondeni now sends images to MSU to have fellow radiologists provide valuable and timely assistance seamlessly as if they were in the same hospital. “With these new systems we will be able to serve dozens more patients each day,” said Dr. Sam Kampondeni.

“This will help in so many ways,” Dr. Terrie Taylor said — University Distinguished Professor of internal medicine and an osteopathic physician with Michigan State. “We will use it for the research we do, we’ll be able to use it for everyday patients that come through the hospital, and it will help to attract and retain more doctors to Malawi.” Dr.Taylor spends the rainy season — January through June — working at the Queen Elizabeth Central Hospital, treating malaria patients and conducting research on a disease that kills as many as 2 million children in sub-Saharan Africa every year.

This success was possible through the efforts of James Potchen, an MSU University Distinguished Professor of radiology and chairperson of the department. MSU is looking at expanding the project to other parts of the world.

About Acuo Technologies

Acuo Technologies was founded in 2000 with the objective of developing the first enterprise-wide vendor neutral solution for medical DICOM images residing in a Picture Archiving and Communications System (PACS). Over 240 implementations around the world have deployed AcuoMed(TM) and AcuoStore(TM) software solutions. For more information, visit http://www.acuotech.com/.

Acuo Technologies

CONTACT: Michael Simon, VP, Business Development – Sales of AcuoTechnologies, +1-651-730-4110, [email protected]

Web site: http://www.acuotech.com/

Targeted Therapy Cancer Brands to Achieve Sales of Over $42 Billion By 2017

Targeted therapies have improved treatment outcomes in cancer notably, becoming the leading therapy class in the oncology market. As a result, they are expected to achieve sales of over $42 billion by 2017. Eight more marketed brands are set to achieve blockbuster status over the 10-year forecast period, driven by the persistent unmet need that still exists across a number of tumor types.

In 1997, Biogen Idec/Genentech/Roche/Zenyaku Kogyo’s Rituxan (rituximab) – a monoclonal antibody used to treat non-Hodgkin’s lymphoma – became the first targeted cancer drug to reach the market. Since Rituxan’s launch, researchers have elucidated more of the mechanisms driving cancer and have identified a variety of potential drug targets, resulting in a proliferation of the number of marketed targeted therapies. Currently, 24 different targeted cancer therapies are commercially available in at least one of the seven major markets of the US, Japan, France, Germany, Italy, Spain and the UK.

Targeted therapies (used either alone or in combination with cytotoxic therapies) have led to improvements in treatment outcomes across many tumor types, allowing some of them to become the standard-of-care in their approved indications. The resulting high level of uptake, coupled with their premium prices, make targeted therapies the leading therapy class in the oncology market in terms of sales. Global sales of targeted therapies totaled $17.3 billion in 2007, growing a staggering 33% in just a year, according to Datamonitor. A number of targeted therapy cancer brands have achieved blockbuster sales, and have become important sources of revenue for some of the leading pharmaceutical and biotech companies.

Not surprisingly, an increasing number of companies have turned their attention to the cancer targeted therapy market, undoubtedly trying to emulate the blockbuster status that several brands have already achieved. Since 2005, 10 new branded targeted drugs have entered the market. With more pipeline drugs looking likely to gain approval in the near future, the market is set to become even more competitive and fragmented.

Some drug targets play a role in several different types of cancer, which means that targeted therapies have considerable potential for expansion across different indications. For example, Genentech/Roche/Chugai’s Avastin (bevacizumab) – a monoclonal antibody that prevents the growth of new blood vessels to a tumor – is already approved for four different solid tumors: colorectal cancer, lung cancer, kidney cancer and breast cancer. Given the persistent level of unmet need across a number of tumor types, Datamonitor anticipates further indication expansions for a number of marketed targeted therapies in the next five years.

Several other factors will drive continuing market penetration by the targeted therapy cancer brands, including growing physician awareness of recently launched brands, use in earlier lines of therapy and different treatment settings such as the adjuvant and maintenance settings.

Datamonitor forecasts some of the key targeted therapies to achieve high sales growth between 2008 and 2017, driven by these factors. Combined sales of the targeted therapy brands will grow at a compound annual growth rate of 11%, reaching over $42 billion in the seven major markets by 2017. As a result, eight new targeted therapy cancer brands will achieve blockbuster status by 2017, including Pfizer’s Sutent (sunitinib), OSI/Genentech/Roche/Chugai’s Tarceva (erlotinib) and Bayer Schering/Onyx’s Nexavar (sorafenib).

Although the targeted therapies cancer brands market will be one of the biggest areas of growth in the pharmaceutical and biotech industry over the coming years, it will face a number of significant threats. The rising incidence of cancer and growing use of targeted therapies, coupled with their high cost, will put healthcare budgets under increasing strain. In more cost-conservative markets, this has already led to restricted use of certain brands. In the UK, for example, the National Institute for Health and Clinical Excellence has recommended against the use of a number of targeted cancer drugs for NHS patients on the grounds of low cost-effectiveness. If other healthcare systems follow the UK’s example, which looks like an increasing possibility, this could significantly dampen growth of the market and will ultimately impact the effectiveness of treatment available to patients.

Additionally, a number of brands will have to contend with the threat of patent expiry by 2017, including Novartis’ Gleevec (imatinib) and Takeda/Johnson & Johnson’s Velcade (bortezomib). Similarly, if legislation allowing biosimilar (biologic follow-on products) monoclonal antibodies goes ahead, sales of certain other brands could also suffer.

In the rapidly evolving competitive landscape of the targeted therapy cancer brands market, the current market leaders – Genentech and Roche – look well-placed to consolidate their position. The companies’ oncology portfolio includes the three leading brands in 2007 – Rituxan, Herceptin (trastuzumab) and Avastin – which alone represent more than half of the total targeted therapies market value. Datamonitor believes these brands will remain the three leading targeted therapy cancer brands in 2017, achieving combined sales of over $23 billion in the seven major markets.

While Genentech and Roche are set to dominate the market between 2008 and 2017, the high growth achieved by a number of different brands will make targeted cancer therapies an increasingly important revenue source for several other companies as well.

Blood Systems Licenses Mediware Blood Technologies to Streamline Services Provided to Hospitals

Mediware Information Systems (NASDAQ: MEDW), a provider of ClosedLoop(TM) clinical systems for blood and medication management, announced today that Blood Systems (“BSI”) has licensed two additional blood management software products. BSI, which includes United Blood Services (UBS) and Blood Systems Laboratories (BSL), is one of the nation’s largest blood collection and testing organizations and has licensed both HCLL Transfusion and ORDER Trak to improve service offerings to hospital clients. BSL, BSI’s testing organization, has leveraged Mediware’s LifeTrak(R) donor management system for more than 5 years to test and process approximately three million units annually.

“We are very pleased to expand our relationship with BSI through these agreements,” said Kelly Mann, Mediware’s president and chief executive officer. “Through its divisions, BSI manages the full spectrum of blood management services — from donor to recipient — and represents an ideal customer for Mediware. Their range of services matches our own, where we provide integrated software systems that span from donor recruitment to bedside transfusion administration.”

Under the new agreement, BSI has licensed HCLL Transfusion for use in providing outsourced transfusion services to hospitals across the southwestern United States. HCLL is considered the leading transfusion management system for large institutions and organizations with multi-facility requirements. Licensed by more than 320 top tier hospitals in North America and abroad, HCLL Transfusion software is 510(k) cleared as a medical device in the United States by the Food and Drug Administration.

Also under this agreement, UBS may begin using Mediware’s ORDER Trak(TM) product to provide its hospital customers an innovative online supply and inventory manager that manages order placement, tracks delivery status, provides reoccurring orders, recalls order history, and monitors inventory and consignment orders.

“Our agreement with BSI is an excellent example of how our solutions span from blood centers all the way through to hospital services,” said Mann. “These capabilities are only possible with an integrated solution that can seamlessly manage data throughout the entire blood supply chain, from donor recruitment to patient transfusion.”

More information about all of Mediware’s blood management products is available on Mediware’s web site, www.mediware.com.

About Blood Systems

With its headquarters in Scottsdale, Arizona, Blood Systems is an internationally known leader in blood banking and is one of the nation’s oldest and largest blood service providers. Together with its divisions, Blood Systems is a 501 (c) (3) non-profit, tax exempt, charitable organization that has been making a difference in people’s lives and creating strong ties in the communities they serve for more than 65 years.

About Mediware

Mediware delivers blood and medication management software systems that encapsulate information supporting patient therapies, reinforce patient safety practices and improve efficiencies to lower costs. Mediware’s customers include prestigious hospitals, clinics, correctional institutions, blood centers and other public and private health care institutions throughout the world. For more information about Mediware products and services, visit www.mediware.com.

Certain statements in this press release may constitute “forward-looking” statements within the meaning of the Private Securities Litigation Reform Act of 1995, as the same may be amended from time to time (the “Act”) and in releases made by the SEC from time to time. Such forward-looking statements are not based on historical facts and involve known and unknown risks, uncertainties and other factors disclosed in the Company’s Annual Report on Form 10-K for the year ended June 30, 2007, which may cause the actual results of the Company to be materially different from any future results expressed or implied by such forward-looking statements. The Company disclaims any obligation to update its forward-looking statements.

 Contact: John Van Blaricum 913.307.1017  

SOURCE: Mediware Information Systems

Lilly and Deciphera Pharmaceuticals Announce Licensing and Collaboration Agreement

INDIANAPOLIS, Ind. and LAWRENCE, Kan., Oct. 3 /PRNewswire-FirstCall/ — Eli Lilly and Company and privately-held Deciphera Pharmaceuticals, LLC today announced that the two companies have entered into a collaboration and worldwide licensing agreement related to Deciphera’s preclinical B-Raf kinase inhibitor program for the study of potential oncology therapeutics.

The collaboration will apply Deciphera’s phylomechanics discovery platform, a unique, proprietary approach to kinase inhibitor design, together with Lilly’s expertise in discovery, development and commercialization to pursue first-in-class and best-in-class drug candidates for a variety of cancers.

Under the terms of the agreement, Lilly and Deciphera will collaborate in four different project areas involving selective or multi-kinase targeted B-Raf inhibitors. Lilly will obtain exclusive worldwide rights to any products developed as part of this collaboration. In return, Deciphera will receive an upfront payment and research funding over the next two years from Lilly, and may also receive up to $130 million in potential development, regulatory and sales milestones for each of the four project areas. If a product is successfully commercialized from this collaboration, Deciphera will be entitled to royalties on sales.

“This collaboration is further evidence of Lilly’s ongoing commitment to oncology research,” said Dr. William W. Chin, M.D., vice president of discovery research and clinical investigation for Lilly. “We look forward to working with Deciphera to leverage their B-Raf kinase inhibitor program, with the ultimate goal of developing promising drug candidates for cancer patients.”

“The collaboration and license agreement with Lilly marks an important milestone in the growth and development of our company,” said Daniel Flynn, President & CEO of Deciphera. “Lilly’s strength in drug discovery and development, and in particular their commitment to cancer drug research, provides Deciphera with the opportunity to advance our B-Raf kinase ‘switch pocket’ inhibitors into the clinic and ultimately to patients in need of these therapies. We are very pleased to have Lilly as our partner in this endeavor.”

About B-Raf Inhibitors

BRAF kinase is one of the most frequently mutated members of the kinase family across all cancers, and is particularly common in malignant melanomas, colon, and thyroid cancers. The V600E mutant form of BRAF kinase in particular has been associated with increased tumor aggressiveness and decreased survival rates in many types of cancers. Deciphera is pursuing two distinct strategies centered on BRAF inhibition. The first strategy seeks potent and highly selective BRAF inhibitors. The second strategy pursues BRAF inhibitors which also inhibit other kinases of interest.

About Deciphera

Deciphera Pharmaceuticals, LLC was established in 2003 as a drug discovery and development company with the mission to design, optimize and introduce “best-in-class” small molecule switch inhibitors of protein kinases for human clinical trials and the global pharmaceutical marketplace through the use of its proprietary drug discovery technology platform, Phylomechanics. Deciphera’s kinase inhibitors target the mechanisms that render kinases oncogenic, retain potency against gatekeeper mutations, and afford selectivity profiles not easily attained by other approaches. For more information, visit the Company’s website at http://www.deciphera.com/.

About Lilly

Lilly, a leading innovation-driven corporation, is developing a growing portfolio of first-in-class and best-in-class pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, Ind., Lilly provides answers – through medicines and information – for some of the world’s most urgent medical needs. Additional information about Lilly is available at http://www.lilly.com/.

C-LLY

This news release contains forward-looking statements. These statements are subject to known and unknown risks and uncertainties that may cause actual future experience and results to differ materially from the statements made. Factors that might cause such a difference include, among others, the completion of clinical trials, the FDA and other foreign review processes and other governmental regulation, Lilly’s and Deciphera’s abilities to successfully develop and commercialize drug candidates, competition from other pharmaceutical companies, the ability to effectively market products, and other factors described in Lilly’s most recent filings with the Securities and Exchange Commission. Lilly undertakes no duty to update forward looking statements.

(Logo: http://www.newscom.com/cgi-bin/prnh/20031219/LLYLOGO )

Photo: NewsCom: http://www.newscom.com/cgi-bin/prnh/20031219/LLYLOGOPRN Photo Desk, [email protected]

Eli Lilly and Company

CONTACT: Mark E. Taylor, Lilly, +1-317-276-5795; Daniel L. Flynn,Deciphera, +1-785-838-3767

What’s Cooking in Today’s Retirement Communities?

PHILADELPHIA, Oct. 3 /PRNewswire-USNewswire/ — The following is being issued by the American Association of Homes and Services for the Aging:

WHAT: The days of pureed peas and lukewarm meatloaf are long gone. Today’s retirement communities offer menu options that make them dining destinations for visitors young and old.

Don’t believe us? Taste for yourself at American Association of Homes and Services for the Aging’s (AAHSA) Annual Meeting & Exposition at the Pennsylvania Convention Center.

Each day, executive chefs from local retirement communities will race against the clock to create delicious dishes using a secret ingredient on the exhibit hall floor. Area chefs will judge their culinary creations and ultimately decide who will reign supreme as AAHSA’s “Iron Chef.”

   WHERE: Pennsylvania Convention Center   Exhibit Hall BC   1101 Arch Street   Philadelphia, Pa.19107    WHEN:  Exhibition Hours:  Monday, Oct. 13, noon to 4 p.m.   Tuesday, Oct. 14, noon to 3:30 p.m.   Wednesday, Oct. 15, noon to 3:30 p.m.    WHO:   Participating chefs include:    Richard Hoschar Executive Chef   Muncy Valley Long Term Care at Susquehanna Health   Muncy, Pa.    Fred Lee   Executive Chef   The Lafayette - Redeemer   Philadelphia, Pa.    William Hockenberry   Executive Chef   Shenango Presbyterian Senior Care   New Wilmington, Pa.    Joseph Baj   Executive Chef   Twining Village Retirement Community   Holland, Pa.    Kathleen Whiley   Executive Chef   Friends Village   Woodstown, N.J.    Adam Grafton   Director, Dining Services   Dock Woods Community   Lansdale, Pa.    Evaristo Gustines   Executive Chef   Asbury Methodist Village   Gaithersburg, Md.    Jonathan Long   Executive Chef   Wellington at Hershey's Mill   Chester, Pa.    

Local sponsors include ARAMARK Senior Living Services, Cura Hospitality, Sodexo Senior Services and Morrison Senior Dining.

To attend or for more information, contact Lauren Shaham, (202) 508-1219 or [email protected], or Sarah Mashburn, +1-202-508-9492, [email protected].

About AAHSA

The members of the American Association of Homes and Services for the Aging (http://www.aahsa.org/) help millions of individuals and their families every day through mission-driven, not-for-profit organizations dedicated to providing the services that people need, when they need them, in the place they call home. Our 5,300 member organizations, many of which have served their communities for generations, offer the continuum of aging services: adult day services, home health, community services, senior housing, assisted living residences, continuing care retirement communities and nursing homes. AAHSA’s commitment is to create the future of aging services through quality people can trust.

American Association of Homes and Services for the Aging

CONTACT: Lauren Shaham, +1-202-508-1219, [email protected], or SarahMashburn, +1-202-508-9492, [email protected], both of American Associationof Homes and Services for the Aging

Web Site: http://www.aahsa.org/

Weis Markets Completes Rollout of New 90-Day $9.99 Prescription Plan for 350+ Generic Prescriptions

SUNBURY, Pa., Oct. 3 /PRNewswire-FirstCall/ — Weis Markets Inc. today said it has completed the chainwide rollout of its new generic prescription plan offering a 90-day supply of more than 350 generic prescriptions for $9.99.

The generic prescription plan was introduced in 59 store pharmacies located in Central PA, and Northeast PA (including Scranton, Wilkes-Barre and the Pocono’s), New Jersey and Elmira, NY. This plan is now available in all 118 Weis Markets in-store pharmacies.

The plan was initially introduced in August in 59 Weis Markets pharmacies in Harrisburg, Lancaster and York along with all of its in-store pharmacies in Maryland West Virginia.

“We’re extremely pleased with the strong customer response to our generic prescription plan and have decided to roll it out chainwide. Increasing healthcare and prescription costs remain a huge issue for our customers and their employers. Our generic prescription plan offers strong savings and gives more choices to physicians and customers such as state and federal employees who are often limited to mail order,” said David J. Hepfinger, Weis Markets President and COO.

“Our 90-day generic prescription plan offers the best of both worlds: low prices in a full service retail pharmacy, where patients overwhelming prefer to have their prescriptions filled. Pharmacists in the retail setting are uniquely positioned to offer personal pharmaceutical care and medication management, something that’s difficult to do with mail order,” said Jeff Maltese, Weis Markets Vice President of Pharmacy.

Weis Markets’ 90-Day Prescription plan includes the new generic drug Altace, which is used to treat high blood pressure and heart failure. The plan also includes generic drugs and antibiotics used to treat allergies, asthma, arthritis, cholesterol, diabetes and digestive ailments.

Founded in 1912, Weis Markets is a Mid-Atlantic supermarket company. It currently operates 155 stores in five Mid-Atlantic States: Pennsylvania, Maryland, New Jersey, New York and West Virginia. It also owns and operates SuperPetz, a pet supply superstore chain with 28 locations in nine states.

Weis Markets Inc.

CONTACT: Dennis V. Curtin of Weis Markets, +1-570-847-3636,[email protected]

Overeating Makes the Brain Go Haywire

U.S. researchers have determined that overeating makes the brain go haywire, which could lead to diabetes, heart disease, and many other problems.

Eating too much food activates a typically dormant immune system pathway in the brain. This process sends out immune cells to attack and destroy invaders that are not there, according to Dongsheng Cai of the University of Wisconsin-Madison.

The findings were published in the journal Cell. The research could help explain why obesity causes so many different diseases.

“This pathway is usually present but inactive in the brain,” Cai said.

Obesity is a growing problem worldwide with 1.8 billion people estimated to be overweight or obese in 2007.

Cai’s team studied mice, and tried to explain previous studies that have shown that obesity causes chronic inflammation throughout the body.

Inflammation is found in a range of diseases related to obesity, including heart disease and diabetes.

Researchers focused on a compound known as IKKbeta/NK-kappaB.

Cai’s team found the compound in the hypothalamus, a part of the brain linked with both metabolism in mice and humans.

They wrote, “The hypothalamus is the ‘headquarters’ for regulating energy.”

When researchers fed mice a high-fat diet, it became extremely active.

The body ignored signals from leptin when the body was active. Leptin is a hormone that normally helps regulate appetite, and insulin, which helps convert food into energy.

Stimulating IKKbeta/NK-kappaB made the mice eat more, while suppressing it made them eat less.

Cai said the research points a master switch for the diseases caused by overeating.

“Hypothalamic IKKb/NF-kB could underlie the entire family of modern diseases induced by overnutrition and obesity,” his team said.

Cai does not know why this compound is in the brain and in the immune system.

Scientists hypothesize it evolved long ago in primitive animals that do not have the same sophisticated immune system as modern animals, including mice and humans.

“Presumably it played some role to guide the immune defense,” Cai said. “In today’s society, this pathway is mobilized by a different environmental challenge ““ over nutrition.”

“Knocking out” the gene using genetic engineering kept mice eating normally and prevented obesity.

Cai say this cannot be done in people but instead believes a drug, or even gene therapy, might work.

Gene therapy means a virus is used to carry corrective DNA into the body, but the approach is still highly experimental.

Microneedles in Medicine Report – Technology, Markets and Prospects

Research and Markets (http://www.researchandmarkets.com/research/abda33/microneedles_in_me) has announced the addition of the “Microneedles in Medicine – Technology, Markets and Prospects” report to their offering.

Advances in the processing of materials on a micro-scale have led to the development and introduction of devices that employ very small needles – microneedles – that have significant potential in devices for diagnostics, healthcare monitoring and drug delivery by mechanically perforating the outer skin layer and allowing for transdermal drug absorption or fluid sampling. These processing techniques incorporate one or more technologies that enable the precise machining, extrusion, casting, and/or forming of from one to an array or grid of microneedles. Several factors – include an aging patient population, biological drug therapies for chronic conditions, and an emphasis on patient self-monitoring and self-care – are driving an evolution in the way that healthcare is delivered. Evolving microneedle systems will be well-positioned to address a significant segment of the large -molecule biological drugs expected to emerge from the convergence of automated discovery and genome mapping. Before microneedles find widespread use, researchers must perfect the techniques for optimally inserting them into the skin, and complete the integration of microneedles into a full diagnostic, monitoring or drug delivery system.

Microneedle Technology and Minimally Invasive Medicine:

Advances in the processing of materials on a microscale have led to the development and introduction of devices that employ very small needles – microneedles – that have significant potential in devices for diagnostics, healthcare monitoring and drug delivery by mechanically perforating the outer skin layer and allowing for transdermal drug absorption or fluid sampling. These processing techniques incorporate one or more technologies that enable the precise machining, extrusion, casting, and/or forming of from one to an array or grid of microneedles.

Several factors – include an aging patient population, biological drug therapies for chronic conditions, and an emphasis on patient self-monitoring and self-care – are driving an evolution in the way that healthcare is delivered. Evolving microneedle systems will be well positioned to address a significant segment of the large -molecule biological drugs expected to emerge from the convergence of automated discovery and genome mapping. Before microneedles find widespread use, researchers must perfect the techniques for optimally inserting them into the skin, and complete the integration of microneedles into a full diagnostic, monitoring or drug delivery system.

Market Data

The study presents qualitative and quantitative data and information on key market measures and benchmarks:

– Microneedle Market

– Segment Analysis

– Market Dynamics and

– Sensitivities

– Microneedle

– Technology Economic

– Factors

– Technology Enablers

– Development Status

– Commercial Strategies

– Third-party Stakeholders

– Market Participant

– Profiles

– Device-Pharma Alliance

– Activity and Deal

– Structure

– Competitive Risks

– Proprietary Technology

– User Issues

– Technology Risk Factors

– Regulatory Risk Factors

Forecasts and projections cover the period from 2007 to 2010.

Feature Summary

– Analyzes and evaluates microneedle technology and product research and development, and assesses the medical market potential for existing and probable future products

– Analyzes proprietary technologies and market development issues

– Provides detailed descriptions of medical microneedle business opportunities, market demographics, and business strategies

– Charts product sales data, market share, and forecasts to 2010

– Profiles microneedle medical product and technology participants, their activities, business strategies, and corporate alliances and affiliations

– Assesses the importance of licensing, alliances and partnerships on the success of medical applications for microneedles

– Evaluates the impact of economic, technology, and regulatory factors on the commercial potential of microneedle systems

Key Topics Covered:

Executive Summary

Microneedle Medical Market Overview

– The Trend to Minimally Invasive Medicine

– Drug Delivery & Self-Administration

– Continuous & Remote Monitoring

– Shifting Patient Demographics

– Managed Care Initiatives

– Commercial Microneedle Devices

– Competitive Landscape

Microneedle Design & Technology

– Solid Microneedles

– Hollow Microneedles

– Coated Microneedles

– Microneedle Arrays & Array Geometries

– Microneedle Manufacturing

– Material Selection Issues

– Fabrication Techniques

– Emerging Fabrication Methods

Markets for Microneedle Technology

– Biosensing

– Sampling

– Drug Delivery

– Tissue Enhancement

Microneedle Technology Transfer Factors

– Europe

– Japan

– North America

– Selected Research Programs

Microneedle Market Drivers

– Drug Discovery Trends

– Continuous Monitoring

– Large-Molecule Biologics

– Remote Patient Care

– Patient/Consumer Sentiment

– Enhanced Compliance

Commercial Therapeutic Opportunities

– Cancer Therapeutics

– Dermatology/Cosmetic Surgery

– Diabetes

– Diagnostics

– Fertility

– Genetic Engineering

– Pain Management

– Therapeutic Proteins/Peptides

– Vaccines

– Emerging Markets

Market Factors

– Regulatory

– FDA

– EMEA

– Pharma & Medical Devices Agency

Microneedle Company Profiles

For more information visit http://www.researchandmarkets.com/research/abda33/microneedles_in_me

Waterfront Media to Merge With Revolution Health Network Establishing the Everyday Health Network As the Preeminent Online Health Destination

Waterfront Media, the largest private online health company, and Revolution Health Network, another leading online health information company, today announced that they have signed a definitive agreement to merge that will create a new powerhouse in the online health space. With this merger, the Everyday Health Network, which is operated by Waterfront Media, will now include RevolutionHealth.com and all the online properties associated with the Revolution Health Network, forming the most comprehensive online destination designed to enable consumers to live healthier lives every day. Both companies’ boards of directors unanimously approved the merger.

The combined company is projected to have more than 20 million unique users* and, according to a comScore Plan Metrix custom report for the month of June, will be the market leader in audience reach for 23 health conditions. Waterfront Media CEO and co-founder Benjamin Wolin will remain chief executive officer of the new company. Steve Case, chairman and CEO of Revolution Health Group, and an additional member of Revolution Health’s board of directors to be named later, will join the Waterfront Media board of directors. The company will keep the name Waterfront Media, and will operate all sites under the Everyday Health Network. The company will remain headquartered in Brooklyn, NY. Doug McCormick, former CEO of Lifetime TV and iVillage, will remain chairman of the company. Mike Keriakos will remain president of the company. Financial terms were not disclosed.

“The inclusion of Revolution Health and its properties in the Everyday Health Network creates the most powerful, expansive online health experience for consumers,” said Wolin. “Both companies share a common heritage of providing consumers with access to online information, tools and support for healthier living. We look forward to adding Revolution Health’s world class features and sites to the Everyday Health Network. The combined company will bring together some of the industry’s best assets and enable us to accelerate our growth, reaching our respective goals faster with newly combined resources.”

“When we entered the health care market we knew one of the areas we wanted to focus on was using the Internet to empower consumers and give them more choice, control and convenience,” said Case. “The merger of Waterfront Media and Revolution Health Network builds on each company’s complementary strengths to create a new industry powerhouse – thus enabling us to accelerate our efforts to reach the largest, most engaged audience and help people stay healthy, manage chronic disease and deal with serious illness.”

Waterfront Media, which operates the Everyday Health Network, was founded by Wolin and Keriakos in 2002 and has since grown to become one of the top online health companies. Its network of more than 20 leading sites includes its flagship site, EverydayHealth.com, as well as WhatToExpect.com, SouthBeachDiet.com, JillianMichaels.com, and more.

Revolution Health Network has also become a leading online health information company since its launch in 2007. Web sites operated by or affiliated with the Revolution Health Network that complement Everyday Health will include:

— RevolutionHealth.com, a health and wellness destination with deep expert content and sophisticated online tools;

— HealthTalk.com, one of the most in-depth information sites for those dealing with chronic illnesses;

— CarePages.com, offered by more than 700 hospitals to patients so they may easily communicate with loved ones; and

— Affiliate agreements with Drugstore.com, Sparkpeople.com and DailyStrength.org.

By combining, the companies will have 24 online health properties, which will offer advertisers the unique opportunity to target consumers across the entire spectrum of online health and wellness.

Upon the closing of the transaction, which is expected by mid-October 2008, Revolution Health will become a significant shareholder of Waterfront Media and join existing investors Rho Ventures, Scale Venture Partners, Foundation Capital, Neocarta Ventures, BEV Capital, Time Warner Investments and Village Ventures. Revolution LLC – the parent company of Revolution Health – will continue to maintain its broad health portfolio through investments in RediClinic, a leading convenient care provider; Extend Health, a leading provider of defined contribution programs; Brainscope, which develops breakthrough technology that assesses brain function at the initial point of care; and SparkPeople, an online community that empowers users to change their lives for the better.

According to comScore Media Metrix August 2008 figures, Everyday Health had more than 14 million unique users and more than 80 million page views. Revolution Health Network had more than 12 million unique users and 200 million page views over the same period. The combined company is expected to reach well more than 20 million unique users and generate more than three billion page views per year, making it a leading health company in terms of both reach and utilization.

The respective financial and legal advisors to Waterfront Media are Credit Suisse and Pillsbury Winthrop Shaw Pittman LLP, and to Revolution Health Network are Morgan Stanley and Cooley Godward Kronish LLP.

About Waterfront Media and the Everyday Health Network

Waterfront Media is the largest privately held online health company and operates the Everyday Health Network, which attracts over 14 million unique users per month. Through its portfolio of health & wellness, diet, fitness, and pregnancy Web sites, including its flagship EverydayHealth.com, Waterfront Media enables consumers to live healthier lives every day. Waterfront Media was founded by CEO, Ben Wolin, & President, Mike Keriakos in 2002.

About Revolution LLC and Revolution Health

Revolution LLC was created by AOL Co-Founder Steve Case to create products and services that empower people and promote consumer-centered change. Today Revolution owns businesses in the healthcare, financial services, resorts, wellness and digital sectors. It is the largest investor in five principal health-related investments, including Revolution Health Network, with its flagship RevolutionHealth.com, and sites CarePages.com, HealthTalk.com, and affiliate partners; RediClinic, a leading convenient care provider; Extend Health, a leading provider of defined contribution programs. Revolution is also a significant minority investor in Brainscope, which pioneers breakthrough technology that assesses brain function at the initial point of care; and SparkPeople, an online community that empowers users to change their lives for the better.

* Source: comScore Media Metrix, August 2008

Seatbelt Injury Resulting in Functional Loss of a Transplanted Kidney

By McHugh, Patrick P Clifford, Timothy M; Johnston, Thomas D; Banerjee, Ambar S; Gedaly, Roberto; Jeon, Hoonbae; Ranjan, Dinesh

The transplanted kidney, lying heterotopically in the iliac fossa, is especially vulnerable to damage from blunt trauma, particularly compression by vehicle seatbelt. We present a case wherein a functioning renal allograft lying in the right iliac fossa was severely injured by seatbelt compression, (resulting in significant functional compromise and eventual loss. The patient later underwent successful retransplantation with a second living donor kidney. Management of injured renal transplant recipients requires appreciation of mechanisms likely to cause damage to the graft, as well as familiarity with available treatment options, both surgical and nonsurgical. As functional life spans of renal allografts improve, this type of injury will most likely be encountered with increasing frequency. (Progress in Transplantation. 2008;18:199-202) A high suspicion for intra-abdominal injury must always accompany the initial assessment of a patient involved in a motor vehicle collision, particularly if physical examination reveals the characteristic “seatbelt sign” (ecchymosis and/or abrasion of the lower part of the abdomen with or without similar markings across the side of the neck and the shoulder).1 Blunt trauma to this region can result in damage of variable severity to nearly any abdominal structure, visceral or musculoskeletal, depending on the dynamics of the impact. We present a case in which a functioning renal allograft lying in the right iliac fossa was severely injured by seatbelt compression, resulting in significant functional compromise and eventual loss. The patient later underwent successful retransplantation with a second living donor kidney.

Case Report

In December 2006, a 45-year-old man who had undergone living donor kidney transplantation in 1992 was a restrained driver who broadsided another vehicle. Although his condition was initially stable, he became hypotensive and received aggressive resuscitation with blood and crystalloids during transfer. On arrival at our level I trauma center, the patient had hematuria, abrasions over the right side of his chest, and an abdominal seatbelt sign demarcating an area of tenderness overlying his right-sided allograft. When focused abdominal sonography for trauma revealed free fluid, he was taken emergently to the operating room for exploratory surgery.

During laparotomy, he was found to have massive hemoperitoneum. Injuries included tears of the splenic capsule and the serosa of the transverse colon, and a grade IV injury of his renal allograft, with partial avulsion of the upper pole extending into the hilum and active bleeding resulting in retroperitoneal hematoma. Splenectomy was performed, and after evacuation of the hematoma, allograft bleeding was controlled with hemostatic sutures, topical application of procoagulants, and packing. His abdomen was closed in a temporary fashion, and he was taken to the intensive care unit for continued resuscitation and completion of his trauma assessment. Computed tomography of the abdomen obtained immediately postoperatively showed only segmentai perfusion of the injured allograft in the right iliac fossa (Figure 1).

Initially the patient responded well, with stable hemodynamics and urine output greater than 100 mL/h. Sixteen hours later, the patient had worsening tachycardia, hypotension, and oliguria, and underwent exploratory surgery again for presumed hemorrhage. However, no significant bleeding was seen; in fact, the allograft was found to be hemostatic with intact vasculature. The patient was returned to the intensive care unit and required no additional surgical procedures during this admission. A subsequent nuclear medicine renogram showed partial perfusion and suboptimal function of the allograft, with delayed excretion of radio-isotope into the urinary bladder, but no urine leak (Figure 2).

During this hospitalization, the patient’s serum level of creatinine initially stabilized at 3.7 mg/dL (to convert to micromoles per liter, multiply by 88.4). Previous creatinine levels were 2.5 mg/dL at baseline and 3.0 mg/dL on presentation. However, the creatinine level increased to 5.3 mg/dL 2 weeks after the accident. Computed tomography of the abdomen showed a large perinephric fluid collection; this was drained percutaneously with some improvement in renal function. The fluid was found to be a seroma. The patient’s urine output remained greater than 1 L daily. At discharge to a rehabilitation facility 1 month after the accident, his creatinine level was 3.6 mg/dL. During the months following, his serum level of creatinine gradually increased to a peak of 6.7 mg/dL, and he returned to our center for possible retransplantation. The patient underwent a second living donor transplantation 6 months after the trauma event. His postoperative recovery was uneventful and he was discharged home on postoperative day 5, with a serum creatinine level of 0.9 mg/dL (Figure 3).

Discussion

Although the benefit of seatbelt use in providing passive occupant restraint during motor vehicle accidents is widely accepted, their use is not without risk. The patterns of injuries resulting directly from use of seatbelts have been widely investigated and described.2 Nearly every major abdominal structure is reported to have been injured by blunt abdominal trauma, although some are more susceptible to injury than others. The propensity of an organ or structure to be damaged by blunt impact, particularly as delivered by an overlying seatbelt, is related to its anatomic location and attachments. Especially vulnerable are structures that are either fixed, thereby unable to reconcile shear forces, or superficially located, with limited surrounding soft tissue to provide a protective cushion. For these reasons, a heterotopic renal allograft lying in the iliac fossa is at significant risk of injury from seatbelt compression.

Surprisingly, blunt trauma involving transplanted kidneys is infrequently described, and among the reported cases, only a handful are related to seatbelt injury.3″5 A review of the literature by Akabane et al6 indicated that reported cases of blunt allograft trauma shared preservation of the graft, either with surgical or conservative management. Our review including more recent reports confirms this finding, with the exception being described by Mohammed et al.7 In that case, the allograft lost function over several months after blunt impact, necessitating the patient’s return to hemodialysis. Our patient may be the only reported case of seatbelt-related allograft injury with significant functional compromise and eventual loss, although it is also possible that such an adverse outcome after allograft injury by this specific mechanism is both seldom encountered and underreported.

Management of acutely injured kidney transplant recipients is not altogether different from their counterparts who do not have a transplanted kidney, because the priority is always to save the patient. Selective nonoperative management, now becoming the preferred treatment for most blunt trauma to native kidneys, should still be the guiding principle in addressing allograft trauma, if the patient is clinically stable.8 For instance, angiographic embolization, which is commonly used for injuries to the native kidney, was recently reported to be successful in preserving function of a renal allograft following seatbelt injury, thus avoiding transplant nephrectomy.3

If surgery is unavoidable, the most appropriate procedure depends on the severity of injury. Previously, Urquhart et al9 proposed that no graft-directed operation besides nephrectomy is feasible or beneficial in trauma to an allograft, as efforts to repair the damage are often unsuccessful. More recent cases have described use of various surgical approaches short of nephrectomy to preserve allograft function. According to the organ injury scale,10 our patient sustained a grade IV injury, with the laceration extending through the renal cortex, medulla, and collecting system (see Table). Grade IV injuries are arguably the most controversial in terms of management, as lesser injuries are typically well-managed conservatively and greater injuries usually necessitate intervention.” Admittedly the situation is different when addressing a damaged renal allograft rather than a damaged native kidney: the transplanted graft is solely responsible for obviating hemodialysis, unlike the shared function of paired native kidneys. It is difficult to speculate whether our patient’s allograft injury alone would have directed the same course of action, because he required exploratory surgery for hemorrhage from his splenic injury. In retrospect, repairing the damaged allograft, rather than performing nephrectomy, allowed some degree of renal function to exist for several months until retransplantation.

We expected allograft function to return with medical and expectant management, because its vascular supply was intact. Despite this, the allograft eventually proved unable to withstand the multiple injuries to which it was subjected. Already compromised by chronic allograft nephropathy, the kidney was subjected not only to direct compression by the seatbelt causing parenchymal damage, but also to early prolonged hypotension, as well as generous amounts of intravenous contrast material from the initial computed tomography, which together resulted in acute tubular necrosis and functional compromise. Blunt trauma to a renal allograft has been reported to precipitate acute rejection.7 Our patient, however, had appropriate immunosuppression levels throughout his hospitalization, and we never suspected involvement of an acute rejection process. Rather, it was the cumulative effect of these events that accelerated progression of the patient’s underlying chronic nephropathy and led to allograft failure. Conclusion

As more people undergo kidney transplantation, and advances in immunosuppression allow improved allograft survival, it is inevitable that an increasing number of patients with kidney transplants will be treated by trauma centers for injuries directly or indirectly involving their allograft. It is important to remember that measures taken to preserve allograft function should never compromise efforts to resuscitate the patient. As such, losing the allograft should not be regarded as failure, because the patient can still be a candidate for retransplantation and can have a successful outcome.

References

1. Velmahos GC, Tatevossian R, Demetriades D. The “seat belt mark” sign: a call for increased vigilance among physicians treating victims of motor vehicle accidents. Am Surg. 1999; 65(2):181-185.

2. Rutledge R, Thomason M, Oller D, et al. The spectrum of abdominal injuries associated with the use of seat belts. J Trauma. 1991;31(6):820-825; discussion 825-826.

3. Cabello R, Acosta D, Echenagusia M, et al. Renal allograft laceration treated by superselective embolization. J Endovasc Ther. 2006;13(2):260-263.

4. Coulshed SJ, Caterson RJ, Mahony JF. Traumatic infarct at the lower pole of a renal transplant secondary to seat belt compression. Nephrol Dial Transplant. 1995;10(8):1464-1465.

5. Sarramon JP, Durand D, Lazorthes F, et al. An accident related to a seat belt. Lymphocoele and extrinsic stenosis of the ureter in a transplant patient. Reparative surgery [in French]. J Urol Nephrol (Paris). 1976;82(7-8):601-605.

6. Akabane S, Ushiyama T, Hirano Y, et al. A case of traumatic renal graft rupture with salvage of renal function. Clin Transplant. 2001;15(4):289-292.

7. Mohammed EP, Venkat-Raman G, Marley N. Is trauma associated with acute rejection of a renal transplant? Nephrol Dial Transplant. 2002;17(2):283-284.

8. Santucci RA, Fisher MB. The literature increasingly supports expectant (conservative) management of renal trauma-a systematic review. J Trauma. 2005;59(2):493-503.

9. Urquhart CK, Hawkins ML, Wynn JJ, et al. Management of the injured renal transplant recipient. South Med J. 1991;84(4): 524- 526.

10. Moore EE, Shackford SR, Pachter HL, et al. Organ injury scaling: spleen, liver, and kidney. J Trauma. 1989;29(12): 1664- 1666.

11. Santucci RA, McAninch JM. Grade IV renal injuries: evaluation, treatment, and outcome. World J Surg. 2001;25(12): 1565- 1572.

Patrick P. McHugh, MD,

Timothy M. Clifford, PharmD,

Thomas D. Johnston, MD,

Ambar S. Banerjee, MBBS,

Roberto Gedaly, MD,

Hoonbae Jeon, MD,

Dinesh Ranjan, MD

University of Kentucky, Lexington

To purchase electronic or print reprints, contact:

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101 Columbia, Aliso Viejo, CA 92656

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Copyright North American Transplant Coordinators Organization Sep 2008

(c) 2008 Progress in Transplantation. Provided by ProQuest LLC. All rights Reserved.

Patients Seeking Alternatives to the Long Waiting List

By McKay, Dianne Potter, Steven R; Behrend, Terry; Stella, Frank; Steinberg, Steven

The need for deceased donor organs for kidney transplantation in the United States continues to increase. The increasing demand has fueled desperate attempts by patients to circumvent the long waiting list of the United Network for Organ Sharing. We report 4 patients with end-stage kidney disease who sought and obtained a live donor kidney transplant outside the United States. In each case, a nephrologist was following up with the patient regularly. Each patient experienced significant unexpected adverse events after the transplant surgery. Desperate attempts to obtain an organ are common and are likely to continue. Although patients with end-stage renal disease who obtain an organ transplant at an unregulated transplant center can have successful outcomes, transplant physicians should be aware of the common practice and should advise their patients of potential complications associated with acquisition of organs through means that circumvent standard oversight by the United Network for Organ Sharing and by institutions. (Progress in Transplantation. 2008:18:203-207) The United States is faced with an epidemic of kidney disease, with the prevalence of end-stage renal disease forecast to exceed 2 million by the year 2030.1 Kidney transplantation is the preferred method of renal replacement therapy for many patients. Currently, more than 76000 candidates in the United States are on the waiting list for a kidney transplant (according to data from the Organ Procurement and Transplantation Network [OPTN] as of July 18, 2008), and that number is increasing daily. Conversely, only 16626 kidney transplants were performed in 2007 (10587 from deceased organ donors and 6039 from; live donors; according to OPTN data as of July 18,2008). The median waiting time for a kidney from a deceased donor in the United States is between 2 and 6 years,2 with longer waiting times predicted for the future. The disparity between availability of organs for transplantation and their demand will increase because the numbers of patients with chronic kidney disease are increasing as a result of the aging of the population and the increasing numbers of people with diabetes mellitus and hypertension.3

We report 4 patients from our transplant center who traveled outside the United States to obtain a living donor kidney transplant. Each patient had undergone pretransplant evaluation and had been approved and placed on the waiting list for kidney transplantation in the United States. In each case, the transplant team was unaware that the patient had sought an organ outside the United States until the patient requested posttransplant care. Clinical information provided to the patients from the foreign transplant center was often limited and not in English. In each case, significant unexpected complications were associated with the transplant procedure.

Case Reports

Each patient in our case series obtained an allograft outside of the United States and experienced significant complications after the transplant procedure. The cases are described in detail here, including all information available from the transplant center.

Case 1 : Posttransplantation Malaria

A 54-year-old white man with end-stage renal disease caused by unspecified glomerulonephritis came to our institution with fever and rigors 18 days after receiving a kidney transplant from a living unrelated donor in Pakistan. The patient had received a kidney transplant from a deceased donor in the United States 29 years earlier that had ultimately been lost to chronic allograft nephropathy. The patient had returned to hemodialysis for 2 months before deciding to travel to Pakistan to purchase a kidney. He had not traveled outside the United States for 4 years before that and had no known exposure to infectious agents. The patient had been evaluated for transplantation in the United States and had recently been placed on the waiting list and designated status 1 by the United Network for Organ Sharing (UNOS). He had a high level of panel-reactive antibody, and his anticipated wait for a deceased donor organ was projected to be lengthy.

Unknown to the transplant team in the United States, the patient decided to travel to Pakistan with the assistance of a transplant broker he contacted via the Internet. The patient was matched by the broker to a living unrelated donor-a female donor who traveled from India to donate. Medical records were sent with the patient in English. The donor’s tissue typing was performed at the Pakistani transplant center, and the recipient’s tissue typing results were obtained from historic typing performed in the United States. The donor and recipient were matched for a single HLA-A and HLA-DR antigen and mismatched for 4 HLA antigens. Both donor and recipient were negative for antibodies to cytomegalovirus, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. Donor and recipient blood typing and crossmatching were performed at the Pakistani transplant center immediately before transplantation.

The patient was admitted to the hospital in Pakistan on December 31,2006, and the transplant procedure was performed on January 7, 2007. Induction immunosuppressive therapy was not used, but a standard posttransplant immunosuppressive regimen was prescribed that included cyclosporine, mycophenolate mofetil, and prednisolone. The dose of calcineurin inhibitor was adjusted on the basis of cyclosporin A levels 2 hours after dosing (C2 levels) in an attempt to avoid calcineurin nephrotoxicity. No intraoperative or perioperative complications were reported, and the nadir creatinine level was 1.5 mg/dL (to convert to micromoles per liter, multiply by 88.4) by 10 days after transplantation. The only obvious postoperative complication was an Escherichia coli infection of the urinary tract, which resolved with antimicrobial therapy. The patient was discharged with a ureteral stent in place 10 days after transplantation and a triple-drug regimen of cyclosporine, mycophenolate mofetil, and prednisone. He was instructed to have the ureteral stent removed 7 days after returning to the United States and was advised to have cyclosporine levels measured and routine laboratory tests done every 10 days for 3 months.

One week after returning to the United States, the patient was evaluated in the emergency department for fever and rigors. His oral temperature was 103[degrees]F (39[degrees]C), but the rest of the physical examination was unrevealing. The laboratory tests showed anemia, and a serum creatinine level of 1.9 mg/dL. Liver enzyme levels were slightly elevated. Upon hospital admission, malarial parasites were noted on a peripheral blood smear by a laboratory technician. The blood parasite screen revealed Plasmodium vivax, with 1.5% parasitemia. The patient was treated successfully for uncomplicated P vivax malaria with 14 days of oral chloroquine and primaquine. No further complications occurred, and the patient continues to experience a stable posttransplant course on standard triple-drug immunosuppression, with serum creatinine levels of 1.4 to 1.6 mg/dL.

Case 2: Posttransplantation Tuberculosis, Deep Venous Thrombosis, Lymphocele, and Ureteral Stricture

A 42-year-old female resident of Saudi Arabia was temporarily living in the United States and receiving routine care for chronic kidney disease at our nephrology center. The patient had a history of end-stage renal disease due to chronic glomerulonephritis of unclear origin and had been evaluated and accepted for deceased donor transplantation in Saudi Arabia. She had a history of chronic hypertension and hyperparathyroidism and hyperlipidemia, but no history of hepatitis, liver disease, heart disease, cancer, or tuberculosis. She also had no known history of Bacille Calmette- Guerin (BCG) vaccination. A skin test for tuberculosis before transplantation was negative.

The patient, unbeknownst to her nephrologists in the United States or Saudi Arabia, traveled to the Philippines to obtain a living unrelated kidney transplant on March 17, 2006. The patient underwent an incidental open cholecystectomy at the time of kidney transplantation. The immediate postoperative course was uneventful, except for the receipt of 6 units of packed red blood cells in the perioperative period, presumably necessitated by intraoperative hemorrhage. The patient was discharged 7 days after transplantation, taking cyclosporine, mycophenolate mofetil, and prednisone for maintenance immunosuppression. It is not known whether induction immunosuppressive therapy was given. Medical records were not supplied by the Philippine transplant center.

Upon discharge from the transplant center, the patient claimed that she noted increased swelling in her right lower extremity. The swelling in the right lower extremity worsened on return to the United States, and she came to our transplant center with severe ipsilateral leg swelling, leg pain, and acute renal failure. A magnetic resonance imaging examination revealed a large lymphocele and superficial thrombosis in the right femoral vein and deep venous thrombosis in the external iliac vein extending into the transplant renal vein. In addition, retroperitoneal lymphadenopathy was noted. She was admitted to the hospital and underwent percutaneous lymphocele drainage and thrombolysis of the deep vein thrombosis with infusion of tissueplasminogen activator for several days. Thrombolysis resulted in resolution of the leg edema and improvement in renal function. A biopsy of an enlarged mesenteric lymph node revealed necrotizing granulomas that ultimately cultured positive for Mycobacterium tuberculosis. The serum was negative for cryptococcal antigen and coccidiomycosis antibody. The patient was treated with a 4-drug antitubercular regimen consisting of isoniazide, rifampin, ethambutol, and pyrazinamide. After drainage of the lymphocele, thrombolysis, anticoagulation, and initiation of antituberculous therapy, the patient regained excellent renal function, measured by a serum creatinine level of 1.1 mg/dL. Three months later though, she came back with an increase in serum level of creatinine to 3.0 mg/dL, which was ultimately found to be due to a long-segment ureteral stricture thought to be unrelated to the tuberculosis. The patient underwent surgical repair of the ureteral stricture via ureteropyelostomy of the native right ureter to the renal transplant pelvis. After correction of the ureteral stricture, she did well, with a stable serum creatinine level of 1.1 to 1.3 mg/ dL, and she was discharged back to her physicians in Saudi Arabia.

Case 3: Posttransplantation Acute Rejection

A 56-year-old Chinese woman, resident of the United States, with end-stage renal disease due to diabetic nephropathy traveled to China to undergo live donor transplantation from a remote relative. She did not discuss the intent to travel to China for transplantation with her physicians. In addition to renal disease, the patient had a history notable for myocardial infarction followed by coronary revascularization in 2005, and internal carotid artery stenosis resulting in leftsided cerebrovascular accident and treated by carotid endarterectomy. Her medical history was also notable for chronic hepatitis B and hepatitis C infection. A liver biopsy showed minimal portal and lobular inflammation without evidence of portal fibrosis or periportal bridging. Despite multiple medical comorbidities, the patient had been deemed a suitable candidate for kidney transplantation and she was activated on the kidney transplant waiting list at UNOS status 1 in 2005. In addition, she had 6 children and a husband who were willing potential live donors.

One year after UNOS listing, the patient disappeared from our transplant center. She reappeared in January 2007 with a new living donor kidney transplant and severe acute renal failure. An English translation of the Chinese hospital records was provided by the transplant center. The records stated the patient received a “living- related” donor allograft in November 2006. The donor was a 19-year- old woman who was a distant relative of a half-sister. The donor was blood type O and the recipient was blood type A. Donor and recipient were matched for 1 HLA-A antigen and 1 HLA-DR antigen. The kidney appeared to function well for the first 3 weeks after transplantation, with urine volumes of 1600 to 2000 mL daily and a nadir serum creatinine level of 80 [mu]m/L (0.9 mg/dL). The immunosuppressive regimen consisted of cyclosporine 100 mg twice a day and azathioprine 75 mg twice a day. No evidence indicated that serum cyclosporine levels had been monitored postoperatively. Approximately 3 weeks after transplantation, urine output and renal function declined abruptly. The patient was reported to have evidence of fluid overload and cardiac ischemia developed. Hemodialysis was initiated in China, although no renal biopsy was performed. No antirejection therapy was administered, and corticosteroids were not prescribed. In addition, the dose of cyclosporine was lowered in order to treat “delayed renal function.” She was discharged with the recommendation to seek professional therapy in a transplantation center in the United States.

On presentation to the emergency department at our institution, her creatinine level was 9.7 mg/dL, her serum level of urea nitrogen was 142 mg/dL (to convert to millimoles per liter, multiply by 0.357), and her potassium level was 5.9 mEq/L. The patient was admitted to the hospital, treated with methylprednisolone, and a renal biopsy revealed acute interstitial nephritis and intimai arteritis, Banff grade [Eth]E. Hemodialysis was initiated and the patient received methylprednisolone and eventually thymoglobulin with no improvement in renal function. Ultimately, chronic hemodialysis was started, and the patient has recently been reevaluated to determine her candidacy for listing for a deceased donor organ in the United States.

Case 4: Posttransplantation Hemorrhage, Renal Failure, Disseminated Intravascular Coagulation, and Death

A 33-year-old Hispanic female resident of the United States with end-stage renal disease due to chronic glomerulonephritis was listed with our transplant center as a UNOS status 1. She decided, without discussion with her nephrologist, to travel to Mexico to undergo live kidney transplantation from a sister. The family did not clarify the reasons for her choice of transplant center. According to the Mexican hospital records (provided in Spanish) and reports of the family, no operative or peritransplant complications occurred, and she was doing quite well for the first 5 days after transplantation. Her creatinine level decreased from 13 to 4 mg/dL. On the fifth day after transplantation, hypertension, oliguria, and pain over the right lilac fossa developed suddenly. Based on these symptoms, she was empirically administered 3 doses of methylprednisolone, which improved the pain over the right iliac fossa, although the renal function was not known. She was then discharged from the hospital in Mexico to a hotel adjacent to the hospital on December 24, 2006.

Within a few days of discharge, on December 28, the patient came back to the hospital with oliguria, hypertension, and pain over the right iliac fossa. She also had bruising over the left flank and severe pain on palpation of the right side of the abdomen. The laboratory findings showed a white blood cell count of 14 800/nL, a serum level of urea nitrogen of 165 mg/dL, and a creatinine level of 6 mg/dL. The hemoglobin level was 4.5 g/dL with a hematocrit of 13%. An ultrasound revealed a large perirenal hematoma, but no obvious site for the bleeding was noted during the imaging. Exploratory surgery was performed via a midline incision, and a large peritransplant hematoma was drained. Brisk bleeding at the site of the vascular anastomosis was noted in the hospital records. The area around the anastomosis was packed with sterile pads, although no attempted surgical repair of the bleeding site was reported.

The patient’s mental status began to deteriorate during the next few days, and disseminated intravascular coagulation was diagnosed on the basis of the hemogram. Multiple transfusions of blood, fresh frozen plasma, cryoprecipitate, and platelets were administered during this admission, but the patient’s condition continued to deteriorate. An area of full-thickness necrosis had developed on her anterior abdominal wall at the nexus of her transplant incision and midline. The patient continued to bleed through her incision and through this area of necrosis during her admission. As the patient became completely obtunded, the family became increasingly worried for her safety. The family ultimately transferred the patient from the hospital in Mexico to our facility on January 16,2007. On arrival at our facility, the patient was obtunded, had severe renal failure, and was extremely acidotic. She was emergently intubated on arrival, but was noted to have fixed and dilated pupils and eventually died.

Discussion

Patients with end-stage renal disease who are in need of a kidney transplant are waiting extraordinarily long times to receive a deceased donor organ. These lengthy delays are fueling desperate attempts at earlier transplantation. We described 4 patients who left the United States to receive a kidney transplant. In each case, a nephrologist at our transplant center was following up with the patient, and 3 of the patients had been placed on the waiting list with a UNOS status of 1. None of the patients discussed their interest in transplantation outside of the United States with the transplant center. Furthermore, the patients were not asked about their knowledge of alternative means of obtaining a transplanted organ such as transplantation at a foreign transplant center or the practice of “transplant tourism.” In each case, an adverse outcome was experienced, which in one case led to the death of the transplant patient.

The disparity between the need for and the availability of kidneys for transplantation is growing and leading many patients to seek alternatives to the lengthy wait for a deceased donor organ in the United States. In many cases, the alternatives include solicitation of altruistic donors through personal advertisements and Internet sites, altruistic live donation from relatives living outside the United States, and purchase of organs at foreign transplant centers.

The purchase of organs involves a practice called transplant tourism, defined as the practice of patients seeking organ transplantation in countries where donors are potentially exploited, such as through paid living donation.4 It is often difficult to identify patients that have purchased an organ. Indeed only 1 of the patients in our case series admitted to the purchase of an organ. Several transplant societies as well as the World Health Organization and the United States Institute of Medicine have condemned the practice of transplant tourism.” Despite national and international condemnation, the growing disparity between the need for and the availability of organs will inevitably result in an increasing trend of transplant tourism.

International transplant centers that provide organ transplantation for purchase are readily accessed through several Internet sites. Commercialization has extended to solid organ “transplant brokers,” who, for a fee, will match a recipient with a live donor. Allinclusive packages with airfare, meals, lodging, and transplant services are provided. In many cases, the organ donor is a willing participant who is in need of financial compensation. In other cases, the organ donor is an unwilling participant, and prisoner executions for the purpose of providing organs have been reported. The cost to the recipient for the purchase of an organ has been estimated to range from US$15000 to US$70000, depending on the transplant center.7 Potential recipients might feel that this is a low price compared with the psychosocial and medical costs associated with remaining on dialysis. Therefore the temptation to circumvent the long waiting times for an organ will inevitably result in greater interest of patients in transplant tourism. Not all cases of desperation involve the practice of transplant tourism. Indeed, many foreign hospitals will transplant an organ from a live donor who is not paid for their organ. One of the patients in our case series went to a hospital in Mexico for her transplant. The reasons she did not have the transplant performed in the United States are not clear, as she was unable to communicate upon her return to our transplant center.

Although many transplant centers outside the United States provide excellent surgical and medical care for transplant donors and recipients, the market of transplantation involving organ sales or involving limited adherence to UNOS guidelines is growing. The transplantation of organs at transplant centers without rigorous oversight can lead to limited donor and recipient evaluations and limited follow-up after transplantation. Transmission of infectious diseases such as malaria and tuberculosis, as seen in our patients, is possible when donors are from regions in which those transmissible diseases are endemic. Indeed, several reports8,13 have described donor transmission of both malaria and tuberculosis. Management of acute rejection might also be risky at transplant centers with limited availability for monitoring immunosuppressive drug levels or limited tools for diagnostic evaluations. Diagnosis and treatment of surgical complications can be compromised in centers that do not have transplant expertise.

On the basis of our experience, we propose that all patients evaluated and listed for transplantation be offered advice about the risks of transplantation at a center that does not have rigorous oversight or that participates in transplant tourism. The risks include transmission of infectious diseases, transmission of noninfectious donor-related diseases, limited surgical and medical expertise, limited pretransplant evaluations of recipient and donor, and limited postoperative follow-up at the transplanting center. In addition, the ethical issues involved in the practice of transplant tourism should be discussed with the patient. The selection of donor and recipient pairs may be compromised to the detriment of both donor and recipient. These centers might also have limited ability to care for their complications or adverse outcomes such as acute rejection. Patients should be informed in an open, nonjudgmental manner so as to maintain their trust and maintain the relationship between the physician and the patient. If patients pursue organ transplantation at a transplant center that participates in organ trafficking, the patients should be encouraged to return to their physician when they get back to the United States and be monitored for potential medical and surgical complications. It must be noted though that some transplant physicians may not be willing to provide care for patients who received an organ through transplant tourism.

References

1. Szczech LA, Lazar IL. Projecting the United States ESRD population: issues regarding treatment of patients with ESRD. Kidney Int Suppl. 2004;(suppl):S3-S7.

2. 2004 Annual Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: Transplant Data 1994-2003. Washington, DC: Department of Health and Human Services; 2004.

3. Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis. 2003;41:1-12.

4. OPTN Board Opposes Transplant Tourism, http://www.optn.org/ news. Accessed June 30, 2008.

5. Delmonico FL, Dew MA. Living donor kidney transplantation in a global environment. Kidney Int. 2007;71:608-614.

6. Childress JF, Liveman CT. Organ Donation: Opportunities for Action. Washington, DC: National Academies Press; 2006.

7. Shimazono Y. The state of the international organ trade: a provisional picture based on integration of available information. Bull World Health Organ. 2007;85:955-962.

8. Babinet J, Gay F, Bustos D, et al. Transmission of Plasmodium falciparum by heart transplant. BMJ. 1991;303:1515-1516.

9. Chiche L, Lesage A, Duhamel C, et al. Posttransplant malaria: first case of transmission of Plasmodium falciparum from a white multiorgan donor to four recipients. Transplantation. 2003;75:166- 168.

10. Fischer L, Sterneck M, Claus M, et al. Transmission of malaria tertiana by multi-organ donation. Clin Transplant. 1999;13:491-495.

11. Graham JC, Kearns AM, Magee JG, et al. Tuberculosis transmitted through transplantation. J Infect. 2001;43:251-254.

12. Hernandez-Hernandez E, Alberu J, Gonzalez-Michaca L, Bobadilla-del Valle M, Correa-Rotter R, Sifuentes-Osomio J. Screening for tuberculosis in the study of the living renal donor in a developing country. Transplantation. 2006;81:290-292.

13. Malone A, McConkey S, Dorman A, Lavin P, Gopthanian D, Conlon P. Mycobacterium tuberculosis in a renal transplant transmitted from the donor. Ir J Med Sci. 2007;176:233-235.

Dianne McKay, MD,

Steven R. Potter, MD,

Terry Behrend, MD,

Frank Stella, MD,

Steven Steinberg, MD

Sharp Memorial Hospital, San Diego,

California (SRP, TB, FS, SS), and

The Scripps Research Institute,

La Jolla, California (OM)

To purchase electronic or print reprints, contact:

The InnoVision Group

101 Columbia, Aliso Viejo, CA 92656

Phone (800) 809-2273 (ext 532) or

(949) 448-7370 (ext 532)

Fax (949) 362-2049

E-mail [email protected]

Copyright North American Transplant Coordinators Organization Sep 2008

(c) 2008 Progress in Transplantation. Provided by ProQuest LLC. All rights Reserved.

High-Conflict Parents Model Behavior

Children with high-conflict parents are more likely to think that aggressive responses are good ways to handle social conflicts, U.S. researchers said.

The study, published in the Journal of Family Psychology, by researchers at Indiana University said children who grow up in aggressive households may learn to process social information differently than their peers who grow up in non-aggressive environments.

“This partly explains why they are more likely as young adults to have conflict in their own romantic relationships,” study co-author John Bates Indiana University said in a statement.

Unlocking the developmental link between growing up in an aggressive or violent household and becoming the perpetrator of such behavior could prove useful for stopping the cycle of violence, Bates said.

Parents and children were recruited from Nashville and Knoxville, Tenn., and Bloomington, Ind., when the children were age 5, when they and their parents were interviewed — beginning in 1987. At ages 13 and 16, the teens were presented with hypothetical social situations and asked to express their perceptions and reactions.

From ages 18 to 21, the offspring reported on the amount of aggressive behavior in their romantic relationships. The researchers continue to track participants.

Charity Ride in Memory of Friend

Charity fund- raisers are about to set off on an 85-mile round trip in memory of a friend who died from cancer.

Michael Dobbs (44), his son Ben (17), from Beckside Village in Lincoln, and friends Tracey and Rob Armstrong, from Heighington, are setting off on their journey at 7am on Saturday.

The plan is to cycle from Lincoln Cathedral to Anderby Creek on the Lincolnshire coast – and back again, in aid of St Barnabas Hospice.

Sue Dobbs, who will be driving the support vehicle, said: “We are hoping to raise as much money as possible for St Barnabas Hospice which is where our friend Jane Seywald, who died of cancer, was cared for.”

To sponsor, call Mrs Dobbs on (01522) 887886.

(c) 2008 Lincolnshire Echo. Provided by ProQuest LLC. All rights Reserved.

Haunted Houses Bring Out Screams of Fear and Laughter

By Kellie B Gormly

Each fall, at haunted houses and other scary attractions, many macho young males will come strutting in with an arrogant “You can’t scare me” attitude.

Oh, really? The zombies, vampires, ghouls and chainsaw-wielding maniacs can’t wait to challenge the tough guys, whom the monsters love to target and break down.

“We love the macho guys,” says Scott Simmons. He is co-owner of Scarehouse, a large Etna haunted house that was ranked as the fifth best haunted attraction in America by the editors of Hauntworld magazine.

“If we see a group of screaming girls and a macho guy, he’s the one who’s going to be on his knees by the end of the night,” Simmons says.

Whether you’re a macho horror fan, a scaredy-cat or something in between, you can find something appealingly spine-tingling about the area’s many haunted attractions, including haunted houses, creepy hayrides, spooky walking trails and more, promoters say. Haunted attractions, which operate mostly on weekends in October, are becoming an international industry that gains popularity every year, Simmons says.

Celebrating the Halloween season explains the timing and some of the appeal of these haunted attractions, but their eerie allure goes much deeper, some owners and operators say. Simmons compares haunted houses to roller coasters. You may see a steep, intense ride and refuse to go on it because it looks too scary, but then change your mind. Once it’s over, you feel such a rush. Likewise with haunted houses, he says.

“When people come out … they come out of the door and they’re screaming,” Simmons says. “But soon, you see them laughing and smiling. You’re facing your fear, but in the back of your mind, you know there’s no chain on the chainsaw. Like the roller coaster, you’re playing at something that’s an illusion.”

Shawn Maudhuit — designer of Chilly Billy Cardille’s Temple of Terror, a large haunted house in Harmar — agrees.

“(People) love being scared … and kids involved with it love scaring people,” he says. “When you get scared, you laugh afterward.”

Temple of Terror — hosted this year by Cardille, who hosted “Chiller Theatre” on local television for almost 20 years — gets plenty of macho dudes, Maudhuit says, but “a lot of times, you look at those teenage guys and they have their eyes closed.”

At the Scarehouse — which, along with Temple of Terror, might be too intense for kids younger than 13, Simmons and Maudhuit say — visitors will go through three distinct sections: Hall of Nightmares, Delirium 3D and the Screamatorium. They won’t see any of their favorite movie serial killers, like Jason and Freddy, but they’ll see plenty of original scary characters, like a deranged dentist named “The Killer Driller.” The cast, which includes professional actors, has as many as 65 people, many of whom invent the characters they play.

Chainsaws and clowns — which, Simmons says, seem to be the most dreaded things for people who call and ask — are included at the Scarehouse. At Temple of Terror, chainsaws will appear, and “a clown may pop up here and there,” Maudhuit says. Also, every species of spook imaginable — vampires, zombies and the like — will be awaiting visitors, he says. Like the Scarehouse, Temple of Terror has three areas: Nightmares Haunted House, Vampire’s Lair and Chiller Theatre.

At a haunted house, Simmons says, patrons become the stars of their own personal horror movies.

“I think haunted houses are popular because they offer an experience that you can’t really get anywhere else,” he says. “The big rides at theme parks sort of make it seem like you’re in a movie, and a good haunted house gives the same illusion.”

Walking through a haunted attraction, Simmons says, also is a great bonding experience, and an opportunity to cling closely to someone you like.

Scares and frights aren’t the only appeal of haunted attractions: There’s plenty of humor, too, promoters say. Sandy Allen, one of the owners of Allen’s Haunted Hayrides — a Smock, Fayette County, attraction in its 29th year — says part of the fun is people laughing at their fears and other people’s fears. After all, the scares are make-believe and there’s no actual danger, as opposed to encountering a madman in real life.

“I think it’s just a good, old-fashioned scare,” Allen says. “You hear people scream … then other people in the wagon are laughing because it’s funny to see someone startled. … The laughter is contagious, just as well as the screams.”

Allen’s Haunted Hayrides — which take riders through a forest and cornfield, and end in a haunted barn — have become a multi- generational tradition for many families. Sights and scares include a chainsaw and graveyard, and the attraction ranks about an eight on a scare scale of one to 10, Allen says.

“We fit in with every phase of a person’s life,” she says. “I compare it to Kennywood: We’re the Kennywood of hayrides.”

Find your haunts

Allen’s Haunted Hayrides: Through Nov. 1. 7:30-10:30 p.m. Fridays and Saturdays; 7:30-9 p.m. Sundays and Oct. 23, 30 and Nov. 1. A wagon leaves every 15 minutes and winds through the woods, cornfields and a haunted barn along Route 666. $10; free for age 4 and younger with adult. 2430 Pittsburgh Road, Smock, Fayette County. 724-677-2589 or online.

The Art of Horror: Oct. 10-31. Exhibit of the spooky, horror- related work of regional artists. Noon-6 p.m. Wednesdays and Thursdays, noon-9 p.m. Fridays, noon-4 p.m. Saturdays. Free. 344 S. Main St., Butler. 724-283-6922.

Castle Blood: Through Nov. 1. 7-10 p.m. Fridays, Saturdays and Sundays. The MacCabre family gives tours of its home, without the chainsaws and ax murderers. $13. 2860 Main St., Beallsville, Washington County. 724-632-3242 or online.

Cheeseman’s Fright Farm: Through Nov. 1. Fright Farm haunted house and hayride, from dark through at least 10 p.m. Fridays and Saturdays, and Oct. 23 and 30. $12. Cheeseman Road (off Route 19), near Portersville, Butler County. 724-368-3233 or online.

Chilly Billy Cardille’s Temple of Terror: Through Oct. 30. 7-10 p.m. Wednesdays, Thursdays and Sundays; 7-11 p.m. Fridays and Saturdays. $10. Syria Shrine Center, 1877 Shriners Way, Harmar. 724- 274-7000.

Creepy Hollow: Through Oct. 25. Dusk-11 p.m. Oct. 10-11, 17-18 and 24-25. Walk through a haunted trail. Hookstown VFD, 102 Silver Slipper Road, Hookstown, Beaver County. 724-777-4993.

Fright Farm: Through Nov. 1. Dusk-10 p.m. Wednesdays, Thursdays and Sundays, and Oct. 27-28; dusk-midnight Fridays and Saturdays. $15; $10 for students. Route 857, Smithfield, Fayette County. 724- 564-7644 or online.

Demon House: Through Nov. 1. 7 p.m.-midnight Fridays and Saturdays; 7-10 p.m. Oct. 16, 23 and 30. $15. 417 Coyle Curtain Road, Monongahela. Online.

“Haunted Halloween” storytelling: 6-9 p.m. Oct. 24-25, 5-8 p.m. Oct. 26. Guests can be entertained by scary stories in a spooky setting. $4; $1 for age 11 and younger. Compass Inn, Route 30, Laughlintown. 724-238-6818 or online .

Haunted History Hayride: 7-10 p.m. Oct. 25. Guided historical hayrides every half-hour along the trails of the battlefield. $8; $5 for age 12 and younger. Reservations required. Bushy Run Battlefield, Route 993, Jeannette. 724-527-5584, ext. 102.

Haunted Weekend at West Overton Village: 6:30-9 p.m. Oct. 24-26. $10 Oct. 24 and 26; $15 Oct. 25 (includes Goblin Ball dance); $5 for age 12 and younger. West Overton Museum, Route 819, between Scottdale and Mt. Pleasant. 724-887-7910.

The Haunted Mine: Through October. 7-10 p.m. Thursdays, 7-11 p.m. Fridays and Saturdays. $10. Tour-Ed Mine, off Route 28 (Exit 14), Tarentum. 724-224-4720.

Hundred Acres Manor Haunted Attraction: Through Nov. 1. 7-11 p.m. Fridays and Saturdays; 7-10 p.m. Sundays, Wednesdays and Thursdays. $13-$20; attraction benefits Homeless Children’s Education Fund and Animal Friends. Hundred Acres Drive, South Park. 412-851-4286 or online

Haunted Hills Hayride and the Valley of Darkness Haunted Walking Trail: 7-11 p.m. Fridays and Saturdays through October, 7-10 p.m. Sundays and Oct. 22-23 and 29-30. Hay wagon pulled by tractor through densely wooded trail. $10 for each attraction; $15 for both. Benefits The Autism Society of Pittsburgh and Spectrum Charter School. Route 48, North Versailles, north of Route 30 Kmart. 412- 824-1214 or online.

Haunted Tales of Manchester Walking Tours: 6-9 p.m. Oct. 17-18. Tours leave every 15 minutes until 9 p.m. $8; $5 for students and children. Conroy School, Page Street, Manchester. 412-321-7701.

Haunted Train Rides on the Fayette Central Railroad: 7 p.m. Oct. 11, 18 and 25. $15; $10 for children. 39 N. Gallatin Ave., Uniontown. 877-321-3277.

Northern Nightmares Halloween Festival: Through October. 6:30, 7:30, 8:30 and 9:30 p.m. Fridays and Saturdays. Departure times for 45-minute bus tours of spooky places between Zelienople and Harmony, Butler County. $12; $8 for age 12 and younger. Benefits Strand Theater Initiative. Tours begin at Main Street and Grandview Avenue. 724-742-0400 or online.

Phantom Fright Nights at Kennywood: Through Nov. 1. 7 p.m.-1 a.m. Fridays and Saturdays, 7-11 p.m. Oct. 12. Haunted rides, mazes, monsters, music. Attraction is rated No. 3 amusement park Halloween event by “Hauntworld” magazine. $23 at gate; $20 at participating Giant Eagles. Kennywood Park, 4800 Kennywood Blvd., West Mifflin. 412-461-0500 or online.

The Scarehouse: Through Nov. 1. 7 p.m.-midnight Fridays and Saturdays, 7-10 p.m. Thursdays and Sundays. Hint: Come early in the month, because in late October, the wait can be two-and-a-half hours. $17 on Fridays and Saturdays, $16 on Thursdays and Sundays. The former Etna Elks Lodge, 118 Locust St., Etna. 412-781-5885 or online.

Scream Asylum: Through Oct. 28. 7-11:30 p.m. Fridays and Saturdays, 7-10 p.m. Thursdays and Sundays. Three separate paths through three levels of horror. $13 (includes parking). Benefits Presto VFD. Trader Jack’s, 5330 Thoms Run Road, Bridgeville. Online.

The “It’s Alive!” 2008 Zombie Fest: 10 a.m.-9:30 p.m. Oct. 25, noon-6 p.m. Oct. 25. Zombie and horror convention, with film screenings, memorabilia, auction, special guests. Mall events are free. Monroeville Mall, Monroeville. Online.

Zombie Walk: 10 a.m. Oct. 26. Join the largest gathering of zombies in the world. Free; bring a non-perishable food item to benefit the Greater Pittsburgh Food Bank. Monroeville Mall, Monroeville. Online.

Kid-friendly attractions

Bump in the Night: 7-9 p.m. Oct. 17-18 and 24-25. Non-scary family event with storytelling, nature walk on the trails, and more. $10; $8 for children; member discount available. Registration required. Frick Environmental Center, 2005 Beechwood Blvd., Squirrel Hill. 412-422-6538.

Gateway Clipper Fleet’s Halloween Monster Fun Cruise: 11 a.m. and 1:30 p.m. Oct. 25. The cruise has monsters, a DJ dance party and a magic show. $16; $15 for age 60 and older; $9.50 for ages 3-12. Station Square. 412-355-7980 or online.

HOOtin’ Owl-O-Ween: 11 a.m.-2 p.m. Saturdays in October. With Halloween candy and crafts for kids, and interactive encounters with the birds. Free with admission: $9; $8 for senior citizens; $7.50 for children age 2 and older. National Aviary, North Side. 412-323- 7235 or online.

KDKA ZooBoo for Kids’ Sake: 11 a.m.-4 p.m. Oct. 18-19 and 25-26. With haunted house, trick-or-treating and costume contest. Free with zoo admission: $12; $11 for senior citizens; $10 for ages 2-13. 412- 665-3640 or online.

Hallowboo!: Through Oct. 26. Noon-6 p.m. Saturdays and Sundays. Family Halloween celebration, with trick-or-treating in Storybook Forest, a hedge maze, haunted train ride and more. $19.95. Idlewild Park, Ligonier. 724-238-3666 or online.

Halloween Happenings: 4-8 p.m. Oct. 26. Kids can come in costume and take part in Halloween activities. Phipps Conservatory and Botanical Gardens, 1 Schenley Park, Oakland. Free with general admission: $10; $9 for age 62 and older and students; $7 for ages 2- 18. 412-622-6914 or online.

Pumpkin Patch Trolley: 10 a.m.-5 p.m. Oct. 10-12, 17-19 and 24- 26. Trolley rides to and from a pumpkin patch. $8; $7 for age 62 and older; $5 for ages 3-15. Pennsylvania Trolley Museum, 1 Museum Road, Chartiers, Washington County. 724-228-9256 or online.

(c) 2008 Tribune-Review/Pittsburgh Tribune-Review. Provided by ProQuest LLC. All rights Reserved.

Community Calendar: Arcadia and Temple City

Health fairs

The fourth annual Temple City Senior Health Fair will be held Saturday, Oct. 4, from 10 a.m. to 2 p.m. at Live Oak Community Center, 10144 Bogue St., Temple City.

There will be blood pressure and bone density checks, stroke screening and body analysis.

For more information, call (888) 715-4922.

The Senior Citizen Health Insurance Fair for Arcadia will be held from 9:30 a.m. to 2 p.m. on Oct. 3 at the Arcadia Community Center, 365 Campus Drive.

The fair is free. There will be a free breakfast at 9:30a.m.

For more information, call (626) 574-5130.

Water Fest

The Upper San Gabriel Valley Municipal Water District will hold Water Fest 2008 from 9 a.m. to 2 p.m. on Saturday, Oct. 4, at Arcadia County Park, 405 S. Santa Anita Ave., Arcadia.

This event is free. Learn about water conservation, while enjoying free food, games and prizes.

For additional information, call (626) 443-2298.

Bag the talk

The Arcadia Historical Museum will continue presenting its popular brown bag lunch talks on the third Thursday of every month in the museum’s meeting room. Bring your own lunch, or enjoy the pizza provided.

The Arcadia Historical Museum is located at 380 W. Huntington Drive.

For more information, call (626) 446-8512.

Garden talk

Thursday Garden Talks with Lili Singer will be from 9:30 a.m. to noon through Nov. 13 at the Arboretum, 301 N. Baldwin Ave., Arcadia.

This is an informative gathering with horticultural specialists for passionate home gardeners and landscape professionals. Cost is $100 for the series or $20 per class.

“Where Architecture and Horticulture Intersect: Designing the Built and Planted Garden Environments” will be the topic on Oct. 2.

For additional information, call (626) 821-4623.

Cat show

The International Cat Association and Purr Pourri of Cats will present “Halloween Cats” from 9:30 a.m. to 4 p.m. on Oct. 18 and 19 at the Arcadia Masonic Center, 50 W. Duarte Road, Arcadia. Admission is $5 for adults, and $4 for seniors, kids under 12 are free.

For more information, call (949) 770-2996.

Kids night out

The next kids night out will be from 6 to 11 p.m. on Friday, , at the Arcadia Community Center, 365 Campus Drive, Arcadia.

Cost is $12 and includes pizza.

For information, call (626) 574-5400.

ESL classes

Lutheran Church of the Cross, 66 W. Duarte Road in Arcadia, is offering free English as a Second Language classes every Saturday morning.

There are two levels of instruction: Level I, taught by Rosemary Allen, emphasizes speaking English and learning grammar and vocabulary; Level II, taught by Russ Andrews, uses articles from mainstream media and emphasizes reading and learning about American social life.

The church offers a combined English/Chinese worship service with simultaneous Chinese translation at 9:30 a.m. every Sunday.

For more information, call (626) 447-7232.

Weight loss

TOPS (Take Off Pounds Sensibly) meets from 6 to 8 p.m. every Wednesday at Our Savior Lutheran Church, 512 W. Duarte Road, Arcadia.

For more information, call (626) 254-9212.

Reading groups

The Temple City Library hosts a book club for children in kindergarten through third-grade at 3:30 p.m. on the second Tuesday of each month at the library, 5939 Golden West Ave., Temple City.

For children in grades four through six, a book discussion club meets at 3:45 p.m. on the first Wednesday of each month. A book discussion group for seventh- and eighth-graders meets at 3:45 p.m. on the third Wednesday of each month.

The library also hosts a reading group for adult readers, which meets at 3:30 p.m. on the last Tuesday of each month.

For more information, call (626) 285-2136.

Volunteers

The Arcadia Public Library is looking for adult volunteers to help with the library’s Teen Zone program, which meets Wednesdays from 3 to 5:30 p.m. Previous experience with teens is preferred along with patience, good humor, flexibility and a high tolerance for noise.

Volunteers can apply by following the “Helping the Library” link on the library’s Web site at http://library.ci.arcadia.ca.us.

For more information, call (626) 294-4801.

Half-shell lovers

The Foothill chapter of the California Turtle & Tortoise Club is looking for new members.

The club — which focuses on caring for and adopting California Desert Tortoises, box turtles and pond turtles — meets the fourth Friday of each month at the Los Angeles County Arboretum and Botanical Gardens, 301 N. Baldwin Ave., Arcadia.

For information, call (626) 836-0399.

(c) 2008 San Gabriel Valley Tribune. Provided by ProQuest LLC. All rights Reserved.

Big Read Event to Feature ‘To Kill a Mockingbird’ Actress

By Imani Tate

Staff Writer

Mary Badham, the actress who played Scout in the classic courtroom drama “To Kill A Mockingbird,” will be among the special features of the 2008 Pomona Big Read events.

Big Read officials involved in the literacy campaign conducted by Cal Poly Pomona Downtown Center, Pomona Public Library, Pomona Valley Historical Society, Pomona Unified School District, Fairplex and the city selected Harper Lee’s Pulitzer Prize-winning novel “To Kill A Mockingbird” as the book everyone should read or re-read this fall.

The Big Read is “an initiative of the National Endowment for the Arts in partnership with the Institute of Museum and Library Services and Arts Midwest,” said project coordinator Jonnie Owens.

The community-wide program begins today with a kickoff celebration from 6 to 7:30 p.m. at the university’s downtown center at 300 W. Second St. Activities continue through Nov. 8 in various locations around town.

Badham highlights the calendar of events with her discussion of playing Scout, the tomboy daughter of high-principled attorney Atticus Finch. Award-winning actor Gregory Peck played Finch who defended Tom Robinson, the black character unjustly accused of raping white Mayella Ewell. Brock Peters played Robinson in the film recently named No. 1 courtroom drama by the American Film Institute.

Badham will discuss the significance of “To Kill A Mockingbird” within the context of race relations in America as well as the life- altering experiences of working on the movie. She will speak from 7 to 8:30 p.m. at the Pomona Ebell Museum of History, 585 E. Holt Ave. on Oct. 23.

“You will never really understand a person until you consider things from his point of view … Until you climb inside of his skin and walk around in it,” Atticus’ advice to Scout and words which dramatically impacted Badham’s non-cinematic life.

A reception follows Badham’s speech. Garments from the early 1930s, the Great Depression era that served as the book’s setting in Alabama, will be displayed.

Big Read events will be held at various sites.

CAL POLY POMONA DOWNTOWN CENTER: 6 to 7:30 tonight, kickoff celebration; Big Read Challenge, Oct. 11, 6 to 9 p.m. during the Second Saturday Art Walk; screening of the movie “To Kill A Mockingbird,” Oct. 17, 6 to 8:30 p.m.; Big Read Fall Family Festival at Family Fun Days, Oct. 25, 1 to 4 p.m., featuring art, storytelling, book giveaways and literacy activities for children; ArtScene writer and author Ray Zone, Oct. 30, 6 to 7:30 p.m.; Big Read closing celebration, Nov. 8, 6 to 8 p.m.; Big Read partner celebration, Nov. 13, 6 to 7:30 p.m.

POMONA PUBLIC LIBRARY: Film screening and discussion of “To Kill A Mockingbird,” 1 to 4 p.m. Saturday and Oct. 8 and 25; library adult book-talk, 6 to 8 p.m. Oct. 16 and 1 to 3 p.m. Oct. 22; library Spanish book-talk with attendees receiving a free Spanish language copy of the text, noon to 2 p.m. Oct. 18; library book- talk moderated by Dr. Denisa Chatman-Riley whose research includes African-American women writers, Oct. 18, 2 to 4 p.m.; young adult Harper Lee biography author Kerry Madden author talk, Oct. 22, 4 to 5:30 p.m.; Big Read fun day of family activities, vintage clothing, 1930s memorabilia, crafts and children’s story time, Nov. 8, 1 to 5 p.m.

FAIRPLEX: Trivia Bee for Literacy, Nov. 6 from 6 to 8 p.m.

Film screenings and discussions will additionally be held at Palomares Senior Center, 9:30 a.m. to noon Monday; La Casita Teen Center, 3 to 5:30 p.m. Wednesday; and Ganesha Community Center, 6 to 8:30 p.m. Oct. 29. Mockingbird Family Nights will be held from 6 to 8:30 p.m. on Oct. 15 at Westmont Community Center and Oct. 22 at Washington Community Center.

The city of Pomona’s annual Chalkart Festival from 9 a.m. to 2 p.m. on Nov. 8 will involve professional artists and children in a chalkart competition with themes from “To Kill A Mockingbird” and 120 years of Pomona history. Prizes will be awarded for best of theme, most creative and most realistic for the chalkart drawn in the Thomas Plaza at Second and Thomas streets.

(c) 2008 Inland Valley Daily Bulletin. Provided by ProQuest LLC. All rights Reserved.

Exelixis Files IND Application for XL888

Exelixis, Inc. (Nasdaq:EXEL) announced today that it has submitted an investigational new drug (IND) application to the U.S. Food and Drug Administration for XL888, a novel anticancer compound. XL888 is an orally available small molecule inhibitor of HSP90, which is a chaperone protein that promotes the activity and stability of a range of key regulatory proteins, including kinases. The activity of HSP90 is particularly prominent in tumor cells where it promotes the activity of proteins controlling growth and survival.

“Natural product-based inhibitors of HSP90 are currently in clinical trials and have shown encouraging signs of efficacy, but their utility has been limited by poor pharmacokinetic properties and by their side effect profiles,” said Gisela M. Schwab, MD, Executive Vice President and Chief Medical Officer of Exelixis. “XL888 inhibits HSP90 with potency comparable to that of natural product-based inhibitors, but with good oral bioavailability and an improved preclinical tolerability profile. XL888 exhibits substantial anti-tumor activity at well-tolerated doses in multiple preclinical xenograft models. Therefore, we believe this novel HSP90 inhibitor has the potential to become a best-in-class therapy, and we are excited to advance it into clinical development.”

About XL888

XL888 is a fully synthetic, orally available, small molecule that was derived from a novel chemical scaffold. XL888 is a potent and selective ATP-competitive inhibitor of HSP90, and binds to its target in a manner that is structurally distinct from other HSP90 inhibitors currently in the clinic. In preclinical studies, XL888 inhibits the proliferation of a broad panel of human tumor cell lines and induces marked degradation of HSP90 client proteins. In addition, XL888 is highly active in multiple human tumor xenograft models in mice. Pharmacokinetic studies in rodent and non-rodent species demonstrate that XL888 is preferentially retained in tumors relative to plasma and liver. The activity profile of XL888 is highly supportive of its clinical development for the treatment of cancers driven by HSP90 client proteins.

About Exelixis

Exelixis, Inc. is a development-stage biotechnology company dedicated to the discovery and development of novel small molecule therapeutics for the treatment of cancer and other serious diseases. The company is leveraging its fully integrated drug discovery platform to fuel the growth of its development pipeline, which is primarily focused on cancer. Currently, Exelixis’ broad product pipeline includes investigational compounds in phase 3, phase 2, and phase 1 clinical development. Exelixis has established strategic corporate alliances with major pharmaceutical and biotechnology companies, including GlaxoSmithKline, Bristol-Myers Squibb, Genentech, Wyeth Pharmaceuticals, and Daiichi-Sankyo. For more information, please visit the company’s website at http://www.exelixis.com.

Forward-Looking Statements

This press release contains forward-looking statements, including, without limitation, statements related to the future development and potential efficacy of XL888. Words such as “believe,””potential,” and similar expressions are intended to identify forward-looking statements. These forward-looking statements are based upon Exelixis’ current plans, assumptions, beliefs, and expectations. Forward-looking statements involve risks and uncertainties. Exelixis’ actual results and the timing of events could differ materially from those anticipated in such forward-looking statements as a result of these risks and uncertainties, which include, without limitation: the potential failure of XL888 to demonstrate safety and efficacy in clinical testing; the therapeutic and commercial value of XL888; the ability to conduct XL888 clinical trials sufficient to achieve a positive completion; and the uncertainty of the U.S. Food and Drug Administration approval process. These and other risk factors are discussed under “Risk Factors” and elsewhere in Exelixis’ quarterly report on Form 10-Q for the quarter ended June 27, 2008, and other filings with the Securities and Exchange Commission. Exelixis expressly disclaims any duty, obligation, or undertaking to release publicly any updates or revisions to any forward-looking statements contained herein to reflect any change in Exelixis’ expectations with regard thereto or any change in events, conditions, or circumstances on which any such statements are based.

Exelixis and the Exelixis logo are registered U.S. trademarks.

Uroplasty Enrolls First Patients in Urgent(R) PC Clinical Trial

MINNEAPOLIS, Oct. 2 /PRNewswire-FirstCall/ — Uroplasty, Inc. announced today the enrollment of the first patients in a new randomized, controlled multicenter clinical study of its FDA cleared Urgent PC neuromodulation system for the treatment of overactive bladder (OAB) symptoms of urinary urgency, urge incontinence and frequency of urinary voids.

The study is designed to directly compare the effectiveness of Urgent PC treatment to non-active treatment. Uroplasty is undertaking this study primarily to support third-party reimbursement coverage. The study will evaluate reductions in urinary urgency, urge incontinence and frequency of urinary voids, as well as patient quality of life measures. This study, expected to be completed by early fall of 2009, is to take place at approximately 20 urology and urogynecology centers across the United States, with total enrollment of 214 patients. As previously discussed, Uroplasty has reallocated expenditures this fiscal year to expedite these efforts, and expects to spend between $1.0 million and $1.4 million this fiscal year on the study.

More than 33 million Americans suffer from OAB symptoms, dramatically impacting the quality of their lives. The Urgent PC system is a minimally invasive, office-based, nonsurgical, percutaneous tibial nerve stimulation (PTNS) device that treats these symptoms. The Company believes physicians, patients and many third party payers are embracing the Urgent PC therapy because this low cost, non-surgical, non-drug treatment alternative is clinically effective.

Kenneth M. Peters, M.D., the Principal Investigator leading this study, is internationally known for his work on neuromodulation, interstitial cystitis, and painful bladder syndrome. Dr. Peters is the Chairman of the Department of Urology and Director of Clinical Research — Department of Urology at William Beaumont Hospital, Royal Oak, Michigan. He has published several studies and written extensively on the effect of neuromodulation in treating voiding dysfunction, interstitial cystitis and pelvic pain, is a peer reviewer for several journals, and lectures internationally on the topic. He has several years of experience using PTNS routinely in his clinical practice.

Dr. Peters commented, “I am pleased to commence a well designed, randomized controlled trial to provide the medical community with additional scientific data regarding the use of PTNS. When completed, this study will provide a valuable complement to previous studies comparing the effectiveness of PTNS to active controls such as pharmaceuticals.”

David Kaysen, President and CEO of Uroplasty said, “This significant new study is a cornerstone to our U.S. reimbursement efforts, and is part of a very focused strategy to solidify reimbursement coverage for PTNS. Recently, the American Urological Association published the American Medical Association’s (AMA) advice to the medical community that their previously recommended “listed” CPT code for Urgent PC treatments be replaced with an “unlisted” code. Some third-party insurance carriers are now reassessing their coverage and reimbursement policies for Urgent PC treatments. However, many other third-party payers, including Aetna, under its national coverage policy, and several local Blue Cross/Blue Shield plans across the country, as well as many other carriers on a case-by-case basis, continue to cover Urgent PC treatments.”

“We anticipate applying to the AMA for a specific “listed” CPT reimbursement code for Urgent PC treatments. We believe data from this new clinical study, if successful, along with the substantial existing clinical evidence, will expedite the medical community’s strong support of this effort,” continued Kaysen.

“Given the reassessment of coverage by some third party insurance carriers, and additional time being spent by our organization to educate customers and carriers to solidify reimbursement of the procedure, we have seen a moderation in our U.S. sales growth during the second fiscal quarter ending September 30. While we still expect solid U.S. sales growth over the previous fiscal year, we do not expect to reach the sales growth forecast we have provided for the fiscal year. We expect to better understand the impact on our current fiscal year sales as some insurance carriers complete the reassessment of their reimbursement policies and will update our investors during our second fiscal quarter conference call in early November,” Mr. Kaysen concluded.

About Uroplasty, Inc.

Uroplasty, Inc., headquartered in Minnetonka, Minnesota, with wholly-owned subsidiaries in The Netherlands and the United Kingdom, is a medical device company that develops, manufactures and markets innovative proprietary products for the treatment of voiding dysfunctions. Our primary focus is continued commercialization of our Urgent PC system, which we believe is the only FDA-approved minimally invasive nerve stimulation device designed for office-based treatment of urinary urgency, urinary frequency and urge incontinence — symptoms often associated with overactive bladder. We also offer Macroplastique(R) Implants, an injectable urethral bulking agent for the treatment of adult female stress urinary incontinence primarily due to intrinsic sphincter deficiency. For more information on the company and its products, please visit Uroplasty, Inc. at http://www.uroplasty.com/.

Forward Looking Information

This press release contains forward-looking statements, which reflect our best estimates regarding future events and financial performance. These forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially from our anticipated results. We discuss in detail the factors that may effect the achievement of our forward-looking statements in our Annual Report on Form 10-K filed with the SEC. These factors include:

   -- decisions by government and third party reimbursement agencies as to      the rate of reimbursement for our products, or whether reimbursement      will be allowed;   -- the impact of international currency fluctuations on our cash flows and      operating results;   -- the impact of technological innovation and competition; acceptance of      our products by physicians and patients;   -- our intellectual property and the ability to prevent competitors from      infringing our rights;   -- the effect of government regulation, including when and if we receive      approval for marketing products in the United States;   -- the results of clinical trials; and   -- our continued losses and the possible need to raise additional capital      in the future.    

We cannot assure you that our clinical trial will produce favorable results, that third-party payers will provide or continue to provide coverage and reimbursement, or reimburse the providers an amount sufficient to cover their costs and expenses, nor can we assure you that we will timely obtain, or even succeed at all at obtaining, a specific “listed” CPT code from the AMA for Urgent PC treatments. We further cannot assure you that reimbursement or other issues will not further impact our fiscal 2009 results.

    For Further Information:    Uroplasty, Inc.    David Kaysen, President and CEO, or    Medi Jiwani, Vice President, CFO, and Treasurer,    952.426.6140     EVC Group    Doug Sherk/Dahlia Bailey (Investors)    415.896.6820    Chris Gale (Media)    646.201.5431  

Uroplasty, Inc.

CONTACT: David Kaysen, President and CEO, or Medi Jiwani, VicePresident, CFO, and Treasurer, both of Uroplasty, Inc., +1-952-426-6140; orInvestors, Doug Sherk, or Dahlia Bailey, +1-415-896-6820, or Media, ChrisGale, +1-646-201-5431, all of EVC Group, for Uroplasty, Inc.

Web site: http://www.uroplasty.com/

Lawsuit Hits Tainted Milk — Unusual Liability Case in Chinese Scandal

By Gillian Wong

BEIJING – The parents of a 1-year-old boy who developed kidney stones after drinking infant formula tainted with an industrial chemical are suing the dairy at the heart of the scandal, state media reported, as tests implicated 15 more companies Wednesday.

The case is believed to be the first civil lawsuit filed in response to the contamination of milk, yogurt and other dairy products with melamine, which causes kidney stones and can lead to kidney failure. Nearly 54,000 children have been sickened and four infants have died.

According to the lawsuit, the boy was fed baby formula made by Sanlu Group Co. from the time of his birth, said the report by Caijing, a leading Chinese business magazine.

The child’s parents filed a lawsuit in a court in Zhenping county seeking $22,000 in compensation from Sanlu for medical, travel and other expenses incurred after the child developed kidney stones, the magazine said.

The Zhenping court has yet to accept the case, said the report, which gave only the parent’s surname, Sun.

Jerome Cohen, a Chinese legal system expert and a professor at New York University School of Law, said it was surprising the couple was even able to file a lawsuit.

“That itself is news,” Cohen said. “Lawyers are not being permitted generally to help people bring about such suits. Sometimes, though, the system is porous and they don’t have uniform rules. Sometimes lawyers just take a chance.”

China’s government, meanwhile, named 15 more dairy companies found to have products contaminated with melamine after a new series of tests.

The tainted samples were mostly milk powder products for adults.

Thirty-one samples of Chinese milk powder provided by 20 companies were found to contain melamine, according to data seen Wednesday on China’s food safety administration’s Web site.

——————–

In the U.S.

Tainted candy in Calif., Conn. also

HARTFORD, Conn. – Melamine, an industrial chemical blamed for sickening thousands of Chinese infants, was found in candy in four Connecticut stores this week, a state official said Wednesday.

Details

Connecticut Consumer Protection Commissioner Jerry Farrell Jr. made the announcement days after contaminated White Rabbit Creamy Candy was also found in California.

Queensway Foods Company Inc. of California distributed the candy and says it is recalling it. Guan Sheng Yuan Co., said last week it was halting production of the sticky confection.

Melamine has been associated with contaminated infant formula and other Chinese products containing milk protein.

——————–

Originally published by Gillian Wong Associated Press .

(c) 2008 Commercial Appeal, The. Provided by ProQuest LLC. All rights Reserved.

Dr. Cynthia Haines Named Chief Medical Officer of HealthDay News

NORWALK, Conn., Oct. 2 /PRNewswire/ — Dr. Cynthia Haines has been named Chief Medical Officer of HealthDay, an award-winning health and medical news service.

Dr. Haines, who is also managing editor of HealthDay’s Physician’s Briefing news service, will head up the company’s physician-directed content division, which provides a variety of services for client Internet sites, involving medical content being reviewed and created by board-certified physicians.

Other Chief Medical Officer duties will have Dr. Haines overseeing a process to ensure the medical accuracy of all HealthDay content and representing the company as its physician spokesperson to the public and professional medical community.

“The combination of Cindy Haines’ abilities as a physician, an editor, and a communications specialist makes her an amazing asset for our company,” said HealthDay CEO Dan McKillen.

Dr. Haines is a member of the staff and faculty of the Department of Family and Community Medicine at Saint Louis (Mo.) University School of Medicine. She is active within several national organizations, including the American Academy of Family Physicians where she currently serves as Vice President of the St. Louis chapter, the American Medical Association, and the Healthcare Businesswomen’s Association. She serves as a Diplomat of the American Board of Family Medicine and has been named one of the Who’s Who of Executives and Professionals and one of America’s top physicians by America’s Top Doctors. She received her undergraduate degrees in biology and psychology from Saint Louis University and a doctorate of medicine, with distinction, from Saint Louis University School of Medicine.

Dr. Haines has provided in-studio medical commentary for local and national networks, including NBC and FOX News Live. She is a weekly columnist for The St. Louis Beacon.

HealthDay’s Physician-Directed Content Division provides a thorough and professional review of medical content on Internet sites. The program includes reviewing medical articles, reference materials, and disease management materials to see if they need updating or rewriting. The physician-directed content division also creates new health content for web publishers written with search engine optimization (SEO) as one of the key deliverables of this service.

Physician’s Briefing is written for medical professionals and provides timely and concise summaries from peer-reviewed medical journals. HealthDay’s consumer news service provides daily health news that appears on more than 2,000 hospital and health care Web sites and major Internet news sites.

HealthDay’s parent company, ScoutNews, LLC is a privately held information firm, headquartered in Norwalk, Conn. For more information visit http://healthday.com/

HealthDay

CONTACT: Dan McKillen of HealthDay, +1-203-855-1400 ext. 100,[email protected]

Web Site: http://www.healthday.com/

Quantros Launches Patient Safety Organization Manager to Streamline PSO Data Management and Submission to the Network of Patient Safety Databases

SAN FRANCISCO, Oct. 2 /PRNewswire/ — Quantros, a leading provider of safety, quality, and compliance solutions for the healthcare industry, today announced the release of Quantros Patient Safety Organization Manager (PSOM). This new application provides a comprehensive, flexible data infrastructure to support the data aggregation and management requirements for organizations seeking PSO certification.

Quantros has leveraged its clinical expertise and proven technology platform to offer Quantros PSOM. This application was designed specifically for use in supporting the data infrastructure requirements that are a critical component of PSO certification. Quantros PSOM provides a turnkey solution for collection, management, and analysis of Patient Safety Work Product (PSWP) data as well as data submission to the Network of Patient Safety Databases (NPSD).

Quantros PSOM enables rapid implementation of the required data infrastructure with a field tested, proven system. The core infrastructure of this solution has been in use for over 5 years by more than 800 healthcare facilities as part of the Quantros Safety and Risk Management (SRM) Suite of Applications.

“One of the key requirements of organizations desiring PSO status is the ability to provide a secure, means for aggregation, management, submission, and analysis of patient safety event data from participating healthcare facilities,” said Chris Bethell, Vice President of Marketing and Product Management for Quantros. “Quantros PSOM provides this and more in a complete, configurable, and scalable solution.”

Quantros PSOM provides the most comprehensive software solution available in the market today. With Quantros PSOM PSO’s gain a host of benefits including:

   -- A secure, HIPAA compliant system that automatically extracts and      isolates PHI and other confidential data so only those in certain roles      with certain permissions are able to view the data   -- A powerful administration module that allows the PSO to easily set-up,      activate and manage participating organizations in the PSO   -- The ability to aggregate facility data in a variety of ways including:          -- Automatic transfer of PSWP data from those using Quantros SRM             into Quantros PSOM          -- An easy PSWP data upload process for healthcare facilities using             either internally developed or commercial systems other than             Quantros SRM          -- Making available an API that can be licensed by 3rd party             vendors for transmission of PSWP data into Quantros PSOM          -- A fast and efficient data entry screen for manual capture of             PSWP data    -- A submission module that can both generate completed forms for      submission of PSWP data to the NPSD as well as the ability to transmit      that data automatically once the NPSD provides an electronic submission      avenue   -- A medium to efficiently distribute knowledge content and best practice      information to participating healthcare facilities   -- A full complement of reports with the ability to save specific      parameters as well as AD-Hoc reporting for use in report generation and      data analysis at both a facility and at a multi-tiered, aggregate      facility level    

Quantros PSOM is in use today and available for organizations seeking PSO certification. For additional information on this solution, email [email protected] or call toll free at (877) 782-6876.

About Quantros

Quantros provides real-time solutions for safety and risk management, outcomes and performance monitoring, accreditation and compliance, and surveillance and decision support for leading healthcare providers throughout the nation. Quantros’ web delivered applications provide a standard platform that creates actionable knowledge that helps its clients save lives, improve quality, and conserve assets. Through a variety of direct sales and vendor partners, more than 1,800 healthcare facilities use Quantros’ web-based technology solutions every day.

Quantros team members include physicians, nurses and healthcare professionals as well as an experienced team of information technology specialists. Visit Quantros on the web at http://www.quantros.com/.

Quantros, Inc

CONTACT: Chris Bethell of Quantros, Inc, +1-408-957-3300, fax,+1-408-957-3320

Web site: http://www.quantros.com/

CSHP Selects Jay Rho As 2008 Pharmacist of the Year and Mirta Millares for Distinguished Service

At a time when an increasing number of Californians are managing their health with daily medications and pharmacists are playing a growing leadership role in patient care, the California Society of Health-System Pharmacists (CSHP) has recognized several of its members for their outstanding professional dedication with its highest honors.

Jay Rho, PharmD, FASHP, FCSHP, has been selected as CSHP’s 2008 Pharmacist of the Year. Rho serves as Area Pharmacy Director at the Kaiser Permanente Los Angeles Medical Center.

“Jay has distinguished himself in every role he has filled and has mentored many students and pharmacists who have become leaders in our profession,” said John Carbone, PharmD.

Mirta Millares, PharmD, FASHP, FCSHP, has been selected as the recipient of CSHP’s Distinguished Service Award. Millares is Manager of Kaiser Permanente’s Drug Information Services and Pharmacy Outcomes Research for California.

“Mirta is an exceptionally gifted and talented pharmacist, and her dedicated contributions have influenced us in so many positive ways,” said CSHP past president Brian Hodgkins.

The 2008 Fellows –Veronica Bandy, PharmD, FCSHP, with Walgreens Pharmacy in Stockton; Daniel Dong, PharmD, FCSHP with Northern California Kaiser Permanente; and Maria Serpa, PharmD, FCSHP, with Sutter Medical Center, Sacramento – are formally recognized as pharmacists who have demonstrated a consistent commitment to educating students, practitioners, and the public about the practice of pharmacy.

Darren Besoyan, with UC Davis Medical Center in Sacramento, will receive the Technician Achievement Award for his active promotion of the advancement of the technician’s role in pharmacy. All recipients will be recognized at Seminar 2008, CSHP’s annual meeting on October 9-10 at the Disneyland Hotel in Anaheim.

Founded in 1962, the California Society of Health-System Pharmacists represents over 3,800 pharmacists and associates who serve patients and the public by promoting wellness and the best use of medications. CSHP members practice in a variety of organized healthcare settings — hospitals, health maintenance organizations, clinics, home healthcare, and ambulatory care settings.

Editors’ note: Individual photos and full bios available at CSHP.org.

OnePoint Patient Care Moves Oklahoma Pharmacy to Larger, More Central Location in Response to Growing Need From Hospice Partners

OnePoint Patient Care, an independent specialty pharmacy serving hospice patients, announced today that it has moved its Oklahoma operation to a larger, more centrally located facility in the Oklahoma City metropolitan area to help it better meet the demands of its growing base of hospice partners in Oklahoma. The new pharmacy, which is conveniently located in Yukon, will allow it to better serve its existing hospice partners in the Oklahoma City area and gives it the additional capacity it needs to expand its services to Tulsa and other parts of the state.

OnePoint Patient Care is the nation’s leading local hospice pharmacy services provider, filling prescriptions, creating custom compounds and providing home deliveries for an average of 7,500 patients per day. The pharmacy’s local operations provide 24-hour accessibility, personal interaction, accurate prescriptions and prompt delivery, allowing hospices to get patients their medications quickly, simply and reliably.

“Our belief is that the hospice community has unique needs that are best met by a local, dedicated hospice pharmacy. We are investing heavily in infrastructure and people in Oklahoma and other areas of the country to provide the level of clinical expertise and responsiveness that the hospice community demands,” said Jeffrey Hohl, President and Chief Operating Officer of OnePoint Patient Care.

“Our new Oklahoma pharmacy will allow us to implement state-of-the-art technologies and workflow efficiencies that will ensure superior prescription accuracy and cost management, as well as the prompt deliveries and personalized service that Oklahoma hospices cannot find anywhere else,” added Jody Herren, President of OnePoint Patient Care’s Oklahoma Division.

OnePoint has been serving Arizona hospice patients for more than 20 years. Building on its dominant position there, it acquired pharmacies and began serving hospices in Nevada in 2007 and Oklahoma in early 2008. The company plans to expand into other states in the coming year.

“We have established ourselves as the premier specialty hospice pharmacy by delivering unique and cost-effective pharmacy products and services, enabling extraordinary hospice care,” said James A. Otterbeck, Chairman and Chief Executive Officer of OnePoint Patient Care. “We are experiencing explosive growth due to the tremendous enthusiasm our locally driven business model is generating in the hospice market. We plan on building on these successful partnerships with hospice by doubling the number of local markets we serve with custom compounding and delivery by the end of 2009.”

About OnePoint Patient Care

OnePoint Patient Care is a national hospice pharmacy services provider with operations in Arizona, Nevada and Oklahoma and more locations scheduled to be added throughout the coming year. For more than 20 years, OnePoint has been helping hospice patients get the medications they need quickly, simply and reliably. Working for its hospice partners 24 hours a day and 365 days a year, OnePoint provides clinically advanced and personal service customized to their needs. OnePoint was one of the first pharmacies to begin serving the hospice industry when the Medicare hospice benefit began in the 1980s, and today it has grown to be one of the leading independent hospice pharmacies in the United States. For additional information, visit www.oppc.com or call (866) 771-6772.

 Contact: Jessica Schnack OnePoint Patient Care Ph (917) 855-4830 Email Contact

SOURCE: OnePoint Patient Care

Weissenborn, Alice Mae

Weissenborn, Alice Mae

Age 88. Please see Wednesday paper for full notice or call. KRAUSE FUNERAL HOMES and Cremation Service 9000 W. Capitol Dr. 414- 464-4640

(c) 2008 Milwaukee Journal Sentinel. Provided by ProQuest LLC. All rights Reserved.

Health Insurance Industry Discusses Strategies to Lower Costs and Expand Coverage With Arkansas Governors Roundtable on Health Care

To: NATIONAL EDITORS

Contact: Robert Zirkelbach of Americas Health Insurance Plans, +1- 202-778-8493

Dialogue withArkansasleaders is latest stop on industrys listening tour

LITTLE ROCK, Ark., Oct. 2 /PRNewswire-USNewswire/ — Americas Health Insurance Plans (AHIP) President and CEO Karen Ignagni today met with the Arkansas Governors Roundtable on Health Care to discuss the health insurance industrys proposals to reduce health care costs, improve quality and ensure that every American is covered.

Im pleased to join this distinguished panel of leaders to exchange ideas and solutions on how we can make the health care system work better for all Arkansans and all Americans, said Karen Ignagni, President and CEO of AHIP. Health plans have made specific proposals to ensure that all Americans have quality, affordable health care. I look forward to discussing these proposals with the roundtable members and hearing their feedback and discussion.

Ignagnis participation in todays discussion is the latest stop of AHIPs Campaign for an American Solution national listening tour. The Campaign is a grassroots and educational initiative launched by AHIP in July to build support for workable health care reform based on core principles shared by the American people: coverage, affordability, quality, value, choice and portability.

The Governors Roundtable on Health Care embodies the approach that is needed across the country. Ignagni said. We also believe that the only way to solve our health care challenges is to work together to build consensus. The partisan politics of the past wont work, Ignagni continued.

Over the past two years, AHIPs Board of Directors has developed a range of comprehensive policy proposals to provide all Americans with greater access to high-quality, affordable health care coverage. These proposals can be viewed at www.ahip.org/media.

According to the Kaiser Family Foundation, 17% of Arkansans are uninsured, compared to 15% nationally. Fifteen percent of Arkansass gross state product is expenditures for health care, and these costs are growing by 9% per year on average.

The Arkansas Governors Roundtable on Health Care was formed to help improve Arkansans health and productivity through optimal program development, community support, and empowerment of individuals.

The Roundtable has been meeting bi-monthly to identify, develop, and implement strategies to improve health, deliver care, and enhance both worker productivity and the business climate to advance the state.

About the Campaign for an American Solution

The Campaign for an American Solution is a non-partisan, educational and grassroots initiative of Americas Health Insurance Plans (AHIP), the national trade association whose members provide coverage to more than 200 million people. Our campaign is grounded in reform principles that are shared by the American people: coverage, affordability, quality, value, choice and portability. Please visit www.americanhealthsolution.orgfor more information.

Americas Health Insurance Plans — Providing Health Benefits to More Than 200 Million Americans

SOURCE America’s Health Insurance Plans

(c) 2008 U.S. Newswire. Provided by ProQuest LLC. All rights Reserved.

Over 115 Merchants Offer Unique Items for Holiday Gifts At The Christmas Company Shopping Extravaganza, the Junior League of Orange County Annual Fundraiser

NEWPORT BEACH, Calif., Oct. 2, 2008 (GLOBE NEWSWIRE) — More than 115 merchants from Orange County and around the country will offer unique items for holiday gifts at The Christmas Company, the Junior League of Orange County, California, Inc., (JLOCC) shopping extravaganza to be held November 13-16 at the OC Fair & Event Center. The specialty merchandisers at the fundraising event, themed “A Holiday to Remember,” offer wares that are often unavailable through traditional stores.

Over 40 percent of the 2008 exhibitors are new. Great gift selections ranging from products used every day to holiday-themed items will be on display. Everything from women’s fashions to children’s clothing and books, home decor, gardening items and gourmet foods will be presented. Clothing, jewelry and accessories will be available from Slater and Sloane, Sassy Stars, Shelley’s Fashions, Accessor Eyes, Hippie Chix Studio, Little Miss Bling Bling, The Cherished Accessory, Lu Ping Pearls, Cookie Lee Fine Fashion Jewelry, Ronelle Designs, Safia, Kate Joiner, and Paco Soler, to name just a few. A Whale of a Tale, Pizzazzing You, Dollites, Baby Ally, Bellas Dream, Hopscotch Designs, and Prima Collections, among others, will offer children’s books, clothing, furnishings, and toys. Frontier Soups, Addington Confections, A Store For Cooks, Cherchies Specialty Foods, Cafe D’Amore, Diamond Valley Gourmet, Gourmet Blends, and Charter Oak Preserving Company will present gourmet foods, dishes and cookware. Designer Details, A Room to View, and English Gardenstone are among the household and garden item vendors. For a complete list of participants, go to www.jlocc.org.

Many special events also will be included in The Christmas Company, which will kick off with a Preferred Shopping Breakfast sponsored by Panera Bread ($35) 8-11 a.m., Thursday, Nov. 13. The first night will feature a “Girls Night Out” ($20) sponsored by Gallo Family Vineyards, Panera Bread, Patti Bakes, and Mars Snackfoods, to be held 6-10 p.m.

An “Evening of Food & Wine” ($75) will be held 6-10 p.m., Friday, Nov. 14. Gallo Family Vineyard wines will be available along with small plate dishes provided by local restaurants and bakeries including Five Crowns, Bluewater Grill, Ovations, RA Sushi, Newport Rib Company, Five Sweets Bakery, and Pure Bliss.

Additional special occasions include a luncheon celebrating Red Hat Society members at Noon, Saturday, Nov. 15 (sold out). Book readings for children will be held Noon-2 p.m., Sunday, Nov. 16.

Early Bird “Grab and Go” Shopping ($20) on Friday, Saturday, and Sunday begins at 8 a.m. Guests will enjoy a continental breakfast sponsored by Panera Bread and shop before the event opens to the public. No baby strollers are allowed at the Preferred Breakfast and Early Bird events.

The Christmas Company general admission is $10 per person, which includes entrance to the shopping extravaganza and parking. General admission show hours are 11 a.m.-9 p.m., Thursday, Nov. 13; 11 a.m.-10 p.m., Friday, Nov. 14; 10 a.m.-7 p.m., Saturday, Nov. 15; and 10 a.m.-7 p.m., Sunday, Nov. 16. Tickets are available for purchase online at www.jlocc.org or by calling (949) 263-3785.

Top sponsors of the event to-date include Gallo Family Vineyards; Panera Bread; Tigo Gifts, Inc.; Winchell Chiropractic; and Orange Coast Magazine.

Funds raised annually by the JLOCC directly impact the community through collaborative projects with partner organizations and support JLOCC’s mission of promoting voluntarism, developing the potential of women and improving the community. This year’s projects include the Kinship Project and Bridges to Higher Education, both offered through Orangewood Children’s Foundation; Higher Education Mentoring Program (in partnership with the Orange County Bar Foundation); Court-Appointed Special Advocates (CASA) Emancipated Youth Program; and Bear Hugs, a JLOCC project supporting emancipated teens in Orange County.

About the Junior League of Orange County, California, Inc.

The Junior League of Orange County, California, Inc., is an organization of women committed to promoting voluntarism, developing the potential of women, and improving the community through the effective action and the leadership of trained volunteers. JLOCC has contributed to Orange County by helping found organizations such as Orangewood Children’s Home and the Volunteer Center of Orange County. As a solely educational and charitable organization, the JLOCC’s trained volunteers actively support the community through collaboration with organizations that promote and support the health, safety and education of women and children. A 501(c)(3) organization, the JLOCC reaches out to women of all races, religions, and national origins. Originally founded in 1956 as the Newport Harbor Service League, the JLOCC is a member organization of the Association of Junior Leagues International, Inc. To learn more about the JLOCC, call (949) 261-0823 or visit www.jlocc.org.

This news release was distributed by GlobeNewswire, www.globenewswire.com

 CONTACT:  Ballou Communications           Susan Ballou           (949) 477-3070           [email protected] 

Researchers Use Hypnosis To Ease Post-Breast Cancer Hot Flashes

New research published in the Journal of Clinical Oncology shows hypnosis can help reduce hot flashes among breast cancer survivors.

Hot flashes are a significant problem for many breast cancer survivors, the authors reported.

The new findings are particularly important because estrogen therapy, the current best treatment for hot flashes, is off limits for most women who have had breast cancer.

Dr. Gary Elkins said, furthermore, many women must take estrogen-blocking drugs like tamoxifen for years after breast cancer treatment, but “hot flashes can be so severe that some women make a decision to not continue those medications.”

Elkins of Baylor University in Waco, Texas, said several small studies showed hypnosis benefited women suffering from hot flashes. He and his research team randomly assigned 60 breast cancer survivors to hypnosis once a week for five weeks or no treatment.

The 50 minutes hypnosis sessions involved helping the patient to reach a deeply relaxed state, and then offering suggestions for mental imagery to help her relax and feel cool. This could mean having a woman imagine herself walking down a cool mountain path, for example. Women also received instructions on how to practice hypnosis on their own.

Among the 51 women who completed the study, those who had hypnosis reported a 68% reduction in the severity and frequency of their hot flashes. This translated to 4.39 fewer hot flashes a day, on average, for women in the hypnosis group, while there was little change in the control group.

Dr. Nancy E. Avis of the Wake Forest University School of Medicine in Winston-Salem, North Carolina, calls the reduction in hot flashes seen by Elkins and his team “impressive,” but points to the need to compare hypnosis to some type of placebo, rather than no treatment at all.

Elkins said he and his colleagues are now launching a National Institutes of Health-funded study to address this issue, which will enroll 180 postmenopausal women and will compare hypnosis to another type of mind-body intervention.

Elkins noted that the mechanism behind hot flashes is still poorly understood. “We know that they are related to decreases in estrogen, however that relationship is not direct in the sense that hot flashes lessen over time even though estrogen levels remain low,” he explained.

He added that hot weather, spicy food and stress can also trigger hot flashes, so it’s possible that women undergoing menopause may have a more difficult time regulating their body temperature in response to these triggers.

Elkins explained that hypnosis treatment can reduce stress by helping women to relax, and may also give them a sense of control that allows them to keep their body temperature more stable.

On the Net:

Doctors Urge FDA To Halt Cold Medication Sales For Children

In preparation for the upcoming cold season, pediatricians have called for the Food and Drug Administration to recall several over-the-counter cold medications for kids.

Some doctors worry that the drugs’ risks outweigh their benefits and have demanded a recall of the medicines for children younger than 6.

“Parents should know that there is less evidence than ever to support the use of over-the-counter cough and cold medicines for young children,” said Dr. Joshua Sharfstein, Baltimore’s health commissioner. “There is nothing that is holding the FDA back from asking for a voluntary recall now of products marketed to kids under 6.”

Overall, U.S. families spend at least $286 million each year on cough and cold remedies for children, according to the Nielsen Co. market research firm.

Doctors say the drugs are unnecessary because plenty of rest and fluids are the best cure for the common cold.

The FDA this year warned against giving OTC cold medicines to children younger than 2. At that time, officials said they expected to decide by spring on recommendations for youngsters up to 11. Now the agency is seeking more advice from doctors, industry and consumers.

The industry maintains that cold drugs have been used for many years and are safe for those older than 2. However, manufacturers are carrying out new studies involving the most common ingredients in the medications.

After the industry voluntarily stopped selling cough and cold medicines to babies and toddlers last fall, the FDA said more needed to be done to ensure the drugs were not used in children under the age of 6.

When the FDA set standards for cough and cold medicines some 30 years ago, no separate studies were done for kids.

Cough and cold medicines send about 7,000 children to hospital emergency rooms each year with symptoms ranging from hives and drowsiness to unsteady walking. Low doses of a medicine are not likely to cause a problem; the main risk comes from unintentional overdoses.

The same ingredients usually are found in different products. For example, giving a child a cough syrup and a decongestant could inadvertently lead to an overdose.

The Consumer Healthcare Products Association, which represents the manufacturers, says preventable errors are the problem, not the safety of the ingredients in the medicines. The industry is starting an educational campaign aimed at parents, doctors and day care providers on the importance of following directions and storing medicines in places where kids cannot get at them.

On the Net:

PanGenex (PGXC) Provides Product Update on LIPIDEME(TM)

In June, 2008, PanGenex Corporation (Pink Sheets:PGXC) formally introduced LIPIDEME(TM), the all-natural product formulated to address cardiovascular health by having a positive impact on blood lipids. LIPIDEME, made from scientifically proven ingredients is the first product to combine the triglyceride-lowering power of Omega-3 fatty acids with the cholesterol managing ability of phytosterols and tocotrienols – plus the free-radical fighting capacity of Coenzyme Q10 (CoQ10).

Since the introduction of LIPIDEME, PanGenex’s customers have experienced significant reductions in blood lipid levels. Dr. Gregory Zwirn, a Chiropractic Physician, and owner of Axis Chiropractic in Tampa, FL states, “I struggled with high cholesterol for years. After taking LIPIDEME for about 2 months, my total cholesterol dropped nearly 60 points.” Dr. Zwirn, currently the president of the Hillsborough Chiropractic Society and a member of the Florida Chiropractic Association, went on to say that his patients were experiencing similar, positive results.

“LIPIDEME is a safe and effective way to naturally manage your blood lipids. It’s the best product I have come across … it is cost effective, easy to take, and it obviously works to help promote cardiovascular health. LIPIDEME is the gold standard in natural cholesterol lowering supplements.”

Mrs. Sandra Kreul, MSN, ARNP, CLS and one of only a few registered Lipidologists in the country, has begun a 60-day marketing trial this month in order to further quantify the heart healthy effects of LIPIDEME on known cardiovascular risk factors such as cholesterol, triglycerides, homocysteine, and blood pressure. Volunteers are recruited directly from her practice which she shares with cardiologist, Dr. Benedict Maniscalco.

“We are anxious to spread the word of the efficacy of LIPIDEME through our growing network of health care practitioners,” stated Jeff Roman, CEO and President of PanGenex. “LIPIDEME is making a difference in the lives of our customers and practitioner resellers and we look forward to reaching people with heart healthy solutions.”

LIPIDEME is formulated with pharmaceutical grade fish oil that is over 86% pure Omega-3s, the highest concentration available without a prescription for heart, mental, joint and skin health. The Omega-3s in LIPIDEME are triple molecularly distilled and rigorously tested to ensure that there are no detectable levels of Mercury, PCBs, or other toxins or heavy metals. The US Food and Drug Administration and the American Heart Association all recognize that the consumption of Omega-3 fatty acids from fish provide much needed protection for your heart.

About PanGenex Corporation:

PanGenex is a publicly traded corporation (PINK SHEETS:PGXC) and pursues business opportunities in the $70 billion dollar nutraceutical and dietary supplement industry. With a focus on the cardiovascular health segment, PanGenex develops and markets sector leading, patented or patent pending, condition specific nutraceuticals and topical over-the-counter (OTC) drugs and personal care products. Each product is scientifically formulated to address specific health conditions. Many of our products contain the purest grade of nutraceutical components available anywhere without a prescription. PanGenex markets products through healthcare practitioners, retail establishments and the internet on websites such as www.PanGenex.com, www.Calgenex.com and www.HeartHealthyWorld.com.

Disclaimer:

Cautionary Statement about Forward-Looking Statements

This press release contains “forward-looking statements,” which are statements related to future, not past, events. In this context, the forward-looking statements often include statements regarding our goals, plans, projections and guidance regarding our financial position, results of operations, market position, pending and potential future acquisitions and business strategy, and often contain words such as “expects,””anticipates,””intends,””plans,””believes,””seeks” or “will.” Any such forward-looking statements are not assurances of future performance and involve risks and uncertainties that may cause results to differ materially from those set forth in the statements. These risks and uncertainties include, among other things, (a) general economic and business conditions, (b) the level of strategic partner incentives, (c) the future regulatory environment, (d) our cost of financing, (e) our ability to complete acquisitions and dispositions and the risks associated therewith, and (f) our ability to retain key personnel. These factors, as well as additional factors, could affect our forward-looking statements. We urge you to carefully consider this information. We undertake no duty to update our forward-looking statements, including our earnings outlook. The statements in this press release have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

Children’s Hospital of Pittsburgh of UPMC Receives Prestigious Recognition for Patient Safety Efforts in National Survey

PITTSBURGH, Oct. 2 /PRNewswire/ — Children’s Hospital of Pittsburgh of UPMC is one of only seven children’s hospitals in the nation to have been selected as a 2008 Top Hospital by a national organization that evaluates patient safety at more than 1,220 participating hospitals.

Children’s Hospital’s recognition was based on the results of the 2008 Leapfrog Hospital Survey, which is the nation’s premier hospital patient safety evaluation tool. Thirty-three hospitals, including seven children’s hospitals and 26 hospitals participating in the voluntary survey were named Top Hospitals by the Leapfrog Group. The Top Hospitals:

   -- Fully met Leapfrog standards for implementing computer physician order      entry (CPOE) systems that help prevent medication errors, and have also      carefully tested their CPOE systems with Leapfrog's CPOE Evaluation      Tool   -- Fully met stringent performance standards for at least one of the      complex, high-risk procedures (such as heart surgery) done in that      particular hospital   -- Fully met the Intensive Care Unit staffing standard   -- Fully met or demonstrated "substantial progress" on 13 additional      nationally recognized safety practices, such as preventing pneumonia or      bloodstream infections.    

“Families place an amazing amount of trust in us when they bring their children here for care, and because of that, Children’s Hospital’s highest priority has always been and always will be the safety and well-being of our patients,” said Christopher A. Gessner, president, Children’s Hospital. “This recognition is a testament to the tremendous dedication of our nurses, physicians, employees and staff to upholding that trust and working hard to provide a safe environment.”

The voluntary survey evaluates hospitals about their performance in four crucial areas:

   -- Do physicians enter prescriptions and other orders into computers      linked to medication error prevention software? And are those systems      tested to assure that users are warned about serious prescribing      errors?   -- How well do hospitals perform seven complex high-risk procedures and      care for high-risk deliveries? The high-risk procedures are coronary      artery bypass graft, percutaneous coronary intervention, abdominal      aortic aneurysm repair, aortic valve replacement, pancreatic resection,      esophagectomy and bariatic surgery. (Do we need to mention how this is      evaluated in a pediatric hospital, where most of these things are done      in very low volume if at all?)   -- Are hospital intensive care units staffed by qualified specialists?   -- Do hospitals have safety practices and policies advocated by the      National Quality Forum to reduce harm and errors?    

“Children’s Hospital has been at the forefront of efforts by health care institutions to improve patient safety. In 2002, we became the first children’s hospital in the country to adopt a CPOE system, and when we move to the new Children’s Hospital in 2009, our order entry and inpatient and ambulatory medical records will be completely paperless,” said Steven G. Docimo, vice president, Medical Affairs. “Our new hospital will further enable us to enhance patient safety by measures such as offering private inpatient rooms, which reduces the risk of infection. We’re proud of the fact that the dedication of our physicians, nurses and staff to patient safety has been recognized by Leapfrog.”

A study published in the June 2008 issue of the Journal of Quality and Patient Safety found that hospitals that perform well on the Leapfrog Hospital Survey have lower mortality and better quality of care than those that either didn’t perform as well on the survey or that chose not to complete it.

“Top Hospitals demonstrate an exceptional level of performance and serve as models for other hospitals,” said Leah Binder, CEO, The Leapfrog Group. “However, all participating hospitals deserve praise for their willingness to raise the veil on how well they perform.”

About Children’s Hospital

Renowned for its outstanding clinical services, research programs and medical education, Children’s Hospital of Pittsburgh of UPMC has helped establish the standards of excellence in pediatric care. From Ambulatory Care to Transplantation and Cardiac Care, talented and committed pediatric experts care for infants, children and adolescents who make more than 500,000 visits to Children’s and its many neighborhood locations each year.

Children’s also has been named consistently to several elite lists of pediatric health care facilities, including ranking eighth among children’s hospitals (FY 2006) in funding provided by the National Institutes of Health, and is named one of the top 10 best pediatric hospitals in the United States by U.S. News & World Report.

For more information about Leapfrog’s 2008 Top Hospital list, please visit http://www.leapfroggroup.org/. For more information about Children’s Hospital, please visit http://www.chp.edu/.

Children’s Hospital of Pittsburgh of UPMC

CONTACT: Marc Lukasiak, +1-412-692-7919, or +1-412-692-5016,[email protected], or Melanie Finnigan, +1-412-692-5502, or+1-412-692-5016, [email protected]

Web site: http://www.chp.edu/http://www.leapfroggroup.org/

MaxCyte and Medinet to Present at the 10th International Symposium on Dendritic Cells in Kobe, Japan

GAITHERSBURG, Md. and YOKOHAMA, Japan, Oct. 2 /PRNewswire/ — MaxCyte, Inc. and Medinet Co., Ltd. announce a joint poster presentation at The 10th International Symposium on Dendritic Cells. The meeting is being held October 1-5, 2008 in Kobe, Japan.

The presentation is entitled: “Tumor lysate electroloaded mature human DC exhibit enhanced antigen-specific potency compared to lysate co-incubation in clinical manufacturing scale” and will discuss the findings of a study that combined MaxCyte’s platform and Medinet’s novel immunocell therapy technologies to produce more potent cancer vaccines. The session is scheduled for Friday October 3rd from 1-2 pm and 6:15-8:00 pm.

The study was performed under an exclusive license, development and supply agreement to use MaxCyte’s proprietary cell loading system to support clinical development and commercialization of Medinet’s cancer immunotherapy service in Japan. MaxCyte has optimized its technology platform for Medinet’s novel cancer immuno-cell therapy service for implementation in a closed system, cGMP manufacturing process at Medinet’s cell processing centers.

The presentation will discuss how the electroloading of previously matured DC with whole cell tumor lysates generates a DC vaccine that has up to 20-fold enhanced antigen-specific potency compared to traditional DC vaccines obtained via lysate co-incubation of immature DC, followed by maturation. Direct loading of mature DC also saves significant processing time. Using

MaxCyte’s cell-loading technology, this process was successfully scaled up to allow processing of large, clinically relevant volumes of DC (>100 million cells) in a closed system, as a single lot that can be subsequently cryopreserved for multiple dosing. The manufacturing methodology uses MaxCyte’s proprietary cell loading platform, a technology that has been described in a Master File with CBER-United States FDA and has been cross-referenced in multiple clinical studies.

About MaxCyte

MaxCyte is the leader in providing clinical/commercial cell modification technologies and unparalleled expertise to the global leaders in cell-based therapies. MaxCyte’s cell transfection technology platform enables the discovery, development, manufacturing and delivery of innovative and important therapeutic products for a wide range of diseases. MaxCyte’s licenses its cell modification technology to companies developing cell-based therapies and sells instruments and disposables to leading biopharmaceutical companies for drug discovery. Current clinical programs with MaxCyte-engineered cells include: a Phase IIa clinical study for treatment of Chronic Lymphocytic Leukemia (CLL) and a Phase IIa study using engineered stem cells for the treatment of primary Pulmonary Arterial Hypertension (PAH). In addition, there are advanced preclinical programs in oncology and regenerative medicine. More than a dozen commercial and academic partners are currently using the MaxCyte technology. The MaxCyte system has an FDA Master File in place at the Center for Biologics Evaluation and Research (CBER). Building on its core technology and relationships, new opportunities are being pursued in the development of first-in-class targeted therapies for cancer, autoimmune and infectious diseases. MaxCyte intends to develop these programs to the proof-of-concept stage and then enter into codevelopment agreements with biopharmaceutical companies. For more information, visit http://www.maxcyte.com/.

About Medinet

Medinet is a world leading company in cell therapy, supporting medical service providers in Japan. Through its service, Medinet provides medical institutions with advanced technologies and knowhow in: cell processing and culturing, quality control, and facility management with respect to the immuno-cell therapy. Medinet has extensive experience in autologous cell processing; with more than 7,500 cancer patients treated in actual clinical practice through more than 60,000 cell therapy manufacturing processes. Medinet continues to invest in R&D to improve cell processing

technologies in an effort to increase efficacy in collaborative clinical studies with university hospitals and medical institutions. Medinet went public in October, 2003 on the MOTHERS, Tokyo Stock Exchange.

For more information, visit http://www.medinet-inc.co.jp/english/

MaxCyte, Inc.

CONTACT: Anthony Recupero, Ph.D., Vice President Business Development ofMaxCyte, Inc., +1-301-944-1700, or Kunihiko Suzuki, General Manager, CorporateStrategy & Planning Department, of Medinet Co., Ltd., +81(45)478-0046

Web Site: http://www.maxcyte.com/http://www.medinet-inc.co.jp/english/

Transave, Inc. Secures $12.5 Million in New Financing

MONMOUTH JUNCTION, N.J., Oct. 2 /PRNewswire/ — Transave, Inc., a biopharmaceutical company focused on developing innovative inhaled pharmaceuticals for the site-specific treatment of serious lung diseases, today announced that it has secured a $12.5 million venture loan from CIT Healthcare and Compass Horizon Funding Company LLC, an affiliate of Horizon Technology Finance Management LLC.

In June, Transave, Inc. reported positive Phase II data on Arikace(TM) (liposomal amikacin for inhalation) from a randomized, placebo-controlled, 15-center study conducted in Europe. The study demonstrated that Arikace, delivered once daily for 28 consecutive days using a novel inhalation device, an Investigational eFlow(R) Nebulizer System (PARI Pharma GmbH), produced a significant improvement in lung function, was well-tolerated, and had a side-effect profile comparable to placebo in the treatment of Pseudomonas aeruginosa, a lung infection common in cystic fibrosis (CF) patients. The improvement in lung function was dose-dependent and was sustained at 28 days after completion of dosing, which was day 56 of the study. The data were presented at the European Cystic Fibrosis Society Conference in Prague, Czech Republic. Cystic Fibrosis Foundation Therapeutics, the nonprofit affiliate of the Cystic Fibrosis Foundation, provided a $1.7 million award to support the development of Arikace. The Foundation is the leading organization devoted to curing and controlling cystic fibrosis.

“Our ability to close this financing in a difficult financial services environment speaks to the commitments and deep industry experience of CIT Healthcare-Life Sciences and Horizon. The potential benefits this drug may hold for patients — as demonstrated in the recently completed Phase II study — is very promising,” said Chris Morell, senior vice president and director, of CIT Healthcare.

“This financing, in addition to a $35M Series D financing closed in March, will enable us to complete our Arikace Phase II program for the treatment of Pseudomonas infections in cystic fibrosis patients,” said Tim Whitten, Transave’s chief executive officer. “It also allows us to broaden the Arikace clinical trial program by initiating a Phase II clinical trial in a second area of high unmet need: bronchiectasis patients who have pseudomonas lung infections.”

Based on the strength of the Arikace clinical profile to date, the company has initiated a Phase II trial to evaluate the compound for treating Pseudomonas infections in patients with non-cystic fibrosis-related bronchiectasis in Europe and India. The U.S. Food and Drug Administration (FDA) has also agreed to the company’s plans to expand this trial into the United States. Bronchiectasis is the permanent widening of the bronchi (the large tubes which begin at the bottom of the trachea and branch into the lungs). Individuals with bronchiectasis are vulnerable to recurrent respiratory infections, which often have a Pseudomonas component.

Kristen Kosofsky, managing director of Horizon, noted, “Our goal at Horizon is to support the growth and success of innovative companies like Transave that develop important next-generation technologies that serve as the cornerstone for improving human health and quality of life.”

About Arikace (liposomal amikacin for inhalation)

Arikace is a form of the antibiotic amikacin that is enclosed in nanocapsules of lipid called liposomes. This proprietary next-generation liposomal technology prolongs release of amikacin in the lung while minimizing systemic exposure. The treatment uses biocompatible lipids endogenous to the lung that are formulated into small (0.3 micrometers), neutrally-charged liposomes that enable biofilm penetration and are highly efficient, with very low lipid-to-drug ratio (0.65). Arikace can be effectively delivered through nebulization since the small aerosol droplet size (~3.0 micrometers) facilitates lung distribution. Arikace has been granted orphan drug status in the United States by the FDA and has received an orphan drug designation in Europe by the European Medicines Agency (EMEA) for the treatment of Pseudomonas infections in patients with CF.

About Transave, Inc.

Transave, Inc. is a biopharmaceutical company focused on the development of innovative, inhaled pharmaceuticals for the site-specific treatment of serious lung diseases. The company’s major focus is on developing inhaled antibiotic therapy delivered via next-generation liposomal technology in areas of high unmet need in respiratory disease. Transave is dedicated to leveraging its advanced liposomal development and commercialization expertise, along with its intellectual property, to bring life-extending and -enhancing medicines to patients. For more information about Transave’s technology and development programs, visit http://www.transaveinc.com/.

About CIT

CIT is a global commercial finance company that provides financial products and advisory services to more than one million customers in over 50 countries across 30 industries. A leader in middle-market financing, CIT has more than $70 billion in managed assets and provides financial solutions for more than half of the Fortune 1000. A member of the S&P 500 and the Fortune 500, CIT maintains leading positions in asset-based, cash flow, and Small Business Administration lending, equipment leasing, vendor financing, and factoring. The CIT brand platform, Capital Redefined, articulates its value proposition of providing its customers with the relationship, intellectual, and financial capital to yield infinite possibilities. Founded in 1908, CIT is celebrating its Centennial throughout 2008. For additional information, please go to http://www.cit.com/.

About Horizon

Horizon Technology Finance Management is a privately-held independent venture debt finance company that provides senior and subordinated venture debt financing solutions to venture capital-backed technology and life science companies through its affiliated investment finance company Compass Horizon Funding Company LLC. The Horizon team has provided over $2 billion in financing to more than 750 venture capital-backed technology and life science companies over a span of 20 years. Horizon provides a compelling alternative to the restrictive structures offered by banks and corporate finance companies. Horizon’s team has over 150 years of collective venture and commercial lending experience and uses its extensive knowledge, expertise, and industry relationships to provide custom venture debt products and financing solutions for its customers. Horizon has offices in Farmington, CT and the San Francisco, CA area. For more information, please visit http://www.horizontechfinance.com/.

About PARI Pharma and the Investigational eFlow Nebulizer System

Arikace is delivered by the Investigational eFlow Nebulizer System. The Investigational eFlow Nebulizer System uses eFlow Technology to enable extremely efficient aerosolization of liquid medications via a vibrating perforated membrane that includes thousands of small holes that produce the aerosol mist. Compared to other nebulization technologies, eFlow Technology produces aerosols with a very high density of active drug, a precisely defined droplet size, and a high proportion of respirable droplets delivered in the shortest possible period of time. Combined with its silent mode of operation, small size (it fits in the palm of your hand), light weight, and battery use, eFlow Technology reduces the burden of taking daily, inhaled treatments. The Investigational eFlow Nebulizer System is proprietary to PARI Pharma and can be optimized to specific drug formulations.

PARI Pharma focuses on the development of aerosol delivery devices and therapies. Based on PARI’s 100-year history working with aerosols, PARI Pharma develops treatments for pulmonary and nasal administration optimized with advanced delivery technologies, such as eFlow technology. Online at http://www.paripharma.com/.

Transave, Inc.

CONTACT: Jennifer Corrigan for Transave, Inc., +1-732-382-8898,[email protected]

Web Site: http://www.cit.com/http://www.horizontechfinance.com/http://www.paripharma.com/http://www.transaveinc.com/

New Tests Find Melamine in 31 Chinese Milk Batches

New tests find melamine in 31 Chinese milk batches

BEIJING, Oct. 2 (Xinhua) — Additional 31 batches of milk powder were found to contain melamine while most products of this kind on the market were safe, the country’s food safety watchdog said Wednesday following a nationwide special check on the chemical. The State Administration of Quality Supervision, Inspection and Quarantine said it had tested 265 batches milk powder produced by 154 different companies prior to Sept. 14, and found 31 batches produced by 20 domestic dairy companies were tainted with melamine.

The new batches being tested were mostly milk powder products for adults. The melamine content in the Sanlu brand reached 6,196 mg per kg in its so-called high iron and zinc formula, the highest among all the samples.

Chinese inspectors have found the chemical melamine in 69 batches of baby milk powder produced by 22 companies nationwide in the mid- Sept.The authorities then ordered a halt to the sale of the tainted products which included such well-known brands as Sanlu, Mengniu, Yili and Yashili, among others.

Relevant departments have begun an investigation of the implicated companies to find out the problematic source and punish those responsible.Tian Wenhua, the group’s chairwoman and general manager, was fired from her posts in the wake of the scandal.

China’s food quality has been criticized recently, as 13,000 infants nationwide were hospitalized with kidney problems and at least three were killed after drinking baby formula tainted with melamine, a toxic chemical added to raw milk so the protein content of the milk appears higher than it actually is.

(c) 2008 Xinhua News Agency – CEIS. Provided by ProQuest LLC. All rights Reserved.

Stem Cell Transplantation Program at Hackensack University Medical Center

HACKENSACK, N.J., Oct. 2 /PRNewswire/ — The Blood and Marrow Stem Cell Transplantation Program at the John Theurer Cancer Center at Hackensack University Medical Center is the first in the United States to receive Disease Specific Care Certification for stem cell transplantation from The Joint Commission, the nation’s leading accrediting agency for hospitals and healthcare organizations. The Blood and Marrow Transplantation Program also recently became the first and only program in New Jersey to be named a Blue Distinction(R) Center for Specialty Care by the nationwide Blue Cross and Blue Shield companies.

Both of these designations attest to the high quality of the program’s clinical services, the expertise of its faculty and staff, stringent quality indicators that are maintained, research studies that are under way, and a rigorous quest for continuous improvement. The Blood and Marrow Stem Cell Transplantation Program is one of the 10 largest in the United States. Nearly 300 adults and children throughout the country with cancer and serious blood disorders come to the John Theurer Cancer Center each year to undergo a life-saving stem cell transplant at the program. Last year, the program reported outcomes success rates of more than 95 percent for the procedure.

“These designations attest to the high level of expertise offered by our Blood and Marrow Stem Cell Transplantation Program’s chief, Dr. Scott Rowley, by his associate, Dr. Michele Donato, and by the entire transplantation team,” says Andrew L. Pecora, M.D., chairman and executive administrative director of the John Theurer Cancer Center at Hackensack University Medical Center.

The Blood and Marrow Stem Cell Transplantation Program received Disease Specific Certification after a rigorous on-site, unannounced, day-long evaluation on August 29 that assessed clinical practices, policies and procedures, and performance measurement requirements. Four specific program measures were monitored, including discharge criteria, survival at 100 days, acute graft-versus-host disease documentation, and donor follow-up. The reviewer evaluated the program’s adherence to the clinical standards of the Foundation for the Accreditation of Cellular Therapy.

The Blue Distinction(R) Center for Specialty Care designation is awarded by the BC/BS companies to medical facilities that have demonstrated experience in delivering quality healthcare. The Blood and Marrow Stem Cell Transplantation Program is one of 70 Blue Distinction(R) Centers for Transplants nationwide, but the only one in New Jersey. The designation is based on evidence-based selection criteria established with leading medical specialists and societies, including the Center for International Blood and Marrow Transplant Research and the Foundation for the Accreditation of Cellular Therapy. In achieving the Blue Distinction(R) Center designation, the program was evaluated on volume of cases, survival, a stable team of transplantation experts and subspecialists, the facility, data management, patient management plans, post-operative phase, patient education, policies and procedures, quality management, and patient satisfaction review process.

The John Theurer Cancer Center’s Blood and Marrow Stem Cell Transplantation Program is the only one in New Jersey that is approved by the National Marrow Donor Program to perform all types of transplants: autologous (using the patient’s own stem cells), allogeneic (using a donor’s stem cells), and umbilical cord (using stem cells collected from umbilical cords). Many of the advances in stem cell transplantation techniques used today were developed here. There are currently more than 50 clinical trials under way at the program.

The John Theurer Cancer Center provides extraordinary cancer care by offering multidisciplinary care, personalized treatment, innovative research, superior outcomes, and patient satisfaction within 14 disease-specific divisions. For more information, call 201-996-5900 or visit humc.com.

Available Topic Experts: For information on the listed expert(s), click appropriate link.

Scott Rowley, M.D |. https://profnet.prnewswire.com/Subscriber/ExpertProfile.aspx?ei=78490

Michele L. Donato, M.D. | https://profnet.prnewswire.com/Subscriber/ExpertProfile.aspx?ei=79128

John Theurer Cancer Center

CONTACT: Linda Steuerwald of LJS Communications, +1-201-612-2221,[email protected]

Web Site: http://humc.com/

STUDY: Lights Out In 2009?

The United States Faces Serious Risks of Brownouts or Blackouts in 2009, Study Warns

A new study released this week highlights what experts have been saying for years:  the U.S. faces significant risk of power brownouts and blackouts as early as next summer that may cost tens of billions of dollars and threaten lives.

The study, “Lights Out In 2009?” warns that the U.S. “faces potentially crippling electricity brownouts and blackouts beginning in the summer of 2009, which may cost tens of billions of dollars and threaten lives.”

“If particularly vulnerable regions, like the Western U.S., experience unusually hot temperatures for prolonged periods of time in 2009, the potential for local brownouts or blackouts is high, with significant risk that local disruptions could cascade into regional outages that could cost the economy tens of billions of dollars,” the report warned.

U.S. baseload generation capacity reserve margins “have declined precipitously to 17 percent in 2007, from 30-40 percent in the early 1990s,” according to the study.  A 12-15 percent capacity reserve margin is the minimum required to ensure reliability and stability of the nation’s electricity system.  Compounding this capacity deficiency, the projected U.S. demand in the next ten years is forecast to grow by 18 percent, far exceeding the projected eight percent growth in baseload generation capacity between now and 2016.

The study, which can be downloaded here, estimated that the U.S. will require about 120 gigawatts (GW) of new generation  just to maintain a 15 percent reserve  margin.  That will require at least $300 billion in generation and transmission facility investments by 2016.

“The facts presented in this study should stimulate a call for action by policymakers everywhere.  Our nation’s electricity system is clearly in trouble and we need to take rapid steps as soon as possible to remedy the situation,” said Bob Hanfling, Chairman of the non-profit NextGen Energy Council, which conducted the study.  “This isn’t the first study to come to these conclusions, and it won’t be the last.  We hope it illuminates current policy debates, from those on climate change to resource development to infrastructure build-out to national security. We also hope it will sound the alarm for every elected official, policymaker, business leader and citizen concerned about the future prosperity and security of our nation.”

The study also identified the primary barriers to getting new power plants and transmission lines built.  Chief among these is the “opposition of well-funded environmental groups that oppose and file lawsuits against virtually every new infrastructure project proposed.”

Other obstacles include opposition to natural gas production, which is needed to fuel the growing reliance on natural-gas fired power plants; challenges associated with putting more intermittent renewable power sources on the grid; regulatory uncertainty associated with climate change policy development; reluctance by state regulators to approve rate increases related to the imposition of new environmental or climate-related regulation; and the relatively shorter-term approach to resource planning and acquisition that industry has been forced to adopt because of all of the above factors.

Among its other findings were these:

  • The U.S. will require more than 14,500 miles of new electricity transmission lines by 2016.  Regions represented by the Florida Reliability Coordination Council (FRCC) and the Northeast Power Coordinating Council (NPCC) may require less than 400 miles of new transmission lines, while the Southeast Reliability Council (SERC) may require nearly 2,300 miles.  The Western Electricity Coordinating Council (WECC) may require nearly 7,000 miles.
  • Substantial increases in wind turbine orders, and new wind capacity, has been slowed by a worldwide turbine shortage and local opposition to wind projects. Since wind generation is expected to grow substantially throughout the U.S., the integration of intermittent resources into the bulk power system is becoming increasingly complex and difficult.
  • While renewable energy proponents, and some elected officials, are saying that the U.S. needs to only add renewable power facilities such as wind farms, the annual capacity factor of wind generators is typically about 25 – 35 percent. However, the probability that wind generators are available at their rated value during annual peak periods is only between 5 – 20 percent and varies greatly from year to year and region to region.  Wind cannot be considered a reliable baseload capacity resource.
  • Rapidly increasing demand for steel and copper has caused spot scarcity of the resources required to manufacture key electrical components, and this commodity demand has increased the theft of critical system components.  Manufacturers have attempted to eliminate excess inventories and capacity to increase productivity of their assets, but they are reluctant to add more capacity until they can be certain about future industry investments.

The study also presented a survey of political developments and trends that amount to “structural political barriers being erected to system reliability.”  It pointed to the fact that “environmental activist groups” are now:

  • Suing to block the construction of virtually every single baseload coal-fired power plant, in spite of advanced environmental technologies these plants would deploy.
  • Gearing up to block construction of any baseload nuclear power plants across the West.
  • Suing or protesting virtually every proposed lease on public lands in the Rocky Mountains for natural gas drilling.
  • Working to slow or stop the completion of the two main multi-year, stakeholder-based transmission corridor processes that both Democrats and Republicans in Congress approved as part of the Energy Policy Act of 2005.
  • Pushing for additional endangered species designations, which will make siting and construction of both power plants and transmission lines difficult.
  • Pressuring government leaders to limit access by larger, baseload technologies to the region’s high-voltage transmission grid and, instead proposing to artificially favor non-baseload, intermittent power facilities that will (at some point) further stress the reliability of the entire Western grid.

On the Net:

Study Suggests AIDS Virus Originated A Century Ago

Researchers said on Wednesday the deadly AIDS virus has been circulating among humans for nearly a century “” decades longer than scientists had first thought.

Genetic analysis pushes the estimated origin of HIV back to between 1884 and 1924, with a more focused estimate at 1908. The disease is thought to have originated in sub-Saharan Africa, just as modern cities were emerging in the region.

Scientists had originally estimated the origin at around 1930. AIDS wasn’t recognized formally until 1981 when it got the attention of public health officials in the United States.

“The new result is not a monumental shift, but it means the virus was circulating under our radar even longer than we knew,” said Michael Worobey of the University of Arizona, an author of the new work.

The newly calculated dates fall during the rise of cities in Africa, and the researchers suggest urban development may have promoted HIV’s initial establishment and early spread.

HIV is believed to have descended from a chimpanzee virus that jumped to humans in Africa, probably when people butchered chimps. Researchers say many individuals were probably infected that way, but so few other people caught the virus that it failed to get a lasting foothold.

Worobey suggested that the growth of African cities might have changed that by putting lots of people close together and promoting prostitution. “Cities are kind of ideal for a virus like HIV, providing more chances for infected people to pass the virus to others,” he said.

He believes that perhaps a person infected with the AIDS virus in a rural area went to what is now Kinshasa, Congo and “now you’ve got the spark arriving in the tinderbox.”

“I think the picture that has emerged here, is that changes the human population experienced may have opened to the door to the spread of HIV,” he said.

“Previous work on HIV sequencing had been done on frozen samples and there are only so many of those samples available,” Woroby said. The 1959 and 1960 samples are presently the oldest links to the HIV epidemic.

The research is based on 48-year-old gene fragments dug from a wax-embedded lymph node from a woman in Kinshasa in the Democratic Republic of Congo, formerly Zaire.

The 1960 sample is the second-oldest genetic sequence of HIV-1 group M, the main strain of the virus responsible for the AIDS pandemic.

The oldest sequence came from a 1959 blood sample given by a man in Kinshasa, formerly known as Leopoldville.

“Once you have two you can line them up and compare them and once you do that, you see these two sequences are very different. That means the virus had already been there for a long time even by 1959 or 1960,” Worobey said.

Researchers took advantage of the fact that HIV mutates rapidly. So two strains from a common ancestor quickly become less and less alike in their genetic material over time.

The research study used genetic data from the two old HIV samples plus more than 100 modern samples to create a family tree going back to these samples’ last common ancestor.

Worobey said researchers got various answers under various approaches for when that ancestor virus appeared, but the 1884-to-1924 bracket is probably the most reliable.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the new work is clearly an improvement over the previous estimate of around 1930.

Fauci said disease prevention is one of the most important issues in HIV. “For every one person that we put on therapy, two to three people in the developing world get newly infected,” he said. “The only way we are going to get our arms around this is through prevention.”

Professor Paul Clark, a researcher into evolutionary history at the University of Edinburgh, said that while the finding was mainly of “historical interest”, it might provide more clues about how the virus changed over time.

“We can now paint a remarkably detailed picture of the time and place of origin of HIV-1 group M viruses and their early diversification, and thus of the prehistory of the AIDS pandemic.”

On the Net:

Hill-Rom Announces Acquisition of Liko (Liko Vardlyft AB And Liko North America Corporation)

BATESVILLE, Ind., Oct. 2 /PRNewswire-FirstCall/ — Hill-Rom and Liko (Liko Vardlyft AB and Liko North America Corporation) announced today the acquisition of Liko by Hill-Rom for approximately $183 million (U.S.) dollars. Hill-Rom, based in Batesville, Ind., is a leading worldwide manufacturer and provider of patient support systems and other related medical technologies and related services for the health care industry. Liko, based in Lulea, Sweden, is a leading supplier and developer of lifts and slings that facilitate the safe movement and transfer of patients. Through a comprehensive range of products that handle all lifting situations, Liko’s patient lifts and accessories have set the standard for performance in both acute and post acute care settings around the world.

The transaction was completed on October 1, 2008. The transaction is expected to be slightly accretive to Hill-Rom’s GAAP earnings per share in 2009 and increasingly accretive thereafter. In addition, once integrated, this acquisition should enhance Hill-Rom’s organic revenue growth rate and margins. Liko generated revenues of approximately $75 million during its fiscal 2008. The transaction will be financed from existing cash balances and available lines of credit. Upon closing, Hill-Rom expects to benefit from synergies created by combining Liko’s strong product platforms, engineering capabilities, clinical competencies and sales channel capabilities with Hill- Rom’s established brands, long standing reputation for high quality products and service, and its large and established sales and service organizations in both North America and Europe.

“The addition of Liko to our Hill-Rom family represents a direct connection to Hill-Rom’s mission of enhancing outcomes for patients and their caregivers,” said Peter H. Soderberg, president & CEO of Hill-Rom. “Hill-Rom has previously stated its desire to add complementary technologies to its portfolio that leverage our global business footprint and presence across the continuum of care. This acquisition is an important step in this direction as nearly 75 percent of Liko’s revenue is derived outside of North America and the company has a well balanced focus on the acute, extended care and home care segments – all care settings where lifts are widely deployed and where Hill-Rom is intensely focused. The safe and efficient movement of patients or residents to and from their beds is a challenge that we will now be able to more completely assist with through the acquisition of Liko, a leading innovator in this space.”

Soderberg added that the addition of Liko is consistent with Hill-Rom’s previously articulated strategies. “We have chosen to add a high-performing company that supplements and augments our business, particularly in our European markets and our post-acute care segment,” he said.

“Hill-Rom brings Liko the opportunity to grow, reaching more patients and caregivers worldwide,” said Gunnar Liljedahl, founder of Liko. “Our missions, both of which focus on improving outcomes for patients and caregivers are similar, and our cultures, which focus on innovation and excellence, are entirely aligned. I see our two companies coming together as a winning combination for our employees, our communities and for all the customers we serve.”

Liko has been a family-owned and operated business for more than 25 years. Its history is one of providing the most advanced technologies and full solutions to meet the lifting and assist needs of patients from critical care through extended care and into the homecare markets. Liko employs about 275 people worldwide.

It is intended that Liko products will continue to be marketed under the Liko name with the addition of Hill-Rom branding. The primary Liko business operations now carried out in Liko’s headquarters in Lulea and at its other locations (notably Franklin, Mass. in the United States and locations in the United Kingdom and in Germany) will continue with only minor adjustments.

Evli Bank acted as financial advisor to Hill-Rom and Ernst & Young acted as financial advisor to the sellers. Vinge and Bracewell & Giuliani LLP served as legal advisors to Hill-Rom and Cederquist served as legal advisor to the sellers.

Conference Call Webcast and Replay

Hill-Rom will sponsor a conference call and webcast for the investing public at 8:30 a.m. EDT today, October 2, 2008. During the call, management will discuss details of the Liko transaction. The webcast is available at http://www.hill-rom.com/ or by following this link: http://ir.hill-rom.com/eventdetail.cfm?eventid=60089 and will be archived on the company’s Web site through October 2, 2009 for those who are unable to listen to the live webcast. A replay of the call is also available through October 9, 2008 at 888-203-1112 or for International callers 719-457-0820. This code is needed to access the replay using either of the mentioned dial-in numbers: 7742506.

ABOUT LIKO

Liko is one of the leading suppliers of patient lifts and slings in the world. More than 25 years of continuous development has resulted in the market’s safest, most effective and most complete system of lifting and transfer devices.

In Sweden and other markets, the name Liko is synonymous with patient lifts. Today, Liko is market leading in the Nordic region, with nearly 20 percent of the world market. Liko now employs 275 people worldwide.

   Liko  ... Lifts with care   http://www.liko.com/    ABOUT HILL-ROM  

Hill-Rom is a leading worldwide manufacturer and provider of medical technologies and related services for the health care industry, including patient support systems, non-invasive therapeutic products for a variety of acute and chronic medical conditions, medical equipment rentals, and information technology solutions. Hill-Rom’s comprehensive product and service offerings are used by health care providers across the health care continuum in hospitals, extended care facilities and home care settings to enhance the safety and quality of patient care.

   Hill-Rom ... enhancing outcomes for patients and their caregivers.   http://www.hill-rom.com/    Disclosure Regarding Forward-Looking Statements  

Certain statements in this press release contain forward-looking statements, within the meaning of the Private Securities Litigation Reform Act of 1995, regarding the Company’s future plans, objectives, beliefs, expectations, representations and projections. The Company has tried, wherever possible, to identify these forward-looking statements using words such as “intend,””anticipate,””believe,””plan,””encourage,””expect,””may,””goal,””become,””pursue,””estimate,””strategy,””will,””projection,””forecast,””continue,””accelerate,””promise,””increase,””higher,””lower,””reduce,””improve,””expand,””progress,””potential” or the negative of those terms or other variations of them or by comparable terminology. The absence of such terms, however, does not mean that the statement is not forward-looking. It is important to note that forward- looking statements are not guarantees of future performance, and the Company’s actual results could differ materially from those set forth in any forward- looking statements. Factors that could cause actual results to differ from forward-looking statements include but are not limited to: the Company’s dependence on its relationships with several large group purchasing organizations, whether the Company’s new products are successful in the marketplace, changes in customers’ Medicare reimbursements, collections of accounts receivable, compliance with FDA regulations, antitrust litigation, potential exposure to product liability or other claims, failure of the Company’s announced strategic initiatives and restructuring and realignment activities to achieve expected growth, future restructuring or realignment activities, efficiencies or cost reductions, disruptions in the Company’s business or other adverse consequences resulting from the recent spin-off of the funeral service business, failure to realize the anticipated benefits of the spin-off, failure of the Company to execute its acquisition and business alliance strategy through the consummation and successful integration of acquisitions or entry into joint ventures or other business alliances, increased costs or unavailability of raw materials, labor disruptions, the ability to retain executive officers and other key personnel, and certain tax- related matters. For a more in depth discussion of these and other factors that could cause actual results to differ from those contained in forward- looking statements, see the discussions under the heading “Risk Factors” in the Company’s Annual Report on Form 10-K for the period ended September 30, 2007, its Current Report on Form 8-K filed with the SEC on March 17, 2008, and the Quarterly Report on Form 10-Q for the quarter ended June 30, 2008. The Company assumes no obligation to update or revise any forward-looking statements.

Hill-Rom

CONTACT: Media: Lauren Green-Caldwell, Director, Corporate Communications& Public Relations of Hill-Rom, +1-812-934-8692,[email protected]; or Investors: Blair A. (Andy) Rieth, Jr.,Vice President, Investor Relations, Corporate Communications & Global BrandDevelopment for Hill-Rom, +1-812-931-2199, [email protected]

Web site: http://www.hill-rom.com/http://www.liko.com/http://ir.hill-rom.com/eventdetail.cfm?eventid=60089

Parental Influence and Teens’ Attitude Toward Online Privacy Protection

By Youn, Seounmi

This study examines the impact of parental influence on teens’ attitude toward privacy protection. Survey data show that teens high in conceptoriented family communication tend to engage in discussion mediation, which, in turn, affects their level of privacy concern. In contrast, teens high in socio-oriented communication tend to have more family rules and surf the Internet with parents. Rulemaking mediation is not directly related to teens’ level of privacy concern, while cosurfing mediation is related to their level of concern. This study also finds that parental mediation and teens’ concern level explain their attitude toward privacy protection measures. Implications for policymakers and educators are discussed. With teens increasingly becoming an influential online retail demographic (Business Wire 2006; Greenspan 2004), e-marketers are targeting them through new interactive marketing platforms such as gamevertising, viral video, and social networking site (Chester and Montgomery 2007; Howard 2006). These marketing practices may open opportunities for communication, product learning, and e-commerce to teens; however, they also raise public concerns about online risks resulting from teen privacy loss (Donnerstein 2002; Lenhart 2005; Willard 2006).

Among potential online risks, privacy advocates have addressed financial risks stemming from e-marketers’ attempts to collect personal information from teens (Schonberger 2005). The Federal Trade Commission (FTC) received 10,835 identity theft complaints in 2006 from teens aged eighteen and younger. This is an approximate 13 percent increase over the 9,595 complaints in 2004 (FTC 2007a) and accounts for about 5 .percent of the 225,532 identity theft complaints in 2006. That same year, 1,498 Internetrelated fraud complaints from teens aged nineteen and younger were filed with FTC, accounting for 2 percent of the 61,168 complaints in 2006 (FTC 2007b). Another online risk is the constant barrage of unwanted commercial e-mails caused by teens giving their private information to e-marketers (Grant 2006; Liau, Khoo, and Ang 2005).

In response to these online risks teens face, parents and privacy advocates have voiced concerns about teen privacy loss. The Pew Internet & American Life Project study discovered that 81 percent of parents believe that teens are not as careful as they should be with disclosing personal information online (Lenhart 2005). The Annenberg Public Policy Center study reported that 74 percent of parents worry that their child gives out personal information through Web sites or chat rooms (Turow and Nir 2000). In the same study, 96 percent of parents agreed that teens older than thirteen years should be required to obtain parental consent before disclosing their information online.

However, the current FTC rule under the Children’s Online Privacy Protection Act (COPPA) does not protect privacy rights of teens aged thirteen to seventeen years, although it regulates e-marketers’ data collection on sites that target children younger than thirteen years. Consequently, privacy advocates have contended that the COPPA should be extended to include teens older than thirteen years (Aidman 2000). Given such growing concerns among parents and privacy advocates over teens’ privacy, it is important to examine how teens aged thirteen years and older perceive e-marketers’ information practices.

To date, few academic studies have addressed teens and online privacyrelated issues. Studies have examined what factors explain teens’ level of privacy concern and how their level of privacy concern has an impact on privacy coping behaviors (Grant 2006; Moscardelli and Divine 2007; Youn 2005). These studies do not, however, explore parental involvement in teen privacy issues and the influences on teens’ motivation to safeguard privacy rights. Thus, this study investigates the process by which parental influence shapes teens’ attitude toward the protection of privacy online. This study specifically attempts to answer the following questions: (1) What type of family communication patterns (FCPs) is related to parental mediation of privacy? (2) What type of parental mediation has a stronger association with teens’ level of privacy concern and their attitude toward privacy protection? and (3) How is teens’ privacy concern level associated with their attitude toward privacy protection?

To examine these questions, this study utilized the consumer socialization perspective as a conceptual framework. Research on consumer socialization has demonstrated that teens’ understanding of consumption activities and persuasion is influenced by a variety of socialization agents such as parents, peers, schools, and the mass media (Carlson et al. 1994; Mangleburg and Bristol 1998; Mangleburg, Grewal, and Bristol 1997). Among these agents, this study focuses on the role of parental influence. Indeed, there is much anecdotal evidence showing that parental interaction is the most important tool for protecting teens’ online safety (e.g., Privacy Rights Clearinghouse 2007), but few studies empirically examine the relationship among parental influence, teens’ level of privacy concern, and their attitude toward privacy protection.

The findings of this study are of value for several reasons. They will provide deeper insight into the importance of parental influence on increasing teens’ level of privacy concern and advance our knowledge in identifying teens’ attitude toward privacy protection as a function of parental influence. More importantly, a detailed understanding of teens’ attitude toward privacy protection will assist educators and policymakers in developing policies to help teens protect themselves from e-marketers’ information practices and engage in safe online activities.

BACKGROUND OF THE STUDY

Consumer Privacy and Teens’ Vulnerability

Consumer privacy has various meanings for scholars; it is a contextspecific and an ever-evolving concept. Yet, the literature illustrates the convergent view toward consumer privacy, which recognizes the importance of individuals’ ability to control their personal information within the context of a marketing transaction (Goodwin 1991; Lee 2002; Milne and Rohm 2000; Nowak and Phelps 1995; Phelps, Nowak, and Ferrell 2000). Information control assumes that consumers are able to restrict the terms under which their personal information is collected, disseminated, accessed, and used by marketers (Culnan 1995, 2000; Goodwin 1991). Information control is desirable for multiple reasons, one of which is to reduce the number of intrusive marketing messages received. This relates to consumers’ wishes to be left alone (Milne and Rohm 2000; Nowak and Phelps 1995). The view of consumer privacy as a control of personal information stems from the premise that personal information belongs to the consumer, namely, it is one’s private property (Milne and Rohm 2000; Nowak and Phelps 1992, 1995).

As the growth of the Internet facilitates e-marketers in gathering a substantial amount of personal information, consumers have little control over what e-marketers know about them and how e- marketers collect and use their personal information. Scholars have identified the conditions under which consumers lose control of their personal information and, thus, have high levels of privacy concern. Nowak and Phelps (1992, 1995) argue that consumers’ privacy concerns heighten when they are unaware that their personal information is collected and used by marketers and/or when their information is compromised beyond the original purpose without their awareness or permission. In addition, Sheehan and Hoy (2000) elaborate three more dimensions that underlie the degree of online privacy concern. The level of concern increases when consumers are asked to provide marketers with sensitive information (Phelps, D’Souza, and Nowak 2001), when consumers are contacted by unfamiliar companies that they do not trust (Milne and Rohm 2000), and when consumers perceive that the risks of information disclosure exceed the benefits (Milne and Gordon 1993; Phelps, Nowak, and Ferrell 2000).

Several studies show that teens are often exposed to potential privacy risks online. The Teen Internet Safety Study by Cox Communication in partnership with the National Center for Missing & Exploited Children (NCMEC) revealed that 71 percent of teens aged thirteen to seventeen years received messages from someone they do not know, and among them, 40 percent usually replied to and chatted with that person (Teenage Research Unlimited 2006). Forty-five percent of teens were asked to provide personal information to someone they do not know, 37 percent were not worried about someone using their personal information in ways they have not authorized, and 20 percent perceived it safe to disclose personal information on a public blog or networking site (Teenage Research Unlimited 2006). The Pew Internet Study showed that only 21 percent of teens online were concerned about mishaps involving privacy breaches in which their email, instant message, or text message would be shared with entities other than the recipient (Lenhart, Madden, and Hitlin 2005). These risks have given rise to much debate on measures to protect teens’ online privacy by policymakers, consumer advocates, and parents. Such measures include government regulation, school- based education, and industry self-regulation, which will be discussed in turn. Teens’ Privacy Protection Measures

Regarding government regulation, Congress introduced the Children’s Privacy Protection and Parental Empowerment Act in 1999. This act requires information brokers to prohibit the sale or purchase of personal information on children below the age of sixteen without parental consent (Tech Law Journal 1999). Congress also passed the Student Privacy Protection Act to safeguard the privacy of kindergarten to grade 12 students from companies that conduct market research in schools. This Act requires companies to seek parent’s written permission before collecting personal information for marketing purposes from any student below the age of eighteen (Ruskin 2001).

In 2001, the Federal Communications Commission (FCC) implemented the Children’s Internet Protection Act to deal with minors’ access to inappropriate content on school and library computers. To receive federal funding on technology, schools and libraries must install filtering or blocking technologies to shield minors from harmful materials and prevent the “unauthorized disclosure, use, and dissemination of personal information regarding minors” (FCC 2006). The FTC also enacted the CAN-SPAM Act in 2004 in an effort to eradicate deceptive unsolicited commercial e-mail and provide consumers with the right to ask spammers not to send future commercial e-mails (FTC 2004). To reduce unwanted contacts by strangers on the Internet, the U.S. House recently passed the legislation to restrict teens’ access to social networking sites in schools and libraries (Romer 2006).

In concert with growing governmental regulations, consumer advocates and educators have called for implementing school-based education for privacy protection as part of media literacy programs (Brookshire and Maulhardt 2005; McCannon 2002). Media literacy refers to “the ability to critically consume and create media” (Strasburger and Wilson 2002, 422). Media-literate consumers can understand the meanings underlying commercial media messages. The NetSmartz program, sponsored by the NCMEC, has been a successful media literacy program. Students who participated in NetSmartz increased their awareness and knowledge of online risks and expressed they would be more cautious when using the Internet and sharing information (Brookshire and Maulhardt 2005).

Federal agency rulemaking and public concerns over teens’ privacy invasions have driven the industry’s efforts to self-regulate e- marketers’ information practices. Web sites targeting teens older than thirteen years do not fall under the force of COPPA, so trade associations such as the Better Business Bureaus and the Direct Marketing Association encourage companies to comply with industry standards regarding the types of personal information that can be collected from teens, who has access to it, and how it is used (Safe & Smart). Some companies offer consumers an opportunity to remove their names from marketing lists by opting out (Milne and Boza 1999; Phelps, Nowak, and Ferrell 2000). An opt-out procedure is a mechanism that enables consumers to perceive control over their information, thereby allaying the level of concern for privacy (Milne and Rohm 2000; Nowak and Phelps 1995).

The privacy-protective measures discussed above would be more effective when teens are motivated to support them. It would then be critical to identify factors that motivate teen support for these measures because such factors can help minimize privacy risks. “Adult” privacy literature has examined factors related to the level of privacy concern, which drives motivations for privacy protection. These factors include control over information (Milne and Boza 1999; Phelps, D’Souza, and Nowak 2001; Phelps, Nowak, and Ferrell 2000), knowledge about information practices (Milne and Boza 1999), attitude toward direct marketing (Milne and Boza 1999; Phelps, D’Souza, and Nowak 2001; Phelps, Nowak, and Ferrell 2000), information sensitivity (Cranor, Reagle, and Ackerman 1999; Phelps, D’Souza, and Nowak 2001), past purchase behaviors (Graeff and Harmon 2002; Milne and Rohm 2000), and demographics (Graeff and Harmon 2002; Milne and Boza 1999). Although these studies help explain adults’ motivation to protect their privacy, little has been known about factors that motivate teens to safeguard their privacy. Thus, this study, using the consumer socialization perspective, identifies factors that explain teens’ attitude toward online privacy protection.

Consumer Socialization and FCP

Consumer socialization is the process by which young people learn skills, knowledge, and attitudes necessary to their role as consumers in the marketplace (Ward 1974). Researchers have emphasized the importance of parental socialization in shaping and developing consumer norms, values, and motivation among young people (Moore and Moschis 1981; Moschis 1985). This is especially true when consumption behavior involves risks. Teens learn how to cope with potential perceived risks from both direct and indirect interaction with parents through discussions, rulemaking, reinforcement, and modeling (Koesten and Anderson 2004; Koesten, Miller, and Hummert 2001; Mangleburg, Grewal, and Bristol 1997; Moore et al. 2002; Moschis 1985; Moschis and Moore 1979). For example, Moore et al. (2002) found that teens engaged in parental interaction and more communication with parents are less likely to develop problematic sexual behaviors. Given that providing personal information to e- marketers involves a variety of risks such as identity theft, fraud, spam, or conflicts with parents (Grant 2005; Lenhart 2005; Youn 2005), parental influence is expected to be one of the most important socialization agents in increasing teens’ level of privacy concern and motivation to protect their privacy online.

In this study, parental influence is examined through FCP on consumption issues. FCPs have been conceptualized as the quality and type of communication that takes place among family members (Carlson et al. 1994; Moore and Moschis 1981). Previous FCP studies have identified two distinct patterns: socio- and concept-oriented communications (Moore and Moschis 1981; Moschis 1985; Moschis, Moore, and Smith 1984). Sociooriented communication attaches importance to harmonious relationships between parents and children, emphasizing deference and obedience to parental authority. Parents in this communication orientation advise their children to steer clear of arguments with family members and signify conformity to family values at the expense of individual expression. This pattern leads parents to monitor and control their children’s consumption activities in the marketplace while encouraging their children to utilize consumption values that are congruent with parental ones (Carlson, Grossbart, and Stuenkel 1992; Carlson et al. 1994; Moore and Moschis 1981; Moschis 1985).

In contrast, concept-oriented communication encourages children to develop and express their own views of the world through give- and-take discussions with parents. Disagreement or debate through open discussion is welcome for furthering children’s critical thinking about an issue. This communication style allows children to consider several alternatives prior to decision making, evaluate different sides of an argument, and promote independence with consumption (Carlson, Grossbart, and Stuenkel 1992; Moore and Moschis 1981; Moschis 1985; Ritchie 1991). The development of consumer skills and competence is greatly valued in this style.

Different FCPs have been found to lead to different socialization outcomes in a variety of research areas, including attitude toward advertising (Mangleburg and Bristol 1998; Rose, Bush, and Kahle 1998), ability to filter puffery in advertising (Moschis and Moore 1979), social and economic motivations for consumption (Carlson et al. 1994), children’s purchasing influence and shopping independence (Moschis, Prahasto, Mitchell 1986; Rose, Boush, and Shoham 2002), parental response to purchase requests (Carlson, Grossbart, and Walsh 1990), and media use (Carlson, Grossbart, and Tripp 1990). Yet little research has related FCP to privacy issues in the online marketplace except the Moscardelli and Divine’s (2007) study. They found that teens’ privacy concerns were influenced by concept- oriented FCP but not by socio-oriented FCP. By extending FCP to the context of online privacy, this study examines how FCPs relate to parental mediation of privacy, which, in turn, influences teens’ level of privacy concern and their resultant attitude toward privacy protection.

Relating FCP to Parental Mediation of Privacy

Parental mediation refers to any strategies parents use to supervise children’s media use or help children interpret media content (Warren 2001). Prior studies have identified three types of mediation: rulemaking, coviewing, and discussion (Fujioka and Austin 2002; Warren 2001). Rulemaking is defined as restrictions that control children’s media use in terms of quantity, time, or content. Coviewing is defined as the shared experience, in which parents and children use media together but do not necessarily engage in critical discussions about media use. Discussion refers to active discourse about media content to help children understand the underlying meanings of content (Fujioka and Austin 2002; Warren 2001, 2002). This study applies these mediations to the online privacy context, which can be captured as parental mediation of privacy (e.g., rulemaking, cosurfing, and discussion), and links FCP to these mediations. The differences between socio- and concept- oriented FCP would predict different practices of privacy parental mediation.

FCP and Rulemaking

The FCP literature has indicated that parents high on socio- oriented communication are prone to limit their children’s access to outside influences such as media because they may consider these external influences as threats to parental authority (Carlson, Grossbart, and Stuenkel 1992; Carlson, Grossbart, and Walsh 1990; Fujioka and Austin 2002; Moschis, Prahasto, and Mitchell 1986; Rose, Bush, and Kahle 1998). Those parents exert parental control through rules meant to protect children from controversial media messages or persuasive attempts by marketers (Moschis 1985). Prior research has shown that socio-oriented parents tend to place limits on children’s television exposure (Carlson, Grossbart, and Tripp 1990; Carlson, Grossbart, and Walsh 1990). Fujioka and Austin (2002) found that families with socio-oriented FCP were more likely to use the television ratings system in selecting programs for children in comparison to their concept-oriented counterparts. With regard to e- marketers’ information practices, we expect families with socio- oriented communication to impose more limits on children’s Internet use and information disclosure to e-marketers. Hence, teens growing up in the socio-oriented communication environment are more likely to have family rules concerning Internet use and information disclosure. Family rules may allow parents to reduce family disputes possibly caused by children’s information disclosure. Thus, it is hypothesized:

H1: Teens with socio-oriented FCP are more likely to have family rules about Internet use and information disclosure than those with concept-oriented FCP.

FCP and Cosurfing

The literature on FCP and parental mediation implies an inconsistent relationship between FCP and coviewing. Researchers contended that coviewing television is more appealing to concept- oriented parents because it facilitates parent-child conversations about the contents seen on television while watching together. Carlson and his colleagues found that parents high on a concept- oriented communication were more apt to coview television with their children (Carlson, Grossbart, and Tripp 1990; Carlson, Grossbart, and Walsh 1990). An inverse relationship in other studies, however, has been found. Fujioka and Austin (2002) revealed that socio- oriented parents were more likely to watch television with their children. It is argued that coviewing television is not a necessary prerequisite for purposeful parentchild discussions of content (Austin et al. 1999; Warren 2001). It seems that socio-oriented parents use coviewing as a tool for monitoring their children’s media use and exposure. On the other hand, Rose, Bush, and Kahle (1998) reported that both concept- and socio-oriented parents watched television with their children.

In the online media environment, cosurfing can be viewed as the parallel concept of coviewing, which refers to a parent and child surfing the Internet together. Despite mixed findings regarding FCP and coviewing, we speculate that cosurfing may be perceived by children as a means for parental control over their Internet use and information disclosure (e.g., Lenhart, Rainie, and Lewis 2001; Liau, Khoo, and Ang 2005). It is likely that parents browse the Internet with their children to set a model for their children to follow, instead of exchanging different ideas or opinions. Cosurfing may be used more frequently by socio-oriented parents because it allows for parent-child harmony in a controlled circumstance, alleviates conflicts resulting from children’s misuse of the Internet, and protects children from outside influences including e-marketers or controversial contents. Thus, this study develops the following:

H2: Teens with socio-oriented FCP are more likely to surf the Internet with their parents than those with concept-oriented FCP.

FCP and Parent-Child Discussion

Prior FCP studies found a positive relationship between conceptoriented communication and parent-child discussion (Carlson, Grossbart, and Tripp 1990; Carlson, Grossbart, and Walsh 1990). For parents high on concept-oriented communication, parent-child discussion is considered a precondition for developing child’s consumer competence. Carlson and his colleagues observed that concept-oriented parents had more discussions about advertising (Carlson, Grossbart, and Tripp 1990; Carlson, Grossbart, and Walsh 1990). This finding has been confirmed in the studies of Mukherji (2005) and Rose, Bush, and Kahle (1998). Mangleburg and Bristol (1998) reported that teens whose FCPs are concept-oriented showed the development of advertising skepticism, as discussions with parents are likely to foster critical attitudes toward advertising. Fujioka and Austin (2002) found concept orientation to be associated with parental engagement in critical discussions of content seen on television. Altogether, this study anticipates the following hypothesis:

H3: Teens with concept-oriented FCP are more likely to discuss e- marketers’ information collection and use practices with their parents than those with socio-oriented FCP.

Parental Mediation and Teens’ Motivation for Privacy Protection

As a socialization process, prior studies have asserted that parental mediation of media content or consumption influences the development of children’s knowledge, attitudes, and behaviors on diverse consumer issues (Austin 1993; Austin and Nach-Ferguson 1995; Austin, Pinkleton, and Fujioka 2000; Fujioka and Austin 2003; Nathanson 2001). Compared to FCP in general, it has been argued that topic-related communication tied to marketplace or consumption activities has more explanatory power in predicting socialization outcomes (Lee, Salmon, and Paek 2007; Mangleburg, Grewal, and Bristol 1997; Moschis, Moore, and Smith 1984). For example, Mangleburg, Grewal, and Bristol (1997) found that communication with parents on products, prices, or stores was related to teens’ use of product label information. Austin and her colleagues discovered that active discussion of persuasive media messages with parents affects children’s skepticism toward those messages, counteracting their undesirable effects (Austin 1993; Austin, Pinkleton, and Fujioka 2000). Other scholars have speculated that parent-child discussions would provide parents with an opportunity to talk about misleading ad claims and marketers’ selling intents (Carlson, Grossbart, and Walsh 1990; Carlson et al. 1994; Mangleburg and Bristol 1998; Rose, Bush, and Kahle 1998).

Similar to this argument, this study proposes that parent-child discussion about e-marketers’ information practices would foster critical views on privacy issues, resulting in higher levels of privacy concern. An open mode of discussion would create the atmosphere of broaching the importance of privacy rights and encourage children to engage in free inquiry on e-marketers’ information practices. Such discussions would help children evaluate all sides of possible consequences caused by giving up privacy online and weigh risks against benefits in exchange for information disclosure. Taken together, it is predicted:

H4: Teens with parental mediation based on discussion are likely to show higher levels of privacy concern about e-marketers’ information practices.

As discussed previously, parental mediations of rulemaking and cosurfing may be served as tools to maintain control over children’s Internet use and information disclosure (Liau, Khoo, and Ang 2005). Such mediations are expected to minimize family privacy risks online and avoid family disputes resulting from divulging family or personal information to e-marketers. They are unlikely, however, to facilitate parent-child discussion on privacy issues or develop teens’ critical attitude toward privacy. In line with this speculation, Mangleburg and Bristol (1998) identified that socio- oriented FCP had no significant effect on teens’ advertising skepticism. Moscardelli and Divine (2007) discovered that socio- oriented FCP was not related to teens’ privacy concerns, indicating that privacy concerns are not necessarily developed through explicit rules. Liau, Khoo, and Ang (2005) found that parental supervision such as cosurfing or checking in on teens was not effective in decreasing risky Internet behavior of meeting with someone encountered on the Internet. These findings imply weak linkage between rulemaking and cosurfing mediations and the increase of teens’ privacy concerns. Due to a lack of compelling evidence on the relationship between these parental mediations and teens’ critical attitude toward marketers’ information practices, this study examines the following research questions:

RQ1: What is the relationship between rulemaking mediation and teens’ level of privacy concern?

RQ2: What is the relationship between cosurfing mediation and teens’ level of privacy concern?

In a similar vein, this study asserts that parental mediation of privacy would directly affect teens’ attitude toward the protection of online privacy. As the outcome of consumer socialization, teens’ attitude toward privacy protection measures would be important because it may lead to their engagement in privacy coping behaviors. Still, little is known about the effect of privacy parental mediation on teens’ attitude toward privacyprotective measures.

A small number of studies have just begun to examine how different types of parental mediation have an impact on children’s online activities (Lee and Chae 2007; Liau, Khoo, and Ang 2005; Rideout, Roberts, and Foehr 2005). Lee and Chae (2007), for instance, found that parental mediation of the Internet had a favorable impact on children’s educational online activities when parents recommended useful Web sites and co-used the Internet with their children. Restrictive mediation, such as time limits and Web site prohibition, appeared ineffective for guiding children’s Internet use. These findings indicate that parental mediation of privacy may serve as an important contributor in explaining teens’ support for privacy protection measures, such as government regulation, school education, and name removal request. Since an influence of parental mediation on teens’ attitude toward privacy protection has not previously been examined in the literature, this study offers the following research question: RQ3: What is the relationship between privacy parental mediation and teens’ attitude toward privacy protection measures?

Level of Privacy Concern and Attitude toward Privacy Protection

Prior studies suggest a positive relationship between the level of concern and privacy protection behaviors. LaRose and Rifon (2007, 133) regarded privacy involvement as “a heightened state of attentiveness to privacy protection” and argued that consumers highly involved with privacy issues are more likely to attend to and read privacy statements and resist e-marketers’ requests to provide personal information. It is argued that consumers with high privacy involvement expect negative consequences from information disclosure. Milne and Culnan (2004) discovered that higher concerns for privacy were positively related to a tendency to read online privacy notices as a strategy to handle privacy risks. In the studies of an online panel and student sample, Milne, Rohm, and Bahl (2004) found that the level for privacy concern was a strong predictor of online privacy protection behaviors. Sheehan and Hoy (1999) found that as privacy concern increased, consumers tended to adopt privacyprotective behaviors.

In line with the studies conducted with the adult population, several studies have examined how the level of privacy concern among teens is related to their privacy protecting behaviors. Following up on the research of Sheehan and Hoy (1999), Moscardelli and Divine (2007) found that teens with higher concern for online privacy were more likely to use behaviors that would assist in protecting them from privacy risks. Youn (2005) uncovered that teens’ unwillingness to disclose information to e-marketers was positively related to their privacy coping behaviors such as falsifying personal information, providing incomplete information, or seeking alternative Web sites that do not ask for information. Based on these findings, the study posits that teens desire to support privacy-protective measures when they are concerned about online privacy. Therefore, the following hypotheses are developed:

H5a: Teens’ level of privacy concern would be positively related to their attitude toward governmental limits on marketers’ information gathering and use.

H5b: Teens’ level of privacy concern would be positively related to their attitude toward school-based education for privacy protection.

H5c: Teens’ level of privacy concern would be positively related to their motivation to have more information about how to remove their name from lists.

All constructs and relationships discussed in the hypotheses are presented in Figure 1.

METHOD

Data Collection and Samples

The survey data were collected from 395 students at one public high school in a mid-sized Midwestern city, with a 31 percent participation rate. Respondents’ age ranged from fourteen to eighteen years, with an average age of fifteen years. Fifty-six percent were female. The sample was relatively homogenous, with 85 percent of the respondents being identified as Caucasian. After receiving approval from the district superintendent, the school principal supported the project. The school received a $2.00 contribution for each completed questionnaire. The teachers handed out the parental consent forms in class and collected the signed forms. Students also signed the consent form and completed the surveys in class under the teacher supervision.

Measures

The survey instrument consisted of items to measure the following constructs: (1) FCP, (2) privacy parental mediation, (3) level of privacy concern, (4) attitude toward privacy protection, and (5) demographics. All the items for each construct are listed in Appendix 1, and the correlation matrix, along with descriptive statistics, is presented in Appendix 2. Two dimensions of FCP, concept- and socio-oriented communication, were respectively measured with six items developed by Moschis, Moore, and Smith (1984). Responses were estimated on a 4-point scale anchored by 1 = “never” to 4 = “very often.” Concept-oriented FCP had an alpha of .67 and socio-oriented FCP had an alpha of .77. For further analysis, raw scores were summed.

Three privacy-related parental mediations were examined: (1) rulemaking, (2) cosurfing, and (3) parent-child discussion. The items to measure privacy mediations were developed specifically for this study, reflecting the literature on parental mediation of advertising and the media (Austin et al. 1999; Carlson, Grossbart, and Tripp 1990; Carlson, Grossbart, and Walsh 1990; Rose, Bush, and Kahle 1998; Valkenburg et al. 1999; Warren 2001) as well as that on teens and privacy (e.g., Lenhart, Rainie, and Lewis 2001; Turow and Nir 2000). The wording was modified to consider relevance to Internet use and privacy issues. It is important to note that these measures examine teens’ perceptions of parental mediation on Internet privacy, instead of inquiring parents about the actual mediation.

For rulemaking mediation, teens were asked whether they have family rules regarding Internet use and information disclosure. Those who reported having family rules were then asked to indicate what kinds of specific family rules they have. Eight items were rated using a “yes” and “no” dichotomous format, with a summated index adding the items, and higher scores indicating more family rules. Cosurfing was measured by asking teens how often they surf the Internet with their parents. Parent-child discussion was measured by asking how often teens talk to their parents about the ways that companies collect and use personal information online. Both measures were rated on a 4-point scale ranging from 1 = “never” to 4 = “very often.”

The level of concern for online privacy was assessed with four items. One item measuring the general level of privacy concern was derived from prior privacy studies (Milne and Boza 1999; Phelps, D’Souza, and Nowak 2001; Phelps, Nowak, and Ferrell 2000). Teens were asked how concerned they were about the ways that companies collect and use their personal information on the Internet. The responses were assessed using a 4-point scale anchored by 1 = “not at all concerned” and 4 = “very concerned.” The remaining three items were developed from various industrial surveys on consumer privacy (e.g., BusinessWeek Online 2000; Cranor, Reagle, and Ackerman 1999; DDB Needham 2003; EPIC 2007; Harris Interactive 2002; Fox et al. 2000). These surveys examined privacy invasion caused by Web site tracking of users, insecure transaction on e-commerce sites, and company request for excessive amounts of personal information from consumers. This study borrowed items from these surveys and modified the wording for teens. Responses were measured with a 4-point scale ranging from 1 = “strongly disagree” to 4 = “strongly agree.” Four items were aggregated, with higher scores meaning greater concerns about online privacy, and had an alpha of .61.

To assess teens’ attitude toward online privacy protection, the survey contained three items designed to rate their support for governmental regulation, school education, and industry self- regulation such as an opt-out option. The three items were generated from prior studies investigating beliefs regarding privacy protection (Nowak and Phelps 1992) and attitudes toward information control (Phelps, Nowak, and Ferrell 2000). These items were also selected because they represent important areas of privacyprotective measures to safeguard teens’ privacy. They were estimated by a 4- point scale anchored by 1 = “strongly disagree” and 4 = “strongly agree.” The wording has been tailored for teens where necessary.

To determine other factors that may affect the relationship among the focal variables under study, this study included the following variables that have been found to influence the outcome of consumer socialization: gender, age, Internet use, and peer influence (Boush, Friestad, and Rose 1994; Lenhart and Madden 2007; Mangleburg and Bristol 1998; Mangleburg, Grewal, and Bristol 1997; Moscardelli and Divine 2007; Youn 2005). Studies found that female teens were more concerned about online privacy and were more susceptible to privacy risks (Moscardelli and Divine 2007; Youn 2005), older teens were more apt to disclose their personal information to a Web site (Lenhart and Madden 2007; Turow and Nir 2000), and heavier users of the Internet tended to show higher privacy concerns, while there were no clear peer influences on privacy concerns (Moscardelli and Divine 2007). Thus, this study used these variables as covariates. Age was measured in years. Internet use was estimated by asking the frequency of Internet use. Peer influence was assessed by three of the items developed by Bearden, Netemeyer, and Teel (1989) (alpha = .61), which were used by Boush, Friestad, and Rose (1994).

Data Analysis

To test the hypotheses, this study performed hierarchical multiple regressions. Potential predictor variables such as demographics, Internet use, and peer influence were entered in the first block as control variables. After this, the independent variables to be tested for each hypothesis were entered into the regression equation as a separate block, sequentially. The entry order of the variables permits examination of whether the variables of interest account for any additional variance in the criterion variable that is not explained by previously entered predictors. This analytic approach provides a stringent test for the impact of privacy parental mediation and privacy concern level on teens’ attitude toward privacy protection. This study also tested a multicollinearity problem for the parental socialization measures to confirm that these measures are distinguishable constructs. The results indicated little problem with multicollinearity, suggesting that these measures appeared to be discernible in the minds of teens. RESULTS

H1-H3 investigated whether different styles of FCP would lead to different parental mediations of Internet use and privacy issues. As illustrated in Table 1, teens with socio-oriented communication were more likely to have family rules (beta = .191, p = .002) and surf the Internet with parents (beta = .181, p = .003). Teens with concept-oriented communication appeared to talk more with their parents about companies’ information practices (beta = .200, p = .003). Therefore, the hypotheses regarding FCP and parental mediation were supported. Notably, this study revealed that teens with socio-oriented FCP tended to engage in parental mediation of discussion, although the relationship was not statistically significant (beta = .105, p = .083).

This study developed H4 and two research questions (RQ1 and RQ2) concerning the relationship between parental mediation and teens’ concern level (Table 2). As predicted by H4, teens’ discussion with their parents led to higher levels of privacy concern (beta = .233, p = .000). RQ1 and RQ2 were related to the influence of parental mediations of rulemaking and cosurfing on the level of concern for privacy. Rulemaking mediation was not a significant predictor in explaining the privacy concern level (beta = .076, p = .142). On the other hand, cosurfing mediation turned out to be positively related to the level of privacy concern (beta = .119, p = .026).

RQ3 examined the relationship between parental mediation and teens’ attitude toward privacy protection. Rulemaking and cosurfing mediations led to support for government regulation (beta = .127, p = .016 for rulemaking; beta = . 112, p = .040 for cosurfing). Rulemaking and discussion mediations led to support for school education (beta = .108, p = .043 for rulemaking; beta = .148, p = .008 for discussion). Desire for name removal request was not significantly related to any style of parental mediations. Discussion mediation had a marginal relationship with the desire for name removal request but did not reach significance (beta = .093, p = .098).

As expected in H5a-H5c, the results found a positive relationship between teens’ privacy concern level and their attitude toward privacy protection, even after other variables were controlled. Privacy-concerned teens tended to be in favor of supporting government regulation (beta = .231, p = .000) and school education (beta = .247, p = .000), and desired to receive more information about name removal request (beta = .255, p = .000) (Table 3).

DISCUSSION AND CONCLUSIONS

With the consumer socialization perspective as the theoretical framework, this study found the role of parental influence in motivating teens to protect their privacy online. The findings supported the contention that general FCPs affect teens’ perceptions of privacy-related parental mediation, which, in turn, have an impact on heightening their privacy concerns and formulating their attitude toward protective measures. The findings also showed that privacy-concerned teens want to protect their privacy with support for government regulation, school-based education, and name removal request. These results provide valuable insight for consumer educators and media literacy practitioners, who aim to increase parental involvement in teens’ Internet safety as a socialization agent.

Results showed that teens perceiving their FCP as concept- oriented were more likely to engage in family discussions on e- marketers’ information practices. This perceived mediation, subsequently, tended to increase their level of concern for privacy. On the contrary, teens citing their FCP as socio-oriented reported to have more family rules, and importantly, such perceived mediation did not contribute to increasing the level of concern. Teens citing their FCP as socio-oriented also perceived cosurfing as a way of interacting with their parents; however, unlike rulemaking mediation, cosurfing was related to increasing the level of privacy concern.

These findings confirm the argument that concept-oriented FCP promote the open mode of family discussion on privacy issues. Such discussion mediation appeared to be more effective than rule-driven parental mediation in augmenting the strength of privacy concern. A further comparative analysis revealed that those teens who have talked to their parents showed a greater level of concern than those who have not (mean = 10.23 vs. 8.76, t = 5.37, p

Socio-oriented FCP have been argued to control and supervise children’s information disclosure through explicit rule setting. Such rulemaking mediation that does not help teens increase the level of privacy concern necessary to safeguard privacy from e- marketers’ information requests. This study initially viewed cosurfing as a means of parental control over teens’ Internet use and information disclosure and speculated a weak linkage between cosurfing and the level of concern. Counter to this expectation, a positive relationship between cosurfing and the concern level was found. Several explanations for this finding are possible. Cosurfing may provide opportunities of having parent-child conversations about privacy issues, which lead to the high level of concern. Alternatively, cosurfing may function as a gatekeeper for screening e-marketers’ influences on children. Parents may cosurf because they wish to impart their negative attitude toward e-marketers with their child. This would also lead to an increase in teens’ privacy concerns. Future research should examine this possible dual nature of cosurfing mediation-a trigger for either a discussion or a gatekeeper, or both, for filtering e-marketers’ influences.

Parental mediation has been found to influence teens’ attitude toward privacy-protective measures. Mediations of rulemaking and cosurfing were related to a more positive attitude toward government regulation, and mediations of rulemaking and discussion were related to support for school education. Teens with rulemaking and cosurfing mediations may appreciate and yield to parental authority because parental guidance, in the form of explicit directives or modeling, is a way of interacting with their parents when they are online. For privacy protection, these teens may thus rely on governmental force as an alternative authority figure to parental control. In tandem, teens with rulemaking mediation would support a stronger role of school education with a similar reason. However, teens reporting discussion mediation may see school education as a source of learning privacy issues and favor school-initiated media literacy programs as a means of developing consumer skills to deal with e- marketers’ information practices. This study also found that the different styles of parental mediations did not relate to teens’ desire to receive more information about how to remove their name from marketing lists. Regardless of different types of mediations, it seems that most teens feel unsolicited marketing messages online intrusive, leading to interests in the opt-out serf-regulatory option. Further research needs to explore the reasons for this result.

When interpreting the role of parental influence on teens’ motivation for protection, caution needs to be taken with regard to parental influence measures. The findings on parental influence are based on the perceived parental mediation by teens, which is formed through their own perspective, but not on the actual mediation reported by parents. The objectives of this study were to identify teens’ privacy concern level and their attitude toward privacy protection, instead of parental concerns over teens’ privacy and parental attitude toward privacy protection for teens. Thus, an examination of how teens’ perception of FCP and parental mediation influences their level of concern and attitude toward privacy protection is more appropriate and has more practical implications for educators or policymakers. Teens may receive maximum benefits when the policies are developed on the basis of their own evaluations. Teens’ perceptions of their parents’ views may better explain the development of their beliefs and attitudes toward privacy issues. Parents’ views on mediations do not always transform into their children’s views, indicating “a weak correspondence” between the two views (Carlson et al., 1994; Fujioka and Austin 2003, 418; Nathanson 2001). Given this information, the perceived parental influence by teens, compared to the actual mediation by parents, may have its own unique impact on the socialization outcomes about privacy issues.

Due in part to the nature of parental mediation measures, this study does not indicate a causal relationship between parental mediation and teens’ motivation for privacy protection. Since parental mediation is measured from teens’ perspective, discussion, for example, may influence teens’ level of privacy concern, but teens’ level of concern may also generate discussion with parents. Even though our conceptual model assumes that parental influence plays a role in explaining teens’ motivation for privacy protection, the correlational nature of the relationship should be considered when interpreting the results.

Conclusions stemming from the findings should be tempered by the limitations of this study. Despite the fit of the regression models, a substantial amount of variance in teens’ attitude toward privacy protection measures remains unexplained. Some possible explanations for this include the following. A single-item measure was used to measure parental mediation (e.g., cosurfing and discussion) and teens’ attitude toward privacy protection. The skewing of an item is more likely to occur to a single-item measure, especially in the area of privacy research. This would make it difficult to detect relations, thereby resulting in a small amount of explained variance. Multiple items might measure the construct better and explain more variance. Research on teens and privacy issues is newly emerging, so the formal scale consisting of multiple items has not yet been developed for privacy parental mediation. Future research needs to develop the scale to measure this construct. Parental mediation measures may be problematic because they did not offer a comprehensive list of online activities that parents and teens might discuss. They did not include the domain of social networking sites or chat rooms, in which most teens are currently engaged. Instead, they focused on e-commerce-related activities in the commercial Web sites. Online transactions are not as common with teens as social networking activities. Emphasis on the domain of e-commerce in measuring parental mediation may offer an explanation for weak effects. This suggests a need to include social networking activities for future research. This study also asserts that parental influence plays a pivotal role in explaining teens’ motivation for privacy protection, but other predictors may contribute to an increase in the explained variance of the models. For example, personality factors such as locus of control or self- efficacy in privacy protection would be possible factors to consider.

As public concerns with privacy invasion among teens grow, there is a need to develop effective privacy education for this segment. By applying the consumer socialization perspective to the online privacy context, this study explored the role of parental influence in increasing teens’ privacy concerns and their subsequent attitude toward privacy-protective measures. It is hoped that consumer advocates and educators find these results valuable when developing policies for privacy protection of teens.

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Starve a Headache

By Barnard, Neal

Can cleaning up your diet help clear your head? Q I get a lot of headaches. Could they be caused by something I’m eating?

A Yes, they certainly could be. A common example is MSG (monosodium glutamate), a flavor enhancer often used in Chinese restaurants and also found in processed foods. People who are sensitive to it get a feeling like a tight band around the head that kicks in about 20 minutes after MSG touches their lips.

Sinus headaches strike in the forehead or under your eyes, and feel like a constant ache, as opposed to a pulsing pain. Environmental allergies often are responsible, but sometimes foods- even innocuous-seeming ones such as wheat, dairy products, citrus fruits, or eggs-can contribute.

More common are caffeine-withdrawal headaches, which cause a dull, continuous ache that disappears as soon as you have your daily dose. You can eliminate these headaches permanently by gradually eliminating caffeine from your diet.

Among the most miserable of all headaches are migraines. A migraine is not just a bad headache; it’s usually a throbbing pain, often on one side of the head. And it does not pass quickly. It can last for hours-sometimes days. Along with the pain, you are likely to feel sick to your stomach and may even vomit. Sometimes a migraine is preceded by an aura-flashing lights or other sensory phenomena. Foods can trigger these headaches, but so can stress, sleep deprivation, hunger, an approaching menstrual period, or weather changes.

Q Which foods have been linked to migraine headaches?

A Migraine sufferers have long known that red wine, chocolate, and aged cheeses can lead to migraines. But by putting migraine patients on very restricted diets, and then adding foods back into the diet, one at a time, researchers have been able to identify several common food triggers, which I call the “migraine dirty dozen”: apples, bananas, chocolate, citrus fruits, corn, dairy products, eggs, meat, nuts, onions, tomatoes, and wheat.

I should point out that there is nothing unhealthful about an apple, banana, or several other common migraine triggers. But just as some people are allergic to strawberries and have to avoid them, the same is true for foods that trigger migraine headaches.

Like the aforementioned red wine, some beverages have been implicated too: alcohol (any kind), caffeinated beverages, and drinks that are artificially flavored and/or sweetened. On the other hand, some foods almost never cause migraines: brown rice, cooked vegetables, and cooked or dried fruit.

Q How can I determine what my trigger foods are?

A To identify your diet sensitivities, eliminate all the potential triggers (the “dirty dozen” plus the problem beverages) for 10 days or so. Once you are migraine-free, bring these foods back into your diet one at a time, every two days. Have a generous amount of each new food to see if it triggers a headache. If it does, eliminate it again. If not, you can keep eating it.

If an elimination diet does not prevent all your migraines, you might consider butterbur or feverfew. These herbal supplements are sold at health food stores and are used as preventives, rather than treatments. Studies chat examined each herb individually found that participants experienced fewer migraines and reduced migraine pain with no significant side effects.

Q Could anything else besides food be causing my headaches?

A The most common headaches of all are stress headaches. They are dull and constant (not throbbing) and are on both sides of your head. The best treatment is relaxation. Slow your breathing, and intentionally relax the muscles of your head and neck. Visualize tension leaving these muscles every time you breathe out. If stress headaches are frequent, be sure to get adequate rest and exercise.

One final point: Sometimes headaches can spell danger. If you have a headache that is severe or persistent, be sure to have a doctor evaluate it. That is especially true if you also have fever, neck or back pain, or any neurological or mental symptoms.

Some foods almost never cause migraines, such as brown rice, cooked vegetables, and cooked or dried fruit.

BY Neal Barnard, MD

In 1985, Neal D. Barnard, MD, established the Physicians Committee for Responsible Medicine, a nonprofit organization advocating for preventive medicine and higher ethical standards in research.

Copyright Active Interest Media Oct 2008

(c) 2008 Vegetarian Times. Provided by ProQuest LLC. All rights Reserved.

Gender, Taste, and Material Culture in Britain and North America, 1700-1830

By Weber, William

Gender, Taste, and Material Culture in Britain and North America, 1700-1830. Edited by John Styles and Amanda Vickery (New Haven: Yale University Press, 2007. viii plus 358 pp. $65.00). This is an extremely important book for providing a window into the lively recent thinking about material culture, consumption, and gender in England and North America between 1700 and 1830. It is an attractively produced collection of thirteen contributions, introduced by editors John Styles and Amanda Vickery, that offers a sophisticated array of pieces, illustrating how the study of consumption has developed since Neil McKendrick, John Brewer, and J. H. Plumb published The Birth of a Consumer Society: The Commercialization of Eighteenthcentury England in 1982. Aided particularly by Brewer’s leadership of conferences at UCLA’s William Andrews Clark Library, research on England and North America in the early modern period has been in the forefront of study of consumption, as Peter Stearns suggested in his review article on the subject.1 What began in using wills to figure out how houses were furnished now ranges widely in the reconstruction of spaces and domestic responsibilities influenced by gender, social, class, taste, and regional cultures.

The field of Atlantic studies comes to the fore in this collection, since almost half of its contributions involve North America. The Atlantic framework ends up suggesting more similarities than differences between provincial and capital cities, showing a grid of influence rather than a hierarchy of control. While most of the contributors are historians by training, the interdisciplinarity of approaches blurs the lines between them and contributors in art historians and cultural studies. In fact, historians Bernard L. Herman and Robert Blair St. George go the farthest in theoretical directions, applying the concept of social imaginary to space and habitus. Herman takes the tabletop, featured in William Hogarth’s drawings, to bring material objects and conventional sociability together conceptually. He argues shrewdly that Philadelphians designed their houses with a manner of taste “cultivated not through acts of imitation and confrontation, but acts of conversation” (p. 57). St. George stretches conceptual unity farther by bringing passages from novels together with the small, personally-defined room, the “closet”: “Material objects and narrative strategies are thus mutually constitutive; there are strings that tie things to texts, and then lash texts back and into things” (p. 102). Karen Lipsedge looks more closely into treatment of the closet by Joseph Richardson in Clarissa. Such a room served as a refuge, a privately “owned” space, it nonetheless was thought also to be shared with others in the daily social life.

Shopping is now seen as a collaborative process during the early nineteenth century. Ellen Hartigan-O’Connor shows how in well-off South Carolina families slaves, servants, or relatives obtained goods by credit in “proxy” for man or wife of the household. She concludes that “[acknowledging that discourses of consumption were shared across divisions of race and class does not slight the inequalities that existed in late colonial and early national urban society” (p. 146). Similarly, Claire Walsh defines shopping as social interaction between members of a household and between them and the merchants, done through a learned “art of decision-making.” Some readers may be surprised to find that the majority of shops were not workshops into which a counter had been placed. Ann Smart Martin argues that such a set of relationships between merchant and shopper lasted well into the twentieth century in some regions of the United States. She shows women and men sharing these roles in a subtle interaction, allowing “myriad, flexible ways in which women had connections to and experience with the workings of cash economies” (p. 188). Amy H. Henderson illustrates an equalitarian relationship between a husband and wife planning a townhouse in Philadelphia in the 1780s: “women participated to an ever greater degree in building and furnishing their domestic environment and frequently worked alongside men” (p. 267). Amanda Vickery likewise makes a sophisticated argument that, for all the obsession with decorum in fitting a house, taste in wallpaper did not seem to vary significantly between choices made by men and women. Much cheaper than stucco or wainscoting, wallpaper quickly acquired a culture of choice after its arrival in the late seventeenth century.

No longer does one hear of people degrading themselves by “aping” the fashions of those superior to them. Just as Martin speaks of “conversations” rather than “imitation,” so Hannah Greig portrays the beau monde of eighteenth-century London as including the nobility, the parallel bourgeois elite, and professionals working with them all. She perceptively sees fashion as “a creative response to the changing conditions of elite existence” that had something of a democratizing effect upon upper-class life. Fashion therefore was a group process rather than a trickling-down in the social hierarchy. I have found similarly that the opera halls in London and Paris did not separate bourgeois and nobles, as was done by a wood partition in Vienna’s Kartnertortheater.2 Linzy Brekke likewise critiques the “great renunciation” thesis that sees men eschewing sumptuous clothing in the late eighteenth century. She finds instead a political discourse regarding dress surrounding President George Washington in his balancing choices for “republican simplicity” and fine foreign tailoring. Art historian Kate Retford looks at portraiture in a new way in showing how families promoted dynastic heritage with portraits they hung in their stately homes. Arranged by women as often as men, these galleries were seen as genealogy rather than art, and indeed sometimes involved self-serving misidentification of the persons portrayed.

While most chapters concern the upper classes, John Styles dexterously coaxes what furnishings ordinary families possessed from records held at the Old Bailey. He demonstrates that many furnishings were provided by others through “nonmarket, semi- market, or indirect mechanisms”(p. 62). Plebeian men and women nonetheless played active roles in expanding the range of their possessions, especially in regard to clothing, which might include considerable color. Jonathan White explores how writers on political economy began taking these working-class homes seriously. Higher wages were potentially in the interests of the business community because workers were functioning as consumers, though they naturally needed to be discouraged from the temptations of luxury or dissipation.

ENDNOTES

1. John Brewer and Roy Porter, Consumption and the World of Goods (London, 1993); Peter N. Stearns, “Review: Stages of Consumerism: Recent Work on the Issues of Periodization,” Journal of Modem History, 69 (1997), 102-117.

2. “Musical Culture and the National Capital: The Epoch of the Beau monde in London, 1700-1870,” Concert Life in Eighteenth’Century Britain, edited by Susan Wollenberg and Simon McVeigh (Aldershot (UK), 2004).

California State University, Long Beach William Weber

Copyright Peter N. Stearns Fall 2008

(c) 2008 Journal of Social History. Provided by ProQuest LLC. All rights Reserved.

Umor Revisited: a Diachronic Study of Sacrosanct Principles Embedded in the Yakurr Leboku Festival

By Salami, Gitti

Drawing on the field of performance studies, this article investigates the nature of the alterations made between 1939 and 2001 to the overall format of the Yakurr Leboku festival, an annual new yam rite performed in the Middle Cross River region of southeastern Nigeria. Ideas promulgated within performance studies, largely the result of a dialogue that began in the early 1980s between anthropologist Victor Turner and avant-garde theater director Richard Schechner, have drawn attention to a close link between religious ritual and theatrical drama.1 The salient characteristics of these particular performance genres – one more closely associated with efficacy, the other with entertainment – although at first glance appearing to be diametrically opposed, in fact share constituent components and represent opposite ends of a “dialectical-dyadic continuum” (Schechner 1983:141). It appears that the Leboku festival, once a religious rite characterized by transformation brought about during a period of liminality, has largely been transformed into a theatrical drama that provides liminoid (liminal-like or metaphorical) experiences (Turner 1982:20- 60). Ritual and theatrical performances both entail the execution of rehearsed acts that exist independently from a performance script/ plan (mise-en-scene). They therefore involve actors’ and audience members’ agency, that is, participants’ capacity to deviate from the script and to respond during the performance to their own internal state or to external factors. Examples of the latter might be weather conditions or political upheaval. Additionally, these performances occur within a symbolic timeframe that is set apart from real time. They take place within a bounded performance arena, whether an open field demarcated by spectators or a proscenium theater (Schechner 1988:6-9, 61-5).

The greatest difference between ritual and theatrical drama resides not in their overall goal, for both try to effect change: ritual in participants’ status, and theater in actors’ and spectators’ consciousness. Rather, the distinction lies in the social environments that set the parameters for performance events. Thus, religious rites presuppose shared beliefs of members of a close-knit group and are largely regarded as a necessity. Engagement with a theatrical drama, on the other hand, appeals to select members of complex, large-scale societies and is pursued voluntarily within the framework of industrialized societies’ concept of leisure time (Turner 1982:29). Within this discourse, Turner points out that, in regards to performance, “all societies subsequent to the Industrial Revolution, including the industrialized Third World societies which, although dominantly agrarian, nevertheless represent the granaries or playground of metropolitan industrial societies” (ibid., p. 30) operate according to the parameters of largescale societies. Turner further notes that the symbols employed in rites staged by remote agrarian societies, far from being rigid, “have the character of dynamic semantic systems, gaining and losing meanings … as they ‘travel through a single rite or work of art, let alone through centuries of performance” (ibid., p. 22).

Despite these insights into the nature of performance, there is a tendency in art history to inscribe an exclusively inwardly focused potentiality on African festivals, i.e., an ability to communicate meaningfully only to members of the kinship-based groups that invented the celebrations’ sacred and secular rites (Reed 2005, Arua 1981, Ugonna 1981, Warren 1973). Tb concede to the contemporaneity of such communal presentations no more than a capacity to absorb foreign-induced changes to African material culture and societies’ sociopolitical, economic, and religious orientation does not do justice to the Yakurr Leboku festival.2

Analysis of this first-fruit rite as a Gesamtkunstwerk, along the lines of Herbert Cole’s examination of the Akan Odwira festival (Cole 1975), then, is not a matter of identifying modernity’s impact on Yakurr practices. Rather, as Sylvester Ogbechie asserts (2005:66), it is a question of decoding “indigenous knowledge systems” and of assessing the impact of Yakurr practices on a specifically African modernity. Also at issue is the nature of the contribution that an indigenous African genre such as the West African new yam festival makes to an economically globalizing world’s developing “intercultural aesthetic” (Schechner 1988:281).

When todays custodians of Yakurr culture-priest-chiefs who conduct most of the Leboku rites-discuss the efficacy of their performances, they only rarely make reference to the explicit objectives of the festival; these involve solicitation of tutelary spirits’ cooperation in securing an abundant harvest, maintaining peace, and facilitating human fertility. These goals, intertwined because working and defending the land requires a large population, are not Yakurr ritual actors’ primary concern.

The elderly priests, some of whom are devout Christians, instead frequently express concern with the constitution of their audiences and often contemplate the effect of the glamour of Yakurr “traditions” on foreign spectators. The Okpebili (town speaker) of Ugep, Cornelius Ikpi Edet, for example, explained that he intended to Westernize his office so that he would “seem less frightening to visitors.”3 Effiam Bassey, a priest-chief of Nko, also desired to communicate with a wider world. He explained, “the white man has exposed his culture on television. Anyone can see it. I expose [Yakurr] culture to you, so it [too] can be on television and everyone can see.”4 Much of the general Yakurr population concurs with this outlook. Ken Ubi wrote in the Nigerian Chronicle newspaper,

The festival is full of decency, tradition and custom depicting an African tradition and custom in its true perspective …. Indigenes of Ugep urban [sic] in Lagos should step up their publicity arrangements to attract the attention of the Blacks in America and elsewhere and in the international community (1999).

Clearly, the Leboku festival is no longer intended to function purely as a transformative rite aimed at a homogenous group; rather, as a theatrical drama it endeavors to educate a heterogeneous audience, one Yakurr society envisions as including people from all over the world (cf. Schechner 1988:172-3).

But what exactly does this remote citizenry wish to communicate to an international audience? Heeding Jan Vansina’s advice to make use of a historical process model in African art (1964:378-9), its importance reiterated by Sidney Kasfir (1984), I engage in a diachronic study of the Yakurr Leboku festival to look for an answer to this question. I acknowledge that this model has been criticized for not taking individuals’ agency or particular circumstances into account (Bentor 1994:19-20). However, it is the particular performance, according to Gawin Brown, that “constantly recasts the performance script” and thereby functions “as a cultural vehicle of transformation” (2003:6, emphasis in the original). Rather than ignoring the performative dimension of Yakurr cultural practice, my use of a historical process model assumes that historical change, evident in a comparison of two synchronic performances, is brought about by a series of alterations to rites’ forms, which originate in specific performance moments. In Yakurr culture, where alteration to formal aspects of rites is discouraged, the changes made to the ritual script at any one time are minute.5 They amount to a meaningful, clearly discernable trajectory only after a long period. I then compare my field notes of the 2001 festival in Ugep, a town of over 250,000 people, to Daryll Forde’s documentation of the same proceedings as they unfolded in 1939 in what was then the village of Umor, population 11,000 (1949, 1964). I benefit from examples of historical analysis of yam festivals such as of the Akan Odwira festival (Gilbert 1994), the Aro Ikeji festival (Bentor 1994, 2005), and the Benin Ague ceremony (Curnow 1997).

Forde’s objective was to systematically study a West African economic system in relationship to sociopolitical factors, not aesthetics per se. Thus his description of the festival is sparse, yet invaluable. As the only historical record of the Leboku festival, Forde’s text makes it possible to identify the society’s internal changes through “elements of culture that once were meaningful, but have lost their significance to the whole;”6 Vansina somewhat problematically refers to such elements of ritual as “fossils” (1964:376). Forde’s 1939 testimony also affords the opportunity to isolate aspects of the culture that Yakurr people hold sacrosanct. The latter, Stanley Tambiah explains in a different context, involve

principal cosmological notions … [or] orientating principles and conceptions that are … constantly used as yardsticks, and are considered worthy of perpetuating relatively unchanged” (1979:121).

Such a “complex permanent attitude,” as Suzanne Langer puts it (1951), which Clifford Geertz also locates in “expressions of human purpose and the pattern of experience [a people] collectively sustain” (20oob:96), lies at the heart of the Leboku festival’s outwardly- focused potentiality. Following Geertz’s notion that, as Catherine Bell observes (1997:66), ritual not only serves as a model of how things are, but also of how things should be, I submit that Yakurr people perpetuate their festival in part to present the sacrosanct principles of their customs to a globalizing world. In terms of social values, their culture’s essence serves as a viable if not superior alternative to a global culture that so far primarily appears to be determined by industrialized society. In doing this, I take to heart Richard Schechner’s cautionary remark that interpretations along these lines may be “unavoidably expressions of Western hegemony, attempts to cull and harvest the world’s cultures” (Schechner 1995:257). But I am also rather certain that if Yakurr priest-chiefs’ plea for a voice on a global stage goes unanswered, it is, as Ulf Hannerz asserts, because “grieving for the vanishing Other is after all in some ways easier than confronting it live and kicking” (1997:109).

CULTURAL BACKGROUND

Twenty-three priest-chiefs (bina, sg. ina), who constitute the council of elders (yabol), are the principle custodians of Yakurr culture and are its ritual actors. They represent either their matriclans, in which case they function at least nominally as priests of fertility shrines, or they lead patriclan-owned secret societies. As the traditional rulers of Yakurr society, they are charged to uphold customary law within the framework of Nigeria’s federal constitution.

These men are selected when they are in their fifties, after they have proven themselves in the community as farmers or have led successful careers within the Nigerian military, police force, or civil service. As such, they have varied educational backgrounds: Some bina have a postsecondary education and speak English fluently, while others, primarily the older chiefs, are illiterate and speak Pidgin English and/or Lokeh. The mens religions also vary, involving both local beliefs and practices and Christianity, with a greater personal affinity for one or the other. Accordingly, the men express different attitudes towards their performance practice. To some chiefs, the rites have efficacy and their accurate execution is of utmost importance, while to others the rituals merely represent a “custom,” maintained more for its folkloric value than its religious purpose.

Once installed, the bina serve for life. They abide by dietary and behavioral restrictions and appear in public wearing ritual attire at all times. On ordinary days, this consists of a “walking dress,” a wrapper made out of a printed cotton cloth; a woven shawl or a commercially produced towel draped over the left shoulder of an otherwise nude upper body; a jute cap; and camwood paste rubbed on bare feet. Constant chewing on a root keeps the men from divulging secrets.7 Their exotic appearance among people clad in modern Nigerian or European dress affords the bina great visibility in the town. In fact, they parade up and down the streets much of the day and are frequently seen in single-file processions on their way to council meetings, traditional weddings, or funerals. Dodging the elaborate greeting rites required by an encounter with them is almost impossible. The bina are everywhere and as performers they are always “on.”

These leaders of a once-egalitarian society are today headed by His Royal Highness Ubi Ujong Inah, the Obol Lopon of Ugep. The town leader assumes his role by virtue of his custodianship of the Odjokobi shrine, which has a protective function not only for the royal family, but for the whole town. The king, as people refer to him, has been in office since 1986. In 1999 he was appointed as the Paramount Ruler of Yakurr Local Government Area and since then has served on the Nigerian Council of Obas. The king holds daily audience at Umor Otutu Palace, an imposing building whose grounds in the center of the town constitute the ritual arena.8

The Yakurr Leboku festival, as a new yam rite, is part of an annual ritual cycle that entails a planting festival in March called Listomi/ Ukoong, and a two-week long harvest festival – Yose – and a purification rite – Saa – in November. Although these events continue to be executed and involve spectacular performances, they are of minor importance today.9 Saa draws a sizable crowd of children and young adults; symbolically chasing evil spirits out of town affords them an opportunity to release pent-up energy. On the other hand, citizens avoid any involvement with Lisetomi/Ukoong. As an esoteric practice during which the bina descend upon private compounds to seize chickens, Lisetomi/Ukoong is an aggressive act that situates the elders as superior to locally held Christian codes of ethics. Because of conversion to Christianity, people also tend to avoid their matriclans’ fertility rites at shrines dedicated to tutelary spirits during the harvest festival. The bina, presumably because of the lack of public interest, in turn do not talk about these annual routines very often.

The new yam festival, on the other hand, which consists of twenty- five distinct ritual acts executed over a period of two months between early July and the end of August, is an elaborate affair with many layers of meaning; it enjoys support from an overwhelming percentage of the population.10 It also gives rise locally to a critical discourse that extends beyond the Yakurr community. Ordinary people, priests of Yakurr religion, Christian pastors, politicians, and journalists all use the Leboku festival as a locus for reflecting on their ever-changing society.

Three examples shed light on this discourse. In 2001, some heavy- set women with a preference for wearing tight jeans brought a complaint before the king because of constant harassment from young men who challenged them to “kpaseke,” i.e., to “shake their behinds.” When the town leader issued a decree to end the aggravation, “kpaseke” spontaneously evolved into the slogan of that year’s festival. Soon everybody, even a masquerade, was dared to kpaseke. This scenario allowed people to air concerns about what constitutes appropriate decorum.

As an example of premeditated engagement of the festival as a forum for negotiating various factions’ interests, Father Joseph Ibu of the Catholic Diocese of Ogoja in Ugep explained,

The Christians come in to make sure nothing of [Leboku] comes from Satan . . . Gradual intervention by Christianity tried to baptize [Leboku] so that it would become a universal event.11

Today, members of Ibu’s congregation bring yams to church for a Christian purification rite before people celebrate Leboku.

A third example highlights political concerns. In 2005, Cross River State Governor Donald Duke, himself not of Yakurr descent, introduced to the Leboku festival a compulsory day of popular Yakurr dances as a means to unify the state’s diverse population and to attract tourism. Although Yakurr bina do not perform any rites on “Yakurr Day” and mockingly refer to this imposed “festival” event as “Donald Duke’s own,” it appears they nevertheless embrace state- wide promotion of Yakurr culture. As the king commented, “the governor invited a lot of friends from the outside to come and accompany him to make the festival really international. It was nice.”12

Local discourse, however, neither articulates concern with the aesthetic strategies employed to communicate various rites’ meanings, nor makes reference to several intertwined narratives that constitute the festival’s complex ritual structure. Aside from underlying concerns with stages of yam cultivation, performances convey deep-rooted notions about gender and about the relationship of Yakurr society to a wider world. The general theme of the festival – the idea that successful farming depends on human fertility and on safeguarded territory – is taken for granted, but people appear not to be aware of the intricacies of the Leboku drama’s script. These are so deeply embedded in minute gestures of seemingly disjointed rites that they are difficult to discern. It is these deeper knowledge systems that reveal the principles of Yakurr society, which the people hold to be sacrosanct and proffer to a global audience as worthy of contemplation. Drawing out these narratives requires a chronological overview of the festival events.

THE LEBOKU FESTIVAL OF 2001

When Obol Okalefong and his attendants march in single-file procession to the edge of town to fish at a sacred stream (Fig. 1), bystanders are struck with awe.13 Yakurr men, women, and children immediately withdraw to create a respectful distance between themselves and the ritually charged party. They resume their activities by the roadside only after the performers’ rhythmic sounding of bells has faded into the distance. Although there is nothing remarkable about this ceremony, called Omileta, as the first preparatory rite of the season it has a dramatic impact. Omileta disrupts the doldrums of ordinary village life. The bina’s ritual passage from one geographic location to another symbolizes transformation and signals the end of six months of grueling labor during oppressive heat (cf. Schechner 1983:245). Later that day, the yabol, the council of elders, gathers to plan subsequent festival events. The bina meet under “the shade,” a sun shelter erected over the cemetery of all former town leaders, which is situated on the palace grounds near the Odjokobi shrine. Seated on boulders that transmit ancestral wisdom to them – in Yakurr conception creativity is divinely inspired – the bina consume the consecrated fish procured earlier, and discuss/rehearse their various assignments.

Beginning the following afternoon, on six consecutive “big market days” (and these in turn are spaced six days apart), the messenger of the festival, Obol Leboku, positions himself at the entrances to the farm roads of various wards with a consecrated pot. He collects donations of palm wine from men returning from the bush (Fig. 2). For this ceremony, called Eti Kakomi (‘watching the road’), the messenger dresses in “traditional dress” resembling hunter and warrior attire, consisting of a short raffia cloth worn over shorts. The striped “towel,” now knotted around the waist, signifies a transcendent state. The chief’s feet are rubbed with red camwood paste, a symbol of fertility, and his legs are painted with yellow ejongo paste. Ejongo, which in the past was allegedly made from the mashed brains of the bina’s predecessors, indicates empowerment.14 This adornment and his comportment give the chief an otherworldly appearance. The rite is designed to communicate the festival’s dates. These do not have to be overtly stated, since word of the ceremony spreads quickly from compound to compound. The utter silence in which the exchanges between the messenger of the festival and the farmers take place accentuates the ritual calendar’s supernatural authorization. Silence in Yakurr culture functions as a framing device that situates performances in symbolic vs. real time, inviting spectators to “read meaning into whatever they witness” (Schechner 1988:8). The messenger’s positioning at the crossroads between the bush and the town is precarious.15 The festival hangs in the balance pending the palm-wine tappers’ responses. Their voluntary donations of wine symbolize the spirits’ blessing of and particular wards’ continued commitment to the “traditions.” As Gawin Brown (2003:5) points out, ritual activity is inherently indeterminate since actual performers and audience members alike possess the facility to deviate from the performance script.

Leboku Kepili (‘breaking of Leboku’) coincides with the last installment of Eti Kakomi, still three weeks before visitors typically arrive in town. Superficially, this event entails a feast sponsored by the town leader to express gratitude to the nine bina responsible for the festival. Prayer at Odjokobi shrine is followed by invocation of a spirit that resides in the sacred Leboku bundle. Officiating at shrines is a straightforward affair of praying, pouring libations, and marking ritual paraphernalia and participants’ chests with consecrated chalk. Here, this observance alerts ancestral spirits to the impending celebrations in their honor.

At a deeper level, what makes Leboku Kepili compelling as a performance is the seemingly undue dramatization of the bina’s procession from one ritual site to another (Fig. 3). The elders wait by the roadside near their various compounds to join the procession one by one. Led by the town speaker, as this lengthening file of men moves from one ina’s house to the next, it crisscrosses the town’s busiest intersection over and over again for no apparent reason. Since cultural precepts dictate that pedestrians stay back and watch from afar and that drivers and motorcyclists stop their vehicles for the event, the elders effectively arrest all traffic for several hours. The dignity that emanates from the bina’s silent passage renders the space around the men sacred, its edges defined by the audience. Through their acquiescence, the citizens endorse the perpetuation of the culture. They do so, said Edupon Ubor, “because the custom is so sweet.”16 The rite’s religious implications may be rejected by Ugep’s today primarily Christian citizens, but the simplicity with which the bina dramatize a history of cooperation between the town’s disparate clans and emphasize their equality inspires pride in Yakurr identity, if not, to use Victor Turner’s term, a sense of “spontaneous communitas” (1982:47).

Leboku Kepili draws far more attention to this disruption of modern life than it does to the rites conducted at shrines. The king confirmed this assessment. He explained that

the people who will be passing will be passing with bigger steps. And then they make sure they do not come back to meet [the bina] as they are passing. Everywhere is cleared. That is exactly the beauty of our tradition. When [the bina] are doing their thing, the people give them the chance to do it properly.17

Although the bina go through the motion of bringing various tutelary spirits into association with each other, the rite’s content today revolves around asserting the preeminence of indigenous over foreign-introduced culture, around avowing local identity in the face of conflicting demands made on it by national and global affiliations.

At an even deeper level, subtle details of Leboku Kepili confirm that its concern lies with safeguarding a close-knit community from an external threat. To use Victor Turner’s processual model of a social drama (1987:22), the ritual signals a breach in the social fabric and initiates action to deal with an ensuing crisis. The Leboku festival in essence is structured around a fictitious, victorious war fought against an unspecified enemy. The drama is drawn out over the entire festival and is replete with a victory celebration (Turner’s redressive action) and replenishment of life lost during battle (Turner’s reintegration).

Explicitly, Leboku Kepili marks the beginning of a liminal period during which it is strictly forbidden to make any loud noises. Again, silence is used to frame ritual events. Festivities, such as public ceremonies of secret societies, weddings, burials, or funerals, henceforth are suspended throughout the festival period so that one may discern an approaching enemy’s war drums. Less obviously, the town speaker, just before he joins the messenger of the festival at the very beginning of the ceremony (Fig. 4), ever so briefly turns his attention to a particular boulder at the foot of a tree in front of his compound and alternately places each of his feet on it. This act, which appears insignificant in the moment if it is noticed at all, entails ritual preparation required of warriors before they go to the battlefield. The boulder is one of eight akota (sg. lakota) war stones, animated rocks that are dispersed throughout town and function as oracles. In the event of a real war, soldiers gather around them to receive the associated spirits’ blessing the night before they move to the front. Further, the town speaker carries a spear, ukoongbulutu, said to render him and his charge immune to danger. The spear embodies the collective memory of the ancestors’ perilous migration from the people’s putative homeland in Akpa near the Nigerian/Cameroonian border, an event thought to have occurred during the eighteenth century when people in the wider region reconfigured themselves, probably in response to slave-trading in Calabar.18 More careful observation also shows that when the bina pass through the town center, they briefly fan out and subtly act as if they are scouting out enemies (Fig. 5). As has been shown, the deeper levels of meanings of Yakurr culture reside in minute details of the performance script; superficial or partial observation of festival events does not lay them bare.

Provisions ensue to deal with the loss of life anticipated from the fictitious war. Immediately after Leboku Kepili, young women, whose sexual maturation gives rise to added social anxiety, also enter a period of liminality They are off-limits to the touch of any man from this time until fertility rites at the end of the festival sanction their relationships with young men who have proven their prowess.

The women’s outfits (Fig. 6), which closely resemble those of better-known Monenkim initiates of Ejagham society (Thompson 1984, Roschenthaler 1993), derive in part from discarded seclusion practices – in the past, women spent substantial time in a “fattening room,” ostensibly in preparation for marriage but more generally to promote/ensure infertility. The attire consists of short wrappers and Western-style bras, heavy coiled brass bangles that reach from the ankle to the knee, accessories such as costume jewelry and handbags, and paraphernalia such as flywhisks and umbrellas. Bared bellies and seedpods draped around hips suggest childbearing capacity; a hairstyle designed to imitate yam heaps underscores women’s ability to nurture a family; peacock feathers inserted into the coiffure indicate association with the forces of the bush; and various forms of money (brass coils, cowries, and colonial coins) allude to wealth and set a high bar for potential suitors.

The young women parade up and down Ugep’s roads from morning to night, transformed into glamorous festival maidens. Their continuous presence creates a heightened atmosphere. Their colorful costumes punctuate the gloomy landscape typical of the rainy season, while the persistent beating of brass bangles echoes the thunderstorms that promise the maturation of yams. The festival maidens’ performances visually weave the bina’s seemingly disjointed, sporadically occurring rites into a continuous, well-structured display.

Moreover, the stomping of brass bangles provides the warriors with spiritual reinforcement, although Christian women in Ugep today vehemently deny this aspect. According to Yakurr lore, brass bangles, which are incorporated into fertility shrines throughout the region (Peek and Nicklin 2002), are associated in Yakurr society with the invocation of various conflated female spirits, the most important of which, Mma Esekpa, is thought to have installed the akota war stones from which the warriors derive their power. Thus, although Yakurr people assign no more than an ornamental function to the festival maidens’ role during Leboku, it is actually substantial. Yakurr oral history is full of women who, like the maidens, temporarily exchange their childbearing capacity for the ability to communicate with spirits. These spirits consistently furnish women with the facility to invent cultural institutions and to establish the social order.19

While festival maidens’ performances inform intertwined narratives about yam cultivation, gender expectations, the significance of tutelary spirits, and Yakurr society’s adverse relationship with foreign foes, they also illustrate the degree to which liminal ritual has become liminoid theatrical drama. Today’s festival maidens are unaware of the spiritual connotations of their performances. They participate “to promote Umor culture, to keep the glamour and fun of it,” and to honor their mothers.20 Rather than performing rituals, they see themselves as reenacting rites in which their mothers took part; their engagement is not one of “doing” but of “showing of doing” (Schechner 1988:108). It must be mentioned that participation by young women in these performances is dwindling. In 2001, I estimate there were no more than 500 festival maidens in Ugep, and most of them girls under the age of 12. In Idomi, there were less than a dozen. Young women who hold jobs or study at the university do not have the time to devote themselves to these performances. In addition, Christianity’s requirement for modesty and the bangles’ association with the ancestress Mma Esekpa create a moral conflict for the young women. Nevertheless, the festival maidens’ number increases during subsequent weeks and the atmosphere in the town becomes more and more charged. People wind up their farm work, refurbish their homes, and prepare for the arrival of guests. As members of age grades they additionally take charge of repainting the palace, restoring civic sculptures, and cleaning up roads.

Three days before the climax of the festival and three “traditional” (six-day) weeks after Leboku Kepili, the bina go to work in earnest. For Oboku Pom (‘morning prayer’,) executed by the messenger of the festival, the bina clear the roads along a ritual route that links the Odjokobi and Obolene shrines (both in vicinity of the palace) with the shrine of Korta (a male initiation society) and the compound of the late leader of Ekao (a female initiation society). The male initiation society’s function as a regulatory society is today much diminished. The women’s initiation society has been leaderless for more than half a century and completely defunct for two decades. Nevertheless, the messenger of the festival traverses the considerable distance between these destinations three times. He does so with great fanfare (Fig. 7). He forcefully reprimands bystanders for inappropriate behavior and fines the occasional person who intercepts his path. The associated rituals at the sacred sites are all but nonexistent; the ceremony has lost its original meaning. As with Leboku Kepili, Oboku Pom deemphasizes religious signification and instead “presences” the indigenous culture by accentuating the bina’s sway over the population.

Immediately after Oboku Pom, the king ceremoniously cuts firewood for use during a subsequent night ceremony and stores it underneath the rafters of “the shade” (Fig. 8). In the past, such wood derived from maidens’ “marriage piles” (Forde 1964:240), but today a couple of random branches suffice. As this is the only public ritual executed by the king, it is much applauded. The ceremony, Mangkepai, is accompanied by the eerie sounds of bull-roarers and a membrane- covered bamboo flute that distorts words sung into it. This auditory dimension insinuates the spirit world’s approval. Just as silence functions in Yakurr society to demarcate a symbolic timeframe, noise is used to signify an opening between the terrestrial and spiritual realms.

Very early in the morning of the following day, known as Mblami day, women go to their farms and openly harvest new yams for the first time. In the afternoon, they dress in their finest attire, parade the tubers through town, and then display them in front of the palace either in brand-new enamel basins or in “traditional” wooden containers. The designation “Mblami” indicates that in the past women adorned their skin for this purpose with a form of body painting of the same name. As recently as a decade ago, I was told, virtually the whole female population took part. In 1998 and 2001, however, the number of women who appeared at the palace with yams during the course of the day was very small, less than thirty. As with festival maidens, these women made a conscious effort to preserve the culture and their performance was theatrical, not ritual.

Concurrently, the festival’s drummers, dressed as and acting like fierce warriors, collect and reskin the Ekoi (war) drums in preparation for the main celebration. The instruments are dispersed in several bina’s compounds so that “if there is any danger, not all of them should be affected.”21 Ekpakeke (Fig. 9), as the ceremony is called, dramatizes the fear that the original owners of the drums, from whom they were stolen when Yakurr people conquered the region, might some day return for their belongings.22 Precaution is also taken during later performances at the palace, at which time the drums are hidden inside a palm-frond enclosure (ekoiben). Ekpakeke thus serves as an example of a rite that reinforces Yakurr identity through the reenactment of local history. In fact, minute aspects of the ritual script-a gesture here or an emblem thereencode specific historic events. A detailed account of these, however, goes beyond the scope of this article.

Around Mblami day, expatriates begin to arrive in town in great numbers. These men and women, who earn their living in Port Harcourt, Abuja, or Lagos, soon visually command the scene. Dressed in immaculate boubous or “up-and-downs” made of exquisite fabrics, they emerge out of Peugeots and Mercedes that soon clog up the narrow mud roads. As they file into hotels and visit beer parlors, pay their respects to the king, and partake in family meetings, the clanking of bottles carried in crates and the smell of goat meat roasted on grills increase exponentially.

Shortly after midnight, the nine bina set out to call on the ancestors to join the living. This is a ritual for which a curfew is imposed on the town for residents and visitors alike. Despite the size of the population and its conversion to Christianity, people strictly adhere to the prescribed protocol.23 During the ceremony, called Okondel, the messenger lights a fire in the arena using burning embers handed to him by the king. Then he cooks yams for sacrifice to the ancestors and informs the other chiefs that preparations are complete. Once the town speaker has received this message, he prays as loudly as he can, “[holding] so many things and [standing] on so many things to really conjure up the gods.”24 He recounted,

When I move out enveloped in the night at about 2 am, I go out and offer the prayers …. Otherwise, all others, they stay in their houses. They listen very attentively because the manner in which I offer the prayers and what I say is so sentimental, so sweet, very nice, and very stoical that everybody would like to hear.25

During the rest of the night, the bina activate the eight akota war stones. They are supported in this activity by members of Lekpedunga, who sound tusk trumpets and bullroarers and imitate shrill animal sounds. This reverberation, mixed with the shuffling of feet and amplified by its secrecy, is an effective dramatic device that invites contemplation of the ethereal. Afterwards, the original owner of the Leboku festival, Obol Atewa, conducts a prayer at a shrine in his ward. From there, he walks to a shrine located two miles out of town to bury the remains of the sacrificial meal.26 The bina finish up this “sequence of episodes in sacred space-time” (Turner 1982:27) around 5 am, after the Presbyterian church bell has already rung in the next day.

Two hours later on Janan Boku (‘People’s Day’), the bina sit in state in front of the palace to eat and sanction everyone else’s consumption of new yams. This event, called Akong, is preceded by a dance at a site, which the chiefs also visit in November, when they chase evil spirits out of town. There, Onun Eko, the chief of war, dances with spears associated with the town’s main fertility shrine (Forde 1964:244).27 He wears the attire of a victorious warrior, for he is dressed in a lavish textile wrapper with a striped “towel” draped around his waist. His upper arms are decorated with fleece from sacrificial rams’ necks. Suddenly, he slams his weapons into the ground. When carried to the warfront, these spears are said to facilitate victory. Staked into the ground at this particular site, they constitute a declaration of war. Recognition of this rite’s significance to the warfare structure of the Leboku festival, dependent on the knowledge that this particular performer is indeed the chief of war, escapes casual observation. To gain a real understanding of Yakurr culture, one must delve into the intricacies of Yakurr symbols.

Concurrently, ordinary Yakurr citizens conduct private rites at tombs of their female ancestors who died during the preceding year. This observance involves sacrifices and a feast. As one of the most cherished aspects of the culture, it is repeated at male ancestors’ tombs the following morning.

In the afternoon, two secret societies are highlighted. The first, Lekpedunga, involves the men who were active the night before. Now they display their instruments of power publicly. Their leader carries a huge, flat basket that invites speculation as to its content. He pivots this object around his own axis, side to side, throughout the several-hours-long procession (Fig. 10). Other bina carry fear-inspiring clubs and medicine-filled baskets that double as stools. Thereafter, Ekpongkara, an aspect of Kekpan, the most highly respected and still greatly feared society, takes over the arena. More than forty men join hands to dance around the palace and various wards’ town halls. They reenact the cover-up of a crime that in ancient times led to the founding of their society (Fig. 11). Bundles said to contain the skulls of two murder victims are carried ahead of their procession, while a female member impersonates a witness who observed the original felony. Although both societies are today largely ceremonial, Lekpedunga’s and Ekpongkara’s displays still evoke a sense of the enormous power they wielded in precolonial times. The evening and night hold much excitement. Young men and women initially divide their attention between a generally frowned-upon government-sponsored “Miss Leboku” contest held at a hotel and socializing in groups that leisurely stroll towards the palace. By midnight, the entire arena is filled with thousands of people who sing and dance and eagerly await the commencement of the Ekoi drumming. Reinforced by the maidens’ bangles, the drums eventually produce a solemn, almost foreboding rhythm that appears to narrate the fictitious, offstage battle. Local historian Ibor Esu Oden explained,

The beating of our Ekoi drums is telling something. That which it is telling is in Agwagune language:

Umabah yeteh, umabah ye tern tern.

Umabah yeteh, umabah ye tern tern.

Umabah yeteh, umabah ye tern tern.

Meaning, the people who kill our fathers is those who are shooting gun: Tern, tern. They are shooting their gun: Tern, tern. The shouting: Oh hoiyeh, oh hoi; that is remembering the old people who died in the family … that time. Instead of you to cry, you will not cry during that time. You will say: Oh hoiyeh, oh hoi.28

It is of interest that the enemy at the time of the festival’s inception apparently possessed Western-derived weapons.

Just a few hours later, early in the morning of Ledam Boku (‘Men’s Day’), citizens persuade Etangala, a masquerade associated with a spirit that protects crops, to leave his forest abode and to circumambulate the town. They produce polyphonous rhythms with dried bamboo sticks and sing songs to entice Etangala to show his prowess (Fig. 12). An entourage controls the mask via chains and staffs, but Etangala nevertheless chases after men who dare him and threatens them with his machete. His iconography derives from Obam, a hunter and warrior society, but the gestures used are those employed by Ekpe, the famed leopard society of the region (Nicklin and Salmons 1982, Leib and Romano 1984, Ottenberg and Knudson 1985). Now and then, the audience encircles and humiliates a person perceived to have committed an offense during the past year. As such, the masquerade has a regulatory function. In addition, Etangala gathers an audience for the bina’s grand entry onto the festival grounds.

After a respite, people gather at the arena around 3 pm to witness the highlights of the celebrations. These bear all the trappings of modern Nigerian festivities, from plastic chairs set up under canopies and announcements of who is who over public address systems, to soldiers who control the masses. While young men shoot guns to scare off witches, festival maidens parade up and down the road in front of the audience (Fig. 13). The seemingly incidental juxtaposition of the maidens with the frina/warriors at various moments during the festival, amplified on this occasion, models idealized Yakurr gender relationships in which the promise of young women’s fecundity is best supported by mature warriors’ proven capacity to sustain and protect families.

On the palace grounds, at quite some distance from the audience, drummers carefully guard their enclosure, while a party of five bina led by Ebinyang (Fig. 14), the festivals host, ritually secures the arena. Ebinyang moves about to the droning Ekoi rhythm throughout the afternoon. His eyes are encircled with yellow paste to indicate mystic vision, and he carries a talisman and a sword marked with a prayer for peace, power, and fertility.

The remaining bina (Fig. 15), accompanied by stool bearers, enter the festival grounds in two merging lines (Ekoi Kemle). They wear their “ceremonial dress,” wrappers made of forty-eight feet of cloth, festive “towels” draped over the shoulder, and an array of hats. The town speaker’s jute cap is set with human teeth, while those of representatives of the original clans are decorated with leopard claws. The indigenous caps are worn in addition to foreign- introduced red stocking caps and bowler hats. To demonstrate that the bina are in awe of their responsibility, they shake their staffs of office, reed brooms. The reeds symbolize the people while the handle suggests the chiefs’ firm grip on power. Once the elders are seated in state (Figs. 16-17), citizens show them appreciation by throwing money at their feet.

The proclaimed climax of the event consists of the Ekoi war dance, which is performed by two or sometimes three specially selected men. Here the warfare structure of the festival comes almost full circle, for the Ekoi dance is a victory celebration. The dance is not particularly flamboyant in terms of footwork, but rather consists of enormously dignified but subtle bouncing movements. The occasional leap into the air on one foot just before changing directions (Fig. 18) allows the dancers to gracefully demonstrate their power and victorious spirit.

After reverse processions, the day ends with a final sacrifice made by the town speaker. When he returns to the arena, carrying a talisman designed to facilitate fertility, the Ekoi drumming stops.

The “small market day” three days later, festival maidens perform dances around their respective wards’ town halls while other people go about their ordinary business. For Lete Boku, they line up according to their strength (Fig. 19), which was determined earlier during wrestling competitions. The girls’ somber expression and restrained body movements are due to the weight of the bangles, but are also culturally prescribed. Women in Yakurr society are conditioned to act “cool” and to contain their emotions.

This overture towards replenishing life lost during battle is complemented the following “big market day.” Early in the morning, Obla, the head of the diviners, briefly initiates young men into a fertility spirit during Lobo/Yekpi. Possessed, the initiates (yabunga) run into the bush and uproot trees with their bare hands. Procuring a year’s supply of sacred firewood for preparation of ritual meals in this fashion allows the initiates to demonstrate their prowess. As a countermeasure to the young men’s exuberance, the diviner circumambulates the town and brings blessing to all clans’ fertility shrines, accompanied by an ensemble of men who play rhythms on dried turtle shells (Fig. 20).

In the afternoon, for a ceremony called Yabunga that draws as large a crowd as the Ekoi drumming, the young men drag trees through town. Equipped with whips, they defend themselves against insults hurled at them so that they might prove their manhood (Fig. 21). As this ceremony concludes the festival maidens’ liminal state, men’s demonstration of their prowess involves mock sexual intercourse (Fig. 22). People burst out laughing at the displays and joyously dowse couples with talcum powder, ordinarily symbolic of the desire to conceive.

One week later, the festival ends. Young men of Liben, a wardbased organization, produce a racket with rattles and impromptu songs that address social issues and criticize the government (Fig. 23). Throughout the night, they move from compound to compound to sweep away evil spirits. During the morning, they circumambulate the town halls led by the bina. The vigor of their dance, the frenzy of their proclamations, and the threats contained in their lyrics, leave the town feeling “hot” but the men fully in control of their community and their lives. Concurrently, two priestesses “cool” the town by spraying it with consecrated water in a rite called Yepoonfawa (Fig. 24).

A final “royal” dance, Odele, is rather esoteric, its symbolism obscure. It appears to represent the spirits’ retreat to the underworld, but also implies a demand for human sacrifice. In Yakurr lore, the latter always involves the pledging of a victim to the spirit world rather than outright execution. Dancers, who are said to die soon after their performance, are said to bend over as if they were very old men.29 They miss all of their dance steps, which are performed to barely audible, seemingly distant music. Odele inverts ordinary reality as it represents the official end of the festival.

For another week, however, as the festive atmosphere slowly dissipates, young children are given a chance to perform Egbendum and Oka dances. With the help of sponsors, who organize the children into pretend associations and supervise their progress throughout the festival, the youngsters not only learn to master roles that enable them to perpetuate the “traditions” in the future, but much more importantly, they are conditioned to filter their experiences through the logic of Yakurr conceptions and idioms.

THE LEBOKU FESTIVAL OF 1939

Daryll Forde’s documentation of the Leboku festival as it unfolded in 1939 is almost identical to my description of the 2001 festival, yet the two events have almost nothing in common. Forde observed of the festival that its primary concern in 1939 was with “an integrative function with respect to the community which far transcend [ed] the maintenance of effective patterns of agriculture” (1964:234). In his functionalist/structuralist reckoning, various rituals essentially reaffirmed the social order. The succession of rites was designed to visually demonstrate the differing moral and social authority vested in various institutions and to express clearly the status they enjoyed relative to each other (ibid., p. 249). In this, Forde placed much importance on the fact that the spiritual forces that empowered the loosely aggregated associations lacked overall conceptual integration (ibid., p. 210).

Forde’s admirable assessment of the 1939 festival has little bearing on the yam festival of today. The council of elders continues to be politically viable because Nigeria’s federal administration officially recognizes it as the “traditional” government of the people and, more importantly, because socioeconomic facility still largely resides in clans with communal landownership. But all other associations that vied for power during the 1939 festival, where they survived, nowadays operate strictly as ceremonial organizations. In today’s Christian society, assessment of their status relative to each other based on a hierarchy that measures the efficaciousness of their tutelary spirits is no longer relevant. Forde listed all of the bina’s rites I describe above except Omileta and Okpebili’s last sacrifice. The chronology and timing of events relative to each other differs, but only slightly. Forde did not mention Etangala (the masquerade was incorporated into the festival in the early 1990s) or Libin. He paid no attention to women; his discussion of festival maidens’ performances is limited to a single reference to “Lite” dancers who moved in a parade from town hall to town hall (ibid., p. 246). Although Forde did not discern the festival’s warfare structure, he nevertheless described most of the components that constitute it; he mentions activation of the akota (ibid., p. 243), the dance with spears of Odjokobi (ibid., p. 244), the beating of the Ekoi drums, the Ekoi dance (ibid., p. 245), and the fertility rites facilitated by the head of the diviners.

There are a number of negligible differences between Forde’s 1939 account and my observations in 2001. These might represent minor modifications of the performance script over time, but they may also just reflect the specificity of particular performances. For example, in 1939, offerings at shrines included money, i.e. brass rods or hoe currency, which the chiefs rubbed over their own and participants’ chests before they deposited these items on the shrines. Also, in 1939, it was the messenger of the festival, not the town leader, who ritually cut firewood (ibid., p. 240). Then, Mangkepai took place three days before Oboku Pom, rather than immediately after it.

Other passages of Forde’s description indicate today’s near total loss of the rites’ spiritual significance. In 1939, initiating young men into a fertility spirit in preparation for Lobo/Yekpi took twenty diviners’ efforts throughout the night, even though participation then was restricted to members of the patrician of the head of the diviners (ibid., p. 247). In 2001, the same initiation, open to anyone, was performed by a single remaining diviner. Initiation procedure consisted of no more than a token gesture executed immediately before and even after commencement of the Lobo/ Yekpi ceremony.

Oboku Pom, which I described above as having lost its original meaning, today does little more than send the messenger of the festival spinning in circles around town. Six decades ago, the rite involved the manipulation of spiritual paraphernalia and substances whose powers were probably considered awesome (ibid., p. 240). Then, the messenger of the festival did not merely pass by the palace in order to be seen and to collect fines from interceptors. Rather, he gathered sacred items, one by one, from the Odjokobi and Obolene shrines to take them to the leader of the men’s initiation society.30 There, the two chiefs removed some of the Odjokobi materials and placed them inside the Leboku bundle, which the messenger of the festival then returned to the Obolene shrine. The messenger therefore would have moved by the palace three times. In the meantime, in keeping with today’s Oboku Pom ceremony, the leader of the women’s initiation society, Ekao, embarked on a procession followed by forty initiates. Decorated with camwood paste, these women engaged in empowering rites at a shrine in a forest grove (ibid., p. 241).

Only two aspects of Okoku Pom are still intact. The rite continues to link Korta, Ekao, Odjokobi, and Obolene; Obol Leboku still passes by the palace three times. But today there is no activation of ritual paraphernalia. The messenger’s purpose during Oboku Pom, as is true of all the other rites, is to jolt people out of their preoccupation with their modern strivings, to remind them of the indigenous culture’s core values, and to facilitate the experience of spontaneous communitas. From my experience, the bina’s simple yet majestic appearances invariably ignite a sense of pride in the people. Even the most avid adherents of Christianity cannot pull themselves away.

This emphasis on “presencing” ethnic identity did not yet exist during the height of the colonial age. In 1939, Forde remarks, affording bina respect so they could execute their rituals properly meant staying hidden indoors; the bina then fined anyone who caught a glimpse of their acts (ibid., p. 240). Whereas Yakurr people then were not allowed to witness any of the rites at all, today, I submit, the objective of the rituals is precisely to be seen. It is when people drop their activity to encircle the bina’s performances, when an audience member breaches the protocol and submits to paying a fine on the spot for everyone to witness, that Yakurr “traditions” are made visible and are validated.

ANALYSIS

A diachronic study of the Yakurr Leboku festival has revealed that the performance script of this Gesamtkunstwerk in terms of its formal aspects underwent minor modification between 1939 and 2001, but that the meaning attributed to performances has changed radically. The dramatic focus of religious rituals in 1939 resided in secret rites conducted at shrines. By 2001, the same rites had become theatrical performances that stressed highly visible processions centered on display of a constructed ethnic identity, and performers considered their impact on an international audience.31

The shift in emphasis from activity at shrines to movement between them is reminiscent of postmodernism’s privileging of the signifier over the signified (Derrida 1976). This assessment may appear incongruous, but, according to Anthony King, conditions that gave rise to postmodern tactics existed in the Third World before they manifested themselves in the West (1997:8), and according to Ruby Rich (1993), such postmodern strategies resemble those of Third World survival. The open-ended structure of the Leboku festival- a fictitious victorious war staged against an unspecified enemy who lends himself to multifarious inscription (surely a fight for continued existence) – overwhelmingly reinforces the Leboku drama’s contemporary postmodern logic. This suggests not only a capacity to contribute meaningfully to an intercultural aesthetic, but based on the people’s greater depth of experience with global forces, confers on the culture (at least from a gerontocratic perspective) a degree of authority.32

The sacrosanct principles Yakurr people proffer to a globalizing world are not easily encapsulated in words. They are embedded in intertwined narratives that juxtapose gender-specific attributes- women’s spirit-derived capacity to generate life and social order, men’s great physical strength and inclination to fiercely protect resources – in scenarios whose themes derive from “people who died in the family that time.” These relate that in the face of overpowering forces such as droughts, floods, epidemics, political enemies, etc., nothing is more important than people and the support they lend each other.

The essence of these values is embodied in specific performance modes, costumes, adornment, gestures, attitudes, and demeanor by people who, communally fashioned into works of art, subdue their personal desires in favor of expressing the community’s goals. Single-file processions by bina, representing various clans, underscore the unity and cooperation of lineages that extend back to primordial ancestors. The innately stronger women, as festival maidens, yield the majority of public attention to the men to maintain gender equality. In boosting the men’s importance, they help to project an image of a fierce society in which the warriors bear the brunt of violent confrontations. As the spectators toss money at the performers’ feet in appreciation, they emphasize that support derives from sharing resources. Yakurr people place a premium on equality, cooperation and generosity, and therein lies their plea to a global audience.

However, is kinship-based performance art reliant on culturespecific ritualized acts able to engender cross-cultural communication? Ethologists and neurologists have demonstrated that ritualized behavior, “overdetermined, full of redundancy, repetition, and exaggeration” (Schechner 1995:230), is hardwired into the cognitive function of the human brain where it evokes an instinctive response.” Thus, Cole observed, “The well-staged festival brings everyone into its ambiance” (1975:12) and Turner, that it facilitates a sense of spontaneous communitas that can send “a shiver running down the back” (1990:13). To Tambiah, in fact, the sacrosanct principles of a culture “cannot be recognized through any clearer medium than that of formalized gesture” (1979:125).

Since ritual is a tool of analysis reflective of nineteenth century conceptions of the modern age (Bell 1997:21), having been devised by “major shapers of the modern mind,” e.g. Freud and Frazer (Weisinger 1961:389), and since Yakurr rites in particular employ strategies that resemble those of postmodernism, why would Yakurr expressive culture not be accessible to Western minds? I have anyhow made the case that the Yakurr Leboku festival today largely functions as a theatrical drama, and “both Richard Schechner and [Victor Turner], approaching the issue from different directions, envision theater as an important means for intercultural transmission of painfully achieved modalities of experience” (Turner 1982:18). Assessing Yakurr culture’s intricacy and complexity requires no more intellectual preparation than comprehension of any other highly complex work of art. If Western scholarship dismisses kinship-based artistic genres’ outwardly focused potentiality, is it because the values these cultures promote threaten current geopolitical power dynamics? Because, as Brown points out (2003:3), ritual does not merely reflect cultural ideas, but as a dynamic process generates cultural values. 1 Omileta is the first rite of the season. Obol Okalefong (left), the leader, wears “traditional” dress. He is accompanied by two members of Ebilambi, a security force with origin in Agwagune (Akunakuna people) by the Cross River. The female diviner neutralizes juju or witchcraft that may have been laid in Obol Okalefong’s path. Ugep, July 1998.

2 Eti Kakomi. A palm wine tapper donates palm wine to Obol Leboku and thereby confirms his ward’s continued commitment to the rites. Although no viewers are visible in this photograph, people are in fact surrounding this event; they watch impatiently from afar and sigh with relief when a farmer finally approaches the priest-chief and saves the day. Ugep, July 14, 1999.

3 The lineup of the nine bina responsible for the festival during Leboku Kepili; the men are led by Okpebili. His spear renders the bina immune to danger. The bina are on their way to invoke the spiritual force of the sacred Leboku bundle, which resides in the Obolene shrine. “The belief is, the spirits will be woven all around the town,” explained Michael Obeten. Ugep, August 2001.

4 Okpebili (left) takes the Obol Leboku’s extended hands in his own, blows into their palms, and pushes them towards the chief’s heart. This exchange amounts to both a sign of respect from the one and a blessing from the other. The expectation that it momentarily transforms ordinary reality into a celebratory one renders it an epiphany. Ugep, August 8, 2001.

5 The bina fan out and subtly act as if they are scouting out enemies. Leboku Kepili sets in motion a symbolic, victorious war staged against an unspecified foe, who can be variously interpreted. This war constitutes the underlying structure of the Leboku festival. It allows the community to symbolically fend off external threats to its integrity as an indigenous society. Ugep, August 8, 2001.

6 Members of the Ekeledi Girls association stage dances wearing festival maidens’ attire. Numerous references to money (colonial coins, cowries, brass bangles) and difficult-to-obtain Items such as elephant tusk bracelets and horsetail flywhisks allude to a high standard of living. Ugep, July 18, 1998.

7 During Oboku Pom, Obol Leboku passes four formerly significant ritual sites, the Odjokobi and Obelene shrines near the palace, the Korta house, and the house of the late leader of a female initiation society, Ekao. People clear the road as the Obol Leboku approaches. By doing so, they act as active agents in the perpetuation of rites that no longer hold any religious significance. Ugep, August 17, 2001.

8 His Royal Highness the Obol Lopon of Ugep, Ubi Ujong lnah, cuts firewood during a rite called Mangkepai. This is the only time during the festival that the town leader appears in “traditional dress.” The firewood is used during a night ceremony, Okondel, for which a curfew is imposed on the town. It is during this nocturnal event that spirits are invited to join the living for the celebration of the arrival of new yams. Ugep, August 17, 2001.

9 During Ekpakeke, the festival’s drummers wear warriors’ attire. They collect and refurbish the Ekoi drums In preparation for the main celebrations. The men’s fiercely protective behavior toward the drums reenacts the fear that the original owners of the instruments, the former Inhabitants of the land, might return for them. Ugep, August 19, 2001.

10 Lekpedunga members carry their instruments of power during a procession accompanied by the eerie sounds of an ewonwong flute. The party is led by Obol Akekpe, the custodian of the “leopard voice.” Ugep, August 19. 2001.

11 Ekpongkara members reenact their society’s origin story, which is steeped In the cover-up of a murder. The name derives from a Lokeh phrase that means This world is frightening.’ Members of Ekpongkara, who number more than forty, represent all patricians except those of the two murder victims. Ekpongkara’s parent organization, Kekpan, in precolonial times constituted a powerful court. Here, Ekpongkara is performed during the Yose festival. Ugep, November 24, 2001.

12 Etangala’s netted suit is embellished with raffia and fleece. Associated with a society of rich men, Etangala has an enormous stomach said to contain a human skull. The mask can afford “to rub his tummy.” Freshly cut palm frond denotes the mask’s sacred nature. A head crest makes reference to a gorilla. Etangala is controlled by chains and staff bearers. Here, an elder cools the masker’s spirit by pouring water over his feet. Ugep, August 21 , 2001.

13 Festival Maidens stroll across the festival grounds as If they had nothing to do with the main event: the bina’s ceremonial entry into the arena (Ekoi Kemle) and the Ekoi war dance. The young, fertile maidens’ juxtaposition with the mature, accomplished men bespeaks an ideal union. Ugep, August 21, 2001.

14 Throughout the Ekoi dance, various bina ritually secure the arena. Obol Ebinyang (I), the head of a men’s initiation society (Korta) and host of the festival, holds a sword marked with a prayer for power, peace and fertility. During the event, his eyes encircled with yellow, empowering ejongo paste, he walks around with a talisman. The men’s chests are smeared with chalk. The particular marking indicates that sacrifices to the Leboku bundle preceded the public event. Ugep, August 21, 2001.

15 Ekoi Kemle, the bina’s ceremonial entry onto the festival grounds: The men carry their staffs of office, brooms, whose reeds signify ordinary people and whose handles indicate the men’s firm grip on power. On this occasion, the bina’s wrappers are knotted in the manner of Efik people in Calabar. Various combinations of red knitted chiefs’ caps, jute caps decorated w

‘Homeless Not Getting Aftercare Support They Need’

By Cherie Gordon

The health of homeless people is being put at serious risk because they are not getting the support they need after being discharged from hospital, a survey has found.

The report, carried out by Shadow Housing Minister Grant Shapps, shows that, in the South West, the number of homeless people leaving hospital to live on the streets has shot up in the past five years.

Mr Shapps believes the Government is failing some of society’s most vulnerable people by not giving them the aftercare support they need.

He said: “This report highlights the extremely precarious existence within which homeless people live, with many entering a vicious circle of homelessness which is difficult to break without active intervention.”

The report looked at the number of patients recorded as leaving hospital with no fixed abode from 2003 to 2007.

South Devon Healthcare NHS Trust has seen the third highest increase nationally, with 18 people discharged on to the streets in 2003 rising to 81 last year – a jump of 350 per cent.

Throughout the UK, there has been a 36 per cent increase in the number of homeless patients being discharged to the streets in the past five years.

In the Westcountry, there was a 13 per cent increase by Plymouth Hospitals Trust, from 61 in 2003 to 69 last year, and Royal Devon and Exeter NHS Foundation Trust saw an increase of 36 per cent from 14 to 19.

In Cornwall, there was a 40 per cent rise at Royal Cornwall NHS Trust from 146 people to 205.

Mr Shapps said the aim of the report was to assess the extent of the problem of hospitals releasing patients on to the street with no idea where to go.

He said: “These figures reveal how homelessness and healthcare are inextricably linked and how easily a vicious circle can develop for those who are discharged from hospital on to our streets.”

But South Devon Healthcare NHS Foundation Trust said the figures were flawed.

Caroline Hill, head of corporate communications for the trust, said the data used in the report did not reflect homeless figures, but hospital admission numbers where no address was given by the patient.

She said: “We would hope that South Devon Healthcare would, in fact, be seen as an example of good practice in relation to caring for homeless people on several counts: having a comprehensive policy to guide staff about the agencies and organisations locally who anyone without an address can be referred to for help and the procedures to put those referrals in place; having an on-site discharge co-ordination team with the expertise to train and advise staff on this; and having seven-days-a- week social services and occupational therapy cover in our Accident and Emergency Department, so that anyone with no fixed abode, even if they do not require admission to hospital or treatment, can have information provided about where they can obtain meals and get a roof over their head.”

Her comments are echoed by Steve Ellis, chief executive of Cornwall’s St Petroc’s Society, which provides accommodation and social care services for single homeless people in the county.

He said: “I am startled by the figure. I do not believe that 205 people have come to us – that is practically one every working day, and that is not the case.”

In response, Mr Shapps said: “We sought to indicate the number of people being identified as ‘of no fixed abode’. The report is not intended to identify rough-sleeping homeless, but rather to indicate an overall increase in the number of people without fixed accommodation.”

Mr Shapps has recommended that more work be done between individual NHS trusts and homeless organisations to provide support.

He said: “Much more needs to be done to link up those patients who are discharged into homelessness with the many excellent organisations out there who have the expertise to help.

“We are now proposing progressive policies aimed at both recognising the problem and addressing the solutions, because failing this group of people is counterproductive in terms of their being able to rejoin mainstream society and both the cost to their own health and the NHS as a whole.”

(c) 2008 Western Morning News, The Plymouth (UK). Provided by ProQuest LLC. All rights Reserved.

Executive Physicals – Bad Medicine on Three Counts

The Oct. 2 edition of the New England Journal of Medicine features a commentary by Brian Rank, M.D., medical director of the HealthPartners Medical Group, which criticizes a new trend in executive perks. The commentary, Executive Physicals – Bad Medicine on Three Counts, points out that executive physicals fail on three important factors: effectiveness, cost and equity. Executive physicals, which typically cost $2,500 and up are a set of preventive screenings aimed at corporate executives. The screenings take place over one or two days and also include amenities such valet parking, fruit, juice, bath robes and slippers. While some of the screening services offered in executive physicals meet recommended guidelines, many do not and are nothing more than retail revenue sources for the organizations that offer them.

 WHAT:    Commentary in the Oct. 2 edition of the New England Journal of Medicine WHO:     Brian Rank, M.D., medical director of the HealthPartners Medical Group. WHEN:    Tues, Oct. 2, 2008 CONTACT: Joe Dangor, 952-883-5223 Pager: 612-613-4527 [email protected] 

About HealthPartners

Founded in 1957, the HealthPartners (www.healthpartners.com) family of healthcare companies serve more than one million medical and dental health plan members nationwide. It is the largest consumer-governed, nonprofit health care organization in the nation, providing care, coverage, research and education to improve the health of members, patients and the community. For the third year in a row, HealthPartners is rated one of the best commercial health plans in the nation by U.S. News & World Report/ NCQA’s “America’s Best Health Plans 2007” and is ranked “Highest in Member Satisfaction among Commercial Health Plans in the Minnesota-Wisconsin Region” by J.D. Power and Associates.

Closing the Healthcare Divide to Be Explored at NAHSE’s 23rd Annual Education Conference and 40th Anniversary Celebration

NAHSE:

 WHAT:   The 40th Anniversary Celebration and 23rd Annual Education Conference, Business Meeting, Exhibition, and Diversity Recruitment Expo - "Closing the Healthcare Divide to Improve Health Outcomes: The Integration of Services, Technology, Finance and Training" - of the National Association of Health Services Executives (NAHSE). National, state and community- based health care providers and experts will participate across all healthcare fields at this five-day conference to address a wide-range of issues related to health disparity populations.  WHO:    Earvin "Magic" Johnson, chairman and chief executive officer, Magic Johnson Enterprises; Dr. Michael Eric Dyson, award- winning scholar, university professor of sociology, Georgetown University; Judge Glenda Hatchett, Emmy Award- nominated TV personality; Ed Gordon, Emmy Award-winning journalist of Black Enterprise TV; Honorable John Lewis (D- GA), civil rights activist; Carolyn Barley-Britton, MD, current NMA President; Larry Gage, President, National Association of Public Hospitals and Health Systems; -- as well as several of the nation's top twenty-five (25) minority healthcare executives as ranked by Modern Healthcare magazine, Kevin Lofton, FACHE President and CEO, Catholic Health Initiatives; Lloyd H. Dean, President and CEO, Catholic Healthcare West; Adam M. Robinson, Jr., M.D., Vice Admiral, Medical Corps, US Navy; Surgeon General, Chief, Bureau of Medicine and Surgery will participate as keynote or featured speakers and/or panelists.  WHEN:   Tuesday - Saturday, October 14-18, 2008  WHERE:  Hyatt Regency Atlanta 265 Peachtree Street, NE Atlanta, GA 30303 

The National Association of Health Services Executives (NAHSE) will celebrate its 40th Anniversary during their 23rd Annual Education Conference, Business Meeting, Exhibition and Diversity Recruitment Expo, October 14-18, 2008, at the Hyatt Regency Atlanta in Atlanta, Georgia. This year’s theme — “Closing the Healthcare Divide to Improve Health Outcomes: The Integration of Services, Technology, Finance and Training” — embraces the association’s mission of promoting the advancement and development of African-American healthcare leaders, while elevating the quality of healthcare services rendered to minority and underserved communities. Denise Brooks-Williams, President, NAHSE is poised to lead her membership, over five days, in a series of intriguing, in-depth educational sessions to empower African-American and minority healthcare professionals to advocate for greater resources for those in underserved communities. “I am very excited about the programs and speakers that we will have participating in this historic and momentous event,” said Charlisa R. Watson, MHSA, Executive Director, NAHSE.

Info: Conference participants will have the opportunity to attend:

— Earvin “Magic” Johnson, chairman and chief executive officer, Magic Johnson Enterprises, will host and introduce his latest ventures, SodexoMAGIC and MAGIC Workforce Solutions during the Opening Night Reception/Exhibition Hall Opening, Wednesday, Oct. 15, 2008.

— Bone marrow testing Thursday and Friday Oct. 16, and 17th, 2008.

— CEO/Senior Executive Session I, The Plight of Public Hospitals/Public(Safety Net) Hospitals: An “endangered” species featuring Larry Gage – President, National Association of Public Hospitals and Health Systems, Thursday, Oct. 16, 2008.

— Opening Session, moderated by Ed Gordon, of Black Enterprise TV to feature panelists: Carolyn Barley-Britton, MD, President, National Medical Association; Thursday, Oct. 16, 2008.

— President’s Luncheon, featuring Judge Glenda Hatchett, TV Personality; Thursday, Oct. 16, 2008.

— Leadership Luncheon, featuring Dr. Michael Eric Dyson, award winning scholar, Georgetown University; Friday, Oct. 17, 2008.

— Scholarship Awards Dinner & Gala, featuring Honorable John Lewis, (D-GA) Friday, Oct. 17, 2008.

Reporters who wish to attend should call the NAHSE Press Office, tel. 202-429-6060 or email [email protected] . All others seeking conference information and wishing to register should e-mail Beverly Glover: [email protected] or call 202-429-6060. Atlanta media contact: Diane Larche’, [email protected] or 404 273-3227.

— For more information on conference sessions and events, log onto www.nahse.org.

About NAHSE

Founded in 1968, the National Association of Health Services Executives (NAHSE), a 501(c)3 nonprofit organization, is recognized globally as the premier professional association for African-American executives in the health care industry. Its leadership and members are both administrators and practitioners working in a wide variety of healthcare organization.

AFSCME Council 25 Obtains Injunction Stopping Wayne County From Increasing Healthcare Costs for Retirees

DETROIT, Oct. 1 /PRNewswire/ — In an attempt to take the path of least resistance to cut costs, Wayne County has attempted to reduce the healthcare benefits for its retirees which would have been effective on October 1, 2008. On September 29, 2008, Circuit Court Judge Gershwin Drain granted AFSCME’s request for a temporary restraining order halting the healthcare cost increases to AFSCME’s retirees.

AFSCME argues that it had agreed on healthcare benefits for its employees upon retirement and the County may not unilaterally alter that contractual benefit. AFSCME requested the injunctive relief while it seeks to enforce its contractual rights. The halting of the change to retiree healthcare benefits assures that while the case is pending, AFSCME retirees do not have to decide between their medical treatment and gas, heating their homes, food, or other necessities that are undergoing dramatic price increases.

AFSCME Council 25 Lead Wayne County Negotiator Richard Johnson stated, “This is a victory in a greater struggle to stop employers from cutting costs on the backs of American seniors.” He also mentioned other pending actions to protect retiree benefits for AFSCME retirees and stated that these actions against seniors would be largely unnecessary if there was substantial national healthcare reform.

Bruce A. Miller and Robert D. Fetter of Miller Cohen P.L.C. litigated this case on behalf of AFSCME Council 25.

Miller Cohen P.L.C.

CONTACT: Bruce A. Miller of Miller Cohen P.L.C., +1-313-964-4454