The Churchland Kiwanis Club recently awarded six $1,000 scholarships to graduating seniors . The three recipients from Portsmouth were Michael B. Stuck, Kierra D. Jones and Emily M. Meyers, all from Churchland High School.

Each student delivered a five-minute speech on his or her educational and career goals.

Winners were selected based on scholastic achievements, school and community activities, letters of recommendation, career plans, educational goals and financial needs.

In addition to its scholarship program, the Churchland Kiwanis Club provides support to more than 20 local organizations serving the needs of children and their families. The club meets at 7:30 a.m. each Thursday at the Church of St. Therese, 4137 Portsmouth Blvd. For information, e-mail [email protected]. The 22nd Annual Unity Celebration known as Gospelrama will again be held on the Portside water stage at North Harbor on the downtown waterfront.

Twenty-six acts will be presented in 30-minute segments 3-9 p.m. Aug. 2 and 3. They include singing groups, vocal, saxophone and violin soloists, dancers and mime.

The free event is presented by HOPS (Helping Others Progress Successfully), an organization established in 1985 by Christine M. Davis.

Ms. Davis traditionally has suggested people take a canned food donation for the homeless.

For information, call 393-0318.

A family affair The Craver Memorial Scholarship Concert will be presented by the choir of St. Andrew’s United Methodist Church today at 5 p.m.

A reception will follow in the church fellowship hall.

The late Harry and Ruth Craver were the parents of Harriet Heath, director of music at the church, where her mother served in the same position for 25 years.

Heath started the scholarship fund in 1984 to honor her parents, who came to Portsmouth in 1942, when the Rev. Craver became the pastor of Elm Avenue Methodist Church. They stayed here and were active in the community in many ways.

The concert today will feature solos by the Cravers’ granddaughters, the Rev. Celeste Heath, Melodie Warren and Melodie’s son, James Warren. Melodie’s husband, Jim Warren, and Harriet’s husband, Ed Heath, also will be singing in the choir.

Over the years, the concert has produced more than $25,000 in scholarships for 30 students. This year the recipients are Curtis Rathbone, a 2008 graduate of Churchland High, and Alicia Rose, the parish nurse at St. Andrew’s who is continuing her studies at Liberty University.

Saving it! The I.C. Norcom Singers were part of “Music in the Garden” in West Park View two weekends ago. As bad weather moved in, musicians depending on electronic equipment did not perform.

“But the show went on, thanks to the Norcom singers, Sue Landerman Cavalieri said. “They saved the evening.”

The group of 10 students sang a cappella and to quote Cavalieri, “when you hear voices like theirs, it warms your heart and makes you feel all is well with the world.”

The Norcom students, directed by Margaret Gayadeen, were Joseph Whitehurst, Antonio Church, Christopher Minter, Shakir Cook, Tauren Ortiz, Demetrius Worrell, Diane Brame, Joy Odom, Chanel Minter and Briana Barnes.

T he show also featured solo performances by singers Carole Downing, Brenda Miller, David Cushner, Tiero Cavalieri, Lucy Denier, Herb Smith, Robin Welsh and Faith Gutierriez.

Good recovery “Highway,” the female pit bull puppy rescued in May from the I-264 entrance to the Downtown Tunnel after being run over, is alive and well.

Now almost a year old, the dog was adopted from the Portsmouth Humane Society by Karen Halston, a physical therapist who lives in Seaford.

About $9,500 in contributions rolled in from the public in response to an announcement by the society that the pup needed operations that would cost more than $5,000.

Michael Monroe, operations manager at the shelter, said the remainder of the money is in a special account to be used for other animals that need medical attention.

Anyone wishing to make a donation to the Medical Needs Account of the Portsmouth Human Society may do so at any BB&T office, Monroe said.

What’s your opinion? The city planning department is conducting a “visual preference survey” for residents to comment on a new zoning ordinance.

The results will aid in development of design standards to be included in the new ordinance.

The survey can be found on the city’s Web site at www.portsmouthva.gov/planning/Survey/index.htm. Hard copies are available on the fourth floor of City Hall or will be mailed to citizens who call the planning department at 393-8836.

Where’s that? A new unit at the Naval Medical Center will open next June with a name similar to a Portsmouth bed-and-breakfast establishment not far from the hospital: Patriots Inn.

The $3.3 million Navy project will provide services for military members going from inpatient to outpatient care. It will include 13 private rooms “designed more like hotel rooms than hospital rooms.”

The privately-owned Patriot Inn, at the corner of North Street and Crawford Parkway, is in the phone book.

Ida Kay Jordan, 399-3845

(c) 2008 Virginian – Pilot. Provided by ProQuest Information and Learning. All rights Reserved.

By Sue Stock, The News & Observer, Raleigh, N.C.

Jul. 27–CARY — Darlene Gardner may be a small-business owner, but that’s the last way she would identify herself.

Sure, she’s the proprietor of The Lovely Lady, a store that sells wigs, caps, gifts and other items for women fighting cancer.

But Gardner doesn’t simply sell stuff. She’s part nurse, part doctor, part counselor, part mom and part friend.

Gardner has worked with thousands of women coping with a cancer diagnosis, freely offering advice and support.

“When you hear that word, cancer, people think the C word is a D word, and it is not,” she says.

A brunette with short, curly hair and a flair for bright, colorful clothing, Gardner possesses the admirable ability to focus her undivided attention on the person with whom she is speaking. She has based her business on it, talking women through their cancer treatments for 30 years — 20 of those in Cary.

“The president could enter my shop, and the woman I’m working with would still be first,” she says.

Gardner hires cancer survivors because they can better relate to the women who come to her. This year, she and her staff will work with about 700 women, sometimes as many as seven or eight a day.

The store on East Chatham Street is small, with four rooms. In one, she cuts hair for women whose hair has thinned or fallen out from chemotherapy. In the front room, she displays merchandise: neatly arranged rows of wigs on mannequin heads, cotton hats, nonirritating deodorants and shampoos.

Another, with a set of couches, is just for talking.

Gardner spends hours talking with each woman, learning their stories and medical histories and listening to their fears. She takes notes in longhand and liberally dispenses near-perfect two-armed bear hugs.

And she surrounds her guests with uplifting thoughts.

On one wall hangs a framed poster quoting 1 Corinthians 13: 4, the verse that begins “Love is patient, love is kind. … “

On a nearby shelf, a small sign advises “Cherish today,” adding, “Yesterday is but a dream. Tomorrow a vision of hope. Look to this day for it is life.”

Gift items like little bags with phrases such as “Happy days are made by happy people, happy people are made by choice” line shelves in neat rows.

For those who are beginning chemotherapy, she offers to buzz their hair off and help them find the perfect wig — the one that will help them feel a bit more like themselves again.

“The women who come in here need to know that the light at the end of the tunnel is life and not a train,” she says. “All the years I’ve done this, I’ve never heard the same story.”

Loving acceptance

The store may be her livelihood, but Gardner says she spends a lot of time wishing that fewer people would visit her shop.

“I still have to, of course, pay the rent,” she acknowledges. “But hopefully the number of cancer patients will not increase.”

The store has always been profitable, Gardner says. But she tries not to focus on the money.

“A woman who is with me is just as important as my sister or my mother would be,” she says.

Her understanding and loving acceptance of cancer patients has led many Triangle medical professionals to refer their patients to Gardner as well.

Over the past three and a half years, Julie McQueen estimates, she has sent more than 100 women to Gardner’s shop. One of two “patient navigators” for the Duke Raleigh Cancer Center and a breast cancer survivor herself, McQueen says Gardner offers one-on-one attention not available elsewhere.

“There’s something about a cancer diagnosis that makes you feel really alone,” she says. “And Darlene’s shop is so welcoming and it makes you feel like you are not alone.”

The store draws women from areas east of the Triangle. To help accommodate them, Gardner will open a second store in Smithfield in September.

But customers such as Nancy Soo-Hoo say they’d travel any distance to chat with Gardner. On Tuesday, Soo-Hoo, who is fighting early-stage breast cancer, stopped in to pick up a few items for a friend who was recently diagnosed with cancer.

When Soo-Hoo pulled off her cotton cap to show that her hair had started growing back, Gardner reached out to feel and exclaimed, “Oh, the cactus!” Laughing, the two women continued talking as if they were two old friends on a shopping trip.

“We all say she should go on the Oprah show,” Soo-Hoo says. “She knows every single drug. She tells you what will happen to your body.”

Gardner has never been diagnosed with cancer. She says her knowledge comes from all those years of talking — building on the experiences of one cancer sufferer after another. “It’s the idea of knowledge being passed by women from woman to woman,” she says.

A detour from nursing

Gardner has always been interested in caring for others.

She was a nursing student in the 1970s in California, assigned to an oncology ward, when her best friend was diagnosed with breast cancer.

“When my friend was diagnosed, there was nothing as far as wigs and hats,” she said. “So I helped make her one. The women I was working with [in the oncology ward] had nowhere to go.”

For a year and a half, she operated a home business before finally opening a store. She never completed school because she got sick with pneumonia during her final year. But she found helping women with cancer was as fulfilling as any career she had imagined in nursing.

After a divorce, Gardner moved to North Carolina rather than back to her home state of Massachusetts, because she liked the climate better and had fond memories of childhood vacations here.

Twenty years later, Gardner is still greeting women in her Cary store and making plans for that new Smithfield operation, which is closer to her Johnston County home and some of her clients.

Now 62, Gardner says she has days when she feels a bit overwhelmed by it all.

But she has also gained an increased appreciation for small joys and has learned to force herself to take breaks from work. She does not own a cell phone and often turns her home phone off when she wants some peace.

“I’ll probably always work,” she says, laughing. “Maybe I’ll go part-time eventually, but right now it’s gung-ho.”

[email protected] or (919) 829-4649

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To see more of The News & Observer, or to subscribe to the newspaper, go to http://www.newsobserver.com.

Copyright (c) 2008, The News & Observer, Raleigh, N.C.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Bonnie Henry, The Arizona Daily Star, Tucson

Jul. 27–For an instant time machine, nothing beats an old handbook bristling with rules and regulations — particularly those aimed at young women.

I give you: “What Every Coed Should Know,” the University of Arizona women’s handbook, circa 1941.

Though delivered in a deliberately chatty manner (“Before you know it, that cute fellow in the first row will be grinning all over his face when he passes you.”) the pamphlet makes no bones about infractions.

For example, coeds could face suspension if they left the city without permission from the Dean of Women. Thankfully, Sabino Canyon, “A” Mountain and the airport were not considered out of town.

Coeds also faced the dreaded curfew: 11:30 p.m. Sundays through Thursdays, midnight Fridays, 1 a.m. Saturday nights.

And when they said curfew, they meant it, with lights flashing five minutes before and doors locked right on time.

I still remember being out on a double date in the 1960s and our car pulling up to a dorm to let someone out. It was 5 minutes to 1 and girls were scrambling up the steps right and left.

Being a town girl, I faced no such urgency — other than a mother, of course, waiting at home.

Also: “Young women students do not go to men’s halls, fraternity houses, apartments or rooms unless the housemother or a chaperon approved by the Dean of Women is present.”

“Necking” is also addressed, as in don’t do it in public, or even worse, become a “grass lounger” when spring arrives.

While the ’41 handbook gives no direct do’s or don’ts on dress, it does advise girls to wear blouses and skirts, suits or “simple tailored frocks” to class. Dresses of silk, along with hat and gloves, are recommended for afternoon teas.

Dress codes were still in place when I matriculated at the UA back in the ’60s: no jeans or shorts weekdays until 4:30 p.m.

Things had changed a tad when I re-entered the classroom a decade later.

Many of the young women looked like they had gone directly from bed to lecture hall, wearing either rumpled sweats or T-shirts, shorts and flip-flops.

Back in the ’40s, playing the piano, radio or other musical instruments was not allowed during study hour or after 11 p.m. Friday and Saturdays.

Despite the prissiness of the times, the handbook does illustrate some good points about university life. All 400 incoming freshman women had their own sponsor, a senior coed, to look to for advice.

Members of Spurs, the sophomore women’s honorary, were also on hand to meet all trains and buses disgorging freshman coeds the week before classes.

All rooms in the four UA women’s dorms contained a wash basin, study tables with lamps, chest of drawers and a day bed.

Unless you had a doctor’s excuse, you were expected to sleep on screened, open-air porches.

Still, the price was right: $10 to $32 a month. Compare that to today’s yearly dorm costs of around $4,500 to $5,500, double occupancy. Also, monthly meal tickets were $15.

Girls who had trouble meeting those ’41 expenses were encouraged to get jobs on campus as stenographers or library attendants.

Oddly, where the handbook differs most with today’s mores is its stance on smoking:

“To many of us it’s second nature,” goes the approving line, while cautioning coeds not to smoke in the library, or “on the hoof.”

Wouldn’t be ladylike, after all.

–Bonnie Henry’s column also appears Thursdays in Accent. Reach her at 434-4074 or at [email protected], or write to 3295 W. Ina Road, Suite 125, Tucson, AZ 85741. –Bonnie Henry’s two history books are being sold as a set for $50 through Labor Day. Contact Renee Weatherless at 807-7760 or [email protected] to place an order.

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To see more of The Arizona Daily Star, or to subscribe to the newspaper, go to http://www.azstarnet.com.

Copyright (c) 2008, The Arizona Daily Star, Tucson

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Bob Lamendola, South Florida Sun-Sentinel

Jul. 27–South Florida has become the nation’s capital for doctors without medical malpractice insurance, experts say, leaving patients at risk of getting little financial help for care after a medical error.

Nearly one-quarter of doctors in Broward and Palm Beach counties, more than one-third in the Miami area, and one-eighth statewide opt out of malpractice insurance under a state law that lets them go without coverage, a state physician database shows.

That’s about double the rates in 2003, when uninsured doctors and medical malpractice became a state policy crisis.

Florida has allowed doctors to go without malpractice coverage for decades. Critics of the law that allows it said it raises the chances patients cannot collect enough money in court to cover medical bills from physician mistakes. Also, malpractice victims and lawyers are less likely to sue doctors who don’t carry insurance.

State Sen. Dennis Jones, R-Seminole, a chiropractor who has filed bills to require doctors to buy coverage, said the increase in uninsured doctors strengthens his case.

“You have to have insurance to drive a cab, but you don’t have to have insurance to do brain surgery?” Jones said. “Patients basically are at risk.”

No one tracks the number of U.S. physicians without coverage or who have filed bankruptcy in the face of a negligence case, but insurance officials, malpractice attorneys and doctors in and out of Florida agreed that no other area of the country has a bigger problem with uninsured doctors than South Florida.

“We’re sort of the [uninsured]-doctor capital of the world,” said Matt Gracey Jr., a malpractice insurance broker in Delray Beach. “I go to conferences and people say, ‘What the heck is going on down there?'”

Boynton Beach retiree Rhoda Fruchter fears she has no recourse against an uninsured doctor she said left her in chronic pain and unable to turn her neck.

Fruchter, 68, sued Dr. Douglas Martin in 2005 claiming the neurosurgeon inserted — then removed — screws in the wrong spot in her neck, said her attorney, Kenneth Sobel. She didn’t realize Martin had dropped his coverage.

Martin’s attorney, Roy Watts, denied the doctor did anything wrong and said Martin went uninsured because his premiums would cost more than the coverage offered. “It makes no sense for him to have it,” Watts said.

Complicating matters, Martin had filed for bankruptcy in 2000, which if approved would shield many of his assets. Among them, his 6,000-square-foot home on the Intracoastal Waterway valued by the county at $2.1 million.

“The doctor hurt me,” Fruchter said. “He’s living in his mansion, living the high life. How does this guy get away with this?”

Watts said the bankruptcy was unrelated to the lawsuit. Both cases are pending.

Florida has long required chiropractors, podiatrists, midwives, some nurses, acupuncturists and optometrists be insured, but medical doctors were allowed to go without coverage to help them cope with Florida’s high malpractice premiums. Some family doctors pay more than $50,000 a year; some high-risk specialists such as surgeons pay more than $200,000.

The law says doctors can go uninsured if they post signs in their offices and promise to pay up to $250,000 per malpractice award, with a maximum of $750,000 per year. If a doctor doesn’t pay, the state can revoke his or her license.

In 2003, legislators moved to lower premiums and get more doctors insured by limiting pain-and-suffering awards to $500,000 in cases of injury or $1 million in cases resulting in death. There’s no limit on payments for medical expenses.

Premiums since have gone down yearly by less than 10 percent; insurer profits climbed to an average of 20 percent in 2006.

But Florida premiums are still highest in the nation, a national survey shows. Those high prices, a high number of lawsuits, liberal bankruptcy laws, a squeeze in physician income and other factors have persuaded 5,200 Florida doctors — 3,450 in South Florida — to go without coverage, physicians and insurance officials said

Many physicians argue that malpractice insurance makes them targets for suits when a patient’s health goes bad, even if there’s no fault. Coral Springs cardiologist Alan Rosenbaum said he dropped coverage in December after his insurer paid $1.2 million to settle two suits in which he felt blameless.

“I have a strong feeling I’ll never hear from another attorney again,” Rosenbaum said. “Sure, I’m nervous. But I practice carefully. The first thing lawyers do when they have a case is [check] all the doctors involved to see who has how much coverage.”

Financial advisors now specialize in sheltering doctors’ assets from malpractice verdicts. Marc Singer, a partner at Singer Xenos Wealth Management in Coral Gables, said he advises doctors to drop coverage and, if sued, offer the patient a choice: a small settlement or get nothing when the doctor goes bankrupt.

“The idea here is not to beat the patient, the idea is to lower the expectations of the plaintiff’s attorney,” Singer said.

Bankruptcy has become a growing option for uninsured doctors, experts said. Federal and state laws shield the main home, retirement accounts, annuities and life insurance from malpractice awards.

Uninsured Juno Beach neurosurgeon Jacques Farkas filed for bankruptcy in 2004 after two patients sued. In the more severe case, a paralyzed man said in a lawsuit that his brain was pierced by a back rod Farkas implanted badly. Bankruptcy court records show Farkas sheltered $2.6 million in assets, including a $1.6 million oceanfront home. His payout to creditors: $16,200. The two patients got nothing.

“Fair or not fair… he did what the law allowed,” said Charles Cohen, a Farkas attorney who said the doctor denies wrongdoing in the surgeries.

Attorneys said declaring bankruptcy gives doctors another edge. If a malpractice award does not get paid because of bankruptcy, the state no longer considers a doctor in violation for not paying it, preserving his or her medical license. Only a handful of doctors have lost licenses for not paying.

Still, uninsured doctors risk a lot if they have not properly sheltered their nest eggs, said Bob White, president of First Professionals Insurance, Florida’s largest malpractice carrier. What’s more, the size of malpractice verdicts has been growing.

But White does not favor making doctors buy insurance, saying some doctors may leave the state if forced to take on the cost.

Malpractice attorney Stuart Ratzan and others counter that Florida’s present laws may attract doctors who have been sued in other states and can’t get coverage.

Six states require doctors to be insured, and eight require it in certain circumstances, the American Medical Association said.

In many states, hospitals require doctors be covered to see patients there. But not all in Florida do so. Also, courts have ruled hospitals cannot be held legally liable if doctors drop coverage.

Bob LaMendola can be reached at [email protected] or 954-356-4526 or 561-243-6600, ext. 4526.

Is your doctor covered? Check out your doctors on our new database, where you can check medical malpractice coverage and disciplinary history.

Sun-Sentinel.com/doctors

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To see more of The South Florida Sun-Sentinel or to subscribe to the newspaper, go to http://www.sun-sentinel.com/.

Copyright (c) 2008, South Florida Sun-Sentinel

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Lewis, Paul C

In this issue of MEDSURG Nursing, we are fortunate to have an article written by a nursing expert in the areas of tobacco use, addiction, and abstinence. Dr. Lewis provides an overview of the prevalence of tobacco use and the risks of exposure to tobacco and second-hand smoke for both adults and adolescents. He explains the challenges surrounding smoking cessation and encourages abstinence, starting at the grade school level. He concludes by emphasizing that nurses can provide a vital role in addressing this continued public health crisis. Additionally, Web sites that contain valuable information regarding smoking are included. A future article in MEDSURG Nursing will focus on tobacco cessation programs, new national guidelines, and policy implications. – Linda H. Yoder, PhD, MBA, RN, AOCN(R), FAAN

Cigarette smoking among adults has remained at about 20.8% since 2004 (Centers for Disease Control and Prevention [CDC], 2005b). Those most likely to smoke include men, adults less than age 40, and those living below the poverty line. American Indians/ Alaskan Natives smoke at a much higher rate (32.4%) than non- Hispanic Blacks (23.0%), non-Hispanic Whites (21.9%), or Hispanics (15.2%). Cigarette smoking among adolescents has stopped declining since 2005 at a level of 23% (CDC, 2005c, 2005d). Adolescent males and females are equally likely to smoke (22.9% vs. 23.0%), with White adolescents smoking more often (25.9%) than Hispanic (22.0%) or non- Hispanic Black (12.9%) adolescents.

While most people recognize the harmful effects of tobacco use, and particularly smoking, few are able to quit easily. Relapse is common among people trying to quit, with up to a 80% relapse rate (U.S. Department of Health and Human Services [HHS], 2006). Additionally, most people experience a relapse in the first 3 months after the quit attempt (National Institute on Drug Abuse, 2006). Only about 6% of those who try to quit are successful for over a month.

Tobacco use is particularly difficult to address because the addiction produced by nicotine is very strong; the cravings and withdrawal symptoms have been compared to those of cocaine (HHS, 1988). More than 4,000 individual chemicals have been identified in tobacco (see Table 1), including more than 60 that are known carcinogens (cancer-causing agents) (see Table 2). Cigarette smoking accounts for at least 30% of all cancer deaths. It is a major cause of cancers of the lung, larynx, oral cavity, pharynx, esophagus, and bladder, and it contributes to the development of cancers of the kidney, pancreas, cervix, and stomach (HHS, 2004). Smoking also is a major contributor to heart disease, aneurysms, bronchitis, emphysema, male and female reproductive diseases, and stroke. Smoking will worsen existing pneumonia and asthma significantly. Among pregnant women, smoking has been linked to low-birth-weight infants, miscarriages, and infant deaths (HHS, 2001).

Even more problematic is the fact that most tobacco use begins in adolescence, with the risks of negative health consequences unlikely to be a sufficient deterrent during the developmental stage marked by a sense of immortality. Adolescents seem to develop addictive symptoms very quickly and very early in their experimental smoking careers; once addicted, few stop until well into their adult years. An overview of tobacco use, the effects of smoking, theories on why people smoke, and how nursing can affect this public health crisis will be provided.

The Prevalence of Tobacco Use in the United States

Nicotine, in its various delivery forms of cigarettes, cigars, pipes, and chewing tobacco, is one of the most heavily used addictive drugs in the United States (National Institute on Drug Abuse, 2008). An estimated 45.1 million Americans currently smoke, which equates to about 21% of the population or more than one out of five people. Almost 24% of those ages 18 to 44 are current smokers, compared to 10.2% in those age 65 or older (CDC, 2007). Nationwide, 22.3% of high school students and 8.1% of middle school students were smoking in 2004 (CDC, 2005c, 2005d). About an equal number of males and females smoked cigarettes, but more White and Hispanic youth smoked than African-American youth (see Table 3).

Overall, almost an equal percentage of adults smoke compared to adolescents (20.9% vs. 22.5%), which is consistent with the fact that the majority of smokers begin before they are 18 years old (HHS, 1995). There is, however, a slightly smaller percent of females who smoke as adults than smoke as adolescents (18.5% and 22.4 respectively) (see Table 4). When broken down by race/ ethnicity, every adolescent category has a higher percentage of smokers with the exception of Black, non-Hispanic smokers. About 20.2% of adult Black non- Hispanics smoke compared to only 11.4% of adolescent Black non- Hispanics (CDC, 2005b, 2006).

Smoking on average reduces an adult’s life expectancy by about 14 years (CDC, 2005a). Tobacco use does not lead quickly to death. Smoking will affect first a person’s health by damaging internal organs. The CDC estimated in 2000 that around 8.6 million people had a chronic illness because they were either current or former smokers (CDC, 2005a). The most common diseases experienced by smokers include chronic bronchitis, emphysema, heart attacks, strokes, and cancer (HHS, 2004).

Smoking is responsible for an estimated 437,000 premature deaths each year, (CDC, 2005a). From 1997 to 2001, smoking-attributable health care expenses and lost productivity as a result of smoking exceeded $167 billion a year, while state-based investment in prevention and control programs was 200 times less (CDC, 2005a).

Smokeless Tobacco: A Good Alternative?

Because many of the dangers of tobacco have been linked to the smoke, people who use smokeless tobacco may feel they are at less risk by choosing a safer alternative to smoking. Smokeless tobacco (SLT) includes dip (or snuff), chew, and leaf tobacco. Smokeless tobacco was used commonly on this continent during the 1600s after being introduced by John Rolfe. It was touted to have medicinal value in alleviating toothaches, disinfecting cuts, relieving insect or snake bites, and preserving and whitening teeth (HHS, 1986), all of which subsequently have been proven untrue.

Today an estimated 8% of children in high school (CDC, 2005c, 2005d) and 2.3% of adults (CDC, 2006) are SLT users in the United States. SLT use is most predominant among White males. However, American Indians/Alaskan Natives have a higher usage among adults (9%) (Substance Abuse and Mental Health Services Administration [SAMHSA], 2006), while Whites have a higher usage among adolescents (10.2%) (CDC, 2005c, 2005d) (see Table 5).

The nicotine from SLT is absorbed readily through the mucous membranes. Placing tobacco in the mouth introduces about twice the dose of nicotine as a standard 1 mg cigarette. Therefore, a person who uses 8 to 10 dips a day is receiving the equivalent nicotine dose to someone who smokes 30 to 40 cigarettes per day (Massachusetts Department of Public Health, 2007). SLT is a known human carcinogen that contains over 28 cancer-causing agents. While the incidence of lung cancer is lower, SLT users have an increased risk for oral cancer which can form in as little as 5 years of starting SLT use (Hatukami & Severson, 1999).

Second-Hand Smoke: What Is The Cost of this Hand-Me- Down?

Being exposed to secondhand tobacco smoke (SHS) also poses a serious health risk. Second-hand smoke, which has also been called environmental tobacco smoke, comes from either sidestream smoke (from tobacco left burning) or exhaled mainstream smoke (smoke exhaled by the person smoking). SHS contains 250 toxic chemicals, with at least 50 designated as known human carcinogens. These toxic and carcinogenic chemicals are the same as those found in inhaled tobacco smoke, including formaldehyde, benzene, vinyl chloride, arsenic, ammonia, and hydrogen cyanide. Due to the different temperature at which tobacco burns, sidestream smoke actually contains a higher concentration of certain toxins than the inhaled tobacco smoke (HHS, 2006). Because many toxins are released, no minimum level of SHS has been deemed safe. All sidestream or exhaled mainstream SHS has been designated as a known carcinogen (U.S. Environmental Protection Agency [EPA], 1992).

Nonsmokers are not exempt from the negative health effects of SHS. Within minutes of a nonsmoker’s exposure to a smoky environment, the platelets will become stickier and damage to the lining of the blood vessels begins. Decreased coronary blood flow and decreased heart rate variability occur. In people with pre- existing cardiac disease, the risks increase. Those with sensitive airways will begin to experience shortness of breath, phlegm production, and a cough. People with respiratory diseases, such as asthma, are at high risk for rapidly worsening symptoms. Long-term exposure to SHS by nonsmokers has been linked to a significant increase in heart disease and about a 20% to 30% increased risk of developing lung cancer (HHS, 2006). Children who live in homes with parents who smoke, particularly the mother, are at greater risk for middle ear infections, bronchitis, pneumonia, asthma exacerbations, and even sudden infant death syndrome (Gaffney, 2001; Mannino, Homa, & Redd, 2002). Up to 300,000 annual cases of bronchitis and pneumonia in children less than age 18 months are due to SHS exposure. As many as 1,000,000 children have their asthma worsened annually by exposure to SHS (EPA, 1992). The greatest exposure for SHS is from the home environment (Martin, Feyerbend, Bryant, Hedges, & Primatesta, 2001; Okah, Choi, Okuyemi, & Ahluwalia, 2002). However, significant exposures to SHS have been seen even among children in homes where smoking has been banned (Hopper & Craig, 2000). The particles of SHS tend to be smaller, and therefore stay airborne longer than mainstream smoke. This also results in the particles being distributed rapidly and evenly by convection throughout any enclosed space (HHS, 2006; Woodward & Al-Delaimy, 1999). The Surgeon General concluded that fully eliminating all smoking from indoor areas is the only reliable means of protecting nonsmokers from the ill effects of SHS (HHS, 2006).

Learning the Negative Effects Of Tobacco

Tobacco has been a part of the fabric of American life since the time of the first settlers and has been a major cash crop for several hundred years. This public perception has been further supported by very effective marketing campaigns by the tobacco industry (CDC, 2006; Federal Trade Commission, 2007). Only relatively recently did the scientific community start to take a closer look at the impact tobacco has on the health of its users. The dangers of cigarette smoking first came to public attention in 1962, when the Surgeon General issued a report on the harmful effects of tobacco (HHS, 1964). A second report from the Surgeon General 20 years later identified cigarette smoking as the major single cause of cancer deaths in the United States (Office of the U.S. Surgeon General, 1982), a distinction that continues to be true today. Not until 32 years after the Surgeon General’s report did the American Psychiatric Association (1994) include nicotine dependence in its Diagnostic and Statistical Manual of Mental Disorders (DSM- IV). The U.S. Food and Drug Administration determined 12 years ago that nicotine was an addictive substance and that most tobacco users continued to use tobacco to satisfy that addiction (Kessler, Barnett, Zeller, Mande, & Schultz, 1997). Continuing research into the many harmful effects of tobacco prompted the Surgeon General to issue a report stating that smoking has now been shown to have a negative health effect on nearly every organ of the body (HHS, 2004).

However, despite research that consistently finds harmful effects from tobacco use or even exposure to tobacco smoke, tobacco use continues to be normalized in the media, which in turn influences adolescent smoking behavior (Pierce, Distefan, Jackson, White, & Gilpin, 2002; Sargent et al., 2000, 2001). Tobacco is an identified addictive and carcinogenic drug but it continues to be so accepted in the United States that over 95% of kindergarten students can correctly identify cigarettes (Hahn et al., 2000). As the science has advanced, the public’s perception of the dangers posed by tobacco has not seemed to keep pace.

Why Do People Start Using Tobacco?

With literature showing the harmful, usually irreversible, effects of tobacco, why do people continue to use it? Unfortunately, the answer is not as simple as could be expected. Almost 80% of all smokers start before age 18 (HHS, 1995) and some begin before age 12 (CDC, 1995). Each day in the United States, approximately 4,400 adolescents ages 12- 17 initiate smoking (SAMHSA, 2003). The earlier that adolescents begin to use tobacco, the heavier their usage as adults is likely to be (HHS, 1995); half of all adolescent smokers will still be smoking over 16 years later (Pierce & Gilpin, 1996). The difficulty with preventing adolescents from using tobacco is that often they do not consider the long-term health effects of tobacco use. Adolescents have said they use tobacco for reasons ranging from positive mood enhancement (Blitstein, Robinson, Murray, Klesges, & Zbikowski, 2003) to peer pressure (McFeely, 2001) and weight control (Blitstein et al., 2003). However, some adolescents may be at risk for smoking based solely on other factors, such as low self-esteem (Lewis, Harrell, Bradley, & Shibing, 2001), low socioeconomic status (Gilman, Abrams, & Buka, 2003), or low parental connectedness (Tilson, McBride, Lipkus, & Catalano, 2004), or because of gender or ethnicity (Blitstein et al., 2003).

Why Don’t More People Quit? Tobacco Use: Dependence And Addiction

The tobacco companies continually develop new products in an effort to entice new users. They introduce specific products with a specific audience in mind. For instance, women have been targeted with ads proclaiming the social desirability of smoking, independence, and weight control, all delivered in pink cigarette packs (Campaign for Tobacco-Free Kids, 2007; HHS, 2001). Adolescents also have been targeted with pleasing flavors added to cigarettes, cigars, and smokeless tobacco (Campaign for Tobacco-Free Kids, 2008). One large tobacco company admitted to targeting media promotions to adolescents while another tobacco company used cartoon characters to lure adolescent interest (HHS, 2000).

Whatever the reason to try tobacco, the outcome remains the same: nicotine is introduced to the body. Nicotine exposure has long been recognized as the primary active and addictive substance in tobacco that leads to physiological addiction (HHS, 1988). Nicotine is known to activate neuronal nicotinic receptors in the mesolimbic dopamine system (Trauth, Seidler, McCook, & Slotkin, 1999). Animal models have shown that once these receptors become sensitized to nicotine, they will remain hypersensitive to the psychomotor activating effects of nicotine for extended periods (Garrett, Dwoskin, Bardo, & Henningfield, 2003; Robinson & Berridge, 2000). Sensitization also has been demonstrated with infrequent nicotine administrations (i.e., once a week) and persisted over 21 days with no additional nicotine exposure (Miller, Bardo, Crooks, & Dwoskin, 2001).

An important distinction should be made with regard to tobacco addiction. When a person is exposed to nicotine a number of times and links to that exposure are made with repetitious behaviors (smoking behaviors), a dual dependence will develop. While some put both under the heading of addiction, the syndrome is clearer if broken out separately. In regard to tobacco use, a difference exists between dependence and addiction. Dependence is “cravings of the mind” (Lewis, 2005). This refers to the behavioral consequences of smoking. Dependence is characterized by urges which can be satisfied by the motions and sensations of smoking, a phenomenon called classical conditioning. The act of smoking, for instance, gives a degree of relief even before the nicotine is introduced into the system. Symptoms of dependence may include depression, anxiety, tension, restlessness, and the urge to smoke. Addiction, on the other hand, is “cravings of the body.” This refers to the persistent neurobiological sensitization and the visceral felt need for smoking. It is characterized by cravings that can be alleviated only by nicotine administration in any form. Symptoms of addiction may include irritability, somatic complaints, cognitive deficits, and withdrawal discomfort (Lewis, 2005).

The dopamine system in the human brain is responsible for the sense of reward and pleasure. It is the same system that is activated by cocaine, heroin, and marijuana (National Institute on Drug Abuse, 2008), confirming why abstinence from tobacco is very problematic in the individual addicted to nicotine. When the dopamine system is activated, the person begins to feel relaxed and slightly euphoric. This feeling may become very welcome to youth seeking a cheap “high” or the busy executive who is seeking a stress break from a hectic schedule. Very aware of this phenomenon, the tobacco companies have altered advertising techniques over time to target different groups of regular smokers and potential smokers (Slater, Chaloupka, Wakefield, Johnston, & O’Malley, 2007). The effects of the nicotine will be felt within seconds of the first inhalation from the cigarette or placement of the dip/chew into the mouth. This quick coupling of the tobacco use behavior and seemingly immediate effect of the nicotine is essential for the classical conditioning to occur, which further guarantees longevity in tobacco use.

Once the brain receptors become sensitized by the introduction of nicotine, they begin to cause the person to seek tobacco. These receptors are linked to the dopamine system; each time they are stimulated by nicotine, a sense of well-being is given to the person. In relatively short order, with only a few nicotine exposures, this up-regulation and repeated stimulation of the nicotinic receptors leads to the physiological addiction. If the nicotine-addicted person does not reintroduce nicotine at regular intervals, he or she may begin to experience withdrawal symptoms. Each of these repeated pairings of smoking and the release of dopamine secondary to the nicotine begins to condition the person to the stimuli of smoking. In Pavlovian fashion, with repeated pairings of the smoking actions and nicotine stimulation of the receptors, the person begins to associate the very act of smoking with the sense of well-being. An established smoker will begin to feel this sense of satisfaction even before lighting the cigarette. In this manner, the action of smoking becomes part of the behavioral addiction. Ironically, this behavioral stimulation of addiction may be more difficult to extinguish in many cases than the actual nicotine addiction itself.

Abstinence, Not Quitting, Is The Key

As knowledge of the dangers of smoking has grown, so has knowledge of the difficulties of cessation attempts. Because nicotine has been recognized as a highly addictive drug, research has led to application of the concept of abstinence. Smokers previously were encouraged to quit and told they would be cured once they stopped smoking. Unfortunately, as many as 80%-90% of those who try to quit return to regular smoking within a year. This quit failure rate increases to around 97% if the person has a smoking lapse (defined as smoking on 3 or more consecutive days) (Shiffman et al., 1996). Scientists and clinicians alike began to realize that nicotine abstinence was a long-term issue and that former tobacco users needed to stay away from tobacco or risk falling back into the addiction trap. The primary metabolite of nicotine, cotinine, has a half life of 16 to 20 hours; the drug clears the system within 2 days (Moolchan, Ernst, & Henningfield, 2000). However, a person can relapse into tobacco use months or years after quitting, and resume former levels of tobacco use as a result of numerous issues. The person has physiologic changes as a result of formerly smoking and those neuroreceptors are primed and waiting for nicotine. These sensitized receptors remain primed for any future nicotine exposure. The second piece to the late relapse is due partly to the behavioral conditioning, or the dependence described previously, that has accompanied the tobacco habit. The person decides that he or she needs a cigarette to help with a stressful day, remembering either consciously or unconsciously that stress relief was achieved in the past with nicotine. The sense of well-being from the dopamine release also is recalled. The person even may experience the urge to smoke based on the behavioral conditioning. From anecdotal interviews, this urge may take up to a year to lessen and may never extinguish completely. Once nicotine reaches the sensitized receptors, the addiction cycle escalates in a much quicker fashion than it did initially. Whereas the person may have taken 1-2 years to reach an equilibrium of tobacco intake, he or she will achieve that usage level within days when a relapse occurs.

For these reasons, the traditional approach of smoking cessation is no longer thought to be appropriate. Given the significant addictive aspects of tobacco, lapses in quit attempts are recognized as in other drug treatment programs. Recent programs expect lapses (temporary tobacco use) and differentiate that from a full relapse (regular daily use). This subtle change in paradigm helps the person trying to stop using tobacco understand the long-term ramifications of the decision to quit. Many people seek the quick solution seemingly offered by many new drugs on the market today. However, it generally takes around 12 weeks to get past the nicotine cravings (based on standard medication treatment schedules), and over a year to have a lessening of behavioral urges to use tobacco. Most people attempting abstinence have been smoking for many years and smoking has become part of their daily behavior. It is important to put that into perspective for the individual who wants to stop using tobacco. What has been a reinforced behavior over years is unlikely to disappear rapidly through an intervention such as taking a pill for only 3 months. It also should be noted that any reduction in smoking or days of abstinence reduce health consequences. It is never too late to quit (HHS, 2004).

What Can Nurses Do To Help?

One thing has been shown consistently to help people quit smoking – talking to them. Not everyone is ready to quit smoking when he or she arrives at a hospital or clinic, even after having a heart attack. What seems to be simple to health care providers may be more than the patient can accept along with the stress of a health problem. The patient has to be ready to quit before he or she is able to quit. However, research indicates that many inpatients may be ready to quit; 22%-30% of inpatients who are offered a method to quit while hospitalized eventually will quit successfully (Chouinard & Robichaud-Ekstrand, 2005). The U.S. Public Health Service Clinical Treatment Guidelines confirm that the more frequently a smoker talks with his or her doctor, nurse, pharmacist, or other health care provider, the greater the chance that he or she will be successful in the attempt to quit smoking (HHS, 2008). Medical-surgical nurses are in an excellent position to approach the patient. A recent health scare or near-miss may create readiness in a patient to consider quitting. Teaching about smoking cessation should be a part of discharge instructions for any smoker, regardless of the reason for admission. Even though a patient currently may not want to stop, providing information may serve as the impetus to get him or her ready to attempt to quit. If a health care facility has a smoking cessation program, the nurse should encourage the patient to participate. The most successful programs incorporate counseling, medications, and a support group activity, dealing with both the addiction and the dependence. Any aspect of such programs is more effective than the person attempting to quit “cold turkey” (Mermelstein, 2003).

A patient often looks to a trusted nurse for advice and assistance. However, that trust may be undermined if the nurse who counsels smoking cessation is continuing to smoke as a personal habit. Smoking rates among nurses may be as high as 22% (Chalmers, Seguire, & Brown, 2002; Patkar, Hill, Batra, Bergare, & Leone, 2003). A nurse will be more effective as a role model by displaying the preferred patient behavior. A nurse is aware of the harm related to smoking and second- hand smoke, and should lead the campaign for a new paradigm of nonsmoking for everyone. Few things will make a bigger health impact on the population than to encourage smoking cessation, first among nurses, and then across the nation.

Conclusion

Tobacco use remains high in the United States and may even be increasing among adolescents, the highest risk group (CDC, 2005c, 2005d). All forms of tobacco are harmful to the human body, increasing the risk for numerous cancers and other diseases. Nicotine is a highly addictive drug and even limited exposure may “hook” a person for almost 20 years. Nurses should take a stand against this significant national health threat by becoming involved with tobacco cessation classes and participating in events such as the Great American Smoke Out sponsored by the American Cancer Society. Most importantly, nurses can be health advocates for patients. Nurses can educate the public about the dangers of tobacco use, offer them assistance to quit, and be persistent in terms of follow up and encouragement.

Table 1. Partial Listing of Ingredients in Cigarettes

Acetone

Methane

Arsenic

Nicotine

Vinyl chloride

Stearic acid

Acetic acid

Butane

DDT/Dieldrin

Hexamine

Nitrous oxide phenols

Hydrogen cyanide

Ammonia

Naphthalene

Cadmium

Carbon monoxide

Ethanol

Methanol

Nitrobenzene

Toluene

Formaldehyde

Source: Massachusetts Department of Public Health, 2007.

Table 2. Known Carcinogens in Tobacco

Nitrosamines

Benzo(a)pyrene

Polycyclic aromatic hydrocarbons

Urethane

Crysenes

Polonium 210

Dibenz acidine

N. Nitrosonornicotine

Cadmium

Nickel

B-Napthylamine

Toluidine

Source: Massachusetts Department of Public Health, 2007.

Web Sites With More Information

General Information

American Lung Association

http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22938

American Cancer Society

http://www.cancer.org/docroot/PED/ped_10.asp?sitearea=PED

American Legacy Foundation

http://www.americanlegacy.org/

C-Change (see Publications and Reports, as well as Calls to Action on this site)

http://www.c-changetogether.org

Campaign for Tobacco-Free Kids

http://www.tobaccofreekids.org/

Centers for Disease Control and Prevention

http://www.cdc.gov/tobacco/

National Cancer Institute

http://www.cancer.gov/cancertopics/smoking

Quit Assistance

Great American Smokeout

http://www.cancer.org/docroot/subsite/greatamericans/ Smokeout.asp

American Cancer Society’s Guide to Quitting Smoking

http://www.cancer.org/docroot/PED/content/PED_10_13X_Guide_for_ Quitting_Smoking.asp

SmokeFree

http://smokefree.gov/

National Cancer Institute

http://www.cancer.gov/cancertopics/tobacco/quittingtips

U.S. Department of Health and Human Services (includes patient handouts)

http://www.surgeongeneral.gov/tobacco/

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Lewis, P. (2005). Secondhand tobacco smoke and adolescent smoking cessation behaviors.Unpublished doctoral dissertation. University of Kentucky, Kentucky.

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Patkar, A., Hill, K., Batra, V., Bergare, M., & Leone, F. (2003). A comparison of smoking habits among medical and nursing students. Chest, 124, 1415- 1420.

Pierce, J., Distefan, J., Jackson, C., White, M., & Gilpin, E. (2002). Does tobacco marketing undermine the influence of recommended parenting in discouraging adolescents from smoking? American Journal of Preventative Medicine, 23(2), 73-81.

Pierce, J., & Gilpin, E. (1996). How long will today’s new adolescent smoker be addicted to cigarettes? American Journal of Public Health, 86(2), 253- 256.

Robinson, T., & Berridge, K. (2000). The psychology and neurobiology of addiction: An incentive-sensitization view. Addiction, 95(Suppl. 2), S91-S117.

Sargent, J., Beach, M., Dalton, M., Mott, L., Tickle, J., Ahrens, B., et al. (2001). Effect of seeing tobacco use in films on trying smoking among adolescents: Cross sectional study. British Medical Journal, 323(7326), 1394-1397.

Sargent, J., Dalton, M., Beach, M., Bernhardt, A., Heatherton, T., & Stevens, M. (2000). Effect of cigarette promotions on smoking uptake among adolescents. Preventative Medicine, 30, 320-327.

Shiffman, S., Hickcox, M., Paty, J.A., Gyns, M., Kassel, J.D., & Richards, T.J. (1996). Progression from a smoking lapse to relapse: Prediction from abstinence violation effects, nicotine dependence, and lapse characteristics. Journal of Consulting and Clinical Psychology, 64, 993-1002.

Slater, S., Chaloupka, F., Wakefield, M., Johnston, L., & O’Malley, D. (2007).The impact of retail cigarette marketing practices on youth smoking uptake. Archives of Pediatric and Adolescent Medicine, 161, 440-445.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2003). 2001 national household survey on drug abuse: Trends in initiation of substance abuse. Retrieved June 24, 2005, from http://www.oas.samhsa. gov/nhsda.htm#2k1NHSDA

Substance Abuse and Mental Health Services Administration (SAMHSA). (2006). Results from the 2005 national survey on drug use and health: Detailed tables. Retrieved March 30, 2008, from http:// oas.samhsa.gov/ NSDUH/2k5nsduh/tabs/Sect2peTabs 37to41.pdf

Tilson, E., McBride, C., Lipkus, I., & Catalano, R. (2004).Testing the interaction between parent-child relationship factors and parent smoking to predict youth smoking. Journal of Adolescent Health, 35,182-189.

Trauth, J., Seidler, F., McCook, E., & Slotkin, T. (1999). Adolescent nicotine exposure causes persistent upregulation of nicotine cholinergic receptors in rat brain regions. Brain Research, 851, 9-19.

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U.S. Department of Health and Human Services (HHS). (1995). Youth and tobacco – Preventing tobacco use among young people: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

U.S. Department of Health and Human Services (HHS). (1998). Tobacco use among U.S. racial/ethnic minority groups – African Americans, American Indians and Alaska natives, Asian Americans and Pacific Islanders, and Hispanics: A report of the Surgeon General.Washington, DC: Author.

U.S. Department of Health and Human Services (HHS). (2000). Reducing tobacco use: A report of the Surgeon General.Atlanta, GA: U.S. Department of Health and Human Services and Centers for Disease Control and Prevention.

U.S. Department of Health and Human Services (HHS). (2001). Women and smoking: A report of the Surgeon General.Washington, DC: Author.

U.S. Department of Health and Human Services (HHS). (2004). The health consequences of smoking: A report of the Surgeon General. Atlanta, GA: Author.

U.S. Department of Health and Human Services (HHS). (2006). The heath consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

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Additional Readings

Bono, R., Russo, R., Arossa, W., Scurasatone, E., & Gilli, G. (1996). Involuntary exposure to tobacco smoke in adolescents: Urinary cotinine and environmental factors. Archives of Environmental Health, 51(2), 127-131.

Cook, D., & Strachan, D. (1999). Health effects of passive smoking: Summary of effects of parental smoking on the respiratory health of children and implications for research. Thorax, 54(4), 357- 366.

Dappen, A., Schwartz, R., & O’Donnell, R. (1996). A survey of adolescent smoking patterns. Journal of American Board of Family Practice, 9(1), 7-12.

DuRant, R., & Smith, J. (1999). Adolescent tobacco use and cessation. Primary Care: Clinics in Office Practice, 26(3), 553- 574. Miller, N., Smith, P., DeBusk, R., Sobel, D., & Taylor, C. (1997). Smoking cessation in hospitalized patients: Results of a randomized trial. Archives of Internal Medicine, 157(4), 409-415.

Shaham, Y., Adamson, L., Grocki, S., & Corrigall, W. (1997). Reinstatement and spontaneous recovery of nicotine seeking in rats. Psychopharmacology, 130, 389-403.

Simon, T., Sussman, S., Dent, C., Burton, D., & Flay, B. (1995). Prospective correlates of exclusive or combined adolescent use of cigarettes and smokeless tobacco: A replication-extension. Addictive Behavior, 20(4), 517-524.

Paul C. Lewis, PhD, FNP-C, RN, is a Nurse Researcher, U.S. Army. He has been on active duty for over 20 years.

Notes: This column is made possible through an educational grant from C-Change, a 501(3)c (not-for-profit) organization. The purpose of the Cancer: Caring and Conquering column is to strengthen the cancer knowledge, skills, and confidence of medical-surgical nurses who care for patients at risk for or living with cancer.

C-Change is a not-for-profit organization whose mission is to eliminate cancer as a public health problem, at the earliest possible time, by leveraging the expertise and resources of our members. C-Change is the only organization that assembles cancer leaders from the three sectors – private, public, and not-for- profit – from across the cancer continuum – prevention, early detection, treatment, and quality of life. C-Change invests in the resolution of problems that cannot be solved by one organization or one sector alone. For more information about C-Change, visit www.c- changetogether.org.

The author and all MEDSURG Nursing Editorial Board members reported no actual or potential conflict of interest in relation to this continuing nursing education article.

The opinions or assertion contained herein are the private views of the author and should not be construed as official or as reflecting the views of the U.S. Army Medical Department, Department of the Army or the Department of Defense.

Copyright Anthony J. Jannetti, Inc. Jun 2008

(c) 2008 Medsurg Nursing. Provided by ProQuest Information and Learning. All rights Reserved.

By Malcolm Venable, The Virginian-Pilot, Norfolk, Va.

Jul. 27–One Saturday evening in spring, female impersonators strutted, sashayed and lip-synched to R&B and gospel songs at a Norfolk banquet hall while guests showered them with dollar bills. People feasted on a down-home spread of green beans, fried chicken and macaroni, on tables sprinkled with confetti.

Presiding over it all in a crimson evening gown was Vega Perry, who played the part of the regal, occasionally bawdy hostess. She threw the party to thank supporters of her business, Miss Models Inc., which puts on pageants for local members of the transgender community.

“Please be aware,” she said with sugary aplomb, stepping gingerly over the microphone’s cord, “that there is no alcohol to be consumed on the premises. Please do not embarrass me by violating this policy. I thank you so much. Up next we have… “

Vega, of Norfolk, is a pro at this. She’s managed hundreds of pageants and balls for “gender illusionists” up and down the East Coast.

It wasn’t long ago, though, that she was onstage herself, agonizing over the right wig and eyelashes to create a flawless routine. But to look like a beautiful woman instead of the man she was at birth, she played a decade-long, dangerous game of medical roulette.

Around 2002, she lost.

Vega paid a friend to shoot liquid silicone directly into her legs and hips to make them rounder, more feminine. The procedure is called pumping, and it’s well-known among members of the local transgender community.

Pumping is illegal and risky, but it’s a cheap alternative to the extensive cosmetic surgery required to turn a man into a woman. Often, people who pump experience no immediate adverse side effects. Yet things can go horribly awry. Vega barely escaped death and is reminded every day of that close call by discolorations along her legs that ended her competition days.

“The type of showgirl I am now,” she said, “I don’t wear anything too revealing because I couldn’t compete in a portion where I would have to show hip. I would be so self-conscious.”

To win pageants like the ones Vega hosts, a padded bra won’t cut it. Contestants need to look as much like ladies as possible.

The rewards can be great. Many drag pageants are surprisingly professional, sometimes lavish affairs with all the stuff you’d see at Miss America: talent competitions, swimwear, midfinals and finals. Bigger pageants award prizes in the tens of thousands of dollars; one gives cash, a new car and a per diem for all-expenses-paid cross-country appearances.

And so, in order to seize that tiara and all its glory, Vega, 38, and many others like her on the pageant circuit have gladly taken a needle or two.

The legal method of getting silicone is through a physician, and in the form of implants, which keep the substance safely encased in pouches. But with pumping, a friend or “doctor” met through word of mouth injects the stuff directly under a customer’s skin.

Like street drugs, silicone can be pure or cut with something else, such as baby oil. “Sil doctors,” as they’re called, can use medical-quality material or the sealant you buy at an auto parts or hardware store.

The liquid can migrate to other parts of the body. It can harden and form clumps. Tissue can become infected and fill with pus. Cases in which people died, sometimes within hours of an injection, have made the national news.

Many times, though, nothing bad happens. For a few hundred dollars, someone who has spent his entire life feeling as if he was born the wrong gender can do something about i t.

Vega grew up in a stable, loving, two-parent home in Newport News, with a family who supported her when she was a feminine gay boy.

By 19, she was performing in pageants in Hampton Roads and along the East Coast. But after a while she was ready to change, ready to live as a woman all the time. So on a summer day in 1992, she went to a friend’s house in the Lynnhaven section of Virginia Beach to get silicone in her face, to round out her cheekbones.

“I wasn’t nervous,” Vega said. “I just wanted it so bad. I wanted to look as convincing as possible and wanted to soften up my look. I reserved in the back of my mind that, ‘If you really want the silicone, Vega, you have to lay there and accept the pain.’ “

The house was clean and well-decorated, she remembered.

The “doctor” was a transsexual named Michelle, in town from Florida. In exchange for hosting Michelle and allowing her to inject other people, the Virginia Beach friend received a commission — free injections, cash or both.

Michelle had access to high-quality silicone, and she was known for good work. Over the course of a weekend, Vega said, as many as 50 transgender women would see Michelle. She wouldn’t even come to Hampton Roads unless she knew there’d be at least $10,000 waiting for her.

When Vega arrived, five others were waiting; it was what’s called a “pumping party.” Those getting major work — adjustments of the hips, buttocks and thighs — went first because Michelle didn’t want to run out of silicone for clients spending the most.

When it was her turn, Vega went into her friend’s bedroom and saw a hospital bed, which Michelle had rented. That made Vega feel safe.

Tools were laid out on white towels on a dresser. Michelle was adamant about not using a needle twice; she liked for you to see a fresh needle coming out of a pack, Vega said, and after she was done she would drop it into a biomedical waste container. She even changed the sheets after each customer.

“She wanted you to feel like you were coming into a doctor’s office,” Vega said.

Michelle numbed Vega with Novocain and, for $150, shot silicone into her face, starting at her temples and working down the side, with special emphasis on the fleshy area of the cheeks nicknamed the “apple.”

“The girls would be waiting for you to come out,” Vega said, “and they’d say, ‘Ooh, girl, that is flawless’ or, ‘I love it,’ “

State law makes it illegal to perform such procedures without a license. But it’s a healthy little industry in Hampton Roads, according to local transgender people, medical workers and a statewide transgender health survey.

The survey, conducted two years ago by researchers at Virginia Commonwealth University for the Virginia Department of Health, found that the eastern region of Virginia, including Hampton Roads, had the highest number of respondents in the state who admitted to getting silicone injections.

Three transgender people interviewed for this story — Vega and two others who did not want to be named because they still get pumped — said there are two to four practitioners in Hampton Roads, each with a thriving customer base.

Last August, a transgender woman named Frances White was arrested in Suffolk for injecting people with silicone in the lips, cheeks and breasts. She pleaded guilty in December and was sentenced to five years of supervised probation.

“If there is any humor in it,” said De Sube, a Norfolk transgender woman and activist for the Hampton Roads gay, lesbian, bisexual and trans community, “it’s that she was charged with ‘practicing medicine without a license.’ What she was doing isn’t medicine.”

Peggy Meder, a registered nurse who runs Skin, a Norfolk medical spa specializing in cosmetic injections, has been so concerned about pumping locally that she’s extended discounts to transgender people, so they’d have an alternative.

“Are these people medically trained?” she asks. “Do they clean needles? If a person gets an infection, where do they go? There are all kinds of things that can go wrong, from infection to lumps and bumps on their faces to tissue necrosis — which means the face goes dead. And that’s permanent. I have seen skin infections lead to death.”

White’s arrest was unusual locally, because people within the pumping culture don’t snitch. There was speculation that a nemesis or disgruntled customer ratted her out.

“I’m probably the only person in Portsmouth law enforcement that knows what it means to be pumped,” said Roberta Monell, a sheriff’s deputy who transitioned from male to female years ago. She has never been pumped but said she knows many people who have. “The only way it gets found out is if someone is not happy with the result or there’s some dispute over money.”

Ordinarily, a transgender person like Vega would begin his transformation by meeting regularly with a psychotherapist. Then he would receive female hormones from a physician, in the form of shots, pills, patches or a combination of them.

Then, after maybe a year, the next step would be small procedures, including electrolysis to remove body hair. Only after all this treatment, at a cost of thousands of dollars, would the patient begin full feminization through plastic surgery. That’s $20,000 to $150,000 more, typically not covered by insurance.

“Now imagine yourself coming from the projects facing all this,” said De Sube.

At one time, transgender people could have turned to a physician for the liquid silicone, but the potential dangers prompted the U.S. Food and Drug Administration in 1992 — the same year Vega got her first illegal shots — to order doctors to stop offering it.

The FDA approved silicone for fixing detached retinas in 1997, so some doctors have begun using it again, off label, for cosmetics. But it’s not recommended.

Many clinics offer other products that are believed to be safer for sculpting the face, but those injections are more expensive than silicone shots offered by unlicensed practitioners, and they’re temporary. Silicone is permanent.

In some circles, peer pressure encourages pumping. Especially vulnerable are teens who’ve been kicked out of their homes after revealing that they want to become women.

These young men are often adopted by a “mother” — another feminine man or transgender woman who heads a tribe. Driven by trauma, low self-esteem and a search for belonging, they turn to pumping as an easy, quick fix. Same for sex workers, for whom appearance is vital. Pumping is a rite of passage. Beauty is just a syringe away.

“They’re scared,” De Sube said. “They aren’t stupid. They understand the negative outcome. But they don’t have the medical ability to get it the right way. From their perspective, this is life-giving.”

Vega hosts a support group for trans women called TS Ladies Talk. They meet twice a month, talking over issues relevant to their community. Pumping comes up every so often, and although Vega does discourage the practice among her peers, she doesn’t sermonize.

“The reality is that it’s one of those things that girls are just going to do,” she said.

One way of minimizing the practice, the study from VCU and the Virginia Department of Health concluded, is to offer transgender people safer, more affordable medical care.

Park Place Medical Center in Norfolk started a program in April called Transition Your Life Clinic, in part as a response to the study.

The idea is to encourage transgender people to get routine health screenings and to discourage behaviors that could result in HIV infections. The program is modeled after Richmond’s Fan Free Clinic, which draws people from all over the state and is known for its transgender outreach program.

For half a day on Fridays, staff members at the cozy Park Place clinic see up to six trans people. Some can get prescriptions for hormones instead of buying them on the black market. The program is being paid for by the Health Department and a donation from the MAC cosmetic company’s AIDS fund.

“The basic concept is that if you make people feel good about themselves, the more likely they are to protect themselves and take care of their bodies,” said Dr. Subir Vij, a doctor at the clinic. “The reality is that many transgender people do not have doctors. They don’t feel comfortable going to other routine providers. We want to create that safe feeling for them and eventually have them adopt Park Place Medical Center as their home.”

Specialized medical care has been hard to find locally for transgender people — even those who don’t pump. When Tona Brown, a classical violinist living in Norfolk, was transitioning from man to woman in 2003, she had to go to Baltimore to find an endocrinologist.

She knows that there are people who will deem her transgender peers unworthy of sympathy, because, well, shouldn’t common sense stop them from getting shots with a used syringe full of silicone from a hardware store?

“People know they’re not supposed to have unprotected sex or use drugs, but they still do it,” Brown said. “You have to put yourself in their shoes. Be empathetic. What if you had breasts and you didn’t want them, and someone said they could remove them for $300?”

That’s the thing with pumping: It is so fast and so cheap that it’s very tempting. But then, the dream of a better life can quickly become a nightmare. One woman who has been pumped, but asked not to be named, said silicone “doctors” will sometimes half-joke, “Girl, if anything happens, I’m dropping you off in a Dum pster.”

Vega knows well what happens when pumping goes wrong, after that night six years ago.

A friend had offered to do the work as a way of advertising her expertise. She gave Vega a discount.

Vega had reservations but went ahead anyway. What could go wrong?

After three injections, she started getting worried.

“I’m more a lady,” she said. “I didn’t want a gigantic butt and wide hips, but she started pumping me really wider and wider. I said, ‘You have to stop.’ “

On the fourth shot, she began to bleed uncontrollably. Bleeding is common in pumping, and sometimes to contain it, the “doctor” will dab a bit of household glue on the site. But Vega didn’t want glue on an open wound, and anyway, no glue would hold this in — blood was gushing everywhere.

“I was scared,” Vega said.

A few hours later, she was wheezing, totally out of breath.

“It was like my lungs were giving out.”

She called her friend, who had pumped herself in the breast that same night; she was also feeling bad. At around 5:30 a.m., they went to the emergency room.

“On the way, she was afraid of me pointing at her as the one who did it,” Vega said. “I told her I would never tell them who did it, but I did tell her that I would have to let them know I had injections.”

She’d gotten a bad grade of silicone, an ER doctor said. The substance had already caused an infection that had begun migrating to her lungs. Doctors gave her antibiotics, and she remained hospitalized for two days. Her friend didn’t have insurance and had to be released sooner, but she didn’t suffer any lasting harm.

In the following weeks, bruises appeared on Vega’s legs. Eventually she had plastic surgeries to correct the work; one doctor cut into her face to scrape out silicone that had solidified. In another, silicone was sucked out of her hips with a medical vacuum. She wore tubes in her hips for four months.

She regrets her bad luck, but not necessarily the pumping.

“There are so many success stories that would outweigh the bad ones,” she said. “There are lovely, lovely girls out here that have had silicone done the illegal way and have not had any problems for years.

“It’s that instant gratification of seeing the result right there, versus going to the plastic surgeon if you don’t have the money. So, honestly, I think I would possibly consider doing it again.”

Malcolm Venable, (757) 446-2662, [email protected]

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To see more of the The Virginian-Pilot, or to subscribe to the newspaper, go to http://www.pilotonline.com.

Copyright (c) 2008, The Virginian-Pilot, Norfolk, Va.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

A Breast cancer victim has won a competition to have her own message on the popular sweet Love Hearts.

Beverley Kerry, of Ilkeston, hopes her “Think Pink” slogan will help save fellow sufferers.

The 37-year-old said she was lucky to escape with her life after being diagnosed with the disease in March, 2005.

She is currently in remission after having an operation to remove her left breast followed by six doses of chemotherapy over seven months.

Mrs Kerry says she hopes her Love Hearts message will raise awareness that the disease can affect young women as well as old.

The “Think Pink” slogan is used by Cancer Research UK when advertising its breast cancer fund-raising events, such as Race for Life.

Mrs Kerry said friends and family, including husband Martin, 35, had told her not to worry when she found a large bruise on her breast because she was “too young” for it to be cancer.

Mrs Kerry, of Shirebrook Close, said: “They were just as shocked as me when I got the diagnosis.”

Mrs Kerry was diagnosed with grade three cancer, which, she said, gave her a “50% chance of survival”.

Surgeons at Derby City General Hospital removed her breast 10 days later. She now has to take hormone tablets daily and regularly returns to hospital for scans.

Mrs Kerry came across the Love Hearts competition when looking on the website of manufacturer Swizzles Matlow to find out which of its products were vegetarian.

Earlier this month, she discovered she was one of 10 winners nationwide.

Mrs Kerry said: “I was delighted to have won. I didn’t think I stood a chance.”

The personalised sweets will hit the shelves by September.

Swizzles Matlow director Andrew Matlow said response to the competition had been amazing.

He said: “We always knew that Love Hearts held a special place in the nation’s heart.”

(c) 2008 Derby Evening Telegraph. Provided by ProQuest Information and Learning. All rights Reserved.

By Joyce Lobeck, The Sun, Yuma, Ariz.

Jul. 26–TWILIGHT BOOK PARTY DATE USED — 7/27/08 REPORTER — jkc CATEGORY — nws PAPER — sun ART — PAGE — __

POSTED-C Bookstore throws party for latest in ‘Twilight’ series f=Abadi MT Cn Ex Bd s=9|BY JOYCE LOBECK| f=Abadi MT Cn Lt s=9|SUN STAFF WRITER| o Barnes and Noble Booksellers is throwing a party Friday night to rival New Year’s Eve.

But in this instance, the partygoers will be counting down to the stroke of midnight so they can get their hands on the latest in the “Twilight” series penned by Phoenix author Stephanie Meyer.

While they’re waiting to read about the latest adventures of Eddie, a handsome vampire, and Bella, just an average girl, fans can pass the time with a costume contest, participate in a scavenger hunt, play “Who Wants To Be a Millionaire?” with trivia questions from the books and just plain share the excitement with other fans of the series.

The party will take place from 9 p.m. to midnight at the bookstore at 819 W. 32nd St. At one minute after midnight, “Breaking Dawn,” the fourth book in the series, will go on sale.

All ages are invited to “come take a bite out of fun,” said Penny Bell, who recently took over as manager for the bookstore’s children’s department. The store will be decked out in black and red, and there will be fun things throughout the store, she said..

Bell described the series as written for teens, “but I know all age levels enjoy the books. It’s about vampires and werewolves and just plain fun.”

She herself got hooked when teens she was working with as a children’s reading specialist in San Diego talked her into reading “Twilight,” the first in the series.

“I read it in one day,” she said. And she’s excited as anyone else to read “Breaking Dawn.”

“I’m dying to see what happens with the characters,” she said.

Other books in the series are “New Moon” and “Eclipse.”

On her Web site, Meyer recalled how she first met the characters of her books. She dreamed that two people were having an intense conversation in a meadow in the woods.

One was just your average girl. The other person was fantastically beautiful and a vampire. They were discussing the difficulties inherent in the facts that they were falling in love with each other while the vampire was particularly attracted to the scent of the girl’s blood.

There was nothing to be done but to start pounding the keys to tell their story, Meyer said. One book led to another, then a third and now the fourth.

Not to mention a movie contract. The movie made from the first book will be released Dec. 12.

Meyer graduated from Brigham Young University with a degree in English literature. She lives with her husband and three young sons in Phoenix.

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Joyce Lobeck can be reached at [email protected] or 539-6853.

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To see more of The Sun or to subscribe to the newspaper, go to http://www.yumasun.com/.

Copyright (c) 2008, The Sun, Yuma, Ariz.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Craig Outhier, The Tribune, Mesa, Ariz.

Jul. 26–Bret Contreras is a strong believer in the hip-thrust. And he’s looking for converts.

“Nothing can beat it,” proclaims the 31-year-old Scottsdale entrepreneur and fitness trainer. “It’s the most efficient, effective way to re-proportion the human body that I’ve ever seen. And most people don’t know about it.”

If Contreras sounds a bit like an environmentalist touting the untapped benefits of solar power, there’s a good reason. The hipthrust, long the domain of cagefighters and Elvis impersonators, is also the inspiration for a device that Contreras hopes will one day join the likes of Bowflex and the ThighMaster in the pantheon of fitness marketing.

It’s called the Skorcher Butt Machine, and with it, the former schoolteacher and self-made bodyshaping guru hopes to thrust himself all the way into your garage or fitness room.

It all started when Contreras, a former bodybuilder and lifelong fitness buff, caught an Ultimate Fighting Championship match on television and noticed that one competitor lacked the core strength to free himself when his opponent piled on top of him. Inspired, Contreras combined two pieces of common gym equipment and came up with the prototype for the Skorcher — in crude terms, an elevated sit-up module with the middle taken out.

The way Contreras recalls it, his first Skorcher workout was a revelatory event to rival Moses receiving the 10 Commandments on Mount Sinai: “My butt muscles were so fired up, they actually started twitching. I’ve been working out for 15 years, and that never happened before.”

Sensing a Bowflex-style windfall, Contreras took out a second mortgage, quit his job as a high school math teacher and commissioned a fitness consulting firm called Human Performance and Wellness Biomechanics to run stress tests on the device. He also hired a public relations firm to help launch the product.

So far, Contreras’ business plan seems to be paying off. Last spring, he managed to place several Skorchers in the gift room at the Tony Awards in New York. The next day, the New York Daily News and New York magazine each ran snarky items about “Harry Potter” star Daniel Radcliffe falling in love with the Skorcher leading up to his much-publicized nude scene in “Equus,” due on Broadway this fall.

It hardly mattered that Radcliffe never actually said he would use the Skorcher to tone up for “Equus.” (He did say: “We don’t have things like this in England.”) The media, pathologically incapable of resisting the opportunity to use “butt” and “Daniel Radcliffe” in the same sentence, simply drew their own, Radcliffe-butt-angst conclusions.

Contreras says an avalanche of orders followed the star’s pseudoendorsement, along with official inquiries from the likes of celebrity trainer Gunnar Peterson and an offer to appear on “The View.” (The introductory Skorcher model, priced at $299, doesn’t beginning shipping until next month.)

“Better Butt, Better Body” is the company’s motto, and at least one of Contreras’ clients agrees. Scottsdale resident Brooke O’Conner began seeing Contreras at his Gainey Ranch-area studio, called Lifts, last January to shape up for her June wedding to minor league hockey player Sean O’Conner. Contreras put her on a regimen of 23 Skorcher-related exercises and she promptly saw a difference in her physique.

“I told him, ‘If you make me bulk up, I’m going to kill you,’ ” O’Conner recalls. “But that didn’t happen. I lost 2 inches on my waist and butt and totally transformed my body.

“It definitely burns. And you can feel the workout the second you get on it.”

Contreras is eager to distinguish his product from the flimflam that has traditionally saturated the fitness market (i.e., the aforementioned ThighMaster). He offers a mountain of biomechanical data that demonstrates, for instance, how the Skorcher delivers “three times as much muscle activation in the hamstrings as a squat workout.”

Still, the success of the Skorcher may have less to do with its biomechanical merits than the marketing savvy of its inventor. By the time two beefed-up versions of the Skorcher — the “Skorcher Pro” and “Skorcher Extreme” — hit the market later this year, Contreras hopes to be personally pitching his butt-shaping invention in an infomercial.

“This is a revolutionary piece of equipment,” he says, with steely certainty. “It’s not just something for the gym. It’s a gym replacer.”

Indeed. No buts about it.

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To see more of The Tribune, or to subscribe to the newspaper, go to http://www.eastvalleytribune.com.

Copyright (c) 2008, The Tribune, Mesa, Ariz.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Justin Schoenberger, The Free Press, Kinston, N.C.

Jul. 26–At 3 a.m. on July 6, Kinston police responded to a report that seven men were at Lenoir Memorial Hospital’s emergency department.

They were each being treated for gunshot wounds.

And while only four actually stayed at LMH (two were transferred to Pitt County Memorial Hospital’s trauma center and one to Goldsboro), all of them triggered a facility-wide shift in hospital procedure called restrictive access mode.

“Restrictive access mode is what happens whenever someone comes in who is a potential threat to hospital safety,” director of security Glenn Clark said, adding that assailants sometimes follow victims to the hospital. “How soon we get into it depends on how the victims are transported to the hospital. Sometimes we have warning, sometimes we don’t.”

If a shooting victim is brought in by ambulance, police are dispatched by the 911 call center at the same time emergency medical technicians are. Law enforcement monitors the situation closely and works to ensure the safety of medical personnel.

The hospital, in turn, receives full warning that a shooting victim is en route and can prepare for his or her arrival. This is ideal for the emergency department, said E.R. Manager Christina Miller.

“EMS will not transport from the scene of a shooting until police say the scene is safe,” Miller said. “If a person is shot, Lenoir County EMS will respond, but the scene has to be secure before they will actually go in and treat the patient.

“Usually law enforcement is right behind the ambulance once they bring the person (to the emergency room).”

However, if shooting victims are self-transported — that is, if they did not come to the emergency room by ambulance — the hospital cannot prepare for their arrival and is forced to adjust accordingly.

“Law enforcement is notified whenever a shooting victim comes here,” Miller said. “But our first call will be (that) the patient is brought back and treatment is started. The next call will be to Lenoir County communications to say we have someone who’s been shot or stabbed, then they respond to it.”

Regardless of how dangerous a situation may be without police presence, the hospital’s main concern is to help the patient. While E.R. doctors and nurses are often aware that there could be an impeding police investigation following a shooting victim being brought in, taking care of an injured person is what’s most important to them.

Nurses will bag personal belongings of someone who has been shot, which police may use as evidence in a criminal case, but it’s not a priority.

“Hospital staff will go out and pull a gunshot victim out of the backseat of a car and put themselves in harm’s way because that is necessary to the life of the patient,” Miller said. “We don’t care if you’re the shooter or the person that was shot. It doesn’t matter to us.”

Restrictive access mode is felt throughout the hospital. Security personnel controls the access people have to the treatment areas — specifically, the number of individuals allowed there. No visitors are permitted in or out of the emergency department until the hospital staff — and police department, if necessary — feels comfortable there is no longer a threat from whoever may have been the assailant.

“That presents a challenge because you have to control the access, but you can’t lock people into a place,” Clark said. “We use all of our resources with local security as well as the Kinston Police Department and Lenoir County Sheriff’s Deputies to help us control the access.”

Family and friends of shooting victims may also want to enter the emergency department while it’s under restrictive access.

“Their access is controlled as well,” Clark said, adding that making sure a person is at each entrance is fundamental in securing the hospital. “That’s really how we control it.”

When minors are involved in an incident that spurred restrictive access state, Clark said the hospital makes sure parents of the victim are allowed to see their son or daughter and are escorted to their room. Sometimes nurses and doctors will ask for a family member to be present if a patient is in serious condition.

“No (non-family),” Clark said. “The policy is as-is. We don’t let anybody back there until the nursing staff and police feel that the threat is no longer a viable threat.”

Usually, only three hospital security officers are on duty at once, but law enforcement assists regularly to make up the difference. Clark said the Kinston Department of Public Safety is a big help to hospital security — particularly when a shooting victim is in-house.

“You want to make sure the assailant is no longer a threat to the victim,” Clark said. “You have to be real careful of that because these days, people will follow their victim.”

Assistant Kinston Police Chief Annette Boyd said lawmen are a large part of LMH’s procures for handling people who have just been shot. Not only do police secure scenes of shootings and provide security at the hospital, but they offer protection to the victim after he or she is released.

“Police stay at the hospital as long as the suspect is at large,” Boyd said, noting that cops often give first aid to victims before EMS arrive. “We stay with (victims) once they leave or if they ask us to. Most end up going their own way and don’t want us to follow them — but we would help anybody who requests it.”

Despite the differences in procedures when the hospital falls into restrictive access mode, Miller maintains that the quality of care remains the same — it just happens a little bit quicker.

“It really doesn’t affect us,” Miller said. “The flow of the emergency room remains the same. We still have to prioritize patients according to our same system, so you’re still going to get the same level of care, still going to get taken back in the same fashion as it would be on any other given day.

“Everybody’s just working a little bit faster.”

Justin Schoenberger can be reached at (252) 559-1075 or [email protected].

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To see more of The Free Press or to subscribe to the newspaper, go to http://www.kinston.com/.

Copyright (c) 2008, The Free Press, Kinston, N.C.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Liz Hayes, The Valley News-Dispatch, Tarentum, Pa.

Jul. 26–State Sen. Sean Logan said he is both pleased and discouraged to learn the Community Health Clinic in New Kensington was visited 17,000 times last year.

The Plum Democrat said the efforts of the expanding clinic are impressive, but it spotlights the need for better health care.

“This is a huge problem,” Logan said. “A very expensive problem.”

Logan joined Dr. Calvin B. Johnson, the state secretary of health; state Sen. Jim Ferlo, D-Highland Park; and state Rep. John Pallone, D-New Kensington, on Friday to celebrate the forthcoming availability of dental services at the Fourth Avenue clinic.

Clinic board member Bill Hall said the clinic should open in early August. It features seven exam rooms plus laboratory space and will be staffed by at least one full-time dentist plus a roster of 38 volunteers from the Alle-Kiski Dental Society.

Executive Director Josephine Guy estimated that about half of the clinic’s medical patients also have dental problems.

“It’s a part of health care that is so often neglected,” said Dr. Johnson. “Oral health care is so critical to our overall health.”

The clinic also is adding eye care to its array of services and soon hopes to provide psychiatric care.

Guy and Hall said the clinic is working to cover all the health needs of the Alle-Kiski Valley. Hall said at least half the board members must be clinic patients, which allows directors to better understand the community’s needs.

Hall said the recent move to the 900 block of Fourth Avenue in the former Hart’s department store offers considerably more space than the clinic had in its former office on Seventh Street.

“It’s amazing to see this place and know how far it’s come,” said Myra Guin, president of the clinic board.

The cheerful and spacious offices and exam rooms are painted blue and white, and many are decorated with Hall’s photography of the region.

The Community Health Clinic serves the Alle-Kiski Valley’s four counties and has been in operation since 1971, Guy said.

The clinic provides services on a sliding scale depending on a patient’s ability to pay. Although it meets all the criteria for a Federally Qualified Health Center, officials still are waiting for official designation that will allow them to receive federal funding.

“Most of our patients are uninsured,” Guy said. “Ninety-eight percent earn less than $15,000 a year.”

Officials object to the stereotype that people don’t have quality health insurance because they don’t work.

Johnson said 70 percent of the estimated 800,000 uninsured Pennsylvanians have jobs — often more than one.

Pallone said the clinic is what helps maintain the community’s vitality.

“If (the clinic) was not here,” Johnson said, “there would be a lot of people with no options for their health care. You cannot grow a community when your population is not healthy.”

“Health is the reason many are poor,” Hall said of the clinic’s patients. “If we can get them healthy, we can turn their lives around.”

Liz Hayes can be reached at [email protected] or 724-226-4680.

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To see more of The Valley News-Dispatch or to subscribe to the newspaper, go to http://www.pittsburghlive.com/x/valleynewsdispatch/.

Copyright (c) 2008, The Valley News-Dispatch, Tarentum, Pa.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By JONI AVERILL

Lewis Bayley of Bangor is proud of the Penobscot Area AARP chapter he serves as president.

The group of people 50 and older considers itself an active chapter, working to make a difference in the lives of others and the community.

To learn more about this organization, or if you are already a member, Bayley cordially invites you to attend its first AARP picnic at 11 a.m. Tuesday, July 29, at Dorothea Dix Park in Hampden.

Bring your own lunch. Anyone of AARP age is welcome.

The next Summer Concerts in the Park, with host the Old Town Public Library, will be at 6:30 p.m. Wednesday, July 30, at Riverfront Park in Old Town.

Performing will be the Maine family ensemble Zevulon. Bring a blanket or chair. If it rains, the concert will be in the Old Town High School cafetorium.

The Mary Potterton Memorial Faculty Concert will be at 7:30 p.m. Wednesday, July 30, at Lubec Congregational Christian Church, reports Ann Carter.

The concert features faculty members Suzanne Gilchrest, Sheng- Tsung Wang, Yi-Hsin Lin, Joachim Woitun, Winslow Browning, Trond Saeverud, Anna Maria Baeza and Bruce Potterton.

Donations benefit the church piano-tuning fund, and intermission refreshments will be provided by Campobello Gift Shop and the Owen House.

For information about the concert boat from Eastport, call 853- 2500.

Nan Cobbey reports the next Belfast Open Garden Day will be 10 a.m.-5 p.m. Friday, Aug. 1, at the garden of Jeff Richards and Shelby Wilbourn, 108 Congress St., Belfast. This garden is described as “a work in progress,” where you will “learn about creating new gardens.” The suggested donation, to support the civic work of the BGC, is $3. A list of all garden club Open Garden Days, on Fridays through Sept. 19, is available at local businesses, at the birdhouse at Post Office Square in Belfast and at www.belfastgardenclub.org.

News of the next 2008 Music by the Bay Concert Series is that it features jazz and bossa nova, with Wave, at 7 p.m. Friday, Aug. 1, at Milbridge Congregational Church.

Wave features vocalist-flutist Mary Spence and Muk Dodge on classical guitar. They will be accompanied by special guest drummer and percussionist Mark Harrell.

This is one in a series of concerts to benefit the Women’s Health Resource Library in Milbridge. The suggested donation is $10 for adults, free for children 14 and under.

For more information, call WHRL at 546-7677.

Anne Russenberger-Keefe of Woodlawn Museum in Ellsworth invites you to participate in a workshop, “Nature Prints on Canvas Bag,” with Liliane Kell, from 9 to 11:30 a.m. Saturday, Aug. 2, at The Black House, Woodlawn Museum, Route 172 in Ellsworth.

You will learn how to transfer botanical designs onto a large canvas tote bag. Children, accompanied by parents, are welcome, but pre-registration is required since space is limited.

The cost is $20 for members, $25 for nonmembers. The charge for additional family members is $6 each. To reserve your space, call 667-8671 or e-mail [email protected].

Betty Watson wrote that anyone who attended Castine High School is invited to meet at 10 a.m. Saturday, Aug. 2, at the public dock in Castine. “Everyone is responsible for their own lunch,” Watson added while requesting that you “please call any classmates who live out of the area.”

Dale Marie Clark of Hospice Volunteers of Waterville Area reports that registrations are being accepted for the seventh annual Swing for Hope and Hospice Golf Tournament, which begins with a shotgun start at 9 a.m. Monday, Aug. 4, at Natanis Golf Course in Vassalboro. The cost per player for the team scramble is $70.

Registrations or sponsorships may be made by calling committee co- chair Paul Drouin at 873-1493, or the Hospice office at 873-3615. Singles, twosomes and threesomes are welcome. A brochure and registration form is also available at www.hvwa.org/special-events.

Clark wrote that this year’s tournament, which benefits the organization’s grieving children and teen program, is being held in memory of its former youth service coordinator, Susan McConnell, who died in an April motorcycle accident.

Joni Averill, Bangor Daily News, P.O. Box 1329, Bangor 04402; [email protected]; 990-8288.

(c) 2008 Bangor Daily News. Provided by ProQuest Information and Learning. All rights Reserved.

By La Crosse Tribune, Wis.

Jul. 26–The story of two girls accidentally switched at birth at a Prairie du Chien, Wis., hospital will air on the public radio show “This American Life” this weekend.

Martha Miller and Susan McDonald left the Old San Hospital with the wrong families on a summer day in 1951 and didn’t find out until age 43, said Sarah Koenig, a producer of “This American Life.” One of the mothers, Mary Miller, knew she didn’t have the right baby from the day she brought Martha or “Marty” home, as she weighed less than she did in the hospital

and didn’t behave like her five other children, said Koenig. However, she didn’t say anything.

The hour-long documentary is told in four chapters, from the two mothers, Mary Miller and Kay McDonald; and the daughters, Martha “Marty” Colwell and Susan Boutni.

“They are really honest about it in a way that is pretty rare to find in a radio interview,” said Koenig. “They were really open with us, which was incredibly brave of them.”

In the end, all said they were glad to know what happened, said Koenig.

“I think there is something so powerful about biological connections,” she said. “I think both girls always felt a little different in their families, growing up.”

The show will air at 3 p.m. Saturday and 8 p.m. Sunday on Minnesota Public Radio 91.1- FM.

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To see more of the La Crosse Tribune or to subscribe to the newspaper, go to http://www.lacrossetribune.com/.

Copyright (c) 2008, La Crosse Tribune, Wis.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

The mother of a boy who survived cancer is preparing to abseil 85ft down the side of a hospital.

Jackie Orton, of Twyford Road, Willington, will be taking part in the challenge on Sunday in aid of children’s cancer charity CLIC Sargent.

The 55-year-old will abseil from the roof of Nottingham’s Queen’s Medical Centre, where her son, John Harbord, now 15, was treated in 2001.

John, a pupil at John Port School, Etwall, was diagnosed with rhabdomyosarcoma, a rare cancer that forms in the soft tissues of the body.

Surgeons tried to remove the tumour but could not get rid of it all because it was close to nerves that affected his facial movement.

He then had nine months of chemotherapy and radiotherapy.

John got the all-clear in September, 2001.

(c) 2008 Derby Evening Telegraph. Provided by ProQuest Information and Learning. All rights Reserved.

MIAMI _ Federal agents have seized $74,000 worth of tablets from a Miami company that claimed it was making “an all-natural sexual stimulant” when in fact it was selling unapproved pills that contained a chemical similar to what’s found in Viagra.

The Food and Drug Administration warned people it could be dangerous to take the tablets, which are sold under the brand name Xiadafil VIP, made by SEI Pharmaceuticals.

Not only is Xiadafil not tested and approved for use, the FDA said in a news release, but its chemical properties may be particularly dangerous for men with certain physical conditions who seek a natural solution for erectile dysfunction after being told by their doctors to avoid Viagra because of serious side effects.

A woman who answered the phone at SEI Pharmaceuticals on Friday said, “At the moment we have no comments.” She refused to give her name.

Xiadafil was listed for sale Friday on several Web sites. FitFuel.com was offering eight tablets for $39.95. The product is intended for “24 hour maximum sexual enhancement,” the Web site said. Listed ingredients included dogwood fruit, foxglove root, gingko biloba and Korean ginseng.

Not mentioned was hydroxyhomosildenafil, the ingredient the FDA says is in the tablets. It is similar to sildenafil, the active ingredient in Viagra.

The tablets fit a pattern of “natural” pills sold in Miami that secretly contain pharmaceutical drugs.

Three years ago, Brazilian diet pills were heavily used in South Florida. The pills, which were said by many to produce huge weight losses, claimed to be all-natural but in fact contained amphetamines and tranquilizers that are legal only through prescription.

Most of those pills were manufactured in Brazil. In January 2006, three months after The Miami Herald reported problems with the pills, the FDA issued a public warning to consumers not to use the diet pills.

A Miami toxicologist, Terry Hall, who several years ago reported people were failing employment drug tests after taking Brazilian pills, said he had not seen any of the diet pills recently, although a few months ago he was asked by FDA investigators to provide information on the diet pills. Hall said he didn’t know anything about Xiadafil.

FDA spokeswoman Rita Chappelle said the erectile-dysfunction pills weren’t connected with the companies that made the Brazilian diet pills, but appear to be part of a trend of “undeclared drug ingredients in products positioned as dietary supplements.”

Juan Carlos Paredes, a Miami Beach doctor, said tablets with hidden Viagra ingredients could be quite dangerous, even lethal, to persons taking nitrates for heart conditions.

Those taking “party poppers” _ amyl nitrates _ may experience a sudden loss of consciousness if they add a Viagra-like tablet to the mix.

The FDA advised those experiencing adverse reactions from Xiadafil to consult a health care professional.

State records show SEI’s president is Edward Miller. Its answering machine states the company is a “manufacturer of the world’s leading nutrition and pharmaceutical products.”

Chappelle said SEI used a contract manufacturer somewhere in the United States to manufacture the tablets, using some ingredients imported from outside the country.

The Xiadafil tablets were given away at trade shows or sold in bottles of eight tablets and/or blister cards of two tablets, the FDA said.

On April 22, the FDA inspected the SEI facility after testing Xiadafil and “warned the company of possible legal actions, including seizure and/or injunction if corrective actions were not implemented,” according to the FDA.

SEI promised to halt distribution and it deactivated its Web site, but “it refused to recall the product already in the market.”

On May 13, Florida issued a “stop sale” action for the product, requiring SEI to keep Xiadafil VIP tablets at its facility. On May 27, the FDA formally asked the company to recall the pills.

“The company … refused to recall these products,” the FDA reported, “making the seizure action necessary to prevent additional, illegal Xiadafil VIP products from entering the marketplace.”

___

(c) 2008, The Miami Herald.

Visit The Miami Herald Web edition on the World Wide Web at http://www.herald.com/

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Cindy Larson, The News-Sentinel, Fort Wayne, Ind.

Jul. 25–Fido and Fluffy have two fewer places to shop in Fort Wayne.

Both local Petland pet-supply stores closed June 29, said Julie Washburn, public relations coordinator for Petland Inc. All Petland stores are franchises, she said, and the franchisees of the Fort Wayne stores decided to close them.

“We’re working to reopen them as soon as possible,” she said. Anyone interested in becoming a franchisee should go to www.petland.com and click on franchise opportunities. The stores were located in Glenbrook Commons and at 10538 Maysville Road.

Pavlov would be proud

Speaking of dogs, did you know your dog can have its own doorbell? Poochie-Bells are a new item at the Monogram Shoppe, 6410 W. Jefferson Blvd. in Covington Plaza. They’re bells attached to a grosgrain ribbon that hangs from a doorknob. It comes with training instructions so you can teach your dog to ring a bell when it wants to go outside. They’re designed for large and small dogs and come in a variety of colors. Cost: $18.50.

Take a big bite

Ever start reading something, and the more you read, the less it makes sense?

We recently received a news release from Barnes & Noble about an event planned for the Glenbrook Square store called Bella’s Bite Nite!, a “Breaking Dawn” party.

Huh?

This was obviously something I should have known about, but didn’t, so I did a little research on the Internet. Allow me to translate for those of you who are as clueless as I am.

The Glenbrook store is staying open until midnight Aug. 1, hosting a party in anticipation of the 12:01 a.m. release of “Breaking Dawn,” the fourth and final book in Stephenie Meyer’s Twilight Saga. The vampire-based fantasy/romance/horror series features the exploits of Bella Swan, who falls in love with a vampire. Apparently the books are wildly popular with adolescent and teenage girls.

Barnes and Noble at Glenbrook, 4201 Coldwater Road, has special events planned, including a trivia contest, giveaways, and a complimentary “Transformation Station” courtesy of the store and Libby Lu, where girls can get makeovers.

Sidewalk sale at Glenbrook

Now that summer is in full swing, of course all the stores are looking ahead to winter months and warmer fashions. So now’s the time to get bargains on summer clothes and accessories. Glenbrook Square, 4201 Coldwater Road, may be a good place to snag deals this weekend at its annual sidewalk sale. The mall is open through 10 p.m. tonight, 10 a.m.-10 p.m. Saturday and 11 a.m.-6 p.m. Sunday.

Exhibit celebrates outdoor beauty

What would the Lakeside Rose Garden be like without color? Believe it or not, stunning.

Photographer Martha Trenkner’s stark black and white photographs present the park in a new and eerily beautiful light. Her work is on display Aug. 1-30 at the Orchard Gallery of Fine Art, 6312-A Covington Road, as part of the gallery’s “Outdoors … Works Inspired by the Beauty of the Landscape” exhibit.

The exhibit includes local landscapes and those from abroad, and includes work from artists Sarah Creason, Sheila Fink, Dawn Geradot, Pat Lewis and Sue Davis.

Gallery hours are 10 a.m.-5 p.m. Monday, Wednesday, Friday and Saturday; and 10 a.m.-7 p.m. Tuesday and Thursday.

Know of a store opening, closing or remodeling? Find a good deal? Call Cindy Larson at 461-8284, fax 461-8817, e-mail [email protected] or write to: In the Bag, C/O The News-Sentinel, PO Box 102, Fort Wayne, IN 46801.

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To see more of The News-Sentinel, or to subscribe to the newspaper, go to http://www.FortWayne.com.

Copyright (c) 2008, The News-Sentinel, Fort Wayne, Ind.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

NYSE:BKS,

By PAMELA WOOD Staff Writer

Rain poured down on Anne Arundel County during a summer storm last night, partially flooding the emergency room at Baltimore Washington Medical Center.

The Glen Burnie hospital also lost power for several hours and had to turn away ambulances.

Hospital spokesman Allison Eatough said workers, firefighters and even local businesses pulled together to keep the hospital running.

The power was knocked out at about 9 p.m., and emergency power immediately came on.

While no patients had to be transferred, the hospital had to stop accepting patients by ambulance. Walk-in patients still were treated.

In addition to the power problem, part of the emergency room was flooded, Mrs. Eatough said.

Hospital workers said water was coming through the ceiling “in waterfalls.”

Firefighters helped soak up the mess in the emergency room, which is one of the busiest in the state, treating 90,000 patients a year.

With the hospital on emergency power, some luxuries had to be cut off – there was no air conditioning and not all of the outside signs and lights were on.

The Pasadena Home Depot donated 40 fans to help the hospital cope, Mrs. Eatough said. Firefighters brought in outdoor lights.

“We were very, very grateful,” Mrs. Eatough said. “It shows that we’re a community hospital and the community pulled through for us.”

Full power was restored at about midnight and the emergency room resumed accepting patients by ambulance at about 4 a.m.

By this morning, everything was back to normal and there were few signs of last night’s ordeal – just a “wet floor” sign and a carpet dryer fan.

Anne Arundel Medical Center reported no problems because of the storm.

County police and firefighters also weren’t called to many storm- related problems, other than the flooding at BWMC.

“All things considered, we were relatively slow last night,” said Capt. Harry Steiner, a spokesman for the Fire Department. “A couple of trees and wires were down like we typically get, but it’s not as bad as we’ve seen even with smaller storms we’ve had (this summer).”

BGE reported having 623 Anne Arundel customers still without power at 10:20 a.m. And 9,402 customers who lost power the night before had their power restored.

The greatest concentrations of outages were in Baltimore City, Baltimore County and Harford County. All told, since Tuesday, BGE has brought 78,000 customers online who lost power in storms.

“We’ve been working on multiple storms over the last few days,” said Kelly Shanefelter, a BGE spokesman.

Yesterday’s storms dropped 2.42 inches of rain at BWI Thurgood Marshall Airport in Linthicum, said Jared Klein, a meteorologist with the National Weather Service.

That was a record rain total for that date. The previous record of 1.75 inches was set in 1988.

Mr. Klein said there were reports of 3 inches of rain in spots in the Baltimore region.

The storms were slower moving than most summer storms, allowing more rainfall to pour down, Mr. Klein said.

The forecast for the next few days calls for slightly cooler temperatures than normal for this time of year.

Tomorrow should be mostly sunny with a high near 89. Saturday will be mostly cloudy with a 40 percent chance of rain and a high near 88. There’s a 30 percent chance of rain on Sunday, when the high should be near 89.

Staff writers Sean Patrick Norris and Heather Rawlyk contributed to this report. {Corrections:} {Status:}

BWMC LOST POWER, HAD TO STOP ACCEPTING PATIENTS BY AMBULANCE

(c) 2008 Capital (Annapolis). Provided by ProQuest Information and Learning. All rights Reserved.

By Michael Gilbert, The News Tribune, Tacoma, Wash.

Jul. 25–A nurse who treated victims of one of the Army’s worst air disasters and at the Pentagon on Sept. 11, 2001, took command Thursday at Madigan Army Medical Center.

Maj. Gen. Patricia D. Horoho comes to Madigan after 15 months as commander of the Walter Reed Health Care System. She was also promoted earlier this month to command the Army Nurse Corps, a job she’ll keep in her new post at Fort Lewis.

Horoho was working in an administrative assignment at the Pentagon when hijackers crashed American Airlines Flight 77 into the building on Sept. 11.

She is credited with rushing to the scene and quickly setting up first aid care and triage for the wounded, work that later won her recognition as a “nurse hero” by the American Red Cross.

She was also at Fort Bragg, N.C., during the Green Ramp disaster in 1994, when 24 soldiers from the 82nd Airborne Division were killed and dozens more injured in an aircraft crash and fire at Pope Air Force Base.

The hospital won a superior unit citation for its response. Horoho was head nurse in the emergency room.

“Patty always seems to be where the action is,” said Maj. Gen. George W. Weightman, commander of the U.S. Army Medical Research and Materiel Command.

Horoho succeeds Brig. Gen. Sheila Baxter, who led Madigan the past three years. The past year she oversaw sweeping changes aimed at improving care for wounded and injured soldiers and their families.

Baxter is retiring and plans to pursue a master’s degree in divinity studies at the Interdenominational Theological Center in Atlanta.

Madigan received numerous awards during Baxter’s tenure for its educational and research programs, and its medical simulation training center won recognition as one of the most advanced in the country.

The hospital also developed a screening and health assessment program for soldiers returning from deployments in Iraq and Afghanistan that became a model for the rest of the Army, officials said.

But Madigan also felt the effects of the scandalous conditions reported in February 2007 at Walter Reed Army Medical Center, which launched an Army-wide reform of health care for the wounded.

At Fort Lewis, many soldiers complained of insensitive treatment in the medical holding companies and bewildering red tape in the Army’s medical bureaucracy.

Lt. Gen. Jim Dubik, who worked with Baxter for two years as Fort Lewis commanding general, credited her with a style that endeared her to patients and staff.

“She focused on the right values,” Dubik said Thursday, “and it’s the values that get you through the hard times, that keep you from running from one thing to the next with each new problem. Her values got us through the hard times.”

Baxter on Thursday received the Distinguished Service Medal, the Army’s highest award for service not involving combat valor.

She told her successor she’s “inheriting a fantastic team, and they will inspire you every day.”

Horoho began her Army career as a trauma nurse after graduating from the University of North Carolina in 1982. She and her husband, Ray, have two sons, 21 and 15, and a daughter, 14.

She was placed in command of day-to-day operations at Walter Reed in May 2007 in the personnel moves that followed disclosure of the conditions for some soldiers there.

On Thursday, she said the past year has been “a time like no other in Army medicine.”

“It’s been a year of tremendous inward looking at where we can make improvements across every aspect of health care in support of our warriors,” she said.

The Madigan job includes the Western Regional Medical Command, with responsibility for Army medical facilities and care across six western states.

And in Horoho’s case, she’ll also be in charge of the service’s nurse corps.

She said the multiple duties will not take away from her ability to ensure quality care at Madigan.

“Absolutely not. Absolutely not,” she said.

“Part of my responsibilities will be a regional responsibility, looking at the overall good of everybody who is entrusted to our care.

“But at the same time, I can be looking at Army Nurse Corps issues because at all of our facilities we have Army nurses.”

Michael Gilbert: 253-597-8921

—–

To see more of The News Tribune, or to subscribe to the newspaper, go to http://www.TheNewsTribune.com.

Copyright (c) 2008, The News Tribune, Tacoma, Wash.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

ARLINGTON, Va., July 25 /PRNewswire-USNewswire/ — The American Association for Homecare opposes the decision by the agency that oversees Medicare to cancel the accreditation deadline for durable medical equipment providers in the 70 metropolitan areas throughout the U.S. designated for Round Two of the Medicare competitive bidding program.

The Centers for Medicare and Medicaid Services (CMS) announced last week that it was canceling its January 14, 2009 accreditation deadline for durable medical equipment (DME) or home medical equipment providers in the 70 metropolitan areas that were to be included in Round Two of the recently postponed bidding program.

“The home medical industry has advocated accreditation of homecare providers for three decades because accreditation helps ensure quality care for Medicare beneficiaries and can serve as a powerful tool in preventing fraud,” said Tyler J. Wilson, president and CEO of AAHomecare. “We are surprised that CMS would in the first case argue against the reforms and the delay enacted by Congress in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) by stating that it would delay accreditation – and then cancel the accreditation deadlines it had already set for providers in 70 metropolitan areas. Enactment of MIPPA is no reason to push back accreditation deadlines.”

The new law, MIPPA, mandates a September 30, 2009 deadline for accreditation of all durable medical equipment providers nationwide. CMS had set a January 14, 2009 deadline for Round Two providers. MIPPA also closes a loophole that had allowed non-accredited DME providers to serve Medicare beneficiaries. The American Association for Homecare enthusiastically supported these provisions as well as the important reforms to the competitive bidding system that are designed to improve access to care for seniors and people with disabilities and prevent arbitrary exclusion of qualified, accredited providers from participating in Medicare. The Association has also urged CMS to subject all new medical equipment providers to a rigorous on-site inspection by the government to help prevent fraud.

“We do not favor government delays to the accreditation requirement,” said Wilson. “Accreditation for this industry is already 30 years overdue. If the federal government wants to get serious about preventing fraud and preventing theft of taxpayer dollars, it should use tools like accreditation more aggressively and use its ample, existing authority much more effectively.”

“Congress estimates that Medicare loses $70 billion per year to fraud. CMS says $700 million in DME payments are improper, due to billing errors or fraud. So less than one percent of Medicare fraud can be attributed to DME. While our industry has zero tolerance for fraud, the $70 billion number begs the question: Where is the more than $69 billion in non-DME fraud occurring? You have to wonder whether the focus on DME is designed to shift attention away from the failure of CMS to use its existing authority and tools at its disposal to ferret out and stop fraud against Medicare. CMS has just renewed its contract with Palmetto GBA, the private company that serves as the National Supplier Clearinghouse for Medicare. Palmetto serves as the gatekeeper for issuing and renewing DME Medicare billing privileges and is required to establish and maintain programs to prevent and detect fraud. The renewal raises the question, why is a contractor that has failed miserably being rewarded with another contract?” Wilson said.

Background on MIPPA

Earlier this month, the Senate and the House enacted MIPPA by overriding the President’s veto. Provisions of the law include the following:

— “The Medicare Improvements for Patients and Providers Act of 2008” includes improvements to the Medicare competitive bidding program for home medical equipment that will help to ensure that seniors and people with disabilities continue to have access to quality medical equipment and services at home.

— The bill saves Medicare billions of dollars in reduced payments for home medical equipment. While the bill delays the Medicare bidding program, the home medical equipment industry pays for the delay in the form of a 9.5 percent nationwide reimbursement reduction on the bid upon items and services. This reimbursement cut saves taxpayers the billions of dollars that the flawed program would have saved. So taxpayers win through reduced Medicare spending, and beneficiaries win because they will continue to receive quality care from their local providers.

— The bidding system has been fraught with problems that have confused seniors, threatened severe reductions to care, and unfairly disqualified hundreds of accredited homecare providers. In cities where competitive bidding was implemented, the process befuddled hospital discharge personnel to the point where patients were being forced to stay longer in hospitals while frantic efforts were underway to locate the hospital beds, power wheelchairs, home oxygen therapy, and other equipment and services needed for patients to continue their recovery and therapy in their homes.

For more information, visit the Newsroom at http://www.aahomecare.org/.

Contact: Michael Reinemer, 703-535-1881, [email protected]; or Tilly Gambill, 703-535-1896, [email protected].

The American Association for Homecare represents durable medical equipment providers, manufacturers, and other organizations in the homecare community. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. The Association’s members operate more than 3,000 homecare locations in all 50 states. Visit http://www.aahomecare.org/.

American Association for Homecare

CONTACT: Michael Reinemer, +1-703-535-1881, [email protected], orTilly Gambill, +1-703-535-1896, [email protected], both of AAHomecare

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

By Donna Wright, The Bradenton Herald, Fla.

Jul. 24–Planned Parenthood officially opened its first health center in Manatee County on Wednesday night when supporters gathered to celebrate the event after decades of opposition.

But critics were still present as more than three dozen peaceful protesters gathered in front of the clinic at 1105 53rd Ave. E., holding signs that read, “Pray to end abortion.”

Nevertheless, the protesters’ presence did not dampen the enthusiasm of more than 100 supporters who cheered when the ceremonial ribbon was cut.

“This is a monumental day for Manatee County because there is such a monumental need,” said Karen Grablin, chairwoman of Planned Parenthood of Southwest and Central Florida.

“It’s a dream come true,” said Barbara Zdravecky, chief executive officer of the regional Planned Parenthood affiliate. “It’s a proud day because, standing here beside me is Greg Porges who, when he heard the county commission deny Planned Parenthood children’s services tax funds, picked up the banner to raise money for us.”

Porges, a local attorney, said the Manatee clinic is vital to the community’s health because it provides access to sensible reproductive and family planning education for all people.

But for Pastor Tad Matthews, who led the protest, Planned Parenthood is the wrong solution.

“We are out here because we believe that every life is precious to God and therefore to us and we oppose abortion,” said Matthews who leads Church of the Rock in Palmetto. “Every human being, including those in the womb, have a right to life.”

Clinic supporters said it will focus on health services, not abortions.

“We will not perform abortions here,” Zdravecky said. “The center will bring much-needed health care services to members of the community, regardless of income.”

Those services include health screenings, annual gynecological exams for $85, low-cost birth control, pregnancy testing, vaccines and screening for HIV and other sexually transmitted disease.

Thanks to an anonymous donor, the Manatee clinic offers teens an annual gynecological exam for $7 and birth control pills for $5 a pack, said Zdravecky said.

County Commissioner Gwendolyn Brown, who represents District 2, blamed Manatee County’s high teen pregnancy rate on community leaders’ unwillingness to deal effectively with the problem.

“I have an unfortunate high rate of teen pregnancies in my district,” Brown said. “There is a high rate of teen pregnancies in the state of Florida and it’s all because of a lack of information and education.”

Manatee County has the 17th highest teen pregnancy rate in the state, surpassing all Hillsborough, Pinellas and Sarasota counties. The youngest mother to give birth in Manatee County was just 10, according to health department statistics.

A recent survey of 2,196 ninth graders showed one-third of those students are sexually active. One out of 10 said they have had sex with four or more people.

Manatee County has an urgent need for expanded, low-cost reproductive health for people of all ages, said Lori Stabinski, the nurse practitioner in charge of the new clinic who once worked for Manatee County Health Department.

“I remember having to turn people down because we did not have the staffing,” Stabinski said. “We now have another facility that provides affordable reproductive health care. We provide care for men, too. “

The clinic is open from 11 a.m. to 7 p.m. on Tuesdays, 10 a.m. to 6 p.m. on Wednesdays and 9 a.m. to 3 p.m. Saturdays. Hours will be expanded as clientele increases.

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To see more of The Bradenton Herald or to subscribe to the newspaper, go to http://www.bradenton.com.

Copyright (c) 2008, The Bradenton Herald, Fla.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Megha Satyanarayana, Detroit Free Press

Jul. 25–More than 1,000 overdose deaths across the country — and 230 in Wayne County — were linked to illegally made fentanyl, a powerful prescription-only painkiller mixed with heroin and other drugs for street use, according to a report released Thursday by the Centers for Disease Control and Prevention.

Last year, the Free Press published a yearlong examination of the fentanyl overdose epidemic and its impact on the Detroit area.

Free Press reporters tracked down chemist Ricardo Valdez Torres, who made fentanyl in Mexico. His fentanyl moved north and was mixed into heroin sold to people of all walks of life. Much of the story focused on Lauren Jolly, a Birmingham Groves High School student who died of an overdose in a Detroit drug house.

The CDC report, which focused on fatal overdoses from April 2005 to March 2007, also links the fentanyl deaths to the Mexican lab. According to the Drug Enforcement Administration, 1 gram of pure fentanyl could create up to 8,000 doses to cut an illegal drug. At 50 to 80 times stronger than morphine, a tiny amount can kill, said Wayne County Mental Health Medical Director Dr. Michele Reid.

Fentanyl is prescribed in skin patches to treat chronic pain. But if snorted or injected, the sudden burst of the drug into the bloodstream can lead to breathing failure.

The CDC study calls for better public health efforts to report drug overdoses and more information and treatment options for users, which Wayne County health officials said they have been doing and providing for a while.

Soon after fentanyl was identified, the county formed a task force. It has about $50 million for drug abuse outreach and treatment, said Reid.

There is no national standard for testing and reporting, said Wayne County Medical Examiner Dr. Carl Schmidt. That makes it difficult to know exactly how many people overdosed or died from fentanyl-laced drugs.

“People don’t think of drug abuse as a public health issue,” he said.

Contact MEGHA SATYANARAYANA at 313-223-4544 or [email protected].

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To see more of the Detroit Free Press, or to subscribe to the newspaper, go to http://www.freep.com

Copyright (c) 2008, Detroit Free Press

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By The Free Press, Kinston, N.C.

Jul. 25–A new round of effective parenting classes from the Parent Outreach Program is scheduled to begin soon, offered by the Young Women’s Outreach Center.

“Parents Perspective of Effective Parenting,” will meet from 3-5 p.m. Thursdays for six weeks, beginning Aug. 14.

There will be a small gathering and certificate of completion for everyone who finishes the sessions. Registrations for parents or individuals will be accepted through Aug. 14.

Parenting involves supporting the development of healthy behaviors in children by setting sufficient lifestyle models through communicating and providing healthy beliefs and clear standards. YWOC helps those in parenting roles meet these criteria.

The center provides counseling, education, youth and family support, life development skills, after-school/summer programs, mentoring, teen pregnancy prevention, referrals, employment training and a Family Resource Center. It offers tools to build children’s futures, with goals for them to become productive, independent contributors to their family and to their community.

YWOC is a private, non-profit organization whose primary purpose is to improve the welfare of individuals, males and females, and their families by keeping them abreast of education and prevention methods.

For more information, call Claudja Pachceo at (252) 527-7844.

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To see more of The Free Press or to subscribe to the newspaper, go to http://www.kinston.com/.

Copyright (c) 2008, The Free Press, Kinston, N.C.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

NEW YORK, July 25 /PRNewswire/ — On July 22nd, 2008 Lierac Paris, Europe’s celebrated skincare brand, and mediabistro.com hosted a cocktail party to celebrate Lierac Paris’ U.S. skincare expansion into pharmacies such as CVS/pharmacy, Duane Reade and Long’s Drugs. Guests enjoyed complimentary skin analysis, hand massages with Lierac’s Repair Mains anti-aging hand cream, and gift bags that included summer favorites such as Aqua D+ Tinted Moisturizer, Mesolift toning and radiance serum, Diopticreme anti-wrinkle eye cream.

(Photo: http://www.newscom.com/cgi-bin/prnh/20080725/NYF054 )

Lierac Paris and mediabistro.com were also proud to partner with the Step Up Women’s Network, a non-profit organization that supports a variety of initiatives for women. Together, along with local journalists, they helped create 100 “wellness bags” which will include: Lierac Paris skincare products, fuzzy socks, Steaz tea drinks, comfy gel in-soles by the Gel Doctor, and eye masks. The wellness bags will be distributed too women undergoing cancer treatment at the NY Presbyterian hospitals at Cornell and Columbia hospitals. This is a way to bring a little pampering to women who need it most.

Janelle Lin, Managing Director, Step Up Women’s Network shares, “We are thrilled to be partnering with Lierac Paris on our Women’s Wellness Bag initiative. Step Up Women’s Network puts together over 40,000 wellness bags a year, which are filled with beauty and health items to provide comfort for women undergoing cancer treatment throughout the country. We hope that these bags will brighten the day for several women here in New York.”

   mediabistro.com & Lierac's Summer Cocktail Party was hosted at:   The Hudson Hotel   356 West 58th Street, 15th FL   New York, NY 10019    About Lierac Paris  

Lierac Paris, Europe’s celebrated cosmeceutical skincare line, continues its expansion at select Derma Skincare Centers at US pharmacies such as CVS/pharmacy and Duane Reade. These centers unite the world of beauty and health in order to respond to the needs of knowledgeable consumers who seek effectiveness, quality and innovation. Lierac Paris Laboratories adheres to a strict scientific approach merging advanced scientific research with botanical expertise to develop high-performance skin care products and corrective beauty treatments for all ages and skin types. Retail prices range from $23-75.

Step Up Women’s Network is a national non-profit membership organization dedicated to strengthening community resources for women and girls. Through teen empowerment programs for underserved girls, women’s health education and advocacy, professional mentorship and social networking opportunities, we educate and activate our members to ensure that women and girls have the tools they need to create a better future.

About mediabistro.com

mediabistro.com is dedicated to anyone who creates or works with content, or who is a non-creative professional working in a content/creative industry. That includes editors, writers, producers, graphic designers, book publishers, and others in industries including magazines, television, film, radio, newspapers, book publishing, online media, advertising, PR, and design. Our mission is to provide opportunities to meet, share resources, become informed of job opportunities and interesting projects and news, improve career skills, and showcase your work.

Photo: NewsCom: http://www.newscom.com/cgi-bin/prnh/20080725/NYF054AP Archive: http://photoarchive.ap.org/PRN Photo Desk, [email protected]

Lierac Paris

CONTACT: Jenna Muller, +1-212-707-6240, [email protected], orAnne-Cecile Blanchot, +1-212-707-6241, [email protected], both forLierac Paris

Web site: http://www.lierac.com/http://www.mediabistro.com/

By Lisa Vernon-Sparks, The Providence Journal, R.I.

Jul. 24–NORTH PROVIDENCE — Beneath foreboding skies yesterday afternoon, nurses from Our Lady of Fatima Hospital and their union leadership marched with picket signs to protest recent contract negotiations, future benefits and what they say are unsafe staffing levels.

About 300 staff members and per-diem nurses at the Catholic hospital are represented by the United Nurses & Allied Professionals.

Talks have bogged down over staffing numbers during shifts, which union officials say are far below what is needed. The numbers are also not in sync with what the hospital has been reporting to the state Department of Health about staffing levels, according to union officials. The union says management has trimmed health and pension benefits in its proposed offer, which it says will hinder efforts to hire more nurses.

Negotiations began in May; the current agreement is set to expire midnight July 31.

“In the last 3 1/2 years, nurses have filed 400 unsafe staffing forms,” said Christopher Callaci, a field representative for the union. “The significance of that number [of complaints] should not be underestimated. These guys are out of touch.”

R. Otis Brown, a hospital vice president, said “Staffing is not a problem. We stand behind our care. There are no federal or state mandates,” he said. “We have to have flexibility in staffing because of our volume and acuity.”

Brown said the hospital has included 14 new registered nurse positions and 9 observational assistant positions to assist nurses in the monitoring of select patients. The hospital has 84 nurses in its per-diem float pool to provide flexibility in handling staff absences or increases in the number of patients, he said.

“We are anxious to get back to the bargaining table. Any issues that need to be addressed at all are better addressed at that setting than out here or in the newspaper, or on the radio,” he said.

Yesterday, a few dozen nurses, some family members and a former patient marched with signs that read: “Bad faith,” and “Where is the Bishop?” a reference to Bishop Thomas J. Tobin. They chanted, too, saying “More nurses.”

According to some unsafe-staffing forms filled out by supervisors, the patient-to-nurse ratio is higher than it should be. For example, a heart unit with 23 patients during an overnight shift should be staffed with four nurses, but was only staffed with two.

Lynn Blais, a registered nurse and the union’s local president, said the short-handed shifts have eroded morale.

“In my 24 years as a nurse, this has been the worse that I’ve ever seen. [Nurses] can’t understand why they won’t staff. They are worried that they are going to hurt a patient. They are worried about their licenses,” Blais said.

Members voted last week to authorize the union leadership to call a strike if needed. State law stipulates that the union must give the hospital a 10-day notice before a strike.

“A strike notice sets off a number of things. Nobody wins in a strike. We’ll do what have to reach a settlement,” Brown said.

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To see more of the The Providence Journal, or to subscribe to the newspaper, go to http://www.projo.com.

Copyright (c) 2008, The Providence Journal, R.I.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Rachel Carta, The News-Item, Shamokin, Pa.

Jul. 25–Ten-year-old Matt Avellino came running into the kitchen at his grandmother’s Marion Heights home to give his 94-year-old great-great-grandmother a hug.

Matt, one of 21 great-great-grandchildren of Violet Feudale, said it’s great having his “Bushie” within walking distance of his home.

Feudale, who is legally blind, lives in the Marion Heights home of her granddaughter, Carol Wolfgang. Wolfgang, 58, said she has been caring for relatives in her home for many years, and was happy to have her grandmother move in.

Though such care is second nature for her, Wolfgang said there is obviously a noticeable extra expense. With that, she was pleased to hear last week about a proposed tax credit for caregivers.

With 80 percent of long-term care coming from caregivers, and the fact that people are living longer in retirement, U.S. Rep. Christopher Carney, D-10, along with fellow Pennsylvania Congressman Todd Platts, R-19, have introduced the Bipartisan Caregiver Tax Relief Act of 2008.

The bill, which is awaiting action in committee, calls for a $2,500 tax credit for anyone providing long-term care. The full credit would be available to individuals making up to $75,000, and to couples with a combined $150,000 income. The credit would fall by $100 for every $1,000 over those income caps.

“The way we take care of our seniors tells a lot about us as a community,” Carney said in a statement announcing the bill.

Today, a lot of families are taking on that responsibility, he said, and the relief act would provide assistance to seniors and their families to make it easier for these families to stay together.

“This means helping a working mother who also cares for her elderly father, or making it easier for families to chip in and pay for long-term care,” Carney said in his announcement.

‘Long time coming’

A study completed by the U.S. Department of Health and Human Services in 2000 found that more than 50 million people provide care for a chronically ill, disabled or aged family member or friend during any given year.

In 2005, 71 percent of adults had at least one parent living with them. In addition, the fastest-growing segment of people are those over age 85.

“I think it is a long time coming,” said Pat Rumberger, director of the Northumberland County Area Agency on Aging, about help for in-home caregivers. “There are a lot of people in this county and across the country that have been taking care of family members for a long time. They have quit their jobs and are not getting anything in return.”

Rumberger said the proposed tax credit would be a way for caregivers to get something for their service.

Pat Rosini, the agency’s deputy director, said the tax credit will help all taxpayers in the long run because it keeps aging people out of nursing homes.

“With the baby boomers coming in, anything that the government can do to keep them out of the nursing homes is an advantage,” she said.

$306 billion for ‘free’

According to www.familycaregiver.org, the value of the services family caregivers provide for “free” is estimated to be $306 billion a year. That is almost twice as much as the $158 million spent on home care and nursing home services combined.

“If we are not getting additional funding, it just hurts the people,” Rumberger said. “The caregiver tax is at least something. They really have to give up a lot to take care of their loved ones.”

Surrounded by family

When Wolfgang’s grandmother was faced with the choice between a nursing home or living with a relative, it was an easy decision. At the Wolfgang home, she has her own room, prepared meals, freedom to come and go and her dog. Also, most importantly, she is surrounded by her family.

“It is just easier to sit and be able to talk with her,” Wolfgang said of having her grandmother close.

Wolfgang, who is the oldest of Feudale’s grandchildren, said she was happy to offer her home to her grandmother because it provided peace of mind for the entire family. When Feudale was living at her home and did not answer the phone, relatives would immediately worry and travel to check on her.

Also, Wolfgang said she believes an aging relative can live longer in the loving home of a relative as opposed to an assisted-living facility or a nursing home.

“They will just have a better outlook on life,” she said.

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To see more of The News-Item or to subscribe to the newspaper, go to http://www.newsitem.com.

Copyright (c) 2008, The News-Item, Shamokin, Pa.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Jennifer Reeger, Tribune-Review, Greensburg, Pa.

Jul. 25–A new forensic housing unit for criminals at Torrance State Hospital is on schedule to open by the end of the year, the Derry Township hospital’s chief executive officer said at a board meeting Thursday.

Renovations are under way and Torrance employees who want to work in the forensic unit are being trained, Edna McCutcheon said.

The unit is opening because of the planned closing of Mayview State Hospital in Allegheny County.

Up to 75 patients will be housed at the new Torrance facility, which will provide in-patient mental health evaluation and treatment for county jail inmates who are awaiting trial or sentencing for crimes.

Minor renovations have begun at the hospital’s Beistal Building, which will house the forensic unit. That building houses juvenile sex offenders sentenced to incarceration after they become adults.

Those offenders will be moved to the now-vacant Wiseman Building, which needs extensive renovations. The hospital’s renovation plans for that building were recently approved by the state Department of Labor and Industry, McCutcheon said.

In the meantime, the juvenile sex offenders will be moved to another recently vacated building while their new home is being readied.

She said the hospital anticipates 70 staff members will be transferring from Mayview.

Torrance employees who are transferring to the forensic unit are starting extensive training as well, McCutcheon said.

The transition should wrap up by Dec. 31.

“No one except a very small group of people will know the exact date when the transition will occur, obviously for security and safety reasons,” she said.

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To see more of the Tribune-Review or to subscribe to the newspaper, go to http://www.pittsburghlive.com/x/tribunereview/.

Copyright (c) 2008, Tribune-Review, Greensburg, Pa.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

Zipfizz, a maker of healthy energy drink products, has signed a distribution deal with CVS/pharmacy. Earlier in 2008, Zipfizz signed distribution agreements with Target, Rite Aid, H-E-B, Bartell Drugs and Vitamin Shoppe for the company’s flagship product, Zipfizz Healthy Energy Mix.

CVS/pharmacy will carry the Zipfizz three-pack in orange and pink lemonade flavors. The Zipfizz Healthy Energy Drink Mix is packaged in a test tube-like, single-serving container, and contains only 10 calories, no sugar, and two net carbs, according to the company.

Adrian Vicente, vice president of Zipfizz, said: “We are very excited to partner with CVS/pharmacy. It is another important step for us as we become a national brand.”

By John Dayberry, Hickory Daily Record, N.C.

Jul. 25–HICKORY — A weak economy may have slowed the demand for spa services, but the industry remains robust and growing, according to area providers of massages, facials and related treatments. “I knew there was a market here for these services, but people have been incredibly supportive,” said Kasie Hildebran, owner of the 6-year-old Riah 103 salon and day spa in Morganton. “The degree of our success has surprised me a little,” she said. The picture is rosier at the region’s medical spas, where requests for Botox, microdermabrasion, derma fillers, laser hair removal and similar procedures are at an all-time high. Grace McLaurin said business has grown “like gangbusters” at Vitality Anti-Aging Center and Med Spa since the business opened in 2006 in northwest Hickory. “We’re still experiencing growth,” McLaurin said. Trends apparent in the Catawba Valley spa scene tend to mirror those on the national level. According to the International Spa Association, there were an estimated 14,615 spas in the United States in August 2007, up 6 percent from 13,757 spas in August of 2006. Day spas comprise about 80 percent of the spas in the United States and are by far the most common type in the Greater Hickory Metro. Typical day-spa treatments include massages of various types, facials, manicures and pedicures, waxing, body wraps and aroma therapy. Treatments are offered separately and as part of packages. Many day spas are associated with hair salons or employ hair stylists, and therefore offer a variety of hair services. Medical spas, which comprise about 7 percent of the spas in the United States, are becoming more common in the region. At medical spas patients are supervised by medical professionals and can receive procedures and diagnostic testing typically performed in a medical setting.

Day spas The region’s most elaborate day spa is The Spa at Rock Barn in Conover. The 20,000-square-foot spa includes a full-service salon, treatment rooms, a relaxation room, boutique and juice bar. In addition to size and its location at Rock Barn Golf and Spa, an elaborate pool area sets it apart from other day spas in the region. The area includes a mineral pool with piped-in underwater music, an indoor whirlpool with a cold plunge, a waterfall whirlpool and an outdoor whirlpool with fireplace. “The pool area has that Wow! factor,” said Tanya Hartsoe, Rock Barn’s spa manager. Separate, private locker rooms are offered for women and men. They are equipped with full shower amenities, steam rooms and saunas. Robes and slippers are available. A range of services is offered at the four-year-old day spa, including facials, massages, manicures, pedicures, hair services and such body treatments as polishes and wraps. Services are tailored to women, men and couples. While many clients live in the Greater Hickory Metro, nearly half come from as far as Charlotte and Hendersonville to use the spa and other amenities at Rock Barn, Hartsoe said. Hartsoe and Danielle White, spa supervisor, said more men are enjoying spa treatments, and that women and men alike are willing to splurge on the luxury. Thomas “Hyder” Holland agrees. The 25-year-old massage therapist has been with the spa for four years. A dramatic increase in the demand for massage therapy prompted the former personal fitness trainer to go back to school to learn massage. “You can make a good living at this,” Holland said. “And you’re helping people.” Hildebran designed the colorful and airy Riah 103 building in downtown Morganton as a salon and day spa. “I didn’t want to be the same old hairdresser in town,” Hildebran said. “I wanted something different for Morganton. I wanted to set some high goals for hairdressers.” Hildebran said most of Riah’s clients come from the Morganton area, but that many regulars drive from Marion, Lenoir and Hickory and from as far as Charlotte. She said the economic slowdown has prompted some of her customers to set priorities, which sometimes means cutting back on the frequency of services. “I’m glad they are honest with me,” she said. “Once they get a facial or massage they’re hooked,” Hildebran said.

Medical Spas Vitality Anti-Aging Center and Med Spa’s McLaurin, a physician assistant, has practiced in the Hickory Metro for 12 years. She has advanced training in Botox, dermal fillers, cellulite reduction and multiple laser systems. She also has experience in internal medicine and women’s health. In addition to traditional day-spa services, Vitality performs laser hair removal, vein therapy, acne treatments, chemical peels, microdermabrasion, Botox and dermal filler applications, cellulite treatments and other non-surgical procedures typically done in a medical setting. It offers medical-grade cosmetics as well as cosmetic consultations. The center also offers medically supervised weight loss, bio-identical hormone counseling and wellness examinations for women. McLaurin said Vitality’s philosophy is that a person must feel well on the inside and look good on the outside to attain a sense of complete well-being. “With Vitality, I wanted to put all of the pieces together,” she said. “I believed Hickory was ready for this, and I’ve been proved right.” The center’s growth led to the opening of a satellite location at The Spa Athletic Club in Hickory, where it offers massages, facials, body wraps and other non-medical services. McLaurin said Vitality has about 1,200 regular clients, and is getting new patients every day. Vitality’s patients favor non-surgical facial rejuvenation because there is little or no down time involved, she added. The center’s patients also value expert training and experience, McLaurin said. “It’s not the laser and the lights that are dangerous, it’s the people driving them,” she said. “Here, our people are trained and experienced, and we invest a lot of money in their continuing education. That’s important.”

Education As the demand for spa services grows, so does the need for people trained to provide them. “We’re getting calls from spas and from doctors’ and chiropractic offices every day,” said Renee Hicks, director and instructor at Natural Touch School of Massage Therapy, Esthetics and Spa Technologies in Hickory. The Greensboro-based school offers programs in massage therapy and in esthetics that students can complete in six to 14 months attending day or evening classes. The 550-hour massage therapy program prepares students to take the national certification exam required by the North Carolina Board of Massage and Bodywork Therapy. The 600-hour program in advanced esthetics prepares students to take the N.C. State Board Exam for estheticians. Tuition and fees total $6,800. The school also offers a range of services performed by students who have completed at least their first 100 hours of training. Massage therapists are employed in such settings as wellness clinics, spas, doctors’ offices, chiropractic offices, athletic training centers and cruise ships. Some are self-employed. Estheticians often work in spas, salons, medical spas, laser hair removal centers, doctors’ offices or as manufacturers’ representatives for skin-care products and equipment. Since the Hickory school opened four years ago, people from 18 to their 70s have attended classes. About 30 are enrolled at any given time. The school draws from the Greater Hickory Metro and from surrounding cities including Statesville, Mooresville and Wilkesboro. Many students have job offers before they graduate. “There’s a growing demand,” Hicks said. Valentin Popov, a massage therapy instructor and continuing education provider at Natural Touch in Hickory, said that as baby boomers age, they are seeking treatments that complement care they receive from physicians. Hicks and Popov say the most successful massage therapists have a desire to help and to heal people. “You have to be caring, nurturing, supportive,” Hicks said. “The ones who go into it for the money get burned out.” Popov said that as technology advances, so do lifestyles that depend on technology rather than the human body. “We remind people that they have a body and teach them how to feel comfortable in their bodies,” Popov said.

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To see more of the Hickory Daily Record or to subscribe to the newspaper, go to http://www.hickoryrecord.com.

Copyright (c) 2008, Hickory Daily Record, N.C.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

DETROIT, July 25 /PRNewswire-USNewswire/ — Albert Garrett, President of Michigan Council 25 of the American Federation of State, County and Municipal Employees (AFSCME), AFL-CIO, issued the following statement regarding the Performance Audit of the Suitability of Child Development and Care Program Providers issued on July 22, 2008 by State Auditor General Thomas H. McTavish:

“Over 98 percent of the child care providers have been vetted by both the Department of Human Services and now by the Auditor General, and found to be completely free of criminal records,” stated Garrett. “There is no indication that they pose any threat to any child in their care. They are in fact providing excellent and badly needed care.

“But even one child in danger is not acceptable. The Auditor General has not indicated the time lines or even the severity of the behavior he deems ‘inappropriate’ in the remaining 1.6 percent of child care providers,” continued Garrett. “So we are constantly looking for even better ways to improve the quality and safety of child care.”

“The audit refers to a period before we represented these child care providers,” noted Herbert A. Sanders, AFSCME Council 25 Administrative Director. “Since the audit period, we have been working with the Department of Human Services to address a number of these concerns. In the contract, the department and the Union have agreed upon an extensive training process to address and eradicate most concerns related to provider qualifications. The Auditor General is pointing to outdated concerns which are already being addressed.”

“We have also supported legislation to address the need for greater training and accountability, as well as safety,” added Nick Ciaramitaro, AFSCME Council 25 Director of Legislation and Public Policy. “The Michigan House of Representatives has already passed a package of Child Day Care Reform Bills (House Bills 6214-21). These bills include a new safety checklist, limitations on the number of children under the care of day care aides, enhanced training requirements, and requirements for criminal background checks at the time of enrollment.”

“The Auditor General is speaking to a set of conditions which existed from 2003 to 2006; however, it is now 2008, and the rest of us are implementing the solutions, rather than just discovering these concerns,” concluded Garrett.

Albert Garrett also serves as Vice President of AFSCME International. Michigan AFSCME Council 25 represents more than 90,000 public workers across Michigan. AFSCME International represents 1.4 million public workers nationwide. News releases issued by Michigan AFSCME Council 25 are available at http://www.miafscme.org/Releases.htm.

Michigan AFSCME Council 25

CONTACT: Nick Ciaramitaro, Director, Legislation & Public Policy,Michigan AFSCME Council 25, AFL-CIO, 800-237-2632

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

Q: The label on my prescription bottle (diabetes med) says to avoid prolonged sun exposure. Why?

A: Some drugs may cause a photosensitivity reaction (sensitivity to UVA rays of the sun or tanning devices). The result can be an exaggerated sunburn or, more rarely, an allergic reaction with itching and a blister-like eruption.

Your best defense is to wear protective clothing and apply a sunscreen that protects against both UVB and UVA rays.

Here’s an alphabetized list of potentially photosensitizing drugs (by generic/brand). The list may not be complete, so check prescription labels for a photosensitivity caution.

ANTI-ANXIETY/SLEEPING AGENTS

alprazolam (Xanax), chlordiazepoxide (Librium), eszopiclone (Lunesta), zaleplon (Sonata), zolpidem (Ambien)

ANTIBIOTIC/ANTIFUNGAL/ANTIVIRAL AGENTS

acyclovir (Zovirax), amantadine (Symmetrel), azithromycin (Zithromax), capreomycin (Capastat), cefazolin (Ancef), ceftazidime (Fortaz), ciprofloxacin Cipro), cycloserine (Seromycin), dapsone, demeclocycline (Declomycin), doxycycline (Vibramycin), ethionamide (Trecator-SC), flucytosine (Ancobon), gemifloxacin (Factive), griseofulvin (Fulvicin, Gris-PEG), isoniazid (Nydrazid), levofloxacin (Levaquin), lomefloxacin (Maxaquin), metronidazole (Flagyl), minocycline (Minocin), moxifloxacin (Avelox), nalidixic acid (NegGram), norfloxacin (Noroxin), ofloxacin (Floxin) , oxytetracycline (Terramycin), pyrazinamide, ritonavir (Norvir), saquinavir (Fortovase, Invirase), sulfamethoxazole/trimethoprim (Bactrim), sulfasalazine (Azulfidine), sulfisoxazole (Gantrisin), terconazole (Terazol), tetracycline (Achromycin) , voriconazole (VFEND), zalcitabine (Hivid)

ANTI-CANCER AGENTS

bexarotene (Targretin), capecitabine (Xeloda), dacarbazine (DTIC), epirubicin (Ellence), fluorouracil (5-FU), interferon alfa (Intron A, Alferon-N) methotrexate (Mexate), pentostatin (Nipent), procarbazine (Matulane), tretinoin oral (Vesanoid), vinblastine (Velban, Velbe)

ANTICONVULSANTS

carbamazepine (Tegretol), felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), topiramate (Topamax), valproic acid (Depakene)

ANTIDEPRESSANTS

amitriptyline (Elavil), amoxapine (Asendin), bupropion (Wellbutrin), citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Tofranil), maprotiline (Ludiomil), mirtazapine (Remeron), nefazodone (Serzone), nortriptyline (Pamelor), paroxetine (Paxil), protriptyline (Vivactil), sertraline (Zoloft), trazodone (Desyrel), trimipramine (Surmontil), venlafaxine (Effexor)

ANTIDIABETIC AGENTS

acetohexamide (Dymelor), chlorpropamide (Diabinese), glimepiride (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta, Micronase), tolazamide (Tolinase), tolbutamide (Orinase)

ANTIHISTAMINES

cetirizine (Zyrtec), cyproheptadine (Periactin), diphenhydramine (Benadryl), loratadine (Claritin)

ANTI-MALARIA AGENTS

chloroquine (Aralen), hydroxychloroquine (Plaquenil), pyrimethamine (Daraprim), pyrimethamine/sulfadoxine (Fansidar), quinine

ANTIPSYCHOTICS

chlorpromazine (Thorazine), clozapine (Clozaril), fluphenazine (Prolixin), haloperidol (Haldol), loxapine (Loxitane), olanzapine (Zyprexa), perphenazine (Trilafon), prochlorperazine (Compazine), quetiapine (Seroquel), risperidone (Risperdal), thioridazine (Mellaril), thiothixene (Navane), trifluoperazine (Stelazine), ziprasidone (Geodon)

DIURETICS

bendroflumethiazide (Corzide), chlorthalidone (Thalitone), furosemide (Lasix), hydrochlorothiazide (Microzide), hydroflumethiazide (Diucardin), indapamide (Lozol), methyclothiazide (Enduron), metolazone (Zaroxolyn), polythiazide (Renese), triamterene (Dyrenium)

HIGH BLOOD PRESSURE AGENTS

captopril (Capoten), diltiazem (Cardizem, Tiazac), enalapril (Vasotec), nifedipine (Procardia)

HORMONES

Corticosteroids (e.g., prednisone), Oral contraceptives

LIPID-LOWERING AGENTS

atorvastatin (Lipitor), fenofibrate (Tricor), fluvastatin (Lescol), gemfibrozil (Lopid), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor), simvastatin (Zocor)

PAIN-RELIEVERS

celecoxib (Celebrex), cyclobenzaprine (Flexeril), dantrolene (Dantrium), diclofenac (Cataflam, Voltaren), diflunisal (Dolobid), etodolac (Lodine), ibuprofen (Motrin), ketoprofen (Orudis), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Anaprox), oxaprozin (Daypro), piroxicam (Feldene), sulindac (Clinoril), sumatriptan (Imitrex)

TOPICAL AGENTS (applied to the skin)

benzocaine (Americaine), benzyphenones, cinnamates, coal tar, hexachlorophene (PHisoHex), minoxidil (Rogaine), PABA, tacrolimus (Prograf, Protopic), tazarotene (Tazorac), tretinoin (Renova, Retin-A)

OTHER

amiodarone (Cordarone, Pacerone), chlorhexidine (Peridex, Hibiclens), clopidogrel (Plavix), gold salts, isotretinoin (Accutane), methoxsalen (Uvadex, Oxsoralen), promethazine (Phenergan), quinidine, selegiline (Eldepryl), sotalol (Betapace), thalidomide (Thalomid)

DIETARY SUPPLEMENTS

bitter orange, chlorella, dong quai, gossypol, gotu kola, St. John’s wort, Vitamin A, Vitamin B6 (pyridoxine)

___

(Richard Harkness is a consultant pharmacist, natural medicines specialist and author of eight published books. Write him at 1224 King Henry Drive, Ocean Springs, MS 39564 or [email protected].)

___

(c) 2008, The Sun Herald (Biloxi, Miss.).

Visit The Sun Herald Online at http://www.sunherald.com/

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Steve Sternberg

A study that unexpectedly linked the heart drug Vytorin to excess cancer deaths has provoked controversy among heart specialists worried that the drug’s risks may outweigh its benefits.

The study, called SEAS, was designed to test whether Vytorin could prevent severe, age-related heart valve problems by sharply reducing cholesterol. But lead investigator Terje Pedersen of Ulleval University Hospital in Oslo reported Monday that the study turned up a “disturbing” link to cancer.

At that same session, Oxford University experts released a separate analysis comparing SEAS data with two other ongoing studies and concluded that the cancer link wasn’t “credible.”

The debate rages on, with prominent heart specialists reluctant to discount the cancer risk. “Evidence like this should raise concerns,” says cardiologist Harlan Krumholz of Yale University. “Patients should be aware that there’s some uncertainty about the safety of Vytorin that will not be resolved until we get more definitive trial evidence.”

Vytorin and its chemical cousin, Zetia, are widely prescribed. Sales for both drugs, made by Merck and Schering-Plough, total more than $4 billion a year. Both are made with the cholesterol-blocker ezetimibe; Vytorin also contains simvastatin, now a generic cholesterol-lowering drug.

The 2,000-patient SEAS study found a roughly 70% increase in the risk of dying from cancer. But the Oxford analysis of the two ongoing studies, called IMPROVE-IT and SHARP, found about a 33% increase in the risk of dying from cancer. That’s considered borderline in statistical significance.

Oxford’s Sir Richard Peto says he could find no pattern that could plausibly link the cancer deaths to Vytorin, such as a rise in the number of cancer deaths as exposure to the drug increases.

The evidence leaves many doctors uncertain. “Obviously, if you see it in one study, even if it’s not statistically significant, you’ve got to be worried,” says oncologist Ezekiel Emanuel of the National Institutes of Health. “Maybe this has a biological mechanism we don’t know anything about.”

Federal regulators also wrestle with how to respond, says former FDA commissioner David Kessler, now of the University of California-San Francisco. “The hard part is if you’re a patient before all the data come in, when you have scientists waging these (debates) about the level of risk.”

Robert Califf of Duke University, a co-leader of IMPROVE-IT, says that until the evidence is in, patients should take the standard cholesterol-lowering drugs called statins, rather than Vytorin, if they can. “Vytorin should be used for patients who can’t hit their target with a statin,” he says.

Vytorin was approved in 2004 based on its power to reduce cholesterol. Yet researchers still don’t know whether that potency translates into lives saved. The answers won’t be available until 2012, when the 18,000-patient IMPROVE-IT trial ends.

A statement by Merck and Schering-Plough acknowledged a higher incidence of cancer and “a non-significant increase” in cancer deaths in study patients. It adds: The finding is “an anomaly that, taken in light of all the available data, doesn’t support an association with Vytorin.”

“Your first reaction is, ‘Is it just a chance finding?’ Then you see it in a second trial, and say, ‘Whoa, can this be true? What’s the science here?'” says Allen Taylor, chief of cardiology at Walter Reed Army Medical Center. (c) Copyright 2008 USA TODAY, a division of Gannett Co. Inc. <>

FESTIVALS

International Quilt Festival. More than 1,000 quilts, textiles and wearable art on display; classes, lectures; crafts workshops; vendors. 10 a.m.-7 p.m. today-Saturday, 10 a.m.-3 p.m. Sunday, Long Beach Convention Center, 300 E. Ocean Blvd. $10; $8 seniors, students; ages 10 and under free with paying adult; three-day pass $25. (562) 436-3661, www.quilts.com

Dragon Boat Festival. Dragon boat races; Chinese music, dance, acrobats and martial-arts demonstrations; food booths. 10 a.m.-6 p.m. Saturday, 9 a.m.-3:30 p.m. Sunday, Marine Stadium, 5255 Paoli Way, Long Beach. Free. (562) 570-3215, www.lbdragonboat.com

Semana Jalisciense Festival. Mariachi bands, folkloric dancers, Miss Jalisco-Los Angeles pageant. 4:30 p.m. Saturday, Terrace Theater, 300 E. Ocean Blvd., Long Beach. Free, but ticket required for admission; call (562) 228-3483.

Caribbean Festival. Reggae musicians including Shabba Ranks and Junior Reid; food; vendors. Noon-10 p.m. Sunday, Queen Mary Events Park, 1126 Queens Highway, Long Beach. $50 in advance, $60 at gate; ages 9 and under free with paying adult. (310) 424-1276, www.caribsumfest.comFAMILY

Orange County Fair. Noon-midnight Tuesday-Friday; 10 a.m.- midnight Saturday-Sunday; closed Monday; through Aug. 3. OC Fair & Event Center, 88 Fair Drive, Costa Mesa. $9; $7 seniors 60 and over; $5 ages 6-12; ages 5 and under free. (714) 708-3247, www.ocfair.com; or (213) 480-3232, (714) 740-2000, www.ticketmaster.com

Ringling Bros. and Barnum & Bailey Circus. Various times Tuesday- Sunday through Aug. 3 at Honda Center, 2695 E. Katella Ave., Anaheim. $15-$90. (213) 480-3232, (714) 740-2000, www.ticketmaster.comTHEATER

“Company.” Stephen Sondheim’s musical set in 1970 s New York City, about a bachelor’s look at relationships and aging on his 35 th birthday. Opens 7:30 tonight. 7:30 p.m. Friday-Saturday, 2 p.m. Sunday; through Aug. 3. Rose Center Theater, 14140 All American Way, Westminster. $20; $15 seniors, students. (714) 793-1150, www.rosecentertheater.com

“The Drunkard.” Musical-comedy spoof of the 19 th-century temperance play, featuring an upstanding hero, sweet heroine and dastardly villain; followed by “Those Golden, Olden Days” vaudeville revue. 7:30 p.m. Thursday-Friday, 4:30 and 8:30 p.m. Saturday, 7 p.m. Sunday; through Aug. 24. All American Melodrama Theater and Music Hall, 429-E Shoreline Village Drive, Long Beach. $18; $16 seniors, military, students; $14 ages 12 and under. (562) 495-5900, www.allamerican melodrama.com

“Urinetown, the Musical.” The Relevant Stage Theatre Company presents the musical satire set in a drought-stricken place where the government controls all toilets. Opens 8 p.m. Thursday. 8 p.m. Thursday-Saturday, 2:30 p.m. Sunday; through Aug. 10. Warner Grand Theatre, 478 W. Sixth St., San Pedro. $20; $15 seniors, students; $5 ages 18 and under. (310) 929-8129, www.therelevant stage.comCHILDREN’S THEATER

“Brundibar.” Children from Long Beach Opera’s Opera Camp project perform the children’s opera by Hans Krasa about a young sister and brother who defeat an evil bully with the help of their animal friends. 7 p.m. Thursday, Long Beach Opera Stage Facility, 507 Pacific Ave. Free. (562) 432-5934.DANCE

Long Beach Ballet. Program from the company’s upcoming tour of China: second act of “Swan Lake,””Ballet American Style,””Americans Study Jing Ju.” 7 p.m. Saturday, Lakewood High School Auditorium, 4400 Briercrest Ave., Lakewood. $20. (562) 426- 4112.COMEDY

Last Sunday Stand-Up. Jackie Kashian and Joe Wilson host six stand-up comedians in a show for ages 16 and older. 7 p.m. Sunday, Found Theatre, 599 Long Beach Blvd., Long Beach. $10. (562) 433- 3363, www.foundtheatre.orgFILM

“Breakfast at Tiffany’s.” 1961 romantic comedy starring Audrey Hepburn. 1 p.m. today, Los Altos Library, 5614 Britton Drive, Long Beach. Free. (562) 570-1045.

Family Film Festival. “Bee Movie.” 3 p.m. today, Mark Twain Library, 1325 E. Anaheim St., Long Beach. Free. (562) 570-1046.

Bellflower Movies Under the Stars. “Daddy Day Camp.” Dusk tonight, Town Center Plaza, near Bellflower Boulevard and Belmont Street. Free. (562) 804-1424, ext. 2268.

“The Graduate.” 1967 comedy starring Anne Bancroft and Dustin Hoffman. 12:30 p.m. Saturday, Brewitt Library, 4036 E. Anaheim St., Long Beach. (562) 570-1040.

Family Film Festival. “A Bug’s Life.” 2 p.m. Saturday, Los Altos Library, 5614 Britton Drive, Long Beach. Free. (562) 570-1045.

“The Wild Bunch.” 1969 Western starring William Holden and Ernest Borgnine. 5:30 p.m. Sunday, 7:30 p.m. Monday and Wednesday, Bay Theatre, 340 Main St., Seal Beach. $8; $6 seniors, students. (562) 431-9988, www.baytheatre.com

La Mirada Family Swim-In Movies. “Shark Tale” is projected on a large poolside screen. 7:30 p.m. Sunday, La Mirada Regional Aquatics Center, 13806 La Mirada Blvd. $6. (562) 902-3191.

Cerritos Monday Afternoon Movies. “James and the Giant Peach.” 3 p.m. Monday, Cerritos Library, Skyline Room, 18025 Bloomfield Ave. Free, but registration required: (562) 916-1388.

Paramount Monday Night Movies. “101 Dalmatians.” 7 p.m. Monday, Progress Park, 15500 Downey Ave. Free. (562) 220-2121.

Long Beach Movies in the Park. “Bee Movie” starts at dusk Friday at Bixby Park, 130 Cherry Ave. “Surf’s Up” starts at dusk at these locations: Monday at College Estates Park, 808 Stevely Ave.; Tuesday at Drake Park, 951 Maine Ave.; Wednesday at DeForest Park, 6255 DeForest Ave.; Thursday at Scherer Park, 4600 Long Beach Blvd.; Aug. 1 at Stearns Champions Park, 4520 E. 23 rd St. Free. (562) 570- 3100.

Movie Mondays at the Orange County Performing Artscenter. “The Muppet Movie.” Dusk Monday at the center’s community plaza, 600 Town Center Drive, Costa Mesa. Free. (714) 556-2787.

Cerritos Monday Night at the Movies. “The Aristocats.” 8:15 p.m. Monday, Liberty Park Amphitheater, 19211 Studebaker Road. Free. (562) 916-1254.

Long Beach Moonlight Movies on the Beach. “Back to the Future,” dusk Tuesday, Granada Beach, 5101 E. Ocean Blvd. “North by Northwest,” dusk Wednesday, Cherry Beach, Ocean Boulevard and Junipero Avenue. Free. (562) 434-1542, www.alfredosbeachclub.com

Cinema Orange. “The Village Barbershop,” 2008 comedy about a crusty Reno barber (John Ratzenberger) forced to hire a feisty young woman (Shelly Cole) in order to save his business. 7:30 p.m. Thursday, Orange County Museum of Art Auditorium, 850 San Clemente Drive, Newport Beach. Free with museum admission: $10; $8 seniors, students; free for children under age 12. (949) 759-1122.ART

“Viva Frida!” Works portraying Mexican artist Frido Kahlo; opens Tuesday; through Sept. 13. Noon-6 p.m. Tuesday-Friday, 10 a.m.-4 p.m. Saturday. Picture This Gallery, 4130 Norse Way, Long Beach. (562) 425-4861.

(c) 2008 Press-Telegram Long Beach, CA.. Provided by ProQuest Information and Learning. All rights Reserved.

By Bill Lohmann, Richmond Times-Dispatch, Va.

Jul. 25–Gas prices are gnawing a hole in your wallet, and the cost of everything else is making your head hurt, too.

How do you have a little family fun without spending the grocery money?

Here’s a start:

Quit reading Fabulous Vacations of the Rich and Annoying Monthly and ratchet down your expectations. Besides, do you really need a $10,000-a-week beach house to have the time of your life?

Don’t answer that.

Instead, think of the simple pleasures of finding fun where you can close to home.

With the help of readers, we’ve fashioned a partial list of free or inexpensive family activities around town. Area parks

–James River Park covers more than 550 acres of shoreline and islands, extending from the Huguenot Bridge eastward to just beyond the Interstate 95 bridge, and it’s all free. You can hike or bike on the walking trails. Go down to the water and hop from rock to rock. Fish or sunbathe. More adventurous? Shoot the rapids or find a swinging rope and take a flying dunk into the water. Belle Isle, with its 1-mile path, is a favorite destination. Find out more: www.jamesriverpark.org

–Maymont is a perfect picnic destination. Besides strolling among the Italian and Japanese gardens and meandering over the hills, you can pet a chicken at the Children’s Farm or watch the otters at the Robins Nature and Visitor Center. Admis sion is free, although donations are welcome at the Nature Center. Find out more: www.maymont.org

–Pocahontas State Park, in Chesterfield County, is not free admission is a $5 parking fee — but it’s close. The mammoth park — at more than 7,600 acres it’s Virginia’s largest — has the usual picnic shelters and camping, as well as hiking and biking trails. But it also offers an impressive pool (swimming fee is $6 for 13-and-older guests on weekdays, kids 3-12 are $5, and younger than 3 are free) and two lakes. My 11-year-old and I paddled our kayaks around Swift Creek Lake on a recent Sunday afternoon and had a most enjoyable time exploring the various coves. Turtles were everywhere. If you don’t have your own vessel, you can rent rowboats and paddle boats ($6 per hour) and kayaks (singles, $8 per hour, and tandems, $10 per hour) at the lake. www.dcr.virginia.gov/state_parks/poc.shtml

Other parks of interest include:

–Chesterfield : Dutch Gap Conservation Area, 800 acres of woodlands and wildlife, perfect for hiking and birding and Robious Landing Park, a 50-acre park with 3 miles of nature trails and access to the James River. www.co.chesterfield.va.us/humanservices/parksandrecreation/parksites.asp

–Henrico County: Take your kids bike-riding at Deep Run Park in the west or go fly a kite at Dorey Park in the east. Playgrounds are available in most every park. www.co.henrico.va.us/rec

–Hanover County: Try Pole Green Park, which has an equestrian area, jogging trails, ball fields and a skateboard park. www.co.hanover.va.us/parksrec/ Walking free

Stroll around Capitol Square and take a tour of the newly restored Capitol. Tours are free. www.virginiacapitol.gov

* –Amble along Richmond’s 1.25-mile Canal Walk. It has access points at nearly every block between Fifth and 17th streets, with historical exhibits along the way. www.venturerichmond.com

–Saunter through Carytown. Buy if you’d like, but just browse if you’d prefer. “One day, I decided to just go into every shop in a one-block area,” said Liz Snead, a Chesterfield resident who has lots of ideas about free or inexpensive fun. “It was fun. I got to see lots of real neat stuff. It was like going to a museum where you are allowed to touch the exhibits. I got to talk to a lot of people, too.” www.carytown.org

–Wander through The James Center’s atrium on East Cary Street, between 10th and 12th streets and ride the glass elevators. Kids always like glass elevators. www.thejamescenter.com Music to my ears

Performances at Dogwood Dell are free. The summer season is winding down, but several shows remain. Tonight, Simply Kevin B (jazz funk) performs at 8 p.m. Tomorrow at the same time, local legend Robbin Thompson (Americana, blues) takes the stage. The Latin Ballet dances Sunday at 4 p.m. “Little Shop of Horrors” will be performed Aug. 1-3 and 7-9, 8:30 each night. The Whitlocks (vocal music) are scheduled for Aug. 3 at 4 p.m. on the Ha’Penny Stage behind the Carillon. www.ci.richmond.va.us/departments/parks/dogwood.aspx

* –Short Pump Town Center offers a free concert every Friday (weather permitting) through the summer. Shows run 6-8 p.m. in the Main Plaza. Tonight: Son Quatro. Next Friday: Marna and Macy. www.shortpumpmall.com

–Take a lawn chair and enjoy the Henrico Community Band free outdoor concerts at Deep Run Park (July 31 and Aug. 28, 7 p.m.) or Dorey Park (July 27 or Aug. 24, 6 p.m.) www.co.henrico.va.us/rec

–Ashland has Sunday-evening concerts through the summer at 7 p.m. on the lawn at the Hanover Arts and Activities Center, 500 S. Center St. This coming Sunday, it’s Oretea Knicely, with music from the Andes. On Aug. 3, it will be Laurie Lewis and the Right Hand, featuring California bluegrass. www.bluemont.org/concerts/town_ashland.html Be cool

Visit Stony Point Fashion Park, off Stony Point Parkway, and let the kids run through the fountain. Being a dog-friendly place, Stony Point is a good place for pooch-watching as well. www.shopstonypoint.com Odds and ends

* –Public libraries. Free books. Air-conditioned space. Tracy Lewis, a family educator at Commonwealth Parenting Center, said she and her children enjoy visiting different public libraries for a fresh look. “People usually go to the same one all the time,” she said. “We go to different ones all around us and then to Wendy’s drive-through for a Frosty. It kills a few hours, and it costs me less than $10.”

–Virginia Museum of Fine Arts. Admission is free to most exhibits, although a donation is welcome. www.vmfa.state.va.us

–Go browsing or shopping at one of the increasing number of local farmers markets. Go to inRich.com and search the site for “Farmers markets.”

–Grab a blanket and enjoy family movie night under the stars at Henrico’s Hidden Creek Park (Aug. 2, 8:30 p.m., “Daddy Day Camp”) or Walkerton Tavern (Aug. 23, 8:30 p.m., “National Treasure: Book of Secrets”). Free popcorn and lemonade while supplies last. www.co.henrico.va.us/rec

–Historic St. John’s Church, 2401 E. Broad St., where Patrick Henry stood and said a few words. Historical re-enactments of his “Give Me Liberty” speech are held each Sunday in the summer through Labor Day weekend. Free tickets are distributed at the church, beginning at 1 p.m. The re-enactment begins at 2 p.m. A voluntary donation is collected after the performance. Tours of the church are not free ($6 for adults, $4 for children ages 7-18, and free to those younger than 7) but they’re inexpensive, and the education is priceless. www.historicstjohnschurch.org

–Speaking of history, the Richmond Braves are almost that. A general-admission ticket can be had for $7 for adults or $5 for seniors and children. It doesn’t have to be an expensive outing if you eat before you go and don’t drop a bundle on food and if you can find street parking nearby for free. www.rbraves.com

–Colonial Downs is a bit of a hike to New Kent County, but general admission is only $2, with children younger that 12 free, and parking is free, too. Racing for the summer Thoroughbred meet concludes Aug. 6. www.colonialdowns.com If all else fails

–Find a lake and feed a duck.

Contact Bill Lohmann at (804) 649-6639 or [email protected].

—–

To see more of the Richmond Times-Dispatch, or to subscribe to the newspaper, go to http://www.timesdispatch.com.

Copyright (c) 2008, Richmond Times-Dispatch, Va.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

NYSE:WEN,

By Mukamal, Barry

In the following article, the author discusses the challenges faced by CPA firms as generational differences among employees and technological changes have an impact on client service and relationships. Over the years, my partners and I have discussed at length the changing landscape of the accounting profession. Often these discussions centered upon what we perceived to be a shift in the manner in which clients are serviced and, therefore, a comparable shift in the work of the partners and professional staff who are charged with providing that service.

Recently, a college professor spoke at a firm-wide meeting regarding the generational issues that have challenged organized entities throughout the United States. Frankly, I was unaware that this issue had even achieved the status of academic recognition. It did not, however, take long to become fully engaged in this topic and recognize the importance of the message that the professor was attempting to deliver.

The professor’s theory was essentially this: Three different generations concurrently occupy the contemporary workplace (Baby Boomer, Generation X, and Millennial). Each generation possesses vastly different attitudes, mores, and priorities that affect both their work lives and their personal lives. The reasons for this landscape are many, but the lines of demarcation themselves are bright. Moreover, those individuals who were born on the cusp of the two generations are caught in a situation of some ambiguity, which in turn, may create a sort of identity crisis for them.

The professor attempted to explain and ultimately rationalize the behavior of each generation and those conflicts that are created by the tension of competing, and often conflicting, attitudes and priorities. He also suggested ways to bridge the differences.

Balancing personal priorities with client service

In the context of a professional or business environment, this effort seemed to me at first to be overwhelming and potentially unattainable. After all, as a Boomer myself, bred in the credo that client needs must be fulfilled when the client expects it (regardless of whether those expectations are reasonable), it was hard for me to accept the Millennials’ notion that client service can take a back seat to personal and family obligations. After much reflection, it became clear to me that the challenge facing our profession is to create an environment and a culture that accommodates both. Our firm is working very diligently to achieve this objective.

The influence of such generational analysis, however, is often exaggerated. Although one can hardly doubt that intergenerational differences affect how our profession operates, they do not fully explain the significant changes that I have witnessed over the years in the manner in which accounting professionals discharge their day- to-day duties to clients, the firm, and themselves. I do not believe that the pursuit of work-life balance or of nonwork personal goals adequately accounts for the radical changes that have characterized accountant-client relations and our approach to our work. Something more is happening here.

To properly examine this issue, one must first define it. I am old enough to remember the days when doctors made house calls, milk was delivered fresh each morning to the door, and accountants, by necessity, visited their clients on a scheduled, periodic basis. These were the norms of the day. In our contemporary technology- driven world, they seem quite bizarre and dated.

Changes in interaction

The demise of the first two examples was impelled by simple economics, but other factors drove the demise of the third example. The shift from personal onsite client service to office-based remote delivery has many root causes, but the desire of firms and clients to attack the escalating costs of providing professional accounting services is not one of them.

Our professional and personal relationships have been forged by constant contact and interaction, resulting in deeply rooted and long-lasting relationships. Accountants were the financial and strategic confidants of their clients, keenly aware of their clients’ deployment of family financial resources, their financial and strategic goals, and even their emotional needs and those of their families. Consequently, client loyalty remained consistently strong. It was unusual to see clients migrate from one firm to another, and polls consistently ranked accountants as their business clients’ most trusted professional.

Truly understanding clients

These bonds were not created spontaneously, nor did they arise solely from constant contact. Mutual respect between an accountant and the client was earned. It required an in-depth understanding of the client’s business operations, competitive situation, financial and administrative resources, strengths, weaknesses, vision for the future, legal environment, succession plans, and liquidity (just to name a few of the pertinent issues affecting the relationship). This required a commitment on the part of the accountant to achieve a delicate balance incorporating the twin goals of ultimate benefit to the client by way of providing superior service and advice, while at the same time affording a high degree of security and stability to the accountant’s practice. Thus, a truly symbiotic relationship has been traditionally sought.

Robotic relationships

Stepping into the twenty-first century, I observe a markedly changed landscape. Although many changes appear to be subtle, they are eventful and may even seem insidious. Gone are the days when we visit clients on a monthly basis to “write-up” their “books,” to talk about the events that may affect their businesses, to review the challenges and opportunities that are affecting their industry, or to learn what is transpiring in their personal lives. This approach has been replaced with an antiseptic and impersonal processing of financial information and data flowing through myriad different hands and sophisticated computer programs. We often simply compare the results that these programs spew out with those of our clients’ peers and with prior period results. If they fall within an acceptable range, all is right with the world.

Certainly, I am not averse to the many tools that technology has offered to our profession. These tools have enabled us to greatly expand our service offerings and to enhance the efficiency with which we deliver them, all while helping to contain costs. There is, however, a price to pay for over-reliance upon or chronic misuse of this technology, particularly if it comes at the expense of diluting the relationships we have developed with our clients and our ability to truly understand their needs.

When e-mails replace phone calls and face-to-face interaction; when third-party bookkeepers, many of whom are located outside of the country, process routine financial transactions, but fail to perform necessary fundamental analysis; when “blast” mass mailings or e-mail becomes the preferred method to effectuate planning or to advise clients of changes that may affect them, we must pause and re- evaluate our business model.

Counselors or commodities?

From my vantage point, I routinely observe professionals who have grown up in, and who have become accustomed to, an environment in which it is acceptable and perhaps even encouraged to conduct their practices in this oddly detached manner. The growing trend towards industry and practice-area specialization validates this observation.

Sometimes, little thought is given to passing off a client’s situation to another professional, who might be better suited to deal with a specific immediate need, but cannot possibly be familiar with the full range of that client’s needs or have the personal ties to that client that underlie the type and quality of service to which our profession so uniquely aspires. This trend towards substituting people in a manner comparable to substituting fungible technological tools, if not managed properly, will lead inevitably to the erosion and even dissolution of the bonds between us and our clients. Left unchecked, it will turn us into commodities, rather than ensure our place as valued counselors and advisors.

When I visit Disney World with my family, I make a point of touring the Carousel of Progress. Although I never question the benefits brought by the advances of each decade, I do reflect on the values and visions of the past, particularly those that have stood the test of time. The future of our profession depends on our staying faithful to the fundamental principles and methods of practice that have sustained its development and its reputation. These principles and practice methods must be bolstered, but not supplanted, by the tools and appliances that can make us more effective if handled properly-or obsolete if they are not.

By Barry Mukamal, CPA, PFS, ABV, CFE

Barry Mukamei, CPA, PFS, ABV, CFE, is a partner with Rachlin Coben & Hoitz, which has offices in southern and central Florida.

Copyright American Institute of Certified Public Accountants May 2008

(c) 2008 Practicing CPA, The. Provided by ProQuest Information and Learning. All rights Reserved.

By Bill Estep, The Lexington Herald-Leader, Ky.

Jul. 24–A doctor and pharmacist in Ohio took part in a conspiracy to smuggle hundreds of thousands of pain pills into Kentucky to be sold illegally, a federal grand jury has charged.

Lloyd S. Naramore, a doctor of osteopathy, and pharmacist Thomas F. Stark took part in a conspiracy with Floyd County resident Timothy Wayne Hall and others that dealt in OxyContin, methadone and cocaine, and also committed illegal financial transactions, according to an indictment made public Thursday.

Hall, 45, had been charged earlier in the case with operating a major drug ring in Eastern Kentucky.

In addition to buying and smuggling pain pills from Michigan, Hall allegedly had scores of people visit doctors in Louisiana, Pennsylvania and Ohio to get prescriptions for painkillers, fill the orders and bring back the pills to Kentucky for Hall and others to sell.

One man who pleaded guilty said participants in the drug ring brought 200,000 pain pills back to Kentucky over several years.

One doctor from Philadelphia was charged in the case earlier. The new indictment added Naramore and Stark as defendants.

Police have said people bringing pills into Kentucky from elsewhere is one of the most serious drug problems in the state.

That is happening, in large part, because of Kentucky’s system for tracking prescriptions. That scrutiny and enforcement by police and prosecutors have driven drug dealers and addicts out of the state to seek pills.

Police have seen numerous cases in recent years of Kentucky residents going to other states to get pills from doctors and drug dealers. When authorities raided one doctor’s office in South Florida, they found nearly 500 files on patients from Eastern Kentucky, according to documents in that case.

The new indictment in Hall’s case said Naramore got $100,000 for prescribing pills as part of the conspiracy. It says Stark, the pharmacist, also got $100,000.

The indictment did not say where the two are from, but licensure boards list a doctor and pharmacist by those names in Ohio.

The Web site of the medical board in Ohio said Naramore’s license was suspended earlier this month for failure to pay child support. In June, Naramore had agreed to certain treatment and monitoring after being diagnosed as bipolar and suffering post traumatic stress disorder, according to the Web site.

The doctor charged earlier in the Eastern Kentucky case, Randy Weiss of Philadelphia, received $50,000 as part of the conspiracy, the indictment said.

The charges against the two doctors and the pharmacist carry a maximum sentence of 20 years.

—–

To see more of the Lexington Herald-Leader, or to subscribe to the newspaper, go to http://www.kentucky.com.

Copyright (c) 2008, The Lexington Herald-Leader, Ky.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

Custom-made insoles may help reduce arthritic foot pain, Australian researchers concluded after a review.

The review, published in The Cochrane Library, found custom foot orthoses — insoles molded to a cast of the foot — can relieve pain within three months in adults with rheumatoid arthritis, as well as in children with juvenile idiopathic arthritis, an early form of the disease. Adults with painful highly-arched feet or painfully prominent big toe joints also benefited from treatment with orthoses over three- and six-month periods, respectively.

The researchers examined results of 11 trials that together involved 1,332 people. They found the custom orthoses were safe interventions, but said more research is required to develop an understanding of their effectiveness.

Custom foot orthoses can be an effective treatment for a variety of conditions, but there are still many causes of foot pain for which the benefit of this treatment is unclear, study lead researcher Fiona Hawke of the Central Coast campus of the University of Newcastle, Australia, said in a statement. There is also a lack of data on the long-term effects of treating with orthoses.

By Kellen Henry

The new five-floor Robert C. Byrd Ambulatory Building at CAMC Memorial Hospital will be ready for its first occupants this week.

The Charleston division of West Virginia University’s Health Sciences Center will move some operations into the building’s fifth- floor offices and clinics, and doctors will begin seeing patients Monday, said David Ramsey, CAMC’s chief executive officer.

The building, which also will house two cardiac catheterization labs, will be fully open by January. Different departments will move in as lower floors are ready.

“Everybody’s pretty excited about it, as a modern medical education facility,” Ramsey said after the CAMC Board of Trustees met Wednesday.

The board also authorized an application for 34 more acute care beds at Memorial. The beds have already been placed at the hospital for use in preparation and post-procedure observation, but need to be licensed by the Health Care Authority. The process could take several weeks, but the cost will be only for the application fees.

Though CAMC hospitals admitted about 5 percent fewer patients this June than a year ago, that doesn’t reflect the actual number of beds occupied, said Larry Hudson, CAMC’s chief financial officer. When patients stay longer than expected or need observation without meeting the criteria for admissions, the hospital can still need more beds.

“Memorial is so full that we think we will clearly be able to show the Health Care Authority there’s a need,” Ramsey said. The state authority must sign off on major projects for West Virginia hospitals.

The CAMC board is also waiting to hear the results from its Trauma Survey evaluation last week by the American College of Surgeons.

Hospitals are evaluated every three years by the ACS and receive a ranking of their ability to provide emergency medical services. The survey team must discuss its evaluations with a committee, but Ramsey said the response from the survey team indicates a Level I ranking is likely, meaning CAMC would be equipped to manage the highest level of emergency care.

Ramsey said the hospital is already designated as a Level 1 center by the state, but was given a Level II ranking by the ACS during the last evaluation. However, the hospital has increased its research activity in the last three years, a deficiency for the Level 1 criteria in the last ranking.

“It will be a significant performance standard that will measure us with hospitals around the country,” Ramsey said.

Reach Kellen Henry at [email protected] or 348-5179.

Originally published by Staff writer.

(c) 2008 Charleston Gazette, The. Provided by ProQuest Information and Learning. All rights Reserved.

Thursday, June 5

9:04 p.m. On East Lugonia Avenue at North Wabash Avenue, vehicle accident with injuries, advanced life support provided

Friday, June 6

10:48 a.m. On North Church Street at East Lugonia Avenue, vehicle accident with injuries, advanced life support provided

2:55 p.m. On Central Avenue at North Church Street, vehicle accident with injuries, advanced life support provided

5:10 p.m. On Eastbound Interstate 10 at Orange-Tennessee, vehicle accident with injuries, advanced life support provided

Saturday, June 7

9:54 p.m. On East Sunset Drive North at South Wabash Avenue, vehicle accident with injuries, advanced life support provided

Sunday, June 8

1:07 p.m. On Grove Street at San Bernardino Avenue, vehicle accident with injuries, advanced life support provided

6:55 p.m. 400 block of East Cypress Avenue, trash fire, extinguished

Monday, June 9

3:32 p.m. On South Center Street at West Olive Avenue, vehicle accident with injuries, basic life support provided

Wednesday, June 18

12:08 a.m. On Judson Street at East Pioneer Avenue, grass fire, control fire

4:57 p.m. On Cajon Street, smoke scare

5:29 p.m. On I-10 at Yucaipa-Wabash, vehicle accident, general cleanup, cancelled en route

7:07 p.m. On 1100 block of Judson Street, brush and grass mixture fire, extinguished

8 p.m. On 200 block of East High Avenue, vehicle accident, no injury, investigated

8:18 p.m. On Orange-Tennessee at WB I-10, vehicle accident, no injury, provided manpower

Thursday, June 19

8:53 a.m. On 940 Carob Street, gas leak

1:07 p.m. On Citrus Plaza Drive at Lugonia Avenue, motor vehicle/ pedestrian accident, provided basic life support

6:38 p.m. On Highland Avenue at Redlands Boulevard, vehicle accident with injuries, provided basic life support

8:44 p.m. At 1000 Pine Avenue, building fire, salvaged and overhauled

Friday, June 20

2:57 a.m. At 1200 Colton Avenue, Arcing, shorted electrical equipment, investigated

8:11 a.m. On 1540 Marion Avenue, cultivated trees or nursery stock fire, extinguished

12:06 p.m. On I-10 at Tennessee-Alabama, grassfire, extinguished

12:57 p.m. On I-10 at Tennessee, grass fire, salvaged and overhauled

5:28 p.m. At 1008 E Brockton Avenue, building fire, extinguished

8:04 p.m. On N Church Street at E Lugonia Avenue, outside rubbish, trash or waste fire, extinguished

Saturday, June 21

12:34 p.m. On S Center Street at W Cypress Avenue, vehicle accident with injuries, provided advanced life support

Sunday, June 22

5:38 a.m. On 621 Colton Avenue, gas leak, notified other agencies

8:46 a.m. On 212 Brookside Avenue, vehicle accident with injuries, provided basic life support.

8:17 p.m. At 2857 Mill Creek Road, attempted burning, investigated

8:21 p.m. On Orange Street at Western Avenue, vehicle accident with injuries, provided basic life support

8:46 p.m. On Orange Street at Union Avenue, vehicle accident with injuries, provided advanced life support

Monday, June 23

12:14 p.m. On Cajon Boulevard at Kenwood Avenue, forest fire, estinguished

12:36 p.m. At 1425 W Lugonia Avenue, building fire, investigated

3:45 p.m. At 1655 Industrial Park, vehicle accident, no injury, provided manpower

Tuesday, June 24

5:47 p.m. 500 block of University Street, gas leak, investigated

* The locations of certain incidents are withheld to protect the identities of victims involved.

(c) 2008 Redlands Daily Facts. Provided by ProQuest Information and Learning. All rights Reserved.

By David Allen, The Shelby Star, N.C.

Jul. 24–Updated 3:47 p.m.:

The Cleveland County Sheriff’s Office along with the State Bureau of Investigation made it a mission about four months ago to target prescription pill pushers and poppers.

The operation has hit hard –four arrests this week, two other suspects and seizures of $33,000 in possible drug money and more than 1,000 pills.

But officials are still on the hunt for more.

“There will be more arrests,” said Lt. Joel Shores, who heads the sheriff’s office narcotics division. “We’ve been hitting crack houses, meth houses, and finding a lot of prescription medications. Come to find out a lot of people are really trying to get a hold of the medication, especially the pain medication.”

Hundreds of Xanax pills. Enough Hydrocodone to last months. Synthetic opium possession charges. How are suspects getting their drugs?

‘Doctor shopping’

For one, there are those who steal from their own parents.

“We’ve had people that are caretakers of their parents that will go get their parent’s medications filled, sell half of it and only give their parent half of it,” Shores said.

Another method, “doctor shopping,” involves timing shifts at the hospital to land a different doctor –and an additional prescription.

“They were going in at different shifts complaining of the same symptoms to try and get this pain medication,” said Shores. “Finding loopholes. What we’re getting is people going around to different doctors getting five or six prescriptions.”

Shores sits on a task force that intends to do something about the problem.

A solution?

“The medical community has started seeing it’s a problem,” Shores said.An inter-business system that could track filled prescriptions might catch offenders using multiple pharmacies to rack up on drugs, he said.

Currently, a red flag is only shot up when someone tried to fill duplicate prescriptions at the same pharmacy. With a new system, more potential criminal activity could be spotted, Shores said.

Word-of-mouth tips and informants help, too.

“For a lot of them, we’re using informants to go purchase who are willing to testify,” Shores said. “Through the use of informants, we’re able to do this.”

The following suspects have been recently arrested on prescription drug-related charges:

Amy Lineberger Davis, 116 E. Zion Church Road

Jackie Lineberger Black, 116 E. Zion Church Road

Jerry Martin, 1904 Sulphur Springs Road

Floyd Dean Smith, 122 W. Double Shoals Road

The Cleveland County Sheriff’s Office is seeking the following suspects:

Lewis K. Archie, 234 Roseborough Road

Eric Scott Turner, 6710 Casar Road

From the Sheriff’s Office (1:58 p.m.)

About four months ago, the Sheriff’s Office Narcotics Division along with the State Bureau of Investigation became an operation to target those who are selling prescription medication.

The investigation consisted of using confidential informants to purchase the medication and the execution of four search warrants.

The investigation has led to the arrest of four individuals and the Sheriff’s Office is currently looking for two other suspects. More arrests are pending as the investigation is ongoing.

The investigation has yielded the seizure of the following:

$33,042 cash

775 Xanax

172 Hydrocodone

113 Oxycodone

2 Methadone

6 Aderall

27 Ativan

20 Morphine patches

Suspect 1: Amy Lineberger Davis

116 E. Zion Church Road

Shelby, NC

Charges:

1. Three counts of possession with intent to sell and deliver schedule IV substances

2. Two counts of sell and delivery of schedule IV substances

3. Possession with intent to sell and deliver schedule II substances

4. Sell and delivery of schedule II

5. Possession with intent to sell and deliver marijuana

6. Sell and deliver of marijuana

Davis’ bond was set at $100,000 secure.

Suspect 2: Jackie Lineberger Black

116 E. Zion Church Road

Shelby, NC

Charges:

1. Three counts of possession of schedule II

2. Possession of schedule IV

3. Possession of marijuana

Black’s bond was set at $5,000 secure.

Suspect 3: Jerry Martin

1904 Sulphur Springs Road

Shelby, NC

Charges:

1. Trafficking in opium

2. Two counts of possession with intent to sell and deliver schedule

3. Two counts of sell and deliver of schedule II

4. Possession with intent to sell and deliver schedule IV

Martin’s bond was set at $50,000 secure.

Suspect 4: Floyd Dean Smith

122 W. Double Shoals Road

Shelby, NC

1. Trafficking in opium

Smith’s bond was set at $50,000 secure.

The Sheriff’s Office is currently seeking the following two suspects. Anyone with information concerning their whereabouts should contact the Sheriff’s Office at 704-484-4822.

Suspect 5: Lewis K. Archie

234 Roseborough Road

Grover, NC

Charge:

1. Trafficking in opium

Suspect 6: Eric Scott Turner

6710 Casar Road

Lawndale, NC

Charges:

1.Trafficking in opium

2. Possessing with intent to sell and deliver schedule III

—–

To see more of The Shelby Star or to subscribe to the newspaper, go to http://www.shelbystar.com/.

Copyright (c) 2008, The Shelby Star, N.C.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

DETROIT _ More than 1,000 overdose deaths across the country were linked to illegally made fentanyl, a powerful, prescription-only painkiller mixed with heroin and other drugs for street use, according to a report released Thursday by the Centers for Disease Control and Prevention.

Last year, the Detroit Free Press published a yearlong examination of the fentanyl overdose epidemic.

Free Press reporters tracked down chemist Ricardo Valdez Torres, who made fentanyl in Mexico. His fentanyl moved north and was mixed into heroin sold to people of all walks of life.

The CDC report, which focused on fatal overdoses from April 2005 to March 2007, also links the fentanyl deaths to the Mexican lab. According to the Drug Enforcement Agency, 1 gram of pure fentanyl could create up to 8,000 doses to cut an illegal drug. At 50 to 80 times stronger than morphine, a tiny amount can kill, said Wayne County Mental Health Medical Director Dr. Michele Reid.

Fentanyl is prescribed in skin patches to treat chronic pain. But if snorted or injected, the sudden burst of the drug into the blood stream can lead to breathing failure.

The CDC study calls for better public health efforts to report drug overdoses and more information and treatment options for users.

There is no national standard for testing and reporting, said Wayne County Medical Examiner Dr. Carl Schmidt. That makes it difficult to know exactly how many people overdosed or died from fentanyl-laced drugs.

“People don’t think of drug abuse as a public health issue,” he said.

___

(c) 2008, Detroit Free Press.

Visit the Freep, the World Wide Web site of the Detroit Free Press, at http://www.freep.com.

Distributed by McClatchy-Tribune Information Services.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

MIAMI, July 24 /PRNewswire/ — MDwebLive, an innovative medical service where patients can communicate with their doctors, face-to-face in real time, via webcam, has recently partnered with Bayview Center for Mental Health, South Florida’s premier mental health provider. Together, the two organizations will provide online mental healthcare services nationwide. In the face of federal budget cuts, this partnership will expand outpatient mental health treatment options, while reducing overall costs.

For 29 years, Bayview has offered a continuum of mental health and addiction treatment services in Miami-Dade and Broward Counties. MDwebLive uses the latest in internet technology to create a unique doctor-patient experience from the privacy of the client’s home or office. By combining their services, both companies will be able to reach segments of the population which have been neglected.

To celebrate their partnership, MDwebLive is waiving the program’s membership fee for all potential customers during the month of July and intends to honor our armed forces by offering special deals for veterans and those who are still deployed.

Current members of the armed forces and veterans are invited to communicate with our doctors and to access quality health services from any location with a broadband connection.

About MDwebLive:

MDwebLive is a brand name of Amerigroup Holdings, Inc. created to provide a convenient and cost effective alternative to standard healthcare delivery. It is the first program of its kind where patients can communicate with their doctors via webcam anywhere in the world. All physicians of MDwebLive are U.S.-trained and board-certified in many specialties. MDwebLive provides healthcare access to consumers 24 hours a day, seven days a week. The program stores patients’ medical records electronically which can be accessed from any computer on the Internet. For more information, please visit http://www.mdweblive.com/

About Bayview Center for Mental Health:

Bayview Center for Mental Health is a Non-profit Community Health Agency providing behavioral health services since 1979 with locations in Miami-Dade and Broward counties. Bayview Center provides a strong continuum of quality services. For more information, please call (305) 892-4600.

Amerigroup Holdings, Inc.

CONTACT: Rebecca Ponce, [email protected], Keith V Preciados,[email protected], both of Gordon Diaz-Balart, +1-305-381-7909

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

VisualMED Clinical Solutions Corp. (The “Company”) (OTCBB: VMCS) (FRANKFURT: VA6) announces that it has completed a comprehensive corporate and operations restructuring in order to focus on its more promising markets of oncology, Internet and private clinics.

“Much of this will involve licensing the technology to resellers such as VisualMED Distribution Inc., Medical.MD and Integrated Cancer Care Corp. VisualMED is to become a provider of technology, implementation support, integration and maintenance services to its licensees and distributors in exchange for fees and a steady royalty stream,” notes VisualMED Chairman Gerard Dab. “We will continue to be a developer of unique technology while seeking sales and marketing partnerships. This restructuring allows the company to diversify sources of revenues and helps to keep expenses in line with revenues.”

The new business focus is proving promising. Our reception at the American Society of Clinical Oncology (ASCO) 2008 annual meeting in June garnered much attention and sales interest for our oncology technology, particularly at the specialized EHR lab.

With the deployment of our VisualONCOLOGY module at the McGill University affiliated Segal Cancer Center and the coming implementation of at Montreal’s St. Mary’s Hospital, our oncology platform is rapidly finding a niche in the market for improving cancer care.

We are pursuing our partnership with Plexo Inc. developing a comprehensive clinical management system for this leader in private executive health.

A significant part of this new orientation has been a major overhaul of our executive team that has seen Dr. Arthur Gelston, CFO Mr. Larry Kurlender and VP Finance Ms. Jayne H. Kirby leave the company to pursue other opportunities.

“We will continue to grow our business through new partnerships,” concludes Mr. Gerard Dab. “We now focus on markets that are willing and ready to adopt our technology.”

ABOUT VISUALMED

VisualMED Clinical Solutions Corp. creates and maintains complex clinical information solutions that help hospitals healthcare authorities and private healthcare facilities eliminate medication errors, increase personnel efficiency and reduce operating costs. Its unique proprietary technology and data management software are core components of the new agenda to promote greater patient safety and to implement real quality control in a healthcare setting.

Detailed information on our company and its products is available on our web site at www.visualmedsolutions.com.

Forward-Looking Statements

Except for historical information provided herein, this press release may contain information and statements of a forward-looking nature concerning the future performance of the Company. These statements are based on suppositions and uncertainties as well as on management’s best possible evaluation of future events. Such factors may include, without excluding other considerations, fluctuations in quarterly results, evolution in customer demand for the Company’s products and services, the impact of price pressures exerted by competitors, and general market trends or economic changes. As a result, readers are advised that actual results may differ from expected results.

 Contact: Barry Scharf C.O.O. VisualMED Clinical Solutions Corp. Tel: 514 274 1115  

SOURCE: VisualMED Clinical Solutions Corp.

To: NATIONAL EDITORS

Contact: Lanni Thomas, +1-404-502-9109, or Alisa Mosley, +1-240- 350-7531, both of National Medical Association

WASHINGTON, July 24/PRNewswire-USNewswire/–The National Medical Association (NMA) will kick off the 2008 Annual Convention and Scientific Assembly with a health initiative, Walk a Mile with a Childto fight childhood obesity on Saturday, July 26 at the Georgia World Congress Center in Atlanta, Ga.

Walk a Mile with a Childis a one-mile walk and 5K run for mens health that culminates in a health festival with free health screenings, provided by PEACE of Heart campaign, as well as information on healthy living, free giveaways and school supplies. The walk and health festival will take place on July 26 from 7 a.m. to 1 p.m.

This years theme, Elimination of Health Disparities through History and the Collaboration of Health Professionals marks the NMAs 106th annual convention and return to its birthplace in Atlanta, Ga.

As the NMAs premier medical science and health event, the convention is expected to draw thousands of attendees nationwide and will take place from July 26-31, 2008. The six-day event features an array of plenary sessions, scientific presentations and a continuing medical education program and unites some of the most prominent medical scholars, scientists, practitioners, government experts and health care advocates from around the country.

This years convention is part of a broader national effort to combat health disparities in all communities, said Nelson L. Adams, M.D., NMA president. NMA has been on the frontlines fighting health disparities for many decades and our goal this year is to bring together our partners to work together as one unit to improve the health of all Americans.

Confirmed speakers include: Mayor of Atlanta, Shirley Franklin; philanthropist, Camille Cosby; Super Bowl Champions, Jerome Bettis and Nathanial Wayne; former Surgeon General and Director of the Center for Excellence on Health Disparities, David Satcher, M.D., Ph.D.; U.S. Representative Elijah Cummings (D-MD); President, American Academy of Pediatrics, Renee Jenkins, M.D.; Immediate Past President, Ronald M. Davis, M.D. and President-Elect, J. James Rohack, M.D.; Acclaimed actress, Phylicia Rashad; Today Show Contributor, Janet Taylor, M.D.; and Chairman and President of the Dikembe Mutombo Foundation, Dikembe Mutombo.

As one of the best national forums on African-American health and medicine, the convention plenary sessions and forums explore critical health disparities and policy issues.

Convention Highlights

Saturday, July 26, 2008

— Walk a Mile with a Child

Georgia World Congress Center

7:00 a.m. to 1:00 p.m.

— Walk a Mile with a Child Press Conference 9:00 a.m. – 9:15 a.m.

Key Plenary Sessions

Saturday, July 26, 2008

— Edward C. Mazique, M.D. Symposium,

U.S. Health Care Reform-Are We Asking the Right Questions?

Kenneth E. Thorpe, Ph.D., Robert W. Woodruff Professor

1:00 p.m.-3:00 p.m.

Sunday, July 27, 2008

— HIV/AIDS Plenary Session

HIV/AIDS in the African America Community: From Crises to Calamity

9:00 a.m.-11:00 a.m.

Monday, July 28, 2008

— Medical Missions and Global Health

9:00 a.m.-11:00 a.m.

— Katrina Impact on Gulf Coast: Recovery & Remediation

LTG (Ret) Russell L. Honore

2:45 p.m.-3:15 p.m.

Tuesday, July 29, 2008

— American Cancer Society/National Medical Association

Collaboration in Addressing Cancer Disparities

9:00 a.m.-11:00 a.m.

Wednesday, July 30, 2008

— Satcher Health Leadership Institute

Mental Health in the Black Family

3:05 p.m.-5:05 p.m.

For more information, contact Lanni Thomas, 404-502-9109 or Alisa Mosley 240-350-7531.

About the National Medical Association

Founded in 1895, the NMA is a nonprofit organization that is the nations oldest and largest medical association representing the interest of more 30,000 African American physicians and their patients. The NMA advocates health care for policies that would assure equitable and quality health care for all.

SOURCE National Medical Association

(c) 2008 U.S. Newswire. Provided by ProQuest Information and Learning. All rights Reserved.

GREAT NECK, N.Y., July 24 /PRNewswire/ — Leading nail, hand and foot care company Barielle announces that select products will now be available exclusively at CVS/pharmacy locations nationwide. Beginning August 2008, CVS/pharmacy will offer eight assorted products for nails, hands and feet on the cosmetics wall in its salon center.

“By having a national presence in CVS/pharmacy, Barielle is now available to the one-stop beauty shopper who desires prestige-quality nail products for an at-home or in-salon regimen,” says Mark Pollock, President of Barielle.

CVS/pharmacy will offer a variety of Barielle’s leading products, including treatment lacquers and creams designed specifically for nails and cuticles, as well as moisturizers for hands and feet. Barielle’s classic Nail Strengthening Cream-the brand’s first product to launch over thirty five years ago-will be part of the line-up, as well as nail-supporting treatment lacquers including Fortifying Nail Builder, Instant Liquid Nail Hardener and No Chip Speed Dry. Targeted treatments include Extra Gentle Cuticle Minimizer and Fungus RX. Total Foot Care Cream and Professional Protective Hand Cream, in convenient, travel-approved sizes, will round out the range.

“CVS/pharmacy is committed to offering the best beauty selections from around the world, and our mix of beauty brands will be enhanced through the inclusion of Barielle’s line of products,” says Sherry Saffert, Divisional Merchandise Manager for Beauty, CVS/pharmacy.

As a company that began with a unique approach to treating, protecting and maintaining nails, Barielle has evolved into one of the leading prestige nail, hand and foot care lines sold world-wide. Over the past 30 years, Barielle has stood apart in its dedication to delivering and maintaining quality products with visible results for truly healthy and beautiful nails, hands and feet. Barielle uses safe, effective and natural ingredients including Keratin, Protein, Vitamins, and Oil and Plant Extracts. Absolutely none of Barielle’s creams and lacquers contains formaldehyde, toluene or lye, ingredients that are harsh irritants.

CVS/pharmacy, the retail division of CVS Caremark Corporation, is America’s largest retail pharmacy with 6,300 retail locations. CVS/pharmacy is committed to improving the lives of those we serve by making innovative and high-quality health and pharmacy services safe, affordable and easy to access, both in its stores and online at CVS.com. General information about CVS/pharmacy and CVS Caremark is available at http://www.cvscaremark.com/.

WWW.BARIELLE.COM

Barielle

CONTACT: Arielle Cohen, [email protected], or Lauren Weissman,[email protected], both of Whisper PR, for Barielle, Ph, +1-646-336-6420,Fax, +1-646-336-6429; or Joanne Dwyer of CVS|pharmacy, +1-401-770-2898,[email protected]

Web site: http://www.barielle.com/http://www.cvs.com/http://www.cvscaremark.com/