Resurgent Health and Medical Launches CleanTracker at APIC Annual Conference

Resurgent Health and Medical, a leader in automated handwashing and sanitizing technology, announced the launch of the CleanTracker at the Association for Professionals in Infection Control and Epidemiology (APIC) annual conference last week. The CleanTracker is the only fully functional RFID technology available to track handwashing compliance.

“At APIC we had interest from over 550 healthcare professionals and performed over 1300 handwashes with our machines,” said Jim Glenn, CEO of Resurgent Health and Medical. “With infection rates rising, mandatory reporting, and changes in reimbursement, healthcare facilities must do more to improve handwashing compliance to reduce HAIs.”

The CleanTracker software and RFID compliance monitoring technology is for use with Resurgent’s CleanTech IC automated handwashing systems. Users wash their hands and the CleanTech system and CleanTracker software do all the reporting. The easily navigated software gathers users’ data at the handwashing system and pushes the information to the database without intervention by an administrator.

The CleanTracker offers infection control departments streamlined hand hygiene data. The CleanTracker also offers the following benefits:

— Easily review reports of hand hygiene activity by a specified time period or by department, job title, or individual.

— Create and store quick reports for both past and current data.

— Generate simple graphs or tables for visual indications of hygiene events by department, job title or user.

— Automatically track hand washes that are complete or incomplete.

— Create customizable handwashing targets that can be assigned by department, job title or individual user to give staff a comparative record of hand hygiene compliance.

— User identity can easily be turned off to protect personal information.

The CleanTech touchless system performs a fully-automated twelve-second wash, sanitize and rinse cycle. Using Resurgent’s proprietary Chlorhexidine Gluconate (CHG) sanitizing solution, the single cycle removes over 99.9% of pathogens and continues to kill germs for up to six hours. The FDA certified CHG-based sanitizer contains mild skin conditioners to continuously improve skin health while removing dangerous germs.

The system further boosts compliance by ensuring a pleasant, uniform hand wash using high-pressure water jets that perform a consistent wash-and-sanitize cycle every time the machines are used.

About Resurgent Health & Medical

Resurgent Health and Medical delivers state of the art employee hygiene technologies to hospitals and healthcare facilities that are serious about infection prevention and the elimination of dangerous pathogens in the healthcare industry. Our patented CleanTech infection prevention technology brings science and precision to the process of removing dangerous microbes from hands. For almost 20 years, its CleanTech brand systems have been used worldwide in agriculture, food processing, food service, cleanroom manufacturing and healthcare. CleanTech uses up to 75% less water than manual handwashing, discharges 75% less wastewater, and reduces waste in soap utilization. For more information, visit http://www.resurgenthealth.com

PatientsLikeMe Geneticist, Catherine Brownstein, Ph.D. Wins Prestigious Research Award

PatientsLikeMe is proud to announce that team geneticist Catherine Brownstein, Ph.D. will receive the 2008 Young Investigator Award from the American Society for Bone and Mineral Research (ASBMR). The award, given for Dr. Brownstein’s post-graduate creation and study of the Klotho/HYP double knockout mouse, which further elucidates the genes responsible for bone density and phosphate metabolism, will be conferred this September at the ASBMR Annual Meeting in Montreal, Canada.

“I’m honored and excited to receive such a prestigious award,” says Dr. Brownstein. “The ASBMR is a fantastic organization with many brilliant experimental and clinical scientists. I look forward to the meeting in September.”

Dr. Brownstein recently joined the PatientsLikeMe Research & Development team to ready its platform for the incorporation of genetic and biomarker information. PatientsLikeMe’s unique platform gives patients with life-changing illnesses sophisticated personalized outcome tools that previously were only available to clinical research centers like Yale where Dr. Brownstein completed her award winning work. The open data model of PatientsLikeMe and the thousands of active patients provide a unique new opportunity to do collaborative disease discovery and help improve patients’ lives. Dr. Brownstein will be responsible for defining and building the data structures that allow patients, for the first time, to actively participate in disease discovery as well as treatment.

Dr. Brownstein joins an internationally recognized research group including: Paul Wicks, Ph.D., an expert in psychological aspects of neurodegenerative conditions; behavior informaticist Jeana Frost, Ph.D. and social-statistician Michael Massagli, Ph.D., whose recent joint paper on “Social Uses of Personal Health Information Within PatientsLikeMe” is in the peer-reviewed Journal of Medical Internet Research; and Sally Okun, RN, an industry veteran focused on health data integrity for PatientsLikeMe communities. The team is led by James Heywood, co-founder of PatientsLikeMe, and renowned expert on Amyotrophic Lateral Sclerosis (ALS).

“Catherine has received a great honor with this award. Yet, we know her work is just beginning,” says Heywood. “Giving patients the power to discovery and use genetic information to support discovery and improve care will change the landscape of medicine as we know it.”

ABOUT PATIENTSLIKEME

PatientsLikeMe (www.patientslikeme.com) is the leading online health community for patients with life-changing conditions. PatientsLikeMe creates new knowledge by charting the real-world course of disease through the shared experiences of patients with ALS, Multiple Sclerosis, Parkinson’s, HIV and Mood conditions (including depression, bi-polar, anxiety, OCD and PTSD). While patients interact to help improve their outcomes, the data they provide helps researchers learn how these diseases act in the real world. PatientsLikeMe endeavors to create the largest repository of real-world disease information to help accelerate the discovery of new, more effective treatments.

 Contact: Lori Scanlon (617) 499-4003 Email Contact

SOURCE: PatientsLikeMe, Inc.

Area Dermatologist Busy

By Darrell Hughes, The Sun News, Myrtle Beach, S.C.

Jul. 8–Editor’s note: This is part of the weekly “Take Five” series of Q&As that give you a glimpse of what it’s like working in various fields along the Grand Strand and introduce you to the people doing the work.

The dermatology profession in Myrtle Beach is filled with promise — thanks to sunshine.

As the region’s aging population grows, so has the number of individuals, seniors in particular, who have skin problems ranging from rashes to cancer.

Too much fun in the sun doesn’t do the body good, and dermatologist Robert Purvis can attest to that.

Purvis’ schedule is booked as far out as February 2009.

Purvis, who owns Grand Strand Dermatology, 3001 Newcastle Loop, and is a practicing physician in his office, sees about 30 patients a day. “More or less, depending on how many surgeries I’m doing,” the father of two teenagers said.

As the pool of patients increase, more dermatologists are needed along the Grand Strand. Purvis has two new dermatologists but says that’s not enough.

Question — What’s the dermatology industry like in Myrtle Beach?

Answer — It’s very busy. All the dermatologists in Myrtle Beach, as far as I know, are pretty much overbooked. And predominately it’s an older population with sun damaged sun, skin cancers and pre-cancers. We do see the whole gamut of dermatological problems, ranging from acne to rashes like psoriasis. … Predominantly the patients are Medicare patients who have a lot of sun-damaged skin and cancers. That takes the bulk of our time.

Q. — Is there demand for dermatologists?

A. — Well, I’m bringing two in, and I think that’s scratching the surface. I think we could probably have five more [in the area]. And even then, we’ll probably just be keeping up. … [Dermatologists in other states also] tend to be busy. We just happen to have fewer dermatologists relative to the population. … There just aren’t that many [dermatologists] out there, and if you don’t come from here, then you’re probably not likely to come here and practice. … You get a lot of doctors that like to go back to where they came from, who want to be near their family. If you don’t have people going into dermatology from this area, then you don’t have many coming back. We do have an advantage over some areas in that this is a very nice area to live in — it’s a resort community. So it may be a bigger draw in that regard, but the supply of dermatologists is so limited that they’re hard to come by.

Q. — What impact will the new dermatologists have?

A. — We’ll be able to see more patients. But my fear is that I’ll be every bit as busy as I was before they joined. … I think that patient access during emergency situations will be better because there will be more of us to work the patients into the schedules. But from what I hear, the new people are booked out until August already.

Q. — What impact has the economy had on the dermatology profession?

A. — I haven’t seen any impact. The economy, whether it’s good or bad, I’m still busy. People have skin problems and they need to have it taken care of. Most of my business consists of Medicare patients, so they have insurance and [their] bills are pretty much covered. I may miss out on some of the uninsured who can’t afford to come, but I’m so busy that it doesn’t make much of an impact. … The economy impacts more on dermatologists who tend to perform a lot of cosmetic procedures, electro procedures that if they don’t have the money for, they just won’t have them performed. Most of what I do is medical dermatology and surgical dermatology — more necessity than desires.

Q. — With most of your patients having Medicare benefits, how are your Medicare reimbursements?

A. — The times are changing when Medicare is actually one of the better payers. The private insurances have cut back the rates significantly. Medicare keeps threatening to cut the rates and, fortunately, the cuts keep getting pushed back, but if they do get cut enough, it would really be a disaster.

Because … there’s going to be a lot of patients who have nowhere to go for care.

Contact DARRELL HUGHES at 626-0364.

—–

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

Copyright (c) 2008, The Sun News, Myrtle Beach, S.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.

YMCA Grant Targets Diabetes, Obesity

By Gary Gray, Bristol Herald Courier, Va.

Jul. 8–BRISTOL, Tenn. — Tennessee ranks No. 1 in the nation for the number of children 18 and under with Type 2 diabetes. The state also ranks third for the overall number of people considered obese.

“We’ve got some issues,” Chris Ayers, Bristol Family YMCA chief executive officer, said Thursday at the facility.

The YMCA recently was awarded a $250,000 grant from the Tennessee Department of Health to help deal with those issues.

Beginning this fall, the YMCA will partner with Wellmont Health System and Bristol Tennessee City Schools to provide “Project Activate Bristol.”

Workshops, presentations, testing and exercise programs will be aimed at identifying at-risk children and providing them and their parents with the education and motivation to fight these two growing epidemics.

“The goal is to work with 100 families and eventually 1,000 kids,” Ayers said. “We’re going to roll out the red carpet for these families. And we won’t have kids in here running on treadmills and lifting weights. We want it to be fun.”

Ayers said the youngsters will go through a 10-week program in which they are monitored and encouraged to participate in “active play — the way we used to play as kids where you’re continually moving,” Ayers said.

Services will include blood-glucose screenings, health fairs and incentives to keep the schoolchildren motivated.

One form of motivation will be through Fitlinxx technology. Connecticut-based Fitlinxx makes a computerized monitoring system that fits on top of an athletic shoe. The device can calculate the number of steps taken.

“Anyone in the program that registers at least 10,000 steps a day will be eligible to win a new bicycle,” Ayers said.

Early detection of Type 2 diabetes can prevent heart attack, stroke and other health problems, said Jim Perkins, Bristol Regional Medical Center director of diabetes treatment.

“About 40 percent to 50 percent of patients that are in BRMC for treatment are diagnosed with Type 2 diabetes — and that’s the people that are not there to be diagnosed,” Perkins said. “Type 2 used to be called ‘adult onset,’ but now we’re seeing children as young as 8 being diagnosed with it. Typically, Type 2 diabetes is diagnosed in people in their 40s or 50s.”

In the last 10 years, the number of people between the ages of 30 to 39 diagnosed with Type 2 diabetes has risen 76 percent, Perkins added.

“That group is smack dab in the middle of our work force, and that’s scary,” he said. “Preventing this is all about early detection and moderate but steady changes in peoples’ lifestyles. Basically, if you exercise more and take in fewer calories, you’ll benefit.”

The following is an outline of the program:

August: workshops for YMCA staff and BTCS teachers and nurses provided by Wellmont’s Diabetes Treatment Center.

September: Wellmont will provide 10-minute programs for parents and students on the emerging health issues linked to diabetes.

September: A YMCA bus will be outfitted as a mobile education and testing unit. It will be staffed by health care professionals.

October: America on the Move, an educational health fair, will be held and include free blood-glucose screenings by the YMCA.

October: Fitlinxx system installed at YMCA and remote access points at each school.

October: YMCA Family Support Program begins. At-risk children will be provided with a one-year membership that includes personal training, seminars and meal planning.

October-November: YMCA after-school program offers kickball, dodge ball and playground activities.

December: School Gym and Swim Days program allows school children to take a field trip to the YMCA.

January: YMCA eight-week Stick to It program. Fitness charts will be placed in every classroom, where daily activities will be recorded.

March: School Gym and Swim Days.

April: Healthy Kids Day will offer swimming lessons and provide youngsters and parents with diabetes screening.

[email protected]| (276) 645-2512

—–

To see more of the Bristol Herald Courier or to subscribe to the newspaper, go to http://www.tricities.com.

Copyright (c) 2008, Bristol Herald Courier, 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.

Cancer Drug Pioneer Colin Dies With Family By His Side

By Barry Nelson

A FATHER-OF-THREE who was trying to raise [pounds]20,000 to buy a new cancer drug has died at home surrounded by family.

Colin Glease, 45, from Dipton, near Stanley, County Durham, died on Saturday from advanced pancreatic cancer. Since he was diagnosed with cancer a year ago, Mr Glease endured repeated bouts of chemotherapy at hospital in Durham City.

His hopes were raised recently when he was enrolled on an experimental drug trial, but he failed to respond to treatment.

His wife, Jeanette, said it recently became clear that Mr Glease would not be well enough to go on a new drug called Tarceva even if they raised the money.

She said: ?There was no way the doctors would have allowed him to have it because he was too poorly, but we still had to let Colin think he had a chance. ? Although he was warned his illness was probably incurable, his cancer specialist told him Tarceva might extend his life.

Despite being approved for the treatment of advanced pancreatic cancer in the US and Europe, Tarceva is not available on the NHS.

It is blocked because the National Institute for Health and Clinical Excellence has not assessed whether the drug is good value for money.

Last month, Mr Glease told The Northern Echo: ?If I do go private for (Tarceva), then I will have to pay for all the scans, blood tests and injections that I normally get as an NHS patient. It is annoying, but that is how it works. ? Mrs Glease said: ?I just want to thank everyone who has raised money for Colin. I am donating it to ward five at Durham hospital, where Colin had his chemotherapy, and to the Macmillan nurses who helped him. ?

She asked anyone who has not handed in money to donate it to a charity of their choice.

Mr Glease?s daughter, Jenna, 21, brought forward her wedding to November last year so her father could walk her down the aisle.

The former van driver is also survived by sons Tony, 23, and Jack, eight, and grandchildren Amber and Kenzie.

His funeral will take place on Thursday at St John?s Church, Dipton, at a time to be arranged.

(c) 2008 Northern Echo. Provided by ProQuest Information and Learning. All rights Reserved.

Oil Man Pickens Unveils Wind Power Plan

SWEETWATER, Texas — Get ready, America, T. Boone Pickens is coming to your living room.

The legendary Texas oilman, corporate raider, shareholder-rights crusader, philanthropist and deep-pocketed moneyman for conservative politicians and causes, wants to drive the USA’s political and economic agenda.

“We’re paying $700 billion a year for foreign oil. It’s breaking us as a nation, and I want to elevate that question to the presidential debate, to make it the No.1 issue of the campaign this year,” Pickens says.

Today, Pickens will take the wraps off what he’s calling the Pickens Plan for cutting the USA’s demand for foreign oil by more than a third in less than a decade. To promote it, he is bankrolling what his aides say will be the biggest public policy ad campaign ever. The website, www.pickensplan.com , goes live today.

Jay Rosser, Pickens’ ever-present public relations man, promises that Pickens’ face will be seen on Americans’ televisions this fall almost as frequently as John McCain’s and Barack Obama’s.

“Neither presidential candidate is talking about solving the oil problem. So we’re going to make ’em talk about it,” Pickens says.

“Nixon said in 1970 that we were importing 20% of our oil and that by 1980 it would be 0%. That didn’t happen,” Pickens says. “It went to 42% in 1991 with the Gulf War. It’s just under 70% now. Where do you think we’re going to be in 10 years when our economy is busted and we’re importing 80% of our oil?”

Finding solutions to other major issues, including health care, are important, he concedes. But “If you don’t solve the energy problem, it’s going to break us before we even get to solving health care and some of these other important issues.” And it has to be done with the same sense of urgency that President Eisenhower had when he pushed the rapid development of the interstate highway system during the Cold War.

Of course, Pickens also has a particular solution in mind.

Wind. And natural gas.

Last week, Pickens loaded up his $60 million, top-of-the-line Gulfstream G550 corporate jet with reporters and a few associates from his Dallas-based BP Capital energy hedge fund and related companies and flew here to illustrate just how big — and achievable — his vision is.

There’s not much to Sweetwater except for wild grasses, scraggy mesquite trees and rattlesnakes (Sweetwater hosts its famous Rattlesnake Roundup each spring). The gently rolling terrain and vegetation make it ideal for raising cattle, which is what its first settlers did in the 19th century, and what their descendants do today. A regional oil boom in the 1950s and 1960s poured money into the area’s economy, as have two oil revivals since: one in the 1980s and one now.

But the exciting new industry in town is wind energy. You can drive for 150 miles along Interstate 20 and never be out of sight of a giant wind turbine, claims Sweetwater Mayor Greg Wortham, who does double duty as executive director of the West Texas Wind Energy Consortium.

Were it a country all by itself, Nolan County, Texas, would rank sixth on the list of wind-energy-producing nations, says Wortham. Year-round wind conditions, the terrain, low land prices and a small population make it an ideal location for wind farms. It already produces more wind-generated electricity in a year than all of California. And the business is growing so fast that he struggles to define it by numbers. By year’s end, there’ll be more than 1,500 turbines in Nolan County, representing a $5 billion investment. In the multicounty Rolling Plains region, there are already 2,000 operating turbines.

Add those operating further west, the Permian Basin region around Midland and Odessa, and the entire area has more than 3,000 turbines operating, producing about 6,000 megawatts of electricity — about equal to the power produced by two to three nuclear power plants.

Growth potential

The growth potential is, well, electrifying.

New turbine towers are going up at a rate of three to four a day in the Sweetwater area, Wortham says. “It depends on the (Texas) Public Utility Commission, but the number could be 20,000 ultimately,” Wortham says.

Pickens, who over the past two years has become the USA’s biggest wind-power booster, is quick to note that “there could be lots of Sweetwaters out there,” especially in the nation’s midsection, where winds are ideal for power generation.

Indeed, though Sweetwater is a windy place, plenty of locations farther north in the Great Plains are even better suited to wind farming. One is about 250 miles north of Sweetwater, near Pampa, northeast of Amarillo in the Texas Panhandle. That’s where Pickens is building what would be the world’s largest wind farm, four times larger than the current titleholder near here. So far, he has spent $2 billion on the project, including a record purchase of nearly 700 wind turbines this year from General Electric. He expects to spend up to $10 billion on the project and to begin generating electricity in 2011.

Though Pickens doesn’t own a single wind turbine in the Sweetwater area, Wortham was eager to play host to the oil baron and the reporters traveling with him. Sweetwater, he says, is proof that wind power has much more potential than its many skeptics believe.

“People hear about the 8-foot-tall wind turbines at Logan airport in Boston or the five turbines at Atlantic City and think ‘interesting,'” Wortham says. “But they don’t see how we can get to the 300,000-megawatt-production level” established by the Bush administration as a national goal for 2030. “Once you come to Sweetwater, you see that it can be done, and be done pretty easily, not only here, but … anywhere there are prime wind conditions. None of this existed seven years ago. Now, we produce enough electricity in this one county to power a large city, and we do it cheaply and cleanly.”

Getting lots more electricity with wind is only half of the Pickens Plan. Increasing wind-power production by itself won’t reduce U.S. dependence on foreign oil because most of that oil is consumed as gasoline.

The key, Pickens says, is that wind energy can be used as a substitute for natural gas now burned to generate electricity. That, in turn, will make far more natural gas available for use as a transportation fuel. Pickens’ plan is to produce enough wind power within 10 years to divert 20% of the natural gas now used to fuel power plants for use in cars and trucks. That’s much more aggressive a growth plan for the development of wind energy than envisioned by the Depart of Energy, which doesn’t expect the USA to be getting 20% of its total energy needs from wind until at least 2030.

Pickens foresees as many as a third of the vehicles running on natural gas within only a few years. Julius Pretterebner, director of the Global Oil Group at Cambridge Energy Research Associates, says getting 15% to 20% of the USA’s cars to run on natural gas — in some cases, in mixtures with other fuels in dual-fuel vehicles — by 2020 would be an outstanding achievement, and doing that will require federal support to expand the necessary infrastructure.

Powering vehicles with compressed or liquefied natural gas, CNG or LNG, has been Pickens’ pet project since the late 1980s.Yet the concept has been very slow to catch on.

Distribution is a major problem. CNG drivers can, like Pickens, install inexpensive equipment to fill up at their homes. But with fewer than 800 natural gas filling stations around the USA, drivers can’t count on being able to fill up wherever they go. So, for the most part, CNG, or LNG, has remained limited to fleet operators, such as local bus companies or big-city police departments.

And that’s where David Friedman, research director in the vehicles program at the Union of Concerned Scientists, says most natural-gas-powered vehicles will continue to be operated because of the distribution problem, the lack of vehicles made specifically to run on CNG, and the cost of converting conventional vehicles to run on CNG.

“I honestly think (natural gas’) role will be in medium- to heavy-duty vehicles and fleets — and as a stepping stone to hydrogen fuel-cell-powered vehicles in the future,” Friedman says. Only one car, a version of the Honda Civic, is available from the factory ready for CNG fuel, he says, and only at a significant premium over the price of a conventionally fueled version.

If you build it …

Pickens aims to shout down the skeptics by taking his case to the people via his TV ad campaign. If the nation is to break its addiction to foreign oil, a network of CNG stations could be built along interstates and in major cities for a relatively small investment, he says. Some gasoline retailers have told him they would add CNG pumps to their stations once they’re certain there’ll be enough vehicles capable of running on natural gas to justify costs.

Washington, Pickens adds, can encourage the move to natural-gas-powered vehicles by providing modest economic incentives for fuel retailers to invest in CNG pumps at their stations, for automakers to build CNG-powered cars and for individuals to convert their existing vehicles to CNG use. And it should continue to provide tax incentives for another 10 years to encourage wind energy’s rapid development as part of an overall plan to wean the nation from foreign oil, he says.

“It certainly would be cheaper than what they’re doing already for nuclear,” Pickens adds. But he’s also in favor of developing more nuclear energy, and every form of alternative energy to reduce oil imports. “Try everything. Do everything. Nuclear. Biomass. Coal. Solar. You name it. I support them all,” he says. “But there’s only one energy source that can dramatically reduce the amount of oil we have to import each year, and that’s (natural) gas.”

Pickens is an outspoken believer in the so-called peak oil theory that holds that maximum world production has peaked at about 85 million barrels a day — vs. current demand of about 86 million barrels a day — and will never rise much above that even with lots of new drilling and production.

“Even people who continue driving gasoline-powered cars and trucks will benefit,” he says.

Critics could easily accuse Pickens of advocating a major new public policy initiative that will line his own pockets. He is, after all, a big player in both the wind power and natural gas businesses. Pickens says that while his hedge fund will earn money for its investors, earning more money personally is meaningless: “I’m 80 years old and have $4 billion. I don’t need any more money.”

He’s more concerned that his efforts to make reducing foreign oil dependency the No. 1 issue on the national agenda will be dismissed by the public and, therefore, by Washington. So he says he’s carefully steering his plan clear of partisan bickering.

He’s already enlisted an unlikely supporter: the Sierra Club. “I will be in the front row of the chorus cheering” him on, says Carl Pope, its executive director, who flew with Pickens to Sweetwater.

Pope sees wind and solar energy as inexpensive sources of power that, along with other non-carbon forms, can be pooled to greatly reduce the need for oil- and coal-fired electric-generating plants.

“When it’s cloudy in Dallas and the wind’s not blowing in Sweetwater, but the sun’s blazing in the (Western) deserts, solar energy can run all those air conditioners in Dallas. When it’s windy in Sweetwater and cloudy in the desert, wind energy from Sweetwater can heat homes in Chicago.

“Mr. Pickens and I probably don’t see eye-to-eye on some other matters,” Pope concedes. “But he’s right on this one.”

Setting goals, clearing roadblocks

Washington’s role, Pope said, should be in setting the goal and clearing roadblocks such as the patchwork of state, regional and federal regulations that block the creation of a true national grid that can shift electricity from anywhere in the country to anywhere that it’s needed.

Getting support from groups and people not ordinarily aligned with his conservative political views is important to Pickens. A lifelong Republican, he’ll vote for McCain. But he’s not involved with McCain’s campaign, largely to keep his plan from being dismissed as mere campaign rhetoric.

“This has to be a bipartisan effort,” says the man who four years ago offered $1 million to anyone who could disprove the charges made against Democrat nomine Sen. John Kerry by the Swift Boat Veterans for Truth.

“This is not about Republicans vs. Democrats,” Pickens says. “This is about saving our country from the ruination of spending $700 billion a year on oil imports. Ninety days after the oil hits our shores, it’s all burned up, and we’ve got nothing to show for it. But they (foreign oil producers) still have our money. It’s killing our economy.”

S. Fla. Hospitals Join Trend of Becoming Stroke Centers: State Law Spurs Race for ‘Stroke Center’ Status

By Patty Pensa, South Florida Sun-Sentinel

Jul. 7–View Detailed Version

Reset Map

As stroke care advances, hospitals are lining up to create centers to treat these “brain attacks” with as much urgency as they treat trauma patients.

Hospitals are propelled by a 2004 state law that sends ambulances to stroke centers even if another hospital is closer. Florida leads the nation in the number of stroke centers because of the law, the state’s large population and older demographic. Broward County has 11, second only to Pinellas County’s 12.

But not all stroke centers are the same, and it can be hard for patients to know the differences. Some hospitals don’t have neurosurgeons to handle complications or bleeding strokes. Most are primary stroke centers, which offer baseline care. A few are comprehensive centers with cutting-edge treatment, but patients aren’t always transferred to them.

Doctors agree centers are a better approach to stroke care, but some question how many are needed.

“The more hospitals that are actually able to qualify as stroke centers, the better off it is for the patient,” said Dr. Nabil El Sanadi, chief of emergency medicine for Broward Health, “because every second counts.”

About 780,000 Americans have strokes each year, and the disease remains the nation’s No. 3 killer after heart disease and cancer, according to the American Stroke Association.

Dr. Jonathan Harris would have preferred only four stroke centers in Broward. But competition prevailed. Fewer centers would have resulted in higher patient volumes, more experienced care and reliable specialty coverage.

“As soon as you had two or three, everyone wanted to be a stroke center,” said Harris, stroke center medical director at North Broward Medical Center in Deerfield Beach. “Frankly, I was a little disappointed.”

Suffering a stroke used to mean paralysis. Little could be done until the clot-busting drug tPA was approved for strokes in 1996. Outcomes hinge on how fast patients seek help: Nine out of 10 stroke sufferers are ineligible for tPA treatment. But combined with surgical advances, some stroke patients today need little rehabilitation.

North Broward in 2005 became the county’s first stroke center. A year later, it became the first of three comprehensive centers in the county. A comprehensive stroke centers is a step up from primary center. It has a neuro-interventional radiologist who uses a catheter and tools to remove blood clots. Such procedures can be done up to eight hours after the onset of a stroke, compared with a three-hour window for tPA.

The Joint Commission, which accredits hospitals, launched stroke certification in 2003. Stroke care is largely about standards. How long does it take to get an image of the brain? How much longer to read that image? No more than 45 minutes combined, according to the standards. Lab tests must be done in that time, too.

“You’re making a decision on how that patient is going to be treated the minute they hit the door,” said Jean Range, an executive director at the Joint Commission.

About 100 hospitals in the state are stroke centers, and Range expects that number to grow. Imperial Point Hospital, for example, plans to be certified in about a year.

The Fort Lauderdale hospital experienced a bump in emergency visits, admissions and surgeries since nearby North Ridge Medical Center closed this year. With an older demographic, the hospital wants to serve its growing patient base, said Calvin Glidewell, chief executive officer.

“We want to make sure we’re prepared for the type of patients we might receive,” he said. “We’d like to get to the point where EMS are bringing stroke patients to Imperial Point.”

If hospitals don’t join the trend, they’ll not only lose patients but will open themselves up to liability. Dr. El Sanadi, of Broward Health, compared it to a trauma patient going to a hospital that isn’t a trauma center. That patient would be a “hot potato” and the hospital would be better off transferring the patient to a certified stroke center.

Hospitals routinely handled stroke patients before the concept of a stroke center developed and state law dictated patients would go there. Before the mid-1990s, rehabilitation was the main treatment. When tPA — a drug originally used for heart attack patients — was approved for stroke, it opened up a world of possibility for stroke sufferers.

Its main drawback: Nine of 10 stroke patients can’t get the drug because they don’t recognize their symptoms early enough.

At Cleveland Clinic in Weston, about 13 percent of stroke patients qualify for tPA, said Dr. Efrain Salgado, the hospital’s stroke center director. The average nationwide is 3 percent to 4 percent of patients, doctors say.

“The Achilles’ heel is patients don’t get to the ER on time,” said Salgado, “and that’s really a shame.”

Patty Pensa can be reached at [email protected] or 561-243-6609.

Find one near you Search an interactive map of South Florida stroke centers at Sun-Sentinel.com/strokecentermap

—–

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.

New Bed-Tracking System Helping Hospital Staff Improve Services: CVPH Uses Bed-Tracking System to Improve Service

By Jeff Meyers, The Press-Republican, Plattsburgh, N.Y.

Jul. 8–PLATTSBURGH — An electronic tracking system is helping officials at CVPH Medical Center manage patient movement more efficiently.

The hospital initiated the pre-admittance bed-tracking system a month ago, allowing staff from departments and patient floors to communicate via an electronic paging system that reduces the need to call one another when patients are being admitted or discharged.

“The phones are quiet now,” said Marty Picard, a patient-care coordinator for the Medical Center. “The system tracks patient movement and patient needs. Information is automatically sent from one unit to another simply by pushing a button.”

JUST ONE CALL

In the past, when patients were admitted to the hospital from the Emergency Department, Surgical Wing or other department, staff from the admitting unit would call Admissions, who in turn would call the patient floor. The patient floor would then call the admitting unit back when a bed was open.

“It would typically take seven phone calls once a patient came through the door,” said Rhonda Kowalowski, supervisor of In-Patient Services at the hospital. “Now, with pre-admit tracking, there’s usually only one call to the charge nurse on the intake unit. Everything else is handled electronically.”

“We were encumbered by the process of using the phone,” Picard added. “The system worked well if things were calm, but when things get busy, it’s not always that easy to get calls in or calls back.”

The system can be followed at a central location where staff can identify the status of the hospital’s 180-plus beds in minutes. An electronic table lists each bed and shows whether it is occupied, empty and being prepared for the next patient or awaiting a new patient.

The chart also lists the specific needs for the patient, so each can be matched with the specialty available on each inpatient wing.

“A hospital room is very much different than a hotel room,” Picard said. “In a hospital, the needs of the patient have to be matched with the special skills of the staff and the nursing units.”

REAL-TIME PROCESS

Staff members have electronic pagers that allow for communication among the different units. Once a room is cleaned following a patient discharge, for instance, that information is keyed into the system, and Admissions and other units know immediately it is available.

“It simulates real-time communication across the organization,” Picard said.

Officials are expecting the new system to be especially beneficial during times when the hospital is busy.

“Capacity protocol is a template for disciplines to follow when we have too many admissions,” Kowalowski said. “This procedure will no doubt speed up the admission process.”

CVPH has not reached full capacity since the system has been put into place. The hospital typically enters capacity-protocol periods during winter months when patient volume increases for such reasons as flu outbreaks.

Officials are looking at the system as one of several steps to help alleviate long waiting periods in the Emergency Department, which is responsible for a large number of daily admissions to the hospital.

“We have many programs in effect and in place to try to address that issue,” said Chris Blake of the hospital’s Public Relations Office. “This is part of a house-wide effort to improve patient flows.”

TREATING PATIENTS

As a patient-care coordinator working the late-night shift, one of Picard’s duties was to collect hard-copy admission sheets to identify patients being admitted the next day following surgeries and coordinate those admissions with upcoming discharges and empty beds.

Now, he and other PCCs can follow bed changes through the automated system, freeing time to spend with patients.

“Nurses intrinsically want to treat patients, and support staff want to get in after discharge to prepare rooms for the next patient,” he said. “The system gives everyone here more time to do their jobs.”

The process is also useful in preparing patients for transfer from one unit to another. Staff members can set up a patient’s needs prior to the move to ensure a smooth transition for patients.

The system has been installed with several security measures to protect patient confidentially, Kowalowski noted.

[email protected]

—–

To see more of The Press-Republican or to subscribe to the newspaper, go to http://www.pressrepublican.com/.

Copyright (c) 2008, The Press-Republican, Plattsburgh, N.Y.

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.

Vietnam’s Ho Chi Minh City, Mekong Delta in Grip of Dengue Fever Outbreak

Text of report in English by Vietnamese newspaper Thanh Nien on 7 July

[Unattributed report “Dengue Fever Plagues HCMC and Mekong Delta”]

Ho Chi Minh City and the Mekong Delta are in the grip of a dengue fever outbreak, with many hospitals overloaded with cases.

HCMC Preventative Health Department Deputy Director Nguyen Dac Tho said about 4,000 cases of dengue fever had been reported in the city in the first six months of the year, with about 100 new cases recorded every week.

Thu Duc District has reported the highest number of dengue fever cases, followed by districts 7, 8 and Tan Phu, Tho said.

Dang Hai Dang, deputy director of Ca Mau Province’s Preventive Health Department, said the number of patients struck down with dengue fever in his province over the past month was nearly double the number reported in the first five months of this year.

Tran Van Thoi District has been hardest hit, with 600 cases reported so far this year, followed by the U Minh and Thoi Binh districts and Ca Mau Town, he said.

At the Children’s Emergency Department of Ca Mau General Hospital, two or three patients share each bed.

The tropical disease, transmitted by the Aedes mosquito, has claimed four lives in Ca Mau Province this year.

Soc Trang Province has the highest number of cases, with more than 1,900 cases reported so far this year.

The provincial hospital’s children department often struggles to cope with the influx of Dengue patients.

In Tien Giang Province, more than 1,400 cases of the disease have been reported this year.

One death, a seven-year-old boy, was also reported.

Between 300 and 700 cases each of Dengue fever have been reported in the Mekong Delta provinces of Dong Thap, Bac Lieu, Kien Giang and Ben Tre.

Ho Chi Minh City’s Pasteur Institute has run prevention and treatment training courses for health officials from Soc Trang, Ca Mau, Bac Lieu and Hau Giang provinces.

Ca Mau’s health agency staff have been touring the province to advise residents on how to prevent the disease.

The health departments of Soc Trang, Dong Thap, Kien Giang and HCMC have launched mosquito eradication programmes.

Originally published by Thanh Nien, Ho Chi Minh City, in English 7 Jul 08.

(c) 2008 BBC Monitoring Asia Pacific. Provided by ProQuest Information and Learning. All rights Reserved.

The Bermuda Triangle of Healthcare

By White, Robert S Hall, David M

An Illinois healthcare system closes the gaps in patient handoff communication. When you hear “Bermuda Triangle” what comes to mind? Fear and confusion as planes and ships seem to disappear without a trace? It’s a mysterious and unsettling image. What’s more unsettling is that an activity that takes place thousands of times each day in healthcare organizations – handing over care of a patient to a new caregiver or location – has come to be known as the Bermuda Triangle of Healthcare. Various sources identify this step as the cause of a large portion of mistakes and oversights that result in harm to patients. Whether the mistake is giving a patient a dose of a drug already given on the previous shift, or an oversight that leads to intubation of a patient with a “Do Not Resuscitate” order, it’s easy to imagine the many ways faulty handoff communication can lead to disastrous results.

In light of the well-documented problems, the Joint Commission made handoff communication the subject of its National Patient Safety Goal Requirement 2E. Now it’s up to organizations like ours – OSF HealthCare System based in Peoria, Ill. – to wrestle with how to improve this fundamental activity without making patient care more complex or cumbersome.

OSF HealthCare is owned and operated by The Sisters of the Third Order of St. Francis, Peoria, Ill., and includes seven acute care facilities, one long-term care facility, two colleges of nursing, the philanthropic OSF HealthCare Foundation and other healthcare related businesses. It also has a primary care physician network consisting of 194 physicians and 48 mid-level providers known as OSF Medical Group.

Bringing Hondoffs Into Focus

In early 2006, OSF took aim at improving handoff communication as part of an enterprisewide patient safety push. As the authors of “Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes” concluded in their book, faulty systems, not bad people, are responsible for medical errors. With that in mind, we focused on facilitating the underlying process for handoff communication, which we believed to be the key to improving patient safety overall.

We started by bringing together a highly collaborative, multi- disciplinary group that included nurses, patient safety officers, physicians, IT specialists and corporate executives from our six acute care facilities. Using Six Sigma principles, our charge was to create a standard process and format for handoffs, and determine how best to support the process electronically.

OSF uses the GE Centricity Enterprise clinical information system. Having a clinical system in place gave us the advantage of having critical patient information available. However, we needed additional tools to bring the information together in a format that supported our handoff process. We looked to our GE alliance partner (The Menon Group Inc.) to provide an application that would augment the capabilities of our clinical system.

According to Kathy Haig, RN, OSF corporate patient safety officer, the previous non-standardized handoff communications model meant that, enterprisewide, nurses had their own unique routines that worked for them. Additionally, a non-standardized framework left the information included in the handoff up to each person, which was based on individual assumptions about what the next caregiver needed to know.

The new caregiver also had to anticipate any questions that might arise before the departing caregiver left their shift.

Recognizing those inherent gaps, we soon settled on the SBAR communication model. SBAR – Situation, Background, Assessment and Recommendation – has been adapted from a process used to quickly brief nuclear submarine commanders during a change in command. We found this model to be a good framework for a concise yet thorough approach to patient handoffs.

One of the biggest challenges was to define content such that we didn’t regurgitate what is already contained in the online patient record. The intent was to distill the essential elements into a one- page-per-patient format that puts a rigorous structure around the SBAR model. At the same time, if a nurse needs additional information for a patient, it is readily available online.

Distilling those essential elements presented challenges as well. For example, it was fairly straightforward to pick the top few lab values, but the last few were in a grey zone. We needed feedback from actual use.

“This group was willing to experiment with the prototypes,” says Cathy Smithson, RN, vice president and chief nursing officer for OSF St. Mary Medical Center, explaining how we enlisted a group of ICU nurses. “They tried them out and worked through the pros and cons to give us the feedback we needed to refine our form.”

As a parallel process, we had to make sure that the electronic handoff report would become an integral part of the workflow. With that in mind, our Six Sigma team studied the workflow and found it to be a 12-step process. By utilizing the new electronic report, they found that we would eliminate the need to gather information from the patient’s chart and write it down. This enabled us to condense the process down to eight steps. At the same time, it would support a standard communication between caregivers.

Throughout the process, we worked closely with The Menon Group to create the electronic handoff report. With discussion and compromise, we arrived at consensus for the specific data needed from the electronic record and the format of the SBAR handoff. The application was designed to pull the data directly from our clinical system and place it in the SBAR handoff format. The new report could be used either online or in print.

Handoff Report Rollout

We began the application rollout in March 2007 with a pilot unit. Based on that pilot, we made some additional adjustments to the application before making it available enterprisewide. Each facility planned their user education and rollout according to their environment. We found that although our staff could use the report online, most preferred to print it for each of their patients in preparation for shift report or other handoff situations.

According to Kelly Anderson, OSF team lead for clinical development and clinical decision support, use of the handoff report grew steadily over the first year. By the end of 2007, caregivers across six OSF facilities were creating an average of more than 66,000 handoff reports per month. By the end of March 2008, they were creating more than 85,000 reports per month. Word around our facilities was that the handoff report was faster, cleaner and more complete. According to Smithson, we have nearly 95 percent compliance with use of the electronic handoff at OSF St. Mary Medical Center.

Just as telling, are the results of a time study conducted at one of our facilities. Before implementation, patient handoffs took an average of 8.7 minutes. Post implementation, similar handoffs averaged only 4.1 minutes. Conservatively, if nurses complete two handoffs per shift for each of five patients, this translates to a potential savings of about 45 minutes per nurse per shift.

Our recent Joint Commission survey validated our results further. “Our staff used the report when discussing patients with The Joint Commission surveyors,” says Smithson. “The handoff report has been a great validation of communication and the use of SBAR. Because the electronic tool was developed in that format, it keeps those communication points in everyone’s mind.”

Lessons Learned

For OSF, there were two key elements that were critical to making this project a success. First, we had active participation and support of the leadership of the corporation as well as the individual facilities. Just as important, nursing drove the format and content, as they would be the primary users. Put the two together and you have an environment where collaboration and concrete changes can occur.

As physicians responsible for implementing IT solutions within our organization, we have found that as long as we continue to seek to understand the workflow of our clinical staff – particularly the painful parts – we can continue to imagine solutions that will help.

Taking imagination to implementation takes us back to one of the conclusions of the book “Internal Bleeding,” which states that faulty processes are the central cause of errors. By and large, the people in healthcare organizations – from the clinicians who care directly for patients through the executive leadership – want what is good for the patients in their care. With that higher purpose in focus, wide-scale change that helps rather than hinders the work of caregivers across large, complex organizations is possible.

For more information on The Menon Group, www.rsleads.com/807ht- 203

By Robert S. White, M.D., and David M. Hall, M.D.

Robert S. White (left), M.D., FAAFP, is the chief medical officer of clinical informatics and David M. Hall, M.D., FAAP, is a physician informatics specialist for OSF HealthCare System. Contact them at [email protected] or [email protected].

Copyright Nelson Publishing Jul 2008

(c) 2008 Health Management Technology. Provided by ProQuest Information and Learning. All rights Reserved.

Wind Power: The Ultimate Renewable Energy Source

By Null, Jan Archer, Cristina

As the debate over the need for renewable energy heats up in meeting rooms, legislatures, and boardrooms across the globe, the ultimate renewable energy source is blowing all around us. On average, there is enough power from the wind to meet the world’s electricity needs 35 times over. Today, as the cost of a barrel of oil soars and global warming has us searching for clean, renewable sources of energy, policymakers and scientists around the world are working to make the idea of gleaning electrical power from the wind on a larger scale a new reality. The goal of drawing 20 percent of all generated electricity from the wind once seemed pie-in-the-sky, but it has been realized in Denmark and is a realistic goal in other parts of the world, such as Spain and Germany. In the United States, wind currently provides less than 2 percent of the electricity demand. But in several states, such as California, plans exist to reach the target of generating 20 percent of energy from renewable sources, including wind, by 2010 and 33 percent by 2020. Wind Power Through the Ages

Using the wind for power is certainly nothing new. As far back as 5,000 years ago, there were wind-powered ships on the Nile River in Egypt. In ancient Persia around the year 1,000 B.C.E., some of the earliest windmills were used to grind grains. These very early windmills resembled large paddlewheels and were not terribly efficient at harnessing the wind. It wasn’t until the end of the twelfth century that windmills with horizontal axes and vertical blades were developed along the Mediterranean.

Windmills subsequently spread rapidly north across Europe. They became a dominant power source and remained so into the nineteenth century, when there were an estimated 50,000 operational windmills across the continent for both grinding grain and pumping water. The Dutch were innovators throughout this period, developing Holland’s ubiquitous four-blade rotors and a yaw mechanism to change the pitch of the blades. At one point in the nineteenth century, some 700 windmills supplied power for factories in Amsterdam before they were replaced by steam power.

Windmills evolved in the New World with the “wind pump” as an integral part of the taming of the West in the United States. Used as a means of pumping water, they dotted the landscape around farms and along the expanding railroads to supply water to locomotives. Even today, it is estimated there are still 60,000 wind pumps in the United States and a million worldwide.

The first windmill used to generate electricity, a wind turbine, was built by the Danes in 1892 to run a generator that in turn charged batteries for direct current (DC) power. Wind as a source of electrical power didn’t evolve until the 1930s in the United States, when cities became more and more electrified, while rural areas remained “off the grid.” To take advantage of the latest electric appliances, such as radios, wind turbines were used to charge batteries that in turn were used for power. These “wind chargers” took advantage of the new propeller aerodynamics from the burgeoning aircraft industry to generate electricity efficiently on a small scale.

Large-scale wind turbines, with capacities to generate thousands of kilowatts (kW) and connect to existing power grids, were experimented with in the 1950s but did not really become a viable resource for generating electricity until the 1970s. The oil crisis in that decade helped rekindle an interest in alternative power sources in general and wind power in particular. Over the next 10 years, thousands of 55-kW turbines sprang up on wind farms in California, primarily along the ridges east of the San Francisco Bay area and east of the Los Angeles basin. However, this number remained fairly static through the end of the twentieth century as subsidies for wind power waned and other energy sources dominated.

Wind Power Today

The world has seen a renewed interest in renewable energy at the turn of the twenty-first century. This, combined with a new generation of megawatt- size wind turbines, has given new life to wind power as a viable alternative not only in the United States but around the world. By 1996, 550-kW wind turbines were commonly being installed worldwide. These turbines were about 10 times more productive than the turbines of the 1970s. Today, the latest turbines being installed average 1.5 megawatts (MW), with some wind farms putting in 3.0-MW machines. Projections show that over the next 10 years, turbines in excess of 5.0 MW will be common. Already, a prototype 7.0-MW wind turbine is spinning in Germany.

These trends have translated into a dramatic increase in the power generated from wind both in the United States and around the world. At the end of 2007, there were 94 gigawatts (GW) of installed capacity globally, nearly double the capacity of 2004, when there were 48 GW, and more than 5 times the 2000 figure of 18 GW. Germany leads the pack with nearly 22 GW installed, followed by the United States and Spain with 17 GW and 15 GW, respectively. Projected growth worldwide is expected to continue at these dramatic rates, with an electrical capacity from wind of 160 GW by 2010. Areas with great potential worldwide include northern Europe along the North Sea, the southern tip of the South American continent, and the island of Tasmania in Australia.

However, for the past three years, the United States has been leading the world in new installed capacity, with a spurt of 45 percent in 2007 alone. The latest “wind rush” has been in Texas, whose wind power capacity has doubled in the past two years. Other states leading the growth spurt include California, Iowa, Minnesota, and Washington. The growth in these states has been in large part due to a two-cent per kilowatt-hour federal tax credit that was part of the 2005 energy bill. This incentive has made wind energy competitive with coal-fired power plants, producing electricity at approximately 3.6 cents per kilowatt hour, compared with 2.4 cents per kilowatt hour, including fuel cost, for coal-fired electricity.

Only about 13 percent of land worldwide is windy enough for wind power installations to be economical. Assuming that we can cover that fraction of the land with 1.5-MW, 80-meter-tall turbines, the wind power potential turns out to be 72 Terawatt (TW). One TW is 1,000 GW, and 1 GW is the size of a modern coal-fired power plant. Consequently, the world’s wind potential is equivalent to 72,000 new coal plants, which corresponds to 35 times the global electricity demand and 6 times the Earth’s total energy demand (which also includes heating, transportation, and other energy).

The midwestern United States is known for its untapped, massive wind potential, and the northeastern and northwestern coasts of the United States likewise offer large potential for offshore wind power development. Several proposals are pending approval for offshore farms in the Gulf of Mexico as well. Due to its relatively shallow continental shelf, the East Coast of the United States has an offshore wind power potential of 330 GW. This is out to a depth of 100 meters and takes into account exclusion areas for bird migrations, competing uses, beach rehabilitation, military exclusion, and shipping lanes. This is more than enough capacity to supply the adjacent region, whose demand is “just” 212 GW. Along the Pacific Coast, because of the steeper coastal shelf, the offshore potential is one order of magnitude less.

Overcoming the Barriers

Given the controversial nature of the topic, wind power is not without its proponents and detractors. Those touting wind energy point to its vast potential, its image as the poster child for clean, renewable power, and the fact that it is not impacted by world stock markets or political instability. It is also the most competitive renewable power source and by its very nature will maintain those credentials. The bottom line is that it is a “free” fuel, one that can never be charged for by the barrel.

Opponents to wind power most often point to avian fatalities from the rotors, noise, concerns about aesthetics, wind intermittency, and the occasional mismatch between wind availability and electricity demand, especially during heat waves.

Modern turbines have already mitigated many of the issues associated with both birds and noise. The new, larger high-capacity turbines turn at a slower rate, which ameliorates the noise and makes it possible for birds to avoid the turning blades. But even before the newer turbines, the number of bird killed was fewer than 2 deaths per turbine per year, and the total amount was about 0.1 percent of those killed by cats and 0.02 percent of those caused by birds flying into windows and buildings.

Meanwhile, the aesthetics of a wind farm is in the eye of the beholder. Put into historical context, before the Eiffel Tower and Golden Gate Bridge were built, they were widely mocked because it was thought they would ruin the surroundings. Today, views of these edifices are highly sought after and bring premium dollar on the real estate market. It should also be noted that many of the current and planned wind farms are not even visible to the vast populations of the world, making their impression upon the scenery irrelevant.

A more serious barrier to large-scale implementation of wind power than concerns about aesthetics or bird kills is the intermittency of winds. It is possible to experience sudden, unexpected changes in wind speed, such as gusts or lulls. This means that wind power as a reliable source of electricity has some problems. One way to reduce wind power swings is interconnected power. By linking multiple wind farms together, it is possible to improve the overall performance of the interconnected system- or array-substantially compared with that of any individual wind farm. The idea is that, while wind speed could be calm at a given location, it will be active somewhere else in the aggregate array, so there can be a constant flow of power outward from the entire system if the farms are all interconnected. Spain, one of the world’s leaders in wind power production, has created a system in which sudden wind power swings are eliminated. During a particularly windy period in the spring of 2007, wind power in Spain contributed 27 percent of the nation’s electricity-more than coal, nuclear energy, or hydropower. Another problem of wind power is its temporal mismatch with the electricity demand. The winds are often weakest when the electricity demand is highest, such as during a heat wave. One solution to this is pumped hydroelectric storage. During periods when there is high production from the wind and low demand (for example, at night), the excess electricity is used to pump water from a reservoir located at low altitude to a second, higher reservoir. Subsequently, during times of high demand (for example, in the afternoon), water from the higher reservoir is released to generate electricity and complement the wind’s reduced generation. Similarly, the wind’s excess electricity can be used at night to compress air into a cavern below a wind farm. The compressed air is then run through a traditional turbine to generate electricity during high-demand hours. On a small scale, a network of car batteries from electric or plug-in vehicles connected to the grid can provide emergency backup electricity.

New Technologies

New technologies are also emerging in the wind power sector. From kites tethered to a ground-based generator to four-armed rotorcrafts with electric generators on board, many new wind turbine designs have been patented in recent years. But regardless of the technology, the aim is universal: tapping the enormous resource of high-altitude wind power, possibly one day harnessing the jet streams.

The drive for clean, inexpensive power from the wind is not confined to megawatt turbines. Small and even microscale wind power is becoming an increasingly popular alternative. A small wind energy system that is capable of producing 10 kilowatts (enough power for a household) costs $30,000 to $50,000 to install and has a lifespan of 20 to 30 years. If sited in an area with moderate wind potential (for example, wind speeds of 10 mph) and with existing tax credits, it can pay for itself in about 15 years, a length of time that is comparable to similarcapacity solar energy systems. Or if you just need to power your iPod and want to “go green,” there is a hand- sized mini-turbine called HyMini that will charge most five-volt gadgets.

As the demand for clean, renewable energy sources increases both in the United States and around the world, wind will become an increasingly important component; subjective aesthetic qualms are not enough to ground a largely eco-friendly energy source. If recent years are an indication, the future will be brightly lit by wind- generated electricity.

The Wild Horse Wind Power Project in Kittitas County, Washington, has a generating capacity of 228 megawatts, which can power 50,000 households annually.

Wind farms like this one in Tehachapi, California, proliferated in the 1980s as the oil crisis helped kindle an interest in alternative power sources.

Germany’s Enercon E-112 wind turbine, which is 394 feet tall (120 meters) and can produce 4.5 megawatts, was the largest wind turbine in the world until December 2004. At the end of 2004, it was upgraded to 6 megawatts.

“The world’s wind potential is equivalent to 72,000 new coal plants…[or] 35 times the global electricity demand.”

The turbines at the Sacramento Municipal Utility District in Solano County, California, are the largest currently operational in the United States at 3 megawatts and 415 feet tall, higher than the Statue of Liberty. They operate at as little as 8 mph and peak at 33 mph to 56 mph.

JAN NULL is an adjunct professor of meteorology at San Francisco State University and a Certified Consulting Meteorologist with Golden Gate Weather Services. CRISTINA ARCHER is a research associate in the Department of Global Ecology of the Carnegie Institution for Science and a consulting assistant professor in the Department of Civil and Environmental Engineering at Stanford University

Copyright Heldref Publications Jul/Aug 2008

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

The Scientific Solution

By Sixsmith, Rachel

DR JULIAN LITTLE, CHAIRMAN, AGRICULTURAL BIOTECHNOLOGY COUNCIL This season, hundreds of potato growers are tentatively watching their crops for signs of one of the most virulent strains of blight to have so far evolved in the UK – genotype 13.

Its presence has prompted the Potato Council to step up its Fight Against Blight (FAB) and Blightwatch alerting services and is a reminder of the increasing threat that diseases and pests pose to UK horticulture and agriculture.

Given these circumstances, a genetically modified (GM), blight- resistant crop could be a saviour to many potato growers – as could other kinds of GM crops to a number of growers.

But controversy still surrounds this technology – despite the fact that countries such as Canada and the US have been using it for years.

A blight-resistant potato crop is currently being trialled in Leeds, but it was vandalised two weeks ago. One man who was particularly disappointed to hear of this crime is Dr Julian Little.

As chairman of the Agricultural Biotechnology Council (ABC), it is his job to educate the sceptics on the benefits of GM food by promoting the role of biotechnology in sustainable agriculture. Given that GM crops have been accused of being “Frankenstein foods” over the past decade, this is not an easy task.

But Little insists that, despite the vandals, there has been a “fundamental change” in the public’s overall attitude towards GM.

“I have been lucky as I took up the role of chairman [in autumn last year] at a time when people’s views of these technologies changed considerably.

“The world is looking at reducing the environmental footprint of agriculture and trying to increase food production because of food security issues and inflation. So it’s now about whether or not we want GM to help. People are saying: ‘Which bits of this technology are we interested in?’

“If they want to safeguard crops from pests and diseases – or from drought and other stresses – then GM is one of the options.”

Little, who is also the public and government affairs manager for Bayer CropScience, could be right in his observation. Last month, the BBC ran a series of programmes on how GM foods can help us. Meanwhile, newspapers such as The Daily Telegraph are running articles on “Why We Need GM Foods”.

The current media interest no doubt stems from the alarming issue of global food security – a matter which, earlier this month, was the focus of the Food & Agriculture Organisation of the United Nations conference in Rome.

The resounding conclusion of this conference was that securing world food security, in light of the impact of climate change, may be one of the biggest challenges we face in this century.

So why is Europe still so reluctant to embrace these new technologies?

For the past 10 years, the EU has put a “freeze” on growing GM crops and, in 2004, the UK government announced that no GM crops would be grown in the country for the “foreseeable future”.

The EU is now under increasing pressure to ease up its policies, and some politicians are pro-GM. But the general consensus is that EU ministers are still uncomfortable with the idea.

Little explains what he believes is the root of this Europe-wide hostility: “GM technology came out at a time when there were a lot of scare stories [such as BSE] and when there was plenty of food available. Things like set-aside were introduced as ways of reducing production and so people were asking: ‘Why do we need a crop that yields more at a time when we are reducing crop yields?'”

He also blames non-governmental organisations (NGOs) like Greenpeace for taking advantage of this Zeitgeist. “They were in a situation where they could see an opportunity to promote organic farming… and demonise some of the more scientific parts of agriculture.”

Little is a reminder that this technology stems not from monsters and demons but from scientists who want to help solve the world’s problems. “What most people are not aware of is that GM technologies have been a fact of life for over 10 years,” he says. “Some 12 million farmers are growing GM crops in areas well over twice the size of the UK [100 million hectares].”

So when are GM crops likely to become a regularfixture in the UK? “Sometime between now and never,” jokes Little. Traditionally, he says, the UK has been at the forefront of everything – but now, its scientific legacy is being held back by politics.

On a more serious note, he says: “I would anticipate that within five years we will be growing them relatively quickly. I say that with my fingers crossed, though, because NGOs have to take a more relative view.

“When you are talking about droughtresistant crops, that is just as relevant to farmers in East Anglia as farmers in East Africa. Places like that suffer from drought or too much water. Drought resistance is about keeping yields high whatever the weather. I hope we see these sorts of crops available by 2013.”

Rachel Sixsmith

CV

1989 Graduates from Swansea University with a PhD in molecular plant pathology

1989 Joins May & Baker (later RhonePoulenc), “mainly working out how herbicides kill plants”

1990s Spends a couple of years in Leon, France, then returns to the UK to work on herbicide project management with Rhone-Poulenc and Aventis Crop Science, which is purchased by Bayer

2002 Moves to communications initially biotech communications, then agrochemicals

Copyright Haymarket Business Publications Ltd. Jun 19, 2008

(c) 2008 Horticulture Week. Provided by ProQuest Information and Learning. All rights Reserved.

School Voucher Programs: What the Research Says About Parental School Choice

By Wolf, Patrick J

I. INTRODUCTION A number of important policy questions surround school voucher initiatives. Before a new voucher program is enacted, policymakers usually want to know answers to questions such as: (1) Do voucher programs primarily serve disadvantaged students?; (2) Do parents like voucher programs?; and (3) Do students benefit academically from vouchers? The answers to these questions provide policymakers and the general public with crucial information regarding what societal goals are and are not advanced when parents are allowed to use public funds to enroll their child in a private school of their choosing.

Fortunately, enough voucher programs have been established and evaluated to provide us with consistent and reliable answers to many of the policy questions surrounding school vouchers targeted at disadvantaged students. Had the Utah universal school voucher program not been defeated in a recent public referendum, it would have been the thirteenth school voucher program launched in the United States.1 The Utah initiative would have been the first voucher program in this country open to all school-age children.2 The twelve voucher programs that are approved and operating in the United States3 all target voucher eligibility to students that are disadvantaged in various ways. Thus, the research to date on school vouchers provides only speculative information about the likely effects of universal programs even as it provides a wealth of data on the effects of the targeted voucher programs that are becoming an increasingly common feature of the school-reform landscape.

The high-quality studies on school voucher programs generally reach positive conclusions about vouchers. The many evaluations of targeted school voucher initiatives confirm that these programs serve highly disadvantaged populations of students. Of the ten separate analyses of data from “gold standard” experimental studies of voucher programs, nine conclude that some or all of the participants benefited academically from using a voucher to attend a private school. The evidence to date suggests that school voucher programs benefit many of the disadvantaged students and parents that they serve.4

Part II of this Article describes the twelve voucher programs that currently exist in the United States and the student populations that they serve. Part III discusses and critiques the various methods that have been used to evaluate school voucher programs. Part IV argues that the evidence from rigorous voucher evaluations indicates that voucher programs increase parental satisfaction with schools and tend to boost student test scores, at least for some participants. Readers are cautioned that this evidence is drawn from targeted voucher programs and may not apply to universal programs such as the one proposed for and subsequently rejected by the citizens of Utah. Part V concludes by encouraging more rigorous research on the impacts of voucher programs with various design features.

II. SCHOOL VOUCHER PROGRAMS IN THE UNITED STATES

A school voucher program is an arrangement whereby public funds are made available to qualified parents to cover some or all of the expenses associated with enrolling their child in a participating private school of their choosing. Privately funded scholarships are not school vouchers, although, like vouchers, they are used to allow disadvantaged students to gain access to private schools. The placement and funding of special needs students in private schools by public school districts also is not a voucher program, since district officials, and not parents, choose the school. The definitional aspects of school vouchers are the source of the funds (governmental), the purpose for which the funds are provided (to enroll a school-age child in a private school), and the party whose decisions fulfill that purpose (a parent or legal guardian of the child).5

According to this definition of school vouchers, twelve voucher programs had been established or were being implemented in the United States as of the fall of 2007.6 A total of 56,285 students were enrolled in these programs at the start of the 2006-2007 school year.7 America’s first school voucher program was established in Vermont in 1869. The Vermont “town tuitioning” program provides vouchers for students in rural areas without public junior high or high schools.8 The vouchers in most towns enable parents to enroll their children in the public or private high school of their choosing.9 Other towns send all their students to one school. A similar program has operated in Maine since 1873.10 Milwaukee, the site of the largest school voucher program in the country, enrolled 17,275 students in the fall of 2006.11 Two new voucher programs were enacted in Arizona in 2006, serving students with disabilities and students in foster care.12 Georgia also enacted a voucher program for students with disabilities in 2007.13

The incremental trend of establishing additional voucher programs in the 1990s paused from 1999 to 2003 as policymakers awaited the outcome of the constitutional challenge to the Cleveland voucher program. Upon the issuance of Zelman v. Simmons-Harris,15 in which a majority of the Supreme Court upheld the constitutionality of school voucher programs such as Cleveland’s, school voucher initiatives re- emerged on the policymaking docket in many states. Whereas only five voucher programs had been established in the 130 years between 1869 and 1999, an additional seven programs were enacted in just the first five years post-Zelman.16

A brief review of the twelve school voucher programs in the United States shows how they were designed to serve exclusively students with various disadvantages. The first two programs in Vermont and Maine were limited to students without public junior high or high schools in their communities.17 The urban school voucher programs in Milwaukee, Cleveland, and the District of Columbia are restricted to students whose family incomes are at or below 185% of the poverty level.18 Five statewide voucher programs, including the Carson Smith Scholarship Program in Utah, are limited to students with disabilities.19 A pioneering voucher program in Arizona is restricted to students in foster care who otherwise would have to change public schools whenever they were placed with a new family.20 Finally, a statewide voucher program in Ohio is limited to students attending schools designated in a state of “academic watch” or “academic emergency.”21 To even qualify for a school voucher in one of the communities that offer them, a student must have some condition that disadvantages the student vis-a-vis the student’s peers.

The existing school voucher programs deliver on their promise to enroll highly disadvantaged populations of students. For example, over 30% of the students currently served by school vouchers have a diagnosed disability that affects them educationally, which is more than twice the national rate of 14% of K-12 students diagnosed with disabilities.22 John Witte, who led the first official evaluation of a school voucher program in the United States, reported that the Milwaukee Parental Choice Program (MPCP) served disproportionate numbers of students who were low-income, African American, Latino, or who came from single-parent families. Witte wrote, “The MPCP was established and the statute written explicitly to provide an opportunity for relatively poor families to attend private schools. The program clearly accomplished that goal.”23

Like America’s first urban school voucher program, the most recent voucher initiative, in the District of Columbia, serves a highly disadvantaged population of students. Over 94% of the students who used a D.C. Opportunity Scholarship (i.e. voucher) during the first year of program operation were African American, compared to 85% of the students in the D.C. public schools (DCPS) who are African American.24 The average family income of initial Opportunity Scholarship Program (OSP) users was $18,652.25 Eligible applicants to the OSP were significantly more likely to be in special education and also more likely to be enrolled in the federal lunch program for low-income students than non-applicants in DCPS.26 Eligible applicants in the first year of the OSP were performing at achievement levels in reading and math that were statistically similar to non-applicants in the DCPS.27 In a city disproportionately populated by underprivileged children, the D.C. voucher program has attracted and enrolled an especially disadvantaged subgroup of students.

As with the other eleven voucher programs, the D.C. OSP has disproportionately attracted and served highly disadvantaged students by design. To be eligible for a voucher, students must live in D.C. and have family incomes below 185% of the poverty level.28 Even the 216 students who were attending private schools when they were awarded vouchers in the first year of the OSP came from highly disadvantaged backgrounds that enabled them to meet the statutory criteria for program eligibility.29 Whenever the program is oversubscribed, which has been the case in all but the first of four years of program operation, public school students attending “needs improvement” schools must be assigned a higher probability of receiving a voucher.30 As Terry Moe discusses in his Article in this volume, statutory instruments of program targeting such as these can be and are regularly used by policymakers to ensure that voucher recipients are less advantaged than the typical K-12 student.31 Hard evidence from the twelve voucher programs currently in existence in the United States confirms that targeted vouchers reach students with significant educational needs. The students who apply for and use vouchers also tend to be educationally disadvantaged because of the logic of parental choice. Commentators can assume, mistakenly, that school choosers must and do engage in “maximizing” behavior that involves an obsessive canvassing of all relevant information and careful consideration of all options. As Herbert Simon observed in his seminal study Administrative Behavior, however,

Administrators (and everyone else, for that matter) take into account just a few of the factors of the situation regarded as most relevant and crucial. . . . Because administrators satisfice rather than maximize, . . . they can make their decisions with relatively simple rules of thumb that do not make impossible demands upon their capacity for thought.32

When it comes to the education of their children, the simple rule of thumb that parents tend to follow is, “If it ain’t broke, don’t fix it.” Because switching schools is highly disruptive to students- educationally and socially-and requires a significant investment of time and energy by parents, few parents will seek additional schooling options for their child unless they are convinced that the student is underperforming in their current school and that a switch to a different school is likely to generate a significant upside gain. As a result, students perceived by their parents as underperforming will disproportionately comprise the ranks of voucher students.

In summary, school voucher programs are arrangements whereby government funds enable parents to enroll their children in private schools of their choosing. The twelve such programs that currently exist in the United States all are targeted towards student populations that are disadvantaged in one or more ways. Research has confirmed that these voucher programs actually reach their targets. Disadvantaged and underperforming students swell the ranks of voucher programs due to a combination of program design and the logic of parental decision-making. Any universal voucher program that lacks the targeting mechanisms present in all existing voucher programs would be expected to enroll a less disadvantaged population of students.

III. METHODOLOGIES FOR EVALUATING SCHOOL VOUCHERS

The remainder of this Article reviews the evidentiary record surrounding the impacts of school vouchers on the students and parents who seek and use them. Because voucher evaluations present significant research challenges, the various methodologies used by voucher researchers are first reviewed and critiqued and only the evidence from the most rigorous and reliable class of studies is presented and discussed.

Even though school voucher programs disproportionately serve highly disadvantaged students, this fact does not allow us to determine the effects of vouchers simply by comparing the outcomes of voucher users to students who do not use vouchers. The parental motivation associated with private school enrollment-with or without a government-financed voucher-could plausibly influence student achievement in the long run independent of the effects of the private school. In methodological terms, simple comparisons of private school students with public school students, voucher applicants with non-applicants, or voucher users with non-users, all will be subject to varying degrees of selection bias. Researchers cannot even be certain of the direction of the bias, as parent motivation to switch their child to a private school may be driven by a sense of desperation, in which case the uncontrolled selection effect will operate in the direction of reporting a negative voucher effect. Parental motivation also may be driven by an inordinate concern for the education of their child, in which case the uncontrolled selection bias will operate in the direction of reporting a positive voucher effect. In either case, the finding would have been false. In the presence of uncontrolled selection bias in education research, analysts simply cannot be confident that any observed difference in the outcomes of program participants relative to non-participants is due to the program and not the selection bias.33

Education researchers have applied a number of methods in attempts to control for or eliminate selection bias from their evaluations. These approaches can be broadly categorized as cross- sectional studies that statistically model selection, longitudinal studies employing matching techniques, and randomized experiments.

Cross-sectional observational studies that attempt to statistically model selection into private schools provide the weakest protection against selection bias. They are also known as quasi-experimental studies because they use statistical modeling to imperfectly approximate the ideal conditions for identifying causal impacts that actual experiments provide.34 In the case of voucher evaluations, such studies use measurable characteristics of students already attending private schools, at a single point in time, to try to control statistically for the unmeasurable trait of parent motivation and thereby estimate the effects of voucher programs.35 They suffer from three major flaws.

First, estimates of school voucher effects based on cross- sectional analyses use data that are not actually about the question that they seek to answer. Such studies draw evidence from the private sector as a whole, of which over 99% of the students are not voucher users, in order to estimate the likely effects of voucher programs. As discussed above, students who attend private schools using vouchers are, on average, more disadvantaged than the typical public school student and thus dramatically more disadvantaged than the average private school student. Previous research has established that private schooling tends to have larger positive achievement effects on disadvantaged students than on advantaged students.36 Thus, cross-sectional studies of private sector effects on achievement that claim to forecast voucher effects are using data about what is true in the absence of voucher students to predict what would be true for voucher students. These studies represent the logical equivalent of estimating the effect of a weight-loss program on obese people by studying its effect on normal-weight people. As Henry Levin states, “Of course, none of the public-private comparisons can be as instructive as the direct evaluation of a voucher intervention.”37

Moreover, cross-sectional studies of private schooling or school choice typically rely heavily upon participation in federal government aid programs as variables to “control” for selection bias in private-public school comparisons.38 The rates of school-level participation in such programs are much higher in the public sector than in the private sector.39 For example, student disability status is signified in public schools by a student having an Individualized Education Plan (IEP). Students with disabilities who switch to private schools remain disabled but surrender the IEP label.40 While the federal government free and reduced price lunch program is offered to students in all public schools, school-level participation in the federal lunch program is discretionary for private schools. Many private schools decline to participate in the federal lunch program because of the extra administrative burden involved.41 For these reasons, a student with the exact same low income and disability is much more likely to be a participant in the lunch program and have an IEP if he or she attends a public school than if he or she attends a private one.42 As a result, modeling selection by including a control variable for participation in the federal lunch program or having an IEP has the practical effect of controlling for the negative effects of low income and disability on test scores among public school students but not among private school students. The predictable effect of such a flawed analytic approach is that the estimate of the “private schooling effect” becomes a negatively biased combination of the true private schooling effect minus the effect of being low income and disabled.43

The third major flaw in cross-sectional analyses of voucher effects is that they are static in that they rely exclusively upon measures of variables at a single point in time. Such studies do not and cannot examine change or growth that is a result of private schooling or school vouchers because their data consists of a single snap-shot of students.44 Based on this shortcoming in observational studies, the Charter School Achievement Consensus Panel, a national panel of research experts assembled to evaluate various methods of evaluating school choice interventions such as charter schooling, concluded, “studies using one-year snapshots of achievement cannot have high internal validity, no matter how large a database they draw from or how carefully the analysis is done.”45 Robert Boruch sums up the basic weakness of quasi-experimental analyses of cross- sectional data thusly:

Analyses of data from passive surveys or nonrandomized evaluations or quasi-experiments cannot . . . ensure unbiased estimates of the intervention’s relative effect. We cannot ensure unbiased estimates, in the narrow sense of a fair statistical comparison, even when the surveys are conducted well, administrative records are accurate, and analyses of quasi-experimental data are based on thoughtful causal (logic) and econometric models. The risk of misspeciBed models, including unobserved differences among groups (the omitted variables problem), is often high.46 Even perfectly executed analyses of cross-sectional data on private and public schooling are incapable of reliably determining whether or not private schooling has positive, negative, or no effects on students.

Cross-sectional analyses of private schooling effects to estimate voucher effects are the equivalent of using a single photo of a weight-loss client to judge the efficacy of a particular diet compared to other diets similarly judged by single photos of clients. The statistical controls included in many of those studies are like air-brushing the photos of the weight-loss clients that you think might have been heavier at the start of their diet-they represent an artificial adjustment based on guesswork. If customers insist on before-and-after photo comparisons at a minimum to evaluate weight-loss programs, shouldn’t we insist on at least that much information in evaluating educational interventions such as school vouchers?

Longitudinal studies address the self-selection problem associated with school vouchers by examining changes in student outcomes over multiple time periods. The simplest forms of longitudinal evaluations are individual fixed-effects methods that control for the particular characteristics of study participants by restricting their analysis to variance in the outcomes of the same students over periods when they were and were not exposed to the intervention.47 Since the same students are present on both sides of the comparison at different times, student selectivity cannot bias the analysis.48 More sophisticated “matching” longitudinal approaches to evaluating school vouchers use information about the characteristics of voucher participants to identify non- participants who “look like voucher participants” in all relevant respects except for voucher participation.49 Such voucher-like non- voucher students are described as having a “propensity” to be voucher students, and therefore serve as a more reliable comparison group than just any public school student in evaluations of voucher effects.50

Longitudinal studies suffer from none of the major flaws of cross- sectional evaluations of voucher effects.51 Unlike cross-sectional studies, longitudinal studies examine actual voucher students in estimating what differences, if any, voucher programs make. Longitudinal studies are less subject to bias due to measurement problems since they do not use student characteristics, beyond the identity of students themselves, as explicit controls for selection effects. Finally, longitudinal studies are superior to cross- sectional studies in that they provide evidence of comparative change over time as opposed to mere isolated snapshots of students.52 They basically line up the before-and-after photos produced by participants in various weight-loss programs so that the viewer can better evaluate which diet regimen is producing the best results.

Longitudinal studies of school vouchers, though far superior to observational ones, do suffer from one potential flaw. They assume that any effects of selection bias have already influenced the conditions in which students find themselves at the start of the study, but will have little or no influence over the rate of change in those conditions over time. If higher levels of parental motivation really are associated with voucher students, and simultaneously influence how well a student is currently achieving, such unmeasured parental values might presumably influence the rate of change in student achievement as well.53 Thus, longitudinal studies can limit the threat of selection bias to the validity of voucher evaluations, but they cannot eliminate the possibility of such bias entirely.

Random assignment studies can eliminate the threat of selection bias and therefore have justly earned their reputation “as the gold standard for the evaluation of educational interventions” such as voucher programs.54 Also known as experiments or randomized controlled trials, random assignment studies take a population of equally motivated families and use a random lottery to separate them into a “treatment” group that receives an offer of a voucher and a “control” group that does not receive such an offer.55 Because mere chance determined which students are in the treatment and control groups, any differences in educational outcomes subsequently observed between treatment and control students can be reliably attributed to the voucher opportunity as the cause.56

Random assignment studies are such powerful instruments for evaluating educational programs that the U.S. Department of Education’s What Works Clearinghouse (WWC) has declared that they are the only research design that meets its evidence standards for rigor “without reservations.”57 In contrast, all cross-sectional education studies fail to meet even the minimal WWC evidence standards, and therefore cannot be included in formal reviews of what does and does not work in education, because their lack of both random assignment and baseline data means that we cannot be confident that their treatment and comparison groups were equal in all relevant respects except for the treatment intervention.58

Judith Gueron states that a policy experiment “offers unique power in answering the ‘Does it make a difference?’ question. With random assignment, you can know something with much greater certainty and, as a result, can more confidently separate fact from advocacy.”59 Robert Boruch describes random assignment evaluations as the modern-day equivalent of the scientific principles of Newtonian physics that Thomas Jefferson described as producing a situation whereby, “‘Reason and experiment have been indulged, and error has fled before them.'”60

The high reliability of randomized experiments is the reason why the efficacy of new drugs must be demonstrated in two randomized trials before the Food and Drug Administration permits them to enter the market.61 Such evaluations are the equivalent of taking a group of over-weight people who all want to lose weight, using a lottery to determine which ones will receive a supervised administration of the Nutrisystem diet and which ones will be left to their own devices, and calculating the average weight-loss for the two groups at a later point in time. Because random assignment approximately equalizes groups on both measurable and unmeasurable characteristics, we could confidently attribute any significantly higher or lower level of weight-loss among the treatment group to the Nutrisystem intervention.

Even though random assignment studies are widely revered in medicine, economics, political science, and education, some researchers have recently raised claims that such experimental studies suffer various biases.62 These researchers claim that since some members of the treatment group inevitably decline to use vouchers and some members of the control group obtain private schooling without the assistance of a voucher, the estimates of the program suffer from “compliance/attrition bias.”63 This claim stems from a basic misunderstanding of the logic of experimental program evaluations. Public policies cannot force clients to use programs. They can only offer the services to qualified clients. A public policy can fail to produce significant outcomes, either because it is not effective if used, or because it is effective but low percentages of clients use it consistently. As such, the outcomes that a policy intervention like vouchers generates for non-users should be and typically are averaged into the effects that it produces for voucher users, thereby producing an accurate and unbiased estimate of the impact of the offer of a voucher, which is all that public policy can provide. Similarly, control group members that obtain the equivalent of the voucher “treatment” without the assistance of the voucher offer are an authentic part of the control group counterfactual. We know that, absent a voucher program, those students would have attended private school anyway, because their actual behavior has revealed this to us. Control group “crossover” to a treatment-like condition is thus not a source of bias in experimental analyses.

The fact that some students randomly offered vouchers do not use them, and some control group members attend private schools without vouchers, does not in any way bias the estimate of the impact of offering students vouchers, though it does generate a conservative estimate of the effects of actually attending private school.64 This is because the outcomes for voucher decliners, for whom the impact of the voucher is zero, are averaged in with those of voucher users in calculating the experimental impact of vouchers. Likewise, any change in outcomes experienced by control group members who attend private schools are included in an experimental analysis on the control-group side of the comparison. If analysts or policymakers want to draw from an experimental evaluation in determining the impact of actual voucher usage or private schooling, established statistical techniques exist and are regularly employed in experimental voucher evaluations to produce unbiased estimates of those impacts.65 So, if one is interested in the average effects of a program that merely offers students vouchers, random assignment studies, as traditionally implemented, generate unbiased estimates of that average “intend-to-treat” impact. If one is instead interested in the average effect of obtaining the actual experience that vouchers are supposed to enable students to receive-private schooling-then established statistical methods exist that can be and are applied to experimental voucher data to produce unbiased estimates of private schooling either through voucher usage or in general. The most commonly used such method is Instrumental Variable (IV) analysis with the original voucher lottery as the ideal instrument.66 Second, some researchers claim that experimental evaluations of voucher impacts suffer from “generalizability” bias because the populations of students who choose to apply for voucher programs are different from non-applicants. It is true that the results of any particular experimental voucher evaluation only strictly apply to the special conditions in which the program was designed and implemented. It would be risky to claim that the results of an experimental voucher evaluation of a means-tested inner-city program would automatically apply to a statewide voucher program for students of any income level but with disabilities. Those are two populations that differ in ways that could plausibly influence their response to vouchers, so analysts should not, and generally do not, make such generalizability claims. This condition is not, properly understood, a “bias” of experimental voucher studies, since it does not undermine the validity of experimental impact estimates. It is simply a limitation.

Experimental evaluations are purposely designed to be exceptionally strong in their “internal validity”-that is in their ability to reach an accurate determination as to whether or not the voucher program impacted a certain group of study participants.67 Experiments of all types are inherently limited in their “external validity,” that is, in the ability to apply the results of one study of a particular student population to the context of a very different student population. Presumably, one need determine with confidence whether or not an educational intervention works with a given set of students before one considers whether it might work for a different group of, or all types of, students. That is why experimental evaluators of voucher programs qualify their findings to make it clear that different results could emerge from similar evaluations of very different student populations.68 That is not a bias, just good scholarly practice.

In a broader sense, the charge that voucher evaluations are biased because they are limited to families interested in applying for vouchers borders on the ridiculous. True, such evaluations only tell us what impact the program will have on families who want to use it. What else would policymakers want to know? Certainly it would be of little value to know what impact voucher programs have on families who do not want to and never will use them. Would we care what effect a particular diet program had on people who do not want to lose weight?

Finally, some researchers claim that experimental evaluations of voucher programs are biased by the fact that the peer groups in private schools are different from those in public schools.69 If, in fact, the backgrounds of students in voucher-participating private schools are more advantaged on average than those of students in the schools attended by control-group students, then that is a legitimate aspect of the treatment. Voucher programs enable students to switch from one type of educational environment to another one. If that new educational environment, in a participating private school, is different, for example because it includes more high- income peers, then that is part and parcel of the treatment. Analysts must not control for the differing characteristics of peer groups in the schools being attended by students in experimental voucher evaluations because doing so “controls away” one of the legitimate sources of any treatment effect. If voucher students learn more because they are surrounded by more advantaged peers in their new schools, then that is an explanation for why vouchers work, not something that should be subtracted out from any calculation of whether or not vouchers work.

Our weight-loss example is again instructive. When comparing the effectiveness of different weight-loss programs, should we control for the caloric intake of their prescribed menus? Researchers who argue that experimental voucher studies need to control for peer- group effects would have to similarly claim that weight-loss program comparisons would have to control for the fitness of the people in the weight-loss candidate’s support group. Their claim would be that a given program is not more effective-it merely surrounds the over- weight person with more fit and inspiring peers. The legitimate defense of such a weight-loss program is that it may be more effective than alternative programs because fit support group members inspire participants to lose weight, but the specific reason for its greater effectiveness does not change the simple fact that it is more effective. The relative fitness of other weight-loss participants is part of the treatment package, not a biasing factor, just as differing peer-group characteristics are a legitimate part of the voucher treatment and not something that should be netted out of the equation.

Because experimental voucher evaluations are rightly viewed as the gold standard of evaluation, and the claims of bias raised against them do not survive close scrutiny, here we confine our examination of the impacts of vouchers to the growing body of ten analyses that meet this highest of standards for rigor.70 All ten of these studies appeared in reports that survived peer review prior to their public release or publication.71 They paint a modestly positive picture of the impacts of school vouchers on parent and student outcomes.

IV. VOUCHER IMPACTS AS REPORTED IN RANDOM ASSIGNMENT STUDIES

The random assignment studies of actual school voucher programs in the United States indicate that they have consistently large positive effects on parental satisfaction with schools and smaller and less consistent effects-but always positive-on student test scores. Voucher programs demonstrate their most immediate and largest positive impacts on the expressed levels of satisfaction that parents have with their child’s school. This school voucher impact has been confirmed in all five random assignment studies that explored the question of parental satisfaction.72 Voucher programs appear especially to increase parent satisfaction regarding curriculum, safety, parent-teacher relations, academics, and the religious environment of schools.73 The positive impacts of voucher programs on parental satisfaction are large, averaging three-tenths of a standard deviation, or more than one-third of the size of the notorious blackwhite test score gap.74 As an example, seventy-four percent of parents of students offered a voucher in the new District of Columbia Opportunity Scholarship Program graded their child’s school “A” or “B,” compared to just fifty-five percent of the control group.75

Although it is indisputable that parents are more satisfied with their child’s school if they have been given a voucher, we do not yet know why they are so much more satisfied. The private schools that parents select using vouchers might be more effective schools that do a better job educating students. Voucher parents might be more satisfied with schools because they are a more comfortable environment for their child, in terms of safety and programs, than their previous public school-even if the voucher schools do no better than public schools at educating students. Finally, the large impacts that voucher programs have on subsequent parental satisfaction might be the result of cognitive dissonance. Since parents themselves selected their child’s new school, they might feel vested in the outcome of the choice and filter their perceptions in such ways that the voucher schools look better to them even if, objectively, they are no better than the child’s previous public school. Voucher studies have yet to determine if greater parental satisfaction with voucher-accepting private schools is grounded in fact or false perception, but central to that consideration is the impact that vouchers have on student achievement.

A substantial base of evidence is emerging that indicates that school voucher programs tend to boost the achievement of some or all of the students who use them. As discussed supra, enough gold- standard random-assignment studies have been completed that we can and should limit our consideration exclusively to those highly rigorous evaluations. A total of eight different research teams have conducted ten separate analyses of data produced by six random assignment voucher programs in five different cities.76 Three of the analyses-two in Milwaukee and one in the District of Columbia-had full-tuition, publicly funded school vouchers as the subject of the evaluation.77 The other seven analyses were of data from voucher- like, privately funded, partial-tuition scholarship programs in Charlotte, Dayton, D.C., and New York City.78 All ten of the analyses examined the impacts of using a voucher on subsequent student achievement measured by test scores in reading and math, either separately or combined into a single composite score.79 All of the studies, except for the re-analysis of the New York City experiment by Krueger and Zhu, used the combination of random assignment data and well-established statistical methods to produce unbiased estimates of the educational impacts of actually using a voucher or voucher-like scholarship. What follows is a brief review of the studies:

Two independent studies have been produced using experimental data from the privately funded, partial-tuition, voucher-like scholarship program in Charlotte, North Carolina. Jay P. Greene of the University of Arkansas conducted the original Charlotte study.80 Of 1143 eligible students who had entered a scholarship lottery and had been randomly assigned to the treatment or control groups, a total of 452 (40%) in grades two through eight produced outcome data one year after random assignment.81 Using Instrumental Variable (IV) analysis to correct for the differences between users and non-users among the treatment group, Greene reports statistically significant achievement gains of 5.9 percentiles in math and 6.5 percentiles in reading for the voucher students compared to the control group after one year.82 This study was published in the peer-reviewed section of the journal Education Matters, which later became Education Next, rated by Education Week as the most influential education policy journal in the United States. Joshua Cowen of the University of Wisconsin has re-analyzed the data from the Charlotte voucher experiment and largely replicates Greene’s original results.83 Cowen uses a variety of new maximum likelihood statistical techniques in place of IV analysis to generate unbiased estimates of achievement effects of the voucher program on voucher users, which he calls the “compiler average causal effect.”84 Cowen reports voucher achievement gains of 4-6 percentiles in math and 5-8 percentiles in reading that are statistically significant with at least 90% confidence in five of the six alternative regression models that he estimates.85

William Howell of the University of Chicago led a research team that evaluated the impact of privately funded, partial-tuition, voucher-like scholarship programs in Dayton, the District of Columbia, and New York City.86 In Dayton, Ohio, 56% of the 803 randomized voucher applicants turned out for outcome data collection one year after and 49% turned out two years after random assignment.87 The authors report the simple “intent-to-treat” results of being offered a voucher, regardless of whether or not it is used, and use IV analysis to generate unbiased estimates of the effects of actual scholarship usage.88 Howell and his colleagues report no statistically significant achievement gains for the group treated with vouchers in Dayton in years one or two.89 They do, however, report statistically significant achievement gains from voucher usage for the African American subgroup of students in their Dayton sample of 6.5 percentiles in math and reading combined in the second year.90 The results of the Dayton voucher experiment were published in the Journal of Policy Analysis and Management, which is the leading peer-reviewed public policy journal in the United States, as well as the peer-reviewed research section of Education Matters.

Howell and his research team also reported the results of a similar analysis of the impact of privately funded, partial- tuition, voucher-like scholarships in Washington, D.C. A total of 1582 students were randomly assigned to treatment and control in the initial D.C. voucher experiment.91 Sixty-three percent of participants turned out for outcome data collection in year one and 50% in year two.92 The research team reported no statistically significant general impacts of voucher usage in year one but observed significant gains of 7.5 percentiles in combined math and reading achievement for the D.C. students treated with vouchers by year two.93 In the subgroup of students in the D.C. study who were African American-over 90% of the study sample-the voucher gains in the second year totaled 9.2 percentiles.94 These results of the initial D.C. voucher experiment appeared in the same two peer- reviewed journals as the Dayton results discussed above as well as a book by the Brookings Institution Press in its second edition.95

The initial D.C. voucher experiment was not the final word on voucher impacts in the nation’s capital. In January of 2004, Congress passed and President Bush signed into law the first federally funded school voucher program.96 The Opportunity Scholarship Program is being implemented in Washington, D.C., and evaluated using rigorous experimental methods.97 A total of 2308 low- income D.C. students in two cohorts (2004 and 2005) were randomly assigned to receive a voucher worth up to $7500 or serve in the control group.98 Effectively 77% of this large sample of study participants turned out for outcome data collection one year after random assignment.99 The evaluation team reported no overall test score gains due to the vouchers in the first outcome year.100 They did report achievement gains in math of 7.8 scale score points for voucher students who previously had been attending lowerperforming public schools as well as math gains of 6.7 scale score points for voucher students whose baseline test score performance was in the upper two-thirds of the overall low test score distribution of the students in the sample.101 This evaluation, supervised by the U.S. Department of Education’s Institute for Education Sciences, is ongoing.

Two independent research teams produced separate analyses of experimental data from the initial evaluation of the Milwaukee Parental Choice (voucher) Program (MPCP), originally conducted by John Witte of the University of Wisconsin. Witte’s evaluation used longitudinal and not experimental methods.102 Voucher lotteries were used in the MPCP in its early years, however, allowing subsequent researchers to employ experimental methods to analyze the data.103 The first experimental study of the Milwaukee program, by Jay Greene and his colleagues, reported statistically significant voucher impacts on both math and reading test scores that were modest for three years after random assignment but moderately large after four years.104 The researchers reported no significant voucher impacts on test scores until students had used them for at least three years.105 Their study was published in the peer-reviewed journal Education and Urban Society.

In a separate analysis, Cecilia Rouse of Princeton University largely replicated the Greene et al. Milwaukee study.106 She used “years of voucher use” as her explanatory variable-instead of looking at impacts in separate years-concluding that the Milwaukee voucher program generated math gains of 1.5 to 2.3 percentiles per year but no statistically significant reading gains.107 Rouse’s replication study was published in the peer-reviewed Quarterly Journal of Economics.

Finally, three different research teams have analyzed random assignment data from the New York City experiment with privately funded, partial-tuition, voucher-like scholarships.108 All three studies reported no statistically significant achievement gains overall due to the vouchers. Two of the three studies, however, reported voucher achievement gains for one or more subgroups of study participants.

John Barnard, a research statistician at deCODE Genetics, and his colleagues produced the most optimistic assessment of the test score impacts of the New York City voucher experiment. Using propensity- score matching techniques instead of IV analysis to generate unbiased estimates of the impact of voucher usage on student achievement one year after random assignment, Barnard and his colleagues found no statistically significant gains overall.109 They did, however, report statistically significant voucher gains in math of 4-6 percentiles for African Americans and students who previously were attending lower-performing schools.110 Their study was published in the peer-reviewed Journal of the American Statistical Association, the top-ranked statistics journal in the United States.

Howell and his colleagues published the first reports drawing from data collected on the New York City voucher experiment.111 Their results are almost identical to those reported by Barnard et al. Using IV analysis to generate unbiased estimates of the impacts of voucher use, Howell et al. found no statistically significant test score impacts overall but did report statistically significant achievement gains for African Americans.112 The voucher gains for African Americans were significant in all three years of the evaluation and ranged from 4.3 to 9.2 percentiles.113 The results from the first two years of this study were published in the peer- reviewed Journal of Policy Analysis and Management and the peer- reviewed research section of Education Matters. The results from all three years were published in a book, now in its second edition, by the Brookings Institution Press.114

Finally, Alan Krueger and Pei Zhu of Princeton University conducted the third analysis of the New York City experimental data.115 By adding test scores from kindergartners who were not tested at baseline, reclassifying the races of study participants, and including a more extensive set of baseline variables in their statistical models, Krueger and Zhu generate estimations of voucher impacts that are still positive but are not statistically significant overall or specifically for African Americans.116 Their unconventional approach to analyzing these data has been the subject of heated controversy.117 Their study was published in the peer- reviewed journal The American Behavioral Scientist.

None of the experimental analyses of voucher effects on student achievement reports exactly the same results. Nevertheless, a careful examination of the evidentiary record to date reveals some general patterns of outcomes. Nine of the ten gold standard evaluations of voucher programs have reported positive and statistically significant achievement impacts for all or at least some subgroup of voucher recipients.118 Five of the ten analyses concluded that all types of participants benefited academically from a school voucher.119 Of the five other studies that did not report a significant “general” voucher effect on test scores, four of them reported clear voucher achievement gains for at least one major subgroup of participants.120 Only one of the ten studies-the re- analysis by Krueger and Zhu of the earlier New York City experiment- concluded that a voucher program had no clear achievement benefits for any group of participants.121 No random assignment study of vouchers to date has indicated that vouchers harm students academically.

The results of random assignment studies of school vouchers reveal more than simply a general tendency for vouchers to boost student achievement. The pattern of experimental results suggests that achievement gains from using a voucher are more common in math than in reading. This finding is not surprising, given that math achievement is more heavily a function of school instruction than is reading achievement. Educational achievement gains from vouchers appear to be largest and most consistent for African American students, the ethnic category of students long recognized as being most disadvantaged by residential assignment to poorly performing public schools.122 Voucher-induced test score gains for all or some of the study participants were apparent in the first outcome year of experimental studies in Charlotte, New York City, and the second experiment in the District of Columbia.123 For the voucher experiments in Dayton, the original D.C. program, and Milwaukee, positive and statistically significant voucher impacts on student test scores did not emerge until two or more years after students switched schools using the voucher.124 Since school switching is a necessary element of voucher use known to temporarily disrupt student learning,125 it is not surprising that voucher test score gains were somewhat slow to appear in several of the experimental studies. Researchers have been studying the effects of school voucher programs on participating students and parents for more than a decade. A total of ten gold-standard, peer-reviewed experimental studies have been produced thus far, demonstrating conclusively that school vouchers increase parental satisfaction with schools and providing substantial evidence that at least some students are helped academically by vouchers.126 More high quality experimental research is needed before we can close the books on the participant effects of school vouchers, but the results to date are generally promising.

It is important to acknowledge that all previous studies of school vouchers and voucher-like private scholarships involved programs targeted to low-income, inner-city students. Public opinion surveys regularly indicate that urban, minority, and low-income parents are more supportive of school vouchers than the general public,127 and policy makers have responded by targeting voucher programs to serve the constituency that is most loudly calling for them.128 The research findings reviewed here are characteristic of the targeted voucher programs that currently exist in the United States. We cannot be certain that similar outcomes would be generated by a universal voucher program such as the one that failed the recent referendum vote in Utah.

V. CONCLUSION

Much is already known with confidence regarding school voucher programs in the United States. The most reliable information about such programs has been generated by way of ten gold-standard analyses of random assignment voucher or voucherlike experiments. We know that they are targeted to underprivileged children and, as a result, disproportionately serve students that are highly disadvantaged. We know that parents are much more satisfied with their child’s school if they have used a voucher to choose it. We know, through the assistance of a substantial body of rigorous experimental studies, that the effect of vouchers on student achievement tends to be positive; however, achievement impacts are not statistically significant for all students in all studies and they tend to require several years to materialize. The existing research base, however, tells us nothing with certainty about what would happen were school vouchers offered to all students of a particular state or our nation. Such a policy proposal would be a voyage into the unknown. The voucher journey targeted to disadvantaged students is well-charted and promising. The evidence to date suggests that policymakers are relatively safe in traveling that course.

Policy makers are also urged to increase support for randomized trials to evaluate controversial education interventions such as school vouchers. Eschewing randomized trials in education research, as Boruch observes, leaves “the great questions of society to the ignorant advocates of change on the one hand and ignorant opponents of change on the other.”129 For the sake of the next generation of children, we can and should do better.

1. See infra Table 1. See generally MILTON & ROSE D. FRIEDMAN FOUNDATION, THE ABCS OF SCHOOL CHOICE (2006-2007), available at http://www.friedmanfoundation.org/ friedman/downloadFile.do?id=102 [hereinafter FRIEDMAN FOUNDATION].

2. See FRIEDMAN FOUNDATION, supra note 1, at 46-47. Chile has operated a universal school voucher program since 1982. For information on that program, see Claudio Sapelli, The Chilean Education Voucher System, in WHAT AMERICA CAN LEARN FROM SCHOOL CHOICE IN OTHER COUNTRIES 41, 41-62 (David Salisbury & James Tooley eds., 2005). European and Commonwealth countries such as the Netherlands, Belgium, and several Canadian provinces provide full government funding to students who attend qualified private secular and religious schools. In the Netherlands, for example, nearly seventy percent of K-12 students attend religious schools at public expense. Such school choice arrangements are distinct from American- style school vouchers in that the payments are made directly to the schools, not to the parents, and the money comes with extensive regulatory strings attached. Stephen Macedo & Patrick J. Wolf, Introduction: School Choice, Civic Values, and Problems of Policy Comparison, in EDUCATING CITIZENS 1, 9-12, 15-17 (Patrick J. Wolf & Stephen Macedo eds., 2004).

3. As our interest here is in the voucher programs and evaluations in the United States, the reader should understand the domain under discussion to be limited to the United States unless otherwise specified.

4. Due to space limitations, this Article does not discuss the potential “systemic” or competitive effects of school voucher programs on public schools and the students that attend them. Many empirical studies speak to that question. Interested readers should see Clive R. Belfield & Henry M. Levin, The Effects of Competition Between Schools on Educational Outcomes: A Review for the United States, 72 REV. EDUC. RES. 279 (2002), and Caroline Minter Hoxby, Rising Tide, EDUC. NEXT, Winter 2001, at 68, for reviews of the theory and evidence regarding the systemic effects of school vouchers. The Article also does not consider the effects of voucher programs on civic values and the public purposes of education. Although that is a crucial concern, that topic is effectively explored in David Campbell’s article in this volume as well as two previous articles of mine. See Patrick J. Wolf, Civics Exam: Schools of Choice Boost Civic Values, EDUC. NEXT, Summer 2007, at 66; Patrick J. Wolf, School Choice and Civic Values, in GETTING CHOICE RIGHT: INSURING EQUITY AND EFFICIENCY IN EDUCATION POLICY (Julian R. Betts & Tom Loveless eds., 2004).

5. Patrick J. Wolf, Vouchers, in THE ROUTLEDGE INTERNATIONAL ENCYCLOPEDIA OF EDUCATION 635, 635 (Gary McCulloch & David Crook eds., 2008).

6. See infra Table 1.

7. Id. Thousands of students displaced by Hurricanes Katrina or Rita received federally funded school vouchers from 2005 to 2007. Because these emergency school vouchers were temporary, those students are not included in this count. See Friedman Foundation Newsroom, The School Choice Advocate, http:// www.friedmanfoundation.org/friedman/ newsroom/ShowArticle.do?id=23 (last visited April 4, 2008).

8. FRIEDMAN FOUNDATION supra note 1, at 48; Christopher W. Hammons, The Effects of Town Tuitioning in Vermont and Maine, 1 SCHOOL CHOICE ISSUES IN DEPTH 5 (Milton & Rose D. Friedman Foundation 2001), available at http://www.friedmanfoundation.org/ friedman/downloadFile.do?id=61.

9. FRIEDMAN FOUNDATION, supra note 1, at 48; Mammons, supra note 8, at 11.

10. FRIEDMAN FOUNDATION, supra note 1, at 48; Hammons, supra note 8, at 8.

11. FRIEDMAN FOUNDATION, supra note 1, at 50. Recently, a new report on the Milwaukee voucher program established that 17,749 voucher students were enrolled in the 122 voucher schools that operated through the entire 2006-2007 school year. See Patrick J. Wolf, THE COMPREHENSIVE LONGITUDINAL EVALUATION OF THE MILWAUKEE PARENTAL CHOICE PROGRAM: SUMMARY OF BASELINE REPORTS 1 (2008), available at http://www.uark.edu/ua/der/SCDP/Milwaukee_Eval/ Report_1.pdf. The slightly lower count is presented here because it is drawn from the same source as the counts for other programs that were gathered based on a consistent methodology across voucher programs.

12. FRIEDMAN FOUNDATION, supra note 1, at 14,16.

13. Georgia Department of Education, http://public.doe.k12.ga.us/ sb10.aspx (follow “Questions & Answers” hyperlink) (last visited Apr. 4, 2008).

14. Information compiled from FRIEDMAN FOUNDATION, supra note 1. See also Georgia Department of Education, supra note 13.

15. 536 U.S. 639 (2001).

16. See FRIEDMAN FOUNDATION supra note 1, at 4; see also supra Table 1 (Arizona, District of Columbia, Florida, Georgia, Ohio, and Utah all enacted some kind of voucher program after 2001 ).

17. Hammons, supra note 8, at 5.

18. Specifically, the income ceiling to qualify initially for a voucher is 175% of the poverty level or less in Milwaukee and 185% of the poverty level or less in Cleveland and D.C. FRIEDMAN FOUNDATION, supra note 1, at 18, 34, 50.

19. Id. at 14, 20, 36, 44 (Arizona, Florida, Ohio, Utah, and Georgia).

20. Id. at 16.

21. Id. at 38.

22. U.S. DEP’T OF EDUC., NAT’L CTR. FOR EDUC. STATISTICS, NCES 2006-030, DIGEST OF EDUCATION STATISTICS tbl. 50 (2006).

23. JOHN F. WITTE, THE MARKET APPROACH TO EDUCATION: EVIDENCE FROM AMERICA’S FIRST VOUCHER PROGRAM, 58-59 (Princeton University Press 2000).

24. WOLF ET AL., EVALUATION OF THE DC OPPORTUNITY SCHOLARSHIP PROGRAM: FIRST YEAR REPORT ON PARTICIPATION (U.S. Department of Education/Institute of Education Sciences 2005) (comparing Table 4- 9, fifth row, at. 49, with Table 4-1, third row, at 35). 25. Id. at 49.

26. Id. at 35.

27. Id.

28. Id. at 1.

29. Id. at 23. Because the OSP was oversubscribed in the second and all subsequent years of operation, and applicants already attending private school were the lowest programmatic service priority, no additional voucher awards were made to private school applicants after the first year of implementation. Id. at 8-9.

30. Id. at 19-22.

31. See generally Terry M. Moe, Beyond the Free Market: The Structure of School Choice, 2008 BYU L. REV. 557.

32. See HERBERT A. SIMON, ADMINISTRATIVE BEHAVIOR 119-20 (The Free Press 4th ed. 2000) (1945), for the classic treatment of the distinction between maximizing and satisficing:

Whereas economic man supposedly maximizes-selects the best alternative from among all those available to him-his cousin, the administrator, satisfices-looks for a course of action that is satisfactory or “good enough” . . . . Administrators (and everyone else, for that matter) take into account just a few of the factors of the situation regarded as most relevant and crucial. In particular, they deal with one or a few problems at a time, because the limits on attention simply don’t permit everything to be attended to at once. . . . Because administrators satisfice rather than maximize, they can choose without first examining all possible behavior alternatives and without ascertaining that these are in fact all the alternatives. Because they treat the world as rather empty and ignore the interrelatedness of all things, . . . they can make their decisions with relatively simple rules of thumb that do not make impossible demands upon their capacity for thought.

33. See generally Robert Boruch, Dorothy De Moya, & Brookc Snyder, The Importance of Randomized Field Trials in Education and Related Areas, in EVIDENCE MATTERS: RANDOMIZED TRIALS IN EDUCATION RESEARCH 50-79 (Frederick Mosteller & Robert Boruch eds., 2002).

34. See generally id.; WILLIAM R. SHADISH, THOMAS D. COOK & DONALD T. CAMPBELL, EXPERIMENTAL AND QUASI-EXPERIMENTAL DESIGNS FOR GENERALIZED CAUSAL INFERENCE (2001).

35. See generally HENRY BRAUN ET AL., COMPARING PRIVATE SCHOOLS AND PUBLIC SCHOOLS USING HIERARCHICAL LINEAR MODELING, NCES 2006- 461, available at http://www.nces.ed.gov/nationsreportcard/pclf/ studies/2006461.pdf; Christopher Lubienski & Sarah Theule Lubienski, Chaner, Private, Public Schools and Academic Achievement: New Evidence from NAEP Mathematics Data (Nat’l Ctr. for the Study of Privatization in Education, Working Paper Jan. 2006), available at http://epsl.asu.edu/epru/articles/EPRU-0601-137-OWI.pdf;

36. See, e.g., JAMES S. COLEMAN & THOMAS HOFFER, PUBLIC AND PRIVATE HIGH SCHOOLS: THE IMPACT OF COMMUNITIES (Basic Books 1987).

37. Henry M. Levin, Educational Vouchers: Effectiveness, Choice, and Costs, 47 J. POL’Y ANALYSIS & MGMT. 373, 376 (1998).

38. See generally Lubienski & Lubienski, supra note 35.

39. GREGORY A. STRIZEK ET AL., NAT’L CTR. FOR EDUC. STATISTICS, CHARACTERISTICS OF SCHOOLS, DISTRICTS, TEACHERS, PRINCIPALS, AND SCHOOL LIBRARIES IN THE UNITED STATES: 2003-2004, at 19-20,33-34 (2006).

40. See PAUL E. PETERSON & ELENA LLAUDET, PROGRAM ON EDUCATION POLICY AND GOVERNANCE, ON THE PUBLIC-PRIVATE SCHOOL ACHIEVEMENT DEBATE, NCES 2006-313 REVISED 20 (2006) (paper prepared for the annual meetings of the American Political Science Association).

41. Id. at 16; see also Lubienski & Lubienski, supra note 35, at 22.

42. PETERSON & LLAUDET, supra note 40, at 17.

43. For a discussion of the general tendency of analyses of observational data to suffer from negative bias because of measurement limitations, see Robert Boruch, Encouraging the Flight of Error: Ethical Standards, Evidence Standards, and Randomized Trials, 113 NEW DIRECTIONS FOR EVALUATION 55, 65-66 (2007).

44. See PETERSON & LLAUDET, supra note 40, at 4-5 (discussing restrictive conditions that must be present in order for a cross- sectional study to produce valid results); Gene V. Glass & Dewayne A. Matthews, Are Data Enough?, EDUC. RESEARCHER, Apr. 1991, at 24, 25 (reviewing JOHN E. CHUBB & TERRY M. MOE, POLITICS, MARKETS, AND AMERICA’S SCHOOLS (1990)).

45. JULIAN BETTS & PAUL T. HILL (principal drafters for The Charter School Achievement Consensus Panel), KEY ISSUES IN STUDYING CHARTER SCHOOLS AND ACHIEVEMENT: A REVIEW AND SUGGESTIONS FOR NATIONAL GUIDELINES 3 (Ctr. on Reinventing Public Education, Nat’l Charter Sch. Research Project, NCSRP White Paper Series, Paper No. 2, 2006), available at http://www.ncsrp.org/cs/csr/view/csr_pubs/5.

46. Boruch, supra note 43, at 60.

47. E.g., David N. Figlio & Cecilia Elena Rouse, Do Accountability and Voucher Threats Improve Low-Performing Schools? 3- 5 (Nat’l Bureau of Econ. Research, Working Paper No. 11597, 2005) (discussing problems with longitudinal studies and formulating a method that addresses these concerns).

48. See id. at 5 (noting the benefit of tracking the same students throughout the study).

49. JOHN F. WITTE ET AL., MPCP LONGITUDINAL EDUCATIONAL GROWTH STUDY BASELINE REPORT: SCDP MILWAUKEE EVALUATION REPORT #5, at 8 (2008).

50. Id.; Boruch, supra note 43, at 64.

51. See PETERSON & LLAUDET, supra note 40, at 9.

52. Id. (“[S]cholars are most confident of their results when they are able to track student performance over time. Ideally, they prefer four or more observations of the performance of the same student over time, so they can get a sense of the direction a student is moving before and after an educational intervention takes place.”).

53. See BETTS & HILL, supra note 45, at 12 (“There are a growing number of student-level analyses of trends over time in student test scores that control for individual student characteristics. This represents a far better research design [than observational studies], because it takes into account where a student began on the achievement spectrum and controls for observable student characteristics. However, there remains a risk that a lack of proper controls for unobserved characteristics o

Pregnant Women Enjoy Tailored Pampering Services

By Kellie B. Gormly, The Pittsburgh Tribune-Review

Jul. 8–Kara Krawczykiewicz, who is expecting her first baby on July 18, has been enjoying her pregnancy — especially since pampering, prenatal massages became a part of it.

Krawczykiewicz, 26, of Oakmont, says that the massages — which she gets at Pittsburgh Center for Complementary Health and Healing in Regent Square — are a nice treat that help her to relax.

“By the end of my massage, I’m incredibly relaxed,” says Krawczykiewicz, who also has been doing yoga and meditation. “I think that touch is really important. The baby gets that good energy going, too.”

These days, many pregnant women — aware that, once the baby is born, they will get little sleep and time for self-care — are seeking pampering services during the prenatal months. These mothers-to-be go to spas to indulge in massages specifically for pregnant women — which are recommended after the first trimester has passed — along with facials, manicures, pedicures and more. Some even hire personal chefs — or doulas, whose mission is to “mother the mother” — to give themselves time to relax, and just prepare for the upcoming childbirth.

Pampering services for pregnant women seem to have come into greater demand in recent years, says Stephany Frede, manager of the Sewickley Spa in Ligonier.

“I just think that women are just starting to treat themselves better in general,” she says. “People are starting to really understand how hard motherhood is, and especially pregnancy.”

Lili Gill, a massage therapist with Pittsburgh Center for Complementary Health and Healing, agrees.

“Ten to 20 years ago, pregnant women were told not to get massages,” says Gill, who includes prenatal massage as one of her specialties. “It can really help them to be able to get ready for labor.”

During pregnancy, “a lot of women are anxious at this time, and might not feel very attractive,” Gill says. “Receiving the touch and the nurturing is very healing for the soul.”

Kim Metzger, a Hampton resident who is expecting her first child, already named Colton, on July 16, recently scheduled a massage with Gill because of a sore back and swollen feet.

“It sounds excellent, considering you can’t sleep in all the positions that you want,” says Metzger, 29. “A massage sounds like heaven at this point.”

Many pregnant clients come to “Daydreams: A Relaxing Space and Time,” a Lower Burrell spa, with lower back pain resulting from the weight distribution changes in their bodies, says spa owner Susan Beal. A prenatal massage — which costs $60 for one hour, and $80 for 90 minutes — helps to alleviate the pain and tension in the lower back, neck and shoulders. During the massage, a client lays on her side, with pillows under her head, legs and arms, and it’s blissful, Beal says.

“A lot of people fall asleep,” she says.

Many women come for prenatal massages — or other pampering services, like facials — as a gift from their spouses, or friends at a shower.

“A lot of times, the husbands come in and are interested in setting up the appointment for their wives, because they know they need it,” Beal says.

At Sewickley Spa — with locations in Ligonier, Sewickley and Deep Creek, Md. — clients enjoy being pampered with prenatal massages, which cost $80 for 50 minutes, along with manicures, facials, pedicures with foot and leg exfoliation, and more. The pedicures especially can be helpful to pregnant women, who often get sore and swollen feet, Frede says. She has two children — Cole, 3, and Willa, 10 months — and says that prenatal massages helped her with back pain.

Many women come in for pampering just days before their babies’ due dates, so that they feel nice and pretty in the delivery room, Frede says. Then, many women return for continued pampering after the baby is born.

“Its really nice to kind of get your body back in order,” she says. “A lot of women feel … after they haven’t had any sleep, they just want to come in and get pampered again, and get their back rubbed again.”

Cindy Blasko, consumer education coordinator for Magee-Womens Hospital of UPMC in Oakland, and a registered nurse, recommends that pregnant women first follow the basics of good health in order to pamper themselves. This includes getting plenty of sleep, drinking plenty of water, and eating lots of fruits and vegetables, lean protein foods and calcium-filled foods. Of course, avoid alcohol and cigarettes, too, she says.

Blasko recommends seeking massage therapists who have special experience in prenatal massages, and avoiding jacuzzis and saunas, which will raise the body temperature of a pregnant woman too much.

Pampering treatments can be wonderful for pregnant women, Blasko says.

“Certainly, it can be very relaxing, and relaxation is great for pregnancy,” she says. “You always want to do things that will reduce stress.”

Yoga is another good practice for pregnancy, Blasko says. Magee-Womens started offering weekly, hour-long prenatal yoga classes this year, and they were so popular that the hospital will offer them on Monday and Thursday nights, starting in the fall, at a cost of $60 for six sessions.

“Not only do (women) practice muscle toning with the yoga, but it’s very relaxing as well,” Blasko says. “It’s good for them and the baby.”

—–

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

Copyright (c) 2008, The Pittsburgh Tribune-Review

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.

Don’t Confuse Viral Illness With Reye’s Syndrome

By Jeanine Kendle

This is information parents and grandparents need to be aware of, or anyone who might provide child care.

Reye’s syndrome is a disease that swiftly attacks every organ in the body, but especially the liver and the brain. What you need to be aware of is even though the cause is unknown, there is an association between a previous viral infection (influenza, cold, or chicken pox) and salicylates (aspirin like products). Reye’s syndrome is not contagious. Unfortunately, it is often misdiagnosed as encephalitis, meningitis, diabetes, drug overdose, poisoning, sudden infant death syndrome or psychiatric illness.

Reye’s tends to correlate with the months associated with the highest number of cases of viral illness, though cases are reported every month of the year.

Reye’s syndrome typically follows a pattern such as the person is recovering from a viral illness, abnormal accumulations of fat begin to develop in the liver and other body organs and a severe increase in pressure in the brain. If not diagnosed early and properly, death can occur in a few days.

There are two stages of Reye’s syndrome:

1. Persistent or continuous vomiting or diarrhea in infants, signs of brain dysfunction (abnormal performance), listlessness, loss of pep and energy, and drowsiness.

2. Personality changes, irritability, aggressive behavior, disorientation, confusion, irrational behavior, combative, delirium, convulsions and coma.

Not all of the symptoms have to occur or displayed in the above order. Fever usually is not a symptom.

The National Reye’s Syndrome Foundation, FDA, CDC and the American Academy of Pediatrics warns anyone 19 years of age or younger should not consume or apply “aspirin-like” products. Unfortunately, these products are everywhere on store shelves, with small type warnings, if at all.

“Aspirin-like,” or more appropriately, salicylic acid containing products are found in pain relievers, stomach or gastrointestinal aids, shampoos, acne preparations, wart removers, etc.

Consumers are conditioned to read labels, but in particular, since this is a life-threatening disease for anyone, but most especially teens and younger children, the following names should be scanned for and avoided in conjunction with a viral illness: Acetyl Salicylic Acid, Acetylsalicylate, Acetylsalicylic Acid, Aluminum Acetyl Salicylate, Ammonium Salicylate, Amyl Salicylate, Arthropan, Aspirin, Benzyl Salicylate, Butyloctyl Salicylate, Calcium Acetyl Salicylate, Choline Salicylate, Ethyl Salicylate, Lithium Salicylate, Methyl Salicylate, Methylene Disalicylic Acid, Octisalate, Octyl Salicylate, Phenyl Salicylate, Procaine Salicylate, Sal Ethyl Carbonate, Salicylamide, Salicylanilide, Salicylsalicylic Acid, Santalyl Salicylate, Sodium Salicylate, Stoncylate, Strontium Salicylate, Sulfosalicylic Acid, Tridecyl Salicylate and Trolamine Salicylate.

The names are confusing, but if you look closely there is some commonality.

Unfortunately, several medications are targeted to children or unsuspecting parents with children such as Kaopectate New and Improved Children Cherry Flavor (at one time Kaopectate contained Kaolin and Pectin and not, as now, bismuth subsalicylate), Pepto- Bismol (bismuth subsalicylate), Pamprin, Clearasil, Stri-Dex, Clearskin, Skin-So-Soft, Biore, Fostex, Sebucare, Aspercreme, Icy Hot, Flexal, Sportscreme, several L’Oreal products, several Mary Kay products, several Neutrogena products, etc.

This certainly is not a complete list, but as you can see, these products are, if not directly marketed to, would certainly appeal to children or teens.

Consult your pharmacist before making an over-the-counter selection to avoid hidden sources of salicylates.

(c) 2008 Daily Record, The Wooster, OH. Provided by ProQuest Information and Learning. All rights Reserved.

Girl, 14, Emerges From Lake As a Champion ; Swimmer Crosses to Derby and Sets Three World Records

By Andrew Rafferty

Natalie Lambert emerged from Lake Erie on Sunday and walked straight to her father, Ron, who had a bear-sized hug ready for his record-setting daughter.

As the two embraced on an empty beach at Sturgeon Point Marina in Derby, it didn’t resemble the type of fanfare that might be expected for a teen who just set three world records.

The 14-year-old spent almost eight hours swimming her way across Lake Erie, and as she exited the water, she looked energetic enough to swim her way back.

“My body is tight and I’m hungry, but other than that I’m pretty good,” Natalie said.

She traversed from Crystal Beach, Ont., to Sturgeon Point Marina in 7 hours, 47 minutes and 30 seconds. She is now the fastest and youngest person to make the 19-kilometer swim.

What makes it more impressive is that she is the first to do it using the butterfly stroke — considered one of the most demanding styles of swimming.

“I love the challenge of it,” said Natalie of why she swam butterfly. “It’s considered one of the hardest strokes.”

These three new records go on top of the two she earned from swimming across Lake Ontario from Sackets Harbor to Kingston, Ont., last summer. She made the 54-kilometer route in 23 hours and 15 minutes, making her the youngest and fastest person ever to complete that swim.

But the humble teen isn’t looking for recognition. She didn’t get into marathon swimming for herself — she did it for her older sister, Jenna, who has cerebral palsy and motivated Natalie to attempt marathon swims in the first place.

More important to Natalie than the records is bringing awareness to athletes with disabilities. She got into marathon swimming in 2006 when her then 15-year-old sister swam for 32 hours to become the first female with a physical disability to successfully cross Lake Ontario.

“Seeing her doing that, using her God-given talents, it was just amazing,” said Natalie.

So when the all-star swimmer sets her records, she does it for the Y Penguins Aquatic Club, a program at the Kingston, Ont., YMCA that allows children with physical disabilities to swim alongside their able-bodied siblings. Her Lake Ontario venture raised $44,000 for the cause.

Sunday’s swim was geared more towards raising awareness than money, Natalie said.

And as Natalie’s family, friends and coach packed into boats and a kayak to follow her on Sunday, it was Jenna who was her biggest cheerleader.

But the Harrowsmith, Ont., native didn’t seem to need much motivation. When she launched out from Crystal Beach at 7:30 a.m., she wasn’t looking to set a speed record.

But her coach noticed her pace was fast enough to break the previous mark of eight hours and 14 minutes set last summer.

“In some respects, she accidently set that record,” said Vicki Keith, Natalie’s coach of 71/2 years.

Every half hour, Natalie would break to be given food and water by her coach, who followed her in a kayak. She had to stay in the water and could not so much as touch anyone else for the record to be legitimate.

The teen trains year round with Keith, who holds 16 world records in marathon swimming, including being the first person to cross all five Great Lakes in 1988. Keith has helped Natalie overcome her fear of the open water and her biggest fright — seaweed.

Another battle Natalie fights during the long swims is boredom. During Sunday’s swim she did math problems and sang songs in her head to pass the time. “Sometimes I think about what I’m going to think about next,” she said.

It’s Natalie’s maturity that has most impressed Keith. Last summer, she attempted the 52-kilometer (32.4-mile) crossing from Niagara-on-the-Lake, Ont., to Toronto, but 12-foot waves caused her to get out of the water just 9 kilometers (5.6 miles) short of the finish.

“She looked at me and said, ‘I don’t want to hurt my body,’ ” said Keith.

But crossing just one Great Lake each summer isn’t enough for Natalie who, weather permitting, will rechallenge the Niagara-on- the-Lake to Toronto route on July 21.

“Every time she does a swim,” said Ron Lambert, “I am unbelievably proud as a father.”

e-mail: [email protected]

Originally published by NEWS STAFF REPORTER.

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

MyChart: Technology Allows Access to Your Records Online

By Gina Duwe, The Janesville Gazette, Wis.

Jul. 7–JANESVILLE — Consumers expect service–from ordering pizza to cars–on the Internet.

They also want to talk to their doctors online, and now the local health care scene is catching up.

“The health care industry is just a little more behind because of the privacy to consider,” said DJ Curran, project manager of MyChart for Dean Health System and SSM Healthcare.

MyChart is an Epic Systems product that allows patients to schedule and view appointments, pay bills, request prescription refills, send secure messages to physicians and view their medical records.

Local Dean patients have been using the program since 2006, and Mercy Health System plans to add the feature this fall.

“I think it’s standard now that people have access to medical records and (are) able to get questions resolved efficiently in a way they want them resolved,” said Dr. David Murdy, who practices internal medicine at Riverview Clinic in Janesville.

He compares the digital transition to the advent of telephone health service.

Some patients would rather stick to phone conversations, but e-mailing through the MyChart system probably is saving office visits, Murdy said. He responds to two to 10 messages from patients daily.

“It’s not meant to replace the use of the phone or face-to-face (visits), but it’s a new avenue for people to get access to doctors they need … and it’s free.”

Building success

Patients set up their own accounts and can access only their own records. A family feature allows parents to view their children’s records or adult children to view their parents’ records.

Patient Ed Paape of Janesville has been using MyChart for more than a year to communicate with his physician, Dr. Murdy. Being able to message his doctor is helpful in treating his diabetes, as well as a recent bout with anemia, he said.

“There was a lot of communication back and forth on MyChart on that one,” he said of the anemia. “He wrote back the same day.”

The transition to electronic records has been gradual, managers at Mercy and Dean say.

Dean started using Epic’s electronic medical record system in 2002 before launching MyChart in 2006 with a limited number of providers, Curran said.

“We needed to build up enough data to make the patient experience worthwhile,” he said.

Now that Dean has a couple successful years of use, it is rolling out MyChart across specialty providers and marketing it more to patients.

“We know the system’s solid enough now. We know that it works,” Curran said.

When the new Dean/St. Mary’s hospital opens in 2010 in Janesville, patients there also will be on the MyChart system, he said.

Mercy will start using MyChart in the fall with a pilot program involving pediatric patients at Mercy East, then expand to other clinics, said Laurie Howes, Mercy electronic medical records manager.

Mercy started building its electronic records system with Epic two years ago, she said. Providers at different Mercy locations now can access the same patient’s records, she said.

Last September, Mercy started e-prescriptions, allowing providers to electronically send prescriptions to a pharmacist, replacing written notes patients take to the pharmacy, she said.

Limiting security risks

Patients setting up their MyChart account must go through a multiple step verification process including receiving an activation code from a doctor or through the mail to ensure the security and privacy of their records, Curran said.

The MyChart Web site does not store any information because the data is retrieved from the secure Epic system, he said.

“That’s done so there’s no information compromised,” he said. “Someone could hack the Web site, but it wouldn’t do them any good.”

Getting positive feedback

Patient feedback has been “extremely positive,” Curran said.

Dean started a pilot group of about 1,000 patients and now has about 30,000 using MyChart, he said.

“The main things we hear from patients and providers is the convenience,” he said. “Patients really love the ability that they’re not tied to office hours.”

The messaging system also allows for more privacy. Instead of sitting in your cubicle at work talking to your doctor on the phone about your nasty foot fungus, patients can send a private e-mail.

It also is easier for patients to keep track of their health by accessing vaccination records and graphing lab results and vital signs over time, Curran said.

If Paape wants to recall his doctor’s instructions from a previous appointment, he can bring up the details in MyChart.

“If I want to know what we talked about, it’s right there,” he said. “That’s neat.”

—–

To see more of The Janesville Gazette, or to subscribe to the newspaper, go to http://www.gazetteextra.com.

Copyright (c) 2008, The Janesville Gazette, 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.

Intestinal Barrier May Be Alternative to Gastric Bypass

By Christine Phelan, The Sun, Lowell, Mass.

Jul. 7–BURLINGTON — Doctors at Lahey Clinic are investigating a new device that may prove a non-surgical alternative to gastric bypass and a route for resolving type 2 diabetes — a disease that plagues nearly one in 10 American adults and nearly 250 million people around the world.

The EndoBarrier Gastrointestinal Liner — a two-foot plastic sleeve with a nickel-titanium anchor at one end that adheres to the soft tissue in the duodenum — nestles within the first two feet of the small intestine, allowing food to pass through a portion of the tract without being absorbed.

The effect mimics gastric bypass — a procedure that reduces stomach size and surgically reroutes first few feet of the small intestine — but without going under the knife. It’s currently being tested in 40 gastric bypass patients at four U.S. medical centers, including Lahey, who are required to lose weight before surgery.

There are few options for the nearly 70 million American adults who are either obese or morbidly obese, defined as a BMI of 35 and 40, respectively. They’re often beyond making dietary changes, and exercise — given the physical limitations of their size — is often out of the question.

For many, it’s surgery or facing life with the debilitating effects of obesity — everything from heart disease to cancer, depression to diabetes. Obesity is considered the second leading cause of preventable death in the U.S., after smoking.

And while gastric bypass is increasingly

popular — one study found a six-fold increase in the surgeries between 1998 and 2002 — Lahey surgeon Dmitry Nepomnayshy said roughly one percent of obese people eventually choose it. About 200,000 Americans had the surgery in 2007.

“A lot of people are afraid, and rightfully so,” said Nepomnayshy, the chief investigator in the EndoBarrier trial.

“There’s pain and suffering associated with surgery, risk of complications, even though it’s the most effective treatment for obesity. But obesity is dragging down our health care system like a big anchor. Right now (other than surgery), all we can tell you is go out and exercise, eat right. This is another tool for treatment, another option.”

Inserted through the mouth while the patient is under general anesthesia, the EndoBarrier is nudged into place and then deployed into the intestine like an unraveled parachute. The procedure takes 30 minutes. Patients are kept on a liquid diet for a week, purees for another, finally progressing to normal meals thereafter.

“Percentage-wise, the device isn’t covering a big portion of the small intestine,” explained Nepomnayshy, “but the results are impressive and we think it’s because it’s the area — that first part — where the absorption of nutrients takes place.”

While there’s not complete scientific agreement on how the body processes food, most doctors agree that the first couple of feet of intestine are critical both for nutrient absorption and spurring hormonal shifts that stimulate the pancreas to produce insulin.

The FDA has approved the device for a 12-week period, and patients in the trial have lost between 11 and 26 pounds. The next stage, said spokesman Jonathan Hartmann from Lexington-based GI Dynamics, will be to test the device’s efficacy over three, six and 12 months. There are no plans, Hartmann added, to ever permanently implant the EndoBarrier.

Though the device requires further testing, Nepomnayshy called the device promising.

“Right now, obesity is one of the biggest health problems out there, and not just obesity itself but the diseases it causes — cancer, diabetes, joint pain,” he said. “People not choosing surgery still need help; we have to offer them something else. This is an example of something that’s down the road that may just help them.”

—–

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

Copyright (c) 2008, The Sun, Lowell, Mass.

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.

BioElectronic’s ActiPatch(TM) Product Chosen As ‘One of 9 Medical Breakthroughs That May Change Your Life’

FREDERICK, Md., July 7 /PRNewswire-FirstCall/ — ActiPatch(TM), the product marketed by Bioelectronics Corp. (Pink Sheets: BIEL), is changing the face of medicine and the way we heal. Recently chosen as “One of 9 Medical Breakthroughs That May Change Your Life,” by MedicalHeadway.com, ActiPatch is fast becoming the treatment of choice for everything from soft tissue injuries to surgical recovery.

“The decision to include ActiPatch in the top 9 medical breakthroughs was an easy one,” said Reginald Saxton, President of Medical Headway. “ActiPatch fills the void created by consumers who would rather not take pain medications and are seeking safe and effective alternative treatment options,” Saxton added, “I knew our readers would be very interested in this product for that reason”.

ActiPatch is a drug-free wafer thin patch with an embedded battery operated microchip that delivers weeks of continuous pulsed RF therapy for less than a dollar a day. The unique ActiPatch delivery system, using patented technology, provides a cost-effective, home use method that reduces soft tissue pain and swelling, and accelerates healing.

When using ActiPatch, bruises that would normally take three weeks to heal often heal in a week; ankle sprains usually respond positively with reduced pain and swelling in only a single day; plastic surgery incisions that would normally take weeks to heal typically heal in less than a week. These claims are supported by multiple clinical trials and strong endorsements from leading surgeons and physicians.

BioElectronics has already received FDA clearance for one surgical procedure, (blepharoplasty), and is now able to sell the product within the United States through physician referral. In addition, BioElectronics has received blanket approval in the European Union, Canada, and dozens of countries. These international approvals have allowed the product to be placed in stores for over-the-counter purchase outside the United States.

Andrew J. Whelan, CEO of BioElectronics Corporation, explains, “ActiPatch with its non-invasive, very efficient treatment for swelling and pain while accelerating recovery is the medicine of the future available today. We are actively pursuing additional reimbursement approvals nationally. ActiPatch is an important product that not only works without side-effects, it also has the potential to help keep medical costs down at a time when they appear to be spiraling out of control,” adds Whelan.

MedicalHeadway.com is an online medical breakthrough library published by Medical Headway, LLC of Houston, TX. Dedicated to arming the public with news of the latest breakthroughs in the world of medicine, the company offers consumers free and complete access to its growing library of cutting-edge, professional medical treatment and product information. “In our opinion, ActiPatch is a huge advance for millions of people who would rather not take a pill or who need faster pain relief … a clear breakthrough everyone should know about,” explains Saxton.

For more information visit http://www.bioelectronicscorp.com/ or call 866-757-2284.

About BioElectronics Corporation

BioElectronics Corporation is the maker of the ActiPatch(TM). ActiPatch is a drug-free anti-inflammatory patch with an embedded battery operated microchip that delivers weeks of continuous pulsed therapy for about a dollar a day. The unique ActiPatch delivery system, using patented technology, provides a cost-effective patient friendly method to reduce soft tissue pain and swelling. ActiPatch is approved by Health Canada for the relief of pain in musculoskeletal complaints. The US government’s food and drug administration (FDA) has cleared the use of the product for reducing edema (swelling) following blepharoplasty and the European Union has approved the product as a class two pulsed electromagnetic medical device as have numerous other international record for agencies.

Information on ActiPatch and BioElectronics Corporation is available at the following websites:

   -- U.S. Consumer: http://www.actipatchonline.com/   -- Podiatry: http://www.pemfpodiatry.com/   -- Plastic Surgery: http://www.plasticsurgeryrelief.com/ and                       http://www.makemeheal.com/   -- German orthopedic foot & ankle: http://www.diesfussexperten.de/   -- Italy and Switzerland: http://www.actipatch.it/   -- Canada: http://www.actipatchpaintherapy.ca/   -- Netherlands: http://www.actipatch.de/   -- Singapore & Malaysia: http://www.astonixlife.com/   -- BioElectronics Corp: http://www.bioelectronicscorp.com/     Safe Harbor Statement  

This news release contains forward-looking statements related to future growth and earnings opportunities. Such statements are based upon certain assumptions and assessments made by management in light of current conditions, expected future developments and other factors it believes to be appropriate. Actual results may differ as a result of factors over which the company has no control.

   Media Relations Contact:   Patricia Baker, The Big Picture Agency LLC   Voice:  413-623-0950 ext. 221, email: [email protected]    Investor Relations Contact:   Joe Noel, Emerging Growth Research LLP   Voice:  925-922-2560, email: [email protected]  

Bioelectronics Corp.

CONTACT: Media Relations Contact, Patricia Baker, The Big Picture AgencyLLC, for Bioelectronics Corp., +1-413-623-0950 ext. 221,[email protected]; or Investor Relations Contact, Joe Noel, EmergingGrowth Research LLP for Bioelectronics Corp., +1-925-922-2560,[email protected]

Web site: http://www.bioelectronicscorp.com/http://medicalheadway.com/

Nestle Healthcare Nutrition, Inc. And BodyMedia Form Strategic Partnership to Help Weight Loss Patients Impact Long-Term Management

PITTSBURGH, July 7 /PRNewswire/ — Nestle HealthCare Nutrition, Inc. and BodyMedia, Inc., have formed a strategic partnership to promote SenseWear(R) WMS to clinics using OPTIFAST(R), Nestle’s medically monitored weight loss program.

The OPTIFAST Program, offered in over 400 clinics nationwide, is one of the most comprehensive weight loss options available and has been shown to be effective in more than 80 clinical studies. In a study of over 20,000 participants who completed a 22-week program, the average weight loss was 52 pounds with an average decrease of 15 percent in cholesterol, 29 percent in blood glucose and 10 percent in blood pressure.(1) The OPTIFAST Program combines support and counseling, lifestyle education, and medical monitoring with meal replacements to help people lose weight and reduce weight-related health risks. A team of dedicated medical professionals provides support to participants during each phase of the program.

“We are very eager to make SenseWear WMS available to our customers and their participants,” said Sean Foster, Vice President of Marketing, Nestle HealthCare Nutrition. “It’s the perfect fit. Combining OPTIFAST and SenseWear enables weight loss clinics to offer the OPTIFAST meal replacement programs with comprehensive lifestyle education through personal body monitoring. We feel strongly that these complementary solutions will help patients lose weight, while allowing them to truly understand what it takes to achieve calorie balance by having personal data to assist in keeping the weight off.”

SenseWear WMS gives health professionals a powerful tool to teach patients how their day-to-day activity, nutrition and sleep habits help or hinder weight loss progress. SenseWear WMS consists of an armband, display and Web site that allow both professional and patient to see how many calories they really burn, how many they really consume and how well they really sleep, every day. The solution promotes patient self-care and enables practitioners to offer short-term metabolic and lifestyle assessments as well as more effective and educational weight-management programs.

“BodyMedia is very excited to work with the global leader in healthcare nutrition,” said Michael Soule, Senior Director of Sales and Partnerships. “We are confident that by combining these two world-class offerings, patients will see improved and sustained weight loss.”

(1) Drawert S, Beford K, Largent D. Changes in glucose, blood pressure and cholesterol with weight loss in medically obese patients. Obesity Research. 1996;4(S1):67S.

About Nestle HealthCare Nutrition, Inc.

Nestle HealthCare Nutrition, Inc. part of Nestle Nutrition, offers complete nutritional solutions for people with specific illnesses, disease states or the special challenges of different life stages. Nestle HealthCare Nutrition was formed from the combination of Novartis Medical Nutrition, acquired by Nestle in 2007, and the existing Nestle Clinical Nutrition business. The company offers the most comprehensive range of nutritional support products in the marketplace.

Nestle Nutrition helps to enhance the quality of life by supporting health and providing care for people with special nutrition needs at every stage of life. Nestle Nutrition is built around four core businesses: Infant Nutrition, HealthCare Nutrition, Performance Nutrition and Weight Management. For more information about Nestle Nutrition, please consult http://www.nestlenutrition.com/us.

About BodyMedia, Inc.

BodyMedia provides both healthcare professionals and consumers with lifestyle monitoring tools for metabolic assessment and long-term weight loss programs. By increasing patient self-awareness of their true activity, nutrition and sleep habits, BodyMedia solutions educate and motivate individuals to modify their daily behavior, to be more active, and lose weight safely and effectively. For more information on SenseWear WMS contact BodyMedia at 412-288-9901 or visit http://www.sensewear.com/.

   Nestle Contact:   Carie Wlos   Public Relations Counselor   (608) 256-6357   [email protected]    BodyMedia Contact:   Chris Pacione   Director of Customer Marketing   (412) 543-1329   [email protected]  

BodyMedia, Inc.

CONTACT: Carie Wlos, Public Relations Counselor of Nestle,+1-608-256-6357, [email protected]; or Chris Pacione, Director of CustomerMarketing of BodyMedia, +1-412-543-1329, [email protected]

Web site: http://www.nestlenutrition.com/ushttp://www.bodymedia.com/

Childhood Obesity Levels Set to Rise Unabated

Childhood obesity is set to increase, with incidence rates growing at the fastest rates in Asia Pacific countries, particularly China, while Europe and the US will retain the highest overall ratios. Excessive consumption of energy-dense food and drinks is partly to blame, however, sedentary lifestyles, particularly a dependence on cars and public transport, are also part of the problem.

Datamonitor forecasts that over 35% of European kids aged five to 13 will be overweight or obese by 2012. In the US, this figure will surpass 40%, while Asia Pacific countries, particularly China, are seeing the fastest increase in the percentage of overweight or obese kids. In the UK, childhood obesity has trebled since the 1980s, and Datamonitor estimates that in 2007 33% of five to 13 year olds were overweight or obese, which equates to 2.1 million children. This number is expected to rise to 2.3 million by 2012.

In addition to recorded statistics, European adult consumers have also noticed the perceived spread of the problem. According to a Eurobarometer survey, some 85% of consumers in the UK feel that there are more overweight children now than five years previously. In France, Sweden and Germany, this proportion exceeds 90%.

Food consumption is clearly a factor, with children in Europe consuming more than the population average in many energy-dense, indulgence food and drink categories. European kids consume 17% more than the population average in confectionery (9.8% UK), 23% in savory snacks (20.4% UK), almost 26% in ice cream (27.5% UK), and 33% in fizzy drinks (31.4% UK). Furthermore, a reliance on packaged food has led to many children accessing a diet that is geared towards convenience rather than balanced nutrition. In the western world, children are now suffering because their diet is not balanced and is too rich in calories.

Much of the problem of childhood obesity is that the conditions for its prevalence are so rife, making a healthy weight more difficult to maintain. Modern lifestyles can encourage bad eating and exercise habits, which makes keeping slim a difficult goal to achieve. In countries where many retail developments and leisure venues are increasingly located on the periphery of urban centers, the importance of cars is likely to continue unchallenged, unless either regulation or the cost of ownership makes them less affordable.

Furthermore, increasing numbers of children are traveling to school by car or public transport, and this may become even more problematic going forward, if more children travel greater distances to access the best-ranked schools, in a parallel of adults commuting to work over greater distances. As the distance between home and school grows, so will the dependence on cars and public transport, meaning that fewer children regularly benefit from the moderate exercise of walking, limiting the amount of ‘unnoticed’ exercise that they take.

Scientists Urge More Fungi Research

U.S. scientists, noting fungi cause many outbreaks of disease, are calling for studies of fungi that impact human health and agriculture.

Although fungi cause a number of life-threatening diseases, a report from the American Academy of Microbiology says research has been seriously neglected — a situation with grave negative repercussions for human health, agriculture, and the environment.

The report is the product of a colloquium, during which experts in mycology, medicine, plant pathogens and ecology discussed the state of research in mycology.

The average person is at risk for several fungal diseases, from toenail infections to athlete’s foot to life threatening systemic infections, said Dr. Arturo Casadevall of the Albert Einstein College of Medicine. Fungi may also predispose people to asthma and allergic diseases,

He said fungi also cause more than half of all plant diseases.

Dr. Joseph Heitman of the Duke University Medical Center, added: Fungi are workhorses for research and biotechnology. Both the hepatitis B vaccine and Gardasil (the vaccine for papilloma virus) are produced in yeast.”

The researchers said the importance of fungi demands better research to gain a better understanding of the organisms.

Concierge Choice Physicians Expands Into Delaware, Virginia and Texas

Concierge Choice Physicians(TM) (CCP), the largest national company offering a “hybrid” model of concierge medicine, today announced its expansion into three new states. Physicians in 10 states have now converted their practices to CCP’s model, which allows them to combine concierge care with a traditional practice.

“Primary care physicians are struggling to make their practices financially viable, to avoid burnout from long hours, and to provide the type of ‘old fashioned’ personalized care that patients want to receive and doctors want to give,” said Wayne Lipton, managing partner, Concierge Choice Physicians. “With our program, they can have the best of both worlds: a concierge practice where they can offer more personalized, preventive services, and a traditional practice for their patients who want to remain with their doctor and have this level of service.”

For an annual fee, concierge patients receive comprehensive preventive care and an annual physical, 24/7 access to their physicians, and no waiting time for appointments, among other benefits. Initially viewed as an option that appealed to the affluent, concierge medicine is now affordable for a much wider audience, thanks to programs like CCP’s.

Lipton sees the hybrid concierge model as a viable solution to the growing shortage of primary care physicians in the United States. Physicians who are retiring, fewer graduates selecting primary care, and the anticipated needs of an aging population all contribute to this worsening doctor shortage. Concierge medicine, especially CCP’s hybrid model, enables physicians to keep their practices open while offering options to patients who don’t select the concierge package.

“The primary care physician plays a critical role not only for detecting and treating illness, but also for helping to prevent it,” said Dr. Michael Mandel, who, along with his colleagues at Associated Internists in Richmond, Va. – Dr. Anand Lothe, Dr. Amy McConnell and Dr. Joy Rowe – are practicing concierge medicine. “However, reductions in reimbursements for primary care have reduced the time we can spend with patients, especially in counseling on prevention. With CCP’s model, I have that time again.”

“In medical school, you’re taught that 80-90 percent of a patient’s diagnosis is history, and that includes family history and social history,” said Dr. Lothe. “CCP’s program allows me to go back to the way we were taught to practice medicine – taking the time to thoroughly discuss family and personal histories, determining if there are extensive risk factors, including depression, career or stress issues, emerging symptoms – all of which are important to take into account when making a diagnosis and recommending a treatment plan.”

The cornerstone of CCP’s concierge program is a comprehensive physical examination upon which to base a preventive healthcare program.

“We use the results of this physical and tests to design a personalized wellness plan for patients, including nutrition, fitness and stress reduction,” explained Dr. Rowe. “Then we have time to work with the patient on the program, as well as manage any chronic conditions they may have. Providing a more personalized level of service ensures a higher quality of long-term care for my patients.”

About Concierge Choice Physicians

Concierge Choice Physicians(TM) is a private company headquartered in Rockville Centre, New York. Concierge Choice Physicians offers the hybrid model of concierge medicine so doctors can practice traditional and concierge medicine within a single practice. Physicians never have to dismiss current patients and continuity of patient care is maintained. Concierge Choice Physicians also operates in California, New York, Arizona, Nevada, Florida, Massachusetts and New Jersey.

For more information, visit our web site at www.choice.md or call 877-888-5590.

Some Experts Say Snuff Is A Safer Alternative To Cigarettes

One group pushes abstinence as the only true way. The other argues that such thinking is unrealistic and narrow-minded.

At times, passions flare, sometimes to the point of name calling.

It sounds like an argument over the distribution of contraceptives in schools, but this publichealth showdown centers on what many people assumed was a long-settled issue: the dangers of tobacco.

For decades, health experts have been fighting Big Tobacco. In recent years, however, some of them have been arguing among themselves.

At issue is whether all tobacco should be presented to the public as equally dangerous, or if statistically safer tobacco products such as chewing tobacco should be promoted as a less risky alternative for smokers. In other words, some public health experts argue, if you can’t quit cigarettes, you’re better off switching to a smokeless product.

Health experts have quietly debated the idea for years, but their disagreements have grown from a minor distraction to a major dispute as smoking bans sprout up across the country and smokeless tobacco sales soar.

The tobacco tussle

Mainstream public-health practice has long treated all tobacco products as equal and preached a message that a reduction of health risks comes only with cessation. Since 1986, smokeless products such as snuff and chew have been required to carry a warning that says “This product is not a safe alternative to cigarettes.”

But research has shown that smokeless tobacco products — while not risk free — are significantly less deadly than cigarettes, leading some health experts to pitch them as an alternative for those who can’t or won’t quit smoking. The smokeless products might not help people kick the habit, but it removes the primary dangers associated with cigarettes, the thinking goes.

The concept, known as harm reduction, is nothing new in the public-health field. Over the years, it has been put into action in the form of needle-exchange programs for drug abusers and methadone treatment for heroin addicts.

In the fight against tobacco, harm reduction was a back-burner discussion because 90 percent of tobacco sales came from cigarettes.

That’s changing.

Sales of moist snuff increased from 800 million cans in 2002 to an estimated 1.2 billion cans this year, and cigarettes now make up 80 percent of sales, said Bill Godshall, director of Smokefree Pennsylvania. A number of new products — electronic cigarettes, tobacco lozenges and even nicotine-infused skin cream — are being marketed to smokers who can’t light up where they please.

The trend has put the harmreduction debate in the middle of the fight against tobacco, and there’s little room for neutrality.

A case for the spitoon

Godshall, who has a master’s degree in public health, has spent more than two decades fighting smoking. He considers himself a formidable foe of companies such as Phillip Morris, and says he was one of the first to lobby for a tobacco tax and the removal of cigarette vending machines from public places. He’s spoken at national and international conferences on tobacco.

He’s also a harm-reduction advocate.

“Any time you’re using a lesshazardous form of nicotine than cigarettes, my point is you’re reducing your risks,” he said.

He talks with the passion of a war protester or a radical environmentalist, speaking fast and spewing well-rehearsed facts and figures. Nicotine, by itself, isn’t all that different from coffee, Godshall says. It is addictive and elevates the heart rate.

The real damage to smokers’ health comes from the dozens of carcinogens in cigarettes, cigars and pipes — products that are lit and inhaled. Of more than 45 million people who smoke in the U.S., about 438,000 die each year, according to the Centers for Disease Control and Prevention. About 40,000 people die because of secondhand smoke, according to some estimates.

Chewing tobacco and snuff contain 28 carcinogens and have been known to cause oral cancer, but the numbers pale in comparison with smoking. Smoking is estimated to take an average of eight years off a person’s life, compared with 15 days for smokeless tobacco, say Godshall and others in his camp. They contend that smokeless tobacco is 98 percent safer than cigarettes.

True, smokeless tobacco users were four times more likely to get oral cancer than nontobacco users, but they are still half as likely to get oral cancer as smokers, research shows.

The Royal College of Physicians of London, a highly regarded medical group composed of an international team of doctors, issued a report last year defending harm reduction. In the report’s preface the group said:

“The ideas we present are controversial, and challenge many current and entrenched views in medicine and public health. They also have the potential to save millions of lives. They deserve serious consideration.”

Picking your poison

But most public health professionals and physicians aren’t swayed by such statistics and arguments.

“We’re talking about a theory that’s being presented as a fact,” said Alan Blum, a family physician and director of the University of Alabama Center for the Study of Tobacco and Society.

The American Cancer Society, American Heart Association, and virtually all publichealth departments oppose all tobacco and nicotine products, except cessation tools, such as the patch or gum, that are produced by pharmaceutical companies.

The numbers, they say, tell only part of the story.

Stephen Telatnik is a pulmonologist for Memorial Health System who oversees a smoking-cessation program and helped implement the hospital’s smoke-free campus. A practicing doctor for 40 years, he’s seen too many patients suffering from head and neck cancer to ever defend smokeless tobacco.

“There’s just no excuse for that type of approach, regardless of the research,” he said. “I’ve seen the disasters, and it only takes one of those disasters.”

For Dan Martindale, health promotion division director for the El Paso County Department of Health and Environment, it is a matter of picking poisons. “From a public-health perspective, you’re just playing Russian roulette,” he said.

Blum is well-versed in the harm-reduction argument but dismisses the idea as a “pitiful way to reduce death and disease.”

The concept is based on assumptions that people will go from one product to the other, and then might eventually quit. “They wind up doing both or can’t get off the smokeless (tobacco),” Blum said. CDC data show that teens who take up smokeless tobacco are more likely to start smoking.

And, as with any publicawareness push, he said, there’s the message to think about. A relaxed stance on certain types of tobacco might give children the confidence to try it.

The risks of a wrong message are significant, he said. Cigarette filters were once touted as a way to reduce the harmful effects of smoking. Their effectiveness has been debunked, Blum said, but people still smoke them, thinking they are safer than unfiltered ones.

And there’s a lack of research on nicotine and smokeless-tobacco products. Nicotine affects blood pressure and heart rate, but how that affects heart disease and the brain has not been studied in isolation. While a theoretical switch might take away one risk — lung cancer — it might introduce new ones, Blum suggested.

Digging trenches

The impasse over harm reduction has led to pointed accusations, newspaper editorials and a war of words. The American Cancer Society has been accused of a conflict of interest and hypocrisy because it supports and is paid to endorse pharmaceutical products such as the patch or gum but goes after similar tobacco products.

Harm-reduction activists, in turn, are accused of being too friendly with the enemy.

Godshall, the harm-reduction advocate, is clearly in a minority among health professionals, and he said speaking engagements at conferences have been hard to come by in recent years as he’s become more vocal about his stance. People have called him “crazy,” he said, and panelists dismiss his questions when he breaches the subject at conferences.

He, in turn, calls his critics “abstinence moralists” and “prohibitionists” who want people to “quit or die.”

“I don’t need the permission of the American Cancer Society to save lives,” he said.

Blum says Godshall and others on the side of harm reduction act as if they’d found “the true religion.” He called Godshall “brilliant,” but accused him of not seeing clearly on this issue.

“I don’t know how to resolve this,” Blum said. “I really don’t.

BY THE NUMBERS

– 800 million cans of snuff sold in 2002. Estimated 1.2 billion cans sold in 2008.

– 8 percent of high school students use smokeless tobacco.

– Smokeless tobacco contains 28 cancercausing agents.

SOURCES: CENTERS FOR DISEASE CONTROL AND PREVENTION; BILL GODSHALL OF SMOKEFREE PENNSYLVANIA

STATES WITH FULL STATEWIDE SMOKING BANS

Arizona 2006

Arkansas 2006

California 1994

Colorado 2006

Connecticut 2004

Delaware 2002

Hawaii 2006

Illinois 2008

Iowa 2008

Maine 2004

Maryland 2007

Massachusetts 2004

Minnesota 2007

Montana 2005

Nebraska 2008

New Jersey 2006

New Mexico 2007

New York 2003

Ohio 2006

Oregon 2007

Rhode Island 2005

Utah 2006

Vermont 2005

Washington 2005

STATES WITH PARTIAL SMOKING BANS

Florida 2003

Georgia 2005

Idaho 2004

Louisiana 2007

Nevada 2006

New Hampshire 2007

North Dakota 2005

Oklahoma 2006

Pennsylvania 2008

South Dakota 2002

By Brian Newsome

Centene Corporation Announces Key Management Appointments

Centene Corporation (NYSE: CNC) today announced key management appointments in support of its growing business.

Steven A. White has joined the company as President and CEO of Centene’s Ohio subsidiary, Buckeye Community Health Plan (Buckeye), effective July 7, 2008. Mr. White will report to Christopher Bowers, Senior Vice President, Health Plan Business Unit for Centene, and will be based in the Buckeye corporate office in Columbus, Ohio.

Mr. White brings more than 20 years of experience in the health insurance and managed care industry to his new position. In his previous role as President of Southeast Region for Great-West Healthcare, he oversaw the operations of HMO and PPO companies in seven states comprising 300,000 members. White has also held executive positions at CIGNA HEALTHCARE and HEALTHSOURCE, where he was responsible for profit/loss and strategic direction for the managed care companies. Mr. White received an honorary B.S. in Accounting from Southern College in Tennessee and an M.B.A. in Finance from Indiana University.

Mark Eggert, Centene’s Executive Vice President, Health Plan Business Unit, said, “The addition of this strong leader exemplifies the strength and depth of Centene’s senior management. Steve has a clear understanding of the managed care industry and will strive to help Buckeye provide better health outcomes at lower costs.”

Jeffrey A. Schwaneke, CPA, has been named Corporate Controller for Centene Corporation. Effective July 7, 2008, Mr. Schwaneke will oversee the Company’s business activity and financial position in areas of income, expenses and earnings for operations. He will report directly to Eric R. Slusser, Executive Vice President and Chief Financial Officer.

“Mr. Schwaneke has a unique blend of technical accounting expertise, communication skills and leadership,” said Mr. Slusser. “He brings to Centene both a demonstrated financial leadership and a wealth of experience that will enable us to achieve the next level in our growth and development.”

Previously, Mr. Schwaneke worked as the Vice President, Controller and Chief Accounting Officer at Novelis Inc. In that role, he managed global financial and technical accounting activities across multiple divisions. Prior to his position at Novelis, he worked as Controller for the SPX Corporation and also Marley Cooling Technologies. Mr. Schwaneke received a B.S. in Accounting from the University of Missouri-Columbia and has also earned his C.P.A.

About Centene Corporation

Centene Corporation is a leading multi-line healthcare enterprise that provides programs and related services to individuals receiving benefits under Medicaid, including the State Children’s Health Insurance Program (SCHIP), Supplemental Security Income (SSI) and Medicare (Special Needs Plans). The Company operates health plans in Arizona, Georgia, Indiana, New Jersey, Ohio, South Carolina, Texas and Wisconsin. In addition, the Company contracts with other healthcare and commercial organizations to provide specialty services including behavioral health, life and health management, long-term care, managed vision, nurse triage, pharmacy benefits management and treatment compliance. Information regarding Centene is available via the Internet at www.centene.com.

Superior Patient Clinical Outcomes Confirms DaVita’s Leadership Position on Quality Dialysis Care

EL SEGUNDO, Calif., July 7 /PRNewswire-FirstCall/ — DaVita Inc., a leading provider of kidney care services for those diagnosed with chronic kidney failure and disease (CKD), significantly exceeds national averages with regard to patient quality, as validated by both the Clinical Performance Measures Report published in 2006 by the Centers for Medicare and Medicaid Services (CMS), and the December 2007 Fistula First Vascular Access Improvement Initiative. This achievement is notable among the nation’s kidney care community because DaVita(R) serves more than 1-in-4 dialysis patients in America.

(Logo: http://www.newscom.com/cgi-bin/prnh/20020729/DAVITALOGO)

“At DaVita, our highest priority is the health and well-being of the more than 100,000 patients cared for by our professional partners and teammates,” said Kent Thiry, CEO of DaVita. “We’re pleased that this commitment has once again been validated by the findings from CMS.”

Research studies show that patients who meet all four of the CMS Clinical Performance Measures (CPM) and the National Kidney Foundation’s (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) achieve the lowest mortality.(a,b) Outcomes data confirms that the risk of mortality faced by patients dialyzed at DaVita facilities may be as much as 8% lower than the national average.

DaVita consistently surpasses national averages for CMS CPM and KDOQI outcomes. Most recently, DaVita outperformed the national averages by as much as 44% on four key clinical performance outcomes. A recent study that compared the mortality trends for the major dialysis providers found that DaVita had a significant improvement in survival compared to non-chain facilities.(c)

                                                         DaVita % Favorable   Performance Indicator    DaVita    National Average     to the National                                                               Average    Kt/V 

"An important part of measuring and tracking our clinical performance is through the DaVita Quality Index, or DQI," explained Dr. Allen Nissenson, DaVita Chief Medical Officer. "The DQI focuses on the performance of seven key clinical parameters, giving physicians a snapshot of how the patients in their clinics are performing. We have seen a clear correlation over the past five years of using the DQI that as overall DQI scores improve, overall mortality decreases."

"By focusing on clinical training and continuous quality improvement, we are able to partner with nephrologists," said Robertson. "As a doctor still in practice myself, I want my patients to feel their best and enjoy their lives. DaVita's tools and teammate training help me reach these goals."

DaVita is a registered trademark of DaVita Inc. All other trademarks are the property of their respective owners.

About DaVita Inc.

DaVita Inc., a FORTUNE 500(R) company, is a leading provider of kidney care in the United States, providing dialysis services and education for patients with chronic kidney failure and end stage renal disease. DaVita manages more than 1,300 outpatient facilities and acute units in more than 700 hospitals located in 43 states and the District of Columbia, serving approximately 107,000 patients. As part of DaVita's commitment to building a healthy, caring community, DaVita develops, participates in and donates to numerous programs dedicated to transforming communities and creating positive, sustainable change for children, families and our environment.

For more information about DaVita, its kidney education and its community programs, please visit http://www.davita.com/.

   Reference List   a. Tentori F, Hunt WC, Rohrscheib M, Zhu M, Stidley CA, Servilla K,      Miskulin D, Meyer KDB, Bedrick EJ, Johnson HK, Zager PG. Which Targets      in Clinical Practice Guidelines Are Associated with Improved Survival      in a Large Dialysis Organization?, 1998 to 2004. J Am Soc Nephrol 18:      2377-2384, 2007. doi: 10.1681/ASN.2006111250.   b. Wolfe RA, Hulbert-Shearon TE, Ashby VB, Mahadevan S, Port FK.      Improvements in dialysis patient mortality are associated with      improvements in urea reduction ratio and hematocrit, 1999 to 2002. Am J      Kidney Dis 2005; 45(1):127-135.   c. Duong, Uyen, Kalantar-Zadeh K, Kovesdy,C, Mehrotra, R. Mortality Trend      of Hemodialysis Chains in the USA: 1996-2004.  National Kidney      Foundation Spring Clinical Meeting 2008.  

Photo: NewsCom: http://www.newscom.com/cgi-bin/prnh/20020729/DAVITALOGOAP Archive: http://photoarchive.ap.org/PRN Photo Desk, [email protected]

DaVita Inc.

CONTACT: Basak Ertan of DaVita Inc., +1-310-536-2482

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

ImmunoGen, Inc. Announces Start of IMGN388 Clinical Testing

ImmunoGen, Inc. (Nasdaq: IMGN) today announced the start of patient dosing in a Phase I clinical trial evaluating the Company’s IMGN388 targeted anticancer compound for the treatment of solid tumors. IMGN388 uses ImmunoGen’s Tumor-Activated Prodrug (TAP) technology with an antibody that binds to an integrin target. ImmunoGen submitted the Investigational New Drug (IND) application for IMGN388 to the US Food and Drug Administration in mid-May 2008 and gained authorization to initiate clinical testing in mid-June 2008.

“We believe IMGN388 offers significant promise for the treatment of solid tumors, as the target for this compound is found on many types of solid tumors and also on endothelial cells in the process of forming new blood vessels,” commented John Lambert, PhD, Senior Vice President and Chief Scientific Officer. “IMGN388 can actually attack tumors in two ways – by attaching to cancerous cells that express its target and killing them directly and by disrupting the formation of the new blood vessels that every type of solid tumor needs in order to grow. Thus, the potential opportunity for IMGN388 extends beyond tumors that express its integrin target to an even broader pool of solid tumors.”

IMGN388 consists of the Company’s DM4 cell-killing agent attached to an antibody that binds specifically to an integrin expressed on a wide range of solid tumors – melanomas, sarcomas and many carcinomas, including lung, bladder, renal cell and thyroid carcinomas.

The Phase I trial (Study 201) underway at South Texas Accelerated Research Therapeutics (START) in San Antonio, TX is designed to assess the tolerability and pharmacokinetics of IMGN388 in patients with solid tumors; efficacy information also will be obtained. Increasing doses of the compound, administered every three weeks, are to be evaluated in new cohorts of patients with solid tumors until the maximum tolerated dose (MTD) is established and the dose-limiting toxicities are identified. Once the MTD is established, enrollment will be limited to patients with tumors that are melanomas, sarcomas or those carcinomas that characteristically express the relevant integrin target.

About ImmunoGen, Inc.

ImmunoGen, Inc. develops targeted anticancer therapeutics using its expertise in cancer biology, monoclonal antibodies, and the creation and attachment of potent cell-killing agents. ImmunoGen’s TAP technology uses monoclonal antibodies to deliver one of the Company’s proprietary cell-killing agents specifically to cancer targets. ImmunoGen has three TAP compounds in clinical testing – IMGN901, IMGN242 and IMGN388. Four additional TAP compounds – trastuzumab-DM1, AVE9633, SAR3419 and BIIB015 – are in clinical testing through the Company’s collaborations with Genentech, sanofi-aventis (two compounds), and Biogen Idec, respectively, and a fifth compound is at IND stage. Also, the naked antibody, AVE1642, is in clinical testing through the Company’s collaboration with sanofi-aventis. Additional compounds are in earlier stages of development.

This press release includes forward-looking statements. For these statements, ImmunoGen claims the protection of the safe harbor for forward-looking statements provided by the Private Securities Litigation Reform Act of 1995. It should be noted that there are risks and uncertainties related to the development of novel anticancer compounds, including IMGN388. A review of these risks can be found in ImmunoGen’s Annual Report on Form 10-K for the fiscal year ended June 30, 2007 and other reports filed with the Securities and Exchange Commission.

On a Mission to Educate About Adult Stem Cells

By Leah Beth Ward, Yakima Herald-Republic, Wash.

Jul. 6–Rachel Wright gave her mother nearly an extra three years of life and together they played a pioneering role in the battle against a rare form of cancer called mantle-cell lymphoma.

In the fall of 2005, Rachel, an Eisenhower graduate living in Seattle, allowed researchers to harvest her stem cells for transplantation into her mother, longtime Yakima resident Mary Roche Wright.

Mary received a new immune system from her daughter that would hopefully fight off the lymphoma cells. The odds that Rachel would even be a donor were only 1 in 10,000.

“We often don’t even check the daughter because it’s so unlikely there will be a match,” said Dr. Ajay Gopal of the Seattle Cancer Care Alliance, a treatment center that unites expert doctors from Fred Hutchinson Cancer Research Center, UW Medicine, a practice run by the University of Washington and Seattle Children’s Hospital & Regional Medical Center.

Once she learned she was, Rachel’s outlook on health, life and happiness changed.

“I stopped believing in statistics and started believing in serendipity,” she said.

Now she’s on a mission to share her mother’s story and educate people about the promising role of stem cells in the war on cancer. The topic is often inflamed by debate over the ethics of using cells derived from 5- to 6-day-old embryos. Stem cells from adults are often misunderstood, said Wright. “I didn’t even know an adult could give stem cells.”

“But stem cells aren’t this big scary thing,” she said. The process of donating them — called apheresis — was a bit daunting.

Rachel was hooked up to a machine two days in a row for four to six hours at a stretch. She watched as her stem cells percolated up into a blood bag. “It felt like growing pains all over my body,” she said.

When enough cells had been collected, the nurses helped her out of bed and took her to her mother’s room. “There was my mom, sitting there, waiting. It was so sci-fi but it was also so natural,” said Rachel, 36, who now lives in New York City where she works for Corbis Corporation, a creative advertising and media company owned by Bill Gates.

The hope was to provide Mary with a long remission and she did enjoy more than two years before the tumor returned. She ultimately succumbed to the chief risk of transplantation — graft versus host disease. Mary’s new immune cells saw her tissues as the enemy and attacked. She died of an infection in May.

“It’s the double-edged sword that we have to learn how to deal with,” Gopal said.

Success in the war on cancer doesn’t come in leaps and bounds, he said.

But Mary’s role — she was only the fifth person in the world to undergo this specific treatment for mantle-cell lymphoma — supplied an important building block.

For Rachel, her brother Jonathan, who is a Seattle urologist, and their father, retired Yakima lawyer Larry Wright, it’s important to keep building. They’ve set up the Mary Wright Memorial Fund at the Seattle Cancer Care Alliance. The Web site is www.marywrightmemorial.com.

—–

To see more of the Yakima Herald-Republic or to subscribe to the newspaper, go to http://www.yakima-herald.com/.

Copyright (c) 2008, Yakima Herald-Republic, 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.

Para-Medical Institute to Open at NMCH

By Madhuri Kumar

NALANDA: It’s a harsh reality that Nalanda Medical College Hospital (NMCH), once touted as a state-of-the-art hospital in making, is faced with a plethora of problems – from dilapidated buildings to unhygienic conditions.

Besides building renovation, drainage repair and wirings removal, the hospital also urgently needs car-park renovation, new furniture, smoking areas, improved ventilation and a well-equipped pathological lab.

NMCH has some unique features. The college building and the undergraduate hostel are almost three km from the hospital. Students in third year and their seniors have to take ring service buses to reach the hospital. They are unanimous in their view that had the hospital been nearer to the college building, it would have been more convenient for them.

Said Dr Barkha Sinha, who completed MBBS from the college recently: “Every rainy season, we had to face a harrowing time on the college hostel. Waterlogging made life hell.” A student, on the condition of anonymity, said, “We face many problems. The infrastructure is inadequate and a lot is needed to be done to improve the condition of the college, the hospital and the hostel.”

However, NMCH has also some good news, specially for students aspiring to do para-medical courses. Recently, a team from the Union ministry of health identified the NMCH to set up a composite para- medical institute.

“About 20 acres of land has been identified for the purpose in front of the hospital campus,” NMCH superintendent Dr NP Yadav said.

The institute is likely to start its session in September and will initially offer 11 courses, including two-year diploma courses in radiography and imaging, operation theatre, medical laboratory, blood bank and ECG technology. It will also impart one-year training in skilled birth attendant besides offering a certificate course in pre-hospital trauma technology.

According to Dr Yadav, the proposed institute will offer more courses in years to come. “We have offered our buildings like the directorate of TB Control, food-processing lab, pharmacy institute and a portion of NMCH for starting the institute,” said the superintendent.

But a proposal to start post-graduate teaching in NMCH is still hanging fire. The strength of teachers required at the undergraduate level is not adequate as per MCI guidelines. Hence, it is difficult to start post- graduate courses, said Yadav.

(c) 2008 The Times of India. Provided by ProQuest Information and Learning. All rights Reserved.

Health Benefits in Cinnamon

AN estimated one in 10 middle-aged Malaysians has diabetes.

But that’s not what worries experts the most. Another one in five has what doctors call “pre-diabetes”.

The number of pre-diabetics is expected to climb as the nation gets older, fatter and more sedentary.

Pre-diabetics are not only at risk of developing diabetes but are also at risk of suffering heart attacks, strokes, kidney failure, blindness and nerve damage.

“Your risk of heart attack or stroke is two to four times higher if you have diabetes. It is 1 1/2 times higher if you have pre- diabetes,” says Judith Fradkin of the National Institute of Diabetes & Digestive & Kidney Diseases in the United States.

“Between a third and half of pre-diabetics will go on to develop diabetes within five or 10 years,” says Frank Vinicor, director of the Diabetes Programme at the Centres for Disease Control and Prevention in Atlanta, USA.

Insulin Resistance

Pre-diabetes and Type II diabetes usually begin with insulin resistance. Blood sugar (glucose) level in the body is regulated by insulin, a hormone produced in the pancreas. Insulin helps to transport glucose from the blood through the cell membranes and into the cells of the body.

As long as the cell membranes remain sensitive to insulin, the shuttling of glucose to the cells occurs quickly.

When the cell membranes become insensitive to insulin (also called insulin resistance), the pancreas will have to pump out more insulin to force the glucose into the cells.

When this doesn’t work, the result is high levels of sugar in the blood (considered a pre-diabetes condition).

Over time, the pancreas no longer produces enough insulin to control blood sugar and Type II diabetes develops.

Researchers now know that diabetes does not just happen. Before you get diabetes, you’d have a condition known as pre-diabetes where your blood sugar is higher than normal but not high enough to be termed diabetes.

If you are told that you fall into the pre-diabetes range, it is not such a bad news after all.

People with pre-diabetes can lower their risk of getting diabetes by nearly 60 per cent through healthy eating, regular exercise and taking supplements to prevent or delay the onset of diabetes and reduce the risk of complications.

CINNAMON EXTRACT: When Dr Richard Anderson, a chemist at the US Department of Agriculture, was searching for foods that might mimic the action of insulin in controlling blood sugar (glucose) levels, he found a class of water-soluble compounds in cinnamon called Polyphenol Type-A polymers. This can help boost insulin activity about 20 fold.

Water-soluble cinnamon polyphenol Type A polymers extract is 70 per cent more effective than whole cinnamon.

BANABA EXTRACT: A number of medicinal plants from India, China and Japan are used for diabetes. One of the most effective plant compounds discovered is corosolic acid from the leaves of the banaba (Lagestroemic speciosu) tree, which exhibits antidiabetic properties.

Corosolic acid acts like insulin. The hormone that naturally increases glucose transport activity across cell membranes thus facilitates the lowering of blood sugar.

Clinical studies in the US and Japan show that corosolic acid is safe and effective in lowering blood sugar levels in pre-diabetes and Type II diabetes.

If you are at risk of pre-diabetes, take a blood test. Even if you don’t consider yourself at risk, it is still advisable for those over 35 years of age to check their blood sugar levels annually.

Most of the studies on cinnamon use the water-soluble extract standardised to contain Trimeric and Tetrameric A-Type Polymer (polyphenol Type A polymer) and as for banaba, it is standardised to contain one per cent corosolic acid.

* This article is courtesy of Stay-well To Live-well by Pahang Pharmacy Sdn Bhd. For more information, consult your pharmacist or call: Stay-well to Live-Well TOLL-FREE LINE: 1-800-88-1450 (Monday to Friday: 9am-5pm) or email [email protected].

(c) 2008 New Straits Times. Provided by ProQuest Information and Learning. All rights Reserved.

Tofu Could Contribute To Memory Loss

A new study found consuming large quantities of soy products might increase the chance of memory loss.

Researchers studied 719 elderly Indonesians living in urban and rural regions of Java, and found daily tofu consumption was associated with poor memory, particularly among the over-68s.

Scientists from the Loughborough University led the study, which is featured in the journal Dementias and Geriatric Cognitive Disorders.

In the developing world, soy products are a popular protein source for millions of people. But the soy sales are gaining ground in the west, where it is often promoted as a “super food”.

Soy products are known for their rich micronutrients called phytoestrogens, which mimic the impact of the female sex hormone estrogen. The study findings suggest phytoestrogens – in high concentration – may actually heighten the risk of dementia.

In past history, there has been some evidence phytoestrogens protected the brains of younger and middle-aged people from damage. Yet, their effect on the older brain is not as clear-cut.

Lead researcher Professor Eef Hogervorst said past research had linked estrogen therapy to a one hundred percent increase in the dementia risk for people over 65.

Hogervorst said estrogens were found to promote growth among cells, not necessarily a good thing in the ageing brain. Researchers also found high doses of estrogens promote the damage caused to cells by particles known as free radicals.

A third theory is that brain damage is actually not caused by the tofu, but by formaldehyde. A popular preservative agent used in Indonesia.

Researchers conclude more studies are needed to see if daily consumption of tofu affects other ethnic groups. However, older research has linked high soy consumption to an increased risk of dementia in older Japanese American men.

University of Oxford Professor David Smith said tofu was a complex food with many ingredients that might have an impact. But he said, “There seems to be something happening in the brain as we age which makes it react to estrogens in the opposite way to what we would expect.”

The latest study also found that eating tempe, a fermented soy product made from the whole soybean, was linked to better memory. Professor Hogervorst said the beneficial effect of tempe might be connected to the fact it contains high levels of the vitamin folate, which is known to reduce dementia risk.

“It may be that that the interaction between high levels of both folate and phytoestrogens protects against cognitive impairment.” She also stressed that eating tofu in moderation posed no health problem.

Rebecca Wood, of the Alzheimer’s Research Trust, which funded the study, said more studies were needed to find the potential risks and benefits of so-called super foods. 

She said there is a desperate need to find new preventions or cures, “This kind of research into the causes of Alzheimer’s could lead scientists to new ways of preventing this devastating disease.”

Image Courtesy Sakurai Midori (Wikipedia)

On the Net:

Alzheimer’s Research Trust

Loughborough University

Dementias and Geriatric Cognitive Disorders

Salmonella Scare Has Damaged Tomato Sales

A nationwide salmonella scare has left tomato farmers reeling from financial losses estimated in the hundreds of millions of dollars. Industry leaders are now calling for a congressional investigation into the government’s handling of the outbreak. 

Losses across the supply chain top $100 million, but the source of the outbreak has still not been determined. U.S. tomato farmers have plowed their fields, only to leave the crop rotting in packinghouses.

Tomato farmers say the hot selling summer season has already withered away: the Fourth of July holiday is normally one of the top tomato weekends. So far, the outbreak has sickened an estimated 922 people, but the government says they’re now investigating if other fresh produce may have caused the salmonella.

“Now the government has a doubt as to whether it was tomatoes after they’ve already blackened our eye?” said Paul DiMare, president of The DiMare Companies in Johns Island, S.C.

Farmers, packers and shippers fear it could take months to rebuild the $1.3 billion market for fresh tomatoes.

DiMare said, “June and July are the best time of the year for tomatoes, but our movement has completely stopped in the United States.”

The last few weeks, McDonald’s Corp. (MCD), Wendy’s International Inc. (WEN) and Yum Brands Inc. (YUM) began offering limited tomatoes on their menus.

In Fresno County, one farmer lost $225,000 by letting his tomatoes rot in the fields this weekend because it would have been more expensive to harvest them, said Ed Beckman, president of the statewide cooperative California Tomato Farmers.

“This is normally a huge week for the industry because everyone barbecues, but we’re just not seeing that demand materialize,” Beckman said. “We are slowly starting to see consumers recognize that California tomatoes are, in fact, safe. But for a grower to walk away from a $225,000 investment, there’s a lot of pain.”

The price per 25-pound box of red round tomatoes dropped from $16 to just $10 in Ruskin, Florida, after the outbreak began in early June. Tony DiMare said he had no choice but to let the fruit turn to mush at the family’s packing facilities. His customers simply refused to pick up their orders.

“It’s like pulling teeth right now trying to move product,” he said. “We’ve been kind of guilty by association in this blunder of an investigation.”

DiMare joins others in the produce industry that are critical of the Food and Drug Administration’s progress on the investigation.

FDA and Centers for Disease Control and Prevention officials blame the enormous supply chain, and the sheer complexity of the outbreak for slowing down efforts to find the sources of contamination.

Federal agriculture authorities visited Florida packinghouses and tomato farms on a special mission to assess food safety conditions in April. That was just days before the first victim fell ill.

Immokalee, – is considered a possible origin of the outbreak.  FDA investigators found “conditions and practices of concern,” including the presence of domestic animals, problems with the water system and poor sanitation.

FDA spokesman Michael Herndon said all facilities corrected the problems immediately and none were deemed “egregious.”  But officials say they can’t rule out the possibility that salmonella may be linked to one of those locations.

Red plum, red Roma and red round tomatoes harvested in the area during that period were later shipped out to market. They have not been cleared as the source, but they also aren’t proven as the cause.

DiMare, said investigators found no problems with his company’s repacking plant in Ruskin. He said it would be tough for inspectors to find traces of salmonella on farms now, weeks after harvest ended. 

Last week, the FDA said tomatoes harvested weeks ago could have contaminated packing sheds or warehouses that are only now sending their products to market. The source said also a possibility that the source itself is still on the market or a different kind of produce is making people sick.

Western Growers, which represents 3,000 growers in California and Arizona, is pressuring the House Committee on Agriculture to hold hearings on the outbreak.

“The collateral damage inflicted on thousands of innocent producers in this country by FDA blanket ‘advisories,’ such as with spinach and tomatoes, cannot go unchallenged,” said the group’s president, Tom Nassif. “Congress must investigate this matter and determine ways to avoid this in the future and make the innocent tomato growers, packers and shippers whole.”

Source of Pain Pills Dries Up

By Linda B. Blackford, The Lexington Herald-Leader, Ky.

Jul. 6–Patients are flooding into doctors’ offices and emergency rooms around Lexington, seeking a replacement for two local doctors suspended for overprescribing pain medications.

The state’s disciplinary action against Dr. Charles Grigsby and Dr. James Heaphy appears to have dried up an important source of prescription drugs for those who need them — and for those who might simply be addicted.

“I’ve got people going through withdrawal in my waiting room,” said Dr. Ben Huneycutt, who recently opened a family practice on Third Street.

In the past two weeks, he’s gone from seeing four to five patients a day to two an hour, most of them looking for new prescriptions, he said.

Local emergency rooms are also affected.

St. Joseph Hospital’s emergency room has seen a “significant” increase in patients with chronic pain problems in the past few weeks, said spokesman Jeff Murphy. Good Samaritan Hospital, now owned by the University of Kentucky hospital system, has been seeing several patients a day with withdrawal symptoms, said spokeswoman Mary Margaret Colliver. Central Baptist Hospital is also referring people to treatment centers.

The Fayette County Health Department has received “numerous calls from people wanting appointments because their regular doctor cannot practice medicine,” said spokesman Kevin Hall. However, the health department doesn’t offer pain management services, nor does it manage patients requiring withdrawal from controlled substances.

Late last month, the Kentucky Medical Licensure Board suspended Grigsby from prescribing and suspended Heaphy’s medical license. Both doctors were sanctioned for repeatedly prescribing drugs meant for short-term use for pain, prescriptions for combinations of drugs favored by people who abuse or divert such substances. Investigators concluded that both doctors constituted a danger to the welfare of their patients.

They will appear in formal hearings before the licensure board later in the year.

Kentucky has some of the worst prescription drug problems in the country. Between 2002 and 2004, the state had the highest percentage of people using prescription drugs for non-medical reasons, about 8 percent.

Between 12 and 15 percent of all grievances filed with the licensure board are prescription issues.

Robert Walker, a professor and researcher at UK’s Center for Drug and Alcohol Abuse, says the recent reports of patients seeking prescriptions “make sense. Any time you have people who have established a pattern of obtaining opiate medications from sources like that and the source dries up, you’re going to find people desperate to find a prescription.”

Lexington police Detective William Goldey, of the prescription fraud unit, says he expects to see an increase in doctor-shopping in the region. More desperate patients might try to steal prescription pads or get pain medication, and in the worst-case scenario, resort to robbery.

“It’s inevitable,” Goldey said. “Prescription drugs are becoming the No. 1 drug of choice.”

The two cases in Lexington show just how complicated the issue is, said Van Ingram, branch manager of compliance at the Office of Drug Control Policy in Frankfort. “We want patients to get the things they need, but we don’t want them to abuse it,” he said.

Most people who abuse pain medication start out with a legitimate problem and seek appropriate help. That’s why it often takes so long to investigate doctors.

Grigsby and Heaphy were investigated by the licensure board after grievances were reported to the Cabinet of Health and Family Services. Neither doctor returned phone calls from the Herald-Leader.

“It’s important to recognize the board wants doctors giving appropriate pain medications to patients who need them,” said Lloyd Vest, the licensure board’s general counsel. “Each case is different and each case warrants a different response.”

Prescriptions only

Grigsby and Heaphy are both longtime internal medicine specialists in the area. The charges against Heaphy were more severe, including altering patients’ charts and a lack of basic care to his patients outside of pain prescriptions.

Debra Milton of Lexington was one of his patients. In 21/2 years, she said, “he never checked my blood pressure, he never took my temperature, never weighed me, nothing. All he did was give me medicine for my back and neck and anxiety.”

Heaphy prescribed Lortab and Xanax for Milton for injuries received in a 2000 car wreck. “I have chronic pain, and I need the medications,” she said.

She’s now looking for another doctor, and said she tried Grigsby’s office, but was told she would have to pay $348 just to come in. She does not have health insurance.

Heaphy — who, according to Fayette County property records, owns a 102-acre horse farm on Old Frankfort Pike assessed at $3.4 million — also practiced in Frankfort. That’s where Louise Schraeder saw him for the past 10 years. “He’s been a good doctor to me and never been one to push medication,” she said, although he did prescribe some controlled substances to her. “There had been some concerns I’d voiced to him about some of the people I’d seen his office.”

Schraeder said Heaphy worked with her to pay for her treatment and would give her free samples of things such as blood pressure medication. Because of that, she said, “I’m sure there will be physicians reluctant to take his patients.”

Pain specialists needed

UK’s Robert Walker said one of the complications to the prescription drug puzzle is that in Kentucky, there aren’t many doctors trained in the field of pain management. New research is showing that long-term use of controlled pain medication might actually increase pain sensitivity over time, and non-steroidal, anti-inflammatory drugs could be more useful.

“You want a well-trained pain specialist prescribing these things, not necessarily a primary care doctor who has 10 minutes to spend with a patient,” Walker said. “There’s a lot of personal history you need to collect before prescribing an opiate, like a history of addiction or alcohol problems. There are people who are partly addicted, partly in chronic pain Ӛ­– and making that discrimination takes time.”

Meanwhile, back on Third Street, Huneycutt says he’s still seeing a portion of Grigsby and Heaphy’s former patients, trying to tell them he won’t just prescribe medications, while he tries to diagnose some of the underlying problems they have. “It’s good these guys were busted,” he said, “but when you yank both their licenses at the same time, you create a big problem.”

Reach Linda Blackford at (859) 231-1359 or 1-800-950-6397, Ext. 1359.

—–

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.

Everything on the Table at Landmark

By Felice J Freyer; Paul Grimaldi; Jonathan N Savage

Jonathan N. Savage, the court-appointed special master, says he’ll “be looking at a number of possible scenarios by which the hospital will move forward.”

The lawyer appointed by Superior Court to take control of the financially ailing Landmark Medical Center says he plans no immediate changes in the functioning of a hospital that he calls “a pretty well-run institution.”

To stabilize the Woonsocket hospital’s finances, Jonathan N. Savage, the court-appointed “special master,” stopped paying vendors for services provided before June 26, the date he was appointed. For services provided since his appointment, however, all vendors will be paid on time.

Although at least some of those pre-June 26 debts will eventually be paid, the moratorium on payments gives the hospital enough cash to operate for more than a year, Savage said in an interview Thursday.

As special master, Savage, who has little experience in health care, functions as the hospital’s president, chief executive officer and chairman of the board, approving all expenditures, hiring and other decisions — at least until July 17, when Superior Court Judge Michael A. Silverstein will decide whether Savage will continue in that role, work with a consultant or be replaced. Meanwhile, Savage has been conferring regularly with the judge, and the hospital’s upper management remains in place.

Savage was appointed as special master because the hospital petitioned the court for help with its financial crisis. A special master has added powers that hospital management did not have before the court’s intervention. With the court’s approval, Savage can modify or abrogate certain contracts and agreements that the hospital has made; the nature and extent of those changes vary depending on the contract.

Savage’s Pawtucket law firm, Shechtman Halperin Savage, has a team of several lawyers and legal assistants working on Landmark, and at least one representative is at the hospital every day, he said.

Dr. David R. Gifford, director of the state Department of Health, said that his staff has been meeting with Savage to provide information and keep tabs on what’s happening, but has not been on site at the hospital. “We don’t have any issues or concerns about quality of care,” Gifford said. “So far I think things are moving in the right direction. … . I feel more confident today with this process than I did before the special master was appointed.”

Gifford said that, in the end, Landmark will have to partner with another hospital and also curtail services, eliminating some specialty programs to focus on the “core services” that the community needs. “To be financially viable up there, a hospital cannot continue to provide the same breadth of services,” Gifford said. Landmark recently shut down its cardiac-surgery program because it could not attract enough patients.

Landmark is due to make a $1.3-million payment Oct. 1 on a bond issue that dates to 1993. Secured through the Rhode Island Health and Educational Building Corporation, that bond was refinanced in 2005. There is $12.5 million outstanding on that bond, according to the corporation’s executive director. There is also $758,000 in payments to Bank of America remaining on a lease apparently tied to the hospital’s cardiac-care program, according to the corporation and Woonsocket municipal records.

Savage said the hospital would be able to meet these obligations.

Landmark, founded in 1873 as the Woonsocket Hospital “for the relief, cure and general care of the sick,” today has 1,055 employees and operates the third-busiest emergency room in the state. A midsized community hospital, Landmark has been losing money for many years and, since 2005, has had more debts than assets. At the end of the last fiscal year, Landmark was $7.2 million in the hole.

Although most community hospitals in Rhode Island are struggling, a Health Department study of hospital finances last year said Landmark had the greatest risk of failing because it is the only hospital whose debts exceed its assets. Other hospitals have endowments producing income that can fill deficits. Landmark has no such cushion.

In his first week as special master, Savage said he has been working to set up procedures to ensure that all expenditures, and other decisions, are approved by his office. He is also meeting with employees, doctors, community leaders and others to describe his role and assure them that the hospital continues to function as always. He said he’s seen no signs that patients are turning else- where. “The community views this court intervention as a very positive step,” Savage said.

Savage estimated that court supervision will last for 12 to 15 months, with the goal of maintaining a strong hospital to serve the Woonsocket area.

How that will be accomplished remains unclear. Savage said he’s so far done only a “very cursory review” of the finances, and has found no evidence of malfeasance or even mismanagement. “The recurring theme,” he said, is that Landmark has provided quality care in a cost-effective manner.

Savage blamed Landmark’s financial problems on low reimbursements and a high burden of uncompensated care, factors a special master cannot change.

The hospital serves many elderly and poor people covered by government programs that pay low rates. Some 64 percent of Landmark’s inpatient revenues come from the federal Medicare program, for example. (A Health Department analysis earlier this year found that Landmark’s uncompensated-care burden was greater than the state average but lower than that of five other hospitals.)

Many of those patients are sent to Landmark from Thundermist Health Center, in Woonsocket, which refers 15,000 a year, more than any other medical group. About 80 percent of Thundermist’s patents live at or below the poverty level, according to Maria Montanaro, Thundermist’s president and chief executive.

Montanaro said that Thundermist should have some input into Landmark’s future and health-care delivery in northern Rhode Island. “Thundermist needs to be an elemental partner for whatever is planned for Landmark,” she said.

“Landmark is a critically important hospital for the people of northern Rhode Island,” said Rick Brooks, director of United Nurses and Allied Professionals, a union that represents 500 workers at Landmark. Union leaders are scheduled to meet with Savage this week.

The hospital, Brooks said, “serves a disproportionately poor and elderly population — which is nobody’s fault, and neither the hospital nor the community should be effectively punished for that by the threat of closure. That leads us to conclude that there needs to be some reallocation of the dollars that are financing our hospital system in the state.”

Landmark has tried many times over the years to merge with another hospital in Rhode Island or Massachusetts, with no success. Recently, Landmark officials said they were in negotiations with Memorial Hospital of Rhode Island, located 15 miles to the south, in Pawtucket. Last month, in the final days of the General Assembly session, Woonsocket lawmakers filed legislation that would have enabled Landmark and Memorial to bypass a law requiring intense and time-consuming scrutiny of any hospital merger. The bill faced opposition and never came to a vote, however.

Savage now also has control over any negotiations with Memorial. Asked about those talks, he said, “We will be looking at a number of possible scenarios by which the hospital will move forward. I suspect [Memorial] may be part of that. Everything is possible and everything is on the table.”

Savage said he will also review Landmark’s plans to sell its rehabilitation hospital, in North Smithfield, to a for-profit company from St. Louis.

“We will be looking at a number of possible scenarios by which the hospital will move forward. … Everything is possible and everything is on the table.”

Originally published by Felice J Freyer; Paul Grimaldi, Journal Staff Writers.

(c) 2008 Providence Journal. Provided by ProQuest Information and Learning. All rights Reserved.

Friendship House Looks to Expand, Help More Autistic Children

By Daniel Axelrod, The Times-Tribune, Scranton, Pa.

Jul. 6–Patti Duguay used to worry about soda machines. Her autistic son Douglas, 10, was so fascinated by the tall, brightly colored drink dispensers he would become stubbornly fixated on them.

That was until Friendship House’s clinical specialist Melissa St. Ledger explained them to him.

“Now, when I show him a soda machine he says, ‘OK, Mommy, we put the money in and get a soda,'” said Ms. Duguay, of Waverly. “Friendship House is great. As a parent of an autistic child, there are so many services we need that aren’t out there. They need to expand.”

Friendship House’s leaders agree. Five years after beginning educational and enrichment programs for autistic children, the Scranton-based nonprofit wants to grow to meet heavy local demand.

With a $15 million annual budget and 300 employees in Scranton, Philadelphia, Pottstown, Pottsville and Honesdale, Friendship House is among Eastern Pennsylvania’s largest providers of mental health and welfare services for children.

But its East Mountain location is maxed out, serving 67 autistic children. So, in the next month, its leaders will decide whether to construct a new building, add to existing structures or renovate them to accommodate 120 children.

Whatever they decide as they meet with architects, they hope to break ground by November and finish in 18 months.

“We’d like to be the hub for autism services in Northeastern Pennsylvania,” said Friendship House President Robert Angeloni. “We have a great need in this region, and the resources have not matched the needs.”

Now, the 137-year-old organization’s leaders must consult donors before beginning an expansion. Friendship House currently has $1.7 million in cash and pledges raised from that capital campaign, which began in 2004.

But those donors pledged to build a center for children staying there while undergoing mental health treatment. The nonprofit changed its priorities in 2007 following overwhelming demand for autism services and a state shift toward foster care and school-based therapy for children with mental health issues.

For now, the Maple Street building’s staff are enjoying the $85,000, 3,000-square-foot addition of therapeutic rooms opened June 23 for roughly 20 autistic children.

Staff members use the latest approaches to teach autistic individuals from 18 months old to age 21, tracking their success learning skills for daily living, communicating and socializing. And they have big future goals.

“We’d like to provide cradle to tomb services for people on the autism spectrum,” said Mary Christine Remick, the nonprofit’s clinical director for autism services.

Contact the writer: [email protected]

—–

To see more of The Times-Tribune or to subscribe to the newspaper, go to http://www.thetimes-tribune.com/.

Copyright (c) 2008, The Times-Tribune, Scranton, 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.

Chosen One: Kathy Gabler Views Her Tragedy As a Way to Save Others From Going Through the Same

By Erin Wisdom, St. Joseph News-Press, Mo.

Jul. 6–Kathy Gabler missed out on Thanksgiving dinner, and she was determined not to do the same thing come Christmas.

So she went to the doctor, hoping for some medicine for indigestion that was stronger than what she’d purchased over the counter. A series of just-in-case tests later, Christmas did come — but not in a way she wanted.

A PET scan displaying cancer cells in red lit Kathy up like a Christmas tree from her neck to her pelvis. At just 47, the Savannah, Mo., woman and mother of three adult children was diagnosed with stage-four colon cancer that had spread to many other areas of her body, despite the fact that she’d always led a healthy lifestyle and had never been seriously sick.

She was given two months to two years to live. That is, after all, what medical books predict for most people in her condition: Only 10 percent of those diagnosed with colon cancer in its most advanced stage survive five years.

But Kathy doesn’t do anything by the books.

“I had faith I wasn’t going to fall into that,” she says, now more than six months out from her diagnosis. “I knew I had a lot of living to do — I have weddings and grandkids to come — and I believed I was going to beat it.”

And that wasn’t all she was determined to do. What bothered her most about this cancer was its reputation as a “silent killer” — one her oncologist told her likely originated last summer when she first began experiencing what she thought was indigestion and that advanced quickly from there. Like her, many people who have the cancer have few or no symptoms, and the Gablers decided to turn their tragedy of being taken by surprise by Kathy’s far-advanced disease into something that could save other people from going through the same.

They established Kathy’s Cause, a fund they intend to use to support colorectal cancer awareness in the St. Joseph area, and they organized a 5K run/walk and golf tournament scheduled to take place in Savannah on July 19. All proceeds from the event, rather than going toward Kathy’s cancer treatment, will be used locally to educate people about colorectal screening and to help pay for colorectal screening tests offered for free to the public.

“This cancer is 90 percent curable if it’s caught in the early stages,” Kathy says, adding that she thinks the age at which people are urged to get their first colonoscopy should be lowered from 50 to 40. “If I can get one person who needs a screening to have one, this effort will be well worth it.”

The effort they’ve put into planning their awareness event also has been a way to distract themselves from the devastation they felt following the cancer diagnosis, Kathy and her husband, Greg, say. But devastation is far from the end of their story.

In April, four months after learning she had cancer and after undergoing just as many months of chemotherapy, Kathy went in for another PET scan. For some reason beyond what doctors could explain, this one showed no cancer — meaning that although Kathy isn’t cured completely and will likely need chemotherapy for the rest of her life, her treatment had eliminated all the cancerous cells the original test showed, and no new ones had occurred. Her doctor told her he had never seen chemotherapy work so well so quickly.

“To know that in four months, the cancer cells were gone — it’s an absolute miracle,” Kathy says, adding that she and her family attribute this outcome not only to her positive attitude but also to the prayers of people all over the country — most of whom they don’t know.

“One Sunday night, I got a call from a friend in Kansas City,” Greg says, “And he said, ‘Do you hear that? That’s the sound of 600 people you’ve never met praying just for you.'”

The Gablers also see God at work in their situation in other ways, such as in the fact that after wintering in Florida for years, Greg’s parents decided not long before Kathy’s diagnosis that they didn’t want to do that anymore and sold their motor home. This meant that ever since Kathy’s diagnosis, Greg’s mother, Helen, has been here to sit with her through all of her five-hour chemotherapy sessions, and both she and Greg’s father, Ken, have played a big part in planning this month’s awareness event.

“It has brought us closer as a family,” Ken says. “We’ve been bound by Kathy’s cause, because we think it’s both admirable and necessary.”

Too many people think being screened for colorectal cancer is unnecessary, he adds, and invariably, some of those are the ones who need the screening most. They’re the ones, too, who Kathy considers her purpose for living with cancer.

“I use the term I’m the ‘chosen one,'” she says. “I’m one person who’s supposed to bring awareness to this disease. That’s how I view it, and that’s what I want to do.”

Kathy’s Cause

The event Kathy Gabler and her family have planned to raise money for Kathy’s Cause, a fund that will be used locally to raise awareness about colorectal cancer and to pay for test kits offered free to the public, includes a 5K run/walk that will begin at 9 a.m. July 19. Registration will begin at 8 a.m. at the Clasbey Community Center in Savannah, Mo.

The day also will include lunch at 11 a.m. and a four-man scramble golf tournament beginning at 1 p.m. at Duncan Hills Golf Course in Savannah. The first-place team will receive a refund of its entry fee, and the second-place team will receive a refund of half its entry fee. A $10,000 prize will be given for a hole-in-one, and hole and raffle prizes will be awarded at the end of play.

An entry fee of at least $25 is asked of each 5K participant, and each will receive a T-shirt. The entry fee for each golf team is $300, which will pay for participant gift bags, a cart, green fees and T-shirts.

Donations and memorials also are being accepted for the fund and can be mailed to Kathy’s Cause, c/o Heartland Foundation, 502 Angelique St., St. Joseph, MO 64506. To donate by phone, call 271-7200.

For more information, call Kathy at 271-6011 or 324-5573 or Helen Gabler at 233-3408 or 294-0214.

Lifestyles reporter Erin Wisdom can be reached at [email protected].

—–

To see more of the St. Joseph News-Press or to subscribe to the newspaper, go to http://www.stjoenews-press.com/.

Copyright (c) 2008, St. Joseph News-Press, Mo.

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.

RMC Prepares to Appeal Denial of Accreditation

By Mary Jo Shafer, The Anniston Star, Ala.

Jul. 6–Representatives from Anniston’s Northeast Alabama Regional Medical Center will appear before a review panel in Chicago on Thursday to appeal the Joint Commission’s preliminary denial of accreditation of the hospital.

“The key word is preliminary,” said RMC spokeswoman Susan Williamson. “Our goal is to clarify some of the findings and work toward full accreditation.”

The preliminary denial is the result of a series of “requirements for improvement,” identified by the Joint Commission, an independent body that evaluates hospitals nationwide.

The current status is the result of an unannounced survey members of the Joint Commission conducted at the hospital in August 2007.

“Hospitals are surveyed every three years on an unannounced basis,” said Ken Powers, spokesman for the Joint Commission. Teams visit and “look at pretty much everything.” This includes treatment services, the continuum of care, management of medication and information, safety procedures and the physical plant itself, he said. There are more than 200 standards that the teams can look at, he said.

When a preliminary denial happens, there is an appeals process, which can take months, he said.

If the Joint Commission identifies areas as needing improvement, an organization has the opportunity “to submit evidence to clarify, or submit evidence that the findings were inaccurate or show evidence that they were indeed in compliance,” he said.

RMC is currently in the appeals process.

At the review Thursday, RMC will “address how we feel we were in compliance at the time of the survey in some of the areas” the Joint Commission identified as needing improvement, Williamson said “We want to clarify the responses and prove that we actually were in compliance.”

Williamson said accreditation often involves “fluid standards,” which change from year to year. Because of those changes, “you have to adapt your process” to fit, she said.

Accreditation by the Joint Commission is voluntary. “It is a voluntary decision to open themselves up to being evaluated on care and safety,” said Powers. “The purpose of accreditation is for the Joint Commission to work with the organizations to identify areas where they do need improvements and where they are doing well.”

Powers said the Joint Commission surveyed about 4,200 hospitals in 2007. Of those, approximately 1 percent of hospitals undergoing a full survey received a preliminary denial, he said and there were only seven denials of accreditation nationwide.

“It is a very stringent survey, and we have always chosen to participate in it,” said Williamson. “We ask them to come and do this stringent review, and you want them to help you find things and improve in areas you need to improve in.”

“One thing that concerns me is that I don’t want people to think that we aren’t a quality facility because we are,” she said. “These are just things that we need to improve.”

Williamson also pointed to a long list of other accreditations the hospital’s programs has from other agencies, including the hospital’s designation as a Tier 1 hospital by Blue Cross Blue Shield of Alabama, denoting quality care; and separate accreditations by the Academy of Sleep Medicine, the Food and Drug Administration (for breast-care services), the American College of Radiology, and the Commission on Cancer of the American College of Surgeons, among others.

RMC has been Joint Commission accredited for 51 years, Williamson said.

Areas needing improvement, according to the Joint Commission’s report include: labeling and storage of medication, completion of medical records, maintenance of fire-safety equipment and building features, and planning and documentation regarding anesthesia.

In the surveys, in addition to the requirements for improvement, RMC scored above the performance of most accredited organizations in heart-failure care.

In the end, Williamson said, having the “gold standard of surveys,” represented by the Joint Commission, even if there are areas needing improvement, “is an opportunity to improve the quality of care we offer.”

Once the appeals process is completed, “we expect to be back in full compliance. We take it very seriously,” she said.

About Mary Jo Shafer Mary Jo Shafer is assistant metro editor and business editor for The Star.

—–

To see more of The Anniston Star or to subscribe to the newspaper, go to http://www.annistonstar.com/.

Copyright (c) 2008, The Anniston Star, Ala.

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.

Medicare Cuts Take Air From Elderly

By Keith Purtell, Muskogee Phoenix, Okla.

Jul. 6–Government cuts in Medicare are doing more than slashing costs; they are cutting off the air supply to millions of elderly Americans.

As a part of the Deficit Reduction Act of 2005, the federal government is capping Medicare benefits for portable oxygen tanks and concentrators. Concentrators are home machines that extract pure oxygen from the air. The cap will mean that people currently on oxygen will become responsible for maintenance, repairs and replacement of their existing equipment.

The American Association for Homecare says that the typical Medicare home oxygen beneficiary is a woman in her 70s who suffers from late-stage chronic obstructive pulmonary disease and as a consequence has severe low levels of oxygen in her blood. Approximately 12 million Americans have been diagnosed with COPD, and an additional 12 million more remain undiagnosed.

Providers of oxygen and oxygen-related supplies are in a section of health care known as Durable Medical Equipment.

Barry Watson, with DME provider AlternaCare on West Okmulgee Avenue, said the public has not been fully informed about what’s about to hit.

“The average person has no clue this is happening,” he said. “It’s going to affect a lot of people. They make decisions like this on Capitol Hill, and the public doesn’t find out about it until later.”

Watson said he is worried about what will happen when Medicare no longer pays for servicing and maintenance of those concentrators after 36 months.

“Rental of the oxygen concentrator pays for a lot of the extra costs that are limited by Medicare,” he said. “For portable oxygen tanks, we are allowed $55 a month (per patient). A lot of our patients go through that in a week. So the rest comes out of the rental of the concentrator. We have patients who cost us $100 to $150 a month in tank rentals.”

When the cap comes down in January 2009, Watson said it will immediately change lives.

“What’s going to happen is that there will have to be a limit, and these patients will not be able to get out of their house as much as they want to,” he said.

Watson said that when concentrator service is limited, patients may not have any warning of faulty performance.

“Right now, every 30 days we are doing our concentrator checks as a service,” he said. “What will happen now is that unless the patients can pay companies to come out, they won’t know how efficient the concentrator is or how pure the oxygen is. Until it’s too late.”

Watson said he’s concerned that only human suffering will motivate the government to carefully consider the Medicare cuts.

“What I’m afraid of is that what will be required for this situation to change is for someone to get really sick or die,” he said.

Sherri Hiseley, co-owner of DME provider Medic-Aire Inc. on West Okmulgee Avenue, said the first wave of impact will be felt in only six months.

“Anyone on oxygen on or prior to January 2006; that was day one,” she said. “Medicare will pay 36 months and then cap at the beginning of 2009.”

And the effects are already being felt in how Medic-Aire does business.

“We’ve had to turn people away because we can’t afford to take on someone who is about to cap out,” Hiseley said.

RespiratoryMgmt.com published a data analysis conducted by Avalere Health that shows impending cuts to Medicare’s home oxygen benefit are much deeper than anticipated, totaling $710 million in 2009 and $855 million in 2010. The reductions in funding — which amount to an 18.8 percent reduction in the reimbursement rate — are the result of changes brought by the Deficit Reduction Act of 2005 and the Medicare Modernization Act of 2003, and will affect a significant portion of the more than one million Medicare beneficiaries with chronic lung disease who rely on home oxygen for health and independence.

The analysis shows more than 1.4 million Medicare beneficiaries will be impacted by the changes, amounting to approximately a $325 cut per patient.

“When you consider these cuts in a historical context, the severity is particularly significant,” said John Richardson, of Avalere Health, and one of the analysis’ authors. “Not adjusted for inflation, the average Medicare home oxygen payment by 2010 will be almost half what it was in 1997.”

Hiseley said only last minute action by Congress could halt what is about to happen. She is disappointed in the government’s decision-making process.

“I’ve seen this happen in our industry; the government never does their homework,” she said. “Our industry is only two percent of the budget for Medicare.”

The AAH agrees with that, saying the Durable Medical Equipment sector represents about 1.7 percent of the $400 billion-plus in total Medicare spending and is the slowest-growing sector in Medicare. There was 3.8 percent growth in Durable Medical Equipment spending from 2005 to 2006 (the latest year for which figures are available), compared to 19 percent growth for the entire Medicare program spending during the same period.

Additionally, according to a December 2007 survey of 1,000 adults by research firm Harris Interactive, Americans overwhelmingly prefer to receive home-based care over that delivered by nursing homes and other institutions. Moreover, three out of four (74 percent) Americans agree with the statement posed by the survey workers, “Homecare is part of the solution to the problem of rapidly increasing Medicare spending for America’s seniors.” That result is consistent across Democratic and Republican party lines and across age groups.

Hiseley said she is dismayed at the apparent lack of research in the federal government’s decision making. She can’t understand why such a small portion of the health care industry is being hit so hard.

“Somebody in the government just got the idea that we were making a killing,” she said. “There have been three cuts in our payments during the past 11 years. We get a set amount of $180 a month. It doesn’t matter how often we have to go out. We’re available 24 hours a day.”

Hiseley said that even from an accounting perspective, the numbers don’t work.

“It doesn’t add up in terms of dollars and cents,” she said. “It costs $2,000 a year to provide a geriatric patient with oxygen, but if they don’t get it and have to go to the hospital, it can cost $2,000 a day.”

As dramatic as that sounds, it may be an underestimate. The data analysis by Avalere Health stated the government is cutting a benefit that’s proved to be cost saving to the Medicare program. According to the Council for Quality Respiratory Care, home oxygen costs the Medicare program $7.62 per day versus as much as $4,600 per day in the hospital. In 2002, there were 673,000 hospitalizations for COPD with an average length of stay of 5.2 days.

In addition to the cap, the government has already introduced competitive bidding among providers, a move that is expected to add to paperwork received by patients.

After full implementation of the new competitive bidding program and 36-month cap, daily reimbursement for home oxygen will fall to between approximately $4.50 and $5.50.

The analysis went on to say that fully 22 percent of the 1.4 million Medicare beneficiaries who require home oxygen use it for more than 36 months.

Congressman Dan Boren, D-Muskogee, said in a media release that the DRA was something he considered flawed from the beginning.

“These health care cuts are yet another reason I voted against the Deficit Reduction Act of 2005,” he said. “My hope is that Congress and a new Administration will address this issue before Oklahomans, who desperately need these health services, are forced to pay increased fees for the use of oxygen-equipment.”

—–

To see more of the Muskogee Phoenix or to subscribe to the newspaper, go to http://www.muskogeephoenix.com.

Copyright (c) 2008, Muskogee Phoenix, Okla.

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.

NASDAQ-NMS:HPOL,

AirTran Planning 10 Percent Pay Cut

Discount carrier AirTran Airways said Wednesday that it’s seeking to cut its overall employee pay by about 10 percent to help offset soaring fuel prices.

“Our plan is to temporarily reduce pay rates for six months commencing with the start of the August pay period, and we will then review the situation again,” CEO Bob Fornaro told employees in a memo. “I must be clear that while we are starting with a conservative reduction as we monitor oil prices and industry conditions, we may need to do more in the future.”

Fornaro said cost-saving efforts the Orlando, Fla.-based carrier has already implemented — reducing capacity by 15 percent, cutting costs, raising $150 million in cash by selling stock, capping a portion of the company’s fuel exposure with hedges and raising ticket prices and fees — have not been enough to deal with the impact of oil prices that have doubled in the last year to more than $140 a barrel.

Pay cuts for union covered employees must be negotiated.

AirTran’s hub is in Atlanta.

Originally published by Bloomberg, AP and staff reports.

(c) 2008 Tulsa World. Provided by ProQuest Information and Learning. All rights Reserved.

As Joint Replacements Have Increased, so Have Payments to Surgeons

PHILADELPHIA _ In the past decade, hip- and knee-replacement surgery has exploded _ nearly doubling to about 750,000 operations a year and fueling a multibillion-dollar implant industry with profit margins approaching 20 percent.

With so much money in play, competition among artificial hip and knee manufacturers has fostered a system of five-, six- and seven-figure payments to doctors in royalties, consulting deals and speaking fees.

Those financial arrangements, long an open secret in the medical community, have now come under intense scrutiny from federal prosecutors and members of Congress _ who are considering legislation requiring disclosure.

Critics question whether the payments can present a conflict of interest by skewing doctors’ judgments on how best to treat their patients. At the same time, some concede that payments to pioneering surgeons who help design and patent artificial joints and other medical devices are legitimate.

Federal investigators who have examined the deals have in some cases found large consulting fees paid to doctors for little or no work, lavish trips disguised as medical seminars, and direct payments to surgeons that seemed aimed at convincing them to use a company’s products.

Last year, a U.S. attorney in New Jersey filed criminal complaints alleging that four of the largest artificial-joint makers conspired to violate a federal anti-kickback statute by making payments to surgeons as inducements to use their medical devices.

In a settlement, the companies _ Biomet Inc., DePuy Orthopaedics, Smith & Nephew, and Zimmer Holdings Inc. _ paid a total of $310 million, without admitting wrongdoing. A fifth manufacturer, Stryker Corp., cooperated with the probe and was not charged.

One byproduct of that settlement is disclosure statements, posted on the companies’ Web sites, showing for the first time all of the payments made to doctors. There is no breakdown detailing which payments were for royalties on patented devices, and which ones were for other purposes.

A Philadelphia Inquirer analysis found that 51 doctors got more than $1 million each in 2007 alone.

Locally, 29 doctors and others received a total of $7.9 million last year. Most of that money went to two of the region’s busiest and most prominent orthopedic surgeons.

Richard H. Rothman, founder of the Rothman Institute at Thomas Jefferson University Hospital, received nearly $3 million last year from Stryker. A Rothman spokesman said most of that money came in royalty payments for a hip Rothman helped design.

The other surgeon, Robert E. Booth Jr., who practices at Pennsylvania Hospital, received nearly $2 million from Zimmer Corp., the company that makes the so-called gender knee for women. Booth is one of eight patent holders on it.

Both doctors declined to be interviewed. Through spokeswomen, they said they disclose their company ties to patients. There is no indication that either have engaged in any wrongdoing.

Indeed, many patients seek out surgeons like Booth and Rothman, who help design implants, precisely because they are known as pioneers in the field.

At the University of Pennsylvania Health System _ which includes Pennsylvania Hospital _ patients are told which implant companies are paying the doctors, though not the amounts, officials said.

“It is important that you are aware of these relationships with implant manufacturers,” the Penn form states.

The surgery consent form at Thomas Jefferson University Hospital doesn’t list the companies, saying only that surgeons participate in the implants’ research and design.

“I am further aware that my surgeons may receive compensation” from the manufacturers, the form says.

Both Penn and Jefferson also have royalty policies aimed at preventing conflicts of interest, officials said. Doctors such as Rothman and Booth can’t get a royalty payment for any device used at the hospitals, whether they do the surgery themselves or not.

Neither health system requires that surgeons disclose the size of the payments they receive.

The implant makers and many others argue that surgeons’ expertise helps the companies develop better, longer-lasting implants. And, the proponents say, doctors deserve to be paid for their contributions.

“Guys at the top end are developing products, doing research, and are truly consultants for the companies,” said surgeon Paul Lotke, a former Penn professor now in private practice in Delaware County.

He says most patients actually like to hear that their doctors helped perfect the devices or surgical techniques they are recommending. Lotke was paid at least $125,000 last year consulting for two of the companies.

In this still-secretive world, it’s difficult even for investigators to figure out which payments are legitimate and which ones might be considered improper inducements intended to sway doctors to use a particular device.

The solution, many say, begins in better disclosure: making sure patients know who’s paying their surgeons _ and how much.

Several members of Congress are pushing a bill that would require better disclosure.

“Collaboration between device companies and surgeons can lead to medical innovation, so we’re not interested in severing those ties completely,” said Sen. Herb Kohl, D-Wis.

“Our hope is that requiring these relationships to be transparent will serve as a litmus test for legitimacy.”

For the doctors, the hospitals, and the device makers, the stakes are huge.

Hospitalizations for hip and knee surgeries generate about $25 billion in revenue a year.

In this boom atmosphere, one company executive said, the deals with doctors got out of hand.

“With hindsight, it now appears that as industry expanded to meet patient needs, the use of consultants may have been excessive at times,” said Chad Phipps, Zimmer’s general counsel, in testimony before Congress.

“Such excess has fostered a degree of mistrust, and invited the understandable scrutiny of the government.”

From 2002 to 2006, the major hip- and knee-implant makers spent more than $800 million on royalties, speaking fees, consulting deals and other payments to orthopedic surgeons, according to the U.S. Department of Health and Human Services’ Office of Inspector General.

“How can we trust what is said if the surgeons deciding which devices to use are paid huge amounts of money by the manufacturers?” asked Charles Rosen, a California spine surgeon.

To be sure, many or even most of the deals with doctors were legitimate, investigators say.

There’s nothing wrong with paying doctors to speak at conferences, or to train others to use a company’s implants. Firms routinely underwrite the cost of research, and pay royalties to doctors who help design devices.

But in some cases, prosecutors say, doctors did little or nothing for the money, other than agree to use a company’s products. Prosecutors contend that amounts to an illegal kickback.

“This had become a deeply ingrained practice … and we needed to do more than issue an admonition to stop,” said Michael Drewniak, a spokesman for New Jersey U.S. Attorney Christopher Christie.

“Until now, there was no transparency, and they operated in this kind of closed world,” he said.

Christie and the inspector general are continuing their investigation, now focusing on doctors and smaller companies.

“We are looking at the physicians who were receiving what we believe were kickbacks,” said Greg Demske, the OIG’s assistant inspector for legal affairs.

No doctors have yet been charged.

Makers of other types of medical devices are also under scrutiny.

In 2006, device-maker Medtronic Inc. of Minneapolis agreed to pay $40 million to settle accusations that it paid kickbacks to spinal doctors. The company did not admit wrongdoing.

In the case, which began with a whistleblower complaint, the government alleged that “Medtronic paid kickbacks in a number of forms, including sham consulting agreements, sham royalty agreements, and lavish trips to desirable locations.”

In a 2003 e-mail to a whistleblower, a Medtronic lawyer said he would pay for golf and theme-park visits, but thought it would be a good idea to have the doctors kick in for the fishing, sailing and surfing.

“When we are sending scores of doctors to a nice resort like this under the guise of training and education on our products, I think we need to be more careful and stick to the limits of our rules as best we can.”

Now, the cardiac-device industry is getting a close look as well.

Medtronic, in corporate filings, said it is cooperating with Philadelphia U.S. Attorney Patrick L. Meehan’s inquiry into payments to doctors who put in stents and other heart implants.

Meehan would not discuss the investigation. In general, he said, doctors should be giving feedback to device makers. But when financial ties don’t “pass the smell test … you begin to invite scrutiny,” he said.

Even if a doctor performs a real service, Meehan noted, a payment can still be a kickback if the goal is to sway the doctor to use the product.

Medtronic and several other heart-device makers also have been asked to supply information to investigators for the U.S. Senate.

At 72, Rothman, the former chairman of orthopedic surgery at Jefferson, remains busy, replacing more than 600 hips and knees a year. Implants cost as much as $7,500 each.

According to Stryker’s disclosures, the company paid Rothman $2.9 million in 2007. In addition, Rothman received $316,885 in “corporate assistance” for research, $52,906 in air travel, $4,705 for ground transportation, and $1,757 in meals.

“The vast majority of payments Dr. Rothman receives from Stryker are royalties for the Accolade hip implant,” said a statement provided by the practice he founded, the Rothman Institute.

Other surgeons at the institute, William J. Hozack and Peter Sharkey, received between $625,000 and $675,000 each that year from Stryker, according to the company’s disclosure, which provides no further detail about the nature of the payments. Together, Hozack and Sharkey replace about 900 knees and 800 hips a year, according to an Inquirer analysis of billing records.

Both doctors declined to comment. Whitney Hays, a spokeswoman for the Rothman Institute, said that some medical staff receive compensation for “the expertise and counsel they provide to medical device manufacturers,” either as royalty payments “because the physician invented or participated in the invention of a device,” or as consulting fees.

“We disclose these relationships to patients and other interested parties as appropriate,” she said.

At Pennsylvania Hospital, Booth, one of the nation’s busiest knee surgeons, routinely replaces a knee in under a half-hour _ 12 to 14 a day, or about 1,200 a year.

Last year, Zimmer paid Booth $1.9 million, plus $35,729 in air travel, $3,135 for lodging, $1,214 for meals, and a $6 gift.

Susan E. Phillips, a senior executive at the University of Pennsylvania Health System, said Booth’s contract with Zimmer prevents him from discussing royalties.

Another surgeon in Booth’s practice, David Nazarian, replaces about 650 hips and knees combined annually. He received $392,829 from Zimmer last year. He declined to comment. The company paid an additional $319,302 to the practice.

Until recently, few doctors or hospitals routinely told patients the details of these financial ties.

“I think it has evolved over the last five years or so,” said Nicholas A. DiNubile, chief of orthopedic surgery at Delaware County Memorial Hospital. “Certainly, the federal investigation accelerated that process.”

Rosen, the California spine surgeon, and other critics are pushing for more transparency. And that means not just revealing the names of the companies _ as is commonly done in the leading medical journals _ but detailing how much was paid, and for what.

“To just see the name of a company doesn’t have the same clarity of being told that he or she gets $800,000 a year from the company,” said Rosen, founder of the Association for Ethics in Spine Surgery.

One former prosecutor says the sheer size of some of those deals raises questions about whether doctors’ decisions were tainted and, ultimately, whether patients were harmed.

“What services were the doctors rendering to warrant those kinds of fees? What particular studies, lectures and research was performed to justify these payments?” asked David R. Hoffman, a former federal prosecutor in Philadelphia. Hoffman developed the legal foundation that enabled the federal government to sue nursing homes and other health providers for fraud based on poor quality of care.

The Physician Payments Sunshine Act, sponsored by Sens. Kohl and Charles Grassley, R-Iowa, would require companies to disclose all gifts, fees or other compensation of more than $500 a year.

If it passes, the federal health department would, starting in 2011, create a searchable database of industry payments to all doctors.

Recently, trade groups representing pharmaceutical and device companies endorsed the measure.

For now, only payments by the top five hip- and knee-implant makers _ who command 95 percent of the market _ are available for the public to see.

For at least one implant maker, the era of huge payouts to doctors may be ending.

In April, the Indiana-based Zimmer announced that it would overhaul its compensation deals with doctors, ban gifts, and tighten its training programs.

And from now on, Zimmer’s sales and marketing staff will have no role in setting payments to physicians. Nor will the company pay doctors to give talks at medical seminars.

Bringing the payments system to light is making a difference, Christie said.

“This industry routinely violated the anti-kickback statute by paying physicians for the purpose of exclusively using their products,” Christie said at the time of the settlement with the device makers.

“With these agreements in place, we expect doctors to make decisions based on what is in the best interests of their patients _ not the best interests of their bank accounts.”

___

(c) 2008, The Philadelphia Inquirer.

Visit Philadelphia Online, the Inquirer’s World Wide Web site, at http://www.philly.com/

Distributed by McClatchy-Tribune Information Services.

_____

PHOTOS (from MCT Photo Service, 202-383-6099): IMPLANTS 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. 1060110

Family House Comforts, Strengthens Patients

By Chris Togneri, The Pittsburgh Tribune-Review

Jul. 6–Julie Trahan was scared and homesick.

She had not eaten solid food in 18 months. Her weight plummeted to just under 70 pounds. Several organs were failing, and she was too weak to get out of the car.

But as her mother went inside Family House Shadyside and signed papers clearing the way for an indefinite stay in Pittsburgh, Trahan, 28, of Rodman, N.Y., got a good feeling.

“From where I sat in the vehicle, I could see little lamps and paintings through the windows,” she said. “I thought, ‘What have I stepped into? This is going to be good.’

“I kept thinking about Christmas for some reason,” she said. “I thought, ‘Well, if I’m still here, I’ll dream about walking down the stairs to a Christmas tree.’ We would have a huge tree. I imagined everyone around it, decorating it, putting presents under it.

“And then I wouldn’t have to miss home.”

That’s the goal at Family House. Now in its 25th year of providing shelter and moral support to critically ill patients and caregivers who travel to seek treatment in Pittsburgh, Family House is expanding. Officials recently began building a fourth facility, in Oakland.

Family House officials said they aim to create a homelike environment so patients can focus on fighting their illnesses, and to charge as little as possible. Rooms start at $30 for a single and run to $50 for a suite for four people. Prices at nearby hotels are two to three times higher.

The nonprofit was founded in 1983 by doctors and civic leaders who said they were tired of watching patients’ caregivers sleep in chairs in hospital waiting rooms. Donations and volunteers help to keep it running.

For critically ill patients such as Trahan, Family House is a blessing. She was diagnosed with post-viral gastroparesis, which prevented her from digesting food. She arrived in Pittsburgh on April 30 to await stomach, small bowel and pancreas transplants.

Trahan did not know where she was on the waiting list, only that she was close enough to the top that University of Pittsburgh Medical Center officials needed her nearby.

She was called in June 25, underwent transplant surgery and is recovering at UPMC Montefiore.

“She’s amazed the doctors and nurses with how great she looks,” Mary Trahan said of her daughter last week. “When she came out of the surgery, she said she’s hungry.”

Julie Trahan still faces a long and difficult road. She does not know how long she will be in Pittsburgh, only that when she is well enough, she will move from her hospital bed back to Family House for at least six months so doctors can closely monitor her recovery.

Because of the uncertainty around the surgery, her dad and sister stayed behind in Rodman.

Trahan misses them, but said she has found a family here.

“You end up acting and doing things like you would in your home,” she said. “We have puzzle night in the library, and that’s what I used to do with my sister back home. They have built this place for us — lonely people that are sick and need a place to stay.

“This is scary, but everyone here understands. Somewhere else, I’d be isolated and alone. Here, all of that melts away.”

Theresa Lewis, 48, and her mother, Beverly Lewis, 68, agree that staying at Family House has helped them navigate difficult times.

They travel to Family House every few weeks from Norman, Okla., while Beverly Lewis receives breast cancer treatment at UPMC Presbyterian and Shadyside.

“I was willing to go anywhere in the world, but staying at Family House is like staying with an extended family,” Theresa Lewis said. “You can talk to strangers here because you’re all going through the same thing.”

“It’s a place of hope,” Beverly Lewis said. “People come in here fighting for their lives.”

Theresa Lewis said she and her mother are their family’s only living members. In 1982, a plane crash in New Mexico killed her father and two brothers.

“We’re all going to die, but she can’t die until I go because I’m the only one left,” Theresa Lewis said. “I tell her that the day I die, she can go the next day.”

There are three Family Houses in Pittsburgh — two in Oakland, on Neville Avenue and McKee Place, and one in Shadyside, where Trahan stays, across the street from UPMC Shadyside. The facilities have a total of 115 rooms.

Demand is high: The facilities run at an average occupancy rate of 93 percent, and officials must turn away more than half of those seeking accommodations, Executive Director Christie Knott said.

To meet demand, the fourth facility is being built on the top four floors of the University of Pittsburgh’s University Club building in Oakland. That will add 45 guest rooms and suites, Knott said. The $4 million project is being paid for with donations — half has been raised — and should be completed by February.

After the expansion, the “turn-away rate” will drop from 54 percent to 28 percent, Knott said.

“That feels more in line with our mission,” Knott said. “Turning people away — it’s heartbreaking.”

Trahan is thankful she was not turned away. Before her surgery, Trahan said the wait for healthy organs was made easier by the staff and guests at Family House.

“In a hotel, I’d be the sick one,” she said. “People would stare at me. Here, there are whole days when I don’t even think about it. When you’re sick, sometimes you just need comfort. It takes your mind away from the aches and pains.”

More than comfort, the supportive atmosphere at Family House might actually give patients a better chance of surviving, said Holly Lorenz, vice president of Patient Care Services and chief nursing officer at UPMC Presbyterian.

“Cancer patients that have a strong faith or a strong family support system, their outcome, their response to treatment is much stronger than those who don’t,” she said. “I’m sure that there is that kind of effect going on at Family House.”

The 12 full-time and 22 part-time staff members at the three homes try not to become emotionally involved with guests, said Kay Bebenek, manager of the Shadyside facility.

But that’s not always possible, Bebenek said.

For example, she recalled the day Trahan arrived.

“Meeting her — it kind of choked me up,” Bebenek said. “I had to look away. I try not to get close, but how can you help it? I admire these people. Everyone who comes in here is fighting for their life. Yeah, we lose sometimes. But we have many success stories here.”

Even before her surgery, when Trahan did not know if the organs she needed to live would become available, she said Family House had given her the strength to imagine a future.

“When I’m married and have children,” she said, “I want my children to see this place that gave me hope and the will to carry on, the place that cared for their mother when she needed it most.

“I think that will be a beautiful day.”

—–

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

Copyright (c) 2008, The Pittsburgh Tribune-Review

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.

Changing Times Bring Greater Candor, Period

By Joanne Weintraub, Milwaukee Journal Sentinel

Jul. 6–Between the 1920s and the 1990s, the makers of what are rather primly called “feminine hygiene products” released a blizzard of booklets for the American girl.

The titles were discreet, if not downright puzzling. “Marjorie May’s Twelfth Birthday.””Growing Up and Liking It.””From One Girl to Another.””Very Personally Yours.”

No one published more of these pamphlets, which carefully blended education and product promotion, than Neenah’s Kimberly-Clark. The Wisconsin paper giant even commissioned a 1946 Walt Disney animated short, “The Story of Menstruation,” which was a classroom mainstay for more than 25 years.

But sometime in the last couple of years, notes Kimberly-Clark’s Deborah Hannah, the last of these booklets, “It’s a Girl Thing,” quietly went out of print.

“With the advent of the Internet, of course,” says Hannah, senior brand manager for Kotex products, “it was only natural.”

Girls surf the Net for games, gossip and help with their history homework, so why not for information about their periods? And to oblige them, www.kotex.com offers page after Web page of instruction, advice and good old-fashioned marketing aimed at turning young consumers into lifelong brand loyalists.

Ultra Thin Overnight Pads with Wings provide “all-night protection worth dreaming about,” while triangular Kotex Lightdays Pantiliners/Thong promise “light protection designed to fit thongs, (with) no bunching, no panty lines, no holding back.”

But even the replacement of the awkward belt-and-napkin apparatus of another generation with stick-on pads and tampons is no more significant than a pronounced change in tone over the decades.

The 1948 edition of “Very Personally Yours,” for instance, told girls to expect nothing more than “a touch of backache” and perhaps “a session of the glooms” during or just before menstruation. In the event of sudden gloominess, the young reader was advised: “Don’t dramatize yourself! Smile, Sister, smile!”

By comparison, the Web site is quite candid about the sensations that often accompany a teen’s periods.

“Your stomach hurts, you want to cry and you can’t fit into your favorite jeans,” girls read today. “Find out what causes these symptoms and what you can do to get rid of them and get on with your life.”

Then there’s the question of color.

In terms of skin tone, not surprisingly, the white-on-white look of the girls of ’48 has yielded to the usual suspects of today: the dark-skinned mom, the peaches-and-cream preteen with her cafe-au-lait friend, et al.

More interesting, though, is that the soft, ultrafeminine background colors of the ’40s and ’50s — a prime example of “Pink Think,” as Milwaukee-born social historian Lynn Peril called the era’s female ideal in her 2002 book of the same name — are now brightened by the addition of a forthright crimson. It is almost, but not quite, the color of blood.

What made Kotex abandon its better-dead-than-red design philosophy?

“Our ‘red dot’ campaign started in 2000,” Hannah says. And when she reminds me of the associated tag line — “Kotex Fits. Period” — I realize how familiar both the words and the red dot have become.

With the ad campaign, as with the still-evolving Web site, Hannah says, “we felt that, as important as it is to be discreet, there’s an opportunity for honesty, too.” A contemporary candor, she adds, is part of the Kotex “brand personality.”

Candor is what Molly O’Connell aims for, too, when she introduces girls to the subject of menstruation.

A former education director of the nonprofit Family Services of Milwaukee, O’Connell has been teaching about puberty since the ’80s, first in the Milwaukee Public Schools and later for the Girl Scouts.

O’Connell, who now speaks at the request of individual church groups, schools and youth organizations, doesn’t promote one brand over another.

Instead, she has a collection of “just about every kind of pad and tampon I can find, in every size,” for girls and their mothers to look at.

The questions from 10-year-old girls, the age of O’Connell’s usual audience, haven’t changed much in 20 years, she notes.

“They want to know if they can go swimming, and what to do if their clothes get stained, and whether it’s OK to wear tampons,” she says.

Unlike the old pamphlets, which referred to childbearing in terms almost guaranteed to mystify a preteen, O’Connell’s program is designed to explain “how babies get in and how they get out,” as she puts it, as well as how to understand the effects that hormones may have on a teen’s emotions.

She teaches a similar program for 11-year-old boys and their fathers that touches on menstruation but is devoted mostly to changes in the male body and psyche.

Both programs, O’Connell says, “cover everything from drugs and alcohol to emotions and pimples.”

—–

To see more of the Milwaukee Journal Sentinel, or to subscribe to the newspaper, go to http://www.jsonline.com.

Copyright (c) 2008, Milwaukee Journal 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.

NYSE:KMB, NYSE:DIS,

Infirmary Was the Worker’s Hospital

The North Staffordshire Royal Infirmary began life as a voluntary hospital, which lasted until the National Health Service arrived in 1948.

In 1804, a dispensary offering free advice and medicines was established in Etruria, and a fever ward, called the House of Recovery, was built in order to treat the infectious diseases that were rife in the area.

These buildings stood near to the site of the present Etruria Industrial Museum.

However, rapid industrial development and increased mechanisation in workplaces led to a rise in serious accidents.

The Etruria buildings, located on a cramped site, were clearly not adequate for the needs of the area’s growing population, whilst the nearest larger infirmary was located some miles away, in Stafford.

A new infirmary building was opened in 1819, near to the present Etruria Park.

With relatively few affluent people in the area ready to support the cost of providing free care, an appeal to the working classes was made.

The appeal proposed a system of financing the infirmary wherein workers would pay a small weekly subscription, a penny a week or less, through their place of work.

The workers then received free treatment for themselves and, by 1822, for members of their families.

This subscription strategy provided a successful financial framework for the infirmary right up until the creation of the NHS in 1948.

As medical technology and research advanced, the infirmary moved with the times. Although a medical record book written by R. C. Garner in 1854-6 gives a graphic account of cases in the infirmary, illustrating what life was really like in a busy working hospital.

The building itself was blighted at this time by the effects of coal mining, subsidence and industrial pollution.

As a result, the infirmary moved to Hartshill in the 1860s. The move may have come sooner, were it not for good old Potteries parochialism.

Burslem and Hanley led the opposition in the northern pottery towns against the move to healthier Hartshill.

The new, larger building was arranged according to the pavilion pattern adopted, although not invented, by Florence Nightingale. It was regarded as state-of-the-art and stood in what had been a hayfield.

The new venture was believed to need a lady superintendent, as advocated by Florence Nightingale. However, when tensions grew between the working men of the area and the lady, it was decided to replace her with a superintendent of nurses.

Intensive training of nurses followed and new methods of care were implemented.

In 1876, a caesarian section operation was performed by John Alcock. It was one of the first in the country in which both the mother and baby survived.

By 1906, complaints were lodged about over-crowding, especially in the outpatients’ department. But the ageing infirmary, with all its faults, performed well during the First World War, treating 2,500 war-wounded in-patients during the conflict, plus civilians.

King George V opened the new extensions to the infirmary in 1925, declaring to be Stoke-on-Trent a city and the infirmary to be a “Royal” one.

Sizeable donations from the Pottery Union, Miss Twyford and others enabled new wards and theatres to be created.

The coming of the Second World War saw a centralisation of hospital services.

The emergency hospital scheme brought together voluntary hospitals and municipal hospitals such as the City General and the seven infectious diseases hospitals across North Staffordshire.

This was seen as convenient re-organisation ahead of the creation of the National Health Service in 1948.

Tell us your memories of the North Staffordshire Royal Infirmary. Email [email protected]

(c) 2008 Sentinel, The (Stoke-on-Trent UK). Provided by ProQuest Information and Learning. All rights Reserved.

Tomato Growers Losing Millions in Shopping Boyco8 Over Salmonella

Tomato farmers across the US are losing millions of dollars as shoppers shun their crops after they were linked with a salmonella scare.

Growers have been forced to plough up their fields or leave their tomatoes to rot in packing houses.

With losses across the supply chain topping EUR100 million (pounds 50 million), industry leaders are calling for a congressional investigation into the government’s handling of the outbreak, the source of which has still not been found.

Fast-food chains McDonald’s, Wendy’s and Yum Brands resumed offering some tomatoes on their menus in the last few weeks.

But now, during one of the biggest barbecue weekends of the year, tomato farmers say their summer season has already withered despite the government’s recent announcement that some other type of fresh produce might have caused the salmonella outbreak, which has left more than 900 people ill.

“Now the government has a doubt as to whether it was tomatoes after they’ve already blackened our eye?” said grower Paul DiMare.

Farmers, packers and deliverers fear it could take months to rebuild the EUR1.3 billion market for fresh tomatoes.

In Fresno County, one grower chose to lose EUR225,000 by letting his tomatoes rot in the fields because he would have taken a bigger hit hiring people to harvest them.

Officials with the FDA and Centres for Disease Control and Prevention have said the sheer complexity of the outbreak and the industry’s vast international supply chain have hampered efforts to find the sources of contamination.

Last week, the FDA suggested tomatoes picked weeks ago could have tainted packing sheds or warehouses that are only now sending their products to market.

There is also the possibility that the source itself is still on the market or that a different kind of produce is making people sick.

(c) 2008 Birmingham Post; Birmingham (UK). Provided by ProQuest Information and Learning. All rights Reserved.

Dr. Lemieux Joins Central Maine Heart

LEWISTON – Cardiologist Michael C. Lemieux, M.D., F.A.C.C., has joined Central Maine Heart Associates, 60 High St., a cardiology practice affiliated with the Central Maine Heart and Vascular Institute. He will see patients at the Lewiston offices and at Central Maine Heart Associates Waterville office.

Prior to beginning his work with Central Maine Heart Associates, Lemieux worked for several years with Northeast Cardiology Associates in Waterville. His professional experience also includes work as a private practitioner in the Lewiston-Auburn area.

A Lewiston native, Lemieux graduated summa cum laude from St. Francis College in Biddeford. He also studied at the University of Southern Maine in Portland and earned his medical degree from Louisiana State University of Medicine in New Orleans. He served an internship and residency in internal medicine at Worcester Memorial Hospital in Worcester, Mass., where he received the Chief of Medicine Award for outstanding excellence in medical education and patient care. He completed a fellowship in cardiology at Maine Medical Center in Portland.

Lemieux is certified in cardiovascular disease and internal medicine by the American Board of Internal Medicine. He is a fellow of the American College of Cardiology.

He is the son of Lionel and Therese Lemieux of Lewiston and has three sons.

The Lewiston practice can be reached at 753-3900.

(c) 2008 Sun-Journal Lewiston, Me.. Provided by ProQuest Information and Learning. All rights Reserved.

Sudanese Artist Shows ‘in the Raw’ Pieces Tahir Saleh’s Artwork Reflects His African Heritage and His Transition to the United States

LEWISTON – An exhibit titled “6,000 miles” and comprised solely of artwork by Tahir Saleh, an accomplished artist originally from the Sudan who now resides in Lewiston, will open at L/A Arts Community Gallery Wednesday, July 9.

An artist reception will be held from 5 to 7 p.m. Friday, July 11. The exhibit runs through Aug. 22.

Unlike most exhibits where artwork is matted, framed and then hung precisely on the gallery wall, this exhibit boasts artwork “in the raw,” acrylic paintings on canvas, board, and paper taken straight out of the artist’s studio to hang “en masse.”

Viewers will be surrounded by rich colors, bold strokes, flowing curves and rhythmic patterns blended together in vibrant abstract impressions, intimate tableaus and graceful figures. Much of the art focuses on the female figure – in Saleh’s words, “Dieu crea la femme.”

The title of the exhibit refers to the distance from the United States to the Sudan, but Saleh’s life has not been a straight line. Raised in what he considers “the crossroads of Pharonic, Nubian, African and Arab cultures,” his official art education began in Cairo, Egypt, where he received his first diploma. He soon moved to Italy and completed several degree programs ranging from painting to theater/cinema to biology at The Academy of Arts in both Florence and Rome. Since then, Saleh has had solo and group exhibits in Egypt, Italy, France, Germany, Switzerland, Eritrea, The Sudan, and most recently Houston, Texas, and Atlanta, Ga.

“When Tahir began talking with us about showing his work, we were intrigued. His credentials are that of a master. Now to see his work on the walls confirms his talent but also speaks of his compassion for the human condition that permeates so much of his artwork,” said L/A Arts Marketing Director Cheri Donahue.

Besides the opportunity to meet Saleh at the artists reception, the public is invited to stop in during one of his demonstrations: from noon until 3 p.m. July 17, from 10 a.m. to 3 p.m. July 18, from noon until 3 p.m. Aug. 14 and from 10 a.m. until 3 p.m. Aug. 15 .

The Community Gallery is at 221 Lisbon St., across from the Lewiston Public Library. Gallery hours are 10 a.m. until 3 p.m. Monday through Friday.

(c) 2008 Sun-Journal Lewiston, Me.. Provided by ProQuest Information and Learning. All rights Reserved.

Physician Was Beloved in Pulaski County

By Tricia Neal, Commonwealth Journal, Somerset, Ky.

Jul. 5–“To have such an esteemed person in our midst here in Somerset is an honor — not necessarily because of his designation as a doctor, but because of the person he was, is, and his legacy will continue to attest to long after he is gone.”

Karen Shepherd, a longtime friend, spoke those words of the beloved Dr. Richard “Dick” Weddle earlier this year as plans were being made for a celebration in honor of Weddle’s 96th birthday.

On Thursday, the physician — who never seemed to notice that he was too old to go to work every day — passed away after a brief illness.

He is survived by his wife, Estalene “Bitsy” Weddle — with whom he had celebrated a 67th anniversary just two weeks ago — three children, and several grandchildren and great-grandchildren.

A few years ago, Dr. Weddle told a reporter he couldn’t recall how or when he decided he wanted to be a physician. But the choice was obviously a good one for him. He became one of the most dedicated, respected, and well-liked doctors in the Somerset area during his lifetime.

He kept his own office open until 1993. Then he became the medical coordinator at Lifeline Home Health Agency and medical director at Sunrise Manor Nursing Home.

Until 2005, at the age of 93, he continued to report to his office at Lifeline in Somerset.

“I’m still kicking. I just don’t kick as high as I used to,” he said of his “retirement.”

“I don’t know how I did it,” Dr. Weddle said of his longevity in 2002. “I haven’t done anything particularly right. I’m just fortunate to have hit this age.”

His daughter, Susan Sullivan of Austin, Texas, believes that Dr. Weddle did plenty of right in his lifetime.

“He was a true gentleman,” Sullivan said last night. “Oh, that the rest of us could be half as good. … He had not felt well for a while, but he never complained. He was a small man who was bigger than life.”

Sullivan said her father “put everyone else before himself. He wanted everyone to have a positive attitude and to keep smiling.”

“He was a great listener,” she continued. “If he felt like you were asking for advice, he would give it, but if not, he would keep quiet.”

Richard Hunt Weddle was born in Somerset on April 17, 1912, “at 2:30 in the afternoon on a Wednesday,” he recalled recently.

He began spending time at the local hospital at the age of 14, developing an interest in patients’ illnesses.

“If my mother wanted me, she knew where to call,” he once said.

He traveled to the far reaches of Pulaski County with Dr. Green Cain — driving anywhere an automobile would go and then using a horse and buggy to reach the more rural areas — to help treat the population.

In 1930, he graduated from Somerset High School. He then attended the University of Kentucky and the University of Cincinnati College of Medicine.

He met Bitsy in 1939. Their first meeting was a blind date.

“She wasn’t much impressed with me in the beginning. … How she’s put up with me this long, I don’t know,” Dr. Weddle once said of Bitsy, who became his wife on June 21, 1941.

An observer of the Weddles’ relationship would find it difficult to believe that Mrs. Weddle would have ever been less than impressed with the bow-tie-donning doctor.

“He loved my mother more than anything,” Sullivan said of her father.

“They had a relationship like no other. They never went anywhere without each other, and he simply doted on her. … They lived a very charmed life in Somerset.”

The couple was known to share a dance on their kitchen floor when reruns of “The Lawrence Welk Show” aired.

Weddle shared his thoughts on marriage with a reporter in 2002.

“I heard once that in marriage, it’s 60/40 — both ways,” he said. “Sometimes it goes to 70/30.”

The Weddles lived in New Orleans for a time, and then Dr. Weddle was called to serve as a flight surgeon in World War II. He returned home in 1945.

In late 1949, the Weddles moved back to Somerset, and Dr. Weddle began his long career in his hometown — moving his family, which included four children, into a home on College Street built by his grandfather in the 1800s. The Weddles would remain in that home — across from Somerset High School — for the duration of their marriage.

In 1950 he helped open the Somerset Clinic.

Dr. Weddle once lamented that his wife raised their four children because he was too busy with his career. But Sullivan disagrees.

“He was always wonderful with us,” she said. “He was there for us if we needed him, just as he was there for just about anybody in Somerset who needed him.”

“I’ve had a good life,” Dr. Weddle said in 2002. “I wouldn’t change it.”

He was proud that he had kept his family in his hometown of Somerset, in spite of offers he received to move elsewhere.

“I guess I’m just a country boy,” he mused.

A funeral service will be held for Dr. Weddle Monday, July 7, at 11 a.m. at First United Methodist Church in Somerset. Visitation will be held Sunday from 5 to 8 p.m. at the church. Dr. Weddle’s complete obituary appears on page A3 of this edition or in the Obituaries section of this website.

—–

To see more of the Commonwealth Journal or to subscribe to the newspaper, go to http://www.somerset-kentucky.com/.

Copyright (c) 2008, Commonwealth Journal, Somerset, 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.

Points for Style

By Holtz, Shel

Points for style bookmark While not especially well organized, this slim volume offers solid guidance on handling Web-related style issues about the book The Elements of Internet Style: The New Rules of Creating Valuable Content for Today’s Readers by EEI Press Editors EEI Press (with Allworth Press), 2007 162 pages I have to confess to being a bit confounded by The Elements of Internet Style: The New Rules of Creating Valuable Content for Today’s Readers. There’s an expectation that any book leveraging the strength of Strunk and White’s The Elements of Style will mirror the organizational and structural approach taken by that ubiquitous reference guide. The Elements of Internet Style, though, is an odd mixture of narrative text and Strunk-ish listings. It’s easy, for example, to discern what the editors at EEI Press-the book’s authors- think of new or troublesome jargon. It’s all contained in a single chapter, listed in alphabetical order. If you’re seeking specific guidance on a particular dimension of writing for the Web, though, you’re pretty much stuck with reading through an entire chapter on the subject.

Nevertheless, The Elements of Internet Style has found a home with the other reference books I keep within easy reach. Those chapters that do provide quick access to preferred styles have enough value to earn a spot with the Harper Dictionary of Contemporary Usage, Words into Type, The Elements of Grammar, The Elements of Editing and Fowler’s Modern English Usage, not to mention my well-worn copy of Strunk and White.

I do wish the book were organized to make it easier to find a rule. For example, suggestions on how to deal with abbreviations, currency, dates, numbers and units of measure appear in a catchall chapter called “The Rules Used to Matter. What Now?” So do rules on electronic citations (how, in print, would you display the citation for a web site or a CD-ROM?). The book does have a comprehensive index, which addresses some of the problems. Nevertheless, I would have preferred it to be as easy as it is to find advice on using the active voice in “Principles of Composition” in Strunk and White.

You may not agree with everything you read in The Elements of Internet Style. One minor example: The authors advise against using http:ll and unvw when producing printed text containing URLs. I find it still useful for a number of reasons. Some URLs direct you to secure sites and use the https://form. It’s necessary to include that in print; if people don’t enter it, they won’t get to their destination. And as long as you need to include those, consistency suggests you should include the basic http:// as well. There are also some sites that don’t use the www (such as my blog, at http:// blog.holtz.com); adding the http:// and, if there is one, the www, simply makes the URL crystal clear.

But the remaining advice on URLs is sound. The authors advise against breaking them into two separate lines and, when that’s unavoidable, doing so after a slash but before a period “to avoid the appearance of terminal punctuation. And don’t insert a hyphen when breaking a URL; since internal punctuation is part of the address, adding a hyphen where it doesn’t belong can misdirect readers.”

That’s the kind of advice a lot of people are looking for, and The Elements of Internet Style is chock-full of it.

The Elements of Internet Style has found a home with the other reference books I keep within easy reach.

reviewed by shel holtz, abc, iabc fellow

about the reviewer

Shel Holtz, ABC, IABC Fellow, is principal of Holtz Communication + Technology in Concord, California. With his co-host Neville Hobson, ABC, Holtz produces the podcast “For Immediate Release: The Hobson & Holtz Report,” available at www .forimmediaterelease.biz.

Copyright International Association of Business Communicators Jul/ Aug 2008

(c) 2008 Communication World. Provided by ProQuest Information and Learning. All rights Reserved.

Grandmother Should Make Costs Appeal

I Read that a family who had to get rid of a gravestone because it was “too shiny” now has to pay pounds2,650 to the church but grandmother Margaret Storey can’t afford it (Echo, July 2).

I hope Mrs Storey will appeal against the costs award.

Her inability to pay is a factor that should be considered by the body that awarded costs.

Ability to pay is usually considered in other courts.

One would have hoped that the awarding body would take into account the emotional distress that Mrs Storey has experienced in going through this hearing.

Name supplied, Cheltenham.

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

Water Babies Take the Plunge

Laura Stuart-Cook

[email protected]

Riet Tupling (45), from Healing, has run swimming lessons for many years – and now she’s turned her attention to tiny tots.

She said: “I’m running basic swimming lessons for babies aged from just a few weeks old to three-and-a-half-years.

“Young babies love to get in the water because it gives them a freedom to move which they don’t have on land.”

Riet, who has four children – Rose (17), also a qualified swimming instructor, George (15), Frank (14) and Ruby (12) – is currently running two baby swimming classes each week.

She added: “Most people aren’t aware that you can take babies swimming at a very young age, they don’t even need to have had their first vaccinations, although most parents prefer it.

“There are special swimming costumes that you can buy to make sure they keep warm too.”

The sessions are held each Saturday at Whitgift School swimming pool.

Tots aged 18 months to three-and-a-half-years swim from 11.30am to noon, and babies from birth to 18 months go in from 1pm to 2pm.

Contact

The classes, which all involve parents, are pounds3.50. More information from Riet on (01472) 595848.

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