Steamy Web Sites Beckon Users to Massage Services

By Robert Gavin, Times Union, Albany, N.Y.

Jun. 27–ALBANY — It’s not every Web site where a raven-haired woman named “Nayka” will quote the finer points of Eastern arts, tossing in references to Tibetan lamas, all to help one have better sex.

On Albany’s craigslist site, such services are not only advertised, they lead readers to a Tantric Temple in Schenectady for massage and, among other options, “Ecstasy and Goddess Ceremonies.”

There’s just one catch.

According to police, many of the men and women who advertise massage services on the Internet are working illegally and, in some cases, are exchanging cash for sexual services.

“Most of these people are not licensed the state of New York for massage therapy. If they did do it, they could hurt somebody,” said Inspector John Burke of the Albany County Sheriff’s Department, which charged a Cohoes man who advertised on craigslist with prostitution on Wednesday after an undercover sting.

The craigslist ads range from the Web site’s “therapeutic” and “erotic” services to “casual encounters.”

Nayka’s advertisement, tame compared to others, shows a cartoon of a topless woman. “Come to, ignite and expand orgasmic energy,” her Web site, misspelling some words, stated on June 23. “Master ejaculatory control. Seperate ejaculation from orgasm, and become multi-orgasmic. Discover the magic of the G spot.”

On her Web site, Nayka identifies herself as a “Goddess Guru.” Her actual name is Farrah Ashline, 33, of Schenectady, formerly of Alexandria, Va.

She was charged with prostitution in August 2000 after a two-day police sting at motels in Colonie that netted six arrests. She pleaded guilty to disorderly conduct.

A 2004 Washington Post article identified Ashline as founder of GirlsGoingOut.com, a social group that “brought twentysomething women together at events where they bonded over food, wine, yoga and ‘Sex and the City’ viewings.” A past Post article said she had ‘the moxie of a young Gloria Steinem.”

In a phone interview Thursday, Ashline described her work as legitimate — and needed in the Capital Region.

“If people look at my Web site, they can clearly see I’m not a prostitute,” she said, noting she once lived in India. “I don’t just go see people off the street.”

She added, “I’m not even in the same category as these people. … This is something I take very seriously.”

Nayka said she is not a masseuse — though that was in her ad’s headline. Her ads note two Massachusetts licenses, neither of which could be verified by public records. Ashline acknowledged she has no license.

In any case, out-of-state massage licenses don’t count in New York, said Dan Kelleher, director of investigations for the state Education Department.

On craigslist, many postings openly state their massage practice is “unlicensed,” even though it’s illegal in New York.

“What they’re saying, it’s almost an open invitation for us to go into craigslist,” Kelleher said.

Illicit ads are not only on craigslist. A representative of the site could not be reached Thursday for comment.

On one Web site — http:// www.escorts.com — Capital Region residents give graphic details of what they offer, even using abbreviations for various services rendered.

Authorities call it the latest addition to the Capital Region’s sex trade, which runs the gamut from city streetwalkers to high-priced “escorts” working Saratoga Springs during track season.

On Wednesday, Burke’s investigators charged Keith Comire, 50, of Cohoes, with prostitution after he allegedly advertised his services as a masseur named “Erik.” Before the arrest even became public, law enforcement’s attention to the craigslist entries drew some attention.

“POLICE are out\taking people and computers,” posted one Albany-based advertiser, who did not use a name, in the casual encounters section of the Web site before noon. “I am a provider and was taken in this a.m.”

Even after the Times Union first reported the arrest online, one admittedly unlicensed Ballston Spa masseur named Jason was advertising “Hot rocks or natural professional Body Rub.” Two days earlier, another craigslist ad touted “Reiki Therapy” in Latham, Watervliet, and Loudonville, also acknowledging it was unlicensed.

—–

To see more of the Times Union, or to subscribe to the newspaper, go to http://www.timesunion.com.

Copyright (c) 2008, Times Union, Albany, N.Y.

Distributed by McClatchy-Tribune Information Services.

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Parents Take Consolation After Baby’s Death Through Organ Donation

ALLENTOWN, Pa. _ A blond, blue-eyed tyke who loved Goldfish crackers and showing his belly died too soon but gave something extraordinary in his short life: a liver, intestines and two kidneys.

On June 13, the day he died after a sudden seizure, 16-month-old Nathaniel Deitzel of Catasauqua, Pa., became an organ donor _ an unusual deed for a toddler.

Because of his parents’ heart-rending decision to contribute their son’s organs, at least two other children and one adult have chances to live longer, healthier lives.

“We both know how it feels” to lose a child, Valerie Deitzel said in a living room filled with her son’s toys, books and photos. “If we could prevent someone else from going through this …”

“This is a living hell,” said her husband, Jason, finishing her thoughts. “Mommies and daddies shouldn’t have to go through the pain we did, but it may be almost worse to have a sick child and know there’s help out there but it’s not coming to you.”

Nationwide, 646 children younger than 5 are waiting for a new heart, lung or other organs to survive. But young donors, whose organs are the right size for transplanting, are scarce.

Last year, only 192 children younger than 2 became organ donors after death, according to the United Network for Organ Sharing in Richmond, Va. And in the 20 years UNOS has collected data, children younger than 5 account for about 5 percent of the nation’s donor pool _ 6,104 of the total 117,022.

In many ways, that’s a good thing, UNOS spokeswoman Anne Paschke said, because it means few children are dying.

But it also makes it all the more difficult for families that are waiting for smaller organs and for transplant teams to broach the subject with couples consumed with grief.

“We know from surveys that it is harder to approach” families that have lost children than those who have lost adults, said Art Caplan, director of medical ethics at the University of Pennsylvania in Philadelphia.

Adults can make their wishes known in advance, he explained, or might have contributed to their deaths by driving recklessly, drinking or using drugs.

Parents who make such a decision can heal from knowing they’ve helped others, Caplan said, calling the act “heroic.”

The Deitzels said their decision wasn’t easy. Although both had registered to be organ donors when they obtained driver’s licenses, neither had thought about donating Nathaniel’s organs because he had never been really sick.

“We still don’t know exactly, 100 percent,” what caused his death, his mother said. Nathaniel developed “febrile seizures,” which doctors told them are brought on by a sudden and rapid rise or drop in temperature.

Nathaniel had a similar episode before, in February, his parents said, but he recovered from it. They said doctors believed the seizure was linked to common ear infections that weren’t always apparent. The boy went home after tests ruled out meningitis.

When he had another seizure this month, however, doctors at Lehigh Valley Hospital-Muhlenberg and Cedar Crest couldn’t keep his heartbeat and oxygen levels stable, the Deitzels said. Nathaniel’s brain swelled and he died.

Approached by representatives of the Gift of Life Donor Program, the Deitzels said at first they didn’t want to make that decision. Then they figured Nathaniel probably would have signed a donor card when he was old enough to drive.

Gift of Life is a 34-year-old organization based in Philadelphia that has helped coordinate more than 26,000 transplants in Pennsylvania, New Jersey and Delaware. Employees make sure the organs are suitable for transplant.

While awaiting autopsy results, the Deitzels take comfort in remembering the “tough little bugger” who smiled a lot and rarely complained. Nathaniel was talking more, his mother said, and would say “Da Da” and “uff uff” to imitate the family dogs.

“He made it fun to be a parent,” Jason Deitzel said.

The couple hopes they can keep the memories alive through a scholarship at Nathaniel’s Cambridge Day School in Catasauqua, Pa., and the transplants.

Valerie Deitzel said she had hoped her son’s heart could have saved another child’s life, but it had been damaged by resuscitation efforts. Doctors can, however, use valves from his heart in another child, she said.

Her husband said he heard Nathaniel’s liver went to a child close to his son’s age, his intestines to another child and two kidneys to an adult.

“We’re finding more and more what his legacy may be,” he said. “Hopefully what he’s done can provide more life to more children.”

___

(c) 2008, The Morning Call (Allentown, Pa.)

Visit The Morning Call at http://www.mcall.com/

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

CryoCath Introduces Arctic Front in Italy, Belgium and Spain

MONTREAL, June 27 /PRNewswire-FirstCall/ — CryoCath(R) Technologies Inc., the global leader in cryotherapy products to treat cardiac arrhythmias, today announced the introduction of Arctic Front(R) in Italy, Belgium and Spain. Arctic Front, the Company’s lead product for the treatment of paroxysmal atrial fibrillation (PAF), is a unique cryoablation balloon catheter that allows physicians to safely and effectively isolate all four pulmonary veins for the treatment of PAF.

“The introduction of Arctic Front in Italy, Belgium and Spain provides us with an exciting opportunity to deliver the benefits of our breakthrough therapy to a larger patient population and drive one of our key corporate goals of explosive and profitable revenue growth in Europe,” said Jan Keltjens, President and CEO of CryoCath. “As was the case in Australia and Hong Kong, the European medical community has demonstrated great confidence in Arctic Front based on its growing body of clinical evidence. By expanding our already strong presence in Europe, we are continuing to drive the adoption of our Arctic Front system worldwide.”

Prof. Dr. Claudio Tondo, Chief of the Cardiology Division and Director of the Cardiac Arrhythmia and Heart Failure Research Institute at the San Camillo-Forlanini Hospital in Rome, Italy performed the first procedures with Arctic Front in Italy on June 9, 2008. Dr. Tondo will provide leadership for the program in Italy, the second largest electrophysiology market in continental Europe.

“Arctic Front represents a step forward in the ablative strategies for atrial fibrillation. The cryoballoon from CryoCath offers a safe and effective approach favoring a substantial reduction of x-ray exposure time and, without the need to carry out a double transseptal puncture,” said Dr. Tondo. “The cryo technology represents an effective alternative to radiofrequency energy for safety reasons, prompting the extension of the ablative treatment to a larger population of patients suffering from paroxysmal atrial fibrillation. We are looking forward to a strong contribution towards expanding the use of the cryo technology in the ablation of atrial fibrillation.”

The first Arctic Front procedures in Belgium were performed in May 2008 by Prof. Dr. Pedro Brugada, Head of the Heart Rhythm Management Centre, UZ Brussel – Vrije Universiteit Brussel and Dr. Gian Battista Chierchia, Director Atrial Fibrillation and Pacing Program. Drs. Brugada and Chierchia have treated four patients in Brussels to date.

“We see great promise in the procedural simplicity of the Arctic Front System. The cryoballoon’s innovative shape facilitates anatomical placement in the atrium at the ostium of the targeted pulmonary vein,” said Dr. Brugada. “By its very design, the Arctic Front catheter simplifies the ablation of pulmonary veins and may reduce procedural time in the treatment of atrial fibrillation, in turn offering greater comfort for the patient and operator alike.”

Prof. Dr. Julian Villacastin and his team at Hospital Clinico San Carlos in Madrid, Spain have treated two patients since first using Arctic Front on June 24, 2008. The patients treated to date have had successful outcomes and no safety concerns have been reported. “We were very pleased with the ease of use afforded by the cryoballoon, its simplicity and the success with our first patients. We were particularly impressed with the spontaneous termination of the patient’s atrial fibrillation during the cryoablation and return of sinus rhythm,” said, Dr. Villacastin.

About Arctic Front

Arctic Front is a minimally invasive cryo-balloon catheter designed specifically to treat paroxysmal Atrial Fibrillation. This bi-directional, double balloon catheter enables physicians to rapidly isolate all four pulmonary veins for the treatment of AFib. More than 2,600 patients have been treated in more than 45 centres across Europe.

About CryoCath

CryoCath – http://www.cryocath.com/ – is a medical technology company that leads the world in cryotherapy products to treat cardiac arrhythmias. With a priority focus on providing physicians with a complete solution of catheter products to treat cardiac arrhythmias, CryoCath has multiple products approved in the U.S., across Europe and several ROW countries. The Company is developing additional products to expand its pipeline of products to treat cardiac arrhythmias.

This press release includes “forward looking statements” that are subject to risks and uncertainties, including with respect to the timing of regulatory trials and their outcome. For information identifying legislative or regulatory, economic, currency, technological, competitive and other important factors that could cause actual results to differ materially from those anticipated in the forward looking statements, see CryoCath’s annual report available at http://www.sedar.com/ under the heading Risks and Uncertainties in the Management’s Discussion and Analysis section.

CryoCath Technologies Inc.

CONTACT: visit our website at http://www.cryocath.com/, or contact Michael Moore,Investor Relations, Phone: (416) 815-0700 ext. 241, Fax: (416) 815-0080,E-mail: [email protected]

Arab American Nursing Organization Founder Rose Khalifa Honored By University of Calgary — Qatar

DEARBORN, Mich., June 27, 2008 (PRIME NEWSWIRE) — National American Arab Nurses Association founder and president Rose Khalifa, RN, BSN, was honored last month by the University of Calgary — Qatar during International Nurses Week in a tribute to nurses who have made extraordinary contributions and who have distinguished themselves and their profession.

Khalifa is executive director of Metro Healthcare Services, Inc., a Detroit-based non-profit fiscal intermediary that distributes federal, state and local funds to hospitals and healthcare centers for the care they provide to uninsured and underinsured patients. Before joining Metro in April 2007, she was a Clinical Nurse Educator, Transcultural Services, at Oakwood Healthcare System, Dearborn, for more than eight years.

Khalifa holds a BS degree in nursing from Davenport University and associate’s degrees in nursing, arts, science and commerce from Henry Ford Community College in Dearborn.

She is spearheading NAANA’s Inaugural Convention at the Detroit Renaissance Marriott Hotel, October 9-10, “Building Cultural Bridges in Healthcare: Strength in Diversity,” which will focus on healthcare workplace diversity and diversity among patients. Besides NAANA, Hispanic, African American and Filipino nursing groups and the co-sponsoring National Arab American Medical Association will conduct sessions directly related to their cultures.

U Calgary — Qatar also honored:

    * Florence Nightingale, the first real advocate for nursing as a    respected career;  * Walter Whitman, American author and humanist who enlisted as a    nurse in the U.S. Civil War;  * Dr. Nabila Al Meer, executive director of Nursing at Hamad Medical    Corporation, Qatar;  * Chontelle Frost, a 10-year nurse specializing in pediatric    intensive care;  * Jeanne Mance, a National Historic Person of Canada for her courage    in making hospital care available in a new land;  * Dr. Harry Plummer, professor of Nursing at UC -- Qatar;  * Dr. Fouzia AlNaimi, nursing advisor for the Qatari National Health    Authority;  * Layla Al-Jesmi, director of Staff Development in the Primary    Health Care Corporation, Qatar;  * Nada Zeidan, a 15-year Qatari career nurse who has worked in the    operating theatre and as a Head Nurse;  * Maithaa Aboueleinain, nursing director at Hamad Medical    Corporation, Qatar;  * Rufaidah Bint Sa'ad, founder of the nursing profession in the    Islamic world; and  * Hussien Nasser Mohammed, Chief Male Nurse in Occupational Health    for Qatar Petroleum. 

Khalifa founded the American Arab Nurses Association in 2002, which expanded its scope nationally in 2006, as a voice, a network and a resource for men and women in their pursuit of employment and advancement within the nursing profession. NAANA focuses primarily on the Arab-American nurse but it is an inclusive nursing organization fostering knowledge of cultural diversity and sensitivity between members and the community in the area of transcultural health care.

For information about the NAANA convention, contact 586-979-3801 or visit www.n-aana.org. For information about the University of Calgary — Qatar nursing program, visit http://www.ucalgary-qatar.ca/nurse.

The National American Arab Nurses Association logo is available at http://www.primenewswire.com/newsroom/prs/?pkgid=1446

This news release was distributed by PrimeNewswire, www.primenewswire.com

 CONTACT:  Ahee Communications            Renee Ahee            586-979-3801           [email protected] 

GOP Bills Aimed at Oil-Shale Use

By Suzanne Struglinski Deseret News

WASHINGTON — House and Senate Republicans picked up on President Bush’s request to open up oil shale exploration in Utah and other domestic oil production options with two bills introduced Thursday.

Each bill would remove the existing ban on the Interior Department from finalizing regulations to allow oil shale exploration on public lands. It would be a means to encourage companies to seek out producing oil in the West.

In a speech from the White House Rose Garden last week, Bush challenged House and Senate Democrats to approve a proposal that would increase domestic production to help reduce gas prices as well as the country’s dependence on a foreign energy supply, including developing oil shale.

Although Bush touted it as an immediate solution to gas price increases, opponents such as the Wilderness Society have cautioned that it is not a short-term solution, and the long-term problems may be worse than any benefits.

The Senate Republicans introduced the Gas Price Reduction Act of 2008, which also calls for oil exploration in the outer continental shelf, increase federal money for plug-in cars and increased staff for the Commodities Future Trading Commission.

“Our bill can be summed up in four words: ‘Find more, use less,'” said Sen. Alexander Lamar, R-Tenn., at a press conference Thursday with 20 Republican Senators, including Sen. Orrin Hatch, R-Utah, and Sen. Bob Bennett, R-Utah.

Part of the “find more” concept includes looking at oil shale resources. Bennett pointed out that the moratorium barring the Interior Department from finishing the rules of oil exploration on public lands puts the resource off the table for domestic production.

“Nobody is going to play a game in which there are no rules,” Bennett said. “So by effectively preventing the drawing up of the rules for the leasing process they have made sure that there will be no exploration on federal lands with respect to oil shale.”

Bennett said Utah has a pilot project moving forward on state land that could prove as early as later this summer how technology works to produce oil shale.

“There are over two trillion barrels potentially available for oil shale,” Bennett said. “Even if you narrow that down to what is technically available using present technology, and not anticipating any further progress in technology, there are 800 billion barrels of technically recoverable oil in eastern Utah, western Colorado, and southern Wyoming. It’s time we get going on that. It’s there for the taking, we need to take it.”

But Chase Huntley, energy policy advisor for The Wilderness Society said oil shale development is a “cruel fiction on the American people, promising a false solution to high gasoline prices that instead would hand over potentially tens of thousands of acres of federal lands to oil shale speculators.

“This bill falsely promises that oil shale will lower gasoline prices, when in fact the industry is years if not decades away from proving the economic viability, technical feasibility, and environmental safety of the technologies needed to squeeze oil from rock,” Huntley said in a statement.

Huntley said the technology to develop oil shale is not ready and its environmental impacts — particularly how much water it needs to be developed — are not understood.

“Pushing the BLM to finalize rules governing commercial leasing and production of oil shale now is irresponsible,” Huntley said.

The Senate bill also includes incentives for plug-in cars or vehicles that would run on batteries and use less gas, something Hatch has been advocating as a way to diversify transportation fuels.

“Some argue we must promote solar, wind, and geothermal as an answer to high gas prices,” Hatch said. “Well, obviously, cars and trucks don’t run on electricity. But what if we changed all that? Why not use plug-ins to apply hydroelectric, solar, wind, geothermal, and nuclear to our transportation sector?.”

Hatch said the electric grid is a domestic resource and much cheaper and cleaner than gas.

Meanwhile, the Republicans from the House Western Caucus introduced the Americans for American Energy Act, which also removes the moratorium from the Interior Department.

Rep. Rob Bishop, R-Utah, introduced the bill standing between two giant “Declaration of Energy Independence” posters playing off the upcoming July Fourth holiday, which caucus members signed.

“Congress should end the tyrannical rule over our nation by hostile foreign nations by encouraging more production of American energy from all of America’s bountiful resources,” according to the “declaration.”

The House bill is more extensive than the Senate one and includes opening up oil drilling in the Arctic Natural Wildlife Refuge. The Senate bill purposely left that proposal out, Alexander said, because some Democrats have problems with it.

But Bishop is glad to see ANWR in the House bill.

“You can’t piddle around,” Bishop said. “You either do everything or you don’t do everything.”

E-mail: [email protected]

(c) 2008 Deseret News (Salt Lake City). Provided by ProQuest Information and Learning. All rights Reserved.

Detox Diets Can Lead to Malnutrition

A patient recently asked me about a new diet plan called “Master Cleanse.”

It is a popular “detox” diet that starts off with 7 to 10 days of strict adherence to a concoction of lemon juice, maple syrup, water and cayenne pepper, topped off with salt water and a laxative tea.

“Will it help me lose weight?” he asked. I’m sure it will. When you withhold food and calories (the body’s source of energy), the body is forced to feed off its own stores of fat and protein. It’s called starvation.

According to a recent article in Today’s Dietitian _ a magazine for registered dietitians _ research on “toxin-ridding diet regimens” is practically nonexistent. After all, who’s going to pay for randomized, double-blind, placebo-controlled studies? Lemon juice companies? Maple syrup manufacturers?

And why _ when book sales are so brisk without any sound research _ would anyone want to go to the trouble and expense to actually prove these diets work?

But I digress.

Fasting _ not eating or drinking for a certain period of time _ has been used for centuries as a way to cleanse or purify the body. “Clear liquid” diets that allow only clear fluids such as broth, Jell-O and apple juice are often prescribed when tummies are sick and need some rest from digesting solid foods.

But besides cleaning out the bowels, how does the body rid itself of harmful substances? I hit my anatomy and physiology books to find out. Lo and behold, within each man, woman and child are two exquisitely designed detoxification systems:

_ The liver (a.k.a. “Master Detox Unit.”) This high-tech recycling plant is the body’s most active organ. Alcohol, harmful chemicals, toxic metals and other substances the body deems “not good” are shuttled to the liver where they are processed to be safely removed from the body.

_ Kidneys have been called the body’s “water purification plant.” They continuously filter toxins and other wastes from circulating blood and dispose of them out of the body. It’s a little too simple to reason _ as some adherents to these plans describe _ that harmful chemicals “get stuck in ells” and can be cleaned out with a certain diet. My liver and kidneys still shoulder the brunt of detox work to rid my body of unwanted toxins.

It is true that some toxic substances are stored in fat cells. And if you’re not eating, your body will process fat into energy, releasing these toxins. Any weight loss diet will do that.

Are detox diets harmful? Probably not in the short term if you are in good health. Not surprising side-effects include diarrhea, food cravings, tiredness and headaches.

Over the long term, severe restriction of nutrients and calories can lead to life-threatening imbalances. Malnutrition can be toxic, too.

___

(Barbara Quinn is a registered dietitian and certified diabetes educator at the Community Hospital of the Monterey Peninsula. E-mail her at [email protected].)

___

(c) 2008, The Monterey County Herald (Monterey, Calif.).

Visit the Monterey County Herald’s World Wide Web site at http://www.montereyherald.com/

Distributed by McClatchy-Tribune Information Services.

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

Phorm and Function Fuel Privacy Fears

By Walmsley, Andrew

From Whitehall’s loss of CDs containing the child benefit records of 25m citizens, to the hacking of customer databases, every week seems to bring another story of incompetence or criminality in the data world. Everywhere we go, we leave a data cloud behind us. From shopping habits to Tube journeys, little bits of information track our behaviour, while an estimated 4.2m cameras watch our indiscretions.

When we move online, we bask in the assumed privacy it brings us. People act out fantasies, masquerading as members of the opposite sex. Vast amounts of porn are watched, and otherwise responsible people download illegal copies of Hollywood films.

We also value our privacy for legitimate purposes. We talk to friends online, and prefer these conversations to remain private. We give our credit-card details to websites when we make purchases – and so the data cloud becomes denser.

Every search we make and web page we view, someone is tracking our interest. When AOL released the search behaviour of 650,000 users in 2006, it caused an outcry; few had realised how much information was routinely kept by companies.

Sir Tim Berners-Lee, inventor of the web, highlighted the issue in an interview with the BBC this week. ‘I want to know that if I look up books about some form of cancer, it’s not going to get back to my insurance company so that I find my insurance premium going up by 5%,’ he said, when asked for his thought about Phorm, the behavioural targeting company that has just signed a deal to supply data to Virgin, TalkTalk and BT.

Behavioural targeting (confusingly also known as BT) is the practice of gathering data about what people do online to inform decisions about what sort of content to display to them. A media owner tracks visitors to its site, and this enables them, for example, to serve ads for gardening products to people who have visited the gardening section of the site, even when those people are subsequently looking at the finance channel.

Until now, though, BT has been possible only on websites with tracking code installed. The number of competing systems available has also traditionally limited the coverage of each one.

Phorm is different. Through a deal with ISPs, it watches everything you watch, and takes notes. If you look at gardening content, it adds you to a gardening segment of users, and enables interested advertisers to target you later. It also differs from other behavioural systems in another major way – it doesn’t keep any data.

The search you make, or site you look at, allows it to segment you as a user. But Phorm discards the source information afterwards. In that sense, it is a lot less worrying than equivalent technologies offered by Google, Yahoo! and Microsoft, which store search histories for between 13 and 18 months. Most of us value our privacy, and guard it vigilantly from crooks and unwarranted intrusion from government. But privacy is also an area in which you find a lot of people wearing tin foil on their heads, convinced the CIA is reading their brains using microwaves. This can make it hard for the rest of us to tell what is really worth worrying about.

It may be that what Phorm does is less invasive of privacy than many of its rivals’ practices. But this will be ignored because Phorm is a convenient target that has helpfully stuck its head above the parapet. In so doing, it may have succeeded in spreading consumer concerns about privacy beyond the tin-foil lobby.

Phorm is different. Through a deal with ISPs, it watches everything you watch, and takes notes

30 seconds on… behavioural targeting

* Behavioural targeting (BT) emerged in 2005. Specialist networks include Tacoda, Wunderloop and BlueLithium

* Most providers have privacy policies that prohibit the personal identification of users and enable them to Opt out’ of allowing their data to be used.

* In research by Revenue Science and the Ponemon Institute, 63% of users claimed to prefer advertising that is based on their interests.

* BT is expanding in mobile. L’Oreal used mobile network Blyk to ask users which celebrity they looked like, and tailored offers to their replies.

* BT is most commonly used in the automotive, travel, finance, technology and entertainment categories.

* 2007 study by Jupiter Research showed that 63% of users targeted by BT ads were receptive, compared with 49% targeted by contextual ads.

Andrew Walmsley is co-founder of i-level

Copyright Haymarket Business Publications Ltd. Mar 26, 2008

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

Contemporary Women’s Roles Through Hmong, Vietnamese, and American Eyes

By Long, Lisa A

For many Americans, Southeast Asia and its inhabitants- particularly the Vietnamese and transnational ethnic groups such as the Hmong-become visible only through the lens of the Vietnam War. At the same time, contemporary Vietnamese tend to see that war as only one of the many imperialist conflicts in which they have been engaged for the past millennium.1 And the Hmong, with traditional roots in agriculture and no national ties to speak of, hold an even longer view, seeing this war and subsequent migrations as part of an ancient four-thousand-year-old history of conflict and flight through the highlands of modern China, Vietnam, Laos, Thailand-and now to the United States. Not surprisingly, gender roles in Southeast Asia and the United States have been profoundly shaped in both cultures by these traditions of invasion, resistance, and, often, flight. A complex, diasporic confluence of political history, militarism, immigration, and feminism emerged in the wake of the Vietnam War. To tease out these delicate global intersections, which continue to shape contemporary women’s lives, in this paper I explore representations of Viet and Hmong women in Vietnamese publications and public spaces and compare them to representations of women in the writings of Vietnamese American and Hmong American women. To this end, I pair images of Viet women culled from two Vietnamese publications, Images of the Vietnamese Woman in the New Millennium (2002) and Female Labour Migration: Rural-Urban (2001), and from the Vietnamese Women’s Museum housed in Hanoi with Lan Cao’s negotiations of Vietnamese American womanhood in her novel, Monkey Bridge (1997). As well, I examine representations of Hmong women at the Vietnam Museum of Ethnology in Hanoi, specifically a book of photographic essays by Hmong girls titled Through H’Mong Eyes (2003), and compare them to selections by Hmong American women writers and storytellers from the anthologies Bamboo among the Oaks: Contemporary Writing by Hmong Americans (2002) and Hmong Means Free: Life in Laos and America (1994). This essay questions the ethical and practical ends of Western, Vietnamese, and Hmong considerations of Southeast Asian women’s gender roles, especially when viewed through the sometimes totalizing grip of the Vietnam War-or the American War of Aggression, as it is called in the War Remnants Museum in Saigon.

To pursue such a comparative analysis, it is necessary to place American publications alongside Vietnamese texts that are often muitiauthoredsometimes with no clear sense of individual attribution. While the communal nature of these latter texts might reflect cultural traditions, the powerful state’s role in shaping them also presents a challenge in reading Vietnamese publications as sources of contemporary reality. In contrast, American texts of the sort I analyze here, produced in the relatively freer West, can be read as authentic, individual cris de coeur. Yet it is important to keep in mind that both types of publications are crafted in response to audience expectations and the unique demands of their respective publishing enterprises. The American texts are shaped by cultural traditions, gendered expectations, and economics. And even though the Vietnamese texts are products of the state, I read for moments that not only submit to but also strain against state orthodoxy.

It might also seem impolitic to pair the Vietnamese and the Hmong in this essay, for they came to the United States under very different circumstances: the former, almost immediately after US troop withdrawal from Vietnam as officially acknowledged compatriots at war; the latter, somewhat later as unacknowledged fighters in covert Laotian operations. Many southern Vietnamese immigrants come from educated, urban backgrounds, while many Hmong emerge from a rural and oral culture. And yet the Vietnamese and the Hmong sometimes struggle to convey their distinct cultures and histories to Americans who do not distinguish between them and may see members of both groups as painful reminders of failed American military might-as Lan Cao puts it, “invisible and at the same time awfully conspicuous.”2 Nevertheless, both the Hmong and the Vietnamese came to the United States as a direct result of this conflict and are associated in cultural representations of modern Vietnam in the United States.3 Not surprisingly, their ethnic and class differences are rigidly maintained in contemporary Vietnamese public spaces, where America is predictably represented as the failed imperialist, Vietnam as the resistant victor. This war clearly has different ideological meanings within Southeast Asia than it does in the United States, meanings that profoundly affect gender roles.

Western feminists have also had to resist different but equally significant imperialist impulses. They have often and rightly been accused of cultural blindness as they have sought to analyze the plights of non-Western women in non-Western and Western countries by applying Western models. Amrita Basu summarizes this practice: “The vast literature on women’s movements is characterized by three broad tendencies: it ignores women’s movements in the postcolonial world, considers women’s movements products of modernization or development, and assumes a sameness in the forms of women’s oppression and women’s movements cross-nationally.”4 These are all tendencies that have contributed to the insistence of some scholars and activists that women’s progress in Southeast Asia was antithetical to the colonialist wars that ravaged the region during the twentieth century and remains impossible under socialist or emerging capitalist regimes. Ultimately, such reading practices promote the idea that Southeast Asian refugee women become more “liberated,” more feminist, as they become more American. Inderpal Grewal and Caren Kaplan add that some women “live in the ‘West’ without being ‘Western,'” fostering interstitial identities that are not “unitary”; however, the “postmodern celebration of hybridity often retains the ‘us’ and ‘them’ paradigm that stems from modernist modes of description and representation.”5 Grewal and Kaplan’s work implicitly encourages us to probe further the specific contours of the relationship between the United States and Southeast Asia-and, subsequently, the relationship between the women who immigrated and those who stayed behind-because of the “losing” war waged in Southeast Asia.6

To decenter the West, I compare the gender roles represented in texts by Vietnamese American and Hmong American women to those of Southeast Asian contemporaries, rather than measuring them directly against multicultural, Western (“American”) traditions of womanhood.7 What do we do with the gender consciousness of women who have been exiled from the socalled third world to the first? Of Vietnamese women whose former nation is proud of the third world’s defeat of the first? How do these women’s adaptations of Western and Eastern gender roles help to clarify a global understanding of women’s roles and resistance to patriarchy? The oral narrative of one Hmong woman immigrant illustrates the particularities of such complicated subject positions. In “Ka Xiong’s Life Story,” as told to her son, Xiong writes to her children of their escape to Thailand from newly Communist Laos.

You were all still so small then. You were like little mice and piglets running alongside their mom. I loved you children so much then, and I love all of you so much now. You children meant and still mean everything to me. Sometimes, these days, when I see poor little children of other countries on television, it reminds me of how my own children were dressed in rags and were so very skinny due to the shortage of food and the difficulties we encountered along our way.8

This remark dramatizes the psychic mobility of women who reside between the so-called first and third worlds, whose children were once the “mice and piglets” struggling for survival, but who now see the rag-dressed, starving children of other mothers through the distance of television and time and relative plenty. Those children are now of “other countries.”9 I seek to map this space between nations that Southeast Asian and Southeast Asian American women inhabit together. For Hmong women, who have long eschewed national identities, this deconstructed, in-between space is especially crucial.

Thus it is necessary to understand Vietnamese and Hmong women in Southeast Asia and America in a specific historical and diasporic context. The women represented in the texts I consider here are not just non-Western or ethnic American women-they are non-Western and ethnic American women at war and after-hostile enemies and fervent compatriots, heroic mothers and vulnerable daughters. However, while militaristic understandings of womanhood continue to occupy Vietnamese and Hmong writers in Southeast Asia, the present-day realities of dot moi, or the post-igSo crumbling of the Soviet Bloc and subsequent integration of Vietnam into the global free market economy, preys on their minds just as keenly. The economic vacillations of post-war Vietnam and subsequent privatization of many social services, coupled with the maintenance of socialist control in many arenas of life, have had far-reaching effects on women’s gender roles, simultaneously encouraging individual self- sufficiency while requiring national fealty. Yet another part of this specific context is the recent historical trajectory of American feminism. Those who have come to the United States as firstor first-and-a-half-generation (those who moved as children) immigrants have arrived here in the midst of or in the wake of the second wave of feminism and the cultural changes that have resulted. Thus while immigrants to the United States have always had to reconcile gender roles and expectations from their home countries with those of the United States, it seems we have witnessed and are witnessing a particular and interesting phenomenon in the texts of Southeast Asian American women. Vietnamese American and Hmong American memoirs and fictions that treat gender roles and women’s experiences in the United States typically highlight the more oppressive aspects of native gender relationships. Indeed, the emergence of the personalized forms of Southeast Asian American writing treated here, as opposed to the more formalized, state- sponsored works that depict the status of women in Southeast Asia, reinforces the notion that the “personal is political.” Vietnamese and Hmong American literatures portray what Westerners would call “domestic abuse” and other cultural constraints that do not allow women to reach their full potentials. One might argue that these new Americans’ exposure to Western feminism and a so-called freer way of life has led them to see with new eyes the gendered worlds they have left behind-despite the immigrant communities’ desire to maintain cultural traditions. But in saying this I might be accused of falling prey to precisely the sort of arrogance and cultural myopia that I encourage us to question and that informs many Americans’ understandings of other non-Western cultures-particularly nations with which we are at war.

Vietnamese and Hmong texts situate what they assert as women’s “separate but equal” status within a broader military, national, and ethnic context and explain women’s current troubles in terms of the difficult yet lucrative transition into a market-based economy, rather than as the failure of traditional gender systems or the long- term fallout of imperialist wars. The war in Southeast Asia and its chaotic aftermath are understood as the triumphant proving ground of traditional values and women’s importance to their national and ethnic communities. In this context, the deployment of “traditional” women’s roles may be interpreted as the progressive retrieval of a repressed woman’s culture, rather than as a sign of a retrograde society.

Finally, it is important to remember that much Vietnamese American and Hmong American literature is written by first- and first-and-a-halfgeneration immigrants and tells of the women’s experiences migrating to the United States-a narrative with a starting point inevitably situated in war. Thus stories by and about these women are more properly called refugee literature than immigrant literature, and this changes the relationship of these particular groups of recently arrived Americans to the national narrative and to American gender roles. While those who remained in Southeast Asia contextualize the war with the United States in a larger narrative that includes any number of wars and experiences of exile, the stories of those who immigrated begin with the war with America-indeed, in many cases insist that we not forget their war service, for it is their loyalty to the United States forces that, in part, entitles them to Americanness.

Still, much is lost in the move from East to West. Dwight Conquergood reminds us that “The Hmong word for refugee is neeg tawg rog, ‘war-broken people,'” that “refugee” and “war” are integrally bound in the language, and that only war can drive the Hmong from their communities, threatening Hmong identity.10 Min Zhou and Carl L. Bankston III contend that Vietnamese American narratives proceed from a similarly mobile and milltaristic identity politics: “The difficulties suffered in Vietnam and in the move from Vietnam to America have given adult Vietnamese a strong sense of their own identity,” they suggest, confirming that the traumas of war and exile are seminal and defining experiences.” Indeed, given the ubiquitous realities of our postcolonial world rooted, as Constance S. Richards argues, in “contemporary global configurations” of “displacement, exile, and alien domination,” one must keep in mind that we are all constituted through these modern phenomena in ways that require more precision of our reading strategies.12

THROUGH VIETNAMESE EVES

The high position of women in Southeast Asian culture is shown to be distinctive by the authors of Images of the Vietnamese Woman in the New Millennium, published by the Center for Gender, Family, and Environment in Development in Hanoi. Basu has argued that “One way that women’s movements have sought to challenge the notion that feminism derives from bourgeois or Western inspiration is by finding symbols of women’s power within the precolonial context.”13 While such formulations still suggest that indigenous feminist icons have been reclaimed to meet Western expectations, nevertheless warrior women and powerful mothers attain prominent roles in national narratives to this day. Contemporary writers are careful to point out that women’s high status is not founded on modern Western feminist principles of freedom and choice; rather, they show how traditional strengths are refined by the numerous, increasing, and modern responsibilities assigned to women. For example, like many contemporary thinkers, the authors of Images of the Vietnamese Woman begin by both critiquing and recouping traditional Confucianism, initially decrying the fact that “it denied the women’s intelligence.”14 Instead, they recast the four traditional virtues of “industry, appearance, speech, and behavior” to focus on the woman’s role in a modern, industrialized world: women should, first, work hard; second, they should appear gracious, courteous, and intelligent to be a “female leader to solve successfully all affairs”; they should speak sweetly and patiently to “increase their powers of persuasion and the effectiveness of work”; and, finally, they should behave in a stereotypically feminine fashion to work for “the welfare of other people.”111

The “women warriors” who dominate contemporary renderings of Vietnamese women’s history are depicted as sacrificing not just for the good of the individual or the family, but, more important, for the benefit of the culture. In the beginning of When Heaven and Earth Changed Places, Le Ly Hayslip explains that her father taught her “to sacrifice one’s self for freedom … in the manner of our women warriors, including Miss Trung Nhi Trung Trac, who drowned herself rather than give in to foreign conquerors” when she and her sister triumphed over Chinese invaders in 40 A.D.16 For many Vietnamese, “liberation” and “freedom” are terms that do not connote personal or sex-specific advancements, but rather national progress, although Western feminists, as Kathleen Barry phrases it, look still for the formation of an “independent women’s movement” as a sign of progress. Alexander Soucy sees public images of warrior women, such as the dominant sculpture of Au Co, mother of the Vietnamese race, displayed at the Women’s Museum, as promoting a “feminism in Vietnam, [that,] rather than challenging the hegemonic masculine structure, tends to become only a vehicle for carrying broader policy issues; it has become a Trojan horse of nationalism.”17 Yet his critique, too, measures the women’s movement within Vietnam against an idealized notion of an autonomous feminism distinct from cultural and political constraint. Hayslip reminds us that the fundamental form of oppression in Vietnam is perceived as Western imperialism: “Vietnam was con rong chau tien-a sovereign nation which had been held in thrall by Western imperialists for over a century.”18 Contemporary scholar Bui Thi Kim Quy does not argue for the primacy of women’s or national liberation but, rather, for their interdependence: “liberating women is tantamount to liberating society as a whole.”19 Thus Vietnamese publications reanimate traditional views of women within modern paradigms, or try to argue that those who have assumed that ancient Vietnamese culture was inherently oppressive for women have been wrong all along as they have been unable to see the ways that women’s liberation is bound to the struggle for national autonomy.

In recent years, scholars have sought to reclaim the heroism of Vietnamese women during the war with the United States-a common tactic of liberal Western feminism as “lost” women are found and added to stories traditionally thought to be the sole domain of men. As well, war service is often proffered as a means for oppressed groups to earn fuller citizenship rights. Karen Gottschang Turner asserts that the reclamation of women’s voices is meant to “empower them”-in other words, “help” them to see the value of their work.20 However, this work, too, has been recast within traditional Vietnamese paradigms; Sandra Taylor argues that the more contemporary “long-haired warriors” who fought during the war with the United States, though still subject to traditional notions of Confucian womanhood and filial piety, saw liberation fighting as a family tradition and a national one that went back to the triumph of the Trung sisters. Though becoming more visible now through new scholarly work, the long-haired warriors were during the conflict the “invisible army” of “peasants by day, soldiers by night” who would booby-trap villages, hide Communist fighters, and communicate with guerillas in the jungle in the evenings while tending to children, the elderly, the home, and the economic needs of the family during the day.21 The supposedly private “productive labor” of the Mother (i.e., childbirth and childrearing) and the publicly meaningful “social labor” of the worker and nationalist warrior are mingled explicitly in the Vietnamese Women’s Museum, where the first priority is to “portray the significance of the ‘Mother’ image in the Vietnamese frame of mind.” secondarily, the exhibits represent the characteristics of Vietnamese women in the “course of national defense and construction as well as women’s activities in the international arena.”22 One of the largest and most compelling exhibits in the museum is a tableau showing a Vietnamese woman in a hut speaking with hulking American soldiers while members of the “revolutionary cadre” nestle in a shelter below her home. While it might seem as if the woman is merely trying to defend her home, hide the revolutionaries, and get the Americans to leave, Tuyet et al. suggest that she may be working on the offensive, as well: “many enemy servicemen asked mothers to show them the way to side with the revolution or to assist them with returning home. One of the commanders of US-puppet troops admits: ‘Mothers constitute a very effective weapon of attack in a political struggle. Their attack on the troops was the most dangerous.'”23

Again and again, the museum materials and displays insist upon women’s vital role in national construction and defense. However, just as the home is military theatre, domestic and military roles are naturally allied; as Tuyet et al. write, “the Mother myth is first of all the one of fighting foreign aggressors,” Indeed, the “birth of the nation is closely connected with the mother’s myth,” thus intimately linking national identity, militaristic narratives, and reproductive capabilities.24 Western associations of peace with femininity and war-mongering with masculinity do not correspond with these gender roles. While these stories of war-era heroism surely highlight the significance of women’s work during wartime, they also focus the triumphs and plight of contemporary women through the all- encompassing lenses of war and essentialized gender roles.

Though motherhood is almost fetishized in Vietnamese texts, becoming a “stay-at-home mom” as Americans understand the term in the context of modern capitalism is not an option for Vietnamese women, who are exhorted again and again to contribute to the national cause outside of the home. Even though Vietnam increasingly operates under free-market capitalism, the specific notion of distinct public and private realms does not seem to be a part of the Vietnamese tradition, though Western scholars continue to describe Vietnamese spaces in these terms. For example, Barry writes, “With economic development, women are able to move into the public economy and labor force, breaking their traditional confinement to the private sphere.”25 At the same time, Vietnamese writers chart their awareness of this paradigmatic slippage. Tuyet et al. state,

according to the conception of almost all countries in the world, men are responsible for bringing about income to the family, while women are economically dependent on the male sex, stay at home to do housework to look after children and at the same time, try to get additional income for the family. In Vietnam, it is the tradition that women are also economically responsible and this remains unchanged.26

Indeed, as the Vietnamese incorporate the free market with socialist impulses, Tuyet et al. suggest not only that individual women should be economically productive, but also that the family structure itself should be exploited for capitalist ends: “it is the positive aspect of the market economy to turn the family, which was in the past essentially considered a ‘sentimental unit,’ into an ‘economic unit.'”27 Families have become even more important to the national economy since the emergence of dot moi. Vietnam is still largely an agrarian society, where 80 percent of the population live and labor in rural settings; many urban families run small businesses or, increasingly, take on entrepreneurial ventures. Thus women’s labor “outside” and next to the home has always been integral to the economy.28 Indeed, the Constitution of the Socialist Republic of Vietnam, Articles No. 55 and 68, “define that working is a right and obligation of every citizen.”29 Thus the model woman in Tuyet et al.’s text runs an entrepreneurial household, but she works not just for the good of the family but, rather, for the whole community, using her profits to support charitable activities in her village.30 Barry also notes that the recognition of domestic chores as public domain activities “may actually contribute to the transformation, rather than the reinforcement, of gender identities.”31 The private realm that some in the United States understand as an isolated, limiting space, does not correspond to the Vietnamese division of space and labor in the post-war era, where “the woman worker is the image of the new woman.”32

In Female Labour Migration: Rural-Urban, Ha Thi Phuong Tien and Ha Quang Ngoc outline the contours of “work/home” expectations for contemporary Vietnamese women who migrate from farming areas to urban centers. Tien and Ngoc emphasize again and again that the economic well-being of the entire family rests on women’s shoulders; agricultural activities only take up the energies of the family for five to six months per year.” Indeed, Tien and Ngoc argue explicitly that women are more suited to the task of working outside and away from their rural homes than men. As they write, “despite of the fact that the wage of women was often fewer than men, they sent back to family as much as men did, because they saved better and recognized their obligation and responsibility for family much more.”34

One young porter interviewed by these authors asserts that she, rather than her husband, works in the city because “I am a woman. I can drink pipe water if I am thirst and eat rice with salt even I can stand with hungry, hardship, but man can nof.”35 Elsewhere, the authors assert that men spend their money on cigarettes, coffee, alcohol, and gambling.36 Thus men are as likely to stay at home, taking care of the children and minding the farmwork as women are in contemporary Vietnam, especially if it is perceived that women will be able to bring home more money-it is an economic decision as much as a gendered one. Le Thi argues that women do “everything,” taking care of the labor at home and outside, while the husband “is the one to play the role of decision-maker and of manager of production and family activities.”” Thus, one could infer that gender roles as Westerners understand them, to some extent, are reversed. Women are the hardcore laborers, while men “manage” the household. Men are unable to manage their bodily desires, while women are eminently in control. The money these women earn sustains whole communities as it is used to take care of relatives, support their children’s schooling, build houses, invest in new ventures, and pay debts.38 And yet they endure toxic work sites, sexual harassment, inadequate living conditions, and extortion from local mafia; the familiar and self-destructive rhetoric of female self-sacrifice resonates through these descriptions, as well.39

The authors of Vietnamese texts about women insist that women produce on what they call “an equal footing with men.” Indeed, “the idea of equality, participation in the electorate, and an independence movement on terms of shared sacrifice” initially drew women to support Ho Chi Minh and the communist movement as early as the 19305 in Vietnam.40 Literacy, equal pay for equal work, maternity leaves, and spousal choice were also integral elements of this ideology-familiar demands, not surprisingly, since Ho Chi Minh had been educated in the West. However, though some changes have occurred (e.g., polygamy has been outlawed), the promises made by the communists have not all been fulfilled, in part, because, while the government maintains control in many areas of private life, it has not created an economic safety net to provide for the basic needs of all citizens. Given the multiple demands made on Vietnamese women during war and after, it should come as no surprise that women’s contemporary complaints arise around what Western feminists would call “second shift” issues, or as they are framed in Vietnam, the “‘double burden’ of work in society and work at home.”41 The woman must “work in the rice fields, in society, in the office and factory. She takes care of the children and holds the secondary job.”42 Most scholars recognize, as Tuyet et al. write, that “in the process of economic restructuring women are much more affected than men,” though they maintain that women are able to quickly adapt themselves to new circumstances.43 The female migrants and other urban dwellers increasingly take on jobs in the “unofficial economic sector” that provide no social, health, or long-term economic benefits.

The definition of “gender equality” deployed in Vietnam, then, entails the “gender-based labour division,” creating a separate but equal logic that can be at odds with itself.44 Tuyet et al. argue that traditional relations between wives and husbands have changed; according to a 1994 study 96.5 percent of wives devote themselves to sick husbands, while 78.7 percent of husbands will wholeheartedly care for sick wives, proving “today men and women have equal rights: mutual respect, concern and care for each other.”45 Yet the authors find no contradiction in the numerical discrepancy cited here, nor in going on to describe the distinct roles of men and women within the family structure, for example, the disproportionate amount of housework taken on by women.46 In Vietnamese state-produced publications such as Images of Vietnamese Women, Female Migrant Labour, or the Vietnamese Women’s Museum Brochure, both differences in rights, which are supposedly ameliorated politically, and those of biology, which are immutable though celebrated, are acknowledged, and the dilemma for contemporary women is how to be all things at once. Though these representations clearly have their limitations, a more attentive reading of their imagery suggests the ways that a Vietnamese history of war and imperialism, as well as a present state oscillating between socialism and capitalism, both encourage and sabotage women’s ambitions in contemporary Vietnam. THROUGH VIETNAMESE AMERICAN EYES

Rather than producing state-sanctioned, historical documents of the sort found in Vietnam, first- and first-and-a-half-generation Vietnamese American women have developed a new series of autobiographical novels to tell their stories. Yet both genres seek to articulate a distinct ideology of womanhood rooted in historical tradition and present-day exigencies. Recent United States publications include Le Thi Diem Thuy’s The Gangster We Are All Looking For (2003) and Dao Strom’s Grass Roof, Tin Roof (2003), among others. For the purposes of this essay I will focus on Lan Cao’s Monkey Bridge.47 While there are many important differences among these autobiographical novels, for all, the protagonists’ childhood memories of their young lives in their native country are interwoven with the tall tales of adults, which together constitute the women’s connections to Vietnam and their negotiations of contemporary gender roles in the United States. As Cao reveals in an interview, her shifting between past and present, Vietnam and the United States, her mother and daughter protagonists, and, I would add, Vietnamese and Vietnamese American notions of womanhood in Monkey Bridge is “natural” because “as an immigrant what happens is that when you look at an event or an object even in the present world, very often you view it the way you view it now as well as the way you view it in a different cultural context . . . through two different cultural lenses almost simultaneously without even necessarily noticing it.” Cao points out that this simultaneity is now signified by an ampersand rather than a hyphen-Vietnamese & American versus Vietnamese-American-not only representing a dual rather than a melded ethnic-national identity, but also gesturing toward the particular “double burdens” of gender and ethnicity, cultural responsibility and individual desire, war and refuge, that occupy many women refugees.48

In Monkey Bridge, a Vietnamese American teenager, Mai, attempts to unravel the mysteries of her family’s history in Vietnam, which are most obviously embodied in her inscrutable mother, Thanh, who has also fled to the United States. As Mai notes repeatedly, Thanh’s napalm scarred and stroke-ravaged “body had become a battlefield, she a war wound.”49 Thus when Mai feels “the tug of my mother through my body,” she means not only her biological mother, but also her war-torn motherland and its notions of motherhood, heroism, and sacrifice.50 However, the seminal and traumatic war experience is also embedded in Mai, who wants desperately to escape memories of war-torn Vietnam. In the opening scene of the novel, Mai is visiting her mother in an American hospital after her stroke. There Mai endures flashbacks of her work in a Saigon hospital during the war, focusing on the explosion in an operating room that killed and injured many staff members: “Who could have known before the man was cut up that an unexploded grenade, fired from a launcher-not a dead bullet-had lodged in the hollowness of his stomach?” This man and his dangerous load can be read metaphorically as representing how war becomes literally entwined into the beings of survivors like Mai, a “subverted interior” an “implant in (her) brain” as she calls it, that leads her to see and know things in multiple ways.51

Mai and her mother embrace television’s The Bionic Woman as a transnational symbol of heroic womanhood, “a little bit of Shaolin kung fu mixed with American hardware, American know-how.”52 The Bionic Woman’s “bionic ears” are compared explicitly to Thanh’s ears, the length of which were believed to provide her with longevity and good luck. Indeed, Thanh claims in her diary that her ears heroically hear and then reanimate the lives of generations of young women whose inability to produce virginal blood on their wedding nights was announced by an earless roasted pig paraded through their villages-a ritual that led to their and their family’s ruins and even deaths: “Inside my ears were the rage and revenge of every girl from every generation before whose return with a shameful and earless pig had destroyed her family’s lives-lives my mother had now gloriously resurrected” the mother reveals in her secret diary.53 Cao has spoken of the Vietnamese martial arts novels that inspire Vietnamese girls today and influence such scenes. While American fairytales with their evil stepmothers and Prince Charmings promote a “kind of envy and competition among girls and women” these Vietnamese novels often feature handsome, skilled male protagonists, but “the main female is always his equal or better and always self- sufficient and knows how to do martial arts just as well as her male counterpart.”54 Thus Mais desire to leave home and study at Mount Holyoke is, as she explains to her mother, the “equivalent of a martial artist leaving her village to study kung fu at the Shaolin Temple.”55 While in her interview Cao concedes that Vietnamese culture is traditional, restraining women in many ways, she also reminds us that women “are not seen as needing male rescue . . . the idea of one’s identity deriving completely from the husband or the father, I do not see it.” This comment indicates, as Michele Janette also argues, that Cao is keenly aware of the Orientalist ways Western feminists might view Vietnamese gender roles, as well as the woman warrior tradition still dominant in Vietnam.56

The woman warrior tradition is an integral part of Mai’s story as well, particularly that of the “sword-wielding Trung sister, the greatest of all Vietnamese warriors.” The fact that Mai imaginatively inhabits the life of this Trung sister three times in the novel indicates that despite her seemingly successful integration to America, she continues to see her life in battle terms. However, she clarifies that the Vietnamese traditions she invokes are not those developed by an “empire-building country” but derive rather from “a history of defending, not crossing boundaries”- not the United States, but Vietnam.57 Thus, when she shows up at Mount Holyoke for the “dreaded college interview,” she draws strength from the “brilliant battlefield maneuvers” of the Trungs.”58 The art of war the sisters develop is one where the woman warrior does not “oppose an adversary head-on” but rather steps aside, pulling the enemy (in the folktale, a tiger) “forward, deeper in the direction of its own motion.”59 While some scholars read this “all-out guerilla warfare, the poor person’s weapon,” as uneasily representing Vietcong tactics within the context of the novel, one might read it at the same time as a gendered strategy. The ability to “turn even an armed force one hundred times our strength into a terrorized one” is the strategy of the physically weak but strategically superior force-the strategy of women who might deliberately make the enemy “see a weak front” but who have “strengths-columns of reserves” from which to draw upon.60 Again, given the cultural context in which Mai operates, one could argue that she is manipulating American stereotypes about meek Asian women, ironically, by drawing upon traditional Vietnamese women’s roles.

This warrior strategy is not deployed literally in the novel; rather Mai, her mother, and the other women in the refugee community transform the ancient tactics of martial arts into rhetorical and even economic strategies meant to help them not only survive, but thrive, in a culture which would underestimate them because of racist and gendered stereotypes and situate them in disturbing militaristic narratives. At her college interview Mai chooses not to confront head-on the “preconceived notions” of the interviewer about Vietnam but rather to rhetorically weave “drunken-monkey style” and master the “art of evasion and distraction.” Janette labels this strategy a “guerilla irony” that makes Vietnamese experience “indigestible” to American readers.”1 Thus when the interviewer asks curiously what it was like in Vietnam, Mai describes the weather-clearly not the sort of sensational or tragic detail the interviewer was soliciting. As Mai claims later, “stereotypes aren’t my enemy, as long as we tinker with them in a way that strikes an American chord,” suggesting that she turns the rhetorical weight and heft of stereotypes to her advantage.62

And just as the Trung sisters trained an army of women to fight together, to He in wait, and to stalk, the older women immigrants who dominate the refugee community work together to set up a “hui, a community pot of money designed to give those who would otherwise be unqualified for bank loans immediate access to a lump sum of cash.”63 This strategy is in keeping with Vietnamese notions of female economic ambition coupled with communal tendencies. Later on, Thanh writes that her daughter is “under an illusion of freedom. Unless you create your own circumstances, make your own luck, determine your own fate, forge your own path through uncharted territory, you’re not free in her eyes.”64 Despite the fact that the hui members discover “their favorite English word was ‘entrepreneur’,” notions of American individualism and capitalism do not suffice; Thanh believes in the pull of the past and the power of the community.65 Indeed, her entrepreneurial venture is directly derived from her Vietnamese past (she will produce “authentic” Vietnamese pickles for local restaurants) and from the pain encoded therein: “anyone with the right know-how and patience could massage the bittersweetness of nostalgia into hard cash.”66 Just as contemporary Vietnamese pragmatically market war culture through venues such the nightclub “Apocalypse Now,” the embalmed giant tortoise supposedly gunned down by United States forces in Hanoi, the Hanoi Hilton, the Museum of the War of American Aggression, and the Cu Chi tunnels, replete with wax figure soldiers, Mai’s mother is willing to traffic in sensual memories of Vietnam-which are attached to war for Americans and Vietnamese refugees alike. As the novel unfolds further, Cao comments on traditional Vietnamese “gender equality” and the Mother myth from a distance. As Mai is about to leave home for college, she begins to understand her mother’s life in Vietnam. Thanh leaves a diary account of her marriage that draws on the language of battle and exile to make sense of women’s gendered positions.67 As she prepares to move to her new husband’s family’s home at the age of fifteen, she claims that her marriage has been a love match; however, Thanh didn’t realize at the time that she had lost a silent yet decisive battle: “there had been no singular calamity that conspired to vanquish me, no remarkable catastrophe that would warrant a battlefield badge or a medal.” Like other Vietnamese women, she lives in a sort of perpetual exile, even in her own country, as she is driven from her parents’ home and into the home of her new in-laws. “This, of course, was the beginning of my emigration, years before my second one, to the United States” Thanh writes, explaining that she is a “special kind of exile . . . in [her] own country.”(TM) Married Vietnamese women are already immigrants, a diasporic population within the home country. The traditional expectations of her husband “may not be much different from wars and other acts more stark and obvious in their capacity for violence,” she realizes.69 Cao focuses not on physical violence within this relationship but rather on an intellectual and emotional distancing and abuse that causes a psychological disaffection similar to that suffered by some refugees and colonized peoples.

And it is through the tropes of war and exile that Thanh can connect her gendered experience as a Vietnamese woman to the immigrant experience of her increasingly Americanized daughter: she writes of her in-laws’ properties, “a house, even another’s house, a kitchen, a country store, each of these things could be made to have its own hidden beauty. That, I suppose must be what my daughter has learned to see in this new country we have suddenly found ourselves in, a beauty that she finds palpable but which seems to be beyond my reach.”7” The mother’s exile is situated geographically in the domestic realm (a house, a kitchen), while the daughter is located in the vast expanse of a “new country.” However, they are both forced to identify the “beauty” of their adopted surroundings and to fit themselves to its contours.

Thanh’s body becomes a living symbol of the fragmentation of war and exile; her stroke makes her appear to her daughter “altogether undone like bits of glass reglued.” However, later we learn that the old burn scars that mark her face are not the result of a domestic cooking fire, as Mai had always been told but rather are “seared by a fire dropped into the free-fire zone from a plane.”71 Thus the wounds supposedly suffered in the name of domesticity are both superseded by and politicized as the wounds of war. Cao eventually makes this connection between war and Motherhood explicit. In the end of the novel, Thanh commits suicide, and in doing so reclaims the role of the traditional Mother, but here for individualistic ends, to save her daughter from bad family karma. As Cao states in an interview, “the epitome of female virtue would be a woman who, even though she is very strong and could be alone and does not need male protection, nonetheless decides to sacrifice herself completely for her husband and the children.”7′ Thanh is, then, a self- sacrificing hero within the domestic realm, protecting her family line. However, the passage describing Thanh’s suicide is followed immediately by a description of the Buddhist monks who immolated themselves to protest the war, an act of “supreme devotion”;71 this juxtaposition gives the Mother’s suicide political and social significance beyond the family. Thus Cao negotiates an Americanized, a traditional Vietnamese, and even a socialized view of the Mother in her text. Indeed, motherhood-and subsequently war-become transnational categories, “the same in every language,” according to Cao. “The true division in this world, I believe, is not the division founded on tribe, nationality, or religion, but the division between those of us who are mothers and those who aren’t,” Thanh concludes, denying the male/female dualism integral to Western feminist paradigms and instead announcing an alternative duality- mothers versus nonmothers.74

Cao replaces one dualism-“tribe, nationality, or religion” versus outsiders-with another that is even more central to some feminisms in its essentialism-mother versus nonmother. Ultimately her novel does not eschew the Mother power of Vietnamese tradition but rather transforms and extends Jt, in this case, to the first-and-a-half generation of refugees who become not literal but figurative mothers to their parents, creating a “transmaternalism” of sorts. Largely because of Thanh’s lack of facility with English, Mai becomes her translator and protector in the new country, using her English skills and her growing knowledge of American culture to do her mother’s bidding. This often requires deception on Mai’s part, in keeping with the strategies of the Trung sisters, and elicits her embarrassment. But she recognizes that she has no other choice as she “scoop [s her] mother out of harm’s way and give[s] her sanctuary.”75 And though she is ultimately unable to “save” her mother, Mai can use her defensive techniques to try and provide her with the safe space the perpetual exile has never had.

THROUGH HMONG EYES

While Vietnamese women claim the label of perpetual exile, the Hmong as a whole are a deeply diasporic culture, for they have never truly had a “homeland.” Ines M. Miyares demonstrates in her study of Hmong immigrants that the strong cultural identity of the Hmong developed precisely because of their existence as a migratory people who have during the last four thousand years “dispersed throughout southern China, northern Vietnam, northern Thailand, northern Myanmar, northern Laos, and since the fall of the Royal Lao government in 1975, in Australia, France, Canada, Argentina, and the United States.”76 To maintain their traditional ways, despite lacking a common geographic space or national identity, the Hmong tended to live in relatively isolated mountain communities in Southeast Asia, where they organized themselves in patriarchal clans and farmed rice, corn, and poppies. Most scholars believe that they had no written language until the 19505 and relied on oral narratives, material artifacts, and animist beliefs to convey cultural traditions.

Some scholars assert that the word “Hmong” translates roughly as “free.”77 Given the ideological importance of “freedom” to Americans generally, and feminists in particular, it is not surprising that this translation of “Hmong” has remained attractive for many in the United States. Regardless of its direct meaning, the search for-or maintenance of, depending on one’s point of view-cultural autonomy is clearly as significant for the Hmong as it is for the Vietnamese. Indeed, it is this passion for freedom that led the Hmong to work with the Americans during the Vietnam War, joining forces with the American CIA to wage a covert war against the North Vietnamese, who the Hmong feared would take over the Southeast Asian peninsula and once again disrupt their lives. Despite widespread belief among the Hmong that the CIA promised them an ‘”autonomous kingdom'” if they should suffer defeat, in 1969 the US government concluded that the United States was under no obligation to help the Hmong,78 Subsequently, when Laos fell to the Pathet Lao and the North Vietnamese after American troop withdrawal, “100,000 Hmong perished and an equal number fled across the Mekong.”79

Since the Pathet Lao murdered or marginalized the Hmong who remained in Laos, making their traditional mountain lives impossible, contemporary representations of Hmong women in Southeast Asia often derive from groups residing in Vietnam or Thailand, either in the traditional rural communities that have survived or in the refugee camps set up for the persecuted Hmong after the Communist takeover. Given this context of war, flight, and contact with Western culture, contemporary representations of Hmong women in Southeast Asia draw upon traditional Hmong notions of female subservience and domesticity and new notions of freedom claimed for the lives of modern women. For example, while ethnic Viet women are represented in the Women’s Museum in Hanoi as engaging in the public world of national defense and politics, ethnic Hmong women appear only on the floor that features the traditional handicraft products of various tribal cultures. In this way, they are made marginal to national narratives and ahistorical, as their handicrafts are shown to be unchanging and irrelevant to contemporary concerns. However, when one understands the history and subsequent recorded culture of the Hmong, as well as the contemporary roles of Hmong women in the capitalist economy, these handicrafts come to have significant meanings.80

Discussions of women’s needlework in the postwar era in particular draw on the past and the future roles of Hmong women, as well as their exploitation of militaristic narratives. For example, Jane Hamilton-Merritt claims that the ancient Hmong did have a written language despite claims to the contrary, but that it was outlawed by the Chinese under penalty of death. It was women, she asserts, who cleverly kept their alphabet alive by including its letters in intricate, hieroglyphic-like patterns passed on generation after generation from mother to daughter to adorn tribal dress. During the years of fleeing and disruption, however, the Hmong lost the ability to use their written language. Many twentieth- century Hmong women who still painstakingly embroider or batik ancient symbols and ideographs of historical events, are not able to read or write the language which their needles preserved.81

This claim gives additional historical resonance to the handicrafts still done by Hmong girls and women. Not only marginalized in Southeast Asia, but often trivialized in the United States, despite recent efforts to garner appreciation for such women’s work (e.g., quilting), the handiwork of Hmong women has been instrumental in maintaining cultural traditions and, in an oral culture, likely transmitting traces of a repressed written language- usually thought to be the purview of the patriarchy.

Indeed, as Dwight Conquergood continues, there was “no tradition of graphic representational art” in Hmong textiles before war in Southeast Asia. Influenced by life in Thai refugee camps and contact with the West, Hmong women have devised new modes of signification- altering traditional forms for Western tastes and developing embroidered story cloths that illustrate traditional Hmong tales and more recent war and exodus stories.1″ Indeed, story cloths that detail escapes on foot out of Laos and across the Mekong river to Thailand are the most prized by Western collectors and the museums that have begun to display Hmong handicrafts in the United States.81 This needlework is produced primarily out of financial necessity, demonstrating the ways that Hmong women have managed to accommodate traditional work to the needs of their families in the new economies they negotiate/4 American buyers symbolically “consume” conventional narratives of the “tragic” war in Southeast Asia, notions of the Hmong as ahistorical and unchanging craft workers, and Hmong women in particular as bound to tradition.

In the recent book Through H’Mong Eyes, published by the Vietnam Museum of Ethnology, the Hmong girls who narrate the photographic text also situate Hmong women in a contemporary, economic context. Provided with cameras by a program called Photovoice, Hmong girls who live near the tourist destination of Sa Pa, Vietnam, documented their lives in word and image for the book. In this way, we see girls and young women who are engaged in the traditional domestic work of childrearing, cloth dying, and embroidery. Yet we also glimpse a new economy where girls are integral to the financial well- being of their families, much as other nationalistic Vietnamese texts extol the importance of Viet women to the national economy. One girl writes of the traditional gender roles in Hmong families that “each daughterin-law in a family owns a barrel of indigo, because daughters-in-law have to dye and make clothes for their husbands’ parents and brothers…. No boys know how to make indigo and hemp. That is the job of mothers and daughters.”85 Thus the cloth-making work is neatly relegated to women in conventional ways and women provide domestic labor for their husband’s families upon marriage.

The meanings and value of this traditional work have also been transformed. Another twelve-year-old claims important and lucrative public work for women as well: “first I came to town with my mother, and she taught me how to sell [Hmong handicrafts],” she writes. “I like selling. If I stayed at home, we wouldn’t have any money and food to eat. Now I am the only one who goes selling in the family and I give my parents all the money I make.”86 Thus working with the tourists in the village excuses girls from domestic chores and gives them a powerful place in the family structure. Another girl writes that she would like to go to school so that she “will be able to go working in a hotel” and thus make a bigger financial contribution to her family.”‘ Yet another ten-year-old proclaims she would like to have three girls and two boys when she has children; “I like having girls more,” she explains, “because girls can work and earn money to help parents. Boys are very shy, they only stay at home.”88 Here she inverts traditional Western and Hmong stereotypes of boys’ assumed worth and earning potential versus girls’ homebound status.

Though these Hmong girls live within the national borders of Vietnam, they do, of course, have a vexed relationship to Vietnamese national identity and ideology. And so the more individualistic and even rebellious claims made in this book could be seen as part of a distinctive ethnic tradition as well as evidence of an emerging national economy. A sixteen-year-old married girl writes that even though her husband’s family is well-off, she still wants to “work to save some money, so that [she] can buy whatever [she] wants.”89 This audacious claim also resonates with notions of Western individualism. However, this project was endowed by the Toyota Foundation and supported by the ethnology museum, which is funded by the French government. One could argue that this artifact of tourism is designed to appeal to Westerners eager for depictions of outspoken and independent girls. Indeed, there is an interesting confluence between the representations of Hmong women’s work in the Vietnam Women’s Museum, the book on young Hmong women, and understandings of Hmong women’s work in the United States, for all focus on traditional handiworks, women’s increasingly enterprising roles in Hmong culture, and the economics of ethnic arts. As Conquergood insightfully observes, “Perhaps more than any other feature of Hmong culture, the textile artworks have been accessible and attractive” to Westerners and Americans in particular;90 apparently, they showcase both women’s “private” domestic work and their entrepreneurial spirits.

THROUGH HMONG AMERICAN EYES

Because cultural identity is the defining feature of Hmongness, rather than geographic or national association, and because “kinship ties define culture and priorities,”91 traditional women’s gender roles in the Hmong American community are freighted with extraordinary importance. For women (and men) to resist Hmong kinship roles and the “oppressions” they entail is for this migratory Hmong culture to disappear. However, one might also argue that the emergence of Hmong American womanhood is not only the result of Western feminism’s unmooring of traditional Hmong womanhood but also is a new and innovative extension of adaptive and yet persistent Hmong traditions. As NaIy Yang writes in her poem, “Spirit Trails,””My pltg will always wander, / though many may try to tie it down. I … I And the shaman’s cloth, / made to bind, / falls not upon my legacy.”92 Yang rewrites traditional belief systems that argue for the bound nature of the female soul, much as Cao rewrites the Trung sisters into modern warriors. Nancy Donnelly agrees that Hmong culture may not be as aggressively gender-divided as traditional readings would suggest, writing that “the seeds of gender equality are present in Hmong folk tales and in the concept that both men and women need each other to achieve maturity”-a version of the “separate but equal” philosophy evident in Vietnamese texts.93

Recent Hmong immigrants to the United States are not as sanguine about life in Southeast Asia as the girls in Through H’Mong Eyes, nor as optimistic about the plight of Hmong American women. Many of the women whose stories Sucheng Chan transcribes in her collection of oral narratives, Hmong Means Free: Life in Laos and America, are empowered, the book suggests, by age and distance to tell much darker stories of Hmong life on both continents. The unique features of new Hmong American written narratives also shape their content. As Mai Neng Moua, editor of Bamboo among the Oaks: Contemporary Writing by Hmong Americans, the first landmark anthology of Hmong American writing in the United States, contends, Hmong texts are “emerging” forms that bridge the oral and material traditions of Hmong culture and the imperatives of Western literacy. Moua explains that in traditional Hmong culture there “was no separation between what was art and what was culture,” so that daily activities such as storytelling, cloth-making, metal-work ing, and even the construction of traditional homes all communicated emotions in ways that extended beyond “plain language.”94 Thus transcriptions of oral narratives and the material cultures they seek to convey are central to this new Hmong American literature.

In Bamboo among the Oaks, we find a number of Hmong American women writers who are quite critical of gender relations in the ethnic community, both in Southeast Asia and in America. In “A Good Hmong Woman,” True Hang transcribes the abuses suffered by her mother in Southeast Asia at the hands of her sadistic in-laws. Indeed, according to Hmong custom, “marrying is called ‘becoming a daughter-in-law’ (ua nyab)” and young Hmong brides entered the homes of their husband’s family with few rights.95 Like Cao’s mother, Thanh, Hang’s mother recounts feeling like an exile in her new home. Hang’s mother-in-law berates her, refuses to eat the food she prepares, ignores her, and even encourages the son and husband to beat and kill his young wife. Hang thinks “I am their daughter-in- law. They married me, and I came to live with them. Why don’t they know how to use my strength?”96 Notice the use of pronouns here: the girl has not married just her husband but his whole family, “they,” connoting a communal subjectivity opposed to notions of individualism. As well, she understands that her “strength” is of most value to the family, though in this case they see it as a threat rather than a valuable commodity and it elicits their abuse. These abusive practices are carried to America. For example, in the poem “broken,” by Pa Xiong, the author depicts crippling domestic abuse:

I watched him hurt her

verbalizing and emotionalizing scars

into her childhood

and her womanhood

… I watched her receive three years of his fists

three years of blue and purple

around her neck

and in her heart

I watched.97

Xiong’s reference to the “purple heart” could also be a subtle nod to militaristic modes of understanding domestic life; it is the women who deserve recognition for their sacrificial service in family battles. However, what Westerners call domestic abuse is a recurrent theme in writing by Hmong American women, as well is in interview transcripts-the dominant mode of communication for illiterate first-generation women. Indeed, in the introduction to her collection of interviews with Hmong women, Chan speaks to the difficulty of accounting openly for Hmong women’s experiences in the United States. Her cadre of Hmong students assigned to carry out interview projects with family members found they could get more candid responses when they left women tape recorders, because the men who attended the interviews would often interrupt the women, and the women felt inhibited from speaking freely about painful topics.98 Donnelly posits that domestic violence and divorce rates escalated in Hmong American households after settlement in the United States because men felt they were losing their basis of command in the household-thus spousal domestic abuse was exacerbated rather than ameliorated by immigration to this “freer” society. A popular joke among both men and women claims, ‘”When we get on the plane to go back to Laos, the first thing we will do is beat up the women!'” Donnelly explains that this joke registers Hmong men’s frustrating unemployability, “the sudden economic value placed on women’s work and the men’s fear of losing power in their families. The state could circumscribe the authority of a man even within his own household, for instance by forbidding him to beat his wife.”99 Physical violence against women often accompanies extreme cultural transformations.

A Western feminist might be tempted to read this confessional literature as the product of a more open society and Western feminism’s influence on Hmong worldviews. As Chan observes, echoing the views of many other scholars, “Given the greater freedom as well as greater protection that women in the United States enjoy, it is not surprising that several available studies indicate Hmong women are adjusting more eagerly than Hmong men to life in America.”100 One cannot deny that such claims are true in many respects. Young Hmong women of the first-and-a-half or “Rising Sun” generation are beginning to postpone marriage and childbearing beyond their teen years, to attain higher education, and even to live outside the family home. And protecting women from physical assault is clearly a priority. But this focus on “liberation” in the United States, the assertions that women like it better here than at home, is a bit troubling, for it does not acknowledge what has been lost in the transition, nor the fact that life had been chaotic in war-torn Southeast Asia for years before immigration to the United States, making the immigration route and cultural transition more complicated and even violent than it might have been otherwise. For example, in “Vue Yang’s Life Story as told to her daughter,” Maijue Xiong, transcribed in Chan’s edition, 48-year-old Vang says:

I feel that there are good and bad things about America. The good part is we don’t have to sweat over a piece of land to produce food for every meal. The bad part is, even though I am told that the United States is a land of freedom, I feel no freedom at all. Freedom, to me, is being able to farm our own land, raise our cattle, and own our own homes without obligation to anyone.101

Vang does not accept capitalistic notions of “freedom,” though she does long for communal ownership of land-or more properly, proprietorship-and a sense of self-sufficiency that resonates with American notions of rugged individualism. But not any land will do; she misses her family in Laos desperately and expresses a corporeal connection to the homeland: “Day after day, I long to return to my country. My heart is not here in America” she claims.102

Mayli Vang, in her poem entitled “We Women of the Hmong Culture,” writes

We women of the Hmong culture

may now clean the plates of what the men have left…

They call this a privilege,

to be seated at the table of those who were seated before….

Yet some she-witched women

“possessed by this newfound knowledge

of excessive freedom” are weary

of participating in such patriarchal rituals of the old motherland.103

While Hmong girls in Vietnam write confidently of new gendered economic roles, Hmong American girls are witness to Old World oppressions. However, notice in this passage that freedom is “excessive”-not a word with positive connotations; the fact that the women are “she-witched” and “possessed” by the new knowledge suggests that there is something magical and perhaps even evil to some about women who now resist their native culture almost against their own wills. While the mealtime rituals are “patriarchal,” the native land is the “mother,” connoting a tension between Southeast Asian maternalism and Western feminism that Hmong American women must negotiate.

Interestingly, “motherhood” does not seem to be fetishized in Hmong culture to the same extent that it is in Vietnamese lore or Western cultures. Miyares claims that while “the family is elastic in character,””clan membership is permanent,” and the clan’s structures and hierarchies supersede those of the nuclear family.104 Thus while Hmong women’s value in the traditional economy was based on their fecundity and their labor potential, the extended family is much more important than the nuclear family in organizing domestic relation

Hypopigmentation

By Watkins, Jean

VITILIGO This man had patchy loss of pigment on his hands and around his mouth. The white macules, of otherwise normal looking skin, were increasing in size and were itching. Vitiligo is said to be an acquired inflammatory disorder in which melanocytes in the skin fail to function. It is a common problem affecting about 1 per cent of the population, 30 per cent of those affected have a family history of the condition, and of these 30 percent may have problems with other autoimmune conditions, such as thyroid disease.

DIAGNOSIS OF VITlLIGO-WOOD’S LIGHT

The diagnosis of vitiligo can usually be made on clinical grounds. Lesions are often bilateral. The skin is essentially normal apart from the depigmentation and there is no scaling, thickening or inflammation. If viewed under Wood’s light, the contrast between the pigmented and depigmented skin is emphasised. If there is any doubt, skin scrapings may be taken to exclude fungal infection or a biopsy performed. Checks on thyroid function, blood glucose and B12 levels should be made to exclude problems in these areas.

RE-PIGMENTATION AND MANAGEMENT OF VITILIGO

Islets of pigmentation around the follicles may indicate the start of a spontaneous recovery. Active treatment is more effective if given early. GPs should initiate topical steroids before seeking specialist advice. Only potent or very potent preparations seem to be effective, and may be used once a day, except on thin-skinned areas, for up to eight weeks. Topical immunosuppressants such as tacrolimus are recommended. Narrow band UVA, may induce long remissions and appears to be more effective than PUVA.

PITYRIASIS VERSICOLOR

This woman had ‘pale patches’ on her neck and upper chest for some time. The irregularly shaped macules showed areas of scaling. When viewed under a Wood’s lamp a yellow-green fluorescence was noted. The condition was thought to be pityriasis versicolor, which is caused by the yeast Malassezia. A skin scraping, mixed with potassium hydroxide, showed hyphae and yeasts. The condition responded well to the application of a topical azole preparation. Alternatives are selenium sulphide orterbinafine gel, and if this fails to respond, oral ketaconazole or itraconazole may be required.

POST-INFLAMMATORY HYPOPIGMENTATION

The skin shows an inflammatory response to a variety of trauma. Substances are released that alter the activity of immune cells and the melanocytes that affect the colour of the skin. In some cases this may lead to increased pigmentation, in others hypopigmentation follows. In the case of this woman she had been scratching her back for months. Although the skin may take a long time to re-pigment, it tends not to be a permanent change. If it is in a situation that causes problems for the patient, cosmetic camouflage may improve the appearance.

GENITAL LICHEN SCLEROSIS

This woman presented with itching of the vulva. She had controlled it with topical clobetasol cream applied daily. She was advised to increase the cream to twice daily. A biopsy was taken to exclude malignant change. Lichen sclerosis (LS) presents with shiny, white, smooth-topped papules. Patients with genital LS should be followed up, because malignant change can occur. Treatment involves potent topical steroids. Alternatives are calcipotriol cream, retinoids or systemic steroids. Surgery may be necessary if the vaginal opening is narrowed or in men where there are problems with micturition.

EXTRA-GENITAL LICHEN SCLEROSIS’

In about 15-20 per cent of cases, LS may occur at sites other than the genital area. The lesions are ivory white, atrophie patches. They may occur anywhere on the body but are most common on the front of the wrists, neck, upper part of the chest or around the umbilicus. They may remain symptomless and treatment is not normally necessary. The cause of LS is thought to be an immune process in which there are antibodies to one of the components of the skin. It may occur at any age but when it presents in children, it usually resolves with puberty.

PLAQUE MORPHEA-LOCALISED SCLERODERMA

This woman had noticed skin changes in the upper abdomen. The indurated skin looked pale. A biopsy of the lesion confirmed the diagnosis of morphea. This is the most common type of presentation of morphea, with thickened patches of variable size. Initially they appear mauve but later become white, shiny and hairless, with a lilac edge. It may persist for several years before softening leaving an area that may be depressed and brown. The cause of this condition may follow local injury, viral infections or pregnancy. There is no effective treatment for the problem.

Reference: Douglas W, Whitton M. What’s new in vitiligo? Dermatology in Practice 2008; 16:1

Contributed by Dr Jean Watkins, a sessional GP in Hampshire

Copyright Haymarket Business Publications Ltd. May 16, 2008

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

Thyrotoxicosis

By Kohler, Sibylle Wass, John A H

CLINICAL REVIEW Section 1 Epidemiology and aetiology

CAUSES OF THYROTOXICOSIS

* Graves’ disease.

* Multinodular goitre.

* Toxic solitary nodule.

* Postpartum thyroiditis.

* Drug-induced thyroiditis (for example, amiodarone).

* Overtreatment with thyroid hormone.

* Thyrotoxicosis factitia (surreptitious ingestion of thyroid hormone in supraphysiological doses).

* Struma ovarii (teratoma containing functional thyroid tissue).

* Pituitary thyrotroph adenoma (TSHoma).

Thyrotoxicosis refers to the clinical syndrome that results when tissues are exposed to excess levels of thyroid hormones. It is 10 times more common in women than in men in the UK and affects approximately 2 per cent of the female population. The annual incidence is 3 per 1,000 women.

The most common cause is Graves’ disease, which mostly affects young women, but may affect all ages and both sexes.

Multinodular goitre affects the elderly most commonly and 30 per cent of patients are mildly thyrotoxic.

A single toxic adenoma is the third common cause and affects all ages. Rarer causes of thyrotoxicosis are shown in the box.

Risk factors include a family history, high iodine intake, smoking, and certain drugs, for example amiodarone. Amiodarone can cause thyrotoxicosis in two ways: it can increase thyroid hormone synthesis (type I) and have a direct toxic effect on the thyroid (type H).

Presentation

The diagnosis of thyrotoxicosis maybe delayed if the symptoms are not classical. Obviously a goitre and eye changes point to a clear diagnosis. Unexplained weight loss, muscle weakness, oligomenorrhoea, palpitations, breathlessness, diarrhoea, loss of libido and pruritus can all be caused by thyrotoxicosis.

PRESENTATION OF THYROTOXICOSIS

SYMPTOMS

* Weight loss despite an increased appetite.

* Increased or decreased appetite.

* Irritability.

* Weakness and fatigue.

* Diarrhoea +- steatorrhoea.

* Sweating.

* Tremor.

* Mental illness: may range from anxiety to psychosis.

* Heat intolerance.

* Loss of libido.

* Oligomenorrhoea or amenorrhoea.

SIGNS

* Palmar erythema.

* Sweaty and warm palms.

* Fine tremor.

* Tachycardia-AF (common in elderly).

* Hair thinning or diffuse alopecia.

* Urticaria, pruritus.

* Brisk reflexes.

* Goitre.

* Proximal myopathy (muscle weakness +- wasting).

* Gynaecomastia.

* Lid lag (may be present in any cause of hypertnyroidism).

Section 2 Diagnosis

If symptoms and signs suggest thyrotoxicosis, thyroid function tests are indicated.

The single most useful test in confirming thyrotoxicosis is TSH which is undetectable in most cases of thyrotoxicosis (TSH

There are two exceptions to this rule, pituitary thyrotroph adenoma (TSHoma) and pituitary thyroid hormone resistance syndrome. In these cases, TSH is inappropriately normal or elevated despite high circulating levels of free hormones.

T3 thyrotoxicosis accounts for 5 per cent of all thyrotoxicoses, and is characterised by an undetectable TSH, elevated fT3 but normal fT4. Its management does not differ from that of typical thyrotoxicosis.

Subclinical thyrotoxicosis is characterised by suppressed TSH but normal concentrations of free hormones.

Once the diagnosis of thyrotoxicosis has been made, the cause has to be established. Clinical examination of the neck, thyroid antibodies and thyroid uptake scans are helpful.

Neck examination

A goitre is usually painless; if palpation of the neck is painful, thyroiditis de Quervain is likely. A diffuse goitre may be present in Graves’ disease and early stages of Hashimoto thyroiditis.

It is also important to search for palpable nodules or lymph nodes. If either is found, the patient should be referred to exclude thyroid cancer. Several palpable nodules may indicate a multinodular goitre.

Thyroid antibodies

Anti-TPO and anti-thyroglobuHn antibodies are present in 70-80 per cent and 30-50 per cent of patients with Graves’ disease respectively and in cases of Hashimoto thyroiditis. However, antibodies are non-specific and insufficient for a diagnosis.

Thyroid uptake scan

In Graves’ disease, uptake is typically homogenously increased, but a solitary area of high uptake is typical of a toxic nodule.In Hashimoto, de Quervain and postpartum thyroiditis, uptake is decreased, as thyroid tissue has been destroyed.

An uptake scan can be done two to three months after treatment for thyrotoxicosis has commenced.

Although the intensity of uptake will decrease, distribution will remain visible, and this is the important feature in discerning thyroid diseases.

Further investigations

In all cases, if symptoms have lasted for more than a year, a bone mineral density scan should be done to check for osteopenia/ osteoporosis and the patient examined for AF.

Ophthalmopathy develops in up to 30-40 per cent of patients with Graves’ disease and leads to swelling of the extraocular muscles, proliferation of orbital tissue as well as late fibrosis. All patients with thyroid eye disease shouldbe referred to anophthalmologist

Graves’ disease may be associated with other autoimmune conditions and screening is recommended.

A goitre is usually painless; if palpation of the neck is painful, thyroiditis de Quervain is likely

All patients with thyroid eye disease should see an ophthalmologist

Section 3 Management

Graves’ disease

Standard treatment for Graves’ disease is an 18-month course of antithyroid drugs (ATD). Carbimazole is the first choice in the UK. During pregnancy and lactation, propylthiouracil (PTU) is first choice because of its lower concentration in breast milk and the possible association of carbimazole with aplasia cutis.

Side-effects ofboth drugs are rash and urticaria, which are usually mild. A rare (0.5 per cent of patients) but serious sideeffect is agranulocytosis. Patients should be advised to discontinue ATD and contact a doctorimmediatelyshouldfeverand evidence of infection develop.

The starting dose of carbimazole is 40mg once daily if fT3 is >6pmol/l and 30mg if fT3 is

Propranolol 20-80mg three times daily is added if symptoms such as tremor, anxiety and palpitations are present and continued until the ATD have been effective (4-6 weeks).

TFTs should be repeated every 6-8 weeks and the dosage of ATD adjusted if necessary: carbimazole is gradually reduced in steps of 5 to 10mg(PTU in steps of 50 to 100mg) every 6-8 weeks as soon as fT4/fT3 have dropped into the normal range and later TSH begins to rise.

Treatment should be continued for a total of 18 months to ensure a 50 per cent chance of cure.

Radioactive iodine is administered orally as a capsule or drink. A dose of 400-800MBq is sufficient to cure thyrotoxicosis in 90 per cent.

Aminority of patients require a second dose of radioiodine (15 per cent) and only very rarely is a third dose necessary.

Patients should not have close contact (

Surgery is indicated in patients with moderate-to-severe Graves’ ophthalmopathy, patients who fear or reject radioiodine or patients in whom a rapid control of symptoms is required.

ATDs (or potassium iodide in severe thyrotoxicosis) are given preoperatively to achieve euthyroidism.

Risks of surgery are infection, laryngeal nerve damage, hypothyroidism and hypoparathyroidism.

Thyroxine replacement is started postoperatively at 100 microgram once daily and adjusted by 25 microgram upwards or downwards to get the TSH in the low part of the normal range. Calcium is checked postoperatively or if symptoms develop.

Graves’ ophthalmopathy

In Graves’ ophthalmology, hypothyroidism must be avoided, because this worsens the ophthalmopathy. All patients should be encouraged to stop smoking, as this exacerbates the problem. Referral is indicated.

Toxic solitary nodule

In this cause of thyrotoxicosis, as the nodules are autonomous, thyrotoxicosis will recur after ATDs are stopped, so definitive treatment is indicated. The first choice is radioiodine treatment

Multinodular goitre

Because relapse is invariate after discontinuing ATDs in multinodular goitre with thyrotoxicosis, radioiodine treatment is recommended for definitive control. Surgery is preferred for patients with local compressive symptoms. In elderly patients (>70 years of age) without osteoporosis or AF, ATDs can be continued lifelongifaeuthyroidstate is achieved with low dosages.

De Quervain thyroiditis

This viral infection is treated with NSAIDs. Occasionally, if painful, prednisolone 20-40mg once daily is effective. ATDs are rarely indicated because in De Quervain thethyrotoxicosis settles. The TFTs have to be monitored regularly as patients may develop hypothyroidism.

Postpartum thyroiditis

Postpartum thyroiditis affects 5-10 per cent of women within one year of pregnancy and is caused by a postpartum immune response. Often, hyperthyroidism develops within the first four months of delivery, followed by hypothyroidism 3-7 months after delivery, and spontaneous recovery within one year.

Treatment is recommended if the patient is symptomatic. If hyperthyroid, PTU is the drug of choice because of its lower concentration in breast milk. If hypothyroid, thyroxine is prescribed. Treatment should be withdrawn after six months to determine if spontaneous recovery has taken place. TFTs should be monitored annually in women with previous postpartum thyroiditis, as hypothyroidism develops in 40 per cent.

Amiodarone-induced thyroiditis

These patients may be difficult to render euthyroid because the iodine in the drug induces resistance to ATDs and should therefore be referred to an endocrinologist. If possible, amiodarone should be discontinued.

Subclinical thyrotoxicosis

There is evidence thatcomplications (such as AF) in subclinical thyrotoxicosis are more common if the TSH is completely suppressed (

In pregnancy, PTO is the drug of choice because of its lower concentration in breast milk

Section 4 Prognosis

Hyperthyroidism is characterised by relapses and remittances, with the relapse rate at about 50 per cent.

There is a threefold increased risk of death from osteoporotic fracture and 1.3-fold increase risk of death from cardiovascular disease (CVD) and stroke in untreated hyperthyroidism.

Long-term follow-up studies have shown increased mortality from CVD and cerebrovascular disease in those with a past history of treatment with radioiodine for overt hyperthyroidism.

Follow-up

After discontinuing ATD, TFTs are repeated every 6-8 weeks for six months, then six-monthIy for two years and annually thereafter, or earlier if symptoms return.

If there is recurrence, definitive treatment (radioiodine or surgery) has to be discussed with patients, as a second course of ATDs alone almost never results in remission.

Surgical treatment and radioactive iodine can both lead to hypothyroidism, and close follow up with TFTs is therefore required.

Followingradioactive iodine, hypothyroidism develops in 50 per cent of patients after 10 years, so that TFTs need to be checked every six months and thereafter yearly or earlier if symptoms are noted.

New developments

The management of thyrotoxicosis has not changed greatly in thelastfewyears.

It seems that ophthalmic Graves’ disease is less common, partly related to a decrease in smoking.

Amiodarone-induced thyroid disease remains common and difficult to treat.

In some centres radioactive iodine therapy is given ear lier in the treatment of Graves’ disease, because of the high recurrence rate – typically in men – and a lack of long-term side-effects.

The prognosis is good with treatment, but regular monitoringof thyroid function, probably yearly, is recommended.

Resources

1. Bartalena L, Wiersinga W, Tanda M et al. Diagnosis and management of amiodaroneinduced thyrotoxicosis in Europe: results of an international survey among members of the European Thyroid Association. Clin Endo 2004; 61:494-502.

2. Pearce E, Farwell A, Braverman L. Current concepts: Thyroiditis. NEngl J Med 2003; 348:2,646-55.

3. Weetman A. Medical progress: Graves’ disease. NEngl J Med 2000; 343:1,236-48.

4. Toft A. Subclinical hyperthyroidism. N Engl J Med 2001; 345:512-6.

5. Wiersinga W, Bartalena L. Epidemiology and prevention of Graves’ ophthalmopathy. Thyroid 2002; 12:85s5-60.

6. Schwartz K, Fatourechi V, Ahmed D, Pond G. Dermopathy of Graves’ disease (pretibial myxedema): long-term outcome. J Clin Endocrinol Metab 2002; 87: 438-46.

Contributed by Dr Sibylle Kohler, specialist registrar, and Professor John A H Wass, consultant endocrinologist, at Churchill Hospital, Oxford

Copyright Haymarket Business Publications Ltd. May 16, 2008

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

California Biker Pastor on 48-State Motorcycle Tour for Local Ministry

Sunday Rally Kicks off Cross-Country Ride to Raise Funds for Homeless, Jobless and Hungry

Flood Ministry

Kim Albers, 661-213-7697

Mark Merical touches lives every day in his role as a pastor of Bakersfield’s Calvary Bible Church and now he is embarking on the ride of his life, an eight-day, 48-state motorcycle tour to raise critically needed funds for the Flood Ministry, a local faith-based organization that works with area churches to serve the physical, emotional and spiritual needs of the impoverished and underprivileged.

Merical, a 44-year-old motorcycle enthusiast, hits the road Sunday, June 29, on his 1998 Suzuki Bandit 1200 for a nearly 7,600- mile odyssey that will take him to each state in the continental U.S., culminating on July 7 in Oregon. A send-off rally is set for Sunday evening at 7:15 PM (PDT) at Calvary Bible Church, 48 Manor St. Bakersfield, CA. The eight day journey officially begins Monday morning from Needles, CA.

Funds raised through the whirlwind “48-in-8” tour will enable the Flood Ministry to continue a variety of successful outreach programs to meet the physical, emotional and spiritual needs of the homeless, residents of sober living homes, motel dwellers and others caught in the cycle of poverty in Bakersfield.

“I can’t think of a more worthwhile way to celebrate the 4th of July than to get on my bike and touch every state in this great nation, whose citizens are the most generous on Earth and who might feel so moved to extend a helping hand to our disadvantaged neighbors in Bakersfield,” said Merical. “With a dependable bike under me, a good map and, God willing, lots of sunshine, I’ll complete this journey safely and on-time, and along the way raise the funds necessary for Flood’s important work.”

His route eastward will take Merical through the Four Corners, across Texas, Oklahoma and the Deep South, north through Appalachia, and along the eastern seaboard from Baltimore to New England. Riding west, Merical’s route runs through the Great Lakes region to Chicago and the Upper Mid-west, and across the Great Plains to the Pacific Northwest, where he’ll conclude his journey in the northeastern Oregon town of Pendleton. Merical will return to his home church in Bakersfield on July 10th.

Bakersfield/Kern County has the third highest poverty rate in California, 53% of all renter households are cost-burdened putting them at higher risk for homelessness. According to a new study commissioned by Housing California, a political organization dedicated to affordable housing for all Californians, a minimum wage earner in Kern County would have to work 106 hours per week to afford a Fair Market Rental apartment in this community. On any given night there are nearly 1,500 homeless people in the Metro Bakersfield area including almost 200 children. There are also 60 sober living homes with over 1,300 beds for those battling drug and alcohol addiction in Bakersfield.

In 2008, Flood will serve 12,000 meals to the hungry, provide at least 8,000 food packs to impoverished families and help hundreds of disadvantaged individuals begin to rebuild their lives.

“We are blessed by the depth of Mark’s passion for the people of Bakersfield and inspired by his dedication to serving our neediest neighbors,” said Kim Albers, a local volunteer leader of the Flood Ministry. “We pray that God will keep him safe and on-course during the eight-day journey and return him to Bakersfield to continue the work that needs to be done in the community.”

Contributions to “48-in-8” can be addressed to the Calvary Bible Church, 48 Manor St., Bakersfield, CA 93308 or by accessing www.floodbako.com.

Note to Editors: Following is a list of days and times when Mark is estimated to pass through major media markets. A map of his route is available at www.floodbako.com/events/48in8.html. Reporters and editors interested in talking with Mark along his tour should contact Kim Albers at 661-213-7697.

Albuquerque 6/30 2:00 p.m.

Oklahoma City 6/30 11:00 p.m.

Little Rock 7/1 3:00 p.m.

Hattiesburg 7/1 9:00 p.m.

Atlanta 7/2 2:00 p.m.

New York City 7/3 4:00 p.m.

Cleveland 7/4 6:00 p.m.

Chicago 7/5 10:00 p.m.

Billings 7/6 9:00 p.m.

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

OptumHealth Receives ‘HIP’ NCQA Quality Certification

OptumHealth today announced that three of its offerings – Health Risk Appraisals, Interactive Consumer Health Tools and Health Information Line – received Health Information Products (HIP) certification from the National Committee for Quality Assurance (NCQA).

“Earning NCQA’s HIP Certification demonstrates that an organization has expertise in gathering and disseminating health care information for health plan members,” said NCQA’s Kathleen C. Mudd, vice president of product delivery. “OptumHealth is to be commended for being one of the first organizations in the nation to be reviewed and certified for these services.”

The certification process is rigorous and involves an off-site evaluation conducted by physicians, if appropriate, and experts in the product being evaluated. A review oversight committee of physicians analyzes the team’s findings and assigns a certification level based on the organization’s performance against NCQA’s standards.

“We appreciate receiving HIP certification because it is independent, external validation of how effectively we manage aspects of our data collection and systems operation,” said Scott Heimes, senior vice president of OptumHealth’s Consumer Solutions business. “This certification also reflects our ongoing commitment to deliver best-in-class programs and care management services that enhance clinical outcomes, reduce costs for our customers and help consumers receive the right care at the right time in the right place.”

Health Risk Appraisals, Interactive Consumer Health Tools, Health Information Line and other OptumHealth interactive health management programs are delivered via personalized web experiences to consumers. OptumHealth’s solutions empower consumers to address their health and wellness needs through lifestyle modification programs, evidence-based health content, an easy to use personal health record, and interactive tools, trackers and quizzes.

About OptumHealth

As one of the nation’s largest consumer health services companies, OptumHealth makes health care easier and better for employers, health plans, public sector entities and the 61 million people with access to its services. The Company’s goal is to optimize health, well-being and financial security, while lowering benefit costs and helping consumers make informed decisions about their health through standalone or integrated services. OptumHealth is a company of UnitedHealth Group (NYSE:UNH). More information about OptumHealth can be found at www.OptumHealth.com.

About NCQA

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes physicians in key clinical areas. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS(R)) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices. For more information, visit http://www.ncqa.org/.

(HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).)

There’s No Time Like the Present for Today’s Girls, According to The N’s New Research Study ‘The Story of Girl’

NEW YORK, June 26 /PRNewswire/ — Today’s millennial girls (ages 13-24) say they have more opportunities than prior generations of women ever had, but feel stressed about having to “do it all.” This is according to The N’s new research study, “The Story of Girl,” which assesses the state of the millennial girl. Key findings indicate that these young girls are happy and optimistic, but worry more than their male peers about school, money, their future and their appearance, respectively. They also say they are growing up without role models outside of their own personal lives: millennial girls say they are not looking to Hollywood celebrities as influencers, for instance, but instead rely on themselves or their mothers as primary role models. Additionally, this generation is extremely tech-savvy — splitting their time among at least two-dozen tech-related activities everyday. The N, available in 64 million U.S. homes, is Nickelodeon’s 24-hour basic cable network exclusively for and about teens.

“Today’s millennial girls say they are growing up in a world with boundless opportunities,” said Ron Geraci, Senior Vice President of Research and Planning for Nickelodeon/MTVN Kids and Family Group. “The young women of this generation are more self-assured and more tech-savvy than ever, but stress is also becoming one of their hallmarks because they feel they have so much to accomplish. They are shifting the definition of success from having it all to doing it all.”

“The Story of Girl” research conveys insights from females 13-24 years-of-age and includes qualitative discussions and national representative quantitative surveys. The study was fielded from winter 2007 until April 2008.*

   Highlights from the study include:    Belief in Equal Opportunity, but Know There's Room to Grow  

Research findings indicate that girls 13-24 believe that traditional roles have changed and there are more opportunities for them today than past generations, but there is still room to grow.

   -- 86% of girls say they have prior generations of women to thank for all      the opportunities they have now.   -- 59% of girls believe they are smarter than their male counterparts and      more than four out of ten girls (43%) believe they will earn more money      than their spouse.   -- While 34% of females 13-24 believe that women have achieved equality      with men, 85% still believe a double standard exists and 84% believe      women are still discriminated against in the workplace.   -- Girls surveyed say it's easier for males to become CEO (62%), get      promoted (45%), have a good job (28%) and have it all (23%).     Overall, It's Good to be a Girl   -- 72% of girls believe there has never been a better time to be a female.       -- 29% of girls believe that because there are more opportunities for          women today like owning their own businesses or getting a good          education.       -- 16% feel it's due to greater freedom and independence than the          generations before them.   -- 60% of girls describe themselves as happy.   -- Girls define success broadly -- basing it mostly on how happy they are,      if they have a job they love or if they have a good balance of work and      personal life.     Stressed Out with So Much To Do!  

Millennial girls today feel stress, more so than their male counterparts, from the desire to “do it all.”

   -- 43% of girls describe themselves as stressed out, as opposed to only      19% of guys; and 75% often feel overwhelmed by everything they do.      Girls say they stress about everything, including: school (72%); the      future (72%); money (71%); homework (70%); and their appearance (61%).   -- Girls stress the most (48%) between 17- and 18-years-old, as they are      about to enter college or as the reality of financial responsibilities      takes hold.     Whom to Look Up to  

Teen girls today say they are growing up without clear role models outside of their personal lives, so tend to look inward and to their parents as role models or to their mothers.

   -- More than one third (34%) of girls look up to themselves or do not have      a role model at all.   -- One quarter (25%) of girls look up to there moms as their primary role      models.   -- Only 6% of girls said a famous athlete, musician or singer, actress or      actor, author or writer is their role model.     Full Tech Immersion  

Qualitative research shows that television is primarily used among millennial girls but in their day-to-day lives, they are positively immersed in technology. They identify at least two dozen technology-centric activities they engage in every week, including:

   -- Watching television;   -- Surfing the net;   -- Listening to music;   -- Watching DVDS;   -- Blogging;   -- Shopping online;   -- and reading newspapers and magazines.     About The N  

The N, the 24-hour TV network exclusively for and about teens, is currently available in 64 million households via cable, digital cable and satellite, as well on mobile, VOD and broadband. The N’s distinct perspective connects its audience to the electricity and possibilities of teendom, anytime and anywhere, with original series and ever-popular favorites. The N’s Emmy Award-winning website, The-N.com, paired with sister site Quizilla.com, makes The N the number-one online destination for teens. The N and all related titles, characters and logos are trademarks of Viacom Inc. .

*Specific details about methodologies used in the research presentation are available upon request.

Nickelodeon

CONTACT: Joanna Roses, +1-212-846-7326, [email protected], or NakiahCherry Chinchilla, +1-212-846-6492, [email protected], both ofNickelodeon

Web site: http://www.nick.com/http://the-n.com/

CIGNA HealthCare of California Names Gene Rapisardi Vice President of Sales for Southern California

CIGNA HealthCare of California has named Eugene (Gene) Rapisardi vice president of sales and service for Southern California. Based in Glendale, Rapisardi will oversee CIGNA HealthCare’s sales operations in Los Angeles and will direct all activities associated with the growth and retention of its middle market health care business.

“I am pleased to have someone with Gene’s experience and talent join our team and help us continue to grow our business in the Los Angeles area,” said Christopher De Rosa, president of CIGNA HealthCare for Southern California. “His experience and leadership will help us strengthen our ties to the Southern California producer community and further our ability to improve the health and wellness of our customers and members.”

With more than 25 years of experience in the Southern California market, Rapisardi brings a varied background in health care benefits sales, strategy and client service to CIGNA HealthCare of California. Before joining CIGNA HealthCare, he was a vice president of sales and service for PacifiCare responsible for new business growth and customer strategy for San Diego and the Inland Empire. In addition to his tenure with PacifiCare, Rapisardi was the former vice president of sales with Health Net and worked in the group sales and service division of MetLife.

Active in the community, Rapisardi serves a volunteer chaplain for a drug and alcohol rehabilitation center in Lancaster and is an advisory board member of the Christian Okoye Foundation. He also participates in several professional organizations.

CIGNA HealthCare, a health service organization based in Bloomfield, Conn., works to improve the health, well-being and security of the people we serve. A leading provider of employee benefit services and programs, CIGNA HealthCare offers a broad array of medical, dental, behavioral health, and pharmacy benefits plans and coverage. We also build and provide health and wellness coaching programs and consumer information tools designed to improve health and help people in their health care decision-making. “CIGNA HealthCare” and the “Tree of Life” logo are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation (NYSE:CI) and its operating subsidiaries, including Connecticut General Life Insurance Company. Products and services are provided by such operating subsidiaries, and not by CIGNA Corporation. For more information, visit www.cigna.com.

Salmon Creek Eyed for Rehab Hospital

By Paul Craig, The Columbian, Vancouver, Wash.

Jun. 26–A $17.3 million hospital proposed for construction in Salmon Creek would be the first in Clark County and one of a handful in the state specializing in medical rehabilitation.

Select Medical Corp. of Mechanicsburg, Pa., has filed a letter of intent with the Washington Department of Health to build a 44-bed, 50,000-square-foot facility two blocks southwest of Legacy Salmon Creek Hospital.

Select Rehabilitation Hospital of Vancouver would provide care to people with spinal cord injuries, brain trauma and those recovering from a stroke, said Richard Fiske, Select’s vice president of development.

“There are no services like this provided in the area,” he said.

The company operates 92 specialty hospitals and approximately 1,000 outpatient rehabilitation clinics in the U.S.

Select’s Kessler Institute for Rehabilitation in New Jersey ranked second among rehabilitation hospitals in the country for its quality of care, according to a physicians survey published by U.S. News & World Report.

Fiske said the company wants to build in Clark County because of the geographic area it would serve, drawing patients from Skamania, western Klickitat, Cowlitz, Wahkiakum and Pacific counties in Washington, as well as “some draw” from Oregon. The proximity to Legacy Salmon Creek Hospital was also appealing.

The rehab hospital would employ 200 people. The goal is to open by late fall 2009, according to Fiske. The company must first submit an application to the state’s Certificate of Need program. Karen Nidermayer, program analyst for the Certificate of Need, said it typically takes six to eight months for a decision to be made on an application. She said statistics on the number of beds already available in the area dedicated to rehabilitation won’t be compiled until after Select’s application is received.

Fiske said Select would break ground immediately if the state approves the project and the hospital would take 10 months to construct.

Paul Craig covers the health care industry for The Columbian. He can be reached at 360-735-4520 or via e-mail at [email protected].

—–

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

Copyright (c) 2008, The Columbian, Vancouver, 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.

Pittsburgh Opera Appoints Christopher Hahn Its General Director

PITTSBURGH, June 26 /PRNewswire/ — The Pittsburgh Opera board of directors yesterday promoted Christopher Hahn to serve as General Director, effective immediately. Mr. Hahn has been the Opera’s Artistic Director since 2000. He received the unanimous endorsement of the Opera’s board. The appointment followed a rigorous six-month international search and interviews with candidates from many prestigious opera companies.

Board Chair Michele Fabrizi said: “Christopher Hahn’s appointment as General Director is a great achievement for Pittsburgh Opera. Christopher has consistently established his leadership and artistic credentials during his tenure here and has garnered tremendous respect within the Company, the community, and the international opera world. In his role as artistic director, he has led productions which have won us national recognition. He has also demonstrated very strong administrative and fundraising skills. Pittsburgh Opera is well positioned for today and in the future with Christopher at the helm.”

Mr. Hahn stated: “It is a true honor and privilege to accept the leadership of Pittsburgh Opera. In my eight years with the Company I have developed enormous respect for the local community which has been so supportive of our work and of me personally. The staff and I look forward to taking this outstanding opera company to even greater heights.”

Board President H. Woodruff Turner said: “We are delighted that Christopher Hahn will serve as our General Director. He is a talented and dedicated artist and administrator. This is an important time for Pittsburgh Opera, as we begin an exciting season and work to complete our expansive new building in the Strip District. Christopher’s devotion and experience will make this remarkable opera company even better.”

Mr. Hahn succeeds Mark J. Weinstein who moved to the Washington National Opera as Executive Director in February. Since then, Dr. Joseph A. Marasco Jr., a former board president, has served as Interim Managing Director. “We are immensely pleased that Christopher will take the helm of our company. With the dynamic team of Christopher Hahn and Music Director Antony Walker, our company could not be in better hands.”

About Christopher Hahn

A native of Port Elizabeth, South Africa, Christopher Hahn was trained as a stage director and actor. He began his opera career in 1983 as Rehearsal Administrator for the San Francisco Opera, later managing the San Francisco Opera Center and its Merola Opera Program, the nation’s top program for training young singers.

Mr. Hahn subsequently moved to the Los Angeles Opera as artistic administrator, working with Placido Domingo and Peter Hemmings, its founding director.

He is a sought-after juror at various American and international vocal competitions, including the Metropolitan Opera National Council auditions.

For more information, visit http://www.pittsburghopera.org/

Pittsburgh Opera, celebrating 70 years of opera in southwestern Pennsylvania, is a member of OPERA America, the national organization for opera companies, and the Greater Pittsburgh Arts Council. Pittsburgh Opera’s performances are supported, in part, by the National Endowment for the Arts, Pennsylvania Council on the Arts, the PA Department of Community and Economic Development, and Allegheny Regional Asset District.

Pittsburgh Opera

CONTACT: Beth Parker of Pittsburgh Opera, +1-412-281-0912, ext. 248,[email protected]

Web site: http://www.pittsburghopera.org/

Fixing a Fallen Uterus Through Surgery

DEAR DR. DONOHUE: Will you address the problem of a prolapsed uterus? What treatment would you suggest? – M.V.

ANSWER: “Prolapse” means “a falling down.” A prolapsed uterus is one whose supporting ligaments and muscles have become too weak and lax to keep it in place. The uterus drops downward and can drop so far that it protrudes through the vagina.

About 50 percent of women older than 50 have some degree of uterine prolapse, so age is a major factor in causing the problem. So is vaginal delivery.

Since the urinary bladder and the rectum are next-door neighbors of the uterus, they are often pulled down with a uterine prolapse. Symptoms include pelvic heaviness and pain, trouble voiding, sometime loss of bladder control and difficulty with bowel movements. If the uterus projects outside of the vagina, it becomes irritated and sore.

Treatment depends on the distance the uterus has fallen, a woman’s age and a woman’s health. For mild to moderate prolapse, pelvic-floor muscle exercises (Kegel exercises) can keep the prolapse from worsening. To perform these exercises, a woman contracts the muscles used to avoid passing urine. Alternate short contractions – ones held three to five seconds – with long contractions – ones held for 10 seconds. Perform 30 to 40 contractions daily. They don’t have to be done all at once. Ten done consecutively is enough.

Pessaries are devices fashioned to keep the uterus propped up. They are inserted into the vagina, and some fit around the cervical neck to hold the uterus in place. They often solve the problem.

If a woman is up to surgery and if the uterus has descended a significant distance, an operation is the answer. The number of surgical procedures is large, and your gynecologist will inform you which is best for your circumstances.

DEAR DR. DONOHUE: I struggle with my weight, and I drink diet pop to keep from gaining. One friend tells me to stop drinking diet pop because it increases your craving for sugar and calories. An instructor in my diet class says the chemicals in diet soda actually scar your arteries and lead to heart disease. I never heard of that. Is it true? I love my diet pop. – B.B.

ANSWER: I never heard the scarring bit either, and I don’t believe it.

You can drink diet pop, but you shouldn’t go overboard. Acids in pop – including diet pop – attack tooth enamel. Cola drinks, including diet colas, contain phosphoric acid, and it increases the risk for osteoporosis.

Whether diet pop prevents weight gain or promotes weight loss is a disputed proposition.

DEAR DR. DONOHUE: My insurance company denies coverage unless I have a disease or an accident or need an operation. I have heard about a special test for detecting chickenpox antibody in the blood. The clinic where I get my health care says a charge for that test plus the shingles vaccine shot would be more than $300. However, my county health department says I can get the shingles vaccine for $8. My problem is, I don’t know if I had chickenpox. If I get the shot, how would it affect me? Will it cause shingles if I never had chickenpox? – R.H.

ANSWER: More than 90 percent of adults have had chickenpox, whether they remember it or not. You can safely get the shingles vaccine even if you did not have chickenpox. It won’t hurt you. If you’ve never had chickenpox, you don’t need the vaccine, because shingles is the awakened chickenpox virus that becomes active in later life. But if I were you, I’d assume that I had had chickenpox.

DEAR DR. DONOHUE: When my daughter was 12, she bit her nails. I bought her nail polish. She never bit her nails again. – N.A.

ANSWER: A clever approach to end nail-biting for girls. Got one for boys?

DEAR DR. DONOHUE: I have two granddaughters who bite their fingernails. Is there anything that stops this awful habit? – B.S.

ANSWER: What prompts people – children and adults – to bite their nails is often unexplainable. Stress, boredom, imitation of other nail-biters and relief of anxiety are offered as explanations for the habit, but proof is lacking for a cause in most cases. Close to 60 percent of 10-year-olds bite their nails. As children grow older, the number of nail-biters lessens.

Doing nothing about it is often the best policy. If the child wants to stop, then there are ways to help him or her break the habit. When children are at home, Band-Aids over the fingers remind them not to bite. Chewing sugarless gum makes nail-biting less convenient. Readers are welcome to give us their solutions.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853- 6475. Readers may also order health newsletters from www.rbmamall.com

(c) 2008 Sun-Journal Lewiston, Me.. Provided by ProQuest Information and Learning. All rights Reserved.

IPRO Honors 15 Health Professionals and Organizations for Quality Improvement Efforts

LAKE SUCCESS, N.Y., June 26 /PRNewswire/ — Fifteen health care practitioners and providers from across New York State are the recipients of this year’s IPRO Quality Awards. The awards are given annually by IPRO to members of New York’s health care community that have demonstrated outstanding performance in the area of quality improvement. This year’s awards were conferred during IPRO’s 24th Annual Meeting, which also featured a keynote address by Jo Ivey Boufford, MD, President, New York Academy of Medicine. Based in Lake Success and Albany, New York, IPRO is a national leader in health care quality measurement and improvement.

“We’re proud to recognize this group of hospitals, nursing homes, home health agencies, physician offices and health care professionals for their efforts in quality improvement,” said Theodore O. Will, Chief Executive Officer, IPRO. “Each has shown an outstanding commitment to the health of New Yorkers.”

Awardees were acknowledged for quality improvement in one or more areas, including: organization-wide commitment to quality improvement, performance improvement and patient safety; sharing of best practices; reducing unnecessary hospitalizations and use of restraints; adoption of electronic health records and bar coding; improving care for diabetes; decreasing use of anticholinergic drugs in the elderly; reducing unnecessary acute care hospitalizations; and pain management. (NOTE: Photos are available. See contact information. For complete information on the awards and photos of the awards ceremony, please see http://company.ipro.org/index/quality-awards.)

   Awardees include:   -- Glen Cove Hospital, Glen Cove, New York   -- UHS/Delaware Valley Hospital, Walton, New York   -- Long Island Jewish Medical Center, New Hyde Park, New York   -- Ellis Hospital, Schenectady, New York   -- HCR Home Health Agency, Rochester, New York   -- Twin Tier Home Health Agency, Inc., Vestal, New York   -- Jose S. Leon, Jr., MD, Medical Director, Dolan Family Health Center,      Huntington Hospital, Greenlawn, New York   -- Nathaniel Brownlow, MD, New York, New York   -- River Valley Family Medical Services, Barryville, New York   -- HIP Health Plan of New York, New York   -- Independent Health, Buffalo, New York   -- Catskill Regional Medical Center, Harris, New York   -- Clove Lakes Health Care and Rehabilitation Center, Inc., Staten Island,      New York   -- Sea View Hospital Rehabilitation Center and Home, Staten Island, New      York   -- Woodmere Rehabilitation and Health Care Center, Inc., Woodmere, New      York    

With more than 20 years of experience in health care quality improvement and evaluation, IPRO holds major contracts with state and federal governments, as well as private-sector clients, to review the cost and quality of services provided to Medicaid recipients, Medicare beneficiaries, and patients enrolled in managed care organizations and to work with the health care community to improve those services. IPRO also manages the End Stage Renal Disease Network for New York.

   Rebecca Janoff / Dennis Tartaglia   (212)481-7000    Spencer Vibbert / Barbara Schwartz   (516)326-7767  

IPRO

CONTACT: Rebecca Janoff or Dennis Tartaglia, +1-212-481-7000; or SpencerVibbert or Barbara Schwartz, +1-516-326-7767, all for IPRO

Web site: http://company.ipro.org/index/quality-awards

Getting Gassed: Hospital, Emergency Personnel Test Readiness During Mock Disaster

By Jeff Kaley, Waurika News-Democrat, Okla.

Jun. 25–WAURIKA — By Jeff Kaley

When you went outside and took a deep breath Thursday, were you feeling a bit odd the rest of the day?

As the day progressed, did you experience difficulty in breathing and bouts of coughing? Maybe you noticed your heart beat picked up or, perhaps, it slowed down dramatically.

Were you smitten by flu-like symptoms; nausea, vomiting, a headache?

Even more startling, by Thursday evening, were you completely worn out? Did you see discoloration spots forming on your body? Was there a frothy “mucus” in your mouth or nose?

If you noticed any of these unusual physical experiences, then you were among the hundreds of people in western Jefferson County who were exposed to phosgene gas, what your grandfathers or great-grandfathers called “mustard gas.”

—-

OK, before the power of suggestion takes over and you start calling a physician or driving to Jefferson County Hospital to be examined, what you just read is a fantasy. Western Jefferson County WAS NOT invaded by a cloud of phosgene gas; no one in these parts really came down with the array of symptoms mentioned, and the threat of a poisonous airborne agent was a fabrication.

But what if it had been real? How would area medical and emergency personnel have reacted if a dangerous chemical had been released and hundreds — perhaps, thousands — of area residents had been in need of emergency treatment?

That’s why the Duncan Score 2008 Exercise was held on Thursday. That’s why medical and emergency workers from Ardmore to Waurika to Lawton to Chickasha were involved in a four-hour interagency exercise that focused on field-level and hospital response to a terrorist incident.

In this case, the terrorist incident involved an explosion at a hypothetical chemical plant in Duncan, which released phosgene gas into the atmosphere. An area from Grady County down to the Red River was exposed to what World War I veterans remember as “mustard gas,” and the resulting public health emergency brought a variety of agencies into play. (See scenario story Page X.)

During the mock disaster, Jefferson County Hospital became a decontamination site that was staffed by hospital personnel and members of the Jefferson County Health Department. In addition, the hospital was a action/communication location for the Jefferson County Emergency Management Agency, whose director, Steve Goza, was one of two evaluators for the exercise.

Members of Boy Scout Troop 4460 acted as “victims,” who were brought to JCH for decontamination, observation and treatment of the various symptoms that accompany the poisonous gas. The hospital’s performance was “graded” by Kendal Darby, an HCC evaluator for the regional Medical Emergency Response Center (MERC) based in Lawton.

“It all went real well,” said Jefferson County Hospital CEO Jane McDowell. “Kendal and Steve, the two evaluators, said we did very well in getting our ‘victims’ decontaminated and taken care of.

In addition to response to “victims” being brought to JCH, the evaluation process included assessing facility security, protection of staff and notification procedures.

Such exercises are necessary, because what looks good on paper isn’t always effective or efficient in practice. As McDowell noted, “One reason you hold these exercises is to find out if there are things that you need to do differently and to look into other methods you might use in a real emergency.

“We did find some problems in our communications — mainly, we needed to have hand-held walkie talkies, which would have made it much easier and faster to communicate with personnel inside and outside the hospital.

“But Kendal and Steve thought we got our decontamination showers and equipment set up real quickly, and they were impressed by how smoothly things went within the hospital. I was pleased with our staff.”

This was the second mock disaster exercise in a year that’s involved Jefferson County medical and emergency personnel. In June 2007, a five-county Mass Immunization Prophysaxis System/Point of Distribution System practice run was held in reaction to a public health epidemic that was instigated by animal rights activists.

“Exercises like this really are important,” McDowell noted. “You like to think you won’t have a disaster like this, but you never know, and you need to be prepared for any possibilities.”

An complete evaluation of the Duncan Score 2008 exercise will be done by MERC and the Regional Medical Response System, with its conclusions to be presented in late July.

—–

To see more of the Waurika News-Democrat or to subscribe to the newspaper, go to http://www.waurikademocrat.com.

Copyright (c) 2008, Waurika News-Democrat, 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.

Doctor to Face Regulatory Hearing: Anne Litton White is Being Accused of False Advertising

By Elizabeth DeOrnellas, Winston-Salem Journal, N.C.

Jun. 26–For the third time in four years, a local doctor’s state medical license is in jeopardy.

Charges filed earlier this month against Dr. Anne Litton White by the N.C. Medical Board allege that she advertised in a false and misleading manner, forged another doctor’s name on forms authorizing advertisements, and provided false information to a board investigator.

In 2005, the board suspended White’s license twice. In February of that year, she received a two-year suspension for overcharging patients, treating a patient with drugs not approved by the federal Food and Drug Administration, and issuing misleading ads that falsely implied that she was board-certified in dermatology.

As part of a consent agreement, White’s suspension was reduced to 60 days provided that she adhere to specific conditions, including audits of her billing records and tighter controls on office surgeries.

White also agreed to not advertise herself as board certified without clearly stating that her certification is in family medicine and to not advertise her services in conjunction with a board-certified physician of another specialty without clearly noting her own area of certification.

In May 2005, the board alleged that White had violated those conditions by prescribing treatment for a patient whom she had not examined and by failing to maintain accurate records for that patient.

Her license was again suspended for two years. That suspension was reduced to 30 days provided White improve her office records, submit to random site inspections and take medical-ethics courses, among other conditions.

White had not practiced medicine for 30 days because of the earlier sanction so the board deemed the 30-day suspension already satisfied.

In August 2007, the board received a new complaint about an ad in the Winston-Salem Yellow Pages that listed B. Marcus Treen, a board-certified dermatologist who practices in South Carolina, as working at White’s practice.

According to the charges, an office worker saw White forge Treen’s signature on a form authorizing the ad. White later told a board investigator that she did not forge the signature.

A board investigator also reported that Treen’s name was displayed on the door of White’s practice in September 2007.

Treen provided training to White “on an irregular basis several years ago,” but he never practiced at her office nor provided permission to use his name in any advertisement or on the front door of White’s practice, the charges allege. Both White and Treen declined to comment.

White has hired an attorney and a hearing before the medical board is scheduled for Aug. 20 in Raleigh.

Thom Mansfield, the board’s legal director, said he couldn’t comment on the specifics of White’s case.

“The charges against her speak for themselves,” he said.

White’s Web site currently advertises her services as a “cosmetic surgeon,” which is not an official board-certified specialty.

A growing number of doctors have moved into the lucrative field of cosmetic medicine, which includes such procedures as wrinkle filling, chemical peels, lip augmentation, liposuction and laser hair removal.

Doctors risk sanctions if they falsely identify themselves as board certified, but regulation of terms used to describe cosmetic work is less cut and dried.

“With regard to terminology, there’s a gray area regarding cosmetic procedures because so many physicians have moved into doing those kinds of procedures,” Mansfield said. “There tends to be a lot of vague language that’s used.”

A state medical license generally does not limit what kind of medicine a doctor can practice, said Antoinette Hood, the executive director of the American Board of Dermatology.

“In reality, a physician can claim to be any specialist he or she wants to claim, and that’s legal,” she said. “However, they cannot claim to be board-certified in that specialty.”

Claiming to be a specialist without completing board certification raises a lot of questions, Hood said.

“Although it may not be illegal, I think you have to ask whether it’s ethical or whether it’s professional.”

Elizabeth DeOrnellas can be reached at 727-7279 or at [email protected].

—–

To see more of the Winston-Salem Journal, or to subscribe to the newspaper, go to http://www.journalnow.com/.

Copyright (c) 2008, Winston-Salem Journal, N.C.

Distributed by McClatchy-Tribune Information Services.

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

Governor Rendell Says 2020 Vision Report Outlines Challenges Facing State Government As Pennsylvanias Population Ages

To: STATE EDITORS

Contact: Gary Miller of Pennsylvania Office of the Governor, +1- 717-783-1116; or Jane Crawford, Aging, +1-717-783-1549

HARRISBURG, Pa., June 26/PRNewswire-USNewswire/ — Governor Edward G. Rendell today announced the release of the Pennsylvania 2020 Vision Report, a blueprint outlining how the state can prepare to address a growing population of older adults.

Pennsylvania already has the third-highest percentage of older adults and, by 2020, one in four state residents will be 60 or older – a situation that will create new opportunities and new challenges, Governor Rendell said. Thats why I authorized this important study to help ensure that state government is ready to serve a growing number of older adults.

The 2020 Vision Report, developed by the state Department of Aging with the input of numerous state agencies, evaluates the projected impact of aging Baby Boomers in four main areas: workforce and education; health care and wellness; housing and transportation; and energy and environment. It also assesses the effect on state government of population trends across the age spectrum.

This report creates a strategy for the anticipated dramatic growth of the older population, as well as identifying new programs to help meet the future challenges Pennsylvania faces as a result of its changing demographics, said Nora Dowd Eisenhower, secretary of Aging. By planning ahead, we can ensure that Pennsylvania continues to provide a supportive environment for older adults to live, work and enjoy their later years.

The report indicates that Pennsylvania is preparing for the future in a number of ways: by expanding energy production and technology sectors to create over 35,000 jobs; an average of $946 million will be spent per year over the next decade on mass transit and road and bridge projects; new educational and training programs will be created in economic high-risk areas; English language classes will be enhanced; nutritious meals will be delivered to seniors homes, vouchers for fresh produce will be available; and long-term living options will facilitate the ability of seniors and other people with disabilities to choose where they receive services.

In addition, the report provides examples of current and planned initiatives in other nations to address similar demographic shifts. The 2020 Vision Reportis available online at www.aging.state.pa.us.

The Rendell administration is committed to creating a first-rate public education system, protecting our most vulnerable citizens and continuing economic investment to support our communities and businesses.To find out more about Governor Rendell’s initiatives and to sign up for his weekly newsletter, visitwww.governor.state.pa.us.

CONTACT:

Gary Miller

717-783-1116

Jane Crawford, Aging

717-783-1549

SOURCE Pennsylvania Office of the Governor

(c) 2008 U.S. Newswire. Provided by ProQuest Information and Learning. All rights Reserved.

T. Michael Long, General Partner of Brown Brothers Harriman, Elected New Chairman of the Board of The HealthCare Chaplaincy

NEW YORK, June 26 /PRNewswire/ — The HealthCare Chaplaincy announced today that T. Michael Long, a general partner of Brown Brothers Harriman, will lead the board of trustees as its new chairman. During the early 1990s, Mr. Long served for five years as a trustee of The Chaplaincy and has been a stalwart supporter of the organization for almost twenty years. Mr. Long will succeed Lawrence J. Toal, who served as chairman for the past eight years.

“I feel very confident that The Chaplaincy will continue to grow under Mike’s exemplary leadership,” said Mr. Toal, former chairman, president & CEO at The Dime Savings Bank of New York, FSB. “Mike has the business acumen and experience necessary to lead the board as it oversees the execution of a new strategic plan and the launch of an ambitious capital campaign.”

Mr. Long joined Brown Brothers Harriman in 1971, and in December 1972, he aided in founding the firm’s newly organized corporate finance department, where he was instrumental in the development of its mergers and acquisitions and financial advisory activities. After serving as department head of Brown Brothers’ corporate finance department, Mr. Long was co-founder of the firm’s first “1818” private equity fund in 1989. Since then, the three 1818 Funds have invested in 34 companies, and Mr. Long has served as an active director of 18 companies, typically as a major or controlling shareholder.

Both as a corporate director and as co-manager of the 1818 Funds, Mr. Long has been closely involved in the development of several leading public and private healthcare and medical technology companies including, among others, HCA (the country’s largest operator of hospitals and out-patient surgery centers); National Healthcare (a leading operator of nursing homes); Steri-Oss and Nobel Biocare AB (two leading dental implant companies); CMS and Picis, Inc., (two leading clinical software providers); and MedSource, Inc. (a global provider of outsourced medical device manufacturing services). Mr. Long has also served as a director of numerous other firms, especially in the energy sector.

“I am pleased with Mike’s election and his acceptance of the chairmanship,” said the Rev. Dr. Walter J. Smith, S.J., president & CEO of The Chaplaincy. “Mike’s legendary success during his investment banking career at Brown Brothers and his notable achievements in growing several healthcare and medical technology companies will complement the strengths of our other trustees. He is a seasoned business leader with an equally passionate commitment to health care, research, education, and community service. His contributions during the next several years will be invaluable as The Chaplaincy looks beyond its 50th anniversary in 2011, and strategically works to insure its future,” Fr. Smith added.

Mr. Long has also served as a trustee of the Greenwich Country Day School, Ithaca College, and the Upper Canada College Educational Foundation. Mr. Long graduated cum laude from Harvard College with a B.A. in Government in 1965, and was the recipient of the Harvard University Corning Glass Traveling Fellowship. After beginning his career in higher education and management consulting, Mr. Long received an MBA with high distinction from Harvard Business School in 1971, where he also served as president of its Century Club.

The HealthCare Chaplaincy is a multifaith and multicultural community of professionals dedicated to caring for persons in spirit, mind, and body. Its mission is to advance the profession of pastoral care through visionary leadership and continuing excellence in innovative research, education, and clinical services.

http://www.healthcarechaplaincy.org/

The HealthCare Chaplaincy

CONTACT: Steven Shannon of The HealthCare Chaplaincy, +1-212-644-1111,ext. 141, [email protected]

Web site: http://www.healthcarechaplaincy.org/

New Agreement With MultiPlan and PHCS Includes All Tenet Hospitals

Tenet Healthcare Corporation (NYSE:THC) today announced that it has signed a multi-year agreement with MultiPlan, Inc., which includes participation in both the MultiPlan and PHCS (formerly Private Healthcare Systems) networks. The agreement includes all Tenet hospitals, outpatient and ambulatory care centers beginning July 1, 2008. Contracts for employed physicians will be finalized in the coming weeks.

The following hospitals will be added to the MultiPlan and/or PHCS networks:

— Hahnemann University Hospital, Philadelphia, Pa., 541 beds (PHCS Network)

— Doctors Medical Center, Modesto, Calif., 465 beds (PHCS Network)

— Fountain Valley Regional Hospital and Medical Center, Fountain Valley, Calif., 400 beds (PHCS Network)

— Frye Regional Medical Center, Hickory, N.C., 355 beds (PHCS Network)

— St. Christopher’s Hospital for Children, Philadelphia, Pa., 170 beds (PHCS Network)

— Sierra Vista Regional Medical Center, San Luis Obispo, Calif., 165 beds (PHCS Network)

— Central Carolina Hospital, Sanford, N.C., 137 beds (PHCS Network)

— Placentia-Linda Hospital, Placentia, Calif., 114 beds (PHCS Network)

— Twin Cities Community Hospital, Templeton, Calif., 114 beds (PHCS Network)

— Sierra Providence East Medical Center, El Paso, Texas, 110 beds (MultiPlan and PHCS networks)

— Coastal Carolina Medical Center, Hardeeville, S.C., 41 beds (MultiPlan Network)

— Sylvan Grove Hospital, Jackson, Ga., 25 beds (PHCS Network)

“We are pleased that the MultiPlan and PHCS networks will add all of our hospitals and outpatient services to create nationwide coverage,” said Stephen L. Newman, M.D., Tenet’s chief operating officer. “This agreement continues our goal of securing the full participation of all our facilities at market competitive rates.”

Clint Hailey, Tenet’s chief managed care officer, said, “National contracts with comprehensive managed care plans like this one allow us to simplify the payment methodology across all of our facilities. This agreement is significant because the MultiPlan/PHCS networks together represent one of Tenet’s top 10 largest health plans when ranked by revenue.”

Finally, Michael Ferrante, MultiPlan’s chief of operations, added, “Tenet delivers key hospitals in many markets for our clients, and we are very pleased to offer expanded access to these high-quality facilities through both our primary and complementary PPO networks. We look forward to a continued strong partnership between our companies.”

Tenet has announced several national contracts with major payors for all its hospitals and outpatient facilities in the past year including UnitedHealthcare, Aetna and CIGNA. The company also successfully negotiated regional contracts including Independence Blue Cross in Philadelphia; Blue Cross Blue Shield of Texas; Blue Cross of California; Great-West Healthcare in Florida, Memphis, and Philadelphia; Coventry Healthcare in Texas and California; and Blue Cross and Blue Shield of North Carolina.

Tenet Healthcare Corporation, through its subsidiaries, owns and operates acute care hospitals and related ancillary health care businesses, which include ambulatory surgery centers and diagnostic imaging centers. Tenet is committed to providing high-quality care to patients in the communities we serve. Tenet can be found on the World Wide Web at www.tenethealth.com.

Some of the statements in this release may constitute forward-looking statements. Such statements are based on our current expectations and could be affected by numerous factors and are subject to various risks and uncertainties discussed in our filings with the Securities and Exchange Commission, including our annual report on Form 10-K for the year ended Dec. 31, 2007, our quarterly reports on Form 10-Q and periodic reports on Form 8-K. Do not rely on any forward-looking statement, as we cannot predict or control many of the factors that ultimately may affect our ability to achieve the results estimated. We make no promise to update any forward-looking statement, whether as a result of changes in underlying factors, new information, future events or otherwise.

Essex Community Concerts Offers Daytime and Evening Performances

By Suzanne Moore, The Press-Republican, Plattsburgh, N.Y.

Jun. 26–ESSEX — At one end of the continuum are performers such as word-class organists Frederick Hohman and Carol Williams.

At the other, said Essex Community Concerts board member Jim Van Hoven, “are local people who are good at what they do.”

All are met with enthusiasm in the small historic community of Essex, where the gift of a Dutch pipe organ supplied the downbeat for an 18-year musical tradition sustained by a hardworking committee and a strong local appreciation of the arts.

SERIOUS ENDEAVOR

The 2008 concerts begin with the Evening Concert Series on Saturday with pianists Rose Chancler and Jennifer Moore in a four-hand performance. The Thursday Midday Concerts series, also in Essex Community Church, kicks off with the area’s longest-established brass quintet, After Five Brass, on July 10 with a repertoire of classical, jazz, Broadway and pop numbers.

The daytime concerts are free, featuring local performers ranging from organist Pamela Durant, a seasonal resident who memorizes her pieces from Braille scores; to high-energy vocalists Ya Got Treble; to Songs of the Northway, a trio whose repertoire includes songs about the environment, women’s issues, and contemporary Jewish folk and liturgical music.

Returning this year on Aug. 14 are the Goff Boys, who Van Hoven said are probably the most popular performers in the daytime series. Ages 7 to 13, the brothers play classical music.

“It’s a serious endeavor by the family,” said board member Alison Hain. “But these boys also do everything boys of that age will do.”

QUALITY PERFORMANCES

Daytime performances are free, but donations are accepted.

“One of the goals … is to encourage local talented people to perform, give them an audience,” Hain said.

The admission for the evening shows rises from $5 to $10 this summer.

Essex Community Concerts pays those performers $700 per show, along with lodging and meals for those who come from farther away.

“We’re persuaded 10 bucks for a quality performance is not a bad deal,” Van Hoven said.

The Concert Series is supported in part by a Developing Community Arts Grant with public funds from the New York State Council on the Arts Decentralization Program. That money is administered by the Arts Council for the Northern Adirondacks.

Donations also help fund the programs.

The church seats 150, and the concerts draw crowds ranging from moderate to a full house.

Late last summer, some music lovers traveled from Charlotte, Vt., on the ferry that docks at Essex — board members want to encourage that participation.

“The ferry runs late enough,” Van Hoven said. “People can have a nice ferry ride and walk over and enjoy the concerts.”

MUSICAL VARIETY

A neatly kept scrapbook chronicles the history of the Essex concerts, beginning with the late Donald Beggs, an Essex man who so loved organ music that he bought the Dutch tracker instrument that made its home in Essex Community Church.

“He gave it to the community, but the church was the only building big enough for it,” Van Hoven said.

Accompanying the organ — which was built by a family in Holland who then traveled to Essex to install it in the church over the course of many weeks — was a $50,000 endowment to maintain the organ and bring organists to Essex to perform.

That endowment is carefully maintained; most recently, it was used to rebuild the organ’s wind chest at a cost of about $18,000.

Beggs died in 1991, not long after the first concert, but the Essex Organ Committee lived on.

At first, the evening concerts only featured organists. Eventually, the midday performances joined the schedule with a variety of genres. The endowment allowed purchase of a piano, and from that point, the evening program expanded to include vocalists, instrumental quartets and other kinds of performances.

Two years ago, the committee changed its name to Essex Community Concerts to better reflect that shift; this year, just two organists will perform, among them one of only two civic organists in the United States.

Carol Williams holds that position in San Diego; a native of England, she is an associate of the Royal Academy of Music.

“Carol Williams has been with us many, many times,” Van Hoven said. “She comes to Essex because, I think, she likes Essex.

“Carol will bring a full house.”

[email protected]

IF YOU GO

Essex Community Concerts presents its Evening Concert Series at Essex Community Church, all shows at 7:30 p.m. followed by meet-the-artist reception. $10 admission; children free. The summer schedule is:

E Saturday, June 28. Rose Chancler and Jennifer Moore, Four Hand Piano.

E Saturday, July 12. Frederick Hohman, organist.

E Tuesday, July 22. “Meadowmount String Quartets & Piano.”

E Friday, July 25. “An Evening of Opera and Art Songs.” Constance Fee, Kelley Kimball, Steven Tompkins, Julie Runion.

E Sunday, Aug. 17. Vocalists Atea Ring and Raymond Domenico, and pianist Russ Ames.

E Saturday, Aug. 29. Carol Williams, organist.

E Friday, Sept. 12. Key Winds Trio: Janice Kyle, Janine Scherline, David Carpenter.

Thursday Midday Concerts are at 11:30 a.m. at Essex Community Church. Donations accepted. The schedule is:

E July 10. After Five Brass: Jeanette Woodruff, Beth Barr, Frank Langr, Jim McCarthy, Steve Woodruff.

E July 17. Daniel Linder, pianist.

E July 24. Ya Got Treble: Vocalists Susan Forney Hughes, Gigi Carroll, Catherine Houseal; pianist Mary Lou Kirsty.

E July 31. Songs of the Northway: Ann Hope Ruzow Holland, Cathie Davenport, Jennifer Van Benschoten.

E Aug. 7. Pamela Durant, organist.

E Aug. 14. The Goff Boys: Mitchell, Matthew and Jonathan.

—–

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.

New Technology Provides Drug-Free Approach to Treat Migraine

Neuralieve, a medical technology company pioneering a new approach to treat migraine headache, today reported completion of its clinical trial. The results will be presented June 27 during the annual American Headache Society (AHS) scientific meeting in Boston by Dr. Richard B. Lipton, Professor and Vice Chair of Neurology and Professor of Epidemiology and Population Health at the Albert Einstein College of Medicine in New York.

The randomized, double-blind, parallel-group, sham-controlled clinical study at 16 centers studied the use of Neuralieve’s portable transcranial magnetic stimulation (TMS) device for treating migraine with aura. The study demonstrated that for migraine with aura, treatment with Neuralieve’s non-drug, non-invasive TMS treatment system is superior to sham treatment, and led to patients being pain-free at 2 hours, 24 hours and 48 hours. The trial also confirmed that use of the Neuralieve TMS device, which delivers single pulse TMS treatment, is extremely safe. As a result, Neuralieve is in the process of submitting pre-market notification to the FDA. Neuralieve is also actively planning additional studies to further demonstrate that its TMS treatment can clinically benefit more people.

Used for years, TMS is a proven, safe method of studying the brain. It works by creating a focused magnetic pulse that passes non-invasively through the skull, inducing an electric current. Neuralieve’s TMS device utilizes this technology to send signals to disrupt the abnormal brain waves known as cortical spreading depression (CSD); a condition that precedes migraine with aura. Some studies have also suggested that CSD may be present in migraine without aura. By disrupting CSD early, Neuralieve’s TMS treatment system has the potential to preempt headache altogether, reduce the duration or severity of migraine episode, and even reduce the frequency of migraine attacks.

“The study is based on the hypothesis that TMS disrupts CSD in progression. The results prove that TMS is a safe and effective treatment for aura and headache in patients diagnosed with migraine with aura,” said Richard B. Lipton, M.D., lead investigator on the study “This non-drug early treatment modality offers a promising alternative to existing migraine therapies.”

“We are pleased with the study results and the potential of our TMS treatment to help the people out there who suffer from migraine,” said Ting W. Lu, president of Neuralieve. “We are now taking steps to make the device available for physicians to prescribe to patients as soon as possible after regulatory clearance.”

Migraine is a syndrome characterized by recurrent, often excruciatingly-painful headaches. Migraines are classified by type, the most common of which are migraine with and without aura. Migraine with aura involves pain preceded by abnormalities in neurobiological function, most commonly visual disturbances. Migraine without aura is characterized by attacks of unusually intense, temporarily disabling head pain often accompanied by nausea and sensitivity to light and sound. Patients may suffer from migraine with aura, migraine without aura, or both. Up to 30% of migraine sufferers experience migraines with aura.

It is estimated that nearly 30 million Americans suffer from migraine; more than half report severe impairment or require bed rest during their episodes. In addition, the National Headache Foundation estimates that migraine causes 157 million lost workdays each year due to pain and associated migraine symptoms, resulting in a $13 billion burden to American employers.

Migraine is typically treated with acute drug therapy, most often with a class of agents known as triptans. Although these drugs have been a significant step forward in treating migraine, it is estimated that as many as 40 percent of patients do not do well with triptans. In addition, the drugs can cause serious cardiovascular side effects.

The safety of single-pulse TMS, as used in Neuralieve’s treatment system, is accepted by the National Institutes of Health (NIH) and National Institute of Neurologic Disease and Stroke (NINDS). Neuralieve worked with its medical advisory board to design the trial based upon the promising results seen in feasibility studies of TMS Treatment for migraine. Studies at Ohio State University, Borgess Research Institute and McMaster University utilized an in-clinic based TMS Treatment System. This research led to the design of a portable system which was then utilized in the multi-center randomized trial to assess its safety and efficacy in treating migraine with aura.

Neuralieve is a private company located in Sunnyvale, California. For full clinical trial results, please visit the company’s website at www.Neuralieve.com.

UM Autism Clinic Takes to the Road in Van

By Erika Capek, The Miami Herald

Jun. 26–Friendly and popular with University of Miami students and staff, Kent Schomber’s disability is hard to see. He is autistic; yet, Schomber doesn’t let that get in his way.

He works in the UM psychology department as a senior clerk for the Autism Center and has been called a “poster child” for how parents want to see their autistic children functioning in the world.

“I’ve noticed much improvement in the study of autism over the last 10 years,” said Maria Lapone, the mother of 12-year-old Gabriella, who was diagnosed with autism when she was a baby.

Even with improved research, one out of every 150 children is diagnosed with autism, according to Diane Adreon, associate director of the UM-Nova Southeastern University Center for Autism and Related Disabilities. It is estimated there are 40,000 children in Miami-Dade, Broward and Monroe counties who have autism or autistic-related disabilities and aren’t getting the help they need.

But with the unveiling of the first Mobile Autism Family Clinic on June 19, families who didn’t have the means to get to a center now will have a free autism clinic brought to them.

The UM-NSU CARD is the first to try this approach.

“It’s clear that the families that needed us most couldn’t get to us,” said Dr. Michael Alessandri, executive director of the center. “These people are underserved, underrepresented, and now finally we’re able to do something about it.”

Five years ago, Alessandri came up with the idea of a mobile autism clinic after seeing a Red Cross blood mobile. But his vision didn’t begin to take shape for several years because of a lack of funding.

But with a recent $56,000 grant from Unicorn Children’s Foundation, an international nonprofit organization, and private donations, the mobile clinic was completed this month.

The 23-foot UM-NSU CARD bus is customized with a therapy and evaluation room in the back and a waiting room and work station in the front. The back of the bus has video cameras that connect to recording equipment and a monitor in the waiting room, so families can watch and interact with their children.

“When children are diagnosed early, there’s overwhelmingly better results,” said Florida Secretary of Health/Surgeon General Ana Viamonte Ros. “This mobile unit is great because it will help with early screenings and treatment methods and provide support services to families in need.”

According to Natalee George, coordinator for UM-NSU CARD, the mobile clinic does not diagnose a child with any disability. However, visiting the clinic is the first step to take for parents looking for answers.

Families will be able to meet with a clinician and have a reading done on the child. If there is a disability, the parents will be given information on what to do next, including where to go for a more formal assessment.

“Early intervention is very important,” George said. “It’s imperative that we get into the communities that have been in the dark about autism and do something about it.”

The mobile clinic’s first stop will be Sept. 13 at The Children’s Trust Health Expo. It will be outside Arnold Hall at the Miami-Dade County Fairgrounds from 10 a.m. to 6 p.m.

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

Copyright (c) 2008, The Miami Herald

Distributed by McClatchy-Tribune Information Services.

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

A 2008 UK Private Healthcare Market Report Including SWOT Analysis and Company Profiles

Research and Markets http://www.researchandmarkets.com/research/a47f9b/private_healthcare has announced the addition of the “Private Healthcare Market Report 2008” report to their offering.

The total UK market for private healthcare was worth GBP 24.77bn in 2007, a rise of 8.1% on 2006 and an increase of 31.9% since 2003. The market is currently thriving, with sectors such as mental health, elderly care homes and, to some extent, acute care benefiting from increased levels of public funding and a shift from public to private provision.

The NHS is in a period of transition and it is not yet clear how it will compare with its privately funded rival over the next few years. Waiting lists have been reduced and the quality of care is perceived to have improved in a number of areas of the service. This presents a very real threat to the future of the private healthcare market and could deter use of private treatment. In addition, while sectors such as acute care have benefited from the NHS commissioning of provision to cut waiting lists, this situation may not continue. Indeed, over the next 5 years (2008 to 2012), a clear and secure path to revenue growth is not evident.

The independent hospital sector has also had to become more competitive and deliver greater cost efficiency in order to comply with the controlled tariffs imposed by the NHS. The entire acute care industry is likely to have to become more efficient, with pressure coming from the private medical insurance (PMI) industry, which is continually looking for ways to deliver a cheaper and more attractive proposition to its consumers. The PMI industry itself is highly mature, and a fall in membership levels over the past 5 years is currently being addressed with more competitive, and perceptibly cheaper, products on the market.

In terms of long-term care for both the elderly and the mentally ill, greater outsourcing by local authorities is the prevailing trend, but again, a focus on costs and the need to deliver a lean and efficient business model to attract long-term commissioning appear to be pre-requisites. The same can be said for short-term acute provision for the mentally ill in the independent mental health hospital sector, which is currently burgeoning, but which needs to stay cost-efficient and competitive.

Consumers are ambivalent in their attitudes towards the private healthcare market. Key Note’s consumer research reveals that the large majority of consumers are extremely loyal to the NHS — more than 80% would prefer to use it if quality of care could be guaranteed. However, at the same time, almost half aspire to the privileged treatment afforded through the private system. This ambivalence presents opportunities for the industry: the future for the private healthcare industry may be one offering cheaper forms of healthcare and insurance packages which really give patients benefits that the state system is unable to provide.

 Key Topics Covered: - Market Definition - Report Coverage - Market Sectors - Market Trends - Market Position - Market Size -Industry Background - Number of Companies - Regional Variations in The Marketplace - Distribution - How Robust Is The Market? - Legislation - Key Trade Associations - Competitor Analysis - Strengths, Weaknesses, Opportunities and Threats - Buying Behaviour - Uptake of Private Medical Insurance - Use of Healthcare Services - Attitudes and Concerns towards Healthcare - Current Issues - The Global Market - Forecasts - Company Profiles Companies Mentioned: - Atos Origin It Services Uk Ltd - Axa Ppp Healthcare Ltd - Bupa Care Homes (cfg) Plc - Bupa Insurance Ltd - Capita Health Solutions Ltd - Care Uk Plc - Craegmoor Healthcare Company Ltd - Nuffield Hospitals - Partnerships In Care Ltd - Priory Healthcare Investments Ltd - Southern Cross Healthcare Group PLC - Spire Healthcare Ltd 

For more information visit http://www.researchandmarkets.com/research/a47f9b/private_healthcare

Naughty Workout Good For The Bootie

By Maryellen Fillo, The Hartford Courant, Conn.

Jun. 26–Exoticize? Or maybe bump-and-grinderobics. No matter what you call it, putting the XXX in exercise has its benefits.

From California to Connecticut, lap-dance moves once designed for gentlemen’s clubs have taken on a new life as a women-only way to move as if no one were watching. And, as an added benefit, lap dancing gives those always needy leg and ab muscles a workout they are sure to remember the day after.

Core Studio, a Plainville exercise studio, has parlayed a single lap-dancing class into a monthly gathering for 25 women, from twentysomething to seventysomething, who can’t wait to get out of the house and under the strobe lights, where they can be not so nice in a perfectly appropriate way.

“I’m 48; I feel like 18,” said Linda Brierty, sporting turquoise chandelier earrings and a short white skirt — not your typical exercise-class apparel — as she got ready for her first try at the fitness lap-dance class.

“This program is out of the box,” said Brierty, of New York City, who came with girlfriend, Lisa Geissler of Farmington. “You can’t find anything like this in the city.”

Under the tutelage of studio owners Jenn Miller and Joy Perugini, the session opens with a champagne toast and themed goody bags that include body glitter and lip gloss for everyone — just to set the mood. A range of body types fills the room, but all agree they look pretty good, thanks to forgiving strobe lights that spotlight the two owners as they demonstrate the night’s routine.

The only prop, other than some sexy attitude, is a folding chair. A playlist of 23 songs — like Eminem’s “Shake That,” Mariah Carey’s “Touch My Body,” Beyonce’s “Naughty Girls,” Def Leppard’s “Pour Some Sugar On Me” and Motley Crue’s “Girls, Girls, Girls” — provides the down-and-dirty music for the choreographed dance.

“Who’s in your chair?” yells out Miller as women take turns sauntering up to one of the empty chairs to practice each new segment of the routine. “Work it, ladies; be a naughty girl” is the battle cry as dancers encourage each other while simultaneously trying to channel the likes of Jennifer Beals’ character in “Flashdance” or Jamie Lee Curtis’ housewife-gone-wild in “True Lies” to get the moves just right.

“My husband thinks it’s a riot that I’m here,” said Linda Kennedy of Avon, who has been married for 22 years and is taking the class for the first time. “I guess we’ll find out when I get home if he is into it.”

But don’t think this is only about working on the sensual side. After two hours of learning and relearning the three-minute dance, you barely notice that you have given your body a serious workout until it is too late to dial it back a bit.

Perugini and Miller are dead serious about providing clients with a good exercise option at their studio, which also offers more traditional classes, such as spinning and Pilates. But when they offered a one-time-only lap-dancing class, it proved so popular that they now offer it once a month, with each class filled to capacity.

“I think this gives women a safe environment to let go of inhibitions and find their sexy side,” said Perugini. “Learning to lap dance or pole dance is more socially accepted, and women are more empowered these days to try it. And there is the exercise benefit to it. It’s not traditional cardio work, but it is a great workout for hips, legs, abs and balance. You sweat, you have fun and you free your mind of all the junk that goes on all day.”

For 37-year-old Robin Condon of Farmington, who is single, the class is not only an interesting workout alternative to the classes she usually takes but a way to go out, dance and let loose without having to deal with the bar scene.

“I’ve gone to all three of the classes so far and love it,” said Condon. “It’s a way to be sexy and free and liberated.”

The next fitness lap-dancing classes at Core Studio, 32 Whiting St., Plainville, are July 18 and Aug.22. Cost is $35 for nonmembers and $20 for members. Information: 860.793.6683 or corefitnessinc.com.

Contact MaryEllen Fillo at [email protected].

More articles

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To see more of The Hartford Courant, or to subscribe to the newspaper, go to http://www.courant.com/.

Copyright (c) 2008, The Hartford Courant, Conn.

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.

GSK and Sanofi-Pasteur

The FDA has approved Kinrix and Pentacel, two new combination products for the prevention of diphtheria, tetanus, pertussis and polio. Although the new combinations will reduce the number of shots and increase the convenience for vaccinees, their introduction may cause financial challenges for physicians, potentially limiting their uptake.

Sanofi Pasteur’s Pentacel is a 5-valent combination vaccine, protecting against diphtheria, tetanus, pertussis (DTP), polio and infections with Haemophilus influenzae b in one single shot. The vaccine has been approved for use as a four-dose series at two, four, six and 15-18 months of age for infants and children between six weeks and four years old. However, it will face some tough competition in this segment: GSK is marketing its 5-valent combination vaccine Pediarix, which provides protection against DTP, polio and hepatitis B, in the same age group.

GSK’s Kinrix, the other vaccine which has been approved by the FDA this week, combines antigens against DTP and polio in one shot. Unlike Pentacel, this vaccine is not targeted at the infant population, but is aimed instead at the pre-school booster market. In the US, a DTP/polio booster is recommended for all children aged four to six years of age, and, prior to this approval, no combined vaccine was available. As a result, Kinrix, which has been approved precisely for this segment, has good prospects for capturing a large share of sales in this segment. Since Kinrix’s approved indication is limited to use in those children who have previously received GSK’s DTP vaccines Pediarix or Infanrix, it would seem that the company is attempting to protect its leading position in DTP infant vaccination, providing tailored options for each age group. However, following the approval of Pentacel, the tables could turn if physicians prefer Sanofi’s new vaccine over Pediarix.

A common challenge for both of these vaccines, however, is the reluctant attitude of many US pediatricians towards combination products. Although they increase the convenience for the vaccinee by reducing the number of shots they must endure, US physicians claim that, under current reimbursement rules, using combination vaccines instead of single-antigen products results in financial losses for them. This is because most payers reimburse combination and single antigen products at the same rate, although the administrative effort for combination vaccines is significantly higher. In other words, less pain for the children translates into less gain for the physician. These concerns need to be addressed in order to maximize the uptake of combination vaccines such as Pentacel and Kinrix across the US.

Robotic Surgery at AIIMS for Rare Neuro Disorder

NEW DELHI: On Saturday, for the first time ever, the All India Institute of Medical Sciences (AIIMS) performed robotic thoracoscopic thymectomy on patients with myasthenia gravis, a rare autoimmune disorder.

AIIMS has been performing video assisted thoracoscopic (VAT) thymectomy, or removal of thymus gland, for the past eight years involving more than 200 cases so far. But this is the first time that doctors used a robot for the purpose, making the procedure more precise. “Robotic surgery is more precise and accurate. It is the future of all surgeries. The robots are so designed that they can reach inaccessible areas in the body and bend and curve as per the shape of the organ. If it works well, then AIIMS would be the only government hospital in India to offer robotic thymectomy,” said a senior doctor.

Myasthenia gravis is a neuromuscular disease that leads to muscle weakness and fatigue. Though no definite cause is known, removal of the thymus gland often helps cure the problem completely. “The thymus gland plays an important role in the development of the immune system in early life. In infants, the size of the gland is really big and covers almost the entire chest, but with age the size reduces and has no role to play in the body. It is full of fat. In nearly 75% of myasthenia gravis patients, the size of the thymus gland is considerably big and the functioning is abnormal,” said Dr Arvind Kumar, professor, surgery with specialisation in thoracoscopic thymectomy, AIIMS.

According to sources, nearly 12-16 thymectomies had been planned till Monday evening, but only six could be executed. Dr Arvind Kumar performed all the surgeries and was assisted by two experts from Germany, who had flown down especially for the three-day session.

Thymectomy can be either performed through an open method or VAT. The former is similar to open-heart surgery in which the chest bone is cut open and the thymus gland, which is anterior to the heart, is taken out. In VAT thymectomy, three tiny incisions are made in the left chest through which the surgical instruments along with a small scope is introduced into the body and the surgery is carried out with the help of a visual monitor. The robotic surgery is similar to VAT, but the only difference is that the surgeon uses a specialized console with monitor to perform the surgery. The plus point of VAT thymectomy is that it leaves minimal scars.

In myasthenia gravis, the body produces certain antibodies which attacks its own immune system and blocks or destroys the communication between nerves and muscles, thereby preventing muscle contraction.

Incidentally, thymectomy is also done on patients with thymic carcinoma (a rare type of thymus gland cancer) and non-metastic thymoma.

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

RFIDs May Pose Hospital Risk

Dutch researchers say radio frequency identification devices may cause critical-care medical equipment to fail.

The study, published in the Journal of the American Medical Association, looked at the effect the devices have on pacemakers, ventilators and other equipment, USA Today said Wednesday.

Radio frequency identification devices, which are commonly used in hospitals on items ranging from security cards to surgical sponges, caused interference with medical devices in 34 of 123 tests, the newspaper said.

Dr. Erik Jan van Lieshout of the Academic Medical Centre of the University of Amsterdam said medical equipment makers need to create protective technologies to keep the devices from interfering with their products. Donald Berwick, president and chief executive officer of the Institute for Healthcare Improvement in Cambridge, Mass., said more research is needed to determine the true risk of RFIDs in hospital settings.

American Heart Association Launches Patient Web Site

DALLAS, June 25 /PRNewswire-USNewswire/ — There is a new place for heart patients, their families and caregivers to go for lifesaving information — and they won’t have to leave their home.

The American Heart Association’s new patient Web site — http://www.hearthub.org/ — provides tools, resources and information on an array of heart conditions in an easy-to-understand, interactive format. Users will find:

   --  Interactive Glossary: Patients can quickly learn the meanings of       unfamiliar medical terms by typing in the search field or clicking on       a letter.    --  Click-To-Talk: When users enter their name and telephone number, a       representative from the American Heart Association's 24-hour call       center will contact them.    --  Quick Facts Video Library: Patients can stay informed with the latest       videos and animations on heart disease and stroke.    --  Updated Newsfeed: Patients can get the latest health news with daily       updates   

“Heart Hub offers one-stop shopping for people diagnosed with heart disease and stroke, those who have high cholesterol or other risk factors, and healthy people who want to stay that way,” said Daniel Jones, M.D., president of the American Heart Association and dean of the School of Medicine at the University of Mississippi Medical Center in Jackson.

Heart Hub also includes an easy-to-navigate ‘health centers’ menu with information on everything from cardiac arrhythmia to peripheral artery disease. With one mouse click, patients navigate deeper into the content to find information.

With easy-to-identify icons, the helpful tools section of the site gives users quick access to risk assessments, health trackers, treatment options, animations, illustrations and more. These interactive tools help patients evaluate their risk levels and track their blood pressure, weight or other personal health information to help them live healthier.

“With Heart Hub, doctors, nurses and other healthcare providers can quickly and easily lead patients to a credible, abundant source of heart and stroke information,” Jones said.

   For more information, visit http://www.hearthub.org/.    About the AHA  

Founded in 1924, the American Heart Association today is the nation’s oldest and largest voluntary health organization dedicated to building healthier lives, free of heart diseases and stroke. These diseases, America’s No. 1 and No. 3 killers, and all other cardiovascular diseases, claim nearly 870,000 lives a year. In fiscal year 2006-07 the association invested more than $554 million in research, professional and public education, advocacy and community service programs to help all Americans live longer, healthier lives. To learn more, call 1-800-AHA-USA1 or visit http://www.americanheart.org/.

American Heart Association

CONTACT: Cindy Lewis of the American Heart Association, +1-214-706-1433,[email protected]

Web Site: http:/// http://www.hearthub.org/http://www.americanheart.org/

TranS1 Inc. Announces the First Patients Treated With Its Percutaneous Nucleus Replacement, PNR, in Europe

WILMINGTON, N.C., June 25, 2008 (PRIME NEWSWIRE) — TranS1 Inc. (Nasdaq:TSON), a medical device company focused on designing, developing and marketing products that implement its proprietary minimally invasive surgical approach to treat degenerative disc disease affecting the lower lumbar region of the spine, today announced the first patients treated with its revolutionary, 2nd generation PNR(r) implant. The PNR(r) is designed to relieve lower back pain while restoring full range of motion and axial compression within the affected lumbar disc. The PNR(r) is the only motion preserving implant capable of being surgically delivered into the degenerated disc through a single, one and a half inch incision without damaging or dissecting any supportive soft tissue structures such as muscles, ligaments and the disc annulus. Consequently, the patients receiving the PNR(r) were ambulatory within two hours of the surgery. These first patients are part of a pilot study to assess the safety and effectiveness of the PNR(r).

“This is the next step in leveraging the company’s proprietary spinal access and implant technology; this procedure will allow surgeons to restore normal disk function to patients suffering from debilitating low back pain, through our least invasive approach,” stated Rick Randall, President and CEO of TranS1. “I want to thank Dr. Dick Zeilstra and the staff of the Neurosurgical Centre in Zwolle for their cooperation and support of this study.”

The first procedures were performed at the Neurosurgical Centre in Zwolle, The Netherlands by Dr. Dick Zeilstra. Dr. Zeilstra was an early adopter of the TranS1 AxiaLIF(r) lumbar fusion procedure and is a lead investigator with the PNR(r) pilot study. “We are very proud to be the first facility in the world to implant the next generation TranS1 PNR(r). The transacral approach is the easiest way to deliver a nucleus replacement and be sure that it stays in place. The PNR(r) is a revolutionary technology to add to my armamentarium of treatment options for my patients suffering from back pain. This implant allows me to restore the function of the patient while relieving their pain,” said Dr. Dick Zeilstra.

The PNR(r) implant is inserted into the degenerative disc via a small surgical opening created adjacent to the patient’s tailbone, thereby minimizing soft tissue damage, blood loss and pain. The soft, polymeric implant is designed to replace the damaged disc nucleus and anatomically restore normal spinal motion. The procedure can be performed in under an hour.

About TranS1 Inc.

TranS1 is a medical device company focused on designing, developing and marketing products that implement its proprietary minimally invasive surgical approach to treat degenerative disc disease affecting the lower lumbar region of the spine. TranS1 currently markets two single-level fusion products — the AxiaLIF(r), the AxiaLIF 360(tm) and the AxiaLIF 2L(tm) in the U.S. and Europe. TranS1 was founded in May 2000 and is headquartered in Wilmington, North Carolina. For more information, visit www.trans1.com.

Forward-Looking Statements

This press release includes forward-looking statements, the accuracy of which is necessarily subject to risks and uncertainties. These risks and uncertainties include, among other things, risks associated with the adoption of a new technology by spine surgeons, product development efforts, regulatory requirements, maintenance and prosecution of adequate intellectual property protection and other economic and competitive factors. These forward-looking statements are based on the company’s expectations as of the date of this press release and the company undertakes no obligation to update information provided in this press release. For a discussion of risks and uncertainties associated with TranS1’s business, please review the company’s filings with the Securities and Exchange Commission, including its Annual Report on Form 10-K for the year ended December 31, 2007.

This news release was distributed by PrimeNewswire, www.primenewswire.com

 CONTACT:  TranS1 Inc.           Investors:           Michael Luetkemeyer, Chief Financial Officer           910-332-1700            Westwicke Partners           Mark Klausner           410-321-9651           [email protected] 

The Spine Institute of Louisiana is Selected to Implant an Investigational Device for Patients With Lumbar Spinal Stenosis

Most patients facing surgery to correct a painful spinal condition are usually a bit apprehensive. Not so for 70-year-old Marveen Boone of Chase, Louisiana, who will become the first patient in the United States to surgically receive a new investigational device. The VertiFlex(R) Superion(TM) Interspinous Spacer is a small spacing device for lumbar spinal stenosis (LSS). LSS is a common and debilitating problem for people over age 50.

Boone’s surgery will be performed at the Spine Institute of Louisiana in Shreveport on Thursday, June 26, 2008. Spine surgeon, Pierce D. Nunley, M.D., will be the first surgeon in the United States to implant the new device in a research study. Dr. Nunley states: “The instrumentation developed by VertiFlex(R) allows patients only a small scar and a quicker recovery. It integrates a minimally invasive technique that seeks to preserve all the normal anatomical structures of the spine. This is a good option for patients that would potentially be candidates for traditional fusion – a more invasive procedure.”

The Superion(TM) device is intended to correct LSS by opening the space in the spinal column that has gradually narrowed over time; resulting in pain and numbness from pressure on the spinal cord and nerve roots. The Superion(TM) device is implanted through a minimal incision that does not require general anesthesia. The out-patient procedure can be completed in as short as 20 minutes per level.

Compared with traditional fusion procedures, in which patients typically undergo hours of surgery, with extended hospital stays and lengthy rehabilitations, this device hopes to offer patients a much less invasive option, briefer hospital stay and a rapid recovery time. Boone says she can’t believe her luck in being the first patient in the U.S. to receive this revolutionary new device here in Shreveport. “I am so thankful to have this done without a big procedure. This one is so simple.”

The Superion(TM) Interspinous Spacer is a titanium metal implant that is delivered through a small 12-15 millimeter incision in the patient’s back. A small delivery tube is placed through the incision and the device is then opened underneath the patient’s skin. As the implant is opened the wings embrace the spinous processes of the lower and upper level vertebra of the affected level. Once the device has been opened the delivery tube is removed and the incision is closed.

“Superion(TM) is available only through this clinical trial at selected sites in the U.S., including the Spine Institute of Louisiana,” says Medical Research Director Ajay Jawahar, M.D. He adds, “This implant procedure may be a solution for elderly patients who are suffering with LSS, and have been reluctant to have surgery to correct it.”

Earl Fender, President and Chief Executive Officer for VertiFlex(R), stated: “This is a significant milestone for VertiFlex(R). The Superion(TM) Interspinous Spacer may be a contribution to treating an aging population suffering from spinal stenosis. VertiFlex(R) looks forward to demonstrating clinical success in the trial so that Superion(TM) can soon be offered to the general public.”

Superion has already had considerable success in Europe. To date hundreds of Superion devices have been implanted in eight countries by over 30 surgeons.

About VertiFlex(R)

Founded in 2005, VertiFlex(R), Inc. is a privately held venture-backed medical device company headquartered in San Clemente, California, and operating both in the U.S. and globally. The company is dedicated to the development and advancement of minimally invasive and motion preservation technologies for disorders of the spine. VertiFlex(R) is committed to delivering advanced products that transform patient outcomes, and offers a full compliment of solutions for minimally invasive lumbar fusion of the spine. These include the Silverbolt(TM) MLR Screw System, which allows for multi-level minimally invasive or mini-open screw fixation, the Octane(TM) VBR and the Oracle Expandable Retractor. VertiFlex’s product line also includes the Dynabolt(TM) Dynamic Stabilization System, a pedicle screw-based motion system delivered through the Silverbolt(TM) system, and the Superion(TM) Interspinous Spacer. These motion preservation product offerings allow for an array of solutions for multiple indications. The Superion(TM) Interspinous Spacer is currently under clinical investigation in the U.S.

About Spine Institute of Louisiana

www.louisianaspine.org

Glen Burnie West: North Glen Announces Presidential Award Recipients

By Kathleen Shatt

North Glen Elementary School announced this year’s recipients of the presidential academic awards. The awards are sponsored by the U.S. Department of Education and winners receive a certificate signed by the president.

There are two categories for the awards. The President’s Award for Educational Excellence is awarded to students whose overall grade point average is 3.5 in the fourth and fifth grades. The students must also exhibit high motivation, initiative, integrity, intellectual depth, leadership and exceptional judgment.

The award winners are Chloe Diggs, Parker Gesualdi, Korinne Glidden, Candace Griffin, Natalie King, Erykah Paige, Denashaja Simpkins and Percy Woodlon.

The President’s Award for Educational Achievement is awarded to students who show outstanding growth, improvement, commitment, or intellectual development in academic subjects.

The award winners are Samantha Alexander, Kendra Bloom, Lydia Burkhart, Tamoira Duncan, Samantha Han, D’Asia Jacobs, Yolanda Moses, Joshua Shin, Sydney Southers and Michael Traynham.

For more information, call the school office at 410-222-6416.

Lifeguard training

The North Arundel Aquatic Center, located at 7888 Crain Highway, will offer American Red Cross lifeguard training from 10 a.m. to 6 p.m. Saturday and Sunday and from 8 a.m. to 4 p.m. Monday through Wednesday. The course also will be offered Aug. 4 through 8.

Advance registration is required. The cost is $160 plus a $35 book fee.

Participants must be at least 15 years old and able to pass a 300 meter swim test that includes object retrieval.

Participants must attend all sessions and pass a written and water test to receive certification.

For more information, call Jennifer Richards at 410-222-0090, Ext. 6.

Yard sale

The Women of the Community Church of God will sponsor an inside yard sale from 8:30 a.m. to 1 p.m. Saturday at the church, 306 Fifth Ave. S.E.

Luncheon items will be sold.

Funds raised at the event will be used to support missionaries in the United States and abroad.

For more information, call Fran Shiffrin at 410-766-5732.

George Burns impersonator

Al Long will re-create comedian George Burns during a one-man show at 10:30 a.m. tomorrow at the Pascal Senior Center, 125 Dorsey Road.

Admission is free and open to the public.

The Pascal Book Club will meet at 10 a.m. Friday. Members will discuss the book “The Color of Courage” by Patricia Davids. New members are welcome. A listing of future books to be discussed is posted at the center.

A bake sale and flea market will be held from 8:30 a.m. to 2 p.m. Friday. The flea market will also be open from 8 a.m. to noon on Saturday (June 28).

Donations will be accepted Wednesday (June 25) and Thursday (June 26). Magazines and clothing will not be accepted.

For more information, call the center at 410-222-6680.

Basket bingo

The Holy Trinity Youth Ministry will sponsor a basket bingo on July 17 in the Monsignor Slade Catholic School cafeteria, 120 Dorsey Road.

The doors will open at 6:15 p.m. Bingo games will begin at 7 p.m.

Admission is $10 in advance, or $12 at the door, if tickets are still available. Seating is limited.

The bingo will include 20 regular games of bingo and door prizes. Extra cards will be sold at the door along with cards for special games.

Refreshments will be sold.

For more information, Karen Ng at 410-766-5070 Ext. 18 or Jennifer Danko at 420-863-5845.

Summer concert

The Glen Burnie summer concert series will continue on Friday as the Bayside Big Band performs favorites from the 40s, 50s and 60s from 7:30 to 9 p.m. in the Corcoran Pavilion in the Glen Burnie Town Center, 101 Crain Highway N.E.

Admission and parking are free. Those attending should park in the county parking garage on Baltimore Annapolis Boulevard.

Alcoholic beverages and pets are not permitted at the event. Patrons are encouraged to take a lawn chair for seating.

The 2008 concert series will be held on Friday evenings through July 19.

For more information, call Betsy Slikker at 410-647-0057.

Ravens Roost 18

Ravens Roost 18 will meet at 7 p.m. Monday at the Ferndale Volunteer Fire Company hall, 4 S. Broadview Blvd.

For more information, call Elaine Happel at 410-761-7790 or visit the Web site www.ravensroost18.org.

Bingo

The Ferndale Community Club offers bingo games on Tuesday afternoons and Thursday evenings. The club is located at 15 N. Fifth Ave.

The doors open at noon for the Tuesday Sunshine bingo. The first games begin at 1 p.m. Twenty-three bingo games are offered. Cash prizes of $15 for regular games and $25 for special games are offered.

The doors open at 6 p.m. for the Thursday evening bingo. Early bird games begin at 7 p.m. Thirty-six games are played. Cash prizes of $30 for regular games and $60 for special games are offered. In addition, there is also a $500 jackpot game.

Food and refreshments are sold. No smoking is permitted at either games.

For more information, call the club at 410-766-9727.

Babysitting training

The North Arundel Aquatic Center will offer the American Red Cross baby-sitting training course from 10 a.m. to 4 p.m. Saturday and Aug. 16 at the county pool, 7888 Crain Highway.

The program is designed for youth ages 11 to 17 years old.

The cost of the course is $75. Advance registration is required.

Participants will learn skills to baby-sit infants and school age children, including first aid, rescue breathing, managing young children, and feeding, diapering and caring for infants.

Participants should take a bag lunch.

For more information, call 410-222-0090.

Vacation Bible school

Oakwood Wesleyan Church will offer vacation Bible school classes from 9 a.m. to noon July 7 through 11 at the church, 505 Oakwood Station Road.

Children will have fun making discoveries at the power lab, learning about Jesus’ miracles. The program is free and includes games, treats, music, videos, stories and crafts.

Teenagers and adult volunteers are needed to help with the program.

For more information, call 410-761-4530 or send e-mail to [email protected] or visit the Web site www.myowc.org.

Clubs and organizations in the 21061 ZIP code area can call Maryland Gazette correspondent Kathleen Shatt at 410-766-8547 for publication of their news. They can also fax information to her at 410-766-1520 or send e-mail to [email protected].

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

UroToday International Journal Publishes the First Issue

The 4th International Consultation on Incontinence (ICI) will be held in Paris July 5-8, 2008. The organizers of this workshop have summoned the world’s leading experts in urology, gynecology and urodynamics to present and discuss the most recent advances in the field, including epidemiology, basic science, and treatment. Additionally part of the purpose is to propose validated standard international instruments to evaluate incontinence, and to help standardize response criteria and recommendations for clinical research on incontinence.

The abstracts of the posters that will be presented at the consultation are now published exclusively in this first issue of Urotoday International Journal (UIJ). These abstracts comprise not only different aspects of the overactive bladder such as treatment, epidemiology, basic science, but also summarize recent advances in the areas of stress incontinence, pelvic floor disorders and prolapse.

The aim of UIJ is to elevate the access of relevant urology science to professionals around the world and to make this scientific information available to a broad audience. We believe that this aim will be fulfilled for these abstracts, since UIJ currently reaches over 60,000 professionals in urological diseases.

It is our hope that all professionals in the fields of incontinence research and management, both experienced and newcomers, will benefit from these abstracts, and become inspired towards further efforts.

UroToday International Journal

UroToday International Journal(R) (http://www.urotodayinternationaljournal.com) is an online open-access, peer-reviewed, fast-tracked urology and urologic oncology publication. UIJ is the first urology journal to provide free submission and free access to full text.

 For More Information: Tracy Ireland UroToday Inc. Managing Editor Email Contact +1-510-984-1648  

SOURCE: UroToday Inc.

Faithful Fund Girl’s Cancer Treatments

By Jennifer L. Boen, The News-Sentinel, Fort Wayne, Ind.

Jun. 25–Emilija Lapas’ interests are wide and imaginative. She loves to make up games to play with her three brothers one day, go swimming the next and sit quietly in a corner afterward reading a book. This summer, however, the Fort Wayne 12-year-old is in a real-life battle with cancer.

Diagnosed with a brain tumor in 2005, Emilija underwent chemotherapy and radiation and was declared in remission until last fall. Doctors found malignant cells had spread to her spine. She had surgery, more chemotherapy and autologous stem cell transplants, in which her stem cells — generic cells that can be used to replace a variety of damaged cells — were harvested and filtered, then put back into her with the goal of replacing the cancerous ones. The second stem cell transplant took place about a month ago. Now she needs more than two months of radiation treatments to her brain and spine.

Friends and fellow parishioners of Our Lady of Good Hope Catholic Church, where the Lapas family attends, have organized several fundraisers for Emilija and her family to offset medical-related expenses.

Those who know Emilija have seen her beliefs remain strong, no matter what she has faced, said her parents, Vilius and Paulette Lapas.

“She has a strong faith and loves going to Mass,” Vilius Lapas said. “Emilija’s illness has tested her character, and she has proved herself to be a strong, resilient and brave young lady.”

—–

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

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

Distributed by McClatchy-Tribune Information Services.

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

AORN Endorses the WHO Safe Surgery Saves Lives Initiative

DENVER, June 25 /PRNewswire-USNewswire/ — The Association of periOperative Registered Nurses (AORN) announced its endorsement of the World Health Organization’s (WHO) Safe Surgery Saves Lives initiative, which includes the WHO Surgical Safety Checklist. The initiative, which was officially launched today in Washington, D.C., is intended to generate global awareness and bolster the message that concrete efforts for safe surgery will contribute to patient safety worldwide.

By endorsing the Safe Surgery Saves Lives initiative, AORN and other organizations express their support of the WHO Surgical Safety Checklist as a tool to improve patient safety in global settings. “The benefits will be that we’ll be able to compare results across the world in terms of what are safe environments and what are the practices that produce safe surgical outcomes,” said Linda Groah, RN, MSN, CNOR, CNAA, FAAN, executive director of AORN.

The checklist promotes safe surgical outcomes by ensuring patients across the globe undergo the right operation at the right site, with safe anesthesia, established infection-prevention measures and effective teamwork. Statistics from WHO indicate there are nearly twice as many surgeries performed worldwide as there are child deliveries, with significantly more risks involved. “Surgery is a very important part of health care,” Groah said. “There are over 230 million surgeries done every year across the world. That means that one out of every 25 people in the world will have surgery this year.”

AORN is among 23 international organizations that have endorsed the Safe Surgery Saves Lives initiative, including ACORN (Australia), AfPP (the United Kingdom), ORNAC (Canada), KAORN (Korea), PNCNZ (New Zealand), SATS (South Africa) and ZOTNIG (Zambia).

“This initiative is so important because it’s one of the first times that we bring nurses, surgeons and anesthesiologists together to agree on a minimum standard of care that will provide safe patient care for the surgical patient,” Groah said.

AORN, Inc., the Association of periOperative Registered Nurses, represents approximately 40,000 Registered Nurses in the U.S. and abroad who facilitate the management, teaching and practice of perioperative nursing, or who are enrolled in nursing education or engaged in perioperative research. Its members also include perioperative nurses who work in related business and industry sectors. AORN’s mission is to support RNs in achieving optimal outcomes for patients undergoing operative and other invasive procedures. AORN promotes quality patient care by providing its members with education, standards, services and representation. For more information, visit aorn.org.

Association of Perioperative Registered Nurses

CONTACT: Tasha Patterson of AORN, +1-303-755-6304, Ext. 234,[email protected]

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

Duke University’s Award-Winning Employee Health Management Program Featured at 13th Annual Health Management Congress

MINNEAPOLIS, June 25 /PRNewswire-USNewswire/ — A long investment in employee health and wellness is paying dividends for Duke University with lower health care costs and a health-focused work environment. Duke’s award-winning LIVE FOR LIFE employee health management program is a model framework for success. Its key characteristics are outlined in a new issue brief from HealthFitness (BULLETIN BOARD: HFIT) with a keen focus on the environmental factors Duke has developed to create a culture of health.

Duke’s LIVE FOR LIFE program will also be featured at the 13th Annual Health Management Congress Thursday, July 24 at 9:15 a.m. at Disney’s Contemporary Resort. “Creating a Healthier Workforce; Duke Medicine’s Tobacco-Free Initiative” will be presented by George Jackson, MD, director of employee occupational health and wellness, at Duke; and by Jason Horay, ATC, MS, HealthFitness health education program manager for the LIVE FOR LIFE program at Duke.

Duke’s Tobacco-Free Initiative is just one component of the integrated health management program Duke offered to employees through the LIVE FOR LIFE program. In the issue brief, “Laurels abound, but no rest for Duke: Health promotion pioneer pushes ahead to create healthier environment,” Duke’s Vice President for Human Resources H. Clint Davidson, Jr. details the evolution the program has undergone since its start as a general wellness initiative in 1988. The issue brief is available free of charge at http://www.hfit.com/briefs.cfm.

In the issue brief, Davidson says Duke is “creating a supportive culture for healthy behaviors and practices. In the last five to seven years we have increased the focus on bringing together all of the elements of a healthy work culture and the practices to support it.” Key practices contributing to success include integration of programs from several vendors, promoting healthy eating and exercise through onsite fitness programs and a campus farmer’s market, and aggressively addressing population health risks through targeted programs.

While Davidson emphasizes that Duke’s program goal is to keep employees healthy and to improve productivity, the issue brief notes that Duke has also seen lower average claims costs and $1 million in savings over five years in cost of claims for employees with chronic illness.

“Duke’s program focuses on behavior change, from high risk to low risk,” said Gregg Lehman, president and CEO of HealthFitness. “When you couple that focus with accountability and a great support system, that’s where you really see risk factors start to be reduced significantly, year over year.”

For more information or to register for the 13th Annual Health Management Conference, go to http://www.healthmanagementcongress.com/.

About HealthFitness

HealthFitness is a leading provider of employee health improvement services to Fortune 500 companies, the health care industry and individual consumers. Serving clients for more than 30 years, HealthFitness partners with employers to effectively manage their health care and productivity costs by improving individual health and well-being. HealthFitness serves more than 300 clients globally via on-site management and remotely via Web and telephonic services. HealthFitness provides a complete portfolio of health and fitness management solutions including a proprietary health risk assessment platform, screenings, EMPOWERED(TM) Health Coaching and delivery of health improvement programs. HealthFitness employs more than 3,000 health and fitness professionals in national and international locations who are committed to the company’s mission of “improving the health and well-being of the people we serve.” For more information on HealthFitness, visit http://www.hfit.com/.

HealthFitness

CONTACT: Karla Hurter, +1-703-319-0957, [email protected],for HealthFitness

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

Changing Terror’s Course; Book Details How Midwest Plane Avoided Sept. 11 Crash

By TOM DAYKIN

Midwest Airlines pilot Gerald Earwood was flying about 100 miles west of New York when he first noticed what seemed like wisps of smoke coming off the World Trade Center.

Roughly 15 minutes later, Earwood and co-pilot Eric Fjelstad were frantically maneuvering their DC-9 jet to avoid colliding with United Airlines Flight 175, the second airplane to hit the World Trade Center on Sept. 11, 2001. Their work, following orders from air traffic controllers, saved the lives of about 30 passengers and five crew members of Midwest Flight 7.

A minute or so later, United 175 — which also came close to colliding with other planes that morning — struck the south tower of the World Trade Center.

A collision between United 175, flying out of Boston, and the Midwest jet, flying from Milwaukee to New York’s LaGuardia Airport, “would have changed history,” Earwood said this week in an interview with the Journal Sentinel, his first newspaper interview about the incident.

“Yeah, I’ve thought about it numerous times,” Earwood said. “But I never knew, and to this day I still don’t know, how close we came.”

The near collision is among several stories told in the new book, “Touching History: The Untold Story of the Drama that Unfolded in the Skies Over America on 9/11,” by Lynn Spencer. The book, published this month by Simon & Schuster, tells how airline pilots, air traffic controllers and military pilots reacted to the terrorist attacks on the World Trade Center and Pentagon.

Spencer, a commercial pilot and Milwaukee-area native, interviewed controllers, Federal Aviation Administration officials, military pilots and civilian pilots, including Earwood.

The story of Midwest Flight 7 is among the most compelling in the book, which also features one other story of a Midwest jet that was diverted from Newark, N.J., to Pittsburgh during the chaos of that morning.

It would be difficult to estimate the number of lives that would have been lost if a midair collision had occurred between Midwest Flight 7 and United 175 before the south tower was hit, Spencer said. Burning debris from two jets could have been scattered throughout New York. “It’s hard to know how many buildings would have burned,” she said.

Smoke got thicker

Earwood, 46, has been flying for Oak Creek-based Midwest since 1990. He recalls leaving Milwaukee’s Mitchell International Airport early in the morning on Sept. 11, 2001, and watching the sun rise through clear blue skies as the flight headed east over Lake Michigan.

The first hint of anything amiss came about an hour after the flight left Milwaukee, as Earwood and Fjelstad noticed unusually slow radio responses from air traffic controllers in New York. A short time later, as their jet flew over eastern Pennsylvania, they glimpsed smoke rising from the World Trade Center, a familiar landmark for pilots flying to New York. American Airlines Flight 11 had hit the north tower at 8:46 a.m., but the pilots learned about that only after their plane landed at LaGuardia.

Earwood and Fjelstad thought the smoke might be a fire, or perhaps steam being discharged from the building’s boilers. As they got closer, Earwood told Fjelstad that the increasingly thick smoke might make it difficult for them to keep the airport in sight. They were approaching LaGuardia from the southwest, just off the Staten Island shoreline, and Earwood was growing impatient as he waited for a controller to respond to his latest radio transmission.

Suddenly, a controller called repeatedly for Midwest 7. Earwood responded and was told to turn left, as quickly as possible. The jet was about two miles southwest of the Verrazano-Narrows Bridge, which marks the entrance to New York Harbor.

As they began turning left, the controller broke in about 20 seconds later, Earwood said. This time, the controller was yelling for the pilots to tighten their turn, to make it as sharp as possible.

“I’ve never had a controller scream at me like that,” said Earwood, who was used to hearing controllers speak in calm, even- handed tones.

Seconds later, the controller broke in again, now calling for the plane to turn hard to the right.

“I remember those words, ‘Hard! Hard right turn!’ ” Earwood said.

Earwood and Fjelstad were straining at the controls, “yanking and banking,” as Earwood put it. Among other things, Earwood was concerned that if the DC-9 banked too steeply, the jet could stall and begin a rapid dive.

The two turns took a minute or so to execute. A flight attendant was tossed to the floor. But the maneuvers weren’t particularly violent, Earwood said, and none of the crew or passengers was injured.

Ordered off jet

According to Spencer’s account, other flights also were being cleared out of the path of United 175. The hijacked flight’s radar signal and the signal for Midwest 7 became so close that they appeared to horrified controllers to be merging, the book says. But United 175 continued on toward the World Trade Center.

A collision was avoided “by the narrowest margin,” Spencer writes.

United 175 hit the south tower perhaps 60 to 90 seconds after passing Midwest 7, Earwood estimated.

Meanwhile, Midwest 7 was directed back onto its approach to LaGuardia. As the plane turned back toward the airport, Earwood overheard a radio transmission from another pilot. A second airplane had just hit the World Trade Center.

“I looked up, and I saw the fireball,” said Earwood, who didn’t make an immediate connection that the south tower was hit by the plane he had maneuvered to avoid.

Thick smoke from the explosion obscured the airport, so the controllers had Midwest 7 fly east for several minutes before turning around and coming back to land. The jet was on the ground for about 30 minutes after taking evasive maneuvers to avoid colliding with United 175. As they waited on the runway, Earwood and Fjelstad could see the towers burning.

Once Earwood got off the plane, he checked his cell phone and found three messages from his wife, pleading for him to call as soon as he could. She filled him in on what was happening.

“As she’s talking to me, she says, ‘Oh my God, an airplane has just hit the Pentagon!’ ” he said. “And that’s when I knew it was time to get out.”

Earwood returned to the DC-9, where Fjelstad and the flight attendants were preparing for their next flight. He told them to get off the plane immediately.

“I said, ‘We’re under attack by terrorists. The last place you want to be is in an airport when we’re under attack by terrorists,’ ” Earwood said.

Around then, a New York port authority police officer showed up and ordered the crew off the jet. The officer told them that police didn’t want terrorists kidnapping pilots and forcing them at gunpoint onto a plane.

First airline to fly

Earwood didn’t begin making the connection between his evasive turns and United 175 until the evening of Sept. 11, 2001, when he told a Midwest flight manager about the incident. He later unsuccessfully sought FAA records that might shed more light on the near-collision.

FAA spokeswoman Alison Duquette said some information remains under wraps, but she also said many of those Sept. 11, 2001, documents are being turned over to the National Archives.

Earwood and other Midwest crew members stranded in New York were able to leave two days later. Dale Schaub, Midwest’s chief pilot and a former Air Force major, called in some favors and got federal government approval for Midwest to fly home — making it the first airline to fly from LaGuardia.

“Midwest Airlines shined during that time,” said Earwood, recounting how Schaub, now retired, and other airline employees worked to ensure the safety of their flight crews.

Just as the flight home was about to take off, Earwood and Fjelstad were told by the controller that there had been a bomb threat at the airport. The takeoff was aborted, and the 35 or so passengers — all of them Midwest crew members anxious to return to Milwaukee — had to wait on the runway while the jet was inspected, and it later got clearance. The incident didn’t truly hit home, Earwood said, until he saw the 2006 movie “United 93,” which depicts the events of Sept. 11, 2001. A psychiatrist from the Air Line Pilots Association, whom Earwood was seeing to help him deal with what happened, told him the movie featured an account of a near collision.

In the movie, that incident refers to a Delta Air Lines flight, and press accounts from 2001 and 2002 reported that United 175 nearly hit a Delta jet. But Earwood is convinced that the scene depicted in the movie — with dialogue from the controller similar to what he recalls — is a depiction of Midwest Flight 7. “It sent chills up and down my spine,” Earwood said.

Nearly seven years later, Earwood still thinks about what happened every time he flies to LaGuardia.

“It’s something that will live with me for the rest of my life,” he said. “I just can’t imagine the horror of being on that (United 175) airplane. . . . I think about those people a lot.”

One thing he’s never considered is to stop flying. He started flying as a 17-year-old in 1979.

“I was not going to let them scare me out of my life,” Earwood said.

JSOnline.com

To hear Midwest pilot Gerald Earwood retell the events of Sept. 11, 2001, in an audio slideshow, go to jsonline.com/links.

Copyright 2008, Journal Sentinel Inc. All rights reserved. (Note: This notice does not apply to those news items already copyrighted and received through wire services or other media.)

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

Keeping Fit With the Joneses

By Heather Newman, Detroit Free Press

Jun. 25–Michigan, it’s time to get moving.

The beaches are warming up and that long July 4 weekend is almost upon us. If you’re staring at that swimsuit in dismay, you’ve got a lot of company.

We asked readers to tell us what they did to get and stay in shape, and got more than 600 responses.

Find several of them here — and an avalanche of them at www.freep.com/shape, where you can add your own.

There are some big reasons to take the suggestions seriously. The Michigan Department of Community Health reported this month that according to preliminary 2007 data, we’re in shockingly bad shape.

More than a quarter of us are obese. That’s more than 6 million people in this state who could use a little help trimming their waistline.

The number of us getting any kind of leisure-time exercise at all has also declined to 20.9%. That’s down by more than 11 percentage points since 1990.

Ready to help change that statistic? Check out what others have been doing to get moving and get the weight off:

“I am trying, really trying to exercise in some fashion daily. The good news has been my rediscovery of the treadmill. The key to return visits to the treadmill has been a special selection of books. I love to read, and fortunately, I can read and walk fast at the same time!”

Betsy Hemming, 49, Beverly Hills

“I have a 7-year-old daughter, Miranda, and just keeping up with her is a real workout. She’s involved with soccer, swimming, and tae kwon do. She and I spend a good deal of time working on her skills. As a result, I too get a decent workout.”

Eric Stileski, 46, and Miranda Stileski, 7, Waterford

“My favorite thing to do in order to stay in shape is swimming. … It is a great all-over workout for the body.”

Allison Baumhart, 23, St. Clair Shores

“I have lost more than 60 pounds over the past two years, and strength training really has made a difference. … I can lift, pull, and push more things around the house and garden. I love feeling strong!”

Elan Sandelin, 39, Detroit

“A young colleague at work turned me onto ‘Dance Dance Revolution.’ It helped me lose about 12 pounds.”

Brian Nichols, 42, Livonia

“I recently started playing pickup basketball for 60-90 minutes at a time, two to three times a week. That, combined with better diet choices, I have now lost eight pounds in the past four weeks.”

Jason Schairer, 29, Royal Oak

“In my attempts to get fit and stay healthy, I find taking my dog, Eddie, for walks to be most rewarding.”

Jessica Shuler, 26, Novi

“For peace of mind, I started an intense workout schedule: Five to six days a week doing intense aerobics and light weightlifting. I’m hooked! I have never felt better, been more energetic and excited to keep going. The surprising benefits are just as rewarding as the weight loss!”

Ezra Graziano, 25, Birmingham

“I play Wallyball during the winter months and do strength and flexibility exercises at home to stay fit, and with the nicer weather, have been walking and riding my bike. Wallyball is volleyball played inside of a racquetball court.”

Kim Howard, 42, Novi

“I am a 38-year-old stay-at-home mother of 6-year-old kindergarten triplet girls, and I do all possible to stay fit — I have to! My husband, Mark, and I take Allison, Abigail and Noelle to Lifetime Fitness in Novi every weekend to show them how important it is to be fit and active.”

Kimberly Dunn, 38, Northville

“I put on concerts with my 9-month-old daughter. … First, I put my MP3 player on shuffle, then I dance and sing while I’m holding my daughter. I incorporate exercise moves with the dances. We do all of this to the beat of the music for about 20-30 minutes. It’s great exercise, since my daughter is over 20 pounds, and is a break from my normal gym exercise routine.”

Laila Jackson, 34, Detroit

“One thing I am doing to try to get in shape is to focus on fitness while at work. I am parking further away to get more walking in, taking the stairs, walking at lunch and bringing my lunch to watch calories and portions.”

Lori Martich, 45, Harper Woods

“I bribe my body (with the promise of one snack-size bag of M&Ms) to get up each morning and hit the gym. Once I hear the thumping of the music and the bright lights hit my eyes, it is all about getting that heart rate up and sweating.”

Maria E. Gilbert, 45, Birmingham

“I Rollerblade, walk briskly on a treadmill, play the Nintendo Wii and use an exercise ball and hand weights.”

Miria Strzalkowski, 39, New Baltimore

“Five years ago, I decided to get in shape. I found a plastic stepper at a garage sale on the last day marked down to 25 cents. I began to use it in my basement and, along with South Beach diet, lost 30 pounds.”

Marie Showers, 60, Dewitt

“I play indoor soccer from September through April in over-30 leagues, for men and coed.”

Michael Kelly, 42, Canton

“For a while now, my daughter has been after me to learn to fence. … So, here’s what I’m doing to work on getting fit enough to fence: I’m digging a pond in our backyard. I make sure to use correct posture as I hop on my shovel, lift the dirt and haul the wheelbarrow. It’s really an all-over workout … a nice mix of strength training and cardio …and I’ll have a nice product when I’m done.”

Marge Lisius, 46, Redford

“To stay fit, my son likes to ride a unicycle. His dad and sister also ride, and have participated in the local Fourth of July parade for a few years.”

Nancy Abram, 40, Alpena

“I belong to the YMCA Wellness center, which is right around the corner from where I work. So to stay fit, I give up lunches in exchange to go work out on my lunch hour.”

Nancy Baran, 50, Haslett

“For one year now, I’ve been taking a class at Schoolcraft College called Swimnastics. It consists of water exercise and has helped my back a great deal. I’ve lost over 20 pounds from having a better attitude about eating.”

Dorothy Minch, 68, Livonia

“I play sports as much as I can. I play roller hockey twice a week and golf in between the two days.”

John Pawlik, 27, Hudsonville

“I just keep moving. I make sure I don’t sit for long periods of time. I am 82, and think that it is important to keep on moving, up the stairs, down the stairs, household chores, walking — walking a lot.”

Lorraine Perry, 82, Birmingham

“Twelve weeks ago, I changed the way I eat and started trying to get more exercise. In those 12 weeks, I’ve lost almost 43 pounds. … I walk at least three times a week, more if you count push-mowing our half-acre lawn. … People need to know that by making a few simple changes that they can become healthier. I still stop at the coffee shop every morning for a large mocha whatever-you-call-it coffee…but now I get no whipped cream and I order it nonfat. I’m drinking water instead of soda, too.”

Steve Woerner, 34, Dansville

Contact HEATHER NEWMAN at 313-223-3336 or [email protected].

—–

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

Copyright (c) 2008, Detroit Free Press

Distributed by McClatchy-Tribune Information Services.

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

Fitch Downgrades St. Joseph Health Services of Rhode Island to ‘BB’

Fitch Ratings has downgraded Rhode Island Health and Educational Building Corporation’s $18.6 million series 1999 revenue bonds (St. Joseph Health Services of Rhode Island Issue; SJHS) to ‘BB’ from ‘BBB-‘. Fitch has also revised the Rating Outlook to Negative from Stable.

The downgrade reflects SJHS’ growing operating losses, a rapidly shrinking liquidity position, and poor debt service coverage. The financial deterioration is a result of the hospital’s inability to respond effectively to a multi-year decline in inpatient and outpatient volumes. Since fiscal 2004, SJHS’ operating performance has consistently worsened, with the hospital losing $3.4 million for the year ending Sep. 30, 2007 (negative 1.9% margin). Through six months ended March 31, 2008, SJHS recorded an operating loss of approximately $1.8 million, which equated to a negative 2.0% operating margin. Management projects the full year loss to be $3.6 million, despite having implemented a 40 FTE staff reduction in April 2008. Despite the losses, SJHS’ debt load is moderate, with maximum annual debt service at just 1.6% of revenues, cash to debt at 94%, and debt to capitalization at 40%.

SJHS’ cash and unrestricted investments have steadily declined since 2005, and stood at 38 days of expenses as of March 31, 2008. At Sep. 30, 2007, SJHS had approximately $22.5 million in unrestricted cash and investments, which was down from FY06 and FY05’s positions of $30.8 million and $34.0 million, respectively. Cash flow from operations turned sharply negative for fiscal 2007, while investment losses have further trimmed the hospital’s liquidity position. Moderate but prolonged erosion in patient volumes is chiefly responsible for the financial decline, with admissions dropping over 2% per year since 2004. Outpatient activity has also dropped, with surgeries declining to 14,295 for fiscal 2007 from 18,645 in 2003. Management indicates that recent utilization declines are due to softening inpatient volumes throughout the state as well as growing outmigration and competition for surgical services.

The Rating Outlook revision to Negative indicates that potential further negative rating action may be warranted if SJHS’ cannot improve operating profitability and stabilize its liquidity position.

Management expects to reduce expenses through two near term initiatives. First, SJHS eliminated 40 full time equivalent positions in April 2008, and management is reviewing additional expense savings measures as part of the FY2009 budget process. Second, the hospital has filed a certificate of need application to allow the consolidation of inpatient services at the newer of the hospital’s two campuses in Providence. Approval and implementation is expected over the next several months. The projected benefit of the inpatient consolidation is $4.2 million.

SJHS is also contemplating a merger with Roger Williams Medical Center, (RWMC) similarly sized and also located in Providence, which could strengthen SJHS’ market presence and reduce expenses through streamlined business operations. Pursuant to a May 2008 memorandum of understanding, both organizations would consolidate under a parent organization. The combined entity would have approximately $340 million in revenues and a 15% market share. Details regarding the management team and obligated group structure have yet to be determined. For the year ended Sep. 30, 2007, RWMC broke even from operations on net revenues of $168 million.

Located in Rhode Island, SJHS consists of 271-bed Our Lady of Fatima Hospital in North Providence, St. Joseph Hospital for Specialty Care (115 beds) and St. Joseph Living Center (62 assisted living units) in Providence. SJHS had $177.6 million in total revenue in 2007. SJHS has covenants to provide only annual disclosure to the NRMSIRs, which Fitch views as a weak legal covenant. SJHS has provided timely annual disclosure to the NRMSIRs and management intends to provide quarterly disclosure.

Fitch’s rating definitions and the terms of use of such ratings are available on the agency’s public site, www.fitchratings.com. Published ratings, criteria and methodologies are available from this site, at all times. Fitch’s code of conduct, confidentiality, conflicts of interest, affiliate firewall, compliance and other relevant policies and procedures are also available from the ‘Code of Conduct’ section of this site.

Baxter Gets Big Win in Tri-Meet

By Mac Banks, Fort Mill Times, S.C.

Jun. 25–The Baxter Barracudas picked up their first win of the season this week, beating Shiland and Leroy Springs before falling to Rock Hill later in the week.

Against Rock Hill, despite losing, Baxter did improve its score by 40 points compared to the first time they saw them.

Baxter won several relay events including the girls 10 and under 100-yards medley relay and freestyle relay, as well as, boys 18 and under 100-yard medley relay.

Individual winners for Baxter against Rock Hill included:

–Carly FitzMorris — girls six and under 25-yard freestyle

–Dylan Helms — boys six and under 25-yard freestyle

–Madelon Thompson — girls 9-10 25-yard freestyle, 25-yard backstroke, and 25-yard breaststroke

–Tucker Bisel — boys 13-14 50-yard freestyle

–James Brashear — boys 15-18 50-yard freestyle, 50-yard breaststroke and 50-yard butterfly

–Sarah Dressel — girls six and under 25-yard backstroke

–Ben Rich — boys six and under 25-yard backstroke

–Ben Fenwick — boys 7-8 25-yard backstroke

–Franklin Westernkamp — boys 11-12 50-yard backstroke

“¢Nicole Brashear — girls 13-14 50-yard backstroke

–Elise Alagoz — girls 10 and under 100-yard individual medley and 25-yard butterfly

–Will Barradale — boys 9-10 25-breaststroke

–Kyle Brooks — boys 11-12 50-yard breaststroke

–Skye Jacobson — girls eight and under 25-yard butterfly

–Andrew Crossland — boys eight and under 25-yard butterfly

Against Leroy Springs and Shiland, Baxter won 279-267, and won four of eight relay events. Individual winners in the tri-meet for Baxter was:

–Madison Arnette — girls six and under 25-yard freestyle

–Dylan Helms — boys six and under 25-yard freestyle

–Ben Fenwick — boys 7-8 25-yard freestyle and 25-yard backstroke

–Maria Hartung — girls 13-14 50-yard freestyle and 50-yard butterfly

–James Brashear — boys 15-18 50-yard freestyle and 50-yard butterfly

–Carly FitzMorris — girls six and under 25-yard backstroke

–Noah Griffin — boys 9-10 25-yard backstroke

–Anina Hartung — girls 11-12 50-yard backstroke

–Zachary Bohland — boys 11-12 50-yard backstroke

–Nicole Brashear — girls 13-14 50-yard backstroke and 100-yard individual medley

–Tucker Bisel — boys 13-14 50-yard backstroke

–Bailey Rich — girls 11-12 100-yard individual medley

–Brooks Merdith — boys eight and under 25-yard breaststroke

–Will Barradale — boys 9-10 25-yard breaststroke

–Kyle Brooks — boys 11-12 50-yard breaststroke

–Morgan Barradale — girls 13-14 50-yard breaststroke

–Skye Jacobson — girls eight and under 25-yard butterfly

–Andrew Crossland — boys eight and under 25-yard butterfly

–Elise Alagoz — girls 10 and under 25-yard butterfly

–Sasha Jimenez — girls 11-12 50-yard butterfly

–Franklin Westernkamp — boys 11-12 50-yard butterfly

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Copyright (c) 2008, Fort Mill Times, S.C.

Distributed by McClatchy-Tribune Information Services.

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Mediware Ships Software to Track Transplant Safety

By David Hayes, The Kansas City Star, Mo.

Jun. 25–Mediware Information Systems today began shipping a new software system designed to keep track of organs, blood and other transplantable materials in hospitals and surgery centers.

The Lenexa medical software firm said its BiologiCare software will help health care facilities as they deal with a surge in transplants. More than 10 million transplants have been completed. More than 50 percent of U.S. hospitals now perform transplants of some kind, Mediware said in a release.

“BiologiCare is the first of its kind in a market that is new and rapidly developing,” said Kelly Mann, Mediware’s chief executive. “Until now healthcare facilities have not had specific computer systems available to assist them with the complex tracking, storage and reporting requirements of these types of tissues.”

Mediware said tracking transplantable materials has become a logistical problem at many hospitals, where those materials may be stored in a number of different places and in a number of different ways.

Mann said the problem can lead to financial losses for the health care facility.

“One customer audited their tissue inventory, which was stored in boxes and refrigerators throughout the hospital, and found that they had $40,000 worth of products that had expired,” Mann said. “This was a tremendous financial loss for this facility.”

[email protected]

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Copyright (c) 2008, The Kansas City Star, 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.

NASDAQ-SMALL:MEDW,

Wilkes-Barre Names New Head for Its Health Department

By Denise Allabaugh, The Citizens’ Voice, Wilkes-Barre, Pa.

Jun. 25–WILKES-BARRE — Ted Kross, former operations manager in the emergency department at Geisinger Wyoming Valley Medical Center in Plains Township, has been hired as the director of the city’s health department.

The position pays an annual salary of $66,036, according to the 2008 city budget.

Kross, 47, replaces longtime director Henry Radulski, who retired after working for the city for 28 years. Radulski worked as a health inspector for 18 years, deputy director for the health department for two years and director for eight years.

The Wilkes-Barre Health Department, formed in 1998 after a battle between former Mayor Tom McGroarty and the Kirby Health Center board over restaurant inspections, emphasizes preventive health services and provides a wide array of services to city residents from communicable disease control, testing and clinical services to inspections, animal control and education.

Kross oversees 10 employees, including three inspectors, three nurses, two health educators, a secretary and new animal control officer Ed McDade.

McDade replaces former animal control officer Rick Macko, who resigned to start his own business.

Kross also is responsible for applying for grants for injury prevention, bioterrorism prevention, maternal and children’s health, immunizations, HIV and AIDS testing, skin and colorectal cancer education and prevention, and heart disease and stroke prevention.

The health department rents space on North Franklin Street inside the Kirby Health Center, which is undergoing renovations.

Kross had been employed by Geisinger since 1985 and spent six months working as the director of the emergency department at Calvert Memorial Hospital in Maryland.

In his former positions in the private sector, Kross said he was familiar with reacting to health problems. In his new public health position, he said his goal is to be proactive and “keep people healthy and prevent disease.”

To assist low-income people who need help, the health department partners with the Commission on Economic Opportunity and other local agencies to provide services residents couldn’t afford, he said.

Kross is a 1979 graduate of Bishop Hoban High School and earned a master’s degree in health care administration from King’s College. He and his wife, Gina, have four children.

He was chosen for the position after interviews with three qualified applicants who met the criteria mandated by the state, said Christine Jensen, the city’s director of human resources. Mayor Tom Leighton conducted the final interview with Kross and hired him after Jensen, City Administrator J.J. Murphy and Deputy Administrator Marie McCormick conducted interviews and recommended him. The position was advertised statewide, Jensen said.

[email protected], 570-821-2115

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Copyright (c) 2008, The Citizens’ Voice, Wilkes-Barre, Pa.

Distributed by McClatchy-Tribune Information Services.

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X-Gen Partners With Enzyme Manufacturer to Keep Pancreatic Enzyme Product Available to Patients

X-Gen Pharmaceuticals Inc. announces that it has entered into an exclusive distribution agreement with Eurand Pharmaceuticals Inc. for the company’s non-branded pancreatic enzyme product (PEP) Pancrelipase. In accordance with the agreement, X-Gen will represent Eurand as its authorized exclusive distribution agent for its currently marketed unbranded product.

Consistent with the April 28, 2004 Federal Register Notification (as supplemented in October 2007), Eurand has both an IND and an NDA on file for a pancreatic enzyme product and is actively seeking regulatory approval.

As Eurand’s exclusive distribution agent, X-Gen will supply the product in four separate strengths. Pancrelipase 4,500 (NDC# 39822-9045-1), Pancrelipase 10,000 (NDC# 39822-9100-1), Pancrelipase 16,000 (NDC# 39822-9160-1) and Pancrelipase 20,000 (NDC# 39822-9200-1). Capsules are orally administered and contain delayed-release microspheres of porcine pancreatic enzyme concentrate, predominantly pancreatic lipase, amylase and protease. For further information about these pancreatic enzyme products, contact X-Gen Pharmaceuticals at (607) 562-2700.

About X-GEN

X-Gen Pharmaceuticals specializes in the development and manufacture of pharmaceutical products which serve the healthcare community. X-Gen’s expanding product line offers a broad range of dosage forms including injectables, anti-infective solutions, oral solids and inhalants. For further information about X-Gen Pharmaceuticals call (866) 390-4411, or visit the web-site at www.x-gen.us.

 Contact: X-Gen Pharmaceuticals (866) 390-4411 www.x-gen.us

SOURCE: X-Gen Pharmaceuticals

Library Techies: Beyond the Dewey Decimal System

By Joseph Szadkowski, The Washington Times

Jun. 23–SEATTLE, Wash. — The modern librarian must be Twitter-savvy and able to manipulate the Web and aggregate RSS feeds as quickly as compile competitive intelligence.

In other words, a librarian must be good at social networking, customizing computer databases, filtering data and getting the facts.

That 21st-century paragon of the information professional was well represented here at the 99th annual Special Library Association’s (SLA) conference last week.

Nearly 5,000 specialized librarians working in such diverse areas as news, energy resources, military, engineering, chemistry and the law descended on the Emerald City to look at how their industry continues to evolve in a world dictated by digital bytes and the immediate access of information.

The opening session’s keynote presentation set the tone for the conference and was led by one of the Internet’s founding fathers.

Vinton G. Cerf, Google vice president and self-professed Geek Orthodox Chief Internet Evangelist for the search leader, looked at the past, present and future of cyberspace.

Cerf’s early contributions include helping to develop a packet switching network and TCP/IP protocols for ARPANET (Advanced Research Projects Agency Network) back in the 1970s, some of the key pieces of the Internet’s infrastructure.

Prompted by PBS interviewer Charlie Rose, Cerf offered a prediction that by 2010, 50 percent of the world (more than 3 billion people) will be online thanks to the continued innovations of mobile devices.

Rose conducted the proceedings in his easygoing style and made an auditorium full of librarians feel as though they were back in their living rooms.

Cerf primarily came to spread the word about the importance of the continued free sharing of knowledge via the Internet, a key concept familiar to everyone in attendance.

“The openness of the Internet has permitted a cornucopia of creativity and innovation,” he said.

In a cyber world where 10 hours of new video are posted on YouTube every minute, his greatest fear is that the software used to decipher the increasing amount of digital objects (in the form of everything from spreadsheets to videos) won’t be maintained and updated.

He can see a time when future generations have no idea who we were because they cannot decipher our documents or play our games.

Cerf, a science-fiction fan, was “driven to make fiction real” and concluded by discussing his latest work.

His projects include the Interplanetary Internet initiative with the Jet Propulsion Laboratory (a standard to communicate in space and between planets) and solar-powered Internet cafes linked to satellites offering free Web access to anyone in the world. With dozens of instructional sessions and almost 300 exhibitors at the SLA conference, attendees found enough exposure to a variety of technology and innovations to give them an edge in the current specialized library marketplace.

Here’s just a taste of some of the presentations and products found:

The 10-month-old Courtroom Live (www.courtroomlive.com) displayed its browser- based, real-time, video-streaming service that offers access to 90 percent of the state court trials in the U.S. John Shin, managing director of the New York-based company, said the service grew out of wiring courtrooms for Internet access and finding a way to quickly deliver digital court transcripts.

With its wide selection of civil and product-liability trials — also archived — Courtroom Live’s current appeal is to legal firms for training and hedge funds looking for an edge in volatile markets. The clever piece of the service is a proprietary server setup that captures evidence presented in the court and displays it on a user’s screen alongside the video streaming.

Shin said the subscription-based service can be set up for as little as $2,000 per year.

It was a bit of an eye-opener to find out SLA is so hip these days that it has its own space in the Second Life virtual world. So it seemed a natural progression to find a couple of sessions devoted to the world of learning through computer gaming.

First, former laser physicist and now Defense Advanced Research Projects Agency project manager Ralph Chatham presented his trials and successes in developing military training simulations for U.S. soldiers.

The DARWARS initiative back in 2004 led to the creation of the multiple video games that helped train more than 20,000 soldiers in 2006 alone.

Of his efforts, the Tactical Language Tutor is a culture assimilator that teaches Arabic by challenging users through language lessons. It also takes them into real-world scenarios using digitized characters and even keeps their skills sharp with a Pac-Man-style game.

Chatham’s first-person, multiplayer game Ambush is much more intense and uses the Unreal Tournament game engine to give soldiers a virtual three-dimensional look at hostile missions in Iraq and teaches them how to survive before ever driving on a real road in Baghdad.

Chatham’s enthusiasm with the video game as a learning tool comes down to its ability to easily teach complicated, nonintuitive behavior and the way it forces players to think about problems at a system level.

Next, Elizabeth Lane Lawley, the director of the Lab for Social Computing at the Rochester Institute of Technology, explored the phenomenon of how gaming produces the online rebound.

Basically, humans interact in a virtual world and then strive to turn digital back into tactile. Lawley said that explains the popularity of Nintendo’s Wii — a tangible way to interact with virtual worlds — and why Moo.com, a photo printing company friendly with social networks such as Flickr and Facebook, is so popular.

Lawley also believes game developers are a lot like librarians as they classify, disseminate and determine how knowledge is found.

The aptly titled session “Technology Free for All,” delivered in the round, gave news-media librarians a chance to show off some of their slickest helpers from the World Wide Web.

Derek Willis, a Web developer for the New York Times, led the way. Among his offerings were a tip on GNU’s free piece of software Wget (www.gnu.org), a way to download an entire Web site to a desktop, as well as the use of the Many Eyes site (http://services.alphaworks.ibm.com/manyeyes/home) from IBM used to help visualize data.

Believe it or not, libraries still use microfilm, and that gave professional genealogist Rick Slavens a reason to invent the ST Genie. The portable digital microfilm scanner plugs into a PC and handles 16mm and 35mm roll film along with 35mm slides. The device turns screens into 2,700-DPI images available in easy-to-read TIFF, JPEG, PNG and PDF formats. The device costs $1,095.

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To see more of The Washington Times, or to subscribe to the newspaper, go to http://www.washtimes.com.

Copyright (c) 2008, The Washington Times

Distributed by McClatchy-Tribune Information Services.

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Adecco Engineering & Technical Honored By GE Healthcare Division

MELVILLE, N.Y., June 25 /PRNewswire/ — GE Healthcare recently presented Adecco’s Engineering & Technical division with the Productivity Award at the 2008 GE Healthcare Global Supplier Day held in Milwaukee, Wisconsin. Adecco is the world’s largest recruitment and workforce solutions provider ( http://www.adeccousa.com/ ).

Presenting the award at the Pfister Hotel, Ralph Strosin, General Manager, Global Sourcing & Operations for GE Healthcare, stated, “As the single largest staffing supplier across GE Healthcare, Adecco has made a commitment to GE Healthcare’s success within the U.S. by providing an on-site team that engages directly with requestors, becoming intimately familiar with our environment and our staffing needs. They delivered significant deflation in 2007 in an inflationary labor environment and have guaranteed savings in 2008. Adecco ensures full compliance to the GE requirements, including co-employment rules, background checks, drug screens, etc.”

“GE Healthcare has 6,000 suppliers, so to be selected as one of the 13 recipients of this award is a tremendous honor,” said Jamie Parker, president and chief operating officer of Adecco E&T. “Their recognition in the productivity category is a testament to our commitment to efficiency, always striving to exceed the expectations of our clients.”

Adecco Engineering and Technical, an international scientific engineering company, consults with companies regarding their technological challenges, by matching them with experts and resources that are best adapted to their set of challenges.

About GE Healthcare:

GE Healthcare provides transformational medical technologies and services that are shaping a new age of patient care. Our expertise in medical imaging and information technologies, medical diagnostics, patient monitoring systems, performance improvement, drug discovery, and biopharmaceutical manufacturing technologies is helping clinicians around the world re-imagine new ways to predict, diagnose, inform, treat and monitor disease, so patients can live their lives to the fullest.

GE Healthcare’s broad range of products and services enable healthcare providers to better diagnose and treat cancer, heart disease, neurological diseases and other conditions earlier. Our vision for the future is to enable a new “early health” model of care focused on earlier diagnosis, pre-symptomatic disease detection and disease prevention. Headquartered in the United Kingdom, GE Healthcare is a $17 billion unit of General Electric Company . Worldwide, GE Healthcare employs more than 46,000 people committed to serving healthcare professionals and their patients in more than 100 countries. For more information about GE Healthcare, visit our website at http://www.gehealthcare.com/

ADECCO NORTH AMERICA:

Adecco is the workforce solutions leader in the United States and Canada, with a comprehensive service offering that includes temporary and contract staffing, permanent recruitment, outplacement and career services, recruitment process outsourcing, training and consulting.

In addition to its administrative, clerical and light industrial staffing services, Adecco operates the following specialty divisions:

    -- Engineering & Technical    -- Finance & Accounting    -- Information Technology    -- Medical & Science    -- Legal    -- Human Capital Solutions    -- Government Solutions    -- Transportation    

Adecco S.A. is registered in Switzerland (ISIN: CH001213860) and listed on the Swiss Stock Exchange with trading on virt-x (SWX/VIRT-X: ADEN) and Euronext Paris – Premier Marche (EURONEXT: ADE).

Additional information is available at the company’s website at http://www.adeccousa.com/

Adecco North America

CONTACT: Jacqueline Chen Valencia, Vice President, Public Relations,+1-347-453-7156, [email protected]; or Anthony Guerrieri, Director,Public Relations, +1-917-434-4296, [email protected], both ofAdecco Group North America

Web site: http://www.adeccousa.com/http://www.gehealthcare.com/

Terumo Heart Obtains IRB Approval From the University of Michigan to Initiate DuraHeart(TM) Left Ventricular Assist System U.S. Pivotal Trial

ANN ARBOR, Mich., June 25 /PRNewswire/ — Terumo Heart, Inc. announced today approval from the Institutional Review Board (IRB) at the University of Michigan to move forward with the DuraHeart(TM) Left Ventricular Assist System (LVAS) U.S. Pivotal Trial for a Bridge-to-Transplant (BTT) indication. Francis Pagani, M.D., Ph.D., Director of the Adult Heart Transplantation and Artificial Devices Program at the University of Michigan, will serve as the National Co-Principal Investigator of the U.S. Pivotal Trial.

(Logo: http://www.newscom.com/cgi-bin/prnh/20070227/CLTU043LOGO )

The University of Michigan IRB approval is the final step to initiate the DuraHeart LVAS U.S. Pivotal Trial following the completion of staff training and equipment delivery. The University of Michigan also serves as the primary training site for the U.S. Trial.

Chisato Nojiri, M.D., Ph.D., Chief Executive Officer for Terumo Heart, Inc., said, “With the IRB approval, DuraHeart LVAS will be the first third-generation centrifugal pump with magnetic levitation under investigation in the U.S. We look forward to working with Dr. Pagani and his team on the U.S. Pivotal Trial.”

The DuraHeart LVAS Pivotal Trial is a multi-center, prospective, non-randomized study of 140 patients and will include up to 40 centers. Yoshifumi Naka, M.D., Ph.D., from Columbia Presbyterian Hospital in New York, will serve as the National Co-Principal Investigator with Dr. Pagani.

The DuraHeart LVAS is a third-generation circulatory support device intended to provide cardiac support for patients who are at risk of death due to end-stage left ventricular failure. It is currently the only CE marked implantable LVAS combining a centrifugal pump with magnetic levitation of the impeller, providing exceptional reliability and minimizing the potential for blood damage and thrombus. The DuraHeart LVAS is not available for sale in the United States.

Terumo Heart, Inc. is a U.S. subsidiary of Terumo Corporation with headquarters and manufacturing facilities in Ann Arbor, Michigan. The company’s focus is the innovation and introduction of products to improve the quality of healthcare for heart failure patients. Terumo Corporation, located in Tokyo, Japan, is a leading developer, manufacturer and global marketer of a wide array of medical products.

For more information, please contact Carmen Fox, Senior Marketing Communications Specialist, Terumo Heart, Inc. at (734) 741-6345 or [email protected].

http://www.terumoheart.com/

Photo: NewsCom: http://www.newscom.com/cgi-bin/prnh/20070227/CLTU043LOGOAP Archive: http://photoarchive.ap.org/PRN Photo Desk, [email protected]

Terumo Heart, Inc.

CONTACT: Carmen Fox, Senior Marketing Communications Specialist, TerumoHeart, Inc., +1-734-741-6345

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

With Other Opiates Difficult to Get and More Expensive, Heroin Use is Growing

ANCHORAGE, Alaska _ With one pinch of the needle, Shenna Bolger was hooked on the warm, euphoric wave that washed over her as the black tar heroin coursed through her blood.

That first time was at home with her boyfriend in their Anchorage apartment. A regular user, he stuck her arm. She was curious. And a quick learner. Five years later, dark brown scar tissue traces the veins along the insides of her arms from above her elbows to her wrists as a reminder of what she had become.

She lied. Stole from friends. Set them up, ripped them off. Got others hooked, then sold to them. Watched friends overdose in her house. Worried about getting busted, losing her kids. Shot up in front of her 5-year-old daughter. But none of it mattered at the time. She was dope sick.

“It was just part of the drug addict game,” Bolger said. “After I started doing tar, there was nothing else that could make me well.”

At the height of her affair with heroin, she was shooting up a gram every day _ a $500 habit that could have cost her her life.

Law enforcement officials say they have seen a dramatic increase in the number of heroin cases over the past year or two.

“It went from something that we knew existed and saw periodically to something that is, probably at this point, more than 50 percent of our work,” said Sgt. Rob Langendorfer, who runs the Alaska Bureau of Alcohol and Drug Enforcement’s Mat-Su unit.

Heroin cases are also booming for Anchorage police, who in 2003 entered evidence from only eight heroin cases into their locker. Last year, there were 49 cases. There are more commonly used drugs in Anchorage _ marijuana, cocaine and crack, meth _ and therefore bigger drug problems, but stopping the rapid advance of heroin is becoming a top priority for police, said Lt. Nancy Reeder, head of the Anchorage police Metro Drug Enforcement Unit.

Although heroin use is growing, treatment options are not. Since March, the only way to get into Anchorage’s only methadone program is to be pregnant: That’s what got Bolger, 23 and six months pregnant with her third child, a coveted spot.

Eight of the 77 clients at the Narcotic Drug Treatment Center in Anchorage are pregnant or recently gave birth, said clinical director Ron Greene. And the clinic is taking in an average of two more pregnant women each month.

One theory about the uptick in heroin use is that a rash of methamphetamine lab busts in recent years pushed addicts to take whatever is cheap and available, in this case heroin. But the amount of available meth hasn’t declined as quickly as the labs have: It’s now being imported, Langendorfer said.

The prevalent theory is that heroin is cheaper and easier to get than prescription medicines like Oxycontin, a much-abused painkiller whose opiatelike effects are similar to heroin’s, said Viki Wells, behavioral health specialist with the Alaska Department of Health and Social Services.

Today’s addicts are not always stereotypical junkies. Some are longtime drug abusers who switch to something more potent. And there are the high-school kids wanting to party who try Oxys. But there are also people who have had steady jobs and mortgages before being injured and getting an Oxy prescription for the pain, Wells said.

No matter what leads them to try opiates, they get hooked. Some then find out that getting prescription pills is a lot harder than scoring a bag of dope on the streets, Reeder said. And heroin runs about $50 per tenth of a gram dose, making it bargain-basement cheap compared to Oxys, which can run up to $180 each in Alaska.

Bolger knows that well. She used other opiates, but heroin was always just a call away. Now it’s been about four months since she has gotten high. At the clinic, she gets homework, counseling and her daily dose of methadone. The drug didn’t satisfy her cravings at first, but now she’s on the right dose.

“It doesn’t make you high at all,” she said. “It just makes you normal to where you don’t have ideas about using, you don’t have cravings, you don’t have the withdrawal symptoms.”

Heroin has so far remained largely a metropolitan issue in Alaska, but city problems usually foreshadow what’s to come in the Bush, said Lt. Andy Greenstreet, deputy commander of the Alaska Bureau of Alcohol and Drug Enforcement. Law enforcement officials across the state say they are stepping up their efforts to stem heroin’s flow, primarily by going after the source _ or as close to it as possible.

“You can certainly pick end users up on the road, but realistically you’re really not having much effect if all you’re doing is arresting someone who’s using,” Reeder said. “What you really want to do is try and cut their head off.”

So far, though, the numbers indicate their efforts have not dissuaded drug runners from importing the stuff. In 2004, for example, state drug officials seized 113 grams of heroin. Last year, they seized 10 times that, according to the Alaska Bureau of Alcohol and Drug Enforcement’s annual drug report. Federal drug seizures are up as well. In 2002, the Drug Enforcement Administration seized only 0.1 kilograms of the drug in Alaska. Last year, it seized nearly three.

The center where Bolger is a client is one of two clinics in Alaska that treat patients with methadone, a drug that reduces opiate withdrawal symptoms. The Interior AIDS Association in Fairbanks is at capacity, as is the Anchorage clinic, which has a 27-person waiting list. As recently as May, there were 45 on it. But after months of waiting, many stopped calling.

“I know what they’re doing,” Greene said. “They’re out committing crimes trying to get their drugs, that’s what they’re doing. They feel like there’s no hope, and they’ve just given up.”

Addicts on the list are desperate, and they’re waiting six months or more in some cases. Some call twice a day saying they’re stealing and prostituting. They beg to get in. Some parents have even offered bribes to get their kids into the program, Greene said.

Even clinics that don’t offer methadone are getting pinched. For example, in the Matanuska-Susitna Borough last year, Reba Brady saw five heroin addicts treated at Ascent Treatment Services. As of Wednesday, she had 14 in treatment and 12 more pending cases this year.

Other drug treatment centers across the state offer drug counseling without the medication, and, for those who have insurance or can afford it, there are about 40 doctors in the state who are qualified to prescribe buprenorphine _ an alternative to methadone, Wells said.

But few addicts can afford such medication _ often a crucial component to ending heroin addiction. So for many, methadone clinics are rehab Shangri-Las because they rein in withdrawal symptoms. The Anchorage clinic treats all opiate addicts, and, according to Wells, 39 percent of those on the wait list in 2007 reported heroin as their drug of choice. That jumped to 62 percent in the first quarter of this year. At the same time, 77 percent also reported being injection drug users.

“You have to be really, really desperate and willing to do anything before you go to a methadone program for treatment,” Wells said. “The people that they see are pretty much late-stage and they have pretty much gone through any savings; most aren’t working, they have a chaotic work history. They don’t have insurance.”

While the number of heroin users is apparently rising, the number of people the clinic can afford to treat is not. There are 77 people in treatment _ down from 83 a month ago _ but Greene says he only can cover 75. Next year, that number will be down to 64, and he is reducing the number of patients by only accepting pregnant women.

By using methadone _ considered a safe alternative to heroin for fetuses _ to prevent pregnant women from using, the clinic hopes to prevent future, costlier problems in the child’s life, he said.

“We’re talking about not only the woman herself, but also the fetus that she’s carrying as well,” Greene said. “It’s to protect the woman and the child.”

As addicts wait to get into a program, many continue to use. Last July, a 22-year-old woman died while waiting to get in, Greene said. She had already applied twice.

“It’s out of control. It’s going to get a whole lot worse before it gets better,” Greene said of the heroin problem in Alaska. “It’s just sad. There’s days I close my door and I put my head on my desk and I weep for these people.”

Health and Social Services has sought additional funding to scale back the wait list, said Stacy Toner, deputy director of the Division of Behavioral Health. The treatment program is targeted for an increase this year if the money is available, she said.

Last year the clinic took a $20,000 cut, and between relatively flat funding over time and such cuts, the center is “running on fumes” trying to cover costs, Greene said.

Bolger said her kids are her motivation to keep clean. Bolger’s mother has custody of her 5-year-old daughter, Bionka, and she wants the child back. There is also her 7-month-old-son, Zaradesht, who tested positive for drugs when he was born, prompting the Alaska Office of Children’s Services to take him away. Bolger has since gotten him back, she said, and, though he went through withdrawals for a while, he seemed healthy as he played with her fingers in her apartment one recent afternoon.

Bolger doesn’t want to go through that again. The clinic lets users decide how long they want to stay, and she plans to remain at least until she gives birth.

Getting in wasn’t easy, and this isn’t her first time trying to clean up. She’s tried it all. Cold turkey, with the simultaneous sweats and chills, the cramps, the unrest, the desperation. She once tried a local rehab clinic but dropped out her second day. Too much temptation here. She had some success at an Outside rehab clinic. But when she returned to Alaska, and her crowd, she got sucked back in.

“I thought that would never happen,” she said. “Happened to me twice.”

Ellen Field, 51, has been a patient at the Anchorage clinic for more than three years. Bolger considers her something of a sponsor and even moved into an East Anchorage apartment directly below Field’s where she can find support 24/7.

“Some days she can be hard, and I believe that’s part of fighting the addiction,” Field said. “It’s a battle for her every day.”

Bolger is the first to admit recovering has been hard. She doesn’t see her old friends anymore. She attends counseling and support meetings daily and gets in line for the clinic’s crack-of-dawn openings to drink her dose.

But it’s worth it. Bolger says failure is not an option.

“I honestly believe that the devil knows your weakest moments, and I feel like he takes advantage of that and pushes that urge,” she said. “I wish I would have never tried it.”

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HEROIN

WHAT IS IT: An addictive drug, processed from morphine, which itself is extracted from the seed pods of the Asian poppy plant.

WHERE IT COMES FROM: Worldwide, most heroin comes from Afghanistan, but most heroin in the United States and Alaska comes from Mexico and Colombia.

TYPES: Black tar, brown sugar and china white

STREET NAMES: Anti-Freeze, Beast, Smack, Horse, Mud, Brown Sugar, Junk, Black Tar, China White, Big H, Dope, Skag, Tigre de Blanco

SIGNS OF USE: Euphoria, drowsiness, impaired mental functioning, slowed breathing, constricted pupils, nausea

DANGERS: Infection of the heart lining and valves, abscesses, bacterial skin infections, liver disease, pneumonia, collapsed veins, clogged blood vessels from unnatural additives, infectious diseases such as AIDS and hepatitis, miscarriage, low birth weight babies, fatal overdose

Sources: Anchorage, Alaska and U.S. drug enforcement officials; U.S. Department of Health and Human Services; National Institute on Drug Abuse

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(McClatchy Newspapers correspondent T.C. Mitchell contributed to this report.)

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(c) 2008, Anchorage Daily News (Anchorage, Alaska).

Visit the Anchorage Daily News online at http://www.adn.com/

Distributed by McClatchy-Tribune Information Services.

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