Vibra Healthcare Acquires the Kindred Long Term Acute Care Hospital in Southeastern Michigan

MECHANICSBURG, Pa., May 13 /PRNewswire/ — Vibra Healthcare, LLC announced today that it has acquired a Long Term Acute Care Hospital (LTACH) in southeastern Michigan. The 83 bed hospital will continue to operate as the largest free-standing LTACH in Michigan. It will be known as Vibra of Southeastern Michigan.

LTACHs provide specialized acute and rehabilitative care to medically complex patients. These patients are critically ill or have multi-systems complications or failures that require extended acute care treatment after discharge from a traditional acute care hospital, typically from the intensive care unit. Focused clinical care in the LTACH environment promotes high quality outcomes and offers cost-effective treatment to patients who may be dependent on life support systems, such as feeding tubes, ventilators, dialysis, and respiratory and/or cardiac monitoring.

Brad Hollinger, Founder, Chairman and CEO of Vibra Healthcare, stated that “This Hospital has a long history of providing excellent patient care and is recognized for its clinical excellence. We are pleased to add this hospital to our growing family of specialty hospitals.”

The five story hospital building was recently renovated to accommodate private patient rooms. Don Yoder, Vibra’s chief development officer explained the company’s interest in the operation: “The large number of intensive care unit beds within several large health systems in the metropolitan area make Southeastern Michigan an obvious location for a large free standing LTACH. The private patient rooms, ample space for future growth and well trained clinical staff are extremely attractive to Vibra.”

Vibra has also indicated that it has formed a Medical Advisory Committee to engage its current and potential staff in identifying the needs of the surrounding healthcare community and assist in program development.

Vibra Healthcare, LLC is a specialty hospital provider based in Mechanicsburg, Pennsylvania, focused on the development, acquisition and operation of freestanding long-term acute care and medical rehabilitation hospitals. With the addition of the Michigan hospital, Vibra will operate fourteen free-standing hospitals with 900 beds in eight states.

Vibra Healthcare, LLC

CONTACT: Brad Hollinger of Vibra Healthcare, LLC, +1-717-591-5700

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

CDPHP Cafeteria Puts Health on the Menu

By Jennifer Gish, Albany Times Union, N.Y.

May 13–The CDPHP cafeteria buzzes with lunchtime activity. Employees surround the soup and salad station, where a sign about the health benefits of whole grains rests not far from a large bowl of organic quinoa Waldorf salad.

And Todd Wolfe, district chef for the food service company Eurest, a division of Compass, stands behind the entree station preparing bowls of made-to-order Vietnamese Pho, explaining that the dark grain offered as an option in the healthy soup is a fiber-rich black rice.

Meanwhile, only a few people linger in the more traditional side of the cafeteria, where burgers and fries still have a home.

Two years ago, the health insurance company decided it was time to live by the message it relays to its customers and took a look at its own Albany office.

“If we’re out there promoting healthy food choices, healthy living, all of that, then it’s got to start at home,” says Mary Ann Roberts, health educator for CDPHP.

Today, almost 25 percent of the cafeteria offerings are organic. Frozen vegetables are off the menu in favor of fresh ones. Recipes are vetted by dietitians, and the nutritional information is passed on to employees. The recently introduced steel-cut oats, which are higher in fiber than regular oatmeal, are such a hot item during breakfast that sales outpace traditional oatmeal about four to one.

“I didn’t want to do standard meatloaf, comfort food things that were just sitting in a pan. We wanted to keep it light,” Wolfe says. “Things that we thought wouldn’t work, worked.”

The wellness committee sponsors Weight Watchers sessions, healthy cooking classes and an occasional “The Biggest Loser”-style weight loss contest that in two years has netted an estimated 4,000-pound weight loss among the more than 700-employee company.

Employees can use the company’s in-office fitness center free of charge, “walking meetings” are sometimes held rather than boardroom-based ones, and Roberts says they plan to host a farmers market at the site at least every other week to encourage employees to buy fresh, local food at affordable prices.

Roberts says the goal is not to force lifestyle changes on people, but to offer them the options. Since the cafeteria had its health-conscious makeover, she says employees have asked her for resources on managing their blood pressure and diabetes.

And employees like Errol Limani, a business analyst, say the quality of the food (with entrees that don’t break $7) make the switch an easy sell.

“The thing about the healthy food is that it’s very appealing,” he says. “You don’t think of it as healthy food. It’s a restaurant-quality platter.”

Jennifer Gish can be reached at 454-5089 or by e-mail at [email protected].

—–

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U.S. Army Selects HemCon Medical Technologies As Sole Source Partner to Develop Lyophilized Human Plasma

The U.S. Army has selected HemCon Medical Technologies Inc. as the sole source to develop, test and secure FDA approval for a lyophilized (freeze-dried) human plasma (LHP) product and delivery system. The $15.4 million multi-year cooperative agreement will support the research and development of the new process. The project is expected to be complete in 2010.

The use of plasma as a resuscitation fluid, according to early U.S. Army studies, has shown to significantly reduce battlefield mortality. In many situations, use of fresh frozen human plasma is limited by storage requirements and the short shelf-life for thawed plasma. As a life-saving measure for coagulopathy, the US Army Medical Research and Materiel Command has identified the LHP initiative as a high priority. The new LHP product and delivery system will offer individual units of single source donor plasma that are safe and easy to carry, reconstitute and administer.

HemCon previously partnered with the U.S. Army to develop the HemCon® Bandage. Since 2003, HemCon has produced and distributed the HemCon Bandage and ChitoFlex® dressings for the U.S. Army and other military and civilian medical professionals. The chitosan-based hemostatic dressings, manufactured using a proprietary process, are currently included in every U.S. soldier’s battlefield first-aid kit. The success of the HemCon Bandage led to improved civilian patient care when the bandage moved to acute care facilities in 2007.

Leveraging a core competency in lyophilization, HemCon plans to do the same with its LHP initiative — improve battlefield and civilian care. Success of the LHP process on the battlefield could mean improved care for civilians. Responsible for more than 160,000 deaths annually, the National Trauma Institute reports that trauma is the leading cause of death in the U.S. for individuals ages one to 44. An LHP product and delivery system that is readily available at the point of care could significantly decrease mortality for these patients. Another advantage of LHP is the ability to reconstitute in less than 2 minutes; where waiting 20 minutes for fresh frozen plasma to thaw — may be the difference between life and death.

“This is a crucial initiative, and HemCon is honored to be the choice of the U.S. Army,” said John W. Morgan, president and CEO of HemCon. “Developing a lyophilized human plasma product and delivery system will be a significant evolution for battlefield and civilian trauma care. It’s also an important evolution for HemCon as we expand our presence in global health care markets. As the use of LHP carries into the civilian medical space, I believe we will see increased survival rates in patients treated at smaller hospitals and numerous trauma centers where currently, fresh frozen plasma is not readily available.”

About HemCon Medical Technologies Inc.

HemCon Medical Technologies Inc., founded in 2001, develops, manufactures, and markets innovative technologies to control bleeding and infection resulting from trauma or surgery. HemCon products are designed for use by military and civilian medical professionals in pre hospital, hospital, dental and clinical settings where rapid control of bleeding is of critical importance. The HemCon® Bandage was developed in collaboration with the Oregon Medical Laser Center and Providence St. Vincent’s Hospital. HemCon’s manufacturing and corporate headquarters are located in Portland, Ore. For more information, please visit www.hemcon.com.

Managing Part-Time Employees

By Rowh, Mark

Just because they work fewer hours doesn’t mean they can’t be key contributors to your organization. To ensure they’re as committed as your fulltimers, show them you care. Most organizations depend to some degree on pan-time employees. After all, parttimers offer one of the best bargains around. They cost substantially less in wages and benefits than most rull-time staffand provide needed talent along with flexibility in dealing with business fluctuations. And in the current economic environment, they may be more important than ever.

“The demand for people to work part time is growing dramatically,” says Melanie Holmes, vice president of World of Work Solutions at Manpower Inc. “Mature workers, who are at or near retirement age, want time to pursue other interests. Younger workers are interested in work/life balance. As the skills shortage intensifies, employers need to be creative about the ways they attract talent. Providing part-time positions is a key strategy.”

At the same time, part-time employees provide special challenges to managers. Some are at least as dedicated as their fulltime counterparts. Others work at the margins, with little sense of commitment. In either case, managing part-timers requires attention to their unique situations.

OUT OF MIND

By definition, part-time employees don’t put in as many hours as full-time personnel. But even when they’re not physically present, they remain a part of the organization. Don’t make the mistake of forgetting about part-timers when they’re not working or, especially, when you make plans that could affect them.

“Be careful not to overlook these people for promotion and training and other opportunities simply because they are not around as much,” says Heather Gatley, executive vice president of human resource services at AlphaStaff Group, an HR firm based in Ft. Lauderdale, Fla. “Out of sight sometimes really does cause someone to be ‘out of mind,’ and it is on both the supervisor and employee to make sure that doesn’t happen.”

From the manager’s end, some simple measures can prove helpful. Keeping parttimers’ work schedules dose at hand where they’re visible daily can help keep their names from being overlooked. Developing individualized goal lists for each employee and consulting them frequently can also prove helpful. Other measures might range from including all staff in developing departmental goals, to copying them on memos and e-mails.

“It’s important to position part-timers as valuable members of the team,” Holmes says. “Include them in meetings, which could mean adjusting their schedules so they can attend. And, include them in all written communications.”

Depending on the practices within a given organization, opportunities for substantive feedback might also be expanded. For example, if part-timers aren’t included in a formal performance evaluation process at least once a year, making that practice more inclusive could be a worthwhile initiative. Or if this isn’t possible because of policy or time constraints, supervisors might take the time to schedule brief, but regular, one-on-one meetings with part-time staff to discuss job expectations, performance, and employee questions or concerns.

This approach might also include professional development activities. If possible, make part-timers eligible for benefits such as support for college classes or attendance at relevant workshops. If budgets or company policies preclude such measures, take a creative approach. Schedule inexpensive inhouse workshops or hold brown-bag lunch sessions on topics of professional or personal interest.

“Keep part-timers engaged,” Holmes says. “There is always a danger that they might fall off the radar, so you must make them feel like an equal part of the team. It’s also important to expect commitment and encourage initiative in your part-timers.”

THE CULTURE AT HAND

In some cases, part-timers simply have a hard rime fitting in. Achieving synergy with other personnel can be a real challenge for them. “Because part-time employees are at the workplace for only part of the time, it is more difficult for them to fully understand the culture of the organization,” says Billie Blair, Ph.D., president of Leading and Learning, a Los Angeles-based consulting firm. “It can be hard [for them] to relate to it and to their fellow workers successfully and to lend themselves to the needs ofthat culture.”

Dr. Blair says that workgroups often are made up primarily of full-time employees who tend to overlook their part-time colleagues. Even if they’re not overtly rude or uncooperative, they may rely more fully on fellow full-timers and spend a disproportionate amount of their time interacting with one another at the expense of meaningful communication with part-time workers. Rectifying such situations may require managers to focus on bridging gaps between the two groups.

“Managers of part-rime employees should spend time sorting out misperceptions and misinterpretations, both of the work needs and the interactions with fellow workers,” Dr. Blair says. “Managers must also be evervigilant in forming and managing work teams because of the perceived differentiation between full-time and part-time employees.”

To supplement involvement in the workplace itself, one simple strategy is to include part-timers in social activities. Keep them informed, and consider their schedules when planning birthday celebrations, showers, or other social events. “Just because someone works pan time, a boss shouldn’t assume that he doesn’t want to attend a weekend seminar or attend an office cocktail hour or holiday party,” says Gatley “The need to be ‘a part of something’ remains just as strong as it does for full-time employees.”

The same goes for recognition programs. “Don’t ignore part- timers when it comes time to distribute bonuses, rewards, and other forms of recognition,” says Francie Dalton, president of Dalton Alliances, a consulting firm based in Columbia, Md. “Part time doesn’t mean pan mind. Indeed, you may find you net greater productivity from multiple part-timers than you do from a single fulltimer.”

Providing adequate workspace is also pan of the equation. Ruth King, CEO of ProfitabilityChannel.com and author of The Ugly Truth about Managing People, recalls an incident where a part-time employee had an office that she used regularly. She reported to work one day and found another person in her office. Management had reassigned her office to a full-time employee, and she had to scramble to find a place to work. “Don’t treat a part-time employee as a step-child,” King says. “This person should have his regular work area and be treated the same way a fulltime employee is treated.”

RECOGNIZING DIFFERENCES

Although efforts to include part-time staff make sense, it’s also important to understand the different goals they bring to the workplace. “Managers need to realize that parttimers have different goals in mind,” says Nick Vaidya, a partner with the 8020Strategy Group, a management consulting firm based in Austin, Texas. He notes that most parttime employees fall into two types. One prefers pan- time status, or at least doesn’t mind it. The other wishes for full- time employment.

“To be successful, you must recognize that there is a reason that they are part time, and you must honor that reason and support it,” he says. “All else being equal, with such an attitude, you will command their respect and commitment.”

For some part-timers, outside interests are major reasons they prefer that status. If you can identify their outside interests, you may be able to link them to workplace performance. “They are part- timers for a reason, which is likely that something else is more important in their lives,” says Maryann Karinch, author of I Can Read You Like a Book. “You will not effectively manage and motivate a person like that by focusing on the work alone. Find out what is important to the person-family, budding acting career, night school- and link work performance to that important aspect of his or her life.”

As an example, she says that a worker who is also a student might benefit if you find a way for him to apply what he’s learning at work

“If he’s an accountant or an artist, there’s probably a way to make his new skills live at work,” she says, “even if it’s a matter of asking for his opinion on redecorating your office.”

Whatever their motivation, part-time employees are likely to be an important part of any workforce. As a result, efforts to work effectively with them, and to provide the right kind of leadership, are imperative.

“Part-timers are going to become increasingly more common as work/ life balance choices by younger workers take precedence over boomer workaholism,” says Dalton. “Realize that really smart, highly accomplished people are choosing to work part time. So appreciate them. And work hard to retain them!”

five tips for managing part-timers

Joyce L. Gioia-Herman, president of the Herman Group, a management consulting firm based in Greensboro, N.C. (www.hermangroup.com), offers these tips for successfully managing part-time employees:

* Give people specific responsibilities.

* Make sure that part-timers are clear about their days and hours.

* Let them know where they fit in and how critical their work is to the success of the enterprise.

* Make sure that workers understand exactly what is expected of them. * Focus on results.

different strokes

Recognizing the differing priorities of part-time employees is key to motivating them, according to Cindy Ventrice, author of Make Their Day! Employee Recognition That Works. “Many of the needs of part-timers are exactly the same as [those of] fulltimers. They want to receive fair and equitable compensation, do meaningful work, like the people they work with, have their opinions valued, and receive recognition for what they do,” Ventrice says. “But they can also have very different needs from full-time staff. An important consideration for motivating them is to understand why they are part time.”

She advises asking questions such as these:

* Are they going to school in a related field? Project opportunities that provide relevant experience will motivate them.

* Have they retired and are looking for a way to keep busy? Give these older workers a chance to show off their expertise or make a visible difference.

* Are they part time because they have family obligations that are a priority? Honor that time, and recognize and reward them with time off that they can take when needed.

“The more managers know about individual part-timers, the more likely they are to be successful in motivating and engaging them,” adds Ventrice.

Mark Rowh is a frequent contributor to OfficeSOLUTIONS.

Copyright Quality Publishing, Inc. Apr 2008

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

Focus on the Pharmacogenomic Testing Markets

Reportlinker.com announces that a new market research report related to the Medical devices industry is available in its catalogue.

Pharmacogenomic Testing Markets

http://www.reportlinker.com/p089473/Pharmacogenomic-Testing-Markets.html

Pharmacogenomics, the science of individualizing drug therapy based on the genetic makeup of individual patients, offers an unusual opportunity for future market growth. Applying pharmacogenomics would allow doctors to treat specific segments of the population based on their particular responses to a drug. The knowledge of the likely effectiveness of a drug in a patient makes the drug more reliable, and fewer drugs would have to be taken off the market due to adverse reactions in some, but not all, of the patients to whom they were administered. Additionally, reducing the occurrence of adverse effects to a drug effectually reduces the cost of patient care overall. This TriMark Publications study examines the market for diagnostic tests based on this science and the clinical measurement methods, the reagents and supplies being utilized in clinical medicine and the pharmaceutical industry. This report presents an overview of the latest information regarding emerging new products and industry trends and will not only quantify, but also, qualify the pharmacogenomic market segments as an area of research, product development and investment opportunity. Forecasts of the pharmacogenomic market and an analysis of products in the worldwide diagnostics market will provide a basis for understanding the significance of past developments and the immense possibilities of the future.

Please note: Trimark uses a digital rights management tool to distribute their reports. The client will need to download SealedMedia viewer before the client will be able to access the secured PDF files. Upon ordering an electronic version, the Publisher will provide a link to download the software and the purchased report.

 1. Overview 1.1 Statement of Report 1.2 Objectives of this Report 1.3 Scope of the Study 1.4 Methodology 1.5 Executive Summary 2. Introduction 2.1 Pharmacogenomic Testing 2.1.1 Clinical Applications 2.1.2 Demand for Pharmacogenomic Diagnostic Tools Worldwide 2.1.3 Key Factors that Contributed to the Growth of Pharmacogenomic Demand 2.1.4 Clinical Applications 2.1.5 Drug and Diagnostic Combinations 2.1.6 Economic Impact of Healthcare Costs 2.2 Individual Genetic Differences 2.2.1 Population Genomics 2.2.2 SNPs and Haplotypes 2.2.3 HapMap 2.2.3.1 The International HapMap Project 2.2.3.2 HapMap Participants and Funding Sources 2.2.4 Metabolism 2.3 Drug Treatment Outcomes 2.3.1 Contribution of Cytochrome P450s 2.3.2 Adverse Drug Reactions (ADRs) 2.3.3 Drug-Test Combinations 2.4 Role of Pharmacogenomics 2.4.1 How Will Gene Variation be Used in Predicting Drug Response? 2.4.2 How will Drug Development and Testing Benefit from Pharmacogenomics? 2.4.3 Advantages of Pharmacogenomics 2.4.4 The Diagnostics-Therapeutics Fusion 2.4.5 Potential Challenges 2.4.6 Importance of Testing for the PM Phenotype 2.4.7 Drug Repositioning 2.5 Top Pharmacogenomic Tests 2.5.1 CYP2D6 2.5.2 CYP2C19 and CYP2C9 2.5.3 CYP3A4 and CYP3A5 Genotyping 2.6 Barriers to Pharmacogenomic Testing 2.7 Drivers of Pharmacogenomic Testing 3. Pharmacogenomic Testing Market: Size, Growth and Share 3.1 Global Pharmacogenomic Testing Markets by Technology Segments 3.1.1 Market Structure 3.1.2 Market Drivers in the Pharmacogenomic Diagnostics Testing Sector 3.1.3 Market Restraints in Pharmacogenomic Diagnostic Testing Segment 3.1.4 Principal Market Segments for Genomics Testing 3.1.4.1 Diagnostic Testing 3.1.4.2 Pharmacogenomic Testing 3.1.4.3 SNP Identification 3.1.5 Key Players in the Pharmacogenomic Diagnostics Testing Segment 3.1.6 Pharmacogenomic Testing Sector Analysis 3.2 U.S. Pharmacogenomic Testing Market 3.2.1 Market Overview 3.2.2 Diagnostic Testing Categories 3.3 European Pharmacogenomic Diagnostic Testing Market 3.4 Japanese Diagnostic Testing Market 4. Pharmacogenomic Disease Markers 4.1 SNPs 4.1.1 SNP Identification Market 4.1.2 Overview of SNP Identification 4.1.3 Strategies for SNP Identification 4.1.4 Candidate Gene Selection 4.1.5 Whole-Genome LD Mapping 4.1.6 SNP Databases 4.1.7 Computational Tools for SNP Identification 4.1.8 SNPbrowser, Applied Biosystems 4.1.9 ChromosomeBrowser(tm), Orchid Cellmark 4.1.10 Sentrix(r) Array Matrix, Illumina 4.1.11 Celera Discovery System(tm), Celera Genomics, Appelera Corporation 4.1.12 Third Wave Technologies 4.2 Predictive Pharmacogenomics 4.2.1 Cancer Testing 4.2.2 Breast Cancer 4.2.3 Melanoma 4.2.4 Colon Cancer 4.2.5 Cystic Fibrosis 4.2.6 Genetic Test for Cardiac Ion Channel Mutations (Cardiac Channelopathies) 4.2.7 Thiopurine S-methyltransferase (TPMT) Genetic Test 4.2.8 CARING Study 4.2.9 Vilazodone 4.2.10 STRENGTH Trials (Statin Response Examined by Genetic HAP Markers) 4.2.11 Predictive Cancer Testing Market Size 4.2.12 HIV and AIDS 4.2.13 Cardiac Transplants 4.2.14 Prostate Cancer 4.2.15 Herceptin and Tykerb 4.2.16 Asthma 4.2.17 Lung Cancer 4.2.18 Hepatitis C Viral Load 4.2.19 Acute Myelocytic Leukemia (AML) 4.3 Examining the Role of Pharmacogenomics in Specific Disease Application 4.3.1 The Role of Pharmacogenomics in Bipolar and Other Psychiatric Disorders 4.3.2 Pharmacogenomics in Warfarin Treatment 4.3.3 Pharmacogenomics and Breast Cancer Treatment 4.4 Gene Chips to Detect Cytochrome Variations 4.4.1 AmpliChip CYP450-Roche Diagnostics 4.4.2 GeneChip System 3000Dx-Affymetrix 4.4.3 NanoChip(r) Molecular Biology Workstation-Nanogen, Inc. 5. Pharmacogenomic Testing: Development Issues 5.1 Adoption of Pharmacogenomic Testing 5.2 Factors Influencing the Integration of Pharmacogenomics into Clinical Trials 5.3 Moderators of Growth 5.3.1 Classification of Extensive vs. Poor Metabolizer 5.3.2 Genetic Testing 5.3.3 Cost-Benefit of Pharmacogenomic Testing 5.3.4 Workforce Issues 5.3.5 Reimbursement 5.3.6 New CPT Test Codes and Payment Amounts 5.4 Clinical Guidelines and Pharmacogenomic Testing 5.5 Good Laboratory Practice 5.6 Quality Assurance Issues 5.6.1 Criteria Required to Establish a Genomic Test for Clinical Use 5.6.2 Microarrays in Clinical Diagnostic Use 5.7 Pre-therapeutic Pharmacogenomic Testing 5.8 Regulatory Requirements 5.9 Screening 5.10 Cost of Phenotyping vs. Genotyping 5.11 Pharmacogenomic Tests: New Product Development 6. Business Trends in the Industry 6.1 Pharmacogenomic Initiatives within Pharmaceutical Companies 6.2 Pharmacogenomic Testing Growth Factors 6.3 Acquisition, License Agreements, Internal Development and Partnerships 6.4 Product Testing Depth in Pharmacogenomic Testing 6.5 Government Regulation 6.5.1 U.S. Regulations 6.5.2 U.K. Regulations 6.5.3 E.U. Regulations 6.5.4 Japanese Regulations 6.6 Increased Market Penetration in Pharmacogenomic Testing 6.7 Legal Issues 6.8 Barriers to Growth 6.9 Drivers of Growth 6.10 Product Launches and Developments 6.11 Investment Parameters for Diagnostic Companies 6.12 Key Elements of the Pharmaceutical Value Chain 6.13 An Evaluation of Successful Pharmacogenomic Business Models 6.14 Pharmacogenomic Applications of Ethical Considerations 6.15 Drug Repositioning Services 6.16 Patent Protection of Pharmacogenomic Technology 6.17 FDA Pipeline for Pharmacogenomic Tests 7. Important Technology Trends in Pharmacogenomics 7.1 Trends in Pharmacogenomic Testing 7.1.1 Toxicogenomics 7.2 Drug Metabolism 7.3 Personalized Medicine for Cardiovascular Disorders: Genomic and Proteomic 7.4 Biomarkers 7.4.1 Cancer 7.4.1.1 Leukemia: Gleevec and Dasatinib (BMS-354825) 7.4.1.2 Colorectal Cancer 7.4.1.3 Cardiovascular Drugs 7.4.1.3.1 Arrhythmia 7.4.1.3.2 Hypertension 7.4.1.3.3 Hyperlipidemia 7.4.1.3.4 Myocardial Infarction 7.5 Future Developments 7.5.1 GSK's Pharmacogenomic Program 7.5.2 Roche's Biomarker Strategy 7.5.3 Hypertension Markets 7.5.4 Expression Data to Integrate Pharmacology and Chemistry Data 7.5.5 Metabonomics 8. Company Profiles 8.1 Abbott Diagnostics 8.2 Affymetrix 8.3 Ambion (Asuragen) 8.4 Applera Corporation 8.5 AstraZeneca 8.6 Bayer Healthcare 8.7 Bristol-Myers Squibb 8.8 Celera Diagnostics (Appelera Corporation) 8.9 Clinical Data 8.10 CuraGen Corporation 8.11 Dako (formerly DakoCytomation) 8.12 deCODE Genetics 8.13 DNAPrint Genomics 8.14 DxS 8.15 EraGen Biosciences 8.16 EXACT Sciences 8.17 Expression Analysis 8.18 FivePrime Therapeutics 8.19 GE Healthcare 8.20 Genaissance Pharmaceuticals (now Clinical Data) 8.21 Gene Logic (Ore Pharmaceuticals) 8.22 Genentech 8.23 Genomic Health 8.24 Gentris 8.25 Genzyme 8.26 GlaxoSmithKline 8.27 Human Genome Sciences 8.28 Iconix Pharmaceuticals, Inc. 8.29 Illumina 8.30 Incyte, Inc. 8.31 Interleukin Genetics 8.32 Johnson & Johnson 8.33 Luminex Corp. 8.34 Merck & Co. 8.35 Merck KGaA (now Merck Serano) 8.36 Merck Serano 8.37 Millennium Pharmaceuticals 8.38 Myriad Genetics, Inc. 8.39 Nanogen 8.40 Nanosphere 8.41 Nitromed 8.42 Nuvelo, Inc. 8.43 Orchid Cellmark 8.44 Prediction Sciences 8.45 PharmaSeq 8.46 PPGx (now Clinical Data) 8.47 Prometheus Laboratories 8.48 Roche Diagnostics 8.49 Sequenom 8.50 Third Wave Technologies 8.51 Tm Bioscience Corp. (now Luminex) 8.52 Vertex Pharmaceuticals 8.53 Warnex 8.54 Wyeth INDEX OF FIGURES Figure 2.1: Relative Contribution of Human CYP450s in Drug Metabolism. INDEX OF TABLES Table 2.1: Clinical Applications of Diagnostic Pharmacogenomic Testing Table 2.2: Groups Participating in the International HapMap Project Table 2.3: Drugs Pulled from the Market that Might Have Benefited from Pharmacogenomic Analysis Table 2.4: Currently-Marketed Drugs that Might Benefit from Pharmacogenomic Analysis Table 2.5: Major Cytochrome P450 Isozymes Table 2.6: Examples of Test-Drug Combinations Table 2.7: Factors that Determine a Successful Pharmacogenomic Test Table 2.8: Pharmacogenomics' Influence on Drug SalesTable 2.9: Pharmacogenomics' Effect on Maximizing R&D Productivity Table 2.10: Prevalence of Metabolically-Active Enzymes Table 2.11: Role of Pharmacogenomics in Phases II-III Drug Trials Table 2.12: Pharmacogenomic Drug Development Tests Table 2.13: AACC Top Ten List of PGx Tests Table 2.14: CYP2D6 Table 2.15: CYP2D6 Drugs Table 2.16: Response to Tricyclic Antidepressants Table 2.17: CYP2C19 Table 2.18: CYP2C9 Table 2.19: Barriers to Pharmacogenomic Testing Table 2.20: Drivers of Pharmacogenomic Testing Table 2.21: Users of Pharmacogenomics Table 2.22: Markets for Pharmacogenomic Testing Table 3.1: Worldwide Pharmacogenomic Market Size by Technology Segments, 2001-2011 Table 3.2: Total Pharmacogenomic Testing Market Size, 2001-2011 Table 3.3: Diagnostic Pharmacogenomic Testing Market Size, 2001-2011 Table 3.4: Benefits of Pharmacogenomic Diagnostics in Patient Care Table 3.5: Genotyping Pharmacogenomic Testing Market Size, 2001-2011 Table 3.6: Benefits of Pharmacogenomics in Clinical Trials and Drug Development Table 3.7: Five Key Action Points for Pharmaceutical Companies Table 3.8: Global SNP Identification Tools Market Size, 2001-2011 Table 3.9: Pharmacogenomic Testing Market Structure Table 3.10: P450 Isozymes and Pharmaceuticals Table 3.11: List of Companies that Market Pharmacogenomic Tests Table 3.12: Key Collaborations in the Pharmacogenomics Industry Table 3.13: Prominent Drugs' Withdrawals from the Market Table 3.14: Key Elements in the Drug Development Process Table 3.15: Major Suppliers of PCR-based Assays and PCR-based Technologies Table 4.1: Methods for Performing NAT Table 4.2: SNP Consortium Members Table 4.3: Developmental Atherosclerosis Drugs Table 4.4: Myriad Genetics Predictive Medicine Sales, 2001-2005 Table 4.5: DNA-based Predictive Medicine Product Sales for Cancer, 2006-2010 Table 4.6: Summary of Assays for HIV Viral Load Testing Table 4.7: U.S. Market Share of HIV Testing Kits Table 4.8: Monogram Bioscience, Inc. Products for HIV Testing Table 4.9: Asthma Therapeutic Drug Pipeline Table 4.10: Psychiatric Case Studies-Organized Pharmacokinetically Table 6.1: U.S. Prescription Drug Expenditures, 2000-2012 Table 6.2: U.S. Pharmaceutical Market Size and Growth Rate, 1996-2006 Table 6.3: Top Ten Pharmaceutical Companies by U.S. Prescription Sales, 2006 Table 6.4: Top Categories of U.S. Prescription Drug Spending Percentage Total Sales, 2006 Table 6.5: Therapeutic Classes by U.S. Prescription Sales, 2006 Table 6.6: Number of NME Approvals and Mean Approval Times, 1984-2007 Table 6.7: Global Market for Tools and Consumables Used in Drug Discovery and Development, 1999-2010 Table 6.8: Drug Sales Therapeutic Categories as a Percentage of the World Market, 2002 and 2006 

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Pharmacogenomic Testing Markets

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Learn About the Cancer Diagnostic Testing World Markets

Reportlinker.com announces that a new market research report related to the Medical devices industry is available in its catalogue.

Cancer Diagnostic Testing World Markets

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Cancer testing is one of the most important growth opportunities for the next three to five years in the diagnostics segment. The National Cancer Institute estimates that about ten million Americans have or have had some form of cancer. Overall costs of the disease are $126 billion annually. Pharmaceutical companies are developing more than 300 new medicines for cancer, some of which are in development for more than one type of the disease, for a total of more than 500 ongoing R&D projects.

The goal of this TriMark Publications report is to review the market for tumor marker testing equipment and supplies using screening reagents and instruments for analysis of individual components in blood, serum or plasma. It defines the dollar volume of sales, both worldwide and in the U.S., and analyzes the factors that influence the size and the growth of the market segments. Also examined are the subsections of each market segment, including: the physician office labs, hospital labs and commercial laboratories. Additionally, the numbers of institutions using this type of testing and the factors that influence purchases are discussed. The report surveys almost all of the companies known to be marketing, manufacturing or developing instruments and reagents for the clinical point-of-care market in the U.S. Each company is discussed in depth with a section on its history, product line, business and marketing analysis, and a subjective commentary of the company’s market position.

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 1. Overview  1.1 Statement of Report  1.2 About This Report  1.3 Scope of the Report  1.4 Objectives  1.5 Methodology  1.6 Executive Summary  2. Introduction to Cancer Biology and the Diagnostic Industry  2.1 Cancer  2.1.1 The Disease  2.1.2 Metastasis  2.1.3 Demographics and Statistics of Cancer  2.2 The Drivers of the Biotech and Diagnostics Industry  2.2.1 Technological Innovation  2.2.2 Government Funding  2.3 Outlook for Tumor Markers  3. Tumor Markers Market Segment Analysis: Size, Growth and Share  3.1 Market Description  3.2 Clinical Diagnostic Serum Based Cancer Markers  3.3 PSA Testing Market Size  3.4 DNA Markers  3.5 Serum Proteins  3.6 Enzymes  3.7 Occult Blood  3.8 Histology and In Situ Hybridization (ISH)  3.9 Cervical Cytology  3.10 Immunohistochemistry  3.11 In Vivo Detection Cancer Products  3.12 Radionuclides and X-Ray Detection Products  3.13 Human Papillomavirus (HPV) Testing  3.14 Bladder Cancer Testing  3.15 Tumor Assays for Adjuvant Chemotherapy  4. Diagnostic Methods for Cancer Detection  4.1 Organ Specific Tumor Markers  4.1.1 Colon Cancer  4.1.2 Prostate Cancer  4.1.3 Pancreatic Cancer  4.1.4 Breast Cancer  4.1.5 Ovarian Cancer  4.1.6 Cervical Cancer  4.1.7 Lung Cancer  4.1.8 Testicular Cancer  4.1.9 Bladder Cancer  4.1.10 Hepatic Cancer  4.1.11 Stomach Cancer  4.1.12 Malignant Melanoma  4.1.13 Acute Myeloid Leukemia (AML) and Acute Lymphoblastoid Leukemia (ALL)  4.1.14 Lymphoma  4.2 Clinical Laboratory Methods for Measuring Tumor Markers  4.2.1 Abbott Diagnostics AxSYM  4.2.2 Roche Diagnostics Elecsys  4.2.3 Beckman Coulter Diagnostics Access  4.2.4 Bayer Diagnostics ADVIA Centaur  4.2.5 Dade Diagnostics Stratus  4.2.6 Diagnostic Products Corporation Immulite  4.2.7 Tosoh Medics A1A  4.2.8 CIS bio International Kryptor  4.2.9 Ortho-Clinical Diagnostics Vitros ECiQ  4.2.10 Fujirebio Diagnostics, Inc.  4.2.11 bioMerieux Vidas  4.2.12 Eisai Picolumi  4.2.13 Tosoh Medics, Inc.  4.3 New Technologies for Cancer Diagnostics  4.3.1 New and Improved Immunoassays  4.3.2 Immunohistochemical Tests  4.3.3 Molecular (DNA and Genomic) Diagnostic Assays  4.3.4 Genomics and Genetic Markers  4.3.5 Proteomics and New Protein Markers  4.3.5.1 Inside the ProteinChip System  4.3.5.2 Rapid Biological Assays on a Chip  4.3.5.3 Proteome Pattern Recognition  4.3.6 New Platform Technologies Including Flow Cytometry  4.3.7 Stem Cell Markers  4.3.8 Monoclonal Antibodies  4.3.9 Proteomics and Cancer Antibodies  4.3.10 Pharmacogenomics and Oncology Diagnostics  4.3.11 DNA Microarrays  4.3.12 In Vitro Diagnostic Multivariate Index Assays (IVDMIA)  4.3.13 Prostate PX Score  4.3.14 Prostate-63  4.3.15 Future Directions  4.4 Clinical Methods for Diagnosis of Cancer  4.4.1 Screening  4.4.2 Sigmoidoscopy  4.4.3 Imaging  4.4.4 Theranostics  5. Implications of Molecular Biology for New Diagnostic Cancer Tests  6. Companies Entering the Cancer Diagnostics Market with Novel Technology  Platforms  6.1 Abbott Diagnostics  6.2 Affymetrix, Inc.  6.3 Agendia BV  6.4 Agensys, Inc.  6.5 Ambrilla Biopharma, Inc.  6.6 AMDL, Inc.  6.7 Asuragen, Inc.  6.8 Aureon Biosciences Corporation  6.9 Bard Diagnostics, Inc.  6.10 Bayer Diagnostics  6.11 Beckman Coulter, Inc.  6.12 Biocode S.A.  6.13 BioCurex  6.14 Biomedical Diagnostics  6.15 Biomerica  6.16 bioMerieux  6.17 Biomira  6.18 BioModa, Inc.  6.19 Bruker Daltonics  6.20 Byk Gulden  6.21 Cepheid  6.22 Clarient, Inc.  6.23 CytoCore (Formerly known as Molecular Diagnostics, Inc.)  6.24 Correlogic Systems, Inc.  6.25 Cytogen Corporation  6.26 diaDexus, LLC  6.27 DiagnoCure, Inc.  6.28 Diagnostic Products Corporation  6.29 Diagnostic Systems Laboratories, Inc.  6.30 DRG International, Inc.  6.31 Eisai Co., Ltd.  6.32 Enigma Diagnostics Ltd.  6.33 Epigenomics  6.34 Exact Sciences Corporation  6.35 Exagen Diagnostics, Inc.  6.37 Gene Logic, Inc.  6.38 Gen-Probe, Inc.  6.39 Genomic Health  6.40 Geron Corporation  6.42 Immunicon Corporation  6.43 Immunomedics, Inc.  6.44 Incyte Pharmaceuticals, Inc.  6.45 Ipsogen  6.46 LabCorp  6.47 Matritech  6.48 Mitsubishi Kagaku Medical  6.49 Molecular Devices (Formerly known as Arcturus Bioscience, Inc.)  6.50 Myriad Genetics, Inc.  6.51 Poniard Corporation  6.52 Nexell Therapeutics, Inc.  6.53 Northwest Biotherapeutics, Inc.  6.54 Nuvelo, Inc.  6.55 Panacea Pharmaceuticals, Inc.  6.56 Oncotech, Inc.  6.57 Polymedco, Inc.  6.58 Princeton BioMeditech Corporation  6.59 Qiagen  6.60 Sanko Junyaku Co., Ltd.  6.61 Tosoh Medics, Inc.  6.62 TriPath Imaging, Inc.  6.63 UroCor, Inc.  6.64 Ventana Medical Systems, Inc.  6.65 Veridex  6.66 Vermillion, Inc. (Formerly known as Ciphergen)  6.67 Worldwide Medical Corporation  6.68 Xenomics, Inc.  7. Business Trends in the Industry  7.1 Industry Consolidation  7.2 Breadth of Product Offering and Pricing  7.3 Government Regulation of Medical Devices  7.4 Strategic Business and Marketing Considerations  7.5 Commercial Opportunities in Cancer Markers  7.6 Moderators of Growth  7.7 Biotechnology Industry Trends  7.8 Pharmaceutical Industry Trends  7.9 Acquisition, License Agreement, Partnerships  7.10 Legal Developments  7.11 Sales and Marketing Strategies for Tumor Marker Tests  7.11.1 North American Market  7.11.2 International Markets  7.11.2.1 Europe  7.11.2.2 Central and South America  7.11.2.3 Asia/Pacific  8. Tumor Marker Testing: Important Issues  8.1 Trends in Patient Care and Reimbursement  8.2 Trends in Reimbursement Practice  8.3 Clinical Laboratory Improvement Act (CLIA)  8.4 Unmet Needs in Tumor Markers  9. Important New Technology Areas  9.1 Proteins  9.2 DNA Sequencing  9.3 The Human Genome Project (HGP)  9.4 Liquid Phase Chromatography  9.5 Polymerase Chain Reaction (PCR)  9.6 Capillary Electrophoresis  9.7 Proteomics  9.8 Use of Mass Spectroscopy in Sequencing  9.9 High-Throughput Organic Synthesis  10. New Cancer Markers in Basic Research  10.1 Genetics of Cancer  10.2 Telomerase  10.3 Stomach Cancer  10.4 Head and Neck Cancer  10.5 Breast Cancer  10.6 Prostate Cancer: p27 (Kip1) A New Molecular Marker for Prostate Cancer 10.7 PSMA  10.8 Cervical Cancer: NMPI79  10.9 Pancreatic Cancer: Peritoneal Cytology  10.10 Colorectal Cancer: CEA Doubling Time  10.11 Uterine and Kidney Cancer: MN/CA9  10.12 MMSC1 Scaffold Gene  10.13 p16 Tumor Suppressor Gene  10.14 MTS2 and p19 Cell Cycle Genes  10.15 Complement Factor H Related Proteins  10.16 MUC 2, 3, 4  10.17 Cytokeratins  10.18 Colon Cancer: Serum VEGF  10.19 Ras Oncogenes  10.20 Lung Cancer: Ribonucleoprotein A2/B1  10.21 BCLA-4 Matrix Protein  10.22 RAK Antigens  10.23 Serum Urokinase Receptors  10.24 Chips  10.25 Survivin  10.26 Human Endometrial Specific Steroid Binding Factor (hESF1)  10.27 Reg-4 Protein  10.28 Nox-1  10.29 PSP94 Binding Protein  10.30 Ettan DIGE Technology  10.31 YKL-40  10.32 AFP-L3  10.33 DNA Methylation Technology  10.34 Transthyretin and Apolipoprotein A1  10.35 ADAM 12  10.36 Ovarian Cancer: Vermillion's SELDI-based ProteinChip  10.37 Lung Cancer: Labeled Porphyrin Binding  10.38 C-MAP, A Cervical Cancer Screening System  10.39 Lung Cancer: Pro-Gastrin-Releasing Peptide (ProGRP)  10.40 Prostate Cancer: PCA3  10.41 Bladder Cancer: ImmunoCyt(TM)/uCyt+(TM)  10.42 Shc Proteins  10.43 Oncology Biomarker Qualification Initiative  10.44 Anti-Glycan Antibodies  11. Market Trends and Forecasts  11.1 Ultrasensitive Cancer Tests  11.2 Mergers and Acquisitions of Diagnostic Companies  11.3 RT-PCR  11.4 Genetic Tests of Hereditary Cancer Risk  11.5 DNA Measurements  11.6 Technical and Practical Issues for Potential New Markers  11.7 Genetic Profiling  11.8 Ploidy  11.9 Advances in Sputum Analysis for Screening and Early Detection of Lung  Cancer  11.10 Pharmacogenetic Tests for Cancer11.11 Worldwide Healthcare Spending  11.12 R&D Expenditures  Appendix 1: Web Links  Appendix 2: Cancer Information Resources  Appendix 3: Colon Cancer Staging  Appendix 4: Reimbursement for Tumor Marker Testing  Appendix 5: The Pathology of Prostate Cancer  Appendix 6: Government Regulation of Tumor Marker Tests  Appendix 7: The Clinical Laboratory Improvement Act (CLIA)  Appendix 8: Marketers of Occult Blood Diagnostic Test Kits  INDEX OF FIGURES  Figure 4.1: Model of Colorectal Cancer Development  Figure 4.2: ASCO-CAP Guidelines for HER2 Testing in Breast Cancer: Equivocal  Results with IHC  Figure 4.3: ASCO-CAP Guidelines for HER2 Testing in Breast Cancer: Results  by FISH  Figure 4.4: The BTA stat Test vs. Cytology  Figure 6.1: Qiagen Global Sales  Figure 10.1: Estimates for PCA3 Test Volume in U.S., 2005-2008  INDEX OF TABLES  Table 2.1: Organ-Specific Medicines in Development for Cancer, 2007  Table 2.2: Estimates for the Leading Sites of New Cancer Cases and Deaths in  the U.S. by Sex  Table 2.3: Estimated Worldwide Number of New Cancer Cases and Deaths by Type  of Cancer  Table 2.4: Estimated Number of New Cancer Cases and Deaths by Region  Table 2.5: Cancer Death Rates per 100,000 Population (and Rank) for all  Cancer Sites by Country  Table 2.6: Cancer Associated Genes  Table 2.7: Carcinogens in the Workplace  Table 2.8: Private Funding Levels for the Biotechnology Segment, 1995-2006  Table 2.9: Herceptin Worldwide Sales, 2000-2007  Table 2.10: Classes of Drugs Used to Treat Breast Cancer  Table 3.1: In Vitro Cancer Marker Market Segments Worldwide, 2001 and 2007  Table 3.2: Tumor Markers Currently in Common Use  Table 3.3: Global IVD Cancer Tumor Marker Testing Market Segments Projected  Growth Rates, 2005-2010  Table 3.4: Worldwide Market Size in Dollar Volume for Tumor Marker Assays  Product Market, 2001-2010  Table 3.5: U.S. Market Size in Dollar Volume for Tumor Marker Assays Product  Market, 2001-2010  Table 3.6: Worldwide In Vitro Cancer Tumor Marker Diagnostics Market Size,  2001-2010  Table 3.7: U.S. In Vitro Cancer Tumor Marker Diagnostics Market Size,  2001-2010  Table 3.8: Japanese In Vitro Cancer Tumor Marker Diagnostics Market Size,  2001-2010  Table 3.9: European In Vitro Cancer Tumor Marker Diagnostics Market Size,  2001-2010  Table 3.10: Global Distribution of IVD Cancer Tumor Marker Diagnostic  Testing, 2005  Table 3.11: Estimated Market Share of Major Competitors in U.S. Cancer Tumor  Marker Diagnostics Market  Table 3.12: Major Presence in Cancer Tumor Marker Diagnostics Markets  Table 3.13: Worldwide PSA Sales, 2000-2010  Table 3.14: U.S. PSA Sales, 2000-2010  Table 3.15: Serum Markers Used Clinically  Table 3.16: ASCO-CAP Guidelines for HER-2 Testing in Breast Cancer  Table 3.17: Drivers of IHC Growth  Table 3.18: Bladder Cancer Testing Efforts in the U.S. and Germany  Table 3.19: Worldwide Bladder Cancer Marker Sales, 2001-2010  Table 3.20: U.S. Bladder Cancer Marker Sales, 2001-2010  Table 3.21: Worldwide NMP22 Sales, 2001-2010  Table 3.22: Current Breast Cancer Product and Product Opportunities  Table 3.23: Products in Various Stages of Development for Cancers Other than  Breast Cancer  Table 4.1: Colorectal Cancer Stages  Table 4.2: Worldwide CEA Sales, 2001-2010  Table 4.3: U.S. CEA Sales, 2001-2010  Table 4.4: Population Statistics of Serum Levels of PSA in Men Over 50 Years  of Age  Table 4.5: PSA Doubling Time and Time to Reach PSA of 1,000  Table 4.6: PSA Doubling Times  Table 4.7: Worldwide CA-19-9 Sales, 2001-2010  Table 4.8: U.S. CA-19-9 Sales, 2001-2010  Table 4.9: CA-19-9 Levels in Management of Pancreatic Cancer  Table 4.10: Worldwide CA-15-3 Sales, 2001-2010  Table 4.11: U.S. CA-15-3 Sales, 2001-2010  Table 4.12: TPA Marker Sensitivity  Table 4.13: ASCO-CAP Guidelines for HER2 Testing in Breast Cancer:   How to Interpret Test Results  Table 4.14: Siemens Oncogene Science Biomarker Group Reagents  Table 4.15: Worldwide CA-125 Sales, 2001-2010  Table 4.16: U.S. CA-125 Sales, 2001-2010  Table 4.17: Number of Pap Smears Performed by Country  Table 4.18: Lung Cancer Survival Rates  Table 4.19: Lung Cancer Facts  Table 4.20: Patient Category Applications  Table 4.21: Worldwide AFP Marker Sales, 2001-2010  Table 4.22: U.S. AFP Cancer Marker Sales, 2001-2010  Table 4.23: Potential Uses of Molecular Diagnostics in Cancer Management  Table 4.24: Colorectal Cancer Monoclonal Antibody Imaging Kits  Table 6.1: Product Sales as a Percent of Total Product Sales, 2004-2006  Table 6.2: Tumor Diagnosis Immunoassay  Table 6.3: Tumor Diagnosis Radioimmunoassay  Table 6.4: Summary of Matritech's Product Development Programs  Table 6.5: Statements of Operations Data for Matritech, 2002-2006  Table 6.6: Results of Operations of Matritech, 2005 and 2006  Table 6.7: PBM Product List  Table 7.1: List and Discounted Prices for Abbott Tumor Marker Tests  Table 8.1: CPT Codes for Tumor Markers  Table 10.1: Familial Cancer Syndromes and Tumor Suppressor Genes  Table 10.2: Oncogenes and Anti-oncogenes  Table A3: TNM Classification  Table A7: Financial Comparison for Moderate and Waived CLIA Labs  Table A8: List of Marketers of Occult Blood Diagnostic Test Kits  

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Antidote Being Developed For Potential Bioweapon

An effective antidote for botulinum toxin, one of the world’s most feared biological weapons, is being developed.

A single gram of the poison can kill hundreds of thousands of people, according to defense experts.

Botulism from food poisoning affects many people each year, however, a different form of the toxin, known as botox, is used in cosmetic ways to relax wrinkles in the face.

Researchers at the Brookhaven National Laboratory, New York, and the United States Army Medical Research Institute of Infectious Diseases (USAMRIID), Maryland, have broken through a barrier towards developing an effective antidote against the most potent form of the toxin. The US government is funding the study.

A protein has been developed that blocks the effects of the toxin by tricking it into not attacking cells in the body, researchers say.

“We anticipate at least four to five years before this can be turned into an approved drug,” said biologist and research leader Subramanyam Swaminathan.

Seven different neurotoxins are produced by the Clostridium botulinum bacterium that attach to proteins inside human nerve cells and block the chemicals they use to communicate with each other and with muscles””resulting in paralysis in breathing muscles causing victims to suffocate.

Scientists at the Brookhaven National Laboratory developed the new protein that acts on the most powerful of these seven toxins, for which there is no medical treatment.

The protein prevents paralysis by acting as a decoy to proteins in the nerve cells, meaning the toxin chooses not to attach itself to the nerve cells when it enters the body.

“It is about 10 to 15 times better than the best one available so far,” said Subramanyam Swaminathan.

Vaccines that counter botulinum before an attack already exist, but the current research could develop a drug that would work after exposure.

The US government has proposed increasing funding for research into defense against bioweapons such as botulinum to $9 billion in 2009″”a rise of more than 5% on the previous year.

Aum Shinrikyo, a Japanese terrorist cult, tried three times to acquire the botulinum toxin between 1990 and 1995, but the toxin has never been successfully used as a bioweapon.

Iraq also reportedly produced thousands of liters of the toxin before the Gulf War in 1991.

The US team’s findings appear in the Journal of Biological Chemistry.

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Brookhaven National Laboratory

United States Army Medical Research Institute of Infectious Diseases

Journal of Biological Chemistry

Hawfinch

The Hawfinch (Coccothraustes coccothraustes), is a passerine bird in the finch family Fringillidae. This bird breeds across Europe and temperate Asia. It is mainly resident in Europe, but many Asian birds migrate further south in the winter. It is a rare vagrant to the western islands of Alaska. Favored breeding habitat includes deciduous or mixed woodland with large trees, especially Hornbeam, and also parkland.

The hawfinch is 6.5 to 7 inches long and is bulky and bull-headed. Its head is orange-brown with a black eyestripe and bib, and a massive bill, which is black in summer but paler in winter. The upper parts are dark brown and the underparts orange. The white wing bars and tail tip are striking in flight. The sexes are similar. The call is a hard chick. The song of this unobtrusive bird is quiet and mumbled.

This large finch species does not form large flocks outside the breeding season, and is usually seen as a pair or small group. It builds its nest in a bush or tree, laying 2-7 eggs. The food is mainly seeds and fruit kernels, especially those of cherries, which it cracks with its powerful bill.

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Oklahoma ProCure Treatment Center Receives Cancer-Fighting Cyclotron

The first piece of the 220-ton cyclotron has arrived in Oklahoma City from Belgium to be installed at the Oklahoma ProCure Treatment Center, which will begin treating cancer patients in summer 2009.

Officials involved with the center celebrated the equipment’s arrival on Monday.

William C. Goad, M.D., a radiation oncologist with Radiation Medicine Associates, said the cyclotron’s arrival brings him one step closer to treating patients with proton therapy. Proton therapy is an alternative to radiation therapy without many of the short and long-term side effects that are often experienced by patients. Proton therapy’s ability to precisely target tumors is ideal for treating tumors near vital organs and is particularly beneficial for pediatric cancer patients who are more susceptible to the side effects of radiation treatment.

“Next summer can’t come soon enough,” he said. “Protons offer Oklahomans another weapon against cancer.”

The arrival of the cyclotron is a key milestone in the development of a proton therapy center as it is prepared to treat patients.

The cyclotron, weighing as much as a Boeing 747 jet, was manufactured in Belgium by IBA, a world-leader in cancer technology. The cyclotron traveled four weeks and about 5,700 miles by sea, arriving first in Houston. A trailer made for extraordinarily large cargo traveled at a top speed of 45 mph during a nearly 500-mile journey to the Oklahoma City center, located at the northwest corner of Memorial and MacArthur. Half of the cyclotron arrived on Saturday. The trailer will return to Houston to bring the second half of the cyclotron to Oklahoma City.

“The cyclotron is impressive not only in its size but also for its technologically advanced cancer-fighting power,” said Ed Bertels, executive director of the Oklahoma ProCure Treatment Center. “We are excited to bring this cutting-edge technology here to fight cancer at the nation’s first community-based proton center.”

The cyclotron is responsible for splitting the atom and accelerating protons to nearly the speed of light to create a beam of energy that can deliver a more-effective dose to the patient’s tumor.

The 55,000-square-foot, four-treatment-room center broke ground last April. The center is being developed in partnership with Radiation Medicine Associates, an Oklahoma City-based private practice physician group. About 1,500 patients a year will be treated at the Oklahoma ProCure Treatment Center. Cancer is the second leading cause of death in Oklahoma with nearly 18,000 new cases diagnosed each year, according to the state Health Department. One out of three Oklahomans are affected by cancer during their lifetime.

Ancillary cancer-care services will be provided by the INTEGRIS Cancer Institute of Oklahoma, a comprehensive cancer center connected to the Oklahoma ProCure Treatment Center.

“We are excited for our ProCure partners in achieving this significant step toward bringing proton therapy and the latest in cancer treatment to Oklahoma,” said Phil Lance, vice president of oncology development for INTEGRIS Health. “Groundbreaking for the next phase of construction which will house the INTEGRIS Cancer Institute of Oklahoma is anticipated to take place in the next 60 days.”

About 50,000 patients worldwide have benefited from proton therapy. There are currently three proton therapy centers under construction and only five centers operating in the United States, which provides about 6,000 treatment slots per year. The procedure is non-invasive, painless, and destroys tumors while greatly reducing healthy tissue damage.

ProCure is joining with hospitals and radiation oncology practices to open proton centers across the country. In addition to the Oklahoma ProCure Treatment Center, ProCure has proton therapy centers planned for South Florida, Illinois and Michigan.

For more information on ProCure Treatment Centers visit www.ProCureCenters.com.

Editor’s Note: ProCure press materials are available at www.procurenews.com.

About ProCure Treatment Centers

Headquartered in Bloomington, Ind., ProCure Treatment Centers, Inc. was founded in 2005 by Dr. John Cameron, a particle therapy physics pioneer who was pivotal in the development of the Midwest Proton Radiotherapy Institute. ProCure provides management support and a model for the complete design, construction, operation and maintenance of world-class proton therapy centers. Through partnerships with leading radiation oncologists and hospitals, ProCure’s business model reduces the time, effort and cost involved in creating a facility, which allows physicians more time to focus on patient care. ProCure plans to increase the number of centers across the country to make proton therapy affordable and accessible to patients who would benefit from the treatment.

About Radiation Medicine Associates (RMA)

Radiation Medicine Associates, a leading radiation oncology practice in Oklahoma City, is bringing proton therapy, the most advanced external radiation therapy treatment, to Oklahoma City. They are well known and respected clinical physicians with a long history of clinical excellence. The doctors practice at the leading institutions in the area and have always pioneered the newest and most appropriate cancer treatment technologies in the community. The physicians are longstanding members of the Oklahoma community who have dedicated their professional lives to the improvement of cancer treatment. RMA consists of William C. Goad, MD; John R. Taylor, MD; Robert Gaston, DO; Elaine Nordhues, MD; Gary L. Larson, MD and Kiran Prabhu, MD.

About INTEGRIS Cancer Institute of Oklahoma

The INTEGRIS Cancer Institute of Oklahoma includes one of the foremost collections of medical and radiation oncologists, surgeons, radiologists and pathologists in the Southwest. The cancer institute proton campus will offer world-class cancer treatment and house a full complement of services to diagnose, treat and support cancer patients, their families and care providers.

About INTEGRIS Health

INTEGRIS Health, a not-for-profit organization, is the state’s largest Oklahoma-owned health care corporation and one of the state’s largest private employers, with hospitals, rehabilitation centers, physician clinics, mental health facilities, fitness centers, independent living centers and home health agencies throughout much of the state. Corporate headquarters are located on the campus of INTEGRIS Baptist Medical Center in Oklahoma City.

Demand for Teachers Sparks Hiring War in Dallas-Fort Worth

By Kathy A. Goolsby and Katherine Leal Unmuth, The Dallas Morning News

May 12–Teachers who complain about being underpaid may need to find another beef. How does $50,000 a year for a newly minted teacher sound?

A lack of qualified instructors in some critical subject areas has set off a hiring war in North Texas. School districts are raising teacher salaries, awarding signing bonuses and offering annual stipends to lure hard-to-find teachers.

DeSoto ISD is a case in point.

The district approved a whopping 9-plus percent raise for all teachers next year and a $5,000 signing bonus for elementary bilingual teachers and high school math, science and foreign language instructors.

“We’re just putting ourselves in the position of stealing teachers from other districts,” DeSoto trustee Donald Gant said.

Math and science teachers with a master’s degree receive a $7,500 signing bonus in Cedar Hill, where base salaries for first-year teachers will be $44,500 starting this fall. And in Irving, total income for first-year bilingual teachers will top $50,000 this fall.

“What we’ve seen over the last four or five years has been a fairly big spike in starting teacher salaries across the board in Texas,” said Richard Kouri, public affairs director with the Texas State Teachers Association. “The state average is moving toward $40,000 a year, but in your part of the state it’s up around $45,000. It’s more intense in the metroplex because of the large number of school districts in a relatively small area.”

Many districts delay setting salaries until they know what other districts plan. But Irving officials approved their 2008-09 salary schedule early to lure teachers at this spring’s job fairs.

“We had applicants walk by who saw it [the salary schedule] and turned back,” said personnel director Robyn Wolters. “It’s drawn a lot of attention, and it’s catching people’s eye.”

Irving has the region’s highest percentage of students limited in English, at 39 percent. But the district is not alone in its quest for bilingual teachers, who are being courted by recruiters across the area.

“If districts see you’re bilingual, they’ll just automatically offer a helping hand,” said University of North Texas senior Clarissa Cantu, 22, who is scheduled to graduate this month with a bilingual education degree. “Offering money may change some people’s minds about becoming teachers, and it could promote the need.”

‘A deciding factor’

Heather Rooth, 22, a first-year algebra teacher at North Dallas High School, said Dallas ISD’s offer of a $2,500 stipend for teaching math and another $6,000 for teaching in a struggling school was too good to pass up.

“That was a deciding factor in whether I would take the job,” she said. “I know a lot of people who won’t leave Dallas because of the stipends.”

Ms. Rooth said she snagged an interview and a job offer an hour after she applied to Dallas ISD. Dallas officials are considering raising the math stipend to $4,000 next year.

In short supply are foreign language, special education, science and math teachers. The need for science and math instructors is expected to increase in 2010 when high school students will need a fourth year in those subjects to graduate.

Larry Davis, human resources director for DeSoto schools, said only seven of the more than 200 teacher applicants he spoke to at a recent North Texas job fair were certified to teach math. In El Paso, he found two math instructors out of 100 applicants.

“What you’re going to see two years down the road is a panic for math and science teachers,” said University of North Texas associate professor Pamela Esprivalo-Harrell. “These candidates are going to be in a very good position to be choosy about where they work.”

Karla Zarate, 23, a new first-grade bilingual teacher at Irving’s Townley Elementary, said recruiters often visited her classes at the University of North Texas to give out information and gifts such as pens. At job fairs, her name tag showed she was bilingual.

“People are literally pulling on you and yelling your name,” she said. “They’re kind of like hawks.” She had several options before choosing Irving.

“The stipend of $4,000 was a big plus especially for a recent graduate having to pay off loans,” she said. “It makes a difference with the way the economy is going and gas prices.”

Seeing drawbacks

But a few extra dollars are not going to close the gap between what a science or math graduate can make in the classroom vs. the private sector, Mr. Kouri said. Signing bonuses also create a vicious cycle of teacher job-hopping from one district to another to collect the bonuses, he said.

And some argue that throwing extra money at a few teachers sends the wrong message to others.

“We value all our teachers, and I think that sends a mixed signal to, say, English and fourth-grade teachers who work hard, too,” said Becky Wussow, human resources director in Plano ISD, which does not pay signing bonuses.

Texas school districts employ about 300,000 teachers, but lose 10 percent to 15 percent annually through attrition, Mr. Kouri said. Between 30,000 and 45,000 new teachers are needed to fill the openings, but Texas universities are graduating only about half that number.

That forces recruiters to cast ever-widening nets to find qualified teachers. They’re traveling to neighboring states and even Puerto Rico.

Fort Worth ISD bought billboards in San Diego after California teachers were threatened with 30,000 layoffs. The signs generated more than 100 phone inquiries and 20 applications, said Clint Bond, a Fort Worth ISD spokesman.

Ms. Wussow said there is a certification imbalance among graduates. The market is flooded with early childhood through fourth-grade teachers and sparse on upper-level certification, she said.

“Just about anything in secondary [grades] is critical as far as I’m concerned,” Ms. Wussow said. “It used to be that secondary English and social studies teachers were a dime a dozen, but that’s not the case any more.”

The University of North Texas graduated 1,055 educators last year, but only 52 were bilingual, math or science certified.

Colleges’ incentives

Colleges are trying to inspire high school students to choose teaching careers in critical-need subject areas. Special scholarships are being created. New programs next year at the University of North Texas and the University of Texas at Dallas will focus on attracting more students to math and science teaching careers.

Texas Woman’s University professors urge students to earn dual certification in shortage areas, said education dean Nan Restine.

Those students are the ones graduating with job offers, she said, often earning more than some college professors.

“You get more bang for your buck,” Dr. Restine said. “You need to get as many tools in your toolbox as we can possibly provide. The districts are willing to pay for that.”

But in the long run, Mr. Kouri said districts must find ways to keep the teachers they’ve hired. Otherwise, it’s a never-ending battle.

“Districts have to deal with retention as much as recruitment,” Mr. Kouri said. “Otherwise, it’s like trying to fill a swimming pool with a hole in the bottom by adding more water. You have to fix the hole, or it’s just going to keep losing water.”

—–

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Study Finds More Than One in Two Women Are Too Embarrassed to Discuss Vaginal Discomfort With Their Doctors

WHITE PLAINS, N.Y., May 12 /PRNewswire/ — Despite living in a society that promotes images and icons of female empowerment like “Sex and the City’s” Carrie Bradshaw, popular sex therapist Dr. Sue Johannsen and even former Supreme Court Justice Sandra Day O’Conner, more than one in two women are embarrassed and uncomfortable discussing pertinent issues of vaginal health. That’s the major finding from the Vagisil(R) Voice for Women survey, administered to U.S. women, ages 18 and older, by independent research firm Harris Interactive.

With almost 70 percent of women experiencing separate episodes of vaginal discomfort (i.e. vulvar itching, burning, unusual or excessive discharge) one to five times a year, there is no reason any woman should be living in silence. In recognition of National Women’s Health Week (May 11 – 17), Vagisil(R) is encouraging women to let go of their fears and seek help when dealing with an uncomfortable situation “down there.”

Although more than 85 percent of women agree that occasional vaginal discomfort is a natural part of every adult woman’s life, it does not stop the majority of them from suffering with strong emotions like frustration (80 percent), increased self-consciousness (68 percent) and even anger (29 percent), when experiencing vaginal discomfort. Additionally, more than three quarters of women (77 percent) do not feel sexy or feminine when experiencing vaginal discomfort and 68 percent even feel unclean.

“It’s understandable that women might feel unattractive or unclean when they have vaginal discomfort, but there’s absolutely no reason why they should,” says Leslie Reisner, PhD, a clinical psychologist specializing in emotional wellness. “Being empowered about their health and speaking with a physician, family member or even friends will allow women to understand they’re not alone, and what they’re going through is completely natural.”

Beyond the emotional toll, 50 percent of women say that vaginal discomfort has an impact on their daily lives; so much so that they change their behavior. Eighty-two percent of women avoid being intimate with a significant other and almost one-third (31 percent) change their plans, avoiding social interactions.

What’s a Woman to Do?

Experiencing vaginal discomfort is normal for every woman. It is a lack of knowledge about this topic that leads women to equate bad hygiene (50 percent) or promiscuity (9 percent) with vaginal discomfort. It’s important for women to realize there are many reasons for experiencing itching, burning, discharge and sometimes pain. Whether it is from excessive perspiration or constantly wearing too tight clothing, there are easy ways for women to take charge of their vaginal health.

   -- Pay Attention - Your body is smart. It will give you "warning signs" if      something needs attention. Look for changes that may serve as an      indicator to take a closer look.   -- Test Yourself - Women tend to automatically assume that they are      suffering from a yeast infection, and self-treat incorrectly. Try      keeping your medicine cabinet stocked with a pH test, like the      Vagisil(R) Screening Kit, to help determine the possible cause of any      symptoms such as unusual odor, discharge, itching or burning. An above      normal pH reading might indicate other types of infections that a      doctor would need to diagnose and treat.   -- Be Honest - Don't let embarrassment keep you from discussing any      symptoms of discomfort you're having with your doctor.  Remember, this      is what gynecologists deal with everyday.  Whatever you are      experiencing, your doctor has likely seen it before and can help you      find a simple solution.   -- Don't Suffer - There's no need to tolerate the discomfort.  There are      many over-the-counter products to treat your symptoms and provide      relief.     Break the Cycle  

The Vagisil(R) Voice for Women survey showed that, in relation to women 30 years old and up, younger women were more likely to feel self-conscious (78 percent v. 61 percent), nervous that it could be something more serious (72 percent v. 57 percent) or that they’ve done something wrong (33 percent v. 17 percent) when experiencing vaginal discomfort. The survey also revealed that 62 percent of women never thought about talking to their daughter(s) about vaginal discomfort. Vagisil(R) believes that National Women’s Health Week offers the perfect opportunity to have an open conversation about vaginal health, which might help prevent any misconceptions and negative feelings your daughter might be apt to experience.

“There is an underlying emotional toll to vaginal itch and discomfort that is often not addressed. This survey will be monumental to informing women that life does not have to stop, and they do not have to suffer in silence anymore,” says Jane Wadler, vice president of marketing for Vagisil.

Survey Methodology

An online survey of 500 adult women was conducted from March 18th thru April 11th by Harris Interactive. The survey targeted a sample of women ages 18 and over who have experienced vaginal discomfort which includes yeast infections or other vaginal infections, as well as vaginal itching, odor, irritation, discharge, pain or burning. The survey, conducted on behalf of Combe Inc., explored the emotional and physical impact of vaginal discomfort of women in the above demographic.

About the Vagisil(R) Screening Kit

The Vagisil(R) Screening Kit, which helps women identify the possible source of their vaginal discomfort, is widely available in the feminine hygiene section at food, drug and mass merchandise stores. It is the only rapid results at-home screening kit for vaginal infections.

About Combe Inc.

Combe Inc. is the maker of Vagisil(R) products, including Original Strength Vagisil(R) Creme, Maximum Strength Vagisil(R) Creme, Vagisil(R) Medicated Anti-Itch Wipes, Vagisil(R) Deodorant Powder and Gynecort(R) Anti-Itch Creme. These well-known products can be used to help with the symptoms associated with external vaginal discomfort, like itch, odor, wetness and burning. They are also ideal for external relief while a prescribed medicine works at treating an infection.

Combe Inc.

CONTACT: Deepa Khetan, x179, [email protected]; Sharelyn Devonish,x128, [email protected], both of Lippe Taylor, +1-212-598-4400

Study Medicine at MSU’s Bangalore Campus

THE setting up of the International Medical School (IMS) in Bangalore, India, illustrates Management and Science University’s (MSU) commitment in offering critical and relevant programmes of study, particularly in health and medical sciences.

It is MSU’s first international offshore branch campus and the seventh school under its flagship of faculties, schools and centres of learning.

The medical school is a unique regional collaborative effort between MSU and M.S. Ramaiah Medical College.

The school, which focuses solely on the Bachelor of Surgery and Bachelor of Medicine (MBBS), is helping the government to provide more places for those interested in medicine.

Its 26ha campus is adjacent to a teaching hospital, the M.S. Ramaiah Memorial Hospital, equipped with excellent facilities and medical staff.

“Bangalore provides an excellent setting for MSU to establish its medical school. The wealth of experience and development in medical field that India has to offer is unique and meets the expectations of many medical authorities,” says IMS dean Datuk Dr Abdul Ghani Mohammed Din.

Other than studying under the supervision of medical experts, he says students will also be exposed to a multi-specialty world-class hospital.

“A combination of modern facilities, hands-on experiences and dedicated teaching staff have contributed to enhance the quality medical programme offered by IMS.”

Lessons and practical classes on anatomy, for example, are more insightful and effective as students can practise on cadavers.

MSU believes IMS will help realise the government’s plans of meeting the doctor-patient ratio of 1:600 by 2020.

In 2006, the doctor-patient ratio in Malaysia was 1:1,214, with the total number of doctors standing at 21,937.

The duration of the MBBS programme is 51/2 years, including a year’s rotatory programme in Bangalore.

Upon completion, students have to register with the Public Services Commission and complete a two-year housemanship at selected government hospitals under the supervision of the Health Ministry.

The academic terms begins in September and qualified students are required to sit for the Medical Entrance Test. Intake for the new students are limited to 150.

Students pursuing the MBBS programme at IMS are housed in a three- storey fully furnished apartment complex, which is 10 minutes away from campus. Buses are provided by IMS for students to attend classes.

For details, call 03-5510 6868, fax 03-55108668, email [email protected] or visit www.msu.edu.my

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

How Microsoft Plans to Challenge Google

It’s April, and Microsoft’s (MSFT) top U. S. salesman for online advertising, Keith Lorizio, is visiting clients in New York City. In a midtown office tower, he sits down with Nicholas Utton, the gregarious chief marketing officer at online broker E*Trade (ETFC). Utton is plenty impressed with Microsoft’s technology, and he’s a big advertiser on the company’s MSN Money site. But when it comes to Internet search sites, the largest and most lucrative advertising market online, Utton makes it clear that Microsoft is, as he sees it, way behind front-runner Google (GOOG). “They’re not getting much of our search dollars,” he says.

Lorizio’s pitch just got even tougher. On May 3, Microsoft CEO Steven A. Ballmer withdrew his offer for Web giant Yahoo! (YHOO), the No. 2 power in online ads, after the two sides failed to agree on a price. Ballmer had said that the proposed acquisition, which valued Yahoo at $47.5 billion, was the best way for Microsoft to gain the scale necessary to compete against Google for online advertising dollars. Now, after three months of talks, it looks as though Microsoft and Yahoo will be left trying to catch Google on their own, at least for now. And their prospects are grim. “We think Google’s the winner,” says Clayton F. Moran, analyst with the financial-services firm Stanford Group. “Its two main competitors are separate and floundering.”

For Ballmer, however, the game is far from over. Even before yanking the Yahoo offer, he had begun laying the groundwork for a strategy to compete with Google in online advertising. He’s convinced that getting the online ad business right is essential to Microsoft’s future. The reason: Consumers and businesses increasingly are switching from desktop software like Microsoft’s to free online services that do the same things. “We are absolutely committed to be the leading player in that endeavor,” Ballmer told employees at a recent gathering.

It may be impossible to catch Google in search advertising. The company dominates the market, taking in 77% of the revenues from those little text ads that show up alongside the results for Internet search queries. Microsoft, after years of trying, is at 5% of U.S. search revenue, according to search marketing firm Efficient Frontier.

But Microsoft has a fighting chance on several other fronts. Perhaps most important is display advertising, the colorful banner and video ads that run at the top or along the side of Web pages. Microsoft is among the leaders in the fragmented field, while Google is a bit player. Although the display market is smaller than search, it’s expected to grow faster over the next few years because of a surge in video ads. Market research firm IDC (IDC) figures that by 2012 the display market will double, to $15.1 billion; revenue from search will reach $17.6 billion.

Microsoft makes money in the display business in two ways. It sells ads on its own popular Web sites, such as MSN and Hotmail, and it acts as a broker by placing ads on other companies’ Web sites and then splitting the revenue with them. Smaller Web sites use Microsoft because they don’t have a salesforce to call on advertisers and ad agencies. And even large players like media giant Viacom have found that letting Microsoft sell some of the space on sites like Comedy Central and MTV can lead to higher revenues. “They can achieve better monetization than we can on our own,” says Viacom CEO Phillipe Dauman.

It’s Lorizio and his 180-person salesforce who are leading Microsoft’s fight for this up-for-grabs market””and for the future of Microsoft itself. Their pitch is that, in display advertising, Microsoft has the most sophisticated technology of any company. It can help advertisers precisely target display ads and assess the value of ads even when Web surfers don’t click on them.

Microsoft is also making the case that search advertising, Google’s gold mine, is overrated. In the months ahead, it plans to introduce new ad technology that it says will demonstrate that to advertisers. “We’re going to win with this strategy,” Lorizio says.

“BEHIND THE EIGHT BALL”

Google isn’t giving any ground. It’s pushing hard into the display business, even as it builds on its lead in search. In March the company closed on its $3.2 billion acquisition of DoubleClick, a leading player in placing banner and video ads on other companies’ Web sites. Google plans to combine DoubleClick’s display technology with its own technologies””and its broad base of advertisers””to establish a stronger position in the market. “Google now has the leading display ad platform,” said Google CEO Eric Schmidt at the time, adding that together the companies will be able to “dramatically improve the effectiveness, measurability, and performance of digital media.” Google also bought YouTube, the top video site on the Web, although it hasn’t generated much revenue from it so far.

There’s plenty of skepticism that Microsoft can make real headway even in display advertising. The company has floundered in the online ad business so far. Besides getting trounced by Google in search, Microsoft has flummoxed consumers with a muddle of online products, including its dueling MSN and Live brands. The Yahoo deal would have more than doubled the size of Microsoft’s Web audience, to north of 250 million visitors a month, and tripled its online ad revenues, to $10 billion. Without Yahoo, the company is expected to generate $3.3 billion in online advertising this year, compared with Google’s $22 billion. Microsoft has lost $1.5 billion in its online division over the past three years. “They’re behind the eight ball,” says Charles Di Bona, an analyst at Sanford C. Bernstein & Co.

“WE’RE VERY PERSISTENT”

Still, Microsoft is a fearsome competitor, with nearly unlimited financial and engineering resources. It has proven its determination to take down upstarts again and again over the years, from the Web browser market to the market for mobile-phone software. “We’re very persistent,” said Ballmer at a wireless conference last year, “If we don’t get it right, we’ll keep coming and coming and coming.”

Plenty of advertisers would like to see Microsoft succeed, if only to blunt Google. Although they appreciate the effectiveness of Google’s search ads, they’re nervous about one company dominating the online advertising market. “Competition from an advertiser’s perspective is a really good thing,” says Rob Master, director of media for North America at consumer products giant Unilever Group.

For Ballmer, this isn’t just about taking Google down. Indeed, it’s hard to overstate how important it is for the company to master online advertising. While Microsoft is phenomenally profitable today, adding $1 billion each month to the cash hoard from its lucrative software business, it faces a serious long-term threat. The company’s fortunes have been built on software that runs on PCs, especially its Windows operating system and its Office word-processing, spreadsheet, and e-mail programs. But that kind of software is beginning to shift online. People with pretty much any kind of computer can go to the Web and use applications for things like word processing and communication. The programs are typically available for free, funded by online advertising. Google is offering a number of these programs, and there are a flock of others doing the same, such as upstart Zoho.

So far, the shift to online software is more of a drip than a flood. The programs often don’t work as smoothly as, say, Microsoft Office, and they can require some tech savvy to use. But the shift seems sure to accelerate in the years ahead, and no company has more to lose than Microsoft. If the tech giant doesn’t develop a strong ad business to pay for programs it will eventually have to offer online, it will face big trouble. ”

Microsoft’s biggest fear is that once you start putting Google [software programs on the Internet], then the price Microsoft can charge for its software will erode markedly,” says David B. Yoffie, a professor at Harvard Business School. “Just the threat means that Microsoft has to be able to offer advertising as a choice.”

That’s why there are few jobs more important at Microsoft than Lorizio’s. Kevin Johnson, president of the division that includes Microsoft’s online operations, says the salesman and his team are “front and center” in the battle for the online ad market. Unlike the stereotypical Microsoftie””a frumpy, maladjusted code freak””Lorizio is every bit the polished professional. He’s tall and lean, a gym rat when he’s on the road. A salesman at Yahoo before he joined Microsoft in 2005, he favors starched shirts and designer shoes.

He grew up in an Italian Catholic family just outside of Boston. His dad ran a trucking business, and his mother taught him to cook classic dishes like braciole. The 43-year-old still lives in Boston, though his primary office is in New York. And when he talks, the New Englander in him shows through, turning words like park into “pahk” and idea into “idear.”

MICROSOFT’S FLEDGLING FAN CLUB

When Lorizio deals with advertisers, though, it’s clear that his pitch for Microsoft’s display technology is resonating with some. In E*Trade’s offices, marketing chief Utton has spreadsheets splayed across a conference table when Lorizio comes to visit. Utton loves how Microsoft’s analytical tools give him the ability to track the precise effectiveness of his display advertising. He knows, for example, how many people came to E*Trade after clicking on an ad on MSN Money, how many of those people set up brokerage accounts, and even how many became active traders. “It’s a math project,” he says, as Lorizio grins across the conference table.

Next up on Lorizio’s New York tour is MindShare Interaction, a media buying unit of ad giant WPP Group. Microsoft has worked with the company to create a Web site called In The Motherhood, with video programming targeted at new moms. Lorizio stops in to chat with Margaret M. Clerkin, head of MindShare’s North America operations, about the show and its advertisers. Microsoft not only manages the ads that run with the show, it also provides the technology for streaming the video and tosses in editorial content from its MSN pages. “They do a different level of customer service than anyone else,” says Clerkin.

Over at Viacom, Microsoft has a substantial presence. The two companies cut a wide-ranging $500 million deal in December, which includes Microsoft selling ads on Viacom’s Web sites. What impressed CEO Dauman is Microsoft’s ability to generate decent ad sales on what’s known as “remnant inventory,” those rarely visited Web pages deep inside sites. Microsoft uses its Web-tracking tools to find out what individual Web surfers are interested in and then delivers relevant ads to them when they’re on Viacom’s less-clicked-on pages. The ad space is cheap, but the value for advertisers is substantial. “We don’t have the kind of targeting capabilities that Microsoft has,” says Dauman. This sort of “behavioral targeting” is becoming more widely used by a number of companies, including Yahoo.

The most provocative pitch from Lorizio and his sales team will come late this summer. It goes like this: Search advertising is vastly overrated. Today, when a Web surfer is looking for a car, he might type “Chevrolet” into Google and then click on an ad alongside the search results. Google gets all the money for that click, even though other marketing efforts, both online and off, probably helped persuade that person to conduct the search. Ideally, an advertiser would know about all the ads that a potential customer sees before he makes a purchase. “They’re trying to say that Google’s getting too much credit, and there’s probably a lot of truth to that,” says Curt Hecht, chief digital officer for the media buying giant Starcom MediaVest Group.

PUTTING AD CAMPAIGNS TO THE TEST

Microsoft has been developing a technology that will give advertisers a more complete picture. It’s called Engagement Mapping, and 16 advertisers and agencies have been testing it out since February. The technology anonymously tracks cookies, those digital footprints left on PCs by Web sites, to see if a consumer saw display or video ads within a month of making that ultimate click. Then it places values on each related online ad, weighting things like videos more heavily, since they’re likely to have more impact. That way publishers and marketers have a better understanding of the effectiveness of ad campaigns and can adjust pricing accordingly. “It’s not anti-search,” says Brian McAndrews, the Microsoft senior vice-president overseeing the effort. “It’s just a better way to measure.”

Ben Winkler is a believer. He’s director of interactive media at the Ingenuity Media Group, part of ad firm The Martin Agency. He’s been testing the Microsoft technology for one of his clients, wireless provider Alltel. The technology, he says, shows that display ads have an impact that had never been clear before. As a result, he plans to advise clients to spend a greater share of their ad dollars on display vs. search ads. “We’re taking credit away from search to a high degree,” he says.

Google declined to comment on Microsoft’s initiative for this article. In the past, the company has said that it doesn’t think that advertisers should focus exclusively on the number of clicks on search ads. In fact, it’s developing its own tools to give a broader view of all kinds of advertising.

Will all of this be enough to help Microsoft become a top competitor in online advertising? It’s not at all clear. Even as Google moves into display advertising, Yahoo presents a serious threat. For all its struggles of late, an independent Yahoo is a potent rival. The Internet portal helped pioneer the display ad business, and analysts say it has a somewhat larger share of the market than Microsoft, thanks to its more than 500 million monthly users. Yahoo also has leading positions in online media segments such as news, sports, and finance. “I still maintain that our great consumer experiences, combined with our leadership on the advertising side, make us truly unique,” says Yahoo CEO Jerry Yang in an interview.

Ballmer could ultimately turn back to his investment bankers. He may decide that Microsoft needs an acquisition to have a legitimate shot at Google in online advertising. There has been speculation that Microsoft could buy America Online or a social-networking site like Facebook to gain some of the scale it would have gotten with Yahoo. People are convinced that Microsoft and Yahoo will end up together, despite protestations that their talks are over. “I have to believe that they will get back to the table,” says Anant Sundaram, professor of finance at Dartmouth College’s Tuck School of Business.

But for now, Lorizio and his sales force have to battle with what they have. The New Englander sees himself as the underdog, much like his beloved Boston Red Sox, who were runners-up to the New York Yankees for decades. Ultimately, the Sox defeated the Yanks in 2004 on the way to their first World Series win since 1918. Lorizio thinks Microsoft has the technological firepower and financial wherewithal to persevere just the same way. “I’m here to win,” he says.

On the Net:

www.microsoft.com

www.google.com

Exhaling for Exploration: Scientists Test Lunar Breathing System

Imagine yourself hip-to-hip, shoulder-to-shoulder, inside a room the size of a walk-in closet for eight hours with five people you just met. Does that make you sweat? Or maybe make your breathing a little more animated?

For three weeks, 23 volunteers dedicated time to do just that — sweat and breathe — inside a test chamber so NASA scientists at Johnson Space Center in Houston could measure the amount of moisture and carbon dioxide absorbed by a new system being developed for future space vehicles. The system is designed to control carbon dioxide and humidity inside a crew capsule to make air breathable and living space more comfortable.

The tests, which took place from April 14 to May 1, are some of the first to use human subjects in support of NASA’s Orion crew capsule, Altair lunar lander and lunar rovers.

“We’re moving from paper studies to tests with hardware that will evolve and become part of the spacecraft that will fly back to the moon,” said test volunteer and NASA engineer Evan Thomas at Johnson.

Known as the Carbon-dioxide and Moisture Removal Amine Swing-bed, or CAMRAS, the Exploration Life Support project within NASA’s Exploration Technology Development Program is developing the new system. The program is investigating technologies that will help sustain life on exploration vehicles and reduce the dependence on resupply from Earth.

“Our goal for CAMRAS is to develop a simple, regenerative, lightweight device that will work for both the Orion crew capsule and the Altair lunar lander,” said lead researcher Jeff Sweterlitsch.

Testing on the device began more than a year ago with machines used to create humidity and carbon dioxide in the test chamber. The tests proved the system worked well, but the machines could not generate the wide variety of metabolic loads — amounts of energy the body’s chemical reactions produce to maintain life — that humans create.

This series of tests put volunteers inside a test chamber scaled to be the size of the Orion crew capsule, about 570 cubic feet. The volunteers, who were selected and grouped to replicate a typical crew, were asked to sleep, eat and exercise during test sessions that lasted from a few hours to overnight.

“The air smelled a little artificial, like on a plane, and it was a little crowded,” said Aaron Hetherington, one of the volunteers and a director for the test. “But the air was fine; the temperature comfortable. My biggest observation is that it was unremarkable, which is good because that means the hardware was working.”

Two additional phases of testing on CAMRAS are planned.

The CAMRAS absorption beds are regenerated by the vacuum of space, and processing the carbon dioxide and moisture requires little energy. CAMRAS uses an organic compound known as amine that absorbs the carbon dioxide and water vapor from the cabin’s atmosphere. The system then vents the two waste products overboard, and the vacuum of space regenerates the amine to work again.

The Exploration Life Support project also is developing technologies that will recover oxygen and water vapor, recycle spacecraft wastewater into drinking water and recover usable resources from wastes.

On the Net:

Constellation Program

Ultrasound-Guided Brachial Plexus Block in a Patient With Multiple Glomangiomatosis

By Duggan, Edel Brull, Richard; Lai, Jacob; Abbas, Sherif

Background and Objectives: Glomangiomas are rare, vascular tumors consisting of an afferent artery, arteriovenous canal, neuro- reticular elements, collagen, and efferent veins, and are most often located in the soft tissue of the upper extremities. We describe how the use of ultrasound-guided nerve blockade altered the anesthetic management of a patient with multiple glomangiomatosis undergoing elective forearm surgery. Ultrasound Findings: A 32-year-old man was scheduled for excision of painful glomangiomas from the ulnar aspect of his right wrist, with exploration of his ulnar nerve. The anesthetic concerns included (1) morbid obesity, (2) chronic pain syndrome and opioid intolerance, (3) a potentially difficult airway, and (4) obstructive sleep apnea. Ultrasound-guided supraclavicular blockade was the proposed anesthetic of choice. Ultrasound scan of the supraclavicular fossa revealed numerous vascular lesions surrounding the divisions of the brachial plexus. Color Doppler imaging confirmed these pulsatile lesions to be vascular in origin. Even under two-dimensional ultrasound guidance, we believed that the risk of vascular puncture and unintentional intravascular injection of local anesthetic was high, and therefore we abandoned the supraclavicular approach. A successful ultrasound-guided axillary brachial plexus blockade was performed uneventfully.

Conclusions: Although multiple glomangiomatosis is a rare disease, this case illustrates the invaluable contribution that ultrasound has made to modern, regional anesthetic practice, especially for patients with aberrant anatomy in whom traditional nerve-localization techniques could result in serious complications. Reg Anesth Pain Med 2008;33:70-73.

Key Words: Brachial plexus, Glomangioma, Regional anesthesia, Ultrasound.

Ultrasound (US) for nerve localization has gained popularity worldwide, because US guidance affords real-time visualization of the needle, target nerve, and surrounding structures. Ultrasound guidance can improve blockade success and reduce the potential likelihood of vascular puncture, and may avoid traumatic nerve injury.1-4 Traditional “blind” nerve-localization techniques, based on surface anatomical landmarks and surrogate endpoints such as peripheral nerve stimulation or the mechanical elicitation of paresthesias, can be hazardous in patients with aberrant anatomy or unsuspected pathology. We report on a patient with multiple glomangiomatosis in whom peripheral nerve blockade would have been precarious in the pre-US era. This report underscores the pitfalls of performing “blind” regional anesthetic techniques in patients with altered anatomy or vascular anomalies that can be visualized with US technology.

Ultrasound Findings

A 32-year-old man was scheduled for the excision of a painful glomangioma from the ulnar aspect of his right wrist, with exploration of his ulnar nerve. He had been diagnosed with multiple glomangiomatosis as a child, and had similar resections of these painful lesions in the past. Although his previous operations under general anesthesia had been uneventful, he now presented with numerous anesthetic concerns. The patient’s daily opioid requirement exceeded 700 mg of morphine sulfate for the treatment of chronic pain associated with his vascular neoplastic disease. He was obese (body mass index = 41 kg/m^sup 2^), having gained considerable weight in the previous year. Based on clinical symptoms, he was recently diagnosed with obstructive sleep apnea. A preoperative physical examination of the patient revealed multiple, tender lesions on his right forearm. Of note, he had no symptoms in his shoulder area and no palpable lesions proximal to his right elbow. In addition, no bruits were present on auscultation of his neck. He was found to have sensory loss in the distribution of his right ulnar nerve, with associated muscle weakness. An airway assessment revealed a short neck with limited mouth opening, and a modified Mallampati score of III. A magnetic resonance image of the right wrist revealed vascular lesions infiltrating the flexor carpi ulnaris and extensor digiti minimi muscles. Magnetic resonance imaging of his shoulder was not performed.

Fig 1. Transverse sonogram of right supraclavicular region. Arrowheads indicate first rib. A, subclavian artery; N, divisions of the brachial plexus; X, abnormal hypoechoic structures. B: Color Doppler imaging to demonstrate position of the subclavian artery. C: Color Doppler imaging confirms that hypoechoic pulsatile structures lateral to the subclavian artery are vascular lesions with turbulent flow.

Ultrasound-guided supraclavicular blockade was proposed as the most appropriate anesthetic option for this patient. An L12 5-MHz linear transducer US probe (ATL HDI 5000 unit, Philips Medical Systems, Bothell, WA) was placed in the supraclavicular fossa, and revealed numerous vascular lesions surrounding the divisions of the brachial plexus and subclavian artery (Fig 1A, B). Color Doppler imaging confirmed that these pulsatile lesions were vascular in origin (Fig 1C). Because of the high likelihood of vascular puncture and possible unintentional intravascular injertion of local anesthetic, we abandoned the supraclavicular approach to the brachial plexus. Ultrasound scan distally into the ipsilateral axillary region revealed remarkably normal vasculature and discrete nerve targets. No aberrant vascular structures were visualized (Fig 2). Using a combined US and peripheral nerve-stimulator technique to ensure correct needle placement, the radial, medial, ulnar, and musculocutaneous nerves were stimulated, using a minimum current of 0.4 mA. After negative aspiration, 10 mL of local anesthetic (a 50:50 mixture of 2% lidocaine and 0.5% bupivacaine with 1:200,000 epinephrine) was deposited around each of the four nerves. The spread of local anesthetic was visualized surrounding each of the nerves, using US. Surgical anesthesia was successful; the patient underwent an uneventful surgery, and was discharged home later that day.

Discussion

Multiple glomangiomatosis presents a unique challenge to the regional anesthesiologist. Glomangiomata are vascular lesions that consist of an afferent artery, arteriovenous canal, neuro-reticular elements, collagen, and efferent veins.5 They are usually found in the extremities, head, and neck, but can also be located in the trachea, lung, bowel, and stomach.6 Given that 1% to 2% of all soft- tissue tumors are glomus in origin, the incidence of multiple glomangiomatosis is estimated at 2 in 1,000,000.7 Clinically, these lesions closely resemble hemangiomas, arteriovenous malformations, and lymphangiomas. Forty-two percent of all patients with glomangiomatosis complain of pain.8 Treatment is aimed at symptomatic relief, and consists of analgesics, surgical excision of the glomangiomata, and recently, laser and sclerotherapy.9

The anesthetic implications of multiple glomangiomatosis include an increased risk of complications when performing regional techniques, difficulty in managing postoperative pain, substance dependence, and potential airway complications because of tracheal lesions.10 Important risks of peripheral nerve blockade in a patient with multiple glomangiomatosis include (1) a failed blockade secondary to abnormal anatomy, (2) unintentional vascular puncture and potential local anesthetic toxicity, and (3) hematoma formation, with an increased risk of neural ischemia. Indeed, previous studies showed that the increased pressure generated by a localized hematoma or pseudoaneurysms can compromise the neural microcirculation, leading to neurologic deficits.11 These potential drawbacks notwithstanding, regional anesthesia was selected for this patient, given his multiple comorbidities. General anesthesia would have been challenging because of the patient’s morbid obesity and potentially difficult airway. The patient’s diagnosis of sleep apnea, combined with his chronic, high-dose opioid use, would likely have confounded postoperative pain management. Moreover, general anesthesia combined with chronic opioid use and a diagnosis of sleep apnea is contraindicated for day-case surgery.12 At our institution, we perform more US-guided supraclavicular blockades than any other brachial plexus blockade. We find this blockade easy to perform, with a reliable and quick onset of anesthesia of the entire forearm, wrist, and hand. An interscalene blockade would have spared the site of surgery (i.e., the ulnar aspect of his right wrist, with exploration of the ulnar nerve). The supraclavicular approach is especially useful for obese patients, because the divisions of the brachial plexus are relatively superficial beneath the skin, compared with other approaches to the brachial plexus. To that end, we felt that an infraclavicular blockade, even with ultrasound, would have been difficult to perform. In our experience, the supraclavicular blockade achieves faster surgical anesthesia of the entire distal upper extremity with a single needle puncture and small amounts of local anesthetic.13

Fig 2. Transverse sonogram of the right axillary region. Arrows indicate spread of LA around the nerves. M, median nerve; U, ulnar nerve; R, radial nerve; A, axillary artery; LA, local anesthetic.

This case demonstrates the value of US for regional anesthesia in patients with abnormal anatomy, for whom “blind” nerve-localization techniques could be hazardous, and perhaps even life-threatening. Ultrasound allows the operator to trace the target nerve along its expected trajectory, thereby enabling selection of the safest needle approach to the nerve. This report also highlights the use of Doppler imaging for determining the safest approach to blocking the brachial plexus. Color Doppler imaging captures the change in frequency of reflected sound waves, to detert blood flow through a vessel. We think that color Doppler imaging is an important addition to the regional anesthesiologist’s armamentarium, and that any patient with a suspected vascular abnormality should undergo sonographic anatomical assessment with color Doppler imaging prior to peripheral nerve blockade. Although multiple glomangiomatosis is a rare condition that most anesthesiologists will never encounter, similar considerations may apply to patients with arteriovenous malformations or space-occupying tumors that distort normal anatomy. Numerous recent case reports highlighted the successful use of US in patients with coagulation abnormalities, underlying neurologic disease, and altered anatomy.14,15 Together with the present report, these cases illustrate the valuable contribution that US has made to the management of patients with risk factors in whom traditional nerve-localization techniques could result in serious complications.

References

1. Marhofer P, Sitzwohl C, Greher M, Kapral S. Ultrasound guidance for infraclavicular brachial plexus anesthesia in children. Anesthesia 2004;59: 642-646.

2. Chan VW, Brull R, McCartney CJ, Xu D, Abbas S. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth 2007;54:176-182.

3. Soeding PE, Sha S, Royse CE, Marks P, Hoy G, Royse AG. A randomized trial of ultrasound-guided brachial plexus anesthesia in upper limb surgery. Anaesth Intensive Care 2005;33:719-725.

4. Maalouf D, Gordon M, Paroli L, Tong-Ngork S. Ultrasound- guidance vs. nerve stimulation for the infraclavicular blockade of the brachial plexus: a comparison of the vascular puncture rate. Reg Anesth Pain Med 2006;30:A46.

5. Myers RS, Lo AMK, Pawel BR. The glomangioma in the differential diagnosis of vascular malformations. Ann Plast Surg 2006;57:443-446.

6. Fabiani P, Benizri E, Michiels JF, Gugenheim J, Saint-Paul MC, Mouiel J. A new case of gastric glomangioma. Gastroenterol Clin Biol 1993;17:974-975.

7. Schiefer TK, Parker WL, Anakwenze OA, Amadio PC, Inwards CY, Spinner RJ. Extradigital glomus tumors: a 20-year experience. Mayo Clin Proc 2006; 81:1337-1344.

8. Carvalho VO, Taniguchi K, Giraldi S, Bertogna J, Marinoni LP, Filius JN, Reis Filho JS. Congenital plaquelike glomus tumor in a child. Pediatr Dermatol 2001;18:223-226.

9. Barnes L, Estes SA. Laser treatment of hereditary multiple glomus tumors. J Dermatol Surg Oncol 1986; 12:912-915.

10. Gowan RT, Shamji FM, Perkins DG, Maziak DE. Glomus tumor of the trachea. Ann Thorac Surg 2001;72:598-600.

11. Tsao BE, Wilbourn AJ. Infraclavicular brachial plexus injury following axillary regional block. Muscle Nerve 2004;30:44-48.

12. Turner K, Van Denkerkhof E, Lam M, Mackillop W. Perioperative care of patients with obstructive sleep apnea-a survey of Canadian anesthesiologists. Can J Anaesth 2006;53:299-304.

13. Soares LG, Bruii R, Lai J, Chan VW. Eight Ball, Corner Pocket: The optimal needle position for ultrasound-guided supraclavicular block. Reg Anesth Pain Med 2007;32:94-95.

14. Sites BD, Spence BC, Gallagher JD, Beach ML. On the edge of the ultrasound screen: regional anesthesiologists diagnosing nonneural pathology. Reg Anesth Pain Med 2006;31:555-562.

15. Bigeleisen PE. Ultrasound-guided infraclavicular block in an anticoagulated and anesthetized patient. Anesth Analg 2007;104:1285- 1287.

Edel Duggan, M.B., F.C.A.R.C.S.I., Richard Brull, M.D., F.R.C.P.C, Jacob Lai, M.D., F.R.C.P.C, and Sherif Abbas, M.D.

From the Department of Anesthesia and Pain Management, Toronto Western Hospital University Health Network, Toronto, Ontario, Canada.

Accepted for publication October 23, 2007.

Reprint requests: Richard Brull, M.D., F.R.C.P.C, Department of Anesthesia and Pain Management, Toronto Western Hospital University Health Network, 399 Bathurst St., Toronto, Ontario M5T 2S8, Canada. E-mail: [email protected]

(c) 2008 by the American Society of Regional Anesthesia and Pain Medicine.

1098-7339/08/3301-0001$34.00/0

doi:10.1016/j.rapm.2007.10.003

Copyright Churchill Livingstone Inc., Medical Publishers Jan/Feb 2008

(c) 2008 Regional Anesthesia and Pain Medicine. Provided by ProQuest Information and Learning. All rights Reserved.

Care of the Patient With Crohn’s Disease: A Case History

By Morrison, Dee

Karen C., a 35 year-old wife and mother of twin boys, was diagnosed with Crohn’s disease (CD) after an endoscopy, colonscopy, and tissue biopsy revealed discontinuous aphthous ulcerations, inflammation, and narrowing in the terminal ileum and left colon. After years of conservative therapy with medications and diet, and several episodes of relapses and remissions, she underwent a resection of the terminal ileum and hemicolecotmy, removing the cecum and appendix. Prior to surgery, Karen had been severely debilitated and malnourished, having lost 20 pounds over a 6- month period. She needed extensive nutritional support, and also admitted feeling anxious, fatigued, and depressed. Research has shown that anxiety and depression are sequelae of CD (Kurina, Goldacre, Yeates, & Gill, 2001). CD is a chronic inflammatory condition of unknown etiology, which may involve the whole digestive tract from the oral cavity to the anus. It most commonly involves either the lower part of the ileum, ileocecal region, or the colon (Metcalf, 2002). Because it has an immune-mediated pathology, treatment is geared toward attenuating the immune response. The incidence of CD is around 5 to 10 per 100,000 per year, affecting young people, with a peak incidence between the ages of 10 and 40 years (Carter, Lobo, Travis, & the IBD Section of the British Society of Gastroenterology, 2004).

The disease is familial and affects certain groups, such as Ashkenazi Jews, suggesting that genetic factors are significant. These ethnic groups are susceptible to environmental triggers, such as infection, drugs, or other agents. Crohn’s disease is 2 to 4 times more common in smokers, and the effect of stress in causing relapses remains controversial (Metcalf, 2002).

Surgery for CD is a last resort because it does not cure the disease. However, about 50% of patients will require surgery within 10 years, and 80% will require surgery by 20 years usually to stop bleeding, close fistulas, bypass obstructions, or remove the affected areas of the intestine (Kurina et al., Tandon, Penner, & Fedorak, 2008).

Post-Operative Care

Pain Control

The immediate post-op goal for Karen is to keep her comfortable. Effective pain control helps maintain hemodynamic stability and prevent pulmonary complications. The typical patient will receive opioids via a patient-controlled analgesia pump during the first two post-operative days and be switched to oral forms by the third post- operative day.

Positioning, distraction, and relaxation techniques also can be used to control pain. Early ambulation is encouraged to facilitate return of bowel function and prevent the formation of venous thromboemboli.

Wound Care/NG Tube

Karen’s surgery did not necessitate an ostomy, but it is still important to provide general post-operative wound care. Explain to her to support the operative site during deep breathing and coughing after pain medication is given. Teach her to report wound redness, swelling, bleeding, drainage, and fever to her physician. Expect the nasogastric tube to remain in place, attached to low intermittent suction, until bowel activity resumes. Irrigate the tube with normal saline solution as needed to keep the tube patent.

Diet Therapy

Post-operative weight loss follows almost all bowel resections. Restoring and maintaining good nutrition is a key principle in the management of Crohn’s disease. Karen will need an individualized, carefully planned, and nutritionally wellbalanced diet in consultation with the dietician. She should be instructed to keep a food journal and to eliminate foods that may trigger her disease. A food journal can pinpoint which foods are troublesome for her and also can reveal whether or not her diet is providing an adequate supply of nutrients. Small, frequent meals should be encouraged, and acidic, fried, and pickled foods should be avoided. She also needs to increase fluid intake to prevent dehydration.

Discharge Medications

Karen was continued on immunosuppressants, immunomodulators (6- mercatpo-purine and azathioprine), and antibody therapy (infliximab) for prevention of recurrence after surgery. These drugs are used when a person has had very severe or complicated disease prior to surgery. Infliximab had been shown to be effective for the treatment of acute flares of CD as well as maintenance therapy after surgery. Karen continued to have diarrhea as a result of bile salt overflow and was treated with cholestyramine. She also needed vitamin B12 every three months for life to avoid megablastic anemia.

Psychological Factors

Karen’s anxiety and depression should be addressed by employing good listening skills, which will validate her feelings. Providing her with the Crohns’s and Colitis Foundation of America’s Web site address (http://www.ccfa.org/) as a forum to share her thoughts about the disease is also beneficial. Other proven therapies that may lesson anxiety include acupuncture, aromatherapy, and meditation.

General Lifestyle

The following recommendations also may be suggested to Karen to assist her with maintaining general good health.

* Get sufficient rest and sleep. A daily nap is helpful.

* Chew food very well and avoid overeating.

* Ingest foods only when there is emotional calm and real hunger is present.

* Participate in moderate exercise, avoiding exhaustion.

* Obtain adequate sunshine and fresh air.

* Maintain cordial relationships with friends and family.

* Pursue work that is rewarding.

* Avoid toxins, such as coffee, tea, soft drinks, and alcohol.

References

Carter, M.J., Lobo, A.J., Travis, S.P.L., & the IBD Section of the British Society of Gastroenterology. (2004). Guidelines for the management of inflammatory bowel disease in adults. Gut, 53(Suppl. V), V1-V16.

Kurina, L.M., Goldacre, M.J., Yeates, D., Gill, L.E. (2001). Depression and anxiety in people with inflammatory bowel disease. Journal of Epidemiology and Community Health, 55(10), 716-720.

Metcalf, C. (2002). Crohn’s disease: An overview. Nursing Standard, 16(31), 45-52.

Tandon, P., Penner, R., & Fedorak, R. (2008). Medical prophylaxis of postoperative Crohn’s disease. UpToDate? for Patients. Retrieved March 31, 2008, from http://www.uptodate.com/ patients/content/ topic.do?topicKey=inf lambd/9847

Dee Morrison, MSN, APRN-BC, CNS, is a Clinical Nurse Specialist, Albert Einstein Medical Center, Bryn Mawr, PA.

Note: A related article on this topic, “Postoperative Pain Management: The Challenges of the Crohn’s Disease Patient,” can be found in the April 2008 issue of MEDSURG Nursing: The Journal of Adult Health , the official journal of the Academy of Medical- Surgical Nurses.

Research Shows Doctors at Higher Suicide Risk

An estimated 300 to 400 U.S. doctors kill themselves each year””a suicide rate thought to be higher than in the general population, although exact figures are unknown.

Some doctors are wary of admitting psychiatric problems because they feel it could harm their careers, so they suffer in silence to avoid the magnified stigma of mental illness in a profession where stoicism and bravado are valued.

When their pain becomes unbearable, doctors have the access and specific knowledge of prescription drugs to stop breathing and halt the heart.

“All physicians have access to neat, clean ways to commit suicide,” said Dr. Robert Lehmberg, a Little Rock, Ark., surgeon who has battled depression.  He has admittedly considered suicide “an exit strategy if absolutely necessary.”

Physician suicide has been called “an endemic catastrophe” by the American Medical Association. Two years ago they pledged to begin work on prevention of the problem.

Still, suicides have persisted and the American Foundation for Suicide Prevention has begun an educational campaign to make troubled doctors more willing to seek help.

The program is funded by the American College of Psychiatrists and Wyeth Pharmaceuticals, a maker of anti-depressants. A documentary made by the program titled “Struggling in Silence” is set to air on public television stations.

Dr. Paula Clayton, the suicide foundation’s medical director, said it’s an issue that has really been swept under the carpet.

Research from the foundation suggests 300 to 400 physician suicides a year, but a precise count would require further study.

A recent article published in American Medical News by Dr. Louise Andrew puts the estimate at 250 a year, but accurate numbers aren’t available because the AMA doesn’t track doctor suicides, according to a spokesman.

Suicide figures in society as a whole are typically unreliable, as suicide is often not given as the cause of death.

Recent government data in the U.S. shows the overall suicide rate among men is four times higher than in women (23 per 100,000 versus about 6 per 100,000 in women).

However, among doctors suicide rates are equal among men and women.

Women doctors were more than twice as likely as women in the general population to kill themselves, according to a 28-state study from 1984-95. Men were more than 70 percent more likely inside the medical profession than overall to commit suicide.

“One explanation is that most suicide attempts in the broader population are unsuccessful, while doctors know how to successfully commit suicide,” said Dr. Erika Frank, who specializes in research on physician health.

Depression is usually the catalyst.

Dr. Glenn Siegel, who runs a suburban Chicago program that treats doctors with drug abuse, depression and other psychiatric problems, said that depressed doctors frequently decide to self-medicate but don’t seek psychotherapy that could help them deal with underlying issues.

“It’s not a safe topic to be as open about in that profession because you’re responsible for the well-being of others,” Siegel said. “If you’re admitting something like that, you’re saying maybe you’re not fit to do your job.”

“You just would rather take a risk with your health than your career. It’s not like you get a second chance with it,” said Lehmberg, who is featured in the documentary.

Some studies have suggested depression is more common among doctors, especially women physicians, and that the high demands of a job dealing with life-and-death issues makes them prone.

A study published last year in Denmark found more suicides in doctors than among more than 20 other professions, including nurses, factory workers, elementary school teachers, corporate managers and architects.

In the U.S., there are few comprehensive studies on suicides among U.S. doctors.

“Some have been based on newspaper obituaries, which are flawed at best because suicide often isn’t listed as a cause of death,” said Dr. Morton Silverman, a University of Chicago suicide expert.

Mumtaz Bari-Brown, widow of Ron Brown, a physician in New Jersey who took his own life in 2002 after a long battle with depression, said she believes the stigma kept her husband from getting help in time to save his life.

“We have to stop the hiding and the ignorance and recognize it as a disease like high blood pressure or diabetes,” said Bari-Brown, who also is featured in the new documentary.

“Doctors need assurance they won’t risk their jobs if they seek psychiatric help,” said Dr. G. Richard Smith, Lehmberg’s doctor and director of the University of Arkansas for Medical Sciences’ psychiatric research institute.

He has been successful in getting changes to questions on medical license applications in Arkansas that he believes will help. The older applications asked doctors if they were being treated for mental illness or ever had been. A “yes” answer required a psychiatrist’s note declaring they were fit to practice medicine. Now, they need only disclose mental health treatment that was advised or required by medical authorities.

“The previous form didn’t keep doctors with psychiatric problems from practicing. But it did keep doctors who needed treatment from getting the treatment that they needed,” Smith said.

On the Net:

American Medical Association

American Foundation for Suicide Prevention

Brain Food: You Think What You Eat

Nutritious, plant-based foods greatly increase strength and vitality in the human body. Most know that. Today, researchers are rediscovering a long-held truth: foods also generate a profound effect in the human brain. You think what you eat.

They’re one of the mysteries of life-those tiny flashes of light deep in the recesses of our brains. Soft sparks ignite whenever we remember; whenever we plan, rejoice, or sorrow. Every moment of awareness takes place because of neurotransmitters-chemicals that our brain uses to communicate with other nerve (neuron) cells. This communication results in action. We respond, we move, we defend, we adapt.

Here’s the most intriguing part: These chemicals aren’t selfgenerated. We must eat them.

Acetylcholine is a neuron cell exciter designed for thought retention (memory), while dopamine is an excitatory neurotransmitter vital for attention and learning. Another chemical, serotonin, acts as an excitatory neurotransmitter, providing pleasure. It’s also an inhibitor that helps create arousal, sleep, mood, appetite, and sensitivity.

Thought Nutrition

Protein foods allow neurotransmitters to improve mental performance, while carbohydrates serve as the brain’s main energy source. Fats, especially omega-3 fatty acids, regulate memory, learning, and intelligence.

Vitamins and minerals also contribute to brain energy-especially in the realm of mental function, performance, and thinking. Magnesium enhances memory-especially in individuals middle age and older-and controls the ability to learn and then form memories. The mineral zinc is the student’s best friend, sharpening his or her attention span and increasing memory.

Finally, plain old water serves as the nutrient transportation system to the brain. It also acts as a back-flushing system, eliminating toxins and nutritional waste. This often-ignored liquid is necessary for concentration and alertness.

Brain Foods

So called “brain foods” — foods rich in certain nutrients — affect the brain’s ability to function in real and measurable ways. Need to increase mental alertness? Choose protein foods such as soybeans with their powerful load of isoflavones. Need to increase mental stamina? Eating small, regular, plant-based meals allows the brain to function at its best. Ingesting carbohydrates slows mental function and brings about sleepiness.

Iron-rich foods derived from whole grains, fruits, and beans- combined with vitamin C foods-allow children’s developing brains to generate the necessary neurotransmitters for increased attention spans and improved learning abilities. Infants and school children need brain development, and nature happily responds by providing omega-3 fatty acid and docosahexaenoic acid (DHA) found in ground flaxseed, canola oil, walnuts, and soy milk.

Simple Solutions

India’s ayurvedic herbal remedy, amla berry, is said to stimulate the brain for enhanced mental functioning. This gooseberry (amalaki) can be taken as a dietary supplement. Its fruit has long been used to make chutney as a sauce topping many Indian foods. Known also as medhya, amalaki is believed to nurture the mind for enhanced coordination, acquisition, retention, and recall. Some say it helps sharpen both intellect and mental functioning.

DHA was used to treat the only survivor of the Sage Mine disaster, rebuilding the white matter (myelin) he lost in that January 2, 2006, cataclysmic event. After three months of rehabilitation and DHA treatment, this fortunate survivor was able to recover normal brain functions.

The chief of the Bethesda, Maryland, National Institutes of Health (MH) Laboratory of Membrane Biochemistry and Biophysics commented that DHA is a major structural component of the brain and serves a myriad of important functional roles, including the lessening of Alzheimer’s-related dementia.

Exercise Helps

Exercise also helps to sharpen thinking by oxygenating the brain and optimizing mental performance. A study of seventy-one 93-year- old, non-smoking men demonstrated that those who walked less than a quarter of a mile daily had twice the risk of acquiring Alzheimer’s disease as those who walked two miles per day. This information reinforced research done on nearly nineteen thousand 70- to 81-year- old women. Those who performed one and a half hours or more of high- level exercise per week scored better on cognitive performance tests than those living more sedentary lives.

The NIH National Institute on Aging also found that elders who exercise are less likely to experience cognitive decline as they continue to age.

Treating Memory Loss

Treating memory loss began 4,000 years ago in China-possibly earlier by Native Americans. Ancient medical practitioners had no way of knowing why their favorite herbal potions worked. They just knew that they did. Today, we know why.

In 2000 Eric Kandel, M.D., won the Nobel Prize for uncovering how short-term memories are transferred to the long-term storage and retrieval center in our brains. The then 75-year-old Dr. Kandel reported at the National Academy of Sciences, “The brain takes explicit [declarative] facts and events and implicit [procedural] unconscious skills and habits and habitualizes them.” This, he said, is why we’re able to learn skills such as driving a car. He added that our brain “repeatedly synthesizes new proteins and makes new connections from one nerve cell to another [synapses].” The mind and body merge through two different molecular biology anatomical processes. Serotonin grows new connections from one nerve cell to another and improves both types of memories.

Any food or herb that provides die nutrients necessary for this synthesis and connective process will improve memory and our ability to reason or create.

Nutritional Balance

Beginning with the Chinese Song dynasty of 1,000 years ago, a handful of herbs, used alone or in combination with others, have proven themselves to aid the human mind in achieving that all- important nutritional balance necessary to improve memory. These long-tested and historically proven herbs include:

GINKGO BILOBA, a fanshaped, two-lobed leaf grown by farmers in China, Japan, and Korea as a medicinal crop alongside their regular food plantings. Its concentrated extract (GBE) is said to increase memory performance.

A Yale University complementary and alternative medicine study found enhanced memory in healthy adults when taking GBE. Ginkgo biloba is the most scientifically researched botanical on earth and works by increasing oxygen to the brain. Its huperzine content maintains the brain’s acetylcholine level, which allows unrestricted transmission from one neuron cell to another.

GINSENG, an adaptogen comprised of ginsenosides, improves the memory modulator hormone, corticosterone.

HUPERZINE-A (Huperzia serrata), an alkaloid found in Chinese club moss, enhances a synapse connection between two nerves to improve memory deficits by inhibiting destruction of acetylcholine in both aging and young people. When junior middle school students took 100 micrograms of Huperzine-A twice daily for four weeks, they scored significantly higher on standard memory tests for recognition, reproduction association, and tactual memory.

GBE AND HUPERZINE-A: Adolescents taking this Chinese moss herb showed significant memory improvement after four weeks.

GBE AND LUOHAN KUO (LHK)-a rare Chinese fruit cultivated on the Longjiang River. Test subjects achieved memory improvement by drinking a sixounce powdered dietary supplement formula hot or at room temperature.

GBE AND SAGE AND ROSEMARY are said to improve memory by increasing blood flow and oxygen to the brain. In many societies, rosemary and sage have come to symbolize strength, remembrance, and courage.

In her book Four Centuries of American Herbs, Patricia Mitchell claims that sage was the number one memory herb from the 1600s to the mid-1940s, and that rosemary tea was proven to restore lost memory. Herbalists’ texts written in 1597 and 1653, uncovered by a medicinal plant research center, reported that sage “quickeneth and heals” the memory.

THYME (Thymus vulgaris) oil capsules, studied at the Scottish Agricultural College, were shown to slow memory loss through its phenol, thymol, and carvacrol content. The oils were taken from dried or partially dried leaves and flowering tops.

HOLY BASIL (Ocimum sanctum or Tulsi): During the first century A.D. this herb was known as the “royal herb” in France and was thought to have been originally grown on the Grecian shores of the Mediterranean Sea. In the 1600s, early American colonists grew it in their gardens. This mint family herb contains volatile oils that help support memory. It’s often steeped as a tea.

BLUEBERRY LEAVES (Vaccinium spp.), used as a medicinal herb, is Native American in origin and derived from blueberry highbush plants grown in the northern U.S. and Canada. This memory booster grows in moist bog sites, while lowbush blueberries are indigenous to dry, rocky areas.

In 1999 Dr. James Joseph, chief of the Department of Agriculture Human Nutrition Research Center on Aging at Boston’s Tufts University Neuroscience Laboratory, was the principle investigator in a joint USDA and NIH National Institute on Aging-funded study. Joseph reports that aging rats that ate blueberry extracts experienced significant improvement in reversing short-term memory loss. Newly available blueberry herb tea contains natural herb leaves, ground-up blueberry fruit, and blueberry extract flavor. The brain, like any organ in the body, needs proper nutrition to operate to its fullest potential. Nature provides that nutrition in many forms. By feeding the brain what it needs most, we can maintain sound mental health for many years to come.

by Barbara Anan Kogan, O.D.

Barbara Anan Kogan, O.D., known to her friends as “Beltway Barb,” lives in Washington, D.C., and enjoys access to many of the nation’s top medical science facilities.

Atrium Medical Receives FDA Approval for Its Novel C-QUR Lite(TM) V-Patch and C-QUR Edge(TM) V-Patch

HUDSON, N.H., May 8 /PRNewswire/ — Atrium Medical Corporation is pleased to announce it has obtained US FDA 510(K) approval for two new Omega 3 surgical mesh products; C-QUR Edge(TM) V-Patch and C-QUR Lite(TM) V-Patch.

These new products are indicated for use in the surgical repair and reinforcement of soft tissue, including hernia repair — a common procedure performed more than 700,000 times in the US each year. This novel technology combines Atrium’s ProLite Ultra(TM) polypropylene surgical mesh with a proprietary, pharmaceutical grade Omega 3 fatty acid bio-absorbable gel coating. Atrium’s discovery of combining an inert thin wall polypropylene mesh with an Omega 3 biological coating in pre-clinical studies has demonstrated a minimization of tissue attachment as well as a significant reduction in both foreign body reaction and inflammation, resulting in a well healed, reinforced repair.

C-QUR Edge(TM) V-Patch and C-QUR Lite(TM) V-Patch are designed to simplify umbilical, epigastric, trocar-site, and other small abdominal wall hernia repairs. C-QUR Edge(TM) V-Patch offers long-term protection from visceral tissue attachment when placed intra-abdominally while the C-QUR Lite(TM) version offers superior handling and healing characteristics for a pre-peritoneal repair.

The use of Atrium’s all natural Omega 3 bio-absorbable coating with its advanced lightweight surgical mesh provides today’s clinicians with a broad spectrum of options for soft tissue repair. Atrium’s C-QUR Edge(TM) V-Patch and C-QUR Lite(TM) V-Patch will be available in a variety of sizes mid-year 2008.

About Atrium

Atrium’s vast expertise in medical device technologies for the treatment of cardiovascular disease, hernia and adhesion prevention has brought a number of breakthrough advances in several diversified healthcare markets including interventional cardiology and radiology, chest trauma care and thoracic drainage, vascular surgery, and soft tissue repair. Maintaining a commitment to the latest ISO13485 Quality Standards, state-of-the-art manufacturing and automation, cell biology and biomaterial discovery programs, Atrium continues to excel in those healthcare segments that require more advanced surgical intervention for improvements in patient outcome. For more information, call 800-370-7899 or visit http://www.atriummed.com/.

Atrium Medical Corporation

CONTACT: Kelly MacMillan, Marketing Communications Manager of AtriumMedical Corporation, +1-603-880-1433 x5209, fax, +1-603-880-4545,[email protected]

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

Wave Pattern Discovered in Saturn’s Atmosphere

Two decades of scrutinizing Saturn are finally paying off, as scientists have discovered a wave pattern, or oscillation, in Saturn’s atmosphere only visible from Earth every 15 years.

The discovery of the wave pattern is the result of a 22-year campaign observing Saturn from Earth (the longest study of temperature outside Earth ever recorded), and the Cassini spacecraft’s observations of temperature changes in the giant planet’s atmosphere over time.

The Cassini infrared results, which appear in the same issue of Nature as the data from the 22-year ground-based observing campaign, indicate that Saturn’s wave pattern is similar to a pattern found in Earth’s upper atmosphere. The earthly oscillation takes about two years. A similar pattern on Jupiter takes more than four Earth years. The new Saturn findings add a common link to the three planets.

Just as scientists have been studying climate changes in Earth’s atmosphere for long periods of time, NASA scientists have been studying changes in Saturn’s atmosphere. Glenn Orton of NASA’s Jet Propulsion Laboratory in Pasadena, Calif., says patience is the key to studying changes over the course of a Saturnian year, the equivalent of about 30 Earth years.

“You could only make this discovery by observing Saturn over a long period of time,” said Orton, lead author of the ground-based study. “It’s like putting together 22 years worth of puzzle pieces, collected by a hugely rewarding collaboration of students and scientists from around the world on various telescopes.”

The wave pattern is called an atmospheric oscillation. It ripples back and forth within Saturn’s upper atmosphere. In this region, temperatures switch from one altitude to the next in a candy cane-like, striped, hot-cold pattern. These varying temperatures force the wind in the region to keep changing direction from east to west, jumping back and forth. As a result, the entire region oscillates like a wave.

Mike Flasar, co-author of the Cassini paper, and principal investigator for Cassini’s Composite Infrared Spectrometer at NASA’s Goddard Space Flight Center, Greenbelt, Md., said that Cassini helped define this oscillation in combination with the ground observation campaign.

“It’s this great synergy of using ground-based data over time, and then getting up close and personal with the oscillation in Saturn’s atmosphere through Cassini,” said Flasar. “Without Cassini, we might never have seen the structure of the oscillation in detail.”

Cassini scientists hope to find out why this phenomenon on Saturn changes with the seasons, and why the temperature switchover happens when the sun is directly over Saturn’s equator.

More information on the Cassini-Huygens mission can be found at: http://saturn.jpl.nasa.gov, and http://www.nasa.gov/cassini.

The Cassini-Huygens mission is a cooperative project of NASA, the European Space Agency and the Italian Space Agency. JPL, a division of the California Institute of Technology in Pasadena, manages the Cassini mission for NASA’s Science Mission Directorate, Washington, D.C. The Cassini orbiter was designed, developed and assembled at JPL. The Composite Infrared Spectrometer team is based at NASA’s Goddard Space Flight Center, Greenbelt, Md.

MetLife Mature Market Institute(R) Unveils New Web Site

The MetLife Mature Market Institute’s® (MMI) newly designed Web site, www.maturemarketinstitute.com, is now available with additional resources for those interested in aging, caregiving, the changing workforce, retirement and demographics.

“With this enhanced site our aim is to continue to provide meaningful research and insights for constituents interested in aging and retirement,” said Sandra Timmermann, Ed.D., director of the MMI. “This new site will also serve as a source of valuable information for individuals who may be planning for retirement or find themselves in the role of caregiver.”

The site, which can also be accessed through the MetLife Web site, www.metlife.com under the “Retirement” section — contains information divided by category to facilitate quick and easy research. The areas are:

Lifestyles and Life Stages — People are living longer, healthier lives, and as a consequence are redefining life stages and their lifestyles. The MMI tracks these changes and provides insight into areas such as changing family structures, living arrangements, and seeking meaning and fulfillment in the second half of life.

The Changing Workforce — The demographic shifts in the workforce have ramifications for both employers and employees. The MMI conducts research on multigenerational workforce issues and provides helpful insights.

Emerging Topics — The MMI offers analysis of cutting-edge trends and responses to emerging areas of focus, such as longevity and the aging population.

Caregiving and Long-Term Care — Age is the most significant risk factor for needing long-term care. The effects are felt by individuals, families and many others. The MMI provides thoughtful analysis into this area, and tools to assist both those who need care and those who provide it.

Retirement Finances — Financial considerations about retirement, including attitudes toward retirement among pre-retirees and retirees, the impact of longevity and inflation on retirement income and the changing employee benefit environment are highlighted.

Our Diverse Society — Research and other resources related to the family, workplace and retirement issues experienced by various segments of our increasingly diverse population are addressed.

In addition to links on various research topics, the MetLife Mature Market Institute Web site has links to the MMI’s many studies published over the past 10 years, its Since You Care® Guides on more than 15 caregiving topics, an archive of the MMI’s monthly QuickFACTS newsletter and links to outside resources. The “In Focus” segment on the Web site will change on a regular basis to highlight an area of aging study. Additionally, there will be links to “visiting faculty,” and outside contributors — many of whom are prominent in the aging field — who have assisted with MMI research.

The MetLife Mature Market Institute has been conducting research and publishing consumer education resources for midlife and older adults since it was founded in 1997. The MMI is well known among researchers and policymakers and is often cited in the media. Partners in research over the past decade include: the National Alliance for Caregiving (NAC), the Women’s Institute for Secure Retirement (WISER), the American Society on Aging (ASA) and the National Association of Area Agencies on Aging (n4a), among others.

In addition to Dr. Timmermann, the MMI staff includes the following experts in the aging field who are frequent speakers at seminars and meetings: Barbara Howard, M.B.A., Director of Gerontology; John N. Migliaccio, Ph.D., Director of Research; Kathy O’Brien, R.N., M.S., Senior Gerontologist; and Fay Radding, M.A., R.N., Senior Gerontologist.

About the MetLife Mature Market Institute

Staffed by gerontologists, the MetLife Mature Market Institute, part of the company’s Retirement Strategies Group, has been providing research, knowledge management, education, and policy support for over ten years to Metropolitan Life Insurance Company, its corporate customers, and business partners. MetLife, a subsidiary of MetLife, Inc. (NYSE: MET), is celebrating 140 years and is a leading provider of insurance and financial services to individual and institutional customers.

For more information about the MetLife Mature Market Institute, please visit www.maturemarketinstitute.com. You can also go to www.metlife.com, click on “Retirement” and then “MetLife Mature Market Institute.”

Server Farms Becoming a Cash Crop in the Midwest

KANSAS CITY, Mo. — A new kind of farm is popping up. Tucked away on small plots on America’s back roads, it cultivates no soil or seed.

Rather, it nurtures curiosities about everything from porn to pinochle expressed in a nearly endless sequence of 1s and 0s queried from desktops, laptops and iPhones around the globe.

The computer server farm _ huge banks of computer servers doing the heavy-lifting logic of Internet giants like Google, Yahoo and Amazon _ is bringing bits of Silicon Valley to places like Pryor, Okla., and Council Bluffs, Iowa.

Moving inland means quicker connections by getting closer to customers. Spreading hubs across the continent makes networks more dependable. And tax breaks await.

But server farms also guzzle electricity, the way computer technicians gulp Red Bull. The farms are massive, up to football-field-sized, buildings filled with racks of servers.

So finding places where the light bill is, well, lighter goes a long way toward pleasing stockholders.

“If you can make the machines use power 5 percent more efficiently, that could save tens of millions of dollars,” said Dan Wallach, a computer science professor at Rice University.

Consider Google’s decision to plop down server farms on the outskirts of Pryor and Council Bluffs _ the latest expansions from its original hub in California. Both sites come with tax abatements that will save millions. And by sitting 1,000 miles from another new server farm that the company has planted on the banks of the Columbia River in Oregon, the search engine lowers the chances that a West Coast brownout will dash your ability to Google your blind date.

Similarly, diversifying locations makes Google’s network more stable as sabotage or natural disaster in a single location will have less impact.

Google acknowledges building five server farms _ all in cheap-electricity locales _ in the United States and dozens around the world.

At the MidAmerica Industrial Park in Oklahoma, amid a Gatorade plant, a pipe manufacturer and nearly 80 other companies, Google is piecing together a plain-looking 100,000-square-foot building it will stock with servers. Next to the industrial park stands a coal-fired electrical generating plant operated by the Grand River Dam Authority.

It helps that the price is right. Google’s corporate headquarters sit in Mountain View, Calif. The average industrial electrical rate in the Golden State runs about 9 cents per kilowatt hour. In Iowa and Oklahoma, the meter runs at between 4 and 5.5 cents.

“Google is … not the type of industry that is really dependent on location, since its product is Internet-based,” said Justin Alberty, Grand River spokesman. “The real factors in choosing a location tend to be land, water and electricity.”

Server farms, also referred to as data centers by the industry, are also becoming more common with the growth of “cloud computing.” The term refers to companies building massive computing power and then renting that capacity out to other firms. Amazon, for one, sells not just books, but time on its servers to run Web sites or store electronic records.

In that way, computing is starting to look like the next utility. In the same way it would be inefficient for each home to have its own electrical generator, it can make sense for consumers and businesses to farm out their computing needs. Some analysts even see consumers buying less highly powered personal computers in the future and relying on firms like Google to fire up the necessary microprocessors when the demand requires.

Even the Microsoft of Bill Gates, who said just a year ago that “we’re making the (personal computer) the place where it all comes together,” has just launched a data storage and Web software system called Live Mesh. It’s the company’s late entry into cloud computing. Already, Google offers word processing, spread sheet and slide show programs for free that compete with what Microsoft sells (think Word, Excel and PowerPoint) with its operating systems.

“You gain efficiency,” said Gurdip Singh, a computer scientist at Kansas State University. “Instead of having your own servers sitting idle part of the time, you share that capacity with others using the same service.”

That consolidation of data processing power is becoming a powerful industry trend. Last year, Sun Microsystems unveiled modular units designed for cloud computing and fitted into 20-foot shipping containers. This month, IBM introduced the iDataPlex with claims that it squeezes twice as many computers in the same space as other systems and runs on 40 percent less power.

Server farms can grow huge, consuming up to 100 megawatts of electricity, enough to power more than 20,000 American homes.

With perhaps 100,000 pizza -box-sized machines, the buildings are filled with the constant sound of fans blowing over the processors.

Cooling costs _ yet more energy consumption _ can rival the electricity demand to run the computers.

In that way, even your Google search has a carbon footprint. The Environmental Protection Agency estimates that server farms consume at least 1.5 percent of all U.S. energy.

“Definitely, there’s no getting around the energy,” said Dan Andresen, and associate professor of computing and information services at Kansas State, where he runs a small-scale server farm. “At the same time, you can think of how many millions of gallons of gas have been saved by people using Google Maps rather than aimlessly driving around.”

Besides electricity, server farms typically require a good water source because the outposts often use water-cooled systems (for a 20 percent energy savings) rather than conventional air-conditioning.

Server farms, like their agricultural counterparts, require ever fewer people to produce even more. The facility going up in Council Bluffs will need only 100 workers to tend to thousands of computers that represent a $300 million investment by the company. And it plans to double the facility.

“It’s big,” said Mark Norman of the Council Bluffs Area Chamber of Commerce. “And it’s only getting bigger.”

Price of Flour is Rising Fast

Nick Ferraro’s business plan for opening Lancaster County’s first Philly Pretzel Factory was based on paying $10 for the 50-pound bags of flour he would need to operate.

That seemed safe enough last July when the pre-mixed pretzel flour was selling for $8 a bag. But Ferraro said he might as well have thrown his business plan out the window.

With the price of wheat going through the roof this winter, Ferraro has been paying $27 a bag for flour instead of $10, plus a fuel surcharge that got tacked on shortly after he opened last September in the Shoppes at Kissel Village along Lititz Pike.

I’ve had to raise my prices a couple of times already, and I’ve only been open seven months, he said. I’m struggling.

The same thing happened to Mike Stauffer, who is in the process of buying Ric’s Bread at 24 N. Queen St. When he started running the bakery six months ago, he was paying $15.50 for a 50-pound bag of flour. Last week, it was $26.80.

It’s not just the flour. It’s the canola oil, the eggs, Stauffer said. I had to raise prices, and it was the last thing I wanted to do.

Bread that he was selling for $4 a loaf is now $4.50 a loaf, Stauffer said.

He said he was beginning to have second thoughts about buying a bake shop because nobody seemed to know exactly what was going on with the price increases or when they would stop.

Nor is it just startups struggling with flour prices.

My flour bill went up $1,500 in one week, said Tim Mineo, owner of Alfred & Sam’s Italian Bakery, 17 Fairview Ave. You have to pass it on to the consumer, or you go out of business.

Economists point to a complex web of international forces that have sharply increased U.S. exports and driven the price of wheat to all-time highs in this country.

Part of it stems from a shortage of grain on the world market because of drought and poor harvests.

Another part is a rising demand in populous countries where personal income has increased with the growing economies.

China and India are two good examples, said Sanjay Paul, an associate professor of international economics at Elizabethtown College.

And yet another significant part has been the decline in the value of the dollar that has accompanied the turmoil on Wall Street over the past few months.

It’s a lot of things that seem to be coming together at the same time, said Lou Moore, a professor of agricultural economics at Penn State University.

Australia, which has been a major exporter of wheat, has been locked in a drought and has had little to contribute to the world market, Moore said. And last year, Russia and Ukraine had poor harvests and cut exports.

According to the U.S. Department of Agriculture, exports from this country began to rise dramatically last summer, increasing about 50 percent from the year before and then more than doubling during the fall.

From September through November, the U.S. exported 433 million bushels of wheat, compared with 212 million bushels in 2006.

A year ago, hard spring wheat, the best for baking bread, was selling in Chicago for $5.60 a bushel, Moore said. This week, it was selling for around $15.

Soft red winter wheat, which is used in snack foods and pretzels, was selling for $4 a bushel last year, compared with $7.52 this week.

But Moore also points to the depreciation of the dollar as a big factor, not only because it’s kept wheat affordable for foreign consumers while prices were rising here, but also because futures traders started putting more money into commodities – including corn, wheat and soybeans – as a hedge against the value of the dollar falling even more.

Despite all these factors, there may be some relief in sight. Wheat futures were trading between $9 and $10 a bushel last week, off significantly from the record of nearly $13.50 in late February, the result in part of a recent USDA report projecting a 5.5 percent increase in wheat plantings this year.

The signals we’re getting from farmers is that they’re paying more attention to growing wheat than they ever have, said Greg Roth, a professor of agronomy at Penn State University.

That includes farmers in Lancaster County, who plant a fair amount of wheat, Roth said, citing figures from the Pennsylvania Agricultural Statistics Service.

The 8,900 acres of wheat planted here in 2006 is small potatoes compared with the 175,000 acres planted in corn that year, but that acreage will probably rise with rising wheat prices.

Farmers here are able to double-crop their soft winter wheat with spring plantings of soybeans, Roth said, giving them two grain crops and a straw crop in the same year.

High prices for soybeans are also prompting farmers nationwide to shift some of their cropland from corn to soybeans this year.

As farm economists always say, the cure to high prices is high prices, Roth said.

The cost of flour appears to have had little effect on bakery, grocery and restaurant sales, despite the higher prices businesses have been forced to pass on to their customers.

Mineo, of Alfred & Sam’s, raised the wholesale price of his company’s sandwich rolls 20 cents a dozen in January, the first increase since 2005, and he may have to raise the price again.

When flour for 55 dozen rolls costs $66 instead of $35, the added 20 cents a dozen has offset only about a third of the increased flour cost.

The pizza parlors and sandwich shops that are Alfred & Sam’s customers have complained about the higher cost because they’ve had to raise what they charge for their sandwiches, Mineo said, but it hasn’t affected the volume of his sales.

Glenn Lapp, owner of Good ‘n Plenty Restaurant on Route 896 in Smoketown, which makes its own bread, also said his price increases haven’t kept pace with higher costs.

We sell our bread as well as serve it in the restaurant, Lapp said. We gave up a little in price on what we sell and a little bit in price in the restaurant. And we’re a little bit stuck.

However, higher prices may have prompted some grocery customers to shift to cheaper brands of flour and bread.

Sam Hamaker, grocery manager for Darrenkamp’s Willow Valley store, said he’s seen increased sales of the store’s private-label bread at the expense of name-brand breads.

We’ve seen bread prices go through the roof, Hamaker said. We get increases every other month.

Romaine Wetzel, author of Easy and Tasty Recipes From Romaine’s Kitchen, said rising prices hurt people like her who are living on Social Security, but they haven’t affected the amount she cooks.

I still love to do it and give it away, she said.

Wetzel said she prefers Gold Medal flour for baking, but doesn’t buy it unless it’s on sale. Instead, she has three five-pound bags of Shurfine flour sitting on her shelf.

Roger White, an assistant professor of international economics and trade at Franklin & Marshall College, said people have little recourse when it comes to staples like corn and wheat.

When the price increases, it’s not easy for consumers to substitute, he said.

White said he thinks one underlying cause of the higher prices is simply the worldwide growth in population and the costs involved in increasing food production to keep pace with it.

The current shifts in the export market are removing some of the trade distortions that have existed in the past, he said, and moving the world toward the correct pricing for food.

Super Solar Flares Stun the Solar System

At 11:18 AM on the cloudless morning of Thursday, September 1, 1859, 33-year-old Richard Carrington””widely acknowledged to be one of England’s foremost solar astronomers””was in his well-appointed private observatory. Just as usual on every sunny day, his telescope was projecting an 11-inch-wide image of the sun on a screen, and Carrington skillfully drew the sunspots he saw.

On that morning, he was capturing the likeness of an enormous group of sunspots. Suddenly, before his eyes, two brilliant beads of blinding white light appeared over the sunspots, intensified rapidly, and became kidney-shaped. Realizing that he was witnessing something unprecedented and “being somewhat flurried by the surprise,” Carrington later wrote, “I hastily ran to call someone to witness the exhibition with me. On returning within 60 seconds, I was mortified to find that it was already much changed and enfeebled.” He and his witness watched the white spots contract to mere pinpoints and disappear.

It was 11:23 AM. Only five minutes had passed.

Just before dawn the next day, skies all over planet Earth erupted in red, green, and purple auroras so brilliant that newspapers could be read as easily as in daylight. Indeed, stunning auroras pulsated even at near tropical latitudes over Cuba, the Bahamas, Jamaica, El Salvador, and Hawaii.

Even more disconcerting, telegraph systems worldwide went haywire. Spark discharges shocked telegraph operators and set the telegraph paper on fire. Even when telegraphers disconnected the batteries powering the lines, aurora-induced electric currents in the wires still allowed messages to be transmitted.

“What Carrington saw was a white-light solar flare””a magnetic explosion on the sun,” explains David Hathaway, solar physics team lead at NASA’s Marshall Space Flight Center in Huntsville, Alabama.

Now we know that solar flares happen frequently, especially during solar sunspot maximum. Most betray their existence by releasing X-rays (recorded by X-ray telescopes in space) and radio noise (recorded by radio telescopes in space and on Earth). In Carrington’s day, however, there were no X-ray satellites or radio telescopes. No one knew flares existed until that September morning when one super-flare produced enough light to rival the brightness of the sun itself.

“It’s rare that one can actually see the brightening of the solar surface,” says Hathaway. “It takes a lot of energy to heat up the surface of the sun!”

The explosion produced not only a surge of visible light but also a mammoth cloud of charged particles and detached magnetic loops””a “CME”””and hurled that cloud directly toward Earth. The next morning when the CME arrived, it crashed into Earth’s magnetic field, causing the global bubble of magnetism that surrounds our planet to shake and quiver. Researchers call this a “geomagnetic storm.” Rapidly moving fields induced enormous electric currents that surged through telegraph lines and disrupted communications.

“More than 35 years ago, I began drawing the attention of the space physics community to the 1859 flare and its impact on telecommunications,” says Louis J. Lanzerotti, retired Distinguished Member of Technical Staff at Bell Laboratories and current editor of the journal Space Weather. He became aware of the effects of solar geomagnetic storms on terrestrial communications when a huge solar flare on August 4, 1972, knocked out long-distance telephone communication across Illinois. That event, in fact, caused AT&T to redesign its power system for transatlantic cables. A similar flare on March 13, 1989, provoked geomagnetic storms that disrupted electric power transmission from the Hydro Qu©bec generating station in Canada, blacking out most of the province and plunging 6 million people into darkness for 9 hours; aurora-induced power surges even melted power transformers in New Jersey. In December 2005, X-rays from another solar storm disrupted satellite-to-ground communications and Global Positioning System (GPS) navigation signals for about 10 minutes. That may not sound like much, but as Lanzerotti noted, “I would not have wanted to be on a commercial airplane being guided in for a landing by GPS or on a ship being docked by GPS during that 10 minutes.”

Another Carrington-class flare would dwarf these events. Fortunately, says Hathaway, they appear to be rare:

“In the 160-year record of geomagnetic storms, the Carrington event is the biggest.” It’s possible to delve back even farther in time by examining arctic ice. “Energetic particles leave a record in nitrates in ice cores,” he explains. “Here again the Carrington event sticks out as the biggest in 500 years and nearly twice as big as the runner-up.”

These statistics suggest that Carrington flares are once in a half-millennium events. The statistics are far from solid, however, and Hathaway cautions that we don’t understand flares well enough to rule out a repeat in our lifetime.

And what then?

Lanzerotti points out that as electronic technologies have become more sophisticated and more embedded into everyday life, they have also become more vulnerable to solar activity. On Earth, power lines and long-distance telephone cables might be affected by auroral currents, as happened in 1989. Radar, cell phone communications, and GPS receivers could be disrupted by solar radio noise. Experts who have studied the question say there is little to be done to protect satellites from a Carrington-class flare. In fact, a recent paper estimates potential damage to the 900-plus satellites currently in orbit could cost between $30 billion and $70 billion. The best solution, they say: have a pipeline of comsats ready for launch.

Humans in space would be in peril, too. Spacewalking astronauts might have only minutes after the first flash of light to find shelter from energetic solar particles following close on the heels of those initial photons. Their spacecraft would probably have adequate shielding; the key would be getting inside in time.

No wonder NASA and other space agencies around the world have made the study and prediction of flares a priority. Right now a fleet of spacecraft is monitoring the sun, gathering data on flares big and small that may eventually reveal what triggers the explosions. SOHO, Hinode, STEREO, ACE and others are already in orbit while new spacecraft such as the Solar Dynamics Observatory are readying for launch.

Research won’t prevent another Carrington flare, but it may make the “flurry of surprise” a thing of the past.

On the Net:

www.nasa.gov

Reliability of New Pulse CO-Oximeter in Victims of Carbon Monoxide Poisoning

By Coulange, M Barthelemy, A; Hug, F; Thierry, A L; De Haro, L

Coulange M, Barthelemy A, Hug F, Thierry AL, De Haro L. Reliability of new pulse CO-oximeter in victims of carbon monoxide poisoning. Undersea Hyperb Med 2008; 35(2): 107-111. Study objective: The purpose of this study was to evaluate the reliability of noninvasive real-time measurement of carboxyhemoglobin (COHb) using a pulse CO-oximeter in victims of carbon monoxide poisoning (COP). Methods: During the 7-month study period, pulse CO-oximetry was measured on patients admitted to the emergency department (ED) for suspected COP. Each patient included in the study underwent concomitant assessment of COHb by blood sampling and noninvasive pulse CO-oximetry (SpCO). Results: Twelve non-smoker patients were included. Mean age was 40 +- 17 years. No difference was found between the two COHb assessment techniques (p>0.05). Analysis using the Bland and Altman procedure suggested good alignment of the two techniques with a slight bias (i.e. -1.5%) indicating slight overestimation by the pulse CO-oximeter. Analysis using the Passing and Bablok statistical protocol further documented the reliability of the two methods. Conclusion: This study documents the precision of the correlation between readings obtained with the noninvasive pulse CO-oximeter and COHb measurements from blood samples. This preliminary result demonstrates that this simple rapid noninvasive technology could be useful before and after arrival at the ED. INTRODUCTION

Carbon monoxide (CO), one of the most common causes of fatal poisoning in Western countries (1), requires emergency therapy. Hyperbaric oxygen therapy (HBO^sub 2^) is the gold-standard treatment in severe cases and can decrease the incidence of cognitive sequelae (2). However there are no clear guidelines for the use of HBO^sub 2^ due to variations in clinical presentation, discrepancies between clinical and laboratory findings and, above all, pitfalls in documenting elevated carboxyhemoglobin (COHb) levels. Some authors have found no consistent correlation between clinical signs and COHb concentration (1) but typically a COHb concentration above 25% is considered as sufficient to indicate HBO^sub 2^ in a patient with or without severe symptoms (2). Thus there is an urgent need for a reliable technique which measures COHb level. Currently detection of CO in ambient air using portable electrochemical sensors provides an effective method of preventing accidental exposure but there is no simple method of evaluating the extent of individual poisoning. Performing measurements on expired air requires special operator training and patient cooperation. In addition, expired air measurement, although highly cost-effective, is unsuitable for use during emergency rescue due to poor sensitivity and specificity, technical complexity and long calibration time (3). Analysis of blood samples is a rapid and easy- to-perform invasive technique for routine inhospital measurement of COHb level provided that the necessary equipment is available, well maintained and properly calibrated. However it can provide misleading results if the time interval between exposure and blood sampling in the emergency department (ED) or between blood collection at the rescue scene and assay in the hospital is prolonged. The purpose of this study was to evaluate the reliability of pulse CO-oximetry technology for noninvasive realtime measuremnt of COHb level in victims of carbon monoxide poisoning (COP).

METHODS

Study setting and design

This study was carried out at the Hyperbaric Center at Sainte Marguerite Hospital in Marseille, France. Pulse CO-oximetry was proposed to patients treated for COP in the ED from October 2005 to April 2006. After informed consent was obtained, noninvasive assay was performed in combination with standard workup procedures without changing therapeutic strategies (according to French law, no ethics committee advice was necessary). For the child included in the study, the parents’ consent was obtained. This prospective descriptive study was undertaken independently, with no funding from the device manufacturer. It was not designed as a clinical trial.

Patient selection

Patients admitted to the ED with suspected COP but prior to blood sampling and hospital admission were included in the study. Smokers were excluded.

Methods of measurement and data collection

All patients included in this study were managed as usual for COP: physical examination, electrocardiography, chest x-ray and typical laboratory tests were conducted. Measurement of COHb level was performed by a nurse under physician supervision using the standard spectrophotometric measurement on a venous blood sample (IL 682 CO-oximeter, Instrumentation Laboratory, Barcelona, Spain) at the same time as measurement using a Rad57 pulse CO-oximeter (SpCO) (5) (Masimo Corporation, Irvine, CA, USA). In addition to measuring conventional pulse oximetry variables, the PDA-approved Rad-57 system uses 8 wavelengths of light for rapid (within seconds) noninvasive measurement of COHb via a sensor placed on the middle or ring finger (6). The COHb level is expressed in percent of total hemoglobin.

Measurement results

Table 1 lists COHb data and presents the symptoms of each patient studied. Clinical signs were scored as absent; minor, i.e., headache, dizziness, nausea, vomiting, weakness; and severe, i.e., confusion, loss of consciousness, coma, hypotonia, convulsions, and precordialgia.

Data analysis

Data analysis was performed using the MEDCALC statistical package for windows (version 8.1.1, Medcalc, Belgium). A Kolmogorov-Smirnov test was used to check normal data distribution. All values were reported as means +- standard deviation (SD). The level of significance was 0.05.

Differences between COHb levels measured using the conventional technique and pulse CO-oximetry were assessed using a paired t- test. Method reliability was assessed as described by Bland and Altman (7). Mean difference (bias) and SD of the differences between the values obtained using the two methods were calculated. Data was plotted graphically to allow a comparison between the differences with mean values in %. Mean differences were plotted on graphs.

The statistical protocol described by Passing and Bablok (8) were used to test the equality of values obtained using the two techniques. After testing the linearity of the relationship between values, confidence limits were computed for the slope beta and intercept alpha. These limits were used to assess whether the difference between beta and 1 and between alpha and O were random.

RESULTS

During the 7-month study period, twelve patients admitted to the ED for suspected COP were also monitored with the pulse CO- oximeter. Table I presents the characteristics of these patients along with the results of the two COHb assays and the initial severity of symptoms. Mean patient age was 40 +- 17 years with an equal proportion of men and women. One woman was pregnant. Three patients had COHb levels above 20% (using the standard spectrophotometric measurement on a venous blood sample) without severe clinical symptoms. Conversely four of the remaining 9 patients with COHb levels below 20% presented severe symptoms.

Mean COHb values were 13.9 +- 8.3% and SpCO values were 15 +- 9%. The difference between these two means was not significant (p>0.05). Analysis using the Bland and Altman protocol (7) demonstrated good alignment for both techniques (figure IA) with a bias of -1.5% suggesting that pulse CO-oximetry slightly overestimated. The analysis using the Passing and Bablok statistical protocol (8) also demonstrated good alignment (figure 1B).

The 12 patients included in the study recovered rapidly and left the hospital after 24 hours of observation.

LIMITATIONS

A major limitation of this study was patient recruitment. This problem was related to the number of available pulse COoximeter devices, which was insufficient to allow routine SpCO assay at each time venous blood was collected. A more widespread use of this technology should expand the patient database.

From a more practical standpoint, it should be noted that to use the device correctly, particularly the finger sensor, requires training and practice. The manufacturer emphasizes that there are several known causes of potentially incorrect readings such as placing the finger improperly in the sensor, intense ambient light or high levels of methemoglobin. In our study, poor signals were obtained from the sensor for a patient with false fingernails and a small infant. A pediatric sensor will soon be available.

DISCUSSION

This study is the first report correlating the SpCO value from the Rad-57 with blood COHb measured on a laboratory CO-oximeter in the real world setting (ED) and not in laboratory experiment. Values measured in this study ranged from 1.2% to 31.6%. All previous articles demonstrating the reliability of noninvasive assessment have involved smokers (5, 6) or healthy volunteers (9) breathing 500 ppm of carbon monoxide with COHb levels below 15%. Noninvasive measurement of COHb using a pulse CO-oximeter provides instantaneous readings. This is an advantage not only for prompt diagnosis but also in the choice of therapy for patients with minor or no clinical symptoms. Indeed, our results confirm that there is no correlation between carbon monoxide concentration and severity of the symptoms (Table I). Weaver et al. documented the benefit of HBO in preventing neurological sequelaes in patients with COHb levels above 25% with or without severe symptoms (2). These findings underline the need for quick accurate assessment of COHb levels even for patients with seemingly minor symptoms. Pulse CO-oximeter could satisfy this need with a slight but acceptable measurement bias (figure 1A). Pulse CO- oximetry provides a means of early recognition of severe poisoning thus optimizing ED decision-making. In this clinical series no false positive readings were obtained with the pulse COoximeter compared to the COHb. This differs from the findings of O’Malley (10), who reported a number of false positives. The company gave several explanations for the initial false readings (10) as already mentioned, including the problem of finger position in the sensor, presence of methemoglobin, sickle cell or hemolytic anemia (11), ambient light or dark patient skin pigment. O’Malley does not take into account these factors in his report.

Our data indicate that pulse CO-oximetry could be useful for the management of COP in two possible situations. First in hospital emergency departments, pulse COoximetry would accelerate detection time of COHb levels. More reliable and cost-effective than conventional laboratory techniques, CO-oximetry could be used for routine measurement of COHb in all patients admitted to the ED (12). Routine screening would be an excellent tool to reduce the misdiagnosis rate especially for patients who present nonspecific symptoms (13). Pulse CO-oximetry technology could also be used to perform serial or continuous readings to ascertain therapeutic compliance.

Although not tested in this study, a second situation that could benefit from the use of pulse CO-oximetry is emergency rescue and transportation. Since this technology is portable, it could be used for differential diagnosis for patients presenting nonspecific symptoms, neuropsychiatric signs, gastrointestinal symptoms, chest pain, collapse or smoke inhalation. Pulse CO-oximetry seems more suitable for disaster situations than measurement of CO in expired air since it does not require patient cooperation or calibration between measurements. Furthermore CO readings from exhaled air expressed in ppm may be affected by recent ingestion of alcohol. Another point is that the automatic conversion of CO levels to percentage of COHb does not take into account a number of important variables such as ventilatory parameters, partial pressure in pulmonary capillaries, hemoglobin level, cardiac output, blood pH and endogenous CO production. It is also worth noting that although blood sampling at the emergency scene is highly recommended in cases involving COP, it is subject to a number of operational constraints. When taken, samples are rarely used due to prolonged delay or doubts concerning quality (3). In situations involving household poisoning, pulse CO-oximetry would allow prompt differential diagnosis between food-born intoxications and carbon monoxide exposure and facilitate triage especially for patients with low-grade symptoms.

This study documents the good alignment between readings obtained with a pulse CO-oximeter and COHb measurements from blood samples. The findings of this study demonstrate that simple rapid noninvasive technology is reliable both before and after arrival at the ED.

REFERENCES

1. Kao LW, Nanagas KA. Carbon monoxide poisoning. Med Clin North Am. 2005 Nov;89(6): 1161-94.

2. Weaver LK, Hopkins RO, Chan KJ, Churchill S, Elliot CG, Clemmer TP, Orme JF Jr, Thomas FO, Morris AH. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med 2002; 347(14): 1057- 67.

3. Lapostolle F, Raynaud PJ, Le Toumelin P, Benaissa A, Agostinucci JM, Adnet F, Fleury M, Lapandry C. Measurement of carbon monoxide in expired breath in prehospital management of carbon monoxide intoxication. Ann Fr Anesth Reanim 2001; 20:10-5.

4. Hampson NB, Scott KL, Zmaeff JL. Carboxyhemoglobin measurement by hospitals: Implications for the diagnosis of carbon monoxide poisoning. J Emerg Med 2006; 31(1):13-6.

5. Rad-57 Pulse CO-oximeter. Available at: http:// www.masimo.com/ rad-57/index.htm. Masimo Corporation Web site. Accessed July 26,2006.

6. Hampson NB, Scott KL. Use of a noninvasive pulse CO-oximeter to measure blood carboxyhemoglobin levels in bingo players. Respir Care 2006; 51(7):758-60.

7. Bland JM, Airman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1(8476):307-10.

8. Passing H, Bablok. A new biometrical procedure for testing the equality of measurements from two different analytical methods. Application of linear regression procedures for method comparison studies in clinical chemistry, Part I. J Clin Chem ClinBiochem 1983; 21(11):709-20.

9. Barker SJ, Morgan S, Bauder W. New pulse oximeter measures carboxyhemoglobin levels in human volunteers. Lecture presented at: Society for Technology in Anesthesia, Scientific Assembly, January 19-20, 2006; San Diego, CA.

10. O’Malley GF. Non-invasive carbon monoxide measurement is not accurate. Ann Emerg Med 2006; 48(4):477-8.

11. Hampson NB. Carboxyhemoglobin elevation due to hemolytic anemia. JEmerg Med 2007; 33( 1 ): 17-9.

12. Chee KJ, Suner S, Partridge RA, Sucov A, Jay GD. Non invasive carboxyhemoglobin monitoring: screening emergency department patients for carbon monoxide exposure. Acad Emerg Med 2006; 13(5):S179.

13. Dolan MC, Haltom TL, Barrows GH, Short CS, Ferriell KM. Carboxyhemoglobin levels in patients with flu-like symptoms. Ann Emerg Med 1987; 16(7):782-6.

Submitted: 7/5/07 – Accepted: 9/27/07

M. COULANGE1, A. BARTHELEMY1, F. HUG2, A.L. THIERRY1, L. DE HARO3

1 Reanimation Medicale et Hyperbarie, Hopital Sainte Marguerite, Marseille, Fr, 2 Universite de Nantes, Laboratoire JE 2438, Nantes, Fr,3 Poison Center, Marseille, Fr

Copyright Undersea & Hyperbaric Medical Society Mar/Apr 2008

(c) 2008 Undersea & Hyperbaric Medicine. Provided by ProQuest Information and Learning. All rights Reserved.

Should You Take a Powder and Put It on Your Eyelids?

Mineral makeup is all the rage _ beauty products said to be better for your skin because they’re made from natural minerals derived from the earth instead of chemicals and preservatives. Loose mineral powder foundation is one thing _ you apply it with a fat brush on a wide expanse known as your face. But loose powder eye shadow seems trickier. How can you control the amount of pigment that’s being deposited on your eyelids or keep the flecks from flying all over your face? We had one tester try two loose mineral shadows and one pot of non-mineral glittery loose powder eye shadow. What was her eye-opening experience?

THE BALM

Sexpot Series mineral shadow, in If you’re rich, I’m single (pewter), $14, makeup.com.

POWDER POT: “I’m a fan of loose mineral powder foundation. Like the mineral foundation, this shadow came with a perforated lid to shake just a tad out at at time. Or, so I hoped.”

SHAKE IT OUT: “I used a brush to apply it on my lid. The earthy, coppery hue blended very easily and complimented my Asian skin tone.”

GLAM-EYE-ZON? “Because the container is a tad wider and squattier than the others, it feels more secure in my grip. It washed off easily with my usual makeup remover.”

___

MAC COSMETICS

MAC Glitter in Reflects Gold, $16.50, MAC stores and Nordstrom.

POWDER POT: “Once you unscrew the cap on this good-size container and remove the inner lid, you better not have nervous-Nellie fingers or this powder is going to go flying all over the place.”

SHAKE IT OUT: “This stuff is so glittery gold that it truly reminds me of the stuff I used to stick onto construction paper with Elmer’s glue in first-grade arts and crafts. It was a little daunting to think about putting it on my eyelids.”

GLAM-EYE-ZON? “Of the three shadows, it had the sheerest, subtlest color and the most sparkle. It was like stardust, perfect for a special evening, but not so over-the-top that you couldn’t wear it on a summer afternoon with a nice tan.”

___

YOUNGBLOOD

Crushed mineral eye shadow in Sedona, $16.95, Amazon.com.

POWDER POT: “I’m a pressed powder shadow kind of gal. It’s easy to carry, easy to apply, but frankly loose powder scared me to death at first glance.”

SHAKE IT OUT: “This tiny pot comes with a salt-shaker-like top. So I shook some into the cap ever so carefully, hoping to get just the right amount. I used a shadow brush to sweep some over my eyelids.”

GLAM-EYE-ZON? “Of the three loose shadows, this one was definitely the boldest. It has a deep, dramatic coppery-coffee hue with a touch of sparkle. Because I’m a more subtle kind of woman, I swiped a lighter taupe shade over it to tone it down.”

Basic Health Care Lacking for Children in Developing Countries

A recent report showed that more than 200 million children under age 5 lack proper health care, resulting in almost 10 million deaths each year.

The ninth annual State of the World’s Mothers, conducted by US-based independent humanitarian organization Save the Children, shows the first-ever “Basic Health Care Report Card” of 55 developing countries.

Together these countries account for nearly 60 percent of the world’s under-5 population and 83 percent of all child deaths worldwide, the report said.

Basic health care was defined as “a package of lifesaving interventions that includes prenatal care, skilled care at childbirth, immunizations and treatment for diarrhea and pneumonia.”

In 30 of the 55 developing countries, less than half of all young children receive health care, including bottom-ranked Ethiopia, where more than 80 percent of children under age 5 do not receive basic lifesaving care.

Four out of five mothers in sub-Saharan Africa are likely to lose a child in their lifetime, according to the report, which found eight of the 10 bottom-ranked countries to be located in the region.

Within the top three out of 55 developing countries ranked by Save the Children, the Philippines, Peru and South Africa were noted to be the top three providers of basic health care. Indonesia and Turkmenistan tied for fourth.

The Philippines has nearly cut its child death rate in half since 1990, said David Oot, Save the Children’s associate vice president.

More than 75 percent of children in the Philippines with diarrhea receive rehydration therapy, compared with 15 percent of Ethiopian children, he said.

Sweden, Norway and Iceland were at the top of the entire list in terms of well-being for mothers and children in the total 146 countries surveyed, while Nigeria was ranked last.

“A child’s chance of celebrating a fifth birthday should not largely depend on the country or community where he or she is born,” said Charles MacCormack, president and CEO of Save the Children.

“We need to do a better job of reaching the poorest children with basic health measures like vaccines, antibiotics and skilled care at childbirth. These simple measures, while taken for granted in the United States, are not reaching millions of children under age 5, and can determine whether a child lives or dies in poor countries and communities.”

The report recommended that a coordinated global effort was necessary to close the child survival gap between countries. Training of health care workers wouldn’t require high education to master the necessary skills, said the report.

Experts predict that over 60 percent of the nearly 10 million children who die every year could be saved through basic health services from a health facility or community health worker.

The report said that health care programs need to be tailored to the needs of the poorest mothers and children.

“The last mile or kilometer “” the distance between the health clinic and the home “” in developing countries is the most difficult to reach with basic health services,” said MacCormack.

“Yet, to save the majority of young lives lost each year, you need to bring care closer to home, where most children get sick and die.”

The report also called on governments to close the child survival gap by increasing commitments to deliver basic health care, especially to the poorest children, in developing countries, adding that The U.S. share of this commitment, known as the Global Child Survival Act, would help save the lives of millions of newborns, babies and young children globally.

“Each day that we wait to act on this legislation, nearly 27,000 lives are lost. We can do better,” said MacCormack.

“We urge Congress to get behind this legislation and give mothers and their children the chance to celebrate Mother’s Day not only this year, but in years to come.”

On the Net:

Save The Children

Take Care Health Clinics Open at Three Walgreens in Denver

Take Care Health Systems, one of the largest managers of convenient care clinics and a wholly-owned subsidiary of Walgreens (NYSE, NASDAQ: WAG), has opened three Take Care Health Clinics at Walgreens drugstores in the Denver area. The clinics are walk-in, professional health care centers open seven days a week with extended evening and weekend hours.

Denver is the first Colorado market to have Take Care Health Clinics. Additional locations will open in the Denver area soon. Future expansion is planned for the state later this year. Take Care Health Systems plans to open more than 400 clinics at Walgreens drugstores by the end of 2008.

“Take Care Health Clinics have brought tremendous value to our existing 16 markets, and we are excited to bring our clinics to Colorado for the first time,” said Peter Miller, Take Care Health Systems’ President and CEO. “We have treated more than 475,000 patients nationwide since November 2005 and received exceedingly high patient satisfaction ratings. We look forward to offering a high-quality, affordable and convenient health care option to the Denver community.”

Take Care Health Clinics in Denver are staffed by board-certified family nurse practitioners who treat patients 18 months and older for common illnesses such as strep throat, ear and sinus infections, pink eye and poison ivy, and are licensed to write prescriptions that can be filled at the patient’s pharmacy of choice. Take Care Nurse Practitioners also provide school, sports and camp physicals and offer vaccinations for flu, hepatitis B, meningitis and tetanus.

Clinics have two patient examination rooms, exam tables, sinks, innovative patient registration kiosks and electronic medical record technology for visit documentation. Clinics are open Monday-Friday, 8 a.m. — 7:30 p.m.; Saturday and Sunday, 9:30 a.m. — 5 p.m., and are located at the following Walgreens drugstores in the Denver area:

Broomfield: 5190 W. 120th Ave.

Wheat Ridge: 4401 Wadsworth Blvd.

Parker: 19028 Lincoln Ave.

Take Care Health Systems has partnered with national insurance plans including Aetna, ChoiceCare, CIGNA, Great West Healthcare, Humana, Multiplan/PCHS and UnitedHealthcare to provide covered services to patients, in addition to accepting Medicare. Additional regional insurance plans will be added soon. If insured by one of these plans, patients pay their regular co-pay or coinsurance amount. For the uninsured or cash payers, prices average $59-$74 and are listed on clinic sign-in kiosks.

“Take Care Health Clinics offer high-quality, affordable health care by experienced nurse practitioners,” said Carol Gannon, Lead Take Care Nurse Practitioner for Denver. “Take Care Nurse Practitioners understand their local communities and provide an integrated approach to the patient’s long term well-being. We are thrilled to be able to extend our model to yet another state.”

Take Care Nurse Practitioners encourage all patients to have a health care home, a provider they see routinely for on-going medical needs and routine exams. If a patient’s condition falls outside of the scope of service at the clinic, the patient is referred back to his/her primary care provider for follow-on care. If a patient does not have a primary care provider, nurse practitioners will offer a list of providers in the area accepting new patients. Take Care Nurse Practitioners collaborate with local physicians who are available for consultation at all times the practitioner is treating a patient. Collaborating physicians and other local providers work with Take Care Nurse Practitioners to accept patient referrals.

Take Care Health Systems uses nationally recognized, evidence-based clinical guidelines for treatment and electronic medical record technology allowing patients to take visit records to their other providers, promoting continuity of care. Take Care Nurse Practitioners follow quality and safety standards as outlined by the Convenient Care Association, the industry’s trade association, and are aligned with guidelines for retail clinics set by the American Academy of Family Physicians and the American Medical Association.

Take Care Health Systems is part of Walgreens new Health and Wellness division, alongside Walgreens newly-acquired I-trax/CHD Meridian Healthcare and Whole Health Management, two leading providers of worksite health centers that operate under the name Take Care Employer Healthcare Solutions. Including Take Care Health Clinics, Walgreens has more than 500 worksite health and wellness centers and retail health clinics within the division.

Take Care Health Systems currently manages 168 total clinics in 17 cities throughout 14 states, including Atlanta, Chicago, Cincinnati, Cleveland, Denver, Houston, Kansas City, Las Vegas, Miami, Milwaukee, Nashville, Tenn., Orlando, Fla., Pittsburgh, St. Louis, Tampa, Fla., Tucson, Ariz. and West Palm Beach, Fla..

About Take Care Health SystemsSM

Take Care Health Systems (www.takecarehealth.com), one of the largest managers of convenient care clinics, is a wholly-owned subsidiary of Walgreens and part of Walgreens Health and Wellness division. The Company combines best practices in health care and the expertise and personal care of its providers — nurse practitioners and physician assistants – to deliver access to high-quality, affordable and convenient health care to all individuals. Take Care Health Clinics are located at select Walgreens drugstores nationwide, where providers focus exclusively on the diagnosis and treatment of common family illnesses and offer vaccinations and physicals. Take Care Health Systems currently manages 168 Take Care Health Clinics in 17 cities throughout 14 states, with plans to have more than 400 clinics in operation by the end of 2008. Patient care is provided by Take Care Health Services, an independently owned state professional corporation established in each market.

About Walgreens

Walgreens is the nation’s largest drugstore chain with fiscal 2007 sales of $53.8 billion. The company operates 6,204 drugstores in 49 states, the District of Columbia and Puerto Rico. Walgreens is expanding its patient-first health care services beyond traditional pharmacy through Walgreens Health Services, its managed care division, and Walgreens Health and Wellness, its worksite and retail health center division. Walgreens Health Services assists pharmacy patients and prescription drug and medical plans through Walgreens Health Initiatives Inc. (a pharmacy benefit manager), Walgreens Mail Service Inc., Walgreens Home Care Inc., Walgreens Specialty Pharmacy LLC and SeniorMed LLC (a pharmacy provider to long-term care facilities). Walgreens Health and Wellness division is compromised of Take Care Employer Healthcare Solutions, a provider of worksite-based health care services, and Take Care Health Systems, the manager of 168 convenient care clinics at Walgreens drugstores. More information about Walgreens is available at Walgreens.com.

Microsemi Announces New 1.7KW RF Generator Reference Design Kit

IRVINE, Calif., May 6, 2008 (PRIME NEWSWIRE) — Microsemi Corporation (Nasdaq:MSCC), a leading manufacturer of high performance analog/mixed signal integrated circuits and high reliability semiconductors, has announced a 1.7KW, Push Pull, Class-D reference design kit that enables RF design engineers to immediately evaluate a highly efficient, high power, Class-D amplifier.

Based on Microsemi’s DRF1300 Driver/MOSFET hybrid, the new reference design kit provides an essential tool in developing high-power, high-voltage RF generators, optimizing efficiency and power densities for plasma generation, switch mode power amplifiers, pulse generators, ultrasound transducer drivers and acoustical optical modulators.

KEY FEATURES

      * Greater than 1700 Watts Output Power     * Better than 80% Efficient Class-D Operation     * 13.56 MHz Switching Frequency     * Up to 250 Supply Voltages     * Internal MOSFET Rated at 500V BV(DSS)     * Low Cost System Design     * Solid State Transition for Tube Amplifiers 

Class-D amplifiers offer a degree of efficiency unavailable with linear designs. Many engineers, however, avoid the complexities of Class-D amplifier designs — or are forced to spend months acquiring its fundamentals. Now, with Microsemi’s new DRF1300/Class-D reference design kit, engineers can rapidly overcome the pitfalls of high voltage Class-D design, saving months of designer time and countless design iterations.

Using Microsemi’s DRF1300 Driver/MOSFET hybrid as its core, the kit’s reference board enables performance levels previously unachievable with solid state Class-D amplifiers. The DRF1300 hybrid combines two drivers, two high voltage MOSFETs and internal bypass capacitors in a push pull configuration making it a highly efficient, high voltage, cost effective solution. The drivers combined with optimally located bypass capacitors are capable of driving the high voltage MOSFETs at more than 30MHz. The 500V MOSFET enables high voltage applications, greatly simplifying output matching and reducing complexity of the output combining networks.

The new Microsemi Class-D reference design kit includes a designer’s application note discussing the progression through various output voltages, while identifying proper output waveforms necessary for safe transition to greater than 1700 watts into a 50 Ohm load. It also demonstrates how to achieve efficiencies higher than 90% at sub 1KW outputs. It demonstrates supply bypassing and building the high power magnetics required for high power Class-D designs. The board comes fully assembled and is mounted to a machined heatsink.

The Class-D reference design kit is extremely versatile. After evaluating a design with the preloaded 500V, 30A DRF1300 hybrid, applications can be modified for higher voltage requirements by using the 1000V, 15A DRF1301 Driver/MOSFET hybrid.

The DRF1300 hybrid features an air cavity-flangeless package for improved reliability over plastic encapsulated packaging. Constructed with materials with closely matched CTEs the flangeless package maximizes system reliability by alleviating the stress between components during power cycling. Typical applications have demonstrated in excess of 1 million cycles with power densities of 700 Watts/square inch. The flangeless package design also reduces cost, eliminating expensive copper tungsten flanges that are typical in conventional high power RF packages.

DRF1300/Class-D reference design kits are available now, with a unit price of $1600. Samples of the DRF1300 and DRF1301 Driver/MOSFET hybrids are also available now. Additional DRF1300 hybrids are available for a unit price of $225.00 in 100 piece quantities. All devices are available through the factory or from authorized distributors of Microsemi RF products.

About Microsemi Corporation

Microsemi Corporation, with corporate headquarters in Irvine, California, is a leading designer, manufacturer and marketer of high performance analog and mixed signal integrated circuits and high reliability semiconductors. The company’s semiconductors manage and control or regulate power, protect against transient voltage spikes and transmit, receive and amplify signals.

Microsemi’s products include individual components as well as integrated circuit solutions that enhance customer designs by improving performance, reliability and battery optimization, reducing size or protecting circuits. The principal markets the company serves include implantable medical, defense/aerospace and satellite, notebook computers, monitors and LCD TVs, automotive and mobile connectivity applications. More information may be obtained by contacting the company directly or by visiting its web site at http://www.microsemi.com.

The Microsemi Corporation logo is available at http://www.primenewswire.com/newsroom/prs/?pkgid=1233

PLEASE READ THE FOLLOWING FACTORS THAT CAN MATERIALLY AFFECT MICROSEMI’S FUTURE RESULTS.

“Safe Harbor” Statement under the Private Securities Litigation Reform Act of 1995: Any statements set forth in this news release that are not entirely historical and factual in nature, including without limitation statements concerning our expectations regarding new or existing products or technologies, are forward-looking statements. These forward-looking statements are based on our current expectations and are inherently subject to risks and uncertainties that could cause actual results to differ materially from those expressed in the forward-looking statements. The potential risks and uncertainties include, but are not limited to, such factors as rapidly changing technology and product obsolescence, weakness or competitive pricing environment of the marketplace, uncertain demand for and acceptance of the company’s products, adverse circumstances in any of our end markets, results of in-process or planned development or marketing and promotional campaigns, difficulties foreseeing future demand, potential non-realization of expected orders or non-realization of backlog, product returns, product liability, and other potential unexpected business and economic conditions or adverse changes in current or expected industry conditions, difficulties and costs of protecting patents and other proprietary rights, and inventory obsolescence and difficulties regarding customer qualification of products. In addition to these factors and any other factors mentioned elsewhere in this news release, the reader should refer as well to the factors, uncertainties or risks identified in the company’s most recent Form 10-K and all subsequent Form 10-Q reports filed by Microsemi with the SEC. The forward-looking statements included in this release speak only as of the date hereof, and Microsemi does not undertake any obligation to update these forward-looking statements to reflect subsequent events or circumstances.

Investor Inquiries: Robert C. Adams, Microsemi Corporation, Irvine, CA (949) 221-7100.

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

 CONTACT:  Microsemi Corporation           Financial Contact:           John W. Hohener, Vice President and CFO             (949) 221-7100           Investor Relations:           Robert C. Adams, Vice President Business Development &            Investor Relations             (949) 221-7100 

Novartis Menveo(R) Vaccine Shows Superior Immune Response Against Four Types of Meningitis Disease in Pivotal Phase III Trial

New Phase III data for Menveo(R) (MenACWY-CRM) show that the vaccine produced a greater immune response against meningococcal serogroups A, C, W-135 and Y in adolescents 11-18 years of age compared to Menactra(R). Infection with any of these four vaccine-preventable serogroups can lead to bacterial meningitis, an infection of the membrane around the brain and spinal cord, or sepsis, a serious infection of the blood stream.

Results of this first head-to-head trial of Menveo compared to Menactra, show that adolescents who were immunized with Menveo generated higher levels of antibodies against all four serogroups.

Notably for serogroup Y, among adolescents with low levels of immunity at the time of vaccination, 81% of subjects receiving Menveo generated a protective immune response vs. 54% with Menactra, as measured by the hSBA assay. Serogroup Y causes approximately 39% of meningococcal disease cases in the US.

“To protect children against all major serogroups of meningococcal disease, we need vaccines that provide broad coverage and that can be used in all at-risk age groups,” said Keith S. Reisinger, MD, MPH, Medical Director, Primary Physicians Research, Inc. Pittsburgh, PA. “These data are encouraging because they show that Menveo may provide greater protection for the more than 8 million infants and adolescents in the US against these four vaccine-preventable serogroups than the currently available vaccine.”

Menveo is an investigational quadrivalent meningococcal conjugate vaccine in Phase III clinical development by Novartis Vaccines. The data were presented at a late-breaker platform session on May 5 during the 2008 Pediatric Academic Societies (PAS) Annual Meeting in Honolulu, Hawaii.

Meningococcal disease, a leading cause of bacterial meningitis, is a rare but contagious and potentially life-threatening infection. Infants and adolescents have the highest rates of disease, which can be fatal. Each year approximately 1,400 to 2,800 cases of disease occur in the US, and about 10-14 percent of patients die. The currently available vaccines are not licensed for use in infants, in whom the highest rates of meningococcal disease are observed. Phase II data published in the January 9, 2008, issue of the Journal of the American Medical Association demonstrated Menveo to be the first meningococcal vaccine to produce a strong immune response in infants.

The US Centers for Disease Control and Prevention (CDC) recommends routine immunization with a quadrivalent meningococcal conjugate vaccine for all adolescents 11-18 years of age, college freshmen living in dormitories and people in other high risk groups who are two to ten or 19-55 years of age.

“The patient need for vaccines for meningococcal disease remains substantial. We are quickly realizing our goal of providing broad coverage against all serogroups of meningococcal disease across all age groups,” said Joerg Reinhardt, CEO of Novartis Vaccines and Diagnostics. “Given the broad range of age groups this vaccine is expected to protect, Menveo could truly fulfill an unmet need in the meningitis vaccine market.”

Study details

This Phase III trial involved more than 2,100 11-18 year olds who received a single vaccination with either Menveo or Menactra. One month after vaccination, geometric mean titers (a measure of immune response) for Menveo vs. Menactra were: serogroup A, 29 vs. 18; serogroup C, 59 vs. 47; serogroup W-135, 87 vs. 44; and serogroup Y, 51 vs. 18. Additionally, the percentage of participants who achieved a protective immune response, determined by a human serum bactericidal antibody titer (hSBA) greater than or equal to 1:8, with Menveo vs. Menactra was: serogroup A, 75% vs. 67%; serogroup C, 84% vs. 84%; serogroup W-135, 96% vs 88%; and serogroup Y, 88% vs. 69%. Similar results were seen in the large subset of sero-negative participants, who are the participants without any natural immunity to the bacteria before vaccination. The hSBA assay measures the body’s protective immune response to the meningococcus based on the ability of antibodies to kill the bacteria.

About Menveo

These data build on previous studies that demonstrated Menveo generates a strong protective immune response against these four vaccine-preventable serogroups in people across age groups from infancy to adulthood. Novartis expects to submit a Biologics License Application (BLA) to the US Food and Drug Administration later this year.

Menveo is currently in multiple Phase III clinical trials involving infants, young children, adolescents and adults. The vaccine is based on the same technology Novartis pioneered to produce Menjugate(R), a meningococcal serogroup C conjugate vaccine approved outside the US since 2000 for use in individuals from two months of age through adulthood.

Novartis is a global leader in providing vaccines to protect against the deadly meningococcal disease. In addition to developing Menveo, Novartis has already distributed more than 26 million doses of Menjugate around the world and produced MenZB(R), a vaccine against a strain of meningococcus B specific to a recent outbreak in New Zealand. Novartis is also developing a recombinant vaccine to provide broad coverage against multiple strains of serogroup B, for which no vaccine is currently available.

About meningococcal disease, a leading cause of bacterial meningitis

Meningococcal disease can manifest as bacterial meningitis — an infection of the membranes around the brain and spinal cord — or sepsis, a bloodstream infection. It is caused by the bacterium Neisseria meningitidis (N. meningitidis). The symptoms — which can include sudden onset of fever, rash, headache, and stiff neck — can progress rapidly. Even with early and appropriate treatment, some cases are fatal, typically within 24-48 hours. For those who survive, as many as 19 percent suffer serious long-term consequences such as deafness, neurological damage or limb loss.

Disclaimer

The foregoing release contains forward-looking statements that can be identified by terminology such as “may”, “expects”, and “encouraging”, “potentially”, “can be”, “goal”, “expected”, or similar expressions, or by express or implied discussions regarding potential future regulatory filings or approvals for, or potential future sales of, Menveo or other vaccines currently in development by Novartis. Such forward-looking statements reflect the current views of Novartis regarding future events, and involve known and unknown risks, uncertainties and other factors that may cause actual results with Menveo to be materially different from any future results, performance or achievements expressed or implied by such statements. There can be no guarantee that Menveo or any other vaccine currently in development by Novartis will be submitted or approved for any indications in any market. Nor can there be any guarantee that Menveo or any other vaccine, if approved, will achieve any particular levels of sales. In particular, management’s expectations regarding Menveo could be affected by, among other things, unexpected clinical trial results, including unexpected new clinical data and unexpected additional analysis of existing clinical data; unexpected regulatory actions or delays or government regulation generally; Novartis’ ability to obtain or maintain patent or other proprietary intellectual property protection; competition in general; government, industry and general public pricing pressures, and other risks and factors referred to in Novartis AG’s Form 20-F on file with the U.S. Securities and Exchange Commission. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those anticipated, believed, estimated or expected. Novartis is providing the information in this press release as of this date and does not undertake any obligation to update any forward-looking statements contained in this press release as a result of new information, future events or otherwise.

About Novartis

Novartis Vaccines and Diagnostics is a division of Novartis focused on the development of preventive treatments. The division has two businesses: Novartis Vaccines and Chiron. Novartis Vaccines is the world’s fifth-largest vaccines manufacturer and second-largest supplier of flu vaccines in the US. The division’s products include influenza, meningococcal, pediatric and travel vaccines. Chiron, the blood testing and molecular diagnostics business, is dedicated to preventing the spread of infectious diseases through the development of novel blood-screening tools that protect the world’s blood supply.

Novartis AG provides healthcare solutions that address the evolving needs of patients and societies. Focused solely on growth areas in healthcare, Novartis offers a diversified portfolio to best meet these needs: innovative medicines, cost-saving generic pharmaceuticals, preventive vaccines and diagnostic tools, and consumer health products. Novartis is the only company with leading positions in these areas. In 2007, the Group’s continuing operations (excluding divestments in 2007) achieved net sales of USD 38.1 billion and net income of USD 6.5 billion. Approximately USD 6.4 billion was invested in R&D activities throughout the Group. Headquartered in Basel, Switzerland, Novartis Group companies employ approximately 98,000 full-time associates and operate in over 140 countries around the world. For more information, please visit http://www.novartis.com.

* Menactra is a registered trademark of Sanofi Pasteur.

SOURCE: Novartis Vaccines and Diagnostics

Chinese Protest Environmental Problems

Hundreds of people marched in a western provincial capital over the weekend to protest environmental risks they say are associated with the construction of a petrochemical factory and oil refinery, witnesses said Monday.

It was the latest in a series of rare but increasingly ambitious grass-roots movements in Chinese cities aimed at derailing government-backed industrial projects that could damage the environment.

The peaceful protest Sunday, like its predecessors, was organized through Web sites, blogs and cellphone text messages, showing how some Chinese are using digital technology, despite government attempts to control the Internet, to spur on the kind of civic movements that are usually disapproved of by officials. Cellphone messages being sent countrywide Monday showed organizers were trying to publicize their cause across the vast sweep of China.

In addition, the kinds of health and environmental concerns expressed by the protesters are likely to grow across China as property ownership increases among the urban middle class, leading people to scrutinize the companies setting up shop in their backyards.

The protesters in Chengdu, capital of Sichuan Province, walked calmly through the center of the city for several hours Sunday afternoon to criticize the building of an ethylene plant and oil refinery in Pengzhou, a few minutes’ drive outside the city. Some protesters wore white face masks to highlight the dangers of pollution. About 400 to 500 protesters took part in the march, which was watched by dozens of police officers, witnesses said. Organizers circumvented a national law that requires protesters to apply for a permit by saying they were only out for a “stroll.”

Police officials in Chengdu declined to comment on the march when reached by telephone.

Critics of the project said in interviews Monday that the government had not done proper environmental reviews of the projects, which they said could pollute the air and water and lead to health hazards.

“We’re not dissidents; we’re just people who care about our homeland,” said Wen Di, an independent blogger and former journalist living in Chengdu. “What we’re saying is that if you want to have this project, you need to follow certain procedures: for example, a public hearing and independent environmental assessment. We want a fair and open process.”

Fan Xiao, a geologist and environmental advocate based in Chengdu, sent out a mass cellphone text message Monday morning that had been written by one of the leaders of the protest movement and was being widely circulated across the country. “Protect our Chengdu, safeguard our homeland,” it read. “Stay away from the threat of pollution. Restore the clear water and green mountains of Sichuan.”

In an interview, Fan said, “People have been hoping this issue would get more attention.”

The petrochemical project is a joint venture of the Sichuan provincial government and PetroChina, a publicly traded oil company that is the listed arm of China National Petroleum Corp., the state- owned concern that is the country’s largest oil producer. The $5.5 billion project, approved last year, is expected to produce 800,000 tons of ethylene per year and refine 10 million tons of crude oil per year, according to a Web site dedicated to the project that was set up by the Pengzhou city government. Ethylene is widely used in the production of such goods as packaging and trash liners.

Repeated calls to the company set up by the joint venture, PetroChina Sichuan Petrochem Industry, went unanswered Monday. The project’s Web site said that $565 million of the total investment would be dedicated to environmental protection.

The march Sunday appears to have put government officials on the defensive. A brief front-page article arguing the merits of the project appeared Monday in a state-controlled newspaper, The Chengdu Business News.

“The Sichuan refinery project will install advanced equipment, apply new techniques and improve environmental protection facilities with strict pollution prevention and risk control schemes,” the article said. “The project passed an assessment by the relevant national departments after several hearings and revisions by many distinguished experts in the oil-refining industry and environment protection.”

The latest protest came at a time when the Chinese government and its policies are coming under growing international scrutiny. Anti- government demonstrations by Tibetans in March led to a government crackdown, which in turn has fueled criticism by human rights advocates and others outside China. The Olympic torch ran a gantlet of anti-China protests in foreign cities including London and Paris before arriving on the mainland Sunday.

The criticism of China has been met by a fervent wave of nationalism among Chinese both here and abroad, much of it organized by students denouncing the Western news media and calling for a boycott of Carrefour, the French supermarket chain.

But the protest in Chengdu has little to do with those events and has much more in common with urban grass-roots movements to protect the environment and people’s health that have been surprisingly successful in the past year or so.

Rural protests by farmers have taken place for years, with occasional heavy-handed suppression by the police. Much more rare, but growing in number, are street protests in large cities by educated, professional, middle-class Chinese.

The government has taken a softer approach to these, allowing them to run their course, even though the protesters are clearly marching without official permission.

The protest movement in Chengdu is at least the third such groundswell to emerge in recent years.

Last year, construction of a chemical plant outside Xiamen, in Fujian Province, was halted after residents held a series of street protests.

More recently, residents in Shanghai protested construction of a high-speed rail line designed to link a suburb with the airport, forcing officials to announce that the project was being delayed.

In both cases, residents complained that the projects would bring significant environmental and health risks.

Transcultural Nursing: Its Importance in Nursing Practice

By Maier-Lorentz, Madeline M

Abstract: Transcultural nursing is an essential aspect of healthcare today. The ever-increasing multicultural population in the United States poses a significant challenge to nurses providing individualized and holistic care to their patients. This requires nurses to recognize and appreciate cultural differences in healthcare values, beliefs, and customs. Nurses must acquire the necessary knowledge and skills in cultural competency. Culturally competent nursing care helps ensure patient satisfaction and positive outcomes. This article discusses changes that are important to transcultural nursing. It identifies factors that define transcultural nursing and analyzes methods to promote culturally competent nursing care. The need for transcultural nursing will continue to be an important aspect in health-care. Additional nursing research is needed to promote transcultural nursing. Key Words: Nursing, Transcultural Nursing, Nursing Practice, Importance of Transcultural Nursing

Transcultural nursing has become a key component in Healthcare and a requirement for today’s practicing nurses because of the soaring multicultural phenomenon occurring in our American population. According to the U.S. Bureau of the Census (2000), over 30% of the total population, or one out of every three persons in the United States (U.S.), is comprised of various ethnicities other than non-Hispanic Whites. This statistic highlights that the U.S. has a significant multicultural population today. Additionally, the U.S. Department of Commerce (2000) projects a steadily growing population of persons from ethnicities other than non-Hispanic Whites, comprising 50% of the whole population by 2050.

Yet, while the U.S. population continues to rapidly grow in diversity, nurses have remained a homogenous group. Approximately 90% of all Registered Nurses are Caucasian. Although Hispanics have become the majority minority in the U.S. (U.S. Bureau of the Census, 2000), it is estimated that there are only 2% Hispanic Registered Nurses in the nursing profession ((Minority Nursing Statistics, 2005). The escalating cultural diversity in the U.S. population and the few number of non-Caucasian registered nurses calls attention to the need for addressing the issue of transcultural nursing.

Because of the escalating multicultural society in the United States, transcultural nursing is a vital constituent of nursing care, mandating that nurses are culturally competent in their daily practice. Culturally competent nurses have knowledge of other cultural ways and are skilled in identifying particular cultural patterns so that an individualized care plan is formulated that will help meet the established healthcare goals for that patient (Gustafson, 2005).

Additionally, nursing practice includes providing care that is holistic. This holistic approach in nursing addresses the physical, psychological, social, emotional, and spiritual needs of patients. It is important to emphasize that nurses must identify and meet these needs in order to provide individualized care, which has been stipulated as a patient’s right and a hallmark of professional nursing practice (Locsin, 2001).

Holistic care means planning care to meet patients’ individual needs. In order to provide holistic care, nurses must also account for cultural differences in their care plans. This helps ensure that nurses provide holistic care because care plans are formulated based on individuals’ needs and cultures. Thus, nurses must be culturally competent in order to provide optimal care for their patients. Most important, nurses need to maintain cultural competency in their daily practice to instill in their patients a feeling of being known and cared for as individuals in a very complex Healthcare system and culturally diverse society.

DEFINITION OF CULTURAL COMPETENCE

Nursing has borrowed from the social work to define cultural competence. Social workers describe cultural competence as a continual process of striving to become increasingly self-aware, to value diversity, and to become knowledgeable about cultural strengths (Bonecutter & Gleeson, 1997). The nursing profession has adopted this concept. Nurses depict cultural competence as having the ability to understand cultural differences in order to provide quality care to a diversity of people (Leininger, 2002). Culturally competent nurses are sensitive to issues related to culture, race, ethnicity, gender, and sexual orientation. Furthermore, culturally competent nurses have achieved efficacy in communication skills, cultural assessments, and knowledge acquisition related to health practices of different cultures. Cultural competence involves nurses continuously striving to provide effective care within the cultural confines of their patients. The most comprehensive definition of cultural competence in nursing practice is stated as being an ongoing process with a goal of achieving the ability to work effectively with culturally diverse persons, and additionally, to care for these individuals with a keen awareness of diversity, a strong knowledge base and skills in transcultural nursing, and especially a strong personal and professional respect for others from various cultures (Leininger, 2002).

Having knowledge of the patient’s cultural perspectives enables the nurse to provide more effective and appropriate care. For example, understanding one’s religious or cultural beliefs may be a deciding factor against the administration of a blood transfusion for a patient who is a Jehovah’s Witness since these individuals are forbidden to receive this medical treatment. It is clear that having specific knowledge about patients’ cultures ensures holistic and cultural competent nursing care.

LEININGER’S CULTURE CARE THEORY

Leininger (1978) introduced the concept of transcultural nursing and developed the Culture Care Theory to explain cultural competency. It was the first attempt in the nursing profession to highlight the need for culturally competent nurses. Leininger’s theory of Culture Care may be considered the major contribution in support of transcultural nursing as both a discipline and vital component of daily nursing practice. Her theory continues to be used as a credible, holistic model that continually contributes new research-based and advanced knowledge to transcultural nursing.

Leininger (1978) explained that nurses had to acquire an in- depth knowledge of different cultures in order to provide care to people of various ethnicities. Moreover, it is the only theory that explicitly focused on the relationship between culture and care on health and wellness. Leininger points out that the purpose and goal of her theory is for nurses to understand diverse and universal culturally based care factors. These factors influence the health, and well-being of others. An understanding of these factors enable nurses to provide care that is individualized and meaningful to individuals of various cultural backgrounds.

Nurses may encounter patients from numerous cultures in daily practice. It is unlikely that nurses would know about the culturally- based, health-related beliefs and practices of all persons. However, nurses can gain knowledge and skifls in cross-cultural communication to help them provide individualized care that is based on cultural practices. Nurses skilled in cross-cultural communication may then be better equipped to provide culturally competent care to their patients.

Cross-Cultural Communication

Cross-cultural communication includes certain factors that must be considered when nurses interact with patients and their family members from cultural backgrounds that differ from their own (Andrews, 2003). However, it is important that nurses first understand their own cultural values, attitudes, beliefs, and practices that they have acquired from their own families before learning about other cultural ways. This helps nurses gain insight into personal prejudices that may exist. These prejudices must be recognized in order to avoid stereotyping and discrimination, which may jeopardize the ability of nurses to learn and accept different cultural beliefs and practices especially in health-related issues.

Cross-cultural communication involves several aspects that should be understood in order to achieve cultural competency, which is necessary in order to provide optimal nursing care (Andrews, 2003). It is, therefore, necessary to examine ways in which people from diversified cultural backgrounds communicate. This involves more than oral and written communication. Nonverbal cues play a vital role in conveying messages, and these may vary considerably among different cultures. Understanding these communication cues and their meanings to persons of different cultures is necessary in order for nurses to attain and maintain cultural competency.

Recent qualitative studies have shown that communication problems were the major reasons nurses were not able to provide culturally competent nursing care (Boi, 2000, Cioffi, 2003). The nurses reported that they were not comfortable with patients from cultures other than their own because of language barriers. More importantly, the nurses explained that they were not able to understand other cues used by these patients to communicate. The nurses expressed a need to receive education and training in transcultural communication skills in order to provide effective care for their patients from various cultures. Although it is not likely that nurses will master many languages, understanding the meaning of certain nonverbal communication cues used by different cultures may be very beneficial for providing culturally competent nursing care. Eye Contact. Eye contact is an important nonverbal means of communication. It is also the variable that differs the most among many cultures (Canadian Nurses Association, 2000). American nurses are taught to maintain eye contact when speaking with their patients. This is in direct contrast to Arabic persons, who consider direct eye contact impolite and aggressive. Similarly, Native North Americans also regard direct eye contact as improper; in their culture, staring at the floor during conversations shows that they are listening carefully to the speaker. Hispanics use eye contact only when deemed appropriate by their cultural standards. This is based on age, sex, social position, economic status, and position of authority. For instance, Hispanic elders speaking with children use eye contact, but it is considered inappropriate for Hispanic children to look directly at their elders when speaking to them. In a health care environment, Hispanic patients expect that nurses and other health care providers give direct eye contact when interacting with them, but it is not expected that Hispanic patients reciprocate with direct eye contact when receiving medical and nursing care. These are only a few examples to demonstrate that persons of various cultures perceive eye contact differently. It is essential that nurses be cognizant that several meanings may be attached to direct eye contact in order to communicate effectively with their patients.

Touch. Nurses educated in American schools are taught to use touch as a therapeutic means of communication with their patients. (Understanding Transcultural Nursing, 2005). However, nurses must also realize that touch may not have the same positive meaning in healthcare for people who are from other cultures than American. Some cultures prohibit or restrict touching other persons. Patients from Arab and Hispanic backgrounds do not allow male health care providers to touch certain parts of females. Females from both cultures also may be restricted from caring for male patients. Asians do not approve of touching the head, because it is thought to be the source of a person’s strength.

It is unlikely that nurses would know all the special meanings attached to touch by persons of many various cultures. However, nurses should recognize that touch has different meanings in different cultures and to be respectful of others’ ways with regard to touch. It is advisable for nurses to explain to patients their reason for touching them to prevent these individuals from misconstruing the use of touch in their care. Understanding and respecting other cultural ways of using touch helps nurses maintain cultural competency.

Silence. This is another nonverbal cue, which has a different meaning for persons of various cultures. Nurses may feel uncomfortable when there is a period of silence while talking with their patients. They may interpret silence in a negative way for several reasons. Nurses may conclude that silence represents miscommunication or that the patient is depressed and not willing to respond. They may even question whether their patients have impaired hearing. While these are important explanations for silence and must be considered by the nurse when talking with their patients, they should also realize that silence is used differently in communication among persons from other cultures.

Silence can be a positive nonverbal cue in communication among people in various cultures (Andrews, 2003). It is common for Native North Americans to use silence as a way of showing respect for the person speaking to them. They also use silence much like a pause after being asked a question. This signifies that they are giving careful consideration to the question, responding with meaning and attention to the matter. This is common in Chinese and Japanese people. Silence is also mandatory when speaking to elders in Asian cultures. It is a sign of great respect for older people. Both English and Arab persons use silence out of respect for another’s privacy. French, Spanish, and Russian individuals demonstrate their agreement with the use of silence.

Space and Distance. Usually individuals are not consciously aware of space and distance between themselves and others until they come in direct contact with people from other cultures. They then realize their own preferences with regard to space and distance from other people. Individuals of European North American descent usually feel most comfortable when they are not in close contact with any others. In direct contrast, Hispanics, Asians, and Middle Easterners feel very comfortable in close proximity to others (Andrews, 2003).

Nurses should realize that space and distance between themselves and their patients is very important to consider when providing care to individuals from cultures that are different from their own. Patients may either position themselves unusually close or far from the nurse based on their cultural needs for space and distance It may be especially difficult for nurses to distance themselves sufficiently from patients who need the most space because nursing care requires close contact with patients. However, the key point in transcultural nursing is to understand and respect the needs of patients from various cultures with regard to space and distance requirements.

Healthcare Beliefs. There are also variations among people from different cultures regarding certain beliefs in healthcare. These various beliefs are based on the culture’s perspective about an individual’s relationship with the environment (Understanding Transcultural Nursing, 2005). Persons who believe that they have some control of life events will also believe that they have some control over their healthcare. These individuals will tend to be more compliant in following healthcare regimes prescribed for them and will be more likely to develop positive healthcare habits. Asian Americans are usually of this nature. In contrast, Hispanics feel that they have less control over their lives and tend to be more fatalistic in their views about health. These patients may not be as cooperative about complying to a prescribed diet and medication regime.

Culturally competent nurses would understand these different views and provide care that includes consideration for these differences. For instance, nurses may provide more patient teaching about diet and medications to patients who feel they have less control in their healthcare. Culturally competent nurses are respectful of others’ cultural habits especially in healthcare and their nursing care plans should be individualized to account for the various cultural differences. Developing cultural competency requires first and foremost having the interest to become competent culturally, and secondly taking the necessary steps to attain it.

STEPS TO ATTAIN CULTURAL COMPETENCE

There is a current focus on eliminating disparities in healthcare to ensure that persons of diverse cultural backgrounds receive effective care. The government enacted the Healthy People 2010 to enforce this standard of treatment (Office of Disease Prevention and Health Promotion, 2000). Regulatory, accrediting, and professional organizations are also supporting this effort (Office of Civil Rights, 2000; Joint Commission for Accreditation of Healthcare Organizations [JCAHO], 2000; American Nurses Association [ANA], 1999). Additionally, certain national policies have been established to provide equitable and effective treatment for people from diverse cultures entering the health care system (Office of Minority Health, 2000).

The nursing profession has been actively involved in meeting the goal of eliminating discrepancies in providing health care to minorities for the past decade. Nurses have been leaders in this pursuit. They have emphasized the need to provide culturally competent care to their patients five years before the legislative Healthy People 2010 was initiated by the government (ANA, 1999). The Nursing profession upholds this focus on cultural competency not only to comply with regulatory enactments, but also to promote patient satisfaction. When nurses provide care that is in accordance with patients’ cultural beliefs, values, and practices, the assumption is that patients will be more likely to adhere to the plan of care than if cultural needs were not addressed by nurses. Cultural competency is best achieved by taking three progressive steps that help nurses provide care for patients from diverse backgrounds (Narayan, 2001).

Step 1. Adopt Attitudes to Promote Transcultural Nursing Care

Certain attitudes have been associated with effective and culturally competent nursing care (Narayan, 2001). Caring is one of four important attitudes necessary for promoting transcultural and culturally competent nursing care. Nurses demonstrate a caring attitude when they take time to understand and appreciate their patients’ cultural needs and perspectives. This also shows true respect and concern for these individuals. Patients feel confident that they are being cared for because nurses have addressed their cultural preferences. Empathy is the second quality for nurses to adopt for cultural competency. This requires that nurses view problems or situations from the patients’ cultural perspectives. This gives patients a sense of security, knowing that their cultural ways are understood and appreciated by their nurses caring for them. Openness is the third attitude for nurses to cultivate for effective transcultural nursing. Having openness to others’ cultural perspectives shows patients that nurses give consideration to their particular ways. It also demonstrates that nurses appreciate these different perspectives and value cultural diversity. Flexibility is the fourth attitude nurses should adopt to become culturally competent. They need to integrate their patients’ cultural beliefs, values, and practices into nursing care plans for these individuals and not impose their own cultural desires in caring for these persons. Nurses demonstrate flexibility by showing their willingness to provide care based on their patients’ cultural ways, which helps them feel reassured that their care is individualized, and consequently, helps achieve mutually set goals. Step 2. Develop Awareness for Cultural Differences

To provide culturally competent care, nurses should be aware that their patients may have various cultural differences. Certain variables are important for nurses to know in order to design a care plan that meets the needs of their patients while complying with their cultural requirements. As stated earlier, cultures vary on communication patterns and social etiquette (Narayan, 2001).

Although it is helpful to obtain information about patients’ cultural norms, nurses need to remember that even within a cultural group, there is still diversity. No person is a stereotype of a culture. Individuals have beliefs, values, and practices that may deviate from their cultures. This points out the need for nurses to take the next step toward cultural competency, which is to perform cultural assessments on their patients.

Step 3. Perform a Cultural Assessment

A concise cultural assessment is an effective way to obtain pertinent information about patients’ perspectives on important aspects of their care (Narayan, 2001). It is important for nurses to learn which foods are culturally acceptable andif there are certain foods that are not tolerated. These questions guide nurses in planning care. More important, it gives nurses better insight as to which foods are considered healthy and helpful when experiencing an illness. Nurses will also gain pertinent information when they conduct a medication assessment. A thorough investigation will identify whether these patients subscribe to alternative medicine, as well as traditional medicine. Pain Assessment is especially important for nurses to conduct on persons from diverse backgrounds. Pain is a very subjective feeling because patients describe the sensations differently and have different tolerance levels for pain. Nurses need to assess pain by asking patients’ to describe how they feel, but it is also necessary to include facial expressions and body language in their assessments. This helps nurses better identify pain in patients from cultures that are expected to be stoic about pain, such as the Native Americans. In contrast, Mexican Americans exhibit high levels of emotion and anxiety with pain (Munoz & Luckman, 2005). Nurses need to examine their own beliefs and values about pain and pain control in order to be objective when performing pain assessments on their patients. Learning about patients’ family structures is important to understand when performing a cultural assessment. Family is the basic social unit, and it defines how persons of various cultures view health and illness. It also gives nurses insight about the support systems for their patients (Spector, 2000). These factors play a significant role in restoring and maintaining the health of patients.

Nurses should develop their plan of care with their patients in order to derive mutual goals that are compatible with their cultural norms. Patients will develop trust with their nurses and be comfortable with the nursing care plan because it is consistent with their cultural values and practices. They will likely adhere to the plan of care because they feel respected for their different cultural practices, promoting a positive outcome.

At times, nurses may assess that their patients’ cultural patterns are in conflict with their health needs. It is then necessary for nurses to try to create and implement new health patterns for these patients. This is best achieved when nurses listen with openness and understanding regarding their patients’ perspective about their illness. Nurses must then try to educate their patients about using therapeutic means different from their cultures that are helpful for restoring and maintaining health. Culturally competent nurses design care plans that promote patients’ compliance and incorporates safe and effective cultural practices.

FACTORS OF TRANSCULTURAL NURSING

The changes occurring in the U.S. population can be attributed to demographic, social and cultural changes. A growing elderly population and the escalating number of immigrants have attributed significantly to the overall increased total population in the United States. The large number of immigrants has had the major impact on the changes in the population. It has created a very diverse cultural population in recent years. The large number of persons from diverse cultures has enforced the need for social changes as well, such as routinely providing bilingual translations wherever needed.

Additionally, the health care system has had to also make changes to accommodate a diversified patient population. One of these changes in the health care system was to protect health care beliefs of persons from various cultures. The Nursing profession has shown support for accommodating other persons from different cultures by promoting transcultural nursing in daily practice. This is also referred to as culturally competent nursing.

A model that encompasses six factors can be used to promote transcultural nursing and assess nurses’ cultural competency (Campinha-Bacote, 2002). The first factor is awareness. Nurses need to be aware of personal biases and prejudices toward others from different cultures. Skill is the second factor. Nurses must have the skill to conduct cultural assessments in a sensitive manner. The third factor is knowledge. Nurses must adopt a broad perspective regarding different points of view to accommodate patients’ various cultural views. Encounters is considered the forth factor for transcultural nursing. It is important for nurses to expose themselves to patients from diverse backgrounds and provide effective care that is congruent with their cultural ways. The fifth and most important factor is desire. Nurses must want to achieve cultural competency. This means having an enthusiastic attitude to learn about others’ cultural ways and integrate them into the nursing care plans. The last factor is assessment. Nurses must perform a self-assessment to determine whether they are culturally competent in their nursing care.

TRANSCULTURAL NURSING AND ETHICS

Nurses encounter difficult ethical situations in daily practice. These situations may be even more challenging for nurses when the patients involved are from various cultural backgrounds. One ethical dilemma is whether nurses should discuss advance directives to patients who are uncomfortable about this because of cultural differences in their health beliefs.

One of the roles of nurses is to provide patients with in formation about advance directives. These are to protect patients’ autonomy in circumstances when they can no longer make a decision. Advance directives are readily accepted by the American culture. Other cultures do not view advance directives as a positive measure in healthcare. Some cultures subscribe to the belief that the fate of human beings is beyond their control. Filipinos are one such group who feel that planning for one’s death should not be in their control. Their view is that to do so, it is tempting fate and will bring death for sure. American nurses may feel uncomfortable obtaining information for advance directives without understanding that in times of illness Filipinos rely on fate for the outcome (Pacquiao, 2001).

Nurses encounter an ethical dilemma as to whether they should carry out their responsibility to discuss advance directives with Filipino patients knowing that Filipinos feel that it is very taboo to discuss such matters and even believe that any discussion of this will result in death. Nurses have a difficult decision in this situation, especially because above all, they are required to be sensitive and protect their patients’ cultural health beliefs.

Nurses learn that veracity and fidelity are ethical princi ples that guide their interactions with patients and families. Nurses are taught to support individual autonomy to benefit the patient. In the American culture, nurses provide truthful information to the patient in order that they can then make a decision about their healthcare. However, in other cultures, family members are the decision makers about the patient’s health matters. This is especially true when an illness is terminal. In certain cultures, it is the family’s role to protect the patient from the anxiety and distress associated with the knowledge of impending death. Families from Eastern cultures are especially protective of the terminally ill. They believe it is their responsibility to protect the patient, allowing the patient to die in peace (Moazam, 2000).

American nurses may encounter an ethical conflict when caring for terminally ill patients. They have learned to be truthful to dying patients in order to give them control. Yet, caring for patients from Eastern cultures would prevent them from being open and honest about their terminal illness. It would be important for nurses to recognize the cultural values and beliefs when making ethical decisions.

Nurses must maintain cultural competency in their care. It is important for nurses to be always aware of cultural differences in health beliefs. It is necessary for nurses to attain information about their patients’ cultural perspectives in order to provide care that is culturally congruent with their patients’ views and wishes. In making ethical decisions, nurses need to safeguard the health of their patients, yet still provide culturally competent nursing care in these situations. EDUCATION AND TRANSCULTURAL NURSING

Nurses have repeatedly expressed their frustration that they lack the education necessary to provide culturally competent care for a diverse mix of patients from other cultures (Labun, 2001). They have also acknowledged their limitations in caring for these individuals because they do not have enough transcultural knowledge and skills to enable them to deliver culturally sensitive nursing care. Nurses have stated that their basic nursing education did not prepare them to be culturally sensitive or enable them to provide care to patients of various cultures (Boi, 2000).

Practicing nurses should be offered a staff development program that focuses specifically on the knowledge and skills needed for transcultural nursing. In this program, nurses would first develop an awareness of their own cultural values and beliefs. This is necessary to do before nurses can go to the next step of accepting different cultural ways in healthcare. Nurses, who are able to accept others’ cultural beliefs, would then be able to learn to conduct cultural assessments. The last segment of this program would be for nurses to evaluate themselves regarding their ability for providing culturally competent nursing. Patients showing trust in their nurses and satisfaction with their care may be proof of culturally competent nursing care.

CONCLUSION

Transcultural nursing is essential in daily nursing practice. The ever-growing number of patients from various cultural backgrounds creates a major challenge for nurses to provide individualized and holistic care based on each patient’s cultural needs. This requires nurses to understand cultural differences in healthcare values, beliefs, and customs. Nurses must be open-minded and have a positive interest as well as a sincere desire to learn other cultural ways. Transcultural knowledge is important for nurses to acquire in order for them to become sensitive to the needs of patients from various cultures especially as societies become increasingly global and complex.

Since nurses have the most intimate contact with patients and are responsible for formulating care plans that help meet the individual needs of patients, it is a necessity for nurses to understand, appreciate, and respond to the patients’ cultural preferences. The most effective way to accomplish this is for nurses to increase their awareness of cultural differences and become knowledgeable about the cultural preferences of their patients under their care.

This highlights the need for nursing education to include transcultural nursing in the curriculum. It should instill in nursing students an appreciation for cultural differences in healthcare values, beliefs and customs. The curriculum in transcultural nursing should also teach the knowledge and skills needed to provide culturally competent nursing care. Furthermore, hospitals and other health care facilities should offer nurses frequent in-service programs on cultural competency in order to increase their level of confidence and knowledge of transcultural skills.

In addition, there is a need for future research to expand the knowledge base of culturally competent nursing care. One area to investigate in particular may be the meaning of quality nursing care from different cultural perspectives. Continued research should also focus on determining effective nursing interventions that advocate and provide culturally competent care to patients in a meaningful and acceptable way.

More federal and state funding should be appropriated to educate, research, and apply the findings to nursing practice. This will help promote transcultural nursing and ensure cultural competency in nursing care.

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Narayan, M.C. (2001). Six steps toward cultural competency: A clinician’s guide. Home Health Care Management and Practice, 14, 40- 48.

Office of Civil Rights, Department of Health and Human Services. (1998). Guidance Memorandum, 1964 Civil Rights Act Title VI prohibition against national origin discrimination. Retrieved July 15, 2005, from http://w.w.w.hhs.gov/progorg/ocr/ lepfinal.html#background..

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Pacquiano, D.F. (2001). Addressing cultural incongruities of advance directives. Bioethics Forum, 17, 27-31.

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MADELINE M. MAIER-LORENTZ, MSN, RN

Madeline M. Maier-Lorentz, MSN, RN, has a bachelor of arts degree in psychology, a bachelors and masters degrees in nursing, and is a doctoral candidate in human services. Ms. Maier-Lorentz is an adjunct nursing faculty member at National University in San Diego, California. Ms/ Maier-Lorentz may be reached at: Madeline. [email protected].

Copyright Tucker Publications, Inc. Spring 2008

(c) 2008 Journal of Cultural Diversity. Provided by ProQuest Information and Learning. All rights Reserved.

Constructing Cognitive Scaffolding Through Embodied Receptiveness: Toni Morrison’s The Bluest Eye

By Rokotnitz, Naomi

I. Truth in Timbre In a passage close to the beginning of The Bluest Eye, Claudia, the narrator, and her sister Frieda, are dutifully washing jam jars while their mother chats with her friends in the kitchen. Claudia compares the experience to a

wicked dance: sound meets sound, curtsies, shimmies, and retires. Another sound enters but is upstaged by still another: the two circle each other and stop. Sometimes their words move into lofty spirals; other times they take strident leaps, and all of it punctuated with warm-pulsed laughter – like the throb of a heart made of jelly. The edge, the curl, the thrust of their emotions is always clear to Frieda and me. We do not, cannot, know the meaning of all their words, for we are nine and ten years old. So we watch their faces, their hands, their feet, and listen to truth in timbre. (10)

The wealth of understanding that Claudia is able to glean from this seemingly passive act of observation is remarkable.. First, Morrison endows her childprotagonist with a highly developed receptiveness, a keen sensibility, acute musicality and vivid imaginative powers that translate female prattle into images of dance, abstract geometrical shapes, and sensuous representations such as a heart made of jelly. Claudia is unable to understand the meaning of the adults’ words, but she is able to ascertain the ambience of the conversation, and its significance, by converting its emotional “thrust” into mediums she can understand. Then, she projects herself into the action, so that she is effectively participating in it.

I wish to suggest in this article that the kind of empathetic projection described above, and the concomitant sensation of participation in observed action, constitute a powerful epistemological tool that is facilitated by the biological architecture of all human beings who are not disabled by neurological impairment. Through exercising her potential for receptiveness, Claudia is able to surmount the linguistic barrier between herself and the others and to gain valuable knowledge. As she explains in her testimonial narrative passages, recounted with such vividness they are rendered in present tense: “Adults do not talk to us – they give us directions. They issue orders without providing information” (5). Her knowledge base, therefore, is accumulated gradually, in fragments, and relies overwhelmingly on embodied knowledge. She learns to “read” gesture, expression, eye movement,1 body odor: to feel the ambience and cadence of a conversation through attunement to its physical and emotional thrust. Thus she listens for “truth in timbre” (10). Through repeated practice and increasing refinement, Claudia reaches a level of understanding that enables her in later life to articulate, with subtlety, sensitivity and captivating poetry, the constellation of events that lead to the tragedy recounted in The Bluest Eye.

Claudia may be modeled on Morrison herself, and there are certainly many autobiographical elements in the book, so that it is difficult to make a decided distinction between Claudia’s first- person accounts, and the third-person omniscient narrator passages. Naturally, narrator and author are not identical, and Claudia does not define herself as the writer, but I read the novel as the product of the adult Claudia, a stylized expression of her personal history, and that of her community.2 The Bluest Eye traces the process of Claudia MacTeer’s selfconstruction, and of Pecola Breedlove’s (self)destruction. The novel recounts a year in the lives of the two girls, and reflects upon the dramatic differences in character and circumstances that enable one to become a defiantly independent individual, while the other is abused, marginalized and finally driven to insanity.

In the first half of this article I aim to demonstrate that Claudia’s breadth of vision, grounded in her natural intelligence and creative abilities, is absorbed from her direct environment by a process of cognitive interaction. This kind of interaction has been the focus of many recent neuropsychological studies. Research shows that human perception of actions is influenced by the implicit knowledge of the central nervous system concerning the movements that it itself is capable of producing. To a great extent, we are able to interpret the actions of others because we share their motor schemata – we share a bodily knowledge of them. The neurologist Vittorio Gallese terms this “motor equivalence” (47). Gallese argues that humans are endowed with a mirror-matching capacity, an inborn inclination to imitate, indeed simulate, actions they observe others perform. Mirror-matching, appears to be “a basic organizational feature of the brain” (46).

This assertion was sparked by the discovery in the early 1990s of mirror neurons.3 Mirror neurons are activated by goal-related behaviors. They do not respond to random movements, such as a tree swaying in the wind, but only to the apprehension of meaningful interaction, such as a hand reaching to pick an apple. When we observe an action we perceive as intentional, our mirror neurons activate both the visual areas that observe the action and, concurrently, recruit the motor circuits used to perform that action – the circuits that we would use were we to perform that action ourselves. Giacomo Rizzolatti and Michael Arbib explain further that this mirror system is involuntary. Even though we are able to resist imitating actions we observe others perform, we are not able to prevent our bodies from responding at a preconscious imitative level. As Gallese notes, “action observation implies action simulation” (37). This implies that Claudia’s sensation of participating in the action in the kitchen is justified. Not only is she able to take part, through simulation, in the conversational dance she witnesses, but she is able to learn from it, physically, as she would were she really to take part.

Mirror neurons participate in human action-understanding and actionimitation processes (Rizzolatti and Craighero 169). They also influence motor memory (Stefan).4 However, accumulating research suggests that our mirrorresponse mechanisms are distributed about the brain and are not confined to a particular region (Keysers 343; Agnew 291). Quite to the contrary, it seems increasingly likely that our mirror neurons work in conjunction with other neural networks, such as those responsible for memory and inference, and also with an intricate network of peripheral nervous system pathways stretching all over the body, activating empathetic “motor equivalence.”

The philosopher Andy Clark identified this conjunction in 1998. He observed that humans are evolved to exploit “any mixture of neural, bodily, and environmental resources, along with their complex, looping, often nonlinear interactions” in order to inform and supplement their understanding, as well as compensate for their limitations (“Where Brain” 259). The biological brain is just a part, albeit a crucial part, of “a spatially and temporally extended process” of cooperation between brain, body and environmental aids (“Where Brain” 271 ).5 In a sentence that is particularly apt to the passage I have cited from The Bluest Eye, Clark claims that humans “exist, as the thinking things we are, only thanks to a baffling dance of brain bodies and cultural and technological scaffolding” (Natural Born 11 ). The human mirror-system both enables and encourages us to maximize our cognitive potential by drawing upon multiple information gathering and processing mechanisms that extend our “cognitive scaffolding” (“Where Brain” 274). Cognitive Scaffolding, as will shortly becomes clear, also plays an instrumental part in Morrison’s construction of the protagonists in her novel, and in her analysis of the community she describes.

II. Pecola

The Bluest Eye is Morrison’s first fictional attempt to explore how one “learns””racial self-loathing” (Morrison, TBE 167). She recognizes that “the damaging internalization of assumptions of immutable inferiority [originate] in an outside gaze” (168). Yet, at the same time, she examines how the community described in the novel has internalized the white-man’s degrading gaze, so that it grows like a cancer from within.6 Morrison aims to impress upon the African-American community the extent of their (largely unconscious) complicity in the warped hierarchy of values that perpetuates their subjugation. If dominant white ethics define beauty in terms of light skin, light hair and blue eyes, this does not sufficiently explain why most of the African-Americans in Morrison’s novel not only accept but reinforce this view, exposing “the raw nerve of racial selfcontempt” (168).

Although they are free, relative to their slave ancestors, Morrison’s representation of African Americans implies a continued enslavement by cultural prejudices. Their internal enslavement is far more difficult to identify, and so more difficult to eradicate. It implies, of course, a long history of violence, slavery and discrimination, but the process of learning self-depreciation described in the novel is, for the most part, conducted through commercialized market forces: Hollywood movies and their byproducts – Shirley Temple mugs (16), Mary Jane chocolates (37), Jean Harlow hairstyles (96), etc. Ironically, the target-audience for these products is the White middle-class consumer and not minority ethnicities. However, when consumers such as Pauline Breedlove find themselves entirely excluded from marketed notions of desirability, they begin to see themselves through the (blue) eyes of others, thus perceiving a distorted self-image. The more a character becomes convinced of the White beauty-ethic, the more he or she feels innately inadequate. Increasing frustration and rejection develop into a conviction of ugliness – external and internal – that results in pathological behaviors ranging from indifference to abuse, both of self and others. Morrison is careful to portray a range of different responses to this predicament, but she repeatedly shows how focusing on material gains and a fantasy of beauty they cannot possibly fulfill, robs the majority of the AfricanAmericans both of respect for their own merits and of pride in their past heritage. In other words, by simulating the dominant cultural practices which they observe about them, through individual and collective mirror- matching potentialities, the members of the community described in the novel have learned to efface, even deny, their own beauty, social significance and personal worth.7

Morrison explains in the Afterword to her novel that Pecola’s family is not representative but, rather, a study case of the most extreme, even “monstrous” potential of the internalization of racial hatred (168). And yet, as Jane Kuenz points out, the case of Aunt Julie delineates a precursor for Pecola’s own escape into madness, suggesting that “the town has an undiagnosed and unexamined history of producing women like Pecola, that her experience – and the extremity of it – is not an isolated instance” (429).

In the first scene in which the ironically named Breedlove family is presented to the reader, Pecola’s parents, Pauline and Cholly, are engaged in violent combat brought on by “inarticulate fury and aborted desires” (TBE 31). While their son screams at his mother “Kill him! Kill Him!” eleven-year-old Pecola tries to make herself disappear. She tries to imagine away every limb in her body, literally erasing her physical presence. She finds, however, that she cannot erase her eyes. This may imply to the reader that she cannot extract herself from the harsh realities of her home. Unable to grasp the metaphoric significance of her eyes as windows to her soul, Pecola becomes obsessed with their physicality. She prays continually for blue eyes, hoping that were she to have blue eyes, maybe her parents would be different: “Maybe they’d say ‘Why, look at pretty-eyed Pecola. We mustn’t do bad things in front of those pretty eyes'”(34).

Pecola’s invisibility may be a feat of imagination, a studied defense mechanism, but it has tangible effects in the real world. As Malin La Von Walther asserts, “the effect of popular American culture’s specular construction of beauty is that it bestows presence or absence. One’s visibility depends upon one’s beauty” (777). Pecola’s experience of invisibility and her belief in her own ugliness and, thus, her worthlessness, renders her so weak, that even the lowliest characters in her society can take advantage of her. Time after time she is ruthlessly abused, by the school boys, by Junior and his mother Geraldine, by Church Soaphead, and by her own parents. And each time her only response is to try to diminish her own presence. She does not attempt to defend herself, to justify herself, or to attain any measure of understanding. She simply accepts – almost expects – violation after violation.

III: Cognitive Scaffolding

In contrast, Claudia, the narrator, though two years younger than Pecola, possesses a powerful drive to self-determination. I have begun to suggest that this drive is fed by her receptiveness to external stimuli, a receptiveness that enables her to learn from her environment. As the evidence regarding mirror neurons and the theory of cognitive scaffolding jointly suggest, humans learn through interaction. Pecola is disabled, mentally, physically, and socially, by being entirely cut off from all forms of human interaction, while Claudia is exposed to a wide variety of inputs that enable her to extend and develop her personal capabilities: to construct complex cognitive scaffolding.

In a telling scene early in the novel, Claudia and her sister Frieda come across Pecola, encircled by a group of rowdy boys who are taunting her. She has dropped her books and stands in their midst covering her eyes. This devastatingly infantile gesture emphasizes her lack of sophistication. She behaves as a toddler might. The gesture also ties into her obsessive preoccupation with her eyes. She wishes not to see her abusers, and at the same time, hide her ugliness from them. Frieda and Claudia instinctively leap to the rescue. This act of defiance and solidarity exemplifies the extent to which their life-experience has been enabling, where Pecola’s has been crippling. First, Claudia and Frieda have each other as constant companions who expand each other’s fields of knowledge. It is Frieda, for instance, who tells Claudia about menstruation. Pecola has a brother, but the dynamics of her family unit are such that they do not communicate on any level. Instead, like the characters in Sartre’s No Exit, each of them is locked “in his own cell of consciousness, each making his own patchwork quilt of reality” (TBE 25). However, the MacTeer girls’ chief advantage over Pecola is that they are part of a community. Their mother has friends who gossip in the kitchen and, when they try to sell their marigold seeds, the girls are taken in, given lemonade and become privy to the women’s chatter. In this bullying episode, Claudia and Frieda display an understanding of the strategies of threat and negotiation, an understanding they have presumably acquired while overhearing the such chatter – and so participating in conversational-dances of the kind cited above. Frieda has enough confidence in her sexuality to target Woodrow, the ringleader, whom she knows has a crush on her. She implies that she knows a secret that he would not like revealed, and thereby diffuses the situation.

Claudia attributes her sister’s success to the fact that she is physically taller than the boys, but also to the facial expression she assumes: “set lip and Mama’s eyes” (SO).Vanquishing the bullies is achieved through embodied simulation – through adopting the very gestures and expressions their mother uses when taking a stand. Indeed, Mrs. MacTeer is the most influential contributor to the construction and reinforcement of her daughters’ cognitive scaffolding. She has taught her girls, through example, rather than by ever speaking of it, that they have a right to be angry sometimes, that they can and should defend themselves, and that they can take an active stand against abuse. Later on, when Mr. Henry tries to fondle Frieda, she does not hesitate to tell her parents. Outraged, they end up shooting at him, so that he leaves town in disgrace. This stands in stark contrast to poor Pecola who, confiding in her mother after being brutally raped by her own father, is beaten viciously in response. Mrs. MacTeer has also shown her girls, once again through example, that they should help their friends. When Pecola’s father first burns down their house, it is the MacTeer who takes her in, while her own family fail to inquire whether their child is “live or dead” (TBE 17). By observing their mother, the girls have also learned to imitate successfully her very manner and demeanor. This unconscious body-based knowledge, performed through “motor equivalence,” is the most important tool they wield. Blue eyes are not attainable Mama’s are. Successful simulation has tangible effects. This fact is of profound and determining importance in the novel.

Another aspect of Mrs. MacTeer’s unconscious scaffolding- construction can be found in her singing. Morrison’s mother was a singer and it is not by chance that music provides an underlying structure in the novel. The improvisational Jazz, which requires each player to exhibit both individual skill and acute attunement to his fellow musicians, together with the sensual Blues, constitute a form of self affirmation in the novel. As Cat Moses points out, the melody and lyrics of the songs Mrs. MacTeer sings, suggest to Claudia a sense of hope, of freedom and of personal agency. She learns that it is possible to steer the course of one’s own life. The songs also disclose a world of sensuous romance and sexual delight. When Mrs. MacTeer gives way to her singing mood, her voice becomes sweet and her “singing-eyes so melty” that her songs seem “delicious” (18). Her singing is not directed at, nor particularly conscious of, the listening child. Yet it nonetheless imparts invaluable knowledge. Claudia is infused with affection for AfricanAmerican culture and for her own kind. In contrast, Pecola can see no way out of her predicament. She is not fully conscious of the possibility of escape. She has never been sung to, she is hardly ever spoken to. Pauline’s rejection of her own daughter, in favor of the girl for whose family she works, with her corn-colored hair and blue eyes, constitutes one of the most heart-wrenching episodes in the novel (84). Pecola sees herself through increasingly hostile filters, represented by other people’s viewpoints and, significantly, their eyes: Shirley Temple’s idealized innocent blue eyes, and her mother’s oppressive black eyes, filled with scorn. How could Pecola ever work up the confidence or initiative to escape?”

Clark argues that the processes by which individual and environment interact are reciprocal: we both create and, in turn, are created by the very same interactions (“Natural Born”! 1 ). In a reasonably supportive environment, we can adjust, adapt, transform and advance: through accumulating experiences, through gradually refining our understanding. Claudia is able to do just this. And this is what one would normally expect. As Clark asserts, the only constancy our extended cognitive system may be said to enjoy, is its “continual openness to change” (8). Pecola, on the other hand, is denied the benefits of the interactive “loop” and remains unassisted by any form of scaffolding. She stands alone, rejected, on the periphery of the loop. Her plight is made more tangible if we consider her not merely as neglected, but as disabled. Zuckow- Goldring and Arbib have shown that caregivers normatively direct and focus, verbally and nonverbally, the child’s attention to, and. understanding of, the potential uses of specific objects. By both demonstrating the use of a fork, or cup, or ball, and by guiding the child’s initial experimentation with the object, caregivers expand the infant’s understanding of both the opportunities for action available to them, which they term “affordances,” and the repertoire of actions their own bodies may perform, which they term “effectivities” (ZuckowGoldring 2181). Learning through assisted trial and error, infants not only increase their range of skills, but also their confidence in experimentation itself. This is crucial. By being denied any form of caregiving – in infancy or at any other stage of her life – Pecola is left to fend for herself in a sea of information. Indeed, if the assisting caregiver’s direction reduces “search space and thus speed[s] learning,” it becomes clear why Pecola’s learning process is so much slower than that of other children (Zuckow Goldring 2181). She is neither assisted in the learning process nor told which elements in her environment are invariants-persistent or stable-and so do not require continual vigilance. Moreover, though Pecola learns through imitation – through translating observed action into self-executed action, thus drawing upon her mirror-matching neural networks-she is usually denied insight into the impetus for, and the significance of, these actions. This hampers not only her understanding of the actions themselves, or the appropriate moment to imitate them, but also restricts her ability to predict when such behavior may .be used against her. How can she learn to read the signs that would lead another to suspect Junior or Church Soaphead?

Although humans have a natural-born curiosity, a great deal of our interest in exploring the world around us depends upon the encouragement of our caregivers; on what Zuckow-Goldring and Arbib call “educated attention”(2183). Children who are stimulated, encouraged, and then rewarded, by praise or by success, for their (mental) activity, may be expected to continue this behavioral trait in later life. On the other hand, children who are largely ignored will also, eventually, learn to eat, walk, and even talk, but their level of enthusiastic engagement with, and independent exploration of, their environment will be radically reduced “looking is not enough, since the gaze of the untutored infant cannot pick out the relevant affordance”(2182). Pecola, as I continually suggest, represents the “untutored infant”; she is disabled by those who ought to provide care and guidance.

My analysis of the discrepancies between Claudia and Pecola’s cognitive potentialities is, thus, corroborated by neuropsychological research. It seems that the older one gets, and the more one is exposed to demonstrations of complex actions (that can be imitated via the neural system described above), and the more practice one gets in performing these actions oneself, the more one increases one’s range of cognitive complexities. These complexities are registered in the very biological structures of the brain (Molnar-Szakacs). ‘ Moreover, there exists an overlap in activations of action-recognition and language-production areas of the brain (Arbib; Molnar-Szakacs). Increasing cognitive complexity occurs in both action-perception and language production areas concurrently, since these two share the very same cognitive resources and neural substrata (Molnar-Szakacs 925). Understanding observed action, initiating independent action and developing linguistic dexterity are all interlinked and are all facilitated by our mirror-matching system.

The mirror through which Pecola has observed herself since birth is the one reflected in her mother’s disapproving eyes. At the very end of the novel, she stands before a real mirror, gazing into her own eyes, which she thinks are blue, a tragic representation of her desperation to fulfill her mother’s expectations. Ironically, finally obtaining, in her mind, blue eyes does not earn her the minimal recognition for which she hoped. While she was overlooked when she had black eyes, she is actively ostracized once she obtains blue eyes. That she does not understand it is her pregnancy that people are avoiding, emphasizes the solipsistic loop of her radically limited cognitive spectrum.

Meanwhile Claudia’s family context enables her to access a primal power, something close to nature, in tune with the body, that is her natural right. While Pecola consumes milk from a Shirley Temple mug (TBE 16), and devours Mary Jane chocolates (37), literally trying to ingest the beauty these girls represent to her, Claudia buys “Powerhouse bars” (59). Her resilience is a concerted effort, one she actively reinforces everyday – “against everything and everybody” ( 150). Her power enables her to shun cultural restrictions. She recounts how she once received a “big blue-eyed Baby Doll” for Christmas. The gift was physically repellant to her. She had only one desire: “to dismember it” (14). Instead, her image of an ideal Christmas is a harmonious and intimate experience, quite opposed to the dominant consumer culture:

Had any adult with the power to fulfill my desires taken me seriously and asked me what I wanted, they would have known that I did not want anything to own, or to possess any object. I wanted rather to feel something on Christmas day. The real question would have been, “Dear Claudia, what experience would you like on Christmas?” I could have spoken up, “I want to sit on the low stool in Big Mama’s kitchen with my lap full of lilacs and listen to Big Papa play his violin for me alone.” The lowness of the stool made for my body, the security and warmth of Mama’s kitchen, the smell of the lilacs, the sound of the music, and, since it would be good to have all of my senses engaged, the taste of a peach, perhaps, afterward. (IS)

This unapologetic attention to the body is key, I believe, to the greatest discrepancies between Claudia and Pecola, and the very fountain of Claudia’s strength. At the end of the novel, Pecola becomes imprisoned in solitary confinement, forever a child, forever longing for the bluest eye. Claudia, supported by intricate and sturdy scaffolding networks, is able to become one of the most influential fictional characters who helped young girls in the 1970s internalize that black is beautiful.

IV. Just As No Count

In parts IV and V of this article I focus upon Pauline Breedlove, Pecola’s mother, and a number of other adult female figures in the novel, in order to try to locate the cognitive slippage that disables Pecola. The Bluest Eye suggests that the healthiest environment for a growing child is one which rewards body-based, sense-rich, and intuitive perceptions and, thus, provides a necessary balance between embodied knowledge and linguistic, analytical skills. Analytical skills are, of course, equally body- based, in that they take place in the brain, but they function differently, involving the application of reasoning and narrative- constructing skills. It appears, moreover, that there is a biologically predetermined chronology to their application. The neurologist Antonio Damasio asserts that it is the body that first responds to emotional signals, while reflection upon the embodied response is a secondary process (283). This does not imply a hierarchy of importance but simply the stages by which humans regularly comprehend.

The Bluest Eye explores the potential effects of a radical imbalance between automatic body-based responses, and secondary, discursive modes of apprehension and comprehension. Since the novel was written in the 1960s, and published in 1970, Morrison could not have known of either the theoretical arguments or the scientific investigations that now support her claims. My aim is not simply to prove her intuitions were correct by supplying scientific evidence for them, but to show how her astoundingly complex analysis matches what we now know regarding brain functions and human understanding. As Catherine Emmott has asserted: “Cognitive science can provide new technical tools for narratologists, but, conversely, narratology has a wealth of understanding of complex narrative texts to offer cognitive science” (319).

A poignant example of Morrison’s intuitive accuracy can be seen in the passage that describes Pauline Breedlove’s childhood. The reader is impressed by Pauline’s unusual attraction to colors. Her recollection of home is characterized by “a streak of green” created by effervescent June-bugs (TBE 87). She also recalls a time when, as a child, she had picked berries and the juice had seeped through her pockets, staining her very skin. “My whole dress was messed with purple, and it never did wash out. Not the dress nor me. I could feel that purple deep inside me” (90). It is not merely that Pauline is naturally comfortable with her sensuality but that her perceptions, and her memories, are formed though embodied receptiveness. Her sensuousness and her imagination combine to imply both a potent desire for “an all-embracing tenderness” (88) in the form of a partner, and also a distinctive artistic inclination. Pauline, we are led to suspect, was born with the kind of sensibility that, were it encouraged, may have been expressed in beauty. Unfortunately, however, Pauline missed, “without knowing what she missed paints and crayons” (87). Nonetheless, when Pauline falls in love, it is likened to an explosion of color, mingled with varied textures and tastes: berries, lemonade, June-bugs and yellow eyes fuse together into an intense and tactile experience that merges abstract and physical apprehensions. Kuenz notes that, for Pauline, sexual pleasure is tied into a sense of “a power” (TBE 101 ; Kuenz 427). Pauline’s sexual appetite is generated by Cholly’s desire for her, but “not until I know that my flesh is all that be on his mind” (TBE 101). Then, she continues, “/ be strong enough, pretty enough, and young enough to let him make me come.” I must add that Pauline’s orgasms, beyond the sexual pleasure they afford, the sense of communion with her partner, and the gratification of being desired, carry significant weight in terms of empowerment because they remind her of her embodied self. Sex makes her feel “… those little bits of color floating up in me – deep in me[…] then I feel like I am laughing between my legs, and the laughing gets all mixed up with the colors […] and it be rainbow all inside. And it lasts and lasts and lasts” ( 101 -2). But it does not last. The fact that she needs to feel Cholly’s desire in order to release her own, is tragically replicated in her need to feel that others respect her in order to be able to respect herself. When this does not occur, she loses respect and sexual drive. In the industrial north, Pauline’s increased isolation and loneliness, coupled with the Hollywood films she regularly watches, subdue her nature. Cholly fails to embody a canvas for her colors, and as their intimacy declines, the colors fade. Sensuality is stifled and replaced by his drunkenness and her adoption of dogmatic Church doctrines. The rainbow colors that accompanied her country-life are replaced by color blindness. Her life becomes black and white: black and white movies, black and white skins.

Pauline’s blackness, her pregnancy, and every other manifestation of her physicality are entirely absent from her visual and cultural intake. Gradually understanding the extent of her own invisibility, Pauline tries to match the representations she does see. She changes hair styles, buys new clothes, experiments with makeup. But these efforts only engender a “collecting [of] self contempt by the heap” (95). She feels ridiculous, and she is not accepted by the community of women, who make her feel “just as no count” (91).

The thinning of her physical apprehensions, the threat to the sensuous and artistic rainbow embodiment of experience in which she delighted until then, is represented by her losing her front teeth. “Everything went then… I just didn’t care no more after that” (96). This is particularly telling when viewed in light of Jerome Kagen’s assertion that “chronic identification with a category of self marked by disadvantage and compromised status contributes to the vulnerability to illness”( 181). Poverty is less a hindrance to personal advancement than is the belief in one’s “relative disadvantage” (180). This becomes all the more pronounced among children who are both poor and members of a minority ethnicity. Suspicion that one’s social and biological inheritance is inferior stunts confidence and can often create a level of psychological stress that may contribute “greater morbidity” (181).

Thus, Pecola is born to a mother who has already perfected the devaluation of herself through commercialized fantasies (Rosenberg 440), she has already performed an “abdication of self (Kuenz 422). Her choice of the name Pecola is a symptom of this condition. As Maureen Peal (rather than her own mother) tells Pecola, her namesake is a character in a film called, significantly, Imitation of Life: “this mulatto girl hates her mother ’cause she’s black and ugly” (TBE 52). Morrison adds extra irony to this anecdote through Maureen’s evaluation of the film: “It was real sad. Everybody cries in it” (52).10

I wish to suggest that Pauline’ s story in The Bluest Eye describes how a process is put in motion, by which the constructive potentialities of human mirrormatching capabilities are reversed. Pauline blocks out any external sources with which her own networks may interact productively and tries instead to emulate networks that are alien to her. She rejects all that she is, but cannot attain that which she is not. If, as suggested above, empathetic projection and the sensation of participation in actions observed provide a powerful epistemological tool, then, by the same token, Pauline’s self-effacement can be understood to be a powerful epistemological obstacle. Pauline, in effect, dismantles the cognitive scaffolding that she had constructed for herself in childhood and that, ironically, served her very well until after she was married.

One of Pauline’s greatest cognitive obstacles is an underdeveloped capacity for narrative. In childhood, while her embodied receptiveness was exceptionally vivid, she had a natural aversion to words, even felt “depressed by words” (87). Pauline’s natural inclinations, her innate kind of understanding and her sense of (aesthetic) pleasure, are all abstract, experienced very actively in the body, and lacking, even eschewing, any logical or narrative analysis. This, I submit, makes her vulnerable to the narrative frameworks suggested by others, particularly those most prevalent in her society. As Jerome Bump phrases it, she “accepts the master narrative without questions” (164-65).” Her immersion in the dominant, white, popular culture leads her to assimilate a racist view of herself.

While Claudia has a heightened capacity for embodied receptiveness, she also possesses the ability to frame her sensations, to interpret cause and effect in a social context. Kay Young and Jeffery Saver maintain that “what predominates or fundamentally constitutes our consciousness is the understanding of self and world in story” (73). Claudia is adept at expressing herself in narrative form while Pauline finds it harder to conceive of a narrative progression in her life. Her modes of understanding are antithetical to this secondary process, and this may be one of the causes of her demise.12 This view is enhanced by considering dark’s assertion in “Language, Embodiment, and the Cognitive Niche” that language is “a mode of cognition-enhancing self- stimulation”(370); a “key cognitive tool enabling us to objectify, reflect upon, and hence knowingly engage with, our own thoughts, trains of reasoning, and personal cognitive characters”(372). This may also explain, in part at least, how Pauline’s own pain performs a short-circuiting of her empathetic reactions. Sympathetic as the reader may be to her plight, few can remain tranquil in response to her complete indifference to her daughter’s pain. Pauline’s inability to identify with her daughter derives from her perception of Pecola as embodying all that she rejects in herself. Her resistance to Pecola is fed by her (culturally prompted) resistance of her self. She perceives both herself and Pecola through eyes that deem them repugnant.

Pauline is left stripped of any kind of cognitive scaffolding.” What, then, is left of her essential self? And with what tools may she interact with the world? The answer comes in the form of servitude. Pauline adopts willed schizophrenia. She makes a conscious choice to live a double life, ignoring her own home and family and living exclusively for the benefit of the Fisher family for whom she successfully embodies “the ideal servant” (TBE 99). At the Fisher’s she enjoys “power, praise and luxury.” They even give her “what she had never had – a nickname – Polly” (99). Jennifer Gillan argues that Pauline gladly trades in “her own troubled body and history” for the freedom of movement afforded by her new identity as Polly. Pauline “believes that she is squalid and dark like her apartment and that the Fishers are stately and clean like their house. Pauline can only maintain a positive self-perception by affiliating herself with the Fishers” (Gillan 291). I wish to extend this observation by arguing that the Fishers provide Pauline with the narrative framework she lacks and with a well-defined role. Pauline is blind to the ironies of her exploitation. She is entirely convinced – even comforted by – her own rejection of her essential self in favor of this Polly-persona. And yet she cannot inhabit Polly all the time. At the end of each day, the fantasy must be set aside and the old identity of Pauline re-assumed. Pauline’s persisting dissatisfaction and bitterness remain untouched.

V. Natural Funkiness

Morrison demonstrates that denying one’s natural inclination and denying the physicality of one’s body, result in self- nullification. Consider, for instance, Miss Delia Jones. When her husband is asked “why he left a nice good church woman like Delia for that heifer,” he replies that “the honest-to-God real reason was he couldn’t take no more of that violet water Delia Jones used. Said he wanted a woman to smell like a woman. Said Delia was just too clean for him.” The gossips’ response is telling:

“Old dog. Ain’t that nasty!” one exclaims.

“You telling me,” another replies, “What kind of reasoning is that?” (TBE 8)

This question resounds throughout the novel, for the point is precisely that reason is irrelevant here. It is a matter of physical, sexual attraction, of passion and of authenticity. Just as Claudia cannot relate to the plastic dolls, so Delia’s husband cannot relate to his lavender-besmothered wife. Delia, like Pauline and Geraldine, unable to construct her own narratives, instead adopted those of others, particularly the narrative represented by the Dick and Jane primer passage, which serves as an epigraph to the novel.14 Della and Geraldine cultivate “thrift, patience, high morals, and good manners” at the expense of “the dreadful funkiness of passion, the funkiness of nature, the funkiness of the wide range of human emotions” (64). ” In the process, they nullify their own being, and lose their attractiveness. Indeed, in accordance with the Dick and Jane primer, the “hunger for property, for ownership” is the primary preoccupation of the community (12). “Propertied black people,” recalls Claudia, “spent all their energies, all their love, on their nests.” The use of the word nest implies a nurturing and natural environment, but the fact that all their love is expended on the external structure, implies a lack on the inside. This obsession for housing and cleanliness is partly bred by a fear of being put “outdoors” and partly by a (sub)conscious desire to emulate the white American dream (11). The struggle to fit into a dream from which they are entirely excluded takes up all their energies. This leaves little time or emotional energy for the people who live in the house: themselves and their children.

Interestingly, the more the women in The Bluest Eye care about their houses, the less they care for their own bodies. They are kept clean of course, but to such an extent that they are sterilized. As I have been arguing, the white beauty ethic divorces the women from their sexuality. The more Geraldine and Pauline, in their own ways, try to erase their blackness, the less sexually desirable they become. Morrison complicates this further by tying into Pecola’s rape. The action that Pecola performs that stirs desire in Cholly is the scratching of her ankle – a repetition of the very action her mother was performing when he first met her. Although this rape is rooted in a twisted knot of complicated personal and collective histories, it appears that one of its roots is Cholly’s longing for a simple, unaffected, natural easiness, which Pauline once had.16 While the women hanker after an impossible white ideal, the men still desire their real imperfect bodies.

This is explored further through the characters of Miss Marie, China, and Poland, the three prostitutes. They are, or at least believe themselves to be, prostitutes by choice. They are not owned by any man, nor are they enslaved by drug addiction. They are as much in control of their own lives as any of the other African- American characters in the novel.17 Moreover, though they are no longer young, though China has bandy legs and Marie is overweight, they remain desirable – the men want them. Ironically, these three are the only ones who express any interest in, or exhibit any affection towards, Pecola. While the churchgoing women follow the fire-and-brimstone ethics of judgment, the prostitutes represent an alternative ethic – that of (equally Christian) compassion. Though universally feared and abhorred by all the other female characters in the novel, their company provides a small oasis of ease for Pecola. It is not by chance then, I suggest, that it is in their company that Pecola experiences a momentary awakening of her sensual potentialities. In their midst, she allows her imagination, for one brief instant, to be stimulated. When Marie recalls frying fish with her lover, Pecola not only visualizes the details of this sensuous experience, but experiences an allinclusive sense-rich apprehension:

Pecola saw Marie’s teeth settling down into the back of crisp sea bass; saw the fat fingers putting back into her mouth tiny flakes of white, hot meat that had escaped from her lips; she heard the “pop” of the beer-bottle cap; smelled the acridness of the first stream of vapor; felt the cold beerness hit the tongue. (41 )

However short-lived this “daydream” may be, it allows the reader a glimpse into a window of possibility, biologically available, yet perpetually emotionally closed before Pecola.

This observation feeds back into our assessment of Claudia’s confidence, for it too cannot be detached from her own imagination and sensuality. When Frieda is molested by Mr. Henry, instead of being shocked or outraged, Claudia asks “how did it feel?” This is acknowledged to be “the wrong question” – but is it? (76) I wish to suggest that by fostering her sensuality – her keen senses and her delight in engaging them all-Claudia opens up a world of multiplicity and possibility, of sensual interaction with the world. Claudia is not repelled by the body functions or body products that culture teaches us to clean up.18 She studies her own vomit (6), wants to see the blood of menstruation (20), spends her time picking “toe jam,” and enjoys her nakedness (IS). She and Frieda not only feel comfortable in their own skins, but “admire” its dirt and “cultivate” its scars (57). This ease is partly explained by their young age, still oblivious to the gender and sexuality politics that condition and delimit the feminine, the desirable. And yet, although Claudia admits that, soon after, both sisters succumbed to the dominant cultural prescriptions, this acquiescence is temporary. Adult Claudia, the narrating Claudia of the novel, has seen through her teenage weakness, and has re-acquired the defiance her childhood self championed. Similarly, the rampant jealousy, hatred and violence towards white dolls and their human counterparts, which Claudia and Frieda deem “natural” in 1941, is soon curbed by socialization (59). And yet, physicality and passion are reclaimed – in socially acceptable and far more productive manifestations – by the adult Claudia. As I have indicated above, Claudia’s embodied receptiveness is assisted by increasingly sophisticated discursive modes of analysis – psychological, social, political – that inform the artistic creativity expressed in her narration of her story.

VI. Marigolds

When Pecola’s pregnancy becomes apparent, she is made to leave school and is shunned by all. Claudia recalls the common response: “Ought to be a law: two ugly people doubling up like that to make more ugly. Be better off in the ground” ( 149). People are “disgusted, amused, shocked, outraged, or even excited by the story.” Claudia and Frieda listen for someone to say “Poor little girl,” or “Poor baby,” but they encounter “only head wagging where those words should have been” (149). Against the current of their community’s antipathy, Claudia and Frieda try, once again, to rescue Pecola. They decide to plant marigold seeds, hoping that “if we planted the seeds, and said the right words over them, they would blossom, and everything would be alright” (4).

But the mangolds do not grow, the baby dies, and Pecola goes mad. For years Claudia holds herself responsible, believing she was to blame for these premature deaths. However, as she grows older, as she amasses cultural and sociological knowledge, and as her analytic faculties are developed, she recognizes the web of circumstances that were pitted against flowers and babies alike in 1941. The linguistic skills and idiosyncratic modes of expression she has developed enable her to finally voice those words that were left unsaid – to cry out “Poor Baby”!

This cry is comprehensive in scope. As Claudia herself explains: “More strongly than my fondness for Pecola, I felt a need for someone to want the black baby to live – just to counter the universal love for white baby dolls, Shirley Temples, and Maureen Peals” (149). The girls do not consider the social outrage, or the biological dangers, of Pecola having a baby by her father. But they do sense the “overwhelming hatred for the unborn baby.” Claudia and Frieda want this baby to survive, almost as an existential equivalent of their own struggle for survival and recognition. Claudia’s attunement to the physicality of human bodies also intensifies her sense of the baby’s reality. To her, the child is not an abstract abomination but a living, breathing baby. Conjuring the physicality of the body, its fragility, its blackness, its lovability, counteracts the distorting and distancing discourse of the adults. And this is exactly what she does later on in life by writing this novel.19

Indeed, the written record of Claudia’s testimony, and the intricate narrative devices deployed by Morrison, express not only the maturity of understanding that the protagonist has reached, but the fundamental appreciation of words themselves as intrinsic to our cognitive scaffolding. Clark argues that language is not merely a form of communicating pre-formed ideas but an integral part of the thinking process itself. Words have a “physical existence as encountered and perceptible items, as sounds in the air, as words on the printed page”(“Language” 370). As concrete perceptible items, words allow us to engage in forms of reasoning that would otherwise elude us (371). “Thinking about thinking,” asserts Clark, is “dependant on language for its very existence”(372). By understanding words as “bodily forms,” Clark reconfigures their relation to humans as embodied agents (370). In turn, Claudia’s natural talent for building upon her embodied perceptions through a secondary process of analysis and narrative construction, assisted by intricate external aids – or cognitive scaffolding-enable her to blossom, against the odds, instead of the marigolds. Pecola is lost, but Claudia can try to tell Pecola’s story, and her own. As an adult, Claudia can finally unpack the linguistic component of the conversational-dance she overheard in childhood, enabling her to accept responsibility for her part in the collective ills of the 40s, to lament a tragic loss, and to ask for a measure of forgiveness, while also extending a warm embrace to her own kind. In recounting her story, Claudia manages to overturn the earth, sprinkle it with nutrients, and prepare it for a new batch of marigold seeds. Generations to come will be able to enjoy these flowers, smell their delicate scent, and rejoice in their beauty.

Considering Morrison’s novel in light of recent neuropsychological studies and theories of mind, embodiment and cognition, I suggest that The Bluest Eye offers incisive insights into human processes of intersubjective communication. Morrison’s sensitive portrayal of the emotional histories of her characters facilitates an examination of the role of what Andy Clark terms “cognitive scaffolding” in the construction of self. Claudia’s powerful attraction to the body, which stands in contrast to the accepted norms of the dominant white-Christian culture of her time, allows her to access a primal form of understanding that ought to be available to all humans through “motor equivalence.” Her particular form of receptiveness, which both embraces the body and maximizes its multiple means of knowledge acquisition, and her keen attunement to emotional cadence, generate both self-empowerment and productive socialization. Notes

1 For instance, when Mrs. MacTeer realizes she should not have whipped the girls for “playing bad” when they had in fact been helping the menstruating Pecola, she does not apologize outright. “She pulled both of them towards her, their heads against her stomach” (22). Claudia understands this gesture, and observes that her “eyes were sorry.”

2 For an interesting discussion of narrative technique and narrator personas in the novel see Tirrell.

3 Evidence obtained primarily through electroencephalography (EEG) and magnetic resonance imaging (fMRI), which provides information about regional cerebral blood flow, enabling the analysis of neural activity, suggests that the human mirror system stems from activity in the inferior parietal lobe, inferior frontal gyres (including Broca’s area), and superior temporal sulcus (STS) (Fadiga; Hari; Muthukamaraswamy and Johnson; Rizzolatti and Craighero). For a detailed summary of the most important stages of the extensive research on mirror neurons see Agnew.

4 Transcranial magnetic stimulation (TMS) was used to show that observation of another individual performing simple repetitive thumb movements gives rise to a kinematically specific memory trace of the observed motions in Mland influences the direction of subsequent actions, supporting evidence of the role of mirror neurons in memory formation and also – possibly – human motor learning.

5 Clark describes the brain as “wetwear,” the body as “hardwear,” and environmental aids as “widewear” (“Where Brain” 271).

6 In Playing in the Dark, Morrison claims that the Whites defined their “Americannes” and their sense of freedom in opposition to what they perceived as raw and savage Africanism (65). Projecting their own anxieties – the “dread of failure, powerless, Nature without limits, natal loneliness, internal aggression, evil, sin, greed” (37- 38) – onto the African “other,” they created an illusion of their own empowerment.

7 By showing the African-American consciousness from within, Morrison resists its marginalization as ethnic other, or at least, counteracts its categorization as inferior. But the community she represents has not reached the level of political awareness or empowerment that the author has achieved.

8 She could, perhaps, have learned from her brother, who often runs away, but he never invites her to join him, and he always returns. Except at the very end of the novel, when she has already lost her mind, he leaves without her and never returns.

9 This relates interestingly to Damasio’s experience with “as if body loops” (281). These simulation mechanisms, bypassing the body proper through the internal activation of sensory body maps, create a representation of emotion-driven body-related changes and result in “significant alteration of brain function” (282).

10 Maureen Peal is a mulatto herself. Gillan argues convincingly that Morrison uses Maureen’s braids, arranged into “two lynch ropes that hung down her back,” to introduce a submerged discussion of racial violence. Gillan draws a parallel between the women’s willful blindness, that adores Maureen’s light skin and green eyes, and “forgets” the historical implications of racial and sexual abuse encoded in her body, and the willful blindness of the political establishment, that preferred to fight racism abroad in World War II, rather than to confront its domestic manifestations.

11 Bump draws parallels between the “emotional literacy” required for, and developed by, family systems therapy, and that exhibited by “family romance” novelists, arguing that “this may well be one of literature’s most important contribution to our culture” (159-60). Indeed, he suggests that Claudia is “one of a long tradition of narrators who escape family disintegration that can be traced back at least to Helen in Anne Bronte’s Tenant of Wildfell Hall. Helen is the only person who breaks out of the cycle of abuse and addiction in that novel because she too adopts a form of the talking cure” by writing ajournai (163).

12 Roger Schank claims that “intelligence is bound up with our ability to tell the right story at the right time” (21 ). For an exploration of current notions of “theory of mind (ToM), a discussion of the role of quality literary works play in both describing and extending our capacity for reading other people’s minds, and the notion of ‘imagining serially embedded representations of mental states (that is, “representations of representations of representations” of mental states)'” (271) see Lisa Zunshine’s excellent 2003 essay and her recent 2006 book.

13 This is replicated in her daughter, as I have argued above; Pecola is denied the constructive benefits of cognitive scaffolding.

14 This innovative and complex narrative technique, by which Morrison prefaces her novel with a mass-produced paradigm of white consumer culture, and then deconstructs its message through removing spacing and punctuation in three distinctive stages, has been widely discussed. see, for instance, Tirrell or Kuenz.

15 This kind of behavior is primarily encouraged by the church doctrines these women live by and is not a specifically African- American behavioral pattern. However, because Protestant ethics are combined with their self-loathing, born of racial discrimination, these women take their refusal to acknowledge their own bodies to the extreme.

16 Morrison’s attitude to and representation of both Cholly’s life history and his act of rape are complex and very important to a comprehensive understanding of the novel. They can also shed interesting light upon the embodied receptiveness for which I argue in this essay. However, in order to focus this particular paper, I have decided to leave out Cholly and the broader discussion of male sexuality in the novel that he invites. In addition to Morrison’s own discussion of Cholly in her Afterword to the novel, see also, once again, Gillan’s excellent article, as well as Kuenz and Wong.

17 The novel is set in 1941, the year America joined the war. The prostitutes are named after Poland and China, representing the two fronts, European and Asian, of the war. Marie is referred to by the community as “The Maginot Line” (the fortifications built by the French as defense against Nazi invasion, which proved wholly inadequate). Kuenz argues that, in these three, Morrison “literalizes the novel’s overall conflation of black female bodies as sites of fascist invasions” (421 ). Moreover, Ae comparison between these three and the other female figures in their community, who by and large repress their own domestic problems through uniting in abhorrence against prostitutes, is telling. As Jennifer Gillan rightly points out: “There is much focusing on the wrong front in the novel: The townswomen concentrate on vilifying the prostitutes for denigrating black womanhood, but do not acknowledge the economic inequalities that foster prostitution in the first place; the prostitutes focus on hating the townswomen, but exempt from their scorn the churchwomen who seem most to embody the ideology of true womanhood that, in actuality, excludes black women; and the Breedloves focus on attaining the material goods that will enable them to maintain an aura of citizenship, instead of recognizing that the system of commodity compensation not only excludes black people, but also distracts attention from the growing economic inequalities between the rich and the poor of all races” (285).

18 See also Kuenz (423).

19 Let me reiterate the disclaimer I make at the opening of this paper: Claudia and Morrison are not identical, but I believe that the narrative structure of the novel implies that it has been written by the fictional character Claudia.

Works Cited

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Arbib, Michael A. “From Monkey-Like Action Recognition to Human Language: An Evolutionary Framework for Neurolinguistics.” Behavioral and Brain Sciences 28 (2005): 105-24.

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Damasio, Antonio. The Feeling of What Happens: Body and Emotion in the Making of Consciousness. New York: Harcourt, 1999.

Decety Jean, Julie Grezes , N. Costes., Daniela Perani, Marc Jeannerod, Emanuel Procyk, Fondazione Paolo Grassi and Ferruccio Fazio. “Brain Activity During Observation of Actions: Influence of Action Content and Subject’s Strategy.” Brain 120 (1997): 1763-77.

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Naomi Rokotnitz

Bar Ilan University

Naomi Rokotnitz ([email protected]) teaches at Bar Ilan University. Her article, ‘”It Is Required You Do Awake Your Faith’: Learning to Trust the Body through Performing The Winter’s Tale,” appeared in Performance and Cognition: Theatre Studies After the Cognitive Turn. Eds. F. Elizabeth Hart and Bruce McConachie (Routledge 2006). She is currently finalizing a book entitled Trusting P(l)ays, a cognitive reading of the potentialities of dramatic performance which seeks to mitigate radical skepticism through encouraging attunement to embodied knowledge.

Copyright Northern Illinois University, Department of English Winter 2007

(c) 2007 Style. Provided by ProQuest Information and Learning. All rights Reserved.

Valeant Pharmaceuticals Announces Temporary Stay in Efudex(R) Case

Valeant Pharmaceuticals (NYSE:VRX) today announced that Spear Pharmaceuticals has agreed not to market, sell or ship a generic fluorouracil cream 5% pursuant to a stay in Valeant’s legal case against the Food and Drug Administration (FDA). The stay will remain in place until May 14, 2008, or until a further order of the Court is issued.

On April 11, 2008, the FDA approved an Abbreviated New Drug Application (ANDA) for a fluorouracil cream 5% sponsored by Spear Pharmaceuticals. On the same day, the FDA responded to Valeant’s December 21, 2004, Citizen Petition regarding potential generic versions of Valeant’s pioneer drug product, Efudex® (fluorouracil) Cream 5%. Efudex Cream 5% is approved by the FDA for the treatment of multiple actinic or solar keratoses, and for the treatment of superficial basal cell carcinomas when conventional methods of treatment are impractical. In the Citizen Petition, Valeant requested that the FDA decline to approve generic versions of Efudex Cream 5% where the generic company has failed to provide test data comparing the generic product to Efudex Cream in patients diagnosed with superficial basal cell carcinoma, a form of skin cancer.

On April 25, 2008, Valeant filed a federal lawsuit against the Secretary of Health and Human Services, Michael O. Leavitt, and the Commissioner of the FDA, Andrew C. von Eschenbach, M.D., challenging the FDA’s denial of Valeant’s Citizen Petition and the approval of a generic to Efudex Cream 5%. Valeant requested a temporary restraining order (TRO) to suspend the FDA’s approval of Spear’s ANDA. Following an initial round of briefing, the FDA requested and obtained from the court a two week stay of the lawsuit. In addition, Spear Pharmaceuticals informed the court it will suspend all further sales and shipment of its product for the duration of the court ordered stay.

“We filed suit because we disagree with the FDA’s decision and we are concerned for the safety of our patients suffering from basal cell carcinoma,” stated J. Michael Pearson, Valeant’s chairman and chief executive officer. “The potential for these patients to receive a substitute product that has not been tested in patients with skin cancer, when they expect to receive our Efudex Cream, is unacceptable. Efudex Cream 5% has been shown to have greater than a 90% success rate in treating superficial basal cell carcinoma. Under the FDA’s Citizen Petition response, generic versions of Efudex Cream 5% need only be tested in patients with actinic or solar keratoses.”

Important Safety Information

Efudex® (fluorouracil) Topical Solutions and Cream is recommended for the topical treatment of multiple actinic or solar keratoses. In the 5% strength it is also useful in the treatment of superficial basal cell carcinomas when conventional methods are impractical, such as with multiple lesions or difficult treatment sites. Safety and efficacy in other indications have not been established.

Efudex is contraindicated in women who are, or may become, pregnant during therapy because of potential hazards to the fetus. Cases of miscarriage and birth defects have been reported in women who are pregnant.

The most frequent adverse events occur locally and may include itching, burning, soreness, tenderness, scaling, and swelling. Application to mucous membranes should be avoided due to the possibility of local inflammation and ulceration. For complete Prescribing Information, please visit www.efudex.com.

About Valeant

Valeant Pharmaceuticals International (NYSE:VRX) is a multinational specialty pharmaceutical company that develops, manufactures and markets a broad range of pharmaceutical products primarily in the areas of neurology, infectious disease and dermatology. More information about Valeant can be found at www.valeant.com.

Efudex is a registered trademark of Valeant Pharmaceuticals International or its related companies. For information on Efudex visit www.efudex.com.

FORWARD-LOOKING STATEMENTS

This press release contains forward-looking statements, including, but not limited to, statements regarding the company’s legal case against the FDA and the filing of a temporary restraining order against Spear Pharmaceuticals, and other risks detailed from time to time in the company’s SEC filings. The company cautions the reader that these factors, as well as other factors described in its SEC filings, are among the factors that could cause actual results to differ materially from the expectations described in the forward-looking statements. The company also cautions the reader that undue reliance should not be placed on any of the forward-looking statements, which speak only as of the date of this press release. The company undertakes no responsibility to update any of these forward-looking statements to reflect events or circumstances after the date of this press release or to reflect actual outcomes.

Some May Be Denied Treatment In Pandemic

A task force of members from the military, government agencies, major universities and medical groups has drafted recommendations on which patients should receive lifesaving care should a pandemic or other disaster occur. The guidelines reflects the somber reality that not everyone who needs treatment would receive it, and that some, if not all, will die as a result.

The task force included members of the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

Dr. Asha Devereaux, a critical care specialist in San Diego and the report’s lead writer, told the Associated Press that the proposed guidelines are designed to be a blueprint for hospitals “so that everybody will be thinking in the same way” when pandemic flu or another health care disaster hits.  The idea, task force members said, is to ensure scarce resources, such as ventilators, medicine and medical professionals, are used in a consistent, objective way.

“If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing,” the report said.

The task force wrote that hospitals should designate a triage team with the Godlike task of deciding who will and who won’t receive treatment. Those refused care would be at a high risk of death with a slim chance of long-term survival.   However, the report gave specific details about who should be denied treatment, a list that includes:

  • People older than 85.
  • Those with severe trauma, which could include critical injuries from car crashes and shootings.
  • Severely burned patients older than 60.
  • Those with severe mental impairment, which could include advanced Alzheimer’s disease.
  • Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

Dr. Kevin Yeskey, a task force member and director of the preparedness and emergency operations office at the Department of Health and Human Services, told the Associated Press the report would be among many the agency reviews as part of preparedness efforts.

Lawrence Gostin of Georgetown University, a public health law expert, called the report important but also “a political minefield and a legal minefield.”

“The recommendations would probably violate federal laws against age discrimination and disability discrimination,” said Gostin, who was not on the task force.

“If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability,” he said.

“There are some real ethical concerns here,” he said, while also acknowledging that health care rationing would be necessary in a mass disaster.

James Bentley, a senior vice president at American Hospital Association, told the AP that the report would provide input to hospitals as they put in place their own preparedness plans, even if they don’t follow all the guidelines.   Bentley added that the draft resembles the battlefield approach of allocating limited health care resources to those most likely to survive.

He said the report was  “the most detailed one I have seen from a professional group.”

“While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary,” Bentley said.

Devereaux said compiling the list “was emotionally difficult for everyone,” partly because members believe it is only a matter of time before such a catastrophic pandemic occurs.

“You never know,” Devereaux said.

“SARS took a lot of folks by surprise. We didn’t even know it existed.”

The task force recommendations appear in a report in the May edition of Chest, the medical journal of the American College of Chest Physicians.

On the Net:

Journal Chest

Results of Brodmann Area 25 Deep Brain Stimulation Pilot Study Offer Hope for Patients With Severe Depression

St. Jude Medical, Inc. (NYSE:STJ) today announced pilot study results from the first multi-center study investigating deep brain stimulation (DBS) of Brodmann Area 25 for major depressive disorder.

Results of the study, which were presented today at the American Psychiatric Association (APA) meeting in Washington, D.C., found that 6 months after the procedure, 56 percent of the patients experienced at least a 40 percent decrease in depressive symptoms. Patient’s symptoms were measured using a standardized test called the Hamilton Rating Scale for Depression.

Results were presented by Sidney Kennedy, M.D., psychiatrist-in-chief with the University Health Network in Toronto. “Severe depression destroys a person’s ability to be productive and have a normal quality of life,” said Dr. Kennedy. “The results from this study are very promising, and we are hopeful that our research will lead to a therapy that can help these patients.”

Prior to beginning the study, all patients were classified as having severe depression after multiple treatments — such as medications, psychotherapy and electroconvulsive therapy — had failed to provide sustained relief from depression. Each study patient had tried a minimum of 12 depression medications over his or her lifetime.

DBS was targeted at an area of the brain known as Brodmann Area 25, which appears to become overactive when people are profoundly sad and depressed. Conducted at three leading Canadian academic medical centers, the study expands and supports the groundbreaking research of Helen Mayberg, M.D., and Andres Lozano, M.D., which was published in Neuron in March 2005.

On average, the 20 study participants had suffered from depression for more than 20 years; they were disabled and unable to work at the time of enrollment. The study also found that:

At their most recent psychiatric evaluation, 78 percent of the patients experienced at least a 40 percent decrease in depressive symptoms.

Three of the study patients are considered to be in remission.

Eight patients have re-engaged in life activities such as work, school, relationships and travel.

In the study, DBS was delivered through the St. Jude Medical Libra® Deep Brain Stimulation System, which delivers mild electrical current from a device implanted near the collarbone; the device is connected to small electrical leads placed at specific targets in the brain.

“These results are important as they help establish the body of evidence that will continue to move depression research forward,” said Chris Chavez, president of the St. Jude Medical ANS Division. “We are committed to leading the development of products that can make life better for patients suffering from this debilitating condition.”

Based on the results of this research, St. Jude Medical announced the BROADEN™ (BROdmann Area 25 DEep brain Neuromodulation) study in February 2008, to further investigate the use of DBS for major depressive disorder. A controlled, multi-center, blinded clinical study, BROADEN is being conducted in the U.S. under an Investigational Device Exemption (IDE) from the U.S. Food and Drug Administration (FDA).

St. Jude Medical owns the intellectual property rights and has various patents issued and pending for the use of neurostimulation at Brodmann Area 25. For more information about this clinical trial, call toll-free 866-787-4332 or visit www.BROADENstudy.com.

According to the National Advisory Mental Health Council, of the 21 million adult Americans who suffer from depression, approximately 4 million live with severe depression that does not respond to medications, psychotherapy and, in certain cases, electroconvulsive therapy.

About St. Jude Medical

St. Jude Medical is dedicated to making life better for cardiac, neurological and chronic pain patients worldwide through excellence in medical device technology and services. The Company has five major focus areas that include: cardiac rhythm management, atrial fibrillation, cardiac surgery, cardiology and neuromodulation. Headquartered in St. Paul, Minn., St. Jude Medical employs more than 12,000 people worldwide. For more information, please visit www.sjm.com.

About the ANS Division of St. Jude Medical

The ANS Division (Advanced Neuromodulation Systems) became a part of St. Jude Medical in 2005. The ANS Division is an innovative technology leader dedicated to the design, development, manufacturing and marketing of implantable neuromodulation systems to improve the quality of life for people suffering from disabling chronic pain and other nervous system disorders (www.ans-medical.com).

Forward-Looking Statements

This news release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 that involve risks and uncertainties. Such forward-looking statements include the expectations, plans and prospects for the Company, including potential clinical successes, anticipated regulatory approvals and future product launches, and projected revenues, margins, earnings, and market shares. The statements made by the Company are based upon management’s current expectations and are subject to certain risks and uncertainties that could cause actual results to differ materially from those described in the forward-looking statements. These risks and uncertainties include market conditions and other factors beyond the Company’s control and the risk factors and other cautionary statements described in the Company’s filings with the SEC, including those described in the Company’s Annual Report on Form 10-K filed on February 27, 2008 (see Item 1A on pages 13-20, and page 20 of Exhibit 13 to the Company’s Form 10-K). The Company does not intend to update these statements and undertakes no duty to any person to provide any such update under any circumstance.

Divigel(R) (Estradiol Gel) 0.1 Percent Offers Lowest Approved Dose of Estradiol for Treatment of Moderate to Severe Hot Flashes Associated With Menopause

MAPLE GROVE, Minn., May 5 /PRNewswire/ — Medical specialists from around the country will gather this week to discuss the latest research in obstetrics and gynecology, and menopause and estrogen therapy will be among the information presented.

“Estrogen therapy continues to be the gold standard for the management of hot flashes, the most common physical sign of menopause,” said Dr. Ricki Pollycove, fellow, American College of Obstetrics and Gynecology and clinical faculty member, University of California, San Francisco. “However, because of misconceptions that still exist today due to the influx of conflicting information that has emerged since the Women’s Health Initiative Study, women may not be aware that advances in low-dose hormone therapies exist.”

In June 2007, the U.S. Food and Drug Administration (FDA) approved Divigel(R) (estradiol gel) 0.1 percent, the lowest approved dose of estradiol available for the treatment of moderate to severe hot flashes associated with menopause. Guidelines from the North American Menopause Society (NAMS) indicate that estrogen hormone therapy should be used at the lowest effective dose for the shortest amount of time.

“Transdermal estrogen therapies, such as Divigel(R), are emerging as an effective and safe mode of treatment,” said Dr. Pollycove.

The estrogen in Divigel(R) is derived from plant sources and is bioidentical to the primary estrogen produced by a woman’s ovaries before menopause. Certain older oral estrogen therapies contain conjugated estrogens derived from the urine of pregnant mares. Divigel(R) is a quick-drying gel that is odorless when dry, and is available in convenient, individual-use packets. One packet of gel is applied daily to an area that measures approximately 5 x 7 inches on the thigh, the smallest application area compared to all other available gel or lotion estrogen products. After the gel is applied, it absorbs directly into the bloodstream without having to pass through the liver. Divigel(R) also offers dosing flexibility with three different strengths (0.25 mg estradiol/day, 0.5 mg estradiol/day and 1.0 mg estradiol/day) to individualize treatment for each woman.

Important Safety Information for Patients

The following are not all the possible risks for Divigel(R). Please read the full Patient Information leaflet and talk to your healthcare provider.

Estrogens increase the chance of getting cancer of the uterus. Report any unusual vaginal bleeding right away while you are taking estrogens. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb). Your healthcare provider should check any unusual vaginal bleeding to find out the cause. In general, the addition of a progestin is recommended for women with a uterus to reduce the chance of getting cancer of the uterus.

Do not use estrogens, with or without progestins, to prevent heart disease, heart attacks, or strokes. Using estrogens, with or without progestins, may increase your chance of getting heart attacks, strokes, breast cancer, and blood clots.

Do not use estrogens, with or without progestins, to prevent dementia. Using estrogens, with or without progestins, may increase your risk of dementia.

Do not use estrogen products, including Divigel(R), if you have unusual vaginal bleeding, currently have or have had certain cancers, had a stroke or heart attack in the past year, currently have or have had blood clots, currently have or have had liver problems, are allergic to any Divigel(R) ingredients, or think you may be pregnant.

The most common side effects for all estrogen products are headache, breast pain, irregular vaginal bleeding or spotting, stomach/abdominal cramps and bloating, nausea and vomiting, and hair loss. Less common but serious side effects include breast cancer, cancer of the uterus, stroke, heart attack, blood clots, dementia, gallbladder disease and ovarian cancer.

In Divigel(R) clinical trials, the most common side effects were inflammation of the nasal passages and pharynx, upper respiratory tract infection, vaginal yeast infection, breast tenderness and vaginal bleeding. Call your healthcare provider right away if you have any symptoms that concern you.

Estrogen products should be used at the lowest dose possible for your treatment and only as long as needed. You and your healthcare provider should talk regularly about whether you still need treatment with Divigel(R).

For more information, including copies of the professional prescribing information and patient information leaflet with the black box and other warnings, call 1-800-654-2299 or visit http://www.divigelus.com/.

Orion Corporation (OMX: ORNAV, ORNBV) has a licensing agreement with Upsher-Smith Laboratories for the development of Divigel(R) in the United States. Orion is one of the leading pharmaceutical companies in northern Europe through its development, manufacturing and marketing of pharmaceuticals, active pharmaceutical ingredients and diagnostic tests for global markets. The core therapeutic areas in Orion’s product and research strategy are central nervous system disorders, cardiology, critical care and hormonal and urological therapies.

Upsher-Smith Laboratories, Inc. is a rapidly growing pharmaceutical company that manufactures and markets both prescription and consumer products. Privately held since 1919, the company strives to recognize the unmet healthcare needs of our customers. Upsher-Smith prides itself in providing safe, effective, and economical therapies to the ever-challenged healthcare environment. For additional information about Upsher-Smith, visit http://www.upsher-smith.com/.

Upsher-Smith Laboratories, Inc.

CONTACT: Sara Anderson of The Reilly Group, +1-773-348-3800, ext. 205,[email protected], for Upsher-Smith Laboratories, Inc.

Web site: http://www.divigelus.com/http://www.upsher-smith.com/

Major League Baseball Hall of Famer Don Sutton Helps Kidney Cancer Patients Stay In The Game(TM)

NEW YORK, May 5 /PRNewswire-FirstCall/ — In response to the increasing incidence of kidney cancer in the United States,(1) Major League Baseball (MLB) Hall-of-Fame pitcher and advanced kidney cancer survivor, Don Sutton, has teamed up with the Kidney Cancer Association, Bayer HealthCare Pharmaceuticals and Onyx Pharmaceuticals to launch the Stay In The Game(TM) kidney cancer awareness program. Stay In The Game is an educational program that empowers people affected by kidney cancer to seek support, resources and information that can help them build and stay with a treatment plan. Over the past few years, new therapies have transformed the treatment of kidney cancer, allowing patients to manage their disease more effectively.

Stay In The Game is inspired by Don Sutton’s personal quest to continue leading a productive life as an advanced kidney cancer survivor. Stay In The Game provides educational materials, an informational Web site (http://www.stayingame.com/) and personal appearances by Don to support and provide inspiration to patients and their loved ones. The program encourages kidney cancer patients to take a team approach by working closely with their healthcare professionals and loved ones to understand the latest treatment options and stick with a treatment plan to successfully fight their disease.

“Being diagnosed with cancer can be overwhelming and scary,” said Don. “As an advanced kidney cancer survivor, I’ve learned to stay positive, confident and persistent with my treatment plan, which has helped me manage my disease. Through Stay In The Game, I’m hoping to encourage other kidney cancer patients to take charge by finding the right support team and talking to their doctors about which treatment options are right for them.”

As an individual living with advanced kidney cancer, Don credits maintaining a healthy lifestyle, the knowledge of his healthcare team, cutting-edge medicine and the support of his family and friends for allowing him to continue to do the things he enjoys.

“Don’s story can inspire other kidney cancer patients and their loved ones to understand that today, more than ever, many people can stay in the game even with this diagnosis,” said Bill Bro, Chief Executive Officer, Kidney Cancer Association. “This program offers necessary and valuable support that helps families understand their treatment options and identify a team that can help them navigate the road ahead and stay on track with their individual treatment plan.”

There are approximately 208,000 people living with kidney cancer worldwide including 37,000 Americans. Each year more than 100,000 people globally, including 12,500 Americans, will die from the disease.(2) It is estimated that in 2008 there will be 54,390 new cases of kidney cancer in the United States.(3) Kidney cancer has been difficult to treat, however, new targeted cancer therapies have emerged that have changed the way physicians are able to manage advanced kidney cancer.

More information about the campaign — including resources on kidney cancer, details about Don and information about Don’s local appearances — can be found by visiting http://www.stayingame.com/.

About Stay In The Game(TM)

Stay In The Game(TM) is an awareness program designed to provide kidney cancer patients and their loved ones with information and resources to help them more effectively manage their disease. Major League Baseball Hall-of-Famer and advanced kidney cancer survivor, Don Sutton, serves as the national spokesperson for the program. Don and Keith Flaherty, M.D., Assistant Professor of Medicine at the Abramson Cancer Center at the University of Pennsylvania, will kick off the program in New York. The program also includes appearances in Los Angeles and Atlanta, at MLB stadiums, where Don will speak about the campaign and honor kidney cancer patients and their families. For more information please visit http://www.stayingame.com/.

About Don Sutton

Don Sutton is a 63-year-old MLB Hall-of-Famer who is living with advanced kidney cancer. Don is sharing his story through the Stay In The Game program in order to provide inspiration and encouragement for others touched by the disease.

Don had a 23-year long MLB career and served as a pitcher for a number of teams, most notably for the Los Angeles Dodgers where he played for most of his career. He’s recognized for control, consistency and commitment — during his career, he never missed a game due to injury or illness. Don won a total of 324 games in his career and ranks eighth on baseball’s all-time strike out list. Don went to the World Series four times and is a four-time all-star player. He was elected into the Baseball Hall-of-Fame in 1998.

Don credits maintaining a healthy lifestyle, the support of his healthcare professionals and loved ones and cutting-edge medicine for allowing him to continue to lead a productive life. Don now works as a sports broadcaster for the Washington Nationals and lives in California with his wife and family.

About the Kidney Cancer Association

The Kidney Cancer Association is a global charitable organization supported by patients, family members, friends, physicians and other health professionals. It was founded in Chicago in 1990 by Eugene P. Schonfeld, PhD., a small group of patients, and their doctor. The Association funds, promotes, and collaborates with the National Cancer Institute, American Society of Clinical Oncology, American Urological Association, and other institutions and organizations on research projects. Its mission also includes patient and physician education and advocating on behalf of patient interests at the state and federal levels.

The American Cancer Society estimates there will be more than 54,000 new cases of kidney cancer in the United States and about 13,000 people will die from this disease. Kidney cancer is among the 10 most common cancers, affecting men more frequently than women. The incidence of kidney cancer has been rising slowly since the 1970s and death rates have remained fairly stable since the 1980s.

The Kidney Cancer Association has been designated as a tax exempt organization under Section 501(c) (3) of the U.S. Internal Revenue Service code. Donations to the Association are tax deductible. If you would like to learn more about this disease or to get involved please visit http://www.kidneycancer.org/ or call 1 (800) 516-8051.

About Bayer HealthCare Pharmaceuticals Inc.

Bayer HealthCare Pharmaceuticals Inc. is the U.S.-based pharmaceuticals unit of Bayer HealthCare LLC, a division of Bayer AG. One of the world’s leading, innovative companies in the healthcare and medical products industry, Bayer HealthCare combines the global activities of the Animal Health, Consumer Care, Diabetes Care, and Pharmaceuticals divisions. In the U.S., Bayer HealthCare Pharmaceuticals comprises the following business units: Women’s Healthcare, Diagnostic Imaging, Specialized Therapeutics, Hematology/Cardiology and Oncology. The company’s aim is to discover and manufacture products that will improve human health worldwide by diagnosing, preventing and treating diseases.

About Onyx Pharmaceuticals, Inc.

Onyx Pharmaceuticals, Inc. is a biopharmaceutical company committed to improving the lives of people with cancer by changing the way cancer is treated(TM). The company, in collaboration with Bayer HealthCare Pharmaceuticals, Inc., is developing and marketing Nexavar(R), a small molecule drug. Nexavar is currently approved for the treatment of advanced kidney cancer and liver cancer. Additionally, Nexavar is being investigated in several ongoing trials in non-small cell lung, melanoma and breast cancers. For more information about Onyx, visit the company’s website at: http://www.onyx-pharm.com/.

   (1) Mayo Clinic. Available at:       http://www.mayoclinic.com/health/kidney-cancer/DS00360.  Accessed       April 2008.   (2) International Agency for Cancer Research. GLOBOCAN 2002. Available at:       http://www-dep.iarc.fr/. Accessed February 2008.   (3) American Cancer Society.  Available at:       http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_       statistics_for_kidney_cancer_22.asp?sitearea=.  Accessed April 2008.  

Bayer HealthCare Pharmaceuticals Inc.; Onyx Pharmaceuticals, Inc.

CONTACT: David Freundel of Bayer HealthCare Pharmaceuticals Inc.,+1-973-305-5310, [email protected]; or Alex Santos of OnyxPharmaceuticals, Inc., +1-510-597-6504, [email protected]; or media,Adrienne Turner of WeissComm Partners, +1-415-946-1092, [email protected],for Bayer HealthCare Pharmaceuticals, Inc. and Onyx Pharmaceuticals, Inc.

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

ConvaTec Upgrades Flexi-Seal(R) Fecal Management System to Increase Ease of Use

ConvaTec, a world-leading manufacturer of ostomy and wound care products, today announced that its Flexi-Seal® Fecal Management System (FMS), a temporary containment device indicated for immobilized, incontinent patients with liquid or semi-liquid stool, has been redesigned for easier use and storage.

The innovative Flexi-Seal® FMS was designed to safely and effectively divert fecal matter, protect patients’ wounds from fecal contamination, and reduce the risk of both skin breakdown and spread of infection, such as Clostridium difficile (C. difficile).1 The improved Flexi-Seal® FMS retains all of the original product benefits, but also now includes recyclable and re-closeable molded plastic packaging that is 25 percent smaller than the original package size and allows for easy storage of collection bags and syringes; a new blue irrigation port that allows for immediate identification; a re-labeled syringe that is precisely marked to 45 ml and measures the exact amount of water or saline necessary; and a smaller, more user-friendly, pocket-size package insert. The new and improved Flexi-Seal® FMS will be available to medical professionals from the end of April, 2008, at no increase in cost.

“The upgrades to the Flexi-Seal® Fecal Management System were based upon the feedback we received from our customers – critical care nurses who use Flexi-Seal® FMS on a regular basis and provide exceptional care to the patients who benefit from the system,” said Ronald Galovich, Vice President/General Manager, U.S. Wound Therapeutics. “Interest in Flexi-Seal® FMS has continued to expand since its introduction, particularly in light of the increased focus on pressure ulcer prevention under the new Medicare rules, and the ongoing focus on infection control in general.”

About Fecal Incontinence and Pressure Ulcers

The management of fecal incontinence, a significant risk factor in the development of pressure ulcers and the transmission of nosocomial infections, is a priority in acute and critical care hospital settings. Findings from a model incorporating retrospective data indicated that the odds of having a pressure ulcer were 22 times greater for hospitalized adult patients with fecal incontinence, compared to those who were continent.2 Pressure ulcers, which are among the most prevalent forms of chronic wounds, are reported in approximately 10-18 percent of acute-care settings in the United States,3 and can increase both patient mortality rates and the cost of patient care.4 By October, 2008, the U.S. Centers for Medicare and Medicaid Services (CMS) will institute reimbursement reforms for hospital-acquired pressure ulcers, prompting many U.S. hospitals to implement pressure ulcer prevention guidelines and utilize systems and devices that can help prevent pressure ulcer development.5

About Flexi-Seal® Fecal Management System

Flexi-Seal® FMS is a temporary containment device indicated for patients with little or no bowel control, and can be used for up to 29 consecutive days. Unique features of Flexi-Seal® FMS include:

A closed-end collection bag which may help reduce the spread of infection.

A soft, low-pressure balloon designed to minimize the chance of tissue necrosis.

A soft, flexible silicone catheter that can collapse to an 8 mm diameter after insertion and conform to sphincter tone and anatomy.

An entirely latex-free design.

A prospective, phase II, open-label, non-randomized clinical study involving 42 patients from seven U.S. hospitals was performed to evaluate the safety of Flexi-Seal® FMS.1 The study found that Flexi-Seal® FMS maintained or improved skin condition in 92 percent of patients, and that use of the device revealed no adverse effect on rectal mucosa. Most patients were able to retain the device until removal. Caregivers from both the intensive care units and acute care units reported that Flexi-Seal® FMS improved control of fecal incontinence with minimal leakage, and was practical, efficacious, time-efficient, and both caregiver and patient-friendly. Four subjects experienced non-serious adverse events. One subject, who had a history of gastrointestinal (GI) bleeding, developed a lower GI bleed with ulceration four days after placement of the device, and was discontinued from the study. The event was considered to be related to the use of the device. Five subjects expired during the study, and all deaths were determined to be unrelated to the device.

To date, Flexi-Seal® FMS is the number one brand6 in unit sales to distributors, and is being widely used at over 1,800 intensive care unit hospitals7 in the United States.

About ConvaTec

ConvaTec, a world-leading manufacturer of ostomy and wound care products, is at the forefront of the movement to change the way health care professionals are managing chronic and acute wounds. Since the introduction of DuoDERM® Hydroactive Dressing in 1982, ConvaTec has been a pioneer in the establishment of moist wound healing. Today, ConvaTec is building on this strong heritage with its Hydrofiber® technology, featured in advanced wound dressings such as AQUACEL® Ag, an absorbent, soft, conformable, antimicrobial dressing with ionic silver, which forms a cool gelling sheet on contact with exudate. ConvaTec is a Bristol-Myers Squibb Company (NYSE:BMY), a global pharmaceutical and related health care products company. For more information, please call 800-422-8811 or visit www.convatec.com.

Flexi-Seal, DuoDERM, Hydrofiber and AQUACEL are registered trademarks of E.R. Squibb & Sons, L.L.C.

© 2008 E.R. Squibb & Sons, L.L.C.

US-08-972

1. Padmanabhan A., Stern M., Wishin J., Mangino M., Richey K., DeSane M. Clinical evaluation of a flexible fecal incontinence management system. American Journal of Critical Care, July 2007; Volume 16, No. 4.

2. Maklebust J, Magnan MA. Risk factors associated with having a pressure ulcer: a secondary data analysis. Adv Wound Care. 1994 Nov; 7(6):25, 27-8, 31-4 passim.

3. Pressure ulcers in America: prevalence, incidence and implications for the future. An executive summary of the National Pressure Ulcer Advisory Panel monograph. Advances in Skin and Wound Care 2001; 14:208-15.

4. Wishin J, Gallagher TJ, McCann E. Emerging options for the management of fecal incontinence in hospitalized patients. J Wound Ostomy Continence Nurs. 2008;35(1):104-110.

5. Centers for Medicare and Medicaid Services, Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates: Final Rule, 72 Federal Register 62 (August 22, 2007), 47201-47206.

6. HPIS. Q4 2007 data. Moving Annual Total (MAT) Fecal Control Category. Data on file, ConvaTec.

7. ConvaTec Redistributed YTD Sales through February 2008. Data on file, ConvaTec.

Walgreens Acquires I-Trax and Whole Health Management

Drugstore operator Walgreens has acquired I-trax, parent company of CHD Meridian Healthcare, and privately held Whole Health Management, that together operate more than 350 worksite health centers.

The acquired companies’ services include primary and acute care, wellness, pharmacy and disease management services and health and fitness programming.

Combined with Walgreens wholly owned subsidiary and convenient care clinic manager, Take Care Health Systems, they will form the platform for the new Walgreens Health and Wellness division.

Chadds Ford, Pennsylvania-based I-trax/CHD Meridian and Cleveland-based Whole Health will combine to operate under the name, Take Care Employer Healthcare Solutions.

Jeffrey Rein, chairman and CEO of Walgreens, said: “Our official entry into the health care services and wellness space marks a very exciting day for our shareholders, customers and employees. We believe our leadership position in pharmacy, trusted health care brand and goal of 10,000 points of care by 2012 will give us opportunities to meaningfully address the access issues that currently challenge the US health care system.”

Oreos Took Strange Journey into China

Unlike their iconic American counterpart, some Oreos sold in China are long, thin, four-layered and coated in chocolate. But the cookies have this in common: Both are now best-sellers.

The Oreo has long been the top-selling cookie in the U.S. market, but Kraft Foods had to reinvent the Oreo to make it sell well in the world’s most populous nation. Although Chinese Oreo sales represent a tiny fraction of Kraft’s $37.2 billion annual revenue, the cookie’s journey in China is an example of the kind of entrepreneurial transformation that Chief Executive Irene Rosenfeld is trying to spread throughout the food giant.

Kraft reported a 13 percent drop in first-quarter net income Wednesday because of high commodity costs and increased spending on product research and marketing. Kraft’s international business, which now represents 40 percent of the company’s revenue thanks to its recent acquisition of Groupe Danone’s biscuits business, was a bright spot in the quarter, aided by the weaker dollar.

In an effort to boost growth at the company, Rosenfeld has been putting more power in the hands of Kraft’s business units around the globe, telling employees that decisions about the company’s products shouldn’t all be made by people at the Northfield, Ill., headquarters.

To take advantage of the European preference for dark chocolate, Kraft is introducing dark chocolate in Germany under its Milka brand. Research in Russia showed that consumers there like premium instant coffee, so Kraft is positioning its Carte Noire freeze- dried coffee as upscale by placing it at operas, film festivals and fashion shows. Rosenfeld also has been encouraging marketers to “reframe” product categories – in other words, not to think of an Oreo exclusively as a round sandwich cookie.

Oreos were launched in 1912 in the United States, but it wasn’t until 1996 that Kraft introduced Oreos to Chinese consumers. Nine years later, a makeover began. Shawn Warren, a 37-year-old Kraft veteran who had spent many years marketing the company’s cookies and crackers around the world, arrived in Asia in 2005 and noticed that Oreo’s China sales had been flat for the previous five years.

At that time, the world’s second-largest food company by revenue was simply selling the U.S. version of Oreos in China. Albert Einstein’s definition of insanity – doing the same thing repeatedly and expecting different results – “characterized what we were doing in China,” said Warren, vice president of marketing for Kraft Foods International.

The Chinese weren’t big cookie eaters; the market for biscuits in fiscal 2007 was just $1.3 billion, versus $3.5 billion in the United States at food retailers excluding Wal-Mart.

Warren assigned his team to a lengthy research project that yielded some interesting findings. For one thing, Kraft learned that traditional Oreos were too sweet for Chinese tastes. Also, the packages of 14 Oreos priced at 5 yuan were too expensive.

The company developed 20 prototypes of reduced-sugar Oreos and tested them with Chinese consumers before arriving at a formula that tasted right. Kraft also introduced packages containing fewer Oreos for 2 yuan.

Kraft also began a grass-roots marketing campaign to educate Chinese consumers about the American tradition of pairing cookies with milk. The company created an Oreo apprentice program at 30 Chinese universities that drew 6,000 student applications. Kraft trained 300 to become Oreo brand ambassadors.

Students rode around Beijing on bicycles outfitted with wheel covers resembling Oreos and handed out cookies to more than 300,000 consumers. Others held Oreo-themed basketball games to reinforce the idea of dunking cookies in milk. Television commercials showed youths twisting apart Oreo cookies, licking the cream center and dipping the chocolate cookie halves into a glass of milk.

Rosenfeld called the bicycle campaign “a stroke of genius that only could have come from local managers,” saying “the more opportunity our local managers have to deal with local conditions will be a source of competitive advantage for us.”

Still, Kraft realized it needed to do more than just tweak the recipe of its traditional round cookies if it wanted to capture a bigger share of the Chinese biscuit market. China’s cookie-wafer segment was growing faster than traditional biscuitlike cookies, and Kraft was trailing rival Nestle SA, the world’s largest food company by revenue, which had introduced chocolate-covered wafers there in 1998.

So Kraft remade the Oreo itself. In China in 2006, the company introduced an Oreo that looked almost nothing like the original. The new Chinese Oreo was four layers of crispy wafer filled with vanilla and chocolate cream, coated in chocolate. Kraft developed a proprietary handling process to ensure the chocolate product could be shipped across the giant country and withstand the cold climate of the north and the hot, humid weather of the south yet still be ready to melt in the mouth.

Kraft’s Oreo efforts have paid off. In 2006, Oreo wafer sticks became the best-selling biscuit in China, outpacing Hao-ChiDian, a biscuit brand made by Chinese company Dali. The new Oreos also are outselling traditional round Oreos in China, and Kraft has begun selling the wafers elsewhere in Asia, as well as in Australia and Canada. Kraft has since introduced in China wafer rolls, a tube- shaped wafer lined with cream.

Kraft has doubled its Oreo revenue in China over the past two years. With the help of those sales, Oreo last year brought in more than $1 billion for the first time.

remake

In 2006, Kraft introduced in China an Oreo that was four layers of crispy wafer filled with vanilla and chocolate cream, coated in chocolate.

Desalination is the Solution to Water Shortages

By Conway, McKinley

With water shortages looming, it’s time to commit to building seawater desalting plants. Prompt action can bring new rivers of freshwater and avert disasters. Desalination is likely to become one of the world’s biggest industries. Growing communities and new industries must have dependable water supplies in order to prosper. If droughts, exhaustion of groundwater sources, decline of lake or river levels, or a combination of such factors threaten an area’s water supply, siteseeking firms may look elsewhere, giving waterrich areas a competitive advantage.

Certainly, water conservation programs should come first as a strategy for regions facing water problems. Many jurisdictions are already imposing wateruse limits. Other communities try drilling wells deeper and deeper until their aquifer is maxed out, or they propose to pipe water from distant streams. But such shortsighted strategies can do incalculable damage to the environment.

There is a better solution. Desalting systems have long proven effective in Kuwait, Bahrain, Qatar, the United Arab Emirates, Oman, and Saudi Arabia. Where once there were bleak villages on barren deserts there are now bright modern cities with treelined streets. There are homes with lush gardens. In the countryside there are productive farms.

The big desalting plant at Jubail, Saudi Arabia, is a model for the world. A pipeline carries a river of freshwater 200 miles inland to the capital city of Riyadh, and desalted seawater has given a large region an entirely new future filled with opportunities.

There are more than 7,000 desalination plants, mostly small ones, in operation worldwide. About twothirds are located in the Middle East, and others are scattered across islands in the Caribbean and elsewhere. Aruba’s hightech water plant has for many years met the needs of a thriving tourist industry.

The largest plant in the United States is the pioneering $158million project of the Tampa Bay Water agency. The project was let to contract in 1999 and after overcoming some technical problems in its early years is now performing well and causing no significant environmental problems. But no U.S. water agency has yet undertaken a really big project comparable to those found along the Arabian Gulf.

A CHALLENGE FOR WATER OFFICIALS

The first obstacle is cost: Today’s desalting plants are multibilliondollar projects, and it will take time for improving technology to bring the cost down. Timid government officials and politicians delay action for years, during which the cost of a plant and related distribution facilities may double or triple.

Fuel for desalination is a major challenge. Desalination plants in most nations don’t have access to cheap oil as do plants in the Middle East. So planners of big new units in the western United States need to think of energy from wind and solar installations. Along the Florida coast, ocean energy could become important. The Gulf Stream is an enormous asset waiting to be used. Electric utilities that need cooling water may engage in joint ventures for such under takings.

Today, plans are under way in California for a seawater desalting plant to meet about onehalf of the water requirements of Santa Barbara. A group that includes Bechtel and several utilities has proposed to build a desalting plant near San Diego to produce 100 million gallons per day of potable water. A private developer has built a small plant on Catalina Island. North of San Francisco, Marin County is considering a seawater unit.

Texas, meanwhile, has built a $2million pilot plant at Brownsville to explore ideas for a $150million installation planned for 2010.

Coastal states obviously have a big advantage in coping with future water needs, and many cities sit at the ocean’s edge or nearby. Inland cities are likely to face bigger problems, and, sooner than we think, it will be necessary to build pipelines to some of them. Right now, Las Vegas is planning a $2billion, 300mile pipeline to bring water from rural northeast Nevada counties to the city.

Booming Orlando, Florida, has been expecting to meet future water needs by piping water from the St. Johns and other rivers. However, this scheme is strongly opposed by ecologists. After the expensive environmental mistakes of the crossFlorida barge canal and manipulation of the Everglades, the state may be hesitant to approve any more drastic changes in natural flow patterns.

Thus, Orlando could be the first large inland city in Florida to resort to a seawater system, as difficult as that might be. There would be powerful opposition to building a large desalting plant at the nearest point on the East Coast, where it might conflict with the NASA launch complex at the Kennedy Space Center. An offshore site might work.

Even Atlanta, 300 miles from the ocean, may someday have to turn to seawater. Since the 1950s, when no one foresaw the possibility of longterm water shortages for Atlanta, a population explosion accompanied by an extended drought of unprecedented severity has lowered water levels drastically in Lake Lanier and Lake Allatoona- two huge reservoirs serving the area.

Clearly, planning and developing large numbers of seawater desalting plants will cause many problems, but the desalting plants that cause local problems may in the aggregate help against a huge global problem- the rise of sea levels due to the melting of ice in mountain ranges and at the poles.

Solar thermal desalination plant developed by the Fraunhofer Institute for Solar Energy Systems in Freiburg, Germany, could help poor countries transform seawater or brackish water to pure drinking water for low cost. Unlike largescale industrial desalting plants with access to energy infrastructure, Fraunhofer’s projects would be appropriate for small, rural areas with autonomous solar power supplies.

“Today’s desalting plants are multibillion- dollar projects, and it will take time for improving technology to bring the cost down. Timid government officials and politicians delay action for years, during which the cost of a plant and related distribution facilities may double or triple.”

About the Author

McKinley Conway is an engineer and founder of Conway Data Inc., a firm involved in research, publications, and telecommunications, specializing in futures studies, global megaprojects, and site selection. His address is Conway Data Inc., 6625 The Corners Parkway, Suite 200, Norcross, Georgia 30092. Web site www.conway.com.

Changing Nutrition Standards in Schools: The Emerging Impact on School Revenue

By Wharton, Christopher M Long, Michael; Schwartz, Marlene B

ABSTRACT BACKGROUND: Although great focus has been placed on nutritional and other consequences of changes in food-related policies within schools, few reports exist describing the impact of such changes on school revenue. This review provides an overview of the few revenue-related studies published recently, as well as information from a sampling of state reports on the subject.

METHODS: A systematic review of the literature was conducted. Four peer-reviewed papers and 3 state-based reports were identified that assessed the impact on revenues of either targeted policy changes or overarching, district-wide changes in food-related policies.

RESULTS: Thus far, few data exist to substantiate the concern that changes in nutrition standards in schools lead to a loss in total revenue. An interesting phenomenon of increased participation in the National School Lunch Program was noted in a number of reports and might play a role in buffering financial losses.

CONCLUSIONS: A renewed focus on school policies related to health provides the opportunity for researchers to investigate how nutrition-related policy change can affect, if at all, food service and overall school revenues.

Keywords: child and adolescent health; health policy; nutrition and diet; school funding.

Citation: Wharton CM, Long M, Schwartz MB. Changing nutrition standards in schools: the emerging impact on school revenue. J Sch Health. 2008; 78: 245-251.

Health professionals play a key role in the development and implementation of health policy for children. One policy topic that has received considerable attention is the nutrition environment in schools, where great opportunity exists to teach nutrition principles and support education with provision of healthy foods. To capitalize on that opportunity, it is important for health professionals to be aware of the current state of the nutrition environment in American public schools and to be aware of opportunities for involvement. Under the federal Child Nutrition and WIC Reauthorization Act of 2004, local school districts receiving federal school meal reimbursement were required by the first day of school in 2006 to implement school wellness policies; these policies set goals for nutrition education and guidelines for all food sold on campus with the objective of reducing childhood obesity.1 This has brought attention to the issue of nutrition in schools and provided an opportunity for health professionals, such as dietitians, school nurses, and other school personnel, to influence school food policy in the districts where they live and work.

While the wisdom of selling only healthful foods in schools may seem clear, local districts that have attempted to make these changes have reported a number of challenges. One of the most difficult obstacles is the fear that revenue from a la carte and vending items will drop, reducing profits (ie, overall revenue- expenses incurred), and creating a financial hardship for the district. Advocates argue that it is wrong to sell children unhealthy foods in order to subsidize their education. Education professionals and food service directors argue that the economic reality demands this additional revenue. Opinions are plentiful, but there are few data to guide policy decisions. The aim of the present review was to examine the available data on what happens financially when strong nutrition standards are applied to foods sold in schools and across districts. We consider first the current school food environment and then examine peer-reviewed research as well as publicly available data collected by states that address this question.

Competitive Foods: Revenue Versus Child Health

Studies of the school food environment show that current offerings do not fully support a healthy diet in children and adolescents. Competitive foods are defined as foods sold at the same time as National School Lunch Program (NSLP) foods are available. While these foods sometimes include fruits and vegetables, they are more likely to be snacks high in fat, sugar, and salt, such as potato chips, cookies, and ice cream.2 Reports on the school food environment in individual states have found that schools often sell competitive foods to their students that have little nutritional value.3-5 The Government Accountability Office (GAO) found that 9 of every 10 US public schools in 2003-2004 offered competitive foods to their students, noting that middle schools have significantly increased their sale of competitive foods in recent years.6

The GAO reported that almost 30% of public high schools earned more than $125,000 from competitive food sales.6 A separate GAO review of 6 large states’ food service revenues from 1996 to 2001 found that food sales accounted for more than 40% of total food service revenue, whereas state funding supplied only 3% of revenues. In these schools, a la carte sales accounted for 43% of total food sales. In 2 of 6 states reviewed by the GAO (Ohio and Virginia), food sales provided more revenue to schools than federal reimbursement, which provided on average 53% of total revenues.7

While competitive foods may be earning schools needed revenue, the introduction of a la carte foods in middle school has been shown to significantly reduce the amount of fruit, vegetables, and milk that children consume at lunch while increasing consumption of sweetened drinks and high-fat vegetables.8,9 Students in schools with policies that restrict access to foods high in fat and sugar have lower rates of consumption of these foods.10 The picture is complicated, however, by the variety of factors that affect competitive food sales, such as eligibility rates for free or reduced-price meals, vending machine presence and contracts, open campus policies, time of lunch period, school size, and policies restricting fast food being brought into the lunch room.11 Even so, school districts are beginning to address their impact on the obesity epidemic through the implementation of policies governing the types of competitive foods that can be sold on campus.12 However, a sampling of 112 local wellness policies in 40 states implemented by the July 1, 2006, deadline found that only half met the minimal requirements of the federal mandate.13

In addition to federal legislation mandating local school district wellness policies, state legislatures are working to change the nutrition environment in schools at the state level. As of April 2006, legislatures in 28 states were considering bills addressing school nutrition.14 Despite increased attention from policymakers, a review of state policies enacted through July 2006 found that only 16 states set nutritional requirements for foods sold outside of the school lunch program and only 20 states set limits on where and when foods may be sold outside of the school meal program.15 State school nutrition policies enacted in 2006 include: expansion of existing nutritional guidelines for competitive foods sold in elementary and middle schools to high schools in Arizona, creation of minimal nutritional standards for all competitive foods sold in schools in Louisiana and Maine, sugar and calorie limitations on foods sold in vending machines in North Carolina, complete removal of beverages other than water and 100% fruit or vegetable juice from all schools in Connecticut, and the requirement that schools offer “healthier” beverage and snack alternatives in Indiana and Rhode Island. Connecticut’s law also includes an optional healthy snack program, where participating districts receive additional state funding. Additionally, Maryland and North Carolina enacted laws restricting when and where vending machines can operate in schools.15

LITERATURE REVIEW

Relevant literature was identified by performing literature searches in PubMed, PsycINFO, CINAHL, and the Cochrane Systematic Literature Review for the past 10 years. Key word searches included combinations of the terms such as “school,””lunch,””economics,””cost,””a la carte,””competitive foods,””participation,” and “revenue(s).” Other searches included reviewing “related articles” through PubMed links and references included in articles identified through original searches. In total, 121 publications were identified. Thirty-five articles were identified through PubMed, 60 through PsycINFO, 18 in CINAHL, and 8 through the Cochrane Systematic Literature Review.

Studies that tested effects of nutrition policy changes to a la carte and vending options were included if they met the following criteria: (1) assessments of NSLP participation were made or (2) food service or school revenues were assessed in association with nutrition policy changes. Additionally, state-based reports known to contain financial and NSLP assessments were also reviewed. Based on these inclusion criteria, a total of 4 peer-reviewed articles and 3 state reports were included in the present review (Table 1).

Financial Impact of Policy Change

School administrators have consistently expressed concerns that improving the nutritional quality of the competitive foods offered may negatively impact competitive food revenues. These revenues comprise a significant proportion of total food service revenues and in many cases provide discretionary funds for use throughout the school.6’7 This question has been addressed empirically in the following peer-reviewed studies and state-based reports. Peer- Reviewed Studies. Wojcicki and Heyman16 conducted an analysis of the impact of nutrition policies implemented within the San Francisco, California, Unified School District in 2003. These strong policies included limits on portion sizes of various foods, nutrient requirements based on Recommended Dietary Allowances and the Dietary Guidelines for Americans,17 and a variety of specific criteria dictating allowable beverages in schools.18 These policies were implemented at the beginning of the 2003-2004 school year across the district and affected all foods served as part of federal food assistance programs; foods sold at snack bars, in vending machines, and in school stores; and foods sold in fund-raising efforts.16

The policies were first pilot tested within a single middle school in San Francisco during the 2002-2003 school year. Researchers collected data on participation rates in the NSLP and overall food-related revenue prior to and across the implementation school year for this school. Results showed that, with increased participation in the NSLP over the course of the year, revenue during May 2003 totaled more than $2000 compared to the final month prior to implementation, during which the school lost about $1000. Overall profit data were not available over the entire school year, but based on personal communication, the authors noted that revenue remained unaffected over the course of the year despite the sweeping changes to food offerings.

At the time of publication, data for the district-wide implementation of nutrition policies were incomplete. Similar trends of increased participation in the NSLP were noted, and these results could not be explained by shifts in student enrollment in schools. Of the 40 middle and high schools for which data were collected, 67.5% had increased participation in the NSLP, 17.5% did not register a change in participation, and 15.0% had a decrease in participation.16 Revenue data had not been calculated, but the majority of schools showed an average net loss of $13,155 in a Ia carte sales. It is not known if these losses might have been offset by greater federal food assistance program participation.16

French et al have published a series of studies employing different strategies related to foods in schools.19-21 The Trying Alternative Cafeteria Options in Schools study included 20 schools in a 2-year intervention. Schools were randomized into control (n = 10) and intervention (n = 10) groups, and changes in food availability were coupled with peer-based promotions for specific foods. In particular, lower fat a la carte offerings (those foods containing 5 g of fat or less per serving) were increased to 42% in intervention schools, and student groups were trained to promote lower fat food options to their peers through posters, taste tests, newspaper articles, and other activities. Results showed intervention schools had significantly higher average percentage of sales from lower fat foods (33.6%) compared to control schools (22.1%) after year 2 of the intervention. The authors indicated that the intervention and the presence of more lower fat options had no impact on overall food service revenue.20

Two earlier studies by French et al assessed the effects of reducing prices of healthier food options, such as low-fat snacks or fruits and vegetables.19,21 In the first of these studies, fruit and vegetable a la carte options were lowered in price by 50% over a period of 3 weeks, and a variety of promotional strategies were employed to increase interest in the reduced-price foods. During the intervention period, sales of reduced-price produce items increased significantly, suggesting increased fruit and vegetable intake among students. Interestingly, this occurred without a significant change in total a la carte revenues.

Another study by French et al, called Changing Individuals’ Purchase of Snacks, focused on vending machine fare.19 The researchers introduced 2 rows of low-fat snacks (those containing 3 g of fat or less) in all vending machines of 12 schools within the Minneapolis-St Paul, Minnesota, area. In 4-week intervals, the prices and type of promotion of the low-fat snacks were changed. In one condition, the price of the low-fat snacks was reduced between 10% and 50%. The promotion condition included 3 levels: not promoted, promoted with low-fat labels, or promoted with labels and signs encouraging purchase. Sales data from all vending machines were collected from the vending company’s central database.

Consistent with previous research, price reductions resulted in significantly greater sales of low-fat snacks, with the greatest volume of sales occurring with a 50% price reduction.19 Similarly, when low-fat snacks were promoted with labels and signs, sales also rose significantly. Importantly, no significant differences were noted in overall vending revenue with the changes in price or promotions, suggesting that lowpriced healthier snack options have no impact on general sales in vending machines.

State-Based Pilot Studies. Results from nutrition policy pilot studies are now available from at least 3 states.22-24 The Healthy Snack Pilot project, conducted by the State Department of Education in Connecticut, was implemented in 5 schools, including 2 elementary schools, 2 middle schools, and 1 high school.24 Three additional schools from the same towns did not make any changes during the year and were used as comparison schools. The intervention schools changed all snack food offerings, in both vending and a la carte, to specific nutrient and portion size criteria.25 For instance, snack foods could not contain more than 35% of calories from fat or 10% of calories from saturated fat. They were also required to contain less than equal to 35% of sugar by weight. Portion sizes for snacks and beverages were limited as well.

At the end of the year, the intervention schools reported increases in the number of students participating in the NSLP. Further, the Healthy Snack Pilot did not affect overall school revenue.24 The researchers hypothesize that the increase in NSLP participation offset the decrease in revenue from a la carte and vending. Statistical analyses to test this hypothesis were not conducted due to the lack of randomization, the small sample size, and the fact that 2 of the intervention schools did not have comparison schools. Because these data represent only a 2-year period, the argument that changes in meal participation rates are due to fluctuations resulting from factors other than the intervention cannot be ruled out; however, the overall picture is encouraging.

The Department of Education in Arizona conducted a similar pilot study, although it allowed greater latitude for implementation within each of 8 intervention schools.22 A School Environment Model Policy was provided to all participating schools. The policy mandated that foods offered during the normal school day meet the Dietary Guidelines for Americans (eg, foods could not contain more than 30% of calories from fat or 10% of calories from saturated fat) and no foods of minimal nutritional value could be sold during the normal school day. The policy covered foods sold within the school and as part of fund-raising efforts.25 Of the 8 schools, 3 made changes to vending options or time of operation, 3 made changes to a la carte or school store food offerings, 1 changed breakfast and lunch menu items to better conform to Dietary Guidelines, and 1 (in which no foods were sold other than those as part of the NSLP) began a program introducing a variety of novel fruits and vegetables to children with taste tests in the cafeteria and coordinated classroom lessons. Five of the 8 schools incorporated novel nutrition-related curriculum to support environmental changes as well.22

Financial data were gathered for 2 months before policy implementation and again for 4 months following implementation. Variables included a Ia carte and vending sales as well as overall food sales. No loss of revenue was found for 4 of the 6 schools where vending options were available prior to policy implementation, while the other 2 schools did report a loss in vending revenue. In 1 case, the losses likely were due to shutting off vending machines during meal times when previously this had not occurred. Despite the cases of vending machine revenue loss, all schools reported no overall food service revenue losses after making policy changes. Similarly, no net losses were recorded in any school making curriculum or other changes.

California carried out a similar pilot project using the nutrition standards that were included in state legislation.23 These standards were similar to those found in other states: snack foods in vending machines or a la carte stations could not contain more than 35% of calories from fat, more than 10% of calories from saturated fat, or more than 35% of sugar by weight. There were also restrictions in the types and sizes of beverages sold. A 21-month pilot project implementing these criteria was conducted between January 2003 and September 2004 in 16 California middle and high schools.

Ten of the 16 schools reported on the fiscal impact of changes in nutrition policy. Eighty-one percent of the food service directors reported an increase in gross revenue after the nutrition standards were implemented compared to the previous school year. Within this group, 85% reported that this revenue increase occurred due to greater sales of reimbursable meals, even when decreases were noted in a la carte sales. Interestingly, the greatest increases in revenues came at those sites where a la carte foods were eliminated completely. Net income from food service increased between $19,000 and $133,000 in 3 of the 5 school districts that provided quantitative data. Two districts, however, reported net losses between $6000 and $17,000.23 The researchers attributed the net losses to increased labor costs and the expense of greater amounts of fruits and vegetables. Importantly, costs associated with provision of produce were essentially unrelated to the nutrition requirements delineated within state legislation; rather, they were related to a separate initiative to promote use of California produce.23 DISCUSSION

The collective results of these reports suggest 2 important points of discussion: (1) fears of net negative financial impact due to changes in food options and overall school nutrition are unfounded; to the contrary, available data suggest that most schools do not experience any overall losses of revenue. (2) In some schools, there was increased participation in the NSLP after the intervention, which might compensate for revenue losses in snack sales where they occurred. In addition to these data, anecdotal evidence has been compiled by the Centers for Disease Control and Prevention in their publication Making it Happen: School Nutrition Success Stories. These stories provide accounts of either no net losses or even net gains in school revenue after nutrition standards were put into place.26

Some limitations in the literature should be noted. Primarily, the state of the literature related to the financial impact of school nutrition policy changes is in its infancy. As such, no long- term controlled studies have been conducted, and it is impossible to guarantee that making major changes to nutrition policies within schools will not negatively impact overall food service profits. Similarly, researchers have focused on measures of revenue rather than profit, which might provide an incomplete picture of the financial impact of policy changes. For example, the increased sale of school meals generates revenue, but it comes with a cost that likely is higher than costs associated with vending machines. Changing or eliminating vending sales could, theoretically, reduce revenues without greatly reducing costs, while increasing sales of school meals might increase revenues while also increasing costs. This potentially could result in a reduction in total profits. Future studies should therefore take revenue and profit into account. Last, no studies have yet determined whether financial success of any policy or environmental change within schools continues over time and whether success depends on nonfinancial factors. Future research should examine the issue of whether there is increased participation in the NSLP when a la carte options are limited. It will also be important to track financial changes over time as societal attitudes about eating and nutrition, as well as the student body affected by nutrition policies, will change as well.

Another important question relates to implementation of nutrition policy changes. Little research has been conducted assessing the management of such changes by principals and food service directors. Survey data used to assess perceptions of food policies by principals and food service directors suggest a lack of communication between these groups in relation to existence and enforcement of nutrition-related policies. In 1 such study, although nearly 40% of principals surveyed reported enforcement of an a la carte-related policy, only 15% of food service directors noted this as an enforced policy.11 These results suggest the possibility that mismanagement or poor communication could affect the actual implementation of policy initiatives and, perhaps, concomitant revenue. Other nonfinancial barriers to successful environmental interventions could affect revenue in schools as well. These include mass marketing of unhealthy foods outside of schools sufficient to drive down demand of newly introduced healthier options;27 teasing and bullying, which are related to unhealthy weight management behaviors;28-31 lack of healthy culturally diverse food choices;28 and time limitations for eating a full meal.31 Further, the impact of socioeconomic status and grade level (ie, elementary, middle, and high school levels), as well as off-campus policies, should be assessed. As research commences on school wellness policies across the country, it will be imperative to incorporate financial analyses when school nutrition policies are implemented. Researchers should also consider nonfinancial factors that might play a role in the financial success, and perhaps continued implementation, of strong school nutrition policies.

REFERENCES

1. Local Wellness Policy of the Child Nutrition and WIC Reauthorization Aa of 2004, Public Law 108-265; 2004.

2. Kann L, Grunbaum J, McKenna ML, Wechsler H, Galuska DA. Competitive foods and beverages available for purchase in secondary schools-selected sites, United States, 2004. J Sch Health. 2005;75(10):370-374.

3. French SA, Story M, Fulkerson JA, Gerlach AF. Food environment in secondary schools: a la carte, vending machines, and food policies and practices. Am J Public Health. 2003;93(7): 1161-1167.

4. Gemmill E, Cotugna N. Vending machine policies and practices in Delaware. J Sch Nun. 2005;21(2):94-99.

5. Probart C, McDonnell E, Weirich JE, Hartman T, Bailey-Davis L, Prabhakher V. Competitive foods available in Pennsylvania public high schools. JAm DietAssoc. 2005;105(8):1243-1249.

6. Government Accountability Office. School Meal Programs: Competitive Foods Are Widely Available and Generate Substantial Revenues for Schools. Report No. Washington, DC: Government Accountability Office; 2005. Report no. GAO-05-563.

7. Government Accountability Office. School Meal Programs: Revenue and Expense Information from Selected States. Washington, DC: Government Accountability Office; 2003. Report no. GAO-03-569.

8. Cullen KW, Zakeri I. Fruits, vegetables, milk, and sweetened beverages consumption and access to a la carte/snack bar meals at school. Am J Public Health. 2004;94(3):461-467.

9. Kubik MY, Lytle LA, Hannan PJ, Perry CL, Story M. The association of the school food environment with dietary behaviors of young adolescents. Am J Public Health. 2003;93(7):1168-1173.

10. Neumark-Sztainer D, French SA, Hannan PJ, Story M, Fulkerson JA. School lunch and snacking patterns among high school students: associations with school food environment and policies. Int J Behav Nutr Phys Act. 2005;2(1):14. Available at: http://www. ijbnpa.org/ content/2/1/14. Accessed February 10, 2007.

11. McDonnell E, Probart C, Weirich E, Hartman T, Bailey-Davis L. School competitive food policies: perceptions of Pennsylvania public high school foodservice directors and principals. J Am Diet Assoc. 2006; 106:271-276.

12. Greves HM, Rivara FP. Report card on school snack food policies among the United States’ largest school districts in 2004- 2005: room for improvement. Int JBehavNutr Phys Act. 2006;3:1. Available at: http://www.ijbnpa.Org/content/3/l/l. Accessed February 10, 2007.

13. Action for Healthy Kids. An Action for Healthy Kids’ report: a snapshot view of local school wellness policies more than half fall short of federal mandate. Available at: http://www. actionforhealthykids.org/filelib/pr/Fact%20sheet%20on%20 WP%20Analysis%208%2021%202006.pdf. Accessed February 11, 2007.

14. Health Policy Tracking Service, a Thomson West Business. State Actions to Promote Nutrition, Increase Physical Activity and Prevent Obesity: A 2006 First Quarter Legislative Overview. Health Policy Tracking Service; 2006. Available at: http://www.rwjf.org/ files/ research/RWJReport%20Oct2005.pdf. Accessed February 10, 2007.

15. Trust for America’s Health. Supplement to ‘F as in Fat: How Obesity Policies Are Failing in America, 2006’: Obesity-Related Legislation Action in States, Update. Washington, DC: Trust for America’s Health; 2006.

16. Wojcicki J, Heyman M. Healthier choices and increased participation in a middle school lunch program: effects of nutrition policy changes in San Francisco. Am J Public Health. 2006;96(6): 1542-1547.

17. US Departments of Agriculture and Health and Human Services. Dietary Guidelines for Americans. 6th ed. Washington, DC: US Departments of Agriculture and Health and Human Services; 2005. HHS- ODPHP-2005-01-DGA-A.

18. San Francisco Unified School District. SFUSD Student Nutrition and Physical Fitness Plan Time: Revised. San Francisco, Calif: San Francisco Unified School District; 2003.

19. French S, Jeffery R, Story M, et al. Pricing and promotion effects on low-fat vending snack purchases: the CHIPS study. Am J Public Health. 2001;91(1):112-117.

20. French S, Story M, Fulkerson J, Hannan P. An environmental intervention to promote lower-fat food choices in secondary schools: outcomes of the TACOS study. Am J Public Health. 2004;94(9):1507- 1512.

21. French S, Story M, Jeffery R, et al. Pricing strategy to promote fruit and vegetable purchase in high school cafeterias. JAm Diet Assoc. 1997;97(9):1008-1010.

22. Arizona Department of Education. Arizona Healthy School Environment Model Policy Implementation Pilot Study. Arizona Department of Education; 2005. Available at: http://www.azed.gov/ health-safety/cnp/teamnutrition/2003-2004/results2003-2004/ FmalReport-FullSummary.pdf. Accessed February 9, 2007.

23. Center for Weight and Health, University of California, Berkeley. Pilot Implementation of SB 19 in California Middle and High Schools: Report on Accomplishments, Impact, and Lessons Learned. Berkeley, Calif: Center for Weight and Health, University of California, Berkeley; 2005.

24. Connecticut State Department of Education. Summary Data Report on Connecticut’s Healthy Snack Pilot. Hartford, Conn: Connecticut State Department of Education; 2006.

25. Connecticut State Department of Education. Connecticut Nutrition Standards. 2006. Hartford, Conn: Connecticut State Department of Education. Available at: http://www.state.ct.us/sde/ deps/ Student/NutritionEd/index.htm#Standards. Accessed February 10, 2007. 26. Food and Nutrition Service, US Department of Agriculture; Centers for Disease Control and Prevention, US Department of Health and Human Services; and US Department of Education. Making It Happen: School Nutrition Success Stories. Alexandria, Va: Food and Nutrition Service, US Department of Agriculture; Centers for Disease Control and Prevention, US Department of Health and Human Services; and US Department of Education; 2005.

27. Sallis J, McKenzie T, Conway T, et al. Environmental interventions for eating and physical activity. Am J Prev Med. 2003;24(3): 209-217.

28. Bauer K, Patel A, Prokop L, Austin S. Swimming upstream: faculty and staff members from urban middle schools in lowincome communities describe their experience implementing nutrition and physical activity initiatives. Prev Chronic Dis. 2006; 3:1-9. Available at: http://www.cdc.gov/pcd/issues/2006/ apr/05_0113.htm. Accessed February 9, 2007.

29. Haines J, Neumark-Sztainer D, Eisenberg M, Hannan P. Weight teasing and disordered eating behaviors in adolescents: longitudinal findings from Project EAT. Pediatrics. 2006; 117:209215.

30. Neumark-Sztainer D, Falkner N, Story M, Perry C, Hannan P, Mulert S. Weight-teasing among adolescents: correlations with weight status and disordered eating behaviors, lnt J Obes. 2002; 26:123- 131.

31. Bauer K, Yang Y., Austin S. “How can we stay healthy when you’re throwing all of this in front of us?” Findings from focus groups and interviews in middle schools on environmental influences on nutrition and physical activity. Health EducBehav. 2004; 31(1):34- 46.

CHRISTOPHER M. WHARTON, PhD(a)

MICHAEL LONG, AB(b)

MARLENE B. SCHWARTZ, PhD(c)

a Assistant Professor, ([email protected]), Department of Nutrition, Arizona State University, 6950 E. Williams Field Rd, Mesa, AZ 85212.

b Research Assistant, ([email protected]), School of Public Health, Yale University, 60 College St, New Haven, CT 06520.

c Deputy Director, ([email protected]), Rudd Center for Food Policy and Obesity, Yale University, 309 Edwards St, New Haven, CT 06520.

Address correspondence to: Christopher M. Wharton, Assistant Professor, ([email protected]), Department of Nutrition, Arizona State University, 6950 E. Williams Field Rd, Mesa, AZ 85212.

The authors acknowledge the Rudd Center for Food Policy and Obesity at Yale University for supporting the writing of this article.

Copyright American School Health Association May 2008

(c) 2008 Journal of School Health, The. Provided by ProQuest Information and Learning. All rights Reserved.

14 Allergy Strategies That Bring Fast Relief

By Schaaf, Rachelle Vander

Don’t resign yourself to sneezing and watery eyes. Make this the year you reclaim the outdoors-with these expert tips. Ah, spring. Trees are budding and gentle breezes are blowing-and your nose is running, your eyes are itching, and your brain is fuzzy. As much as you’d love to just curl up with a box of tissues, you shrug it off and soldier on. After all, it’s only allergies, right?

While it’s easy to trivialize these annoying symptoms-which plague some 36 million Americans-experts say they’re nothing to sneeze at. In feet, 80 percent of seasonal allergy sufferers report being less productive because of the condition, costing the U.S. economy an estimated $700 million a year in lost work, according to a study by the Asthma and Allergy Foundation of America.

Also called hay fever, seasonal allergies worsen when the weather warms up and blossoming flowers, trees, weeds, and grasses spew pollen into the air. “An overzealous immune system mistakes these harmless particles for intruders and releases inflammatory chemicals called histamines and leukotrines to combat them,” explains Thomas B. Casale, chief of allergy/ immunology at Creighton University School of Medicine in Omaha, Nebraska, and president of the American Academy of Allergy, Asthma, and Immunology (AAAAI). Consequently, your airways and nasal linings swell, triggering congestion, wheezing, and foggy thinking.

Although experts aren’t clear why people develop the lifelong condition in the first place, they say genes are partly to blame. While there’s no instant fix for seasonal allergies, making a few tweaks to your environment and schedule-like showering at night instead of in the a.m.-can alleviate symptoms. Try these easy everyday strategies and you’ll finally have a sniffle-free spring.

AT HOME

* Block out allergens The No. 1 antiallergy move is to keep those triggers at bay, so be sure to leave your windows shut during pollen season. Then run the air conditioner on the “recycle” setting, which filters the air that’s indoors. “That will trap any particles that did sneak inside,” says Eric Schenkel, M.D., a clinical assistant professor of medicine at Drexel University School of Medicine in Philadelphia. Also rinse or replace the filter every two weeks to remove any dust and keep it running efficiently.

* Rethink your bedtime routine Hopping in the shower in the morning is one way to kick-start your day, but switching to a nighttime routine during the spring and summer can curb your symptoms. You’ll wash away the allergens that stick to your hair and face, so they won’t rub off on your pillow and irritate your eyes and nose. “At the very least, gently clean your eyelids with a little baby shampoo each evening,” suggests Clifford W. Bassett, M.D., an assistant clinical professor of medicine at Long Island College Hospital in Brooklyn, New York

* Hit the laundry room more frequently When you get back from a walk or barbecue, change into a clean set of clothes. Then toss the old ones right into your hamper or laundry so you won’t track allergens throughout the house. And wash your sheets once a week on the hot cycle: Korean researchers recently found that water heated to 140[degrees]F eliminates virtually all allergens, including pollen and dust mites, sneeze-causing organisms that thrive in humid weather.

* Put pets in their place Dogs and cats that frolic outdoors can collect pollen in their fur and transport it into your home. During hay fever season, ban your pet from your bedroom or at least keep him off the furniture, says Bassett. Bathe him as frequently as possible or wipe him down when he comes in from the yard with a premoistened cloth, such as Simple Solution Allergy Relief from Pets ($7; petco.com).

* Clear the air Almost half of seasonal allergy sufferers are also bothered by irritants such as fragrances and cleaning products, according to a recent study in the journal Indoor Air. To breathe easier, invest in a HEPA air purifier, which filters out aggravating indoor pollutants. A good pick: Honeywell HEPA Tower Air Purifier ($250; target.com).

* Trim your lawn Not only will your manicured yard be the envy of your neighbors, the shorter blades won’t trap as much pollen from trees and flowers. (But because mowing can stir up pollen, ask someone else to do it-or cover your nose and mouth with a face mask or handkerchief.)

DURING OUTDOOR WORKOUTS

* Fine-tune your fitness routine “You breathe at least twice as fast when you’re working out, which means you’ll inhale even more allergens if you exercise outdoors,” says Brian Smart, M.D., a Chicago allergist and AAAAI spokesperson. Morning exercisers are hit hardest of all because airborne allergens peak during the early hours, starting at 4 a.m. and lasting until noon. Because pollen rises as morning dew evaporates, the ideal time for an outdoor workout is in the mid-afternoon, says Christopher C. Randolph, M.D., a clinical associate professor at Yale University’s Division of Allergy in New Haven, Connecticut. He notes that where you work out can also matter: Exercising on the beach, an asphalt tennis court, the track at your local high school, or in the swimming pool are better options than working out on a grassy field.

* Run right after it rains “The best time to hit the pavement is immediately after a downpour, because the moisture washes away the pollen for up to several hours,” says Gillian Shepherd, M.D., a clinical associate professor of medicine at Weill Medical College of Cornell University. But once the air dries, take cover: The additional moisture generates even more pollen and mold, which can hang around for a few days afterward. (Before heading out, check pollen and mold reports on aaaai.org.)

* Slip on shades Not only do wraparound sunglasses shield you from harmful UV rays, they’ll also stop airborne allergens from getting in your eyes. Another way to ward off symptoms: a Use allergy-relieving eyedrops, such as I Visine-A ($7; drug store.com), a few hours before heading outside. This will combat histamines, which are the compounds that cause your eyes to water and itch.

* Drink up Fill up a water bottle or hydration pack to bring on your run, walk, or bike ride. “Fluids help thin mucus and hydrate the airways, so you won’t get as stuffed up,” says William S. Silvers, M.D., a clinical professor of allergy and immunology at the University of Colorado in Denver. Then use the rest to rinse off any pollen that’s on your face and hands.

AT THE DOCTOR’S OFFICE

* ID your triggers “If you know what they are, you’ll know how to defend yourself against them,” says Smart. Request a skin-prick test, in which an allergist applies a man-made version of the potential allergen to your forearm and makes a small prick in the skin so the solution can enter. If you’re allergic, a lump resembling a mosquito bite will appear at the site.

* Give your medication a checkup While some may find relief with an over-the-counter medicine, such as Claritin, Alavert, or Zyrtec- D, others may prefer a stronger one-a-day prescription tablet, such as Singulair. Ask your doctor for her recommendations, but don’t mix your meds: Following a non-drowsy 24-hour drug with a different p.m. pill that night could lead to dizziness, increased heartbeat, and nausea. “But what’s most important is that you take allergy medications as regularly as suggested by a doctor to ward off attacks, rather than when you’re just experiencing symptoms,” says Casale.

* Try a spray If you find that pills aren’t easing your symptoms, your M.D. may prescribe a nasal steroid like Veramyst, Flonase, or Nasonex. “These sprays effectively treat runny noses and watery eyes,” says Randolph, who adds that you shouldn’t be put off by the word “steroid.””Nasal sprays are extremely safe. The small amount of steroids you spritz into your nose is metabolized quickly, so little-if anyactually enters the body.” Use one a few weeks before allergies hit; symptoms will start later and be less severe.

* Get your shots If you’re affected by seasonal allergies for more than three months of the year, allergy shots, also called immunotherapy, may be in order. An allergist will inject you with gradually increasing doses of an allergen one to three times a week over the course of up to seven months, which enables you to build up tolerance to the offending substance. (After that, you’ll get the shots once a month for three to five years.) “Shots change the immune system’s pathway,” says Randolph. “They are effective for a number of years, and they can even prevent the development of other allergies as well as asthma.”

With the bright game plan, you’ll be able to stop and smell the flowers

Let your cat out in the afternoon, when pollen counts are lowest

If you know what your triggers are, you’ll know how to defend yourself breathe easy with these natural fixes

1 NASAL IRRIGATION New research from the University of Michigan, Ann Arbor finds that a simple saltwater solution can offer relief from symptoms. “It’s perfect for postnasal drip or if mucus has become thick or dry, causing congestion,” says lead author Melissa A. Pynnonen, M.D. Dissolve a quarter of a teaspoon each of kosher salt and baking soda in a cup of warm water. Using a bulb syringe, squirt bottle, or neti pot ($36 at netipot.org’), squirt this solution into your right nasal passage while leaning over a sink. Then tilt your head to the left, allowing the water to drain out of your left nostril; repeat on the other side. 2 QUERCETIN Taken in tablet or caplet form, this bioflavonoid, found in foods like red wine, tea, and apples, has anti-inflammatory effects. Researchers from Boston University School of Medicine found that quercetin helps block the production of symptom-causing histamines. A 1,000- milligram tablet, taken one to three times a day, is enough to alleviate allergies, says William S. Silvers, M.D., a professor at the University of Colorado.

3 OMEGA-Ss These antiinflammatory fatty acids may alleviate symptoms in hay fever sufferers, reports a study in the journal Allergy. Silvers recommends having a serving of cold-water fish, such as salmon or mackerel, walnuts, ground flaxseed, or a fish-oil supplement at least three to four times a week.

A serving of allergy relief: 14 walnut halves

Agriscience: Sustaining the Future of Our Profession

By Thoron, Andrew C Myers, Brian E

Sustainable agricultural practice refers to the ability of a farm to produce food indefinitely, without causing irreversible damage to ecosystem health. According to Feenstra (1997) “sustainable agriculture integrates three main goals-environmental health, economic profitability, and social and economic equity”. Reflecting on the Sustainable Agriculture-Sustainable Education topic we can gleam some principles from our industry partners. Using the industry’s definition of sustainable agriculture as a guide, we may define sustainable agricultural education as “the ability to produce agriculturists indefinitely, without causing irreversible damage to our core values.” Using this framework for sustainable agriculture and the National Research Agenda 2007-2010 (Osborne, n.d.) as a guide, sustainable agricultural education involves three main goals- curricula adapted to the needs of our students, enhanced program delivery through integration of industry concepts, and assessments which address both student and district needs.

How can we increase (quantity and quality) our development of agriculturists? Local control and shared input from teachers across the nation can provide valuable insight into this issue. A common thread has emerged through the years in successful programs which are able to produce agriculturists indefinitely. The integration of agriscience into the curriculum is an important consideration. Since the mid-1980’s agricultural education has been in the process of incorporating science into the agricultural education curriculum. Research supports this integration which also indicates teachers are supportive of agriscience education and the transition from purely production to a more consumption focus. Numerous states allow agricultural education courses to satisfy science requirements for high school graduation and college admission. As a profession we now must ask ourselves, are we integrating science into our agricultural curriculum or are we teaching agriculture as an integrated science?

At first glance the previous sentence may be confusing. Integration of science into the curriculum means taking specific science concepts and then finding an agricultural application. Teaching our students about photosynthesis or the components of the water cycle are examples. This approach considers what science concepts are to be taught first, then finds agricultural principles to illustrate those science concepts. Conversely, the development and implementation of an agricultural curriculum that teaches agriculture as the integrated science – the science where biology, chemistry, and physics all come together – would highlight the science which already exists as the foundation of agricultural practices. This approach begins with the practices and then works to explain the scientific principles behind it – why it works. Discovering what genotypes are tied to efficient milk production in dairy cattle is an example. It is this second approach that will lead to agricultural education sustainability.

Effective use of technical agriculture and partnerships with industry help shape the programs which develop students who have a scientific way of thinking. Development of science process skills and students having the ability to think critically when faced with a problem are important attributes of the next generation of learners. Gardner (2006) writes, in his book titled Five Minds of the Future, about the need for learners who can think critically and recognize changes when they need to be made. He goes onto state our educational system as a whole does not do enough to promote this type of learner. It is in this gap that agriscience education can stand to support not only our industry of agriculture but be an active and productive member of the educational system.

Agriscience education has a unique ability to develop this critical thinking type of student. This requires curricula adapted to the needs (current and future) of our students, integration of industry concepts, and assessments addressing both student and district needs. Continual focus on sustainable agriscience education requires inquiry based learning leading to students developing much of their own thoughts about science through laboratory activities. These laboratory activities may occur in the land laboratory, greenhouse, garden, mechanics laboratory, computer simulations, or many other locations.

Agriscience education is a leading component in the progress toward sustainability due to these facts and the growing demand for science based agricultural careers. According to the USDA Cooperative State Research Education and Extension Service (CSREES) most recent report in 1999, 32% of all agricultural jobs will require scientific degrees in food science and engineering. The need for formal education be formal education may be a 6-month certificate program, an associate’s degree, or an advanced degree. With job opportunities abundant and industry facing the effects of the baby boom generation retirement, Agriscience educators must heed the call of preparing the next generation of agriculturalist.

Educational curricula receive their strength from the teachers in the classrooms. No organization, state, or national persuasion can change agricultural education as effectively as the classroom teacher. The teacher-led push toward sustainable agriscience education focuses on two goals – reflecting on where we teach and how we teach.

To be sustainable in a changing future, agriscience education must better utilize laboratory facilities which promote critical thinking skills. Perhaps, for some educators at the local level this means reinventing the “shop” into a learning laboratory which contains computers, experiment stations, and scientific equipment. More simply, mechanics laboratory facilities should be better utilized to effectively teach physical science principles in agriculture. Partnering with industry to bring in industry equipment and to train students with updated modules is one way to sustain agriscience education.

Secondly, being honest with ourselves as teachers by reflecting on our teaching methods and philosophies we present to our students. As a profession we must continually ask ourselves if we are really teaching agriscience as the integrated science or have we just renamed our curriculum and placed it in a new package. It is astounding to recognize that students in our classrooms today will be working with technology in their future careers that has yet to be invented. Are we preparing students for these future jobs? Do our students leave our programs with the knowledge and skills to adapt to this new reality or are they equipped with an antiquated skill set?

The key to the sustainability of agricultural education is through agriscience education which can effectively teach students how to think and how to construct their knowledge. Employers seek students who can solve problems and work with others, and agriscience education is the best vehicle to attain those goals.

Looking Back

An interesting activity that goes hand in hand with producing this magazine, is reflecting on information past and present. In case you have access to past issues, here are a few articles you might want to look up….

1932, January, Volume 4, No. 7

* Suggested activities for developing Supervised Practice Problems common to a group of beginning students, Don M. Orr

* Suggestions on Farm Shop Management, Carl G. Howard

1942, January, Volume 14, No. 7

* A farm shop clean-up plan, Roy A. Olney

* Evaluation from the point of view of a teacher, L. J. Hayden

1952, January, Volume 24, No. 7

* A study of the occupational status of state farmer degree members in Kansas, Frank R. Carpenter

* Vocational education and the individual, Raymond M. Clark

1962, January, Volume 34, No. 7

* A new Farm Mechanics contest, Carl S. Thomas

* “Operation Concrete,” Clayton R. Olsen and Ray Husen

1972, January, Volume 44, No. 7

* Change needed in Agricultural Mechanics curricula, Wiley B. Lewis and Ralph J. Woodin.

* National Agricultural Mechanics Contest-A reality in the making, Thomas A. Hoerner

Interesting to see the similarities and the changes in these five decades. Take time to visit the past-and see how it compares to today!

Agriscience education is a leading component in the progress toward sustainability due to these facts and the growing demand for science based agricultural careers.

References:

Feenstra, G. (1997). What is sustainable agriculture? Retrieved December 1,2007, from UC Sustainable Agriculture Research and Education Program, University of California, Davis, CA. Web site: http://www.sarep.ucdavis.edu/concept.htm

Gardner, H. (2006). Five minds for the future. Boston, MA: Harvard Business School.

Goecker, A. D., Gilmore, J., & Whatley, C. (1999). Employment opportunities for college graduates in the food and agricultural sciences: Agriculture, natural resources,

and veterinary sciences, 2000-2005. Retrieved December 6, 2007, Website: http://faeis.ahnrit.vt.edu/hep/employ/employ00-05.html

Osborne, E. W. (Ed.) (n.d.) National research agenda: Agricultural education and communication, 2007-2010. Gainesville, FL: University of Florida, Department of Agricultural Education. Andrew C. Thoron

Graduate Teaching/Research

Assistant

Department of Agricultural

Education and Communication

University of Florida

Brian E. Myers

Assistant Professor

Department of Agricultural

Education and Communication

University of Florida

Ecuadorian Hermit Crab

The Ecuadorian Hermit Crab (Coenobita compressus), also known as the Pacific hermit crab is a species of land hermit crab commonly sold in the United States as a pet, along with the Caribbean hermit crab (Coenobita clypeatus). It is a member of the phylum Arthropoda and the class Malacostraca. Native to Ecuador and Chile, these hermit crabs live on the Pacific seashore around the tidal pools and high-tide zone. Their bodies have adapted to this seashore existence and are able to metabolize the salt in seawater. In fact, they have adapted so well to their environment that they actually need seawater to live.

They can be up to a half inch in length and are thought to be one the smallest species of land hermit crabs. They have four walking legs, a small pincer, a large pincer, and antennae. The eyes of Ecuadorians are more oval-shaped when compared to the round eyes of Caribbean hermit crabs and are thicker. Their big claw has 4 or 5 small ridges on the upper part. The tips of the second pair of walking legs are darker than the rest of the leg. The abdomen of the Ecuadorian hermit crab is short and fat. They vary greatly in color, some are bright (yellow, dark gray, or orange), but more often they are a tan color. Sometimes they may have a blue or green tint to their bodies or the insides of their legs.

Like most hermit crabs they are scavengers and will consume seaweed, dead fish and other detritus that washes up on the shore. A study conducted by the department of biology at the University of Michigan showed that land hermit crabs prefer the odors of foods that they have not recently eaten. The crabs that were exposed to one food for at least 9 hours preferred foods having other odors for the next 6 hours. It is this short-term avoidance of food (like human beings who get “bored” of the same meals over and over again) that compels the crabs to seek out a wider range of food might be advantageous to the crab, possibly through the consumption of a more nutritionally balanced diet.

‘Pixie Dust’ Used to Regrow Severed Fingers

Sixty-nine-year-old hobby shop worker Lee Spievak is a symbol of hope for some medical scientists who believe that human tissue can re-grow itself.

When Mr. Spievak severed half an inch of his finger off, doctors said he’d lost it for good.

Today, however, Spievak boasts of his completely re-grown finger ““ nerves, skin, nails and fingerprint ““ it’s all there.

But, he didn’t receive a transplant. Mr. Spievak used a powder, given to him by his brother Alan, who worked in the field of regenerative medicine.

The powder, or “pixie dust” as he refers to it, was developed by Dr. Stephen Badylak in a lab at the University of Pittsburgh.

Badylak creates the tissue through a process that takes cells from the lining of a pig’s bladder, leaving the remaining cell-free tissue.

The tissue is then dried and turned into sheets or powder.

“There are all sorts of signals in the body,” explains Dr Badylak.

“We have got signals that are good for forming scar, and others that are good for regenerating tissues.”

“One way to think about these matrices is that we have taken out many of the stimuli for scar tissue formation and left those signals that were always there anyway for constructive remodeling.”

Spievak said he put some of Dr Badylak’s powder on his injured finger for about 10 days.

“The second time I put it on I already could see growth. Each day it was up further,” Spievak said. “Finally it closed up and was a finger”

“It took about four weeks before it was sealed.”

Researchers hope to one day use similar techniques to stimulate cells to re-grow skin of burn victims like Robert Henline, an Iraq war veteran who was almost killed in an explosion.

Henline suffered 35% burns to his head and upper body. His ears are almost totally gone, the skin on his head has been burnt to the bone.

So far he has undergone surgery 25 times, and he assumes he has got another 30 to go.

Henline said he hopes that doctors could develop a way to heal his wounds through matrices like those being produced by Dr. Badylak.

“Life changing! I think I’m more scared of hospitals than I am of going back to Iraq again.”

Doctors plan to soon begin a clinical trial in Buenos Aires on a woman with cancer of the esophagus.

In the trial they will place the extra cellular matrix inside the body from where the portion of oesophagus has been removed, and hope to stimulate the cells around it to re-grow the missing portion.

“I think that within ten years that we will have strategies that will re-grow the bones, and promote the growth of functional tissue around those bones. And that is a major step towards eventually doing the entire limb,” said Dr Badylak.

On the Net:

Watch The Video: The man who grew a finger

Watch The Video: How it works in detail

University of Pittsburgh

Probiotics May Benefit Health and Quality of Life of Older People

WASHINGTON, May 1 /PRNewswire/ — Cutting-edge science on the potential for probiotics in geriatric health and disease was presented at The American Geriatrics Society (AGS) Annual Meeting in a symposium, “Probiotics: Impact on Health and Quality of Life in Older People.” Leading scientists and physicians shared the newest science on probiotics and how they relate to immune function, intestinal disorders, inflammation, and cancer in older adults.

Probiotics are “friendly” bacteria, like those in certain yogurts and fermented dairy drinks that can provide health benefits beyond basic nutrition. Research has shown that regularly consuming certain specific probiotics can help strengthen the body’s natural defenses, or improving digestive health.

At the symposium, John E. Morley, MB, B.Ch. of Saint Louis University School of Medicine led a world-class panel of speakers who stimulated scientific dialog concerning the benefits from specific “friendly” bacteria in older adults and their use in clinical applications.

Dr. Allan Walker, Director of the Division of Nutrition at Harvard Medical School, opened by providing an overview of probiotics. He explained that probiotics act on the intestinal tract to modulate the intestinal microbiota and other intestinal functions. Adding probiotics to the diet can change the composition of gut flora in older people, optimizing the functioning of the intestinal lining as well as the immune system. About 70 percent of our body’s immune system is located in the digestive tract.

There will be approximately 2 billion people over the age of 60 by 2050. As we age, there is impairment of all of the different arms of immune function, reported Dr. Simin Meydani, Associate Director of the Jean Mayer USDA Human Nutrition Research Center at Tufts University. The main problem older people face is a higher incidence of morbidity or mortality from infectious diseases because they are lacking a proper immune function. Dr. Meydani also discussed how probiotics could be beneficial to immune response and intestinal diseases in the aging.

Peter R. Holt, Senior Research Associate at Rockefeller University, highlighted the role of probiotics in inflammation and cancer. One of the main cancers contributing to death in the US is colorectal cancer, which has been associated with our diets. Dr. Holt reviewed the promising body of evidence, which supports the role of certain probiotic cultures in colon cancer risk reduction. He reported that probiotics may be beneficial by influencing several major intestinal functions that may accompany the development of colon cancer, such as detoxification, colonic fermentation, and gastrointestinal transit.

Probiotics have been used worldwide and their health benefits have been noted for some time. As the science on probiotics continues to emerge, their use in the United States has become more prevalent. A large body of evidence is showing that the addition of certain types of “friendly” bacteria to the diet can have beneficial effects on immune function and microbial activities throughout the body and in people of all ages. The role of probiotics in health may extend far beyond what was originally conceived.

The symposium was supported by an educational grant provided by The Dannon Company, Inc. and Yakult Honsha Co., Ltd.

A Webcast of the symposium will be made available at http://www.americangeriatrics.org/ , http://www.probioticscenter.com/ and http://www.yakult.co.jp/front/institute/.

Dannon and Yakult Continue to Advocate and Lead Probiotic Research and Education

Active cultures have been used for centuries to help promote healthy functioning of the body. New food products have been introduced and more are on the horizon that provide these good bacteria. For example, Dannon and Yakult are leading companies researching probiotics with academic approaches and providing various products worldwide. Dannon produces DanActive(TM), a cultured probiotic dairy drink that has been clinically proven to help strengthen the body’s defense system, Activia(R), a yogurt that has been clinically proven to help naturally regulate the digestive system by helping with slow intestinal transit, and Danimals(R) which is clinically proven to help kids stay healthy. Yakult, with its signature probiotics Lactobacillus casei Shirota, has been educating people around the world about the benefits of probiotics with their cultured probiotic dairy drink, Yakult(R) for more than 70 years.

In March 2004, Yakult Honsha Co., Ltd. and Groupe Danone, the parent company of The Dannon Company, jointly established the Global Probiotics Council. The role of the GPC is to promote and advance probiotics in the world by raising public awareness through education, communicating the latest knowledge to relevant interest groups, and supporting collaborative research in the areas of probiotics and intestinal flora.

The Dannon Company is America’s founding national yogurt company and continually leverages its expertise to develop and market innovative cultured fresh dairy products in the United States. Headquartered in White Plains, NY, Dannon has plants in Minster, OH, Fort Worth, TX, and West Jordan, UT. The company produces and sells approximately 100 different types of flavors, styles and sizes of cultured fresh dairy products. Dannon is owned by Groupe Danone, one of the world’s leading producers of packaged foods and beverages, and Dannon is the top-selling brand of yogurt products worldwide, sold under the names Dannon and Danone. With a strong commitment to high-quality, wholesome, nutritious and innovative products, The Dannon Company is committed to encouraging healthy eating and living. This commitment is also illustrated through The Dannon Company’s support of the Dannon Institute, an independent, non-profit foundation dedicated to promoting research, education, and communication about the links between nutrition, diet and health. For more information, please visit http://www.dannon.com/.

For more information on probiotics, visit http://www.probioticscenter.com/.

Yakult Honsha Co., Ltd., headquartered in Tokyo, Japan, is the world’s pioneer in probiotics by introducing the first single shot probiotics drink, Yakult(R), in 1935. Founded by microbiologist Dr. Minoru Shirota, Yakult(R) contains high amounts of its signature strain, Lactobacillus casei Shirota. Yakult is committed to researching the endless applications for probiotics and the use of intestinal bacteria in human health around the world. The company has established two science institutes to support its efforts; one in Japan (Yakult Central Institute for Microbiological Research) and one in Europe (Yakult Honsha European Research Center for Microbiology ESV). Since developing its overseas network in 1964, Yakult has expanded its business to 31 countries and territories. In addition to producing the internationally recognized probiotic beverage, Yakult is also accredited in the pharmaceutical field for its development of Campto Injection (Camptosar), the first-line drug for colorectal cancer in the U.S. Yakult U.S.A. Inc., the subsidiary of Yakult Honsha Co., Ltd., is stationed in Torrance, CA. For more information, please visit http://www.yakult.co.jp/english, http://www.yakult.co.jp/institute, http://www.yakultusa.com/.

The Dannon Company, Inc.; Yakult Honsha Co., Ltd.

CONTACT: Patricia Kearney or Kasey Heintz, +1-703-841-1600,[email protected], for The Dannon Company, Inc. and Yakult Honsha Co.,Ltd.

Web site: http://www.americangeriatrics.org/http://www.probioticscenter.com/http://www.yakult.co.jp/front/institutehttp://www.yakultusa.com/

National Cancer Registrars Association and IMPAC Medical Systems Announce Best Paper Award Recipients

MINNEAPOLIS, and SUNNYVALE, Calif., May 1 /PRNewswire/ — IMPAC Medical Systems, Inc., an Elekta company, and leading provider of oncology information technology solutions, joined the National Cancer Registrars Association’s (NCRA) Journal of Registry Management (JRM) today to announce recipients of the Sixth Annual IMPAC-JRM Best Paper Award. IMPAC and JRM, the official journal of the NCRA, partnered on this award to recognize exemplary work in the cancer registry field throughout 2007. The awards were presented to the prize-winning co-authors during NCRA’s Annual Education Conference, currently taking place in Minneapolis, Minnesota.

The IMPAC Award for Journal of Registry Management: Best Paper of the Year 2007, went to: “Use of Free-text Documentation for Research Involving Imaging and Scoping Procedures in Lung Cancer in the Sacramento Region of the California Cancer Registry” published in the Winter 2007 issue of JRM. Monica Brown, MPH, PhD; Katrina Bauer, MD, CTR; Nancy Schlag, BS, CTR; Karen G. Chee, MDc; and Prima N. Lara, Jr, MD co-authored this paper.

The 2007 Honorable Mention was awarded to: “Economic Assessment of Central Cancer Registry Operations. Part I: Methods and Conceptual Framework” published in the Fall 2007 issue of JRM. Suijha Subramanian, PhD; Jeremy Green, BA; Florence Tangka, PhD; Hannah Weir, PhD; Frances Michaud, CTR; and Donatus Ekwueme, PhD co-authored this paper.

“This award was designed to honor and recognize outstanding contributions to disease surveillance systems and the literature addressing those systems,” says Reda Wilson, RHIT, CTR, and Editor-in-Chief of the Journal of Registry Management. “The NCRA Journal of Registry Management is pleased that IMPAC has, again, provided support for this award. The original manuscripts selected are of great importance to everyone working with disease surveillance systems by documenting new ways in which the critical information may be accessed and utilized, and by describing methods by which the cost effectiveness of these important systems can be evaluated.”

“This is the sixth consecutive year NCRA has awarded the IMPAC-JRM Best Paper award, and IMPAC is delighted to continue award sponsorship into the future,” says Donna Getreuer, RN, MSN, CTR, and IMPAC’s Director of Decision Support. “We remain dedicated to JRM’s commitment to excellence and acknowledgement of authors for outstanding work in the field of cancer registry.”

About IMPAC Medical Systems, Inc.

IMPAC Medical Systems provides healthcare IT solutions that streamline clinical and business operations across the spectrum of cancer care. IMPAC’s open integration to multiple healthcare data and imaging systems offers oncology-specific patient charting and practice management, as well as best-of-breed systems for anatomic pathology, clinical laboratory and cancer registry. With products that range from diagnosis and treatment through long-term follow-up, IMPAC provides a comprehensive oncology management solution that helps improve overall communication, process efficiency, and quality patient care.

IMPAC is part of the Elekta Group, providing oncologists, radiation therapists, neurosurgeons and many other medical specialists with state of the art tools to fight cancer and brain disorders.

With more than 2,500 employees globally, Elekta’s corporate headquarter is located in Stockholm, Sweden and the company is listed on the Nordic Exchange under the ticker EKTAb. More information can be found at http://www.impac.com/ and http://www.elekta.com/.

About the National Cancer Registrars Association

Chartered in May 1974, NCRA is a non-profit organization that represents more than 4,500 cancer registry professionals and Certified Tumor Registrars. The mission of NCRA is to promote education, credentialing, and advocacy for cancer registry professionals. Cancer Registrars capture a complete summary of patient history, diagnosis, treatment, and status for every cancer patient in the United States, and other countries as well. Cancer Registrars hope their work will lead to better treatments, and ultimately, a cure. The Journal of Registry Management is published quarterly and subscriptions are available.

For more information about NCRA, visit http://www.ncra-usa.org/.

IMPAC Medical Systems, Inc.

CONTACT: Product Inquiries: Donna Getreuer, Director of DecisionSupport, IMPAC Medical Systems, +1-408-830-8000, [email protected]; Mediainquiries: Michelle Lee, PR and Advertising Manager, Elekta, +1-770-670-2447,[email protected]; Investor Inquiries: Peter Ejemyr, Group VP CorporateCommunications, Elekta AB, +46 733 611 000 – mobile, [email protected];Global Marketing Inquiries: Peter J. Gaccione, Vice President, GlobalMarketing, Elekta, +1-770-670-2380, email: [email protected]

Web site: http://www.ncra-usa.org/http://www.elekta.com/http://www.impac.com/

Apieron, Inc. Begins Customer Shipments of the Insight(TM) eNO System

MENLO PARK, Calif., May 1 /PRNewswire/ — Apieron, Inc. (http://www.apieron.com/) announced today that it has begun shipments of its Insight(TM) eNO System. Cleared by the FDA in March 2008, the Insight eNO System combines the accuracy, speed, and ease-of-use needed for the healthcare professional to provide office-based measurements of exhaled nitric oxide (eNO). Exhaled nitric oxide is a well established clinical indicator of airway inflammation and asthma control. With the use of eNO measurements, physicians can adjust inhaled corticosteroid therapy to optimize asthma control and avoid exacerbations or ‘asthma attacks’.

The Insight eNO System’s proprietary biosensor technology accurately measures eNO in parts per billion. Its single-use breath tubes are designed to be hygienic and convenient for the patient, and the disposable sensor generates a reading in less than a minute. Patient data can be stored and maintained in a unique format for trend analysis and printed for insurers’ and patients’ files. All of the System’s functions are accessible through a small desktop monitor with a large color display and clinician-friendly interface.

“We showcased the Insight System at the March meeting of the American Academy of Allergy, Asthma and Immunology, and physicians responded enthusiastically to its graphical interface and its elegant technology,” said Rich Lotti, President and CEO of Apieron, Inc. “As current methods for monitoring asthma airway inflammation are subjective, the Insight eNO System provides quantifiable information to increase therapeutic compliance. We believe this product will enable physicians to optimize medical therapy on an individualized basis, and therefore improve the standard of care for patients with asthma.”

Sales and distribution of the Insight eNO System have been initiated with the introduction of an Apieron National Direct Sales Force in targeted major metropolitan regions.

About Apieron Inc.

Apieron Inc. is a private, venture-backed medical device company based in Menlo Park, CA that was funded in 2003 to develop a simple-to-use, non- invasive monitor for the measurement of exhaled nitric oxide (eNO) for the management of asthma. The Apieron biosensor technology platform utilizes a patented technology that allows for the highly sensitive detection of selected analytes such as eNO. Apieron is committed to collaborating with physicians and patients to develop innovative medical solutions to improve quality of life and standards of care.

    Refer Questions to:    Holly McGarraugh    Apieron, Inc.    650-454-8101  

Apieron, Inc.

CONTACT: Holly McGarraugh of Apieron, Inc., +1-650-454-8101

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