By Bill Estep, Lexington Herald-Leader, Ky.

Mar. 4–There was a time in the late 1980s when J.C. Lawson of Clay County symbolized the pugnacious defiance of Kentucky marijuana growers.

He became the most notorious cultivator in the state, at least for a time, by talking openly with the Herald-Leader about his success in the illegal business, bragging about making $1 million in a few months and posing for a photo in his pot patch, diamond cluster rings glittering on his fingers.

He defended his “farming” as a way of providing money in a poor county, saying he employed more than 20 people.

“There’s bad pit bulls and there’s good pit bulls, just like there’s bad dope dealers and good dope dealers,” Lawson said back then.

These days, Lawson is still a symbol, but of a world and a war that is much different than 20 years ago. The drug problem is worse in some ways, the war against it has escalated, and Lawson is headed to federal prison.

Now 53, he pleaded guilty Monday to conspiring to grow more than 100 marijuana plants in Clay County in the summer of 2006. His ex-wife, his son, another relative and a partner also pleaded guilty.

Robert O’Neill, an agent with the U.S. Forest Service, said in a court document that he saw Lawson and Douglas Imhoff in several pot patches in the Mosley Cemetery area and later learned the two were working to set up an indoor growing operation in Imhoff’s basement.

Lawson, who could be classified a career criminal and face life in prison when he is sentenced in June, told a reporter last week he didn’t want to comment on his case, at least not yet.

It was a different time when Lawson came to fame.

State and federal authorities felt that many people in Eastern Kentucky embraced marijuana cultivation — or at least tolerated it — because of the money it brought. Some took Lawson’s public defense of pot growing as a sign of that acceptance; in a 1989 article that called him a “Robin Hood,” a preacher told USA Today that Lawson had given him money to repair the roof and parking lot at his church.

Drug money had corrupted some local officials. A key federal investigation that led to the conviction of three Eastern Kentucky sheriffs, a deputy and a police chief grew from information in the late 1980s that one of the sheriffs was taking payoffs to protect marijuana growers, said David Keller, the FBI agent who handled the case.

The acceptance of marijuana growing colored local justice systems, according to some authorities who thought they couldn’t get a meaningful conviction in some counties.

“That was a time when there was a lot of apathy as far as the marijuana problem in Kentucky,” said Keller, who now heads the Kentucky section of the Appalachia High Intensity Drug Trafficking Area. “It was just wide open.”

Pot growers “knew if they got caught in local court probably nothing would happen,” he said.

Lawson had been arrested twice in Clay County on drug charges before the 1987 article, including once for growing pot, but hadn’t spent any time in jail.

These days, police have more resources to fight drugs than they did in 1987, and the approach is different.

The HIDTA was set up in 1998 — a recognition that parts of Kentucky, Tennessee and West Virginia were supplying high-quality domestic marijuana to other parts of the country.

With the HIDTA came a U.S. Drug Enforcement Administration office in Eastern Kentucky and more money to hunt for marijuana, though the agency has since been designated to work against a variety of drugs.

O’Neill, the officer who caught Lawson, is assigned to the HIDTA.

Another key change is that state police now work year-round on the program to eradicate marijuana, cooperating in a task-force approach with the HIDTA, the National Guard and other agencies.

And police have high-tech weapons, putting cameras in the woods to spot growers and plotting the location on helicopter-borne computers.

Growers have responded by reducing the size of plots and trying to hide them better, sacrificing weight at times to keep the plants under better tree cover, said Lt. Ed Shemelya, who heads the state-police marijuana program. “They adapt and evolve their techniques just like we do,” he said.

Prosecutions by the U.S. attorney’s office have been a big plus in fighting drugs in Eastern Kentucky the last several years, including marijuana cultivation. Drug traffickers often receive stiffer sentences in federal court, and there is no parole.

Lawson is an example of those prosecutions. He went to prison in 1990 and again in 1999 on federal drug charges.

Another weapon against drugs came online after U.S. Rep. Hal Rogers, R-Somerset, created Operation UNITE in 2003. The task force takes a three-pronged approach, investigating drug traffickers, providing addict treatment resources and backing education efforts to curb drug abuse.

Dan Smoot, a former state police detective who is now law enforcement director for UNITE, said the treatment component is critical to trying to get the upper hand on drug abuse, because many pushers are just selling drugs to feed their own addiction.

“That’s how I think we’re going to win,” he said.

State and federal authorities said local police have gotten more professional and that local officers and courts are doing a better job in many places in the fight against drugs.

As for public corruption, “It’s still out there, but it’s nothing like it was in the ’80s and ’90s,” Keller said.

Attitudes about drugs have evolved as well, in large part because of abuse of powerful prescription pills, unavailable in the late 1980s, that have brought misery and death to many families.

People who said little or nothing about marijuana cultivation in 1987 now work to promote awareness of drug abuse and keep track of how cases are handled.

“The real change that you would see is the attitude of people in the community, particularly in our churches,” said Manchester City Council member Harvey Hensley, a retired Clay County banker.

Some people still tolerate marijuana for economic reasons, but in general people do not support it, Hensley said.

Some groups that advocate legalizing or decriminalizing marijuana use for adults argue that programs to eradicate marijuana do little to reduce the supply of pot, serving only to keep the black-market price artificially high.

“It maintains a price support for vegetable matter,” said Allen St. Pierre, executive director of the National Organization for the Reform of Marijuana Laws.

But police argue it is important to wipe out as much marijuana as possible because it is a much more powerful drug now than in the 1980s, and is the substance many abusers start with before trying others. Eradicating it also limits the supply of cash available to buy other drugs or use for other criminal purposes, such as buying votes, authorities said.

Police said they have been successful in knocking down the supply of Kentucky marijuana.

One thing that hasn’t changed much in some parts of Eastern Kentucky since Lawson first got famous is the economy. The poverty rate in Clay County in 1989 was 40 percent, according to U.S Census figures; in 2005, the estimated poverty rate was 37.2 percent.

Police say that one mature marijuana plant produces a pound of pot worth $2,000. Some critics say that figure is too high, but no one denies pot cultivation can be lucrative.

The economy, and the belief that some people still have that it’s OK to grow pot, is why people keep slipping into the woods to try to plant pot patches in Eastern and Southern Kentucky despite efforts to wipe out the crop, said Shemelya. “Until those things change, we’ll always have people wanting to grow dope,” he said.

KENTUCKY MARIJUANA PLANTS ERADICATED:

–1990: 546,125

–1991: 828,776

–1992: 918,931

–1993: 659,811

–1994: 477,355

–1995: 607,713

–1996: 529,560

–1997: 453,486

–1998: 350,171

–1999: 517,400

–2000: 463,989

–2001: 413,851

–2002: 373,117

–2003: 519,986

–2004: 471,075

–2005: 507,862

–2006: 557,628

–2007: 490,020

Herald-Leader News Researcher Lu-Ann Farrar contributed to this report.

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To see more of the Lexington Herald-Leader, or to subscribe to the newspaper, go to http://www.kentucky.com.

Copyright (c) 2008, Lexington Herald-Leader, Ky.

Distributed by McClatchy-Tribune Information Services.

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GCI,

By Karen Robinson and Maki Becker, The Buffalo News, N.Y.

Mar. 2–SOUTH DAYTON — This rural village was in shock Saturday as residents learned that two 13-year-old girls who grew up here, participated in Girl Scouts and played softball together were killed in a snowmobile accident.

“It’s a devastation to a community this small,” said Benny Bottita, the chief of the South Dayton Fire Department. “Two teenage girls — it’s just tragic.

Shelly-Ann Comstock, an eighth-grader at Pine Valley Junior-Senior High School, and her friend, Hannah Hunt, who was home-schooled in a family of 10 children, were reported missing Friday night after a third girl they were riding with lost track of them.

Three dozen law enforcement officers and volunteers searched all night and into the morning, fighting the bitter cold.

At 9 a.m. Saturday, a trooper spotted their overturned snowmobile off a large private driveway near the trail where they had last been seen and soon found their crumpled bodies. Both girls were wearing helmets. A preliminary autopsy indicated the girls both suffered spinal and internal injuries that likely killed them instantly.

“It was just two little girls,” State Police Capt. Steven A. Nigrelli said. “They were little dolls. It’s heartbreaking.”

Investigators were trying to piece together what happened, but all evidence seemed to point to an accident.

On Friday evening, Shelly-Ann, Hannah and the third girl, a 14-year-old whom authorities declined to identify because of her age, set out for a night of snowmobiling.

Shelly-Ann and Hannah were riding tandem in Hannah’s family’s shiny red 2000 Polaris 700 — with Hannah, a seasoned snowmobiler, driving. The 14-year-old rode solo on another snowmobile. At about 7 p.m. they gassed up before heading to a popular, well-groomed trail.

It had been frigid earlier in the day, but the temperature had risen to about 27 degrees by evening. There was about 7 inches of fresh snow on the ground and the winds were blowing the snow around, limiting visibility.

The 14-year-old told authorities that the three headed up Merrill Road. She turned right at the trail head, but it appeared Shelly-Ann and Hannah missed it and kept going straight, police said.

At about 7:30 p.m., the 14-year-old looked back and realized her friends weren’t there and began to panic. She rode around trying to find them and returned to her home.

Calls were made to the missing girls’ parents and to other places the girls may have gone, but no one had seen them.

The family members set out looking for the girls. Shelly-Ann’s mother, Cathy Pasinski, flagged down a state trooper at about 10:30 p.m., asking for help in the search.

Immediately, troopers, members of the Cattaraugus and Chautauqua County sheriff’s offices and volunteers on snowmobiles began a search of the area.

The blowing snow and darkness made for difficult search conditions, Nigrelli said.

A command post was established at the South Dayton Fire Hall, and troopers had begun directing volunteers to trail heads to pass out fliers with photos of the girls.

Accident reconstruction investigators say they believe the girls’ veered off the side of a wide, private driveway and struck a tree that sent them airborne. The girls then hit another set of smaller trees.

“These poor girls — they just didn’t see it,” Nigrelli said.

Hannah was part of a family that embraced the snow. Saturday, a big snowman stood in front of their white, two-story farmhouse. Two snowmobiles were parked outside. The porch was covered with snowboards, snowmobile helmets and gloves.

“Hannah was a vivacious girl,” said her aunt, Mary Roche of North Buffalo. “She loved to play softball, and she skied.”

Hannah was an experienced snowmobiler, she added, although she wasn’t very familiar with the trail off Merrill.

As one of 10 children, Hannah helped out in taking care of her younger brothers.

“She was a little mom to the little ones, and they keep asking when she’s coming home,” Roche said.

Her 23-year-old brother, Will, was among those who stayed out all night looking for the girls.

This village of 664 residents, where snowmobiling is a way of life, was reeling from the tragedy Saturday.

Many high school students ride their snowmobiles to school. On the weekends, the snowmobile trails are packed.

“Kids start snowmobiling down here as soon as they just about start walking,” said Marlene Przybycien, a Pine Valley Central Schools employee.

The mood was somber at the coffee shop of Jenny Lee Country Store, a popular gathering spot, as customers discussed the events.

“Imagine what that other kid [the 14-year-old] will live with,” said Walt Herrington of the nearby hamlet of Cottage.

“People that young have no fear of speed,” said Horace Ivett, a retired snowmobile dealer, although there’s been no indication that the girls were going excessively fast.

“That 700 sled never should have been built for trails,” said Ivett, who said this model of snowmobile is capable of speeds of 100 mph and more. “That motor is too powerful for trail riding.”

Ivett and Herrington, who used to ride snowmobiles together for years, called the snowmobile “too much sled for a kid.”

With just 350 students at Pine Valley Junior-Senior High and 400 at the adjoining elementary school, the deaths hit the young people of the community hard.

Shelly-Ann, an eighth-grader, had gone to Pine Valley schools since kindergarten, and she was a member of both the modified girls softball and basketball teams.

“Shelly was like a mom to her little brother,” said Donna Snyder, a guidance secretary at the school. “He absolutely adored his sister. He will be heartbroken.”

She also has an older brother.

Hannah, who was home-schooled, was well-known and liked in the village.

Counselors were rushed to both the elementary and high schools Saturday to console stunned and grieving students and staff. A battle of the bands, a fundraiser for the senior class that had been scheduled for Saturday night, was canceled.

“It’s going to be tragic,” said Pete Morgante, Pine Valley Central School District superintenden t. “It’s sad. You feel sorry for the kids.”

The schools currently don’t offer any snowmobile safety classes, although local ski clubs do throughout the season.

“Maybe we need to,” Morgante said. “Sometimes, it takes a tragedy.”

At least three other people have been killed in snowmobile accidents in the region this season.

On Tuesday, Michael L. McClellan, 35, of Stow was killed while riding a snowmobile on Chautauqua Lake. Chautauqua County sheriff’s officials say they believe he struck a concrete breakwater, flipped into the air and struck a boat lift stored on the shore.

On Feb. 10, John Kaczmarski, 18, a former football player at St. Francis High School and a resident of Kaisertown, died while snowmobiling in Verona, Oneida County. Kaczmarski was riding on a field when he hit some rough terrain . His death marked one of four in nine days that struck Oneida.

And on Dec. 21, Mario V. Sabia, 24, of West Seneca died in Pembroke, where he crashed into a metal gate, according to Genesee County authorities.

At least five other people suffered serious injuries in snowmobile accidents in December.

By state law, children between ages 10 and 13 are allowed to ride snowmobiles if they have completed a safety course and are accompanied by an 18-year-old. For teens between 14 and 17, they may ride unaccompanied if they’ve completed the safety training.

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To see more of The Buffalo News, N.Y., or to subscribe to the newspaper, go to http://www.buffalonews.com.

Copyright (c) 2008, The Buffalo News, N.Y.

Distributed by McClatchy-Tribune Information Services.

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

By Michael Biesecker and David Raynor, The News & Observer, Raleigh, N.C.

Mar. 1–Three employees at a state-run mental hospital beat Dean G. Smith so severely they broke his nose and fractured a rib.

But it hurts Smith more that his tormentors went largely unpunished, even though a state investigation substantiated that he was assaulted by staff at Cherry Hospital in Goldsboro.

“When I’m manic, I’m not exactly the easiest guy to be around,” said Smith, who lives in Roanoke Rapids. “But this happened to me in a mental hospital. They’re there to help you, not beat you up.”

In the seven years since North Carolina decided to reform its mental-health system, regulators have sanctioned at least 192 state employees for abuse, neglect or stealing from patients. Another 38 employees of state mental hospitals and homes for people with developmental disabilities are under investigation, records show.

They are listed on a state registry available to prospective employers. Though most lost their state jobs, employees blacklisted for abusing and neglecting patients were charged with a crime 13 percent of the time.

Convictions are rarer still, with employees often denying the accusations and the only other available eyewitnesses being victims whose mental illness can be used to undermine their credibility.

At least 19 employees on the blacklist were allowed to keep their positions or were subsequently rehired, according to a review of state personnel records. At least nine others were allowed to transfer to new government jobs as prison guards or law enforcement officers.

The mental-health reforms of 2001 aimed to de-emphasize the use of hospitals and to promote community treatment. But treatment hasn’t developed as expected, and the hospitals have become busier while being considered less important.

Each of the 192 employees on the blacklist worked in institutions under increasing strain; the number of patient beds was cut by nearly a third as demand for treatment rose.

Admissions have gone up while the average length of stay has shrunk. Patients are admitted more frequently and often discharged before they are ready.

It’s unclear whether abuse in state psychiatric institutions is getting worse, because more than three dozen complaints from the past two years are still being reviewed. But federal investigators have been penalizing the state more severely in recent months for cases of abuse, neglect and wrongful deaths, cutting off federal funds to Broughton Hospital in Morganton and threatening to do the same at John Umstead Hospital in Butner and at Cherry.

While legislators and administrators at the state Department of Health and Human Services have focused on replacing aging hospitals with new buildings, low salaries have driven experienced workers to better-paying jobs at private facilities.

“The inevitable consequence of understaffing, overwork and low wages is poor employee morale,” said Vicki Smith, the executive director of Disability Rights North Carolina, a group that investigates abuse in state facilities. “Poor morale results in staff turnover, making it harder to ensure that workers are appropriately trained. Poorly trained workers provide poor services. This translates to poor patient care, meaning increased abuse and neglect.”

In an interview this month, the head of the state hospital system said he was unaware so few were charged with a crime.

“I cannot tell you why these were not [prosecuted] in the past,” said James Osberg, chief of the state-operated services section of the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services. “But I’m saying at this point that when there is a case of substantiated abuse … and it is determined that charges are appropriate, we will direct that they take the charges on those individuals.”

Least-trained workers

Dempsey Benton, who became head of the Department of Health and Human Services in September, announced in January that a 5 percent raise would be granted to psychiatrists and other doctors to help retain and attract qualified professionals to the state hospitals. Boosting pay for lower-ranking positions is under review.

With doctors and nurses policed by licensing boards that oversee those professions, it is nurses’ aides and health-care technicians, the least-trained and lowest-paid members of the clinical staff, whose names end up on the employee blacklist. They also have the most one-on-one contact with patients.

Becoming a health-care tech requires no special certification beyond a high school diploma or GED. Starting pay is $11.42 an hour.

The reported offenses range in severity from stealing patients’ clothes and money to beatings and rape. Cases of abuse confirmed by investigators included:

–Forensic-health technician Daniel Lang repeatedly had sex with a mentally ill woman at Dorothea Dix Hospital in Raleigh. Lang was fired in January 2003. But before he was arrested on six felony rape and sexual offense charges, he slit his wife’s throat and dumped her body in woods near the hospital.

–Matthew Allen Rose, a health-care technician at Broughton, performed oral sex on a mentally ill child in August 2002.

–Broughton employee Justin Travis Wood hit a resident in the genitals with his keys while the patient was strapped down in restraints in July 2007.

–Romaine Keith Earnest, a health-care technician at the Caswell Center in Kinston, abused a resident in October 2001 by inserting a broom handle into the patient’s rectum, causing severe internal injuries.

Each employee in these cases pleaded guilty or was convicted of a criminal offense. But many employees who abuse patients are never charged.

An example is nurse’s aide Bettie Ruth Mercer. While she was an employee of the Longleaf Neuro-Medical Treatment Center in Wilson in September 2003, a state investigation concluded Mercer abused a patient “by holding a razor at his throat and threatening to cut him, by pulling on the resident’s penis, threatening to pull it off and by hitting the resident with her fists.”

She was fired but not charged with a crime.

Many of those who abused patients have faced criminal charges before. Michael Eugene Dalton of Marion was fired from the Alzheimer’s unit at the Black Mountain Center for hitting a resident in the head, pulling the chair out from under a resident and pushing a resident, causing a stumble. Before he was hired, Dalton had a lengthy record that included multiple DWIs and an assault conviction.

A review of conditions in North Carolina’s mental hospitals by the U.S. Department of Justice in 2004 concluded that staff members routinely violated patients’ civil rights. The inappropriate use of physical restraints and seclusion was specifically cited. So was failure to “ensure the reasonable safety of patients.”

Attack in a quiet ward

Dean Smith, who has bipolar disorder, was involuntarily committed in October 2006 to Cherry Hospital, a sprawling campus of brick buildings in Goldsboro originally founded in 1880 as an institution for African-Americans.

Desegregated in 1965, Cherry is now the designated state psychiatric hospital for a region that includes 33 Eastern North Carolina counties. Though it once housed more than 3,500 patients, the hospital now has 274 patient beds.

Smith admits he wasn’t well-behaved during his stay on Ward U-2, No. 3 East, making fun of the health-care technicians and complaining when they refused to give him requested medicine.

Shortly after he was involved in an argument, Smith remembers that nurses took many of the other patients on the ward outside for a smoke break.

Smith stayed behind inside the nearly empty ward and was walking to the bathroom when he says he was struck from behind and knocked to the floor. He was then “swooped up” by three staffers.

He kicked one of them, James A. Smith, in the groin — a reflex that he says sparked a severe beating, with staff members repeatedly punching and kicking him.

“I’d seen what they did to other patients,” said Dean Smith, who believes the attack was premeditated to occur when supervisors were out smoking. “I thought the best thing to do was resist, because somebody might hear something. I thought they were going to kill me.”

The assault continued as he was dragged down a hall and into a secluded room. As he sat on the floor bleeding, Dean Smith says, he was coached to say he had injured himself in a fall and was threatened with further violence if he reported what happened.

He was then forced to take off his blood-soaked clothes, clean up pools of his own blood and take a shower before he was allowed to get medical treatment from a nurse for injuries that included a broken nose and rib.

The hospital’s internal police department was asked to find out what happened. Dean Smith, still bleeding and with dark bruises emerging on his body, was photographed by an officer. The report describes his face as looking like “hamburger meat.”

In a police lineup, he identified health-care technicians James Smith, Eric Jerrod Isler and Billy Gerald Wynn Jr. as the employees who had beaten him. Investigators matched the tread on Isler’s shoes to purple bruises left on Dean Smith’s flesh.

James Smith and Isler both said Wynn was the one who hit Dean Smith. Wynn told investigators that he was not present when the patient was injured but that he later walked in on the other two employees while they had Smith in the back room.

‘Too many to count’

In an interview, Wynn said his co-workers were coerced by hospital police officers and administrators to lie about his hitting Dean Smith.

Asked how many abuse complaints were filed against him during his 13 years at Cherry Hospital, Wynn said he didn’t know.

“Too many to count,” he said. “There isn’t a person working at Cherry who hasn’t had some allegations.”

Some of those incidents are outlined in Wynn’s personnel file, part of which is disclosed in an investigative report. In the months before Smith was beaten, Wynn received written warnings for placing a pillow six inches from a restrained patient’s face and for improperly grabbing a patient and putting his hands on his chest.

Though all those accusations were lies, he said, the “therapeutic hold” techniques taught for safely restraining mental patients were sometimes impractical during a physical altercation.

Some of the patients at Cherry, which serves an area that includes several military bases, are former soldiers and Marines with training in hand-to-hand combat. If a patient starts acting aggressively, Wynn said, in his experience it was best to go ahead and “put him down.”

“I’m not the sort of person I’m out there to abuse patients,” Wynn said. “You get backhanded in the mouth, who knows? You might react.”

One of the earlier complaints against Wynn involved Jason DeArellano, who was a patient on the same ward six months before Dean Smith was assaulted.

William O. Mann III, a staff psychiatrist at Cherry in 2006, filed an abuse complaint on DeArellano’s behalf after he noticed large bruises on his patient’s face, though no report of an injury was included in his medical records, as required.

DeArellano told investigators Wynn beat him after DeArellano used a racial slur. Wynn is black. DeArellano is white.

A former Marine with bipolar disorder, DeArellano says he was tackled by several male employees who put him in restraints and punched him.

“They had me face-down with I don’t know how many people on top of me,” DeArellano, who now lives in Florida, said in an interview. “I couldn’t do anything.”

A report shows DeArellano later picked Wynn out of a lineup and said Wynn beat him while taunting him to repeat the derogatory name. DeArellano was left with a bloody nose and bruises on his face, ribs and back.

DeArellano’s version of events is backed by another patient interviewed by investigators.

“He didn’t make the first move,” said Mark Sellers, a former Army medic who lives in Wilmington. “They took him down, and then they were punching him in his back and torso and pushing his face into the floor. He was yelling, ‘I’m sorry, I’m sorry, let me up.’ It was just brutal force. I couldn’t believe what I was seeing. It made me sick to my stomach.”

Wynn and other health-care technicians involved claimed DeArellano injured himself falling over a chair, according to their handwritten statements.

The hospital’s investigation ended with officials unable to substantiate that DeArellano was abused. The review did conclude that Wynn “inappropriately touched patient on the chest” and suggested that he take a refresher course in the proper techniques for restraining patients, but it recommended no disciplinary action.

Mann said he reported at least 10 similar cases of abuse before quitting his job in disgust. He said he was not told what came of those reports.

“In the 14 months I worked at Cherry Hospital, I saw more cases of patient abuse than I have in the rest of my career,” said Mann, whose previous experience included working at two state mental hospitals in Pennsylvania. “The large majority of people there were good staff members, but there was a small group, usually the health-care technicians, whose idea of treatment was hurting the person to teach them a lesson.”

Trust misplaced

In Dean Smith’s case, hospital police determined there was sufficient evidence to press criminal charges. An officer cited Wynn, Isler and James Smith with a single count each of patient abuse and neglect, a misdemeanor.

All three health-care technicians were fired in October 2006 and their names added to the state health care worker blacklist.

The case was assigned to Thomas H. Perlungher, an assistant district attorney. In May 2007, Perlungher dropped the misdemeanor counts with the stated intent of refiling more serious charges of aggravated assault on a handicapped person.

Wynn appealed his dismissal to the N.C. Office of Administrative Hearings. At a hearing in October, Wynn’s attorney was able to point to contradictions in the accounts of Isler and James Smith.

Special Deputy Attorney General Dorothy Powers agreed to a deal that paid Wynn $9,526 in back pay and attorney’s fees in exchange for Wynn ending his effort to get his job back. Wynn’s name is to remain on the state blacklist for abusing Dean Smith.

Perlungher, the assistant DA in Wayne County, said that after talking to Powers, he decided not to refile criminal charges against the three health-care technicians.

“There was just not enough evidence to move forward,” he said. “For witnesses, we had three charged defendants and a victim who was mentally ill. That’s what the case boiled down to. There were a lot of other doctors and nurses on the floor, but they were not willing to come forward.”

Mann, the staff psychiatrist, escorted a bleeding Dean Smith to hospital police to report the beating. He said he was never contacted about testifying.

Fear for patients’ lives

Mann said that just because someone has a mental illness does not mean the person should be rejected by the legal system as a credible witness. Dean Smith’s bipolar disorder would in no way hamper him from accurately remembering or truthfully telling what happened to him, Mann said.

“The reason I left Cherry Hospital is because I was afraid eventually one of my patients was going to end up dead,” Mann said. “I thought the system was moving too slow to address these cases of abuse. It was scary.”

Dean Smith was not invited to the hearing for Wynn and learned from a reporter that the criminal charges had been dropped.

For more than a year, he maintained faith the state would punish its employees for his beating. He says that trust was misplaced.

“They’re not going to do any time,” Smith said of his abusers. “No justice has come out of this.”

(News researcher Brooke Cain and staff writer Pat Stith contributed to this report.)

[email protected] or (919) 829-4698

News researcher Brooke Cain and staff writer Pat Stith contributed to this report.

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

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

Distributed by McClatchy-Tribune Information Services.

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

OAKLAND, Calif., Feb. 29 /PRNewswire-USNewswire/ — California’s largest nonprofit hospital provider and the state’s largest healthcare workers’ union convened negotiations Thursday covering 15,000 hospital workers across California.

Both parties are eager to get this round of negotiations underway and continue their joint efforts to improve patient care and expand access to quality hospital services across the state. In 2004, Catholic Healthcare West (CHW) and SEIU locals United Healthcare Workers-West (UHW) and 121 RN, a union of registered nurses, negotiated a master agreement that covers 31 facilities statewide. Now, that contract is expiring and both sides look forward to addressing key areas including staffing and quality issues, training and education opportunities for caregivers, and the expansion of wages and benefits to better recruit and retain qualified caregivers.

“We are excited to begin negotiations with CHW and continue to raise standards for nurses and patients across California,” said Chris Slane, registered nurse and 121 RN member. “We look forward to working with CHW to be a model employer for hospital systems across the state.”

Hospital workers at all 31 SEIU-represented facilities recently elected members to the union’s negotiating team, and more bargaining dates have been set for March. The current contract expires April 30. CHW is also currently in negotiations with 2,000 SEIU members in Nevada.

“During the past several years, we have worked with CHW to develop a productive and positive relationship that has included working together on improving conditions in our hospitals as well as on policy and legislative issues and the development of a jointly managed fund to provide training to thousands of healthcare workers,” said Martha Vazquez, radiology technician and UHW member. “We look forward to establishing new standards in this next round of negotiations.”

Hospitals covered by the bargaining include: Sequoia Hospital in Redwood City; Saint Francis Memorial Hospital and St. Mary’s Medical Center in San Francisco; Bakersfield Memorial Hospital, Mercy Hospitals of Bakersfield and Mercy Southwest Hospital in Bakersfield; St. John’s Pleasant Valley Hospital in Camarillo; St. John’s Regional Medical Center in Oxnard; French Hospital Medical Center in San Luis Obispo; Marian Medical Center in Santa Maria; Mercy Medical Center Mt. Shasta; St. Elizabeth Community Hospital in Red Bluff; Mercy Medical Center Redding; Mercy San Juan Medical Center in Carmichael; Mercy Hospital of Folsom; Mercy General Hospital and Methodist Hospital of Sacramento in Sacramento; Woodland Healthcare; Mark Twain St. Joseph’s Hospital in San Andreas; St. Joseph’s Behavioral Health Center and St. Joseph’s Medical Center in Stockton; Dominican Hospital in Santa Cruz; St. Mary Medical Center in Long Beach; California Hospital Medical Center in Los Angeles; Northridge Hospital Medical Center; Community Hospital of San Bernardino and St. Bernardine Medical Center in San Bernardino.

San Francisco-based CHW is a system of 42 hospitals and medical centers in California, Arizona and Nevada. Founded in 1986, CHW is the eighth-largest hospital system in the nation. It’s committed to delivering compassionate, high-quality, affordable health care services.

The 150,000-member SEIU United Healthcare Workers-West is the largest hospital and healthcare union in the western U.S. and represents every type of healthcare worker, including nurses, professional, technical and service classifications. Its mission is to achieve high-quality healthcare for all.

121 RN is an SEIU-affiliated Southern California union of 7,000 nurses in Riverside, Los Angeles and Ventura counties.

SEIU United Healthcare Workers-West

CONTACT: Melanie Myers of SEIU United Healthcare Workers-West,+1-510-869-2229

Web Site: http://www.seiu-uhw.org/

Fresenius Medical Care North America (“FMCNA”), wholly-owned subsidiary of Fresenius Medical Care AG & Co. KGaA (“FMC”) (Frankfurt Stock Exchange; FME and NYSE: FMS), will introduce the Liberty™ Cycler during the 28th Annual Dialysis Conference, Orlando, Florida, March 1-4, 2008. This proprietary device is designed for use in Automated Peritoneal Dialysis (APD) therapy, which continues to be the most frequently utilized home therapy for the treatment of end-stage renal disease (ESRD).

The Liberty™ Cycler is the latest technology offering from Fresenius Medical Care for patients being treated for ESRD at home. The cycler combines advanced pumping technology with ease of use. Patients and medical personnel throughout initial trials and testing have reported enhanced training speeds and confidence with treatment through utilization of the device. The introduction of the Liberty™ cycler completes the total system approach offered by Fresenius Medical Care for the peritoneal dialysis patient. Several years ago, the organization successfully launched stay•safe®, a connection technology designed to reduce risk associated with touch contamination during connection and disconnection from treatment. With the introduction of the Liberty™ cycler, nephrologists can now prescribe APD and CAPD therapy for patients and have access to stay•safe® connectology.

More than 300,000 ESRD patients currently require dialysis treatment in the United States. This number is projected to increase beyond historical rates with the elevated incidence of hypertension and diabetes within the general population. A viable option for a very specific percentage of the ESRD patient base, medical treatment for dialysis at home continues to maintain a respectable market share against the more traditional in-center dialysis treatment. Over ninety percent of the home dialysis patient population undergoes peritoneal dialysis for treatment of their disease.

“Based on our initial feedback from leading nephrologists,” reported Rice Powell, CEO, Renal Therapies Group and Co-CEO of Fresenius Medical Care North America, “we believe that there will be a strong reception for this innovative, easy-to-use product. Our development team, along with caregivers and patients, has worked diligently to create a device that enhances the ease of treatment set-up as well as the intra-dialytic user interface. We are pleased to have reached this significant milestone and are proud to be able to bring this product to the home therapy community.”

Fresenius Medical Care is the world’s largest integrated provider of products and services for individuals undergoing dialysis because of chronic kidney failure, a condition that affects about 1,600,000 individuals worldwide. Through its network of 2,238 dialysis clinics in North America, Europe, Latin America, Asia-Pacific and Africa, Fresenius Medical Care provides dialysis treatment to 173,863 patients around the globe. Fresenius Medical Care is also the world’s leading provider of dialysis products such as hemodialysis machines, dialyzers and related disposable products. Fresenius Medical Care is listed on the Frankfurt Stock Exchange “FME” and the New York Stock Exchange “FMS”.

Michael Salius, Media Contact O: 860-482-2978, Cell: 860-543-1683 or [email protected]

This release contains forward-looking statements that are subject to various risks and uncertainties. Actual results could differ materially from those described in these forward-looking statements due to certain factors, including changes in business, economic and competitive conditions, regulatory reforms, foreign exchange rate fluctuations, uncertainties in litigation or investigative proceedings, and the availability of financing. These and other risks and uncertainties are detailed in Fresenius Medical Care AG & Co. KGaA’s reports filed with the U.S. Securities and Exchange Commission. Fresenius Medical Care AG & Co. KGaA does not undertake any responsibility to update the forward-looking statements in this release.

By Lundquist, Jennifer Hickes

The belief that enlisted military divorce rates are unusually high is a recurring theme expressed among those living in the military community, yet quantitative data on military divorce rates remain a virtual lacuna. The all-volunteer enlisted force also happens to be an almost all-married enlisted force. Assessing the degree of marital dissolution experienced by military personnel has important implications for the well being of military families and also for readiness levels and reenlistment likelihood. In this paper, I analyze underutilized military data from the National Longitudinal Survey of Youth and find that enlisted divorce rates in the Armed Forces are higher than for comparable civilians within a specific age range. “It offers a lot of great benefits, but there are a lot of downsides to the military, too. I guess that ‘s why people say the military has the highest divorce rate.”

Dane’s story from Invisible Women: Junior Enlisted Wives

(Harrell 2000, p. 31)

The belief that enlisted military divorce rates are unusually high is a recurring theme expressed among those living in the military community, yet quantitative data on military divorce rates remain a virtual lacuna. Assessing the degree of marital dissolution experienced by military personnel has important implications for the well being of military families and also for readiness levels and reenlistment likelihood. The all-volunteer enlisted force also happens to be an almost all-married enlisted force. This demographic transition is aptly illustrated in the replacement of the old expression, “If the Army wanted you to have a wife, it would have issued you one” with “We recruit soldiers, but we retain families” (Scarville 1990:1). In this paper, I analyze underutilized military data from the National Longitudinal Survey of Youth and find that enlisted divorce rates in the Armed Forces are higher than for comparable civilians within a specific age range.

That so little is officially known about levels of military divorce owes largely to the cross-sectional nature of most military data. To accurately measure divorce prevalence, it is necessary to follow couples from marriage formation forward, while also taking into account attrition from the military and any other changing individual-level characteristics during the period of analysis. To place such findings within their proper context, one needs a civilian baseline for comparison. However, it is rare that military surveys include civilian data. Instead, divorce percentages are often compared across the civilian and enlisted populations in the absence of controls for compositional differences. This lack of comparability can sometimes be partially remedied by comparing Pentagon data to cross-sectional data from the civilian Current Population Survey (CPS); however, there are significant inconsistencies across the datasets in their sampling design and variable stracture. Using the CPS as an augmentative comparison is further compromised when analyzing divorce rates because the CPS contains variables only for “currently divorced” rather than providing dates of divorce. This paper provides a more rigorous means of evaluating the prevalence of military divorce by using the National Longitudinal Survey of Youth, a longitudinal dataset that allows for a simultaneous comparison of divorce outcomes for both enlisted military and civilian respondents.

BACKGROUND

Cumulative US divorce literature has identified a group of factors that consistently predict heightened marital instability across time and context, most of which are highly intenelated (for a comprehensive review of the determinants of divorce see Faust & McKibben, 1999). Lower education and economic instability are conelated with unstable marriages due to increased levels of financial stress (Cherlin, 1992; Conger and Elder, 1994; Oppenheimer, 1994). Younger ages at marriage are associated with higher divorce rates because early marriages are increasingly rare, taking place during non-normative and less stable life stages (White, 1991). There is also evidence for an intergenerational transfer of marital instability, where adults whose own parents divorced are more likely to do so themselves (Amato, 1996; Amato and DeBoer, 2001; McGue and Lykken, 1992; White, 1991). Strong religious orientation and church attendance frequency are negatively associated with divorce. It appears that particularly religious individuals are less likely to elect marital exit as a remedy to marital duress (Hackstaff, 1999). Finally, racial status is an important factor in theorizing divorce. Largely due to disproportionate levels of poverty and residential segregation, African Americans have higher divorce rates than people from other ethnic groups (Amato, 2000; Current Population Reports, 2000; Tucker & Mitchell-Kernan, 1995).

It is likely that determinants of marital instability for society at large similarly determine marital instability in the military, but as result of the aforementioned data issues, little has been published on military divorce, particularly in the post all- volunteer era, and the limited information that does exist is contradictory. Research indicates that divorce rates were unusually low in the seventies, especially in the Air Force (Goldman, 1973) and that military marriages formed during Vietnam service were not associated in the long term with higher than usual divorce rates (Call and Teachman, 1996; Ruger et al., 2002). On the other hand, a recent article reports that divorce rates in the Marines are higher than the national average, with 32% of marriages among Marines ending in divorce before age 25 (Carlborg, 2001). In a non-random, small-scale survey of Army personnel collected in September 2002, a majority of those surveyed perceive divorce rates to be much higher in the military than in the civilian world (Lundquist, 2004b).’ There is some recent evidence that divorce and remarriage occur earlier and at somewhat elevated rates among the military population, but this data is based on military surveys that report cunent marital status only and lack a direct civilian comparison (Adler-Baeder et al., in press). Yet the Walter Reed Army Institute of Research reports that divorce levels in the Army are comparatively low, which “contradicts the perception that divorce is frequent and widespread in the Army” (Fafara, 1997).

Factors that predict divorce, such as age at maniage, socioeconomic class, parental divorce, religiosity, and race, figure strongly when considering the unique demographic makeup of the military population. In addition, there are specific environmental factors of military service that may exacerbate marital instability and others that may, alternatively, promote marital stability.

Maniage rates in the military are extraordinarily high, and this is particularly true at young ages (Lundquist, 2004a, 2004b; Lundquist and Smith, 2005; Martin and McClure, 2000). Young ages at marriage normally predict divorce in the civilian world and may do the same in the military, yet the fact that early maniage is so pervasive may mean that it is a normative process in the military, with supportive social and economic stractures. In fact, it is possible that the same forces driving such high maniage rates in the military contribute to equally high levels of marital stability. From a transition to adulthood life course perspective, it is likely that increased military marriage rates reflect relatively high levels of socioeconomic stability2 for young enlisted adults who would otherwise be in college or employed in low-skilled, low-wage jobs. Stable employment and secure socioeconomic status are positively correlated with entry into marriage, and they are negatively conelated with divorce. For those who face otherwise poor economic prospects, as do many military enlistees, the military offers a unique set of economic opportunities and benefits.

Alternatively, other characteristics of the military population provide reason to think that divorce may be quite prevalent. As shown in the descriptive data section of this paper (Table 1), enlisted personnel are twice as likely as civilians to have divorced parents and are also significantly less religious than civilians. The African American presence in the enlisted US armed forces is also high, at about twice the size of their proportion in the civilian population. Beyond such compositional differences between the military and the civilian population, there are distinctive qualities of military life itself that may contribute to high divorce rates. It is possible that marriage rates are driven in part by several structural incentives for marriage associated with the military. There has been some controversy in the military regarding pay premiums for married couples (Pexton and Maze, 1995) and even some speculation that couples marry one another temporarily to receive such benefits (Until ETS Does Us Part 1977). In contrast to unmarried service members, married members are given an offbase housing allowance and food expense subsidy. Single soldiers are usually expected to live on base and in cases where on-base housing is unavailable for all soldiers, single soldiers receive substantially less housing allowance than those with dependents. Married couples also receive a family separation allowance and higher moving allowances. To the extent that material incentives unite couples who would not otherwise have married, such marriages may be built on weak foundations and divorce may therefore be prevalent.3 It is true that marriages that have been entered into with greater incentive, for example the nonmarital conception of a child, have high probabilities of marital dissolution (Teachman, 2002). Alternatively, as is often assumed in cunent maniage promotion policies, financial incentives may exert a stabilizing force on marriages. It is well known that divorce occurs more frequently among low income families due to lower returns to marriage when neither partner can provide an economic advantage to being married, as well as to greater poverty-related stress levels (Cherlin, 1992). However, there are additional aspects of military service that potentially exert negative effects on marital stability.

Military life may be unusually stressful for the spouses and children of enlisted members. Mady Segal (1986) has described the spheres of military life and family life as greedy institutions in constant competition against one another. Military families are subject to a distinct set of demands, including frequent geographical relocation, extended spousal/parental separations, residence in foreign countries, and, not least, occupational risks of injury and possibly death. Evidence from the first Gulf War, for example, shows a linkage between deployments and marital dissolution for female soldiers (Angrist and Johnson, 2000). Frequent relocations mean that spouses often face poor employment prospects, which can contribute to personal dissatisfaction as well as economic problems. According to one study, employed military spouses earn 40% less than comparable civilian spouses for this reason (Payne et al., 1992). The Pentagon has acknowledged the stresses afflicting military families. Recent “homesteading” policy reform seeking to reduce family instability increases the period between relocations to approximately six years in order to reduce disruption to a spouse’s career and children’s schooling (Ricks, 2004).

In conclusion, the factors that potentially predict divorce in the military are conflicting. When considering the above characteristics, it is plausible to imagine both a scenario in which divorce rates are very low and another in which divorce rates are very high. Stractural constraints of military service and the demographic makeup of enlisted personnel coupled with short-term incentives that possibly encourage marriage may predict higher risks of marital instability, yet the relative socioeconomic stability and benefits provided by the military would arguably lead to less rather than more divorce. It is entirely possible that these opposing factors ultimately balance one another out, leading to equivalent divorce rates as those of civilian society.

SAMPLE AND DESCRIPTIVE DATA

This paper employs data from the National Longitudinal Survey of Youth (NLSY). Its longitudinal survey design and military subsample are unique in that it provides information on family formation patterns at multiple points in time for substantial numbers of both civilians and military enlistees. The NLSY is a national probability sample that went to the field on January 1, 1979, and included a subsample of military active-duty enlisted personnel serving in one of the four branches, ages 17-21 as of September 30, 1978 (N= 1,280). The sampling design of the NLSY is multi-staged, consisting of stratified random samples with a small degree of nonresponse. I use the constructed weights, strata, and proportional-sampling units provided by the NLSY in estimating descriptive data but not multivariate data.4 Subsequent funding cuts resulted in the retention of only 201 of the original military cases from 1985 onward. This analysis is therefore necessarily constrained to a five- year time period, such that respondents can be followed only through their early to midtwenties (ages 23-27 in the final year). It is thus important to note that the young age of the respondents necessarily constrains all analyses to be those of early marital dissolution trends for both enlisted personnel and civilians. Fortunately, because such large proportions of enlisted men and women marry at very early ages, the sample size of married respondents is large enough to ensure a robust comparison to the married civilian sample.

Figure 1 shows overall proportions of ever divorced individuals across both samples over time. The proportion of ever-divorced individuals is higher among enlistees than civilians during the time period. However, the generalized divorce data shown in Figure 1 may simply reflect the larger population of enlisted couples than civilian couples at risk for divorce, explaining, perhaps, the widespread belief that military divorce is common. Figure 2 illustrates such differences vis-a-vis overall ever-manied proportions over the time period (note that the scale of Figure 2 has been changed to reflect a higher total ceiling); by the end of the time period, 21% more soldiers than civilians had married.

Using Event History Analysis in discrete-time units (Allison 1984), I control for such compositional differences. I limit the total sample to those in a marital union and predict the log odds of marital dissolution occurring over a five-year consecutive period. The analysis for each individual begins upon marriage, and I create maniage-years for each unit year of observation in order to capture variation in time-sensitive characteristics, for a total of 12,747 personyears.5 Although permanent attrition is rare in the NLSY, movement between the military and civilian samples is frequent. There are particularly high levels of exit from the military sample into the civilian sample, which in most cases reflects term of service completion. Less frequently, respondents who were originally interviewed in the civilian sample enlist with the military. My analytic models take this attrition into account by censoring military members upon their exit from the service. They also censor civilians who enlist with the military during the time period.

BIVARIATE RESULTS

Table 1 shows weighted bivariate distributions of variables used in the analyses that follow. They fall into three groupings associated with marital stability: basic demographic characteristics, religiosity, and socioeconomic status. The left hand column shows distributions for the manied military sample, and the right hand column shows those for married civilians. Statistically significant differences across the two groups are indicated with an asterisk in the middle column. Some of the demographic differences across the two populations are stractural artifacts of military service. For example, females comprise a minority of the enlisted population, and so there are significantly fewer married female enlistees than there are married female civilians. African Americans, on the other hand, are ovenepresented in the military subsample, reflecting the fact that African Americans comprise a larger overall percentage of the military population than the civilian population, and also that their marriage rates are substantially higher than black civilians (Lundquist, 2004a). Remaining demographic characteristics, such as the presence of children, age at marriage, residence at age 14, and previous marital status do not vary significantly across the two groups.

Religiosity, a consistent predictor of more conservative views toward divorce, is notably higher for civilians than soldiers. Enlistees’ reports of infrequent church attendance or no church attendance are 10% higher than those for civilians, whereas 11% more civilians report weekly and higher rates of attendance. The majority religious affiliation of both civilians and enlistees is Protestant; however, Catholicism is more common among civilians than enlistees.

Socioeconomic status, another instrumental conelate of marital stability, is measured via a number of educational attainment and childhood household structure variables. Differences in educational levels across the two subsamples again reflect some institutional elements of the military. Military recraitment standards generally require a high school degree, and many enlistees at these ages are either replacing or forestalling higher education through military service. Therefore, more enlisted members have a high school education than civilians but fewer have attended college. Scores on the Armed Forces Qualifying Test (AFQT), largely a reflection of schooling quality, are three points higher for soldiers than civilians. As a matter of sample construction, 100% of the military sample is employed full-time and none is in school on a full-time basis. Despite higher levels of secondary schooling and no unemployment, the military subsample members were raised in more disadvantaged households, with almost twice the proportion of single parents and larger numbers of siblings. Even so, maternal education levels (paternal education was less likely to be known by respondents) are on par across the groups.

I also include two types of Likert scale variables to measure attitudinal variation. The first is the Conservative Family Values scale, an index of agreedisagree statements, like “Women’s place is in the home, not the office or shop,” ranging from 7 to 28 by degree of conservatism. Traditionalist orientations are associated with less open attitudes toward divorce and may also be conelated with the attitudinal orientation of those who enlist with the military. The Conservative Values score is slightly higher for the enlisted group. The second scale is the Rotter score, a gauge of one’s locus of internal or external control, intended to measure resilience to adversity and self esteem. One agree-disagree statement comprising the scale, for example, is “What happens to me is of my own doing.” The Rotter score ranges from 4 to 16, and the lower the score, the higher the degree of internal control. There is little difference across the two populations on this measure. An examination of the characteristics of married individuals across the two populations of interest in Table 1 indicates inconsistent predictors of marital stability. Educational attainment and employment are associated with marital stability. As such, the enlisted population’s almost universal high school graduation rate and employment rate would then predict relatively low divorce levels. From another perspective, however, the enlisted population has lower levels of religiosity than the civilian population and was also more likely to be raised in a single-parent family, a characteristic associated both with socioeconomic disadvantage and lack of socialization into two- parent family environments. The number of African Americans enlistees is double that of African American civilians in the sample, which may also contribute to potentially higher overall divorce rates.

MULTIVARIATE RESULTS

In the multivariate event history analyses that follow, I predict the likelihood of divorce for civilians and soldiers in a series of nested models that estimate the role played by each of the above compositional characteristics. Divorce risk is measured in terms of marital duration.

Each model in Table 2 estimates the logistic likelihood of divorce. The primary independent variable of interest across each nested model is “Enlisted in the Military,” highlighted in gray across the top of the table. The first two columns of Table 2, Model 1 and Model 2, estimate baseline models. In the absence of any controls, military members are 27% (e^sup ..237^) more likely than civilians to divorce. Upon adding variables which measure marital duration in order to introduce a time hazard element to the model, the magnitude of the military divorce effect increases significantly to an odds of 44% (e^sup ..365^). It is not a surprise that duration of marriage generally predicts marital dissolution (although the risk declines over the length of marriage), and the shift in magnitude and significance across Models 1 and 2 indicates that, upon taking comparable years spent married into account, military marriages are at a higher risk of dissolution than civilian marriages.

Model 3 introduces a basic reduced-form model comprised of basic demographic independent variables. When controlling for all the basic demographic factors, the relationship between enlisted status and divorce likelihood increases in strength. Married enlisted individuals are now 62% (e^sup ..481^) more likely to divorce during the time period than married civilians. It appears that before demographic controls were introduced, the larger population of African Americans in the military population exerted a depressant effect on military divorce rates. This is counterintuitive given that African Americans in the civilian world generally have higher divorce rates (Amato, 2000; Current Population Reports, 2000; Tucker & Mitchell-Keman, 1995). The model includes an interaction between race and military status, which shows that white enlistees rather than black enlistees are the ones experiencing comparatively high divorce rates. I speculate in another analysis (currently under review) that this may reflect group reference theory (Meade, 1934). African American enlisted couples may be willing to endure greater levels of marital stress in exchange for the greater gains they receive relative to the civilian world. It may also be that the stresses of military marriage are not so different from those experienced in civilian society by blacks; as a result, African American military marriages may be more immune to hardship than white military marriages.

In addition, Model 3 indicates that having children is negatively correlated with divorce, which is compatible with most findings showing that the presence of children in the household heightens marital stability. The model also shows that the age at which individuals marry contributes to stability levels. The younger the age at marriage, the higher the risk of divorce becomes.

Model 4 adds the grouping of religiosity variables to the analysis. Upon their inclusion, the military status variable diminishes slightly both in terms of magnitude and significance level; however, military members are still 54% (e^sup ..435^) more likely than civilians to divorce. This suggests that accounting for civilians’ higher levels of religiosity only in part explains their lower propensity to divorce. Generally in the model, frequent religious attendance is associated with a 10% (e^sup .-.101^) reduction in divorce risk, but being female is associated with a 23% (e^sup ..206^) higher risk for both populations.6 A likelihood ratio test comparing the log likelihoods across the two models indicates that the addition of the religion variables significantly improves the model’s goodness of fit.

Model 5 introduces socioeconomic variables into the analysis, further improving the overall goodness of fit from the basic reduced form model, although only marginally. Controlling for differences in education, socioeconomic background, and employment reduces the likelihood of divorce for military by only five percentage points, and the standard error, though slightly inflated, still falls within the

The addition of attitudinal measures in Model 6 fails to improve model fit and has a negligible impact on the relationship between military status and likelihood of divorce. Although high scores on the Rotter scale (indicating a low locus of internal control) have a slightly positive effect on divorce likelihood, the military status variable is unaffected, continuing to indicate that military marriages are 49% (e^sup -402^) more likely to dissolve than civilian marriages. An interpretation of the race-military interaction coefficient in the full model indicates that compared to white civilians, white enlistees are 49% more likely to divorce while African American enlistees are 12% less likely.

The fact that racial composition has an unexpected effect on military divorce rates3 raises the possibility that other variables potentially work in opposite directions than expected across the two populations, but are diluted when combined into the one analytic sample. To test this, I predicted the logistic likelihood of divorce for each subsample separately. I found that, net of race considerations already captured in the interaction, the civilian and enlisted models look no different in their array of characteristics predicting divorce (not shown for this reason).

CONCLUSION

In summary, the widespread belief that divorce is prevalent in the military has some credence, at least when applied to young enlisted personnel during the early years of the all-volunteer force. Some of this belief is purely compositional; previous work has found that military enlistees are more likely than civilians to marry at younger ages, and hence there is more opportunity for marriages to end (Martin and McClure, 2000; Lundquist, 2004a; Lundquist, 2004b; Lundquist and Smith, 2005). When compared to same aged, married civilians in the presence of multiple demographic, religious, socioeconomic, and attitudinal controls, enlistees are still more likely to divorce than comparable civilians. The nested analyses in Table 2 suggest that controlling both for religious attendance and having been raised in a single parent household slightly mitigates the higher divorce rate in the military; however, none of the variables in the model fully explains the military- civilian disparity. Unfortunately, the NLSY does not contain variables to test causal explanations for this differential, such as measures of marital stress that might capture the unique demands of military service or the role that military marriage benefits might play in encouraging the formation of unsubstantial marital unions.

The latter explanation is somewhat less credible when considering the finding that African American service personnel have comparatively low rather than high marital dissolution rates. There is no obvious explanation for why ulterior incentives for marriage would be more common among one race than another. In a separate analysis not shown here, I divided the military sample into those whose marriages formed prior to military service versus those whose marriages formed during military service (Pre-service marriages can be assumed to have begun in the absence of possible military- benefits opportunism). There were only 42 such marriages, so results should be interpreted with caution, but I found that divorce was highly likely for these pre-military marriages as well. This casts doubt on the perverse incentives hypothesis, and suggests that the combination of marriage with military service may simply produce greater stress levels.

The NLSY data employed in this analysis are not without their weaknesses. As previously mentioned, the data represent only a specific age group of married couples. They also represent an earlier time period that may be less applicable to today’s Armed Forces. If anything, however, they are more likely to underestimate current divorce levels in the military than overestimate them. In recent years, marriage rates among enlisted personnel have risen sharply, so much so that the Marine Corps Commandant proposed a marriage ban on firstterm enlistees (Connable, 2002). With the increasing military orientation toward international peacekeeping missions, spousal separation episodes have become increasingly prolonged. The decline in Cold War era permanent base occupations also means that military families are much less likely than in the past to be included in relocations along with the spouse. Finally, in a time period when most families are comprised of dual-wage earners and wives often have career aspirations of their own, geographical restrictions of spousal military employment impose a heavier burden than in the past. All such developments are reason to believe that maintaining military marital stability has become more of a challenge today than when the NLSY sample was originally collected. This paper is an attempt to remedy major weaknesses of many civilian-military comparative analyses by conducting a time- sensitive, multivariate analysis of marital dissolution and utilizing a dataset comprised of both civilians and enlisted personnel for accurate comparison. By providing evidence in answer to colloquial beliefs on the topic, the analyses in this paper confirm that divorce is in fact high among young enlisted personnel in the military during the early years of the all-volunteer force.

* Editor’s Note: This article was intended for publication in the Winter 2006 edition; however, due to organizational difficulties in transitioning between typesetters, it was substantially delayed. We apologize for the delay.

1 The total sample size was 61. I collected the surveys at the annual BOSS conference held in Lansdowne, VA. The conference acronym stands for “Better Opportunities for Single Soldiers,” which speaks to the Pentagon’s recognition of the possible alienating conditions experienced by unmarried individuals living in a largely married population.

2 Relative to the civilian sector, returns to lower education levels are high in the military. Those without college degrees have high career mobility within the enlisted ranks, and educational benefits confened both on and off duty provide opportunities to sharpen one’s credentials in preparation for reentry into a competitive civilian job market.

3It should also be noted that as of 1981, the US government enacted the Uniformed Services Former Spouses Protection Act, which treats military retirement benefits as joint property of both husband and wife (Thole and AuIt 1994). This can include up to 50% of the military spouse’s retirement benefits, the amount of which is determined by paygrade at the time of retirement, not at the time of divorce. Ex-spouses are entitled to retirement benefits regardless of their subsequent remarriage status. Thus, the accraal of military benefits does not necessarily end with divorce.

4 When weights are a function of the observed independent variables in the models, as they are in my analyses, unweighted regressions will result in efficient, consistent, and unbiased estimates (Winship and Radbill 1994). Furthermore, I have determined that the dependent variable I use in the following analyses (marital status) is not a function of the NLSY’s sampling stratification; therefore, the standard enors should not be affected in the absence of weights (Winship and Radbill 1994). This is in keeping with many NLSY studies that discard weights for multivariate analyses but employ them for accurate representation of descriptive data.

5 A very small percentage of marriages occurred prior to the first interview year. They are left censored because their risk of divorce leading up to 1979 cannot be measured; however, the marriage duration variable does take into account the number of years they have been married leading up to sample formation.

6 Given that women’s experience of military service may differ substantially from that of men’s, I tested for whether military status varied by gender in divorce outcomes. There was no evidence for an interaction effect.

1 The lack of correlation between most of the socioeconomic variables and divorce is invariant to the order in which I nest the various models.

2 The latter is less of a shortcoming than the former, since divorces are most common in the first few years of marriage.

3 Models tested in the absence of the military-race interaction show a substantial reduction in the military status variable, illustrating the counteracting effect of a large African American composition in the military sample.

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1999 Divorce, separation, annulment and widowhood. Pp.475-499 in Handbook of Marriage and the Family, edited by M.B. Sussman, S. Steinmetz, and G.W. Peterson New York: Plenum.

Goldman, Nancy

1973 “The changing role of women in the armed forces.” American Journal of Sociology 78:892-911.

Hackstaff, K.B.

1999 Marriage in a Culture of Divorce. Philadelphia: Temple University Press.

Harrell, Margaret

2000 Invisible Women: Junior Enlisted Army Wives. Thousand Oaks, CA: Sage.

Lundquist, Jennifer Hickes

2004a “When race makes no difference: Marriage and the military.” Social Forces 83(2): 1 -28.

2004b A Counterfactual Approach to the Black-White Differential in Family Trends: The Effect of a ‘Total Institution. Ph.D. Dissertation, University of Pennsylvania, Philadelphia.

Lundquist, Jennifer Hickes, and Herbert Smith

2005 “Family Formation in the U.S. Military: Evidence from the NLSY” Journal of Marriage and the Family 67:1 -13.

Martin, J. A., and P. McClure

2000 “Today’s active duty military family: the evolving challenges of military family life.” Pp 3-24 in The Military Family: A Practice Guide For Human Service Providers, edited by J.A. Martin, L.N. Rosen, and L.R. Sparacino. Westport, CT: Praeger.

McGue, M., and Lykken, D.T.

1992 “Genetic influence on divorce.” Psychological Science 3:368- 373.

Mead, George

1934 Mind, Self and Society. Chicago: University of Chicago Press.

Oppenheimer, Valerie

1994 “Women’s rising employment and the future of the family in industrial societies.” Population and Development Review 202:293- 342.

Payne, Deborah, John Warner, and Roger Little

1992 “Tied migration and returns to human capital: the case of military wives.” Social Science Quarterly 73: 324-339.

Pexton, P., and R. Maze

1995 “A Gap in Military Pay.” Air Force Times: Military Times Media Group (May 29).

Ricks, Thomas

2004 “Army Policy to Reduce Soldier Relocations: Change seeks to Aid Training, Family Life.” Washington Post (February 10):A-01.

Ruger, William, Sven Wilson, and Shawn Waddoups

2002 “Warfare and welfare: military service, combat and marital dissolution.” Armed Forces and Society 29:85-107.

Segal, Mady

1986 “The Military and the Family as Greedy Institutions.” Armed Forces & Society 13:9-38.

Scarville, J.

1990 Spouse Employment in the Army: Research Findings. #1556 Arlington, VA: U.S. Army Research Institute.

Teachman, Jay

2002 “Stability Across Cohorts in Divorce Risk Factors.” Demography 29:331-351.

Thole, Marsha, and Frank Ault

1994 Divorce and the Military: A Comprehensive Guide for Service Members, Spouses and Attorneys. Redlands, CA: American Retirees Association.

Tucker, M.B., and C. Mitchell-Kernan

1995 “Marital behavior and expectations: ethnic comparisons” Pp. 229-254 in The Decline in Marriage Among African Americans: Causes, Consequences and Policy Implications, edited by M.B. Tucker and C. Mitchell-Kernan. New York: Russell Sage Foundation.

White, L.

1990 “Determinants of Divorce: A Review of Research in the Eighties.” Journal of Marriage and the Family 52:904-912.

Winship, Christopher, and Larry Radbill

1994 “Sampling Weights and Regression Analysis.” Sociological Methods & Research 23:230-257.

JENNIFER HICKES LUNDQUIST

University of Massachusetts Journal of Political and Military Sociology, 2007, Vol. 35, No. 2 (Winter): 199-217

Jennifer Lundquist is an assistant professor in the Department of Sociology and the Associate Director of the Social and Demographic Research Center at the University of Massachusetts. She received a joint Ph.D. in Demography and Sociology from the University of Pennsylvania in 2004. A social demographer with an emphasis on race and ethnic stratification, family formation patterns, and immigration, she evaluates racial disparities along a variety of demographic outcomes, including marriage, family stability, fertility, and infant mortality.

Copyright Dr. George Kourvetaris Winter 2007

(c) 2007 Journal of Political and Military Sociology. Provided by ProQuest Information and Learning. All rights Reserved.

Fresenius Medical Care North America, operator of the nation’s leading network of dialysis clinics, today announced the opening of Fresenius Medical Care Kapahulu, a new advanced dialysis treatment center. The Medicare-certified facility is located at 750 Palani Avenue, ten minutes from Waikiki Beach. For more information on the clinic, which is now accepting new patients, call 808-732-7702 or 1-866-4-DIALYSIS (1-866-434-2597).

Fresenius Medical Care of Kapahulu features:

24 dialysis stations.

Modern entertainment system featuring individual cable with headsets and at each station.

Upcoming CHAIRSIDE™ online charting system with touch screen monitors at dialysis stations, so clinical staff can securely enter, access and track critical patient data at all times, ensuring the highest level of patient care and safety.

In addition to in-center hemodialysis services, Fresenius Medical Care — Kapahulu Dialysis Clinic offers home dialysis. Other dialysis patient services include a kidney transplant support program, anemia management, nutrition counseling, bone disease management and social worker support.

The new clinic offers the Treatment Options Program to inform new and prospective dialysis patients and their families about chronic kidney disease and dialysis. Sessions are FREE and are held monthly at the facility; call 808-440-4894 to reserve space.

Clinical Manager Renee Esteban, RN, heads up a staff of highly trained registered nurses, patient care technicians, a social worker, a dietitian and technical and administrative personnel.

“We are thrilled to be opening this advanced new treatment center, which enables us to serve the Honolulu area’s growing dialysis patient population,” said Alvin Cecil, Regional Vice President for Fresenius Medical Care. “In keeping with our UltraCare® commitment, Fresenius Medical Care of Kapahulu provides the highest level of quality care through innovative treatment methods, advanced dialysis technology and superior customer service.”

“We have a fantastic team of Fresenius-trained people who are dedicated to providing patients with advanced dialysis care,” said Esteban. “We also want to make treatment sessions more enjoyable for them by providing special amenities like our individual entertainment systems.”

The Fresenius Medical Care standards and practices include single use of dialyzers, unlike other facilities that may disinfect and re-use artificial kidney systems. Fresenius Medical Care also utilizes technologically advanced dialysis systems and Diasafe® filters designed to provide ultrapure dialysate. In addition, the company uses a proprietary “traffic light” Adequacy Monitoring Program, a caregiver alert system enabled by On Line Clearance monitoring, to continuously show the effectiveness and progress of every dialysis treatment.

This clinic opening brings the total number of Fresenius Medical Care facilities in the Hawaii region to eight. Clinics are located in the Honolulu, Aloha, Pearlridge, Kapolei, Wahiawa, Windward, and Lanai areas. The ninth center is expected to open this summer, Fresenius Medical Care of Ko’olau in Kaneohe, Oahu.

About Fresenius Medical Care North America

Fresenius Medical Care North America is a subsidiary of Fresenius Medical Care AG & Co. KGaA, the world’s largest integrated provider of products and services for individuals undergoing dialysis because of chronic kidney failure, a condition that affects more than 1,600,000 individuals worldwide. Through its network of 2,238 dialysis clinics in North America, Europe, Latin America, Asia-Pacific and Africa, Fresenius Medical Care provides dialysis treatment to approximately 173,860 patients around the globe. Fresenius Medical Care is also the world’s leading provider of dialysis products such as hemodialysis machines, dialyzers and related disposable products. Fresenius Medical Care is listed on the Frankfurt Stock Exchange (FME, FME3) and the New York Stock Exchange (FMS, FMS-p).

For more information about Fresenius Medical Care’s U.S. network of more than 1,600 dialysis facilities, visit the Company’s website at www.ultracare-dialysis.com. For more information about Fresenius Medical Care, visit the Company’s websites: www.fmcna.com or www.fmc-ag.com.

BOSTON, Feb. 28 /PRNewswire/ — The 125-member Coalition to Protect Massachusetts Patients applauds the vote today by the joint Committee on Public Health Committee to approve a bill to guarantee safe RN staffing in all Massachusetts hospitals. The measure, The Patient Safety Act, calls upon the Massachusetts Department of Public Health to set safe limits on nurses’ patient assignments, and also prohibits mandatory overtime and includes initiatives to increase nursing faculty and nurse recruitment.

(Logo: http://www.newscom.com/cgi-bin/prnh/20070530/NEW064LOGO )

The bill responds to increased concern over quality care in Massachusetts hospitals as well as evidence linking disease and deaths to poor patient oversight caused by nurses being forced to care for too many patients at one time. In recent years medical errors and hospital acquired infections have soared, with the Centers for Disease Control (CDC) now reporting that 2,000 people, or six people per day, are dying in Massachusetts because of them every year. A number of studies link the rise in hospital-acquired infections and other medical complications to understaffing of nurses. A report published in the July issue of the journal Medical Care found that safe RN staffing levels could reduce hospital acquired infections by 68 percent.

In May 2006, the Massachusetts House of Representatives passed similar legislation by a margin of 133 to 20 but the bill was not taken up by the Senate. The Patient Safety Act: House Bill 2059 is co-sponsored by State Senator Marc Pacheco (D-Taunton) and State Representative Christine Canavan (D-Brockton). “At last, we have movement on H. 2059!” said Rep. Canavan. “I am so pleased that the Joint Committee on Public Health recognizes the merits of this bill as written, and that it has released the compromise bill. Now we must all join together to successfully move H. 2059 through the House and Senate processes. Let’s make this the year we finally reach the Governor’s desk!”

“We commend the Public Health Committee for their favorable vote on this bill and we look forward to a successful vote in the full House,” said John McCormack, the co-chair of The Coalition to Protect Massachusetts Patients. “Every day we wait for this bill to be passed, a distressing number of patients in our hospitals are suffering, and many are dying due to a lack of appropriate nursing care.”

   Key components of the bill include the following:   -- The bill directs the Massachusetts Department of Public Health to      develop and implement staffing standards and enforceable limits on the      number of hospital patients assigned to a registered nurse at any one      time.   -- The staffing standards would be developed within 12 months of the      bill's passage and be based on scientific research on nurse staffing      levels, patient outcomes, expert testimony, and standards of practice      for each specialty area.   -- The bill calls for the safe staffing limits to be implemented in all      teaching hospitals by 2009, with implementation in all community      hospitals by 2011.   -- The bill allows DPH to grant waivers for hospitals in financial      distress.   -- The bill provides flexibility in staffing and accounts for patients who      require more care. Once established, the staffing levels will be      adjusted up or down based on patients needs using a standardized, DPH-      approved system for measuring patient needs.   -- The Act will reduce errors caused by fatigue and overwork by      prohibiting hospitals from forcing nurses into mandatory overtime.  It      will also prevent hospital administrators from moving nurses into      unfamiliar assignments without proper orientation.   -- The Act prevents the reduction of support services, including services      provided by licensed practical nurses, aides and technicians.   -- The bill establishes a number of nurse recruitment initiatives --      sought by the hospital industry and supported by the Coalition -- to      increase the supply of nurses, by providing nursing scholarships and      mentorship programs, as well as support for increases in nursing      faculty to educate new nurses.  It also would create refresher programs      to assist nurses in returning to practice at the hospital bedside.  A      survey of Massachusetts nurses found that more than 65 percent of those      not practicing in hospitals would be likely to return if a law      providing safe limits was passed. In California, where similar limits      have been in place for three years, 80,000 nurses have returned to the      bedside.   -- The bill establishes strong consumer protections for safe RN staffing,      including a prominent posting of the daily RN staffing standards on      each unit.    

To date, 125 of the state’s leading health care and patient advocacy groups have endorsed HB 2059 and have joined forces to push for its passage in both the House and Senate. Recent voter surveys indicate that more than 80 percent of the public supports establishing safe staffing limits.

The Patient Safety will now move to the Joint Committee on Health Care Finance.

Photo: NewsCom: http://www.newscom.com/cgi-bin/prnh/20070530/NEW064LOGOAP Archive: http://photoarchive.ap.org/PRN Photo Desk, [email protected]

The Coalition to Protect Massachusetts Patients

CONTACT: Alex Zaroulis, +1-617-549-0358,[email protected], for The Coalition to Protect MassachusettsPatients

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

By Feinberg, Jeff H Toner, Charles B

ABSTRACT A 22-year-old African American U.S. sailor presented with an intermittent pruritic eruption precipitated by mild activity for the last 2 years. She developed an extremely pruritic papular rash that would quickly coalesce into larger wheals following any exercise, light activity such as vacuuming, or taking hot showers. This condition had been getting progressively worse, preventing her from successfully completing her physical readiness test and other required physical training for the last 2 years. Previous treatment with antihistamines and steroids had failed to control her symptoms. She was diagnosed with cholinergic urticaria, successfully controlled with a combination of cetirizine, montelukast, and propanolol. She has since been returned to full military duty and is able to exercise regularly. CASE REPORT

A 22-year-old African American female in the U.S. Navy presented with a 2-year history of exercise-associated rash. Almost immediately after starting exercise, she would develop extremely pruritic papules beginning on her arms that would quickly increase in both number and size, spreading to her trunk and extremities. She also had occasional involvement of her central face and postauricular neck. Although symptoms had been present for 2 years, they had increased significantiy 15 months before presentation, at which time she had noticed she had stopped sweating. At the time of presentation, she could not tolerate even light activity such as vacuuming or housecleaning without eliciting an outbreak of the rash. hot showers would provoke a similar response. She denied associated chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, wheezing, and lightheadedness with her episodes. Symptoms would typically last an hour, although on several occasions, they would last until aborted by the administration of either diphenhydramine or epinephrine. She had one documented episode of edema of the lips, but no difficulty swallowing. Hydroxyzine (Atarax) afforded minimal improvement in pruritus, but it was too sedating and did little to prevent her outbreaks. She had also tried loratadine (Claritin), ranitidine (Zantac), and oral steroids without any sustained success. Her condition and associated symptoms have prevented her from participating in mandatory physical training and passing the physical readiness test.

Her past medical history is unremarkable and is notable for no previous history of seasonal allergic rhinitis, atopy, or other allergies. Her only medication is loratadine, 10 mg daily, for symptom control. She had no other history of skin rashes. Her examination was equally unremarkable with no cutaneous lesions. She did not exhibit dermatographism. Skin-prick allergy testing was remarkable for 2+ reactions to pecan tree aUergens, and 1 + to molds, with a 3+ reaction to histamine, and a 0 reaction to control. Pulmonary spirometry tests were unremarkable. Intradermal methacholine chloride challenge (0.1 mg of methacholine in 0.1 mL normal saline intradermally) caused the development of small satellite lesions. Provocative exercise treadmill testing yielded a stable blood pressure (systolic range: 120-130 mm Hg; diastolic range: 76-82 mm Hg) and an appropriate increase in pulse (range, 82- 128). After 18 minutes of testing, the patient stopped the test due to fatigue and lightheadedness. Her body temperature had increased from 97.2 to 99.4[degrees]F and she was sweating. At 21 minutes from the start of the test, she developed an outbreak of small, 2-mm papules (Fig. 1) over her trunk and extremities. By 47 minutes, the number of papules had increased and had begun to coalesce into wheals (Fig. 2), the largest confluent lesion measuring five centimeters. Repeat pulmonary spirometry after the exercise provocation test was essentially unchanged.

The patient was diagnosed with cholinergic urticaria (CU), given cetirizine HCL (Zyrtec), 10 mg twice a day, which provided significant improvement, but incomplete resolution. Montelukast (Singulair), 10 mg once a day, and propanolol HCL (Inderal), 20 mg twice a day, were added. Since she became stable on the regimen, she is able to shower, clean her house, and exercise. Her perspiration has returned to normal. She now participates in command physical training, running 1.5 miles with minimal irritation and no outbreaks.

DISCUSSION

The physical urticarias are a unique subgroup of the chronic urticarias which can occur through a variety of mechanisms, including allergic, idiopathic, cytotoxic, and autoimmune. Physical urticarias have a wide variety of triggers as well, including water, heat, cold, exercise, sunlight, pressure, and vibration.

CU was first described by Duke in 1924, as a subset of the physical urticarias. Thirty percent of patients with physical urticarias have CU. The majority of the cases occur over the age of 20 and the peak incidence between 26 and 28 years of age.1 Symptoms are brought on by an increase in heat, physical exercise, spicy foods, or extreme emotions. Of those with CU, exercise is the most provocative factor, able to cause an outbreak in 89%. Passive warming (sauna or hot bath) can cause symptoms in 80%, while strong emotions can lead to an attack in 60%; finally, spicy food is able to trigger an attack in 29%.2 The condition will usually improve with time and 14% of CU patients can develop spontaneous remission.3 CU can evoke significant disability to those afflicted with the disease. The level of disability, based on Dermatology Life Quality Index, is similar to severe atopic dermatitis and is much greater than psoriasis or acne.4

CU begins as 1- to 3-mm wheals with surrounding flare typically about the extremities and truncal skin.3 It less commonly involves the face and neck with episodes following a precipitating event by 10 minutes and resolves within 2 to 4 hours spontaneously.1 It may be preceded by pruritic or tingling sensation.3 Atopic dermatitis occurs concurrently in 30% of the cases.2 CU typically limited to skin involvement, however, it can have a more systemic appearance, blurring the line between it and exercise-induced anaphylaxis. Abdominal pain, nausea, diarrhea, in addition to respiratory symptoms have been described, initiated by exercise or emotional stress.5 Some of the earlier reported cases were more likely exercise-induced anaphylaxis, a condition which was not independently described until the 1980s.6,7 It can certainly coexist with exercise-induced anaphylaxis.8 Reduction in FEV1 without full- blown anaphylaxis has been described as well.9

Pathogenesis is still a matter of debate; it is likely that CU represents a multifactorial pathogenesis, and the disease process itself is not entirely homogenous. Histamine is believed to be a central mediator, as histamine levels are generally increased after an episode of CU, as are eosinophil and neutrophil chemotactic factors.7,9 The newer theories focus on sweat itself being fundamental in the pathogenesis. Fukunaga et al.10 studied 18 patients with CU and 10 controls by injecting saline-dmited sweat (1/ 100) and filtered serum intradermally and compared reactions, as well as the ability of sweat to induce histamine release from the basophil in vitro.10 They concluded that CU involves a hypersensitivity or autoimmunity to sweat. Furthermore, they determined that CU should be subdivided clinically and pamologically among those with a foliicular appearance and those with a nonfolicular appearance. The foliicular type was characterized by a weaker reaction to autologous sweat, greater sensitivity to autologous serum, and a negative methacholine skin test There is further evidence from Murphy et al.11 that a serum factor may be responsible, as evident by a localized reaction to heat in monkeys that received an intradermal injection of serum from patients with CU. The nonfolicular subtype described by Fukunaga et al.10 had an increased incidence of hypersensitivity to sweat, an increased sweat- induced histamine release from basophils, as well as a positive methacholine skin test. They demonstrated mat autologous sweat itself stimulated histamine release from basophils in a majority of those with CU, especially the nonfolicular type. This reaction was absent in controls. Additionally, Adachi et al.12 proved that patients with CU can have an aUergic reaction to their own excreted sweat. These findings suggest that the local skin reactions in CU may be more akin to an allergic contact dermatitis. Interestingly, CU has also been present in those with anhydrosis and hypohidrosis. Kobayashi et al.13 put forth that since CU can be induced in those with hypohidrosis, it may be that the sweat itself infiltrates into the surrounding dermis and stimulates mast cell degranulation. Although our patient initially presented with a complaint of anhydrosis, it is unlikely that she actually had that condition, as she easily perspired when properly challenged. In her case, it is more likely that her symptoms of CU are triggered below her normal sweating threshold leading her to stop the physical activity before any noticeably induced perspiration.

Another pathogenic theory involves an increased sympathetic tone which in turn stimulates the postganglionic cholinergic fibers to the eccrine sweat glands.2 Acetylcholine causes mast cell degranulation leading to the typical wheal presentation. The increased acetylcholine activity can be a result of increased acetylcholine levels, decreased Cholinesterase activity, or increased acetylcholine receptor either sensitivity or number. However, a generalized increase in receptor sensitivity is unlikely based on studies involving pupillary response, blood pressure and pulse.14 Diagnosis is frequently a clinical one with a typical history and eliciting factors. Confirmation is best done by provocation testing. Skin testing, to include skin prick and intradermal injections, is also possible but usually only positive in those with moderate to severe disease.14,15 The methacholine skin challenge involves injecting 0.01 mg of methacholine in 0.1 mL of saline solution intradermally and looking for satellite lesions.15 Although the test is fairly specific, it only has a sensitivity of 30 to 50%.2,3,16

Provocative testing is the gold standard and best done under a controlled environment with either a bath test or an exercise test- usually a bike ergometer, step, or running test. The goal is to raise the core body temperature and thereby induce the CU. Many prefer using a 40[degrees]C bath or hot shower to induce the typical wheals of CU. If there is a question of aquagenic urticaria, the same can be done with a sauna or keeping some body parts dry. If an exercise challenge is to be done, care must be taken to properly exclude exercise-induced anaphylaxis or perform the test under more stringent circumstances. It is the preferred method at our institution to perform a Bruce protocol exercise stress test with full resuscitative capabilities.

There are few well-designed placebo controlled studies involving the treatment of CU and, of those, the number of patients involved is usually still small. Nonpharmacological treatment consists of avoidance of precipitating factors or a cooling bath. There has been some benefit shown by use of a desensitization program and the fact that outbreaks lessen after a severe outbreak.17

Antihistamines are the cornerstone of pharmacological treatment of CU. H1 blockers, specifically hydroxyzine (Atarax), have been shown to decrease both pruritus and lesion count versus placebo.18 Cetirizine is less sedating and very effective. In two separate double-blind studies, Zuberbier et al. showed cetirizine had a significantly greater response than placebo with an increase in mild or symptom-free days from 51 to 74.19 In his second study, 13 patients had a significant reduction in wheal formation, pruritus, and erythema compared with placebo.20

Danazol, an attenuated androgen, has been used successfully in treating refractory CU. Berth-Jones21 described successful monotherapy with danazol in a 19-year-old male with a history of CU for 3 years. Wong et al.22 did a double-blind placebo controlled crossover study with 17 males with CU. The primary endpoint was wheal count and change in biochemical markers. Danazol produced a significant decrease in wheal count (pruritus was not assessed), from 150 wheals after a standard exercise protocol to 39 wheals after 4 weeks of treatment. However, because danazol is a strong androgenizing agent it should be avoided or given with extreme caution in females.

An experimental asthma drug, not currently available in the U.S., Ketotifen has been shown to be effective in refractory cases. Three of four subjects had symptoms suppressed with 8 mg per day, which is four times the usual dose.23 The usual dose of 2 mg has not been shown to be as effective.24

Both beta blockers and calcium channel blockers have been tried. Beta blockers have been shown to be effective in refractory cases in several case reports.25,26 Pigatto et al.27 studied the efficacy of nimodipine (Nimotop) in a study of 32 patients with physical urticarias, of which 8 had CU. In the CU subgroup, nimodipine was not superior to terfenadine. Because of its anticholinergic side effects, oral scopolamine butylbromide at 10 mg three times a day has been reported in a case report to be effective in controlling CU with minimal side effects.28

In conclusion, CU has a high lifetime prevalence, with a course that can occasionally be debilitating. The diagnosis can typically be made on clinical grounds alone with no need for diagnostic or laboratory work up. Treatment regimens should be individualized for best results.

REFERENCES

1. Zuberbier T, Althaus C, Chantraine-Hess S, Czarnetzki B: Prevalence of cholinergic urticaria in young adults. J Am Acad Derm 1994; 31: 978-81.

2. Hirschmann JV, Lawlor F, English JS, Louback JB, Winkelmann RK, Greaves MW: Cholinergic urticaria: a clinical and histologic study. Arch Dermatol 1987; 123: 462-7.

3. Dice JP: Physical urticaria. Immunol Allergy Clin North Am 2004; 24: 225-46.

4. Poon E, Seed PT, Greaves MW, Kobza-Black A: The extent and nature of disability in different urticarial conditions. Br J Dermatol 1999; 140: 667-71.

5. Kounis NG, MacMahon MB: Cholinergic urticaria with systemic manifestations. Ann Allergy 1975; 35: 243-5.

6. Kaplan AP, Natbony SF, Tawil AP, Frachter L, Foster M: Exercise-induced anaphylaxis as a manifestation of cholinergic urticaria. J Allergy Clin Immunol 1981; 68: 319-24.

7. Volcheck GW, Li JTC: Exercise-induced urticaria and anaphylaxis. Mayo Clin Proc 1997; 72: 140-7.

8. Baadsgaard O, Lindskov R: Cholinergic urticaria with anaphylaxis induced by exercise or heating. Acta Derm Venereol 1984; 64: 344-6.

9. Sorter NA, Wasserman SI, Austen KF, McFadden E: Release of mast-cell mediators and alterations in lung function in patients with cholinergic urticaria. N Engl J Med 1980; 302: 604-8.

10. Fukunaga A, Bito T, Tsuru K, et al: Responsiveness to autologous sweat and serum in cholinergic urticaria classifies its clinical subtypes. J Allergy Clin Immunol 2005; 166: 397-402.

11. Murphy GM, Greaves MW, Zollman PE, Winkelmann RK: Cholinergic urticaria, passive transfer experiments from human to monkey. Dermatologica 1988; 177: 338-40.

12. Adachi J, Aoki T, Yamatodani A: Demonstration of sweat allergy in cholinergic urticaria. J Dermatol Sci 1994; 7: 142-9.

13. Kobayashi H, Aiba S, Yamagishi T, et al: Cholinergic urticaria, a new pathogenic concept: hypohidrosis due to interference with the delivery of sweat to the skin surface. Dermatology 2002: 204: 173-8.

14. Murphy GM, Smith SE, Smith SA, Greaves MW: Autonomic function in cholinergic urticaria and atopic eczema. Br J Dermatol 1984; 110: 581-6.

15. Commens CA, Greaves MW: Tests to establish cholinergic urticaria. Br J Dermatol 1978; 98: 47-51.

16. Kontou-Fili K, Borici-Mazi R, Kapp A, Matjevic LJ: Physical urticaria: classification and diagnostic guidelines: an EAACI position paper. Allergy 1997; 52: 504-13.

17. Moore-Robinson M, Warin RP: Some clinical aspects of cholinergic urticaria. Br J Dermatol 1968; 80: 794-9.

18. Kobza Black A, Aboobaker J, Gibson JR, Harvey SG, Marks P: Acrivastine versus hydroxyzine in the treatment of cholinergic urticaria: a placebo controUed study. Acta Derm Venereol 1988; 68: 541-4.

19. Zuberbier T, Aberer W, Burtin B, Rihoux JP, Craznetzki BM: Efficacy of cetirizine in cholinergic urticaria. Acta Derm Venereol 1995; 75: 147-9.

20. Zuberbier T, Munzberger C, Haustein U, et al: Double-blind crossover study of high dose cetirizine in cholinergic urticaria. Dermatology 1996; 193: 324-7.

21. Berth-Jones J, Graham-Brown RA: Cholinergic pruritus, erythema, and urticaria: a disease spectrum responding to danazol. Br J Dermatol 1989; 121: 235-7.

22. Wong E, Eftekhan N, Greaves MW, Milford-Ward A: Beneficial effects of danazol on symptoms and laboratory changes in cholinergic urticaria. Br J Dermatol 1987; 116: 553-6.

23. McClean SP, Arreaza EE, Lett-Brown MA, Grant AJ: Refractory cholinergic urticaria successfully treated with ketotifen. J Allergy Clin Immunol 1989; 83: 738-41.

24. Czarnetzki BM: Ketotifen in cholinergic urticaria. J Allergy Clin Immunol 1990; 86: 138-9.

25. Ammann P, Surber E, Bertel O: Beta blocker therapy in cholinergic urticaria. Am J Med 1999; 107: 191.

26. Conway MJ: A beta-adrenergic blocker for cholinergic urticaria. Practitioner 1982; 226: 940-1.

27. Pigatto PD, Fumagalli M, Bigardi A, Altomare G, Finzi AF: Nimodipine versus terfenadine in the treatment of physical stimulus- induced urticaria. Allergy 1990; 45: 71-4.

28. Tsunemi Y, Ihn H, Saeki H, Tamaki K: Cholinergic urticaria successfully treated with scopolamine butylbromide. Int J Dermatol 2003; 42: 850.

LCDR Jeff H. Feinberg, MC(FS) USN*; CDR Charles B. Toner, MC USN[dagger]

* Marine Helicopter Squadron One, 2100 Rowell Road, Quantico, VA 22134.

[dagger] National Naval Medical Center, 8901 Rockville Pike Road, Bethesda, MD 20889.

This manuscript was received for review in January 2007. The revised manuscript was accepted for publication in July 2007.

Copyright Association of Military Surgeons of the United States Feb 2008

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

By Shay, Laura E

There are numerous factors that influence an individual’s ability to adhere to a healthy behavior. The literature cites common events that must take place prior to maintaining an exercise plan, a medication regimen, and a healthy diet. The purpose of this paper is to examine the concept of adherence in relation to weight loss using Walker and Avant’s (1995) framework for concept analysis. This analysis revealed an extensive list of events or antecedents that may prove to be important when considering new strategies for weight management. Search terms: Adherence, compliance, maintenance

Introduction

The concept of adherence is widely discussed in the literature by healthcare disciplines including nursing, medicine, psychology, pharmacy, physical therapy, and nutrition. Essentially anyone who provides treatment, counseling, advice, or support considers adherence when determining outcome goals. The same is true for educators, lawmakers, and even parents. Adherence is a concept known to most law-abiding citizens. According to the Oxford Dictionary (1984), the verb to adhere is to give support or allegiance to a person, party, agreement, or opinion. It also means to behave according to a rule or undertaking, and to stick fast to a substance. The noun adherent is defined as a supporter or devotee of a party or activity. For the purpose of this concept analysis, the term adherence will be discussed as it relates to weight loss. In health care, the term adherence is generally associated with one’s ability to maintain the behaviors associated with a plan of care. This often involves taking medications, keeping appointments, or changing health behaviors. Adherence is also referred to in the healthcare literature as compliance and maintenance. The opposite of adherence is often referred to as noncompliance or nonadherence. CINAHL and PubMed databases were searched for the key words adherence, compliance, and maintenance. Prior to 1996, the term compliance appeared more often than adherence. The use of the term compliance versus the term adherence has been debated for years. According to McDonald, Garg, and Haynes (2002), the term adherence is intended to be nonjudgmental, in that it is a statement of fact rather than of blame of the prescriber, patient, or treatment. Burke and Dunbar-Jacob (1995) describe the term adherence as emphasizing the mutual responsibility between patient and provider reinforcing the commitment of the provider to help the patient implement and follow their treatment plan. Murphy and Canales (2001) performed a concept analysis on the term compliance. Their analysis found that the concept of compliance is viewed by nurses as either evaluative, rationalization, and/or acceptance. Nurses who view compliance as evaluative are uncomfortable with the term compliance because they feel it is paternalistic and sets patients up to be viewed as “difficult” or “troublesome” if they are found to be noncompliant. Nurses who view compliance as rationalization understand the negative views related to the word compliance; however, they believe that it is appropriate to use it in some healthcare situations. And, nurses who view compliance as acceptance use the word compliance freely and without concern.

The perception of compliance from a patient’s point of view was addressed by Thorne (1990). She found that patient’s perceived noncompliance as an intentional and conscious decision not to adhere to professional advice. Schaf fer and Yoon (2001) described adherence as an interactive patient-clinician relationship and compliance as a passive response to an authoritative relationship. Chockalingam et al. (1998) described both adherence and compliance as meaning the same thing: how well a patient follows and sticks to the management plan developed with her or his healthcare provider, which may include pharmacologic agents as well as changes in lifestyle (Chockalingam et al.).

The term maintenance is frequently used when describing adherence to health behaviors such as weight loss and exercise. A common model used to study health behaviors is the Transtheoretical Model of Stages of Change (Prochaska & DiClemente, 1983). This model is used to describe change as a process involving the progression through six stages: precontemplation, contemplation, preparation, action, and maintenance. The precontemplation stage is often characterized as the stage in which people are noncompliant, unmotivated, or not ready for treatment (Prochaska, 2001). On the other end of the spectrum is the maintenance stage, which is defined as the stage when an individual has achieved the targeted behavioral change for greater than 6 months and is working to sustain (adhere) to the change (Prochaska & DiClemente; Vallis et al., 2003).

The time period used to define maintenance and adherence varies throughout the literature. Speck and Harrell (2003) defined the ability to maintain regular exercise as participating in regular exercise for greater than 6 months. Phelan, Hill, Lang, Dibello, and Wing (2003) described weight loss maintenance as maintaining weight at or below baseline value for 2 years. Adherence in relation to cancer screening is based on whether or not an individual has had a screening test. For example, Fernandez, DeBor, Candreia, Wagner, and Stewart (1999) define nonadherence to mammogram screening guidelines as: (a) women 40 years of age or older who report never having a mammogram or (b) women who have never received a mammogram within the American Cancer Society-recommended interval for their age (Fernandez et al.). Women who are nonadherent to Pap test screening guidelines are defined as women who have never had a Pap test or if they had one, the lapse time was greater than a year since their last Pap test (Fernandez et al.).

In summary, the word adherence in the healthcare literature is also referred to as compliance and maintenance. The word compliance is viewed by some as paternalistic and is therefore being used to a lesser degree. The word maintenance is used more often when describing health behaviors such as exercise and weight loss. The amount of time used to define adherence, compliance, or maintenance varies from a single time point to greater than 2 years. The purpose of this paper is to examine the concept of adherence in relation to weight management in the adult population. In the literature, one finds the term maintenance used to describe the ability to remain at a targeted weight (e.g., one’s ability to maintain weight loss) and the term adherence to describe the behaviors employed to lose weight (e.g., adhering to a low-calorie diet). The concept of adherence in relation to weight management will be analyzed using Walker and Avant’s (1995) framework for concept analysis.

Antecedents Related to Adherence to Health-Promoting Behaviors

A pattern of antecedents related to an adult’s ability to adhere to health-promoting behaviors was found in the literature. Antecedents are events or incidences that must take place prior to the occurrence of the concept (Walker & Avant, 1995). Samaras, Campbell, and Chisholm (1998) summarized many of these antecedents in the following statement: “Understanding the complex nature of non- adherence involves tackling issues such as motivation and self- esteem, ability to use available resources, physical barriers, and socioeconomic restrictions” (p. 195). These issues are consistently referred to in the literature as motivation, self-efficacy, access, environment, and socioeconomic status. Giannetti (2005) identified the following as key factors that predispose patients to nonadherence to therapeutic regimens: complex dosing regimens, sensory anomalies, age, lack of social support, lack of knowledge, psychiatric diagnosis, and financial problems. Lopez, Burrowes, Gizis, and Brommage (2007) found knowledge, socioeconomic status, and family support to be important factors influencing dietary adherence to a renal diet. Boyette et al. (2002) explored exercise behavior in adults over the age of 60 years through an extensive review of the literature. They narrowed their findings down to nine antecedents that they identified as incentives and/or obstacles to exercise initiation and adherence: age, gender, ethnicity, occupation, educational level, socioeconomic status, smoking status, and past exercise participation. The research studies and literature summaries focused on adherence to diet, exercise, and medication regimens for chronic diseases such as diabetes and hypertension. For the purpose of this concept analysis, antecedents that focus on adherence to a health-promoting behaviors are reviewed. Table 1 depicts antecedents with a brief description of each. These antecedents are consistently addressed in the literature when describing adherence to health-promoting behaviors.

Critical Attributes to Adhering to or Maintaining Long-Term Weight Management

Obesity in the United States is a public health epidemic and is the second leading cause of death from modifiable risk factors, after tobacco use (Mokdad, Marks, Stroup, & Gerberding, 2004). Between 1980 and 2002, the prevalence in obesity doubled in adults and tripled in children (Flegal, Carroll, Ogden, & Johnson, 2002; Flegal, Graubard, Williamson, & Gail, 2005). The most current estimate of overweight and obesity calculated from the National Health and Nutrition Examination Survey found that the prevalence of overweight among children and adolescents and obesity among men increased significantly from 1999 to 2004. For women, there was no overall increase in the prevalence of obesity; however, when the data for women are analyzed by racial /ethnic group, there is a steady increase in the prevalence of overweight and obese seen with non-Hispanic Black women, and for Mexican American women (Ogden et al., 2006). To date, many interventions have been successful in producing short-term improvements in diet, physical activity, and weight, but few, if any, have been found to produce long-term behavioral change (Hill, Peters, & Wyatt, 2007). Research has placed greater emphasis on initiating and obtaining weight loss even though only an estimated 21% of obese/overweight persons are successful at achieving long-term weight loss (Ayyad & Andersen, 2000; Wing & Hill, 2001). “Maintenance is a critical stage, and much less is known about interventions to sustain change over time until it becomes an integral part of a lifestyle” (Pullen & Noble Walker, 2002, p. 176). Fortunately, a group of researchers recognized this problem and, as a result, developed the National Weight Control Registry (NWCR) as a way to study weight loss maintenance. The NWCR is the largest database with the most detailed information on successful adult weight maintainers. The NWCR was founded in 1994 by Drs. James Hill and Rena Wing as a way to investigate the behaviors and characteristics of individuals who have been successful at achieving long-term weight loss (Wing & Phelan, 2005). To be eligible, individuals must be 18 years old or older, have lost at least 13.6 kg (30 lbs), and have maintained their weight loss for at least 1 year. Recruitment was done through public service announcements and local and national media. Registration was by telephone and informed consent and questionnaires were completed through the mail. A healthcare provider’s documentation of the weight loss was obtained when possible. The database currently contains over 4,000 subjects. The average age is 46.8 years, 77% are women, and 95% are Caucasian (factors contributing to the disproportionate recruitment of Caucasian women is unknown; however, it is discussed as a study limitation by the researchers). The average reported weight loss is 33 kg (-73 lbs), and the average duration of weight loss maintenance is 5.7 years (Wing & Phelan). Since the start of the program, the data have consistently demonstrated the following critical attributes for successful weight loss maintenance: (a) eating a low-fat, low-calorie diet; (b) frequent monitoring of weight of at least once a week; and (c) 1 hr of moderate-intensity physical activity per day. In addition, most registry members reported eating 4.7 meals or snacks a day and 78% reported eating breakfast daily (Wyatt et al., 2002; Wing & Gorin, 2003; Wing & Phelan). Consequences and Empirical Referents

Consequences “are those events or incidents that occur as a result of the occurrence of the concept” (Walker & Avant, 1995, p. 46). The consequences that result from adhering to or maintaining a targeted weight loss are numerous. Even small weight losses can reduce obesity-associated risk factors for chronic diseases such as diabetes, hyperlipidemia, and hypertension (Greenwood, 2007; McInnis, 2003; Serdula, Khan, & Dietz, 2003). An additional benefit to weight loss is a reduction in joint pain associated with osteoarthritis (McInnis). Over 90% of subjects sampled from the NWCR reported improvements in their overall qualify of life, energy level, mobility, general mood, and self-confidence (Wing & Hill, 2001; Wing & Phelan, 2005).

The empirical referents of a concept are classes or categories of actual phenomena that by their existence demonstrate the occurrence of the concept (Walker & Avant, 1995). Adherence to a targeted weight loss is simply demonstrated by one measure: weight. Examples of secondary empirical referents would be normal hemoglobin A1c, blood pressure of

The following two cases provide examples of adherence and non- adherence in relation to weight management:

Model Case

Ms. A. is a 46-year-old woman who has lost weight several times in the past. Her first attempt was when she was 26 years old. Each time she was successful only to regain her weight within a year. She decided to try again, but this time she knew things were different. She felt more confident from what she had learned in the past. She was successful and happy in her job and was now working for a company that allowed her to take time off for health-promoting activities. She is dating someone who is overweight and also determined to lose weight. She also has more knowledge about the health benefits of weight loss and is seeing a nurse practitioner who has developed a multidisciplinary plan of care for her that includes frequent follow-up visits to monitor her weight loss. She has set realistic goals that include a low-fat, low-calorie diet, eating at least three regular meals a day, and daily exercise. She weighs herself every day and keeps a log of her progress. Her boyfriend participates in the same plan and whenever possible they eat and exercise together. After 6 months, she has lost 30 kg. She continues to watch her fat and calorie intake. She also continues to exercise and weighs herself daily. Five years later, she has continued to maintain her 30-kg weight loss with less effort. Her boyfriend, now husband, also maintains his weight loss. Despite family histories of diabetes and cardiac disease, they both have a normal blood pressure, normal blood sugar, and normal cholesterol and report a marked improvement in their quality of life.

Contrary Case

Ms. B. is a 21-year-old woman who tried to lose weight once before but was unsuccessful. She is 30 kg overweight and desperately wants to lose weight so she can look like the models in the magazines. She has decided to try again but is not very confident. Her job is very stressful and she works a lot of overtime hours and is given very little time off. Because she does not own a car and has to take public transportation to go to the grocery store, she finds herself frequently going to fast-food restaurants in her neighborhood because they are more accessible. She is dating someone who expresses that he likes women who have “meat on their bones” and he does little to encourage her. She only seeks medical care once a year for her gynecological exam or if she has an occasional respiratory infection. At these visits, a weight loss plan is never discussed. She decided if she stopped eating breakfast and lunch and ate only dinner she could lose weight. She also decided to go on a 2- week “cleansing” diet that prescribed eating only cabbage soup. She avoids weighing herself every day because she is afraid of being disappointed. She weighs herself once every few weeks. She lives in the city and rarely exercises because she does not feel safe to exercise in her neighborhood and she is not able to afford the cost of a health club membership. After 2 months, she lost 30 kg. She feels great; however, her boyfriend keeps telling her she is too skinny. She is tired of eating only one meal a day and has begun to slowly increase her intake to three meals a day. Three months later, she regained the 30 kg. She feels very discouraged and reports having a poor quality of life. At her annual gynecology appointment, she is found to have an elevated blood pressure, blood sugar, and cholesterol. She is not surprised about these findings because her whole family developed these health problems at an early age. She started treatment with a blood pressure medicine, an oral glycemic agent, and a cholesterol-lowering agent. Her medical visits have increased to every 3 months for blood pressure checks and blood glucose and cholesterol monitoring. After 5 years she remains obese. Her blood pressure, diabetes, and hyperlipidemia are in fair control after multiple changes in her medication regimens. She is thankful that her job has good health insurance with a prescription plan because her medications cost over $500 a month. She states that she is not dating anyone because her job and medical visits take up all of her free time.

Conclusion

The concept of adherence is complex. With only an estimated 21% of obese/overweight persons being successful at achieving long-term weight loss, clearly more research is needed in this area. Antecedents associated with adherence (self-efficacy, outcome expectation, perceived value, prior relapse, time, social support, knowledge, socioeconomic status, perception of harm or adverse effect, active participation, provider influence, mental status, motivation, and perceived goal attainability) are important to consider when conducting research and developing clinical strategies aimed at maintaining weight loss and long-term weight management.

Acknowledgment. The author would like to acknowledge Dr. Karen Elberson for her editorial assistance.

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Laura E. Shay, PhD(c), RN

Laura E. Shay, PhD(c), RN, is a PhD student in nursing

at the Uniformed Services University, Bethesda, MD.

Author contact: [email protected], with a copy to the Editor: [email protected]

Copyright Nursecom, Inc. Jan-Mar 2008

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

CHICAGO and PHOENIX, Feb. 27 /PRNewswire-FirstCall/ — Allscripts, the leading provider of clinical software, connectivity and information solutions that physicians use to improve healthcare, announced today that Banner Health will implement the Allscripts Care Management discharge planning solution at six Phoenix-area and two Colorado hospitals to streamline patient movement through the hospital and enhance patient care following discharge. The Allscripts solution will help Banner send more patients to a “care alliance” of select post-acute facilities that meet Banner’s stringent quality requirements.

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Banner Health is one of the largest non-profit care systems in the country, with 20 hospitals and other facilities in seven Western states that offer an array of services including hospital care, home care and hospice care, nursing registries, surgery centers, laboratories and rehabilitation. Allscripts will automate Banner’s formerly paper-based process of discharging hospital patients to post-acute care facilities, eliminating information bottlenecks and helping to ensure continuity of care at the highest quality facilities.

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“As our population continues to age, leading hospitals are focusing on creating a seamless transition to the long-term care facilities that provide the next level of care for so many patients,” said Glen Tullman, Chief Executive Officer of Allscripts. “Every time a case manager or discharge planner picks up the phone or waits by a fax machine, it erodes the quality of care patients receive and costs hospitals time and money. Allscripts is helping Banner Health solve these problems by providing connectivity with critical post-acute facilities.”

Allscripts discharge planning is a key element of the company’s industry-defining Care Management solution, which is deployed in more than 600 hospitals nationwide. Allscripts Care Management combines the best features from the company’s Canopy(R) care management software with technology from Extended Care Information Network, Inc. (ECIN), which Allscripts recently acquired. The web-based “software as a service” solution automates and streamlines the entire care management process in hospitals, from admission through discharge, resulting in increased productivity, improved patient throughput and better outcomes.

The Banner facilities that will deploy the Allscripts solution include Banner Gateway Medical Center, Banner Baywood Medical Center, Banner Desert Medical Center, Banner Good Samaritan Medical Center, Banner Estrella Medical Center, and Banner Thunderbird Medical Center, all in the Phoenix area; and Banner’s Colorado facilities McKee Medical Center and Northern Colorado Medical Center.

About Banner Health

From Alaska to Arizona, Banner Health’s dedicated medical professionals are fulfilling their mission of providing excellent patient care to thousands of people in need through hospital care, home care, hospice care, long-term care, nursing registries, surgery centers, laboratories and rehabilitation services. Based in Phoenix, Ariz., Banner Health is one of the largest, nonprofit health care systems in the country, with 20 facilities, more than 3,000 licensed acute care beds, nearly 200,000 annual admissions, and more than 500,000 annual emergency department visits. On the Web at http://www.bannerhealth.com/.

About Allscripts

Allscripts is the leading provider of clinical software, connectivity and information solutions that physicians use to improve healthcare. The company’s unique solutions inform, connect and transform healthcare, delivering improved care at lower cost. More than 40,000 physicians and thousands of other healthcare professionals in clinics and hospitals nationwide utilize Allscripts to automate and connect everyday tasks such as writing prescriptions, documenting patient care, managing billing and scheduling, and safely discharging patients. To learn more, visit Allscripts at http://www.allscripts.com/.

This announcement may contain forward-looking statements about Allscripts Healthcare Solutions that involve risks and uncertainties. These statements are developed by combining currently available information with Allscripts beliefs and assumptions. Forward-looking statements do not guarantee future performance. Because Allscripts cannot predict all of the risks and uncertainties that may affect it, or control the ones it does predict, Allscripts’ actual results may be materially different from the results expressed in its forward-looking statements. For a more complete discussion of the risks, uncertainties and assumptions that may affect Allscripts, see the Company’s 2006 Annual Report on Form 10-K, available through the Web site maintained by the Securities and Exchange Commission at http://www.sec.gov/.

Photo: http://www.newscom.com/cgi-bin/prnh/20061005/ALLSCRIPTSLOGO-bAP Archive: http://photoarchive.ap.org/PRN Photo Desk, [email protected]

Allscripts

CONTACT: Dan Michelson, Chief Marketing Officer, +1-312-506-1217,[email protected], or Todd Stein, Senior Manager|Public Relations,+1-312-506-1216, [email protected], both of Allscripts

Web site: http://www.allscripts.com/http://www.bannerhealth.com/

NASHVILLE, Tenn., Feb. 26 /PRNewswire/ — Kristalose(R), a prescription laxative product that treats acute and chronic constipation, may be an effective option for physicians and pharmacists looking for a prescription alternative to MiraLAX(R) and generic PEG 3350 products. Marketed in the U.S. by Cumberland Pharmaceuticals, Kristalose(R) is now the only prescription- strength laxative available in a convenient powder packet.

(Photo: http://www.newscom.com/cgi-bin/prnh/20080226/CLTU122 )

Previously available by prescription, MiraLAX(R) (polyethylene glycol 3350 or PEG 3350) became an over-the-counter (OTC) treatment for occasional constipation in early 2007. Due to U.S. Food and Drug Administration policy which does not allow the same formulation of a product to be marketed simultaneously as both a prescription and OTC drug, generic PEG 3350 products are now also becoming unavailable by prescription.(1) These generic products will not be available on the OTC market for at least three years following the MiraLAX(R) introduction due to marketing exclusivity granted by the FDA.

Physicians wrote more than 9 million prescriptions for MiraLAX(R) and generic PEG 3350 products in 2006 for treatment of constipation. As the PEG 3350 products are becoming unavailable by prescription, Cumberland believes Kristalose(R) offers a safe, effective alternative for physicians looking to retain prescriptive control for their patients.

Kristalose(R) (lactulose) for Oral Solution is a proprietary prescription laxative and the brand name for a unique crystalline form of lactulose that treats acute and chronic constipation. Available in pre-dosed packets, the drug dissolves quickly in four ounces of water, offering patients a virtually tasteless and grit-free alternative to other liquid lactulose treatments. There are no age limitations or length of use restrictions for Kristalose(R), and it is the only osmotic prescription laxative still sampled to physicians.

“Kristalose(R) has a long history of providing safe and effective relief to sufferers of acute and chronic constipation with few side effects,” said A.J. Kazimi, CEO of Cumberland Pharmaceuticals. “We look forward to communicating the unique features of this drug to the medical community and ultimately to patients who may benefit from it.”

Cumberland Pharmaceuticals Inc. is a Tennessee-based specialty pharmaceutical company that develops and markets niche pharmaceutical products for specific physician segments including critical care, emergency medicine and gastroenterology. Cumberland is dedicated to providing high-quality products which fill unmet medical needs. For more information, please visit the Cumberland Pharmaceuticals website at http://www.cumberlandpharma.com/ or http://www.kristalose.com/.

To the extent any statements made in this release contain information that is not historical, these statements are essentially forward-looking and actual results or events may differ from Cumberland’s expectations. Results may differ depending upon, among other things, the impact of actions by regulatory authorities on the marketing and distribution of products that compete with Kristalose(R). These statements speak only as of the date of this press release, and Cumberland undertakes no obligation to update or revise the statements.

Kristalose(R) is indicated for the treatment of acute and chronic constipation. It is a unique, proprietary, crystalline form of lactulose, with no restrictions on length of therapy or patient age. Initial dosing may produce flatulence and intestinal cramps, which are usually transient. Excessive dosage can lead to diarrhea with potential complications such as loss of fluids, hypokalemia and hypernatremia. Nausea and vomiting have been reported. Use with caution in diabetics. Kristalose(R) is contraindicated in patients who require a low-galactose diet. Elderly, debilitated patients who receive lactulose for more than six months should have serum electrolytes (potassium, chloride, carbon dioxide) measured periodically.

   References    (1)  Food and Drug Administration 21 CFR Part 310. Drug Approvals:        circumstances under which an active ingredient may be simultaneously        marketed in both a prescription product and an over-the-counter drug        product. Federal Register. Sept. 2005; 70(169) 52050-51. While the        FDA's interpretation does not have the force of law and is subject to        change at any time, it is the current interpretation of the FDA upon        which Cumberland believes it can rely.  

Photo: NewsCom: http://www.newscom.com/cgi-bin/prnh/20080226/CLTU122AP Archive: http://photoarchive.ap.org/AP PhotoExpress Network: PRN14PRN Photo Desk, [email protected]

Cumberland Pharmaceuticals Inc.

CONTACT: Rebecca Kirkham of Cumberland Pharmaceuticals Inc.,+1-615-297-7766

Web site: http://www.cumberlandpharma.com/http://www.kristalose.com/

Aetna (NYSE:AET) announced today that it has launched a new secure provider website with NaviMedix, a leading innovator in automating health care provider communications. Through NaviNet, NaviMedix’s multi-sponsor health care communication platform, health care providers have easy, one-stop access to most major payers and select regional carriers, improved security options and improved electronic administrative transaction capabilities.

“Building on Aetna’s solid foundation and investment in timely, easy-to-use, meaningful communications for providers, we are taking the next step by transitioning our secure provider website to NaviNet. Through the new platform, Aetna will be able to provide physicians, hospitals, other health care providers and their staffs with new and increasingly efficient electronic options to transact business and receive information,” said Paul Marchetti, head of National Networks and Contracting Services, Aetna.

Now located on the NaviNet portal available at https://navinet.navimedix.com, Aetna’s secure provider website via NaviNet offers many easy-to-use features to both participating and nonparticipating physicians, hospitals and other health care professionals.

Free real-time transactions are available with Aetna as well as other payers including major health plans and the Medicare program.

Enhanced administrative options provide one-stop service. Only one user name and password is needed to interact with Aetna or other health plans.

Improved functionality provides customized transactions with more detail and easier navigation. Health care providers can check eligibility and benefits in real time, submit or inquire about claims, review claim payment policies, view and print explanation of payments online within 24 hours of claims processing, obtain electronic remittance advices, access Aetna’s education site and conduct many other activities.

Easy-to-use support tools help providers use the site and manage transactions.

With increased, HIPAA-compliant security options, providers can also define access within Aetna’s secure provider website for different users. For example, health care providers can give staff responsible for appointments and check-in access to eligibility information only, while accounting staff may have additional access to claim and payment information. Convenient access to important messages from Aetna can also be customized according to users’ roles.

“Building its secure provider communications on NaviNet is one way Aetna is moving aggressively to assist providers and members in navigating the health care system and their options,” said Tim Hargarten, president and chief executive officer of NaviMedix. “Our platform is extremely attractive to providers as a much more efficient way to engage patients and to help providers more efficiently and easily manage consumer-directed products and health care consumerism.”

“The new website is more streamlined and user-friendly. I am delighted that we can access our payment information online and request claim reconsiderations. The precertification code tool is extremely valuable. I am impressed by the amount of online information from Aetna,” says Donna Putnam, billing/collection supervisor for Medical Oncology, LLC, in Baton Rouge, LA.

NaviNet will serve as the foundation for Aetna’s future secure provider communications strategies, including additional interactive and clinical features. Aetna continues to support health care provider offices as they convert to NaviNet from Aetna’s existing secure provider website, which will retire in spring 2008.

For more information about Aetna’s provider website via NaviNet, or to enroll, providers may visit www.aboutnavinet.com/aetna.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 36.7 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans and expatriates. www.aetna.com

About NaviMedix

NaviMedix is the industry leader in healthcare provider communications, with a national network of over 350,000 subscribed providers using its solutions and services. NaviNet®, the company’s sophisticated Web-based communications solution, allows providers to interact with the country’s leading health plans, including four of the six largest payers, and other sponsoring healthcare service organizations. NaviNet enables sponsors to reach into a national network of providers who tap into the solution frequently for medical and business interactions. NaviMedix solutions deliver relevant information from multiple sources into the provider office to support clinical, administrative and financial decision-making and drive more effective physician engagement. For more information, please visit www.navimedix.com or call us at 617-715-6000 or 800-805-7569.

Supervalu Pharmacies, owned and operated by grocery retailer Supervalu, has announced the companywide deployment of ARx, a pharmacy management system.

According to Supervalu, designed, developed, and tested by Supervalu pharmacists and technicians, ARx streamlines pharmacy workflow and operations. ARx introduces new technologies such as prescription label imaging and thermal printing. The application also features process enhancements which include a fully integrated electronic prescribing, or e-prescribing, module which provides a safer, more efficient method for prescription delivery, the company said.

Chris Dimos, president of Supervalu Pharmacies, said: “Supervalu Pharmacies is committed to the concept of empowering our pharmacy teams to provide convenient, personalized pharmacy care. By equipping our pharmacies with the innovative technologies included in ARx, we are providing our pharmacists with greater opportunity to apply their expertise as medication experts and develop creative solutions to common health conditions.”

The Children’s Cancer Hospital Foundation 57357 (CCHF) in Egypt announced today that it has selected Cerner Corporation (NASDAQ:CERN) as the healthcare information technology (HIT) provider for Children’s Cancer Hospital Egypt 57357. The hospital will use multiple Cerner Millennium® solutions to help clinicians provide state-of-the-art care for an estimated 1,500 pediatric cancer patients each year. This implementation is part of Cerner’s growing worldwide business, which now includes clients on five continents and a global presence in more than 20 countries.

“Children’s Cancer Hospital Egypt 57357 is focused on meeting the unique needs of each child and leveraging medical findings to help children in the whole community,” said Dr. Sherif Abouelnaga, Children’s Cancer Hospital Egypt 57357 Professor of pediatric oncology and VP of Academic Affairs, Research and Outreach. “We have partnered with Cerner to implement technology that will help us ensure safety and reliability in the delicate process of caring for pediatric cancer patients.”

CCHF was founded with a mission to care for pediatric cancer patients free of charge regardless of race, creed or financial status. The Foundation, which is funded by donations from the people of Egypt and philanthropists from around the globe, began building the region’s first pediatric oncology hospital in one of Cairo’s oldest suburbs in 2001. The hospital opened select areas in July 2007, treating more than 500 patients in its first four months of operation. A full grand opening is scheduled for the end of 2008/early 2009.

When complete, Children’s Cancer Hospital Egypt 57357 will use a complementary suite of Cerner Millennium solutions to create a unified, patient-centric health record throughout the various hospital venues. Hospital administrators said they chose Cerner because they believe Cerner is best positioned to help them achieve their mission of delivering the highest-quality care possible to children. The solutions will be used to automate nursing communication, intensive care unit operations, clinician documentation, image management, pharmacy and laboratory operations, medication administration processes, patient accounting and surgery operations. Children’s Cancer Hospital Egypt 57357 will also use Cerner Knowledge solutions to provide clinicians with access to knowledge-based, patient specific information.

“Our relationship with CCHF will help to link the findings from research and education by leveraging evidence-based care to transform clinical practice,” said Amr Mostafa, Cerner Middle East Director. “Cerner has the solutions to help the CCHF create a hospital that utilizes leading-edge technology to provide clinicians with timely and easy access to information that is critical to patient care.”

By selecting Cerner, Children’s Cancer Hospital Egypt 57357 chose a supplier with a proven track record. Cerner has more than 7,500 Cerner Millennium solutions live at more than 1,200 client facilities around the world. Cerner technology helps healthcare organizations — ranging in size from independent physicians to nationwide healthcare organizations — streamline operations and improve the quality of care they deliver to patients.

As part of the Cerner Millennium implementation, the hospital also will implement ElDorado Donor™ software from Global Med Technologies®, Inc. (OTCBB:GLOB), an international e-Health, medical information technology company and parent of Wyndgate Technologies®. ElDorado Donor (510(k) pending, not for sale in the United States) is a comprehensive blood-management software application designed to manage, automate and control activities associated with donors, donor collections, testing, manufacturing, inventory and distribution of blood components in blood banks and donor centers.

About Children’s Cancer Hospital Egypt 57357

Children’s Cancer Hospital Egypt 57357 is a pediatric cancer hospital in the El Sayeda Zeinab district of Cairo, Egypt. The hospital currently houses 179 inpatient beds, a 300-patient outpatient facility, a specialized clinical pharmacy, intensive care and bone marrow transplant units, a comprehensive surgery department and multiple specialty clinics. Hospital 57357 is proud to be the home for several “firsts” in Egypt, including the first specialized department of psychology, social work and psychiatry for pediatric oncology patients; the first child life and school program for hospitalized children; and the first comprehensive physiotherapy department for oncology patients. To learn more about Children’s Cancer Hospital Egypt 57357, visit www.57357.com.

About Cerner

Cerner is taking the paper chart out of healthcare, eliminating error, variance and waste in the care process. With more than 6,000 clients worldwide, Cerner is the leading supplier of healthcare information technology. The following are trademarks of Cerner: Cerner, Cerner’s logo and Cerner Millennium. (NASDAQ:CERN). www.cerner.com.

This release contains forward-looking statements that involve a number of risks and uncertainties. It is important to note that the Company’s performance, and actual results, financial condition or business could differ materially from those expressed in such forward-looking statements. The words “will” and “believe” or the negative of these words, variations thereof or similar expressions are intended to identify such forward-looking statements. Factors that could cause or contribute to such differences include, but are not limited to: the possibility of product-related liabilities; potential claims for system errors and warranties; the possibility of interruption at our data centers or client support facilities; our proprietary technology may be subjected to infringement claims or may be infringed upon; risks associated with our global operations; recruitment and retention of key personnel; risks related to our reliance on third-party suppliers; changing political, economic and regulatory influences; government regulation; and, failure of the parties to achieve the intended benefits. Additional discussion of these and other factors affecting the Company’s business is contained in the Company’s periodic filings with the Securities and Exchange Commission. The Company undertakes no obligation to update forward-looking statements to reflect changed assumptions, the occurrence of unanticipated events or changes in future operating results, financial condition or business over time.

PERRYSBURG, Ohio, Feb. 25 /PRNewswire/ — A groundbreaking, Northwest Ohio program to improve the medical, humanistic and financial elements of diabetes care will receive funding from the National Business Coalition on Health (NBCH). FrontPath Health Coalition, through its non-profit Western Lake Erie Health Quality Initiative of Perrysburg, Ohio, will lead this community-wide effort that includes the City of Toledo, the University of Toledo and a group of Toledo-area pharmacies.

FrontPath was one of 14 business health coalitions nationwide to be awarded a $25,000 diabetes seed grant promoting diabetes care improvement at a community level. The project is funded by Pfizer, Inc. and the Community Coalitions Health Institute (CCHI).

The local, one-year pilot grant will help to fund an enhanced diabetes management program for City of Toledo employees and their families who have been diagnosed with or are currently taking medication for Type II diabetes. Participants will work with one of the designated pharmacies in managing their diabetes over the course of the year. The University of Toledo’s Pharmaceutical Care and Outcomes Research Laboratory in the College of Pharmacy will provide ongoing data collection and final analysis of the program.

Enrollment, limited to 150 City of Toledo employees and their dependents, is underway through February.

“We’re thrilled to have received this funding,” said Susan E. Szymanski, FrontPath CEO. “This program was developed by The Pharmacy Counter, and is modeled after the very successful ‘Asheville Project,’ a pharmacy-coordinated patient self-management program. As a result of this medication therapy management program, the patient becomes more educated, more interested and more empowered to better manage their own health.”

“The University of Toledo is dedicated to improving the human condition,” said Dr. Lloyd Jacobs, president. “By lending our academic expertise to this project, we will be able to maximize the return on investment and help more of our citizenry understand and manage their diabetes.”

Program participants will contact one of the members of the Coalition of Toledo Area Independent Pharmacies, including The Pharmacy Counter, Erie Drug, Glenbyrne Pharmacy, Ryan Pharmacy and Kahler Pharmacy. During visits over the course of the one-year program, participants will meet with clinical pharmacists to raise the level of their awareness and learn about how to best manage their condition by utilizing the local resources available to them.

The Coalition of Toledo Area Independent Pharmacies provides easy access to clinical pharmacists who work and communicate with a patient’s healthcare team, including physicians and specialists. They will create a customized plan to treat each individual’s condition. In addition to collecting clinical data and suggesting lifestyle changes, pharmacists will teach patients how and when to use their medications and how those medications work to control their condition.

To measure the impact of the program on patients’ health, several analytical procedures will be used. Dr. Sharrel Pinto, assistant professor and director of the University of Toledo research laboratory, will head the team conducting the analysis using a variety of statistical tests and measures. The goal of Dr. Pinto’s research team will be to evaluate economic, clinical and quality of life-related outcomes for patients with diabetes, providing insight into improving the delivery and quality of care for patients with such chronic conditions. The research team will include pharmacy undergraduate and graduate students.

“More than one-third of the U.S. adult population has diabetes or is well on their way to getting it,” said Andrew Webber, president and CEO of NBCH. “Diabetes care is expensive and if we can improve the quality of that care, we can reduce the cost to businesses and enrich the quality of life for employees.”

After the pilot program is complete, a similar program will be offered to FrontPath members as a value-added service. FrontPath’s membership currently represents 135,000 covered lives throughout Northwest Ohio.

“Through this local collaboration we hope to empower these patients to better self-manage their diabetes and improve their overall health,” said Szymanski. “And our ultimate goal is to improve the overall health outcomes of diabetics in Toledo and the surrounding communities. We plan to take this message to the community at large, improving diabetes management and quality of life throughout the Western Lake Erie region.”

About FrontPath Health Coalition:

FrontPath Health Coalition, a not-for-profit member-managed corporation, works with employers, unions, municipalities and public entities to provide members direct access to a broad network of health care providers. FrontPath also partners with these healthcare providers to improve the quality of healthcare delivered throughout the Western Lake Erie region. The Perrysburg, Ohio-based organization was established by eight Fortune 500 employers in 1988 as the Western Lake Erie Employers’ Coalition.

About the National Business Coalition on Health:

The NBCH is a national, non-profit membership organization of nearly 60 business and health coalitions representing over 7,000 employers and 34 million employees and their dependents across the United States. Visit nbch.org for additional information.

FrontPath Health Coalition

CONTACT: Julie Pompa, APR, +1-419-887-6827, [email protected], forFrontPath Health Coalition

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

CHICAGO, Feb. 25 /PRNewswire/ — Dr. Steve Stryker gastrointestinal surgeon and founder of Digestique has appointed Empower Public Relations to help spread the message about diagnosing and treating digestive diseases in women. The board certified physician is currently a Professor of Clinical Surgery at Northwestern University Feinberg School of Medicine and is widely recognized for his expert diagnosis of often ignored gastric symptoms.

Located at 680 N. Lake Shore, Digestique offers an array of services ranging from comprehensive evaluations to more focused investigations.

CEO of Empower PR Sam Chapman states, “Dr. Steve Stryker is devoted to helping women of all ages improve their quality of life. He is a renowned doctor in the city of Chicago and it is an honor to represent him.”

ABOUT DR. STEVEN STRYKER:

Dr. Stryker has devoted his entire career, spanning more than two decades, to the diagnosis and treatment of gastrointestinal disorders. His medical degree is from Northwestern University and his surgical internship and residency were undertaken at Northwestern Memorial Hospital in Chicago. Dr. Stryker is currently Professor of Clinical Surgery at Northwestern University Feinberg School of Medicine. He is board certified by both the American Board of Surgery and the American Board of Colon and Rectal Surgery. Dr. Stryker is widely recognized as an expert in the treatment of gastrointestinal diseases and has extensively published on these subjects. He has just recently opened the Digestique clinic, exclusively for the diagnosis and management of chronic digestive disorders in women.

ABOUT EMPOWER PUBLIC RELATIONS:

Empower Public Relations is one of Chicago’s most accomplished PR firms, with a focus on television appearances. Empower has clients in a variety of industries, ranging from the nation’s leading sex therapist, Space Command’s “Stress Doctor,” and ultra-premium liquor brands. Clients have appeared on the nation’s largest television outlets, including Good Morning America, 20/20, The Today Show, NBC Nightly News, and The Oprah Winfrey Show. Empower Public Relations CEO Sam Chapman has been featured in several media outlets such as Good Morning America, BBC Radio News, Fox & Friends, Eye on Chicago, BusinessWeek, Advertising Age, and the CNNMoney website. For more information, please visit http://www.empowerpr.com/.

Empower Public Relations

CONTACT: Lina Khalil of Empower Public Relations, +1-312-255-4017,[email protected]

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

Company News On-Call: http://www.prnewswire.com/comp/133897.html

Text of report by Sri Lankan newspaper Daily Mirror website on 23 February

Researchers at the Bandaranaike Memorial Ayurvedic Research Institute (BMARI) in Nawinna [west Sri Lanka] have developed an Ayurvedic [traditional medicine system] formula to further the life span of AIDS patients and lessen their sufferings, Indigenous Medicine Minister Tissa Karalliyadda claimed yesterday.

Senior BMARI Research Officer Dr Pushpa Wickramasingha said research conducted at the BMARI so far had proved that the sufferings of AIDS patients could be lessened by indigenous medicine. Experimental treatment carried out on five HIV-positive patients have brought positive results, she claimed.

The BMARI has also found a therapy to cure vitiligo (sudu kabara) using Ayurvedic medicine and a method of treatment, she said. There are 200,000 Vitiligo patients in the country and the Nawinna Ayurvedic Research Institute has developed an effective indigenous medicine to cure Vitiligo, minister Karalliyadda said, addressing journalists at the Government Information Department. He said experiments conducted by the BMARI since 1969 had established that Vitiligo could be cured using traditional prescriptions.

“There are hundreds of Vitiligo patients who have been fully cured through Ayurvedic treatment, which involves the use of medicinal oil and essence of leaves. There is a stigma attached to this skin disease. Hence, those who got fully cured are reluctant to say that they once had this disease. They even send a third party to the Ayurvedic hospitals to obtain their drugs,” minister Karaliyadda said.

Dr Pushpa Wickramasingha explaining the method of treatment said oil “bakuchi” prepared by the BMARI is the main drug used in treatment of Vitiligo patients. This oil is applied on the white patches of the patient’s body and exposed to sunlight for about one hour from 7 to 8 a.m. In addition, one teaspoonful of Manibadra powder is administered orally along with water boiled with Nelli and Rasakinda. When treated in this manner for a few weeks the white patches of the skin begin to disappear and after a few months of continuous treatment the disease would completely disappear.

“The main cause for Vitiligo is food contaminated with pesticide and fast foods. The use of excessive antibiotics, mouse and snake bites, the damage of skin by chemicals, cosmetics and hair die and paints could be the cause for Vitiligo. However, this skin disease is not life threatening. The research has also established that Vitiligo can be hereditary,” she said.

Indigenous Medicine Ministry Adviser Dr Jayasiri Mendis also addressed the media.

Originally published by Daily Mirror website, Colombo, in English 23 Feb 08.

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

SAN JOSE, Calif., Feb. 23 /PRNewswire-FirstCall/ — VNUS(R) Medical Technologies, Inc. , a worldwide leader in medical devices for the minimally invasive treatment of venous reflux disease, today presented positive clinical performance data for the VNUS ClosureFAST(TM) catheter at the 20th annual meeting of the American Venous Forum in Charleston, South Carolina. An international panel of distinguished physicians presented clinical trial results and perspectives affirming the efficacy and patient comfort levels of endovenous radiofrequency (RF) vein ablation using VNUS ClosureFAST. The ClosureFAST catheter, in a procedure often performed in the physician’s office, heats and seals the diseased leg veins that cause the varicose veins afflicting more than 25 million Americans.

Prof. Dr. Thomas M. Proebstle of Heidelberg, Germany presented one-year followup data from a prospective, multi-center study of the efficacy of the ClosureFAST catheter. Raymond G. Makhoul, M.D., of Richmond, Virginia presented results from the RECOVERY trial, a single-blinded, randomized trial comparing the ClosureFAST catheter with endovenous laser ablation in 62 limbs.

“Our study found the ratio of efficacy to side effects of the VNUS ClosureFAST catheter to be superior to any previous endovenous ablation device,” said Dr. Proebstle. “In 223 cases where the ClosureFAST device was used, 96.7% of the veins remained sealed after one year using Kaplan-Meier analysis. Of my patients, only one in five experienced postoperative pain due to study treatment. The excellent clinical outcome, the speed of treatment and the very low rate of side effects are certainly contributing to the enthusiastic embrace of this new device by the physician community.”

“Our RECOVERY trial data makes it clear that radiofrequency vein ablation with the ClosureFAST device is superior to laser ablation in terms of patient comfort and satisfaction,” said Dr. Makhoul. “27% of the ClosureFAST patients reported that the procedure itself was completely pain-free, compared with just 3% of the laser patients, and the need for postoperative analgesics was lower with ClosureFAST patients than with laser patients. We believe that the increased patient satisfaction with ClosureFAST is serving as a strong incentive for vascular physicians to transition to the ClosureFAST catheter from previous devices.”

“The ClosureFAST device has significantly improved endothermal ablation with a smooth, deliberate, controlled and much swifter technique,” said Robert F. Merchant, M.D., of Reno, Nevada, who has been performing RF vein ablation since 1999. “With some simple but elegant modifications to the technique — proper positioning of the catheter away from the deep vein system, elevation of the leg — we’ve been able to produce an even lower rate of complications and make the procedure even easier for the physician.”

“Endovenous ablation of the great saphenous vein has revolutionized the way that we care for the venous patient,” said Thomas F. O’Donnell Jr., M.D., of Boston, Massachusetts, who moderated the physicians’ panel. “In our own practice I have seen confirmation of the results from Dr. Proebstle’s multi- center ClosureFAST trial that this newer generation catheter is faster and easier to use. And the evidence-based results from the randomized, prospectively controlled trial by Dr. Makhoul and his colleagues confirms anecdotal experience that the RF catheter appears to be kinder and gentler without sacrificing effective durable closure rates.”

“We believe the findings presented by the physicians paint a compelling picture of the VNUS ClosureFAST catheter as the new treatment of choice for patients who suffer from the pain, swelling and discomfort of varicose veins,” said Brian E. Farley, President and CEO of VNUS. “The documented efficacy of the device and the overwhelmingly positive responses of physicians and patients regarding its ease of use, comfort and mild recovery are driving the rapid adoption of the ClosureFAST catheter, resulting in substantial benefits to varicose vein patients in over 40 countries.”

ABOUT VNUS MEDICAL TECHNOLOGIES, INC.

Founded in 1995 and headquartered in San Jose, California, VNUS Medical Technologies is a worldwide leader in medical devices for the minimally invasive treatment of venous reflux disease, a progressive condition that causes the varicose veins afflicting 25 million Americans. The pioneering company in the field, VNUS now offers the ClosureFAST system, which consists of a proprietary radiofrequency (RF) generator and proprietary disposable endovenous catheters and devices to close diseased veins through the application of temperature-controlled RF energy. VNUS devices have been used in more than 200,000 procedures worldwide. For more information, please visit http://www.vnus.com/.

FORWARD-LOOKING STATEMENTS

In addition to statements of historical facts or statements of current conditions, VNUS has made forward-looking statements in this press release. Words such as “thinks” or “believes” or variations of such words and similar expressions, are intended to identify such forward-looking statements in this press release. Actual results may differ materially from current expectations based on a number of factors affecting VNUS’ business, including, among other things, market acceptance of the ClosureFAST catheter, customer and physician preferences, and the experience of other physicians with our products. The reader is cautioned not to unduly rely on these forward-looking statements. VNUS expressly disclaims any intent or obligation to update these forward- looking statements except as required by law. Additional information concerning these and other risk factors can be found in press releases issued by VNUS and VNUS’ periodic public filings with the Securities and Exchange Commission (SEC), including its Annual Report on Form 10-K filed with the SEC on March 30, 2007. Copies of VNUS’ press releases and additional information about VNUS are available on the corporate website at http://www.vnus.com/.

VNUS Medical Technologies, Inc.

CONTACT: Jon Kitahara, Director, Marketing Programs, +1-408-360-7220,[email protected]

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

ORLANDO, Fla., Feb. 22 /PRNewswire/ — (HIMSS08) — Dr. Neil Martin, Founder/CEO of Global Care Quest and Chief of Neurosurgery at UCLA Medical Center and will deliver a presentation at HIMSS08 on a new wireless mobile technology solution that allows physicians to view CT and MRI images and scans from remote locations. This solution, ICIS Mobile, transmits images over high speed wireless networks to a physician’s cell phone or PDA.

(Logo: http://www.newscom.com/cgi-bin/prnh/20080222/LAF019LOGO)

According to Dr. Martin, “The first three hours following the onset of a critical health episode like a stroke are critical. If care is delayed beyond this critical time window, the chance of recovery or even survival declines substantially.”

Dr. Martin will present how new wireless technology has proven especially effective in addressing this limited time window by allowing rapid transmission and viewing of images wherever the physician is located.

“Much of the first hour following the onset of these critical episodes is spent simply getting the patient to the emergency room,” Dr. Martin related. “Then the patient must then be diagnosed, CT and MRI images and scans taken and developed. Finally, a specially trained physician must review the images and make a decision on the appropriate treatment protocol,” he said.

The ICIS Mobile viewer developed by Martin and his colleagues greatly reduces the time required in making the crucial diagnosis. Dr. Martin will explain in detail how this wireless mobile solution sends images to the diagnosing physician who can view the images from his home, another office, or even from his car using a PDA or cell phone and then call or email his diagnosis and treatment instructions to the patient’s location.

“Only recently has wireless networking, imaging technology and handheld devices (such as powerful cell phones) progressed to permit diagnostic quality images to be delivered remotely at an affordable price point,” said Martin.

Once implemented in hospital settings, this technology will greatly benefit many critically ill patients by saving significant amounts of time that is crucial in the initial three hour window. This savings will translate directly to saved lives and improved treatment outcomes.

Dr. Martin’s presentation, Wireless Mobility: Remote PACS Access in Your Pocket” will be delivered at HIMSS08 in Orlando, Florida Wednesday, February 27, 2008 from 8:30 to 9:30 AM, presentation number 128 and is designated as an advanced presentation in the Emerging Technologies category. For more information, go to http://www.globalcarequest.com/.

About UCLA Medical Center

UCLA Medical Center is a nonprofit, self-supporting 668-bed hospital providing patient care in all medical specialties. It is the primary teaching hospital for the David Geffen School of Medicine at UCLA. The Lynda and Stewart Resnick Neuropsychiatric Hospital at UCLA is a separately licensed acute psychiatric hospital providing adults, teens and children with a full continuum of psychiatric care, including inpatient, day hospital and outpatient services. Located in the UCLA Medical Center, Mattel Children’s Hospital UCLA includes a 106-bed inpatient unit and an outpatient pediatric care center that together serve more than 98,000 patients each year. In addition to providing well-child care and immunizations, Mattel Children’s Hospital maintains the country’s leading pediatric organ-transplant program and is renowned for its research into pediatric cancers and epilepsy, as well as the genetics of childhood diseases.

About Global Care Quest

Founded in 2005, Global Care Quest develops and sells the Integrated Clinical Information System (ICIS), which performs real-time integration and delivery of digital medical records, charting, diagnostic imaging, bedside monitoring equipment, and laboratory results to physicians and medical teams to desktops, laptops, and smartphones. ICIS increases clinician effectiveness, enhances patient safety, and lowers patient costs by delivering critical patient information when and where it’s needed.

Photo: NewsCom: http://www.newscom.com/cgi-bin/prnh/20080222/LAF019LOGOAP Archive: http://photoarchive.ap.org/PRN Photo Desk, [email protected]

Global Care Quest

CONTACT: Mr. Alan Portela, Executive Vice President of Global CareQuest, +1-949-330-7450, [email protected]

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

By William F. West, The Herald-Sun, Durham, N.C.

Feb. 22–ROXBORO — Person Memorial Hospital will have a new CEO on April 14.

Jamie Guin Jr. has been hired to replace Craig James, who left in September after six years in the post.

Attempts to reach Guin and hospital trustees chairman Gordon Carver were unsuccessful Thursday.

James left Roxboro to accept positions as vice president of Mountain States Health Alliance and CEO of Dickenson Community Hospital in Clintwood, Va., and Norton (Va.) Community Hospital.

Guin comes to Roxboro from Mountain View Regional Medical Center, also in Norton, Va.

Mountain View is a member of the Wellmont Health System, founded in 1996.

Wellmont, on its Web site, proclaims itself the premier health care provider in southwestern Virginia, southeastern Kentucky and northeastern Tennessee.

Guin has served as Mountain View’s CEO since 2005.

He previously was CEO of Williamson (W.Va.) Memorial Hospital and COO of Davis Regional Medical Center in Statesville.

He earned science and health-related bachelor’s and master’s degrees from the Medical University of South Carolina.

In a statement issued through Person Memorial, Guin said he was attracted to the hospital because of the excellence of services offered to the community, the opportunity to live and work in the community and the hospital’s contract with Duke Management Services.

He is married and has a son.

Person Memorial was dedicated in 1950 and has been in the midst of a $14 million modernization program. The work is expected to be completed by the end of the year.

—–

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

Copyright (c) 2008, The Herald-Sun, Durham, N.C.

Distributed by McClatchy-Tribune Information Services.

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

By Joe Depriest, The Charlotte Observer, N.C.

Feb. 22–Officials at Gaston Memorial Hospital have launched a probe into the stabbings of two employees Wednesday night.

A 15-year-old psychiatric patient has been charged in the incident.

Hospital technician Kelly Maureen Loepp was in fair condition Thursday at Carolinas Medical Center.

“Our staff was shocked at these tragic events,” said hospital spokeswoman Laura Poloniewicz. “The hospital’s senior administrative team is investigating and analyzing everything for a better understanding of what happened and to ensure the safety of employees and visitors. This is the first time anything like this has happened.”

Gastonia authorities said Loepp was making the rounds in patient rooms on the hospital’s seventh-floor psychiatric wing about 8:45 p.m. when the teen stabbed her multiple times in the neck with a pair of scissors.

Authorities said it’s unclear how the patient, who had been involuntarily committed from Monroe, got the scissors.

“During the attack the technician (Loepp) pressed an alarm button and tried to get help,” said Gastonia Police Sgt. Gene Weaver. “The nurse came in and he (suspect) attacked her. After a struggle, he was able to get out of the psychiatric ward to the elevator.”

Registered nurse Rolanda Turner was treated for stab wounds and released.

Weaver said officers with a K-9 unit caught the suspect on Summit Crossing Place on the west side of the hospital a short time later. Hospital officials said the arrest took place about 20 minutes after the attack.

The 15-year-old was taken to the juvenile detention in Dallas. After a mental evaluation, he was charged on Thursday with two counts of assault with a deadly weapon with intent to kill inflicting serious injury, West said.

Poloniewicz said security guards patrol the hospital floors and that each unit has varying levels of security. Surveillance video cameras monitor every floor along with the parking lot and parking deck.

“All normal procedures were in place,” Poloniewicz said. “We’re hoping the investigation will tell us what we have to do different in the future to make sure this doesn’t happen again.”

—–

To see more of The Charlotte Observer, or to subscribe to the newspaper, go to http://www.charlotte.com.

Copyright (c) 2008, The Charlotte Observer, N.C.

Distributed by McClatchy-Tribune Information Services.

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

The American Cancer Society’s annual cancer statistics report finds that death rates from cancer in the United States have decreased by 18.4 percent among men and by 10.5 percent among women since mortality rates began to decline in the early 1990s, which translates to the avoidance of more than half a million actual cancer deaths (534,500) in the United States. Society epidemiologists predict that in the U.S. in 2008 there will be 1,437,180 new cancer cases (745,180 in men and 692,000 in women) and 565,650 cancer deaths (294,120 among men and 271,530 among women).

The findings come from Cancer Statistics 2008, published in the March/April issue of CA: A Cancer Journal for Clinicians, as well as in the 57th edition of its companion publication, Cancer Facts & Figures 2008.

Despite a continuing decline in the cancer death rate from 2004 to 2005, there was an increase of 5,424 actual deaths (559,312 cancer deaths in 2005 compared to 553,888 cancer deaths in 2004). This increase follows a decrease in the number of cancer deaths in the two previous years. The change is largely due to a smaller decline in the cancer death rate between 2004 and 2005 compared with that in the two previous time periods. From 2004 to 2005, overall cancer mortality dropped about 1 percent, compared to a 2 percent drop from both 2002 to 2003 and 2003 to 2004. With respect to the four major cancer sites, colorectal cancer death rates decreased by about 3 percent from 2004 to 2005, compared to about 6 percent from 2003 to 2004. The decrease in death rates for cancers of the lung and bronchus and prostate in men and breast in women was also smaller from 2004 to 2005 than from 2003 to 2004. It is important to understand that for the number of cancer deaths to decrease, the decline in the overall cancer mortality rate must be large enough to offset the increasing numbers due to growth and aging of the population.

“The increase in the number of cancer deaths in 2005 after two years of historic declines should not obscure the fact that cancer death rates continue to drop, reflecting the enormous progress that has been made against cancer during the past 15 years,” said John R. Seffrin, Ph.D., American Cancer Society chief executive officer. “While in 2005 the rate of decline was not enough to overtake other population factors, the fact remains that cancer mortality rates continue to drop, and they’re doing so at a rate fast enough that over a half million deaths from cancer were averted between 1990/1991 and 2004.”

The cancer incidence and mortality data were collected by the Centers for Disease Control, the National Cancer Institute, the North American Association of Central Cancer Registries, state and local health agencies, and thousands of cancer registrars throughout the country. Since 1952, when the first edition of Cancer Facts & Figures consisted of four typewritten pages, the American Cancer Society’s annual estimate of new cancer cases and deaths has become a critical tool for scientists, public health experts, and policymakers in assessing the current burden of cancer. These estimates are some of the most widely quoted cancer statistics in the world. The Society’s leading team of epidemiologic researchers, in collaboration with scientists from the National Center for Health Statistics, compiles and analyzes incidence and mortality data to estimate the number of new cancer cases and deaths for the current year nationwide and in individual states.

Highlights from this year’s publications:

• Among men, cancers of the prostate, lung and bronchus, and colon and rectum account for one in two (50 percent) of all newly diagnosed cancers. Prostate cancer alone accounts for one in four (25 percent) of the total cases in men.
• The three most commonly diagnosed types of cancer among women in 2008 will be cancers of the breast, lung and bronchus, and colon and rectum, accounting for 50 percent of estimated cancer cases in women. Breast cancer alone is expected to account for one in four (26 percent) new cancer cases among women.
• Lung cancer surpassed breast cancer as the leading cause of cancer death in women in 1987. Lung cancer is expected to account for 26 percent of all female cancer deaths in 2008.
• Cancer incidence rates stabilized in men from 1995 to 2004 and in women from 1999 to 2004. Between 2002 and 2004, death rates for all cancer sites combined decreased by 2.6 percent per year in males and by 1.8 percent per year in females.
• Mortality rates have continued to decrease across all four major cancer sites in men and in women except for female lung cancer, in which rates continued to increase by 0.2 percent per year from 1995 to 2004.
• Death rates from all cancers combined peaked in 1990 for men and in 1991 for women. Between 1990/1991 and 2004, death rates from cancer decreased by 18.4 percent among men and by 10.5 percent among women.
• Lung cancer incidence rates are declining in men and appear to be plateauing in women after increasing for many decades.
• Colorectal cancer incidence rates decreased from 1998 through 2004 in both males and in females.
• Female breast cancer incidence rates decreased by 3.5 percent per year from 2001 to 2004, after increasing since 1980. The decreases may reflect the saturation of mammography utilization and reduction in hormone replacement therapy use that followed the publication of study results from the Women’s Health Initiative in 2002.
• Among males under age 40 years, leukemia is the most common fatal cancer, while lung cancer predominates in men aged 40 years and older.
• Among females, leukemia is the leading cause of cancer death before age 20 years, breast cancer ranks first at age 20 to 59 years, and lung cancer ranks first at ages 60 and older.
• African American men have a 19 percent higher incidence rate and 37 percent higher death rate from all cancers combined than white men. African American women have a 6 percent lower incidence rate, but a 17 percent higher death rate than white women for all cancers combined.
• Among other racial and ethnic groups, cancer incidence and death rates are lower than those in whites and African Americans for all cancer sites combined and for the four most common cancer sites.
• Cancer is the second leading cause of death among children between ages one to 14 years in the U.S., after accidents. The five-year relative survival rate among children for all cancer sites combined improved from 58 percent for patients diagnosed in 1975 to 1977 to 80 percent for those diagnosed in 1996 to 2003.

Estimates of the expected numbers of new cancer cases and cancer deaths should be interpreted with caution. These estimates may vary considerably from year to year, particularly for less common cancers and in states with smaller populations. Despite these limitations, the American Cancer Society’s estimates of the number of new cancer cases and deaths in the current year provide reasonably accurate estimates of the burden of new cancer cases and deaths in the United States. Such estimates will assist in continuing efforts to reduce the public health burden of cancer.

Each year, Cancer Facts & Figures features a Special Section highlighting one aspect of cancer prevention, early detection, or treatment. In recent years, the section has focused on tobacco, obesity, infectious causes of cancer, environmental pollutants, and cancer-related pain. The Special Section of Cancer Facts and Figures 2008 is “Insurance and Cost-Related Barriers to Cancer Care.” About 47 million people in the U.S. are uninsured; minority populations and/or those with low income are disproportionately represented in this category. Recognizing that reducing barriers to cancer care is critical in the fight to eliminate suffering and death due to cancer, the American Cancer Society and its sister advocacy organization the American Cancer Society Cancer Action Network (ACS CAN) are working together to bring the need for meaningful healthcare reform to the forefront of public and political debate. One important goal of this campaign is to educate Americans about the extent of the access to care problem and to motivate them to take action in support of change. The Special Section provides an overview of systems of health insurance and describes the impact of being uninsured or underinsured on cancer prevention, diagnosis, treatment, and outcome.

“The progress that has been made in reducing cancer death rates is a direct result of investment in approaches that we know work, such as comprehensive tobacco control and screening for breast, cervical, and colorectal cancers, as well as research that has identified more successful treatments,” said Otis W. Brawley, MD, chief medical officer of the American Cancer Society. “However, we believe that lack of health insurance and inadequate health insurance is one of the most important barriers to continued progress. A growing body of data shows that compared to those with private insurance, those without health insurance are less likely to receive smoking cessation advice and treatment, about half as likely to receive cancer screening, more likely to be diagnosed at late stage, and less likely to survive after a cancer diagnosis. We are committed to addressing this critical issue.”

—

On the Net:

The full report can be viewed at www.cancer.org/statistics.

American Cancer Society

You might think that life begins, well, when you’re born – that’s just logical, isn’t it?

But even though we count our age from the day we arrive, kicking and screaming into the world, it is actually in the womb that we begin to develop our likes and dislikes.

And according to a leading midwife, the taste of avocado and the soothing voice of Cerys Matthews are two of the things unborn babies commonly enjoy.

Although there is no hard scientific research to back up her claims – yet – Helen Rogers, head of the Royal College of Midwives, Wales, says the anecdotal evidence from pregnant women she has cared for over the years is overwhelming.

Time and again they have told her that the voice of the Welsh pop star works like a traditional nanny’s lullaby and that babies seem to turn towards avocado if it is offered to them in the months following birth.

She said, “Babies tend to like melodies, and lots of mums tell me that Cerys has a lovely mother-like female voice that seems to be soothing for babies developing in the womb, during labour and after they are born too.

“If a baby is restless after birth, often a new mum doesn’t quite know what to do with them.

“But if the baby is played music they are already familiar with it seems to calm them down – it really does seem to work.

“It appears that they associate the music with a relaxing time during pregnancy, when their mum would perhaps take a morning or afternoon break and put some music on.

“And this association can last throughout the first year of life.

“Other mums say they play Bach’s cello concertos, because they are mathematical and are supposed to be good for stimulating logic. Mozart is also supposed to help with brain development.

“Books for radio on tape can work too, for example Under Milk Wood by Dylan Thomas.

Mums say there is something about the rhythm of Burton’s voice and the poetry that seems to suit babies.

“Even if they are hearing it in a muffled way, they can pick up the vibrations. And the important thing is for mothers-to-be and new mums to be relaxed.”

When it comes to food tastes, each individual is different.

There is a lot of myth and folklore surrounding the type of foods that suit or upset babies, but Helen says the most important thing is for pregnant women to avoid alcohol, soft cheese such as Brie and raw eggs during their pregnancy.

She added, “If you drink wine then it will be passed on to the baby. So we advise mothers to abstain from alcohol for the duration of the pregnancy.

“But although there are fears about eating spicy food and curries, eating a hot curry won’t do any harm.

“Babies are living and breathing in the womb and might get the odd hiccup but if you get heartburn that is because food disagrees with you, not necessarily your baby.”

One thing that does seem to appeal commonly to a lot of babies is avocados, both inside and outside of the womb. Many mothers Helen speaks to are convinced that the fruit appeals to a baby’s developing tastebuds “They often say they have eaten avocado throughout their pregnancy and that their babies will turn towards it after they are born,” she said.

Nutritionists say avocados are a good choice for babies because they contain plenty of the carotenoid lutein, which some studies suggest may help maintain healthy eyes.

And one-fifth of a medium avocado has only 50 calories yet contributes nearly 20 vitamins and minerals, making it a good nutrient choice as well.

Avocados contain valuable nutrients including folate, potassium, vitamin E and iron, as well as fibre.

Per serving, they also have about 3.5g of unsaturated fats, which are known to be important for normal growth and development of the central nervous system and brain.

And the avocado’s smooth, creamy consistency makes it one of the first fresh fruits a baby can enjoy.

Karen Coates, dental adviser for the British Dental Health Foundation, recommends a healthy, balanced diet for pregnant women, containing all the necessary vitamins and minerals to pass on to their baby through the placenta.

She said, “Good nutrition from the mother during pregnancy is important for the baby’s teeth to develop.

“Calcium in particular is important to produce strong bones and healthy teeth. This can be found in milk, cheese and other dairy products.

“Women who suffer from morning sickness may want to eat little and often. If you are often sick, rinse your mouth out afterwards with plain water to prevent the acid in your vomit attacking your teeth.

“Try to avoid sugary snacks and drinks between meals to protect your teeth against decay.”

One thing babies in the womb don’t like is stress passed on to them from their mothers, according to the Royal College of Psychiatry.

Research from several independent studies last year shows that if the mother is anxious or stressed while pregnant, her child is substantially more likely to have behavioural, emotional or cognitive difficulties.

Some research shows there is an increased risk of attention deficit hyperactivity disorder (ADHD), anxiety and language delay in the children of mothers stressed in pregnancy.

And anxiety in pregnancy seems to have greater effects than antenatal depression.

A Royal College of Psychiatry spokesperson said, “The causes of these effects are not fully understood, although the evidence points to raised levels of the stress hormone cortisol being a factor.

“The foetal environment may be altered if stress in the mother changes her hormonal profile.

“There is a strong association between stress and levels of cortisol, both in the mother’s blood and in her amniotic fluid.

“Recently, a link has been found between cortisol levels in the amniotic fluid and the child’s mental development index – the higher the level of cortisol, the lower the index.”

So if you want to make sure you have a happy “bump”, why not stick a Catatonia CD on, make yourself an avocado salad, put your feet up and relax… bliss.

By Mike Copeland, Waco Tribune-Herald, Texas

Feb. 17–It would be impossible to recognize the old Target store at Sanger Avenue and State Highway 6.

No bull’s-eye signs or shopping carts to be seen.

The 98,500-square-foot building has been transformed into Central Texas Medical Center, where doctors relocating from other parts of town will offer an array of services.

“It’s fully committed,” says spokesman Wes Gilliland, referring to lease space in the building. The owners, including 22 local physicians, spent $3 million gutting the place and modernizing its shell into an attractive medical complex.

Now the owners have turned their attention to “finishing out” space for tenants who want to customize their leased areas.

Gilliland says the owners are paying up to $40 a square foot for the finish-out work. The tenants are responsible for any amount above that, “and it typically costs $80 to $100 a square foot for medical finish-out,” he says, adding that most tenants are choosing to pay what they owe upfront and not roll it into their leases.

So far, two groups have occupied space in Central Texas Medical Center: the Waco Center for Women’s Health, which took 17,000 square feet, and Heart of Texas Pediatrics, which is leasing 5,000 square feet.

Dr. Jeff Chancellor says the Waco Center for Women’s Health represents a “melting pot” of physicians and services. He left Scott & White to join the staff; Dr. John Bagnasco previously was with Providence Health Center; and Dr. Katherine Haynes and Dr. Paul Redman had private practices. They joined the original women’s- health staff of Drs. Richard Haskett, Brian Becker, Mark Moore and Michelle Manning.

The center, which also has nurse practitioners and nurse midwives, provides standard obstetric and gynecological services, Chancellor says. The center also handles minor surgical procedures, treats patients suffering from heavy bleeding and performs health maintenance exams.

“We take care of pregnant patients, but we have no birthing center,” he says. “Deliveries will take place at Providence.” Chancellor says the staff is proud of its new location, “and the patients seem pleased with the facilities we have to offer. We have plenty of elbow room, so we’re not stumbling over each other with our combination of practices. It’s a pleasant atmosphere.”

Other services are committed to moving into the new center. Most are relocating from other Waco locations, including the Hillcrest Medical Tower, which appears on track to become Waco’s new police headquarters. Services include:

–Central Texas Urology, which is relocating from Fish Pond Medical Plaza, 15,000 square feet.

–Fish Pond Surgery Center, 17,000 square feet.

–Waco Ear Nose & Throat, 8,000 square feet.

–Dr. Joe Knipper, dermatologist, 2,500 square feet.

–Central Texas Eye Clinic, 9,000 square feet.

–Central Texas Pathology Laboratory, 12,000 square feet.

“Those are our main tenants, but there are going to be other core services in the building, including laboratory and radiology services,” Gilliland says.

On top of all that, the center will have a coffee shop.

Good location, timing The building has a combination of owners, including some physicians who will practice there. Gilliland says a few doctors with a stake in Central Texas Medical Center also have ownership interest in Fish Pond Medical Plaza, 6600 Fish Pond Rd.

CGC Southwest Management Services, which manages medical offices locally, also is an owner. Partners in CGC are Gilliland, accountant John Cawthron and attorney Meredith Cawthron.

The Target on State Highway 6 became vacant in 2003 when a new Target Greatland opened on Bosque Boulevard.

Waco real estate agent Jim Peevey says space in the old Target hit the market at just the right time c as more doctors and health- related professionals move to be near Providence Health Center and the pair of hospitals Hillcrest Health System is spending $184 million to build at State Highway 6 and Interstate 35.

“It’s an ideal location, and it offers the space we need as a growing group,” Chancellor says. “We already have close proximity to Providence, and we’re looking forward to Hillcrest’s project.

“The future looks nice,” he says.

—–

To see more of the Waco Tribune-Herald, or to subscribe to the newspaper, go to http://www.wacotrib.com.

Copyright (c) 2008, Waco Tribune-Herald, Texas

Distributed by McClatchy-Tribune Information Services.

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

IRVINE, Calif., Feb. 19, 2008 (PRIME NEWSWIRE) — Microsemi Corporation (Nasdaq:MSCC), a leading manufacturer of high performance analog/mixed signal integrated circuits and high reliability semiconductors, has introduced a new solid state 1KW, Single-Ended, CLASS-E reference design kit based on Microsemi’s DRF1200 Driver/MOSFET hybrid.

The reference design kit enables the design engineer to immediately evaluate an 86% efficient 1000W CLASS-E RF generator. It provides an essential tool for 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

    -- 1000 Watts Output Power  -- 86% Efficient CLASS-E Operation  -- 13.56 MHz Switching Frequency  -- Up to 320V Supply Voltages  -- Internal MOSFET Rated at 1000V BV(DSS)  -- Low Cost System Design  -- Solid State Transition for Tube Amplifiers 

CLASS-E amplifiers offer a degree of efficiency unavailable with linear designs. The trade-off has been the high level of design complexity that engineers have either shied away from or spent months discovering the fundamentals of practical CLASS-E amplifier design. With the DRF1200/CLASS-E reference design kit an engineer can rapidly overcome the pitfalls of high voltage CLASS-E design. It demonstrates fundamental design techniques that can save months of countless design iterations.

Using the DRF1200 Hybrid as the core of the design, the reference amplifier enables performance previously unachievable with solid state CLASS-E amplifiers. The DRF1200 hybrid combines a driver, high voltage MOSFET and internal bypass capacitors making it a highly efficient, cost effective, high voltage solution.

The driver combined with optimally-located bypass capacitors is capable of driving high voltage MOSFETs at over 30MHz. The 1000V MOSFET enables higher voltage applications, greatly simplifying output matching and reducing the complexity of the output combining networks.

The kit includes the designer’s application note, discussing the progression through various output voltages while identifying proper output waveforms necessary for the safe transition to the maximum 1KW, 925V peak output voltage. It also demonstrates efficiencies as high as 95% that can be achieved at lower voltages. The kit’s circuit board comes fully assembled and mounted to a machined heatsink. It demonstrates the supply bypassing and high power inductor construction required for high power CLASS-E designs.

The DRF1200/CLASS-E is extremely versatile. After evaluating the 1KW generator design with the preloaded 1000V, 13A DRF1200 driver, an application can be easily modified for different power requirements using either 1000V, 26A DRF1201 or 500V, 50A DRF1202 hybrids.

The high power reference design features the DRF1200 hybrid in an air cavity-flangeless package for improved reliability over conventional plastic encapsulated packaging. Constructed with materials having closely matched CTEs 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 700W/square inch. The flangeless package design also reduces cost by eliminating expensive copper-tungsten flanges typically found in high power RF packages.

The DRF1200/CLASS-E Reference Design Kit is available now with a unit price of $1,333.00. Samples of the DRF1200, DRF1201 and DRF1202 are available now. The DRF1200 is available for a unit price of $143.49 in 100 piece quantities. All devices are available through the factory or authorized Microsemi distributors.

About Microsemi Corporation

Microsemi, 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 and reliability, optimizing battery performance, reducing size or protecting circuits. The principal markets the company serves include defense, commercial air, satellite, medical, notebook computers, LCD TVs, mobile, and 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 the news release that are not entirely historical and factual in nature are forward-looking statements, including without limitation statements concerning our expectations regarding our business outlook, our performance and competitive position during the coming year, visibility into our customer demand, and any other statements of belief or about our plans or expectations. 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 changes in generally accepted accounting principles, the difficulties regarding the making of estimates and projections, the hiring and retention of qualified personnel in a competitive labor market, acquiring, managing and integrating new operations, businesses or assets, uncertainty as to the future profitability of acquired businesses, delays in the realization of any accretion from acquisition transactions, any circumstances that adversely impact the end markets of acquired businesses, difficulties in closing or disposing of operations or assets, difficulties in transferring work from one plant to another, rapidly changing technology and product obsolescence, difficulties predicting the timing and amount of plant closure costs, the potential inability to realize cost savings or productivity gains and to improve capacity utilization, potential cost increases, 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, changes in demand for products, difficulties foreseeing future demand, effects of limited visibility of future sales, 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, business disruptions, epidemics, health advisories, disasters, national emergencies, wars or potential future effects of the tragic events of September 11, 2001, political instability, currency fluctuations, variations in customer order preferences, fluctuations in market prices of the company’s common stock and potential unavailability of additional capital on favorable terms, difficulties in implementing company strategies, dealing with environmental or other regulatory matters or litigation, or any matters involving litigation, contingent liabilities or other claims, difficulties and costs imposed by law, including under the Sarbanes-Oxley Act of 2002, difficulties in determining the scope of, and procuring and maintaining, adequate insurance coverage, difficulties and costs of protecting patents and other proprietary rights, work stoppages, labor issues, inventory obsolescence and difficulties regarding customer qualification of products, manufacturing facilities and processes, and other difficulties managing consolidation or growth, including in the maintenance of internal controls, the implementation of information systems, and the training of personnel. 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. Additional risk factors may be identified from time to time in Microsemi’s future filings. 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: David R. Sonksen, Microsemi Corporation, Irvine, CA (949) 221-7101.

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 CONTACT:  Microsemi Corporation           Financial Contact:           David R. Sonksen, Executive Vice President and CFO             (949) 221-7101           Editorial Contact:           Cliff Silver, Manager, Corporate Communications             (949) 221-7112 

Biolex Therapeutics today announced that it has entered into an agreement with Merck KGaA, Darmstadt, Germany, acting for its division for innovative pharmaceuticals Merck Serono, to evaluate antibody optimization and production in Biolex’ proprietary LEX System(SM). The cooperation will evaluate the ability of the LEX System to improve therapeutic profiles through optimization of antibody glycosylation structures.

As reported in Nature Biotechnology in December 2006, Biolex has engineered its proprietary LEX System to produce antibodies with a fully human glycosylation structure without fucose. Research suggests that antibodies with a glycosylation structure lacking fucose may have greater efficacy and potency as a result of enhanced antibody dependent cellular cytotoxicity (ADCC), particularly in the treatment of cancer, autoimmune diseases, infectious diseases and inflammatory diseases. The LEX System also has the ability to produce antibodies that have a fully “G0” glycosylation structure, lacking galactose. Research suggests that a G0 glycosylation structure provides the additional potential benefit of reducing complement dependent cytotoxicity (CDC), thereby reducing side effects and the long infusion times associated with certain antibodies. Preclinical results associated with LEX System optimization were also presented at the 49th Annual Meeting of the American Society of Hematology (ASH) in December 2007.

“Antibodies are the fastest-growing class of therapeutics in the pharmaceutical sector, and glycosylation can play a significant role in their therapeutic profile,” said Mr. Jan Turek, Biolex President and Chief Executive Officer. “We are pleased to work with Merck Serono, a leader in biologics, to investigate the potential benefits that can be achieved by linking their novel antibody candidate with the glycosylation optimization capabilities of the LEX System.”

About Biolex Therapeutics

Biolex is a clinical-stage biopharmaceutical company that uses its patented LEX System(SM) to develop hard-to-make therapeutic proteins and to optimize monoclonal antibodies. The LEX System is a novel technology that genetically transforms the aquatic plant Lemna to enable the production of biologic product candidates. The company’s product candidates are designed to provide superior efficacy/tolerability profiles and to address large, proven pharmaceutical markets. Biolex’s lead product candidate, Locteron(R), under joint development with OctoPlus N.V (Euronext: OCTO), is in Phase 2 clinical trials and is the only controlled-release interferon alfa known to be currently in clinical development for the treatment of chronic hepatitis C. Biolex has also developed two other product candidates that capitalize on the benefits of the LEX System, which it is advancing toward clinical trials: BLX-155, a direct-acting thrombolytic designed to dissolve blood clots in patients; and BLX-301, an anti-CD20 antibody it is optimizing for the treatment of non-Hodgkin’s B-cell lymphoma and other diseases.

 Biolex Contacts: Media: Michelle Linn Linnden Communications 508-362-3087 Email Contact  Investors: Dale Sander Chief Financial Officer 858-663-6993 Email Contact

SOURCE: Biolex Therapeutics