Evidence Based Nutrition, Inc., First to Offer Sciona MyCellf(TM) DNA Personalized Genetics Analysis Kit to Chiropractors

Evidence Based Nutrition, Inc. (EBN, www.ebnsupplements.com) announced today that it has entered into a strategic alliance with Sciona, Inc. (www.MyCellf.com) to distribute MyCellf™ personalized genetics test kits to chiropractors.

The EBN MyCellf™ Test

This advanced test is performed in the comfort of the individual’s home. A cotton swab is used to collect cheek cells from the individual’s cheek; much like as seen on television.

After swabbing, the individual answers the lifestyle and health questionnaire about diet and exercise. The swab and completed questionnaire are sent to Sciona for laboratory analysis, where the individual’s DNA is analyzed from 27 specific genes. The genetic findings reflect how the individual’s genetic makeup metabolizes and utilizes foods and beverages. Combined with the lifestyle answers, the result is valuable insight into the individual’s unique nutritional and supplement needs.

A sophisticated, confidential analysis of an individual’s DNA profile and Lifestyle Questionnaire is conducted with the proprietary Sciona Genostic Rules Engine™ software. The DNA Nutrition Action Plan makes nutritional and lifestyle recommendations based on an understanding of the individual’s unique genetic profile. The Action Plan is a highly accurate assessment based on genetic screening for variations in a specific set of genes that have been proven in numerous studies to respond to nutritional and lifestyle changes.

Chiropractors Provide Individuals with Laboratory Analysis

Approximately two weeks after the analysis, the chiropractor receives a comprehensive report and then meets with the individual to discuss the analysis. The individual learns what, if any, modifications are recommended to his/her lifestyle, nutritional and supplemental regime.

Founder and President of the World Chiropractic Alliance Weighs In

“People are taking all sorts of nutritional supplements. They’re also eating fortified-nutrient rich foods — the result is that many people are now ending up on the side of vitamin stacking. Both vitamin deficiency and vitamin overdose are harmful to the body. The EBN MyCellf testing kit eliminates the guess work. Everyone who knows me personally knows that I’m a health fanatic — so I’ve decided to have the EBN MyCellf test performed to find out what my DNA discloses,” said Terry Rondberg, founder and president of the World Chiropractic Alliance.

Dr. Kurt Donsbach, D.C., N.D., PhD., founder of Evidence Based Nutrition stated, “Proper nutritional balance with chiropractic care enhances the benefits of chiropractic adjustments.”

President and CEO of Sciona, Peter Vitulli commented, “The strategic relationship between Sciona and EBN provides entrance into a new and growing market of 60,000-plus chiropractors who perform services on behalf of millions of consumers each year. The use of our Mycellf DNA Kits will assist chiropractors in attracting new business and bringing clients back for continued care and purchase of nutritional supplements — as most of these individuals are seeking optimal health.”

The EBN Mycellf Kit is sold directly to licensed chiropractors, nutritionists and healthcare practitioners through the EBN supplement website at www.ebn.supplements.com for resale to their clientele.

Terry Rondberg continued, “It’s not CSI, but it’s very close. By utilizing advanced technology, it is going to give patients knowledge they can’t get anywhere else in the industry.”

About Evidence Based Nutrition

Evidence Based Nutrition, Inc., (EBN), provides nutritional supplements to health practitioners involved in the science of natural healing and overall wellness. EBN sells all-natural, evidence-based supplements and nutritional products and hosts educational seminars about nutrition to support patient acquisition and retention efforts. For more information, visit www.ebnsupplements.com. Media contact Diana Spicer 949-281-6262 or [email protected].

About Sciona, Inc.

Sciona is an international company founded in 2000 to provide personalized health and nutrition recommendations based on an individual’s diet, lifestyle and unique genetic profile. Sciona has created a powerful set of tools utilizing their proprietary Genostic Rules Engine™ which allows consumers to harness the scientific information uncovered in the landmark Human Genome Project. For more information, visit www.Mycellf.com. Media contact Jan Strode 619-890-4040 or [email protected].

Missouri Board Revokes License of Wentzville Physician

By Blythe Bernhard, St. Louis Post-Dispatch

Feb. 19–The Missouri Board of Healing Arts revoked one local doctor’s license and suspended the license of another in the last half of 2007. In addition, two other medical doctors and a physical therapist were disciplined in that time period, according to documents recently released by the board.

The board is responsible for licensing and regulating the state’s 31,000 doctors and other health care providers, including physician assistants and physical therapists.

Investigations of doctors are sparked by the 900 complaints the board receives each year from patients, law enforcement agencies, malpractice claims, hospitals and other physicians. About twice each year, the board releases the names of the doctors who were disciplined in the last six months.

Dr. Pearletha Phillips-Washington of Wentzville lost her license in July after she was convicted of felony prescription drug fraud and fraudulent use of a Social Security number, according to board documents. The medical board determined that the charges were related to her profession and revoked her license. Washington and her attorney, Carter Law, could not be reached for comment.

In August the board reprimanded ear, nose and throat specialist Wallace Berkowitz of St. Louis after charging he violated drug laws in prescribing painkillers and cough syrup.

State investigators in 2006 said they found a patient’s bottle of prescription painkillers unattended on a shelf in Berkowitz’s office. In reviewing medical records, investigators found that 50 out of 64 prescriptions authorized for a patient were not recorded in that patient’s chart. Five other patients’ charts dating back to 2002 failed to note the strength or amounts of the cough syrups and painkillers prescribed to them, according to board documents.

Berkowitz could not be reached for comment.

Also in August, the board suspended the license of anesthesiologist David Mohart of Wildwood for two years. The board charged Mohart with illegally obtaining drugs, including cocaine and ketamine, an anesthetic. To reinstate his license, Mohart must consent to periodic drug tests and complete rehabilitation treatment.

Mohart said he became addicted to painkillers after a back injury.

“I want to assure the public that at no time was I impaired or under the influence while caring for patients,” Mohart said. “I’ve been in a recovery program for the past year sponsored by the state of Missouri and I hope to further study the field of addiction medicine and to help others who suffer from this devastating disease.”

The board reprimanded Chesterfield psychiatrist Narsimha Muddasani in August for practicing without a license. Muddasani twice failed to renew his license before it expired and worked for four months in 2007 and three months in 2004 without a valid license, according to the board. Muddasani could not be reached for comment and was not represented by a lawyer in the case.

Physical therapist Roland Scott Van Nest in August was placed on probation for five years after the medical board charged him with treating a patient without a prescription and hiring unlicensed employees to treat patients.

Van Nest billed insurance companies for services between Jan. 2004 and Oct. 2006 that were performed by unlicensed workers. He also treated a patient for five months in 2005 without a prescription, according to board documents.

Under the terms of his probation, Van Nest must take a class in medical billing and make his billing records, schedule and patient charts available to investigators.

Van Nest works at the Sports Medicine and Training Center in Webster Groves; he could not be reached for comment. His lawyer, Elaine Moss, declined to comment.

The medical board is made up of five medical doctors, three doctors of osteopathy and one public member. Each complaint investigation typically takes the board and its staff six to nine months to complete.

In 2006, the last year with complete figures available, the board disciplined 82 physicians out of more than 14,000 who were practicing in the state.

For more information or to check a doctor’s disciplinary record, visit pr.mo.gov/healingarts.asp or call 573-751-0098.

[email protected] — 314-340-8129

—–

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Copyright (c) 2008, St. Louis Post-Dispatch

Distributed by McClatchy-Tribune Information Services.

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Hammerhead Shark Makes Endangered Species List

The scalloped hammerhead shark will be added to the “globally endangered” species list this year.  Among the reasons are over-fishing and demand for shark fins, according to discussions that took place during last week’s annual meeting of the American Association for the Advancement of Science (AAAS).

Speaking at the Boston meeting, Dr Julia Baum, a marine ecologist at the Scripps Institution of Oceanography and a member of the World Conservation Union (IUCN), said excessive fishing was putting many hammerhead sharks at risk of extinction.

BBC News reported a total of 233 shark species are currently on the IUCN Red List, with twelve classified as “critically endangered”.  Nine more will be added this year, including the scalloped hammerhead.  Three species of thresher shark along with the shortfin mako shark are considered “vulnerable to extinction”.

“Sharks evolved 400 million years ago, and we could now lose some species in the next few decades – so that would be just a blink of an eye in evolutionary time,” said Dr. Baum.

She added that while concern for the sharks had been growing for many years, it was now imperative that effective action be taken to protect and restore the number of hammerhead sharks.  

Material presented during last week’s AAAS meeting is beginning to shed light on shark behavior, and reveal ways to best protect the shark population.  

The research found that hammerhead and great white sharks inhabit fixed routes in the ocean, and gather at fixed spots around islands in the Eastern Pacific Ocean to mate and feed.  The animals also move between a series of “stepping stone” sites off coastal islands between Mexico and Ecuador, as well as congregate around various undersea mountains.  

Electronic tagging of 150 great white sharks off the coast of central California revealed similar findings that showed the sharks gather in “hotspots”.  Researchers have even named a  site between Mexico and Hawaii “the white shark caf©” because of its large numbers of sharks.  In a BBC News report, Salvador Jorgenson, a researcher at Stanford University’s Hopkins Marine Station, said it was unclear why the sharks went there.

“They’re going there to feed, or they’re going there for meeting, where males and females could meet perhaps away from a feeding area, where there’s less competition and more focus on mating behavior,” he suggested.

Researchers believe information on shark “superhighway” routes and congregation sites can be used to help fisheries managers concentrate on protecting these areas.  As a result, conservation groups are now calling for urgent measures to set limits on shark catch and fishing quotas in international waters, a practice that is now unrestricted.

They added that demand for shark fins as an expensive delicacy has also placed increasing pressure on shark populations, and are calling for a  ban on the practice of shark finning, a practice where the shark’s fins are removed and the rest of the animal is thrown back into the ocean to die.  Hammerheads are among the most commonly caught sharks for finning, and a large shark fin can sell for over 100 dollars per kilo.

Previous research by Dr Baum’s and her colleagues had shown the shark population fast declining in parts of the Atlantic Ocean, with numbers declining over 50 percent during the past 30 years in every species they studied.   The drop in numbers was much greater for many large coastal shark species, with tiger, scalloped hammerhead and dusky shark populations declining by over 95%.

On the Net:

American Association for the Advancement of Science

Scripps Institution of Oceanography

World Conservation Union (IUCN)

Carraguard Gel Fails to Stop HIV Infection

Researchers announced their disappointment upon finding that an anti-AIDS vaginal gel failed to stop HIV infection in their study of 6,000 South African women. The gel was the first of its kind to make it through late-stage testing.

Over 9,000 women volunteered for the study which was conducted from March 2004 through March 2007 in Gugulethu, Isipingo and Soshanguve. About 27 percent of the volunteers were found to already be infected with HIV and were disqualified from testing. The women were given either Carraguard, a microbicide developed by the nonprofit, New York-based Population Council, or a placebo gel without knowing which one they had received. They also received safe-sex counseling and condoms.

Among the participants, 4,244 completed the study overall. Almost 18 percent dropped out because they became pregnant, and the gel is not known to be safe for use during pregnancy. Also, 13 percent were unable to be located for follow up information.

Testing resulted in a rate of 3.3 infections per 100 women each year or 134 new HIV infections in the microbicide group and 3.7 or 151 in the placebo group.

“The results are comparable,” with no statistically significant difference, said Khatija Ahmed, a microbiologist who headed the study’s Setshaba Research Centre site near Pretoria.

Although researchers are still trying to determine the cause of the failure, they noted that women reported using the gel less than half the number of times they had sex, while only 10 percent said they used it every time as directed.

Researchers hope to improve upon the former gel with an updated formula which contains an experimental AIDS drug, MIV-150, that is already in the works. Development of a cream or gel women could use to lower their risk of getting HIV through sex has spanned the past two decades.

Research for a female-controlled method is crucial in poor countries where the women can’t always persuade their partners to use a condom.

Scientists discontinued two late-stage tests of a different gel last year because early test results showed that it might increase the risk of HIV infection rather than lowering it.

Researchers are still trying to determine if nonuse was an impacting factor in the latest study. Barbara Friedland, the study’s behavioral coordinator noted that if the rate of nonuse in the microbicide group was higher than in the placebo group “it could have had an impact on our final study results.”

Condom use reportedly increased from 33 percent at the start of the study to 64 percent during it.

The study was paid for by the Bill & Melinda Gates Foundation and the U.S. Agency for International Development, or USAID.

Jeff Spieler, an official at USAID, said that the testing showed some optimistic results for the future.

“We have always known that the path to developing a successful microbicide would be a long one.”

Photo Caption: Carraguard is an odorless, tasteless, clear gel made from carrageenan, a derivative of seaweed. credit: Karen Tweedy-Holmes/Population Council

On the Net:

Population Council

Bill & Melinda Gates Foundation

USAID

New Food Trend: It’s All About the Gut

LEXINGTON, Ky. _ It’s not all in your head. These days, it’s all in your gut.

Twenty years ago, oat bran was the food that was going to put us all into a state of high-fiber, clear-hearted bliss.

Now the food trend is lower in the body. You want to be healthy in 2008? Ponder your intestines.

Dannon sells Activia yogurt, which promotes bathroom regularity. It also hawks mini-smoothies called DanActive, that claim to boost immunity. You didn’t know? Much of your immunity lies in the foot after foot of epithelial cells lining your intestines _ a kind of spongy exchange center where nutrients are absorbed and wastes are expelled.

Kraft sells “probiotic” cheese and cottage cheese. Planters has introduced a “digestive health mix” that includes “prebiotic” high-fiber items including granola, almonds and dried cherries.

There’s even a new book, “Health Begins in the Colon” (Ulysses Press, $19.99) by Edward Group. Says Group of his epiphanic moment: “I never hear anything in the medical community about the intestinal tract.”

Group says part of our problem, not to put too fine a point on it, is transit time: how long it takes for what you ingest to do its body business and exit you. People in good health should have a bowel movement two or three times a day, Group says. An ideal transit time for food to get in, break down and be on its way? Ten to 18 hours.

To get an idea of how the intestines work, Group says, consider mixing up everything you eat and drink in a day and smearing it on your skin: After a few hours, it’s going to get pretty vile.

That’s the other part of the intestinal-health equation: urging the toxins in our food to move on out. Or, with Group’s dietary recommendations, never eating them in the first place. He doesn’t like laxatives _ which he says are drugs _ or even psyllium, which he says doesn’t repair or cleanse the colon but instead scrapes the intestinal walls a little. He prefers an oxygen-based colon cleanse followed by a diet low in junk and high in fruit.

Then there’s Dannon’s method of colon overhaul.

Dannon has touted the health benefits of its yogurt as far back as the iconic 1970s commercials that promoted the long-lived yogurt-eating Russian Georgians. Now, Dannon has added Activia and DanActive as specialty products that promote intestinal fortitude from the dairy case.

Where does Activia sell best? Dannon spokesman Michael Neuwirth isn’t saying, although he acknowledges that an excretion-encouraging yogurt tends to sell better in regions of the country where poor eating habits predominate.

Dannon’s biotically charged yogurts are lifestyle products that produce a benefit _ but only if you continue taking them. “You have to consume these products regularly,” Neuwirth said. “It’s not an on-off switch.”

Whether a product is on or off, of course, depends on the consumer. And that’s where food fads, as much fashion as science, start.

OAT BRAN’S FALL FROM GRACE

Dr. James Anderson of the University of Kentucky saw the boom and bust of his favored grain 20 years ago.

One day, oat bran was being added to seemingly every product on the grocery shelf because of its heart-healthy properties. Anderson was dubbed Dr. Oat Bran for his role in popularizing oat bran.

At the height of the oat bran frenzy, a New York baker who couldn’t get oat bran described it in terms that made it sound like flaked, fibrous gold: You could charge anything you wanted for it, he said, and people would pay it.

Then, in January 1990, oat bran plummeted from favor. The New England Journal of Medicine said that it wasn’t any more effective than wheat fiber. Both worked by displacing other items in the diet. An additional whammy was the suggestion that oat bran caused diarrhea and bloating.

And that was the single moment, the dull thunk, that killed oat bran.

Oat bran pandemonium was less about eating varied and healthy and more about getting the big cool food of the moment. In 1988, that was an oat bran muffin. Now it’s anything containing omega-3 oils or probiotics.

In between, there were innumerable superfoods to enthuse about, buy and abandon, among them vitamin E, beta carotene, soy, green tea and “fat-free” formulations that, as the food-villain focus shifted, morphed into “low-carb” foodstuffs.

And why do consumers think they need to flit among foods? Part of the blame gets tossed into the vast blame pit known as journalism: A 1994 New England Journal of Medicine article by Marcia Angell and Jerome Kassirer argued that reporters and the public were complicit in seeking easy, definitive, permanent answers from scientists who don’t have them.

Christine Gerbstadt, a registered dietician and doctor who works with the American Dietetic Association, knows that the consistent message put forward by her organization _ eat a varied diet, exercise and maintain a restrained lifestyle _ doesn’t resonate with consumers the way food fads do.

She acknowledges the appeal of “natural” products for consumers who like to think there’s some lost Valhalla of health down the next grocery aisle _ and for business people “trying to make a buck off the latest buzz product.”

We don’t like complexity and fluid knowledge. We want to live longer, and we have little patience with complicated ideas about how to get there: They’re boring.

We want our prescription for health to be peppy, easy and available in a word _ two at most.

Hence: “oat bran,””low fat,””low carb.” And now, “digestive health.”

What’s vexing is that some of the food fads eventually are confirmed by additional research. The University of Kentucky’s Anderson says additional studies have proved that he was right after all: Oat bran is good for your heart. Being right might not bring back the oat bran-enhanced tortilla chip, but Anderson is gratified nonetheless. Regular consumption of oats changes the intake of lipid particles in the blood, he says. Oats have anti-inflammatory effects, and hardening of the arteries is an inflammatory process. Oats are rich in anti-oxidants, help lower blood pressure and help in weight management.

But these are complex concepts. “Oat bran equals good” played better at the grocery store.

COLON CONFUSION

Of course, marketing to your intestinal tract is hard: It’s tough to distinguish between prebiotic (more fiber) and probiotic (more bacteria). And there’s the gross-out factor in any detailed discussion of colon cleanliness.

Beth Loiselle, who offers nutritional counseling at Lexington, Ky.’s Good Foods Market and is the author of “The Healing Power of Whole Foods” (HealthWays Nutrition, $24.95), says that natural health products have a part in a balanced diet but that consumers have to be wary of putting all parts of diet and supplementation in the context of a thoughtful, varied eating plan.

“All of these things are important, but when people hear a little bit and just do one thing and don’t look at their overall diet I that’s not going to help them,” she says.

She urges clients to eat more whole grains, cut back on sugar and make sure they eat some protein with each meal. Loiselle believes in “real food” with as little processing as possible, and lots of vegetables.

Even Anderson, the lord of oat bran, is a little skeptical of the “digestive health” boomlet. How, he asks, can you measure increased intestinal efficiency?

“Cholesterol is easy to measure I but if you want to enhance the immune system, it’s sort of tricky,” he says. “What do you measure? Cholesterol is a strong predictor of heart disease, but there are no strong predictors of immune function.”

Anderson himself watches calories and limits his consumption of even heart-healthy foods such as almonds. But even Dr. Oat Bran has a sweet tooth: He likes anti-oxidant-rich dark chocolate, and sometimes he will pop a few pieces of milk chocolate, too.

Even the man who saw his star rise and fall and rise again on oat bran research finds reason to listen to some research studies on other foods: “I was really pleased with the emerging research on dark chocolate.”

Chipotle Begins Serving Naturally Raised Beef in All of Its Minnesota Restaurants

Chipotle Mexican Grill today announced that it is now serving naturally raised beef in all 44 of its Minnesota restaurants, making 100 percent of its meat in Minnesota naturally raised. All of Chipotle’s naturally raised beef, pork, and chicken comes from animals that are humanely raised, never given antibiotics or added hormones, and fed a pure vegetarian diet.

“We are changing the way the world thinks about and eats fast food,” said Chipotle Founder, Chairman and CEO Steve Ells. “Our commitment to working with like-minded suppliers who share our belief that food should be raised with respect for the environment, the animals, and the people involved is helping us make superior quality food, including naturally raised meat, accessible and affordable so everyone can eat better.”

That thinking is at the heart of a philosophy Ells calls “Food With Integrity” that has Chipotle looking at all of the ingredients it uses to make its food, and how it can use ingredients from more socially responsible, sustainable sources. Under this philosophy, all Chipotle restaurants nationwide serve naturally raised pork, while about 85 percent serve naturally raised chicken, and more than half are serving naturally raised beef. In all, that will total more than 52 million pounds of naturally raised meat this year, more than any other restaurant company.

Beyond its use of naturally raised meat, all of the dairy products Chipotle serves are made with milk from cows that are not treated with the synthetic hormone rBGH (recombinant bovine growth hormone), which is used to stimulate milk production in dairy cows. And 25 percent of all of its beans are organically grown, an amount that increases annually as additional supply becomes available.

Ells’ quest to make Chipotle the first restaurant chain to serve naturally raised meat began in 1999. That’s when an article by food writer Ed Behr prompted him to look at the farms of Niman Ranch, a network of family owned farms that were raising pigs in traditional ways, on open pastures or in deeply bedded barns and without the use of antibiotics or added hormones. Visits to Niman Ranch farms and to the Concentrated Animal Feeding Operations (CAFOs) that provide most of the nation’s pork made Ells’ decision an easy one.

“I don’t want Chipotle’s success to contribute to the kind of exploitation I see on CAFOs and industrial farms,” says Ells. “Now we are using our size and purchasing power not just to make better food in our restaurants, but to help create a better food supply system.”

“That article probably accomplished the most concrete good of anything I’ve written,” Behr wrote several years later in his quarterly publication, The Art of Eating, noting that, “Steve Ells read the article and began to buy pork from Niman. AoE may never again have so much practical influence for the good.”

But Behr is not alone in noticing Chipotle’s impacts to improve the nation’s food supply. Others have commended Chipotle for its commitment to animal welfare and socially responsible food.

“We have applauded Chipotle a number of times,” says Paul Shapiro, senior director of the Factory Farms Campaign for the Humane Society of the United States. “That a company like Chipotle can have a successful business model while not supporting the abuses in the agribusiness industry is a positive sign. Companies ought to be rewarded for helping to reduce animal suffering.”

For more information about the progress of Food With Integrity, including a guide to Chipotle’s naturally raised meat, suppliers used, and the company’s standards for naturally raised meat, visit www.chipotle.com.

About Chipotle

Chipotle Mexican Grill (NYSE:CMG) (NYSE:CMG.B) offers a focused menu of burritos, tacos, burrito bowls (a burrito without the tortilla) and salads made from fresh, high-quality raw ingredients, prepared using classic cooking methods and served in a distinctive atmosphere. Through our vision of Food With Integrity, Chipotle is seeking to change for the better the way people eat not only from using fresh ingredients, but ingredients that are sustainably grown and naturally raised with respect for the animals, the land and the farmers who produce the food. Chipotle opened its first restaurant in 1993 and currently operates more than 700 restaurants. For more information, visit www.chipotle.com.

Updated Vaccine Needed for Mutated Flu Viruses

The World Health Organization (WHO) recommended last week that next year’s flu vaccine be updated to reflect changes in the three most common influenza viruses.

The report corroborates findings from the U.S. Centers for Disease Control and Prevention (CDC) that the viruses have mutated and made the current flu vaccines less effective.

The WHO said similar reports from health agencies around the world have also reinforced the need for a new vaccine.

The organization reported that H1N1 viruses in 18 countries had developed mutations that made them resistant to Tamiflu, currently the best treatment for flu.  Resistance to the older drugs amantadine and rimantadine is now so common that their use is no longer recommended.

Although less effective than in typical years, this year’s flu vaccine can still protect people against the most serious effects of the infection, according to the CDC.

Flu vaccines contain the three most common circulating strains, usually two “A” strains and one “B” strain.  However, influenza viruses constantly mutate, and health experts meet throughout the year to monitor the viruses and determine how to best formulate the vaccine.

Because the vaccines are made using a time-consuming process involving chicken eggs, the process must begin several months before the next flu season starts.  During that time the WHO begins advising companies that make the vaccine, and governments that purchase them, about which three flu strains would best protect the general population.

“As in previous years, national control authorities should approve the specific vaccine viruses used in each country,” the WHO said, according to a Reuters report.

In an average year up to half a million people worldwide are killed by the flu.  Last week’s CDC weekly flu report said forty-four states had widespread flu activity, and ten children had died from the illness.

On the Net:

Additional information about influenza can be found at:

http://www.who.int/csr/disease/influenza/en/ and http://www.cdc.gov/flu/

Doctor Group Endorses Medical Marijuana

The American College of Physicians (ACP) issued a new policy statement this week endorsing medical marijuana use.  The group is urging the government to reverse its ban on medical treatments using marijuana.

“ACP encourages the use of nonsmoked forms of THC (the main psychoactive element in marijuana) that have proven therapeutic value,” the new policy statement said.

The group also advocates research into other therapeutic uses of marijuana.

The Philadelphia-based organization, the second largest doctors group in the United States, cited studies into marijuana’s medical applications such as treating severe weight loss associated with illnesses such as AIDS, and treating nausea and vomiting associated with chemotherapy for cancer patients.

The ACP said the government should weigh marijuana’s status as a schedule I controlled substance, alongside such drugs as LSD and heroin, given scientific evidence of marijuana’s safety and efficacy for some medical conditions.

The new policy further called for exempting doctors who prescribe or dispense marijuana for medicinal purposes in accordance with state law from federal criminal prosecution.  It also recommends that patients who use medical marijuana as permitted under state laws be protected from criminal penalties.  Currently, 12 states have laws allowing the use of medical marijuana, but supporters of medicinal marijuana use say the federal government is undercutting state laws through Drug Enforcement Administration (DEA) raids of medical marijuana providers.

David Murray, chief scientist for the White House Office of National Drug Control Policy, told Reuters, “The science should be kept open. There should be more research. We should continue to investigate.”

Rob Kampia, executive director of the Marijuana Policy Project, which supports legal and regulated marijuana sales, told Reuters, “This statement by America’s second-largest doctors group demolishes the myth that the medical community doesn’t support medical marijuana.  The ACP’s statement smashes a number of other myths, including the claims that adequate substitutes are available or that marijuana is unsafe for medical use.”

“The richness of modern medicine is to carefully evaluate new treatments. Marijuana has been in a special category because of, I suppose, its abuses and other concerns,” Dr. David Dale, the group’s president and a University of Washington professor of medicine, said in a Reuters telephone interview.

“Additional research is needed to clarify marijuana’s therapeutic properties and determine standard and optimal doses and routes of delivery. Unfortunately, research expansion has been hindered by a complicated federal approval process, limited availability of research-grade marijuana and the debate over legalization,” the group said in a news release announcing the new policy.

On the Net:

American College of Physicians (ACP)

The American College of Physicians full report  “Supporting Research into the Therapeutic Role of Marijuana” can be viewed at http://www.acponline.org/advocacy/where_we_stand/other_issues/medmarijuana.pdf.

New Safe Harbor at McQuade Road Has Become Popular Place for Anglers

By Sam Cook, Duluth News-Tribune, Minn.

Feb. 17–Most of the ice on Lake Superior this winter is unreliable. It’s there one day, blown out the next. Or it’s there one day, then piled up in crinkly windrows along shore the next.

It isn’t the kind of ice a trout angler can count on.

But inside the protective breakwalls of the nearly completed McQuade Public Boat Access, anglers have discovered thick, smooth ice that the big lake cannot tamper with. On Tuesday afternoon, four or five temporary fishing shelters had sprouted from the ice like winter mushrooms. Inside them, anglers such as Justin Hocevar of Caribou Lake jigged waxworms and other offerings for Kamloops rainbow trout and coho salmon.

“This is what I live for,” said Hocevar, 19, who had already pulled a 5- or 6-pound Kamloops rainbow from the 9-foot depths.

The public access at McQuade Road is being built to offer a safe harbor for boaters using Lake Superior during months when ice is only a memory. It’s scheduled for completion June 10. Work is continuing at the site on a restroom building well away from the lake. The ramp is not officially open, but anglers are using the site as long as their presence doesn’t interfere with construction.

North Shore anglers discovered the man-made fishing spot almost as soon as the breakwall rocks were plunked in the lake, sometime in 2006. The two breakwalls encircle the harbor like a pair of arms. The enclosed area is somewhat larger than a football field, and on Tuesday, it was covered with about 14 inches of ice. The only area of concern was at the mouth of the harbor, where a west wind had small wavelets chewing away the edge of the ice.

Hocevar and his fishing partner, Brett Capra of Pike Lake, each had augered three connected holes in the ice. The resulting cloverleaf-pattern holes offered a wide view of the water, the jigs they were dangling and the lake bottom.

To say the water is clear is an understatement. Looking into the depths is like looking through a windowpane. Every detail of the rock and silt bottom 9 feet below is visible. Everyone fishing the harbor Tuesday afternoon had seen fish coming and going down below. Most of them were Kamloops rainbows.

“I’ve seen three ‘loopers,” Capra said early in the afternoon.

Bruce Berggren of Duluth, fishing in a nearby shelter, had just missed a rainbow.

“He spit it out,” Berggren said.

“I’ve seen four,” said Jim Ferriera of Duluth, fishing in a shelter on about the 30 yard line. “You see ’em coming in. It seems first light is the best time for them to come in and bite.”

Several anglers had punched the cloverleaf holes to better see incoming trout or salmon. The fishermen offered an array of baits — artificial “‘looper bugs” tipped with wax worms, small white jigs tipped with waxworms, small jigs tipped with shiner minnows, or waxworms on plain hooks. Most anglers used 4-pound and 6-pound-test line because the water was so clear.

The Kamloops rainbows they were seeing are the typical size. Nice fish, as they say.

“Most are 4 to 5 [pounds],” Ferriera said. “A couple were 7 or 8.”

It is something to see fish of that size, mere feet below you, patrolling the clear waters. Some would simply stop and eye a waxworm, then turn away. Even if one inhaled a bait, hooking it was not automatic. In the clear water, watching the action, an angler must resist the urge to set the hook too soon.

“When you see ’em take it, you have to wait until you see the bug disappear,” Hocevar said.

Tom Lemon of Duluth, fishing in a shelter with Ferriera, saw his bait disappear into a rainbow’s jaws, so he set the hook. Too soon.

“He hadn’t closed his mouth yet,” Lemon said.

But Lemon had a small whitefish on the ice as a consolation prize.

All of the anglers were toasty warm inside their shelters Tuesday afternoon, warmed by propane heaters. And that’s the beauty of ice on Lake Superior. Without ice, anglers must hope for temperatures near or above freezing so they can cast from shore into open water.

—–

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Should Parents Have Access to College Students’ Grades?

By ASHLEY KINDERGAN, STAFF WRITER

Do college students benefit when parents have access to their grades online?

Federal law generally restricts colleges and universities from releasing educational records without a student’s written permission.

Colleges handle that restriction in different ways. Some schools hand parents waivers during orientation for their children to sign. Other schools, such as Rutgers and William Paterson universities, give out waivers only when requested and assume that students and parents will share information on their own.

Experts say students benefit when parents take interest in their academic progress, but others warn that too much involvement can prevent students from taking responsibility for their own achievement.

PRO:

Sharing grades is usually a non-issue because both parents and students expect that parents will want to see them, administrators said.

“A significant number of students are not opposed to their parents being involved,” said Pamela Bischoff, vice president of student affairs at Ramapo College of New Jersey, where parents get waiver forms at orientation. “I think many of them have the expectation of sharing [grades] because the parents are often contributing significantly financially.”

Pattie Oliver of Middletown asked for and received the password to access her 21-year-old son Jason’s grades online. Oliver said the family talked about sharing information when Jason started at Fairleigh Dickinson University, and she tells her son before she checks his grades.

“He fully expected that I was paying his tuition, and I would be entitled to get his grades,” Oliver said. “If you have that conversation right off the bat, it’s not that big a deal.”

Parents who look at grades can suggest ways struggling students can improve.

“Grades can be an early warning sign that something is awry,” said James Boyle, president of College Parents of America, an advocacy group based in Washington, D.C.

Milton Fuentes, associate professor of psychology and director of Latin-American and Latino Studies at Montclair State University, said culture can play a role in how much monitoring is too much.

“All too often, from an American core culture, we perceive other cultures as being overbearing, whereas in their culture, it’s not an overbearing thing at all,” Fuentes said. “If the parent is good- natured and wants to support their child and monitor them to see how they can be helpful, I think that’s healthy.”

CON:

But parents who watch grades too closely or try to intervene with professors may hinder students from taking full responsibility.

“The pressure parents can put on students by constantly monitoring grades, or when a parent calls up with the student’s consent or not to argue about a grade, strikes me as defeating the whole purpose of asking them to act like adults,” said Dan Bronson, chairman of the English department at Montclair State University.

In a worst-case scenario, students are more worried about pleasing their parents than their own ambitions.

“I hear sometimes, ‘My mother is going to be so mad at me if I fail,’ said Irwin Badin, a psychology professor at Montclair State, who also coordinates advising for the department. “Because mom and dad’s feelings are so large, they don’t have to think about how they feel. You don’t want to go into adulthood with that as your guide.”

Parents should also talk to students about low grades to make sure they understand the back story, Boyle said.

“The parent who is used to the grade inflation of most high schools may be unnecessarily alarmed by the fact that, suddenly, their son or daughter is getting B’s and C’s,” Boyle said.

Azizza Scordo, a senior at William Paterson University, said her mother asks for a printout of her grades every semester. But the Saddle Brook native said she does not give her parents her online password, which would allow access to her campus e-mail along with her grades.

“College is not high school,” Scordo said. “It is now the student who must interact with professors and discuss any concerns they may have, instead of parental oversight over a bad paper grade or an unfair homework assignment.”

***

E-mail: [email protected]

(c) 2008 Record, The; Bergen County, N.J.. Provided by ProQuest Information and Learning. All rights Reserved.

High-Speed Rail Revolution in the Making

By Briginshaw, David

THE normally select world of high-speed rail, where construction of new lines has been limited to a small, but slowly-growing, club of generally rich or powerful countries, has been turned upside down this month with major developments on three continents and more to come. Argentina has shocked the world by deciding to build the first high-speed railway in the Americas. Nuovo Trasporto Viaggiatori (NTV) in Italy looks set to be the world’s first open-access high- speed rail operator. China has unveiled its first 300km/h train and started to award contracts for its huge Beijing-Shanghai high-speed project.

These events look set to have a profound impact on the future development of highspeed rail and give it a major boost. They could also pave the way for a major revival in intercity rail travel in parts of the world that haven’t seen long-distance passenger trains for decades.

The most crucial hurdle to overcome for any major infrastructure project is gaining political support. Win it and doors swing open to planning approval and funding, but fail to obtain it and the task is a great deal harder if not impossible.

Argentina’s newly-elected president, Mrs Christina Kirchner, is determined to make a substantial mark on her country in the form of major projects, including highSpeed rail and a planned 28km electrified railway tunnel through the Andes to Chile to create a new rail link between the Atlantic and the Pacific.

While the tunnel is competing for approval with a highway scheme in Buenos Aires, the high-speed rail project has cleared the first hurdles with the signing of an agreement between Argentina and France, and the decision to appoint the Alstom-led Veloxia consortium to build the line.

Up to now, Argentina has been one of only a handful of South American countries that have struggled to keep a skeleton long- distance passenger service alive on a predominantly freight network. Introduction of high-speed trains between Buenos Aires, Rosario, and Cordoba will revolutionise rail travel in Argentina and be a big boost to the economy. Bids are already in for a second line, from Buenos Aires to the coastal resort of Mar del Plata, paving the way for a highspeed network.

Brazil, which has abandoned virtually all longdistance passenger trains, is already planning a network of intercity passenger routes plus a high-speed line between Sao Paulo and Rio de Janeiro. The potential for passenger rail is much greater in Brazil than Argentina, because it has a larger population and a stronger economy, although the topography is far more challenging.

Even in North America, there are the first glimmers of change in this road-dominated continent. A new Congressbacked study urges the development of intercity passenger rail in the United States, and a high-speed rail study has been commissioned in Canada for the WindsorToronto-Montreal-Quebec corridor.

A different rail revolution is about to start in Europe with the opening up of the passenger network to competition in 2010.

NTV is the first serious attempt to take advantage of this. NTV has powerful backers including Mr Luca Cordero di Montezemolo, who is president of fiat, Ferrari, and the Federation of Italian Industry (Confindustria).

Italy is a challenging market to launch a private high-speed service because train fares are very low, Trenitalia already has a strong presence in the market, and there is strong competition from low-cost airlines. But if NTV succeeds in Italy, others will follow in stronger markets such as Germany and France.

In Asia, China has been putting a tremendous and increasing effort into developing its long-distance passenger services. A series of so-called speed-ups have cut journey times substantially. Construction of a huge highspeed network is underway, and as I write this work is about to start on the massive Beijing-Shanghai project.

China has also unveiled its first home-produced 300km/h train (below) – 250km/h trains in the CRH series are already in service. Increasing technical expertise in all spheres of high-speed rail will make China a force to be reckoned with in the rapidly expanding high-speed rail market.

While prospects for an extension to the Shanghai maglev line are fading fast due to escalating costs, noise fears, and lack of government backing for the technology, JR Central in Japan is pushing ahead bravely with its maglev dream: to build a line from Tokyo to Nagoya to relieve congestion on the Tokaido Shinkansen. This is despite the government refusing to back the project financially and JR Central’s share price tumbling 15% in two days because of concerns over rising debt. Nerves of steel are required to get maglev off the ground, as JR Central is quickly discovering.

The next high-speed rail news will come from Russia, Morocco and Saudi Arabia, where plans for new lines are at an advanced stage of preparation. When these projects get the green light, high-speed rail will be well on the way to becoming a global phenomenon.

The most crucial hurdle to overcome for any major infrastructure project is gaining political support.

David Briginshaw

Editor-in-Chief

[email protected]

Copyright Simmons-Boardman Publishing Corporation Feb 2008

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

Natural Ways to Boost Libido

By Bowden, Jonny

TRY THESE TIPS, FOODS, AND SUPPLEMENTS TO PROMOTE SEXUAL WELLNESS

You can never be too rich or too thin, they say. Nor, apparently, too hot. The quest for potions, foods, herbs, and supplements to increase a sagging libido never ends. Erectile dysfunction (ED) affects up to 30 million American men and one-third of American males between ages 40 and 70. And according to a 1999 report in the Journal of the American Medical Association, 43 percent of women reported having some kind of sexual dissatisfaction; about one- third of them specifically reported low sexual desire.

What’s up with that? And can food help? Read on.

Back in the 1970s and 80s, there was a famous erotic entertainer named Seka. When asked to name the most erogenous zone in the body, she wisely answered “the area between the ears.” Fact is, flagging libido can have a lot more to do with the brain than with the areas down below. Stress, lack of energy, fatigue, depression, anger, and worry are all sexual appetite killers, and few foods-even erotic staples such as oysters and chocolate-are going to make much of a dent if your mind is somewhere else. On the other hand, sometimes low libido for men or women has a physical base. As often as not, it’s a mix of both-desire plus the ability to do something about it.

Assuming the “spirit is willing,” we still have to make sure the body is able. First order of business: circulation. And the best way to improve overall circulation is exercise. Almost any kind will do. As long as your heart is pumping, blood is flushing through your organs, and oxygen is cleaning out the cobwebs in the brain. Exercise also raises feel-good chemicals in the brain called catecholamines, making it far more likely that you’ll feel amorous rather than exhausted. Certain yoga postures done prior to sex are said to be fantastic enhancers, notably a shoulder stand for men and the butterfly pose for women.

Then there are the sexy foods. Here’s my top list of foods that may increase libido naturally:

* Almonds (or nuts). They contain important fatty acids that help the brain work better.

* Avocados. Not only are they a sensual delight, they also contain important fatty acids that help the brain and heart.

* Celery. Guys take note: Celery actually contains a small amount of androsterone, a male hormone released in sweat that’s been known to turn women on.

* Chili peppers. hot peppers contain capsaicin, which can stimulate circulation.

* Chocolate. It’s no accident that chocolate is the gift of love It contains phenylethylalamine (PEA), a chemical that’s raised in the brain when you’re in love

* Oysters. High in zinc, which is essential for male sexual functioning, oysters have been associated with sex since the days of Casanova.

* Figs. They’re high in amino acids and are believed to increase sexual stamina. Plus, they’re sensual, juicy, and sweetperfect for “food foreplay.”

* Nutmeg. According to Daniel Amen, MD, author of Sex on the Brain, nutmeg is used in Indian medicine for enhancing desire. In one animal study, an xtract of nutmeg had the same effect on mating behavior as Viagra.

High-carbohydrate dishes, such as pasta, are morelikely to lead to snoozing than to romancing Go with energy-producing protein and vegtables, and leave the table just a bit hungry. Some foods, by sheer nature of their sensuality, can trigger thoughts of amour- think of a juicy peach, for example, or even an avocado. Foods with luscious textures and tastes enhcance mood. The sheer sensuality of ating them-especially with a partner over a romantic dinner-may lead to even more sensual delights later on.

To turn on the brain naturally, think of smells. Almond and coconut are good bets and make great scented candles. Lavender has been shown to be one of the most universal turn-ons, as have- believe it or not-the smells of pumpkin pie and buttered popcorn for men, and baby powder and licorice candy for women.

There’s no aphrodisiac on earth like romantic love-attraction is the ultimate aphrodisiac. It’s better than any supplement, food, or potion. You can’t buy it, eat it, or create it out of nothing, but if you have it-and the body’s in good shape-you’re in for a great time.

Supplement Options

If foods and other therapies aren’t enough to awaken your libido, consider a supplement. A combination formula is a good place to start. Two examples of products available at health food stores are Natural Factors’ Sex Essentials Women’s Formula, and Irwin Naturals’ Steel Libido (for men). Both contain the amino acid L-arginine, which has been shown in studies to help improve sexual function in males and females. Researchers believe it works by boosting circulation.

Sensual Snacks

Get creative with your food combinations. For example, try pairing some of the sexy foods mentioned above: Spread celery sticks with almond butter or dip dried figs, in dark chocolate. Also, avocado and chili peppers make great additions to a Southwestern- style soup or salad.

By Jonny Bowden, PhD, CNS

Jonny Bowden, PhD, CNS, is a boardcertified nutritionist and author of The 150 Healthiest Foods on Earth and The Most Effective Natural Cures on Earth. He has appeared on CNN, Fox News, MSNBC, ABC, CBS, and NBC and in more than 50 national magazines as an expert on nutrition, weight management, and natural health. For his free newsletter and audio courses, please visit jonnybowden.com. Stay tuned next month for more Healthy Solutions with Jonny Bowden.

Manteca Family to Be on ‘Montel’

By Paul Burgarino

MANTECA — The episode of “The Montel Williams Show” featuring a Manteca family that gave their deceased son’s organs to others will air Tuesday, representatives from the show said Wednesday.

The episode, titled “When Catastrophe Strikes,” features the story of Matthew Zaragoza-Van Gelderen, a Manteca teenager who died from a brain contusion sustained in a high school football game in September 2005.

Matthew died a week after his injury, but his parents decided to donate his organs.

Jose and Zona Zaragoza Van Gelderen, along with their three children were flown to New York on Oct. 18, 2007, to be on “The Montel Williams Show” where they met Tom Starr and Lorma Sealey.

Starr, 59, of Centerville, Iowa, was the recipient of Matthew’s kidneys while Sealey, 41, of Bowie, Md., received his heart and lungs.

The show was very emotional, members of the Zaragoza family said.

“It’s finally going to air,” Zona Zaragoza-Van Gelderen said, “we’re very excited. Hopefully, everybody marks their calendars and sets their TiVos.”

The show had been scheduled to run Thanksgiving Day 2007, but did not air.

The rendezvous on Montel was arranged by the California Donor Transplant Network — the group that helps donors and recipients to communicate through cards.

Zona immediately tried to

contact the recipients of Matthew’s organs.

Though the majority of donor-recipient groups don’t meet for a variety of reasons, this pairing connected quite well, said Cathy Olmo, a volunteer coordinator with the transplant network.

A program coordinator with “The Montel Williams Show” contacted the donor network about a possible story. Olmo recommended the Zaragozas.

Since Matthew’s death, his father has become a volunteer for the California Donor Transplant Network — touring schools over the past two years in San Joaquin County, eastern Contra Costa County and Tri- Valley about the benefits of organ donation.

“The Montel Williams Show” airs in Sacramento markets on KOVR Channel13 at 2 p.m. and in San Francisco markets on KTVU Channel 2 at 4 p.m.

Reach Paul Burgarino at 209-832-6143 or [email protected].

Originally published by Paul Burgarino, STAFF WRITER.

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

Improving Phonological Awareness and Decoding Skills of High School Students From Diverse Backgrounds

By McQuiston, Kathleen O’Shea, Doris; McCollin, Michelle

HIGH SCHOOL STUDENTS FROM culturally and linguistically diverse backgrounds frequently struggle with the literacy demands of middle and high school curricula. Many students with severe impairments do not have basic phonological awareness and decoding skills. To improve the reading achievement of these students and promote their success in content-area classes, teachers must apply best practices supported by reading research to help these students close the gap between themselves and their normally achieving peers. Teachers who use direct and explicit instructional strategies that are both developmentally appropriate and culturally and linguistically responsive are most likely to be effective with students of diverse backgrounds. It is critical that the intervention match the student’s level of reading development. Opportunities to improve phonological awareness and decoding skills will assist these students in building reading fluency, developing vocabulary knowledge, and enhancing comprehension. Phonological awareness refers to an individual’s ability to hear and manipulate the sound structure of language. It involves both an understanding of syllable and rhyme and sensitivity to the individual sounds of language, or phonemes (McCollin & O’Shea, 2005). Students with reading problems frequently struggle with these skills and can benefit from instruction in this area. In concert with direct and explicit instruction in phonological awareness skills, teachers of very poor readers will need to teach them decoding and word-attack skills.

Research has demonstrated both cognitive and affective benefits of learning contexts that are responsive to students’ familiar home and community experiences (Ball, 2000; Godina, 2003; Ladson- Billings, 1995). Effective practices include affirmation of ethnic identity, curricular emphasis on students’ cultural heritage, and classroom structures that promote peer-to-peer interaction and sharing of knowledge (Boykin & Bailey, 2000; Foster, Lewis, & Onafowora, 2003; Lee, 2001). One way for educators to place diverse students, their histories, and their experiences at the center of the learning process is to use culturally relevant materials, including multicultural literature and content-area texts with multicultural themes and applications. Another way is to give students opportunities to view themselves as sources of knowledge and valued members of the learning community. Last, a climate of respect for cultural and linguistic diversity provides a motivating context for literacy learning (Cummins, 1986). Culturally responsive instruction is not merely a matter of focusing on holidays or ethnic foods. Rather, it is instruction integrated into the daily activities of the classroom (McCollin & O’Shea, 2005).

Improving Phonological Awareness

For students who lack phonological awareness, teachers should provide explicit instruction, focusing on only one or two phonemic awareness skills, such as segmenting and blending, at a time. After beginning with auditory phonemic activities, teachers can link sounds to letters and provide opportunities for students to apply their phonological awareness when reading and writing. As with other students who display difficulties with phonological awareness, students from culturally and liguistically diverse backgrounds can benefit from systematic instruction in identifying and manipulating the sounds of spoken language (Vaughn, Bos, & Schumm, 2005). Effective instructional strategies that target phonological awareness can improve literacy learning. In addition, by using culturally relevant materials and approaches that build on students’ cultural funds of knowledge, educators can increase student learning and engagement.

Develop Students’ Facility With the Sounds of Language Through Hip-Hop Music

Hip-hop music developed from an oral tradition and is therefore an ideal medium through which students can exercise auditory discrimination skills. Hip-hop uses alliteration, rhyme, and near rhyme-all of which educators can use in teaching students to discriminate and manipulate phonemes. Hip-hop is a vital part of youth culture, particularly for students of diverse ethnic heritage. Although educators have sometimes perceived hip-hop music as inappropriate for instruction, it offers unique opportunities. (However, teachers should preview lyrics before playing music in their classes; some hip-hop songs contain language or messages that may be offensive.) For example, in one activity, teachers and students can examine the study of rhyme and near rhyme in popular hip-hop lyrics. Then, teachers can ask each student to write two poems or raps: one that only uses perfect rhyme and one that uses at least four instances of near rhyme. Students can share the poems or raps in class the next day, comparing the effects of perfect and near rhyme.

Play Word Games With Culturally Specific Language

Students can create alliteration, rhymes, and other wordplay with language that is familiar to them. For example, students can use sociorelevant vocabulary: “Miguel misses mangoes Monday.” Teachers can easily incorporate these activities into daily routines. For example, when students are ready to be dismissed, the teacher may ask that all students whose names end in “t” close their books and prepare to leave. Or the teacher might start a game by designating a starting sound (e.g., “b”), having the class decide where they would like to go (e.g., Trinidad), and saying, for example, “I’m going on a trip to Trinidad, and I’m going to take [an item that begins with the starting sound “b”] a ball.” Each student has to repeat the sentence, with its growing list of items that have been named, and must modify the sentence by adding an item beginning with the starting sound. For example, a student may recite, “I’m going on a trip to Trinidad, and I’m going to take a ball, a bat, a burrito, and a banjo.” Students will naturally think of items that are culturally familiar to them.

In addition, tongue twisters may present to students an enjoyable challenge. This one is particularly difficult: “The sixth sick sheik’s sixth sheep’s sick.” The teacher may divide the class into small groups that can create their own tongue twisters, which they present to the class. Spoonerisms can also be fun. For example, students could correct phrases such as “pweet sotato” (sweet potato), “chilled grease” (grilled cheese), and “chish and fips” (fish and chips). Teachers can use sentences, too: “You’re hitting on my sat” (You’re sitting on my hat). Again, teachers can encourage students to use culturally familiar examples.

Use the Power of the Arts: Music, Visual Arts, Drama, Dance, Movement

Teachers can make segmentation of phonemes more fun by using the rhythm of a particular ethnic instrument or beat. For example, teachers can ask students to tap an African drum for each sound in the word “dragon.” Teachers can also incorporate movement activities, each representing a phoneme, whereby students perform the material in some way, reinforcing learning through multisensory approaches.

Use Multicultural Poetry to Teach Phonological Awareness

Gwendolyn Brooks’ poems “The Bean Eaters” and “The Pool Players” appeal to young adults and contain various literary devices that support phonological-awareness learning (Brooks, 2006). Playing an audio recording of the author reading the poems would be a unique way to present this material. Students could invent their own poems that are similar to those. Also, teachers could introduce students to counting syllables through the reading and writing of haiku.

The explicit understanding of a word’s sound structure is critical for the efficient decoding of printed words and the ability to form connections between sounds and letters when spelling. Students need solid phonological awareness for decoding instruction to be effective.

Improving Decoding and Word Identification Skills

Some secondary students may need extensive decoding instruction. For these students, the teacher must begin with the basic phonetic rules of English. The use of decodable books is an effective way for students to gain practice decoding words in text. When culturally relevant decodable texts are not available, it may be necessary for the teacher to encourage students to discuss ways in which they can relate the decodable text to their own experiences. For example, when a student reads “a cat sat on the mat,” he might relate it to the Spanish folk song “El senor don Gato .” Another student might be able to relate it to the Korean folk tale “The Dog and the Cat.” For some students, more challenging word and sentence study-including study of rimes, roots, affixes, and sentence construction-would be appropriate. Teachers can engage more capable readers by providing instruction in strategic word-attack skills, including syllabication and morphemic analysis of words. Whenever possible, teachers should emphasize culturally relevant reading material to practice word- attack skills.

Mapping Phonemes to Graphemes

Students’ mapping phonemes to graphemes on a chart is excellent practice in building decoding skills (Grace, 2005; Moats, 2005). Diagramming the sound-letter relationship is an effective method for helping students to understand the often-confusing relations between phonemes (the sounds that we hear in a word) and graphemes (the letters that represent those sounds). Students who are unable to transfer their phonological awareness to print can learn to map words while diagramming the sound-letter relationship. Using Onset and Rime

Goswami and Bryant (1990) suggested that the linguistic units of onset and rime may be crucial in explaining the link between rhyming and reading. Onset is the word’s initial consonant or consonant clusters, and rime is the vowel of a syllable plus any consonants that might follow. For example, in the word “pat,” p is the onset and at is the rime. In the word “splat,” spl is the onset and at is the rime. Children who recognize onsets and rimes can learn to make analogies between spelling patterns in words to help them read new words. For example, a child who can read table can more easily learn to read stable, cable, gable, and fable . Adams (1990) concluded that teachers’ use of analogy is an effective method for teaching students to decode.

Teaching Strategies for Decoding Multisyllabic Words

As they move through the grades, students are confronted by multisyllabic words, such as polymorphous, habitat, and undesirable. Secondary students need to develop the ability to read orthographic chunks to help them decode these words. Teachers can model and do think-alouds to support students in blending practice to improve their ability to read longer words. Lenz and Hughes (1990) offered the mnemonic DISSECT to help secondary-level students decode unknown words. The steps are:

Discover the context.

Isolate the prefix.

Separate the suffix.

Say the stem.

Examine the stem.

Check with someone.

Try the dictionary.

Educators can teach students this strategy, and students can practice it while reading culturally relevant texts at their instructional level.

Teaching Syllabication

Teaching syllabication begins with teachers’ helping students to recognize what a syllable is and how to count the syllables in words. Students can learn the six common syllable-spelling patterns in order from the simplest patterns (closed syllables and open syllables) to more difficult patterns (e.g., r-controlled diagraphs, vowel diagraphs). For each syllable type, students can look for examples in culturally relevant texts. In another activity, the teacher can divide words that were selected from upcoming reading texts into syllables, write each syllable on a note card, and display the syllables in jumbled order. Students would work in pairs to arrange the syllables to form the word. Another variation would have the teacher write 20 multisyllabic words from an upcoming story. Students would work with a partner to draw an arc under each syllable as they read aloud each word. Last, students would code each syllable type; alternatively, students could code a specific syllable type. For example, they could circle all the consonant- plus-le syllables or underline all closed syllables. Teachers can use stories with multicultural themes and topics to motivate students.

Providing Instruction in Patterns of Morphologic Elements

Students can learn and practice morphology, which explains word origins and development in terms of roots, prefixes, and word families, in both reading and writing. For example, students can keep a word family notebook with entries such as suggest, suggestibility, suggested, suggestion , suggestible, and suggestive. English language learners could be encouraged to relate English morphological elements to those in their native language through cognates.

Conclusion

Students who have failed to read well are capable of learning to read when teachers offer them (a) sufficient time and intensity for interventions and (b) appropriate instructional practices. When secondary students of diverse backgrounds struggle with reading, teachers need to provide systematic and explicit instruction in foundational skills with sensitivity to the cultural and linguistic experiences of those students. Teachers can create classroom structures that provide more socially interactive environments that tap into the cultural and linguistic resources within students’ communities to connect school literacy practices with the students’ own histories and experiences. Use of culturally relevant materials and methods is one way of engaging students of diverse backgrounds, motivating them to continue the hard work necessary to close the gap between themselves and their normally achieving peers.

REFERENCES

Adams, M. J. (1990). Beginning to read: Thinking and learning about print. Cambridge, MA: MIT Press.

Ball, A. (2000). Empowering pedagogies that enhance the learning of multicultural students. Teachers College Record, 102, 1006-1034.

Boykin, A. W., & Bailey, C. (2000). The role of cultural factors in school relevant cognitive functioning: Synthesis of findings on cultural contexts, cultural orientations and individual differences (Report No. 42). Washington, DC: Howard University, Center for Research on the Education of Students Placed at Risk.

Brooks, G. (2006). Essential Brooks [CD]. New York: Caedmon.

Cummins, J. (1986). Empowering minority students: A framework for intervention. Harvard Educational Review, 56, 18-36.

Foster, M., Lewis, J., & Onafowora, L. (2003). Anthropology, culture, and research on teaching and learning: Applying what we have learned to improve practice. Teachers College Record, 105, 261- 277.

Godina, H. (2003). Mesocentrism and students of Mexican background: A community intervention for culturally relevant instruction. Journal of Latinos and Education, 2, 141-157.

Goswami, U., & Bryant, P. E. (1990). Phonological skills and learning to read. London: Erlbaum.

Grace, K. (2005). Phonics and spelling through phoneme-grapheme mapping. Longmont, CO: Sopris West Educational Services.

Ladson-Billings, G. (1995). But that’s just good teaching! The case for culturally relevant pedagogy. Theory Into Practice, 34, 159- 165.

Lee, C. (2001). Is October Brown Chinese? A cultural modeling activity system for underachieving students. American Educational Research Journal, 38, 97-142.

Lenz, B. K., & Hughes, C. A. (1990). A word identification strategy for adolescents with learning disabilities. Journal of Learning Disabilities, 23, 149-163.

McCollin, M., & O’Shea, D. J. (2005). Increasing reading achievement of students from culturally and linguistically diverse backgrounds. Preventing School Failure, 50(1), 41-44.

Moats, L. C. (2005). Language essentials for teachers of reading and spelling (LETRS). Longmont, CO: Sopris West Educational Services.

Vaughn, S., Bos, C. S., & Schumm, J. S. (2005). Teaching exceptional, diverse, and at-risk students in the general education classroom (3rd ed.). Boston: Allyn & Bacon.

Kathleen McQuiston is a doctoral candidate in the Department of Instruction and Learning at the University of Pittsburgh. Her research interests are struggling readers, culturally relevant instruction for students with disabilities, and bilingual special education. Doris O’Shea is a professor in the Department of Special Education at Slippery Rock University of Pennsylvania. Her research interests are instructional strategies, legal issues in special education, and teachers’ work with diverse families. Michelle McCollin is a professor in the Department of Special Education at Slippery Rock University. Her research interests are culturally relevant instruction and reading strategies. Bob Algozzine, column editor, is a professor in the Department of Educational Leadership and is director of the Behavior and Reading Improvement Center at the University of North Carolina at Charlotte. His research interests are effective teaching, schoolwide positive behavior support, and improving basic early literacy skills. Copyright (c) 2008 Heldref Publications

Copyright Heldref Publications Winter 2008

(c) 2008 Preventing School Failure. Provided by ProQuest Information and Learning. All rights Reserved.

In Times of Uncertainty: Predicting the Survival of Long-Distance Relationships

By Cameron, Jessica J Ross, Michael

ABSTRACT. The authors examined the degree to which ratings of negative affectivity (NA) and relational security predicted the breakup of long-distance and same-city dating relationships. Couples completed initial surveys and were contacted 1 year later about the status of their relationship. In the initial surveys, both partners completed NA and relational security assessments. Overall, both the NA and relational security of men and women predicted stability. However, as predicted, structural equation modeling revealed a gender difference in the interaction between NA and long-distance status. The presence of high NA in men was associated with breakup for long-distance but not same-city couples. High NA in women was not differentially associated with relational stability on the basis of long-distance status. The authors discuss the psychological basis of this gender difference. Keywords: gender differences, negative affectivity, personality, relationships

LONG-DISTANCE RELATIONSHIPS are becoming increasingly common (Guldner, 2003). About one third of all dating relationships among university students are long distance (Stafford & Reske, 1990), and the proportion is even greater among 1st-year university students (Aylor, 2003). Physical separation of partners is associated with increased distress and depression (Guldner, 1996) and reductions in relationship satisfaction (Van Horn et al., 1997) and stability (Helgeson, 1994a; Lydon, Pierce, & O’Regan, 1997). Nonetheless, many long-distance dating relationships do survive. What are the conditions that lead some long-distance relationships to survive and others to fail?

Although few researchers have investigated the persistence of long-distance relationships, many have studied dating and marital stability. Most researchers interested in relational stability in proximate couples have examined characteristics of the relationship and of the individuals within those relationships as predictor variables (see Cate, Levin, & Richmond, 2002, and Karney & Bradbury, 1995, for reviews). Most relational stability research on distant daters has focused on the characteristics of physical separation, such as the number of miles separating residences (e.g., Carpenter & Knox, 1986) or the method of communication between partners (e.g., Dainton & Aylor, 2002), whereas few researchers have investigated characteristics of the relationships themselves (e.g., Schwebel, Dunn, Moss, & Renner, 1992). Researchers have also neglected to investigate the influence of individual differences on the stability of long-distance relationships. We argue that one personality characteristic-negative affectivity (NA)-is especially important for understanding stability in long-distance relationships. NA encompasses (a) dispositional pessimism about the future, (b) low self-esteem, and (c) the tendency to experience negative emotions such as anxiety and depression (Watson & Clark, 1984). High-NA individuals are less able to cope with general stress (Bolger & Zuckerman, 1995; Marco & Suls, 1993) and may therefore be particularly ill-suited to cope with the physical separation in long- distance relationships. Accordingly, the purpose of the present study was to examine whether NA differentially predicted the stability of long-distance and same-city relationships. To accomplish this goal, we followed dating couples involved in long- distance and same-city relationships over the course of 1 year to assess stability.

Predicting Relational Stability

Research has indicated that being involved in an enduring romantic relationship is beneficial for both physiological health and psychological well-being (Pierce, Sarason, & Sarason, 1996). Many psychologists have pursued ways to understand how people can establish stable relationships and consequently reap these benefits. Researchers investigating relational stability have focused on understanding the characteristics of stable relationships, the characteristics of individuals within those relationships, and the environments that facilitate or hinder these relationships (see Cate et al., 2002, for a review). Perhaps the most intuitive finding in this area is that people who are unhappy with their relationships are more inclined to break up (e.g., Karney & Bradbury, 1995; MacDonald & Ross, 1999). However, underlying this sense of relationship satisfaction rests a more important variable: relational security, or the sense of trust and faith one has in one’s partner and relationship (Reis, Clark, & Holmes, 2004). Relational security appears to be a necessary requirement for progress in any interaction. Relationships, both proximal and distant, generally require a “leap of faith,” a belief that one’s partner will keep one’s own best interests at heart and will try to maintain the relationship (Murray & Holmes, 1997; Murray, Holmes, Griffin, Bellavia, & Rose, 2001). One must have faith that a partner is both motivated (i.e., in love and committed) and actively behaving in a manner to maintain the relationship (i.e., not seeking alternative partners) to reciprocate similar behaviors and build intimacy and stability (Murray, Holmes, & Collins, 2006). Individuals who have a high sense of relational security should be more likely to work actively to maintain the stability of the relationship and therefore less likely to break up. Individuals with low relational security, who have little faith in either their partner’s regard for them or the viability of the relationship, should invest less in the relationship, behave in a less committed manner, and ultimately initiate or cause the demise of their relationship. Accordingly, we predicted that relational security would be associated with greater relational stability in both long- distance and same-city relationships (Hypothesis 1). Previous research findings support such an expectation. For example, MacDonald and Ross found that people with greater optimism about the future of their relationship were less likely to break up, and Kurdek (2002) found the same for people who reported greater trust in their partners. Le, Smoak, and Agnew’s (2006) meta-analysis of research on the stability of dating relationships demonstrated that individuals who report high trust are much less likely to break up.

Both individual characteristics and environmental factors can influence relational security, which in turn affects relational stability. Of all of the individual differences that relationship researchers have investigated, NA appears to have the strongest influence on relational stability (Hendrick, Hendrick, & Adler, 1988; Karney & Bradbury, 1995). High-NA individuals seem to possess several tendencies that make their relationships less likely to succeed than the relationships between low-NA individuals. In contrast to low-NA individuals, those with high-NA tend to (a) experience more negative emotions, which increases the negativity of their interactions with others (Furr & Funder, 1998; Vittengl & Holt, 1998); (b) worry more about how their partners view them and consequently report lower levels of relational security (Murray, Holmes & Griffin, 2000); (c) react to stressful experiences with greater negative affect (Bolger & Zuckerman, 1995; Marco & Suls, 1993); and (d) experience greater motivation to protect the self (Baumeister, Tice, & Hutton, 1989).

The self-protective, low risk-taking tendencies of high-NA individuals (Baumeister et al., 1989) may lead them to preemptively end their relationships in times of stress or relational threat. Alternatively, research involving both daily diary studies and laboratory studies has demonstrated that high-NA or rejection- sensitive individuals tend to respond to threats to relationship security with more negative, harmful interpersonal behaviors, such as devaluing their partners and distancing themselves from them (Downey, Feldman, & Ayduk, 2000; Downey, Freitas, Michaelis, & Khouri, 1998; Murray, Bellavia, Rose, & Griffin, 2003; Murray, Holmes, MacDonald, & Ellsworth, 1998). By withdrawing from their partners, insecure individuals presumably shield themselves from possible rejection (Murray, 2005; Murray & Derrick, 2005). Nevertheless, these behaviors lead the partners of high-NA individuals to feel reduced relationship satisfaction, which encourages contemplation about ending the relationship (Downey et al., 1998; Pietrzak, Downey, & Ayduk, 2005). Thus, the relationships of high-NA individuals, when under duress, may be more likely to end because these individuals have behaved so poorly that their partners take action to terminate the relationship. Given these tendencies toward self-protection and retaliation rather than toward relationship maintenance, we expected that high NA would be associated with low relational stability (Hypothesis 2), as previous researchers have found (see Karney & Bradbury, 1995, for a meta- analysis).

High NA alone does not necessarily lead relationships to terminate prematurely. Rather, the reactions of high-NA individuals to situations that threaten the security of their relationship-for instance, conflict (Downey et al., 2000; Downey et al., 1998) and stress (Bolger & Zuckerman, 1995; Marco & Suls, 1993)-contribute to a relationship’s demise. In the present study, we expected that distant dating would serve as one of those situations that elicits threats to relational security and ultimately reduces the stability of relationships for high NA individuals. Long-distance dating can disrupt relational security, making partners worry about the future of their relationship (Aylor, 2003). In comparison with same-city couples, individuals in long-distance relationships are less able to monitor their partner’s behavior and offer emotional support (e.g., Guldner, 1996). Research indicates that the majority of undergraduate students believe that long-distance relationships are less stable than same-city relationships (Helgeson, 1994a) and that distance worsens existing relationships (Knox, Zusman, Daniels, & Brantley, 2002). This belief might further reduce the perceived relational security of long-distance couples. Indeed, researchers have found that the physical separation involved in long-distance dating is associated with lower relationship satisfaction (Van Horn et al., 1997) and stability (Helgeson, 1994a; Lydon et al., 1997). Thus, we predicted that long-distance relationships would terminate earlier than would same-city relationships (Hypothesis 3). Moderation and Mediation: The Role of NA, Relational Security, and Long-Distance Status

Long-distance relationships appear to be especially threatening to relational security. Because high-NA individuals respond poorly to relational insecurity (Downey et al., 2000; Downey et al., 1998; Murray et al., 2003; Murray et al., 1998), we expected that high NA would be more damaging to the stability of long-distance relationships than to that of same-city relationships. In high-NA individuals, situations that elicit interpersonal risks, such as long-distance dating, should trigger (a) greater suspicions about a partner’s regard, (b) more negative emotions, and (c) greater engagement in self-protective behaviors. Thus, we predicted that high-NA individuals in long-distance relationships would be more likely to break up with their partner within 1 year than would both high-NA individuals in same-city relationships and low-NA individuals in both types of relationships. However, we reasoned that gender, a variable known to impact multiple aspects of heterosexual relationships (see Peplau & Gordon, 1985, for a review), would be essential for predicting the impact of NA on relational stability in long-distance and same-city relationships.

We obtained assessments from both dating partners about their relationship, which enabled us to examine whether the NA levels of men and women differentially predicted the dissolution of long- distance relationships. The current literature on gender differences in relationship research is extensive, but findings are mixed. In a prominent review of the relationship literature, Karney and Bradbury (1995) found that individual characteristics of both husbands and wives predicted marital stability to about the same extent. In an earlier review of the literature, however, Barry (1970) reported that assessments obtained from husbands were generally stronger predictors of marital stability than were comparable assessments obtained from wives. More recent research (e.g., Kinnunen & Pulkkinen, 2003) has suggested that some individual differences predict stability for men, whereas other traits predict stability for women.

Differences in the predictability of men’s and women’s assessments may be particularly evident in long-distance dating relationships. Compared with women, men (a) place greater importance on face-to-face contact (Carpenter & Knox, 1986), (b) are less likely to build intimacy through distant communication methods (e.g., e-mail; Boneva, Kraut, & Frohlich, 2001), and (c) are less satisfied with and less able to adjust to long-distance relationships (Dellmann-Jenkins, Bernard-Paolucci, & Rushing, 1994; Helgeson, 1994b). Research on married couples indicates that for social support, men generally rely on their wives, whereas women depend heavily on friends and family (Antonucci & Aikyama, 1995; Fischer & Phillips, 1982; van Daalen, Sanders, & Willemsen, 2005). Long-distance dating may especially affect the relational security of men because they have reduced contact with their primary source of social support. If long-distance dating is more threatening to men’s relational security, then NA may be more predictive of breakup in long-distance relationships when the partner with high NA is a man rather than a woman. In other words, we added greater specification to the prediction that high NA would be more detrimental in long-distance relationships than in same-city relationships. Specifically, we predicted that long-distance dating relationships in which the male partner has high NA would be more likely to have dissolved within 1 year of the study than would either (a) distant relationships with low-NA men or (b) same-city relationships regardless of the NA status of the men (Hypothesis 4). We also predicted that in long-distance relationships, men’s NA would be more predictive of breakup than would women’s NA (Hypothesis 5).

Long-distance dating should be a particularly stressful circumstance for high-NA males, one that ultimately reduces their relational security and leads to the early end of these relationships. Men’s greater value of face-to-face contact and their primary reliance on female partners for social support (Antonucci & Aikyama, 1995; Fischer & Phillips, 1982; Van Daalen, Sanders, & Willemsen, 2005) may lead high-NA men to have reduced levels of trust and faith in a partner. Decreasing social support and contact with a partner is associated with reductions in relational security (Parks & Adelman, 1983) and stability (Baxter, 1986). Thus, the reduced relational security experienced by high-NA men in distant relationships likely leads these men to either initiate a breakup of these relationships or behave so poorly toward their partners that their partners end the relationships. We therefore anticipated that men’s ratings of relational security would mediate the relation between men’s NA and the dissolution of long-distance relationships (Hypothesis 6).

Study Overview

We conducted the present study to investigate how NA, gender, and long-distance status interact to predict relational stability. To our knowledge, researchers have not previously integrated research on NA, gender, and relationship security into predicting the stability of long-distance relationships. Several scholars, however, have called on researchers to investigate such factors. For example, in recent reviews of the literature, Rhodes (2002) called for more researchers to investigate personality, and Aylor (2003) suggested that more researchers investigate trust-a central component of relational security-in distant relationships. We believe that by investigating these variables in the context of long-distance relationships, we can identify which long-distance relationships are more likely to remain intact and which are likely to dissolve.

We designed this study to test the aforementioned six hypotheses. The first three hypotheses relate to previous research whose results we hoped to replicate, whereas the latter three hypotheses are previously untested in the literature. To test our predictions, we conducted a 1-year longitudinal study with same-city and long- distance dating couples. At the outset (Time 1), both partners completed questionnaires assessing different components of NA and relational security. Researchers contacted participants 2 months, 6 months, and 1 year later to determine whether the couples had remained together.

Method

Participants

Participants were 91 introductory psychology students who volunteered to participate with their current dating partner. To qualify for the study, potential participants had to be in an exclusive dating relationship that had started more than 3 months earlier. Sixty-eight couples completed the questionnaires in the laboratory. For the remaining 23 couples, one partner completed the survey in the laboratory, and the other partner, who was unable to attend, completed the survey at home and returned it by mail. Individuals recruited from the introductory psychology class received partial course credit; their partners not in the class received $10.

Participating couples reported dating exclusively for an average of 12.56 months (SD = 8.76 months, range = 3-60 months). The average age of participants was 19.45 years (SD = 1.56 years, range = 16-27 years). Participants also indicated whether they considered their relationship to be long distance. We verified their self-described status by comparing the area codes of partners’ phone numbers. In all cases, self-described status matched the status derived from area-code comparisons. Thirty-seven (42%) of the couples were in long-distance relationships. Participants in same-city and long- distance relationships did not differ in age or length of relationship, Fs(1, 180)

Procedure

Participants completed the survey after we had obtained their informed consent. Participants who completed the survey in the laboratory were separated by partitions and instructed not to communicate with one another as they completed the questionnaires in groups of up to 6 individuals. Participants who submitted their surveys through the mail were instructed not to discuss the survey with their partner prior to returning it. To assess relational stability-our dependent variable in all six hypotheses-we telephoned participants 2 months, 6 months, and 1 year after the initial survey. If we did not reach participants after three phone calls on 3 different days at 3 different times, we contacted them at another phone number (e.g., their parents’ phone number) or by e-mail. Participants indicated whether they were still with their original partner and, if the relationship had ended, when the breakup had occurred. At least one member from each couple participated in this short interview at each time period. We were able to obtain information on relationship status 1 year after the initial survey for 100% of the couples. After the 1-year period, we provided all participants with feedback on the original research goals and the general findings from the study. Measures of NA at Time 1

We assessed NA with three standard scales that measure (a) self- esteem, (b) depression, and (c) pessimism.

Self-esteem. To assess self-esteem, we used Rosenberg’s (1965) Self-Esteem Scale (RSES; as = .88 and .87 for men and women, respectively, in the present study). Participants responded to each of the 10 items on the RSES (sample item: “I feel that I am a person of worth, at least on an equal basis with others”) on a 9-point scale ranging from 1 (very strongly disagree) to 9 (very strongly agree). After reverse coding the negatively worded items, we averaged each individual’s scores on the 10 items to create a total score whereby high scores indicated high self-esteem.

Depression. To assess depression, we asked participants to complete Beck’s (1967) Depression Inventory (BDI; as = .85 for both men and women in the present study). The BDI contains 21 groups of four related statements. Respondents select one of the four statements in each grouping that best describes their current emotional and physical state; responses are then coded from 0 to 3 to represent increasing degrees of symptom severity. For example, the first group of statements was as follows: (a) “I do not feel sad” (coded as 0); (b) “I feel sad” (coded as 1); (c) “I am sad all the time and I can’t snap out of it” (coded as 2); and (d) “I am so sad or unhappy that I can’t stand it” (coded as 3). Scores are then summed to indicate presence and severity of depression; they can range from 0 (no depression) to 63 (high depression ).

Pessimism. Participants responded to three items from the revised Life Orientation Test (LOT-R; Scheier, Carver, & Bridges, 1994) designed to measure dispositional pessimism (as = .73 and .63 for men and women, respectively, in the present study). Participants responded to each of the three items (sample item: “If something can go wrong for me, it will”) on a 5-point scale ranging from 1 (disagree a lot) to 5 (agree a lot). We then averaged scores to create a total pessimism score whereby high values indicated greater pessimism.

To create a composite score of negative affectivity for each participant, we first reverse scored the self-esteem average so that for all three scales, lower numbers reflected lower levels of negative affectivity (i.e., higher self-esteem, lower depression, and lower pessimism). We then standardized and combined scores on the three measures to create a reliable index of negative affectivity (as = .87 and .84 for men and women, respectively).

We selected these scales because in addition to demonstrated reliability in the present study, all have demonstrated high performance in similar samples. The RSES is the most widely used of the various self-esteem measures (Blascovich & Tomaka, 1991; Gray- Little, Williams, & Hancock, 1997); it has also received the most empirical validation (Byrne, 1996; Gray-Little et al.; Wylie, 1989), and Wylie recommended its use across a variety of populations, including university and college samples. The BDI is the most widely used self-report-based depression measure in empirical studies (Shaver & Brennan, 1991) and is appropriate for use in nonclinical college samples (Kendall, Hollon, Beck, Hammen, & Ingram, 1987). Last, the LOT-R is the most widely accepted measure of pessimism and optimism (see Chang, 2001, for examples) and was originally validated on college samples (Scheier et al., 1994).

Measures of Relational Security at Time 1

We measured three variables-faith in partner, expected support, and relationship optimism-to assess relational security. Unless otherwise noted, participants responded to items on the measures on a 9-point scale ranging from 1 (not at all true) to 9 (extremely true). Some items were reverse coded so that for all three measures, higher scores would represent greater security. We then averaged each participant’s scores on each measure.

Faith in partner. Participants responded to the following four items from the Faith subscale of Rempel, Holmes, and Zanna’s (1985) Trust Scale: (a) “I feel completely confident that my partner loves me”; (b) “I feel that I can trust my partner completely”; (c) “Though times may change and the future is uncertain, I know my partner will always be ready to offer me strength and support”; and (d) “I am confident that my partner will always be able to see the best in me, no matter how poorly I behave” (as = .75 and .73 for men and women, respectively, in the present study).

Expected support. Participants indicated how likely it was that their partner would engage in four different support-related behaviors (derived from Murray et al., 1998) in the next 6 months. Participants responded to the following items: (a) “My partner will want more independence and pull away from me” (reverse coded); (b) “My partner will neglect my needs and feelings” (reverse coded); (c) “My partner will forgive me if I disappoint him or her”; and (d) “My partner will provide needed support when I’m feeling down” (as = .62 and .61 for men and women, respectively, in the present study).

Relationship optimism. Participants indicated how confident they were that they and their partner (a) would be together 5 years from now, (b) would get married, and (c) would remain together for life (derived from MacDonald & Ross, 1999). A response of 100% to each item indicated that participants were completely certain this outcome would occur, a score of 50% indicated that they were completely uncertain about that outcome, and a score of 0% indicated that they were completely certain that outcome would not occur (as = .98 for both men and women in the present study).

We standardized each participant’s mean score for faith in partner, relationship optimism, and expected support and collapsed across them to create an index of relationship security (as = .86 and .76 for men and women, respectively, in the present study).

Results

Analysis Strategy

Our first task was to determine whether any of the couples had terminated their relationships within the assessment periods; because all six of our hypotheses involved relational stability, any further analysis would have been futile if all couples had remained intact. However, this was not the case with the present sample: Four of the couples (4.4%) had separated at 2 months, 11 (12.1%) had separated at 6 months, and 26 (28.6%) had separated at 1 year. Because of low variability in breakup at the 2- and 6-month assessments, we conducted analyses only on the breakup rate at the 1- year period. In the main analyses to test the six hypotheses, we adjusted for the interdependence of the data. Because we assessed both members of the couple, the reports of men and women described the same relationship and thus had a high probability of being interrelated. Consequently, the dyad was the unit of analysis. That is, men’s and women’s NA and relational security represented four variables within the data file: (a) men’s NA, (b) women’s NA, (c) men’s relational security, and (d) women’s relational security. We treated each of these predictors as a within-subject variable. Two variables, however, were independent of the other cases: proximity status and relationship outcome. Because there was only one status and one outcome per couple, we treated these variables as between- subject variables. We discuss below the strategy used to adjust for the interdependence of the data.

Predicting Relational Stability

To test the first and second hypotheses, we examined whether measures of relational security and NA obtained at Time 1 predicted relationship breakup. We conducted zero-order point-biserial correlations between each of the Time 1 indexes and relationship status at 1 year (coded as 0 for broke up and 1 for intact) for the entire sample. Overall, relational security was positively associated with relational stability for men, r(90) = .37, p

Next, we tested whether the proximity of partners predicted subsequent breakup (Hypothesis 3). A cross-tabulation of proximity status (long distance vs. same city) and stability outcome (together vs. broken up) revealed that a nonsignificantly greater proportion of long distance relationships had dissolved (35% vs. 24%), .2(1, N = 91) = 1.32, ns. Thus, our first three predictions were confirmed, and our results replicated the previous findings on which our research was based. We next tested the previously untested hypotheses.

To test Hypothesis 4-that men’s NA in long-distance relationships would be more predictive of relationship outcomes than would either (a) men’s NA in same-city relationships or (b) women’s NA regardless of proximity-we conducted a hierarchical multiple regression analysis with relationship status at 1 year (coded as 0 for apart and 1 for intact) as the criterion variable and the dyad as the unit of analysis (see Kashy & Kenny, 2000). Per Aiken and West’s (1991) recommendation, we centered the continuous variables of men’s and women’s relationship security and NA by subtracting the mean for each variable from each score to yield a mean score of 0. We effect- coded proximity (long distance = -1, same city = 1). In Step 1 of the analysis, we entered as predictors (a) men’s relationship and NA indexes, (b) women’s relationship and NA indexes, and (c) the long- distance status of the relationship (see Table 1 for intercorrelations between variables). Step 1 tested for any main effects that these variables may have had on relationship outcome. In Step 2, we entered simultaneously as predictors the two-way interactions (a) between men’s and women’s relational security and NA indexes and (b) between these indexes and long-distance status. In Step 3, we entered the three-way interactions (a) between men’s NA, relational security, and proximity and (b) between women’s NA, relational security, and proximity.2 Step 1 (including main effects), Step 2 (including the two-way interactions), and Step 3 (including three-way interactions) were all significant, R = .42, F(5, 85) = 3.63, p

As Table 2 shows, the more favorably that men evaluated the security of their relationship, the more likely were both same-city and different-city couples to be intact 1 year later. A significant interaction between men’s levels of NA and proximity revealed that men’s NA was significantly related to relational stability only in long-distance couples (see Figure 1). For long-distance relationships, the greater was the men’s NA, the less likely were these relationships to be intact 1 year later, B = -0.32 (SE = 0.09), ss = -.53, t(36) = -3.67, p

Testing gender differences. We sought to test whether men’s NA predicted stability in long-distance relationships more than did (a) men’s NA in same-city relationships and (b) women’s NA in both types of relationships. Because we had collected data from both members of the couple, we could not run the straightforward test of the predicted three-way interaction between gender, NA, and proximity (Hypothesis 5). Instead, we had to compare the significance of the two-way interaction between men’s NA and proximity to the interaction between women’s NA and proximity. A finding that the interaction between men’s NA and proximity was significantly more predictive of relationship outcome than was the interaction between women’s NA and proximity would have supported Hypothesis 5 (that it is men’s and not women’s NA that predicts relationship outcomes in long-distance relationships).

To examine whether the men’s NA x Proximity interaction was significantly more predictive than was the women’s NA x Proximity interaction, we created and compared two structural equation models using Amos 4.0 (Arbuckle & Wothke, 1999). In both models, we included (a) men’s NA, (b) women’s NA, (c) men’s relational security, (d) women’s relational security, and (e) proximity as predictors of relational stability (see Table 2) and allowed all predictors to covary with each other. The first model represented a situation in which no gender differences existed (no gender difference model). We constrained paths for each set of predictors (NA, relational security, NA x Proximity, and Relational Security x Proximity) so they would be equal for men and women. For example, we set men’s NA and women’s NA to equally predict relational stability. This model fit the data very well, .2(5) = 5.72, ns, CFI = .997, RMSEA = .040. In the second model, we constrained all paths so they would be equal across genders, except for the NA x Proximity interactions (predicted gender difference model). This model fit the data extremely well, .2(4) = 2.88, ns, CFI = 1.00, RMSEA = .000. We conducted a chi-square difference test to compare the no gender difference model to the predicted gender difference model. Results indicated that the predicted gender difference model, in which the NA x Proximity interactions were not constrained, fit the data marginally better than did the no gender difference model, .2(1) = 2.84, p = .09. Thus, the interaction between men’s NA and proximity was more predictive of relational stability than was the interaction between women’s NA and proximity, supporting Hypothesis 5.

Mediation analysis. We conducted a test of mediated moderation, as outlined by Baron and Kenny (1986), to examine whether the effect of the interaction between men’s NA and proximity on relational stability was mediated by men’s perceptions of relational security (Hypothesis 6). In the first step, in which we controlled for lower- order main effects, men’s NA x Proximity was significantly associated with relational stability, B = 0.16 (SE = 0.08), ss = .29, t(87) = 2.84, p

Testing Alternative Explanations

In theory, differences between men and women on the initial measures of NA and relationship security could have impacted our findings on predictions of relational stability. To rule out this possible explanation for the gender differences we found in predicting stability, we tested for gender differences in our initial measures by conducting a 2 (gender: men’s measure vs. women’s mea-sure) x 2 (proximity: long distance vs. same city) repeated-measures analysis of variance (ANOVA) for each of the components of NA (self-esteem, depression, pessimism), with the dyad as the unit of analysis. In this analysis, gender was a within- subject factor-because the responses of the woman and the man in a couple were potentially interrelated-whereas proximity was a between- subject factor. We could not directly run this test on the index of NA because each of the measures of NA used a different scaling system, and thus the systems were standardized to form the index of NA. Therefore, any test of mean gender differences on NA would ultimately lead to nonsignificance because the means of men’s NA and women’s NA (being two separate variables) would always be zero on the standardized index. There were no significant main effects and no significant interaction for any of the NA components. Thus, gender differences in initial levels of NA could not have accounted for the greater impact that high NA in men had on the stability of long-distance relationships (see Table 3 for means, standard deviations, and correlations between partner’s scores on these measures).

We next examined whether possible gender differences in relational security could have contributed to men’s NA being a stronger predictor of stability for long-distance relationships. To test this alternative explanation, we conducted a 2 (gender: men’s measure vs. women’s measure) x 2 (proximity: long distance vs. same city) repeated-measures ANOVA. Again, gender was a within- subject factor and proximity was a between-subject factor. As in the above analyses, we ran this test separately on each component of relational security. There were no significant main effects for proximity and no significant interactions between gender and proximity on any of the relational security measures. There were, however, unexpected main effects for gender on the relational security scales: Compared to their male partners, women (a) were more optimistic about the future of their relationship, F(1, 89) = 6.86, p

Discussion

As long-distance relationships become increasingly more common (Guldner, 2003), it becomes essential that relationship researchers focus on the dynamics and processes of these relationships (see Aylor, 2003; Stafford, 2004, 2005). Although we do not propose that the processes in these relationships are qualitatively different from those in geographically close relationships, we believe that being geographically distant from a partner enhances interpersonal risk and stress, and certain relationship processes may therefore be exaggerated in long-distance relationships. Indeed, our results largely confirmed these expectations. Our findings support our first three hypotheses, which relate to replicating previous work: Lower relational security and high NA were associated with reduced relational stability (Hypotheses 1 and 2), and long-distance relationships were somewhat less likely to endure than were same- city relationships (Hypothesis 3). More important, two of our previously untested hypotheses were confirmed: Men’s NA was significantly associated with relational stability in long-distance but not same-city relationships (Hypothesis 4), and men’s NA in long- distance relationships significantly predicted stability, whereas women’s NA did not (Hypothesis 5). However, our expectation regarding the mechanism of this effect was not confirmed: Relational security did not mediate the impact of men’s NA on stability in long- distance relationships (Hypothesis 6). In contrast to the majority of researchers who have investigated the predictors of relational stability in dating couples, we assessed relational security and the individual characteristics of both partners. Also, we included dating couples experiencing a particularly interpersonally risky situation-living in different cities-as well as couples living in the same city. Past research findings have been inconsistent with respect to whether the assessments of men and women are differentially predictive of relational stability (Barry, 1970; Karney & Bradbury, 1995). Our findings provide support for both Barry’s and Karney and Bradbury’s conclusions. When examining the entire sample, we found that the pattern of correlations was very similar for men and women, as Karney and Bradbury’s review would suggest. When we included the proximity variable, however, the results indicated a different relation. The multiple regression analyses indicate that the association between stability and men’s NA hovers near zero in same-city relationships but becomes statistically significant in long-distance relationships. Moreover, as revealed in the structural equation analysis, the interaction between NA and proximity is significantly more predictive for men than for women. In essence, men with high NA seem to contribute to the dissolution of long-distance but not same-city relationships to a greater degree than do high-NA women.

One possible explanation for the lack of association between women’s NA and relational stability is that the women’s NA scores may have a truncated range (i.e., reduced variance) or may be generally higher than are men’s. However, we tested for and did not find any gender differences in means, variances, or distributions on any of the NA variables. Another possibility is women’s assessments may be less reliable than men’s, again reducing the possibility of finding significant associations between variables for women. Importantly, however, women’s NA was not less reliable than men’s NA.

Although the zero-order correlations and regression analyses yielded largely consistent findings, there is one important difference: Both men’s and women’s assessments of relational security were associated with relational stability in the zero- order correlations, but only men’s assessments predicted stability in the hierarchical regression. We likely did not obtain a prediction for women’s assessments in the regression analysis because partners’ evaluations of relational security were moderately related, r(90) = .49, p

Unexpectedly, women’s reports of relational security were higher than those of their male partners. We examined whether selection factors may account for our finding that women were more positive about the future of their relationships at Time 1 than were men. Because we recruited couples from an introductory psychology course in which approximately 70% of the students were women, the majority of participants recruited from the course were women (n = 60). Conceivably, individuals who volunteer to participate in relationship studies are more secure with their relationships. If so, it may explain why women, who mostly volunteered from the psychology course, reported higher relational security than did men, who may have been forced into the study by their partners. To examine this possibility, we compared reports of relational security from the men recruited from the psychology course to those from the men recruited by their partners; we then studied the same comparison for women. We found no statistical differences between men recruited from the psychology course and men recruited by their partners.

Strengths and Limitations

The majority of researchers studying dating couples have investigated the reports of only one partner. The use of such one- sided reports may have reduced the likelihood of finding significant gender differences. Our assessing reports from both partners may represent a more sensitive test of gender differences within relationships. In comparison to many previous researchers, we followed dating couples for a relatively long period of time after the initial survey. Although 1 year is short in comparison to the intervals examined in studies of marital stability, it is longer than the few months typically studied by researchers of dating relationships. Had we stopped at 2 or even 6 months, we may have missed the predicted interaction between men’s NA and long-distance dating because the variation in relational stability may have been too low.

We also measured and tested psychological processes that could explain why high NA in men is associated with reductions in relationship longevity in long-distance couples. High-NA men’s experiences of diminished faith in their partners’ regard and support may be exacerbated by the physical separation from a partner. Relative to their high-NA female counterparts who have substitute support networks, high-NA men may experience a greater reduction in social support and approval (Kernis, Cornell, Sun, Berry, & Harlow, 1993; Leary, Tambor, Terdal, & Downs, 1995) in long- distance relationships. Unexpectedly, on average, men in long- distance relationships did not experience less security in their relationships than did men in same-city relationships, and relational security did not mediate the relationship between the men’s NA x Proximity interaction and relational stability. In retrospect, we should have assessed relational security at each follow-up session because a reduction in relational security of high- NA men may have occurred after longer periods of physical separation. However, another possible explanation for why Hypothesis 6 was not supported is that the measures of relational security, which have received less psychometric investigation than have the measures of NA, are not sufficiently reliable. Although the internal consistencies of these scales are comparable to those for NA in this sample, the validity of these scales is not as well established (see Fletcher, Simpson, & Thomas, 2000).

Alternatively, other psychological processes could account for why high NA in men is detrimental to their long-distance relationships. For instance, previous researchers have demonstrated that individuals with high NA find life events more stressful than do low-NA individuals (Bolger & Zuckerman, 1995; Marco & Suls, 1993). Diminished support from a partner may lead high-NA men to experience greater distress rather than reduced relational security, which may in turn diminish the likelihood of a relationship’s success. Thus, at each follow-up assessment, we should have measured not only relational security but also distress. Future researchers should include such aspects in any further investigation of these effects.

One strength of our research is that we were able to collect both longitudinal data from both partners and stability data from 100% of the original couples. We attribute this success to our extremely short follow-up interviews. However, this success is paired with the drawback that we did not assess relational security or NA at these follow-up assessments.

Although our study had many strengths-including our (a) confirming most hypotheses, (b) investigating a novel situation, (c) exploring the mechanism behind a predicted effect while including both members of the couple, and (d) obtaining outcome data from all couples in the sample-it also had several limitations. As previously mentioned, in retrospect we should have included measures of relational security, NA, and distress at each of our follow-up assessments to fully explore change and the possible mechanism behind men’s NA being a more significant predictor in long-distance relationships. Three factors that we neglected to assess may be critical to the success of long-distance dating relation-ships: (a) actual geographical distance, (b) frequency and amount of contact, and (c) periods of geographical closeness. Although actual geographic distance may be an important fact in the stability of long-distance relationships, we chose to define a long-distance relationship on the basis of whether the partners identified themselves as in such a relationship, which is similar to the method used by Dellmann-Jenkins et al. (1994) and recommended by Stafford (2004) in a recent review of the literature. Because of this decision, we neglected to assess the mileage between residences, which Carpenter and Knox (1986) deemed crucial to understanding long- distance relationships. Regardless of our definition of long- distance dating, by not assessing actual distance between the partners, we may have missed an important predictor.

Although some researchers have reported that the actual geographical distance between partners may be important (e.g., Carpenter & Knox, 1986), certainly the amount and type of contact between long-distance partners is essential to the success of long- distance relationships. Several researchers have reported that greater face-to-face contact is associated with greater satisfaction and trust (Dainton & Aylor, 2002; Holt & Stone, 1988) and with relational stability (Carpenter & Knox). The frequency of letters (Stafford & Reske, 1990), telephone calls, and e-mails (Dainton & Aylor) between partners is also associated with increased satisfaction and relational security. However, other researchers have argued that contact may actually have potentially negative effects for long-distance relationships, such as increased conflict (Sahlstein, 2004) and disillusionment (Gerstel & Gross, 1984). In the current study, we did not assess the amount or type of contact and therefore cannot address whether these variables moderated or mediated any of the results reported here. Our long-distance dating sample consisted of first-year university students, a population that may experience periods of frequent geographical closeness followed by periods of distance. Many of the relationships in the present sample became long distance when one or both partners moved away to attend university or college. It is not uncommon for university students who move away to attend university during the fall and winter to return to their primary residence during the summer. If both members of a couple were to do this, they could essentially spend the summers as same-city couples. Unfortunately, we did not assess whether couples in the present study experienced periods of geographical closeness, despite Stafford’s (2005) recent appeal for researchers to investigate such circumstances.

Directions for Future Research

Despite the strengths of our approach, we were unable to discover the mechanism that explains why men’s NA is more predictive of the breakup of long-distance couples than is women’s NA. To track underlying psychological processes more precisely, future researchers could include a more diary-like accounting procedure, in which individuals in long-distance relationships report relationship- relevant episodes and their feelings and assessments on a regular basis. At the very least, researchers should investigate participants’ relational security, NA, and distress on a regular basis. Presumably, declines in relational security and increases in distress and NA predict breakup in long-distance couples, and couples with high-NA men are more likely to experience a rapid decline in these areas. Researchers may find ongoing assessments of the psychological and physical well-being of couples in long- distance relationships to be particularly valuable. If high-NA men experience less social support, they may also be more vulnerable to the negative health consequences accompanying a reduction in social support (e.g., Reis, 1984) and the dissolution of a relationship (e.g., Bloom, Asher, & White, 1978).

Ongoing assessments may also assist researchers in understanding how the amount and type of contact and periods of geographical closeness may mediate or moderate the impact of men’s NA on relational stability in long-distance couples. High-NA men should experience particular difficulty when prevented from having regular face-to-face contact with their partners (Carpenter & Knox, 1986). These individuals may also experience distress when telephone and e- mail contact is unavailable. A vicious cycle may exist in these contexts: When contact with a distant partner becomes less frequent, high-NA men may experience reduced relational security, which may lead them to distance themselves emotionally from their partners and may reduce their motivation to initiate contact with a distant partner. Such behaviors would surely cause concern for the female partner and may discourage her from initiating contact. Relationship breakup may be an inevitable outcome in such circumstances. Alternatively, high-NA men may be more vulnerable to the increased conflict (Sahlstein, 2004) and disillusionment (Gerstel & Gross, 1984) to which long-distance couples are susceptible when they become geographically close or when the amount of contact is high. Again, a daily-diary approach would be most useful for future investigations of this possibility.

Conclusions and Implications

Our results indicate that not all couples need worry about the viability of long-distance dating relationships. Couples with high- NA men, however, should be wary of maintaining a long-distance relationship and perhaps should take steps to find other sources of social support or to boost their levels of security. Mental health professionals should be especially aware of the possibility that the high NA males in long-distance relationships in their practice may be at increased risk of breakup and the negative consequences of such relationship dissolution.

One of the most important contributions of this study is that our findings emphasize that individual characteristics do not exist in a vacuum separated from context. The interaction between situational context (e.g., living apart) and enduring vulnerabilities (e.g., high NA) best predicts relationship outcomes. Consistent with an interactionist perspective (Endler & Parker, 1992), our results highlight the importance of investigating the interaction between personal characteristics and situations in relationships. In the present study, the interaction occurred exclusively for men, but this finding is likely a product of the particular context that we investigated. If we had studied a context that is more likely to heighten insecurity in women than in their male partners (e.g., transition to parenthood; see Osofsky, 1985; Ross & Van Willigen, 1996), we may have found that women’s NA is more predictive of relational stability than is men’s NA.

NOTES

1. Correlation analyses using the individual measures instead of the indexes replicated a similar pattern. To conserve space, we report here results only for the indexes. We performed subsequent analyses only with the indexes.

2. We selected only a few predicted and possible interaction terms to include in the presented regression analysis. However, to ensure that we had not missed a statistically important interaction, we conducted a hierarchical linear regression with the terms included in the presented regression (Table 2) in Step 1 and all other possible interaction terms in Step 2. Step 1 was significant, F(11, 79) = 3.16, p

3. We replicated these analyses using logistic regression. The results are virtually identical to those presented here.

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MEDRAD Marks Milestone for Angiography Injector

MEDRAD, INC. announced the manufacture and delivery of the 10,000th Mark V ProVis(R) Angiography Injection System, which is used worldwide for live imaging during therapeutic interventions and diagnostic angiography procedures.

The Mark V ProVis debuted in 1999 as the heir to the successful “Mark” line of angiography injectors dating back to MEDRAD’s founding in 1964. Continuing a long tradition of consistent performance, Mark V ProVis is widely recognized as one of the most reliable injection platforms, delivering a historical average up-time of 99.9%. It also provides industry-leading flexibility with multiple system and syringe configurations and a mechanical stop to ensure patient safety by physically limiting an injection to the selected volume.

“The Mark line of Angiography injectors established MEDRAD’s reputation for reliability, and the Mark V ProVis has carried that reputation to the extreme,” said Kraig McEwen, senior vice president, MEDRAD Cardiovascular Business Unit. “Demand for Mark V ProVis has been remarkably consistent in cardiology, interventional radiology, and vascular surgery despite the movement of some diagnostic procedures to non-invasive modalities like CT and MR. Even as MEDRAD continues to innovate and deliver new products with broader capabilities, there will always be a need for an injector like ProVis.”

MEDRAD’s latest generation injection system for live imaging, the MEDRAD Avanta(R) Fluid Management Injection System, provides fixed or variable flow contrast and saline delivery on-demand, replacing the manual manifold and syringe. By enhancing digital fluoroscopy with operator-controlled contrast injections, workflow is improved and contrast consumption is reduced.

Robert Schwartz, M.D., medical director, Abbot Northwestern, Minneapolis Heart Institute Foundation, explained the appeal of a system like MEDRAD Avanta. “The words are control and safety. I have control of what I am putting into the coronary artery, in terms of how much, and how fast of an injection. I’ve got feedback. I can minimize contrast, tailor the dose and save money, but it’s about control and safety.”

Physicians have traditionally used Angiography injectors to inject contrast media into the arterial system of a patient through a catheter to help them see and diagnose vascular disease. While non-invasive modalities are rapidly becoming preferred for diagnosis, Angiography injectors are fundamentally necessary to perform “live imaging” during therapeutic interventions such as angioplasty or the placement of stents. Live imaging refers to the practice of visualizing the arterial system in real-time during a procedure rather than scanning a patient and later reviewing the visuals as is required for non-invasive diagnostic modalities.

MEDRAD, INC. is a worldwide leading provider of medical devices and services that enable and enhance imaging procedures of the human body. Used in diagnostic imaging, MEDRAD’s product offerings include a comprehensive line of vascular injection systems, magnetic resonance (MR) surface coils and patient care products, and equipment services. Total 2006 revenues were $478 million. MEDRAD is a 2003 recipient of the Malcolm Baldrige National Quality Award, the top honor a U.S. company can receive for quality and business excellence. The company’s world headquarters is near Pittsburgh, Pennsylvania, in the United States. MEDRAD is an affiliate of Bayer AG. More company information is available at www.medrad.com.

The Bayer Group is a global enterprise with core competencies in the fields of healthcare, nutrition and high-tech materials. Bayer HealthCare, a subsidiary of Bayer AG, is one of the world’s leading, innovative companies in the healthcare and medical products industry and is based in Leverkusen, Germany. The company combines the global activities of the Animal Health, Consumer Care, Diabetes Care and Pharmaceuticals divisions. The pharmaceuticals business operates under the name Bayer Schering Pharma AG. Bayer HealthCare’s aim is to discover and manufacture products that will improve human and animal health worldwide. Find more information at www.bayerhealthcare.com.

Cautionary statement regarding forward-looking statements.

Certain statements in this press release that are neither reported financial results nor other historical information are forward-looking statements, including but not limited to, statements that are predictions of or indicate future events, trends, plans or objectives. Undue reliance should not be placed on such statements because, by their nature, they are subject to known and unknown risks and uncertainties and can be affected by other factors that could cause actual results and MEDRAD’s plans and objectives to differ materially from those expressed or implied in the forward-looking statements. MEDRAD, INC. undertakes no obligation to update publicly or revise any of these forward-looking statements, whether to reflect new information or future events or circumstances or otherwise.

 For additional information contact: Travis Deschamps MEDRAD Cardiovascular Business Unit 412-767-2400 ext. 3412 Email Contact  Dan Dieter MEDRAD Marketing Services 724-940-6949 Email Contact

SOURCE: MEDRAD, INC.

Ross University School of Medicine Expands Clinical Rotations in New York

Ross University School of Medicine is pleased to announce it will add a total of 50 new core clinical rotation spots at Caritas Health Care Planning’s Mary Immaculate and St. John’s Queens hospitals in New York City. Ross University has clinical rotations available at 22 hospitals in New York.

With over 1,100 opportunities available at more than 70 institutions nationwide, Ross University offers more clinical rotation spots in the United States than any medical school in the world. In 2007, Ross had more than 1,300 students complete over 60,000 clinical weeks.

“We aim to provide our students with the best educational experience possible to prepare them for their future careers, and this includes their clinical rotations,” said Dr. Thomas Shepherd, president of Ross University. “We are very pleased to have the ability to offer our students additional opportunities in the New York area, and more importantly, opportunities at some of the country’s most outstanding hospitals.”

With these recent additions, Ross University now has 110 core clinical positions available at Caritas hospitals in New York. Ross University also offers students the chance to complete their core clinical rotations at 20 additional New York-area hospitals that include Bronx-Lebanon Hospital Center, Brookdale Hospital Medical Center, Brooklyn Hospital Center, King’s County Hospital Center, Long Beach Medical Center, Long Island College Hospital, Lutheran Medical Center, Maimonides Medical Center, Mount Vernon Hospital, New York Downtown Hospital, North General Hospital, NYU Hospital for Joint Diseases, Peninsula Hospital Center, Queen’s Hospital Center, Rochester General Hospital, Staten Island University Hospital, St. Barnabas Hospital, St. Clare’s Hospital of Schenectady, St. John’s Episcopal Hospital, and Wyckoff Heights Medical Center.

About Ross University School of Medicine:

Ross University was founded in 1978 and is a provider of medical and veterinary education offering doctor of medicine and doctor of veterinary medicine degree programs. The School of Medicine is located in Dominica, West Indies, and the School of Veterinary Medicine is in St. Kitts.

The first four semesters of pre-clinical training are taught in Dominica over a 16-month period. Students complete their fifth semester, Advanced Introduction to Clinical Medicine, in either Miami, Florida or Saginaw, Michigan. Semesters six through ten consist of core and elective clinical rotations in U.S. affiliated teaching hospitals. Ross University graduates are eligible to practice medicine in all 50 U.S. states and 10 provinces of Canada upon successful completion of the requisite licensing examinations.

Ross University’s administrative offices are located in Edison, NJ. For more information about Ross University, visit www.rossu.edu or call 732.978.5300.

The Distribution of Inflammation and Virus in Human Enterovirus 71 Encephalomyelitis Suggests Possible Viral Spread By Neural Pathways

By Wong, Kum Thong Munisamy, Badmanathan; Ong, Kien Chai; Kojima, Hideaki; Noriyo, Nagata; Chua, Kaw Bing; Ong, Beng Beng; Nagashima, Kazuo

Abstract Previous neuropathologic studies of Enterovirus 71 encephalomyelitis have not investigated the anatomic distribution of inflammation and viral localization in the central nervous system (CNS) in detail. We analyzed CNS and non-CNS tissues from 7 autopsy cases from Malaysia and found CNS inflammation patterns to be distinct and stereotyped. Inflammation was most marked in spinal cord gray matter, brainstem, hypothalamus, and subthalamic and dentate nuclei; it was focal in the cerebrum, mainly in the motor cortex, and was rare in dorsal root ganglia. Inflammation was absent in the cerebellar cortex, thalamus, basal ganglia, peripheral nerves, and autonomic ganglia. The parenchymal inflammatory response consisted of perivascular cuffs, variable edema, neuronophagia, and microglial nodules. Inflammatory cells were predominantly CD68- positive macrophage/microglia, but there were a few CD8-positive lymphocytes. There were no viral inclusions; viral antigens and RNA were localized only in the somata and processes of small numbers of neurons and in phagocytic cells. There was no evidence of virus in other CNS cells, peripheral nerves, dorsal root autonomic ganglia, or non-CNS organs. The results indicate that Enterovirus 71 is neuronotropic, and that, although hematogenous spread cannot be excluded, viral spread into the CNS could be via neural pathways, likely the motor but not peripheral sensory or autonomic pathways. Viral spread within the CNS seems to involve motor and possibly other pathways.

Key Words: CNS infection, Enterovirus 71, Human encephalomyelitis, Immunohistochemistry, In situ hybridization.

INTRODUCTION

Enterovirus 71 (EV71) is a picornavirus belonging to the same group of human enteroviruses that includes poliovirus and coxsackievirus (1). Many epidemics of EV71-associated hand, foot, and mouth disease, complicated or uncomplicated by neurologic disease, have been documented worldwide (2-6). The neurologic complications are varied and may manifest as aseptic meningitis, acute flaccid paralysis, and, more seriously, as a fatal encephalomyelitis or rhombencephalitis (3, 5, 7-9). Nonetheless, neurologic disease is relatively rare, and the mechanisms for tissue damage and the mode of viral spread into and within the central nervous system (CNS) are still not fully understood.

Magnetic resonance imaging (MRI) of the CNS in patients with encephalomyelitis has demonstrated that the distribution of lesions in EV71 encephalomyelitis seemed to be distinct and rather stereotyped (3, 10, 11). Lesions were found mainly in the medulla, pontine tegmentum, midbrain, and dentate nucleus of the cerebellum. Anecdotal reports from a few autopsies seem to support this and indicate, in addition, that other parts of the brain (e.g. hypothalamus and cerebral cortex) may also be inflamed (12-14). Interestingly, in some patients with severe neurologic disease, acute lesions revealed on brain MRI have been reported to disappear completely on recovery (11).

Detailed neuropathologic analysis of the features and distribution of inflammation have not been published and may offer insight into the pathogenesis of the neurologic disease. There is some evidence that neurologic disease has resulted from encephalitis, including immunohistochemical and ultrastructural evidence for direct neuronal infection as a cause of tissue damage (6, 12, 13, 15-18). It is possible that other CNS cell types can be targets for infection, but to date, there is no published information on this question. Little is also known about viral presence in non-CNS lymphoid and nonlymphoid organs.

The mechanism for viral spread into the CNS after the presumed viremic phase after fecal-oral transmission is not fully understood. Possible retrograde spread of the virus through peripheral nerves has been proposed (3, 13, 14). In recent years, mouse models for poliovirus and EV71 have suggested that for both enteroviruses, neural pathways as a means for viral spread into the CNS may have a larger role than previously thought (19, 20). Moreover, the possible involvement of the autonomic and sensory nervous system in neural transmission in human infection has not been investigated.

The purpose of this study is to investigate the CNS cellular targets of EV71 infection and the nature and distribution of the CNS inflammatory response in a series of autopsy cases using light microscopy on small and large brain sections, immunohistochemistry (IHC), and in situ hybridization (ISH). On the basis of these findings, we propose that in human EV71 encephalomyelitis, viral spread into and within the CNS can be by neural pathways.

MATERIALS AND METHODS

Preparation of Cell Culture and Mouse Tissue Controls

Enterovirus 71 was inoculated into Vero cells at a multiplicity of infection of approximately 1 and fixed with 10% buffered formalin after 48 hours. The virus was previously isolated from a fatal human case of EV71 encephalomyelitis and obtained from the Department of Medical Microbiology, University of Malaya. Harvested cells were routinely processed and embedded in paraffin as a positive control in IHC and ISH to detect EV71 antigens and RNA, respectively. Mock- infected cells (negative controls) were also prepared in the same manner as for infected cells.

TABLE. Patient Data

One-day-old ICR suckling mice (n = 7) were inoculated intracerebrally with the same stock virus contained in 0.01 mL of EV71 Vero cell culture lysate. After 5 days, the mice were killed, and brains and hindlimb muscles were dissected out, fixed in 10% buffered formalin, and routinely processed and embedded in paraffin blocks to serve as a second positive control. Tissues from 2 uninfected mice were prepared in the same way as negative controls. Ethical clearance was obtained from the Animal Care and Use Committee, Faculty of Medicine, University of Malaya.

Preparation of Human Tissues

A total of 7 cases of fatal EV71 encephalomyelitis were studied (Table). Brain, spinal cord, and other major non-CNS organs (lung, kidney, heart, pancreas, spleen, liver, thymus, intestine, skeletal muscle, and peripheral nerve) were obtained from autopsies of 4 children who died of culture-proven EV71 infection in a 1997 hand, foot, and mouth disease outbreak. The autopsies were done in the Department of Pathology, University of Malaya, and the clinical features of these cases were previously published (9). Of the remaining 3 suspected cases of EV71 encephalomyelitis, 2 were autopsied in Melaka Hospital and Alor Setar Hospital, respectively, during the same outbreak period in Malaysia; the third case was autopsied in the University of Malaya during a later non-outbreak period in 1999. These cases were included in this series when positive results were obtained for IHC and ISH.

All of the tissues were fixed in 10% buffered formalin for at least 2 weeks before trimming into small blocks, routine processing, and paraffin embedding. The Table summarizes the cases and the tissues examined. In addition, large brain sections of the cerebrum and cerebellum were done on the 5 cases autopsied in the University of Malaya. For this purpose, 1-cm coronal slices of cerebral hemispheres were cut after separation from the midbrain. The cerebellum with the brainstem attached was cut horizontally and perpendicularly to the long axis of the brainstem at 1-cm thickness at the midpons level. The large brain sections were processed manually during 2 to 3 weeks as for routine processing except that each change of the processing solution was spread out equally during this period.

For negative controls, normal brainstem and spinal cord tissues from 2 autopsies were obtained from the Department of Pathology, University of Malaya. In addition, autopsy CNS tissue blocks from known cases of viral encephalitis, including Nipah virus, Japanese encephalitis virus, and measles virus, were retrieved from the archives of the Department of Pathology to serve as negative controls. All of these samples were fixed and processed in a manner similar to that of the other CNS tissues. Sections from all the small blocks were cut at 5 [mu]m, stained initially with hematoxylin and eosin stains, and examined by light microscopy.

Plotting the Distribution of Inflammation

Slides with hematoxylin and eosin-stained, 8-[mu]m-thick large brain tissue sections were overlaid with 4-mm^sup 2^ square grids printed on transparent plastic sheets. The brain sections were then examined under a light microscope and evaluated for inflammation by manually marking on the grids in which inflammation (perivascular cuffing, microglial nodules, or parenchymal inflammation) was found. Squares with evidence of inflammation estimated to cover more than half or less than half of the grid area were marked differently.

Immunohistochemistry

Immunohistochemistry was performed on all small blocks of test and control tissues and selected large blocks. Tissue sections (5- to 7-[mu]m thick) were placed on silane-coated slides and deparaffinized with xylene and graded ethanol solutions. Antigen was retrieved by microwaving for 10 minutes in sodium citrate buffer of pH 6.0. A modified standard IHC protocol as described previously for EV71 was used (17, 21). Briefly, the sequential steps included 1) primary antibody incubation with anti-EV71 polyclonal antibodies (obtained from Dr. H. Shimizu, Japan) for 2 hours at room temperature; 2) secondary swine anti-rabbit antibody (DAKO, Glostrup, Denmark) incubation for 30 minutes; and 3) avidin-biotin immunoperoxidase (DAKO) technique with 3,3’diaminobenzidine (Sigma, St. Louis, MO) as the chromogen according to the manufacturer’s protocol. The slides were then counterstained with hematoxylin. A repeat IHC staining with a second, commercially available, anti- EV71 monoclonal antibody (Cat. No. 3323; Chemicon, Temecula, CA) as a primary antibody was also performed using the same protocol except that rabbit anti-mouse secondary antibody was used instead. A “minus- primary antibody” negative control in which the primary antibody was omitted from the procedure was also performed on test tissues. The EV71-infected mouse tissues and Vero culture cells were used as positive controls, whereas uninfected tissues and cells served as negative controls. Further negative controls using non-EV71 viral encephalitis tissue blocks were included in the IHC procedure.

Immunohistochemistry for the detection of CD8 (clone 1A5, Novocastra, Newcastle upon Tyne, UK) and CD68 (clone PGM1, DAKO) was performed on small blocks of test tissues using a similar procedure as described in the previous paragraph except that for the antigen retrieval step, the buffer used was TRIS-EDTA.

Preparation of Probes for ISH

Digoxigenin (DIG)-labeled DNA probes were generated from a 500- bp nucleotide generated from a reverse transcriptase (RT)- polymerase chain reaction (PCR) procedure using the Access RT-PCR kit (Promega, Madison, WI) and published primers (22) to the 5- nontranslated region of EV71. The 1-step RT-PCR was performed in a DNA thermocycler (Perkin Elmer, Waltham, MA) under the following conditions: 1) 60 minutes at 37[degrees]C then 2 minutes at 94[degrees]C; 2) 1 minute at 94[degrees]C, 1 minute at 55[degrees]C, and 1 minute 72[degrees]C for 35 cycles; and 3) 5 minutes at 72[degrees]C. The approximately 500-bp PCR fragments were purified with a High Pure PCR purification kit (Boehringer Mannheim, Mannheim, Germany) and cloned into the pGEM-T easy vector (Promega) according to the manufacturer’s protocol. Plasmids containing the correct insert in either orientation were used as a template to produce DIG-labeled DNA probes by incorporating DIG-11-deoxyuridine triphosphate nucleotide (Boehringer Mannheim) in a separate PCR reaction (PCR condition was the same as described in the previous sentences except that the RT step was omitted). The DNA probes were purified with the High Pure PCR purification kit (Boehringer Mannheim).

Riboprobes were produced by linearizing the plasmids containing inserts in 2 orientations using the SpeI restriction enzyme (Promega) according to the manufacturer’s protocol. In this way, sense and antisense riboprobes were produced using a DIG RNA labeling kit (Roche, Mannheim, Germany) according to the manufacturer’s instruction. Synthesized riboprobes were purified as before.

FIGURE 1. (A) Whole brain coronal sections of cerebral hemispheres with distribution of inflammation indicated by black dots (>half-field inflamed) and circles (

In Situ Hybridization

In situ hybridization was performed on all small tissue blocks as previously described, with minor modifications (23, 24). The tissue slides were deparaffinized, hydrated, and treated with 0.2 N HCl before digestion with 100 [mu]g/mL proteinase K at 37[degrees]C for 20 minutes. Specimens were immersed in 0.2% (wt/vol) glycine in 0.15 mol/L phosphate-buffered saline (PBS) and washed with PBS. The sections were then prehybridized with 100 [mu]L prehybridization mixture containing 6 x saline sodium citrate, 45% formamide, 5 x Dendhardt solution, and 100 [mu]g/mL denatured salmon sperm DNA, and incubated for 30 minutes at 42[degrees]C for DNA probes (45[degrees]C for riboprobes). Next, the sections were hybridized with 50 [mu]L of hybridization solution incorporating 10% dextran sulfate and 2 [mu]g/mL of probe at 95[degrees]C for 10 minutes (this heating step was omitted for riboprobes) and then incubated overnight at 42[degrees]C for DNA probes (45[degrees]C for riboprobes).

After hybridization, slides were washed in 6 x saline sodium citrate at 42[degrees]C, 2 x saline sodium citrate, Tris-NaCl buffer for 5 minutes and blocked with 1% blocking solution (Boehringer Mannheim) for 30 minutes at room temperature. Hybridization was detected by anti-DIG Fab fragments linked to alkaline phosphatase (Boehringer Mannheim) and a color reaction obtained when nitroblue tetrazolium/5-bromo-4-chloro-3-indolyl phosphate (Boehringer Mannheim) substrate was applied. The reaction was stopped after 5 minutes by immersing in TRIS-EDTA buffer, and the slide was counterstained with Mayer hematoxylin. Duplicate ISH assays were also performed on all control tissues, as was used in the IHC. Additional negative controls used in the ISH assay included RNAase-treated, EV71-infected tissue sections and an assay that omitted the probe in the procedure.

RESULTS

Distribution and Histopathologic Features of Inflammation

Inflammation was observed in many parts of the CNS but always in a consistent, stereotyped distribution and intensity. More or less equally intensely inflamed areas included the entire gray matter of the spinal cord from sacral to cervical levels, the entire medulla, pontine tegmentum (sparing anterior pontine nuclei area), tegmentum of the midbrain (sparing the cerebral peduncle but not the substantia nigra), hypothalamus, and subthalamic and dentate nucleus (Fig. 1A, C). Inflammation was also found in the cerebral cortex but was far less intense and more focal and mainly involved the motor cortex (Fig. 1A, B).

FIGURE 2. Parenchymal inflammation (arrows) and perivascular cuffing in the inferior olivary nucleus area of the medulla (A). In more severely inflamed areas (B), there may be varying degrees of edema (*) and neuronophagia (C, arrows). More subtle inflammation in the motor cortex is indicated by very mild perivascular cuffing (arrow) and parenchymal inflammatory cells (circle) (D). Numerous CD68-positive macrophages/microglial in the parenchyma and perivascular location (E), and a CD8-positive lymphocyte adjacent to a neuron (F). Viral RNA in the anterior horn cells of the spinal cord (G) and viral antigens in neuronal body and process in the hypothalamus (H). Adjacent sections of the same neuron that was positive for viral RNA (I) and antigens (J). (A-D: hematoxylin and eosin stains; E, F, H, J: immunohistochemistry/peroxidase/DAB; G, I: ISH/ nitroblue tetrazolium/ 5-bromo-4-chloro-3-indolyl phosphate stains. Original magnification: (A) 4 x ; (B, D) 10 x ; (C, F) 40 x ; (G, H, I, J) 20 x .

There was no noteworthy inflammation within the caudate nucleus, putamen, globus pallidus, thalamus, and mamillary body, although focal areas in the periphery or inferior parts of these structures and other areas adjacent to the hypothalamus occasionally showed mild inflammation. Likewise, very focal areas of white matter adjacent to inflamed anterior horns also showed perivascular cuffing. The olfactory bulb and cerebellar cortex, including Purkinje cells, were generally free of inflammation.

The inflammatory response consisted of perivascular cuffing, parenchymal infiltration by inflammatory cells, and microglial nodules (Fig. 2A). The inflammatory cells usually consisted of macrophage/microglia with lymphocytes, plasma cells, and neutrophils in varying combinations. In some areas, neutrophils were more prominent, but usually, their numbers were insufficient to be characterized as abscesses. Edema was variable, but in the most severely affected areas, the parenchyma seemed microcystic (Fig. 2B). Neuronophagia in various stages was noted, but viral inclusions were absent (Fig. 2C). Mild meningitis was found throughout the CNS, particularly over areas where there was parenchymal inflammation. In the cerebral cortex, inflammation was usually represented by mild perivascular cuffing (often a single layer of inflammatory cells) involving 1 or 2 adjacent vessels and the occasional small microglial nodule (Fig. 2D).

Most parenchymal inflammatory cells were strongly CD68-positive macrophages/microglia (Fig. 2E). CD8-positive lymphocytes were usually absent, but if present, they were found rather sparsely in the perivascular space or parenchyma. Rarely, CD8-positive lymphocytes were adjacent to neurons (Fig. 2F). Inflammation was observed in 1 dorsal root ganglion, but peripheral nerve, intestinal autonomic ganglia, and skeletal muscle had no inflammation. There was also no evidence of inflammation in the other non-CNS organs, including the heart and intestines. Varying degrees of edema were observed in the lung parenchyma, but no convincing inflammation was found.

Detection of Viral Antigens and RNA

Viral antigens were detected to varying degrees in neuronal cell bodies and processes in different parts of the CNS, particularly in the most intensely inflamed areas such as the spinal cord, brainstem, dentate nucleus, and hypothalamus. In the spinal cord, viral antigens were mainly detected in anterior horn cells (Fig. 2G). In general, however, neuronal staining was focal and typically involved only 1 or at most a few adjacent neurons even in the most intensely inflamed areas (Fig. 2G-J). Virus-positive neurons were very rare in the cerebral cortex. Inflammatory phagocytic cells participating in neuronophagia occasionally showed viral antigen in their cytoplasm. No positive staining was found in dorsal root and autonomic ganglia, skeletal muscle, or other non-CNS organs. In general, ISH using both DNA probes and riboprobes showed findings that closely paralleled IHC findings (Fig. 2I, J). In the positive neurons, staining was confined only to the cytoplasm of the neuronal body and/or neuronal processes, with no nuclear staining in both assays. Staining was often granular in the IHC assay. There was no evidence of virus in the ependyma, astrocytes, oligodendrocytes, choroid plexus, and blood vessels. Overall, there did not seem to be major differences in the sensitivity of the 2 assays of viral detection, and all of the IHC- and ISH-positive and negative controls gave the expected results.

DISCUSSION

The distribution and varying intensity of inflammation in our cases of fatal EV71 encephalomyelitis seem to be distinct and stereotyped, suggesting a similar pattern of viral spread into and within the CNS. As far as we are aware, neuropathologic evidence for this has not been previously reported in EV71 infection. Based on these findings, we speculate that 1 of the major pathways for virus entry into the CNS is via the peripheral nervous system, and from there, virus spreads rostrally up established neural pathways. The most obvious pathway that seems to be involved is the motor pathway. In the spinal cord, all cord levels have more or less the same intensity of inflammation and viral antigens/RNA in the anterior horn cells. In contrast, the degree of inflammation and evidence of virus in the motor cortex was far less. This suggests simultaneous retrograde viral spread up somatic motor nerves to infect anterior horn cells and then up the corticospinal tract to infect neurons in the motor cortex. In this scenario, it is assumed that the first areas (anterior horn cells) to be infected showed the highest degree of inflammation.

The distribution of inflammation in the brainstem was consistent with this mode of spread because motor nuclei were found in all of the areas that had marked inflammation. As in the spinal cord, we postulate that virus may have traveled up cranial nerves with motor components (3rd to 12th nerves) to infect the corresponding motor nuclei in the different parts of the brainstem, and subsequently spread up corticobulbar tracts to the motor cortex. Anterior pontine nuclei (which are not motor nuclei and do not have connections to the ascending corticospinal/corticobulbar tracts) were never found to be inflamed, nor did they show evidence of virus infection.

Further spread within the brainstem via other pathways such as the reticular formation may have occurred as suggested by the presence of inflammation in the central regions of the brainstem. Likewise, hypothalamic involvement can be via its extensive and complex interconnections with the brainstem and spinal cord. Involvement of the dentate nucleus may be through its connections to the inferior olivary nucleus, red nucleus, or other pathways.

Interestingly, the distribution of inflammation in our cases seems to bear a close resemblance to the rare encephalitic form of poliovirus infection (25). It is well known that in poliovirus infection, there is a higher incidence of paralysis after tonsillectomies and intramuscular injections, suggesting a role for viral spread by neural pathways (25). Recent evidence from transgenic mice expressing the human poliovirus receptor had increasingly suggested that poliovirus is able to spread via neural pathways into the CNS (20). Moreover, evidence from both our EV71 mouse model (unpublished data) and from other investigators (26) have strongly suggested that viral spread occurs by neural pathways into the CNS. Interestingly, in contrast to EV71 encephalomyelitis, the thalamus in polioencephalitis was reported to be severely involved, whereas the inferior olivary nucleus was apparently spared (25). The reasons for these differences are unknown. Because the receptor for EV71 is not the same as the poliovirus receptor and has yet to be identified, it is difficult to speculate if differences in viral receptors might account for this observation (27, 28).

The other possible pathway for viral entry into the CNS would be by hematogenous route and subsequent crossing of the blood-brain barrier. The apparent synchronous nature of anterior horn cell involvement and perhaps the involvement of nonmotor areas such as the hypothalamus and dentate nucleus might support this route of viral spread. If this occurs, certain groups of neurons would necessarily be more susceptible to EV71 infection, thereby resulting in the stereotyped distribution of inflammation. Whether or not this route plays a significant role in EV71 encephalomyelitis and why certain neurons can be more susceptible than others to infection require further investigation.

The peripheral autonomic and sensory nervous system does not seem to be involved in retrograde EV71 viral spread into the CNS. Occasional involvement of the dorsal root ganglion can represent rare anterograde viral spread through its connections to anterior horn cells. It is possible that more widespread centrifugal spread into the peripheral nervous system, as occurs in rabies, might occur if EV71 encephalomyelitis was more chronic.

Detection of viral antigens and genome in the neuronal bodies and processes but not in glial or other cells confirmed that EV71 is neuronotropic. Because infected neurons undergo neuronophagia, direct viral cytolysis is likely an important mechanism of cell damage. Extensive involvement of the medulla, including the nucleus ambiguus, by inflammation, edema, and neuronal loss, was probably sufficient to cause sudden cardiovascular collapse and the presumably neurogenic pulmonary edema in our cases (4, 9). All of our cases succumbed to the disease within 2 to 3 days of illness because most of them presented to the hospital severely ill and deteriorated precipitously. This clinical course would be consistent with a rapid entry of virus into the CNS over a few days.

Brain MRI findings generally seemed to correlate with the distribution of inflammation in our cases, although we are not aware of any reports of MRI-detectable lesions in the cerebral cortex (10, 11). It is probably related to the very focal and mild inflammatory foci found in this location. Absence of virus in non-CNS organs such as the spleen and Peyer patches of the small intestines does not imply that these organs cannot be infected because the tissues obtained from our autopsy cases probably represented a later stage of the disease. If poliovirus infection represents a model for EV71 infection, it should be possible to detect the viral presence in lymphoid organs in the early stage of infection (29), but as far as we are aware, this has not been reported to date.

Few CD8-positive (cytotoxic) lymphocytes were found in areas with abundant neutrophils and a predominance of CD68-positive macrophages/ microglia. This finding is consistent with the short duration of the encephalitis and with the assumption that the recruitment of CD8 lymphocytes into the CNS would take longer because it is an adaptive, rather than innate, immune response. Other authors have reported an apparent reduction in CD8- and CD4-positive cells in peripheral leukocytes in patients with EV71 infection and pulmonary edema (30), and it is possible that this may also contribute to the paucity of CD8-positive cells in the CNS. Nonetheless, CD8-positive lymphocytes seem to have a role in the immune response to this infection, and this issue requires further evaluation.

ACKNOWLEDGMENTS

The authors thank Dr. Hiroyuki Shimizu (National Institute of Infectious Disease, Tokyo, Japan) for the antibodies used for immunohistochemistry; and the Ministry of Health, Malaysia, for some of the cases studied.

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Kum Thong Wong, MBBS, MPATH, FRCPATH, Badmanathan Munisamy, BSc, MMedSc, Kien Chai Ong, BSc, Hideaki Kojima, PhD, Nagata Noriyo, DVM, PhD, Kaw Bing Chua, MD, PhD, Beng Beng Ong, FRCPA, and Kazuo Nagashima, MD

From the Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (WKT, BM, OKC); Tokyo Metropolitan Institute for Neuroscience, and Mitsubishi Chemical Medicine, Tokyo, Japan (KH); National Institute of Infectious Disease, Tokyo, Japan (NN); Public Health Laboratories, Selangor, Malaysia (CKB); Queensland Health Pathology and Scientific Services, Brisbane, Queensland, Australia (OBB); Department of Anatomic and Molecular Pathology, Hokkaido University, Sapporo, Japan (NK).

Send correspondence and reprint requests to: Dr. Kum Thong Wong, Department of Pathology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; E-mail: [email protected]

This study was supported in part by the Core University System Exchange Programme under the Japan Society for the Promotion of Sciences, coordinated by the University of Tokyo, Graduate School of Medicine, and Universiti Sains Malaysia, School of Medical Sciences. This study was also supported by a grant from the Japan Health Sciences Foundation, Tokyo, Japan.

Copyright Lippincott Williams & Wilkins Feb 2008

(c) 2008 Journal of Neuropathology and Experimental Neurology. Provided by ProQuest Information and Learning. All rights Reserved.

Pulmonary Pathology Society 5th Biennial Meeting Abstracts

By Anonymous

Didactic lectures, original research posters and presentations, and case presentations were conducted at the 5th Biennial Meeting of the Pulmonary Pathology Society June 20 through 22, 2007, at the El Dorado Hotel and Spa in Santa Fe, NM. The meeting drew participants from 10 nations. Fiftytwo faculty members participated in invited lectures and discussions on neoplastic and nonneoplastic lung disease. A discussion on The Utility of Consensus Classifications was organized by Dr JeffreyMyers of the University of Michigan, with opposing views provided by Dr Alain Borczuk of Columbia University and Dr William Travis of Memorial Sloan Kettering Cancer Center. A Techniques Session was organized by Dr Samuel Yousem and moderated by Dr Sanja Dacic, both of the University of Pittsburgh Medical Center. Multidisciplinary sessions were given by Dr Teri Franks and Dr Jeffrey Galvin of the Armed Forces Institute of Pathology, Dr Andrew Churg of the University of British Columbia, and Dr Moises Selman of the Instituto Nacional de Enfermedades Respiratorias. Special presentations were given by Dr Aliya Husain of the University of Chicago and Dr Richard Attanoos of Llandough Hospital, Cardiff, Wales. Dr Douglas Flieder of Fox Chase Cancer Center chaired the Abstract Committee, Dr Andras Khoor of Mayo Clinic Jacksonville chaired the Case Presentations, and Dr Mary Beth Beasley of Mount Sinai School of Medicine, New York, chaired the Mystery Cases. The abstracts from this meeting appear below.

Minute Pulmonary Meningotheliallike Nodule Syndrome

Frank Schneider1 ; Lewis J. Wesselius2 ; Henry D. Tazelaar.2 1Duke University Medical Center; 2Mayo Clinic, Scottsdale, Ariz.

Minute pulmonary meningotheliallike nodules (MPMNs) are small, cellular structures of unknown origin that are frequently identified as incidental findings in lung biopsies. Once thought to be chemodectomas because of their association with vessels, MPMNs’ lack of endocrine granules and nerve fibers helps to dispel this notion. The current designation was prompted by MPMNs’ immunohistochemical and ultrastructural features of meningothelial cells; yet, the histogenesis of MPMNs remains unclear. The presence of more than 3 MPMNs in a patient, as identified by imaging and subsequent histologic examination, has been referred to as MPMNomatosis. Whereas isolated nodules are thought to be of a reactive nature, recent studies suggest that MPMNomatosis might represent the transition between a reactive and neoplastic proliferation. This rare syndrome is usually asymptomatic. We describe a 69yearold woman nonsmoker who had a history of asthma for more than 10 years. She presented with a chronic cough and shortness of breath, which did not improve despite intensification of treatment. Imaging studies showed innumerable bilateral small groundglass opacities in the periphery of the lung. Open biopsies demonstrated multiple MPMNs in each of the 3 lung wedges. In addition, constriction of airways by submucosal fibrosis consistent with obliterative bronchiolitis was found, likely contributing to the patient’s symptoms. After 6 months of steroid treatment, the patient showed neither clinical improvement nor deterioration of her symptoms. It is unclear whether the MPMNs were causally related to the patient’s symptoms or whether they were innocent bystanders.

Metastatic Carcinoma of the Lung to Male Breast or Anterior Chest Wall on FineNeedle Aspiration: A Review of 36 Cases

Monica I. Ruiz1 ; Rodolfo J. Nudelman1 ; Linda K. Green.2 1Baylor College of Medicine, Houston, Tex; 2Veterans Affairs Medical Center & Baylor College of Medicine, Houston, Tex.

Context: Carcinoma of the breast is uncommon in men. When a man presents with a breast or anterior chest mass, a primary tumor must be distinguished from a soft tissue metastases. Lung cancer is the most common tumor metastasizing to soft tissue. It may be difficult to distinguish from a primary tumor. We designed a study to examine the incidence, characteristics and features of primary breast cancer and metastatic lung cancer to the male breast on fineneedle aspiration (FNA).

Design: We reviewed our files dating from 1986 to 2007 for primary and metastatic carcinomas of the male breast diagnosed by FNA. Each case was reviewed for tumor location, cell type, immunohistochemistry, electron microscopy, clinical history, radiographic findings, and clinical course.

Results: There were 36 metastatic lung carcinomas: 12 (33%) adenocarcinomas, 12 (33%) nonsmall cell carcinomas, 8 (22%) squamous cell carcinomas, and 4 (11%) small cell carcinomas. There were 10 primary breast carcinomas. The most important aid in arriving at the correct diagnosis was computed tomography and magnetic resonance imaging of the thorax.

Conclusions: In our patient population, metastatic lung carcinoma to the male breast or chest was much more common than primary breast carcinoma. On FNA, a poorly differentiated carcinoma may be primary or metastatic to the breast. Estrogen and progesterone receptors may be seen in both lung and breast cancer. Immunohistochemistry is variable and may not always distinguish a breast primary from a lung primary. A search for a lung primary should always be considered in a male with a breast or chest mass malignancy.

Metastatic Lung Carcinoma to the Stomach Masquerading as a Primary Gastric Malignancy: A Review of 64 Cases

Rodolfo J. Nudelman1 ; Monica I. Ruiz1 ; Linda K. Green.2 1Baylor College of Medicine, Houston, Tex; 2Veterans Affairs Medical Center & Baylor College of Medicine, Houston, Tex.

Context: Rarely will lung tumors metastasize to the stomach and present as bleeding ulcerated masses. They may be difficult to distinguish from primary gastric malignancies. Differentiation between the two is crucial for therapeutic management.

Design: The files of our institution from the last 40 years were searched for surgical, necropsy, and cytologyproven metastases to the stomach. The tumors proven to be lung in origin by clinical, necropsy, or ancillary tests were selected, and the clinical findings, upper gastrointestinal endoscopy findings, radiographic data, histology, and ancillary tests were reviewed for each case.

Results: There were 123 metastases to the stomach with 64 proven lung cancers. The histopathologic types included the following: 27 (42%) adenocarcinomas, 19 (29%) small cell carcinomas, 12 (19%) squamous cell carcinomas, and 6 (9%) large cell carcinomas. The lesions were often volcano like in appearance. The lack of transformation from the gastric mucosa was a helpful clue. In some cases, immunohistochemistry was valuable.

Conclusions: Lung cancer can present as an ulcerated lesion in the stomach. Lesions with glandular, squamous, and neuroendocrine differentiation all occur in the stomach; therefore, distinction between the two is difficult. If a lesion has an uncharacteristic endoscopic or gross appearance, a metastatic lesion should be entertained. Immunohistochemistry may be helpful (thyroid transcription factor 1 positive), but not in all cases. Clinical and radiographic data is often helpful. To prevent diagnostic errors, it is important to recognize that metastatic carcinomas from the lung may, on rare occasion, present as gastric ulcers or masses.

Superoxide Dismutase Polymorphisms and Expression in Idiopathic Pulmonary Fibrosis

Patrizia Morbini1 ; Simona Inghilleri2 ; Ilaria Campo2 ; Chiara Villa1 ; Tiberio Oggionni2 ; Maurizio Luisetti.1 1Universita` di Pavia; 2 Fondazione IRCCS Policlinico S. Matteo.

Context: Superoxide dismutases (SOD), genetic variants associated with reduced scavenger activity and/or stability, could play a role in the development of pulmonary fibrosis mediated by increased oxidative stress.

Design: The Arg213Gly polymorphism in EcSOD and the Ala16Val polymorphism in MnSOD were investigated in 70 patients with a clinical and instrumental diagnosis of idiopathic pulmonary fibrosis (IPF), in 38 different patients with a confirmed histopathologic diagnosis of usual interstitial pneumonia (UIP) according to ATS/ ERS criteria, and in 295 normal subjects. EcSOD and MnSOD expression were assessed immunohistochemically in UIP samples.

Results: MnSOD Ala16Val polymorphism was significantly more frequent in histologically confirmed UIP cases (heterozygous, 39%; homozygous, 44%) than in control cases (heterozygous, 51%; homozygous, 25%; P

Conclusions: Molecular investigations documented the significant association of a MnSOD genetic variant associated with reduced antioxidant activity in a series of histologically confirmed UIP cases, but not in a series of clinically diagnosed IPF cases. This result stresses the importance of basing molecular association studies of UIP on carefully selected patient series. Negative antioxidant activity in fibroblastic foci, together with the molecular results, suggests that foci can be the site of increased oxidative stress. Glomangiomyopericytoma Arising in a Diffuse and Nodular Myofibromatosislike Process in the Lung With Vascular Endothelial Growth Factor Receptor 3 Expression

Ulrike M. GruberMoesenbacher1 ; Alicia MorresiHauf2 ; Helmut H. Popper. 3 1Teaching Hospital Feldkirch; 2Fachkliniken Asklepios; 3Medical University of Graz.

Tumors of the perivascular system, glomustumor, hemangiopericytoma, and PEComas have been reported in the lung. We present a large tumor arising in a nodular and diffuse growing perivascular process with focal myoid and glomangiopericytoma differentiation for which we propose the term glomangiomyopericytoma. A 46yearold woman presented with a mediastinal mass and pulmonary nodular densities on chest xray, which were interpreted as Langerhans cell histiocytosis. After 5 years, a large lung tumor developed. Both lungs contained nodules composed of small spindle cells with inconspicuous oval nuclei and indistinct borders of the slightly eosinophilic to clear cytoplasm growing around capillaries in a hemangiopericytomalike pattern. The large tumor consisted of spindle and epitheloid cells, increased nuclear polymorphism, some multinucleated giant cells, and no necrosis. Immunohistochemistry of the tumor and diffuse proliferation were negative for pancytokeratin, thyroid transcription factor 1, surfactant apoproteinA, neuronspecific enolase, S100 protein, CD56, leukocyte common antigen, CD68, desmin, estrogen receptor, progesterone receptor, vascular endothelial growth factor (VEGF), CD31, cAMPkinase-alpha, and hamartin, but were positive for vimentin, VEGF receptor 3, endothelkinase Tie2, tuberin, and focally for smooth muscle actin and CD34. Exclusively in the large tumor, PEComalike cells expressed HMB45; 1 to 5% of tumor cells were positive for MIB 1. In the differential diagnosis, lymphangioleiomyomatosis, PEComa, hemangioendothelioma, hemangiopericytoma, histiocytic tumors, and solitary fibrous tumor were considered but could be excluded based on immunohistochemistry. Due to the loss of hamartin, the reticulonodular proliferation clearly belongs to the spectrum of perivascular tuberous sclerosis complexrelated diseases. Hormone therapy with Letrozol and chemotherapy with doxorubicin were unsuccessful. Bevacixumab and Gemcitabine as secondline therapy stopped progression and resulted in shrinkage of the large nodules.

Hodgkin Lymphoma Presenting as Multiple Cavitary Pulmonary Nodules

Shannon Pavlich; Jacqueline K. Trupiano. William Beaumont Hospital.

Context: Hodgkin lymphoma (HL) involving the lung is uncommon. It may present in a variety of radiographic and histologic patterns, including solid, necrotizing, and cavitary lesions with or without associated mediastinal adenopathy. Histologically, it may masquerade as a necrotizing, inflammatory, or granulomatous reaction and may be misdiagnosed as an infectious process. HL should be considered in the differential diagnosis of pulmonary lesions, particularly those associated with adenopathy.

Design: We report a case of an 18yearold man presenting with cough, fever, multiple cavitary pulmonary nodules, pleural effusion, and mediastinal adenopathy.

Results: Bronchoalveolar lavage and pleural fluid cytology revealed neutrophilic inflammation. Initial biopsies of both a mediastinal lymph node and lung nodule showed necrotizing, neutrophilic inflammation consistent with abscess. An infectious etiology was the working diagnosis, and multiple cultures and serologic studies were performed, all of which were negative. The pulmonary nodules increased with enlargement and coalescence. Repeat pulmonary biopsy revealed a marked necrotizing inflammatory reaction with scattered CD30positive ReedSternberg cells and focal areas of fibrosis, consistent with HL, nodular sclerosis type.

Conclustions: HL may involve the lung as a primary process, or more commonly, in association with mediastinal disease. The histology is variable and often masquerades as an inflammatory reaction, which may be misdiagnosed as a presumed infectious process, leading to delay in treatment and progression of disease. HL should be considered in the differential diagnosis of necrotizing, inflammatory, and granulomatous pulmonary lesions.

Expression of Angiostatin Receptor Annexin II in Lung Squamous Cell Carcinoma: A Potential New Therapeutic Target

Kai Zhang; Fan Lin; Jianhui Shi; Ce Zhang. Geisinger Medical Laboratory, Geisinger Health System, Danville, Pa.

We reviewed a total of 44 lung resection cases of lung nonsmall cell carcinoma, including G2, G3 squamous cell carcinoma (SCC) (n = 20) and G2, G3 adenocarcinoma (ACA) (n = 24). Immunostain (IHC) was done using monoclonal antiannexin II (ANX2) antibody. Visible cytoplasmic and/or membranous staining was considered as positive staining. The intensity was graded subjectively as weak, intermediate or strong. The distribution was recorded as negative (no staining), 1+ (75%). Western blotting was done on 1 G2 SCC, 1 G2 ACA, benign lung tissue, and a known positive control. beta Actin was used for checking equal loading. The results were as follows: In all 44 benign lung tissues, no cells were positive for ANX2 by IHC. Positive staining for ANX2 was observed in 19 (95%) of 20 SCCs, and most cases showed strong or moderate staining intensity, with 55% of cases showing 3+ or 4+ staining. In contrast, only 1 case (of 24; 4%) of ACA showed very focal and weak (1+) staining. In addition, the cells located at the basal layers of some of the benign bronchioles near SCCs expressed ANX2, which was not observed in the cases of ACA. Western blotting showed a positive band at 38 kd on SCC and on the positive control sample but not on benign lung tissue and ACA. The Western blotting results support immunohsitochemical findings. In conclusion, the novel findings of expression of ANX2 on lung SCC provide a basis for a potential new therapeutic target, a useful marker for distinction between SCC and ACA, and a potential role in the pathogenesis of lung SCC.

Metastatic Lung Adenocarcinoma of Fetal Type to the Ovaries

Mostafa M. Fraig. Medical University of South Carolina, Charleston.

This case concerns a 37yearold woman with a 5year pack history of smoking who presented with a 7.5cm wellcircumscribed mass in the left lower lobe. Abdominal computed tomography scan performed at the time of presentation revealed no abdominal or pelvic masses. An initial biopsy was reported as carcinoid tumor. A lobectomy was performed, and the tumor was diagnosed as pulmonary blastoma. The woman experienced recurrences in the opposite lung as well as in bone. Six years later, she was found to have a 10cm ovarian mass that was positive for adenocarcinoma. Because of the morphologic similarities between lung adenocarcinoma of fetal type and endometrioid adenocarcinoma, thyroid transcription factor 1 immunostains were performed on both tumors and proved to be positivie in both. The differential diagnosis of both tumors and a review of the literature on the metastatic potential of the welldifferentiarted fetal adenocarcinoma will be presented.

Solitary Intrapulmonary Cystic Lymphangioma

Hiroshi Minato1 ; Sachiko Kaji2 ; Eriko Kinoshita1 ; Nozomu Kurose1 ; Takayuki Nojima.1 1Kanazawa Medical University, Ishikawa, Japan; 2 Chiba Cancer Center, Chiba, Japan.

Context: Intrapulmonary lymphangioma rarely presents as a solitary pulmonary lesion, and the abnormal vessels may be capillary, cavernous, or cystic in type. We experienced a case of solitary cystic lymphangioma of the lung and here present its clinicopathologic findings.

Design: A 2monthold male infant was referred to our hospital because of a persistent cough. Chest radiograph showed a large cyst in the right lung. He was born of a fullterm, normal delivery. No other lesion was observed extrapulmonary or intrapulmonary. Under the preoperative diagnosis of bronchogenic cyst, he underwent right lower lobectomy at the age of 11 months.

Results: A resected specimen contained a septate cystic lesion that measured 5.5 x 5.5 x 4.5 cm. The cyst had a small amount of serous fluid, and the inner surface was smooth. Microscopically, the lesion was composed of a large cystic space and interconnected slitlike spaces surrounding bronchovascular islands. The cysts were lined by a monolayer of flat cells and occasional multinucleated giant cells. Neither significant smooth muscle proliferation nor lymphoid follicles were observed. Immunohistochemically, the lining cells of the cystic lesion were diffusely positive for D240, CD34, and CD31, but were negative for AE1/3 and HMB45. Postoperative course was uneventful. Differential diagnosis of intrapulmonary lymphangioma may include lobar or interstitial emphysema, bronchogenic cyst, congenital cystic adenomatoid malformation, and alveolar adenoma.

Conclusions: Solitary intrapulmonary lymphangioma is a rare, benign, and localized lesion. D240 was useful in differentiating it from other diseases and in determining the extent of the lesion.

Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation in a Patient With Active Wegener Granulomatosis

Lakshmi Puttagunta; Khalida Nasim; Dale C. Lien; Kenneth C. Stewart; Joanne Homik; Steven S. Caldwell; Justin Weinkauf. University of Alberta, Alberta, Canada.

Context: Lung transplantation is a rare indication in patients with Wegener granulomatosis (WG) with failed medical treatment. Ventilator dependence and extracorporeal membrane oxygenation (ECMO) have traditionally been regarded as relative contraindications to lung transplantation. We report on a patient with WG who was maintained on ECMO until the lung allografts became available and were successfully transplanted.

Design: A 17yearold adolescent boy was diagnosed with WG based on clinical history, positive cantineutrophil cytoplasmic antibodies (ANCA), a renal biopsy, and a subsequent lung explant pathology report. Despite rigorous medical treatment with cyclophosphamide,methyl prednisolone, hemodialysis, plasmapheresis, and rituximab, his condition deteriorated, and he developed massive pulmonary hemorrhage and hypoxemic respiratory failure. On day 11 of his admission, the patient was started on venoarterial ECMO along with anticoagulation, but with no improvement in oxygenation. He received bilateral lung allografts on day 15 of his hospitalization and was taken off ECMO intraoperatively. He received standard immunosuppressive therapy and continued with intermittent hemodialysis. He subsequently regained nearly normal renal function and his ANCA titers became negative. He is now 550 days posttransplant and is doing well. Conclusions: To our knowledge, this is the first report of successful use of ECMO as a bridge to lung transplantation.

Diffuse Lymphangiomatosis Mimicking Interstitial Lung Disease

Helmut H. Popper; Jana Polachova. Medical University of Graz.

A 67yearold woman presented having experienced cough and dyspnea for months. From an xray, infection was suspected, and treatment with antibiotics was started. The process worsened. On highresolution computed tomography, ground glass and consolidation areas were seen. Total body irradiation showed organizing pneumonia. Bronchoalveolar lavage diagnosed a lymphocytic, CD4dominated, and mildly granulocytic alveolitis. A videothoracoscopic biopsy was taken. The tissue was processed routinely. Sections were stained with hematoxylineosin and Movat. Serial sections were immunostained for CD31, VEGFC/D, VEGF receptor 3, and podoplanin (D240). On frozen section, a diagnosis of a complex interstitial lung disease was made, composed of organizing pneumonia and focal interstitial fibrosis resembling usual interstitial pneumonia and nonspecific interstitial pneumonia. However, there was also interstitial edema and several foci of an angiomatoid proliferation. These vessels showed a single layer of endothelia, usually flattened, and a thickened wall composed of thickened connective tissue without a muscle layer. In Movatstained sections, adjacent veins and arteries were highlighted by their elastic laminae. The angiomatoid proliferation, however, was devoid of any lamina elastica. Immunohistochemical staining for CD31, VEGFC, podoplanin, and VEGF receptor 3 was performed on the vascular proliferation and were found positive. A diagnosis of diffuse pulmonary lymphangiomatosis was made. Diffuse pulmonary lymphangiomatosis is a rare disorder that usually affects children and young adults. A systemic form (GorhamStout syndrome or vanishing bone disease) can affect lymphatic ducts in bone, mediastinum, soft tissues, and also lungs, liver, and spleen. We present here this rare disease in an adult, combined with complex interstitial pneumonias. No treatment other than transplantation has been successfully applied in isolated pulmonary lymphangiomatosis.

Primary Malignant Melanoma of the Pleura: Report of an Autopsy Case

Toshiaki Kawai1 ; Takayuki Haga2 ; Kuniaki Nakanishi.1 1National Defense Medical College, Tokorozawa, Saitama, Japan; 2National Higashi Saitama Hospital, Hasuda, Saitama, Japan.

Melanoma metastatizing to the lungs is common, but primary pulmonary or pleural melanoma is extremely rare. We present an autopsy case of malignant melanoma of the pleura in a 49yearold man. The patient presented with cough and right back pain. On admission to hospital, 2.5 months before he died, the man was found to have an elastic, hard, subcutaneous mass the size of a thumb in the right chest. The large amount of pleural effusion was bloody and was diagnosed cytologically as negative. From fineneedle aspiration cytology, the right chest mass was diagnosed as spindle cell sarcoma. Autopsy showed that a yellowwhite tumor primarily located in the right visceral pleura had invaded into the right lung and also into the right thoracic wall and had metastatized into the left lung, visceral pleura, thyroid, and left adrenal. No primary site was found (including skin and other mucous membranes). Histologically, the predominantly spindle cell foci exhibited a fascicular growth pattern with elongated to ovoid pleomorphic cells possessing large hyperchromatic nuclei and vague nucleoli, accompanied by areas of a nuclear palisading pattern and extensive necrosis. Some nested and epithelioid foci were seen, intermingled with cartilagelike differentiation. Some finely granular brown pigment was present within tumor cells and macrophages. Most of the pigment was FontanaMasson positive and bleached by potassium permanganate. Immunohistochemical analysis showed the tumor cells to be positive for S100 and focally positive for HMB45, but negative for other markers (including keratin, CAM 5.2, and calretinin). Ultrastructural examination of formalinfixed wet tissue showed the neoplastic cells had a melanosomelike structure.

PlatletDerived Growth Factor Receptor beta, a Potential Target for Molecular Chemotherapy, Is Expressed in Malignant Mesothelioma

Patrizia Morbini1 ; Chiara Villa1 ; Simona Inghilleri2 ; Camillo Porta.2 1University of Pavia; 2Fondazione IRCCS Policlinico S. Matteo.

Context: The synergistic combination of gemcitabine or pemetrexed with tyrosine kinase (TK) inhibitor imatinib mesylate seems to be effective in controlling malignant mesothelioma (MM), both in experimental and in as of yet unpublished clinical settings. Imatinib blocks TKassociated receptors, including cKit/CD117 and platletderived growth factor receptor beta (PDGFRbeta), by inhibiting kinase binding with adenosine triphosphate. PDGF autocrine production seems to be relevant in mesothelioma cell growth. Furthermore, one of the most common genetic abnormalities observed in MM involves chromosome 22q13, where the PDGFRbeta gene is mapped. PDGFRbeta was documented in MM cell cultures, but it has never been investigated in MM tissue samples.

Design: PDGFRbeta (Rb1692, Labvision, Freemont, Calif) and CD117 (A4502, Dako Cytomation, Carpinteria, Calif) expression was investigated immunohistochemically in 138 MM cases and correlated with clinical and tumor data (histological type, patient survival, and type of exposure to asbestos).

Results: One hundred five cases (76%) were moderately or intensely reactive for PDGFRbeta; 33 (24%) showed weak or absent immunoreactivity. Consistent expression of CD117 was observed in 16 cases (11.5%), which were also reactive for PDGFRbeta. CD117 expression was significantly associated with epithelioid histology (P

Conclusions: The present study confirms for the first time in vivo in a large series of MM cases the expression of PDGFRbeta, further supporting the promising therapeutic strategy of combining the TK inhibitor imatinib mesylate with antifolates or gemcitabine.

The Role of cKit (CD117)Positive Mast Cells and Its Ligand (Stem Cell Factor) in Chronic Fibrosing Bronchiolitis Obliterans Including Chemical Exposure: Is There a Potential for Treatment With Imatinib (Gleevec)?

Neil Fuehrer1 ; Alberto Marchevsky2 ; Jaishree Jagirdar.1 1University of Texas Health Science Center, San Antonio; 2Cedar Sinai Medical Center, Los Angeles, Calif.

Context: In many fibrosing lung diseases, it is not clear what leads to the progression of fibrosis following a remote injury. Immunemediated progression may be a reason. cKit (CD117)positive mast cells (M cells) have been associated with chronic fibrosing diseases and carry a potential to be treated with imatinib (Gleevec), a tyrosine kinase inhibitor.We evaluate the role of M cells in fibrosis associated with bronchiolitis obliterans (BO).

Design: Four cases of BO (household cleaner exposure, ammonia exposure, idiopathic, and posttransplant) were compared with asthma/ emphysema. Small and large airways were stained for CD20, CD3, CD4, CD8, CD117, CD34, toluidine blue, hematoxylineosin, trichrome, and stem cell factor (SCF; cKit ligand). CD117stained slides were digitally scanned with Aperio Scanscope, and stained cells were counted within the epithelium and subepithelium of small and large airways (per millimeter of basement membrane).

Results: M cells were concentrated within the involved subepithelium of small airways in BO (122 cells per mm), unlike asthma/emphysema (25 cells per mm). Conversely, there were more M cells in the epithelium in asthma/emphysema than in BO (7 cells permm vs 2 cells per mm, respectively). M cells were significantly increased around involved airways versus uninvolved airways (52 cells per mm vs 14 cells per mm, respectively). Large airways in either group had similar CD117 expression. SCF was not increased. All other stains were similar between the groups.

Conclusions: Mast cells appear to be concentrated in the lesional small airway subepithelium in BO, suggesting that early administration of imatinib may be of value in preventing progression to fibrosis.

Malignant Mesothelioma: Guidelines for Pathologic Diagnosis

Aliya N. Husain1 ; Alain Borczuk2 ; Philip T. Cagle3 ; Andrew Churg4; Thomas V. Colby5 ; Francoise GalateauSalle6 ; Allen R. Gibbs7 ; Allen M. Gown8 ; Samuel P. Hammar9 ; Thomas Krausz1 ; Leslie A. Litzky10 ; Nelson G. Ordonez11 ; Victor L. Roggli12 ; William D. Travis13 ; Mark R.Wick.14 1 University of Chicago Medical Center; 2Columbia University Medical Center; 3The Methodist Hospital; 4University of British Columbia; 5Mayo Clinic College of Medicine; 6Laboratoire d’Anatomie Pathologique; 7 Llandough Hospital; 8PhenoPath Laboratories; 9Diagnostic Specialties Laboratory; 10University of Pennsylvania Medical Center; 11M. D. Anderson Cancer Center; 12Duke University Medical Center; 13Memorial Sloan Kettering Cancer Center; 14University of Virginia Medical Center. A pathology panel was convened in October at the International Mesothelioma Interest Group (IMIG) biennial meeting to discuss guidelines for the pathologic diagnosis of malignant mesothelioma (MM). This resulted in a consensus opinion, which can be divided into the following: (1) distinguishing between benign and malignant mesothelial proliferations (both epithelioid and spindle cell lesions); (2) cytologic diagnosis of MM; (3) key histologic features of pleural and peritoneal MM; (4) use of histochemical and immunohistochemical (IHC) stains; (5) differentiating epithelioid MM from various carcinomas (lung, breast, ovarian, and colonic adenocarcinomas, as well as squamous cell and renal cell carcinomas); (6) diagnosing sarcomatoid mesothelioma; (7) use of molecular markers in the differential diagnosis; (8) electron microscopy; (9) what not to use in the diagnosis; and (10) pitfalls in the diagnosis of MM. IHC panels are suggested, the exact makeup of which is dependent on the differential diagnosis, experience of the pathologist, and antibodies available. The panel should contain both positive and negative markers, with at least 60% sensitivity and specificity. Interpretation of positivity generally should take the number of cells staining (>10%) and the localization of the stain (eg, nuclear vs cytoplasmic) into consideration. These guidelines are meant to be a practical reference for the pathologist, rather than a mandate or review of the literature.

Financial discloser: Dr Travis receives financial compensation from plaintiffs and defendants for expert testimony on malignant mesothelioma.

Kiln Burner Pneumoconiosis

Izidor Kern; Katarina Osolnik. University Clinic of Respiratory and Allergic Diseases.

Context: Charcoal can be produced by carbonization of wood in kilns. It is a traditional seasonal job. When the pyrolysis is complete, a kiln burner manually removes the charcoal. While doing this, he is exposed to smoke and charcoal dust. We report a case of socalled kiln burner pneumoconiosis.

Design/Results: A 71yearold man, who was a nonsmoker and farmer, was admitted to the hospital because of bilateral pneumonia. Antibiotic therapy was efficient. Two months after complete resolution of radiologic lung infiltrates and normalization of his laboratory results, pulmonary function testing disclosed a restriction pattern (vital capacity 67% and forced expiratory volume in the first second 75% of predicted values) with diminished diffusion capacity (74% of predicted value). With time, pulmonary function did not improve, and highresolution computed tomography showed a diffuse centrilobular groundglass nodular pattern with subpleural small areas of consolidations. Transbronchial biopsy revealed deposition of black pigment in the bronchiolar interstitium, similar to the histologic appearance of simple coal workers pneumoconiosis, with no signs of fibrosis. A lot of black amorphous material was found in bronchoalveolar lavage. Additional environmental history was taken to elucidate the patient’s lifelong occupation as a kiln burner.

Conclusions: We report a case of lung disease due to inhalation of carbonaceous materials. The patient was exposed to incomplete combustion of wood burning and large amounts of charcoal dust while kiln burning for a long period.

Benign Lymphocytic Angiitis and Granulomatosis

Belinda E. Clarke. Queensland Health Pathology Service.

A 55yearold obese diabetic woman presented with 6 months of fluctuating skin lumps, dry cough, exertional dyspnea, and mild fatigue. No environmental exposures were documented. Serology for infections, connective tissue diseases and vasculitis was negative. Serial computed tomography scanning demonstrated multiple fluctuating pulmonary nodules. Excision of a skin nodule yielded a diagnosis of nodular vasculitis. Videoassisted thoracoscopy lung biopsy revealed an area of infarctlike necrosis associated with lymphocytic and granulomatous vasculitis. There was no atypia of the lymphoid infiltrate, which consisted predominantly of CD4 CD56 T cells. Results of EpsteinBarr virus in situ hybridization (EBVISH) were negative, and polymerase chain reaction for Tcell receptor and immunoglobulin heavy chain rearrangements demonstrated polyclonal DNA. A diagnosis of benign lymphocytic angiitis and granulomatosis (BLAG) was made. The patient was started on chlorambucil with little measurable benefit. Since the original description of 14 cases of BLAG in 1977, controversy has surrounded its existence as an entity distinct from lymphomatoid granulomatosis (LYG). Understanding LYG itself has evolved during that time. Liebow described the classic triad of changes in 1972, but only during the 1980s was it recognized to be an angiocentric lymphoma, thought to be of Tcell origin. Not until 1994 were most shown to be Tcellrich, EBVdriven Bcell lymphomas. Cases of otherwise typical LYG in which the cytologically malignant lymphoid cells mark as T cells and lack evidence of EBV infection are now classified as peripheral Tcell lymphomas. Cases such as that reported here have been designated angiocentric immunoproliferative lesions, grade 1. Some have been shown subsequently to progress to malignant lymphoma.

Primary Epithelioid Angiosarcoma of the Pleura

Kirtee Rishi1 ; Philip T. Cagle1 ; Timothy C. Allen.2 1The Methodist Hospital, Houston; 2University of Texas Health Center at Tyler.

A 61-year-old man presented with shortness of breath and right- sided chest pain. On radiographic studies, he was found to have a large rightsided pleural effusion and a large rightsided pleural mass with adjacent pleural thickening. He underwent thoracotomy, and approximately 750 ml of bloody fluid was drained from his right chest. A hemorrhagic, circumscribed mass was excised from the right pleura. On sectioning, the mass was hemorrhagic and necrotic. Histologic sections showed sheets of epithelioid cells with large, vesicular nuclei and prominent nucleoli. At higher power magnification, similar features with scattered cytoplasmic vacuoles and occasional mitoses were seen. The neoplastic cells were immunopositive for CD31 and factor VIII and focally immunopositive for keratin.

Spontaneous Pleuropulmonary Endometriosis in Baboons: Insights Into Pathogenesis

Jaishree Jagirdar1 ; Jeffrey Christal1 ; Matthew Martin1 ; Gene Hubbard.2 1University of Texas Health Science Center; 2South West Foundation for Biomedical Research.

Context: Endometriosis is a common gynecologic disorder in women. Spontaneous pleuropulmonary endometriosis (PPE) is rare. The pathogenesis of endometriosis, particularly of PPE, remains unclear. Major theories include the following: coelomic metaplasia, embolization from the uterus or pelvis, and retrograde menstruation with transperitonealtransdiaphragmatic migration of endometrium. Although not reported, PPE is common in baboons, which may serve to further our understanding of the pathogenesis and to refine management.

Design: Ten cases of PPE and 4 cases of intraabdominal endometriosis were identified at necropsy in baboons (Papio spp.). Hematoxylineosin stain and immunohistochemistry were performed on sections, using antibodies to estrogen receptor (ER), progesterone receptor (PR), thyroid transcription factor 1 (TTF1), CD10, and the proliferation marker Ki67.

Results: Grossly, clear hemorrhagic, 0.5 to 2mm cystic lesions were noted on the lung surfaces and within the lung parenchyma in the 10 baboons. The cysts were lined by TTF1 , ER/PR columnar/ cuboidal epithelium and cuffed by ER /PR /CD10 stromal cells. Unexpectedly, small deep parenchymal nodular interstitial aggregates of ER /PR / CD10 stromal cells rimmed by TTF epithelial cells were found with variable Ki67 proliferative activity. In contrast, the epithelium and stroma in abdominal endometrioisis was TTF1, ER /PR.

Conclusions: The abdominal endometriosis differs from the PPE in that the latter is lined by TTF1 cells, which suggests that the pathogenesis of PPE is other than what is speculated above. The presence of deep parenchymal interstitial aberrant nodular stromal aggregates suggests that the stroma is the driving force in PPE upon which the lungspecific epithelium condenses and may require a novel approach to therapy.

Tumor Lymphangiogenesis, Lymphatic Invasion, and Micrometastasis in Stage I Lung Cancer Using D240 Immunohistochemistry

Irene CastanedaSanchez1 ; Elizabeth Kurian1 ; Philip T. Cagle2 ; Jaishree Jagirdar.1 1The University of Texas Health Science Center, San Antonio; 2The Methodist Hospital, Houston.

Context: Stage I nonsmall cell lung cancer (NSCLC) carries survival rates of approximately 70% at 5 years, with approximately 30% of patients experiencing poor outcome, despite complete surgical excision. Squamous cell carcinomas (SCCs) fare slightly better. In the search for prognostic markers, this study proposes to evaluate lymphatic invasion, micrometastasis, and lymphangiogenesis in stage I lung cancer, using a specific marker of lymphatic endothelium (D240/podoplanin).

Design: Paraffinembedded tissue sections of tumor and lymph nodes from 60 patients with stage I NSCLC were retrospectively analyzed for lymphatic invasion, micrometastases and lymphatic microvessel density (MVD) using D240. The presence of these pathologic factors were correlated with clinical factors in the search for prognostic markers in early disease. Tumor types included the following: 35 adenocarcinomas (ACAs), 9 bronchoalveolar carcinomas, 10 SCCs, and 7 large cell carcinomas.

Results: Lymphatic invasion, although uncommon, showed a trend toward poor outcome. MVD was uniformly low in SCC. Minimal lymphatic MVD was noted in peritumoral areas in all types of stage I NSCLC. Incidence of increased lymphatic MVD was highest in scar areas (2 to 3 ), particularly in ACAs. Larger scar size correlated with increased lymphatic microvessel density and with a poor prognosis. Conclusions: The increase in lymphatic density in the tumor scar may account for the prognostic significance of scar size in ACAs. The better prognosis of stage I SCCs may be due to low lymphatic MVD and absence of scar. D240 is a valuable marker for lymphatic invasion in stage I lung cancer.

A Case of Pulmonary Epithelioid Hemangioendothelioma With an Unusual Presentation and an Aggressive Clinical Course

Armita Bahrami1 ; Philip T. Cagle2 ; Timothy C. Allen.3 1Baylor College of Medicine, Houston; 2The Methodist Hospital and Weill Medical College of Cornell University, Houston; 3University of Texas Health Center at Tyler.

A 37yearold white man presented with a 1year history of progressively severe posterior chest wall pain. Magnetic resonance imaging of the spine revealed an intrathoracic mass, which on a chest computed tomography scan was described as a 4cm solid left upper lobe lung mass, arising from the left hilum. Initial attempts by bronchoscopic and transthoracic biopsies failed to obtain diagnostic material. The patient underwent thoracotomy and was found to have a locally advanced, surgically unresectable tumor involving the pleura, pericardium, and diaphragm. Bone imaging studies showed loss of periosteum of several ribs in the area where the patient complained of pain. Results of the metastaticworkup were otherwise negative. The patient failed to respond to radiochemotherapy and died 11 months following the diagnosis with large pleural and pericarcdial effusion, tamponade, and metastasis to the skin of the thoracoabdominal wall. Histologically, the tumor had a biphasic (epithelioid and spindled) appearance, suggestive of mesothelioma. The epithelioid cells had roundoval vesicular nuclei, with mild to moderate nuclear pleomorphism without significant mitoses, arranged in nests and strands within a dense hyalinized to chondromyxoid stroma. Immunohistochemically, neoplastic cells expressed endothelial markers CD31, CD34, and FLI1 and were negative for mesothelioma markers. Cytokeratin AE1/AE3 was focally positive. The tumor was diagnosed as epithelioid hemangioendothelioma. Despite lack of unequivocal highgrade histologic features, the tumor had an aggressive biologic behavior. In conclusion, epithelioid hemangioendothelioma is a rare tumor in the lung that can mimic other more common pathologic entities. It should be considered in an approach to unusual pulmonary neoplasms with epithelioid or biphasic morphology.

Angiogenesis in Bronchial Dysplasia and Angiogenic Squamous Dysplasia Is Associated With the Formation of Immature Vasculature

Daniel T. Merrick1 ; Elizabeth S. Buyers2 ; York E. Miller1 ; Robert L. Keith1; Timothy C. Kennedy2 ; Wilbur A. Franklin.2 1Denver Veterans Administration Medical Center; 2University of Colorado Health Sciences Center.

Angiogenic squamous dysplasia (ASD) is a dysplastic lesion of the bronchi of smokers that is distinguished from other dysplasias by virtue of the presence of characteristic vascular morphology with projection of microvessels into the overlying dysplastic epithelium. To date, we have identified ASD in 167 of 721 patients who have undergone LIFE bronchoscopy at the University of Colorado Health Sciences Center: in nonmalignant airways of 37 patients with invasive carcinoma (28 prevalent carcinomas and 9 incident carcinomas) and in 130 patients without carcinoma. ASD can be associated with marked stromal matrix remodeling. These lesions are associated with increased vascular endothelial growth factor expression and high microvessel densities (MVD) in comparison to normal bronchial epithelium. We examined the microvessel maturation index (MMI) (actin+ MVD/CD31+ MVD) of 12 ASD lesions and 4 samples of normal mucosa. The mean MMI for dysplastic lesions was significantly less than that measured for 4 normal bronchial biopsies (MMI, 0.62 vs 1.02, respectively; P = .04). When analyzed independently, the vessels that project into the intraepithelial papillae of ASDs showed the lowest MMI of 0.56. This was not statistically different than the MMI for the dysplasia group as a whole, but was significantly decreased in comparison to normal MMI (P = .71 and .04, respectively). Incomplete vascular maturation is associated with dysplastic change in the bronchi of smokers and is most striking in the vascular structures of ASD. In this respect, ASD is similar to invasive carcinoma. Increased delivery of protumorigenic factors, such as growth promoting factors and mutagenic substances, may be facilitated by immature vascular networks in premalignant airways.

Malignant Solitary Fibrous Tumor of the Pleura

Jerad M. Gardner1 ; Philip T. Cagle1 ; Timothy C. Allen.2 1The Methodist Hospital, Houston; 2University of Texas Health Center at Tyler.

A 65-year-old woman presented with a pleuralbased mass of the right lower lobe. The mass was surgically resected, and the gross specimenwas a 14cm, 858g nodular tumor with a white whorled cut surface. Microscopically, some areas of the tumor were composed of irregularly arranged plump spindle cells with intervening dense collagen and a hemangiopericytoma like vascular pattern. These areas were confluent with areas of highly pleomorphic spindle cells with prominent nucleoli and numerous atypical mitotic figures. Multinucleated tumor giant cells and rhabdoid tumor cells were also seen, as well as focal areas of tumor cell necrosis. The specimen was diagnosed as a malignant solitary fibrous tumor (MSFT). MSFT is a very uncommon lesion. Such tumors may have the architectural characteristics of a benign solitary fibrous tumor but with malignant cytologic features, or they may resemble obvious highgrade sarcoma. Most MSFTs are CD34 positive, but CD34 negativity has been reported. Although there is potential for local recurrence as well as distant metastasis, many patients can be cured of MSFT by complete surgical resection. Interestingly, radiation and chemotherapy may actually decrease survival in patients with this lesion. This case of MSFT is particularly unique because representative areas of both typical solitary fibrous tumor and highgrade MFHlike sarcoma are seen within the same lesion.

Adenoid Cystic Carcinoma of the Trachea

Melissa L. Stanton1 ; Philip T. Cagle.2 1University of Texas at Houston Medical School; 2The Methodist Hospital, Houston.

Primary pulmonary adenoid cystic carcinoma (ACC) is a rare, slowgrowing tumor histologically similar to that found in the salivary glands. Most tumors arise intraluminally within the trachea, main stem, or lobar bronchi. They are generally well circumscribed but can have infiltrative margins along the tracheobronchial wall, extending far beyond the localized mass. Histologically, cribriform, tubular, or solid growth patterns are seen with mucinous and hyalinized basement membranelike material found within the cribriform cylinders or tubules. Local recurrence is common because of the distinctive invasion patterns, and distant metastases have been reported. We report a case of a 61yearold woman who presented with chronic cough and tracheal stenosis. A 1.7cm mass that was attached to and partially filling the tracheal lumen was identified. A segmental tracheal resection was performed, and a diagnosis of ACC was made. ACC comprises less than 1% of all primary lung and bronchial neoplasms. Patients typically present with airway obstructive symptoms, such as dyspnea, cough, chest pain, and hemoptysis. ACC is thought to be an indolent tumor because, in many cases, multiple local recurrences precede the development of distant metastases.

Endobronchial Primary Pulmonary Meningioma

Enrique M. Gomez. University of Texas in Houston.

Primary pulmonary meningioma (PPM) is a very rare entity, with only 33 reported cases in the literature. PPMs are usually benign and located in the peripheral pulmonary parenchyma. None of the previously reported cases had an endobronchial location. To our knowledge, we report the first endobronchial benign PPM case. This case presented in a 34yearold woman who was admitted with symptoms of hemoptysis. Radiographic and bronchoscopic studies revealed an endobronchial mass obstructing the right intermediary bronchus. A right lobectomy was performed. On gross evaluation, a 2.5 x 2.0cm unencapsulate welldemarcated masswas identified, with associated distal pulmonary atelectasis. Histologically, the lesion was composed of whorles and bundles of bland polygonal to fusiform cells with oval to round nuclei and dispersed chromatin. Immunohistochemical studies were performed, supporting a diagnosis of meningioma. Imaging studies did not find evidence of any intracranial or intraspinal meningioma; therefore, this case was diagnosed as a PPM. Although most cases of PPM have no pulmonary symptoms and are discovered as incidental intraparenchimal nodules during routine chest roentenograms, this case presented with symptoms of hemoptysis, probably due to the intrabronchial localization of the disease.

The Concordance of Clinical Asbestosis With Pathological Asbestosis: A 10-Year Survey

Richard Luther Attanoos; Gareth Rowlands; Allen R. Gibbs. Llandough Hospital.

Context: In the United Kingdom, recent governmental guidelines recognize clinical asbestosis without a requirement for supportive pathology. Moreover, diffuse interstitial fibrosis (DIF) without asbestos bodies and/ or low fiber burdens are not considered of value in questioning the clinical diagnosis of asbestosis. This survey was performed to compare the postmortem pathology diagnosis of asbestosis with diagnoses made on clinical grounds.

Design: Of 4800 postmortem examinations from 1997 to 2006, 355 (7.4%) cases were selected for detailed examination on the basis of a history of asbestos exposure and/or DIF. According to established College of American PathologistsNational Institute for Occupational Safety and Health guidelines, lung tissue was sampled and the diagnosis of asbestosis evaluated according to the 1997 Asbestos, Asbestosis, and Cancer report (Scand J Work Environ Health). Asbestos fiber counts were performed by transmission electron microscopy with energydispersive xray analysis. Results: One hundred three cases with an asbestos history had nonneoplastic changes clinically deemed asbestosis. Twentythree (22.3%) cases showed DIF, 73 (71%) cases showed no significant fibrosis, and in 7 (7%) cases, there was insufficient tissue for diagnosis. Of the 23 DIF cases, 5 (21.7%) complied with the Helsinki pathologic criteria for asbestosis, 3 showed fewer than 2 asbestos bodies per square centimeter of lung, and 15 showed no asbestos bodies. After mineralogic analysis, only 1 of 3 and 1 of 15 cases were subsequently diagnosed as asbestosis.

Conclusions: Significant (70%) discordance between the clinical and pathologic diagnoses of asbestosis exists. The validity of basing compensation on clinical asbestosis alone is questionable. There persists a requirement to standardize pathologic and mineralogic criteria for asbestosis. Other causes of DIF recognized pathologically are misdiagnosed clinically.

Financial disclosure: Drs Attanoos and Gibbs receive financial compensation for expert testimony on abestosrelated disease in various countries.

Primary Glomangiosarcoma of the Lung

Munir Shahjahan; Donna M. Coffey; Philip T. Cagle. The Methodist Hospital, Houston.

A 40yearold woman presented with a right lung mass and underwent subsequent lobectomy of the upper lobe. The tumor measured 9 cm in greatest dimension with extension into the adjacent bronchus. Initial clinical impression and gross examination pointed toward a neuroendocrine tumor. Microscopic examination revealed no nuclear atypia or necrosis. However, focal areas with increased mitoses (up to 7 per 10 highpower fields) and features of lymphovascular invasion were identified. Tumor cells were immunopositive for actin, vimentin, collagen type IV, and calponin but negative for chromogranin, synaptophysin, S100, pankeratin, cytokeratin 7, epithelial membrane antigen, desmin, CD99, CD10, inhibin, and progestoreone receptor. Electron microscopic examination showed cells with cytoplasmic bundles of microfilaments, external lamina, and micropinocytotic activity. No desmosomelike junctions and no dense core neurosecretory granules were seen. Presence of lymphovascular invasion with increased focal mitotic activity together with the immunohistochemical staining pattern and ultrastructural findings were characteristic of a malignant glomus tumor. Glomangiosarcomas (malignant glomus tumors) of the lung are extremely rare tumors with only a few cases described to date. Rarity of this tumor and its histologic similarity to more common primary and metastatic neoplasms makes this a very challenging diagnosis. This case emphasizes that clinical, histologic, and immunohistochemical examination are essential in establishing a diagnosis of glomangiosarcoma.

Bronchiolitis and Peribronchiolar Interstitial Disease in 4 Patients Exposed to World Trade Center Smoke and Dust

Maoxin Wu1 ; Maria Padilla2 ; Jacqueline Moline2 ; Robin Herbert2 ; David Mendelson2 ; Virginia Litle2 ; William Travis3 ; Joan Gil.2 1Mount Sinai School of Medicine; 2Mount Sinai Medical Center; 3Memorial SloanKettering Cancer Center.

Persistent respiratory conditions have been described among rescue and recovery workers exposed to smoke and dust from the World Trade Center (WTC) disaster. Sarcoidlike pathologic findings have been reported in some cases. We report findings in 4 patients (ages 4256 years) with WTC exposure commencing on September 11 or 12, 2001, who are being followed at the Mount Sinai WTC Medical Monitoring and Treatment Program. Patients presented with complaints of shortness of breath and nonspecific radiologic findings (diffuse interstitial disease and rarely nodules) and underwent videoassisted thoracoscopic biopsies. The 4 biopsies all revealed generally severe bronchiolitis with variable characteristics. In lessinjured areas, it was associated with peribronchiolar fibrosis with bronchiolar metaplasia; in other fields, the degree of interstitial fibrosis was so extensive that the peribronchiolar origin was less ascertainable. One of the cases was remarkable for areas of honeycombing isolated in an otherwise unremarkable alveolar parenchyma; another case showed eosinophils with very poorly organized granulomas, also present in the lymph nodes. The overall appearance was unusual in that it did not correspond to any of the common interstitial diseases. In none of the cases were classic patterns of usual interstitial pneumonia, nonspecific interstitial pneumonia, or desquamative interstitial pneumonia seen. The lower lobes appeared slightly more affected. We conclude that these findings represent an uncommon pathologic reaction to the inhalation of the smoke and dust generated from the WTC disaster.

This work was supported by the Centers for Disease Control and Prevention and the National Institute for Occupational Safety and Health under contract 20020020038 and grants 5U1O 0H008232, World Trade Center Medical Monitoring and Treatment Program.

New Biomarkers in the Cancerous Stroma: Podoplanin, SPARC, and Galectin9; Tissue Microarray Analysis

Junya Fukuoka; Haruhisa Kitano; Yuta Sakai; Tomonori Tanaka; Kishio Kuroda; Kazuhiro Nomoto; Naoko Kumagai; Takashi Hori. Toyama University Hospital, Toyama, Japan.

In a multiinstitutional collaboration (some antibodies were obtained from National Cancer Institute [Bethesda, Md], Kinki Chuo ChestMedical Center [Sakai, Japan], Kyoto University [Kyoto, Japan], National Institute of Advanced Industrial Science and Technology [Tsukuba, Japan], DAKO [Kyoto, Japan], and Shiga University of Medical Science [Otsu, Japan]), we have dedicated ourselves to archiving a protein expression database of lung cancer using tissue microarray. Of the nearly 100 evaluated markers, we found 3 molecules (podoplanin, SPARC (osteonectin), and galectin9) that are selectively stained in the cancerous stroma, mainly fibroblasts, and significantly associated to cancer progression. Podoplanin is a marker widely used to detect lymphatic endothelial cells. We found that stromal podoplanin expression was significantly associated with nodal metastasis (P

Multinodular Neuroendocrine Carcinoma With Intraepithelial Neoplasia of the Large and Small Airways

Patrizia Morbini; Chiara Villa. Universita di Pavia.

A 64yearold male smoker complaining of cough and fever underwent upper left lobectomy after a computed tomography scan showed concentric stenosis of the upper left lobar bronchus with distal inflammatory opacities and endobronchial biopsydocumented atypical squamous cells. Macroscopic examination showed thickened lobar and segmental bronchial walls and multiple peripheral nodules ranging from 5 to 15 mm in diameter. A histologic examination revealted peripheral nodules consisting of neuroendocrine cell proliferations consistent with atypical carcinoid/ moderately differentiated neuroendocrine carcinoma (NEC) with extensive fibrosis. Distorted airways were observed in the center of some nodules. Stenotic cartilagineous bronchi showed in situ carcinoma, extending to peribronchial glands, and marked fibrosis. The epithelium of many segmental and terminal bronchioli and of some surrounding airspace was also severely atypical. Dysplastic bronchial and bronchiolar epithelia were diffusely immunoreactive for highmolecularweight (HMW) cytokeratins and cytokeratin 7. Focal expression of neuroendocrine markers was also observed. Neoplastic cells invading peribronchial mucous glands expressed neuroendocrine markers and cytokeratin 7, whileHMW cytokeratins were expressed in a small number of cells, mostly negative for neuroendocrine markers. Mixed neuroendocrine and squamous cell carcinoma is a welldocumented entity; however, the coexistence of neuroendocrine and squamous cell markers in intraepithelial bronchial carcinoma extending distally into the bronchial tree, with multiple moderately differentiated NECs, has not been described before. The present case offers many subjects of investigation: Is squamous and neuroendocrine cell proliferation independent? Is endobronchial tumor spread responsible for multinodular dissemination? Could the bronchocentric distribution of neuroendocrine proliferation be related to diffuse idiopathic neuroendocrine cell hyperplasia?

Pulmonary Capillary Hemangiomatosislike Histologic Changes and Severe Clinical Pulmonary Hypertension in Interstitial Lung Diseases: Report of 3 Explant Cases Eunhee S. Yi; Jay H. Ryu. Mayo Clinic, Rochester.

Pulmonary hypertension (PH) has been suggested to play an important role in the prognosis of interstitial lung disease (ILD) in patients. However, it is not clear whether PH in ILD is a reflection of the extent of interstitial remodeling or an independent process. Clinical studies have demonstrated that severe PH in ILDs can occur in the absence of advanced pulmonary dysfunction or hypoxemia. Recent studies reported that there are increased alveolar capillary densities in ILDs. We have also noted that some ILD cases show extraordinary capillary proliferations that mimic an isolated pulmonary capillary hemangiomatosis (PCH) or the PCH associated with pulmonary venoocclusive disease. Herein, we report 3 ILD cases with severe clinical PH for which the patients underwent double lung transplantations. Explanted lungs showed diffuse PCHlike reactions, hemosiderin deposition, muscularized pulmonary arterioles, and occasional occluded pulmonary veins or venules, as well as ILD. The first patient was a 59yearold woman who had a clinical diagnosis of systemic sclerosis. The explanted lungs showed the features of fibrosing nonspecific interstitial pneumonia. Pulmonary artery pressures (PAPs) by right heart catheterization (RHC) measured 75/22/39 mm Hg, in systolic, diastolic, and mean pressure, respectively. The second patient was a 64yearold man with no underlying disease who was diagnosed as having usual interstitial pneumonia (UIP). PAPs by RHC were 62/29/35 mm Hg. The third patient was a 35yearold woman who had the clinical diagnosis of scleroderma, and her explanted lungs showed UIP. Her PAPs were 103/ 42/67 mm Hg. Widespread PCHlike changes in these cases might have caused an increase in pulmonary vascular resistance and severe PH.

Significance of Molecular Alterations in Alveolar Cells in Usual Interstitial Pneumonia With or Without Lung Cancer

Sylvie Lantuejoul1 ; Andrew G. Nicholson2 ; Dimitri Salameire1 ; Christophe Pison1 ; Gilbert Ferretti1 ; Elisabeth Brambilla.1 1CHU A Michallon; 2Royal Brompton Hospital.

Context: Idiopathic pulmonary fibrosis, the most common interstitial lung disease with the worse prognosis, is characterized histologically by a usual interstitial pneumonia (UIP) pattern. Incidence of lung cancer on UIP is higher than that of lung cancer alone. As molecular abnormalities were reported in atypical and/or metaplastic alveolar cells in UIP, we hypothesized that they could characterize carcinoma precursors.

Design: Immunohistochemical expression of proteins involved in proliferation or apoptosis, p53, cyclines D1 and E, p21, Bax, Bcl2 and p16, were scored and compared in 29 UIP cells with cancer, 15 UIP cells without cancer, 11 fibrotic nonspecific interstitial pneumonia (NSIP) cells, and 10 inflammatory lungs. We have analyzed concomitantly the phenotype of tumor cells.

Results: Numerous atypical and/or metaplastic alveolar cells were found in 39% and 43% UIP with and without cancer, respectively, but in 9% of NSIP and in none of the inflammatory cases. p53, cyclin D1, p21 and p16 expression and a Bax:Bcl2 ratio of

Conclusions: Molecular abnormalities in UIP atypical alveolar cells are more frequent but similar to those found in NSIP. However, they are not specifically related to the presence of cancer but are likely a normal DNA damage response to alveolar cell injury leading to apoptosis or G1 arrest for DNA repair.

Three Cases of Diffuse Miliary Lesions in Asymptomatic Human TCell Lymphotrophic Virus Type 1 Carriers

Junya Fukuoka1 ; Kazuya Ichikado2 ; Tomonori Tanaka1 ; Kishio Kuroda1; Moritaka Suga.2 1Toyama University Hospital, Toyama, Japan; 2 Saiseikai Kumamoto Hospital.

Human T-cell lymphotrophic virus type 1 (HTLV1) is a retrovirus that causes adult T-cell leukemia (ATL). Besides that, similar to HIV carriers, those with HTLV1 occasionally can contract other inflammatory disorders, including arthropathy and bronchopneumonopathy. ”HTLV1 Associated BronchioloAlveolar Disease (HABA)” is an immunemediated pulmonary reaction proposed by Kimura et al in 1989. Several additional articles indicate HABA has 2 major morphologic patterns: diffuse panbronchiolitis and lymphocytic interstitial pneumonia. However, the reports are limited in Japan, and the disease entity is not completely established. We have experienced 3 unique cases showing diffuse miliary lesions in HTLV1 carriers. The lung wedge biopsies obtained before treatments showed 1 to 3mm multiple nodules with marked lymphoid infiltration, granuloma, and tissue eosinophilia. Various degrees of organizing pneumonia with airspace fibrin were found inside the nodules in all cases. Two cases showed tiny foci of necrosis in the center of nodules. Most nodules were located around airways, but some were in the periphery of the secondary lobule. No atypical lymphoid cells were identified, and imunohistochemical profile did not show monoclonal proliferation or aberrant expression indicating neoplasm. In situ hybridization against Epstein Barr virus was negative. Genetic analysis done in one case did not show monoclonality, and ATL involvement was found in none of the cases. Examinations, including culture, serum antibodies, and special staining, did not reveal evidence of infection. All patients experienced improvement within a month either by observation alone or with lowdose steroids, and no recurrence was found on followup at 0.5, 4, and 6 years. Those cases may

Nurse Died of Aids Seven Years After Needle Prick

By KIRAN RANDHAWA

A NURSE died seven years after contracting HIV while taking blood from an infected patient, it is revealed today.

Juliet Young accidentally pricked her thumb on a needle after it slipped when she was taking the sample.

The 42-year-old, who lived in Kennington, was testing the patient’s blood sugar levels as she suspected he was having a hypoglycaemic attack.

The hospital room was not equipped with the specialist disposable device usually used for HIV patients, so she used a different type of needle, Southwark coroner’s court was told.

Soon after the accident on 3 June 1999 at Maudsley Mental Health Hospital in Denmark Hill, she was diagnosed with the African strain of HIV..

She went on to develop Aids and died of pneumonia in January last year, the inquest heard.

The Glasgow-born nurse, who had studied the cello for three years at the London Guildhall Music School, spent her last days at Trinity Hospice in Clapham.

Her sister Abigail Young told the court: “The whole family was with her. She wasn’t coherent but she knew that we were all there.

” Colleagues paid tribute to her at the hearing. One, Sharon Fox, said: “She was a very funny presence on the ward and a stickler for making sure patients got the best possible treatment.” Her GP Dr Raja Sinha, of the Maddock

Way surgery in Walworth, asked that his fee for preparing a report for the coroner be donated to the hospice.

A spokesman for The South London and Maudsley NHS Foundation Trust, said: “This is a tragic and unusual incident. Juliet Young was a valued member of staff and we would like to extend our sincere condolences to her family and friends.

” The jury returned a verdict of accidental death. About 100 health care workers worldwide are thought to have become infected through accidental exposure to HIV, according to data from Imperial College London.

About 1.5per cent of hospital inpatients in London are thought to be HIV-positive. The risk of transmission following a needlestick accident with HIV positive blood is approximately 300/1, but could be as high as 30/1for a deep injury with injection of blood.

The risk from a blood splash onto a mucous membrane, for example into the eye, is 3,000/1 according to Imperial.

Deborah Jack, chief of the National Aids Trust, said there had only ever been five reported cases of health care workers accidentally contracting HIV in the UK. None since 2003.

She said: “We want to reassure healthcare workers the risk of HIV transmission from a patient is extremely small. In the unlikely event that someone is inadvertently exposed to risk, such as a needlestick injury, there is treatment widely available.”

(c) 2008 Evening Standard; London (UK). Provided by ProQuest Information and Learning. All rights Reserved.

Artificial Sweeteners Confuse The Body

Cutting the connection between sweets and calories may confuse the body, making it harder to regulate intake

WASHINGTON “” Want to lose weight? It might help to pour that diet soda down the drain. Researchers have laboratory evidence that the widespread use of no-calorie sweeteners may actually make it harder for people to control their intake and body weight. The findings appear in the February issue of Behavioral Neuroscience, which is published by the American Psychological Association (APA).

Psychologists at Purdue University’s Ingestive Behavior Research Center reported that relative to rats that ate yogurt sweetened with glucose (a simple sugar with 15 calories/teaspoon, the same as table sugar), rats given yogurt sweetened with zero-calorie saccharin later consumed more calories, gained more weight, put on more body fat, and didn’t make up for it by cutting back later, all at levels of statistical significance.

Authors Susan Swithers, PhD, and Terry Davidson, PhD, surmised that by breaking the connection between a sweet sensation and high-calorie food, the use of saccharin changes the body’s ability to regulate intake. That change depends on experience. Problems with self-regulation might explain in part why obesity has risen in parallel with the use of artificial sweeteners. It also might explain why, says Swithers, scientific consensus on human use of artificial sweeteners is inconclusive, with various studies finding evidence of weight loss, weight gain or little effect. Because people may have different experiences with artificial and natural sweeteners, human studies that don’t take into account prior consumption may produce a variety of outcomes.

Three different experiments explored whether saccharin changed lab animals’ ability to regulate their intake, using different assessments ““the most obvious being caloric intake, weight gain, and compensating by cutting back.

The experimenters also measured changes in core body temperature, a physiological assessment. Normally when we prepare to eat, the metabolic engine revs up. However, rats that had been trained to respond using saccharin (which broke the link between sweetness and calories), relative to rats trained on glucose, showed a smaller rise in core body temperate after eating a novel, sweet-tasting, high-calorie meal. The authors think this blunted response both led to overeating and made it harder to burn off sweet-tasting calories.

“The data clearly indicate that consuming a food sweetened with no-calorie saccharin can lead to greater body-weight gain and adiposity than would consuming the same food sweetened with a higher-calorie sugar,” the authors wrote.

The authors acknowledge that this outcome may seem counterintuitive and might not come as welcome news to human clinical researchers and health-care practitioners, who have long recommended low- or no-calorie sweeteners. What’s more, the data come from rats, not humans. However, they noted that their findings match emerging evidence that people who drink more diet drinks are at higher risk for obesity and metabolic syndrome, a collection of medical problems such as abdominal fat, high blood pressure and insulin resistance that put people at risk for heart disease and diabetes.

Why would a sugar substitute backfire? Swithers and Davidson wrote that sweet foods provide a “salient orosensory stimulus” that strongly predicts someone is about to take in a lot of calories. Ingestive and digestive reflexes gear up for that intake but when false sweetness isn’t followed by lots of calories, the system gets confused. Thus, people may eat more or expend less energy than they otherwise would.

The good news, Swithers says, is that people can still count calories to regulate intake and body weight. However, she sympathizes with the dieter’s lament that counting calories requires more conscious effort than consuming low-calorie foods.

Swithers adds that based on the lab’s hypothesis, other artificial sweeteners such as aspartame, sucralose and acesulfame K, which also taste sweet but do not predict the delivery of calories, could have similar effects. Finally, although the results are consistent with the idea that humans would show similar effects, human study is required for further demonstration.

On the Net:

American Psychological Association

Article: “A Role for Sweet Taste: Calorie Predictive Relations in Energy Regulation by Rats,” Susan E. Swithers, PhD and Terry L. Davidson, PhD, Purdue University; Behavioral Neuroscience, Vol. 122, No. 1. (Full text of the article is available from the APA Public Affairs Office and at http://www.apa.org/journals/releases/bne-feb08-swithers.pdf )

Purdue University

Palm Beach Health Associates Acquired By MCCI Holdings

MCCI Holdings, LLC (“MCCI”), a South Florida-based provider of medical management services for managed care organizations, announced today the acquisition of Palm Beach Health Associates, Inc. (“PBHA”). MCCI acquired the privately-held Palm Beach Health Associates for an undisclosed sum. Goldman Sachs Urban Investment Group (“UIG”), Pharos Capital Group, LLC (“Pharos”) and the MCCI management team are among the existing investors in MCCI.

Palm Beach Health Associates, Inc. is a leading provider of primary care physician services in Palm Beach County, Florida. PBHA was founded in 1998 by a group of physicians and currently provides medical services to over 9,000 Medicare beneficiaries enrolled in Humana plans. PBHA differentiates itself by providing superior preventative and urgent care to its patients and focusing its clinical model on improving the overall health of its membership base.

The combined organization will have over 56,000 members and a significant market position in Palm Beach, Dade and Broward counties. The acquisition complements and solidifies MCCI’s existing presence in Palm Beach County.

“We are excited about the opportunity to add PBHA to the MCCI family of medical centers,” said Dr. Jose Armas, Chairman and Chief Executive Officer of the combined companies. “MCCI’s acquisition of PBHA exemplifies our commitment to delivering high-quality, technologically advanced care to a diverse population. The combined companies will be uniquely positioned to support market-leading health plans, physicians, and hospitals in providing exemplary care to patients.”

About MCCI Holdings, LLC:

Headquartered in Miami, Florida, MCCI Holdings is a leading provider of outpatient health care services to approximately 56,000 Medicare, Medicaid, and commercial beneficiaries in the rapidly growing South Florida region. The Company was formed in 1998 by Dr. Jose Armas and Dr. Eduardo Alarcon and has since become a leading provider of medical management services for several managed care organizations. Currently, MCCI provides high quality primary care services on an outpatient basis through its 31 facilities located in South Florida’s Miami-Dade, Broward, and Palm Beach counties and nine affiliated physician groups.

About The Goldman Sachs Urban Investment Group:

The Goldman Sachs Urban Investment Group is a private equity initiative within The Goldman Sachs Group, Inc. (NYSE:GS), that invests capital in ethnic minority-owned or targeted businesses and urban real estate. Founded in 1869, Goldman Sachs is a leading global investment banking, securities and investment management firm. The firm is headquartered in New York and maintains offices in London, Frankfurt, Tokyo, Hong Kong and other major financial centers around the world. Goldman Sachs also has offices in Miami, Florida and Dallas, Texas. To learn more about The Goldman Sachs Urban Investment Group, please visit www.gs.com/uig.

About Pharos Capital Group, LLC:

Based in Dallas and Nashville, Pharos Capital Group currently has $500 million in capital under management through three private equity funds. Pharos primarily invests in companies seeking later stage equity funding for internal growth, acquisitions, management buyouts or recapitalizations across industry sectors, with particular focus on health care, business services, and applied technology. To learn more about Pharos Capital Group, LLC, please visit www.pharosfunds.com.

IMU Helping to Fill Current Shortage of Dentists

STUDENTS can now get a world-class dentistry qualification with the option of completing their degree at a partner dental school overseas or spending the full five years locally.

This is the attractive new programme being offered by the International Medical University (IMU).

With its first intake on Feb 25, the Bachelor of Dentistry programme is a comprehensive course in medical and dental sciences with significant community health, behavioural science and clinical practice components.

Students will have early clinical experience in treating patients at the IMU dental facilities at the Bukit Jalil campus.

The programme is designed to provide students with a sound and relevant knowledge base, a responsible learning attitude and clinical skills.

Students can complete their degree at IMU’s renowned partner dental schools in Australia and New Zealand, or receive the Bachelor of Dental Surgery (BDS) degree from IMU.

“Dentistry is a dynamic health profession that provides a rewarding career, especially because of the insufficient number of dentists available in Malaysia to provide adequate oral healthcare to its population,” says Dean of the School of Dentistry, Prof Toh Chooi Gait.

“Dentists are both artists as well as scientists as they are not only required to have the scientific knowledge and technology to diagnose, prevent and treat oral diseases and oro-facial anomalies but also need to be skilful in handling the wide variety of materials, instruments and equipment to execute treatment,” she said.

Besides filling cavities and extracting teeth, routine cleaning and scaling, the job of a dentist also includes aligning and straightening teeth, restoring function to badly decayed, broken or infected teeth, and replacing missing teeth with dentures, bridges or implant-supported prostheses.

A dentist also educates patients to preserve oral hygiene.

Students aspiring to be dentists should have excellent interpersonal skills and be patient, caring and sympathetic.

Other personal attributes needed include a keen eye for detail, manual dexterity and the ability to understand, retain and recall scientific should have excellent interpersonal skills and be patient, caring and sympathetic.

Other personal attributes needed include a keen eye for detail, manual dexterity and the ability to understand, retain and recall scientific.

Excellent dentists are also committed to lifelong learning to keep themselves constantly updated with the latest scientific information and technology.

Dentists start off with a monthly salary of about RM2,800 in the public service in Malaysia.

Upon starting a practice in the private sector, a young dentist can earn up to RM8,000 per month.

Plenty of opportunities exist for those entering the field of dentistry today.

As the public’s awareness of the importance of dental care increases, so does the need for both qualified general practitioners and dental specialists.

Dental graduates can also have fulfilling careers in education and research.

Too often, dentistry is viewed as a second choice alternative to medicine.

It should not be viewed this way but instead as a highly specialised branch of medicine.

Other programmes available in IMU are medicine, pharmacy, nursing, psychology, medical biotechnology, biomedical science, nutrition and dietetics, pharmaceutical chemistry and postgraduate studies.

For more information, contact 03-88567272/7273, visit www.imu.edu.my or email to [email protected].

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‘Montel’ to Feature Manteca Family: Show Tells Story of Couple Who Donated Late Son’s Organs to Others

By Paul Burgarino, Contra Costa Times, Walnut Creek, Calif.

Feb. 10–MANTECA — The episode of “The Montel Williams Show” featuring a Manteca family that gave their deceased son’s organs to others will air Tuesday, representatives from the show said.

The episode, titled “When Catastrophe Strikes,” features the story of Matthew Zaragoza-Van Gelderen, a Manteca teenager who died from a brain contusion sustained in a high school football game in September 2005.

Matthew died a week after his injury, and his parents decided to donate his organs.

Jose and Zona Zaragoza Van Gelderen, along with their three children were flown to New York on Oct. 18, 2007, to be on “The Montel Williams Show,” where they met Tom Starr and Lorma Sealey.

Starr, 59, of Centerville, Iowa, was the recipient of Matthew’s kidneys while Sealey, 41, of Bowie, Md., received his heart and lungs.

The show was very emotional, members of the Zaragoza family said.

“It’s finally going to air,” Zona Zaragoza-Van Gelderen said. “We’re very excited. Hopefully, everybody marks their calendars and sets their TiVos.”

The show had been scheduled to run Thanksgiving Day but did not air.

The rendezvous on Montel was arranged by the California Donor Transplant Network — the group that helps donors and recipients to communicate through cards.

Zona immediately tried to contact the recipients of Matthew’s organs.

Though the majority of donor-recipient groups don’t meet, for a variety of reasons, this pairing connected quite well, said Cathy Olmo, a volunteer

coordinator with the transplant network.

A program coordinator with “The Montel Williams Show” contacted the donor network about a possible story. Olmo recommended the Zaragozas.

Since Matthew’s death, his father has become a volunteer for the California Donor Transplant Network — touring schools over the past two years in San Joaquin County, eastern Contra Costa County and Tri-Valley about the benefits of organ donation.

“The Montel Williams Show” airs in the Bay Area at 4 p.m. on KTVU, Channel 2.

—–

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Copyright (c) 2008, Contra Costa Times, Walnut Creek, Calif.

Distributed by McClatchy-Tribune Information Services.

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AMEX:TIV,

Bottom Feeders Go for the Scent and Taste of Shrimp – Dead or Live

No matter how you present them, dead shrimp are undoubtedly one of the most effective natural baits a South Mississippi angler can toss into our coastal waters.

Yes, live shrimp are top-notch offerings, but the scent oozing from a dead shrimp can be better than the live ones at times under certain conditions.

Let’s take for example the conditions we’re facing at this time with rivers and bays being heavily influenced by all the latest rainfall.

With water conditions having the look of chocolate milk due to heavy, water-staining sediment, an angler must present the bait right in front of most fish, and the extra allure of the scent is the kicker.

Since salt water is heavier than fresh water, fishing at this point and time will be conducted on the bottom.

Although cold weather bottom feeders like black drum, sheepshead, flounder and redfish are quick to suck in a dead shrimp, at times a deep-dwelling speckled trout will eat a dead shrimp dangled in front of its nose.

There are many ways to fish a dead shrimp, and going with a lone jig head is one of them.

The beauty of using a jig head is that all one has to do is tie it to the end of the reel’s main line or leader material.

It’s that easy because the jig offers a combination of both hook and weight all in one.

One of the best ways to fish dead shrimp on a jig is to pinch off the first two joints at the tail section, and then thread the hook from the tail section down toward the head.

To keep the presentation as natural looking as possible, make sure the shrimp lays out flat behind the jig head, instead of being curled up on the hook.

A whole shrimp can be threaded on the jig, too, but by pinching off the tail section, this allows more scent to disperse. Also, by pinching off the tail of a live shrimp, the same method can apply at times, especially when fishing in clear water.

This tactic applies well when fishing the sandy bottoms and clear waters of the barrier islands. It will fool specks, reds, whiting, flounder and pompano. Another way to offer a dead or live shrimp on a jig is to insert the hook under the bottom and out the top of the head, missing the small dark spot, which is the shrimp’s brain.

The traditional Carolina rig is a proven bottom fishing rig, too, and works well in our coastal waters for most bottom-dwelling species when sweetened with shrimp.

To rig, first slide a quarter-ounce egg or bullet weight on the main line and then tie on a small barrel swivel. The barrel swivel keeps the weight from sliding down to the hook and allows the fish to swim away with the bait without detecting the tension of the weight.

Next, tie on a length of leader material like 25- or 30-pound-test Seaguar fluorocarbon, and finish off with your hook of choice. Generally, this will be a j-hook, octopus hook or treble hook. A Gamakatsu 4X Strong treble hook works well for bottom-hugging flounder, especially since they have a hard mouth and a knack for shaking off at boatside.

To present a whole dead or live shrimp on a treble hook, one can hook it through the head at the base of the horn, or even pinch off a tail section and hook through the last tail section. Either way, the shrimp will lay out in a natural horizontal matter along the bottom, and by moving it along slowly will generate flounder strikes.

Remember, don’t be shy to set the hook hard on a flounder due their tough mouth, and be quick with a landing net at boatside.

Many anglers make the mistake of using too much leader on their Carolina rig. Generally, the leader needs to be no longer than 6 to 12 inches in length. For most species that keep their nose and mouth to the bottom, a short leader will keep the shrimp in their feeding zone.

If the leader is too long, then it may drift about in the current well off the bottom, thus resulting in many missed opportunities for redfish, flounder and black drum feeding close to the bottom, especially in muddy water.

The basic three-way rig is another simple way to fish a dead shrimp.

Tie on a small SPRO three-way swivel to the main line. There will be two eyes left, and on one tie on 12 inches of 25- to 30-pound-test leader material, and finish off with a 1/0 or 2/0 Gamakatsu Octopus hook.

On the last unused eye, tie on a length of leader material a bit shorter or longer than the hook’s leader, and finish off with a one-quarter to 2-ounce bank sinker.

Depth of water and strength of current will determine the amount of weight needed.

You’ve heard the credit card commercial saying, “Never leave home without it.”

Well, that same saying should always apply to taking along a supply of fresh dead shrimp. And if you’re into bumping a soft-plastic bait across the bottom like a Cocahoe Minnow, Norton Shad, Salt Water Assassin or Deadly Dudlies, feel free to sweeten them up with a pinch of fresh dead shrimp.

Especially in tainted water conditions, the extra scent and taste may increase your number of strikes, and lead to a wider variety of species taken.

Bottom line: If it swims, it will eat a shrimp, so be sure to take advantage of these crustaceans and their appealing effect on the taste buds of Coast species.

Know your bait shops

There are numerous baits shops scattered about South Mississippi that offer both live and dead shrimp.

Generally, most of the camps, shops and marinas carry a supply of dead bait, but one should always call ahead of time, especially if it’s live bait you seek.

If you ever need a heads up on the latest fishing reports, pick up the phone and call the shops.

Warming Up to Freeze Therapy for Heart Patients

First of two parts

As he raced across town to the hospital, Adrian Roberson knew something bad had happened to his wife, Darrice, but he was unprepared for what he would find in the emergency room.

Darrice Roberson, a 33-year-old mother of three, had suffered a cardiac arrest last year and had been brought back to life by an electric shock.

Now doctors at Froedtert Hospital were putting her on ice, literally covering her body with ice packs and sending frigid saline solution into her veins.

They gave her a paralyzing drug to prevent her from shivering as they plunged her body temperature to about 90 degrees.

“I touched her arm and leg,” Adrian Roberson said. “She was icy cold. It didn’t seem right, someone being that frigid.”

Over the next 24 hours, Darrice Roberson would be kept in a hypothermic state to preserve her brain cells.

When doctors began rewarming her, she would emerge as one of the lucky ones.

Last July, Darrice Roberson was one of a handful of cardiac arrest patients from the area to benefit from a new treatment known as hypothermia therapy.

Not many more patients have received the treatment since then, though doctors say it is inexpensive, relatively easy to perform, has only a small risk of causing serious complications and could benefit hundreds of patients around the state.

Few hospitals around the country regularly perform the therapy, though it can improve survival and preserve brain function by about one-third over conventional treatment.

Indeed, since 2003, the American Heart Association has recommended the use of hypothermia in cardiac arrest cases caused by an arrhythmia known as ventricular fibrillation. The organization also says hypothermia might be beneficial for other types of cardiac arrest.

“It’s the only therapy that I know can improve long-term survival,” said Terry Vanden Hoek, an associate professor of emergency medicine at the University of Chicago Medical Center, and a member of the group that developed the heart association’s recommendation.

It also improves the ability of patients to function, allowing some to go home or go back to work, he said.

Uncertainty cited

But not everyone is fully convinced.

“I think there still is a great deal of uncertainty,” said Lee Biblo, vice chairman of medicine at the Medical College of Wisconsin in Wauwatosa. “It’s a neat little thing to do. I think the data weakly supports a benefit.”

Biblo — who practices at Froedtert in Wauwatosa, where the treatment will become standard this month — said the therapy is supported by two small studies.

He said hypothermia is not without risk. Potential side effects include infections such as pneumonia, increased risk of blood clots and the possibility of developing an arrhythmia.

(In the two clinical trials so far, there was no increase in complications or adverse events caused by the hypothermia.)

Biblo acknowledged that he would recommend the therapy for his patients and even for a family member, but said he is not sure that it will have a huge impact in the field of medicine.

Less than 80 miles away, however, doctors are so convinced of the therapy’s value that soon paramedics will be performing it in the field. For more than a year, the therapy has been a standard treatment at the University of Wisconsin Hospital and Clinics in Madison.

Starting March 1, cardiac arrest patients will get the therapy before they arrive at the hospital, said Darren Bean, an assistant professor of emergency medicine at UW.

Paramedics will sedate the patients, administer a paralytic drug and infuse frigid saline into their veins, starting the cooling therapy in the field. As many as 100 people a year will receive the therapy, he said.

“It’s not rocket science,” Bean said.

More important, he said, the therapy can mean the difference between patients surviving in a persistent vegetative state or surviving with most of their brain function intact.

Milwaukee County paramedics eventually also might start cooling cardiac arrest patients in the field, but not until all the hospitals in the county are committed to continuing the therapy once patients reach the hospital, said Ronald Pirrallo, director of medical services for Milwaukee County Emergency Medical Services.

“My hope is that this year, multiple hospitals will make a commitment,” said Pirrallo, a professor of emergency medicine with the Medical College.

In Milwaukee County, about 200 people a year who suffer a cardiac arrest outside the hospital and are revived would be candidates for the therapy, said Tom Aufderheide, a professor of emergency medicine at the Medical College who practices at Froedtert.

“There should be no hospital that can’t do this,” Aufderheide said.

But at the moment it’s a matter of geography as to whether a cardiac arrest patient will receive the therapy.

Paramedics generally take those patients to the nearest hospital, and it is a matter of chance — with the odds being less than 1 in 5 — that they will get the therapy at a Milwaukee-area hospital.

Indeed, the therapy itself seems to have been in a deep freeze for the past few years, an example of how long it can take for the mainstream medical community to warm up to a new idea. Although some hospitals have experimented with it, the therapy only now is crossing the threshold from novel to accepted practice.

“I don’t think there is any excuse for it, but it takes 15 years for (a new therapy) to really penetrate in medicine,” said Guy Clifton, a hypothermia researcher and professor and chairman of the department of neurosurgery at the University of Texas Health Science Center at Houston.

Clinical trials

For decades, there have been hints that cold brains did better than warm ones in cardiac arrest cases.

Since the 1950s, hypothermia has been used in the operating room to protect the brain in patients undergoing open heart surgery.

At the same time, there have been countless anecdotal reports of miraculous outcomes after kids fell through the ice and were submerged for long periods or adults who arrived at the hospital cold after their hearts stopped while outside in frigid temperatures.

Eventually those incidents led to studies in which hypothermia was deliberately induced, including two clinical trials published in the New England Journal of Medicine in 2002.

In one study involving 77 cardiac arrest patients, 49% of those treated with hypothermia survived and had a good neurological outcome, compared with 26% of those who did not get hypothermia therapy.

In the other study, which involved 273 cardiac arrest patients, 55% of those who got hypothermia therapy had a favorable neurological outcome, compared with 39% of those who did not get the therapy.

Nationally, 50,000 people could benefit from the therapy, but only about 1 in 4 hospitals offer it, said Benjamin Abella, an assistant professor of emergency medicine at the University of Pennsylvania.

“Right now there is a therapy that can save thousands of lives a year that isn’t being implemented by hospitals,” Abella said. “It’s unfortunate that implementation has been so slow.”

In 2006, Abella and other physicians published research showing that 74% of U.S. doctors working in emergency medicine, cardiology and critical care medicine had not used hypothermia.

Commonly cited reasons were “not enough data,””too technically difficult” and “have not considered it.”

In his study, Abella compared the lag in lack of acceptance of hypothermia therapy to other treatments such as the use of beta-blocker drugs after a heart attack.

Doctors and nurses who have seen the therapy in action say it has led to some remarkable recoveries.

In at least two cardiac arrest patients at Aurora St. Luke’s Medical Center in the past year, the initial outlook was grim, said Karin Schmeling, a clinical nurse specialist at the hospital. However, after being put into hypothermia, the patients did much better than expected, she said.

The success of the therapy, she said, has led to a saying among doctors and nurses who have used the therapy:

“You’re not dead until you’re warm and dead.”

It might be another four years before the matter is settled.

That’s when a clinical trial of up to 1,200 cardiac arrest patients in the Seattle area is scheduled to be completed. The trial will test the use of hypothermia therapy started in the field by paramedics.

‘Quality of survival’

Clara Ellison remembers sitting in her living room with a funny feeling and tightening in her chest.

When emergency medical personnel arrived a few minutes later, she was on the floor and her nephew was performing CPR.

“We shocked her three times,” said Dave Howard, director of ambulance services at Moundview Memorial Hospital in Friendship, where Ellison lives. “We lost a pulse and shocked her three more times.”

In the ambulance, she had to be shocked again before being taken by Med Flight to UW Hospital in Madison.

After cooling her to about 90 degrees for 24 hours, doctors began rewarming her.

“When you start the rewarming process, you just hold your breath,” said UW’s Bean. “You just don’t know. In her case, she just woke up.”

Ellison, 64, doesn’t remember much about the ordeal, but she says she is convinced that hypothermia therapy is one of the reasons why she is alive and doing well.

“I feel great,” she said.

UW Hospital has performed hypothermia therapy on about 20 cardiac arrest patients since about a year ago, Bean said.

Although there still is some mystery about how it works, hypothermia slows down metabolism in the brain and calms the squall of damaging brain chemicals that bursts in when the blood supply is restored after a long interruption. The ideal temperature range — 89.6 degrees and 93.2 degrees — has to be maintained for 24 hours.

Bean said he believes that the sooner hypothermia is started, the better. He noted that survival rates for cardiac arrest are dismal. Even among those who reach the hospital, up to 70% die.

“We have to rethink this disease and be very aggressive about it,” he said.

And the therapy is not just about improving mortality rates, he said.

“It’s about quality of survival,” he said. “We don’t want people surviving in persistent vegetative states. The worse thing would be having people survive to be in a nursing home for 25 years.”

A new life

Adrian Roberson is watching his wife as she lies unconscious in the ICU at Froedtert Hospital. The couple’s three children, ages 13, 9 and 2 months, are at home with Darrice’s mother.

Electrodes are attached to her head to monitor brain wave activity.

Suddenly a buzzer goes off, alerting a nurse that her body temperature has dropped below 91 degrees. The nurse takes some of the ice packs off her body.

A few hours later nurses start rewarming her.

Her eyes open. She looks at her husband.

She still has the breathing tube in her mouth, so he gives her a piece of paper and a pencil.

“Why am I here?” she asks.

The breathing tube is removed.

She says, “Hi.”

Darrice Roberson remains in the hospital for another 10 days, and a defibrillator is implanted in her chest.

Today her brain function is normal, but there is no way of knowing if it’s because of the hypothermia.

“I feel like it never happened,” she says.

A month or so after going into cardiac arrest, she becomes pregnant. The baby, a boy, is due in April.

Coyotes and Foxes are Not Best of Friends

Going back three decades or so, foxes had a pretty sweet deal in the East.

Two species, red fox and gray fox, were the only wild canine predators present. They could claim that exclusive status since red wolves were persecuted out of business by people somewhere back in the 1800s.

During the 1970s, however, Western-native coyotes little by little immigrated east, spreading their range into the vacuum left by the red wolf. Since then, coyotes have occupied virtually all of the eastern United States, overlapping ranges with the foxes already at home.

So how has that gone? For the coyotes, fine. For the foxes, not too good.

Coyotes have flourished in their new territories. There are some anecdotal observations that coyotes boomed soon after they became well established in the East, then declined only slightly to settle in at an abundant status quo.

“I’ve had several people say that they’re not hearing coyotes (howling) as much as they once did,” said Lee Cope, a Kentucky Department of Fish and Wildlife Resources conservation officer based in Marshall County. “But there’s still plenty of coyotes.

“Sometimes I think people have gotten so used to coyotes being around that they just don’t notice them like they did when coyotes were new to the area.”

While coyotes’ proliferation may have moderated somewhat, it is widely accepted that any substantial presence of coyotes is a kick in the head to foxes. Coyotes and foxes, reds and grays, are competing canine predators at odds with each other. There’s no spirit of peaceful co-existence between them.

Coyotes are by far the physically dominant species, roughly three times the bulk of foxes.

Foxes — big powder puffs in fluffy winter coats — aren’t as big as many people think. The red fox typically is only a 10- to 12-pound critter, and the gray fox is just a bit smaller, usually 8 to 11 pounds. Contrast that with a common coyote ranging from 29 to 33 pounds and some considerably more.

When there are conflicts between these canines, they aren’t resolved with debate. The foxes might want to just get along, but there’s a tendency of coyotes to attack foxes when the species come into contact.

A federal study of interactions between coyotes and foxes based on happenstance observations found that in 71 percent of documented coyote/fox interchanges, the result was aggressive behavior by the coyotes. There were numerous reports of coyotes running down and killing foxes. In some instances they fed on the foxes, but in other confrontations they killed and left them lying, sometimes after mutilating the carcasses.

Throughout the eastern U.S., wildlife managers rather uniformly note that most species have shown no significant declines because of the influx of coyotes except for foxes.

“We used to have a lot of gray foxes, but over time after coyotes started becoming established, our fox population declined quite a bit,” said Land Between the Lakes wildlife biologist Steve Bloemer. “That happened several years ago, and the population remains significantly lower now than it did before the coyotes showed up.”

Bloemer said red foxes traditionally have been low in numbers in the LBL because of their preference for open habitat and the heavily timbered nature. With coyotes in the mix, relatively few gray foxes and even fewer reds exist, he said.

Trapper John Goheen of Calvert City, a student and catcher of furbearing critters since well before coyotes arrived on the scene, said foxes clearly are the losers in the predatory match-ups. He sees a direct link between the coming of the coyote and the decline of foxes.

“The red fox are down, and the grays are really slim in numbers now,” Goheen said. “Some counties are more overrun than others, but coyotes are pretty much everywhere.”

Goheen said, despite a downturn in numbers of red foxes, that species may be more evident to some people nowadays because of one way reds have adapted to the presence of bullying coyotes.

“Red fox may be pressured by coyotes, but one thing they’re doing is moving into town,” he said. “Coyotes are more shy of people, and red foxes get along pretty well right around where people live. Reds are fairly commonly seen these days in yards.”

There’s no likelihood that red foxes are packing their bags and moving into subdivisions and other such people-populated neighborhoods to get away from coyotes. It might be, however, that foxes that naturally gravitate to human residential areas tend to survive better because of less presence of coyotes.

Illinois Department of Natural Resources furbearer biologist Bob Bluett said open farming country has gone though some habitat changes that, added to coyote pressures, have squeezed many more foxes toward suburbia.

Farming practices that favor huge, mono-cropped fields leave little suitable habitat once grain crops are harvested, Bluett said. The demise of small farms that once offered overgrown corners, fences and hedge rows eliminated much of the edge cover and food base that once supported foxes. The patchwork of cover and mixed open ground that is found in human neighborhoods may become the preferred option.

“They have more or less moved into residential areas and have seemed to do well there,” Bluett said. “We probably have more rabbits and other food in urban areas.”

Where foxes can find small prey like bunnies and mice plus the occasional bowl of dog or cat food on nearby porches, they can make a living. And if they can feed themselves and have some adequate lounging cover in a place where coyotes are reluctant to forage, that sounds more like ideal habitat.

"It Takes a Village to Raise a Child": The Role of Social Capital in Promoting Academic Success for African American Men at a Black College

By Palmer, Robert Gasman, Marybeth

Historically Black colleges and universities (HBCUs) were created to provide educational opportunities for African Americans when other higher education venues restricted their participation. HBCUs are credited with nurturing and producing leaders who embraced W. E. B. Du Bois’s concept of the “Talented Tenth, ” and exhibiting fortitude in advancing social equality for all. Over the years, as legalized segregation was overturned and efforts were made to expand opportunities for African Americans, some have questioned the continuing need for HBCUs. A study of 11 African American men attending a public, urban HBCU, indicated that the university’s rich supply of social capital (a direct consequence of its mission and history) makes it a unique fixture in the landscape of higher education, one whose special features have not been replicated by historically White institutions. Historically Black colleges and universities (HBCUs) have served an important role in promoting access to higher education for African Americans when other venues were closed to them. During their inception, HBCUs were far from equal in terms of infrastructure, resources, and operating budgets; these inequities persist to the present day (Anderson, 1988; Brown & Davis, 2001; Brown, Donahoo, & Bertrand, 2001; Drewry & Doermann, 2004). Despite the lack of resources, HBCUs have a rich legacy of producing charismatic leaders (for example, W. E. B. Du Bois, Martin Luther King, Jr., Thurgood Marshall, Ella Baker, Barbara Jordan, and Stokely Carmichael) who valiantly advocated for societal change for all and served as positive role models to many African Americans. Black colleges also provide a rich source of social networks to students, fostering an empowering educational climate. However, as legislative and programmatic initiatives have made it possible for African Americans to gain access to Historically White Institutions (HWIs), HBCUs have seen their enrollments drop drastically. At present, they enroll 16% of African Americans at the undergraduate level (Provasnik, Shafer, & Snyder, 2004). Furthermore, as governmental constituencies seek to eradicate de jure segregation by promoting student integration and eliminating program duplication (i.e., Adams v. Richardson, 1973; United States v. Fordice, 1992), some scholars fear that HBCUs may disappear (Blake, 1991; Brown & Davis, 2001; Days, 1992; Stefkovich & Leas, 1994).

The significance of HBCUs cannot be understated. At present, these institutions award nearly one-fifth of all bachelor degrees to African Americans. HBCUs also award 20% of all first professional degrees (Hoffman, Liagas, & Snyder, 2003). According to Allen (1992), these enrollment and degree statistics are significant, especially given that HBCUs represent only 3% of the nation’s institutions of higher learning. Furthermore, despite limited resources, HBCUs manage to create an environment in which African Americans are educated regardless of academic preparation, test scores, socioeconomic status, or environmental circumstances (Allen & Jewell, 2002; Kim, 2002; Kim & Conrad, 2006). Scholars argue that HBCUs are necessary because of their ability to educate many African American students who otherwise would not be able to study at the college level (Berger & Milem, 2000; Brown & Davis, 2001; Brown et al., 2001; Drewry & Doermann, 2004; Freeman & Cohen, 2001; Roebuck & Murty, 1993). In this study, we draw from a qualitative study conducted with African American men attending a Black college to discuss the impact of social capital on academic success at this institution.

REVIEW OF LITERATURE

HBCUs were established with the assistance of the Freedman’s Bureau, Black churches, Northern missionaries, private philanthropists, and governmental initiatives (i.e., Morrill Act of 1890) to provide access to higher education for African Americans. From approximately 1865 until the 1960s, the majority of African Americans who went to college attended these colleges and universities, which helped to promote their social equality and social mobility. These universities have nurtured strong, courageous leaders who helped to usher in social advancement for all Americans (Drewry &c Doermann, 2004).

Over the years, there has been a precipitous drop in the number of African Americans attending HBCUs, prompted by several governmental initiatives (i.e., Brown v. Board of Education, 1954; Adams v. Richardson, 1973; The Civil Rights Act of 1964; and the implementation of the federal aid program). Whereas previously a critical mass of African Americans attended HBCUs, by 1973 three fourths of African Americans were attending HWIs (Allen & Jewell, 2002; Brown et al., 2001; Green, 2001; Moore, 2001).

Despite the decline in the number of African American students attending HBCUs, researchers have consistently argued that Black colleges and universities foster a nurturing, family-like environment, and faculty members are supportive of African American students (Brown et al., 2001; L. A. Davis, 2006; Fries-Britt & Turner 2002; Seifert, Drummond, & Pascarella, 2006 ). African American students at these institutions are more satisfied, engaged in the community, and well-adjusted (Allen, 1992; Fleming, 1984; Fries-Britt & Turner; Harper, Carini, Bridges, & Hayek, 2004; Pascarella & Terenzini, 2005).

Research has also shown that African American students on Black campuses exhibit positive psychosocial adjustments, cultural awareness, and increased confidence (Allen, 1992; Fleming, 1984; Fries-Britt & Turner, 2002). African American students perform well academically, even though some students enter college with academic deficiencies and come from low socioeconomic backgrounds (Allen, 1992; De Sousa & Kuh, 1996; Outcalt & Skewes-Cox, 2002). Up-to- date, comprehensive research on Black colleges’ impact is sparse. However, past research has indicated that these institutions aid the growth and development of African American males. According to Fleming (1984):

Males in Black colleges exhibit the happiest adjustment to college life that can be found. Despite some ambivalence surrounding their interactions with teachers, their experience is more strongly characterized by absorption with role models, greater satisfaction, and positive outcomes from the educational experience, and gains in assertiveness of self-expressions and in dealing with others, (p. 168)

Fleming (1984) also explained that intellectual development is more positive for African Americans in Black colleges. These students experience more contact with faculty, experience greater satisfaction with their academic lives, and exhibit higher career aspirations. According to Fleming (1976), HBCUs are known for admitting students who are under-equipped for college level work, improving their academic deficiencies, and graduating them with the skills to successfully compete in society. In fact, in a more recent article from Kim and Conrad (2006), who drew on data from the NCES, HBCUs continue to effect students in the way that Fleming described in 1976-having a value-added impact for students attending Black colleges. That is, students receive both a secondary and college education. Research also has indicated that the HBCU experience propels more African Americans into graduate and professional degree programs (Allen, 1991, 1992; Brown & Davis, 2001; Brown et al., 2001; Garibaldi, 1997; Perna, 2001; Roebuck & Murty, 1993; Wenglinsky, 1996). According to the United Negro College Fund (2007), of the top 10 colleges that graduate African Americans who go on to earn Ph.D.’s or M.D.’s, 9 are HBCUs, as are 8 out of the 10 top producers of African American graduates in mathematics and statistics. And the 12 top producers of African American graduates in the physical sciences are all Black colleges, including Xavier University of Louisiana, which is ranked first. In fact, Xavier is responsible for placing more African American students in medical school than any other institution in America. And, even more important, 92% of these students complete medical school and pass board exams. Moreover, Brown and Davis (2001) noted that “historically Black colleges remain the undergraduate home of 75% of all Black army officers, 80% of all Black federal judges, and 85% of all Black doctors” (p. 1).

Although some scholars have argued that HBCUs improve the social and academic experience of African American students, researchers have found that African American students attending HWIs often experience alienation and are not engaged in the campus (Allen & Haniff, 1991; Feagin, Vera, & Imani, 1996; Pascarella & Terenzini, 2005; Rankin oc Reason, 2005; Tinto, 1987). Kimbrough and Harper (2006) asserted that “with much of the national attention being placed on issues facing African American students at predominantly White institutions … the quality of life at HBCUs for African American students-especially African American men-has gone virtually unnoticed” (p. 190). Numerous researchers (Allen, 1987, 1992; J. E. Davis, 1994; Fleming, 1984; Fries-Britt, 1997, 1998; Fries-Britt & Turner, 2002) have investigated the experiences of African Americans attending HWIs in comparison to HBCUs. However, many of these studies neglected to disaggregate the experiences of African Americans “by gender and achievement patterns” (Harper, 2007, p. 2). As such, a lack of current literature exists (e.g., Harper, 2006; Ross, 1998) to document the experiences of African Americans men at HBCUs, particularly those students who enter higher education as academically unprepared and persist to graduation. Consequently, this study seeks to help alleviate the dearth of knowledge about African American male experiences at HBCUs. In this paper, we discuss the results of a study of 11 academically underprepared African American men who entered a public, urban HBCU, in a mid- Atlantic state and were able to graduate in spite of their disadvantaged status. One of the salient factors that emerged from this study is the abundance of social capital at this HBCU and its impact on fostering academic success. The goal of this paper is to illuminate the many examples of social capital that positively influence retention and persistence for African American men. CONCEPTUAL FRAMEWORK

According to Bourdieu (1986), social capital refers to the ways in which some individuals are privileged because of their membership in a social network. He posited that the amount of social capital individuals possess hinges on the size of their network as well as their economic and cultural standing. Importantly, Bourdieu viewed social capital as a mechanism of control that the ruling classes use to maintain their dominant position over the general population (Lin, 2001). In this way, social capital can be seen as a negative attribute; however, when members of the underclass gain social capital, they can act in ways that disrupt the influence and power of the upper class. In Coleman’s (1988) words, social capital consists of a variety of entities, embedded in social structures, which make possible the achievement of certain goals not plausible in the absence of such social structures. Coleman’s conceptualization of social capital is premised on understanding the norms, trust, authority, and social control that an individual must learn to succeed. Anheier, Gerhards, and Romo (1995) provided a more lucid explanation of social capital. They explained that social capital “is the sum of the actual and potential resources that can be mobilized through membership in a social network of actors and organization” (p. 862). According to Brown and Davis (2001), social capital “is a type of resource that is socially reproduced, such as the possession of knowledge, accomplishments, or formal and informal relations and network” (p. 41). By means of social capital, individuals may gain support from a social network, which facilitates the awarding of “social rewards, such as status, privilege, and positions in certain social circles, professions, or organization” (Brown & Davis, p. 41). Brown and Davis also asserted, “The relations and networks that Black colleges construct into tangible and meaningful resources are known as social capital” (p. 41). In other words, the phenomenon that Bourdieu (1973, 1976) and others have discussed in theory is actualized in the Black college setting.

Though researchers (Farmer-Hinton & Adams, 2006; Perna & Titus, 2005; Smith, 2007; Tierney & Venegas, 2006) have used social capital to examine access, retention, and persistence for college students in the contexts of supportive relationships within the college community (e.g. mentors, peers, and counselors), there are few studies (e.g., Brown & Davis) that have examined social capital and its impact on fostering student success at Black colleges. In this study, we applied Brown and Davis’s (2001) delineation of social capital, which espouses the social networking and supportive relationships that exists at Black colleges, to draw on examples of the social capital that permeates the Black college campus and their impact on supporting academic achievement for African American men.

METHODOLOGY AND DATA COLLECTION

We conducted this study at a public, doctoral research intensive HBCU in a mid-Atlantic state. According to the Office of Institutional Research (OIR) at this university, approximately 6,000 undergraduate and 400 graduate students were enrolled when data were collected. With regard to the freshmen class, the average high school grade point average (GPA) was 3.00. Twenty-four percent of the new students scored over 500 on the SAT verbal exam, and 25% scored over 500 on the SAT math exam.

We used a qualitative approach to guide this study because we sought to understand the social experiences of African American men in a particular context. Specifically, we used the case study approach as we collected data from multiple sources of information through an extensive exploration in a bounded system. As such, our epistemological approach was anchored in the constructivist tradition to build knowledge, understanding, and meaning through human interactions (Jones, Tores, & Armino, 2006).

Participants for this study consisted of African American male juniors and seniors who entered a public HBCU through its precollege program and persisted to graduation. The pre-college program serves as an intervention for academically unprepared students who do not meet traditional academic standards (i.e., GPA, SAT scores, and ACT scores) for admission to the university. Students in this study participated in this 6-week intensive summer preparatory program to strengthen their academic skills for college. To complete the program successfully, students must earn at least a grade of “C” in all pre-college courses, complete all assignments, and attend all scheduled events.

Procedures and Participants

The university’s OIR provided us with a list of 111 African American male students who entered the university through its pre- college program during the summers of 2000 through 2003. Of the 111 students, we contacted only 73 students given that 38 had graduated. We e-mailed the 73 potential students a poster about the study and asked them to contact us if they were interested in participating. We later followed the e-mail with a letter to their on-campus and home residences. As an incentive, we offered participants a $20 gift certificate. We also sought the help of staff members (or gatekeepers) at the university whom we believed knew students who matriculated to the university through the pre-college program. (Creswell, 2003). The staff members identified and contacted students who met the criteria for the study, which also enabled us to gain the confidence of our participants (Creswell, 2003)). We recruited additional participants through snowball sampling (i.e., asking those who joined the study to recommend others who might meet our criteria).

Although 73 students were contacted, few displayed an interest in participating in the study. With snowball sampling and help from university administrators, we recruited 11 African American men to participate. The average student involved was 21 years of age, majored in business, had earned 93 credits, and had earned a 2.7 GPA. Participants’ fathers’ occupations included a teacher, lawyer, police officer, minister, and maintenance worker, and their educational attainment ranged from a GED to professional and graduate school. Participants’ mothers’ occupations included a pediatrician, minister, congressional representative, daycare worker, and United States Postal Service worker. Participants’ mothers’ educational attainment ranged from high school to medical school. Seven participants were raised in the suburbs, 3 were raised in a large city, and 1 was raised in a small city. Many of the participants came from a two-parent household. Most of the participants planned to further their education beyond their baccalaureate degrees. Specifically, 4 participants planned to obtain doctoral degrees, 6 planned to obtain master’s degree, and 1 participant did not have plans to further his education.

We conducted 70-90 minute, face-to-face, in-depth interviews with each participant. All interviews were completed within 6 weeks. Prior to beginning the interviews, participants signed a consent form, completed a brief demographic form and a short open-ended questionnaire to help us understand factors germane to their academic success. With the participants’ consent, we also obtained information about their grades and GPA from the director of the pre- college program, who had tracked the participants’ academic progress since their matriculation into the university. During these interviews, we engaged participants about their academic and social experiences at the university. We placed particular emphasis on understanding their pre-college experiences and investigating key factors to their success. Many of the questions were open ended, which enabled participants to talk in depth about their experiences. We recorded our observations regarding how the participants responded to a question and their willingness to engage in the interview. We also conducted follow-up phone interviews with participants to clarify issues that emerged. We audio taped and transcribed all of the interviews.

Data Analyses and Reporting

We used constant comparative analysis on field notes, observations, and interview transcripts. According to Jones et al. (2006), constant comparative analysis engages the researcher in a process of collecting and analyzing the data simultaneously at “all stages of the data collection and interpretation process, and results in the identification of codes” (p. 44). We used ATLASTI, a qualitative data management software program, to organize, manage, and code the data. We used open coding to identify themes, analyzed the interview data obtained from each participant independently, and included cross-case analysis as well (Yin, 2006). In discussing the findings, we present excerpts from the participants’ responses verbatim to paint a picture of the participants’ voices. We used pseudonyms to maintain the anonymity and confidentiality of each participant. In addition, we excluded information that would compromise the confidentiality of the participants, administrators, faculty, and staff. Credibility

We employed several techniques presented by Merriam (1998) to ensure credibility of the study. For example, we provided thick description in the article so that others interested can draw their own conclusions from the data. Moreover, providing thick description enables the reader to vicariously experience the participants’ challenges at the university and the strategies they employed to surmount them.

We also returned the transcribed interviews to all participants so they could check for accuracy and clarity in the information from open-ended interviews. Lastly, we used feedback from five peer debriefers who were well versed in the topic of exploration and case study methods. These debriefers provided their own interpretations of the themes from the data to ensure creditability (Jones et al., 2006).

LIMITATIONS

A limitation of qualitative research is that the findings can only be generalized to other cases similar to the case of focus. Moreover, interviews may not be an effective way to collect reliable information when the questions pertain to matters the participants perceive as personally sensitive.

We proceeded with the qualitative methodology because we were interested in investigating the social experiences of academically unprepared African American men. We specifically focused on African American men at a Black institution because of the scarcity of research on retention and persistence for African American men attending Black colleges and universities.

FINDINGS

The data from this study contribute to the literature by examining manifestations of social capital and their impact on success for academically unprepared African American men attending an HBCU. The participants indicated that professors and administrators were accessible and displayed a willingness to form supportive relationships with students. These relationships encouraged persistence because the students realized that professors and administrators cared about them and their success at the university. Faculty and administrators mentored and served as role models for many of the students. They also directed and encouraged student participation in student support services, campus organizations, internships, and scholarship programs. Participants reported relying on peers to sustain their motivation, to provide a cathartic outlet, and for academic or social networking. They also indicated that the institution’s community functioned as a purveyor of social capital and reported feeling valued, challenged, supported, and nourished.

We have grouped our findings according to five themes. First, we discuss participants’ relationships with faculty. Next, we explain participants’ reflections of campus administrators. Then, we describe participants’ relationships with people they regarded as mentors and role models. In addition, we discuss participants’ interactions with their peers and how they helped strengthen students’ resolve to succeed. Finally, we include participants’ reflections on the overall climate on campus.

Faculty Relationships: Displaying Empathy and Support

Participants commented on the linkage of helpful and encouraging faculty to academic success. Faculty supported these students by displaying concern, not only for their academic success, but also for their personal welfare. Faculty members displayed empathy for their students and tried to help students maximize their potential. James, a business major, noted the importance of building rapport with faculty by taking initiative to interact with them during their office hours. He emphasized that these relationships enabled his professors to know that he is diligent about his studies and serious about succeeding academically:

All of my teachers know me on a first name basis. I’m able to make that relationship with them, and they know if I’m trying or if I’m not, or you know, they just know me personally, so I’ve been able to make that relationship with them, so it kind of helps me out.

James also explained that some of his African American professors try to maximize his potential because they realize that he is capable of excelling academically.

Most of them are Black, which I do appreciate because what I learned now is that the teachers who are not Black usually . . . water things down. So I feel like the Black professors are usually harder, because they know that you have the potential and they’ll push you, and drive you, which of course will only help you in the long run.

Anderson, a theater major, commented on the faculty’s caring and concern for his welfare and how this extended beyond academic issues. He also explained that faculty members were there for him and took extra time to make certain he understood the information presented in class:

Yeah, faculty has been great man. I always tell myself, “[If I had] gone to another university, would I have gotten this experience?” I hear people say bad things about the [university] to me; it doesn’t get any better than this. The faculty really has just cared beyond caring, you know. These are people with doctoral degrees, “Like why are you even talking to me? Like what can I offer you?” Absolutely nothing! I have no money. I have no advice to give you. I have nothing to offer you. Yet you sit down for hours and you just try to help me. I come to your office and you sit there for an extra hour, and it’s just amazing. I never knew people [could] be that generous. I didn’t know that kind of generosity still existed. I thought it died out in the 60s.

Samuel, a sociology major, also commented on how his professors made themselves available and accessible:

Knowing the professors there, [one professor] has really stepped in. . . . You can email [him]. You can call him. You can knock on his door. He’s open and willing to tell you things that some professors won’t tell you. He’s willing to tell you things that you just need to know, but somehow do not know. He takes the extra initiative.

Many of the participants conveyed that faculty took a genuine interest in getting to know them and building relationships with them. They developed an interest in the students’ academic and personal lives and made attempts to relate to the students’ life situations. This approach strengthened the faculty members’ overall rapport with the students.

Robert, a business major, commented on how he felt faculty created a warm, welcoming environment, indicative of a “home away from home,” which is additional evidence of the care and concern faculty display for their students.

Especially for the people that . . . don’t live here . . . you might not always have the opportunity to run home, run to a family member. Plenty of professors and advisors [here] care [about you]. You may not get home, but here they try to make it home.

Wilson, a physical therapy major, underscored how faculty demonstrated empathy based on their own experiences and established a supportive relationship with students:

We had an assignment-we had to write an essay talking about something that happened in the past. I wrote a essay about, I don’t even remember what the essay was about, but the professor came to me after class and was like, “Oh, you know I went through the same thing or you know if you have any problems, you can call me.” She gave me her phone number, her email address. I was able to call her if I had problems with homework, or if I needed help with the assignment.

Faculty went beyond their professional duty to form supportive relationships with students. They created a close-knit community in which out-of-state students felt a part of the institutional fabric of the campus. They also used empathy to foster a better connection with the students, helping students to personally identify with faculty. Furthermore, students reported that African American professors tried to maximize their potential because they knew that the students possessed the capability, desire, and motivation to achieve.

Going Above and Beyond the Call of Duty: Supportive Administrators and Academic Success

Participants commented that administrators are another vital component of the support system. These administrators are helpful, accessible, and demonstrate a caring attitude about student success. Anderson felt:

There’s . . . staff and sometimes I forget they work here because they’re so kind, and so generous. . . . You become on a first name basis with people because they just take you under their wing as a freshman and they show you that [there’s] more to school than doing well. If you have a bad semester, if you have a bad class, [they say], “Come talk to us. We’ll work these things out for you and we’ll try to help you.” The whole honors department . . . really care about their students and care about their work, and you begin to really care so much about these people . . . if you do not do well, it will not only hurt you, but it will hurt them. You become more concerned about not hurting them that you try so hard. Those things helped me, having administrators that actually care. . . . Like Dr. Howard, her door is always open. I asked the lady one day “When do you get any work done because you always help students in here?” She just replied simply, “The students are my life,” and I was like, “Damn.”

Lawrence, a sociology major, concurred with Anderson’s assertion of the importance of supportive administrators. “You know the administrators and staff-they all got open arms, so they’re willing to mentor you without you even knowing you’re being mentored.” Continuing, Lawrence indicated,

Mr. Jackson helped me out. He mentored me, you know, coaches, you know, different teachers, you know. I mean even though [they’re] teaching so many different students, they care about the students and want you to succeed, so they’ll go the extra mile and help you out if you really need it. Samuel echoed this sentiment: “You can look up to them, people that really care, not telling you what you want to hear, more so telling you things that can really impact your life, making it comfortable here.” Students commented that some administrators, much like faculty, took a personal interest in the students and were supportive. These administrators adopted an “open door policy” and illustrated care that extended beyond their academic performance. Some of these administrators also served as role models and mentors to these students, which illustrated the richness of social capital at this institution.

“My Brothers’ Keeper”: Relying on Peers for Motivation and Encouragement

In addition to faculty and administration, numerous participants explained that their peer groups significantly influence their academic achievement. James indicated he strives to create a community of peers who are motivated, persistent, and work diligently toward their educational aspirations. He strongly believes that his peers fuel his desire and drive to become academically successful:

Most of my friends . . . they have goals, they’re ambitious, they have drive, passion. I try to keep people like that close to me and I think that’s how that’s changing me, because I kind of emulated them in a way; it kind of made me become more focused.

He elaborated,

If I didn’t surround myself with people who are hardworking, intelligent and ambitious, I think it would be difficult because I do believe that you feed off your friends. I mean you choose your friends . . . who you choose is very important. If I didn’t have the friends that I have now it would be hard to be successful because we all want to go to the same place; we all see ourselves as successful.

Anderson commented on the positive impact peers had on his academic achievement. Specifically, he explained that peer pressure enhanced his motivation and desire to perform well:

If you got a whole bunch of friends pressuring you to do well, you don’t really have a choice if you want to stay with that group to do well, and peer pressure might sound very elementary but it’s true. I don’t care how old you get, it’s very true. I was indirectly pressured into doing well through others.

Chris, an industrial engineering major, agreed that one’s social network has personal implications for success. “People that you hang around, they could lead you into doing things you don’t want to do so, you also have to hang around people who have the same goals and drive as you.” Many participants commented on how their peers encouraged and motivated them to succeed academically. For example, Simmons, a business major, explained that sometimes you have to act as a figure of authority to peers to ensure that they do not lose their focus. Specifically, he said,

One of my good friends he had a 0.7 [GPA]. . . . As friends . . . if somebody is down, we have to bring them up by talking to them, encouraging them . . . making sure that they are doing their work. Even though they might be of age, you still have to [be a father figure and say], “Did you do your work? . . . Did you do homework? Do you have homework?”

Robert also explained how one of his peers encouraged him to persist: “I found two of my friends through the precollege program. . . . Whenever we need to be encouraged, we just encourage each other, ‘Like don’t give up, don’t give up.’ I mean, it’s the good support system that Black men need.” He added:

Some of the buddies . . .who I’ve formed friendships with are . . . the ones who have really like challenged me to like, to not be discouraged because in college there are a lot of times your buddies are graduating early before you, or they’re way past graduation . . . but you’re still here, still stuck in that one class.

Douglass, a business major, also agreed with how his peer group encouraged and motivated him. He noted:

Having friends that have the same common goals as I do, that inspires me to push myself even farther, ’cause they all have personal achievements, and it’s not a competition thing. It’s all about uplifting one another, and pretty much have all your goals set, one day at a time when you look to the future 5 years from now, paying loans off, debts, buying houses, investments, and if you are planning for retirement, you’d be thinking long-term, that’s the way our mind-set is.

Lastly, Chris expressed how his peers provided a support system for him. They keep him invigorated, and provide an outlet to relieve stress, as well as help him focus on his goals. He noted:

[Friends] give you another reason to stay in school ’cause a lot of people, they commit suicide and ’cause of stress, ’cause nobody loves them. I didn’t realize how important friends are. . . . Even though I got brothers and sisters . . . friends are really important, ’cause you’re going to need the support and all.

By forming supportive relationships with other students, which facilitates perseverance and persistence toward the goal of graduation, peers provide a rich source of social capital. Although not explicit, it is plausible that without the relationships students have with their peers, their academic success would be hindered. The participants reported that their friends encouraged their persistence by displaying concern for their academic success, motivating them to persist, and acting as authority figures.

Role Models and Mentors: Using Wisdom, Dedication, and Experience to Illuminate the Pathway Toward Success

Many participants explained how, in addition to peer relationships, access to role models and mentors emerged as a significant factor to support academic success. James noted that having access to someone who has been successful certainly affects success.

I think . . . if maybe we can reach out to the freshmen more. If they know that, you know, I was in the same position as [them]. I was in pre-college, and now . . . I’m graduating . . . and you know I’m in these organizations.

Anderson agreed with James’s assertions, but added that having some commonalities (e.g., gender, ethnicity, educational background, socio-economic status) with the successful person can foster a sense of self-efficacy. Recalling a visit by Dancy, an alumnus and successful lawyer, Anderson explained,

I think it’s . . . a male seeing another male doing something that he wants to do. Dancy is [on] the university council, and he came down to my [residence hall] one time. I invited him to come down and speak with some of the guys when I was a RA. A lot of people said I want to be a lawyer. I want to be a doctor, but you don’t see any Black lawyers, you don’t see any Black doctors, how feasible [is it] to ever reach that goal if you don’t see anyone that looks like you? So when he came down, that guy is young, man. He’s a lawyer really, in actuality that’s instant inspiration because you’re like, “If he could do it, I could do it, he looks just like me.” So I think males on campus, African American males in general, on a college level, if you see someone doing something that you want to do, it will inspire you to do it.

Anderson added,

But when you see someone that’s not like you, and you want to do it . . . it’s already enough stacked up against the Black male, and I’m not saying there’s some external force that’s trying to keep the Black male down. Personally, I think a lot of what keeps us down, is ourselves. But the inspiration you can get when you see another [Black] man doing what you want to do, there’s nothing like it. That’s why I think a lot of students or a lot of [Black] males want to be athletes, because that’s all they can see, or they want to be musicians, ’cause that’s all they see. But if you saw a whole bunch of Black doctors running around all day, and saving lives, that’s what you want to do, because it’s feasible.

Walter, an architecture major, talked about how his fraternity brother on campus serves as a positive influence on his success. Specifically, he stated,

Well, my brother in the fraternity and I have a wonderful relationship. He continues to look out for me. He’s always supportive of me, man, and he is a role model for me as well. . . . I look up to him a lot. He was academically successful and he’s here to serve as a motivational tool. Again, it’s just a continual process of motivation.

Douglas also indicated that access to role models drives success. “I say have more Black male role models. Because if you have Black male role models, you’ll look at them and say, ‘This person has been in the same situation I have, and look how successful he is.'”

Participants identified a relationship between mentoring and persistence. Access to mentors is important because they provide support and guidance. Simmons offered this explanation about mentoring:

Mentoring has played a big part because if mentoring wasn’t there, I think I’d probably failed my English class-my freshman year. The teacher . . . how she used to want us to write our papers, was very different from what I was used to. So the first paper I wrote, she failed me. She gave me a 50 or something on it. . . .So I let my mentor read it, and . . . [he] thought it was okay, but when I explained to . . . [him] how . . . she wanted me to write it, then he understood it more and then he helped me out a little more with it. So after that, I passed the class with a B.

Robert agreed that mentoring had a significant impact on academic success. He encouraged young students to form a mentorship with someone older. This mentorship would positively enhance students’ success because they would have access to an experienced person to help them navigate the rough terrain of college life and circumvent the pitfalls that lead to poor academic performance. In Robert’s words, I think that . . . older Black men need to sit down with younger Black men and just rap together, just talk. I mean not about just hip-hop, but about growing up, dealing with women, dealing with living on your own, because when you grow and you move out on your own, it’s hard, especially if you’re from a different state. It’s kind of like, moving to a different country, ’cause you don’t know anybody. So you’re dealing with all this temptation and it’s like. I remember there is a Bible verse that says, “The old know the way, the young they have strength.” The old are wise because they know the way, but the young, they’re good because they’re strong. I mean it’s all about connecting with Black men who know the way already.

And, Walter emphasized the centrality of a mentor to academic success:

I know one of the most important things, I’ve probably said this about a billion times already, is to get a mentor. You must get a mentor. Without a mentor, you’re lost. Without anybody to look up to, it’s like you don’t have a sense of where you could be. One of the first things I got was a mentor around this campus; my grandfather introduced me to Dr. Lattisaw. And once you start talking with mentors and socializing, you begin to understand . . . and start setting goals for yourself, and . . . then you can go from there, and whenever you need him, he’ll be there. It’s like a brotherly relationship, and also like a parental figure.

Like peers, mentors and role models provide a lavish source of social capital, particularly in the contexts of HBCUs. They provide guidance, nurturing, social networks, and encouragement, and help socially integrate students into the university’s community.

Supportive Campus Community and Success

Many participants described their university’s environments as supportive and caring. Anderson noted that it is hard to identify one factor at this HBCU that has enabled him to succeed. He credited all of the university personnel (i.e., faculty, administration, and staff) for providing a source of support, motivation, and words of encouragement. Specifically, he said,

It’s just the environment that the [university] fosters. When I came here, it’s so hard to pinpoint one thing that really got me to this point. ‘Cause one without the other, it’s like mayonnaise without bread, I mean like you know, you’ve got to have a sandwich in order to get what you want. Everything here at the [university] just came together to get me to this point. . . . The most important thing, I think it was the administration and the faculty and the staff that helped me out. From talking to maintenance staff who tells you to stay in school, from talking to a doctoral student, or someone with a Ph.D. telling you to file your taxes, it all broadens to this point. So, it’s hard to pinpoint one thing.

Lawrence agreed that the university offered a family-like environment. “There’s really good people on campus that really care about you and it’s all been an uphill ride for me since I’ve been at the [university].”

Although Walter described the [university] as supportive, he noted that students need to be proactive about seeking assistance:

It’s important for the student to take action. Don’t expect teachers to go running after you. . . . If you don’t seek help, they will probably assume that you don’t need it. [Faculty will] always be available to you, [but] you have to take the opportunity [to seek support]. Be prepared for the opportunity when it presents itself.

James mentioned that social support systems at the university helped him to raise his GPA: “The social aspect is completely different at Black colleges, which I’m very thankful for. I probably wouldn’t have the grades I have [elsewhere].” James also offered that a HWI seemed to be less personal [based on his visits with friends at HWIs], whereas an HBCU seems more personal. He indicated that professors are available and demonstrate a willingness to build relationships with students:

At a predominantly White university, it’s easy for you to just feel like a dot or just [a] number. But here, it’s more . . . personal, it’s more relationship-building . . . it’s very easy for you to go to your teacher and be like, “Listen I’m not understanding,” and half the time they will take time out to help you. So, I think that’s what it is-it’s the smallness of the classes and the close feeling-you can really get to kind of know your teachers. So you don’t get lost in the whole college setting. So I try to think of it . . . it’s the classroom sizes, which are good ’cause initially my whole vision of college was you know, I want to be in a classroom with 400 people. I wanted that, but now that I’m here, I’m really glad that I didn’t because I’m so thankful that I’m in these small classes, and my teachers know me on a first and last name basis. That I can easily call them up and [say], “Hey I need a recommendation or I need help with this and that,” [and] they have the time to devote to me.

Anderson, Robert, and Lawrence described the positive effect of the [university’s] racial homogeneity. Specifically, they explained that having access to a cadre of African American students who are motivated and focused on attaining their baccalaureate degrees affects their motivation to succeed. Simmons articulated, “It’s like most of the African American males here are like we’re striving for one thing-to be successful, and that makes me want to be successful.” Robert commented:

Seeing other Black people [makes] us want to succeed too. Like so much of society, they show us as scavengers . . . they show us as not intelligent. Corporate America shows us what they want us to see, and they show people what they want us to be thought [of as], and I don’t like that. But when I came to the [university] . . . I saw Black people. I saw Trinidadian people. I saw people from all shades of Black . . . who [are] motivated [and] driven for success.

Lawrence added,

It makes you want to do better, ’cause you’re at an institution with a majority of your race, and you don’t want to be a failure. You want to succeed and you already know that some people will look at a HBCU as being on a smaller level, so you want to try to get the most out of it that you can.

Samuel stated that the environment at the [university] positively shaped his professional preparedness for the world. He reflected:

[The university] has groomed me and made me a contender for the world. Many times like I said when you [graduate from an] HBCU, people look at you . . . a little strange, but it’s not where you come from, it’s what you learned from where you come from. . . . When someone sees my application, see my resume or something like that, they’ll see the knowledge that I possess, that I can write and speak. I am marketable . . . [the university] has made me a marketable, Black, young man.

DISCUSSION

The findings from this study are consistent with those of researchers who have characterized HBCUs as supportive and nurturing (Allen, 1987, 1991, 1992; Berger & Milem, 2000; Fleming, 1984; Fries- Britt & Turner, 2002). Brown and Davis (2001) noted that HBCUs are rich in social capital, which is positively related to academic success. At the HBCU in this study, the depth of social capital includes the entire campus community, which reinforces the adage that “it takes a village to raise a child.” The participants indicated that professors and administrators were accessible and displayed a willingness to form supportive relationships with students. These relationships encouraged persistence because the students realized that professors and administrators cared about them and their success at the university. Faculty and administrators mentored and served as role models to many of the students. They also directed and encouraged student participation in student support services, campus organizations, internships, and scholarship programs. In many ways, the interactions and experiences created a climate that the participants considered to be supportive and nurturing. These relationships provided a rich source of social capital for the African American males at this HBCU that many minority students at HWIs may not experience.

Research has shown that positive student-faculty interaction is linked to academic achievement and success for all students (Astin, 1993, 1999; J. E. Davis, 1999; Eimers & Pike, 1997; Pascarella & Terenzini, 2005). Although research supports this relationship between faculty interaction and success, scholars have indicated that generally African Americans lack close contact with faculty at HWIs (Allen & Haniff, 1991; Feagin et al., 1996; Pascarella & Terenzini, 2005; Rankin & Reason, 2005; Tatum, 1997; Tinto, 1987; Watson et al., 2002). Conversely, some researchers have argued that students have close, supportive relationships with faculty at HBCUs (Allen, 1987, 1991, 1992; Berger & Milem, 2000; Fleming, 1984; Fries- Britt & Turner, 2002). In fact, L. A. Davis (2006) indicated that “at HBCUs, it takes the entire institutional family to produce competent graduates. The administration, faculty, staff, alumni, and community people who take a personal interest in the . . . student act as an extended family” (p. 44). Guiffrida (2005) noted that faculty, like those at the university in this study, who do not limit their professional responsibilities solely to teaching and research but also work to enhance students’ psychosocial and emotional development, are student-centered.

The perceptions of the African American males in this study mirror Allen’s (1992) assessment of HBCUs. He asserted that “Black universities provide positive social and psychological environments for African American students that compare to those experienced by White students who attend [a] White University” (p. 40) and explained that the social aspects encompass networks of peers, social outlets, and supportive relationships. The psychological component, on the other hand, includes a heightened level of self- confidence and self-esteem and a sense of belonging and ownership of the campus. Green (2000) explained, “The collegiate experience for African Americans at HBCUs is a cathartic one, in that it is a nurturing environment; faculty members at HBCUs discern student’s difficulties and offer to them the social, cultural, and psychological support” to achieve and thrive academically (p. 16). The link between peer interaction and academic success noted in our findings is consistent with earlier research (Astin, 1999; Guiffrida, 2005; Harper, 2006; Kuh, Douglas, Lund, & Ramin-Gyurnek, 1994 ; Pascarella & Terenzini, 2005; Thomas 2000). Davis, Jenkins, Hunt, and Page (2002), authors of The Pact, attributed their cohesive relationships with each other as helping to successfully navigate medical and dental school. Furthermore Astin (1993) stated, “Student interaction with peers can positively influence overall academic development, knowledge acquisition, analytical and problem- solving skills, and selfesteem” (p. 45). Astin (1999) also found that the greatest source of influence on cognitive and affective domains is the student’s peer group. Additionally, research from Thomas suggested, “Those students with a proportion of ties to their peer group perform better academically and are more likely to persist” (p. 609). He explained that a portfolio of relationships improves persistence by providing access to academic and social resources. At the HBCU in this study, peers provided a social network for students to access for support, encouragement, and motivation. The participants’ peers provided them with a rich source of social capital, which positively enhanced their academic performance and success.

Additionally, in this study we found that accessibility to mentors and role models is related to academic success. This finding is consistent with current literature (Craig, 2006; Green, 2000; Ross, 1998; Tinto, 1987; Wallace, Abel, & Ropers-Huilman, 2000). For example, Lavant, Anderson, and Tiggs (1997) found that when universities have implemented mentoring programs, African American men have been more successful academically. They highlighted six mentoring models at various institutions: (a) The Black Man’s Think Tank, (b) The Student African American Brotherhood, (c) The Black Male Initiative, (d) The Meyerhoff Program, (e) The Bridge, and (f) The Faculty Mentor Program, all of which have been instrumental in reducing attrition for African American males. Although there are some differences among these programs, they provide a safe place for African American men, help them to cultivate leadership skills, and develop positive mentoring relationships with the university’s constituencies. Institutions such as City University of New York and the University of West Georgia have implemented programs designed to enhance African American male retention (Holsendolph, 2005; Watson, 2006 ). This list is not exhaustive, as there are similar programs at many of institutions across the country. Participants indicated that mentors and role models provided guidance, nurturing, social networks, support, and encouragement.

CONCLUSION

HBCUs serve as important promoters of African American social mobility. Though fraught with economic inequalities in comparison to their HWI counterparts, they can be credited with nurturing the academic talents and potential of their students, many of whom have made great contributions to society. These 11 participants attending an HBCU have described an environment that was supportive, encouraging, and nurturing, enabling them to overcome their academic weaknesses and to graduate with a relatively strong GPA. The findings from this research support Brown and Davis’s (2001) supposition that HBCUs are purveyors of social capital. The participants emphasized that these relationships were not limited to student affairs practitioners. Rather, the relationships encompassed the entire university community, including professors, administrators, staff, and peers. Faculty went beyond their formal roles to build a sense of connection with students; they listened, supported, demonstrated empathy, and displayed a concern for students’ academic and personal well-being. Some administrators also possessed these qualities of warmth and concern, and established a rapport with students. Peer influence emerged as a vital aspect of social capital. Students encouraged their fellow students to persist by staying focused on their goals and completing assignments in a timely manner. Some participants commented that the university created a family-like environment that nourished students’ talent and developed their potential.

As the results from this study were predicated on research from one Black college, additional research is needed across various types of HBCUs to see whether these findings are applicable to other HBCUs. A study of this magnitude is important because it would not only put into practice Brown and Davis’s (2001) supposition that HBCUs must continue to be studied for their contribution to higher education, but also it might provide further evidence that these institutions are still significant in the landscape of higher education.

RECOMMENDATIONS AND IMPLICATIONS FOR INSTITUTIONAL POLICY AND PRACTICE

Several implications for policy and practice can be derived from this study. From a practitioner perspective, universities, regardless of institutional type, should note the importance of the university community working collectively to support students’ academic success at Black colleges. This article demonstrates that success in college does not lie in the hand of any one person; rather, the entire university community is responsible for deploying social capital in a way that promotes student persistence and retention. College and university administrators should consider urging faculty to move beyond their prescribed roles of teaching and research to establish meaningful relationships with their students. Faculty should consider collaborating with student affairs practitioners to explore creative ways that they can work in tandem to enhance student success. To encourage faculty to become more supportive of students, universities should place more emphasis on student advising and mentoring in the criteria for tenure. Specifically, universities and colleges should contemplate implementing programs to encourage faculty to serve as mentors to students, particularly students who are at risk, as they may need more support and guidance.

Furthermore, college and universities should encourage administrators and other personnel of the institution to go beyond their prescribed roles to support students’ success. These individuals can support, encourage, guide, mentor, and serve as role models to students. This synergy will ensure that the campus is truly a supportive enclave and place a strong emphasis on creating an environment that values student persistence and success.

Student affairs practitioners should consider encouraging students to form supportive, nourishing relationships with their peers. As such, students will have a strong social network to access should they encounter a problem, or need assistance or a listening ear. Additionally, student affairs practitioners, especially those who operate within academic departments, should also advocate for faculty’s employment of collaborative learning approaches, which would give students an opportunity to increase their peer network and support circles.

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Man Found Guilty in Kidnap, Sex Assault of 11-Year-Old Girl in North Okanagan

By THE CANADIAN PRESS

VERNON, B.C. – The Crown may seek long-term or dangerous offender status for a British Columbia man convicted Friday of the kidnapping and sexual assault of an 11-year-old girl.

B.C. Supreme Court Justice Peter Rogers found Paul LePage guilty of abduction and administering a drug to commit an indictable offence.

Rogers also found LePage guilty of sexual assault causing bodily harm, saying there wasn’t enough evidence for the more serious charge of aggravated sexual assault.

Outside the court, prosecutor Howard Pontious said LePage, who has one previous sex crime also involving a minor, will be assessed before sentencing takes place.

“It’s up to the psychiatrist whether we proceed with a dangerous offender or long-term offender application but the first step is to get the consent to ask for a psychiatric assessment,” Pontious said.

“It’s party because of his record but mostly it’s just because of the sheer magnitude of the crimes. Snatching a child off the streets of Armstrong and raping her is about as aggravated as I can think of.”

Pontious said the range of sentence for kidnapping alone is eight to 14 years.

But if LePage is declared a dangerous offender, he would face an indefinite sentence.

The girl, now 13, sat in the courtroom with her parents at her side to hear the verdict Friday.

She was 11 years old in 2006 when she was grabbed on her way home from a video store in the Okanagan community of Armstrong, B.C.

Her belongings, including a scooter, cellphone and a rented movie, were found nearby.

About 50 police officers and members of the close-knit community searched frantically for the girl. Police dogs and a helicopter were brought in to help search.

After an intense, 36-hour manhunt, police found the girl alive.

LePage, who represented himself at trial, claimed the girl failed to pick him out of a line-up and that there were inconsistencies in the police testimony.

The girl testified from a separate room by a video link so she would not have to face the accused under cross-examination in the courtroom.

Pontious called her “an incredible witness”.

During her ordeal, she obtained a cigarette butt from her attacker that she later provided to police.

Pontious told the court the DNA evidence alone was enough for a conviction.

LePage’s DNA matched a sample taken from the girl but he argued that his backpack, which contained used condoms, was stolen from him and returned prior to his arrest.

The girl’s palm print was also found on the inside of an orange garbage bag that had LePage’s fingerprints on the outside. She testified that her attacker tried to put the garbage bag over her head.

The girl also provided police with a detailed description of her attacker and what he was wearing and told them where he had gone.

LePage was found in that area by police.

Six More Premier Alliance Members Join WNC Health Network to Increase Savings

The Premier healthcare alliance and the WNC Health Network (WNCHN) today announced that six more Premier member hospitals in the Carolinas and Virginia have joined WNCHN. This brings to 52 the number of hospitals enjoying increased supply chain savings through affiliation with the Asheville, N.C.-based organization’s group purchasing program.

WNCHN members have saved more than $31 million on top of savings from Premier contracts since the WNCHN group purchasing program began in 2001. An independent regional network, WNCHN is affiliated with Premier Purchasing Partners, LP, for its group purchasing programs. All WNCHN members are Premier owners or affiliates.

The newest members are

Lenoir Memorial Hospital, 261 beds, in Kinston, N.C., serving Lenoir and surrounding counties;

Wayne Memorial Hospital, 316 beds, in Goldsboro, N.C., serving Wayne and surrounding counties;

Maria Parham Medical Center, 102 beds, in Henderson, N.C., serving Vance and surrounding counties;

Loris Healthcare System, 105 beds, in Loris, S.C., serving part of Horry and surrounding N.C. and S.C. counties;

Stanly Regional Medical Center, 119 beds, in Albemarle, N.C. serving Stanly and the surrounding counties; and,

Buchanan General Hospital, 134 beds, Grundy, Va., serving Buchanan and surrounding counties.

Wayne Memorial Materials Management Director Bob Zongaro has been at the hospital for more than 21 years. “During that time we have had and continue to have a strong and rewarding relationship with Premier,” he said. “When it came time to review GPOs, it was a no-brainer to also choose WNCHN, which is affiliated with Premier. WNCHN impressed us with their professionalism during their presentation. They understand contracts and, more importantly, have the people and resources to make the savings happen.

“We have identified over $400,000 in product savings with no changes or product disruption,” Zongaro said. “Unlike other GPOs that promised savings, only as the result of painful product changes, which can take up to a year to realize, with WNCHN we saw immediate savings. We look forward to our new relationship with WNCHN.”

WNCHN Executive Director Gary Bowers said, “We are pleased to welcome these six well respected hospitals into the WNC Health Network. Our network is a collaboration of hospitals, county health departments and other healthcare providers to support the delivery of cost-effective, quality health services. Our focus is on helping the communities represented in the network and that dovetails with Premier’s core purpose of improving the health of communities.”

Premier Purchasing Partners President Mike Alkire said, “As one of the country’s largest group purchasing organizations, we use our $31 billion national buying power to leverage best-price contracts for members, but we don’t stop there. We have learned to harness the power of regional collaborations, such as WNCHN, to generate even greater value for participating members. We fully support these efforts. WNCHN’s success in aggregation and standardization among its member hospitals is saving participating Premier members additional millions, resources that are critical to improving the services they offer in the communities they serve.”

WNCHN Vice President of Member Services Tim Bugg said, “What sets WNCHN apart is the value we bring to our members — all our members, large and small. Our cost savings to dues average ratio is 22:1. Our members embrace the network. They are the reason our programs work. We are positive our newest members will both strengthen our network and realize substantial savings.”

Bugg added, “Our goal is and will continue to be to find as many cost reduction opportunities as possible to help our membership deal with the continued decreasing reimbursement, increasing costs, and growing uninsured and indigent care costs. At the end of the day it’s not about WNCHN, but the hospitals we serve.”

About the WNC Health Network (WNCHN)

The WNC Health Network is a collaboration of hospitals, county health departments and other healthcare providers to support the delivery of cost-effective, quality health services. WNCHN maintains a visionary community focus supported by collaboration, integrity and respect among its healthcare providers. Based in Asheville, N.C., it began in 1995 to identify, explore and implement cost-effective, collaborative opportunities among the hospitals and healthcare systems in western North Carolina and now includes 52 hospitals, 13 health departments and Mountain AHEC. A not-for-profit corporation with oversight from a 16-member board of directors, WNCHN is an independent regional network, helping members meet the challenges of a changing healthcare environment through activities including shared services, patient quality of care, and group purchasing.

About Premier Inc., 2006 Malcolm Baldrige National Quality Award recipient

Serving 1,700 U.S. hospitals and more than 49,000 other healthcare sites, the Premier healthcare alliance and its members are transforming healthcare together. Owned by not-for-profit hospitals, Premier operates one of the leading healthcare purchasing networks and the nation’s most comprehensive repository of hospital clinical and financial information. A subsidiary operates one of the nation’s largest policy-holder owned, hospital professional liability risk-retention groups. A world leader in helping healthcare providers deliver dramatic improvements in care, Premier is working with the United Kingdom’s National Health Service North West and the Centers for Medicare and Medicaid Services to improve hospital performance. Headquartered in San Diego, Premier has offices in Charlotte, N.C., Philadelphia, and Washington. For more information, visit www.premierinc.com.

Sadness Impairs Ability to Spend Wisely

How you are feeling has an impact on your routine economic transactions, whether you’re aware of this effect or not.

In a new study that links contemporary science with the classic philosophy of William James, a research team finds that people feeling sad and self-focused spend more money to acquire the same commodities than those in a neutral emotional state. The team’s paper, “Misery is not Miserly: Sad and Self-Focused Individuals Spend More,” will be published in the June 2008 edition of Psychological Science and will be presented at the Society for Social and Personality Psychology’s Annual Meeting on Feb. 9.

The new study follows up on earlier research that established a connection between sadness and buying. Researchers Cynthia Cryder (Carnegie Mellon University), Jennifer Lerner (Harvard University), James J. Gross (Stanford University), and Ronald E. Dahl (University of Pittsburgh) have now discovered that heightened self-focus drives the connection — a finding that expands understanding of consumer behavior and, more broadly, the impact of emotions on decision-making.

In the experiment, participants viewed either a sad video clip or one devoid of human emotion. Afterward, participants could purchase an ordinary commodity, such as a water bottle, at various prices. Participants randomly assigned to the sad condition offered almost 300% more money to buy the product than “neutral” participants. Notably, participants in the sadness condition typically insist, incorrectly, that the emotional content of the film clip did not carry over to affect their spending.

Self-focus helps to explain the spending differences between the two groups. Among participants “primed” to feel sad, those who were highly self-focused paid more than those low in self-focus. Notably, sadness tends to increase self-focus, making the increased spending prompted by sadness difficult to avoid.

Why might a combination of sadness and self-focus lead people to spend more money?Óš  First, sadness and self-focus cause one to devalue both one’s sense of self and one’s current possessions. Second, this devaluation increases a person’s willingness to pay more for new material goods, presumably to enhance sense of self.

Notably, the “misery is not miserly” effect may be even more dramatic in real life, as the low-intensity sadness evoked in the experiment likely underestimates the power of intense sadness on spending behavior. The effect could extend to domains beyond purchasing decisions, causing people to engage in increased stock trading, for example, or even to seek new relationships– without conscious awareness that they are being driven by their emotions.

The study is an early step toward uncovering the hidden impact of different, fluctuating, and what would otherwise seem irrelevant emotions on our day-to-day decisions.

The paper is co-authored by a multi-disciplinary team of scientists. Cynthia E. Cryder, a doctoral student at Carnegie Mellon University, studies behavioral decision research. Jennifer S. Lerner, a professor at Harvard Kennedy School, specializes in the study of emotion and decision making. James J. Gross, an associate professor at Stanford University, studies emotion and personality. Ronald E. Dahl, a professor at the University of Pittsburgh Medical School, specializes in brain maturation and emotional functioning.

The article is available at several websites:

Carnegie Mellon: http://www.contrib.andrew.cmu.edu/~ccryder/miseryisnotmiserly.pdf

Lerner Lab: http://content.ksg.harvard.edu/lernerlab/papers.php

Mapping Fingertip Dexterity in the Brain

USC biomedical engineer traces precision hand manipulation skills to specialized neural circuits in the brain

Quickly moving your fingertips to tap or press a surface is essential for everyday life to, say, pick up small objects, use a BlackBerry or an iPhone. But researchers at the University of Southern California say that this seemingly trivial action is the result of a complex neuro-motor-mechanical process orchestrated with precision timing by the brain, nervous system and muscles of the hand.

USC Viterbi School of Engineering biomedical engineer Francisco Valero-Cuevas is working to understand the biological, neurological and mechanical features of the human hand that enable dexterous manipulation and makes it possible for a person to grasp and crack an egg, fasten a button, or fumble with a cell phone to answer a call.

“When you look at the hand, you think, “Ëœfive fingers, what could be more straightforward?’ ” Valero-Cuevas said, “but really we don’t understand well what a hand is bio-mechanically, how it is controlled neurologically, how disease impairs it, and how treatment can best restore its function. It is difficult to know how each of its 30-plus muscles contributes to everyday functions like using a cell phone or performing the many finger tasks it takes to dress yourself.”

In a study published online in the Feb. 6, 2008 issue of The Journal of Neuroscience, titled “Neural Control Of Motion-to-Force Transitions with the Fingertip,” Valero-Cuevas and co-author Madhusudhan Venkadesan of Cornell University’s Department of Mathematics asked volunteers to tap and push against a surface with their forefinger while the researchers recorded the fingertip force and electrical activity in all of the muscles of the hand.

These researchers, in a first-of-a-kind experiment, recorded 3D fingertip force plus the complete muscle coordination pattern simultaneously using intramuscular electromyograms from all seven muscles of the index finger. Subjects were asked to produce a downward tapping motion, followed by a well-directed vertical fingertip force against a rigid surface. The researchers found that the muscle coordination pattern clearly switched from that for motion to that for force (~65 ms) before contact. Venkadesan’s mathematical modeling and analysis revealed that the underlying neural control also switched between mutually incompatible strategies in a time-critical manner.

“We think that the human nervous system employs a surprisingly time-critical and neurally demanding strategy for this common and seemingly trivial task of tapping and then pushing accurately, which is a necessary component of dexterous manipulation,” said Valero-Cuevas, who holds a joint appointment in the USC School of Dentistry’s division of Biokinesiology and Physical Therapy.

“Our data suggest that specialized neural circuitry may have evolved for the hand because of the time-critical neural control that is necessary for executing the abrupt transition from motion (tap) to static force (push),” he said. “In the tap-push exercise, we found that the brain must be switching from the tap command to the push command while the fingertip is still in motion. Neurophysiological limitations prevent an instantaneous or perfect switch, so we speculate that there must be specialized circuits and strategies that allow people to do so effectively.

“If the transition between motor commands is not well timed and executed, your initial forces will be misdirected and you simply won’t be able to pick up an egg, a wine glass or a small bead quickly,” he said.

The findings begin to explain why it takes young children years to develop fine finger muscle coordination and skills such as precision pinching or manipulation, and why fine finger manipulation is so vulnerable to neurological diseases and aging, Valero-Cuevas said.

But perhaps even more importantly, he said, the findings suggest a functional explanation for an important evolutionary feature of the human brain: its disproportionately large sensory and motor centers associated with hand function.

“If, indeed, the nervous system faced evolutionary pressures to be able to anticipate and precisely control routine tasks like rapid precision pinch, the cortical structures for sensorimotor integration for finger function would probably need to be pretty well developed in the brain,” Valero-Cuevas said.

“That would give us the neural circuits needed for careful timing of motor actions and fine control of finger muscles,” he said. “Thus, our work begins to propose some functional justifications for the evolution of specialized brain areas controlling dexterous manipulation of the fingertips in humans.”

By understanding the neuromuscular principles behind dexterous manipulation, Valero-Cuevas hopes to help those who have lost the use of their hands by guiding rehabilitation and helping to develop the next generation of prosthetics. In addition, the work will allow industry to build machines that have versatility comparable to that of the human hand.

“As an analogy, I ask people to imagine going through life wearing winter gloves,” he said. “If you can grasp things in only the grossest of ways without fine manipulation, life is pretty difficult. Yet millions of people worldwide go through life without the full use of their hands. Diseases and aging processes that affect the hand function tend to disproportionately degrade the quality of life, and we want to reverse that.”

The research was supported by the Whitaker Foundation, the National Science Foundation and the National Institutes of Health.

Photo Caption: The human nervous system employs a surprisingly time-critical and neurally demanding strategy for the seemingly trivial act of finger-tapping. Hand art by Brendan Holt.

On the Net:

University of Southern California

USC Viterbi School of Engineering

Actor’s Legacy: Mixing Meds Can Kill You

A medical examiner’s report that actor Heath Ledger died of an accidental overdose of several prescription drugs is a warning not to mix medications, doctors in North Jersey said Wednesday.

Ledger, the 28-year-old Australian star of “Brokeback Mountain,” died from a lethal combination of prescription painkillers, sleeping pills and anti-anxiety drugs, the New York City medical examiner said.

The findings came two weeks after Ledger was found dead in the bed of his rented SoHo apartment. Police found bottles of six types of prescription drugs in his bedroom and bathroom, raising speculation of an accidental drug overdose.

Most patients are not aware of the cumulative effect of mixing medications prescribed for different purposes, said Dr. Anthony Laneve of St. Joseph’s Regional Medical Center in Paterson.

“They think, ‘A sleeping pill is just for sleep and Valium is for my nerves, then I’ll also take a pain pill,’ ” said Laneve, chief of internal medicine at St. Joseph’s.

“They’re taking pills for specific reasons, not realizing they’re interacting in their system,” he said.

The toxicity of mixing drugs goes up more quickly and more intensely in patients who have medical conditions, such as liver or kidney problems, he said.

“It affects the breakdown and excretion of these products, so they stay in your system a longer time,” Laneve said.

Ledger died of “acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine,” the medical examiner’s spokeswoman Ellen Borakove said in a news release.

Oxycodone is the generic name for the powerful painkiller OxyContin, while diazepam and temazepam are generic names of Valium and Xanax, respectively. Alprazolam and doxylamine are sold as the sleep aids Restoril and Unisom, and hydrocodone is a widely used painkiller marketed under numerous brand names, including Vicodin.

Prescription drug overdose is now the second leading cause of accidental deaths in the United States, after auto accidents, according to federal officials. About 9 million people use prescription drugs for non-medical purposes; 3 million of them are between ages 12 and 17. Prescription drugs figure in 25 percent of all overdose deaths.

People also often don’t realize that prescription drugs and over- the-counter medications can have a cumulative effect when mixed, Laneve said.

It is hard to imagine a doctor prescribing one patient so many overlapping medications, such as the anti-anxiety drugs Valium and Xanax, at the same time, said Laneve.

Often this is a case of drug swapping among patients, or of patients obtaining medications through the Internet, he said.

Dr. Diego Coira, who is chairman of psychiatry at Hackensack University Medical Center, said he tries to prescribe a minimum amount of drugs.

“What happens with these medications is patients build up a tolerance for them,” Coira said. “The more you take, the more you need.”

People often have a false sense of security that prescription drugs can’t have dangerous side effects if used incorrectly, said Dr. Asghar S. Hossain, medical director and chief of geriatric psychiatry at Bergen Regional Medical Center in Paramus.

“There seems to be a growing misconception that prescription drugs can be used without considering the dangers of combining them with other prescribed medications … and even nutritional supplements,” Hossain said.

Patients should stick to one physician so computer records can keep track of their prescriptions, said Bob Zadra, pharmacist at Town and Country Apothecary & Fine Cosmetics in Ridgewood.

“That’s the reason patients shouldn’t hop from doctor to doctor and pharmacist to pharmacist,” Zadra said.

“There’s drug interaction, and the computer will pick it up that much easier” if the patient stays with the same health providers, he said.

A pharmacist can spot whether the patient has a prescription for a drug that’s the same or similar to one he is already on, and check with the doctor before dispensing it, Zadra said.

***

Lethal combination

Actor Heath Ledger died of an accidental overdose of prescription drugs, including:

* Painkillers: Oxycodone, hydrocodone

* Anti-anxiety medication: diazepam, alprazolam

* Sleeping pills: temazepam, doxylamine

***

This article contains material from the Associated Press. E- mail: [email protected]

***

McGraw-Hill Higher Education Publishes Text on Innovative Electronic Health Records System

NEW YORK, Feb. 7 /PRNewswire/ — Immediate access to a patient’s medical records is essential to quality medical care and can mean the difference between the life and death of a patient. Electronic Health Record (EHR) systems, used by physicians’ offices in ambulatory care settings, make patient history readily available in those critical moments. McGraw-Hill Higher Education has published a new textbook, Hamilton/Electronic Health Records, to educate medical personnel on these revolutionary systems. As part of this initiative, McGraw-Hill has partnered with Spring Medical Systems, the creator of the SpringCharts(R) EHR system, to provide fully functional demo software to all students, offering a unique hands-on patient care learning experience.

“We are thrilled to offer Hamilton/Electronic Health Records, with the accompanying SpringCharts software — a comprehensive learning package for the medical community,” commented Jim Kelly, president, McGraw-Hill Career Education Group. “EHRs are an innovative improvement in health care information systems, and this new content will enable ambulatory and medical care professionals to understand and use this technology to its fullest potential.”

Hamilton/Electronic Health Records, by Byron and Leesa Hamilton of the Med-Soft National Training Institute, provides theoretical content and introductory software, as well as an advanced training program and illustrated training details, such as visual screen captures and menu icons from the SpringCharts EHR software included in the package. Certificates of completion of the training program are available through McGraw-Hill Higher Education’s Online Learning Center. The textbook content also correlates with the certification criteria of the Certification Commission for Healthcare Information Technology (CCHIT).

About McGraw-Hill Higher Education

McGraw-Hill Higher Education is a unit of McGraw-Hill Education, a leading global provider of instructional, assessment and reference solutions that empower professionals and students of all ages. McGraw-Hill Education, a division of The McGraw-Hill Companies , is located in 33 countries and publishes in more than 40 languages. Additional information is available at http://www.mheducation.com/.

About Spring Medical Systems

Spring Medical Systems, Inc. was founded by a team of physicians and technology professionals with the primary goal of developing easy-to-use software solutions that empower physicians to increase efficiency, reduce costs, and provide better patient care. The Company’s flagship offering is the SpringCharts(R) family of products — SpringCharts EHR and SpringCharts Essentials. These innovative electronic health records solutions combine the right mix of rich functionality, intuitive ease-of-use, and affordability needed to enable rapid and complete documentation with a minimum of cost and disruption. Now in its tenth year of development and in use by physicians in a variety of medical specialties, SpringCharts products provide complete EHR Solutions for independent medical offices.

   Contacts:    Tom Stanton                              Mark Benvegnu   McGraw-Hill Education                    Spring Medical Systems   (212) 904-3214                           281-537-0186   [email protected]              [email protected]  

McGraw-Hill Higher Education

CONTACT: Tom StantonMcGraw-Hill Education(212) [email protected] BenvegnuSpring Medical [email protected]

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

Bacterial Conjunctivitis Vs Acute Anterior Uveitis

By Watkins, Jean

AT A GLANCE BACTERIAL CONJUNCTIVITIS

Presentation

* Conjunctivitis is inflammation of the conjunctiva caused by bacteria, virus or allergy or associated with foreign body.

* Bacteria involved are commonly Staphylococcus, Streptococcus pneumoniae or Haemophilus influenza.

* More often Gram-negative bacteria in patients with contact lens.

* Eye feels gritty (allergic conjunctivitis is itchy).

* Watering of the eye discharge may be yellow/white and mucopurulent.

Management

* Check to exclude foreign body.

* May resolve without treatment.

* Avoid spread to contacts.

* Swab from discharge for culture and sensitivities.

* Topical chloramphenicol or gentamicin eye drops.

* Azithromycin twice daily for three days may be helpful.

* Gonococcal and chlamydia conjunctivitis requires topical and systemic antibiotics. This is likely to be sexually transmitted and so a full check of patient and contacts would be required.

Conjunctivitis causes watering and discharge from the eye

ACUTE ANTERIOR UVEITIS (IRITIS)

Presentation

* Painful red eye – usually unilateral.

* Photophobia and watering of the eye – not mucopurulent.

* Usually occurs after the age of 20. Usually idiopathic and may have recurrent episodes.

* May be associated with HLA-B27, herpes zoster, ankylosing spondylitis, inflammatory bowel disease, sarcoidosis, reactive arthritis or reaction to drugs.

* Irregular, poorly reactive constricted pupil as the condition develops.

Management

* Patients should be referred urgently to the ophthalmic unit for slit lamp examination, fundoscopy, measurement of intraocular pressures and check of visual acuity.

* Specialist advice regarding mydriatics and cycloplegics such as cyclopentolate or homatropine eye drops. Prednisolone eye drops.

As acute anterior uveitis develops, the pupil becomes constricted

Contributed by Dr Jean Watkins, a sessional GP in Hampshire

Copyright Haymarket Business Publications Ltd. Jan 25, 2008

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

Margaret Dimond Named President and CEO of McLaren Medical Management Inc.

FLINT, Mich., Feb. 6 /PRNewswire-FirstCall/ — Margaret Dimond, executive vice president and chief operating officer of Henry Ford Macomb Hospitals — Warren Campus, has been named President and Chief Executive Officer of McLaren Medical Management, Inc. (MMMI), a wholly-owned subsidiary of McLaren Health Care, effective March 24th.

McLaren Medical Management, Inc. (MMMI) operates the corporate ambulatory services network consisting of more than 120 primary and specialty physicians. Dimond will be responsible for planning and meeting MMMI’s strategic goals to continue McLaren’s growing market share.

“We have the highest confidence in Margaret Dimond’s ability to take McLaren Medical Management, Inc. into a new chapter of growth,” said McLaren Health Care President and CEO, Philip A. Incarnati. “Dimond has nearly 15 years of experience managing large ambulatory service networks in Southeast Michigan. She has demonstrated her ability to lead and grow complex health care organizations by aligning multiple stakeholders around the same goal of providing excellent health care to the communities that they serve.”

Dimond in 1994 was charged with managing Henry Ford Health System’s ambulatory services network for key specialty service areas including orthopedics, neuroscience and athletic medicine. Dimond was later promoted to vice president, ambulatory services, for Henry Ford Hospital and Medical Group where she was responsible for overall campus operations of specialty and primary care clinics — an area that included 1,500 faculty physicians and support staff, and generated 500,000 ambulatory visits and $400 million annual net revenue.

Dimond was promoted to senior vice president and COO of Henry Ford Bi- County Hospital in Warren, Michigan in 2005, and later became executive vice president and COO of Henry Ford Macomb Hospitals – Warren Campus, a 203-bed acute care community hospital with osteopathic graduate medical education programs.

Dimond has also served as vice president of patient care for Toledo, Ohio- based ProMedica Health System’s Toledo Hospital, a 700-bed hospital with ambulatory clinics, and as assistant dean of finance and administration at Michigan State University’s College of Human Medicine and Physician Plan.

Dimond earned a bachelor’s degree in Social Work from St. Mary’s College, a master’s degree in Social Work from Boston College and a master’s degree in Public Administration from the University of Michigan.

She continues to hold academic privileges at Michigan State University’s School of Medicine and School of Social Work, sits on the boards of Focus Macomb and the Macomb Chamber of Commerce, and is a member of the Macomb Chamber of Commerce Membership & Benefits Committee. She is currently pursuing a Ph.D. at Michigan State University.

McLaren Medical Management, Inc. (MMMI), a wholly-owned subsidiary of McLaren Health Care, manages the corporate ambulatory services network consisting of more than 120 primary and specialty physicians, McLaren Community Medical Centers, McLaren OB/GYN Centers, minor emergency clinics, occupational health centers and freestanding imaging facilities located throughout mid- and southeast Michigan. For the past three years, MMMI’s community medical centers have earned the Governor’s Award of Excellence for Patient Care Standards in Preventative Medicine.

Recognized by Verispan as one of the top Integrated Health Networks in the nation, McLaren Health Care includes more than 150 locations, 15,000 employees and nearly 3,600 physicians. It includes eight regional hospitals: McLaren Regional Medical Center in Flint; Lapeer Regional Medical Center; Ingham Regional Medical Center and Ingham Regional Orthopedic Hospital in Lansing; Bay Regional Medical Center and Bay Special Care Hospital in Bay City; Mount Clemens Regional Medical Center in Mt. Clemens and POH Regional Medical Center in Pontiac. Visiting Nurse Services of Michigan, an award winning home health provider, and McLaren Health Plan, a top rated commercial and Medicaid HMO are also a part of the system.

McLaren Health Care

CONTACT: Kevin Tompkins of McLaren Health Care, +1-810-342-1173

Pre-Chewing Food Can Transmit HIV

The Centers for Disease Control (CDC) reported for the first time that mothers with the AIDS virus could transmit it to their infants through pre-chewed food.

The practice is seen typically in developing countries, and officials believe this type of transmission is rare in the United States where such behavior is considered unusual.  In some countries, mothers pre-chew infant food because they have no access to baby food or are without other ways of pulverizing food for infants who haven’t yet grown teeth.

During a presentation at this year’s Conference on Retroviruses and Opportunistic Infections in Boston, government scientists reported three such cases in the U.S. from 1993-2004.

“But even one case is too many,” the CDC’s Dr. Ken Dominguez, who helped investigate the U.S. cases, told AP.

The CDC said that they believed all of the transmissions were carried through blood, and not saliva, since in at least two of the cases the mothers had either gum sores or bleeding gums.

Although more study is needed, government health officials are asking parents and caregivers with HIV not to pre-chew infants’ food, and are educating doctors about this kind of transmission.

The first U.S. case occurred in Miami, where a 15-month-old African-American boy was diagnosed in 1993.  His great-aunt was infected with HIV and pre-chewed food for the boy when he was between the ages of 9 months and 14 months.

The second case involved a 3-year-old Caribbean-American boy, also in Miami. He was diagnosed in 1995, after his HIV-infected mother had pre-chewed his food.

After seeing the two cases, doctors suspected, but were not yet certain, of a connection between pre-chewing food and HIV transmission.  

Their suspicions were confirmed in 2004, when a third case, a 9-month-old African-American girl in Memphis, was diagnosed with HIV. The mother had been pre-chewing the girl’s food for approximately 5 months.

Authorities said all three children were infected with HIV during a time they would have been teething and had inflamed gums.  Investigators suspect that both caregiver and child must have wounds in their mouths for the virus to pass from one bloodstream to another.

Prior studies have shown a link between pre-chewing and the spread of other infections including Helicobacter pylori, a bacteria that causes stomach ailments, and streptococcal pharyngitis, which triggers sore throat.  However, CDC officials told AP the research is still preliminary and needs to be confirmed.  

Some health officials are wary of any broad scale effort to curb or eliminate pre-chewing, saying it could be nutritionally harmful.  

Kimberly Hagen at the Emory Center for AIDS Research in Atlanta told AP, “This would really take a lot of thinking before you could say, ‘We’ve had three cases in 11 years, so you have to stop pre-chewing your child’s food.'”

On the Net:

Centers for Disease Control

Additional Information about this year’s Conference on Retroviruses and Opportunistic Infections can be viewed at
http://www.retroconference.org/2008/

Chronic Pain Can Damage Brain

People who suffer chronic pain have constant brain activity in areas of the brain that would normally be at rest, according to a new study at Northwestern University’s Feinberg School of Medicine. 

The study suggests chronic pain changes the way information is processed in the brain, and the findings could explain why those who experience long-term pain frequently suffer other symptoms such as anxiety, depression, sleep disorders, and difficulty making decisions.

During the study, researchers used functional magnetic resonance imaging (fMRI) to scan the brains of 15 people with chronic low back pain and 15 pain-free volunteers while both groups were tracking a moving bar on a computer screen.  Although the pain sufferers performed the task well, when researchers measured areas of the brain activated, differences emerged.

In the healthy brains all regions existed in a state of equilibrium — when one region was active, the others quieted down.  But in those with chronic pain, a front region of the cortex mostly associated with emotion “never shuts up,” said Dante Chialvo, the study’s lead author and associate research professor of physiology at the Feinberg School. The region was stuck on full throttle, wearing out neurons and altering their connections to each other.

“The areas that are affected fail to deactivate when they should,” Chialvo said.

“Where we were surprised is the difference in how much brain they used to do the task compared with the healthy group. It was 50 times larger,” Chialvo told Reuters.

This is the first demonstration of brain disturbances in chronic pain patients not directly related to the sensation of pain.   

When certain parts of the cortex were activated in the pain-free group, some others were deactivated, maintaining a cooperative equilibrium between the regions. This equilibrium is known as the resting state network of the brain. In the chronic pain group, however, one of the nodes of this network did not quiet down as it did in the pain-free subjects.  Instead, a front region of the cortex mostly associated with emotion is constantly active, disrupting the normal equilibrium.

The researchers said disruptions in this default network could explain why pain patients have problems with attention, sleep disturbances and even depression.

This constant firing of neurons in these regions of the brain could cause permanent damage, Chialvo said. “We know when neurons fire too much they may change their connections with other neurons or even die because they can’t sustain high activity for so long,” he explained.  

‘If you are a chronic pain patient, you have pain 24 hours a day, seven days a week, every minute of your life,” Chialvo said. “That permanent perception of pain in your brain makes these areas in your brain continuously active. This continuous dysfunction in the equilibrium of the brain can change the wiring forever and could hurt the brain.”

Chialvo hypothesized the subsequent changes in wiring  “may make it harder for you to make a decision or be in a good mood to get up in the morning. It could be that pain produces depression and the other reported abnormalities because it disturbs the balance of the brain as a whole.”  

“These findings suggest that the brain of a chronic pain patient is not simply a healthy brain processing pain information but rather it is altered by the persistent pain in a manner reminiscent of other neurological conditions associated with cognitive impairments,” the researchers wrote in their report.

Chialvo said the study’s findings show it is essential to research new approaches to treat patients not just to control their pain but also to evaluate and prevent the dysfunction that may be generated in the brain by the chronic pain.

The study was supported by the National Institute of Neurological Disorders and Stroke, and is published in the Feb. 6 issue of The Journal of Neuroscience.

On the Net:

Northwestern University

Video: View evidence of brain disturbance in a chronic pain patient

Audio: Dante Chialvo, associate research professor of physiology at Northwestern University’s Feinberg School of Medicine, discusses the study’s possible implications on clinical treatments

Turning Crystals Into Conductors

Squeeze a crystal of manganese oxide hard enough, and it changes from an electrical insulator to a conductive metal. In a report published online this week by the journal Nature Materials, researchers use computational modeling to show why this happens.

The results represent an advance in computer modeling of these materials and could shed light on the behavior of similar minerals deep in the Earth, said Warren Pickett, professor of physics at UC Davis and an author on the study.

Manganese oxide is magnetic but does not conduct electricity under normal conditions because of strong interactions between the electrons surrounding atoms in the crystal, Pickett said. But under pressures of about a million atmospheres (one megabar), manganese oxide transitions to a metallic state.

Pickett and colleagues Richard Scalettar at UC Davis, Jan Kunes at the University of Augsburg, Germany, Alexey Lukoyanov at the Ural State Technical University, Russia, and Vladimir Anisimov at the Institute of Metal Physics in Yekaterinburg, Russia, built and ran computational models of manganese oxide.

Using the model, the researchers were able to test different explanations for the transition and identify the microscopic mechanism responsible. They found that when the atoms are forced together under high pressure, the magnetic properties of the manganese atoms become unstable and collapse, freeing the electrons to move through the crystal.

Manganese oxide has similar properties to iron oxide and silicates (silicon oxides), which make up a major part of the Earth’s crust and mantle. Understanding how these materials behave under enormous pressures deep underground could help geologists understand the Earth’s interior, Pickett said.

The paper was published Feb. 3 in the online edition of the journal Nature Materials.

On the Net:

University of California – Davis

INSIDERS: Trustees’ Dual Interests: Several on North Shore-LIJ Board Also Supply Services, Hold Leases

By Elizabeth Moore, Newsday, Melville, N.Y.

Feb. 6–The vice chairman of the North Shore-Long Island Jewish Health System may be its biggest landlord, but other trustees have companies that also have done business with the health system over the years, records show.

Each year, the system’s tax returns, which by law are available to the public on request, list a dozen or more trustees who also have business relationships with the health system.

The list has included senior executives of the health system’s investment bankers, as well as its lawyers, insurers, employee benefit brokers and the paying agent for its bonds.

It has included Dr. Peter Walker, medical director at North Shore University Hospital, whose private company has a lucrative exclusive contract to provide anesthesia at 11 system hospitals; Morton Bass, whose wife, Sandra Atlas Bass, is a major donor and also rents a building to the health system; and John King, whose Holtsville food-service company won a five-year exclusive contract with the system while he served on the board’s executive committee.

The health system tries to avoid doing business with companies in which its trustees have an interest, according to Ralph Nappi, president of the North Shore-Long Island Jewish Health System Foundation, which works with trustees to raise funds for the system.

In a Jan. 28 memo to trustees, Nappi criticized as “unfair” a Newsday story that day that detailed vice chairman William Mack’s ties to a former defense plant renting space to the health system. Nappi did not respond to requests for an interview.

Common interests

William McGinly, president of the Association for Healthcare Philanthropy, based in Falls Church, Va., said it’s often a challenge for wealthy board members at community-based nonprofits to avoid doing business with the organizations they serve — and it is common for those doing business with a nonprofit to want to give their time and money to support it.

So the mere fact that nonprofit board members have a contract should not be considered a sign they are using their inside track to help themselves, McGinly said. “Ninety-nine-point-nine percent of people who have a conflict of interest — as long as it’s stated — they are not going to benefit from serving on a board,” he said.

The key, McGinly said, is full disclosure. “We need sunshine on these issues, and we need transparency,” he said.

Among the relationships reported to the IRS are:

Walker, the health system’s salaried vice president for anesthesia services, is the founder, longtime chairman and partner in a private, for-profit company that provides anesthesia services at 10 of North Shore’s 15 hospitals and an affiliate.

Walker started North American Partners in Anaesthesia at North Shore in 1986, and the 11 health system hospitals account for most of the 19 entities NAPA serves. The company says it generates $500 million in annual billings.

Walker did not respond to a request for comment last week, but health system spokesman Terry Lynam said the exclusive contract with the Harvard-trained physician’s highly regarded practice has assured the system of reliable access to top-quality care. Walker was asked to join the board in 2003, in recognition of his expertise, Lynam said.

Holtsville businessman John King, a former chairman of Hospice Care Network, was added to the North Shore-LIJ board in 1999, and the following year the health system’s tax return reported that J. Kings Food Service Professionals was supplying perishable food to hospitals in the system.

King told the Long Island Business News in a 2006 interview that he came to see “hospitals and the thousands of people they feed each day as a potentially massive customer base,” and so “wrote in a three-year strategy aimed at growing health-care customers from 5 percent to about 20 percent of J. King’s total business.”

King designated himself as his company’s chief customer officer for health care. “You knock on the right doors,” the paper quoted him as saying.

In February 2004, while King was serving on the executive committee, North Shore selected his company over a rival’s for a five-year, $25-million contract to become the primary food supplier to the health system. He resigned from the board a year later.

King did not return a call last week for comment. Lynam said King’s food service contract was approved after competitive bidding, and that he disclosed his ties and recused himself from the vote. King was replaced as the system’s food supplier after it rebid the contract late last year, but retains a contract to provide food in emergencies, Lynam said. King also was hired to design, build and equip three cafes in health system hospitals.

Trustees Jeffrey and Lyn Jurick were the longtime principals of Fala Direct Marketing, based in Melville, and starting in 2002, the year Lyn Jurick became a member of the health system board’s executive committee, the system’s tax return noted that Fala provided direct-mailing services to the system.

Lyn Jurick, founder of the Ronald McDonald House of Long Island, did not return a message left at her home in Boca Raton, Fla.; Lynam said Fala has done little business with the health system in recent years.

Longtime trustee Morton Bass is married to Sandra Atlas Bass, a North Shore benefactor whose name graces the main Manhasset campus of the health system — and whose limited-liability corporation owns a building collecting rent from North Shore.

Lynam said Sandra Atlas Bass’ 60,000-square-foot building at 1554 Northern Blvd., the onetime Manhasset Hospital building inherited from her father, Sol Atlas, was leased to Long Island Jewish, with a new 35-year lease term starting in 1988, while she was a trustee at then-competitor North Shore University Hospital. Only after the 1997 health system merger did she and her husband become landlords to their own health system board. Lynam declined to say what it pays to rent the building.

Among longtime trustees were Richard Don Monti and Joseph Monti, executives of the Crest Hollow Country Club in Woodbury, which has catered as many as 10 functions a year for the system.

Joseph Monti was also one of the health system’s leading benefactors before he died in September, establishing the Don Monti Memorial Research Foundation in memory of his late son, which raised more than $30 million for cancer research. Richard Don Monti did not return a call.

Holding the line

For those already doing business with a hospital, McGinly said it is often natural to become supporters as well, which poses a different ethical problem for a hospital.

“There is a line,” McGinly said. “We don’t believe it’s fair to put undue pressure on someone to make a contribution because they are doing business with the hospital, but it’s perfectly acceptable for that person to support the hospital, so you may have a linen service that may buy a table at a gala.”

There are legitimate reasons for business people to donate money and serve on boards without seeking a penny of direct commercial benefit, McGinly said.

“What is the benefit to them? … They are faces in the paper, making a difference,” he said. “If you’re doing good things and you sell cars in my community, maybe I’ll consider your dealership.”

OF INTEREST

North Shore-Long Island Jewish Health System, which comprises 15 hospitals, is the third-largest, nonprofit, secular health care system

—–

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Copyright (c) 2008, Newsday, Melville, N.Y.

Distributed by McClatchy-Tribune Information Services.

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Effectiveness of Solution-Focused Brief Therapy in a School Setting

By Franklin, Cynthia Moore, Kelly; Hopson, Laura

This study evaluated the effectiveness of solution-focused brief therapy with children who have classroom-related behavior problems within a school setting. Five to seven sessions of solution-focused brief therapy services were provided to 67 children, identified by school faculty and staff as needing assistance in solving behavior problems. Teacher inservice training and three to four consultation meetings were also provided. Externalizing and Internalizing scores from both the Youth Self-Report and Teacher Report Forms of the Child Behavior Checklist were used as outcome measures. Outcomes were evaluated by using a pretest/posttest follow-up design with a comparison group. Effect sizes and improved percentage scores were calculated. Findings provide support that solution-focused brief therapy was effective in improving internalizing and externalizing behavior problems. KEY WORDS: brief therapy; effectiveness; intervention; middle school; solution-focused

School social workers are increasingly called upon to demonstrate the effectiveness of their interventions. Reliably improving student outcomes requires the use of interventions that have research support and evaluation of interventions on an ongoing basis in school settings (Franklin & Hopson, 2004).This article describes a study that evaluated the effectiveness of solution-focused brief therapy (SFBT) with middle school students.

SFBT, an approach that first originated at the Family Therapy Center in Milwaukee, Wisconsin,by its cofounders Steve DeShazer (DeShazer, 1985, 1988, 1991, 1994; DeShazer et al., 1986) and Insoo Kim Berg (Berg, 1994; Berg & DeJong, 1996; Berg & Miller, 1992) and colleagues (for example, Miller, Hubble, & Duncan, 1996; Walter & Peller, 1992), has been successfully applied to change child and adolescent behavior problems. Using a multiple baseline design, Conoley et al. (2003) found, for example, that three families experienced positive outcomes for children’s aggressive and oppositional behavior after four or five sessions of SFBT.

Only a handful of studies have explored the effectiveness of SFBT in school settings (Franklin, Biever, Moore, Clemons, & Scamardo, 2001; Geil, 1998; LaFountain & Gardner, 1996; Littrell, Malia, & Vanderwood, 1995). However, SFBT is an approach that has demonstrated promising outcomes in these studies (Franklin & Streeter, 2003; Krai, 1995; Metcalf, 2002; Murphy, 1997; Sklare, 1997;Webb, 1999). Because SFBT takes a social construction approach and encourages engaging teachers, parents, and others involved with the child in treatment, it is consistent with the intervention characteristics that are successful in school settings (Roans & Hoagwood, 2000). Both Metcalf (2002) and Murphy (1997) used clinical case studies to demonstrate that SFBT is a useful approach in schools (Franklin et al.,2001;LaFountain & Garner, 1996;Littrell et al., 1995; Newsome, 2004).

Research on SFBT in school settings demonstrates promising outcomes in increasing self-esteem and positive attitudes. Littrell and associates (1995) evaluated SFBT in comparison with two other approaches. High school students (N =61) were randomly assigned to one of three groups: a problem-focused brief counseling approach with a task, a problemfocused brief counseling approach without a task, and a solution-focused brief counseling approach with a task. The results indicate that all students experienced positive outcomes in goal attainment and alleviating concerns and in decreasing the intensity of undesired feelings. However, the three brief- counseling approaches did not differ in their effectiveness.

In more quasi-experimental designs, several researchers found statistically significant positive outcomes (LaFountain & Garner, 1996; Newsome, 2004; Springer, Lynch, & Rubin, 2000). LaFountain and Garner (1996) investigated the impact of solution-focused groups on schoolage children (N- 311) and practitioners. They found significant between-group differences on three subscales of the Index of Personality Characteristics (Nonacademic, Perception, and Acting In), suggesting that the experimental group had higher self- esteem, more positive attitudes and feelings about themselves, and more appropriate ways of coping with emotions. Springer et al. (2000) determined that children receiving SFBT made significant pre- and posttreatment improvement on the Hare Self-Esteem Scale, whereas scores for those receiving no treatment were unchanged; the effect size of .57 was moderate.

SFBT has also been associated with positive academic and behavioral outcomes. Students in a quasi-experimental, pre- and posttest design with SFBT (N = 6) were found to have increased their posttest grade point average (GPA) scores if in the SFBT group compared with those in the comparison group when using pre-GPA scores as the covariate (Newsome, 2004). School attendance, however, showed no difference between the two groups. Franklin and associates (2001) in a single-case design study with fifth and sixth graders found that five out of seven (71 percent) of the cases of special education students with classroom behavior problems improved per the teacher’s reports. Franklin and Streeter (2004) compared attitudes of students attending a school in which all staff were trained in SFBT techniques with attitudes of similar students attending a more traditional high school. Student responses to the School Success Profile indicated that students attending the solution-focused school rated school satisfaction and teacher support as assets, whereas the comparison group rated them as risk factors. The solution-focused group also earned significantly more credits than did students in the comparison group.

Although these studies show promise for the solution-focused interventions in schools, replication of effectiveness studies that use larger sample sizes and improved research designs is needed to further substantiate these findings and to build an evidenced-based SFBT therapy for education. The majority of the studies were quasi- experimental designs that did not use random assignment because schools often do not permit assigning students randomly to treatment conditions. In addition, it may be important to combine individual and group-level intervention with organizational interventions to achieve positive outcomes for students to strengthen treatment outcomes. Franklin and associates (2001) suggested from the results of their single-case study that SFBT intervention might be more effective in a school if the teachers and staffare trained in the model. These authors stated their belief that in order to maximize the model’s effectiveness in a school setting, the entire school culture, norms, and practices would need to change and follow the strengths and empowerment orientation of the solution-focused model.This is consistent with research demonstrating that multicomponent interventions that work to change the school climate as well as teacher and parent interactions with the child are useful in school settings (Rones & Hoagwood, 2000).

PURPOSE OF THE STUDY

The purpose of this study is to build on the growing body of quasi-experimental research on the effectiveness of SFBT in school settings.This study focuses on the effectiveness of an SFBT approach with middle school children identified as having school-related behavior problems. Previous studies found that SFBT resulted in positive behavior changes for students and was promising as an intervention with students experiencing academic and behavior difficulties (Franklin & Streeter, 2003; Krai, 1995; Metcalf, 2002; Murphy, 1997;Sklare, 1997;Webb, 1999). This study builds on this previous research by investigating the impact of a multicomponent SFBT approach with behavior problems in students.

METHOD

Participants

Sixty-seven students who exhibited schoolrelated behavior problems from the Schertz Cibolo Universal Unified Independent School Districts were recruited for participation in the study. Students were enrolled in the Dobie Intermediate School and the Wilder Intermediate School and ranged in age from 10 to 12 years (fifth and sixth graders). Principals and teachers purposively selected students in each school who had received more than one behavioral referral from a classroom teacher. The behavioral referral is an incident report that requires disciplinary action and referral for pupil services. Common reasons for behavioral referrals include inattentiveness, tardiness, school phobia, difficulty completing tasks, and social problems that affect school performance.

Thirty children were in the experimental group and 29 were in the comparison group (see Table 1 for demographic characteristics of the sample).There were 15 boys and 15 girls in the experimental group and 25 boys and four girls in the comparison group. A chi-square analysis indicated a significant difference between groups on gender, chi^sup 2^(1, N= 59) 8.85, p = .003. The groups did not differ significantly in age, ethnicity, grades in school, or participation in special education.

With alpha = .05 there were no significant differences between the experimental and comparison groups on the pretest for the children’s Externalizing or Internalizing scores as reported by both the Teacher Report Form (TRF) and the Youth Self-Report (YSR) of the Child Behavior Checklist (CBCL) (Achenbach, 1991;Achenbach & Edelbrock, 1983,1986) (see Table 2). Research Design

Research participants in the SFBT outcome study were evaluated with a pretest-posttest follow-up design with a comparison group. Children who attended Dobie Intermediate School were assigned to the experimental group, and children who attended Wilder Intermediate School comprised the comparison group. A quasi-experimental design in which experimental and comparison conditions were located at two different schools was selected over a traditional randomized experimental design to reduce the possibility of comparison group contamination through interaction between children in the two conditions. Because children are in several classes a day, there was also the possibility that a teacher of a student in the comparison group would also be a teacher of a student in the experimental group, leaving the study open to treatment contamination.

Procedures

Two schools (Dobie Intermediate School and Wilder Intermediate School) were selected to participate in the study, located in the Schertz Cibolo Universal Unified Independent School District in Cibolo,Texas. Cibolo is a rural community now transitioning to a suburban, bedroom community of San Antonio. Dobie and Wilder were selected as schools for this study because of their similar student populations.

Dobie Intermediate School was selected to receive the treatment because of greater availability of space for conducting sessions, and Wilder Intermediate School acted as the comparison condition. The principals, classroom teachers, and practitioners from Dobie and Wilder generated a list of eligible students for the study. Each student had three teachers. The two teachers who saw the child more frequently would fill out the CBCL.

The study included four practitioners who provided SFBT for this study. All four were masters-level practitioners with several years of post-master’s training, including extensive experience with children and families. Three of the four practitioners were concurrently enrolled as doctoral students during the study. The two principal investigators and one of the practitioners received training by Insoo Kim Berg and Steve DeShazer, co-developers of Brief Solution-Focused Therapy, at the Brief Family Therapy Center in Milwaukee where they attended a four-day advanced training.The other practitioners attended a one-day training by Insoo Kim Berg at the Texas Association for Marriage and Family Therapist Conference. All practitioners were clinically supervised by the principal investigators on a biweekly basis.

To evaluate practitioners’ adherence to solution-focused techniques and to ensure treatment integrity, the principal investigators videotaped and reviewed two sessions for each practitioner. The criteria for review were that each session must contain the following: the “miracle question,” exception finding questions, scaling questions, coping and motivational questions, a break, and a formulated task. All reviewed tapes met these requirements.

Pretesting was conducted after consents were obtained from the parents. Children completed the YSR, and teachers completed the TRF of the CBCL. Students were given the pretest YSR by the researcher and research assistant in small group administration of about four to five children. Makeup administrations were given until all children completed the test. As Achenbach (1991) recommended, students needing help received assistance with reading and interpretation of questions. Teachers were provided with the instruments in a folder with a due date.The folders with completed tests were collected several days after dissemination.

After the teacher training was completed and each student in the experimental group participated in an average of five sessions, students were given a posttest, administered in a similar manner as the pretest. Finally, a one-month follow-up test was administered.The students in the comparison group were given pretests, posttests, and a follow-up test without treatment. Incentives included movie passes for students who completed the follow-up and for teachers in the comparison group to compensate for their time. A longer follow-up was prohibited because of the end of the school year. The practitioners were prepared to give follow-up resources to any child who appeared to need further intervention. One child was given a referral because of a concern over possible alcohol abuse, but no other children appeared to need additional resources.

To assess comparability of treatment and comparison groups, we collected, in addition to the CBCL information, demographic and biopsychosocial data through interviews over the phone or in person with the parents.

Measures

Two standardized measures were used to evaluate outcomes: the Internalizing score and the Externalizing score of the YSR and TRF versions of the CBCL. The Internalizing score is defined as the sum of scores of the problem items of the Withdrawal, Somatic Complaints, and Anxious/ Depressed scales.The Withdrawal scale measures traits such as perceiving oneself or perceiving the student (depending on who is answering the questions) as shy, underactive, and sad. The Somatic Complaints scale includes behaviors such as having symptoms of headaches, stomachaches, and other physical complaints. The Anxious/Depressed scale includes affective states like feeling lonely, worthless, nervous, fearful and guilty, in addition to behaviors like self-injurious behavior, frequent crying, suicidal thoughts, and worrying (Achenbach & Edelbrock, 1986).

The Externalizing score is defined as the sum of scores on the problem items of the Delinquent and Aggressive Behavior scales. Delinquent behavior is measured by questions such as frequency of lying and cheating, running away, swearing, truancy, and involvement with alcohol and drugs. Aggressive behavior is evaluated through questions about arguing, being mean to others, being destructive, having a bad temper, and fighting (Achenbach Sc Edelbrock, 1986).

The CBCL was chosen for a measure of school-related behavior because it has wellestablished reliability and validity for use in schools and is considered one of the best instruments for measuring child behavioral disorders (Achenbach & Edelbrock, 1986; Husain & Cantwell, 1991). Achenbach and Edelbrock (1986) reported high reliability in their test manual. For the TRF, the one-week median test-retest Pearson correlation was .90, with negligible changes in mean scale scores. In addition, the TRF has high-content, construct, and criterion validity. The content validity of the TRF was evaluated in terms of whether its items were related to concerns about pupils’need for special help for behavioral and social- emotional problems.

Achenbach (1991) reported that for raw scores on theYSR competence scales, the mean sevenday test-retest reliability was r = .68 for 11- to 14-year-olds and r = .82 for 15- to 18-year-olds. Content validity is supported by the ability of most YSR items to discriminate significantly between demographically matched referred and nonreferred children. Criterion-related validity is supported by the ability of theYSR’s quantitative scale scores to discriminate between referred youths after demographic effects were partialled out.

Intervention

The intervention included a combination of individual sessions of solution-focused brief therapy with students plus teacher training, consultations, and collaborative meetings. see Table 3 for a description of the treatment components, and see Table 4 for the elements of the individual sessions. Students received five to seven individual SFBT sessions lasting 30 to 45 minutes each week (except in cases of illness or absence) with the practitioner. A treatment protocol was followed as a guide for implementing the SFBT model with children in the school (Franklin & Biever, 1996).

The methods specified in the treatment protocol are the ones followed most closely by Berg and DeShazer (Berg, 1994; DeShazer, 1985; 1988). The use of at least three main process sequences (the miracle question, scaling questions, and giving client compliments) in a session is necessary for an intervention to be considered solution-focused (personal communication with LK. Berg and S. DeShazer, Brief Family Therapy Center, Milwaukee, WI, January 2,1997).The miracle question provides a way of helping clients envision solutions to a problem. The practitioners ask something like, “Let’s suppose that overnight a miracle happened and the problem you are having with your teacher disappeared. But, you were sleeping and did not know that it happened. When you came to school the next day, what would be the first thing that you would notice?” Scaling questions ask clients to rate their problems on a scale of 1 to 10 and project their future progress (see Franklin & Moore, 1999, for a more detailed explanation of questioning techniques associated with SFBT). Every session followed the same process and used the same questioning techniques. These types of questions aim to help clients find strategies for improving problem behaviors by building on pre-existing strengths.

Teachers completed a four hour in-service training that educated the faculty, staff, and administration about the study, components of SFBT, and techniques to use in the school setting. Practitioners also spoke with teachers about the progress of the cases and provided teacher consultations for the cases. Each practitioner met with each participant’s teacher three to four times during the study.These meetings included an initial assessment meeting, formal sit-down meetings, casual discussions, and teacher referral and student information worksheets. Most teacher consultations were brief, lasting only 10 to 20 minutes a week (some teachers received more consultation, determined by their commitment and as required by the cases). Teacher referral forms were used to maintain communication with the practitioners when meetings were not possible.The form asked the teacher to list specific behaviors the child did well during the week.The child also completed a form that indicated helpful teacher behavior perceived by the student. In addition, one or two formal collaborative meetings were held with the teacher, practitioner, and student together to discuss successful behavior of both student and teacher. Data Analysis

In the interest of clinical relevance, all analyses were conducted with only those children who scored above the clinical cutoff point (t = 60, with scores of 60 to 63 considered borderline) on the pretest of either the Internalizing or Externalizing scales of theTRF or theYSR. Scores above the clinical cutoffindicate that the child’s behaviors fall into the problem range rather than the normal range. ESs and improved percentage scores were also calculated to corroborate the magnitude of changes between pretest and posttest scores. Multivariate analyses of variance (MANOVAs) with repeated measures (pretest, posttest, and follow-up) were conducted to assess the effect of a solution-focused approach on the children’s Internalizing and Externalizing scores as reported by the YSR and on the externalizing and internalizing behavior of children as reported by the teachers on the TRF of the CBCL.

RESULTS

The treatment and comparison groups were tested for equivalency on the pretest measures by using independent t tests. Because each group consisted of only those students who scored in the clinical range on the particular scale under comparison (clinical range: t >/ = 60), each sample size was different for each measure. For example, only students who scored in the clinical range on the scale measuring teacher reports of internalizing behaviors were included in the analysis for that scale. Because more students scored in the clinical range on the TRF-Externalizing than on the TRF- Internalizing, the analysis of the externalizing behaviors measure had a larger sample. It is important to note that the sample size for each scale does not add up to the total sample size because it is possible for a child to score in the clinical range on more than one scale. These children were included in more than one analysis.

Attrition

During the study one practitioner needed to take a leave of absence. The children she served received the intervention but not in enough time to be included in the study; therefore, four children in the experimental group needed to be dropped from the final data analysis. In addition, two children from the comparison group moved away in the middle of the study, resulting in two scores from the comparison group being dropped from the final data analysis.

Teacher Reports

Most children had at least two teachers who completed the TRF. The only exception was when a child was in only one class and therefore had only one teacher.The mean of the two scores comprised the teacher score for each child. see Table 5 for a summary of the MANOVA results of the externalizing and internalizing symptoms from the TRFs. Analysis of the externalizing symptoms of the TRF revealed significant differences between groups over time [F(2, 84) = 11.20, p

Analysis of the internalizing symptoms of the TRF shows a significant difference between groups over time [F(2, 42) = 4.60, p

Children’s Reports

Analysis of the externalizing symptoms from the YSR shows a significant difference between groups over time [F(2, 54) = 7.80, p

There were no significant group differences on Internalizing scores over time [F(2, 54) = 0.22, p = .90]. Scores for both groups improved to fall in the normal range. The patterns of change in self- report of internalizing behavior was not significantly different for the two groups, suggesting that the intervention had little impact on the pattern of change (ES = 0.08). Both groups started out with similar pretest scores and dropped at an equal rate. see Table 6 for a summary of the results of the Internalizing scores from the YSRs.

DISCUSSION

The findings of this study provide continued support that SFBT was effective in reducing classroom-related behavioral problems (Franklin et al., 2001; LaFountain & Garner, 1996). Students who participated in the experimental group showed significant improvement over students in the comparison group on teacher’s report of internalizing behavior, teacher’s report of externalizing behavior, and student’s report of externalizing behavior. The scores on these assessment measures moved from scores in the clinically significant or problem ranges to the normal range. The intervention failed to show significant effects on the children’s report of internalizing behavior because scores in both groups improved. All children included in the analyses scored above the clinical cutoff point at pretest. With the exception of the children’s report of internalizing behavior, only children in the experimental group scored below the clinical level at posttest and remained subclinical at follow-up.The comparison group maintained scores above the clinical cutoff point up through follow-up. All ESs, except those for the children’s report of internalizing behavior were large, falling between 8 percent to 16 percent variance of the dependent variable (Cohen, 1977; Rubin & Babbie, 1997).

Overall there was a high level of agreement between the adult and child observers of change. One interesting finding was the improvement in externalizing behaviors for children in the SFBT group only, whereas children in both groups improved in their reports of internalizing behaviors. Some extraneous factor may have caused students in both groups to perceive a change in their internalizing behaviors. In addition, students in the comparison group perceived a change in their internalizing behaviors, whereas their teachers did not. The discrepancy between the teachers’ perspectives and the students’ self-perceptions may indicate a need for teachers to re-evaluate the way they perceive and address some of the children’s more internal processing.

More research is needed to investigate the types of behavior for which this intervention is most beneficial. It would also be helpful to examine the components of the intervention to determine which are most responsible for positive outcomes. For example, it would be helpful to know whether the teacher training and consultation components are important for the effectiveness of the intervention or whether the individual sessions would be sufficient for positive outcomes. Future research should also examine factors that could moderate the effectiveness of the intervention, such as the relationship between participating students and teachers or the school climate.

Including the teachers in the training allowed for more cooperative intervention strategies like consultation, both formal and informal.Teacher consultation was a mandatory component of the treatment, allowing the teachers to have “coaching” on the model over time.This served two purposes. One was that the teachers were complimented and shown that they were making changes with the aim of helping them feel successful in their roles. Another was that teachers were able to collaborate with the practitioners on targeted behavioral changes and techniques for interventions.What is more important is that training teachers and administrative staff to use SFBT consistently with students provides a more cohesive approach to student-teacher interactions. Although it is possible that compliments to teachers may bias their ratings of students, collaborating with teachers and providing compliments are an important component in the SFBT intervention. By encouraging teachers to become active change agents, positive results may continue after official treatment has stopped between the child and the practitioner. It will be helpful for future research to determine whether SFBT has long-term effects on both teachers and students (for example, six-month, one-year, two-year, and five-year follow-ups).

It is also expected that an even greater effect might occur if greater emphasis is placed on transforming educational systems into solution-focused cultures (Franklin & Streeter, 2004).This would likely represent a shift in the educational paradigm for many current school systems. Study Limitations

A limitation of the small group administration of measures was that the children may not have felt completely comfortable being honest in their responses. As a result of lack of time and resources, however, group administration was necessary. In addition, because lack of randomization and possible unequal groups was a factor, threats to internal validity are possible and the results must be interpreted with caution.

Because of the limited number of girls in the study, gender may be a confounding variable. However, the t scores for the CBCL were normed for gender and age (Achenbach, 1991; Achenbach & Edelbrock, 1986), so the scores of the YSR and TRF should be comparable. In addition, the Externalizing scores remained the same even after the girls were dropped from the analysis. However, when controlling for girls, the teachers’ reports of internalizing behavior were not retained. It is difficult to make a definitive conclusion about this finding because once the girls were dropped from the analysis, the number of total participants dropped (from N= 23 to N = 15), greatly reducing statistical power.

Implications for Social Work: Practice and Policy

This study, along with the growing body of literature in this area, has great implications for social workers. School social workers need interventions that work quickly. By demonstrating that with an average of five sessions of this intervention children can move from clinical to nonclinical ranges on the CBCL strongly supports the idea that with purposeful short-term intervention significant change can happen rapidly. This is vital information for overworked, underfunded practitioners.

Using the consultation model presented in this study, the practitioners are working with the teachers and administrators as “coaches.” This allows a great deal of the intervention to be performed by the teacher, the individual who has the most contact with the student and as such has the greatest chance of affecting classroom behavior. With increased attention devoted to collaboration in children’s services, an intervention whose purpose is to empower all individuals involved is highly valuable. In addition, by encouraging teachers to become active agents of change along with social workers, positive results can continue long after official treatment has ended between the child and the social worker.

Empowering teachers to effect change is important given the newest No Child Left Behind Act, whose stated purpose is to “close the achievement gap with accountability, flexibility, and choice, so that no child is left behind.” (No Child Left Behind Act, 2001, p. 1) Teachers need to have ways to address the needs of all of their students, especially those students whose behavioral problems are interfering with academic progress.The results of this study suggest that SFBT, combined with teacher training and consultation, may be one way to successfully address behavioral problems that could inhibit learning, particularly more externalizing acting out types of behaviors.

Conclusion

The results of this study add strength to the argument that school-based helping professionals might benefit from training in brief, strengths-based approaches like SFBT Sklare (1997) pointed out that most practitioners are trained in long-term therapies but are expected to abbreviate these therapies to fit into the reality of heavy caseloads. Perhaps by recognizing that school interventions that are short-term in nature are effective, future clinicians can receive training more congruent with the realities and demands of their jobs. By demonstrating that a mean of five SFBT sessions delivered in a school setting with teacher consultations can move children from clinical to nonclinical ranges on the CBCL, the SFBT intervention strongly supports the idea that purposeful short-term intervention can make a difference.

By encouraging teachers to become active change agents, positive results may continue after official treatment has stopped between the child and the practitioner.

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Franklin, O, & Biever.J. (1996). Treatment manual and research protocol for solution-focused therapy with learning challenged students in schools. Unpublished manuscript. University of Texas at Austin.

Franklin, C, & Hopson, L. (2004). Into the schools with evidence- based practices [Editorial]. Children & Schooh, 26, 67-70.

Franklin, C, & Moore, K. C. (1999). Solution-focused brief family therapy. In C. Franklin & C.Jordan (Eds.), Family practice: Brief systems methods for social work (pp. 105-142). Pacific Grove, CA: Brooks/Cole.

Franklin, C, & Streeter, C. L. (2003). Solution-focused accountability schools for the tiventy-first century: A training manual for Gonzalo Garza Independence High School. Austin,TX:The Hogg Foundation for Mental Health.

Franklin, C, BieverJ., Moore, K., Clemons, D, & Scamardo, M. (2001).The effectiveness of solutionfocused therapy with children in a school setting. Research on Social Work Practice, 11, 411-434.

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Cynthia Franklin, PhD, is associate professor, and Kelly Moore, PhD, is a graduate, School of Social Work, University of Texas at Austin, 1925 San Jacinto, Austin, Texas 78712; e-mail: [email protected]. Laura Hopson, PhD, is assistant professor, School of Social Welfare, University at Albany, State University of New York.

Accepted January 12, 2007

Copyright National Association of Social Workers, Incorporated Jan 2008

(c) 2008 Children & Schools. Provided by ProQuest Information and Learning. All rights Reserved.

Southwest Medical Associates Initiates New ‘My SMA Health Online’

Southwest Medical Associates (SMA), a wholly owned subsidiary of Sierra Health Services, Inc. (NYSE: SIE), announced the second phase in an industry-leading initiative to provide paperless, electronic access to medical information and services: “My SMA Health Online.”

“My SMA Health Online” improves the patient experience by giving SMA customers 24/7, touch-of-a-finger access to communications with their medical providers. Now SMA patients with e-mail accounts can:

Schedule, change or cancel primary care and pediatric doctor appointments

View their medical records and test results

Request prescription renewals from their physicians

Receive e-mail confirmations on appointments

Set up and use a new account in real time

Manage and update personal and account information

View outstanding payment balances

Authorize others to schedule appointments online on their behalf

Receive e-mail alerts and notifications regarding certain account activity.

In 2003, Sierra Health Services’ Southwest Medical Associates became one of the industry’s first to utilize technology to create a paperless physicians’ electronic prescribing system and allow online patient access to medical records. “My SMA Health Online” is the second phase of that initiative to make access to medical services and information better, faster and easier.

“Our adoption of e-prescribing has proven to be an excellent investment in improving patient satisfaction and the quality of care delivered at SMA,” said Jonathon Bunker, president, Sierra Health Services. “This new Web portal is our continued response to meeting the needs of our patients and to allow them greater control in and access to their medical care.”

Prior to the online system, patient call volume at SMA’s Call Center exceeded 150,000 calls per month. Additionally, an estimated 100,000 calls were managed at the clinic level. Calls and interactions ranged from simple provider appointments to requests for prescription refills and test results. Years of data on patient requests for information in the electronic medical records and patient management systems resulted in the plans for a Web-based, patient self-service system. The goal was to remove or reduce caller wait time and frustration in order to increase customer satisfaction by providing a convenient, automated alternative to telephone service for more routine requests.

Using additional input from focus groups and SMA physicians, Sierra Health Services’ information technology developers designed a Web site that is easy to understand and navigate even for new Internet users. The initial pilot was released in spring of 2007. To ensure consumers’ privacy and HIPAA compliance, the “My SMA Health Online” web portal was developed on HTTPS (Hypertext Transfer Protocol over Secure Socket Layer) standard, and will be subject to monthly internal and third-party intrusion detection scans. All data is secured behind a corporate firewall.

To date, over 11,000 patients have already established and used their accounts. “My SMA Health Online” users quickly exhibited a preference on the site — over 30,000 “hits” or visits have been made to the medical records link since the new system went live.

According to Dr. Craig Morrow, SMA Medical Director, he’s gotten positive feedback from his patients who have used “My SMA Health Online:””Patients who’ve used the system like the fact that it is so uncomplicated and easy to use. We’ve experienced a reduction in calls in our office, mainly because patients don’t have to wait to get their test results. This also reduces the time we usually spend with patients answering questions about their EKG or cholesterol count. They already know this when they come in for a follow-up appointment, so the dialogue is more focused.”

With the success of the first phase of “My SMA Health Online,” the information systems developers and healthcare providers are continuing rollout of the site’s capabilities. SMA Web users will soon be able to pay bills online; schedule appointments with specialists; access test and procedure preparations and precautions; check prior authorization and referral status; and receive annual exam e-mail reminders. A Spanish-language version of “My SMA Health Online” is also in development.

Sierra Health Services, Inc., based in Las Vegas, is a diversified healthcare services company that operates health maintenance organizations, indemnity insurers, preferred provider organizations, prescription drug plans and a multi-specialty medical group. Sierra’s subsidiaries serve over 860,000 people through health benefit plans for employers, government programs and individuals. Southwest Medical Associates is a wholly owned subsidiary of Sierra and operates 14 medical clinics throughout Las Vegas, including several urgent care centers and an outpatient surgery center. The clinics are staffed by approximately 250 physicians and physician extenders. For more information on Sierra Health Services and its subsidiaries, visit the Company’s website at www.sierrahealth.com.

Misonix Announces Distribution Agreement for New BoneScalpel(TM) Medical Device

Misonix, Inc. (Nasdaq: MSON), a developer of minimally invasive ultrasonic medical device technology for the ablation of cancer and other chronic health conditions, today announced that it has entered into a distribution agreement with Aesculap, Inc., a subsidiary of B. Braun, for the domestic distribution of the Misonix BoneScalpel™, a new Ultrasonic Osteotome (or bone cutting device) for use in orthopedic and neurological applications related to the spine and cranium. Misonix previously received Food and Drug Administration clearance to market its Ultrasonic Osteotome medical devices. The agreement provides Aesculap with the right to sell in the United States and includes minimum purchase requirements and the payment of a royalty on sales of disposables.

“We are excited about starting to sell the Bone Scalpel in this country. We are very pleased to have our friends at Aesculap as our partner in this effort,” said Michael A. McManus, Jr., President and Chief Executive Officer of Misonix. “We have been working with Aesculap for many years in the distribution of our Sonastar™ Ultrasonic Aspirator for neurosurgery and know them to be true professionals that understand the market, particularly for technologically enhanced medical devices. The opportunity to sell the Sonastar and the BoneScalpel together will create additional leverage in the market that will be a benefit to both companies.

“The BoneScalpel is a unique ultrasonic product combining very fine, precise cutting with a soft tissue sparing capability for extra safety in complex spine procedures. The BoneScalpel has been used in well over 100 procedures by more than 7 doctors. We are very pleased with the positive responses we have received from these surgeons. We look forward to working together with Aesculap in building the market for our latest commercialized medical device.

“We will continue our progress in developing strong international distribution partners for the BoneScalpel.”

“We are excited to broaden our relationship with Misonix. The new BoneScalpel technology is a great addition to our product portfolio and we look forward to growing our business with our long term partner,” said Chuck DiNardo, President of Aesculap, Inc.

Prior to the formation of a commercial distribution agreement, the Misonix BoneScalpel had undergone testing at prestigious medical facilities with favorable results. Most recently, Misonix engaged a mix of orthopedic and neurosurgical spine surgeons in teaching and community centers with the University of Pittsburgh Medical Center (UPMC), The Pennsylvania Hospital and Huntington Hospital, NY, to evaluate the device for use in laminectomies, a surgical procedure for treating spinal conditions, such as herniated discs and spinal stenosis, by removing or reshaping of spinal matter.

The principal investigator and surgeon for the UPMC and Pennsylvania Hospital project, Dr. William Welch, is a board certified neurosurgeon who holds the title of Chief of Neurological Surgery at The Pennsylvania Hospital. Dr. Welch concluded that the device is a clinically proficient product that addresses the specialized needs of modern-day surgery:

“I have utilized the device in over 50 patients in cervical, thoracic and lumbar applications. The Misonix BoneScalpel is an extremely precise, easily controllable handheld device that provides the surgeon with increased safety and accuracy during bone cutting operations. The major advantage of the device is the ability to cut bone while preserving underlying neural and non-bony structures. This greatly reduces the risk of dural laceration.

“Aside from the increased safety, the BoneScalpel allows me to create a thinner channel in lamina than is possible using standard devices. This allows the lamina to be removed as a single unit which speeds the laminectomy process and allows re-attachment of the lamina with small bone plating systems for an osteoplastic laminectomy. Accurate reshaping of bone is simplified with the BoneScalpel, as is selective partial removal of bone. The oscillating nature of the BoneScalpel reduces bleeding from the bone edges and efficiently eliminates soft-tissue bleeding.”

The principal investigator for Huntington Hospital, NY, Dr. Arnold Schwartz, is a board certified orthopedic surgeon specializing in scoliosis and spine surgery. His experience is equally positive:

“In performing bone surgery in proximity to the spinal cord one has to be very careful, and I always feel very skeptical towards using powered instruments. This is different with the Misonix BoneScalpel, which gives me a high level of control in cutting bone structures with ease and precision while being able to stop right on the ligamentum flavum. I have performed over 70 cases for lumbar, thoracic and cervical laminectomies for single and multilevel cases and including revisions. In addition to considerably improving safety, the device allows me to reduce the amount of bone cutting work needed and saves me 30-60 minutes per case. The learning curve has been minimal and the BoneScalpel is very intuitive to use.”

The appeal of the Bone Scalpel, which cuts bone in a very precise manner, is a device that meets the growing need for specialty cutting of bone. According to the American Association of Neurological Surgeons, over 320,000 spinal procedures out of some 550,000, or 58%, required some type of bone cutting´.

The BoneScalpel creates straight or curved cuts on any bony plane, with bone cuts as narrow as 0.5mm. There is no charring or thermal necrosis at the cutting site as the ultrasonic action with irrigation keeps the work area at a moderate temperature. The cut of the BoneScalpel is so precise that it can cut a window in an eggshell while leaving the membrane intact.

The BoneScalpel allows the surgeon to cut close to the nerve tissue, and the device is soft tissue sparing to reduce the likelihood of injury to adjacent tissue. This revolutionary device has distinct specialty applications in neurosurgery, orthopedic surgery, maxillofacial surgery, and plastic and reconstructive surgery. The device is portable, simple to operate and could be used in hospitals, clinics or physician offices.

About Aesculap:

Aesculap is the largest worldwide supplier of sterilization containers and surgical instruments. The company designs and produces surgical instrumentation and implants for neurosurgery, microsurgery, ENT, plastic and reconstructive, thoracic, micro-vascular, cardiovascular, orthopedic, laparoscopic and general surgery and central processing. Aesculap is a member of the B. Braun family of healthcare companies. B. Braun is currently the fourteenth largest healthcare manufacturer in the world. For more information, please contact Customer Service at 1-800-282-9000 or visit the Aesculap website at www.aesculapusa.com.

About B. Braun:

Since 1939, B. Braun has built an unparalleled store of knowledge and expertise in delivering innovative healthcare products, medical devices and programs that enhance both patient and health-professional safety. Its 30,000 employees worldwide are proud of their commitment to translating customer needs into products with unmatched quality, superior technology, cost effectiveness and environmental responsibility.

Through its “Sharing Expertise™” initiative, B. Braun promotes best practices for continuous improvement of healthcare products and services. For more information about B. Braun or its safety healthcare products, call 1-800-854-6851 or visit www.bbraunusa.com.

About Misonix:

Misonix, Inc. (NASDAQ: MSON) designs, develops, manufactures, and markets, therapeutic ultrasonic medical devices, and laboratory equipment. Misonix’s therapeutic ultrasonic platform is the basis for several innovative medical technologies. Misonix has a minority equity position in Focus Surgery, Inc. which uses high intensity focused ultrasound technology to destroy deep-seated cancerous tissue without affecting surrounding healthy tissue. Addressing a combined market estimated to be in excess of $3 billion annually; Misonix’s proprietary ultrasonic medical devices are used for wound debridement, cosmetic surgery, neurosurgery, laparoscopic surgery, and other surgical and medical applications. Additional information is available on the Company’s Web site at www.misonix.com.

With the exception of historical information contained in this press release, content herein may contain “forward looking statements” that are made pursuant to the Safe Harbor Provisions of the Private Securities Litigation Reform Act of 1995. These statements are based on management’s current expectations and are subject to uncertainty and changes in circumstances. Investors are cautioned that forward-looking statements involve risks and uncertainties that could cause actual results to differ materially from the statements made. These factors include general economic conditions, delays and risks associated with the performance of contracts, risks associated with intentional tasks and currency fluctuation, uncertainties as a result of research and development, acceptable results from clinical studies, including publication of results and patient/procedure data with varying levels of statistical relevancy, risks involved in introducing and marketing new products, potential acquisitions, consumer and industry acceptance, litigation and/or court proceedings, including the timing and monetary requirements of such activities, the timing of finding strategic partners and implementing such relationships, regulatory risks including approval of pending and/or contemplated 510(k) filings, the ability to achieve and maintain profitability in the Company’s business lines, and other factors discussed in the Company’s Annual Report on Form 10-K, subsequent Quarterly Reports on Form 10-Q and Current Reports on Form 8-K. The Company disclaims any obligation to update its forward-looking relationships.

´ Information compiled from the American Association of Neurological Surgeons (AANS) website.

Think Whole Foods is for Those With Fat Pocketbooks? Think Again

Whole Foods is a great place for shoppers on a budget. Really!

Lurking beside the Bleu d’Auvergne and the Chilean sea bass is a supermarket ripe with deals ready for hard-working individuals wanting a little more bang for their buck, company officials say.

And they can prove it.

Perhaps hoping to combat the store’s “Whole Paycheck” nickname, Whole Foods branches in Santa Fe and other cities, under a directive from the company’s Austin headquarters, recently began offering weekly tours on how to “value shop” and affordably stock a pantry.

“We cater to a whole variety of people, from

gourmets to those feeding families on a reasonable budget,” said Tom DiRuggiero, marketing director of the Santa Fe Whole Foods. Organized tours in the City Different run every Wednesday afternoon and will continue at least through February. While the Casual comparison

idea hasn’t exactly caught fire yet — a Journal reporter and photographer were the only participants during the Cerrillos Road store’s second tour Jan. 30 — guides DiRuggiero and Jeremiah Schultz, chef de cuisine, are eager to spread tidings that Whole Foods budget shopping is not an oxymoron. Their advice boils down to two rather simple suggestions: Buy generic and shop the sales. The company’s private-label 365 Everyday Value brand, which offers a multitude of items, is “probably the greatest value we have to offer in the store,” DiRuggiero said. In addition to 365, Whole Foods carries two other private lines: 365 Organic and the somewhat more expensive Whole Kitchen and Whole Pantry. “Compare the prices and it’s really not out of line with what you see in other stores,” DiRuggiero said. Founded in 1980, Whole Foods has ridden a wave of popularity to become the world’s largest organic and natural foods retailer, as it bills itself. The company now has more than 265 stores in three countries and earned sales of $5.6 billion during fiscal year 2006. But Whole Foods has come under some mockery for its “Whole Paycheck” reputation. The distinction, Schultz said, was earned because stores do carry a large selection of high-end, expensive products — part of the reason people come to the store in the first place. Pointing to a $8.99 can of tuna fish (sitting near 365 tuna selling for $1.49) during the Santa Fe store’s value tour, he asked, “Who the hell is going to spend $8.99 for a can of fish? But they do and then complain about it.” Whole Foods’ claim to be friendly on the wallet may not just be hot air. An unscientific price comparison conducted by the Journal of a few Santa Fe supermarkets revealed that many of Whole Foods’ kitchen staples are priced competitively with generic brands at Albertsons and Trader

Casual comparison

Joe’s. Among other discoveries, the Journal found that canned beans were the same price at all three stores and Whole Foods’ prices beat out the other two on items including eggs and some frozen fruits and vegetables. A “Basic Pantry” Whole Foods shopping list compiled for the tours and consisting of 31 non-perishable kitchen basics rings in at $78.33. “Even the team members that work here were surprised to see that,” said Schultz about the list, which includes diced tomatoes, oats and peanut butter. About 40 percent of the items are organic, he said. But if it’s the high-end items that constitute a large part of the Whole Foods allure, what’s the motivation to buy the 365 brand? The products don’t contain ingredients such as artificial colors, sweeteners, preservatives and hydrogenated oils, DiRuggiero said.

And the company has a quality standards team that checks items regularly and pulls those that aren’t up to par, he noted.

“When you purchase something at our store, you should have a certain amount of confidence,” he said.

Also, the food tastes good, at least according to DiRuggiero and Schultz. To test for themselves, people can take advantage of a store policy that allows customers to sample any item in Whole Foods — with the help of a crew member, of course — without having to make a purchase.

Keep to the center

Customers should also keep in mind that, while it may bring little joy, shopping with restraint when it comes to “fun” items is key. “The perimeter of the store is not where the value is,” Schultz said, referring to the outer areas of Whole

Foods that offer fresh fruits and vegetables, ready-to-go foods, alcohol and fancy cheeses. “If you want value, you’re not buying this stuff,” Schultz noted as he grabbed a $7 pre-packed styrofoam container in the produce section that contained two large mushrooms and one sliced bell pepper. For vegetables and other items, stick to the sales. At any given time, at least one or two items in each department are discounted, DiRuggiero said. Bulk foods aren’t a featured part of the Whole Foods value tour, although the Santa Fe store does have an aisle where shoppers can buy rice, herbs, beans and other items at often cheaper price than their packaged counterparts. DiRuggiero admitted that products in that section “are going to be some of your best deals.”

Here is the Journal’s unscientific price comparison of selected private label products at three Santa Fe supermarkets: 12 oz. cornflakes: $2.49 24 oz. French roast coffee beans: $9.99 15 oz. canned garbanzo beans: $0.69 16 oz. frozen mixed vegetables: $1.29 16 oz. frozen blueberries: $3.99 half gallon reduced fat milk: $2.29 12 cage-free large white eggs: $1.99 18 oz. cornflakes: $2.79 39 oz. French roast coffee beans: $6.99 15 oz. canned garbanzo beans: $0.69 32 oz. frozen mixed vegetables: $3.49 16 oz. frozen blueberries: $4.99 half gallon reduced fat milk: $2.49 12 jumbo eggs: $2.59 15 oz. cornflakes: $2.29 13 oz. French roast coffee: $4.99 15 oz. canned garbanzo beans: $0.69 16 oz. frozen vegetable medley: $2.29 12 oz. frozen blueberries: $3.29 half gallon reduced fat milk: $1.69 12 large cage free white eggs: $2.29 How Whole Foods’ Prices Compare With Others’

Nasal Spray May Treat Alzheimer’s

A nasal spray that could treat Alzheimer’s disease — a dream more than two decades in the making for one Twin Cities researcher — is getting more attention these days.

Several studies are using the nose-to-brain method of delivering drugs that was invented in the late 1980s and patented by William Frey II, director of an Alzheimer’s research center at Regions Hospital in St. Paul. Last month, researchers in Washington state reported using intranasal insulin to improve memory and attention for patients with early-stage Alzheimer’s.

The study is the latest support for Frey’s basic discovery — that drugs targeted at nerve endings in the upper portion of the nose can rush to the brain and bypass the protective blood-brain barrier.

Whether it’s the secret to beating Alzheimer’s is unclear. Doctors and scientists have proposed dietary changes, vitamin supplements, stem cell therapies and vaccines to prevent or treat the now-incurable disease. Frey’s work at least gives hope against a disease that is the seventh-leading cause of death in the U.S.

The nose-to-brain discovery was so simple that Frey spent years convincing officials at the U.S. Patent Office that it was a useful method of drug delivery. Then he spent several more years convincing them that it was an actual discovery and not just a feature of anatomy.

“Some people would say it’s as simple as the nose on your face — that everybody already knew that,” Frey said. “But the truth of the matter

is, no, nobody knew it.”

AVOIDING THE BLOCKADE

Most nasal sprays are directed to the lower part of the nose so medication can quickly enter the bloodstream. Drugs to treat neurological conditions don’t work through this route, though, because of the protective blood-brain barrier.

While this blockade of cells and blood vessels protects the brain and spinal chord from harmful organisms, it also keeps out most drugs and has stymied otherwise promising therapies.

Avoiding this barrier is what makes intranasal delivery “a potentially powerful therapeutic tool,” according to the Washington research group. Its study was small, with 24 patients receiving daily insulin or a placebo, but the results, published in the journal Neurology, were persuasive.

Patients taking intranasal insulin were mentally sharper, and their blood sugar levels remained healthy.

Several companies have made nasal spray devices that can target this nose route to the brain, but it’s unclear if any drugs will take advantage of it.

Frey recently gained federal funding to study the intranasal delivery of deferoximine, a generic drug that removes toxic amounts of iron and other metals from the body. One theory about Alzheimer’s is that excess metals in the brain cause oxidation and damage to the neurons — the brain’s thinking cells.

Canadian company Allon Therapeutics is in the second phase of U.S. clinical trials with an experimental drug that may support the growth and repair of brain cells. The intranasal drug is being evaluated as a treatment for Alzheimer’s and schizophrenia.

Insulin might hold the most immediate promise, given that insulin injections have been used safely for years to treat diabetes. There is building research, including the Washington study, that insulin plays a crucial role in Alzheimer’s and other diseases that erode memory and thinking skills.

“The brain needs insulin to help brain cells take up blood sugar,” Frey said. “It gives them the energy they need so you can think and remember.”

COMPANY NOT INTERESTED

A drug company’s disinterest could slow the development of this potential therapy. Chiron, a subsidiary of Novartis, holds patents for the intranasal delivery of insulin and drugs that mimic insulin. (Both patents were sold to the drug company by HealthPartners — the health system that owns Regions — and still list Frey as the inventor.)

When asked if Novartis is developing the ideas in these patents, a spokesman replied, “We’re not.”

It’s disappointing to Frey and other believers. The idea offers limited financial returns for Novartis, because it doesn’t involve the development of a new drug the company could provide exclusively to the market.

Still, it’s an untapped market. Few therapies exist for the estimated 5.1 million Americans with Alzheimer’s. A primary drug is Aricept, which slows the degeneration caused by Alzheimer’s but doesn’t halt or reverse the disease.

Drug companies are studying other Alzheimer’s treatments, and research institutions are finding more apparent targets in the brain.

Researchers at the University of Minnesota, for example, have discovered a unique cluster of proteins in mice that is connected to memory loss. They suspect drugs could prevent this cluster from forming in human brains, which could prevent or treat Alzheimer’s.

Frey doesn’t know whether his research could end up targeting symptoms of Alzheimer’s or whether it could cure the disease altogether. Drug companies are interested in his findings, and he is meeting with them in the coming weeks.

He spent last week in California at a lab that will help conduct the studies with deferoximine, the iron-reducing drug. The goal is to study in animals whether intranasal use of that drug is safe.

If safety is proven, Frey said, he could start to pursue human clinical trials by the end of the year.

NASA Building Test Pad at White Sands for New Spacecraft

NASA took a step toward sending a new generation of explorers to the moon with the groundbreaking for a new test launch pad at White Sands Missile Range Nov. 14. NASA and a handful of community representatives broke ground at the Launch Complex-32 site, where the Orion Abort Flight Test Launch Complex will be built.

The pad will be the site of a series of tests of the launch abort system that will help ensure the safety of astronauts aboard the Orion spacecraft, NASA’s crew exploration vehicle. The first of five unmanned abort tests is scheduled for Sept. 23, 2008 from the new pad.

White Sands Test Center Commander Col. Bruce Lewis welcomed guests to the range.

“We continue our support of NASA. We are pleased to offer White Sands’ unique assets of extensive land mass, restricted air space, tremendous data collection capabilities, and extremely talented workforce to the Orion flight test program,” Col. Lewis said.

Orion Project Manager Skip Hatfield said NASA has a long history of working with White Sands and testing these kinds of systems. “It is a great privilege for us to be here and continue that relationship,” he said.

Two pad abort tests, known as PA-1 and PA-2, will be followed by ascent abort tests to verify safe abort performance during critical phases of the Ares I ascent profile. The White Sands ascent abort tests will use an abort test booster, which is a retired Peacekeeper missile stage, designed to propel the Orion test elements to the required abort test conditions.

Denco, Inc., of Las Cruces was awarded the contract for the construction of launch site facilities at White Sands. Denco will be responsible for the first work package of the Project Orion Abort Flight Test Launch Facility. The package covers construction of a 120-by-160-foot final integration and test facility building and surrounding site improvements and infrastructure.

Orion is part of the Constellation Program to send human explorers back to the moon, and then onward to Mars and other destinations in the solar system.

The White Sands flight tests will focus on the ability of Orion’s launch abort system to pull the crew safely away from the launch vehicle in the event of a problem on the launch pad or during the climb into orbit.

The five launch abort system flight tests at White Sands are part of a broader flight test campaign that will also include six launches from Kennedy Space Center in Florida.

Orion is similar in shape to the Apollo spacecraft in which astronaut Vance Brand, who was present at the ceremony, flew on as part of the Apollo-Soyuz Test Project in 1975.

Orion takes advantage of 21st century technology in computers, electronics, life support, propulsion and heat protection systems.

Brand said the Orion program is very significant because it will take the U.S. in a new direction and will eventually replace the space shuttle.

He said the launch abort system is very important especially for crew members because it will help ensure their safe return in the event of a problem. “It is very comforting to know you have a system like that, and testing it to make sure it works is very important,” Mr. Brand said.

On Jan. 27, 1967, astronauts Gus Grissom, Ed White and Roger Chaffee died when a fire broke out in the cockpit of their spacecraft during a pre-launch test for Apollo 1.

The launch abort system, mounted on top of the Orion crew module, centers around three solid propellant rocket motors: an abort motor; an attitude control motor; and a jettison motor.

The launch abort system must be ready to operate in a wide variety of different environmental conditions, NASA officials said, adding that the test program is designed to test all of these conditions.

NASA’s Orion project office at NASA Johnson Space Center is leading a government and contractor team to validate and verify the spacecraft’s launch abort system. Lockheed Martin Corp. is NASA’s prime contractor for the Orion spacecraft and its launch abort system.

City Won’t Add Fluoride to Water Despite State Law

Despite a state law passed more than a decade ago requiring communities to fluoridate their tap water, Livermore remains the largest city in the East Bay that doesn’t use the additive.

It has nothing to do with still-alive-and-kicking conspiracy theories or even the cost of fluoridating — at least directly.

Councilman John Marchand, who used to serve on the Zone 7 water board and works as a chemist for the Alameda County Water District, said the reason Livermore doesn’t fluoridate is because residents never wanted to.

“Most communities in the Bay Area put it on the ballot and voted for it,” he said.

Livermore weighed in on the matter twice during the 1950s. Both times, voters opted to eschew the treatment.

Since then, it just hasn’t come up, Marchand said.

In addition to Livermore, Brentwood and Bay Point are fluoride-free. All other Contra Costa and Alameda county communities use it.

The 1995 law requiring fluoridation stipulates that cities with more than 10,000 water connections — or about 25,000 people — add the element if it is financially feasible.

While national estimates hold that the cost of such a change would amount to about 50 cents a person per year in Livermore, Marchand said that it would nevertheless require additional city staff that could be used to do other things.

“Once you start fluoridating, you have to put the monitoring programs in place,” he said. “And there are hazards involved. Fluoride in the water is not

hazardous (under normal circumstances), but it is when in its concentrated form.”

And besides, Marchand said, water isn’t the only source of fluoride, and not the most effective way to get it.

“It’s a topical treatment, and there are all kinds of toothpastes and mouth rinses out there that contain fluoride,” he said.

Merit still debated

While some studies have suggested detrimental effects of fluoride, the Centers for Disease Control and Prevention and other public health groups maintain that it is safe.

And Howard Pollick of the UC San Francisco school of dentistry said there remains a need for it in tap water.

“It’s still very necessary,” he said. “We just saw some results from the Central Valley where 86 percent of adults are in desperate need of dental treatment. There are very severe disparities in oral health in California and a very high level of dental disease.”

But some people say otherwise. Many Web sites link fluoride to problems with teeth, bones, the brain and the thyroid gland.

With a large amount of exposure, it causes fluorosis, a discoloration of the teeth. It was the brown yet cavity-free smiles of Pikes Peak, Colo., that first got the naturally occurring element noticed in the early 20th century.

Since then, scientists have tweaked the amount of fluoride added to water to find a balance at 1 part per million — less than what is found naturally in black tea, raisins and white wine.

Old concerns

Marchand said he sometimes fields calls from residents concerned about fluoride levels.

“I hear from people who tell me, ‘There’s fluoride in rat poison,'” Marchand said. “Well, there’s chocolate in rat poison, too.”

Marchand said some of the more radical suspicions were planted by Hollywood. In particular, that fluoride amounts to mass medication and mind control.

“Do you know where that comes from?” he said. “It’s not from the 1950s, it’s from 1964, a joke in Stanley Kubrick’s ‘Dr Strangelove’ that was done tongue-in-cheek. But it got so ingrained that people remember the conspiracy but not where it’s from.”

Livermore residents most likely won’t have to worry about that sort of thing in the near future.

While there is a program to get state funding for the process, Randy Warner of the city’s public works department said Livermore is “way down on the list.”

And the last vote, by 2,438 people in 1958, set a precedent the city abides by to this day, Warner said.

“Staff made it available, but the people didn’t want it,” he said. “It’s difficult for city staff to do something that goes against what the public decided.”

Dr. Marc Key Joins Celerus Diagnostics As Chief Scientific Officer

Celerus Diagnostics today announced the appointment of Dr. Marc Key as Chief Scientific Officer. The rapid cancer diagnostics company expanded its management team in anticipation of an exciting year of growth and innovation.

“We are extremely pleased to have Marc join our team,” said Michael Sarrasin, CEO. “His experience and technical expertise bring valuable insight to the company.” Responsible for new product development, Dr. Key will provide direction in the creation of next generation diagnostic tools.

With over 25 years of experience in research, development, and product development, Dr. Key has held senior positions with companies such as Dako Corporation and Biogenix Corporation. He has also retained various academic appointments and positions at The National Cancer Institute, Harvard Medical School, State University of New York and the University of South Carolina.

“Celerus is a company with tremendous technology; I look forward to building on what is already an incredible product,” said Dr. Key. “Providing rapid response for patients combined with the ability to create a more efficient lab is the future of anatomic pathology.”

Dr. Key holds a BS from Iowa State University, an MS from the University of Montana, and a PhD from the Medical University of South Carolina.

About Celerus:

Founded in 2004 in Santa Barbara, California, Celerus Diagnostics is committed to enhancing the diagnostic capabilities of the pathology laboratory. Celerus technology provides the capability to decentralize testing, and move results closer to the patient for real time decision making. For more information, please visit our website: www.celerusdiagnostics.com or contact us at 805.685.0797.

This release contains forward-looking statements that involve risks and uncertainties, including, but not limited to, Celerus Diagnostics’ ability to successfully complete its development program, competitive pressures and other factors such as the introduction or regulatory approval of new products by our competitors and pricing of competing products and the resulting effects on sales and pricing of our products, disruptions or other problems with our sources of supply, significant product liability or other claims, difficulties with new product development and market acceptance, changes in the mix of our products sold, patent conflicts, product recalls, United States Food and Drug Administration (FDA) delay in or approval or rejection of new or existing products, changes in Medicare, Medicaid or third-party reimbursement policies, changes in government regulation, use of hazardous or environmentally sensitive materials, our inability to implement new information technology systems, our inability to integrate new acquisitions, and other events. This press release reflects information as of the date of this press release, and the company takes no responsibility in updating the information contained herein now or in the future.

UT Southwestern Ricin Researchers Chafe at Security Crackdown

Researchers at UT Southwestern Medical Center in Dallas have spent years and millions of dollars building vaccines and cancer treatments with ricin, a toxin so lethal that an amount the size of a grain of salt can kill a person.

But as federal oversight of deadly agents has increased dramatically since the 9/11 attacks, so have concerns about the university’s research program. For nearly five years, and as recently as August, some safety inspectors and law enforcement officials have worried that the ricin stockpile isn’t secure enough.

And internal e-mails and safety records depict a research program caught in the struggle between science and security — where some of the nation’s most prominent scientists have chafed at new safety demands and the inspectors who reviewed their labs.

“They sound like a bunch of Bushie Grunts to me,” decorated cancer and vaccine researcher Ellen Vitetta wrote in a 2004 e-mail, after a colleague’s meeting with safety inspectors. “Just carry on and hopefully they will soon leave us alone.”

Among the demands that researchers have expressed frustration about: requests to provide running logs of their ricin inventory, participate in annual safety drills, and install extra layers of security hardware on doors, closets and refrigerators. UT Southwestern has never had a security breach in its ricin program.

“What a headache, especially considering 1) you were using this stuff for years with absolutely NO oversight and 2) if any of us really wanted to cheat, we could do it easily and they’d never know!” ricin researcher Joan Smallshaw wrote in a 2006 e-mail to Dr. Vitetta, after biosafety officers asked for a new inventory of the stockpile. “Why torture us!?”

It’s a culture clash emblematic of debates in university research programs across the country, where these days, there’s almost as much demand for biosafety and risk management officers as there is for scientists.

Dr. Vitetta and her colleagues have broken major ground in the hunt for a ricin vaccine and new cancer therapies. But bidding for lucrative federal grants is a double-edged sword, they and other longtime researchers say, because the money and prestige come with significant red tape.

University officials say that the program has complied with every security measure inspectors have suggested. National security rules prevent them from describing these safety measures in detail or from disclosing how much ricin is stored at the university.

And Alfred Gilman, the medical school’s provost, dean and executive vice president for academic affairs, said the ricin researchers are entitled to the occasional eruption. Since 2001, Dr. Gilman said, they and other university researchers have been overwhelmed by federal reporting requirements.

“The number of issues we must track very, very carefully, we must educate everybody on, we must report back on and swear to the Lord on — it’s getting to be quite dramatic,” he said. “Is it frustrating? Yeah, it’s frustrating. But frustration doesn’t lead you to do something stupid and kill yourself.”

Among the security concerns was a 2001 incident in which two men approached a researcher with a pitch to partner on a ricin-related project. The men were turned away, but at least one police officer felt compelled to alert the FBI, according to a law enforcement official.

Two years later, campus officials were concerned enough about the safety of the ricin stockpile that they considered moving it off campus to a CDC-protected facility. They decided not to because transporting the materials back and forth to conduct research would be too risky.

And records indicate that the researchers have had to scramble to comply with federal regulations in the days and weeks before their inspections.

“If you have EVER used ricin for an experiment, check to see if you still have a tube of it tucked away in the fridge somewhere. … Everyone ELSE who has some MUST get rid of it,” Dr. Smallshaw wrote in an e-mail to staff in 2004, a week before a scheduled inspection. “And finally, the labs are now strictly off limits to anyone without FBI security clearance (you know who you are!)”

Safety conscious

Campus researchers say any suggestion that they are cavalier with ricin is ridiculous; after all, their own lives are on the line. Every lab in the country checks itself in the days before an inspection by the Centers for Disease Control and Prevention, they say. And they argue that the frustration they express to each other privately is a natural side effect of an ever-growing list of federal demands — inspections, meetings and reporting requirements that make them feel more like paper pushers than scientists.

“Anything that takes us away from doing our research, from moving ahead with projects we consider important, we consider frustrating,” said Dr. Vitetta, who directs the university’s Cancer Immunobiology Center.

Dr. Smallshaw added: “We are the first people who would suffer if we got careless. I’m not willing to subject myself to that kind of danger.”

Biodefense watchdog Edward Hammond, whose Austin-based Sunshine Project advocates against biological warfare, sees it another way:

“The biologists don’t think twice about enthusiastically lapping up federal defense money,” said Mr. Hammond, who uncovered one illness and several infections at a Texas A&M University lab last year. “But they don’t want to accept the safety consequences that come with it.”

Ricin vaccine

UT Southwestern’s research with ricin, a poison extracted from castor beans when they are processed to make oil, began in the 1970s, when Dr. Vitetta started using a portion of the toxic molecule to target cancer cells. For the next 20 years, she oversaw experiments on these “immunotoxins” — research that catapulted her into the national spotlight and won her entry to the National Academy of Sciences and the Texas Women’s Hall of Fame. Unlike traditional chemotherapy, Dr. Vitetta’s ricin treatments were intended to attack cancer cells while leaving healthy cells alone.

“She was really one of the first people in this field to develop a drug that … caused partial and even complete remission in patients with life-threatening cancers that were resistant to chemotherapy,” said Dr. Robert Kreitman, chief of immunotherapy research in the National Cancer Institute’s molecular biology division. Dr. Kreitman has run clinical trials with immunotoxins since the mid-1990s. “She is very widely known and very highly regarded in the field.”

By the late 1990s, Dr. Vitetta knew so much about ricin that she had developed an experimental vaccine, something the U.S. Department of Defense had been trying to do for years. She said that after the Sept. 11 terrorist attacks, “when it became obvious these things could be used in a fashion that was threatening to the public,” biodefense grants were plentiful, and she and her staff were awarded millions of federal dollars for vaccine research.

Dr. Vitetta’s ricin vaccine, which is still being tested, is the first to have been tried in humans, a step that comes with even more stringent federal reporting requirements. But she said that she has “been following very strict rules since before there even were rules” — and that security has always been paramount.

“We have a great responsibility, and we recognize that and take it very seriously,” said John Roan, the medical center’s executive vice president for business affairs. “We do believe this research is safe, and we do believe we have the appropriate and adequate security.”

Campus watchdogs, including one law enforcement official, paint a far different picture. They say that over the years, top university executives have treated the ricin experiments like sacred cows because of the funding and prestige they produced, siding with researchers and effectively ignoring police and biosafety officers’ requests for tighter security.

“We were a necessary evil,” the law enforcement official said. “They didn’t want us around and didn’t take us seriously.”

They point to alarm records as evidence of lax safety. Reports obtained by The News indicate the door to the ricin lab was either propped open or failed to close properly 140 times over a recent 14-month period, triggering an alarm each time. In one March incident, a newly installed lab door was found to operate backward, e-mails show; the door remained unlocked most of the time and locked only when someone used a swipe card to try to enter. That door was immediately fixed.

Interim campus Police Chief Bob Newton called the alarm records misleading. None of the door incidents involved criminal activity, he said: The alarms sounded even when a door didn’t latch perfectly, or when someone was standing in the doorway to finish a conversation. Each time, he said, an officer was dispatched to the lab.

An incident that prompted even more concern occurred the summer before the Sept. 11 attacks in 2001. The law enforcement official said police learned that two men had come to campus trying to consult with the university on a project involving ricin. The men never followed up on their pitch. Researchers later reported the incident to police; the law enforcement official said that after campus police conducted routine interviews, they were told to stand down.

“No one in the department had any clue until that point how much [ricin] they had in there,” said the law enforcement official, who said officers eventually passed the incident on to the FBI. “Everyone was saying, ‘Isn’t this something that needs better oversight?’ “

Chief Newton said he knows of no bad blood between researchers and law enforcement officials. In his entire career with the department, which dates to 1980, he has never once felt pushback over a security recommendation, he said.

“I’ve never been a part of any conversation that in any way expressed frustration with getting the necessary security implemented in that area,” Chief Newton said. “We’ve received full support.”

Push for oversight

For a time, university officials appeared to think more oversight of the ricin supply was necessary. In January 2003, e-mails show, publicity over ricin research led to unspecified threats against the program — and prompted the campus police to step up lab patrols. University officials declined to elaborate on the threats, except to say that the ricin supply has never been endangered.

And records and e-mails from March of that year indicate university President Kern Wildenthal wanted the ricin moved to a “Fort Dietrich”-like facility, one where the CDC would monitor the stockpile’s safety. In e-mails Dr. Vitetta sent at the time, she agreed it was “a wise idea to move our material off campus and put it under someone else’s control” — as long as she would have access to the agent whenever she wanted.

“Please realize that the loss of this material would do irreparable damage to my research program and would waste many millions of dollars of already-spent grant and private monies,” Dr. Vitetta wrote. “On the other hand, I fully understand all the security issues.”

The idea was eventually rejected, after officials determined that the risks associated with transporting the agent to and from UT Southwestern were too high. (The law enforcement official said until this decision was reached, campus police were planning an armed convoy to escort the ricin.)

By that point, the CDC had installed new rules to guide researchers using deadly agents, requirements that included frequent federal safety inspections.

Reports from these inspections, obtained by The News, don’t highlight any serious security breaches — like illness or infection — in the ricin lab. But in both 2003 and 2007, federal investigators cited the university for “deficiencies”: not having adequate records of its ricin inventory, not keeping complete logs of researchers entering and leaving lab areas, and not having security plans “commensurate with the risk posed by maintaining such a significant quantity of ricin.”

Under the CDC’s select-agent guidelines, labs must keep “accurate, current inventory for each select agent,” including information on where the agent is stored, how much is available, who last had access to it, and whether any of it has been destroyed.

After meeting with CDC inspectors in June, Dr. Smallshaw wrote in an e-mail that they “ARE worried about the security of the stockpile and recommend more [security] — I knew they would.”

Two months later, CDC officials initiated a conference call with the university to resolve lingering ricin issues, including a discussion over who could access the stockpile.

“I think they have concerns about the amount of ricin,” Julien Farland, then the university’s assistant director of environmental health and safety, wrote in an e-mail to Dr. Vitetta. “In particular they feel that the large amount of semi-purified castor beans are a risk and should be evaluated for increased security.”

During two separate interviews, university officials referred to the CDC inspection reports as “observations,””suggestions” and “clarifications,” and said UT Southwestern always satisfied the agency’s requests.

“Everything we have done, from an environmental health and safety standpoint, in checking and securing these labs, they have been satisfied,” Mr. Roan said. “We’ve had very good cooperation by the faculty, certainly from this lab in particular.”

Lab watchdogs say that’s hardly the case. In internal office e-mails spanning four years, researchers have complained about heightened scrutiny, called biosafety officers “paranoid,” and said federal inspectors make their “lives miserable.”

‘Comic relief’

In 2006, when campus law enforcement insisted on new doors and locks for the ricin stockpile, Dr. Smallshaw again voiced frustration with inspectors’ requests.

“They are not happy with the security of the ricin stash, so they are INSISTING that we install yet another … lock on the outer door,” she wrote to Dr. Vitetta. “I told them they can go CRAZY and install whatever they like so long as they understand … that we are not coughing up one red cent toward this.”

“If they want to hire James Bond, that is also fine with me,” Dr. Vitetta responded, “as long as we don’t foot the bill.”

Dr. Vitetta described the e-mails as “humans talking to humans” and said they’re a way for the researchers to find “comic relief” in the midst of ever-increasing federal mandates.

In every instance where researchers complained about the new safety measures, records and e-mails indicate they still complied with them, and sought ways — through new doors or security cameras — to make inspectors comfortable with their ricin supply.

In an e-mail to Dr. Vitetta after a June meeting with CDC inspectors, Dr. Smallshaw wrote: “Other than updates on some of our paperwork, they’re happy and grateful that we were so receptive and hospitable (which they tell us is not always the case).”

Dr. Vitetta said that there is no lab inspection on a university campus where “you don’t get ready a few days ahead of time.”

“If you know [the inspectors] are coming on Friday, you make sure all the books are up to date by Wednesday. … And sometimes you find small things you really need to get up to speed,” she said.

“Things can get lax in less important areas,” added Dr. Gilman, a Nobel laureate. “But when you’re dealing with a dangerous virus, or a highly toxic agent, people aren’t fools.”

ALL ABOUT RICIN

What is it?

Ricin is a poison produced when castor beans are processed to make oil. It can exist in powder, mist or pellet form, and it dissolves in water. If ingested or injected, a dose the size of a grain of salt is deadly.

How does it work?

Ricin attacks the body’s cells by preventing them from making proteins they need, and generally kills within three days. If inhaled, ricin causes fluid to build up in the lungs, and induces cough and fever. If ingested, it causes vomiting, seizures and hallucinations. Both lead to respiratory and organ failure.

How dangerous is it?

Ricin is a stable substance — it doesn’t break down easily. Unless a person inhales it, swallows it or is injected with it, he will probably not report symptoms. Accidental exposure is highly unlikely; illnesses are generally deliberate. There is no antidote, and vaccines are still in development.

Ricin incidents:

–In 1978, an assassin linked to the Soviet KGB used an umbrella loaded with a ricin pellet to kill Bulgarian dissident Georgi Markov in London.

–In 2003, the Secret Service intercepted an envelope filled with ricin headed for the White House. Ricin was detected on a similar envelope in a South Carolina mail facility.

–In 2004, ricin was detected in the mailroom of a Senate office building in Washington.

–Recent federal intelligence reports have linked ricin production to villages in Afghanistan and groups allied to al-Qaeda in northern Iraq.

SOURCE: Dallas Morning News research

Anti-Parasite Drug Kills HIV

Researchers at University of Rochester Medical Center reported yesterday a drug used to treat parasitic infections in developing countries also attacks the human immunodeficiency virus (HIV) in a new and powerful way.

Past research has established that HIV has “learned” to hide out in certain human cells where it is safe from the body’s counterattack, cells that come to serve as viral reservoirs. Operating from these havens, the virus slowly builds its numbers over more than a decade until it finally becomes capable of dismantling human immune defenses. In the end stages, this process leaves patients vulnerable to the opportunistic infections of AIDS.

The new University of Rochester study explains for the first time how the virus makes chemical changes that keep its chosen reservoirs alive long past their normal lifespan. The report also provides the first evidence that an existing ant-parasite drug can reverse this process.

“AIDS continues to take nearly 3 million lives worldwide each year, and novel treatment approaches are urgently needed,” said Baek Kim, Ph. D, associate Microbiology & Immunology professor in the at the University of Rochester Medical Center, in a press release issued yesterday.

“We think our results are profound because, in discovering exactly how HIV hides in the body, we think we have learned how to take away its hiding places. Without them, the virus would have a much harder time causing disease,” said Dr. Kim, the study’s lead author.

Cell division is a process central to life. A parent cell divides into two cells, each containing copies of the same genes. This enables a single-cell human embryo to divide and grow into the vast number of cells that make up the human body. Different cell types divide at various speeds. T cells, for example, sense foreign organisms have invaded the body, and quickly divide and grow into a large, specifically designed army to attack the invader. Macrophages, on the other hand, are designed to roam the body engulfing and digesting dead tissue and bacteria. To assume this special role, they give up the ability to divide.

Unlike most viruses in its family, HIV has the ability to infect both non-dividing macrophages and rapidly dividing T cells, a key to its deadliness. Given its choice, HIV would prefer to infect rapidly dividing T cells, because with each division comes another opportunity for the virus to copy itself using the T cells’ genetic machinery. On the other hand, T cells sense they are infected and quickly commit suicide, taking out the virus as well. So quickly do T cells self-destruct that the virus would lose its battle with the human immune system if it did not have long-lived macrophages to hide in during the early years of infection, Kim said.

Many cells can “choose” to die when they sense cancer-causing flaws in their own genes, or when they are being used as a virus factory. Certain biochemical pathways call for cell suicide and others postpone it, with the two forces counterpoised to control lifespan. Cancer and AIDS result in part from problems in these pathways.

Past studies found that HIV-infected macrophages can serve as viral reservoirs because some unknown factor extends their lifespan.

However, Dr. Kim’s research shows that HIV produces a protein that turns on a particular cell-survival pathway. After a multistep process, it ultimately activates an enzyme called Akt that in turn prevents cell suicide.

“Up to now, nobody has really thought about how to eliminate the macrophage reservoir,” Dr. Kuan-Teh Jeang, an HIV specialist at the National Institutes of Health, told Associated Press. “The imagination now has turned toward, ‘How do we eliminate reservoirs?’ … The best way to address our problem is to simply kill those cells.”

The discovery was good news, Dr. Kim said, because the Akt pathway is also a culprit in the development of certain cancers. Indeed, oncologists have been trying to target this pathway for some time in developing potential cancer treatments.

In the next phase of his study, Dr. Kim put human HIV-infected macrophages in lab dishes and added drugs known to block the Akt pathway, to determine if any killed the cells. The experiment worked, with both miltefosine and the related drug perifosine both rapidly killed the macrophages, thus depriving HIV of this hideout.

Perifosine is currently being studied as a possible cancer treatment, and miltefosine is known to be safe through its use in leishmaniasis patients. Kim’s goal is to rapidly study miltefosine in animals to determine if it targets infected macrophages well enough to test in HIV patients.

“The evidence they show is in fact pretty good,” said NIH’s Jeang, who says the next step should be a test of miltefosine in monkeys infected with SIV, the monkey version of the AIDS virus.

The research was published online in the open access journal Retrovirology. The full report can be viewed at http://www.retrovirology.com/content/pdf/1742-4690-5-15.pdf

The University of Rochester Medical Center’s full press release can be viewed at http://www.urmc.rochester.edu/pr/news/story.cfm?id=1853