The Greatest Eureka Moments in the Past 150 Years

By Jeremy Laurance

The achievements of medical science in the past 150 years have transformed our world. It is almost impossible to imagine a time when there were no vaccines against polio and diphtheria, no antibiotics and no anaesthetics, and where open heart surgery, transplants and test-tube babies were the stuff of science fiction.

But which is the greatest medical breakthrough? The British Medical Journal, the house journal for Britain’s doctors read by more than 100,000 in the UK and thousands more around the world, is trying to find out, asking its readers to nominate the greatest breakthrough since the journal was launched in 1840.

The BMJ has been inundated with nominations. Announcing the survey in the magazine, Trevor Jackson, a senior editor, wrote: “Trying to answer such questions might seem the stuff of undergraduate essays or medical dinner parties – good fun, but ultimately a trivial pursuit. And yet, in seeking to isolate one breakthrough, we remind ourselves of the interdependence of all these breakthroughs and the importance of all our medical histories. In other words, the process can tell us more than the outcome.”

Nominations for the BMJ’s survey are now closed, and the 15 most popular breakthroughs are to be featured in the journal over coming months before going to a vote. The results will be published in January.

The Independent has drawn up its own list of the 10 greatest breakthroughs, based on the BMJ nominations. “Breakthrough” is perhaps an overused word in modern parlance but when applied to these discoveries it is, for once, justified.

The contraceptive pill

Inextricably linked with the 1960s, the decade in which it came into widespread use, the Pill revolu-tionised social and sexual attitudes. It gave women unprecedented control over their fertility; it required no special preparation; and it did not interfere with spontaneity or sensation. For the first time sex became an act of love or of pleasure rather than of procreation, and women could enjoy sex on an equal footing with men.

Today, three million women in the UK use the Pill. But not all societies were equally impressed; in Japan, fears that the Pill would reduce use of the condom and lead to an increase in sexually transmitted diseases prevented it being approved for nearly 40 years. It was finally licensed in Japan in 1999.

Oral rehydration therapy

Which medicine has saved more lives than any other and can be made by anyone in their kitchen, back bedroom, shantytown hut or dwelling built of sticks – as long as they have access to clean water? The answer is: eight teaspoons of sugar, half a teaspoon of salt and one litre of water. Mix. Drink.

The discovery that sodium (salt) increases the absorption of water and glucose from the digestive tract has saved the lives of millions of children suffering from dehydration caused by diarrhoea, the world’s biggest killer of children. It requires no specialised equipment; uses ingredients that are ubiquitous and have a long shelf-life; has few side effects; and can be made up in any quantity – the perfect medicine.

Aspirin

It is one of the most effective pain relievers. Hippocrates fed ground willow-bark to women in labour, but it was not until Felix Hoffman, a German chemist, synthesised acetylsalicilic acid in 1897 as a treatment for his father’s arthritis that it became the world’s best-selling drug, and in 1969 it went to the moon with Neil Armstrong.

In the past 30 years, aspirin has beenproved to be effective against heart The British disease, at least three types were the of cancer (breast, prostate laboratory. and bowel), diabetes, Alzheimer’s, stroke, infertility and deep vein thrombosis. It is so cheap to make that it cannot yield profits and thousands of research papers each year continue to confirm it as a true wonder drug.

Test-tube babies

The British gynaecologist Patrick Steptoe and his colleague Robert Edwards first to achieve a live birth from an embryo fertilised in the laboratory. Louise Brown was born in Oldham on 25 July 1978 amid controversy over the safety and morality of the procedure. Now 28 married, she is pregnant witth a naturally- conceived child.

Today, more than three million babies have been born through in- vitro fertilisation (IVF) worldwide, each bringing joy to infertile couples.

The NHS

Labour’s greatest creation, it has survived almost 60 years and remains envied around the world, especially by finance ministers. Despite current concerns about rising deficits and falling productivity, the NHS delivers more bang for the buck than any health system. Its founding principle of offering universal care on the basis of need, not on the ability to pay, remains as compelling today as it was when the NHS was founded on 5 July 1948. In America, the country with the highest spending on health and the most sophisticated medical technology, at least 44 million people are without medical insurance of any kind.

Penicillin

A mouldy Petri dish standing on a windowsill in Sir Alexander Fleming’s laboratory at St Mary’s Hospital, west London, led to the discovery of the first effective antibiotic, paving the way for the treatment of infectious disease.

Fleming, with Chain and Florey, shared the 1945 Nobel Prize, and for a few heady years it looked as if infection might be beaten. Instead of patching up the human body, doctors proved themselves able to save lives. But some claim that germ theory – the idea that germs spread disease and that surgeons who failed to wash their hands before operating were transmitting infection – is the more fundamental discovery; it led to the discovery of antisepsis, antibiotics and the transformation of medicine.

Anaesthesia

William Morton, a Massachusetts, dentist, gave a public demonstration of the use of ether to anaesthetise a patient before removing a tumour from his neck on 16 October 1846. From then on, the development of surgery became possible, the experience of childbirth was transformed and intensive care appeared on the horizon.

In England, ether, which is flammable, was soon replaced with chloroform, which gained royal approval when John Snow gave it to Queen Victoria during the birth of Prince Leopold in 1853. Anaesthesia has made possible “the preservation of human dignity and spirit”, said one nomination.

X-rays

William Rontgen, a German scientist, was working on a cathode ray generator in 1895 when he noticed that it was projecting a faint green light on the wall. Strangely, the light was passing through a pile of materials including paper, wood and books. As he experimented by placing other materials in the way, he noticed that the outline of the bones in his hand was projected on to the wall. Two months later he published his paper, “On a new kind of radiation”. Today, radiology is an entire speciality. Medical imaging has advanced to include CT, MRI and ultrasound scanning, used to examine soft tissues for signs of disease.

Chlorpromazine

In 1952 two French psychiatrists, Jean Delay and Pierre Deniker, treated a 57-year-old schizophrenic, Giovanni A, with chlorpromazine, the first antipsychotic drug. Within days he could hold a normal conversation, and within three weeks he was well enough to be discharged.

The discovery heralded a new era in psychiatry. It offered people with unendurable mental illnesses a way out of their misery. And it signalled the end of the asylums and start of community care. Within a decade, the treatment of all mental illnesses had been transformed.

Smoking’s link to lung cancer

When Sir Richard Doll published his groundbreaking study in 1950 – the first to link tobacco and lung cancer – the response was sceptical. Smoking was respectable and the tobacco industry was a major contributor to the Treasury. Ian Macleod, the health minister, waited four years before holding a press conference on the findings – and smoked throughout. Today, smokers and the tobacco companies are in retreat. Because of that early warning, published in the British Medical Journal on 30 September 1950, and the campaigns and reports that followed, millions of lives have been saved. Then, 80 per cent of men and 40 per cent of women in Britain smoked; today, one-third of men and women do.

ALLERGIC CONTACT DERMATITIS IN DENTAL PROFESSIONALS: Effective Diagnosis and Treatment

By Hamann, Curtis P; Rodgers, Pamela A; Sullivan, Kim

ABSTRACT

Background. Like other health care workers, dental professionals are at risk of developing allergic contact dermatitis, or ACD, after exposure to allergenic chemicals. Common allergens include antimicrobials, preservatives, rubber additives and methacrylates.

Case Description. The authors describe an orthodontic assistant with severe skin disease, whose symptoms included redness, cracking and bleeding that persisted for 10 years. The patient had previously received an incomplete diagnosis. After performing patch testing, assessing symptoms and evaluating the patient’s medical history, the authors diagnosed ACD resulting from exposure to several dental allergens. The patient received appropriate treatment and counseling to better manage her allergies; this resulted in resolution of all symptoms and averted permanent occupational disability.

Clinical Implications. Not all skin reactions are related to gloves or natural rubber latex. Dental professionals should be aware of common chemical allergens, symptoms of ACD and the appropriate treatment of occupational skin disease.

Allergenic chemicals can be found in many products used in the dental operatory, such as bonding agents, disinfectants, preservatives and processing chemicals added to rubber products (Table 1). With repeated exposure, these chemicals can cause allergic contact dermatitis, or ACD, in dental professionals.1 Research indicates that the prevalence of ACD in dentistry is increasing, particularly in reaction to the chemicals in bonding agents and disinfectants.2 Because dental professionals often wait several years before obtaining an accurate diagnosis and undergoing effective treatment, chronic skin disease and permanent skin damage can develop.3

ACD (also referred to as a type IV or delayed hypersensitivity) is a localized immune response that is almost always confined to the area of skin contact. Symptoms of ACD can range from dry skin to patchy eczema to chronic sores that weep or bleed, much like a reaction to poison ivy. Skin symptoms develop slowly and may persist for weeks or months. Other irritating chemicals, such as bleach and alcohols, can exacerbate these symptoms. The broken and open skin supports bacterial proliferation and permits the penetration of foreign substances and pathogens. Effective treatment of ACD begins with symptom recognition, assessment of risk factors and diagnostic patch testing to identify the offending allergens (Table 1).

Obstacles to the effective treatment of ACD and other occupational allergies include the misinterpretation of symptoms, presumptive self-diagnosis and incomplete diagnosis by physicians. Dental professionals often assume that skin reactions on their hands are due to gloves. Based on this assumption, they then assume that they have a latex allergy.

This allergy is known clinically as a type I (or immediate) hypersensitivity to the botanical proteins in natural rubber latex, or NRL. Unlike ACD, a type I hypersensitivity to NRL involves systemic immune reactions that develop rapidly, similar to those associated with allergies to medications, insect bites, plants and foods. Unfortunately, few physicians perform the full diagnostic series (that is, a detailed medical history and patch testing, as well as skin-prick or serologic testing) required to correctly differentiate between ACD and a type I hypersensitivity to NRL.4

Effective treatment of occupational skin disease requires a complete and accurate diagnosis by an experienced physician. An incomplete or assumed diagnosis of a type I hypersensitivity or ACD can have serious consequences. By describing this problem and its resolution in a dental professional, we hope to provide guidance for improved diagnostic, treatment and management strategies in dentistry.

CASE REPORT

A 48-year-old female orthodontic assistant came to us for help in identifying a medical glove that would ameliorate her symptoms so that she could continue working. For the past 11 years, she had experienced severe skin problems, including redness, itching and pustules on both hands, as well as cracked and fissured fingertips.

She often treated these symptoms with over-the-counter creams and medications. She reported that she had consulted a dermatologist eight years previously, who attributed her symptoms to a “latex allergy” but did not perform diagnostic testing. The dermatologist prescribed topical corticosteroids and advised her to wear nonlatex gloves at work. Unfortunately, neither polyvinyl chloride, or PVC, nor nitrile gloves relieved the patient’s symptoms. Her severe skin problems continued, eventually leading to several months of occupational disability in late 1999. While on disability leave, the patient experienced complete healing of the skin on her hands. However, when she returned to her job a few months later, the symptoms recurred and intensified, ultimately resulting in a visit to an urgent care center.

Health History and Examination

At her initial visit, the patient’s interview and health questionnaire revealed an extensive history of allergies and allergic reactions during childhood and early adulthood, including the following:

* childhood hay fever;

* eczema;

* an episode of erythema multiforme (purplish-red, itchy, hivelike vesicles) of unknown origin on her face, legs and hands;

* itchy pustules from the application of hair dye;

* hives after penicillin use;

* skin rashes after exposure to thimerosal (contained in overthe- counter antiseptics);

* allergy to pineapple.

During the previous 11 years, the patient also had experienced an increased frequency of localized rashes, itching or irritation after skin contact with household rubber gloves, elastic (for example, waistbands and sock cuffs), bandage adhesive, gold jewelry and other metal jewelry, some fragrances and perfumes, as well as household cleaners and soap. She also noted that she occasionally developed itching and irritation after applying artificial fingernails.

In the dental operatory at work, the patient reported that she reacted to the ultrasonic cleaners, soaps and disinfectants, and felt a burning sensation when her gloved or ungloved hands were in the glutaraldehyde solution for disinfecting instruments. According to the patient, several of the gloves that she had tried over the years (including those made of NRL, PVC and nitrile) had no effect or worsened her skin condition.

We examined the patient’s fingers and hands during her brief initial visit. We observed that her hyperkeratotic fingertips were scaly, dry, thickened and deeply fissured (Figure 1). The skin on the back of her hands and wrists was mottled with red, edematous patches (Figure 2). Her skin was leathery, indurated and thickened near the metacarpal joints, while the skin closer to her wrists appeared thin.

Given her symptoms and medical history, we suspected that the patient had severe ACD related to exposure to several chemicals, with concurrent exposure at work and home. Therefore, in the interim period before diagnostic testing could be performed, we instructed her to avoid direct contact (gloved or barehanded) with disinfectants and cold sterilizing solutions, as well as with the various bonding agents used to place orthodontic bands and brackets. We also advised her to remove her artificial acrylic nails. We requested that she record where and when her symptoms occurred, document the various products that she came into contact with throughout the day and provide copies of product material safety data sheets, or MSDS, or ingredients lists from product labels.

Within two months of her first visit (and before diagnostic testing could be completed), the patient experienced a severe allergic reaction that required treatment at an urgent care center. She had fluidfilled blisters on her palms, as well as multiple raised, hard, red lesions on the backs of both hands, many of which were painfully cracked and weeping. In addition, she had developed a red, itchy area on her cheeks that she believed was related to wearing a face mask. Because of the severity of her hand symptoms, the patient was treated with corticosteroids (via intramuscular injection) and placed on a two-week course of oral prednisone therapy.

Patch and Skin-Prick Testing

We obtained informed consent and scheduled the patient for patch testing, which is used to diagnose ACD. In addition, although she did not have the typical systemic symptoms associated with a type I hypersensitivity to NRL (for example, hives or rhinoconjunctivitis), she did have at least two major risk factors for this allergy.5 These risk factors were her health care occupation (28 years in the dental profession) and extensive allergic history, including an allergy to pineapple, which contains cross-reacting allergens to NRL.6 Moreover, a diagnosis of type I hypersensitivity to NRL should be made on the basis of medical history, symptoms and the presence of NRL-specific immunoglobulin E, or IgE, antibodies.5 Therefore, we also scheduled the patient for skin-prick testing and obtained her informed consent for this procedure.

Patch testing

We selected a total of 43 standardized chemical allergens for patch testing based on the patient’s symptoms and recommended dental screening allergens (Table 2).1 We applied 19 of the chemical allergens (Chemotechnique Diagnostics,Malm, Sweden) to the patient’s back using two customized patch-test panels (Finn Chambers on Scanpor, Epitest, Tuusula, Finland). We applied 23 additional chemical allergens and one negative control using two preassembled patch-test panels of common contact allergens (T.R.U.E. Test, Mekos Laboratories, Hillerd, Denmark).

Using standard patch-test procedures, we applied the four patch- test panels to the patient’s upper back and marked their position with a surgical skin marker. The allergen patchtest panels remained in place for two days, and then were removed. We evaluated the patient’s skin reactions 48 and 72 hours after removing the patch- test panels. Red, raised skin reactions at the site of an applied allergen were considered positive.

Skin-prick testing

This procedure screens for the presence of NRL-specific IgE antibodies and a corresponding type I NRL hypersensitivity. We screened by placing one drop of the following substances on the inside surface of the patient’s lower arm in this sequence:

* histamine (10 milligrams/milliliter) serving as a positive control;

* NRL glove-wash solution number 1 prepared as described by Hamann and colleagues;7

* NRL glove-wash solution number 2 prepared as described by Hamann and colleagues;7

* standardized NRL extract (Stallergenes SA, Antony, France);

* unpreserved saline (150 millimolar concentration) serving as a negative control and prepared as described by Hamann and colleagues.7

We pricked the epidermis lightly with a sterile lancet (Prick Lancetter, Bayer, Leverkusen, Germany) and blotted any remaining solution with a 4-inch piece of gauze. We measured and recorded the size of the wheal or raised area at each prick at 15 minutes. We considered the reactions to be positive if the wheal size was equal to or larger than half the size of the histamine wheal (positive control) and no reaction was observed to saline (negative control).

DIAGNOSIS AND TREATMENT

Positive test results

The patient’s test results were positive for ACD in reaction to several chemicals (Table 2), including the three major groups of processing chemicals commonly found in synthetic and natural vulcanized rubber products: carba mix, thiuram mix and mercapto mix. Therefore, most gloves would worsen our patient’s symptoms because latex (NRL), nitrile and chloroprene (or neoprene) gloves are manufactured with at least one agent from these compounding chemical groups.

Similarly, the patient’s reported skin reactions to elastic waistbands, face mask straps and other rubber products are related to this allergy (Tables 3 and 4). Fortunately, the patient’s skin- prick test results were negative for a type I hypersensitivity to NRL

Our patient tested positive for ACD in reaction to the antimicrobial glutaraldehyde, which is commonly found in several disinfecting solutions (Table 3). Her test results explain her symptoms following instrument disinfection procedures. In dental professionals, skin exposure to glutaraldehyde commonly occurs when solutions and soaked instruments are transferred or handled.8 Because of their lack of chemical resistance to glutaraldehyde, medical gloves are not an effective barrier.9,10 Thicker, chemically resistant gloves are required, particularly when exposure to concentrated stock solutions may occur.

Consistent with her cracked, fissured and scaling fingertips, our patient tested positive for ACD in reaction to three methacrylates. On the basis of the product MSDS, at least one of these methacrylates-2-hydroxyethyl methacrylate, or HEMA-was probably contained in the bonding agents used in the dental operatory. A variety of methacrylates are constituents of bonding agents, resinbased composites and adhesives used in dentistry and medicine and found in consumer goods (Tables 3 and 4). Many methacrylates quickly permeate most medical gloves regardless of their material or composition.11,12 When the patient handled the adhesive directly while placing orthodontic bands, she was likely to be exposed to methacrylates regardless of the gloves she wore.

Compounding her exposure at work, our patient regularly applied artificial nails that often contain ethyleneglycol dimethacrylate. Her facial dermatitis also may have been related to these methacrylate allergies, particularly with respect to artificial nails.13,14

The test results were clearly positive for ACD in reaction to thimerosal and methylchloroisothiazolinone, two of the preservatives tested. Thimerosal can be found in antiseptics, vaccines, over-the- counter eye, ear and nose medicaments, as well as in some cosmetics (Tables 3 and 4). Methylchloroisothiazolinone (for example, Kathon, Rohm and Haas, Philadelphia) is commonly used in medications, cosmetics and personal care products such as hand lotions and moisturizers.

Our patient exhibited a delayed, but somewhat equivocal, reaction to quaternium-15, a common preservative found in personal care products. Although the results were slightly ambiguous, we considered her reaction to quaternium-15 likely to be positive, based on her symptoms, health history and occupation. Therefore, the patient’s skin reactions to various hand care products, soaps and shampoos probably were attributable to an ACD in reaction to thimerosal, methylchloroisothiazolinone and quaternium-15 preservatives. We recommended that she avoid these chemicals when selecting personal care products for use both at home and in the office.

We also made a diagnosis of ACD in reaction to gold. Although she did not initially mention any metal-associated symptoms, our patient acknowledged that certain pieces of jewelry (for example, earrings) occasionally had bothered her. Asymptomatic allergies to gold and other metals are more common than previously thought, but probably are not occupationally related in dental professionals.1,15

Treatment of symptoms and allergen avoidance

To expedite the immediate healing of her hands, we prescribed 0.1 percent tacrolimus ointment used for the topical treatment of atopic dermatitis.16 However, a permanent resolution of symptoms required strict and continuing long-term avoidance of all of the above- mentioned chemical allergens. To help the patient manage her allergies, we provided detailed information regarding these chemicals, including where they might be used and in what types of products (Tables 3 and 4), as well as synonyms and brand names for these chemicals.

We also reviewed the ingredient labels on her personal care products used at home and work, and suggested that she contact product manufacturers with any questions or concerns she might have in the future. We repeatedly emphasized the importance of reading ingredient labels, technical information and MSDS on all of the products she used (or intended to use) both at home and at work.

Nonvulcanized glove materials

To better manage her allergies at work, we suggested she use medical gloves made of PVC, polyurethane (Intacta, Dow Chemical, Midland, Mich.) or styrene-based thermoplastics (for example, Elastylon, ECI Medical Technologies, Ontario, Canada) with patients, because these nonvulcanized glove materials usually do not contain carbamates, thiurams or mercaptobenzothiazoles. For handling chemically treated instruments, we recommended industrial-strength gloves made of polymers (such as FKM fluoroelastomer [Viton, DuPont Dow Elastomers, Wilmington, Del.] or laminated polyethylene and ethylene vinyl alcohol [4H, North Safety Products, Cranston, R.I.]) because of their superior chemical resistance and lack of rubber compounding chemicals.

Because the patient used methacrylates daily, we strongly encouraged her to develop a “notouch” technique. When some of her symptoms persisted, we observed her in the dental operatory and discovered that she still briefly handled uncured adhesives. Because methacrylates in adhesives and bonding agents penetrate all medical gloves, we recommended that she find ways of isolating her fingers, such as by using gauze or instruments to manipulate orthodontic bands.

As a result of the diagnosis, product avoidance and improved understanding about her allergies, our patient’s hands improved greatly within a few months. At her three- and 10-month follow-up visits, her hands had completely healed and remained in good condition for the first time in 10 years (Figure 3). Equally important, she was able to continue working with renewed spirit and communicate a new awareness to her colleagues about potential allergens in the dental environment.

DISCUSSION

Occupationally based dermatoses occur frequently; recent studies suggest that between onethird and one-half are due to ACD.17,18 In the medical and dental professions, staff members are at increased risk of becoming sensitized to several chemical antigens. Compared with the general population, health care workers are at least twice as likely to develop allergies to the biocides thimerosal, glutaraldehyde, formaldehyde and glyoxal, as well as to thiuram rubber processing chemicals.8,19 In addition, dental workers are at risk of developing allergies to the methacrylate components of dental bonding agents and adhesives.1,18

In allergic symptomatic staff members, skin health can deteriorate quickly when repeated allergen exposure is coupled with the drying effects of regular hand washing and incomplete treatment. As discussed above, when ACD in reaction to chemicals is misdiagnosed, skin problems can remain unresolved for years, with significant effects on an individual’s physical health and career.

Between 4 and 12 percent of dental workers are estimated to have ACD in reaction to the compounding chemicals (that is, thiurams, carbamates, thioureas, thiazoles) that are found in synthetic and natural rubber products such as medical gloves and rubber dams.20,21

Staff members often try new gloves and barrier creams to palliate their symptoms. However, these same chemicals are found in home skin and hair care pro\ducts, adhesives, fungicides, herbicides and insecticides, as well as in rubber products. Their combined presence in products at work and at home often increases exposure and exacerbates symptoms.

Health care workers may be up to eight times more likely to develop a glutaraldehyde allergy than is the general population. Staff members often use medical-grade gloves that can be readily permeated despite the special precautions recommended for glutaraldehyde use.12 Fortunately, our patient’s proactive dental practice implemented new and improved disinfecting and sterilizing procedures as a result of her diagnosis.

Methacrylates are a recognized source of ACD in dentistry: 22 percent of patch-tested dental workers experienced positive reactions to one of these compounds.1,18 Two of the most common- HEMA and ethylene glycol dimethacrylate-are found in dental adhesives and artificial fingernail preparations. Moreover, sensitization to HEMA may result in cross-reactivity to other methacrylates.22 In addition to the risk of developing contact allergies, repeated exposure to unpolymerized methacrylates may be responsible for finger or hand neuropathies with burning or prickling sensations.23,24 Medical-grade gloves generally are not resistant to methacrylates and provide little, if any, protection.11,12 Therefore, a no-touch technique is essential for all dental professionals regardless of their allergic history.

According to Schnuch and colleagues,19 health care workers are nearly three times more likely than the general population to be allergic to preservatives, antimicrobials or biocides, which are found in a variety of medical, dental and household products. Of these chemicals, thimerosal and methylchloroisothiazolinone are two of the more common allergens.25 Health care workers with ACD often apply medicaments, moisturizers or protective creams to treat their symptoms. Because these products (both over-the-counter and prescription) usually contain preservatives and antimicrobials, people unknowingly exacerbate their problems.

During the past decade, dental professionals have become aware of the allergenic potential of latex (that is, NRL) gloves, but not of the myriad chemicals in the dental operatory. Therefore, it is not surprising that the prevalence of ACD in reaction to some dental chemicals is on the rise.2 In addition, dental and medical professionals often do not seek immediate treatment; on average, people suffer for three years before obtaining a diagnosis, but they may wait as long as 40 years.3,26 Misinformation and presumptive self-diagnosis can delay obtaining a timely and accurate diagnosis, as well as an effective management strategy.

CONCLUSION

Resolving ACD in dental professionals requires several critical steps. First, dental staff members must acknowledge chemical exposure both at work and at home. Collecting chemical content information from dental and consumer products (for example, MSDS, product inserts, labels) can help identify potential chemical allergens and different routes of exposure.

The second critical step is to obtain an accurate diagnosis of recurring or chronic skin reactions. Batch testing is required and additional skin or blood testing may be needed. Because a diagnosis of ACD also is based on medical history, allergy history and current symptom assessment, chronicling all allergic reactions (for example, when, duration and degree) can be helpful. Moreover, dermatologists, allergists or other physicians with experience in occupational allergies are more likely to be trained in appropriate diagnostic procedures.4 These physicians can be an invaluable resource in resolving the symptoms of ACD.

Finally, once a dental professional is diagnosed as having ACD, he or she must learn to avoid the products that contain the allergen or allergens and eliminate or minimize the potential routes of exposure. Although not a cure, this avoidance strategy is an effective way to manage ACD and its symptoms. However, education is paramount; dental professionals must continually learn about the chemical content of the products used at work and at home. Moreover, patch testing may not identify all allergens, and allergenic cross- reactivity is common between certain chemicals. Therefore, awareness of any new symptoms and potential exposure is important for people with ACD. By following these guidelines, dental professionals can be symptom-free with an intact skin barrier against pathogen transmission.

Notes

With the exception of polyvinyl chloride gloves, SmartPractice does not market any of the products mentioned in this article.

The authors thank Kristina Turjanmaa, M.D., for providing the natural rubber latex glove-wash solutions and unpreserved saline.

The authors gratefully acknowledge the expertise and advice of Daniel Hogan, M.D., chief of dermatology, Louisiana State University Medical Center, Shreveport, in this case study.

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JADA 2003;134(2):185-94.

Copyright 2003 American Dental Association. All rights reserved. Reprinted by permission of ADA Publishing, a Division of ADA Business Enterprises, Inc.

By Curtis P. Hamann, M.D., Pamela A. Rodgers, Ph.D., and Kim Sullivan

Dr. Hamann is chief executive officer and medical director of SmartPractice, a dental supply company:

3400 E. McDowell Road, Phoenix, AZ 85008

e-mail [email protected].

Address reprint requests to Dr. Hamann.

Dr. Rodgers is chief research scientist at SmartPractice.

Ms. Sullivan is vice-president of research and regulatory affairs at SmartPractice.

Copyright American Dental Assistants Association Sep/Oct 2006

(c) 2006 Dental Assistant. Provided by ProQuest Information and Learning. All rights Reserved.

Liquid Bandage Banishes Skin Tags

By Joe and Teresa Graedon

Q: I have noticed quite a few skin tags appearing on my body. I have had one or two of the larger flaps cut off by my doctor.

I was fascinated to read in your column that a reader had success getting rid of skin tags by putting special Band-Aids on them. I tried this but could never get a bandage to stay on long enough.

I was about to give up when I ran across some liquid bandage in my medicine cabinet. I had a large flap growing on my shoulder and put the New Skin Liquid Bandage on it. Within a week, the flap fell off.

I put it on some smaller skin tags, and they shriveled and fell off, too. Have you heard of this before, or have I discovered an alternate way to get rid of these unsightly skin growths?

A: Skin tags are benign, fleshy growths that commonly appear in skin folds such as under the arms, in the groin area or on the neck. They can also show up on the face. They are common and not dangerous. Dermatologists can remove them surgically or with an electric needle.

A few years ago, a reader suggested applying Band-Aid Clear Spots tightly over skin tags to get rid of them in a week or two. Your technique sounds a little easier, and we will be interested to learn if it works for others.

***

Q: My mother recently had emergency surgery (two days after planned hip-replacement surgery) to repair an ulcer that had left a hole the size of a half dollar in her stomach. She had been taking Mobic prior to her hip surgery.

Please alert your readers to the dangers of NSAIDs. They must be informed about the risks of these drugs, particularly for the elderly.

A: It has been estimated that more than 100,000 people are hospitalized each year because of adverse reactions to NSAIDs (nonsteroidal anti-inflammatory drugs). More than 15,000 people die, often because of complications caused by bleeding or perforated ulcers. Drugs in this class include ibuprofen (Advil, Motrin), diclofenac (Cataflam, Voltaren), meloxicam (Mobic), naproxen (Aleve, Naprosyn) and indomethacin (Indocin).

In addition to digestive-tract damage, NSAIDs can raise blood pressure, increase the risk of heart attacks and strokes, as well as injure kidneys and the liver.

***

Q: Is there a generic for the depression drug Paxil? I have already fallen into the “doughnut hole” in Part D (Drug Coverage) of Medicare and would like a substitute for Paxil if one is available.

A: When Medicare patients enter the doughnut hole, they must pay 100 percent of their medication bill. Paxil can cost around $100 a month. The generic paroxetine is available for about a third as much.

The Graedons’ syndicated radio show can be heard on WNED-AM 970 at 1 p.m. Saturdays and at 6 a.m. Sundays.

(c) 2006 Buffalo News. Provided by ProQuest Information and Learning. All rights Reserved.

New England Organ Bank Recognized As One of Nation’s Top Performing Organ Recovery Agencies

NEWTON, Mass., Oct. 26 /PRNewswire/ — The U.S. Department of Health and Human Services has honored New England Organ Bank as one of the nation’s best performing Organ Procurement Organizations (OPO). The Distinguished Performance Award was presented to New England Organ Bank for its success in achieving high levels of performance over an extended period of time and for demonstrating outstanding practice in multiple aspects of the life saving work of organ donation and transplantation.

New England Organ Bank (NEOB) received the award because it excelled in performance measures considered most critical by donation professionals:

    * High conversion rates (the number of potential deceased organ donors      who become organ donors).    * High rate of organs transplanted per donor.    * High percentage of donors who donate following cardiac death      (as compared to the more common donation following brain death).   

Elizabeth Duke, administrator of HHS’ Health Resources and Services Administration, said, “Their achievement shows that we can improve systems to boost donation rates and save more lives in the future.”

Richard S. Luskin, Executive Director of New England Organ Bank said, “The true importance of this award is that by making more organs available for transplant, NEOB helped save the lives of many people on the transplant waiting list. Saving those lives is our mission, and it is why we come to work every day.”

In July of this year, NEOB set a one-month record for organ donors in New England by recovering 92 transplantable organs from 27 donors and is on track for a record breaking 2006.

“As we celebrate these accomplishments, let us remember that behind each number is a human face: an individual who has made a gift of life by becoming an organ donor,” relates RADM Kenneth Moritsugu, Acting U.S. Surgeon General. “The success of these professionals is helping save more lives, and increasing the quality and length of life for more people. It is only fitting that we recognize their exceptional efforts through this Distinguished Performance Award.”

NEOB is the non-profit, federally-designated OPO for all or part of the six New England states. To learn more about donation, visit http://www.neob.org/.

New England Organ Bank

CONTACT: Sean Fitzpatrick, Director, Public Affairs of NEOB,+1-617-558-6626

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

WellPoint to Cover Varicella Zoster Virus, or Shingles Vaccine

INDIANAPOLIS, Oct. 26 /PRNewswire/ — WellPoint, Inc. announced today that effective immediately it will cover the vaccine Zostavax(TM), designed to prevent shingles, a painful condition resulting from the reactivation of the chickenpox virus, typically in older individuals.

The vaccine will be covered for individuals 60 years of age and older whose benefit plans provide coverage for vaccines. WellPoint already provides benefits for Zostavax through its Medicare Part D benefit based on the Food and Drug Administration’s licensure of Zostavax on May 25, 2006. Specific benefit plans may have variable benefits for immunizations.

The decision to cover Zostavax, manufactured by Merck, was made following formal recommendations provided yesterday by the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP). ACIP recommended that Zostavax be offered to all individuals 60 years of age and older. The CDC and U.S. Department of Health and Human Services will now review ACIP’s recommendations and make a formal recommendation on coverage.

“We applaud ACIP’s decision to issue a formal recommendation regarding the use of Zostavax,” said Sam Nussbaum, M.D., executive vice president and chief medical officer for WellPoint, Inc.

Zostavax is currently the only licensed vaccine in the United States that reduces the risk of reactivation of the chickenpox, or varicella virus, which remains dormant in the body after recovery from chickenpox earlier in life. Shingles, also known as herpes zoster, strikes about 1 million Americans a year, mostly those aged 60 and older. Up to 200,000 people who develop shingles have a particularly bad type of nerve pain called post-herpetic neuralgia that can persist for months or years.

“We believe this vaccine is a medical breakthrough that will benefit seniors throughout the country,” said Nussbaum. “Helping to improve the lives of our members and the health of our communities is our mission at WellPoint, and we continuously look to support new, proven treatments that will help our members prevent significant illness.”

According to WellPoint policy, immunization coverage decisions are based on recommendations issued by ACIP and other nationally recognized organizations. ACIP is comprised of 15 experts in fields associated with immunization who provide advice and guidance to the U.S. Department of Health and Human Services and CDC on the most effective means to prevent vaccine- preventable diseases.

About WellPoint, Inc.

WellPoint’s mission is to improve the lives of the people it serves and the health of its communities. WellPoint, Inc. is the largest health benefits company in terms of commercial membership in the United States. Through its nationwide networks, the company delivers a number of leading health benefit solutions through a broad portfolio of integrated health care plans and related services, along with a wide range of specialty products such as life and disability insurance benefits, pharmacy benefit management, dental, vision, behavioral health benefit services, as well as long term care insurance and flexible spending accounts. Headquartered in Indianapolis, Indiana, WellPoint is an independent licensee of the Blue Cross and Blue Shield Association and serves its members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as Blue Cross Blue Shield in 10 New York City metropolitan and surrounding counties and as Blue Cross or Blue Cross Blue Shield in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), Wisconsin; and through UniCare. Additional information about WellPoint is available at http://www.wellpoint.com/.

WellPoint, Inc.

CONTACT: Media Contact: Tania Graves, +1-317-488-6543, or +1-402-218-6198(cell); or Investor Relations: Wayne S. DeVeydt, +1-317-488-6390, both ofWellPoint, Inc.

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

Man Power: Pressure Pads Under Pavements Could Generate Electricity From Every Step We Take

By Meg Carter

Can a staircase capture energy from people walking up and down it, store it as electricity and use it to power lighting? It sounds like science fiction, yet it is one of a number of seemingly far- out ideas being taken very seriously by scientists and engineers whose goal is to harness the generating power of the human body.

“When we walk along a pavement, eight watts of energy is wasted – absorbed by the ground – with each heel. Yet it’s possible to harvest at least 30 per cent of that energy,” explains Claire Price, a director at The Facility Architects in London.

“Think of a dance floor, which is designed to dampen vibrations and limit the damage dancers could do to their limbs. What we’re now working on features a matrix of energy harvesters positioned beneath a floor. These dampen vibrations but store rather than dissipate that energy to provide a source of power – for free.”

Price is leading the Pacesetters Project, an initiative that will involve the installation of the world’s first human energy harvesting staircase in Portsmouth’s Spinnaker Tower early in the new year. Also taking part are electronics company Philips and teams from Hull University – which has developed a heel-strike generator that fits into a shoe to capture the energy exerted as we walk – and Southampton University, which has developed a way of generating power from the vibrations which naturally occur within buildings. Their aim is to show how power can be generated from human movement and to prove its potential to supplement power supply in public spaces.

“How best to store the harvested energy has been a challenge,” Price admits. “Our focus is on improvements to super-capacitors and other storage devices. But we are confident that if the energy is used close to where it was generated, then these plans would be a feasible alternative to the national grid. It could power lighting, LED displays and audio systems used in public spaces.”

When you consider that a busy transport interchange such as Victoria station in London is used by an estimated 34,000 pedestrians an hour at peak times, footfall sounds like a viable alternative source of power. And there’s another potential green benefit: once an electrical appliance no longer needs to be wired into the grid, less copper and plastic will be required.

So if human energy has this sort of potential, why has it not been properly exploited before? Rory Steer, executive chairman of Freeplay, which developed the first wind-up radio, dreamt up by British inventor Trevor Bayliss just over a decade ago, explains. “The energy generated by human activity needs not only to be effectively harnessed but also efficiently stored and then released in a controlled manner,” he says. “And a large amount of human effort is required to generate even a modest amount of power. How long will someone be prepared to work to store the energy for a particular product? However, as electrical products are designed which consume less power, the potential applications grow.”

And it is this that is now kick-starting interest in self-power generation. A growing number of low-power electrical goods are now available. And advances have been made in understanding how to capture, store and release human energy. The Pacesetters Project is not the first attempt to harness human energy, points out Professor Neil White of Southampton University, who has developed a device that can harvest energy from vibrations in buildings.

“Back in the Eighties, Seiko developed the Kinetic wristwatch, powered by human movement. This did away with the need for a conventional battery by exploiting the distances the human arm can cover over time,” he says. “A number of kinetic watches have since been produced, but the potential of this technology to power larger electrical items is limited by the low speed at which people move.” The US and UK armies had experimented with energy-harvesting devices that could be built into soldiers’ boots. One application for this technology was to provide an power supply to run radio telephones traditionally powered by unwieldy rechargeable batteries. However, plans foundered when it became clear the harvesters weren’t robust enough to withstand extreme conditions.

Then in the early Nineties along came Freeplay, with its wind-up radios, lights and torches. More recently, it invented a wind-up generator to charge mobile phones, a foot-pump generator capable of powering larger items and a prototype range of wind-up medical equipment. It is also involved in developing the wind-up mechanism to power the so-called $100 ([pound]53) laptop – being developed to bring the PC to children throughout the developing world. Opinion is divided on what is the best way of harnessing human power. For some, the future lies in built-in devices such as the heel-strike generator; others point to mechanisms able to harness the energy generated by combined human activity.

Price says the Pacesetters Project has already attracted attention from the business world. She is working with a manufacturer of gym equipment to develop a way of harnessing power generated by people using running machines. Steer, meanwhile, has struck a deal to launch renewable-energy-powered products in India. Yet he believes the future for Freeplay lies in developing products that combine wind-up technology with solar and wind power. “Sustainable energy is a niche business in the developed world and probably always will be – except in the UK, where legislation is encouraging its development,” he explains. “The reason’s simple: the average consumer wants the easiest access to energy – the national grid.”

The story so far…

Seiko launched its first no-battery watch powered by the wearer’s movement back in 1988. Its Kinetic range uses an oscillating weight that is rotated by the movement of the wearer’s wrist, which is transformed into a magnetic charge then into electricity, which is stored in a tiny capacitor and rechargeable battery.

Massachusetts Institute of Technology’s MIT Media Lab is one of a number of institutions exploring the potential for devices embedded in shoes to generate power while the wearer is walking and even harvesting energy from finger motion. Possible footfall applications include powering a radio or a wearable computer.

The Japanese rail company East Japan Railways earlier this year installed ticket gates that generate electricity from the vibrations and pressure created as people pass through them. The electricity is used to operate the automatic gates.

Freeplay developed and manufactured the original wind-up radio invented by Trevor Bayliss. Since then it has developed a whole family of wind-up radios; branched out into wind-up torches and hybrid products using solar and wind-up power; and recently launched Weza, its first foot-pump generator. Planned future applications of its technology include self-generated medical equipment.

Researchers at Georgia Institute of Technology have demonstrated that inexpensive nanowires can be used to harvest mechanical energy from inside the human body. This could be used to power advanced medical implants.

Vons and Pavilions Offer In-Store Flu Vaccines

Vons and Pavilions stores announced that they are offering flu vaccines at all 309 locations in Southern California and Clark County Nevada. Now through February 2007, or while supplies last, flu vaccines will be administered at stores. Most stores will give vaccines on a walk-in basis at in-store pharmacies, while others will conduct scheduled flu shot clinics.

“The best way to prevent the flu is to get a vaccine each fall. By administering vaccines on site at our in-store pharmacies, Vons and Pavilions are making it easy for anyone to protect themselves,” said Dave Fong, Senior Vice President, Pharmacy. “Receiving a flu shot is as easy as stopping at the pharmacy during your regular shopping trip.”

The Centers for Disease Control and Prevention recommends flu vaccines for people who are at high risk of having serious flu-related complications and for those who live with or care for high-risk persons. According to the CDC, those who should receive annual flu vaccines are:

Children 6 months to 5 years old

Pregnant women

People 50 years old or older

People of any age with certain chronic medical conditions, including heart disease, lung disease, asthma, kidney disease, diabetes, seizure disorder, anemia, and weakened immune system

Caretakers of children less than 6 months of age

Healthcare professionals who are in close contact with people at risk for the flu

Or anyone wanting to avoid catching the flu

The CDC also recommends those planning to receive a flu vaccine do so in October or November, the beginning of the flu season. However, vaccines can be received anytime during flu season. A list of stores offering flu vaccines and/ or conducting flu clinics can be found at www.vons.com/flu and www.pavilions.com/flu or by contacting a Vons and Pavilions pharmacy. Medicare Plan B participants not enrolled in a Medicare Advantage plan will receive the flu vaccines at no charge.

Store pharmacies offer full-service adult and adolescent immunization services for the prevention of such ailments as shingles prevention, tetanus, hepatitis, pneumococcal and meningococcal. Locations for these immunization services can also be found at www.vons.com/flu and www.pavilions.com/flu.

About Vons, A Safeway Company

The Vons division operates 309 stores throughout Southern California and Clark County Nevada under the Vons and Pavilions banners.

Safeway Inc. is a Fortune 50 company and one of the largest food and drug retailers in North America based on sales. The Company operates 1,767 stores in the United States and Canada and had annual sales of $38.4 billion in 2005. The company’s common stock is traded on the New York Stock Exchange under the symbol SWY.

The Foundation for Managed Care Pharmacy Re-Appoints Dr. Schumarry H. Chao and John Hopkins To Board of Trustees

Schumarry H. Chao, MD, MBA, president of SHC & Associates, Inc. and John Hopkins, RPh, president and CEO, Rocky Mountain Health Plans, have both accepted appointments to the board of trustees of the Foundation for Managed Care Pharmacy for two year terms.

The Foundation for Managed Care Pharmacy is the sister organization of the Academy of Managed Care Pharmacy (AMCP) providing research and educational opportunities in the field of managed care pharmacy. Cynthia J. Pigg, RPh, MHA, executive director of the Foundation, said, “I am delighted to have such esteemed members of the health care community returning to the board. The experience of Chao and Hopkins, combined with the vast knowledge and diversity of the current trustees, will enable the Foundation to continue to deliver on its vision that we all live a better life because we receive and adhere to the medications that work best for us.”

Dr. Schumarry H. Chao is a physician with successful leadership, strategic and operational experience in the insurance, employer, pharmaceutical and health care information technology industries, and is regarded as an expert in the development of a number of strategic and marketing plans for major pharmaceutical, biotechnology and medical device companies. She also serves on the editorial board of the American Journal of Medical Quality, the board of China Center for Health Economics, as co-chair of the steering committee for the Benefit Design Institute and the board of trustees, University of Sciences, Philadelphia.

Dr. Chao has served as chief medical officer and senior vice president, Strategic Development for a pharmacy benefits manager and as vice president and corporate medical director for a large national managed care organization. On the employer/payer side, Dr. Chao developed and implemented innovative health benefit strategies and developed and implemented a direct contract managed care plan. As a consultant, she has led a number of consulting projects in the health care industry as well as a number of pharmaceutical and biotechnology companies.

Dr. Chao received her BS and MBA from the University of Southern California and her MD from the University of California Medical School, San Francisco. She is board certified in Emergency Medicine. Her academic appointments include clinical professor of Emergency Medicine and Family Medicine as well as adjunct professor of Pharmacoeconomics at the University of Southern California.

John Hopkins has held a variety of leadership positions for both the Academy of Managed Care Pharmacy and the former American Association of Health Plans, now known as America’s Health Insurance Plans. He is president elect and past president of the Colorado Association of Health Plans and a governor’s appointee to the board of CoverColorado (formerly Colorado Uninsurable Health Insurance Program). Additional current involvement includes the boards of the Grand Junction Economic Partnership, Grand Junction Chamber of Commerce and the Alliance for Advancing Nonprofit Healthcare.

Hopkins has bachelor of science degrees in Pharmacy and Psychology, both from the University of Wyoming, and was a clinical pharmacy resident at the Veterans Administration Hospital in Palo Alto, CA.

Dianne A. Kane Parker, PharmD, Health Outcomes & Pharmacoeconomics Regional Medical Liaison at Amgen, Inc., is president of the FMCP board of Trustees. Cathy A. Carroll, PhD, director of Patient Care Services Research at Children’s Mercy Hospitals & Clinics, serves as treasurer. Other board members include Steven W. Gray, PharmD, JD, Pharmacy Professional Affairs Leader at Kaiser Permanente,; Jon Clouse, MS, director, Pharmacoeconomic Evaluations of UnitedHealth Pharmaceutical Solutions; Roger L. Hyde, vice president, Managed Markets, AstraZeneca Pharmaceuticals; Hugh O’Neill, MBA, vice president of Integrated Healthcare Markets at sanofi-aventis; Richard Patrylak, MBA, senior vice president, USHH Customer Sales, Marketing & Policy of Merck & Co.; and Richard A. Zabinski, PharmD, vice president, Pharmaceutical Solutions, Health Solutions Group, United HealthCare Corporation. Judith A. Cahill, executive director of the Academy of Managed Care Pharmacy, serves as secretary.

The Foundation for Managed Care Pharmacy (www.fmcpnet.org) is a non-profit charitable trust recognized by the Internal Revenue Service as the educational and philanthropic arm of the Academy of Managed Care Pharmacy (AMCP). The Foundation supports the goals of and mission of AMCP and exists to advance the knowledge and insights of interested individuals and groups on major issues associated with the practice of pharmacy in a managed health care setting.

The Academy of Managed Care Pharmacy’s mission is to empower its members to serve society by using sound medication management principles and strategies to achieve positive patient outcomes. AMCP has more than 4,800 members nationally who provide comprehensive coverage and services to the more than 200 million Americans served by managed care. More news and information about AMCP can be obtained on its website, at www.amcp.org.

Satiety, Inc.’s New Transoral Procedure for Treating Obesity Shows Promising Results in First Clinical Trial

Satiety, Inc. announced today the presentation of data from the first clinical trial evaluating its TOGaTM System for treatment of obesity. The TOGaTM (for “transoral gastroplasty”) Procedure is the first designed to mimic established restrictive surgical procedures for obesity, but to be performed completely transorally, without incisions.

Data from the TOGa pilot trial was presented at two major medical meetings in the U.S. and Europe this week. On Monday, Dr. Steven Edmundowicz of Washington University, St. Louis, presented data from a single center in the President’s Plenary Session at the American College of Gastroenterology Annual Scientific Meeting in Las Vegas, Nevada. In the trial at Hospital Regional 1° de Octubre ISSSTE in Mexico City, 12 obese patients were treated starting in February 2006 by Dr. Gerardo de Jesus Ojeda and Dr. Fabian Luis Cuevas. All patients were treated safely, without any serious adverse events, and the procedure was well tolerated.

Dr. Edmundowicz commented, “The clinical benefit to obese patients treated by currently available bariatric surgery is well established, and the TOGa procedure is exciting because it uses the same mechanism, restriction, but with a much less invasive approach. We are encouraged by the early results of this safety and feasibility trial. If the TOGa Procedure is shown to be safe and effective, it could significantly increase the number of patients that are eligible for obesity treatment because it is less invasive. This is a promising first step.”

In a separate presentation today at the 14th United European Gastroenterology Week in Berlin, Germany, Professor Jacques Devire, MD, PhD of Erasme Hospital in Brussels, Belgium, presented comprehensive safety, feasibility, and 3-month weight loss data for all 21 patients treated in the pilot trial, including patients from the Mexico site as well as nine patients he treated with his multi-specialty bariatric team in Brussels. All patients were treated safely and the procedure was well tolerated. Endoscopy and barium studies showed well-healed, persistent restrictions in the majority of patients. At three months, patients had lost an average of 24.7 pounds, and 20.5% of their excess body weight.

Professor Devire, the principal investigator of the TOGa Pilot Trial said, “This trial was an important step in establishing the acute safety of the procedure, with minor adverse events being similar to those seen during routine upper GI procedures. Tissue healing was good, and we showed that it is possible to achieve a durable restrictive pouch. The weight loss seen in this study is encouraging, and we are optimistic that anatomic and weight loss results may improve above what is seen here in future trials, which will incorporate improvements in the device.”

In the TOGa procedure, an endoscopic device is inserted through the patient’s mouth into their stomach to create a small stapled restrictive pouch. A second device is passed to tighten the outflow tract of the pouch to limit the amount of food a patient can eat in a single meal. The safety of the procedure is currently being evaluated in this pilot study. A second trial evaluating both the safety and effectiveness of the procedure for U.S. FDA approval is expected to begin in the first half of 2007.

Greg Patterson, President and CEO of Satiety, Inc. commented “Satiety is pleased to have achieved this important clinical milestone demonstrating safety and feasibility in humans. While the trial was not designed to focus on weight loss, we are encouraged that the patients lost a significant amount of weight in this first-in-man trial. The TOGa Procedure promises to be a breakthrough technology as it replicates current proven restrictive obesity surgeries, but does so simply by stapling the stomach from the inside out, without the need for incisions. We think this procedure could dramatically expand the treatable patient population as well as enable new categories of endoscopically trained physicians to treat bariatric patients, thus improving accessibility to treatment for obesity and its comorbidities. We look forward to the next step in the clinical trials process and, ultimately, the commercialization of this technology to benefit obese patients worldwide.”

About Obesity, Current Treatment

Obesity is a global disease that affects more than 300 million people, according to the World Health Organization. Obesity causes or contributes to numerous serious medical conditions including type 2 diabetes, hypertension, cardiovascular disease, arthritis, sleep apnea, and certain types of cancer. In the United States, it is estimated that obesity is linked to approximately 300,000 deaths annually and leads to approximately $100 billion in direct healthcare expenditures. Approximately 22 million adults in the United States are considered morbidly obese. This morbidly obese population underwent approximately 170,000 bariatric surgical procedures in 2005, and this procedure base is growing at approximately 18% per year. While the number of surgeries is growing, it is estimated that only 1.2% of eligible patients are treated each year.

The most common treatments for obesity – diet, exercise and pharmacologic therapy — have poor long-term success rates. Obesity surgery, which entails surgical restriction of the size of the stomach with or without rerouting the intestine to cause malabsorption, has been proven to be the only effective means of achieving sustainable weight loss in patients. While the current surgical treatments for obesity are effective, they are major surgical procedures involving irreversible reconstruction of gastrointestinal anatomy or requiring surgical implants. Many patients who could benefit from these procedures forego surgery due to the significant complications and long-term adverse event rates associated with these procedures.

About the TOGaTM Procedure and Satiety, Inc.

The TOGa Procedure is a completely transoral procedure designed to achieve similar weight loss to restrictive surgeries. The procedure is designed to be less invasive, require significantly less recovery time and have dramatically reduced complications, compared to existing surgical options. In the TOGa Procedure, the physician introduces a stapling device transorally and creates a restrictive pouch at the entry of the stomach. The effect is anatomically similar to other restrictive procedures, which physically restrict the amount of food a patient can eat. The procedure is non-surgical, endoscopic, and may be performed by properly trained bariatric surgeons, general endoscopic surgeons, and gastroenterologists. The TOGa System is an investigational device, and is not approved by the FDA or European regulatory agencies.

Satiety, Inc. is headquartered in Palo Alto, California, and is focused on the development of a less invasive treatment for obesity. The company was founded in 2001 through a collaboration of medical device incubators Thomas Fogarty Engineering and The Foundry. The Company is funded by leading venture capital investors including Three Arch Partners, Morgenthaler Ventures, Venrock Associates and ABS Ventures.

`Lax’ Firm Quietly Tapped For

By CASEY ROSS

After repeatedly bashing safety oversight by the Big Dig’s top management consultant, the Romney administration quietly tapped the controversial firm to inspect repairs of the Interstate 90 ceiling system that collapsed and killed a woman in July, the Herald has learned.

A spokesman for Bechtel/Parsons Brinckerhoff said the firm has been conducting daily field inspections of remedial work inside the I-90 Seaport connector tunnel – essentially the same role it played before the collapse that killed Jamaica Plain motorist Milena Del Valle, 38.

“This is just stunning,” said independent gubernatorial candidate Christy Mihos, a former Turnpike Authority board member. “Why would they let the same people who got us into this mess look to find the most opportune way of getting us out of it?”

A spokesman for the Turnpike Authority said last night that Romney’s transportation chief, John Cogliano, was not aware the firm had been working in the connector tunnel until the administration was contacted by the Herald. Romney has been in charge of the tunnel repair work since mid-July.

“When Secretary Cogliano heard about it, he thought it was entirely inappropriate and he is stopping it immediately,” spokesman Jon Carlisle said. Pressed on who made the decision, Carlisle said it was a mid-level manager, but declined to elaborate.

The move to involve Bechtel/Parsons Brinckerhoff contradicted assurances by Romney that repairs in the I-90 connector tunnel would remain scrupulously independent of firms involved in the original construction. It also contrasts with harsh criticisms the governor lobbed at B/PB after the collapse.

“How can it be that oversight was so lax?” an exasperated Romney asked during an Aug. 8 press conference in which he criticized B/PB by name. “The basic structure (of ceiling supports), even had it worked as it was designed, was inadequate to the task.”

Despite those concerns, Romney’s Executive Office of Transportation asked the firm to help oversee day-to-day remedial work by J.F. White and McCourt Construction, the two contractors now handling repairs in the eastbound and westbound lanes of the I-90 connector tunnel. B/PB has been involved in the work for at least two weeks.

Andy Paven, a spokesman for the joint-venture firm, said, “We were asked by EOT (the Executive Office of Transportation) for professional assistance, and we’ll do what we’re asked to help support the reopening of the tunnel.”

Paven added that, despite public finger-pointing at Bechtel, no finding has been reached by agencies probing Del Valle’s death. “There are multiple investigations under way whose purpose is to determine cause and responsibility for the July 10 collapse,” he said.

The administration’s handling of the Big Dig has come under intense scrutiny amid an increasingly bitter campaign for governor in which Lt. Gov Kerry Healey is trying to close a gap in polls in which she trails Democratic rival Deval Patrick.

In a statement last night, Patrick said, “Enough is enough. It is very clear that the Romney-Healey administration has failed in its oversight of the Big Dig. This fox guarding the hen house approach . . . is what got us into this mess in the first place.”

Multiple attempts to get comment from the Healey camapign last night were unsuccessful.

[email protected]

BOX: `Inadequate to the task’

Despite repeatedly bashing the Big Dig’s top management consultant, Gov. Mitt Romney’s transportation appointees have tapped that firm, Bechtel/Parsons Brinckerhoff, to inspect repairs of the Interstate 90 Seaport connector tunnel ceiling that collapsed in July, killing a woman. Here are comments Romney made on the project and Bechtel’s design and oversight role after the collapse:

July 14:

“The history of this project just makes you shake your head. There have been design mistakes, poor construction, poor management. The list goes on and on.”

Aug. 8:

“How can it be that oversight was so lax?” Romney asked during a press conference, referring to Bechtel’s work. “The basic structure (of ceiling supports), even had it worked as it was designed, was inadequate to the task.”

Romney later hit the firm over deficiencies in the design of ceiling brackets: “It’s hard to understand how . . . the engineering firm responsible for integrity and quality assurance of the entire project would not have done a calculation of these connection brackets.”

Aug. 31:

In an Herald interview about how long the tunnel will be closed, Romney says of Bechtel: “With the number of problems with engineering and construction so significant, it’s going to take quite a while. You would think you’d get a little more for your $14.7 billion.”

Sept. 1:

Announcing the discovery of new defects in the tunnel, Romney again hits Bechtel: “Obviously, this compounds the frustration we all have with the engineering, design and quality assurance of the tunnel system. We’ve found three (categories of defects) so far. Will we find a fourth? I don’t know.’

(c) 2006 Boston Herald. Provided by ProQuest Information and Learning. All rights Reserved.

Care Improvement Plus Launches Georgia’s First Health Plan to Focus on Chronically Ill Medicare Beneficiaries

ATLANTA, Oct. 24 /PRNewswire/ — Nearly a quarter of a million Medicare beneficiaries in Georgia are eligible to join Care Improvement Plus, Georgia’s first health plan to focus exclusively on chronically ill Medicare beneficiaries and their unique healthcare needs.

Care Improvement Plus has obtained formal approval from the Centers for Medicare & Medicaid Services to offer a new type of Medicare Advantage “Special Needs” Plan that provides all Medicare covered services, a tailored Medicare Part D drug benefit, and disease management services to Medicare beneficiaries in Georgia with diabetes, heart failure, chronic obstructive pulmonary disease (COPD), and/or end-stage renal disease (ESRD).

“This is the first time a plan like this has been offered to Georgia’s chronically ill seniors,” said Robb Cohen, vice president of government affairs for XLHealth, parent company of Care Improvement Plus. “While disease management-focused health plans are a new concept, our focus on providing tools to help manage chronic conditions makes sense for this population. Not only can our services help them ward off avoidable disease complications such as amputation, blindness, stroke and heart attack, but we also can help address the approaching Medicare crisis by reducing the need for expensive treatments and hospitalizations.”

A recent government forecast (http://www.ssa.gov/OACT/TRSUM) attributes the approaching Medicare fiscal crisis to soaring healthcare costs, the approaching retirement of 78 million baby boomers, and their increasing demand for complex health services. In an effort to help improve care and rein in costs, the Medicare Modernization Act of 2003 allows Medicare Advantage organizations to offer Special Needs Plans to three groups of Medicare beneficiaries: those with chronic illness, those residing in nursing homes, and low-income individuals who qualify for both Medicare and Medicaid. Care Improvement Plus was approved to offer a chronic illness Special Needs Plan to residents of Georgia.

“As Georgia’s senior population grows, issues of healthcare and senior health education confront us all,” said Dennis L. White, chief executive officer of the Georgia Medical Care Foundation. “I encourage programs like Care Improvement Plus that address the needs of chronically ill Georgia residents and provide Medicare beneficiaries’ with valuable services such as the support of a personal nurse, and materials and tools to help them improve their quality of life.”

Each plan member is assigned a Care Improvement Plus care team comprising a dedicated local healthcare manager, local field nurse and telephone coach nurse – all of whom work closely with the beneficiary’s physicians to coordinate services and help provide optimal care. Members receive coverage that offers the advantages of traditional Medicare, plus additional benefits, care coordination, and services as appropriate, such as:

   -- the ability to see any provider that accepts Medicare   -- $0 or no-cost premiums and co-pays   -- comprehensive prescription drug coverage under Medicare Part D - with a      formulary specifically designed for people with diabetes and other      chronic health conditions   -- expanded Medicare benefits including more comprehensive podiatry visits   -- nursing support in person or by telephone   -- medication monitoring and counseling   -- medication and appointment reminders   -- education on symptoms and early warning signs of complications   -- tools to help monitor and manage health, such as diabetic protective      shoes and/or blood pressure cuffs for those who qualify   -- free transportation services   

Care Improvement Plus also supports participating physicians with a variety of services designed to help them care for chronically ill patients, such as: compensation for time spent on non-Medicare covered services, an open-access model that doesn’t require referrals, collection of medical histories in advance of office visits, and easy-to-read reports containing all of each patient’s up-to-date information.

Care Improvement Plus is currently accepting enrollment applications for coverage effective January 1, 2007. To join, individuals must live in Georgia, be eligible for Medicare, and have diabetes, heart failure, COPD and/or ESRD. Those interested in learning more about the plan can call (866) 651-1979 to speak with a plan representative or visit the plan’s Web site at http://www.careimprovementplus.com/.

About Care Improvement Plus

Care Improvement Plus, a new health plan that focuses on the unique healthcare needs of chronically ill Medicare beneficiaries, provides a Medicare Advantage health plan and disease management services to Medicare beneficiaries living with heart failure, diabetes, chronic obstructive pulmonary disease and/or end-stage renal disease. Care Improvement Plus also provides tailored Medicare Part D drug coverage, along with a variety of services designed to support physicians’ efforts to care for their chronically ill patients. Care Improvement Plus has received Full Accreditation for its patient and practitioner disease management program from the National Committee for Quality Assurance (NCQA). The plan is administered by Baltimore-based XLHealth, one of the nation’s fastest growing disease management companies. More information about XLHealth and Care Improvement Plus can be found at \o “http://www.careimprovementplus.com/” http://www.careimprovementplus.com/.

Care Improvement Plus

CONTACT: Kristin Brunnworth, +1-410-962-6447, [email protected], forCare Improvement Plus

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

Mothers-to-Be Can Rest Easy: Victor Valley Hospital Rates in Top 5 Percent Nationally for Maternity Care

By Tatiana Prophet, Daily Press, Victorville, Calif.

Oct. 24–VICTORVILLE — Critically injured patients might need to be transported by helicopter out of the Victor Valley, but mothers-to-be can feel secure about giving birth at a hospital in the area. Victor Valley Community Hospital was rated in the top 5 percent in the nation for maternity care by HealthGrades, an independent health care research firm based in Golden, Colo. The rating also included five stars for Victor Valley’s patient outcomes, indicating that they were better than expected. St. Mary Medical Center, Desert Valley Hospital and Barstow Community Hospital all received three stars for patient outcomes that were “as expected.””We don’t deliver the most, but we do a good job with what we do,” said Ray Marien, manager of public affairs and marketing for Victor Valley. “We’ve got an excellent, experienced staff, I mean they’re truly caring. It’s a top priority for us. The two biggest areas in the hospital are maternity and emergency room.” Marien pointed to the presence of fetal monitors that are in each labor and delivery room as an example of the high-quality of care. He also cited the practice of keeping the infant with the mother at all times, even during emergencies, as evidence of the great care the hospital takes when it comes to bringing children into the world. Hospital CEO Margaret Peterson said she was proud of the maternity staff. “Attainment of this prestigious level of excellence is a direct reflection of not only their dedication and professionalism, but also of the excellence of our medical staff,” she said. For the maternity care rating, a panel of physicians ranked the following criteria: in-hospital complication rates associated with vaginal and cesarean deliveries, in-hospital volume, neonatal mortality and complication rates for non-indicated or patient-choice cesarean sections. The ratings were based on care given between 2002 and 2004. HealthGrades, a publicly traded company, makes its ratings available on its Web site free of charge. About 2.5 million people visit the Web site each month to find hospitals that provide high quality of care, and employers also direct their employees to the firm so they can optimize their health care. HealthGrades analyzes the quality of care at more than 1,400 hospitals across 17 states that make case files available. Victor Valley Community Hospital also received five stars for diagnosis and care involving hip fracture repair, appendectomies and community-acquired pneumonia. Desert Valley Hospital also received five stars in the category of community-acquired pneumonia, while St. Mary received three stars in every category, meaning care was satisfactory. Tatiana Prophet may be reached at 951-6222 or at [email protected].

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Copyright (c) 2006, Daily Press, Victorville, Calif.

Distributed by McClatchy-Tribune Business News.

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Free Fall Fanatics: Arizona Airspeed Skydiving Team Members Jump for Joy and Competition

By Patrick Finley, The Arizona Daily Star, Tucson

Oct. 24–ELOY — Four teammates gather near the concrete basketball court. They appear to be square dancing.

They work on their timing, rotating like characters on the clock outside Disneyland’s “It’s a Small World” ride. Spin. Stop. Grab each other’s arms. Start again.

Nearby, others lay flat on their stomachs on home-made skateboards called “creepers,” rotating with the same militaristic timing.

A half-hour later, the four — plus someone with a video camera strapped to their helmet — will do the same routine 10,000 feet above the spinning earth, free-falling for at least 30 seconds before deploying their parachutes and floating, harmlessly, onto the grass field at Eloy’s airfield.

Welcome to the 49th annual United States Parachute Association National Skydiving Championships.

For the uninitiated, the idea of team competition — in this case, the four-way formation event — seems unnecessary, like holding a synchronized swimming event in a shark tank.

“The thrill here is the competition, trying to do your best on every jump,” said Eliana Rodriguez, who has more than 7,000 jumps to her name. “Right now people are nervous because of the competition, not because they’re jumping out of a plane.”

Rodriguez, 32, is one of the 10 members — plus one part-timer — of Arizona Airspeed, one of the world’s top skydiving teams. The teammates, ages 27 to 41, have managed to do what few in the sport have done — make skydiving their full-time jobs. Arizona Airspeed gives clinics around the world, competes in events and is based out of Skydive Arizona, which lets them use the Eloy dropzone for free.

Skydive Arizona claims it has the largest drop zone in the world. The airfield is a skydiving mecca.

Craig Girard is the senior member of Airspeed and the de facto team captain. For eight years, he was a member of the Army’s elite Golden Knights parachute team, where his only military duties were to perform.

“Like a skydiving scholarship,” he said.

Girard, who joined Airspeed 12 years ago, first jumped out of a plane when he was 15 years old and living in Phoenix. Twenty-three thousand jumps later, the 41-year-old is still living his dream.

“People look at skydiving like it’s a pastime,” he said. “We’ve turned it into a sport. It’s our lifestyle. It’s totally been my career.”

The team had about 20 jumps last week to prepare for the four-man event, in which two divers hang outside the airplane door before the entire team pushes out in unison.

The team has 30 seconds to complete a series of formations — with names such as hammer, ice pick, viper and caterpillar — while in a free fall.

When they land, the fifth jumper on the team — the cameraman — moves his footage onto a computer, which makes a recording fed onto the dozen televisions in the judges’ room. The team with the most accurate formations over 10 rounds wins.

The championships, which started Saturday and will last a week, feature categories for amateurs and more experienced jumpers.

By the end of the week, hundreds of skydivers will have competed in five events — formation skydiving, artistic events, free fall style and accuracy landing, canopy formation and sport accuracy.

On Monday, the two teams representing Airspeed finished third and sixth in the four-way formation skydive.

The free fall style and accuracy event is considered the sport’s classic event. When the event started 49 years ago, parachutists aimed for an “X” on the ground.

Now, because of new parachute technology, jumpers must place their heel on a yellow dot the size of a nickel that sits on an electronic touchpad.

“It’s an adrenalin sport,” said USPA Executive Director Chris Needels, a former Golden Knight. “But as far as competition goes, it’s no different than someone who likes to ski wanting to run gates.”

It’s an interesting combination of cultures.

A sport associated with Mountain Dew commercials and words like “extreme” is made up of many former Army and Air Force members. Needels was director of counterterrorism for President George H.W. Bush, whom he has taken skydiving. When Airspeed members look at their video after a jump, they call it a “debriefing.”

Then there are people like Sean MacCormac, a former X Games skysurfing champion based in DeLand, Fla. Sunday, he and teammate Tristen Green flipped through Eloy’s wind tunnel, an indoor tube that fires air at 120 mph to simulate a free fall.

It is great practice, like a trampoline to a gymnast. People afraid to go up in a plane — or pay to go up — can climb in the tube.

Green and MacCormac flip, spin and twist — like astronauts dancing.

Green, 43, first jumped out of a plane on her 40th birthday.

“My sister told me if you want a new perspective on life, that’s one way to get it,” she said.

Hooked, Green — who homeschooled two children and lives in Hawaii — started training in DeLand in May. This is her first event.

“If you want to succeed, it is a lot of hard work,” she said. “It’s like any other sport.”

Even if it’s 10,000 feet in the air.

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Copyright (c) 2006, The Arizona Daily Star, Tucson

Distributed by McClatchy-Tribune Business News.

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State Disciplines Health Workers

By Nichole Aksamit, Omaha World-Herald, Neb.

Oct. 23–According to recently released documents, officials with the Nebraska Health and Human Services System issued the following allegations and disciplinary actions in June, July and August against medical professionals licensed in Nebraska: –Fined Omaha dentist Dr. Ali Akkoseoglu $10,000, suspended him for 45 days and ordered him to take courses in dental record-keeping and diagnosis, dental X-ray use and interpretation and professional ethics. Inspections and chart reviews allowed under a previous limitation on Akkoseoglu’s license revealed substandard dental diagnosing and record-keeping in his practice and fraudulent insurance claims for two patients. –Fined Kearney pharmacist Richard Asher $2,500 and placed his license on probation for three years. Asher did not contest allegations that he failed to maintain accurate records of controlled substances ordered and dispensed at his pharmacy. –Suspended Omaha nurse Romunda Baker’s license for 30 days and ordered her to take a professional accountability course. Baker left a nursing shift in March without her supervisor’s permission and failed to report her subsequent termination as required. –Suspended Omaha nurse Deborah Brittenham for 30 days. She falsified patient records to suggest she had taken patients’ temperatures and was subsequently fired from the correctional facility where she worked. –Fined nurse Dale Brock of Missouri Valley, Iowa, $1,000 for working during a one-year period in which his nursing license had lapsed. –Accepted the voluntarily surrendered license of Omaha nurse Dezeree Brown. Brown tested positive for amphetamine use in March, was diagnosed with methamphetamine and alcohol dependence and marijuana abuse in April and admitted working while under the influence of methamphetamine. –Revoked the license of Omaha nurse Constance Buresh. Buresh was convicted of misdemeanor driving under the influence, driving under suspension and disturbing the peace in 2004 and 2005. She admitted to chronic use of methamphetamine and alcohol between 2001 and 2005 and occasional use of cocaine in 2004 and 2005 and said she entered a treatment program. She failed to provide treatment records to licensing officials. –Suspended Dr. Judith Butler of Blytheville, Ark., for 30 days for failure to report controlled-substance prescriptions for her patients in Nebraska and to promptly provide patient records to investigators, conditions of her probationary license. Butler said she thought she’d prescribed the drugs under her Arkansas license and noted that she did eventually provide the requested records. –Suspended North Platte nurse Linda Carsten for 30 days. Carsten did not contest allegations that she falsified patient records in February by filling in vital signs and other information before she had seen the patients. She was subsequently fired. –Fined Omaha nurse Jayna Conley $500 and extended her two-year probation by a year. Conley tested positive for alcohol in May and failed to submit proof of attendance at support group meetings, both violations of the terms of her probationary license. –Placed Omaha nurse Tiffani Cullum on five years probation. Cullum tested positive for marijuana on a pre-employment drug-screening in April and was diagnosed as cannabis dependent in May. –Suspended Lincoln nurse Christine Daily for 30 days. Daily falsified an expired CPR certificate to suggest that her certification was current. –Accepted the voluntarily surrendered license of Dr. Anthony Dake of Kearney. Dake did not contest allegations that he repeatedly appeared in the emergency department while not on duty to pray “because the Lord told him he needed to be there”; refused to leave when asked and disrupted the hospital’s orderly operation; stood in the middle of a street praising God; was later diagnosed with bipolar disorder and paranoid schizophrenia; underwent some mental health treatment but refused most prescribed medications for his condition and fled a psychiatric evaluation in March. –Censured Omaha nurse Janice Eckholt for practicing outside the scope of her nursing license when she administered IV medications to a patient in February. –Placed Lincoln nurse John Fahrnbruch on five years probation. Fahrnbruch was convicted of misdemeanor driving under the influence in 1997 and in April and was diagnosed as alcohol dependent in February. He completed treatment in May and entered an aftercare treatment program. –Suspended Lincoln chiropractor Paul Firnhaber 30 days and placed his license on two years probation. Firnhaber failed to maintain an accurate patient record, failed to consult a medical doctor for a patient he believed had cancer and practiced beyond the scope of a chiropractor. –Placed Curtis nurse Tina Foerster on three years probation. Foerster was convicted of misdemeanor possession of marijuana in August 2005 and diagnosed with alcohol and marijuana abuse in January. –Placed Lincoln nurse Bridget Fox on two years probation. Fox was fired for numerous medication errors. She failed to report her firing as required. –Suspended Ralston nurse Karmen Goerks for 120 days and ordered her to take an ethics course if she wants to be reinstated. Goerks discontinued physician-ordered treatments of a patient’s pressure sores, falsified the patient’s record and failed to report her subsequent termination as required. –Suspended Elkhorn nurse Carolyn Griger for 30 days and ordered her to write and present a paper on the licensed practical nurse’s role in medication administration and IV therapy. Griger started an IV for a patient and used leftover flu vaccine from a vaccination clinic on her children and a fellow employee’s children — tasks outside her scope of practice. –Accepted the voluntarily surrendered license of Beatrice psychologist Edward Gross. He was convicted of driving under the influence and diagnosed with alcohol dependency in 2000 and 2004. He failed to submit to a follow-up evaluation in March. –Suspended Chadron pharmacist Arthur Halfhide for 90 days and placed his license on three years probation for repeatedly dispensing medications without a physician’s prescription. –Suspended Lincoln nurse Rochelle Helmick for one month after she took and ingested four pills from the clinic where she worked. –Fined pharmacist Chad Herelyn of Kansas City, Mo., $500. Herelyn’s Missouri pharmacy license was placed on two years probation in July 2005 because he failed to ensure pharmacy technicians were properly registered in Missouri. He failed to report that discipline to Nebraska licensing officials as required. –Suspended the license of Lincoln nurse Kenneth Hirschfeld for one year. Hirschfeld diverted pain medication from his employer for personal use for two and a half years. He was diagnosed as opioid dependent and began outpatient treatment in February. –Placed Gering pharmacist Randall Holloway on five years probation. Holloway did not contest allegations that he overfilled codeine prescriptions for his wife and her two children and refilled them too often. –Fined Dr. Judson Jones of Omaha $2,500 and ordered him to complete a pain management course. Jones prescribed hydrocodone to his brother-in-law, without establishing a doctor-patient relationship or creating a patient record for him. –Fined Omaha physician assistant David Kershner $5,000. Kershner did not contest allegations that he claimed to have received a degree in veterinary medicine from Purdue University but could produce no documentary proof of that degree. –Placed Plattsmouth nurse Heather Kilpatrick on probation for one year. Kilpatrick failed to maintain accurate patient medication records. –Placed Lincoln nurse Amy Krannawitter on five years probation. She was convicted of three misdemeanors for driving under the influence of alcohol in 2002, 2005 and 2006. –Accepted the voluntarily surrendered license of Omaha nurse Gayleen Kuehn. Kuehn has physical problems requiring multiple medications which affect her concentration and nursing ability when she takes them. –Accepted the voluntarily surrendered license of Omaha nurse Debra Kurmel. Kurme
l refused an employer drug test in November, failed to attend support group meetings in December and January and consumed alcohol in January — violations of her probation on a previous discipline for alcohol abuse. –Accepted the voluntarily surrendered license of Holdredge nurse Stephen Larison. Larison became addicted to pain medications both prescribed and diverted from patient supplies. After hospitalization in March, he was diagnosed with alcohol and marijuana abuse and opioid dependency. He enrolled in an outpatient treatment program. –Revoked the license of Lincoln nurse Patricia Marsh, who twice tested positive for marijuana use. –Revoked the probationary license of Scottsbluff nurse Kayla McBride, for methamphetamine use and other violations of her probation conditions. –Revoked South Sioux City nurse Victor McDonald’s license. McDonald did not contest allegations that he possessed methamphetamine, was charged with Class IV felony methamphetamine possessions in January 2006 and had a previous misdemeanor conviction for attempted possession of marijuana. –Suspended Lincoln nurse Bryce Miller for seven months, placed his nursing license on probation for five years and suspended his nurse anesthetist license for one year. At home and on the job in 2005, Miller took some medications documented as being given to patients or thrown away in what he described as an attempt to wean himself from a Vicodin addiction he’d developed a year earlier. Miller completed outpatient treatment in late 2005. –Accepted the voluntarily surrendered license of Rushville nurse Judy Moeller. Moeller was fired in January for unsatisfactory job performance. She had been disciplined in 2004 for making multiple medication errors. –Placed Omaha nurse Denie Nesvan on probation for one year and fined her $500. Nesvan did not contest allegations that she failed to notify a physician and/or document notifying a physician about a care center resident’s worsening condition in 2003 and that she failed to use proper sterile techniques in changing that resident’s catheter. The resident was subsequently hospitalized. –Ordered Omaha pharmacist Greg O’Grady to complete a 12-hour error prevention class. O’Grady failed to check the dosage on a prescription refill against the original prescription. –Fined Dr. Sharidan Parr $1,000 and amended her probationary conditions to specify that she avoid consumption of alcohol or alcohol-containing products such as mouthwash and over-the-counter-medications unless prescribed by a physician. The Omaha doctor refused random body-fluid screening tests between December and May, didn’t submit proof of attendance at support group meetings between January and June and tested positive for high levels of an ingredient in Nyquil in May — all violations of her probationary license. –Accepted the voluntarily surrendered license of Grand Island nurse Carissa Rickard. She did not contest allegations that she laid down after developing a migraine while caring for two patients who required 24-hour care; that video surveillance showed she spanked, shook and dropped a brain-deformed 2-year-old; or that she was charged with class 3 felony child abuse. –Censured and fined Grand Island nurse Shanon Roudebush $2,500. Between December 2004 and April 2005, she made nine documented medication errors.

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Copyright (c) 2006, Omaha World-Herald, Neb.

Distributed by McClatchy-Tribune Business News.

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

Section VI, ECIC Alter Schedules ; First Sectional Games Moved Back to Oct. 27

By Keith McShea

This fall’s high school postseason is going to be different than any other. Just like the storm that caused it.

Section VI and the Erie County Interscholastic Conference joined the Buffalo Public Schools and the Monsignor Martin Association by retooling their schedules due to the myriad school closings caused by last week’s devastating snowstorm.

With most of its member schools not planning to return to classes until next week, the ECIC effectively canceled all of its remaining regular season contests in soccer, volleyball and field hockey. The seasons were to end this week (soccer) or next week (volleyball and field hockey).

Also, at the ECIC’s request, Section VI pushed back the beginning of sectional play to Friday, Oct. 27. The original sectional starting dates were Oct. 23 (boys and girls soccer), Oct. 25 (girls volleyball) and Oct. 26 (field hockey). The Oct. 30 start of boys volleyball sectionals was unaffected.

“This gives those schools going through this disaster time to recuperate, time for their towns to clean up — and then start thinking sports,” said ECIC President Jim Biryla, the principal at Holland. “Right now fields are unplayable. Then there are referees, how many are available? How many are without power? It’s the whole enchilada. The best thing to do for those schools going through this tragic storm is give them time to recuperate.”

Section VI also modified its sectional seeding procedure, which is based on a power points rating determined by a teams’ league schedule. Usually the number of power points is divided by a team’s total scheduled league games to determine a rating; now a team’s total number of league games played will be used.

ECIC teams can continue to play games if they are able to; however, those games will not count towards the standings.

A sampling of other schedule changes:

*The ECIC golf championships tournament, originally scheduled for Oct. 16 (and then Oct. 23) at Tan Tara, is now Oct. 30 at Springville.

*The ECIC girls tennis singles tournament has been canceled and the singles representatives for the Section VI tournament will be determined by the league. Biryla said an attempt will be made to hold an ECIC doubles tournament, but if not, the ECIC will also determine those representatives. (The singles tournament was originally scheduled for Oct. 13-14, then was to be held as part of a doubles tournament, Oct. 20-21-22.)

*The ECIC girls swimming meet has been pushed back a week and will be held at Sweet Home. The diving competition will be Nov. 2, the swimming on Nov. 3. Winners and sectional representatives will be determined by their times (instead of heats and finals, there will just be heats with times dictating places).

*The ECIC cross country meet remains Oct. 28, but has been moved from Alden to East Aurora.

In other scheduling changes:

*The Section VI cross country championships will still be held Nov. 3, but has been moved from from Elma Meadows Golf Course to Long Point State Park in Bemus Point.

*The Niagara Frontier League, which also canceled the remainder of its soccer season, rescheduled some volleyball matches, swim meets and cross country meets. Of note are Tuesday’s volleyball doubleheader of Kenmore East at Kenmore West (4:30 p.m. girls, 6 p.m. boys) and the move of the NFL swim meet to Nov. 2-4 (one week later than scheduled).

In football, several dates have been changed for the Week Eight lineup.

*The T-NT rivalry football game is 6 p.m. tonight at Clint Small Stadium. There will be shuttle service to and from the stadium from three park-and-ride locations: Tops on Niagara Street, the Tonawanda High parking lot and the Big Lots parking lot on Young Street. Shuttle service provided by Rainbow Transportation’s yellow school buses starts at 4:30 p.m. and runs for about an hour after the game.

*The Depew at Lancaster rivalry game has been rescheduled for 6 p.m. Monday.

*St. Joe’s is playing its scheduled game at Niagara Falls tonight at 7:30 p.m.

*The Class B South title — and home-field advantage in the Oct. 28 sectional semifinals — will be determined at 7:30 p.m. Tuesday when Lackawanna plays at East Aurora.

*The Sweet Home-Starpoint Class A North game will be played at 2 p.m. Sunday at UB Stadium.

*Pioneer and Jamestown, two teams whose Week Eight opponents were unable to play, will meet at Jamestown at 2 p.m. Saturday. Canceled were Pioneer at Amherst and Frontier at Jamestown.

*Clarence’s game at Lockport at 2 p.m. Saturday has been moved to Medina.

e-mail: [email protected]

(c) 2006 Buffalo News. Provided by ProQuest Information and Learning. All rights Reserved.

Study Results Found Low-Dose Orlistat (60 Mg) Demonstrates Significant Reduction in LDL Cholesterol While Providing Weight Loss for Up to Two Years

BOSTON and PITTSBURGH, Oct. 22 /PRNewswire/ — Data presented today at the 2006 Annual Scientific Meeting of NAASO, The Obesity Society, found that low-dose orlistat (60 mg) in conjunction with a reduced-calorie diet, provided significantly greater reductions in LDL cholesterol and weight loss when compared to treatment with placebo and a reduced-calorie diet. The data demonstrate that the effect of low-dose orlistat on change in LDL cholesterol persisted even after correcting for weight loss, showing the reduction in LDL cholesterol was independent of weight loss. In addition, a significantly greater number of patients with elevated LDL cholesterol levels at baseline had improved LDL cholesterol levels that shifted to a normal range after treatment with low-dose orlistat for one year.

The results were based on two multi-center, double-blind, randomized, placebo-controlled clinical trials of 576 patients which were conducted over a two-year period to compare the differences in weight loss and LDL cholesterol levels of 60 mg orlistat-treated versus placebo-treated subjects, with both groups consuming a reduced-calorie diet. Study results found that approximately 38 percent of orlistat-treated subjects had a favorable shift in their LDL cholesterol level in comparison to 11 percent in the placebo group.

“These study results are significant in showing the added health benefit of taking low-dose orlistat,” said Vidhu Bansal, Pharm.D, Director of Medical Affairs, GlaxoSmithKline Consumer Healthcare. “Because high cholesterol levels are often associated with overweight and obesity, we were excited to see the positive effect low-dose orlistat had. LDL cholesterol levels returned to a normal level after one year of taking the medication in a significantly greater number of patients on 60 mg of orlistat with elevated LDL levels at baseline and there was a persistent reduction in LDL cholesterol levels, even after correcting for weight loss.”

Additional results showed that during the first year of the study, significantly (p

Currently under review by the U.S. Food and Drug Administration (FDA), orlistat 60 mg, which GlaxoSmithKline Consumer Healthcare proposes to market under the brand name alli(TM) (pronounced AL-eye), would be the only FDA-approved weight loss medication available over-the-counter. Alli would be indicated for use by overweight adults along with a reduced-calorie, low-fat diet. Help and advice on adopting a healthy eating plan will be provided in the alli program.

Xenical(R) (orlistat 120 mg capsules) will remain available by prescription for obesity management and for those who should be treated under the care of a physician. Xenical is manufactured by Roche and co-promoted in the U.S. by GlaxoSmithKline Consumer Healthcare.

About Orlistat

The safety and efficacy of orlistat, which has been marketed as a prescription drug in the U.S. since 1999, is supported by more than 100 clinical studies conducted in more than 30 countries, including the four-year landmark XENDOS trial, the longest study ever of a weight loss medicine. There have been more than 25 million patient treatments with orlistat and it is approved in 145 countries.

Orlistat is a weight loss medication that is taken with meals to inhibit the absorption of dietary fat. Orlistat should be used in conjunction with a reduced-calorie diet that contains no more than 30 percent of calories from fat. Following such a diet maximizes weight loss and minimizes unwanted gastrointestinal treatment effects. Prescription orlistat (120 mg) is Xenical. Non-absorbed fat can lead to some changes in bowel habits. These changes are minimal if the dietary recommendations are followed and generally occur in the first weeks of treatment; however, for some people they may continue for six months or longer while on Xenical. Patients considering taking Xenical should tell their doctor if they are pregnant, nursing, taking cyclosporine, have food absorption problems or reduced bile flow. A daily multivitamin is recommended because Xenical can reduce the absorption of fat-soluble vitamins.

About Overweight and Obesity

Currently, approximately 65 percent of U.S. adults are overweight or obese, according to the National Institutes of Health. Research suggests that overweight individuals appear to be on the pathway to obesity.(i,ii) Overweight and obesity are associated with an increased risk of developing health problems such as hypertension, type 2 diabetes and heart disease.(iii) Factors that can contribute to overweight include an abundance of high-calorie foods, low levels of physical activity, behavior, environment, and genetics.(iv) Multiple studies have shown that a modest reduction in weight improves health outcomes significantly in overweight or obese patients.(v,vi)

About GlaxoSmithKline Consumer Healthcare

GSK Consumer Healthcare is one of the world’s largest over-the-counter consumer healthcare products companies. Its more than 30 well-known brands include the leading smoking cessation products, Nicorette(R), NicoDerm(R) CQ and Commit(R) as well as many medicine cabinet staples, including Abreva(R), Aquafresh(R), Sensodyne(R) and Tums(R).

About GlaxoSmithKline

GlaxoSmithKline — one of the world’s leading research-based pharmaceutical and healthcare companies — is committed to improving the quality of human life by enabling people to do more, feel better and live longer. For company information visit: http://www.gsk.com/.

Cautionary statement regarding forward-looking statements

Under the safe harbor provisions of the US Private Securities Litigation Reform Act of 1995, the company cautions investors that any forward-looking statements or projections made by the company, including those made in this announcement, are subject to risks and uncertainties that may cause actual results to differ materially from those projected. Factors that may affect the Group’s operations are described under ‘Risk Factors’ in the Operating and Financial Review and Prospects in the company’s Annual Report 2004.

   (i)   Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends         in obesity among US adults, 1999-2000. JAMA 2002;288:1723-1727.   (ii)  McTigue KM, Garrett JM, Popkin BM. The natural history of the         development of obesity in a cohort of young US adults between         1981-1998. Ann Intern Med 2002;136:857-864.   (iii) (Centers for Disease Control and Prevention: "Overweight and         Obesity." http://www.cdc.gov/nccdphp/dnpa/obesity/. Accessed         12/22/05.   (iv)  Centers for Disease Control and Prevention. "Overweight and Obesity:         Contributing Factors."         http://www.cdc.gov/nccdphp/dnpa/obesity/contributing_factors.htm.         Accessed 12/22/05.   (v)   Hauptman J, Lucas C, Baldrin MN, Collins H, Segal K. "Orlistat in         the long-term treatment of obesity in primary care settings."         Archives of Family Medicine 9:160-167.   (vi)  NIH, NHLBI. Clinical guidelines on the identification, evaluation,         and treatment of overweight and obesity in adults. HHS, PHS; 1998.         p. 29-41.  

GlaxoSmithKline

CONTACT: Malesia Dunn of GlaxoSmithKline Consumer Healthcare,+1-412-200-3544, [email protected]

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

NH3 + Ca(NO3)2: Researchers in Iowa Find That Adding Calcium Nitrate to Farm Fertilizer Makes a Key Meth Ingredient Unusable

By Kelly Hassett, The Columbus Dispatch, Ohio

Oct. 21–University researchers in Iowa have discovered a new ingredient that could make it tougher for methamphetamine cooks to concoct their illegal brew.

Researchers at Iowa State University announced last week that adding calcium nitrate to anhydrous ammonia neutralizes the reaction required to make methamphetamine. The highly addictive drug is manufactured in clandestine labs using the farm fertilizer, a common cold medicine and other household products.

Officials hope the discovery will not only curb meth production, but deter thieves from stealing anhydrous ammonia from farmers and farm-supply dealers. And agriculture and law-enforcement officials in Ohio and elsewhere are taking notice.

“If you’re a meth cook, it makes your job a whole lot harder,” said Dale Woolery, associate director of the Iowa Governor’s Office of Drug Control Policy.

Officials in Ohio, New York and several western states have already contacted counterparts in Iowa to find out more about the research.

State law-enforcement officials say stopping meth production is one of their top priorities, both because of the crime associated with its use and because of the danger involved in its production. Meth-lab raids in Ohio increased since 2000 from 36 to more than 400 last year, and the state has spent nearly $2 million just in the past two years to establish and run a law-enforcement unit to combat the illegal drug.

Some in law enforcement wonder if the additive, while possibly deterring thefts of anhydrous ammonia, would slow the production of the drug overall. And those in the farming and fertilizer industries are concerned about the cost.

Anhydrous ammonia generally costs farmers about $45 per acre, said Jerry Ward, president of OHIGRO, a retail farm-supply business in Waldo.

Calcium nitrate would tack on at least another $1 an acre to farmers’ fertilizer bill, and many farmers work thousands of acres.

“That adds up,” Ward said.

Farm suppliers and members of the Ohio AgriBusiness Association had been waiting for the results of Iowa State’s research, said Brian Peach, secretary-treasurer.

They want more information about how the calcium nitrate would be marketed, at what level in the distribution process the chemical would be added and whether it really reduces anhydrous-ammonia thefts, Peach said.

“We’ve tried numerous methods, but nothing was really deterring them,” he added.

The anhydrous-ammonia tanks at Blanchard Valley Farmers Co-op in Findlay have been broken into several times in the past few years, said risk coordinator Joe Hochstettler.

The co-op added tank locks, surveillance cameras and chain-link fences before the number of thefts dropped, he said.

Although Hochstettler said the calcium nitrate formula seems more promising than GloTell, a chemical that makes ammonia glow pink and stains meth users’ hands, he wonders how the added cost would affect competition.

“Unless it became law, not everybody would do it,” Hochstettler said. “We’d be giving away $1 an acre to do the right thing.”

State lawmakers already have moved to make it harder to produce meth.

A law restricting sales of pseudoephedrine took effect in May and is credited, at least in part, for the drop in the number of meth labs and waste sites discovered, from 444 in 2005 to 243 so far this year.

“The new law, it’s making it a lot harder for them,” said Chuck Bell, special agent for the Ohio Bureau of Criminal Identification and Investigation.

Bell predicted the calcium nitrate could also help, but acknowledged that meth addicts are constantly adapting their methods in response to new police tactics.

“We have a lot of people making their own anhydrous ammonia right now,” Bell said. “If they want it bad enough, they’re going to find a way to do it.”

Iowa is still fine-tuning its program, which is voluntary for agriculture suppliers and retailers. Officials don’t think it is necessary to treat every anhydrous-ammonia tank in the state with calcium nitrate, however, Woolery said.

“It’s a very fluid, flexible type of process,” he said. “We think that there’ll be enough of it out there by spring that, for a meth cook, they might as well quit.”

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Copyright (c) 2006, The Columbus Dispatch, Ohio

Distributed by McClatchy-Tribune Business News.

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Mystery of the Beaker People They Were the First Scots to Celebrate Fashion, Good Food and Free-Flowing Drink. Now, 4,000 Years on, Scientists Are Unlocking the Secrets of the Original Party People…

By JIM MCBETH

THE smiles and convivial air say it all. They are obviously all close friends or family, dressed in their best clothes and fine jewellery for a quiet get-together. It’s the Bronze Age and the first Scots to introduce the social ritual of having people round for drinks are ready to party.

Meet the ancestors the weekend wouldn’t be the same without them. We take for granted the conviviality of Scottish culture, but it was defined 4,000 years ago by a mysterious race that, until now, has kept its secrets. Even their name the Beaker People is derived from the vessels they drank from and buried with the dead. They loved personal adornments and were the ones responsible for introducing alcohol to the land now known as Scotland.

Our forebears were also warlike, religious, industrious and fashion-conscious. So it is not too difficult to make a connection between modern Scots and the mysterious tribe, which created a national culture 2,000 years before the birth of Christ.

For more than a century, antiquarians and archaeologists have debated the hidden life of this enigmatic people, an apparently aristocratic class who invented a honey-based drink with the bite of a sabre-toothed tiger.

Intelligent and capable, they also farmed, crafted in precious metals and clothed the nation with the first woven garments.

Historians remain divided on what came first drink, jewellery, or the fashion statements.

But, in the sterile surroundings of a laboratory, modern technology is now beginning to reveal the life of the first Scots to dress nicely and enjoy a drink.

Using state-of-the-art technology, the scientists hope to learn all there is to know about an elusive people by examining the finest collection of their remains in Europe.

The Pounds 500,000 scientific investigation into the Beaker People, involving the Universities of Aberdeen and Sheffield, began this week.

Scientists know that they had a tradition of burying their dead with beakers or decorated earthenware jars that contained sustenance for the journey to the other world.

It was the first known evidence in Scotland of the concept of religion and an afterlife.

And, for some reason, the highest concentration of skeletons belonging to the Mesolithic and Neolithic nouveau riche appears to have been in the Northeast.

Their remains were transported this week to Sheffield, where the archaeologist Professor Mike Parker-Pearson has begun the long, slow process of eliciting their secrets.

For more than a century, the 23 skeletons discovered at various sites in the Northeast have been waiting for technology to catch up with them at the University of Aberdeen’s Marischal Museum.

Neil Curtis, a senior curator at the Marischal Museum, says: ‘Our collection is the result of discoveries in the 19th century by farmers and quarrymen.

‘The skeletons have been in the university for more than 100 years, where they have been studied by generations of anatomists, archaeologists and curators.

‘It is very exciting that we may soon get the answers to questions that have been asked for so long. It is also very exciting to be the first museum to take part in this major research project that is using the latest techniques to discover more about people who lived in the North- east many thousands of years ago.’ The new study, which will last for four years, will contribute to a nationally important area of research through collaboration with the National Museums of Scotland.

The Aberdeen remains are well preserved because the Beaker People were among the 1 per cent of the population buried individually in ‘cists’ or stone chests.

Thus, with their bodies facing toward the sun another indication of religious practices their remains were protected from being destroyed by the land or the elements.

‘We still don’t truly know why they appear to have been different from the rest of the population,’ says Professor Parker-Pearson. ‘But, in the next few years, we hope to learn a whole lot more.’ The analysis of samples from the remains will concentrate on strontium, oxygen, lead, sulphur, hydrogen, carbon and nitrogen isotopes in the teeth. Accompanying studies will be made of wear patterns on bones, which should also yield important information on prehistoric health and lifestyle.

It is hoped that the scientists will be able to identify the movement of the people during their lifetime.

Professor Parker-Pearson says: ‘It’s only been a week, and we have yet to begin examining the mobility factor, but we have already thrown up some new and very intriguing insights into what they ate.

‘We have been looking at the microwear on their teeth and the isotopes of nitrogen and carbon as it has been absorbed into their bones.

‘They apparently ate a uniform diet of animal proteins and plant food but, even though many of them lived near the coast, none of them apparently ate seafood.

‘That implies they were well off and had cattle, pigs or sheep. Seafood was not then regarded as a delicacy and it would only have been eaten if they didn’t have anything else to eat.

‘But perhaps the most significant new piece of information we have is in the difference in the diets of the Scottish men and women.

‘From the period of 2400BC to 2000BC, there are more “pits” to be found on the men’s teeth. That is an indication that they ate a wider range of plant matter.

‘Conversely, the women appear to have had a higher intake of animal protein in the form of meat, milk or blood. We don’t know yet why this should be, but there must have been some big, strong Scottish women back then.

‘However, what makes this difference in diet doubly intriguing is that it represents a regional opposite from some earlier findings.

‘When you examine similar remains discovered in Yorkshire, the women favoured the plants while the ” Yorkshiremen” ate more of the meat. It’s a fascinating and so far inexplicable insight.’ The lives of this religious and talented people, who disappeared from the cultural landscape with the emergence of later, Celtic races, is endlessly fascinating.

By making gold jewellery, copper daggers and bows and arrows, the Beaker People were responsible for the critical prehistoric transition from a community-based culture to the beginnings of the warrior-class feudal system.

Some experts believe the Scottish Beaker people were descended from a much earlier people of Iberian origin, who spread across Europe from the third millennium BC.

John Duncan, historian and fellow of the Society of Antiquarians ( Scotland), says: ‘These Iberian huntergatherers moved through France and lower Britain around 7000BC.

‘The West of Scotland Islands give us a further reinforcement to the movement of these Mesolithic people by the finds of large shell mounds and various tools such as fish hooks and harpoons.

‘A slow transition took place and, by 4000 to 2500 BC, they moved into a Neolithic farming life.

‘Many other things must be taken into consideration, such as the introduction of new flint and stone tools, pottery, permanent settlements, new religious beliefs and structured tombs.

‘Other Neolithic monuments discovered in Scotland include henges and stone circles.’ It is believed that the forbears of the Scottish emigrants may have created the first version of Stonehenge, the 5,000- year- old structure on Salisbury Plain, which remains one of Britain’s most important prehistoric monuments.

Mr Duncan adds: ‘Henges are widely spread (across Scotland).

From 2500BC, we see the entrance of the Beaker People from Northern and Central Europe and the start of Scotland’s Bronze Age.

‘ They are recognised as the ones who introduced metalwork to Scotland.’ But it is the Beaker People’s religion that marks them out in what must have been a dark and savage period. Their burial practices were the first example of individual interment, which would later become the norm.

Professor Parker-Pearson says: ‘They may have been a sect or a religious group.’ Beaker People’s graves were often clustered in groups, which suggest family cemeteries, sometimes very close to earlier Neolithic henges and monuments. It was, say the experts, as if they were taking advantage of sites which they already regarded as sacred.

The graves were filled with goods, which indicated the status and importance of the deceased and also suggested a belief in some kind of afterlife.

Some of the goods included pottery, golden buckles, bronze daggers, cups, necklaces, and sceptres in various stones and precious materials.

Both men and women were buried. In many cases, the bodies were carefully laid with the head to the south, with men facing east and women facing west.

The influx of this extraordinary people, with their superior technologies, is believed to have been largely peaceful, but their capabilities inevitably allowed them to dominate the existing population wherever they settled.

Scottish culture was changed dramatically by their arrival and the advent of metalworking.

Learning to smelt gold and copper, and later to combine copper and tin into sturdy bronze, opened broad new vistas in trade, the arts, the accumulation of wealth, and warfare.

With metal implements, the days of thumping someone over the head with a club or throwing stones with slings were over. Expensive and beautifully crafted swords, shields, dirks, daggers and spearheads helped create the warrior aristocracy, which evolved into the nation’s clan system.

There was also a change during the period to living in ‘ proper’ round houses. Scientists believe the huts had a low, stone wall as a base, which was used to brace wooden poles and rafters. On top of this would have been a roof of thatch, turf, or hides.

Eventually, in Neolithic times, the Beaker People also favoured a pastoral pattern of agricultural lifestyle.

As the population grew, more marginal land was brought into cultivation and farmed successfully for several centuries until dramatic climate changes forced its abandonment. The Beaker People were patriarchal and, during the Bronze Age, the individual warrior- chief or kinglet grew in importance, contrasting with the community orientation of the times.

Professor Parker-Pearson says he is delighted to be in a position to finally unlock the secrets of the Beaker People.

He says: ‘We don’t yet know if we will answer all the questions, but the Aberdeen-Sheffield scientific study, which has been funded by the Arts and Humanities Research Council, will take us some way down the road of knowing a lot more about this fascinating people.

‘I am also delighted to be working with the University of Aberdeen.

The long tradition of research on the Beaker People in Aberdeen and the quality of the collection makes it the perfect one to start with.’

(c) 2006 Daily Mail; London (UK). Provided by ProQuest Information and Learning. All rights Reserved.

Katie Brown is Remembered With School Program

By MICHAEL P. McKINNEY; Journal Staff Writer

She was barely out of high school when she was killed in 2001. Now a program works to help others avoid a similar tragedy.

* * *

BARRINGTON – Candles glowed as Larry Brown stepped to the microphone on what would have been his daughter’s 26th birthday. He and others gathered last night to commemorate a domestic violence prevention program in Katie’s name that is now taught in 14 school districts.

But it was impossible, on a day when candles have held another meaning, for a father not to speak of Katie. The way she’d shop for gifts for family, be it Christmas, Columbus Day or Halloween. The way she’d have disliked the rain falling outside — after having been born in sunny California.

“I’m not sure that she came to really understand — or that any teenager can understand — how transient [gifts bought for some special occasion] are,” Brown said to about 45 people who attended at Barrington Town Hall. What really lasts, he said, are the feelings people have for each other, the gift of love.

Katherine E. “Katie” Brown, 20, was murdered in 2001 by Ronald Posner, who was 21 at the time. The two had dated since high school. Posner was sentenced to 60 years, 40 of them to serve in prison. Brown and Posner had both lived in Barrington, with Brown living on Providence’s East Side at the time of her death.

“Domestic abuse in the most extreme,” Superior Court Judge William A. Dimitri Jr. called it at Posner’s sentencing.

In 2001, the Katie Brown Educational Program was launched, in part to give young people skills to prevent violence in their relationships and also to illuminate warning signs people might otherwise miss. Instructors go into classrooms in fifth grade through high schools in a five-session program. The roster recently added East Greenwich and Pawtucket in Rhode Island and includes Fall River and Somerset in Massachusetts.

“We are approaching 20,000 students,” said Dr. Jay S. Schachne, a cardiologist who founded the Katie Brown program. “We’re going to keep this going.”

There are varied troubles to contend with: from school bullying to children who witness a mother being abused, to the 40 percent of high school students who report being victims of dating violence at least once before graduating, according to figures from the Katie Brown program. But in the years since Katie Brown’s death, attendees heard last night, the Internet, MySpace and other technology have become an enormous new source of relationship violence among young people. Organizers of the Katie Brown Educational Program brought in a panel of speakers.

There are adults who hide behind deceptive computer user names, often pretending to be younger than they are and sometimes of a different sex, to try to lure unsuspecting young people into sexual situations. There’s cyber bullying, which includes students who use the computer to spread sensitive information, images or lies about a classmate or a teacher — and also sending hurtful messages to a child through the computer.

Cpl. John Killian, a Rhode Island State Police detective, showed the audience a video featuring the parents of a Vermont boy who committed suicide after being taunted by computer messages from classmates.

Killian and others suggested that parents keep computers in a family-used room and not leave it alone in a child’s room. Also, there is at least some software available through some Internet service providers that can help parents keep track of their child’s Internet activity.

“It’s a reality” that young people are using MySpace, which has some 60 million people using it, Killian said.

Kaitlyn Annunziata, a Barrington High School senior, spoke of a scare when a stranger attempted to make contact through her MySpace site. The person quickly began asking personal and inappropriate questions, she said, and so she told her mother who contacted the police.

“Just to go through that whole experience was very uncomfortable,” said Kaitlyn.

But for the police, trying to pursue someone who tries to solicit someone online can sometimes prove difficult. Barrington Detective Josh Birrell explained that it’s important for people to use the “print save” function on a computer to capture a message and other important information, including instant messaging text in order for authorities to better track down its source.

[email protected] / (401) 277-7447

* * *

Dr. Maryanne Norris, left, joins about 10 others who held candles during a memorial service for Katie Brown, of

Barrington, who was killed in 2001.

THE PROVIDENCE JOURNAL / BOB THAYER

(c) 2006 Providence Journal. Provided by ProQuest Information and Learning. All rights Reserved.

The Star, the Dwarf and the Planet

First Directly Imaged Brown Dwarf Companion to an Exoplanet Host Star

Astronomers have detected a new faint companion to the star HD 3651, already known to host a planet. This companion, a brown dwarf, is the faintest known companion of an exoplanet host star imaged directly and one of the faintest T dwarfs detected in the Solar neighbourhood so far. The detection yields important information on the conditions under which planets form.

“Such a system is an interesting example that might prove that planet and brown dwarf can form around the same star”, said Markus Mugrauer, lead author of the paper presenting the discovery.

HD 3651 is a star slightly less massive than the Sun, located 36 light-years away in the constellation Pisces (the “Fish”). For several years, it has been known to harbour a planet less massive than Saturn, sitting closer to its parent star than Mercury is from the Sun: the planet accomplishes a full orbit in 62 days.

Mugrauer and his colleagues first spotted the faint companion in 2003 on images from the 3.8-m United Kingdom Infrared Telescope (UKIRT) in Hawaii. Observations in 2004 and 2006 using ESO’s 3.6 m New Technology Telescope (NTT) at La Silla provided the crucial confirmation that the speck of light is not a spurious background star, but indeed a true companion. The newly found companion, HD 3651B, is 16 times further away from HD 3651 than Neptune is from the Sun.

HD 3651B is the dimmest directly imaged companion of an exoplanet host star. Furthermore, as it is not detected on the photographic plates of the Palomar All Sky Survey, the companion must be even fainter in the visible spectral range than in the infrared, meaning it is a very cool low-mass sub-stellar object. Comparing its characteristics with theoretical models, the astronomers infer that the object has a mass between 20 and 60 Jupiter masses, and a temperature between 500 and 600 degrees Celsius. It is thus ten times colder and 300 000 less luminous than the Sun. These properties place it in the category of cool T-type brown dwarfs.

“Due to their faintness even in the infrared, these cool T dwarfs are very difficult to find”, said Mugrauer. “Only two other brown dwarfs with similar brightness are presently known. Their study will provide important insights into the atmospheric properties of cool sub-stellar objects.”

More than 170 stars are currently known to host exoplanets. In some cases, these stars were also found to have one or several stellar companions, showing that planet formation can also take place in a dynamically more complex environment than our own Solar System where planet formation occurred around an isolated single star.

In 2001, Mugrauer and his colleagues started an observational programme to find out whether exoplanet host stars are single or married. In this programme, known exoplanet host stars are systematically imaged at two different epochs, at least several months apart. True companions can be distinguished from coincidental background objects as only they move together with the stars over time. With this effective search strategy several new companions of exoplanet host stars have been detected. Most of the detected companions are low-mass stars in the same evolutionary state as the Sun. In two cases, however, the astronomers found the companions to be white dwarfs, that is, stars at the end of their life. These intriguing systems bear evidence that planets can even survive the troubled last moments in the life of a nearby star.

The planet host star HD 3651 is thus surrounded by two sub-stellar objects. The planet, HD 3651b, is very close, while the newly found brown dwarf companion revolves around the star 1500 times farther away than the planet. This system is the first imaged example that planets and brown dwarfs can form around the same star.

More information

These results were first presented in August at the IAU General Assembly in Prague and are in press in the Monthly Notices of the Royal Astronomical Society (Mugrauer et al., astro-ph/0608484). The discovery was later confirmed by another team, using the Spitzer space telescope (Luhman et al., astro-ph/0609464). The spectral classification was confirmed by additional follow-up spectroscopy of the companion (Burgasser, astro-ph/0609556).

The team comprises Markus Mugrauer and Ralph Neuhäuser (Astrophysical Institute and University observatory of the Friedrich-Schiller University of Jena, Germany), Andreas Seifahrt (ESO), and Tsevi Mazeh (Tel Aviv University, Israel).

On the Net:

European Southern Observatory

Educating the “Native”: a Study of the Education Adaptation Strategy in British Colonial Africa, 1910-1936

By Omolewa, Michael

This essay discusses how examinations were used as an “adaptation strategy” beginning in 1910 when British examinations boards were invited to assist with the conduct of secondary school examinations in colonial territories in Africa. Although adaptation covered all aspects of formal schooling, this study focuses on secondary education because of its importance as the highest level of education available, and its significant impact on colonial society at the time. Much of recent literature on the adaptation question has focused on the various levels of schooling beyond basic village education in rural areas.1 The essay examines the responses, particularly in Nigeria, to the suggestion that secondary education should be “adapted to local needs,” and the results of the adaptation efforts, culminating in the introduction of the “Overseas School Certificate Examination” for Nigerian candidates in 1936.

The foundation of Western education in Africa was laid by Christian missionaries who were eager to use literacy training to introduce Christianity and win converts to their religion.2 The missionaries also used Western education to train Africans as catechists, messengers, and other positions needed to assist them in realizing the social and economic development and transformations desired by the European missionaries and their agents. Merchants and traders also required qualified personnel to handle their business transactions. Thus after considerable consultations between the Church Missionary Society (CMS), founded by the Church of England to promote evangelization, and the local merchants and traders, the first secondary school in Nigeria, the Church Missionary Society Grammar School, was founded in Lagos in 1859.3

It is by no means surprising that the first secondary school in Nigeria was established by the Church Missionary Society (CMS). Its secretary from 1841 to 1872, Henry Venn, firmly believed in the development of adequate human resources, and that the school must be self-supporting, self-governing, and self-propagating, and should employ African personnel.4 The African commercial and business elite also required personnel that was well-trained and equipped to handle political and economic transactions between Africans and outsiders involving record keeping and correspondence regarding the exchange of European and African goods and services.5 Africans also gradually began to recognize the advantages and the attractions of post- primary education, especially the increased salaries and wages, and improved conditions of service. Historian Andrew Paterson has observed that in South Africa, “Africans perceived education to be an alternative source for economic security in a time of land dispossession.”6

In a quick succession, additional secondary schools were established by the CMS in various parts of Nigeria, and by other missionary organizations, including the Baptist Mission, the Catholic Mission, and the Wesleyan Methodist Mission, beginning in the 1870s. The Qua Iboe, the Primitive Methodist Society, established secondary schools mostly in Eastern Nigeria starting in 1922. Secondary schools also gradually began to spring up in various other parts of Africa, as community colleges, high schools, and secondary grammar schools, often in cooperation with Christian missions that provided the teachers, the curriculum, and the necessary contacts; however, the local communities provided the buildings and raised funds for these educational services.7 This was the background to the establishment of various mission schools in Africa. In Nigeria, for example, ethnic-based secondary schools such as Oduduwa College, Ile-Ife; Edo College, Benin City; and Imade College, Owo began to sprout up to attend to the various needs of communities and individuals eager to take advantage of the new opportunities for advancement and promotion in the new society that emerged with the coming of the missionaries and the colonial administrative bureaucracy.8

At first the British colonial government was unwilling to have a direct involvement in the promotion of secondary education in Nigeria. However, British officials soon recognized that, following the establishment of colonial rule and the subsequent increase in the demand for clerks, messengers, interpreters, and other administrators needed to maintain British control in the region, it became imperative to establish secondary schools. Thus in 1909 British colonial administrators decided to establish King’s College in Lagos as a model secondary school, providing “sound general education.”9 Government officials also began to complement and supplement the work of the missions by establishing model secondary schools in various provinces. The colonial administrators also began to introduce legislation and provide the policy framework for the expansion of schooling in the colonies.10

This process was accompanied by the invitation to the British examinations board to test the literary competence and ability of the graduates of the secondary school system and to measure its quality. To this end, London University examinations were introduced early to Mauritius, and later to parts of East and West Africa. The colonial administrators also invited the University of Cambridge Local Examination Syndicate into the country in 1910 to assist in conducting the secondary school examinations.11 In doing so the British colonial regime believed that it was taking advantage of the decision of the University of Cambridge in its statute of 11 February 1858, to establish the syndicate for the examination of students who are not members of the university.12 The University of Oxford, which had established the University Delegacy for Local Examinations on 18 June 1857, followed Cambridge in 1929 in the work of conducting secondary school examinations in Nigeria.13

Examinations have remained a very powerful instrument for controlling the content of instruction. They influence curriculum design and preparation, and dictate the teaching and learning process.14 As Fafunwa, a Nigerian education specialist, declared, “It is an educational truism that examinations control the curriculum and whosoever controls a country’s examination system controls its education.”15 Historian Angela Little has made the following important point:

[Examinations represent the ultimate goal of the educational career, they define what are the important aspects of a school curriculum and they dictate to a large extent the quality of the school experience for both teacher and student alike. Moreover, the quality of the examination system itself can have a considerable impact on the quality of skill formation encouraged by the education system, which skills in turn could have a considerable impact on the inputs to the labour market.16

Historian Mary E. Dillard has also observed that it is important to devote closer attention to the instrument of measurement in our effort to understand how educational systems have developed, “in addition to studying educational content, curriculum, and the structure of schooling.”17

DEBATING THE CONTENT OF COLONIAL EDUCATION

Initially, the Africans expected much from the attainment of Western education, but they quickly became disappointed and frustrated over the results.18 This disenchantment was expressed in complaints from Africans and Europeans alike that the “imported” educational system failed to achieve its objectives. Western education was considered “too European,” and therefore, ill-suited and irrelevant to African needs, and that in the process, the indigenous values of love, community relationships, and profound spirituality were being lost. At the same time, some complained that the new system had introduced new values of intolerance, hatred, “cutthroat competition,” disharmony, pride, arrogance, covetousness, and even cheating. It was further suggested that there was too much rote-learning and too little application of the principles being taught in the schools. Colonial officials soon resolved that massive reform was required.19

The plans for reform were influenced by educational practices in the United States and promoted by the Phelps-Stokes Fund, an American philanthropic foundation. In 1920 the Phelps-Stokes Fund launched its African Education Commission, led by Thomas Jesse Jones, a Welshman who had formerly taught at Hampton Institute in Virginia.20 Jones assembled a team of six observers that was to travel to West Africa to survey colonial educational institutions and practices and to make recommendations. The team visited Nigeria from 4 November to 16 December 1920, and traveled to Kano, Onitsha, and Calabar. In its report published in 1922, the team concluded that Western education had little prospect for success in the African colonies because it was transplanted to a soil that was unwilling to let it grow. It was suggested that formal schooling should be adapted to suit its environment. With regard to secondary education, the commission argued that it should aim at training African leaders and suggested that activities of secondary school should be determined with particular regard to the needs of such leadership. Among t\he subjects considered relevant were sciences, physiology, hygiene, sanitation, social studies, mathematics, languages, gardening and rural economics. The report emphasized that formal schooling should, in all lands, concentrate on “indigenous education” and be adapted to local needs.21

Among the team members were education specialists and anthropologists from the Teachers College, Columbia University. They all had a keen interest in examining the educational and social development of “primitive” races, their folkways and history, because they believed that Africans should be made to learn about these cultural beliefs and practices at all stages of their formal schooling. This view was supported by the members of the Advisory Committee on Native Education in Tropical Africa established in 1923 by the Colonial Office in London. Even after the committee was renamed the Advisory Committee on Education in the Colonies, its members continued to insist on the need to design a specific educational system, curriculum, and examination system for Africans, and to adapt the existing system of formal schooling to suit local needs, arguing that Western education was unsuitable for Nigerians and other colonial subjects.22

The colonial government officials who believed that formal schooling in the colonies must take the culture of the “natives” into account shared their views with others in London and this theme was echoed throughout the colonial period. The Imperial Education Conferences of 1912, 1927, 1937 and the Advisory Committee Reports on Education in the Colonies all emphasized this idea, and a 1925 white paper, titled “Education Policy in British Tropical Africa,” highlighted the need to adapt education “to the mentality, aptitudes, occupations and traditions of the various peoples, conserving as far as possible all sound and healthy elements in the fabric of their social life.”23 The 1925 white paper was dispatched to all the provincial governors in African colonies, and Lord Lugard, chronicler of British colonial history, described it as “one of the principal landmarks of imperial policy in the twentieth century.”24 In October 1929, W. Ormsby-Gore, the Under-Secretary of State for the Colonies and the chairman of the Advisory Committee on Education in the Colonies, reiterated the position that schooling had to be adapted to the circumstances and lives of colonial peoples. He declared that:

In all parts alike the need is felt for an education which will preserve and develop the individuality and traditions of the various peoples, whether indigenous or immigrant, and which will give them at the same time the means of acquiring a scientific or technical mastery of the forms of nature and a wider outlook on human experience.25

It appears that the British government considered its policy of adaptation of education to suit local needs as extremely important. In pursuance of this policy, the British government supported the formation of the International Institute of African Languages and Culture, which instituted five prizes for the best books written by Africans in African languages. This action was taken, according to the authorities of the Institute, to give impetus to the production of vernacular literature.26

THE ROLE OF BRITISH UNIVERSITIES

The responsibility for planning secondary school curricula for the African colonies in the early decades of the 20th century in Africa remained with the Departments or Ministries of Education of the various countries. But the initiative for changes in school examinations remained in the hands of the Advisory Committee of the Colonial Office whose primary concern, according to historian Clive Whitehead, “was to maintain more direct control over the spread and content of education, especially at the secondary level.”27 However, the actual examinations were conducted mainly by the University of London School Examinations Board, the Cambridge University Syndicate for Local Examinations, and the Oxford Delegacy for Local Examinations. As was noted, examinations have a decisive influence on the school curriculum, and university examination bodies had expressed their willingness to consider suggestions from various quarters for appropriate modifications.28 The Advisory Committee on Native Education in Tropical Africa acknowledged this fact in June 1929, and as early as 1930, the committee began to consider ways of bringing about changes in the content of the educational programs in colonial schools.29 A sub-committee of the Advisory Committee was later set up under Sir James Currie that corresponded with the English universities and expressed an eagerness to modify the existing syllabi for the colonies to reflect local needs. The Advisory Committee assured university officials that it was not interested in lower standards, but wanted “to retain them [colonial subjects] within the ambit of English education, whilst making such modifications. . . .”30

An education conference was held in London between 25 and 31 May 1935 to review proposals for the reform of the syllabus for secondary school examinations in the colonies. Another meeting was held at the Colonial Office in London on 5 December 1935 between the English examining bodies and colonial officials. At that meeting it was agreed that a sub-committee should be set up to coordinate the activities of the examining bodies and should consist of two representatives from each of the university boards concerned with examinations in the dependencies, as well as individuals nominated by the secretary of state for the colonies.31

After several meetings, the Advisory Committee agreed on the format for the existing examinations and the division into subject groups. It also agreed that the syllabi for history, physics, chemistry, and mathematics should remain unaltered. It recommended that local flora and fauna be substituted for the European plants used in the botany examinations, and that a greater emphasis should be put on local geography. Finally, it recommended that essay topics in the English language paper should be made more meaningful to the African students and therefore considered the inclusion of topics considered relevant to the “natives,” including “Native markets,””Native Music,””Native Dancing,””Popular Superstitions,” and “Polygamy.”32

All the English universities responsible for conducting school examinations in Nigeria favorably considered the proposals submitted by the Advisory Committee on Native Education in Tropical Africa. However, as early as October 1922, London University adopted Hausa and Yoruba as “optional special languages” for its university entrance qualifying examinations. At its meeting on 18 October 1922, the London University Faculty Senate approved the recommendation of the senate-appointed “Board of Studies in Oriental Languages and Literature” that these two languages be adopted as suitable examination subjects.33 However, the University Senate insisted that in making these decisions about the adoption of African languages, it would only be guided on academic grounds. Thus at its meeting of 5 February 1926, it resolved that “Efik is not a suitable subject to be offered at the Matriculation Examination on the ground that there is not a sufficient native literature to allow an adequate test of proficiency in the language.”34

In principle, the study of indigenous languages was a positive move, but the assumption that Africans could not grapple with the nuances of the English language was highly questionable. This probably explains why the indigenous peoples were suspicious of the intentions of the colonial officials whom they believed did not want them to master the English language, and therefore compete with them for positions of authority. In October 1930, London University’s Board of Studies in Oriental Languages and Literature recommended that Igbo be recognized as a special language at the matriculation examination on the grounds that it is the language of over four million people. It was also recommended as a compulsory subject for governmental officials being sent to the region before their appointments could be confirmed. The London University Senate, however, raised objections and refused to consider “extra academic factors” in the recognition of a language at the matriculation examination.35

The Board of Studies in Oriental Languages and Literature had suggested that “some stimulus is needed to induce Igbo young men to study, and to help them in the development of their own language; and the recognition of Igbo in this way may help to this end.”36 However, in making its final recommendation in November 1930 to the Matriculation and School Examinations Council, the Senate concluded that Igbo should not be approved as a special language at the matriculation examination.

It was ascertained from further inquiries that Igbo literature consists at present of the Bible, the Prayer Book, a Reader in the written language known as Union-Igbo, a few books of a religious nature in one or other of the dialects, and a history of a town written by a native of that town, more or less after the Union-Igbo model; and further that Igbo is at present a language of many dialects.37

The University of London also faced problems introducing the study of African history into the curriculum because of the absence of textbooks or other written materials.38 Some colonial officials were convinced that some of the indigenous peoples came to their present destinations “at some time unknown, and had nothing in the way of history, handicrafts, customs, or physique to make them notable.”39 The existing textbooks devoted only a few paragraphs to the history of the African peoples before the coming of the Europeans. Moreover, Englishman T. R. Batten, the author of several textbooks on African history, argued that “throughout the long ages before Africa was controlled by European powers inthe nineteenth century, there were few changes in African ways of living.”40 Most colonial officials did not consider the history of the “natives” worthy of study, largely because they saw “history” as a subject needed to inform the “natives” about the European “civilizing missions.” As one of them put it: “We must tell them the story of how the white man has come in his great ships to show the new ways of mining and planting, bringing also factories and cinemas, railways and motorlorries, that break up the old life.”41 University entrance examinations included questions on Henry the Navigator and the European explorers possibly as part of the promotion of “imperial” African history.

With regard to the art curriculum, Cambridge University carefully considered the proposals submitted by K. C. Murray, who as early as 1931 had criticized the Syndicate’s art examination as unsuitable for developing art education in Nigeria because “they have little to do with art and nothing to do with African traditions.”42 Murray then volunteered to consult Africans who, being “a practicable people,” would be able to design a syllabus in art education. In 1933 the Cambridge Syndicate reported that it was proposing to adapt its course to “tropical needs and conditions.”43 Overall, by 1936 the Syndicate had worked out several new examination programs for the Nigerian candidates, but the examinations retained the titles “Junior School Certificate” and “School Certificate.” Both examinations included “overseas subjects” such as geography, which had some questions inserted to test the candidates’ knowledge of “local conditions.” For the award of certificates, all candidates for the examinations were required to pass the English language paper, which was designed to test the candidates’ ability to write English correctly. Candidates were required to offer English and four to eight subjects chosen from at least two groupings of courses.44

The Cambridge University Syndicate, like the other examination bodies, continued to insist on the attainment of specific marks to determine the level of achievement of candidates, and emphasized that “special attention is paid to the English language test in awarding grades. In no circumstances is Grade I, the highest level, awarded to a candidate who fails to reach the pass standard in this test.”45 This of course had implications for the mastery of other European languages in the country, none of which was made compulsory.46

THE CHALLENGE OF ADAPTATION

The implementation of the adaptation strategy in Nigeria was fraught with difficulties. Western education was introduced into Africa five centuries after universities had been established in Europe, and more than one thousand years after Western education had been in practice in a written form. Those who pioneered Western education in Africa were aware that while they were dealing with “fundamental” schooling in Africa, in England the universities of Oxford and Cambridge and English grammar schools had been established as far back as the 12th century.47 Some colonial officials assumed that formal schooling in Africa was to be limited to basic village education in a rural setting, but there were those who begrudgingly recognized the need to extend schooling to the secondary education level. Furthermore, the Christian missionaries who introduced Western education were ignorant of traditional African educational systems, with their emphasis on apprenticeship training, oral tradition, and respect for elders, honesty, and fair play.48 Many missionaries and colonial officials assumed there was no educational foundation on which they could build. They later realized that their assumptions about the indigenous educational practices were invalid.

Moreover, the new educational system produced unexpected outcomes by conferring rewards such as jobs and social status on successful students. This drove some African students to do almost anything to achieve success, including rote-memorization of the material, cheating, or even buying their way to examination success. Unlike traditional education, which was interwoven into communal life, Western education produced a new breed of Africans who were at times alienated from their own communities because of the power and authority conferred on them by their new status. As one colonial official observed, “Some products of the educational system overestimated their own achievement and worth.”49 The colonial office in the 1950s had to accept that,

Education practice in Africa has come under fire from various quarters…. There are those who say that the education we offer is too bookish, is not related to the environment of the country, and does not pay sufficient attention to character training; that primary education ought to have an agricultural and rural bias; that secondary education turns out too many people with a desire for white-collar employment.50

At independence, a Nigerian minister of education, Chief J. A. O. Odebiyi, described Nigerian secondary school graduates as “mercenary, materialistic and complacent” and added that they “tend to think that possession of a Cambridge or West African Examinations Council certificate entitled them to believe that the world owes them a living.”51

The implementation of the adaptation strategy further undermined its potential success. Indeed, adaptation became cosmetic, incomplete, nonparticipatory, alienating, and exclusive. Those who benefited did not share the educational vision, but went along for personal gain. This was because the officials who implemented adaptation did not anticipate or call for any contribution from the local people. Eventually, British examinations boards accepted the adaptation program and began introducing new elements into the tests. However, these minor changes did not greatly affect the overall development of Nigerian secondary education. The English language paper remained compulsory, and even the addition of new essay topics for Nigerian candidates did not introduce major changes in the paper. Some essay topics such as ‘”Where there’s a will there’s a way’: How far can this proverb be applied to our everyday life?” were more appealing to Nigerian candidates who had come to sit for the examinations only to prove the dictum. The fact that the examinations had to be written in intelligible and meaningful English only reinforced the Nigerian students’ belief that “adaptation” meant greater facility in Western subjects.

However, many of the subjects were not greatly affected by the adaptation strategy. Arithmetic, geometry, and algebra papers continued to be designed to test the candidates’ ability, irrespective of their geographical location. Physics and chemistry examinations, for instance, tested the same information whether they were taken in Britain or in the colonies. Botany and geography were among the “adapted” subjects, but the basic requirements for standard examinations remained and only about one in ten of the questions reflected colonial circumstances. For example, geography papers before and after adaptation included questions on the earth- its form, movement, and atmosphere; construction and use of maps; distribution of land and water; vegetation; distribution of population; and so forth. But for candidates in Africa, at least one question was added that dealt with the regional geography of Great Britain, and either Africa or America.52

The examiners included questions on the history of the exploration of Africa and the growth of the British Empire, but not on the history of African peoples. The subject groups remained, but the list of topics was expanded. However, it was possible for the candidates to avoid some of the newly introduced subjects and still obtain a certificate. It was also possible to avoid any new topic inserted in the old subjects and still pass the examination.

Perhaps it would be better to describe the new system as a modification rather than “adaptation” since the continued emphasis on English as the lingua franca was itself a negation of adaptation. The secretary of state for the colonies, Ormsby-Gore, came close to acknowledging this reality when in an address at the annual Conference of Educational Associations on 5 January 1937, he declared that “external examinations have always tended to influence curricula, and have not always helped the true course of good education.”53

It is significant that the apologists for adaptation did not comment on the negative aspects of external examinations. For example, no consideration was given to the view that examinations inevitably generated “an exaggerated spirit of selfish rivalry, and a desire of immediate praise and reward. . . . Personal ambition prevails over public spirit and patriotism . . . love of self as opposed to love of others.”54 And Sir John Lubbock pointed out in his criticism of the British examinations that “every schoolmaster will be anxious, for the credit of the school, to obtain as large a proportion of certificates as possible, and under these circumstances attention will be concentrated on the four subjects taken. . . .”55 Therefore, it would appear that the promoters of adapted education failed to appreciate the problems of an educational system based solely on examinations, problems which transcended race and nation.

Historian Henry D’Souza observed that the adaptation strategy was largely restricted to the New Zealand Maoris, the black population in the Caribbean, the native peoples of the Philippines, Africans in the sub-Saharan region, and black South Africans. He has further explained that adaptation “implied low standards compared with that offered at comparable institutions in Britain.”56 He also expressed agreement with the description of T. Smith, a British Member of Parliament, who had described adapted schooling as “education on the Woolworth basis.” D’Souza concluded that the adapted curricul\um was “a method of discriminating against the ‘native’ by slowing down the educational pace and watering the curriculum content.”57 Charles Loram, an apologist for the adapted curriculum in South Africa, was concerned with the “natives of South Africa,” and in his view “industrial training should be made the chief end of Native education.”58 Historian Andrew Paterson pointed to the “certainty with which Loram attributed consensus” on the question of adaptation in South Africa among “all white colonial interest groups.”59

In the early 1920s, the distinct form of “Negro industrial education” associated with Hampton and Tuskegee Institutes and aimed at maintaining the subordination of the southern black working class was recommended as appropriate for the “native peoples” in European colonies in Africa. Historian P. S. Zachemuk explained that “informed by the American-based Phelps-Stokes Commission, and modeled in part on what white Americans thought suited their African American underclass, colonial education policy hoped to create loyal Africans who knew their place in gendered colonial and racial hierarchies.”60 Edward Berman contends that the recommendations of the Phelps-Stokes Fund’s Education Commission to Africa had “strong racist overtones,” and would have proved disastrous for the development of Africa had they been adopted.61 He noted that “the belief in African inferiority and depravity led many to conclude that Africans and their American descendants could not possibly benefit from a literary education.”62 Berman also drew attention to the chairman of the Continuation Committee of the World Missionary Conference who observed in 1914 that the “mental digestion” of the “child race” is weak, and that these races “are more successful in getting knowledge than using it.” The chairman then concluded that the intellectual infirmity of the African had grown out of the “low state of his civilisation and the effect on his mind of centuries of barbarous lawlessness and cruelty.”63 Historian Kenneth King has been critical of the recommendations of the Phelps-Stokes Commission because they were based on assumptions of African inferiority and served as a recipe for political and economic subordination.64 These researchers also suggested that the Commission failed to have a direct influence on educational developments in African colonies because it was overly ambitious, spent too little time in Africa, and did not consult well-respected members of the African intelligentsia.65

Rather than planning a more suitable educational system, overworked and inexperienced colonial officials embarked on the adaptation program half-heartedly. It is difficult to resist suggesting that if these officials had kept their own children in the colony’s schools, they would have appealed to more experienced and competent educational planners outside the colony for advice and sought additional financial assistance for local educational programs from the Colonial Office. However, colonial officials refused to bring their children with them because of fears about the tropical climate. The official reports consistently carried the information that “West Africa has always had, and deserved, the reputation of being so unhealthy that almost certain death would be the fate of the white man who endeavoured to make it his home. And in this general condemnation Nigeria has been included.”66 E. Speed, the first Chief Justice of Nigeria, also commented that “by the nature of our service which precludes the possibility of bringing up children in Nigeria, we are forced to maintain a residence for our family at home or at all events in some climate where children can live.”67 The adapted schooling available in the British colonies in Africa was meant only to apply to African children, and historian Martin Carnoy suggests that the failure of Western education to produce a mass of innovative and highly trained individuals was not a failure at all, but the direct result of the colonizing function of schooling, adapted or otherwise, in a capitalist economy.68

In searching for the real motives for the genesis of the adaptation strategy, one must look at the apprehensions of the colonial officials who suddenly discovered that Nigerians were investing heavily in their formal schooling, which was considered a passport to upward mobility in the colonial system. Because the colonial government invested comparatively little in schooling, many Nigerians began courses through self-education, scorned indigenous education and sub-standard educational institutions, and vigorously embraced the English universities’ examinations. Many Nigerian youths began to consider the acquisition of the certificate as their prime objective for social advancement. Commenting on “these misguided aspirations,” of young West Africans, the well-respected Nigerian nationalist Nnamdi Azikiwe pointed out that “the African is not, and never has been, a problem; there is no such thing as an African educational problem.” The real issue was the overarching emphasis on certificates, credentials, and “degrees after one’s name.”69

But these values were rarely acquired through the passing of the School Certificate or the Overseas School Certificate examinations. Azikiwe did not preach the discontinuance of the external examinations, but he wanted them supplemented by training that would inculcate in the Nigerian youth a sense of dedication, patriotism, and loyalty. It seems plausible to suggest that the colonial administration was not prepared to pursue such an educational experiment, and there seems to have been an element of improvisation associated with adaptation because shortly after the colonial officials transplanted Western education in Nigeria, they began to regret the initiative because of its failure to create the colonial subjects “of their dreams.” For example, it was suggested that instead of producing cooperative citizens, “the present picture is one of ferment and conflict in which the individual, much more than in the past, sees himself and his private interests evermore clearly, and society and his duties to it as something outside himself, demanding and frustrating.”70 British officials in Nigeria consistently complained that products of the existing school system were generally disrespectful to colonial authority and generally discourteous toward the traditional elders. Lord Frederick Lugard, the first governor of Nigeria, who was by no means a profound thinker or intellectual, despised the products of the colonial school system. Lord Lugard frequently drew attention to the negative comments about them, and agreed that they were usually “unreliable, lacking in integrity, self-control, and discipline and without respect for authority of any kind.”71

Other advocates of adaptation such as Lord Lugard’s deputy, C. L. Temple A. Mayhew, the joint-secretary of the Advisory Committee on Native Education, Sir Percy Nunn, Professor of Education at the University of London, and a member of the Advisory Committee on Native Education in Tropical Africa, often defended the colonial educational system. For example, J. H. Driberg, who became lecturer in ethnology at Cambridge University after serving for several years in the colonies, argued that the “native” needed knowledge and skills in two crucial areas.

The two most important things are the maintenance of life and the perpetuation of his species. He has therefore to have a thorough knowledge of all the economic activities of his tribe and of all the circumstances which may affect them, such as insects or other pests, the seasons (which introduce him to astronomy), his physical environment. … As a member of society, he must know its laws and regulations and the way in which it is organised.72

In an address to the British Commonwealth Education Conference held in July 1931, Sir Percy Nunn argued that, instead of chemistry, physics, and mechanics, the African must be taught biology because “the operation of biological laws-especially micro-biology laws is ever present to him. … If you ask many teachers in this country what they understand by biology, they answer that they believe it has something to do with sex teaching. Let us get this idea out of our heads when considering the significance of biology in Africa.”73 A. Mayhew suggested that certain subjects (which he did not name), could be eliminated from the list included in the school examinations. He explained that “in tropical Africa or the Pacific we have for the most part primitive races that seem at present to have but little to contribute, and that must undergo long years of patient work before they can effectively assimilate the best that we can offer. . . .”74

As early as 1930, the director of education reported problems of unemployment among Nigerians with certificates of British examination boards, and admitted that only a small proportion could find the clerical employment that they desired. As a result, a large number of candidates were in search of clerical or similar occupations in various parts of the country. The director added that the candidates were “suffering from a legitimate grievance if they are not employed.” In September 1932 at the meeting of the Advisory Committee on Native Education in Tropical Africa, Sir Michael Sadler evoked “the danger of an academic proletariat.” The members drew the attention of the colonial officials to the possibility of the overproduction of these “colonial graduates.”75 W. R. McLean argued that “unless the product of university training, or indeed of any higher training, can be employed in the Dependency, it is probably a political as well as an economic error for the local administration to provide uncontrolled facilities for such training, and for the granting of British External degrees locally to native students.”76

It appears that by the early 1930s there was considerable irritation, \perhaps anger, among colonial officials over the growing number of qualified Africans who demonstrated their competence and training by passing the external examinations, but who were deliberately excluded from the governance and administration of their native land.77

CONCLUSION

Adaptation was clearly a product of the fear of colonial officials who believed that the new African leaders were a threat to continued colonial occupation of Africa, and the domination of the skilled labor market by the colonizers. The criticism of African secondary school graduates therefore was a convenient invention of the colonial officials who wished to maintain their position of authority. But the larger question is whether or not real “adaptation” was possible under the colonial system. Colonialism was dominating and alienating and denied the subject peoples freedom of choice or input in the planning and implementation of policies that affected them. Imperial officials had no respect for the views of the colonized, and the schools were designed, not to meet the needs and aspirations of the indigenous population, but those of their colonizers. The colonial system did not function for the good of the colonized, who desired economic, social, and political development.

In addition, the original concept of “adaptation” had an underlying racist assumption. Even the European supporters of adaptation concluded that the imported educational system had produced only “questionable” colonial subjects, but often failed to acknowledge that the secondary schools produced graduates who went on to become efficient clerks, surgeons, journalists, learned ministers of religion, powerful barristers, and Nigerian patriots. Perhaps it was convenient for some biased colonial officials to brand these “promising” graduates also as potential agitators and ne’er-do-wells. At the same time, there was a very strong suspicion among Nigerians that they were considered incapable of mastering English education, and this explains their resistance to “adapted” education. As one Nigerian nationalist sniped, “What is good for the goose must be good for the gander!” And this determination to resist adaptation was clearly reflected in Nnamdi Azikiwe’s advice to Nigerian youth who wanted to begin higher studies.

There is no achievement which

Is possible to human beings which

Is not possible to Africans.

Your studies of Logic should

Lead to the correct conclusions.

Therefore go forth, thou

Sons of Africa, and return

Home laden with the

Golden Fleece.78

Writing in 1930, Adeyemo Alakija, then a student of Oxford University, admitted that there was chaos in the Nigerian educational system because “the African could not avoid attempting to imitate the European [and] the European did not think it his duty to study the African’s national institutions. He would modernise the African and advance his mode of life from the European point of view.”79 But Alakija challenged any plan to provide substandard education for Africans because that would be based on European conceptions of the African as mentally deficient. In his opinion, “Africans are not to be a nation of clerks without a future.” As part of his education, the African must be exposed to foreign influences and ideas. And he asked, “Should we say that the African ceases to be African because he finds it more convenient to discard his gabardine for the Bond Street style?”80

By the 1920s it was clear that the indigenous African population had become highly suspicious of the intentions of the various educational “commissions” that had sought to “adapt” what they considered to be an adequate educational program to meet the needs of colonial subjects. Many of the educated African elites had been angered by the various recommendations, which they believed would produce only second-rate scholars unprepared to go on to the university or other institutions of higher learning. The context in which the adapted education system was introduced did not foster partnership between the colonizers and the “natives.” In fact, adapted schooling was imposed on the indigenous people, and was strongly resisted by many. As Whitehead has aptly put it:

British models were certainly followed but not because they were deliberately imposed on colonial schools, but rather because Africans and other colonial subjects insisted on them. Anything less would have been considered second rate. It was for this reason that the policy of adaptation, so popular with colonial educators in the interwar years, failed. Africans, in particular, wanted a carbon copy of British education and qualifications acceptable for admission to British universities and University of London external degrees. A study of the classics may have made little practical sense in tropical Africa, but Latin and Greek were part of the European educational gold standard to which Africans aspired.81

Perhaps another reason Africans resisted adaptation was because they were not allowed to make the decision themselves. As R. J. Mason, a contemporary observer, put it, “I think . . . that a successful adaptation can be made only by Africans themselves. An alien people, and a ruling one, however well-intentioned it may be, can only take another people so far along the road. Thereafter, they must find their own way, seeking such guidance as they themselves feel the need.”82 We should also point out that even the nations that had exported educational models to the colonies had to embark on reforms at various points, as is evident in the important changes in the curriculum, educational systems, and accreditation strategies in European and other developed countries.83

It is important to note that most of the educated elite that began to struggle to attain independence from British colonial rule were not those who had the advanced education of the “unadapted” type found outside Africa. In fact, many African nationalists grew up while the “adapted” version of education was being encouraged. The frustrations of the limited education and the fear and suspicion sown in the minds of the young people who went through the experiment blossomed into a rejection of the colonial apparatus, including the educational programs it generated.84

Perhaps we should add that there was scant willingness to use education to prepare Africans for leadership, independent thinking, confidence building, and assertiveness. Character building, self- assurance, and the capacity to work with others were not priorities. Nor was the system equipped to cope with the issues of ethnicity and class, national identity, social justice, or equity and equality of access to advanced training. Certainly, these educational programs were not geared toward finding solutions to the problems of hunger, poverty, technological backwardness, or the challenges of democratic governance.85 Yet these should have constituted the basis for genuine educational adaptation.

NOTES

I am grateful to the staff and authorities of the National Archives, Ibadan, Nigeria; the Cambridge University Syndicate of Local Examinations, Cambridge; the Oxford University Delegacy of Local Examinations, Oxford; Rhodes House Library, Oxford; the University of London Senate House Library, London; the Missionary Societies of Great Britain and Ireland, London; the Institute of Historical Research, London; the Institute of Education, London; and the University of Ibadan in Nigeria for giving me access to their rich collection of materials on this subject. I am also grateful for the assistance provided by the Information Service of the Caxton Publishing Company, London; and to the University of London authorities for permission to quote from the University Senate Minutes. I wish to acknowledge the contribution of Dr. Mercy Ette, and the constructive comments of Professor V. P. Franklin and the anonymous reviewers of this work.

1 See Clive Whitehead, “The Historiography of British Imperial Education Policy, Part II: Africa and the Rest of the Colonial Empire,” History of Education [England] 34 (July 2005): 441-54; Kenneth King, Pan Africanism and Education: a Study of Race Philosophy and Education in the Southern States of America and East Africa (Oxford: Clarendon Press, 1971), Peter Kallaway, “Colonial Education in Natal: The Zwaartkops Government Industrial Native School 1888 to 1892,” Perspectives in Education 10 (Summer 1987): 17- 33; Carol Summers, “Educational Controversies: African Activism and Educational Strategies in Southern Rhodesia, 1920-1934,” Journal of Southern African Studies 20 (March, 1994): 3-25, Henry D’Souza, “External Influences on the Development of Educational Policy in British Tropical Africa from 1923 to 1939,” African Studies Review, 18/2 (1975), 35-43; D. G. Schilling, “British Policy for African Education in Kenya 1895-1939,” Ph.D. thesis, University of Wisconsin, 1972; Trevor Coombe, “The Origins of Secondary Education in Zambia,” African Social Research, 3 (June 1967): 173-205; 4 (December 1967): 283-315; and 5 (June 1968): 365-405; and Penelope HelhenngLon, British Paternalism in Africa, 1920-1940 (London, 1978).

2 For discussion on the subject see Jacob Ade Ajayi, Christian Missions in Nigeria, 1841-1891: The Making of a New Elite (Evanston, IL, 1965); E. A. Ayandele, The Missionary Impact on Modern Nigeria (London, 1966); F. K. Ekechi, Missionary Enterprise and Rivalry in Igboland, 1857-1914 (London, 1972); C. K. Graham, The History of Education in Ghana from Earliest Times to the Declaration of Independence (London, 1971).

3 See A. A. Adeyinka, “The Development of Secondary Grammar School Education in Nigeria,” M.Ed. Thesis, University of Ibadan, 1974; A. A. Fajana, Education in Nigeria, 1842-1939, An Historical Analysis (Lagos, Nigeria, 1972); Jacob Ade Ajayi, “The Development of Secondary Grammar School Education in Nigeria, ” Journal of the Historical Society of Nigeria 2 (No. 3, 1963): 517-35.

4 Ajayi, Chris\tian Missions in Nigeria, 1841-1891.

5 Some of the comprehensive accounts on this subject are available in Helen Kitchen, ed., The Educated African: A Country-by- Country Survey of Educational Development in Africa (New York, 1962); L. J. Lewis, Society, Schools and Progress in Nigeria (London, 1965); Peter C. Lloyd, ed., The New Elites of Tropical Africa (London, 1966); Kristin Mann, Marrying Well: Marriage, Status and Social Change Among the Educated Elite in Colonial Lagos (Cambridge, MA, 1985).

6 Andrew Paterson, ‘”The Gospel of Work Does Not Save Souls’: Conceptions of Industrial and Agricultural Education for Africans in the Cape Colony, 1890-1930,” History of Education Quarterly 45 (Fall 2005): 377-404.

7 The African American community in the United States had shared a similar experience of investing in education in response to the neglect by the state and local officials to provide equal or adequate funding for all-black or predominantly black public schools. For a comprehensive story of the experience in the United States, see V. P. Franklin, “Introduction: Cultural Capital and African American Education” The Journal of African American History, 87 (Spring 2002); 175-218; and “They Rose or Fell Together. African American Educators and Community Leadership, 1795-1954,” Journal of Education 172 (1990); 36-64; and V. P. Franklin and Carter Julian Savage, eds., Cultural Capital and Black Education: African American Communities and the Funding of Black Schools, 1865 to the Present (Information Age Publications 2004).

8 For a useful discussion on the origins of secondary schools in Nigeria, their locations, school enrollment, student background, and retention rates, see Adeyinka, The Development of Secondary Grammar School Education in Nigeria; Fajana, Education in Nigeria, 1842- 1939; and Ajayi, “The Development of Secondary Grammar School,” 517- 35.

9 For some useful discussion on the subject, see Philip Foster, Education and Social Change in Ghana (Chicago, IL, 1965); Leonard James Lewis, An Outline and Chronological Table of the Development of Education in British West Africa (London [n.d]); and Colin Wise, A History of Education in British West Africa (London, 1957).

10 See N. Omenka, The School in the Service of Evangelisation: The Catholic Education Impact in Eastern Nigeria, 1886-1950 (Leiden, Netherlands, 1989); F. K. Ekechi, “Colonization and Christianity in West Africa: The Igbo case, 1900-1915,” Journal of African History 12 ,(No. 1, 1971); M. McLean, “A Comparative Study of Assimilationist and Adaptationist Education Policies in British Colonial Africa, 1925-1953,” University of London, Ph.D. dissertation, 1978; and Fajana, Education in Nigeria, 1842-1939.

11 Among the helpful studies on the subject are Yoshiko Namie, “The Role of the University of London Colonial Examinations Between 1900 and 1939, with Special Reference to Mauritius, the Gold Coast and Ceylon,” London University Institute of Education, Ph.D. dissertation, 1989; and Michael Omolewa, “The Promotion of London University Examinations in Nigeria, 1887-1951,” The International Journal of African Historical Studies 13 (No. 4, 1980): 651-71; and “Cambridge University Local Examinations Syndicate and the Development of secondary Education in Nigeria, 1910-1926,” Journal of the Historical Society of Nigeria 8 (No. 4, 1977): 111-30.

12 There is a comprehensive introduction to the work of the University of Cambridge Local Examinations Syndicate (UCLES) at the (UCLES) Archives, One Hundredth Annual Report to the University of Cambridge, (Cambridge, Eng., 1958).

13 Michael Omolewa, “Oxford University Delegacy of Local Examinations and secondary Education in Nigeria, 1929-1937,” Journal of Educational Administration and History 10 (No. 1, 1978): 39-49.

14 J. Roach, Public Examinations in England, (London, 1971).

15 A. B. Fafunwa, History of Education in Nigeria (London, 1974), 193.

16 Angela Little, “The Role of Examinations in the Promotion of the ‘Paper Qualification Syndrome,'” in International Labour Office; Paper Qualification Syndrome (PQS) and Unemployment of School Leavers: A Comparative Regional Study, Jobs and Skills Programme for Africa (Addis Ababa, Ethiopia, 982), 177.

17 Mary E. Dillard, “Examinations Standards, Educational Assessments, and Globalization Elites: The case of the West African Examinations Council,” The Journal of African American History 88 (Fall 2003): 413-28.

18 For some discussion on this subject, see L. J. Lewis, Society, Schools, and Progress in Nigeria (Oxford, 1965); M. Read, Education and Social Change in Tropical Africa (London, 1955); Kenneth King, Pan Africanism and Education: A Study of Race Philosophy and Education in the Southern States of America and East Africa (Oxford, Eng., 1971).

19 F. Lugard, The Dual Mandate in British Tropical Africa (Edinburgh, Scotland, 1922), especially the section on “Education.”

20 See Thomas Jesse Jones, Education in Africa: A Study of West, South and Equatorial Africa by the African Education Commission (New York, 1922), 67; and Lewis, Society, Schools, and Progress in Nigeria.

21 Jones, Education in Africa.

22 Clive Whitehead, “The Advisory Committee on Education in the [British] Colonies 1924-1961,” Paedagogica Historica 27 (No. 3, 1991): 385-421.

23 Colonial Office, Educational Policy in British Tropical Africa, “Memorandum by the Advisory Committee on Native Education in the British Tropical African Dependences,” His Majesty’s Stationary Office (HMSO) Cmd. 2374, 1925.

24 M. Perham, Lugard, The Years of Authority, 1898-1945 (London, 1960), 661.

25 W. Ormsby-Gore, “Research and Experiment in Overseas Education,” Overseas Education 1 (No. 1, October 1929): 2.

26 See E. A. Ukong-Ibekwe, “On the Study of Vernacular Languages,” Nigerian Teacher 1 (No. 4, 1935): 32.

27 Whitehead, “The Historiography of British Imperial Education Policy,” 442.

28 Copies of the correspondence between the Colonial Office and the universities are included in the Matriculation and School Examinations Council Report submitted to the University of London Senate in 1935 and 1936, and discussed in those two years. see University of London Senate Minutes (hereafter, SM), 1935-36.

29 Ibid.

30 Ibid.

31 Archives of the Missionary Society of Great Britain and Ireland (hereafter, MSG), Box 225. Minutes of the meeting of the Advisory Committee on Native Education in Tropical Africa, 9 September 1932.

32 SM, 1935-36. The topics that were added for the English language paper included: “The Value of Reading Fiction,””Your Favourite Author or Character,””Rain,””Wild Flowers,””The Forest,””Native Salutations and Greetings,””The Choice of Career for an Educated African,””The Good and Bad Characteristics of Native Religions.”

33 SM (18 October 1922), 314. The Oxford Delegacy followed the example of London University and introduced Yoruba as an optional subject for Nigerian candidates in 1929. The Cambridge University Local Examinations Syndicate began, by special arrangement from December 1936, to conduct special examinations for West African candidates. In December of that year, the Cambridge University Local Examinations Syndicate titled its examinations “Special School Certificate for West Africa and the Bahamas.”

34 SM (24 February 1926), 2293.

35 Ibid.

36 Ibid.

37 SM (19 November 1930), 802.

38 For a comprehensive discussion on this subject, see P. S. Zachernuk, “African History and Imperial Culture in Colonial Nigerian Schools,” Africa 68 (No. 4, 1998): 484-505.

39 See J. M. Welch, “Schools and Community Service in a Backward Area,” Overseas Education, 3 (October 1931): 11.

40 T. R. Batten, Past and Present, (London, 1943), iii.

41 B. Mathews, Black Treasure: The Youth of Africa in a Changing HOrW(NeW York, 1928), 109. See also, W. R. Crocker, Nigeria: A Critique of British Colonial Administration (London, 1936), 15; and compare the observation by Sir Philip Mitchell: “And so at the end of the last century, within the vast region enclosed by the coast of Africa, with its widely spaced forts, towns, and settlements of people from other countries, bounded on the north by the Nigerian Emirates, the Sahara, the Nile . . . , and the Abyssinian massif, the West found itself in control of millions of people who had never adopted an alphabet or even any form of hieroglyphic writing. They had no numerals, no almanac or Calendar, no notation of time or measurements of length, capacity, or weight, no currency, no external trade except slaves … no plough, no wheel, and no means of transportation except human head porterage on land and dugout canoes on rivers and lakes. These people had built nothing, nothing of any kind in material more durable than mud, poles and thatch. . . .”; quoted in J. F. Ade Ajayi, “The Continuity of African Institutions under Colonialism,” in Emerging Themes of African History, ed. T. O. Ranger (Dar Es Salaam, Tanzania, 1968), 190-91.

42 K. C. Murray was a tutor with the Department of Education in Nigeria in 1931. For his observation on the Syndicate’s Art Examinations, see K. C. Murray, “Arts and Crafts in West Africa,” Overseas Education 5 (October 1933): 4.

43 Cambridge Local Examinations Syndicate, One Hundredth Annual Report to the University of Cambridge. 1958, University of Cambridge Local Examinations Syndicate (UCLES) Archives.

44 The group classifications are as follows:

Compulsory Subject:

English Language

Group I:

English Literature, Religious Knowledge

Group II:

Latin, Greek, French, German, Spanish, Italian

Other Languages (Yoruba, Hausa, or any other approved language)

Group III:

Elementary Mathematics, Additional Mathematics

General Science, Physics, Chemistry, Biology

Chemistry, Botany, Hygiene and Physiology

History

Geography

Mechanics

Physics

Group IV:

Art, Music, Handicraft, Technical Drawing, Housecraft

45 Cambridge University Syndicate of Local Examinations, Annual Report for 1936. UNCLES, Archives.

46 For a full discuss\ion of this subject, see Michael Omolewa, “The Teaching of French and German in Nigerian Schools. 1859-1960,” Cahiers d’Etudes Africaines, 18 (No. 3, 1978): 379-96; and “The Ascendancy of English in Nigeria Schools 1882-1960,” West African Journal of Modern Languages (No. 3, 1978): 152-66.

47 See, Eric Ashby, in association with Mary Anderson, Universities: British. Indian, African: A Study in the Ecology of Higher Education (Cambridge, MA, 1966).

48 J. A. Majasan, “Yoruba Education: Its Principles, Practices and Relevance to Current Educational Development,” Ph.D. dissertation, University of Ibadan, 1967: O. Ikejiani, ed., Nigerian Education (Lagos, 1964).

49 Department of Education, Nigeria, Memorandum on Educational Policy in Nigeria (Lagos, 1947).

50 J. R. Bunting, “Certificates and Education,” West African Journal of Education 1 (October 1958): 100.

51 J. A. O. Odebiyi, “The Aims of Secondary Education in Western Nigeria,” West African Journal of Education 1 (June 1967): 43.

52 It is particularly interesting to note that the British examinations boards were not influenced by the arguments advanced by the colonial officials on the need to ask African candidates questions on African tribal tales such as the artful antelope and the strong and sometimes stupid lion, or those on “witchcraft” and “superstition.” Perhaps the examiners did not consider such topics of educational importance, or probably recognized witchcraft as a universal phenomenon, that the fear of “the power of the evil eye” is as old as man, and that many of the “pagan” practices in Africa had their origins in ancient beliefs of the Greeks and Romans. Ayandele notes that Mungo Park, the great British explorer, fervently believed in magic and superstition. E. Ayandele, African Exploration and Human Understanding: The Mungo Park Bi-Centenary Memorial Lecture, (Edinburgh, Scotland, 1971).

53 W. Ormsby-Oore, “Educational Problems of the Colonial Empire,” Journal of the Royal African Society 36 (April 1937): 165.

54 Sir John McNeil, “Competitive Examinations,” The Quarterly Review 108 (October 1860): 569.

55 Sir John Lubbock, “On the Present System of Public School Education, with Special Reference to the Recent Regulations of the Oxford and Cambridge School Examinations Board,” Contemporary Review 27 (January 1876): 168.

56 Henry D’Souza, “External Influences on the Development of Education Policy in British Tropical Africa from 1923 to 1939,” The African Studies Review 18 (September 1975): 36. For an examination of the introduction of a form of “adapted education” into separate black secondary and normal schools in the South, see James D. Anderson, The Education of Blacks in the South, 1860-1935 (Chapel Hill, NC, 1988), 33-78.

57 D’Souza, “External Influences on the Development of Education Policy,” 37.

58 Charles T. Loram, The Education of the South African Native (London, 1917), 146.

59 See Andrew Paterson, “The Gospel of Work Does Not Save Souls,” 377.

60 Anderson, The Education of Blacks in the South, 33-88; Zachemuk, “African History and Imperial Culture in Colonial Nigerian Schools,” 487-488.

61 Edward H. Berman, “American Influence on African Education: The Role of the Phelps-Stokes Fund’s 1920 African Education Commission,” Comparative Education Review 15 (June 1971): 145.

62 Ibid.

63 Edward H. Berman, “Christian Missions in Africa” in African Reactions to Missionary Education (New York, 1975), 10.

64 E. A. Ayandele, The Educated Elite in the Nigerian Society (Ibadan, Nigeria, 1974).

65 Ibid. Edward Berman believes that the Commission was also handicapped because it chose to work with J. E. K Aggrey, who was “little known” outside the United States; see “American Influence on African Education,” 143-45; and Sylvia M. Jacobs, “James Emman Kwegyir Aggrey: An African Intellectual in the United States,” The Journal of Negro History 80 (Spring-Fall 1996): 47-61.

66 See, Colonial Office List, “Report on Nigeria,” 1910-20, National Archives, Ibadan.

67 E. A. Speed to Lord Lugard, 3 July 1914, Manuscripts of the British Empire (Mss. Brit. Emp.) 8. 74, Rhodes House Library, Lord Fredrick Lugard Papers, Oxford, England.

68 Martin Carnoy, Education and Cultural Imperialism (New York, 1974); see also, A. Fajana, “Colonial Control and Education: The Development of Higher Education in Nigeria, 1900-1950,” Journal of the Historical Society of Nigeria 6 (December 1972): 323-40. B. O. OIoruntimehin notes that during this period the French were also debating the need for “adaptation” in the education of their colonial subjects for similar reasons. For a discussion on French colonial education, see B. O. OIoruntimehin, “Education for Colonial Dominance in French West Africa from 1900 to the second World War,” Journal of the Historical Society of Nigeria 7 (June 1974): 347-56.

69 Ben N. Azikiwe, “How Shall We Educate the African?” Journal of the African Society, 33 (April 1934), 144.

70 Walter R. Miller, Have WeFailed in Nigeria? (London, 1947), 3. This was the broad view of the colonial education officers, with few exceptions. see, for example, Hans N. Weiler, ed., Erziehung und Politike en Nigeria (Education and Politics in Nigeria) (Freiburg, Switzerland, 1964).

71 Frederick Lugard, The Dual Mandate in British Tropical Africa, 5th Edition, with a new introduction by Margery Perham (London, 1965), 428.

72 J. H. Driberg, At Home with the Savage (London, 1932), 234- 35.

73 Address delivered at the British Commonwealth Education Conference on July 27, 1931, by Sir Percy Nunn. For the report of the proceedings of this conference and the text of Sir Percy’s address, see Overseas Education 3 (October 1931): 1-11.

74 A. Mayhew, Education in the Colonial Empire (London, 1938), 3.

75 E. R. J. Hussey, Memorandum on Educational Policy in Nigeria (London, 1930).

76 W. H. McLean, Memorandum on Colonial Education Instit

Chat Free Online With Healthcare Professionals, 24 Hours a Day

ATLANTA, Oct. 17 /PRNewswire/ — MyMD (http://www.mymd.com/) has launched an innovative program of live chat to answer patients’ questions on a wide range of health issues. People nationwide can now tap into the expertise of healthcare professionals at no charge.

“While 70 percent of people use the Internet to find health-related information, only 16 percent finds what they are looking for using search engines,” said Michael Chalkley, CEO of MyMD. “People need solid, reliable healthcare information. At http://www.mymd.com/ , questions are answered through live text chat HealthChat by healthcare professionals skilled at finding information on the Internet and answering questions about conditions, symptoms and treatment. People get precise answers without sifting through irrelevant web pages.”

MyMD offers the opportunity to reach providers of healthcare services within zip codes. MyMD can find a primary care physician or arrange a same-day appointment at a convenient urgent care center. MyMD plans to expand with information on clinical trials, discounts for medications and other healthcare services relevant to a patient’s search terms or condition.

Physician Match at http://www.alijor.com/ and Solantic Urgent Care, which operates 13 walk-in centers throughout Florida, are sponsoring the launch of HealthChat. Patients looking for a new healthcare provider or requiring urgent care will have access through a direct link to these services.

“Finding medical information can be intimidating. MyMD’s HealthChat along with Alijor’s service of matching patients with doctors who can help them will simplify this often daunting and time-consuming process,” said Allison Scott, president of Alijor, LLC.

MyMD Inc., founded in 1998 in Atlanta, provides a medical service via Internet and telephone to people seeking medical advice and assistance. MyMD physicians, board-certified in their specialties, bring expertise to patients in need of care. MyMD is a direct real time interaction between specialists in primary/specialty care and patients, similar to medicine practiced every day where physicians respond to patients’ needs by telephone, evaluate their requests and information and then take appropriate actions to improve the patient’s health.

Alijor was founded with the purpose of making it easy for patients in need of medical services to find a healthcare provider. Patients post their medical needs and healthcare providers respond with prices and service options.

For information, go to http://www.mymd.com/ or call (866) 252-2913.

MyMD Inc.

CONTACT: Nancy Floyd of MyMD, 1-866-882-5007, [email protected]; orAllison Scott of Alijor, +1-646-290-5551, [email protected]

Web site: http://www.mymd.com/http://www.alijor.com/

Red Tide Models and Forecasts to be Expanded

A new observation and modeling program focused on the southern Gulf of Maine and adjacent New England shelf waters could aid policymakers in deciding whether or not to re-open, develop, and manage offshore shellfish beds with potential sustained harvesting value of more than $50 million per year. These areas are presently closed to the harvest of certain species of shellfish due to the presence of red tide toxins.
   
Researchers at the Woods Hole Oceanographic Institution (WHOI) and colleagues from seven other universities or agencies began the five-year Gulf of Maine Toxicity program, or GOMTOX, on September 1. The  $7.5 million dollar program is funded by a grant from the National Oceanic and Atmospheric Administration”Ëœs (NOAA) National Ocean Service, Center for Sponsored Coastal Ocean Research (NOS/CSCOR) through the ECOHAB program.

The new research effort expands past studies in the Gulf of Maine and builds on data collected during the historic 2005 red tide, which led to closure of both nearshore shellfish beds and offshore beds in federal waters out to Georges Bank.  The toxicity also extended for the first time to the islands of Martha’s Vineyard and Nantucket.

The Gulf of Maine (GoM) and its adjacent southern New England shelf is a vast region with extensive shellfish resources, large portions of which are frequently contaminated with paralytic shellfish poisoning (PSP) toxins produced by the dinoflagellate Alexandrium fundyense.  The 2005 outbreak caused millions of dollars in economic damage, but monitoring programs and cooperation among federal, state and local officials, scientists, and shellfishermen prevented any reported cases of illness from people eating contaminated shellfish.

“As a result of the 2005 bloom and the closures in federal waters offshore and on the Cape and Islands, we realized we needed to expand efforts and develop a full, regional-scale understanding of Alexandrium fundyense blooms,”  lead investigator Don Anderson of WHOI said. “We don’t understand the linkages between bloom dynamics and toxicity in  waters near shore versus the offshore, nor do we know how toxicity is delivered to the shellfish in those offshore waters. An additional challenge is the need to expand modeling and forecasting capabilities to include the entire region, and to transition these tools to operational and management use.” 

Anderson said the information and new technologies gained from the project will help managers, regulators and the shellfish industry to fully utilize and effectively manage both nearshore and offshore shellfish resources, and could lead to harvesting of the offshore surfclam and ocean quahog beds on Georges Bank and Nantucket Shoals, which have an estimated potential value of more than $50 million a year.  The program should also provide information crucial to the development of a roe-on scallop industry in those waters – a product which is presently restricted because of toxin that accumulates in the roe.

GOMTOX will utilize a combination of large-and small-scale survey cruises, autonomous gliders, moored instruments and traps, drifters, satellite imagery and numerical models. Researchers will incorporate field observations into a suite of numerical models of the region for hindcasting and forecasting applications for both near shore and offshore shellfish resources. 

In addition to WHOI researchers, scientists participating in GOMTOX represent Canada’s Department of Fisheries and Oceans, NOAA’s Northeast Fisheries Science Center, the Canadian National Research Council, the U.S. Food and Drug Administration, University of Maine, University of Massachusetts, and the Stellwagen Bank National Marine Sanctuary.

“We will be working closely with federal, state and local officials, resource managers and shellfishermen to synthesize results and disseminate the information and technology,”  Anderson said. “Our ultimate goal is to transition scientific and management tools to the regulatory community for operational use.  This project covers the entire Gulf fo Maine, including the Bay of Fundy, so there are many affected user groups, communities, and industries who stand to benefit.”

On the Web:

http://www.whoi.edu

Natural Quadruplets Born in Illinois

A woman who gave birth to quadruplets at a Naperville, Ill., hospital conceived without the use of fertility drugs — an estimated 1-in-512,000 conception.

Anissa Medrano, who gave birth to the four babies Oct. 4 at Edward Hospital, said multiple births run in her family, the Arlington Heights (Ill.) Daily Herald reported Thursday. She said both of her grandmothers are twins, her aunt and uncle are twins, and her sisters are twins.

Doctors at the hospital said naturally occurring quadruplets are a rare occurrence, and Medrano’s case was even rarer — two of the children are identical twins, the Chicago Tribune reported.

She was kind of meant to have (quadruplets), said Dr. Don Taylor, medical director of perinatology at the hospital, told the Herald. Her body handled it well.

Dr. Bob Covert, director of the hospital’s neonatal intensive care unit, said the infants, who were delivered one day shy of 31 weeks gestation, were doing well but would probably be hospitalized for about 8 weeks.

Involvement, Development, and Retention: Theoretical Foundations and Potential Extensions for Adult Community College Students

By Chaves, Christopher

The aim of this article is to orient those interested in adult community college student research to a wide array of discourses and theoretical tools that can help us understand the underlying complexity of the problems faced by this often-marginalized group. Reviewed are categories of theory about student involvement and engagement, student development, and adult learning that should inform how we educate adult community college students. This article concludes with a discussion of how all these theories, taken together, can improve adult education in community colleges.

Keywords: adult learning; student retention; identity development; relational learning; experiential learning

Many adult students-defined here as students 24 or older- attending community college for the first time are inadequately prepared, both academically and socially, for college-level learning (Howell, 2001). As a consequence, many of these students do not persist, and thus community colleges experience high levels of student attrition. This situation is an especially important challenge for adult educators in light of the fact that 43% of all community college students are older than the age of 24 (U.S. Department of Education, 2005). We must have a basic understanding about the importance of academic and social integration on campus for all college students; adult students are no exception. In addition, defining what can constitute involvement activities for college students in the classroom, in particular, is crucial for establishing a legitimate space for operationalizing curricula that are appropriate for adult students.

For many years, scholars and practitioners have worked to develop retention strategies for other types of community college students, including first-generation, minority, and underprepared students. However, few have examined adult student retention in a comprehensive way, taking into account the myriad sociological, biological, and psychological changes that occur as one grows older (Merriam & Caffarella, 1999). Indeed, as Ryan (2003) has argued, adult community college students face unique challenges and require new forms of academic and institutional support.

The vast majority of research on student retention has been situated in 4-year institutions of higher education that typically enroll White, residential, and traditional-age students (Crawford, 1999; Rendon, 1994). Furthermore, adult students are frequently ignored in scholarship pertaining to community college retention. To better understand this large and growing group of community college students, educators must begin to look at existing literature on adult learners in relation to theories of student development and retention. In doing so, we can begin to understand more about the unique problems adult students face related to identity development, students’ sense of mattering and validation, gender differentiation, and the central effects of one’s cultural background. These factors ultimately coalesce to influence, positively or negatively, an adult student’s ability to persist in college and reach his or her educational goals. In this article, I discuss several theories that can inform the way we educate adults in community colleges. Reviewed are categories of theory about student involvement and engagement, student development, and adult learning that should inform how we educate adult community college students. The article concludes with a discussion of how all these theories, taken together, can improve adult education in community colleges.

First, as Sanford (1966) pointed out, it is essential to consider adult students’ level of precollege readiness, challenges in college, and the support mechanisms necessary for academic success. Next, to preempt the sense of marginalization that many adult students experience during the early stages of college, administrators and adult educators must recognize that adults’ presence and contributions actually matter to the institution’s success (Schlossberg, 1989). Third, as Rendn (1994) has shown, one of the best ways to accord a sense of mattering to adult students is through active forms of validation, both within and outside the classroom.

A fourth underlying support and developmental construct is Chickering’s (1969) work on the seven vectors of higher level identity development; many of these stages are also applicable to adult students. In general, it is essential that adult educators recognize that their students are developing personally, intellectually, emotionally, and socially. Finally, given that the majority of adult community college students are women, understanding that women tend to experience learning in a more relational way (Belenky, Clinchy, Goldberger, & Tarule, 1986) lends support to the use of studentpeer or relational learning models in the classroom.

As Knowles (1984) argued, adult students can operate as self- directed learners, use their experiences as a reservoir of knowledge, and seek to immediately apply new knowledge and skills. Kolb (1984) added that adults create new knowledge through the transformation of experience. Although Knowles argued for self- directed learning and incorporating old knowledge and experiences, and Kolb asserted that learning in community actually facilitates the creation of new experiences and new knowledge, the two constructs-taken together-can greatly inform how community college educators design curricula and classroom activities for adult students. The overarching purpose of all these theories is to achieve transfer of classroom learning, the immediate application of that learning, and greater adult student retention. The aim of this article is to orient those interested in adult community college student research to a wider array of discourses and theoretical tools that can help us understand the underlying complexity of the problems faced by this often-marginalized group. In the pages that follow, each of these theories is discussed in more detail and ways are suggested that, taken together, can improve adult education in community colleges.

The Heart of the Matter: Student Engagement

Academic success in college has been positively associated with classroom engagement, as well as other forms of involvement in college. Tinto’s (1993) interactionalist theory serves to highlight the value of a classroom experience in which students and their teachers can achieve intellectual synergy. Astin (1984), on the other hand, described involvement more generally, both inside and outside the classroom.

Tinto’s Interactionalist Theory

Tinto’s (1993) interactionalist theory of student persistence and retention assumes that individuals arrive at college with differing family backgrounds, socioeconomic statuses, levels of academic preparation, and unique skills and abilities. Students also bring a certain level of commitment to the goal of succeeding academically. According to Tinto (1975), this level of commitment is either bolstered or diminished, depending on how well a student becomes academically and socially integrated on campus. Put simply, Tinto’s (1987) interactionalist theory rests on the idea that students and their institutions continually interact through social and educational communities and that “persistence is contingent on the extent to which students [are] incorporated into” these environments (Rendn, Jalomo, & Nora, 2000, p. 128). For Tinto (1987), student persistence “hinges on the construction of educational communities in college, program, and classroom levels which integrate students into the ongoing social and intellectual life of the institution” (p. 188).

Tinto (1987) noted, however, that urban community colleges that serve large numbers of working students may face several challenges in integrating students into the institution. In particular, because most adult community college students commute to campus, classroom experiences may be the only thing they share with faculty and peers. For adult students, therefore, all academic and social integration must take place in the community college classroom. Indeed, Tinto (1997) argued that the classroom must serve as a smaller social and intellectual meeting place where faculty and students can interact. As he wrote, “Engagement in the community of the classroom can become a gateway for subsequent student involvement in the academic and social communities of the college generally” (p. 82).

But what does effective and appropriate classroom involvement for adults look like? Kolb (1984) argued that experiential teaching and learning methods that incorporate concrete experiences, reflective observations, abstract conceptualization, and active experimentation can help to enrich classroom experiences for adult learners. In particular, experiential learning models offer relevant frameworks that allow adult learners to couple abstract learning objectives with real-world contexts. In other words, these models leverage students’ real-world experiences to connect classroom concepts and discourse with students’ prior knowledge and understanding of the world. This approach may, in turn, positively affect thei\r persistence and success rates.

Astin’s Involvement Theory

Astin (1984) defined involvement as “the amount of physical and psychological energy that the student devotes to the academic experience” (p. 134). He posited five general categories of involvement: academic involvement; faculty involvement; involvement with peers; involvement in work; and involvement elsewhere, which includes watching television, commuting, or attending religious services. According to Astin, faculty-student involvement is the most important category, as instructors have the greatest ability to influence what students actually accomplish. As Astin pointed out, however, faculty-student interaction has historically been minimal in community colleges, which is one potential explanation for low levels of student persistence and retention at those institutions.

Astin (1984) believes that involvement has both qualitative (level of commitment) and quantitative (time devoted) components, that student learning and development are proportional to the quantity and quality of student involvement, and that the effectiveness of any educational policy or program is correlated to that program’s ability to increase the level of student involvement. Theoretically, these general ideas can all be translated to research on adult student involvement in community colleges. However, much of Astin’s work on student involvement has primarily focused on traditional-age, residential students attending 4-year colleges and universities. He has not addressed what involvement may mean for adult community college students who generally commute to campus, work at least part-time, and have significant family responsibilities. Thus, more research is needed to couple Astin’s model of student involvement with research on adult students, as well as curricular frameworks and theories about ways community colleges can support their adult student populations and increase persistence and retention rates.

Theories for Institutional and Social Support of Adult Students

Many of the theoretical constructs that address institutional and social support structures for traditional-age students have crossover value for adult students. Theories such as those developed by Sanford (1966), Schlossberg (1989), Rendn (1994), Chickering (1969), and Belenky et al. (1986) all reflect how adult students negotiate the academic and social landscape at community colleges and suggest a need to understand better how colleges can support these students. Each of these theories is discussed in the following sections.

Sanford’s Person-Environment Theory

Sanford (1966) was a pioneer in advancing the notion that student development services must be designed for-and characterized as-a person-environment interactional experience. He explained his theory by introducing three general concepts: readiness, challenge, and support. Sanford suggested that, for an individual to demonstrate academic and social competency, she or he must be ready to do so and that this readiness must come from either personal maturity or the right environmental conditions. Implicit in his concept is the idea that a social compact between students, faculty, and the institution must be in effect to create an environment whereby the student commits to learning new things and whereby the college provides the appropriate developmental support mechanismslearning assistance centers, for example-for academic success.

Sanford (1966) further asserted that the amount of challenge a person can undertake is largely dependent on the quality of appropriate support an institution provides. If a person faces too little challenge in academic coursework, he or she may become complacent and experience no real benefits to his or her personal or professional development. However, if students are challenged by their coursework, they will either regress to earlier forms of less adaptive behavior, step up to the challenge and change their behavior, or escape or ignore the challenge altogether. By providing effective institutional and social supports, community colleges can help adult students step up to the challenge and succeed in their learning.

For example, Crawford (1999) found that students were more successful in courses that included topics positively correlated to persistence, including memory techniques, time management, tips on managing overload anxiety, and assistance with test taking and required course papers. Whereas he did not specifically address the academic challenges encountered by adult students who typically work at least part-time or who have not attended school for a number of years, Sanford’s theory of readiness, challenge, and support is, it seems to me, applicable to many adult students, and further research that extends the theory to adults would be beneficial.

Schlossberg’s Theory of Marginality and Mattering

Like Sanford’s (1966) theory, Schlossberg’s (1989) concepts of marginality and mattering shed light on the effects institutional support services can have on a student’s commitment to persist in college. Schlossberg defined marginality as “a sense of not fitting in” (p. 5). Feelings of marginality can heighten students’ feelings of irritability or depression and can create unhealthy levels of self-consciousness when encountering new environments or taking on new roles and their accompanying expectations. Adult students, in particular, may feel a sense of alienation or marginality on college campuses that serve largely traditional-age students (Tinto, 1975).

In contrast to marginality, Schlossberg (1989) defined mattering as “our belief, right or wrong, that we matter to someone else” (p. 5). She identified four dimensions to mattering: attention (a student feels noticed), importance (a student feels cared about), ego extension (a student feels that others will be proud of his or her accomplishments and sympathize with his or her failures), and dependence (a student feels needed). According to Schlossberg, students must feel as though they actually matter to the institution before they can feel capable of initiating involvement in academic and social activities that ultimately lead to higher levels of persistence.

To diminish adult community college students’ feelings of marginality and enhance their sense of mattering, community college student support services should include eight functions:

* specialized services adapted for adult needs;

* information about and opportunities to develop skills related to adult development, transitions, and the college experience;

* advocacy for adult students;

* a clearinghouse for campus services and resources;

* referrals to adult student resources, both in the institution and in the greater community; and

* adult student support groups, networking, mentoring, and counseling, including outreach and peer support (Evans, Forney, & Guido-DiBrito, 1998).

Rendn’s Theory of Validation

Like Schlossberg’s (1989) concept of mattering, Rendn (1994) defined validation as “an enabling, confirming and supportive process initiated by in-and out-of class agents that foster academic and interpersonal development” (p. 46). Simply stated, Rendn believed that active forms of validation must be provided to nontraditional students to encourage their continued involvement in college life. Validation, as Rendn defined it, can occur within classrooms and within campus organizations.

Validation must begin in the early stages of a student’s academic program, ideally through instructors and student peer engagement (Rendn, 1994). Validation can help students develop confidence in their learning ability, gain a heightened sense of self-worth, and hold a belief that they actually have something to offer the academic community at large. Although Rendn (1994) did not specifically address adult students in her theory of validation, it is clear from my experiences that adult students must feel validated, especially during the early stages of their academic career, as they are “often first-generation college students experiencing many doubts about their ability to succeed” (Evans et al., 1998, p. 28). Extending the idea of student validation to adult students, however, means that the knowledge and experience they bring into the classroom must be used as a learning resource and validated via the curriculum. Connecting course assignments to workplace requirements also helps to validate adult students’ personal sense of identity and occupational role.

Chickering’s Theory of Identity Development

Chickering’s (1969) seven vectors of identity development in college include the following: developing competence, whereby students produce intellectual, physical, and interpersonal competence; managing emotions, whereby students learn to recognize, express, and control their emotions; movement through autonomy toward interdependence, which Evans et al. (1998) described as “freedom from continual and pressing needs for reassurance, affection, or approval from others” (p. 39); development of mature interpersonal relationships, which refers to interpersonal and intercultural relationships that contribute immensely to a student’s sense of self; establishing identity, which refers primarily to a student’s age, culture, and gender; developing purpose, which occurs when students develop clear vocational goals and persist in their completion; and, finally, developing integrity, which refers to the development of humanitarian and personalizing values, as well as achieving congruence so that “self interest is balanced by a sense of social responsibility” (Evans et al., 1998, p. 40).

Although Chickering’s (1969) seven vectors were created to explain the various psychosocial developments that occur during the traditionalage student’s college years, Wimbish, Bumphus, and Helfgot (1995) asserted that the theory is also applicable to adult students and can indeed inform adult student development practi\ce. For example, “adult students may work through Chickering’s seven vectors and reexamine their identity in the context of going to college” (Wimbish et al., 1995, p. 24). In addition, for many adult students, exposure to global cultures on campus contributes to their sense of self and their relation to the wider global community. As well, it is crucial for adult students to develop purpose about their vocational goals, especially in community or technical colleges. These goals are often strongly tied to family commitments and financial survival and can and should be worked into curricula at community colleges that serve large numbers of adult students. However, researchers investigating the applicability of Chickering’s theory to women have found that “their development differs from men’s, particularly regarding the importance of interpersonal relationships in fostering other aspects of development” (Evans et al., 1998, p. 46). As such, we must also take into account theories about women’s ways of knowing if we are to serve adult students effectively.

Belenky et al.’s Theory of Women’s Ways of Knowing

Belenky et al. (1986) argued that when women experience subjective knowledge, they begin to rely on personal and professional ontologies-or nature of experience-as a source of knowledge. In addition, when women begin to experience learning as connected knowers, they “display trust and patience towards others in the process of knowing” and rely on “truth emerging in the context of personal experience and being grounded in empathy and care” (Evans et al., 1998, p. 149). Belenky et al., as well as other feminist scholars such as Gilligan (1995), believe that women learn in relational and caring ways. Indeed, Evans et al. (1998) stated that “the care voice is derived from a conception of the self that is relational and a view of self and others as connected and interdependent” (p. 191).

Given that, in 2000, women comprised 58% of the student body at community colleges, it is important that community college educators consider women’s ways of knowing and learning when constructing classroom experiences and college support systems (Phillippe, 2000; White, 2001). In particular, curricular models that validate a student’s personal experience in classroom discourse are especially effective for adult students. Belenky et al.’s (1986) work, for example, highlighted the importance of using learning community models that foster student-peer engagement to help women learn in ways that come more naturally to them, rather than in ways that may work better for men.

Major Curricular Theories for Adult Students

The theories described in the preceding section can guide community college educators in creating institutional supports that can be effective in retaining adult learners. The following theoretical constructs relate to adult learning models and couple two major curricular recipes that are important to adult students. One validates and uses students’ personal and professional experiences as a learning resource in the classroom, creates self- directed learners, and argues for immediate application of learned knowledge and skills (Knowles, 1984). The second construct creates a learning environment in which students’ beliefs, ideas, and new experiences are used to create new knowledge (Kolb, 1984). Taken together, these theories for designing curricula allow adult students to understand what they already know more deeply and, more important, learn what new knowledge they have yet to learn.

Knowles’s Theory of Andragogy

Knowles (1984) posited that adult learners are intrinsically, rather than externally, motivated to succeed in higher education. As such, adult educators should take a more egalitarian approach to choosing subject matter and determining how it is taught (Howell, 2001). In particular, educators must shift from a pedagogical approach to one described as andragogical. Knowles defined andragogy as “the art and science of helping adults learn, in contrast to pedagogy which is the art and science of teaching children” (p. 43). Androgogical approaches to learning are “based on the learners’ needs and interests so as to create opportunities for the learners to analyze their experience and its application to their work and life” (Sims & Sims, 1995, p. 3).

According to Knowles (1984), “adult learners . . . demand that the relevance and application of ideas be demonstrated and tested against their own accumulated experience and wisdom. . . . For these adults, learning methods that combine work and study, theory and practice, provide a more familiar and therefore more productive arena for learning” (p. 6). Thus, when designing curricula for adult community college students, faculty must concentrate on the following:

* enabling an adult student to transition from dependent to independent, selfdirected learning;

* drawing upon a growing reservoir of student experience as a learning tool;

* understanding adults’ readiness to learn based on actual social roles;

* recognizing adults’ need to apply new knowledge and skills immediately; and

* understanding that adult learners are internally, rather than externally, motivated.

As Kerwin (1981) pointed out, andragogy can be utilized in community colleges to achieve adult students’ participation in their own learning and, consequently, can enable an active form of involvement, especially in vocational training programs. However, more research on how andragogy can work in the community college setting is needed.

Kolb’s Theory of Experiential Learning and Adults

Like Knowles’s (1984) theory of andragogy, experiential learning- defined as “the process whereby knowledge is created through the transformation of experience” (Kolb, 1984, p. 41)-is especially useful in educating adult students (Merriam & Caffarella, 1999). Experiential learning assumes that learning is a process, not an outcome; that learning is best facilitated when students apply their own beliefs and ideas to a topic; that learning involves feeling, thinking, perceiving, and behaving; and, finally, that learning is the process of creating knowledge.

Kolb’s (1984) experiential learning model connects two dialectically related modes of learning: engaging experiences and transformative experiences. He promoted classroom activities that include concrete experiences (for example, article discussions), reflective observations (such as brainstorming), abstract conceptualizations (hypothesizing, for example), and active experimentation (such as case studies).

Knox (1980) complemented the work of Knowles (1984) and Kolb (1984) by focusing on adult students’ sense of discrepancy between their current role, knowledge, skills, or attitudes and their desired proficiency levels in these areas. According to Knox, “understanding discrepancies between current and desired levels of proficiencies helps to explain motives of adult learners and enables those who help adults learn to do so responsively and effectively” (p. 16).

Implications for Community College Research and Practice

If the goal of adult educators is to achieve better retention through more effective transfer of learning and its subsequent real- world application in students’ lives, then we have a long way to go. Miller, Pope, and Steinmann (2005) recently found that both traditional-age and adult community college students are fairly uninvolved on campus, as measured by their use of on-campus computing resources and their participation in athletic events, eating on campus, rest and relaxation on campus, campus athletic resources, dates on campus, social clubs, and cultural events. Given the myriad out-of-class commitments adult community college students have, we can assume that they are even less involved, at least by this definition. But what does effective and appropriate involvement look like for adult community college students? What are the appropriate social and academic support variables necessary for adult community college students? And what curricular methods can connect old experience and knowledge with current learning objectives to create new experiences and knowledge that are relevant and applicable to adult students’ everyday lives?

For adult students who work at least part-time and whose only faculty and peer interaction is in the classroom, a radical redesign of curricula offered to adult students is necessary. These new curricula should be at least partly self-directed, which allows adult students to be self-starters when not on campus or in the classroom. Inside the classroom, it is essential to affirm and validate adult students’ experiences, highlighting the social and academic connection between students, their teachers, and the college in general. Moreover, educators must include experiential learning in curricular designs and coursework and create opportunities for dialectical learning experiences whereby students and teachers can challenge or affirm old knowledge and at the same time create new understandings.

It is also essential to offer and promote adult-oriented support mechanisms on campus. This effort means recognizing that many adult students do not have basic skills in English, writing, and mathematics and using assessment to measure their abilities and place them into the appropriate course sequences. Social supports should also acknowledge the experiences and contributions that adults bring to the college and make in the classroom environment and demonstrate how they matter to the learning process. Administrators, teachers, and peers on campus must continually validate adult students’ efforts and contributions. Furthermore, we must remember that adult students also undergo identity development while in college and must make new research efforts within this area a priority. Chickering’s (1969) work is a good place to begin, but we must extend his vectors of identity development to adult students or creat\e new ones. Finally, we must recognize that women often have different learning preferences man men. More research in this area is crucial, given that close to 60% of community college students are women and given that this number may be even higher among adult community college students. In particular, coupling Knowles’s (1984) work on andragogy, along with Kolb’s (1984) experiential learning construct, can help educators create a dialectical learning experience where students’ old knowledge and experiences are used to create new knowledge and application, which can then lead to greater involvement, personal significance, and a heightened sense of commitment. Taken together, these theories have the potential to transform adult learning and vastly improve persistence and retention rates on community college campuses.

Editor’s Note: This review is published in cooperation with the Community College Studies Program in the UCLA Graduate School of Education and Information Studies.

References

Astin, A. W. (1984). Student involvement: A developmental theory for higher education. Journal of College Student Personnel, 25, 134.

Belenky, M. F, Clinchy, B. M., Goldberger, N. R., & Tarule, J. M. (1986). Women’s ways of knowing: The development of self, voice, and mind. New York: Basic Books.

Chickering, A. W. (1969). Education and identity. San Francisco: Jossey-Bass.

Crawford, L. (1999, March). Extended opportunity programs and services for community colleges. Paper presented at the annual statewide conference of the California Community Colleges Chancellors Office, Monterey, CA. (ERIC Document Reproduction Service No. ED429642)

Evans, N. J., Forney, D. S., & Guido-DiBrito, F. (1998). Student development in college: Theory, research, and practice. San Francisco: Jossey-Bass.

Gilligan, C. (1995). Hearing the difference: Theorizing connection. Hypatia, 10, 120-127.

Howell, C. L. (2001). Facilitating responsibility for learning in adult community college students. ERIC digest. Los Angeles: University of California, Los Angeles, ERIC Clearinghouse for Community Colleges. (ERIC Document Reproduction Service No. ED451841)

Kerwin, M. A. (1981). Andragogy in the community college. Community College Review, 9(3), 12-14.

Knowles, M. S. (1984). The adult learner: A neglected species (3rd ed.). Houston, TX: Gulf Publishing.

Knox, A. B. (1980). Proficiency theory of adult learning. Contemporary Educational Psychology, 5, 16.

Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice Hall.

Merriam, S. B. & Caffarella, R. S. (1999). Learning in adulthood: A comprehensive guide (2nd ed.). San Francisco: Jossey-Bass.

Miller, M. T., Pope, M. L., & Steinmann, T. D. (2005). A profile of contemporary community college student involvement, technology use, and reliance on selected college life skills. College Student Journal, 39(3), 596.

Phillippe, K. A. (Ed.). (2000). National profile of community colleges: Trends and statistics (3rd ed.). Washington, DC: American Association of Community Colleges. (ERIC Document Reproduction Service No. ED440671)

Rendn, L. I. (1994). Validating culturally diverse students: Toward a new model of learning and student development Innovative Higher Education, 19, 33-51.

Rendn, L. I., Jalomo, R. E., & Nora, A. (2000). Theoretical considerations in the study of minority student retention in higher education. In J. M. Braxton (Ed.), Reworking the student departure puzzle. Nashville, TN: Vanderbilt University Press.

Ryan, E. F. (2003). Counseling non-traditional students at the community college. ERIC digest. Los Angeles: University of California, Los Angeles, ERIC Clearinghouse for Community Colleges. (ERIC Document Reproduction Service No. 477913)

Sanford, N. (1966). Self and society. New York: Atherton Press.

Schlossberg, N. K. (1989). Marginality and mattering: Key issues in building community. In D. C. Roberts (Ed.), Designing campus activities to foster a sense of community (New Directions for Student Services, No. 48, pp. 5-15). San Francisco: Jossey-Bass.

Sims, R. R., & Sims, S. J. (1995). The importance of learning styles: Understanding the implications for learning, course design, and education (Contributions to the Study of Education, No. 64). Westport, CT: Greenwood.

Tinto, V. (1975). Drop out from higher education: A theoretical synthesis of recent research. Review of Educational Research, 45, 89- 125.

Tinto, V. (1987). Leaving college. Chicago: University of Chicago Press.

Tinto, V. (1993). Leaving college: Rethinking the causes and cures of student attrition (2nd ed.). Chicago: University of Chicago Press.

Tinto, V. (1997). Classrooms as communities: Exploring the educational character of student persistence. Journal of Higher Education, 68(6), 82.

U.S. Department of Education, National Center for Education Statistics. (2005). Digest education statistics, 2005. Washington, DC: Author.

White, J. (2001). Adult women in community colleges. ERIC digest. Los Angeles: University of California, Los Angeles, ERIC Clearinghouse for Community Colleges. (ERIC Document Reproduction Service No. ED451860)

Wimbish, J., Bumphus, W. G., & Helfgot, S. R. (1995). Evolving theory, informing practice. In S. R. Helfgot & M. M. Culp (Eds.), Promoting student success in the community college (New Directions for Student Services, No. 69, pp. 17- 30). San Francisco: Jossey- Bass.

Christopher Chaves

Southern Illinois University, Carbondale

Christopher Chaves, EdD, is a visiting assistant professor and program coordinator in the Department of Workforce Education and Development at Southern Illinois University, Carbondale.

Copyright North Carolina State University, Department of Adult and Community College Education Oct 2006

(c) 2006 Community College Review. Provided by ProQuest Information and Learning. All rights Reserved.

Decaffeinated Coffee Is Not Caffeine-free

GAINESVILLE, Fla. – Coffee addicts who switch to decaf for health reasons may not be as free from caffeine’s clutches as they think. A new study by University of Florida researchers documents that almost all decaffeinated coffee contains some measure of caffeine.

Caffeine is the most widely consumed drug in the world. And because coffee is a major source in the supply line, people advised to avoid caffeine because of certain medical conditions like hypertension should be aware that even decaffeinated brew can come with a kick, UF researchers report in this month’s Journal of Analytical Toxicology.

“If someone drinks five to 10 cups of decaffeinated coffee, the dose of caffeine could easily reach the level present in a cup or two of caffeinated coffee,” said co-author Bruce Goldberger, Ph.D., a professor and director of UF’s William R. Maples Center for Forensic Medicine. “This could be a concern for people who are advised to cut their caffeine intake, such as those with kidney disease or anxiety disorders.”

Despite caffeine’s widespread use, most medical texts have no guidelines for intake, Goldberger said, but even low doses might adversely affect some people. So UF researchers set out to conduct a two-phase study designed to gauge just how much caffeine is likely to turn up in decaffeinated coffees.

First they purchased 10 16-ounce decaffeinated drip-brewed coffee beverages from nine national chains or local coffee houses and tested them for caffeine content. Caffeine was isolated from the coffee samples and measured by gas chromatography. Every serving but one – instant decaffeinated Folgers Coffee Crystals – contained caffeine, ranging from 8.6 milligrams to 13.9 milligrams.

In comparison, an 8-ounce cup of drip-brewed coffee typically contains 85 milligrams of caffeine.

In the study’s second phase, scientists analyzed 12 samples of Starbucks decaffeinated espresso and brewed decaffeinated coffee taken from a single store. The espresso drinks contained 3 milligrams to 15.8 milligrams of caffeine per shot, while the brewed coffees had caffeine concentrations ranging from 12 milligrams to 13.4 milligrams per 16-ounce serving.

Even though the amount of caffeine in these coffees is considered low, some people could conceivably develop a physical dependence on the beverages, said co-author Mark S. Gold, M.D., a distinguished professor of psychiatry, neuroscience and community health and family medicine at UF’s College of Medicine.

“One has to wonder if decaf coffee has enough, just enough, caffeine to stimulate its own taking,” Gold said. “Certainly, large cups and frequent cups of decaf would be expected to promote dependence and should be contraindicated in those whose doctors suggested caffeine-free diets.”

And even moderate caffeine levels can increase agitation, anxiety, heart rate and blood pressure in some susceptible individuals, Goldberger said.

“Carefully controlled studies show that caffeine doses as low as about 10 milligrams can produce reliable subjective and behavioral effects in sensitive individuals,” said Roland Griffiths, Ph.D., a professor of behavioral biology and neuroscience at the Johns Hopkins School of Medicine. “More than 30 percent can discriminate the subjective effects of 18 milligrams or less. The present study shows that many decaffeinated coffee drinks deliver caffeine at doses above these levels.

“The important point is that decaffeinated is not the same as caffeine-free,” Griffiths added. “People who are trying to eliminate caffeine from their diet should be aware that popular espresso drinks such as lattes (which contain two shots of espresso) can deliver as much caffeine as a can of Coca-Cola – about 31 milligrams.”

On the Web:

http://www.ufl.edu

Top Hospital Officials in Ennis Resign: Departures Follow News Report About Knowledge of Doctor’s Abuses

By Scott Goldstein, The Dallas Morning News

Oct. 4–Two top officials resigned this week from an Ennis hospital where a doctor who sexually assaulted female patients practiced for at least two years after patients and nurses first accused him of misconduct.

Dr. Aniruddha Ashok Chitale admitted in May 2005 two sexual assaults and two misdemeanor crimes against four sedated female patients at Ennis Regional Medical Center between September 2004 and January 2005.

Ennis Regional CEO Bernard Sweet and chief nursing officer Jennifer Humpal resigned Monday, said Steve Spitzer, an attorney for the hospital. Their resignations followed a report last week in The Dallas Morning News that the hospital was warned by patients about Dr. Chitale’s conduct as early as February 2003 — two years before he was arrested, documents show. Nurses began complaining to hospital officials as early as fall 2003.

The complaints from patients and nurses alleged sexual improprieties during procedures and other violations of hospital policy, including having only one nurse in the endoscopy room.

A lawsuit in Dallas County on behalf of six women accuses Dr. Chitale, the hospital and his former employer of negligence, saying they knowingly put the women at risk.

Reached at his home Tuesday, Mr. Sweet said, “I can’t answer any questions” and hung up. Ms. Humpal could not be reached for comment.

Asked about the resignations Tuesday, Jane Mize, Ennis Regional’s director of marketing and physician recruiting, said in an e-mail response: “It is our policy not to comment on personnel matters. … As we know, this community has rallied behind their hospital in the past, and I fully expect them to support the new leadership.”

The resignations follow a contentious few days at the hospital, according to John Sullivan, the hospital’s chief of surgery, and Basem Jassin, chief of staff.

In a previously scheduled medical staff meeting Friday, angry doctors confronted Mr. Sweet about The News report and why they were not made aware of the earlier complaints against Dr. Chitale, the doctors said. Dr. Sullivan and Dr. Jassin are members of the hospital’s peer review board and said the complaints against Dr. Chitale should have been brought before that body.

“We wanted him to make a statement to the press to be sure that our patients and the community recognized that the normal peer review process was not carried out,” Dr. Sullivan said.

But Mr. Sweet would not answer questions and referred to a prepared statement that said he could not comment because of the pending lawsuit, Dr. Sullivan said.

“The medical staff demanded answers as to why it was that these complaints had not been brought before the formal process,” Dr. Jassin said. “Their answer was, ‘We can’t comment. We can’t comment.’ “

Dr. Sullivan said doctors at the hospital were not aware of complaints against Dr. Chitale until he was arrested in February 2005 on charges of sexually assaulting Sherri Simpson during an October 2004 colonoscopy. DNA evidence in the case determined that Dr. Chitale’s semen was on Mrs. Simpson’s face.

More than a dozen female patients came forward to police and prosecutors after Dr. Chitale’s arrest to allege sexual misconduct by the doctor.

The doctor plea-bargained for six months in the Ellis County Jail and 10 years’ probation for sexually assaulting Mrs. Simpson and Sharon Fincher. The plea deal included two misdemeanor charges of indecent exposure and public lewdness related to medical procedures on two other women at the hospital. Dr. Chitale also agreed to permanently surrender his Texas medical license.

But Dr. Sullivan and Dr. Jassin said it wasn’t until they read Friday’s story in The News that they learned complaints about Dr. Chitale’s conduct dated back at least two years before his arrest.

“This is the disgust of the medical staff, that we’re informed of this by The Dallas Morning News,” Dr. Sullivan said. “It’s absolutely repulsive.”

Dr. Jassin said the peer review board has the power to request that physicians stop procedures pending the outcome of investigations into complaints. If the physician fails to comply, the board can recommend the chief of staff suspend the physician. He said that process probably would have happened in Dr. Chitale’s case if complaints had been brought to their attention.

An official with LifePoint Hospitals Inc., the Tennessee company that owns Ennis Regional, visited the hospital Monday and Tuesday to address physician concerns and discuss the resignations, Dr. Sullivan said.

Les Weisbrod, an attorney representing Mrs. Fincher in the lawsuit, said he does not think the latest development will affect their case. Because Mr. Sweet and Ms. Humpal quit after the fact, he said, the resignations probably will not be admissible as evidence at trial.

“My question is, Why didn’t they fire them a long time ago?” Mr. Weisbrod said.

Meanwhile, Mrs. Simpson said she was elated Tuesday by news of the resignations. The News generally does not identify victims of sexual assault, but Mrs. Simpson and Mrs. Fincher agreed to be identified.

Mrs. Simpson first heard the news from Mrs. Fincher, whom she met as the criminal case was unfolding.

“It’s the first time that there’s been an acknowledgment that in fact there were wrong things going on at that hospital, criminal things,” Mrs. Simpson said. “Up until this point, the hospital has never wanted to acknowledge any sort of responsibility.”

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NASDAQ-NMS:LPNT,

DSS Actions Get Mixed Results

By Issac J. Bailey, The Sun News, Myrtle Beach, S.C.

Oct. 2–About the series [http://15652749.htm]

Rodney and Christine Covington were desperate for assistance. But they say the help they received from the state made their family’s struggles worse.

A brush with a high-profile double murder, ongoing medical problems and a domestic violence arrest combined to exacerbate their daughters’ already troubling school attendance records. That landed the girls, then 11 and 16, in truancy court and eventually in a state-run psychiatric facility for children in Columbia for three months.

Their institutionalization occurred during a time when the DSS training program had been halved, support services had dwindled and its work force was a little more than two-thirds the size it had been six years earlier.

Child protection services “was getting to a crisis point,” said S.C. Department of Social Services Director Kim Aydlette.

It also happened in the aftermath of the death of Ebony Smith, a 4-month-old who died in her father’s care after DSS returned the child to the family following an investigation of a suspicious broken leg.

Three months after the girls were sent to the psychiatric unit, a judge ruled they should not have been removed from their home. The family’s lawyer said the girls were taken because of the fallout from Ebony Smith’s death.

Their case also illustrates the difficulty that the state’s social service workers face when dealing with families in crisis. Doctors, judges, child-care officials and parents don’t always agree on how best to provide help. The trouble starts

The Covingtons first entered the DSS system in 2004, after the girls’ repeated absences from school prompted Horry County Schools to refer them to truancy court. The school district can intervene after three consecutive absences, five total or a combination of tardies, according to testimony given during a Family Court hearing.

Felicia Keeling, 16, and her then 11-year-old sister, Courtney Covington, had a history of attendance and medical problems dating back five years.

Those absences increased after a chance trip through a Burger King drive-through on March 26, 2002, made their mother a key witness in a double homicide case.

Keeling, Courtney and two dogs were in the back seat of a white Chevrolet Impala and their mom and a friend were in the front seat during what Christine Covington said was the first warm day of spring.

“We were getting flip flops, summer clothes,” she said.

They pulled into the drive-through of the Waccamaw Pottery Burger King. They heard an employee yelling obscenities at another worker.

“Quit feeding the [expletive] dogs and get back to work,” Keeling said she heard him say.

The worker, who they’d later learn was Angle Joe Perrie Vazquez, yelled other choice four-letter words. Covington asked him to stop because her daughters were in the car.

“I don’t give a damn about your daughters … ,” Vazquez responded, according to Keeling.

Covington asked to speak to manager Joseph L. Williams. Vazquez was fired.

According to police, he returned about four hours later with his cousin, Michael Howard, and forced Williams, 19-year-old Kuma Walker, and two other employees into a cooler. A short while later, Williams and Walker were dead.

Christine Covington held herself responsible for the two deaths. She didn’t get out of bed for a week.

Rodney Covington, armed with two guns, spent several nights after the shootings standing guard in front of their home, afraid someone might seek retaliation for his wife’s unwitting role in the crimes.

Courtney Covington, now 12, was often terrified to leave her mother’s side.

Keeling knew it was taking a toll on her mother so she didn’t want to let on that it was tough on her as well. She dealt with the stress by cutting herself late at night with a large pair of black-handled scissors.

“I didn’t want anybody to know it was my fault … because if I wasn’t in the car, my mom wouldn’t have cared that [Vazquez] was cussing,” she said. “I’d wake up in the middle of the night and I’d hear her crying.”

Christine Covington was the initial prosecution witness during Vazquez’s death penalty murder trial. He was convicted and is on death row. Howard pleaded guilty and was sentenced to a 20-year sentence without parole earlier this year.

Absences, illnessesEven before the Burger King murders, Courtney had chronic health problems. As a 6-year-old, she picked up a used needle while playing in their former neighborhood. She accidentally pricked her finger, triggering a precautionary month-long regimen of anti-HIV medicine, which meant ingesting 14 pills every day. She had her tonsils removed after several bouts with strep throat, according to the Covingtons and records provided by the family.

During the year of the Burger King episode, she was present in school for 120 days of the 180-day school year, according to school records. By the 2003-04 school year, she was in school for 50 days. It dropped to 16 the following year.

There were diagnosed allergies and asthma, eczema from head to toe, low-grade fevers and frequent visits to pediatricians, according to the medical records provided by the family. Those records also showed that a former pediatrician for the Covington girls called their parents liars.

“Nobody believed us,” Christine Covington said. The DSS caseworker and others thought she was purposefully hurting her kids, she said.

Courtney was first referred to Family Court for truancy by Horry County Schools officials Nov. 9, 2004, according to school documents. Christine Covington was held in contempt of court for Courtney’s absences for not providing proper approved medical excuses. It was later dropped.

Keeling’s absences also increased. Her grades suffered. She was on homebound study much of the past school year. She had migraines and oral ulcers. She spent three days in an intensive care unit after a late-night seizure, according to the family.

“I met with Ms. Covington to keep this from the court system,” Karen Fowler, the attendance director of Horry County Schools, testified in Family Court. “We wanted to get help for these kids.”

The report, errors

In early March, after the initial truancy hearing, the Covingtons submitted to court-ordered psychological evaluations, conducted by Dr. Mahir Shah of the Waccamaw Center for Mental Health.

He wrote that Keeling had a history of self-mutilation and that Courtney experienced extreme separation anxiety, according to a copy of the evaluations the family provided to The Sun News.

“Whenever possible, the greatest possible effort should be taken to avoid a child separating from their nuclear family,” Shah wrote. “However, I feel in this case because of the … repetitive nature of the medical symptoms and the resulting school absenteeism, that in-patient evaluation is necessary.”

The evaluation included several errors, said Thomas “Val” Guest, the Covingtons’ lawyer. Guest once handled cases for DSS while working in the solicitor’s office. Shah did not testify and the executive director of Waccamaw declined comment about the case, citing privacy laws.

Among the errors: Shah wrote that Courtney had oral ulcers and migraines; those were Keeling’s symptoms. He wrote that Courtney was Rodney Covington’s stepdaughter; Keeling is.

The family said other mistakes were more damaging. Christine Covington “has had a history of mental and severe physical abuse at the hands of her husband,” Shah wrote. “This has lasted for 10 years with the beatings taking place about every six months.”

Christine Covington said she told Shah a domestic violence incident had occurred six months earlier, not every six months, and once two weeks into their marriage.

Christine Covington called 911 in October 2005, saying her husband was hitting her. Her husband was handcuffed as the girls watched. The couple separated for several weeks before reconciling and taking court-ordered parenting classes and an anger management course.

Christine Covington said there have been no other episodes and that “Rodney has been my rock through all of this.”

Girls sent awayFamily Court Judge Lisa Kinon ruled that Christine Covington had “educationally neglected” her daughters. DSS was granted custody March 9.

“I was shocked,” said Evelyn Califf, a parent trainer, counselor and executive director of Parents Anonymous. Califf has been conducting parenting and anger management counseling for the family.

The girls were displaying signs of post-traumatic stress disorder, Califf said. A psychiatrist would later confirm that suspicion.

“I was very uneasy about that placement,” Califf said.

The parents had been doing everything they could, she said.

“My parents had just got back together a few months before,” Keeling said. “Everything was starting to get better. And then they took us.”

Officials with DSS and the Department of Mental Health said it is best to keep families together or to keep the children in the area. But there is only one private in-patient psychiatric facility in Horry County for teenagers and adolescents, and it is often full and more expensive than state care.

The girls were sent to William S. Hall Institute in Columbia. Waccamaw Center for Mental Health, which covers Horry, Georgetown and Williamsburg counties, referred 34 kids to the psychiatric center last year.

“When the kids were taken, it devastated us,” Christine Covington said.

Patients at the center are at risk to cause “harm to themselves, harm to others or have serious psychiatric problems,” said Dr. Steve Cuffe, director of medical services at William S. Hall.

Once at the facility, Keeling and Courtney Covington were separated even though Waccamaw Center for Mental Health advised that the girls be together because of Courtney’s separation anxiety.

The Covingtons also say they weren’t allowed to speak to the girls for the first three weeks of their stay. The hospital director said that would contradict hospital policy, although DSS has the authority to limit parental contact.

“There is no time when we say parents can’t visit,” Cuffe said. DSS declined to answer, citing privacy issues.

Christine and Rodney were allowed supervised visits five weeks after the girls were admitted, according to a discharge assessment by Dr. Deepa Sobti, the center’s attending psychiatrist.

Courtney Covington said she had some fun while in the center. She took trips to a park, a museum and Riverbanks Zoo.

But other experiences were disturbing. Courtney said her privileges were taken every time she cried or didn’t eat. Nurses watched as she showered after two boys were caught “being sexually active in the shower,” she said.

Keeling said she saw a couple of the patients try to kill themselves.

“They’ll wrap a sheet around their necks as a gesture, sometimes a paper clip to scratch themselves,” Cuffe said. “It looks bad” but usually isn’t serious.

Keeling said she lived on a hall with a rapist. An 18-year-old girl threw garbage cans and a radio at a staff member. A boy stabbed another in the neck with a pencil. Her roommate cut her wrist. A girl wore diapers.

“We do have kids with significant issues,” Cuffe said. “We investigate any allegation that our staff didn’t follow procedure. We have a dedicated staff. They know how to deal with kids like this.”

The girls were there for 45 days, according to discharge documents. The typical stay is 14 days or less, said Murry Chesson, executive director of Waccamaw Center for Mental Health.

“It doesn’t feel real because we were there for so long,” Courtney said.

Rodney Covington said his kids should have never been there.

“It took my daughters’ innocence away,” he said. “There are not the same hugs and kisses I used to get before bed. I don’t know how to make my kids feel better. I don’t know how to make my kids feel safe.”

Regaining custody

Rodney and Christine Covington appeared in Family Court on May 18 seeking the return of their children.

DSS opposed the girls’ return. The guardian ad litem asked that they remain in custody at least through the end of the school year.

Rodney Covington testified that they never held their kids out of school, except for legitimate medical reasons.

He said he had quit drinking and enrolled in anger management.

“I told [Christine] I’d do anything to make this right, that I just want my family,” he said.

Christine Covington testified that the girls’ illnesses continued even while in DSS custody.

One of the Covington’s caseworkers, Christy Esposito, testified that the girls missed many days from school even after the state began investigating. She visited the family’s home and saw no reason that the girls needed to be removed, even while arguing that they needed to remain in state custody.

She also said there were no services offered to the family before the girls were taken.

Caseworker Tameka L. Williams said she visited the girls twice at William S. Hall Institute while DSS was waiting on a therapeutic foster home to become available.

“I just want the girls to get the treatment they need,” Williams testified.

After a few hours of testimony over two days, the ruling by Family Court Judge H. E. Bonnoitt Jr. came within minutes: The girls would be returned to their parents and DSS would monitor the home for nine months.

“Why Judge Kinon even took these children, I don’t know,” Bonnoitt said.

But he did have concerns.

“We’ve got some kids who must be the most chronically ill on the face of the planet,” he said. “Those people are failing their children in some way. But there is a burden on the state [to prove] substantial risk of harm through educational neglect. I am going to find that DSS has not met the burden of proof.”

“Good luck to you, folks,” he told the Covingtons.

Overcoming fears

The girls have had nightmares since returning home.

Courtney jumps every time the phone rings, afraid DSS is planning to take them away again. She locks the shower door behind her — even if it takes “14 or 15 times” to get it to work — something she didn’t do before. And she takes her food into her room to eat alone, another change.

“I did not know why they were taking me away from my family. I was mostly confused,” Courtney Covington reflected in some writings after being returned home. “I did not know why I was there. It was for abused, neglected and sexually assaulted teens. None of them had happened to me. But I’m home now. And I’m finally happy.”

Keeling said the center’s staff did help her deal with the stresses in her life.

One staff member got her to open up about the Burger King killings and persuaded her to tell her mother — for the first time — her worries about that incident.

“I’m happy, in a way, that I was there,” she said. “I know I needed coping-skills help.”

But she doesn’t want other teenagers to experience what she has.

“In William S. Hall, I was treated like a criminal. I felt like an animal,” Keeling said. “There are hundreds of kids in the same situation our family was in. I don’t think it’s fair.”

The girls have had no unexcused absences from school so far this year.

——

See a list of parenting courses in the area — 6A #HTMLInfoBox~~Parenting courses

Parenting Anonymous, headed by executive director Evelyn Califf, offers free parenting classes and low-cost counseling and anger management courses for adults and teenagers.

Weekly classes are at 803 Howard Avenue on the former Air Force base in Myrtle Beach, at Cherry Hill Baptist Church on Racepath in Conway and at the Myrtle Beach YMCA. Call 448-5804.

Jim R. Rogers, a nationally certified Parent and Family Life Educator, offers parenting courses. Call 238-9291.

First Steps of Horry County offers prenatal, birth through age 3 courses. They are conducted by certified parent educators. Call 349-4054.

Parent/Child/Home Educators, First Steps and Horry County Schools conduct prenatal and birth through pre-school courses. Call 222-9959.

Family Outreach conducts prenatal, birth and beyond courses. Call Sherry Coutain at 248-5392.

Area hospitals also offer prenatal, birthing and baby care classes.

For special needs, contact the Parent Educator Resource Service through Horry County Schools at 488-6240.

For fathers, contact Wallace Evans Jr. at A Father’s Place at 488-2923.

Julia Castillo, a trained social worker for CASA, offers classes for DSS and the faith community. Call 293-2270.

On the Web:

www.parentsasteachers.org [http://www.parentsasteachers.org] www.cwla.org www.parentstoolshop.com [http://www.parentstoolshop.com]

Contact ISSAC J. BAILEY at [email protected] [mailto:[email protected]] or 626-0357.

—–

Copyright (c) 2006, The Sun News, Myrtle Beach, S.C.

Distributed by McClatchy-Tribune Business News.

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

NYSE:BKC,

What’s the Number One Anti-Wrinkle Cream in France?

SALT LAKE CITY, Sept. 30 /PRNewswire/ — In an ironic twist, the “stretch-mark cream turned anti-wrinkle phenomenon,” America’s StriVectin-SD(R), has invaded Paris and captured the French anti-aging, anti-wrinkle skin care market. And in the most recent issue of France’s leading consumer magazine (“60 Millions De Consommateur,” the equivalent of “Good Housekeeping” and “Consumer Reports” in the USA), StriVectin was rated as the best, most effective anti-wrinkle face cream by a panel of 264 French women … beating the likes of Dior, Chanel, ROC, L’Oreal, Lancome and other high-end (and French made) products costing as much as euro 142 (about $185) per ounce.

Launched in Aug. 2004 at Sephora’s flagship location on the fabled Champs-Elysees, StriVectin took the French capital by storm, receiving rave reviews from the media and savvy French consumers … and quickly becoming the best-selling skin-care product in French Sephora stores.

“StriVectin had already set sales records in the United States so we expected great results in France,” said Gina Gay, spokesperson for Klein-Becker, distributor of StriVectin. “But let’s face it, French women have access to the most sophisticated cosmetics in the world and they’re extremely skeptical about products from America. Yet when it comes to reducing the appearance of fine lines, wrinkles and crows’ feet, they prefer a formula from, of all places, Salt Lake City, Utah. That’s an incredible story.”

According to “60 Million” magazine, which is published by France’s leading consumer organization, a panel of 264 women (ranging in age from 30-70) said StriVectin was “best” and most effective.

“We were taken by surprise,” said Ms. Gay, “because the testing was done without our knowledge, and in the same objective way as ‘Consumer Reports’ judges products here in America. The testing was unbiased — although we assume French women are going to like French products best. Imagine, they chose our StriVectin over 11 famous formulations, most of which are made in France. We’re thrilled … and so is Sephora.”

For Those Who Don’t Know the StriVectin Story

In a remarkable turn of events, arguably one of the strangest in the history of cosmetics, women across the country are putting a stretch-mark cream called StriVectin-SD on their face to reduce the appearance of fine lines, wrinkles and crows’ feet. And, if consumer sales are any indication of a product’s effectiveness, StriVectin-SD is nothing short of a miracle. Women, as well as a growing number of “Boomer” men, are buying so much StriVectin-SD that finding a tube at your local cosmetic counter has become just about impossible. Did everyone go mad? Well … not really.

Although StriVectin-SD’s functional components were already backed by clinical trials documenting their ability to visibly reduce the appearance of existing stretch marks (prominent because of their depth, length, discoloration and texture) … the success of StriVectin-SD as an anti-wrinkle cream was “dumb luck,” said Ms. Gay.

“When we first handed out samples of the StriVectin formula to employees and customers as part of our market research, the sample tubes were simply marked ‘topical cream’ with the lot number underneath,” Ms. Gay explained. “As the samples were passed to friends and family, the message became a little muddled and some people used this ‘topical cream’ as a facial moisturizer. As we began to receive feedback from users, like ‘I look 10 years younger,’ and ‘I can’t even notice my crows’ feet,’ we knew we had something more than America’s most effective stretch-mark cream. The point was driven home as store owners began reporting that almost as many people were purchasing StriVectin as an anti-wrinkle cream as were buying it to reduce stretch marks.”

Dr. Daniel B. Mowrey, PhD, Klein-Becker’s Director of Scientific Affairs, says, “Clearly, people were seeing results, but we didn’t have a scientific explanation as to why this wrinkle-reduction was occurring.””Based on the incredibly positive reports from users and the Paris reports,” Mowrey continues, “I started using StriVectin myself … as an aftershave in the morning and before I go to bed at night. And let me tell you — no one has ever accused me of being handsome, but now I’m happy to say that I look young and ugly rather than old and ugly. For me, that’s a big improvement.”

Dumb Luck Strikes Again!

Then, at a meeting of the 20th World Congress of Dermatology in Paris, France, a series of studies detailing the superior wrinkle-reducing properties of a patented oligo-peptide “called Pal-KTTKS” versus retinol, vitamin C, and placebo, on “photo-aged skin” was presented. “As luck would have it,” Dr. Mowrey states, “the anti-wrinkle oligo-peptide tested in the breakthrough clinical trials turned out to be a key ingredient in the StriVectin cream.”

In the trials, subjects applied the patented peptide solution to the crows’ feet area on one side of the face, and a cream containing either retinol, vitamin C, or a placebo to the other side.

Subjects in the Pal-KTTKS/retinol study applied the cream once a day for 2 months and then twice a day for the next 2 months. Using special image analysis, the study’s authors reported “significant improvement” in both the overall appearance of skin tone and wrinkles for those women using the peptide solution.

Better yet, at the 2-month halfway point, the peptide solution worked nearly 1.5 times faster than retinol “in measured parameters,” and without the inflammation retinol often causes in sensitive skin. As was expected, the results of the remaining studies confirmed that the Pal-KTTKS solution’s effectiveness at reducing the appearance of fine lines and wrinkles far exceeded both vitamin C and placebo.

A smoother, younger complexion, with less irritation and faster results — all without expensive (and painful) peels, implants or injections.

Better than Retinol and Vitamin C, But Is StriVectin-SD Better than Botox(R)*?

Dr. Nathalie Chevreau, PhD, RD, Director of Women’s Health at Salt Lake City based Basic Research(R), exclusive distributor for Klein-Becker, explains, “Leading dermatologists agree that Botox is the preferred treatment for glabellar lines, that tiny little space of moderate to severe frown lines between the eyebrows. But ever since it was discovered that StriVectin could reduce the appearance of fine lines, wrinkles, and crows’ feet … the kind of fine lines, wrinkles and crows feet that can add 10-15 years to your appearance and which costly medical treatments often leave behind … skin-care professionals have been recommending, and using, StriVectin.”

In fact, researchers believe non-invasive alternatives are better, because, Dr. Chevreau continues, “Topical creams and gels offer gradual, continual results, while the effects of injections, facial peels, and dermabrasions are rougher on the skin and wear off.” In other words, StriVectin-SD helps give you a youthful, healthy, glowing complexion faster than retinol, far superior to vitamin C, and without irritation, needles, or surgery. Even better, many dermatologists and plastic surgeons recommend StriVectin in conjunction with cosmetic procedures, including Botox.

So, if you see someone applying an anti-stretch mark cream to their face, don’t think they’ve gone off the deep end … they may be smarter than you think.

NOTE: StriVectin is a growing international sensation, shattering records in France, the United Kingdom, Italy, Spain, Poland, Portugal and the Czech Republic. In the United States, StriVectin is available in Sephora, Bloomingdale’s, Saks Fifth Avenue and Macy’s, as well as dermatology and plastic surgeon offices around the country. For more information, visit http://www.strivectin.com/.

(* Botox(R) is a registered trademark of Allergan, Inc.)

All trademarks are the property of their respective owners.

StriVectin

CONTACT: Heather Hurst of Majestic Media, +1-801-530-2911,[email protected], for StriVectin

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

Update: George Lynn, AtlantiCare President and CEO, Announces His Retirement As CEO, Effective March 2007

EGG HARBOR TOWNSHIP, N.J., Sept. 28 /PRNewswire/ — George Lynn, president and chief executive officer (CEO), AtlantiCare, announced plans to retire as CEO after more than 20 years, effective March 31, 2007. David P. Tilton, CEO, AtlantiCare Regional Medical Center (ARMC) and chief operating officer (COO), AtlantiCare, will succeed Mr. Lynn as president and CEO. AtlantiCare’s Board of Trustees has appointed Mr. Lynn President Emeritus. He will continue to work on special projects for AtlantiCare in that capacity.

   (Photo:  http://www.newscom.com/cgi-bin/prnh/20060928/PHTH032A-a )   (Photo:  http://www.newscom.com/cgi-bin/prnh/20060928/PHTH032A-b )  

“I have had the privilege of serving this community for more than 20 years — and of working with board members, senior management, staff, and physicians throughout my career who have helped grow this organization from a hospital to a robust health system, providing health and wellness services across our region. AtlantiCare is very well positioned for the future — and has its brightest days ahead. I felt it was the perfect time to transition to new leadership,” Mr. Lynn said.

“George’s leadership style has inspired dedication, trust and respect from those who work with and for him, including board members, politicians, community leaders, physicians, executives and staff. I am honored to be selected to succeed him and excited about the future of AtlantiCare,” said Mr. Tilton.

Mr. Lynn joined the organization in 1986 as chief executive officer of Atlantic City Medical Center with divisions in Atlantic City and Galloway Township, New Jersey. In 1993, under his leadership, the region’s largest integrated healthcare delivery system was formed. Today, AtlantiCare has nearly 5000 employees, medical staff and volunteers, and is one of the region’s largest employers. AtlantiCare has expanded over the years to include AtlantiCare Regional Medical Center (ARMC), AtlantiCare Behavioral Health, the Center for Community Health, AtlantiCare Health Plans, AtlantiCare Health Services and InfoShare, a health information technology company. Under Mr. Lynn’s guidance, AtlantiCare has grown to offer services at more than 60 locations throughout the region, including development of the Health Park in Egg Harbor Township.

“We cannot begin to acknowledge the visionary leadership George has provided to this community over the years. His legacy of ‘building a healthier community’ will be felt for years to come by those of us who have worked with him and learned from him and certainly by the residents of this community who now enjoy a higher standard of healthcare,” said Roger Hansen, chairman, AtlantiCare Board of Trustees.

Mr. Lynn has been widely recognized for his active charitable, professional and civic involvement in the community and has garnered numerous awards. He has also been active on the state and national healthcare stage serving in various leadership roles. In 1997, he served as chairman the New Jersey Hospital Association, and from 2000-2004, as chairman of the Health Research and Education Trust. He is currently serving a second term as chairman of the American Hospital Association, Board of Trustees. In 2005, Mr. Lynn was named among Modern Healthcare’s “100 Most Powerful People in Healthcare.”

Mr. Lynn’s successor, David P. Tilton, joined ARMC in March of 1987 as administrator of the hospital’s Mainland campus. He has served as ARMC’s CEO for more than 13 years. Mr. Tilton played an instrumental role when ARMC was transformed from a two-campus community hospital to become part of the regional health system — AtlantiCare. Known for his focus on quality improvement, Mr. Tilton led ARMC in becoming one of the elite hospitals nationwide to achieve the J.D. Power and Associates Distinguished Hospital designation in 2004, 2005, and 2006 for providing “an outstanding patient experience.” Under his leadership, ARMC became the 105th hospital in the nation to be designated a nurse Magnet(TM) hospital, the nursing profession’s highest honor.

Also committed to community, Mr. Tilton was recognized by the Atlantic City Branch of the NAACP with its Freedom Fund Award in 2004. The Hispanic Alliance of Atlantic County presented him with its inaugural Leadership Award for his contributions to the Hispanic Community in 2004. The Jersey Shore Council of Boy Scouts of America honored Mr. Tilton in 2003 for his efforts to improve the quality of life for the residents of the region.

AtlantiCare is a regional healthcare organization based in Egg Harbor Township, New Jersey, whose more than 4,500 employees serve the healthcare needs of the community at more than 60 locations. It includes AtlantiCare Regional Medical Center (ARMC), the AtlantiCare Foundation and Center for Community Health, AtlantiCare Health Plans, AtlantiCare Behavioral Health and AtlantiCare Health Services. ARMC earned J.D. Power and Associates Distinguished Hospital designation for the third consecutive year for its commitment to providing “An Outstanding Inpatient Experience,” in July, 2006. ARMC became the 105th hospital in the nation to attain status as a Magnet(TM) designated hospital in March of 2004.

George F. Lynn

George F. Lynn, president and chief executive officer of AtlantiCare, has more than 30 years of healthcare experience. He helped establish AtlantiCare, southeastern New Jersey’s premier integrated healthcare network, in 1993. AtlantiCare is the region’s most comprehensive healthcare delivery system and, with more than 4,300 employees, one of the region’s largest employers. AtlantiCare is the parent company of AtlantiCare Regional Medical Center (ARMC), AtlantiCare Behavioral Health, the AtlantiCare Foundation, AtlantiCare Health Plans, AtlantiCare Health Services and InfoShare, a health information technology company. Under Lynn’s guidance, AtlantiCare has grown to offer services at more than 60 locations throughout the region.

Lynn was among Modern Healthcare’s “100 Most Powerful People in Healthcare” for 2005. Lynn is active in civic, professional and charitable organizations. He is chairman of the Board of Trustees of the American Hospital Association (AHA) and has served as a delegate to Regional Policy Board 2. He has served as a delegate to the Section of Metropolitan Hospitals. Lynn is past chairman of the New Jersey Hospital Association.

Lynn earned his Bachelor’s Degree from Fordham University and received his Masters in Business Administration from the Wharton School, University of Pennsylvania. He was awarded an Honorary Doctorate of Humane Letters from the Richard Stockton College of New Jersey in 1997.

Lynn and his wife Pat have two married children and four grandchildren. They reside in Linwood, New Jersey.

David P. Tilton

David P. Tilton is president and chief executive officer of AtlantiCare Regional Medical Center (ARMC), and executive vice president and chief operating officer of AtlantiCare.

AtlantiCare and each of its six business units are governed by boards comprised of more than 70 volunteer community leaders. With nearly 5,000 employees, medical staff and volunteers and more than 60 locations, AtlantiCare is the region’s largest non-casino employer. AtlantiCare includes AtlantiCare Regional Medical Center (ARMC), the AtlantiCare Foundation, AtlantiCare Health Services, AtlantiCare Health Plans, AtlantiCare Behavioral Health and InfoShare.

Tilton joined ARMC in March of 1987 as administrator of the hospital’s Mainland campus. He played an instrumental role when ARMC was transformed from a two-campus community hospital to become part of the regional health system known as AtlantiCare. Under his leadership AtlantiCare continues to expand the health and wellness services and programs it offers the community.

Whether meeting the challenges of the medical malpractice insurance crisis, petitioning the state to bring a desperately needed cardiac surgery program to the region, advocating patient rights, hosting physician and employee roundtables, seeking sensible solutions to the national nursing shortage, or meeting with community groups; Tilton’s personal commitment to patients, physicians, employees and the community sets the standard high for healthcare leadership.

Tilton has achieved many notable professional honors in the arena of quality improvement. Under Tilton’s leadership, ARMC earned J.D. Power and Associates Distinguished Hospital designation for the third consecutive year for its commitment to providing “An Outstanding Inpatient Experience,” in July, 2006 and ARMC became the 105th hospital in the nation to be designated a nurse Magnet(TM) hospital, which is the nursing profession’s highest honor. Tilton has led ARMC through several successful Joint Commission on Accreditation of Healthcare Organization (JCAHO) surveys. He has implemented initiatives that garnered two recognition awards from the Peer Review Organization of New Jersey. Under his leadership, AtlantiCare was the first health system ever to receive a New Jersey Governor’s Award for Performance Excellence.

Tilton served as general campaign chairman and as a member of the Board of Trustees of the United Way of Atlantic County. He is chairman of the Board of Directors of Franklin Savings Bank in Salem, New Jersey. Tilton is a diplomat of the American College of Healthcare Executives.

The Atlantic City Branch of the NAACP recognized Tilton with its Freedom Fund Award in 2004 for his work toward the betterment of civil and human rights throughout Atlantic City, Atlantic County and New Jersey. The Hispanic Alliance of Atlantic County presented him with its inaugural Leadership Award for his contributions to Hispanic Community in 2004. Tilton served as honorary chairman of the 2003 Festival Latino-Americano in Atlantic City. The Jersey Shore Council of Boy Scouts of America honored Tilton in 2003 for his efforts to improve the quality of life for the residents of the region.

Tilton received his Masters Degree in Business Administration from Rutgers University and his Bachelor of Science Degree from Rider University. He began his healthcare career as a volunteer at Memorial Hospital of Salem County, New Jersey. Tilton was later associate general director of Albert Einstein Medical Center in Philadelphia, and vice president of the Memorial Hospital of Salem County.

Tilton and his wife Jody live in Galloway. They have two children, Michael and Scott.

Photo: NewsCom: http://www.newscom.com/cgi-bin/prnh/20060928/PHTH032A-ahttp://www.newscom.com/cgi-bin/prnh/20060928/PHTH032A-bAP Archive: http://photoarchive.ap.org/AP PhotoExpress Network: PRN14, PRN15PRN Photo Desk, [email protected]

AtlantiCare

CONTACT: Rene Bunting, +1-609-272-6315, [email protected]; orJennifer Tornetta, +1-609-569-7010, [email protected], both ofAtlantiCare

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

New Larger Size of MimyX Cream Introduced

CORAL GABLES, Fla., Sept. 21 /PRNewswire/ — Stiefel Laboratories, Inc. announced today that MimyX(R) Cream, a steroid-free, topical prescription therapy for managing the signs and symptoms of atopic dermatitis, is now available in a new, larger, 140g tube at a substantially lower cost per gram than the original 70g tube and several other prescription treatments. Introduced in October 2005, MimyX Cream has been clinically demonstrated to be successful when used alone or with other products in helping patients who suffer from atopic dermatitis, better known as eczema, manage their dry, itchy skin condition. The new 140g tube is available at pharmacies nationwide. Patients may realize a savings over the original size at the pharmacy because of the new lower cost per gram or their co-pay may remain the same for twice the amount of MimyX Cream.

“This new 140g tube may be more convenient for patients who experience the symptoms of eczema on large areas of the body and may provide a cost savings,” said Dr. Leon Kircik, founder and director of Physicians Skin Care, Louisville, Kentucky. He continued, “In my patients I have found MimyX Cream to be effective non-steroidal treatment for the relief of signs and symptoms of atopic dermatitis, with a great safety profile. The fact that it is hypoallergenic is also helpful for many patients.”

About Atopic Dermatitis (Eczema)

Atopic dermatitis is often simply referred to as “eczema.” It is characterized by extremely itchy skin that leads to persistent scratching. That scratching produces redness, swelling, cracking, “weeping” of clear fluid, and finally, crusting and scaling.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), more than 15 million people in the U.S. have symptoms of atopic dermatitis. In addition, children are more commonly affected than adults, with 90 percent of atopic dermatitis cases diagnosed by age 5. Roughly 60 percent of infants affected continue to have one or more symptoms of atopic dermatitis into adulthood. Atopic dermatitis can cause social and emotional stress associated with changes in physical appearance and its uncomfortable symptoms.

About MimyX Cream

MimyX Cream is available by prescription and only your healthcare provider can determine if it is right for you. MimyX Cream is indicated to manage and relieve the burning and itching experienced with eczema. MimyX Cream is not to be used in patients who have sensitivity to the ingredients of the product. Adverse events seen in clinical studies were mild itching, burning, redness and other localized skin reactions. If you experience worsening of your condition, or adverse symptoms, contact your health professional. MimyX Cream is for external use only. See full prescribing information for complete product information at http://www.stiefel.com/products/inserts/Mimyx%20PI.pdf.

About Stiefel Laboratories, Inc.

Founded in 1847, Stiefel Laboratories is the world’s largest independent pharmaceutical company specializing in dermatology. Its wholly-owned global network is comprised of more than 30 subsidiaries, including: manufacturing plants in six countries; R&D facilities on three continents; and products marketed in more than 100 countries worldwide. Research and development efforts are complimented by aggressively seeking acquisitions of dermatological product lines and companies around the world. To learn more about Stiefel Laboratories, Inc. visit http://www.stiefel.com/.

Stiefel Laboratories, Inc.

CONTACT: Denise Ulrich of Stiefel Laboratories, Inc., +1-678-765-4104,Cell, +1-770-656-9338, or [email protected]

Web site: http://www.stiefel.com/http://www.stiefel.com/products/inserts/Mimyx%20PI.pdf

Topical Cidofovir for Treatment of Resistant Viral Infections

By McElhiney, Linda F

Abstract

Cidofovir is a broad-spectrum antiviral agent with activity against several DNA viruses. An application to approve the use of topical cidofovir for acyclovir-resistant herpes virus infection was denied by the US Food and Drug Administration owing to the lack of phase III clinical trial data. The manufacturer stated that, as of 1997, no further controlled studies were planned or in progress to evaluate topical cidofovir in herpes simplex infections. It is unknown whether there are plans to conduct controlled studies of topical cidofovir for HPV or MVC infections. However, numerous case reports and published studies describe successful use of topical cidofovir to treat resistant and severe forms of viral infections such as molluscum contagiosum, condylomata acuminata, verruca vulgaris, herpes simplex virus infection, genital warts, and gingival infection with human papillomavirus. Because of the mutagenic properties of cidofovir, compounding the preparation is considered hazardous. Since most retail pharmacies do not have the safety equipment necessary to compound hazardous preparations, a compounding pharmacist can play a vital role in preparing topical cidofovir cream or gel.

Cidofovir, a broad-spectrum antiviral agent, is a potent nucleoside analog of deoxycytidine monophosphate. It is commercially available as an intravenous (IV) dosage form. It is the only treatment approved by the US Food and Drug Administration (FDA) for cytomegalovirus (CMV) retinitis in patients with human immunodeficiency virus infection (HIV) or acquired immunodeficiency syndrome (AIDS). Several studies and case reports describe the successful use of compounded topical cidofovir cream or gel to treat viral cutaneous diseases.

Pharmacology

Cidofovir is a water-soluble polar molecule. When incorporated into the host cell, cidofovir undergoes two stages of phosphorylation to form the active intracellular metabolite cidofovir diphosphate. This metabolite acts as a competitive inhibitor and an alternate substrate for CMV DNA polymerase. It is incorporated into the growing CMV DNA strand and blocks further viral DNA synthesis and replication. Cidofovir has a long half-life (17 to 65 hours) because human CMV DNA polymerase cannot excise the incorporated active metabolite of cidofovir from the viral DNA.

Antiviral agents such as acyclovir and ganciclovir are dependent on virally encoded thymidine kinase for activation. Since cidofovir has a different mechanism of action, strains of herpes virus that are resistant to acyclovir, ganciclovir, or foscarnet remain sensitive to cidofovir, as demonstrated in studies by Mendel et al1 and Morphin et al.2

The pharmacokinetic properties of cidofovir in humans are limited to IV administration. Cidofovir is excreted renally, 80% to 100% by renal tubular secretion, with less than 6% protein binding. It does, however, have a black box warning that it may cause nephrotoxicity leading to acute renal failure or death after IV administration of one to two doses. Cidofovir also can cause neutropenia and has been shown in animal studies to cause cancer, birth defects, and hypospermia.3

Unlabeled Uses for Cidofovir

Several cutaneous diseases are caused by DNA viruses, as follows:

* Condylomata acuminata

* Genital warts (human papillomavirus [HPV])

* Herpes simplex virus infection

* Gingival HPV infection

* Molluscum contagiosum (MCV)

* Verruca vulgaris

Published studies and case reports have described the use of topical dosage forms of cidofovir to successfully treat resistant and severe forms of these viral infections with minimal or no adverse events. However, compounded cidofovir creams or gels are prohibitively expensive (approximately $1,000 per ounce) and should be reserved for cases in which all other conventional treatments have failed.

HPV Gingival Infection

Human papillomaviruses constitute a large group of double- stranded DNA viruses, at least 90 specific identified strains. HPV lesions can occur anywhere on the cutaneous surface, but are observed mainly on the extremities, genitalia, and oral mucosa. HPV infections are most common in patients who are immunocompromised, and these patients have more problems with extensive, recurrent, and resistant infections. Certain HPV strains promote dysplasia and squamous cell carcinomas in the oral mucosa. Lesions in the mouth can be transmitted sexually or by nail biting in patients with periungual warts.

Even though the success rate of the following therapies ranges from 40% to 100%, HPV recurrences are frequent after treatment with conventional therapies, such as the following:

* Chemotherapeutic agents (podofilox, retinoic acid, trichloroacetic acid)

* Cytodestructive methods (liquid nitrogen, electrocautery, or carbon dioxide laser photocoagulation)

* Immunostimulants (interferon alpha, imiquimod)

Calista described the treatment of a 45-year old man with AIDS who developed a recalcitrant gingival HPV infection. Several conventional therapies were tried over a 2-year time period with little or no success. A 1% cidofovir cream was compounded, and the patient was instructed to apply the cream to each lesion using a small spatula once daily for 5 consecutive days (no Saturdays or Sundays) for 2 weeks. The lesions flattened within a 24-hour period and completely resolved by the end of the 2-week course. The patient experienced no local or systemic side effects, and reported no recurrence within the subsequent 12 months.4

Genital Warts

HPV is the most common sexually transmitted viral disease in the world and is the cause of anogenital warts. Again, patients with a compromised immune system, such as those with HIV infection, are at greatest risk for this type of infection. In these patients, HPV infection may produce more extensive lesions and have a lower therapeutic response and higher recurrence rate than in immunocompetent persons. The same conventional therapies used to treat gingival HPV infection are also used for anogenital warts; however, they often fail to eradicate subclinical disease and latent virus.

Matteelli et al conducted a randomized, placebo-controlled, single-blinded, crossover pilot study to determine the tolerability and efficacy of topical 1% cidofovir cream for the treatment of external anogenital warts in HIV-infected patients. Six patients were randomized to use the 1% cidofovir cream, and another six to use placebo cream. Eventually, the placebo group also received the 1% cidofovir cream. The cream was applied 5 days per week for 2 weeks, and this treatment period was followed by a 2-week observation period. Treatment with cidofovir reduced total wart area by more than 50% compared to placebo in seven (58%) patients. Four (33%) of the treated patients showed a 1% to 50% reduction in wart area, and only one patient had no response at all. Fifty percent of patients experienced local mucosal erosion as a side effect of therapy, and one third of those patients had to discontinue therapy, but there were no systemic side effects. The mucosal erosion resolved within 7 days, leaving no permanent scarring. This study demonstrated that cidofovir is effective in a very short course of therapy, which may improve patient compliance and reduce the need for long-term therapy.5

Orlando et al conducted an open, randomized, prospective study to evaluate the efficacy of electrocautery (ST), topical cidofovir (CT), and a combination of electrocautery and cidofovir (SCT) in the treatment of genital warts. Seventy-four patients were randomly assigned to one of the three treatment groups: 29 in ST, 26 in CT, and 19 in SCT. The CT group applied cidofovir 1% gel 5 days per week for a maximum of 6 weeks, and the SCT group applied cidofovir 1% gel 5 days per week for 2 weeks within 1 month of electrocautery. Although electrocautery was rapidly effective (93.1% complete resolution), 73.68% of the ST group experienced relapse within 66 days. The CT group achieved a 76.2% rate of complete resolution, but the relapse rate was much lower (35.29%) than in the ST group. The combination SCT group achieved 100% complete resolution and a 27.27% relapse rate.6

Molluscum Contagiosum

MCV is a pox virus that commonly causes a self-limiting infection in children. In immunocompromised patients, however, MCV infection can cause severe disfigurement, leading to social isolation and poor quality of life. The infection may be very difficult to resolve in these patients, and secondary bacterial infection is a common complication. There are numerous case reports describing use of compounded cidofovir cream to resolve MCV infection in both children and adults.

Davies et al published the first case report in which topical 1% cidofovir (in unguentum Merck) was used to treat MCV.7 A 12-year- old boy in whom primary immunodeficiency syndrome was diagnosed in early infancy developed MCV lesions over 75% of his skin surface. The lesions were acutely inflamed within 2 to 3 weeks of beginning topical cidofovir therapy, but shortly thereafter they resolved dramatically. The patient experienced no systemic side effects, skin discoloration, or scarring. At the time of the report, the patient was continuing treatment and recurrence of the le\sions had been minimal.7

Meadows et al reported complete resolution of MCV after 1 month of therapy with a 3% cidofovir cream (in Dermovan) compounded by a local pharmacist. The patient was a 37-year-old HIV-positive Hispanic man who had been afflicted with MCV lesions for 3 years. He applied the cream each morning, Monday through Friday, for 2 weeks. Moderate acute inflammation developed during the second week, but it resolved spontaneously 2 weeks later along with the lesions. At the time of the report, the patient had remained clear of MCV recurrence for 5 months.8

The first report of topical cidofovir use for generalized and facial MCV in children with AIDS was published by Torro et al. Both patients, an 8-year-old African American boy and a 4-year-old Hispanic boy, had hundreds of umbilicated pearly and skin-colored papules disseminated over the entire body, including the face. In fact, the children had severe facial disfigurement and suffered from debilitating social isolation. A 3% cidofovir cream was compounded and applied to the lesions once daily, 5 days a week, for 8 weeks. Nonfacial lesions were also occluded with adhesive tape for at least 12 hours. Both patients developed redness and painful erosions at the sites of previous lesions 5 to 15 days after initiating the therapy, but the adverse reactions resolved during the 2-day weekend period of treatment rest. The lesions healed, leaving superficial scars and post-inflammatory hypopigmentation and hyperpigmentation. Large lesions healed with varioliform scars. Neither child experienced systemic adverse effects. All of the treated lesions showed complete clinical resolution after 8 weeks. The 8-year-old patient had no recurrence during a 21-month follow-up period. At the end of the study, both patients experienced significant improvement in self-esteem and resumed social activities.9

Compounding Topical Cidofovir

Topical cidofovir cream or gel is compounded from the commercial parenteral cidofovir (Vistide) solution and a cream or aqueous gel base. Because of the drug’s mutagenic properties, compounders formulating this preparation should take cytotoxic or antineoplastic precautions. The National Institutes of Health recommends that cidofovir be prepared in a Class II laminar airflow biological safety cabinet or barrier isolator. Compounding personnel should wear chemotherapy gloves and closed-front surgical gowns with knit cuffs during the preparation. If the compounder is accidentally exposed to cidofovir, the exposed area should be washed and flushed with copious amounts of water. All materials in contact with the cidofovir should be disposed of in a waterproof, puncture-proof container or “chemo bucket” and incinerated in an authorized high- temperature incinerator. Since the amount of cream or gel compounded is usually less than 40 grams, the syringe method of preparation is ideal; the procedure is outlined in the accompanying box.

Additional different cidofovir formulations are provided with this article.

Propylene glycol may increase the absorption and bioavailability of cidofovir, especially on abraded skin.10 Since cutaneous lesions due to viral infections typically cause skin damage and may cover an extensive area of the skin, the author recommends that this excipient not be used, to reduce the chance of systemic absorption and adverse side effects.

Patient Monitoring and Counseling

Prior to initiating topical cidofovir therapy, the patient should undergo serum tests of kidney function to establish baseline renal function. The patient’s renal function should be evaluated periodically during therapy to monitor for nephrotoxicity. A white blood cell count with differential also should be done periodically during therapy to monitor for neutropenia. These are precautionary measures, since there have been no reported systemic adverse effects from the topical use of cidofovir.

The patient or caregiver should be advised that acute inflammation, redness, or open lesions may develop about 1 week after initiating therapy. These acute effects often resolve spontaneously during the 2-day rest period or within a 2-week period. If the effects worsen or become too painful, the prescriber should be contacted to re-evaluate the therapy.

Conclusion

Cidofovir is a broad-spectrum antiviral agent with activity against several DNA viruses. Many of these infections develop into recalcitrant infections in high-risk patients. Topical cidofovir has shown promising results in reported case studies and pilot studies. An application to approve the use of topical cidofovir for acyclovir- resistant herpes virus infection was denied by the FDA owing to the lack of phase III data. In 1997, the manufacturer stated that no further controlled studies were planned or in progress to evaluate the use of topical cidofovir in herpes simplex infections.10 It is unknown whether there are plans to conduct controlled studies for HPV or MCV infections.

Since most retail pharmacies do not have the safety equipment necessary to compound hazardous preparations, a compounding pharmacist can play a vital role in compounding topical cidofovir cream or gel. The pharmacist also may assist the physician in obtaining compassionate use supplies for indigent patients in need of this therapy since the drug is very expensive.

It is hoped that more studies will be conducted to confirm the initial reports regarding the therapeutic efficacy and lack of systemic side effects of topical cidofovir. Until a commercial product is developed, marketed, and affordably priced to allow it to be routinely prescribed for these infections, the compounding pharmacist can provide this viable treatment option for patients to resolve infections, prevent severe disfigurement, improve self- esteem and social interactions, and ultimately enhance quality of life.

Syringe Method of Preparation for Topical Cidofovir

METHOD OF PREPARATION

1. Weigh the vehicle base.

2. Backload the vehicle base into a disposable 60-mL syringe.

3. Place the syringe into a hood or barrier isolator.

4. Use a chemoprotective device, such as the PhaSeal (Baxa Corporation, Inglewood, Colorado), to withdraw the desired amount of cidofovir into another disposable 60-mL syringe.

5. Detach the chemoprotective device from the syringe containing the cidofovir.

6. Attach a Luer Lock-to-Luer Lock connector to the syringe.

7. Connect the syringe containing the cream or gel base to the connector.

8. Inject the contents of the syringes back and forth between the two syringes until the cream or gel is thoroughly mixed with the cidofovir solution and the mixture is smooth and consistent in texture.

9. Detach the connector.

10. Empty the syringes.

11. Transfer the mixture to a clean ointment jar or ointment tube.

12. Cap, seal, and label the jar or tube.

Formulations for Topical Cidofovir Cream or Gel

METHOD OF PREPARATION

1. Select the formula you wish to prepare.

2. Calculate the required quantity of each ingredient for the total amount to be prepared.

3. Combine the ingredients based on the selected formula.

4. Package in an appropriate container.

5. Label the container.

STABILITY

Although no stability studies on cidofovir cream or gel have been published, it is reasonable to assign a beyond-use date of 30 days to allow for a full month of therapy with the preparation.

Note: These formulations are prepared at Clarian Health Partners, Inc., Indianapolis, Indiana.

References

1. Mendel DB, Barkhimer DB, Chen MS. Biochemical basis for increased susceptibility to cidofovir of herpes simplex viruses with altered or deficient thymidine kinase activity. Antimicrob Agents Chemother 1995; 39(9): 2120-2122.

2. Morphin F, Snoeck R, Andrei G et al. Phenotypic resistance of herpes simplex virus 1 strains selected in vitro with antiviral compounds and combinations thereof. Antivir Chem Chemother 1996; 7: 270-275.

3. Vistide (cidofovir injection) [package insert]. Louisville, KY: Cardinal Health; 2000.

4. Calista D. Resolution of recalcitrant human papillomavirus gingival infection with topical cidofovir. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90(6): 713-715.

5. Matteelli A, Beltrame A, Graifemberghi S et al. Efficacy and tolerability of topical 1% cidofovir cream for the treatment of external anogenital warts in HIV-infected persons. Sex Transm Dis 2001; 28(6): 343-346.

6. Orlando G, Fasolo MM, Beretta R et al. Combined surgery and cidofovir is an effective treatment for genital warts in HIV- infected patients. AIDS 2002; 16(3): 447-450.

7. Davies EG, Thrasher A, Lacey K et al. Topical cidofovir for severe molluscum contagiosum. Lancet 1999; 353(9169): 2042.

8. Meadows KP, Tyring SK, Pavia AT et al. Resolution of recalcitrant molluscum contagiosum virus lesions in human immunodeficiency virus-infected patients treated with cidofovir. Arch Dermatol 1997; 133(8): 987-990.

9. Toro JR, Wood LV, Patel NK et al. Topical cidofovir: A novel treatment for recalcitrant molluscum contagiosum in children infected with human immunodeficienty virus 1. Arch Dermatol 2000; 136(8): 983-985.

10. Zabawski EJ Jr, Cockerell CJ. Topical and intralesional cidofovir: A review of pharmacology and therapeutic effects. J Am Acad Dermatol 1998; 39(5 Pt 1): 741-745.

Linda F. McElhiney, PharmD, RPh

Clarian Health Partners, Inc. * Indianapolis, Indiana

Address correspondence to Linda F. McElhiney, PharmD, RPh, Clarian Health Partners, Inc. 550 N. University Boulevard, UH 1451, Indianapolis, IN 46202. E-mail: [email protected]

Copyright International Journal of Pharmaceutical Compounding Sep/ Oct 2006

(c) 2006 International Journal of Pharmaceutical Compounding. Provided by ProQuest Information and Learning. All rights Reserved.

Fifth Avenue Veterinary Specialists Expands Staff With New Veterinarians and Pet Care Professionals; New York City’s State-of-the-Art Veterinary Facility Expands List of Services and Referrals

Fifth Avenue Veterinary Specialists and 24 Hour Emergency Care (FAVS) has announced five key additions to the team of veterinary specialists. New members to the FAVS team include: Jean-Sebastien Boileau, DVM, Diplomate ACVIM, referral cardiologist; Jessica Chavkin, VMD, and Aimee Kidder, DVM, both referral internal medicine clinicians; Randi Fishkin, DVM, referral practitioner in emergency and critical care; and Irene Javors, M.ED, licensed mental health counselor, specializing in grief and bereavement counseling.

“The addition of our core staff specialists is a tremendous asset enabling us to expand our comprehensive list of specialty services and availability here at FAVS,” said Sheri L. Berger, DVM, DACVO, medical director at FAVS. “With the addition of our new cardiology service and expansion of our team of internal medicine and emergency and critical care specialists, we are enhancing the spectrum of care for our patients and service to our clients. These additions will advance our mission and commitment to providing compassionate and quality care,” she added.

A graduate of the Universite of Montreal, Dr. Boileau received his residency training in cardiology at the Animal Medical Center (AMC) and joined the FAVS team of expert veterinarians on September 5, 2006. Dr. Chavkin, a summa cum laude graduate of the University of Pennsylvania, is a residency trained small animal internal medicine practitioner. Dr. Kidder graduated from Louisiana State University, and is a residency trained (Kansas State University) small animal internal medicine clinician. These two internists will round out the FAVS list of internal medicine specialists with expertise in nephrology, gastroenterology, and immunology as well as endoscopy and ultrasonography. Bereavement specialist Irene Javors first joined FAVS in July as host of weekly group discussions and continues her counseling on coping with the loss of a pet. Ms. Javors is a licensed mental health counselor and a diplomate of the American Psychotherapy Association.

In addition to the recently added services, FAVS provides specialty practice in the areas of emergency and critical care, oncology, ophthalmology and surgery. FAVS is equipped with state-of-the-art equipment including endoscopy, digital radiography, fluoroscopy, ultrasonography and computed tomography (CT scan). As a leader in emergency and critical care services, FAVS also provides monitoring of critically ill patients in the 24-hour ICU division with two veterinarians and a team of nurses in the hospital nightly.

Fifth Avenue Veterinary Specialists, New York City’s premier specialty-only and 24-hour emergency care facility, is located in the heart of lower Manhattan. FAVS offers a full spectrum of specialty services, including emergency and critical care, internal medicine, oncology, ophthalmology, cardiology and orthopedic and soft tissue surgery. In partnership with referring veterinarians, FAVS is dedicated to maintaining the highest standards with a team of specialists, nurses and support staff to ensure pets receive the very best specialty and emergency care.

For more information about Fifth Avenue Veterinary Specialists, please visit the Web site at www.fifthavevetspecialists.com.

Prescription Assistance Program Helps With Medicare Part D Doughnut Hole

ST. LOUIS, Sept. 18 /PRNewswire-FirstCall/ — Nine months into the new Medicare Part D program, many beneficiaries are finding themselves in the program’s “doughnut hole” coverage gap.

Rx Outreach(SM), a patient assistance program (PAP) offered by pharmacy benefit manager Express Scripts, can help Medicare Part D beneficiaries in the “doughnut hole.”

Rx Outreach’s PAP offers 90-day supplies of 110 primarily generic medications from more than 40 therapeutic classes to treat most seniors’ health needs. The Rx Outreach program’s only cost to the patient is a flat administrative fee of either $20 or $30, depending on the prescription that is dispensed.

Many Medicare Part D beneficiaries have begun to enter the coverage gap and more are expected to meet the same challenge in the coming weeks. According to a June analysis by PriceWaterhouseCoopers LLC, this gap in coverage is forcing more than 3.4 million beneficiaries to make tough choices between the medications they should take and other expenses.

Before reaching the doughnut hole in the Medicare Part D program, patients pay the first $250 for their prescriptions, and then 25 percent of their drug costs for the next $2,000. After that point, plan beneficiaries are in the doughnut hole coverage gap until their out-of-pocket costs reach $3,600. During this time, beneficiaries pay 100 percent of their prescription costs. Upon reaching the $3,600 out-of-pocket limit, Medicare Part D will begin covering a beneficiary’s prescription drugs again.

The amount paid to a program such as Rx Outreach may not be submitted for reimbursement from Medicare and does not count toward the beneficiary’s out-of-pocket costs. Since individuals cannot apply the cost of the Rx Outreach program to their out-of-pocket cost to get them to the $3,600 limit, each individual must determine based on his/her situation if a patient assistance program will help reduce the overall cost of medication.

Introduced in 2004, Rx Outreach is one of the first private-sector solutions to help low-income individuals afford generic medications. Using generic drugs, when medically appropriate, also helps cut costs. Generic drugs have been proven safe and effective and account for more than half of all prescriptions written.

Rx Outreach enables participants to save an average of $100 per prescription compared to the cost of the same medication if obtained without insurance from a retail pharmacy. If a patient fills multiple prescriptions, the savings could be hundreds of dollars per month.

In addition to cost savings, Rx Outreach offers the convenience of a 90-day-supply and home delivery with each prescription. There is no contract to sign or monthly fee to use this program. Enrollment in the program is for a 12-month period.

Rx Outreach has helped more than 400,000 individuals save more than $140 million on their prescription medications. “Currently, 30 percent of all Rx Outreach participants are seniors,” notes Tina Jason, Express Scripts senior director, Rx Outreach. “This program is a valuable resource for seniors needing assistance covering the cost of their prescriptions.”

The program is available in every state and Puerto Rico to individuals with incomes of up to $24,500 per year annually, which is 250 percent of the federal poverty level. A family of four could have a household income of up to $50,000 per year and meet the financial guideline.

The Rx Outreach program is also available to individuals and families that are not on Medicare. Patients who are uninsured or covered by another medical or prescription drug program are also eligible to participate.

For more information on Rx Outreach, including a complete list of generic drugs offered and enrollment forms, visit http://www.rxoutreach.com/ . For more information on generics, visit http://www.express-scripts.com/pr/generics/ .

About Express Scripts:

Express Scripts, Inc. is one of the largest PBM companies in North America, providing PBM services to over 55 million members. Express Scripts serves thousands of client groups, including managed-care organizations, insurance carriers, employers, third-party administrators, public sector, and union-sponsored benefit plans. Express Scripts is headquartered in St. Louis, Missouri. More information can be found at http://www.express-scripts.com/ .

   Media Contact:  Rita Holmes-Bobo   314-702-7584   [email protected]  

Express Scripts, Inc.

CONTACT: Rita Holmes-Bobo of Express Scripts, Inc., +1-314-702-7584,[email protected]

Web site: http://www.express-scripts.com/http://www.rxoutreach.com/http://www.express-scripts.com/pr/generics/

Target Clinics(TM) Open in Select Metro Target Stores; Target Launches Walk-in Medical Clinics

With the cold and flu season right around the corner, Target guests can now visit their new local Target Clinics in select Twin Cities Target stores.

The new Target Clinics are staffed with licensed nurse practitioners and physician assistants and offer a variety of services including: flu shots, treatment for common illnesses such as strep throat, bronchitis and skin conditions. Target Clinic is working to accept all local insurance plans, Medicare and Medicaid.

Target Clinics are designed to be a convenient complement guests’ primary care relationships. Patients can request a full description of the treatment received at Target Clinics to share with their primary physician.

The new Target Clinics demonstrate a true focus on the patient by offering quality and value with convenient features such as spacious exam rooms and a private waiting area. Services are clearly listed along with prices with most costing less than $50. A receptionist will greet patients and expedite their visit which allows practitioners to focus on their patients. To ensure the convenience of Target Clinics guests do not need to make appointments, they can check a clinic’s wait time on the web and they can choose to have their prescription filled at a Target Pharmacy.

Guests can visit the new Target Clinics at the following stores:

— Shoreview

— Woodbury

— Downtown Minneapolis

— Blaine

— North St. Paul

— Minnetonka

— Lakeville

— Champlin

On October 8, Target Clinics will open in the new Fridley and Knollwood/St. Louis Park SuperTarget stores and in November in the Chaska and Eden Prairie stores.

To ensure that guests receive the quality care they deserve, Target has partnered with Medcor, an established medical provider with over twenty years of experience operating clinics in a variety of settings. Physicians from Fairview Health Services will support Target Clinics by providing medical oversight and consult services. Target Clinics also meet or exceed the American Medical Association and the American Academy of Family Physicians’ guidelines for retail healthcare.

About Target

Minneapolis-based Target serves guests at 1,443 stores in 47 states nationwide by delivering today’s best retail trends at affordable prices. Target is committed to providing guests with great design through innovative products, in-store experiences and community partnerships. Whether visiting a Target store or shopping online at Target.com, guests enjoy a fun and convenient shopping experience with access to thousands of unique and highly differentiated items. Target (NYSE:TGT) gives back more than $2 million a week to its local communities through grants and special programs. Since opening its first store in 1962, Target has partnered with nonprofit organizations, guests and team members to help meet community needs.

About Medcor

Medcor provides outsourced medical services to business and government facilities nation-wide, serving a broad spectrum of industries. Medcor’s services include managing clinics located on-site in client facilities, 24-hour injury triage, and medical screenings. Medcor has developed specialized systems and software to support medical staff in non-traditional settings. These systems help Medcor operate efficiently and deliver a high quality of clinical care and customer service. Medcor collaborates closely with businesses and medical providers in the communities it serves. Headquartered in McHenry, Illinois, Medcor was founded in 1984 and now serves over 19,000 sites in all 50 states.

Winners of the 2006 WEIGHT WATCHERS(R) INSPIRING STORIES OF THE YEAR CONTEST & Sarah Ferguson, Duchess of York, Motivate Los Angeleans With Moving Accounts of Their Weight-Loss Transformations

LOS ANGELES, Sept. 15 /PRNewswire/ — Weight Watchers(R) will recognize the eight regional finalists of the 2006 WEIGHT WATCHERS INSPIRING STORIES OF THE YEAR CONTEST during a luncheon held at Los Angeles landmark Beverly Hills Hotel on September 15. Sarah Ferguson, Duchess of York, will honor some of the unique weight-loss success stories among its members and subscribers. The finalists are selected from thousands of entrants across the country by a team of judges based on a variety of factors, ranging from amount of weight lost to the inspirational nature of their personal transformation.

“From my own experience, I know that weight loss is challenging,” says Sarah Ferguson, Duchess of York. “I applaud everyone who shared their stories and I’m proud to help recognize such extraordinary people with different backgrounds and weight-loss goals to encourage others in their journey toward a healthier lifestyle.”

Since 1997, Sarah Ferguson, Duchess of York, has been a media spokesperson for Weight Watchers, inspiring people to take control of their weight. Today, a fit and trim Duchess of York, a Weight Watchers Lifetime Member herself, credits her relationship with Weight Watchers as one that changed her life.

“Being a member of Weight Watchers is about much more than just losing weight,” states Californian Candace Rogalski, one of the eight finalists to be honored. “I’ve dropped pounds but what I’ve gained in better health and energy has changed my life dramatically. Following her father’s diagnosis with diabetes, Candace joined Weight Watchers with her mother. “Today I am happy, healthy and loving my new life. Besides the physical transformation, my personality and lifestyle have been overhauled as well. I am much more confident and comfortable with myself. I no longer fear going out in public and receiving stares. I sleep better and am more alert during the day. And most importantly, I’ve developed a bond with my mother that I never thought possible.”

“At Weight Watchers, we celebrate the success of each of our members and subscribers,” says Linda Huett, CEO and President, Weight Watchers International. “This annual contest allows us to honor those members and subscribers who want to share their personal stories with others.”

In order to motivate others to live a healthy lifestyle, Weight Watchers annual “Inspiring Stories of the Year” contest encourages members and subscribers to celebrate their achievements and share their personal success stories. Entrants were asked to capture their weight-loss journey in fewer than 150 words, describing the positive changes and health benefits experienced as a result of weight loss, along with details about what kept them on track. All of the winners’ stories feature inspiring individual triumphs, proving that victory in weight-loss translates into victory in many other aspects of a person’s life. From Lisa Rodriguez’s collapse while climbing stairs to Janice Gillman’s frightful night of falling asleep while watching her granddaughter, their stories capture a variety of “A-ha!” moments — the turning points that led them to realize it was time to take action and lose weight for good.

Each finalist has his or her own individual story, but all share a common theme — through Weight Watchers they learned about healthy nutrition and got the confidence to make it happen. Weight Watchers message boards are full of remarkable stories that illustrate the ways the plan opens a new world for its members and subscribers. Whether it’s encouragement for new mothers in the “Calling All Moms” board with suggestions on how to lose that pregnancy weight, or bonding on the “Guys on a Diet” board with men helping one another through weight-loss challenges, or support in maintaining goal weight on the “Lifetimers” board — the Weight Watchers community helps one another to live their lives healthier, happier and more confidently.

The grand prize winners’ stories will be featured on http://www.weightwatchers.com/inspiringstories on September 21st along with other helpful weight-loss information.

Luncheons with The Duchess to honor eight finalists per region will also be held in Houston, Chicago and Washington, D.C. During each of the local events, a finalist will be named as one of four national grand prize winners. Grand prize winners are rewarded with a trip to New York City; a deluxe beauty makeover courtesy of Bliss Spa and Salon AKS; share their personal story with “Weight Watchers Magazine”; tickets to a Broadway show; and lunch with fellow Weight Watchers member Sarah Ferguson, Duchess of York, which will take place at Tavern on the Green.

About Weight Watchers

Weight Watchers is America’s trusted name in weight loss and the global leader in weight-loss services, with approximately 48,000 weekly meetings in 30 countries. The mission of Weight Watchers is to help people reach and maintain a healthy weight. At the heart of Weight Watchers are weekly meetings that provide the coaching and tools to help people make the positive changes required to lose weight and keep it off. Weight Watchers also offers Internet subscription products for people wanting access to interactive weight management resources over the Internet. To learn more about Weight Watchers services, products and publications, visit http://www.weightwatchers.com/. To find the nearest Weight Watchers meeting location, call 1-800-651-6000 or click on the “Find a Meeting” link at the top of our homepage, http://www.weightwatchers.com/.

About 2006 WEIGHT WATCHERS INSPIRING STORIES OF THE YEAR CONTEST

The contest, conducted by Weight Watchers since 1998, spotlights the most inspirational and incredible weight-loss success stories among its members and subscribers. Four grand-prize winners, 32 first-prize winners, and 128 second-prize winners are chosen throughout the country. Winners are selected by a team of impartial judges based on a variety of factors, ranging from amount of weight lost to the magnitude and inspirational nature of the personal transformation.

* The luncheon is not open to the public.

Weight Watchers

CONTACT: Wendy Yellin of Weight Watchers, +1-925-866-8180, ext. 2004,[email protected]; or Suzanne Lyons of Ketchum, +1-646-935-3955,[email protected], for Weight Watchers

Web site: http://www.weightwatchers.com/http://www.weightwatchers.com/inspiringstories

GHX Renames HPIS As GHX Market Intelligence

WESTMINSTER, Colo., Sept. 13 /PRNewswire/ — GHX has renamed Healthcare Products Information Services (HPIS) as GHX Market Intelligence, which will operate as a business unit within the company, offering strategic decision-making data to healthcare manufacturers. HPIS was acquired in 2006 as part of GHX’s merger with Neoforma.

GHX Market Intelligence provides reports on distributed healthcare product sales, which manufacturers utilize to make more informed business decisions. Through its partnerships with more than 20 distributors and its exclusive relationship with the Health Industry Distributors Association (HIDA), GHX Market Intelligence obtains and analyzes an estimated 80 percent of all sales transaction data on distributed healthcare products in the U.S. across seven key healthcare market segments: hospital, physician, home health care, clinical laboratory, nursing homes/long-term care facilities, treatment centers, and other, which includes public health and physical therapy.

“Our exclusive relationship with HIDA provides us with the most complete, accurate, and timely source data for distributed healthcare product sales,” says Patrick McCarthy, Executive Vice President, GHX Business Intelligence Solutions. “As a result, we can offer customers the highest quality, decision-making information available to healthcare manufacturers.”

GHX Market Intelligence summarizes product-level sales by market segment with geographic specificity down to a three-digit zip code. With access to reliable, timely, and comprehensive data comprising a large percentage of the monthly transactions industry-wide, GHX Market Intelligence can extrapolate the data to project 100 percent of sales through the domestic medical-surgical and clinical-lab distribution supply chain. This market visibility allows GHX customers to target areas of growth and more effectively focus marketing, sales, business development, and product development efforts.

Most recently, GHX Market Intelligence began offering a series of syndicated market intelligence reports, called Executive Insight, to specifically meet the needs of smaller medical and surgical manufacturers. Larger manufacturers can also utilize the reports when introducing new products or researching new market segments. Executive Insight provides data and analysis on the following:

   *  Class by Major Report -- How a particular class of product, such as      gloves or needles and syringes, is selling in each market segment    *  Major by Market Segment Report -- How an individual product is selling      in a particular Market Segment    *  Manufacturer Trending Report -- Sales performance for a particular      manufacturer in each of the top ten major product classes, e.g.,      gloves, skin care products, and by market segment    *  New Products Report -- The top 100 new products sold in the past four      quarters in the hospital, long term care, and home health care market      segments.   

“GHX is a well-established and trusted name in the healthcare industry,” explains McCarthy. “Bringing HPIS under the GHX name demonstrates our commitment to this important service offering and clearly expresses to our customers the confidence we have in this timely, insightful and actionable business intelligence.”

About GHX

GHX empowers healthcare organizations to reduce costs and improve margins. This is achieved by delivering tools and services that automate processes and increase knowledge-based decision making. Service offerings include:

   *  Exchange services that support trading partner connectivity and provide      electronic transaction sets, order validation and reporting tools    *  Content services utilizing the GHX AllSource(R) product content      repository as the foundation for data synchronization and advanced      content services    *  Contract services that maximize contract utilization    *  Procurement services that enable automation of the requisitioning      process    *  Business Intelligence reports designed to provide strategic decision-      making data    *  Pharmaceutical business solutions allowing manufacturers to gain      control over rebate and contract management processes    *  Sales force automation services that allow healthcare manufacturers to      streamline field sales processes and improve staff efficiencies   

Through these services, healthcare providers and suppliers can improve efficiencies, automate processes and reduce operating expenses. Equity owners of GHX are Abbott Exchange, Inc.; AmerisourceBergen Corp.; Baxter Healthcare Corp.; B Braun Medical Inc.; Becton, Dickinson & Co.; Boston Scientific Corp.; Cardinal Health, Inc.; C.R. Bard, Inc.; Fisher Scientific International, Inc.; GE Healthcare; HCA; Johnson & Johnson Health Care Systems Inc.; McKesson Corp.; Medtronic USA, Inc.; Owens & Minor; Premier, Inc.; Siemens; Tyco Healthcare Group, LP; University HealthSystem Consortium; and VHA Inc. For more information, visit http://www.ghx.com/.

GHX

CONTACT: Karen Conway of GHX, cell, +1-303-564-2147, or +1-720-887-7215,or +1-719-488-0359, [email protected]

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

AHF’s Positive Healthcare to Open Florida’s First Non-Profit HIV/AIDS Pharmacies

FT. LAUDERDALE, Fla., Sept. 13 /PRNewswire/ —

   What:        Grand Opening Receptions for Florida's First Non-profit                HIV/AIDS Pharmacies -- AHF's Positive Healthcare Pharmacies                in Orlando & Tampa    When/Where:  ORLANDO -- Wednesday, September 13th  12 noon to 7pm                1021 North Mills Avenue, Orlando, FL 32803  (407) 770-0507    When/Where:  TAMPA -- Thursday, September 14th     12 noon to 7pm                4323 west Kennedy Blvd., Tampa, FL 33309    (813) 514-6529    Note:        Ribbon-cutting Ceremonies will take place at 12 noon Each                Day    Who:         Michael Weinstein, AIDS Healthcare Foundation (AHF) President                Scott Howell, MD, Southeastern and Caribbean Region Bureau                 Chief for AHF                Donna Stidham, AHF's Chief of Managed Care                Gene Bundrock, Director of AHF's Positive Healthcare/Florida                Patrick Contrado, AHF's National Director of Pharmacy   

AIDS Healthcare Foundation (AHF), which operates Florida’s Positive Healthcare, the innovative disease management program serving over 10,000 people living with HIV/AIDS in Florida who are enrolled in the state’s MediPass (Medicaid) program, will celebrate the grand openings of two Positive Healthcare Pharmacies in Orlando (Wed. Sept 13 at 12noon) and Tampa (Thurs. Sept 14 at 12 noon) this week. The new pharmacies, which are open to all, will be the first not-for-profit HIV/AIDS pharmacies in the state of Florida and will primarily target and serve HIV/AIDS patients in the state’s Positive Healthcare disease management program.

“These two new Positive Healthcare Pharmacies in Orlando and Tampa offer another key link in the continuum of care and services for Floridians living with HIV/AIDS,” said Michael Weinstein, President of AHF. “These are also the first non-profit HIV/AIDS pharmacies in Florida, and by using these pharmacies, clients will also help others, as excess revenues from these sites will help AHF and Positive Healthcare provide HIV/AIDS services to other needy Floridians.”

The Tampa & Orlando Positive Healthcare Pharmacies will operate from 8:30am – 5:30pm Monday through Friday.

AIDS Healthcare Foundation (AHF), the largest AIDS organization in the United States, also operates free AIDS treatment clinics in the US, Africa, Asia and Latin America/Caribbean.

AIDS Healthcare Foundation

CONTACT: Florida, Joey Wynn, AHF Community Relations Manager, mobile,+1-305-793-0680, or Los Angeles, Ged Kenslea, AHF Communications Director,+1-323-860-5225, or mobile, +1-323-791-5526, both of AIDS HealthcareFoundation

NCSBN and ANA Issue Joint Statement on Nursing Delegation

The National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA) have issued a joint statement on delegation designed to reinforce that delegation is an essential nursing skill and to support the practicing nurse in using delegation safely and effectively.

The escalating shortage of nurses, greater acuity of patient illnesses, technological advances and increased complexity of therapies contribute to today’s current chaotic and multifaceted health care environment. The recognition that registered nurses (RNs) need to work effectively with assistive personnel and the abilities to delegate, assign, and supervise are critical competencies for the 21st century nurse led both NCSBN and the ANA to separately adopt papers on delegation in 2005. These delegation papers were conceptually similar thus providing the impetus for NCSBN and ANA to approach this important topic from both regulatory and professional practice positions and work toward a joint statement that distills the best work of both organizations and advances the common ground between the two.

NCSBN and the ANA recognize the following policy considerations:

 --  State nurse practice acts define the legal parameters for nursing     practice. Most states authorize RNs to delegate. --  There is a need and a place for competent, appropriately supervised     nursing assistive personnel in the delivery of affordable, quality health     care. --  The RN assigns or delegates tasks based on the needs and condition of     the patient, potential for harm, stability of the patient's condition,     complexity of the task, predictability of the outcomes, abilities of the     staff to whom the task is delegated, and the context of other patient     needs. --  All decisions related to delegation and assignments are based on the     fundamental principles of protection of the health, safety and welfare of     the public.      

To support nurses in making decisions related to delegation both organizations have developed resources designed to make the delegation process easier to understand and utilize. Two such resources are the “ANA Principles of Delegation” and NCSBN’s “Decision Tree on Delegation” that reflects the four phases of the delegation process.

Both NCSBN and the ANA believe that mastering the skill and art of delegation is a critical step on the pathway to nursing excellence and, when used appropriately, can result in safe and effective nursing care. As a nursing shortage of epic proportions looms, delegation becomes an even more vital tool that can free the RN to attend to more complex patient care needs; develop the skills of nursing assistive personnel; and promote cost containment for health care organizations.

The National Council of State Boards of Nursing, Inc. (NCSBN) is a not-for-profit organization whose membership comprises the boards of nursing in the 50 states, the District of Columbia and four United States territories. Mission: The National Council of State Boards of Nursing (NCSBN), composed of Member Boards, provides leadership to advance regulatory excellence for public protection.

The American Nurses Association (ANA) is the only full-service professional organization representing the nation’s 2.9 million registered nurses through its 54 constituent member nurses associations. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

The joint statement on nursing delegation may be found on NCSBN’s Web site at the following link http://www.ncsbn.org/pdfs/Joint_statement.pdf

 ANA 8515 Georgia Avenue, Suite 400 Silver Spring, Maryland 20910-3492 301.628.6500 Fax 301.628.5001 www.nursingworld.org NCSBN 111 E. Wacker Drive, Suite 2900 Chicago, Illinois 60601-4277 312.525.3600 Fax 301.279.1032 www.ncsbn.org 

 Contact: Dawn M. Kappel NCSBN Director of Marketing and Communications 312.525.3667 direct 312.279.1032 fax Contact via http://www.marketwire.com/mw/emailprcntct?id=301198258AFF4E6E  John Stauffer ANA Public Relations Specialist 301.628.5198 direct 301.628.5340 fax Contact via http://www.marketwire.com/mw/emailprcntct?id=AC6144426BD536DE  

SOURCE: NCSBN

Report on Stomach-Friendly Pain Medication

A report from the Harvard Medical School in Boston provides detailed advice about what types of arthritis pain medications are stomach-friendly.

The report, Arthritis: Keeping your Joints Healthy, provides a step-by-step guide for the safe use of NSAIDs for those with arthritis, who have had ulcers in the past, those with rheumatoid arthritis, and those taking a blood thinner or corticosteroids in addition to arthritis medications.

For those with ulcers in the past, Dr. Robert Shmerling says it might be wise to take a COX-2 inhibitor or to combine an NSAID with one of several stomach-protecting drugs now available.

Those at lower risk–who have experienced stomach distress with NSAIDs but no bleeding or ulcers — might benefit from reducing the dose of the NSAID or trying an entirely different pain reliever such as acetaminophen. In any case, patients should talk with their doctor before changing or combining medicines, says Shmerling.

Unpublished Papers Reveal Research of Sir Issac Newton

Known primarily for his foundational work in math and physics, Sir Issac Newton actually spent more time on research in alchemy, as well as its interrelationships with science, history and religion, and its implications for economics.

Alchemy, as Newton practiced it in the 17th and 18th centuries, was research into the nature of chemical substances and processes ““ primarily the transmutation of materials from one type of matter to another. Newton and others conducted experiments, but also incorporated philosophical thought in their attempts to uncover the mysteries of the physical universe.

“Newton’s extensive work on universal history (which presents human history as a coherent unit governed by certain immutable principles) provides an essential setting for linking his work on alchemy and his work heading England’s mint in the 1690s,” said Georgia Institute of Technology Professor Kenneth Knoespel, who chairs the School of Literature, Communication and Culture. “It is not at all farfetched to think of history as a kind of alchemical process that looks to the creation of value and wealth.”

Knoespel will present an invited talk titled “Newton’s alchemical work and the creation of economic value” at 9 a.m. Pacific time Sept. 11 at the American Chemical Society’s 232nd national meeting in San Francisco. The talk is part of a session dedicated to scholarship based on the unpublished manuscripts of Newton, most of which are housed at the University of Cambridge and in the Edelstein Center at Hebrew University in Jerusalem. For the past 15 years, Knoespel has studied both collections — some portions of which weren’t available to scholars until the 1970s.

By integrating the study of these manuscripts, Knoespel determined that Newton’s alchemical practice “functions as a translation code for a new language of economics in which an investigation of material-spiritual value becomes transformed into a systematic structure of social value understood through economics.”

Newton began to translate his notions of value in alchemy to an economic setting when he was appointed to head England’s mint ““ several years after the 1687 publication of “The Principia,” in which Newton described universal gravitation and the three laws of motion, laying the groundwork for classical mechanics.

“Newton moves from an academic research position to a position of considerable visibility within the state,” Knoespel noted. “He became the symbol of the stability of the British economy at this time. It is hardly an exaggeration to think of such a move as involving a shift from private research to the broad application of policy formed by decades of private research.”

Newton took the new job very seriously, undertaking new research on the history of money and combining it with his work in mathematics, alchemy and metallurgy. He improved the edging of coins, much like U.S. coins are formed today, to prevent people from clipping the edges. Newton also assayed the coins of Europe to determine the amount of gold and silver they contained to help establish England’s economic basis.

As the economic system of capitalism began to be institutionalized in Europe in the decades following Newton, many “thought that capital, or value, within capitalism was being mystified in the same way that gold is within its alchemical transformation,” Knoespel said.

Furthermore, Knoespel asserted, “I believe that Newton thought by improving the English economic system, he was going to contribute to the ongoing transformation of England into God’s kingdom on Earth. A Newtonian approach to matter carries with it a Messianic force that finally grounds itself in natural philosophy that includes an interpretation of human and natural history.

“Newton never makes economic value the sole force that determines history. Instead, the practice of economics is at least twofold, involving both the practice of a monetary system and a conceptual framework that sees within an economic system, the workings of God in time,” he added.

Connecting the published work of Newton the mathematician and the physicist with the unpublished work of Newton the alchemist, historian and religious philosopher provides broader insight into his legacy, Knoespel said.

“The history of science has often separated Newton the complex mathematician from the Newton of the Newtonians,” he explained. “The purists say: ‘Newton is a mathematician and a physicist. Don’t mix him up with religion or alchemy because you’ll turn him into Harry Potter.'”

But it is this purist belief that for 200 years suppressed Newton’s unpublished work in alchemy until the mid-20th century, Knoespel said. “I’m certainly not interested in making Newton into an occult figure,” he added. “Newton was profoundly interested in the relationship between physics and religion. That he was, but that doesn’t turn him into a magician.”

On the Web:

Georgia Tech

The Center for Colorectal Health Removes the Need for Hemorrhoid Surgery With a Unique and Painless Procedure Performed in Less Than a Minute

LOS ANGELES, Sept. 6 /PRNewswire/ — Hemorrhoids can mask symptoms of colorectal cancer, the second leading cause of cancer death in the United States, and until now, painful surgery was frequently recommended to treat hemorrhoids. At The Center for Colorectal Health, the goal is to provide focused medical care for the treatment of hemorrhoids, anal fissures and the early detection of colorectal cancer. The treatment protocol is clinically proven utilizing the proprietary and patented CRH-O’Regan Disposable Hemorrhoid Banding System, which is safe and painless.

The CRH-O’Regan Disposable Hemorrhoid Banding System is only available in the United States through the Center for Colorectal Health. This highly effective (99.9%), minimally invasive procedure is performed in the office and only takes 30 to 60 seconds. This method offers a significant advance in the rubber band ligation technique for effective outpatient treatment of hemorrhoids. Unlike other techniques that use a metal clamp to grasp the hemorrhoid during banding, the CRH-O’Regan procedure uses a smaller and gentler suction device to minimize discomfort and complications.

“This method is faster, more accurate and has virtually no downtime for patients,” said Dr. Houshang Hakhamimi, medical director of the Los Angeles center. “I am delighted to have the opportunity to perform a procedure that provides the patient with the finest pain-free care.”

While other methods rely on re-usuable instrumentation, the patented CRH-O’Regan instruments are 100% disposable and single use. This eliminates the risk of transferring infectious diseases such as HIV and hepatitis B and C from patient to patient due to inadequately sterilized instrumentation. The CRH-O’ Regan Disposable Hemorrhoid Banding System in the only treatment that requires no pre-or post pain medication, virtually no recovery time and is covered by insurance.

The Center for Colorectal Health, the only healthcare provider in the U.S. offering the CRH-O’Regan Disposable Hemorrhoid Banding System, recently opened a new center in Atlanta, Georgia. The Atlanta location increases the number of center locations to four, joining Chicago, and the recently opened centers in Los Angeles and San Francisco. New centers are expected in Las Vegas and other major cities around the country in the near future. Every center is directed by a board-certified surgeon with extensive colorectal experience.

In addition to the center expansion, the company has launched a consumer Web site (http://www.crhcenter.com/) that provides easy-to-understand, in-depth information about hemorrhoids, anal fissures, and colon cancer screening. There is information about the condition, symptoms and treatment methods used by each of the national center locations and the site enables users to schedule a consultation, visit a message board to talk to other patients, and locate the center closest to their zip code.

About The Center for Colorectal Health

At The Center for Colorectal Health, our mission is to provide focused medical care for the treatment of hemorrhoids, anal fissures and the early detection of colorectal cancer. Every center is directed by a board-certified surgeon with several years of colorectal experience, and our philosophy is simple: we treat only one area of the body and this allows us to do it better than anyone. For further information visit http://www.crhcenter.com/

   Contact:  Rachel Martin             Edelman             (323) 202-1031             [email protected]  

The Center for Colorectal Health

CONTACT: Rachel Martin of Edelman, +1-323-202-1031,[email protected], for The Center for Colorectal Health

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

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

Leftist murders spark fear in Philippines

By Carmel Crimmins

CABANATUAN CITY, Philippines (Reuters) – James Ayunga
thinks of death whenever a motorcycle roars past.

“I get goosebumps when I hear one come up behind me,” said
the farmers’ activist and father of three.

Across the Philippines, masked gunmen on motorcycles have
killed scores of left-wing community leaders and Ayunga fears
he could be next.

The 40-year-old, like other leftist organizers, believes
the government is behind the murders.

He has not returned to his village in Nueva Ecija, an
agricultural province around 55 miles north of Manila, since
soldiers accused him of membership of a communist rebel group,
the New People’s Army (NPA), two months ago.

“I’m on the move, anywhere and everywhere. I stay in a
different place every night,” said Ayunga, nervously thumbing a
newspaper in a safe house in Cabanatuan City, the business hub
of Nueva Ecija.

He denied any link with the communist movement, saying his
work was about winning more rights for subsistence farmers.

The Philippines, also fighting Muslim insurgencies, has
been battling the NPA since 1969 in a conflict that has killed
more than 40,000 people.

In June, President Gloria Macapagal Arroyo, who is also
commander-in-chief of the armed forces, declared “all-out war”
on the communist insurgents.

Since then, leftist activists and community leaders have
been shot dead on a weekly, and sometimes daily, basis.

Arroyo denies soldiers or police are behind the murders
despite many of the victims being members of organizations the
military views as fronts for the NPA.

Previously, the government blamed the rebels and their
political wing, the Communist Party of the Philippines, for the
recent surge in killings, saying the movement was purging its
ranks as it did to chilling effect in the 1980s.

But under pressure from rights group Amnesty International,
which this month decried “politically targeted extrajudicial
executions,” Arroyo created a commission, headed by a former
Supreme Court justice, to investigate the murders.

ASSASSINATIONS

In a damning report, Amnesty estimated at least 51
political and community activists were killed in the first half
of 2006, nearing the 66 killed during all of 2005. The group
said it was concerned the military and police were involved.

A day after the Amnesty statement, another community worker
was shot dead in his home.

Despite negative press, Arroyo, who escaped impeachment in
2005 over corruption and election fraud allegations, is not
seen as politically threatened by the killings.

The idea that the NPA is behind the murders is not entirely
discounted by the public after the organization tortured and
executed thousands of its own members in the late 1980s as part
of a clearing out of suspected informants and traitors.

Some people also feel many activists are linked to the NPA
and fear they are winning positive publicity from the murders.

But analysts say the killings could encourage mainstream
leftists to join the NPA and lead to an escalation in violence.

“I think the bulk of these killings are illicit government
assassinations. The question is: How far up does it go and who
is authorizing them?” said Kit Collier, a visiting fellow at
Australian National University.

“It will definitely raise the incentive for legal left-wing
activists to take up arms.”

The NPA was at its most powerful in the 1980s, aided by the
dictatorship of Ferdinand Marcos. In 1987, a year after he was
overthrown, it was thought to have as many as 25,000 fighters.

Currently, the guerrilla army, which extorts money from
farmers and business people, is believed to have around 7,000
members. Fueled by entrenched poverty, corruption and a sense
of injustice, it is active in 69 of 79 provinces.

Peace talks stalled in August 2004 after Manila refused to
persuade the United States and some European governments to
remove the NPA from their terror blacklists. Negotiations are
unlikely to be revived in the current climate.

THE BUTCHER

In Lupao, a small northern town still scarred by a military
massacre nearly 20 years ago, General Jovito Palparan, head of
the 7th infantry division, is launching a charm offensive.

Armed with a Power Point presentation and plenty of
wisecracks, the man left-wing groups refer to as “The Butcher,”
explains to hundreds of residents in a packed town hall how his
soldiers will clear Lupao of NPA supporters.

The screen behind him reads: “Neutralisation of Political
Personalities.”

Accused by local human rights groups of giving his men a
free hand to kill community leaders, Palparan, 55, denies the
charge. But he says the victims are targeted because of their
“offensive” activities.

In Lupao, where the army shot dead 17 unarmed civilians in
a botched encounter with the NPA in 1987, people are reluctant
to talk about the military or the guerrillas.

There are media reports of security forces harassing locals
in the province for identification and enforcing curfews but
Palparan, a jovial man who keeps a photo on his cellphone of
his dog wearing a bow-tie, says the stories are exaggerated.

Feted by Arroyo for his campaign against the communists,
Palparan is worried international pressure to stop the activist
killings will cool the government’s anti-NPA ardor before his
retirement next month.

Some activists have said they will feel safer when the
general leaves active service. But Ayunga is not so confident.

“I don’t think things will get better,” he said. “It’s not
just Palparan, it’s a national policy.”

(Additional reporting by Joseph Agcaoili)

Protective breathing reflex absent in newborns

NEW YORK (Reuters Health) – Research suggests that healthy
newborn infants do not have what doctors call “nasoaxillary
reflex” — a protective reflex that helps keep their nasal
passages open.

In adults lying on their side, the nasoaxillary reflex
ensures that the uppermost nasal airway is open, Dr.
Christopher O’Callaghan of the University of Leicester, UK, and
colleagues explain in the journal Archives of Diseases of
Childhood.

The researchers used acoustic rhinometry, a technique that
measures nasal patency, to see whether the nasoaxillary reflex
is present in 11 healthy term newborns.

Acoustic rhinometry emits wide band noise into the nose and
analyzes the reflected sound in order to measure cross
sectional area/distance mapping of the nasal cavity. The
measurements were made while the infants were lying on their
back (the supine position) and on their side (the lateral
position).

The investigators were unable to show a protective
nasoaxillary reflex in the infants.

When the newborns were turned from a back position to a
side position, the team observed a significant decrease in the
total minimum cross sectional area of the nasal cavity. This
was associated with a decrease in the total nasal volume.

“The finding that the total minimal cross sectional area
decreases when infants move from a supine to a lateral (side)
sleeping position is of interest,” O’Callaghan’s team contends.

“As newborns tend to be obligate nose breathers, a decrease
in the minimal cross sectional area of the nasal cavity is
likely to be linked to an increase in nasal resistance and in
the work of breathing.”

They note that the side sleeping position has been
associated in one study with a slightly greater risk of SIDS
than in the back sleeping position, and that the back sleeping
position “has unequivocally been recommended as being preferred
to any other position to prevent SIDS.”

SOURCE: Archives of Diseases in Childhood September 2006.

Ill Effects of West Nile Infection May Linger

NEW YORK (Reuters Health) – More than a year after being diagnosed with a West Nile virus infection, nearly half of the patients have ongoing health issues including fatigue, memory problems, headache, depression and tremor, a new study shows.

The study also warns that patients diagnosed with West Nile fever, which has generally been thought to be a relatively benign, self-limited condition, are just as likely to have lingering health issues as patients who develop more severe West Nile virus-related illnesses such as encephalitis or meningitis.

“I hope this study will raise awareness that West Nile virus poses a substantial public health threat,” Dr. Paul J. Carson, of MeritCare Health System in Fargo, North Dakota, who led the research effort, said in a statement from the Infectious Disease Society of America. Carson’s research is published in the IDSA journal Clinical Infectious Diseases.

“We knew before that West Nile encephalitis was a serious health threat, but we didn’t appreciate how much ongoing morbidity there is for West Nile fever, which is much more common,” he said.

West Nile virus is spread to humans by infected mosquitoes. The virus first surfaced in the United States in 1999. In 2003, there were more than 9,000 human cases of West Nile virus-related disease, including 264 deaths.

Most people infected with West Nile virus have no symptoms. However, roughly 20 percent will develop a flu-like illness called West Nile fever. Up to 1 percent may develop more severe diseases such as meningitis or encephalitis.

Carson and colleagues assessed the health of 38 patients with West Nile fever and 11 with West Nile meningitis or encephalitis roughly 13 months after being diagnosed.

“Self-reported fatigue, memory problems, extremity weakness, word-finding difficulty, and headache were common complaints,” according to the team. Further investigation revealed an overall sense of poor physical health and fatigue in 24 patients (49 percent), depression in 12 (24 percent), and moderate-to-severe disability in 4 (8 percent).

New tremor was seen or reported in 10 patients (20 percent); neurological and psychological testing revealed abnormalities of motor skills, attention and executive functions.

It’s noteworthy, according to the team, that patients with milder West Nile illness were just as likely as those with more severe West Nile illness to experience these health problems.

Carson hopes these results “may give greater impetus to increase resources for prevention — vector control and vaccine — and treatment development.”

SOURCE: Clinical Infectious Diseases September 15, 2006.

Albert Einstein Healthcare Network Launches BidShift(R) Flexible Workforce Management Technology; Internet-Based Open Shift Management Ensures Effective Staffing

San Diego-based BidShift, the leading provider of web-based flexible workforce management technology for healthcare providers, has implemented its program at the Albert Einstein Healthcare Network, Philadelphia, PA, to provide an automated approach for filling open shifts, empowering employees, and supporting effective staffing practices. Albert Einstein Healthcare Network, including Albert Einstein Medical Center, MossRehab, Einstein at Elkins Park, Germantown Community Health Services, and Center One, is the eleventh provider organization in the Philadelphia area to utilize BidShift’s technology and services to optimize the operational and financial management of their workforce and achieve effective staffing.

BidShift’s innovative program and web-based solution provides convenience and flexibility to both nursing and nursing support personnel for filling open shifts, transforming what traditionally has been a time and labor-intensive manual process, as well as reducing reliance on expensive contract labor. Staff use the technology to log on from work or home, 24 hours a day, seven days a week, to view and request to work open shifts beyond their base schedule and their own unit when qualified to do so.

“Incorporating BidShift’s program helps us centralize and better manage open shift scheduling so that we can effectively staff to meet the healthcare needs of the community,” said Mary Beth Kingston, chief nurse executive, Albert Einstein Healthcare Network. “BidShift is a beneficial program that we have implemented for operational efficiency and nurse satisfaction.”

Albert Einstein Healthcare Network implemented BidShift as a means to automate tracking of per diem utilization, give staff more choice and flexibility over the shifts they work, decrease manager involvement and time in the scheduling process, and provide cross-unit and cross-facility standardization. In the first weeks of implementation, over 1,300 nurses have signed up to take part in the cutting-edge program, and over 6,000 shifts have been filled. Nearly 20% of shifts filled were for requests to work outside of the home unit.

“Albert Einstein Healthcare Network joins a growing group of leading healthcare organizations that have chosen BidShift’s flexible workforce management solutions to ensure effective staffing while lowering operating costs,” stated Bruce Springer, President and CEO of BidShift, Inc. “We are pleased they value our deep operational experience and proven technological offering for revolutionizing open shift management.”

BidShift is currently used in roughly 100 hospitals across 20 states and the District of Columbia.

About Einstein Healthcare Network

Albert Einstein Healthcare Network is a private, not-for-profit organization with six major facilities and many outpatient centers. Einstein is a member of the Jefferson Health System, which includes Thomas Jefferson University Hospital, Main Line Health System, Frankford Health Care System and Magee Rehabilitation Hospital.

About BidShift

BidShift is a flexible workforce management company providing healthcare organizations with the technology, strategy, and insight needed to develop effective staffing practices for the next generation healthcare workforce environment. By aligning incentives and dynamically matching the organization’s needs with workforce availability, BidShift positions organizations to retain and attract qualified staff, deliver high quality, cost-effective health care, and cultivate a world-class workforce/working environment. To learn more, visit www.BidShift.com.

Irwin Pulled Stingray Barb from Chest Before Death

By Michael Perry

SYDNEY — Fatally injured by a stingray, Australian “Crocodile Hunter” Steve Irwin pulled its serrated barb out of his chest before losing consciousness and dying, the world-famous naturalist’s manager said on Tuesday.

Video footage of the attack shows Irwin swimming above the stingray on the Great Barrier Reef on Monday when it lashed out and speared him in the heart with its barbed tail, manager John Stainton told reporters.

“It shows that Steve came over the top of the ray and the tail came up, and spiked him here (in the chest),” Stainton said after watching the footage.

“He pulled it out and the next minute he’s gone. The cameraman had to shut down,” he said.

“It’s a very hard thing to watch because you’re actually witnessing somebody die … it’s terrible.”

Irwin, 44, the quirky naturalist who won worldwide acclaim as TV’s khaki-clad “Crocodile Hunter,” was filming a new documentary off Australia’s northeastern coast when he was attacked.

Marine experts say stingrays can deliver horrific, agonizing injuries from the toxin-laden barbs, which can measure up to 20 cm (8 in) in length and cause injuries like a knife or bayonet.

“The strongly serrated barb is capable of tearing and rendering flesh,” said Dr Bryan Fry, deputy director of the Australian Venom Research Unit.

“It’s not the going in that causes the damage, it’s the coming out where those deep serrations kind of pull on the flesh, and you end up with a very jagged tear which is quite a pronounced injury,” Fry said.

News of Irwin’s death shocked Australians and Irwin’s millions of fans around the world. Prime Minister John Howard interrupted parliament on Tuesday to pay tribute.

“He was a genuine, one-off, remarkable Australian individual and I am distressed at his death,” Howard told parliament.

“We mourn his loss, we’re devastated by the tragic circumstances in which he has been taken from us and we send our love and prayers to his grieving family,” he said.

“CRIKEY”

Environmental documentary maker Ben Cropp said video of the attack showed Irwin swimming alongside a bull stingray, probably weighing around 100 kg (220 lb). His cameraman was filming in front of the ray, which became frightened and lashed out.

Stingrays are usually placid and only attack in self-defense.

Stainton said the cameraman only became aware of the attack when he noticed Irwin bleeding.

Millions had seen Irwin flirt with death many times as he stalked and played with crocodiles, sharks, snakes and spiders. Stainton said he was struggling to come to terms with the fact that a stingray had killed his friend.

“There’s been a million occasions where both of us held our breath and thought we were lucky to get out of that one,” Stainton said. “But he just seemed to have a charmed life.”

Police said they had examined the footage and would prepare a report for the coroner appointed to determine the cause of death.

Film star Russell Crowe called Irwin the “ultimate wildlife warrior,” adding: “He was the Australian we all aspire to be. He touched my heart. I believed in him. I’ll miss him.”

Known for his catchphrase “Crikey” during close encounters with animals, Irwin made almost 50 documentaries which appeared on the cable TV channel Animal Planet.

U.S.-based television company Discovery Communications, which produces Animal Planet, said it would set up a conservation fund in honor of Irwin, dubbed in one tribute a “modern-day Noah,” and planned a marathon showing of his programs.

Discovery said the footage of Irwin’s fatal dive might never be broadcast.

Australian newspapers paid tribute to Irwin on Tuesday, while fans including American tourists laid wreaths outside his Australia Zoo in tropical Queensland state.

“We thought he was Superman, that he was indestructible,” said an editorial in Sydney’s The Daily Telegraph.

“We were wrong”

(Additional reporting by Paul Tait in SYDNEY)

Otis Redding’s widow protects soul man’s legacy

By Tamara Conniff

MACON, Georgia (Billboard) – You can taste the air in
Macon, Ga. — a mix of fresh-cut grass, humidity and barbecue.

On a recent hot summer afternoon, Zelma Redding was keeping
busy at Dreams, a boutique she and her daughter Karla operate
just off Macon’s main drag. The mother-daughter team also owns
Karla’s Shoes, one block away.

“I gotta do something,” Zelma says, shaking her head. “I’m
sure as hell not just gonna sit on my ass.”

Zelma is Otis Redding’s widow. In 2007, it will be 40 years
since the world lost this man of pure soul and his band in a
tragic plane crash.

Otis left behind a legacy of recordings mostly made during
a four-year period — from his first sessions for Stax/Volt
Records in 1963 until his death in 1967. As a songwriter,
Redding penned such timeless songs as “I’ve Been Loving You Too
Long,” “Respect,” “Mr. Pitiful” and the posthumous hit
“(Sittin’ On) The Dock of the Bay.”

He also left behind a woman who loved him and three young
children — Karla, Dexter and Otis III — who needed him.

It must feel like a strange, cruel dream for Zelma. She
found the love of her life, only to lose him and live with his
ghost. When turning on the radio, she never knows if she’s
going to hear his voice — singing a song he wrote for her.

But Zelma doesn’t want to get lost in that kind of
emotional maze. She’s not the type of person to wallow or feel
sorry for herself. She has to focus on what is concrete. She
owns Otis’ publishing, and she runs it like a military
sergeant. It’s her way to keep him alive. She says, over the
years, people have tried to cheat her out of the publishing,
buy it from her or just generally swindle her.

She will have none of it. If she hears one of Otis’ songs
sampled in a hip-hop tune and knows she didn’t give clearance,
she’ll call the artist herself and say, “Where the hell is our
money? That’s my husband’s work. You can’t steal it.”

Zelma lives at the Big O ranch (Otis had a commanding
stature and his nickname was Big O). He bought the sprawling
house and property, just outside Macon, for his family as soon
as he had enough money. Tourists and music fans come from all
over the world just to look at the gate: big, white and
electric with the Big O moniker. Behind the tightly locked
iron, down the long driveway, is Otis’ grave. He wanted to be
put to rest at home.

Karla walks into the house’s living room. She says it
doesn’t look much different than when her dad was there. This
was the room where he played with the kids, where he was a
family man.

When she thinks no one is watching, Zelma gently wipes a
spec of dust off an old photograph of her and Otis. Karla says
to me, “They loved each other desperately.” And they stuck
together through the bad stuff, too — his touring, his
cheating, the heartache. He always came back to Zelma. “His
heart was in this house and with us,” Karla adds. She is
currently working on the first official biography of Otis and
the love story of her mom and dad.

Otis was a renaissance man — a songwriter, recording
artist, performer, businessman and music publisher. He believed
music could be a universal force, bringing together different
races and cultures. Otis had a white manager, Phil Walden, and
a racially mixed band — unprecedented moves for a black artist
in the ’60s. With no intention, Otis became a role model for
generations to come.

Zelma was never a big fan of flying, even though Otis loved
it. He once had to literally drag her on a plane, Zelma
recalls. He said, “Zelma, stop being afraid. We’ll die when
it’s time for us to die. But it’s not going to be in this plane
today.”

Reuters/Billboard

California Sees ‘Greenrush’ in Global Warming Move

By Mary Milliken

LOS ANGELES — In a land where fortunes were spun from gold, films and silicon chips, California’s leaders envisage a “greenrush” with their groundbreaking law to fight global warming.

California’s legislature approved the Global Warming Solutions Act of 2006 on Thursday that will make the state the first to cap greenhouse gas emissions, despite opposition from industry and energy groups that call it “a job killer.”

But Republican Gov. Arnold Schwarzenegger, who gets high marks from environmentalists, backed the bill on Wednesday, saying it “strengthens our economy, cleans our environment.”

He and other bill supporters believe business can make more money by switching to energy-efficient systems and developing clean technologies. New jobs will sprout from a burgeoning service industry to cater to companies’ green demands.

They look at behemoths like General Electric Co., which unabashedly admits to investing in environmentally friendly operations because it sees lots of green, as in cash.

Schwarzenegger has been at odds over climate change with President George W. Bush, who pulled the United States out of the 160-nation Kyoto Protocol in 2001 because he maintained its mandatory caps would be harmful for the economy. He also balked that developing countries like China were wrongly excluded.

In July, the governor upstaged Bush by signing an accord with British Prime Minister Tony Blair for joint research on climate action.

The bill to be signed by Schwarzenegger states that, by taking a global leadership role, California can position its economy, technology centers, banking and businesses “to benefit from national and international efforts.”

JOBS AND MONEY

“This is confirmation of a state that knows an economic opportunity when it sees it,” said Fred Krupp, president of advocacy group Environmental Defense.

California, the world’s eighth largest economy and 12th largest producer of greenhouse gases, aims to reduce its emissions to 1990 levels by 2020, a cut of 25 percent.

Two weeks ago, the University of California, Berkeley, published a study that California’s global warming action will add $60 billion to the $1.5 trillion economy and 17,000 jobs annually.

But if the state also offers innovation incentives to business, the boost to the economy will be $74 billion and 89,000 new jobs annually, the study said.

State officials note that California has already proved itself a world leader on reducing carbon dioxide and other heat-trapping gases with its benchmark law to reduce auto emissions and renewable energy policies.

They see a gold mine of opportunity in developing giants China and India rather than a threat to their economy.

“We will be talking to China because they are asking for our help … on public participation and regulation to deal with pollution,” California Environmental Secretary Linda Adams told Reuters.

“Somebody has to be in the lead and generally it is California,” she added.

Singapore military juggles ties with Taiwan, China

By Fayen Wong

KAOHSIUNG, Taiwan (Reuters) – A dark-green army truck zips
through the hilly countryside in southern Taiwan before
disappearing behind the high walls of an unmarked military base
— the largest of Singapore’s three army camps in Taiwan.

For nearly 30 years, the island state of Singapore, which
lacks the space for large-scale military maneuvers, has trained
its troops in Taiwan under the code name Operation Starlight.

But Singapore has begun scaling back its military presence
in Taiwan in recent years as it sought to warm relations with
China, which regards Taiwan as a renegade province.

“In recent years, Singapore’s close military links with
Taiwan have occasionally been an irritant in the city-state’s
relationship with China,” Tim Huxley, a defense expert who has
written books on Singapore’s military, told Reuters.

The city-state has over the past decade quietly built
defense links with other countries to train its troops
including Australia, New Zealand, Brunei and Thailand.

It also sends air force contingents to the United States
and France following arms purchases and hopes to soon formalize
an agreement with India to train its troops there.

Singapore began Operation Starlight in 1975 when Taiwan,
eager to cultivate ties abroad after it lost its United Nations
seat to China, offered Singapore military training bases.

It was a welcome offer. Singapore faced communist threats
from Malaysia and Indonesia and was keen to build up its
fledgling army. But it lacked the space on an island so small a
fighter jet can fly over it in less than two minutes.

Analysts estimate that by the mid-eighties, at the peak of
the operation, Singapore sent about 15,000 conscripts a year to
Taiwan for large-scale war games.

But the training camps became a sensitive issue over the
past decade as Singapore, which is 75 percent ethnic Chinese,
sought to forge warm ties with China, where Singaporean
government companies are investing billions of dollars.

Despite its military cooperation with Taiwan, Singapore
staunchly supports the “one-China” policy, opposes Taiwanese
independence and does not have diplomatic ties with Taiwan.

CHINA OFFERS TRAINING BASES

It’s a diplomatic juggling act that could result in
Singapore finding itself in an uncomfortable position if
cross-strait relations flare up and it is forced to take sides.

“Singapore is aligned with the U.S. and it also has strong
ties with China. But if there was a war between China and
Taiwan, Singapore could be unwillingly dragged in,” Huxley
said.

Taiwan is Singapore’s eighth-largest partner, while China
comes in third after the U.S. and Malaysia.

The Singapore Ministry of Defense declined all comment on
issues related to Taiwan.

While China has in the past turned a blind eye to
Singapore’s close economic and military ties with Taiwan, it
has been less tolerant of any dealings with Taipei since the
self-ruled island’s leaders started a pro-independence
movement.

London-based Jane’s Defense Weekly reported in 2001 that
Beijing had offered Singapore the use of Hainan island as an
alternative training site to Taiwan. The offer was the first by
China to a foreign country and appeared to be an attempt to
discourage Singapore’s military ties with Taiwan.

“We have never discussed this,” Singapore Defense Minister
Teo Chee Hean said in June after being asked about the offer.

While Singapore has tried to cut back its dependence on
Taiwan, the government had done so carefully, citing reduced
training needs rather than any desire to pacify China, Huxley
said, trying at the same time to avoid offending Beijing.

“As we build new military relationships with countries like
India, it will get more difficult for us to not look like we’re
snubbing China,” said Bernard Loo, a defense analyst at
Singapore’s Institute of Defense and Strategic Studies.

CLANDESTINE OPERATION

Singapore’s operations in Taiwan remain shrouded in
secrecy. While in Taiwan, Singaporean troops wear Taiwanese
army uniforms distinguishable only by a separate insignia.
Several former Singapore soldiers have confirmed this practice,
Huxley writes.

And defense analysts estimate the number of troops sent to
Taiwan for training has been slashed by half to about 7,000
annually. The bulk of Singapore’s army now goes to Australia,
where up to 6,600 soldiers train early year at Shoalwater Bay
in Queensland.

That shift has hurt local business.

“The town used to be teeming with Singaporean soldiers
about twenty years ago. Business was brisk at many of these
eateries and karaoke bars,” Xu Xiu-feng, 42, a restaurant owner
said. “But now this is just a sleepy town,” she added.