Iraq’s US envoy wants to see cousin’s death report

By Deepa Babington

HOUSTON (Reuters) – Iraq’s U.S. ambassador said on
Wednesday he was still waiting to hear from the U.S. military
on the shooting death of his cousin last year that he once
described as “coldblooded murder” by U.S. troops.

Two months after asking for a copy, Samir Sumaidaie said he
had yet to receive access to a U.S. military report that
absolved its troops of all blame in the incident.

His frustration comes as the military investigates other
incidents involving civilian deaths at the hands of American
troops. Many Iraqis complain that unjustified killings of
civilians by American troops are common, although few have been
confirmed officially by investigations.

“In this particular case, all I’m asking for is a copy of
the report. I’m still waiting,” Sumaidaie told Reuters in an
interview at a U.S-Arab economic forum in Houston.

“They have written to me and said it will take time. Now,
two months seems to me is more than enough time to deliver a
report.”

Sumaidaie said he believed the U.S. military’s conclusion
it was not at fault was wrong, but found it hard to dispute
that properly until he saw the report.

“That is inconsistent with what I know happened to my
family,” Sumaidaie said. “I’m very disappointed to learn that
the investigation did not show any wrongdoing.”

The envoy has said his cousin, Mohammed Sumaidaie, 21, was
killed last June while showing Marines conducting
house-to-house searches an old rifle without live ammunition.
When the Marines left, the young man was found in the bedroom
with a bullet in his neck, the ambassador said at the time.

“All indications point to a killing of an unarmed innocent
civilian — a coldblooded murder,” Sumaidaie said last year.

During the probe, the U.S. military interviewed family
members but did not take up an offer to let forensic experts
exhume and inspect the body, Sumaidaie said on Wednesday.

Still, he believes killings of Iraqi civilians by U.S.
troops are an aberration, but that probes into such incidents
should be conducted as a joint effort with some “independent
element” in it, rather than by troops alone.

“Clearly members of the same platoon who have gone through
life-and-death struggles, they bond, and it’s a human
inclination to protect each other,” he said.

(Additional reporting by Manuela Badawy and Matt Daily)

Nicotine metabolizes faster in women than in men

NEW YORK (Reuters Health) – Women metabolize nicotine
faster than men do — especially women who are taking oral
contraceptives — according to a new report. The researchers
say this could affect women’s smoking behavior, as well as
their response to nicotine-based quitting aids.

Dr. Neal L. Benowitz from University of California, San
Francisco, and colleagues, compared nicotine metabolism in 88
men and 206 women, and compared the 53 women who used oral
contraceptives with the 153 who did not. For the investigation,
the subjects received an infusion of nicotine that was
“labeled” so it could be traced as it passed through the body,
which was followed by frequent blood sampling. The findings are
reported in the journal Clinical Pharmacology and Therapeutics

The rate of nicotine passage through the body was
significantly higher for women (18.8 mL/min/kg) than for men
(15.6 mL/min/kg), the investigators found. The rate was also
higher in women who were using oral contraceptives (22.5
mL/min/kg), compared with those who were not (17.6 mL/min/kg.)

By the same token, nicotine persisted in the body longer in
men (132 minutes) than in women not taking oral contraceptives
(118 minutes) and in women who were taking oral birth control
(96 minutes), the researchers note.

There seems to be a spectrum of nicotine metabolism time
that varies by level of female sex hormones, with metabolism
times progressing from slower in men, to intermediate in women
not on oral contraceptives, to faster in women taking oral
contraceptives, Benowitz and colleagues observed.

“Further research is needed to examine the question of
whether oral contraceptive use influences either smoking
behavior or intake of tobacco smoke from cigarettes (or both)
among women,” the team points out.

Because some studies have shown that the “success rates
with nicotine replacement therapies are lower in women than
men,” the researchers suggest that future studies should try to
identify the optimal dose of nicotine these products should
contain for women users.

SOURCE: Clinical Pharmacology and Therapeutics, May 2006.

Traditional therapy combo good for migraines

NEW YORK — A product that combines extracts of Tanacetum parthenium, commonly known as feverfew, with Salix alba, also called white willow, appears to be effective in reducing the frequency, severity and duration of migraine attacks, according to the results of a small study reported by a research team based in France.

The herbal combination goes by the commercial name of Mig-RL and is marketed by Naturveda-VitroBio Research Institute, the French company that sponsored the study. Recent reports have suggested that these products affect some of the same cell targets as conventional medications do.

In the study, reported in the Journal Clinical Drug Investigation, Dr. R. Shrivastava, from Issoire, and colleagues enrolled 12 patients with migraine who were treated with Mig-RL for 12 weeks. Two Mig-RL capsules were given twice daily. Two patients dropped out of the study – one had almost continuous headache and was referred for neurologic evaluation, the other refused to comply with the study protocol.

Migraine frequency was reduced by 57.2 percent at 6 weeks and by 61.7 percent at 12 weeks in 9 of 10 patients. Seventy percent of the patients experienced a 50 percent or greater reduction in headache frequency.

Reductions in attack intensity of 38.7 and 62.6 percent were noted in 10 of 10 patients at 6 and 12 weeks, respectively. Similarly, treatment with Mig-RL led to significant reductions in attack duration.

Mig-RL therapy was also tied to improvements in quality of life and the medicine was well tolerated and not associated with any side effects.

The encouraging results suggest that a larger, placebo-controlled randomized trial of Mig-RL is warranted, the authors conclude.

SOURCE: Clinical Drug Investigation, May 2006.

Yellow or Amber-Tinted Sunglasses Best

By Megan Rauscher

NEW YORK — When picking out a pair of sunglasses this summer, it’s best to avoid blue-tinted lenses and instead to choose yellow- or amber-tinted lenses, advises an eye researcher in New York.

“Yellow- and amber-tinted sunglasses filter out blue light, reducing the amount of blue light getting to your eye,” Dr. Janet Sparrow, professor of ophthalmic science at Columbia University Medical Center in New York explained in an interview with Reuters Health.

Sparrow is researching blue light exposure from sunlight as one of the causes of age-related macular degeneration, a degenerative eye disorder that is the leading cause of blindness in the elderly.

“There are compounds that accumulate in some retinal cells with age and these compounds are light-sensitive,” Sparrow said. Blue light excites these retinal cell compounds, fueling the release of harmful free radicals.

“We see light as white, but contained in that white light are actually different colors of light, like the colors of the rainbow and the wavelengths in the blue portion of the spectrum are able to maximally excite these compounds and imitate oxidative processes that can damage retinal cells,” Sparrow further explained.

Therefore, most people, Sparrow said, regardless of age, should avoid blue-tinted sunglasses. “A blue lens actually selects out blue light, which is not good — you want to diminish the blue light. A yellow lens filters blue light, so a yellow lens would reduce blue and that’s what you want.”

Dark-tinted lenses are also a good choice in sunglasses, Sparrow said, because they decrease exposure to all colors of light.

Sparrow also reminds outdoor enthusiasts to be sure to buy UV-blocking sunglasses. “Not all sunglasses block UV light, so it’s important to buy sunglasses that have been tested for UV blocking capability and they really should block all UV light,” she said. “UV blockers have no color to them, they are just a type of glass that blocks UV light,” she explained.

Mickelson’s Winged Foot meltdown: a major choke?

By Mark Lamport-Stokes, Reuters global golf editor

LOS ANGELES (Reuters) – Phil Mickelson’s dramatic collapse
at the U.S. Open sparked wide debate over whether he choked in
his bid for a third consecutive major title or simply made a
mental error.

Two strokes clear with three holes to play at Winged Foot,
the American left-hander paid a heavy price for his wayward
driving throughout the final round.

Mickelson found only two fairways out of 14 on the day and
pushed his tee shot at the last well left on to the roof of a
hospitality tent. He then struck a tree with his second shot
before running up a double-bogey six.

His nightmare finish left him one stroke short of forcing a
playoff for his first U.S. Open title and in a three-way tie
for second place behind the triumphant Australian Geoff Ogilvy.

A proven campaigner in the heat of major battle since
making his breakthrough with victory at the 2004 Masters,
Mickelson drew comparisons after his Winged Foot meltdown with
Jean Van de Velde and Greg Norman.

Frenchman Van de Velde led the 1999 British Open by three
strokes with one hole to play before carding a triple-bogey
seven and Norman blew a six-shot lead going into the final
round of the 1996 Masters.

Van de Velde, at least, squeezed into a three-way playoff
at Carnoustie before losing out to Britain’s Paul Lawrie.

Depending on who you listen to, Mickelson either choked big
time at Winged Foot or simply paid the price for a bold
strategy.

NO BONES

NBC analyst Johnny Miller, twice a major winner, made no
bones about Mickelson’s club selection on the 18th tee where he
took out a driver instead of a four-wood.

“That’s an horrendous shot and an even worse club
selection,” Miller said.

After Mickelson failed to curve his ball around a tree with
his second shot in an attempt to reach the green, Miller added:
“You couldn’t have worse decisions than he’s had on this hole.

“You don’t have to ride down the stretch on a white
stallion. You can limp in. This is one of the worst collapses
in U.S. Open history.”

Arnold Palmer, however, could identify with Mickelson’s
aggressive game plan on the 72nd hole.

“Knowing me, I’d get a saw and cut the tree down,” said the
seven-times major champion, who was known for his swashbuckling
approach to the game.

“It’s not likely I would have laid up (short of the green
for the second shot). I’ve never done that in my life.

“I’ve been in the same position as Phil was and screwed up
as bad as he did,” Palmer added, referring to the 1961 Masters
when he led by one playing the last before gifting the title to
Gary Player with a double-bogey.

“Phil is strong and he’s young. He’ll come back very
quickly, and he’ll win. He might win sooner than you think.”

SURPRISINGLY SPECTACULAR

What made Mickelson’s Winged Foot demise so surprisingly
spectacular was that he has made a habit of preparing better
for the majors than anyone else in the game over the last two
years.

He made a dozen visits to the par-70 West Course in his
U.S. Open build-up and knew the best spots to land his ball
from tee to fairway to green.

Ice-cool strategy and calm execution under pressure marked
out his three victories in nine major starts and most people
watching the final round at Winged Foot on June 18 confidently
expected Mickelson to land another one.

Was it a major choke? Mickelson’s last-day collapse at
Winged Foot was technical rather than mental, according to his
swing coach Rick Smith.

“It wasn’t the swing that he made to win the Masters, or
the BellSouth by a million,” Smith said of Mickelson’s
consecutive victories in early April at the BellSouth Classic
and at Augusta National.

“The old swing came back a bit. It was technical, not
mental.

“Every player will always fall back into the old,” Smith
told the Los Angeles Times newspaper.

“It’s not a choke. He was struggling with his driving all
day. If you’re striping it every single time and then you hit
it 50 yards off-line, that’s a choke.

“He will come back, and he will come back with a
vengeance.”

Justices reject strict campaign finance limits

By James Vicini

WASHINGTON (Reuters) – A divided U.S. Supreme Court on
Monday struck down strict limits for money contributions and
spending for state political campaigns, dealing a setback to
advocates of campaign finance regulation.

By a 6-3 vote, the justices overturned a ruling that
largely upheld Vermont’s campaign finance law and ruled the
restrictions, the strictest in the nation, violated
constitutional free-speech rights.

The nation’s highest court said the spending limits had to
be struck down in light of its landmark 1976 ruling on a
similar federal law and the contribution limits because they
were much lower than those previously upheld.

The case was the first campaign finance law ruling for
Chief Justice John Roberts and Justice Samuel Alito,
conservatives appointed by President George W. Bush. They both
voted to strike down the law.

The court’s decision was a setback for those who sought to
reduce the influence of money in politics and to relieve
candidates from devoting so much time to raising large sums.

Justice John Paul Stevens said in dissent the authors of
the Constitution “would have been appalled by the impact of
modern fund-raising practices on the ability of elected
official to perform their public responsibilities.”

Stuart Comstock-Gay of the National Voting Rights
Institute, which defended the law, said the ruling “marks a
lost opportunity to end the arms race for campaign cash.

“Even while we watch elected officials being marched off to
jail for corrupt activities, today’s decision gives money an
even larger role in elections,” he said.

Joan Claybrook, president of the group Public Citizen, said
citizens should be able to set reasonable fundraising limits to
deter a war-chest mentality that bred corruption.

The law was adopted in 1997 and was supported by
then-Vermont Gov. Howard Dean, who is now the Democratic Party
chairman after an unsuccessful presidential campaign in 2004.

It limits spending by candidates for governor to $300,000,
for lieutenant governor to $100,000 and other statewide races
to $45,000. It also limits spending on races for the state
legislature and individual contributions to $200 or $400 in a
two-year period, depending on the race.

Writing for the majority, Justice Stephen Breyer said the
Vermont spending limits were too restrictive, violated First
Amendment free-speech rights and were substantially similar to
those struck down in the 1976 Supreme Court ruling.

He said contribution limits that are too low also can harm
the electoral process by preventing challengers from mounting
effective campaigns against incumbents.

The court refused to revisit its 1976 ruling that struck
down federal campaign-spending limits adopted after the
Watergate scandal but allowed political contributions
considerably higher than those in Vermont.

Malaysia’s converts test freedom of faith

By Sebastian Tong

KUALA LUMPUR (Reuters) – Five days after she declared
legally that she had converted from Islam to Christianity,
several officers from Malaysia’s state Islamic department
turned up at the woman’s office and arrested her.

She said they took her, then 21, to a drug rehabilitation
center for men, where a Muslim teacher counseled her on her
conversion and on one occasion, caned her back. After two
months, she found an unlocked door out of the compound and
escaped.

“What they did was wrong. They shouldn’t decide our beliefs
for us,” said the woman — who asked not to be named — of her
ordeal in 1999.

While Malaysia is one of the world’s most modern and
relaxed Muslim countries, its treatment of apostates, primarily
those who have given up the Muslim faith, has ignited a heated
debate.

Malaysia’s Federal Court could rule in the next few days on
whether Islamic courts — which have authority over the
country’s Muslims, accounting for more than 60 percent of the
population — have the sole right to judge apostates.

The ruling comes amid calls for capital punishment for
apostasy, and follows a spate of civil suits by Malaysians
seeking official recognition of their decision to leave Islam.

Half of Malaysia’s 26 million people are ethnic Malays, who
by law must be Muslim, while its Chinese and Indian minorities
include Muslims, Christians, Buddhists, Hindus and Sikhs.

Islamic law is selectively enforced by local officials in
each of Malaysia’s 13 federal states. Unmarried Muslim couples
caught in hotel rooms can be charged, while believers seen
eating in the daytime during the fasting month of Ramadan can
be fined.

Kelantan state, run by an Islamist party, has separate-sex
supermarket queues, but the national capital, Kuala Lumpur, is
more relaxed with plenty of dance clubs where men and women
mingle openly. Yet many say Malaysia’s secular status is being
eroded.

In December, Islamic authorities gave Malaysian
mountain-climber M. Moorthy a Muslim burial against the wishes
of his Hindu widow.

Officials said he had converted to Islam before his death,
despite assertions to the contrary by most of his family.

“Apostasy is not a new phenomenon but the issue has come to
the forefront because it underscores the growing Islamization
of a country that was intended to be secular,” civil activist
Haris Mohamed Ibrahim told Reuters.

Officials also destroyed a commune last July, arresting
members of the Sky Kingdom cult which preached a synthesis of
all religions and had a giant two-story teapot on its premises.
The government said the cult practiced a “deviant” form of
Islam.

BIG SIN

Malaysia’s civil courts have said they cannot recognize
conversions from Islam and refer apostates to the Islamic
courts, where sentences for various offenses range from caning
to jail.

Although such sentences are rarely carried out on
apostates, Malaysians who leave Islam can find themselves in a
legal limbo, unable to register their new religious affiliation
or to marry non-Muslims. Many keep quiet about their choice or
move abroad.

Rights activists say such barriers to conversion are at
odds with Malaysia’s status as a member of the United Nations
Human Rights Council and violate the nation’s constitutional
guarantee of freedom of worship.

Neighboring Indonesia, which has the world’s biggest Muslim
population, has no official sanctions against such converts and
recognizes civil marriages between Muslims and non-Muslims.

“Unfortunately, some people have fixed ideas about Islam
and see apostasy as a challenge to the religion,” said
Norhayati Kaprawi of the Muslim women’s group Sisters in Islam.

Some groups, including the opposition party Parti Islam
se-Malaysia (PAS), want apostasy to be punishable by death. One
government cleric said about 250,000 Malaysians had left Islam.

The Koran forbids Muslims to abandon their faith, but it
doesn’t specify the penalties, said Sohirin Solihin, professor
of Koranic studies at Malaysia’s International Islamic
University.

But traditional writings, or Hadith, associated with the
Prophet Mohammad proscribe death.

“The Koran is clear that there is no compulsion of religion
but the issue of religious freedom is different for Muslims and
non-Muslims. The Muslim understanding of this is different from
the Western one,” he said.

Earlier this year, the case of an Afghan man who faced the
death penalty after he converted to Christianity sparked an
international outcry. He was later granted asylum in Italy.

While efforts to make apostasy a crime punishable by death
in Malaysia are unlikely to succeed given the government’s
multiethnic coalition of Malay, Chinese and Indian parties,
many fear that obstacles to religious conversion will stay in
place.

The minister in the Prime Minister’s Department for
religious affairs, Abdullah Md Zin, declined to comment. His
spokesman referred questions to the government’s Department of
Islamic Development where officials declined comment.

But the department’s Web site recommends isolating and
counseling apostates and then jailing them if they fail to
repent.

“If the person remains an apostate, it is left to the
respective authorities to impose the fitting sentence that is
death,” the department said in its Malay-language “Frequently
Asked Questions” section.

(Additional reporting by Mohaini Ibrahim)

Vegetables, antioxidants may lower lymphoma risk

By Amy Norton

NEW YORK (Reuters Health) – Eating plenty of leafy greens,
broccoli and Brussels sprouts may help ward off the blood
cancer non-Hodgkin’s lymphoma, research findings suggest.

In a study of more than 800 U.S. adults with and without
non-Hodgkin’s lymphoma (NHL), researchers found that those who
ate the most vegetables had a 42 percent lower risk of the
cancer than those with the lowest intakes.

In particular, leafy greens like spinach and kale, and
cruciferous vegetables like broccoli, Brussels sprouts and
cauliflower, seemed to be protective.

Similarly, the study found, two nutrients found in green
vegetables — lutein and zeaxanthin — were related to a lower
NHL risk. The same was true of zinc, a mineral obtained through
meat, nuts and beans.

The “working hypothesis” is that the antioxidant activity
of these vegetables and nutrients explains the connection, said
study co-author Dr. James R. Cerhan of the Mayo Clinic College
of Medicine in Rochester, Minnesota.

NHL begins in the lymphatic system, a component of the
immune system that carries disease-fighting white blood cells
called lymphocytes. The cancer arises when these cells become
abnormal and begin to divide uncontrollably.

Antioxidants help protect cells from such damage by
neutralizing molecules called reactive oxygen species. These
substances are byproducts of normal body processes, as well as
environmental exposures like cigarette smoke, and in excess
they can damage body tissue and lead to disease.

The new findings, published in the American Journal of
Clinical Nutrition, suggest “yet another benefit” of eating
your vegetables, Cerhan told Reuters Health.

Vegetables and fruits are probably the best way to get
antioxidants, he said, because these foods have a host of other
nutrients that may all work together to bestow health benefits.

The study included 466 adults with NHL who were enrolled in
a national cancer registry, along with 391 cancer-free adults
who were matched to patients by age, race and sex. Both groups
answered questions about their diet and other health and
lifestyle factors.

In general, those who ate more than 20 servings of
vegetables a week had a 42 percent lower risk of NHL than those
who ate eight weekly servings or fewer. When the researchers
looked at specific nutrients, lutein and zeaxanthin stood out;
people with the highest intakes were about half as likely as
those with the lowest to develop NHL.

This makes sense, Cerhan noted, given that the major
vegetable sources of these antioxidants, including spinach,
kale and broccoli, also seemed particularly protective against
the cancer.

Zinc, a mineral important to immune function, was also
linked to a lower lymphoma risk. But Cerhan said this has not
been seen in previous studies, and more research is needed to
know what to make of it.

SOURCE: American Journal of Clinical Nutrition, June 2006.

Woman Found Guilty in Love Triangle Murder-for-Hire Case

By Traci Shurley, Fort Worth Star-Telegram, Texas

Jun. 23–FORT WORTH — A Wise County woman tried to hire a hit man to kill the wife of her former lover after an unflattering article appeared in the local newspaper, a Tarrant County jury decided Friday.

Rebecca Simpson, 44, dropped her head as the verdict finding her guilty of solicitation of capital murder was read.

The sentencing phase of the trial was expected to begin this morning. Simpson, the wife of a prominent Wise County attorney, faces up to life in prison.

In closing arguments Thursday, Tarrant County prosecutors said that jurors need look no further than two audiotapes and a videotape made by investigators to convict.

On those tapes, Simpson is not the polite, victimized woman who spent hours on the witness stand this week.

She’s a woman who always gets exactly what she wants, who was motivated, in part, to have another woman killed because of something as simple as a newspaper article, prosecutor Kim D’Avignon said.

“It’s a crazy motive,” D’Avignon said. “A normal person doesn’t think your name in the paper equals trying to have someone killed, but to Rebecca Simpson that made perfect sense. Think about what kind of person that makes sense to.”

Simpson tried to hire an undercover Department of Public Safety officer to kill Shemane Watts, the wife of her former lover, jurors decided.

The trial was in Tarrant County because Simpson had her discussions with the DPS officer in Southlake.

Her seven-woman, five-man jury began deliberating about 4:15 p.m. Thursday. After two hours, they asked District Judge Mike Thomas if they could go home for the evening.

Deliberations resumed at 9 a.m. Friday.

During Simpson’s trial, jurors heard audiotape and saw videotape of two meetings Simpson had with the undercover officer, on Oct. 26, 2004, and two days later.

On those tapes, she agreed to pay $3,000 to have Shemane Watts’ wrists slit. She told the officer that Shemane Watts and her husband, Danny Watts, had been harassing her family and that police in her city, Bridgeport, would not help.

She also wanted Danny Watts beaten up, and instructed the “hit man” to make the assault look like a drug deal gone wrong.

Danny Watts, the owner of a fitness club in Bridgeport, testified that he and Simpson began having an affair shortly after he became her personal trainer in 1999. He said the affair lasted through 2004, even after he married Shemane Watts in June 2003.

Simpson’s husband, Ross Simpson, filed for divorce a few days after her arrest.

D’Avignon and prosecutor Christy Jack told jurors that Simpson wanted Danny Watts for herself and was angered that he would choose Shemane Watts over her.

D’Avignon said that after an Oct. 13, 2004, altercation where Shemane Watts stood up to Simpson, Simpson started looking for a way to get rid of Watts.

About a week later, a front-page article about their fight printed in the Bridgeport Index fueled her anger and strengthened her resolve, the prosecutor said.

Simpson and her defense attorney painted a different picture.

Simpson testified that she began receiving threats of retaliation shortly after she accused Danny Watts of propositioning her 16-year-old daughter in late September 2004.

It was fear, she said, that drove her to ask a security guard named Kevin Cash to point her toward self-defense classes and ask him to vandalize the Wattses’ vehicles.

She said Cash came up with the idea of killing Shemane Watts and wouldn’t listen to her as she tried to back out of meetings with the supposed hit man.

After the first meeting, Cash told her she had to go through with hiring the killer or the man would become angry and harm her family, she testified. Simpson always planned to call off the hit before anyone was hurt, she said.

Ray Bass, Simpson’s attorney, characterized Cash as a wanna-be tough guy fascinated with the intrigue of a murder-for-hire plot. Bass said Cash could have been working on his own or on behalf of someone else.

Cash, in testimony last week, said he went to police when Simpson brought up murder-for-hire.

Bass urged jurors to look at all the evidence in the case, including detailed records of phone calls between Simpson and Cash. After what they had heard, jurors couldn’t help but find that Cash “induced” Simpson into committing the solicitation, Bass said.

Because of that, they had to find Simpson not guilty, he said during closing arguments.

“He set this lady up,” Bass said. “He took advantage of the turmoil that was going on in this lady’s life, and he set her up.”

Traci Shurley, 817-390-7757 [email protected]

—–

Copyright (c) 2006, Fort Worth Star-Telegram, Texas

Distributed by Knight Ridder/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.

“Fluff” flies in school lunch debate

By Scott Malone

BOSTON (Reuters) – When it comes to food, Boston is best
known for baked beans and clam chowder. But this week, state
legislators have engaged in robust debate on Marshmallow Fluff
— a locally made, sugary spread.

State Sen. Jarrett Barrios started the tempest in a lunch
box when he learned that his son’s Cambridge grammar school
cafeteria offered Fluff-and-peanut butter sandwiches daily.

In a nation where child obesity rates have more than
doubled in the past 25 years, Barrios fretted that was not a
healthy option. Monday he proposed a law that would allow
schools to serve the “Fluffernutters” only once a week.

“The key was to start a discussion of what is nutritious,”
said Colin Durrant, Barrios’ director of public policy.

Fluff aficionados defended the sweet spread, which locals
also lather on ice cream and into hot chocolate, and is made by
local company, Durkee-Mower Inc. of Lynn, Massachusetts. A
two-tablespoon serving of fluff, which is made from corn syrup,
sugar and egg whites, has about 60 calories.

State Rep. Kathi Anne Reinstein Tuesday introduced a bill
that would make the Fluffernutter the state sandwich. Barrios
signed on as a co-sponsor of that bill, saying that he liked
Fluff himself but did not want kids eating it every day for
lunch.

Don Durkee, the 80-year-old president of Durkee-Mower, said
Fluff didn’t warrant so much legislative attention.

“It should be up to the consumers and the parents to
determine what is fed to their children,” Durkee said. “There’s
probably more serious things to be concerned about.”

Respiratory Care Unit Opens in Botetourt

By Christina Rogers, The Roanoke Times, Va.

Jun. 21–The simple act of breathing can have a hefty price tag for patients dependent on round-the-clock ventilator care.

And with few assisted-living facilities in Virginia providing this type of long-term specialized care, some patients are forced to move far from their homes — and even out of state — in search of available beds.

It’s a problem that one Fincastle nursing home is trying to address.

On Monday, Brian Center Nursing Care opened a seven-bed respiratory care unit in its 60-bed facility off Old Fincastle Road in Botetourt County.

The new unit is the second of its kind in Southwest Virginia and will provide 24-hour, machine-assisted breathing for patients suffering from everything from spinal cord injuries to lung disease.

Of the 278 nursing facilities in Virginia, only eight offer this type of specialized care to adults.

“We’re adding a much-needed resource to the state,” said Thomas Clarke, president of Roanoke-based Kissito Healthcare, a nonprofit organization that manages Brian Center and 10 other nursing and rehabilitation centers across the country.

The cost of providing such specialized care can range from $350 to $400 per patient a day, Clarke said. Those high operating costs, combined with low reimbursements from Medicaid, have closed similar programs in the past — including one this month in Lynchburg.

Clarke admits it’s a niche market that not many assisted-living facilities are interested in serving.

But that’s a risk the Brian Center for Nursing Care is willing to take. The facility’s staff hopes the service will give Botetourt County’s oldest nursing home a competitive edge over other assisted-living facilities opening in the area.

The new unit should help the nursing facility diversify and extend its marketing reach throughout the state and into surrounding states, Brian Center administrator Ryan Koeniger said.

Though the Fincastle unit will most likely attract elderly patients, Clarke said, it is not unusual for younger victims of car accidents to seek ventilator care.

A ventilator, sometimes called a respirator, is a mechanical substitute for normal breathing that pumps air in and out of the patient’s lungs and airways.

The Brian Center has already admitted one patient. It has also fielded calls from hospitals in Georgia and Tennessee, both of which were looking to place patients in ventilator beds.

The shortage of ventilator nursing care has caused bottle-necking at some Roanoke-area hospitals, where some patients are forced to extend their stays while looking for available beds.

Patricia Rushmore, a director for Carilion Care Management, said she’s seen patients wait for weeks and even months for ventilator beds.

Recently, she said, the hospital had a patient whose daughter lived in Georgia. The hospital hoped to send the patient there. “But what we found in speaking with Georgia is that they are doing placements out of state also,” Rushmore said.

Ventilator care is a costly treatment requiring round-the-clock vigilance and a team of trained specialists. Mechanical ventilators cost from $15,000 to $20,000, although most assisted-living facilities lease them. And because most patients requiring this type of care are on Medicaid, the care is largely funded by the state.

The Brian Center expects to recover the entire cost of its ventilator care from Medicaid, in addition to making a slight profit. It applied for a reimbursement rate with Medicaid of $518 per patient a day, a higher rate than the anticipated cost of $350 to $400 a day.

“There is a financial purpose to the opening of the unit,” Koeniger said.

“We are trying to turn around some financial issues, but at the same time, we’re filling a really big need.”

The region’s other ventilator-care provider, the Avante Group, shut down a similar program at its nursing facility in Lynchburg on June 1, saying it had lost more than $10 million since 2002 on its respiratory therapy to Medicaid patients.

Avante Group vice president Michael Patterson said the state was paying only a fourth of the cost of providing ventilator services, an expense Patterson estimated at about $1,000 a day per patient.

“Basically, [the state] disagrees with the cost of the service,” Patterson said. The Florida-based company, which owns about 20 nursing homes, closed similar programs at Avante facilities in Harrisonburg and Waynesboro. It still operates 18 ventilator beds at its nursing home in Roanoke.

Craig Markva, a spokesman for the state medical assistance department, stands by the reimbursement rate, saying the agency was not familiar with Avante’s decision to close its ventilator care unit in Lynchburg. According to the medical assistance department, the state pays an average rate of $411 per ventilator patient per day.

“There are other facilities with similar rates which have not closed,” he said.

Still, the financial tug-of-war has also made respiratory care a scarce resource in other states.

West Virginia, for instance, offers no additional reimbursements for long-term ventilator care and therefore has no ventilator facilities.

And North Carolina has few facilities — making both states a market the Brian Center can potentially tap.

“It’s a pretty simple formula,” said Carilion Hospital Systems spokesman Eric Earnhart. “When there is adequate reimbursement to provide a service, the service seems to exist fairly well.”

—–

To see more of The Roanoke Times, or to subscribe to the newspaper, go to http://www.roanoke.com.

Copyright (c) 2006, The Roanoke Times, Va.

Distributed by Knight Ridder/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.

In MedPanel Summit, Leading Pain Experts Name Cannabinoids Among Most Promising Approaches to Treating Neuropathic Pain, Assert That Sociopolitical Climate Will Hamper Drug Approvals

CAMBRIDGE, Mass., June 21 /PRNewswire/ — Cannabinoids, chemical agents found in the marijuana plant and endogenous to the human body, are the most promising approach to treating a common type of pain, according to an elite group of pain specialists convened by MedPanel to discuss the challenges and future of treating neuropathic (nerve injury) pain. Despite widespread acknowledgement of the inadequacy of current therapies for this type of pain, the specialists view Food and Drug Administration (FDA) approval of a cannabinoid drug as a thorny process that will be hampered by politics, prejudice and a lack of education on the part of the FDA, Drug Enforcement Agency (DEA) and general public concerning the nature of cannabinoid agents. While it is difficult to estimate the number of people suffering from neuropathic pain, the condition is frequently seen in patients with diabetes, cancer, carpal tunnel syndrome, HIV, diseases of the central nervous system such as multiple sclerosis and Parkinson’s disease, and in certain post-surgical populations.

“During the summit we asked the group to respond to data pertaining to several novel drug therapies and classes of agents under study, and at the conclusion of the meeting they told us that cannabinoids’ potential for a strong analgesic affect, broad action on the central nervous system, reduced side effects and use in combination with other therapies is more exciting to them than several other investigational approaches,” said Matt Fearer, Senior Vice President, Content Development for MedPanel. “It appears, however, that an unfortunate sociopolitical climate could delay or prevent the approval of potentially valuable therapies for millions of people suffering from neuropathic pain,” he added.

To facilitate a cannabinoid drug approval process, some of the specialists recommended that manufacturers develop drug therapies that act selectively — that is, on a few specific rather than on several — cannabinoid receptors in the body. The group agreed that it would be important to involve FDA in clinical trial design, share early trial data, and engage in education with DEA and the general public to overcome the perception that cannabinoids are the same as marijuana.

The summit participants concurred that if approved for prescription use in the United States, a cannabinoid agent would likely be regulated (“scheduled”) by the DEA, as are opioids and certain anti-convulsants — two of the most commonly used types of neuropathic pain therapies.

In considering challenges to developing therapies for and treating neuropathic pain, the group frequently noted the need for more effective therapies, better animal models of pain, new diagnostic tools, and improved clinical trial design — including selection of an appropriate study population and new methods to address bias such as the placebo effect.

MedPanel, Inc., a global organization based in Cambridge, MA, offers a powerful online research platform providing clients greater strategic direction for investment decisions, product development, and marketing. By leveraging its proprietary methodology and vast network of medical experts, MedPanel is uniquely positioned to provide fast, accurate, unbiased market data and information to clients in the biotechnology, pharmaceutical, medical device, and financial industries.

MedPanel, Inc.

CONTACT: Janna Guinen for MedPanel, Inc., +1-781-834-7498,[email protected]

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

HireRight Introduces Next-Generation Drug and Health Screening Solution; Sophisticated Software Solution Facilitates Effective Management of Pre-Employment and Random Drug Testing Programs With Faster Results

HireRight, the leader in on-demand employment screening solutions, today announced its next-generation Drug and Health Screening Solution that allows employers to manage drug testing programs with the same simplicity and performance that they enjoy with HireRight’s background screening solutions. The technology base of the new solution renders the Drug and Health Screening results 50 percent faster than current drug testing options with greater quality and significantly reduced administrative complexity. In addition to providing employers with a vehicle for increased drug testing program performance, the Drug and Health Screening Solution includes features for managing random drug testing programs and draws.

Implementing drug screening programs has not traditionally been simple or straightforward. Unlike many other employment functions that have been highly automated in recent years, such as background screening, drug screening has remained a complicated manual process fraught with confusion. Drug screening has generally begun with a paper form given to an applicant who then takes it to a testing lab that may be some distance away. When the test results are finally sent to the screening provider it can be difficult to match the results with the requesting company and/or applicant, causing frequent delays and errors.

The HireRight Drug and Health Screening Solution brings a new level of automation and quality to the drug testing process by leveraging HireRight’s screening technology platform. Employers initiate tests with the push of a button from their desktop. From there, the employer can track the status of the test in real time and results are automatically posted by the lab to the employer’s secure online HireRight account. Results can be integrated with the background screening report with an average time to completion of less than one and one-half days — half the current industry average. Leveraging this model, the points of potential human error and confusion are virtually eliminated.

According to Scott Buelter, HireRight director of Occupational Health Services: “In today’s employment environment, the speed and accuracy of drug screening reports are critical to hiring the best people and protecting the workplace. The HireRight solution not only delivers greater speed and accuracy, but it also provides the functionality necessary to help employers more effectively and efficiently manage their testing programs.”

For collection, HireRight offers the industry’s broadest selection of “in-network” collection sites, with more than 10,000 collection sites across the U.S. While most drug tests today involve a 5 or 9 drug panel, often not including the newer “street drugs of choice,” HireRight lets employers customize panels from a range of 50 drugs including those currently most abused, as well as alcohol. In addition to standard urine tests, HireRight offers saliva and hair testing which are less invasive to the applicant and can pick up drug use over a longer period of time. HireRight also offers mobile and on-site collection services, often desirable for on-going random drug testing of employees. General health testing can also be performed including physical exams required for the Department of Transportation (DOT) and OSHA, and specialized health testing such as vision, audiometric, iso-kinetic, respiratory, blood pressure, and many others.

The HireRight Drug and Health Screening Solution is now available to employers throughout the U.S.

More than 40 million workers were drug tested last year in the U.S. Most employers drug test because drug users are twice as likely to experience injuries in the workplace; two and a half times more likely to be involved in accidents; have two and a half times greater absenteeism; and are 50 percent more apt to steal from their employers. Also, many companies drug test to be in accord with strict government guidelines.

HireRight will be showcasing its Drug and Health Screening Solution as well as the recently released HireRight Extended Workforce Screening Solution at next week’s Society for Human Resources Management (SHRM) Annual Conference in Washington, D.C., June 25-28. Visit HireRight in booth number 2811.

About HireRight

HireRight is a worldwide leading provider of on-demand employment screening solutions that help large organizations efficiently implement, manage and control multifaceted employment background and drug screening programs. Many of the world’s most innovative and successful companies trust HireRight because the company delivers more effective, customer-focused solutions that provide greater efficiency and faster results. HireRight is the pioneer and recognized leader in providing pre-integrated employment screening services through enterprise e-recruiting solutions from best-in-breed providers such as, Oracle/PeopleSoft, Vurv, VirtualEdge, Deploy Solutions, Taleo and PeopleAdmin. HireRight’s worldwide headquarters are located in Irvine, with offices and affiliates around the globe. For more information, visit the company’s Web site at www.hireright.com.

Southern San Andreas Fault Waiting to ‘Explode’?

By Jeremy Lovell

LONDON (Reuters) – The southern end of the San Andreas fault near Los Angeles, which has been still for more than two centuries, is under immense stress and could produce a massive earthquake at any moment, a scientist said on Wednesday.

Yuri Fialko, of the Scripps Institution of Oceanography at La Jolla, California, said that given average annual movement rates in other areas of the fault, there could be enough pent-up energy in the southern end to trigger a cataclysmic jolt of up to 10 metres (32 ft).

“The observed strain rates confirm that the southern section of the San Andreas fault may be approaching the end of the interseismic phase of the earthquake cycle,” he wrote in the science journal Nature.

A sudden lateral movement of 7 to 10 metres would be among the largest ever recorded.

According to the U.S. Geological Survey (USGS), the earthquake that destroyed San Francisco in 1906 was produced by a sudden movement of the northern end of the fault of up to 21 ft.

Fialko said there had been no recorded movement at the southern end of the fault — the 800-mile long geological meeting point of the Pacific and the North American tectonic plates — since the dawn of European settlement in the area.

He said this lack of movement for 250 years correlated with the predicted gaps between major earthquakes at the southern end of the fault of between 200 and 300 years.

Elsewhere on the fault, there were average slippage rates up to a couple of centimeters a year that prevented the build-up of explosive pressure deep underground.

When these became blocked and then suddenly broke free they produced tremors or earthquakes of varying intensity depending on the movement that had taken place before and the duration of the blockage.

USGS says the most recent major earthquakes in the northern and central zones of the San Andreas fault were in 1857 and 1906.

Fialko said there were three possible explanations for the lack of observed movement in the southern section — creepage under the surface that had no external manifestation, that it simply might not move as much as the rest or a major blockage.

“Except for the first possibility above, the continued quiescence increases the likelihood of a future event,” he wrote.

Making calculations based on a wide range of land and satellite observations, he discounted the idea of creepage and warned of impending disaster.

“Regardless of fault geometry and mechanical properties of the ambient crust, results presented in this study lend support to intermediate-term forecasts of a high probability of major earthquakes on the southern SAF system,” Fialko said.

Top-Line Findings on CX717 From the Darpa-Sponsored Shift Work Simulation Study Will Be Presented at Sleep 2006 Meeting

Cortex Pharmaceuticals, Inc. (AMEX: COR), announced that results from two studies with its lead AMPAKINE(R) drug, CX717, will be presented at the Sleep 2006 meeting in Salt Lake City, UT. Dr. Thomas Balkin, Chief, Department of Behavioral Biology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, will briefly present the top-line findings from the simulated night shift work study conducted at WRAIR and funded by the Defense Advanced Research Projects Agency (DARPA). That study assessed the effect of CX717 on cognitive performance and alertness across 4 nights of simulated night shift work and restricted daytime sleep. The primary finding from the study was that CX717 did not enhance cognitive performance relative to treatment with placebo. However, similar to the observations in the previously reported UK sleep deprivation study, CX717 did alter the recovery sleep architecture as measured by EEG polysomnography in a dose-related manner. The 1000 mg dose of CX717 statistically (p less than 0.05) reduced the amount of slow wave sleep during each of the 4 recovery sleep periods and increased (p less than 0.05) the minutes of wake time after sleep onset during 2 of the 4 recovery sleep periods. CX717 was well tolerated, and no serious adverse events or other significant safety concerns were observed.

Additionally, two presentations will be made detailing the positive findings from the UK sleep deprivation study performed at the University of Surrey in the United Kingdom. Dr. Julia Boyle, Acting Head, Human Psychopharmacology Research Unit, University of Surrey, Guildford, UK will present the primary results from the study. Dr. Nicola Wright, Centre for Human Sciences, QinetiQ, Farnborough, UK will present new data using spectral EEG polysomnography to evaluate the effect of CX717 on the recovery sleep period during the study. In support of the key study findings, the spectral EEG analysis indicated that CX717 increased the level of arousal during recovery sleep.

Differences in study design and the implementation of certain study procedures may have contributed to some of the divergent results between the shift work simulation study and the UK study. While Cortex has received a study report from WRAIR, we look forward to receiving the full data set in order to compare the exact differences in drug performance between the two sleep studies.

From a business perspective, the Company’s licensing discussions have focused on ADHD, Alzheimer’s disease, and other neurodegenerative disorders. The top-line findings from the DARPA-sponsored study do not have a direct impact on the potential of CX717 in those disorders. Cortex’s strategy has always been to retain the sleep deprivation uses as well as Orphan Drug uses of the low impact AMPAKINE(R) drugs for its internal development program. Cortex does not anticipate that future partnering discussions would include sleep disorder indications such discussions are unlikely to be affected by the shift work study findings.

“Our Phase II pilot program which included studies in sleep deprivation, ADHD, and Alzheimer’s disease was designed to help us determine the most promising development pathway for CX717,” said Dr. Roger Stoll, Chairman & CEO of Cortex. “While we are pleased to see some of the findings from the UK study confirmed in the DARPA-sponsored study, given the strong signal from our study in adults with ADHD our current plan is to prioritize ADHD in our future studies with CX717. We also remain committed to the program in Alzheimer’s disease as we await the results from our Phase II study in that disorder. Moreover, we anticipate having the opportunity to conduct additional studies on sleep disorders with either CX717 or with CX701, a back-up compound that should enter clinical trials early next year.”

Cortex will host a conference call and webcast later today, at 2:00 p.m. ET, to further elaborate on this information. Following the conference call, the company will open the phone lines to answer questions from investors and members of the media. Those who wish to participate may do so using the following dial-in information: In the United States, call (877) 407-0782. Internationally, call (201) 689-8567. An audio replay of the conference call will be available through Wednesday, June 28, 2006 by dialing (877) 660-6853 for U.S. participants and (201) 612-7415 for international participants. When prompted, participants should enter account number 286 and conference ID number 206297. For the webcast please use the following link: http://www.vcall.com/IC/CEPage.asp?ID=106039. A replay of the webcast will be available through June 28, 2006.

About the shift work simulation study

The shift work study was a randomized, double-blind, placebo-controlled, parallel group study in healthy young adult male volunteers. Fifty (50) subjects were assigned to one of three CX717 dose groups or placebo. Study medication was taken once per evening for four days. Each night subjects were assessed on a variety of cognitive parameters and tests of alertness in a protocol designed to simulate night shift work. The subjects’ daytime sleep was restricted to 4 hours per day to mimic operational conditions involving chronic, restricted sleep.

About Cortex Pharmaceuticals

Cortex, located in Irvine, California, is a neuroscience company focused on novel drug therapies for neurological and psychiatric disorders. The Company is pioneering a class of proprietary pharmaceuticals called AMPAKINE compounds, which act to increase the strength of signals at connections between brain cells. The loss of these connections is thought to be responsible for memory and behavior problems in Alzheimer’s disease. Many psychiatric diseases, including schizophrenia, occur as a result of imbalances in the brain’s neurotransmitter system. These imbalances may be improved by using the AMPAKINE technology. Cortex has alliances with N.V. Organon for the treatment of schizophrenia and depression and with Les Laboratoires Servier for the development of AMPAKINE compounds to treat the neurodegenerative effects associated with aging and disease, including Mild Cognitive Impairment, Alzheimer’s disease and anxiety disorders. (http://www.cortexpharm.com/)

Forward-Looking Statement

Note – This press release contains forward-looking statements concerning the Company’s research and development activities. The success of such activities depends on a number of factors, including the risks that the Company’s additional tests and activities may further delay clinical studies. As discussed in the Company’s Securities and Exchange Commission filings, the Company’s proposed products will require additional research, lengthy and costly clinical testing and regulatory approval. AMPAKINE compounds are investigational drugs and have not been approved for the treatment of any disease.

Prices Rise for Drugs Used by Elderly: Studies

By Susan Heavey

WASHINGTON — Prices of medicines used by older Americans for chronic conditions such as arthritis and high cholesterol are rising even as new federal drug coverage has been rolled out to help make prescriptions more affordable, two separate studies released on Tuesday showed.

Researchers at Families USA found insurers participating in the Medicare drug benefit program raised overall prices 3.7 percent for the top 20 drugs used by the elderly since enrollment began in November.

Separately, the AARP found prices for nearly 200 of all drugs most used by the elderly — not just under Medicare — rose 3.9 percent from January through March. The AARP is the largest group representing older Americans.

The drug benefits program, which began in January, allows insurers to offer Medicare beneficiaries drug coverage with government oversight.

Participants are locked into a plan until annual open enrollment, although plans are allowed to change prices any time. Many patients were automatically transferred into the program, but about 11 million signed up individually.

“At the same time that the Bush administration and congressional leaders are touting the effectiveness of the Medicare drug plans, those plans are quietly raising the prices that they charge,” said Ron Pollack, director of Families USA.

The Centers for Medicare and Medicaid Services and an insurance industry group had no immediate comment on the studies.

The Pharmaceutical Research and Manufacturers of America, disputed the AARP study, saying data shows drug prices are not rising any more than other medical costs.

Medicare officials have said competition between companies offering the drug benefit would help lower co-payments and annual fees.

According to Families USA, prices for three Pfizer Inc drugs rose at least 6 percent — painkiller Celebrex, cholesterol drug Lipitor and Alzheimer’s disease therapy Aricept.

Drugs in the study that did not have price hikes included the diuretic generic drug furosemide, generic metoprolol tartrate for high blood pressure, and Pfizer’s antidepressant Zoloft, which could soon face generic competition.

OUTPACING INFLATION

AARP, which supported the Medicare drug benefit but has continued to rally against higher costs, said manufacturers initially seemed to keep price hikes in line with inflation.

“The first quarter 2006 results represent a disturbing reversal of that trend. It remains to be seen whether this is a one-time change or the beginning of a pattern of an increasing rate of price increase,” according to the group, which has been surveying drug costs since 2000.

AARP also found prices rose 6.2 percent for the 12 months ending March 2006 — an average annual increase of $59.57 compared with general U.S. inflation, which rose 3.5 percent.

For the typical older patient taking four prescriptions each day, medicines cost $238.28 more for those 12 months, compared with $189.72 more the previous year.

“It is simply unsustainable for American consumers to continue footing the bill for large increases in drug prices,” AARP Chief Executive Officer Bill Novelli said in a statement.

Among generic drugs, the AARP found prices dropped an average of 0.1 percent for the year ending March 2005.

Men Advised to Freeze Sperm Before Vasectomy

PRAGUE — Men should freeze their sperm before having a vasectomy in case they change their mind about having children because the procedure may damage sperm, a fertility expert said on Wednesday.

A vasectomy can be reversed and men have fathered children afterwards. But Professor Nares Sukcharoen, of the Chulalongkorn University in Bangkok, Thailand, said men who have had a reversal may have an increased risk of damaged sperm.

In a small study of men who had a vasectomy reversal, Sukcharoen and his team found a higher number of chromosome abnormalities in sperm than in men who had not had the surgery.

“The conclusion of the study is that the vasectomy seemed to be the cause of the abnormal sperm,” he told a press conference at the European Society of Human Reproduction and Embryology (ESHRE).

“It is advisable to freeze sperm before a vasectomy,” he added.

Vasectomy is a short, minor surgical procedure done under local anaesthetic. It involves sealing the tubes, or vas deferens, that carry sperm. It does not affect a man’s sex drive or performance.

In a vasectomy reversal the tubes are rejoined but the operation is not always successful. Only a small percentage of men seek to have the surgery reversed.

Sukcharoen said more research and larger studies are needed to confirm his results and to answer questions such as whether the problem can be reversed, how long it would take and if babies born after a reversal may have problems.

“We need a lot more evidence and research on this issue before we can be certain of avoiding the dangers,” he added.

Defendant Says Man Hatched Murder Plot

By Traci Shurley, Fort Worth Star-Telegram, Texas

Jun. 21–FORT WORTH — To Rebecca Simpson, security guard Kevin Cash seemed like the right man to trust with her safety when they met at a Bridgeport gas station in October 2004, she testified Tuesday.

Dressed in black, Cash talked about spending time in the Army before starting a career in international security. Later, he showed off his semiautomatic rifle and bragged about “neutralizing threats” for the government, Simpson said.

Simpson wanted to take self-defense classes, but Cash had other ideas, she told jurors.

Choosing Cash to help her deal with harassment from her former lover Danny Watts and his wife, Shemane, is a move she said she sorely regrets.

“He told me he had a permanent solution to a temporary problem,” said Simpson, who was the wife of a prominent Wise County lawyer.

“He said I wasn’t going to get anything done talking to Danny and Shemane, that they were not the kind of people to mess with. … He said that they had connections.”

Simpson is on trial on a charge of solicitation of capital murder. She is accused of trying to hire an undercover Texas Department of Public Safety officer to kill Shemane Watts in October 2004. Her trial is in its second week. The charge carries a maximum sentence of life in prison.

Shemane Watts married Danny Watts in June 2003, about three years after Danny Watts and Simpson began an affair.

Danny Watts testified earlier that he and Simpson became lovers a few months after he began training her at his fitness club in Bridgeport and that the affair continued after his marriage.

On a videotape of an Oct. 28, 2004, meeting that was shown to jurors last week, Simpson gave the undercover officer $2,000 and asked him to slit Shemane Watts’ wrists and let her die. Simpson also tells the “hit man” to beat Danny Watts and make it look like a drug deal gone wrong.

Prosecutors Christy Jack and Kim D’Avignon have characterized Simpson as a controlling and vengeful woman who wanted Danny Watts to herself.

Cash testified last week that he reported a murder-for-hire plan hatched by Simpson to Bridgeport police as soon as he was certain of her intentions. He said he helped police set up the sting and got out of their way.

However, Simpson testified Tuesday that Cash was the one who brought up the idea of causing Shemane Watts’ death.

Simpson said she was desperate to protect herself against the Wattses when Cash approached her at the gas station Oct. 18, 2004. Earlier that month, she had gone to police about a confrontation Oct. 13 with Shemane Watts. She had also threatened to call the Wise County Sheriff’s Department about an inappropriate conversation that Danny Watts had had with her 16-year-old daughter, she said.

The Wattses were threatening to retaliate, and Shemane Watts had nearly run her down, she said.

She testified that on Oct. 20, 2004, Cash told her that “world-class operatives” carried out their activities against their targets on four levels, the first of which was harassment. Shortly before state District Judge Mike Thomas adjourned the trial for the day, Simpson said that’s all she agreed to pay him to do. The next day, Cash went to police.

Earlier Tuesday, Simpson’s attorney, Ray Bass, called his client’s 20-year-old son to the witness stand to talk about other troubles she faced in 2003 and 2004. Sean Simpson described a serious water-skiing accident his mother had in May 2003.

————

Traci Shurley, 817- 390-7757 [email protected]

—–

Copyright (c) 2006, Fort Worth Star-Telegram, Texas

Distributed by Knight Ridder/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.

Help is Available for People With Essential Tremor

By ALLISON SCHIFANI For the Journal

Gene Clement, a 68-year-old retired Bernallio County health director, first noticed his hands shaking in 1985.

In the beginning, the troublesome involuntary movements didn’t have much impact on his working life, but as time progressed, so too did the frequency and magnitude of his tremors.

“After a while I couldn’t write at all,” he says. The shaking affected more than his work. He was forced to give up his much- loved music lessons.

“I stayed away from the piano,” says Clement.

Even social events became trying. He distinctly remembers going out to a meal and watching in dismay as a tomato flew from his wavering fork and landed on another dinner guest’s plate.

“You just kind of have to laugh at it a little bit,” according to Clement. But even that wasn’t so easy. Vanity creeps in.

What if you couldn’t sign your name on a check anymore? Couldn’t move a spoon from bowl to mouth without shaking food off onto the table? What if you had trouble holding the newspaper steady enough to read it?

More than 5 million people in the United States have trouble doing just those sorts of things. They, like Clement, suffer from a degenerative disorder known as essential tremor.

Though the symptoms of essential tremor, or ET as it is referred to by many of its sufferers, vary in severity, the disorder disrupts the professional and personal lives of those who suffer from it. Symptoms include involuntary shaking in different parts of the body including the hands, arms and head. Even the larynx, voice box and tongue can be affected, making speech a laborious endeavor.

Genetic disorder

Essential tremor is, simply put, “a neurological condition that causes tremors,” says Dr. Jill Marjama-Lyons, a neurologist and movement disorder specialist at Albuquerque’s HealthSouth Rehabilitation Hospital.

Sufferers experience these tremors when they actively move. Unlike Parkinson’s disease, which also causes involuntary shaking, ET patients’ tremors cease when people are at rest.

The disorder is genetic, though carriers of the responsible gene don’t necessarily exhibit actual tremors. Symptoms of ET can be exacerbated by fatigue and emotional distress and, because the disorder is degenerative, they can worsen over time.

The diagnosis, though, isn’t a hopeless one. Several medications can help mitigate the symptoms of ET. According to Marjama-Lyons, beta blockers like Inderal can be helpful in some patients as can other drugs like the antiseizure medication Mysoline.

Seventy-four-year-old Frankie Richardson has found medication helpful in dealing with her ET symptoms. She also attends a support group for people with ET and their families.

“I used to be so selfconscious about my head shaking,” she says. “I didn’t like to get my hair done or anything, until I started to go to the support group.”

The Albuquerque group meets about every three months at Erna Ferguson library. Among the topics discussed are ways to ease the burden of ET. Attendees learn, in addition to information about medical treatment, tools they can use to help them with daily tasks. Weighted silverware, for example, can help stabilize a shaking hand during a meal. Patients can also have a signature stamp made to make check-writing and document-signing easier. And, according to Richardson, being among people who understand the disorder truly helps.

“I think the support is something that’s important,” she says.

Brain stimulation

Support and medication, though, weren’t enough for Clement. He wanted to be rid of ET. So he spoke with his doctor and consulted with a neurologist.

The answer was deep brain stimulation, or DBS. The procedure “involves placing an electrode into a very specific part of the brain called the thalamus,” says Marjama-Lyons. The thalamus is the portion of the brain that governs muscle movement and coordination. The electrode stimulates parts of the thalamus to control the tremors. The implanted device is connected by tiny wires under the skin to a battery surgically implanted in the upper chest.

As with any surgery, there are risks. And anyone with tremors who hasn’t been diagnosed should seek a consultation with a neurologist, according to Marjama-Lyons.

For Clement and his physicians, the risks were worth taking. And the cost? Not so bad. Medicare covers the procedure for most patients.

Five months after the surgery Clement is an avid piano and organ player, though he says he isn’t very good yet.

“I shoot pool every day,” says Clement. “I drive a vehicle. I enjoy life.”

He works now with groups like the local ET support group, explaining his experience as a DBS candidate and promoting the procedure.

“If it’s broke,” he’s fond of telling people, “fix it.”

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

Dangers of High Calcium

Dear Dr. Sangani:

What will make or cause someone to have high calcium and what are the dangers. P.S. Where is your office located?

_ High Calcium

Dear High Calcium:

Thank you for asking the question. My office address is printed in any telephone book, but I want you to know that my practice is limited to cardiology. These articles are basically a community service, but we will be glad to refer you to a specialist if you call the office.

Now, let us turn our attention to the real question. Let’s start by reviewing what calcium does in our bodies.

Calcium is important for many bodily functions including bone formation, muscle contraction, heart function, brain function, digestive tract and the release of hormones.

Parathyroid hormone (PTH) and vitamin D regulate calcium balance in the body. PTH is produced by the parathyroid glands which are located in the neck behind the thyroid gland.

Vitamin D is obtained from sun exposure or from dietary sources such as dairy products, egg yolks, fish and fortified cereals. Hypercalcemia is an excessive amount of calcium in the blood.

Q: What are the causes of hypercalcemia?

A: Although there are many causes of hypercalcemia, the most common cause is too much parathyroid hormone (PTH), termed primary hyperparathyroidism.

High PTH causes the excess of calcium termed benign hypercalcemia. Blood calcium can also be high despite low levels of PTH; however, certain malignancies such as lung and breast cancer may cause that.

Certain drugs such as lithium may cause hypercalcemia. Excess vitamin D from diet or herbal supplements may cause hypercalcemia. Other causes include thyroid disorders, prolonged immobilization, and the ingestion of massive amounts of calcium such as the excessive use of Tums.

Q: What are symptoms I might experience with hypercalcemia?

A: Skeletal system symptoms may include bone pain, loss of height, spinal column curvature, fractures, weakness, muscle twitches and decrease in muscle mass. You may also have memory loss, depression, irritability or signs of dementia. Your digestive system may signal decreased appetite, nausea and vomiting.

A: What tests will I need to determine the cause of my hypercalcemia?

Q: Your doctor will order certain lab tests to evaluate the cause of your hypercalcemia. You should have your calcium level test repeated to be sure it is really elevated. If malignant tumors are suspected, a chest X-ray and other diagnostic studies may be ordered to look for a tumor. Bone films also may be ordered.

Q: Are there any treatment options for hypercal- cemia?

A: Treatment is directed at the underlying cause of hypercalcemia. When hypercalcemia is mild and not caused by a malignancy, then patients may be followed closely by their doctor over time. Severe hypercalcemia with symptoms may require hospitalization.

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Submit questions to Dr. Bharat Sangani at [email protected] or 5601 Sound Bluff Road, Ocean Springs, MS 39564. Sangani also would like to hear from physicians interested in contributing to this column.

___

(c) 2006, The Sun Herald (Biloxi, Miss.).

Visit The Sun Herald Online at http://www.sunherald.com/

Distributed by Knight Ridder/Tribune Information Services.

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A Trip Through Kansas’ More Unusual Tourist Attractions

ATCHISON, Kan. _ Ghosts, black squirrels, mummified farmers. Kansas has it all.

To celebrate the 50th anniversary of the founding of the interstate highway system, I wanted to take a drive that avoided the interstates _ the Wal-Marts of the roadways _ and see real, homespun America.

My route would be the back roads where drugstore soda fountains and Mom `n’ Pop diners still thrived, where roadside attractions abounded and where billboards and fast-food joints did not clog the arteries. I wanted big skies and sweeping landscapes where buffalo once roamed and where silos, not skyscrapers, were the tallest buildings.

U.S. 36, an antique two-laner that cuts arrow-straight across the top of Kansas, fit the bill.

Despite the state’s reputation as flat, drab and boring, books have been written about the abundance of oddities, both human and geologic, found on the Kansas prairies.

Pam Grout, author of “You Know You’re in Kansas When …” wrote of the state: “It’s by far one of the most interesting of the 50, yet it has never, like Rodney Dangerfield, gotten the respect it deserves.”

Grout also revealed in the forward to her book that she omitted this one-liner: “You know you’re in Kansas when you’ve seen people wear bib overalls to funerals and weddings.”

Over a spaghetti lunch, I asked one resident about his state’s reputation for weirdness. He pushed back the bill of his cap to ponder, revealing a bone-white forehead over a sun-stained face, and replied, “Well, in Kansas, people have a lot of time on their hands.”

Another explanation, this one from the state school board, is that evolution is merely a theory in Kansas.

That may be why one farmer sat in his barn winding string from his hay bales into what has become the world’s largest ball of twine.

Or why another built a concrete mausoleum in his backyard, dug up his dead wife from the local cemetery and buried her there, and then had his own body mummified and enshrined in a glass-topped casket with a double-exposed photo nearby of himself admiring himself in the coffin. Pay $6 and you can stare down at the withered face, now 74 years dead.

The fun started immediately when I crossed the Missouri River into Atchison, in the northeast corner of Kansas, and found that the town was named for a senator _ from Missouri. In fact, David Rice Atchison was president of the United States for 24 hours, beginning at noon March 4, 1849. He snoozed for most of his term.

The world’s smallest presidential library is housed in the town’s restored Santa Fe depot and tells how Atchison became president when James Polk and his vice president stepped down at noon Sunday and Zachary Taylor refused to take the oath of office on the Sabbath, waiting until noon Monday. Atchison, as head of the Senate, was next in line and slept most of Sunday, although he was awakened occasionally by friends asking to be named to his cabinet.

His presidential library is only slightly larger than another display in the depot that tells the story of William “Deafy” Boular, a deaf and legless man who is credited with paving many of the brick streets throughout town and earned mention in a 1933 “Ripley’s Believe It or Not” column for laying 46,000 bricks in eight hours.

Atchison also is Amelia Earhart’s birthplace, and a park on the edge of town honors the ill-fated pilot and other famed aviators and astronauts.

A sycamore tree in the park was grown from seeds that went to the moon during an Apollo mission. You can buy packets of seeds from the Moon Tree at the train depot.

“We explain to people that they are not seeds from the moon,” said the depot’s clerk. “Nothing grows on the moon, you know.”

But missing aviators, short-term presidents and short bricklayers are not Atchison’s real claim to fame _ ghosts are. The town has been heralded in books and TV shows as Kansas’ most haunted.

John Settich is a seemingly sensible Atchison resident who is head of the political science department at Benedictine College and proprietor of St. Martin’s B&B in a stately home. He also narrates a trolley tour and relates the ghoulish goings-on inside some of the town’s Victorian mansions.

“This is our most famous ghost _ this is Sally’s house,” Settich said of a modest-looking bungalow.

Sally, it seems, was given an emergency appendectomy by a doctor who didn’t wait for the ether to take effect. She died of the pain. Mysterious scratches, apparently payback from Sally, appear on men who sleep in the house.

“It’s empty now,” said Settich. “The owners offered it for $250,000 on eBay, but nobody would buy it. They’re thinking about trying to rent it out for special occasions, maybe on Halloween.”

From Atchison, I took Highway 7, also known as the Glacial Hills Scenic Byway, north to catch U.S. 36. But first I made a quick stop in Troy to check out a rumor that the Home Place Restaurant sold only square pieces of pie.

“It’s easier to portion _ you can cut it faster,” explained owner Jeannie Ricklefs, who handed over a piece of rhubarb-strawberry. Sure enough, beneath the sprig of mint and scoop of vanilla ice cream was a square piece of pie. It tasted just like a triangular piece, maybe even better.

“This used to be a funeral home,” Ricklefs said of the neat-as-a-pin restaurant. “Up there’s where the caskets used to be.”

That reminded me of my next destination. I headed west to Hiawatha and found the Mount Hope Cemetery amid the farm fields on the outskirts of town. Standing just inside the entrance was the memorial John Milburn Davis erected in memory of his wife, Sarah, after she died in 1930.

Davis sent his and his wife’s measurements to an Italian sculptor, and commissioned 11 life-sized statues of the couple in marble and granite. Two of the statues of Davis show him missing his left hand, which was amputated after he cut himself with an ax in a farming accident and the wound became infected despite treatment at a local hospital.

“You want to see the ax?” whispered Bonnie Reetz, who was behind the desk at the nearby Brown County Ag Museum. She led the way to the basement where the ax was framed and hung on a wall. Although the Davis Memorial now draws some 30,000 tourists a year, Reetz said the locals still don’t think much of its creator, who died in 1947 and was buried next to his wife.

“It was during the Depression, and the townspeople were horrified that he was spending all his money on statues,” Reetz said of Davis. “Hiawatha wanted him to build something for the city. We had no swimming pool, no hospital. He said he wasn’t going to build no small-town hospital, because it was a small-town hospital that cost him his hand.”

I was heading for the stairs when Reetz called me to another corner of the basement.

“Here’s something weird that you’ve probably never seen,” she said. “It’s a crow’s nest made out of barbed wire.”

At Seneca, I paused at Harsh Drug to view a rare double-horseshoe soda fountain with pink Formica tops and matching pink stools, where Mary Hunninghake made me a cherry ice cream soda. It was pink and perfect, but then, she’s had 45 years’ experience.

“Each morning, everyone has a seat, and you do not take someone else’s seat,” she said of the regulars. “They solve every problem there is to solve around this fountain.”

Down the road at Marysville, I went hunting for black squirrels. Local lore says the squirrels escaped from a traveling circus in the 1920s, and went forth and multiplied. After a fruitless search, I visited the Pony Express museum in town and there was a stuffed black squirrel on the counter.

“Try the city park,” said clerk Jill Schmidt. “But watch it. There’s a $25 fine if you run over one.”

Red fox squirrels scampered beneath the park’s tall oaks, and then, suddenly, like a passing shadow, a black-as-night squirrel bounded by, peering back at my lens long enough for a photo-op.

It was easier finding Charlie Becker’s house at the corner of 6th and E streets in Washington. Becker, who played the mayor of Munchkinland in “The Wizard of Oz,” lived in the house with his wife, Jesse. A couple strolled by on their evening walk and I asked if the little stucco house belonged to the Beckers.

“Three little people lived there; I think one was his sister,” offered the man. “Look in the window,” said his wife. “The kitchen sink is built down real low.”

I did, and it was.

The next morning began in Cawker City, where the world’s largest ball of twine sat under a pavilion. Frank Stoeber started winding sisal twine from hay bales in his barn in 1953. The ball now is bigger than a Buick and said to contain 7,801,766 feet of twine, weighing 17,886 pounds.

“Frank hadn’t been well, it was winter _ what else is a farmer going to do?” said Linda Clover, the school librarian and unofficial keeper of the twine. “The third weekend in August, people come from all over and we wrap twine at a Twine-a-Thon. We have a parade and games. Honestly, there’s not a whole lot around here for entertainment. If you have lemons, you make lemonade.

“We’ve had people come from every continent to see it. They come in all ages; it isn’t just old people on tour buses. And I know people have climbed it and done things on top. And I mean everything.”

Because many of the storefronts in town were vacant, local artist Cher Heller Olson decided to dress things up by painting familiar figures on the windows, each with a ball of twine. There’s the Statue of Liberty with a ball of twine on her torch, Mona Lisa holding a ball of twine, and the grim-faced farm couple from the Grant Wood painting, “American Gothic,” with twine in the pitchfork.

“We had Michelangelo’s David; he was covering his anatomy with a ball of twine,” Clover said. “You couldn’t see anything, but someone wrote an anonymous letter complaining. So he’s stashed in the studio.”

The ball of twine was going to be hard to beat, but I pressed on, and found the geographic center of the United States at the dead end of a two-lane blacktop just north of Lebanon. The U.S. Geological Survey says the center is the spot where a plane map of the lower 48 states would balance on a pinpoint if it were of uniform thickness.

A marker and an American flag stood at the spot, and there was a tiny white “U.S. Center” chapel with four one-person pews inside. Other than a meadowlark singing and the flagpole clanging in the wind, it was eerily quiet in Middle America.

Downtown Lebanon has seen better times, but Ladow’s Market was full of farmers eating lunch. The bill for the special of spaghetti, salad, garlic bread and pumpkin cake was $4.21. I left a buck tip and Debbie, the waitress, came running after me. “We don’t take tips,” she said. “That way we don’t have to pay taxes and we tell everybody we don’t have to treat `em nice.”

On the day before, the Kansas sky was full of clouds in the shapes of battleships and nuclear-plant cooling towers. But when I arrived at Brewster Higley’s log cabin on a farm north of Athol, the sky was “not cloudy all day.”

Yep, Higley was a doctor who retreated to the remote cabin on Beaver Creek and in 1873 wrote the words to “My Western Home,” which is known all over the world as “Home on the Range.” A plaque on the log cabin said Kansas adopted the tune as its official state song in June 1947. I saw no deer or antelope playing, but a turkey gobbled in the woods by the creek as I drove off.

My travels west ended in Norton, at the Gallery of Also-Rans. Banker Bill Rouse apparently felt sorry for the major-party candidates who ran for president of the United States and lost, so he had them honored in a photo gallery along with their bios on the second floor of the First State Bank of Norton.

Some of the losers _ including Richard Nixon and George H. Bush _ actually were winners in other elections. Curator Lee Ann Shearer refused to predict whose portrait would be the next to be hung. “I can’t really forecast,” she said. “I don’t even know who might be running.” Neither does anyone else.

I was on the stretch run of my four-day, 800-mile exploration of Kansas and spent the morning in Lucas, which is ground zero for Kansas quirkiness. From there, I detoured north on Highway 106 and found Rock City, near Minneapolis.

In an area about the size of two football fields, some 200 giant rocks dot the landscape. I had been told some were as large as houses, but the biggest ones I saw were the size of outhouses. Still, why were they in the middle of otherwise flat terrain? Geologists say they are deposits formed millions of years ago when the area was an inland sea. Whatever.

Heading east on Interstate 70, I couldn’t resist a billboard advertising the new Oz Museum at Wamego, which turned out to be a pretty little town that looked like a movie set itself. The museum was nice, too, although the ruby slippers on display are not the ones that graced Judy Garland’s feet. A highlight was the life-sized figure of the Wicked Witch, with a warty green nose, next to one of her monkey-faced henchmen.

My last appointment was with a dead horse.

“You mean Comanche?” said the clerk at the Super 8. “We used to go see him when I was a kid.”

When the smoke cleared after the battle of the Little Bighorn in 1876, the only member of Gen. George Custer’s U.S. 7th Cavalry still standing was a big brown horse named Comanche. Wounded, he was nursed back to health at Fort Riley in Kansas and lived to the age of 29. When he died, the cavalry at the fort had him stuffed by the taxidermist at the Kansas University Natural History Museum in Lawrence.

But the cavalry stiffed the stuffer, so to speak, and the horse has remained in a glass case in Lawrence ever since. The display recently was closed for a makeover, and reopened with Comanche looking great in his cavalry gear, his mane combed and his coat groomed. “Comanche is back!” said a sign on the exhibit.

You know you’re in Kansas when a dead horse is a state celebrity.

___

IF YOU GO:

In Atchison: The Unofficial David Rice Atchison Presidential Library is in the Santa Fe Depot at 200 S. 10th Street. Visit www.atchisonhistory.org. The Moon Tree in the International Forest of Friendship is at 1-913-367-1419 and www.ifof.org. Haunted Trolley Tours (1-800-234-1854) are $8 per person and offered in the fall. The Chamber of Commerce is at 1-800-234-1854 and www.atchisonkansas.net. St. Martin’s B&B is at 1-877-367-4964 and www.stmartinsbandb.com.

In Hiawatha: For information on the Davis Memorial or the Brown County Ag Museum, call 1-785-742-3702 or the Chamber of Commerce at 1-785-742-7136.

In Cawker City: The Ball of Twine Inn (1-877-266-2963) is across the street from the World’s Largest Ball of Twine.

In Lucas: Grassroots Art Center admission is $4; call 1-785-525-6118 or visit www.grassrootsart.net. Garden of Eden admission is $6; call 1-785-525-6395. Both are open daily, 10 a.m. to 5 p.m. May through October, 1-4 p.m. November through April. The “World’s Largest …” is at www.worldslargestthings.com. The Lucas Country Inn is at 1-785-525-6358.

In Wamego: The Oz Museum is at 1-866-458-8686 and www.ozmuseum.com. Hours are 10 a.m. to 5 p.m. Monday through Saturday, noon to 5 p.m. Sunday. Admission is $7.

Rock City near Minneapolis: Admission is $3; call 1-785-392-2577.

Books: Pam Grout’s “You Know You’re In Kansas When…” is $9.95 and available through Globe Pequot Press at www.globepequot.com, or by calling 1-800-243-0495.

Kansas info: Call the Department of Commerce Travel & Tourism Division at 1-785-296-2009, or visit www.travelKS.com.

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Tom Uhlenbrock: [email protected]

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(c) 2006, St. Louis Post-Dispatch.

Visit the Post-Dispatch on the World Wide Web at http://www.stltoday.com/

Distributed by Knight Ridder/Tribune Information Services.

_____

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Father Learns How Deadly Sixmile Can Be: CLASS V: Rapids Tip Canoes, Suck Nikiski Man, Teen Sons into River.

By Craig Medred, Anchorage Daily News, Alaska

Jun. 18–Flushed mostly underwater for miles through the bedrock canyon on the East Fork of Sixmile Creek, Dan Baeten never saw the bridge that stands stark against the sky where it spans the bluffs near Gulch Creek.

This would cause some confusion later, but at the time it didn’t matter. At the time, all the Nikiski resident could think about was whether he had killed the older of his two teenage sons and whether he was about to die himself.

Already he had seen a Class III white-water section entering the first canyon on the Kenai Peninsula stream swallow the small canoe of 14-year-old son Brian, nearly taking the young man with it.

That had all happened within minutes of putting in on what seemed like little more than gurgling brook next to the scenic Seward Highway.

“We got downriver, and it got rough,” Dan said. “I realized at the point we were really in trouble. I heard, ‘Dad!’ I turned around, and Brian was into the water.”

At the start of this family float, Dan had talked to Brian and Ben, Brian’s 16-year-old brother, about what to do if their solo canoes flipped. Just hang onto the boat and float to the next shallow spot, he told them.

Brian grabbed fast to the canoe now, but this wasn’t the placid stream on which the trip had started. This was big, pounding, scary water.

“Brian was starting to panic,” Dan said. “I told him, ‘Calm down. It’s all right.’ “

Unfortunately, as the Baetens were about to learn, it was far from all right.

RIVER LIKE A WASHING MACHINE

With Brian clinging to his canoe, the craft shot toward what white-water rafters call a pour over — a big boulder with water streaming over the top. Such obstructions create miniature waterfalls with swirling undertows on the downstream side. When a boat goes over, it can be spun toward the bottom of the river.

Brian ended up caught in just this sort of washing machine.

“His canoe went underwater,” Dan said, “and he went underwater with it.”

The worried father was now near panic himself, his only salvation the thought that Brian had completed water-safety training weeks before.

“He had just attended the Safe Kids Program at Central Peninsula General Hospital,” Dan said. One of the benefits was a new Mustang personal flotation device and instruction on how to survive in fast water.

Both were about to pay dividends.

“When he went in and went under, he was floating really well,” Dan said.

All thoughts of the canoe were gone now. It was lost and nobody cared. All Dan wanted Brian to do was get to the side of the creek, grab the bank and haul himself out of the bone-numbingly cold water.

It wasn’t going to be easy.

Brian’s course toward the shore put him into the worst kind of sweeper — a log jam.

“I was so worried and scared for Brian,” Dan said. “I was worried he would get sucked under these logs. (But), he climbs up on the pile of logs, so my last view of Brian was him climbing out on this log jam.”

Brian was now safe, but Dan and 16-year-old Ben were being swept downstream into even bigger water in their 14 1/2-foot, one-man canoes.

“It was moving so fast that it was hard for us to react,” Dan said. “We couldn’t even help each other out.”

What began as a pleasant, Memorial Day weekend outing was about to turn into a near-death experience for father and son.

PEACEFUL LOOKS DECEIVE

Viewed from the Seward Highway below Turnagain Pass at Mile 59, the East Fork of Sixmile Creek doesn’t look like much. It is a 100-foot-wide stream through the forest gurgling over gravel. It moves fast but not dangerously so.

On a hot day, it looks inviting to wade across, although anyone who sticks a toe in quickly learns the water is chillingly cold.

Almost immediately downstream from the Mile 59 pullout, however, the creek’s character changes dramatically. Just out of sight of the highway, Sixmile becomes a raging torrent. Skilled and experienced white-water boaters know it as one of the best thrill rides in the state. For commercial rafting companies, it is a marketable, wet-and-wild roller coaster that must be approached with great caution:

— PFDs, helmets and drysuits are mandatory.

— Lessons in swimming white water are provided to customers.

— Trips are restricted to days when the flow in the creek is moderate.

Still, people have died on commercial tours. Well-known Anchorage physician and travel-industry innovator Gary Archer was among them. The 60-year-old fell out of a raft in Class IV rapid and was killed by the shock of cold-water immersion.

He wasn’t the first to perish.

In 1995, two 22-year-old men decided to try out a new canoe there in much the same manner as the Baetens. They, however, wore no PFDs. Both died.

In 1993, another 22-year-old in a paddle raft was wearing a low-flotation PFD when the raft flipped. Several people went in the water. The others survived. The 22-year-old in the marginal PFD died.

There is no hint of any of this history at the convenient pullout along the highway above the unseen rapids. Dan wishes there had been. He wishes he had known the history before he and his boys started down the river.

“A lot of people I’ve talked to have said, ‘How long have you been in Alaska?’ ” Dan said, as if knowledge is somehow transmitted by some sort of osmosis linked to longevity.

“Well, we’ve been here about nine years,” he said. “We have no TV. I’ve never seen any articles in the paper. We had no clue. We were totally clueless.

“If there had been a sign at that point, saying ‘These are Class V rapids,’ we definitely wouldn’t have put in.

“We were in a place we definitely shouldn’t have been. I was picturing a family canoe trip on a river like (Class I) Swanson River. We’d done Swanson River.

“You look upstream (on Sixmile), it doesn’t look bad. The part you see looks like it’s really nice. There’s some ripples there. The river is moving fast, but it looks fine for a canoe.”

So it was that the Baetens stumbled toward tragedy on the Sixmile.

“It was Memorial weekend, and it was Saturday. We just thought, ‘You know what, it’s such a nice day. Let’s go up in the mountains, and maybe we’ll go for a canoe ride,’ ” Dan said.

The family — Dan, the two boys, wife and mother, Lisa, and two younger daughters — drove north. The weekend before, they had been to the confluence of Canyon and Sixmile creeks below the Seward Highway near the Hope Junction for some gold panning. They decided it would be a good place to return.

As they drove north along the Kenai River, Dan said, they looked at floating the Kenai’s Class II and Class III waters, but he thought, “Oh, there’s quite a bit of water running through there.”

East Fork Sixmile Creek looked more inviting: shallower, narrow, slower. There was a nice pulloff and a gravel ramp that looked like a place where other people had been launching boats.

And though the Baetens had just driven past the wild water between the Hope Cutoff and the put-in, they hadn’t seen it.

“There was no point between the (Canyon Creek) bridge and where we put in where you can look down and see this is a canyon and Class V rapids,” Dan said. “One area, you can see down in. You can see some fast water, but nothing scary.”

As far as the Baetens knew, there was only the rippling water at the start and the rippling water where they planned to take out near Boston Bar, a place near where they had panned for gold the weekend before.

It looked so friendly, Dan thought about taking the whole family.

“All of the kids got their life jackets on,” he said. “There were six of us that were going to go down the river. (But) at the last second my wife said, ‘Are you sure you want to bring the younger ones?’ And I said, ‘What’s the worst that could happen? They could get a little wet.’

“I was thinking the worst it could get was a few little bumps.”

Then Dan took a hard look at the river and could tell the flow was a little high.

“There was a lot of water moving through there,” he said. “The river was moving pretty fast, but at that point, there wasn’t any kind of rapid.”

Still he did decide to leave the girls and Lisa behind. He and the boys would make the first run to check conditions. If it was clear, everyone could go on a second run. The family laughed about taking such precautions.

“You know the kind of jokes,” Dan said. ‘Now don’t tip over and get wet.’ Those kind of jokes.”

It was all in good fun. Lisa shot some video of the gang heading downstream in what Dan called their “cheap, plastic canoes … meant for lakes.”

Off they went onto a creek running so high that commercial rafters had stayed home, judging conditions too dangerous.

IT TAKES A MIRACLE

East Fork Sixmile Creek and Sixmile Creek itself squeeze through three canyons on the way from the Kenai Mountains to Turnagain Arm. The worst of these is the third canyon near Sunrise, where a Class V rapid can become virtually unrunnable at high water.

The two canyons above, including the canyon between Mile 59 and the bridge over Canyon Creek, are rated a less-challenging Class IV, but at high water that can change. They can swell to a Class V status that makes going down the East Fork feel like getting flushed down a toilet.

This was the maelstrom into which Dan and Ben paddled as Brian scrambled up the canyon wall to safety.

“It started getting pretty rough,” Dan said, “and I came around a corner before Gulch Creek, and my eyes just got wide. All I could think was how do I get out of here?”

He was, at that point, looking at a drop of about six feet down a pour over. He learned later this particular obstacle is called 13 Ender because, Dan said, “some kayaker had rolled that many times before he got out.”

Dan went over the top of this pour over not knowing what was about to happen next.

“I got sucked into it,” he said.

The back tow on the other side made it feel like his little canoe had landed on an upstream conveyor belt. As the canoe backed up, the water rushing over the pour over started filling the craft up from the stern.

“With that added weight being pulled to the back,” he said. “It just sucked the canoe to the bottom.”

Dan rolled out. He tried to swim for the surface. He couldn’t.

Behind him, seconds later, the same thing would happen to Ben. Both of them were now in the water, and it was ugly.

“I got sucked to the bottom,” Dan said. “We had some garage-sale life jackets.”

He wished he’d bought something better.

“I remember too vividly what it was like getting sucked to the bottom of the river,” he said, “being dragged along the bottom, trying to inhale and taking it into my lungs.”

The force was such that the clothes he had tied around his waist because the weather was warm were quickly ripped off. He was scared. He remembers telling himself:

“I’ve got to calm down, or I’m going to die.”

The next time the current rolled him to the surface, he managed a couple quick, shallow breaths before he was pulled under again. Unfortunately, he also got a glimpse of where he was headed — into a slot between bedrock walls barely wide enough to pass a raft, a sort of nature-made nozzle on the stream.

“It was boiling, and it was shooting up in the air,” Dan said.

He was shot through underwater. He never saw the bridge that spans this gap. How he didn’t hit his head on the rock walls on either side is, he believes, a miracle. He says the same for Ben, who was behind his father enduring the same experiences.

“We were so lucky,” Dan said. “Probably 90 percent of the time we were underwater — even with life jackets on. There’s so much undertow. You fight it first, but you’re bounced off the walls and the bottom and pretty soon you don’t know what’s up and what’s down.”

Somewhere in the canyon, he came up near shore, saw a small birch tree, reached out and grabbed it.

“I was so exhausted,” he said. “I hauled myself out and laid on the bank for just like three second to gasp for breath. I looked upriver, and here comes Ben. He was just out of reach. Maybe I could have reached him. I don’t know. I was so exhausted I couldn’t move.”

Ben floated past, and then Dan did something only a father could do.

“I couldn’t see my son just going back downriver,” Dan said, “So I jumped back in.”

Ben saw him then, Dan said, and yelled, “Dad, I love you.” He thought those were going to be his last words.

“He was right next to me when that happened, and then he got sucked under. I got sucked under in the same spot. That was the last I saw of Ben.”

Father and son were now little more than rag dolls washing down the creek.

“There was one point I was underwater so long that I thought, ‘OK, this is it, this is the end,’ ” Dan said. “I remember feeling just a real deep depression that I had just killed my son. I was thinking I’m supposed to be there for my family to provide for them, and take care of them, and now I’m going to die here in the river.

“I was so certain it was the end, I just opened my eyes underwater and noticed this dark brown murkiness.

“I don’t know why I did it. I guess I just wanted to see the end.”

A devote Christian, Dan believes what happened next was a miracle.

“I honestly believe an angel grabbed hold of my life jacket and pulled me up, because I was at the end,” he said. “I can hold my breath for a long time, probably a minute and a half, but I was under for a long time.”

He came up just long enough to replenish the oxygen in his lungs. Then he went under again.

“I can’t adequately describe what power that river had,” he said.

He thought it would never let him go and then, just like that, it spit him out. He popped up in slower water, looked up, saw a small birch tree, grabbed it and pulled himself ashore.

“I hadn’t seen Ben anymore, so when I grabbed onto that I pulled myself out and grabbed two quick breaths and started scrambling,” he said.

He tried to run downriver to see if his son had washed out, too, but cliffs prevented that. Numb, exhausted, panicky, he shimmied along a narrow ledge to at least try to get a look downriver.

“I got around this point,” he said, “and I looked downriver, and I could not see my son. I yelled his name. I got no answer. After what I went through, I’m positive he died in that river.”

TRAPPED ON SHORE

Still, Dan was driven to do what he could. He figured if he got on top of the canyon wall maybe he could run downstream to search, so he started climbing. He ended up trapped.

“I got into a spot where I couldn’t go up. I couldn’t go down. I couldn’t go sideways,” he said. “It was about an 80-foot drop straight into the river. I didn’t know what to do. I’m panicky. I’m yelling my son’s name.”

And suddenly Ben is there, peering over the cliff.

“He’d gone farther downriver,” Dan said. “He had about given up. He said he had no strength left whatsoever when he actually kind of washed up right next to shore. He laid his arm up and laid it on some brush and just grabbed hold of it.”

He scrambled onto land and headed upriver looking for his dad. Now they were both alive and ashore, but Dan had to find a way off the cliff. Improvising tools, he found a stick, carved some foot holes and climbed to the top.

“Ben just sort of fell to the ground then and started shaking uncontrollably when I got there,” Dan said. “I didn’t notice how cold the water was until then. When you get into Class V rapids like that, there’s no swimming. You’re just moving on what little adrenaline you have left.”

Out of adrenaline now, Ben was shaking from a delayed reaction to the cold and the fright. Dan dropped to the ground and put his arms around his son.

“I let him sit there for a couple minutes,” Dan said. “Then I told him we needed to move, to get downriver to tell Mom we were OK.”

There was only one problem. They had washed out on the opposite side of the river from where the rest of the family had gone to wait to pick them up near Boston Bar.

“As far as we knew,” Dan added, “there was no bridge going across Six Mile River. We were underwater all the time. We never saw bridge.”

Now, thinking there was no bridge, they decided the only thing they could do was hike back upstream to where the trip had started and swim across. They feared getting in the river below the confluence with Canyon Creek where the stream only got bigger.

They were surprised when the hike upstream brought them to the bridge near Gulch Creek.

“It looked so good I can’t even explain it,’ Dan said. “(But) when we crossed it, we were like, ‘Where are we?’ “

They weren’t sure where to go next and split up to follow different trails toward the sound of the nearby highway.

The family, meanwhile, was in its own little panic. Brian, after getting out of the water, had managed to run downstream to the shore of Canyon Creek where he waved and screamed at his mother and the girls waiting on the far shore for the arrival of the canoes.

Lisa couldn’t hear what he was saying over the rush of water but knew immediately something was wrong.

“(Brian) got there probably 20 minutes before Ben and I got to that point,” Dan said. “Brian was pretty upset at that point.”

Lisa would quickly come to share his fears.

She loaded the family in their Suburban and quickly drove back around Canyon Creek to a parking lot above the stream on Brian’s side. What she heard from him when they met was unnerving. The family immediately started searching for Dan and Ben. They ran into others who joined the search. One of them told Lisa she’d better notify Alaska State Troopers to get a raft to look for Dan and Ben across the river. Others started to fill in the history about how many people had died in Sixmile.

“It was pretty scary,” she said.

And then, Dan and Ben stumbled into view. It wouldn’t take long for the whole family to concluded they had witnessed a miracle.

“I didn’t realize how fortunate we were until we started talking to other people,” Dan said. “It seems like everybody has a story about someone who has gone down the river and died.”

When Dan went back and hiked the canyon, he could see why.

“I went over some spillways and stuff,” he said. “Looking at that, I couldn’t believe we actually lived through it.”

NO SYMPATHY, JUST SIGNS

Dan is now lobbying the U.S. Forest Service to put up a sign at the Mile 59 pullout to warn others of the danger downstream. The federal agency, which manages Sixmile Creek as part of Chugach National Forest, has so far refused to do that.

Dan said a Forest Service employee explained the agency can’t starting signing every possible danger in the Chugach, and added that what happened was really Dan’s fault.

“He has a point,” Dan said. “It was our fault. But if I’d had any idea at all it was going to be like that, we would have walked away from the river.”

Dan said he did get the Forest Service to agree to leave in place laminated signs the Baeten family made and posted at the pullout. They also put one upstream from there on the creek warning anyone who happens to float down from the Forest Service campground at Granite Creek that the highway represents the last, safe takeout before the canyon.

The Baetens know now how lucky they were to have survived to tell this tale.

“The fact we didn’t hit our heads underwater is a miracle in itself,” Dan said. “I totally believe the garage-sale life jackets saved our lives, but by the same token, we’re going to get some better life jackets.

“I was tortured for a good week with the ‘what-ifs,’ ” he added. “What if I’d brought the younger ones? What if we hadn’t been wearing life jackets? What if Ben had been washed under those logs?

“It was so traumatic. That first week, there was so much going on in my mind. I was just struggling (emotionally). I almost took a 5-year-old into that.

“(But) I don’t want anybody’s sympathy or empathy. I’m just interested in saving somebody else’s life. There has got to be a warning sign put up, or somebody else is going to die there.”

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Copyright (c) 2006, Anchorage Daily News, Alaska

Distributed by Knight Ridder/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.

WCCO-TV FINDS ITS PERFECT COUPLE: Vascellaro, Santaniello Are Reportedly the First Married Anchor Team in Twin Cities.

By Amy Carlson Gustafson, Pioneer Press, St. Paul, Minn.

Jun. 17–It’s been nearly seven years since TV personalities Frank Vascellaro and Amelia Santaniello said “I do.” Starting June 29, they’ll take their relationship in a new direction when the pair co-anchor the 6 p.m. weekday newscast for WCCO-TV, Channel 4.

“I think that if we can live together and raise three kids together, we can do this,” Vascellaro said. The duo’s children are Sam, 5, and 3-year-old twins Joe and Francesca.

For years, Vascellaro, 43, and Santaniello, 41, have been questioned about the possibility of co-anchoring a newscast together. When Vascellaro couldn’t come to an agreement on a new contract with KARE-TV, Channel 11, last December, speculation grew about a possible Vascellaro-Santaniello pairing. Santaniello co-anchors WCCO’s 6 and 10 p.m. newscasts.

Now, six months later, Vascellaro and Santaniello will be the first husband-and-wife anchor team in the Twin Cities market, according to WCCO.

“We’re grateful to be given this opportunity,” Santaniello said. “We just know each other so well, and we both have the same work ethic and the same sense of humor. I think it will be a good thing.”

To make room for Vascellaro, the station’s longtime anchor Don Shelby will step down from his 6 p.m. anchor duties. He will continue to co-anchor the 10 p.m. newscast.

“I have long thought of having Frank come on board to work with his wife Amelia in this market, if and when the opportunity presented itself,” Shelby said in news release. “I not only support this move, I welcome Frank whole heartily.”

“Don was magnificent throughout this whole thing,” Vascellaro said. “To a certain degree, Don’s role in this is what made things come together. He created the opportunity to allow this husband and wife anchor team to happen. What he did is unprecedented in this business.”

WCCO General Manager Ed Piette said the chance to pair Santaniello and Vascellaro was an opportunity “we could not pass up.”

Vascellaro says he’s “extremely excited” about his new job and believes people in the Twin Cities have been ready to see a Vascellaro-Santaniello anchor team “for years.” He also assures viewers they won’t have to worry about the duo getting too cutesy on screen.

What he’s not quite sure about, though, is whether his wife will turn out to be a perfect co-worker or how they will deal with those not-so-perfect days that all married couples have.

“That really is the troubling question,” Vascellaro said. “This will be interesting. It’s obviously new territory for Amelia and I to venture into. There are days when husbands and wives are arguing about things, and you’re happy to get away from your spouse for a while. But for better or worse, we’re stuck in this thing together.”

It goes without saying that the folks at WCCO are hoping their 6 p.m. anchor team will be a ratings winner. After all, the station has been steadily improving its numbers and, in May, managed to top the Twin Cities market in the Nielsen household numbers. But the station lags behind KARE, which still rules the 25-54 demographic — the age group most coveted by advertisers — with its 10 p.m. newscast.

Even though KARE is the No. 1 station at 10 p.m. with the 25-54 set, its numbers have slipped 19 percent compared with data from May 2005.

On the other hand, WCCO’s 7.1 rating reflects an 18 percent increase since last year and shows that the station continues to threaten KARE’s top standing.

At third-ranked KMSP-TV, Channel 9 (9 p.m. newscast) and fourth-ranked KSTP-TV, Channel 5, numbers also have risen in the 25-54 demographic. Compared to last year, KMSP had a 19 percent ratings increase, followed by KSTP’s 16 percent ratings jump.

Aron Kahn contributed to this report. Amy Carlson Gustafson can be reached at [email protected] or 651-228-5561.

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Copyright (c) 2006, Pioneer Press, St. Paul, Minn.

Distributed by Knight Ridder/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.

Green Mountain Coffee Roasters, Inc. Completes Acquisition of Keurig, Incorporated

Green Mountain Coffee Roasters, Inc. (NASDAQ: GMCR) announced today that it has completed its acquisition of Keurig, Incorporated, originally announced on May 2, 2006, for total consideration of $104.3 million (the “Purchase Price”). Keurig markets premium single-cup coffee brewing systems for the office and the home. Keurig will remain headquartered in Wakefield, Massachusetts and operate as a wholly owned subsidiary of Green Mountain Coffee.

Green Mountain Coffee financed the cash portion of the Purchase Price through a new five-year $125 million syndicated revolving credit facility led by Bank of America. This facility was also used to finance Green Mountain Coffee’s transaction expenses, as well as the Company’s existing outstanding indebtedness.

Nasdaq Notice

As previously announced, in connection with the acquisition of Keurig, Green Mountain Coffee entered into an employment agreement with Nick Lazaris, Chief Executive Officer of Keurig. Pursuant to the terms of the employment agreement, on June 15, 2006, Green Mountain Coffee made an inducement grant to Mr. Lazaris of a non-qualified stock option to purchase 50,000 shares of Green Mountain Coffee common stock. This option award was granted without stockholder approval pursuant to NASD Marketplace Rule 4350(i)(1)(A)(iv). The stock options vest at a rate of 25% on each of the first four anniversaries of the date of grant and have an exercise price of $37.00, the closing price of Green Mountain Coffee common stock on June 15, 2006. The other terms of these options are consistent with options granted under Green Mountain Coffee’s 2006 Incentive Plan.

About Green Mountain Coffee

Green Mountain Coffee Roasters, Inc. was recently ranked No.1 on Business Ethics Magazine’s list of “100 Best Corporate Citizens.” It is a leader in the specialty coffee industry offering over 100 coffee selections including estate, certified organic, Fair Trade Certified(TM) signature blends, and flavored coffees that sell under the Green Mountain Coffee Roasters(R) and Newman’s Own(R) Organics brands. While the majority of the Company’s revenue is derived from its multi-channel wholesale operations, it also manages a growing direct mail and e-commerce business (www.GreenMountainCoffee.com). Based on its performance and practices, Green Mountain Coffee Roasters has been recognized for the past six years as one of Forbes Magazine’s “200 Best Small Companies,” and for the past two years as one of the Society of Human Resource Management’s “Best Medium Companies to Work for in America.”

Forward-looking Statements

Certain statements contained herein are not based on historical fact and are “forward-looking statements” within the meaning of the applicable securities laws and regulations. Owing to the uncertainties inherent in forward-looking statements, actual results could differ materially. Factors that could cause actual results to differ materially from those in the forward-looking statements include, but are not limited to, fluctuations in availability and cost of high-quality green coffee, the unknown impact of any price increases on net sales, competition, business conditions in the coffee industry and food industry in general, Keurig Incorporated’s ability to continue to grow and build profits in the office and at home markets, the impact of the loss of one or more major customers for Green Mountain Coffee or reduction in the volume of purchases by one or more major customers, delays in the timing of adding new locations with existing customers, Green Mountain Coffee’s level of success in continuing to attract new customers, the Company’s success in efficiently expanding operations and capacity to meet growth, variances from sales mix and growth rate, weather and special or unusual events, as well as other risks as described more fully in the Company’s filings with the Securities and Exchange Commission. Forward-looking statements reflect management’s analysis as of the date of this press release. The Company does not undertake to revise these statements to reflect subsequent developments, other than in its regular, quarterly earnings releases.

Migraine associated with high-normal sex drive

By Karla Gale

NEW YORK (Reuters Health) – For some individuals prone to
migraine, this susceptibility may not necessarily interfere
with their sex life and may in fact improve their libido,
according to research published in the journal Headache.

“The goal of this research was to understand migraine
better,” lead author Dr. Timothy T. Houle told Reuters Health.
“By better understanding how the brain is altered with this
syndrome, we can develop better drugs in the future.”

“Migraines have other commonly associated symptoms, such as
sleep abnormalities and a higher risk of depression. Altered
sex drive may be another quirk of being a migraine,” he added.

Although it is commonly believed that sex drive is reduced
by headaches, and sexual intercourse can cause specific types
of headaches, Houle and his associates note, other research has
suggested that sexual intercourse may alleviate the pain of
migraine in some patients.

Houle, from Wake Forest University School of Medicine in
Winston-Salem, North Carolina, and his associates tested the
theory that migraine and sexual desire may both be associated
with serotonin. Evidence for this is the reduced libido that
often accompanies depression treatment with a selective
serotonin reuptake inhibitor, which increases brain levels of
serotonin, whereas migraine is associated with reduced
serotonin levels.

To investigate this complex relationship, Houle, and his
associates recruited 59 adults who had at least 10 headaches
annually. Twenty-three subjects (7 men and 16 women) were
classified as having migraine, and 36 (18 men and 18 women) as
having tension-type headache.

The subjects completed the self-administered Sexual Desire
Inventory (SDI), which includes nine items measuring dyadic
desire and five measuring solitary sexual desire. “It allowed
the subjects to rate how much they think about sex and how much
they desire sex,” Houle told Reuters Health.

“Men reported about 24-percent higher sex drive than did
women,” the researcher said, “and the difference between
migraine and tension-type headache was almost equivalent — 20
percent.” Thus, women with migraines reported about the same
relative levels of sex drive as men with tension type
headaches.

On the nine-point scale the subjects specifically rated
their own sexual desire compared with that of others of the
same age and sex. The migraine patients reported the highest
level (5.0), which is “above the expected median (4.0) on this
item,” Houle and his colleagues note. Those with tension-type
headaches gave themselves an average rating of 3.7 for this
item.

What was even more interesting, Houle said, was that the
migraine patients were aware that they rated their sexual
desire higher than that of other patients in the group.

However, he added that “there was no evidence that their
sexual desire was beyond that of high normal or that they are
hypersexual.”

“It can now be hypothesized that a serotonergic link may be
implicated in both migraine headaches and sexual desire,” the
researchers conclude. Also, serotonin receptors also appear to
be involved in several aspects of sexual functioning.

On the other hand, they point out that there are multiple
classes and subtypes of serotonin receptors. Therefore, they
conclude that “any neurochemical mechanism(s) that might link
serotonin and migraine would likely be sophisticated and
multifactorial.”

Houle concluded: “Our research is now focused on
mathematical modeling to predict migraine activity, to see if
we can figure out for any individual patient when they are at
increased risk of an attack so it can be aborted.”

SOURCE: Headache, June 2006.

Madera Train Wreck Injures 5: Railroad Crew Workers Jump From Locomotives; Cause of Crash Not Revealed.

By Tim Eberly and Charles McCarthy, The Fresno Bee, Calif.

Jun. 15–MADERA — Three railroad crewmen leapt from a freight train just before it slammed into another train around dawn Wednesday, shutting down one of the state’s main rail lines while workers untangled the wreckage and repaired the tracks.

Five railroad workers were injured. The three who jumped to safety suffered lesser injuries than the others, according to the Madera County Sheriff’s Department. All are expected to survive.

The near head-on collision on the rural stretch of track crushed the front locomotives of the BNSF Railway trains into twisted metal heaps. One pulled about 25 gondola cars filled with cement; the other towed a variety of boxcars and tankers that stretched for about half a mile.

The stench of diesel fuel wafted through the air as nearby residents, jolted from their morning routines, emerged from their homes to see the destruction.

“My wife and I, we just heard a loud boom,” said Miguel Friaz, 53, who lives a half-mile away. “It wasn’t like a car accident, with squealing tires. It was more like crackling, crumbling — metal on metal. And, all of a sudden, nothing. Silence.”

Firefighters pried one of the railway employees from inside the crumpled cab of one of the locomotives, according to the California Department of Forestry. It’s not clear whether that person had the most serious injuries, though. All the victims were taken to University Medical Center in Fresno.

BNSF spokeswoman Lena Kent said the three who jumped were released from the hospital; the other two were in serious condition. Their names were not made public.

Some flames erupted, too, causing early concern about a potential disaster if flammable liquids were spilled. But none were, and firefighters confined the fire mostly to the wooden railroad ties beneath the wreckage.

Homeland Security officials phoned Madera County sheriff’s spokeswoman Erica Smith at the crash site, wanting to know about any suspicious circumstances.

But, Smith assured, “This was not an attack.”

The BNSF did not reveal a reason for the crash nor say how fast the trains were traveling on the tracks that it owns when they hit Wednesday.

Most train collisions, however, typically happen because of railroad equipment failure or fatigue among crew members, said Tim Smith, state chairman of the legislative board of the Brotherhood of Locomotive Engineers and Trainmen in Auburn.

Train movement is controlled by a dispatcher who can talk to the locomotives’ engineers via radio. But in most cases, engineers are guided by railroad signals along the tracks that tell them when to slow or stop.

Kent’s details of the wreck were scant: A northbound train was heading from San Bernardino to Polk, near Sacramento, while the southbound was going from Richmond to Barstow. The northbound train had just begun turning onto a side track parallel to the main track when the southbound train plowed into the side of its lead locomotive.

The sound of the collision shot across surrounding fields.

Standing in front of his bathroom mirror, Friaz put down his toothbrush, fetched his videocamera and drove to the tracks.

“We’ve lived here for three years now, and we’ve never heard that sound,” Friaz said. “We knew that something was wrong.”

He arrived at the Road 26 crossing, northeast of Madera, and saw the long row of locomotives, some of them smashed together like the folds of an accordion.

“A big mountain of cars,” he said.

Another man, Ruben Cardenas, had been watching one of the trains, hauling cement, pass by his kitchen window while he made lunch.

He suddenly heard screeching brakes, howling whistles and the booming sound of the violent impact shortly before 6 a.m. White smoke billowed, then black smoke, followed by flames, he said.

As Friaz filmed, he said he did not see any of the five railway workers who were injured, only curious onlookers like himself.

“Everybody was just kind of watching, just looking at this pile of rubble.”

The rail line is expected to be clear by 3 a.m. today, Kent said.

Amtrak officials hustled to create a backup plan for travelers who bought tickets on trains that usually knife through the Central Valley.

The customers were eventually bused between Fresno and Merced while crews worked to clear the wreckage.

Friaz’s sister, Lupe Friaz of San Jose, was one of them. She had come to Fresno to visit a niece who just had a baby and was going home Wednesday.

She waited at the Amtrak depot in downtown Fresno for a 3:30 p.m. bus to take her to Stockton — a poor substitute for the regularly scheduled train ride, she said.

“I’m hoping there’s not going to be more delays and chaos,” Friaz said.

David Harris of Fresno waited at his car for his mother and sister, who returned Wednesday from an Alaskan cruise. They caught one of the buses from Merced and arrived in Fresno only 20 minutes off schedule.

“Because it was just from Merced, it was OK,” said Harris’ sister, Dina Harris, a middle school teacher in Fresno. “We’re real easy people. It wasn’t any real inconvenience.”

Businesses that rely on the railway for supplies also were slowed, but Union Pacific officials said they were working with BNSF on Wednesday to move some of its train traffic onto Union Pacific’s rail line to the east.

“We try and help each other out the best we can during these times of service interruption,” said Mark Davis, spokesman for Union Pacific in Omaha.

Dale Mendoza, owner of Quali-T-Ruck Service in Fresno, said the closed railway would “back us up about 36 to 48 hours.”

Mendoza depends on freight trains for deliveries of building supplies such as plywood and sheetrock. His product is shipped from Canada to Fresno, where Mendoza unloads it and delivers it by truck to local builders. He and some of his employees were idle as they waited for the tracks to be cleared.

“The problem is that everyone is already so far behind. They don’t have any excess supplies. They need the stuff now,” Mendoza said.

Staff writers Pablo Lopez and Jeff St. John contributed to this report. The reporters can be reached at [email protected], [email protected] or (559) 441-6330. Eyewitness Ruben Cardenas and his wife, Ruby, live in Madera. Ruben Cardenas was fixing his lunch at the kitchen window before going to work when he heard the screeching of train brakes. Five people were injured in the crash; all are expected to survive.

Eyewitness Ruben Cardenas and his wife, Ruby, live in Madera. Ruben Cardenas was fixing his lunch at the kitchen window before going to work when he heard the screeching of train brakes. Five people were injured in the crash; all are expected to survive.

Mark Crosse / The Fresno Bee

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Copyright (c) 2006, The Fresno Bee, Calif.

Distributed by Knight Ridder/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:UNP,

The Acute Care Nurse Practitioner in Hospital-Based Practice

By Bruce, Kira; Steinke, Elaine

Description of the Acute Care Nurse Practitioner Role

The Acute Care Nurse Practitioner (ACNP) is an advanced practice nurse that provides care for acute and chronically ill patients in a variety of settings. The ACNP role arose from adult Nurse Practitioners (NP) whose role evolved to include hospital-based practice and was developed to fulfill a need for inpatient care of acute and chronically ill patients. The adult ACNP role evolved in the late 1980’s and was developed to provide comprehensive care using a holistic model in collaboration with all members of the health care team, patients and their families. As changes in health care reflect the trend of cost containment and shortages of health care providers, the ACNP role continues to emerge. In order to meet the ongoing needs of critically ill patients, ACNPs are being educated to identify health risks, encourage health promotion, and manage acute and critically ill patients in the hospital-based setting (Rust & Magdic, 2000). The important role that the ACNP could play in Kansas was recognized in the mid-1990’s, and Wichita State University implemented an ACNP program in 1996. Since that time, graduates of the program have contributed to quality acute care of Kansans and across the nation. Wichita State University offers the only ACNP program in Kansas.

According to the American Association of Critical Care Nurses (AACN) Critical Care Nursing Fact Sheet, critical care nursing is specialized nursing that “deals specifically with human responses to life-threatening problems (AACN, n.d, p. 1).” Critically ill patients are those patients who have developed or are at risk for developing life threatening complications, and therefore require intense monitoring by critical care nurse. According to AACN, critical care nurses “rely upon a specialized body of knowledge, skills, and experience to provide care to patients and families and create environments that are healing, humane, and caring” (AACN, n.d., p. 5).

Managed health care has promoted the growth of advanced practice nurses in hospital-based settings. An advanced practice nurse is a nurse who has received additional training at the master’s or doctoral level and demonstrates a high level of independence. The ACNP is an advanced practice nurse with specialized training in the clinical management of critically ill patients. In the critical care setting ACNP’s make clinical decisions in the management of critically ill patients and with the problems often discovered in the critically ill. The activities of the ACNP include history and physical exam, assessment of risk factors, ordering and interpretation of diagnostic studies, and providing treatment, including medication, to treat the diagnosed illness (AACN, n.d.).

The ACNP Role in Hospital-Based Practice According to Klein (2005), in a review of the scope of practice of NP’s, the ACNP is described as being prepared to manage patients in a hospital-based setting. She describes the ACNP training as a “specialty focus in acute, episodic, and critical conditions” and the role is targeted toward inpatient focus versus outpatient practice, which is focused on the management of chronic disease. Educational preparation as an ACNP is nationally recognized as the standard for acute care scope of practice. In 2004, the role of the ACNP was further clarified with the development of a document outlining ACNP competencies (National Panel for Acute Care Nurse Practitioner Competencies, 2004). A national certifying exam for ACNP practice is administered by the American Nurses Credentialing Center, and is necessary to be able to practice in many states.

The effectiveness of the ACNP role has been demonstrated in several studies. In a descriptive article by Howie and Erickson (2002) on the initiation of ACNPs as general medical staff for an inpatient general medical service (hospitalist role), multiple studies were cited that reviewed the role and effectiveness of the care ACNPs provide. In those studies, the ACNP was noted to provide care comparable to that provided by medical residents. They also frequently provided more cost effective, individualized care, and provided for increased staff and patient satisfaction. Due to these findings, a large medical center in California established a medical service staffed primarily with ACNPs, who were assisted by a resident and an attending I physician. The ACNP team admitted and managed patients with general medical conditions in the general hospital area. This team did not follow patients in the intensive care units (ICU). The primary goal of the ACNPs was to provide excellent care with a patient-base focus without being distracted by the educational requirements that a medical resident encounters.

The initiation of the ACNP in the medical management setting required the development of the role in this specific institution. Part of establishing the role was that standardized protocols had to be developed in order to reflect the practice of the ACNP. In addition, the institution also worked with the ACNPs to develop protocols for all procedures performed by the ACNP. Continuing education requirements were also mandated for each of the ACNPs because the NPs were originally family nurse practitioners or adult nurse practitioners and required further education for their acute care role. Educational material was distributed to the staff of the institution to educate them on the role of the ACNP. At the end of the initiation period, the allied health team found the ACNP medical management team highly effective, sensitive to their patients needs, and approachable as colleagues (Howie & Erickson, 2002). This article is a good description of the development of the role of the ACNP in a hospital-based setting.

Kleinpell (2005) conducted survey research that tracked the working conditions, job satisfaction, role, and job expectations of ACNPs over a period of several years. Many aspects of these conditions were explored in order to obtain accurate information about the ACNP role. The study was conducted over a 5 year period of time, and the survey was conducted among those practitioners who took the national certification exam for the ACNP role.

The ACNP role was originally intended to function primarily in the ICU and high-acuity setting; however, results from this survey reveal that the ACNP now functions in a variety of settings (Kleinpell, 2005). In addition, the role of the ACNP has expanded greatly since the initiation of this specialty. The competencies that ACNPs learn enable them to provide services that no other advanced practice nurse can offer. The primary responsibility of the ACNP continues to be that of direct management of patient care. A common misperception of the role is that the majority of the ACNP’s time is spent in performing invasive skills. However, often misperceptions of the role stem from inadequate knowledge of the health care team on the role and abilities of the ACNP (Kleinpell, 2005). The advantages of being an ACNP were primarily identified as affecting patient outcomes. The other advantages to the ACNP role for the practitioner include the autonomy of the role, the involvement with patients and their care, and the opportunities to collaborate with other members of the health care team (Kleinpell, 2005).

The ACNP in the Intensivist Role

The ACNP in the intensivist role primarily focuses on the management of critically ill patients in the Intensive Care Unit (ICU). The intensivist role requires the ACNP to have a strong knowledge of the medical conditions and evidence-based treatments for those conditions to result in optimal outcomes. In order to achieve optimal patient outcomes, the ACNP needs to practice in collaboration with other members of the health care team. According to Rust and Magdic (2000), collaboration includes the following: cooperation, assertiveness, shared decision making, communication, planning together, and care coordination. The emphasis for the collaboration should always be the best patient outcomes.

In the intensivist role, the ACNP provides direct patient care in the ICU setting to patients who are acutely and critically ill with complex and multiple health problems. Key competencies for the ACNP include the following:

1. Demonstrates a knowledge of advance pathophysiology

2. Completes a health history

3. Conducts physical exams

4. Demonstrates the ability to order and interpret diagnostic tests

5. Demonstrates technical competence with procedures

6. Collaborates with other care providers to facilitate positive outcomes. (Rust & Magdic, 2000)

These competencies allow the ACNP to practice safely in the intensivist role of managing critically ill patients.

In a multi-disciplinary study by Hoffman, Happ, Scharfenberg, DiVirgilio-Thomas, and Tasota (2004), the perceptions of the contributions ACNPs make to medical management teams in critical care units were explored. Opinions regarding the care provided to critically ill patients by two ACNPs were obtained from physicians, respiratory therapists, and staff nurses in two ICUs in each of two adult teaching hospitals. The responses were grouped into four main areas: accessibility, competence/knowledge, care coordination/ communication, and system issues. The study findings revealed that ACNPs were accessible, experts in the management of patients, and met patient and f\amily needs in the ICU. In addition, the health care team respected the commitment the ACNPs made to provide quality care to critically ill patients, the communication skills they possessed, and the educational role that they provided to not only patients and their families, but also the nursing staff (Huffman et al. 2004). While this study demonstrated several limitations, including the overall response rate of 35% and the review of only two ACNPs from two different units within the same academic system, it does provide a good sense of how the ACNP role is perceived to function in the intensivist role by other members of the health care team.

Huffman, Tasota, Scharfenberg, Zullo, and Donahoe (2003) compared the work activities of physicians in training and ACNPs based on the time spent in management of critically ill patients in the ICU. The authors noted that several research studies have shown that patients managed by ACNPs vs. resident physicians in the ICU tend to have the same outcomes, if not somewhat better. Therefore, the purpose of this study was to explore the rationale behind those findings. This study was conducted over a 19-month period of time in which data was collected in a 6-bed step-down MICU in a university medical center. One ACNP and 6 resident physicians were evaluated during the course of this study. The findings of this study demonstrated that the ACNP and resident physicians spent about the same amount of time in routine management of the patients. However, the ACNP spent much more time (45% vs. 18%, p

This study also found that while there was no real difference in the amount of time the ACNP and the resident physicians spent in direct patient care, there was a significant difference in the amount of time each group spent interacting with other members of the health care team, patients and their families, and in other patient-related activities in the ICU. Due to small sample size of this study, further study is needed to determine if these findings are significant to patient outcomes (Hoffman et al., 2003). However, this study allows us to see the difference in how the ACNP functions in the intensivist role vs. resident physicians.

Conclusion

The ACNP is an advanced practice nurse specializing in the care of acutely and critically ill patients in multiple settings. They are a valued member of the health care team with demonstrated contributions toward improved patient outcomes. Following national trends, ACNP’s in Kansas are finding an increased demand for their role in a variety of hospital-based settings. Kansas ACNP’s collaborate daily with their physician colleagues in specialty practices, Emergency Rooms (ER) and trauma care, hospitalist practices, and intensivist roles. As the ACNP role continues to expand, these practitioners will play a vital role in the recovery of acutely ill hospitalized patients.

“Following national trends, ACNP’s in Kansas are finding an increased demand for their role in a variety of hospital-based settings.”

References

American Association of Critical Care Nurses (n.d). Critical care nursing fact sheet. Retrieved November 20, 2005, from http:/ / www.aacn.org/AACN/practice.nsf

Hoffman, L. A., Happ, M. B., Scharfenberg, C., DiVirgilio- Thomas, D., & Tasota, F. J. (2004). Perceptions of physicians, nurses, and respiratory therapists about the role of acute care nurse practitioners. American Journal of Critical Care, 13, 480- 488.

Hoffman, L. A., Tasota, F. J., Scharfenberg, C., Zullo, T. G, & Donahoe, M. P. (2003). Management of patients in the intensive care unit: Comparison via work sampling analysis of an acute care nurse practitioner and physicians in training. American Journal of Critical Care, 12, 436-443.

Howie, J. N., & Erickson, M. (2002). Acute care nurse practitioners: Creating and implementing a model of care for an inpatient general medical service. American Journal of Critical Care, 11, 448-458.

Klein, T. A. (2005). Scope of practice and the nurse practitioner: regulation, competency, expansion, and evolution. Topics in Advanced Practice Nursing eJournal, 5(2). Retrieved November 20, 2005, from medscape.com Web Site: http:/ / www.medscape.com/viewprogram/4188_pnt

Kleinpell, R. M. (2005). Acute care nurse practitioner practice: Results of a 5-year longitudinal study. American Journal of Critical Care, 14, 211-221.

National Panel for Acute Care Nurse Practitioner Competencies (2004). Acute care nurse practitioner competencies. Washington, DC: National Organization of Nurse Practitioner Faculties.

Rust, D. M., & Magdic, K. S. (2000). The Acute Care Nurse Practitioner. In A. Hamric, J. Spross, & C. Hanson (Eds.), Advanced nursing practice: An integrative approach. (2nd ed., pp. 425-457). Philadelphia: Saunders.

By Kira Bruce, RN, BSN and Elaine Steinke, PhD, ARNP

About the Authors

Kira Bruce, RN, BSN is a graduate nursing student in the Acute Care Nurse Practitioner option at Wichita State University. Mrs. Bruce received her undergraduate degree from Northwestern Oklahoma State University in Alva, Oklahoma in 2000. She is currently employed by Via Christi Regional Medical Center in Wichita, Kansas as a staff nurse in the Surgical Intensive Care Unit on the St. Joseph Campus and is a member of the American Association of Critical Care Nurses.

Elaine E. Steinke, PhD, ARNP is a professor of nursing at Wichita State University. She is the coordinator of the Adult Health & Illness Clinical Nurse Specialist and Acute Care Nurse Practitioner graduate options, and teaches courses related to the acutely, chronically, and critically ill adults. Dr. Steinke presents and publishes nationally and internationally on her research area of sexual counseling and cardiac disease. She is a member of KSNA District 6

Copyright Kansas State Nurses Association May 2006

(c) 2006 Kansas Nurse. Provided by ProQuest Information and Learning. All rights Reserved.

DENTAL PREMEDICATION PROTOCOLS for Patients With Knee and Hip Prostheses: A REVIEW OF CURRENT RECOMMENDATIONS

By Portnof, Jason E; Israel, Howard A; Brause, Barry D; Behrman, David A

Abstract

In 1997, the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) published an advisory statement regarding antibiotic prophylaxis for patients with total joint replacements undergoing dental treatment. The first periodic update of these guidelines was published in 2003. Nevertheless, confusion exists among dentists and physicians as to the clinical indications for premedication in this patient population. This article serves as an overview of current recommendations for use of chemoprophylaxis in the dental treatment of patients with prosthetic joints.

AS THE POPULATION AGES, dentists are encountering increasing numbers of patients who have undergone total joint replacement. In the United States, approximately 450,000 total joint arthroplasties are performed annually.1,2,9 Joint surgery is most common in patients 50 years of age or older.9 The majority of replacement procedures involve the joints of the lower extremities, such as the knee or hip.7

Joint replacement surgery provides a patient with improved function and quality of life. However, infection of an artificial joint prosthesis is a serious complication that causes significant morbidity. Pain, loss of function, wound breakdown, wound discharge and implant failure are severe problems for the patient and physician.17

Long-term antibiotics and extensive revision surgery are often necessary when severe infection results in failure of the implanted prosthesis. Such failures can affect a patient beyond simple quality- of-life issues. In approximately 10% to 15% of cases, attempts at curing the infection fail.17 The afflicted patient is compelled to undergo multiple cycles of treatment and experiences progressively deteriorating joint function.17 These patients may undergo chronic antibiotic therapy, arthroscopic joint drainage, surgical arthrodesis (joint fusion), surgical debridement, surgical removal of infected hardware, one- or two-stage surgical reimplantation of a new prosthetic joint, and, possibly, limb amputation.21,22 Mortality associated with prosthetic joint infections has been estimated to be as high as 2.5%.19

In order to reduce the probability of late infection of artificial joints, the dental practitioner must use current concepts in preventative medicine and chemoprophylaxis. However, antibiotic use is associated with severe risks. These risks include antibiotic- induced anaphylaxis and toxicity, increased incidence of superinfection and selection of antibiotic-resistant bacterial species.1,3,10,13 An inherent risk-benefit relationship exists that precludes indiscriminate premedication of all patients with prosthetic joints. Antibiotic prophylaxis should be reserved for patients determined to be at high risk.1,2,6,9,27

Systemic risk factors for prosthetic joint infection have been proposed to include rheumatoid arthritis, diabetes mellitus, psoriasis, steroid therapy, malignancy, poor nutritional status, advanced age and obesity.17,19,21 Local risk factors for failure of an implanted prosthesis include prior joint surgery, prolonged operating room time, postoperative surgical site infection and a slow-to-heal operative wound.17,19

Pelvic X-ray of patient with bilateral total hip prostheses. The patient’s left prosthesis (right side of image as you view it) is infected with large lucencies present around prosthesis. Right hip prosthesis is not infected.

The most recent ADA/AAOS advisory statement on antibiotic prophylaxis for dental patients with total joint replacements concludes that “antibiotic prophylaxis is not indicated for dental patients with pins, plates or screws, nor is it routinely indicated for most dental patients with total joint replacements.”2 The advisory statement further explains that “it is advisable to consider premedication in a small number of patients who may be at potential increased risk of experiencing hematogenous total joint infection.”2 Patients with potential increased risk include all patients during the first two years following joint replacement, immunocompromised/immunosuppressed patients (that is, inflammatory arthropathies, such as rheumatoid arthritis, systemic lupus erythematosus), and patients with comorbidities (that is, previous prosthetic joint infections, malnourishment, hemophilia, HIV infection, insulin-dependent diabetes, malignancy).2

The large number of patients who suffer from systemic conditions placing them at increased risk for prosthetic joint infection compels dental practitioners to realize that a real and prevalent risk exists. Each patient presenting to the dentist with a prosthetic joint should be screened carefully for potential risk through a meticulous medical history. Ideally, all patients undergo a pre-prosthetic surgery assessment by a dentist, at which time, appropriate dental care is administered.

Pathogenesis

Postoperative infection of prosthetic joints is categorized on a continuum. Early infections are those that occur within two months of surgery, and delayed infections occur between two months and one year.4,14 Late infections are those that present more than one year after implantation.4,14 These infection categories are arbitrary, as there can be long latency periods between the onset of infection and the onset of symptoms and diagnosis.30

Incidence of early infection can be attributed to bacterial contamination during the surgical procedure or the immediate postoperative period (prior to incisional healing). This incidence has been markedly reduced by the use of preoperative antibiotic prophylaxis and modernized surgical methods and aseptic technique.2,4,14,27 Technological advances include antibiotic- impregnated methylmethacrylate cements during placement of the implant prosthesis, operating rooms with controlled laminar air- flow systems, and body exhaust suits that reduce the risk of contamination intraoperatively. 17,18,19 With these advances, the prevalence of early postoperative infection is now approximately 1% of cases.4,18,19

Early infections commonly present with features of obvious wound infection, including localized pain (exacerbated by movement), loss of range of motion, induration, edema, warmth, tenderness and wound drainage.17,19

Delayed and late infections commonly present with pain, a loose prosthesis and occasional sinus track formation.17 The patient may provide a history that includes the statement that the prosthesis “never felt right” and that the surgical wound healed slowly despite antibiotic treatment.17 The major determinants of clinical presentation are the characteristics of the host tissue in which the organism grows, the virulence of the infecting pathogen and the route of infection.29 Table 1 lists the frequencies of common presenting symptoms of prosthetic joint infections.29

TABLE 1

Presenting Symptoms of Prosthetic Joint Infections

Patients experiencing late infection may present to their primary care physician, orthopedist or rheumatologist with reports of pain localized to the site of a previously asymptomatic total joint replacement.14 A patient suspected of having the late complication of septic arthritis in a prosthetic joint will often require arthrocentesis.14 Evaluation of the synovial fluid from the affected joint, including gram staining, culture and sensitivity testing of isolated organisms, is standard.14,18 Radiological and nuclear medicine imaging of infected prosthetic joints is also available, offering a debatable benefit to diagnosis or outcome.19,23 A discussion of the treatment of prosthetic joint infections is beyond the scope of this review.

Delayed and late infection of prosthetic joints can be the result of hematogenous seeding or direct wound contamination. Hematogenous spread is the process by which bacteria from distant sites of infection travel through the bloodstream to seed new loci of infection. It is estimated that approximately 20% to 40% of prosthetic joint infections develop from hematogenous spread.29 The two years immediately following prosthetic joint placement are considered to be the most hazardous periods in terms of potential hematogenous seeding of the implant site.2,12 It has been hypothesized that enhanced vascularity of the implant site during these two years of postsurgical wound healing facilitates hematogenous seeding of bacteria.18

Hematogenous infection of successfully placed prosthetic joints has rarely been linked with dental-induced bacteremia.4,7 Most joint infections are caused by staphylococci (that is, Staphylococcus aureus, Staphylococcus epidermidis and other coagulase-negative staphylococci ).23,27 Viridans streptococci, the predominant oral bacterial species, have been isolated less frequently. 3,4,12,13 Pallasch and Slots combined the microbiological data from six clinical studies to determine that approximately 66% of 281 microbial isolates from prosthetic joint infections were typed as staphylococci, while only 4.9% were categorized as viridans streptococci.13

Steckelberg and Osmon studied 1,033 cases of total hip and knee prosthetic joint infections at the Mayo Clinic between 1969 and 1991. They found that the majority (61%) of infections were caused by aerobic gram-positive cocci.30 The most commonly isolated organisms in this study were S. aureus, coagu\lase-negative staphylococci, beta hemolytic streptococci, viridans group streptococci and enterococci.30

Viridans streptococci, such as Streptococcus mitis, Streptococcus sanguis and Streptococcus mutans, are classified in the laboratory as α-hemolytic, gram-stain-positive organisms. Viridans streptococci are normal flora of the oropharynx, but are potentially pathogenic in the bloodstream. They are the microorganisms of primary concern to the dentist in preventing hematogenous seeding of prosthetic joint implants (and abnormal cardiac valves as well).

Viridans streptococci and other bacteria have virulence factors that enhance their ability to promote infection in a susceptible host. Pathogenic bacteria are noted to express adhesions on their cell surfaces that allow them to attach to host cells and implanted biomedical devices.17,23 These adherent bacteria are capable of forming a complex biofilm with an extracellular polysaccharide matrix that facilitates bacterial colonization and attachment to the prosthetic joint surface. Staphylococci expressing fibronectin- binding proteins have been specifically implemented in prosthetic joint infections.23

In addition, the glycocalyx of the biofilm aids in bacterial resistance to antibiotics and evasion of the host immune response.17,23 The glycocalyx acts as a poorly permeable barrier, preventing antimicrobials and immune cells from reaching bacteria deeper within the biofilm. Some bacteria, including staphylococci, may evade the immune response by invading host cells and surviving intracellularly.23 The M protein found on the cell surface of group A streptococci is antiphagocytic and facilitates immunoavoidance. Motility of certain bacteria (that is, gram-negative bacilli) through flagella and fimbriae also contribute to their virulence.17

It is hypothesized that certain bacterial products stimulate bone resorption by directly affecting the balance between osteoblast and osteoclast function.17 Several bacteria produce tissue toxins and enzymes, such as leukotoxins and hemolysins, that facilitate destruction of host tissue.23 Some authors propose that the presence of infection at the implant site may cause the local production and release of inflammatory cytokines and host enzymes.17,23 These cytokines can result in an inflammatory response and bone loss at the prosthesis cement-bone interface.

The implanted prosthesis is foreign material within the human body. As such, some researchers believe the implanted prosthesis is surrounded by an immuno-incompetent fibro-inflammatory zone that makes the region susceptible to infection.3,7,12,15 Fewer organisms are required to initiate infection, and once an infection is established, it cannot be eradicated easily with antibiotics.

The Dentist’s Role

It is important to focus efforts on preventing infection rather than to engage later on in exhaustive efforts at fighting a tenacious, destructive disease process. Through careful management of the patient’s oral health, the dentist plays a pivotal role in this endeavor.

It is probable that oral bacteremia spontaneously induced by daily events such as mastication and toothbrushing/flossing occur more commonly than bacteremia arising from periodontal treatment. 2,13 Dental treatment-induced bacteremia is considered to be of low- grade intensity and of short duration.13 Procedures thought to be traumatic to the oral tissues (that is, tooth extraction, periodontal surgery, scaling and root planing) cause higher rates of bacteremia than less invasive therapy (restorative dentistry, endodontic treatment). 2,13 Table 2 illustrates incidence stratification of bacteremic dental procedures. Acute dental infections are more strongly linked to bacteremia than dental manipulation in a healthy dentition.4

Recommendations

It is recommended that patients planning to undergo total joint arthroplasty be in good dental health. Maintenance of good oral health should be a major motivation of patients who are candidates for total joint replacement, because it has been shown that as the severity of gingival inflammation increases, the incidence and magnitude of bacteremia also increases.13,16 It is advisable that potential joint replacement patients be assessed by a dentist and determined “dentally fit” prior to surgery.4

TABLE 2

Incidence Stratification of Bacteremic Dental Procedures

Patients who have poor oral health should be evaluated by a dentist, and proper oral care should be administered. Effective daily oral hygiene practices need to be stressed prior to and after joint replacement surgery. Anti-infectives such as chlorhexidine and other antiseptic mouthwashes, administered immediately prior to dental procedures, should be part of the dentist’s armamentarium.4,13,16 The oral health of the prosthetic joint patient should be monitored regularly through routine dental visits. A goal of reducing baseline oral inflammation manifesting as gingivitis and periodontal disease is paramount. Efficient caries control is also vital.

The ADA/AAOS recommendations for antibiotic prophylactic therapy are based on an empiric regimen targeting the microbes most frequently responsible for late prosthetic joint infections. Models theorizing that late prosthetic joint infections are analogous to infective endocarditis are inaccurate. The blood supply, anatomy, microorganisms, host defenses and mechanism of infection are different in the two disease processes.2,13

Dental clinicians must choose prophylactic antibiotic regimens that target pathogenic species more likely involved with dental bacteremia, such as gram-positive streptococci (that is, Viridans streptococci, peptostreptococci). Table 3 provides a list of ADA/ AAOS recommended antibiotic prophylactic treatments. These regimens are single-dose schedules administered one hour prior to the procedure. No second doses are recommended for any of the suggested regimens.

The antimicrobial agents of choice for prophylactic treatment of dental patients with total joint replacements are the β-lactam antibiotics. This class of antimicrobial generates their bactericidal effect as inhibitors of bacterial cell wall synthesis. The extended spectrum penicillin antibiotics, such as amoxicillin (oral administration) and ampicillin (intramuscular or intravenous administration), provide activity against both gram-negative and gram-positive organisms. Because intramuscular injections are painful and unpleasant for the patient, alternative routes of administration should be considered first. Amoxicillin is quickly absorbed through the GI tract and obtains high serum levels, making it ideal for prophylaxis prior to dental procedures.

TABLE 3

ADA/AAOS Suggested Antibiotic Prophylaxis Regimens

First-generation cephalosporins are generally most effective against aerobic gram-positive cocci. Cephalexin and cephradine are first-generation cephalosporins that can be given orally, while cefazolin can be administered intramuscularly or intravenously. There is potential cross-hypersensitivity between penicillins and cephalosporins. If this is a concern, it is best to consult with the patient’s internist or allergist to determine the most appropriate antibiotic coverage.

Clindamycin is a bacteriostatic antibiotic that acts to inhibit bacterial protein synthesis. It targets the 50S bacterial ribosomal subunit and is effective against anaerobes and gram-positive aerobic bacteria. It is provided in either oral or intravenous preparations. Both amoxicillin and clindamycin are highly effective against oral anaerobes. As it is not a β-lactam antibiotic, clindamycin is available for use in patients who are allergic to penicillin.

In order to prevent deleterious sequela, dentists are obliged to be knowledgeable about the protocols for dental treatment of patients with artificial joint implants. With a careful review of the patient’s medical history, dentists must use competent clinical judgment to determine which patients are appropriate candidates for prophylactic antibiotic therapy.

The dentist, primary care physician and orthopedic surgeon should work together in the treatment of the patient with total joint replacement. Open lines of cooperative communication among the specialties provide for optimal patient care.

If a patient who does not meet the ADA/AAOS guidelines for prophylactic antibiotic treatment presents with physician recommendations for chemoprophylaxis, the dentist is obligated to meticulously investigate the risk versus benefits of antibiotic prophylaxis. A consultation with the physician will clarify his or her concerns for the patient. It is possible that the physician’s recommendation is based on a change in the patient’s medical history that is not known to the dentist.

An interdisciplinary approach combining the efforts of physician and dentist allows for the best possible treatment of patients. Clinical decisions regarding prophylactic antibiotics for expectant dental bacteremia should be made on an individual basis.

The ADA Division of Legal Affairs reminds us that “each independent professional is ultimately responsible for his or her own treatment decisions.”1, 2, 10 A dentist should never blindly follow a physician’s recommendations for treatment when those recommendations conflict with the dentist’s professional judgement.1, 10 Rather than prescribing an antibiotic regimen that is inconsistent with the dentist’s clinical judgment, the dentist should discuss the treatment decisions with the patient and his or her physician.

Dentists are encouraged to educate health care providers unfamiliar with the ADA/AAOS guidelines for antibiotic prophylaxis in patients with total joint replacement.1, 2, 6, 11 If no consensus can be reached among the health care providers, the physician may then choose to prescribe antibiotic premedication for the patient. The dentist is not required to write prescriptions for an antibiotic regi\men that conflicts with his or her medical opinion.11 Dentists are obligated to explain all risks, benefits, alternatives and complications of treatment (including antibiotic treatment) to their patients to ensure that the patient makes all treatment decisions with proper informed consent.1, 10

There is a need for scientific studies to determine appropriate candidates for antimicrobial prophylaxis in dentistry.8 In the modern era of evidence-based medicine, a double-blind, randomized controlled clinical research trial is considered a gold standard model for clinical decision making. However, no such clinical trial has been published to determine the efficacy of prophylactic antibiotic treatment on the incidence of late prosthetic joint infection due to hematogenous spread of oral organisms.4, 8, 27 Ethical and logistical issues prevent such a trial from being performed.

As clinical science advances, polymerase chain reaction (PCR) and DNA fingerprinting of organisms isolated from the affected patient’s oral cavity, blood stream and synovial fluid may help us revise our protocol for chemoprophylaxis.4, 25, 26 Until that time, dentists must use clinical judgment to determine whether chemoprophylaxis is indicated for each patient’s specific situation.

The authors acknowledge the assistance of Ms. Kimberly J. Mason, B. A., in the preparation of this manuscript.

REFERENCES

1. American Dental Association, American Academy of Orthopedic Surgeons. Advisory Statement. Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc 1997 Jul;128(7):1004-8.

2. American Dental Association, American Academy of Orthopedic Surgeons. Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc 2003 Jul; 34(7):895-9.

3. Kingston R, Kiely P, McElwain JP. Antibiotic prophylaxis for dental or urological procedures following hip or knee replacement. J Infect 2002 Nov; 45 (4): 243-5.

4. Seymour RA, Whitworth JM. Antibiotic prophylaxis for endocarditis, prosthetic joints, and surgery. Dent Clin North Am 2002 Oct; 46 (4): 635-51.

5. Epstein JB, Chong S, Le ND. A survey of antibiotic use in dentistry. J Am Dent Assoc 2000 Nov;131(11):1600-9.

6. Tong DC, Rothwell BR. Antibiotic prophylaxis in dentistry: a review and practice recommendations. J Am Dent Assoc 2000 Mar;131(3):366-74.

7. Deacon JM, Pagliaro AJ, Zelicof SB, et al. Prophylactic use of antibiotics for procedures after total joint replacement. J Bone Joint Surg 1996;78A (11):1755-71.

8. Lockhart PB, Brennan MT, Fox PC, et al. Decision-making on the use of antimicrobial prophylaxis for dental procedures: a survey of infectious disease consultants and review. Clin Infect Dis 2002 Jun 15;34(12):1621-6.

9. Curry S, Phillips H. Joint arthroplasty, dental treatment, and antibiotics: A review. J Arthroplasty 2002 Jan;17(1):111-113.

10. ADA Division of Legal Affairs. A legal perspective on antibiotic prophylaxis. J Am Dent Assoc 2003 Sept;134(7):1260.

11. Siegel MA. To premedicate or not to premedicate. J Am Dent Assoc 2004 Feb;135 (2):144,146.

12. Hansen AD, Osmon DR, Nelson CL. Prevention of deep prosthetic joint infection. Am J Bone Joint Surg 1996;78-A (3):458-71.

13. Pallasch TJ, Slots J. Antibiotic prophylaxis and the medically compromised patient. Periodontol 2000. 1996;10:107-38.

14. Klippel JH. (editor). Infectious Disorders: Septic Arthritis. Primer on the Rheumatic Diseases. 12th Ed. Arthritis Foundation Publication. Atlanta 2001:259-264.

15. Gristina AG. Implant failure and the immuno-incompetent fibro- inflammatory zone. Clin Orthop 1994;298:106-118.

16. Dajani AS, Taubert KA, Wilson W, et al. Prevention of bacterial endocarditis: recommendations by the American Heart Association. JAMA 1997;277(22):1794-1801.

17. Berendt AR, McLardy-Smith P. Prosthetic joint infection. Curr Infect Dis Rep. 1999 Aug; 1(3):267-272.

18. Brause BD. Prevention of infections in total joint replacements: interviews with experts. Hospital for Special Surgery; April 24,2002: http://www. hss. edu/Professionals/Conditions/ Joint- Replacement-Surgery/Prevent-Infection-Joint-Replacement.

19. Lentino JR. Prosthetic joint infections: bane of orthopedists, challenge for infectious disease specialists. Clin Infect Dis 2003 May 1;36(9):1157-61.

20. Fisman DN, Reilly DT, Karchmer AW, et al. Clinical effectiveness and cost-effectiveness of 2 management strategies for infected total hip arthroplasty in the elderly. Clin Infect Dis 2001;32:419-30.

21. Spirt AA, Assal M, Hansen ST Jr. Complications and failure after total ankle arthroplasty. J Bone Joint Surg Am 2004 Jun; 86- A(6): 1172-8.

22. Bernard L, Hoffmeyer P, Assal M, et al. Trends in the treatment of orthopaedic prosthetic infections. J Antimicrob Chemother 2004 Feb;53(2):127-9.

23. Shirtliff ME, Mader JT. Acute septic arthritis. Clin Microbiol Rev. 2002 Oct;15(4): 527-44.

24. Dubost JJ, Soubrier M, De Champs C, et al. Streptococcal septic arthritis in adults. A study of 55 cases with a literature review. Joint Bone Spine 2004 Jul;71(4):303-11.

25. Gupta MN, Sturrock RD, Field M. Prospective comparative study of patients with culture proven and high suspicion of adult onset septic arthritis. Ann Rheum Dis 2003 Apr;62(4):327-31.

26. Canvin JM, Goutcher SC, Hagig M, et al. Persistence of Staphylococcus aureus as detected by polymerase chain reaction in the synovial fluid of a patient with septic arthritis. Br J Rheumatol 1997 Feb;36(2):203-6.

27. van Schaardenburg D, Kaandorp C, Krinjnen P. Cost- effectiveness of antibiotic prophylaxis for bacterial arthritis. Expert Opin Pharmacother 2002 Mar;3(3): 271-5.

28. Culver DH, Horan TC, Gaynes RP, et al. Surgical wound infections rates by wound class, operative procedure, and patient risk index. Am J Med 1991; 91 (Suppl 3B): S152-7.

29. Brause BD. Infections with Prostheses in Bones and Joints. Principles and Practices of Infectious Diseases. 6th Edition. Mandell GL, Bennett JE, Dolin R, editors. Philadelphia, PA: Elsevier Churchill Livingston. 2005;Chapter 100:1332-1337.

30. Steckelberg JM, Osmond DR. Infections Associated with Indwelling Medical Devices. 2nd Edition. Bisno AL, Waldvogel FA, editors. Washington, DC:ASM Press.1994;Chapter 11:259-290.

Jason E. Portnof, D. M. D., M. D.; Howard A. Israel, D. D. S.;

Barry D. Brause, M. D.; David A. Behrman, D. M. D.

Copyright Dental Society of the State of New York Apr/May 2006

(c) 2006 New York State Dental Journal. Provided by ProQuest Information and Learning. All rights Reserved.

Identity Takeout: How American Jews Made Chinese Food Their Ethnic Cuisine

By Miller, Hanna

WONTON SOUP, BARBECUED SPARERIBS, KUNG PAO CHICKEN, AND shrimp fried rice. This is a Jewish dinner? In the United States, yes. The cuisine of China has emerged as American Jewish comfort food, earning a seat of honor in the assembly of contemporary ethnic practices. Even secular Jews who fumble with tefillin and mezzuzot, the traditional cornerstones of Jewish material culture, may feel a nostalgic stir at the sight of a wirehandled red and white Chinese takeout box. “Eating Chinese” has become a ritualized element of the ongoing acculturation process that affirms traditional values while embracing new ones. It repackages familiar Jewish sensibilities in an exotic and appealing form. In the language of Lenny Bruce, Chinese is Jewish.

I had initially hoped to determine why Jews chose Chinese food as their culinary proxy. But the historical record refused to yield my Lucy, the not-quite simian who is believed to have bridged humans and apes; there is no record of the first dissatisfied immigrant Jew plunking down his spoon in a bowl of borscht before wandering into a neighboring chow mein joint. The whys for which I searched seemed to be lost in a fog of chopstick wrappers and discarded takeout menus. So I opted to concentrate on the questions I could better slice and dice, in the manner of chop suey purveyors everywhere. I set out to discover when and where American Jews developed the habit of eating Chinese food, and how the affinity became an integral component of Jewishness.

The Jewish Belly

The stereotypical Jewish mother’s exhortations to “eat, eat” are hardly an innovative addition to the Jewish cultural tradition. Rather, they echo the Biblical commandment to “eat and be satisfied.” For food is not merely an antidote to a bodily urge in the Judaic tradition, it is endlessly symbolic, representing the human relationship to God, providing the framework for annual festivals, and evoking ancestral traditions. The commingling of food and spirituality-central to holidays such as Passover and Shabbat, which could not continue without the appropriate iconic foodstuffs- was annually reenacted at Eastern European yeshivas where the youngest students were encouraged to lick Hebrew letters written in honey (Marcus 18). So potent was this triangulation of food, holiness, and a good life that Talmudic scholars warned of the woes awaiting those who failed to savor the food component of the equation. “We consider a meal to be a religious act,” Ronald Brauner explained in his essay “Kosher Has Nothing To Do With Food.” It is “an act which calls to mind our relationship with the world around us and our dependence upon the benevolence of the Source of all nourishment” (22).

The Jewish preoccupation with food is at least partially rooted in kashrut, the intricate set of dietary restrictions codified in the Torah. These laws forbidding the mixing of milk and meat products demand the attentions of every hungry observant Jew, for even the slightest lapse in vigilance might result in a situation that only a blowtorch could mend. Jewish homemakers must not only purge mongrel dishes from their menus, they must purchase their meats from a ritual slaughterer; equip their kitchens with two sets of dishes, cutlery, and utensils; and completely shun treyf, or unkosher foods such as pork and shellfish. The reach of kashrut extends far into the realm of the seemingly arcane, regulating the cleansing of dentures and stipulating how much time must pass between a meat and milk meal (six hours, to prevent the milk from mingling with belched meat vapors).

So what did Ashkenazi Jews eat? For much of their history, not enough. Poverty dictated a diet of black bread, potatoes, and herring (Diner 156). The primary seasonings, added with a generous hand, were salt and garlic. The garlic plant in particular was so indelibly associated with Jews that the Nazis issued buttons with pictures of garlic plants to demonstrate the wearer’s ardent anti- Semitism. “The mere mention of garlic by a Nazi orator caused the crowd to howl with fury and hatred,” wrote Mark Graubard (72). Onions were everywhere; Transylvania-born Bella Spewack, reared on a traditional Eastern European diet, recalled being shooed from her Lower East Side elementary school classroom after having eaten one too many of the offending bulbs:

Miss Houston stretched out a white arm and motioned me away and to silence. “Stop,” she said aloud so that the whole class heard. “You smell of onions!” I stopped, and out in the hall I cried softly and argued with myself. “What was the matter with onions? Didn’t she know onions made you feel as full as if you’d eaten meat?” (21)

Their singular culinary indulgence was saved for the end of the week: a Sabbath meal perfectly honed for the cold climes of Eastern Europe, replete with as much choient and tsimmes, gefilte fish, chicken soup, kugels, and knishes as they could afford. It was a celebratory menu derived from thousands of years of exile, incorporating delicacies from Europe’s sleepy rural corners and vibrant urban centers. “The wanderings of the Children of Israel since Biblical times has made Jewish cookery international,” Mary Shapiro wrote in her 1919 assessment of Jewish American nutritional patterns, which concluded with a plea for more fresh vegetables. Shapiro traced the Jewish staples of kasha to Russia, pickles to Holland, olives to Spain, and stuffed fish to Poland (“Jewish Dietary Problems”).

When Eastern European Jews immigrated to America-about two million arrived between 1880 and 1920-they brought their affinity for the hot, fatty, salty, and pickled with them (Howe xix). No longer content to allow the rich to feast while they merely subsisted, new American Jews strove to mimic the meals of the old country’s well-todo. They reveled in excess, producing towering banquets of food for special occasions (Gabaccia 81). They toiled over household budgets which put meat on the table nearly every night of the week. “Now all of us had meat, not only father,” rejoiced the greenhorn heroine of Anzia Yezierska’s largely autobiographical Bread Givers (114). Recalling his boyhood in Brooklyn, comedian MeI Brooks rhapsodized over his mother’s skills with a cleaver: “As long as [my mother] was cooking, we never went to a Chinese restaurant. I mean the pot roast, the knaydlach, the stuffed gedempte, all those things with a ‘chuch’ and a ‘chach’ at the end-they melted in your mouth” (“Eating”).

When inflation threatened to deprive immigrants of their kosher meat fix in 1902, Lower East Side homemakers led a revolt that deteriorated into a riot, with dozens of the 20,000 picketers gathered at New Irving Hall launching slabs of beef at scabs and shopkeepers. A boycott of kosher butchers proved more successful, leading to a four percent price cut after three weeks (Maffi 166).

So entranced were first-generation American Jews by the powers of meat that in 1944, a worried mother wrote The Jewish Daily Forward, urgently seeking help for her son, the vegetarian. “About nine months ago, he took it into his head to stop eating meat,” the woman wrote, every word throbbing with despair. “At first I thought he was tired of meat, but there is no end to it. Not only does he refuse meat, but he doesn’t even eat fish or sardines. Worthy Editor, I’m afraid my son will grow up to be sickly.” The editor of the leading Yiddish newspaper prescribed a trip to the doctor (Metzker 73).

The young vegetarian was likely not alone in his rejection of the meat dishes that weighed down the American Jewish table. Many children of immigrants rued the incessant parade of boiled meats and congealed chickens. Physicians wondered whether the steady diet of fat and grease was not a factor in the reported Jewish propensity for indigestion. Humorist Nathan Ausubel in 1951 struck a serious note in his discussion of the phenomenon:

It has been observed by doctors that Jews, largely those belonging to the well-fed classes, suffer disproportionately to other groups from gastrointestinal disorders. They are tireless consumers of hot water before breakfast, of seltzer water, Epsom salts, milk of magnesia, citrate of magnesia, bicarbonate of soda, Ex-Lax, Turns, Pluto Water, and whatnot. They are only too often afflicted with gallstones, peptic ulcers, and liver trouble. (356)

Second- and third-generation Jews precipitated an ethnic eating revolution by rejecting kashrut as impractical and anachronistic. This embrace of secularism permeated every aspect of Jewish assimilation, from language to dress. Rose Cohen, who moved to New York from Russia at the age of twelve, remembered her easy dismissal of the Jewish law forbidding business transactions on Shabbat. A week after her arrival in the early 1890s, she was horrified by the prospect of transgression:

Father stopped at a fruit stand and told me to choose what I wanted. There was nothing strange to me in that. At home when we sold fruit, Jewish people came on Saturday to eat apples or pears for which they paid the following week . . . I looked up into my father’s face. I felt proud of him that he had credit at so beautiful a fruit stand. As I received the melon in my fingers I saw father take his hand out of his pocket and hold out a coin. I felt theblood rush to my face. Then I dropped the melon on the pavement and ran. “My father has touched coin on the Sabbath!” (65)

Cohen is not consoled by the memory of her grandmother warning her that violating the Sabbath will lead inevitably to violating kashrut. She writes: “Oh God,” I thought, “will it really come to that? Shall I eat swine? No, I shall not eat swine, indeed I shall not!” (78). But her resolve dissipates within the year, and Cohen begins complaining that her father does not give her enough coins with which to buy penny candy treats on Saturdays (94).

Barbara Schreier argues the Jewish abandonment of traditional practices allowed immigrants to “fit in,” and sped their adjustment to a foreign culture. In Yiddish playwright Kobrin’s late nineteenthcentury comedy The Nextdoor Neighbors, Hindele’s success as a wife hinges on her willingness to adopt American clothing. “I am Willy, do you understand?” her husband asks. “Without a beard. And I do not pray, and I eat milk and meat dishes from the same plate-and you are pious!” (96)

The transition from kashrut to the American way of eating was fraught with anxiety for many Jews, who instinctively shuddered at the very thought of treyf. Bronx-dwelling Jews of the 1930s were chilled by a pervasive urban legend of a little boy who had contracted a certain deadly disease which could only be cured by ingesting bacon (Gay 169). Other Jews engaged in intricate bargaining that often struck their children as hypocrital (Fishman 136). Feminist Letty Cottin Pogebrin’s mother, who maintained her home was “strictly kosher,” served her children fried strips of bacon on paper plates, calling them “lamb chops on paper.”

In my family, kashruth was one of those realities with many layers. At home, my mother obeyed the Jewish dietary laws; she bought her meat from the kosher butcher and maintained separate sets of dishes and cookware for meat and dairy meals. However, in the homes of people who did not keep kosher, we ate meat with milk- Chicken a Ia King, for instance-and in restaurants we ate trayf, ritually unclean foods like pork or shellfish. (10)

By 1967, sociologist Marshall Sklare had confirmed decades of seemingly alarmist reports concerning the widespread abandonment of kashrut. Fewer than ten percent of third-generation Jews kept kosher (Sklare and Greenbaum 51).

Freed from the constraints of kashrut, “Jewish” food became a far more flexible category. second-generation Jews began gobbling down bagels and lox, pastrami sandwiches, egg creams, cheesecake, and coffee-based Manhattan Specials, treats with only a tenuous connection to their mothers’ beloved meals. Yet these foods, which would have been unfamiliar to the devourers’ Eastern European ancestors, retained the magical properties attributed to earlier favorites. Food was still believed to foster spiritual connectivity and facilitate the good life.

The easy revision of the American Jewish diet was almost unprecedented in its pace.7 By 1997, philosopher Joshua Halberstam declared traditional Eastern European Jewish fare of the kasha and choient variety extinct: “Jewish foods survive only in the tired humor of tired comedians; American Jews are more familiar with sushi than gefilte fish” (101). Most ethnic groups cling to a culinary conservatism that inhibits the wholesale removal of treasured foodstuffs from its communal pantry. The inevitable cycle of acculturation rarely chips away at what Herbert Passin and John Bennet have termed the core immigrant diet; peripheral foods, such as certain cuts of meat, are more likely to fall prey to the process. Rice, for example, has remained a mainstay of many Asian American diets. Susan Kalcik suggests foodways are particularly resistant to change because “the earliest-formed layers of culture are the last to erode.” Regardless of age, she argues, ethnic foodways function as a signifier of group identity, a cohesive bond, and a communicative device (39).

Kalcik’s conclusions would not have been news to the thousands of adherents to “kitchen Judaism,” a distinctively American riff on Jewish identity that became voguish during the mid-twentieth century. Kitchen Judaism was an informal secular practice marked by the embrace of newly “Jewish” foods, both sacramental and otherwise, as an expression of group loyalty and pride.8 Ausubel documented its followers, including the tearful American in Paris who longed for nothing more than a corned beef sandwich on Jewish rye-“as you eat it, my God!,” the American instructed Ausubel, “think of me!”-and a mandlen fancier in New York City: “He feels as if he were participating in the reception of the mystic Sabbath Bride as visioned by the medieval cabalists. And as for a strip of helzel- holy, thrice holy” (356)! Ausubel prophesized Culinary Judaism would outlast Synagogue Judaism: “a slice of hot noodle kugel should make all in Israel brothers!” (356). This trend worried those faithful to “Synagogue” Judaism, which until recently had not required a descriptive adjective. A rabbi of the 1940s lamented that if religious participation was measured by eating habits, the Jews would boast “a one hundred percent religious community” (Joselit 171).

Oyesessen!

Throughout the eighteenth and nineteenth centuries, most Americans ate where they worked, slept, prayed, and played-at home. The very word restaurant was still trudging along as a present participle until a Parisian bouillon maker and linguistic entrepreneur in 1765 advertised “Boulanger serves divine restaurants.” The term was soon used to describe the eating houses blossoming on either side of the Atlantic (Spang 8).

While the debate surrounding “America’s first restaurant” may qualify as the young nation’s first serious food fight, many historians comfortably bestow the title upon Delmonico’s in New York City. Giovanni Del-Monico, a retired Italian-Swiss sea captain, and his brother Peter opened a caf and pastry shop in 1827 on South William Street. The establishment quickly outgrew its six pine tables and bonbon regimen; by 1835, the brothers and their nephew Lorenzo presided over an exclusive dining room, where wealthy uptowners feasted on course after course of salmon filets and chateaubriand (Hooker 144). Delmonico’s-and a score of imitators- was responsible for the ironclad culinary theorem that guided nineteenth-century foodies: deferential service and finicky French food equals good taste.

The Delmonico’s experience, however celebrated, was decidedly atypical. Most public dining in the early nineteenth century was confined to inns, taverns, and boarding houses, where heartier fare was the rule. Long tables were heaped with corn bread, fat pork, pies, and chickens to feed thousands of travelers and the legion of flies that accompanied them. Most hotels and inns operated on the American plan, meaning guests paid for the privilege of partaking, no matter how much they actually ate. The system led to aggressive elbowing and rushed eating; a doctor in the 1860s marveled at 250 diners in a Maine inn, of whom only twenty remained at the table ten minutes after the meal was served (Hooker 147). The process was ultimately standardized and simplified for westward travelers by Fred Harvey, whose railway restaurants boasted fresh produce, polished silverware, and pretty girls (Hooker 268).

Harvey was not the only innovator reshaping the eating-out experience in the late 1800s. Bustling urban areas were crowded with businessmen and sightseers who could not conveniently return home for lunch. The oyster cellar, an all-you-can-eat institution of early New York, was then reeling from the over-fishing and flagrant pollution of nearby oyster beds. Hungry city folk instead lunched at automats, cafeterias, and department stores, where women were not greeted by an unwelcoming cloak of cigar smoke. Street vendors hawked edible novelties, including pickles, potato chips, ice cream cones, and hot dogs.

The increasingly public dimension of eating was foreign to immigrant Jews, who had little opportunity to dine out in Eastern Europe. Inns were among the few commercial establishments engaged in food service, but the strictures of kashrut kept Jews from becoming regular patrons (Diner 200).

Perhaps generations of abstinence fueled the ferocity with which American Jews embraced the restaurant. By 1903, the Jewish Daily Forward coined a new Yiddishism: oyesessen, or eating out. Oyesessen, the paper reported, “is spreading every day, especially in New York.” The Forwards, editors nodded their heads in approval at the trend, praising participating immigrants for educating themselves about unfamiliar cuisines, integrating themselves into their new communities, and capitalizing on America’s material offerings (Diner 200).

The Jewish immigrants flocked first to neighborhood cafs, or “coffee and cake parlors.” These gathering places served much the same function as beer gardens and saloons did for German and Irish immigrants of earlier generations: they provided recreation, employment, and support. For Jews, who traditionally confined their drinking to festivals within the home or synagogue, the cafs were community centers. Unlike the all-male bastions, which dominated the Irish social scene, the only prerequisite to parlor entry was a political opinion. According to a publication issued in 1906 by New York’s Liberal Immigration League, there were more than 300 such parlors (which, despite their name, trafficked primarily in tea) on the Lower East Side. “Here there is an absolute guarantee of sobriety, and a free, democratic foregathering of kindred spirits,” the league enthused.

If one is up in the coffee and cake geography of the district, he knows where he may find the social and intellectual diversion most to his liking. It is each to his own: the Socialist has his chosen headquarters, the chess-crank his, the music-lover his, and so on right down the line . . . \whether it is to play chess or checkers, or to discuss Karl Marx or Bakounine, or the wonderful colorature (sic) of the last night’s diva at the Metropolitan-(for all of these are included in the light converse of the East Side), these topics are handled best over the glass of tea a la Russe, with a floating slice of lemon and a cigarette. (James 89)

It was often spiritual, not bodily, hunger which drew patrons to the Lower East Side’s cafs. But owners still managed to produce menus at the moment when talk of Zionism had invigorated appetites, or the thought of plucking one’s fur hat off the towering pile near the door and returning to a frosty tenement apartment instigated procrastination. “Many sold food,” neighborhood chronicler Harry Roskolenko recalled. “Bean soup, borscht, cold fish, Russian dishes, Jewish dishes, and something pronounced as samitsb” (100).

The cafs waned as the immigrants’ mastery of English allowed them to venture beyond the narrow boundaries of Alien and Delancey streets. The children of the caf sitters snubbed the institution as redolent of the old country, preferring to build their neighborhoods around more “Americanized” establishments. By the mid-1930s, New York City was home to more than 5,000 delicatessens (Joselit 203).

Jewish immigrants did not invent the deli. Germans and Alsatians had been selling savory delicacies, or delicatessens, since their arrival in America. Jews such as Arnold Reuben followed their lead, enlarging and expanding the entire way: “We had a restaurant open twenty-four hours a day,” Reuben’s son told Jewish food historian Joan Nathan. “By 1918, my father started making big sandwiches. One day a famous actress came in and asked for a big sandwich. He took turkey, ham, Swiss cheese, coleslaw and Russian dressing-which later became the Reuben’s special sandwich” (184 – 85). Whether the epiphany for the quintessential deli nosh did indeed emerge from a chance meeting between Mr. Reuben and a celebrity, or the sandwich grew from bastardized beginnings, as contemporary scholars claim, the reuben was a winning pastiche of the deli experience. The original sandwich, like its more famed descendant, incorporated the finest items plucked from a delicatessen counter: cold cuts, cheeses, and bread. These foods were “our greatest delight in all seasons,” wrote Brooklynite Alfred Kazin. “hot spiced corned beef, pastrami, rolled beef, hard salami, soft salami, bologna, frankfurter “specials” and the thinner, wrinkled hot dogs always taken with mustard . . . and now, as the electric sign blazed up again, lighting up the words Jewish National Delicatessen, it was as if we had entered into our rightful heritage” (32).

But the reuben, in its flagrant defiance of kashrut-rabbis who have long advised their congregants to “minimize treyf when unable to avoid it, were likely heartbroken by the addition of cheese to an already objectionable ham sandwich-flouted the Jews’ traditional heritage. Like the deli itself, the “Jewishness” of the sandwich was more symbolic than substantive. Delis bespoke their allegiance to American Jewish culture through a set of accepted props: oversized portions, mustard in paper cones, and wise guy waiters.

The “kosher style” formula was a great success, inspiring intense loyalty among its devotees. “Without pastrami sandwiches, there could be no picture-making,” Orson Welles wrote. “And I understand there is a project afoot to pipe the borscht across the continent from Lindy’s” (Joselit 203). Jewish housewives also succumbed to the craze, routinely supplementing-or substituting-their meals with goodies from the deli.11 The delis were also popular with the thousands of Jewish women who worked outside the home and had no hot meal waiting at the end of the day. “I didn’t cook,” remembered garment worker Ruth Katz, who immigrated from Poland in 1913.12 “You could get for twenty cents a good dinner in a restaurant. So about three times a week I used to go out. The rest I used to buy smoked fish, cheese, cream and lox” (Kramer and Masur 30). The garment workers who populate Anzia Yezierska’s Bread Givers are forever eating out, having no time to return home for lunch. “I got to eat my meals in the restaurant,” Berel Bernstein moans (44).

As Katz suggests, the trajectory that began with the caf led, ultimately, to the table service restaurant. American Jews owned, managed, and patronized restaurants throughout Manhattan, many of them serving kosher or kosher-style food in settings inspired by Delmonico’s: diners sat at linen-topped tables wedged between soaring wooden panels crowned with Art Deco motifs. Specific trends in elegant oyesessen are preserved by The Hebrew Standard, New York City’s first massmarketed English language Jewish newspaper. The politically conservative weekly newspaper, published from 1881 to 1929, when it was absorbed by the short-lived Jewish Tribune, regularly carried ads for eating establishments.

Few restaurants advertising in 1909 editions of the paper deviated from the strict kosher model: L. Schwartz, Klein’s Hungarian Restaurant, and Little Roumania seduced customers with the promise of oldworld kosher food, a promise sometimes rendered in Hebrew script to further assure observant Jews of their seriousness. Within five years, the classified landscape had changed radically. While Engel’s Strictly Kosher Dining Room was still buying space in the Standard, the restaurant’s competition had proliferated. The number of restaurant ads had nearly doubled. And few of them touted their compliance with dietary restrictions. Readers were instead beckoned to Roma, “for thirty years the rendezvous of refined connoisseurs of French cooking”; Unter Der Linden, “catering to the best elements of all classes”; and Original Maria’s, “serving you with the best the market affords.” For American Jews, restaurants were no longer extensions of the home kitchen, but distinctive sanctuaries of sophistication and value.

The Jewish embrace of the sit-down restaurant experience is captured in All-of-a-Kind Family Uptown, the fourth entry in Lower East Sider Sydney Taylor’s wildly popular All-of-a-Kind Family series. The children’s books, which mirror the Little House on the Prairie series in their sunny disposition and historic pungency, follow an immigrant Jewish family through the urban frontier. The family variously celebrates Shabbat, visits Coney Island, copes with a polio epidemic, and collects war stamps. In All-of-a-Kind Family Uptown, set in 1917, eldest daughter Ella is invited to a restaurant:

“Look Ella, I’ve been thinking,” Jules went on. “You’ve been working pretty hard. You deserve a change. Tonight you’re going to have supper with me in a restaurant.”

“In a restaurant! Oh, boy!” Henny exclaimed. “I’ve always wanted to eat in a restaurant.”

“You ninny!” Ella whispered fiercely in Henny’s ear. “He means me! . . . I’ll just get my hat.”

She dashed into her room, took a final look in the mirror, and dabbed her nose furiously with some of Mama’s rice powder. She was tingling with excitement. Eating in a restaurant was such a grownup thing to do! She wondered what it would be like. (Taylor 61)

The subway deposits Jules and Ella on 59th and Broadway, an early restaurant row glowing with garishly colored advertisements and blinking marquees. Ella is secretly longing for a home-cooked meal when Jules settles on a place.

Ella looked quickly around. She was overwhelmed by the grandeur she saw. Suspended from the ceiling was a huge chandelier with hundreds of sparkling crystal pendants. Endless rows of tables stretched out before her. Small shaded lamps shed a warm intimate light on the snowy-white tablecloths. She was pleasantly aware of the subdued hum of voices, the clinking of china, the silent movements of the waiters as they served the fashionably dressed, important looking people. (64)

Ella’s unease is not alleviated by the arrival of the encyclopedic menu. She orders a cream cheese sandwich, studiously avoiding the silverware dilemma she finds so vexing, then silently wrestles with whether to attack the lone green olive on her plate with fork or fingers. She finally confesses her discomfort during dessert.

“Oh, Jules!,” Ella sighed in great relief. “This is the very first time I’ve ever eaten in a restaurant!”

They looked into each other’s eyes and all strain seemed to melt away . . . in a few moments they were both gleefully digging into heavenly mounds of strawberry and vanilla frozen custard, marshmallow fudge, and whipped cream, topped with pink and white slices of nougat. Between mouthfuls, they chatted easily, as if they had been eating in restaurants all their lives. (69)

Jules and Ella (who are engaged to be married in the series’ final installment) likely did continue eating in restaurants all their lives. By the 1920s, eating out had taken hold in America, and Jews were at the forefront of the fad.

The onset of the Depression rattled the restaurant industry, but never crippled it. Harvey Levenstein has proposed that communal eating acquired even greater significance during the insecurityplagued 1930s; while he points to street festivals and church suppers, his analysis may also help account for the continued popularity of public eating places (Levenstein 41). Not surprisingly, the nation’s Delmonicos failed to thrive during this period of economic hardship. American tastes were becoming simpler and necessarily frugal; the French-influenced dishes synonymous with the most highbrow of restaurants were suddenly uncouth. And even if the crowds were coming, chefs hampered by Prohibition had little luck concocting virgin coq au vins (Levenstein 45). The stage was set for societal acceptance of the sitdown ethnic restaurant.

A few ethnic eating places, particularly those administered by Italians, were already targeting a wider clientele. The adoption of strict immigration laws in the early 1920smade boarding-house operations less viable and forced owners to expand their services (Levenstein 51). But the era of culinary crossovers may have reached its apex in the 1930s, when economic upheaval made dining in an ethnic neighborhood the most affordable way to travel. And the immigrant restaurateurs’ disregard for Prohibition laws thrilled thirsty diners. New Yorkers (and their out-of-town guests) were suddenly flocking to Harlem, Little Italy, and Chinatown.

Chinatown, USA

New York City’s Chinatown, the largest in the United States, is today a sprawling tribute to the 1,000 Chinese who by 1880 had found their way to the notorious Five Points district of lower Manhattan. Those men-among them terrorized miners chased from their jobs in California and laborers smuggled into the hand laundries of New Jersey-represented the whole of Chinese settlement in the city (Kwong 58).

Most nineteenth-century Chinese immigrants settled along the Pacific coast, hoping to scale the “Gold Mountain” known as California. These men laid the tracks to the heart of the gold rush, rolled cigars, and toiled in the textile industry, planning to return to China with their saved paychecks. But their willingness to work for starvation salaries irritated wage-earning whites, who felt their own livelihoods were threatened by Chinese competition. Immigrants were in danger of succumbing to the raging fists of nativists and the cool deal-making of elected officials, who in 1882 ratified the Chinese Exclusion Act. The federal law prohibited further immigration by Chinese laborers and barred Chinese already in the country from becoming citizens (Takaki 15).

Many Chinese still managed to make the trip to the United States, slipping past immigration officials or producing forged paperwork. Domestic migration and immigration had pushed the population of New York’s Chinatown to 7,000 Chinese by 1900, of whom only 150 were women (Kwong 58).

The actual facts and figures of Chinatown somehow managed to elude their neighbors, who were riveted by stories of opium dens, slave girls, and mob violence. In the late nineteenth century, when the number of non-Asian Americans who would ever catch a glimpse of the Far East could easily squeeze into a single room, a peek at Chinatown was terribly exotic. The Chinese spoke a language incomprehensible to most New Yorkers, prayed to a mysterious deity, and proudly sang offkey scales. Local newspapers fed the benign hysteria with a steady stream of stories breathlessly recounting the imagined evil exploits of Chinese dope fiends and rapists (usually of white women).

By the 1890s, guided tours of Chinatown had become a chic pastime for the upper crust. Luc Sant relates the tale of one tour-leading huckster who insisted that participant Salvation Army General William Booth don a fake moustache before entering Chinatown, apparently attempting to heighten the intrigue of the experience. The prank nearly ended badly when a policeman tried to arrest Booth for masquerading in the streets. Most cops, however, were sympathetic to the gawking tourists. Policeman Cornelius Willemse wrote:

Visitors are more or less a nuisance in Chinatown and a good many times they’re disappointed. For they’ve built up such fantastic ideas of what goes on down there that if they don’t see a few Chinamen disappearing down traps in the pavement pursued by somebody with a hatchet or a long curved knife, they haven’t had any fun and go home disappointed. As a matter of fact, Chinatown is a peaceful neighborhood most of the time and there isn’t much for the casual visitor to see. So to make it interesting for out-of-town visitors, sometimes we used to copy the sight-seeing guides and arrange a set- up so as not to disappoint them. (Sante 295)

A similarly cooperative policeman in 1924 led New York Times reporter Steuart M. Emery on a midnight tour of the neighborhood that peered into all the coves unseen by the nightly parade of tourists. Emery’s dispatch from the edges of the Bowery revealed the area to be still a treacherous place: he began by asking the detective whether there was still much opium smoking in the district:

“Plenty,” was the answer. “There isn’t anything that will stop a Chink from taking a shot at the pipe . . .”

Down the street came trotting two or three children- yellowskinned, but with distinctly white facial characteristics.

“Pipies,” said the detective. “That’s what they’re called. Chinese father and white mother. When a girl gets hitting the pipe down here she’s done for.” (Emery)

The detective rounded out his tour with a series of required elements, including a bricked-up entrance to a secret mob tunnel, a gambling den, and a Chinese restaurant.

In 1898, Louis Beck surmised that the wealth of restaurants in Chinatown was an outgrowth of the “bachelor society,” in which dozens of men lived together in tenement apartments or storefront spaces. Their living arrangements were not conducive to cooking, so they routinely ate at restaurants or boarding-house kitchens (46). Beck was taken with the most elegant of the eating houses, reserving a full chapter of his neighborhood guidebook for a discussion of them:

The most gorgeously decorated and illuminated buildings in Chinatown are those occupied by the restaurants. The more pretentious of them usually occupy upper floors in three or four story buildings, having balconies across their fronts, the buildings themselves being gaudily painted in deep green with red and gilt trimmings. Chinese lanterns are suspended in reckless profusion from every available point. The eating rooms are kept with scrupulous cleanliness, and no unusual dirt will be found in the kitchens. A recess or alcove off the dining room, furnished with a cot, is generally provided for those who may wish to indulge in a short nap after dinner. Tables are provided for parties of two, four or more, as required . . . Cutlery forms no part of the table furniture, the national chopsticks being supplied instead. The eatables are brought in a common receptacle-a deep dish or bowlfrom which each guest at the table helps himself at pleasure, dipping in his chopsticks and conveying what is taken directly to his mouth. (47)

Beck further facilitates the neophyte’s visit to Chinatown by listing a few choice recipes and reprinting an entire bill of fare, with prices, from his favorite restaurant. The menu includes dried oyster soup, fried noodles with chicken, roast pork dumplings, and deviled duck. Beck maintains the restaurant in question caters almost exclusively to Chinese, who throng the dining room each Sunday; the conspicuous absence of chop suey from his sample menu bolsters his claim (48).

Chop suey is, politely put, Chinese-esque. It has no direct forebears in China, but utilizes the fine chopping techniques revered by Chinese cooks. The true origins of the dish are obscured by legend, but most historians agree the meat-and-vegetable melange was invented in the late nineteenth or early twentieth century. Its birthplace has been variously listed as California, where a railroad cook may have created the jumble from leftovers in a fit of inspiration; New York, where in 1896 the visiting viceroy and foreign minister of China, Li Hung-chang, may have ordered his own cook to prepare the dish in the kitchen of the Waldorf-Astoria; and Washington, DC, where an entrepreneurial Chinatown restaurant owner may have capitalized on the hoopla surrounding Li’s visit and created the dish in his honor (Hooker 286). The circumstances were irrelevant to the thousands of New Yorkers who developed an insatiable craving for the food.13 In 1928, the New York Times concluded an article debunking the Chinese roots of chop suey by jokingly proposing that China erect a monument to the dish, as so many of its countrymen had built their fortunes on it (“Chop Suey, Popular Here”). Lucien Adkins, invited by Beck to write an epilogue to his guidebook, waxed enthusiastic on the topic of chop suey:

I have introduced many to the delights of chop suey, a standard dish that stands the test of time much as does the roast beef of old England. It can be eaten once every day, and it is a wonder how the desire for it manifests itself in the man who lives principally on French cookery.

Take a friend to Chinatown for the first time and watch his face when the savory chop suey arrives. He looks suspiciously at the mixture. He is certain it has rats in it, for the popular superstition that the Chinese eats rats is in-bred. He remembers his schoolboy history, with the picture of a Chinaman carrying around a cage of rats for sale. He quickly puts aside the chopsticks, which are evidently possessed of the devil, and goes at the stuff with a fork. The novice gets a mouthful or two, all the time declaring it is “great.”

Soon there are times when the gnawing hunger for chop suey, and for nothing else, draws him to dingy Chinatown, alone and solitary. He half believes there must be dope in the stuff. He is now certain that there are no rats in it. He is a confirmed chop suey eater, (qtd. in Beck 296)

Chop suey restaurants ranged far beyond the narrow strip of Manhattan designated as Chinatown; a 1918 raid of chop suey joints allegedly serving liquor to soldiers and sailors led police as far north as 44th Street. “What right have young men who ought to be in the trenches to be playing pool or sitting around Chinese restaurants with women of the streets at 4 o’clock in the morning?” Assistant District Attorney James E. Smith demanded (“Police Capture” 178).

But a right to eat Chinese was rapidly emerging as another right on the long list of those given by God to the good people of America. Chinese food was consumed by members of every class, racial, and religious group (assuming they had two quarters in their pockets). Beck noted black Americans were among the earliest fans of eating Chinese: “their average daily receipts are est\imated at $500, of which comes $25 from Negroes, who seem to delight in frequenting the lower class places” (54). Early menus offered a number of dishes that would have been familiar to the traditional black palate, including collard greens, pig’s feet, and barbecued pork. While the waitstaff may have whispered slurs in their native language, there is no record of any overt ethnic tension in New York’s first Chinese restaurants.1 Indeed, intrepid reporter Steuart Emery found himself seated next to a trio of Italians during his vice-oriented tour of Chinatown.

Next to us there sat a group, unmistakably Italian in character- two men and a flashily-dressed girl.

“Sure,” said our guide in answer to a question. “Lots of Italians come in here to eat. Tired of spaghetti, I guess. The Italian quarterGuinealand, we call it-is right around the next block or so. The Italians run in here pretty often.”

Everybody, it seemed, was eating Chinese.

Mainstreaming Chinese Food

By the mid-1920s, Chinatown had largely shaken off its reputation as a den of evil. Yesterday’s voyeurs had been muscled out by chop suey hounds, who had little use for the gory tales that riveted earlier generations.

At the lunch hour, there is an eager exodus toward Chinatown of the women workers employed in Franklin, Duane and Worth streets. To them the district is not an interesting bit of transplanted Orient. It is simply a good place to eat. They see it as a coldly commercial center, with its thin thoroughfares choked by mammoth motor trucks loaded with bamboo shoots, soy beans and dried mushrooms for shipment to wherever in the five boroughs, Long Island, New Jersey and Connecticut chop suey is chopped . . . chop suey seems destined to become a necessity of New York life. (“Chop Suey’s New Role”)

Those New Yorkers whose salaries and situations allowed them to be less than pragmatic reveled in the bohemian dimensions of Chinatown. They rejoiced in their own cosmopolitanism, reveling in the exotic rhythms of the once-forbidden district. All things Oriental were suddenly stylish, and there was no better place to enjoy the fad than Mott Street. The chop suey craze was accompanied by a mah-jongg mania, which seized the country so violently that Chicago stockyards were rumored to be shipping cattle bones to China so that manufacturers could produce enough of the needed tiles (Strausser and Evans 8).

But eating Chinese survived the roller coaster ride of becoming faddish, enduring to enter the mainstream. It was propelled there by World War II, which initiated a revolution in the nation’s dining habits.

There certainly were soldiers stationed in the Pacific theater who returned home with a taste for Chinese food. But even those servicemen who never left stateside were treated to Chinese-style dishes, courtesy of Uncle Sam. Chop suey and chow mein were staples of the mess hall, joining spaghetti and tamales as the only “ethnic” dishes listed in the 1942 edition of the US Army cookbook (Levenstein 122). The economics of chop suey-which Americans prepared with ketchup and Worcestershire sauce-were as appealing to soldiers’ wives as to their superiors. In many households, the recipe card for the dish was well stained by the end of the war.

Cooks unsure of their ability to replicate the fare from their local Golden Dragon or Phoenix House were aided by a number of mid- century innovations, ranging from the takeout box to the frozen egg roll.

Folded paper food containers had long been used as oyster pails by East Coast fishmongers. The cartons were adopted in the 1940s and 1950s by area Chinese restaurant owners, who realized they were the perfect size and shape for their saucy, amorphous dishes. Manufacturer Riegel Paper Corporation soon after issued a line of boxes bearing pseudo-Chinese motifs, sparking a brisk takeout business for Chinese restaurants across the country.

Advances in freezing and canning also led to more people eating more Chinese more often. In 1955, sales of processed Chinese foods were estimated at $20 million, a 70% increase over World War II period figures (Nagle). The industry’s visionary was Jeno F. Paulucci, a Minnesota-bred son of Italian immigrants who peddled fruit to support his family during the Depression. He never strayed far from the food business: after a short stint at junior college, he sold groceries to stores across Minnesota. While traveling, he noticed there was nary a hamlet without its own Chinese restaurant. “I felt there must be a tremendous, untapped market for ready prepared Chinese foods for home use,” he said later. “The food industry was missing the boat, allowing the restaurants to handle all the take-home business.” Paulucci began canning chicken chow mein in a cramped quonset hut in Duluth; 8 years later, his chicken almond chop suey, rice, and egg rolls helped Chun King win over eighty percent of the frozen Chinese food market. “The egg rolls are crisp and pleasingly flavored,” raved New York Times food writer June Owen. “The chop suey is judiciously seasoned. The rice is fluffy. In fact, the dinner might be described as an outstanding example of what is possible with frozen foods.”

While Owen’s fellow food critic Craig Claiborne seemingly could not pen a review without launching into a lament for the demise of the fork, which he predicted would be forgotten by chopstick- clenching diners, the upsurge in eating Chinese was further legitimized by President Dwight D. Eisenhower. The New York Times in 1953 learned that the Eisenhowers were regulars at the Sun Chop Suey Restaurant in northwest Washington, DC. “Several times since the inauguration the White House has telephoned an order or sent a Secret Service agent to the restaurant with an order. The last order read: “5 chicken chop suey; 6 fried rice; 4 egg foo yung. A few almond cookies,” the newspaper reported. According to restaurant co- owner Jack Wong, the first family had been placing the same order since 1930, asking only that the chop suey be “good and hot” (“Eisenhowers”).

Eating Chinese had become a ritualized experience for many Americans by the 1950s. Early television comics built entire sketches around the habit, assured their audience would have the necessary familiarity with the culinary genre.

In 1955, Sid Caesars Comedy Hour presented a skit set at the Golden Pagoda. Two businessmen are hustling their reluctant friend Bob through the door. “I only have thirty minutes, we could have had a sandwich,” he protests. His protests dissolve into glee as a plate of steaming Chinese food is carried past him. “Chinese food! Oh boy! Ping Pong Goo! Ding Dong Skoo!” The men are seated and their food delivered, but Bob is distracted by one old friend and then another. Unable to get a chopstick in edgewise, he salivates as his lunch partners polish off the entire meal. While the sketch depends on the actors’ comedic timing, the joke only works because viewers can relate to Bob’s suffering.

A similar degree of knowingness was assumed by the writers of The Steve Alien Show, who sent the character of Mr. Neville Nosher, leading gourmet, to critique a Chinese restaurant. “Is it very exclusive?,” Alien asks. “Oh yes,” Nosher responds. “Tonight they threw out a couple for ordering the family dinner. They weren’t married.” Nosher then instructs the audience in the preparation of “special Chinese sauce,” a concoction of soy sauce, plum sauce, and hot mustard, that he renders inedible by his liberal use of the mustard. The ensuing roars of the audience suggest many of them had made the same mistake.

By the 1950s, eating Chinese was no longer exotic. The experience was standardized and predictable, as evidenced by a survey of Chinese restaurant menus dating from 1920 to 1980, in which the only perceptible change is the price. The Chinese restaurant represented neither a culinary adventure nor a contested space. It was culturally neutral, a perception exploited by the writers of Brooklyn Bridge, an early 1990s feel-good sitcom chronicling a 1950s middle-class Jewish family.

In an episode of the series entitled “War of the Worlds,” 14- year-old Alan Silver has begun dating classmate Katie Monaghan. The relationship troubles Alan’s immigrant grandparents and Katie’s father, an Irish American policeman. The teenagers, believing communication can overcome prejudice, persuade their families to meet. After Alan’s younger brother is whisked away by Nick, an Italian-American neighbor (“We’re having gefilte fish for dinner,” Nick announces. “My mother said if we don’t like it we could put spaghetti sauce on it.”), the Silvers head for the chosen meeting place: Flower Garden Restaurant. Mr. Monaghan first places the order for his family: “squid appetizer, oxtail soup, pork kebabs, shrimp in lobster sauce, and flaming octopus rings,” earning the scorn of Alan’s grandmother. “We’re not ready to order, Danny,” she tells the waiter. “It takes us longer because we care about what we eat.” The Silvers finally settle on five orders of chicken chow mein. The evening repeatedly threatens to unravel as the Silvers are unable to summon a Hebrew prayer to match the Monaghan’s blessing and the families fail to find a single acquaintance in common (“You mean you don’t know Sol Moscovitz?” Mr. Silver says in amazement). Tensions finally ease after Alan’s grandfather tastes the Monaghans’ oxtail soup; soon the families are exchanging priest and rabbi jokes. Chinese food is apparently the common denominator that links the two ethnicities. But while both families seem at home in the Chinese restaurant, it is only the Silvers who are greeted by name, encounter a distant cousin, and merit a discount at the end of the meal. Perhaps everyone was eating Chinese food in the 1950s, but the Jewish relationship to it was unique.

“Jewish People Adore Chinese Food …”

Humorist Molly Katz, frustrated by her gentile husband’s inability to grasp the intricacies of AmericanJewish culture, created a guidebook in 1991 for newcomers to the land of Yiddishkeit. Various chapters detail the natives’ attitudes toward dress, conversation, and Chinese food:

For no reason that has ever been clear to anyone, Jewish people adore Chinese food … so if you have anything against it, you’ll have to pretend otherwise.

As foreign as caffeine and cream are to our bodies, soy sauce is our cure. Never mind chicken soup; when Jews need comfort, solace or medicinal nourishment, we dive for Moo Shu Pork.

Chinese treats may be enjoyed anytime, but there are two nights on which Jews flock to Chinese restaurants: Thursday (because it’s the housekeeper’s night off) and Sunday (because we just do). (67)

Katz proceeds to outline the elaborate rites enacted before every Chinese meal, ranging from the practiced debate over “hot” versus “medium hot,” to the juggling of menu items to produce a perfect meal.

You’re asked what you’d like . . . beef with snow peas, you say. There’s a thunderclap of silence. Everyone looks over or around you. Chairs squeak.

Finally someone points out that there’s a beef dish already, two if you count Land and Sea.

You don’t know what to do. Sweating, you suggest peanut chicken. No. Anita has diverticulitis. No nuts.

Eventually you will realize that this game is ancient. These people were ordering Chinese food together when you still thought sesame was something on a Big Mac bun. They always order the same dishes. And they always end up getting another large spare ribs. (68)

But as a slightly more serious Katz would concede, tales of lost tribes of Israel turning up in China notwithstanding, eating Chinese is not an ancient tradition. In the scheme of things Jewish, its evolution barely qualifies as a historic development, having occurred a mere century ago.

While few immigrant memoirs include references to eating Chinese, the English-language American Hebrew in 1899 subtly criticized the newest Jewish Americans’ fondness for the food. The Yiddish press in 1928, at the height of chop suey madness, leveled its own complaints, fretting that Jewish fans of Chinese food were destined to forget their own culinary traditions. Perhaps this was fodder for a new movement, the Der Tog reporter lightheartedly suggested; might not communalminded American Jews everywhere raise the protest sign “Down with chop suey! Long live gefilte fish!” (Joselit 215)?

Not everyone fell under chop suey’s spell; Lower East Sider Sophie Ruskay was shaken by a childhood friend’s whispered warning that “Chinamen eat mice, you know” (Ruskay 53). But the great majority of immigrant Jews were smitten by the 1920s, supporting nearly twenty chop suey shops within walking distance of Ratner’s, the mainstay kosher dairy on Delancey and Essex streets (Joselit 214). Pitkin Avenue, the Champs-Elyses of a stalwartly Jewish section of Brooklyn in 1928, was aglow with Chinese restaurants.

The children of immigrants who patronized these Jazz-Age joints apparently institutionalized the practice of eating Chinese. Jews of the baby boomer generation recall that “my mother and father went out alone Saturday night and took the children to the local Chinese restaurant every Sunday night” (Nathan 156). Allan Ginsberg, who had a famously contentious relationship with his observant father Louis, in 1954 penned a letter home that stuck to the safe subject of Chinese food. “I’ve seen a lot of Chinatown,” Ginsberg wrote during an early trip to San Francisco. “The food is more varied, tasty and original than NYC Chinatown. It is easier to get and it is about half as cheap as NYC. They have a brand of Won Ton soup new to me and better than original New York style.”

The habit had become so entrenched by the 1950s that Borscht Belt comedians could reliably get laughs with lines like: “Jews always look for Chinese restaurants, but how often have you heard of a Chinese looking for gefilte fish?” (Nathan 156). This disparaging view of traditional Jewish cuisine supplied the premise for a favorite joke of the 1960s, in which a struggling Jewish restaurant switches to an allChinese menu:

A few evenings later, a customer ordered egg foo yong.

“Tonight you’re out of luck,” said the waiter. “We used up the last egg an hour ago, and we don’t have any yong left either.”

“In that case,” said the customer, “just bring me a bowl of the foo.” (Spaulding 73)

Buddy Hackett lit up the Concord, one of the larger summer resorts, with his impersonation of a Chinese waiter. He developed the bit in 1949 after a night out with two Army buddies. He reviewed its genesis for interviewer and fellow Jewish comedian Alan King:

Hackett: One night we went for Chinese. There was a waiter named George there. I got up and started yelling fake Chinese at him down the dumb waiter. On stage, it got screams. In the beginning I used to put rubber bands around to make Chinese eyes, but a few years later I decided that was offensive. And I didn’t need it.

King: No, everyone knew, we all went to Chinese restaurants then, one from column A, one from column B. (“Buddy Hackett”)

Jokes told on the Catskills circuit filtered down to restaurant owners like Jimmy Eng, who delighted customers at the King Yum with an ingratiatingly accented version of his favorite: “The Jewish people are 5,000 years old. And the Chinese people are 3,000 years old. So what did the Jews eat for 2,000 years?”

Eng immigrated to the United States from Taysan, China in 1936. He worked in a relative’s laundry in Chinatown, as per his father’s orders. “I was really disappointed he never sent me to school,” Eng said. “I talked to my father’s partner,” I said, “I don’t understand why he don’t send me to school.” He smiled, said “He wants you to go back, be king of China.” Instead, Eng became King of the Yum.

King Yum was a small Chinese restaurant gasping for its last breaths in the wilderness of Queens when Eng was offered the opportunity to buy it. The neighborhood was then thick with trees; the manicured edges of a St. Johns University golf course were the only visible hint of human existence. “I tell you the truth, there’s no business here,” Eng remembers the exhausted founder warning him in 1953. But Eng had noticed that the Jews who patronized the laundries and restaurants where he had worked were embarking on an exodus from the city’s core to its peripheries. He guessed Union Turnpike would one day lead to a vibrant Jewish community and decided he would be the man to feed it.

“The Jewish people always like Chinese food,” Eng said.18

Eng bought the King Yum for $8,000. “They say to me ‘Jimmy, you should have changed the name.’ I should have changed the name, but I didn’t have no money left,” he said. Eng’s friends ribbed him about the purchase, which even he began to doubt after a few early tangles with the mob and nights spent sleeping in the kitchen. But the Jews finally arrived, just as Eng had planned, and he had little trouble cultivating a loyal clientele. He transformed the tiny storefront into a massive red-walled banquet hall, with Chinese lanterns swinging from the ceiling.19

“This place has not changed a bit,” enthused former resident Arthur Wartell, who returned to the neighborhood after a forty-year absence. “Once a week, my family would come here, and I tell you it hasn’t changed a bit. You can’t buy a fried wonton like you get here!” Wartell, who lives in Santa Barbara, recently suffered a srroke. “I couldn’r walk, I couldn’t talk. But I ate won ton soup everyday. I believe what cured me was that soup” (Wartell).

Such intense Jewish allegiance to Chinese food was cemented in the popular imagination by the aforementioned comic routines, film, and television, where Jews were often portrayed as enjoying a Chinese meal.20 In a 1972 episode of Sanford ana Son, “Happy Birthday, Pop!,” Lamont Sanford takes his curmudgeonly father Fred to a Chinese restaurant for his birthday. “I can’t eat in here,” the elder Sanford says. “I can’t eat this chink food. You never know what they’re going to have in it. These people do their cooking and their laundry in the same pot.” Sanford then strikes up a conversation with a diner at a neighboring table, who not only defends Chinese food, but mentions his affection for Fiddler on the Roof.

By the 1990s, sitcom writers had dispensed with the Fiddler on the Roof references, relying on Chinese food alone to signify a character’s ethnic heritage, as in an early episode of Seinfeld (“The Chinese Restaurant”) in which the protagonists attempt to dine at Hunan on Fifth (their seating is delayed by the incessant arrivals of regulars like “Mr. Cohen!,” who the matre’d “hasn’t seen in a few weeks!”).

Christopher Guest hauled out the device for his 1996 film Waiting for Guffman, a mockumentary chronicling a small town’s attempt to storm Broadway with the homegrown musical production “Red, White and Blaine.” The show’s five-member cast includes Alan Pearl, the token Jew and lone dentist in the tiny town of Blaine, Missouri. Pearl believes he is destined for showbiz; his grandfather, Chaim Pearlgutt, premiered the Yiddish standard “My Bubbe Made a Kishke.” But his fellow performers-among them an aging highschool football star and a big-haired travel agent who have never left Blaine-are skeptical of Pearl’s talents. To persuade them he has the chops for community theater, he invites the couple to dinner at Chop Suey Chinese Kitchen. While the restaurant is heralded by a glowing red neon sign, Ron and Sheila insist they have never seen it:

Ron: How did you find this place?

Alan: Oh, we’ve been coming here for many, many years.

Mrs. Pearl: Oh yeah, we’ve been coming here every Thursday.

Alan: We had friends, Barbara and Bruce, remember, who went to China and they went to Peking, where they make the ducks, and they say you can’t get a sauce as thick and sweet over there. They don’t make it like that. The food over there is like steamed or somet\hing. It’s not as good as the food here.

Pearl’s bubbe may have made a kishke, but he and his wife eat dumplings. That’s all the audience needs to know. For in popular culture, Chinese food has become a coded shorthand for Jewishness.

Unraveling the Jewish Affinity

It is clear that the first Jewish immigrants did not immediately stampede the restaurants of Chinatown. The American Jewish affection took hold only after the turn of the century, when economic circumstances made eating out possible and mainstream culture had blessed Chinese cuisine. The practice became fashionable in the 1920s, when a rage for the exotic swept New York and Chinatown became a genuinely safe destination. American Jews, most of whom by then spurned their religious dietary restrictions, actively participated in the trend. By the 1950s, many American Jewish families were making weekly pilgrimages to their local Chinese restaurant.21

But the real question lurking behind the Jewish affinity for Chinese food is an insistent “why?” Why did immigrant Jews not trade their native foods for spaghetti, paella, or teriyaki chicken? Why did Irish or Puerto Rican immigrants not embrace Chinese food with such overwhelming fervor? Is there a single reason chop suey became the chosen food of the chosen people?

Unfortunately for the historian with hopes of keeping the past tidy, probably not. There are a number of possible reasons Jews adopted Chinese food, none of them provable.

Gaye Tuchman and Harry Levine in 1993 attempted the first real analysis of the phenomenon, conducting ethnographic interviews of friends and family members to produce “New York Jews and Chinese Food: The Social Construction of an Ethnic Pattern.” Their article, which takes as its starting point “Chinese food is the second Jewish cuisine,” suggests that price, quality, and taste contribute to the appeal of eating Chinese. But the authors conclude that the primacy of Chinese food in the American Jewish tradition stems from the food’s function as “safe treyf” (388). Tuchman and Levine readily concede that most food consumed in Chinese restaurants was not kosher. It was rife with pork and shellfish. But the offending ingredients were usually sufficiently disguised by chopping, dicing, and sauting, freeing diners from the guilt associated with eating treyf. For even those Jews who did nor strictly observe the laws of kashrut-whether guided by a sense of religious obligation or a palate honed in childhood to reject treyf-often avoided pork or shellfish.22

Most Chinese food did adhere to the prohibition of mixing milk and meat, as dairy was almost non-existent in the Chinese kitchen. And the dishes were familiar to Jews not only in what they lacked but in what they offered: were wontons not jusr a foreign form of kreplach? Immigrant Jews recognized the chicken broth, garlic, onions, and salt from their mothers’ own pantries.

Other immigrant Jews located the allure of Chinese food in its exoticism. They were well aware that spareribs were nor kosher, but thrilled in the rebellion of ordering them. Eating Chinese was cosmopolitan, sophisticated, and secular. Tuchman and Levine quote an older Jewish man as remembering, “I felt about Chinese restaurants the same way I did about the Metropolitan Museum of Art- they were strange and fascinating, and I loved them both” (402). The Jewish obsession with learning repearedly resurfaced in America, perhaps never so stridently as in 1891, when 50,000 Lower East Side residents petitioned the Met to open its doors on Sundays (Ewen 214). Chinese food marked its devotees as true Americans with highbrow habits, a perception encouraged by restaurant owners like Eng who showily refused to offer delivery service. “People say, ‘Jimmy, why don’t you deliver?’ Delivery, I don’t want that. I don’t want customers like that. I want high class people come in here,” Eng explained. The immigrant preoccupation with success and its trappings reached its full exposition in the post-World War II Chinese restaurant.

Paradoxically, eating Chinese may also have appealed to the American Jewish tendency to “identify down.” As described by Michael Alexander, downward, or outsider, identification among American Jews is a vestigial impulse forged by years of oppression and an overriding “theology of exile.” Alexander argues that this identification was strengthened in the 1920s, when great numbers of Jews artained real material success. The decade was the backdrop for a Jewish romance with gangsters, gamblers, jazz, and blackface, culminating in the release of The Jazz Singer in 1927 (Alexander 3). Perhaps Chinese food too deserves a spot on this laundry list.

American Jews also likely responded to the price of Chinese food, which was low enough to qualify as immigrant friendly. They too may have enjoyed the family-style service, which implicitly celebrated the centrality of domestic life. “Sometimes the family was about all that was left of Jewishness,” Irving Howe said (Braunstein and Joselit).

Yet the three most important factors in the link between Jews and Chinese food may be location, location, location. Chinatown bordered the Jewish enclave of the Lower East Side, approaching ever closer as it grew. The two groups were poised to interact.

There were undeniable commonalities between the two groups. Both spoke in tongues mocked for their stereotypical sounds. Both were non-churchgoing in an overwhelmingly Christian nation. Both were victims of sometimes violent racism. Perhaps recognizing these similarities, the Chinese Empire Reform Association of New York City in 1905 presented a performance of “King David,” as a benefit for the Jews of Russia. So many people pressed against the doors of the Bowery Street theater before showtime that additional policemen were called to prevent a fatal stampede. “In this crisis, there is no division of nationality o

India to Tighten Laws to Stop Female Infanticide

By Nita Bhalla

NEW DELHI — India plans to tighten laws banning tests to determine the sex of unborn babies in a bid to curb the killing of thousands of female fetuses, Health Minister Anbumani Ramadoss said on Wednesday.

India’s Pre-natal Diagnostic Techniques Act — which outlaws doctors from carrying out sex determination tests — has been in force since 1994 but social activists say local authorities lack the will to combat female infanticide.

Besides, families seek sons over daughters and unscrupulous doctors attempt to get around the law, making enforcement difficult, they say.

A joint study carried out by researchers in India and Canada recently suggested that half-a-million unborn girls may be aborted in India every year, with parents preferring boys as being a better asset to the family.

Following a meeting with womens’ groups, members of parliament and social activists, Ramadoss told a news conference that a series of amendments aimed at giving the law more teeth were being discussed.

“We are going to take into consideration everyone’s view in order to further strengthen the act and its enforcement and implementation,” he said. “This is an issue where we need quick action.”

Amendments being considered include improved monitoring of deaths of girls across the country, making doctors more accountable, striking them off the medical council if found guilty, and forcing traditionally conservative states to better enforce the law.

Officials say states like Punjab, Haryana, Gujarat, Himachal Pradesh, Rajasthan and also cities like Delhi and Chandigarh are not enforcing legislation and as a result have heavily skewed sex ratios.

“On average in all our states, we have around 924 girls to every 1,000 boys. But in some states like Haryana and Punjab, the ratio of girls has dropped as low as 500 or 600 to every 1,000 boys,” Renuka Chowdhury, junior minister for women and child development, told Reuters.

Ramadoss said the central government could take states to court if they didn’t enforce the legislation banning sex determination tests.

Another amendment to the law seeks to speed up convictions against those found guilty, he said.

Since the legislation was passed 12 years ago, health officials say there have been 387 cases lodged under the act but only one had resulted in a conviction.

Chrissie Tomlinson Memorial Hospital Signs Agreement With American Hospital Management Company for Management of the Hospital and Announces Expansion Plans

GEORGE TOWN, Cayman Islands and BOSTON, June 13 /PRNewswire/ — Chrissie Tomlinson Memorial Hospital has engaged American Hospital Management Company to provide turnkey management services. American Hospital Management Company will be placing a full-time administrator at Chrissie Tomlinson Memorial Hospital to assume the day-to-day management of the hospital.

“This is an exciting time for the Chrissie Tomlinson Memorial Hospital. I am pleased to contract the services of American Hospital Management Company, who will bring a new level of professional management to the Organization. I am confident they will do an excellent job and the public will enjoy many new services, as they come on-line. I will be relieved to do what I do best: take care of patients,” stated Dr. Stephen Tomlinson.

“Chrissie Tomlinson Memorial Hospital, as the only private hospital in the Cayman Islands, has a tremendous responsibility to the community and is well-positioned for growth in a very special market. We look forward to working with the Board of Directors, medical staff, employees and the community to expand the scope of services and to collaborate to meet the healthcare needs locally,” stated Randall D. Arlett, President and Managing Director of American Hospital Management Co.

Chrissie Tomlinson Memorial Hospital has announced plans to build a new Medical Arts building and new investments in medical technology and equipment.

The new Medical Arts building will be on the Eastern portion of the hospital’s campus and will include a new and expanded Physical Therapy, Occupational Therapy and Rehabilitation Centre, Pharmacy and the construction of 12 to 18 new private doctors’ offices. The doctors’ offices would be available either to be purchased or rented by community doctors. Construction of the new Medical Arts Centre is expected to begin within 90 days.

The relocation and expansion of the Physical Therapy, Occupational Therapy and Rehabilitation Centre will allow the hospital to make additional space available within the hospital to expand the imaging, radiology and cardiology services of the hospital.

The hospital is working with the medical staff and in final negotiations for the purchase of new, first-generation equipment for radiology, mammography, CT-Scan, an open MRI and cardiology medical equipment. A portion of the equipment will be a replacement and upgrade of existing equipment, while the open MRI and cardiology intervention capabilities will be new services at the hospital and in Cayman.

The new technology will increase the amount of advanced- and secondary- level care that can be provided at Chrissie Tomlinson and thus reducing the number of patients that must travel abroad for care which can be provided safely and more efficiently locally.

“Continuity of physicians is very important for the quality of medical care. Building the Medical Arts Centre allows Chrissie Tomlinson the ability to retain the quality physicians already practicing in the Cayman Islands and to recruit additional permanent and visiting specialty physicians who are making a long-term commitment to practice medicine here in order to meet the community’s healthcare needs. Retaining and developing close, collaborative relationships with the high-quality doctors already in Cayman is a priority. The current investment in technology as well as the additional investments under consideration are needed to provide the tools and resources for our physicians to best utilize their skills and training locally,” stated Arlett.

About the Chrissie Tomlinson Memorial Hospital

Chrissie Tomlinson is a modern, state-of-the-art private hospital in George Town, Grand Cayman which opened in May of 2000 and offers In-Patient Medical and Surgical facilities, Ambulatory and Day Surgery, Urgent Care, Laboratory, Radiology, Physical and Occupational Medicine, Birthing Centre, Pharmacy as well as Family Medicine and Specialty Physician Clinics. Chrissie Tomlinson Memorial Hospital also operates the West Bay Medical Center as a full-service primary care center.

About the American Hospital Management Company

American Hospital Management Company (AHMC), a member of the Family Hospital Group of Companies, is a Boston, USA-based diversified international healthcare system whose focus is on the administration, management, and development of world-class hospitals and healthcare systems. Founded in 1998, AHMC has grown into the leading international hospital management and administration outsourcing company. The American Hospital Management Company provides turnkey, outsourced administrative and management services to hospitals and health systems. AHMC is the most experienced hospital administrator, project planner, medical equipment procurer, developer and advisory company in the Global market today. AHMC provides individual services, turnkey services and total solutions. Unique to AHMC is the experience and success with Private-Public Hospital Partnerships as well as with international academic, teaching hospitals.

AHMC currently operates medical facilities in Colombia, Ecuador, Honduras, Panama, Trinidad & Tobago, Brazil, Guatemala and the Dominican Republic.

   For more information:   Steve Tomlinson, MD, Chairman of the Board of Directors   Chrissie Tomlinson Memorial Hospital   PO Box 273 GT, Walker's Road   George Town, Grand Cayman   Cayman Islands, B.W.I.   Telephone: (345) 949-6066   Fax: (345) 945-1985   http://www.chrissietomlinsonhospital.com/    Randall D. Arlett, President and Managing Director   American Hospital Management Company   (617) 848-5839 - USA   (617) 848-5840 - USA Fax   +507-227-8354 - Panama   +507-227-4383 - Panama Fax   http://www.americanhospitalmanagement.com/   

This release was issued through eReleases(TM). For more information, visit http://www.ereleases.com/ .

American Hospital Management Company

CONTACT: Steve Tomlinson, MD, Chairman of the Board of Directors, ofChrissie Tomlinson Memorial Hospital, +1-345-949-6066, Telephone,+1-345-945-1985, Fax; or Randall D. Arlett, President and Managing Director ofAmerican Hospital Management Company, +1-617-848-5839, USA, +1-617-848-5840,USA Fax, +507-227-8354, Panama, +507-227-4383, Panama Fax

Web site: http://www.americanhospitalmanagement.com/http://www.chrissietomlinsonhospital.com/

Arena Pharmaceuticals’ Lorcaserin Hydrochloride Phase 2b Study Results Demonstrate Significant Weight Loss and Positive Effect on BMI and Waist and Hip Circumference in Obese Patients

WASHINGTON, June 12 /PRNewswire-FirstCall/ — Arena Pharmaceuticals, Inc. announced today that Steven Smith, M.D., principal investigator in the study and associate professor and chief, in-patient unit of the Pennington Biomedical Research Center is presenting data from Arena’s positive Phase 2b clinical trial of lorcaserin hydrochloride (formerly APD356) for the treatment of obesity in an oral presentation at the 66th Annual Scientific Sessions of the American Diabetes Association (ADA) in Washington, DC. When compared to placebo, patients treated with lorcaserin experienced a highly statistically significant average weight loss and reductions in other physical measures, including body mass index (BMI) and waist and hip circumference. Trends or improvements were seen in fasting glucose and most lipid measures despite normal mean baseline values and the relatively short study duration.

“Lorcaserin demonstrated excellent weight loss in this study, coupled with excellent tolerability and a positive impact on associated physical measures and most lipid parameters in obese patients,” stated Steven Smith, M.D., principal investigator in the study and associate professor and chief, in-patient unit of the Pennington Biomedical Research Center. “More than 60 million Americans are obese, leaving them at increased risk of diabetes, heart attack, stroke, dyslipidemia and cancer. Currently available treatments are limited and new therapies are needed that can provide safe and effective long-term weight loss.”

“Discovered through Arena’s proprietary platform, lorcaserin is a highly selective compound which works on a specific serotonin receptor located in the hypothalamus, an area of the brain known to impact satiety and influence metabolic rate,” stated Jack Lief, Arena’s President and CEO. “Based on the strength of these data, we are currently in discussions with the FDA about initiating a Phase 3 trial of lorcaserin in obese patients later this year.”

Lorcaserin Phase 2b Study Results

Patients completing the twelve-week treatment period with lorcaserin achieved a highly statistically significant (p

The proportions of patients completing the twelve week treatment period with lorcaserin who achieved a 5% or greater weight loss from baseline were 13% (p=0.015), 20% (p

Treatment with lorcaserin was also associated with dose-dependent and statistically significant improvements in BMI (p

A small, non-dose dependent decrease of 3.3-3.5% was observed in HDL levels that was marginally statistically significant at all doses (p=0.038-0.053). The decrease in HDL levels resulted in slight increases in LDL:HDL ratios, which were also non-dose dependent and not statistically significant. A similar small increase was also observed in the placebo group.

Lorcaserin was generally well tolerated at all doses investigated in the trial. Adverse events occurring in greater than 5% in any of the dosed groups were headache, nausea, dizziness, vomiting, dry mouth, nasopharyngitis, fatigue and urinary tract infection.

An assessment of baseline and Day 85 echocardiograms indicated no apparent lorcaserin effect on heart valves or pulmonary artery pressure. No changes in valvular regurgitation greater than one category, no significant differences between any treatment group and placebo in number of increases in valve regurgitation at any valve, and no significant increases in pulmonary artery pressure in any group were identified in the echocardiogram results.

Lorcaserin Phase 2b Study Design

The Phase 2b clinical trial was a randomized, double-blinded, dose-ranging study conducted at approximately 40 sites in the United States. The trial enrolled 469 male and female obese patients with a BMI of between 29 and 46. Patients were randomized into four groups to evaluate the safety and efficacy of daily 10 mg, 15 mg and 20 mg (10 mg dosed twice daily) doses of lorcaserin compared to placebo for 12 weeks. The primary efficacy endpoint of the Phase 2b study was a reduction in weight in patients completing the 12 week treatment period. In addition to standard safety evaluations, patients were assessed by echocardiogram prior to enrollment and at the end of the treatment period. Patients did not receive any diet or exercise advice, but were required to abstain from consuming alcohol during the study.

A complete set of the slides presented today at the ADA annual meeting will be available on the investor relations section of the Arena website at http://www.arenapharm.com/.

About Lorcaserin Hydrochloride

Lorcaserin hydrochloride stimulates the 5-HT2C serotonin receptor, located in the part of the brain called the hypothalamus, which helps regulate satiety and influences metabolic rate. Lorcaserin has approximately 100-fold selectivity in vitro for the 5-HT2C receptor relative to the 5-HT2B receptor. Arena believes the 5-HT2B receptor is primarily implicated in the cardiac valvulopathy observed with non-selective serotonergic agents. In addition, lorcaserin has approximately 15-fold selectivity in vitro for the 5-HT2C receptor versus the 5-HT2A receptor, a central nervous system (CNS) receptor thought to be responsible for many of the CNS adverse effects of non-selective serotonergic agents.

Arena holds similar patents entitled “5-HT2C Receptor Modulators” granted by both the U.S. Patent and Trademark Office and the European Patent Office. The patents relate to novel compounds that modulate the 5-HT2C serotonin receptor. Lorcaserin is covered under the patents.

About Obesity

Obesity affects tens of millions of adults and children in the United States and poses a serious long-term threat to their health and welfare. The number of overweight and obese people has substantially increased over the past several decades. Approximately two-thirds of all adults in the U.S. are obese or overweight. Medical and related costs of obesity in the U.S. were more than $117 billion in 2000. Being obese or overweight is associated with a number of conditions, including heart disease, stroke, diabetes, cancer and osteoarthritis. Medical treatment options for obese and overweight people are currently limited.

About Arena Pharmaceuticals

Arena is a clinical-stage biopharmaceutical company focusing on the discovery, development and commercialization of small molecule drugs in four major therapeutic areas: metabolic, central nervous system, cardiovascular and inflammatory diseases. Arena is developing a broad pipeline of compounds targeting an important class of drug targets called G protein-coupled receptors, or GPCRs, using its knowledge of GPCRs and its technologies, including CART(TM) (Constitutively Activated Receptor Technology) and Melanophore. Arena has four internally discovered, clinical-stage drug candidates for major diseases. The most advanced is lorcaserin hydrochloride, a selective 5-HT2C serotonin receptor agonist that is under investigation for the treatment of obesity and is expected to enter Phase 3 clinical development in the second half of 2006. Arena’s lead drug candidate for the treatment of insomnia, APD125, is a compound with a novel mechanism of action (a selective 5-HT2A receptor inverse agonist) with an IND pending before the FDA for the initiation of a Phase 2 trial in patients with chronic insomnia. Arena also has two clinical-stage collaborations with major pharmaceutical companies: Merck & Co., Inc., began a Phase 2 clinical trial of MK-0354, an Arena discovered drug candidate for the treatment of atherosclerosis and related disorders, in the second quarter of 2006; and Ortho-McNeil, Inc., a Johnson & Johnson company, began a Phase 1 clinical trial of APD668, an Arena discovered drug candidate for the treatment of type 2 diabetes, in the first quarter of 2006.

Arena Pharmaceuticals(R) and Arena(R) are registered service marks of the company. CART(TM) is an unregistered service mark of the company. “APD” is an abbreviation for Arena Pharmaceuticals Development.

Forward-Looking Statements

Certain statements in this press release are forward-looking statements that involve a number of risks and uncertainties. Such forward-looking statements include statements about the results of Arena’s Phase 2 clinical trials of lorcaserin hydrochloride, the tolerability, side effects and efficacy of lorcaserin hydrochloride, the expected clinical trials of lorcaserin hydrochloride and APD125, the potential of lorcaserin hydrochloride to help satisfy a need for new therapies that can provide safe and effective long-term weight loss, and other statements about Arena’s strategy, technologies, preclinical and internal and partnered clinical programs, and ability to develop compounds and commercialize drugs. For such statements, Arena claims the protection of the Private Securities Litigation Reform Act of 1995. Actual events or results may differ materially from Arena’s expectations. Factors that could cause actual results to differ materially from the forward-looking statements include, but are not limited to, the FDA may not allow Arena’s planned clinical trials to proceed at the time Arena expects or at all, the results of preclinical studies or clinical trials may not be predictive of future results, Arena’s ability to partner lorcaserin hydrochloride, APD125 or other of its compounds or programs, the timing, success and cost of Arena’s research, out-licensing endeavors and clinical trials, Arena’s ability to obtain additional financing, Arena’s ability to obtain and defend its patents, and the timing and receipt of payments and fees, if any, from Arena’s collaborators. Additional factors that could cause actual results to differ materially from those stated or implied by Arena’s forward-looking statements are disclosed in Arena’s filings with the Securities and Exchange Commission. These forward-looking statements represent Arena’s judgment as of the time of this release. Arena disclaims any intent or obligation to update these forward-looking statements, other than as may be required under applicable law.

   Contacts: Jack Lief             President and CEO              David Walsey             Director, Corporate Communications              Arena Pharmaceuticals             858.531.7778              Carolyn Wang             WeissComm Partners             Media Relations             415.225.5050    http://www.arenapharm.com/  

Arena Pharmaceuticals, Inc.

CONTACT: Jack Lief, President and CEO, or David Walsey, Director,Corporate Communications, both of Arena Pharmaceuticals, +1-858-531-7778; orMedia, Carolyn Wang of WeissComm Partners, +1-415-225-5050, for ArenaPharmaceuticals, Inc.

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

Use your hands wisely to avoid injury

By Charnicia Huggins

NEW YORK (Reuters Health) – Everyday tasks, like carrying
heavy groceries (which can strain finger joints and arms), or
slicing bagels (which can cause serious cuts) can pose a risk
of injury, according to the American Society of Hand
Therapists.

Those are just two of the five most common causes of hand
injuries that are highlighted during this week’s Hand Therapy
Awareness and Injury Prevention Week.

“Using common sense and joint protection techniques can
help to minimize potential injury or overuse of our hands and
arms,” according to Christine Muhleman, president of the
society, which includes both occupational and physical
therapists.

“Poor daily routines can add up to painful long-term
conditions unless you take proper care and precautions,” she
said in an ASHT statement.

To avoid injury, “slow down and use your hands wisely,”
Stacey Doyon, president-elect of the organization, told Reuters
Health.

Due to the fast-paced nature of society, “we do too much at
once,” without slowing down, she said. This multitasking may
lead to various hand injuries.

For example, some people may carry as many as four or five
bags in one hand while shopping. ASHT recommends that they
instead carry one bag at a time in each hand. Further, Doyon,
an occupational therapist and certified hand therapist, advises
shoppers to not only use carts instead of small baskets, but to
also ask for paper, rather than plastic bags, and use both arms
to carry the paper bags.

Another source of common injuries, although widely
underreported, are injuries to the hand from slicing bagels.
Many of these injuries, referred to as “bagel hand” by some
emergency departments, require surgery and a long period of
hand therapy before people regain their normal hand function.

To avoid these injuries, Muhleman recommends that people
never slice frozen bagels and that they use bagel slicers, if
possible. When bagel slicers are not available, she recommends
a two-stop process: first, holding the bagel down on the table
and slicing it halfway with a serrated knife, and second, stand
the bagel on end, grip the sliced end, and slice downward.

Many people are also injured while washing dishes, as they
search blindly for knives and other sharp tools in soapy
dishwater, according to the ASHT. What’s more, some people may
experience lacerations on the top of their knuckles when they
put their hand inside a narrow glass with a sponge and squeeze
the sponge. “The pressure of your hand may shatter the glass,
causing cuts to the back of your hand,” Paige E. Kurtz, ASHT
vice president, said in a statement.

People can also injure their hands while reading for
extended periods of time. Those who constantly pinch the pages
of a book with their finger and thumb may experience strain in
that area as well as stiffness. “Continuously pinching pages
can aggravate the tendons and joints in the thumb and wrist,”
according to Doyon. Rather than pinching pages, ASHT recommends
that readers rest the book on a flat or inclined surface or
place one hand on the front pages and the other hand on the
back of the book while reading.

Lastly, ASHT points out the dangers of paper cuts, thorn
pricks or other minor wounds, if left untreated. These wounds
should be thoroughly washed with warm water and soap and then
treated with some type of first aid antibiotic ointment.
According to Kurtz, ASHT vice president, “untreated minor
wounds can flare into dangerous infections.”

The good news is that specially trained individuals are
available to help people who have already experienced some type
of hand injury, according to Doyon.

“If you do have any type of injuries there are hand
therapists out there who can help,” she said.

To find one in your area, visit the American Society of
Hand Therapists online at www.asht.org.

Green tea may help explain “Asian paradox”

NEW YORK (Reuters Health) – While smoking is a well-known
cause of heart disease and lung cancer, the rates of these
diseases have remained inexplicably low in Asian countries
where smoking is common. But researchers say there is growing
evidence that green tea is one piece of the puzzle.

Writing in the Journal of the American College of Surgeons,
Yale University researchers detail the body of evidence linking
green tea to better heart health and a lower risk of cancer.

No one is suggesting that smokers ignore the danger of the
habit and simply drink green tea. But research indicates that
the tea’s high concentration of antioxidants called catechins
may offer a range of health benefits, according to Dr. Bauer E.
Sumpio and his colleagues at the Yale University School of
Medicine in New Haven, Connecticut.

Antioxidants help quench molecules known as oxygen free
radicals that, in excess, can damage body cells and potentially
lead to disease. Free radicals are natural byproducts of normal
body processes, but they are also generated by external sources
like tobacco smoke.

In Japan, China and other Asian countries, it is a social
custom to drink green tea, which is less processed — and
richer in catechins — than the black tea commonly consumed in
the West.

And it’s possible that this habit helps explain the
so-called “Asian paradox,” according to Sumpio and his
colleagues.

This paradox becomes clear when looking at global health
statistics, the researchers note. For example, for every
100,000 U.S. men, 348 will die of coronary heart disease each
year. The figure for Japanese men is 186, despite the nation’s
higher rate of smoking.

Coronary heart disease (CHD) develops when the arteries
feeding the heart become hardened and narrowed due to the
buildup of cholesterol-containing plaques on the artery walls.
According to Sumpio’s team, lab research suggests that that
green tea catechins — particularly one called EGCG — may help
thwart the CHD process through their effects on “bad” LDL
cholesterol.

The antioxidants may also help keep artery walls
functioning smoothly, as well as inhibit blood cells from
sticking together and forming clots.

Similarly, lab studies suggest that EGCG and other green
tea antioxidants may block tumor formation or growth in a
number of ways. This may, according to the researchers, help
explain why the lung cancer death rate in Korea is unexpectedly
low.

The rate of lung cancer death among Korean men is less than
40 per 100,000, versus 67 per 100,000 among U.S. men. The
difference among women is more stark: 13 per 100,000 in Korea,
compared with 45 per 100,000 in the U.S.

This is despite the fact that 37 percent of Korean adults
smoke, while only 27 percent of Americans do.

The global disease patterns are not that simple, however;
China has a higher CHD death rate than the U.S. and many other
Western nations, and the rate of death from lung cancer is
about the same among Japanese and American men. Green tea,
according to Sumpio, is no substitute for kicking the smoking
habit.

“Smoking cessation is the best way to prevent
cardiovascular disease and cancer,” he said in a statement.

SOURCE: Journal of the American College of Surgeons, May
2006.

Bird Flu Fear Doesn’t Deter Alaska’s Hunters

By Daisuke Wakabayashi

BARROW, Alaska — At the Apugauti ceremony to celebrate the capture of a bowhead whale during the spring, the men and women of the Patkotak whaling crew serve the traditional nigliq soup made with harvested geese, rice, onions and flavored with curry powder.

The salty rich broth and mikigaq — whale meat and blubber fermented in blood — represent the traditional menu for the ceremony and are delicacies of the Inupiat Eskimo subsistence diet which relies heavily on water fowl and other animals found in the Arctic climate of Barrow, Alaska.

Migratory geese and ducks, staples of the Inupiat Eskimo diet, are also among the 33 priority birds targeted by the U.S. government for its avian flu surveillance program in Alaska, a crossroads for wild birds from Asia.

The H5N1 avian flu virus has killed 128 people in nine countries, according to the World Health Organization, but it has not been found in North America.

“It adds an extra layer of complexity,” said Noah Owen-Ashley, a biologist for Alaska’s North Slope borough department of wildlife. “One of our jobs is to educate the residents about bird flu, but not scare them.”

Federal and local officials must walk a fine line in dealing with native Alaska community regarding bird flu. Officials do not want to cause panic and must reassure subsistence hunters that it is safe to eat wild birds.

At the same time, they want to instill enough concern about the virus to receive cooperation to test harvested birds and encourage the need for increased safety.

However, some Alaska Native residents of Barrow, the northernmost city in the United States and home to the world’s largest Inupiat Eskimo community, did not express any concern.

“It’s not really scary, because our people have hunted these birds since time immemorial and we know our own animals and we know if one is sick,” said Thomas Olemaun, executive director of the Native Village of Barrow.

“It’s our tradition. We can’t stay home and not hunt them, because we grew up eating” the birds, he said, adding that he harvested about 40 geese for his family during the spring hunting season. “It’s way better than chicken.”

GETTING THE MESSAGE OUT

Wildlife biologists and health officials are taking to local airwaves, community newspapers and the Internet to encourage people to handle game safely.

In an hour-long program on local public radio and translated into the native Inupiaq language, a group of officials recommended people cook meat and eggs from wild birds thoroughly and properly wash their hands and equipment after handling dead birds.

Some safety precautions like wearing goggles and rubber gloves when out hunting is simply not realistic, said Charles Brower, director of wildlife at the Native Village of Barrow.

“It’s very hard to carry when you’re out hunting. It’s the last thing people take with them,” said Brower, who is also a hunter and harvested nearly 60 birds during the spring.

Subsistence hunting is also a financial necessity for many residents in the northern reaches of Alaska.

Since Barrow is 350 miles north of the Arctic Circle with no roads connecting it to other towns, food is very expensive in the city’s few grocery stores. A gallon (3.8 liters) of milk can cost nearly $8.

“We eat what God has provided us for so many thousands of years and we’re still living on it,” said Brower.

High rate of self-harm seen among college students

By Anne Harding

NEW YORK (Reuters Health) – One in six young adults have
injured themselves intentionally at least once, according to
the largest US survey to investigate the practice among college
students.

Self-injurious behavior can include scratching and pinching
oneself, cutting, swallowing poison and even breaking bones.
People who injure themselves say it helps relieve distress.

“It’s a harbinger of distress, in all likelihood, and
inability to cope positively,” Dr. Janis Whitlock of Cornell
University in Ithaca, New York, the study’s lead author, told
Reuters Health.

“There’s a fair degree of consensus that self-injury is
fundamentally self-medicative,” she added, noting that injuries
trigger the release of natural opiates known as endorphins,
resulting in an immediate sense of calm.

Whitlock and her colleagues surveyed 2,863 students at two
northeastern US universities, 17 percent of whom said they had
harmed themselves intentionally at least once. While there have
been numerous reports that self-injurious behavior is becoming
more common, Whitlock told Reuters Health, “I don’t think I
expected it to be quite that high.”

Most of the students who reported injuring themselves — 71
percent — said they had done so at least twice. On average,
they had injured themselves for the first time at age 15 or 16,
the team reports in the medical journal Pediatrics.

While 20 percent said they had injured themselves more
severely than they intended and should have gotten medical
help, just 3 percent of the self-injurers had told a physician.
Thirty-six percent said no one knew about their self-injurious
behavior.

Repeat self-injurers were more likely to be female,
bisexual or unsure of their sexual orientation, and were also
more likely to have been abused sexually or emotionally,
Whitlock and her colleagues found. They also were more likely
to have considered or attempted suicide and were more
psychologically distressed.

Given the reluctance of people who injure themselves to get
help, the researchers write, it is “critical” for health
professionals to find ways to recognize, treat and prevent
self-injury. Based on the findings, they add, medical and
mental health providers might make it standard practice to ask
their older adolescent and young adult patients about
self-injurious behaviors.

Signs that a young person may be harming themselves may
include dressing inappropriately for the season, for example
wearing long sleeves and long pants in the summer months, and
wearing adornments that cover the wrists, Whitlock said.

Parents who do discover that their child is injuring him or
herself should try not to react with “horror or incredulity,”
she added. “For a lot of self-injurers there is a high degree
of shame associated with the behavior, and that’s one of the
reasons why they’re so secretive. Adults need to sort of be
aware and know how to respond in a way that’s not judgmental or
reactionary.”

SOURCE: Pediatrics, June 2006.

Nicotine mimic improves cognition in schizophrenia

NEW YORK — A novel agent with nicotine-like properties, dubbed DMXB-A, improves the mental function of patients being treated with anti-psychotic drugs for schizophrenia, researchers report.

As the investigators point out in the Archives of General Psychiatry, people suffering from schizophrenia are often heavy smokers and this is thought be an attempt at self-medication with nicotine. Nicotinic receptors, which are involved in the brain’s machinery for processing sensory input, are dysfunctional in schizophrenia.

In a proof-of-concept study, Dr. Robert Freedman, of the University of Colorado Health Sciences Center in Denver, and colleagues tested DMXB-A in12 schizophrenics on anti-psychotic medications. All patients were nonsmokers for at least one month prior to the trial, to avoid any interaction with long-term exposure to nicotine.

Two doses of DMXB-A were tested, and compared with inactive “placebo” treatment.

The investigators observed “significant neurocognitive improvement” with active treatment in scores on a test for assessing mental performance. Only the lower dose caused significant improvements in overall scores.

“Two patients spontaneously remarked that the drug helped them think more clearly and maintain concentration,” the researchers report.

As a result of the positive findings, Freedman said a phase II trial has been initiated, with DMXB-A given twice a day for 2 months.

SOURCE: Archives of General Psychiatry, June 2006.

FEMA Now Requiring Doctor’s Note for Free Generators

By Amy Sherman

Only people who can prove a medical need will qualify for free generators after a power-cutting hurricane, according to a new federal policy.

Last year, Florida residents — rich or poor — who suffered through major power outages could buy generators for up to $836 and then be reimbursed by the Federal Emergency Management Agency. The bill was huge: about $118 million in 2005.

But a taxpayer watchdog group decried the policy as a waste of money.

Now, under a new national policy that went into effect June 1, storm victims seeking FEMA reimbursement will need to provide a receipt and proof that the equipment is medically necessary, such as a letter from a doctor.

U.S. Rep. Clay Shaw, R-Fort Lauderdale, said he urged FEMA to change its giveaway policy.

“If somebody wants to buy a generator to take care of their home, to take care of outages, it’s their own responsibility,” said Shaw, whose home was without power, or a generator, for two weeks after Hurricane Wilma struck last October. “Obviously being without electricity is a huge inconvenience, but it’s not up to the federal government to compensate people for inconvenience.”

Still, even the new policy could reward some wealthy residents with free generators — if those people can prove they have a medical need.

In 2004, when Florida was pummeled by Hurricanes Charley, Frances, Ivan and Jeanne, FEMA paid about $213 million to provide generators.

In 2005, FEMA reimbursed hurricane victims up to $835.97 each for generators if their power was out at the time of the purchases and they lived in a federal disaster area.

The reimbursement came under the “other needs assistance” category that allowed hurricane victims to purchase up to $1,676.65 worth of goods, which also included chain saws, air purifiers, wet-dry vacs and humidifiers.

Whether to reimburse for generators has not been solely up to FEMA.

States have had a say in the matter, since states pay 25 percent of the tab. Florida, until now, had opted to include generators in what could be reimbursed, regardless of the purchaser’s medical condition.

At a hurricane conference in Fort Lauderdale last month, FEMA’s acting director, R. David Paulison, promised changes in response to criticisms of the way the agency handled last season’s hurricanes — including the generator giveaway.

“We’re revamping our generator program to make sure those who need a generator will get them, but we’re not going to hand them out willy-nilly like we did last year,” said Paulison, a former Miami-Dade fire chief who has a home in Davie.

Dr. Frederick Keroff, district medical director for emergency services for the Memorial Healthcare System in Broward County, noted that diabetics need access to refrigeration for insulin, and some patients, such as people with severe asthma, need electricity to run home nebulizers that help them inhale medications.

But Keroff questioned how FEMA will define medical necessity.

“You can really stretch it,” said Keroff, who specializes in emergency medicine. “If you have an elderly individual who might be susceptible to changes in temperature and might become overheated, do they need A/C to prevent illness? It’s possible. . . . There’s opportunity for gaming the situation.”

The policy does not define medical necessity, but FEMA spokesman Aaron Walker said the agency will publicize more information about what qualifies after a disaster occurs.

Keith Ashdown, a spokesman for Taxpayers for Common Sense, a Washington, D.C., nonpartisan budget watchdog, last year criticized FEMA for giving away generators to people who didn’t need financial assistance.

“We support any effort to make the system more accountable and verifiable,” Ashdown said. “That seems like a step in the right direction.”

The new three-page FEMA policy states that it is an interim policy effective until it’s replaced by a final policy. The generator policy does leave some wiggle room: “The Recovery Director may waive one or more eligibility criteria during extraordinary circumstances (e.g., sustained power outage during a period of subfreezing temperatures), when determined to be in the public interest.”

FEMA started reimbursing residents for generators in 2002, Walker said.

Walker denied that criticism led to the policy change, which he described as a result of a routine policy review.

Walker emphasized the need for residents living in hurricane-prone areas to prepare for themselves this year, including stocking up on medical supplies.

Miami Herald staff writers Dan Christensen and Martin Merzer contributed to this report.

—–

Copyright (c) 2006, The Miami Herald

Distributed by Knight Ridder/Tribune Business News.

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RelayHealth Partners With Montefiore Medical Center to Launch Secure Messaging Services to Improve Patient Access and Practice Efficiency

EMERYVILLE, Calif., June 6 /PRNewswire/ — RelayHealth Corporation, the nation’s leading provider of online provider-patient communication services, today announced an agreement with Montefiore Medical Group (MMG), a division of Montefiore Medical Center in New York City, to provide secure RelayHealth online messaging services to some of its patients as part of a pilot project.

Initially, the service will be available at six Montefiore Medical Group locations in the Bronx and nearby Westchester County. Patients at these locations will be able to communicate with MMG staff from their homes or offices, at a time that is convenient to them, about appointment requests, prescription renewals and lab test results.

“We’re honored to be working with Montefiore as part of its commitment to extraordinary patient care,” said Giovanni Colella, MD, president and chief executive officer, RelayHealth. “We expect this pilot project will show that the RelayHealth service will have a favorable impact on patient satisfaction as well as on overall operational efficiency within each MMG practice.”

About Montefiore Medical Center

Montefiore Medical Center, The University Hospital and Academic Medical Center for the Albert Einstein College of Medicine, ranks among the top one percent of all US hospitals based on its investments in medical innovation and cutting-edge technology.

This 1,062 bed medical center includes the Henry and Lucy Moses Division, the Jack D. Weiler Hospital and The Children’s Hospital at Montefiore, a large home healthcare agency and a 21-site medical group practice located throughout the Bronx and nearby Westchester. Montefiore treats all major illnesses and has distinguished centers of excellence in cardiology and cardiac surgery, cancer care, tissue and organ transplantation, children’s health, women’s health, surgery and the surgical subspecialties. Montefiore Medical Center focuses on providing family-centered healthcare in a nurturing environment that extends well beyond its hospital and ambulatory settings.

About RelayHealth Corporation

RelayHealth is the premier provider of secure, online healthcare communication services. The RelayHealth communications platform connects patients, clinicians, payers and pharmacies to improve clinical productivity, create administrative efficiencies, reduce costs and enhance patient satisfaction. Medical practices can quickly deploy RelayHealth to realized physician productivity and reduced phone volume. With the RelayHealth Interoperability Toolkit, practices can also integrate RelayHealth with most major commercial or custom electronic medical record and practice management systems. RelayHealth’s robust suite of solutions for the medical office includes secure messaging featuring the webVisit, and end to end e-prescribing through eScript. The RelayHealth communications platform also enables care management and continuity of care through tools such as a Patient Health Record that interoperates with physician and payer clinical systems. For more information, visit http://www.relayhealth.com/.

RelayHealth Corporation

CONTACT: Briana Pompei of RelayHealth Corporation, +1-510-428-7853, [email protected]

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

Magnetic Nature of a Mysterious Cosmic X-ray Emitter

An international team of astronomers has discovered that the naked-eye star, tau Scorpii, unexpectedly hosts a complex network of magnetic field lines over its surface.

Our Sun has its explosive flares and spots and high speed wind, but it is a placid star compared to some. Stars that are much more massive live fast and die young, with blue-white, intensely hot surfaces that emit energy at a rate millions of times greater than that of the Sun. These stars are so bright that their light alone propels outflowing stellar winds – up to a billion times stronger than the solar wind – at speeds of up to 30,000 km/s, or one per cent of the speed of light.

Tau Scorpii has been known for some time to emit X-rays at an unusually high rate and to rotate more slowly than most otherwise similar stars. The newly discovered magnetic field, presumably a relic from the star’s formation stage, goes some way to explaining both characteristics, although the mechanism by which the magnetic field slowed down tau Scorpii’s rotation so strongly remains mysterious.

These results will be published in the Monthly Notices of the Royal Astronomical Society.

The processes by which hot, massive stars expel their surface layers through their strong outflowing winds have a major impact on a star’s long-term fate. The cast-off material can also interact with other nearby stars, contribute matter and energy to the surrounding interstellar medium, and even induce bursts of new star formation. Hot massive stars are thus key actors in the life of a galaxy.

One such hot star is tau Scorpii, whose intrinsic brightness is so great that it is easily visible with the naked eye, despite its distance of over 400 light-years. Weighing as much as 15 Suns, tau Scorpii is 5 to 6 times bigger and hotter than our own star. Such massive stars are relatively few in number compared to stars like the Sun, and tau Scorpii is actually one of our closest massive neighbours.

Massive stars are thought to emit X-rays because of supersonic shocks occurring within their outflowing winds. However, tau Scorpii is an unusually strong X-ray source compared to stars which are otherwise similar.

The reason for this enhanced activity was a puzzle until the present discovery, which revealed that the star hosts a complex network of magnetic field lines over its surface (see image). According to the discovery team, this field is most probably a relic from the star’s formation stage.

The most interesting aspect, though, is how the field interacts with the wind, forcing it to flow along magnetic field lines, like beads along wires. Wind streams along ‘open’ magnetic field lines (shown in blue) freely escape the star, something that wind streams in magnetic ‘arcades’ (shown in white) cannot achieve. The result is that, within each magnetic arcade, wind flows from both footprints collide with each other at the loop summits, producing tremendously energetic shocks and turning the wind material into blobs of million-degree, X-ray emitting plasma tied to the magnetic loops.

This model provides a natural explanation of why tau Scorpii is such an intense X-ray emitter. However, it is not yet clear how the magnetic field succeeded in slowing down the rotation rate of the star to less than one-tenth that of otherwise similar, non-magnetic, massive stars.

Sun-like stars can be slowed down through their magnetic wind, just as ice-skaters are spun down when outstretching their arms. Tau Scorpii does not, however, lose material fast enough to have its rotation modified within its very short lifetime of a few million years.

The researchers discovered and examined the magnetic field of the star by looking at the tiny, very specific polarisation signals that magnetic fields induce in the light of magnetic stars. To do this, they used ESPaDOnS [2], by far the most powerful instrument in the world for carrying out this kind of research. This new instrument, currently attached to the Canada-France-Hawaii Telescope [3] on Hawaii, was specially designed at the Observatoire Midi-Pyr©n©es in France for observing and studying magnetic fields in stars other than the Sun.

Video

A movie showing the complex network of magnetic field lines recently discovered at the surface of the massive star tau Scorpii is available at:
http://www.redorbit_new.com/wp-content/uploads/2006/06/tausco_moira_mov.gif 
Click on the image to see an animation (10 Mb) of what the observer sees as the star rotates. Copyright M. M. Jardine and J. F. Donati.

Extractive Metallurgy of Vanadium-Containing Titaniferous Magnetite Ores: a Review

By Taylor, P R; Shuey, S A; Vidal, E E; Gomez, J C

Abstract

Many technologies exist for the treatment of titaniferous magnetites that contain vanadium. Each process is designed based on the relative amounts of titanium, vanadium and iron. In some cases, steelmaking is the primary purpose followed by the secondary recovery of vanadium. In others, the vanadium is the main product. This paper presents a review of these technologies

Key words: Vanadium, Titaniferous magnetites

Introduction

In modem society, vanadium is defined as a strategic metal. Some 90% of the vanadium consumed globally is for use as an alloying agent for carbon steels, tool steels and high-strength, low-alloy steels (particularly for pipelines). Advanced titanium-aluminum- vanadium alloys are seeing application in the aerospace industry. Small, but ever growing amounts, are finding application as catalysts or in electronics. New uses are continually being discovered for this metal. One example of a new application is the vanadium-redox battery for use in generation plants and back-up power sources.

Vanadium is found in a large number of minerals, of which the most important are carnotite, roscoelite, vanadinite, mottramite and patronite. A little more than a third of the world’s vanadium is produced as a primary product; the balance is produced as byproducts of the iron and steel, oil refining, power generation and uranium enrichment industries. Vanadium can also be sourced by recycling spent catalysts from the petrochemical industry and ash produced by the combustion of oil emulsion in power stations. However, recycling activities are believed to account for only a small amount of total world supply. Vanadium is recovered from these ores largely as vanadium pentoxide (V^sub 2^O^sub 5^) (Perron, 2001).

Major sources of vanadium-bearing magnetite ores are scattered throughout Australia, China, Russia and South Africa. Current estimates of the world’s proven and probable vanadium reserves are of the order of 41.3 Mt (Vanitec, 2004a, 2004b). According to the U.S. Geological Survey, current estimates of the world’s reserves stand at 13 Mt with a reserve base of 38 Mt. (Table 1) (U.S. Geological Survey, 2001-2005). Commercial vanadium-bearing titaniferous magnetite deposits can be found in Kachkanar, Russia; Pan Zhihua, China; Bushveld, South Africa; and Windimurra, Western Australia (Lazutkin et al., 2001). Other deposits have been found in New Zealand, Canada and India, as well as in other countries.

Vanadium consumption in the steel sector has increased some 7% per ton of steel during the last 10 years as new alloying applications have been found to improve steel’s strength-to-weight ratio. Future demand from the aerospace and nuclear industries for nonferrous vanadium alloys such as titanium and super-alloys is also likely to grow. Vanadium is usually added in the form of ferrovanadium, a vanadium-iron alloy. Vanadium compounds, especially the pentoxide form, are used in the ceramics, glass and dye industries, and they are also important as catalysts in the chemical industry.

While established approaches may be used at an industrial scale to treat vanadium-bearing titaniferous magnetite ores in several countries, new alternatives are being developed worldwide. This review will give a short overview of the treatment of vanadium- bearing titaniferous magnetite ores.

General Technology

Vanadium can be recovered from titaniferous magnetite ore by either of two processes: precipitating a vanadium salt from a leach of a salt-roasted ore and precipitation from a leach of salt- roasted slag obtained after smelting the ore to make a vanadium bearing pig iron followed by an oxygen blow in a converter forming the vanadium-rich slag (Fischer, 1975).

Table 1 – World mine production, reserves and reserve base.

The smelting of titanomagnetite containing vanadium in conventional blast furnaces using traditional smelting techniques may cause serious problems (Brothers et al., 2002), which may be characterized by poor permeability of the burden column and lower smelting rates and difficulties with slag chemistry and fluidity (Diao, 1999). The development of titanium carbides and nitrides in the blast furnace slags leads to a dense slag with entrained iron, slag sediment in the furnace hearth, periodical “huge slag effusion” and “hot sticking” phenomena; and formation of foamed slag. These phenomena cause abnormal performance of the blast furnace and the breakdown of normal production procedures (Li et al., 1989; Qu, 1989; Wang et al., 1989, Zhao et al., 1989; Ma et al., 2000; Smirnov et al., 2001).

In light of the above factors, duplex processes are used in world and domestic metallurgy to convert vanadium pig iron into steel (Smirnov, 2000). The duplex process used at the Nizhniy Tagil combine in Russia consists of blowing the vanadium pig iron in a first converter without the addition of lime, conversion of as much vanadium as possible into a commercial slag containing ~10% vanadium and the production of a carbon-bearing semifinished product. The vanadium in such a slag is in the form of a trioxide, so that it is environmentally harmless and can be efficiently used for the production of V^sub 2^O^sub 5^. The carbon-bearing semifinished product is converted to steel in a second converter (with the addition of the necessary amount of lime and other slag-forming materials to ensure that the steel has a low content of harmful impurities – phosphorous and sulfur).

Successful use of the duplex process requires an additional converter, which lowers the productivity of the shop and increases conversion costs. However, it also makes it unnecessary to use large quantities of scrap metal, which can introduce undesirable impurities.

There are some others technologies that have been developed for magnetite ores with high titanium content. For example, in the treatment of a large part of the vanadium-bearing magnetite from South Africa, the iron is produced by a process involving the pre- reduction of the magnetite with powdered coal in a rotary kiln followed by reduction in a submerged arc electric furnace. Smelting reduction of titanium-bearing iron ore in blast furnaces has been practiced extensively in recent times in China and Russia. The iron sands of New Zealand are being processed through the normal direct reduction route using the rotary kiln process for reduction (Vanitec, 2004a, 2004b).

Research (Geyrhofer et al., 2003) has been performed to optimize the roasting process in the recovery of vanadium with a control concept based on a temperature controller, a chemistry controller and an overhead controller, which enables a high degree of automation for a roasting process in a multiple heart furnace. Accurate models of the chemical reaction kinetics (Voglauer, 2003) that describe the reaction rate of the vanadium roast and its derivation were considered. Validation of the process model showed good agreement of measurement and simulation data for the transport of mass and temperatures. The authors concluded that the resulting control concept was developed with much emphasis on robustness, and, therefore, it is well suited for industrial application.

Established treatment technologies

South Africa. South African titaniferous magnetites from the Bushveld Complex provide a potential source of titanium, vanadium and iron. These ores generally comprise a magnetite spinel in which titanium is present in solid solution as ilmenite or ulvospinel and vanadium is present in solid solution as the spinel structure coulsonite. The upper 1,750 m of layered basic rocks of the Bushveld Complex contain approximately 8% magnetite disseminated in gabbroic rocks, plus a further 20 m of pure magnetite distributed through in excess of 20 discrete magnetite layers. Chemically, it contains V^sub 2^O^sub 5^ and TiO^sub 2^; the former decreasing in amount upwards from approximately 2%, while the latter increases from about 12% to 20%. No discrete vanadium minerals are present, but vanadium occurs in solid solution in the magnetite (Cawthorn and Molyneux, 2003).

The titaniferous magnetites from the Bushveld Complex in South Africa are of economical importance and are being exploited. South Africa’s vanadium-bearing titanomagnetite ores are mostly processed by four companies (Perron, 2001): Highveld Steel and Vanadium Corp. (Highveld); Vametco Minerals Corp.; Transvaal Alloys Pty Ltd. ; and VanadiumTechnologies (Vantech). One South African processing technology is known as the Highveld Steel and Vanadium Corp. process (Gupta and Krishnamurthy, 1992; Highveld Steel, 2003). The average grade of the company’s vanadiferous magnetite is 54.3% Fe, 1.6% V^sub 2^O^sub 5^ and 14.2% TiO^sub 2^ (Wells, 2003). Owing to the high titanium content of the magnetite ore that Highveld receives from its Mapochs Mine, it cannot be smelted in the same way as more common iron ores in a conventional blast furnace, which relies on the presence of a large excess of carbon to reduce iron oxide to metallic iron.

Highveld’s method of smelting the magnetite ore involves a preliminary “pre-reduction” stage. In this process, the Bushveld titaniferous magnetite ore is concentrated in a series of crushing and magneticseparation steps. The magnetic particles are crushed and screened, before they go to the pelletizing plant. Coal, dolomite and quartz are added to the magnetite concentrate for charge to the pre-reduction rotary kiln. The addition of dolomite and quartz guarantees that the titania will be fluxed out into the slag.

Figure 1 – The Highveld Steel and Vanadium Process – Vanadium Products Flowsheet (Highveld Steel, 2003).

Figure 2 – Flow diagram of the South African vanadium industry (Republic of South Africa, 2001 ).

The kiln is heated by burning pulverized coal to a temperature of 1,140C. (The use of coal and not coke has the effect of lowering the power requirements of the smelting, resulting in a cheaper iron- making process.) The hot pre-reduced charge is placed in a submerged arc furnace and heated to 1,350C. Carbon is added to control fluidity and iron content in the slag. The titanium separates from the molten pig iron and forms a dense slag, which can be drawn off at the start of tapping.

The pig iron typically contains 3.5% C, 1.28% V, 0.25% Si, 0.16% Ti, 0.065% S and 0.075% P. The slag typically contains 0.9% V^sub 2^O^sub 5^, 20% TiO^sub 2^, 18% CaO, 17% MgO, 19% SiO^sub 2^ and 13% Al^sub 2^O^sub 3^. In Highveld’s steel plant the hot metal is agitated and oxygen-blown in shaking ladles to remove the vanadium. Scrap, iron ore, anthracite and iron rejects are added if necessary. The temperature is kept below 1,400C to ensure vanadium oxidation with a minimum of carbon withdrawal from the bath. The slag from the shaking-ladle, oxygen-blowing operation contains the bulk of the vanadium – typically about 12% to 16% (by weight) vanadium. The iron is then transferred to a BOF and the rich vanadium slag transferred to a slag pot for further treatment to extract the vanadium. Figure 1 (Highveld Steel, 2003) shows a flowsheet for this process.

High-grade vanadium pentoxide for the international market is produced by the Vanchem division. The flowsheet for recovery of vanadium is shown in Fig. 2 (Republic of South Africa, 2001). As seen, the recovery process involves the roasting of finely milled ore from the Mapochs mine with a sodium salt. The roasted calcine is leached with water to recover the vanadium, which is then precipitated with an ammonium salt. After ammonia removal the vanadium pentoxide is fused and the flakes are drummed.

In another process, the vanadium-bearing magnetite ore is subjected to conventional crushing, grinding and magnetic separation to produce a magnetite concentrate. The magnetite concentrate undergoes a conventional salt roast/leach/precipitation process to recover saleable vanadium pentoxide (V^sub 2^O^sub 5^). Most of the V^sub 2^O^sub 5^ produced in the future will be converted to ferrovanadium (FeV) alloy.

The vanadium production facilities at Rhovan consist of conventional vanadium pentoxide (V^sub 2^O^sub 5^) and ferrovanadium (FeV) plants (Wells, 2003). The latter entered commercial production in November 2000 with sales commencing in June 2001. Run-of-mine ore is crushed and conveyed to a 5-MW autogenous grinding mill fitted with a pebble crusher and operating in a closed circuit with cyclones. Magnetite is separated from the ground material in low- intensity magnetic separators, followed by regrinding in a ball mill and a second stage of magnetic separation. Magnetite concentrate is filtered and stockpiled under cover prior to being blended with sodium carbonate flux and roasted in a coal-fired kiln. The resulting calcine is conveyed to one of three leach dams that are used to recover the vanadium bearing solution. Barren solid residue is mechanically scraped from the dams and conveyed to the calcine stockpile. Silica is removed from the pregnant solution by addition of aluminum sulfate, followed by filtration. Ammonium metavanadate is precipitated from the clean pregnant solution by addition of ammonium sulfate and filtered. Ammonia is driven off in two electric kilns to form V^sub 2^O^sub 5^ powder that is then melted in an electric furnace to form V^sub 2^O^sub 5^ flakes. V^sub 2^O^sub 5^ flakes form the feed for the ferrovanadium process where V^sub 2^O^sub 5^ is reacted with aluminum, iron and lime in an exothermic process to produce FeV ingots and an alumina slag.

Russia. The Kachkanar Deposit has reserves of more than 9 Mt of titanomagnetites. Titanium-magnetite ore from the Kachkanarskoe deposit is utilized for steel manufacture. Russia’s sole producer of vanadium raw material is the Kachkanar iron ore mining complex in Sverdlovsk oblast in the Urals that mines titaniferous magnetite (Levine, 1996). Vanadium is produced from vanadium rich slag – a co- product of iron production at the Nizhny Tagil and Chusovoy metallurgical plants, also in the Urals (Nizhiny Tagil Iron and Steel Works, 2003). Nizhniy Tagil Iron and Steel Works (NTMK) is located in the city of Nizhniy Tagil in the Ural Mountains. NTMK is one of the world’s largest companies processing vanadium-enriched titaniferous ores with subsequent vanadium recovery in blast furnaces and oxygen converters. Raw materials for the blast furnaces are supplied from the Kachkanarskoe titaniferous ore deposit and Tagilo-Kushvinskaya group of loadstone deposits. The main iron ore suppliers of NTMK are Kachkanarsky mining and dressing complex (KGOK); Vysokogorsky mining and dressing complex (VGOK) and Goroblagodatskoye mining company (GBRU). Due to the low (less than 1%) vanadium content of these ores, the metallurgical plant finds it expedient to combine the recovery of vanadium with the normal metallurgical processing of these ores. In this case, vanadium is a byproduct of the metallurgical conversion.

Studies in this area were begun in Russia in 1925, and metallurgists had developed a blast-furnace smelting technology that entailed the production of vanadium pig iron and a titanium-bearing slag. The ore is first processed in blast furnaces for producing the vanadium-containing cast iron. NTMK’s blast furnaces are designed for making two types of iron: pig iron and ferro-vanadium. They have used a smelting technology for iron with low Si (0.15%), Ti (up to 0.20%) and high V (up to 0.55%) within high-capacity furnaces. Smelting the vanadium-containing steel is performed in a basic oxygen converter with the use of the cast iron.

The presence of titanium in iron ore leads to several problems. The problems can be solved using two basic oxygen converters. NTMK’s BOS offers a two-stage process of smelting resulting into micro- alloyed vanadium steel and commercial slag of 16% to 28% V^sub 2^O^sub 5^. The first basic oxygen converter is used for producing the semiproduct and vanadium-containing slag (Gavrilyuk, 1996; Smirnov, 2000, 2001). This involves blowing the vanadium pig iron in a first converter, without lime addition, to convert the maximum vanadium into a slag containing approximately 10% vanadium. Cooling of the bath with the addition of rolling scale encourages the vanadium to move from the metal to the slag phase. Vanadium transfer from metal into slag is 85%. The semifinished product is 3.0% C and 0.03% V and small amounts of Si, Mn, Ti, P and S. The vanadium in the slag from the first converter exists as a trioxide, which is environmentally benign. The second basic oxygen converter is used for producing high-quality steel. The flow sheet of NTMK’s duplex process is shown in Fig. 3.

The blast-furnace conversion of titanomagnetites in modern blast furnaces, larger than 1,000 m^sup 3^, is based on the smelting of prepared vanadium-bearing materials obtained from iron ore (up to 60% to 70% unfluxed oxidized Kachkanar pellets, high-basicity sinter from the Kachkanar Mining-Concentration Combine (KachGOK), sinter prepared from concentrate and vanadium-bearing wastes), the use of natural gas, oxygen and steam to regulate the combustion temperature (1,950 to 2,000C) and maintenance of the optimum slag regime. In the blast furnace-converters process, it is reported that about 20% of the vanadium present in the initial ore is lost. According to estimates, due to the multiple-stages of processing, only about 33% to 37% of the vanadium in the ore ends up in the steel. Therefore, an alternative process has been proposed to treat Russian vanadiferous magnetite ore.

Figure 3 – NTMK’s duplex process of treating vanadium-bearing pig iron (Nizhiny Tagil Iron & Steel Works, 2003).

The direct production of iron- and vanadium-bearing ore, proposed by Russian metallurgists, is based on the Midrex process (Lazutkin et al., 2001). According to the proposal, the process includes metallization in a shaft furnace (SF), EAF refining and treatment in a “special steel treatment unit” (STU). In this process, the vanadium is present in the form of an oxide in each operation, and it is reduced from the slag to the steel only in the final conversion. The recovery of vanadium reportedly may reach 85% based on test work from 1998. The average degree of metallization of the Kachkanar pellets was 92.2% with 78.8% Fe^sub total^, 1.93% C and 0.76% V^sub 2^O^sub 5^. The feasibility of recovering vanadium in the arc steelmaking furnaces from a metallized product obtained from the Kachkanar deposit was also conducted. With the addition of aluminum injected with argon, vanadium was reduced into steel. Thus, almost any grade of vanadium steel might be produced without the use of ferrovanadium. The highest degree of vanadium recovery obtained was 81% to 84%. The proposed process is still subject to commercial trials.

China. China ranks third in vanadium and titanium reserves in the world, right after Russia and South Africa. The Panzhihua area of Sichuan province in China possesses iron, vanadium, titanium, cobalt and nickel resources. The proven deposits of titanium and vanadium account for 35.17% and 11.6% of world total reserves, respectively. The major producer of vanadium-bearing titanomagnetite concentrate is \Panzhihua Iron and Steel Group Corp., followed by Chengde Iron and Steel Group Co. Ltd. Panzhihua developed ferrovanadium and titanium magnetite smelting technology using conventional blast furnaces with an atomized vanadium extraction process, and a process of extracting titanium from abandoned tailings and vanadium from steel slag.

Figure 4 – Processing vanadium-bearing titaniferous magnetite at Chengde China.

The typical iron ore in this region consists mainly of titanomagnetite (35.42%), ilmenite (12.73%), sulfides (2.16%) and gangue (49.68%). Magnetic separation produces a magnetite-rich concentrate, with approximately 45% of the iron reporting, and an ilmenite rich tailings. The process involves gravity separation, magnetic separation, flotation and electrostatic separation. The vanadium-bearing titaniferous magnetite ore in the Panzhihua area has an average composition of: 39.8% Fe^sub total^, 13.26% TiO^sub 2^,0.39% V^sub 2^O^sub 5^, 11.90% SiO^sub 2^, 6.54% Al^sub 2^O^sub 3^, 5.14% MgO, 3.06% CaO, 0.61% S, 0.021% CoO and 0.024% NiO. After dressing, the vanadium-bearing titaniferous magnetite concentrate contains 51.55% Fe^sub total^ (with 32.10% FeO), 12.74% TiO^sub 2^, 0.579% V^sub 2^O^sub 5^, 4.7% SiO^sub 2^, 4.58% Al^sub 2^O^sub 3^, 3.09% MgO, 1.43% CaO, 0.562% S and 0.025% P. The concentrate is processed in conventional blast furnaces.

High viscosity, foaming of slag and low porosity of the sinter during reduction are three major problems encountered while using conventional blast furnace operation to process vanadium-bearing titaniferous magnetite concentrate. By using a high basic sinter the problems associated with this feed into a conventional blast furnace can be overcome, according to Panzhihua’s practice. The blast furnace slag has a composition of 28.95% CaO, 25.28% SiO^sub 2^, 15.22% Al^sub 2^O^sub 3^, 0.22% V^sub 2^O^sub 5^, 7.22% MgO, 1.06% FeO and 22.20% TiO^sub 2^ with a basicity of 1.15. The pig iron produced has the composition 4.31% C, 0.10%Si, 1.17%Ti, 0.32% V, 0.066% P and 0.054% S.

The Chengde Iron and Steel Group Co. Ltd. in Hebei Province China also processes vanadium-bearing titaniferous magnetite ore. The flowchart of its process is shown in Fig. 4 (Zashu and Chushao, 1996; Wang et al., 1999; Chengde Iron & Steel Groups Co. Ltd, 2003).

A new process for utilization of vanadium-titanium magnetite is comprised of pelletization, selective reduction of pellets in a rotary kiln using a mixture of lignite and anthracite as reducing agents; melting of the reduced cinder in an electric furnace to separate the iron from vanadium and titanium bearing slags; and injection of Na^sub 2^CO^sub 3^ and Na^sub 2^SO^sub 4^ into the molten slag with oxygen as a carrier gas to recover vanadium. Vanadium and titanium are recovered as V^sub 2^O^sub 5^ and TiO^sub 2^. Vanadium recovery is reported to be over 85%.

Canada. A process was developed on a laboratory scale for the recovery of titanium, vanadium and iron from the vanadiumbearing titanomagnetite deposit at Pipestone Lake, Manitoba, through a combined pyro- and hydrometallurgical processing route (Jena et al., 1995). Theore (57.5% Fe, 0.66% V and 16.6% TiO^sub 2^) is subjected to selective reduction smelting with most of the iron reporting to the metal and the vanadium and titanium to the slag. Iron metal purities of 99% have been seen.

The slag contains from 9% to 35% FeO, 31% to 46% TiO^sub 2^ and 1.2% to 1.6% V. More than 98% of the titanium and vanadium reports to the slag. The slag is then roasted with soda ash at 950C and leached with water at 80C to recover vanadium. The leach residue is further treated with hydrochloric acid at 105C to upgrade TiO^sub 2^ content by removing residual Fe, Mg an Al. The final product contains 82.9% TiO^sub 2^, 1.5% FeO, 15.6% SiO^sub 2^, 2% Al^sub 2^O^sub 3^, 1% MgO and 0.3% CaO with overall titanium recovery above 90%.

Aprocess was designed by the Centre de Recherches Minerales (CRM) of Canada for processing Chibougamou titaniferous magnetite concentrate (Gupta and Krishnamurthy, 1992). The flowchart is shown in Fig. 5. The Chibougamou mineral contains 8.46% to 9.80% TiO^sub 2^, 0.48% to 0.57% V^sub 2^O^sub 5^ and 29.19% to 34.5% Fe. Metallurgical tests performed at a pilot plant in the 198Os produced a magnetic concentrate containing 9.11% TiO^sub 2^, 1.35% V^sub 2^O^sub 5^ and 60.8% Fe with recoveries of 83.84% V^sub 2^O^sub 5^ and 62.26% Fe. The ore is crushed and ground to -20 mesh prior to magnetic concentration. The concentrate is further ground to -325 mesh before carbon addition (0.26% by weight) and pelletizing. The charge is processed via EAF, producing a TiO^sub 2^-rich slag, containing most of the vanadium. The vanadium content in the pig iron is kept below 0.07%. The slag is treated for vanadium recovery.

New Zealand. A significant characteristic of New Zealand iron sand is its relatively high titanium content. A typical analysis of New Zealand concentrated titanomagnetite is 80% Fe3O4, 8% TiO^sub 2^, 4% Al^sub 2^O^sub 3^, 3.4% SiO^sub 2^, 3.0% MgO, 0.8% CaO, 0.6% V^sub 2^O^sub 5^, 0.6% MnO, 0.06% P and 0.004% S (Techhistory, 2003). Titanomagnetite iron sand placers form Quaternary onshore beach and dune deposits and offshore marine deposits along 480 km of coastline from Kaipara Harbor south to Wanganui on the west coast of the North Island. The total identified resource is more than 850 Mt of concentrate assaying 55% to 56% Fe, 7% to 9% TiO^sub 2^ and 0.3% to 0.4% V^sub 2^O^sub 5^. BHP New Zealand Steel Ltd. produces about 2.4 Mt/a of titanomagnetite concentrate from two mines south of Auckland. At Waikato North Head, south of Auckland, BHP produces 1.2 Mt/a of titanomagnetite concentrate. Mining of the deposit began in 1969 (New Zealand Ministry of Economic Development, 2003).

Direct reduction, combined with EAF and oxygen steel-making furnace smelting technology is used in New Zealand to process titanomagnetite-iron sand concentrate (Mare, 1997; Christie and Brathwaite, 2003; Techhistory, 2003). Rotary kilns are employed in a direct reduction process, in which hot sponge iron is produced. The hot sponge iron is then melted continuously in an electric arc furnace to produce pig iron, which is finally fed to oxygen steel- making furnace for further processing. Such technology is practiced by BHP New Zealand Steel Ltd.

The concentrate of Waikato North Head is slurried 18 km to the steel mill at Glenbrook, where it is blended with Huntly subbituminous coal in the ratio of about 1.8:1 and fed to multihearth furnaces in which the coal converts to char and the mix is dried and heated. The concentrate/char mix is then hot fed into direct reduction kilns to form sponge iron containing 70% Fe. The sponge iron is melted in electric resistance smelters for further reduction to produce molten pig iron. The pig iron is tapped into ladles for hot charging into the steel plant. Prior to steelmaking, vanadium slag is removed from the iron by injected gas agitation. A vanadium-rich slag is formed and separated as a valuable byproduct. Currently 12,000 t/a is produced and exported to China, representing 1% of the world’s vanadium production.

At Taharoa, iron sand is mined by dredging to produce concentrate averaging 40% titanomagnetite. Annual production has been about 1.4 Mt since the operation opened in 1972. The concentrate is slurried through a 3-km-long pipeline to an offshore loading facility for export, mainly to Japan, with small quantities to South Korea and China.

There has been no production of titanium oxide from New Zealand deposits. Recovery of titanium from the titaniumbearing slag produced by smelting of the Waikato North Head titanomagnetite iron sand is not currently economic.

Australia. Australia is an emerging producer of vanadium, with the development of the Windimurra project in Western Australia. The Windimurra ore body is the largest known vanadiferous deposit in the world. The Windimurra vanadium mines and associated infrastructure are situated some 600 km northeast of Perth in Western Australia. Mineralization is in the form of vanadiferous magnetite hosted in magnetite gabbros. Within the magnetite gabbros, vanadium is present in solid solution with iron within the lattice structure of magnetite crystals.

Vanadium content varies from 1.4% to 2.1 % V^sub 2^O^sub 5^ and averages 1.7% V^sub 2^O^sub 5^ in individual magnetite grains. The combined measured and indicated resources are reported to be 106.32 Mt at 0.47% V^sub 2^O^sub 5^ in oxidized and unoxidized material, including 68.98 Mt at 0.47% V^sub 2^O^sub 5^ in oxidized material and 37.34 Mt at 0.47% V^sub 2^O^sub 5^ in unoxidized material. The ore body will provide for a 21-year mine life, with the potential for 100 years of operation. It was reported that the Windimurra Vanadium Project may be the world’s largest primary producer of vanadium pentoxide. The Windimurra plant is closely allied to the Rhovan and Vantech operations in South Africa. Windimurra follows the standard vanadium pentoxide recovery route of a salt roast of an iron oxide concentrate followed by a water leach and subsequent precipitation of the insoluble ammonium metavanadate (AMV) in a crystalline form. The AMV is then heated to produce vanadium pentoxide, melted and solidified as flake prior to packaging (Fig. 6).

One reported advantage of the Windimurra salt-roast process is the utilization of natural gas, rather than coal, as the fuel source. The use of this clean controllable energy source not only ensures that optimum roasting conditions are maintained but also eliminates a major source of process impurities from coal ash (Roderick, 1998; Xstrata, 2003).

Figure 5 – Flowchart of the CRM Process (Gupta and Krishnamurthy, 1992).

Figure 6 – Flowchart of the Windimurra Process (Roderick, 1998; Xstrata, 2003).

Conclusions

Many different technologies exist for the treatment of titaniferous magnetites that containvanadium. Each process is designed based on the relative amounts of titanium, vanadium and iron. In some cases, steelmaking is the primary purpose followed by secondary recovery of vanadium. In others, the vanadium is the main product.

Preprint number 05-025, presented at the SME Annual Meeting, Feb. 28-March 2, 2005, Salt Lake City, Utah. Revised manuscript received and accepted for publication November 2005. Discussion of this peer- reviewed and approved paper is invited and must be submitted to SME Publications Dept. prior to Nov. 30, 2006. Copyright 2006, Society for Mining, Metallurgy, and Exploration, Inc.

References

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P.R. Taylor, S.A. Shuey, E.E. Vidal and J.C. Gomez

Professor, graduate student, assistant professor and graduate student, respectively, Colorado School of Mines, Golden, Colorado.

Copyright Society for Mining, Metallurgy, and Exploration, Inc. May 2006

(c) 2006 Minerals & Metallurgical Processing. Provided by ProQuest Information and Learning. All rights Reserved.

Local Patients Test Spine Implant: Fort Wayne Orthopaedics is One of 20 Sites Participating in Clinical Trials

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

Jun. 5–Two Fort Wayne-area patients are among the first in the nation and the only individuals in Indiana to receive a new type of implant for treatment of degenerative disc disease of the lower back.

The device is still considered experimental but local doctors participating in the U.S. Food and Drug Administration clinical trials have been given the go-ahead to continue to the next phase of study and are seeking appropriate patients. The condition affects about 12 million Americans, according to the American Academy of Orthopaedic Surgeons.

For Jeremy Fox, 31, of Churubusco, the Wallis Mechanical Normalization System has already made a difference in his quality of life. He had the Wallis implanted three weeks ago in outpatient surgery at Fort Wayne Orthopaedics by Dr. Robert Shugart, one of four FWO surgeons participating in the FDA trials.

“I can go all day long now without taking pain pills. I’ve been on those for almost a year,” said the owner of Fox Tires & More in Churubusco. In his work and as the father of a 4-year-old and 2-month-old, bending and lifting are frequent and necessary tasks. “The pain was there all the time. It progressively got worse until I couldn’t stand it and had to go to the emergency room. I had numbness in the legs.” Months of physical therapy didn’t help.

Just days after the hour-long surgery to implant the device, he returned to work. “I’m feeling really good, not having pain,” he said.

The spine, or backbone, has 33 vertebrae, five of which are in the lumbar area or lower back. A healthy lumbar spine can bend forward and backward. Between the bony parts of the spine are fluid-filled, shock-absorbing discs. As people age, the bones in the spine become less flexible and the tissues connecting vertebrae become less stable. Also, the aging process causes the fluid in the discs to dry out, compressing them. That puts pressure on the nerves along the spine. Bending and tilting the body sends pain signals to the back and often the buttocks and legs.

For decades, orthopedists have surgically fused one or more vertebrae together to prevent motion between them. But the “welding” occurs over time, after the surgeon places bone grafts around the degenerated section of the spine using plates, screws and other hardware. Eventually, like how a broken bone heals, the grafts adhere to the vertebrae, fusing them together.

But the instrumentation alone — the grafts, plates and screws — cost $50,000 to $70,000, said Dr. Kevin Rahn, one of four FWO participating doctors. Surgery is fairly involved, with patients requiring two to three days’ hospitalization.

Today, for advanced disease, an artificial disc is available, but that also requires more invasive surgery in which doctors’ must go through the abdomen to the back. The FDA has approved artificial discs for use only at one level of the lumbar spine.

The Wallis System is designed to stabilize rather than fuse the spine. It can be used at two levels of the lumbar spine. Compared to a fusion or artificial disc, “This is far less invasive. People are up and around right away, with limited lifting for four to six weeks,” Rahn said.

The device looks like a miniature seatbelt, with bands threaded through and locked into a rectangular spacer made of a polymer plastic, a composite used for years in the orthopedic field. The bands wrap vertically around the back of the spine, stabilizing the vertebrae. Only a small incision in the back is needed to implant the device, which comes in several sizes and is easy for doctors to adjust so just the right amount of separation exists between the vertebrae.

The device is intended for people with mild to moderate degenerative disc disease. What is most promising is that it may prevent degenerative disc disease from worsening by allowing blood to flow around the discs to help repair them, the doctors said. In some cases, it could also be used with an artificial disc implant, Rahn said.

The other FWO patient had the device implanted in January and is also doing well. She was recently able to do landscaping around her home, said Chad Badorek, FWO clinical research coordinator.

FWO is one of 20 U.S. sites participating in clinical trials of the Wallis, which is made by Abbott Spine. About 35 patients across the country have had the implant. The doctors acknowledge it is too early to tout its success but say initial results are promising. Abbott provides the Wallis for free. Rahn guessed it would cost under $5,000. The company pays a stipend to cover the doctors’ surgical and staff costs, but the doctors said they are not paid spokesmen for Abbott.

The Wallis has been used outside the United States since 1986. The X-stop, made by St. Francis Medical Technologists and also FDA approved, is a similar mechanism but is for people over 50 with stenosis, a narrowing of the channel through which the spinal cord and nerves run.

The clinical study of the Wallis, Rahn said, “is the only study I’ve seen comparing a device with a non-surgical control option.” Of patients qualifying for the study, two of three will be randomly chosen for the device, with the third patient treated with physical therapy, medication and injections. FWO hopes to enroll 15-20 patients over the next six months for the study.

————

Clinical trials

Individuals interested in participating in a study of the Wallis Mechanical Normalization System, a surgically implanted device to treat mild to moderate degenerative disc disease, should call Chad Badorek, research coordinator for Fort Wayne Orthopaedics, 7601 W. Jefferson Blvd, at 436-8686. More information is available on FWO’s Web site at www.fwortho.com [http://www.fwortho.com]. Participants must be age 18-60, in general good health, have symptoms for at least three months with no improvement, and be able to adhere to the appointment schedule and other protocol requirements. The disc disease must be at the first-fourth levels of the lumbar spine.

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Copyright (c) 2006, The News-Sentinel, Fort Wayne, Ind.

Distributed by Knight Ridder/Tribune Business News.

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Experts say US funding Somali warlords

By David Morgan

WASHINGTON (Reuters) – The United States has been funneling
more than $100,000 a month to warlords battling Islamist
militia in Somalia, according to a Somalia expert who has
conferred with the groups in the country.

The U.S. operation, which former intelligence officials say
is aimed at preventing emergence of rulers who could provide al
Qaeda with a safe haven akin to Taliban-ruled Afghanistan,
appeared to be seriously set back on Monday when an Islamic
coalition claimed control of Mogadishu.

U.S. government officials refused to discuss any possible
secret U.S. involvement in the strategically placed Horn of
Africa state, which has been wrecked by years of fighting.

But former U.S. intelligence officials, speaking on
condition of anonymity because of the sensitivity of the
subject, said an operation to support the warlords’ alliance
appeared to involve both the CIA and U.S. military.

John Prendergast, who monitors Somalia for the think-tank
International Crisis Group, said he learned during meetings
with alliance members in Somalia that the CIA was financing the
warlords with cash payments.

Prendergast estimated that CIA-operated flights into
Somalia have been bringing in $100,000 to $150,000 per month
for the warlords. The flights remain in Somalia for the day, he
said, so that U.S. agents can confer with their allies.

The Bush administration has maintained a silence over
allegations in recent months of a U.S. proxy war against
Islamist radicalism in the country.

Pentagon spokesman Navy Lt. Commander Joe Carpenter
reiterated the administration’s position that the United States
stands ready to “disrupt the efforts of terrorists wherever
they may be active.”

SECRET SUPPORT

Claims of clandestine U.S. support for secular warlords who
call themselves the “Alliance for the Restoration of Peace and
Counter-Terrorism” have been aired by Somali President
Abdullahi Yusuf and independent analysts.

A United Nations team charged with monitoring a U.N. arms
embargo against Somalia has also said it is investigating an
unnamed country’s clandestine support for the warlords alliance
as a possible violation of the weapons ban.

The former intelligence officials said the operation was
controlled by the Pentagon through U.S. Central Command’s
Combined Joint Task Force for the Horn of Africa, a
counterterrorism mission based in neighboring Djibouti
established after the September 11, 2001 attacks.

On Monday, after months of fighting that has killed around
350 people, the Islamic militia claimed control of Mogadishu
and a warlord militiaman said his coalition’s leaders were
fleeing the capital.

U.S. intelligence has produced no conclusive evidence of an
active al Qaeda presence in Somalia, experts said. But there
have been reports of al Qaeda members in the country, including
suspects in the 1998 U.S. embassy bombings in East Africa.

“The Pentagon, and now the U.S. government as a whole, is
convinced these are elements for establishing a religious-based
government like the Taliban, that could be exploited by al
Qaeda,” said a former intelligence official knowledgeable about
U.S. courterterrorism activities.

The CIA has given its warlord allies surveillance equipment
for tracking al Qaeda suspects and appeared to view the
warlords as a counter to the influence of Afghanistan-trained
Islamist militia leader Aden Hashi Aryo, Prendergast said.

“By circumventing the new government and going straight to
individual warlords, the U.S. is perpetuating and even
deepening Somalia’s fundamental problems, and compromising
long-term efforts to combat extremism,” Prendergast said.

Somalia, a country of 10 million people, has had no
effective central authority since 1991 when warlords overthrew
military dictator Mohamed Siad Barre. The central government is
based temporarily in the town of Baidoa and has been unable to
control events in Mogadishu.

Americans have bad memories of U.S. involvement in Somalia
in 1993, when 18 U.S. soldiers were killed and 79 injured in a
battle with guerrillas loyal to warlord Mohamed Farrah Aidid
after entering the country to support a relief effort.

Disciplinarian parents have fat kids-U.S. study

CHICAGO (Reuters) – Parents who are strict disciplinarians
are far more likely to wind up with children who are fat by age
six, perhaps because the youngsters over-eat as a reaction to
stress, a study said on Monday.

The report from Boston University School of Medicine also
found that the fewest weight problems occur among children
whose parents are “authoritative” — having high expectations
for self control but respectful of a child’s opinions and who
set clear boundaries.

The study also found that children of parents who are
permissive, defined as indulgent and without discipline, also
have weight problems but not to the degree of the offspring of
strict disciplinarians with low levels of sensitivity, the
study said.

Researchers also found that children of neglectful mothers
and fathers, those who are emotionally uninvolved with no set
rules, fared about the same as kids raised by permissive
parents.

The study covered 872 children who were part of a group
enrolled at birth in 1991 in a U.S. government study and
followed for a number of years.

“Among the four parenting styles, authoritarian parenting
was associated with the highest risk of overweight among young
children,” concluded the study published in the June issue of
“Pediatrics,” the journal of the American Academy of
Pediatrics.

“These results provide evidence that a strict environment
lacking in emotional responsiveness is associated with an
increased risk of childhood overweight,” the study said.

It may be that strict parents have defined limits on when
and what their children eat that could have a negative impact
if not accompanied by warmth and sensitivity, it added.

“A parent who is relatively insensitive to the child’s
emotional needs and development may impose a structure, such as
requiring that a child clean his or her plate, that results in
learning to eat on the basis of external cues rather than
internal cues,” the report said.

In addition, if a parent demands that a child exercise, it
may result in an aversion to exercise, it said.

And living in a home with high expectations for self
control but little sensitivity can be stressful, it added, and
overeating can become “a stress response.”

After 100 Years, Planters’ Influence Has Faded As Suffolk Has Boomed

By Aaron Applegate, The Virginian-Pilot, Norfolk, Va.

Jun. 4–SUFFOLK — In 1994, when Planters opened a $35 million plant to replace its aging factory, city officials were thrilled.

“Planters has been synonymous with Suffolk longer than we’ve all been alive,” Mayor S. Chris Jones, now a state delegate, said at the ribbon-cutting.

Today, Planters, which turns 100 this year, is no longer the city’s top employer or taxpayer, distinctions it held for decades. With about 350 full-time workers, it ranks 11th, behind Suffolk Public Schools and city government, U.S. Joint Forces Command, Sentara Obici Hospital and businesses such as QVC, Wal-Mart and Ciba Specialty Chemicals.

It’s not that Planters is faltering. Far from it. The 42-acre Suffolk factory churns out about half of all Planters products: peanuts, cashews, almonds, pistachios, filberts, and trail mixes with dried fruit and chocolate for grocery and convenience stores. The other Planters factory, in Fort Smith, Ark., produces the rest.

Planters, owned by Kraft Foods Inc., is one of the food and beverage giant’s 50 brands with annual revenues of more than $100 million, Kraft spokeswoman Cathy Pernu said.

Over the years, though, corporate mergers — Kraft acquired Planters in 2000 — technological advances that reduced its labor force, the decline of the local peanut industry and booming growth in Suffolk have diluted the company’s influence .

While Planters is widely seen as a solid, if somewhat distant, corporate citizen, Suffolkians remember when it was much more.

“When I was mayor, I could walk into Planters headquarters and say, ‘I need some samples to distribute to friends at a regional meeting,’ and I would get it. That wouldn’t happen today,” said Andy Damiani, a downtown businessman who was mayor from 1982 to 1986. “Planters in those days was family. Today, it’s not.”

Like two old friends who have drifted apart, Suffolk and Planters always will have a bond. Generations of families labored at the plant, earning money for mortgages and their children’s college tuition.

Company founder Amedeo Obici, who has achieved mythic status in Suffolk for his benevolence and rags-to-riches story, left millions in his will to build the city’s hospital, which opened in 1951.

Yet today’s bond between Suffolk and Planters is based largely on nostalgia.

Suffolk is no longer Peanut City. That’s an antiquated identity city officials, without offending anyone, are quietly trying to shed.

Suffolk Mayor Bobby Ralph mentioned computer “modeling and simulation” eight times during his recent State of the City address. He never said “peanuts.”

“Yeah, we want to be known as Sim City,” said Lynette White, the city’s tourism director, referring to the nickname officials are cultivating for the high-tech corridor in northern Suffolk. “That’s sexy nowadays. Peanuts aren’t as sexy as they were 100 years ago.”

And they were sexy. In October 1941, young women donned peanut-shell swimsuits to stir up publicity for the first major peanut festival. The festival, parade and industry-boosting event was said to have attracted 40,000 to 50,000 people to Suffolk, more than the entire population of Suffolk and Nansemond County, which had about 30,000 people then.

The governors of Virginia and North Carolina came. A former Miss America was crowned Peanut Queen. After a day’s festivities, Obici took dignitaries for a dinner cruise on the Nansemond River on his 105-foot yacht.

It was a heady time in the peanut boomtown. Peanuts were the dominant cash crop. They were grown, harvested, sorted, stripped of their shells and skin, salted, vacuum-packed, covered in chocolate and pressed into oil and peanut butter. The city was loaded with peanut operations — farmers, pickers, shellers and processors.

A Suffolk radio station, on the air until the mid-1990s, had the call letters WLPM — World’s Largest Peanut Market. At football games, Suffolk High School cheerleaders used to chant: “I’m peanut bred and peanut fed, and when I die, I’ll be peanut dead.”

At the top of the peanut pyramid was Planters Nut & Chocolate Co.

“As you got old enough, when you came out of school, if you weren’t going to college, you went to Planters,” said Mary Steward, 76 , who worked there from 1956 to 1992 as a peanut sorter and later as a machine cleaner .

“I sent two children to college working for Planters, paid for my home working for Planters. Planters took care of us. A lot of homes were bought. People bought cars and educated their children, and then some of their children went to work there. That was my life there. “

Obici founded the company in 1906 in Wilkes-Barre, Pa., and moved it to Suffolk in 1913 to be closer to the peanut fields.

It was a gamble. Obici, an Italian immigrant moving to the South in 1913, was said to have had trouble finding a bank to lend him money. Eventually, he got a loan and started building what, after three expansions, became a mammoth eight-story plant in downtown Suffolk.

Through technological innovations and savvy marketing Obici built a peanut empire in Suffolk that quickly became the city’s largest employer and taxpayer.

Obici discovered a way to blanch peanuts so the red skins came off without breaking the nut. He experimented with chocolate and syrups to create some of the first peanut candy and pioneered vacuum sealing peanuts in a can.

At times, people thought Obici was crazy. For example, shortly after coming to Suffolk, he bought a small railroad spur line that appeared to go nowhere. He promptly built his peanut warehouse over the tracks so workers could load peanuts out of the rain.

“He said, ‘Gee, I cover my railroad cars, I can cover my railroad tracks,’ ” said Janet Daum, librarian at Sentara Obici Hospital.

Yet it was Obici’s marketing that brought the peanut — previously sold in bulk and fed to livestock and elephants at the circus — into pantries and lunch pails all over America.

In 1918, he bought elaborately illustrated advertisements in the Saturday Evening Post, making Planters the first salted nut to be advertised. Five years later, Obici unveiled the “Nickel Lunch” campaign, which promoted an ounce of roasted peanuts as a cheap, filling snack. Then he put one letter of his last name in each bag of peanuts. When customers spelled O-B-I-C-I, they would get a prize. Later, he opened retail stores that sold Planters products directly to the consumer, a departure from traditional grocery store distribution.

Obici’s enduring marketing creation, however, was Mr. Peanut.

Inspired by a teenage boy’s drawing of a smiling peanut with arms, legs and a cane, the Planters folks added a top hat and monocle to create the dapper, aristocratic legume .

Unlike many of today’s artsy advertising campaigns that rely on conceptual or indirect approaches, the success of Mr. Peanut lies in its simplicity.

“There’s no doubt what the product is. It’s the peanut,” said Tom Powell, president of The Addison Group, a Suffolk advertising agency. “Mr. Obici said, ‘Look, we’re selling peanuts.’ The simplicity is the brilliance.”

Obici died in 1947, but Mr. Peanut lived on. In the 1950s, television commercials provided a new outlet for Mr. Peanut. He was an attraction at the 1964 New York World’s Fair. In 1978, a group dedicated to the collection of Mr. Peanut memorabilia formed. Today, Peanut Pals, which will hold its 2007 convention in Suffolk, boasts 525 members.

In 1999, Planters launched the NutMobile, a big yellow truck with a giant Mr. Peanut sitting in the back adjusting his top hat.

The NutMobile, on tour this summer, is scheduled to be in Suffolk on June 13 and in Virginia Beach from June 15 to 18.

For all of Mr. Peanut’s familiarity, though, visitors don’t often see inside the Suffolk Planters factory.

On a recent Friday, workers in blue jumpsuits and hair nets taped shut boxes of packaged trail mix. Forklift drivers whirred around spotless concrete floors carrying pallets loaded with cartons they stack eight high. The warehouse floor feels like the bottom of a steep canyon, walled in by mixed nuts and cocktail peanuts.

The nuts come from all over the United States and the world, said Dan Huss , plant manager . Peanuts come from Virginia, the Carolinas, Georgia, Oklahoma, Texas; almonds and pistachios from California; cashews from India; and filberts from Turkey.

They’re stored and processed in three buildings totalling 575,000 square feet, about the size of 10 football fields. One building, representing about one-third of the factory, has 61 separate cold storage warehouses for raw nuts.

Kraft officials won’t talk about production numbers, but the Suffolk factory makes all Planters products that come in 3- and 4-inch diameter cans found in grocery and convenience stores. The plant is also the single source for all Planters trail mix in plastic bags. The Arkansas factory makes products in larger containers for discount club stores, Huss said.

A new warehouse for storing finished products, added in 2005, freed up space for manufacturing and eliminated off-site storage. It also signalled that Planters intends to stay in Suffolk, a message that hasn’t always been clear.

The relationship between Planters and Suffolk has long been complex.

After the company opened its Arkansas factory in 1975, concerns regularly arose that product lines would be shifted from Suffolk. Corporate downsizing and labor skirmishes kept people on edge.

“It seemed like every few years there was a Planters crisis,” said Suffolk Treasurer Ronald H. Williams. “They were downsizing, laying off workers, threatening to move a line to Fort Smith, Arkansas.”

In 1988, Planters was talking about leaving Suffolk. City officials were nervous. About 900 jobs and a huge chunk of tax revenue were on the line.

Then-City Manager John L. Rowe Jr. explained the threat like this: “It s loss to Suffolk would be like the Hampton Roads region losing the Navy.”

They crafted a deal: A $4.6 million city incentive package kept the company in town.

A few years ago, relations between the company and the city soured when Planters’ warehouse expansion threatened The Fairgrounds, a redevelopment project on land the city leased to Planters. A deal was finally worked out and the project is under way.

City officials would like to set up Planters factory tours as a tourist attraction, like the Hershey chocolate factory in Hershey, Pa., but Kraft has never allowed it.

“While we are very proud of our Suffolk plant, we do not promote this or any other Kraft plant as a tourist attraction,” Pernu, Kraft’s spokeswoman, wrote in an e-mail. “These are food processing facilities, and keeping our products wholesome, safe and secure for consumers is of topmost concern.”

As an example of the disconnect between the company and the city, the Planters Peanut Center in downtown Suffolk, which sells freshly roasted peanuts, candy and Planters products, has never been affiliated with Planters or Kraft and gets its product from a Pennsylvania distributor, owner Faye Beale said.

Today, Planters and the city have settled into a mutually beneficial, if shallow, relationship, usually revolving around Mr. Peanut.

Planters regularly loans Suffolk a Mr. Peanut costume to use in parades. Mr. Peanut was on last year’s city auto decals. Kraft has agreed to let a city group pursue a Mr. Peanut license plate. A 3-foot statue of Mr. Peanut sits on a pedestal in a park downtown.

Suffolk’s Sister City Commission and city officials visited Oderzo, Italy, Obici’s birthplace. Last year, the commission threw an Italian festival in Suffolk with guests from Oderzo.

On the cover of the city’s 2006 tourism brochure is a photograph of the Mr. Peanut statues on company fence posts .

Even though the only thing most tourists can see is the outside of the factory, Mr. Peanut serves a purpose.

“He is so widely recognized that we have found that families, particularly children, are attracted to him, and they pick up the brochure and they hand it to Mom and Dad,” said White, Suffolk’s tourism director.

Much of Planters’ diminishing role is because of rapid development . As one of the fastest-growing cities in Virginia, Suffolk has attracted many new businesses.

“The community is getting so big and the city has done a good job bringing in industry, so we’re not the lone thing anymore,” said Huss, the Planters’ Suffolk plant manager .

City government and public schools, the city’s largest employer, have grown. Wal-Mart, Target and QVC moved in. Northern Suffolk is a hub for military computer technology research.

Planters executives, who used to be community pillars , often come from other Kraft companies and don’t have ties to Suffolk.

Earlier this year, Sentara bought Obici Hospital, perhaps Amedeo’s greatest legacy and one of the region’s last independently-owned hospitals. The Louise Obici Memorial Nursing School, named for Obici’s wife, closed in 2003.

Quietly and without a dramatic pivotal event, Planters, the Obici legacy and the city’s peanut history are fading.

In Suffolk’s old peanut district, cylindrical silos of corrugated metal are topped with towering conveyor belts that don’t move anymore. Boarded-up brick buildings with fading block letters tout extinct brand names. It’s the peanut skyline of another era.

In addition to Planters, two other peanut companies are still plying their trade in Suffolk: Birdsong Peanuts, a sheller, and Producers Peanuts Company, a peanut butter manufacturer.

And when the wind is out of the southeast, the smell of peanuts wafts over downtown, a pungent and nostalgic reminder of what was and the little that’s left.

Reach Aaron Applegate at (757) 222-5555 or aaron.applegate@pilot

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Copyright (c) 2006, The Virginian-Pilot, Norfolk, Va.

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The Working Man’s Hero: Joseph Caleb Was an Activist, Labor Leader and Hero of the Black Working Man

By Luisa Yanez, The Miami Herald

Jun. 4–Joseph Caleb. Say the name and the bustling Liberty City community center comes to mind, but few in Miami-Dade today know of the man and how he earned such an honor.

Caleb was a king of the labor leaders in the late 1960s and early 1970s, a hero to local working-class blacks.

Then someone riddled his body with bullets. The ambush came in the parking lot of a northwest Miami-Dade apartment complex on Feb. 6, 1972, as Caleb shut the trunk of his Lincoln Continental.

It looked like a professional hit on the man who led the nation’s second-largest local, the predominantly black Laborers International of North America, Local 478 (AFL-CIO).

Who wanted the 34-year-old flamboyant labor boss dead?

Was Caleb the victim of union violence? Was it personal; a robbery?

Evidence pointed in different directions. Caleb felt the need to carry a gun, found in his front seat. Police said $747 was left untouched in his socks and the attack came as he left the apartment of a woman who had accompanied him on a business trip to Orlando.

Leads were scarce. No one talked. The union offered a $10,000 reward. There were no takers.

Miami-Dade detectives eventually identified one main suspect, a Fort Lauderdale man who belonged to another union. By then, that man, John Bennett, 35, was also dead, shot with a high-powered rifle and dumped on a southwest Broward County road.

Today, the Caleb case is officially closed.

With no trial, no verdict, no way to air or verify the true details of his murder, Caleb’s loved ones, his wife, Yvonne, and four children, were denied an emotional closure.

“I’ve heard it said that my father was killed because he was getting ‘too big for his own britches,’ ” Caleb’s son, Stanley, 47, who was 13 at the time, said. “In my heart, I know it was union-related.”

T. Willard Fair, head of the Urban League of Greater Miami, agrees. The two were tight. Fair was supposed to have been with Caleb on the Orlando trip but overslept. Fair has a theory. “I think he was killed by the union mafia after angering the big boys in charge.”

He suggested money as a motive. ‘If others in power at the union were getting paid, say $15, and Joe was getting $5, Joe was the kind of guy who would say: ‘I want $15, too,’ ” Fair said.

Caleb’s death rocked Miami-Dade’s black community. The rags-to-riches story of the Overtown hardhat, grandson of an Alabama sharecropper and raised by a single mom, struck a chord with many.

More than 4,000 mourners walked past Caleb’s casket as he lay in state at the union hall. It was one of Liberty City’s best-attended funerals.

Today, some fear Caleb’s memory is fading.

“I see other local black leaders being honored and Joe is never among them. This man did more for blacks in Miami-Dade than anyone else,” said Caleb protege Al Huston, 61, current president of the same union, renamed Local 1652.

SILENT PRESENCE

At the Joseph Caleb Community Center, a mural honors the late union boss, but many who stroll in to pay bills or attend classes and events in its auditorium know little of Caleb.

“I heard something about him, but I don’t remember who he is,” said Andre Hall, 27, who grew up nearby and came to pay a traffic ticket.

Rena Jackson, 50, of Carol City, who said “Caleb mattered,” blames his fading memory on an overall disregard for the contribution of blacks to the local history.

“This man did a lot for Afro-Americans here — but they don’t teach that in school,” said Jackson, who recently visited the center at 5400 NW 22nd Ave.

Joseph Caleb’s younger brother, Robert, 64, of North Miami, agrees: “Older people remember him; the younger ones don’t.”

That pains Caleb’s son, a member of his dad’s local.

“I wish the center would do more to honor my father’s memory,” said Stanley, a labor foreman at a 40-story condo construction site on South Bayshore Drive. “Maybe open a small office where kids can learn about him.”

As president of the large Teamster local, still housed at 799 NW 62nd St., Caleb swelled its dues-paying membership from 400 to 6,000, making it the county’s largest and giving him control of almost every local muscle worker. Caleb also fattened its coffers.

The 6-foot Caleb cut an imposing figure in Miami-Dade’s power circles. In his mod suits, scarves, gold cuff links and pinkie rings, he made an impression.

“We were both angry young men at the cusp of the civil rights movement fighting the system. And we both loved to wear these wild outfits.” Fair said of their friendship.

Fair said Caleb’s appeal was basic: “It didn’t matter how powerful he got, Joe never lost the common touch.”

Friendly and funny, he was always surrounded by a crowd. “Not because he was afraid for his safety, he just loved people,” Fair, 67, said.

Caleb cultivated influence as a rainmaker. He did favors. He paid bail and past-due rent. He put food on empty tables. Most of the funds came out of his own pocket. When he died, Caleb made $35,000 a year in salary and perks.

“His men,” as he affectionately called them, repaid him with their loyalty.

“Joe made the union powerful, but he really cared about people; it wasn’t just about our work, he wanted the quality of our lives to improve,” Huston said. “The men loved him for that.”

Caleb created his union’s pension plan, its scholarship program for the children of workers. He funded summer programs. He staged pro-worker demonstrations.

During his tenure — from 1963 to 1972 — hourly wages for union members more than quadrupled, from $1.15 to $5.30 hourly. That placed Caleb at odds with white contractors and developers who balked at his demands for “union-only” work sites and higher wages for his men.

Once when deep in negotiations with a white contractor, the man complained that he felt discriminated against by Caleb, his son recalled.

“Try waking up black,” the labor leader shot back.

Caleb wanted the best for his men, Huston said, retelling a favorite Caleb story. In the late 1960s, Miami Beach nightlife was hot, but those dining and dancing in fancy hotels were not working class blacks.

“One day, Joe announced that the union was going to host its annual Christmas party at the Fontainebleau Hotel. Us at the Fontainebleau!,” Huston recalled with a chuckle.

“Everyone got dressed up with their wives and headed for the hotel. They served us steaks and he put a bottle of liquor on every table. He made us feel special,” he said.

HUMBLE BEGINNINGS

Caleb’s meteoric rise was sparked by an impulsive move one day when he was 21. In 1958, as a rank-and-file laborer at a Miami Beach worksite he jumped into a dispute when a black foreman was to be replaced by a white one. Caleb led a successful walk-out — and won the attention of union business manager Bernard Rubin, who became his mentor.

The young Caleb was made shop steward. A year later, he traded in his work clothes for a suit and tie when elected recording secretary. The gregarious Caleb was a hit with the membership. He ran for president in 1963 and won. He was 27.

Caleb evolved into a man to contend with, an effective community activist who rubbed shoulders with politicos and power brokers.

The Dade Better Government League voted him Outstanding Citizen in 1971. He chaired the Model City Advisory Board, an ambitious federal program to overhaul blighted neighborhoods.

Caleb’s political contacts grew ever more impressive, from the late Gwen Cherry of Miami, the state’s first black female legislator, to U.S. Sen. Claude Pepper, the longtime state lawmaker. When he died, Caleb was channeling his union’s support even higher, to Democratic presidential candidate Edmund Muskie, who thanked Caleb during a Miami stop.

Caleb’s murder torpedoed the union juggernaut he helped build. “The union was never the same,” Huston said.

Stanley Caleb said his family life also unraveled.

“My father’s death destroyed us; it’s like the lights went out,” he said. “I know my life and that of my two sisters and brother would have been different if he had been around.”

To help the Calebs, the union bought out the $32,000 mortgage on the family home on Northwest 91st Street.

Today, Yvonne Caleb, who never remarried and declines interviews, still lives in that same home she shared with her husband.

Miami Herald staff writer Larry Lebowitz contributed to this report.

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Copyright (c) 2006, The Miami Herald

Distributed by Knight Ridder/Tribune Business News.

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STADTER CENTER: Plan of Action Approved: New Violations Reported As Psychiatric Center Works on Fixing Previous Problems

By Elisa L. Rineheart, Grand Forks Herald, N.D.

Jun. 3–Two months after undergoing a state and federal investigation, the Richard P. Stadter Psychiatric Center is under the microscope again for additional regulation violations.

The 34-bed Grand Forks mental health facility was the subject of simultaneous state and federal investigations in mid-March, which resulted in dozens of citations. But after the center implemented a plan to rectify the violations, the North Dakota Department of Health and Human Services removed the citations.

The investigations were brought on by complaints about staffing and quality of care deficiencies, said Bruce Pritschet, director of the state’s Division of Health Facilities.

And those complaints were legitimate, according to a 111-page report that was released recently to the Herald by the department.

The hospital was cited for more than 50 different issues, including fire safety violations and failure to provide adequate supervision to violent and suicidal patients, the document said.

Psychiatric with that many irregularities are placed under periodical state and federal monitoring, Pritschet said.

State health authorities issued three additional citations to the Stadter Center after a follow-up visit in mid-May.

New plan

As a result of the investigations, the Stadter Center is implementing a state-required plan of correction that exceeds mental health standards, said Bonnie Rice, Stadter’s chief operating officer.

“The state gave us resources that we were not aware of, and that helped us move forward,” Rice said.

Investigators determined that nursing staff failed to provide care in a safe setting. They cited the cases of six patients interviewed who had attempted suicide while in the hospital. Of those, four injured themselves with bathroom accessories such as shower bars. Three other patients escaped from the hospital and later were found. Five patients displayed needle stick injuries and four others displayed signs of self-injury, the report said.

Rice said the industry is more aggressively moving into a suicide-free environment. Items such as bathroom curtains that were deemed safe by the health department in a previous certification inspections weren’t approved this time around, she said.

Lack of staff, supervision

Stadter’s management team turned the incident into a positive experience and used it as catalyst for developing and implementing a more effective patient care system, Rice said.

The center now has a quality improvement and a risk management program that ensure policies and procedures are carried out effectively and hold staff accountable for medical mistakes, Rice said.

Some of the procedures nursing staff failed to follow in the past include failure to prevent abuse and harassment among patients and against medical staff.

Lack of an infection control plan also was a concern, the report said.

In 2005, 48 cases of infections were reported in the center. Of those, 14 involved patients with skin infections. Four others had eye infections.

In one instance, a 12-year-old patient was verbally abused by an older patient who doctors had deemed violent.

Also, a different patient bit a nurse, but investigators found no evidence of injury treatment. Neither the staff, nor the patient were checked for HIV or hepatitis, as required by the hospital’s bylaws anytime human teeth break the skin.

Investigators also found issues involving unrestrained violent behavior of school-age patients. Most of those cases ended up as minor injuries. The incidents weren’t investigated or recorded, the report said.

State and federal investigators said they couldn’t comment on how significant the violations were.

New citations

Three additional citations have been issued by the state since the first investigation concluded.

According to a report released Wednesday to the Herald, a patient received an antidepressant in an amount that far exceeded doctor’s orders and a tranquilizer not prescribed by the physician.

The nurse didn’t check the patient’s vital signs for nine hours after the incorrect dose was administered. Nursing staff didn’t notify the patient of the mistake, and failed to record the error, which impeded the staff’s ability to track and prevent medication irregularities, the report said.

Rice said she couldn’t comment on the specifics of the citations that stemmed from either one of the investigations, but said that medication errors aren’t uncommon in most hospitals.

“What was different in this situation was that we didn’t have a risk management program in place,” Rice said.

The nursing department is under a different supervisor and the hospital has implemented a quality management program, she said. Cynthia Tredwell, the hospital’s vice president of operations, resigned shortly after the investigation.

Rice also said that most of the incidents mentioned in the first report had to do with nursing processes not being followed, and with contractors, who were hired to perform patient care services, violating regulations.

“Now there’s a system in place to prevent that,” she said.

Asked why the hospital hired nurses and health-care technicians without adequate psychiatric background, Rice said, “we don’t get applicants with psychiatric experience.”

Since the end of March, each member of the nursing team has received about 30 hours of patient care training. An individualized professional development program designed to detect individual deficiencies and prevent medical errors was put into practice. And a voluntary training program to improve knowledge of medication dosage and interaction now is offered to nurses, Rice said.

“We took the ball and ran with it,” she said. “We’ve done in one year what most hospitals do in two.”

The Stadter Center is in the process of completing a $20 million expansion that will increase the number of beds in the inpatient psychiatric hospital from 34 to 70.

State citations issued in mid-May should be cleared after a follow-up survey, Weidner said.

Rineheart reports on business and military affairs. Reach her at (701) 780-1269; (800) 477-6572, ext. 269; or [email protected].

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Copyright (c) 2006, Grand Forks Herald, N.D.

Distributed by Knight Ridder/Tribune Business News.

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Painkiller Ads Lead To Sting, Drug Arrests

By Tampa Tribune, Fla.

May 23–ST. PETERSBURG — Pinellas County narcotics detectives swooped down on a popular walk-in medical clinic Monday morning and arrested a physician, two other staff members and two patients on drug-related charges.

Meanwhile, other agents arrested the clinic’s owner, chiropractor Alex Petro, in the parking lot of the Best Buy store in the Tyrone area, sheriff’s Sgt. Jim Bordner said. Petro was carrying more than $10,000 in cash, Bordner said.

The coordinated drug bust capped a five-month undercover investigation, called Operation Pain Relief, at Doctors Urgent Care Walk-In Clinic, 4900 33rd Ave. N. Six agencies took part.

The walk-in clinic treated legitimate patients as well as people who detectives believe are addicts and pushers, so officials are implementing the search warrant carefully to protect patient privacy. Work was continuing in the clinic Monday night.

Dorothy Watsan of Holiday was at the clinic Monday when she was startled by the entry of a team from the sheriff’s office, the Florida Attorney General’s Office, the Florida Department of Health and the federal Drug Enforcement Administration.

“They yelled out, ‘Hands behind your head,’ ‘Drop your purses,’ and everything,” said Watsan, 53.

Petro’s operation, which was formerly called the Acropolis Chiropractic and Sports Medicine clinic, seemed to increase its number of patients after he changed the name, hired physicians and began running ads with the headline “Need Painkillers?” The ads listed several controlled narcotics: Vicodin, Percocet, OxyContin and Xanax.

At times, customers formed lines at the door each morning and cars overflowed the parking lot. The sheriff’s office said it launched the undercover operation after receiving numerous complaints.

Petro’s business model for selling pain medications was criticized by physicians and other medical authorities in a Tribune story last month.

Deputies who posed as patients found it was easy to get prescriptions for controlled narcotics in exchange for cash, without the usual physical examinations, said Capt. Michael Platt, commander of the Pinellas Sheriff’s Office Narcotics Division.

Platt described the clinic as a “pill mill.”

In interviews at the clinic Monday morning, patients Watsan and 28-year-old Jose Calmeron of St. Petersburg said they paid $245 in cash on the first visit. Watsan said she immediately got a prescription for OxyContin and a painkiller skin patch.

Platt said the clinic staff told patients to fill the prescriptions at a particular pharmacy, which he declined to identify. Detectives who conducted surveillance at the pharmacy saw some customers selling pills in the parking lot, he said.

The sheriff’s office identified those arrested as: Petro, 51, of 2785 Bayside Drive S. , St. Petersburg, was charged with three counts of practicing medicine without a license because, as a chiropractor, he cannot write prescriptions, Platt said. Petro also was charged with trafficking in more than 28 grams of Hydrocodone, which carries a minimum mandatory sentence of 25 years, and with two counts of racketeering in narcotics.

Court records show Petro’s only previous brush with authorities was citation in December for operating an adult establishment, Vegas Showgirls on Gandy Boulevard in Pinellas, without a license. That case is pending.

Mary Jane Eicher, an osteopath, which under Florida law is equivalent to a medical doctor, of 333 22nd Ave. S.E., St. Petersburg. Eicher, 71, was charged with two counts of practicing medicine without a license, one count of racketeering in narcotics and one count of trafficking in oxycodone.

The nature of the charge of practicing without a license is unclear. The sheriff’s office said her license was expired; however, a state Department of Health spokeswoman said Monday night that Eicher holds a current Florida license, and the state Web site for health professionals indicates she has a clean record.

Physician’s assistant Saleem Sharar, 32, of 19135 U.S. 19 N. , Apt. D-16, Clearwater, who was charged with four counts of practicing medicine without a license, three counts of racketeering in narcotics and one count of trafficking in hydrocodone.

Officer manager Jon N. Freed, 33, was arrested on one count of practicing medicine without a license and one count of trafficking in hydrocodone. His address was listed as 4015 Bayshore Blvd., Tampa.

Clinic patient Belinda Nuzzi, 39, of 701 Jamaica Road, Venice, was arrested on an outstanding drug warrant.

Patient Leonard John Walasiewicz, 37, of 2 N . Burnwood Ave., Clearwater, was charged with possession of a controlled substance and probation violation.

All other patients were allowed to leave after questioning.

The sheriff’s office said its investigation is continuing and asked that anyone with pertinent information contact Detective Phil Mansfield of the Narcotics Division at (727) 582-2828.

By Carol Gentry and Stephen Thompson

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Copyright (c) 2006, Tampa Tribune, Fla.

Distributed by Knight Ridder/Tribune Business News.

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Patton Pleads Guilty in Niedere Killings: 19-Year-Old Says He Tried to Talk Accomplice Out of Plan

By Frederick Melo, Pioneer Press, St. Paul, Minn.

May 24–Jamie Patton said he hoped to talk his friend Clayton Keister out of killing Peter and Patricia Niedere in October.

But prosecutors believe the 19-year-old expected to earn easy money through the shootings. They say he met with Keister the night of their botched murder attempt on the Hastings couple, eager not to be dropped from the plan.

Patton, the final defendant in the plot, pleaded guilty Tuesday to conspiracy to commit first-degree premeditated murder. As part of the plea agreement, he will be sentenced June 2 to between 12½ and 14 years and five months in prison.

Also as part of the plea, prosecutors agreed to drop a second identical count of conspiracy. State sentencing guidelines would otherwise prescribe between 12½ and 18 years in prison.

Dressed in olive-green jail garb, Patton raised a shackled hand to be sworn in. With his mother and several members of the Niedere family in the courtroom, Patton described for prosecutors how his former classmates Keister and Matthew Niedere contacted him and urged him to join their plot.

Keister, who had known Patton since elementary school, called him two weeks before the murder and invited him to meet at a popular hangout, nicknamed “the cave,” in a Roseville park near Concordia Academy, a religious school. The two teens had been classmates there until Patton transferred to Mounds View High School in his junior year.

In their second after-school meeting at the cave, Matthew Niedere’s and Keister’s idea to kill Niedere’s parents blossomed into a concrete plan. Matthew Niedere promised Patton a hefty sum from the Niedere estate.

“At first, I believe it was somewhere in the range of $30,000,” Patton said. Later, the bounty grew. “Not a definite amount, but he did say the figure would get bigger, yes. He said he’d get it from the insurance claims.”

On Friday, Oct. 7, Patton said he met with Matthew Niedere alone at the cave. Niedere told Patton that Keister would proceed alone to kill his parents.

“I told him to have Clayton meet me at my work that night,” Patton said. “I wanted to talk him out of it.”

Dakota County Attorney James Backstrom said the truth, in fact, was just the opposite. Patton persuaded Keister to let him come along, and the two drove from Little Canada to Hastings together, readying their guns and finalizing details. Keister, who fashioned himself a future military strategist, told Patton how they would shoot through a pillow to soften the shotgun noise, or fire at close range into the couple’s chests.

The two teens never made it inside the house, abandoning their assault after tripping a motion detector in the Niederes’ back yard. The next morning, Keister called Patton and told him the plan was back on. “I said no,” Patton told the court.

The Niederes, widely respected throughout Hastings as business owners and church leaders, were shot to death in their Vermillion Street shop minutes later. Keister and Matthew Niedere, who were 17 at the time, were sentenced in March to life in prison with the possibility of parole in 30 years.

In an interview, Patton’s mother said her son deserved a lighter sentence, closer to the statutory minimum of three years in prison. “I feel like they’re being harsh, to be honest with you, because he said no,” Stanek said. “He said no several times.”

“His motive, I think, was a lot clearer than either of the other two participants,” said Dakota County Attorney James Backstrom. “This was a troubled young man, and he did it for money and money alone.”

Patton was offered a plea agreement in March and turned it down, under the mistaken impression that taking the case to a jury would work in his favor, Backstrom said. But members of the Niedere family were eager to avoid an arduous trial in which Matthew Niedere and Keister had been subpoenaed to testify, and the offer was extended again.

“We’re just glad that this is behind us,” said Kathy Kinneman, Patricia Niedere’s sister, standing with Matthew Niedere’s sister-in-law in the Hastings courthouse. “Our family’s been through enough.”

Frederick Melo can be reached at [email protected] or 651-228-2172.

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Copyright (c) 2006, Pioneer Press, St. Paul, Minn.

Distributed by Knight Ridder/Tribune Business News.

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Saudis hope stones mystery will appeal to tourists

By Andrew Hammond

RAJAJIL, Saudi Arabia (Reuters) – The stones of Rajajil
form a striking pattern against the clear desert sky, the
fallen and tilting sand-colored slabs conjuring up visions of
England’s Stonehenge.

Nobody really knows why the 50 groups of about five pillars
each are clustered on the edge of the Nafud desert in
northwestern Saudi Arabia. Local legend says they are a lost
tribe punished by God.

Whatever their origin, local authorities hope the standing
stones and the history-rich al-Jouf region will form the
centerpiece of a new tourism drive.

“Because of the political situation, tourism has been low
but the strategy is to revive it and we are hoping to make
al-Jouf a tourist attraction,” said Hussein al-Mubarak, a
former museum director who now heads a committee to encourage
tourism.

Archeologists believe the Rajajil stones date from before
3,000 BC — when human civilization first began to thrive in
ancient Egypt and Iraq. The stones also have graffiti linking
them to pre-Islamic deities such as the female goddess Widd.

As with Stonehenge, there is no consensus on whether the
site was a temple, a burial ground, a place used for astronomy
or something else. Scholars believe Stonehenge was built
between 3,000 and 1,600 BC.

Mubarak says the stones were placed on the desert’s edge
deliberately, probably to worship the sun.

“The sun was worshiped in the North of the Arabian
peninsula and the moon was worshiped in the South. High ground
was normally chosen for worship,” he said, surveying the site
near the Skaka oasis, 750 miles from Riyadh.

“Some people say it was a tribe turned to stone for doing
unclean things, like using bread to clean with or washing with
milk,” Mubarak said. “But these are just myths. We don’t want
to connect the site now with religious things since we want to
encourage tourism.”

Rajajil could be related to “rijal,” modern Arabic for men.

DISPUTED ORIGINS

“We have several mysterious sites all over the Arabian
peninsula…but we have failed to know the reason why they were
made and who made them,” said Majeed Khan, a Semitic script
expert who has spent 30 years studying Arabian sites.

Khan said the stones of Rajajil were part of the mystery.

“They have something to do with religion, maybe it has an
astronomical connection. There is no archeological evidence to
prove the date — we excavated and there is no pottery.”

Rajajil could date from a time when the peninsula was
changing from a land of lakes and trees — depicted in hundreds
of rock art sites — into today’s dry, desert region.

Al-Jouf was a center of early Arab civilization, dominated
by powerful queens who are listed in the annals of invading
Assyrians. The area was also the staging-post for the Arab
conquest of the Middle East in the 7th century.

The ancient city of Dumat al-Jandal, where the word “Arab”
was first recorded by Assyrians, is still standing near Skaka.

Many say al-Jouf, which borders Jordan, has been neglected
since it became part of the Saudi state in 1932.

TOURISM BRINGS HOPE

Saudi Arabia, the birthplace of Islam, is not known as a
popular tourist attraction, partly because of its adherence to
the austere Wahhabi form of Islam.

Plans to bring tourists to al-Jouf ran aground when
militants linked to al Qaeda began attacking foreigners in a
campaign to topple the Saudi monarchy launched in 2003.

However, the violence has largely died down and Saudi
Arabia, which already receives millions of Muslim pilgrims to
the holy cities of Mecca and Medina each year, said last month
it would begin issuing tourist visas to foreigners.

Tourism could be a lifeline for al-Jouf’s youth.

“Some young people round here have gone crazy from not
finding a job, even graduates,” said 24-year-old police recruit
Bassam, driving along new tarmac roads that have been built
recently as part of the tourism development drive.

Young people say they hope King Abdullah will make good on
his promise to create more jobs in the civil service. There are
also plans to set up a university in the region.

Analysts say Saudi Arabia’s political system and cultural
mores have fed unemployment and huge disparities in wealth
which are threatening to become a serious problem as the
population of 17 million Saudi nationals grows.

Mubarak said there were limits to how much attention the
remote northern region inhabited by 300,000 people could demand
of the capital Riyadh.

“I can’t compare the money put into Mecca, with its pilgrim
visitors, or Riyadh, as the major population center,” he said.

“I really hope we can bring tourists because it will help
develop the region, it will bring good income for young
people.”