Chef prepares Peruvian cuisine to conquer the world

By Mary Milliken

LIMA, Peru (Reuters) – Peru, the land that gave us the
tomato and the potato, has another gastronomic gift to the
world: a chef named Gaston Acurio.

He aims for nothing less than 50,000 Peruvian restaurants
around the world where food lovers could savor the hot peppers,
lime, onions and fish of a ceviche, creamy yellow Andean
potatoes or maybe even someday the Peruvian delicacy of guinea
pig.

Acurio can’t possibly do it alone and he prefers to stay at
home in Lima creating recipes. But he is so convinced of the
power of Peruvian cuisine that he is inspiring financiers and
fellow chefs to go out and conquer the world.

“Our dream is that in 10 years there will be 50,000 to
100,000 Peruvian restaurants out there,” Acurio said at his
headquarters in a Lima mansion. “There are something like
200,000 Mexican restaurants in the world, so why shouldn’t we
aspire to something similar?”

The 38-year-old chef is an icon in food-crazed Lima, where
he owns — with wife Astrid, a German pastry chef — a handful
of top restaurants, stars in a popular cable TV cooking show
and publishes best-selling cookbooks. His rise has coincided
with what he calls “a total revolution in gastronomy in Peru in
the last 10 years.”

But he not only wins accolades for his food. Peruvians are
puffed up with pride because he is promoting one of their most
beloved cultural treasures.

“Gaston is taking our cuisine around the world,” said Rosi
Zusman as she ate lunch at Tanta, his hip food emporium where
counters are piled high with a Peruvian version of tapas.

Acurio has opened award-winning restaurants in four other
South American cities and recently cooked at the international
chefs’ summit Madrid-Fusion alongside greats like Chicago chef
Charlie Trotter or Ferran Adria of El Bulli in Catalonia.

The Spanish press gave him rave reviews and one newspaper
told readers: “Remember this name: Gaston Acurio.”

LIMA TODAY, LONDON TOMORROW

One visit to his La Mar “cevicheria” near Lima’s oceanfront
is enough to see that Acurio has the Midas touch.

People of all ages line up every day to eat at the breezy,
reasonably priced, lunch-only restaurant. Among 110 dishes on
the menu are a tuna ceviche with Japanese spices and a grilled
octopus brochette over a yellow potato mash.

“We have created a cevicheria that you could envision in
New York, Thailand or Shanghai, and that is an example for
others to imitate as they go and conquer the world,” said
Acurio.

La Mar franchises will open this year in Mexico and Panama,
while California and London could be on the agenda for 2007.
Acurio’s friend, Japanese chef Nobu Matsuhisa of the famed Nobu
restaurants, says Londoners will love his ceviche.

While Acurio stays home, many among his young, 500-strong
staff are ready to travel and spread his vision.

“When the time comes and they ask me to go abroad, I will
go happily,” said chef Silvia Fernandez, 21, working behind the
La Mar ceviche bar. “Who wouldn’t want to go?”

But even with Peruvian chefs, demanding Limenos, as the
locals are known, have doubts their ceviche can be emulated
elsewhere.

Acurio says he has the know-how and technology to create
flavor bases that can be copied all over the world to turn out
a ceviche just like at La March

“Peppers are the umbilical cord to Peruvian cuisine and we
have worked very hard so that this flavor is always present,”
said Acurio.

SANDWICHES AND STREET FOOD

In his office next to his test kitchen, he uses white
boards with lists of hundreds of ingredients and preparations
to cook up his next creations.

He is submerged now in “chifa” — the Chinese-Peruvian
fusion that he feels doesn’t have enough Peruvian in it. He is
thinking of all the Peruvian ingredients he can throw in or on
a wonton.

“When I need ideas, I just go out here,” said Acurio as he
walked out onto the mansion’s balcony on a quaint colonial
square and gestured toward the ocean.

But it is hard to imagine Acurio needing more ideas.

He is close to opening in Lima his first sandwich joints,
where the stars will be pork and ham sandwiches, the recipes
culled from Acurio’s favorite dives.

Instead of French fries, he will serve fried yucca sticks
and he hopes he can pull Peruvians of all classes away from the
ubiquitous American-style fast food.

“We are trying to create the sandwich place of our dreams
with the artisanal character of our cuisine, which is something
people today value much more,” Acurio said.

He also plans to open “anticucho” or brochette joints in
his quest to restore Peru’s street food tradition.

And the sandwich and anticucho restaurants could go abroad
in franchises, just like the cevicheria.

But does he see foreign diners digging into the guinea pig,
usually served whole and splayed, that he insists beats rabbit
any day?

“If you take the head and feet off, yes, perhaps,” he said.
“But all countries have their nonexportable food.”

5 Arrested in Massage Inspections

By Larry Altman DAILY BREEZE

Police arrested five women and issued 17 citations during surprise inspections Thursday to ensure three massage businesses in Gardena were operating legally.

Gardena police officers and state officials showed up unannounced about 2 p.m. at the businesses to determine if masseuses and other employees held proper city licenses to perform rubdowns and other services, and that their employers were adhering to city and state laws.

At one business — Seoul Health Spa at 15212 S. Western Ave. — police found six women hiding in a rear room, apparently lying low while police were making inspections, Detective Pam Robinson said.

Four of the women carried no identification and were arrested. A woman without identification at Sun Accupressure, 14129 S. Van Ness Ave., also was taken into custody.

Police also inspected Fantastic Nails and Spa at 1719 W. Artesia Blvd.

“It’s to protect the workers and to make sure the people who go into these places for a massage actually get a massage,” Gardena City Prosecutor Joan Stein Jenkins said.

Unlike some other operations, investigators Thursday did not conduct undercover stings to check if sexual favors were being performed at the businesses.

Instead, police checked employees for permits, and state employment officials made sure owners kept proper logs of their employees, paid them and made sure no child labor laws were violated.

State authorities also examined records to make sure the businesses paid for workers’ compensation insurance and payroll taxes.

Officials said the inspections are the first step to reduce illegal activity, including prostitution and indentured servitude that sometimes occurs in massage businesses.

At Seoul Health Spa, a woman working the counter welcomed police when they entered, saying she hadn’t seen them in a long time.

The business, with 12 massage rooms, a sauna, whirlpool baths, exercise equipment, big-screen televisions and recliners, appeared cleaner than some restaurants.

“Here only health massage. Many American people like this health massage,” the female owner told a reporter.

However, police quickly found two masseuses working at the time who did not have permits to work in Gardena, police said.

Each woman — one of whom had to wash oil from her hands to pull out her identification — received a ticket and order to appear in court.

One woman held a permit in Los Angeles, but she needed one in Gardena to meet the requirement, police said.

Then, more than an hour after they arrived, officers found six female employees in a locked back room, police said.

The women had tried to keep quiet to remain undetected while police were in the building, Robinson said.

For each woman cited, the owners received a citation.

“It’s always the, oh, shock, ‘We didn’t know you wanted to talk to them,’ ” Robinson said.

A misdemeanor fine for conducting a massage in Gardena without a permit can be up to $1,000, Stein Jenkins said.

Besides employee records, police examined the businesses for such things as unlocked doors to massage rooms (which are required) and employee attire (masseuses must wear smocks, not thongs and miniskirts).

Sun Accupressure’s owner received a citation for a locked front door, Robinson said.

In the past, police have found massage businesses to be fronts for prostitution. Some immigrant employees work as indentured servants to the business owners.

“You have to make sure these workers are there of their own free will,” Stein Jenkins said.

One customer said he was surprised by all the police attention as he scurried away from Seoul Health Spa.

“I take bath and take massage,” he said. “There is nothing illegal.”

Police in other South Bay cities have targeted massage business. Inglewood police cited 41 people at nine businesses in a similar operation in February 2005.

Redondo Beach police arrested six women at massage clinics in December 2004 when they offered more than a back rub to undercover officers seeking massages.

Olive Oil’s Heart Healthy Benefits: OLIVENOL(R) Supplement With Super-Antioxidant HIDROX(R)

According to the FDA, adding approximately 2 tablespoons (25 ml) of olive oil to your daily diet may reduce the risk of coronary heart disease. Fortunately for Heart-Smart consumers and Mediterranean Diet fans, now there is OLIVENOL(R), a dietary supplement that provides the benefits of extra virgin olive oil in an easy-to-take capsule. OLIVENOL contains super-antioxidants, which are associated with lowered LDL (“bad cholesterol”) levels. “OLIVENOL(R) provides health benefits associated with the consumption of extra virgin olive oil — and the Mediterranean Diet — in a pill,” says Dr. Roberto Crea, CEO and Founder of CreAgri, Inc. “It also contains the super antioxidant HIDROX(R), CreAgri’s patented formulation of hydroxytyrosol, which is the natural olive polyphenol with the highest level of free radical protection activity ever reported for any natural antioxidant compound.”

Studies show that powerful antioxidants may reduce not only the risk of coronary heart disease, but also the risk of cancer. According to the European Journal of Clinical Nutrition (2002; 56:114-120), adults who consumed 25ml (nearly 2 tablespoons) of virgin olive oil daily for one week showed less oxidation of LDL cholesterol and higher levels of antioxidant compounds, particularly phenols, in the blood. Antioxidants like HIDROX(R) also help prevent oxidative tissue damage caused by free radicals as well as oxidation of LDL cholesterol, which leads to hardening of the arteries, a pre-condition of heart disease.

CreAgri, Inc. is dedicated to promoting health and wellness though the development of olive-derived antioxidant polyphenols and related innovative products for functional food, health and dietary supplements. CreAgri uses environmentally friendly processes to redefine practices in the olive oil industry resulting in products with tremendous health benefits, including OLIVENOL and HIDROX(R). For more information visit www.CreAgri.com, call 1-866-4CREAGRI, or call Christie Communications at (805) 565-4122. CreAgri, Inc. is located at 3847 Breakwater Ave., Hayward CA, USA.

SIDEBAR ON SUPERANTIOXIDANT HIDROX(R): CreAgri, Inc. is the world’s leading developer and supplier of polyphenol antioxidants from the pulp of organic olives. Founder Dr. Roberto Crea developed their unique process Integrale, a patented process that removes the pits from the pulp of olives prior to milling to reduce impurities, to recover HIDROX(R) from olive juice. HIDROX(R), CreAgri’s patented formulation of hydroxytyrosol, is the natural olive polyphenol with the highest level of free radical protection activity ever reported for any natural antioxidant compound, with a registered ORAC value of 27,000.

Image Available: http://www.marketwire.com/mw/frame_mw?attachid=242237

 Contact: Karen Ko Christie Communications 805-565-4122  

SOURCE: CreAgri, Inc.

No economic growth without women’s rights, UN says

By Evelyn Leopold

UNITED NATIONS (Reuters) – The world is beginning to
understand that integrating women and girls into the life of a
nation is the surest path to economic growth and development, a
top U.N. official told an annual meeting that analyzes the
global status of women.

Louise Frechette, the deputy secretary-general, spoke on
Monday at the opening of the Commission on the Status of Women,
which coincided with an exhibit honoring 1,000 women activists
from around the world, who have been nominated for the Nobel
Peace Prize.

“The world is starting to grasp that there is no tool for
development more effective than the empowerment of women and
girls,” Frechette said.

“Study after study has taught us that no policy is as
likely to raise economic productivity or to reduce infant and
maternal mortality,” Frechette told the gathering, expected to
be attended by some 1,000 activists and government officials.

In a building across the street from the United Nations,
the pictures and biographies of 1,000 women activists from
around the globe fluttered from strips of rope.

The names of the 1,000 women were gathered over two years
by Swiss parliamentarian Ruth-Gaby Vermot-Mangold, who proposed
last year that a Nobel Prize should be bestowed upon women
contributing to world peace. Only a dozen women have been given
the peace prize in Nobel’s 100-year history.

“Young women today desperately need role models,” said Cora
Weiss, president of the Hague Appeal for Peace, who organized
the event, which included Nane Annan, the lawyer-artist wife of
U.N. Secretary-General Kofi Annan.

“These are women from 150 countries who represent all kinds
of disciplines: environmentalists, social workers, nurses,
grass roots organizers.”

Among the women activists honored were Devaki Jain, an
Indian economist and social worker; Noleen Heyzer of Singapore,
executive director of the U.N. Development Fund for Women; Mama
Loite Doumbia of Mali, a human rights campaigner and trade
union leader; and Bogaletch Gebre of Ethiopia, a scientist who
set up a center on women’s livelihood, education and health and
the dangers of female circumcision.

Also honored were Americans Betty Reardon, founder of the
Peace Education Center at Columbia University; and Chris
Norwood, who organizes low-income people in the south Bronx to
train their neighbors in health education.

If Mink Stole Your Fish, Beware, or Fur Will Fly

By Nancy Tullis, Vindicator, Youngstown, Ohio

Feb. 27–CANFIELD — Beware of mink.

Rich McGowan of Blueberry Hill Drive couldn’t figure out why his Japanese koi were disappearing from the ornamental pond in his front yard.

That was until he was walking his Labrador Retriever, Deuce, and saw a koi out of the water, disappearing down a hole near the pond bank. He said he could tell a brown furry animal had the fish in tow but didn’t know what kind of animal it was.

The mystery of the missing koi was solved last week by wildlife trapper Ken Zebrasky of Salem. Zebrasky said Mahoning Valley residents who find koi and other fish missing from their backyard ponds will likely find the bandit is not the more familiar ring-tailed masked raccoon, but mink.

Zebrasky has been trapping native fur-bearing animals since he was a boy and has been operating Nuisance Wildlife Control, a wildlife removal business, for about 20 years.

At McGowan’s pond, Zebrasky saw skeletal remains and scales of fish all around the bank, and holes along the bank, and he suspected mink.

He said otters, muskrats, raccoons, great blue herons and birds of prey will take their share of fish, but mink do the most damage. They eat more than their share, especially when females are feeding and training young.

Raccoon will take fish out of ponds, but raccoons don’t swim, he said. A raccoon will use its front paws to scoop into the water from the bank and grab fish within reach.

Another fur-bearing Ohio native, the beaver, is also an excellent swimmer but not likely to snatch fish. Beaver can do a lot of damage felling trees and rerouting streams, but they are strict vegetarians, he said.

Mink, however, are excellent swimmers and will dive into the pond, even under ice, and snatch fish. They eat all the flesh off the fish, and pick the bones, as evidenced by the fish skeletons around McGowan’s pond.

Zebrasky said he receives about 50 calls a year from area residents whose fish disappear from backyard ponds, but most of that business is in the summer.

The mink he caught in McGowan’s pond last week is the largest he’s ever seen.

“Mink are beautiful animals, but they aren’t cute and cuddly,” he said. “They aren’t pets. They are very mean and aggressive. People don’t think about mink in this area, but there are lots of them.”

Wild mink are native to North America and have been here as long as raccoon, otter and other fur bearers, he said.

Zebrasky said wild mink are much different from mink raised on mink farms. Farm-raised mink could not survive long in the wild, he said.

Fish are the staple of the wild mink’s diet, Zebrasky said.

“If you have a pond stocked with the fish, they’ll stay until the fish are all gone,” he said. “You created an ideal habitat and gave them a fish market.”

He said the large male mink he trapped last week was there because of the available food supply McGowan provided, and because there’s likely a female mink in the area.

Zebrasky said mink like solitude and are active mostly at night. Anyone who sees one, however, should keep a safe distance.

“I’ve caught them [live] before and you can’t do anything with them,” he said. “They are vicious. They’re quick and have a lot of moves.

“If you have a ‘fur fear,” the mink is the ultimate,” he said. “In Alaska they have been known to fight grizzly bears and win. If mink were the size of a grizzly, we’d all be in trouble.

“If you confront one, be ready to run fast.”

—–

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Copyright (c) 2006, Vindicator, Youngstown, Ohio

Distributed by Knight Ridder/Tribune Business News.

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A Case of Broken Trust

By Jeff Swiatek, The Indianapolis Star

Feb. 26–Dr. Michael Goldberg, the head of a tiny company called Emisphere Technologies, doesn’t trust Eli Lilly and Co. anymore.

Not since he concluded Lilly tried to swipe his firm’s best idea — a drug carrier compound worth millions or maybe billions of dollars.

Not since the research contract between the companies fell apart and he found Lilly had set up a secret team to test Emisphere’s compounds in ways that violated the agreement.

And especially not since Emisphere spent millions of dollars defending itself against a breach-of-contract complaint filed by Lilly, a lawsuit that backfired last month when a judge ruled Lilly was the one that breached the contract.

“You can only describe it as a bully trying to beat up on the weaker party,” said an upset Goldberg of his dealings with Lilly. “None of us really believed this could happen. It was really shocking.”

Lilly denies any wrongdoing in the case. Spokesman Philip Belt calls the Emisphere case “an anomaly” at Lilly. It’s the only time in recent years that Lilly has sued one of its research partners, he said, and “shouldn’t be seen as a new trend or indication of how Lilly does business.”

Belt said Lilly won’t discuss specifics of the dispute. He also wouldn’t elaborate on his comment that “there are learnings to be made here” for Lilly.

The ruling by federal judge David F. Hamilton that Lilly breached its contract with Tarrytown, N.Y.-based Emisphere has sent ripples of concern through an industry where trust is the linchpin in thousands of similar exploratory deals.

Details of how Lilly dealt with Emisphere cause some to question whether Indianapolis’ largest private employer can be trusted by its dozens of research partners.

“This is exactly what Lilly doesn’t need. It looks like they are stealing from their partners. There is no question it really does darken Lilly’s reputation,” said Roger Longman, an expert on drug industry research collaborations who is editor of In Vivo, a newsletter for the drug and medical device industries.

Longman said the case surprises him because Lilly “has a fabulous reputation as a biotech partner.” A 2003 survey by IBM Corp. ranked Lilly as the most respected company for its partnering capabilities among 28 large drug companies.

As a result of the court case, small companies may be warier of dealing with Lilly, said Mark Long, president of the Indiana University Emerging Technologies Center, which helps brood start-up businesses. “It will make companies think twice before they do a deal. A potential partner now in particular is going to do a lot more due diligence and potential legal coverage to protect themselves.”

Dozens of partnerships in the drug industry fail every year — many because of management difficulties, others because money runs out, and some because the technology didn’t work.

The Emisphere case is notable because the technology was working. In fact, the technology apparently was so alluring to Lilly and its scientists that they couldn’t keep their hands off it.

What was so alluring? The New York firm has made significant strides toward discovering one of the holy grails of drug research: how to convert large-molecule drugs that can be taken only by injection into pills that can be popped in your mouth.

Emisphere’s patented technology basically takes the active ingredient in injectable drugs and loads it into chemical “carriers.” The carriers are meant to slip through the protective membranes that normally block large-molecule substances from leaving the digestive system and passing directly into the body’s blood supply.

Lilly had compelling reason to be interested in Emisphere’s technology. The Indianapolis drug maker sells several products that are given by injection and could be sold more widely if available as a pill. They include Lilly’s insulins and its growth hormone drug. Finding an effective pill for insulin alone would be a breakthrough worth untold billions of dollars.

The partnership between Emisphere and Lilly, signed in 1997, was supposed to be a hand-in-hand scientific effort to bring something new to patients: an easy-to-take pill form of Lilly’s injectible bone-strengthening drug Forteo. Finding a pill form could vastly expand the popularity and sales of Forteo, which came on the market in 2002.

Emisphere tried to protect its technology with Lilly by limiting its use to work on Forteo only. “Lilly shall not have any rights to use the Emisphere technology . . . other than insofar as they relate directly to the field,” the contract said. The “field” referred to the joint research with Forteo.

The contract called for a joint research committee of six scientists, split between Lilly and Emisphere, to do the work. It was led by a Lilly scientist, Amin Khan.

The committee went to work and reported progress, although both sides expressed after-the-fact dissatisfaction with each other’s contributions.

Goldberg says that he and others at his company became suspicious about Lilly’s actions in 2001. At the time, Lilly suggested broadening the research agreement to include drugs beyond Forteo, but kept finding legal objections to proposals put forward by Emisphere’s attorneys, he said.

What Goldberg didn’t know then was that Lilly had set up a separate research team in January 2001, made up only of Lilly employees, and had begun studying Emisphere’s technology behind its back.

The secret team’s own minutes show it used proprietary information from Emisphere to test materials other than Forteo. Minutes mention Emisphere compounds that no one besides Emisphere and the joint committee knew existed. The team also worked with samples of a pinkish powder provided to the joint committee by Emisphere.

More than a dozen Lilly scientists, managers and an attorney attended meetings of the secret team at Lilly’s Indianapolis campuses.

Who authorized the secret team at Lilly? It remains unclear.

The Lilly executive who oversaw the joint research effort was Richard DiMarchi, a member of Lilly senior management who had the title of group vice president of Lilly Research Laboratories. He reported to Lilly’s top scientist at the time, Dr. August Watanabe. Watanabe, who is no longer at Lilly, reported directly to Lilly’s chief executive officer, Sidney Taurel.

DiMarchi since has retired from Lilly. In an e-mail to The Indianapolis Star, DiMarchi said he is now “too far removed” from the Lilly-Emisphere project to comment on it.

When talks between both sides bogged down over widening the terms of their contract, a lawyer was appointed to the secret team to help develop a strategy for taking its discoveries to market without violating the Emisphere contract. Within months, Lilly constructed a “firewall” around the secret team. The ostensible purpose was to prevent the team from using information Emisphere shared with Lilly under the partnership. One Lilly scientist who served on the joint committee, Henry Havel, also was removed from Lilly’s secret team.

Havel admitted in court that he had freely passed information about Emisphere’s proprietary carrier compounds to the secret team. He testified that his Lilly bosses never told him not to pass information on to the team, or anyone else at Lilly. “I was never instructed on specifics regarding that particular topic,” he said at trial.

The passing of information was so blatant that Havel showed the secret team slides of scientific data stamped “Confidential — Property of Emisphere Technologies.”

Removing Havel from the team and erecting the firewall was supposed to stop the flow of proprietary information.

But the firewall had a gaping hole. The secret team’s leader was none other than Khan, the Lilly scientist who also headed the joint committee and thus was in a position to convey Emisphere’s trade secrets directly to Lilly’s secret team. At trial, Khan denied doing so, and there was no direct evidence presented that he did.

Both Khan and Havel refused to comment on their actions. Both still work at Lilly.

To Goldberg, Lilly’s firewall was “absurd” because it was so porous. Judge Hamilton also apparently thought little of Lilly’s safeguards, referring in his ruling to the “so-called” firewall.

About the time the firewall was established, the secret team shifted its focus from broad research to studying one protein, GLP, which treats diabetes. That research produced promising results quickly, and Lilly began negotiations to license Emisphere’s technology for use with GLP.

During those negotiations, the firewall was removed and Havel was allowed to provide information to the secret team again, according to the judge’s ruling. Also, while the negotiations were ongoing in February 2002, Lilly filed for a patent on the GLP carrier, listing Khan — not Emisphere’s scientists — as the inventor.

Still, Goldberg and other Emisphere officials knew nothing of the secret team.

Goldberg said he became concerned that same year when Lilly hired away one of his top scientists, Godfried Owusu-Ababio, whom Emisphere had hired about a year earlier at the urgings of DiMarchi, the Lilly executive.

Worried Ababio might disclose sensitive information to Lilly, Goldberg said he got DiMarchi’s assurance that Ababio would be limited in his work at Lilly to matters that didn’t impinge on Emisphere technology.

Goldberg said he found out later that Lilly almost immediately put Ababio to work researching pill forms of injectable drugs. Ababio also was listed as attending meetings of the secret team, although in a deposition he claimed the minutes were in error and he actually didn’t attend any secret team meetings, said Colin A. Underwood, an Emisphere attorney.

Ababio, who still works for Lilly, did not respond to requests for comment and Lilly would not make him available.

The renewed negotiations to license Emisphere’s technology for GLP also broke down, and Emisphere was growing suspicious. Goldberg said his lawyers told him at the time, “It really makes me wonder what they’ve done in the past year or two, and what they’ve actually been using your technology for.”

The relationship finally began to fall apart in September 2003, when Lilly’s application for the patent was published.

That was enough to prompt Emisphere to send notice to Lilly that it believed its contract had been breached.

Lilly responded by pre-emptively suing on the same grounds. Lilly said it was worried that Emisphere wanted to license its pill carrier technology to a Lilly rival, Novartis.

As legal proceedings developed, Emisphere did turn to Novartis as its new partner, and the Swiss company gave Emisphere a $10 million upfront payment, much of which was used to pay Emisphere’s legal fees in the lawsuit with Lilly.

“But for that, I don’t think we would have had the financial ability to resist the pressure Lilly was putting on us to settle,” said Goldberg. He said Lilly offered “a few million dollars” to settle the case, and wanted no restrictions on research it could do on pill carrier technology. Goldberg found that unacceptable, because Emisphere stood to lose control of its most valuable technology.

Throughout the legal wrangling, Goldberg and other Emisphere officials still knew nothing of the secret team. It wasn’t until Lilly’s suit went to trial in January 2005, in U.S. District Court in Indianapolis, that Goldberg found out about the team. “A Perry Mason moment,” he calls it now.

At trial, Lilly witnesses testified that the drug maker formed the team to better understand how Emisphere’s carrier compounds work. Havel said no Emisphere scientists were asked to join the team because Lilly “didn’t have any confidence” they would contribute much of value.

That explanation amounted to Lilly saying, “We had to steal the technology in order to help them use it better,” said Underwood, Emisphere’s attorney.

The judge wasn’t buying it.

Lilly’s explanation for forming the secret team “was offered first at trial and it is not supported by contemporaneous documents or other evidence,” Judge Hamilton wrote. “Lilly managers were very much aware of potential problems with Emisphere resulting from this secret… research project.”

At trial, Khan, a central figure who headed both the partnership and the secret team, was evasive, even denying at one point that he was chairman of the joint research effort.

That prompted Emisphere’s attorneys to confront Khan with his own resume, on which he had listed himself as chairman of the joint research effort.

In one of several strange twists revealed at the trial, Emisphere happened to possess Khan’s resume because Khan had tried to get a job at Emisphere a few months before the trial started.

“The whole thing just got sillier and sillier,” Goldberg said of the incident.

Hamilton’s 60-page ruling amounts to a judicial spanking of Lilly. The company “actively concealed for several years” the research it did using Emisphere- supplied materials and later created “a sanitized paper trail” to make it seem like the secret research didn’t draw on proprietary Emisphere technology, the judge said.

With the partnership now dead, Lilly must turn over to Emisphere materials and data it was given during the partnership, said Underwood, the Emisphere attorney. “Getting it back from Lilly doesn’t really mean a whole lot,” he added. “And I’m not sure Emisphere has any great confidence Lilly will abide by those restrictions” to cease working with the carrier technology.

The judge has yet to rule on Emisphere’s charge of patent infringement against Lilly. Emisphere also is expected to ask the court to order Lilly to pay damages, which are as yet unspecified but could be substantial, Goldberg said.

Either company could appeal after the judge’s final rulings.

Despite the bitter falling-out, Goldberg said he would be willing to revive the partnership with Lilly.

On one condition, that is.

“If Lilly could stand up and say, ‘This is wrong. We disavow this. This is not how we treat our partners,”” Goldberg said.

So far, nothing close to that has happened.

ELI LILLY and EMISPHERE

Eli Lilly

–Founded: 1876

–Headquarters: Indianapolis, Indiana

–Revenue: $14.6 billion

–Employees: 43,000

–Products: Insulin, Antipsychotics, Cancer drugs, Osteoporosis treatments, Growth hormone, Male impotence pill

Emisphere

–Founded: 1986

–Headquarters: Tarrytown, New York

–Revenue: $2 million

–Employees: 120

–Products: None

TIMELINE OF DEAL GONE SOUR

A promising partnership between Eli Lilly and Emisphere ended in a lawsuit.

–February 1997: Research partnership signed to develop pill form of Forteo.

–1999: Research put on hold to study Forteo cancer scare in rats.

–2000: Research resumes.

–January 2001: Lilly forms secret research team to test Emisphere’s technology on drugs besides Forteo.

–Early 2001: Lilly negotiates to broaden research to include more drugs.

–Mid-2001: Lilly erects “firewall” around secret team to break its links to joint research.

–2002: Lilly hires away Emisphere scientist, puts him to work with secret research team.

–Mid-2002: Negotiations to broaden agreement break down.

–February 2003: Lilly files for international patent based on Emisphere technology.

–September 2003: International patent published.

–October 2003: Lilly sues Emisphere for breach of contract.

–December 2003: Lilly serves Emisphere with lawsuit, but joint research continues.

–August 2004: Emisphere tells Lilly it’s terminating contract, will work with Novartis instead.

–January-February 2005: Case goes to trial.

–January 2006: Judge rules Lilly breached contract.

—–

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Copyright (c) 2006, The Indianapolis Star

Distributed by Knight Ridder/Tribune Business News.

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LLY, EMIS, IBM, 6680,

Having Fun ; Rio Rancho Offers a Myriad of Activities for Residents and Visitors of All Ages

By DONNA REDMAN For the Journal

There shouldn’t be any excuses for someone to get bored in Rio Rancho.

With plenty of open space, good weather and some creative planning, there’s already a wealth of things to do.

Start with activities offered by the city.

“(As of Nov. 29) year-to-date, we’ve had 7,234 participants in our programs (for the year),” said Carrie Moritomo, communications and marketing director for the Rio Rancho Department of Cultural Enrichment.

“That doesn’t include swim lessons or adult sports,” she said. “It’s things like our adult tennis, our 3- to 5-year-old tumbling classes, art classes, cake decorating, coaching clinics, flag football, sports camps, summer camps — things like that.”

The city has 21 parks and three drainage areas with grass that can be used as parks.

Its two swimming pools, Haynes and Rainbow, are filled to capacity in the summertime, Moritomo said.

“We had over 3,000 participants in our Learn to Swim program between the two pools last year,” she said. “It’s for infants to 14- year-old kids and we also do adult Learn To Swim programs.”

The community’s only indoor pool open to the public is at Defined Fitness on Ridgerock Road, according to Moritomo and Shawn Gale, manager of Defined Fitness.

But that could change if voters approve a bond issue on March 7 to build an indoor aquatic center.

The city has three skate parks — at Rainbow Park, Star Heights Recreation Center and the Rio Rancho Sports Complex — with one more under construction in River’s Edge II.

“There’s all different age levels (at the skate parks),” Moritomo said, “and they’re not just skaters. Some are people who use skate boards, people who use rollerblades, some who hang out there with their little stunt bikes, things like that as well.”

The community’s largest recreation area is the Rio Rancho Sports Complex, which covers 78 acres. It has five Little League fields and two adult softball fields, Moritomo said. Eight acres of grass fields are used for a number of activities and events, such as the Fourth of July celebration and Oktoberfest, adult and youth flag football, dog shows and soccer games.

Each of the city’s three community centers — Haynes, Sabana Grande and Star Heights — offers classes and programs for children and adults.

The city has only one library, but another is under construction on Loma Colorado near the high school. The Esther Bone Library on Pine Street is overflowing with books, people and programs. The new library, scheduled to open in late summer, will afford much-needed room to expand.

The city isn’t the only source of things to do. The private sector has filled some niches:

Tenpins & More is the city’s only bowling alley, and it has undergone several transformations since it opened as Ranchero Bowl in 1983. It was also called Ideal Lanes and Fun Lanes before current proprietor Steve Mackie bought the place in December 1999 and changed the name.

The 24-lane Tenpins annually hosts the richest event in the state, the New Mexico Open, which offers a purse of about $15,000 every August.

The city’s only golf course, Chamisa Hills Country Club, is a private, 27-hole course. During its 35-year existence, it has also been called Rio Rancho Country Club and has bounced between private and public status.

The old Rio Rancho Country Club also used to host the Charley Pride celebrity tournament every year. It has hosted countless professional events through the years, including the New Mexico Open for men and women.

The Sports Corral, just north of Intel on Sara Road, offers miniature golf and batting cages. In March, it plans to open a paint ball field, partner Gary Kitts said.

Ice skating, hockey and soccer enthusiasts have the Blades Multiplex Arena.

Blades offers an ice rink, as well as an indoor soccer field. It has been around for 10 years or so and changed hands several times, said day manager Cherie Wiltsie. It used to be an ice arena and a roller rink, but about five years ago the roller rink was converted to a soccer field, she said.

“We hold soccer leagues year round there,” she added.

Everywhere you turn in Rio Rancho, you can see runners. Some run for fitness and fun, some are competitive runners.

The community offers at least two running events in the city every year — the Defined Fitness Duathlon for runners and bicyclists in April and Tammy’s Run on New Year’s Day. There is at least one runner’s club, the High Desert Wind Runners.

There is also a club for those who like to run, bike and swim. It’s Team TriSport, which is USA Triathlon sanctioned.

Those who lean toward motorized recreation can join any number of motorcycle clubs in Rio Rancho, said Rick Weinbrecht of Crossroads Cycles.

Among them are the Rio Rancho chapter of ABATE (American Bikers Aim Towards Education); the Black Berets, a veterans group based in Albuquerque, but most of whose members live in Rio Rancho, Weinbrecht said; the Mestizos; the Legion Riders, another veterans group; the Bandeleros; and the Christian Motorcycle Association.

“They all have members or chapters here,” he said.

There is also an ATV club called the Rio Red Riders based at West Honda.

There is a caveat about riding ATVs in Rio Rancho, though.

“There’s a lot of rules and laws (governing the use of ATVs),” said West Honda manager Will Fallis. “One of the laws in Rio Rancho is they cannot ride these things in the Rio Rancho city limits. Rio Rancho residents can buy them and take them somewhere else, but they can’t operate them anywhere in the city limits.

“We do have a club with about 35 members and we meet monthly and take trips,” he said. “We schedule appropriate rides in appropriate locations.

Journal staff writer James Yodice contributed to this story.

Public’s wish list

City consultant SITE Southwest conducted a survey last year to determine the recreation projects Rio Rancho residents believe are most needed in the future. The survey was done in conjunction with the city’s recreation master plan update.

Here were the top eight, not necessarily in order of preference:

Indoor aquatic center (Residents will vote March 7 on a $7 million bond issue to help build the center).

Community recreation center and park in the northern part of the city.

A community park and festival ground.

Rio Rancho sports complex in northern Rio Rancho.

A neighborhood park development package, which includes improvements or modifications to existing parks.

A community recreation center and park for western Rio Rancho.

An aquatic center for the north side of the city.

Improvements to arroyo corridors and maintain open space where people can walk and enjoy the outdoors.

Former Salsa Club Attracts Notorious Crowd

By David Ovalle, The Miami Herald

Feb. 26–Cuban exiles flocked to the riverside club for years to dance salsa. A party cruise debarked there every week. Antonio Banderas even filmed a scene of Miami Rhapsody on its dance floor.

But Centro Espanol, open since the early 1970s, has morphed into the most notorious, crime-ridden strip club in Miami-Dade County, police say.

Detectives regularly raid the club near Miami International Airport for prostitution and drugs — logging 33 arrests one night alone this month.

Suspected gang members from Pembroke Pines wanted in a triple shooting recently told investigators the club is known across South Florida for allowing underage patrons.

“It’s gotten to a whole new level,” Miami-Dade Capt. Jorge Garcells said of the crime at Centro Espanol.

The club has become such a problem that the department has taken Centro Espanol to the county’s nuisance abatement board, which aims to curb crime on problem properties, usually drug houses.

The strip club, at 3615 NW South River Dr., goes before the board again in March.

The club appeared before the board in October 2004 and agreed to fix outside lighting and add extra security personnel.

“It’s all lies,” Maria Besancon, one of the club’s owners, said of the police allegations.

“We’ve been open 40 years. We were the first nightclub for poor people.”

An attorney for the club, Joseph Portuando, says the club has complied with the board’s requests.

He said Miami-Dade police officers “have exaggerated the situation out there.”

The longtime owners, Abdon Grau, his sister Maria and her husband Jean Pierre Besancon, built the club on a two-acre property on the Miami River.

The land, bought in 1971 for $37,000, was largely abandoned with “hippies” camping out on the river banks, Maria Besancon said.

Future music legends such as Celia Cruz played there. Grau built a chickee across the parking lot and renamed the part of the bar “Mi Bohio.” He even fixed up a boat, called El Galeon, and started a weekly musical cruise down the river.

A juice bar sold drinks and tamales for 75 cents each. A tent covered the dance patio outside.

“This is a family kind of place where we sell things cheaply and 350 people come most Sundays,” Grau told The Miami Herald in 1991.

“It’s a clean place where people can come to relax,” Grau said.

Bernardo Benes, a well-known Cuban exile, remembers going to the club with his wife during the 1970s.

“It was a nice place. They had good music, food. It was a family place,” Benes said.

In the late 1980s, county inspectors told the owners everything but the original building had been illegally built.

For years, the owners and the county haggled.

Like any nightspot, clubgoers had brushes with the law — in 1991, a man named Rafael Salvi was gunned down in the bathroom. Salvi had laughed at a man who had just been doused with beer by a woman.

After a two-year closure for the illegal building, it reopened in 1999 as a mostly gay club renamed the Waterfront.

Today, the Spanish-style building is again known as Centro Espanol. The land is much more valuable — in 2004, it was worth $405,000. Last year, it had jumped to $600,000, county records show.

Planes en route to MIA still thunder overhead. Rusty warehouses dot South River Drive. Tourists frequent two rental car agencies that operate across the street.

Signs at Centro Espanol advertise “Go Go Girls,” $3 screwdrivers and $2 Cuba Libres on Tuesdays.

“Our dancers are not employees of El Centro Espanol” a sign reads.

The 60-foot former party boat, El Galeon, is still moored behind the club. Police say condoms are often found strewn inside.

Since mid-1999, police have logged nearly 400 incidents there, everything from reports of vehicle burglaries to shots fired to fights, statistics show.

Robberies and shootings around the club are frequent. A stripper robbed another stripper in November by slashing her under the eye, police say.

Prostitution is not unheard of at strip clubs, but Miami-Dade police say the women operate blatantly and sex happens in any dark corner of the club.

“By allowing prostitution, they’re creating a crime wave,” said Miami-Dade Major Ruben Galindo, the commander of the airport station. “And they’re catering to juveniles.”

In September 2004, 41-year-old Florentino Perdomo was shot and killed in a robbery attempt in the nightclub parking lot. His killers were later arrested.

In December, three bouncers were wounded by bullets during a fight. Airport station detectives later arrested three teenagers suspected as members of a small-time gang called the Bang-Bang Boys.

On Feb. 10, a sting netted 33 arrests, mostly on prostitution and drug charges. Eleven firearms and cash found in several safes were confiscated.

Portuando, one of the club’s attorneys, criticized police, saying officers seized club money without giving proper receipts. He added that any night spot is bound to attract a few bad clients.

Said Portuando: “I can guarantee if you go to the most elegant place on Lincoln Road in South Beach, you’ll find a piece of crack in a purse.”

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Copyright (c) 2006, The Miami Herald

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected].

CAMHS Liaison: Supporting Care in General Paediatric Settings

By Watson, Emily

ABSTRACT

Increasing numbers of children and young people with mental health problems are being cared for in general paediatric settings, presenting a challenge to nurses who do not have mental health nursing qualification and experience. A survey of nurses in a children’s hospital identified their concerns and attitudes to caring for this client group. On-call nursing support was felt by almost all nurses (87 per cent, n=90) to be the most beneficial aspect of a liaison service, followed by teaching (84 per cent) and individual support with the young person/family (84 per cent). Based on the findings, a project was initiated to improve nursing liaison with CAMHS nurses providing support and advice to general children’s nurses. Effective liaison between general paediatric wards and child and adolescent mental health services (CAMHS) can improve care for children and young people with diagnosed mental health problems. However, there is still a gap in addressing the need of the significant numbers of children with physical illness who also have mental health needs.

KEY WORDS

CAMHS

Liaison roles

Children: services

Child and adolescent mental health is a sub-speciality of both mental health and paediatrics. The disparity between these two fields has sometimes delayed development of child and adolescent mental health services (CAMHS). Liaison between mental health and general services (both in adult and paediatric settings) can be challenging and is often unplanned and unmanaged (Benjamin et al 1994, Anders 1997, Black et al 1990).

The need for a robust model of liaison is recognised, but collaborative working between professionals is not always evident (Tipper and Moon 2001). A multi-disciplinary framework is thought to be the most effective working model for liaison; commitment from professionals in paediatric, psychiatric and psychological disciplines are essential to its success (Williams and Wright 2003, Lask 1994).

At Birmingham Children’s Hospital the psychiatry and psychology departments already had a fully functional liaison service but a need was identified for improved nursing liaison. This article reports on a project to develop more effective liaison between CAMHS nurses and nurses working in general wards.

Service context

More children and young people are presenting to A&E departments with self-harm and being admitting with other conditions such as psychosomatic problems, eating disorders and psychosis. The number being accommodated on general paediatric wards and adolescent units is therefore increasing. Inpatient CAMHS provision has yet to catch up with the now widespread recognition of this increased need. Fortunately, the mental health needs of children and young people have been given a high priority in recent health policy (DH 2004). Provision of collaborative evidenced-based mental health care for children and young people, irrespective of clinical environment, has been identified as a role for all nurses (RCN 2004).

The CAMHS nursing role is often very specific and can add a dimension to the care of children and adolescents with mental health problems which other disciplines may not have the time, resources or skills to deliver. Liaison nursing focuses on the interpersonal relationship between nurses and patients rather than on diagnosis and treatment of illness (Robinson 1987). Nurses in a CAMHS liaison role provide clinical care, consultation, supervision, education, and undertake research (Tunmore and Thomas 1992). Crucially, they provide support and advice to nursing colleagues in the general paediatric setting who have 24-hour responsibility for the wellbeing and safety of this client group. Recognising that these nurses are providing care in a less than perfect clinical environment is key to building effective partnerships within liaison, as is acknowledging the challenges of caring for troubled adolescents in a paediatric ward or emergency department.

Exploring concerns

Possible objectives for a CAMHS liaison service were identified through discussion with staff in existing liaison services and feedback from senior nurses within both paediatric and mental health environments (Box 1). This initial exercise reflected an idealised view of the type of service that might be established within Birmingham Children’s Hospital. It was important to explore the real concerns and needs of nurses rather than base developments on our perception of the shortfall in service provision. Anecdotally, nurses seemed to feel frustrated and were reluctant to provide care for this patient group. There seemed to be confusion about the services provided within CAMHS, as the comments from three children’s nurses demonstrate:

‘If I’d had wanted to “do” mental health I would have been a mental health nurse’

“The doctor said we have to feed the girl continuously through the night as we need her weight to increase ready for discharge’

“The CPN (Community Psychiatric Nurse) will talk to her about why she took the overdose, its best we don’t get involved’

To identify nurses’ actual attitudes and concerns, a questionnaire was developed and piloted and then distributed to nurses working in a number of paediatric environments in the trust. Specialist units, such as infant care, day care, theatres, intensive care and oncology, were excluded. The areas covered in the questionnaire included: how much contact the nurses had with young people with mental health problems, the training they had received, their anxieties and attitudes towards caring for this client group and the amount and type of support they would like from the liaison service.

Results

Two hundred questionnaires were distributed and 90 returned, a 45 per cent response rate. Sixty four per cent of those who responded said they nursed this client group in their clinical area, and 79 per cent stated that they did not feel experienced in meeting the needs of young people with mental health problems. These figures suggest that there is a lack of experience and evidence-based knowledge in the care of this client group. Most respondents (88 per cent) felt that training in mental health issues is needed for all nurses in paediatric settings. Universities include child and adolescent mental health nursing in pre-registration children’s nursing courses, but this provision is not reflected in the training and development of qualified nursing staff (Hooton 1999, RCN 2003).

Interestingly, 58 per cent of these nurses felt that mental health nurses should be included in the staffing of paediatric wards, suggesting either that other nurses would benefit from the constant presence of mental health nurses, or that they see caring for this client group as someone else’s role.

Box 1 Objectives of a Nursing Liaison Service at Birmingham Children’s Hospital NHS Trust

Table 1. Areas of support considered beneficial within a mental health nursing liaison package (n=90)

Nurses appeared to have little knowledge of CAMHS provision. They seemed to think there was a lack of ‘beds’ and specialist CAMHS staff to meet the needs of these patients. Most (84 per cent) agreed that this is what frustrated them indicating a need to raise awareness about CAMHS structure, input, roles and assessment procedures throughout the trust. This lack of awareness may explain why the majority of respondents felt the trust does not do enough for this client group.

When asked about what support their clinical area receives, 67 per cent reported little or no support from mental health professionals. Almost all (90 per cent) felt that all young people with a diagnosed mental health condition should receive assessment and individual support from mental health professionals. This, at present unrealistic, expectation raises the question of who should deliver care and how we should move towards this practice.

These results gave some insight into the attitudes and feelings of nurses in one acute paediatric trust. A gap in support for patients and staff in non-CAMHS areas was clearly identified and the nurses were able to identify what they would find useful in a programme of liaison (Table 1). On-call nursing support was most frequently rated as a beneficial aspect of liaison (87 per cent), followed by teaching on conditions and management approaches (84 per cent), and individual support with the young person/family (78 per cent).

Outcomes

Education and collaboration

Once the liaison service was initiated, the biggest component quickly became teaching and education. Wards and departments scheduled sessions on a range of mental health conditions and approaches as the project unfolded. General adolescent areas, trauma and orthopedic wards and the A&E department received regular sessions on self-harm, attention deficit hyperactivity disorder, eating disorders and psychosis. Nurses in these fields demonstrated a commitment and awareness of their educational needs that was encouraging and helped to develop a greater sense of collaborative working between themselves and the project liaison nurse. The informal nature of the sessions led to confidential case discussions allowing for practical challenges to be explored and real-life concerns to be aired.

A one-day study event that soon extended to a twoday programme enabled paediatric nursing colleagues to become better informed on the holistic aspects of mental health care. The involvement of hospital teaching colleagues, play services, ne\wly qualified CAMHS inpatient nurses and interest from other professions led to a multi- professional/multi-agency study programme. This enables professionals working with child and adolescent mental health patients within the trust to discuss together optimum care approaches and gain better understanding of each other’s roles and limitations in managing this patient group.

Consultation and support

A record was kept of the varying problems of children and young people for whom CAMHS nursing consultation/support was requested over the 18-month period. (Figure 1). Referrals for nursing consultation came from two sources: consultant liaison psychiatry and children’s nurses. The total number of requests over the 18 month period was 62 and although this figure may seem low, the liaison service was only provided once a week and by one clinician. This figure does not reflect other sources of support from psychiatry and psychology services, community mental health professionals and others such as dietitians and physiotherapists giving guidance and reassurance within a holistic package of care.

The most significant outcome of the programme was increased awareness of mental health issues and the informal discussions generated within paediatric environments. This culminated in the formation of a mental health interest group by children’s nurses in the trust. Informal feedback indicated that nurses were liberated by being able to contact their CAMHS colleagues for telephone advice and guidance; they were able to question their current or traditional practices. Armed with evidence-based material, nurses were more confident in challenging approaches and attitudes of paediatricians and other disciplines as they established new working practices and methods for care delivery.

Conclusions and challenges

This project provided the opportunity for greater collaboration between paediatric and CAMHS nursing colleagues in caring for the mental health needs of young people in non-CAMHS areas. The overall response to the project was extremely positive from both nursing colleagues and professionals already involved in psychiatric/ paediatric liaison. Nurses reported gaining new knowledge on the signs and symptoms of a range of mental health conditions and felt better equipped in the management of this client group. Several wards now receive regular teaching sessions and updates. Nursing staff have also provided feedback on the benefits of increasing links between ward areas and CAMHS. Developing care plans from both a general children’s nursing and a CAMHS nursing perspective has reportedly enhanced the individualised holistic care of patients. It has also enlightened CAMHS nursing staff about the challenges faced by nurses in nonCAMHS areas.

While this project identified the need for mental health nursing liaison for young people presenting with a diagnosable mental health condition, it did not address the needs of the large number of young people who experience such difficulties alongside a physical illness. Approximately a half of all paediatric outpatient attendees have conditions in which psychological factors are a major factor (Lask 1994). Children’s nurses caring for such children need to be aware of their mental health needs, and mental health professionals require the same awareness of the physical components of illness to ensure they offer an integrated, seamless service (Williams and Wright 2003).

A firm commitment to collaborative working between CAMHS and other ward areas has been demonstrated in the interest shown in developing guidelines and core care plans together for a variety of mental health conditions. The CAMHS inpatient unit on-site now provides respite and emergency action for young people located on other wards. This practical intervention further encourages the development of liaison and generates a positive relationship between CAMHS and general paediatrics. However, to sustain a long lasting and valuable relationship and move from a project to standard permanent practice requires resources, effort and enthusiasm.

Figure 1 Conditions for which consultations were requested (n=62)

Clinical governance also needs to be recognised as an essential force in promoting the effective care of young people with mental health problems in general paediatric settings. Risk assessments in support of evidenced-based care approaches will go some way to ensuring a safer environment for this patient group and to reassure patients, families and professionals that the area has been adapted to promote the safety of the young person.

It is not enough to state that young people, for example with extreme confusion, psychotic presentations or eating disorders, are CAMHS patients and as such will just be maintained in paediatric environments using whatever approaches come to mind. The reality is that increasing numbers of young people with a variety of mental health problems will be placed in a range of paediatric settings. They are entitled to be cared for by health and social care professionals who are competent to address their mental health needs with early intervention and assessments and with the support of effective liaison between paediatrics and psychiatry

ACKNOWLEDGEMENTS

Ray McMorrow, Nurse Consultant, CAMHS, Birmingham Children’s Hospital NHS Trust.

Ward 3 Nursing and Medical Teams, CAMHS, Birmingham Children’s Hospital NHS Trust.

Wards 5,7,8,9,12 and A&E, Birmingham Children’s Hospital NHS Trust.

The number of children with mental health conditions being accommodated on general paediatric wards and adolescent units is increasing

REFERENCES

Anders T (1997) Child psychiatry and paediatrics. The state of the relationship. Paediatrics. 60, 616-620

Black D, McFayden A, Broster G (1990) Development of a psychiatric liaison service. Archives of Disease in Childhood. 65, 1373-1375.

Benjamin S, House A, Jenkins P (1994) Liaison Psychiatry: Defining needs and planning services. London, Royal College of Psychiatrists, Gaskell.

Hooton S (1999) Results of a survey undertaken to establish the degree to which post registration programmes address child and adolescent mental health. London, ENB.

Lask B (1994) Paediatric liaison work. In Rutter M et al (eds) Child and Adolescent Psychiatry: Modem Approaches. Oxford, Blackwell.

DH (2004) The National Service Framework for Children, Young People and Maternity Services. London, Department of Health.

Robinson L (1987) Psychiatric consultation liaison nurses and psychiatric consultation doctoring: similarities and differences. Archives of Psychiatric Nursing, 1, 2, 73-80.

Royal College of Nursing (2003) The post-registration education and training needs of nurses working with children and young people with mental health problems in the UK. London, RCN.

Royal College of Nursing (2004) Children and Young People’s mental health – every nurse’s business. London, RCN.

Tipper P, Moon L (2001) Bringing it all together: linking mental health and paediatric services. Paediatric Nursing. 13, 1, 14-16.

Tunmore R, Thomas B (1992) Models of psychiatric consultation liaison nursing. British Journal of Nursing. 1, 9, 447-451.

Williams C, Wright B (2003) Paediatric liaison. In Richardson G, Partridge I (eds) Child and Adolescent Mental Health Services, An Operational Handbook. London, Royal College of Psychiatrists.

Emily Watson RN, BSc is children’s service manager, Barnado’s, Tamworth. At time of writing she was professional development facilitator (CAMHS) Birmingham Children’s Hospital NHS Trust

Copyright RCN Publishing Company Ltd. Feb 2006

Magpie

Image Credit: Thinkstock.com

Magpies are medium to large passerine birds of the crow family, Corvidae. These colorful and noisy birds are closely allied to the jays and treepies. The names ‘jay’, ‘treepie’ and ‘magpie’ are to a certain extent interchangeable, and do not reflect any genuine genetic difference between the groups.

Research has recently cast doubt on the taxonomy of the Pica magpies, since it appears that P. hudsonia and P. nuttalli may not be different species, whereas the Korean race of P. pica is genetically very distinct from the other Eurasian (and even the North American) forms. Either the North American, Korean, and remaining Eurasian forms are accepted as 3 or 4 separate species, or there exists only a single species, Pica pica.

Species

Genus Pica

  • European Magpie Pica pica
  • American Black-billed Magpie Pica hudsonia (may be conspecific with P. pica)
  • Yellow-billed Magpie Pica nuttalli (probably conspecific with P. pica/P. hudsonica)
  • Korean Magpie Pica sericea (may be conspecific with P. pica)

Genus Urocissa

  • Formosan Blue Magpie Urocissa caerulea
  • Red-billed Blue Magpie, Urocissa erythrorhyncha
  • Gold-billed Magpie, Urocissa flavirostris
  • White-winged Magpie, Urocissa whiteheadi
  • Sri Lanka Blue Magpie, Urocissa ornata

Genus Cyanopica

  • Azure-winged Magpie, Cyanopica cyana

Genus Cissa

  • Green Magpie, Cissa chinensis
  • Yellow-breasted Magpie, Cissa hypoleuca
  • Short-tailed Magpie, Cissa thalassina

The Black Magpie, Platysmurus leucopterus, despite its name, is a jay.

Other corvids resembling magpies include the treepies, genus Dendrocitta.

The Australian Magpie (bird) has the black and white colors of a magpie, but it is not a magpie (or a corvid). The black and white Magpie moth is also named for its appearance.

Redefining Sewing As an Educational Experience in Middle and High Schools

By Montgomery, Bette

Sewing is a traditional educational experience in family and consumer sciences (FCS) education in middle and high school. Learning sewing skills, however, is not as relevant today as it was in the past. To better prepare adolescents for life roles, FCS education needs to reflect the changes in society and focus more broadly on the work of the family. This article (a) contrasts the traditional or technical science-based curriculum model (which emphasizes sewing skills) with a critical science-based model (which emphasizes the work of the family), and (b) proposes that the critical science approach is more relevant for today’s individuals and families. In addition, significant questions that need to be addressed are identified in order to examine sewing as an educational experience in FCS.

Sewing is a tradition within home economics and family and consumer sciences (FCS) education. A century ago, sewing became part of home economics programs-developing sewing skills, whether they were for fancy work or utilitarian purposes, was viewed as important to assuming domestic roles (Burman, 1999). By the 1960s, learning clothing construction skills was an important part of preparing young women for occupations related to clothing as well as for homemaking roles. In the 21st century, an emphasis on sewing skills has continued within exploratory or introductory courses at middle and high schools, and in advanced or career development courses at the high school level.

Families and society have changed, however, which calls into question the need to learn sewing skills. For example, although women once made much of the family’s clothing, now ready-made apparel is available and accessible in neighborhood stores and from catalogs and internet-based retailers. Most individuals and families can obtain clothing and textiles to meet their needs without knowing how to sew.

In addition, financial and human resources are limited both within families and society. Individual students, families, or schools may or may not be able to purchase the sewing supplies, kits, or equipment needed for sewing to be cost-effective. Public schools, as well as colleges and universities, are experiencing a reduction of financial resources. Human resources are limited as well. In many areas of the U. S., FCS teachers are in short supply. Due to limited resources, families, public schools, including colleges and universities, are forced to make difficult decisions regarding educational priorities.

Although families and society have changed, and despite the desire of the profession to eliminate the stereotypical image of “cooking and sewing,” sewing, from a technical perspective, continues to be a predominant part of FCS classrooms. It is essential, therefore, to reflect upon how learning experiences such as sewing support educational goals and the enduring understanding of concepts important to individual, family, and community life (Eisner, 2003; Harrison, Andrews, Saklofske, 2003; Shumer, 2001; Wiggins & McTighe, 1998). To begin this process, two curriculum models are examined: the technical and the critical sciencebased curriculum models (see Table 1) (Plihal, Laird, & Rehm, 1999). The premise of each model is briefly described related to the view of the family, focus of learning, and role of the teacher and students. It is proposed that a shift from a technical science-based curriculum model to one that is more critical science-based will help improve FCS education and redefine the role of sewing as an educational experience.

TECHNICAL SCIENCE-BASED CURRICULUM MODEL

Technical science is the dominant curriculum model that has guided sewing activities or clothing construction courses in both middle and high school. The major premise of this model is that families sew in order to produce their own clothing. The family is perceived as engaging in primarily technical or “how to” actions related to clothing and textiles, such as how to make clothing or how to do laundry. Sewing is viewed primarily as an isolated activity because the family context, responsibilities, or actions are not included within the curriculum.

In this model, emphasis is placed on learning technical actions, such as efficient sewing skills and techniques to complete a textile product. Lessons may include how to sew straight seams, when to use stay stitching, or how to hand-sew a hem. The complexity of the project may vary from simple (such as bean bags or square pillows) to more complex (such as making a shirt with a collar and cuffs), but the emphasis on sewing skills remains the same.

Hands-on learning experiences are emphasized as students apply the skills or techniques to make sewing samples or textile projects. Activities also may support the achievement of academic standards (e.g., measuring to learn math skills or following pattern directions to learn reading skills) or personal outcomes (e.g., increasing one’s self esteem or creativity). Learning sewing construction skills is viewed as important to job preparation in the textiles and apparel industry (Brandes & Garner, 1997; Lee, 2002). However, curricula based on sewing skills only, without any focus on the family or related concepts, is unlikely to prepare adolescents for their current and future roles within the family and society.

In addition, this curriculum model relies on direct instructional approaches in which the teacher describes or demonstrates the skill to be learned and then leads students, either as individuals or as a group, through most of the instructional experiences (Burden & Byrd, 2003).

Teachers are considered sewing experts who transmit knowledge to students and help resolve sewing construction problems as well as technical difficulties with the sewing machines. Alternative instructional approaches may better facilitate students’ understanding of concepts rather than skills alone.

CRITICAL SCIENCE-BASED CURRICULUM MODEL

An alternative to the technical perspective is the critical science-based curriculum model. In the 1980s, FCS critical science- based curriculum gained momentum in Ohio, Wisconsin, and Minnesota (Smith, 2004). Ohio developed a critical science-based curriculum focused on meeting personal and family textile needs (Ohio State Department of Education, 1983). The interest in critical science continues, but overall educational changes in FCS have not yet been documented (Johnson & Fedje, 1999; Vincenti & Smith, 2004; Vincenti, 1999).

Table I. Curriculum Models

View of the family

From a critical science perspective, individuals and families are more likely to be viewed as consumers rather than producers of clothing (Firat, 2001). Many individuals find sewing meaningful, but most are not likely to sew as part of their jobs, nor is it as common as it once was for families to sew to meet their clothing needs. The average family spends only $13 on sewing materials, patterns, and notions for clothing annually (1999 Consumer Expenditure Survey as cited in Russell & Mitchell, 2001). In contrast, in 2002, families on average spent approximately 4.3% of their total expenditures, or $1,750 annually, on apparel and services such as dry cleaning1 (U.S. Department of Labor, 2003).

The family is viewed as carrying out responsibilities and actions related to clothing in more integrated ways. Textiles and clothing- related experiences can be part of the work of the family, which includes providing an environment in which individuals develop their potential, nurture relationships, transmit culture, and assume social responsibility (Wisconsin Department of Public Instruction, 1987; Wright, 1999). The actions in which families engage to carry out these responsibilities include technical actions as well as communicative and critical actions.

The family can use technical actions as a means to carry out the responsibility of developing nurturing relationships. For instance, a parent can assist a child in learning how to sew while they share quality time together. Communicative actions are those through which persons come to a mutual understanding, share beliefs, or transmit culture. A grandmother can tell about the family’s journey to the U.S. as well as cultural traditions while sharing the paisley shawl her own mother carried from her native country.

Critical actions are those that result in empowerment or helping others to become empowered. For example, a family can engage in critical actions by examining their perceptions of the homeless population in the community. Families could carry out social responsibility by identifying needs of the homeless related to food, shelter, or clothing, and by volunteering to work at a shelter, starting a food drive, or by collecting or even making clothing. Such actions can be thought of as critical or emancipative, because in the process, distorted beliefs and assumptions are critiqued and examined.

FCS teachers can help students further examine these actions in relationships to families. Technical or hands-on experiences such as sewing are not eliminated, but are placed within the context of the work of the family. Sewing can provide a means for carrying out family responsibilities and actions, but the task of sewing itself is not a central focus of the family today. Within the classr\oom, the work of the family, rather than sewing skills, helps to identify broad concepts that lead to enduring understanding.

Focus of Learning

In the critical science model, the focus of learning is on broad concepts, the enduring concepts, or the big ideas that hold the course or unit of study together (Hauxwell & Schmidt, 1999; Wiggins & McTighe, 1998). These are the important ideas students should remember after the details have been forgotten (Wiggins & McTighe, 1998). In FCS, broad concepts are selected based on the work of the family. Examples of broad concepts include resource management, caring for family members, and social responsibility. Broad concepts also include cognitive processes, such as practical reasoning.

Individuals and families can engage in practical reasoning to address real-life individual, family, or community concerns (Brown & Paolucci, 1979). To implement this in the classroom, for example, a teacher may present the problem of what to do with regard to consumer redress for an apparel product that does not last through several wearings. Students then develop questions related to the practical reasoning categories.

Practical reasoning includes an examination of four categories of questions related to the context and valued ends related to the problem, alternative actions (technical, communicative, critical) needed to resolve the problem, and consequences of alternative actions (see Table 2). Students use these questions to guide problem investigation. Information gathered is used to form a judgment about what to do about the problem (e.g., write consumer complaint letter to the garment manufacturer).

Ideally, after problem investigation, students implement appropriate actions, which may or may not result in the construction of a textile product. For example, students could use the practical reasoning process to investigate the concerns of children in poverty in the U.S. and the clothing and textile needs of these children- which could result in the making of clothing items, blankets, or other sewing-based projects (Zieman, 2002). In this scenario, the greater emphasis is placed on the problem-solving process rather than on the development of expert sewing skills and techniques.

One concern is that the critical science model eliminates hands- on activities. Although the nature and focus of activities may be different, students can be actively engaged in learning through a variety of experiences. Practical reasoning may be only one of multiple learning strategies that are used in a course or program. For example, students may be actively involved through learning opportunities such as:

* Reading literature or watching movies that highlight work of the family components, such as sharing family responsibilities in the home, or cultural aspects of apparel.

* Examining teenager’s concerns about body image, clothing, and “fitting in” with their peers.

* Reviewing case studies that describe work of the family involving technical, communicative, or critical actions related to clothing and textiles.

* Writing stories, songs, or creating posters that illustrate the impact of clothing/textiles on human development.

In the critical science model, students also may sew, but sewing is connected to broader concepts that are explicitly identified in the curriculum and taught in the classroom.

Role of the teacher and student

In the critical science-based classroom, the role of the teacher and student are different from that of the technical model. The teacher facilitates and structures learning experiences and is, therefore, not viewed as the sewing expert (Brooks & Brooks, 1999). Solutions to problems are discovered collaboratively through the investigation process. Students are assessed on their use of problem solving and collaborative processes rather than primarily on their sewing skills or product completion.

TRANSITION TO A CRITICAL SCIENCE-BASED CURRICULUM

To move from a technical science to more critical science-based curriculum requires an examination and possible change in both educational practices and beliefs (Fullan, 1991; Montgomery, Brozovsky, & Lichty, 1999). To begin the transition, FCS professionals need to think about sewing as an educational experience within FCS courses in middle and high schools, and address difficult questions such as:

Table 2. Practical Reasoning Example Questions

* What are the educational priorities in FCS? Can these priorities be supported with available human, financial, and materials resources?

* What are the opportunity costs if emphasis is placed on sewing skills rather than on broad concepts, such as the work of the family? What are the benefits?

* What broad concepts guide the foundation of the FCS sewing- based curriculum? Are broad concepts clearly communicated to students, parents, administrators, and the community?

* What are the educational goals of the FCS course or program? How do learning experiences or activities support the educational goals? Do sewing experiences enhance these goals in a meaningful way?

* Is sewing an essential educational experience? Or are there alternative experiences that would better prepare youth for their current and future roles in the family and community?

Answers to these questions may be difficult but they can contribute to improving FCS education. Sewing is an important tradition that can continue to be built upon but FCS educators need to be sure that the needs of today’s individuals, families, and communities are met.

REDEFINING SEWING AS AN EDUCATIONAL EXPERIENCE

The technical science and the critical science-based curriculum models represent two distinctly different approaches to the use of sewing in the FCS classroom. It is time to redefine the educational priorities of sewing, clothing, and textiles in FCS classrooms. An examination of the enduring concepts related to clothing and textiles can help the FCS profession move away from the emphasis on sewing skills and may create a powerful, necessary metamorphosis of the FCS curriculum in middle and secondary schools.

The author acknowledges the assistance ofAimee Prawitz, PhD, and Sarah Cosbey, PhD, who are both Associate Professors in the School of Family, Consumer & Nutrition Sciences at Northern Illinois University.

Curricula based on sewing skills only, without any focus on the family or related concepts, is unlikely to prepare adolescents for their current and future roles within the family and society.

1 Based on an average annual expenditure of $40,677.

REFERENCES

Brandes, K., & Garner, M. (1997). The case for high school clothing construction classes. Journal of Family & Consumer Sciences, 89(1), 62-65.

Brown, M. M., & Paolucci, B. (1979). Home economics: A definition. Washington, DC: American Home Economics Association.

Brooks, J. G., & Brooks, M. G. (1999). In search of understanding: The case for mnstruclivist classrooms. Alexandria, VA: Association for Supervision and Curriculum Development.

Burden, P. R., & Byrd, D. M. (2003). Methods of effective teaching. Boston: Pearson.

Burman, B. (Ed.). (1999). The culture of sewing: Gender, consumption and home dressmaking. New York: Berg.

Eisner, E. W. (2003). Questionable assumptions about schooling. Phi Delta Kappan, 84(9) 648-657.

Firat, A. F. (2001). Consumer research for (the benefit of) consumers. Journal of Research for Consumers, I. Retrieved April 13,2004 from, http://jrc.bpm.ecu.edu.au/consumer/ index.asp

Fullan, M. G. (with S. Stiegelbauer) (1991). The new meaning of educational change. NY: Teachers College Press.

Harrison, G., Andrews, J., & Saklofske, D. (2003). Current perspectives on cognitive and learning styles. Education Canada, 43(2), 44-47.

Hauxwell, L., & Schmidt, B. (1999). Developing curriculum using broad concepts. In J. Johnson & C. Fedje (Eds.), Family and consumer sciences teacher education: Yearbook 19. Family and consumer sciences curriculum: Toward a critical science perspective (pp. 91- 102). Peoria, IL: Glencoe/ McGraw-Hill.

Johnson, J., & Fedje, C. (Eds.). (1999). Family and consumer sciences teacher education: Yearbook 19. Family and consumer sciences curriculum: Toward a critical science perspective. Peoria, IL: Glencoe/McGraw-Hill.

Lee, C. (2002). Competencies in clothing and textiles needed by beginning family and consumer sciences teachers. Journal of Family and Consumer Sciences Education, 20(1), 27-31.

Montgomery, B., Brozovsky, S. L., & Lichty, M. (1999). Taking action regarding change. In J. Johnson & C. Fedje (Eds.), Family and consumer sciences teacher education: Yearbook 19. Family and consumer sciences curriculum: Toward a critical science perspective (pp. 226-237). Peoria, IL: Glencoe/ McG raw-Hill.

Ohio State Department of Education. (1983). What to do regarding meeting personal and family textile needs. Columbus, OH: Author.

Plihal, J., Laird, M., & Rehm, M. (1999). The meaning of curriculum: Alternative perspectives. In J. Johnson & C. Feclje (Eds.), Family and consumer sciences teacher education: Yearbook 19. Family and consumer sciences curriculum: Toward a critical science perspective (pp. 2-22). Peoria, IL: Glencoe/McGraw-Hill.

Russell, C., & Mitchell, S. (2001). Best customers: Demographics of consumer demand. Ithaca, NY: New Strategist.

Shumer, R. (2001). A new, old vision of learning, working, and living: Vocational education in the 21″ century. Journal of Vocational Education Research, 26(1), 447-461.

Smith, B. P. (2004). FCS curriculum development and the critical science perspective. Journal of Family & Consumer Sciences, 96(1), 49-51.

U. S. Department of Labor. (2003). Table 3. Age of reference person. Bureau of Statistics. Retrieved April 13, 2004 from ftp:// ftp.bls.gov/pub/special.request3/ce/standard/ 2002/age.txt

Vincenti, V. (1999). Consequences of action. In J. Johnson & C. Fedje (Eds.), Family and consumer sciences teacher education: Yearbook 19. Family and consumer sciences curriculum: Toward a critic\al science perspective (pp. 284-296). Peoria, IL: Glencoe/ McGraw-Hill.

Vincenti, V, & Smith, F. (2004). Critical science: What it could offer all family and consumer science professionals. Journal of Family & Consumer Sciences, 96(1), 63-70.

Wiggins, G., & McTighe, J. (1998). Understanding by design. Alexandria, VA: Association for Supervision and Curriculum Development.

Wisconsin Department of Public Instruction. (1987). Λ guide to curriculum and planning in home economics. Madison, WI: Author.

Wright, P. J. (1999). Work of the family. In J. Johnson & C. Fedje (Eds.), Family and consumer sciences teacher education: Yearbook 19. Family and consumer sciences curriculum: Toward a critical science perspective (pp. 103-116). Peoria, IL: Glencoe/ McGraw-Hill.

Zieman, N. (with G. Brown). (2002). Creative kindness. Iola, WI: Krause.

Bette Montgomery, PhD

Assistant Professor

School of Family, Consumer & Nutrition Sciences

Northern Illinois University

[email protected]

Copyright American Association of Family & Consumer Sciences Jan 2006

Ask Zimo: What Exactly is ‘First Light’?

By Pete Zimowsky, The Idaho Statesman, Boise

Feb. 23–Question: Settle and clarify this: What are the definitions of first light, daylight, sunup, legal shooting, sunrise, etc.

Some of us say first light is the very first light in the sky in the east, others say it is when you can first make out the ground where you can walk.

How do cowboys use these terms?

Fritz Dixon, Meridian

Answer: I don’t know about the cowboy way, but let me shed some light on what I think.

— First light: The best example of this for me was when I was camping on a high plateau in the Owyhees in the spring. I awoke to songbirds just starting to chirp and move out of their roosts in trees and bushes.

The eastern sky was barely a black-purple color with slightly seen silhouettes of mountains. The ground was still dark, and you couldn’t walk without tripping.

— Daylight: This is when the surroundings are lit but the sun isn’t up yet. You can walk around and see the ground.

To me, daylight is the period between the start of legal waterfowl shooting hours and sunrise. That’s one-half hour before sunrise.

— Sunup: It’s not exactly sunrise. To me sunup is when the full circle of the sun is just barely over the horizon.

If you’re sitting on a beach in the Florida Keys and watching the sun rise over the ocean, it’s pretty simple. Sunup will probably be close to the official time for sunrise.

If you’re in Idaho, watching sunup over the jagged mountains or a steep canyon, sunup probably going to be later than the official sunrise.

— Legal shooting hours: Here’s the legal scoop from the Idaho Department of Fish and Game’s hunting regulations on big game, upland game and waterfowl.

For waterfowl, it’s one-half hour before sunrise to sunset.

The legal shooting hours for upland birds and big game is one-half hour before sunrise to one-half hour after sunset.

— Sunrise: I’ll just go by the official sunrise that’s printed on the weather page on the back of Sports in the Idaho Statesman.

Top fishing spots

Question: I have friends in Alabama who do a lot of fishing in the Gulf of Mexico but have never fly-fished or fished in the West.

Not being a fisherman myself, I thought perhaps you could offer them some advice as to places to go and also times to go.

Rick Gale, e-mail

Answer: If they’re coming to Idaho to fly-fish, they have to hit Idaho’s premier trout fishing waters. These are the holy places, where fly anglers from around the world make pilgrimages.

I’d schedule a few days on the Henrys Fork of the Snake River in Island Park during the green drake hatch, which usually occurs sometime between June 15 and June 30. Then there’s the brown drake hatch around June 20 to July 10.

They’ve also got to hit the salmon fly hatch on the South Fork of the Snake River. That’s around the third week in June. It’s usually a high-water hatch. It lasts sometimes through July 4.

Let’s not forget the opening of trout fishing season on Silver Creek on Memorial Day weekend. There are good hatches during that time, and the rainbows and browns aren’t so wise to anglers.

There’s no fishing like cutthroat fishing on the Middle Fork of the Salmon River when the water calms down a little in July. A float trip through the Frank Church-River of No Return Wilderness is a must.

Then there’s mid- to late-summer on the Lochsa River in northern Idaho for cutthroat trout.

These are the primo places, the unforgettable places, the holy places of fly fishing.

Good fishing.

Need an elk hunt

Question: I have been exhaustively searching the Internet for a wilderness elk hunt in Idaho but have not found exactly what I am looking for.

Where can I find a wilderness elk hunt that involves a pack trip into a wilderness area to a camp with an excellent chance for harvesting a 5-point or better bull?

I am relatively young (29), relatively fit (6-foot-3, 185 pounds) and more than willing to put in the extra effort for an elk.

As a matter of fact, part of what I am looking for is a physically challenging hunt that will make the trophy that much more rewarding in the end.

Any advice or contact information you may have would be greatly appreciated. I am not interested in spending $8,000 to $9,000 to hunt on a private ranch where you can drive a pickup to the hunting area and get out and shoot your bull.

I want to earn my trophy and would be willing to pay $4,000 to $5,000 for a hunt in a good area with an excellent chance for success provided the hunter is willing to put in the effort.

Derek, e-mail

Answer: Idaho has reputable outfitters that can take you into a wilderness area for an elk hunt.

You’ve got to shop around, but you should start by going online at the Idaho Outfitters and Guides Web site at www.ioga.org.

I’m glad you want a real hunt. Idaho is seeing more canned elk hunting on ranches, which we don’t need. A canned hunt is where animals are kept in fenced areas.

If you want a true Idaho elk hunt, head out into the wilderness and relish the challenge.

Here are a few tips and things to keep in mind when you’re choosing an outfitter from the Idaho Outfitters and Guides Association:

— Check to see if the outfitter is licensed in Idaho. You can do that by contacting the Idaho Outfitters and Guides Association at (208) 342-1438; or getting on the association’s Web site.

The association is like the outfitters’ Better Business Bureau and can tell you if the outfitter has had any complaints.

You also can contact the Idaho Outfitters and Guides Licensing Board at (208) 327-7380.

— What animal do you want to hunt or what recreational activity are you interested in? That will influence your choice for a guide.

— How much are you willing to spend? Remember to include airfare, taxidermy fees, license cost, guide fees and tip.

— How important is the type of country or terrain? Do you want the trip in wilderness, roadless areas, or general areas closer to town?

— What about accommodations? Do you want to be in the wilderness in a wall tent or a cabin, or in a hotel or motel on the edge of town and driving to the hunt each day?

— Do you want a guided hunt or a drop camp? In a drop camp, the outfitter drops you off and you do your own thing.

— How much can you afford for guided services?

Good hunting.

Ideas From Readers

Birds and windows

Hey Zimo!

We have this big picture window and, man, I had more birds smack that window (Ask Zimo, Jan. 26).

We kept finding juncos, cedar waxwings, and finally a dove. Then I got this really cool book that had an idea that worked. The book is called “Stokes Backyard Bird Book.”

It recommended cutting out a life-sized silhouette of a diving hawk and putting it on the window in a diving position.

I made it out of black construction paper and then had it laminated. I taped it on the outside of the window.

The silhouette of a diving hawk is a fear factor for little birdies.

It really helped, and I haven’t had a bird hit the window for a year and a half.

Vonnie Merlini, Nampa

Anglers, get online

Hey Zimo!

Are you familiar with BigFishTackle.com?

If you go to the discussion board and then to the “Idaho” board, there is an active discussion of eastern Idaho fishing, with Dick Schleis, guru of Henrys Lake fishing, among the regular contributors.

I am the only contributor from our side of the state. Boise area anglers need to get online and share information.

Perhaps you could mention it in the Outdoors section.

Mike K, e-mail

Dog’s feet

Hey Zimo!

I’ve worked around avalanche dogs for a number of years and I’m reading your article in the paper (Ask Zimo, Feb. 9) about getting their feet and putting booties on.

What avalanche dog handlers do is put Vaseline in the dogs feet. It tastes horrible and they don’t lick it off. It seems to prevent the snowballs from forming.

At least it is something for people to try.

Mike W., Boise

Natural ice

Hey Zimo!

On the natural-ice skating thing (Ask Zimo, Feb. 9), I was pheasant hunting on the Montour game refuge shortly after the cold first two weeks of December and walked across the ice on the two-acre pond on the east side of the road.

The pond has numerous islands, and I dreamed of skating around those islands and free-wheeling all over the place.

If I was 50 years younger, I would have gone home for my ice skates. Unfortunately, after two warm weeks following, the ice would have been dangerous. Maybe next year.

Ray Bowden, Emmett

Ideas from Readers and other articles submitted to The Idaho Statesman may be published or distributed in print, electronic or other forms.

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Copyright (c) 2006, The Idaho Statesman, Boise

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected].

Alzheimer’s decline faster in more-educated people

NEW YORK (Reuters Health) – The rate of mental decline seen
with in patients with Alzheimer’s disease is directly related
to the educational level of the affected individual, according
to a report in the Journal of Neurology, Neurosurgery, and
Psychiatry.

The new findings are based on a study of 312 patients
living in New York who were diagnosed with Alzheimer’s disease
and followed for an average of 5.6 years. Up to nine
neuropsychological tests were performed on each subject during
the course of the study.

Overall, mental agility fell by 9 percent of a standard
deviation each year, lead author Dr. Nikolaos Scarmeas and
colleagues, from Columbia University Medical Center in New
York, note. For each year of additional education, the decline
increased by 0.3 percent.

Memory and executive speed, which includes the ability to
adapt to change and organize thoughts, were the primary areas
affected by education level, the report indicates.

Further analysis showed that the link between education and
mental decline was not influenced by age, mental function at
the time of diagnosis, or other factors known to influence
brain function, such as depression and vascular disease.

Previous studies have provided evidence that high levels of
education can delay Alzheimer’s disease. The “cognitive
reserve” hypothesis has been put forth to explain the effects
of education on Alzheimer’s disease, Scarmeas and colleagues
note.

This theory, they explain, holds that highly educated
individuals have more intellectual reserve so the onset of
overt Alzheimer’s disease symptoms is delayed. However, once
symptoms become apparent, more damage has accumulated than in
less educated brains, so the subsequent decline in mental
function is more rapid.

SOURCE: Journal of Neurology, Neurosurgery, and Psychiatry,
March 2006.

Egypt liberals to Rice: Mubarak stifles secularists

CAIRO (Reuters) – Egyptian liberals told visiting Secretary
of State Condoleezza Rice on Wednesday their government was
helping the Islamist opposition by stifling other forms of
political activity.

Rice encouraged the liberals to organize themselves and
speak to the government with “a concerted voice.”

She said the United States would keep pressing the Egyptian
government to carry out the political reform program which
President Hosni Mubarak promised during last year’s elections.

Rice met seven selected members of Egyptian civil society,
all of them English-speaking and most of them associated with
the small secular liberal wing in Egyptian politics.

They included a close associate of imprisoned opposition
leader Ayman Nour, the Egyptian head of the American Chamber of
Commerce, business people, intellectuals and academics.

But none of them spoke on behalf of the Muslim Brotherhood,
the Islamist movement which emerged in last year’s
parliamentary elections as the largest opposition force in the
country. The Brotherhood has 88 members in the 454-seat
parliament.

As in the Palestinian elections last month, the electoral
success of the Islamists poses a dilemma for the United States,
which says it favors democracy in the Arab world.

Tareq Heggy, a liberal oil executive and writer, told Rice
the United States should give the Egyptian government advice on
how to “pull the carpet from under the Muslim Brothers.”

He said that trying to eliminate the Muslim Brotherhood
would be completely undemocratic. “So the issue is how we (the
liberals) can compete with them,” he added.

Corporate lawyer Taher Helmy said: “They (the Muslim
Brotherhood) are much stronger than what you see. The reason
for that is that there is a political vacuum.”

The liberals, including Ayman Nour’s Ghad (Tomorrow) party,
fared poorly in elections in November and December.

SMEAR CAMPAIGN

Hala Mustafa, an academic who is in Mubarak’s National
Democratic Party (NDP), complained to Rice that Egypt’s
government-owned media had waged a smear campaign against
advocates of reform.

Holding up an article attacking liberals in the state-owned
weekly Rose el-Youssef, she said: “If you are really serious
(about pressing for reform), you should criticize this.”

Saadeddin Ibrahim, a sociologist who has both U.S. and
Egyptian citizenship, told Rice the United States must link its
financial aid to Egypt, close to $2 billion a year, to progress
on political reform. “Condition it,” he said.

He said Mubarak’s strategy was to confine the political
competition in Egypt to himself and the Islamists. “(He knows)
that the West will always side with him,” he added.

“She (Rice) urged civil society groups to coordinate, to be
outspoken and to keep the Americans informed,” Ibrahim told
Reuters after the meeting.

At a joint news conference with Egyptian Foreign Minister
Ahmed Aboul Gheit on Tuesday, Rice said the political events of
the last year in Egypt included “setbacks and disappointments.”

The presidential elections, in which Mubarak won 89 percent
of the vote, and the parliamentary elections were seriously
marred by government interference and violence by the security
forces, monitoring groups said.

Rice had talks with Mubarak over breakfast on Wednesday and
then left for the Saudi capital Riyadh. She will also visit the
United Arab Emirates on her Middle East trip.

The Dominion Post, Morgantown, W.Va., Local Police Report No Progress In Area Death Cases Column

By The Dominion Post, Morgantown, W.Va.

Feb. 22–Fairmont Police Tuesday had made no new progress in the November hit-and-run death of WVU nursing student Erin Marie Keener. Meanwhile, area police also said they are still investigating two other local deaths. In the Fairmont hit-and-run case, Fairmont Police Detective J.S. Bennington said Tuesday, “No arrests have been made and no warrants for an arrest have been issued.” When asked how close officers are to making an arrest, Bennington said only, “We’re working this case every day.” Keener died Nov. 23 after being struck by a car in Fairmont. The 21-year-old Rivesville woman was hit just after midnight at Merchant and Guffey streets. The driver left the scene. Marion County Prosecuting Attorney’s office is also investigating. Other cases: Morgantown Police continue to wait for answers surrounding a fatal house fire that killed Suncrest resident James Andrew Michael. Morgantown Police Sgt. H.W. Sperringer said detectives continue to wait for evidence that has been sent to various labs including the State Police Forensics Lab and the U.S. Bureau of Alcohol, Tobacco, Firearms and Explosives lab. Michael was discovered in a bedroom in his home on Killarney Drive in Suncrest on Nov. 29. Michael, 33, who lived in the home with his wife and their four children, was the only person home at the time of the fire. On Feb. 8, investigators announced the fire was intentionally set. On Jan. 24, the body of Morgantown resident Ebony Nicole Brown was found buried in a shallow grave at 42 1/2 Snowy Road, near Chaplin Hill. Charged in Brown’s death are sisters Danielle Taureane Hilling, 23, of Sabraton and Nina Jefferson, 27, of Morgantown, and Hason K. “MEGA” Cleveland, 27, of Morgantown. Hilling and Cleveland are charged with first-degree murder. Jefferson is charged with conspiracy to commit murder. Hilling and Jefferson face the grand jury in May and Cleveland was arrested Nov. 1. in Queens, N.Y. He is expected to be extradited from New York to Morgantown by the end of the month. A tentative hearing is set for March 3. Morgantown Police said Tuesday their investigation into the Feb. 12 stabbing death of WVU student Ryan Robert Johnston is continuing. Johnston was stabbed during an early morning fight between two groups of young adults on Beechurst Avenue. Police have yet to arrest anyone in that case.

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Copyright (c) 2006, The Dominion Post, Morgantown, W.Va.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected].

Philippines:FAIR,

Low-Cost Dental Care is Available: For $20, Students Can Provide Teeth Cleaning for Children or Adults

By Steve Lyttle, The Charlotte Observer, N.C.

Feb. 22–It might be one of the best bargains in town — if you’ve got some extra time and a bit of faith in the educational system.

Central Piedmont Community College’s Dental Hygiene Clinic provides low-cost services for the community, while giving its students a chance to test their newly learned skills on the public.

“It’s one of those secrets — something a lot of people don’t seem to know about,” Judy Qualtieri, chairman of the dental hygiene program at CPCC, said of the clinic, which operates from the Belk building on the school’s central campus.

For about four decades, CPCC’s Dental Hygiene Clinic has provided cleanings, fluoride treatments, X rays and oral health education for the public. The services are provided by students in the program.

The cost — $20 — is a fraction of what is charged by regular dental offices.

“We really aren’t stealing dentists’ patients,” Qualtieri said. “We’re getting mostly people who wouldn’t do it otherwise.”

Many of the clinic’s patients are children or adults who do not have dental insurance and cannot afford the services from a dentist’s office. CPCC’s clinic has dentists on site to check on teeth. In addition, Qualtieri, lab director Sheila Pointer and other teachers look over the shoulders of their students to make sure everything is done correctly.

“Our checkups take a bit longer than usual — sometimes up to three hours — because the students are a bit slower than experienced hygienists,” Pointer said. “In addition, we have our instructors check behind them. But we never have any problems. The students always do a good job.”

At any given time, there are about 30 students enrolled in the two-year dental hygiene program at CPCC.

Qualtieri said the job market has tightened a bit in recent months, because some people are losing health insurance and visiting dentists less frequently than before. But they say nearly all their students find jobs quickly.

“It’s a good profession,” she said. “The hours are good, and the compensation is solid.”

The loss of medical insurance also is causing a change in the condition of teeth among some patients visiting the CPCC clinic, Pointer said.

“We’re seeing more people who are putting off preventive care,” she said. “Without insurance, they can’t afford to see the dentist.”

Qualtieri said CPCC’s students are learning with the latest technology, including ultrasonic instruments to clean teeth and digital X-ray equipment.

“This is like any other aspect of medical science,” she said. “The technology is changing rapidly. We’re changing with it.”

Dental Hygiene Clinic

The CPCC Dental Hygiene Clinic is in the Belk building at the school’s Central Campus, 1201 Elizabeth Avenue. The clinic is open 4 1/2 days a week during the current spring semester. It operates three days a week in the summer and 2 1/2 days a week in the fall semester. For details about the clinic or the dental hygiene program, call (704) 330-6704.

—–

Copyright (c) 2006, The Charlotte Observer, N.C.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected].

Drowning Investigations

By Haupt, Gary

On a lake in Missouri, investigators made a grisly discovery. They found a white male floating with a heavy boat anchor attached to him with a rope. The subsequent autopsy revealed that someone killed him and dumped his body into the water. Eventually, authorities arrested a suspect who later was convicted of murder.

Another case involved a man who was accidentally ejected from a boat traveling at a high rate of speed on a Missouri lake. Apparently, he hit his head, became unconscious, and drowned, disappearing below the surface of the water. The incident occurred in the main channel of the lake, which measured over .5 mile wide and varied from 70 to 110 feet deep. A witness could not closely identify the location of the accident, hampering investigators’ attempts to locate the victim. To further complicate matters, the area had a substantial amount of underwater timber that remained from before the formation of the lake. Authorities made numerous attempts to recover the man’s body by dragging, scuba diving, and using canines-all of these methods proved unsuccessful. Five years later, the remains of a decomposed foot wearing a sock and a tennis shoe surfaced and began floating in the approximate area of the lake where the man’s body disappeared. Authorities identified the sneaker as the one worn by the victim before the accident. Decay was well advanced, and the joint at the ankle had completely rotted away, allowing the foot to float free from the body. Although most corpses come to the surface during the decomposition process, this case probably represented one of the rare instances in which a body remains entangled in some type of underwater obstruction, such as timber or brush.

Law enforcement personnel conduct a large number of drowning investigations. Some involve homicides or suicides, but most result from accidents. Drowning represents the fourth leading cause of accidental death in the United States, with between 4,000 and 5,000 incidents occurring annually.1 This number alone indicates that many police officers, in the marine environment and otherwise, will routinely investigate drowning deaths. Agencies need to ensure that their personnel remain well prepared to handle these cases when they arise.

DEATHS BY DROWNING

Definition

Drowning refers to death due to submersion in a liquid-as shallow as 6 inches in cases involving infants, the elderly, people afflicted with epilepsy, or individuals under the influence of alcohol or other drugs. Irreversible cerebral anoxia, or lowered oxygen to the brain, due to asphyxiation serves as the mechanism of death.2

Experiments conducted in the late 1940s and early 1950s suggested that many drowning deaths resulted from electrolyte disturbances or cardiac arrhythmia produced by high volumes of water entering the circulatory system through the lungs. However, present thought considers hypoxemia, or deprivation of oxygen to the systems of the body, the most important physiological consequence of drowning. Also contrasting previously held theories, recent research suggested that the heart and kidneys can compensate for large amounts of water absorbed by the lungs. In near-drowning cases, physicians have not observed the electrolyte changes previously thought to occur. This information should not discount the possibility of cardiac irregularities due to the inundation of the circulatory system when an individual absorbs large volumes of water; this heart-related stress can contribute to death.3

Experts consider some individuals who drown as victims of dry drowning. In these cases, the fatal cerebral hypoxia, or oxygen deprivation, does not result from water occluding the airway but, rather, from a spasm of the larynx. Water never enters the lungs. These instances constitute 10 to 15 percent of all drownings.

When people sink beneath the surface of the water, they initially react by holding their breath. This continues until they have to breathe, thereby involuntarily inhaling a large volume of water, which either enters the lungs (in most instances) or reaches the larynx-producing the laryngeal spasm that results in dry drowning. In both cases, this gasping for air may continue for several minutes until respiration ceases. Cerebral hypoxia will progress until it becomes irreversible and death occurs.4

The point at which a person dies depends largely on the age of the victim and the temperature of the water-if warm, somewhere between 3 and 10 minutes. Some rare situations involving submersion of children in extremely cold water (less than 40F) have resulted in successful resuscitation with complete recovery after longer periods of time, the longest being 66 minutes. Such cases probably result from the more rapid development of hypothermia in children. Most commonly, people lose consciousness within 3 minutes of submersion. Also, recent research has indicated that the type of water inhaled, whether fresh or salt, probably has very little influence on whether the individual will survive if resuscitation is initiated.

Death by cardiac arrest, rather than by drowning, presents another possibility when individuals become suddenly and unexpectedly submersed in cold water or overexerted. Additionally, uncontrollable respiratory distress due to cold water immersion may cause the victim to inhale water, and investigators may falsely suspect drowning.

The Body in Water

The human body weighs slightly more than fresh water. Consequently, when individuals become unconscious, they sink- regardless of fat level, which slightly increases buoyancy. Generally, a drowning victim will reach the bottom of a body of water in spite of the depth, unless it meets some obstruction on the way down. As the corpse descends further, the pressure of the water tends to compress gases in the abdominal wall and chest cavities. As a result, the body displaces less water as it sinks and, consequently, becomes less buoyant the further down it goes, until it reaches the bottom.5

If a corpse does not sink, investigators should suspect another cause of death, such as heart attack. Or, perhaps, a dry drowning has occurred; in those cases, because the lungs do not contain water, the body will not descend.

Almost without exception, a corpse lying on the bottom of a lake or river eventually will surface because of the gas formed in its tissues as a result of decay and the action of internal bacteria. This results in reduced specific gravity of the body so that it rises. Witnesses to this event have described corpses breaking the surface of the water with force, like the popping of a cork.

Factors that effect the length of time for a body to surface after drowning include fat content, consumption of beverages and food preceding death, water temperature at the bottom, and depth at the location. Recent meals high in carbohydrates (e.g., candy, beer, and potato chips) nourish certain bacteria that will encourage quick refloat.6 In warm and shallow water, the gases within the body form rapidly, resulting in a possible rise to the surface within a day or two. In deep and cold water, bacterial action takes place slowly, and the corpse may not appear for several weeks.7 When the body becomes greatly distended with gas, the tendency to float increases. Many well-documented cases exist of homicide victims dumped into lakes and rivers and then later surfacing, even though perpetrators attached heavy weights to them.

In some cases, the body may remain immersed. Extremely deep, cold water conditions (e.g., natural glacier lakes, deep impoundments) may prevent a corpse from ever becoming buoyant enough to overcome the immense water pressure.

Rivers and the Effects of Currents

Rivers differ from other bodies of water in two ways-they are shallow and have currents. Depths of less than 10 feet do not have a high level of compression on the internal air spaces of drowning victims.

In extremely heavy currents, such as in flash-flood situations, the victim’s body probably will roll on the bottom for a considerable distance-trees or other debris also may carry along the corpse. During normal conditions in most rivers, this is not the case, and investigators usually will find victims on the bottom relatively close to the drowning site. However, after the body floats to the surface, it may drift due to the current before washing ashore or coming to rest in a back eddy.8

Lakes and the Depth Factor

Victims who drown in lakes will sink to the bottom in the area below the point of submergence; authorities usually will locate the body within a radius equal to the depth of the water. However, witness error can come into play. Even when someone sees the incident, authorities may find establishing the site difficult or impossible if the victim drowned far from shore. Because of panic and anxiety, people usually do not think to mark the location where the individual went down or to note nearby landmarks, thereby eliminating triangulation as an option. Investigators find it hard to locate drowned victims in lakes unless the incident occurred near the shoreline, from an anchored boat, or at a dock secured to the shore. This problem becomes further complicated in deep and dingy water, which may eliminate any possibility of recovery attempts by scuba divers. Often, waiting for the body to float to the surface becomes the only viable \option.

Lakes rarely have a current strong enough to affect a body sinking or surfacing. However, the victim likely will move after refloat, and wind can push corpses. In lakes, the effect of even slight wind movement easily can offset any current that might exist.

Often, especially in the summer months, lakes have definite thermoclines-two layers of water at different temperatures. While the surface can measure 75 to 90F, the temperature can drop 20 to 30F at a depth of 40 feet-this cold water will tend to retard the reflotation process.9 A myth exists that a drowning victim can become suspended on a thermocline because of the difference in water density between these two layers. However, no known case exists of this happening; in fact, internal air compression on descent and expansion on ascent make this virtually impossible.10

CONSIDERATIONS FOR INVESTIGATORS

Investigators can look for some distinctive signs to determine cases of drowning. Officers must recognize these indicators and then articulate them to the medical examiner. Presently, no known and proven pathological test exists to determine drowning as the cause of death, so, by itself, an autopsy usually proves insufficient. Authorities can make this diagnosis only with a knowledge of the circumstances and exclusion of other causes.

Investigators need to answer several questions in apparent drowning cases. For instance, did the person drown, or did perpetrators kill the individual and dispose of the corpse in the water? Was the victim conscious upon submersion? Could the person swim well? Did the victim consume any alcohol or drugs? What was the individual doing at the time? Did anyone witness the incident? If any injuries exist on the body, were they caused before death (antemortem), at the same time (agonal), or afterwards (post- mortem)? In the course of their investigation, authorities will find that a combination of external signs will provide valuable information.11

Bodily Substances

Investigators should look carefully around the victim’s head, face, and mouth for any signs of vomitus. They should make this observation first as this very transient evidence easily can wash away. Presence of vomit serves as a reliable indicator that the victim became submerged while alive.

Foam often exudes from the nose or mouth of victims of wet drownings. This froth results from a mix of mucous, air, and water during respiration. Its presence serves as an indication that the person became immersed while still breathing, although authorities do not consider it conclusive evidence that the individual drowned. Some blood resulting from the tearing of lung tissue by forceful breathing just prior to unconsciousness may exist with it. Investigators should note that decomposition can destroy the foam.12 This froth is similar to that often found on individuals who have died from acute heart failure or a drug overdose, both of which usually result in massive pulmonary edema.13

Transient in nature, this frothy foam easily can wash away during recovery operations. Sometimes, it may continue to ooze from the nose and mouth for a period of time after recovery. In other cases, no visible signs of it may exist, even in confirmed drownings. The lack of a froth cone is more typical when the victim did not fight the drowning process and gasp forcibly for air when disappearing below the surface of the water (e.g., intoxicated or unconscious individuals).

Adipocere refers to a fatty wax substance that forms on bodies either submerged in water or buried in damp conditions without oxygen and air. Its presence on a corpse recovered from water indicates that the victim probably has been there for a long time.

Lividity

Investigators normally will find postmortem lividity, or blood pooling, on the portion of the body or head lying on the bottom after drowning. For instance, a corpse that ends up face down should have this condition evident on the chest, abdomen, face, or all of those areas. Typically, lividity is most evident in the head or neck because the body normally assumes a position of head down, buttocks up, and extremities dangling downward. Blood pooling not conforming to these patterns should alert authorities to investigate further to determine if death preceded immersion.

Eyes

A drowning victim’s eyes provide a ready, easily accessible, and useful source of information relating to the cause and time of death. As this evidence also is transient in nature, investigators need to note it immediately after recovery.

If death occurred on land, a noticeable horizontal line should exist on the eyeball if, as is common, the eyelids remained partially open, thereby allowing exposure to air and its drying effects. The line, or border, between the clear and cloudy cornea- the raised, usually clear area of the eyeball covering the pupil and irisand the white and discolored sciera-the opaque, normally white portion-will occur only in these instances.

Conversely, if the victim drowned and is submerged in water at the time of death, then the eyes will retain a lifelike, glistening appearance. No lines will be present.14

Skin

The skin on the hands and feet of a body will have a wrinkled “washerwoman” appearance if immersed for more than 1 or 2 hours. This is called maceration and does not indicate that the deceased has drowned as it will develop whether the individual was alive or dead when entering the water. After prolonged immersion, the outer layer of skin may become completely separated from the feet and hands and come off in a glove or sock fashion. Investigators can obtain fingerprints from the intact or detached skin, which retains the same ridge pattern.

Muscles

Rigor mortis, or postmortem rigidity, results from a chemical reaction that commences at death. It usually begins to develop within 2 hours, becoming fully established in 6 to 12. Rigor mortis results from muscle rigidity, not a stiffening of the joints. Once fully established, it remains for a variable period of time and then gradually diminishes (24 to 36 hours after death). Both the onset and disappearance of rigor mortis will vary depending on water temperature. Investigators should note that cold water can retard the process.15 Also, it may be poorly formed in infants and elderly persons.

When initially recovered from the water, portions of the body- mainly hands and arms-may appear to be in full rigor mortis, even though only a short time has passed since death occurred. This phenomenon, cadaveric spasm, results from the typically violent struggling of an individual at the time of the drowning. Cadaveric spasm forms only under conditions of extreme mental stress and indicates the victim’s last thoughts and actions. It occurs virtually instantly and only in groups of voluntary muscles, unlike rigor mortis, which progresses evenly throughout the body at a steady rate.16

Another condition, cutis anserina, or goose flesh, is a spasm of the erector pilae muscles due to rigor mortis. It does not indicate whether the person was alive or dead while entering the water.

Decomposition

Putrefaction refers to the decomposition of the body because of bacteria and fermentation. Although this process can take longer in water-submerged victims, these individuals may remain concealed longer when they become hidden in water or vegetation or lost in a large body of water; this results in correspondingly advanced postmortem changes before recovery. No time schedule for the stages of decomposition exists as differing water and climatic conditions will have a profound effect. Generally, cold and swiftly moving water preserves bodies, whereas heavy clothing and stagnant, warm water hasten decomposition.

The sequence of events remains relatively constant. Skin maceration begins, followed by progressive bloating and discoloration. The abdomen becomes greenish or purple; it also becomes distended because the body cavity fills with gas. Skin and hair detach and the tongue and eyes protrude. Features swell until authorities find victim identification difficult. Advanced stages of putrefaction can lead to mummification of the skin, especially if the body refloats, becomes exposed to the drying effects of air, and remains hidden for a long time.

Body Posture

Corpses normally exhibit a relaxed, often prone, semifetal position when discovered by divers on the bottom of a body of water. They assume this posture because of the buoyant properties of water; the natural forces exerted by the skeletal muscles, even when relaxed; and the buoyancy of the lungs, which lie nearer the back than the front. In this position, the arms and legs usually are slightly bent at the elbows and knees. The head often tilts slightly forward, and the spine curves slightly. Authorities should see this configuration upon recovery when rigor mortis is developed.

Any person who has died on land and remained in a terrestrial environment during the onset of rigor mortis will display a different posture. The head likely will be rotated to one side, a position almost never found in a drowning victim.17

Hand and Arm Positions

Investigators often will find a drowning victim’s arms bent with the hands turned toward the face when rigor mortis has developed. In those cases, it appears that individuals tried to cover their mouths to prevent drowning. Often, they clinch their hands in a fist. These arm and hand positions are much less pronounced or not present at all in victims who drowned while intoxicated because these individuals generally do not struggle, but simply disappear below the surface of the water.

Sometimes, investigators may find objects in the hands of victims, such as grass from an embankment. If the drowning occurred in relatively shallow water, soil or gravel commonly found on the bottom may be clutched in the hands, indicating that the individual probably entered the water while conscious.18

Injuries and Marks

Immersion of a bod\y in water for several hours may cause leaching of blood from injuries, such as propeller cuts, lacerations, and stab wounds. Thus, an individual may have a number of what appear to be bloodless postmortem injuries, which actually are antemortem or agonal and the cause of the person’s demise. Of course, all recovered bodies need careful inspection for possible antemortem injuries. Because of the leaching effect, investigators may find detecting these wounds difficult.

Severe antemortem or agonal injuries usually will leave definite signs, such as bruising and dispersing of blood into adjoining tissues, because the heart still was pumping blood when these wounds occurred. This appearance will diminish as putrefaction progresses.

Legitimate postmortem injuries can occur to a body, especially around the head, face, knees, tops of the feet, and backs of the hands, although investigators should take care not to confuse these with defense wounds. A corpse that floats to the surface after partially decomposing is subject to currents that can repeatedly drag it across rocks and obstructions. In a very strong current, the body can travel far underwater, also causing these postmortem injuries.

In addition, marine life can cause postmortem damage to a body. It is not unusual for the lips, ears, and nose to be at least partially eaten away.

Boat propellers also can cause postmortem injuries, especially to a body that floats back to the surface at night and then gets hit by a motorboat before discovery. Investigators must differentiate postmortem propeller cuts from antemortem or agonal ones; in most instances, corpses refloat facedown, so those that occur after death nearly always will be to the back and shoulders, back of the head, or buttocks.

Medical examiners can help draw conclusions about the actual nature of wounds detected. But, investigators must provide all pertinent details.

INDICATIONS IN AUTOPSIES

Over the years, experts have developed and tried a number of tests to determine conclusively whether a person drowned. All have proven unreliable on their own. No morphologic findings diagnostic of drowning exist. Although an autopsy usually is not sufficient by itself, it can exclude other possible causes of death.19

Coroners will find the lungs of the typical wet drowning victim large and bulky, completely occupying their respective cavities, with a brick red appearance and large quantities of foamy edema. White foam commonly exists in the trachea and bronchi. The stomach may contain water. There may be dilation of the right ventricle of the heart due to absorption of large quantities of water into the circulatory system.

Examiners may find swelling in the brain and hemorrhaging in the petrous or mastoid bones. Authorities also may encounter these symptoms in people who died of heart disease, abuse of substances, or other causes. Thus, the drug overdose victim dumped in a lake and the heart attack victim collapsing into the water can have the washerwoman and goose flesh appearance, pulmonary edema, and hemorrhage into the petrous and mastoid bones. This demonstrates for investigators the importance of gathering other information to assist medical examiners in determining the proper cause of death when drowning is suspected.20

Once water has flooded the lungs, osmosis may cause a portion of any alcohol in the blood to pass out of the circulatory system into the flooded alveoli. When this occurs, the possibility exists that the resultant postmortem blood alcohol analysis may measure as much as 30 percent less than before death.21

NEW TECHNOLOGY

Through a U.S. Department of Homeland Security grant obtained in the spring of 2004, the Missouri State Water Patrol received money to purchase sophisticated side-scan sonar equipment capable of finding underwater bombs, improvised explosives, and other devices that could pose a risk to bridges, dams, and other structures. Fortunately, it also can locate a human body on the bottom of a lake or river. This technology is far superior to conventional paper or liquid crystal graphs. On a computer monitor, it can paint an accurate picture of the bottom of a waterway and effectively eliminate from consideration large sections of water during a search for bombs, vehicles, planes, evidence, or bodies.

This side-scan sonar equipment has greatly improved the recovery rate of drowning victims in various Missouri waterways. It also has enhanced the efforts of the scuba divers of the Missouri State Water Patrol Underwater Recovery Team. Those personnel now can dedicate their limited air and bottom time to potential targets located by the sophisticated equipment. This technology has successfully found victims in large search areas, even in incidents without a witness or when excited individuals did not precisely note the location of the drowning. The use of the side-scan sonar has resulted in the recovery of victims that otherwise may have remained missing without refloating to the surface.

CONCLUSION

Law enforcement agencies deal with thousands of drowning investigations per year. Officers need to be aware of the unique nature of these incidents. Investigators should not assume that an autopsy will establish cause of death; they need to ascertain as much information as possible at the scene. Then, they must provide these important details to the coroner.

The investigator’s role in a drowning investigation is crucial to a medical examiner in establishing an accurate cause of death. The officer must treat a drowning like any other death investigation and help to make sure it is conducted thoroughly and professionally. Then, the investigator can have confidence in the proper determination of cause of death and, if necessary, will be prepared to pursue the investigation further.

“…many police officers, in the marine environment and otherwise, will routinely investigate drowning deaths.

Captain Haupt serves with the Missouri State Water Patrol in Branson.

“The point at which a person dies depends largely on the age of the victim and the temperature of the water….”

“Investigators can look for some distinctive signs to determine cases of drowning.”

“The investigator’s role in a drowning investigation is crucial to a medical examiner in establishing an accurate cause of death.”

An Online Resource

To assist investigators in conducting drowning investigations, the Missouri State Water Patrol offers an easy-to-follow resource. The Supplemental Underwater Recovery Report is available on the agency’s Web site at http://www.mswp.dps.mo.gov/ SuppRecoveryReport.pdf.

Endnotes

1 The author based this approximate figure on his professional experience and research. For additional information, visit the Web sites of the Centers for Disease Control and Prevention, www.cdc.gov; the National Safety Council, www.nsc.org; and the National Transportation Safety Board, www.ntsb.org.

2 Dominick and Vincent DiMaio, Forensic Pathology (Boca Raton, FL: CRC Press, 1983).

3 Ibid.

4 Ibid.

5 Bradley Stafford, “The Sinking and Rising of Drowned Bodies” (unpublished thesis, 1988).

6 Robert Teather, The Underwater Investigator (Fort Collins, CO: Concept Systems, 1983); and Robert Teather, Encyclopedia of Underwater Investigations (Flagstaff, AZ: Best Publishing, 1994).

7 Supra note 5.

8 Supra note 6.

9 Supra note 6.

10 Supra note 6.

11 Charles Swanson, Neil Chamelin, and Leonard Territo, Criminal Investigation (New York, NY: McGraw-Hill, 1996).

12 Bernard Knight, The Coroner’s Autopsy (London, England: Churchill Livingstone, 1983).

13 Supra note 6.

14 Supra note 6.

15 Supra note 6.

16 Supra note 6.

17 Supra note 6.

18 Supra note 11.

19 Supra note 2.

20 Supra note 2.

21 Supra note 6.

Copyright United States. Federal Bureau of Investigation Feb 2006

Fake Drugs, Including Tamiflu, Thrive on Internet

By Laura MacInnis

GENEVA — Criminals are using the Internet to sell increasing quantities of counterfeit medicines, including fake versions of bird flu drug Tamiflu, a senior U.N. health expert said on Tuesday.

Vitamin and health supplements, so-called “lifestyle medications” like erectile dysfunction drugs, and steroids bought over the Internet were especially likely to be false.

Antibiotics, anti-malarials and pain killers were also susceptible to fraud because of the huge demand, while Tamiflu, made by Swiss firm Roche, had also entered the market amid rising avian flu fears.

“Yes, there have been cases reported in counterfeit Tamiflu,” said Howard Zucker, the World Health Organisation’s assistant director general for health technology and pharmaceuticals.

But he declined to give details on the quantity or where the fake drugs had been found.

The WHO has estimated as many as 10 percent of drugs on the world market are mislabeled or fake, with the phoney medicines sometimes causing illness and even death in consumers.

Speaking to reporters after a high-level meeting in Rome, where pharmarceutical industry and health experts agreed to set up a task force to fight the counterfeit drug trade, Zucker said better oversight of online drug sales was essential.

At the meeting, the U.N. health body said it would help set up an international expert group to raise awareness about fake drugs and to improve cooperation between governments, industry groups and international agencies on the issue.

“Counterfeiting medicines should be distinguished from other types of counterfeiting which do not affect human health and should be combated and punished accordingly,” the conference participants said in a statement at the end of their meeting.

Harvey Bale, director general of the International Federation of Pharmaceutical Manufacturers Associations, said fake medicines remain more prevalent in developing countries than in places like Western Europe.

Still, Bale stressed patients in the rich world were increasingly vulnerable to counterfeit drugs distributed online. He said the new task force would look into that growing sector.

“The Internet needs to be addressed, clearly,” he said.

Welcare Hospital, Dubai’s Premier Multi-Specialty Critical Care Private Hospital

Welcare Hospital, Dubai’s premier multi-specialty, critical care private hospital, is committed to being the leading private healthcare provider in the Middle East. The facility began serving the Dubai and broader regional community in 1998 and combines the best of Eastern hospitality and Western expertise to achieve its overriding goal of exceptional customer service and patient care.

Welcare Hospital, a part of Welcare World Health Systems, the healthcare consultancy and management arm of the Varkey Group, achieves this through a commitment to holistic patient care that ensures a concerned and caring bedside manner is observed by all who interact with the patient and evidence-based medicine that means diagnosis and treatment is focused on each patient’s individual symptoms, responses and needs.

From its multipurpose and modern architectural facility, Welcare’s handpicked team of internationally qualified and experienced healthcare professionals offer a complete range of medical and surgical, inpatient and outpatient care using the latest techniques and state-of-the-art technologies and equipment.

The hospital offers international calibre, multi-disciplinary healthcare through more than 24 specialized departments: Anaesthesiology; Cardiology; Cardiac Surgery; Dermatology; Endocrinology / Diabetes; ENT (Ear, Nose and Throat); Gastroenterology / Hepatology; General and Prosthetic Dentistry / Aesthetic Dentistry; General Surgery; Heart Rescue; Nephrology; Neurology; Obstetrics & Gynaecology; Ophthalmology; Orthopaedics; Paediatrics & Neonatology; Pathology / Laboratory; Physiotherapy and Sports Medicine; Plastic, Cosmetic, Re-constructive & Maxillofacial Surgery; Psychiatry & Psychology; Pulmonology; Radiology; Holiday Dialysis, and Urology.

Keeping attuned to the latest treatment options, Welcare has a growing list of specialized services offered by its departments. These include a 13-bed, 24-hour Accident & Emergency Unit, four extensively equipped operating theatres and a purpose built endoscopic suite for carrying out various diagnostic and therapeutic procedures relating to gastroenterological and liver diseases.

The Nephrology (kidney disease) Department offers both Haemo and Peritoneal Dialysis, while the self-contained Maternity Complex consists of four delivery rooms, two high-dependency rooms, a newborn resuscitation room and an operating theatre. The 15-bed Intensive Care Unit treats paediatrics, neonatal and adult patients with facilities for ventilatory management and total physiological monitoring.

The Radiology Department offers the latest MRI, whole body Multi Slice CT Scanning and CT guided aspirations & biopsies, ultrasound with colour Doppler and ultrasound guided procedures, mammography and panoramic dental and digital x-ray services.

The high-tech Laboratory has been designed as a regional referral centre, covering haematology, immunohaematology, serology, hormone assays, immunochemistry, biochemistry and microbiology. All tests are carried out by the most advanced and sophisticated analyzers with the highest degree of accuracy and with a minimal turn-around time.

The Physiotherapy and Sports Medicine Department offers biometric limb, muscle and joint testing, VO2 max, muscle fatigability (lactic acid), short-wave diathermy, ultrasound therapy, electric muscle stimulation, lumbar and cervical traction and a gymnasium for exercise sessions.

The hospital’s special investigation facilities range from echo Doppler studies, lung disease tests and electroencephalogram to urodynamic studies and Lithrotripsy services.

Other specialized services offered at Welcare include chemotherapy, dietary counselling, Holiday Dialysis, home call consultations (specialist and GP), interventional cardiology, Laparoscopic Surgery, laser treatment for eyes, Vitreoretinal surgery and mammography.

The hospital prides itself on its ‘Commitment to Care’ training program that ensures all staff in addition to being highly qualified and experienced in their fields are fully conversant in customer care practices, quality in the delivery of services, patient feedback, consistency of service, courtesy and effective communication. To assure this, they attend internationally recognized five-star customer care training programs.

The Quality Assurance Department helps reinforce the hospital’s ‘Commitment to Care’ and is involved in developing, evaluating and implementing effective quality management systems and overseeing quality improvement initiatives throughout the hospital. The department aims to provide an effective clinical and non-clinical governance framework, one that ensures all practices are monitored and evaluated. In addition, improvement in any adverse performances is instituted through initiatives that are continuously adapted by the staff through careful self regulation and a continual effort on their part to learn and improve.

In order to provide all its patients with the care and service that best fits their needs, Welcare has developed a number of specialized health packages. They include the Executive Health Check- up, the Routine Check-up, the Diabetes Check-up, the Cardiac Check, the Well Woman Health Review, the Well Woman Screening, the Maternity Antenatal Package, the Maternity Delivery Package, the Keep Fit Program, the Well Baby Package (newborn) and the General Baby Health Check-up.

As part of the hospital’s growth and commitment to serving a broad community, the first satellite branch, the Welcare Ambulatory Care Centre, has opened at Dubai Knowledge Village. The facility provides medical services to populations living and working in Jumeirah, Dubai Internet City, Dubai Media City, Dubai Knowledge Village, Jebel Ali, Umm Suqueim and the Gardens area.

The hospital’s sense of service extends far beyond direct medical care and so Welcare has developed a substantial community outreach program. Included in this program are the Cardiac Surgery initiatives and cooperation with Emirates World Heart, various Community Outreach Programs and breast cancer awareness and screening activities during Breast Cancer Awareness Month.

Welcare also serves the broader medical community by hosting twice monthly the Learning Circle, a continuing medical education lecture series. Attended by general practitioners and doctors from hospitals in both the public and private sectors, the Learning Circle brings local Welcare and international experts to talk on a range of topics. The Learning Circles serve as a unique opportunity for international specialists and Welcare practitioners to share their expertise and update peers on latest clinical trends and best practices.

Welcare World Health Systems manages Welcare Hospital, Welcare Ambulatory Care Centre and Emirates Diagnostic Clinic. As well, Welcare World is developing several other facilities and initiatives, both within the UAE and regionally, including the 210- bed City Hospital in Dubai Healthcare City.

Professional Profile of Mr. Vidur Kaushik

Mr. Kaushik has over 28 years experience in some of the best organizations in India like ICI Paints, Vam Organic Chemicals and SRL Ranbaxy. Prior to joining WWHS he was CEO of SRL Ranbaxy-India

Mr. Kaushik has extensive experience in creating, guiding and managing world class business and is an expert in Business Re- engineering, Setting up new ventures, Business turnaround, Creating & managing brand equity in developed markets and developing & managing anarchic developing markets.

He has the credit of taking over SRL Ranbaxy and creating South East Largest Medical Laboratory Reference Lab system , servicing over 360 towns in India, the UAE and UK; in addition, for SRL, he also guided and created a World Class Clinical Trials business, which includes a 80 bed Clinical Pharmacology unit and phase 1 to phase 4, study capability for pharmaceutical companies.

SRL besides being a highly profitable institution meets all international Quality bench marks equivalent to the Mayo Clinic or Quest Labs, USA. He had similarly turned around a loss making adhesive business (Jubilant Organysis Limited) into a profitable division. Prior to this he spent over 17 years with ICI, and managed their paints business in India, with secondments to the UK, Australia and South East Asia.

Academically he possesses a Masters degree in English Literature from University of Delhi and has attended training programs at Cranfield School of Management and various workshops in France, Australia, Hong-Kong, Sri-Lanka and India. While at ICI he was also responsible for outlining and creating a uniform Marketing Planning/ Strategy process for Paints Business, used Internationally.

Mr Kaushik, during his university, was a freelance broadcaster, a commentator for cricket, hockey, football and badminton at National and Test level matches. He also read the news, was a DJ, did special features and has interviewed prominent national and international personalities including Prime Ministers. His other interests are golf, squash, trekking, cooking, music and writing.

2006 Al Bawaba (www.albawaba.com)

Cambodia: 14 Diseases Caused By Rubbish, Collectors at Risk

Cambodia: 14 diseases caused by rubbish, collectors at risk

PHNOM PENH, Feb. 20 (Xinhua) — According to a survey, there are 14 types of diseases in Cambodia caused by exposure to waste, and the most severely infected people are scrap collectors.

Therefore, those who are unsanitary and have been living in a dirty environment are vulnerable to infection, Development Weekly reported on Monday.

According to a survey on Cambodian scrap collectors in 1998 and Vietnamese scrap collectors in 2000, Cambodian scrap collectors were mainly affected with 14 ailments, including fevers, coughing, headaches, body pain, malaria, various epidemic diseases, heart problems, brain diseases and diarrhoea. The researcher stressed that not only the scrap collectors are infected with the diseases, but also unsanitary people.

Burning waste releases poisons in the air, while carelessly dumping waste could cause poisonous substances to flow into water sources, the professor stated.

Akron Baptist Temple Pastor Will Step Down: Dallas R. Billington Heeds Calling

By Jim Carney, The Akron Beacon Journal, Ohio

Feb. 21–The Rev. Dallas R. Billington has announced his resignation as senior pastor of the Akron Baptist Temple.

Billington, 48, the third generation of Billingtons to lead the historic church at 2324 Manchester Road, will remain on the job for the next six to nine months, until a minister is chosen to replace him.

“I love my family and my church with all my heart,” he said. “It’s truly been a privilege to be part of this ministry and the Akron Baptist Temple.”

Just as he felt a call when he took over the church from his father, Charles Billington, a decade ago, he said he felt a calling from God that the time had come to move to a new chapter in his ministry.

He said he is taking a giant leap of faith in leaving.

“The Bible says without faith, it is impossible to please him,” Billington said.

Billington said he and his family may move to Southern Florida or Southern California.

He said he is considering teaching at a Christian college, working as a church consultant with pastors and their families, or going to another church as pastor.

Billington served 10 years at three churches in the Naples, Fla., area before moving back to Akron in 1994. He took over as senior pastor of the Akron church in March 1996.

The church was founded in 1934 by his grandfather, Dallas F. Billington, who died in 1972.

Charles Billington, 78, took over when his father died and was senior pastor until 1996, when his son took over.

Founder Dallas F. Billington had moved to Akron from Kentucky in 1925 to work at Goodyear, founding the church nine years later.

The first service was held at Akron’s Rimer School, with only 14 people in attendance.

At its peak in the late 1960s, the church had 7,000 active members. At one time, the church said it had the world’s largest Sunday school.

In 1981, a new $4.2 million, 4,000-seat sanctuary was destroyed by fire. Three years later, a new $8 million building was dedicated.

Dallas R. Billington said that when he took over in 1996, the church was $6 million in debt, and one of his goals was to see that its finances were in order.

By the end of the year, he said, he hoped the church debt would be less than $1 million.

During his time as pastor, the church has added a contemporary service to the traditional service, a program of small group study for members and a food and clothing ministry that has provided some 2,000 school backpacks to youngsters.

His leaving, he said, is good news in that he believes the church will continue to grow.

“This is the first time in 72 years the church has had to go through this,” Billington said.

“I love this church and the last thing I want to do is hurt it. It is the Great Lighthouse on Manchester Road and it will continue to be.”

In making his announcement at Sunday’s services, Billington closed with this statement:

“I never have desired my name to appear on the front of the church, because it was my conviction that God alone is the Chief Shepherd,” he said. “It’s appropriate to close with the Scripture that is on the front of the church: As Jesus said, `I will build my church and the gates of hell shall not prevail against it.’ “

Jim Carney can be reached at 330-996-3576 or [email protected]

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Copyright (c) 2006, The Akron Beacon Journal, Ohio

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected].

West Palm Beach, Fla., Doctor Admits to Illegally Distributing Oxycontin

By John Coté, South Florida Sun-Sentinel

Feb. 19–A West Palm Beach pain management doctor pleaded guilty Friday to federal charges of illegally distributing the painkiller Oxycontin.

Federal prosecutors accused Dr. Andrew D. Weiss of getting at least $200,000 in kickbacks for illegally prescribing 36,600 painkiller pills — including Oxycontin, Percocet and hydrocodone — to people who weren’t patients from 2001 to 2004.

Weiss, 45, of Boca Raton, faces up to 20 years in prison on each charge after pleading guilty to four counts of illegally distributing a controlled substance.

Defense attorney Richard Lubin declined to comment on details surrounding the plea, saying: “There are mitigating factors that will be presented to the court both prior to and at the time of sentencing.”

U.S. District Court Judge Daniel T.K. Hurley has not set a sentencing date. Under terms of the plea deal, Weiss must forfeit $200,000. The remaining 37 counts against him will be dropped.

Weiss operated the St. Lucie Pain Center and a West Palm Beach clinic called Pain Management of the Palm Beaches, according to prosecutors.

Weiss acknowledged in court that he prescribed pills to non-patients, including the roommate and girlfriend of one of his patients, Brian Wojtusik.

Wojtusik was sentenced to about 16 years in prison in the case, pleading guilty to multiple felonies after federal agents found more than 3,000 vacuum-sealed pills in a hidden compartment in his car, Assistant U.S. Attorney Stephen Carlton said in court.

Wojtusik was prepared to testify he became friends with Weiss via a mutual interest in Rachel’s Adult Entertainment and Steakhouse in West Palm Beach, and eventually asked him to provide prescriptions for money, Carlton said.

Wojtusik also would testify that he shipped Oxycontin obtained from Weiss to Marc Wells in Vermont, where it was sold illegally on the street. Wells pleaded guilty in January to abetting the illegal distribution of the drug as well as using a facility of interstate commerce to illegally distribute Oxycodone.

“The source turned out to be Dr. Andrew Weiss,” Carlton said outside court. “I think it’s unusual that the government finds the end source. This is a rare example of that.”

Weiss’ medical license is under emergency suspension, state records show.

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Copyright (c) 2006, South Florida Sun-Sentinel

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected].

Most teenage boys with cancer can bank sperm

NEW YORK — Sperm banking is possible for most teens with cancer who must undergo fertility-impairing treatment, British researchers report.

Several types of chemotherapy can damage the sperm-producing portion of the testes, while radiation of the testicular area can also lead to infertility, For this reason, infertility is very common among male survivors of childhood cancer.

Freezing sperm obtained by masturbation is the most widely available method for fertility preservation, and patients as young as 13 are capable of producing semen samples with normal sperm counts, report Dr. Guy Makin of the University of Manchester and colleagues in the journal, Archives of Disease in Childhood.

A 2002 study found 77 percent of childless male cancer patients aged 14 to 40 said they would like to father children in the future, they note. But the same investigation found just half of these patients had been given the option of banking sperm, and less than a quarter had done so successfully.

To investigate what obstacles exist to sperm banking among these patients, the researchers surveyed 55 males aged 13 to 21 at their cancer diagnosis who had undergone potentially infertility-producing treatment and had been offered the option of banking their sperm.

Of the forty-five who completed the questionnaire, 67 percent had banked their sperm successfully. Three of the 15 who did not bank their sperm were too sick to do so, while one patient had not reached puberty.

The remaining men who were unable to obtain a sperm sample were younger than the men who succeeded in doing so (15.3 years vs. 17.8 years). They also showed higher levels of anxiety, more difficulty in discussing fertility, and tended to be less knowledgeable about sperm banking.

The findings suggest that giving these patients better-quality information on sperm banking, as well as training medical professionals to discuss this issue with patients, could help more young patients bank their sperm, the researchers conclude.

SOURCE: Archives of Diseases in Childhood, February 2006.

Rebirth, fear on ruined Ethiopia-Eritrea frontier

By C. Bryson Hull

ZALAMBESSA, Ethiopia (Reuters) – It’s hard to tell which
stones are the rubble of war and which are the ingredients of
reconstruction in the frontier town of Zalambessa.

In 1998, Eritrea’s soldiers invaded and destroyed this town
on the disputed border with Ethiopia at the start of a two-year
war in which 70,000 people were killed.

Now, six years after a peace pact, Zalambessa’s 12,000
people are rebuilding, stone by stone. But the hope that drives
them is tainted by fear of another war and memories of pain.

“We have to survive with what we have now, and we are
feeling the threat of war,” businessman Hailu Zerafa, 70, said.

When he came back two years ago, his grinding mill, grain
store and bar had been destroyed and all the hardware had been
carted to Eritrea. His wife had returned from an Eritrean jail
but, weakened by sickness, she died months later. “The
Eritreans took all of my property, including my wife. They
didn’t even leave a nail. Now I have nothing — zero and zero,”
he said.

Hailu, and people like him, are now rebuilding their homes
and businesses, in the shadow of a military standoff playing
out just yards from the town’s main street.

Separated by a dusty bowl less than 1.2 miles wide,
Ethiopian soldiers at the edge of Zalambessa stare warily
across at their Eritrean enemies. These men are at the sharp
end of one of the Horn of Africa’s most intractable political
conflicts.

Even though both countries signed a deal in 2000 to end the
war and accept an independent commission’s decision on where
the border should be, the invisible line remains just that –
unseen, unmarked and unresolved.

‘BEST OF FRIENDS’

For the people of Zalambessa, the border should exist in
the mind only. It is nothing neighbors, relatives and trading
partners need to map out with soldiers and fences.

“Eritrea was the best of friends before … The people of
the two countries know their borders. Why should a foreigner
come and tell us where our border is?” hotel owner Hadas
Teklemaimanot said.

When the boundary commission issued a final, binding ruling
in 2002 that favored Eritrea’s claims, Ethiopia balked.

Prime Minister Meles Zenawi has since said Ethiopia accepts
the ruling but wants to negotiate with Eritrea on the mechanics
of marking a border that will change some people’s nationality.

For a model, Meles points to an analogous situation between
Nigeria and Cameroon, where demarcation has begun amid
discussions, even though Nigeria did not like the decision.

Eritrea says a deal is a deal and is angry that world
powers have not forced Ethiopia’s hand. The standoff has grown
worse over the past year, as rhetoric flowed and troops were
moved closer to the border, but then withdrawn.

For Zalambessa, war would undo more than a year of
rebuilding and scupper hopes of a rebirth of the trade that
once flourished on the twisting road to Eritrea’s capital
Asmara.

‘DO YOU SEE ANYBODY?’

Zalambessa lies 7,900 feet up in the otherworldly grandeur
of the northern arid highlands, a land of plunging valleys and
thrusting peaks hued in khaki and soft red.

Cacti and bits of scrub are the only dabs of green under an
expansive sky. The mountain cool belies the strength of the sun
which may have led ancient Greeks to dub the country “Land of
Burned Faces,” giving rise to the name Ethiopia.

Entering Zalambessa, the main road becomes a boulevard —
the first sign of renewal among piles of rubble and walls
shattered by artillery shells and Eritrean bulldozers.

Red and pink flowers adorn the concrete island bisecting
the street. The blooms are ringed with barbed wire to stop cows
and people from trampling the town’s brightest flash of color.

Hadas’ hotel, which once drew passing traders, is typical
of the rebuilding — its new facade is mated to the ruins of
its old walls by a smear of smoothed concrete.

Inside, there are a dozen chairs, four tables, seven
bottles of liquor and a faded poster of an Indian film. The
60-year-old owner apologizes profusely because she cannot offer
food.

“Do you think this is a place of business? Do you see
anybody?” she said, sweeping her arm around the room.

Buying power is gone. All the seed money for reconstruction
provided by the World Bank — 54 million birr ($6.21 million)
in all — went into bringing Zalambessa back up to par.

Without cross-border trade, there will be little chance for
the economies of Zalambessa or its sister city of Senafe, 22
miles into Eritrea.

“If the border is open, Zalambessa would be back to its
normal position,” Hailu said.

Right now, that position is a defensive one.

The hill the Ethiopian troops command, which was used as an
artillery position by the Eritreans as they demolished the
town, sits above dozens of new homes with shiny tin roofs.

Army Major Mebratu Hailu said he hopes his troops will not
have to fire a single bullet and that talks will take place.

But if Eritrea attacks, Ethiopia will not be caught by
surprise again, said the infantry commander who fought in the
2000 counterattack that routed the Eritreans from Zalambessa.

“The next war will be final. This is Meles’ position. There
will be no third war with Eritrea. The only option is to settle
the border problem through dialogue,” he said, looking across
the gully, beyond the invisible line.

Most of Talstar’s Ingredients Toxic

By The Bugman RICHARD FAGERLUND For the Journal

Q: The pest control company that routinely sprays our house is using something called Talstar. When I asked the fellow if it was safe, he said I could drink it. That seems a bit far-fetched to me. Is Talstar safe enough to drink? — S.M., Santa Fe

A: Offer the fellow a glass the next time he comes by. Just kidding. The active ingredient in Talstar is bifenthrin, which is a mild pesticide as pesticides go. However, Talstar contains a number of inert ingredients that are not as safe, including xylene; butanol; ethylbenzene; cumene; 1,2,4-trimethylbenzene; and a few others. High doses of xylene have produced negative effects in the liver, kidney, heart and adrenals of laboratory animals.

Ethylbenzene is moderately toxic by ingestion and mildly toxic by inhalation and skin contact. It is irritating to the eyes, skin and mucous membranes. In high concentrations, ethylbenzene may cause stupor and coma.

Butanol is moderately toxic by ingestion, irritating to skin and severely irritating to eyes. Prolonged exposure may cause headache, dizziness, drowsiness and nausea. Longterm overexposure may cause some loss of hearing.

Cumene is moderately toxic by ingestion or inhalation. It is a central nervous system depressant, with potent narcotic effects of long duration. 1,2,4-Trimethylbenzene is moderately toxic by ingestion or inhalation. The toxicity by skin exposure is moderate to low. It can cause central nervous system depression, anemia and bronchitis.

These aren’t chemicals I would allow around my children or pets.

Also, there is no reason to spray anything at this time of year as there is limited insect activity. You can spray around the house yourself in the spring using diatomaceous earth (natural grade) mixed with water. When the water evaporates out, it will leave a film of diatomaceous earth that will kill any insects that walk across it but won’t hurt your family or pets. Diatomaceous earth is more effective and lasts longer than most commercial pesticides that contain all those so-called inert ingredients that can be more dangerous than the active ingredients.

Q: We are having ants already and it is still winter. I have a baby and don’t want to use pesticides. Do you have any suggestions or recommendations of pest control companies that are not quick to spray chemicals? — J.L., Albuquerque

A: You are correct in being concerned about using pesticides around your child. Children, particularly babies, spend a lot of time on the floor and can come in contact with pesticides and they often put things in their mouths. Children also breathe differently than adults. A 1-year-old child will breath 50 percent more air each minute relative to body weight than adults do. This, of course, gives them the opportunity to inhale more pesticides. Pesticides should never be used where children crawl around — in homes, in day care centers, or in schools.

You will have to determine what kind of ants you have to put in effect a workable control program. Once you know the type of ants, you can use the proper ant repellents and baits to eliminate them. You may try vinegar, cayenne pepper, citric extracts, cinnamon and even perfume.

Several baits that work are boric acid and yeast. Mix a tablespoon of boric acid with 6 ounces of peanut butter and jelly or wet cat food or mayonnaise or whatever the ants are feeding on. You can also mix 1 part dry yeast with 2 parts molasses and 1 part sugar. If you prefer to use a pest control operator, I can help you find one that is environmentally friendly.

Richard Fagerlund is an entomologist. You can contact him by e- mail at

[email protected]; by cell

phone at (505) 553-6660 or at his

home address, P.O. Box 1173 Corrales, NM 87408. His Web site is

www.askthebugman.com.

Developing the Respect and Support of School Administrators

By Oberg, Dianne

GAINING THE RESPECT AND SUPPORT OF SCHOOL ADMINISTRATORS IS THE NUMBER ONE CHALLENGE FACING SCHOOL LIBRARY PROFESSIONALS IN THE 21ST CENTURY (ISHIZUKA, MINKEL, & ST. LIFER, 2002). THE SCHOOL LIBRARY LITERATURE FROM ITS EARLIEST YEARS CONTAINS DISCUSSIONS OF THE ROLE OF THE PRINCIPAL IN SCHOOL LIBRARY PROGRAMS, OFTEN CENTERING ON THE NOTION OF PRINCIPAL SUPPORT. “THE PRINCIPAL’S SUPPORT OF THE LIBRARY AS A VITAL PART OF THE EDUCATIONAL SYSTEM IS EXTREMELY IMPORTANT,” WINIFRED B. LINDERMAN WROTE IN AN ARTICLE ENTITLED “WHAT SHOULD THE SCHOOL LIBRARIAN EXPECT OF THE SCHOOL PRINCIPAL?” IN THE DECEMBER 1944 ISSUE OF THE SCHOOL REVIEW (P. 614). THIS QUOTE, FROM 60 YEARS AGO, COULD EASILY HAVE COME FROM A MUCH MORE RECENT SOURCE.

WHY PRINCIPAL SUPPORT MIGHT BE LACKING

Principals have a critical role in the implementation of change in schools. The educational change research (see, e.g., Fullan, 1991, 1993) and the effective schools research (see, e.g., Rosenholtz, 1985, 1989) have helped us to understand the contributions of the principal in terms of vision building, evolutionary planning, empowering others, resource mobilization, and problem coping and monitoring. Effective principals are collaborative leaders who use these strategies to facilitate the transformation of school culture. Research in the school library field has shown that although teacher-librarians generally view principal support as being critical to the success of the library program (Haycock, 1995), they often have low expectations of principal support (J. M. Campbell, 1991) and rarely engage in the kind of activities that would increase their principals’ understanding and support (Edwards, 1989).

TABLE 1

Principals and School Libraries: Research Findings

A growing body of research from around the world centers on what principal respect and support involve (see Table 1). However, not surprisingly, not all principals respect and support the school library programs or teacherlibrarians. In the worst-case scenario, the principal believes that libraries are basically warehouses, that teacherlibrarians are fussy introverts whose most important role is selecting and circulating materials, and that teacherlibrarians are not leaders or proactive educators but service providers who merely respond to teacher or student requests.

Hartzell (2002) suggests some of the reasons that may underly the worst-case scenario. He points out that when information is limited, people tend to rely on stereotypes to make judgments. Teacherlibrarians suffer from occupational invisibility, and the occupational socialization of principals rarely focuses on libraries or teacher-librarians. Teacher-librarians tend to be invisible because the nature of their work involves empowering others, and building relationships with other educators-including the principal- is limited by their physical isolation in the library and by scheduling.

Teacher-librarians also tend to be invisible because of their low profile in the educational literature. Principals often had limited exposure to the role of the teacherlibrarians when they were students in school and when they were classroom teachers. Few had opportunity to learn about the role of the teacher-librarian in their education as teachers or as administrators. Additionally, media images rarely add positively to their perceptions of teacher- librarians or librarians in general.

Teacher-librarians’ occupational invisibility is exacerbated by the low levels of librarianship education within the profession. When some members of a professional group lack appropriate professional education, their potential clientele are unsure about what to expect in expertise and quality of service, and the image and status of the whole group suffer from this uncertainty.

However, many teacher-librarians are visible leaders in their schools, and many principals are supportive of the work of their teacher-librarians; we can learn a great deal from those principals and their teacher-librarians. My own understanding of what is involved in gaining the respect and support of principals comes from over a decade of work as a teacher-librarian in three schools as well as from the research done by myself and others. Since the 1980s, I have been analyzing the professional literature and research literature dealing with the concept of principal support (see, e.g., Oberg, 1995).

With a colleague from the field of educational administration, I have conducted research, through interviewing principals, teacher- librarians, and district leaders in a district with exemplary school library programs, on how school culture facilitates school library programs (LaRocque ft Oberg, 1991). Our case study of two teacher- librarians’ establishing library programs in schools where the programs were new to them as well as teachers and principals expanded my understanding of the role of the principal in supporting the school library program and that of the teacher-librarian in gaining the respect and support of the principal (Oberg Et LaRocque, 1992). Most recently, 1 was part of an international survey on the role of principals in supporting school library programs (Henri, Hay, & Oberg, 2002). Drawing on this research, 1 explore three questions:

* How does the principal support the school library?

* What do principals believe about the teacher-librarian and the school library program?

* How can teacher-librarians develop principal respect and support?

HOW DOES THE PRINCIPAL SUPPORT THE SCHOOL LIBRARY?

The research involving principals who support the school library program and the teacher-librarian indicates that principal support occurs through four key roles of the principal: that as a supervisor working directly with teachers, that as a model demonstrating personal commitment, that as a manager enabling the program, and that as a mentor providing visibility and importance. The first three roles focus on the principal’s support for the school library program and the fourth, on the principal’s support for the teacher- librarian.

As supervisors working directly with teachers, supportive principals outlined expectations for library use and provided professional development for teachers. These principals made it clear that teachers were expected to be involved in the school library program on an ongoing basis. For example, principals required that evidence of collaboratively planned projects be provided as part of the teachers’ annual performance reviews (LaRocque ft Oberg, 1991). Principals encouraged teachers’ professional development in relation to the school library program by providing inservice education and by providing time for discussions related to the program in staff meetings.

As models demonstrating personal commitment, supportive principals explicitly expressed their understanding of the value of the school library program, and they were visible in the library. These principals conveyed the importance of the library program to teachers (Mandrusiak, 1993). They also interpreted the role of the school library program to students and parents and to district- level personnel and other principals (LaRocque ft Oberg, 1991). They demonstrated an understanding of the value of information literacy and encouraged teachers to embrace it (Hay ft Henri, 1995). Principals who also taught in the classroom modeled their commitment by using the program in their teaching.

As managers enabling the program, supportive principals created the school context and structures within which the principal, the teachers, and the teacherlibrarian could work collaboratively (Nasedkin, 1989). These principals ensured the provision of adequate budgets for materials and information technology. They arranged for the flexible scheduling that allowed collaborative work between teachers and teacher-librarians (Hay & Henri, 1995). In addition to providing flexible schedules for the teacher-librarians, principals built into school schedules common planning times for teachers at the same grade or level. Some principals used their administrative time to release teachers from their classrooms for planning, and others used discretionary funds to hire substitute teachers or provide additional clerical support in the library (Oberg, 1997). Principals ensured that the school library program was integrated into the planning and evaluating structures of the school.

As mentors providing visibility and importance for the teacher- librarians, supportive principals spoke highly of the teacher- librarians in their schools and gave clear evidence that they trusted the teacher-librarians’ knowledge and expertise. They made time for meetings with the teacher-librarians and encouraged their personal and professional development. Principals also provided resources to teacher-librarians to allow release from teaching to undertake professional development (Hay a Henri, 1995; Oberg, 1997).

In both the professional and the research literature, the role of the principal in supporting the school library program is often referred to as simply “principal support.” An analysis of the complex relationships between principals and school librarians has demonstrated that principal support involves at least four kinds of principal actions or role categories. Only one of these roles involves what is often seen as the core of principal support, whic\h is that of ensuring collaborative planning time and providing funding for program resources.

WHAT DO PRINCIPALS BELIEVE ABOUT THE TEACHER-LIBRARIAN AND THE SCHOOL LIBRARY PROGRAM?

The research involving principals who support the school library program and the teacher-librarian indicates that these principals have positive perceptions about the contributions of the program and those of the teacher-librarian to teaching and learning in their schools. For example, principals in Alberta, Canada, who had teacher- librarians working half-time or more in their schools stated that teacher-librarians improved the quality of teaching and learning through in-servicing staff, cooperative planning and teaching, and collection development. The principals believed that teacher- librarians had valuable expertise and should inform their principals about issues affecting the potential of the library. The principals also believed that teacherlibrarians should be key players in the school’s information literacy programs and that an important part of the teacherlibrarian’s role in the school was providing appropriate in-servicing to the teaching staff. The strengths of their libraries, according to these Alberta principals, were the qualified and cooperative staff, the resources and equipment, and the focus on learning and curriculum.

These findings are consistent with those of studies in other parts of the world. Principals interviewed in an Australian study (Hay ft Henri, 1995) expected their teacher-librarians to have a vision of the future development of the library’s program and services and to have or develop the skills needed to be leaders in the school. They were prepared to support teacherlibrarians as senior members of staff as long as the teacher-librarians met those expectations. Principals in a U.S. study (J. M. Campbell, 1991) reported that their major source of information about library programs was that of their teacher-librarians; that is, teacher- librarians provided professional development for principals as part of routine communications with principals.

HOW CAN TEACHER-LIBRARIANS GAIN PRINCIPAL RESPECT AND SUPPORT?

Teacher-librarians gain the respect and support of their principals in three key ways: by building their professional credibility, by communicating effectively with principals, and by working to advance school goals.

Teacher-librarians must build their credibility as experts in the field of teacherlibrarianship as school leaders and as agents or catalysts of change. According to Alberta principals (Hay, Henri, et Oberg, 1998), being experts in teacher-librarianship means having qualifications in both education and librarianship. Teacher- librarians should have the same level of education as the other leaders in their schools; in most schools and school districts, school leaders are expected to have master’s degrees. Expertise in librarianship brings to teaching and learning the core values of librarianship (including freedom of information and the right to privacy) as well as the practical knowledge required to deal with issues such as censorship, cultural diversity, and Internet filtering.

By contributing as school leaders to schoolwide initiatives and concerns, teacher-librarians build their credibility as educators and increase the willingness of others to work with them (Lance, 2001). When asked to list the tasks that the teacher-librarian does that are critical to the quality of teaching and learning, both principals and teacher-librarians identified those of in-servicing staff (Oberg, 1997), cooperative planning and teaching, and collection development. The teacher-librarians put the strongest emphasis on the cooperative planning and teaching role, whereas the principals put the strongest emphasis on the in-servicing role.

Time and money alone are not sufficient for meaningful change. Principals and teacher-librarians need to have a shared view of the potential of the school library program as one that reaches beyond the library and into the teaching and learning of the whole school. Together principals and teacher-librarians need to develop a deep and rich understanding of resourcebased and inquiry-based learning that will allow them to link these changes to restructuring efforts focused on improving opportunities for student learning. This may mean discussing the implication of research, such as studies showing that integrated resource-based instruction is the most effective means of acquiring information skills (Hara, 1997) and that it leads to improved levels of content knowledge (Todd, 1995).

Teacher-librarians must communicate effectively with their principals. Teacherlibrarians need to begin by enhancing their principals’ knowledge of the school library program and the role of the teacher-librarian. This includes clearly explaining the goals of the school library program and the teacherlibrarian. Some studies have found that principals seemed uncertain about how to evaluate the success of library and information literacy programs (Hay ft Henri, 1995; Wilson, Blake, Et Lyders, 1993). However, where district, state, or provincial guidelines were made available to them, principals reported feeling confident in evaluating their teacher-librarian and the library program (Dekker, 1989; Wilson, Blake, ft Lyders, 1993). Teacher-librarians also need to clearly explain their professional needs, in terms of both mentoring and professional development.

Teacher-librarians must work to advance school goals. Teacher- librarians should begin by knowing and promoting with others their principal’s views of school goals. The principal needs to be able to see the teacher-librarian as an ally, not as someone with an endless list of demands and complaints. The teacher-librarian needs to be able to share the principal’s worldview (or find another, more compatible assignment). Teacher-librarians should help their principals see the strong connection between library program goals and school goals, that a close alignment between the principal’s vision and the teacher-librarian’s vision is of benefit to both of them (Oberg, 2000). Principals have valuable resources to share with teacher-librarians; teacher-librarians need to be clear that they have valuable resources to share with principals. Together, the teacher-librarian and the principal can form a strong team.

Finally, teacher-librarians need to be patient and understanding of the evolution of the school library program. Gaining principal support can be a difficult task and may take several years of effort based on a planned approach and taking advantage of the opportunities that occur. With each new school assignment, teacher- librarians have to begin anew the work of communicating with the principal about their role and the school library program. Hartzell (2002) put it this way: “The only way to change principal perceptions is to assault them directly, repeatedly, and from a multiplicity of directions. Reshaping perceptions takes time and effort and commitment” (p. 106).

WORKING TOGETHER AS A TEAM

Research has shown that the principal is the key factor in the development of the collaborative school culture that is needed for a strong school library program. The principal gives support for the program and for those working to build the program. The principal provides opportunities for teachers to work and learn together. A foundation activity for any school is working together to decide on a vision for the school, a vision that clearly describes what it is that students are to learn and how they are to show what they have learned. This requires active leadership from the principal.

The expertise of teacher-librarians in information literacy, collaboration, and program design and implementation can provide a valuable contribution to teaching and learning. For example, teacher- librarians often begin their work in a school by analyzing the changes that will be needed in the ways that educators have traditionally organized and thought about teaching and learning. Teacher-librarians understand that teachers work from different philosophical bases or platforms, something that complicates the task of collaboration. They often initiate an explicit sharing and examination of these differing platforms. They are experienced in working with teachers to develop learning activities for students, and they are accustomed to working with others to develop schoolwide approaches-this requires active leadership from the teacher- librarian.

The active leadership of the principal and teacher-librarian team is facilitated by district support for collaboration. The support provided by school district administrators, school trustees, and district policy and administrative structures has been shown to be important in enabling principals and teacher-librarians to work together. This teamwork also appears to be much less difficult where teacher-librarians have access to a strong and active teacher- librarian network that is committed to ongoing professional education and mentoring as well as advocacy and policy development. Teacherlibrarians need to be aware of and utilize professional networks throughout their professional lives; certainly, most principals are aware of and utilize their own professional networks. As has been pointed out (see, e.g., Haycock, 1992; Strachan, 1995), principals and teacher-librarians have a lot in common and a great deal to gain by working together.

Feature articles in TL are blind refereed by members of the advisory board. This article was submitted September 2003 and updated and accepted October 2005.

TEACHER-LIBRARIANS SUFFER FROM OCCUPATIONAL INVISIBILITY, AND THE OCCUPATIONAL SOCIALIZATION OF PRINCIPALS RARELY FOCUSES ON LIBRARIES OR TEACHER-LIBRARIANS.

AS MENTORS PROVIDING VISIBILITY AND IMPORTANCE FOR THE TEACHER- LIBRARIANS, SUPPORTIVE PRINCIPALS SPOKE HIGHLY OF THE TEACHER- LIBRARIANS IN THEIR SCHOOLS AND GAVECLEAR EVIDENCE THAT THEY TRUSTED THE TEACHER-LIBRARIANS’ KNOWLEDGE AND EXPERTISE.

TEACHER-LIBRARIANS MUST WORK TO ADVANCE SCHOOL GOALS. TEACHER- LIBRARIANS SHOULD BEGIN BY KNOWING AND PROMOTING WITH OTHERS THEIR PRINCIPAL’S VIEWS OF SCHOOL GOALS. THE PRINCIPAL NEEDS TO BE ABLE TO see THE TEACHER-LIBRARIAN AS AN ALLY, NOT AS SOMEONE WITH AN ENDLESS LIST OF DEMANDS AND COMPLAINTS.

REFERENCES

Baldwin, M. K. (1996). Enhancing learning through library and information services in K-12 education: A future search conference (Doctoral dissertation, Seattle University, 1995). Dissertation Abstracts International, 56(08), 2918A.

Campbell, B. S. (1995). High school principal roles and implementation themes for mainstreaming information literacy instruction (Doctoral dissertation, University of Connecticut, 1994). Dissertation Abstracts International, 56(03), 770A.

Campbell, J. M. (1991). Principal school library media relations as perceived by selected North Carolina elementary principals and school library media specialists (Doctoral dissertation, University of North Carolina, 1991). Dissertation Abstracts International, 52, 2336A.

Charter, J. B. (1982). case study profiles of six exemplary public high school library media programs (Doctoral dissertation, Florida State University, 1982). Dissertation Abstracts International, 43, 293A-294A.

Corr, G. P. (1979). Factors that affect the school library media specialist’s involvement in curriculum planning and implementation in small high schools in Oregon (Doctoral dissertation, University of Oregon, 1979). Dissertation Abstracts International, 40, 2955A.

Dekker, B. (1989). Principals and teacherlibrarians-Their roles and attitudes regarding school libraries: Results of a survey of elementary schools in Ontario. School Libraries in Canada, 70(2), 32- 37.

Dorrell, L D., & Lawson, L. (1995). What are the school principals’ perceptions of the school library media specialists? NASSP Bulletin, 79(573), 72-80.

Edwards, K. K. (1989). Principals’ perceptions of librarians: A survey. School Library Journal, 34(S), 28-31.

Farwell, S. M. (1999). Profile of planning: A study of a three- year project on the implementation of collaborative library media programs (Doctoral dissertation, Florida International University, 1998). Dissertation Abstracts International, 59(11), 4042A.

Fullan, M. (1991). The new meaning of educational change. Toronto: OISE Press.

Fullan, M. (1993). Change forces! Probing the depths of educational reform. London: Palmer Press.

Gehlken, V. S. (1995). The role of the high school library media program in three nationally recognized South Carolina Blue Ribbon secondary schools (Doctoral dissertation, University of South Carolina, 1994). Dissertation Abstracts International, 55(11), 3338A.

Hara, K. (1997). A study of information skills instruction in elementary school: Effectiveness and teachers’ attitudes (Doctoral dissertation. University of Toronto, 1996). Dissertation Abstracts International, 57, 3376A.

Hartzell, G. (2002). The principal’s perceptions of school libraries and teacher-librarians. School Libraries Worldwide, 8(1), 92-110.

Hauck, P., & Schieman, E. (1985). The role of the teacher- librarian in Alberta schools. Calgary, AB: University of Calgary. (ERIC Documentation Reproduction Service No. ED262788)

Hay, L, & Henri, J. (1995). Leadership for collaboration: Making vision work. Paper presented at 61st International Federation of Library Associations Conference, Istanbul, Turkey. Retrieved August 11, 2003, from www.ifla.org/IV/ifla61/61-hayl.htm

Hay, L., Henri, J., O Oberg, D. (1998). The principal’s role in developing information literacy: Findings from Australia and Canada. In S. Shoham & M. Yitzhaki (Eds.), Education for all: Culture, reading and information-Selected papers of the 27th International Conference of the International Association of School Librarianship (pp. 36-80). Seattle, WA: International Association of School Librarianship.

Haycock, K. (1992). Career alternatives: The teacher-librarian as school principal-? natural progression. Emergency Librarian, 19(5), 21-22.

Haycock, K. (1995). Research in teacherlibrarianship and the institutionalization of change. School Library Media Quarterly, 23, 227-233.

Hellene, D. L. 1. (1974). The relationships of the behaviors of principals in the state of Washington to the development of school library/media programs (Doctoral dissertation, University of Washington, 1973). Dissertation Abstracts International, 34, 3835A.

Henri, J., Hay, L., & Oberg, D. (2002). An international study on principal influence and information services in schools: Synergy in themes and methods. School Libraries Worldwide, 8(1), 49-70.

Ishizuka, K., Minkel, W., & St. Lifer, E. (2002). Biggest challenges for 2002. School Library Journal, 48(1), 50-53.

Kolencik, P. L. (2001). Principals and teacher-librarians: Building collaborative partnerships in the learning community (Doctoral dissertation, University of Pittsburgh, 2001). Dissertation Abstracts International, 62(05), 1784A.

Lance, K. C. (2001). Proof of the power: Quality library media programs affect academic achievement. Multimedia Schools, 8(4), 14- 20.

LaRocque, L, & Oberg, D. (1991). The principal’s role in a successful library program. Canadian School Executive, 77(4), 27- 30.

Linderman, W. B. (1944). What should the school librarian expect of the school principal? School Review, 611 -617.

Mandrusiak, S. J. (1993). The role of the teacher-librarian as an informal instructional leader in addressing program continuity. Unpublished master’s project, University of Alberta, Edmonton, Canada.

Nasedkin, S. (1989). The teacher-librarian/ principal partnership in operating an effective school library program. Unpublished master’s thesis, University of Alberta, Edmonton, Canada.

Oberg, D. (1995). Principal support-What does it mean to teacher- librarians? In Sustaining the vision: A selection of conference papers from the 24th Annual Conference of the International Association of School Librarianship (pp. 17-25). Kalamazoo, Ml: International Association of School Librarianship.

Oberg, D. (1997). The principal’s role in empowering collaboration between teacher-librarians and teachers: Research findings. Scon, 76(3), 6-8.

Oberg, D. (2000). Educating your principal: Lessons from research. Teacher-Librarian Today, 6(2), 24-28.

Oberg, D., & LaRocque, L. (1992). Learning to be a teacher- librarian: A play without a script. Alberta Learning Resources Journal, 77(1), 17-21.

Rosenholtz, S. (1985). Effective schools: Interpreting the evidence. American Journal of Education, 53(3), 352-359.

Rosenholtz, S. (1989). Teachers’ workplace: The social organization of schools. New York: Longman.

Strachan, B. D. (1995). Crossing the hall: Teacher-librarianship as a route to school administration. School Libraries in Canada, 75(1), 10-15.

Todd, R. J. (1995). Integrated information skills instruction: Does it make a difference? School Library Media Quarterly, 23(2), 133-138.

Turner, P. M. (1980). The relationship between the principal’s attitude and the amount and type of instructional development performed by the media professional. International Journal of Instructional Media, 7(2), 127-138.

Wilson, P. J., Blake, M., ft Lyders, J. A. (1993). Principals and teacher-librarians: A study and a plan for partnership. Emergency Librarian, 27(1), 18-24.

Yetter, C. L. (1994). Resource-based learning in the information age school: The intersection of roles and relationships of the school library media specialist, teachers, and principal (Doctoral dissertation, Seattle University, 1994). Dissertation Abstracts International, 55, 1130A.

ACKNOWLEDGMENTS

This article grew out of presentations given in 2003 at the Alberta Library Conference in Jasper, Alberta, and at the American Library Association/Canadian Library Association Conference in Toronto. I acknowledge with thanks the contributions of the participants whose questions and comments helped to shape my thinking about this topic.

Dianne Oberg is a professor in teacherlibrarianship in the Faculty of Education at the University of Alberta in Canada. Before coming to the university, Dianne worked as a classroom teacher and teacher-librarian in the public school system. Her research focuses on the implementation and evaluation of school library programs. Dianne is the editor of an international journal, School Libraries Worldwide, and an active member of school library associations at local, national, and international levels. She can be reached at [email protected].

Copyright Ken Haycock & Associates Feb 2006

The Generation Z Connection: Teaching Information Literacy to the Newest Net Generation

By Geck, Caroline

YOUTHS BORN IN OR AFTER 1990 ARE MEMBERS OF THE NEWEST NET GENERATION, DEFINED IN THIS ARTICLE AS GENERATION Z. THESE YOUNG PEOPLE ARE UNIQUE BECAUSE THEIR BIRTH COINCIDES WITH THE INTRODUCTION OF THE GRAPHICAL WEB THAT RESEMBLES THE INTERNET OF TODAY. THESE ADOLESCENTS ARE AMATEUR INTERNET SEARCHERS LACKING SKILLS IN EVALUATING WEB CONTENT AND USING RESOURCES OTHER THAN POPULAR INTERNET SEARCH TOOLS SUCH AS GOOGLE. THE INTERNET CAN BE THE PERFECT MEDIUM TO INTRODUCE AND DEVELOP INFORMATION LITERACY SKILLS BECAUSE THESE YOUNGSTERS WILL BE RECEPTIVE TO ANY SORT OF INSTRUCTION THAT MAKES THEM APPEAR WEB SAVVIER. IDEAS AND STRATEGIES ARE OFFERED HEREIN TO UPDATE BOTH INSTRUCTION AND LIBRARY SERVICE USING THE INTERNET AS AN INSTRUCTIONAL AID.

According the Encarta World English Dictionary, Generation Y is defined as people born in or after 1980. Although Generation Z is not yet defined in the dictionary, the term is sometimes used to describe the already-existing net generation of teenagers born in or after 1990 in technologically advanced countries. Today’s Generation Z currently comprises 14-year-olds or those approaching their early teens; these youths were born into a totally different technological world than what their immediate predecessors were, Generation Y. In fact, the Generation Z birth years closely correspond to the conception and birth of the World Wide Web. Tim Berners-Lee created this system of hyperlinks in 1990 and officially introduced this new way of web browsing in 1991. A critical milestone in improved web browsing came in 1993 with the introduction of the Mosaic Web Browser, the first graphical web browser. Mosaic generated huge interest in the Internet because web users could visualize how they were traversing the Web. These initial digital events in the early 1990s triggered an entire technological revolution and are key factors in understanding how this generation’s development to adolescence has been affected since birth.

WHY IS THIS GENERATION SPECIAL IN TODAY’S WORLD?

These youths are the first generation to be born into a digital world. What distinguishes these adolescents from those of every other generation is that they are the most electronically connected generation in history. From infancy, these teenagers grew up in an environment surrounded by and using

* graphical web browsers;

* laptops;

* cell phones;

* instant messenger services;

* broadband;

* wireless;

* video games.

These adolescents have been exposed to many high-tech influences, and today’s high-speed digital devices enable them to always be connected to the Internet, their friends, and others. This connectivity permits teens to communicate and collaborate in real- time regardless of physical location; to access a wealth of diverse information, including vast digital collections; and to author or contribute content instantaneously to web sites and weblogs.

These teens will more likely than any previous generation evolve into electronic multitaskers. For example, they will seek information by simultaneously

* searching and using several Internet browser windows at the same computer;

* using several different software applications at the same computer;

* using two computers at the same time, such as computer workstations and laptops;

* instant messenging peers who are not physically located within conversation range;

* using cell phones to contact other peers who are not physically present or are not responding to instant messenging;

* using cell phones for activities other than talking.

These teens also use an arsenal of tools to manage, store, and protect informationincluding e-mail, peripheral devices such as flash drives and iPods, and file transfer protocol systems. Adolescents have successfully mastered technologies of e-mail to take full advantage of its gathering, organizing, and forwarding capabilities (Levin ft Arafeh, 2002, p. iii).

Because these young people know no other reality than their Internet-based world, they are likely to have heightened technical expectations, attitudes, and beliefs. For example, they expect libraries and research resources to be accessible remotely (from home), where they can multitask comfortably and snack and watch television.

ARE THESE TEENAGERS INTERNET EXPERTS OR NOVICES?

Even though these youths have had early experiences with digital technologies, they do not have a deep understanding of the inner workings of the Internet or how commercial search engines rank results. These youngsters are often just familiar with the tip of the Internet iceberg. For example, they are not familiar with information that is part of the invisible Web or deep Web, dynamically generated web pages. Such web databases are often hidden from search engine results and are difficult to find for even those who are considered web savvy. Furthermore, these teens are unfamiliar with electronic resources that are not free on the Internet, such as commercial subscription databases.

Many of these students have never engaged in formal exercises comparing advantages, disadvantages, strengths, and weaknesses of the Web with other informational tools such as books and print journals. Members of other generations are more likely to do this sort of mental comparison automatically, only because they have had more experience with the different types of research tools, especially print indexes and reference books. For example, returning adult college students will often ask, “What electronic index replaced or is similar to the Reader’s Guide to Periodical Literature?” Younger students have no knowledge of this resource.

Teens will devote large amounts of time out-of-school browsing the Web (Levin & Arafeh, 2002). They tend not to place time constraints on themselves. Their inability to use the Web most effectively causes them to spend exorbitant amounts of time browsing. Evidence suggests that these students will devote large amounts of time engaging in activities personally relevant to them.

These students often started using the Internet before having been given any sort of formal instruction on locating and evaluating web pages. However, they quickly figured out through trial and error that retrieved web results located at the top of a web page are usually more relevant than results found at the bottom of the page. In fact, they do not do any scrolling but will concentrate on results at the top of the screen. This strategy of using only the highest-ranked results on the first page of retrieved results and automatically disregarding the rest implies that these young searchers are not closely evaluating any results and are just viewing all top results as being equal and worthy.

These youngsters believe that the information they need to find a research answer or to complete a homework assignment is freely available on the Internet. According to the Pew Internet and American Life Project, a nonprofit organization that studies digital behavior, statistics concerning the use of the Internet to complete homework assignments among this approximate age group keep spiraling upward (Levin & Arafeh, 2002).

This group’s preferred method of Internet searching is to start with a Google search, even if that may not be the most efficient or fastest means to the answer. This generation’s overreliance on Google as its first choice to find answers indicates that they may not be aware of other information search strategies and resources, especially print materials that are better suited to answer certain types of questions. These youngsters use Google confidently because they find tens of thousands of results in a few seconds. Their interaction with Google makes them feel self-sufficient, smart, and powerful when retrieving many results. They often do not have the metacognitive skills to know when to stop using Google and other search tools and to try a different information search strategy. Further, these young searchers often use Google carelessly to determine or measure the significance of a topic or individual, thereby leading to faulty conclusions. For example, these students, like many older Google searchers, may type in a person’s full name to check how many web pages can be retrieved. If these students do not find any results using Google, they may erroneously assume that the person is neither newsworthy nor historically important.

IS THIS NEW NET GENERATION INFORMATION LITERATE OR ILLITERATE?

According to the American Library Association’s “information literacy standards for student learning” (1998), a student is only information literate if he or she “accesses information efficiently and effeclively,””evaluates information critically and competently,” and “uses information accurately and creatively” (pp. 1-2). The previous discussion suggests that these teens are not information literate.

HOW CAN TEACHER-LIBRARIANS PROMOTE LIBRARY SERVICES AND THEMSELVES AND START HELPING STUDENTS BECOME INFORMATION LITERATE?

Teacher-librarians can begin by

* collaborating with classroom teachers to integrate Internet technologies into the curriculum;

* providing students and classroom teachers with quality information from traditional library sources and from Internet resources;

* showing these students and classroom teachers how to save time when searching;

* supp\lying students and classroom teachers with web page design technologies to deliver effective presentations;

* creating communities of learners or electronic learning modules by linking classmates’ web pages to a central page or starting point.

HOW CAN TEACHER-LIBRARIANS EFFECTIVELY COLLABORATE WITH TEACHERS TO BEGIN INTEGRATING THE INTERNET INTO THE CURRICULUM?

Teacher-librarians will probably have to update their libraries’ mission statements to begin integrating Internet technologies in their schools. The new missions may have to be formulated not only to support the curriculum but also to attract foot traffic to the brick-and-mortar library. Teacherlibrarians can persuade both classroom teachers and students to visit the library by advertising what is new and exciting. Examples include advertising the addition of new books or technical resources. The library homepage is a crucial element in attracting teachers as well as teens to the actual library. A well-designed web page that is information rich and interactive will capture both groups’ attention and encourage them to visit the library. Additional steps include updating policies, signage, broadband connections, and workstations to support multitasking, collaborating abilities and to make visits enjoyable.

Teacher-librarians should take a lead role in establishing and designing online communities of learners. If classroom teachers do not yet see the potential of online learning delivery, teacher- librarians should try alternative approaches, such as creating handouts with visuals that classroom teachers can incorporate into their lesson activities. The handouts can advertise both key print and digital resources, including new web sites and web pages that can be quickly accessed via the school library web site.

Teacher-librarians should clearly identify these handouts as products of their school library and may include brief requests at the bottom of handouts, both in print and e-mail format, to forward copies to colleagues who might be interested. Teacher-librarians should try e-mailing copies to classroom teachers so that they can electronically forward handouts deemed important or useful. The goal is to create a “viral marketing” effort in which key handouts and library advertisements are spread by physical and virtual word of mouth (Diorio, 2002, pp. 72-74).

Another collaborative strategy may be to visit different classrooms. Teacher-librarians can volunteer to do 50-minute sessions on a research topic or information literacy skill of the classroom teacher’s choice. The key aim is for teacher-librarians to make themselves indispensable to classroom teachers both virtually and physically.

HOW CAN TEACHER-LIBRARIANS PROVIDE AND PROMOTE PRINT AND DIGITAL RESOURCES?

Because of their early exposure to large amounts of graphic and web content and their comfort level with new digital applications, teens will be receptive to new information incorporated with graphics or introduced using Webquests and other types of Internet- based lessons. Equally important, these youngsters will pay attention and will be motivated to learn material that makes them appear more web savvy or helps them to become more knowledgeable about the Internet.

Using the library homepage, teacher-librarians should offer curriculum-focused web bibliographies or lists of the best quality Internet sites to support the curriculum or grade coursework. Levin and Arafeh (2002) observed that 12- to 17-year-old students prefer to use web sites that are approved and accepted by their schools.

Teacher-librarians can also impress this youthful clientele by becoming the school experts on the invisible Web or even Google. Youths can be offered instructional sessions on how to recognize misinformation and bogus information on the Web, and teacher- librarians can show these students other skills important in evaluating the quality of web resources. To keep these youngsters’ attention, teacher-librarians should provide instructional sessions about searching Google effectively, such as using Google Boolean searching and being aware of the Google PageRank system. Other ideas include discussing search engine optimization and how corporations employ webmasters to raise their Google rankings.

HOW DO YOU IMPRESS STUDENTS AND TEACHERS WITH TIMEMANAGEMENT SKILLS?

Teacher-librarians can reinforce that Google is not the best or first choice timewise in many situations. By showing students how print resources and electronic subscription databases can be used effectively to find answers, teacher-librarians can make students aware of the enormous amounts of time that may be wasted browsing and sorting through Google results. It is vital to communicate how answers can be found faster than by doing a Google search. Teacher- librarians can also reinforce these efforts by publishing success stories and anecdotes on the school library homepage.

HOW DO YOU IMPRESS STUDENTS AND TEACHERS WITH WEB PRESENTATION SKILLS?

Student research projects, including the presentation component, need to be revamped and reconsidered in the new digital environment. According to the Pew Internet and American Life Project, even though these young people are technologically savvy, only 17% of current 12- to 17-year-olds have created a web page for a school project (Lenhart, Simon, O Graziano, 2001).

Teacher-librarians can serve as experts in web page creation and then help teachers and students gather and organize information for their web pages. If classroom teachers are not initially receptive to having students design web pages as part of a project, teacher- librarians should not give up. Teacher-librarians can demonstrate how to present and use web pages effectively in the learning delivery process.

Many teachers tend to focus on the Internet as a source of content or information, but they need to be encouraged to design assignments that foster the Internet as a communication and teaching tool. In fact, the organization of key concepts themselves as presented on web sites may aid students in the formation or understanding of new knowledge representations-in other words, learning.

Web pages can be used as an important aid in teaching or facilitating the information search process. Instead of having students simply present orally, teachers can have them present using web pages in combination with presentations similar to those using PowerPoint. For example, students’ individual web pages can be on their topics of interest, with links to their thesis statements, reports, key informational sites, and graphics. Web pages can serve as starting points for research and can continue as centralized gathering points for information and as a sort of virtual filing cabinet or storage system when students do research over extended periods. In this capacity, the web page can be used as a platform to generate new knowledge and facilitate new learning connections.

Topic-specific web pages will also facilitate students’ developing personalized focuses. Central ideas and main links can be located on the main page whereas subtopics and less important information can be accessible from linked pages. Students will constantly need to evaluate and make decisions about what information they will present on their main web pages and what information they will link to other web pages because it is less important. According to Kuhlthau’s study (1988) of the cognitive and affective aspects of the library search process, the collection, synthesizing, and organization of key concepts into finished web page products should provide students with increased confidence as well as feelings of satisfaction and achievement derived from completing the web pages before presenting.

HOW CAN TEACHER-LIBRARIANS IMPRESS AND MOTIVATE STUDENTS TO LEARN WITH ELECTRONIC LEARNING (E-LEARNING) MODULES?

It is fairly easy to create a virtual community of learners by linking web pages because the Internet is by definition a hypertext system of links. Linked web pages are a new form of instructional delivery to enhance knowledge acquisition and communicate key ideas. Teacher-librarians can facilitate the creation of these e-learning communities by establishing one centralized main page where students can go and access different class or peer web pages.

Students will enjoy exploring and researching web pages created by their classmates. They will also take pride in having their own personalized web sites and in seeing concrete representations of their research. The students will be part of the elearning process by sharing this web information with their classmates and by having the opportunity to offer and receive realtime feedback. The other benefits of e-learning delivery systems include convenience, the ability to manage one’s learning, and the opportunity to take advantage of learning opportunities any time of day and from any Internet access point.

WHAT WILL IMPLEMENTING THESE STRATEGIES ACCOMPLISH?

Implementing these strategies will not only help teacher- librarians minimize the generation gap between themselves and their students but will also enable them to effectively teach students and to collaborate with classroom teachers. These strategies should also prove beneficial in developing adolescents’ technology and information literacy skills and in preparing them to be independent lifelong learners.

Feature articles in TL are blind refereed by members of the advisory board. This article was submitted August 2004 and updated and accepted September 2005.

Important Web Dates of the Early 1990s

November 13, 1990

* The first known web page is written.

February 26, 1991

* Tim Berners-Lee introduces the web browser.

April 22, 1993

* Release of version 1.0 of the Mosaic web browser.

Source: Wikipedia, www.wikipedia.com

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Madden, M. (2003, December 22). America’s online pursuits: The changing picture of who’s online and what they do. Retrieved June 1, 2004, from www.pewinternet.org/pdfs/PlP_ Online_Pursuits_Final.PDF

Oblinger, D. (2003). Boomers, gen-xers & millennial: Understanding the new students. EDUCAUSE Review, 38(4), 37-47. Retrieved June 1, 2004, from www.educause.edu/ ir/library/pdf/ erm0342.pdf

Caroline Geek is a bibliographic instruction librarian at Kean University Library, Union, NJ, who is interested in young people and how they seek information. She holds a master’s degree in library services from the Rutgers University School of Communications, New Bruswick, NJ. Her ongoing research project is developing subject web bibliographies for faculty and student use at the library. She can be reached [email protected].

Copyright Ken Haycock & Associates Feb 2006

Davis makes Games history

By Karolos Grohmann

TURIN (Reuters) – Shani Davis made history on Saturday by
becoming the first black male to win an individual gold medal
at a Winter Olympics when he cruised to victory in the
speedskating 1,000 meters.

Confirming his status as the best skater over the distance,
Davis, the 1,000 meters world record holder, was slow at the
start but accelerated in the final 400 meters to cross the line
with a time of 1:08.89.

“Since I was a kid I joked around saying one day I am going
to win the 1,000. Now it’s happened,” he told reporters. “A
childhood dream comes true.”

Fellow American Joey Cheek was second, grabbing another
medal following his gold in the 500 meters on Monday.

Cheek’s close friend, Erben Wennemars, squeezed into the
medals after battling it out with fellow Dutchman Jan Bos.

Davis, from Chicago’s South Side, skated over to Wennemars
following his race, hugged him and waved to the thousands of
Dutch fans who had packed into the Oval Lingotto for what they
consider the most exciting race in speedskating.

“Joey (Cheek) gave me a fright with how fast he was going
in the beginning of the race. But finally I get rewarded for my
hard work,” he said.

DIFFERENT PATH

American 5,000 meters gold medallist Chad Hedrick, who fell
out with Davis over his refusal to race in the team pursuit,
set the pace early on with a moderately fast race of 1:09.45.

But Davis, who has not lost a single 1,000 meters race he
has entered this season, was too good to be denied the top
spot.

Asked how he felt to be the first black man to win a gold
medal, Davis said: “I don’t know. I think it’s cool to have a
gold medal regardless of the color. Although African-Americans
choose basketball or some other sport I chose a different
route,” he said.

“Regardless of the color I wake up in the morning and work
as hard as anybody.”

“It’s still a breakthrough though.”

Russian 500 meters silver medallist Dmitry Dorofeyev was
unlucky when Erik Zachrisson, with whom he was paired, blocked
him in the lane change as the Russian was on his way to beating
Hedrick’s time.

The Swede was disqualified but the damage to Dorofeyev’s
time was done.

Students’ Reasons for Entering Nigerian Primary Teacher Education and Their Career Plans

By Ejieh, Michael U C

The objectives of this study were to find out what motivated the students in a college of primary teacher education in Nigeria to seek admission into the college, and to identify their career plans. The instrument for data collection was a questionnaire administered on 117 final year students of the college towards the end of their programme of studies. It was found that the most important reason for their entering the programme was to have an opportunity to go for further education. Over half of the students had no plans to take up teaching immediately after completing their programme of study. Most of them (59.62 per cent) planned to enter a university or an equivalent institution for further studies in both education and other professional and non-professional courses.

Key words Motivation for teaching, Entry into teaching, Student teachers and career plans, Nigerian primary teacher education, Nigerian student teachers, Student teachers.

Many studies have been carried out in both developed and developing countries of the world to find out what motivates students in teacher education institutions or programmes to choose teaching as a career. In general, the studies have shown that such students choose teaching as a career for various intrinsic, extrinsic and altruistic motives (Bastick, 2000; Bergma and Chu, 1981; Goh and Atputhasany, 2001; Kyriacou et al., 1995; Olasehinde, 1972; Philips and Hatch, 1999).

The assumptions in most of these studies seem to be that students in teacher education institutions or those following teacher education programmes in relevant educational institutions will enter the teaching profession after completing their courses of study. Evidence from some studies, however, shows that not all such students intend to teach after graduation. Wang and Fwu (2002), in their study of pre-service graduate students’ views of choosing teaching as a career in Taiwan, found that even though a majority of them liked teaching as a career, there was a small group among them that were not decided if they really wanted to teach. The authors referred to this group as career explorers. They were trying to find out if they were fit for teaching or if they could make a difference through education. There was yet another small group of the graduates that they referred to as the ‘uncommitted’-those who decided not to take teaching as a job immediately after they graduate and who regard teaching as irrelevant to their future goals. Although the students in this study followed a two-year teacher education programme after graduating from university, there is no reason to believe that a similar group of students cannot be found among teacher trainees that do not hold university degrees. In some education systems this uncommitted group may be quite large. Moreover, studies elsewhere have shown that many of those who join the profession after graduation leave early (Halford, 1998; Heath, 2001); such people who leave the profession early probably had a career plan other than teaching.

Primary teacher education in Nigeria

Until fairly recently the training of teachers for the nation’s primary schools was the responsibility of Grade Two teacher training colleges. In the federal government’s efforts to improve the standard of instruction in primary schools, it has made the Nigerian Certificate in Education (NCE), which is higher than Teachers’ Grade Two Certificate, the minimum qualification for teaching in primary schools. The NCE is awarded to graduates of colleges of education, which are different from teacher training colleges, after successfully following a three-year programme of studies, including the teaching practicum. Holders of the certificate were supposed to teach in junior classes of secondary schools and Grade Two teachers’ colleges. With the making of NCE the minimum qualification for teaching in primary schools, most holders of the certificate previously teaching in secondary schools and teachers’ colleges now teach in primary schools. Primary school teachers can move on to teach in secondary schools only after obtaining relevant university degrees. Also with this raising of the qualification for primary school teaching Grade Two teachers’ colleges have been gradually phased out, and most colleges of education have incorporated primary education studies (PES) programmes in their curricula.

Although many serving primary school teachers have availed themselves of the opportunities offered by the PES programme to upgrade their qualifications, the programme is not usually an attractive option to school leavers who seek admission to colleges of education. This is mainly because while products of other programmes in colleges of education can still find employment in secondary schools, those of the PES programme can be employed only in primary schools, with limited employment outlets in the public sector. A recent innovation in primary teacher education in the country is the establishment, by a state government in Nigeria, of a college of primary education-an NCE-awarding institution with all its departments and programmes devoted to producing teachers for primary schools only. Compared with other colleges of education in the country, the number of candidates seeking admission into it through the Joint Admissions and Matriculations Board every year has been too low. At present the college gets its full complement of students through its preliminary studies programme designed for students that lack the requisite qualifications for entry into its three-year programmes.

The problem

It has been pointed out that not all students in teacher education institutions intend to teach after graduation and that many of them who join the profession after graduation leave early. The implication is that many students who enter teacher education programmes do so for reasons other than joining the profession. In the Nigerian context, teaching, especially in primary schools, is still a low-status job and does not attract many school leavers, despite federal and state governments’ efforts to improve the lot of teachers in recent times. This notwithstanding, even a relatively novel college of education attracts a good number of applicants. A question that comes to mind is: why do students choose to enter a college of education whose products have prospects of teaching only in primary schools?

This study was therefore designed to find out what motivated students in a college of primary teacher education in Nigeria to seek admission into the college and not, as in most studies of this type, why they chose to enter teaching profession, and also to identify their career plans. This type of study is necessary for planning the supply of teachers.

Research method

The subjects

The subjects were final-year students of the college of primary education mentioned above. The college has five schools-namely Education, Arts and Social Studies, Sciences, Vocational Studies, and Languages-each with a number of departments which offer three- year programmes for the award of the Nigerian Certificate of Education in primary education. To be eligible for admission, students in this programme are supposed to have obtained the West African Examination Council or General Certificate examination certificates with a prescribed number of credits in relevant subjects. The study was carried out in the second semester shortly before their final examinations in the programmes. The rationale was that by that time almost all of them would have made up their minds about what to do in the future.

Instrument

The instrument used in the study was a questionnaire developed by the investigator. The questionnaire items were based on informal discussions with the students during his one-year stay in the college as a visiting lecturer. An item in the questionnaire was a list of possible reasons why students usually seek admission to teachers’ colleges and the subjects were asked to tick those reasons which were applicable to them. One item required them to indicate the most important reason why they sought admission to the college. Another item consisted of a list of possible options available to students who graduate from colleges of education in the country and they were asked to indicate what they intended to do after completing their studies in the college by putting a check at the appropriate option. Space was provided for them to state what they intended to do if such was not available in the list. The subjects who indicated that they would go for further studies in a university were asked to state the courses they hoped to study if offered admission.

The face validity and content validity of the questionnaire were determined by a panel of two principal lecturers and one senior lecturer in the college involved in the study to whom the purpose of the study and the research questions were provided and who were requested to review the questionnaire items in terms of coverage, clarity and appropriateness of language and instructions to the respondents. The necessary modifications were made in line with their suggestions. Thereafter, the reliability of the instrument was ascertained by pilot-testing it on a sample of twenty Part Thr\ee students of a college of education following a primary education studies programme in the same state. The result of the pilot test showed that the questionnaire items were clear enough to the respondents.

Procedure

Copies of the questionnaire were given to all the 117 students present during a lecture in a core course in education, involving all Part Three students in the different schools in the college. After explaining the contents to them, they were asked to complete and return it to the investigator there and then. Care was taken to ensure that the students did not discuss the content with each other while completing the questionnaire, in order to minimise response bias. Out of the 117 copies of the questionnaire collected, 106 were correctly and completely filled in and were analysed for the purposes of this study.

Findings and discussion

Reasons for seeking admission

The reasons given by the students for seeking admission to the primary teacher education programme and the numbers and percentages of students to which they are applicable are presented in Table 1. The table shows that over 50 per cent of the students sought admission to the college for two main reasons, namely the possibility of proceeding to university, and the encouragement of parents. The ease of getting a teaching job on completion, the student’s interest in the aims and objects of the teacher education programme and the ease of gaining admission to the programme motivated over 40 per cent of the students to seek admission to it.

Table 1 Reasons given by students for seeking admission to primary teacher education programme and the number and percentage of students giving them (n = 106)

Among the ‘other reasons’ not included in the list only two were given by not less than five of the students: ‘Nothing else to do at home to avoid staying idle’ (eleven students, or 10.4 per cent); ‘To prepare for Joint Admissions and Matriculation Board examinations’ (seven students, or 6.6 per cent).

The most important reason

The numbers and percentages of the students who indicated that each of the reasons was the most important to him/her for seeking admission into the programme are indicated in Table 2. As can be deduced from the table, the student’s desire to gain admission into a university is the most important reason to the highest number of the students. Being encouraged by parents to apply, and their desire to learn how to teach in primary school, occupy distant second and third places, going by the numbers and percentages of students who rated them as their most important reasons for seeking admission to the college. It may be significant to note that being influenced by their former teachers was not indicated by any of them.

Table 2 Reasons for seeking admission and the numbers and percentages of students regarding each as the most important (n = 106)

Students’ career plans

The students were asked to indicate what they intended to do on completing their studies in the college. Only 104 of the students responded to this item. Their responses to the item are presented in Table 3. Table 3 shows that most of the students (almost 60 per cent of them) planned to enter a university or its equivalent for further studies. Only thirteen, or 12.5 per cent of them, intended to teach in public primary schools. The numbers and percentages of the students who planned to pursue other options after completing their studies were insignificant compared with the numbers and percentages of those who planned to go for further studies.

Table 3 Students’ plans after completing their studies (n = 104)

An item in the questionnaire requested those students who planned to go for further studies to state the courses they would like to read in a university or equivalent institution. Data analysis revealed that, out of sixty-two of them who planned to go for further studies, twenty-eight (or about 45.2 per cent) stated that they would study education or education-related courses. Other courses that they planned to read in the university by three or more students included law (five students), computer science (four), mass communication (four), business administration (three) and agricultural economics (three students). Apart from two of the students, one of whom stated that he/she wanted to study accounting and the other banking and finance, the other students planned to read non-professional courses such as sociology, political science and the Yoruba language. One student, however stated, ‘Course yet unknown but not education.’

Discussion

Table 1 shows that the greatest number of the students sought admission to the college in order to have an opportunity to have university education. Table 2 also shows that this is also the most important reason to about one-third of the students. This is not surprising, as acquiring a university degree is the ultimate aspiration of most students in the Nigerian educational system. A good Nigerian Certificate in Education, which is awarded to the students on successful completion of the programme, enables one to gain direct entry to a Nigerian university. It is apparent from this finding that a majority of the students entered the teacher education programme, not for any intrinsic, extrinsic or altruistic motives connected with the teaching profession, but to enhance their chances of gaining admission to a university. This aspiration to enter higher institutions of learning is also reflected in one of the Other reasons’ given by students, i.e. ‘to prepare for the Joint Admissions and Matriculations Board examinations’.

Hoping to gain admission to a university by obtaining the NCE qualification in a college of education, as revealed in their career plans (see Table 3), is not peculiar to the subjects of this study. Most student teachers in other colleges of education in the country also nurse the same ambition. It has been estimated that about 70 per cent of the graduates of these colleges in Nigeria enter the universities within two years after graduation rather than going into the classroom to teach (Aghenta, 1992, p. 193).

These two tables also show that parental encouragement or bidding comes next, both in terms of the number of students influenced by it and also in terms of the number that considered it as the most important reason. This finding may also not be surprising, as many secondary school leavers can no longer find jobs in our labour market and most parents would not like them to stay idle at home or elsewhere. Those of their children and wards who are academically weak and cannot gain admission to universities are often advised or encouraged by them to enter any post-secondary institution that offers them admission. This is most commonly poor and working-class parents in the country. ‘Having nothing else to do/Avoiding staying idle at home’, as stated by some of them as the motive for seeking admission to college, is also indicative of similar reaction by some of the students themselves to the situation.

Table 1 shows that one of the reasons given by about 43 per cent of the students was that it was easy to gain admission to the college of education. Another was that they did not gain admission to higher institutions of learning. It is common knowledge that competition for places in colleges of education and polytechnics in the country is in no way to be compared with that of places in the nation’s universities, as the number of applicants to the former types of institution far outweigh the number that seek admission to universities. The academically strong ones, under normal circumstances, gain admission to the universities, leaving the weaker ones to find their way into colleges of education.

The results of this study lend credence to the observations made by some Nigerian educationists and educational researchers about the quality of our teacher education candidates, namely that it is mainly those students who are academically weak and who cannot aspire to more prestigious professions that enter teacher education programmes (Nwosu, 1976; Fadipe, 1992). This trend seems not to have changed over the years, and unless it is reversed the chances of meeting the nation’s objective of producing ‘highly motivated, conscientious and efficient classroom teachers for all levels of our educational system’ (Federal Republic of Nigeria, 1977, revised 1998: 33) will continue to be remote and the quality of instruction in our schools will continue to be low.

It may be of interest to note that many of the reasons given by a good number of the students (e.g. Nos 1, 2, 6 and 7 in Table 1) are not suggestive of genuine interest in teaching or in taking up teaching as a career. It is among the students giving such reasons for seeking admission to teacher education programmes that most of Wang and Fwu’s (2002) career explorers and the uncommitted are likely to be found. Such people, when they graduate, are likely not to take up teaching as a career or, at best, to leave it early. Some of them may also be found among those who hoped to continue their education in the university after graduating from college to probably read courses that will lead to other professions.

It can be deduced from Table 3 that only about 20 per cent of the students had plans to teach immediately after completing their courses of study. It is worthy of note, however, that five of them who planned to take up teaching hoped to teach in secondary schools, even after undergoing training as specialist primary school teachers. This probably has to do with the poor image of the primary school teacher in society.

The table also shows that almost 60 per cent of the students had no immediate plans to engage in any job. They planned to go for further studies in a university or an equivalent institution. This figure, although smaller than Aghenta’s (1992) estimate, confirms his observation that most of the graduates of colleges of educ\ation find themselves in universities instead of teaching in the classroom. Out of the sixty-two of them, twenty-eight (or a little less than half of them) planned to do courses in education or those courses which involve a combination of education and some teaching subjects. These twenty-eight may eventually take up teaching as a career after graduating from university. Adding this number of students to the number that planned to teach in primary schools (public and private) and nursery schools gives a total number of forty-nine (less than 50 per cent of the subjects) who may ultimately seek employment as teachers. Although of not much significance for the purposes of this study, it is good to note that those who may likely join the teaching profession after obtaining university or equivalent degrees are not likely to seek employment in primary schools, as teaching in primary schools is less attractive than teaching in higher institutions.

One surprising finding of this study is that a good number of those students who planned to go for further studies, after hopefully being certified as professional teachers on successful completion of their courses in the college, hoped to read other professional courses. As it is not the practice for holders of the NCE to be given direct entry to Nigerian universities or equivalent institutions to read professional courses other than teaching, the implication is that such candidates will have to sit the university matriculation examination for admission to Nigerian universities. If they are successful at that examination, they will start their programmes of study in the university from Part One (or the first year) while their counterparts holding the same qualification and wishing to continue to read courses in education do not sit for university matriculation examinations and start their programme of studies from Part Two. Thus reading another professional course or any course apart from education at the university by a holder of the NCE is tantamount to losing the three or more years spent in the college of education, with all the attendant financial, material and other losses. It would seem that many of the students in this study were prepared to make such a sacrifice in order to avoid teaching. The educational system itself also incurs huge losses when the products of teacher education programmes do not join the teaching profession. Such losses include the education resources invested in the student teachers and the student teacher places wasted by them while in college.

It should, however, be noted that the number of subjects involved in this study is small and does not include students following the primary education studies programme in other colleges of education in the country. The limitations of this study are, therefore, admitted.

Conclusion and policy implications

The findings of this study suggest that the most important reasons given by the students for seeking admission to the teacher education programme are not suggestive of commitment to or genuine interest in teaching as a career. It seems then that knowing students’ reasons or motives for seeking admission to a teacher education programme rather than knowing their reasons for choosing teaching as a career may serve more useful ends to educational administrators and teacher educators in recruiting them into such a programme. It is also apparent that about half the students who were being prepared for the teaching job had no plans to take up teaching as a career after completing their programme. Thus, while some students enrolled in the programme in order to become teachers, a greater number did so either as an alternative way of gaining admission to a university or equivalent institution or in order to receive more education before taking up jobs other than teaching. The picture that emerges is that the programme is fulfilling its objective of producing teachers for primary schools to only a limited extent but it is also serving a useful purpose: providing a bridge to university entrance for relatively weak candidates, thereby widening access to university education, which is another educational policy objective of the federal government.

It can be inferred from the findings of this study that a majority of the students following the programme in the college under study had no interest in teaching in primary schools for which they were being prepared as specialist teachers. Unless candidates with a genuine interest in teaching are recruited into the primary teacher education and efforts are made to retain them after graduation, much of the efforts and resources devoted to producing teachers for the nation’s primary schools will continue to be wasted.

This situation, added to the generally widely held belief in the country that teaching is mainly for the academically weak people, calls for policies aimed at improving the image of teaching as a profession. Otherwise some bright school leavers with a genuine interest in teaching may be loath to enter teacher education institutions. This calls for, among other measures, the raising (no matter how slightly) of the general entry qualifications for teacher education institutions and strictly adhering to the prescribed minimum qualifications by the authorities of various teacher education institutions and abolishing all preparatory programmes that necessitate the lowering of standards or qualifications for entry to such programmes. It may also call for free tuition for students in teacher education institutions, as was the case before the launching of universal primary education in 1976. The beneficiaries of such programmes should be bonded to teach for a specific minimum number of years before leaving the profession if they so desire. Such a measure would go a long way in discouraging the type of students referred to as uncommitted by Wang and Fwu (2002) from entering a teacher education programme and in extending the period of service of those who leave the profession early (Halford, 1998; Heath, 2001). It may also discourage career explorers from entering the teaching profession.

With the raising of entry qualifications into the primary and other teacher education programmes, free tuition and other incentives for students in primary teacher education programmes, and other incentives and rewards (which should not necessarily be monetary, e.g. opportunities for part-time university education) planned for primary school teachers, the reasons why many candidates will seek admission into primary teacher education programmes in the country and subsequently enter the teaching profession for only intrinsic, altruistic and extrinsic motives.

References

Aghenta, J. A. (1992), Objectives, achievements and shortcomings in the implementation of policies on teacher education in Nigeria’ in A. Ndu (ed.), Educational Policy and Implementation in Nigeria, Awka: National Association for Educational Administration and Planning.

Bastick, T. (2000), ‘Why teacher trainees choose the teaching programme: comparing trainees in metropolitan and developing countries’, International Review of Education 46 (3-4), 343-49.

Bergma, H. M., and Chu, L. (1981), ‘What motivates Introductory and Senior Education Students to become Teachers?’ Paper presented at the annual general meeting of the American Educational Research Association, Los Angeles.

Fadipe, J. O. (1992), ‘The achievements and shortcomings of teacher education programme in Nigeria: an administrator’s view’, in A. Ndu (ed.), Educational Policy and Implementation in Nigeria, Awka: National Association for Educational Administration and Planning.

Federal Republic of Nigeria (1977), National Policy on Education (revised 1982 and 1998), Lagos: NERDC Press.

Goh, K. C., and Atputhasamy, L. (2001), Teacher Education in Singapore: What motivates Students to choose a Teaching Career?’ Paper presented at the International Educational Research Conference, Fremantle, December.

Halford, J. M. (1998), ‘Easing the way for new teachers’, Educational Leadership 55 (5).

Heath, G. (2001), ‘Teacher Education and the new Knowledge Environment’. Paper presented to the Australian Association for Educational Research conference, Fremantle, December.

Kyriacou, C., Hultgren, A., and Stephens, P. (1999), ‘Student teachers’ motivation to become a secondary school teacher in England and Norway’, Teacher Development 3 (3), 373-81.

Olasehinde, M. O. (1972), ‘An analytical study of the motives of primary school teachers for choosing teaching as a career’, Journal of Teacher Education 23 (2).

Nwosu, S. N. (1976), ‘Recruitment and training of teachers for the universal primary education’, in N. A. Nwagwu (ed.) UPE; Issues, Prospects and Problems, Benin City: Ethiope Publishing.

Philips, M. B., and Hatch, J. A. (1999), ‘Why teach? Prospective Teachers’ Reasons for entering the Teaching Profession’. Paper presented at the Reconceptualizing Early Childhood Education conference, Columbus OH.

Wang, H., and Fwu, B. (2002), ‘A backup choice or not? Pre- service graduate students’ views of choosing teaching as a career in Taiwan’, International Education Journal 3 (1).

Michael U. C. Ejieh Obafemi Awolowo University

Address for correspondence

Faculty of Education, Obafemi Awolowo University, Ile-ife, Nigeria. E-mail [email protected]

Copyright Manchester University Press Nov 2005

The Causes, Views and Traits of School Absenteeism and Truancy: An Analytical Review

By Reid, Ken

This article presents an up-to-date synthesis and review of recent research in the field of school absenteeism and truancy. Topics covered include: definitional issues: the OfStEd position; the LEA perspective; the causes of non-attendance and truancy; the role of parents; the link between truancy and crime; out-of-school provision; current trends; the implications of Every Child Matters and the Children Act 2004, and conclusions. The evidence reveals that, despite all the good practice which is taking place within schools and local education authorities, the number of pupils missing school continues to resist staunchly the best endeavours of the full range of caring professionals.

Key words Truancy, School absenteeism, Non-attendance, Parentally condoned absence, OfStEd, Every Child Matters.

The purpose of this article is to focus on a review of recent research into school absenteeism and truancy. The specific aim is to provide detailed information which should be particularly helpful for teachers and staff in schools to use, along with a range of caring professionals such as education welfare officers, learning mentors, home school liaison officers and educational researchers. Consequently, this review is limited to a consideration of: definitional issues; the causes of truancy and non-attendance; out- of-school provision; the Office for Standards in Education (OfStEd) position; the role of parents; the link between truancy and crime; current trends and the Children Act 2004.

Definitional issues

One of the key issues when considering ‘school absenteeism’ and ‘truancy’ is to understand correctly the meaning and definition of the terms. This is not quite as simple as it sounds. There are various types of school absenteeism. They include specific lesson absence, post-registration absence, parentally condoned absence, psychological absence, school refusal and school phobia. This is where the ‘problem’ begins. For some, specific lesson absence, post- registration absence and parentally condoned absence are not truancy. For others they are, and are often retitled specific lesson truancy, post-registration truancy and parentally condoned truancy. For some, ‘absent without good reason’ can be equated with truancy. For others, having a reason for the absence – for example, being a parentally condoned absentee – means by definition that this form of behaviour is not truancy (Reid, 1999).

An Office for Standards in Education report (OfStEd, 2001) indicates that truancy should not be synonymous with unauthorised absence, as some authorised absences can result from the school’s refusal to authorise excessive absences for holidays taken during term time without the prior consent of the school. Due to these definitional problems, most authors using the term ‘truancy’ provide situation-specific definitions, as the generic terms often means different things to different people.

In a study of absence from school Malcolm et al. (2003) use three different terms to describe pupils’ non-attendance. For them, ‘truancy’ was defined as ‘absences which pupils themselves indicated would be unacceptable to teachers’. ‘Unacceptable absences’ were defined as ‘absences which were unacceptable to teachers and local education authorities (LEAs) but not recognised as such by pupils’. Finally, ‘parentally condoned absences’ were the results of parents or carers keeping pupils away from school.

Other researchers have taken different stances. Stoll (1990) defined truancy as being ‘absent from school for no legitimate reason’. Atkinson et al. (2000) introduce the concept of time into their definitions as they point to differences in the extent of the absence, from avoidance of a single lesson to those of several days, weeks or even, in rare cases, months. O’Keefe et al. (1993) reveal the difficulties in classifying post-registration truancy and specific lesson truancy, as these forms of absence are normally omitted from official school returns. Similarly, Kinder et al. (1996) remind us that ‘postregistration truants’ are not necessarily absent from school, as they may be specifically ‘hiding’ on the premises.

Some pupils miss school with the active encouragement or consent of the parent/s or carer/s. The Audit Commission (1999) estimated that at least 50,000 pupils of the official 400,000 who miss school daily in England are kept off by their parents without the permission of either schools or local education authorities. If detailed research was ever conducted into the phenomenon of parentally condoned absence, this estimate would probably be found to be an understatement. It is probably little comfort to recognise that similar definitional and numerical difficulties influence studies of truancy and school absenteeism in both Europe (Kitching and Morgan, 2001) and the United States (Gabb, 1995) and are one reason why everyone needs to be cautious when receiving and interpreting attendance data (Reid, 2002a). Another is the inherent difficulty which confronts teachers when trying to categorise the reason for their pupils’ non-attendance. Munn and Johnstone (1992) point to the particular difficulties which teachers in Scottish schools face when attempting to determine whether an absence is parentally condoned or otherwise. After all, how many pupils on their return to school are going to say, ‘My mother told me not to come’?

It is for these reasons that researchers like Malcolm et al. (2003) define clearly the meaning of terms used in their findings, whilst others prefer Operational’ definitions. Reid (1985), for example, in his study of ‘persistent school absentees’, defined them as pupils missing school for 65 per cent or more in the school year preceding the study.

School absenteeism and truancy are also often considered to be a peculiarly British problem. Whilst non-attendance and truancy rates are much higher in Britain than in the rest of Europe, a number of other European countries do have their own difficulties. An Education Social Fund Objective 3 project on disaffected youth in Europe (Nicaise et al., 1999) has reported on the variations of truancy in Europe. While Spain (Nicaise et al., 1999) is reported to have few problems, France has significant difficulties, with, for example, marked differences between the attendance of pupils in rural and urban areas (Kitching, 2001; Morgan, 2001). In the United States there is considerable debate about the causes of and reasons for differential rates of pupils’ attendance and truancy between schools and within and between the various states. Schools in California, for example, can be either high- or low-attendance schools. While some studies blame social pathologies for truancy, others blame practice within state schools (Gabb, 1995). There are debates about the definition, causes and solutions to non- attendance and truancy in Europe and the United States similar to those taking place in the United Kingdom.

This debate on definitional issues has increased since the introduction of targets for schools and LEAs. Improving regular attendance at school for all pupils is a key target of the government throughout the United Kingdom. Not only is regular attendance key to improving attainment (Malcolm et al., 1996), it is imperative in the drive to raise national education standards (DfEE, 1999), widen participation, access and improve social mobility. Truancy also impacts upon self-esteem (Reid, 1982), achievement, behaviour, employability and the subsequent quality and economic status of former truants in their adult life (Reid, 1999).

The causes of truancy and non-attendance

The causes of truancy and non-attendance have been extensively researched. Research indicates that findings can vary depending upon the methodology used. For example, data obtained from whether the methodology utilises school-based surveys, town centre surveys, pupils’ self-referral instruments, parentally obtained information or teacher-assessed questionnaires often reveal some significant differences in outcomes on such matters as the extent of parentally condoned absenteeism. For example, Tyerman (1968) found that home background and social circumstances were the prime reasons for truancy. Reid (1985), in a detailed study of 128 persistent absentees and two matching control groups (n = 384), reported that school-based factors such as bullying, the curriculum and poor teaching were the preponderant factors in a clear majority of cases. However, all individual cases contained aspects of social, psychological and institutional features to a greater or lesser extent. As such each case was unique and often interdisciplinary and multidisciplinary in nature. Tables 1-6 provide a framework under which the causes of truancy and non-attendance could be subdivided. These could be: the causes of truancy and its outcomes; home and social background; economic links, warning signs; pupils’ attitudes; and the views of parents.

Kinder et al. (1996) report on their findings with 160 pupils in year 7 and above. They found that the main causes of truancy and disruptive behaviour were (in rank order):

1 The influence of friends and peers.

2 Relations with teachers, often those lacking in respect for pupils.

3 The content and delivery of the curriculum.

4 Family aspects (parents’ attitudes, \domestic problems).

5 Bullying.

6 The classroom context, for example lack of control or pupils’ learning difficulties.

In a different study of professionals in schools and officers working in the education welfare service (EWS), Kinder et al. (1995) found that the prime causes were personal, family and community factors. Individual aspects included: lack of self-esteem, social skills and confidence; poor peer relations; lack of academic ability; special needs; lack of concentration and self-management skills. Family factors included: parentally condoned absence; not valuing education; domestic problems; inconsistent or inadequate parenting; economic deprivation. Community factors revolved around socio-economic factors, location, local attitudes and lack of community selfesteem. Within the school setting, the key issues were: poor management; the ease at which some pupils could slip away unnoticed, poor relations with teachers and peers and the perceived irrelevance of some aspects of the school curriculum.

Malcolm et al. (2003), in their detailed study of seven LEAs in England, examined the causes of non-attendance and truancy. Their key findings are presented in Table 1. Research (Whitney, 1994; Hallam, 1996; Reid, 1999; Atkinson et al., 2000; Ireson and Hallam, 2001) also indicates that truants and persistent absentees are most likely to come from disadvantaged home backgrounds and unfavourable social circumstances. A summary of these findings is presented in Table 2. Recent research, for example, has underlined the link between free school meals and pupils’ non-attendance (Zhang, 2003). Table 3 outlines the key economic descriptors likely to be involved in truancy and other forms of non-attendance. Table 3 indicates that truants and persistent absentees are also more likely to emanate from a further and wider range of social disadvantage.

Finally, social psychological and psychological research (Reid, 1999, p. 77) suggests that a higher proportion of truants and persistent absentees than the normal school-age population have lower academic self-concepts, lower general levels of self-esteem, greater patterns of alienation from school over certain issues, higher levels of neuroticism and higher levels of antisocial behaviour. Also, they are not liked much by other children; often appear miserable, unhappy, tearful or distressed; have poor concentration or short attention spans; often tell lies; are often disobedient, and may have stolen things on one or more occasions. Research also highlights the difficulties which children experience when their parents separate and divorce, including the potential impact upon school attendance (Butler, 2003 a, b).

Table 1 The causes of non-attendance and truancy

Table 2 The home and social background of truants and persistent absentees

Table 3 Economic links with truancy and non-attendance

Non-attendance and schooling

The overall national target in England was to reduce truancy by one-third between 1997 and 2002, something which the administration in England, Wales and Scotland failed to achieve. Since September 2002 all secondary schools were supposed to achieve a target of 92 per cent for overall attendance. For primary schools the target has remained constant at 95 per cent. Thus schools, LEAs and the DfES have begun to instigate numerous schemes to discourage truancy and promote regular school attendance. These include the introduction of: nationally co-ordinated truancy sweeps with follow-ups by individual LEAs; fast-track prosecution for parents of persistent truants, the location of police in certain schools, the provision of specific grants to LEAs to promote initiatives on attendance and behaviour, amendments of the national curriculum, including the extension of vocational education, and the promotion of schemes such as Sure Start, Excellence in Cities and the work of Education Action Zones.

Combating truancy is the focus, too, in many recent legislative and guidance documents such as Circular 3/99 and the Welsh Assembly government’s reports (Welsh Assembly Government, 2003 a, b). One such initiative resulted in the Antisocial Behaviour Act, which has introduced parenting contracts for truancy and misbehaviour, parenting orders for serious forms of misbehaviour and penalty notices for truancy. These measures are designed to reiterate the fact that responsibility for school attendance and behaviour lies with parents and carers. Of course, the failure to ensure that a child enrolled in school attends on a regular basis has been a long- standing criminal offence for parents. However, taking legal action against parents in cases of non-attendance has never proved very successful (Zhang, 2004), often because of the strong link between absenteeism from school and child poverty (perhaps measured by the acquisition of free school meals), socioeconomic status, location and neighbourhood factors (Reid, 1999; Zhang, 2003).

Research indicates that teachers and other professionals and semi- professionals (e.g. learning mentors) may notice a range of potential warning signs prior to pupils truanting or missing school for other reasons. A checklist is presented in Table 4. Research (Reid, 1999, p. 75) also indicates that a higher proportion of truants and persistent absentees than the normal school-age population tend to manifest certain traits towards their schools. These are shown in Table 5. There are wide variations in attendance rates between schools, even schools located in similar catchment areas and homogeneous places. Whilst social class and pupil intake factors may on occasion account for some of these differences, there are undoubtedly a range of within-school factors which are also highly significant. These include the quality of teaching, teacher- pupil relations and pastoral care; a school’s ethos, leadership and management style; the extent of bullying, out-of-school and after- school facilities and provision (Rutter et al., 1979; Hallam, 1996; Hallam and Roaf, 1997; Reid, 1999, 2002a; Atkinson et al., 2000). The attitudes of teachers, head teachers and other professionals (e.g. education welfare officers) to the management of attendance within schools is a new area of research which is beginning to be explored (Reid, 2004c, 2005e).

A recent study by Malcolm et al. (2002) of primary and secondary schools located in different LEAs in England found that head teachers varied in their willingness to authorise up to ten days’ absence for term-time holidays. In some cases this willingness was influenced by the time of year in relation to examinations. Schools accepted a range of evidence for the authorisation of absences. These varied from verbal messages from siblings to medical certificates. In some cases, school staff gave attendance high priority because of concerns about children’s safety. Nearly all teachers believed that the absence problem focused on a small number of pupils in each school. Many teachers said they would begin to worry if pupils were absent for blocks of time. Only a few teachers said they would begin to worry immediately. Boys in primary school years 5 and 6 were more likely to truant than girls. Girls in all- white secondary schools were more likely to truant than boys. White girls in mixedethnicity schools were more likely to truant than white boys in year 9, but less likely in years 7 and 8; 27 per cent of primary school children said they had truanted without the collusion of their parents. This creates a cycle of poor attendance which is hard to break. In 17 per cent of these cases the child was able to leave school without being detected. Many truants said the reason they wanted to miss school was boredom, and over half said they were not sorry afterwards. Most truants believed their parents would be angry to discover they had truanted. Sixteen per cent of secondary school pupils admitting to truanting from school. White girls in years 7, 8 and 9 in all-white secondary schools are more likely to truant than boys but less likely to truant than white boys in years 7 and 8 in schools with a mixed racial intake. Very few secondary pupils from ethnic minority groups admitted to truancy.

Table 4 Checklist of warning signs for staff in schools

Table 5 The attitude of truants and non-attendees to school

Secondary school pupils are more likely to attribute their absence from school to school-related factors than to home-related factors. These reasons included problems with lessons, problems with teachers, being bullied, peer pressure and social isolation. Most primary teachers believed absence from school is always parentally condoned. Only a small number of primary school staff believed that school factors contributed to primary school children’s absences. Schools promoted good attendance through reward schemes, improvements in school ethos and facilities, closer links between primary and secondary schools, and building good relations with parents. Nearly all schools used electronic registration systems to track pupils and analyse attendance figures. Some undertook truancy sweeps. Despite these systems determined pupils continued to skip classes, especially when being taught by supply teachers. Most schools reintegrated poor attenders by utilising education welfare officers (EWOs), pastoral systems and one-to-one discussions. Some used learning mentors, social inclusion units, adapted timetables, clubs, group work, befriending and collection schemes. Views of their efficacy varied.

Out-of-school provision

Over recent years there has been a considerable growth in the amount and extent of out-of-school provision. This includes pupil referral units (PRUs), alternative curriculum centres, education at home and voluntary sector activity. Equally, the demand for child care has grown along with pre-school and after-school provision such as breakfast clubs. The provision of this outof-school care is often time-consumin\g and expensive (Malcolm et al., 2002).

Since 1997 the number of out-of-school units, especially PRUs, has been rising significantly. Prior to 1997 there was comparatively little systematic co-ordination of out-of-school provision and there were few inspections conducted by OfStEd. However, between 1997 and 2004 the number of PRUs in England rose from 309 to 452. A few LEAs still do not offer any formal out-of-school provision (OfStEd, 2004a). Moreover, some are still not fully complying with the requirement that out-of-school pupils should receive teaching equivalent to a full school week. In fact evidence shows that one in ten children stopped in truancy sweeps claims to have been expelled from school and not to have been relocated to appropriate out-of- school provision (OfStEd, 2004a).

Studies reveal significant differences between out-of-school units in terms of intake composition. For example, some out-of- school units contain more than four times as many boys as girls. In others, girls are in a majority. Some units are established for Key Stage 4 pupils only. Others include pupils from age 11 upwards (OfStEd, 2004a; Welsh Assembly Government, 2004a).

One of the biggest difficulties is finding alternative placements for pupils who are either disaffected or excluded from school (Audit Commission, 1999). While some LEAs are able to manage alternative placements within a few days others are taking between forty-five and seventy-five days to achieve this goal (Social Inclusion Report, 1998; OfStEd, 2004a). Moreover, in most LEAs there is generally a shortage of places to meet the demand (Wilson and Pirie, 2000).

Schools, LEAs, EWS teams and others in out-of-school provision or projects are involved in a whole host of local initiatives to raise and improve attendance (Pritchard and Williams, 2001). Despite this research, there remains comparatively little published material on the effect or outcome of out-of-school units on improving pupils’ attendance. As recent OfStEd (2004a) and Welsh Assembly Government (2004b) reports have acknowledged, it is many of these disaffected pupils who fail to gain alternative outof-school places, or fail to improve their attendance whilst in this form of provision, who subsequently become involved in crime-related activities or who exhibit antisocial behaviour (Social Inclusion Report, 1998). Some of these pupils are inclined to walk the streets because of the lack of alternative education or out-of-school units in their area. Moreover, many of these pupils are excluded from official statistics on school attendance (Reid, 2002a).

The Chief Inspector’s annual report for 2002-03 (OfStEd, 2004a, para. 294) found that for out-of-school provision:

1 Overall attendance in many of the units is below that in mainstream schools.

2 For a majority of pupils in PRUs, their attendance is better than it was before admission to the units.

3 Overall attendance figures in many units are reduced by a small number of persistent absentees.

4 Attendance is unsatisfactory in the majority of units.

5 Procedures for monitoring and improving attendance are either good or better in most PRUs.

With the development of all forms of mentoring, classroom assistants and other types of paraprofessional assistance, some out- of-school activities and schooling functions have started to blur (Street, 1999; Smith and Barker, 2000; Callender, 2000). Provision at the most basic of levels provides a safe place where children can be looked after by responsible adults (Fashola, 1998). At the other extreme is specialist provision which meets the needs of pupils with special needs, behavioural and/or emotional disorders and who repeatedly fail to attend school or truant. Research is beginning to monitor and evaluate these schemes (Keys et al., 1999; Hutchinson et al., 2001). So is OfStEd (2004d). However, much more research in this field is needed.

The OfStEd position

The Office for Standards in Education (OfStEd) inspects schools, LEAs and out-of-school providers on the quality of their State education. Each year the Chief Inspectors for England, Wales, Scotland and Northern Ireland report on their findings, which includes responsibility for school attendance. For example, in England, the Chief Inspector’s annual report for 2002-03 (OfStEd, 2004a) found:

1 The level of attendance for primary schools was about the same as the previous year at 94.2 per cent (para. 84).

2 Attendance in secondary schools had improved slightly, with total absences of 8.3 per cent, compared with 8.7 per cent in 2001- 02 (para, 116).

3 Unauthorised absence rates averaged fifteen days per pupil (para. 116).

4 Procedures for monitoring and improving attendance are better than they were in secondary schools but remain unsatisfactory in one school in twelve, often despite the best efforts of many schools. The Chief Inspector believes that a minority of parents, often with poor experience of education and low expectations of their children, do not do enough to ensure that their children attend school regularly or to support the school in taking action on truancy (para. 159).

On the role of LEAs, the Chief Inspector reported (p. 89) that they ‘are doing more to promoted good attendance’ although ‘support for behaviour has weakened’. Most LEAs inspected provide ‘at least satisfactory support to schools for improving attendance and in a third it is good’. Increasingly they have clear service standards and set out the range of support available for schools. Truancy sweeps and collaboration with the police are proving effective. The increasing use of data systems and analysis to inform strategies is also effective, as is the targeting of work with vulnerable groups of pupils transferring from primary to secondary schools. However, rates of attendance remain stubbornly low in many LEAs (p. 96). It will be interesting to see how schools and LEAs perform under OfStEd’s new inspection criteria (OfStEd, 2004b, c).

In Wales the Chief Inspector (Estyn, 2004) reported that whilst some improvements in rates of attendance and truancy had taken place, it was now the prime issue facing Welsh education. For example, as a result of its disproportionately higher rates of non- attendance than the rest of Wales, the City and County of Cardiff had instigated its own review of the issue (Cardiff, 2004; SIHE, 2005).

Similarly, in England, a number of LEAs have conducted their own internal and/or externally led review of attendance in schools and the education welfare service under their jurisdiction. Sheffield (2001), Sefton (2002) and Walsall (2003) are three prime examples, with the latter making one of the largest professional development investments in attendance ever undertaken (Reid, 2005a).

Some encouragement can be found from recent government initiatives to raise standards and combat non-attendance and truancy. Excellence in Cities and Education Action Zones (OfStEd, 2003) reported a range of interesting findings:

1 Learning mentors are beginning to make a significant impact on the attendance, behaviour, self-esteem and progress of the pupils they support; they are highly valued by pupils and parents alike, and they help to provide flexible support for pupils when they need it (p. 46, para. 154).

2 Education Action Zones which had improved attendance among secondary pupils have also had success in raising attainment (p. 17, para. 56).

3 Trends in pupils’ behaviour and attendance were improving in Excellence in Cities programme schools more than the national average (p. 45, para. 153).

However, the same report (OfStEd, 2003) also found a number of negative features in the management of attendance in Excellence in Cities (EiC) and Education Action Zone schools. For example:

1 Low levels of attendance among secondary pupils were a cause of concern in zones inspected in 2001-02. The average attendance was well under 90 per cent. Attendance was declining or static in over half the zones inspected. Other attendance initiatives had proved ‘ineffective’. The second-round zones inspected have begun to raised standards and attendance (p. 17, para. 54).

2 Attendance remains a serious problem for schools in Education Action Zones, as it does for many schools nationwide (p. 63, para. 220).

3 The overall average figures for attendance mask some large fluctuations across zones and some of the schools within them (p. 63, para. 221).

4 While around a third of the secondary schools in the survey had improved their attendance, two-thirds had not. The vicious circle is clear: if pupils do not attend school they do not make progress; if the school does not help them to learn and achieve, they become disenchanted and do not attend. The same problem was evident in primary schools. In too many, not enough action was being taken to address poor attendance (p. 68, paras 242-4).

The report concluded by recommending that the DfES should provide more support for schools on how to tackle poor attendance (p. 71, para. 252).

Similarly, the Chief Inspector for England found (OfStEd, 2004a) that schools utilising the skills of learning mentors and who participated in the EiC initiative were improving their rates of overall attendance faster than the national average.

Reid (2005b, c) has conducted a full review of a sample of OfStEd reports undertaken on primary (n = 200) and secondary (n = 227) schools in 2003 along with a full cohort of inspection reports on LEAs (n = 32) and out-of-school provision (n = 71). These data reveal that whilst inspectors appear to allow out-of-school providers some leeway in their inspection reports, no such facilitation is given to primary and secondary schools. Primary and secondary schools are normally judged by comparing their attendance returns against national data and targets. Interestingly, a large number of LEAs have improved their grades for attendance between their first and second inspections. This may suggest that som\e OfStEd inspections are beginning to have a positive impact and, in a minority of cases, bite.

The role of parents

Kinder and Wilkin (1998) have reported on their findings from a National Foundation for Educational Research (NfER) project on where parents lay the blame for truancy. They found that parents believe children misbehave and play truant because they are bored and the National Curriculum is failing to address their needs. They also blame their own shortcomings as parents, as well as peer pressure and a breakdown in pupil-teacher relations. Also important were bullying, boredom at home, lack of school discipline and parental attitudes to schools.

Reid (2002a) suggests there is no single category of parent whose children miss school. His pioneering study puts forward some preliminary evidence which found that five different types of parents of truants and absentees exist. These were parents who depict the symptoms of being anti-education, laissez-faire, frustrated, desperate or adjusting. For example, frustrated parents are those who, despite their best endeavours, including appeals to schools, education welfare officers and/or other caring professionals, are unable to ensure their child attends school regularly. In some cases the pupils abscond even when the parent/s escort them daily to the school gates.

Table 6 The views of parents on regular attendance

Whereas there is clear research evidence that a disproportionate and higher number of pupils from ethnic minority groups are excluded from school when compared with their white peers (Social Inclusion Report, 1998), there is very little evidence on the relationship between ethnicity and non-attendance.

There is a clear need for a research study of the causes of truancy and nonattendance among pupils from ethnic minority backgrounds (Osler, 1997). There are some signs that some pupils from ethnic minority backgrounds miss school for entirely different reasons from their white peers. Might, for example, bullying be a more prohibiting factor among some ethnic minority pupils? Equally, there is a further need for more research into the value of teaching parenting skills among parents of disaffected pupils like truants and absentees.

Malcolm et al. (2003) conclude that in the main parents believed that school-related factors were the cause of pupils’ poor attendance. However, most parents still thought that their children’s education was valuable and believed that good attendance was important. Parents of poor attenders were less positive about school and more likely to keep their children off school (see Table 6). Recent research showing that more girls are manifesting disaffected behaviour and turning to criminal activities should be a source of concern (Ostler et al., 2002). Smith (2004) has revealed a substantial difference in levels of serious delinquency between boys and girls between the ages of 12 and 15. There was, however, little difference in delinquency between girls and boys if trivial as well as serious incidents were included.

On parenting, the main findings were that many aspects of parenting have an influence on behaviour-tracking and monitoring behaviour, persuading young people to be open about what they are doing and who they are spending time with, being consistent about rewarding only good behaviour, avoiding conflicts and arguments as far as possible, and avoiding harshness and punishment. The parenting practices of children aged 12-13 predict their level of delinquency at age 15.

The LEA perspective

Sefton (2002), Walsall (2003) and Cardiff (2005) are three examples of LEAs which have conducted a detailed analysis of their attendance problems. Walsall, in particular, has been able to turn round its previous difficulties through a policy of reorganisation, prioritising attendance and engaging a significant amount of professional development training (Reid, 2005a).

Evidence obtained from a study of attendance issues at seven LEAs in England (Malcolm et al., 2003) found that all LEA representatives thought attendance was important but the scale of the problem varied in each authority. LEA representatives thought their objective of getting children into school was defeated when schools authorised absence too readily. Although schools followed LEA and DfES guidance, it may be interpreted differently by different schools. Most LEA and school staff believed that there are links between attendance and attainment. This accords with previous published research.

They also reported that all LEAs and teachers believed that attendance was important because it was related to attainment, disruptive behaviour and children’s safety. Several LEAs thought that schools were over-ready to accept the reasons given for absence and also authorised too many absences because they were under pressure to reduce unauthorised absence. Most LEA representatives and teachers thought that truants had parents who placed a low value on education and were more likely to condone absence. Local education authorities supported schools and promoted work with parents, general awareness raising with the general public and multi- agency working to combat truancy.

Local education authorities engaged in Excellence in Cities in England are undertaking an in-depth examination of pupil absence between years 7 and 10 over a two-year period, partly to examine the influence of the project on pupils’ overall attendance rates (Morris and Rutt, 2004).

The link between truancy and crime

The link between truancy and crime has been established for almost 100 years (DfEE and Home Office, 2001). Despite this, there is no evidence that the importance of the link is diminishing (Social Inclusion Report, 1998) and considerable evidence that offending among 11-16 year olds appears to be increasing (Youth Justice Board, 1999). Not only are those who truant more likely to offend than those who do not but they are also more likely to commit repeated offences. In one study by the Youth Justice Board 65 per cent of truants had committed criminal offences, compared with only 30 per cent of those who had not (Youth Justice, 2002). One survey reported that only seven out of ten schoolchildren can say with certainty that they have not committed an offence during the previous twelve months. Only one in six of those who admitted offending stated that their last offence had been detected by the police (NACRO, 2001).

The government in England has established a cross-Whitehall group which includes senior representatives from the DfES, Home Office, Department of Health, Youth Justice Board, Social Exclusion Unit and the Police Federation which meets regularly to discuss issues affecting the truancy and crime agenda. Below this are a series of regional committees. A series of national and regional conferences have been held. Schools and LEAs were asked to review the application of their use of police protocol procedures. The police, LEAs and schools now work closely together on:

1 Truancy sweeps.

2 Challenging young people’s attitudes to criminal behaviour.

3 Developing youth participation in community projects.

4 Schemes to alert police to the proximity of truants in shopping centres or supermarkets. Schemes such as ‘Shop a truant’ have proved very effective in Liverpool.

Together, police and schools are beginning to work more closely on: their protocols with other caring agencies; information sharing; the vexed issue of confidentiality, human rights and the Freedom of Information Act; pupils’ rights; and the use or otherwise of restorative justice in schools. Schools are encouraged to appoint a dedicated teacher as a liaison officer with local police. Local groups are beginning to meet to give advice in such key areas as child guidance and community support as well as, at a practical level, to help bus companies manage difficult situations. In some local authorities, police and schools together are beginning to target high-risk disruptive truants and focusing their attention on ‘hot spot’ locations which are frequently used by truants and antisocial teenagers.

In the study undertaken by Smith (2004) at Edinburgh University:

1 Only one in five persistent truants at primary school was a girl, but this increased to three in five by the third year of secondary school – overtaking the boys.

2 By contrast, boys were much more likely to be excluded from school than girls – 74 per cent of those excluded in the third year of secondary school were boys.

3 Truants were more likely to smoke, drink and use illegal drugs than nontruanting pupils. At age 15 half of all truants reported using drugs during the last year. This increased to two-thirds among the long-term truants.

4 Factors such as weak parental supervision, dislike of school and lack of self-control help to explain both why young people use substances and why they skip school. After allowing for these other factors, there was still a direct link between using substances and truanting. For example, being out of school provides more opportunities for smoking, drinking and taking drugs.

Current trends

Some pupils appear to be caught in a cycle of poor attendance, which affects their attainment and attitude to school and leads on to subsequent authorised absence (Malcolm et al., 1996). Worryingly, there is evidence that the age of the onset of truancy and non- attendance is becoming increasingly younger. Malcolm et al. (2003) found that 27 per cent of primary pupils compared with 16 per cent of secondary schools started missing school at some point – figures they believed to be an underestimate. Thus researchers are increasingly stressing that early intervention strategies are essential to combat truancy and other forms of non-attendance (Learmouth, 1995; easen et al., 1997).

Equally of concern is the finding that more pupils in years 7, 8 and 9 are beginning to miss school (OfStEd, 2004a), possibly because of the adverse ef\fects of the National Curriculum. Therefore, how the revised 14-19 curriculum and increasing provision for after- school, out-of-school, pre-school and alternative curriculum strategies will impact upon attendance will be of considerable interest to policy makers and teachers alike. Certainly, these initiatives should be only of benefit to some less able and disaffected pupils.

The sharp rise in unauthorised absences in England should be another cause of concern (DfES, 2004). As missing school and truancy are habitforming, there is unlikely to be a significant decrease in truancy behaviour in the foreseeable future (Malcolm et al., 2003) unless earlier intervention strategies start to become more successful than is the case at present, as most school-based and LEA initiatives tend to be secondary and adolescent-oriented.

It used to be considered that more boys than girls truanted. Conversely, more girls than boys were parentally condoned (Reid, 1985). This, too, may be changing. Malcolm et al. (2003) found that a higher percentage of girls than boys now truant, although there were some variations among pupils from ethnic minority backgrounds. Interestingly, however, absentees and truants do not form a homogeneous group (Malcolm et al., 1996; Easen et al., 1997). Although the work of individual schools can make a difference, there appears to be no single prescriptive way to reduce truancy (Hallam and Roaf, 1997).

Whilst there has been a proliferation of semi-professional and paraprofessional appointments within both schools and LEAs, the position of the education welfare service remains unresolved. The NFER (2002, 2003) evaluation of the pilot devolution project of education welfare services to schools reported encouragingly on this trend. However, different policies and practices between local schools and the education welfare service abound. Nationally, the education welfare service has been attempting to devise its minimal occupational standards and professional development needs (TAG, 2004). Thus, whilst OfStEd (2004a) is finding that the role of learning mentors and classroom assistants is helping to raised standards, promote social inclusion and improve attendance, the service with prime responsibility for managing pupils’ attendance continues to struggle. For example, the DfES (2001, p. 31) document Good Practice Guidelines for Learning Mentors reinforces the role of these staff in managing attendance as part of good practice at school level.

The evidence from research suggests that, whilst there are any number of useful strategies in place in schools and LEAs, no one has yet found the magic panacea to overcome all the difficulties in preventing non-attendance and truancy and enabling pupils to successfully reintegrate back into schools. Reid (2002a) found 120 different short-term solutions were in use in the schools and LEAs which he visited, with any amount of good practice available. He has also been engaged with selected schools and LEAs in implementing some successful long-term strategic solutions (Reid, 2003a, b, 3004b). Yet, some of these endeavours are local. Almost every LEA and school has its own individual schemes; some of which function better than others.

Atkinson et al. (2000) provide a useful classification of initiatives aimed at improving attendance. It includes:

1 Having appropriate service-level agreements.

2 Formulating preventative strategies, involving all pupils within a school or year group or all teachers within a school.

3 Having clear initial and first-day responses for absence, targeting particular pupils, days and lessons.

4 Implementing appropriate early intervention schemes.

5 Targeting pupils whose attendance falls below a certain level.

6 Identifying specific attendance problems in schools.

7 Having good strategies to deal with disaffected behaviour.

8 Fostering appropriate interdisciplinary and multidisciplinary links.

The prosecution of parents for their children’s truancy has never proved very satisfactory despite constant legislative changes, research and practice. Recent research has focused upon analysing the outcome of court cases from both professional and effectiveness positions (Kendall et al., 2003, 2004) as well as the consequences of the introduction of fast-track prosecution procedures (Halsey et al., 2004). The link between non-attendance, drugs, substance abuse, smoking, drinking and exclusion is another emergent field (McAra, 2004).

Looking to the future

The introduction of the Children Act 2004 is resulting in the biggest organisational change to face schools, especially primaries, for many a long year (Reid, 2005d). The basic idea is to ensure that schools and their facilities are available for 365 days’ use a year and throughout each extended day. Some schools will become the epicentre of local community, multidisciplinary and interdisciplinary services for all children perceived to be at risk, whatever the reason. The Children Act, along with the Crime and Disorder Act and Antisocial Behaviour Act, are at the heart of New Labour’s strategy to improve services for vulnerable children and to protect local communities.

The focus of the Children Act is upon improving every level of professional support for children perceived to be vulnerable and in need. The legislation inculcates a whole new radical agenda and philosophy which, directly or indirectly, will involve every school, teacher, paraprofessional and educational support service as well as have implications for initial teacher training, induction and continuous professional development.

It will also involve changes in supporting parents and carers, and lead to much earlier intervention, more accountability and integration between services as well as enhancing workforce reform. In conjunction with the Antisocial Behaviour Act, it will help to provide a new impetus to tackling truancy and disruptive conduct. It is also likely to lead to a rethink about the wider role of schools and of pastoral care. The Children Act is therefore, at the heart of future government strategies aimed at combating disadvantage and disaffection.

The government has begun to attempt to build the foundations for improving children’s quality of life through Sure Start, raising school standards and attempting to eradicate child poverty. It recognised, however, that truancy and antisocial behaviour remain serious problems. Too many children are the victims of crime, bullying and poor parenting skills. Therefore, in the next phase, the government is intending to create Sure Start Children’s Centres in each of the 20 per cent of most deprived neighbourhoods. These will combine nursery education, family support, employment advice, child care and health services on one site. It will promote full service extended schools which are open beyond school hours to provide breakfast clubs and afterschool clubs and child care, and have health and social care support on site. It will create more opportunities for children out of school through the creation of a Young People’s Fund. There will be a large investment in child and adolescent mental health services, an attempt to improve speech and language therapy, tackle homelessness and effect significant reform of the youth justice system (DfES, 2003).

Following the Children Act and implementation of Every Child Matters, there is an urgent need for some research into how the reorganisation of LEAs and caring professionals will integrate, operate and facilitate pupils like truants, non-attenders and disrupters and how the new multidisciplinary teams will interface with parents and carers.

Conclusion

After more than 130 years of compulsory schooling and a century of research into school absenteeism and truancy we are little nearer finding definitive solutions. In fact, in some ways research continues to reveal how increasingly complex the field of study of truancy and school absenteeism has become. There is little sign of Britain losing its position as the country in Europe with the highest rates of non-attendance and unauthorised absence. Nonattendance and truancy continue to fester, promoted by such factors as social inequalities, poverty, the anti-educational attitudes and incompetence of some parents, low literacy and numeracy skills, poor and undemanding teaching, boredom among certain pupils, adverse peer pressure, unattractive school buildings and adverse school climates. There is, for example, a long way to go before schools in Britain have a constructive vocational curriculum for all 14-19 year olds which is valued by all parties in the educational enterprise – not least the pupils themselves. One part of the problem is that successive governments are constantly reacting to truancy though a whole range of initiatives, some of which are often ill conceived or too hastily introduced.

No one can really be sure of, or even estimate accurately, the precise longterm costs of non-attendance and truancy from school, especially for the consequences of their adult lifestyles (Malcolm et al., 2002). There is little doubt that disaffected pupils continue to cost the taxpayer considerable sums of money – not least in terms of professionals’ time and support, legal fees, social security, housing benefit, crime prevention, mental health budgets and prolonging the generational truancy syndrome which is affecting some parts of the United Kingdom. This point can be reiterated when the real costs of trying to prevent truancy and return pupils to school are taken into account along with all the multidisciplinary and interdisciplinary support needed, which includes the cost of combating crime and youth offending (Boyle and Goodall, 2005a). The New Philanthropy Capital report (Boyle and Goodall, 2005b) calculates that over their lifetime each truant costs society at least 250,000.

Throughout the United Kingdom the overall improvement in attendance levels over the las\t ten years is only slight. Preventing and combating absence is expensive in terms of staff time. It is also costly for schools, LEAs and the nation. It is becoming increasingly interdisciplinary and multidisciplinaryoriented. Also, the behaviour of truants in school can adversely affect the learning and behaviour of other pupils (Learmouth, 1995; Malcolm et al., 2003).

Despite all the good practice within schools and LEAs – and there is much better practice now than ever previously – the number of pupils missing school continues to staunchly resist all our best endeavours (NAO, 2005). There is still a lack of successful early intervention techniques being applied and the evidence is that more support needs to be given at the primary and initial stages before it is too late and pupils’ attitudes have hardened. Given that 36 per cent of pupils begin their history of truancy or non-attendance in the primary phase, and more girls are becoming disaffected and truanting, much more research into practically based solutions needs to be undertaken. It will be interesting to discover how recent government initiatives such as Every Child Matters and the Antisocial Behaviour Act will help to improve the position over a considerable period of time.

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Ken Reid Swansea Institute of Higher Education

Address for correspondence

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Copyright Manchester University Press Nov 2005

Timing Adjustment Can Lower Nox

My car recently flunked its emission test because of high NOx. The fix that got it through the test was to retard the timing. My question is how this works. I don’t understand how timing works and I am wondering how this adjustment might affect the performance of the car. Was this the best repair for high NOx?

– Al Jacklin, San Francisco

A. Let’s look at oxides of nitrogen (NOx) first. NOx, a combination of nitrogen and oxygen, is created in large quantities when your engine’s combustion chamber temperature rises above 2,500 degrees. NOx is a contributor to acid rain and combines with hydrocarbons to produce ozone, a major component of smog.

The engine-management system does its best to limit NOx production by carefully regulating the air-fuel mixture and ignition timing. A properly functioning catalytic converter reduces emissions further. Common causes of elevated NOx are a lean air-fuel mixture; advanced ignition timing; lower than specified octane fuel; a faulty EGR (exhaust gas recirculation) system, if used; carbon buildup in the combustion chambers; elevated engine temperature and a weak catalytic converter.

Ignition timing refers to the instant the air-fuel mixture is ignited, relative to the position of the crankshaft (and pistons, which drive the crankshaft via connecting rods). Base ignition timing might be adjusted on vehicles equipped with a distributor (largely phased out during the 1990s), and the timing advances additionally via mechanical or electronic means according to engine speed, load and temperature. Proper ignition timing – a combination of the base setting and advance system – is critical for optimum performance, fuel economy and low emissions. An engine with excessively advanced timing will run well, but is prone to ping (harmful abnormal combustion) and produce excessive NOx. Retarded timing reduces engine performance, fuel economy and emissions.

Why was your timing readjusted? The California emissions test requires the timing to be checked. Should it be off spec and the test fails, an adjustment is sold and performed, and the vehicle is retested. It appears the test failure was for excessive NOx only, so it seems the tech might have adjusted timing below specs (more than a couple of degrees is a test violation and ill advised from a performance standpoint). If you find your car’s engine performance and fuel economy to be OK, I wouldn’t worry about the adjustment. If not, the timing should be restored to specs and the true cause of the NOx failure investigated.

My hope is this was a borderline emissions failure and the timing was found to be a couple of degrees advanced – perhaps ignored during the initial inspection – then corrected. Proper conditioning of the vehicle, including fully heating up the catalytic converter, can be a large factor in passing an emissions test. A failed vehicle might pass the tailpipe test on the second try, without adjustments or repairs, simply because of the additional running time.

BRAD BERGHOLDT IS AN AUTOMOTIVE TECHNOLOGY INSTRUCTOR AT EVERGREEN VALLEY COLLEGE IN SAN JOSE. WRITE TO HIM IN CARE OF DRIVE, MERCURY NEWS, 750 RIDDER PARK DRIVE, SAN JOSE, CALIF. 95190; OR E- MAIL TO UNDER-THE-HOODJUNO.COM. HE CANNOT MAKE PERSONAL REPLIES.

Federal Vioxx Jury Says Merck Not Liable in Death

By Michael Depp

NEW ORLEANS (Reuters) – A federal jury said on Friday that drugmaker Merck Co. Inc. was not liable in the 2001 death of a Florida man who used the recalled painkiller Vioxx.

The eight-person jury’s verdict was the first in a federal court and the third out of more than 9,000 cases filed against Merck in U.S. and state courts claiming the company hid the once-best-selling painkiller’s health risks.

Specifically, the jury found Vioxx was not a defective product, that Merck was neither negligent in making the product nor did it fail to warn users of its risks.

MARKET REACTS

Merck’s share price jumped 1 percent to $36.50 in after-hours trade after closing at $36.05 Friday on the New York Stock Exchange.

Analysts said early court victories were good news for the drugmaker.

“This is certainly good for Merck. The more they win these cases early on the better off they are,” said Ram Partners LP hedge fund partner Thomas Bundock, who added the fund does not own any shares of the drugmaker due to the legal hurdles facing the company.

“So far, Merck has done an admirable job of fending them off,” Bundock said. “The question is: Can they continue? This is going to be a long, drawn-out process.”

The case heard in the U.S. District Court for the Eastern District of Louisiana focused on the death of 53-year-old Richard “Dickie” Irvin, whose family claimed Vioxx triggered a heart attack.

Merck argued Irvin’s heart attack was due to an unhealthy lifestyle that led to clogging of his arteries.

“The jury’s decision confirms there is no medical or scientific evidence showing the short-term use of Vioxx increased the risk of heart attack or contributed in any way to the death of Richard Irvin,” Merck said in a statement.

Irvin’s widow, Evelyn Irvin Plunkett, shook her fist and cried as she walked out of court with her attorney Andy Birchfield.

APPEAL POSSIBLE

Irvin’s survivors may consider appealing the verdict, Birchfield said. He added that losses in the early trials did not mean the plaintiffs’ cases are weak.

“Merck is taking the position that they are going to fight every one of these cases and we’re going to do the same,” Birchfield said. “The case only gets stronger and stronger. It paints a darker and darker picture over what Merck did.”

Merck’s attorney, Phillip Beck, said Friday’s verdict strengthens Merck’s contention that it acted appropriately and in response to scientific evidence.

“Juries can understand that the Merck people acted appropriately at all times regarding Vioxx,” Beck said.

The jury’s verdict capped a retrial of the case. In December a nine-member jury could not reach the needed unanimous verdict when one member said Merck was liable for Irvin’s death.

Merck recalled Vioxx in September 2004, after it was shown to double heart attack and stroke risks for those who took it at least 18 months.

This case is the first of the Vioxx lawsuits to be tried in federal court. It was originally tried in Houston after Hurricane Katrina temporarily closed the federal courts in New Orleans.

Two other cases have been completed in state courts, with Merck winning one in New Jersey and losing one in Texas, where the widow of a 59-year-old Vioxx user was awarded $253 million in damages. Merck is appealing that verdict.

Analysts have said the company’s legal costs to fight the lawsuits could total several billions of dollars.

Groups seek broader response to church fires

By Karen Jacobs

ATLANTA (Reuters) – Rights groups on Friday urged U.S.
President George W. Bush to denounce church burnings and devote
more resources to curbing such attacks after a recent spate of
church fires in Alabama.

“The president has to say that it’s a national priority,
because then the resources will flow,” said Rose
Johnson-Mackey, program director for the National Coalition of
Burned Churches, a Charleston, South Carolina, group that helps
burned churches rebuild.

At a news conference in Atlanta, groups including the
Southern Christian Leadership Conference said national
attention to church burnings had waned since 1996, when
then-President Bill Clinton set up a task force devoted to
church fires that led to more arrests and prosecutions.

In 1996, 409 U.S. churches burned, the most during any year
tracked by the church coalition.

“Somewhere along the line, the resources that were
dedicated to stop church arsons in this country have been
scaled back,” said Dexter Wimbish, general counsel for the
Atlanta-based SCLC, which was co-founded by Martin Luther King
Jr.

“We send out a call again to rededicate resources,
reconvene the national church arson task force,” Wimbish said.

Speakers said the government’s response to recent burnings
of Alabama churches, in which scores of federal, state and
local officials are pursuing leads, should be a model for how
every U.S. church arson should be investigated.

Ten churches in southwest Alabama have been destroyed or
damaged since February 3. The FBI has said it was looking into
whether the blazes could be considered hate crimes under the
Church Arson Prevention Act of 1996.

“What you see in Alabama is a coordinated law enforcement
response,” Johnson-Mackey said. “What is happening there is
what should happen for every church that burns anywhere in the
United States.”

The coalition said its arson registry showed 1,507 churches
were burned in the United States from 1990 to 2000, with the
highest number of fires in Southern states such as Florida,
Alabama and South Carolina.

From 2000 to 2006, the group said it documented fires at
roughly 600 U.S. houses of worship.

The Rev. James Posey, pastor at Morning Star Missionary
Baptist Church in Boligee, Alabama, which burned to its
foundation on February 7, said his 30-member congregation hoped
to rebuild, even though it had no replacement insurance.

“It’s traumatic,” Posey said. “I’ve shed tears.”

Orphanages Stunt Growth, Foster Care Better

By Maggie Fox, Health and Science Correspondent

ST. LOUIS – Children raised in orphanages are stunted physically, emotionally and intellectually but good foster care can help orphans start to grow again, researchers said on Friday.

An experiment in which foster homes were set up in Romania showed that children taken out of the country’s notorious orphanages began to grow taller and put on weight, gain intellectually and lose the most marked symptoms of depression and anxiety.

The researchers said their findings apply to all children in orphanages, not just in Romania. Their study, however, provided them a unique opportunity to examine the effects of foster care in a place where it had never existed before.

“An orphanage is a bad place for a child to grow up in,” Dr Dana Johnson, a pediatrician and adoption specialist at the University of Minnesota, told a news conference.

Johnson and colleagues, funded by the John D. and Catherine T. MacArthur Foundation, did the first scientific comparison of what happens to children raised in orphanages versus those raised in foster care and children raised in normal families.

They persuaded the Romanian government to place 69 children in foster homes — something that had not existed in Bucharest before. Another 67 had to remain in the orphanage and the researchers compared the two groups.

Social workers trained the foster families and checked on the children’s progress.

“At age of entry, institutionalized children are doing very poorly compared to community controls,” Dr. Nathan Fox of the University of Maryland told reporters.

“Their mean IQ score is close to the retarded range compared to community children and compared to standard norms. The good news is … foster-care children showed increases in IQ at 42 and 54 months (4 1/2 years).”

Girls, especially, did well, Fox and colleagues told a meeting in St. Louis of the American Association for the Advancement of Science.

“At the age of 42 months (3 1/2 years) there is a significant group difference between children who were placed into foster care and children who remained in institutions,” Fox added.

TOO SAD TO EAT

Johnson found the children also grew very quickly in foster care.

“Children who are neglected or abused do not grow,” Johnson said. They may not be fed properly, but also depressed children do not eat well, he said.

“You can predict in regular orphanages that you are going to lose one month of growth for every three months in the orphanage,” Johnson said. “A three-year-old child will be the size of a two-year-old.”

But, placed into foster care, they literally shoot up, Johnson said.

“By the time they have been in foster care for a year and a half, they had reached normal size in terms of height,” he said. “I always tell the families not to buy many expensive clothes.”

Johnson believes physical growth can be used as a way to measure a child’s progress overall.

Not everything dramatically improved in the foster children. Behavioral disorders, especially in boys, did not always disappear.

And Dr. Charles Nelson of Harvard University found that brain scans did not change as dramatically as he had hoped among the children in foster care.

His team had found that electroencephalograms, or EEG scans, done on institutionalized children were much different from those of children raised in families. The children are scanned while looking at pictures of human faces with various emotional expressions.

“There is a diminution of brain activity,” Nelson said.

Foster care did not immediately improve this, although those children who spent the longest time in foster care did begin to show some improvement, he said.

Dr. Charles Zeneah of Tulane University said the study might help governments come up with better ways to help children orphaned or abandoned due to wars, the AIDS epidemic and other scourges.

“There has never been an institution, even in the West, that has been able to promote normal development, but there are interventions that can make it a more family-like environment,” Zeneah said.

Panama Tribe Faces Threat as Cocaine Comes Ashore

By Mike Power

KUNA YALA, Panama (Reuters) – Two Kuna Indian fishermen haul a bale of cocaine from their rickety sailboat onto a busy dock on a tiny island off Panama’s Caribbean coast then sprint with it to a safe house.

That brings the day’s catch to 14 packages, says a local. Each contains 30 one-kilo (2.2-pound) packets of cocaine, for a total haul of 420 kilos (924 pounds), dumped at sea by Colombian smugglers fleeing coastal patrols.

The traffickers travel at night in fiberglass boats with three 200-horsepower engines, shipping drugs from Cartagena to the United States in seas north of Kuna Yala, a chain of 365 mostly uninhabited islands along Panama’s northern coast that comprise a semi-autonomous homeland for the Kuna Indians.

When chased by patrols the traffickers often sink their ships or dump their cargo and take the loss in order to avoid the risk of being prosecuted for drug smuggling.

“When we find them at sea without drugs or passports we have to turn them over to immigration officials,” said Jose Guerra, a spokesman for the national maritime service. “Then they are deported as illegal immigrants.”

Impoverished locals scoop up the abandoned cargo and sell most of it to visiting drug dealers. But tribal chiefs say the influx of drugs and money is threatening Kuna culture and health, as some cocaine stays on the islands to be consumed.

By sunrise most of this day’s haul is sold to dealers from nearby Colon for over $250,000, islanders say. By lunchtime, the cash windfall has been shared out and a festive mood prevails. Children clutching bills skip to small shops to buy toys. No one has change for even the smallest note for the next 24 hours.

“Everyone is involved in this, even the women and children. It’s like winning the lottery,” said one fisherman mending his nets.

WHITE GOLD

The setting is idyllic. The wind blows through stick-walled cabins and rustles thatched roofs until it sounds like the whole island is whispering. The horizon is dotted with islanders in tiny boats searching the sparkling seas for the “white gold” that comes closer to land in the dry season when the north wind blows.

The Kuna are an independent people who practice subsistence agriculture, embroidery, coconut farming, lobster fishing and small-scale tourism in the 200-mile (322-km) long archipelago.

It is just 30 minutes from cosmopolitan Panama City by plane, but culturally it is a world away. Kuna is the first language here, and many women wear traditional vivid dresses, adorning themselves with colored bracelets, fine gold jewelry and delicate nose rings.

The islands feature in government tourism campaigns, but the reality behind the glossy brochures is extreme poverty, with up to 70 percent infant malnutrition, according to the United Nations. So some communities welcome the drug hauls.

But as more islanders consume the cocaine, the windfall’s flipside is a wave of addiction and domestic violence.

Dr. Edison Murillo has worked across the area for 13 years and says he sees an increase in drug-related illnesses. Lobster divers are using cocaine to help them fish, he said.

“Most of the deaths from cocaine intoxication are found in this group,” he said. “They use it to help them dive deeper.”

GLOBAL ILL

The Kuna General Congress, a legislative body in Panama City, says it cannot fight the problem alone.

“The Panamanian government is not offering enough help,” said tribal leader Gilberto Arias. “This is a global problem. We do not grow coca (the raw material for cocaine), nor do we export it. We punish those who we find involved in this.”

One local chief told Reuters that drugs were changing his island. “Some young men don’t farm any more. They just go to the hills to take cocaine,” he said.

The chief, who asked not to be named, wants to organize a secret police force to fight drugs after a teen-ager died on the island last year of an overdose.

The national police have local units made up of Kuna Indians to police the islands, though some residents say they turn a blind eye to the drugs.

Patricio Candanedo, Panama’s public prosecutor for narcotics, said Kuna chiefs are assisting national anti-drugs forces. “They are supporting our work and we have excellent cooperation,” he said.

On another island farther east, dozens of hand-painted signs warn villagers: “Drugs Destroy Families.” “Drugs Kill.”

Farmer Arturo brought ashore a traffickers’ boat last year. “I was guarding my coconuts when I saw this thing floating in the sea. I was scared as I thought it was a monster, but then I saw it was a boat.

“I got help to bring it ashore. It had three 200-horsepower engines,” he said. “We sold them, and now we are waiting to sell the boat.”

As he spoke, a group of children played in the shade beneath the 40-foot (12-m) hull, hanging above their heads secured only by bricks and slender wooden ramps made of coconut trees.

Original Smokestack Restaurant Closes Doors

By Joyce Smith, The Kansas City Star, Mo.

Feb. 17–“My children were little babies when we moved there. But my husband had this dream of having a barbecue and we all worked together and we were all together. It was a success and generated all the rest of them.”

Flora Fiorella

The original Smokestack Barbeque at 8129 South U.S. 71 has closed after nearly 50 years in business.

Flora Fiorella, matriarch of the barbecue clan linked to five other area restaurants, blamed a changing market area, construction on U.S. 71 and growing barbecue competition for the restaurant’s demise.

“It’s very hard for me,” she said. “My children were little babies when we moved there. But my husband had this dream of having a barbecue and we all worked together and we were all together. It was a success and generated all the rest of them.”

Fiorella said her in-laws were Independence farmers who shifted to the grocery business when farming profits started falling. Her husband, Russell Fiorella, a butcher in the store, also changed careers when new supermarkets entered in the late 1950s and made it hard for “mom and pop” grocers to compete.

In 1957, Russell and Flora Fiorella opened the first Smokestack Barbeque. The family of eight — including a newborn — moved from a 23-room Brookside house into a six-room apartment above the restaurant. Customers would bang on their apartment door after-hours demanding barbecue, she said, but the Fiorellas didn’t mind.

In late 1974, their son Jack Fiorella opened a Smokestack location in Martin City, and later added locations in Overland Park and in the Crossroads Arts District. The three restaurants now operate under the Fiorella’s Jack Stack Barbecue name.

“I spent 15 years of my life there; it was my introduction to the food business when I was 14,” said Jack Fiorella of the original location. “My mother was the waitress and we came in to work after school. It didn’t even have a liquor license but it was extremely popular from the mid-1960s to mid-1980s. People lined up to get in.”

Two of Russell and Flora’s daughters, Carol Fiorella and Diane Fiorella Marak, later took over the original location “temporarily” after their father had a stroke. When he died they operated the restaurant for their mother for more than 20 years.

Another sister, the late Mary Fiorella McPheron, opened a Smokestack at 8921 Wornall Road, which is now owned and operated by her children, Sarah, David and Ben Eisman. Another son, Russell Fiorella, owns and operates a location at 8250 N. Church Road in Kansas City, North.

In 1997, more than 60 persons who ate baked beans catered from the original location became ill with salmonella, one of the largest food-borne disease outbreaks in recent years in the Kansas City area, but Flora Fiorella said it didn’t affect sales.

A health inspection from May 2005 showed three critical violations — for black buildup on a coffeepot, lack of knowledge by kitchen staff on cooking temperatures, and shelves in a walk-in cooler with rust buildup.

Jack Fiorella, who has not been involved with the operation of the original restaurant for many years, said succession plans are important in a family-owned business. Managers also need to benefit financially from the business, he said, because then if the owners are not in the building or the next generation is not as talented, someone has an incentive to keep up high quality and service.

“When I first had a restaurant and would leave to take a break with my family, the next day customers would call saying it wasn’t as good because I wasn’t there,” he said. “So I worked hard to make sure it would be.”

As the south Kansas City market changed, he said, his family needed to change how they marketed the original location, much like his father did when he offered full-service barbecue when most barbecue restaurants were cafeteria-style.

“My dad was a very innovative person, quite the marketer and merchandiser,” he said. “Places don’t have the greatest locations but people flock to them. The (original location) should have shifted; it should have been a more roadside barbecue; a great carryout place.”

To reach Joyce Smith, call (816) 234-4692 or send e-mail to [email protected] .

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Copyright (c) 2006, The Kansas City Star, Mo.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected].

‘America’s Most Wanted’ to Air Edwardsville Killing: Will Cover Shooting of 25-Year-Old in October 2003

By Brian Brueggemann, Belleville News-Democrat, Ill.

EDWARDSVILLE — The television program “America’s Most Wanted” will air a segment Saturday about an unsolved Edwardsville murder.

Police discovered Antonio “Tony” Jones, 25, shot to death when they responded to a 911 call from Jones’ apartment in Edwardsville on Oct. 20, 2003. The man’s 6-year-old son had called 911.

A man who disguised or covered his face rang the doorbell at the apartment. When the boy opened the door, the attacker fired multiple shots at Jones.

The show will be broadcast at 8 p.m. on the Fox network, KTVI Channel 2.

Edwardsville Detective Barb Frolik said police do not have a suspect.

“We’ve developed new leads, and that’s why we’ve contacted ‘America’s Most Wanted,'” Frolik said. “We hope to develop more leads in the case.”

Police have stated in affidavits that Jones’ son heard the gunman ask where the money was. Jones refused to answer. Police found $5,000 in cash, an ounce of cocaine and two electronic scales in the apartment on Vandalia Street, near downtown Edwardsville.

Police obtained a search warrant for the cellular phone records of a man who was with Jones on the day of his murder. Jones’ wife told police the man dealt drugs with her husband.

Frolik said investigators are not certain about a motive for the killing. Police also have said they believe the killing was not a random act of violence.

The family of Jones has offered a $10,000 reward for information that leads to a conviction in the case. Anyone with information can contact Frolik at 781-3188, the Edwardsville Police Department’s anonymous tip line at 692-7552 or “America’s Most Wanted” at (800) CRIME-TV (274-6388).

Contact reporter Brian Brueggemann at [email protected] or 692-9481.

—–

Copyright (c) 2006, Belleville News-Democrat, Ill.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected].

Researchers Find Trigger for Cocaine Addiction

Discovery could lead to new treatments, researchers say

Experiments in rats have linked the craving for cocaine to a specific molecule that appears to train the brain to crave the drug.

The finding could lead to addiction treatments that would block this biologic trigger, experts say.

The researchers found that a protein, called orexin A, acts on an area of the brain that is key to priming the brain for addictive drugs. In experiments with rats, they show that orexin A causes an adaptation that is needed for the development of behavior associated with drug craving in human addicts.

The findings appear in the Feb. 16 issue of Neuron.

“We have looked at the protein orexin A, and found that it causes plasticity in an area of the brain that has been shown to be involved in reward behaviors,” said study author Stephanie L. Borgland, a researcher at the Ernest Gallo Clinic and Research Center at the University of California, San Francisco.

This area of the brain has been found to be activated when animals prefer morphine, Borgland said. “Our paper is actually showing the mechanism of how that happens,” she added.

Borgland’s team based their experiments on past studies that found that orexins are important regulatory proteins produced in the brain’s lateral hypothalamus. It has been known that orexins activate an area in the brain called the ventral tegmental area (VTA), which is a critical site of brain adaptation caused by addictive drugs.

In their experiments, Borgland’s group demonstrated that orexin A increases the activity of neurons in the VTA associated with such plasticity. In addition, they found that orexin A was needed for “behavioral sensitization” to cocaine. This was shown as an increase in activity by the animals when they received the drug and even after the drug was withdrawn. This indicates that the animals experienced an increased craving for the drug, Borgland said.

“This gives us a better understanding of a pathway that’s involved in addiction,” Borgland said. “It may provide a new target for developing anti-craving medications.”

One expert believes this finding may have therapeutic implications.

“The finding is consistent with other work in addiction focusing on processes that project onto the dopaminergic pathways, either upstream or downstream,” said Steven Shoptaw, a research psychologist at the Integrated Substance Abuse Programs at the University of California, Los Angeles.

“The finding is an exciting development, and provides compelling support for the working thesis that a critical basis for addiction lies within neurobiology,” Shoptaw said. “There is plenty of evidence here to move forward the idea that orexin receptors represent novel targets for developing new medications that are intended to treat addiction.”

Another expert agrees that drugs that block orexin might be effective in treating drug addiction.

“Antagonist of orexin looks like a very exciting tool,” said Dr. Thomas Kosten, a professor of psychiatry at Yale University Medical School.

If these behaviors are changed in animals, then these drugs can be tried on people, he said.

“Human studies would determine whether this type of medication might reduce cocaine euphoria, craving or other subjective effects associated with addiction and relapse,” Kosten said. “This work is clearly approaching a finding that would excite the community of clinical researchers in addiction.”

More information

The National Institute on Drug Abuse can tell you more about cocaine addiction (www.nida.nih.gov ).

Nerve Damage May Underlie Mystery Pain Syndrome

NEW YORK (Reuters Health) – The findings from a new study lend support to the hypothesis that the so-called “complex regional pain syndrome” is a bona fide neurologic disorder caused by persistent nerve injury affecting small fibers that can feel pain.

Complex regional pain syndrome involves post-traumatic limb pain and other disturbances that continue even though the inciting injury seems to have healed. The cause of the symptoms is unknown and because there are few objective findings, diagnosis and treatment is difficult. Some have even questioned whether complex regional pain syndrome has a real biologic basis or is a psychosomatic illness.

In the current study, reported in the journal Pain, Dr. Anne Louise Oaklander and colleagues, from Harvard Medical School in Boston, performed sensory testing and quantitative nerve assessment of affected and unaffected sites on 18 patients with complex regional pain syndrome.

Seven subjects without complex regional pain syndrome, but with similar symptoms served as additional controls.

The complex regional pain syndrome patients had classic histories and symptoms for the disorder. Unexpectedly, the researchers found that complex regional pain syndrome onset was often associated with medical procedures.

Sensory testing showed that sites affected by complex regional pain syndrome were highly sensitive to mechanically- and heat-induced pain and also showed decreased nerve fiber densities.

By contrast, control subjects did not display these reductions at their pain sites, “suggesting that pain, disuse, or prior surgeries alone do not explain complex regional pain syndrome-associated neurite losses,” the authors state.

“The fact that complex regional pain syndrome now has an identified cause takes it out of the realm of so-called ‘psychosomatic illness’,” Oaklander said in a statement.

“Our results suggest that complex regional pain syndrome patients should be evaluated by neurologists who specialize in nerve injury and be treated with medications or procedures that have proven effective for other nerve-injury pain syndromes.”

SOURCE: Pain, February 2006.

Think Your Drugs Are Manufactured in America? Think Again! FDA, Drug Companies Deceive Americans About Where Their Prescription Drugs Come From

ST. LOUIS, Feb. 15 /PRNewswire/ — The publisher of a leading informational web site for America’s seniors today charged the Food and Drug Administration (FDA) with deliberate deceit and misleading the American public about where their prescriptions come from.

Daniel Hines, publisher of http://www.todaysseniorsnetwork.com/ , says that the FDA has engaged in deceit by claiming that prescribed drugs ordered from legitimate pharmacies outside the U.S. are ‘unsafe’ if they come from different countries other than the country in which the order was placed.

“The fact is that the majority of the prescriptions used by Americans — whether they are purchased at a local pharmacy or from a licensed pharmacy outside the U.S. — are not manufactured in this country,” Hines says.

“The FDA is well aware of this since they provide oversight of drug company manufacturing facilities in countries around the world to supposedly ensure that those drugs are manufactured to FDA standards so they can be sold to U.S. citizens.

“To claim that those same prescription drugs for which the FDA has provided oversight are unsafe when prescriptions are filled from licensed pharmacies outside the U.S. is disingenuous at best and fraudulent at worse.”

Hines notes that the latest claims of ‘unsafe’ prescriptions coincide with the introduction of the flawed Medicare Prescription Drug Card Part D plan.

“The cozy relationship between the FDA and large drug manufacturers is well-known and borders on nothing less than a national scandal,” Hines says. “This is an obvious attempt to scare America’s elderly into participating in Part D.

“That is why http://www.todaysseniorsnetwork.com/ will be implementing a petition drive among the elderly, the disabled and low-income people to seek new labeling standards that require identification of the country where prescription drugs are manufactured, whether in the U.S. or other countries where drug companies have manufacturing sites.”

Hines said that it is imperative that Congress reestablish its legislative authority over the FDA, stating that addressing the latest misstatements of the agency would be a good place to start.

“For years, we have watched as Congress has floundered on a number of issues involving the FDA and its relationship with pharmaceutical manufacturers,” Hines explains. “This includes failure to act on allowing access to prescription drugs from outside the U.S., even though a majority of both the Senate and House of Representatives favors such legislation. It also includes being hamstrung as the FDA takes actions such as sporadic and irregularly applied seizures of prescribed drugs ordered from licensed pharmacies outside the U.S. even though existing law allows such purchases by Americans when a drug or medicine is not available in the U.S.”

Hines points out that a prescription that is unaffordable is not available, and therefore makes the elderly, disabled and lower-income people eligible to order from pharmacies outside the U.S.

“The failure of our elected officials to act to remedy this situation and make the law work for the elderly, poor and disabled reflects the pervasive influence of the relationship of many lawmakers with drug companies, or failure by supporters of allowing access to prescription drugs from outside the U.S. to exercise the political courage and leadership that puts the drug companies and the FDA on notice that their actions are not acceptable and will no longer be tolerated.

“Since drug manufacturers and the FDA claim to be so concerned about the country of origin for prescription drugs, they should jump at the opportunity to let American consumers know where their prescriptions are actually produced,” Hines concludes.

First Call Analyst: FCMN Contact: [email protected]

Daniel Hines

CONTACT: Daniel Hines, +1-314-308-2545

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

First Check Receives First-Ever FDA Approval of an Over-the-Counter Home-Use Drug Test to Screen for Prescription Drugs – Now Available to Parents

LAKE FOREST, Calif., Feb. 15 /PRNewswire/ — First Check Diagnostics LLC, the leader in providing the highest quality home diagnostic testing kits to assist people in living safer and healthier lives, today announced that it has received the first-ever over-the-counter 510(k) clearance issued by the U.S. Food and Drug Administration (FDA) for a home-use drug test to screen for prescription drugs. The test, which will be available to parents beginning today online at CVS.com and stocked in retail outlets over the next 60 days, is called the First Check 12 Drug Test. It screens for five prescription drugs: Benzodiazepines, Barbiturates, Methadone, Oxycodone and Tri-cyclic Antidepressants; and seven illicit drugs: Marijuana, Cocaine, Ecstasy, Phencyclidine, Amphetamine, Opiates and Methamphetamine. The test can provide results in as little as five minutes.

“The trends in drug use among the nation’s youth have shifted in the last few years,” said Kevin Gadawski, President of First Check Diagnostics. “Most alarming is that non-medical use of prescription drugs continues to show a sharp increase in terms of use among children aged 12 and higher. With the first-ever FDA approval of an over-the-counter home testing kit, First Check has added another needed resource to help parents and children live safer and happier lives.”

Parents across the nation increasingly have been calling for tools to help fight against drug abuse, including technologies to address the escalating abuse of prescription drugs by children and teenagers. Following the recent release of the Monitoring the Future Survey (http://monitoringthefuture.org/) conducted by the University of Michigan, which showed continued, upward trends in prescription drug abuse among youth, Dr. Nora D. Volkow, Director of the National Institute on Drug Abuse (NIDA) stated, “Prescription drugs are very powerful medicines that are effective when used properly and with a doctor’s supervision. Using these drugs without a prescription is dangerous. It is imperative that teens get this message.” National Institutes for Health (NIH) Director Dr. Elias Zerhouni also stated following the release of the Survey that ” … the upward trend in prescription drug abuse is disturbing. We need to ensure that young people understand the very real risks of abusing any drug.”

“According to additional research from the Partnership for a Drug Free America, close to half of all teens believe using prescription medications to get high is ‘much safer’ than street drugs,” continued Gadawski. Close to one-third believed prescription pain killers were non-addictive. While the issue of drug abuse is national problem, the human toll taken among parents and children dealing with such challenges take on enormous emotional and physical suffering statistics simply cannot convey. Communication and education are essential keys, but also having appropriate technologies available provides an additional layer of assurance for both parents and their children.”

As part of this national challenge, First Check continues to partner with Project 7th Grade, a national drug prevention program. Project 7th Grade today unveiled a 25-city program with Members of Congress in Washington, DC, aimed at educating parents, schools and law enforcement on means to communicate with teenagers on the perils of drug use, including efforts to address the escalating use of prescription drugs. Parents who complete the program are provided a home drug testing kit provided by First Check Diagnostics.

During 2005, Project 7th Grade was successfully rolled out in Phoenix, Cincinnati, Dallas and Omaha. This year, the program has already received invitations from schools in Chicago, Boston, Atlanta, Miami, Baltimore and Pittsburgh; and pending initiatives will be engaged in 25 cities by the fall of 2006. While the project has in the past distributed free test kits to parents that test just for illicit drugs, the recent data regarding the non- medical use of prescription drugs has prompted Project 7th Grade to provide the new expanded kits to address what has become a rising epidemic. In support of the program, First Check Diagnostics has agreed, as part of an overall $1 million plus commitment of funding, to provide Project 7th Grade with the newly introduced First Check 12 Drug Test product.

First Check products are available at CVS Pharmacy, Rite Aid, Wal-Mart, Long’s Drug, Osco/Sav-on, Eckerd, CVS.com, Drugstore.com and Target.com. Major retailers will begin stocking the product over the next 60 days. The product is now available at CVS.com.

First Check Diagnostics, LLC is committed to be the leader in providing the highest quality home diagnostic testing kits that assist people in living safer and healthier lives. We are further committed to supporting Project 7th Grade and notMYkid, a non-profit organizations dedicated to providing information and resources on topics such as drug abuse to aid families in dealing with these and similar issues. For additional information on First Check Diagnostics, please visit http://www.firstcheckfamily.com/.

First Call Analyst: FCMN Contact:

First Check Diagnostics LLC

CONTACT: Kevin Gadawski of First Check Diagnostics, LLC, +1-949-598-8378ext. 208, [email protected]

Web site: http://www.firstcheckfamily.com/http://monitoringthefuture.org/

Short Spell of Celebrex May Be Safe for IBD

By Karla Gale

NEW YORK — In a study of patients with dormant ulcerative colitis, a 14-day course of the selective COX-2 inhibitor, Celebrex (celecoxib), did not cause disease exacerbation. However, another study showed that use of older, nonselective anti-inflammatory agents can quickly induce relapse in patients with Crohn’s disease and ulcerative colitis. However, this study also found that short-term treatment with a Celebrex-like drug or with low-dose aspirin is well tolerated.

The results of the two studies may set the stage for larger, prospective trials of COX-2 inhibitors in patients with inflammatory bowel disease (IBD), researchers say. However, such trials will most likely have to wait until the cardiovascular disease risk from COX-2 inhibitors has been clarified.

Ulcerative colitis (inflammation of the colon) and Crohn’s disease (inflammation of the digestive tract) are two forms of

IBD.

IBD sufferers often require pain medication, but studies have suggested that conventional anti-inflammatory drugs, or NSAIDs, lead to increased rates of relapse in IBD patients. “In general,” Dr. William J. Sandborn told Reuters Health, “gastroenterologists have counseled patients with IBD to not take anti-inflammatory drugs. But when the COX-2 inhibitors came out, we wondered if the risk would be different.”

To investigate, Sandborn, from Mayo Clinic in Rochester, Minnesota, and colleagues randomly assigned 222 patients with ulcerative colitis in remission to Celebrex — 200 mg twice daily for 14 days — or placebo.

There was no difference in rates of ulcerative colitis exacerbation between the two groups (3 percent versus 4 percent). The frequency of side effects was also no different.

“But we have yet to test celecoxib in patients in relapse, and we have not addressed the risk-benefit ratio,” Sandborn cautioned. “What our results do say is that at least in this subgroup of patients you can use COX-2 inhibitors for short-term use.”

In a separate study of patients with ulcerative colitis and Crohn’s disease in remission, Dr. Ken Takeuchi, from Guy’s, King’s, St. Thomas’ Medical School in London and associates found that nonselective anti-inflammatory agents often induce relapse but that short-term treatment with a COX-2 inhibitor or with low-dose aspirin is well tolerated.

The two studies appear in the journal, Clinical Gastroenterology and Hepatology.

The Harvard-based authors of a related editorial, conclude, “with the current information, celecoxib is safe in certain inflammatory bowel disease patients for short-term use, an important, even if small, advance.”

SOURCE: Clinical Gastroenterology and Hepatology, February 2006.

Kinetix Living Offers an Instruction Manual to a Healthy Life; New Company Provides Personalized Nutrition and Fitness

SEATTLE, Feb. 15 /PRNewswire/ — Kinetix Living, a company that provides an integrated approach to fitness, nutrition and community, is now available in the United States. Previously available on a limited basis in Canada only, Kinetix Living provides a realistic solution to achieving and maintaining a healthy lifestyle by combining specific fitness and nutrition programs together to develop personalized plans that include step-by-step exercise instruction. The company has just re-launched its web site, http://www.kinetixliving.com/ , so that more consumers will have entree to Kinetix Living.

Kinetix Living was founded by a married couple, Meagan and Jamie Brunner as a result of their personal journey toward healthy living. Overweight, tired and tired of feeling that way, the Brunners set out to find a better way of life. What they discovered was that by integrating nutrition and exercise in a specific way that was personalized to an individual’s metabolism, activity level and fitness goals, they could essentially develop an instruction manual to living a healthy life. On their program, the Brunners together lost almost 200 pounds.

Realizing that they had discovered a profoundly positive approach to health and fitness, the couple launched Kinetix Living in 2000. Kinetix Living’s food program is designed to help fuel the body in a healthy way, focusing on eating nutritionally balanced meals and snacks five or six times a day. The exercise programs, combining both strength training and cardio elements, are brief, precise and highly effective, helping people reach their personal goals in an efficient manner. Kinetix Living’s balanced approach helps people lose unwanted body fat, increase energy levels and improve overall health.

Healthy living can be a common goal for many people, but the impetus for achieving that goal can be widely different. For some people its weight loss, for others it might be the ability to actively play with their grandchildren. For still others, it may be to get through the day with a feeling of peak energy and endurance.

“At Kinetix Living we don’t define success by one metric such as weight loss. Each person has different goals and dreams and we help them define success on their own terms,” said Jamie Brunner, CEO and cofounder of Kinetix Living. “Of course, a lot of people give Kinetix Living a try because of a very specific weight loss goal. That’s fine with us, because we know we can help them achieve that. But, usually after a few weeks on the program, we see people’s vision of success takes a more comprehensive view. It becomes more than just trying to fit into a certain clothing size, it becomes a matter of tapping into the potential within yourself and recognizing how to fuel and support your body so that you can live a healthier life.”

Kinetix Living community members often cite the Kinetix lifestyle as giving them freedom to focus on the things that matter most to them, without the cumbersome worry of calorie counting. Consumers can go to http://www.kinetixliving.com/ to find delicious recipes, chat with others following the Kinetix Living lifestyle and order nutritious products directly from the site. Kinetix Living products include nutrition bars, healthy soy nut snacks and meal replacement shakes, program journals and a growing catalog of healthy living products. The Kinetix Living program and associated products to support healthy living can be found exclusively online in the U.S., and its line of balanced nutrition products can also be found across a variety of retail outlets in Canada.

Brunner knows that truly lasting change takes a combination of using the right tools, in the most effective manner on a consistent basis. “We believe everyone can benefit from Kinetix Living, said Brunner. “But, we also know this is not going to be a good fit for everyone. Frankly, if you aren’t ready to commit to making a lasting change in your life, then we aren’t for you. We provide a very manageable way to achieve results and sustain them over your lifetime. It takes rigor and commitment. When you’re ready for that, we are here for you.”

About Kinetix Living

Kinetix Living provides a realistic solution to achieving and maintaining a healthy lifestyle by combining specific fitness and nutrition programs together to develop personalized plans that include step-by-step exercise instruction, coaching support, meal plans, nutritious foods and access to an active online community. By successfully integrating the appropriate nutrition with the right combination of exercise, Kinetix Living gives people the “instruction manual” they need to fuel and support their body so they can live a healthier life. Kinetix Living helps its members define success on their own terms and then partners with them to achieve that success. Kinetix Living (http://www.kinetixlivng.com/ ) was founded in 2000 and the company’s headquarters are in Seattle, Washington.

    Editorial Contact:    Julie Swartzlander    Kinetix Living    [email protected]    512-797-6602  

Kinetix Living

CONTACT: Julie Swartzlander for Kinetix Living, +1-512-797-6602, [email protected]

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

The Impact of Stress on Academic Success in College Students

By Murff, Sharon Hall

Abstract: The purpose of this article is to provide a discussion on stress and how it can prevent students from being successful in fulfillment of their educational goals. The literature is supportive of the fact that stress places demands on an individual, and in response to the stress, the body attempts to adapt to the stressful experience to maintain a sense of normalcy (Selye, 1974). Another common theme in the literature is that college students are faced with a unique set of stressors that may be overwhelming, thus altering the ability to cope with a situation. Strategies to reduce stress have been associated with academic success in college students (Dziegielewski et al., 2004).

Key words: Academic, College Students, Stress, Success

Stress is a common element in the lives of every individual, regardless of race or cultural background (Garrett, 2001). Over the past few decades, there has been significant investigation on the issues of stress and management of stress (Dziegielewski, Turnage & RoestMarti, 2004). In addition, college students have been shown to possess a unique set of stressors which can affect their daily experiences (Garrett, 2001). The focus of this article is on stress and how it can affect academic success.

According to Selye (1974 p. 27), stress is a “nonspecific response of the body to any demands made upon it”. In other words, as demands are made on an individual or as situations arise, the body attempts to adjust or adapt to the situation in order to reestablish normalcy (Selye 1974). Selye ( 1974) further states that there is a series of physiological reactions that occurs in response to environmental demands or any noxious stimulus. Some familiar reactions to demands made on the body include increased heart rate, respiratory rate, blood pressure and blood glucose level. These compensatory reactions occur to ensure the muscles and vital organs have an ample supply of oxygen, energy and nutrients to handle the challenging situation (Nathan, 2002). In addition, Nathan (2002) also states that prolonged and severe stress may be psychologically damaging in that it may hinder a person’s ability to engage in effective behavior. Another view of the effect of stress on the body was presented by Lazarus and Folkman (1984), in that they state stress is more than a response to environmental demands, but is also related to personal perception. If an individual perceives a situation as stressful, then it is indeed stressful. Also, if an individual is susceptible or vulnerable to the negative effects produced by stressors, the situation may pose a threat or may be harmful to the individual (Lazarus & Folkman 1984). Furthermore, an individual’s well-being may be at risk whenever their resources to manage the stressful situation is limited or depleted (Lazarus & Folkman, 1984). All in all, when multiple demands are made on an individual, they usually experience intense feelings of stress related to role-ambiguity, role-strain and role-overload (Dziegielewski et al., 2004).

The belief that there is a relationship between stress and disease has been discussed for several decades. Holmes and Rahe (1967) were among the first researchers who identified a relationship between stressful life experiences and the onset of disease. In addition to an overall definition of stress, Lazarus and Folkman (1984) found that hassles and uplifts seem to be a better predictor of a person’s well-being. Daily hassles have been defined by Kanner, Coyne, Schafer & Lazarus (1981) as irritating or annoying factors that occur on a daily basis, and place demands on an individual. On the other hand, uplifts have been described as positive experiences that buffer the negative effects of hassles (Kanner et al., 1981). According to Lazarus and Folkman (1984), the severity and intensity of daily hassles and uplifts are key determinants of illness and well-being

College students have a unique cluster of stressful experiences or stressors (Garrett, 2001). According to Ross, Neibling and Heckert (1999), there are several explanations for increased stress levels in college students. First, students have to make significant adjustments to college life. Second, because of the pressure of studies, there is strain placed on interpersonal relationships. Third, housing arrangements and changes in lifestyle contribute to stress experienced by college students. In addition, students in college experience stress related to academic requirements, support systems, and ineffective coping skills.

Frazier and Schauben (1994) used the Psychological Distress Inventory to obtain information regarding stress experienced by a group of female college students. The researchers found that female college students experienced stress related to financial problems, test pressure, failing a test, rejection from someone, dissolution of relationships, depression and feelings of low self-esteem. On the contrary, Ross et al. (1999), conducted a study on college students of both genders and found a different set of stressors that were common among all college students; those experiences associated with stress included a change in eating and sleeping habits, new responsibilities, heavier work loads and breaks. Similarly, Phinney and Haas (2003) reported a unique set of stressful experiences among ethnic minority, first generation college freshmen. More specifically, sources of stress included difficult financial challenges, domestic responsibilities, responsibilities related to holding a job while in school, and a heavy academic load. Also, the ethnic minority college freshmen experienced stressors such as conflicts in time management, pressure associated with their academic workload and problems within their family (Phinney & Haas, 2003). In addition to identification of stressors experienced by first generation ethnic minority freshmen, Phinney and Haas (2003) found that students who expressed strong social support congruent with their educational goals, experienced more feelings of self- efficacy, self-confidence and selfdetermination. Consequently, these students believed they were more successful in their academic endeavors in that they were better able to cope with their stressful experiences. Dill and Henley (1998) offered another viewpoint on stressors among college students. These investigators suggested that there were pointed differences in the perception of stressors between traditional versus nontraditional college students. A descriptive study revealed that traditional students were younger, and they reported more stressors associated with their peers, and stress related to social activities in college. On the other hand, the nontraditional students were older, and therefore reported stress related to family issues, due to multiple roles within the family setting.

Besides the usual stressors associated with college life, students enrolled in a curriculum of a caring profession seem to face additional stressors related to their clinical practicum (Dziegielewski et al., 2004). Also, burnout among caring professionals, such as those in medicine, nursing and social work, is an issue of concern. In fact, Dziegielewski et al. (2004)) state that the risk of burnout is high among this population of professionals. Burnout is a term that refers to emotional exhaustion which sometimes leads to ineffective professional behavior which may compromise quality care to clients (Rohland, Kruse & Rohrer, 2004).

Health care professionals are subjected to chronic stressors due to the nature of their work and environmental factors. In other words, health care professionals are constantly bombarded with a number of environmental and psychological stressors. Kanner et al. (1981) and Lazarus and Folkman (1984) determined that the number of identified stressors is not the only element that may jeopardize a person’s wellbeing. The researchers found that if there is an increase in the severity and intensity of the stressors, or hassles and uplifts, a person’s well-being is significantly affected. In other words, there is often physiological or psychological disequilibrium when the stressors are severe and intense.

In lieu of the negative effects of stressors among persons in the caring professions, there is a need for early intervention during the college curriculum or early in the professional career. In an investigation by Dziegielewski et al. (2004) subjects were enrolled in a course of study leading to a degree in social work. The researchers (Dziegielewski et al., 2004) noted that prior to the study, all of the students had a strong belief that stress can negatively affect professional performance and achievement of educational goals.

Each student participated in a 45 minute seminar on stress management. The objectives for the stress management seminar were to assist students in identification of personality styles and patterns of behavior, provide general information on stress, and to identify signs of stress. In addition, the seminar participants were taught specific stress reductiontechniques. The results of the study suggested that stress management seminars that provide general information on stress, and teach effective ways to reduce stress are beneficial in strengthening a person’s coping skills. Consequently, if coping skills are effective in decreasing stress and feelings of anxiety students have a greater chance for academi\c success (Dziegielewski et al., 2004).

In summary, stress has the ability to prevent students from being successful in their respective educational goals. If a continual flow of professionals to the workforce is a goal, student success is essential.

Strategies to empower college students to manage stress may prove to be beneficial. According to Dziegielewski et al. (2004) programs that identify stressors and provide information on stress reduction and burnout prevention can help students learn to better cope with stressful experiences. Subsequently, better coping skills are associated with decreased anxiety levels and decreased risk for academic failure. The literature suggests that stress is a common theme among college students, and when stressful experiences are greater than the coping resources, multiple problems often arise (Garret, 2001). Hence, programs which assist in the identification of stressors, and focus on prevention of burnout, and counseling regarding coping strategies should enhance student success (Garret, 2001).

REFERENCES

Dill, L. P. & Henley, B. T. (1998). Stressors of college: A comparison of traditional and nontraditional students. The Journal of Psychology, 132(1), 25-31.

Dziegielwski, S. F., Turnage, B. & Roest-Marti, S. (2004). Addressing stress with social work students: A controlled evaluation. Journal of Social Work Education, 40(1), 105-119.

Frazier, A. P.’ & Schauben, J. L. (1994). Stressful life events and psychological adjustment among female college students. Measuremnt & Evaluation in Counseling and Development, 27(1), 1-12.

Garret, J. B. (2001). Gender differences in college related stress. Undergraduate Journal of Psychology, 14.

Holmes & Rahe ( 1967)’.

Kanner, A. D., Coyne, J. C., Schafer, C. & Lazarus, R. S. (1981). Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events. Behavioral Medicine, 4(4). 1-39.

Lazarus, R. S. & Folkaman, S. (1984). Stress, appraisal and coping. New York, N. Y.: Springer.

Nathan, R.G., “Stress,” World Book Online Americas Edition, Http:/ /www.aolsvc.worldbook.aol.com/wbol/wbPage/na/ar/co/ 536195. April 3, 2002.

Phinney, J. S. & Haas, K. (2003). The process of coping among ethnic minority first generation college freshmen: A narrative approach. The Journal of Social Psychology, 143(6), 707-726.

Rohland, B. M., Kruse, G. R. & Rohrer, J. E. (2004). Validation of a single-item measure of burnout against the Maslach burnout inventory among physicians. Stress and Health, 20, 75-79.

Ross, S. E. Neibling, B. C. & Heckert, T. M. (1999). Sources of stress among college students. College Student Journal, 33(2), 312- 317.

Selye (1974).

Sharon Hall Murff, MSN, CCRN

Sharon Hall Murff. MSN, OCN, is an assistant professor of medical- surgical nursing at Grambling State University, School of Nursing, PO Box 1192, Grambling, Louisiana 71245. She received a Bachelors of Science in Nursing from East Carolina University in 1976. She received a Master of Science in Nursing with a focus on Critical Care Nursing and Education from Northwestern State University in Shreveport, Louisiana in 1997.

ACKNOWLEDGEMENTS

I wish to thank Sandra Sayles PhD, RNfor giving me the opportunity and encouragement to submit this manuscript. Also, I wish to thank Mary Joe Stoglin, EdD, APRN-B, CNS, for encouragement to submit this manuscript. In addition, I wish to express my gratitude to the administrators of Grambling State University School of Nursing, Betty Smith PhD, RN (Dean), and Karin Jones PhD, RN, FNP (Director of BSN Program) for their support in the pursuit of academic excellence.

Copyright Tucker Publications, Inc. Sep/Oct 2005

Horizon Blue Cross Blue Shield of New Jersey Forms Alliance With the SilverSneakers(R) Fitness Program

Top-rated Managed Care Organization to offer nation’s leading exercise program for older adults to Medicare members

Horizon Blue Cross Blue Shield of New Jersey signed a two-year contract with Axia Health Management, the national company that developed and manages the SilverSneakers(R) Fitness Program. SilverSneakers, the nation’s leading exercise program designed exclusively for older adults, is available to Horizon’s Medicare Blue, Horizon Medicare Blue Plus, and Horizon Medicare Value Plus plans in 38 participating sites throughout New Jersey (see axiahealth.com for complete listing). Through this unique program, Horizon Blue Cross Blue Shield members will receive a free basic fitness center membership at participating fitness centers throughout New Jersey where they can enjoy specialized SilverSneakers classes taught by certified instructors focusing on improving strength, flexibility, balance and coordination.

“At Horizon Blue Cross Blue Shield of New Jersey, we are dedicated to keeping our Medicare Advantage members healthy and the SilverSneakers Fitness Program is a great way for them to keep physically fit,” said Keitha Lackey, director of consumer and commercial sales at Horizon Blue Cross Blue Shield of New Jersey. “Promoting exercise through programs like SilverSneakers is just one more way we are Making Healthcare Work for our members.”

In addition to classes, SilverSneakers participants can also enjoy other fitness center membership benefits, including use of each location’s exercise equipment (e.g., treadmills, exercise bikes, pool, etc.), weight training, circuit training, and other fitness offerings (e.g., aerobics, sauna, hot tub, social events).

“As the leading Medicare health plan in New Jersey, Horizon’s decision to offer the SilverSneakers Fitness Program further underscores their commitment to improve the health and well-being of their members,” said Robert Gottschalk, executive vice president of sales for Axia Health Management. “Horizon has empowered its members to take responsibility for their health by providing a program that allows older adults to maintain an active, independent lifestyle. We look forward to a long, successful partnership.”

About Axia Health Management

With an integrated suite of prevention programs, Axia Health Management is leading the way in preventive health care by incorporating personalized solutions that help healthy individuals stay healthy and improve the health of those already affected by disease or disability. This is accomplished through a high-touch delivery system of more than 10,000 fitness center locations, 4,000 Axia-certified health improvement instructors and more than 40,000 chiropractic and whole health network providers. The cornerstone of Axia’s suite of products is the SilverSneakers Fitness Program, a unique physical activity program offered to more than 2.4 million Medicare-eligible members in 46 states at more than 1,500 fitness centers and class sites. For more information, call 480-783-9555 or visit www.axiahealth.com.

About Horizon Blue Cross Blue Shield of New Jersey

Horizon Blue Cross Blue Shield of New Jersey, with headquarters in Newark, is New Jersey’s largest health insurer, providing coverage to more than 3.2 million people. Horizon BCBSNJ’s company Web site is located at www.HorizonBlue.com. Horizon BCBSNJ is an independent licensee of the Blue Cross Blue Shield Association.

Measuring Nurse Practitioner Productivity

By Rhoads, Jacqueline; Ferguson, Laurie Anne; Langford, Cynthia A

As the role of the nurse practitioner (NP) evolves, the need to demonstrate productivity becomes more important. Productivity data provides NPs with practice statistics to generate business or use in contract negotiations with potential clients such as employers, managed care organizations, and insurance companies. However, beyond the numbers of patients seen per day or amount of reimbursement a provider brings to the practice, NPs may provide additional benefit thai is not captured with physician productivity measures. Information to acquaint NPs with key aspects of recording productivity and ways NPs can organize productivity data within their practice to determine worth of service are presented.

Over the years the nurse practitioner (NP) role has evolved into an impressive dimension focused on providing quality care to the community served. This focus includes the tasks of teacher, researcher, consultant, mentor and coach, leader, and ethical decision maker. It involves practice in a variety of acute and chronic care sites such as hospitals, clinics, and private offices. The care the NP provides includes information on health maintenance and disease prevention, counseling, and patient education.

As the role of the NP evolves, the need to demonstrate productivity also becomes more important. Twenty years ago research measurement focused on public safety and quality of care. Today measurement of productivity is important in determining the worth or value of NP practice. Further, productivity measures are used to monitor individual performance, create incentive plans, compare departmental contributions within institutions, and monitor resources needed for patient care (Johnson & Newton, 2002). Industries outside of health care have long recognized the vital importance of productivity measurement on its enterprise. They believe that enhanced productivity improves the business enterprise’s opportunity to create wealth for its workforce (Proctor, 2005). But very little information has been published related to ways NPs can measure productivity and efficiency.

Defining and Assessing Productivity

Productivity has been defined as a measure of output per unit of input. Within the discipline of nursing, productivity is described as proof or evidence of how efficient the NP is in his/her labor, job setting, or how efficiently she/he handles resources and equipment (Martin, 2005). It is a measure of how well the health care provider meets the needs of the community she/he serves (Blumenthal, 1999; Martin, 2005). Frequently productivity is expressed in terms of numbers of patients seen per day or amount of reimbursement a provider brings to the practice. But productivity is really much more than that. Martin (2005) reminds providers that all successful practices build on the three A’s: availability, affability, and ability.

How available the health care provider is to patients is crucial for productivity. Obviously the more available a health care provider is to the community served, the greater the client base. Martin (2005) states that being available to patients is essential: “you can’t get ’em in if you’re not there…” Availability speaks to both physical presence and the ability to move smoothly from one patient to the next. Providers who cannot move from patient to patient because of ancillary demands on their time are not “available.”

Beyond the basic availability question of how many patients can the NP see in one day, is the issue regarding how much support the practice provides for seeing the number of patients expected. For example, does the practice provide the practitioner with adequate space and support staff to see patients efficiently; are support staff available to perform diagnostic and treatment regimes ordered by the practitioner (for example, blood work, immunizations, allergy injections, spirometry, dexascans, EKG, and diabetic education)? If this support is not available, the practitioner may find that a portion of his/her productivity includes functioning as the clinic nurse. Under these circumstances, traditional methods of collecting provider productivity will not capture the full value of the practitioner’s efforts. Practitioners who function as both the clinic nurse and a clinic provider will clearly lower productivity as a provider. In the analysis of “how available is the practitioner,” ancillary duties not performed by other providers will reduce provider revenue, but may be offset by the value of the ancillary duties to the clinic. If this is the case, simply reviewing billables will not provide an adequate picture of the productivity of the practitioner. On the other hand, if the clinic is focused on the income generation potential of the provider, all providers should be given similar supports.

Affability addresses the health care experience from the patient’s point of view. It requires health care providers to examine how pleasant, open, responsive, and approachable they are. Because the discipline of nursing is grounded in caring, most NPs do well on this measure. Nevertheless, we must review how patients view their interactions with us. On the whole, do patients feel comfortable with the provider? Does the provider listen to the patient, taking his/her concerns seriously? Additionally, the patient experience within the clinic should be reviewed. For example, how difficult it is for patients to contact the provider? Is the staff in the clinic responsive to patient needs? Do patients complain about the service or that the staff is rude? This is an important aspect of productivity as providers who spend a portion of every visit apologizing for rude or dismissive staff cannot function as smoothly as those who can dedicate the entire visit to the patient’s health issues. Measurement of these key issues can be done through patient satisfaction surveys.

Ability is also important, not only of the health care provider but of the office staff as well. Is diagnostic data readily compiled for the health care provider to review? Incomplete and confusing medical records reduce the efficacy of the most capable practitioner and set the stage for missing key components of adequate followup. If practice records and scheduling are in disarray, and the practitioner must serve as the manager to alleviate these problems, the practitioner’s revenue figures will be reduced. Support staff who cannot keep records, materials, and bookings up to date will negatively affect the patient’s experience and, over time, will directly reflect on the patient’s evaluation of the practitioner’s competency. This directly impacts the productivity of the office, costing the practice patients and revenue (Martin, 2005).

Although Martin’s (2005) three A’s are one method for reviewing productivity, there are additional models to consider. Ability or NP competency must be held against a specific standard, and availability can be measured indirectly by the number of patients seen each day.

Nurse Practitioner Core Competencies

To determine the foundational framework for NP ability in the productivity equation, the basic core competencies expected of an NP should be used as guiding principles. In August 2000, the U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing, funded the National Organization of Nurse Practitioner Faculties (NONPF) to develop consensus-based primary care competencies for NPs in the areas of adult, family, gerontological, pediatric, and women’s health practice. These core competencies provide description of entry-level competencies of graduates prepared as adult, family, gerontological, pediatric, and women’s health primary care NPs (NONPF, 2003). They are the foundational skills for those NPs who enter into specialty practices such as dermatology, they provide a structure for broad-based, periodic review and are the model for quality assurance reviews of NP in- service training. These competencies can also serve as principles to measure the ability component of NP productivity in practice. Table 1 displays a condensed version of the 2003 NONPF competencies.

Table 1.

Condensed Version of NONPF Competencies

Although these competencies directly address the ability of NPs, using these competencies to demonstrate how a NP meets each competency is, realistically, too time consuming and not reimbursable. Thus an additional burden would be placed on NP practice. For the most part, NPs can track their productivity by identifying the needs and expectations of the population or community served, always keeping these competencies in mind (Martin, 2005). The community served is the NP’s stakeholder those who will determine if they will continue to utilize the service provided or move to another service that will better address their needs. The NP’s contribution to the practice or institution needs to speak to these stakeholders’ needs and include products or services essential to the operation of that practice. Ideally, the NP can track productivity by measuring improvements in health outcomes within a given community, longitudinally over a period of many years.

Provider Measures of Productivity?

Because NPs work is typically paid as that of a health care provider, the productivity measures that are the basis of health care provider payment (physician productivity pa\yment) influence NP reimbursement for services. Traditionally, physician productivity measures are based on a variety of factors including total gross charges, total net medical revenue, total cost, patient panel size, growth rate of patient base, hospital admissions, visits and consults, office hours, practice coverage, and CPT or procedural volume or number of cases (Cascardo, 2003). As for nurse practitioners, productivity comprises additional factors which for the most part can be a challenge to measure: time devoted to productive activities, efficiency of that time (patients seen and dollars made each day), procedures per encounter, appropriateness of that procedure or charge, motivation of the provider to see additional patients such as walk-in, etc. (Cascardo, 2003).

Cascardo (2003) describes a method to measure these challenges in terms of relative value per unit of service or relative value units (RVUs). RVUs were developed by the Center for Medicaid and Medicare Services (CMS) and used to determine compensation for services provided by the physician. In 1986, the Physician Payment Review Commission mandated the creation of a new resource-based physician fee schedule, with a goal of establishing a system that improved reimbursement for primary care services, was less procedure oriented, and controlled health care costs (Johnson & Newton, 2002). They outlined factors that determine providers’ activities and include three components: RVUs, time the provider takes to do the work; RVUpe, practice expense to do the work; and RVUm, malpractice risk to do the work (Johnson & Newton, 2002). RVUs are updated annually by CMS and can be obtained from the CMS Web site. Cascardo (2003) compares three office visit CPT codes to show differences in their values as an effort to determine physician effort, efficiency, and compensation. These measures can translate to NP providers.

Table 2.

CPT Codes and MD Time

Table 2 shows how much time a health care provider is expected to spend with each office encounter/ each office CPT code. For example, the physician provider doesn’t need to be present for an outpatient CPT code 99211, whereas the physician provider time spent is expanded for the outpatient CPT code 99215 because the activity or procedure requires more activity. Table 3 displays how RVUs are compiled for each CPT code based on amount of provider time spent. In this case, CPT code 99212 receives a total RVU of 0.06 and a 99215 receives a total RVU of 2.21.

As expected, low provider activities result in lower RVUs whereas moderate provider activity to high provider presence results in higher RVU value. The higher the RVU value the higher the reimbursement. But it is unclear whether provider generation of high RVUs is a sufficient measure of value to the organization. Because NPs practice in a wide array of settings, some non-reimbursable services may be essential to the maintenance of the practice (for example, staff management).

Factors to Consider

It is agreed that NP productivity is the measure of the work produced during a frame of time. It becomes a measure of efficiency when it includes factors such as time, complexity, and number of clients seen in a certain period of time. But numbers can be deceiving. If a NP is very productive but the quality of his or her work is lacking, the long-term consequences may be negative. For example, patient satisfaction surveys may disclose poor interpersonal communication that resulted in clients leaving the office feeling hurried, not valued, or taken seriously (Jacob, 2001; Proctor, 2002). If a client’s questions and concerns are never addressed, the result can be the client moving to a provider who will meet his/her needs. If the trend is consistently a loss in a provider’s panel or client base, the consequences are financially devastating despite the RVU originally generated (Jacob, 2001; Proctor, 2005).

Table 3.

RVU Comparison

Table 4.

Critical Questions to Ask

So how does one determine productivity of an NP in a certain practice? Critical questions each NP should ask is: Will the CEOs of that practice continue association with the NP because they are productive? Will CEOs be pleased with NP productivity and hire additional NPs? What factors should be measured to determine NP productivity?

In practice, NP productivity is based on a number of factors such as time devoted to productive actions or skills, efficiency of time spent with patients, and volume of CPTs per encounter or RVUs. These variables and those listed in Table 4 can be measured to a degree and provide NPs with useful information on whether they are productive health care providers, and most importantly, if they serve the community efficiently and safely.

Nine critical measures can be used to determine NP productivity:

1. Patient visits – are they consistent or have they decreased? Are patients returning because treatment didn’t work?

2. New patients – are you getting new patients into your practice?

3. Total MD referrals – is this percentage consistent or is the number of MD referrals rising?

4. Diagnoses – numbers rising?

5. Average visits per diagnoses – how many visits does it take to make diagnosis?

6. Percentage of cancellations – how many cancellations per week? Are the numbers increasing?

7. Cancellations or no-show numbers – are these numbers increasing each month?

8. Reasons for no shows.

9. Average wait time per patient.

These measures can provide timely, essential data to determine NP productivity as evidenced not only by RVUs, but patient satisfaction as well.

Methods to Measure Productivity

How can these measures be utilized in a format conducive to NP practice? A format is needed that will provide the NP with information useful to measure productivity. Traditionally the NP has resorted to keeping track of patients encountered each day by hand, struggling to log in or track patients with the help of the office manager and staff. Today computerized databases can be used to reflect key measures of NP productivity. It is a simplified way to collect each patient encounter data utilizing instant on-line access to view tallies and charts of cumulative clinical experiences. Such programs as ePatient, Pocket MD, Patientkeeper, Wardwatch, and Typhon NP Portfolio System are a few of the most widely used designs.

For the purposes of this article, it is not possible to report on all listed patient tracker programs that exist today. The choice of a specific program will depend on the specific needs of the NP. The system should be practical and useful. An electronic format is important as health care records are moving toward electronic data. The program must keep an organized and complete log of all cases/ clinical encounters and have the capacity to analyze the productivity data within the NFs current practice as well as provide the NP with instant reports, tallies, and charts demonstrating the NP’s productivity (Merlin, 2005). Additionally, the system should allow each NP to design a practice portfolio to record her/his work histories, or other information useful in contract negotiations, regulatory reporting, research, and data export for proof of billing with managed care organizations and/or insurance companies. Finally, quality indicators such as patient satisfaction surveys, colleague evaluations, and staff input on work efficiency would be desirable (Merlin, 2005).

The NP should be able to log in anywhere using home or office PCs, or handheld devices. The software should be able to work with any Web browser and without any additional software; therefore, the NP can retain control and ownership of all data (Merlin, 2005). As NPs enter encounter data for each patient, the system should dovetail with the encounter system to provide maximum data at lowest additional response cost. At the end of a quarter, month, or year, the NP can print out tallies or charts on any or all productive measures identified as important to provide evidence of productivity (Merlin, 2005). Daily data entry is required for each patient; the downside to this and any software productivity program is that data must be entered daily. The greater the information needs, the greater the data entry needs. Because data entry is not reimbursable, the data must be important enough to justify the response cost of entering the data. Some may decide to live with fewer data components due to time constraints and subsequent cost.

Conclusion

There are many variables to measure NP productivity, some that have been used traditionally and other well-defined measures that have come into use more recently. No measure is perfect, each has its own limitations. Measurement systems must reflect the reality that NPs are affected by a large range of independent variables, including competencies expected of the role and the organization in which the NPs practice. Nurse practitioners must track their productivity with mechanisms that allow capture of key elements of the practice. NPs who let others (for example, employers) determine their value without understanding the basis of that evaluation will certainly be undervalued. Ownership of the evaluative components for productivity, quality, and patient satisfaction measurements will allow NPs to survive and flourish within an organization. To maintain this ownership, it is important that every NP have direct access to his/her productivity data as well as the capacity to analyze and track productivity in an objective and meaningful way.

Because NP productivity is a measure of an NP’s work or output, it is closely related to efficiency, quality of care, and service provided. Although RVUs were an attempt to measure primary care patient complexity by measuring additional work, it is not clear that it is a sufficient measure of the complexity of different patient populations. RVUs also do not measure the quality of the care received. They do not reflect outcomes or pat\ient satisfaction; they merely reflect what work was done (Johnson & Newton, 2002). Although RVUs positively increased the average Medicare payments to family physicians by 35% from 1991 to 1997, the quality-complexity gradient was not fully addressed (Johnson SL Newton, 2002).

Ideally, measures of nurse practitioner productivity would account for all that a NP does in practice and for participation in activities that are not easily valued in an objective way. Traditional and current productivity measures do not address the valueadded components the nurse practitioners bring to the practice environment. New methods of documenting productivity as it relates to quality, service, and outcomes are needed. These methods should embrace existing technology to allow ease of data collection.

References

Blumenthal, D. (1999). Duration of ambulatory visits to physicians. Journal of Family Practice, 45(4), 264-271.

Cascardo, D.C. (2003). Standard measures help reward physician productivity. Medscape Money & Medicine, 4(1). Retrieved May 12, 2005, from http://www.medscape.com/viewart icle/456632

Jacob, J.A. (2001, August 13). Modest compensation gains for most doctors. American Medical News, 25. Retrieved May 12, 2005, from http://www.aafp .org/PreBuilt/physprod.pdf

Johnson, S.E., & Newton, W.P. (2002J. Resource-based relative value units: A primer for academic family physicians. Family Medicine, 34(3), 172-176.

Martin, S. (2005). Money-Saving strategies. Retrieved May 12, 2005, from http://nurse-practitioners.ad vanceweb.com/Common/ editorial.as px?CC=35724

Merlin, M. (2005). Six steps to create positive results from your performance data. Retrieved May 12, 2005, from http://www.aaasc.org/ features/monitor2003/six_steps_create_positive.htm 1

National Organization of Nurse Practitioner Faculties (NONPF). (2005). Nurse practitioner competencies. Retrieved May 12, 2005, from http://nonpf.com/

Proctor, J. (2005). Gauging emergency physician productivity: Are RVUs the answer? Retrieved May 12, 2005, from http://www.acep.org/ webportal/Practi ceResources/IssuesByCategory/Reim bursement/Gaugi

Additional Readings

American Medical Association Center for Health Policy Research. (2001). Physician sodoeconomic statistics: 20002002 Edition. Retrieved May 12, 2005, from http://www.hschange.org/ CONTENT/544/

American Academy of Family Physicians (AAFP). (2001). AAFPpolicies on health issues. Retrieved May 12, 2005, from http:// www.aafp.org/xl9749. xml

American Academy of Family Physicians. (2000). FACTS about family practice. Retrieved May 12, 2005, from http://www.aafp.org/x530.xml

Medical Group Management Association. (2000). Physician compensation and production survey: 2000 report based on 1999 data. Retrieved May 12, 2005, from http://www.acc.org/pmr/trends / dec_tables.htm

Rodeghero, J.A. (1999). Benchmarking physicians’ practices: Trends toward the millennium. Journal of Health Care Finance, 25(4), 15-37.

Jacqueline Rhoads, PhD, ACNP-BC, ANP-C, GNP, CCRN, is a Professor, Louisiana State University Health Science Center School of Nursing, New Orleans, LA.

Laurie Anne Ferguson, MSN, FNP-C, ANP-BC, is an Assistant Professor, Louisiana State University Health Science Center School of Nursing, New Orleans, LA.

Cynthia A. Langford, PhD, APRN-BC, FNP, is an Associate Professor, Louisiana State University Health Science Center School of Nursing, New Orleans, LA.

Copyright Anthony J. Jannetti, Inc. Feb 2006

Allergic Contact Dermatitis

By Cohen, Philip R; Schulze, Keith E; Totz, Robert; Nelson, Bruce R

The “Clinical Snapshot” series provides a concise examination of a clinical presentation including history, treatment, patient education, and nursing measures. Using the format here, you are invited to submit your “Clinical Snapshot” to Dermatology Nursing.

History: A 49-year-old white man had a squamous cell carcinoma of his nose excised using the Mohs micrographie surgical technique. The post-surgical defect was repaired with a full-thickness skin graft taken from his right preauricular area. Prior to bandaging, Mastisol liquid adhesive was applied to both sites.

Description of Skin Lesions: Within 36 hours pruritic erythematous edematous plaques with minute vesicles appeared on the patient’s face where the adhesive had been applied: the right preauricular cheek (see Figure 1), the nose, and the bilateral paranasal and malar regions (see Figure 2).

Etiology: Allergic contact dermatitis is a cell-mediated type IV delayed hypersensitivity reaction. It occurs when a specific antigen penetrates the epidermis of the skin, combines with a protein mediator, travels to the dermis, and sensitizes the patient’s T lymphocytes. The allergic reaction occurs following each subsequent exposure of the skin to the allergen.

Location: The cutaneous lesions appear at the skin sites that have come in contact with the antigen to which the patient is allergic.

Hallmark of the Disease: Clear fluid-filled vesicles or bullae on pruritic, erythematous, and edematous skin, which subsequently become exudative and weeping after the lesions rupture, characterize the presentation of an acute allergic contact dermatitis. Subacute and chronic clinical forms of the dermatitis can also occur; the former often appears as papules with less edema whereas the latter typically develops as lichenified plaques with scaling and fissures.

Figure 1.

Pruritic red edematous plaques with minute vesicles on the preauricular area.

Figure 2.

The erythematous and itching dermatitis includes not only the area of the skin graft on the patient’s nose, but also the bilateral adjacent paranasal and malar regions.

Treatment: The initial management requires removal and avoidance of the offending agent. Topical measures include wet soaks (such as Burow’s solution) if the affected area is weeping, and corticosteroid application in either a cream, ointment, gel, or foam base. Oral antihistamines may be helpful to alleviate pruritus. Also, systemic corticosteroid therapy may be necessary if the dermatitis is severe, generalized, or both.

Normal Course: The lesions resolve within 1 to 3 weeks after exposure to the associated allergen has been stopped and topical (with or without systemic) treatment has been started.

Patient Education: Avoiding contact with the dermatitis-inducing material is essential. In addition, prevention of subsequent cutaneous exposure to the allergen is important. For some patients, patch testing to the components of the dermatitis-causing agent may be helpful to identify the specific allergen(s). Alternatively, if the etiologic agent of the dermatitis is unknown, patch testing to several common allergens may be useful to determine the specific allergen(s).

Nursing Measures: This patient’s dermatitis persisted after topical treatment with a mid-potency corticosteroid (fluticasone propionate [Cutivate] 0.05%) cream was initiated. A 6-day tapering course of a systemic corticosteroid (methylprednisolone, starting at 24 mg and decreasing by 4 mg each consecutive day) was started. Subsequently, the patient promptly improved over the next few days. The patient was instructed to avoid future use of the Mastisol liquid adhesive and the potential allergens which it contains: gum mastic and styrax liquid. Avoidance, or patch testing prior to die use, of other topical adhesives was also recommended.

Philip R. Cohen, MD, is a Mohs Micrographic Surgery Fellow, Dermatologie Surgery Center of Houston, and Clinical Associate Professor of Dermatology, Department of Dermatology, University of Texas-Houston Medical School, Houston, TX.

Keith E. Schulze, MD, is Co-Director, Dermatologie Surgery Center of Houston, Houston, TX.

Robert Totz, MD, is in Private Practice, Houston, TX.

Bruce R. Nelson, MD, is Director, Dermatologie Surgery Center of Houston, Houston, TX.

Copyright Anthony J. Jannetti, Inc. Feb 2006

Autoimmune Bullous Diseases: Diagnosis and Management

By McCuin, Jill B; Hanlon, Terri; Mutasim, Diya F

Autoimmune bullous diseases are a heterogenous group of diseases characterizfd by cutaneous and mucosal vesicles and bullae. Diagnosis is based on a combination of clinical, histopathological, and immunofluorescence findings. Current treatment, including vigilant wound care, significantly reduces disease morbidity and mortality.

Objectives

This educational activity is designed for nurses and other health care providers who care for and educate patients regarding autoimmune bullous diseases. For those wishing to obtain CE credit, an evaluation follows. After studying the information presented in this article, the nurse will be able to:

1. Describe the characteristics of bullous pemphigoid, mucous membrane pemphigoid, pemphigus vulgaris, and pemphigus foliaceus.

2. Define paraneoplastic pemphigus, epidermolysis bullosa acquisita, and linear IgA dermatosis.

3. List diagnostic and management principles associated with autoimmune bullous diseases.

Bullous diseases are a group of skin disorders in which the primary lesion is a vesicle (1 cm). The main etiologic groups of bullous diseases are autoimmune, allergic, mechanical (inherited), metabolic, and infectious (see Table 1).

The autoimmune bullous diseases are characterized by the production of antibodies to adhesion molecules (Burgeson & Christiano, 1998). In the pemphigoid group of diseases the target adhesion molecules are part of the hemidesmosornes at the dermal- epidermal junction. The pemphigus group is characterized by antibodies against molecules in the desmosomes, between neighboring epithelial cells. Although the targets for the autoantibodies have been characterized, the mechanism of initiation of the autoimmune response is unknown (Diaz & Giudice, 2000). There is no method for preventing this group of diseases, and there is no clearly identified genetic tendency. With current treatment modalities, mortality is low and is more often related to complications of therapy rather than the primary disease. Morbidity can be severe.

Table 1.

Main Etiologic Groups of Bullous Diseases

Figure 1.

Bullous pemphigoid: Note edematous plaques and bullae.

Figure 2.

Bullous pemphigoid: Note edematous plaques and vesicles.

Diseases

Bullous pemphigoid. Bullous pemphigoid (BP) primarily affects individuals greater than 60 years of age. There is no gender or racial predilection. The initial manifestation of the disease ranges from pruritus without clinical lesions to pruritic urticarial papules and plaques. The classic BP lesions are tense bullae, filled with clear fluid, on an erythematous base. These lesions are often generalized, and most commonly involve the lower abdomen, inner thighs, groin, axillae, neck, and flexural aspects of arms and legs (see Figures 1 & 2) (Freedberg et al., 2003).

Ruptured bullae lead to erosions that heal without scarring. These erosions can be an entry for bacterial superinfection. Mucosal lesions can occur, although they are usually mild and transient. The typical course of BP is 5 years. Exacerbations following remission are rare and are mild when they do occur.

Mucous membrane pemphigoid. Mucous membrane pemphigoid (MMP) affects middle-aged to elderly individuals, with a slight female predominance. Approximate incidence is 1 case per 1 million people each year, and there is no racial predilection. MMP can involve any mucous membrane with stratified squamous epithelium. It has a high incidence of oral and ocular involvement (see Figure 3). Other mucous membranes that may be involved are the pharynx, nose, larynx, genitals, rectum, and esophagus. Skin involvement occurs in 10% to 43% of patients (Mutasim, Pelc, & Anhalt, 1993a).

Figure 3.

Mucous membrane pemphigoid: Note bullae and erosion on buccal mucosa.

Oral involvement may occur in the gingiva, buccal mucosa, palate, alveolar ridge, tongue, and lower lip, and is commonly characterized by desquamative gingivitis. The findings include gingival erythema and edema followed by desquamation of gingival mucosa or frank blister formation, resulting in erosions. Another presentation is that of delicate, white, reticulated patches, resembling those seen in lichen planus (Mutasim et al., 1993a).

Ocular involvement presents as chronic intractable conjunctival inflammation that may be unilateral or bilateral. Patients typically complain of a burning sensation, dryness, or foreign-body sensation. As the disease progresses, entropion (inversion of the eyelid margins) and trichiasis (inversion of lashes to the corneal surface) can cause further corneal injury resulting in erosions and neovascularization with eventual blindness. Symblepharon (fusion of the bulbar and palpebral conjunctiva) often occurs as a result of the scarring.

Nasopharyngeal involvement includes erosions of the nasal mucosa, crusting discharge, and epistaxis. It is often painful, and erosions can progress to stenosis and nasal obstruction. Esophageal involvement, which is more difficult to detect, is characterized by heartburn, dysphagia, and phagodynia. A barium swallow and endoscopy, with histologie and immunofluorescence studies, confirm this diagnosis. Laryngeal and tracheal involvement is rare but may be life threatening secondary to sloughing of the mucosa and aspiration. The anorectal area presents as pain on defecation, intermittent bleeding, and narrowing of the anal canal. Pain upon urination or with intercourse is associated with genitourinary involvement. Without treatment MMP has a high morbidity.

Pemphigus vulgaru. Pemphigus vulgaris (PV) is a relatively rare disorder that affects individuals in the 3rd to 5th decades of life (Korman, 1988). Although no genetic pattern has been established, the disease is much more common in persons of Mediterranean and Jewish descent than in the general population (Freedberg et al., 2003). It presents as oral blisters that rupture rapidly and progress to painful erosions. Involvement of other mucous membranes is rare. Most patients develop cutaneous flaccid blisters that rupture easily and leave painful erosions, which are slow to heal (see Figures 4 & 5). These erosions are prone to secondary bacterial infection. Without treatment the disease is progressive and mortality approaches 100%.

Pemphigus foliaceus. Pemphigus foliaceus (PF) typically affects individuals over 50 years of age and is characterized by superficial blisters that rupture and leave shallow erosions that heal without scarring (see Figure 6). Lesions favor the head and upper trunk and almost never present in the mucosal surfaces. Many patients follow a chronic course with this disease, but have a lower morbidity than those with PV due to the superficial nature of the erosions and the lack of mucosal involvement (Mutasim, Pelc, & Anhalt, 1993b).

Paraneoplastic pemphigus. Paraneoplastic pemphigus (PNP) is associated with malignant and benign neoplasms. Mucous membrane involvement is a prominent feature. Patients typically present with persistent, painful blisters or erosions of lips, gingival, buccal, and lingual mucosa. Other areas where erosions can present include nasopharynx, oropharynx, nasal septum, epiglottis, hypopharynx, tracheobronchial mucosa, esophagus, and the ocular and genital areas.

The cutaneous lesions are polymorphous and pruritic, and can mimic erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, morbilliform drug eruption, lichen planus, BP, or lichen planus pemphigoides. The most commonly associated neoplasms are non- Hodgkin’s lymphoma, chronic lymphocytic lymphoma, or Castleman’s disease (giant lymph node hyperplasia). Diagnosis of the neoplasm typically precedes or shortly follows the development of PNP (Anhalt et al., 1990).

Figure 4.

Pemphigus vulgaris: Note erosions and flaccid bullae.

Figure 5.

Pemphigus vulgaris: Note oral erosions.

Epidermolysis bullosa acquisita. Epidermolysis bullosa acquisita (EBA) affects middle age to elderly individuals with no gender or racial predilection. There are multiple types of EBA. The classical presentation is spontaneous or traumainduced blisters on the dorsum of hands, elbows, knees, or other trauma-prone sites. Chronic lesions are associated with scarring and milia formation. EBA may also be primarily or exclusively mucosal, and clinically indistinguishable from MMP. Finally, EBA can present as generalized blisters with underlying inflammation similar to BP (Gammon, Briggaman, Woodley, Heald, & Wheeler, 1984).

Linear IgA dermatosis. Linear IgA dermatosis (LAD) is a symmetrical, generalized bullous eruption that is often pruritic (see Figure 7). Mucosal involvement is common. It can be mild and asymptomatic, or can be significant and scarring, similar to that in MMP. LAD has been reported in association with multiple drugs including vancomycin, lithium, furosemide, atorvastatin, captopril, and diclofenac (Freedberg et al., 2003). Therefore, a thorough medication history should be elicited from patients.

Diagnosis

In addition to history and physical examination, the diagnosis of bullous diseases is based on histopathology and immunofluorescence (Mutasim & Diaz, 1991). The specimen for histopathological examination should be a shave biopsy of an early, small, intact vesicle. This type of specimen is most likely to reveal the primary pathology, including the location of the split (intraepidermal or subepidermal) without secondary changes such as infection, in\flammation, or ulceration. It may also help differentiate this group of diseases from others that can present clinically with vesicles or bullae (see Table 1).

Direct immunofluorescence (DIF) highlights the location of the autoantibodies in the epidermis or basement membrane zone. A biopsy specimen from normal-appearing skin immediately adjacent to a clinical lesion (perilesional skin) is incubated with fluorescently tagged antibody probes (Mutasim, Pelc, & Supapannachart, 1993). The pattern of binding is often diagnostic and correlates with the location of the target antigen. The ideal specimen is either a shave or a punch biopsy of perilesional skin, which is normal-appearing skin adjacent to a clinical lesion. The inflammation and vesicle- formation in lesional skin can obscure the diagnostic patterns of antibody binding.

Indirect immunofluorescence (IIF) reveals the binding location and pattern of circulating autoantibodies (Beutner, Chorzelski, & Kumar, 1987). The sample for IIF is blood, serum, or blister fluid. This is incubated with standard epithelial substrates and the pattern of antibody binding is visualized with a fluorescent microscope. As in DIF, the pattern of binding is often diagnostic and correlates with the location of the target antigen.

Pathophysiology

Bullous diseases are caused by an autoimmune response to the adhesion molecules either in the desmosomes between epithelial cells, or in the basement membrane zone between the basal layer and the underlying dermis. After binding to their target antigens the antibodies cause blister formation in one of two ways: (a) direct disruption of intercellular adhesion interactions or (b) initiation of inflammation leading to destruction of adhesion molecules. The first mechanism underlies the pemphigus group (Amagai, Karpati, Prussick, & Klaus-Kovtun, 1992) of diseases and the second the pemphigoid group (Liu et al., 1997).

Figure 6.

Pemphigus foliaceus: Note shallow erosions on back.

Figure 7.

Linear IgA dermatosis: Note erythema and bullae.

Table 2.

Drugs for the Three Main Areas of Therapy

Management

Before treatment is initiated, an accurate diagnosis should be made by combining the clinical, histopathological, and immunofluorescence findings. The three main goals of therapy are suppression of the immune response (antibody production), inhibition of inflammation (see Table 2), and wound care.

Choice of a specific agent is guided by disease-related and patient-related factors. Diseaserelated considerations include the type of disease as well as severity. For example, the pemphigus group of diseases is mediated by direct disruption of intercellular adhesion interactions so suppression of antibody production is needed. In the pemphigoid group, however, inflammation leads to vesicle formation so anti-inflammatory agents are employed. Patient- related factors include age, co-morbidities, compliance, etc. Duration of treatment is often prolonged (months to years) depending on the patient’s disease and response to therapy.

Corticosteroids are often the first agent used. Although mild to moderate disease may be treated with topical Corticosteroids, systemic therapy is required for more extensive disease activity. Corticosteroids are both anti-inflammatory as well as immunosuppressive, but have well-known adverse effects on many organ systems including progressive loss of bone density. Therefore, transition to steroidsparing agents is planned early in the therapeutic course. If response to the immunosuppressive and antiinflammatory systemic agents is insufficient, other agents such as intravenous immunoglobulin (IVIg), rituximab, or plasmapheresis may be considered (Mutasim, 2004).

Wound care is an important component of the treatment plan. Hydrating, occlusive dressings prevent excessive fluid and electrolyte loss in extensive disease, and promote healing. Erosions and ulcerations should be treated with clean warm water compresses twice a day followed by application of antibiotic or hydrophilic ointment and gauze wraps. Eschar or crust formation should be prevented since they slow healing and encourage infection. The prevention of secondary bacterial infection, which can lead to sepsis, is essential. Finally, pressure ulcers may be avoided in bedridden patients with frequent position changes.

Conclusion

The autoimmune bullous dis eases are mediated by autoantibody production to cutaneous adhesion molecules. Diagnosis is based on a combination of clinical, histopathological, and immunofluorescence features. Current treatment regimens have greatly reduced mortality, but morbidity is often significant. There is no means of prevention. Wound care should be employed to decrease secondary complications such as bacterial infection and sepsis as well as promote healing.

This article and the CE answer/ evaluation form are also available online at www.dermatologvnursing.net

Publisher’s Note: Publication of this article was supported by a grant provided by Nurse Competence in Aging, a 5-year initiative funded by The Atlantic Philanthropies (USA) Inc., awarded to the American Nurses Association (ANA) through the American Nurses Foundation (ANF), and representing a strategic alliance between ANA, the American Nurses Credentialing Center (ANCC), and the John A. Hartford Foundation Institute for Geriatric Nursing, New York University, The Steinhardt School of Education, Division of Nursing.

For more information, contact the John A. Hartford Foundation Institute for Geriatric Nursing, New York University, The Steinhardt School of Education, Division of Nursing, 246 Greene Street, 5th Floor, New York, NY10003, or call (212) 998-9018, or email [email protected] or access the Web site at www.hartfordign.org

References

Amagai, M., Karpati, S., Prussick, R., & Klaus-Kovtun, V. (1992). Autoantibodies against the amino-terminal cadherin-like binding domain of pemphigus vulgaris antigen are pathogenic. Journal of Clinical Investigations, 90, 919-926.

Anhalt, G.J., Kim, S.C., Stanley, J.R., Korman, N.J., Jabs, D.A., Kory M., et. al. (1990). Paraneoplastic pemphigus. An autoimmune mucocutaneous disease associated with neoplasia. New England Journal of Medicine, 323(25), 1729-1735.

Beutner, E.H., Chorzelski, T.P., & Kumar, V. (1987). Immunopathology of the skin (3rd ed.). New York: John Wiley & Sons.

Burgeson, R.E., & Christiano, A.M. (1998). The dermal-epidermal junction. Current Opinions in Cellular Biology, 9, 651-658.

Diaz, L.A, & Giudice, G.J. (2000). End of the century overview of skin blisters. Archives of Dermatology, 136, 106-112.

Freedberg, I.M., Eisen, A.Z., Wolff, K, Austen, K.F., Goldsmith, L.A., & Katz, S.I. (Eds.). (2003). Fitzpatrick’s dermatology in general medicine (6th ed.). New York: McGraw-Hill Inc.

Gammon, W.R., Briggaman, R.A., Woodley, D.T., Heald, P.W., & Wheeler, C.E. Jr. (1984). Epidermolysis bullosa acquisita: A pemphigoid-like disease. Journal of American Academy of Dermatology, 11, 820-832.

Korman, N.J. (1988). Pemphigus. Journal of American Academy of Dermatology, 18, 1219-1238.

Liu, Z., Giudice, GJ., Zhou, X., Swartz, S.J., Troy, J.L., Fairley, J.A., et. al. (1997). A major role for neutrophils in experimental bullous pemphigoid. Journal of Clinical Investigations, 100, 1256-1263.

Mutasim, D.E. (2004). Management of autoimmune bullous diseases: Pharmacology and therapeutics. Journal of the American Academy of Dermatology, 51, 859-877.

Mutasim, D.E, & Diaz, L.A. (1991). The relevance of immunohistochemical techniques in the differentiation of subepidermal bullous diseases. American Journal of Dermatopathology, 13, 77-83.

Mutasim, D.E, Pelc, N.J., & Anhalt, G.J. (1993a). Cicatricial pemphigoid. Dermatologic Clinics, 77(3), 499-510.

Mutasim, D.E, Pelc, N.J., & Anhalt, G.J. (1993b). Paraneoplastic pemphigus, pemphigus vulgaris, and pemphigus foliaceus. Clinics in Dermatology, 77, 113-117.

Mutasim, D.E, Pelc, N.J., & Supapannachart, N. (1993). Established methods in the investigation of bullous diseases. Dermatologic Clinics, 11, 399-418.

Jill B. McCuin, MD, is a Dermatology Resident, University of Cincinnati Medical Center, Cincinnati, OH.

Terri Hanlon, BSN, RN, is Director of Practice Operations, Department of Dermatology, University of Cincinnati, Cincinnati, OH.

Diya F. Mutasim, MD, is Professor and Chairman, Department of Dermatology, University of Cincinnati Medical Center, Cincinnati, OH.

Copyright Anthony J. Jannetti, Inc. Feb 2006

Livedo Reticularis in Antiphospholipid Antibody Syndrome

By Pullen, Richard L Jr; Rowh, Mark E

The “Clinical Snapshot” series provides a concise examination of a clinical presentation including history, treatment, patient education, and nursing measures. Using the format here, you are invited to submit your “Clinical Snapshot” to Dermatology Nursing.

History: The patient is a 37-year-old female with a history of systemic lupus erythematosus (SLE). She is positive for antinuclear antibodies and anti-Ro/SSA antibodies. She also has antiphospholipid antibodies including anticardiolipin, anti-beta-2 glycoprotein I, and antiphosphatidylserine. She has a rash on her arms, which has a red mottled appearance. The rash is more prominent and takes on a purplish hue when she is exposed to cold temperatures. This rash does not cause pain nor discomfort.

Description: Livedo reticularis (LR) (see Figure 1) is a rash that results from dilation of capillary blood vessels. Stagnation of blood within these vessels causes mottled discoloration of the skin. It is described as being a reticular (net-like) reddish-blue discoloration of the skin. Anything that decreases blood flow further, such as exposure to cold, will make the condition worse.

Etiology: LR may be a benign condition or indicate systemic disease such as antiphospholipid antibody syndrome (APS), vasculitis, or arteriosclerosis. APS may occur as a primary disease or secondary to autoimmune disorders such as SLE.

Location: LR may be widespread or localized on the limbs or on the trunk or buttocks. Patients may also experience livedo on the palms of the hand.

Hallmark of the Disease: LR is a hallmark of cutaneous manifestation of APS. This syndrome is a disorder of the immune system that is characterized by excessive clotting of the blood. A diagnosis of APS is made when antiphospholipid antibodies are detected in the blood and the patient exhibits LR and/or has experienced a thrombotic event anywhere in the body.

Figure 1.

Reticular or net-like pattern of livedo. The rash fades somewhat when the skin is warmed.

Treatment: LR does not generally cause discomfort. No special treatment of the rash is indicated. The patient with APS may be treated with baby aspirin, clopidrogel bisulfate (Plavix), warfarin (Coumadin), or heparin to reduce the incidence of thrombosis.

Normal Course: LR may wax and wane during the course of APS. The rash may never completely disappear.

Patient Education: The patient should minimize exposure to cold environments to reduce the prominence of the rash. Monitoring antiphospholipid antibody levels is also important. The patient should report symptoms of a blood clot, such as changes in the color of an extremity, shortness of breath, and chest pain as well as any bleeding tendencies from anticoagulant therapy, to the health care provider.

References

Evans, J. (2004). Dermatoses are often the first sign of antiphospholipid antibody syndrome (APS). Internal Mediane News, 37(23), 19.

Pullen, R.L., Cannon, J.D., & Rushing, J.D. (2003). Managing organ-threatening systemic lupus erythematosus. MEDSURG Nursing, 72(6), 368-379.

Richard L. Pullen, Jr., EdD, RN, is a Professor of Nursing, Amarillo College, Amarillo, TX.

Mark E. Rowh, BS, RT(R), CNMT, is Director of Nuclear Mediane, Amarillo College, Amarillo, TX.

Copyright Anthony J. Jannetti, Inc. Feb 2006

Over 40 pct of Mild Heart Attacks Undetected – Study

By Patricia Reaney

LONDON — Mild heart attacks in four out of nine people are undetected because patients do not recognize or dismiss the symptoms, Dutch scientists said on Tuesday.

Women, particularly those who are overweight, diabetics and the elderly are more likely to have an undiagnosed heart attack which increases their risk of suffering future cardiac problems.

“We found an incidence of nine heart attacks in 1,000 people from the general population above the age of 55. Four out of nine were clinically not recognized by the people themselves or their doctor,” said Dr Eric Boersma, of the Erasmus Medical Center in Rotterdam.

Although the findings, which are reported in the European Heart Journal, are based a study of 4,000 men and women in the Netherlands, Boersma said they are likely to apply to any developed country.

Heart attack is a leading cause of death in industrialized nations. Chest pain is the most common but by no means the only sign that sufferers notice.

“They may sense shoulder pain instead of chest pain, they may think they have severe flu that is taking a long time to recover from,” he told Reuters.

In the study, Boersma and his colleagues studied patients who had not had a heart attack. All had an examination and an electrocardiogram (ECG).

The researchers followed up the patients for a median time of more than 6 years. The patients were also given at least one repeat ECG to assess undiagnosed heart attacks.

They found that overall 43 percent of heart attacks had not been recognized — a third of heart attacks in men and more than half of those in women.

Diagnosing people who have suffered a heart attack is important to prevent future heart problems. Doctors can recommend lifestyle changes or prescribe aspirin or drugs to prevent another attack.

Smoking, high blood pressure, raised cholesterol levels, being overweight and lack of exercise increase the odds of heart attack.

Cardiovascular disease accounts for 29.2 percent of total global deaths, according to the World Health Organization (WHO). About 20 million people survive heart attack and stroke each year but many require long-term treatment.

“Women should be aware that with increasing age there is a definitely a probability that they will suffer a heart attack,” said Boersma. “The medical community should invest in screening for silent heart attacks because we know those people are at risk of future cardiac events.”