Vaidisova resolves to do even better

By Barnaby Chesterman

LIBEREC, Czech Republic (Reuters) – Every New Year, Czech
tennis player Nicole Vaidisova makes a secret resolution.

In 2004, she vowed to break into the top 100 players in the
world rankings. The wish came true, and she ended the year
72nd.

What the 2005 resolution constituted, the 16-year-old
Vaidisova will not say until the year’s end. She has, however,
already shot to 27th in the world and was a leading light in
the Czech Fed Cup team at the weekend.

“In January I make goals for the next January but I keep it
to myself,” said Vaidisova, a product of the Nick Bollettieri
tennis academy in Florida like 2004 Wimbledon champion Maria
Sharapova.

“It’s something I’ve done since I was 10 and I’ve never
told anyone what those goals were and they have always worked
out, so I want to keep doing that.

“Last year I had no ranking and I wanted to reach the top
100 but I got to 72, so I was happy with that.”

Czech Fed Cup captain Thomas Petera believes Vaidisova is
the finest player in her country and a future Grand Slam
champion.

“She will definitely be a top-10 player,” said Petera. “She
is definitely the biggest talent we have in this country.

“She hits the ball very hard from the baseline and she can
mix it up if she needs to. I think she can serve at around
180-190 kph.”

FIRST WIN

Despite Vaidisova’s two straight-sets singles wins in the
Liberec world group one play-off, the Czechs lost 3-2 to Italy.

Vaidisova won her first tournament, the Tier IV Vancouver
event, last year at the age of 15 years three months — a year
younger than Russian Sharapova was when she won her first tour
title.

The win made Vaidisova the sixth youngest singles champion
in history. At the time, she was ranked just 180 in the world
and had had to come through qualifying.

She reached the third round at Wimbledon last month at the
first attempt, matching her third-round appearance at the
Australian Open in January, and she beat former French Open
champion Anastaysia Myskina in Charleston in April as she
reached her first Tier I quarter-final.

The 1.81-meter Vaidisova, coached by her father, backs up a
fearsome serve with booming groundstrokes.

Introduced to tennis by her mother at the age of six,
Vaidisova was also keen on swimming, ballet, gymnastics and
basketball as a child.

At 10 she started attending the Bollettieri school and now
splits her time between Florida and the Czech Republic.

TOUGHER TOURNAMENTS

In 2003, she won the Orange Bowl, the unofficial under-16s
world championship.

Petera thinks life will get harder for Vaidisova now she is
joining the ranks of the grown-ups in an increasing number of
tournaments.

“She has to concentrate on her game because now she will
starting playing much tougher tournaments than she is used to
playing in,” he said.

For the moment, Vaidisova is enjoying her relative
obscurity.

“Where I live (in Florida) it’s kind of like a hip place,
so even if Sharapova walks through the mall no-one recognizes
her either.

“In the Czech Republic I don’t play exhibitions or go to
parties so mostly people just read about me in the paper.
Sometimes I get stared at but it’s not like there is a crowd
running behind me.

“It is hard to do everything and sometimes I have to pass
up on normal life. I can’t have a weekend away with friends but
I have a huge opportunity to make something in my tennis life.”

Nearly Two Million Eye Injuries in the US Each yYear

CHICAGO ““ Nearly two million Americans are treated for eye injuries per year, with males experiencing twice the rate of injury than that of females, according to a study in the July issue of Archives of Ophthalmology, one of the JAMA/Archives journals

Because eye injuries are rarely serious enough to require hospitalization, to understand the extent of eye injuries in the U.S., inpatient and outpatient facilities, in addition to other settings, must be considered, according to background information in the article.

Gerald McGwin, Jr., M.S., Ph.D., from the University of Alabama at Birmingham, and colleagues combined data from the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, and the National Hospital Discharge Survey for 2001, to estimate eye injuries in the U.S. Eye injuries treated in emergency departments, inpatient and outpatient facilities, and private physicians’ offices, as well as their causes and characteristics, were included in the study.

The researchers found that in 2001 an estimated 1,990,872 individuals (6.98 per 1,000) experienced an eye injury in the U.S. Most of the eye injuries were treated in emergency departments (50.7 percent); 38.7 percent were treated in private physicians’ offices, 8.1 percent in outpatient facilities, and 2.5 percent in inpatient facilities. Overall, males had more than twice the eye injury rate than that of females (9.5 injuries per 1,000 compared with 4.5 injuries per 1,000). White males in their 20s had the highest rate of eye injury (more than 20 injuries per 1,000). Injury rates were highest for superficial injuries, foreign bodies, contusions, and open wounds.

The authors state: “While the epidemiologic pattern of eye injury presented in this article is consistent with previous research from other settings, some important differences emerged. Private physicians represent an important source of care for eye injury in the United States, particularly for middle-aged adults. Future research should focus on a more detailed documentation of the causes of eye injuries as well as long-term functional outcomes as, despite the relatively frequent nature of eye injury documented in this study, injuries with potential visual significance more accurately reflect the public health impact of eye injury in the United States.”

On the World Wide Web:

JAMA and Archives Journals

Stores’ Sudafed Restrictions Vary

Jul. 9–Sudafed — a popular drug for the common cold — is off the shelves thanks to drug abusers.

And each pharmacy has found its own way of handling the new state law.

“Everybody has got their own policy,” said Jack Joseph, pharmacist at Eisenhower Parkway Pharmacy in Macon. “I limit people to one box. When I found out there was an issue with (Sudafed), I said I don’t want to be a part of that.”

In effect since July 1, a state law requires any product whose single ingredient is pseudoephedrine to be placed behind a pharmacy’s counter. Customers will have to seek a clerk or pharmacist to buy it.

The law limits access to cold medications containing only pseudoephedrine products commonly used to make an addictive drug, methamphetamine, according to a Georgia Sheriffs’ Association news release.

“If you leave it on the shelf, you have no control over it,” said Jim Kennedy, owner of Kennedy Drugs on Poplar Street. “I think there is definitely a problem with meth use.”

The medicines affected by the law only include Sudafed and generic knockoffs, but Pfizer, which manufactures Sudafed, has already launched a version of the drug that does not include pseudoephedrine — called Sudafed PE.

“Regular Sudafed may last longer for some people,” said Erica Johnson, Pfizer spokesperson. “If you are a customer who wants to purchase Sudafed, we advise them just to follow the applicable rules.”

But widely varying procedures at retail outlets might leave some consumers confused.

Buddy Harden, executive vice president of the Georgia Pharmacy Association, said rules will vary per pharmacy but that they will all meet the state requirements.

“Others may go a little beyond that depending on what their management feels is best,” Harden said. “A lot of the larger retail stores have pulled it behind the counter even before the July 1st date.”

The Georgia law states that no more than three packages or nine grams of drugs that contain only pseudoephedrine can be sold per customer.

But Walgreens has limited the purchase of Sudafed to two packages in all of its pharmacies nationwide.

At CVS on Bloomfield Road, six different varieties of Sudafed that mix pseudoephedrine with acetaminophen remain on the shelves — while 24-hour and 12-hour Sudafed is placed behind the counter.

Go to Fred’s Pharmacy, however, and all nasal decongestants with any hint of pseudoephedrine are behind the counter – including Aleve, Claritin-D, and Drixoral.

Customers will be required to sign an inventory log and show identification.

“It’s no inconvenience at all,” said James Richard, 43, of Macon outside Kennedy Drugs.

Richard said a friend recently lost two kids to an explosion from a meth lab in a barn in Jones County.

“You have people out here just getting literally crazy with the Sudafed. They’re ruining lives.”

Police say the law will help stop “smurfing” — known on the streets as when several people go from one store to another buying thousands of Sudafed and ephedrine tablets.

“Methamphetamine is everywhere,” said Twiggs County Sheriff Darren Mitchum. “Methamphetamine use in Twiggs County is definitely a problem. It seems to be a never-ending problem, no matter how hard you combat it.”

Methamphetamine is a synthetic stimulant drug that induces a strong feeling of euphoria. Pure methamphetamine is a colorless crystalline solid, sold on the streets as glass, ice or crystal. It is also sold as a less pure crystalline powder, termed crank or speed.

Mitchum said meth drug pushers make the drugs with glass jars and tubes in makeshift meth labs.

Mitchum said he hoped the new law will be enforced and personnel at drug stores trained to spot abusers.

But some pharmacists feel the law does not go far enough.

“I don’t know how it’s going to regulate who is buying them,” said Nickie Shley, a certified technician at CVS on Mercer University Drive. “I don’t think it will be effective. There is no signing or an inventory kept on how many each person is getting.”

Milton Powell, owner of Powell’s Bloomfield Pharmacy on Bloomfield Road, agreed.

“I think it would help, but I don’t think it would stop it,” Powell said. “Anyway, there are other sources always available.”

Meanwhile, police say meth cooks keep sprouting up.

At 10 a.m. Tuesday, Bibb County deputy sheriff Ted Darley received a tip about a 35-year-old man cooking meth off Gailo Drive in rural Bibb County.

“He had a hot plate plugged up and ether inside of a container on that hot plate,” Darley said. “One unit of ether is equivalent to one stick of dynamite.”

Ingredients used to “cook meth” can create a “highly toxic and combustible atmosphere” that can cause an explosion, the sheriffs’ association release stated.

Darley said the fire department evacuated neighboring houses, and arrests were made for trespassing and trafficking.

“A lot of that stuff has cancer-causing agents and can cause severe burns,” Darley said.

Darley said meth users can go without sleep for days, have sores on their skin, dilated pupils, suffer from hallucinations, high fever, and “shakes.”

“They pinch and pull at their skin,” Darley said. “They absolutely just go nuts.”

Darley said recipes for “cooking meth” are available on the Internet.

“You have young people that sit on the Internet and learn how to do this stuff,” Darley said. “I’ve seen everything from a 13-year-old girl to a 60-year-old man cooking meth.”

Methamphetamine abuse also contributes to other crimes because addicts typically cannot keep jobs, so they commit other crimes to pay for their habit.

“People are stealing to feed their habit,” Peach County Sheriff Terry Deese said.

In Houston County, a methamphetamine lab explosion killed a Houston County man in August. Two people face felony murder charges in relation to that death.

“By (pharmacists) not keeping it so easily available on the shelves, it cuts down on this stuff,” Darley said. “Especially with younger teens who go on the Internet and get a recipe and then go to a drugstore and get some Sudafed. This has helped us tremendously.”

Staff Writer Becky Purser contributed to this article.

—–

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Copyright (c) 2005, The Macon Telegraph, Ga.

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].

WAG, CVS,

Lamictal cuts effectiveness of the pill

By Richard Woodman
LONDON (Reuters Health) – Drug maker GlaxoSmithKline has issued
a “Dear Doctor” letter advising that its anti-epilepsy drug
Lamictal (lamotrigine) can reduce the effectiveness of oral
contraceptives.

New data have demonstrated an interaction between combined
oral contraceptives and lamotrigine which could lead to reduced
effectiveness of hormonal contraceptives, a revised product
label states.

“Women should have a review of their contraception when
starting lamotrigine, and the use of alternative non-hormonal
methods of contraception should be encouraged,” the new label
states.

It adds: “A hormonal contraceptive should only be used as
the sole method of contraception if there is no other
alternative.”

“If the oral contraceptive pill is chosen as the sole
method of contraception, women should be advised to promptly
notify their physician if they experience changes in menstrual
pattern (e.g. breakthrough bleeding) while taking Lamictal as
this may be an indication of decreased contraceptive efficacy.”

Lamotrigine concentrations are cut in half during
co-administration of oral contraceptives, the label further
states.

“This may result in reduced seizure control in women on a
stable lamotrigine dose who start an oral contraceptive, or in
adverse effects following withdrawal of an oral contraceptive.
Dose adjustments of lamotrigine may be required,” it advised.

Rapid drop in air pressure may trigger heart attack

By Anthony J. Brown, MD

NEW YORK (Reuters Health) – A rapid drop in air pressure —
as opposed to cold weather — may trigger some heart attacks,
research shows. According to a study published this month, the
incidence of heart attack, but not stroke, is increased in the
24 hours after a rapid fall in barometric pressure.

“Previous reports have shown that there are more (heart
attacks) in the wintertime,” lead author Dr. Philip D. Houck,
from The Scott & White Hospital and Clinic in Temple, Texas,
told Reuters Health. But, this does not seem to relate to cold
temperatures because even warm locations, such as Hawaii, have
shown an increase in heart attacks during the winter, he
explained.

Houck and others correlated atmospheric pressure data with
the occurrence of heart attack and stroke in central Texas
between 1993 and 1996. A total of 1327 heart attack patients
and 839 stroke patients were identified.

The fall and winter showed the greatest variability in
atmospheric pressure readings, the report indicates. As noted,
an increased risk of heart attack, but not stroke, was seen in
the day following a drop in air pressure.

“My experience taking care of patients over the years told
me that the day after a major weather event, like a
thunderstorm, we would see a cluster of heart attacks,” Houck
said. “Our study now shows that a relationship does exist. The
more the pressure falls, the greater the chance someone has of
having a heart attack the next day.”

Changes in atmospheric pressure don’t explain all heart
attacks, the researchers say, and the risk is likely highest in
individuals with heart disease.

“An atherosclerotic plaque may be a lot like a
bathysphere,” Houck said. As a bathysphere descends in the
water, pressure accumulates. When they fail, however, it
typically occurs during ascent when pressure drops. In a
similar way, changes in barometric pressure may cause plaque
rupture, resulting in an MI (heart attack).”

SOURCE: American Journal of Cardiology July 1, 2005.

Antwerp battles to stay world diamond capital

By Elizabeth Fullerton

ANTWERP (Reuters) – In Antwerp, the world’s diamond
capital, traders seal multi-million-dollar gem deals with a
simple handshake and the Yiddish word “mazel,” meaning “luck,”
just as they have done for the past 600 years.

Trust is such an integral part of life at Antwerp’s four
diamond exchanges that members post notices for lost and found
stones on a notice board.

But times are changing fast.

Such quaint customs belie an industry struggling to keep
pace and fend off competition from centers like Dubai, which
last year exported $1 billion in uncut diamonds to Antwerp and
offers investors big tax incentives.

Antwerp’s supporters point to the extensive infrastructure,
expertise and quality of life that benefit diamond traders.

“Having said that, everything can be repeated elsewhere. We
shouldn’t be complacent,” said Dilip Mehta, chief executive of
the Indian diamond company Rosy Blue, which has 15,000 workers
globally. It is based in Antwerp but has also opened an office
in Dubai.

Antwerp’s diamond business had a turnover of $36 billion
last year and accounted for 7 percent of Belgian exports.

Antwerp’s diamond landscape has already undergone enormous
change in the past 30 years. Trade was dominated by Jews from
the 15th century until the 1970s, when Indians began arriving.

Today, Indian diamantaires have at least 60 percent of the
market, leaving the Jews with around 30 percent.

And 90 percent of diamond manufacturing — the cutting and
polishing of rough stones — has moved to India where labor
costs are up to six times cheaper. Just 1,700 highly
specialized polishers remain in Antwerp, compared with 25,000
three decades ago.

Eight out of 10 uncut diamonds traded in the world and one
in two polished stones still pass through the Belgian port
city.

But hubs such as Dubai and Hong Kong are well-positioned to
snatch more share, given their proximity to India and China —
the world’s fastest growing consumer markets for diamonds as
economic growth spawns a swelling middle class.

BRAVE NEW WORLD

Rival hubs are not the only worries for players in
Antwerp’s “diamond mile” — two pedestrian-only streets that
are home to most of the diamond companies, diamond banks,
security firms, diamond exchanges and a synagogue, all under
heavy camera surveillance.

As former colonial master of the Congo, Belgium long had
special ties with Africa’s diamond-producing countries, but
these now want to reap more value from their gems.

South Africa has talked about regulating diamond exports
and developing a cutting and polishing industry at home.

Threatened with a potentially drastic reduction in the
number of rough diamonds passing through Antwerp, the Diamond
High Council, representing the city’s 1,600 diamond companies,
is responding with plans to expand to jewelry distribution.

The idea is that jewellers could pick their diamonds and
have them cut or set, or buy ready-made jewelry in Antwerp.

“We want to create a one-stop shop for jewels,” said Youri
Steverlynck, the council’s marketing director.

Some traders, such as Rosy Blue, are getting involved in
the whole process, from mining gems to selling them in jewelry.

The need for adaptability in this industry has been
underscored by recent major changes in the way De Beers, the
South African mining giant that supplies 55 percent of
Antwerp’s diamonds, does business.

De Beers, 45 percent owned by Anglo American, has slashed
the number of its so-called sightholders, or dealers allowed to
buy its prestigious gems, leaving many small- and medium-sized
businesses out in the cold.

BRILLIANT FUTURE?

Hasidic Jews in their dark hats, overcoats and side curls
haggle and joke with Indians in smart suits — a sign of the
apparently successful coexistence of old and new in Antwerp.

But in today’s tough environment, many young Jews are
finding new professions rather than taking over family diamond
businesses handed down over several generations.

Many Indian dealers, however, see a future in Antwerp and
are passing the baton on to their children.

“This is a market where the fittest will survive,” said
Bharat Shah, founder of Diampex. His son will shortly join the
company, which has an annual turnover of about $80 million.

To help traders who are not De Beers sightholders and to
promote the city, the diamond council last year launched the
Antwerp brand guaranteeing the quality of gems sold there.

It is also negotiating with the Belgian government to make
the import-export process smoother for diamond dealers.

But critics say Antwerp has reacted too slowly to defend
its gem trade.

“I’m afraid people are waking up now and we hope it’s not
too late,” said Eli Ringer, who has a medium-sized business.

There are now 24 diamond exchanges in the world compared
with just four in 1950, when all were in Antwerp.

“In future, Antwerp will be one of a number of diamond
centers, I doubt it will be the diamond center in the world,”
said one long-time industry insider.

But even that reduced role could become vulnerable if
Antwerp can’t hold onto some of its most important players.

“All that has to happen is one or two major mining groups
taking their headquarters away from here, which will be
followed by the leaders of the industry and then it can become
a ghost town,” Rosy Blue’s Mehta said.

Prostitutes of the world unite in Dubai

By Andrew Hammond

DUBAI (Reuters) – At a downtown Dubai hotel crammed full of
prostitutes, a Russian lady caked in make-up boasts about all
the rich clients she’s been hanging out with of late.

“Shoo, ya habibi!” (“what’s up, baby!”) she purrs in Arabic
in an effort to impress a prospective English customer. But he
isn’t having any of it and turns his attention to some of the
other nationalities on offer.

“I think he prefers black,” Katerina rasps in disgust, as
the man falls into conversation with a group of Ethiopians.

Business is booming in freewheeling Dubai where everyone,
including ladies of the night, is flocking to make his or her
fortune amidst another surge in Gulf Arab petrodollar wealth.

The semi-autonomous city-state in the United Arab Emirates
— the scene of round-the-clock work on brazenly ambitious
urban development projects — is attracting a global mix of
blue and white collar labor and realized 16.7 percent growth in
2004.

But unusually for the conservative Gulf region, it also has
a vibrant nightlife serving its population of 1.6 million, most
of them foreigners, with easy-access sexual relations for all.

Police said last year the UAE was considering imposing visa
restrictions on women tourists, especially Eastern Europeans,
to curb prostitution, which is officially illegal here.

Sara and Mariam, two Muslim sisters from Azerbaijan, prowl
the city’s bars by night looking for customers. They rarely
have a problem.

Tonight they’ve made the trek from the neighboring city of
Sharjah, where rents are cheaper than Dubai, to a nightclub
where the city’s cosmopolitan mix of men know there is a
global-wide choice of partners for the night.

“Money — in Dubai there’s lots of money. Everybody talks
about it where I come from,” says Sara, decked out in give-away
knee-length leather boots and a tight white top.

On earnings of $6,000 a month, with $600 paid to her
Turkish pimp, she says it’s an easy game for the sisters, who
watch out for each other in case there is trouble. They are
doing well in a country with a per capita income of more than
$20,000.

“Our day jobs pay almost nothing, but we can make a lot of
money at night. It’s very easy for us here,” says Mariam, who
along with her sister has a low-paid professional job by day.

DARK SIDE

But there is another side to prostitution in the Emirates
— women lured by pimps to the country on false pretences who
find themselves forced into selling themselves by night.

The State Department last month singled out the UAE as one
of the world’s worst offenders in human trafficking, partly
because of women it said are forced into prostitution.

Alia, a 25-year-old from Kazakhstan, says she is one of
them. A recent arrival, she earns about $1,000 a month but pays
most of it on rent and her Kazakh pimp who has kept her
passport until Alia’s payments hit the $8,000 figure.

“I was tricked to do this. I thought I would be working as
a secretary or something. I was ill for the first one and a
half months from the shock,” she says stoically, surveyeing the
large array of competition filling the hotel bar.

“I was amazed when I first came at the number of girls
here,” she adds, before leaving the scene alone. One police
official acknowledged the large numbers of prostitutes but said
many of the complaints could not be taken seriously.
Professional “Natashas,” or Russians, say they have been duped
only after arguments with their pimps over money, he said.

JUMPED FROM WINDOW

According to local charity group Valley of Love, there has
been a rising number of women forced into prostitution over the
last year. The networks are often run by Indians, the largest
ethnic group in the cosmopolitan mix of the United Arab
Emirates.

“There have been more than 150 cases in the last six
months, while previously it was very few. Now people have come
to know these things are happening,” said its head, C.P.
Mathew.

“They were forced or nearly forced into prostitution. Most
of them escaped, and most of them were Indian. They come as
babysitters, maids and salesgirls. Some will do whatever they
can to get out of the situation,” he added.

One such woman was Amali Wijiyatunga, a 25-year-old Sri
Lankan maid who jumped out of a second-storey window when she
realized she was being forced into sex for money.

Police found her broken and bloody on a downtown pavement
earlier this year and took her to a hospital. Amali says Indian
acquaintances had promised to help her after she went through a
series of unpleasant employers in other UAE cities.

But things turned from bad to worse when she was taken to a
Dubai apartment on the promise of help in finding better work.

“They wanted me to do a blue movie and I didn’t know what
to do. This is my life, I can’t do this. So I jumped out of the
window,” she said from her hospital bed where she convalesces.

(Additional reporting by Odai Sirri)

Seoul school bully groups spawned crime syndicates

By Jon Herskovitz and Kim Yoo-chul

SEOUL (Reuters) – The old problem of school bullying has
taken a modern twist in South Korea, where gangs use the latest
communications technology and form mini-crime syndicates that
combine gangs from several schools.

With names such as the “Seoul Association,” the syndicates,
recently the target of a clampdown, linked bullying gang
members from several schools in the capital Seoul to carry out
extortion, assault, robbery and prostitution.

South Korea’s National Police Agency stamped out the
syndicates earlier this year and cut down on bullying with a
forceful nationwide campaign.

But experts on the subject say what happened in South Korea
may represent the future for school bullying in the country and
other parts of the world.

Police identified and disbanded three gang networks. The
Seoul Association was the largest with 307 members from 94
junior and senior high schools while the other two syndicates
were organized among junior and senior high school students
from two affluent areas, also in Seoul.

“If we had let them alone, they would have gone
nationwide,” said Lee Kum-hyoung, director of the Women and
Juvenile Affairs division of the National Police Agency, adding
police believed they had stamped out all the syndicates.

Lee said the groups set up their own Internet sites for
organizing events, such as street brawls with other syndicates
to see which group had the better fighters. Members used text
messaging to communicate in class and to members in nearby
schools.

In South Korea’s Confucian society, the syndicates were
highly ordered based on seniority, and Web sites also listed a
pecking order of gang members based on fighting skill.

This top-down structure mirrors life in South Korea’s
pressurized schools, which have a rigid system of discipline
and structured relationships where juniors must obey their
seniors. Seniors can often act with impunity toward juniors,
which helps bullying become a part of school life, experts say.

Add to this the world’s most wired country and gangs will
automatically turn to high-tech communications to branch out
and to organize extortion or other rackets that prey on the
weak, experts said.

SELLING DATES, STEALING RADIOS

The groups would put the squeeze on students to raise money
for senior syndicate members so they could go out on expensive
dates. The Seoul Association used its organizational skills to
host seven sexually charged dance shows, where they auctioned
off dating partners.

The groups mostly conducted petty crimes and but some also
engaged in prostitution and rape, members said. They comprised
elite students as well as class bullies, with girls forming a
large part of the syndicates.

A 16-year-old high school student, who asked that she only
be identified as Kim, was a part of the “Songpa Association”
which banded together boys and girls from an affluent area of
Seoul.

“My seniors forced me to steal car stereos from parking
lots in the middle to the night, and to bring girls around for
their birthday parties so they could have fun,” Kim said.

“Selling sex to top members was a way other leaders in the
group could keep their control,” she said.

In March, police, along with parents, teachers and
prosecutors, launched a huge program to curb school violence
that included setting up 24-hour telephone hotlines, counselors
for victims, special school police and an amnesty period for
gang members who wanted to confess to petty crimes.

“We set up this program to teach the students of the
dangers of these gangs. Our emphasis is on helping the victim,
reforming the assailant, and seeking criminal prosecution for
those few who commit terrible crimes,” said the police agency’s
Lee.

CRIMINAL MINDS

Experts are worried the trend could also emerge in other
parts of the world that have high population densities and
tech-savvy students who communicate electronically.

“What is going on now in South Korea could become the model
in other parts of the world,” said Shin Young-hee, a criminal
sociologist at Seoul’s Hanyang University.

“Access to the Internet and sending SMS text messages by
mobile phones are among the easiest and fastest ways to
organize crime efficiently,” she said. So far, other police
forces have not worked with South Korea on this problem.

Although the crime syndicates may have been eradicated,
gangs at individual schools still thrive, police say.

Police studies show if a student joins a gang it is usually
in junior high school. Among the gangs tracked nationwide, 54
percent are for boys and 46 percent for girls, who tend to
borrow the name of a high-end designer brand for the group
name.

“Criminal organizations will gain more power if they are
connected under a big, central command,” Shin said. “I think
these junior and senior high school students understood this
concept and used the tools at hand to seize on forming their
syndicates.”

Every One of These S Starsis Deadly Thin

THEY are gorgeous and glamorous – and hungry for fame.

But an exclusive Sunday Mail survey has discovered top female celebrities are literally starving themselves for stardom. With the help of scientist Nilani Sritharan, we checked out some of the biggest names and discovered that all of them wereunderweight.

When Nilani revealed what the acceptable weight range SHOULD be for each celeb, based on their height, all 10 fell short.

And we checked their Body Mass Index – a scale used by doctors to tell if a patient’s weight falls within a healthy range – only Big Brother celeb Kate Lawler managed to scrape above the critical 18.5 limit.

The ultra-slim stars are at risk of damaging their long-term health unless they start eating properly.

Body Mass Index is calculated by dividing a person’s weight in kilograms by their height in metres squared.

Anything between 18.5 to 25 in adults is considered healthy, more than 25 is classed as overweight and above 30 is obese.

But obesity is something the women featured here certainly have no fear of.

Low BMIs mean many of them could be left with serious long-term health problems, including osteoporosis and iron deficiency anaemia.

They can also suffer tiredness, irritability and low concentration and it can also lead to problems during pregnancy and children being born with a low birth weight.’

Nutrition scientist Nilani, who is based at the MRC Human Nutrition Research in Cambridge, said: ‘All of these celebrities are underweight.

‘They need to re-introduce a healthy diet to avoid suffering nutrient deficiencies, heart, bone and fertility problems or, worse still, premature death.’

Our findings confirm a survey of medics who warned undernourished stars are setting a bad example about how to lose weight and keep it off while keeping yourself healthy.

A massive 85 per cent of doctors feel Brits who follow celebrities such as Teri Hatcher, Nicole Kidman and Victoria Beckham are endangering their long-term health by going on faddy eating plans.

GP Dr Ann Robinson, who helped compile the survey, said: ‘Celebrities are not nutritionists.

‘Many are actually underweight and undernourished but they don’t even realise it.

‘They have a vested interest in looking ‘perfect’ and are often taken in themselves by the latest diet crazes. While such extremes might be okay for those whose livelihoods depend on it, it doesn’t make for a sensible or sustainable healthy living planfor the rest of us.’

But as our findings reveal, the diets are not sustainable or healthy for the super-skinny stars either

Kate Lawler,25

Height: 5ft 7ins # Weight: 8st 8lbs BMI: 18.69THE former Big Brother winner won’t eat carbs in the evening and trains four to five times a week at the gym.

Kate said: ‘I’ve always been a big eater but I stay skinny because I’m so active.’ For breakfast she eats cereal and skimmed milk. Lunch is soup or a tuna jacket potato and dinner is often chicken salad. She said: ‘I never have dessert but I can’t resistbread#Acceptable weight for height: 9st 3lbs – 11st 9lbs Nilani said: ‘It’s good to see Kate doesn’t skip meals but she could improve her fruit and veg consumption and vary her diet a bit more to include more fish and fewer processed foods

Lara Flynn Boyle,35

Height: 5ft 4ins # Weight: 6st 8.5lbs BMI: 15.81SHE may have appeared in Men in Black II with Will Smith but this actress is more famous for her skin and bones figure.

She claims she doesn’t diet and insists she has porridge for breakfast and eats ‘roast beef, peas in mashed potatoes, escargots, caviar, peanut butter and jelly, Pop-Tarts’ – but it’s difficult to believe her.

Lara also says she doesn’t exercise. ‘I just work. I get up at 4am and I’m on my feet most of the day. I like to swim, too#Acceptable weight for height: 8st 5lbs – 10st 8lbs Nilani said: ‘Lara is the most underweight of these celebrities. It’s unlikelyshe is eating well or enough. It can affect fertility, the heart and blood pressure

Nicole Kidman,38

Height: 5ft 10.5ins # Weight: 8st 6lbs BMI: 16.85THE ex-Mrs Cruise keeps herself trim by following the South Beach Diet. But recently, Nicole has looked stick-thin.

She says: ‘I’ve always had this long, lean body type and I haven’t changed since I was 15. I eat healthily but I also love pies and chocolate.’

Many would agree however that she could do with eating a few more pies.

Nicole has cut starches and sugars out of her diet, including dairy produce#Acceptable weight for height: 10st 4lbs – 12st 13lbs Nilani said: ‘By cutting out virtually all carbs and dairy foods, you lose one of the best sources of calcium and nutrientssuch as Vitamin B12 and riboflavin

Donna Air,25Height: 5ft 9ins # Weight: 8st

BMI: 16.65THE former Byker Grove actress tries to eat as much organic produce as possible.

But that hasn’t stopped people accusing her of being anorexic, especially when she regained her size 8-10 figure soon after giving birth to her daughter in 2003. ‘I eat loads,’ she insists. That means brown pasta, brown bread, fruit, veg, pulses, fishand milk. She also does Pilates and swims. Breast-feeding may have helped her get back into shape#Acceptable weight for height: 9st 12lbs – 12st 5lbs Nilani said: ‘High fibre content probably means Donna fills up before she has eaten enough. ‘Good fats’such as olives, avocados and nuts, may help

Eva Herzigova,32Height: 5ft 11ins # Weight: 9st 4lbs

BMI: 18.21EVA loves French, Italian and Japanese cuisines. She drinks plenty of tea and water and eat lots of fruit for breakfast.

She blames ‘stress and travelling’ for her shrinking size, saying: ‘I love food. I’m not even particularly careful about what I eat. I live on bread, cheese and salami. Chips are my favourite#Acceptable weight for height: 10st 6lbs – 13st Nilani said:’Vegetables have anti-cancer agents as well as vitamins and minerals, especially cruciferous veg (broccoli, cauliflower etc) which seem to be lacking in her diet. Judging by her weight, Eva doesn’t eat nearly enough and is missing out on many nutrients

Nicole Richie,23Height: 5ft 1ins # Weight: 6st 9lbs

BMI: 17.48THE Simple Life star is a shadow of her former self. She claims it is down to a healthy balanced diet and increased physical activity.

Her trainer Adam Estner says: ‘Richie now eats more food than before but she eats the right kind.’ She claims she put on weight because she couldn’t exercise in rehab when she being treated for her drug addiction#Acceptable weight for height: 7st 9lbs -9st 9lbs Nilani said: ‘Nicole may be more underweight than her BMI suggests. Increasing physical activity means you can eat more but it’s important to ensure you’re getting enough calories

Teri Hatcher,40

Height: 5ft 6ins # Weight: 7st 6lbs BMI: 16.65DURING her Lois and Clark days Teri was more curvy. Her weight has plummeted since starting on Desperate Housewives.

Some sources claim she is battling an eating disorder. But Teri claims she’s just careful about what she eats, adding: ‘The only thing I’m guilty of is being too athletic and refusing to eat garbage. I eat a lot of fruit.’ She also says she eats grilledchicken, fish and veg#Acceptable weight for height: 8st 13lbs – 11st 2lbs Nilani said: ‘It’s good to ‘go large’ on fruit and veg but carbs, especially whole-grains, seem to be lacking. Pasta, rice, bread and potatoes are a great way of keeping youfeeling fuller for longer

Lindsay Lohan,19

Height: 5ft 6ins # Weight: 8st BMI: 18.07THE star of Mean Girls puts her dramatic weight loss down to illness after she was diagnosed with acid reflux, anaemia, hypoglycaemia, a swollen liver and an infected kidney.

The condition, she claims, led her to lose 28lbs and shrink to a UK size 6.

One website – www.feedlindsay.com – has already seen 200 of her fans sign a petition begging the star to eat. But she claims: ‘Compared to a lot of actresses my age I’m actually over- weight#Acceptable weight for height: 8st 7lbs – 10st 10lbs Nilani said:’Lindsay is putting herself at an increased risk of several diseases, including menstrual problems

Victoria Beckham,31Height: 5ft 6ins # Weight: 8st

BMI: 18.07#Acceptable weight for height: 8st 13lbs – 11st 2lbs Nilani said: ‘Victoria may be excluding dairy foods, whole-grains, fish and red meat which could mean she’s missing out on lots of vital nutrients such as calcium, essential fats, iron and Bvitamins POSH has always snapped back into shape following the birth of each of her three sons .

But it’s her new Mediterranean diet which she believes has really helped her get back into shape. Since the birth of Cruz she’s been living on lots of olives, prawns, chicken, fresh fruit and vegetables such as avocados. Victoria regularly does pilatesand yoga

Renee Zellweger,36

Height: 5ft 4ins # Weight: 7st 7lbs BMI: 18.07After the second instalment of Bridget Jones, Renee relied on a high-protein diet to help shed the pounds.

Carbs are limited because without them, low-carb diet fans claim, your body switches to burning fat for energy.

She also booked herself into the Ashram weight-loss spa in California – where guests must do 12-mile hikes daily – and lost three stone#Acceptable weight for height: 8st 5lbs10st 8lbs Nilani said: ‘A restrictive diet like this would lead to weight lossbut they are deficient in certain nutrients and can cause bad breath and constipation. The long-term effects are totally unknown

Gene for Immune Deficiency Syndromes Found

A newly discovered gene mutation may account for many cases of immune deficiency, in particular two syndromes known as immunoglobulin A (IgA) deficiency and Common Variable Immunodeficiency (CVID), report researchers in the July issue of Nature Genetics. The discovery may lead to a new diagnostic test for these conditions, which make people highly susceptible to infections and often go unrecognized because of a lack of good tests.

IgA deficiency affects 1 in 600 people; CVID is less common but more severe. Children and adults with either condition suffer relentlessly recurring ear infections, sinus infections, bronchitis, pneumonias and gastrointestinal infections. IgA deficiency and CVID can occur in the same family, and also predispose people to autoimmunity, particularly affecting the thyroid gland and resulting in thyroid hormone insufficiency. Finally, people with CVID are susceptible to B-cell lymphomas.

The researchers, led by Raif Geha, MD, and Emanuela Castigli, PhD, in the Division of Immunology at Children’s Hospital Boston, found mutations in a gene known as TACI in 4 of 19 unrelated patients with CVID and in 1 of 16 unrelated patients with IgA deficiency. None of 50 healthy people tested had a TACI mutation. Four of the 5 patients with TACI mutations were studied further, and all 4 had relatives with the same mutations. Eleven of the 12 identified relatives with TACI or IgA deficiency reported a history of recurrent infections and were found to have low levels of immunoglobulin A (IgA), immunoglobulin G (IgG) or both.

TACI mutations interfere with two aspects of the immune response that involve maturation of B cells, the white blood cells that make immunoglobulins, which function as antibodies, to fight infections. Normally, TACI triggers B cells to switch from making immunoglobulin M (IgM), an antibody produced early in the body’s immune response, to making other immunoglobulins like IgA and IgG. More important, TACI signals B cells to produce antibodies with a high affinity for specific attackers. Because TACI mutations are dominant, people with even one copy of the mutation will be unable to mount a strong antibody response.

“A test for TACI would allow for diagnosis of more children and their relatives,” says Geha, senior author of the study and a professor of pediatrics at Harvard Medical School. “Many children who are sick are now missed, because they can have normal IgA and IgG levels, yet they still have poor antibody responses and get the same bacteria and viruses again and again.”

The gene discovery will immediately not change therapy, Geha adds. “For the time being, it’s prophylactic antibiotics or IV immunoglobulin infusions every three weeks,” he says.

Geha’s team previously demonstrated that TACI binds to two other proteins made by cells in the respiratory and gastrointestinal lining, known as APRIL and BAFF, to trigger the signal for B cells to mature. Geha believes that additional cases of immune deficiency result from mutations in the APRIL and BAFF genes, and plans to verify this in further studies.

On the World Wide Web:

Children’s Hospital Boston

Implementing a Research-Based Model of Cooperative Learning

ABSTRACT

The author used qualitative research methods to explore an 8th- grade mathematics teacher’s personal definition of cooperative learning and the enactment of cooperative learning in his classroom according to that definition. Data collection involved interviews and classroom observations. The author used coding schemes and descriptive statistics for data reduction and analysis. Constructivist psychology provided the theoretical groundwork for conclusions based on consistency across interview and observational data. Results revealed that while the teacher implemented a research- based model of cooperative-learning instruction, he adapted the model for use in his classroom. Results also identified the teacher’s prior experience and teaching context as factors that influenced his implementation of cooperative-learning instruction.

Key words: cooperative learning, implementation, qualitative research

Cooperative learning involves groups of students working to complete a common task. It is a rich educational strategy because it affords elaborate student interactions. That richness makes cooperative learning a complex construct to study. Given its complexity, researchers have attempted to specify its methods and to control its implementation.

The preponderance of research on the outcomes and processes associated with cooperative learning suggests that it can effectively promote academic achievement and social skills development (Elmore & Zenus, 1992; Johnson & Johnson, 1978, 1982, 1983; Johnson, Johnson, Buckman, & Richards, 1985; Johnson, Johnson, & Stane, 1989; Johnson, Maruyama, Johnson, Nelson, & Skoi, 1981; Madden & Slavin, 1983; Nastasi & Clements, 1991, 1993; O’Melia & Rosenburg, 1994; Qin, 1992; Qin, Johnson, 6k Johnson, 1995; Slavin, 1983a, 1983b, 1985, 1987; Stevens 6k Slavin, 1995a, 1995b). In those studies, however, cooperative learning differed from what might happen in actual classrooms and schools. The researchers decided (a) which instructional methods to use for fostering cooperative learning, (b) the frequency and duration of cooperative learning lessons, (c) which activities and materials to use, and (d) the composition of student groups. Whereas those researchers considered experimental rigor in their decision making, teachers are more likely to consider (a) curriculum content, (b) available time and materials, and (c) student factors when they make such decisions.

Because of its potential to increase student academic achievement and social skills development, researchers have advocated the implementation of cooperative learning for school reform (Carnegie Council on Adolescent Development, 1989; Johnson & Johnson, 1983; Stevens & Slavin, 1995b). To researchers, the implementation of cooperative learning in reform settings has been construed as an issue of treatment fidelity. That is, researchers define successful implementation as adherence to a research-based model (Hertz- Lazarowitz, Ivory, & Calderon, 1993; Hintz, 1993; McCarty, 1993; Sapon-Shevin, 1992; Stevens & Slavin, 1995a, 1995b; Talamage, Pascarella, & Ford, 1984). That conceptualization emphasizes the standards of fidelity, effectiveness, and longevity typically used by researchers to judge the effectiveness of education reform, but it ignores the adaptations of reform practices valued by teachers (Cuban, 1996). In contrast to researchers who view variations in practice as signs of poor implementation, teachers view variation as evidence of creative problem solving (Cuban). If teachers likely modify cooperative learning as they implement it, the results of quasi-experimental studies of cooperative learning will have limited “generalizability” to real-life classrooms.

Grossen (1996) cautioned against recommending educational innovations based on the results of quasi-experimental studies with limited generalizability. She argued that in order to understand how new practices are integrated into existing school structures, research of instructional innovations in full context is needed. Potentially negative (or positive) side effects may be visible only over time in uncontrolled settings. Grossen identified cooperative learning as one such instructional innovation that, despite its research base, may produce different effects when implemented by practitioners rather than researchers.

Theoretical Framework

In the present study, constructivist psychology provides the framework for investigating the implementation of cooperative learning by teachers in real classrooms. Traditional constructivist psychology is rooted in the beliefs that knowledge is constructed (i.e., built on prior knowledge) and that knowledge is acquired through interactions with the environment (Perret-Clermont, Perret, & Bell, 1991; Vygotsky, 1978). A constructivist approach suggests that in the process of implementation, teachers are engaged in the active construction of knowledge about cooperative learning. Newly developed concepts will be reflected when cooperative learning is used in the classroom.

When teachers are trained to use cooperative learning, their understanding should be influenced by their existing knowledge of teaching practices and instructional methods and by their previous knowledge of current teaching contexts, including school structure, curriculum, and student characteristics. Through the mechanism of assimilation, teachers should reorganize the information that they receive about cooperative learning to fit their existing schema of teaching. In addition, the teaching schema should include cooperative learning.

As a result of changes in their mental frameworks, teachers should use new methods in the classroom. Teachers should internalize the resulting classroom experiences so those experiences contribute to their further understanding of cooperative learning. In some cases, teachers’ understanding and subsequent use of cooperative learning may need to be altered to accommodate new information obtained through their experiences. Thus, a constructivist approach suggests that teachers’ understanding of cooperative learning and the enactment of cooperative learning in their classrooms are related. Constructivism suggests that when teachers implement cooperative learning, they will not adhere precisely to researcher- developed models of cooperative learning.

Researchers who were interested in the education reform movement have used the constructivist approach to examine teachers’ understanding and use of instructional innovations (Alexander, Murphy, & Woods, 1996; Ball, 1996), changes in new teachers’ concepts of effective teaching (Jones &. Vesiland, 1996), systematic mathematics reform (Grant, Peterson, & Shojgreen-Downer, 1996), and effects of subject content on efforts to restructure high schools (Grossman &. Stodolsky, 1995). I located only one study, however, that considered the ways in which teachers think about and use cooperative learning in their classrooms. Antil, Jenkins, and Wayne (1998) used surveys and interviews to examine the prevalence, conceptualization, and form of cooperative learning employed by elementary school teachers. As one would expect from a constructivist point of view, teachers described their use of cooperative learning as modifications or adaptations of “more formal” research-based models. Antil and colleagues concluded that a chasm between researchers’ and practitioners’ approaches to cooperative learning existed, noting that few teachers were using recognizable models of cooperative learning. However, the researchers noted that their method did not allow them to identify the source of such differences. A further limitation of the Antil et al. study is that it relied solely on interviews and surveys. Classroom observations are required for one to complete the examination of implementation in real-life classrooms.

To summarize, the goal of many researchers who investigated cooperative learning has been to document its effectiveness. To that end, researchers have attempted to standardize the methods for using cooperative learning and control its implementations. As a result, little is known about cooperative learning as it is used in real- life classrooms. Although evidence suggests that teachers adapt research-based models of cooperative learning for use in their classrooms, teacher concepts of cooperative learning by teachers without researcher input and control are not well understood. Finally, the relationships between concepts and enactment have not been considered.

Method

Purpose

My purpose was to explore the implementation of cooperative learning by an expert eighth-grade mathematics teacher. Rather than examine the extent to which the teacher adhered to a research-based model, I, along with members of a larger research team,1 described how he conceptualized and enacted cooperative learning instruction in his classroom. Specifically, we examined the teacher’s personal definition of cooperative learning and the enactment of cooperative learning in his classroom according to that definition.

This study was part of a large project titled The Model Project for the Reform of Special Education in the Iroquois School District. (Iroquois is a pseudonym.) In that larger project, researchers docume\nted the reform efforts and instructional innovations designed to change the overall education system of a school district.

During the reform process, schools in the Iroquois district adopted various reform initiatives; middle school teachers adopted a cooperative-learning initiative. To provide the staff development needed for implementing reform initiatives, the district administration established the position of project leader. The role of the project leader was twofold. He or she received training in the initiative and then used various methods to educate other teachers. An eighth-grade mathematics teacher was appointed as the cooperative-learning project leader (also referred to as the “teacher” in this study) to facilitate the implementation of cooperative learning in the middle school. He was taught how to use the Johnson and Johnson (1983) model of cooperative learning. After his initial training, he was involved in providing training to and consulting with teachers who used cooperative learning in their classes. In the present study, we examined the implementation of cooperative learning by the project leader.

Design

The author chose qualitative methods for this study to address the limitations of the previous implementation research. According to Miles and Huherman (1994), qualitative research is conducted through an intense or prolonged contact with a real-life setting. A main task of qualitative research is an explication of the ways in which persons in a particular setting understand, account for, take action, and otherwise manage their day-to-day situations. The researcher attempts to identify themes to describe persons in their contexts. Finally, although many interpretations of qualitative data are possible, conclusions are made on the basis of theory and internal consistency.

Prolonged contact between the Iroquois school district and faculty and graduate students from the University at Albany provided the groundwork for this study. For 5 years, researchers from the university collected data in the school district. Data collection included participating in and observing project leader meetings, observing middle school classes, and interviewing project leaders, middle school teachers, and middle school students. Through conversations with school district administrators, we identified critical research questions. From a broad initial interest in school reform, cooperative learning became the focus of this study.

Our main task was to explicate the ways in which the cooperative- learning project leader understood and used the cooperative learning in his classroom. Data collection involved interviews and observations for soliciting the teacher’s perspective. The goal of data analysis was the identification of themes that explained the teacher’s conceptualization and enactment of cooperative learning. Constructivist theory provided the framework for conclusions on the basis of consistency across interview and observational data.

Participant

Administrators in the Iroquois school district appointed an eighth-grade mathematics teacher as the district’s cooperative- learning project leader. After receiving initial training in cooperative learning, he used cooperative learning in his eighth- grade mathematics classes and provided training to and consulted with other teachers who were using cooperative learning. He was viewed as the “cooperative learning expert” in the district. Other teachers referred to him as their “guru.” For those reasons, the author chose the project leader as the participant in this study.

In addition to being the district’s cooperative-learning expert, the project leader possessed several other interesting professional and personal characteristics. He taught eighth-grade mathematics students at a variety of levels, including remedial, general, and accelerated. Special education students were included in his remedial and general mathematics classes. The project leader had an inquisitive nature and motivation for professional development, which together resulted in his being best described as a lifelong learner. Although the project leader was near the end of his teaching career, he eagerly embraced new methods. In addition to his involvement in the cooperative-learning initiative, he explored ways to incorporate authentic assessment into his curriculum.

Interviews

To obtain information about the project leader’s personal definition of cooperative learning, we interviewed him several times. We conducted two formal interviews at the start and at the end of the data collection period and developed the protocol for this study. The initial interview protocol, which is contained in Appendix A, is a semistructured instrument intended to engage the teacher in conversation about cooperative learning. We developed follow-up interview questions based on data that we collected during the study for clarification purposes. Follow-up interview protocol is contained in Appendix B of this study. Both interviews were tape- recorded for later transcription and analysis.

In addition to the two formal interviews, we engaged in conversation with the project leader throughout the data collection period. During the informal conversations, the project leader provided information about his understanding of cooperative learning and explained the use of cooperative learning in his classroom. We recorded information from those informal conversations and considered it as data for analysis.

Observations

To obtain information about the enactment of cooperative learning in the project leader’s classes, we conducted classroom observations. The observations focused on students in cooperative- learning groups during 40-min class periods. We observed six student groups-three groups from one general mathematics class and three groups from one accelerated mathematics class. We observed each group three times, totaling 18 observations, over a period of 10 weeks during the third marking period of the 1995-1996 school year. We did not observe remedial mathematics classes because the project leader said that he used cooperative learning less frequently in those classes.

To ensure that key events were not overlooked, the author developed a preliminary coding scheme along with another researcher who was examining cooperative-learning instruction in a high school in the Iroquois school district. On the basis of the literature and previous observations in the district, we identified the following broad categories of interest: (a) basic elements of cooperative learning; (b) grouping patterns; (c) presentation of content, learning tasks, material, and activities; and (d) evaluations of learning, classroom management, and classroom environment. During classroom observations, we recorded narrative field notes in 5-min intervals. We then coded observations by recording observed events in each category and modified and elaborated categories to account for all observed events.

Interrater agreement for the preliminary coding scheme and observation procedure was established; the researcher and I simultaneously observed classes. Using that scheme, we recorded field notes independently. We examined results for congruent evidence of each category identified; iruerrater agreement was 92%.

Data Analysis

To analyze the data specific to the current study, the researcher and I developed a more focused coding scheme. From the data organized in broad categories identified in the preliminary coding schema, two major categories of phenomena emerged as relevant: cooperative-learning methods and lesson plan format. Cooperative- learning methods included those aspects of instruction that were specific to cooperative learning; lesson plan format included those aspects of instruction that represented the project leader’s general teaching style. We developed several subcategory codes to classify different types of events under each category. In the process of classification, we identified 20 cooperative-learning variables and 6 lesson plan variables; Table 1 contains a list of those variables.

Following the development of the coding scheme, we used descriptive statistical methods to analyze and reduce the emergent variables. We used the 18 class periods, which served as the units of observation, as the primary units for data analysis. Although some cooperative-learning methods were used in nearly all class periods, many of them were evident in only some of the classes that were observed. For that reason, we used frequency counts by class period to summarize the cooperative-learning variables. To obtain frequency counts, we determined the presence or absence of each cooperative-learning variable in each class period. For example, we counted 13 of the classes as including evidence of round-robin discussion between student group members (i.e., face-to-face interaction via turn taking). Frequency counts for cooperative- learning variables are shown in Table 2.

In contrast to the use of cooperative-learning methods that varied, the project leader’s lesson plan format appeared consistent across multiple classes. Therefore, we determined that calculations of the amount of class time engaged for each lesson plan variable would be the most descriptive method. For each class period, we identified the number of minutes that we observed each lesson plan variable. To summarize the data further, we calculated the average number of minutes for each variable by dividing the total number of minutes across observations by total number of observations. For example, we recorded engagement in cooperative-learning activities as occurring for 360 min, which we calculated was an average of 20 min for each of the 18 classes observed. Average amount of time engaged for each lesson plan variable is shown in Table 3.

In the process of computing frequency counts and determining amount of class time engaged, we detected differences between the genera\l mathematics class and the accelerated mathematics class. Although differences between groups within the same class were considered, these comparisons did not demonstrate a consistent pattern. For purposes of further analysis and comparison between types of classes, we calculated percentages for each of the cooperative-learning frequency counts and for each of the lesson plan class time averages. We calculated cooperative-learning percentages by dividing the number of classes for which each variable was observed by the total number of classes observed. Returning to the previous example, round-robin discussion between group members was evident in 72% of the classes observed. We calculated lesson plan percentages by dividing the average amount of class time by the total number of minutes per class (i.e., 40). For example, I found that cooperative-learning activities accounted for 50% of class time. Cooperative-learning percentages and lesson plan percentages are shown in Tables 2 and 3, respectively.

TABLE 1. Emergent Variables

TABLE 2. Cooperative Learning Variables (Occurrence by Type of Class)

TABLE 3. Lesson Plan Variables (Minutes of Class Time by Type of Class)

We next applied the coding scheme to transcripts of the teacher interviews. We used teacher descriptions of observed events to elaborate major themes and subcategory codes. In addition, we used quotes from the transcripts to explain (a) the teacher’s understanding and use of emergent cooperative-learning and lesson plan variables in general and (b) differences in these variables between the two types of classes. I based my conclusions on consistency between observation and interview data.

Results

Analysis of observation and interview data supported three major findings. First, the project leader’s conceptualization of cooperative learning was consistent with a research-based model. second, as would be expected given a constructivist approach, the project leader adapted the research-based model for use in his classroom. Finally, we identified three distinct types of adaptations: (a) the project leader used personal techniques to implement cooperative learning, (b) implementation involved the integration of cooperative learning with the project leader’s previous basic lesson plan, and (c) implementation differed between accelerated and general mathematics classes.

Personal Definition of Cooperative Learning

As revealed in the interview transcripts, the project leader’s concept of cooperative learning reflected the Johnson and Johnson (1983) model in which he was trained. He defined cooperative learning as instruction that contained the five essential elements identified by Johnson and Johnson: (a) face-to-face interaction, (b) individual accountability, (c) positive group interdependence, (d) social skills instruction, and (e) debriefing. The project leader described face-to-face interaction as “equal participation and discussion between all group members.” He identified individual accountability as “the part that makes most kids work, and do the job . . . whether it is a test, a quiz, or verbal questions, something that makes them know they each have to understand what’s being taught.” Also, he defined positive group interdependence as “the idea that we sink or swim together, everyone has to understand and do the work.” He described social skills instruction as teaching students “how to listen, how to speak, and practice taking turns” at the beginning of the school year. The project leader explained that he emphasized the social skills of “politeness and courtesy, showing respect for other people and their ideas” throughout the school year. Finally, he described debriefing as “the time at the end of the class to reinforce what was good and discourage what was bad,” including academic and social aspects of group functioning.

Implementation of a Research-Based Model With Personal Techniques

Analysis of classroom observation data revealed that the teacher used specific techniques to implement each of the five elements of cooperative learning. Examples of the techniques and percentages of classes in which they were observed are presented in Table 2. I observed face-to-face interaction in most classes as students took turns explaining problem solutions to the group. The teacher fostered individual accountability through individual tests and quizzes and structured activities. He used group worksheets to promote positive interdependence. Because I conducted observations in the second half of the school year, verbal directions and reminders were the most commonly observed method of social skills instruction. Finally, we observed that debriefing most often entailed the teacher providing general comments during group work.

Review of classroom observation data further revealed that the enactment of cooperative learning in the project leader’s class involved the integration of the five elements with his basic lesson plan. This lesson plan consisted of review of previously learned material, introduction of new material, and practice of newly acquired skills. Data on the lesson plan variables are shown in Table 3. The teacher used cooperative learning primarily for practicing newly acquired skills and occasionally for reviewing previously learned material.

A typical lesson in the project leader’s classes began with students sitting in rows facing forward. The project leader began with review. He announced answers to the previous night’s homework or a recently administered quiz. Students checked to see if their answers were correct. The teacher demonstrated solutions to difficult items. In the accelerated mathematics classes, students compared and discussed homework answers with their group members.

Following review, the teacher often introduced new material. He outlined definitions of concepts and sample problems on the blackboard. The teacher used a type of guided practice to model solutions to sample problems. During that process, he demonstrated initial steps to a solution and then called on students to answer questions or provide the next step in the solution. For example, when demonstrating how the students could determine the area of a triangle, the teacher drew a triangle on the blackboard and announced the length of the base and the height. He then asked, “What’s the formula for the area of a triangle?” When a student replied, “One-half base times height,” the teacher wrote the formula on the board and asked, “What should I do next?” As students supplied the answers to his questions, the teacher completed the steps on the chalkboard. He often used that method to model several examples before he assigned students to small groups for continued practice.

Following the whole-class introduction of new material, the students typically worked in groups of 2 or 4 students to practice new skills. The project leader presented the assignment and directions for group work by writing them on the chalkboard or distributing a typed list. The assignment often included real-life applications of the new skills. For example, group practice problems on percentages and decimals consisted of calculating restaurant bills and determining the appropriate tip.

The students moved their desks from facing forward to facing their group members. Each group worked with one textbook or worksheet. Typically, one student who was the discussion leader read the problem to the group and verbalized the solution. Other group members wrote down the solution as it was explained. If a calculator were necessary to complete the problem, a second student in the group entered numbers and computed the answer as the first student described the solution process. If the group were required to submit one page of written answers to the teacher, a third student in the group took the responsibility for writing the answer. Students switched roles at the beginning of each problem. The textbook, the calculator, and the answer page were passed to other group members.

Most often, the process was enacted in each group for each question. Variations to the typical process occurred, however, when students did not understand the problem or when members disagreed about the solution described. When misunderstandings did occur, students (a) asked for clarification, (b) gave more detailed explanations, (c) tried different methods of problem solving and comparing answers, (d) referred to the textbook, or (e) asked the teacher for help.

During group practice, the teacher observed the students, monitored group progress, and provided help where needed. Occasionally, the teacher called out reminders for the students to “stay together,””help each other,” and “take turns.” As he walked around the classroom, he also stopped to provide feedback to groups about their process of interaction. Sometimes that feedback consisted of a verbal summary of the group process as seen by the teacher. On other occasions, the teacher returned a group worksheet or quiz with an academic grade and a group-process score. He explained how he had arrived at the score and offered suggestions for improving group functioning.

At the conclusion of the group activity, the teacher typically collected one worksheet or answer page per group. Sometimes he randomly selected one student’s paper. Other times, the group had completed one paper to be submitted. Following group practice, the teacher often assigned homework problems for individual practice. If time were remaining in the class period, students moved their desks back into rows facing the blackboard and began the practice problems. On a few occasions, the teacher made concluding comments about the new skills that were practiced or described positive aspects of group functioning that he observed.

Effects of Context

In terms of the emergent variables, we noted differences between the general and accelerated mathematics classes.

Although differences in individual va\riables were not large, taken together they represented a pattern of difference between the classes. That pattern was evident in the cooperative-learning variables and the lesson plan variables (see Tables 2 and 3, respectively).

With regard to lesson plan format, we noted differences between the two types of classes in the amount of time and type of activity for which each variable was used. For example, in the general mathematics classes, cooperative learning accounted for 40% of class time; 55% of class time was designated for whole-class instruction. In contrast, in the accelerated classes, 60% of class time was spent in cooperative-learning activities, and 40% of class time was spent in whole-class instruction. In the general mathematics classes, cooperative-learning activities were limited to practice of new skills. In contrast, cooperative-learning activities were used for review of previously learned material as well as practice of newly acquired skills in accelerated classes. Teacher-led review of previously learned material accounted for a greater percentage of class time in general (30%) than in accelerated mathematics classes (20%).

With respect to cooperative-learning methods, we noted differences between the two classes regarding methods for promoting individual accountability and group interdependence. To promote individual accountability, the teacher used individual assignments and structured activities more often in general classes (22% and 100%, respectively) than he did in accelerated classes (11% and 44%, respectively). He used worksheets to promote group interdependence in 67% of the observed general mathematics classes; no instances of group worksheets were observed in the accelerated mathematics classes.

In addition to teacher behavior, differences in student behavior between the two types of classes also were noted among the cooperative-learning variables. Disagreements during group discussion were observed less often in the general mathematics classes (33%) than in the accelerated mathematics classes (78%). When disagreements did occur, students in general mathematics classes asked the teacher for a solution twice as often as they solved the disagreement through group discussion (22% vs. 11%). In contrast, group solutions to disagreements were observed in most of the accelerated classes (67%), with no instance of asking the teacher.

We reviewed narrative notes for further analysis of the differences between general mathematics and accelerated mathematics students’ approaches to disagreements. In the general mathematics classes, the discussion leader’s method for solving a problem, as well as providing the solution, was typically viewed as correct and adopted by the group. On the few occasions when general mathematics students disagreed about the solution process, they adopted another member’s method and solution as correct, referred to the textbook, or asked the teacher for help. In contrast, in the accelerated mathematics class, students in groups often disagreed with the discussion leader’s method for solving a problem. Accelerated students suggested alternative solutions and discussed different possible solutions within the group. Often, more than one solution yielded the correct answer. Individual group members adopted different methods, but all agreed on one answer.

Perspective of the Project Leader

Data from interview transcripts provided insight about the project leader’s (a) perspective on his adaptation of the Johnson and Johnson (1983) model, (b) integration of the model with his previous lesson plan, and (c) differences between the general and accelerated mathematics classes.

According to the project leader, his approach to cooperative learning differed from the Johnson and Johnson (1983) model in two ways. First, the project leader explained that he did not assign students to specific jobs. Rather, he suggested that students take turns and switch roles throughout the lesson. He believed that his approach encouraged each student to practice a variety of different skills. second, he limited group size to two to four students. Whereas Johnson and Johnson recommended up to six or eight students in a group, the project leader believed that smaller group size better facilitated equal participation.

In terms of the integration of cooperative learning with his basic lesson plan, the project leader explained that tie used cooperative learning in this manner because he had been trained to use cooperative learning only after teaching for 20 years. He added that if he had been trained in cooperative learning as a new teacher, he probably would have used it differently.

When planning a cooperative-learning lesson, the project leader considered the content that he would cover, as well as student ability. Differences in those factors between his general and accelerated mathematics classes might have accounted for observed differences in implementation. The project leader explained that when planning for cooperativelearning lessons, he first determined the lesson objective and then considered “how to do it in a cooperative way.” He reported that objectives in the accelerated classes often required multiple-step problem solving that fit with cooperative-learning activities. When planning for review of previously learned material, the project leader also considered student ability. He said he often used cooperative learning for review activities in the accelerated classes because he was “confident at least one student in the group would have an accurate understanding” of the procedure or content. He admitted that he had less confidence in the ability of students in the general mathematics classes and suggested that he subsequently felt a need to use teacher-led instruction methods for review in those classes.

Conclusions

Because of its potential to increase student achievement and social skills development, cooperative learning has been advocated for school reform. Prior to such broadbased recommendations, however, Grossen (1996) identified a need for research in real-life classrooms, as opposed to researcher-controlled classes. In response to Grossen’s recommendation, the author undertook the research reported here to demonstrate that the implementation of cooperative learning in real-life classrooms is a complex process, a point that despite the extensive previous research in cooperative learning appeared to be lacking. The findings of this study are consistent with Cuban’s (1996) conclusion that teachers will adapt research- based models for use in their classroom, but they contrast with results reported by Antil and colleagues (1998) in which research- based models of cooperative learning were unrecognizable among practitioner approaches. We expanded Cuban’s conclusion by identifying sets of factors that influenced variations in teachers’ implementation of cooperative learning. Interpreted within a constructivist framework, results support the conclusions that in real life, the project leader used personal techniques derived from prior knowledge and experience to implement research-based models of cooperative learning and that use of these personal techniques was influenced by his teaching context.

Consistent with Cuban’s (1996) conclusion that, in practice, teachers’ use of instructional innovations will vary, the project leader’s approach to cooperative learning demonstrated that he adapted the Johnson and Johnson (1983) model for his classroom. A constructivist framework suggests that one set of factors influencing a teacher’s use of cooperative learning will be his or her prior knowledge of teaching and experience as a teacher. The effect of the project leader’s prior knowledge and experience was evident in his basic lesson plan. During his 20 years as a mathematics teacher, the project leader had developed a personal structure for executing his classes. For implementation purposes, the project leader used cooperative learning within his existing lesson plan format. A constructivist framework suggests that a second set of factors influencing a teacher’s use of cooperative learning is his or her teaching context. The project leader’s explanation of differences in implementation between his accelerated and general mathematics classes revealed that his use of cooperative learning was influenced by lesson content and perceived student ability.

The results have implications for educators who are interested in school reform. Rather than making broad-based recommendations to use cooperative learning, proponents of this instructional initiative should consider designing professional development programs based on a constructivist framework. Specifically, in-service training should include activities that encourage teachers to describe their knowledge of teaching and their daily teaching practices, strategies that help teachers incorporate cooperative learning (or other instructional innovations) into their daily practices, and opportunities for teachers to consider specific contextual variables that may influence their use of cooperative learning.

A unique contribution of this study was that the project leader implemented a research-based model of cooperative learning without researcher supervision. That finding contrasts with results reported by Antil and colleagues (1998) in which practitioner approaches differed significantly from research-based models. One possible explanation for the discrepancy is that the research methodology and theoretical orientation used in this study might have allowed for the detection and explanation of a research-based model, which was not evident through the methods used by Antil and colleagues. Those researchers used interview and survey methods to obtain information about teachers’ use of cooperative-learning techniques. Although those methods yielded considerable information about implementation, the researchers repor\ted that they were left to infer some things about their practice from illustrations of cooperativelearning lessons that were described in earlier studies. The use of observations and follow-up interviews in the current study left little to researcher inference. Furthermore, Antil and colleagues evaluated practitioner approaches by using a checklist of criteria derived from the research literature on cooperative learning. In this study, I used a theoretical framework that allowed for examination and explanation of the relationship between a research- based model and a practitioner’s approach.

There are several alternative explanations for the discrepant findings between this study and the Antil et al. (1998) research, each of which has implications for practice. First, in the Antil et al. study, practitioners were trained in several different research- based models of cooperative learning. In contrast, the Iroquois School District adopted one model of cooperative learning-the Johnson and Johnson (1983) model. The use of other models was not encouraged. Antil and colleagues hypothesized that when teachers are exposed to multiple methods of cooperative learning, they are likely to conclude that there is great latitude in what is considered cooperative learning. The results of this study suggest that fidelity of implementation can be increased when teacher attention is focused on one model.

A second alternative explanation for the greater fidelity of implementation that I observed was the congruence between the project leader’s belief system and the Johnson and Johnson (1983) model of cooperative learning. The project leader reported that the goals of education are to promote academic, as well as social, development of students. To the project leader, cooperative learning was one logical way to attain those goals. That finding has implications for educators who are interested in school reform, as well as researchers who are studying cooperative-learning implementation. To facilitate use of cooperative learning (and other instruction innovations), one might need to consider the congruence between teacher philosophy and novel methods. Knowledge of teacher beliefs about education might allow researchers to predict which teachers will be more likely to implement cooperative learning.

Finally, the project leader’s implementation of the Johnson and Johnson (1983) model could be related to the fact that he has taken ownership of the model. In the position of “project leader,” he has been assigned a leadership role. He defined that role as modeling the implementation of the Johnson and Johnson approach to cooperative learning. To encourage the use of cooperative learning, the project leader invited newly trained teachers to observe how he used cooperative learning in his classroom. Thus, the present results suggest that in order to promote the use of cooperative learning for school reform, teachers need to share in the ownership of the instructional innovation.

Discussion and Future Directions

The major limitation of this study is that conclusions were drawn on the basis of data from 1 teacher. Considered an expert in cooperative learning, the project leader is not a typical teacher. Thus, the current findings may have limited generalizability to other teachers. Nonetheless, results of this study demonstrated that teacher implementation of cooperative learning is influenced by prior knowledge and experience and current teaching context. In addition, findings suggest that use of cooperative learning can be promoted by (a) teacher attention to one model, (b) congruence between teacher philosophy and instruction methods, and (c) teacher ownership of the innovation.

In contrast to previous implementation studies that emphasize the researcher’s perspective, I provide a description of the practitioner’s perspective of cooperative learning implementation. To obtain that perspective, I used (a) qualitative methods of prolonged engagement in a natural setting, (b) collaboration with the participants in defining the research agenda, (c) multiple data collection methods, and (d) data analysis based on consistency of findings within a theoretical framework. Those aspects of the current design are strengths of this study. The design provided methods for the exploration of expected variation in the teacher’s use of cooperative learning, specifically differences between practitioner and researcher approaches. In addition, the design allowed for detection of unanticipated variations, most notably within-teacher differences in implementation.

Researchers need to use a constructivist framework and qualitative methods to examine cooperative learning. Data provided by other teachers would allow researchers to further explore the notion that variations in teacher implementation are related to differences in prior knowledge and experience and would confirm the conclusion that within-teacher differences in implementation are related to differences in teaching contexts. Further exploration also would reveal other factors that influence teacher implementation of cooperative learning.

NOTE

1. The pronoun “we” is used throughout the article to indicate that this research was conducted by the author and by members of a larger research team, including faculty and graduate research assistants, unless otherwise specified.

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Grossman, P. L., & Stodolsky, S. S. (1995). Content as context: The role of subjects in secondary school teaching. Educational Researcher, 24, 5-11.

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CHRISTINE SIEGEL

Georgia State University

Address correspondence to Christine Siegel, Department of Counseling and Psychological Services, Georgia State University, MSC 6A0915, 33 Gilmer Street, SE Unit 6, Atlanta, GA 30303-3086. (E- mail: [email protected])

CHRISTINE SIEGEL is an assistant professor of school psychology, Georgia State University. Her research interests include instructional consultation, academic interventions, and implementation of evidence-based practices in psychology and education.

APPENDIX A

Initial Teacher Interview Protocol

1. What grade level and subject do you teach?

2. How many years have you been teaching?

3. How long have you been at (Iroquois) school district?

4. Describe your students in general.

5. Describe the cooperative learning training that you received.

6. What is your personal definition of cooperative learning?

7. How did you arrive at that definition?

8. What do you think are the essential elements of cooperative learning? Why?

9. What do you think are the goals of education?

10. What are the goals of (subject area) instruction?

11. How is your definition of cooperative learning consistent with those goals?

12. What do you believe is the teacher’s role in cooperative- learning instruction?

13. What do you believe is the student’s role during cooperative- learning instruction?

14. What are the advantages/disadvantages of cooperative learning?

15. Why do you use cooperative learning?

16. How does cooperative learning vary in your classes and why?

17. For what tasks do you think cooperative learning is the most appropriate? Why?

18. How do you plan for cooperative-learning lessons?

19. What factors influence your planning decisions?

20. How do you group your students for cooperative-learning lessons?

21. How do you arrange your classroom during cooperative- learning lessons?

22. What materials do you use during cooperative-learning lessons?

23. What do your students produce during cooperative-learning lessons?

24. When and how often do you use cooperative learning? Why?

25. For cooperative learning activities, what aspects of student functioning do you assess? How?

APPENDIX B

Follow-up Teacher Interview Protocol

1. What is your personal definition of cooperative learning?

2. What do you mean by positive group interdependence?

3. How do you establish individual accountability?

4. What does social skills instruction mean to you?

5. Describe face-to-face interaction.

6. What do you consider debriefing?

7. What do you think are the advantages of cooperative-learning instruction?

8. What are the disadvantages of cooperative-learning instruction?

9. How do you plan for cooperative-learning lessons?

10. What does a typical cooperative-learning lesson look like in your class?

11. Why do you use cooperative learning this way?

Copyright HELDREF PUBLICATIONS Jul/Aug 2005

More Fast Food Means More Calories, Fat, Salt

NEW YORK — Girls who frequently eat fast food also consume significantly more fat, calories and sodium overall than girls who order fast food less often, study findings show.

On average, fast food lovers — eating the high-fat and high-calorie fare at least 4 times per week — downed an extra 130 calories and 150 milligrams of sodium every day, along with more total and saturated fat, relative to girls who ordered fast food less than once per week.

These findings suggest that cutting back of fast food may improve overall diet quality, the researchers note in the Archives of Pediatrics and Adolescent Medicine.

“The girls that eat a lot of fast food are getting too much fat, salt and calories,” study author Marcia Schmidt of the Cincinnati Children’s Hospital in Ohio told Reuters Health. “This is partly due to the content of the food and partly due to the portion size,” she added.

Consequently, if girls want to eat out, they should keep track of what they order, and how much, the researcher advised. “If (girls) eat out a lot, and especially at fast food establishments, it is important to make good choices and beware of the portion size,” Schmidt noted.

In their report, Schmidt and her colleagues note that children and teenagers are eating more food away from home; indeed, one study showed that teenagers eat fast food, on average, twice a week. These meals tend to be rich in calories, sodium, fat and cholesterol, they write, and may displace healthy meals that contain fruits and vegetables.

To investigate how eating fast food affects girls’ overall diet, the researchers followed 2379 black and white girls for 10 years, asking them periodically about their diet.

The researchers found that girls tended to eat more fast food as they aged, and black girls ate more fast food at all ages than white girls.

Girls who ate more fast food tended to consume more calories, calories from fat, calories from saturated fat, and sodium. On average, black girls tended to eat significantly more calories, calories from fat, and sodium than white girls, across all ages.

Schmidt explained that girls likely eat more fast food as they get older because they become more independent, and can go to a fast food restaurant on their own. Fast food is also appealing because it is often inexpensive, girls may feel peer pressure to eat it, and it is often sold in schools, making it “readily available,” Schmidt noted.

However, this availability may hurt girls in the long run, she noted. “The diet worsens with more fast food because the choices tend to be high in fat, sodium and calories,” Schmidt said.

SOURCE: Archives of Pediatrics and Adolescent Medicine, July 2005.

Podcasts Get Lift From ‘iTunes Effect’

Jul. 8–Until last week, the Twin Cities’ Wanda Wisdom had enjoyed only marginal success with her podcast — a radio-like program offered online as a digital file for subscribers to download and put on their portable music players.

The cross-dressing character and the alter ego of Bradley Traynor, a Minneapolis resident, figures the podcast attracted only several hundred visits or “hits” to its address or “feed” per day.

Then came the June 28 “iTunes effect.”

That’s when Apple Computer released a new version of its popular iTunes music-jukebox software with the built-in ability to locate and automatically download podcasts. Since then, downloads of Wanda Wisdom’s podcast — which has a title that cannot be printed here — have ballooned into the thousands per day.

Suddenly, the obscure, geeky podcasting world was thrust into the mainstream as millions of average Windows and Macintosh users discovered the downloadable shows and took to them in droves. Within about two days, iTunes fans subscribed to podcasts more than a million times for use on their Apple iPod players.

This doesn’t mean that Wanda Wisdom and other area podcasting personalities are suddenly awash in cash. Most podcasts are free, after all, so their authors have to settle for the increased visibility that comes with their recent surges in Web traffic.

That has caused a few of them minor technical problems. One local podcaster said his initially popular show vanished from the directory, then reappeared with an “explicit” label he said it hardly deserves.

But local podcasters said the iTunes effect, on balance, has been a good one.

St. Paul-based marketing and public relations firm Provident Partners, for instance, is delighted that its 4-month-old podcast, “The Marketing Edge,” now has a broader audience. Podcast-feed hits, initially hovering around 100 to 150 a day, roughly tripled just after the new iTunes program was released and have since roughly quintupled.

“It’s been amazing,” said Mike Keliher, a Provident Partners staffer.

Tim Elliot of Lakeville said his “Winecast” has gone from 242 to 650 file downloads a day. Joel Anderson of St. Paul said his “A Klingon Word from the Word” podcast centered on the “Star Trek” aliens’ guttural language saw a tenfold increase in hits just after the new iTunes came out. Nick Ciske of Minneapolis said his “Bluer” religion show went from 5 to 7 gigabytes of file transfers per month to about 2.6 gigabytes in the first four days of July alone.

One of Ciske’s complaints: Bluer is strangely listed in Apple’s “food” category as well as the “religion” category, but not in the “Christianity” category.

For local podcasters not yet listed on the iTunes directory, excitement is building.

“Creot Radio,” an informal group of amateur musicians with members here and around the world, has been podcasting in semi-obscurity for months.

“Apple’s decision to include podcasts as part of its iTunes program will mean more opportunities for independent musicians to have their music heard and for listeners to enjoy a wider range of songs,” said St. Paul’s Alissa Barthel, “Creot Radio’s” founder.

At least one top local podcaster didn’t see a major traffic surge. Garrick Van Buren of St. Anthony said his “First Crack Podcast” had been steadily building a following prior to the new iTunes’ release, which may partly account for why only a marginal uptick occurred just after June 28.

For local podcasters, the iTunes program and its directory have become the main consumer tools for getting at their shows. Other podcast-downloading programs, such as iPodder and iPodderX, have largely been marginalized as iTunes becomes the de facto podcast “receiver.”

This worries St. Paul’s Mike O’Connor, author of the “Sex and Podcasting” podcast, who said he has been a victim of censorship. His problem: The word “sex” in his podcast’s title is a joke. His show has nothing to do with sex. Yet, possibly because of user complaints, the podcast briefly vanished from the directory and then was labeled “explicit.”

Podcasting was once “entirely a conversation between the podcaster and the listener,” O’Connor said. “Now there is an intermediary. This bugs me a lot. (Apple is) essentially a third-party arbiter of taste.”

Greg “Joz” Joswiak, Apple’s vice president for iPod marketing, said Apple is applying to its podcast listings the same family-friendly cautionary labels it has used with iTunes Music Store offerings that feature explicit content.

He added that the word “sex” alone needn’t get a podcast booted from its directory or branded “explicit.” What happened to “Sex and Podcasting” may be due to misinformed user complaints, he said, and the firm will investigate.

—–

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Distributed by Knight Ridder/Tribune Business News.

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AAPL, 6689,

She Can’t Hear the Music, but Dancer Amazes With Her Talent

Can you imagine going to a school dance if you couldn’t hear the music? How about taking dance lessons if you couldn’t hear your teacher’s instructions?

Allison Becker, who just graduated from Clarence High School, has won many awards throughout her 13 years of dancing. A devoted, talented dancer, she had spinal meningitis when she was 16 months old, which left her profoundly deaf, able to hear only sounds of 95 decibels or louder.

“The normal conversation usually occurs between 20 to 30 decibels,” Allison says. “A jet plane decibel level is 120.”

How does Allison know when to start her dance routine at recitals? “With my hearing aids, I can usually hear the lower sounds, like the bass, when the music is turned up really loud,” says Allison. “Sometimes I watch the other dancers to keep in step, but as I have gotten older, I have grown out of it because there are times when I’m the one in the front; I have started to rely more on myself.”

At competitions, judges are not notified that she cannot hear the songs she dances to. Most recently, at the American Dance Awards, Allison was awarded several “Ultimate Golds” for her two solos and for the group dances she was in. Allison also came in first place for choreography in the whole competition.

Her sister, Ashley Becker, a 19-year-old dance major at Point Park University in Pittsburgh, choreographed one of her solos. “My sister is my inspiration!” Allison says.

Allison doesn’t just study one or two types of dance — try seven: jazz, tap, ballet, hip-hop, lyrical (dancing to a mix between a slow jazz number and non-classical ballet), acro (a flip number which involves a lot of tumbling), pointe (like ballet except she wears pointe shoes which have a “box” shape at the end, and she dances on that “box”). You name it, she does it. “My favorites are jazz and hip-hop,” she says.

Allison has been dancing at the David DeMarie Dance Studio since she was four years old. This is her last year dancing there.

“Allison is the ideal student; she never ceases to amaze me. When she was younger, I never thought she would get to the senior level of dance because of her impairment, but with her incredible work ethic and talent, she has,” says her dance instructor Lenny Castilone. “Allison is an amazing, beautiful dancer. She has accomplished much more than dancers who don’t have hearing loss.”

Allison puts as much time — if not more — into dancing as other students put into school sports. “I practice 15 to 20 hours a week. Sometimes I have Wednesdays and Fridays off, but when I have upcoming recitals, I rehearse every day. I normally have seven recitals a year, and this year I have two competitions,” Allison says.

She is in Boston this week dancing in the American Dance Awards Competition. This is her second time going to Boston for Nationals.

Somehow, in high school she managed to find time to participate in several activities. “I’m involved with Student Council, Varsity Club, and in the fall I did cheerleading,” she says. Allison does the cheers in cheerleading just as anyone else would.

Allison reads lips. “When I was younger, my family and I decided to go with oral communication. We knew if that didn’t work, we would use sign language,” she says.

In most ways, Allison is a typical teenager. She has a cell phone, which she uses not only for text-messaging, but to talk on as well. “I wear two hearing aids to bring my hearing level up, but they don’t necessarily make the words clearer. A phone conversation can be very difficult,” she says. “Sometimes, using a speakerphone works better. My new cell is hearing-compatible; I can control the volume to better hear whoever is speaking.”

Hearing aids allow her to enjoy music. “I love a lot of music; I’m very into pop music. Without my hearing aids, I normally can’t hear the words or the lyrics,” she said.

Most people who don’t know Allison can’t tell that she is deaf. “I can speak fairly well; I only mention that I’m deaf if I can’t hear someone or if I’m not sure what’s going on,” she says. Being deaf isn’t a hassle in the school setting, either.

“In school, I use a phonic hearing system, which is a microphone that is hooked up to my hearing aids. All my teachers have to do is use the phonic microphone, and I change the levels of my hearing aids to hear them,” she says.

She will be leaving in the fall for Point Park University in Pittsburgh where she plans to major in dance.

“There are definitely times when things are difficult for me, but with the support of my family, I am able to get through the tough times,” she says.

Justine Januszkewicz is a graduate of Amherst Central High.

Not All Inflammation in the Right Lower Quadrant Is Appendicitis: A Case Report of Escherichia Coli O157:H7 With a Review of the Literature

Although significant work has been presented on this subject in pediatric, infectious disease, and epidemiologic literature, there is a noteworthy lack of information on Escherichia coli O157:H7 in any surgical journals. As this disease can present with signs and symptoms often ascribed to the acute abdomen, it is imperative that the general surgeon, pediatric surgeon, and colorectal surgeon are all familiar with this infection and its clinical ramifications. A case report followed by a review of the literature is presented.

Case Report

A 19-year-old white woman presented to the emergency room with a 3-day history of crampy abdominal pain. The pain was initially throughout the lower abdomen but had increased in severity and localized to the right lower quadrant during the past 24 hours. She also admitted to at least four or five loose bloody stools per day. The patient denied nausea, vomiting, fever, chills, chest pain, back pain, weight loss, or jaundice. She had no current respiratory or urinary symptoms. She denied any previous similar episodes of abdominal pain or bloody diarrhea.

On further questioning, the patient stated that she had completed a 1-week course of Septra DS and ciprofloxacin 6 days prior as therapy for a urinary tract infection. She also admitted to eating a rare steak for dinner the night before the onset of her discomfort. Her dinner companions had also eaten meat but were not symptomatic. She confirmed one primary residence and denied any recent travel or any prior history of inflammatory bowel disease, irritable bowel syndrome, or colonic disease.

The past medical history was significant for septic arthritis of the left hip approximately 10 years prior. The patient denied any surgical history. The patient stated she used oral contraceptives to regulate her menses; she denied allergies to any medications, use of tobacco, alcohol, or illicit drugs, or any family history of inflammatory bowel disease, autoimmune disease, or polypoid syndromes.

In the emergency room, the patient’s vital signs were temperature 98.3F, pulse 114, blood pressure 114/62, and respiratory rate 16. Physical examination revealed a well-developed, well-nourished woman in mild distress. Her skin had normal turgor, her oropharynx appeared normal, and her cardiopulmonary examination was remarkable only for sinus tachycardia. Auscultation of the abdomen revealed active bowel sounds, and palpation was significant for a soft, non- distended abdomen with mild tenderness of the right lower quadrant without guarding or rebound. Rectal examination was significant for grossly bloody stool, but no tenderness, masses, fissures, or fistulas. The sphincter tone was normal at rest and squeeze.

The patient’s laboratory results included white blood count (WBC) 8.8K without evidence of a left shift, hemoglobin (Hgb) 14K, platelets (Plt) 165K, chloride (Cl) 103, carbon dioxide (CO2) 26, blood urea nitrogen (BUN) 8, creatinine (Cr) 0.9. Liver function tests, amylase, lipase, and urinalysis were within normal limits. Abdominal films displayed a nonspecific bowel gas pattern. CT scan of the abdomen and pelvis were interpreted as marked circumferential thickening of the cecum and terminal ileum with stranding of the pericecal and ileal fat consistent with appendicitis, as well as a small amount of free fluid within the pelvis and several enlarged lymph nodes within the root of the mesentery. There was no evidence of abscess or free peritoneal air. Surgery consultation was requested to rule-out appendicitis.

As the patient’s symptomatology and presentation was more consistent with an infectious colitis or inflammatory colitis, the diagnosis was questioned. Further review of the CT scan showed inflammation involving the entire ascending colon, rather than simply the cecum and terminal ileum (Fig. 1). The patient was admitted to the hospital with a diagnosis of infectious colitis; initial treatment included bowel rest and resuscitation with intravenous fluids. Stool was sent for culture including Clostridium difficile, shigella, Salmonella, Escherichia coli O157:H7, ova, and parasites.

During the next 2 days, the patient experienced less abdominal pain and fewer episodes of bloody diarrhea; however, she was not completely resolved of her symptoms. The physical examination was significant for low-grade fever and right-sided abdominal tenderness (although improved). At this time, her laboratory results revealed leukocytosis (14.7K) with left-shifted differentiation (82% segmented), mild thrombocytopenia (120K), and large amounts of protein and ketones in her urine. Her stool cultures (repeated each day) remained negative for all bacterial, fungal, and parasitic pathogens. Intravenous metronidazole was initiated at this time for a presumed invasive infectious colitis.

FIG. 1. CT scan of abdomen and pelvis demonstrating marked circumferential thickening of the cecum and ascending colon with stranding of the pericolonic fat suggestive of inflammatory changes.

FIG. 2. Endoscopic appearance of E. coli O157:H7 colitis. The mucosa is friable and ulcerated with large areas of confluent subepithelial hemorrhage and necrosis.

Colonoscopy was performed to examine the colonic mucosa and obtain tissue samples for pathological review. There were ulcerations and areas of confluent mucosal necrosis with subepithelial hemorrhages in the cecum, ascending colon, and proximal transverse colon (Fig. 2). The remainder of the distal colon and rectum appeared normal. Additional stool cultures were sent from aspiration samples during the colonoscopy.

A biopsy of the ascending colon showed extensive mucosal ulceration with marked acute inflammation. Microthrombi were noted in vessels of the lamina propria associated with small regenerative glands (Fig. 3). There was goblet cell depletion in the glands with acute cryptitis and crypt abscess formation. A biopsy of the left colon showed normal mucosa.

With a working diagnosis of E. coli O157:H7 colitis, the patient was continued on intravenous fluid support and bowel rest. The intravenous metronidazole was discontinued. During the next 36 hours, the patient was without fever or abdominal complaints and was having normal bowel movements. She initiated oral intake and advanced to a regular diet without incident. Although her white blood count returned to normal (8.0K), her thrombocytopenia worsened (27K). Additionally, she developed signs of renal insufficiency including fluid sequestration, anasarca, oliguria, and elevation of BUN (25) and creatinine (1.6), despite large volumes of intravenous fluid support. Neurologic manifestations developed at this time, including hallucinations and generalized confusion. A single stool culture from the day of admission was now reported as positive for E. coli O157:H7. All other stool and blood cultures remained negative.

FIG. 3. Pathologic examination revealed mucosal ulceration with small regenerative glands and microthrombi in the capillaries.

The patient’s course suggested E. coli O157:H7 colitis- associated hemolytic-uremic syndrome (HUS). She was transferred to the intensive care unit for worsening renal insufficiency, pulmonary edema, severe thrombocytopenia, anemia, and the onset of seizures. At this time, laboratory data revealed Hgb 8.2, Pl 33, Cr 2.1, PT 15.4, D-dimer 9.9, and LDH 4120. Her urinalysis showed severe proteinuria and hematuria.

Plasmapheresis therapy was initiated. The patient underwent a total of 12 plasma exchanges, remained in the ICU for 6 days and in the hospital for a total of 17 days. At the time of discharge from the hospital, she had improved renal function, normalizing blood tests, and an unremarkable neurologic examination. At her 2-month follow-up visit, she had a normal physical examination, and normal blood tests, including Hgb 13, Plt 183, Cr 0.8, and LDH 100.

Discussion

Originally described in 1983,1 E. coli O157:H7 is now recognized as a common cause of bloody and nonbloody diarrhea and is responsible for most cases of hemolytic-uremic syndrome in children in North America. In the United States alone, E. coli O157:H7 is believed to cause more than 20,000 infections and approximately 250 deaths each year.2 Although individuals of all ages may be infected, the highest rates occur in children younger than 5 years of age.3 Outbreaks have been reported more frequently during the past decade, as awareness increases among medical and public health professionals. Sporadic cases and outbreaks are more frequent in the northern states and during the warmer months, but it is not well understood why these trends exist.

Ingestion of undercooked bovine meat such as hamburger patties has been responsible for many of the large outbreaks of E. coli O157:H7 colitis, but other modes of transmission have been reported as well. Infection from pork, chicken, steak, unpasteurized milk, yogurt, vegetables from manured gardens, apple cider, and municipal drinking water has occurred. Sporadic cases have also been attributed to swimming in contaminated lakes (fecal-oral route). Lastly, personto-person modes of transmission have also been documented in child-care centers, nursing h\omes, and between family members in the home.3-6 Typically, incubation period is 3 to 4 days but may be as short as 1 day or as long as 21 days.7

The mechanism by which E. coli O157:H7 causes gastrointestinal and systemic symptoms is not completely understood. Bacterial factors such as those required for adhesion to enterocyte apical membranes may be responsible for the diarrheal response. The bacterium adheres to the endothelial cells of the gut mucosa and produces verotoxin (shiga-like toxin) that probably acts locally and systemically. There is evidence that the verotoxin locates on the endothelium of the intestinal vasculature, which may help explain the breakdown of the blood tissue barrier.8 Loss of intestinal integrity allows exposure of systemic circulation to inflammatory agents such as bacterial lipopolysaccharide (LPS), verotoxin(s), and various cytokines. The multiorgan failure sometimes seen in patients with HUS may be secondary to the damaging effects on each organ’s vascular endothelium by these and other inflammatory mediators.3 Patients who develop bloody diarrhea and signs of invasive infection, rather than simply watery diarrhea, are more prone to hemolytic-uremic syndrome and other organ injury.9

The range of clinical presentation is broad, often making diagnosis difficult. Patients may be asymptomatic or present with nonbloody diarrhea, bloody diarrhea, the hemolytic-uremic syndrome, thrombocytopenia purpura, seizure, coma, or death.7 Typically, patients experience crampy abdominal pain and diarrhea, which becomes bloody after 48 hours, and some may have nausea, vomiting, and low-grade fever. The colitis will be characterized by diarrhea in 100 per cent, bloody stool in 90 to 95 per cent, abdominal pain in 91 to 95 per cent, nausea and/or vomiting in 40 to 54 per cent, and fever in 27 to 45 per cent.4, 10 As many as 8 per cent may present with rectal prolapse.7 Obtaining a thorough history in regard to recent eating habits and travel is extremely important in these patients. Differential diagnosis should include other infactious causes of diarrhea, inflammatory bowel disease, ischemic colitis, intussusception (in children), and causes of the acute abdomen.

Routine blood tests may reveal leukocytosis, bandemia, dehydration, or proteinuria. Abdominal radiographs can demonstrate ileus and in more severe cases thumbprinting patterns in the colon. Stool cultures for E. coli O157:H7 must be specifically requested, as MacConkey-sorbitol agar plates and agglutination with 0157 antiserum is required for routine diagnosis.6 A single stool culture when performed early in the disease can be expected to be approximately 43 to 72 per cent sensitive.6, 7 Several factors may limit detection of E. coli O157:H7 in stool culture including unsuspecting treating physicians, failure to request or properly process specific stool cultures, short detection periods of the organism in the stool, and frequent use of antibiotics before obtaining cultures. After HUS develops, it is difficult to detect the organism in stool samples.3

Further information may be gained from endoscopy, which often shows edematous, hyperemic mucosa and superficial ulcerations and provides opportunity for biopsy. Classically, the mucosal abnormalities progress in severity from rectum to cecum.3 Although often dramatic, as in this case report, the pathologic findings are nonspecific. Histological examination reveals infectious or ischemic patterns of colonic injury, usually in a patchy distribution and occasionally with fibrin microthrombi. The differential diagnosis in biopsies often includes pseudomembranous colitis, ischemia, and fulminant inflammatory bowel disease in addition to hemorrhagic colitis associated with E. coli O157:H7. However, pathology and culture reports do not return for days, often after the gastrointestinal manifestations have improved.

On average, the gastrointestinal prodrome lasts 1 week and resolves without permanent sequelae. Hemolytic-uremic syndrome can be expected to develop at this time in 7 to 25 per cent of patients4- 6 and is characterized by microangiopathic hemolytic anemia, thrombocytopenia, acute renal dysfunction, and central nervous system manifestations. HUS is a multi-system disease, and although the microangiopathy that characterizes the disease primarily affects the kidneys, any organ system may be involved.

Studies to elucidate risk factors for the development of HUS in patients infected with E. coli O157:H7 have been somewhat informative. Most authors agree that fever, leukocytosis, and use of antimotility agents all predict higher rates of subsequent HUS. Others have suggested elevated C-reactive protein (CRP), severity of colitis, use of antibiotic therapy, and age (infants and elderly) as additional predictors of HUS. Ikeda et al.9 proposed a “predictor index scoring system,” giving scores of 0 or 1 for different values of CRP, WBC, and temperature. Those with scores of 2 or higher were significantly more likely to develop HUS (32.6% vs 1.8%).

Those patients who develop HUS are at risk for both acute and long-term sequelae. Neurologic complications including seizure, coma, and hemiparesis may develop in 30 per cent of these patients.3 During their acute illness, 64 to 76 per cent of patients will require transfusion of packed red blood cells, and 10 to 53 per cent will require platelet transfusions.2, 7 Platelet transfusions should be avoided if possible because of the theoretical risk of augmenting the thrombotic process with fresh platelets. More than half will require either acute dialysis or plasmapheresis. Dialysis therapy or hemofiltration should be instituted early in oliguric patients with HUS as it has been shown to improve mortality.3

Mortality rates up to 5 per cent can be expected in patients who develop HUS and its associated morbidities. An additional 5 per cent may suffer chronic renal failure and/or permanent neurologic injury. Lopez et al.11 reported that 21 per cent of patients had persistent proteinuria at 1 year and 35 per cent had significantly decreased creatinine clearance at their last follow-up (up to 10 years). These authors also found that patients who originally presented with more severe colitis had higher incidences of extraintestinal morbidity and worse long-term outcomes. They concluded that the spectrum of gastrointestinal manifestations relates to the subsequent microvascular process and its consequences.

During the first week of the illness (gastrointestinal prodrome), management entails fluid resuscitation, bowel rest, and early culturing of stool. It is important to monitor patients for signs of noncolonic organ dysfunction. Hypertension, edema, or oliguria may alert the physician to impending renal insufficiency, and pallor, malaise, or tachycardia might suggest anemia. Tests such as peripheral-blood smears, blood counts, electrolyte profiles, and urinalysis should be ordered. Specifically, evidence of leukocytosis, anemia, thrombocytopenia, and azotemia are worrisome. Fragmented erythrocytes, schistocytes, and burr cells seen on blood smear help establish the diagnosis of HUS.3, 12

No specific therapy has been proved effective in the treatment of E. coli O157:H7 colitis. The question of antibiotic use in this disease has generated much controversy and research effort. Retrospective evidence suggests the use of antibiotics (trimethoprimsulfamethoxazole) may increase the risk of developing HUS.13 However, bias is inherent in such retrospective data as the more ill patients were probably treated with antibiotics more frequently. Proulx et al.10 conducted a randomized, controlled trial of antibiotic therapy for E. coli O157:H7 enteritis and demonstrated no improvement in the clinical course; did not convert patients to negative cultures sooner; and did not statistically change the incidence of HUS. Most recently, Wong et al.14 conducted a prospective cohort study of 71 children with E. coli O157:H7 infections. Upon multivariate analysis, antibiotic treatment was found to increase the risk of HUS. Antimotility agents are contraindicated in patients with bloody diarrhea and have been shown to increase the incidence of HUS and neurologic sequelae in these patients.2, 15

Management of HUS includes meticulous attention to fluid balance and electrolyte replacement. Overhydration must be avoided in the face of oliguria. Hyponatremia, hyperkalemia, hyperphosphatemia, and metabolic acidosis should be managed medically; however, should medical treatment fail, dialysis or hemofiltration is indicated.16 Quite often, transfusion of blood products and plasmapheresis is required. Convulsions are treated with intravenous administration of diazepam or phenytoin. Less standardized therapies include intravenous immunoglobulin, verotoxin inhibitors, and thrombolytics.

The highest success in managing E. coli O157:H7 infection can be achieved through public health initiatives. Education regarding proper preparation and cooking of meats, health policies regarding food processing and handling, and rapid detection and containment of outbreaks can prevent and control future infection. When seeing the patient in consultation, as always, obtaining a thorough history and physical at the time of presentation is of paramount importance. Early suspicion of E. coli O157:H7 infection should lead to more rapid diagnosis, improved hospital courses, and decreased long-term morbidity and mortality.

REFERENCES

1. Riley LW, Remis RS, Helgerson SD, et al. Hemorrhagic colitis associated with a rare Escherichia coli serotype. N Engl J Med 1983;308:681-5.

2. Boyce TG, Swerdlow DL, Griffin PM. Escherichia coli 0157:H7 and the hemolytic-uremic syndrome. N Engl J Med 1995; 333:364-8.

3. Pickering LK, Obrig TG, Stapleton FB. Hemolytic-uremic syndrome and enterohemorrhagic Escherichia coli. Pediatr Infect Dis J 1994;13:459-76.

4. Slutsker L, Ries AA, Maloney K, et al\. Nationwide case control study of Escherichia coli O157:H7 infection in the United States. J Infect Dis 1998;177:962-6.

5. Bell BP, Goldoft M, Griffin PM, et al. A multistate outbreak of Escherichia coli O157:H7 associated bloody diarrhea and hemolytic uremic syndrome from hamburgers: the Washington experience. JAMA 1994;272:1349-53.

6. Belongia EA, Osterholm MT, Soler JT, et al. Transmission of Escherichia coli O0157:H7 infection in Minnesota child day care facilities. JAMA 1993;269:883-8.

7. Brandt JR, Fouser LS, Watkins SL, et al. Esherichia coli O57:H7-associated hemolytic-uremic syndrome after ingestion of contaminated hamburgers. J Pediatr 1994;125:519-26.

8. Richardson SE, Karmali MA, Becker LE, Smith CR. The histopathology of the hemolytic uremic syndrome associated with verocytotoxin-producing E. coli infections. Hum Pathol 1988;19: 1102- 8.

9. Ikeda K, Ida O, Kimoto K, et al. Predictors for the development of haemolytic uraemic syndrome with Escherichia coli O157:H7 infections with focus on the day of illness. Epidemiol Infect 2000;124:343-9.

10. Proulx F, Turgeon JP, Delage G, et al. Randomized, controlled trial of antibiotic therapy for Escherichia coli O157:H7 enteritis. J Pediatr 1992;121:299-303.

11. Lopez EL, Devoto S, Fayad A, et al. Association between severity of gastrointestinal prodrome and long-term prognosis in classic hemolytic-uremic syndrome. J Pediatr 1992;120:210-5.

12. Igarashi T, Inatomi J, Wake A, et al. Failure of pre- diarrheal antibiotics to prevent hemolytic uremic syndrome in serologically proven Escherichia coli O057:H7 gastrointestinal infection. J Pediatr 1999;135:768-9.

13. Tarr PI, Neil MA, Christie DL, Anderson DE. Escherichia coli O157:H7 hemorrhagic colitis (letter). N Engl J Med 1988; 318:1697.

14. Wong CS, Jelacic S, Habeeb RL, et al. The risk of hemolytic- uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections. N Engl J Med 2000;342:1930-5.

15. Cimolai N, Morrison BJ, Carter JE. Risk factors for the central nervous system manifestations of gastroenteritis-associated hemolytic-uremic syndrome. Pediatr 1992;90:616-21.

16. Kaplan BS, Meyers KE, Schulman SL. The pathogenesis and treatment of hemolytic uremic syndrome. J Am Soc Nephrol 1998;9:1126- 33.

SETH A. ROSEN, M.D.,* STEVEN D. WEXNER, M.D.,* SHERRY WOODHOUSE, M.D.,[dagger] PATRICK COLQUHOUN, M.D.,* ERIC G. WEISS, M.D.,* JUAN J. NOGUERAS, M.D.,* JONATHAN EFRON, M.D.,* ANTHONY VERNAVA, III, M.D.*

From the Departments of * Colorectal Surgery and [dagger] Pathology, Cleveland Clinic Florida, Weston and Naples, Florida

Address correspondence and reprint requests to Dr. A. Vernava, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331.

Copyright The Southeastern Surgical Congress Jun 2005

Research Shows Dr. Abraham’s Allernon, Formulated By Allervax Lab, a More Effective Way to Fight Allergies

CANADIAN, Texas, July 7 /PRNewswire/ — Research presented at this year’s annual meeting of the American Academy of Allergy, Asthma, and Immunology has shown that sublingual immunotherapy, or placing drops under the tongue, can be a highly effective approach to administering allergy medications and is safe and effective in children under 5.

A group of Italian researchers found that over a 3-year study period, a significant reduction in nasal obstruction, itching and cough, and a decreased need for symptom-relief medications in patients treated with sublingual immunotherapy compared with those treated with standard medications for allergic rhinitis and asthma.

“The clinical efficacy of sublingual immunotherapy has been previously established in pollen, but not dust-mite allergy,” said lead author Carlo Lombardi, M.D., citing the results of the extensive research project.

Another unrelated Italian research group found sublingual immunotherapy to be safe and effective in children younger than 5 years — a group considered ideal for early allergy intervention, according to Italian researchers.

“Immunotherapy has been shown to prevent the onset of asthma in allergic patients…Therefore, children are optimal candidates,” said Giovanni Passalacqua, M.D., professor of allergy and immunology at the University of Genoa, Italy.

He said concerns about the safety of subcutaneously administered allergy immunotherapy in children make the prospect of sublingual administration particularly appealing.

“Subcutaneous immunotherapy injections can provoke systemic urticaria, angioedema, asthma, or even anaphylaxis — all of which are more difficult to manage in children, compared with adults,” he explained.

The Italian studies confirm what homeopathic medicine has long recognized, which is that administering immunotherapy treatments for allergies using drops under the tongue can be highly effective and safer than other approaches.

All of this is good news for Dr. Abraham’s Allernon, the fastest growing sublingual homeopathic allergy relief product on the market.

Dr. Abraham’s Allernon uses a homeopathic immunotherapy approach to treating a broad range of allergies. The basic Allernon formula incorporates a combination of weed, trees, and grass pollens, molds, household dusts, and bacteria that have been shown to cause upper respiratory infections. Through the use of drops under the tongue (sublingual administration) Allernon introduces minute amounts of allergens and bacteria into the body that stimulate the immune system to build natural defenses against attacks by allergens and bacteria. The immune system then develops antibodies that help desensitize the body from allergens and bacteria. The fending off of allergens and bacteria allows the body to function higher on an overall level because it is not fighting off sickness.

A graduate of Southwestern Medical School, Malouf Abraham, M.D. received a Commendation with the Strategic Air Command Force for running an Allergy Clinic that treated returning soldiers from Vietnam and their dependents. After serving his country he returned to his hometown of Canadian, Texas and built one of the largest practices in the Texas, treating over 45,000 people and becoming one of the most trusted M.D.’s in West Texas. For over thirty years Dr. Abraham further refined his treatments by using minute amounts of substances that seemed to be root causes of certain allergies and maladies in his patients.

In 2003, Dr. Abraham began working closely with one of the top FDA approved homeopathic laboratories in the United States to create a line of health products based on his many years of experience treating patients with severe allergies and upper respiratory illnesses. His concern for the high medical costs that families face today and his belief that he could make a positive difference in their quality of life led Dr. Abraham to release his Dr. Abraham’s Allernon and Dr. Abraham’s Immuna-Flu into retail stores in 2004.

Dr. Abraham’s Allernon is now one of the top selling products in the West Texas area and is now available at pharmacies supermarkets, and health food stores throughout the Southwest United States. For more information or to order Allernon direct, go to http://www.allernon.com/ . Allervax is the formulator of Dr. Abraham’s Allernon and Immuna-Flu. All formulas were personally written by Dr. Abraham. Allervax Lab is headquartered in Canadian, Texas.

    For Immediate Release:    Media Contact - Lisa Day    [email protected]    877.530.9881  

Allervax Lab

CONTACT: Lisa Day of Allervax Lab, +1-877-530-9881, [email protected]

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

The Cost of Dengue Fever Challenges Public Health and National Economies

Waltham, MA ““ A new study of the disease burden of dengue fever in Malaysia strengthens the case for development of a vaccine against the mosquito-borne illness.

Despite the nation’s efforts at treatment and control, 10,000 cases are reported each year at a l cost of almost $13 million, slightly less than half for vector control and the rest for treating hospitalized patients with dengue fever, an often painful and sometimes fatal virus.

These costs are equivalent to 940,000 lost workdays of output, said lead author Professor Donald Shepard, a health economist at Brandeis University’s Heller School for Social Policy and Management. In contrast, a prior study by Shepard and other researchers found that a dengue vaccine, if development proceeds as hoped, would offset 87 percent of treatment costs for all of Southeast Asia, as well as reduce the cost of vector control with fumigants and insecticides.

In effect, a vaccine made widely available would cost only marginally more than current treatment and control efforts, but with dramatic gains in public health and economic output.

“This study dramatically strengthens the case for developing and implementing an affordable vaccine wherever dengue is common,” said Shepard. Although no vaccine is yet commercially available, several approaches are under development.

The first findings from this research, to be presented Thursday at the Symposium on National Health Accounts as part of the International Health Economics Association conference in Barcelona, Spain, evaluated the cost of treatment and control of dengue fever from 2000-2004 in Malaysia. Professor Lucy Lum of the University of Malaya and Dr. Jose Suaya of Brandeis co-authored the study.

“One hospitalized case of dengue fever costs one-fifth of Malaysia’s per capita gross national product (GNP)” noted Shepard. “The cost of treatment, the pain and suffering, the fear that a parent or child could die from this virus ““ all these facts are reasons why dengue is a salient candidate for vaccine development,” Shepard said.

Currently, each person hospitalized with dengue fever or dengue hemorrhagic fever in Malaysia costs about $718 to treat. About 70 percent of the cost is paid for by the government, and the rest by insurers and individual households. This cost per patient is equivalent to 53 days of lost economic output, according to the study.

“Our study suggests just how devastating dengue is to economies and people, and by extension, how important it is to start thinking strategically about the most effective way to reduce the myriad costs of this illness,” Shepard said. Dengue is endemic in much of Southeast Asia, Latin America and the Caribbean. Urban areas tend to be most affected because mosquitoes that transmit dengue live near people and breed in standing water found in discarded tires, old cans, flower pots, water tanks and other man-made containers.

In Southeast Asia dengue fever causes an estimated 27 million infections, 6 million illnesses, 400,000 hospitalizations and 3,000 deaths annually. In the Americas, 267,050 clinical cases and 71 deaths were reported in 2004, according to the Pan American Health Organization. Brazil reported the most cases in the region that year.

The study was sponsored by the Pediatric Dengue Vaccine Initiative, an organization created in 2002 to accelerate the development and use of a safe and effective dengue vaccine.

Brandeis University is currently managing dengue disease burden studies, which examine the economic burden of disease on households, governments and others, in nine countries: six in Latin America and three in Southeast Asia.

On the Web:

Brandeis University

Bacteria Linked With Dangerous Mouth Cancer

WASHINGTON — Three different types of mouth bacteria are associated with the most common form of oral cancer, researchers said Thursday in a discovery that may lead to a simple test for the often-fatal tumor.

The study, published in the Journal of Translational Medicine, also suggests the bacteria may play a role in causing the cancer, called oral squamous cell carcinoma, the researchers said.

“Finding bacteria associated with (oral squamous cell carcinoma) encourages us to hope that we have discovered an early diagnostic marker for the disease,”said Donna Mager of the Forsyth Institute in Boston, who led the study.

“If future studies bear this out, it may be possible to save lives by conducting large-scale screenings using saliva samples.”

The American Cancer Society estimates about 29,370 people will be newly diagnosed with oral cavity and oropharyngeal cancer in the United States in 2005 and 7,320 people will die.

A test is important because the five-year relative survival rate for all the cancers is 59 percent, mostly because they are not detected until they have spread.

Mager’s team compared bacteria samples from the saliva of 229 healthy people to samples from 45 oral cancer patients. The team found unusually high levels of three bacterial species — C. gingivalis, P. melaninogenica and S. mitis — in the oral cancer patients.

It could be the cancer changes mouth chemistry, allowing the bacteria to flourish, the researchers said.

“We cannot rule out the possibility that the bacteria themselves may be causally involved in the development of the disease,” said Max Goodson, Director of Clinical Research at Forsyth.

Bacteria and viruses are known to cause cancer. Helicobacter pylori bacteria are the main cause of stomach cancer, for example, while human wart virus is the only known cause of cervical cancer.

Faith Healing Gaining Among Colorado Hispanics

Efrain Flores, 71, stood motionless as Maria Contreras sprayed the front and back of his shirt with mist from cans labeled “San Cipriano” and “Santa Barbara.”

Afterward, Contreras rubbed a raw brown egg over his torso, his limbs and the soles of his shoes. She then cracked it into a clear plastic glass.

Flores had come to Contreras because of a bad back. “Your condition is not good. The egg is runny. Look,” she told Flores, holding up the glass to a bare bulb hanging in the basement of her Lakewood home. “The yolk is runny. That means there is something wrong with your health.”

She prescribes three “cleansings” over a period of a month. He agrees and feels a sense of calm.

Meanwhile, people begin filling Contreras’ living room, waiting for their turn.

The 46-year-old native of El Salvador is a curandera, a folk healer who uses limpias, or spiritual cleansings, to cure everything from ear infections to broken hearts.

At night, she cleans offices. By day, she cleanses bodies and souls, seeing between five and 10 people a week.

“If I worked as a curandera full time, I’d be working seven days a week, 24 hours a day,” she said of the increased demand for her services.

Curanderismo, a centuries-old form of faith healing from Latin America, combines the power of prayer and home herbal remedies. It has risen in popularity along with the dramatic increase in Colorado’s Hispanic immigrant population.

Dr. Ricardo Padilla, a physician at Denver’s Westside Family Health Center, in 2001 led a study that showed more than 29 percent of patients surveyed had been to a curandero at least once. The study estimated there were between 150 and 200 curanderos in the Denver metro area alone.

Curanderismo is a growing, unregulated industry. While the power of the mind and spirit in promoting healing can’t be denied, Padilla said, there also can be substantial health risks: Some herbal preparations may interfere with prescribed medications, or may be toxic themselves. And some people needing medical attention may delay or forgo treatment.

“Many Hispanic patients, especially those who use the public hospital system, use the services of curanderos,” said Padilla. “This potentially has important implications for their health care.”

Massage, prayer, herbs, rituals Curanderismo, derived from the word curar or heal, stems from the religious beliefs of Aztec, Mayan and Incan tribes that their many gods punished sins with illness. It was believed that some mortals, who were spiritually chosen, were given the power to heal the wounded spirit and cure illness or disease. These traditions were later combined with elements of Catholicism.

Curanderos generally use massage, prayer, herbs and rituals to treat patients. Health care experts say the practice has its pluses and pitfalls.

Padilla believes curanderismo is a form of “culturally sensitive health intervention.” But he also worries about the potential severity of some of the problems being treated by curanderos.

“The fact that headache was the most common problem treated by curanderos in our study was worrisome,” he said, noting a headache can be a sign of a serious neurological problem. The same applied to evaluations for stomach and back pain, kidney problems, and diabetes, which is more prevalent among Hispanics than among other Colorado groups.

“These problems should definitely be evaluated by a trained medical professional,” he said.

Many patients believe their ailments are the product of witchcraft, called mal puesto.

“There are people who have had hexes put on them,” said Contreras.

Some people, she says, come under demonic possession.

“They act crazy. They’ll lunge at you and spit on you. They’re the victims of black magic. Their bodies can’t take the weight of evil forces. They need someone with a lot of force and will power to counteract those forces. I can take it. I’m not afraid. I put them to sleep, and they wake up fine.”

Born with a special gift

Amos Martinez, a manager at the mental health licensing program for the state Department of Regulatory Agencies, said curanderos and other “naturopaths” are unregulated in most states, including Colorado.

“They have more of a religious orientation, which is why most states don’t regulate them,” he said. “For them, it’s more a matter of a ‘buyer beware.’ “

Curanderos charge anywhere between $25 and $100 per consultation, but some charge much more. Fees are often in the form of donations. Most rely on word of mouth.

Born and raised in San Salvador, Contreras said she did not attend school, but she knew at an early age that she had a special gift. She ran away from home at age 9, she said, and ended up in Honduras, where she was taken in by a curandera who taught her about limpias and other rituals.

“The only thing I knew is that I had natural forces inside of me. I can’t explain it. I can cure other people,” she said. “I’m not Catholic. But I believe in God almighty. I also feel that the spirits surround me. I feel them.”

Contreras sees customers from as far away as El Paso and Houston. Locally, they come from all over: Denver, Greeley, Fort Lupton and Brighton. Contreras charges $20 for limpias. She also sells candles, powders and other items for a slight markup.

Her consultations begin with a sort of diagnosis.

“I first assess what state they’re in. I pass an egg over them and I feel in my hand what they feel. I will sometimes tell them that they need to see a doctor. If it’s something I can do with prayer and herbs, then I will help them,” she said.

Maria Juarez, who divides her time between Denver and the small Texas town of Fabens, has been working as a curandera for 25 years. Her rates are $60 for an initial consultation that lasts between 30 and 45 minutes. A spiritual cleansing, which ranges from an herbal bath and prayer ritual to the burning of herbs or candles similar to the Native American tradition of smudging, is $70 for one hour. To supplement her income, she sells furniture at local flea markets.

Sitting at her desk in her home office, she pulled out a drawer filled with used men’s underwear. They are among the more unusual remnants of past curandera consultations.

Strewn about her office are bottles of potions and bags of powders. Agave, which comes from the cactus plant that tequila is made from, is good for attracting money and for men with “weak sperm when they are trying to impregnate a woman,” she said. There’s a diverse hodgepodge of religious and spiritual iconography: a Native American dream catcher, a golden Buddha, pictures of angels, saints and various representations of the Virgin Mary.

To attract a love interest or dispel unwanted advances, she uses personal items such as locks of hair or the sole of shoe. Having a person’s tears, sweat or other bodily fluids also works well, hence the underwear.

Juarez, who has a nursing degree from Mexico, said the use of herbs and prayer can cleanse a person’s aura and purify the soul.

“Many people confuse faith healing with witchcraft,” she said. “It’s more about spiritual faith.”

Juarez said that along with healing physical and emotional ailments, she has helped people with legal and financial problems, alcoholism and the “evil eye.” She claims to have cured a man of colon cancer.

She also reads tarot cards and predicts fortunes and futures.

“Men want to hold on to their women. Women want to keep their men. They want to know their future. Will I get my immigration documents? Will I get a new job? Will my wife leave me?” she said.

Four botanicas in Denver

The Botanica Yelegua on Washington Boulevard in the Globeville district is sort of a spiritual drugstore for curanderas and other faith healers.

On a recent day, Cesar Dominguez was there waiting anxiously for Jorge Mauricio, a Santeria priest.

As with curanderismo, Santeria also involves the “cleansing” of malevolent forces that can cause physical and emotional ailments. Mauricio has been able to attract Hispanics from Latin American countries as well as from the Caribbean.

Distress over marital problems led Dominguez to Mauricio, a Cuban native who moved from Miami to Denver in 1983, bringing along his practice based on West African religions.

“After my wife left me . . . I couldn’t stop shaking and had a bad cough. I lost 20 pounds. I went to a doctor and a family counselor, neither of which could help me,” said Dominguez, a native of Guerrero, Mexico.

“He was in such bad shape, that it took the sacrifice of two roosters and a chicken to help him,” said Mauricio, whose religious traditions include the use of animal sacrifice.

“I was going to get a divorce,” said Dominguez, who works as a cook. “Things are improving with my wife. We’re talking now. Now I’m more tranquil.”

At Botanica Caridad del Cobre on Lawrence Street, owner Martin Ramirez sees taxi drivers from Jamaica, St. Croix and other Caribbean islands.

“They come in here speaking French,” said Ramirez, who has owned his shop for 22 years. His sister, who was once married to Mauricio, owns Botanica Yemaya on Federal Boulevard in northwest Denver. The city’s fourth botanica, Oshun, is on Santa Fe Drive.

Ramirez, who also runs his family’s own herbal distributing business, opened a store in Colorado Springs three years ago and is planning to open another in Greeley. He said business has steadily grown.

Customers consist of both faith healers and laymen familiar with the use of herbs, potions and prayers. Most of his clients are Mexican immigrants.

“Many come in for herbs and potions for illnesses. Some want candles that will give them protection from immigration authorities,” he said.

He carries all the traditional products, including some of the more unusual such as dried tarantulas, seahorses and snakes. Ramirez sells more than 200 candles with names such as “Get Out of Jail,””Court Cases,””Envy Go Away,””Steady Employment,””Stay Home” and “Triple Stay Home.”

There’s even a powder that claims to cure alcoholism called “Guts of Devil with Snake Powder.”

“It really works,” said Ramirez. “It makes the alcohol taste really nasty. And sort of gives drinkers a bad stomachache and diarrhea.”

KZSB News-Press Radio Heralds Return of Community News and Talk

Jul. 2–The Santa Barbara News-Press has hit the airwaves. Nostalgia radio station KZBN-AM 1290 officially became KZSB News-Press Radio on Friday, debuting a local news and talk format that has been absent from the area for nearly two years.

KZSB fills a void in the market for local news and community talk shows created when KEYT-AM 1250 was sold in October 2003 to Oxnard-based Lazer Broadcasting and became a Spanish-language music station.

News-Press Radio will feature more than 80 hours each week of locally produced news and live talk shows, according to KZSB General Manager Les Carroll.

“In this day and age, that is an ambitious task,” he said, adding that local TV stations produce about 50 hours a week of local programming.

An all-local news and talk format generally has been a money loser for commercial radio stations. KEYT 1250 struggled financially for five years before its owner, the late Bob Smith, decided to sell the station. At the time of the sale, Mr. Smith told the News-Press that the station lost $1 million since the year he purchased it in 1998. Those losses approach the $1.6 million he paid for the station.

“The only way that this format makes sense financially is to create a partnership with an existing news company,” Mr. Carroll said. Only about a dozen such partnerships between local newspapers and local radio stations currently exist in the United States, he said.

Most of the KZSB’s news content will come from stories found in the pages of the News-Press, and live local talk programming. Traffic reports from drivers of the Santa Barbara Airbus fleet and the Clean Air Express will provide updates from the road during the morning and evening rush hours.

Regular KZSB newscasters will include longtime radio personality “Baron” Ron Herron and radio veteran Bob Ducibella.

“The News-Press has the best and most in-depth local news report in Santa Barbara County,” said Jerry Roberts, editor and vice president of news. “We are delighted to enter this new partnership with KZSB, enabling us to carry our brand of community journalism to their listeners.”

World news will be provided throughout the day by satellite broadcasts from the British Broadcasting Corp. and CNN Radio News reports.

“We are one of the few commercial radio stations in the country that is carrying news programming from the BBC,” said Mr. Carroll. “National Public Radio stations have been licensed to carry BBC for a long time, but less than a handful of commercial stations are licensed to do this.”

Talk programs running during the week include “Our Town with Ed Giron,””Radio Real Estate,””The Third Age with Dr. Peter Brill,””The Golf Show,””The Chamber of Commerce Radio Show,””Around the World with Arthur & Barney,” (featuring News-Press restaurant critic Arthur von Wiesenberger and columnist Barney Brantingham), “The Grape Vine with Gabe Saglie” and “Garden Gossip.”

KZSB and KJEE-FM 92.9 are the only two independently owned and operated English-language stations on the South Coast that are not linked to a broadcasting giant.

Comedian Bob Newhart owned AM 1290 before selling the station last year to telecommunications executive Dennis Weibling of Seattle for $750,000. The sale of the station, officially owned by Mr. Weibling’s Santa Barbara Broadcasting Inc., was approved by the Federal Communications Commission last January.

Mr. Weibling is a friend of News-Press owner Wendy McCaw.

The News-Press operated a radio station — KTMS, named for T.M. Storke, then the paper’s owner and publisher — from 1937 to 1985.

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TWX,

Measures Can Help Save Frontal Sinuses

A few X-ray measurements can help determine whether chronic problems with the hard-to-reach frontal sinuses can be corrected with surgery, according to a new study.

“The frontal sinus is behind the forehead and it has a very tortuous drainage,” says Dr. Stil E. Kountakis, vice chair of the Medical College of Georgia Department of Otolaryngology-Head and Neck Surgery. “It’s the most difficult sinus to work with.”

The good news is the frontal sinuses, which run parallel to the eyebrows, are not the most common site for infection. The bad news is the sinuses between the eyes ““ the ethmoids, into which the frontal sinuses drain ““ are, says Dr. Kountakis.

“The general recommendation is to avoid frontal sinus surgery as much as possible,” he says, citing potential hazards that come with their proximity to the skull base and the orbits.

But when chronic symptoms such as headache, cough, sore throat, nasal congestion and drip don’t respond to medical therapy, miserable patients may opt for surgery that effectively obliterates their frontal sinuses. Surgeons crack open the skull, open the frontal sinuses, remove the lining and fill the empty cavity with abdominal fat. “A better solution is to perform functional endoscopic surgery that provides a large area for the sinuses to drain while preserving sinus function,” says Dr. Kountakis, who directs the Georgia Sinus and Allergy Center.

He is corresponding author on a study published in the May/June issue of the American Journal of Rhinology that should help surgeons determine if patients are instead candidates for a sinus-saving modified Lothrop procedure.

The procedure enables sinus surgeons to work through the nose to create a larger drainage pathway for the frontal sinuses by removing the floor of the sinuses between the eyes and creating a hole in the septum that separates the nose. “This opens up the sinuses so they drain without obstruction,” says Dr. Kountakis. “ËœThis is a last-ditch effort to try and fix chronically obstructed frontal sinuses.

“By doing the surgery over and over again, I’ve learned to look at the (computerized tomography) scan and check to see if I had room for my instruments to go through,” says Dr. Kountakis, senior author of the recently released first textbook on the frontal sinuses.

He wondered if guidelines could be developed to help others do the same.

He and colleagues Dr. Ramon E. Figueroa, MCG neuroradiologist, and Dr. Firas T. Farhat, MCG sinus fellow who is now the first fellowship-trained rhinologist practicing in Lebanon, determined those measurements by studying the CT scans and anatomy of seven cadavers.

They identified the critical measurements as the thickness of the nasal beak, the boney structure between the eyes where the nose and forehead meet, as well as the “accessible dimension,” a term Dr. Kountakis coined for available working space inside the frontal drainage area.

“Even with the smallest instruments that are available today, this dimension should be at least 5 mm (about .2 inches) to allow for safe drill insertion,” the study authors write of the accessible dimension.

“The smaller it is, the harder it is,” says Dr. Kountakis. “You need to have some space that will admit all these instruments going up into the forehead.”

Researchers also measured the distance between the nasal beak and the front of the nearby skull base as well as the widest front-to-back depth of the frontal sinuses.

By their new measurements, four of the seven cadavers qualified for the sinus-saving modified Lothrop procedure. The researchers suggest long-term clinical studies to further assess the efficacy of the measurements.

On the Web:

Medical College of Georgia

Nine Misconduct Charges Filed Against Former U-M Urology Chief

Jul. 5–Dr. Joseph Oesterling , a once-leading urologist who resigned in disgrace in 1997 from a top job at the University of Michigan over expense-account abuses, faces new professional misconduct charges.

Oesterling, 49, will have a July 12 compliance conference with the state Board of Medicine to try to negotiate a settlement over four counts of negligence, four counts of incompetence and one count of lack of good moral character.

The Michigan Attorney General’s Office filed the charges with the Michigan Department of Community Health, the administrative arm of the state Board of Medicine.

In the charges, Oesterling is accused of failing to properly treat urological problems in four patients — identified only by their initials — at St. Mary’s Medical Center in Saginaw, where he is on staff.

Oesterling allegedly mishandled urological conditions in two men, causing each to lose a kidney, according to the complaint. In the other cases, Oesterling is accused of damaging bladder and reproductive organs in two women during surgery.

Possible penalties range from probation to suspension or revocation of his license. If a settlement can’t be reached, a public hearing will be scheduled at which patients might testify, said Ray Garza, Freedom of Information Act officer with Michigan’s Bureau of Health Professions.

Oesterling’s attorney, Michael Schwartz, denied the charges and said the doctor will not comment on the cases.

Jill Goodell, hospital spokeswoman, said Oesterling’s status at St. Mary’s is part of a peer review process and is confidential.

Throughout June, Oesterling has been on and off the members list of the medical staff on the hospital’s Web site, www.saintmarys-saginaw.org.

Oesterling was not on the list Monday.

Oesterling rose to the top of his profession by age 38, when he was named chair of urology at the University of Michigan Medical Center in 1994.

He also was the top editor of Urology, a leading journal in the field.

But in 1997, he resigned from U-M after pleading guilty to a felony of expense -account fraud in a case that gained international attention as an example of physician conflict-of-interest issues.

Oesterling was sentenced by Washtenaw County Circuit Judge Melinda Morris to a year s of probation and community service, his medical license was suspended, and he was placed on two year s of probation by the state Board of Medicine.

A U-M investigation showed Oesterling accepted hundreds of thousands of dollars from more than a dozen companies; that he failed to report that income to U-M , and that he double- and triple-billed the university, urology groups and the companies for expenses.

He said at the time that he put the money into several for-profit and nonprofit companies he established for prostate cancer research.

But a 1997 Free Press investigation found that Oesterling put some of the money into his personal banking account and that there was no accountability to establish that the rest of the money went to prostate cancer activities.

Oesterling reimbursed U-M for $105,000 after his conviction.

The following year, t he American Board of Urology revoked his board certification and he resigned as editor of Urology. He moved his practice to Saginaw, where he obtained hospital privileges from St. Mary’s.

In 2000, Oesterling was reprimanded by the state Board of Medicine for misrepresenting results of a study for a company, VidaMed Inc., that funded his research and in which he owned stock, according to state records.

As part of a consent agreement, the state dropped charges that he lied to eight prostate cancer patients about their prognoses after Oesterling agreed not to misrepresent patient prognoses anymore. He also was ordered not to conduct clinical trials for five years, engage only in supervised research for the following five years and ” play no role with respect to the financial aspects of any clinical research trials.”

Lawyer claims smear campaign

Schwartz said the previous disciplinary actions in 1997 and 2000 did not involve patient care issues or result in findings of medical misconduct. The current charges are part of a campaign to discredit Oesterling, he said.

“We have other urologists saying what he did was within the standard of care and constitutes neither malpractice or misconduct,” Schwartz said. “There has been a campaign by particular individuals to cause harm to Dr. Oesterling’s career. … Dr. Oesterling is a man who has a history of excellent work.”

Some of the charges in the state complaint involve several of Oesterling’s patients who have also filed medical malpractice suits currently pending in Saginaw County Circuit Court, according to court records.

Oesterling currently works out of the Midwest Prostate and Urological Institute, with a main office in Saginaw and satellite offices in Frankenmuth, Mt. Pleasant and West Branch, according to the institute’s Web site, www.mpui.org.

To check disciplinary records on Oesterling and other health care providers, visit the Michigan Department of Community Health’s Web site, www.cis.state.mi.us/free/default.asp.

By Maryanne George and Patricia Anstett

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Copyright (c) 2005, Detroit Free Press

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VIDA,

Organization Evolution: The Natural Change Model for Organizational Structure in Changing Times

Abstract

For Earthlings, the earth is a closed system. As a huge, impossibly complex organization, it is not operating in its own best interests. This paper examines the fundamental nature of organizations and proposes that a major paradigm shift is needed to move from the centuries-old, command-and-control mechanistic model to a new, more dynamic, self-organizing, self-renewing model based on nature itself. The rationale is presented with a description of how such organizations would form and function.

“Houston, we have a problem!”

We are all passengers on this eco-spaceship Earth as it travels into the future. It is an exceedingly complex vehicle and becoming increasingly more complicated every day. It has problems. And, as we all know, complex problems have simple, easy-to-understand, wrong answers. We had better start looking for some root causes of our problems or our vessel may literally disintegrate beneath our feet. And, given the increasing pace of change in today’s world, we had better come up with some valid answers quickly.

But, first things, first-before seeking solutions, let’s be certain we have accurately defined real problems, not merely symptoms.

At the time of Christ’s birth there were about 300 million people on earth. It took more than 1,600 years for it to double to 600 million. As we enter the new millennium there are about 6,055 million, nearly 2 times the 1950 population, with a projected population of about 9,000 million people by 2050 (United Nations Population Division, 1998). The global village will be a crowded place and anarchy is the likely mode of interaction if we cannot find a way for global coexistence based on principles of community and civility rather than pursuit of independent, competitive self- interests. The increasing global disorder we are seeing today is only the leading edge of what will come if we do not change the way we do things. The “there ain’t room enough in this town for the both of us” attitude of the Old West is reaching global proportions with global consequences unless something changes. What can change?

The earth remains stubbornly the same size and its resources are dwindling at ever-increasing rates. Some people can even remember a time when the air was clean and sex was dirty. Today, both our physical environment and our social environment are being pushed to the point of failure if current trends continue.

Environmentally: At current rates of consumption the planet’s oil will be depleted in 28 years, copper in 34 years, and nickel in 59 years (Stead & Stead, 1992). At current levels of increase, CO2 levels will double in the next several years, further raising the global temperature by an estimated several degrees centigrade (Eisraa, 1995) And, if, as some studies suggest, that increase were as much as 5 degrees, whole countries would be inundated with water (Feagans, 1998; Gordon & Suzuki, 1991).

Socially: In our current global village, 20% of the people control 75% of the wealth while another 20% receive only 2% of the wealthand the gap is growing with developed nations evolving into the two-tier, haves and have-nots class system that dominates undeveloped nations. (There is no shortage of books and articles that document this phenomenon [Franks & Cook, 1995]). Eighty percent of the village population lives in substandard housing. Twenty-five percent of its women have either been raped or suffered attempted rape. Only 0.01% have computers; 70.8% are Asians or Africans. Despite the growing usage of English in business, only 8.6% of the total population speaks English; 16.5% Mandarin, 8.3% Hindi, 8.4% Spanish, 5.8% Russian, 3.7% Arabic and 206 other languages make up the remaining 50% of the people-communication is tough! (The World Village Project, 1999).

How did things get this way? Organizations are both the cause and potential cure for Earth’s problems! It is organizations that leverage and amplify human ingenuity into massive mechanisms- mechanisms for controlling human behavior, for developing social institutions, particularly media and contents, that program values and beliefs, institutions that consume natural resources, institutions for the distribution of wealth, and institutions responsible for poisoning the environment. And it is not that any organizations set out to intentionally do bad things; it just sort of happened and continues to happen. We must examine why and look for better ways for organizations to operate.

Why Do Organizations Exist and What Is the Purpose of This Paper?

Simply put, organizations exist to do things that individuals cannot accomplish by operating alone-i.e., the obvious answer! BUT, the real question goes to the underlying rationale: Why do you want to do something, what is the PURPOSE?

The fundamental question proposed by this paper is just how should people organize for achieving common purposes in a very complex and constantly changing world, and additionally, what would that process look like?

The question arises because our old answers are no longer working. The old model of organizations is predicated on classic economic theory and operationalized using centuries-old, command- and-control concepts based on Newtonian mechanistic theory. This model has died-it just has not been given a proper burial yet!

What are we talking about? Basically, a revolution in the mental model that people use in business and government to create, interpret, and deal with their worlds. “Until recently, business people saw their worlds through the Industrial Age metaphor of the machine and built their organizations accordingly” (Petzinger, 1999, B1). We have evolved from the Agrarian/Craft Age through the Industrial Age to the Information Age in our technology and capabilities to interact with the environment, but we do not seem to have evolved comparably in our sociological capabilities for maintaining community well-being.

The Industrial Age was a linear step up from the Agrarian/Craft Age when humans began amplifying manpower with machines. Everything we know about organizations is extrapolated from the notion that the universe is a giant clockwork type mechanism. From the late 1600s onward we have been using equations-the laws of nature-to predict the tides, orbits, the movement of anything that could be seen or felt. This approach has resulted in organizations that are designed like clockwork mechanisms with levers that if pulled in one place should produce results in another-increase the advertising budget by “X” million dollars for a projected “X” percent increase in sales; pay a sweat-shop foreign female an extra peso and we can expect her to produce five more units per hour-and we have continued on with that model, glibly ignoring the facts that rarely did pulling levers or pushing buttons produce the precise results expected, and callously ignoring that such mentality reduced people to the status of mindless gears in a machine.

Nevertheless, this has become the inherent mode of all industrialized economies’ operations. “Traditionally conservative economists, most notably Nobel laureate Milton Friedman at the University of Chicago, have long argued that the sole mission of a corporation is to maximize profits for the benefit of shareholders” (Daviss, 1999, p. 30). Economics departments and MBA programs universally teach quantitative methods that continue to treat the workplace and world as clockwork mechanisms too for the purpose of converting resources into shareholder value. By the end of the 1980s, businesses essentially existed for no other purpose other than to compulsively fulfill this sacred obligation (Petzinger, 1999). Ask any business school student what is the purpose of a business, and he or she will emphatically state, “TO MAKE MONEY.”

Sadly, there has been, and continues to be, a tremendous resistance to change in this Friedman-driven philosophy and the organizational practices it drives. We continue to perpetuate the mechanistic command-andcontrol model because, as Dan Sweeney, a vice president at IBM’s retail consulting practice puts it-we have learned to equate “professional management” with the inherent belief (assumption) that purpose is profits and that stability means a continuous stream of shortterm profits (an assumption) and that our lives (and in particular, our business lives) should be stable and predictable (Harari, 1999). This string of assumptions is acceptable to people who have been told by respected professors and Nobel prize winners that the future can be predicted by linear projections of the past. HOWEVER, THIS IS PROVING TO BE PATENTLY UNTRUE!

And to what places has doggedly sticking to this invalid model brought us?

Money has become the “purpose” of everything; all things have become monetized in order to fit them into our clockwork computations, yet…. One sixth of the world is on the edge of starvation. Eight-five percent of the world’s people are living on 15% of the resources. Two-thirds of our arable land is gone. Fifty percent of fresh water is contaminated. Four thousand acres of rain forest disappear each hour. (Hock, 1998)

Is there a problem? Duh!

In the world today, we have:

* Economic turbulence spreading from Asia, Eastern Europe, Latin America\, and the USA

* A disappearing middle-class of consumers everywhere

* Schools that cannot teach

* Welfare systems in which few fare well

* Police that cannot enforce laws

* Judicial systems without justice

* Families that are far from familial

* Communities that cannot communicate

* Governments that cannot govern

* Individuals everywhere that are alienated from the institutions of which they are constituents

* Growing worldwide poverty-1.3 billion people earning less that $1 per day in 1993, which is an increase of 100 million from 1978

* Workers in the U.S. without high school degrees, who have lost 25% of their purchasing power since 1973; those with degrees-15%

* The earnings gap between men with college degrees versus without growing from 42% to 89% over the past 20 years

* The incentive for males to leave their families reaching a 73% increase in personal standard of living while that of the abandoned family decreasing 42% (and, in the process of abandonment, the transmission of family values being relegated to TV and music media which are a celebration of sex, violence, and instant gratification) (Hock, 1999; Piturro, 1999; Zuckerman, 1998)

It is not working for people, for society. The rise of a two- tiered society is reflected in the emergence of the “knowledge” industries whose workers prosper while those employees without a college education or technical skills fall by the wayside. And it is a problem that is growing: Consider that out of 7.5 million available high school graduates that should go on to higher education, only 2 million can meet the qualifications (Hock, 1999). Where do they go, what do they do? Can they raise families on “would you like fries with that” salaries? In 1970,2.8 million auto and steel industry workers enjoyed middle-class incomes and generous benefits; today fewer than one million do so. Median wages of average workers today, adjusted for inflation, are below the $8 per hour of the late 1980s and even $1 lower than the 1973 rate (Zuckerman, 1998).

Clearly it is not working for the general citizenry. Is it working for business? Not like it used to. Of Fortune 500 companies in 1955, 70% are out of business! (“Factoids,” Training & Development, 1998) A 1983 study by Shell oil concluded that corporations live only half as long as human beings (Wah, 1998). It makes one wonder what is really happening? If looking out for the shareholder is the prime directive, what happened to looking out for the future shareholders of these companies? What is the legacy of our clockwork organizations using command-and-control tactics to focus on shortterm strategies to maximize shareholder value? As Lester Thurow of MIT put it: “How far can inequality widen and real wages fall before something snaps in a democracy?” (Thurow, 1996, p. 261) Thurow is concerned in the greater sense of an international slide into a new Dark Ages as a result of the dominant “winner- takeall” logic that dominates market dynamics. Sadly, opposition to such thinking runs deep as evidenced by Thurow’s fellow economist at MIT Paul Krugman who brushes aside the concerns for society as “essentially literary sensibility” rather than a scientific- mathematical outlook (Krugman, 1996). Apparently non-monetarist moral principles are difficult to factor into regression equations and therefore must be discarded as not relevant. Hence, we understand the tongue-in-cheek definition of an economist as one who can tell you tomorrow why what he predicted yesterday did not happen today.

How can we avoid such a slide into a new Dark Ages? Ironically, “business is the best hope of the poor because companies that invest in emerging nations will grow profits and abundance for their new global partners…”; and because the alternative is no alternative at all, i.e., “a world in which one billion people trapped in a vicious circle of poverty and the population explosion foment political unrest and increased anti-Westernism as an antidote to their misery” (Piturro, 1999, p. 17), a scenario that seems to be well into its initial stages of playing out.

The 82-year-old Chairman and CEO of the billion-dollar American Income Life Insurance Company understands the problem and what is needed. He alludes to his childhood when his father was appalled when he discovered that the flat tire on his Model T Ford had so many patches on it that it could no longer be fixed and buying a new tire was the only option. “I suspect that’s the state of the world today. We’ve run out of patch room. For many of the problems we face in this world, it’s time to buy new tires.” (Harari, 1999, p. 35)

Figure 1. Natural Change Organization Concept

Organizations’ inability to evolve, to experience ongoing metamorphosis, in a rapidly changing and continuously evolving environment, is resulting in the physical and social destruction of the societies and economies of which they are a part. The same rationale for the way organizations continue to operate would forecast that there is no future for the human race. Surely this cannot be right, or allowed. We must wake up and recognize a major root problem: Current organizational designs are unable to cope with the real world in manners effective for long-term survival.

The future has traditionally been thought of as an extension of the past. If you know the starting point, one can predict the future by following a projected line influenced by known past factors. BUT, the discovery of nonlinear, dynamic systems by Edward Lorenz of MIT in the mid-1960s changed all of that in fundamental ways. Enter Chaos Theory-the concept that chance, changing conditions and creativity enter complex systems at any point and alter the course.

Indeed, in spite of all of the fancy economic analysis models, over the long run the stock market has been described as a random walk, and that is largely due to unpredictable changing events over time-a sort of Chaos Theory in slow motion. However, the speed of change in the environment has continued to pick up pace and that is the one trend that everyone is most confident about; i.e., that, oxymoronically, the only constant we can count on is increasing change. Since we cannot control the environment, and mechanistic organizations cannot adapt quickly enough using top-down command- and-control structures, the only alternative is to move to a more natural, organic model, that like its biological counterpart, organisms in nature, responds quickly at the point of contact with the environment to changes it is experiencing. This means localize short-term responses to local conditions and long-term evolution of the whole over time.

Such organizations would form around a common Purpose and have as its “DNA” a common set of Principles that govern all internal decision-making and implementation. Such an organization would necessarily have to be responsive to any and all People who could either affect its operations and existence or who are affected by its operations and existence. Purpose, Principles, and People would be the driving forces for determining Managerial Philosophy, Structure and ongoing Operations. All elements of this model would be focused on “Customers” and its success would be measured in terms of constituency satisfaction, and, of course in the case of for- profit businesses, money.

Figure 1 diagrams the genesis or concept for formation of such organizations. It could be used as a generic blueprint for designing such selforganizing, naturally evolving organizations. Such organizations would experience “natural change” because one of their basic purposes (as is the case for all biological organisms) would be continued survival; hence the name Natural Change Model.

Where do the concepts of vision and mission fit into this model? They do not fit in so much as derive from it. The concept of Vision is an articulation of the core organizational purpose, its philosophy, values, and beliefs along with a description of ultimate actualization. “Vision” serves as an anchor for all multiple scenario strategic planning. The concept of mission is an articulation of what (products and/or services) is produced for whom and how, all expressed in terms of the organization’s philosophy, values, and beliefs. “Mission” serves as an anchor for all operational decision-making. In general, all of the model elements in the six numbered boxes can be thought of as lenses through which the customers are kept in central focus. Probably the most unique aspect of this model compared to traditional economic theories of organizations is the focus on customer first and foremost as a beneficiary of the organization’s purpose and the inclusion of constituencies from the greater environmental community in which the organization exists (i.e., affirmative social responsibility as a core value).

Simply put, the elements of this model are:

* Purpose: a clear, socially responsible reason for existing

* Principles: the values and ethics-based rules and guidelines by which the organization will operate

* People: staffing by those whose values and beliefs are congruent with the purpose and principles and who will thereby achieve personal satisfaction by helping the organization to be successful.

* Management Philosophy: embracing purpose and principles and allowing people to be empowered to do their best.

The concept portrayed in Figure 1, can be thought of as the development of a single-cell organization, alive and existing for its purpose. To the extent that other people subscribe to the same purpose and basic set of principles they could form their own “cell” or organization and link with the original “cell” to form a more complex organization. Such a linkage would imply the creation of yet another type of process element in the more complex organization-an element for the purpose of Information Sharing and Coordination (IS/ C). This is a far different function than the traditional hierarchical command-and\-control function as it is driven by common subordination to Purpose and Principles rather than the power and intentions of a dominant coalition of senior managers.

To the extent that anyone or group wants or needs to join the organization, they may do so by subscribing to the common Purpose and Principles and self-organizing in harmony with them. Each new “cell” added to the growing organization is empowered to have voice in the overall organization by inclusion at the next higher IS/C element. This would be analogous to increasingly more complex living, biological organisms that have evolved.

What does such a business organization look like in real terms? Two are familiar to everyone: the Internet and Visa. Both are very real organizations and yet they are almost invisible. Where are their physical “Headquarters”? They haven’t any! Who is “in charge” over either of them? No one person or group. They are self- organizing organizations in which multitudinous subordinate organizational elements simultaneously compete with each other for market shares and niches and at the same time cooperate with each other through common subscription to Purpose and Principles, using collaboratively shared resources. Do they work? Visa processes more financial transactions worldwide in a week than the entire U.S. Federal Reserve System does in a year (Hock, 1999). Anyone can join up and create their own Visa card organization as evidenced by the multitude of new card offers in the mail from every sort of organization, from banks to alumni associations to religious groups.

Viewed up close, the individual elements of the overall Natural Change Organization Model might seem to be independent or not even visible at all, lending an appearance of chaos to the environment at any one place at any particular point in time. However, as with the weather, we are coming to learn that there is an interconnectivity to all elements and it is their combined, cumulative effect that gives evidence to order and patterns that can be made sense of. It is the manner in which the flapping of a butterfly’s wings in the Amazon valley does have an effect on the weather in Europe, and it is the underlying principle for the power and importance of individuals and groups of people at the most local of levels (Lorenz, 1994; Wheatley, 1994). And it is the interconnectivity of such people in pursuit of common Purposes that transcends political borders and enables such huge organizations to function effectively and independently of governments. As Dee Hock puts it, if you organize in this manner, so long as you do not break laws, who could stop you? No one! And, it is why the solution to the world’s problems does not lie with government nor with the old command-and- control mechanistic organizations that have largely created most of the problems, albeit unintentionally.

Hock, “one of the most original thinkers on the subject of organization” according to Peter Senge, formed the Chaordic Alliance in California for the Purpose of helping to create new organizations and transform organizations to demonstrate the viability and vitality of this organizational concept (www.chaordic.org). Dee calls such organization “Chaordic” based on continuously existing on the line where chaos and order intersect. “The Chaordic Alliance is committed to creating the conditions for the formation of practical, innovative organizations that blend competition and cooperation to address critical societal and environmental issues” (Hock, 1999, p. 324).

What have we learned from Chaos Theory? case studies (Wah, 1998) have shown:

* The main characteristics of natural change, adaptive systems are:

1. Truly flat organizational structure

2. Team-based operations

3. Evidence that team members always tell coworkers important issues in person

* Successful organizational development depends on communication awareness: multi-directional, multi-channel, and continuously asking the question of who else needs to be included.

* An inherent value or belief that needs to be developed is a positive sense of ability to deal with change plus a positive mental image of one’s self and the world one is dealing with.

* Becoming a “living system” means breaking down hierarchies into groups of people who can move from one part of the organization to another quickly, which requires cross-training and development of self-directed work teams.

* Organizations can and need to compete while simultaneously collaborating with each other to identify emerging conditions and events that are not linearly predictable, using alliances to capture the “bigger picture” more clearly and interacting more effectively in a turbulent environment.

What are Some Conclusions to be Drawn from the Natural Change Organization Concept?

If organizations are living parts of a larger organization called the environment or Earth, their health and behavior have a direct impact on the health and behavior of the greater organization. An organization can be a functioning contributor to the greater good, or an irritant, or even a cancer.

Organizational “boundaries” are highly flexible and permeable versus mechanistic organizations where “boundary” is a function of the intentions of the top management dominant coalition who necessarily interact with traditional cognitive limitations that lead to short-term focused “bounded rationality” (Engdahl, 1993; Galbraith, 1983; March & Simon, 1958; Simon, 1980).

The observable organization in an increasingly “virtual” world would be the patterns and content of information flow, plus the information retention and maintenance systems (Weick, 1979). Organizational “structure” in the classical sense, would be ever changing as a result of:

1. Continuous response to interpreted information from both the external and internal environments, classically called “strategizing”, and

2. Subsequent internal sense-making and marshaling of resources in response to constantly changing strategies, classically called “directing”, and

3. Subsequent adaptation in operational implementations, classically called “managing,” all done at the lowest possible self- managed team levels within the organization rather than directed by top management.

Also, a major moderating variable is inherent in the NCO. March and Simon (1958) refer to it as “uncertainty absorption,” which occurs when information that is transmitted is really interference rather than relevant hard data. O’Reilly (1980) presents a model for information distortion in organizations and suggests that not only could “interference” be measured, but that it should be as obvious that it has effects on the decision-making process (Engdahl, 1993). In other words, information must be regarded as a primary “resource input” for any organization and it is critical to be sure that the organization operates on “real” information, not just raw data or even worse, meaningless noise to which some meaning has been erroneously or egregiously given.

Some Closing Thoughts

From James Higgin’s book Strategy: Formulation, Implementation, and Control, (1985, p. 43)

“To manage a business well is to manage its future; and to manage its future is to manage information” quotation from Marion Harper, Jr.

From Lester Thurow:

“If it is to succeed, the corporation of the future will have to shift from a consumption ideology to a builder ideology” (Thurow, 1996, p. 315).

And lest we forget that in the sense of Charles Perrow’s (1980) “great chain of being” and his nested box analogy, there are serious implications in our interdependent world for a compatibility and consistency in the nested Purposes, the moral virtues, of organizations:

“I never did, or countenanced, in public life, a single act inconsistent with the strictest good faith; having never believed there was one code of morality for a public, and another for private man” (Thomas Jefferson, 1809).

Intent and purpose can interact in various ways, with various results-Aristotle warned us that the acquisition of empire could undermine the common good of the community (Wolin, 1960).

“Things have gone on for much too long and are much too bad for pessimism; optimism is the only real choice” (Dee Hock, Founder and CEO Emeritus, VISA, 1997).

“To learn is to change. Education is a process that changes the learner . .. Learning involves interaction between the learner and his environment, and its effectiveness relates to the frequency, variety, and intensity of the interaction” (Leonard, 1968, pp. 18- 19). This is true for all things in nature, from sub-atomic particles, to bacteria, to amoebas, to whales, to whale pods, to humans, to organizations, to societies!

NOW WHAT ARE YOU GOING TO DO ABOUT HOW YOU, WE GET THINGS DONE!!!??? “INVENT” ANOTHER GEAR TO TURN, ANOTHER LEVER TO PULL… OR REDESIGN BY BEGINNING WITH AN AFFIRMATION OF “PURPOSE” AND “PRINCIPLES”? Just remember that “he who dies with the most toys….” is still dead regardless of whether it is people, organizations, or whole societies. On the other hand, maybe George Carlin got it right when he quipped:

“There is nothing wrong with the planet. The planet is fine…. Been here 4 billion years. We’ve been here, what a 100,000 years, maybe 200,000. And we’ve only been engaged in heavy industry a little over 200 years. 200 years versus 4 billion. And we have the conceit to think that somehow we’re a threat? The planet isn’t going away, we are.”

And beyond the ecological disaster that is imminent, remember that the Natural Change Organization concept can apply to evil as well as good Purposes. The people of spaceship Earth are currently engaged in a global war with terrorism as the opponent. Terrorist supporters understand the Natural Change Model perfectly: They are driven by common Purpose, they subscribe to common Principles, and their People are highly motivated by personal identification with the same. Their Management Philosophy is totally driven by \Purpose and Principles, and they are structurally organized to allow any and all to join and function fully at the lowest self-managed team level to accomplish Purpose. This is the reason that it is so difficult to stop terrorism. Terrorism is almost like a bacteria that has invaded our natural system, and the only way we can eradicate it is to organize in a manner that mobilizes a unified global response at the lowest possible levels (antibiotics work by killing the individual bacteria) The implications of this life-or-death challenge are clear: Some aspects of Purpose and Principles are sacrosanct basics to civility and human existence.

This paper is about a real problem! It is about the inability of organizations today to accomplish their purposes in a manner that secures a healthy future for the human species.

Today, both our physical environment and our social environment are being pushed to the point of failure if current trends continue.

Organizations are both the cause and potential cure for Earth’s problems!

We have evolved from the Agrarian/ Craft Age through the Industrial Age to the Information Age in our technology and capabilities to interact with the environment, but we do not seem to have evolved comparably in our sociological capabilities for maintaining community well-being.

Economies departments and MBA programs universally teach quantitative methods that continue to treat the workplace and world as clockwork mechanisms too for the purpose of converting resources into shareholder value.

This string of assumptions is acceptable to people who have been told by respected professors and Nobel prize winners that the future can be predicted by linear projections of the past. HOWEVER, THIS IS PROVING TO BE PATENTLY UNTRUE!

Organizations’ inability to evolve, to experience ongoing metamorphosis, in a rapidly changing and continuously evolving environment, is resulting in the physical and social destruction of the societies and economies of which they are a part.

Probably the most unique aspect of this model compared to traditional economic theories of organizations is the focus on customer first and foremost as a beneficiary of the organization’s purpose and the inclusion of constituencies from the greater environmental community in which the organization exists (i.e., affirmative social responsibility as a core value).

Just remember that “he who dies with the most toys….” is still dead regardless of whether it is people, organizations, or whole societies.

References

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Weick, K. (1979). The social psychology of organizing. Reading, MA: Addison-Wesley.

Wheatley, M. (1994). Leadership and the new science: Learning about organization from an orderly universe. Berrett-Koehler Pub.

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Richard A. Engdahl, PhD, RODC

Richard A. Engdahl, PhD, RODC internationally known speaker and Associate Professor of Management, Cameron School of Business Administration, University of North Carolina, Wilmington (UNCW), has a broad range of experience in OD consulting and management development. He has published books on management and papers on OD. He is CEO of Organisational Imagineering International, Ltd., and the principal architect of UNCWs Total Quality University TQ model. He has served the Wilmington community on leadership and quality councils.

Contact Information

[email protected]

Copyright O D Institute Summer 2005

U.N. Inspection Turns Up Cracks and Asbestos

UNITED NATIONS — The official tour will tell you the founding of the United Nations in 1945 brought the world from post-war misery toward prosperity and happiness. Analternative “dirty” tour will tell you the United Nations is crumbling.

The building, that is. While critics, particularly inWashington, may be worried about the oil-for-food scandal and investigations into mismanagement in allocating U.N. contracts, some at the United Nations have more practical concerns.

Such as leaky pipes lined with asbestos, creaky airconditioning systems and an eerie locked room housing outdated electrical systems pulsing with so much energy that computerswon’t work on the floor below.

Some years ago part of the roof blew off the sleekly curved General Assembly building, landing, by good fortune, on someparked cars rather than a passing ambassador.

Inside the chamber where delegates from the 191 member states gather to discuss poverty, human rights, peace andsecurity, even the ambassadors were not immune from danger.

“We had to replace the entire ceiling there because partsof the ceiling were falling down on delegates’ heads,” said Peter Wendeborn, one of the architects working on a six-yearrenovation plan for the U.N. complex due to start in 2007.

The United Nations has been working for years on a $1.2billion Capital Master Plan for renovating its aging headquarters on Manhattan’s East River, completed in 1952.

Financing is not finalized since the United States declinedto make an interest free loan, instead offering it at 5.54percent. Member states are still deciding what to do.

The United Nations has been inviting diplomats, U.S.congressmen and media to take the “dirty” tour of the buildingas part of a campaign to secure the necessary funding.

Not everybody is convinced. Sen. Jeff Sessions, a Republican from Alabama, urged the U.S. Senate in April toslash the proposed loan by half, saying $1.2 billion was an”outrageous” sum by commercial standards.

“This renovation plan is far too expensive. Donald Trump told me … he had offered to do the project for $500 million, yet U.N. Secretary General Kofi Annan did not seem interested,” Sessions told the Senate, referring to real estate tycoon Trump who has built skyscrapers throughout New York.

SEEKING TEMPORARY HOME

The plan has hit another snag with the refusal this year bythe New York City Legislature — partly antagonized by U.N. opposition to the war in Iraq — to approve a plan to build anew 30-story office in a park next door as a temporary home for the 3,400-plus people who work at the United Nations.

U.N. officials are seeking alternatives. Brooklyn, across the river, wants the business while other suggestions include a new tower at the World Trade Center site or even a moored cruise ship.

Meanwhile, Wendeborn wants to tell anybody who will listen that the architectural landmark which boasts the likes of LeCorbusier among its designers has not weathered well.

Peeling back the cover of an air conditioning unit in aconference room high in the domino-shaped skyscraper thathouses the U.N. Secretariat, Wendeborn crouches and peers in.

“That powdery stuff in the wall, it’s asbestos,” he says, adding that 4,000 units around the U.N. building contain asbestos, now linked to cancer and other diseases.

“Whenever we want to put in a light fitting we have tobring in men in space suits,” Wendeborn said of the asbestosproblem in the building.

Three floors of the skyscraper house ancient airconditioners with giant snaking pipes, coated in asbestos andmany crumbling, rusting or leaking.

“The equipment was designed to last 25 years. It’s 30 years beyond its lifespan,” Wendeborn said. “The equipment manufacturer is out of business so we can’t even buy parts.”

“They’ve asked us to give this back for their museum,” headded, pointing to a control panel with antique dials thatcould come straight from a 1950s film set of a space ship.

Though it is on international territory, the United Nations signed treaties agreeing to abide by local U.S. regulations, but Wendeborn said U.S. authorities did not come in to check.With constant budget woes and no commercial pressure to keep up, the building has not been maintained.

The heating and cooling system is so erratic that employees often shiver or bake with no recourse except to open the windows. Unlike most modern office blocks the windows do open, but that’s yet another headache for building managers worriedabout bomb attacks.

There are also no sprinklers, and the fire alarm system isso outdated controllers can pinpoint the source of an alarmonly to within three floors in the 39 story tower.

The buildings will be completely gutted internally andrefitted, though the basic shell will remain as Wendeborn saidit would be more expensive to tear it down brick by brick.

The U.N. complex draws some 800,000 tourists a year, with visitors paying up to $11.50 for tours in several languages.

Josephine Wanjiku, a guide from Kenya leading a recenttour, explained the U.N.’s work to visitors from Wales, Mexicoand California. Standing in front of a mural she said: “You see destruction, concentration camps, people fighting. Then theU.N. is founded and you see resurrection where families start to move on after the U.N. is founded.”

On the alternative tour, Wendeborn does not like to focus on the $1.2 billion cost of the renovation project. “Sometimes it scares people, but that’s what it costs,” he said.

Mexico’s past and future meet at Corruption Palace

By Lorraine Orlandi

ZIHUATANEJO, Mexico (Reuters) – A replica of the GreekParthenon stands decaying on a cliff above a Mexican Pacificresort, a gaudy monument to graft and brutality that neighborslong ago dubbed the Palace of Corruption.

It was built as a vacation retreat by the late ArturoDurazo, “El Negro,” a notorious Mexico City police chief whogot rich on official misdeeds during a heyday of corruption inthe 1970s. Legend says he murdered a couple of house guests inthe Parthenon’s lagoon-sized pool, now half filled with slimy,green water.

The caretaker fears the ghost of El Negro himself hauntsthe deserted grounds. He prefers to hang his hammock outsidethe towering front gate, keeping watch from a distance.

“Definitely, that Parthenon is a monument to corruption,”said Zihuatanejo Mayor Amador Campos. “However, it is abeautiful place worth a lot of money that can be rescued as acultural center or theater for the people.”

Guerrero state has claimed the property, and nowtownspeople hope to turn it into a community treasure.

If the Parthenon is a product of an authoritarian past,then its eventual fate may reflect hopes for Mexico’s future asit struggles toward full democracy.

Since President Vicente Fox won historic elections in 2000to end the 71-year rule of the Institutional RevolutionaryParty, or PRI, change has come — but slowly — to this andother corners of Mexico long run like private fiefdoms.

In Guerrero, a longtime PRI bastion, the party was oustedfrom the governorship this year and has lost dozens of localoffices, a sign people are taking power into their own hands.

“People learned that you could beat the PRI. Here therewere people who would assure you that the PRI could not bedefeated,” said Campos, a member of the leftist Party of theDemocratic Revolution, or PRD, who was elected mayor two yearsago.

Still, autocratic vestiges remain, breeding corruption,rights abuse and political cronyism, much as in Durazo’s day.

“An old regime cannot be dismantled in two months,”Guerrero Governor Zeferino Torreblanca of the PRD warned aftertaking office in April.

CHIEFTAINS RULE

In Guerrero, long a hotbed of activism and insurgency,people are used to facing iron-fisted crackdowns. Here, as inother poor, violent states like Oaxaca and Chiapas, politicalbosses have used the army, police and courts to protect privateinterests against those fighting for change.

Torreblanca’s election victory made history, but already heis accused of caving into pressure from Guerrero’s old guard.

“The new governor, although he won with a people’s mandateand it was an anti-PRI vote, has decided to govern like thePRI,” said Juan Angulo, editor of Guerrero newspaper El Sur.

“Key posts remain in the hands of the PRI, above all in thearea of security where the people had most hoped for change.”

Torreblanca kept on a deputy state prosecutor widely blamedfor human rights abuses in the past and cited by rightswatchdogs in two states, among other PRI names in his cabinet.

Torreblanca’s defenders say he wants to maintain stabilityby offering the PRI an olive branch. Angulo and rights leaderssay it is a sign the entrenched chieftains still hold sway.

“The traditional power groups feel that with Zeferino’scabinet there will be no change, they feel protected,” Angulosaid. Recent events may bear out that claim.

In May nine student protesters were arrested, beaten andheld for bus theft before the charges were withdrawn.

Days earlier, two sons of an environmental activist died inan ambush that international rights groups called a targetedattack by powerful interests linked to the PRI. Other farmersfighting logging say they are persecuted by authorities.

POLITICAL ROT

Durazo, whose opulent taste once was described as “earlyNero,” ran the Mexico City police force as his personal Mafia,acquired a string of race horses and reputedly had his enemieskilled at will. He was convicted of racketeering and othercharges and died in 2000.

The Parthenon’s decadence still stuns, although it issoftened by dusk and time. Murals fade on the walls and the seashimmers below. Broken statues of Greek gods stand forlorn.

Many see Durazo as just one symptom of political rot. Hisboyhood friend, Jose Lopez Portillo, became president and rodean oil boom that fed some of the most blatant graft, nepotismand excess ever seen in Mexico. Economic crisis ensued, and adisgraced Lopez Portillo died last year.

Even militant leftists give the conservative Fox credit forchipping away at abuse and impunity and letting in some light.But change at the grass roots is subtle, at best.

Amid frustration with Fox’s failure to win radical reform,the PRD faithful like Mayor Campos see their best chance yet totake the presidency next year, with leftist Mexico City MayorAndres Manuel Lopez Obrador leading opinion polls in the race.

El Sur’s Angulo warns change cannot come soon enough toGuerrero, a state racked by cycles of uprising and repression.

“Without fundamental change there could be socialupheaval,” he said. “If people see that so much struggle hasachieved nothing and things are the same or worse than before,it may make way for other kinds of struggle.”

Dr Mayr Believed That Epsom Salts, Fruit Tea and No Dinner Was the Path to Good Health

Iknew I’d got fat again. My face was puffy, no one said how well I looked any more. And besides, none of my clothes fitted. One skirt might just have shrunk, but all of them, no. I was eating too much, and in a nervous, gobblegobble way. It was time I took myself back to the Mayr for an MOT; it wasn’t cheap, but then neither was buying a whole new wardrobe. Besides, I wouldn’t spend any money on anything else while I was there.

Three years ago I booked myself into the Mayr Health Spa Golfhotel on Lake Worthersee, in the foothills of the Austrian Alps. I was exhausted, had put on lots of weight and developed a horrible rash whenever I was in strong sunlight which had ruined a series of expensive holidays. An Austrian friend recommended this place she said it specialised in detoxification, and taught you how to eat so you never got fat again. She also said that it helped you to get pregnant, but that wasn’t the reason I wanted to go.

Dr Mayr, an Austrian dietician, believed in the benefits of ‘cleansing’ the intestines regularly to remove toxins, and chewing all your food into a pap before you swallow. It worked for him: he was well into his nineties when he died, and looks repulsively healthy on all of the posters. But it means that in the clinic you eat very little, and what you do eat doesn’t stay inside very long rushed through by a morning dose of Epsom salts. Mayr also believed that a cleaner intestine makes you more fertile.

In two weeks, I lost a stone and my sunlight allergy vanished; I was a convert to the Mayr cure.

For the next two and half years, I ate no wheat and chewed every mouthful up to 50 times. Another stone melted away. But last autumn, the bad ways began to creep back in and after the three-week Christmas marathon, my weight seemed set like concrete on my thighs.

So back I came. The clinic looked just the same a wooden chalet on the banks of the lake, with onion-domed churches stretching up towards the mountain tops, and a white wedding-cake schloss across the water. It made me think of the Thirties Chalet School stories, set in a fictitious English girls’ school in the Austrian Tyrol: not for the Golfhotel the extravagances of marble and plate glass. Here the sauna leads directly on to the lake, and you can run through a gully of weeds and throw yourself right in, and this term I wasn’t the new girl any more. And not being a new girl, I decided to arrive via Venice, which I knew from last time was only three hours and E30 away by train; that way, at least my last weekend in civilisation would be delicious.

I was a bit worried that I’d be lonely last time I had come here with a friend, and everyone else had been German. But now the place was half full of English because Fergie had raved about its benefits in the Daily Mail. I had two brand-new friends allocated to my table. One of them seemed to know everyone whose heroin addiction had been plastered over the papers in the early Eighties, so we were entertained by the next chapter in the lives of ageing aristocratic junkies.

Nell, let’s call her, was, like me, an old hand; so was the German property developer on our table who came annually to get rid of a year of client dinners and play a lot of golf the hotel stands on the oldest golf course in Austria.

One of the other English girls was there to help herself get pregnant.

I was on tea only for the first week. Everyone else was chewing stale spelt rolls. I felt so ill for 48 hours, I don’t think I could have kept anything solid down at all. The doctor, the masseur, and the woman whose job it was to immerse my hips alternately in hot and freezing water all beamed with satisfaction. ‘It’s the toxins leaving your body,’ they chorused. I wished they’d leave me more quietly.

By Saturday, I felt better and Nell and I decided to go to Salzburg, Mozart’s home town, for the weekend. The clinic packed us a picnic (stale spelt roll, smoked trout pate, and by now I had moved on to potatoes, plus our obligatory Epsom salts)

and we set off by train. It rained the whole time, so we spent two days in a cafe, opposite the cathedral, watching Japanese tourists discover sachertorte and drinking fruit tea. Perhaps that was why we spent E300 on Mozart Kugeln chocolates which we had to lug back to Britain I think I was suffering from bulimia by proxy, or maybe Nell was a bad influence. In the evening we went to the opera I was hoping for Mozart, but it was Jesus Christ Superstar, in German.

Three days later, we were in a pedalo out on the lake (very good exercise for the thighs, the gym instructor said) when a storm blew up one afternoon.

Any port in a storm, we thought, so we headed to shore, tied the pedalo to a strange restaurant’s quay and sat congratulating ourselves on our escape over fruit tea. When we looked, the pedalo had vanished. We tracked it down, being buffeted against the rocks, and had to call on two passers-by to help us pull it out of the water and on to someone’s lawn. It was four days before the weather was good enough to rescue it again.

After two weeks, the potatoes were beginning to pall, but I’d lost 10lb, my skin was sparkling and I could fit into all the clothes I’d brought with me just in case. I wish I could say that I’d saved the money the clinic had cost me by not spending anything or needing to buy any new clothes. But sadly, we found a shop in the local town with a Prada sale, so I got a whole new wardrobe anyway.

It should last me till I go again in two years’ time.

Out and about in Austria GETTING THERE Ryanair (www. ryanair.com) flies to Klagenfurt, the nearest airport, half an hour away. Or you could fly to Vienna and then on to Klagenfurt. Easyjet (www.easyjet.com) flies to Venice, three hours away by train.

WHAT TO DO The mornings are full of chewing, massages, kneipping (alternate hot and cold baths) or hay packs for your liver. In the afternoons, play golf, watch DVDs, have a sauna, take the pedalo out or swim in the lake.

Visit the Schloss Herberstein near Graz and see its private zoo.

Take the boat (or the bus) to Klagenfurt for the afternoon. At the weekend, you can nip off to Venice, Vienna or Salzburg, all of which are only three hours away by train. But really, you are not supposed to be doing anything at all. Dr Mayr thought idleness good for the digestion.

SHOPPING Rikki Reiner in Klagenfurt (Alter Platz 1) has a fantastic selection of Prada, John Galliano, Jean Muir etc the first floor perfect people who want to feel happy about having lost weight. Palmers (opposite Rikki Reiner) is the only shop to sell sexy thermal underwear. Other than that, you can get nice flip- flops for about a quid.

There seemed to be some good sachertorte in the cafes, but I didn’t eat it. And great-looking chocolate in Salzburg.

WHEN TO GO The Golfhotel is open all year round, but the early summer months are perfect because the lake is warm enough to swim in. In the winter you can nearby, although, being Carinthia, the mountains are quite low.

SPOTTING The Duchess of York and Sir Clement Freud have both stayed at the Mayr Health Spa.

Mayr Health Spa Golfhotel: need to know Room Wooden, and decorated in Seventies Austrian gasthaus style. You get a bath or a shower Category A gets you a balcony facing the lake as well.

Food Ha ha ha. Breakfast is tea, stale spelt rolls or potatoes, yoghurt and a variety of spreads. For lunch, if you’re on potatoes, you get vegetables as well.

There is no supper. Dr Mayr didn’t believe in eating at night.

Who goes there English county ladies, Austrian toffs and German bankers.

The golfers eat in a separate area.

Cost 360 Travel (020 7439 4319) offers one week at the Mayr from Pounds 1,250 per person, including flights, full board, initial and final medical examinations, one abdominal massage, one detoxifying massage, three special massages, one alkaline detoxification bath, one food incompatibility test, one alkaline powder and three hay liver packs.

Mayr Health Spa, Golfhotel am Worthersee, Golfstrasse 2, A-9082 Maria Worth-Dellach, Kamten, Austria (00 43 427 325 110; www.golfhotel.at)

Body Mass Index, Body Fat Mass and the Occurrence of Amenorrhea in Ballet Dancers

Abstract

To evaluate the connection between menstrual disorders and body fat mass, we examined a group of 30 ballet dancers and a group of 30 non-athletic girls (controls). Body mass index (BMI) was calculated and percent body fat (FAT^sub %^) was measured using the bioelectrical impedance method. A questionnaire was used to obtain age at menarche and duration of menstrual cycles. Ballet dancers had significantly lower values of BMI (18.56 1.53 vs. 19.96 2.2 kg/ m^sup 2^) and FAT^sub %^ (18.85 4.50 vs. 23.41 4.34%) compared with controls. According to BMI, 50.0% of ballet dancers and 23.3% of the control group were underweight. Of underweight ballet dancers, 66.7% had lower values of body fat, while most underweight girls from the control group had normal body fat. Normal-weight obesity was registered in 40.9% of the control group and in 6.7% of ballet dancers. Amenorrhea was found in 20.0% and oligomenorrhea in 10.0% of ballet dancers. Ballet dancers more frequently had later appearance of menarche and menstrual cycles of longer duration than did non-athletic girls. A significant negative correlation was found between menstrual cycle duration and FAT^sub %^ among ballet dancers (r=-0.415). To prevent complications caused by changes of body fat mass, we conclude that body composition assessment in ballet dancers is very important.

Keywords: Body fat, amenorrhea, ballet dancers, bioelectrical impedance, body mass index

Introduction

It has been reported that reduced body fat and weight loss are accompanied by later appearance of menarche, menstrual cycle disorders and problems with conception, related to the reduction of sex-specific body fat involved in functioning of the reproductive system [1-3]. It has been recognized that the critical amount of body fat leading to amenorrhea is below 17%, while 22% is needed for regular menstrual cycles [4]. Athletes have lower values of body fat mass than sedentary individuals. Body fatness values for most female athletes range from 12 to 16%, depending on the sport [2]. For female athletes who participate in esthetic-acrobatic activities (like ballet and gymnastics) and strenuous endurance sports, low body fat is desirable because it is believed to enhance performance [2,3]. These sportswomen are those with the highest prevalence of amenorrhea [5]. Amenorrhea is accompanied by low bone density and early osteoporosis development owing to low estrogen secretion. Its occurrence in conjunction with a high level of physical activity accompanied by disordered eating and osteoporosis is described as the ‘female athlete triad’ [5]. The exact pathophysiological mechanism for developing amenorrhea has not yet been defined. Abnormal patterns of endogenous hypothalamic secretion of gonadotropin-releasing hormone, with decreased production of luteinizing hormone, is a mechanism considered to lead to decreased production of estrogen. Discovery of the adipose tissue hormone, leptin, has provided a possible connection between fat stores and the reproductive axis [6,7]. In amenorrheic athletes a typical diurnal pattern of leptin secretion is absent [5]. Although low body fat is commonly associated with amenorrhea, the ‘critical body fat hypothesis’ has not been substantiated by longitudinal research. Women with normal body fat may also experience hypothalamic amenorrhea [5].

On the other hand, overweight is usually due to body fat enlargement. Yet some conditions, like muscle hypertrophy or edema, can also result in body weight increase, which can be characterized as obesity according to body mass index (BMI). In contrast, normal- weight people can have a higher amount of body fat, called normal- weight obesity or sarcopenic obesity, with body fat enlargement being made at the expense of lean body mass, especially muscle mass, while total body weight does not change [8].

The present study was undertaken to determine BMI and percentage body fat and to evaluate their relationship with amenorrhea prevalence in ballet dancers and non-athletic girls.

Methods

The study group comprised 30 ballet dancers (mean age 17.4 2.01 years). The mean period of ballet dancing was 9.3 1.75 years, and the mean training intensity was six 6-h sessions per week. The control group comprised 30 non-athletic high-school girls with mean age of 18.01 1.3 years. The study was performed according to the principles of the Helsinki Declaration, and informed consent was obtained from all participants.

A questionnaire was used to obtain age at menarche and duration of the menstrual cycle. Primary amenorrhea was diagnosed if menstrual bleedings had not occurred by age 14 and the subject had not developed secondary sexual characteristics, or by age of 16 if secondary sexual characteristics were present. Secondary amenorrhea was diagnosed when there were no regular menstrual cycles in a 3month period if previous menstruation had been regular, or in a 6- month period if previous menstruation had been irregular. The appearance of menstrual bleeding in a period of 35 days to 6 months was defined as oligomenorrhea [5].

With the subject wearing light indoor clothes and no shoes, body weight (BW) and height (BH) were measured to the nearest 0.1 kg and 0.1 cm, respectively, and BMI was calculated with the formula: BMI = BW/BH^sup 2^ (kg/m^sup 2^). Evaluation of BMI values was based on the criteria given by the World Health Organization [9] (Table I). Subjects with BMI

Body composition was assessed with the bioelectrical impedance method using a Tanita TBF-310 Body Composition Analyzer (Tanita Corporation, Tokyo, Japan). This impedance analyzer provides measurements of body fat mass (FATkg), percent body fat (FAT^sub %^), lean body mass (LBM^sub kg^) and total body water (TBW^sub kg^). For evaluation of body fat amount we used the reference values given by the manufacturer (Tanita Body Fat Scale) (Table II). Normal- weight obesity was defined as higher percent body fat (> 24%) in normal-weight subjects (BMI =18.5-24.9 kg/m^sup 2^).

Table I. Body mass index (BMI) references for adults.

Table II. Desirable ranges of percent body fat (Tanita Body Fat Scale).

Data are presented as mean standard deviation. In statistical analyses we used Student’s t test and linear correlation.

Results

Table III gives the basic anthropometric characteristics of the group of ballet dancers and the control group of non-athletic girls. Body weight (51.48 5.01 vs. 57.53 7.57 kg, p = 0.000021), body height (166.55 6.07 vs. 169.66 6.30 cm, p = 0.00858) and BMI (18.56 1.53 vs. 19.96 2.12 kg/m^sup 2^, p = 0.00066) were significantly lower in ballet dancers than in the control group.

Mean values of body composition parameters in both study groups are summarized in Table IV. Ballet dancers had significantly lower values of body fat, both as a percentage (18.85 4.50 vs. 23.41 4.34%, p = 0.000012) and absolute amount (10.01 2.68 vs. 13.70 4.17 kg, p = 0.00012), compared with the control group.

Evaluating BMI values (Figure 1) it was noticed that underweight was present in both groups, but to a greater extent in the group of ballet dancers (50.0%). Most subjects from the control group had normal body weight (73.3%) compared with the group of ballet dancers, where it was 50.0%. Pre-obesity was found only in the non- athletic girls (3.3%).

Most of the underweight ballet dancers (66.7%) had at the same time lower values of FAT%, while only 33.3% had normal values of body fat (Figure 2). In the control group, most of the underweight subjects (85.7%) had normal values of body fat with only 14.3% of these subjects having lower values of body fat. In the group of normal-weight ballet dancers, 6.7% had lower values of body fat, while the same category was not registered in non-athletic girls. Normal values of body fat were found for 86.7% of normal-weight ballet dancers and 59.1% of normal-weight subjects in the control group. The phenomenon of normal-weight obesity was registered in 40.9% of subjects from the control group and in 6.7% of ballet dancers. All pre-obese non-athletic girls had higher values of body fat.

Applying the criteria stated above for defining amenorrhea and oligomenorrhea, we analyzed their presence in the study and control groups (Figure 3). No subject from the control group had either of these menstrual cycle disorders, while the presence of amenorrhea in the group of ballet dancers was 20% (secondary amenorrhea) and of oligomenorrhea, 10%. Ballet dancers more frequently had later appearance of menarche (from 14 to 16 years) (Figure 4), and menstrual cycles longer than 30 and 60 days, compared with non- athletic girls (Figure 5). We correlated age at menarche and menstrual cycle duration with BMI, FAT^sub %^, and FAT^sub kg^, finding a significant negative correlation among ballet dancers between duration of the menstrual cycle and both BMI (r=-0.386) and percent body fat (r=-0.415) (Table V).

Table III. Values of anthropometric parameters in ballet dancers and non-athletic girls.

Table IV. Parameters of body composition in ballet dancers and non-athletic girls.

Figure 1. Distribution of body mass index (BMI) values in ballet dancers and non-athletic girls.

Figure 2. Body mass index (BMI) compared with percen\t body fat (FAT%) in ballet dancers and non-athletic girls.

Discussion

It has been very well documented that the prevalence of amenorrhea is much greater in the population of athletes than in the general female population. Skolnick found 3.4-66% of female athletes and 2-5% of non-athletic women to suffer with amenorrhea [10], while a Finnish study reported menstrual disturbances in 27-37% of esthetic, endurance and weight-bearing athletes and in 5% of controls [11].

Frisch and Revelle postulated the ‘critical weight hypothesis’ for the induction of sexual maturation and found a connection between body fat and reproduction, which was confirmed later by the discovery of leptin and its influence on the hypothalamo-hypophyso- ovarian axis [12]. According to Frisch, the minimum level of fatness associated with menarche is 17% and 22% is necessary for the onset of regular menstrual cycles [4]. Recent findings suggest that low energy availability, rather than low body fatness or exercise stress, is the likely mechanism by which exercise negatively influences the hypothalamo-hypophyso-ovarian axis in female athletes [13]. Despite speculations about the possible pathophysiological mechanism of amenorrhea, routine clinical practice needs some useful parameters that could provide early recognition of subjects at higher risk. Ballet dancers have very low body weight and body fat (13-20%) and are known to be at high risk for the development of hypothalamic amenorrhea [1,14-17]. Our results of body fat mass estimation in ballet dancers (mean 18.85 4.5%) are similar to previous values given by Hergenroeder and colleagues (20.1 3.6%) [18] and Yannakoulia and associates (19.4 4.3%) [19]. In our study, amenorrhea was present in 20% and oligomenorrhea in 10% of the ballet dancers, with more frequent later appearance of menarche and menstrual cycles longer than 30 and 60 days, compared with non- athletic females.

Table V. Correlation of age at menarche and menstrual cycle duration with body mass index (BMI), percent body fat (FAT^sub %^) and body fat mass (FAT^sub kg^).

Figure 3. The presence of amenorrhea, oligomenorrhea and eumenorrhea in ballet dancers and non-athletic girls.

Figure 4. Age at menarche in study and control subjects.

Figure 5. Menstrual cycle duration in study and control subjects.

Lin-Su and co-workers noted that although body fatness as a determinant of menarche has been well documented, it is limited to underweight females [20]. Underweight subjects can have normal body fat; as can normal-weight subjects have low body fat. According to our data, 50% of the ballet dancers were underweight. However, underweight was present in a great number of control group subjects too (23.3%) but we did not register menstrual disorders among them. These two groups of underweight subjects showed differences in body fat mass: a higher percentage of underweight ballet dancers had lower values of body fat at the same time (66.7%), while the largest number of underweight subjects from the control group had normal values of body fat (85.7%). These results suggest lower reliability of BMI in the prediction of risk for menstrual disorders compared with body fat. We also found a stronger negative correlation between body fat and menstrual cycle duration, compared with BMI. In contrast, Falseti and colleagues emphasized the value of BMI as a good prognostic factor in recovery from hypothalamic amenorrhea [21]. BMI has been suggested a good predictor of body fat mass, which is used in the diagnosis of underweight, overweight and obesity [9]. But a number of studies have confirmed that discrepancies arise between BMI and body fat. BMI does not discriminate between fat, muscle and bone mass. Some data indicate that even though BMI is reliable measure of fatness, an adolescent’s percentage of fat can change by as much as -3 to + 7% without any difference in BMI; for an individual adult, the same BMI can correspond to changes in fat of 5% [22-24]. Some studies also refer to its low and variable sensitivity as an indicator of the risk for overweight and the presence of overweight, and show that accuracy of prediction is lowest when BMI is

Conclusion

Our data show that ballet dancers had statistically lower values of BMI and percent body fat than did non-athletic girls of the same age. The largest number of underweight ballet dancers (66.7%) had at the same time lower values of body fat, while the most underweight girls from the control group (85.7%) had values of body fat in the normal range. Normal-weight obesity was present in 40.9% of the control group and even in 6.7% of the ballet dancers. Amenorrhea was present in 20% and oligomenorrhea in 10% of the ballet dancers, while the same disorders were not found in the control group. Ballet dancers also more frequently had later appearance of menarche and menstrual cycles longer than 30 and 60 days, compared with non- athletic girls. The finding of a significant negative correlation between menstrual cycle duration and body fat mass (r =-0.415) in ballet dancers leads us to the conclusion that body composition assessment can help in the detection and prevention of menstrual cycle disorders.

References

1. Heyward HV, Stolarczyk ML. Applied body composition assessment. Champaign, IL: Human Kinetics; 1996. pp 4-19.

2. McArdle W, Katch FJ, Katch VL. Exercise physiology: energy, nutrition and human performance. Philadelphia, PA: Lea and Fibiger; 1991.

3. Wolf AS, Marx K, Ulrich U. Athletic amenorrhca. Ann N Y Acad. Sci 1997;816:295-304.

4. Frisch RE. Body fat, menarche, fitness and fertility. Hum Reprod 1987;2:521-33.

5. Warren IP, Ramos RH, Bronson E. Exercise-associated amenorrhea. Physician Sportsmed 2002;30:10.

6. Ailhaud G. L’adipocite cellule secretice et endokrine. Med Sci 1998;14:858-64.

7. Thong FS, Graham TE. Leptin and reproduction: is it a critical link between adipose tissue, nutrition and reproduction? Can J Appl Physiol 1999;24:317-36.

8. Heber D, Ingles S, Ashley JM, Maxwell MH, Lyons RF, Elashoff RM. Clinical detection of sarcopenic obesity by bioelectrical impedance analysis. Am J Clin Nutr 1996;64:472-7.

9. World Health Organization [WHO]. Obesity – preventing and managing the global epidemic. Report of a WHO consultation on obesiry. Geneva: WHO; 1997. pp 7-17.

10. Skolnick A. ‘Female athlete triad’ risk for women. J Am Med Assoc 1993;270:921-3.

11. Fogelholm M, Hiilloskorpi H. Weight and diet concerns in Finnish female and male athletes. Med Sci Sports Excrc 1999;31:229- 35.

12. Frisch RE, Revelle R. Height and weight at menarche and hypothesis of critical body weights and adolescent events. Science 1970;169:397-8.

13. Warren MP, Voussoughian F, Geer EB, HyIe EP, Adberg CL, Ramos RH. Functional hypothalamic amenorrhea: hypolcptinemia and disordered eating. J Clin Endocrinol Metab 1999;84:873-7.

14. Bettle N, Settle O, Neumarker U, Neumarker KJ. Adolescent ballet school students: their quest for body weight change. Psychopathology 1998;31:153-9.

15. Nazarewicz R, Babicz-Zielinska E. Selected indices of nutritional status and food habits among young ballet dancers. Rocz Panstw Zakl Hig 2000;51:393-401.

16. Van Marken Lichtenbelt WD, Fogelholm M, Ottenheijm R, Westerterp KR. Physical activity, body composition and bone density in ballet dancers. Br J Nutr 1995;74:439-51.

17. Broso R3 Subrizi R. Gynecologic problems in female athletes. Minerva Ginecol 1996;48:99-106.

18. Hergenroeder AC, Brown B, Klish WJ. Anthropometric measurements and estimating body composition in ballet dancers. Med Sci Sport Exerc 1993;25:145-50.

19. Yannakoulia M, Keramopoulos A, Tsakalakos N, Matalas AL. Body composition in dancers: the bioelectrical impedance method. Med Sci Sports Exerc 2000;32:228-34.

20. Lin-Su K, Vogiatzi MG, New MI. Body mass and age at menarche in an adolescent clinic population. Clin Pediatr (Phila) 2002;41:501- 7.

21. Falseti L, Gambcra A, Barbctti L, Specchia C. Long-term follow-up of functional hypothalamic amenorrhea and prognostic factors. J Clin Endocrinol Metab 2002;87:500-5.

22. Goulding A, Gold E, Cannan R, Taylor RW, Williams S, Lewis- Earned NJ. DEXA supports the use of BMI as a measure of fatness in young girls. Int J Obcs Relat Metab Disord 1996;20:1014-21.

23. Dietz WH, Bellizzi MC. Introduction: the use of body mass index to assess obesity in children. Am J Clin Nutr 1999;70:123-5S.

24. Hannan WJ, Wratc RM, Cowcn SJ, Freeman CP. Body mass index as an estimate of body fat. Int J Eat Disord 1995; 18:91-7.

25. Malina RM, Katzmarzyk PT. Validity of the body mass index as an indicator of the risk and presence of overweight in adolescents. Am J Clin Nutr 1999;70:131S-6S.

26. Neovius MG, Linne YM, Barkeling BS, Rossner SO. Sensitivity and specificity of classification systems for fatness in adolescents. Am J Clin Nutr 2004;80:597-603.

27. Halpern ZSC, Beyruti M, Oliva ABG, Barros MJ, Monegaglia AP, Tonetti F, Halpern A. Obesity in a population with a body mass index 25 kg/m^sup 2^. Int J Obes Relat Metab Disord 1998;22(Suppl 3):S195.

28. Stokic E, Srdic B, Peter A, Ivkovic-Lazar T. Masna masa tela u normalnoj uhranjenosti. Med Pregl 2002;9-10:407-11.

EDITA STOKIC1, BILJANA SRDIC2, & OTTO BARAK3

1 Department of Endocrinology, Diabetes and Metabolic Disorders, Institute for Internal Medicine, Novi Sad, Serbia and Montenegro, 2 Department of Anatomy, Medical Faculty, Novi Sad, Serbia and Montenegro, and 3 Department of Physiology, Medical Faculty, Novi Sad, Ser\bia and Montenegro

Correspondence: E. Stokic, Department of Endocrinology, Diabetes and Metabolic Disorders, Institute for Internal Medicine, Hajduk Veljkova 1, 21000 Novi Sad, Serbia and Montenegro. Tel: 381 21 524563. Fax: 381 21 524563. E-mail: [email protected]

Copyright CRC Press Apr 2005

Bob Geldof, charity saint and foul-mouthed bully

By Mike Collett-White

LONDON (Reuters) – For someone so often called a saint, BobGeldof has an uncanny ability to irritate and offend.

The Irish rocker has bullied and badgered his way into thehistory books, pulling off the Live Aid rock concerts 20 yearsago and promising to do something even bigger on Saturday with10 Live 8 gigs to raise awareness of African poverty.

The 50-year-old Geldof seems like a walking contradiction.

He was the quintessential anti-establishment figure afterco-founding the Boomtown Rats band in 1975, railing againstauthority and bemoaning the unfairness of it all.

Yet he has been knighted and rubs shoulders with worldleaders, as in a studio show on the MTV channel on Thursdaywhere he extolled British Prime Minister Tony Blair for pushingfor more aid for Africa.

His bedraggled hair, dishevelled suits and penchant forswearing on live television are not the norm for a millionairein the media business.

In interviews he can be offensive to journalists in onesentence and speak with tenderness about his late ex-wife PaulaYates in the next. She died of a drug overdose in 2000, havingalready left Geldof for Australian rock star Michael Hutchence.

Where apologists and critics agree is on Geldof’ssingle-mindedness, without which he could not have become oneof the world’s highest-profile charity organizers.

Musician Peter Gabriel, hosting a Live 8 gig for Africanmusicians after Geldof came under fire for sidelining artistsfrom that continent, called him “Chairman Bob” in a jokingreference to his authoritarian style.

“We asked for Bob’s blessing which he freely gave; that wasin his role as pope.”

MOTIVES QUESTIONED

The fact that Geldof’s music career was in decline when helaunched the Live Aid charity gig means his motives have oftenbeen questioned.

Long before Live Aid made him a household name, his reasonsfor forming a band were more selfish.

“Most people get into bands for three very simple rock androll reasons: to get laid, to get fame, and to get rich,” hetold a music magazine in 1977.

Explaining those remarks 25 years on, he said they were the”three things that I couldn’t get growing up Catholic, inpoverty, in Ireland.”

But few doubt his passion for fighting poverty, famine anddisease in Africa, a continent that has fascinated him since hesaw a newsreel of the famine in Ethiopia in 1984.

“When I saw the pictures of Ethiopia I decided to dosomething other than just put my hand in my pocket. I sat therefeeling horrified, ashamed and disgusted,” he said.

Later that year he gathered pop stars to record “Do TheyKnow it’s Christmas?” which raised 8 million pounds ($14million) for charity, but it was Live Aid in 1985 that provedthe defining moment in Geldof’s career.

Watched by 1.5 billion people and raising $100 million forAfrica’s starving, the gigs in London and Philadelphia broughttogether the likes of Mick Jagger, David Bowie and The Who inan unprecedented display of altruism.

On Saturday, the idea is even more ambitious. Around 1,000acts in 10 venues, from Tokyo in the east to near Toronto inthe west, will try to put pressure on leaders meeting next weekto do more to fight poverty.

“I can’t wait for the end. I’m so tired,” Geldof told anaudience of young people on MTV. “I tell you something … youwill never see it again. It will be the greatest concert ever.”

STRUCK BY TRAGEDY

Robert Frederick Xenon Geldof was born in 1954 in Ireland.His mother died when he was young and he had to fend forhimself from an early age.

After a stint as a music journalist he became a chart starhimself with The Boomtown Rats before Band Aid and Live Aid.

In 1986 he married Paula Yates, with whom he had threechildren, and Geldof was affected deeply when Yates left himfor INXS star Hutchence.

“I was bereft beyond belief but I understood that she hadto go now because she didn’t love me … and it was like thisgreat joy went out of my life,” he said in a recent interview.

Geldof fought for and won custody of his own daughters andthe child Yates had with Hutchence. The Australian died in ahotel room in mysterious circumstances in 1997.

Three years later, Yates also died.

Geldof lives in London with his partner Jeanne Marine.

Tragedy of Girl Who Ate Herself to Death

A WOMAN of 29 has lost her fight against a rare brain disorder which made her want to eat continuously.

Abby Redpath was diagnosed at 16 as having Prader-Willi syndrome – a genetic condition in which messages do not reach the brain to tell it the stomach is full.

Her mum Sally, 50, said: “She’d no life and by the end didn’t want to be here. It’s a cruel way to die.”

Sally nursed wheelchair-bound Abby – who may have died from heart failure – at home in Wooler, Northumberland. The mother spoke of a “loving child” who had become “so poorly with gastric problems, respiratory problems – you name it, she had it. She was also going blind with diabetes.”

There are around 2,000 cases of the condition in the UK and Ireland. Jackie Waters, of the Prader-Willi Syndrome Association, said victims suffered “a double whammy” as an abnormal body composition means they need fewer calories than a normal person.

Researchers Boost White Blood Cells’ Ability to Kill Bacteria

Scientists at UCSD have determined how white blood cells up the ante against invading bacteria, a finding that may lead to new treatments for infections including those caused by invasive”””flesh-eating””” Streptococcus bacteria.

The findings, which are published in the July, 2005 issue of The Journal of Clinical Investigation, represent a collaborative effort between the laboratories of Randall Johnson, UCSD professor of biology and Victor Nizet, associate professor of pediatrics at the UCSD School of Medicine.

The research team discovered that white blood cells respond directly to Streptococcus, Staphylococcus, Salmonella, and other bacteria that cause disease in humans, by increasing their levels of a protein known as hypoxia inducible transcription factor-1, or HIF-1. The protein, in turn, stimulates white blood cells to release antimicrobial compounds that kill bacteria. The team also found that treating white blood cells with chemicals to increase HIF-1 levels could enhance the cells’ capacity to kill bacteria.

“These findings suggest a potential novel approach to treatment of difficult infections such as those produced by antibiotic resistant bacteria or those affecting patients with weakened immune systems due to chronic disease, cancer chemotherapy or AIDS,” said Nizet. “Rather than designing drugs to target the bacteria, medications that promote HIF-1 activity could be used to boost the bacterial killing ability of white blood cells and promote the resolution of infection through the actions of our natural immune defenses.”

Previous work by Johnson and colleagues showed that low oxygen levels, such as those found at the site of an infection, activate HIF-1 in macrophages and neutrophils””white blood cells that ingest and destroy microorganisms. In the current study, the researchers compared how well macrophages in which HIF-1 levels were elevated, normal or zero could kill bacteria, including Streptococcus isolated from a patient with flesh-eating disease. They found that the greater the HIF-1 levels in white blood cells, the greater their bacterial killing power. They also found that mice lacking HIF-1 in their macrophages and neutrophils were less able to combat skin infections than normal mice.

“A direct correlation was established between the levels of HIF-1 present in the mouse macrophages and neutrophils and how efficiently the cells were able to kill the bacteria,” said lead author Carole Peyssonnaux, a postdoctoral researcher with professors Johnson and Nizet.

The HIF-1 protein is known to bind to cellular DNA and activate specific genes to help cells function is a low oxygen environment. The researchers found that in white blood cells, HIF-1 stimulates the production of small proteins, enzymes and nitric oxide, which work together to kill invading bacteria.

“The placement of essential microbial killing functions of white blood cells under regulation of HIF-1 represents an elegant controlled response system,” explained Johnson. “The white blood cells are in a resting state as they circulate in the oxygen-rich bloodstream, but can then be activated in response to the declining oxygen gradient encountered upon migration to sites of infection. Direct encounter with the bacteria then activates the neutrophils and macrophages maximally. Under HIF-1 regulation, antimicrobial genes are expressed only in infected tissues and not in healthy tissues where they could produce unwanted inflammatory damage.”

Recognition of the essential role for HIF-1 in the bacterial killing ability of white blood cells led the researchers to explore potential medical implications of this discovery. With the assistance of Emmanuel Theodorakis, UCSD professor of chemistry and biochemistry, a group of pharmacologic agents that act to increase cellular HIF-1 levels was selected. These compounds significantly enhanced the capacity of macrophages to kill bacteria.

“Our findings offer proof of concept that small molecules can have a beneficial effect by modulating the production of HIF-1 protein in white blood cells,” said Theodorakis.

This research was financed by grants from the National Institutes of Health and the Edward Mallinckrodt, Jr. Foundation. Other authors contributing to the study were Vivekanand Datta, MD, UCSD graduate student in molecular pathology, Andrew Doedens, UCSD graduate student in biological sciences, Nancy Hurtado-Ziola, UCSD graduate student in biomedical sciences, Thorsten Cramer, MD, a gastroenterologist at Charite-Hochschulmedizin in Berlin, Germany, and Richard Gallo, MD, PhD, UCSD professor of medicine and pediatrics.

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University of California – San Diego

Patriots Had Wilderness Smarts; Knowledge of Plants and Land Helped the Revolutionary Soldiers

“Cultivators of the earth are the most valuable citizens. They are the most vigorous, the most independent, the most virtuous and they are tied to their country and wedded to its liberty and interests by the most lasting bands.”

These words of Thomas Jefferson describe the vast majority of patriots who fought in the American Revolution. They worked small, hardscrabble farms, many carved by hand out of an unrelenting wilderness. Today it is difficult to understand what a mammoth effort it was to live off the land in colonial times. But as these men went to war against the British, their knowledge of the land and its plants played a vital role in the birth of our nation.

The patriotic garden is far more than merely a collection of red, white and blue flowers. It is a testament to survival in the wilderness.

And while Jefferson grew a huge range of plants at his plantation, Monticello, it was a far cry from the world of the soldier-farmer. These soldier-farmers and their families held generations of accumulated knowledge, some inherited from their British ancestors and still more gleaned from Native Americans.

This knowledge of wild and useful plants recognized by every hunter-gatherer came into play as starving soldiers foraged through the countryside.

Certainly, battlefield plants were vital to surviving skirmishes with Redcoats. Herbs with antibacterial and coagulant properties were hoarded for the inevitable flood of the wounded.

Three coagulants came out of rural farm gardens, brought from the Old World as a living medicine chest. Yarrow, a European herb, has been carried into battle since ancient Greece. Periwinkle (Vinca major), also brought to America as a medicinal plant, was similarly valued for its ability to help staunch the flow of blood. Marigold (Calendula officinalis) was used as an antiseptic field dressing and was still in use as late as World War I.

These farmer-soldiers also knew which plants yielded food and in which season. Sallet and other pot greens offered foliage that could be eaten. But, more important, the knowledge of plants that did not make good pot herbs was invaluable. (British soldiers foraging in the Jamestown colony so poisoned themselves with datura that it was forever called Jimson weed.) Many other pot herbs were unpalatable in their raw form but quite tasty when stewed.

It was known that a diet required a range of foodstuffs in order to avoid symptoms of unpleasant vitamin deficiency such as scurvy. A majority of these plants are today considered mere weeds, but to knowledgeable foraging armies, they were the essence of life.

Succulent purslane, relished by Henry David Thoreau, already was well-known in colonial times. This plant was eaten fresh as a salad or stewed. The tender young leaves of wild dock, a close relative to common sorrel of England, made their way into soldiers’ stew pots. Dandelions would be the first greens to emerge following the bitter winter at Valley Forge, serving as a vitamin-rich spring tonic whether fresh or stewed. Even nettle was a favored pot herb.

Fruits held into the lean seasons fed the soldier with a sharp eye for plants. Wild rose hips, crab apples, elder, wild plums and many small berries tossed into the stew pot could add flavor, sugar and fiber.

With coffee and tea worth their weight in gold, soldiers sought out alternative plants to flavor their hot winter drinks. Oswego tea, a New York native herb known as bee balm or Monarda didyma, became a colonial favorite after the Boston Tea Party. Chicory also naturalized throughout New England.

The manicured gardens of Williamsburg or the flag-colored “patriotic” flower gardens of today offer few links to the valiant struggles of the American Revolution.

Our truest patriot gardens are a collection of the native and the introduced, the ragged and the cultivated. But, most of all, they express the ingenuity and resourcefulness of a people who fought for independence from tyranny.

* *

Did you know?

British soldiers foraging in the Jamestown colony so poisoned themselves with datura that it was forever called Jimson weed.

New device for sleep apnea seen easier to tolerate

NEW YORK (Reuters Health) – The use of a flexible CPAP
(continuous positive airway pressure) device that adjusts
pressure with inhalation and exhalation can boost adherence to
CPAP therapy in patients with obstructive sleep apnea, research
shows.

People who experience sleep apnea, brief episodes when
breathing stops during sleep, are often treated with CPAP to
help them breathe properly during the night. Standard CPAP
devices deliver air at a constant pressure, which can be
uncomfortable and lead people to give up using it.

The flexible CPAP device, known as C-Flex, alternates
airway pressure on a breath-by-breath basis, which is thought
to improve patient comfort and, in turn, treatment adherence.

In their study, Dr. Mark S. Aloia, from Butler Hospital in
Providence, Rhode Island, and colleagues treated 89 patients
with moderate-to-severe obstructive sleep apnea with standard
CPAP or C-Flex and followed them for 3 months.

Compared with standard CPAP, use of C-Flex was associated
with higher mean treatment adherence, the investigators note.
Specifically, after 3 months, the standard CPAP group was using
the device for an average of 3.1 hours per night, while the
C-Flex users stayed on the device for 4.8 hours.

Although CPAP with C-Flex did not improve clinical
outcomes, users of the device may feel more confident in their
ability to adhere to treatment, the investigators note in the
medical journal Chest

“Further randomized controlled trials will be necessary to
compare this to other flow-delivery patterns to assess the
impact on both short-term and long-term outcomes,” the authors
state.

C-Flex is produced by Murraysville, Pennsylvania-based
Respironics.

SOURCE: Chest June 2005.

Dayton Population Falls 3.6 Percent

Jun. 30–DAYTON — Ohio’s metropolitan cities are near the top of a national ranking, but it’s nothing to brag about.

Cincinnati, Cleveland and Dayton are among the top 10 fastest-shrinking cities in America, says U.S. Census estimates released today.

Dayton lost an estimated 5,904 people or 3.6 percent of its population during the four-year period from April 1, 2000, to July 1, 2004. That put Dayton at No. 10 for population loss among 251 U.S. cities with more than 100,000 people.

For the year ending July 1, 2004, Dayton ranked 18th from the bottom in percent population loss, with a decrease of 1,539 people or 1 percent to shrink to 160,293 residents.

Cincinnati, Toledo and Cleveland all had even larger percentage losses in population than Dayton for the year ending last July 1. Only Columbus, among Ohio’s big cities, showed a population increase for the period. The state capital grew by an estimated 1,442 people for a 0.2 percent increase, ranking it the 139th fastest-growing big U.S. city.

The continued population declines among the four big Ohio cities put them all in the top 25 list of people-losers for the decade through last June.

Cincinnati ranked as the second-fastest shrinking city for the four-year period from April 2000 to July 1, 2004, with a loss of 17,131 people or 5.2 percent. Detroit ranked first by losing 51,072 or 5.4 percent.

Cleveland ranked seventh by losing 18,788 people or 3.8 percent of its population during the four years.

Ohio’s population was flat during the four-year period, increasing by less than 1 percent or about 106,000 people.

Bill Teets, a spokesman for the Ohio Department of Development, said the “mobile society” is playing a part in the continuing exodus from metropolitan Ohio cities.

“People are willing to travel farther for their jobs,” Teets said. And jobs move away from the inner city.”

“Declining population is certainly among the challenges from an economic development standpoint. But eventually it comes down to personal choice of individuals.”

Montgomery County lost an estimated 8,999 people during the four years. But the 10-county region — which includes Clark, Darke, Preble, Shelby, Miami, Greene, Butler, Clinton and Warren counties — grew by just over 42,000 people or 2.6 percent to reach 1.7 million. Warren County, which grew by 19.4 percent or close to 31,000, accounted for almost three-quarters of that growth. Without Warren County, the region grew by less than 1 percent.

In the Dayton area, the losses continued in the inner-ring suburbs, according to the estimates. Oakwood, West Carrollton, Kettering, Riverside, Moraine, Vandalia and Trotwood all lost population during the four-year period. Oakwood, which lost 4.3 percent of its population or an estimated 398 people, led the 45 largest cities and villages in the Greater Dayton region in shrinkage.

And the inner city and suburban loss continued to fuel gains by the so-called exurbs, farther out from the metropolitan core. The nine fastest-growing cities and villages in the region were all in Warren County, led by Springboro, which gained an estimated 3,374 people for a 27.2 percent growth. Mason gained 5,888 people or 26.7 percent.

Jim Dinneen, Dayton’s city manager, blamed sprawl for much of the decline in Dayton and inner ring cities.

“What’s happening is, the population in general hasn’t changed much since the 1970s, but what we’re doing is moving farther and farther out,” he said.

Dinneen said it was “kind of unnerving” to see other cities, such as Oakwood and Kettering losing such a high percentage of their population.

“When the city of Oakwood loses a larger percentage of their population than we do, that tells you something,” he said. “It’s kind of like all the extra retail they’re building here. There’s only so much market to go around and obviously the older your housing is, something has to fall out.”

But continued sprawl in a region that isn’t growing, Dinneen said, will end up costing everyone.

“The price is devalued housing,” Dinneen said. “And you’re creating more and more infrastructure with less and less density, and that creates a higher bill to maintain it over the long run.”

Oakwood City Manager Norbert Klopsch said he was surprised by the new data because the city’s schools are seeing an increase in students. In addition, he said he’s not aware of “any measurable amount” of increase in vacant housing.

“I guess I would have to look at that data and maybe question it,” he said.

Shrinking household size could be a possible explanation, Klopsch said.

“If you had a lot of older kids who had been continuing to live at home, but who have left the nest at a higher rate than previously, it would drop our population but wouldn’t be affecting the schools,” he said.

Springboro City Manager Christine Thompson said her city’s growth figures sounded right.

“We did some buildout projections in 2002 that says we’re pretty much on track,” said Thompson, who has worked for the city 17 years. “Our total growth picture is about 23,000.”

Thompson said the city has seen a slowing in building permits this year that could result in about one-third of its usual 300 annual permits.

“After 15 years of consistent high growth, we’re starting to see a little bit of a slowdown,” she said. “We’re simply running out of land, and we projected that back in 2002.”

Once again, cities in the West and South led the way in population growth. Only two cities outside the Sunbelt — Joliet, Ill., a Chicago suburb; and Raleigh, N.C. — made the top 25 fastest growing cities for the year ending last June.

“Outmigration from the Midwest has been the longstanding trend,” said Census demographer Greg Harper. “Look at the historical data. In 1990, Detroit was still the seventh-largest city in the country.”

But Detroit, the fastest-shrinking big city in the nation, has fallen out of the top 10.

“These trends have been going on for quite awhile,” he said.

—–

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Copyright (c) 2005, Dayton Daily News, Ohio

Distributed by Knight Ridder/Tribune Business News.

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Knowledge of Tuskegee Study Doesn’t Increase Medical Mistrust

Knowledge of the Tuskegee Study of Untreated Syphilis in the Negro Male (Tuskegee Study) does not increase distrust in medical care, according to researchers from the Johns Hopkins Bloomberg School of Public Health. Most of those surveyed were unaware of the Tuskegee Study and, of those who had heard of it, most could not accurately answer multiple-choice questions about the study. The researchers also found that African-Americans were significantly more likely than whites to be mistrustful of medical care. The study is published in the July 2005 issue of the Journal of the National Medical Association.

“No other study explicitly assessed the association between knowledge of the Tuskegee Study and mistrust of medical care among African-Americans or racial differences in this relationship. Our findings indicate that for African-Americans, other factors, such as negative interactions with the health care system, are more important to mistrust than the Tuskegee Study,” said Dwayne T. Brandon, PhD, lead author of the study and an assistant scientist with the Bloomberg School’s Department of Health Policy and Management.

The Tuskegee Study was carried out in Macon County, Alabama, from 1932 to 1972. U.S. Public Health Service researchers planned to record the natural history of syphilis. They withheld treatment from 600 poor, African-American men who had the disease, causing needless pain and suffering. The study participants were not told the purpose of the study, nor were they told if they were infected with syphilis.

The Hopkins researchers completed a telephone survey in the summer of 2003 of 277 African-American and 101 white adults, aged 18-93 years, living in Baltimore, Md. Only two-fifths of those interviewed had heard of the Tuskegee Study. Of those who had heard of it, most knew few details of the study. Almost half of both white and black respondents who had heard of the study thought the U.S. Army conducted it and 75 percent of blacks and 25 percent of whites thought the Tuskegee participants were given syphilis purposely. In fact, the U.S. Public Health Service researchers did not infect the men. Other inaccuracies included underestimation of the duration and size of the Tuskegee Study. For instance, 47 percent of blacks and 41.5 percent of whites believed the study was stopped in the 1950s, two decades earlier than its official end. A substantial number of black (28 percent) and just over half of white (51.2 percent) respondents believed that only 200 men were followed as part of the Tuskegee study.

Over 76 percent of black and 47 percent of white survey participants said they believed that a study similar to the Tuskegee Study could occur again today. Blacks who had heard of the Tuskegee Study were 120 percent more likely than their white counterparts to believe a similar study could occur today.

“Our findings illustrate that a tremendous amount of work needs to be done to repair the trust of African Americans with the medical system, which has direct implications for clinical trials and research,” said Lydia A. Isaac, coauthor of the study.

The Hopkins researchers also analyzed the relationship between race and mistrust of the medical care system. They found that black race was a consistent predictor of mistrust, even after adjusting for knowledge of the Tuskegee Study.

“Clearly, mistrust will complicate efforts to eliminate racial disparities in health, but the root causes of mistrust need to be addressed. We often assume that Tuskegee is central to understanding the high levels of mistrust often expressed by African Americans, but it seems that the sources of mistrust are deeper than any particular event,” said Thomas A. LaVeist, PhD, corresponding author of the study, director of the Bloomberg School’s Center for Health Disparities Solutions and professor in the Department of Health Policy and Management.

On the Web:

Johns Hopkins University Bloomberg School of Public Health

Scientists Discover Identifying Markers for Primitive Blood-forming Stem Cells

ANN ARBOR, Mich. ““ Scientists at the University of Michigan Medical School have discovered the biological equivalent of a grocery store bar code on the surface of primitive, blood-forming stem cells in mice. Called hematopoietic stem cells, they give rise to all the different types of specialized cells found in blood.

By reading the bar code, scientists can separate stem cells from their more advanced descendants ““ progenitor cells that already are committed to becoming one type of blood cell. The secret, according to U-M scientists, is to look for the presence or absence of cell surface receptor proteins expressed by a family of genes called SLAM.

Scientists knew that the 10 or 11 genes in the SLAM family helped regulate the development and activation of white blood cells called lymphocytes, but no one knew they also were associated with hematopoietic stem cells.

“SLAM is the first family of receptors whose patterns of gene expression can be used to precisely distinguish hematopoietic stem cells from progenitor cells, and to identify stem cells in tissue sections,” says Sean Morrison, Ph.D., an associate professor of internal medicine and of cell and development biology in the U-M Medical School and a Howard Hughes Medical Institute investigator.

Results of the research study will be published in the July 1 issue of Cell.

The discovery will be valuable to scientists working in the rapidly advancing field of stem cell science. Currently, scientists must search for many different markers and use complex procedures to separate rare hematopoietic stem cells, or HSCs, from other cells in a blood sample. Using SLAM markers will streamline the process considerably, says Mark J. Kiel, a student in the U-M Medical School’s M.D./Ph.D. program who is co-first author of the study.

“The classical markers work, but they are complex and it takes a high level of skill to obtain a pure sample of HSCs,” Kiel says. “We showed that using just two SLAM markers gives you similar or better purity than 10 to 12 of the best classical markers combined. It reduces the skill and time required to pick out a hematopoietic stem cell and makes the process simpler and less labor intensive.”

“Many of the current markers we use to purify HSCs are expressed as a gradient from high to low across the hematopoietic cell hierarchy,” says Omer H. Yilmaz, co-first author and a student in the Medical School’s M.D./Ph.D. program. “What’s really exciting about this finding is that now we have markers that turn on and off abruptly as stem cells differentiate.”

Kiel and Yilmaz used microarray analysis to measure levels of gene activity in three types of cells ““ hematopoietic stem cells, multipotent progenitor cells and fully developed bone marrow cells. They selected genes that were expressed at higher levels in the HSC population, as opposed to the other two types of cells. CD150, the founding member of the SLAM family of cell surface receptors, was near the top of the list.

To see if CD150 was expressed on hematopoietic stem cells, Kiel and Yilmaz transplanted CD150+ and CD150- cells into laboratory mice whose bone marrow had been destroyed by lethal doses of radiation. Healthy bone marrow was restored in six of six mice receiving CD150+ cells, but reconstitution was successful in only one of nine mice receiving CD150- cells.

When they followed the same procedure to test another SLAM marker, CD244, the results were completely opposite. Cells with CD244 receptors on their surface membranes were unable to reconstitute bone marrow in irradiated mice for more than a few weeks, while cells without CD244 receptors were able to reconstitute indefinitely. This indicated that CD244+ cells were a marker for multipotent progenitor cells (MPPs), but not for hematopoietic stem cells.

In a third step, the team tested another SLAM marker called CD48, and found it to be expressed only on more advanced cells. It was not present on either HSCs or progenitor cells.

“Each marker is expressed at a different stage of the hematopoiesis hierarchy,” Morrison says. “Selecting for cells with the combination of CD150+, CD48- and CD244- markers produced a sample that was highly enriched for HSCs. These cells were extremely rare ““ fewer than one out of 10,000 whole bone marrow cells had this combination of surface markers.”

In the Cell paper, U-M scientists describe how the new markers helped them see hematopoietic stem cells in stained tissue sections from mouse bone marrow and spleen, something that was not possible with existing markers. Knowing where primitive hematopoietic stem cells hang out in blood-forming organs will give scientists important clues to how they work, according to Morrison. For this reason, the identification of markers that allow the localization of HSCs in tissues has been a long-sought goal in the field of hematopoiesis.

“Until this study, we didn’t know exactly where to look for HSCs within bone marrow and the spleen,” Morrison explains. “Most scientists believed they stayed in close contact with cells called osteoblasts, which line the inside of hollow cavities in bone that contain bone marrow. Using SLAM markers, we discovered hematopoietic stem cells also congregate in the sinusoidal endothelium ““ porous cells lining the inside of blood vessels that carry oxygen throughout bone marrow and the spleen.

“The presence of HSCs in sinusoidal endothelium could explain how stem cells are able to enter the bloodstream so quickly,” Morrison adds. “It also suggests that endothelial cells produce substances that regulate and nurture the growth of these stem cells. If we can identify these growth factors, it could help us learn how to manipulate and grow colonies of HSCs outside the body, which could lead to new medical treatments for sickle cell anemia, leukemia and other types of cancer.”

As with most discoveries in stem cell science, U-M scientists say their work raises new questions for future research. So far they have identified three SLAM markers on hematopoietic stem cells, but they have no idea what the other eight genes in the family do. SLAM gene activity creates receptors on the surface of blood-forming stem cells, but what do these receptors do? Are SLAM receptors present on other types of stem cells?

Perhaps the most important unanswered question for future applications in medicine is whether these same markers are expressed on human hematopoietic stem cells. Kiel and Yilmaz confirmed the existence of SLAM markers on HSCs in several strains of laboratory mice, but whether they will be found on human cells remains “a big maybe,” according to Kiel.

“If SLAM family receptors are expressed on human HSCs, these new markers could dramatically enhance the purification of such cells, potentially making bone marrow transplants safer and more effective,” says Morrison, who adds that Kiel and Yilmaz have already started tests to look for them.

Toshide Iwashita, M.D., Ph.D., a former research fellow in Morrison’s laboratory and co-first author on the study, was responsible for the tissue section analysis. Cox Terhorst, Ph.D, from the Beth Israel Deaconess Medical Center and Harvard Medical School also collaborated in the research.

Morrison’s research is supported by the Howard Hughes Medical Institute, the National Institutes of Health and the U.S. Army Research Office. Kiel is supported by a U-M Medical Scientist Training Program Fellowship and Yilmaz is funded by a predoctoral fellowship from the U-M’s Institute of Gerontology.

On the World Wide Web:

University of Michigan Health System

The Jordanaires, voices behind Elvis, still singing

By Pat Harris

NASHVILLE, Tenn (Reuters) – “I’m on a small label right nowmaking some noise,” said the brash, dark-haired kid. “But if Iget a recording contract with a major company, I want you toback me up.”

The year was 1955. The little-known youngster was ElvisPresley, making a backstage pitch to Gordon Stoker, whoseJordanaires quartet had just finished backing up Eddy Arnold ata show in Memphis.

“Nobody had heard of Elvis Presley,” Stoker, now 80,recalled recently, “but apparently he was impressed with ourrendition of ‘Peace in the Valley’ because his first love wasalways gospel, you know. He had listened to us on the Grand OleOpry where we were the first white quartet to sing spiritualsand his music was influenced by that too.”

The collaboration took off and the Jordanaires ultimatelysang back-up on some of Elvis’ biggest hits including “Don’t BeCruel” and “Jailhouse Rock.”

The quartet also sang back-up for Roy Orbison, Johnny Cash,George Jones, Brenda Lee, Kris Kristofferson, Willie Nelson,Merle Haggard, Tammy Wynette, Dolly Parton — even the Beatles’Ringo Starr.

Although they are hardly household names themselves, theyhave recorded with an estimated 2,500 different artists andhave sung on more Top 10 records than any other vocal group inhistory, culminating in record sales of more than $2.6 billion.

Looking back on this career, Stoker lounged in the old RCAstudio where Presley put out those first albums on Nashville’sfamed “Music Row.” His gaze lingered on the somewhat battered1949 Steinway, the recording equipment, the instruments, thestraight-back chairs and the black and white photos on the walltaken when Presley and his entourage were all so very young.

It was almost as if they had left on a break from asession.

Stoker remembers being surprised a year after meetingPresley when the “noise” he spoke of making at Sun Records inMemphis had landed him a contract with RCA. By that time, theJordanaires, who had formed their quartet in 1948 inSpringfield, Missouri, were a fixture in Nashville.

ELVIS HAD A REQUEST

Country star Chet Atkins, who was producing Presley’s firstRCA record, told Stoker that the young fellow had asked for theJordanaires to sing backup.

“Chet didn’t think the kid would go anywhere in the musicbusiness,” said Stoker. “He said that Elvis was just along-haired kid who was a passing fancy and he called me in tosing backup with Ben and Brock Speer on the session.

“It wasn’t that we had anything against the Speers,” saidStoker, “but in music, meshing harmonies and styles can betricky. But I went over to the studio and Elvis asked where therest of the Jordanaires were and was disappointed that theyweren’t there. Four months later, Chet brought in the Speersagain to join me in backing up Presley on ‘I Want You, I NeedYou, I Love You,’ which was a big hit.”

At that point, Elvis insisted not only on the Jordanaireson all future sessions but also their name on his album — anunusual move since no backing musicians, producers or engineerswere given credit on labels then.

This time he got his way. The long-haired kid was a starwith enough clout to overrule Atkins, then a powerhouse in thebusiness.

Presley’s manager, Col. Tom Parker, “told Chet that whenElvis asks for someone, Elvis gets them,” Stoker recalled. And, he added, “to the day he died, Elvis didn’t like Chet.”

It was the beginning of a 14-year relationship during whichthe Jordanaires provided backup on “Don’t Be Cruel,” “All ShookUp,” “Jailhouse Rock,” “Can’t Help Falling in Love” andnumerous other Presley hits.

It lasted until Presley based his career in Las Vegas andthe Jordanaires declined to leave their roots in Nashville forthe bright lights of the gambling mecca.

Was it a hard decision to make?

“Well,” drawled the white-haired Stoker who sees nothingunusual about his continuing to sing harmony at age 80 for thebiggest artists in the business, “not really. We could havegone with Elvis to Las Vegas with our careers tied to his butit made more sense for us to stay here and make music with justabout everyone in the business. So that’s what we did.”

Presley died in Memphis in 1977 at age 42.

STILL ON THE ROAD

The Jordanaires went on to back up other singers sosuccessfully that they are still cutting records and performingin their own shows, now members of the Country Music Hall ofFame.

They take on new challenges, just releasing their firstbluegrass album titled “Believe,” which contains 26 hymnsincluding four new ones written specifically for the project.The album features a Presley favorite, “Angel Band.”

Through the years several members of the original grouphave died and been replaced. First tenor Stoker joined in 1950.Ray Walker became a member eight years later. Other currentmembers are Louis Nunley and Curtis Young.

“We’ve played to a quarter of a million people in Canadaduring the past two years,” said Stoker. “We do between 30 and35 shows a year here in this country and we can’t keep up withthe requests for more.”

“Yeah,” said Walker. “I think people have found out thatwe’re not dead.”

Childhood lost in India’s red light district

By Krittivas Mukherjee

CALCUTTA, India (Reuters) – Every time her mother brings aman home, little Pinky picks up her infant sister and goes outto play in the grimy lanes of Calcutta’s rundown red lightdistrict.

That is, if it is daytime.

At night, the scrawny girls sleep under a cot lifted bylayers of bricks because their mother might need the bed toentertain late night customers.

Seven-year-old Pinky’s sordid life echoes the existence ofthousands of children in Sonagachi, one of India’s biggest redlight centers where childhood is about battling life’s murkyside and often losing it.

A documentary on these children of the bordello won anOscar this year, but recognition worldwide has meant little forSonagachi’s estimated 12,000 children, life for whom remains acycle of poverty and prostitution that is difficult to break.

Many of these unschooled children of prostitutes areemployed in small factories, shops and cheap eateries wherethey scrub dishes and mop floors for as little as 20 rupees (46U.S. cents) a day.

Girls usually take up jobs as domestic help and then end upin prostitution once they are old enough.

The very young ones like Pinky spend their day babysittingtheir infant siblings in the narrow lanes of Sonagachi –exposed to drunken men, street brawls and heroin-shooting pimpsin one of Asia’s biggest red light districts with 6,000prostitutes.

But the streets are the only escape for the children fromthe grim atmosphere of their one-room homes which are beingused by their mothers for business.

“We tell our mothers from outside the door when we arehungry. We play on the streets until we are called in,” saysPinky, rocking her little sister in her arms.

“The men who come are not good people. They swear anddrink. But they give my mother money.”

GLOBAL RECOGNITION

The world saw the children’s struggle, humiliation,exploitation and also their craving for freedom from theirsqualid existence in this year’s Oscar-winning documentary’Born Into Brothels’.

The children themselves helped make the movie, written anddirected by Zana Briski and Ross Kauffman. The children weregiven cameras so they could learn photography and possiblyimprove their lives.

Much of their work including some telling shots of theirsurroundings were used in the film.

But the global recognition that the Oscar brought forSonagachi hasn’t translated into benefits for its unfortunatechildren.

“We have heard that some film has been made on ourchildren. But I don’t know much about it,” says Minati Das,Pinky’s young mother. “Anyway, it doesn’t make a difference tous.”

“Life remains exactly the same ugly way it was forSonagachi’s children before the Oscar award,” said MrinalDutta, secretary of a group set up to represent the prostitutesof Sonaghachi.

But British-born Briski said she planned to set up a schoolfor the children.

“Proceeds from the film will be used to build a schoolspecifically for the children of sex workers, who are otherwiseso stigmatized that no school will accept them.”

A few schools are already functioning in Sonagachi whichteach the children rudimentary English, vocational crafts andthe local Bengali language. But barely 700 children attend theclasses.

Driven by poverty, many of the young girls end up followingtheir mothers’ footsteps.

“It’s all about the kids. They have gone from not beinglistened to, to getting so much attention. But still a lotneeds to be done to remove the stigma and if anybody can changethis, it’s the kids themselves,” Briski said.

Ask the Vet: Toy Poodle Likely Has a Collapsing Trachea; See Vet for Diagnosis, Treatment of Dog’s Coughing, Dry Heaves

Q: I am writing to you because I have a question about my 4-year- old dog. He is a mix between a toy poodle and a Pomeranian.

Sometimes he has what I guess you would call dry heaving. I will be playing with him or sometimes it happens when he just sits around. He starts coughing and I don’t understand why this happens. When I say that he dry heaves, it’s just like when humans do it.

Nothing comes out of this mouth and he can’t seem to catch his breath. I try to calm him down by gently petting him and when I do that sometimes that seems to help and other times I just have to let it pass.

What causes his behavior and can it be really harmful? Can I do anything else to stop it from happening?

A: It sounds like your dog has what is called collapsing trachea. It is seen in older toy breeds usually. The exact reason behind why this happens is still unknown. Some theories include a congenital condition in small breed dogs, obesity, degeneration of trachea and chronic bronchitis.

A collapsing trachea is stressful for both owner and pet. The episodes do tend to get progressively worse in frequency and severity with time. I have never heard of a collapsing trachea causing a death directly but as the disease progresses, the quality of the animal’s life is directly affected.

There are some medical options for prevention and treatment of this condition.

One thing to do for your pet to try to prevent collapsing trachea is to try to limit his exposure to airborne allergens such as dust and pollen. These can start a coughing reflex that can lead to an episode. Try to limit the length of time that you play together and don’t play too aggressively. This will only make him breath harder.

A very important preventative is if he is overweight you MUST take some weight off of him. The bigger he is the harder it will be for him to breathe.

Practice good dental care. Can you tell by now that I love dentistry? I think I could work in animal mouths all day and never bat an eye.

To hear my drill in the morning, it is almost as good as coffee. But, by practicing good dental care you reduce bacterial contamination to the upper airway region.

Also, try to keep your pet well hydrated with fresh water and broth if needed. Vaporizer treatments followed by gentle tapping on the chest can help to clear respiratory secretions that could trigger an episode. You could do this weekly if needed. And lastly as a preventative measure, vaccinate for kennel cough. It can help.

As far as treatments go, your veterinarian could first rule out bacterial contamination with tracheal washes and cultures. If bacteria are triggering the episodes, giving the appropriate antibiotic will help. Also, your veterinarian may reduce airway inflammation with steroids if indicated. Oftentimes owners are instructed to give daily until improvement is noted then continue with treatment every other day.

There are medications that help to open airways and these are often helpful. Lastly, cough syrups or oral pills may be needed to control a cough that can potentially trigger an episode of tracheal collapse.

For now, I think you need to visit your veterinarian and see if his condition really is tracheal collapse and then try some preventative measures at home.

If indicated, you will get some medication as well to help him. Also, I would not stop picking him up to calm him, as it does help. Good luck to you both.

Send questions for Dr. Allison Dascoli to “Ask the Vet,” Charleston Daily Mail, 1001 Virginia St. E., Charleston WV 25301 or e-mail them to [email protected]. Comments or suggestions can be submitted the same way.

Researchers Create First Nanofluidic Transistor, the Basis of Future Chemical Processors

BERKELEY ““ University of California, Berkeley, researchers have invented a variation on the standard electronic transistor, creating the first “nanofluidic” transistor that allows them to control the movement of ions through sub-microscopic, water-filled channels.

The researchers – a chemist and a mechanical engineer – predict that, just as the electronic transistor became the main component of microprocessors and integrated circuits, so will nanofluidic transistors anchor molecular processors, allowing microscopic chemical plants on a chip that operate without moving parts. No valves to get stuck, no pumps to blow, no mixers to get clogged.

“A transistor is like a valve, but you use electricity to open or close it,” explained Arun Majumdar, professor of mechanical engineering at UC Berkeley. “Here, we use a voltage to open or close an ion channel. Now that we’ve shown you can make this building block, we can hook it up to an electronic chip to control the fluidics.”

One application Majumdar and colleague Peidong Yang, UC Berkeley professor of chemistry, are exploring is cancer diagnosis. A nanoscale chemical analysis chip could, theoretically, take the contents of as few as 10 cancer cells and pull out protein markers that can tip doctors to the best means of attacking the cancer.

“This is an ideal way to open up cells and identify the proteins or enzymes inside,” he said. “An enzyme profile would tell doctors a lot about the kind of cancer, especially in its early stages when there are only a few cells around.”

Yang, who built a variation of the transistor using nanotubes, is equally intrigued by the computational possibilities of the device.

“It may sound a little bit far fetched, but we’re thinking about whether we can do the same thing with nanofluidic transistors as we can currently with MOSFETs,” he said, referring to the Metal-Oxide Semiconductor Field Effect Transistors used in most of today’s microprocessor chips. “Using molecules to process information gives you a fundamentally different information processing device.”

Majumdar, Yang and colleagues Rohit Karnik, a mechanical engineering graduate student; Rong Fan, a chemistry graduate student; and mechanical engineering students Min Yue and Deyu Li reported their success – the product of three years of effort – in the May issue of the journal Nanoletters. Yang and Majumdar are also faculty scientists at Lawrence Berkeley National Laboratory.

One big advantage of nanofluidic transistors, Majumdar said, is that they could be made using the same manufacturing technology that today produces integrated circuits. Nanofluidic channels could be integrated with electronics on a single silicon chip, with the electronics controlling the operation of the nanofluidics. The only microscale parts of the device are the microchannels for injecting liquid.

Majumdar and Yang’s team constructed a 35-nanometer-high channel between two silicon dioxide plates, then filled the channel with water and potassium chloride salt. They showed that by applying a voltage across the channel by means of electrodes attached to the plates, they could shut off the flow of potassium ions through the water. This is analogous to the control of electron flow through a transistor by means of a gate voltage.

Such ion manipulations are not possible through microscopic channels because ions in the liquid quickly move to the plates and cancel out the voltage, basically shielding the interior of the liquid from the electric field. Channels less than 100 nanometers across, however, are so small that this shielding doesn’t occur, so ions in the bulk liquid can be pushed or pulled by electric voltages.

If the ions are proteins, they can be shuttled through channels lined with fluorescent antibodies for detecting or sensing. If the ions are pieces of DNA, they can be sorted and sequenced. In fact, the authors say, any highly sensitive biomolecular sensing down to the level of a single molecule could be performed with nanofluidic transistors. They demonstrated that labeled, charged DNA fragments could be manipulated in their transistor.

Yang, who is adept at making nanoscale lasers, tubes, wires and other devices, created a version of the transistor using nanotubes with internal diameters of 20 nanometers, proving that the same sort of molecular processing can be done with these innovative structures. While Majumdar foresees putting electronic and nanofluidic transistors on the same chip to provide computer control of chemical processing, Yang foresees the computing and chemical processing being done by the same nanofluidic channels.

“With nanotubes, you have access to much smaller dimensions compared to conventional nanofabrication, but in terms of integration, it’s more difficult,” Yang said. “For the future, both processes are fundamentally interesting, and eventually devices will combine both.”

Majumdar and Yang acknowledge that a lot more work needs to be done, including understanding the surface effects inside nanochannels. In addition, the voltage required to shut off ion flow is now 75 volts, far too high for any of today’s integrated circuits. But their team has a few other papers waiting to appear in Nanoletters and in the Physical Review Letters that push the technology farther than this initial paper. They hope to beat the time lag between invention of the transistor in 1947 and creation of the first integrated circuit in 1960.

“We want to be the first to build integrated circuits with just three transistors able to do sorting and eluting, just as a two- or three-bit processor can do multiplexing and addressing,” Majumdar said.

The work was supported by the National Cancer Institute’s Innovative Molecular Analysis Technologies program and by the Department of Energy. Current work is being funded by the National Science Foundation.

On the Internet:

University of California – Berkeley

Trimodal approach to prostate cancer promising

NEW YORK (Reuters Health) – In patients with locally
advanced prostate cancer, a three-pronged approach to therapy
can achieve a high level of tumor control, researchers at the
University of Virginia in Charlottesville report.

The trimodal approach involves treatment with
testosterone-blocking drugs coupled with implantation of tiny
radioactive seeds in the prostate, a treatment called
brachytherapy, and external beam radiation therapy.

Trimodality therapy “is an excellent treatment for patients
with high-risk prostate cancer and offers hope in patients with
this life threatening cancer,” senior investigator Dr. Dan
Theodorescu told Reuters Health.

From 3 to 5 years after initial treatment, these patients
have a high likelihood of treatment failure, as evidenced by
rising prostate-specific antigen (PSA) levels, Theodorescu and
colleagues note in the June issue of Urology.

To examine whether the trimodal approach would extend
survival, the researchers conducted a pilot study of 93
patients. Fifty-six patients were considered at high risk and
the remaining 35 were deemed to be at intermediate risk.

The patients received 8 to 9 months of hormone-blocking
drugs, followed by 2 to 3 months of external beam radiotherapy
concluding with brachytherapy.

Patients were examined at regular intervals and median
follow-up was 45 months.

At 4 years, the event-free survival rate was 85 percent for
the intermediate-risk group and 79 percent in the high-risk
group, which suggests that trimodal therapy “offers excellent
tumor control in patients with poor prognosis who often relapse
early,” the team concludes.

They emphasize, however, that longer follow-up “will be
important to determine whether these results are durable over
time.”

SOURCE: Urology June 2005.

Staphylococcus Sciuri: an Unusual Cause of Pelvic Inflammatory Disease

Summary: We present the case of polymicrobial pelvic inflammatory disease (PID) that involved Staphylococcus sciuri, S. epidermidis, and Streptococcus agalactiae. In order to determine the frequency of S. sciuri isolation from the female lower genital tract, 3415 vaginal samples were analysed during the one-year study period. S. sciuri was isolated from three (0.09%) samples. In all the three cases, S. sciuri was obtained in mixed culture from outpatients without symptoms of infection. While the origin of S. sciuri in the female genital tract remains to be elucidated, the present study showed that this bacterium may colonize vagina and, moreover, may be involved in the pathogenesis of an infection as serious as PID. The low rate of isolation we established, however, indicates infrequent and, most probably, transient colonization of the female genital tract by S. sciuri.

Keywords: pelvic inflammatory disease, Staphylococcus sciuri, vagina, incidence

Introduction

Pelvic inflammatory disease (PID) is an inflammatory disorder most commonly caused by the ascent of microorganisms from the female lower genital tract.1 The most important causative pathogens of PID are Chlamydia trachomatis and Neisseria gonorrhoeae.1 However, micro- organisms that can be part of the vaginal flora may also cause PID, especially of polymicrobial aetiology.1 The present study describes for the first time the case of polymicrobial PID that involved Staphylococcus sciuri, and further explores the frequency of isolation of this bacterium from the female lower genital tract.

Case report

In September 2000, a 28-year-old-woman consulted her gynaecologist at the outpatient department because of acute pelvic pain, nausea and vomiting. The gynaecological examination demonstrated bilateral adnexitis, and the patient was directed to the Department of Gynecology and Obstetrics, Regional Hospital Prbram.

Detailed examination in the hospital revealed the presence of pelvic pain, adnexal tenderness, cervical motion tenderness, palpable mass, but not abnormal cervical or vaginal discharge, nor the presence of menstrual abnormalities, urinary or proctitis symptoms.

On admission, her blood pressure was 125/80mmHg, temperature was 37.0C, and pulse 76 beats/min. Her white blood cells count was 8.4 10^sup 9^/L, erythrocyte sedimentation rate 35mm/h, C-reactive protein 15mg/L. Renal function and hepatic enzyme levels were normal.

Final diagnosis of PID was made after laparoscopic examination. Purulent material from peritoneal cavity was obtained by peritoneal lavage. The treatment with metronidazole (500 mg every 8h) and doxycycline (100 mg every 12 h) was introduced. Microbiological examination of vaginal sample revealed the pure culture of Candida albicans only. Results of tests for N. gonorrhoeas, C. trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, and bacterial vaginosis were negative.

After incubation of 24 h at 37C, primary agar media inoculated with material obtained by peritoneal lavage remained sterile, but subcultivation of primary broth cultures revealed S. sciuri, S. epidermidis and Streptococcus agalactiae. Susceptibility of the isolates to various antibiotics was tested by the disc diffusion method and it was established that two staphylococcal isolates were susceptible to doxycycline, while the S. agalactiae was resistant to this antibiotic. Anaerobic cultures of the same material remained sterile, as did the cultures for U. urealyticum and M. hominis.

Irrespective of resistance of S. agalactiae to doxycycline, the patient showed improvement after 48 h of treatment, and, therefore, the treatment with metronidazole/doxycycline combination was continued. After 14 days, the patient left the hospital in a good condition.

Discussion

S. sciuri belongs to the group of coagulase-negative, oxidase- positive, novobiocin-resistant staphylococci. This bacterium is widespread in nature and it could be isolated from a variety of animals2,3 as well as from various food products of animal origin.4,5 It has been shown that this organism may cause serious human infections such as endocarditis,6 peritonitis,7 wound8 and urinary tract infections. However, the incidence of S. sciuri in humans was reported for urinary tract only.9

Although coagulase-negative staphylococci have been recovered from women with PID,10 the present study is the first report describing S. sciuri as the cause of this condition. We presumed that S. sciuri found in the material obtained by peritoneal lavage was clinically significant and not a contaminating organism for three reasons. First, the patient had clear presentation of PID according to both clinical and laboratory parameters. Second, the results of the extensive bacteriological examination excluded all other possible causative agents of PID. Third, S. sciuri, along with S. epidermidis and S. agalactiae, were isolated from the actual infection site which is an otherwise sterile region. Moreover, the material was obtained by peritoneal lavage and not transvaginally, which reduced the possibility for contamination. Therefore, we considered the isolated strain of S. sciuri as one of the causative agents of PID of polymicrobial aetiology.

Since the majority of the cases of PID result from ascending infection from the lower genital tract,1 we evaluated the frequency of isolation of S. sciuri from the vagina. In total, 3415 vaginal swabs were examined for the presence of S. sciuri during 2001. The study population included all patients (2715) attending the outpatient department at the Institute of Microbiology and Immunology, Belgrade, for microbiological examination of the lower genital tract during 2001. The remaining 700 specimens originated from 700 patients attending the Department of Gynecology and Obstetrics at the Regional Hospital in Prbram. Screening for S. sciuri and subsequent identification of the isolates were performed as previously described.9 Of the 3415 vaginal samples examined for the presence of S. sciuri, this bacterium was isolated from three (0.09%) samples. Two isolates originated from patients in Belgrade (0.07%), and one isolate (0.14%) was obtained from patients in Prbram. S, sciuri was isolated from 36-, 39- and 67-year-old women. All women were outpatients and without symptoms of infection. In all three cases, S. sciuri was obtained in mixed culture.

As far as the origin of S. sciuri in the female lower genital tract is concerned, one possible explanation could be sexual transmission. Although we cannot exclude this mode of transmission, it is noteworthy that no S. sciuri isolates were obtained from the urethra of male patients during the period of our study. Since S. sciuri is frequently isolated from animals,2,3 it is reasonable to assume that contact with animals also may have an important role in the colonization of humans. However, the patient with PID as well as three asymptomatic patients with S. sciuri isolates denied the contact with animals. Another possible source for colonization of humans with S. sciuri is food, since S. sciuri has been isolated from dairy and meat products.4,5 It has also been isolated from the digestive tract of animals,11 but its occurrence in human faecal specimens has never been analysed.

While the origin of this principally animal bacterial species in the female genital tract remains mainly speculative, the present study clearly showed that S. sciuri may colonize vagina and, moreover, may be involved in the pathogenesis of an infection as serious as PID. The low rates of isolation we established, however, strongly suggest that colonization of the female genital tract by S. sciuri is only sporadic and, most probably, transient.

References

1 Mann SN, Smith JR, Barton SE. Pelvic inflammatory disease. Int J STD AIDS 1996;7:315-21

2 Stepanovic S, Dimitrijevic V, Vukovic D, Dakic I, Savic B, Svabic-Vlahovic M. Staphylococcus sciuri as a part of skin, nasal and oral flora in healthy dogs. Vet Microbiol 2001;82:177-85

3 Hauschild T, Schwarz S. Differentiation of Staphylococcus sciuri strains isolated from free-living rodents and insectivores. J Vet Med B 2003;50:241-6

4 Bockelmann W, Hoppe-Seyler T. The surface flora of bacterial smear-ripened cheeses from cow’s and goat’s milk. Int Dairy J 2001;11:307-14

5 Papamanoli E, Kotzekidou P, Tzanetakis N, Litopoulou-Tzanetaki E. Characterization of Micrococcaceac isolated from dry fermented sausage. Food Microbiol 2002;19:441-9

6 Hedin G, Widerstrm M. Endocarditis due to Staphylococcus sciuri. Eur J Clin Microbiol Infect Dis 1998;17:673-5

7 Wallet F, Stuit L, Boulanger E, Roussel-Delvallez M, Dequiedt P, Courcol RJ. Peritonitis due to Staphylococcus sciuri in a patient on continuous ambulatory peritoneal dialysis. Scand J Infect Dis 2000;32:697-8

8 Stepanovic S, Dakic I, Djukic S, Lozuk B, Svabic-Vlahovic M. Surgical wound infection associated with Staphylococcus sciuri. Scand J Infect Dis 2002;34:685-6

9 Stepanovic S, Jezek P, Vukovic D, Dakic I, Petras P. Isolation of members of the Staphylococcus sciuri group from urine and their relationship to urinary tract infections. J Clin Microbiol 2003;41:5262-4

10 Walker CK, Workowski KA, Washington AE, Soper D, Sweet RL. Anaerobes in pelvic inflammatory disease: implications for the Centers for Disease Control and Prevention’s guidelines for treatm\ent of sexually transmitted diseases. Clin Infect Dis 1999;28(Suppl 1):S29-36

11 Goyache J, Vela AI, Collins MD, et al. Corynebacterium spheniscorum sp. nov., isolated from the cloacae of wild penguins. Int J Syst Evol Microbiol 2003;53:43-6

(Accepted 26 April 2004)

S Stepanovic MD PhD1, P Jezek MVD2, I Dakic MD MSc1, D Vukovic MD PhD1 and L Seifert MD3

1 Department of Bacteriology, Institute of Microbiology and Immunology, School of Medicine, Dr Subotica 1, 11000 Belgrade, Serbia; Departments of 2 Clinical Microbiology; 3 Gynecology and Obstetrics, Regional Hospital Prbram, U Nemocnice 84, CZ-26126 Prbram, Czech Republic

Correspondence to: Dr S Stepanovic

Email: [email protected]

Copyright Royal Society of Medicine Press Ltd. Jun 2005

Prebirth Gender Talk: A Case Study in Prenatal Socialization

Abstract:

This narrative case study by the author documents the notes, language, and feelings of one mother’s prenatal gender talk to her baby, in utero. The article explores the types of gender socializations which occurred in the womb for one child following a sex-identifying ultrasound. Findings conclude that, for this case, gender socialization begins in utero, the labelling of a sex predetermines a personality for the mother, and the tone of voice becomes sharper and ‘stronger’ when the baby is identified as male.

What happens when an educational researcher, schooled in Women’s Studies, has a baby? Does the researcher’s knowledge of socialized gender roles influence the baby’s otherwise stereotypical socialization? As an education professor with an interest in Women’s Studies, I thought it would; what I discovered was that it did not. In this article, I document words said and feelings expressed to my second born child, in utero. When I was pregnant with my first child, I began to address the child differently following an ultrasound identifying its sex. This bothered me, and yet I could not consciously control, nor identify, the gender socialization that was taking place. Thus, when my second child was in utero, I began to document what was said to the child and what feelings were transmitted to the child both before and after a sexidentifying ultrasound in an effort to more fully understand the gender socialization process taking place as early as pregnancy. As a result of this data, this paper, presented as a case study in narrative, attempts to explore and document one participant’s in utero engendered language and socialization.

Educational research has found that children are socialized into stereotypical gender roles prior to kindergarten (Bailey, 1993; Fisk, 1985; O’Reilly, 1988; Ricks, 1985; Rubin, Provenzano & Luria, 1976). Bailey (1993) and Fisk (1985), for example, claim that gender stereotypes are rigidly formed by age 5; Perry & Sung (1993) found same-sex stereotype knowledge was high at age 3. From the moment of birth, one of the first questions a new parent is asked is, “Is it a boy or a girl?” In the hospital, girls are wrapped in pink blankets and boys in blue. Pink potted flowers arrive for mothers of daughters and blue vases and balloons for mothers of sons. Boys are described as “big,””strong,” and “independent”; girls as “fine,””gentle,” and “beautiful” (O’Reilly, 1988; Ricks, 1985; Thompson, 1975). Studies have even suggested that the process of gender socialization begins prior to birth, in utero. Rothman (1987), for instance, found that mothers who learned the sex of their child through amniocentesis described a male as “moving vigorously,” very active, and a female as “quiet.” Mothers who did not know the sex of their child prior to the birth, did not talk about the fetus – they spoke only of the physical effects of their pregnancy (Rothman, 1987, p. 129). More recently, findings supporting prebirth socialization were produced by Gibson (1998). “Preoccupied” women develop more “rigid, highly elaborated representations of their children with respect to gender”; secure women are more flexible with gender representations prior to birth (Gibson, 1998). I was aware of the power of engendered language (Ayim & Goossens, 1987; Frisch, 1977; MacKay, 1983). Was I, someone who lectured on the ill- effects of gender socialization, inadvertently engendering my own child? As it turns out, I was, and I was doing so even while being conscious of it. How early did the gender socialization for my own children begin? Their socialization began the moment their sex was known, or, during the second trimester of the pregnancy, in utero.

What follows are the unedited field notes which were recorded regularly during my pregnancy. The notes represent the daily repetition of talk to the fetus. The notes document both what was said to the baby, orally, and any feelings or expressions which were conveyed to the fetus either physically or psychologically – both before and after his sex was known. Oral comments to the baby are provided in plain text; thoughts and feelings for the baby are provided in parentheses ().

Prebirth Talk Prior to Sex-Identifying Ultrasound

Although you’re only a few weeks old, you’ve already experienced a lot of very hot weather and terrible fumes from trucks on the bridges. I thought immediately, ‘I want to move out of here so you and your brother can grow up in the fresh air of the country. ‘ No more fooling around – I contacted an architect to build a house on the farm and thought about changing jobs.

Second Month:

I hope you’ll hang in there. Most of the time, we’re a very happy/ content family. We laugh and try to keep our life good and happy. If you arrive, I think you’ll find yourself very loved.

When I was in the ultrasound waiting to see if you were alive, wondering if you were there, the technician let me listen to your little heartbeat and my eyes welled up with tears. You were there! You were alive and living and well! Oh my joy! A new life inside of me. It was the sweetest musical composition a woman could hear.

How are you doing in there? If you need anything – any nutrient – I want you to just send me a sign. I want you to be bright and creative and to be stimulated by life. You and your brother will be close in age, so you will also be the best of friends at times. It’s dark and warm where you are now but here it’s bright and light. You will arrive in one of our most festive seasons.

I would like to have you in Scotland, but am not sure I could manage away from your Daddy that long and it’s still fairly dangerous to travel in your 3rd trimester – you risk a premature birth. Babies need all the time they can manage.

Third Month:

Hi you, how are you doing? (Rubbing belly in clockwise motion.) We go to England tomorrow. I can see you in there – there is already a bump here where you are on my left side.

Hi you, I can feel you moving around in there. Are you going to be an active one? I have lots of upset stomach with you.

Everyone wants to know if you’ll be a girl or a boy. Because I have started to fill out to the sides, instead of out front, this time, they say you’ll be a girl, but who knows.

I don’t have as much time to talk to you while you’re in there as I had to talk to your brother, but I am keeping this journal for you so anytime I say something to you, I will try to write it down here.

Today you go to England with me. I’ll try to keep things as peaceful and relaxing as I can for you – lots of fresh air.

Do you hear your brother crying? I don’t know if he’s getting up yet or just dreaming.

Mordecai Richler died in your third month. After Seumas’ birth, Pierre Trudeau and the ‘Friendly Giant’ both died. It is a new era. I can recall growing up with Richler’s cynical take on the world. It’s why we’re so sarcastic about politics as Canadians, I think.

Time for sleep. You rest, and I will try to keep you away from the airplane radiation okay?

Hi little one – finally some time alone. I’ve barely had time to talk to you. Today I might hear you1 at the Doctor’s. You’ve been very quiet lately. I think you’ll like playing with your brother a lot. I know he can hardly wait to play with you. You relax and I will try to keep everything stress-free for you. It’s an amazing world. I think you’ll really like it when you come and we will love you so much – lots of hugs, lots of kisses. I can’t wait to meet you, but for now you rest, you grow.

Hi little one. How’re you doing in there? I can feel you here. (Rubbing belly clockwise.)

Fifth Month:

Okay, let’s go over here and see if we can find the horse stables. I think they were over here (rubbing belly in clockwise motion). I haven’t spent much time talking to you, have I? How are you doing in there anyway, okay? Are you enjoying listening to your brother? I think I felt you moving this morning you know. Either that, or you’re not liking all the grease I’ve been feeding you, are you? You seem to get a lot of indigestion, don’t you?

That was nice. I could feel you there. I love you so much. (‘Signal of love’ sent to baby.)3 Mmmm.

I know it’s a busy day and rough, but we’ll get some rest soon, so right now, I just want you to relax.

Well little one, how are you doing?

Hi little one. I can feel you over on my left-hand side there. You must be in the same position your big brother was in.

Hi little one, how are you doing in there? Did you know that the woman across the street, Annie, thinks that you’re going to be a girl? What do you think? Are you? Your Daddy thinks this as well.

To Seumas, the baby’s brother: Well Seumas, can you hear your brother or sister in there? What is s/he doing? You’re sitting on your brother or sister, be careful!

Well, your Grandma thinks your Mommy looks different this time too. She must be filling out more. What do you think?

Mrs. Girgis and Ms. Stanley said that our second child will be a girl little one, I guess you’ll show us all on Tuesday when you go to have your ultrasound. Your Daddy and I will find out that day if you’re healthy as well. I only wish that you’re okay.

How are you doing in there little one? I know I haven’t spent much time talking to you, but I love you very much and (rubbing belly; ‘Signal of love’ sent to baby) I want you to know that if you come, \I will take very good care of you.

You will have a lot of fun with your brother. He is very curious.

Mrs. Girgis says I look small for 5 months. I hope you’re growing okay in there and she’s not right – we would hate for there to be anything wrong with you – we love you.

Are you really going to be a Catrona? Well, Daddy thought our next would be a Catrona.4

Sixth Month – Day of Ultrasound:

Well little one, we’re going to find out who you are today and how you’re doing in there. And your Daddy and Seumas are both here with you.

Prebirth Talk Following Sex-Identifying Ultrasound:

When I said, “you’ll show them,” you really did! Your Daddy was so surprised. Another little boy! Now your brother will have someone to play with. You two will be like twins.

Hi ya Neilly beag5, how’re you doing? (Patting stomach.)

How do you like that Neilly? I love you (patting belly.)

Analysis of Prebirth Talk

At the fifth month of pregnancy, as Rothman (1987) indicates, I do not think of the baby as one sex or another. It is an androgynous being to me, the “baby” is much like a “plant.” No genitals, no gender. I imagine it growing and developing, like a “plant.” I “rub my belly clockwise,” send it mental ‘hugs of love’, and talk to it, but “it” is only “it,” or “little one” – a nameless, colourless being with no label. I use inclusive language, “have I?,””okay?,””are you?,””don’t you?,” constantly inviting the baby to participate in the conversation (Ayim, 1987). I wish the being to be a part of the group. This inclusive, gentle language changes when I find out the “being” is male.

Prior to the ultrasound, I say to the baby, “we’re going to find out who you are today.” This implies that if I do not know his sex, I do not “know who s/he is.” That is, “knowing the sex” somehow indicates what type of personality the baby will possess. I was surprised to read this statement in the field notes. It is, at once, an indication of prenatal socialization. It indicates that not only do I ignore the physical signals the baby is sending to me as a fetus as an indication of character, but I do not trust my own, innate instinct when it comes to determining the child’s organically developing persona. Without thinking, I wait to hear the sex, then, and only then, begin to use established gender stereotypes to label “who s/he is.”

Personality is not a trait which I have regarded to be associated with sex; however, the above statement, “[once we find out your sex,] we’re going to find out who you are” certainly infers that it is. In passing, parents will often say, “isn’t it nice to see the child’s personality develop?,” and yet, if a child’s sex comes with a predetermined [socialized] personality, then the character which will develop will inevitability be somewhat limited. The type of speech, and tone of speech, which one models for a child may also limit the child’s personality.

For example, field notes regarding my personal impressions following the sex-identifying ultrasound during the sixth month, or second trimester, indicate that the most distinct change in my approach to the baby, at the time, was non-verbal language and cues. First, for example, when I discovered the baby was male, although we had chosen two names for the baby Catrona and Niall (after my mother and my partner’s father) I immediately felt guilty for referring to the baby as ‘ Catrona’. Prior to the ultrasound, family, neighbours, and friends had suggested that I would be having a girl, and subconsciously, I must have trusted their instinct over my own (hence, the “guilty feeling”). Also, it is possible I wanted to believe this, “I have more in common with a female than a male.”6 secondly, besides guilt, the next distinct change was in the tone of my voice. Suddenly, there was less tenderness in the way I addressed the baby. He was a boy. He was ‘stronger’ now than the child I had I known only one minute before. He did not need to be I addressed with such light and fluffy language, such as, “little one.” He did not need to be coddled. I had been too gentle and careful with him. He must be tough and strong (O’Reilly, 1988). He was ‘Niall’, not ‘ Catriona’. Thus, I lowered my voice to a deeper octave. It lost its tenderness. The tone in my words was more articulate and short, whereas, before, the pitch in my voice was high and feminine. I wanted him to be ‘strong’ and ‘athletic’, therefore, I had to speak to him with a stereotypical ‘strong’, ‘masculine’ voice to encourage this ‘innate strength’.

For the next two months, the baby acquired a nickname, “Nially bheag” (a commonly documented male phenomenon, Bailey, 1993), and the “rubbing of belly clockwise” switched to the “patting of stomach”:

Seventh Month:

The music is a little loud isn’t it? It’s Blues. We’ll only be in here for a short time so just relax.

This is the first time you and Mommy have been alone together. It’s kind of nice, isn’t it?

How are you doing in there, okay? You just let me know if you need anything.

Mommy’s not feeling well Neilly, but she should be better soon. (Patting stomach.)

Ninth Month:

Well, when do you think you’re going to come, eh? You just take your time in there. (Patting stomach.) Do you have enough room? How are you feeling? It won’t be long now before we get to meet you, and you get to meet your brother.

Here’s where you and your brother will be sleeping.

Hey you, how are you doing in there? (Patting stomach.)

Well Niall, what do you think of this place? (Patting stomach.)

Well Niall, your Mommy doesn’t feel too well this morning. Have you turned again?

Hey you, how are you doing in there anyway? (Patting stomach.)

Okay Niall, time to go. (Patting stomach.)

Why “patting,” rather than “nibbing clockwise”? Why “stomach,” rather than “belly”? A “boy” does not require massage nor euphemistic expressions for parts of the body. He is ‘strong’ and ‘intelligent’, he can handle aches, without rubbing, and the proper technical language for an item, without slang.7

This change in language following the finding of the sex, along with the statement attaching sex to personality, indicates the beginning of a socialization process. Prior to the sex identity being known, the baby was “little one,” a “being,” and a blank slate, if you will. Its possibilities for development, more mental, oral, and physical, were infinite. Following the finding of its sex, the social mores imposed upon the infant begin to limit its possibilities for character development. The infant is male, therefore, according to prescribed stereotypes, it will be “healthy, strong,” and will speak in a “firm, lower octave.” As a result, the mother begins to nurture these traits. The mother, even those she is educated in gender and socialization, still possesses deep, ingrained methods for categorizing and speaking to males or females. She instinctly lowers the pitch of her voice, begins to use a firm tone, begins to use correct vocabulary rather than slang (e.g., “stomach” rather than “belly”), and perceives there to be less need to gently touch the baby (“patting” rather than “rubbing clockwise,” the former taking less time). This, in effect, signals the baby of its limits. The mother is now modelling a voice pattern for the baby; she is indicating its language standards; and its need to develop more independently since the mother no longer spends the same amount of time touching or caressing the infant. This teaches the child, “you must speak with a low voice,””you must use the proper words for items,” and “you should not expect others to cuddle you.” As this is only one case example, it is difficult to extend these conclusions to other newboms; however, it is an illustration of how very early in ‘life’ a child’s gender is limited and nurtured through well-established stereotypes.

The above data, or ‘prebirth’ talk, were recorded without editing, and I did not attempt to analyze it until I sat down to represent the narrative findings within this paper. I was, quite honestly, shocked by the findings. If a woman as conscious as I about engendered language, labels and socializes a baby, in utero, according to gender, what sex-stereotyped signals would an average mother send her baby? If even the most conscious and critical mothers do not escape this endemic, gender socializing process, and are bound, through generations of indoctrination, to pass it on, what hope do we have as a society to escape such heavily engulfed stereotypes? If gender socialization begins in utero, as this case study suggests, how can education diffuse the effect of gender stereotypes through prebirth talk?

Notes

1 Author will hear the “heartbeat” of the baby, or the baby, in the doctor’s office.

2 Baby moved.

3 Occasionally, the author will mentally ‘hug’ the baby; that is, she will mentally send the baby a physical feeling of warmth, or love, imagining that she is embracing the child inside.

4 Women in the author’s village perform a “needle and thread” test for the author. A threaded needle is hung over the mother’s belly. According to local myth/custom, if the needle moves in the form of a circle, the baby will be a girl; if the needle swings from side to side, a boy. In this case, the needle happened to move in a clockwise direction.

5 Gaelic for “Little Neil.”

6 As recorded in field notes.

7 A girl cannot?

References

Ayim, M. & Goossens, D. (1987) Issues in gender and language: An annotated bibliography, Resources for Feminist Research, 22(1/2), pp. 3-35.

Bailey, K. R. (1993) The Girls are the ones with the pointy nails: An exploration of children’s conceptions of gender (London, The Althouse Press).

Fisk, W.R. (1985) Responses to ‘neutral’ pronoun presentations and the development of sex-biased responding, Developmental Psychology, 21(3), pp. 481-485.

Frisch, H. (1977) Sex stereotypes in adult-infant play, Child Development, 48, pp. 1671-1675.

Gibson, L.A. (1998) Adult Attachment and Maternal Representations of \Gender during Pregnancy: Their impact on the child’s subsequent gender-role development (Unpublished Ph.D. Dissertation). (New York: City University of New York).

Mackay, D. G. (1983) Prescriptive Grammar and the Pronoun Problem, in: B. Thome, C. Kramarae, && N. Henley, (Eds.) Language, Gender and Society (Rowley, Newbury Press).

O’Brien, M. & Huston, A. C. (1985) Development of sex-typed play behavior in toddlers, Developmental Psychology, 21, pp. 866-871.

O’Reilly, P. (1988) The impact of sex-role stereotyping on human development. Monograph, 3(1). (Columbus, Ohio State Department of Education).

Perry, L. C. & Sung, H. A. (1993) Developmental Differences in Young Children’s Sex-Typing: Automatic versus reflective processing (Miami, Society for Research in Child Development).

Ricks, S. (1985) Father-infant interactions: A review of empirical research, Family Relations, 34, pp. 505-511.

Rotheman, B. (1987) The tentative pregnancy: Prenatal diagnosis and the future of motherhood (New York, Penguin).

Rubin, J., Provenzano, F., & Luria, Z. (1976) The eye of the beholder: Parents’ views on sex of newboms, American Journal of Onhopsychiatry, 44, pp. 512-519.

Thompson, HOMPSON, S. (1975) Gender labels and early sex role development, Child Development, 46, pp. 339-347.

Trepanier-Street, M. L. & Kropp, J. J. (1987) Children’s recall and recognition of sex role stereotyped and discrepant information (Miami, Society for Research in Child Development).

Kara Smith is a language education professor at the University of Windsor in Windsor, Ontario, Canada. Her research focuses on the ways languages are maintained and on the creative ways in which they may be learned. She may be contacted via e-mail at: [email protected]

Copyright George Mason University, Communication Department Spring 2005

Straws May Save Soda Lovers’ Teeth

NEW YORK (Reuters Health) — People who savor their soft drinks may save their teeth some wear and tear by using a strategically placed straw, according to a new report.

In excess, carbonated beverages, like other acidic drinks, can wear away the protective enamel on teeth, leading to tooth decay. While going easy on carbonated beverages is the best way to prevent tooth erosion, sipping them through a straw may offer some added protection.

The key, say dentists at Temple University in Philadelphia, is to place the straw near the back of the mouth so that the teeth aren’t bathed in soda with every sip.

That advice is based on the cases of two teenagers, whose heavy soda drinking — between 1 and 3 liters a day — caused widespread tooth erosion. However, the pattern of tooth damage differed based on how they drank.>

In one case, an 18-year-old man regularly downed his soft drinks from cans and cups, and his dental erosion was more extensive in the back teeth and on the right side of his mouth-where he had the habit of holding his soda for a while before swallowing it.

In contrast, a 16-year-old girl who habitually sipped her soda through a straw developed extensive erosion in her front teeth. Since she normally placed her straw just inside her lips, these are teeth that would mainly be exposed to soft drink acids.

The cases suggest that using a straw — as long as it’s placed near the back of the mouth — may lower the odds of tooth decay by limiting the contact between soda and teeth, according to Dr. Mohamed A. Bassiouny.

He and his colleague at Temple’s School of Dentistry, Dr. Jie Yang, describe the two cases in the current issue of the journal General Dentistry.

“Your best option is to sip soft drinks and other beverages through a straw positioned toward the back of the mouth,” Bassiouny said in a statement.

But, he added, making a habit out of drinking soda instead of water “may cause significant, irreversible long-term problems and damage.”

Besides cutting back on soda and keeping straws handy, people should avoid drinking soda before bed, according to the Academy of General Dentistry. That’s true even for conscientious brushers, as brushing the teeth right after having a soft drink can damage the acid-weakened enamel.

SOURCE: General Dentistry, May/June 2005.

—–

On the Net:

Temple University

High iron and cholesterol equals high cancer risk

NEW YORK (Reuters Health) — High blood levels of iron coupled with high levels of very low density (VLDL) lipoprotein cholesterol appear to interact to increase the risk of cancer.

“Iron and lipids combine to create oxidative stress, and oxidative stress has a role in the development of cancer,” Dr. Arch G. Mainous III, of the Medical University of South Carolina, Charleston, and colleague write in the American Journal of Epidemiology.

The researchers examined the risk of cancer among 3278 subjects in the Framingham Offspring Study who had elevated iron and lipid levels.

The participants were at least 30 years of age when they enrolled in the study between 1979 and 1982, at which point their blood levels of iron and HDL, LDL, and VLDL cholesterol were measured. They were followed up for development of cancer until 1996 to 1997.

The team reports that elevated iron increased the likelihood of developing cancer by 66 percent, and high VLDL cholesterol increased the risk by 54 percent. Combining elevated iron with elevated VLDL increased the risk of cancer by 168 percent.

High iron plus low HDL (“good”) cholesterol also increased the risk to a similar degree.

“These findings support the hypothesis that iron-mediated oxidation of cholesterol increases oxidative stress, which can lead to cancer formation,” Mainous and colleagues conclude.

Assuming the finding is confirmed by others, they say, it suggests a need “to reduce iron and/or lipid levels in persons with dual elevations in these substance as a strategy to decrease cancer risk.”

SOURCE: American Journal of Epidemiology, June 15, 2005.

American companies find manners still matter

By Ellen Wulfhorst

GOSHEN, N.Y. (Reuters) – Business etiquette coach BarbaraPachter likes to tell the story of a financial executive who,dining with a potential client, licked his knife clean at theend of the meal.

“It was a $30 million dollar lick,” she said at a recentetiquette seminar in Goshen, New York, referring to the valueof the deal the executive lost by offending the potentialcustomer.

Businesses are turning to etiquette training to boost theirbottom line, according to the coaches who train employees oneverything from shaking hands to buttering bread.

Simply put, better-behaved employees are more valuable thanbrutish oafs, they say.

“Etiquette is saying that it’s really OK to be nice,” saidPeter Post, the great-grandson of etiquette’s grand dame EmilyPost and himself a writer and lecturer on business etiquette.

“We’ve had an attitude in this country that being nice wassomehow counter-productive to good business, to beingsuccessful,” he said, adding, “In fact, being nice is a way tobe much more successful in business. It has real bottom-line,dollar value.”

He’s seen demand for etiquette training boom in recentyears, he added.

“We’ve heard over and over from corporations who haveemployees with all these skills but can’t let them take aclient out to lunch,” Post said. “I get calls every week.”

In suburban New York, employees of Elant Inc., which runshealth and housing facilities for the elderly, have beenstudying etiquette since the company decided to slash itsadvertising budget and send staff into the community to drum upbusiness through word of mouth.

LOST ART

Sent out to join civic groups and meet people, employeessoon complained they were uncomfortable networking andsocializing, so the company turned to an etiquette coach, ElantChief Executive Donna Case-McAleer said. “It’s a lost art,” shesaid.

Elant employees recently attended a day-long seminar tohear Pachter answer an array of etiquette questions:

–What accessories do people notice first? Watches andpens.

–Where should empty foil butter wrappers go? Fold the foilwrappers in half and place them under the bread plate.

–How does one eat spaghetti at a business dinner? Don’teven touch spaghetti; it’s too messy.

–Should a man be told that his fly is open? Yes, peopleshould be always informed of zipper failure.

Listening, Elant administrator Laurence LaDue said he waswell aware of his own etiquette failings. “I don’t speak up,I’m guilty of the ‘ums,’ and I’m a fidgeter,” he said.

Jan Davis, new to Elant management, found herselfpracticing her handshake with some tips from the coach.

“I’ve never been in the corporate world before. I’ve got alot I need to learn,” she said.

In a telling development in the world of businessetiquette, Post said he has just added a chapter on ethics tothe business etiquette book he first published six years ago.

Not paying attention to ethics, he said, can be costly. Just look at Tyco International Ltd.’s Dennis Kozlowski, facingprison for stealing the company’s money, he said. The formerchief executive could have used a little etiquette, he said.

“We teach people to think before they act. My guess is hewasn’t thinking. He was doing. But unfortunately we’reresponsible for our actions, and now he’s responsible for his,”Post said after a recent lecture in New York.

Experts say modern etiquette is different from just a fewyears ago. Women’s roles have changed, families spend less timein such settings as sit-down meals, children of working parentsoften fend for themselves and television and movies glorifyprofanity and rough-and-tumble behavior.

“If I asked my mother where she learned manners from, itwas probably from Sunday dinner, and I don’t think you findthat today,” said Susan Schulmerich, an Elant vice president.”In many ways, we’re missing a lot in our informal society andloss or tradition.”

BACK TO BASICS

Pachter said she often has to go back to basics. “I amamazed I have to tell people to say please and thank you,” shesaid. “Somewhere between childhood and adulthood, we stop usingthose words.”

Listening to Post, businesswoman Dale Marcovitz said shewished her company, a huge retailer, would train employees.

“I’m from the old school and social graces, or the lack of,is what I notice the most, she said.

A study of people who experienced incivility at work,conducted by the University of North Carolina at Chapel Hill’sKenan-Flagler Business School, showed how costly it can be.

One in five said they worked less hard as a result ofrudeness at work, and one in 10 spent less time at the office.Nearly half considered changing jobs, and more than 10 percentdid so, the study found.

“It’s more than just telling a person the rules,” saidPost. “Etiquette does have value for people. Etiquette makesyou a successful person.”

Airlifts from accidents improve trauma outcome

By Alison McCook

NEW YORK (Reuters Health) – People who suffer a traumatic
brain injury tend to fare better if they’re taken to the
hospital by helicopter rather than by ground transportation,
according to a new study.

Study author Dr. Daniel P. Davis explained that people
don’t necessarily get to the hospital quicker by air, but
helicopters are more likely to carry staffers with advanced
training in critical care, who can do more to stabilize people
before they reach the hospital.

Helicopters cost, on average, 5 to 10 times more than
ground transportation, but if that extra money makes a
difference between life and death, it makes sense to pay it,
noted Davis, who is based at the University of California, San
Diego and Mercy Air Medical Services in San Diego.

“If I’m the brain-injured patient, then it’s definitely
worth it,” Davis told Reuters Health.

He and his colleagues reviewed the outcomes for 10,314
people who experienced moderate to severe brain injuries
between 1987 and 2003 in San Diego County, 3,017 of whom
arrived at the hospital by helicopter.

One-quarter of the people died from their injuries, the
investigators report in the Annals of Emergency Medicine, but
they found that people were more likely to survive their
injuries if they were transported via helicopter.

Helicopters seemed to be most helpful to people with more
severe injuries.

Helicopters typically carry certified flight nurses, and/or
emergency room resident physicians, Davis explained, which
means that they can perform advanced procedures such as
intubation and catheterization before brain-injured patients
reach the hospital.

In an interview, Davis noted that helicopters can get
patients to the hospital quicker from rural areas, but often
offer no speed advantage in other regions. However, if being in
a helicopter means patients get quicker access to advanced
procedures, then air travel does offer another type of speed
advantage, he noted.

Indeed, people transported by air who received intubation
before reaching the emergency department were more likely to
survive their injuries than ground-transported patients who had
to wait for the procedure until they reached the emergency
department.

SOURCE: Annals of Emergency Medicine, June 21, 2005.

Butter boosts West Africa business

By Kwaku Sakyi-Addo

ACCRA (Reuters) – In northern Ghana, tradition forbade men
to stoop and pick up the fruit that fell from the towering shea
nut tree. It was beneath them to do so.

But that’s not the case anymore. Shea butter is the new
‘It’ cosmetic in the West, where it is applied to smooth
wrinkles and cure blemishes, while nut oil is used more and
more in Europe as a cheap substitute for cocoa butter in
chocolate.

For generations women gathered the fruit, pounded the nuts,
and sold the salve to feed their families. Now foreign firms
and home-grown entrepreneurs are scrabbling to boost production
capacity and export to lucrative foreign markets.

“We started with cashew nuts but realized there was much
more potential with shea nuts and we’ve been going all guns
blazing since we moved over,” said Milind Bhat, finance
director and operations manager for Blue Mont Ghana, a company
which has a factory in the northern Ghanaian town of Tamale.

West Africa usually hits the international headlines when a
rebel group blasts its way into a capital or a drought
devastates crops in an already impoverished desert nation.

But when the leaders of the world’s richest nations discuss
African poverty at next month’s Group of Eight (G8) summit,
Ghana may be held up as an exception.

The government of the former British colony is determined
that years of liberal market policies, peace and stability will
drive private sector investment and economic growth.

Starting in 2001 and helped by its British-based parent,
Blue Mont Ghana now employs 45 full-time staff and is seeking
funds to boost capacity at its shea oil plant in northern Ghana
to produce more high-value exports.

For Kwesi Abeasi, chief executive of the Ghana Investments
Promotion Center, the investment and profits made by companies
exporting shea nut butter are “a small slice of the great
opportunities that a small country like Ghana can offer.”

PLENTIFUL SUPPLY OF NUTS AND LABOUR

The shea nut trees grow easily in the savannah belt that
separates the Sahara desert from the verdant, tropical coast of
West Africa. They only start to bear fruit after 20 years,
reach maturity after 45, but can go on producing for two
centuries.

Several countries in the region export 60,000 to 80,000
metric tonnes of shea nuts each year, but the U.N.’s Food and
Agriculture Organization says that could increase ten fold.

“Shea nuts could be big business for West Africa. The
cosmetic and personal care industry in America is becoming more
and more interested in it because consumers have discovered its
magic,” said Peter Lovett, a shea nut consultant, who advises
the West Africa Trade Hub (WATH).

WATH, a U.S.-funded outfit with a regional office in Ghana,
supports West African entrepreneurs to export their products to
U.S. markets under the Africa Growth and Opportunity Act
(AGOA).

Blue Mont’s Bhat says the advantage of being in northern
Ghana, where the company has 16 permanent collection units, is
that there is no shortage of nuts and good labor is plentiful.

“We can always get the cream of the people, who really want
to work and make a living for themselves,” he said. “Pickers
can earn tens of dollars a day” during the peak rainy season.
The world market price per metric ton of raw nuts is $190,
crude butter sells for $450 dollars and refined butter for
$900.

Little known a few years ago in North America, a four-ounce
shea butter body balm can retail for $16 in boutiques across
the Atlantic and demand for creamy, yellowish butter is
growing.

“Shea butter is a high-value product, highly sought after
by middle class suburban women,” said Kara, who founded Planet
Botanicals in New York in 2003 with her sister Michelle
Gilfoil.

HURDLES AND RESTRICTIONS

But having a good idea and being fortunate enough to live
in a relatively stable African country is not always enough.

Bhat said it was a real struggle to get going in northern
Ghana because of poor infrastructure. Getting electricity and
water supplies took time and 18 months after asking for a phone
line, his plant is still not hooked up to the grid.

For Ghanaian entrepreneur John Hayford, breaking into
foreign markets has been the toughest nut to crack.

Hayford, 43, spotted the growing niche market for shea
butter in the United States a few years ago. He invested just
over $2,000 in 2002 and built a machine from scrap metal in
junkyards to mold the butter into cosmetics.

He added a boiler to process the nuts and two years later
his company, Haymor Natural Cosmetics, had turnover of $38,000
and small contracts to supply in the United States and Norway.

But restrictions in one European country meant every time
he bought shea nuts from a different village, his products
would have to undergo a strict testing procedure all over
again.

“We hadn’t anticipated that and we just couldn’t keep up,”
Hayford told Reuters. “I’m not giving up but we’ve learned to
try and walk through this rather than running through it.”

(Additional reporting by David Clarke in Dakar)

Shea butter boosts W. Africa business

By Kwaku Sakyi-Addo

ACCRA (Reuters) – In northern Ghana, tradition forbade men
to stoop and pick up the fruit that fell from the towering shea
nut tree. It was beneath them to do so.

But that’s not the case anymore. Shea butter is the new
‘It’ cosmetic in the West, where it is applied to smooth
wrinkles and cure blemishes, while nut oil is used more and
more in Europe as a cheap substitute for cocoa butter in
chocolate.

For generations women gathered the fruit, pounded the nuts,
and sold the salve to feed their families. Now foreign firms
and home-grown entrepreneurs are scrabbling to boost production
capacity and export to lucrative foreign markets.

“We started with cashew nuts but realized there was much
more potential with shea nuts and we’ve been going all guns
blazing since we moved over,” said Milind Bhat, finance
director and operations manager for Blue Mont Ghana, a company
which has a factory in the northern Ghanaian town of Tamale.

West Africa usually hits the international headlines when a
rebel group blasts its way into a capital or a drought
devastates crops in an already impoverished desert nation.

But when the leaders of the world’s richest nations discuss
African poverty at next month’s Group of Eight (G8) summit,
Ghana may be held up as an exception.

The government of the former British colony is determined
that years of liberal market policies, peace and stability will
drive private sector investment and economic growth.

Starting in 2001 and helped by its British-based parent,
Blue Mont Ghana now employs 45 full-time staff and is seeking
funds to boost capacity at its shea oil plant in northern Ghana
to produce more high-value exports.

For Kwesi Abeasi, chief executive of the Ghana Investments
Promotion Center, the investment and profits made by companies
exporting shea nut butter are “a small slice of the great
opportunities that a small country like Ghana can offer.”

PLENTIFUL SUPPLY OF NUTS AND LABOUR

The shea nut trees grow easily in the savannah belt that
separates the Sahara desert from the verdant, tropical coast of
West Africa. They only start to bear fruit after 20 years,
reach maturity after 45, but can go on producing for two
centuries.

Several countries in the region export 60,000 to 80,000
metric tonnes of shea nuts each year, but the U.N.’s Food and
Agriculture Organization says that could increase ten fold.

“Shea nuts could be big business for West Africa. The
cosmetic and personal care industry in America is becoming more
and more interested in it because consumers have discovered its
magic,” said Peter Lovett, a shea nut consultant, who advises
the West Africa Trade Hub (WATH).

WATH, a U.S.-funded outfit with a regional office in Ghana,
supports West African entrepreneurs to export their products to
U.S. markets under the Africa Growth and Opportunity Act
(AGOA).

Blue Mont’s Bhat says the advantage of being in northern
Ghana, where the company has 16 permanent collection units, is
that there is no shortage of nuts and good labor is plentiful.

“We can always get the cream of the people, who really want
to work and make a living for themselves,” he said. “Pickers
can earn tens of dollars a day” during the peak rainy season.

The world market price per metric tonof raw nuts is $190,
crude butter sells for $450 dollars and refined butter for
$900.

Little known a few years ago in North America, a four-ounce
shea butter body balm can retail for $16 in boutiques across
the Atlantic and demand for creamy, yellowish butter is
growing.

“Shea butter is a high-value product, highly sought after
by middle class suburban women,” said Kara, who founded Planet
Botanicals in New York in 2003 with her sister Michelle
Gilfoil.

HURDLES AND RESTRICTIONS

But having a good idea and being fortunate enough to live
in a relatively stable African country is not always enough.

Bhat said it was a real struggle to get going in northern
Ghana because of poor infrastructure. Getting electricity and
water supplies took time and 18 months after asking for a phone
line, his plant is still not hooked up to the grid.

For Ghanaian entrepreneur John Hayford, breaking into
foreign markets has been the toughest nut to crack.

Hayford, 43, spotted the growing niche market for shea
butter in the United States a few years ago. He invested just
over $2,000 in 2002 and built a machine from scrap metal in
junkyards to mold the butter into cosmetics.

He added a boiler to process the nuts and two years later
his company, Haymor Natural Cosmetics, had turnover of $38,000
and small contracts to supply in the United States and Norway.

But restrictions in one European country meant every time
he bought shea nuts from a different village, his products
would have to undergo a strict testing procedure all over
again.

“We hadn’t anticipated that and we just couldn’t keep up,”
Hayford told Reuters. “I’m not giving up but we’ve learned to
try and walk through this rather than running through it.”
(Additional reporting by David Clarke in Dakar)

Taiwan singer Jay Chou looks East to crack the West

By Alice Hung

TAIPEI (Reuters) – Taiwan pop star Jay Chou looks to thelikes of Jackie Chan and Jet Li, who made it big in the Westwith martial arts from the East, for inspiration.

What they did with Chinese kung fu he reckons he can dowith his Chinese blend of rap music.

Unlike some Taiwan pop stars, who have borrowed heavilyfrom the West, Chou’s music interwines Western R&B and hip-hopwith a distinctive Chinese flavor.

“In order to be noticed in the West, the Chinese culture isthe starting point,” he told Reuters in a recent interview.

“I feel I must take my own, different path, not to followthe paths already taken by other people,” he said in hisstudio.

Chou has yet to make it in the West, but his style hasdrawn a huge following since his debut with the album “Jay” in2000.

He has received awards in Taiwan, Hong Kong, China,Singapore and Malaysia and all his albums have made their wayto the best-selling lists. He is also huge in Japan.

“People notice me because they think my music is unique. Iam always full of confidence in my music,” said Chou, 26, whocomposes his own songs and also plays piano, cello, guitar andthe drums.

In his “Dragon Fist,” Chou combined Chinese instrumentswith rock and roll. He brought Chinese poetry to “East WindBreaks” and the Bruce Lee fan even wrote a song called”Nunchuks” after his favorite martial arts weapon.

The power of his songs did not go unnoticed in Beijing.Some were among this year’s list of 100 approved songs formusic lessons in Chinese middle schools.

“Except for the music, I am an idiot in all aspects oflife. I can’t live without music,” Chou said, who is stillsingle, admitting that he did not even know how to chat to hisfriends on the Internet.

Brought up in suburban Taipei by his mother, Chou flunkedhis college entrance exam and had thought about becoming apiano teacher.

PRETTIER AND PRETTIER

“If I wasn’t a singer, I would have been a piano teacher,”said Chou, whose mother made him learn piano at three. “I thinka man teaching piano is cool because most piano teachers arewomen.”

There was a time when Chou wanted to give up piano becausehe couldn’t stand the endless practicing.

“But my piano teachers got prettier and prettier, so Icarried on,” he said, offering one of his trademark boyishgrins.

Chou was discovered by a TV host at a singing competition.But he started his career by writing songs for other singersand said he was not surprised by his success because he hadfound a formula that works.

“Building on the foundation of classical music, my popsongs combine the Chinese musical elements and Chinese martialarts.

“I see myself as a musician with a unique character. I amnot a puppet. I don’t do what the record company tells me todo,” said Chou, who intends to incorporate Bach into his songsand dislikes being referred to as a pop idol.

“An idol should be good-looking. I am not handsome so Idon’t expect people to notice me because of my looks,” saidChou.

The important thing, Chou said, was to stay cool.

“I hope I will always be number one. Maintaining the levelI am at right now will be my biggest challenge,” Chou said.

“Even when I go downhill, I will go down gracefully,” headded. “I won’t go stumbling.”

For now, Chou is tapping growing popularity of rap music inAsia. In China, a new generation has embraced hip-hop as anemblem of free-spirited expression while the sound has been adominating influence in Tokyo sub-culture since the late 1980s.

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Was 38in Still 38in

WHAT DOES IT PROMISE?

Biocell claims to liquify fat to reveal a sleek new you. It combines two therapies to break down cellulite, improve muscle tone and tighten skin. An ultrasound massage (called Vacusound) removes impurities and breaks down fat. Next comes the Biosculpture step, where micro-currents drain away liquified fat, water and toxins. The pads can be placed on problem areas for a more tailored programme. A course of 8-10 treatments is recommended.

TESTER SAYS: Using what looked like a shower head, but was actually a mini-vacuum, the therapist worked over my thighs, calves, hips, bottom, stomach and upper arms. The first treatment was very painful I only endured it because the therapist told me it would permanently remove my cellulite. Next, the Biosculpture part made my limbs jerk uncontrollably, and afterwards I felt an uncomfortable pins and needles sensation supposedly my muscles toning up. After nine treatments Ive only lost 1lb and nothing from my waist and hips, though my legs have toned up and Ive lost an inch from each thigh. I havent dropped a dress size though after all that pain, I expected a lot more.

INFO: From pounds 55 a session, call 020 7242 5749 or see www.biotecitalia.com

TREATMENT

THE BODYTER SYSTEM

WEIGHT

Was 9st 12lb Now 10st

WAIST

Was 33in Now 32.6in

HIPS

Was 39.3in Now 38.8in

WHAT DOES IT PROMISE? This treatment claims to shift the stubborn pockets of fat and cellulite that diet and exercise cant blitz. You slap on rubber thermal pads that deliver electrical stimulation and infrared heat to raise body temperature, tone muscles and combat cellulite. The makers say the machine gives you a work-out equivalent to a vigorous gym session without moving a muscle.

TESTER SAYS: After stripping down to my undies, gel-smeared plates were strapped to my thighs, bum cheeks and tum and hooked up to a scary-looking machine which sends out electrical pulses I quite literally got a nasty shock when the machine was turned on. Luckily, the zapping was adjustable, and after my initial surprise, I didnt feel pain, just a bit pummelled. But does it work? I was measured before and after each treatment, and didnt see any huge decrease in girth despite the beauticians best attempts at optimism! However, my bum does feel firmer, which had been one of my main concerns. Then again, at my first session, I was told I had to exercise and follow a strict no-carb diet. Youve got to question the point of spending pots of money on a slimming treatment when youve got to exercise and diet anyway.

INFO: pounds 55 per session or pounds 605 for course of 12. Currently exclusive to Janet Ginnings in London, call 020 7499 1904

TREATMENT

PHYSIOTHERM SAUNA

BIGGEST INCH

LOSS

WEIGHT

Was 9st 4lb Now 9st 2lb

WAIST

Was 27.5in, Now 25.8in

HIPS

Was 39in Now 37in

WHAT DOES IT PROMISE?

Its not sold as a weight-loss treatment as such, but it does claim to burn 800 cals a session doing diddly-squat. The sauna emits an infrared heat that forces your body to produce pools of sweat and as each gram of sweat takes 0.5 cals to make, thats a lot of energy youre using. Unlike other saunas, the heat warms your body directly rather than the air, so the temperature is never hotter than 45oC. 3-4 sessions a week recommended.

TESTER SAYS: For the first 10 minutes, I sat in the sauna wondering why nothing was happening then it was as if the waterworks were turned on. One moment my skin was bone-dry, the next sweat spurted out of every pore. Yet I didnt feel uncomfortably hot, just relaxed and oddly cleansed, despite being drenched in sweat. I started off with 30-minute sessions, building up to 45 minutes as I got acclimatised, and each time, I walked out feeling fantastic. After a month, Ive lost weight, inches and body fat, and people keep saying how good my skin looks. Admittedly, I havent been pigging out burning 800 cals means zip if you’re scoffing pizza every night but if youre trying to slim down, this really helps.

INFO: Home saunas

available to buy from pounds 2,400, salon sessions from pounds 15 call 0845 225 5008 or see www.physiotherm.co.uk. We went to Londons hip holistic centre Halo (www.halocity.co.uk), where pounds 85 buys you a months unlimited pass to the sauna.