The FDA announced today that four drugs used to treat rheumatoid arthritis and other serious illnesses will now have stronger black box warnings due to the increased risk of fatal fungal infections. A black box warning is the strongest warning the FDA gives before pulling the product from commercial use.

The four drugs – Cimzia, Enbrel, Humira, and Remicade – suppress the immune system to keep it from attacking the body. This allows relief from swollen and painful joints in patients with rheumatoid arthritis, but also lowers the body's defenses against other infections.

The FDA became concerned when they discovered that doctors were overlooking histoplasmosis, a kind of fungal infection. Of the 240 cases reported to the FDA, 45 patients died, a rate of nearly 20 percent. Histoplasmosis is more common in the middle of the U.S. and mimics the flu. If it is not caught early on and spreads from the respiratory system to other organs, it becomes deadly. Another concern of the FDAs is that doctors may not recognize histoplasmosis when their patients show symptoms. When looking at their database, FDA officials found that of the 240 patients who had been taking the medications and developed the infection, 21 received a late diagnosis. Twelve of those 21 later died.

While the four medications already have a black box warning about the risk of infections, the language varies on each drug. Patients will now be told to alert their doctors if they develop a cough, persistent fever, fatigue or shortness of breath since these are all symptoms of a fungal infection. The FDA also has begun urging doctors to "consider" the use of antifungal drugs in patients who develop symptoms of histoplasmosis. Because these antifungal drugs also have serious side-effects, the FDA says the decision should not be made lightly – which shows the seriousness of histoplasmosis.

Known as TNF-alpha blockers, the drugs are also used to treat Crohn's disease, juvenile arthritis, some kinds of psoriasis, and more. They are all delivered by injection and, with the exception of the newest and less widely used Cimzia, have brought in sales of over one billion dollars annually.

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Mercedes-Benz S 400 BlueHY
ID: The CO2 champion in the luxury class, with an efficient hybrid drive system and lithium-ion technology
Mercedes-Benz is launching its first passenger car model equipped with a hybrid drive system in summer 2009 - the S 400 BlueHY
ID. The combination of a modified V6 petrol engine and a compact hybrid module makes the S 400 BlueHY
ID the worlds most economical luxury saloon with a spark-ignition engine. The NEDC combined fuel consumption is a mere 7.9 litres per 100 kilometres. This makes for the worlds lowest CO2 emissions in this vehicle and performance class - just 190 grams per kilometre. These exemplary figures go hand in hand with assured performance. The 3.5-litre petrol engine develops an output of 205 kW/279 hp, the electric motor generates 15 kW/20 hp and a starting torque of 160 Nm. The result is a combined output of 220 kW/299 hp and a combined maximum torque of 385 newton metres. Moreover, the new S 400 BlueHY
ID is the first series-production model to be equipped with a particularly efficient lithium-ion battery specially developed for automotive use. This is another major contribution by Mercedes-Benz to the electrification of the car.

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Natural lawn care products pose no health risks, and they are very specific in what types of organisms they attack. While other natural lawn care products like vinegar are great for a variety of uses, there are different types of bacteria that you can employ to have more specific targeting of your lawn problems. Milky Spore Disease might have a menacing name, but it works to remove infestations in your yard at the cellular level. Other organisms like Bacillus thuringiensis and beneficial fungus pathogens also destroy invaders at the microscopic level while posing absolutely no health risk to humans, pets, and your favorite plants.
With no health risks, you might be tempted to say that the best lawn care products are completely natural. Certainly, beneficial nematodes might make the average person slightly queasy, but they get the job done. These tiny worms burrow in the soil and attack the larvae of various insects like ants, termites, and Japanese beetles. After injecting the larvae with toxic (to the larvae) chemicals, they wait for the larvae to die before eating them. In this way, natural lawn care products often take care of problems before they can grow up, and once they have consumed all of the insect larvae in your lawn, the beneficial nematodes die off.
Fortunately, all of your lawn problems can be taken care of with natural lawn care products. Take care of weeds, fungal infestations, insects, and grass of poor quality without using synthetic substances that can be toxic to you and your pets. Thats not to say that the health risks posed by synthetic materials are overly large. In fact, most unnatural products are dispersed over such a large area that they dont pose a health risk, although the chance is always there, however small. If you want to take care of your lawn without the fear of developing an illness, then natural lawn care products are the perfect fit.

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WASHINGTON, Aug. 19 -- Adult obesity rates increased in 37 states in the past year, according to the fifth annual report released Tuesday by the Trust for America's Health (TFAH). Adult obesity rates rose for a second consecutive year in 24 states and for a third consecutive year in 19 states. No state saw a decrease, says the report.
Though many promising policies have emerged to promote physical activity and good nutrition in communities, the report concludes that they are not being adopted or implemented at levels needed to turn around this health crisis.
More than 25 percent of adults are obese in 28 states, which is an increase from 19 states last year. More than 20 percent of adults are obese in every state except Colorado. On the contrary, in 1991, no state had an obesity rate above 20 percent. In 1980, the national average of obese adults was 15 percent.
Now, an estimated two-thirds of American adults are overweight or obese, and an estimated 23 million children are either overweight or obese.
The report finds that rates of type 2 diabetes, a disease typically associated with obesity, grew in 26 states last year. Four states now have diabetes rates that are above 10 percent, and all 10 states with the highest rates of diabetes and hypertension are in the South. The report also found a relationship between poverty and obesity levels. Seven of the 10 states with the highest obesity rates are also in the top 10 for highest poverty rates.
America's future depends on the health of our country. The obesity epidemic is lowering our productivity and dramatically increasing our health care costs. Our analysis shows that we're not treating the obesity epidemic with the urgency it deserves, said Jeff Levi, executive director of TFAH.
Even though communities have started taking action, considering the scope of the problem, the country's response has been severely limited. For significant change to happen, combating obesity must become a national priority, said Levi.

Combating obesity must become a national priority. I couldn't agree more with Mr. Levi.
But how to best combat it is as huge of a national debate as abortion, the coming election, tax increases...heck, we spend so much time debating the issues that their is little time or money left to actually solve the problems we face.
Here's the truth, whether Americans want to face it or not. We eat too much fast food, restaurant food and over processed convenience foods, we drink too many soft drinks, juice drinks and drinks that are loaded with high fructose corn syrup (even the seemingly healthy product Vitamin Water is loaded with the crap!) and we sit on our widening rear ends hours on end, pardon the pun, doing NONE or not enough physical activity. The average person watches more TV in a day than the exercise.

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Nimish Dubey, September 1, 2008
The Times of India (Bangalore edition)

It is finally herethe cellphone they call the ubergizmo. After selling millions of units all over the world and re-defining the phoning experience, Apple (with some help from Airtel) has finally brought the iPhone to India. And its the new 3G version too. We got our hands on it and discovered that just like its predecessor, it is a blend of the wholly divine and the utterly human.

The more things change...

The iPhone 3G looks very much like its forerunner, although a closer look reveals that it is slimmer at the corners and a tad wider. Although its back is made of plastic and not metal as in the case of original iPhonea compromise to accommodate the 3G receiverit looks every bit as sleek and still has just one button on the front panel below the screen. Also, under the hood is support for 3G (alas, not yet here in India), GPS, MS

Exchange and access to the App Store, which allows users to download a host of applications (many of them free) on to their devices. There are a few tweaks to existing applicationsyou can save images from websites and emails now, geotag the images you click and, hallelujah, copy contacts from SIM card to phone. Those looking for simple phone functionality in the iPhone 3G (are there such people?) will be glad to know of a considerable boost to the speakerphone as well as better call reception. Finally, battery life has improved significantlywe battered it for a day and half, talking, music and surfing, and it still didnt need a recharge.

Some things, however, remain unchanged. The 2.0-megapixel camera is the same as beforeno sign of video or zoom yet. Bluetooth is still limited to a few headsets and no, you cannot connect the phone to a computer to browse the Net on the latter. And alas, theres no sign of MMS.

What also remains unchanged is the iPhones real strengthits interface. Its touchscreen remains as sensitive as ever with finger-friendly icons that make it one of the easiest devices to use. Music quality is on par with the legendary iPod and its large and excellent display makes it perhaps the best portable device to gawk at videos.

Round this off with the powerful Safari browser which renders Web pages to near perfection (it still does not support Flash, though) and you can see why people call the device a mini-computer rather than a phone. Oh yes, and memory is not in short supply eitherthe phone comes in 8GB and 16 GB versions.

Twice as fast, half the price? Er...

Apple had marketed the iPhone 3G with the tagline Twice as fast, half the price referring to its lower price tag in Europe and the US and the fact that it supported 3G, making for some fast browsing. Alas, Indian users are likely to see neither facet, with Airtel offering the phone at the rather steep price tags of Rs 31,000 (for the 8GB version) and Rs 36,100 (for the 16GB version) and with no 3G networks in sight yet. Tech wags have already started sneering about Half as fast, twice the price. Yes, it has it flaws. But then, ah, so did a feller named Achilles.

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BDA’s focus of services includes a comprehensive revenue operational system review, one on one training in documentation and coding for both E/M and general CPT-4 coding, chart reviews, development of documentation templates, and review of CPT, HCPCS and ICD-9-CM Codes utilized with billing and coding for the purpose of determining omitted codes and other coding issues.
Founded in 1988, BDA provides a select team of experienced clinical, coding and financial professionals with over 200 years of experience in the healthcare field.

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Jin Ma, Mingshan Lu and Hude Quan have a wonderful article in Health Affairs which summarizes how Chinas healthcare system has evolved over the years. Today, I will review this article.
Pre-Reform Era: 1949-1978
The health care system during this timelike the rest of the Chinese economywas centrally plan. There were no private clinics or hospitals in China. The goal of the Chinese government was to ensure equal access to the health care system for all regardless of each individuals ability to pay. Providers were paid on a salaried basis and the government set medication and health care service prices. Emphasis was put on integrating Western medicine with traditional Chinese medicine (TCM). The of health care during this time was the barefoot doctor. These doctors were trained for the needs of the rural population and typically lived within the village.
Health insurance was provided through a number of plans. The Government Insurance Scheme (GIS) covered government workers, the Labor Insurance Scheme (LIS) covered employees of state-owned enterprises (SOE). The majority of the rural population was covered by the Cooperative Medical Scheme (CMS). Private insurance did not exist.
Post-Reform Era: 1978-present
As the government began to decentralize its economy, health care was also decentralized. The central government started to make block grants to each province (similar to the U.S. Medicaid system) rather than the cost-reimbursement system that existed prior to 1978. Physicians were still paid a salary, but could work during their leisure hours for extra income. High service fees were introduced for medical services which utilized the new high-tech medical equipment which was imported into China during this time. The Chinese also allowed forprofit hospitals and cilinics. By 2004, for-profit hospitals accounted for 13.8% of all hospitals and for-profit clinics accounted for 72% of all clinics.
In the 1980s, China allowed commercial insurers to enter the market. Commercial insurers, however, are not overwhelmingly popular since only 5.6% of the population had commercial insurance in 2004. As the market economy ate away at many SOEs, the government decided to merge GIS LIS and created a new urban employee health insurance plan. It is rare for employers to fully cover their employees health insurance cost. Instead, it is popular to offer employees a fixed amount of month to cover basic health insurance and employees are responsible for covering the rest. In rural areas, a laissez faire attitude was adopted and most rural individuals pay out of pocket for health care. In 1994, less than 10% of Chinas rural population had CMS and most barefoot doctors ceased practicing.

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Health care costs will grow an average of nearly 10% in 2009. Pricewaterhouse Coopers reports their anticipated health cost trends in the company's latest issue of Behind the Numbers.

On the good news front, there are several cost decelerators: more employers are depending on targeted health management programs, and aggressive generic substitution for more expensive branded drugs. PwC found that two-thirds of employers have adopted disease management, such as using prescription drugs in lieu of surgical procedures. Furthermore, employers are focusing more on employee wellness for both cost-management as well as productivity, absenteeism and presenteeism. They're bolstering the outcomes for these health investments through personalization.

The countervailing forces for health cost increases include the continued hospital capital projects (both replacing aging equipment and buildings as well as the medical arms race), and cost-shifting from government payers and the uninsured to private payers. PwC estimated that 1 in 4 private payer dollars goes to this category. This is primarily done by hospitals who are shifting the costs of under-compensated and uncompensated care to the commercial side of the revenue ledger.

Health Populi's Hot Points: While employers are doing their level best to contain costs and optimize their health investments in employees, medical cost inflation will continue to exceed general consumer price inflation for the foreseeable future. PwC expects medical inflation to outpace the CPI for the next decade.

The growth in the share that public payers (governments) take on will result in the sector further pushing costs onto employers and private payers. This will continue until a solution is found to deal with Medicare, Medicaid and the uninsured. As this off-loading to the private sector continues, how will employers be able to continue to afford health coverage as it further eats into profit margins.

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Just as Yoga can assist us to take control of our lives, negative energy works against taking charge of your life. At this point, please observe a person, you know, who consistently has terrible luck. Notice that this person always expects a poor outcome on the job, in transit, and at home.
This person expects the sky to fall, the world to end tomorrow, and the sun will never shine again. The negative energy, within this person’s mind, projects itself into daily situations; and, unfortunately, he or she has “bad luck.”
Just imagine what could happen if this same person could purge the negative energy from within. His or her life would undergo a radical change. It is true that, bad luck can happen to anyone, but it is unusual to see it happen for long.
Life has its “ups and downs,” and everyone has seen their luck change for better or for worse. Casinos make a good living, playing the odds to their advantage, and discriminating against known card counters.
At the same time, casinos count on the average person’s good luck to eventually take a turn for the worst. Most of us cannot “ride high” all the time. As a result, it is wise for most of us to stay away from casinos, unless we are extremely lucky, can discretely count cards, or are independently wealthy.
Getting back to your daily life, prepare for the best luck to happen in all situations. Practice Yoga, be positive, make research-based decisions, and envision good things to happen to you and your loved ones.

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IN VIVO - June 2008
The first quarter of 2008 saw a dearth in financings for both the medical device and in vitro diagnostics segments. In the former, volume fell short of the billion dollar mark while the latter failed to reach the success the previous quarter had witnessed, despite completing an equal number of transactions. MA in medical devices didn't look any more promising, bringing in $1.6 billion, a huge slide from the impressive $10 billion total of 2007's fourth quarter. However, there was one bright spot: acquisitions within in vitro diagnostics/research reagents substantially increased to $3.1 billion from the $370 million spent in the previous three months, led by Inverness Medical Innovations' $1.1 billion takeover of Matria Healthcare Inc. Also noteworthy: oncology diagnostics alliances grew slowly and steadily thanks to increasing attention from larger companies.

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A lot of people are intimidated by the thought of starting their own internet venture. This shouldnt be the case. The notion of an internet undertaking is truly very easy. In fact, we can sum up the secret to success for an internet undertaking via the following simplified chart: http://www.small-business-credit.org/business-credit-cards.html
Determine a need Create solutions for that need Sell your solutions
Indeed, the success of an web venture highly depends on being able to discover a market that is flourishing and the ability to grab a big portion of that market that may be converted into income.
Basically, your internet business requires 4 critical factors:
1. A product to sell. This may or may not be your own item. You can opt to come up a digital product that allows digital delivery, such as an electronic book or eBook, a shorter electronic guide like a special report, a software program and other similar items. Or you can build a tangible product, though you have to store and ship the same upon the placement of an order. Or you can look for another businessmans product which you can sell and profit from based on the stated commission per sale. This option can be pursued by enrolling under appropriate affiliate programs.
2. A sales page where you can sell and process sales for your product. Yes, you will need a sales page. Not just any website, but a professional-looking website. Dont rely on free domain names and free web hosting services. If you need your clients to invest their money for your products, you have to let them know that youre willing to spend for them too. Get a domain name that will truly describe your internet business. Develop an effective and visually attractive website and subscribe to a reliable web host for its pages. The central thought behind the concept of an web business is to lead traffic to your website where you can sell to them your items.
3. A payment processor to accept orders. There is a great need to install a system for the placement of orders and the acceptance of payments. This can be done by subscribing to any of the online payment processors in the market today. Your primary consideration should be PayPal because it is the most popular payment option that will allow you to take PayPal payments as well as credit card payments. Simply create payment button on your sales page. When people click on this payment button, they will be directed to the payment processors page where payment will be taken and processed.
4. Internet marketing strategies in full gear. You should market your product by marketing the sales page that is tasked to sell the same. There are a multitude of internet marketing techniques you can avail of, with most of them not costing a single cent in their implementation.
Popularity: 7% [.

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Robin Hanson of George Mason University talks about the phenomenon of signalling--the ways people spend resources to convey information about ourselves to others. It begins with Hanson revisiting his theory from an earlier podcast that we spend too much on medicine because we need to signal our concern for friends and family. The conversation then moves onto apply Hanson's model of signalling to other areas of human behavior. This is a wide-ranging discussion covering not just medicine, but real estate transactions, the wooing of a spouse, the role of education in the job market, parenting, the economics of self-deception, and Robin's argument that we spend too much time on admirable activities.

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Intern Nathan Lamb with little Green
Meet Nathan Lamb, one of our 2008 summer interns and the only one to raise their hand when I asked, Who wants to be first? Nathan is an Environmental Studies major at UNC-CH and we call him our senior plus because hes already graduated and received his degree. After spending time in Costa Rica for his semester abroad, he decided to return to UNC to pick up a minor is Spanish. Perhaps he was hoping to be able to converse with our Kemps Ridleys in their native language.
Nathan and his family have vacationed on Topsail for years so hes no stranger to sea turtles and the work we do at the hospital. He saw our internship as a chance to impact the conservation of marine wildlife in whole by focusing on one species. Thankfully he didnt fall in love with squid, because somebody has to make up the height deficit that exists because the rest of us are munchkins. But seriously, hes got a lot of other qualities that we adore: his positive approach to any job, a team player attitude and his ability to entertain and fascinate our visitors while imparting turtle wisdom.
During his off-hours, rumor has it hes giving surfing lessons to some of our staff, notably our Director of Beach Operations, who can now paddle out to rescue floating turtles and bring them back while hanging ten. But Nathans real talent seems to be diplomacy. Hes living at our intern house with six women, apparently in peace and harmony!
Nathan says the internship is pretty much what he expected with no surprises yet. When he got a chance to carry to the surf at our June release, he realized just what an incredible experience he was about to have. Nothing gives us more joy than seeing a recovered sea turtle go home. Hes already seen a few too many new admits in his first month at the hospital, but especially memorable for him was when came in during open house and he became her primary caregiver.
His advice to would-be interns, If youre not passionate about this kind of work, look elsewhere. If youre lucky enough to be accepted be prepared to work hard, and be open to an amazing educational experience.
Nathan has an independent research project (in Manteo) on his schedule when he leaves us in August. Hell be studying coastal environmental issues. After some time off for travel, hell look for environmental work in the non-profit sector. Until then, you can catch him at the hospital during open house, on his surfboard, or whipping up smoothies at his part-time job at the bookstore.
Hole-y turtle!
Well, it happened again. A mama attempting to nest fell into a monster hole that somebody had dug and then walked away from.. Now youd think common sense and basic courtesy would dictate that if you dig a hole you should fill it in before you leave. Its not only a potential tragedy for a sea turtle trying to nest, its a serious hazard for humans who could stumble in and break a leg, hip or worse.
Now Ill step down from my soapbox and report that this years season is progressing well with lots of successful nestings.
If you want to keep track of the action visit our website: www.seaturtlehospital.org. Please report all sea turtle activity (nestings, strandings, injured turtles or hatchings) to our Director of Beach Operations, Terry Meyer @ 910-470-2880.
Turtle Talks need cart to help with the turtle walks weekly Turtle Talks continues to grow in reputation and attendance. Thats created a good problem: she needs an angel to donate a rolling cart to the cause so she can transport all the turtle stuff and handouts to the sessions; something like a library cart, two or more shelves. Even a beverage cart might do the trick, if its a sturdy one.
So if you have something on wheels that you feel would work, please contact her at 910-328-2374 and shell be happy to make the necessary arrangements (and its tax deductible.)
Cart or no, these fun and informative sessions are held every Wednesday through Labor Day. The one-hour presentation, 3:45 4:45 PM includes lots of hands-on materials to introduce you to the enigmatic world of sea turtles. Visuals and handouts are appropriate for ages K-adult, and bring your camera to get some great shots of your kids, or yourself.
The site is the Surf City Community Center, JH Batts Rd. (off Rt. 210 between Docksider and Gilligans.) Admission is free but donations for our turtles are appreciated. Please leave food and drinks in the car.
For more information call the hospital at: 910-328-3377.
You need to know
Hospital open house: daily from 2-4 PM, except Wednesday and Sunday. The gift shop is also open during those hours. Please note that two incorrect phone numbers appear in various places in the magazine.
The correct number for reporting turtle activity/strandings is: 910-470-2880.
The correct number for the hospital is: 910-328-3377.
Labor Day weekend yard sale: Please continue to put aside donations for this important fundraiser. Because of space limitations we cannot accept clothing (but shoes and accessories are fine) computers, large appliances or mattresses.
Contact Vickie Duncan at 910-328-1688 to volunteer to help, or for more information.
Questions, comments or suggestions for stories
Tell me what you want to hear about by contacting me at: flippers@embarqmail.com.

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serious questions about his reports. Overall, Dr. Nemeroff promotes these drugs by exaggerating their efficacy and glossing over their toxicity in resistant depression.

8. False statements. In this Expert Interview, Dr. Nemeroff leads off his discussion of SGA drugs for TRD with an endorsement of risperidone. The 2 published references to risperidone in TRD have major scientific flaws. Indeed, the study by Rapaport et al (reference 12 in this interview)was retracted. Nevertheless, Dr. Nemeroff still claims this study supports his position on SGA use in TRD. Does Dr. Nemeroff not read the retractions of his own publications (by his own “research team”)? How naïve are Medscape’s editors to be ignorant of these retractions?

9. Talking up the sponsor’s product. In reviewing the toxicity of SGA drugs for TRD, Dr. Nemeroff found something negative to say about the side effects of olanzapine, quetiapine, and risperidone. However, he made no mention of aripiprazole’s side effects, even though he emphasized its recent approval by the FDA for TRD. How convenient, as BMS-Otsuka sponsored his Medscape spot. Where were Medscape’s editors, described by George Lundberg as working to prevent bias and improper influence?

10. Glossing over weak efficacy. Though Dr. Nemeroff endorsed aripiprazole for TRD, he neglected to discuss the weak efficacy of this drug. The Number Needed to Treat for remission with aripiprazole in TRD is a disappointing 10. The studies cited by Dr. Nemeroff only compared aripiprazole against placebo. Dr. Nemeroff surely knows that just beating placebo does not qualify a drug as clinically useful. Dr. Nemeroff neglected to address the comparative efficacy of aripiprazole versus established treatments of TRD, such as lithium augmentation. The available evidence suggests that patients will do better on lithium and that aripiprazole would not be the first line choice, especially in primary care. Where were Medscape’s editors?

11. Reckless promotion of SGAs early in the course of TRD. Dr. Nemeroff emphatically stated he is not opposed to the early use of SGAs for TRD. Here especially he resembled Lindsay Wagner. A conscientious educator would weigh the risks and benefits of the early and broad use of SGA drugs in TRD. Dr. Nemeroff did no such thing. He simply opined. Why did Medscape’s editors allow him to get away with this reckless promotion? There does not appear to have been any effective editorial oversight of this publication.

12. For Dr. Nemeroff to promote early use of SGAs in TRD is reckless because of the serious toxicity associated with these drugs. Where is the discussion of akathisia (26% in the most recent study of aripiprazole in TRD)? Where is the discussion of emergent suicidality associated with akathisia in depression? Where is the discussion of tardive dyskinesia caused by aripiprazole (5% within 12 months in schizophrenia, and quite possibly higher in mood disordered patients)? Where is the discussion of neuroleptic malignant syndrome associated with SGAs like aripiprazole? Where is the discussion of weight gain with aripiprazole in TRD (significantly greater than with placebo)? Where is the overall analysis of risk versus benefit? Where were Medscape’s editors? Who at Medscape was looking out for “the best interests of patients”?

13. Incomplete disclosures. Dr. Nemeroff has a long history of recidivism concerning failure to disclose pertinent financial conflicts of interest. His record in this instance continues that sordid tradition. He failed to disclose that he is currently chairing a national series of CME meetings promoting aripiprazole for TRD, sponsored by, you guessed it, Bristol-Myers Squibb/Otsuka. Perhaps he thinks that because the money is laundered through a Medical Education Communications Company he doesn’t need to disclose it. Tell that to Joseph Biederman, who was called to task last week by Senator Grassley’s Senate Finance Committee for exactly that obfuscation. Dr. Nemeroff also failed to disclose his support from Janssen for studying risperidone in TRD. He failed to disclose his association with CeNeRx, that is developing MAO inhibitors, mentioned favorably in his interview. There is more, but these examples will suffice. Doesn’t Medscape know by now that Dr. Nemeroff cannot be relied on to report his conflicts appropriately? Does Medscape have knowledgeable professionals or ciphers in its editorial office?

So, this sleazy example illustrates many of the systemic problems that Medscape will need to correct if it hopes to remain credible. This documentation gives the lie to Dr. Lundberg’s claims that “We are clean. Our work is transparent.” One suggestion is for Medscape to abandon the degenerate form of scientific journalism exemplified by “Expert Interviews” and News items. In their present formats they cannot be truly educational and balanced items. They do not qualify for CME credit, as I verified with the company. They are simply vehicles for promoting sponsors’ products. And the Medscape staff seem to think their job is to ensure that the spin is firmly in place. Does George Lundberg really intend that.

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Athletic Association is best known for running tournaments for high school athletes, the organization has shifted its efforts to educational programs for students and coaches, including the annual Sportsmanship Summit, which has been held the last three years at Gillette Stadium.
“It was very informative,” said Mr. Dziczek, who captained the basketball and baseball teams this year. “It was all about teaching you to be a leader and getting people to look up to you and have a positive view about it.”
The MIAA was founded 30 years ago when the state’s principals felt they were spending an inordinate amount of time managing athletics. Since then the governing body of high school sports in the state has undergone tremendous growth and extended its influence while dramatically altering its view of where its efforts and resources should be channeled.
“We’re an education association, not an athletic association,” executive director Richard Neal insisted last month during an interview.
To underscore that point Neal didn’t laugh when a visitor jokingly suggested the MIAA is due for a name change, the word “athletics” in its title being outdated. Instead, he took a moment to ponder the thought.
“No one has suggested we change our name, but it would make good sense,” he replied.
Conducting postseason tournaments remains the MIAA’s most visible undertaking and accounts for about 75 percent of its annual revenue. There’s more to it than in the early years, though, because of a huge increase in participation by girls (mirroring a national trend) and the growth of sports such as soccer, indoor track and lacrosse, particularly in Central and Western Massachusetts.
Regulating athletics is another responsibility the founding fathers bestowed on the MIAA, but Neal estimated less than 5 percent of the organization’s resources are now devoted to that area. With the tournaments lasting a total of 12 weeks or so, that leaves a lot of free time for an administrative staff that numbers about 20.
It’s time, the MIAA believes, that is well spent.
Starting in the mid-1980s, the organization aggressively moved into an area it refers to as “educational athletics.” The lessons of leadership, teamwork and sportsmanship that had traditionally been viewed as natural byproducts of the sporting experience would no longer be taken for granted. Nor would the idea athletes were any less immune to alcohol or drug abuse than the general student population, all of which led to the development of so-called wellness programs.
There were 213,073 participants in MIAA athletic programs — a figure that ranked 11th in the nation — in 2006-07 according to a survey by the National Federation of State High School Associations. Virtually all of them are exposed to some level of sportsmanship, leadership and wellness education through mandatory meetings each prospective athlete must attend at his or her school prior to the start of each season.
“Very sound and cutting edge, particularly when you’re looking at athletics as a classroom,” said Brian Callaghan, a former athletic director and current assistant principal at Westboro High School.
“The kids love that stuff,” said Russ Davis, who has coached soccer, basketball and softball at Hudson High School. “I really think those programs are worthwhile. Coaches get upset because they don’t back coaches, but what they do for the kids is outstanding. It really is.”
The MIAA has held the Sportsmanship Summit for the last 14 years, the daylong affair drawing more than 1,000 participants. The audience, which pays $40 to $50 each to attend, includes school administrators, athletic directors, coaches and, perhaps most important, the MIAA’s target audience of student-athlete leaders.
In an effort to get more feedback from student athletes the MIAA initiated a Student Ambassadors program this year. Each member school was eligible to have two students participate with the criteria being they had to include a junior and a senior and a boy and a girl.
Senior-to-be Paul Zapantis was one of two representatives from Clinton High School. Every couple of months the Mid-Wach League schools participating in the program met in Hudson where the students, accompanied by their respective athletic directors, would sound off on all manner of topics while an MIAA representative took notes.
“We definitely got to voice our concerns,” said Mr. Zapantis, a member of the Clinton Gaels’ football and baseball teams. “I think they did listen. Some of the new rules we saw, kids didn’t agree with them. We’d tell (assistant director of student services) Pete Smith why we thought they were wrong and why they were right and he’d take that information back to the head guys.”
Despite its full-fledged commitment, which includes doling out more than $400,000 the last two years (with revenue of $203,000), the question remains whether the MIAA’s efforts are necessary or worth the return on the investment. Health education already is taught in schools and several coaches pointed out their profession has traditionally stressed the virtues of leadership, sportsmanship and teamwork on a daily basis during the season.
Mr. Zapantis guessed about 50 percent of his schoolmates “know about the MIAA” and what it stands for. MIAA president Jim Peters admitted the overall impact of “educational athletics” is difficult to measure.
“It’s like anything else, we’re getting to some,” said Mr. Peters, the principal at Monson High School. “Across the board probably not (a dramatic change), but I think were getting to more than we did 20 years ago. That’s just my belief. I do think we’re coming along with those initiatives across the state and we have to keep plugging away.”
In the last 10 years, the MIAA has plunged into the area of educating principals, athletic directors and coaches through workshops and clinics, many of them mandatory.
“The MIAA is really serving as a flagship for professional development across the commonwealth,” said Sean Gilrein, a member of the nonprofit organization’s board of directors and the Dudley-Charlton school superintendent. “That’s essential.”
The motivation, MIAA representatives said, comes from a decline in the number of qualified principals, athletic directors and coaches entering the field over the last decade.
According to Mr. Neal, there is statistically a complete turnover in the principals and athletic directors at the organization’s 371 member schools every 5-1/2 years. Although schools ultimately fill those positions, “In many cases it’s not what they were hoping to get, but the best person available,” MIAA spokesman Paul Wetzel said.
Mr. Callaghan agreed. “I can personally attest to that,” he said, noting more sports and fewer quality candidates has made for a less-than-desirable situation.
Starting in 1998, the MIAA began requiring first-time high school coaches to take a coaches’ education course within one year of being hired. The course emphasizes creating a positive overall experience for student-athletes, one that places less importance on winning.
According to the MIAA, about 600 coaches received training in each of the past three years.
“It’s part of the mentality that started about 10 years ago, to create winning attitudes rather than winning programs,” Mr. Callaghan said.
Not everyone agrees with the MIAA’s foray into professional development.
“My own personal opinion is I think that’s best left to the schools,” Oxford Superintendent of Schools Ernest Boss said.
And for all the effort placed on diminishing the importance of winning, well, nice try, said one longtime, multi-sport coach.
“The kids play athletics to win,” said Mr. Davis, who coached the Hudson softball team to its third straight Division 2 state final appearance last weekend. “I don’t care what they say, there’s not a kid who goes out there (just) to have fun. Fun is part of it, but ask any kid and they’ll tell you its more enjoyable to be on a winning team than a losing team.

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By Jenny Oropeza
California State Senator
Since Day One of the modern environmental movement that began in the 1960s, California has shown national leadership. We passed landmark Clean Air and Water acts, with bipartisan support, and quick federal adoption of Golden State initiatives set the standard for 50 states — and many countries worldwide.
Among several pro-environment bills passed last year, Assembly Bill 32 became internationally famous for committing California to lead the fight for more energy-efficient buildings and reduced greenhouse-gas pollution.
The next logical step: Ensuring future generations of California’s schoolchildren are protected from air pollution and life-threatening respiratory diseases from nearby freeways. Senate Bill 1507 seeks this goal by barring new construction or expansion of freeways within 500 feet of a school.
With help from the Legislature’s 27-member Latino Caucus and others, the public is becoming increasingly aware of the serious health risks to students and employees when a school is located near direct sources of air pollution.
Consider two alarming facts:
A recent state study of Los Angeles area freeways measured fuel particulates near freeways at up to 25 times greater than less congested areas.
A 2005 study by the California Environmental Protection Agency found health risks were greatest within 300 feet of freeways, with a 70-percent reduction in pollution levels beyond 500 feet.
Clearly, freeway pollution hurts ones’ health, exacerbating asthma and impairing learning ability among children. Adding to this airborne toxicity threat is that cars and trucks emit at least 40 toxic contaminants. These pollutants are shown to be concentrated within 500 feet of freeways and busy roadways and can cause irreversible health problems, such as asthma and other lung diseases. These also slow cognitive and developmental growth.
The reasons children are at greater risk are disarmingly simple:

• Compared to most adults, children breathe faster and run around more, increasing their exposure.
• Children often breathe through their mouths, bypassing the filtering effect of the nose, allowing direct inhalation of more pollutants.
• Their immune systems and organs are still developing.
We must provide greater protections to our most vulnerable and defenseless — our children. That is why I authored SB 1507. Although my bill provides exceptions to accommodate safety projects and commuter lanes, the overall goal is ensuring highway developments will not further worsen air quality near schools.

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Worried about the effect of the recession on your career prospects? Don't be. Even in an economic downturn, one sector is staying strong health care.
According to the Bureau of Labor Statistics' (BLS) Current Employment Statistics, health care employment continued to grow in the first few months of 2008. During the past 12 months, the health care sector overall has grown by 363,000 jobs, making it the largest industry in the United States, accounting for 13.5 million jobs.
Better yet, the health care sector will generate 3 million new jobs by 2016, more than any other industry thanks, in part, to aging baby boomers and increased numbers of retirees. Plus, most positions will require less than four years of college education. Here's a look at the four accessible health care jobs and the education or training necessary to break into this growing field.
Registered Nurse
Registered nurses are in high demand. If you're nurturing, detail oriented, and capable of staying calm in stressful situations, a career in nursing may prove a good fit. By 2010, 1.7 million nurses will be needed, but only 635,000 will be available. Demand is highest for nurses in emergency room, operating room, intensive care, pediatrics and labor and delivery room. Median salary in 2006 was $57,280. To become a nurse, enroll in a nursing program, which range from bachelor's, associate degrees, and diplomas.
Health Information Technicians
Were you the designated "note taker" in class? If you're super organized and meticulous to boot, a career in health information technology may suit you. Health information technologists maintain the medical records for patients -- including observations of their general health, medical history and symptoms, X-rays, diagnoses, surgery and treatments. Don't especially like working with people? This is one of the few careers in the health field where you can hunker down in your office, during day, evening, or night shifts. Computer skills are essential in analyzing data. Health information technicians typically earn around $29,290, according to latest BLS figures, and have an associate degree from a community or junior college. Many employers prefer to hire technicians who have become Registered Health Information Technicians (RHIT).
Dental Hygienists
Dental hygienists earn an average of $64,740 and enjoy a relatively "clean" job fostering good oral hygiene by scraping teeth, applying fluoride or sealants, and sometime taking and developing X-rays. Perks often include flexible hours; more than half of all dental hygienists work part time. Many dental hygienists arrange their schedule so they only work two to three days a week. As for educational requirements, you'll need an associate degree or certificate from an accredited dental hygiene school and a state license.
Health Service Managers
Health service managers, also known as health care administrators, manage the business end of specific clinical departments or entire health care facilities. They can be in charge of millions of dollars worth of equipment and hundreds of employees. They must be good managers with an understanding of finance and accounting. The job generally requires some travel and overtime, and pays a median salary of $73,340, according to the BLS. While a master's degree in health services administration, public health, or business administration is standard, a bachelor's degree can land you an entry-level job at smaller facilities.

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Informed by Michel Foucaults concept of disciplinary normalization (1979), feminist disability studies interrogates the complex web of institutionalized techniques of normalization that sustain patriarchy, white supremacy, class power, compulsory ablebodiedness, and compulsory heterosexuality (McRuer 2002). These myriad, mutually reinforcing techniques of normalization subject bodies that deviate from a white, male, class privileged, ablebodied, and heterosexual norm. Seemingly unrelated technologies such as orthopedic shoes, cosmetic surgery, hearing aids, diet and exercise regimes, prosthetic limbs, anti-depressants, Viagra, and genital surgeries designed to correct intersexed bodies all seek to transform deviant bodies, bodies that threaten to blur and, thus, undermine organizing binaries of social life (such as those defining dominant conceptions of gender and racial identity) into docile bodies that reinforce dominant cultural norms of gendered, raced, and classed bodily function and appearance.
6. Translations, as disabled texts, pose the same challenges to the conventional norm as disabled bodies do. They deviate from monolingual textual expectations, and are thus deviant. They threaten to blur, and thus undermine, organizing binaries of social/textual/literary life (such as those defining dominant conceptions of gender/genre and racial/national/linguistic identity). ‘Compulsory ablebodiedness’ requires that translated texts function as docile bodies that reinforce dominant cultural norms of genred, raced, and classed bodily/textual function and appearance.
7. When publishers, teachers, readers, or translators themselves require the translated text read ‘as if it were written in English’, as an ‘elegant’, ‘fluent’ ‘good’ poem ‘in English,’ they collude with and enforce such ‘compulsory ablebodiedness.’ And this is a best-case scenario, for too often publishers’, teachers’, and readers’ anxiety over translation as an incomplete, diminished, impaired version of an original results in translation not being published, taught, or read at all.
8. The effects of compulsory ablebodiedness on translation are intense and repressive. Translations are excluded from most publications, from most prizes, from most workshops, from most ‘English’ literature classrooms, and from most performances.

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Background: A treatment algorithm and screening examination have been developed to guide patient management and prospectively determine potential for highly active individuals to succeed with nonoperative care after anterior cruciate ligament rupture.
Objective: To prospectively characterize and classify the entire population of highly active individuals over a 10-year period and provide final outcomes for individuals who elected nonoperative care.
Methods: Inclusion criteria included presentation within 7 months of the index injury and an International Knee Documentation Committee level I or II activity level before injury. Concomitant injury, unresolved impairments, and a screening examination were used as criteria to guide management and classify individuals as noncopers (poor potential) or potential copers (good potential) for nonoperative care.
Results: A total of 832 highly active patients with subacute anterior cruciate ligament tears were seen over the 10-year period; 315 had concomitant injuries, 87 had unresolved impairments, and 85 did not participate in the classification algorithm. The remaining 345 patients (216 men, 129 women) participated in the screening examination a mean of 6 weeks after the index injury. There were 199 subjects classified as noncopers and 146 as potential copers. Sixty-three of 88 potential copers successfully returned to preinjury activities without surgery, with 25 of these patients not undergoing anterior cruciate ligament reconstruction at the time of follow-up.
Conclusion: The classification algorithm is an effective tool for prospectively identifying individuals early after anterior cruciate ligament injury who want to pursue nonoperative care or must delay surgical intervention and have good potential to do so.

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