Delta Air Lines Inc. will launch its first flights to China with a daily route between Shanghai and Atlanta beginning March 30.
A Boeing 777 will fly between Shanghai's Pudong International Airport and Hartsfield Jackson Atlanta International Airport, according to the company's Web site.
The flights will begin March 30, U.S. time, but due to the time difference flights from Shanghai begin March …
A Booming North-east town is proving a magnet for big-nameretailers.
And residents in Inverurie are set for a shopping bonanza as amulti-million pound retail park and new Aldi store are planned forthe town.
Irish company Northburn Developments was given the go-ahead lastAugust for a major retail park at Oldmeldrum Road. And the scheme has attracted interest from leading businesses such as Argos andHomebase.
It has been suggested the retail park could pump pounds20 millioninto the local economy and create up to 300 jobs. And this week Aldiwas seeking the go-ahead from Aberdeenshire Council for a store inthe town's Harlaw Road.
The retailer had been …
As mandated by the 1998 Washington State Fertilizer Regulation Act, studies were undertaken to: Quantify metals and dioxins in bulk and homeuse fertilizer products; Determine if certain metals have accumulated in agricultural soils; and Provide an initial assessment of typical concentrations of dioxins in statewide soils. Last month, the Washington Department of Ecology (DOE) provided an executive summary of those studies.
Fifty-one fertilizer products were sampled for eight heavy metals and 17 types of dioxins. Most fertilizers had nondetectable or extremely low levels of dioxin, with 70 percent having less than one-tenth of one part per trillion (pptr) toxic equivalents (TEQs). …
Scott Riddle threw for 386 yards and three touchdowns to lead Elon to a 66-12 victory over Presbyterian on Saturday night.
Bo Williamson caught six passes for 167 yards and two touchdowns for the Phoenix (2-1), who scored the game's first six touchdowns.
A.J. Harris led Elon with 91 yards on seven carries and three touchdowns. Jamal Shuman added 80 yards on the ground as the Phoenix totaled 667 yards of offense.
Dontay Taylor scored Elon's first of five first-quarter touchdowns on an 8-yard run just 2:11 into the game. …
Education and Training: College plus training
Salary: Varies—see profile
Employment Outlook: Varies—see profile
Illustrators and graphic designers are both in the business of creating original art to decorate or to convey information. Illustrators draw pictures for books, magazines, and other print materials, including greeting cards and wrapping paper. Graphic designers use art to communicate a message to a certain audience.
Illustrators use light, shadows, and color to create two-dimensional pictures. Most illustrators specialize in a particular type of drawing. For instance, fashion illustrators work for fashion designers and draw sketches of clothing as it is beingdesigned. Technical illustrators draw diagrams that show how to maintain, repair, and use machines and appliances. They prepare their drawings from blueprints, photoprints, or mock-ups, which are scale models of designs and products. Medical illustrators utilize their knowledge of biology and anatomy to draw sketches of the human body and surgical procedures. Their works are used in medical publications to help make difficult concepts clearer. Scientific …
When smoke penetrated the Yanomami Indian reservation in Braziltwo months ago, the shamans of the Yanomami, the largest recentlydiscovered indigenous people in the Americas, recognized it as theancient sign of Armageddon.
The choking clouds were quite logical: The "white men" were atit again, they believed, and this time, the Earth had simply hadenough.
"The ground has been disturbed, and when that happens, thelegend says a great smoke comes and hell is close," said DaviKopenawa Yanomami, a celebrated protector of his tribe, referring tofires in the northern Amazon started by the slash-and-burnagriculture of encroaching Brazilian settlers. The burnings, most …
PHIL CAMPBELL, Ala. (AP) — The Phil Campbell Convention, which honors people who share the name of the only incorporated town in Alabama with a first and last name, has a new purpose this year after tornadoes raked the state.
A tornado destroyed much of Phil Campbell and killed 26 last month. The convention will call attention to the disaster and the group has launched an "I'm With Phil" campaign.
The convention started in …
Japan will start debating a possible sales tax hike after next month's upper house elections to rein in the nation's bulging debt, Prime Minister Naoto Kan said Monday, stressing that sturdy finances are vital for supporting a strong economy and society.
Kan said that a decision on raising the consumption tax, now at 5 percent, likely wouldn't come for at least two to three years, but said a recent proposal by the opposition conservatives to raise it to 10 percent could be considered.
"Strong finances are indispensable for economic growth and social security," he told a news conference, vowing to continue the government's effort to slash wasteful …
ABSTRACT
Peripheral arterial disease (PAD) is considered a manifestation of atherosclerosis primarily affecting the arteries of the lower extremity. Many patients with PAD have symptoms of intermittent claudication IC (PAD-IC) in which pain occurs in the affected muscle during walking and is relieved by rest. Intermittent claudication is associated with decreased walking ability and decreased physical function particularly in activities that require walking. Historically, PAD has been diagnosed, quantified, and managed primarily on blood flow measurements. A growing body of research suggests that changes in peripheral muscle metabolism are part of the disease and can be altered …
A series of near-simultaneous explosions shook courthouses Friday in three north Indian cities, with blasts going off in Lucknow, Varanasi and Faizabad, officials said.
At least 12 lawyers were injured in the explosion in Varanasi, one of India's holiest cities, said Vipin Mishra, spokesman for the Home Ministry of Uttar Pradesh state, where all three cities are located.
Seven people were killed in the explosion in Faizabad, CNN-IBN television reported.
The blasts went off less than 15 minutes …
The Foundation for Health Coverage Education notes 15 million Americans are eligible for free or low-cost public …
The Global Securities Market: A History. By Ranald C. Michie. New York: Oxford University Press, 2006. ? + 399 pp. Index, notes, bibliography, tables. Cloth, $110.00. ISBN: 0-199-28061-4.
Reviewed by Priscilla Roberts
Ranald C. Michie's comprehensive history of the international market in securities, from its origins in Italy in the late twelfth century up to the present, is in most respects a stimulating tour de force, providing a major reassessment of the role of securities markets in the global economy. Eschewing the focus upon spectacular booms, busts, crashes, and scandals, Michie concentrates instead upon the unglamorous normal quotidian operation of trading in …
ATHENS, Greece (AP) — Authorities say a ship meant to take aid to Gaza has reached Greece after allegedly leaving Libya with a dozen aid workers and port officials held against their will over a pay dispute.
Coast guard officials say the Strofades IV arrived at Greece's main port of Piraeus, outside Athens, on Friday. They provided no further details.
According to the London-based Road to Hope group, three Libyan port officials, as well as six Britons, two Irish nationals, an Algerian and a Moroccan, were being held against their will on the Strofades IV.
The group said the vessel broke its moorings at the Libyan port of Derna late Wednesday and headed for Greece following an argument between the shipowner and a broker.
ROME (AP) — Results in the Serie A, the Italian first-division football league (home teams listed first):
| Friday's Games |
|---|
AC Milan 2, Lazio 2
| Saturday's Games |
|---|
Cesena vs. Napoli
| Sunday's Games |
|---|
Juventus vs. Parma
Catania vs. Siena
Chievo Verona vs. Novara
Fiorentina vs. Bologna
Genoa vs. Atalanta
Lecce vs. Udinese
Roma vs. Cagliari
Palermo vs. Inter Milan
| Saturday, Sept. 17 |
|---|
Cagliari vs. Novara
Inter Milan vs. Roma
| Sunday, Sept. 18 |
|---|
Atalanta vs. Palermo
Bologna vs. Lecce
Catania vs. Cesena
Lazio vs. Genoa
Parma vs. Chievo Verona
Siena vs. Juventus
Udinese vs. Fiorentina
Napoli vs. AC Milan
WASHINGTON (AP) — A chemist with the Food and Drug Administration pleaded guilty Tuesday to using a confidential drug database to earn nearly $3.8 million by trading the stock of companies with new drug applications.
Cheng Yi Liang, a chemist who has worked for the FDA since 1996, acknowledged using the database to find out when the FDA would make announcements regarding new drugs and what the agency's decision would be. In some cases, when an application was about to be approved, he would buy shares of the company's stock. When the stock went up after the drug's approval was announced, Liang would sell the stock at a profit.
Court documents say that between 2006 and 2011, Liang purchased and sold stock in more than 25 companies using insider information.
Liang, 57, agreed as part of his guilty plea to forfeit the money he earned in the scheme.
He declined to comment following a hearing in federal court in Greenbelt, Md., where he pleaded guilty to insider trading and making a false statement by failing to disclose his illicit profits on an FDA financial disclosure form. His attorney, Andrew Carter, said his client has submitted his resignation to the FDA.
Liang was originally charged in March along with his son Andrew Liang. At the time, prosecutors said the scheme involved approximately $2.3 million and that father and son used the money to pay for travel and buy new cars. Liang's son pleaded guilty to possessing child pornography at the end of September, but prosecutors dropped the insider trading charges.
Liang faces a maximum of 20 years in prison and a $5 million fine for insider trading. He also faces five years in prison and an additional fine for making a false statement. Federal sentencing guidelines suggest, however, that he will likely receive around five to seven years in prison when he is sentenced Jan. 9.
A separate civil lawsuit filed by the Securities and Exchange Commission against Liang also appears to be wrapping up. A lawyer for the SEC said in a court document filed in early October that Liang had reached an "agreement in principle" that if approved by the commission would resolve the lawsuit. The SEC said it expected the review of that agreement to take 45 days.
___
Jessica Gresko can be reached at http://twitter.com/jessicagresko
Five weeks after the polls closed, former state Treasurer PatrickQuinn finally conceded the Democratic lieutenant governor's raceTuesday, declaring he could not afford the cost of a recount - andthe party could not afford the confusion.
"There is no question that the recount would take from three tofour months to resolve," Quinn said. "And I think it would be adistraction, and it would take attention away from the importantissues of the campaign."
Quinn's surprise decision is a boon to Democratic gubernatorialnominee Glenn Poshard and running mate Mary Lou Kearns, who had beenforced to watch Quinn's maneuverings play out like an unwelcomesideshow to the campaign.Kearns, who is Kane County coroner, won the party's nominationfor lieutenant governor March 17 by a mere 1,468 votes - the closeststatewide election in 46 years. Quinn endorsed her Tuesday."I'm very ecstatic and very grateful that Pat's not goingforward with any expensive legal proceedings and is not going topursue this anymore," Kearns said. "The important thing is weDemocrats are moving forward with the campaign and presenting aunified party."Quinn conceded two hours before his 4:30 p.m. deadline to filea petition for a recount with the state Supreme Court.Quinn insisted he had already uncovered enough votes to beatKearns.He said his scrutiny of selected precincts in Chicago, KaneCounty and three Downstate counties over the past week turned up2,308 votes that would go for him and another 2,430 absentee ballotsthat needed further investigation.But Quinn, 49, a Northwest Side lawyer, said he could not lineup contributors to help him defray the costs of the recount. Hewould have had to pay $50 for each precinct he wanted scrutinized, upto a maximum cost of $75,000, plus a $10,000 filing fee. Legal feeswould be extra."The amount of money for the recount - $85,000 to $100,000 -would have been more than we spent in the whole campaign," he said.Quinn's decision surprised some longtime supporters.Estelle Cukay, 80, a Berwyn retiree who has done volunteer workfor Quinn for 25 years, said, "I really thought he would challengeit. I'm disappointed. And surprised, because we worked so hard -and he worked so hard, and he is a good man."Quinn, who has lost three elections now in four years, left thedoor open to seek office again."I'm not signing my politicial epitaph here," Quinn said. "Aslong as Pat Quinn's around and the water flows and the grass grows,I'll be organizing for some kind of public interest cause."
ESSEX: Tolls at the Dartford Crossing should be suspended duringnext year's Olympic Games, Boris Johnson has said.
The Mayor of London fears people will use the free BlackwallTunnel and burden East London traffic to avoid to cost of crossingthe river.
Mr Johnson said: "During the Olympic Games we are going to needbusinesses and Londoners to consider alternative ways of working ortravelling.
"Heading for the Dartford Crossing will become a majorconsideration for drivers in the east of the city.
"I have asked the Government to give serious thought to delayingits proposed increase, or even better, suspending the charge duringthe Olympics."
COLLISION EXPRESS
Partnership drives success at Collision Express
Even though Carl Cimino had been in the collision repair business for years, he felt completely unprepared when he opened his first body shop in March of 1982. "My desk was a cardboard box with a phone on top, and I was sitting on a bucket-that literally was my first day," he says. He was also on his own after working with his brother off and on for several years.
Cimino started in the collision repair business at age 15, when he landed a painting gig at the car dealership where his brother Chuck worked as general manager. But the younger Cirnino wasn't interested in making body repair his career and enrolled in college on an ROTC scholarship. After a while he decided to drop out and return to the automotive industry. By then his brother was running his own business, and Cirnino took over as manager of the 15,000-sq.-ft. body shop in Philadelphia.
It was a crash course in body shop management, and Cimino continues to draw on this experience today. "When I left college, I was about 21 or 22 and I was managing men who were double my age, and I learned then that they were an asset and they had to be treated like an asset," he says. He worked hard to earn the respect of body technicians and credits this experience with the high retention rate in his current shops.
This early collaboration lasted five years, until the brothers had a falling out. So Carl Cimino opened his own shop-Cimino Complete Auto Center, a small, 2,000-sq.-ft. shop in a rented building in northeast Philadelphia.
Just two years later he'd gained enough experience to open a second site on about 1.5 acres of land in Bucks County, on the current site of Cimino's Collision Express. "When I bought it in 1984, I didn't use the whole property," he explains. "There were two other tenants in parts of the garage, and then, over the course of the next two years, I didn't renew the leases of the tenants and eventually took over the whole property."
Expanding his business required a shift in priorities for Cimino. "One of the first challenges when I was a single shop owner was making that transition from being involved and hands-on working on repairs to being able to hire someone to write estimates and deal with the customers and begin to back out of that process a bit," Cimino says. "That was a big mistake for me. I made a few mistakes with personnel, and I had to regroup a bit ... and the same thing is true with multiple locations. Fortunately I have my brother as a partner in three of the shops."
The Cimino brothers reunited in 1997. That year Carl Cimino was considering buying an auto body shop in Delaware. It was a great opportunity but far from his Pennsylvania base, and he realized he might have a logistical problem on his hands if he didn't find help running the business. So he talked it over with his old mentor, his brother, who had a private plane and lived closer to the potential location. The two went in together and purchased the 10,000-sq.-ft. Blue Hen Auto Body in Dover, Del. Two years later they partnered again to purchase the 10,000-sq.-ft. shop that is now Brookside Collision Express in Brownstown, Pa. and, finally, the 6,000-sq.-ft. Richboro Collision Express in 2002.
"Three of our shops are 100 miles apart, which is kind of a logistical nightmare, but they were tremendous opportunities, and they have turned out to be successes," Cirnino says. The reason: a strong partnership between Carl and Chuck Cirnino that draws on each brothers strengths.
The Ciminos appoint managers at each location who conform to their management style and philosophy. They also have standard operating procedures on the shop floor and use the same technology in each shop-this allows them to move technicians between shops, depending on workflow. "We're both hands-on managers," Chuck Cimino explains. "Obviously, with four locations, two of us can't be in four locations at once. It's very important to have that key person at each location that you can count on. Every day we spend at one of the four shops, and we're on the phone with all the others."
At two of the locations Carl Cimino handles the vendor and insurance relationships, and at the other two, Chuck does. Today the brothers are in charge of 33,000 total square feet and 40 employees, and their business is thriving. Chuck Cimino says the two are lucky because their strengths complement each other, but admits that "sometimes families can work together, and sometimes they can't."
[Sidebar]
SNAPSHOP
NAME: Collision Express
NUMBER OF SHOPS: Four
NUMBER OF BAYS: 60
VOLUME: 275 cars per month
REVENUE: $6.3 million
AVERAGE REPAIR COST: $1,935
EMPLOYEES: 40
[Sidebar]
EXPANSION ISSUES
Location, location, location
Body shop owners looking to expand their business should pay attention to demographics above all else, Carl and Chuck Cimino advise. Knowing your location, they say, is as important as having a successful business philosophy.
"The first thing that I'd recommend is for people to do a demographic study of the area they are interested in," Carl Cimino says. "Historical information is important, but what we've found is that in a lot of cases communities are changing on the upside or downside-and you have to know what side you're coming into."
Issues such as market saturation and labor costs may vary considerably even within a relatively small geographical area. When you cross state boundaries, even more issues arise. "When you work in three different markets so far away from one another, it's a challenge," Chuck Cimino says. "The labor rates in the Delaware market are $4 to $8 an hour less than in the other markets. If you measure by dollars, it's not equal."
But that shouldn't discourage body shop owners from pursuing opportunities in new markets. On the contrary, says Chuck Cimino. "You have to go where you think the business is and where you can have your best shot of success," he says. "When opportunities become available, demographics are so important. But I would also add, don't worry about mileage and distance ... Do the demographics and go to where the business is instead of being dominant player in a market where there isn't enough opportunity."
[Author Affiliation]
By Heidi Moore
Contributing Editor
[Author Affiliation]
HEIDI MOORE is a Chicago-based writer and children's book author. Before she took the leap to full-time freelancinq, she was special sections editor of a daily newspaper. Her shop profile explains how brotherly love helped a Philadelphia shop grow.
Guest Editorial
Immediately following Christmas this year will mark Kwanzaa's thirty eighth anniversary. From Dec. 26 through Jan. 1, millions of African Americans, like myself, will start their week-long celebration by greeting families and friends with the Swahili term Harbari gani! which means What's happening!
Kwanzaa, which means "the first fruits of the harvest," was founded in 1967 by Dr. Maulana "Ron" Karenga, then chairman of the African American Studies department at California State University at Long Beach. Thought to be a Black version of Christmas, Kwanzaa is neither a religious holiday nor a substitute for Christmas. It is a spiritual and cultural holiday whose seven principles of unity (umoja) , self-determination (kujichagulia), collective work and responsibility (ujima), cooperative economics (ujamma), purpose (nia), creativity (kuumba) and faith (imani) represent and reaffirm traditional African American values that extends to all Americans.
The practice of Black economic power and self-reliance have kept the holiday of Kwanzaa financially afloat. Unlike Christmas, which is characterized by rampant commercialism and the accumulation of material objects, Kwanzaa's emphasis is on human relationships and on the spiritual ties and responsibilities that African Americans first have to one another, and then to the larger society.
However, gifts, called zawadi, do play an important role during Kwanzaa. Gifts exchanged are either handmade or purchased from African American vendors in keeping with the fourth principle of Kwanzaa known as cooperative economics.
As a small but thriving business, Kwanzaa keeps Black dollars afloat longer in African American enclaves across the country than any other national holiday. Because its products, like the kinara (the candle holder for seven candles, one black, three red and three green), the Kikombe Cha Umoja (communal unity cup), the Mkeka (place mat) and the bendea (the African American national flag) can only be found in neighborhood Afrocentric curio shops. African American consumers shop there instead of outside their communities. On the whole, these small African and African American owned businesses profit modestly from Kwanzaa items because they are sold only in abundance during a specific time of the year.
Because African American businesses in this country are plagued with financial instability due to racial and economic disparities, the commercial spread of Kwanzaa in stores like Target and Wal-Mart would keep the Kwanzaa dollars afloat, many argue, but these small African American businesses would not financially profit from this sort of commercial popularity.
With the majority of Black dollars already floating out of the community and into store chains like Target and Wal-Mart, we would see the rapid displacement of small African and African American owned businesses. This Kwanzaa holiday, I'll head out to the neighborhood store to purchase my red, black and green candles for the kinara, because I know that the strength of the U.S. economy is found in its multicultural small community owned businesses that reflect our nation's diversity.
[Author Affiliation]
Rev. Irene Monroe teaches religion and is the Center Associate of Multicultural & Spiritual Programming at Pine Manor College in Chestnut Hill.
The World Health Organization says it doesn't have enough information to know if it is winning the fight against drug-resistant tuberculosis.
In a new report on the global status of drug-resistant TB based on data from 2008, the agency says almost half of all people with the disease are in China and India, with both countries reporting about 100,000 new cases each.
High rates of drug-resistant TB strains were also seen in eastern Europe and central Asia, with up to 60 percent of people who already had TB in some parts of Tajikistan and Uzbekistan developing drug-resistant versions.
About 4 percent of all TB cases worldwide are thought to be non-responsive to the usual TB drugs. The agency estimated there were between 390,000 and 510,000 cases of drug-resistant TB in 2008, including about 150,000 people who were killed by the disease. But those numbers are based on modeling and come with a big margin of error.
The report is based on information from 35 countries worldwide, leaving a huge gap in the global TB picture.
"The country data reported to WHO make it impossible at this time to conclude whether the (drug-resistant TB) epidemic worldwide is growing or shrinking," the agency wrote in its report.
In the United States, the proportion of TB cases that are resistant to at least two first-line antibiotics remained stable in 2008, at less than 1 percent. And there were no cases that year of extensively drug-resistant TB, which is resistant to most available treatments, according to the U.S. Centers for Disease Control and Prevention.
The CDC does not yet have data on drug-resistant TB for last year. But other, preliminary data indicate a historic drop in new tuberculosis cases of all kinds in 2009 _ the largest single-year decrease in more than 50 years of federal record keeping.
TB rates fell more than 11 percent in 2009, to 3.8 cases per 100,000 people. Generally, the annual decline is about 4 percent. CDC officials are investigating, but say it could be related to fewer cases coming in to the country through immigration.
Drug-resistant tuberculosis usually arises when people are poorly treated or take substandard medicines. It takes longer to treat than regular TB and requires more expensive drugs, which also cause bad side effects like liver damage.
In recent years, WHO and other health authorities have warned the collision of TB with the AIDS virus could fuel simultaneous epidemics _ and asked for more money to fight both. In its latest report, however, the agency acknowledged there is little proof of that.
Again citing missing data, the agency says "it has not been possible to conclude whether an overall association between (drug-resistant) TB and HIV epidemics exists."
In Estonia, Latvia and Moldova, WHO said people infected with both HIV and TB were more likely to develop drug-resistant TB. But there is no information from many countries across Africa where the most people with HIV live.
Some health experts wondered why WHO's report failed to mention in detail one of the main drivers of drug resistance: bad medicines.
"Many substandard drugs are fakes, but we are also concerned about legitimately manufactured copies _ mainly from India and China _ which are not made to exacting high standards," said Philip Stevens, a health policy expert at the London think-tank International Policy Network.
Stevens said the lack of global TB data was troubling. "WHO doesn't really have a clue as to the true extent of the problem," he said. "It's difficult then, to start promoting targets and goals when you don't know what baseline you are starting from."
WHO reported rates of drug-resistant TB were dropping in some parts of Russia with previously large outbreaks.
"It's good news that it can be controlled even in those difficult regions," said Ruth McNerney, a TB expert at London's School of Hygiene and Tropical Medicine, who was not connected to the report.
McNerney said that though progress was being made, authorities need more money to fight it, and more information about where the disease is striking. "We've got to find out where there are very serious problems, otherwise we won't know about it until it's too late."
___
AP Medical Writer Mike Stobbe in Atlanta contributed to this report.
___
On the Net:
THREE STEPS TO ENSURE A HAPPY NEW YEAR
1
BEFORE THE PARTY: Take a B vitamin complex Vitamin B6, a prominent ingredient in most B complex formulas, may act as a hangover preventative. A small study in 1973 of 17 men and women (published in the Quarterly Journal of Studies on Alcohol) found that taking vitamin B6 before and during an evening of drinking alcohol reduced hangover symptoms by half.
Sipping a glass of red wine or a beer each evening can be beneficial for heart health, according to multiple medical studies. But have a second or third drink-easy to do during the holidays-and not only do you scuttle the benefits, but the next morning may be a slog through headache, nausea and fatigue. While the surest way to avoid a hangover is to eschew alcohol, this three-step regimen can make all the difference after a spirited evening.
2
WHEN YOU GET HOME: Drink at least one glass of water before going to bed. By counteracting the dehydrating effects of alcohol, water lessens hangover symptoms, according to researchers at the University of California, San Francisco, who reviewed multiple studies published between 1966 and 1999.
3
THE NEXT MORNING: Take. 1,000mg of vitamien C plus 140mg of a standardized milk thistle extract. These supplements can ease toxic effects of over-indulging. Animal research has shown that vitamin C prevents an alcohol-induced rise in cholesterol and, through antioxidant mechanisms, can prevent liver damage. Similarly, milk thistle has been used for centuries for its liver-cleansing effects and is believed to work-at least partially-through antioxidant benefits.
Reserve freshman Jon Leuer scored a career-high 25 points and Marcus Landry added 15 to lift No. 25 Wisconsin to a 70-54 victory over Michigan on Wednesday night in the Big Ten opener for both.
Trevon Hughes, the Badgers' leading scorer, returned after missing one game with an injured right ankle and scored five points. The Badgers (11-2) have won five straight games and their only losses are to Top Ten teams _ Marquette and Duke.
Freshman Manny Harris had 16 points and DeShawn Sims added 13 for the Wolverines (4-9), who have lost nine of 11 and are off to theirs worst start since 1981-82.
The game marked the Big Ten regular-season debut for Michigan coach John Beilein and it was the Wolverines' first in 11 days since playing UCLA on Dec. 22.
Wisconsin scored the game's first 10 points as Michigan missed its first nine field goal attempts. The Badgers led 34-18 at halftime with the Wolverines scoring the fewest points in an opening half this season.
The Badgers increased their lead to as much as 20 points in the second half. Michigan used an 11-3 run midway through the half to cut the deficit to 47-39. Freshman Kelvin Grady's 3-pointer with 6:50 left pulled the Wolverines within eight but that was as close they would get the remainder of the game.
Wisconsin, which came into the game limiting opponents to 35.6 percent shooting from 3-point range, held Michigan to 5-of-18 shooting from behind the arc(27.8 percent).
Objective: To describe initial experience with the new technique of isolated limb infusion (ILI) for in-transit melanoma. Design: A prospective case series. Setting: The major tertiary care oncology centre for the state of Victoria, Australia. Patients: Nine patients having for extensive in-transit limb melanoma Interventions: All patients received ILI (13 treatments). Outcome measures: Patient survival, response to treatment and complications of treatment. Results: There were no perioperative deaths and morbidity was limited to deep venous thrombosis and pulmonary embolism in I patient. Control of the intransit metastases was achieved to some degree in all patients and was complete in 4. Conclusions: ILI is an alternative treatment modality for patients suffering from multiple, advanced in-transit melanoma metastases. It provides effective palliation with limited morbidity and offers a safe, quick, inexpensive alternative to isolated limb perfusion with comparable results.
Objectif: Decrire l'experience initiate de la nouvelle technique de perfusion sur membre isole (PMI) dans le cas d'un melanome en transit. Conception : Serie de cas prospectifs. Contexte : Le principal centre d'oncologie tertiaire de l'Etat de Victoria, en Australie. Patients : Neuf patients atteints d'un melanome en transit etendu a un membre. Interventions : Tous les patients ont recu une PMI (13 traitements). Mesures de resultats : Survie du patient, reaction au traitement et complications. Resultats: Il n'y a eu aucun deces peri-operatoire et la morbidite a ete limitee a la thrombose veineuse profonde et a l'embolie pulmonaire chez un patient. Le controle des metastases en transit a etc reussi jusqu'a un certain point chez tous les patients et complet chez quatre patients. Conclusions : La PMI est un mode de traitement de substitution pour les patients atteints d'un melanome en transit avec metastases multiples avancees. Le traitement permet une palliation efficace entrainant une morbidite limitee et offre une solution de rechange peu couteuse, rapide et sure h la perfusion sur un membre isole et donne des resultats comparables.
Melanoma, a common disease worldwide, is increasing in frequency. In up to 10% of patients with advanced melanoma the curious problem of in-transit or multiple cutaneous metastases (ITM) will develop, extending from the site of the original lesion toward the regional lymph node basin. The development of in-transit metastases is related to tumour thickness and the presence of lymphatic invasion by the primary tumour. The median time to presentation with ITM is 13 to 16 months from the time of initial diagnosis. The 5-year survival has been reported as 12%, with a median survival of 19 months.1 The quality of life for these patients is frequently poor due to multiple, ulcerating, painful lesions and a limb with considerable functional impairment. Efforts to reduce the morbidity of ITM are generally palliative.2,3
Surgery, radiotherapy and intralesional therapies are suitable for cases of limited ITM. Isolated limb perfusion (ILP) is usually reserved for patients with extensive, large or recurrent ITM. ILP is a complicated procedure with substantial morbidity and mortality.2,3 Thompson and colleagues4 from the Sydney Melanoma Unit have recently described the procedure of isolated limb infusion (ILl), which is a quicker, safer and cheaper alternative to ILP and offers comparable results. Briefly, the procedure involves administration of high-dose chemotherapy to a hyperthermic hypoxic limb. The chemotherapy is washed out at the conclusion of the procedure. We review the recent initial experience with ILI in Melbourne and the technical aspects of the procedure.
Patients
Patients with ITM were referred to our multidisciplinary melanoma clinic for assessment. ILI was offered to patients with multiple limb ITM. Information on all patients treated with ILI from August 1997 to April 1999, was collected in a prospective manner. This group of 9 patients had extensive disease and had previously been treated with multiple other modalities, including resection and radiotherapy. A second ILI was planned for all patients 4 to 6 weeks after the initial treatment. In patients who had a good response to the planned protocol, further treatments were considered for recurrent or persistent disease.
Surgical methods
The technique of ILI has been described by Thompson and colleagues,4 but we summarize it here. The initial step is measurement of the volume of the limb to be infused and of the partial volumes of the affected limb that can be excluded from infusion. The major artery and vein of the limb are cannulated under fluoroscopic control in the radiology department. The distal end of the catheters are placed at the lower thigh level (or lower arm). Once the patient is suitably anesthetized, heparin, an anti-nausea serotonin antagonist and dexamethasone are administered intravenously, a heated air blanket is placed around the limb and a tourniquet is placed proximal to the tips of the catheters. Disease extending proximally to at least the mid-thigh can be effectively treated if the tourniquet is situated as high up the limb as possible. The catheters are checked for patency, connected to a 3-way stopcock and joined in a circuit. The distal limb is excluded from the infusion field with an Esmark tourniquet if the area is unaffected in order to reduce the toxicity of the procedure. Papaverine is administered to the limb via the arterial catheter. The dose of melphalan and actinomycin D is prepared proportional to the volume of the limb to be infused (melphalan 5 mg/L, actinomycin D 50 mg/L), added to 400 mL of normal saline and delivered rapidly by pressure infusion. The infusate is then circulated manually for 20 minutes in 25-mL aliquots, using a syringe and the 3-way stopcock. The limb is flushed with a litre of Hartman's solution via the arterial catheter and a similar volume is withdrawn from the venous catheter. The tourniquet is removed, followed by the catheters.4
Postoperatively patients remain in bed for 5 to 7 days, and creatine kinase levels are checked daily. Patients take low-dose acetylsalicylic acid daily for 3 months postoperatively.
Results
The results are shown in Tables 1 and 2. One patient received 3 ILIs, 2 patients received 2 ILIs, 2 patients had a second ILI planned, 2 patients had a complete response after their first ILI and 2 patients died after their first ILI. One death was attributed to progression of the disease elsewhere and the other patient died of pre-existing cardiovascular disease. There was 1 complication of ILI, a deep vein thrombosis in the infused limb and pulmonary embolism, which occurred 6 weeks after an uncomplicated ILI. This patient remains alive and well with limited ITM 18 months after the original procedure. Toxicity was graded using Wieberdink's scale: I - no erythema or edema; II - mild, limited erythema or edema; III - considerable, marked erythema or edema, blistering; IV - extensive skin sloughing or compartment syndrome; V - severe injury necessitating amputation.5 All patients in this series were treated for lower limb ITM. Figs. 1 to 3 illustrate the effects of a successful ILI.
Discussion
ITM is commonly seen in patients with advanced melanoma. These patients often present with multiple, ulcerating, painful lesions. Depending on the severity of the disease, a number of different modalities have been used to treat ITM. Radiotherapy is appropriate for disease limited to a small area.6 Surgical excision, intralesional therapy and cryotherapy may also be indicated if the number and size of the lesions is limited. For ITM that are recurrent, residual after other treatments or extensive, a durable alternative is needed. Traditionally, ILP, initially described in 1958 by Creech and associates,7 has been used. In this technique, the circulation of the affected limb is isolated from the systemic circulation by means of an extracorporeal bypass pump as in cardiac surgery. Highdose chemotherapy is administered and circulated through the limb while the temperature of the limb is maintained in a hyperthermic state. Various chemotherapeutic agents have been used, but melphalan remains the most commonly used agent. ILP may be repeated electively 4 to 6 weeks after the primary treatment.8 This is an effective modality for the problem of ITM, but it is expensive, labour intensive, requires specialized equipment, substantial operating room time and has the potential for significant complications. ILP results in a complete response in about 40% of patients, partial response in 40% and no response in 20% of patients treated.2 Moderate complications, such as edema, erythema, injury to skin and adnexal structures, are common and often result in short-term disability.2,9 Severe complications such as myopathy or neuropathy (7%), compartment syndrome, skin loss, thrombosis (5%) and even limb loss (1%) may occur. The overall morbidity of this procedure is significant.2,10
These early limited results are the first to duplicate the work of Thompson and colleagues,4 who introduced the procedure of ILL They reported a complete response rate of 45% and a partial response rate of 42%, which compares favourably with ILP. The complication rates in that study were low with no grade V reactions, and only I of the last 50 patients suffering a grade IV reaction.4 In our series, we found the procedure to be effective and safe, one that can be performed by surgeons with an interest in the management of patients with melanoma. The complications are manageable and usually limited to erythema, swelling and leg pain that resolves in 10 days. The complications are not as severe as those associated with ILP. ILI can be safely performed in elderly patients or those with other serious medical problems, as was the case with 4 of our patients. Prior exposure to systemic chemotherapy in 4 patients did not appear to affect the response to ILI, nor was excessive morbidity noted in patients previously treated with radiotherapy. Two patients with known symptomatic peripheral vascular disease underwent the procedure without complication.
In-transit metastasis is a problem peculiar to advanced melanoma. Limited disease can be effectively managed by complete excision, which may require local flap coverage or skin grafting. More advanced but localized disease may be managed with radiotherapy. These manoeuvres may control the local disease until there is progression elsewhere. A small group of patients have symptomatic and persistent, aggressive or increasing ITM, and it is this group, many of whom have been exposed to previous treatments including surgery, chemotherapy and radiotherapy, who can benefit from ILI.
[Reference]
References
[Reference]
1. Coit DG. Recurrent regional metastases and their management. In: Balch CM, Houghton AN, Sober AT, Soong SJ. Cutaneous melanoma. St. Louis: Quality Medical Publishing; 1998. p. 301-9.
[Reference]
2. Thompson JF, Lai DT, Ingvar C, Kam PC. Maximizing efficacy and minimizing toxicity in isolated limb perfusion for melanoma. Melanoma Res 1994;4(Suppl 1):45-50.
3. Kroon BB. Regional isolation perfusion in melanoma of the limbs - accomplishments, unsolved problems, future. Eurj Surg Oncol 1988; 14: 101-10.
4. Thompson JF, Kam PC, Waugh RC, Harman CR. Isolated limb infusion with cytotoxic agents: a simple alternative to isolated limb perfusion. Semin Surg Oncol 1998;14:238-47.
5. Wieberdink J, Benckhuysen C, Braat RP, van Slooten EA, Olthuis GA. Dosimetry in isolation perfusion of the limbs by assessment of perfused tissue volume and grading of toxic reactions. Eur J Cancer Clin Oncol 1982;18:905-10.
[Reference]
6. Demierre M, Koh HK Adjuvant therapy for cutaneous malignant melanoma. JAm Acad Dermatol 1997;36:747-64.
7. Creech 0, Krementz ET, Ryan RT, Winbald JM. Chemotherapy of cancer: regional perfusion utilizing an extracorporeal circuit. Ann Surg 1958; 148:616-32.
8. Coit DG. Isolation limb perfusion for melanoma: current trends and future directions. Melanoma Res 1994;4 (Suppl 1):57-60.
9. laase JM, Kroon BB, van Geel AN, Eggermont AM, Franklin HR, Dongen JA. A retrospective ocmparative study evaluating the results of a single-perfusion versus double-perfusion schedule with melphalan in patients with recurrent melanoma of the lower limb. Cancer 1993;71(10): 2990-4.
10. Fraker DL. Hyperthermic regional perfusion for melanoma of the limbs. In: Balch CM, Houghton AN, Sober AJ, Soong SJ. Cutaneous melanoma. St. Louis: Quality Medical Publishing; 1998. p. 281-300.
[Author Affiliation]
Rizwan Mian, MD;*^ Michael A. Henderson, MD;t David Speakman, MB BS;^ David Finkelde, MB BS;^ Jill Ainslie, MB BS;^^ Alan McKenzie, MB BSSec
[Author Affiliation]
From the *Bernard O'Brien Institute of Microsurgery, Fitzroy, Victoria, the ^Department of Surgery, St. Vincent's Hospital, University of Melbourne, Fitzroy, and the ^Department of Surgical Oncology, ^^Department of Radiation Oncology and SecDepartment of Diagnostic Imaging, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia
Accepted for publication Mar. 24, 2000.
Correspondence (no reprints) to. Dr. Michael A. Henderson, Department of Surgery, St Vincent's Hospital, Victoria Parade, Fitzroy 3065, Victoria, Australia; henderson@surgerysvh.unimelb.edu.au
Court filings have linked the arrest of an alleged Mexican drug kingpin to more than 130 pounds of heroin netted in a series of Southern California raids in 2008.
The Ventura County Star reported Friday that Jose Antonio Medina's arrest in Mexico on Wednesday was based on a criminal complaint filed in January 2009 by Ventura County prosecutors.
The court filings state the 2008 drug raids occurred after wiretaps recorded 20 phone conversations about drug transactions over a three-month period between Medina and an Oxnard resident.
Prosecutors say Medina is awaiting extradition to Ventura County, where he will face drug charges.
___
Information from: Ventura County Star, http://venturacountystar.com
Jane Ying, MHSc, CPHI(C),1 Joann Braithwaite, RN, CPHI(C), CIC,2 Rise Kogon, CPHI(C)3
ABSTRACT
In 1994 the City of Toronto Public Health Department conducted a needs assessment in the 235 child care centres (CCCs) in the former Toronto area. The purposes of the study were to construct a profile of Toronto's CCCs, to acquire a better understanding of these centres' operations and administration, and to assess their levels of compliance with current public health standards and regulatory requirements. During the study period, five certified environmental health officers audited the 235 centres and interviewed their supervisors using a standardized questionnaire to record self-reported and observational data. The study identified five priorities for public health intervention: written policy regarding monitoring and management of ill children, handling body substances, environmental sanitization procedures and frequencies, water-play table, and injury prevention. The results clearly call for expanding the conventional inspection focus (i.e., primarily food safety) to include other aspects of disease and injury prevention, and for strengthening the onthe-job training programs for CCC caregivers.
ABREGE
En 1994, le service de sante publique de la ville de Toronto procedait a l'evaluation des besoins des 235 garderies de l'ancienne region de Toronto. L'etude visait a elaborer un profil des garderies torontoises, pour mieux en comprendre le fonctionnement et l'administration, et A evaluer la mesure dans laquelle elles respectaient les normes et les exigences reglementaires de sante publique en vigueur. Au cours de l'etude, cinq agents diplomes en hygiene du milieu ont mene des verifications dans les 235 garderies et en ont interroge les surveillants au moyen d'un questionnaire type que ces derniers ont rempli eux-memes en y inscrivant leurs observations. L'etude a cerne cinq priorites d'intervention en sante publique: l'adoption de politiques ecrites sur le controle et la gestion des enfants malades, les precautions a prendre avec le materiel biologique humain, les mesures d'assainissement du milieu et leur frequence, l'usage des tables de jeu que 1 on remplit d'eau, ainsi que la prevention des blessures. Les resultats obtenus montrent clairement qu'il faut elargir la portee conventionnelle des inspections (surtout axees sur la salubrite des aliments) pour inclure d'autres aspects de la prevention des maladies et des blessures et pour renforcer les programmes de formation en milieu de travail a l'intention des intervenants des services de garde.
Whether due to economic necessity or cultural shifts, a growing number of mothers with young children have been joining the labour force in the past two decades. In Canada, 68% of mothers with young children were employed in 1991, up sharply from 52% in 1981.1 The number of licensed child care spaces in Canada has also increased from 17,000.in 1971 to 321,000 in 1990.2 As more families need to seek non-parental child care services, the demand for licensed child care spaces in Canada is likely to continue to rise.
Compared to those cared for at home, children attending child care centres (CCCs) experience a higher incidence of infectious diseases, in particular respiratory and gastrointestinal infections.3,4 Young children's poor personal hygiene and immature immunity to diseases, as well as their close proximity to other children of the same age group, are thought to be the contributing factors.3,4 Other public health issues such as safety, allergy awareness, nutrition, and prevention of long-term diseases also affect the quality of care provided in CCCs.
Child care centres in Ontario are licensed under the provincial Day Nurseries Act (1990) and Regulation 262, which require any premises that provide temporary care to more than five children under ten years of age to be licensed. Routine inspection of CCCs for control of communicable diseases is usually the responsibility of municipal public health units/departments, and the conventional focus of the inspection is on food safety, due to the health units' responsibility to enforce the Food Premises Regulation. In 1992 the Canadian Paediatric Society released the resource manual Well Beings. A Guide to Promote the Physical Health, Safety and Emotional Well-Being of Children in Child Care Centres and Family Day Care Homes,5 and its ten-part strategy for infection control was subsequently recommended by the Ontario Ministry of Health for health units to adopt as minimum standards.
Prompted by the release of Well Beings, and the Ministry's recommendation, the former City of Toronto Department of Public Health planned to expand its CCC inspection program to address a wider range of public health issues. A needs assessment of CCCs was undertaken by the Department in 1994 to aid in the design of the revised inspection program. The purposes of the needs assessment were to construct a profile of Toronto's child care centres, to acquire a better understanding of their operations and administration, and to assess how well the Well Beings' recommendations and the legislative requirements were being met in the CCCs. This article reports the findings from the needs assessment and identifies priorities in need of public health interventions.
METHOD
The needs assessment was conducted between May and September 1994 and it included all licensed child care centres in the former City of Toronto area. Using a standardized questionnaire, five certified environmental health officers (EHOs) audited the CCCs and interviewed the supervisors* or directors during the fivemonth study period. Training was provided to the EHOs prior to the commencement of the assessment.
The needs assessment questionnaire was developed based on the Ontario Day Nurseries Act and Well Beings, and it includes both self-reported and observational data. A total of 82 questions are contained in the questionnaire addressing: type of centre, age groups of children, management of ill children, sun safety measures, animal keeping, diaper changing, water-play table, food preparation, toy cleaning, injury prevention and security, and staff training and experience. The questionnaire was reviewed by three CCC supervisors and several infection control experts within the Department for content validity and comprehensiveness.
Due to the length of the questionnaire, each needs assessment was pre-arranged with the centre's supervisor. After a brief introduction about the purpose of the assessment, the EHO started by interviewing the supervisor about the centre's administration and health-related policies, followed by a "walk through" of the centre, usually accompanied by the supervisor. At each operational site specified in the questionnaire (e.g., diaper change table, waterplay table, kitchen), the EHO would observe the ongoing practices and ask questions about the operation. Any departure from the legislative requirements or Well Beings' recommendations was discussed with the supervisor, and when necessary, subsequent visits were made to follow up on the issues identified.
RESULTS
General profile
All 235 CCCs in the City were assessed between May and September 1994. An average of two hours was needed in each centre for the EHO to complete the questionnaire and to discuss with supervisors any issues needing attention. In five centres the supervisors were not available and a child care staff member was interviewed instead.
The 235 centres provide a wide variety of programs including "full-day", "halfday", "before/after school", "fewer than five days a week", and "any of the five 2hour periods within a day". The full-day program is however the most common arrangement (76%). Thirty-two (14%) of the 235 CCCs are operated for profit, and the remaining are run by non-profit organizations. Nine CCCs (4%) provide services to children with special needs, and 19 (8%) centres are parent co-operatives where the parents participate in the daily child care operations.
Of the 10,849 children (including fulltime and part-time) attending CCCs in the City, the majority (85%) were pre-schoolers or of school age, and only 15% were infants or toddlers. In fact, 134 (57%) CCCs did not have any infants or toddlers attending their centres during the study period.
A total of 1,666 caregivers were employed in the 235 CCCs in the City during the study period. The turnover rates of caregivers are shown in Table I. In approximately 15% of the 227 centres, more than one third of their current staff had been working in the centres for less than a year.
In terms of caregivers' professional training, Regulation 262 requires that all CCC supervisors must hold a diploma in early childhood education or have equivalent academic qualification, and have a minimum of two years experience in the profession. The Regulation also specifies that at least one caregiver for each age-group of children^ shall hold a diploma in early childhood education or have equivalent academic qualification. However, there is no requirement for a minimum level of education or professional training for all caregivers.
Under these stipulations, a mean of 14 years of experience, ranging from 2 to 36 (normal distribution), in the child care profession was found among the 230 supervisors/directors interviewed (five centres with missing data). Seventeen centres (7%) in the City were found to have at least one caregiver who did not complete secondary school.
Policies and operations
Table II summarizes the needs assessment findings pertaining to 13 administrative and operational aspects in CCCs, and outlines the relevant requirements and recommendations from Regulation 262 and Well Beings respectively for comparison.
DISCUSSION
While this was an assessment of CCCs within the former City of Toronto area, the administration and operation of CCCs elsewhere in the province or in the country are probably vulnerable to similar flaws and failures. The responsibility to enforce the Provincial Food Premises Regulation, and the lack of health-specific requirements in the Day Nurseries Act and Regulation 262, have until recently made food safety almost the sole focus of CCC inspection programs in Ontario. The findings of this needs assessment clearly call for an expansion of the inspection focus to include other aspects of disease and injury prevention.
The study identified five administrative and operational priorities for public health intervention:
1)Written policy regarding monitoring and management of illness
Caregivers of CCCs are faced with the issue of managing ill children on a daily basis, and most CCCs (91%) in the City have a written exclusion/re-admittance policy even though this is not required by any legislation. But a high percentage (24%) of them do not record the health reason when a child is too ill to attend or needs to be sent home. This again is not legally required, but it is important for early detection of outbreaks and control of disease transmission. A three-year longitudinal study conducted by Bartlett et al. found that continuous surveillance can effectively decrease the risk of diarrheal infections in CCCs.6 Daily surveillance can be easily incorporated into the children's daily attendance form using a "D" to denote absence due to diarrheal illnesses, "R" for respiratory illnesses, and "A" for other health reasons. A number of centres in the City adopted this practice after the needs assessment.
2) Handling body substance
Less than two thirds of CCCs have adequate procedures and equipment to handle spills of body substances. This is alarming, considering the widespread public health concerns with HIV and hepatitis infections. The low percentage (62%) of supervisors with an accurate understanding of body substance or universal precautions further attests to the need for education and training in this area.
3)Environmental sanitization procedures and frequencies
It is evident from examining the cleaning and sanitizing routines for diaper change areas, toys, and water-play tables, that many centres' current practices were inadequate. The wide range of sanitizers available in the market can be confusing to some CCC supervisors, and many of them were found to be using a costly but ineffective product for equipment sanitizing. While a number of sanitizers (e.g., quaternary ammonium products) are acceptable for use in CCCs, the Department recommends a chlorine-based sanitizer such as bleach for use at the diaper change area. Chlorine is inexpensive and effective in controlling both bacterial and viral agents. The latter is important for CCCs as viral infections such as rotavirus infection are particularly prevalent among young children attending CCCs.
Although many centres were able to meet Well Beings' recommended frequencies for equipment cleaning and sanitizing (i.e., weekly cleaning and sanitizing of toys and daily sanitizing of water tables), some centres found them unattainable. Staff shortage was often the reason cited, and this difficulty is fully acknowledged by the Department. Alternative means such as limiting the number of toys for each day, or integrating certain sanitizing procedures into the daily cleaning routine may help alleviate the workload.
4)Water-play table
In Ontario, "water-play table" is one of the required play activities for toddlers and older children in CCCs, and over 90% of the centres in the City use water-play tables at least on a monthly basis. Environmental surveys have identified both bacterial and viral contaminations in water-play tables, and one study even found up to 8,000 faecal coliform in some play-tables.78 Steps such as increasing supervision, thoroughly washing children's hands before and after the activity, frequent changing of the water, and when possible providing individual play basins and separate toys for each child, are measures that can help reduce the risk of disease transmission.
5) Injury prevention
Since injury prevention is a very broad subject, 20 specific indoor and outdoor safety checkpoints in Well Beings were selected for the needs assessment as a means of maintaining consistency and minimizing differences between the five assessors (Table III). It is very likely that a more extensive safety audit would have identified more potential safety hazards.
Well Beings provides three sample safety checklists for use on a weekly, monthly, and yearly basis. Only five centres at the time of the needs assessment used these safety audit forms regularly. While most centres do have some form of daily informal safety checks (e.g., check for foreign objects in sandbox), CCC supervisors should be encouraged to conduct a systematic safety check on a regular basis.
The overall study findings also indicate the need for improving CCC caregivers' awareness and understanding of infection control and injury prevention. Despite most CCC supervisors having many years of professional experience, the high staff turnover rate and the lack of any legislative requirement for all caregivers to possess a minimum level of child care training, suggest that on-the- job training for CCC caregivers should be a priority for both public health workers and the CCC supervisors. Krilov et al. showed that a comprehensive educational and infection control program could effectively reduce the rates of infections among children attending a specialized child care facility.9 Equally important is the incorporation of infection control principles and training into the early childhood education curriculum, and this requires a joint effort from provincial and municipal governments, and the educational institutions.
Although whenever possible, precise assessment criteria were incorporated into the questionnaire to reduce variation between assessors, a certain degree of professional judgement and personal interpretation was inevitable. During the study period, the team of EHOs met with the study organizers regularly to discuss concerns and to clarify the assessment criteria. Another limitation of the study is the lack of observational data regarding actual practices in CCCs (such as how caregivers washed their hands and how they changed the diapers). EHOs were unable to observe these practices in many centres during the short time of the visits. It should therefore be pointed out that many of the study findings refer to the centre's policies or are based on information reported by the supervisors as opposed to practices actually observed by the assessors.
CONCLUSION
The role of public health workers in CCCs should go beyond ensuring compliance with legislation. Through routine monitoring, education, and consultation, public health workers can help ensure the quality of care provided to children attending child care centres. By presenting objective details of administrative and operational problems in CCCs within a large urban area, this needs assessment may assist health professionals in Canada to design and provide a more effective inspection and education program for CCCs.
ACKNOWLEDGEMENTS
This study is a result of the commitment to more effective services by the former City of Toronto Department of Public Health. The authors wish to thank the infection control team members for their dedication to this project, the staff of the Metro Community Services Department and the Ministry of Community and Social Services for their support and assistance, and Dr. Tim Sly of Ryerson Polytechnic University for reviewing the manuscript.
[Reference]
REFERENCES
[Reference]
1. Logan R, Belliveau J. Working Mothers. Canadian Social Trends 1995;Spring:25-28.
2. Burke MA, Crompton S, Jones A, et al. Caring for Children. Canadian Social Trends 1991;Autumn:12-15.
3. Thacker SB, Addiss DG, Goodman RA, et al. Infectious diseases and injuries in child day care. JAMA 1992;268(13):1720-26.
4. Holmes SJ, Morrow AL, Pickering LK. Childcare practices: Effects of social change on the epidemiology of infectious diseases and antibiotic resistance. Epidemiol Rev 1996;18(1):10-28.
5. Canadian Paediatric Society. Well Beings: A Guide to Promote the Physical Health, Safety and Emotional Well-Being of Children in Child Care Centres and Family Day Care Homes. Toronto: Creative Premises Ltd, 1992.
6. Bartlett AV, Jarvis BA, Ross V, et al. Diarrheal illness among infants and toddlers in day care centres: Effects of active surveillance and staff training without subsequent monitoring. Am J Epidemiol 1988;127(4):808-17.
7. Butz AM, Fosarelli P, Dick J, et al. Prevalence of rotavirus on high-risk fomites in day-care facilities. Pediatrics 1993;92(2):202-5.
8. Fok N, Zazulak E, Mak T. Water Play-Tables in Child Care Centres: Vehicle for Disease Transmission and Control Strategy. Edmonton Board of Health, 1993.
9. Krilov LR, Barone SR, Mandel FS, et al. Impact of an infection control program in a specialized preschool. Am J Infect Control 1996;24:167-73.
Received: September 15, 1997
Accepted: February 13, 1998
[Author Affiliation]
1. Health Promotion and Advocacy Services, Toronto Public Health
2. Communicable Disease and Epidemiology Services, Toronto Public Health
3. Environmental Health Services, Toronto Public Health
Correspondence: Jane Ying, Program Consultant, Health Promotion and Advocacy Services, Toronto Public Health, Toronto Office, 277 Victoria Street, 3rd Floor, Toronto, ON, M5B IWI, Tel: 416-3927685, Fax: 416-392-1482, E-mail: jying@city.toronto.on.ca
The chief U.N. war crimes prosecutor said Tuesday he expected the trial of Radovan Karadzic, the Bosnian Serb wartime leader, to be a tough case _ made even more difficult by Karadzic's insistence on leading his own defense.
Serge Brammertz said he is confident his prosecution team is ready for the trial and pleased it is finally due to start Monday after 15 months of preparation.
Karadzic's trial at the Yugoslav war crimes tribunal is likely to last more than a year, with an appeal could take the case into 2013.
He is accused of 11 counts of genocide and war crimes for masterminding Serb atrocities during the 1992-95 Bosnian war when an estimated 100,000 people were killed.
"We are not expecting it will be an easy trial," Brammertz said. "What we will try to do is stay focused, to try to make clear what it is about."
He said the essence of his case was to prove Karadzic orchestrated a plan of ethnic cleansing of non-Serbs from parts of Bosnia, "to have tens of thousands of people removed from their areas by killing them, by putting them in camps and by an important number of rapes."
Karadzic's decision to represent himself, although he has no legal background, has raised the prospect of a prolonged trial and political grandstanding, as happened with his one-time mentor Slobodan Milosevic. The former Yugoslav president dragged out his trial for four years until he suffered a fatal heart attack in jail in 2006.
Brammertz said he was critical of self-defense cases because international war crimes law was complex and difficult even for trained lawyers. "I'm not always sure this is in the interest of justice" to have an inexperienced person in charge of the defense.
Prosecutors will outline their case in a two-day opening statement next week, followed by Karadzic's opening defense statement the following week. Brammertz, who handed in his final streamlined indictment on Monday, has submitted a list of 409 witnesses he plans to call, but 230 of them will present written testimony to save time. They will be available for cross-examination, he said.
He said the prosecution would deal with the alleged crimes chronologically, beginning with the sniper siege of the Croatian capital of Sarajevo and concluding with the 1995 massacre of some 8,000 Bosnian Muslims in the U.N.-declared safe haven of Srebrenica.
Brammertz said he hoped the start of the high-profile trial will spur the hunt for the last two fugitives indicted by the U.N. court, including Karadzic's top wartime general Ratko Mladic. The second fugitive is ex-Croatian Serb leader Goran Hadzic.
Both were likely hiding in Serbia, he said. Their arrest would be "a clear message that nobody can sit it out" and elude justice.
Karadzic was arrested in July 2008 after 13 years on the run. He had been hiding disguised as a bushy-bearded new age teacher, but little information has emerged about how long he had been in the Serbian capital or how he evaded capture for so long.
O'Connell, who grew up in Northbrook, will be signing copies of her high society mysteries published by Harper Collins featuring widowed Chicago socialite and amateur sleuth Pauline Cook.
"The Book Bin is a long time independent and I love getting people to visit independent bookstores," O'Connell said.
O'Connell is celebrating last month's paperback publication of Well Read And Dead, the second in her series of high society mysteries which began with Well Bred And Dead in 2007.
"I wanted to create someone who stands out in a crowd," said O'Connell. To accomplish that, O'Connell made Pauline Cook a 5 foot, 10 inch tall, vivacious redhead in her 50s.
"She is a little bit of a difficult character but sympathetic," said O'Connell. "When Pauline wants to get to the bottom of something, she does. She is a blue-blood from the East Coast but she marries a Midwesterner. In the first book Pauline reflects upon the time she lived in Lake Forest with her husband. She also has a house in Lake Geneva and a co-op apartment on East Lake Shore Drive in the city."
In Well Read And Dead, Pauline returns from Europe post Sept. 11, 2001, to face major financial set-backs and discover her co-op isn't finished being remodeled so she moves into the Drake Hotel. When the wife of an Astor Street millionaire goes missing, she accepts the challenge of a huge reward to conduct a search which takes her from Chicago to a book club in Oak Park to Aspen to Southeast Asia.
On April 30, O'Connell will also do a talk and a signing at 7 p.m. at The Book Cellar, 4736 N. Lincoln Ave., Chicago.
O'Connell, who is working on Better Wed Than Dead, grew up reading the Northbrook Star and wanting to be a writer.
"I loved growing up in Northbrook. It is always home. My father still lives in Northbrook. I just love driving down the tree-lined streets in the spring and summer."
A graduate of Glenbrook North High School, O'Connell majored in journalism at the University of Colorado. She has been a ski bum in Aspen and a backpacker in Europe, as well as a hotel maid, a bar manager, a sommelier, a floor runner at the Chicago Board of Trade and a sales executive.
"I am a bohemian, sort of. I think that is just the writer's nature," she said.
Her first book, published in 1993, was "Skins," a murder mystery set in the New York City fur world. Although out-of-print, it is available on Amazon.com and still on shelves in North Shore libraries.
"At the time I made friends with a man named David Grafton. He wrote biographies of wealthy women and he took me under his wing," she said.
In 1993, O'Connell was scheduled to do a talk at the University Club in Chicago with Grafton and socialite-author Sugar Rautbord when she called Grafton's home to learn his body had just been discovered.
"It was ruled a natural cause but there were still people who thought something strange had happened because David was found face down on his bed with his arms crossed underneath him. Then they found he had stolen someone's identity 40 years prior for reasons we never did figure out. He wasn't a criminal. I think he just didn't like who he was."
In 2005, O'Connell wrote a murder mystery that incorporated that relationship and those unusual circumstances.
"I just took a lot of what I had seen when I was hanging around with him and incorporated that into characters in the book," she said. "My agent called me and said, 'Can you make this a series?' And I said, 'I'm so happy to be published again I can do anything you want.' "
Author Catherine O'Connell
Book signing 5:30 to 7:30 p.m. April 23 at The Book Bin, 1151 Church St., Northbrook. www.bookbin.booksense.com, www.catherineoconnell.net or (847) 498-4999.
Northbrook native's book series centers on Chicago socialiteO'Connell, who grew up in Northbrook, will be signing copies of her high society mysteries published by Harper Collins featuring widowed Chicago socialite and amateur sleuth Pauline Cook.
"The Book Bin is a long time independent and I love getting people to visit independent bookstores," O'Connell said.
O'Connell is celebrating last month's paperback publication of Well Read And Dead, the second in her series of high society mysteries which began with Well Bred And Dead in 2007.
"I wanted to create someone who stands out in a crowd," said O'Connell. To accomplish that, O'Connell made Pauline Cook a 5 foot, 10 inch tall, vivacious redhead in her 50s.
"She is a little bit of a difficult character but sympathetic," said O'Connell. "When Pauline wants to get to the bottom of something, she does. She is a blue-blood from the East Coast but she marries a Midwesterner. In the first book Pauline reflects upon the time she lived in Lake Forest with her husband. She also has a house in Lake Geneva and a co-op apartment on East Lake Shore Drive in the city."
In Well Read And Dead, Pauline returns from Europe post Sept. 11, 2001, to face major financial set-backs and discover her co-op isn't finished being remodeled so she moves into the Drake Hotel. When the wife of an Astor Street millionaire goes missing, she accepts the challenge of a huge reward to conduct a search which takes her from Chicago to a book club in Oak Park to Aspen to Southeast Asia.
On April 30, O'Connell will also do a talk and a signing at 7 p.m. at The Book Cellar, 4736 N. Lincoln Ave., Chicago.
O'Connell, who is working on Better Wed Than Dead, grew up reading the Northbrook Star and wanting to be a writer.
"I loved growing up in Northbrook. It is always home. My father still lives in Northbrook. I just love driving down the tree-lined streets in the spring and summer."
A graduate of Glenbrook North High School, O'Connell majored in journalism at the University of Colorado. She has been a ski bum in Aspen and a backpacker in Europe, as well as a hotel maid, a bar manager, a sommelier, a floor runner at the Chicago Board of Trade and a sales executive.
"I am a bohemian, sort of. I think that is just the writer's nature," she said.
Her first book, published in 1993, was "Skins," a murder mystery set in the New York City fur world. Although out-of-print, it is available on Amazon.com and still on shelves in North Shore libraries.
"At the time I made friends with a man named David Grafton. He wrote biographies of wealthy women and he took me under his wing," she said.
In 1993, O'Connell was scheduled to do a talk at the University Club in Chicago with Grafton and socialite-author Sugar Rautbord when she called Grafton's home to learn his body had just been discovered.
"It was ruled a natural cause but there were still people who thought something strange had happened because David was found face down on his bed with his arms crossed underneath him. Then they found he had stolen someone's identity 40 years prior for reasons we never did figure out. He wasn't a criminal. I think he just didn't like who he was."
In 2005, O'Connell wrote a murder mystery that incorporated that relationship and those unusual circumstances.
"I just took a lot of what I had seen when I was hanging around with him and incorporated that into characters in the book," she said. "My agent called me and said, 'Can you make this a series?' And I said, 'I'm so happy to be published again I can do anything you want.' "
Author Catherine O'Connell
Book signing 5:30 to 7:30 p.m. April 23 at The Book Bin, 1151 Church St., Northbrook. www.bookbin.booksense.com, www.catherineoconnell.net or (847) 498-4999.
