Approximately 37 cases of the West Nile-like virus have been verified in the metropolitan area, 35 of which occurred in New York City. As of Thursday, six people have died from the infection. At least 165 cases are under investigation by local health authorities. Most of the cases involved elderly patients.

The outbreak began in late August, when several New Yorkers were incorrectly diagnosed with St. Louis encephalitis, an infection similar to West Nile virus. During this time, wildlife experts and bird enthusiasts in the area also became aware of an unusually large number of deaths among birds, particularly crows. Sophisticated laboratory tests detected the West Nile-like virus in both bird and human samples.

St. Louis encephalitis and West Nile viruses are genetically similar and can be confused for one another when conducting rapid diagnostic tests. Both viruses are transmitted by the bites of mosquitoes that have fed off of infected birds. Humans cannot contract the viruses directly from birds nor from other humans.

The viruses also cause similar flu-like symptoms including fever, headache, stiff neck, muscle fatigue and disorientation. Symptoms generally occur 5 to 15 days after being bitten by an infected mosquito. In some cases, the viruses may even cause death, but for most who are infected, the symptoms are mild or even absent.

“In some individuals, particularly the elderly or infants, SLE [St. Louis encephalitis] and West Nile viruses can cause serious diseases that affect the central nervous system,” said New York City Health Commissioner, Dr. Neal L. Cohen, in a statement.

Although health officials now believe that the recently reported cases of St. Louis encephalitis were in fact West Nile-like virus, they remain cautious.

Regardless of the reclassification of the virus, the precautions initially taken to control the spread of the outbreak remain appropriate, experts said. These include the routine spraying of insecticides, such as malathion, to eliminate as many of the disease-spreading mosquitoes as possible. While some concerns have been expressed about exposure to insecticides, the New York City Department of Health assured residents that the low level use of these chemicals is not harmful to humans.

Health officials also recommend that those in the affected areas limit outdoor activity during evening and dusk hours when mosquitoes are most active; wear long-sleeved shirts, long pants and socks when outdoors; and, use insect repellent to reduce exposure to mosquitoes.

When you experience acute, severe, muscular pain, discomfort, you may buy Soma at low, affordable cost. The results can be successful, qualitative and fast.

You know, it would really suck to be on a Reality TV show for people such as myself who can’t stand the taste of alcohol. Everything seems to be centered on wine or some other alcohol as the centerpoint for celebration. Big Brother, there always seems to be alcohol. The Mole serves only wine at dinner. Amazing Race – more wine. I’d be like, “Crap. Can I just get a Coke?”

Brian continues his weekly politically-incorrect commentary moment, which I really like because it’s what so many people probably would’ve thought but wouldn’t have the balls to actually say, “Well, it’s great to welcome everyone into my kingdom. I love opening up my house – Mikasa estukasa (sp?). They’re in my house now. I already have the home court advantage.”

They came up with the love-fest name for their new tribe, Chuay Jai. Everyone seemed very happy, except for Penny and Erin. They kind of stood on the outside, sort of like the beautiful people do when they’re forced to mingle with the lower life forms. They politely smiled but never made much of an effort to befriend everyone and be a part of their world.

Initially I thought that, as Erin stated, they were watching, just getting a feel of everyone, “sizing up the situation.” But they could’ve done this AND mingled and had fun. I’ve seen this behavior so many times from the popular crowd – they’re just not comfortable truly associating with the dorks. Instead of being curious about everyone, instead of wanting to really learn about how they tick – their likes and dislikes, backgrounds and passions, they are more concerned with how others might perceive them should they open themselves up and just be dorks and have fun.

Of course, I really don’t know Penny and Erin so I could be entirely wrong. But I DO know quite a few beautiful people, so I’m basing my thoughts on my experiences with them.

And I know that some of you reading this have chosen not to associate with certain people for fear of what your friends might think. If so, then you’ve missed out on some fun and some growth experiences. If not, then that’s cool; you’re probably a dork.

Remember what the late genius Frank Zappa once said, “I have a message for all the beautiful people in this world: There are a whole lot more of us ugly bastards!”

So, Penny and Erin are wishing they could fit in with the dorks and Shii Ann is just happy happy happy. It’s like she’s become a whole other person.

Or, instead, it’s like she WAS an entirely different person and now she is able to be her happy self once again (which is quite clear from her audition tape, which is hilarious).

Ken notices this as well, “Shii Ann is smiling again. She took a lot of abuse at the other camp – at the hands of Robb, at the hands of Penny. I mean, flat out abuse. And now Penny’s like, you know, trying to figure out what’s going on, trying to figure out Shii Ann’s angle, which is… well that’s Penny. What’re you gonna do?”

After opening a studio in New York, his training became a staple among professional dancers for developing strength and endurance while simultaneously achieving long, even muscle tone. As advances in physical therapy and knowledge of anatomy progressed, a handful of experts in the field improved the original movements for added safety and better results.

Pilates developed more than 500 exercises, emphasizing torso strength and proper breathing to improve posture and develop strong, flexible muscles without adding bulk.

Routines feature stretching and strengthening exercises and introductory movements that can be performed with or without equipment. Because of the precise nature of the routines, and the breathing techniques and concentration needed, Pilates-based programming keeps the mind more in tune with the body, which is why it has been classified as mind/body exercise.

Directions:

1) Do something – Face the facts: Your hair loss will not reverse itself without help. You have to do something. Unless you like the way you look, a receding hairline will not go away by itself. Fighting it requires a plan of action.

2) Obtain a Prescription for Finasteride, a medication available by prescription only that reduces the levels of Dihydrotestosterone or DHT in the blood. DHT is primarily responsible for genetic hair loss. Generic Propecia is the treatment of choice for medical treatment of hair loss, and is one of only two medications that have been approved by the FDA that have proven to regrown hair. The only thing you need to do is take one daily dose and wait for the results. It might take several months before you notice any change.

3) Utilize Rogaine as a Supplement – Rogaine, a topical hair loss treatment which is also known as Minoxidil, is one of two hair loss treatments that have been approved by the FDA and that have been proven to regrow hair. The other FDA-approved medication is Finasteride. You can buy Rogaine as a liquid or foam, and it comes in two different strengths. To apply Rogaine, you simply rub it in the balding spot every day.

4) Overhaul Your Shampoo – As unbelievable as it may seem, you can buy a shampoo that can help fight receding hair lines and hair loss. An anti-dandruff shampoo Nizoral shows mild ant-DHT effects. There is some anecdotal evidence that the Nioxin line of shampoos and conditioners, when used on a regular basis, can help stop the loss of hair and even regrow hair. Getting rid of as much DHT as possible from your scalp and making sure that your scalp is as well-nourished and healthy as it can be, can assist you in combating hair loss and a receding hairline.

5) Laser Combs – Laser combs are a recent addition to the hair loss treatment market. Following laser comb treatments, many men with hair loss have admitted to seeing slight to moderate improvements in the amount of hair on their heads. Lately, there was a laser comb that got FDA approval as a hair loss treatment. Why not look into it?

Debbie Watson, executive director of community relations, described the marketing effort as “consistent and persistent. Establishing a plan well in advance was key to the promotion,” she says. “We stayed in front of potential members. They couldn’t miss an opportunity to receive our message.”

The center’s message to its audience was that it would be “More than a health club.” It used a number of innovative and cost-effective ways to distribute this message. Advertisements focused on discounts for pre-memberships, a highly educated staff and an array of wellness programs. What’s more, advertisements featured testimonials from members of a sister facility, rather than the pumped up, hard bodies plastered on many fitness advertisements. This consumer-friendly approach appealed to a broad audience.

The plan was to keep this message in front of the target market. Knowing that members of wellness centers typically travel from five to 10 miles, the marketing team zeroed in on that radius, using a mixture of advertising vehicles.

Because advertising can be costly, the center took advantage of direct advertising and mailings that were less expensive and more focused on the target audience. “We were able to extend our dollars and maximize the time period for advertising,” says Watson. The local newspaper offered a “pads of ads” program that allowed the center to purchase a particular number of advertisements that ran at the discretion of the newspaper. Rather than the center selecting the days and locations for the ads, the newspaper ran them when it was most convenient for the publication. This saved the center about one-third of the normal cost to advertise. The newspaper also offered zoning, which allowed Winter Park to advertise only in the sections that were distributed in the target market radius.

Winter Park was also able to reach residents who did not receive the newspaper. It used a mailing list it could sort by demographics, focusing on people in the 35 to 64 age range with household incomes of $75,000 or more. These potential members were targeted through direct mailings. Mailings, also used as inserts in the newspaper, were designed as a newsletter-type publication that included articles on wellness and announcements about the new facility.

Other marketing efforts included face-to-face meetings with members of the community. “We went to physicians and organizations like Rotary and Kiwanis. We addressed the subject of wellness and talked about how the Center would meet their needs,” says Watson.

The major blitz, however, was kept until the end. One week prior to opening, the center held several “exclusive” events. The first was a VIP celebration to which board members, donors, media, local businesses and physicians were invited. “We invited people who would be in a position to refer business,” Watson explains.

Following the VIP party, the center played host to a Chamber of Commerce Business After Hours. The week was topped off with an open house for members who had pre-joined, as well as members from the Winter Park’s sister facility.

The community was eager and curious. “We practically had to bar the doors,” says Watson of the incredible turnout to the events. About 4,000 people toured the center during the week-long events. The open house was especially surprising, Watson says. “We opened our doors, and the world came. Our parking lot was full, and when people drove by, they stopped to see what was happening. It really paid off because it established great momentum.”

The payoff came in pre-membership sales. Winter Park exceeded its goal of 800 pre-sale memberships, selling 855 before opening day. And although the center stopped advertising in February of 1997, it continues to average 100 new members each month.

Class members were randomly assigned to one of three training groups. One group (no stretch) did no stretching exercises throughout the 10-week training program. Another group (static stretch) performed a 20-second static stretch following each strength exercise for the muscle group that had just been worked. For example, they did a 20-second quadriceps stretch after the leg extension exercise, a 20-second hamstring stretch after the leg curl exercise and so on for all 12 strength exercises. A third group (StretchMate Stretch) performed six instructor-supervised stretches on a commercial stretching apparatus. Both the static stretch group and the StretchMate stretch group spent about six to 10 minutes of each class in stretching activity. Table 2 shows the results obtained by the three training groups in the Sit and Reach Test.

Consistent with previous studies, the group that performed full-range strength training without stretching experienced a modest improvement in hip/trunk flexibility. The subjects who performed static stretching for each muscle group made greater gains in flexibility, and the group that did instructor-supervised stretches on the stretching machine attained the best results.

The StretchMate group improved hip/trunk flexibility almost twice as much as the static stretch group. Their better results may have been partly due to more focused stretching on specially designed equipment, and partly due to personal instruction and supervision during each stretching session.

Flexibility gains were similar for subjects who did the stretching exercises during the middle and latter phases of their workouts.

Based on these findings, South Shore has added a stretching component to its fitness classes. It also places greater emphasis on supervised stretching exercises in our golf conditioning program. As shown in Figure 1, the golf conditioning participants who performed both strength training (16 machines) and stretching exercises (six StretchMate stretches), increased their club head speed twice as much as those who did strength training only, indicating a powerful practical benefit of enhanced flexibility.

By a vote of 267-159, members rejected an amendment to the annual spending bill for the Department of Agriculture and the Food and Drug Administration offered by Rep. Bernie Sanders (I-VT), that would have allowed firms to “reimport” exported drugs from other countries. Last year, the House approved Sanders’ amendment by a vote of 363-12.

But members at the same time approved, 324-101, a similar amendment offered by Gil Gutknecht (R-MN) that would allow individuals, but not companies, to bring back drugs from other countries for their own personal use.

Backers of the proposals said they would benefit consumers. “It will save substantial sums of money for millions of Americans,” Sanders said.

Said Dan Miller (R-FL), “Americans are free to bring pork chops and other products across the border. Why can’t they do the same with FDA-approved drugs?”

But unlike last year, when Congress was anxious to address the politically potent prescription drug cost issue any way it could, this year many members rose to warn of the potential dangers posed by reimported drugs.

Among the most vehement were members of the House Energy and Commerce Committee, which held a hearing earlier this spring where FDA and Customs officials said they are already inundated by illegal shipments of legal drugs and cannot guarantee their safety even without a change in the law.

“We’ve seen films from overseas of counterfeit drugs–we know drugs are tampered with overseas,” said Ed Bryant (R-TN), a member of that committee.

On Tuesday, Health and Human Services Secretary Tommy Thompson wrote authors of last year’s version of the law that he agreed with his predecessor, Donna Shalala, who said in December that she could not enforce the law because she could not certify, as required, that allowing reimportation would both lower prices for consumers and protect the safety of the drug supply.

Among those speaking against the Gutknecht amendment was Rep. Henry Waxman (R-CA), who helped write the law in 1988 that made reimportation illegal. He said the amendment “is so vaguely drafted it can be interpreted as either ineffective or dangerous, but under no reading is it worth doing.”

Were there any safety concerns about bringing such a powerful medical device into the club? Escola explains, “The Physio-Control AED is user-friendly. Its computer determines whether the victim has a shockable heart rhythm. It is impossible for the responder to override the AED. Electrodes are placed in specified areas, and the responder presses a button for the computer to analyze. The computer then directs the responder to shock and when to initiate CPR.”

Although AEDs have started showing up in commercial airlines in the last few years, inclusion in a commercial environment such as a health club is rare. In fact, the Little Rock Athletic Club is one of the first fitness centers in the country to obtain one. Escola and her colleagues are working to change that.

Part of the problem is the issue of liability. If people can sue a company for scalding themselves with coffee (and succeed), you can bet that a business’ use of an electric shock device is ripe with opportunities for lawsuits should the victim not survive or not return to full health. [See related Law Notes, page ??.] The Arkansas Heart Association is backing legislation to limit liability under the state’s Good Samaritan Act. The legislation would extend protection to the person who uses the device and its actual owner, as well as the owner of the property on which the device is used and the physician who prescribed it.

Backers of the legislation hope that by removing liability, other commercial enterprises will follow the lead of the Little Rock Athletic Club and obtain an AED for their own premises. Escola and Riley have both testified before state lawmakers on the issue during subcommittee hearings.

“Every fitness center should have one — with a staff properly trained in using the equipment,” Escola says. “You need to be able to handle such a situation.” The members at her club are definitely glad to know that she and her staff can do so.

Fortunately for the 49-year-old man, just three months earlier the club added a path-breaking new feature to its emergency and first aid procedures: It installed an automated external defibrillator (AED), a portable device that dramatically increases the chances of survival for a cardiac arrest victim if used within the first few minutes after an attack. After other players notified the front desk attendant, who called 911, two physicians exercising at the club began CPR on the unconscious man. The manager on duty arrived within seconds with the AED. The unit automatically analyzed the man’s irregular heartbeat and administered a single shock that restored it to a regular rhythm. The man was started on oxygen and monitored until the paramedics arrived 12 minutes after he had collapsed. Within a few weeks, he was back on the court shooting hoops.

With 35 to 40 percent of the club’s members 50 years or older, Escola had been concerned with updating the company’s first aid procedures in the event of just such an emergency. After doing some initial research in 1997, she brought the AED to the attention of the club’s other senior managers, and they began talking about this new technology with representatives from the Arkansas Heart Association.

Getting this life-saving device on the premises first required a doctor’s prescription. A physician who exercises at the club and contributes health-related articles to the club newsletter was glad to oblige. After shelling out $4,000 for the AED unit in September 1997, the club brought in representatives from the AED’s manufacturer, Physio-Control, for a three-hour training session with the company’s dozen or so managers.

This group continues to undergo one-hour training and practice sessions every quarter to ensure everyone is as prepared as possible. Escola is also being trained to teach new staff members on the AED.

She notes that they also updated their overall emergency equipment package with an oxygen tank, blood pressure cuff, stethoscope, air splints and communication bases placed strategically around the club.

Despite its price tag, AED units are small, unobtrusive and can be quickly carried to the location where needed. “It’s almost like a purse,” says Escola. “We keep it at our front desk where it is readily accessible but out of sight. A member couldn’t just walk by and grab it.”

Put together by the Tobacco Use and Dependence Guideline Panel, representatives from the federal government, nonprofit organizations and DHHS staff, this report updates the 1996 guideline to reflect current scientific research and findings regarding tobacco addiction.

The report was published as a guide for healthcare professionals in their efforts to help patients quit smoking. Key recommendations of the updated guideline include treating tobacco dependence as a chronic condition and utilizing treatments identified as effective. It further suggests that every patient who uses tobacco be offered at least one form of recommended treatment.

Smoking is the leading cause of preventable death in the United States. Of particular importance to the DHHS were study findings that indicated tobacco users trying to “kick the habit” were not receiving effective care from health professionals. In fact, only about 50 percent of smokers who see a doctor are actually advised to stop.

“The good news is that many of these smokers want to quit. But the bad news is that it’s not easy to break free from the addiction of tobacco,” said Surgeon General David A. Satcher, in a Public Health Service audio news release.

Rather than placing blame on physicians and other healthcare professionals, the updated guideline is intended for use by practicing clinicians trying to get their patients to stop smoking.

“This guideline promises to decrease the enormous burden of illness, death and economic costs that result from tobacco addiction in our society,” said Dr. Michael Fiore, the panel’s chair.

Studies show that 70 percent of adult smokers in the United States want to quit. While the guideline emphasizes that smokers can benefit from different forms of counseling and social support, it does note that each patient’s willingness to quit should be considered.

Other findings and recommendations include:

Brief treatment for tobacco dependence is effective.

There’s a strong association between the effectiveness of tobacco dependence counseling and its intensity.

Three kinds of behavioral and counseling therapies were found to be reliable and should be used with all patients who want to stop using tobacco: problem solving/skills training; social support as part of treatment; and social support outside of treatment.

Clinicians and other health professionals (including administrators, insurers and purchasers) should be consistent in the identification, documentation and treatment of every tobacco user seen in a healthcare setting.

The guideline challenges health plans to pay for tobacco cessation treatments, given the evidence that smoking-cessation treatments work at a much lower cost than other smoking-related medical treatments. Currently, less than 50 percent of health plans pay the low cost of treatment.

“It is a shame that many health insurance plans fail to cover smoking cessation methods,” said Dr. Gilbert Ross, medical director of the American Council on Science and Health. “It is very short-sighted, given the dreadful rate of quitting without assistance, and the long-term health consequences from continued smoking.”

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