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Looking for help to get Dad home

Dear Action Time: I don't know where to turn.

My father, a World War II veteran, is 84 years old and in aVeterans Administration hospital in Buffalo, N. Y. Dad had beenliving alone when he suffered a stroke. Neighbors found him.

Well, I'd like to bring him to Chicago so I can make his lastyears comfortable. But I don't know how to arrange flightreservations for a bedridden person.

Would he need an ambulance to take him to and from the airport?Would he be entitled to any financial help? Dad's only income is aSocial Security check.

Can you please put me in touch with someone who's experienced insuch matters? ANXIOUS, Waukegan

Dear …

CommScope, Office Depot, Savient big market movers

NEW YORK (AP) — Stocks that moved substantially or traded heavily Monday on the New York Stock Exchange and Nasdaq Stock Market:

NYSE

CommScope Inc., up $7.04 at $30.16

Private equity firm Carlyle Group is in talks to buy the network infrastructure company in a deal valued at about $2.98 billion.

Office Depot Inc., up 16 cents at $4.79

The office supply chain's CEO is resigning after last week agreeing to pay civil penalties as part of the company's SEC settlement.

Eastman Chemical Co., up $3.99 at $82.59

The company is selling assets from a money-losing plastics division for about $600 million to a subsidiary of Mexican conglomerate …

Former Celtic player Balde joins Valenciennes

Former Celtic defender Bobo Balde has joined Valenciennes through the end of the season.

The 34-year-old Balde, who signed Wednesday as a free agent, had already spent several days training with the northern club during the offseason.

Balde said on the club's Web site: "I was very happy with this news and I signed …

We must not allow tyranny of majority

There is a bigger issue lurking behind the debate overaffirmative action. It's the lack of protection for the powerlessminority against the will of a powerful majority.

The historical need for the minority to be protected against the"passions" of the majority has been documented by Steven Lubet, a lawprofessor at Northwestern University. In making the case, he notedthat the framers of the Constitution (Article I, Section 3) set theprecedent for affirmative action by giving special treatment to smallstates to protect them against larger states. It was done byallowing two U.S. senators from each of the small states - Delaware,Maine and later Utah, Wyoming and Alaska - …

lists UPCLOSE: Architecture firms

Two architecture firms share the top spot on the list of architecture firms this year.

Reese, Lower, Patrick & Scott, located in Lancaster, and Crabtree, Rohrbaugh & Associates, Upper Allen Township, Cumberland County, both have 18 local full-time registered architects in their firms.

For this list, the Business Journal contacted 98 companies that provide architectural services. This year, 29 companies responded. One firm did not meet the ranking criteria.

Benatec Associates, which ranked sixth on the 2002 list, is not on the list this year. Fairview Township, York Countybased Benatec, which had six architects last year, no longer provides these services, …

Croatia goes football crazy before quarterfinal at Euro 2008

As Croatia prepares to face Turkey on Friday in the European Championship quarterfinals _ its best sporting achievement in 10 years _ Croats have taking their usual football madness even further.

Little Croatian flags are fluttering from all cars on city streets. School children and officer workers are wearing replicas of the team's checkerboard pattern shirts. Women are having their nails done in the flag colors and a boutique in Zagreb is even offering a checkered tuxedo.

Reporter Olgica Ivic Grizelj wrote in the Slobodna Dalmacija daily that she's almost ashamed to go out of her house without the team shirt on, noting that "everyone is in …

Study: Stitches bar female bladder problems

A few well-placed stitches can prevent bladder problems in tens ofthousands of women each year who have surgery to fix sagging internalorgans, a new study suggests.

"It's a very common problem in women, and this is the first timewe've been able to demonstrate that an operation can actually preventurinary incontinence," said Dr. Linda Brubaker of Loyola University,who led the study. Results were published in today's New EnglandJournal of Medicine.

The nationwide, federally funded study was stopped early becausethe benefits were so clear.

It involved 322 women having surgery for pelvic organ prolapse, anuncomfortable condition that is basically a hernia of …

Textile machinery makers at Techtextil

Dilo At Techtextil, Oskar Dilo

Maschinenfabrik KG will present the latest state of the art in needle loom developments, Spinnbau cards and complete lines for the production of needle felts as well as other consolidation technologies. Special emphasis will be laid on the Profi-Line web forming technology. The Profi-Line system CVl consists of Spinnbau-Super-- servo-card with FBK chute feeder from Truetzschler, AutefaTopliner with profiling and Dilo Hyperpunch needle loom. This line significantly reduces area weight variations and realizes CV values below 1%. This topic will also be the subject of a paper given on the symposium for the nonwoven industry held by VDMA at the same time …

Wales beats Denmark 1-0 in friendly

Craig Bellamy scored a late goal Wednesday to give Wales a 1-0 win over Denmark in a friendly.

Bellamy beat the Danish defense in the 77th minute and shot from outside the area past goalkeeper Thomas Soerensen.

After a strong start by Denmark, Wales had most of the chances. Ched Evans and Bellamy had opportunities, but either Soerensen saved or the ball went wide of a post.

Denmark's Michael Krohn-Dehli, Morten Nordstrand, Nicklas Bendtner, Soren Larsen and Dennis Rommedahl all had chances.

___

Denmark: Thomas …

Leopards in National Cup win after nail-biting final ; Brentwood Centre team comes from behind to beat Bristol 64- 63Basketball

A STUNNING final five minutes saw Leopards come from behind tothe win 2012 National Cup final with a 64-63 victory against BristolAcademy Flyers on Sunday. In front of a packed house at Ponds Forgein Sheffield, the Big Cats recovered from a poor first half to liftthe oldest piece of silverware in English basketball. Vernon Teelpicked up the Most Valuable Player award as he finished with 23points, 13 rebounds and six assists.

Ousman Krubally came up with another big double-double, finishingwith 15 points and as many boards, while five of David Buchberger's11 points came in the final 80 seconds as the Big Cats finishedstrongly.

Emotions Dejan Mihevc's team …

Coast Guard: 5 Killed in Plane Crash

ANCHORAGE, Alaska - A sightseeing plane with a pilot and four cruise ship passengers crashed in steep mountainous terrain Tuesday, killing everyone inside, the Coast Guard said.

The wreckage of the single-engine floatplane was spotted by aerial searchers in the area where an aircraft distress signal had been picked up, said Len Laurance, a spokesman for Taquan Air, the Ketchikan-based operator.

Coast Guard Lt. j.g. George Adams said Coast Guard helicopter crews at the heavily forested site were told by searchers at the scene that all aboard the de Havilland Beaver died.

Earlier reports put the plane at an elevation of 2,400 feet, but Adams said the wing portion …

Lobbyist defends work in run for Senate

The revolving door between former members of Congress and lucrative lobbying firms usually leads one way. But Jim Slattery is trying to make a U-turn.

After spending more than a decade in Washington making millions of dollars at one of the nation's most prestigious law firms, the former Democratic congressman from Topeka is jumping back into the political arena in a bid to unseat Sen. Pat Roberts, R-Kan.

Roberts' campaign has already gone after Slattery with radio ads calling him a "Gucci loafers and all" lobbyist who's out of touch with voters.

Slattery, who left Congress after getting trounced in the 1994 Kansas governor's race, says he's …

Boat carrying Myanmar aid sinks; toll climbs beyond 28,000

Myanmar's monumental task of feeding and sheltering 1.5 million cyclone survivors suffered yet another blow Sunday when a boat laden with relief supplies _ one of the first international shipments _ sank on its way to the disaster zone.

The death toll jumped to more than 28,000 and British Foreign Secretary David Miliband warned that "malign neglect" by the isolated nation's military rulers was creating a "humanitarian catastrophe of genuinely epic proportions."

The junta has been sharply criticized for its handling of the May 3 disaster, from failing to provide adequate warnings about the pending storm to responding slowly to offers of help.

Though international assistance has started trickling in, the few foreign relief workers who have been allowed entry into Myanmar have been restricted to the largest city of Yangon. Only a handful have succeeded in getting past checkpoints into the worst-affected areas.

But in what was seen as a huge concession by the junta, the United States finally got the go-ahead to send a C-130 cargo plane packed with supplies to Yangon on Monday, with two more air shipments scheduled to land Tuesday.

Myanmar's military rulers are deeply suspicious of Washington, which has long been one of the junta's biggest critics, pointing to human rights abuses and its failure to hand over power to a democratically elected government.

"We hope that this is the beginning of a long line of assistance from the United States," White House spokesman Gordon Johndroe told reporters in Crawford, Texas over the weekend. "They're going to need our help for a long time."

Highlighting the many challenges ahead, however, a Red Cross boat carrying rice, drinking water and other goods for more than 1,000 people sank Sunday near hard-hit Bogalay town. All four aid workers on board were safe.

The International Federation of Red Cross and Red Crescent Societies could not say how much of the cargo has been lost, but it said the food supplies were contaminated by river water.

"Apart from the delay in getting aid to people we may now have to re-evaluate how we transport that aid," said Michael Annear, the IFRC's disaster manager in Yangon, who described the sinking as "a big blow."

Other aid was increasingly getting through, the group said, but on "nowhere near the scale required."

Heavy showers were forecast for the coming week, further complicating delivery of aid that is still barely reaching victims in the Irrawaddy delta, which was pounded by 120 mph winds and 12-foot-high storm surges from the sea.

In hard hit Laputta, hundreds of survivors crowded the floor of a monastery's open-air hall, the sound of hungry children wailing. Many people tried to sleep sitting up because of lack of space.

Pain Na Kon, a tiny nearby village of just 300, was completely obliterated. The only 12 known survivors huddled together in a tent set up in a rice field, sharing a small portion of biscuits and watery soup handed out at a local monastery.

"We don't know when they will also run out of food," said U Nyo, casting glances at his 6-year-old niece, Mien Mien, who lost both her parents in the cyclone and sat outside in the dark.

U Nyo called out to her gently, but Mien Mien stared emptily into the darkness. Overcome with emotion, U Nyo walked, teary-eyed, over to the girl and sat beside her in silence.

His wife, Saw San Myant, described in a hushed voice what had happened to Mien Mien's father.

"We hung together on a coconut tree as the tide continued to rise. Her father was separated. He tried to hang onto a pole of the hut but that was broken. The wind was too strong. She saw her father swept away by the water but we didn't see anyone else. We think they are all dead," she said.

On Sunday, Myanmar's state television said the death toll from Cyclone Nargis had gone up by about 5,000 to 28,458 _ with another 33,416 missing _ though some experts said it could be 15 times that if people do not get clean water and sanitation soon.

"A natural disaster is turning into a humanitarian catastrophe of genuinely epic proportions in significant part because of the malign neglect of the regime," said British Foreign Secretary David Miliband.

"I would be amazed if there hadn't been about 100,000 who had died already ... what's more, hundreds of thousands more are at risk," he told British Broadcasting Corp. television.

Meanwhile, aid was piling up in foreign countries, awaiting approval from the junta.

The country's main airport in Yangon is incapable of handling more than five flights a day, when it should be taking in at least one every hour, said PLAN, a London-based children's aid group.

"Logistically, the situation looks bleak," it said in a statement. "In short, they have one congested airport, ill equipped to deal with the influx of cargo, no port, restricted fuel and no trucks."

Aid group World Vision said it has requested visas for 20 people and received approval for two, while the U.N. World Food Program had one approved out of the 16 it requested. Still, the U.N. was making some progress in aid delivery.

The junta released 38 tons of high-energy biscuits to the WFP that were confiscated on Friday and several other shipments were on their way.

"We're delighted and very encouraged by what is a very positive sign," said the group's spokesman, Marcus Prior.

But World Vision, which has a big presence in Myanmar, said relief material delivered so far is a tiny fraction of what is needed.

The junta says it wants to hand out all donated supplies on its own.

But many survivors have been without help for more than a week after fleeing their inundated villages to take shelter in monasteries and schools in towns. The canals and flooded roads to higher ground were littered with the bloated bodies of humans. The stench was everywhere.

"The first few we saw, we were all very shocked," said U Pinyatale, a monk living near the Pyapon River, where dozens of corpses floated in the brackish waters. "After a while, there were just too many."

Time to Get Mad

Isn't this swell: The St. Regis New York is celebrating the new season of "Mad Men," debuting at 9 p.m. Sunday on AMC. (The hotel's King Cole Bar is a favorite watering hole of characters Don Draper and Roger Sterling.) The $895 package includes in-room dining with '60s-style food and drinks, a bottle of Draper's cologne and his wife's red lipstick, among other things. It's available for Sunday night stays all season long; stregisnewyork.com.

U.S. Envoy Warns N. Korea on Provocation

WASHINGTON - A top State Department official cautioned North Korea on Monday to avoid "any type of provocative activity" and to return to negotiations on its nuclear weapons program.

Referring to reports that North Korea might be preparing to launch a long-range ballistic missile, Undersecretary of State Nicholas Burns said "that would be a profoundly unwise step by the North Koreans."

"They have heard from just about everybody in the international community, including China, including Russia, that that would be not only extremely unwise, it would be opposed by all the countries in the world," Burns said in an interview with C-SPAN scheduled for airing Sunday.

"It would be profoundly unwise of them," Burns said, describing North Korea as "an unpredictable regime."

"Our advice to the North Korea is to come back to the six-party talks," Burns said, referring to talks Pyongyang suspended with the United States, China, Japan, South Korea and Russia. "And our strong advice obviously is for the North Koreans not to engage in any type of provocative activity surrounding these talks," he said.

The administration responded sternly to an annihilation threat from North Korea, saying while it had no intention of attacking, it was determined to protect the United States if North Korea launched a long-range missile.

"Should North Korea take the provocative action of launching a missile the U.S. would respond appropriately, including by taking the necessary measures to protect ourselves," Julie Reside, a State Department spokeswoman, said.

Still, the United States has no intention of invading or attacking North Korea, Reside said. Rather, she said, the United States and other countries that have negotiated with North Korea are seeking a fundamentally different relationship. She said it must be based on the complete and verifiable elimination of North Korea's nuclear weapons and nuclear program.

"We and our partners in the six-party process continue strongly to urge North Korea not to launch a long-range missile and, instead, to return to the six-party talks," she said in a statement.

South Korea's former negotiator, Song Min-soon, is due in Washington later in the week for talks, and North Korea's nuclear and missile programs are certain to be on the agenda, said a U.S. official, who spoke on condition of anonymity because the official is not authorized to announce visit. Song is now South Korea's national security adviser.

The confrontation with Pyongyang was one of a number of issues Bush and United Nations Secretary-General Kofi Annan discussed during a phone call Monday evening.

National Security Council spokesman Fred Jones said Annan called Bush to discuss last weekend's meeting of the World Trade Organization. "Both agreed WTO talks were at a critical stage and that the success of negotiations is a priority," Jones said.

The two leaders also discussed Israel, Sudan and Iran during the half-hour conversation, Jones said.

North Korea vowed on Monday to respond with an "annihilating" nuclear strike if its atomic facilities were attacked pre-emptively by the United States.

The warning was a stepping up of the North's customary anti-U.S. vitriol, in which it often accuses Washington of plotting an attack. The reclusive North has recently come under heightened scrutiny after reports by the United States and Japan that it has taken steps to prepare for a test of a long-range missile.

White House spokesman Tony Snow refused to respond to what he called "a hypothetical situation."

"It is a statement about what may happen if something that hasn't happened, happened - if you follow my drift," he said.

The North's Korean Central News Agency, citing an unidentified "analyst" with the state-run Rodong Sinmun newspaper, accused the United States of harassing Pyongyang with war exercises, a massive arms buildup and increased aerial espionage by basing new spy planes in South Korea.

Medicure's MC-4232 exceeds expectations in Phase II trial

Winnipeg - Medicure Inc. (TSX: MPH; AMEX: MCU), a cardiovascular drug discovery and development company, reported that its MC-4232 met primary blood pressure and metabolic endpoints in their Phase II MATCHED study. The study evaluated MC-4232, a combination of MC-1 and the ACE inhibitor, lisinopril, in the treatment of coexisting diabetes and hypertension. Based on these positive results, the company plans to move forward with a pivotal Phase III clinical development program for MC-4232.

"The trial has exceeded our expectations, demonstrating the clinical benefits of MC-4232," commented Medicure's President and CEO, Albert D. Friesen, PhD. "We believe the evidence presents a unique development opportunity, advancing a novel product with combined blood pressure and multiple metabolic benefits for a patient population in desperate need for improved treatment in both areas. We are now advancing MC-4232 into Phase III pivotal studies and these results set the stage for the development of other cardiovascular combination products."

The results of MATCHED demonstrated the positive clinical effects of MC-4232 on primary and secondary blood pressure endpoints, including both systolic and diastolic measurements: The 300mg/20mg (MC-1/lisinopril) dose of MC-4232 had a statistically significant reduction of 12.0 mmHg from baseline over eight weeks on the primary endpoint of mean daytime ambulatory systolic blood pressure (MDASBP).

The 300mg/20mg dose reduced MDASBP by 12.0 mmHg over eight weeks as compared to a 7.5 mmHg reduction with lisinopril alone, demonstrating the improved antihypertensive effects of MC-4232 over lisinopril alone.

In the secondary endpoint of reduction in MDADBP, the 300mg/20mg dose of MC-4232 reduced MDADBP by 7.5 mmHg over eight weeks as compared to a 4.1 mmHg reduction with lisinopril alone, again demonstrating the improved antihypertensive effects of MC-4232 over lisinopril alone.

The results of MATCHED also demonstrated the positive clinical effects of MC-4232 on primary and secondary metabolic endpoints, including glycemic control as measured by fasting serum glucose and glycated hemoglobin (HbAIc), as well as lipid control, after 16 weeks of treatment.

"While medical guidelines recommend stringent blood pressure targets for diabetic patients, such as those studied in the MATCHED trial, achieving and maintaining these targets has proven to be extremely difficult. Although all classes of antihypertensive agents are effective at lowering blood pressure in diabetic patients, treatment has been further complicated by the fact that some major classes have been shown to have deleterious effects on glycemic control," the principal investigator of the study, Yves Lacourciere MD, FRCP, FACP, said. "The results demonstrate that MC-4232 not only provides clinically important blood pressure reduction beyond that of lisinopril alone, but also improves upon the glycemic and lipid control offered by current therapies. Based on this data, I believe MC-4232 could be an innovative new treatment that in addition to significant blood pressure reduction also offers metabolic benefits to patients with coexisting diabetes and hypertension."

The MATCHED study (MC-1 and ACE Therapeutic Combination for Hypertensive Diabetics) was designed as a Phase II trial to determine the optimal dose and endpoint for Phase III development of MC-4232. MATCHED was a randomized, parallel group, cross-over, double-blind, placebo-controlled comparison of 100, 300 or 1000 mg of MC-1 alone and in combination with 20 mg of lisinopril. The study results are based on a population of 120 patients with coexisting type II diabetes and hypertension from 12 sites across Canada. In order to minimize the carryover effects of lisinopril, all patients were randomized in two different treatment sequences. Patients randomized in the first treatment sequence received an eight-week treatment with MC-4232 (20 mg of lisinopril and MC-1) or placebo and then an 8-week treatment with MC-1 alone or placebo. Patients randomized in the second treatment sequence received an 8-week treatment with MC-1 alone or placebo and then an 8-week treatment with MC-4232 or placebo. In each treatment sequence, all patients were randomized to MC-1 at one of the three prespecified dosages.

This trial was conducted under the guidance and direction of the internationally recognized hypertension specialist, Yves Lacourciere, Director of the Hypertension Research Unit, Centre Hospitalier de l'Universite Lavai Sainte-Foy, Quebec. Dr. Lacourciere, one of North America's foremost experts in management of hypertension in difficult to treat patient groups, led a group of specialist investigators who enrolled patients at sites across Canada. Dr. Lacourciere has led numerous important hypertension studies and serves as a scientific advisor to several leading pharmaceutical companies.

Medicure is focused on developing effective therapeutics for unmet needs in the field of cardiovascular medicine, the largest pharmaceutical market sector. The company has two drugs - MC-1 & MC-4232 - in advanced clinical development with three positive Phase II trials already completed.

Undetected Anemia Is Threat to Elderly

Many elderly people may have undiagnosed anemia, and doctorsshould know that the higher prevalence in this age group is notnecessarily a normal sign of aging, a new study suggests.

Anemia is one of the most common signs of underlying disease,and doctors who spot anemia should look for any stomach or intestinalbleeding that could be causing the disorder, according to researchersfrom the Mayo Clinic in Rochester, Minn.

Anemia is characterized by a decrease in red blood cells, or inthe hemoglobin concentration of the blood, that is below a specified"normal" value. Hemoglobin is a compound found in red blood cellsthat carries oxygen to the cells.

In the study, published in the current issue of the journal MayoClinic Proceedings, the researchers studied the prevalence of anemiain residents of Olmsted County, Minn., as well as in a comparisongroup from outside the area.

The Diminished Divide: Religion's Changing Role in American Politics

The Diminished Divide: Religion's Changing Role in American Politics, by Andrew Kohut, John Green, Scott Keeter and Robert Toth, Brookings, 178 pages.

Shows how religion is an important factor on political attitudes, partisanship and voting. Uses extensive survey data to analyze the relationship between politics and religion. **

** HIGHLY RECOMMENDED

* RECOMMENDED

* NOT RECOMMENDED

The effect of epsilon aminocaproic acid on blood loss in patients who undergo primary total hip replacement: A pilot study

Original Article - Article original

Objective: To determine if the use of an antifibrinolytic agent (epsilon aminocaproic acid [EACA]) decreased perioperative and postoperative blood loss in patients who underwent total hip arthroplasty (THA). Design: A prospective, double-blind, randomized, controlled clinical trial. Setting: A university-affiliated tertiary care hospital with a large joint arthroplasty population. Participants: Fifty-five patients who were scheduled for a primary THA. Method: Patients were randomly assigned to 2 groups to receive either EACH or saline placebo perioperatively. Preoperatively, the groups were similar with respect to gender, mean age, mean hemoglobin level, operative time and prosthesis type. Outcome measures: Blood loss from the start of surgery until the Hemovac drain was removed, and the transfusion rate and hemoglobin levels. Results: Mean (and standard error) total blood loss for patients receiving EACH was 867 (207) mL and for patients receiving placebo was 1198 (544) mL (p < 0.025). Four patients in the EACH group received 7 units of packed red blood cells and 7 patients in the saline group required 12 units. Conclusions: Patients receiving the placebo sustained greater total blood loss than EACA patients and were more likely to require blood transfusion. In the current climate of concern over blood transfusions during surgery, EACA administration can reduce blood loss and consequently transfusion and transfusion-related risk.

Objectif: Determiner si l'utilisation d'un antifibrinolytique (acide epsilon amino-caproique [AEAC]) a permis de reduire la perte sanguine perioperatoire et postoperatoire chez des patients ayant subi une arthroplastie totale de la hanche (ATH). Conception : Etude clinique controlee, randomisee et prospective a double insu. Contexte : Hopital de soins tertiaires affilie a une universite, ou sont effectuees un grand nombre d'arthroplasties d'une articulation. Participants: Cinquante-cinq patients chez lesquels on devait pratiquer une ATH de premiere intention. Methode : Les patients ont etc repartis au hasard en deux groupes, pour recevoir de l'AEAC ou un placebo de solution saline en periode perioperatoire. Avant l'intervention, les deux groupes etaient semblables quant au sexe, a l'age moyen, au taux moyen d'hemoglobine, a la duree operatoire et au type de prothese. Mesures de resultats : La perte sanguine entre le debut de l'intervention et le moment oh le drain Hemovac a ete enleve, le taux de transfusion et les taux d'hemoglobine. Resultats : La moyenne (et l'erreur type) de la perte sanguine totale s'etablissait a 867 (207) ml chez les patients ayant recu de I'AEAC et a 1198 (544) ml chez les patients ayant recu le placebo (p < 0,025). On a administre 7 unites de concentre de globules rouges a 4 patients du groupe de traitement par AEAC, et 12 unites a 7 patients du groupe placebo. Conclusions Comparativement aux patients ayant recu de FAEAC, les patients du groupe placebo ont subi une perte sanguine totale plus importante et etaient plus susceptibles d'avoir besoin d'une transfusion sanguine. Dans le contexte actuel des preoccupations que soulevent les transfusions sanguines au tours des chirurgies, l'administration d'AEAC peut reduire la perte de sang et par consequent les transfusions et les risques qui s'y rattachent.

Total hip arthroplasty (THA) may be associated with marked blood loss. Because of the risks of homologous blood transfusions, which have been well publicized,1 surgeons are enlisting the use of various blood-conserving techniques to reduce patient requirements for homologous blood. Autologous predonation programs have become a common method of blood replacement in recent years. Pharmacologic therapies that boost hemoglobin levels preoperatively have also been shown to reduce transfusion requirements.2 Normovolemic hemodilution and hypotensive anesthetic techniques reduce intraoperative blood loss, but they are not preferred techniques for elective THA.3 Although all of these techniques can reduce the requirement for homologous blood transfusion, they do not eliminate the need for homologous blood.

Perhaps the greatest change in homologous blood transfusion therapy has occurred because of modification to the routine practice of transfusion for hemoglobin values less than 100 g/L.4-6 As medical experience with hemoglobin levels in the 80 g/L to 90 g/L range increases, the indications for homologous blood transfusion continue to evolve.7

Administration of pharmacologic agents to decrease surgical blood loss has been well described. The use of epsilon aminocaproic acid (EACA) as a therapeutic agent was first described in 1960.(8) EACA inhibits fibrinolysis as a result of its reversible complex formation with the lysine-binding sites of plasminogen and the active protease plasmin. It therefore acts by preventing the premature dissolution of the normal fibrin clot. The use of EACA for the prevention of surgical blood loss has been well established in the field of cardiothoracic surgery,8,9 and it has also been found to reduce bleeding associated with neurosurgical and urologic procedures.8

The experience with antifibrinolytic agents in orthopedic surgery is limited. A small number of clinical trials have investigated the administration of the synthetic antifibrinolytic tranexamic acid in total knee arthroplasty, and 3 studies examined the use of the natural antifibrinolytic aprotinin in THA.10-15 All of these studies documented reductions in blood loss and decreased blood transfusion requirements. Importantly, the safety of antifibrinolytic agents was clearly demonstrated in these clinical studies. These studies, as well as the cardiothoracic surgery literature, have consistently shown no increased risk of venous thromboembolism as a result of their administration. We know of no study that has examined the effectiveness of EACH in hip or knee replacement surgery.

The primary objective of this study was to determine if the use of EACA reduced blood loss in patients who underwent primary THA. The secondary objectives were to compare hemoglobin levels in patients who received EACA to those who received a placebo, to compare the coagulation profiles in these 2 groups, and to determine if the use of EACH reduced the number of transfusions required. We hypothesized that administration of EACA preoperatively and intraoperatively would reduce blood loss in these patients and thus help to reduce exposure to homologous blood products. Using dosages drawn from the experience in cardiac surgery, we undertook a randomized study of EACA in primary THA.

Patients and methods

This prospective randomized clinical trial comprised patients presenting for primary THA at a major teaching hospital between February 1998 and September 1999. All patients scheduled to undergo a primary THA by 1 of 4 experienced surgeons were eligible for the study. Exclusion criteria included a known allergy to EACA, a history of renal or hepatic failure, coagulopathy, uncontrolled hypertension, symptomatic cardiac or pulmonary failure, or known upper urinary tract bleeding. Ethical approval was received from the regional internal ethics review committee.

Fifty-five patients were enrolled into the study and provided informed written consent. Patients were randomly assigned to receive either EACA or saline placebo administered from uniformly blinded bottles. Patients, anesthesiologists, surgeons and clinical evaluators were blinded to the patient allocation. The anesthetic technique applied was at the discretion of the anesthesiologist and patient. All arthroplasties were performed through a Hardinge lateral approach. The use of cemented or press-fit technique for the femoral component was based on the surgeon's preference. All patients received a press-fit acetabular component. A volumetric drain was placed deep into the wound through a separate skin site in all patients.

Perioperative protocol

An EACA loading dose of 150 mg/kg, or the equivalent dose of placebo, was administered as a bolus load over 20 minutes on the patient's arrival in the operating room. An hourly EACH infusion of 12.5 mg/kg, or equivalent placebo, was subsequently administered for an additional 5 hours. Crystalloid was administered at a maintenance rate at the start of each procedure and was also used in a 3:1 ratio to match ongoing blood loss. Colloid preparations or homologous blood products were not used unless clinical evidence of excessive bleeding was supported by laboratory documentation. Measurement of suction losses and weight of sponges were used to assess intraoperative blood loss. Blood samples were drawn when blood loss exceeded 500 mL and every 45 minutes thereafter. If the hematocrit decreased to 0.24 or lower, intraoperative packed red blood cell were transfused in addition to crystalloid to maintain a hematocrit of 0.24 or more. In the recovery room, a complete blood count and a coagulation profile, including international normalized ratio (INR), partial thromboplastin time (PTT) and D-dimers, were obtained.

Postoperative blood loss was measured from the drain output, with drain removal occurring when drainage was less than 30 mL over an 8-hour period. Drain removal typically occurred on postoperative day 2. Hemoglobin concentrations and hematocrits were measured at the following intervals postoperatively: 5 hours, 24 hours, 3 days and 7 days or prior to discharge. Packed red blood cells were transfused according to standardized guidelines that exist for orthopedic patients at the study institution. These guidelines consist of the following: a hemoglobin level less than 80 g/L or a hematocrit less than 0.24; patients having symptoms from their anemia (including tachycardia, dyspnea, chest pain or recurrent syncope); or medical conditions that render the patient unable to compensate for diminished oxygencarrying capacity.

The THA clinical pathway currently in use at the study institution directed all routine postoperative care. Standard postoperative anticoagulation consisted of 5000 units of heparin administered subcutaneously every 12 hours until the INR became greater than 2.0 with daily coumadin administration. Heparin was then discontinued and patients were continued on coumadin for 6 weeks postoperatively. Patients were assessed for deep venous thrombosis and pulmonary embolism while in hospital through daily clinical examination. Any suspicious symptoms or signs were investigated further with Doppler ultrasonography or ventilation-perfusion scans. All patients received physiotherapy postoperatively and were mobilized as tolerated according to clinical pathway guidelines.

Descriptive statistics and univariate analyses were performed on all variables. chi^sub 2^ tests were used to identify any systematic differences between categorical variables. Nonparametric tests (Mann-Whitney U test) were used for categorical variables that were not normally distributed. Student's t-tests and analysis of variance were used to identify systematic differences between continuous variables that were normally distributed. Statistical analyses were performed using the SPSS software version 7.5. All statistical analyses were performed with 2-tailed tests and at a 0.05 level of significance.

The sample size calculations of this pilot study were based on postoperative blood loss of 800 mL +/- 300 mL, 2-tailed distribution with a 0.05 level of significance and a power of 80%.13,14, 61-18 A 2-tailed test was used because we were indifferent to the direction of the difference between the means for EACA and placebo groups. Moreover, the use of a 2-tailed test was more stringent than a 1-tailed test and would reduce the likelihood of a type I error. The sample size required to detect a clinically important difference of 250 mL was 50 patients. Anticipating a 10% attrition rate, we recruited 55 patients.

Results

No significant differences were detected in demographics between the EACH and placebo groups in any category except for the use of nonsteroidal anti-inflammatory drugs (NSAIDs) (Table 1). A significantly greater number of patients in the EACH group were using NSAIDs preoperatively than in the placebo group (21 v. 15 patients, respectively, rho = 0.02).

Although 55 patients were enrolled, 4 patients in the EACA group and 5 patients in the placebo group were excluded postoperatively due to breaches in the anesthetic protocol or operating room instructions: use of a cell-saver system (2 patients), colloid use (2 patients), incorrect administration of the drug bolus (2 patients), errors in measurement of intraoperative blood loss (2 patients) and packed red blood cell transfusion for an incorrectly reported postoperative hemoglobin level (1 patient).

Randomization resulted in an equal distribution of hybrid and cementless implants, as well as regional and general anesthesia techniques between the groups. No significant difference in blood loss was attributable to the implant type or anesthesia technique in both treatment and control groups (rho > 0.05). When the effect of the surgeon on blood loss and operative time was examined across the 2 groups, no differences were seen (rho > 0.05). Thus, the 2 groups were homogeneous and not stratified according to these factors.

The mean postoperative blood loss in patients receiving EACA was significantly less than in patients receiving saline (rho < 0.003), as was the mean overall blood loss (rho < 0.025) (Table 2). The intraoperative blood loss was not significantly different between the 2 groups (rho = 0.58).

In the EACA group, 4 (18%) of the 22 patients received 7 units of packed red blood cells, whereas 7 (29%) of the 24 patients in the placebo group required 12 units of packed red blood cells (rho = 0.40). The increased transfusion rate in the placebo group was required to maintain a hemoglobin concentration similar to the that in the EACH group throughout the perioperative and postoperative course (Fig. 1).

EACA administration had no demonstrable effect on the intrinsic or extrinsic coagulation pathways in the perioperative period, but fibrinolysis was reduced. No differences could be detected in recovery room INRs (rho = 0.96) or PTTs (rho = 0.47), whereas analysis of D-dimers from samples drawn in the recovery room showed a significant difference between the 2 groups (rho < 0.001) (Table 3). The administration of EACA did not alter the course of postoperative anticoagulation. Similar INRs were documented in the 2 groups from recovery room through to discharge (Fig. 2).

Few drug-related side effects were observed in this study. One patient in the EACH group reported a rash postoperatively, which resolved after diphenhydramine was administered. No patients required investigation for deep venous thrombosis or pulmonary embolism postoperatively as a result of clinical examination.

Discussion

The administration of EACH during primary THA resulted in a 27% reduction in the mean total blood loss. This rate is similar to published results of tranexamic acid used in knee arthroplasty and aprotinin used in THA.10-15 The most notable effect occurred in the postoperative period: total blood loss for patients receiving EACA was, on average, 331 mL less than for patients receiving the saline placebo.

In contrast to the results of studies by Janssens and associates13 and Murkin and colleagues14,15 on the use of aprotinin in primary THA and revision THA, we did not find a significant difference in intraoperative blood loss. However, the mean operative time in this trial was less than half the losses reported in their series. It may be that the reduction in blood loss attributable to aprotinin in those studies was a result of the antifibrinolytic effect over a more prolonged operative course. This presumption is supported by the findings of Benoni and associates19 who demonstrated that administration of tranexamic acid (an antifibrinolytic of mid-potency) during total knee arthroplasty reduced blood loss only in the postoperative setting. We found that D-dimer measurements from peripheral venous blood samples in the recovery room were generally within normal limits in the EACA group, whereas they were significantly more elevated in the placebo group. This postoperative inhibition of fibrinolysis in patients administered EACA likely accounts for the reduced blood loss in the recovery room and postoperative period.

Patients receiving placebo were more likely to require blood transfusions than the patients administered EACA. The 27% reduction in mean blood loss and the 11% reduction in blood transfusion rates in our study are similar to the rates reported in a recent study of aprotinin in a primary THA by Murkin and colleagues14 (24% and 16% respectively). The reduction in transfusion rate was not significant, however, because of the overall low transfusion rates and the relatively small size of the treatment and placebo groups. Further study likely should be limited to a population with an overall higher rate of transfusion (e.g., those with a preoperative hemoglobin level < 135 g/L), so that a manageable sample size could be obtained in a relatively short period of time. Whether our finding of a reduction in transfusion requirements is clinically significant may be a separate and important question.

No patient in this study had clinical symptoms of deep venous thrombosis postoperatively. Routine screening for deep venous thrombosis was not performed for 2 reasons. First, antifibrinolytic agents are used routinely in cardiac surgery, and previous studies in both orthopedic and nonorthopedic populations have failed to show any increased thrombogenic potential from these agents.8-13,19-21 In fact, a study on the use of aprotinin in hip arthroplasty noted a decreased rate of deep venous thrombosis with routine screening.15 Second, a considerably larger sample size than that used in our study would have been required to define a significant difference in deep venous thrombosis rate. Although no increase in venous thromboembolic events was noted, we recognize that clinical examination is an unreliable measure for deep venous thrombosis, and therefore we cannot accurately comment on the rate of this condition between the 2 groups.

Analysis of possible confounding variables between the groups revealed that the randomization process was very effective. Operative time, surgeon factors and anesthetic technique were equally distributed and were found not to be responsible for any of the observed differences in blood loss. Similar numbers of hybrid and cementless arthroplasties were performed in each group, and no differences in blood loss or transfusion requirements could be attributed to the choice of technique, which is consistent with the results reported by Trice and colleagues.22 All patients were instructed to discontinue NSAIDs 5 days before surgery; however, patients were not surveyed to ensure compliance. Benoni and Fredin10 found that compliance of patients instructed to discontinue NSAIDs before total knee replacement was moderate. Given the uneven distribution of NSAIDs used in this trial, a larger number of patients in the EACH group may have failed to discontinue their medication before surgery. Any increase in blood loss due to impaired platelet function as a result of continued NSAID use would therefore underestimate the effectiveness of EACH.

A clinical limitation of this study concerns the measurement of intraoperative and postoperative blood loss. Assessment of intraoperative sponge weight and suction loss fails to take into account blood loss on the drapes, gowns or instruments. Likewise, postoperative assessment of only drain quantity fails to account for blood loss on the dressings or any hematoma present beneath the incision. The parameters assessed in this study provide a quantitative measure that is the most reliable one possible in this setting. These measures represent the accepted standards for blood loss evaluation in the literature.10-15 As all personnel who performed the measurements were blinded to the patient's study status, measurement errors would be expected to be similar in both groups.

Transfusion of homologous blood has traditionally been used to replace the blood loss associated with primary THA. The use of homologous blood is associated with a significant risk of viral and bacterial infection, however, and costs a minimum of Can$700 per unit.1,23,24 Development of techniques to reduce the requirement for homologous blood during THA is therefore important for both financial and medical reasons.

The search for a cost-effective pharmacologic intervention that reduces requirements for homologous blood transfusion in primary total joint replacement is ongoing. Blood conservation strategies including autologous predonation (PAD) programs, red blood cell salvage, erythropoietin and potent antifibrinolytic agents have been proven to reduce rates of homologous blood transfusion, but they are all associated with a high financial cost.15,25-28 Accurate cost-benefit analysis is beyond the scope of this study, but none of these techniques have been proven to be so cost-effective as to become standard medical practice. The cost of the preparation and administration of EACA as described in this study is Can$80 per patient, so this agent represents one of the most cost-effective modalities currently under investigation. EACA administration did not, however, completely eliminate the need for homologous blood transfusion, and like other blood-conservation strategies, it does not represent a perfect solution.

In the current climate of concern about homologous blood transfusions during surgery, any technique or therapy that reduces the likelihood of even a single unit transfusion can significantly reduce transfusion-related risk.4,5,17,23,24 The routine administration of EACA in patients who undergo THA results in a significant reduction in blood loss and a trend to a decreased requirement for packed red blood cell transfusion. Furthermore, no evidence exists in this study or in the literature that would suggest that the administration of EACA can cause increased morbidity in patients who undergo THA. We believe that with further study, the routine use of an antifibrinolytic agent like EACA may prove beneficial in primary THA.

[Reference]

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1. Krever H. Commission of inquiry on the blood system in Canada -final report. 3 vols. Ottawa: Minister of Public Works and Government Ser-6ces Canada; 1997.

2. Blumberg N, Kirkley SA. Blood transfusion. In: Beaty, JH, editor. Orthopaedic knowledge update 6. Rosemont (IL): American Academy of Orthopaedic Surgeons; 1999. p. 55-62.

3. Oishi CS, D'Lima DD, Morris BA, Hardwick ME, Berkowitz SD, Colwell CW Jr. Hemodilution with other blood reinfusion techniques in total hip arthroplasty. Clin Orthop 1997;339:132-9.

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4. National Institutes of Health. Consensus conference. Perioperative red blood cell transfusion. JAMA 1988;260:2700-3.

Spence RK Surgical red blood cell transfusion practice policies. Am j Surg 1995; 170 (6A Suppl):3S-15S.

6. Stehling L, Simon TL. The red blood cell transfusion trigger: physiology and clinical studies. Arch Pathol Lab Med 1994;118: 429-34.

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7. Carson JL, Duff A, Poses RM, Berlin JA, Spence RK, Trout R, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 1996;348:1055-60.

8. Verstraete M. Clinical application of inhibitors of fibrinolysis. Drugs 1985;29: 236-61.

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9. Montesano RM, Gustafson PA, Palanzo DA, Manley NJ, Sadr FS. The effect of low-dose episilon-aminocaproic acid on patients following coronary artery bypass surgery. Perfusion 1996;11:53-6.

10. Benoni G, Fredin H. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty. j Bone joint Surg Br 1996; 78:434-40.

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11. Hiippala ST, Strid LJ, Wennerstrand MI, Arvela JV, Niemela HM, Mantyla SK, et al. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg 1997;84:839-44.

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12. Hiippala S, Strid L, Wennerstrand M, Arvela V, Mantyla S, Ylinen J, et al. Tranexamic acid reduces perioperative blood loss associated with total knee arthroplasty. Br J Anaesth 1995;74:534-7.

13. Janssens M, Joris J, David JL, Lemaire R, Lamy M. High-dose aprotinin reduces blood loss in patients undergoing total hip replacement surgery. Anesthesiology 1994;80:23-9.

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14. Murkin JM, Haig GM, Beer KJ, Cicutti N, McCutchen J, Comunale ME, et al. Aprotinin decreases exposure to allogeneic blood during primary unilateral total hip replacement. J Bone Joint Surg Am 2000;82:675-84.

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15. Murkin JM, Shannon NA, Bourne RB, Rorabeck CH, Cruickshank M, Wylie G. Aprotinin decreases blood loss in patients undergoing revision or bilateral total hip arthroplasty. Anesth Analg 1995;80:343-8.

16. Sculco TP, Gallina J. Blood management experience: relationship between autologous blood donation and transfusion in orthopaedic surgery. Orthopaedics 1999; 22(1 Suppl):S129-34.

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17. Woolson ST. Blood conservation in total joint arthroplasty. In: Callaghan JJ, Dennis DA, Paprosky WG, Rosenberg AG, editors. Orthopaedic knowledge update hip and knee reconstruction. Rosemont (IL): American Academy of Orthopaedic Sur

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18. Woolson ST, Watt JM. Use of autologous blood in total hip replacement. J Bone Joint Surg Am 1991;73:76-80.

19. Benoni G, Lethagen S, Fredin H. The effect of tranexamic acid on local and plasma fibrinolysis during total knee arthroplasty. Thromb Res 1997;85:195-206.

20. Hayes A, Murphy DB, McCarroll M. The efficacy of single-dose aprotinin two million KlU in reducing blood loss and its impact on the incidence of deep venous thrombosis in patients undergoing total hip replacement. J Clin Anesth 1996;8: 357-60.

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21. Vander Salm TJ, Kaur S, Lancey RA, Okike ON, Pezzella AT, Stahl RF, et al. Reduction of bleeding after heart operations through the prophylactic use of episilon-aminocaproic acid. J Thorac Cardiovasc Surg 1996;112:1098-107.

22. Trice ME, Walker RH, D'Lima DD, Morris BA, Colwell CW Jr. Blood loss and transfusion rate in noncemented and cemented/hybrid total hip arthroplasty. Orthopedics 1999;22(l Suppl):S141-4.

23. Blumberg N, Heal JM. Immunomodulation by blood transfusion: an evolving scientific and clinical challenge. Am j Med 1996;101:299-309.

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24. Triulzi DJ, Vanek K, Ryan DH. A clinical and immunologic study of blood transfusion and post-operative bacterial infection in spinal surgery. Transfusion 1992;32: 517-24.

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25. Stowell CP, Chandler H, Jove M, Guilfoyle M, Wacholtz MC. An open-label, randomized study to compare the safety and efficacy of perioperative epoetin alfa with preoperative autologous blood donation in total joint arthroplasty. Orthopaedics 1999;22(1 Suppl):S105-12.

26. Yomtovian R, Kruskall MS, Barber JP. Autologous-blood transfusion: the reimbursement dilemma. J Bone Joint Surg Am 1992;74:1265-72.

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27. Domen RE. Adverse reactions associated with autologous blood transfusion: evaluation and incidence at a large academic hospital. Transfusion 1998;29:296-300.

28. Longjohn DB, Dorr LD, McPherson Ej. Blood management challenges in revision hip arthroplasty. Orthopedics 1999;22(l Suppl):S148-50.

[Author Affiliation]

Brian J. Harley, MD; Lauren A. Beaupre, MSc; C. Allyson Jones, PhD; John G. Cinats, MD; Craig R. Guenther, MD

[Author Affiliation]

From the Division of Orthopaedic Surgery, University of Alberta Hospital and Royal Alexandra Hospital and Royal Alexandra Hospital, Edmonton, Alta.

Accepted for publication Aug 21, 2001.

[Author Affiliation]

Correspondence to: Lauren A. Beaupre, Office of Orthopaedic Research, University of Alberta Hospital, 1F1.52 Walter Mackenzie Centre, 8440-112th Street, Edmonton AB T6G 2B7; fax 780 407-7534

Year marked a loss of industry legends

R&B singer Teddy Pendergrass, who was one of the most electric and successful figures in music until a car crash 28 years ago left him in a wheelchair, died of colon cancer January 13, 2010. He succumbed to the disease in suburban Philadelphia, where he had been hospitalized for months.

The singer's son, Teddy Pendergrass II, said his father underwent colon cancer surgery eight months before he died and had "a difficult recovery."

Before the crash, Pendergrass established a new era of R&B with an explosive, raw voice that symbolized masculinity, passion and the joys and sorrow of romance in songs such as "Close the Door," "It Don't Hurt Now," "Love T.K.O." and other hits that have since become classics.

He was an international superstar and sex symbol. His career was at its apex - and still climbing.

Pendergrass, who was bom in Philadelphia in 1950, suffered a spinal cord injury in a 1982 car accident that left him paralyzed from the waist down - still able to sing but without his signature power.

Pendergrass left a remarkable imprint on the music world as he ushered in a new era in R&B with his fiery, sensual and forceful brand of soul and his ladies' man image, burnished by his strikingly handsome looks.

Months after Pendergrass' death, a legend died.

Lena Home, the enchanting jazz singer and actress known for her plaintive signature song "Stormy Weather" and for her triumph over the bigotry that allowed her to entertain white authences but not socialize with them, died May 9. She was 92.

Home died at NewYork-Presbyterian Hospital.

Home, whose striking beauty and magnetic sex appeal often overshadowed her talent and artistry, was remarkably candid about the underlying reason for her success: "I was unique in that I was a kind of black that white people could accept," she once said. "I was their daydream. I had the worst kind of acceptance because it was never for how great I was or what I contributed. It was because of the way I looked."

"I knew her from the time 1 was bom, and whenever I needed anything she was there. She was funny, sophisticated and truly one of a kind. We lost an original. Thank you Lena," Liza Minnelli said Monday. Her father, director Vincente Minnelli, brought Home to Hollywood to star in "Cabin in the Sky."

In the 1940s, Home was one of the first Black performers hired to sing with a major white band, the first to play the Copacabana nightclub in New York City and when she signed with MGM, she was among a handful of black actors to have a contract with a major Hollywood studio.

In 1943, MGM Studios loaned her to 20th Century-Fox to play the role of Selina Rogers in the all-black movie musical "Stormy Weather." Her rendition of the title song became a major hit and her most famous tune.

Home was only 2 when her grandmother, a prominent member of the Urban League and the National Association for the Advancement of Colored People, enrolled her in the NAACP.

But she avoided activism until 1945 when she was entertaining at an Army base and saw German prisoners of war sitting up front while black American soldiers were consigned to the rear.

That pivotal moment channeled her anger into something useful.

She got involved in various social and political organizations and - along with her friendship with singer-actor-activist Paul Robeson - got her name onto blacklists during the redhunting McCarthy era.

By the 1960s, Home was one of the most visible celebrities in the civil rights movement, once throwing a lamp at a customer who made a racial slur in a Beverly Hills restaurant and, in 1963, joining 250,000 others in the March on Washington for Jobs and Freedom when Martin Luther King Jr. gave his I Have a Dream speech.

Another industry icon was lost May 31.

Ali-Ollie Woodson, who led the legendary Motown quintet The Temptations in the 1980s and '90s and helped restore them to their hitmaking glory with songs including Treat Her Like A Lady." died at 58 after battling cencer.

By the close of the year, Portuguese Love R&B soul singer Teena Marie died. The 54year-old revered and fully immersed herself in Black culture - and in turn was respected and adored by Black authences, not only for her immense soulful talents, but for her inner soul as well.

She died the day after Christmas.

Bank can trade bond options // Fed OKs electronic trading system; would compete with Chicago

The Federal Reserve Board Thursday moved to allow a Californiabank to trade options on U.S. government bonds, a decision that couldbring the bank in direct competition with Chicago's futures andoptions exchanges.

The unanimous Fed vote allows Security Pacific Corp. toestablish an electronic system for trading options on U.S. Treasurybonds. The Security Pacific proposal had drawn sharp attacks fromthe Chicago Board of Trade, Chicago Mercantile Exchange and ChicagoBoard Options Exchange, which had complained that the bank would havea competitive advantage because it would not be faced with the samecosts as regulated exchanges.

The ruling will not take effect immediately, because of amoratorium imposed by Congress that would prevent Security Pacificfrom trading until after March 1. A Board of Trade spokesman saidthe exchange will seek a permanent congressional ban or will take thefight to the courts if necessary.

One industry official expressed surprise that the Fed made itsmove despite the congressional ban, saying: "Maybe they were tryingto assert some independence from Congress."

All six Fed governors approved the Security Pacific requestexcept for Fed Chairman Paul Volcker, who was absent.

The Merc, in a statement, said Security Pacific should berequired to "be under the same rules and regulations as an exchange."

Security Pacific, the nation's seventh-largest bank company with$64 billion in assets, would enter the options business through twosubsidiaries, Security Pacific Options Trading Corp. and SecurityPacific Options Services Corp.

The first subsidiary would act as a so-called "blind broker,"providing the automated network that makes options trading possible.The other company would act as a clearing agent, comparing offers,matching potential deals and settling them.

The Chicago exchanges have complained that the Security Pacificplan does not prevent the bank from trading on its own exchange.Moreover, they say the bank might not have enough capital to protectcustomers in the event of volatile trading.

The fight over the Security Pacific proposal began in earnesttwo years ago after the staff of the Securities and ExchangeCommission took no action on the bank's request that it be allowed toestablish its options market.

Flutie's secret skill, not magic

Doug Flutie would like Chicago to know there is a logicalreason why hocus rhymes with pocus. He wants us to remember his nameis Doug Flutie, not Doug Henning. Magic, he warns, is forcharlatans.

"It does bother me a little bit," he says of the reputationthat escapes like a startled dove every time he takes his hat off inpublic. "It's cute. It's nice and the whole bit. But people almostplay it off as though it's not a real talent - that you don't haveability, that you're lucky - that it's not real football when I dosomething."

Trouble is, Chicago would like Doug Flutie to know it expectsnothing less than another Super Bowl next month. Hail Mary. OpenSesame. And plunk your magic twanger. But just get it done, son.

Presto chango!

It is Saturday afternoon, the day before Flutie will run forone touchdown against Tampa Bay, throw for another and make SoldierField buzz like a giant apiary. He is with his parents, who havearrived from Massachusetts.

Richard Flutie is an engineer for Digital EquipmentCorporation, the same company that made the computers that said his5-9 son was too short to play in the NFL. Joan Flutie has beenRichard's "steady" every since they were 12. They are much moreenergetic than Ma and Pa Kent. So after pizza, Doug and wife Lauriewhisk Richard and Joan off to the planet Photon.

Photon is a futuristic space game emporium in Palatine. Theobject in Photon is to "zap" your opponents and your opponents' base.The four Fluties strap on helmets, battery packs and detectors. Theyfamiliarize themselves with their lasers.

"I was thinking to myself as we were doing this," RichardFlutie says later, "if the people in Chicago only knew that Doug hasnever changed. He loves this kind of stuff. Playing games with hisbrothers, his parents, his sister, friends, anybody. He loves to doit."

Doug's team wins. "It's a strange gift he has," his motherexplains.

Later that night he attends a team meeting and adjourns to hishotel suite with his playbook and roommate, wide receiver KeithOrtego. Flutie studies the playbook and asks questions while Ortegowatches a movie about kids and lasers called "Real Genius." Has that magic Ortego describes Flutie as "pretty much likeanybody else." But in the next breath he admits, "Doug's got magic.I really don't know how to explain it. But I wish I could get someof it."

"Plus," says Richard Flutie, "he's the next door type guy."

Two years ago the National Bureau of Statistics in Hyattsville,Md., listed the average height and weight of the American malebetween ages 18 and 74 as 5-9, 172. That's exactly what the NewJersey Generals listed Flutie at on their roster. His mother insistshe's 5-10.

The Bears now say he has bulked up to 176. His size 42 jerseyis not the smallest on the team. He wears a 9 1/2 football shoe anda 7 1/4 helmet. "He's small,' says equipment manager Ray Earley. "Butwe've got three or four guys that small."

Men like Flutie because they can identify with his struggle.Women are attracted to his boyish good looks. "But he's a one-womanman," warns a family member. And that woman is the former LaurieFortier, his high school sweetheart.

Children draw to him because he radiates ease. "He's too goodto be true," his mother says. And she isn't complaining.

Flutie understands better than most why people respond to him the way they do. "It makes the average person feel like they wouldhave a shot at doing it," he says. "But I don't look at it that way.I'm a football player. I've been playing football all my life."

When he was 8, the athletically precocious Flutie drew crowds inMelbourne Beach (Fla.) for Midget League football games. "Sometimeshe would do things the officials just couldn't comprehend," says hisfather.

As a sophomore at Natick (Mass.) High School he kicked a 38-yardfield goal with no time remaining to beat Braintree 27-25. Notespecially remarkable except it was his first field goal attempt andhe had to convince Natick coach Tom Lamb to give him the opportunity.

In his junior year at Boston College, Clemson and William Perryled Flutie and BC 16-3 in the third quarter. In a 13-minute spanFlutie directed four touchdown drives. Boston College won 31-16."Doug Flutie has got some kind of magic in him," Boston College coachJack Bicknell said after the game. "Flutie was so little," Perrysaid. "He was hard to get to."

Then, of course, there was the Miami game his senior year. Awhole generation of non-parochial sports fans now think the "HailMary" is the 48-yard touchdown pass Flutie flung to wide receiverGerard Phelan on the last play of the game to beat the Hurricanes andBernie Kosar 47-45.

But the "Hail Mary" is a prayer. To longtime Flutie watchers,his game-winning pass was not. "What people don't realize is Doug'sgot a gun for an arm and he's a bright kid," says his father. "Don'tthey give any points for that?"

Nevertheless, the enchanted legend of Doug Flutie grew fasterthan Merlin's garden. "That wasn't Gerard Phelan that caught thatball," said Boston College offensive lineman Mark MacDonald. "Godcaught that ball."

"No," corrected BC teammate Jim Ostrowski. "God threw it."

"Give Flutie a chance and you often get near a miracle,"Newsweek proclaimed.

"Doug Flutie never loses," said Dallas personnel boss GilBrandt. "He only runs out of time."

The Patriots cut Phelan this year. So he was home inMassachusetts last week when he saw the highlights of Flutie'sChicago debut. Like Flutie, he winced when he heard about the spellChicago is under.

"The roller coaster is starting back up the hill," Phelan said."But he's not a magician. I think it's very unfair when people usethe word magic. He works very hard at knowing the game of football."

"It's an awful burden," says Bob Woolf, Flutie's Boston-basedagent.

If anything, Flutie is more magical off the football field thanon. And the source of that magic is his common touch. "I've alwaysreacted that way to him," Joan Flutie says. "It's something in him.I never knew what it was. There isn't a mean bone in his body and hejust exuberates it. You just feel it when you talk to him, when yousee him." Great expectations Too good to be true, his mother had said.And again he is the bearer of expectations, perhaps greater than hecan deliver. "I don't know how things are gonna work out in the longrun." he says. "Or whether or not I'll be here even next year or twoyears down the road. But all you can ask for is opportunity."

After Boston College, the opportunity was in the USFL. Flutiespent 1985 with the New Jersey Generals because Manhattan real estatetycoon Donald Trump wanted to cash in on the Flutie phenomenon thatpeaked in 1984, the year he won the Heisman Trophy.

Trump made Flutie a multimillion dollar offer he couldn'trefuse. And at a subsequent press conference USFL commissioner HarryUsher malapropped that Flutie's impact on the new league would be"unspeakable and immeasurable."

But Generals coach Walt Michaels wasn't a Flutie fan. Teamowner Trump forced Michaels to play him anyway and Flutie threw 13touchdown passes in nine games.

The only thing unspeakable about that season was the pain thatshot through Flutie's left shoulder in his 10th game when astrikingly swift defensive end named Reggie White chased him downfrom behind and broke his collarbone. End of season.

Trump, meanwhile, acquired a newer and bigger toy inquarterback Jim Kelly. Suddenly Flutie's future was even moreuncertain than the USFL's. But one thing led to another, as italways does with Doug Flutie.

Trump and Flutie settled on his personal services contract.The Rams traded Flutie's NFL rights to the Bears. The Bears signedhim Oct. 21. They activated him Nov. 4. And Bear coach Mike Ditka,Flutie's Chinaman from the beginning, sprung Flutie on Chicago lastSunday.

"Joan says that Doug has a star that follows him around," saysRichard Flutie. "And I think that might be true."

At Boston College Flutie had gone from fourth-string to starterin a week. In the USFL he went from rookie to regular in less timethat it takes to memorize a new formation. Now Ditka is hintingFlutie could make his first Bear start by next week in Dallas.

"Maybe I can't lead a team to the Super Bowl," Flutie says."But I don't believe that."

If Flutie does take the Bears to their second Super Bowl in twoyears, he will have to beat out second-year free agent Mike Tomczak.The Bears have won all six of Tomczak's starts this year. AndTomczak has won the unfailing support of his offensive linemen. Healso has the blessing of the injured Jim McMahon.

Loyalty counts for a lot in the male bonding process that goeson in the NFL. And Tomczak is every bit as likeable as Flutie. It'sjust that Flutie is impossible to dislike. "Nobody ever had anyanimosity for Doug here," Ortego says. "And he knew that."

But tight end-comic Tim Wrightman isn't so sure he likes theway Flutie delivers the football. "He throws the ball on a line,"Wrightman says. "I wish he'd put a little more air under it. Maybefrom his angle he thinks he is putting air under it." Zing.

But even Ortego acknowledges difficulty in catching the heavy,"tight" spiral Flutie throws. "The seams can rip you up pretty good,"he says. "You have to make sure you catch his ball on your fingertipsinstead of letting it get into your palms."

And then there's this odd, almost sidearm, way Flutie has ofthrowing while running to his left. His 27-yard touchdown pass toPayton against the Bucs was a case in point. It is one of the fewconcessions Flutie makes to his size.

"It's instinctive," he says. "If you do it by the book, youturn your right shoulder and you cock back up the field and throw theball."

Problem is, he says, "you get plastered all the time from theright side if someone's chasing you."

If his new teammates didn't blame Flutie for the Bear frontoffice's apparent failure to support Tomczak, they didn't hitch uptheir welcome wagon to his star either.

Flutie understood. The day the Bears signed him, they quietlywaived wide receiver Ken Margerum, a close friend of McMahon's. Whenequipment manager Earley later offered Flutie Margerum's locker,Flutie wisely and politely declined. Too much frost left over fromthe chilly reception.

The first notable thaw was running back Walter Payton. Paytonsensed the same child-like quality in Flutie that had enabled him tolast 12 years in a viciously adult environment. "He's always walkingup behind you, goosing you," Flutie says of Payton.

Two years ago Flutie had told a reporter, "I want to be a kidmy whole life." Last week he told another one, "I wouldn't mind if wecame in and practiced twice a day."

Payton liked that. Quicker than you can say Smurf, they werekindred spirits. "All along Walter's sort of been the guy who says,`Hey, don't worry about what other people say, what other people do,just do your own thing,' " Flutie says. "It made me feel that muchbetter when it was Walter who came down with that catch." On Ditka's frequency

Clearly Ditka and Flutie are also "on the same page," to usethe coaching idiom. Flutie's four-yard touchdown sweep-sprintagainst Tampa Bay last Sunday was an example.

"I never said a thing to coach Ditka about it," said Flutieafter the game. "I just had a feeling that if we got into a goal linesituation, that would be the play he would call."

Last year Ditka painted his signature on a world championshipseason with a broad brush named William Perry. Now the strokes aresubtler. But Flutie's hue offers the sharpest contrast to a seasonin which so much energy got wasted on so much bickering. "Mike Ditkaplanned this like a mastermind," says Richard Flutie. Let Flutie prove it

Tell that to Ditka and he might spit in your eye. "I don'tprove anything," he says. "Doug Flutie will prove everything."

Chicago's greatest planner was Daniel Hudson Burnham. Burnhamdesigned the lakefront. And the city fathers later named a harborafter him. "Make no little plans," Burnham said before he died in1912. "They have no magic to stir men's blood."

Lourdes have mercy, there's that word again. "Magic."

McMahon's word is "Outrageous." Perry's is "Refrigerator"Payton's is "Sweetness." Michael Jordan's is "Air." Richard J.Daley's was "Boss." Maybe you have to have a word in this city inorder to have a name.

Like Payton, Flutie also has invested wisely, mostlyconservative stuff. But he does own a large chunk of "Flutie's Pier17," a seafood restaurant in Manhattan near Wall St. and the EastRiver. "The biggest portions I've ever seen in my life," he says."You go in there and you don't finish the meal."

Flutie never finished his vegetables at home. (Gasp! He's notperfect!) And his mother gave up forcing the issue long ago. Sherealized he ate only to live. And he lived to compete. Baseball,basketball, Photon. Name your game. "He's played sports every minuteof his life," Phelan says.

"Doug never in his life had any self-doubts," Joan Flutie says.Still, it's a tall order for a short football player. A simplemiracle will do.

Abracadabra!

The Bear offense has just come out of hibernation and scored 48points against Tampa Bay. But his parents have a plane to catch. SoDoug Flutie is driving almost as fast as he is talking.

"He never stopped," said his mother. "He went over the gameplay-by-play. What he did wrong. Not the things he did right. Whythey went wrong. What he could have done to make it not go wrong.He has to study more. He has to do this. He has to concentratemore. It's just unbelievable his drive for that sport. And that'scontagious."

Doug's team has won again.

Disability charity in survey of accessibility

A national charity with links to Axbridge is urging people tojoin its new campaign.

Leonard Cheshire Disability, which has a centre in the town,wants people to use its new website to test the accessibility ofshops, services and transport in the area.

The website - www.actionforaccess.org - has a map of the UK forpeople to share their opinions on how accessible local services suchas cinemas, banks and shops are.

It also has template letters and guidelines for campaigners tosend to business managers with suggestions on how to improveaccessibility.

Research by Leonard Cheshire Disability found two in five (40 percent) of disabled people have had difficulties accessing goods andservices in the past year.

A quarter of all disabled people (23 per cent) identified theirexperiences as discriminatory.

To get involved in the Action for Access campaign visit thewebsite or phone 020 3242 0410 to receive an information pack.

Bus bombing in Sri Lanka kills 21; government blames rebels

A bomb ripped through a crowded passenger bus near Sri Lanka's capital during Friday's morning rush hour, killing at least 21 people and wounding 47, officials said.

The bombing was the second attack in three days targeting civilians in and around Colombo, and authorities promptly blamed the Tamil Tiger rebels, who have made such attacks a hallmark of their 25-year fight against Sri Lanka's government.

If carried out by the rebels _ who offered no immediate comment and routinely deny any role in such bombings _ the attack would show their ability to strike deep inside government territory despite a maze of security checkpoints around the capital and its suburbs.

Military spokesman Brig. Udaya Nanayakkara said the Tamil Tigers detonated a roadside bomb at about 7:35 a.m. (0530 GMT) in the Colombo suburb of Moratuwa as the passenger bus went by.

The attack killed 21 people and wounded 47, he said, adding that a curfew has been imposed in the area to give soldiers and police a chance to search for suspected rebels.

The explosion shattered the vehicle's windows and peppered it with shrapnel. A 45-year old man who identified himself only as Nalaka said he was thrown from his motorcycle by the explosion.

"When I got up I saw the bus and quickly got into it. Some people lay dead. Some others were bleeding," he told AP Television News. "I heard somebody screaming 'help, help,' and I rushed to him, but I could not move him because he was heavy."

The rebels, blamed for scores of suicide bombings and other attacks on civilians, are listed as a terrorist group by the United States, the European Union and India. They are believed to have been behind a blast Wednesday that targeted a passenger train in Colombo and wounded 19 people.

President Mahinda Rajapaksa blamed Friday's attack on the Tigers and called on Sri Lankans to "remain vigilant against the forces of terror."

With much of the fighting taken place hundreds of miles (kilometers) to the north, the recent attacks have shaken Colombo and left residents fearful of more to come.

"I don't know how this war is being fought in the north. I see that only on the television. But, it now seems the war has come to the capital," said Roshan Dhammika, a 30-year-old who drives a motorized rickshaw.

Meanwhile, the Defense Ministry said 17 rebels and five soldiers were killed Thursday in fighting surrounding the rebel stronghold in the north. The clashes occurred in Jaffna, Mannar, Vavuniya and Welioya districts, a military official said on condition of anonymity, citing government rules.

This week's attacks near the capital appeared to boost already strong support for the war among people in Colombo.

"What else can you do against a ruthless terrorist group. The LTTE now wants to stop operations in the north as they are suffering defeats. That's why they target civilians," said Ganesh Wijenayake, a 45-year-old businessman in Colombo, using a common acronym for the insurgents.

The Tigers, formally known as the Liberation Tigers of Tamil Eelam, have fought since 1983 to create an independent homeland for Sri Lanka's Tamil minority, which has been marginalized by successive governments controlled by the Sinhalese majority. More than 70,000 people have been killed.

Since a long-standing peace process broke down nearly two years ago fighting between the Tigers and government forces has steadily escalated along the northern front lines and in the east, where the military last year overran rebel-controlled enclaves.

But the rebels still run a de facto state in much of northern Sri Lanka, and the government says it plans to completely crush the insurgents by the end of the year _ a threat diplomats and other observers doubt Colombo has the ability to achieve.

The fighting continues and the death toll rises, with civilians bearing the brunt of the violence.

Since the start of the year, more than 200 civilians have been killed by bombings in rebel and government territory, according to the U.N. Office for the Coordination of Humanitarian Affairs.

A blast blamed on rebels on a passenger train last month killed eight people and wounded 70 others near Colombo. A bomb explosion deep in rebel-held territory killed 16 people last month.

Security tightened at schools in western China

TONGREN, China (AP) — Security was tightened Monday at schools in western China following demonstrations last week by students who marched to protest reported plans to impose Chinese as the main language of instruction.

Police and plainclothes security officials were stationed at several minority middle schools and high schools in the town of Tongren in Qinghai province, which is home to numerous ethnic minority groups, including Tibetans and Mongolians. Security personnel prevented reporters from entering schools and talking with teachers and students there.

Use of the Tibetan language is closely tied to the region's political struggles. Many Tibetans argue they have traditionally been self-governing and that Chinese policies are wrecking their unique Buddhist culture.

But the issue is complicated because while many Tibetans feel threatened by development and the migration of China's ethnic Han majority, some also hope their children master Mandarin in order to obtain better jobs.

Last week, hundreds and possibly thousands of students marched in peaceful protests that began in Tongren and spread to other communities in Qinghai, according to the London-based group Free Tibet. There were no reports of arrests or violence.

On Monday, there were no signs of visible disruption as classes quietly resumed, with students seen playing basketball on outdoor courts.

Two Tibetan-language teachers, contacted outside of the classroom, nervously refused to discuss the protests or language plans.

"Let's not talk about the Tibetan language. We can't talk about it," said one male teacher, who refused to give his name.

A shopkeeper near the area, who also wanted to remain anonymous, said she had seen students marching several days ago.

"In this area, things are not stable," she said.

Several students from different schools in Huangnan prefecture, which includes Tongren, confirmed that student-led protests were held last week. Asked whether students were unhappy about the possible changes in language instruction, one 13-year-old student who didn't want to give her name, said, "Yes, it's true."

In one middle school where several police cars were parked out front, security officials said classes had been canceled Monday. One student said teachers were being called for a school-wide meeting Monday.

The demonstrations had been sparked by a new plan to increase use of the Chinese language in the Tibetan regions of Qinghai province.

Qiang Wei, Qinghai province's Communist Party chief, was quoted last month by the party newspaper as praising the use of a "common language" in schools. A report on Qinghai's plans for educational reform over the next decade was even more explicit, saying "the nation's common language must become the language of instruction."

Students fear that means that the current bilingual system will be scrapped in favor of the use of Chinese alone, except in language classes.

The Qinghai provincial education department director, Wang Yubo, was quoted over the weekend as saying that changes won't be forced in areas where "conditions are not ripe," but the official Xinhua News Agency report did not elaborate on how officials would make that determination.

For the Chinese government, any sign of unrest among Tibetans is seen as a threat to national sovereignty and a reminder of past uprisings against China's often heavy-handed rule over the area.

Discontent over Beijing's policies exploded into deadly rioting in Tibet's capital Lhasa in 2008, then spread through traditionally Tibetan areas such as Tongren that lie outside the official Tibetan Autonomous Region.

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Associated Press writer Tini Tran contributed to this report from Beijing.