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Anderson, PhDc, Shaun G. Sociodemographic, clinical, and treatment variables varied between patients discharged on statins and those who were not.

All rights reserved. Manuscript received January 14, ; revised manuscript received and accepted April 24, Currently, 94 hospitals located in 13 countries are participating in this observational study.

The study aimed to enroll an unselected population of patients with ACS; sites were encouraged to recruit the first 10 to 20 consecutive eligible patients each month.

Regular audits are performed at all participating hospitals. Where required, study investigators received approval from their local hospital ethics or institutional review boards for the conduct of this study.

Data were collected at each study site by a trained study coordinator using a standardized case report form. Demographic characteristics, medical histories, presenting symptoms, durations of prehospital delay, biochemical and electrocardiographic findings, treatment practices, and hospital outcome data were collected.

Standardized definitions of all patient-related variables, clinical diagnoses, and outcomes were used. At a targeted interval of 6 months after hospital discharge, standardized follow-up forms were completed during telephone calls to patients or their next of kin to ascertain statin use and the occurrence of selected long-term outcomes, including recurrent MI, stroke, and death.

Of 11, patients meeting these criteria, 6-month follow-up data were available for 8, patients from 13 countries. Candidate variables in our regression models included demographic characteristics, medical history, previous medications, type of ACS, clinical presentation characteristics, in-hospital therapies and procedures, in-hospital complications, and medications at discharge specific variables are listed in Table 1.

This analysis was performed in the total patient subset as well as in patients further stratified according to baseline LDL level.

Irrespective of baseline LDL level, patients taking statins at hospital discharge were younger, more likely to be men, and more likely to have histories of hyperlipidemia or smoking, but less likely to have histories of congestive heart failure or vascular disease, than those not prescribed statin therapy Table 1.

Regardless of LDL level, patients receiving statins at the time of hospital discharge were more likely to have been treated with effective cardiac medications or to have undergone revascularization procedures than those not receiving statin therapy.

Patients receiving statin therapy at hospital discharge were significantly less likely to have died or to have developed our composite study end point during the 6 months after hospital discharge, irrespective of LDL level Table 2 and Figure 1.

Unadjusted 6-month death rates in patients discharged on statin therapy compared with those not discharged on statin therapy according to baseline LDL cholesterol levels.

After multivariate analysis, statin prescription at the time of hospital discharge in the total study population was associated with a significant reduction in 6-month all-cause death rates odds ratio [OR] 0.

Statin prescription at hospital discharge remained significantly associated with a decreased occurrence of the composite end point adjusted OR 0.

C-statistics for the 6 multiple logistic regression models ranged from 0. In the past, concern had been raised about the potential risks associated with treating patients with ACS and low LDL levels at hospital presentation.

These data suggested that early treatment with statins might be harmful as baseline cholesterol levels decreased. Accordingly, the investigators of this study appropriately suggested that caution should be exercised in starting statin therapy in patients with ACS who do not meet current treatment guidelines until randomized controlled trials could further clarify this observation.

Trials indirectly addressing these issues have subsequently been conducted. In summary, in previous randomized trials or studies deriving data from randomized trials the benefits of statin therapy were confined to patients with higher LDL levels or were independent of baseline LDL.

Given the relative homogeneity of clinical trial populations, it is likely that clinical characteristics and outcomes in patients with lower compared with higher LDL levels did not differ as greatly as in our community-based analysis.

As such, the findings from these clinical trials are not necessarily generalizable to patients with ACS who are seen in the community setting.

In our large multinational registry, patients with low LDL levels at presentation were older and more likely to have histories of other important co-morbidities than patients with higher LDL levels.

As such, it is not necessarily surprising that these high-risk patients would benefit as much or more from the receipt of early statin therapy as patients with higher LDL levels.

This hypothesis would also be consistent with the increasingly accepted concept that the beneficial effects of statin treatment are not isolated to LDL lowering but stem from pleiotropic activities that result in plaque stabilization in highrisk patients.

In addition, it appears that when this therapy is initiated, it is preferentially used in younger, lower risk patients. Thus, some practitioners may be delaying the prescription of statins until more accurate determinations of lipid levels may be obtained.

However, the low rate of statin use at 6 months in these patients suggests that this is not routinely occurring. Long-term benefits associated with statin use in patients with ACS and low LDL at presentation have been described in 1 other report.

By virtue of our extensive data collection efforts, we were able to control for a variety of potentially confounding variables in examining the association among LDL levels, the receipt of statin therapy, and long-term outcomes, but we cannot claim to have identified or adequately measured all potential confounders of this association.

Indeed, the observed reduction in 6-month mortality with statin use at discharge was greater than the reductions in AMI or stroke by which statins would be expected to exert their beneficial effect.

This suggests that the highest risk patients in our study were most likely to be left untreated with statins and that we were unable to completely control for this bias.

It must also be acknowledged that information about the use of statins at 6 months was obtained by patient self-report via telephone but was not confirmed by pharmaceutical records or other means.

We were also unable to comment on the use of specific statin types or dosages or other cardiac medications at 6 months.

Spencer had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Sibrafiban vs. Early statin initiation and outcomes in patients with acute coronary syndromes. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial.

Intensive versus moderate lipid lowering with statins after acute coronary syndromes. A multinational registry of patients hospitalized with acute coronary syndromes.

Decadelong changes in the use of combination evidence-based medical therapy at discharge for patients surviving acute myocardial infarction.

Antiatherothrombotic properties of statins: implications for cardiovascular event reduction. Mood, MD, Anthony A.

The benefit of statin therapy on individual cardiovascular outcomes other than restenosis is largely unknown. Hence, a meta-analysis of the available randomized trials was conducted to evaluate individual cardiovascular outcomes with statin therapy compared with placebo after elective percutaneous coronary intervention.

Clinical follow-up ranged from 1 day to 45 months. The incidence of myocardial infarction was 3. The incidence of all-cause mortality was 2.

The incidence of stroke was 0. In conclusion, statin therapy initiated at the time of elective percutaneous coronary intervention significantly reduces myocardial infarction.

Accordingly, we sought to determine if statin therapy initiated at the time of PCI reduces myocardial infarction MI and other individual cardiovascular outcomes through metaanalysis.

Manuscript received February 21, ; revised manuscript received and accepted April 24, Studies that were performed entirely in the setting of unstable angina or acute MI were excluded.

We required that the statin was initiated around the time of coronary intervention and that individual outcome data were available.

The primary end point was MI. Secondary end points were all-cause mortality, cardiovascular mortality, surgical or percutaneous revascularization, and stroke.

For each outcome, 2 independent reviewers GRM, HR tabulated the number of events that occurred in each arm of a trial.

Discrepancies were resolved through a third reviewer AAB. Baseline information was also tabulated, such as patient demographics, time of statin initiation, lipid profile, and the extent of clinical follow-up.

We used the intention-to-treat principle to calculate risks. The incidence of an outcome was defined as the number of cardiac events that occurred in subjects randomized to a certain type of therapy during the extent of clinical followup.

Odds ratios ORs were defined as the odds of an outcome in those who received statin therapy compared with the odds in those who received placebo or usual care.

A Mantel-Haenszel model was used to calculate each summary statistic. We assessed for heterogeneity between studies by computing the Q statistic and for publication bias by www.

Current smokers. All p values were 2 tailed, with statistical significance set at 0. All analyses were performed using Stata version 9.

A total of 58 studies were initially identified through the review of published research. Among these, 6 studies involving 3, patients met our selection criteria.

Clinical follow-up ranged from 1 day to 45 months from the index PCI. The cumulative incidences of MI in the statin group and the placebo group were 3.

The chi-square value for heterogeneity 5 degrees of freedom among the studies was 5. Among the patients randomized to statin therapy versus placebo, the incidence of all-cause mortality was 2.

The weighted mean duration of follow-up was The chi-square value for heterogeneity 2 degrees of freedom among the studies was 2.

The cumulative incidence of cardiovascular mortality was 0. The chisquare value for heterogeneity 1 degree of freedom among the studies was 1.

The cumulative incidences of surgical or percutaneous revascularization in the statin and placebo arms were The chi-square value for heterogeneity 3 degrees of freedom was 5.

The absolute difference between the groups was 2. The cumulative incidences of stroke in the statin arm and the placebo arm were 0.

The chi-square value for heterogeneity 2 degrees of freedom was 0. The number of patients needed to treat to prevent 1 MI was The reduction in MI appeared to occur early and was sustained late after PCI, and it is possible that the initiation of statin therapy before PCI may be preferential to initiation after the procedure.

There was no significant reduction in the risk for all-cause mortality, cardiovascular mortality, and revascularization from statin therapy compared with placebo, although these outcomes all trended toward reductions.

Interestingly, the incidence of stroke was nonsignificantly increased in the statin group compared with the placebo group. A previous large meta-analysis of statin therapy for secondary prevention documented a reduction in stroke as well as other adverse cardiovascular outcomes,6 so it is likely that with sufficient power and a longer duration of follow-up we would have also shown a reduction in stroke from the use of statin therapy.

Statins appear to be an important adjunct to routine pharmacotherapy during elective PCI for stable coronary artery disease.

There was a significant improvement in cholesterol levels in the statin group, which was seen as early as 2 weeks.

The incidence of discontinuation of study medication because of intolerance or adverse effects was seen in 6.

Because there were no significant adverse effects noted between the statin and placebo groups, the addition of statin therapy should be considered to benefit the patients who undergo elective PCI.

It is unclear whether the benefit of statin therapy is due to acute anti-inflammatory effects, long-term lipid-lowering effects, or both.

This point illustrates the difficulty in delineating the mechanism of the beneficial effect of periprocedural statin therapy.

Large cohort studies have reported the role of statins in improving survival and morbidity after PCI. In the German Atorvastatin Intravascular Ultrasound GAIN study, the control arm included statin medications other than atorvastatin, which was used in the statin arm.

Also, a wide range of follow-up periods, from 1 day to 45 months, resulted in an inability to assess the long-term benefits of statin therapy.

Does creatinine kinase-MB elevation after percutaneous coronary intervention predict outcomes in ? Periprocedural cardiac enzyme elevation predicts adverse outcomes.

Troponin I elevation and cardiac events after percutaneous coronary intervention. Early and sustained survival benefit associated with statin therapy at the time of percutaneous coronary intervention.

Effect of statin therapy prior to elective percutaneous coronary intervention on frequency of periprocedural myocardial injury.

Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90, participants in 14 randomised trials of statins.

Long term benefit of statin therapy initiated during the hospitalization for an acute coronary syndrome: a systematic review of randomized trials.

Effect of pravastatin on angiographic restenosis after coronary balloon angioplasty. A randomized placebo-controlled trial of fluvastatin for prevention of restenosis after successful coronary balloon angioplasty; final results of the Fluvastatin Angiographic Restenosis FLARE trial.

Use of intravascular ultrasound to compare effects of different strategies of lipid-lowering therapy on plaque volume and composition in patients with coronary artery disease GAIN.

Fluvastatin for prevention of cardiac events following successful first percutaneous coronary intervention: a randomized controlled trial.

Statin administration before percutaneous coronary intervention: impact on periprocedural myocardial infarction. Relation of inflammation and benefit of statins after percutaneous coronary interventions.

Using statins to treat inflammation in acute coronary syndromes: are we there yet? Inflammation and atherosclerosis.

Effects of HMG-CoA reductase inhibitors on endothelial function: role of microdomains and oxidative stress.

Relation of preprocedural statin therapy to in-hospital procedural complications following percutaneous coronary interventions in patients with hyperlipidemia.

Need to test the arterial inflammation hypothesis. Velazquez, MDa, Eric D. Peterson, MDa, and F. Roosevelt Gilliam, MDa Age-adjusted sudden cardiac death rates are highest for black patients compared with other racial groups.

The prophylactic implantation of an implantable cardioverter-defibrillator ICD provides a significant reduction in sudden cardiac death and overall mortality in patients after myocardial infarctions with significant left ventricular systolic dysfunction.

The purpose of this study was to determine whether black patients with left ventricular systolic dysfunction were less likely than white patients to receive ICDs for the primary prevention of sudden cardiac death.

Overall, 7, patients were identified as eligible candidates for ICDs. This difference in ICD use persisted after adjusting for demographics, clinical characteristics, and socioeconomic factors odds ratio 0.

In conclusion, among patients at an increased risk for sudden cardiac death, blacks were significantly less likely to receive ICDs than whites.

Manuscript received February 21, ; revised manuscript received and accepted April 13, This study was funded by an educational grant from Guidant Corporation, Minneapolis, Minnesota.

A total of centers enrolled patients from June 30, , until study enrollment was closed on December 22, Sites were not selected on specific requirements concerning heart failure admissions or the use of specific ICD devices.

Sites were reimbursed a nominal fee for the enrollment of patients and the completion of case report forms. Clinicians who actively managed left ventricular systolic dysfunction patients in various practice settings nationwide served as investigators.

The enrolling physicians were unspecified for Health care providers were encouraged to enroll consecutive patients during routine follow-up visits.

Eligibility was not contingent on the use of any particular therapeutic agent or device. The goal of the registry was to enroll a representative patient sample receiving care for their heart failure.

Patients within 30 days of MIs and with previous episodes of ventricular tachycardia or ventricular fibrillation were excluded to replicate the sudden cardiac death primary prevention population studied in the Multicenter Automatic Defibrillator Implantation Trial MADIT I and II.

Race and ethnicity were separate categorical variables on the data collection form. The racial categories were American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific Islander, and black or AfricanAmerican and were assessed by study coordinators by direct questions to patients, observation, or review of medical records.

Designated center personnel e. At enrollment, information on co-morbidities, clinical characteristics, and demographics were compiled from patient interviews, medical records, and data collection forms.

Lexington, Kentucky , an independent company responsible for clinical data management, statistical analyses, and data reporting.

Centers provided follow-up information at approximately 6, 12, and 18 months for enrolled patients who remained active in the registry.

The primary outcome of interest, the receipt of an ICD before enrollment or during the registry follow-up, was determined through contact with patients during follow-up visits and review of the medical record.

We determined for the total population, and by race, the number of patients eligible for ICD implantation relative to those who received ICDs either at enrollment or during follow-up in the registry.

Additionally, certain categorical and continuous variables were further categorized for ease in describing trends.

Education was dichotomized according to those with less than high school education and those with high school education or greater.

Payer status was also dichotomized as private or public. Finally, to account for site differences, a variable was created to categorize patients according to the size of the enrolling site.

To adjust for possible confounding, a logistic regression was performed in which the probability of having an ICD was modeled.

Several ap- proaches were considered to determine which potential confounders to include in the model.

For each model considered, there were no real differences in model fit using R2, measures of association, and the Hosmer-Lemeshow goodness-of-fit statistic.

Additionally, the inclusion or exclusion of most potential confounders did not dramatically change the estimate of the odds ratio for race.

Two main approaches were used in determining the potential confounders to include in the model. To start, all potential confounders were included, and forward selection was used to determine a minimum set of variables to include in the model.

These variables were age, gender, EF, syncope, New York Heart Association class, spironolactone use, digitalis use, QRS width, geographical region of enrollment, antiarrhythmic use, and the size of the enrolling site.

The additional variables included were indicators for high school education, diabetes mellitus, previous coronary artery bypass grafting, previous percutaneous intervention, enrollment by an electrophysiologist, atrial fibrillation, hypertension, angiotensin receptor blocker use, diuretic use, and renal disease.

Interactions among race, gender, and enrollment site size were also included. All analyses were performed using SAS version 9. No patients had missing values for race.

Education was not significant in any of the models considered, and there was little difference in the fit or the adjusted odds ratio for race when education was excluded or included.

Additionally, missing educational status was independent of race and ICD receipt. However, after excluding 3, patients, 7, blacks and 7, whites were included in the final study population Figure 1.

There was no statistically significant difference between the proportions of whites and blacks excluded.

Compared with whites, blacks were younger and more often women. Clinically, blacks had a lower mean EF and higher prevalences of hypertension, diabetes mellitus, and renal insufficiency.

White patients had more atrial fibrillation and were more likely to be taking antiarrhythmic medications and to be enrolled in the registry by electrophysiologists than black patients.

There were no racial differences in the use of The American Journal of Cardiology www. Additionally, there were significant racial differences in the type of revascularization, with blacks having undergone more percutaneous coronary intervention and whites more coronary artery bypass grafting Table 1.

The mean follow-up period for patients in this analysis was The median time from MI to ICD implantation was 1, days 25th to 75th interquartile range to 3, among black patients, compared with 2, days 25th to 75th interquartile range to 5, for white patients.

After adjusting for differences in clinical characteristics and socioeconomic factors, black patients were significantly less likely to receive ICDs than white patients odds ratio [OR] 0.

Additional variables associated with greater odds of ICD receipt included younger age; history of syncope; previous coronary artery bypass graft; lower EF; wider QRS width; the use of antiarrhythmic therapy, spironolactone, or digoxin; enrollment in the registry by an electrophysiologist; and larger center size Table 2.

Payer status and education were not independent predictors of ICD implantation. Discussion Figure 1. The arrows denote the level in which various factors led to the exclusion of patients.

Blacks were treated more often with diuretics and spironolactone, consistent with the finding of more symp- Among a broad multipayer population of socioeconomically diverse patients with previous MIs and low EFs, blacks received ICDs for the primary prevention of sudden cardiac death at a significantly lower rate relative to whites.

This disparity does not appear to be explained by potential confounders, including co-morbidities, access to cardiologists, or payer status.

Given that ICD implantation can be lifesaving in this patient population, the disparities in care found in this study are concerning.

This analysis is among the first to report rates of ICD use by race among patients eligible for ICDs for the primary prevention of sudden cardiac death.

Previous reports of ICD use that revealed a racial disparity were limited to Medicare beneficiaries who were older and were survivors of cardiac arrest, a distinctly different population.

Moreover, our results are drawn from a registry, which, unlike large administrative data sets, generally provide more detailed information on patient characteristics, and treatments.

Despite increased awareness of the problem, the inequalities persist, and there remains doubt among health care professionals that racial disparities in cardiovascular care exist.

The basis for disparities is multifactorial and varies across health indicators and health care settings. Disparities in the delivery of cardiovascular care may emanate from a complex interaction of physiologic differential burden of risk factors , cultural patient preferences, mistrust, and patientprovider communication , and socioeconomic provider racial or ethnic bias, poverty, and education factors.

Current research has focused on the health care delivery system as a modifiable contributor to racial disparities in cardiovascular disease management.

Recent studies have found that black patients are more likely to be treated by physicians with lower qualifications and have less access to subspecialty care.

The first analysis examined cardiac arrest survivors aged 66 to 74 years and found lower survival among blacks relative to whites hazard ratio 1.

Additionally, this study demonstrated some reduction in the racial disparity during the period from to that was partially attributed to geographical differences in the diffusion of ICD technology.

Despite the decrease in the racial disparity in ICD use, black patients continued to have significantly lower odds of receiving ICDs compared with white patients OR 0.

We were unable to reliably report the relation between ICD implantation and most recent EF assessment. But when I was 15 or 16, I discovered theater.

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For the writer of personal narrative, happiness is a problem both at the level of art and craft. Several Colgate alumni over the years have attended the conference, where writers of poetry, fiction, and memoir from around the country spend a week on campus talking about the writing life and honing their craft in workshops with the senior staff.

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Sometimes the results are miraculous, and sometimes one changes a life. You see people blossoming. Among peer colleges, Colgate was slow to offer a concentration in theater and has yet to consider dance as an academic discipline.

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The theater remains a fixture of Hamilton in an era of mega-multiplexes and Netflix, according to The Post-Standard.

Forster, T. During the event, the interns assisted the featured artists with everything from setting up stages to turning pages during performances, and attended master classes given by the featured musicians.

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Everything is, goes into, or is transformed into theater. Senior Open qualifying round. Both were named to the third team, the first time any Colgate player has earned a place on the top three teams since the season.

The camp took place in August at York University in Toronto. He graduated with a degree in molecular biology.

In August, Colgate football players plied their strength and endurance to help charities fight a rare disease. University chapters are operated by student-athletes who are dedicated to raising awareness about rare diseases.

Proctor Senior High School, where he was a four-sport athlete and stood out on the football field, in Antone lettered in lacrosse his last two years, becoming an honorable mention Ask Raider Who are you, and what do you do?

As the Colgate mascot, my job is to help get the crowd going at sporting events, represent Colgate athletics at community events like the Fourth of July parade, and really embody the spirit and fun that come along with the Colgate fan experience.

My lips are sealed. Do you have any special talents? I can ice skate and dance. All-American defenseman as a senior, and also played baseball for two years.

Now semi-retired, Antone worked in the petroleum industry. A standout football and track and field competitor, first at Utica Free Academy and then at Colgate, Boykin was a diminutive 5-foot-7, pounds.

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Today, Boykin is special deputy New York attorney general for guns and gangs. Lefevre moved into the second assistant position, while Dexter slid into the first assistant position with the departure of Andrew Dickson, who accepted a scouting position with the Columbus Blue Jackets of the National Hockey League.

John Gilger was named assistant director of athletic communications. He comes to Colgate from Hartwick College.

Tony Regitano, former Onondaga Community College head coach, was named assistant softball coach. He is a former standout track performer at the University of Iowa.

Amy Krakauer and Russell Hunt have been named assistant swimming and diving coaches. Histiocytosis is a blood disease that typically affects children under the age of I take pride in it.

Hartman Coach of the Year Award, ; named a top U. One part of my philosophy is that the players must be the owners of the team, not renters.

They set their own goals and ambitions. Then we identify how we are going to get there, develop a plan, and put it into action. Being an alum, I can illustrate my passion for Colgate soccer, which partially provides the motivation my players need to succeed.

They must understand that playing for the name on the front of their shirt is more important than the name on the back. For scores, call the Raider Sportsline: Ticket office: How did leaving your job as assistant coach at Colgate to coach at Northwestern University before returning to become head coach in impact you?

To be honest, I left kicking and screaming. I had an offer to be their assistant coach. Coming off a big year, and carrying a top 40 recruiting class, how high are your expectations for this season?

I will always set the bar higher each year. But I consider the season a series of seasons, and it is irresponsible to get ahead of yourself.

A benefit is that we have been there before; however, now we have a target on our backs. Do you have a Colgate sports trivia topic suggestion or question for Raider?

Do you have any outside involvements? Anything new and exciting in your life? The wedding is December 20, in Cooperstown, and the Colgate faculty band Dangerboy is going to play.

I enjoy exercising and golfing. I like to grill. One special recipe is my super burger. She consulted the sages at Elle, Marie Claire, O, Self, and others for advice on everything from getting rid of underarm jiggle to how to have a meaningful relationship with her mother.

It is the very process of never-ending argument, Fineman explains, that defines us, inspires us, and keeps us free.

While making the case for nurturing the real American dialogue, Fineman captures the essential issues that have always compelled healthy and heated debate.

Veteran lawyerlobbyist Richard Passmore is recruited by a Mississippi senator to derail a primary election challenge by upstart Congressman Jimmy Biddle.

Richard, a low-key but skillful operator, maneuvers to better understand Jimmy and to discover evidence that may scuttle his campaign.

Told against the background of a year of national election upheaval, this is a tale about politics, history, deception, and change.

Phillips explains that the U. Acting more like Sherlock Holmes than Oliver Wendell Holmes in the courtroom, Hank exonerates clients by catching the real bad guys.

Before Hank and his boss can rescue their new client, a U. To find the killer, Hank must defend the senator by himself in a criminal investigation that is spiraling out of control.

Global overreach, worn-out politics, excessive debt, and exhausted energy regimes are all chilling signals that the United States is crumbling as the Friends of Liberty: A Tale of Three Patriots, Two Revolutions, and the Betrayal that Divided a Nation Graham Russell Gao Hodges coauthored with Gary Nash Basic Books Friends of Liberty tells the story of three men whose lives were braided together by issues of liberty and race that fueled revolutions across two continents.

Agrippa Hull, a freeborn black New Englander who volunteered to join the Continental Army, served Kosciuszko as an army orderly and helped shape his views on slavery.

Professor of history and Africana and Latin American studies. Edmonston Jr. AuthorHouse This is the second novel in the mystery series written under the pen name Owen Magruder by William Edmonston, professor of psychology emeritus.

While assisting his son with house renovations in the city of New Boston, John Braemhor, a retired Scottish policeman, finds a set of dentures in a wall behind a medicine cabinet.

That discovery and the disappearance of the previous owner of the house lead him down a path of intrigue and mystery that involves secret codes, murder, smuggling, and attempted assassinations, all cloaked in deeply troubling psychological relationships.

Braemhor attacks the mysteries with his deductive powers and tenacity, breaking the codes, solving the murders, thwarting the smuggling operation, and resolving the underlying psychological dynamics.

Also of Note: Re-Centering Culture and Knowledge in Conflict Resolution Practice Syracuse University Press is a collection of essays by scholars and practitioners of conflict resolution who explore the role of culture, race, and oppression in resolving disputes.

My experience with them was life changing. But I knew that long before I got to Green Bay. They have different backgrounds, tastes, sensibilities, and interests.

In many ways, the Scene is both a window, and a mirror, into the family home. It also reflects the experiences and views of Colgate people out in the greater world.

And, like a family and its home, Colgate is also continually changing. Sometimes in small ways, sometimes in much larger ones.

Over the last several years, it became clear that the Scene was no longer serving the interests of the family as best it could, nor did it adequately reflect the people and place.

It was time to rebuild the frame, replace the glass, reglaze the panes. In the process, we set out to learn what our readers valued about the Scene, and what else they would like to see in it, so that we could build on what was important and successful, and make it even more useful to them in the long run.

This article will share some of the ins and outs of our renovation process, as well as what you can expect to see in the new Scene, but I also encourage you to check out the rest of the pages in this issue and see for yourself.

And let us know what you think! Welcome home. Our overarching concern was to evolve the Scene so that it would better reflect the qualities that make Colgate a special place.

We sought out a partner who could share unbiased observations of what we could do better, and lend expertise in reimagining the Scene.

And, we knew one thing for sure. The Scene should not be just another generic alumni magazine, but something uniquely Colgate. A note on frequency and class notes Clockwise from left: May , September , April connections with their constitutents through magazines and other publications.

We talked to many of you, our readers. We asked about the topics readers are most interested in, and what stories in past issues really made an impression.

Live and learn Talking points In order to accomplish these ambitious goals, it was necessary from both a resource and a planning standpoint to shift from a bimonthly to a quarterly publishing schedule.

For many, the robust class news columns are the first thing to read in a new issue, so we thought long and hard about the impact a shift in frequency would have, and how we should address it, to not only maintain that strong communication link among alumni, but also to add new opportunities for connections.

First, we made sure the page count will accommodate the same amount of class notes in four issues that normally appears in six.

Minidepartments such as Brown bag, Talking points, and Back on campus will give readers a window into the stunning variety of visitors to campus and what they came to talk about.

Let us know what you might like to see or read about! In addition to feature profiles, a variety of new spotlights will share the fascinating stories and experiences of alumni and other members of our community.

Perspectives A hallmark of the university setting is discourse: the chance to share a variety of viewpoints and observations. The color palette will change with the seasons.

Share Alumni will also share their knowledge, expertise, experiences, and fun in future issues, from Colgate memories and impressions in Rewind and My picture of Colgate to snapshots of sightings of other folks in Colgate gear in Colgate seen.

Have suggestions on how to spend a weekend where to stay, best restaurants, coolest sightseeing spots, etc. Get connected Several sections of the new Scene are meant to connect you to Colgate, and to each other.

Stay Connected will share alumni affairs news and information about special offerings like opportunities to travel with faculty, and updates from the Alumni Council.

Alumni Clubs and Groups will feature alumni clubs, events, and activities. Go online There will be many new links between print and online content, as well as web-exclusive material, on the Scene website www.

The acid rain caused by this flaring has contributed significantly to the virtual extinction of most fish populations in the area. I really thought it was typical harassment, no big deal.

On the day we were ordered out of the boat, we were traveling to a village called Egbema, to film a woman who can no longer fish in waters that had fed her family for more than 70 years.

Ironically, this area is one of the few that has experienced relatively little of the environmental damage that oil production has caused in most of the delta.

Massive oil spills are an ev- 26 scene: Autumn eryday occurrence. And the United States supports the Nigerian military against this increasing insurgency with hardware and military intelligence.

This militancy does have criminal elements, but it is also a political resistance movement. I have found no official State Department expression of concern for the root causes of the unrest.

This situation has drawn paltry media attention. But in all of our time here, the military has only ever stopped us to give us a hard time, and it had never taken more than a bit of cheeky dialogue and a playful refusal to pay we followed the lead of our Nigerian friends before we were on our way.

This time, the situation escalated quickly. Every hurdle the checkpoint officers presented for holding us in custody was overcome: passports, visas, etc.

But each time we overcame a hurdle it was replaced by a new pretend reason for holding us. It was chilling. I tried to negotiate our way out of the situation, loudly and upfront, while my production coordinator, Tammi Sims, quietly sent text messages to our contact in the United States, Leslye Wood, to let her know we might have a problem.

A basic principle in any military situation is this: the orders soldiers have given you hold until their superior officers pass along new orders.

My crew was amazing: calm, smart, and brave. Destroying our work was the right thing to do, but devastating nonetheless. It represented more than two years of work and was crucial to finishing the film.

Thornbury What I wanted was closing footage for my documentary about oil production in the Niger Delta.

What I got was a week in a Nigerian military prison. Unfortunately, I knew that the State Security Services SSS were renowned for fabricating evidence, abusing Nigerian journalists, and detaining people indefinitely without charges.

As we were being driven from one military base to another, I was seated next to the SSS commander. We still had our cell phones, so I called Tammi, who was in another car, to tell her what I had heard.

I had to call rather than furtively send a text because my polarized prescription sunglasses rendered the screen illegible, but without them I was virtually blind.

But it was time to tell our U. I was held in a want this story told. They were open about this. I had sporadic access to food and water.

The lack crew and I would have walked. The truth is that of water was the hardest part. I am struck by and a people living in this region have been ripped off and little embarrassed at how quickly I felt weak and a bit left for dead for half a century.

OK, woken for interrogation. A constant feature of intershot at averting another African travesty. I tried to think of some It was only because 14 U.

Had it not been high. Yet I knew that for the first time in my life, I for the constant lowhad paid the true price of oil.

For one week, my crew grade terror that they and I had been denied our freedom and every other would switch tactics to basic right so that those in power could control that violence, I would have natural resource with impunity.

Here at home, we found some of it interhave abdicated all moral authority to do the same. Now, I can only remember how horrible my Hopefully, those U.

I could not remember basic details international mediation in the Niger Delta. If they do that I had no reason to try to hide.

If they I used to make that point about torture in political do not, it was just awful. Many things that were A Niger Delta villager named Janet prepares containers of gasoline to sell on the black maronce philosophical are ket.

With other income options such as fishing wiped out by the environmentally devastatnow physical. Illegal detention is a blight on our collective soul and has to end immediately.

I was doing a paper for Professor Hunt Terrell in my freshman year. I had to go into the stacks and read the Congressional Record about choices made in regarding Guatemala.

Reading that openly, on the floor of Congress, a decision was made to overthrow a government because of our relationship with the United Fruit Company, my year-old eyes popped out of my head.

I got involved in political activism, through Bunche House and in Syracuse. At one point, after sleeping for two hours, I was woken for interrogation.

Why did you choose documentary as your mode of activisim? Ultimately, art outlives politics. I became devoted to the idea that witnessing, and then retelling that story to other people, was my role in all of it.

So, I looked right at the SSS commander and dialed. It was hard to decide if I wanted the drive to end or hoped it would continue forever, because I had no idea what awaited us.

I was haunted by thoughts of every prison or torture movie I had ever seen. We asked if we could listen to music on our iPods to help with our nerves and burn out the batteries since we had video clips on them we did not want the SSS to find.

Huddled in the back, three of us shared one set of headphones while Tammi played DJ. I have never been so happy to hear the Dixie Chicks in my life.

It literally made that harrowing ride bearable. What was the most important thing that you learned from that? So here I am studying mass movements and resistance, storytelling and filmmaking, and reading Stephen Jay Gould and ideas of punctuated equilibrium.

It all came together. There I was with my little Super 8 camera and hot glue splicer trying to make this experimental film to represent the idea of punctuated equilibrium versus evolution.

To have been given a camera at the same time that I was having such an explosion of ideas was the perfect thing to create someone who, for the rest of their life, would always stop and consider the content of the message first, and then decide which tool of communication to use.

No matter how much the tools of communication move and shift under your feet, you are still in charge of the story. What matters is that I was taught basic editing and storytelling.

Why did you choose to tell the story about oil in the Niger Delta? Originally I was just a camera for hire. So my first trip there, I was filming a nonprofit organization building a library.

I knew that I was looking at what would be in two to three years a huge story. The consequences were about to come home, and no one was watching.

It just seemed like one of those moments that is ripe for an independent camera to get in there fast. What is the one thing the everyday person in America needs to know about this issue?

But I would ask people to go beyond the price of gas and understand the true price of oil. Even if we became green enough tomorrow to stop needing petrol, we are responsible for having decimated places like the Niger Delta for 50 years.

What are we going to do about it? So if my story gets out there, Sweet Crude can be part of a coming wave of people knowing that the Niger Delta is one of probably villages around the world that are impacted by 50 years of oil production, and we have to be a part of how those places turn around.

I intend to use this film as an activist tool toward preventative diplomacy for this issue. For example, the Senate Foreign Relations Committee has promised me that when the movie is done they are going to do a screening.

How are you working around the footage that you lost while you were detained? We hope to be able to raise money so that some of the people whom I had either already interviewed or was supposed to interview can be flown to New York and interview them there.

It would be a sort of painterly, beautiful, experimental documentary. After all this danger and guns, I think it might be time to go to Italy and follow some women making wine.

What kind of a car do you drive? And it got about six miles to the gallon. I have to keep reminding myself not to be intimidated by having pieces of footage missing.

News and views for the Colgate community 29 What is the cost of intellectual sustainability? Of the 2, students returning to Colgate this fall, approximately 60 percent of them are doing so without financial aid.

The situation is hardly unique to Colgate. If you try to enhance productivity, you have the potential to negatively impact quality.

And what is Colgate doing to balance competitiveness and affordability? A word on price and wealth The price of tuition is a tricky thing to enumerate.

Total student charges provide approximately 63 percent. But by the time I got to my senior year, I was a little more interested in business.

Today, we teach sciences with equipment and machines and programs that nobody could have dreamed of twenty years ago. A library, to give another example, must now accommodate technology in addition to providing space for books and studying.

As seen in the accompanying pie chart illustration, although costs have increased significantly over the past 20 years, how the university allocates its resources on an annual basis has not changed.

It critically processes and forms both personal and social persona. By its teaching, it inspires respect for learning and the beginning exploration of the initially unsuspected range of knowledge and relationships that give worth and dignity to our lives, as learning does to human life more generally.

Our singlemost important strategic priority is to make Colgate more accessible by increasing the number of financial aid packages we can offer to admitted students.

Lowering costs in the area of compensation would have a direct and immediate impact on the quality of the educational and extracurricular experiences provided to our students.

Were we to reduce the size of the faculty, class size would increase, and students would lose essential opportunities for close interaction with their professors.

Spending down the endowment beyond levels necessary to maintain intergenerational equity Colgate has averaged a spending rate of 4.

A Patriot League Team Green Committee, for instance, was recently formed to focus on environmental protection and promotion through athletics.

Beyond athletics, in response to the Americans with Disabilities Act, fire safety regulations, asbestos abatement, and the like, Colgate has invested significant resources to make the campus safer, more accessible, and healthier.

The rising cost of fuel then spills over many line items, from athletics travel to airfares for study-abroad programs to the cost of transporting food and other necessities to campus.

And, more broadly, Punsoni and his team are constantly working to negotiate multiyear agreements with suppliers and vendors. In recent years, Colgate has taken steps such as tightening up the benefits plan and asking employees to take on higher copay levels.

Information resources and technology constitute a particularly visible, if predictable, example of a rapidly increasing expenditure.

Add to that double-digit inflation in the costs of books and scholarly periodicals, and you have a budget challenge that may be impossible to sustain indefinitely.

Construction inflation, meanwhile, had been climbing steadily at less than 3 percent annually until a spike in inflation in building materials drove up costs more recently by close to 10 percent.

Thanks to gifts to the university, Colgate is working to provide more than 50 additional financial aid packages to deserving students.

What price education? Oxford to work this summer, and had a job waiting for him with the Princeton Economics Group when he returned to the United States this fall.

According to Harry, Colgate would have been out of reach were it not for financial aid. Studies show people from selective schools or private universities enjoy greater salary growth over the course of their careers than those who attend public schools or nonselective schools.

In the near future, colleges will find themselves competing for a smaller pool of academically qualified students whose families can afford to pay full tuition.

Chris was convinced that it was an earthquake, and hurried us outside. I gasped. Chengdu is almost profiled people who lied to their families and hopped on airplanes to Sichuan, knowing their parents or spouses would never countenance them going into such a dangerous region.

A businessman told me about his friend, also an entrepreneur, who packed suitcases of supplies and money and left her business to work in the devastated region for two weeks.

The people I knew in Beijing donated to the government and the state-run Chinese Red Cross, but they also gave money to acquaintances who happened to own trucks that could be filled with necessities and driven out to a village where someone had a personal connection.

Nongovernmental organizations NGOs that had served other regions turned their focus on Sichuan and sent their people there to see what could be done.

Planes and hotels empty of tourists and business travelers were refilled with volunteers. The Chinese and Western media profiled people who lied to their families and hopped on airplanes to Sichuan, knowing their parents or spouses would never countenance them going into such a dangerous region.

How could an earthquake in Chengdu shake buildings in Beijing? Of course we all know the answer now: a huge earthquake, 7. One that caused a devastating amount of damage: nearly 70, people dead, , injured, and 5 million people homeless.

Yet this enormous tragedy, broadcasted all over the world via television and Internet, also inspired an enormous response.

Hundreds of millions of dollars in cash and materials, accompanied by volunteers, poured in from international sources. But there was another source of donations and volunteers: China itself.

Thousands of Chinese volunteers flowed into the devastated region, individually and as members of organizations. The Chinese and Western media Western journalists and scholars pondered: Could this be a turning point for Chinese society?

Although the impact of the earthquake cannot be underestimated, in fact all of those transformations had been emerging well before May Indeed, the past decade has witnessed an explosion of NGOs in China.

A very short history of charity in China There is actually a long and rich tradition of voluntary and compassionate giving to the poor and needy in China.

But while the Western concept of charity values giving to strangers, the Chinese framework idealizes giving to kin.

After the Communist Revolution, lineage organizations were eradicated. During the aftermath of the horrific Tangshan earthquake, which killed approximately , people, ordinary Chinese people reached into their wallets to contribute to the rescue and rebuilding efforts.

The idea was that everyone would be covered by kin-based charity. In this realm, religious or private charities were moot.

Of course, some people fell through the cracks of this system. The state would also step in during times of major disasters and in very bad times often urged even compelled wealthy citizens to help for example, by donating resources or even setting up food kitchens in times of famine.

This disaster was more devastating than anything China has experienced since the Tangshan earthquake.

The reach of television and the Internet meant that people could see and hear and feel the horror of the situation more fully than in the past.

People in China also have greater financial capacity today. In , citizens contributed the equivalent of pennies and dimes.

In May, the members of the new middle class could give thousands of dollars, and the wealthy could contribute hundreds of thousands, even millions.

Even 20 years ago, NGOs were essentially nonexistent in China. In recent years, however, hundreds and maybe thousands have been founded, focusing primarily on the areas of environmental protection, poverty alleviation, and education.

The Chinese state, caught off guard, had to write up regulations governing these new entities, which went into effect in This transformation has been fueled, in large part, by the idealism and energy of young people.

But this year, a professor at Beijing University told me that all of her students talk about volunteering and discuss the possibility of finding jobs in the nonprofit sector.

At the offices of Golden Key, a charity that serves blind and visually impaired children, a constant stream of student volunteers types and translates documents.

Chinese young people not only join existing organizations; they also start their own. In fact, many of them are suspicious of existing bureaucracies and prefer to rely on their own efforts; for example, student organizations volunteer at orphanages and retirement homes.

According to Ning Zhang at the University of Pittsburgh, the 1kg Project is maintained by volunteers scattered all over China.

This desire to do something helpful, but to work 38 scene: Autumn outside of the state and existing bureaucracies, also motivated the individuals who founded the Chinese grassroots NGOs I studied.

It also inspired the thousands of individuals who poured into Sichuan to volunteer for earthquake relief, some of whom will no doubt organize themselves into future NGOs.

One of the purposes of my research was to examine why this spirit of individual volunteerism is so strong in China today, especially among the young, middle class urbanites.

The first factor is the shrinking of the Chinese state. In the United States, we tend to view the Chinese state as powerful and intrusive, but it plays a much smaller role in Chinese society than it did 30 or even 20 years ago.

Because the party-state bureaucracy ran everything, it had a monopoly on all of the higher-paying jobs.

Since the reforms, the Chinese state has been transforming itself from a paternalistic caretaker into more of an economic manager.

Beginning in the late s Volunteers collect clothes for Sichuan earthquake survivors at the Jiuzhou Stadium in Mianyang. They have never experienced the all-embracing socialist state.

Andrew Daddio Golden Key Founded in , Golden Key Research Center of Education for the Visually Impaired helps visually impaired children receive educational and vocational training and counseling in poor and remote areas of China.

For those who want to make a difference in society, a job in the government is no longer the obvious choice, or even a reasonable one.

And many of them do want to make a difference. The college students I taught in the China of the s were individualistic and apolitical.

Their idea of a good job was one with a good paycheck. Although few would be wealthy by U. You know that you can get a decent one.

So that means people can think about other things. You can think about what interests you, not just what is going to bring in a paycheck.

Brimming with self-confidence, they believe they have something to offer. An associate professor of sociology, she has published articles on Chinese business practices and entrepreneurship, and on political corruption.

A member of the Colgate faculty since , she says one of her favorite courses to teach is the senior capstone seminar in sociology and anthropology, in which students do their own original research.

I love the combination of science and business. Drug companies looking to raise capital present their research and their business case, and I help the promising ones raise the money.

I have to understand the science enough to explain it to investors. Why did you decide to serve on the Alumni Council? When they asked me, my children were 1 and 3, so it was not an automatic decision, but I was honored.

My term was coming to an end, so it seemed like an obvious next step. What issues are most important to you as a council member?

Colgate has a strong alumni network. We want to enhance that, while making better connections with current students.

Also, the call to volunteer frequently goes out to the same set of people. I think there are more people who have the inclination, if they only knew what the opportunities were.

Volunteering can be as simple as donating your airline miles, or having a student shadow you for a day. How do you approach the process of selecting new members?

We look for people from diverse backgrounds who are demographically representative of the alumni body. Tell us about your family My husband, Con, works for a freight-forwarding and logistics firm.

Kate is 7, active, athletic. Timothy is 5, and I found out two nights ago that he can read; he was keeping it secret! You just got a free hour.

How would you use it? Stay tuned for more information! Contact the alumni office to receive club mailings for multiple cities.

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Because PCI in most cases leads to fast and complete revascularization of the infarct-related area, it could be speculated that subsequent ST-segment deviations on Holter monitoring would be less common than observed among The American Journal of Cardiology www.

Absolute percentage of LV ejection fraction. However, this could not be confirmed in our study. It has been shown in a communitybased patient sample that the added absolute benefit of PCI increases with higher overall risk,19 and this was also evident in the DANAMI-2 trial.

However, this was not evident in our study, because other risk factors, such as age, anterior wall AMI, and impaired LV systolic function, were equally distributed between the 2 treatment groups.

In accordance with this finding, long-term mortality rates were also similar in the 2 treatment groups, although there was a trend toward lower mortality in PCI-treated patients.

This is most likely attributable to the fact that the selection of either fibrinolysis or PCI was determined by randomization, whereas in everyday clinical practice, the risk profile of patients selected for PCI may differ from that of patients selected for fibrinolysis, and accordingly, so may the subsequent prevalence of several risk factors, including ST-segment deviations.

Bjerregaard et al22 showed that the outcome of Holter analysis for ischemic events varied from 4. Furthermore, in previous studies, the timing of Holter recording has varied from 1 day to 3 weeks after index infarction.

In the present study, there was a significant association between STd on Holter monitoring and positive exercise test results in the 2 treatment groups.

ST-segment deviation during exercise testing is generally accepted for prognostic assessment of patients after AMI, indicating residual myocardial ischemia.

We therefore suggest that most episodes of STd observed in the present study were ischemic episodes. In contrast, we found the same prevalence of STd in Holter monitoring in the 2 treatment groups.

It is possible that fibrinolysis-treated patients had less complete reperfusion of the infarct-related area compared with those treated with PCI, explaining the greater extent of STd during maximal exercise testing.

We also found a significant association between STe and reduced LV systolic function in the 2 treatment groups, whereas no association was found between STe and positive exercise test results.

This suggests that STe, rather than reflecting transient myocardial ischemia, is a marker of significant LV remodeling, a hypothesis supported by the fact that STe was also significantly more frequent in patients with anterior wall myocardial infarction.

The timing of Holter recording may in some part have affected our results. In the present study, recordings were performed on the day of discharge.

It is possible that the degree of reperfusion and ventricular myocardial remodeling became less frequent during the months after STe myocardial infarction, affecting incident transient ST-segment deviations.

It is therefore possible that the prevalence of ST-segment deviations would differ in the 2 treatment groups if Holter monitoring had been performed at a later stage.

However, Mickley et al6 found no differences in the prevalence of STd in similar patients examined at discharge and 6 and 12 months after infarction.

Another major limitation of the study relates to the general risk profile of the investigated cohort. Because of the exclusion criteria of the DANAMI-2 trial, and the fact that Holter monitoring was performed at discharge, excluding all patients dying before the Holter recording was possible, our cohort was at a lower risk.

It is therefore possible that the prevalence and prognostic implications of the investigated variables differ from what would be found in an unselected STe myocardial infarction population.

A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. Danish multicenter randomized study on fibrinolytic therapy versus acute coronary angioplasty in acute myocardial infarction: rationale and design of the Danish Trial in Acute Myocardial Infarction-2 DANAMI The reliability of echocardiographic left ventricular wall motion index to identify high-risk patients for multicenter studies.

Rapid estimation of left ventricular ejection fraction in acute myocardial infarction by echocardiographic wall motion analysis.

Phase I findings. Changing circadian variation of transient myocardial ischemia during the first year after a first acute myocardial infarction.

Egstrup K. Transient myocardial ischaemia during ambulatory monitoring out of hospital in patients with chronic stable angina pectoris.

Prognostic significance of transient myocardial ischemia on ambulatory monitoring after acute myocardial infarction. Prognostic importance of myocardial ischemia detected by ambulatory monitoring early after acute myocardial infarction.

Silent ischemia on Holter monitoring predicts mortality in high-risk postinfarction patients. Prognostic significance of ischemic episodes in patients with previous myocardial infarction.

Prognostic value of ischemia during Holter monitoring and exercise testing after acute myocardial infarction. Frequency and importance of silent myocardial ischemia identified with ambulatory electrocardiographic monitoring in the early in-hospital period after acute myocardial infarction.

Characterization and prognostic significance of silent myocardial ischemia on predischarge electrocardiographic monitoring in unselected patients with myocardial infarction.

Prognostic significance of transient myocardial ischaemia after first acute myocardial infarction: five year follow up study. Detection and significance of myocardial ischemia in stable patients after recovery from an acute coronary event.

Multicenter Myocardial Ischemia Research Group. Pathophysiology and prognostic significance of Holter-detected ST segment depression after myocardial infarction.

Characteristics and prognostic importance of ST-segment elevation on Holter monitoring early after acute myocardial infarction.

Is primary angioplasty for some as good as primary angioplasty for all? Simple risk stratification at admission to identify patients with reduced mortality from primary angioplasty.

Holter-detected myocardial ischemia. Impact for prognosis and decision making after acute myocardial infarction. ST segment analysis by Holter Monitoring: methodological considerations.

Haldis, DOc, G. Menapace, MDa This study was conducted to evaluate door-to-treatment times before and after the implementation of a rapid triage and transfer system for patients with ST-elevation myocardial infarction transferred from community hospitals to a rural angioplasty center for primary percutaneous coronary intervention PCI.

The system was developed in late and implemented at a rural percutaneous coronary intervention center in early In conclusion, the implementation of a rapid triage, transfer, and treatment protocol can achieve a significant shortening of presentation-to-treatment times.

Our facility instituted a rapid transfer protocol on January 1, We report here the characteristics and results of patients with STEMI transferred to our medical center before and after the initiation of this protocol.

Manuscript received February 16, ; revised manuscript received and accepted April 17, It is a teaching affiliate of a Philadelphia medical college and has an independent cardiology fellowship program.

It serves 37 counties with a population of 2. The PCI center is part of a health system that also owns and operates 4 helicopters based at 4 sites in central Pennsylvania.

The helicopter communications center is located in the emergency department of the PCI center. All patients transferred to our PCI center from January 1, , to December 31, , for PCI within 12 hours of the onset of STEMI were considered for inclusion in this study, including those with cardiogenic shock, hemodynamic instability, or cardiac arrest.

We excluded patients transferred for failed thrombolytic therapy and patients with contraindications to PCI, including patient refusal, allergy to contrast dye, major co-morbidities precluding PCI, and warfarin anticoagulation.

Patients whose initial presentation was to the PCI center were also excluded. The study was approved by the institutional investigational review board.

During , patients were treated according to standard practice. No door-to-balloon time quality improvement projects had been previously attempted.

Prehospital electrocardiography was not available to emergency medical services in rural central Pennsylvania.

Patients with STEMI presenting to community hospitals were evaluated there by emergency physicians, primary care physicians, or cardiologists.

The PCI center emergency physician screened the patient for appropriateness for PCI, checked cardiac intensive care unit bed availability, and then requested helicopter transfer.

When bad weather prevented helicopter transport, transfer was undertaken by local ambulance services. On arrival at the PCI center, the patient was taken to the emergency department, where the emergency physician and the general cardiologist on call assessed the patient, checked laboratory results, and consulted the interventional cardiologist.

If appropriate, the interventional cardiologist directed the paging operator to group-page the catheterization team.

In mid, the PCI center emergency department instituted a streamlined helicopter dispatch protocol. It was designed so that 1 call from a community hospital emergency department to the PCI center emergency physicians on a dedicated phone line prompted immediate dispatch of the helicopter.

Independent of this, over the last half of , a rapid triage, transfer, and treatment protocol for patients with STEMI was developed.

Some of its innovations were informally incorporated into practice through rapid cycle tests of change by individual physicians at the angioplasty center over that time.

The new protocol, implemented on January 1, , encouraged referring physicians to directly call the PCI center emergency department. After reviewing a faxed copy of the electrocardiogram and screening the patient with a 9-question checklist, the emergency department physician dispatched a helicopter and alerted the interventional cardiologist on call, who then called the operator to group-page the catheterization laboratory team.

In most cases, the interventional cardiologist and catheterization team met the patient and helicopter crew at the helipad elevator doors and escorted them directly to the catheterization laboratory.

After obtaining a brief history, examination, and informed consent, PCI was performed. Letters describing the program were mailed to community hospital emergency department directors in the first week of In the first half of , a PCI center interventional cardiologist JCB visited the 8 hospitals that provided most referrals, presenting the program through a didactic conference and written materials.

Eliminating intravenous infusions of heparin and nitroglycerin were suggested as time-saving measures. Community hospitals adopted these recommendations at their own discretion.

PCI was typically performed with 6Fr guide catheters, heparin anticoagulation, predilatation before stenting, and vascular closure with an intra-arterial collagen plug device.

Noninfarct lesions were not treated during the initial PCI. Details of diagnostic catheterization and PCI e. After PCI, patients were admitted to the cardiac intensive care unit under the care of the general cardiology service.

Registry forms were completed immediately after PCI by the operator. Transfer times for the first 6 months of were collected retrospectively using logs from the helicopter service, cardiac catheterization laboratories, and patient charts.

Precise times were available for all key data points for all patients. Starting July 1, , transfer times were collected immediately after PCI on standardized forms.

All data for the study period were entered into data fields that were added, for study patients, to the National Cardiovascular Data Registry.

The time of onset of symptoms was that reported by the patient, as recorded in the chart or obtained directly from the patient.

The time of initial presentation was taken as the first time found on any documentation from the initial hospital.

The time of first electrocardiography was taken directly from the first electrocardiogram performed at the referring hospital.

Dispatch time was the time the helicopter service was called with a request for transfer. Helicopter touchdown and liftoff times from the referral hospital and PCI center were taken from helicopter flight logs as reported by the pilot to the helicopter communications center.

The catheterization laboratory arrival time was defined as the time that the patient entered the catheterization laboratory.

Catheterization laboratory arrival and wire crossing times were taken from the catheterization laboratory procedure logs as recorded in real time.

The rationale for using wire crossing time is discussed further later but centered on the fact that the angioplasty balloon inflation was often not the first reperfusion modality used.

Demographic and procedural data are reported as percentage and number of patients with each characteristic.

Times are reported as medians because all time distributions were skewed and were compared across time intervals using the nonparametric Kruskal-Wallis test for independent samples.

Helicopter transfer patients were used for the calculation of times from electrocardiography to helicopter dispatch; all patients were used for all other time analyses.

SAS version 9. There were no deaths or significant complications during helicopter transport. Demographic and angiographic characteristics Tables 1 and 2 did not change over time during the study data not shown.

Time periods for various milestones in the triage, transfer, and treatment process are listed in Table 3. Times from community hospital arrival to electrocardiography varied from 6 to 8 minutes and did not change significantly during the study period.

Times from electrocardiography to heli- copter dispatch decreased from The other 6 referring hospitals together transferred only 22 patients [range 1 to 7] during the 2-year study period.

Time from presentation to wire crossing decreased from to for all 8 hospitals. Table 4 demonstrates a wide variation in median door-to-wire times, from 91 to minutes.

Outcomes during initial hospitalization were favorable, with a mortality rate of 3. Discussion The most important finding of this study is that the rapid diagnosis, triage, transfer, and treatment of patients with STEMI is possible in a real-world rural American setting.

The median door-to-wire time at the end of the study period for patients transferred for PCI minutes approached the median door-to-balloon time minutes for patients who underwent on-site PCI at hospitals during a similar time period, as reported by Bradley et al.

We conclude that the minute goal is achievable for some transferred patients, even in a rural setting.

A second important finding of this study is that dramatic improvements in time from initial presentation to PCI for transferred patients can be achieved simply, using minimal resources.

Henry et al18 and Bradley et al,12 which were published after our study was completed. Our study documented heterogeneity in door-to-wire times among the frequently referring community hospitals.

This was attributable mostly to practices at the community hospitals; flight time was not significantly associated with overall doorto-wire time.

Formal surveys of community hospital practices were not undertaken, but informal communications revealed dramatic differences in the extent to which community hospital emergency departments embraced the new triage, treatment, and transfer protocols.

Improvements in door-to-treatment times among hospitals varied widely, with 1 hospital decreasing its time by minutes to go from second slowest to second fastest among referring hospitals.

In contrast, the fastest hospital at the outset reduced its time by only 47 minutes, ending up fifth fastest among referring hospitals.

This demonstrates that the most efficient hospitals in our region are significantly faster than others and that they can improve doorto-treatment times for their patients to a greater extent than others.

Raising all hospitals to the levels of efficiency of the fastest community hospitals would have resulted, in our study, in almost half of transferred patients meeting the minute guideline goal.

We used wire crossing time instead of balloon inflation time for several reasons. First, balloon inflation is an arbitrary end point that often does not reflect time of reperfusion.

Many arteries reperfuse spontaneously or with wire crossing before balloon inflation, and often the first balloon inflation does not provide reperfusion.

Second, many procedures began with rheolytic or aspiration thrombectomy, significantly delaying first balloon inflation. Third, direct stenting was performed when possible, often after dottering a lesion without balloon inflation, and delays in choosing The American Journal of Cardiology www.

Fourth, when a balloon was used as the initial reperfusion device, wire-to-balloon times were consistently only 2 to 3 minutes, representing a small increase compared with door-to-wire times.

The number of patients was small. The generalizability of the results may be limited by 2 unique features of the PCI center: the catheterization laboratory is staffed by a single group of experienced, employed interventionists, and the helicopter service is owned by the same health system that operates the PCI center.

Prehospital electrocardiography was not available to local emergency medical center units, and its use may further improve transfer efficiency.

If universally implemented, these might have provided further improvements in efficiency. Patients in this study were not given facilitation therapy; some type of adjuvant medical therapy may in the future prove beneficial for patients with STEMI.

When such delays are foreseeable, a strategy of immediate medical thrombolysis may be preferable, as recommended by the American College of Cardiology guidelines.

Acknowledgment: The past and current success of our program for rapid triage and transfer for STEMI is due entirely to the dedicated efforts of emergency physicians and nurses at our center and at community hospitals, Lifeflight personnel, and the staff members and physicians of our catheterization laboratories.

Long distance transport for primary angioplasty versus immediate thrombolysis in acute myocardial infarction.

A randomized trial of transfer for primary angioplasty versus on-site thrombolysis in patients with high-risk myocardial infarction.

Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States.

Rationale and strategies for implementing community-based transfer protocols for primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction.

Effect of continuous quality improvement analysis on the delivery of primary percutaneous Effect of continuous quality improvement analysis on the delivery of primary percutaneous revascularization for acute myocardial infarction.

Long-term outcomes of regional variations in intensity of invasive vs medical management of Medicare patients with acute myocardial infarction.

Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction. Door-to-balloon time with primary percutaneous coronary intervention for acute myocardial infarction impacts late cardiac mortality in high-risk patients and patients presenting early after the onset of symptoms.

Strategies for reducing the door-to-balloon time in acute myocardial infarction. Williams DO. Treatment delayed is treatment denied.

Hermann HC. Transfer for primary angioplasty: the importance of time. Wharton TP. Should patients with acute myocardial infarction be transferred to a tertiary center for primary angioplasty or receive it at qualified hospitals in the community?

Implementation of acute myocardial infarction guidelines in community hospitals. ST-segment elevation myocardial infarction: recommendations on triage of patients to heart attack centers: is it time for a national policy for the treatment of ST-segment elevation myocardial infarction?

Dehmer GJ, Powell W. Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomized study.

Primary percutaneous coronary intervention in acute myocardial infarction: direct transportation to catheterization laboratory by emergency teams reduces door-to-balloon time.

Pre-hospital lead electrocardiography programs. A call for implementation by emergency medical services systems providing advanced life support.

Feasibility of early emergency room notification to improve door-to-balloon times for patients with acute ST elevation myocardial infarction.

Pharmacological facilitation of primary percutaneous coronary intervention for acute myocardial infarction: is the slope of the curve the shape of the future?

Grayburn, MD, Emily A. There is recent randomized trial data evaluating the use and safety of DES for acute myocardial infarction.

A single-center retrospective analysis was performed on consecutive patients with STEMI treated with primary or rescue coronary angioplasty between March and July The study consisted of 3 groups: patients treated with paclitaxel-eluting stents, 55 with sirolimus-eluting stents, and 18 with bare metal stents.

Outcomes were assessed from 12 to 28 months mean 20, median 19 for major adverse cardiac events MACEs including myocardial infarction, in-stent thrombosis, clinical restenosis, and death.

There were 4 in-stent thromboses in the paclitaxel group 3. The thromboses ranged from acute within 24 hours to as late as 8 months.

Clinical restenosis occurred in 4 patients 3. None of the 18 patients with bare metal stents had thrombosis or clinical restenosis. There were 7 total deaths, all related to complications from the index STEMI: 1 in the bare metal group, 1 in the sirolimus group, and 5 in the paclitaxel group.

Methods A single center, retrospective analysis was performed on consecutive patients admitted from March to July to Baylor University Medical Center with STEMI and treated with primary or rescue angioplasty within 24 hours of onset of symptoms.

Baylor University Medical Center consists of 3 private practice cardiology groups with a total of 13 interventional cardiologists. Manuscript received February 27, ; revised manuscript received and accepted April 10, Three groups consisted of those patients who were treated with paclitaxel-eluting stents, sirolimus-eluting stents, and bare metal stents.

All patients were prescribed aspirin 81 or mg daily. Using telephone interview, in-hospital and office follow-up chart review, the patients were analyzed for major adverse cardiac events MACEs occurring during the index hospitalization, and at up to 2 years of follow-up.

MACE was defined as cardiac death, repeat myocardial infarction, in-stent thrombosis, clinical restenosis, and target lesion revascularization clinical restenosis and in-stent thrombosis.

Stent thrombosis was defined as positive angiographic documentation or unexplained cardiac death. Demographic data along with history of cardiac risk factors were also collected.

Procedural data consisted of stent diameter and length, and vessel stented. Results A total of patients were analyzed.

The 3 groups consisted of patients treated with paclitaxel-eluting stents, 55 patients treated with sirolimus-eluting stents, and 18 patients treated with bare metal stents.

Table 2 lists the procedural data. Only 3 cases involved saphenous vein grafts 2 to the left anterior descending artery, 1 to the right coronary artery.

All patients received aspirin and clopidogrel after coronary stenting. Table 3 lists the clinical outcomes. The follow-up time ranged from 12 to 28 months average All patients completed 1-year clinical follow-up.

Of the patients included in the study, 7 died during their index hospitalization 5 in the paclitaxel group, 1 in the sirolimus group, and 1 in the bare metal group.

Six of the 7 deaths occurred due to complications from the index infarction refractory cardiogenic shock in 3 and anoxic brain injury from prolonged cardiac arrest in 3.

One death occurred due to sepsis. No follow-up deaths were observed in the surviving discharged patients. One patient in the sirolimus group also experienced a non-STEMI within 2 weeks of her index percutaneous intervention.

In-stent thrombosis occurred in 6 patients 3. No deaths occurred as a result of stent thrombosis, and all patients underwent successful percutaneous target lesion revascularization.

Two other patients in the paclitaxel group experienced in-stent thromboses while on dual antiplatelet therapy 1 on day 2 of hospitalization and 1 at 10 days.

Both patients in the sirolimus group who experienced thromboses were taking their dual antiplatelet medicines 1 within 24 hours and 1 at 2 weeks.

No patients in the bare metal group experienced thromboses. Data were also collected on clinical restenoses. Four patients in the paclitaxel group underwent target vessel revascularization due to clinical restenoses.

These procedures occurred as early as 3 months and as late as 12 months. Two patients in the sirolimus group underwent target vessel revascularization secondary to clinical restenoses 1 at 2 months and 1 at 20 months.

No patients in the bare metal group experienced clinical restenosis and may in part be due to the larger stent diameters used Table 2.

They concluded that there was no difference between the DES with regard to the risk of stent thrombosis. Recently, randomized prospective studies have assessed the safety and efficacy of DES when used in the setting of an acute myocardial infarction.

Two studies reported an in-stent thrombosis rate of 3. Our data were minimal for the bare metal stents and therefore limits any comparisons between DES and bare metal stents.

The rates of clinically driven restenoses were also similar between the 2 DES groups 4 of patients, 3. The efficacy of DES with regard to restenosis has been well established by previous trials.

In-stent restenosis and subacute thrombosis are more common in longer length stents. The average length of the bare metal stents was longer than the average length of both the paclitaxel-eluting stent and the sirolimus-eluting stent groups.

Pasceri et al11 studied the use of sirolimus-eluting stents in acute myocardial infarctions. Two of the patients in their study group had subacute thrombosis when they stopped taking ticlidopine.

Previous studies have shown that a potential problem with the DES is late in-stent thrombosis. Two patients in the paclitaxel group were prematurely taken off their antiplatelet therapy, and this likely played a role in the observed MACE events.

One of these patients also had completed the recommended regimen of clopidegrel but had a late event off of aspirin. This study is relatively small in size and was not randomized.

Follow-up angiograms were not routinely performed performed only on patients who had clinical indications for angiography.

Angiographic evaluations of index procedures were not performed to assess for dissection, bifurcation location, stent underdeployment, and residual thrombus, which all have been associated with in-stent thrombosis.

This type of analysis may have helped explain some of the early in-stent thrombosis seen in the present study. Paclitaxel-eluting versus uncoated stents in primary percutaneous coronary intervention.

Sirolimus-eluting versus uncoated stents in acute myocardial infarction. Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up.

Incidence, predictors and outcome of thrombosis after successful implantation of drug-eluting stents. One year clinical follow up of paclitaxel eluting stents for acute myocardial infarction compared with sirolimus eluting stents.

A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. Sirolumus-eluting stents versus standard stents in patients with stenosis in native coronary artery.

A paclictaxel stent for the prevention of coronary restenosis. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization.

A randomized trial of rapamycin-eluting stent in acute myocardial infarction: preliminary results abstr. Am J Cardiol ;92 suppl 1 Incidence of thrombotic stent occlusion during the first three months after sirolimus-eluting stent implantation in consecutive patients.

Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation.

Planar VH-IVUS analysis at the minimum luminal site and at the largest necrotic core site and volumetric analysis over a mm-long segment centered at the minimum luminal site showed that the percentage of necrotic core was significantly greater and that the percentage of fibrofatty plaque was significantly smaller in patients with ACS.

The percentages of fibrotic and fibrofatty plaque areas and volumes were smaller, and the percentages of necrotic core areas and volumes were larger in VH-TCFAs compared with non-TCFAs.

In conclusion, culprit lesions in patients with ACS were more unstable and had greater amounts of necrotic core and smaller amounts of fibrofatty plaque compared with target lesions in patients with SAP.

However, unstable clinical symptoms in patients with ACS are associated with unstable plaque characteristics. Manuscript received March 5, ; revised manuscript received and accepted April 13, Acute myocardial infarction was defined as continuous chest pain at rest with abnormal levels of cardiac enzymes creatinine kinase-MB or troponin T.

SAP was defined as no change in the frequency, duration, or intensity of symptoms within 6 weeks before the intervention.

In patients with SAP who underwent multivessel intervention, the lesion with the worst diameter stenosis and more complex morphology in the territory of scintigraphic reversible defects was selected as the target www.

A remodeling Figure 1. IVUS signs of plaque rupture were a cavity that communicated with the lumen with an overlying residual fibrous cap fragment.

Analysis of variance. VH-IVUS analysis classified and color-coded tissue as green fibrotic , yellow-green fibrofatty , white dense calcium , and red necrotic core.

Results Baseline clinical characteristics are listed in Table 1. Volumetric VH-IVUS analysis over a mm-long segment centered at the minimum luminal site supported these observations.

Clinical characteristics of subgroup patients without plaque rupture are listed in Table 6. The angiographic assessment of coronary luminal stenosis has been considered a surrogate marker of the severity of atherosclerosis.

However, coronary angiography, a luminogram, has low predictive value to assess atherosclerotic plaque burden or to predict ACS events.

The amounts of necrotic core were larger and the amounts of fibrotic and fibrofatty plaque were less in patients with ACS.

Several pathologic studies have suggested that TCFAs are particularly prone to rupture and result in acute coronary artery occlusions.

In the present study, primary lesions lesions targeted for intervention were also more often unstable in patients with ACS than in those with SAP.

A previous pathologic study showed that the percentage of necrotic core was significantly larger in ruptured plaques than in TCFAs.

In addition, we studied lesions after rupture, after the necrotic core may have embolized. However, it is interesting to speculate that the presence of unstable lesion morphology ruptured plaque or VH-TCFA may have contributed to the clinical progression to intervention-requiring symptoms in many of the patients with SAP in the present study.

This study was a single-center, retrospective study. Total occlusions, bifurcation lesions, lesions with severe angulations, and heavily calcified lesions were excluded from this study.

From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: part 1.

Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions.

Pathology of the vulnerable plaque. Extent and direction of arterial remodeling in stable versus unstable coronary syndromes.

Coronary plaque classification with intravascular ultrasound radiofrequency data analysis. In vivo intravascular ultrasound-derived thin-cap fibroatheroma detection using ultrasound radiofrequency data analysis.

Multiple versus single coronary plaque ruptures detected by intravascular ultrasound in stable and unstable angina pectoris and in acute myocardial infarction.

Comparison of coronary plaque rupture between stable angina and acute myocardial infarction: a three-vessel intravascular ultrasound study in patients.

Techniques characterizing the coronary atherosclerotic plaque: influence on clinical decision making? Angiographic progression of coronary artery disease and the development of myocardial infarction.

Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-tomoderate coronary artery disease?

Arterial wall characteristics determined by intravascular ultrasound imaging: an in vitro study. Intracoronary ultrasound imaging: correlation of plaque morphology with angiography, clinical syndrome and procedural results in patients undergoing coronary angioplasty.

Accuracy of in vivo coronary plaque morphology assessment. A validation study of in vivo virtual histology compared with in vitro histopathology.

Coronary plaque disruption. Multiple atherosclerotic plaque rupture in acute coronary syndrome: a three-vessel intravascular ultrasound study.

Intravascular ultrasound analysis of infarct-related and non-infarct-related arteries in patients who presented with an acute myocardial infarction.

Intravascular ultrasound assessment of ulcerated ruptured plaques: a comparison of culprit and nonculprit lesions of patients with acute coronary syndromes and lesions in patients without acute coronary syndromes.

The prevalence of 2-vessel CAD and of 1-vessel CAD was not significantly different between patients with and without previous stroke.

In conclusion, patients with previous stroke have a significantly higher prevalence of obstructive CAD and of obstructive 3-vessel CAD than ageand gender-matched patients with similar coronary risk factors without previous stroke who undergo coronary angiography for chest pain.

We report data from patients with previous stroke and from a control group of patients without previous stroke who underwent coronary angiography because of chest pain.

All patients with previous stroke had cerebral infarction documented by computed tomographic brain scans. Chi-square tests were used to analyze dichotomous variables.

Manuscript received March 1, ; revised manuscript received and accepted April 24, Table 1 also lists levels of statistical significance.

Discussion Patients with previous stroke have a higher prevalence of CAD than patients without previous stroke.

The prevalence of obstructive 2-vessel CAD and of obstructive 1-vessel CAD was not significantly different between patients with and without previous stroke.

Patients with previous stroke should also be screened for myocardial ischemia. Asymptomatic coronary artery disease in patients with stroke.

Prevalence, prognosis, diagnosis, and treatment. Aronow WS, Ahn C. Ness J, Aronow WS. Fatal myocardial infarction following carotid endarterectomy: three hundred and thirty-five cases followed years after operation.

Outcome in patients with asymptomatic neck bruits. Forty-five month follow-up of extracranial carotid arterial disease for new coronary events in elderly patients.

It is also known that smokers have abnormalities in endothelial dysfunction. Although smoking is a major risk factor for coronary artery disease, microvascular abnormalities have not been well shown.

We investigated clinical characteristics and coronary reactivity with adenosine triphosphate in smokers with VSA. Twenty-two consecutive patients whose coronary spasm was documented in the left anterior descending LAD coronary artery with acetylcholine were enrolled.

Coronary blood flow responses were also evaluated by intracoronary Doppler flow velocity recordings in the LAD coronary artery.

APV at rest in smokers However, CFR in smokers 2. In conclusion, multivessel spasm was demonstrated in smokers in clinical settings, and microcirculation damage is prominent in smokers with VSA.

Although acute cigarette smoke exposure may also increase coronary artery vascular resistance, reducing coronary blood flow, less is known about the influence of long-term smoking on coronary blood flow.

Methods and Results A consecutive series of 22 patients whose coronary spasm was induced in the left anterior descending LAD coronary artery were enrolled in this study.

None of the patients revealed any significant coronary artery stenosis. All patients with VSA had episodes of spontaneous typical chest pain with or without documentation of ischemic ST-T segment changes on an electrocardiogram.

No patients had abnormal findings on lead electrocardiograms at rest, 2-dimensional echocardiography, and Doppler echocardiography.

The ethics committee at our institution approved the study protocol and all patients gave informed consent before participation in this study.

The Judkins technique was used to perform coronary angiography in the morning. After documentation of coronary spasm, intracoronary Doppler flow measurements were performed with a 0.

The Doppler wire was positioned in the middle segment of the LAD coronary artery. Average peak velocities APVs were measured at www. Figure 3.

Angiographic characteristics in patients with VSA. White bars, single-vessel spasm; gray bars, double-vessel spasm; black bars, triplevessel spasm.

All patients were in sinus rhythm at the time of study. Measurements were performed in the LAD coronary artery.

Mean arterial blood pressure and heart rate were monitored during the study. These analyses were performed using the StatView 4.

Baseline clinical characteristics in smokers and nonsmokers are listed in Table 1. There were no significant differences between the 2 groups in age, body mass index, systolic blood pressure, diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, and triglyceride level.

Only high-density lipoprotein HDL cholesterol was higher in nonsmokers compared with smokers. To our knowledge this is the first study to demonstrate that microcirculation abnormality is prominent in smokers with VSA.

From the responses to acetylcholine, which is an endothelium-dependent vasodilator, endothelial dysfunction was demonstrated in the LAD coronary artery in this study.

Abnormal CFR can be a result of narrowing of the epicardial arteries, as well microcirculation abnormality. The mechanism of adenosine triphosphate was believed to be endothelium-dependent and endothelium-independent vasodilation.

Although previous reports have shown that smoking is the only major risk factor for coronary artery diseases, the association between long-term smoking and microcirculation abnormality is not as well defined.

Czernin et al7 showed that myocardial blood flow and flow reserve were similar in terms of long-term smoking in young healthy volunteers.

However, Kauffman et al14 demonstrated that smoking affects the regulation via epicardial arteries and coronary microcirculation in healthy volunteers.

Drug companies looking to raise capital present their research and their business case, and I help the promising ones raise the money.

I have to understand the science enough to explain it to investors. Why did you decide to serve on the Alumni Council?

When they asked me, my children were 1 and 3, so it was not an automatic decision, but I was honored. My term was coming to an end, so it seemed like an obvious next step.

What issues are most important to you as a council member? Colgate has a strong alumni network. We want to enhance that, while making better connections with current students.

Also, the call to volunteer frequently goes out to the same set of people. I think there are more people who have the inclination, if they only knew what the opportunities were.

Volunteering can be as simple as donating your airline miles, or having a student shadow you for a day. How do you approach the process of selecting new members?

We look for people from diverse backgrounds who are demographically representative of the alumni body. Tell us about your family My husband, Con, works for a freight-forwarding and logistics firm.

Kate is 7, active, athletic. Timothy is 5, and I found out two nights ago that he can read; he was keeping it secret!

You just got a free hour. How would you use it? Stay tuned for more information! Contact the alumni office to receive club mailings for multiple cities.

No background knowledge is expected, although preference will be given to alumni who took classes in the department. Set your preferences and customize your personal page with RSS feeds, widgets, images, and more!

Share your thoughts on message boards. The online community has many ways for you to connect with fellow alumni.

Log in today! This eight-day trip will depart from and return to Denver, Colo. He was inducted into the Colgate Athletic Hall of Honor in Bill dedicated his career to teaching phys ed and coaching.

See In Memoriam for a complete obit. Hill was a football player in high school who continued playing at Colgate and then coached at Wesley University.

He passed away in Please keep these deadlines in mind when sending information to your correspondents, and understand that your news may take a while to appear in print.

If possible, please identify surviving kin and an address for condolences to be sent. If a newspaper obituary is available, we would appreciate receiving a copy: tel.

Elizabeth Gallagher-Saward Apartment N. I volunteered when I saw a blank in the last Scene, when indeed there are 8 survivors.

I await your notices. I spoke to Ed again and now he had all the info! Paul lives in Toms River, NJ, and moved only a short distance in the same town.

I called him and he is very happy in his new digs. Gets breakfast and dinner but makes his lunch in a small kitchen in his apt. The sign of the times!

King is in Mount Pleasant, SC. We all know he had an implant in his head so that he could hear. I was totally amazed when I called him because as soon as he could identify my voice, we had a great conversation.

Jim Sprague in Miami Cmdr Sprague, to use his title when he was in the navy was up to his usual off-the-beaten-track story!

He then came to the US seeking help, and Jim, who had lived in Burma when he was in the navy but did not speak Burmese, nevertheless was able to make sure that the English grammar and spelling in the book were correct.

His sabbaticals in Europe enabled him to enjoy such events as Wimbledon tennis. He is more or less housebound now, but TV until the wee hours and membership in an oral history club, where he is intensely involved, take up much of his time.

Mary and Jerry Vernon took an day cruise in the Caribbean in March. It was roundtrip from NY, which made it possible!

After retirement he was a securities arbitrator in the greater Boston area. I also talked with William Butler, who lives in a retirement center in Venice, FL, with his wife, Elsie, having sold their home 2 years ago.

Bill went to b-school after Colgate, followed by a career in sales, retiring in He remained active in skiing and other sports until a few years ago.

In an e-mail exchange, Dan Miller said he has had to give up competitive tennis. John Merrick and wife Eloise continue to live in their home in Weatherford, TX, without any significant problems.

They participate in exercise programs and John plays golf occasionally. Their daughters are helpful. Their 6 grandchildren are scattered, with a new great-grandson in Dallas.

The Foleys had a delightful July 4 weekend visit from their great-granddaughter Kaitlyn, accompanied by her parents who drove up from Santa Ana.

This refreshed our memories of how wonderfully active a 2-year-old can be. Sed mattis enim feugiat Gus Nasmith felis. Quisque venenatis lobortis dolor.

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Frank Cum sociis natoque penatibus et magFarnsworth advised me about Hoddy. We hope nis dis parturient montes, nascetur to see Frank in VT this summer.

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In urna justo, Paul White wrote that he is recovering from a dapibus sit amet, mollis eget, dictum broken hip, ergo no skiing for 2 years: time flies, et, ligula.

Aenean posuere, sem quis Paul. Keep us posted. Duis telluswith ac the justo. We all Duis est turpis, aliquam non, hendrerit follow that prescription, Tom.

He also reported vel, fermentum eget, ipsum. Sed conhe and his daughter Sally flew to Minneapolis to sectetuer dolor ut lacus.

Sed vulpuattend the wedding of his granddaughter. Tom tate tincidunt dignissim will be visiting hisquam.

Praesent necand libero. Keep in touch, Tom. Nullam egestas nisl. Mort reported heart failure attacks and uses oxygen most of the time.

Best wishes, Mort, and Sed dolor sed Nullam keep feugiat up your cruising as myvelit. Members Class of , please keep in quis nequeofathe arcu consequat ullamtouch and let me hear from you.

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Nullam ac diam. PO Boxrhoncus, Duis augue quis bibendum Damariscotta, ME dapibus, quam magna porttitor nisi, id sollicitudin nulla nisl a nisi.

If you are reading this, you are still alive. You Maecenas justo a, your comsometimes look backelit, overtincidunt the chapter of modo vitae, rutrum ut, felis.

In your newNulla chapterodio today, I rhoncus magna eu nibh. Aliquam neque. Fusce participation. Your world still needs the real you!

Hope Turney graciously sent meAliquam a letter and sodales. Roy wasac, a libero. Morbi faucibus. Aliquam sit Colgate as well as many pro-am golf tourneys all amet elit.

Cras euismod. He had a distinguished 1 94 1 ment banking that spanned almost 60 years. Roy and Hope were married 63 years and had 2 sons and a daughter, 5 grandchildren, and a great-grandchild.

They knew of Nike, Speedo, and Tyr, but Colgate was a new one. Elmer Nelson delighted me with a long call from Florence, NC. He grew up in Hyde Park, NY, where, after Colgate and 3 years in the air force, he established an insurance company, becoming owner and pres for 35 years.

Retiring in , he and wife Hannah traveled the US in a motor home, then spent 8 winters in AZ and summers in the Adirondacks, followed by Europe and the world.

Now they are happily at home in NC or visiting 2 sons, grandsons, and great-grandchildren. Bob was a lt cmdr in the navy in WWII. He was one of our navy heroes.

Smith Apt. We would appreciate you sharing a comment with your classmates. Carl Bolten reported that he is still upright and breathing and would welcome contact at his e-mail address, which I can pass along.

What are you doing, physically or mentally, these days? Classmates who were not on campus and wished they had been were glad for those who did attend.

Emmett is still surprised when he glances into a mirror and sees no glasses. Jack Sinn is a happy camper.

From Bend, OR, Bob Martin sent his best to all and reported he is resisting old age ailments as best he can.

Meantime he and Irene were roughing it in a sq ft apt. Lee is contemplating organizing a Colgate Club in Jacksonville with help from the alumni office.

Clem Furey, class pres, returned to Cape Cod after 3 months in Naples. Clem reported that George Tift, after 20 years in Naples, has moved to an assisted-living situation in Huntsville, AL, and is doing quite well and happy to be near family there.

Sue and I took a trip to RI in late June. The 4 of us are looking forward to our mini-reunion. Jim and Millie are well. He has mailed special mini-reunion notices to NE classmates and is expecting 14 or more back to campus.

Really classy, eh? I would like to use e-mail as much as possible, so please send me your e-mail address.

I know I have many of them, but not all. There have been changes in providers and some new. They were together Dec 7, listening to the radio in the student union.

Jack said Rog married his HS sweetheart, Fran. Thirty-nine years ago Ned founded the Milton School, a nonprofit, nonsectarian secondary school to help children with learning disabilities.

Bob was a staff sgt in the army medical corps, returned for his AB, and then earned his MD at Rochester. He later specialized in psychiatry and then hospital administration.

Chesty served 2 years as a combat in- fantry in the Pacific ending in Japan. Jacqueline was with him as he passed peacefully.

Yours truly has given up tennis after falling on his head, requiring 14 stitches in the scalp. Now, is that fair?

Chuck keeps in touch with Perry Thompson. Good winter. Miss Colgate. Have 3 teenagers going to Colgate this fall. Hope everybody is still kicking.

The Ingles have 2 children living on LI and 1 in Boston. Seeing the wilds of Africa from the air was fantastic. This April he was fishing in AK when he suffered a heart attack.

He made it back for open heart surgery. He hopes to go to his salmon lodge in Labrador this summer. I was saddened to learn of the passing of William Lunn.

Our sympathy goes out to his widow Carolyn they had been married for 52 years and to Margie Beck Welch and Virginia Lunn. Blair Vedder told me he bought a farm some years ago as a getaway spot.

It has suddenly become profitable with the increased prices on corn and soy beans. Theater was one of his hobbies.

Prof Russ Speirs led the theater group. Those were the days. Blair left me with this quip: There is nothing wrong with old age except it comes at the wrong time of life.

Stay well. A relationship between the Rox and the Roxes has developed over the years, culminating in the Rox the team helping Loren celebrate his birthday on July He threw out the first ball, was applauded by the fans and his family, and took time to drop me a note to let all his classmates enjoy the moment.

The Navy League was instrumental in setting up the festivities. We also did 2 local parades. Spending the day with these fine young people is a day well spent.

Reading the last Scene, I class hopped and saw many familiar names. I decided to contact some from the past.

Received a notice from the alumni office that George E. I have no other information on George, except I remember him.

Keep in touch. I hate silence! George: 19 4 9 David S. An obituary of William K. His good work was in tune with a lifetime of contributions to the community, beginning with being editor of the Colgate Maroon, and going on to newspaper reporting, public information work on behalf of NY Gov Nelson Rockefeller, and similar work in the fed gvt in Washington, DC.

Bill had sparks coming out of his ears whether he was smoking a cigarette or proposing a solution to an editorial problem. He was a valued colleague at the Maroon, letting no issue go to press until he was satisfied that it was the best that could be done.

They began as grounds-keeping laborers, and Denise became supervisor of the powerhouse. Working under the guidance of James M. Taylor, the brothers constructed Taylor Lake, but the tree planting was done on their own time, including the originals on the Willow Path.

When Rome adopted a strong-mayor charter, Chuck was the 1st mayor elected. Needing to think about college tuitions for their 3 daughters and 2 sons, Chuck moved the family to NYC and started a job with Met Life, which lasted 14 years.

But public service still beckoned. Ed said that the one thing he does fast these days is spotting new stuff growing on him and hustling to a doc to find out what kind of cutting or cauterizing is required for the new thing.

Eloise and I have always enjoyed each other, and I do relish more time with her and to do more reading and relaxing both here and in FL.

Our oldest daughter bought an apt next door to us in FL and she makes a very good neighbor with many grandchildren 5, 2 of whom are Colgate grads visits.

Since Ed wrote, Fuzzy has died, in June. Speaking of commitment, he and Eloise celebrated their 60th wedding anniversary in July.

Phil sent along a letter from a recent grad in which she expresses thanks for the assistance given to her from the Class of Memorial Endowment Scholarship.

He and Phyllis also have a daughter. He played basketball and hockey, and was 83 years old when he died. He was one of a kind, and is greatly missed.

The research I worked on had to do with photovoltaics. I worked with plant pigments and proteins.

My work included pipetting, centrifuging, measuring fluorescence, absorbance, and CD spectra, and often working in relatively dark conditions to protect said pigments.

My favorite part was definitely the extraction of pigments from the plants. How is Germany different from Colgate?

Well, a university education is free. The mood of the country swings over the sake of a few goals. What challenges did you face?

Struggling to find ways to connect with German people that go deeper than cheering for their soccer team and working beside them.

What do you think you gained from this experience? I learned about the science, improved my capoeira by joining the club at my host university, saw a different way to live, learned how to live on my own, learned what people think about America.

Apparently, we are stereotyped for liking rap music and thinking soccer is lame. Bottled water If you were a crayon, what color would you be?

But at times when this is predictable, the way they carry themselves. What one word best describes you?

Curious Favorite website? Reading minds. Today, volunteering is a way of life for the orphaned, neglected, abused, and abandoned boys of Bonnie Brae.

They help various groups, including Bridges Outreach Inc. The group made three stops in lower Manhattan, where they divvied up socks and underwear, poured lemonade, and handed out bag lunches to people who live on city streets or in shelters.

At the first stop in Battery Park, about 40 people came looking for help. There, year-old Chris, who had been homeless for three months before moving to Bonnie Brae, doled out soup.

In the process, he did what he could to brighten the day of one little boy. Chris, who dreams of college and a career as a writer, later admitted it was hard for him to see so many people struggling.

Neither, it seemed, did year-old Homer, who once lived in a shelter. Norm served as a rifle platoon guide in Europe, marching from Normandy to the Elbe River.

He was awarded the Bronze Star, Purple Heart, and other decorations. His primary later work in the CIA was in counterintelligence.

Earlier, he had chaired an intelligence community committee monitoring missile activity outside the Soviet Union.

In that 46 scene: Autumn capacity he set in motion actions that informed Pres Kennedy that there was a Cuban missile threat.

He is survived by his wife of 22 years, Caroline Smith. He was buried with full military honors at the Arlington Natl Cemetery on August Marion Syrett Kester, widow of Stewart R.

Kester, tells of his long and successful career in banking and real estate development. Stew died at a hospital in Deerfield Beach, FL, on May 26 after a struggle with myelodisplastic syndrome, a form of blood cancer.

He was a partner in Kester Brothers Realty. Marion and Stew, who were married for 57 years, have 4 children, all of whom live nearby in FL.

Soon after I began collecting these class notes, Classy called me and we had a wonderful conversation. I hardly had to ask a question.

So, Classy, call me if you read this, and give me another chance. And classmates, please do the same. Well done.

He plays tennis regularly but finds that he is not as fast as he used to be. He also fishes offshore, not too successfully lately because fishing there has dropped off considerably.

He said he is still in touch with Jerry Shively and asked about Bob Milgrim who, when we last heard, lives up in the mtns of Sapphire, NC.

He retired in as a sr VP. Joe Reiners retired from phys ed teaching in He taught phys ed for 35 years in public and private schools. For 22 years, he owned and operated the Adirondack Swim and Trip Camp.

He lost his 1st wife, Alice Ann, to cancer in after 38 years. In , he married Lori, a teacher in the school where Alice Ann had been the nurse.

They spend a month in FL plus some time at their place in the Adirondacks, where they run a cabin rental business.

These days Joe is recovering from a double bypass and mitral valve repair. Travel plans include a trip to the Galapagos Islands with brother Chuck in Jan.

They have been able to visit all of the families and also travel to AK, Europe, Australia, and NZ during their 20 years of marriage, blessed with good health and much happiness.

Welcome to Club 80, Bill. Entertainment was provided by the Cleveland Orchestra. On campus, he was an ATO and very much into soccer and hockey and overseeing successful concerts by world-famous artists in the chapel.

He was a Phi Delt, majored in psychology, and was active in track and lax. Sadly, we must report that Dale passed away July 30, Football is now under way.

Any plans to make it to a Raider game this fall? If so, tell us later what you did or what plans you have, and with whom. There are plenty of concerned, interested, or maybe just plain nosey classmates who would like to read about you.

One more time: If you received a dbl postcard from me, please fill it out with your news and send it back. Many thanks to the contributors this time.

If any of you have the opportunity to serve, you should do it, as it will prove a most worthwhile time of your life.

We finally moved into a retirement community called the Mornings in Naples. Ellen and Don Stichter came down for a weekend and we were already talking about our 60th Reunion.

I always enjoy your column. No cold war, no communism, just friendliness. Best to all. We spend lots of time with our grandchildren and try to keep in close touch with all their wanderings and activities.

We feel lucky to be able to live a quiet, interesting, and rewarding life. Perhaps we should have started college at 40 rather than Best to you and Audrey and classmates!

We all know Ernie. Gene is convinced, and a lot of people would agree, that Ernie would have been an annual NBA All-Star if he had concentrated his full attention on basketball.

He recounted the last time he saw Ernie. Gene was stationed in the army CIC school in Baltimore. In the game, Ernie scored 18 points and played his usual fine all-around game.

In his day with Gene, Ernie went to his class, did his labs, then caught a 3 pm train to Baltimore, had a snack, got ready for an 8 pm game, played well, met a college teammate and friends for a beer, and got a late train back to NYC, got some sleep, and made his 8 am class.

We came in 4th, missing a bronze ball by losing our 3rd set tie breaker. Later we went to Jupiter to play in the natl clay-court 80 and over championship.

We lost in the 1st round of the regular tourney but we got to the finals of the consolation tourney and again lost in the 3rd set tie breaker.

We had a great time. Jim has become a golf nut and Doris lets him do his thing quite a few times a week. Stop and see us.

It was either or I saw nothing in the newspaper account revealing the year except that Truman was president.

Best wishes to you and classmates. One in particular stands out: with all the WWII vets in our 1st-year class and upper classes, some Colgate airmen rented a plane and dropped surrender leaflets over the Syracuse Piety Hill Campus.

Later, some Syracuse students sneaked through our student security patrols and placed dye in the lake.

In June, while visiting our daughter and family on the RI coast timing it to see our grandson ballplayers, 12 and 14, play some baseball games , we were able to get together with Pat and Austin Murphy, who live in the same town Westerly.

After lunch, Pat nicely came and led us back to their lovely place for another fun session. They could almost accommodate a small Colgate dorm complement which it will virtually do when the clan comes to celebrate their 50th anniversary in Aug.

Hope you are enjoying a fine autumn. Stay well and active. The reunion events included a hike on the Pali, cocktail party, dinner, picnic, golf tournament, and luau.

Chuck gives his personal thanks to all who contributed. He gives special thanks to Dick Merrill for the work that he did to reach this amount.

Dick Merrill has done a terrific job for Colgate. He spends a lot of time urging classmates to contribute and spends additional time in dealing effectively with non-money issues.

We and the university are thankful for having such a hardworking and effective alumnus in our corner. Contact me if you would like the address to send condolences to his widow, Norma Shores Cance.

His son, Stephen J Cance, graduated from Colgate in Freeman Day passed away on July He had undergone serious throat surgery on July 11 and was unable to speak for several days afterward.

In acquiring an essential component at little or no cost, which will be custom formulated for its diverse customer base, the company will solve environmental problems for paper and sugar mills in Colombia.

These mills create large on-site sludge ponds of toxic material that give off methane gas and other pollutants. The companies are under increasing governmental pressure to clean up their waste by-products.

Colfertil is purchasing a propriety process to convert this material into a high-value organic fertilizer. Furthering its cost-effective manufacturing strategy, Colfertil will also build a mixing plant in a nearby free trade zone.

The fertilizer business in Colombia is growing at a steady, noncyclical rate, based on a strong agricultural sector, the main components of which are coffee, sugar, bananas, cut flowers, and cattle.

Howard Colwell has been selected and has agreed to be our next class president. He is succeeding Dick Beattie, who died last fall. Howard did a super job as the chairman of our 55th Reunion.

She was a special, caring, upbeat person. She was also a big Colgate fan. She and Herb have 3 children, all of whom graduated from Colgate: Christine D.

I would certainly appreciate hearing from you by phone, mail, or e-mail. I was reminded of these quotes when I received notice of the redesign of the Scene and the change from a 6 times a year publication to 4 times a year.

The actuality is far from that. The new Scene has many changes, all to the good. The staff encourages you to give them feedback on the 1st new issue.

Or, if you have comments, send them to me and I will pass them on. Yes, Colgate continues to grow and change to build a better future, which includes all of us.

Had lunch this week with Mo England, which we often do. Lucky to have friends close by to talk about Colgate, etc. My son, daughter, and grandchildren all live in Pittsfield, which is great.

Marcia and he are in Mequon, WI. Dick was planning on attending the Princeton game Oct 11 in Hamilton, so maybe you saw him there. The Betas and others of course intend to have a football weekend in Hamilton this fall.

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