Born 7 April 1920 at Escalon, Calif., Herbert A. Calcaterra enlisted in the Navy 14 December 1939. Motor Machinist's Mate First Class Calcaterra was commended 7 July 1942 for his performance as a member of the crew of Pompano (SS-181), and was awarded the Silver Star Medal posthumously for conspicuous gallantry as a member of a 3" gun crew until fatally wounded during an action against an armed enemy patrol ship 4 September 1942.
(DE-890: dp. 1,200; 1. 306'; b. S6'7"; dr. 8'7"; s. 21 k.;
cpl. 186, a. 3 3", 3 21''tt., 8 dcp., i dcp.(hh.), 2 dct.;
Calcaterra (DE.-390) was launched 18 August 1943 by Brown Shipbuilding Co., Houston, Tex.; sponsored by Mrs. G. M. Stites; commissioned 17 November 1943, Commander H J. Wuensch, USCG, in command; and reported to the Atlantic Fleet.
Assigned to the vital duty of escorting convoys between the United States and the Mediterranean, Calcaterra made eight round trips between 13 February 1944 and 10 June 1945. The ships she guarded provided the men and equipment which insured the success of the invasions of Italy and southern France. Twice the escort vessel met the challenge of enemy opposition when she depth charged a suspected submarine contact and fired on two aircraft. Her alert action helped prevent damage or Loss to the ships under convoy.
On 9 July 1946 Calcaterra headed for the Pacific to tackle a new job, but the war ended shortly before her arrival at Pearl Harbor. She lifted passengers back to the west coast, then sailed on to the Atlantic. Calcaterra was placed out of commission in reserve at Green Cove Springs, Fla., 1 May 1946.
Reclassified DER-390, 28 October 1954, Calcaterra was converted to a radar picket ship at Norfolk and commissioned 12 September 1955. Based on Newport,the radar picket ship has almost continuously served in the violent weather of the North Atlantic to maintain her link in the extension of the Distant Early Warning system. Except for exercises with the fleet in the Atlantic and Caribbean, and a cruise to Europe (August-October 1958), Calcaterra continued this duty through 1960.
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Harald I, byname Harald Fairhair, or Finehair, Norwegian Harald Hårfager, Old Norse Harald Hárfagri, (born c. 860—died c. 940), the first king to claim sovereignty over all Norway. One of the greatest of the 9th-century Scandinavian warrior chiefs, he gained effective control of Norway’s western coastal districts but probably had only nominal authority in the other parts of Norway.
The son of Halvdan the Black, ruler of part of southeastern Norway and a scion of the Yngling dynasty, the ancient royal house of Sweden, Harald succeeded his father at the age of 10. His first conquest came with the suppression of a revolt in the Uplands region. A pact with Haakon, earl of Lade, enabled him to pursue conquest of the western districts, culminating in the battle of Hafrsfjord, dated 872 by medieval historians but placed 10 to 20 years later by modern historians.
Harald’s conquests and taxation system led many chiefs and their followers to emigrate to the British Isles, adjacent lands, and perhaps to Iceland, which first became known to Scandinavians during the era of Harald’s rule. He acquired wealth through his control of coastal trade but ruled indirectly through lesser chieftains in areas other than his own tightly controlled home district, in the southwest. His major governmental contribution lay in the development of provincial administrations through such chieftains.
The most reliable information on Harald’s life is contained in contemporary poems written down in Iceland in the 13th century. His career is also described in 12th- and 13th-century Icelandic and Norwegian historical works of questionable reliability, the fullest account being written by the Icelander Snorri Sturluson (d. 1241) in the Heimskringla.
Extracranial surgical repair of cerebrospinal rhinorrhea
A spinal fluid leak from the intracranial space to the nasal respiratory tract is potentially very serious because of the risk of an ascending infection which could produce fulminant meningitis. Cerebrospinal rhinorrhea typically stems from a complication of head trauma, and fortunately these leaks tend to heal spontaneously. In a smaller percentage of cases, intracranial lesions or congenital osteomeningeal defects are harbored, allowing spinal fluid to enter the nasal cavity, and patients with this condition rarely heal without operative intervention. Succesful repair of a dural defect mandates precise anatomic localization of the leakage site. Although radioisotopes have been a popular method of documenting and localizing a spinal fluid leak, they do not provide the topographic accuracy of intrathecal dyes such as fluorescein. The author not only employs this dye during the preoperative localization of a leak but also uses it intraoperatively to improve visualization of the leakage site and to plan a method of repair. The operating microscope also seems to facilitate visualization of the leak and enables better manipulation of grafts and flaps.
Family: Caregiver wed, left man broke
Frank Calcaterra, 87, stands with his two daughters, Cathy Schoenherr, 49, of North Carolina, left, and Charlotte Knutson, 58, of Minnesota, after discussing their case against Tangie Coleman, at the law offices of Karen Woodside in Livonia, Mich., on Thursday, July 17, 2014. (Photo: Kimberly P. Mitchell, Detroit Free Press)
WATERFORD, Mich. — Frank Calcaterra was in his 80s in 2008 when his family hired a home care company to help the former Detroit-area funeral home owner look after his ailing wife Jonnie, who had dementia.
The company — Kentucky-based ResCare — sent Tangie Coleman, who, at the time, had a warrant out for her arrest, records show.
Jonnie's jewelry soon began to disappear, as did Frank Calcaterra's sizable fortune — estimates from court filings put the loss at anywhere from more than $500,000 to more than $1.5 million. When Jonnie Calcaterra died in a nursing home in January 2012, Coleman and her mother were living in Frank Calcaterra's lakefront home in Waterford, Mich., and he was sleeping in the basement.
A few months later, Coleman married Calcaterra in Ohio, without his family's knowledge.
In April, when Frank Calcaterra's daughters removed him from his home, he was 10 pounds lighter and so broke he no longer had a positive bank balance or a valid credit card. Coleman was driving him to a check cashing place with his monthly Social Security check, his daughters say.
The case highlights what experts say is a significant and growing problem in the U.S. — financial exploitation of elderly people by caregivers. Many cases go unreported and accurate estimates are hard to pin down, but studies suggest there are at least tens of thousands of such cases each year.
&ldquoOur concern is that no other family ever go through this.&rdquo
Charlotte Knutson, Frank Calcaterra's daughter
In Michigan, more than 10% of the 33,710 adult abuse complaints the state received in 2013 — up from about 21,000 in 2011 — related to alleged financial exploitation. The state substantiated financial exploitation in more than 1,000 cases.
"We're seeing more and more of these cases where people pose as legitimate caregivers, befriend the elderly, become a part of their lives, and then start taking advantage of them," said Jim McGuire, director of research for the Area Agency on Aging 1-B in Southfield, Mich., which serves about 30% of the state's senior population in six counties.
The elderly population continues to grow, many elderly people have significant resources, and because they can live longer in their own homes they are often more vulnerable, he said.
Residential home care companies don't require state licensing, and criminal background checks for their workers are only mandatory if public funds are used to pay them.
Though Michigan has recently toughened laws and penalties related to financial exploitation of seniors, making background checks mandatory for all home care workers could have helped Calcaterra, said McGuire, as could a bill stalled in the state Legislature making it mandatory for financial institutions to report suspicious banking activity affecting seniors' accounts.
On Oct. 25, 2012, when Coleman, who was 35, and Frank Calcaterra, who was 86, were married in Ohio, at least two complaints alleging financial exploitation had been filed with the Michigan Department of Human Services' division of Adult Protective Services.
In May of this year, an Oakland County, Mich., judge appointed a conservator for Calcaterra, citing fraud and financial exploitation, which Coleman denies.
Tangie Coleman was 35 when she married Frank Calcaterra, 86, in Ohio in 2012. A court-appointed conservator is seeking to annul the marriage, alleging it was a fraud Coleman perpetrated "solely for her financial gain." (Photo: Southfield (Mich.) Police Department)
Oakland County Public Administrator Jon Munger, Calcaterra's court-appointed conservator, is seeking to annul the marriage, alleging it was a fraud Coleman perpetrated "solely for her financial gain."
Calcaterra's daughters are looking for answers and accountability, too. They're unhappy the state failed to act and that it has been difficult to get police agencies to launch criminal investigations, with some officials saying the 2012 marriage makes the case a civil matter.
"Our concern is that no other family ever go through this," said Calcaterra's daughter Charlotte Knutson, who lives in Minnesota.
Michigan — which was criticized in a recent auditor general's report for failing to properly investigate such allegations — determined the complaints were unfounded and never notified law enforcement.
Coleman, who declined to discuss her history with Calcaterra during a brief encounter with a Detroit Free Press reporter, denied wrongdoing in an answer she filed to the annulment/divorce petition.
She said Calcaterra gave her permission to sign his name to checks and his daughters are biased against her because she is black.
"Frank always gave me stacks of money . and always promised to take care of me," said Coleman, whose Facebook page featured photos of her fanning a stack of $100 bills.
"They kidnapped my husband," Coleman said in a court filing. "I want him back."
Records show Coleman was married when she was hired to help Calcaterra, but got divorced on Oct. 11, 2012 — two weeks before her marriage to Calcaterra. Of the many checks drawn on Calcaterra's bank account in 2011, more than 20 totaling more than $10,000 were payable to Coleman's husband at the time, for services such as painting, lawn care and moving.
Calcaterra said Coleman told him she needed to marry him in order to receive a significant legal settlement resulting from a lawsuit she brought against an Oakland County police department for an alleged police assault against her. Calcaterra had earlier given her money to hire a lawyer.
"They went to court and got a settlement," Calcaterra said. But Coleman told him officials told her she is a spendthrift, and in order to be paid the settlement she first had to get married so she would have someone to watch over how she handled the money.
"That's why we got married," Calcaterra said. "I don't think there ever was a police report of this ever happening."
There also is no record of any such lawsuit.
Text messages and handwritten notes exchanged between Calcaterra and Coleman show he was smitten with her. And Calcaterra pushed back hard when his daughters tried to convince him he was being used.
"He stated he is aware of the allegations and confirmed that he gave Ms. Coleman his debit card, allowed her to make purchases, and paid her rent last month," a state adult protective services investigator wrote in a report after interviewing Calcaterra at his home in April 2012 — six months before he and Coleman got married.
"He denied that he is being financially exploited and reported he does not need assistance from the police."
&ldquoThey kidnapped my husband. I want him back.&rdquo
Tangie Coleman, hired caregiver and Frank Calcaterra's new wife
Calcaterra, who hired Coleman privately after she left ResCare in 2008, said Coleman changed for the worse after the wedding: She became "domineering," and didn't want him cooking eggs on the stove because she said he might cause a fire or opening the refrigerator because he would cough and get germs inside it, he said.
But Calcaterra also sent investigators away after the wedding, telling one as recently as February that Coleman "is not taking advantage of him and he wish (sic) these allegations would stop," according to state records obtained under Michigan's Freedom of Information Act.
Calcaterra explained the loss of his 2.75-karat diamond ring, set with sapphires, which had been on his finger since 1950. His family said it was valued at more than $100,000.
"This is beautiful — I'd really like to show it to my friends," Calcaterra said Coleman told him. "I said, 'OK, but . you take care of it, don't forget I want it back.' " As time went by and Calcaterra kept asking about it, Coleman's response became: "You dropped it in the basement," he said.
Scott Lewis, a private investigator hired by Calcaterra's family, found that Coleman had a warrant out for her arrest from 2002 through July 2010 for failing to appear in court after she was cited for unlawfully driving away a motor vehicle. That charge was ultimately dropped after a witness did not come forward. But Coleman was convicted in July 2010 of writing bad checks, records show.
Coleman has not had a valid driver's license since her July 2010 conviction for impaired driving, and has been cited four times since 2010 for driving with a suspended or revoked license, records show.
&ldquoThis was a textbook case of elder abuse. The children live out of state, they think they've got someone in the house to help, and it turns out she is a predator.&rdquo
Karen Woodside, attorney representing Frank Calcaterra's daughters
Karen Woodside, an attorney and former Wayne County prosecutor representing Calcaterra's daughters, said the state's adult protection unit — which records show received at least four referrals about Calcaterra between April 2012 and February 2014 — should have run a background check on Coleman and then referred the case to the police.
Bob Wheaton, a spokesman for the Department of Human Services, said the department doesn't comment on specific cases, but if a client is "lucid, aware of his or her finances, and says that he or she is not being taken advantage of, we're probably not going to determine that the person is vulnerable, and we're probably not going to file a petition for financial exploitation."
Calcaterra and his family are also suing Coleman and ResCare, alleging a ResCare official said all home care workers received regular background checks, but instead "placed a thief into the plaintiff's home."
Coleman has not yet been served with the lawsuit and has not filed a response. ResCare denied most of the allegations and any liability in its answer to the suit.
Medicare-certified home health agencies are required by state law to perform background checks on workers with direct access to patients, Wheaton said.
ResCare spokeswoman Nel Taylor said ResCare is not Medicare-certified in Michigan, but performs background checks on its workers whether they are required by law or not. The check turned up no criminal issues on Coleman, she said.
A July 2012 study published in the Journal of the American Geriatrics Society, found that of 180 agencies surveyed, nearly half did not conduct a federal background check of caregivers.
Calcaterra's 1998 marriage to Jonnie was the second marriage for both, and each had children from their first marriage, all living out of state. Woodside and daughters of both parents said Coleman was able to exploit the geographical separation and conflicts between and among the two sets of children to enhance her influence over Calcaterra.
"This was a textbook case of elder abuse," said Woodside. "The children live out of state, they think they've got someone in the house to help, and it turns out she is a predator."
Children of parents should take precautions when hiring residential caregivers, including:
• Lock private papers and valuables in a filing cabinet, safe deposit box or safe.
• Have someone trusted (other than the caregiver) pick up the mail, or get it sent to a post office box.
• Regularly review all bank and credit card statements (at least once a month) and periodically request a credit report from a major credit bureau.
• Consider having Social Security or pension checks deposited directly into the bank.
Prevalence of metabolic syndrome (MS) in children and adolescents with varying degrees of obesity
Objective: Childhood obesity is increasingly common and is associated with health problems in particular, obesity plays a central role in the metabolic syndrome (MS). We estimated the prevalence of MS in Caucasian children and adolescents with varying degrees of obesity.
Patients and methods: We studied 191 obese [body mass index (BMI) > 97th percentile] children and adolescents. Obesity was stratified on the basis of a threshold BMI z-score and subjects were classified as moderately (z-score 2-2.5) or severely obese (z-score > 2.5). Seventy-six, nonobese subjects were recruited into a comparison group. Thirty-one of them were of normal weight (BMI < 75th percentile) and 45 overweight (BMI 75th-97th percentile). Patients were classified as having MS if they met three or more of the following criteria for age and sex: BMI > 97th percentile, triglyceride levels > 95th percentile, high density lipoprotein (HDL) cholesterol level < 5th percentile, systolic or diastolic blood pressure > 95th percentile and impaired glucose tolerance (blood glucose level: 7.8-11.1 mmol/l at 2 h). Insulin resistance was calculated using the homeostasis model assessment for insulin resistance (HOMA-IR) and impaired insulin sensitivity was defined as a HOMA-IR > or = 2.5 in prepubertal patients and HOMA-IR > 4 in pubertal subjects.
Results: The overall prevalence of MS was 13.9% and was present in 12.0% of moderately obese and 31.1% of severely obese subjects no overweight or normal weight subjects met the criteria for MS. The rate of the MS increased progressively with increasing BMI categories (P < 0.001). Severely obese patients had a threefold increased risk with respect to moderately obese patients.
Conclusions: The prevalence of the MS is higher in obese as opposed to nonobese subjects and increases with severity of obesity.
Museum Report - Chicago's Military History Mecca
Nestled among the many tall buildings in downtown Chicago lies the Pritzker Military Museum & Library. Founded in 2003 and dedicated to preserving the story of the ordinary citizen-soldier throughout history, the museum is located in the historic Monroe Building on bustling Michigan Avenue near the city’s lakefront. The 16-story Gothic-style structure was built in the early 1900s and has been extensively renovated. The museum and library moved to the building in 2011 and occupies three floors, with two open to the public. Best described as part museum and part library, the facility offers a tremendous opportunity for individuals interested in military history and affairs.
Visitors find a contemporary setting with ornate woodwork and oak floors upon entering the museum and library on the second floor. Rows of books in a typical library arrangement are neatly positioned, with two open areas for museum displays. A magazine area contains current issues of a variety of military periodicals. A comfortable reading area, ideal for researchers, overlooks tree-lined Michigan Avenue. Naval enthusiasts are sure to notice two model warships bearing local names on display among the books. A replica of the USS Chicago (CA-29) honors the heavy cruiser sunk in the Solomon Islands during World War II, while a second model is of the new Virginia-class submarine USS Illinois (SSN-786).
A portion of the second floor display area is dedicated to Medal of Honor recipients. One section contains items from the Hershel “Woody” Williams Collection. The West Virginia native joined the Marines in 1943 and was sent to the Pacific. He fought in the Solomon Islands and on Guam and Iwo Jima. Corporal Williams received the Medal of Honor for his heroic actions against Japanese positions on Iwo Jima on 23 February 1945. The medal and citation are on display along with pictures and a large quilt. Another area honors several Navy SEALs who each received the Medal of Honor for actions in the Vietnam, Iraq, or Afghanistan conflicts. The nearby Edward Drenka Collection includes a World War II–era Coast Guard uniform, photographs, and service medals. The Coast Guardsman served on board several destroyer escorts, including the USS Calcaterra (DE-390), in the Atlantic theater.
A “Remember the Maine” display prominently featured on the second floor honors the U.S. battleship sunk in Havana Harbor in 1898. The collection includes an original 45-star American flag bearing the slogan that became a rally cry for the subsequent Spanish-American War. The display also includes pictures of the warship before and after her sinking. The remaining exhibit space on the second floor houses “Hunting Charlie: Finding the Enemy in the Vietnam War.” It presents a variety of original art and offers a point-couterpoint perspective by pairing North Vietnamese propaganda art with photos, Bill Mauldin cartoons, and reflections from U.S. combat veterans.
Hanging prominently in the center of a rectangular staircase leading to the third floor is a banner used during the 1986 commissioning ceremony of the attack submarine USS Chicago (SSN-721). Lining the stairway are a variety of Navy recruiting and propaganda posters, many from the era of the two world wars. Similar posters can be found scattered throughout the facility. A staff member later said that those on display are only a small portion of the museum and library’s large poster collection and that high-resolution reproductions of many of them are available for purchase.
The third floor holds additional rows of library books with a central information desk staffed at the time of this visit by a friendly and knowledgeable individual ready to answer questions and assist researchers. A large gallery space features “Faces of War: Documenting the Vietnam War from the Front Lines.” The exhibit presents a wide range of unique pictures and film taken by Army special-operations photographers during the conflict. The nearby Veterans Information Center offers a variety of resources related to issues affecting veterans and their families. The collection includes books, brochures, and pamphlets.
The library portion of the facility holds more than 53,000 books, with topics spanning a variety of time periods and U.S. military service branches. Members of the museum and library can check out books directly, while others can obtain materials through interlibrary loan. The general public can gain entry to the library by paying a nominal museum fee. The collection includes about 3,000 rare books available for viewing in-house as well as oral histories and archival materials. Among the library’s offerings of interest to naval devotees are 1960s and 1970s cruise books from the guided-missile cruiser USS Chicago (CG-11). A genealogy area is available to assist individuals in finding information on deceased family members who served in the military. An online library catalog available on the Pritzker website includes a wide variety of digital versions of exhibits and on-demand video and audio of past television broadcasts.
The rear portion of the facility houses a two-story state-of-the-art theater and television studio. The museum regularly hosts speakers including authors, scholars, and historians for later broadcast on local public television and podcast. The Pritzker Military Museum & Library is an interesting and informative stop when visiting downtown Chicago.
Mr. Domagalski is the author of Into the Dark Water: The Story of Three Officers and PT-109 (Casemate, 2014) and Sunk in Kula Gulf: The Final Voyage of the U.S.S. Helena and the Incredible Story of Her Survivors (Potomac, 2012).
The Guiding Light
By Captain John Allen Williams, U.S. Naval Reserve (Retired)
Under Colonel Jennifer N. Pritzker’s leadership, the Pritzker Military Museum & Library she founded has become a major educational and cultural institution. Less well known is her own distinguished record of military service and support of worthwhile causes, both military and nonmilitary.
Colonel Pritzker spent the first five years of her 27 years of active and reserve military duty in the enlisted ranks of the U.S. Army, rising to sergeant. She was in the 82nd and 101st airborne divisions and the VII Corps in Germany, commanded an infantry company, and served in various critical staff positions in the Illinois National Guard. She retired at the rank of lieutenant colonel, with an honorary promotion to colonel in the Illinois National Guard in recognition of her distinguished service. Her personal awards include the Meritorious Service Medal and the Army Commendation and Achievement medals with Oak Leaf Clusters. She also earned the U.S. Army Parachutist and Air Assault badges and parachute badges from six other nations.
Many military-related organizations benefit from the colonel’s support, including Norwich University, the Marine Corps Scholarship Foundation (where she has followed in the footsteps of her grandfather A. N. Pritzker), the USO of Illinois, and the U.S. Naval Institute. Consistent with her views on the importance of the citizen-soldier, she also is a strong supporter of ROTC and Junior ROTC programs, including sending Chicago JROTC cadets on staff rides to the Normandy Invasion beaches and Gettysburg battlefield and on visits to the U.S. service academies.
Colonel Pritzker supports serious scholarship, including Antarctic research, the Inter-University Seminar on Armed Forces and Society, and college education. She holds an honorary doctorate of military science from Norwich University and received Loyola University Chicago’s prestigious Damen Award, which recognizes an alumnus’ leadership in industry and service to others. The City of Chicago recognized her public-spirited generosity by awarding her its John A. Logan Patriot Award. Colonel Pritzker also is a leader in historic preservation. Her restoration successes include the 1912 Monroe Building on Michigan Avenue in Chicago, where the Pritzker Military Museum & Library and her business—Tawani Enterprises—are located, and Frank Lloyd Wright’s Emil Bach House in northern Chicago.
The closest parallel to Colonel Pritzker’s record of military service and private philanthropy in Chicago is that of World War I artillery officer, fellow member of the Illinois National Guard, and Chicago Tribune editor Colonel Robert McCormick. Similarly, Colonel Pritzker pursues a life of service to her country and to civilian society. The nation is greatly enriched by her dedicated efforts.
PARALLEL GRIPPERS FOR EFFICIENT PICK-AND-PLACE SOLUTION
A customer offering customized solutions for CNC/Machining was looking for an efficient pick and place solution for steering column components. The specifications called for high-precision part detection with a simultaneous increase in productivity and a reduction in system weight. A high level of performance in harsh working environments was also specified. The pneumatic RDH-2M-C Parallel Grippers from DESTACO, which are additionally protected against air failure using a safety spring, impressed the customer, who installed a total of 20 of these grippers in five machines. As these are standard grippers from the DESTACO Xpress Program it was possible to resume production within a very short time.
Microvascular reconstruction after previous neck dissection
Background: Microvascular reconstruction of defects in the head and neck is more challenging in patients who have undergone a previous neck dissection, owing to prior resection of potential cervical recipient blood vessels used for free flap perfusion.
Objective: To evaluate the reliability and safety of free flap reconstruction in patients with previous neck dissection.
Patients and methods: Sixty free flaps were performed in 59 patients with a medical history of neck dissection for head and neck cancer. This included patients undergoing salvage surgery for recurrent cancer as well as patients undergoing secondary reconstruction of cancer surgery-related defects. Flap selection included 25 radial forearm flaps, 20 fibula flaps, 7 rectus abdominis flaps, 7 subscapular system flaps, and 1 iliac crest flap.
Results: Recipient vessels were used in the field of previous neck dissection in approximately half the patients with previous selective neck dissection, while contralateral recipient vessels were always used in patients with a history of modified radical or radical neck dissection. Vein grafts were not necessary in any cases. One arterial anastomosis that was created under excessive tension required urgent reoperation and revision, but there were no cases of free flap failure.
Conclusions: Free flap reconstruction of the head and neck is highly successful in patients with a history of neck dissection, despite a relative paucity of potential cervical recipient blood vessels. Heavy reliance on free flaps with long vascular pedicles obviated the need to perform vein grafts in the present series, probably contributing to the absence of free flap failure. Previous neck dissection should not be considered a contraindication to microvascular reconstruction of the head and neck.
Historical Perspectives Reduced Incidence of Menstrual Toxic-Shock Syndrome -- United States, 1980-1990
In May 1980, investigators reported to CDC 55 cases of toxic-shock syndrome (TSS) (1), a newly recognized illness characterized by high fever, sunburn-like rash, desquamation, hypotension, and abnormalities in multiple organ systems (2). Fifty-two (95%) of the reported cases occurred in women onset of illness occurred during menstruation in 38 (95%) of the 40 women from whom menstrual history was obtained. National and state-based studies were initiated to determine risk factors for this disease. In addition, CDC established national surveillance to assess the magnitude of illness and follow trends in disease occurrence 3295 definite cases have been reported since surveillance was established (Figure 1).
In June 1980, a follow-up report described three studies which detected an association between TSS and the use of tampons (3). Case-control studies in Wisconsin and Utah and a national study by CDC indicated that women with TSS were more likely to have used tampons than were controls. The CDC study also found that continuous use of tampons was associated with a higher risk of TSS than was alternating use of tampons and other menstrual products. Subsequent studies established that risk of TSS was substantially greater in women who used RelyPr* brand tampons than in users of other brands and that risk increased with increased tampon absorbency (4-6). In September 1980, RelyPr tampons were voluntarily withdrawn from the market by the manufacturer.
In 1980, 890 cases of TSS were reported, 812 (91%) of which were associated with menstruation. In 1989, 61 cases of TSS were reported, 45 (74%) of which were menstrual. In 1980, 38 (5%) of 772 women with menstrual TSS died in 1988 and 1989, there were no deaths among women with menstrual TSS. Reported by: Meningitis and Special Pathogens Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.
Editorial Note: The number of TSS cases reported annually to CDC has decreased substantially in the 10-year period since menstrual TSS was first recognized. Changes in public awareness and diminished attention to TSS in the medical literature might have resulted in reduced diagnosis and reporting. However, reporting of nonmenstrual TSS has remained constant during this time while menstrual TSS reporting has decreased.
A multistate active surveillance study in 1986-1987 confirmed the trends detected by national passive surveillance (7). Through active case-finding efforts in an aggregate population of 34 million persons, the rate for menstrual TSS was determined to be 1.0 per 100,000 women 15-44 years of age (7). This rate represented a substantial reduction from rates reported in similar studies in 1980 (6.2 per 100,000 women 12-49 years of age in Wisconsin (8), 9.0 per 100,000 women 12-45 years of age in Minnesota (9), and 12.3 per 100,000 women 12-49 years of age in Utah (10)). Active surveillance also confirmed that the proportion of TSS associated with menstruation had decreased considerably: in 1988, menstrual TSS accounted for 55% of cases detected both by active surveillance (7) and by the passive surveillance system.
A principle reason for the decreased incidence of menstrual TSS may be decreases in the absorbency of tampons. In 1980, when tampon absorbency (in vitro) ranged from 10.3-20.5 g (4), very high absorbency products ( greater than 15.4 g) were used by 42% of tampon users (9). After the association between TSS and absorbency was recognized, manufacturers lowered the absorbency of tampons. In 1982, the Food and Drug Administration (FDA) issued a regulation requiring that tampon package labels advise women to use the lowest absorbency tampons compatible with their needs. By 1983, tampon absorbency ranged from 6.3-17.2 g (6), and the proportion of tampon users using very high absorbency tampons had declined to 18%. By 1986, very high absorbency products were used by only 1% of women who used tampons. Effective March 1990, the FDA instituted standardized absorbency labeling of tampons, which currently range from 6-15 g.
Tampon composition has also changed since 1980. RelyPr tampons consisted of polyester foam and cross-linked carboxymethylcellulose, a combination that is no longer used in tampons. Polyacrylate-containing tampons were withdrawn from the market in 1985. Current tampons are manufactured from cotton and/or rayon. The unique composition of RelyPr tampons may have been responsible for the increased risk associated with those products (11) however, the role of current tampon composition as an independent risk factor for TSS is unclear since composition may vary even for a particular brand and style of tampon marketed at a given time.
Other factors may have contributed to decreased reports of menstrual TSS. For example, public awareness of the syndrome may cause women to seek medical care earlier in their illness milder disease may not meet the surveillance case definition of severe multisystem illness. Increased variety in menstrual products and concern related to TSS may have resulted in fewer women using tampons or fewer using tampons continuously.
Current public health efforts to prevent menstrual TSS include tampon package labels and package inserts which describe early signs and symptoms of TSS and warn the consumer about the risk associated with tampons. Tampon users are encouraged to select lower absorbency products to further decrease risk of TSS. Standardized absorbency labeling permits consumers to compare absorbency between brands.
The precise mechanism by which RelyPr tampons increased the risk of TSS is unknown. The increased risk associated with high absorbency tampons is also poorly understood high absorbency may be a surrogate for another effect. However, the withdrawal of RelyPr tampons and the subsequent decrease in use of high absorbency tampons correlate with a marked decrease in incidence of menstrual TSS. The rapid demonstration of the risk of RelyPr and high absorbency tampons resulted in prompt public health interventions and substantial reduction in menstrual TSS.
CDC. Toxic-shock syndrome--United States. MMWR
2. Todd J, Fishaut M, Kapral F, Welch T. Toxic-shock syndrome associated with phage-group-1 staphylococci. Lancet 19782:1116-8.
3. CDC. Follow-up on toxic-shock syndrome--United States. MMWR 198029:297-9.
4. Osterholm MT, Davis JP, Gibson RW, et al. Tri-state toxic-shock syndrome study: I. Epidemiologic findings. J Infect Dis 1982145:431-40.
5. Schlech WF, Shands KN, Reingold AL, et al. Risk factors for development of toxic shock syndrome: association with a tampon brand. JAMA 1982248:835-9.
6. Berkley SF, Hightower AW, Broome CV, Reingold AL. The relationship of tampon characteristics to menstrual toxic shock syndrome. JAMA 1987258:917-20.
7. Gaventa S, Reingold AL, Hightower AW, et al. Active surveillance for toxic shock syndrome in the United States, 1986. Rev Infect Dis 19892(suppl S1):S35-42.
8. Davis JP, Chesney PJ, Wand PJ, LaVenture M, the Investigation and Laboratory Team. Toxic-shock syndrome: epidemiologic features, recurrence, risk factors, and prevention. N Engl J Med 1980303:1429-35.
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LeAnn Rimes and Eddie Cibrian
In 2009, US Weekly first reported news of an alleged affair between LeAnn Rimes and Eddie Cibrian. The two had been filming Northern Lights together and were spotted "holding hands and kissing" at a restaurant. Rimes was married to Dean Sheremet at the time and Cibrian was married with children to model Brandi Glanville.
According to the director of the film, Mike Robe, "LeAnn and Eddie honestly developed a really strong bond and a warm relationship" during the rehearsal and filming process. That appears to have carried on after the cameras stopped rolling. Eventually, the two would divorce their spouses and get married, a union they still hold on to, as of this writing.
In an interview with Giuliana Rancic (via Us Weekly), Rimes insisted that "nothing ever happened between [her and Cibrian]" outside of love scenes for the film, but she still expressed some regret with how the whole thing played out. "I wish I handled it differently," she said. "I wish it could've been better for me, for Brandi, for Dean, for Eddie and for everyone else. . I know in this situation it's gonna take some time, all I wish is that everyone that was hurt, that we hurt, that I hurt, can be happy."