New `Family' member

((PHOTO …

U.S. Denies N. Korea Off Terror List

SYDNEY, Australia - A senior U.S. diplomat said Tuesday that North Korea remains on a list of states that sponsor terrorism, dismissing North Korean claims that Washington decided to remove the designation.

"No, they haven't been taken off the terrorism list," Assistant Secretary of State Christopher Hill told Japanese reporters as he arrived in Australia's business capital for a meeting of Pacific Rim nations. A State Department press officer separately confirmed the remarks.

Hill's comments were the first official denial since North Korea's Foreign Ministry, in a statement carried Monday by the country's official news agency, said that Washington agreed to remove the …

VA expands health care eligibility for nondisabled

The Veterans Affairs Department opened the doors of its health care system Monday to about 266,000 nondisabled veterans with moderate incomes, some of whom have been shut out of those benefits.

The veterans eligible are from a category known as "Priority 8." They have no illnesses or injuries attributed to their military service, and they earn more than the average wage in their communities.

Enrollment previously was denied to them because of a cost-savings move in 2003. Under a new regulation, some, but not all who fall in this category, will now be eligible.

The VA is expanding eligibility by loosening income restrictions. The limit …

U.S. Agency Warns About Russian Flights

The U.S. State Department has warned the public not to travelwithin Russia on successors to the Soviet-era airline Aeroflot. U.S.government officials were earlier warned to defer routine domesticair travel in Russia and to seek alternate means of transporationwhen possible.

In its new Consular Information Sheet on …

Lawmakers move against laser targeting of aircraft

WASHINGTON (AP) — People who knowingly aim laser pointers at aircraft would be committing a federal crime subject to up to five years in prison under legislation that has now passed both the House of Representatives and the Senate.

The House approved by voice vote on Monday the "Securing Cockpits Against Laser Pointers Act," a response to a growing number of incidents of pilots having been distracted or even temporarily blinded by laser beams and the possibility that terrorists might use lasers to bring down aircraft.

The Senate passed the same provision a month ago as an amendment to a Federal Aviation Administration spending bill. The two chambers must now agree on a common …

CIA director says Iranian policy at highest level is to kill Americans in Iraq

CIA Director Michael Hayden said Wednesday that Iranian policy, at the highest government level, is to help kill Americans in Iraq, the boldest pronouncement of Iranian involvement by a U.S. official to date.

Hayden made the statement in response to a student question while delivering the Landon Lecture at Kansas State University.

"It is my opinion, it is the policy of the Iranian government, approved to highest level of that government, to facilitate the killing of Americans in Iraq," Hayden said. "Just make sure there's clarity on that."

In recent weeks, U.S. officials have ratcheted up their complaints that Iran is …

Pirate CEO isn't irate about Ramirez's rise

Pittsburgh Pirates CEO and managing general partner KevinMcClatchy is considered one of the classier executives in baseball.He showed why Tuesday when he walked to the Cubs' side of the fieldduring batting practice to shake hands with third baseman AramisRamirez and congratulate the former Pirate on his strong start.

McClatchy approved the trade that sent Ramirez to the Cubs lastJuly because he couldn't afford to keep him. The Pirates have a teampayroll of $32 million and didn't want to pay Ramirez $6 million thisseason, let alone the bigger money he will get in his next multiyearcontract. The Cubs will iron out that agreement with …

Lyndon Johnson and Europe: In the Shadow of Vietnam

Lyndon Johnson and Europe: In the Shadow of Vietnam. By Thomas Alan Schwartz. Cambridge, Mass.: Harvard University Press, 2003. 352 pp. Index, notes, bibliography, photographs, tables. Cloth, $29.95. ISBN 0-674-01074-4.

Historians have not been kind in their judgments of Lyndon Johnson's conduct of American foreign policy. They have portrayed him as a culture-bound leader, vulnerable to cliches and stereotypes and prone to crude behavior, one who lacked any independent instinct in dealing with other nations. Although scholars agree that LBJ proceeded cautiously and consulted a wide range of advisers, most emphasize the large gap between his performance in the domestic arena and his …

Tropical Storm Hanna set to soak East Coast

Residents watched increasingly bleak skies and beach vacationers prepared to pack up and head inland Friday as Tropical Storm Hanna cruised toward the coasts of North and South Carolina.

The storm, which earlier hung off the coast of Haiti for several days, causing widespread flooding and at least 137 deaths, has only a slight chance of becoming a small hurricane before crashing ashore overnight, forecasters said.

The latest storm will likely wash out the weekend from the Carolinas to Maine. Tropical storm watches or warnings ran from Georgia to Rhode Island.

Even worse, there's another storm _ Hurricane Ike, now a Category 3 hurricane _ that …

Ofwat plans to lower cost of water bills

Regulator Ofwat has revealed plans to drive down the level ofwater bills in the Bath area.

The organisation said that nationally households would benefitfrom a Pounds 14 fall in average annual water bills to Pounds 330before inflation over the next five years.

In the area served by Bath-based Wessex Water, it wants thecompany's average water and sewerage bill to fall by around Pounds 9or two per cent to Pounds 403.10.

The figures have emerged in Ofwat's "draft determination" onprice limits for water and sewerage costs in England and Wales forthe 2010-15 period.

But the regulator's plan sparked protests from water companies,which called for an average …

9/11 Mastermind Confesses in Guantanamo

WASHINGTON - Khalid Sheikh Mohammed, the suspected mastermind of the Sept. 11 attacks, confessed to that attack and a chilling string of other terror plots during a military hearing at Guantanamo Bay, Cuba, according to a transcript released Wednesday by the Pentagon.

"I was responsible for the 9/11 operation from A to Z," Mohammed said in a statement read during the session, which was held last Saturday.

The transcripts also refer to a claim by Mohammed that he was tortured by the CIA, although he said he was not under duress at the U.S. naval base at Guantanamo when he confessed to his role in the attacks.

In a section of the statement that was blacked out, he …

Recalls: solar system kits, DNA kits, popcorn

The following recalls have been announced:

_About 930,000 solar system kits and DNA kits, made in the U.S. and China by FloraCraft Corp., of Ludington, Mich., because the surface coating on the kit's wires can contain high levels of lead, which is toxic if ingested by young children. No incidents or injuries have been reported. The recall involves Solar System and DNA children's educational craft kits sold under the FloraCraft and HYGLOSS brand names. They were sold at Wal-Mart, Michaels, Jo-Ann Stores, Hobby Lobby and other retailers nationwide from January 2003 through last month. Details: by phone at 866-775-8781; on the Web at

Fire destroys gay pride float in Anchorage

Anchorage authorities say they're investigating the cause of a fire that destroyed a gay pride float intended for a 4th of July parade.

KTUU-TV reports that witnesses told investigators that moments before the fire began Friday morning they saw someone running from the driveway where the float was being constructed.

Neighbors and the float's builders say they fear a hate crime. Investigators say they're still working. A report that concludes the fire was set would lead to a criminal investigation.

The builders say they'll still improvise a float using the ashes and charred pieces of the original.

___

Information from: KTUU-TV, http://www.ktuu.com

With election behind him, Medvedev yet to prove he will be his own man as Russia's leader

Dmitry Medvedev, the man Vladimir Putin hand-picked to be his successor, scored a crushing victory in Russia's presidential elections Sunday, a result that was long anticipated but that still raises questions about who will run this resurgent global power.

Medvedev has not yet achieved the stature of the current president _ and is expected to rule in concert with his mentor, an arrangement that could see Putin calling the shots despite his constitutionally subordinate position as Russia's prime minister.

But the scope of Medvedev's victory _ he had 69 percent of the vote with tallies from two-thirds of the polling stations counted _ immediately raises the president-elect's stature.

For all of its lack of suspense, the world closely followed Russia's leadership contest for signs of how this sprawling nation, with its immense oil and gas reserves, will engage with global rivals and partners at a time of rising commodities prices.

Most Russians expect the mild-mannered, 42-year-old Medvedev to follow Putin's lead _ perhaps even allowing his mentor to rule from behind the scenes. Although Medvedev has presented himself as a liberal, he has also been one of the key implementers of Putin's drive to give the Kremlin a near monopoly on political power in Russia.

In the coming weeks and months, analysts will be looking for signals of changes in Kremlin policy under Medvedev, who in his rhetoric at least has presented a more democratic, Western-leaning face to the world than Putin.

At a news conference early Monday, Medvedev was asked who would run foreign affairs _ him or the prime minister. "Under the constitution, the president determines foreign policy," he said.

Medvedev ran against three rivals apparently permitted on the ballot because of their loyalty to the Kremlin line. But the two candidates _ Communist Party chief Gennady Zyuganov and ultranationalist Vladimir Zhirinovsky _ still alleged violations after the voting ended.

Zyuganov, Medvedev's nearest challenger with 18 percent in the incomplete results, said he would dispute the result. Zhirinovsky threatened to do so as well, before backing down.

As a key implementer of Putin's polices, Medvedev is seen as unlikely to alter Putin's assertive stance with the West, reduce state control over Russia's mineral riches or allow more real opposition movements to flourish.

The 70 percent Medvedev is likely to win is about the same as Putin's tally when he won re-election in 2004 _ raising the possibility of a potential rivalry.

"Our candidate, Dmitry Anatolyevich Medvedev, has taken a firm lead," Putin said late Sunday, appearing alongside his protege at a celebration at the Red Square outside the Kremlin.

"I'm congratulating Dmitry Anatolyevich and I wish him success," Putin said. "Such a victory carries a lot of obligations. This victory will serve as a guarantee that the course we have chosen, the successful course we have been following over the past eight years, will be continued."

Medvedev _ pronounced med-VEHD'-ev _ thanked voters and vowed to pursue Putin's policies.

"We will increase stability, improve the quality of life and move forward on the path we have chosen," Medvedev said. "We will be able to preserve the course of President Putin."

That teacher-pupil relationship will be tested immediately after Medvedev's inauguration. Medvedev has said he would propose making Putin his prime minister, and Putin has said he would agree. But in Russia, the premier wields significantly less power than the president, and Putin may find his new chair narrow and confining.

After eight years in the international limelight, Putin may also miss the job of representing Russia in gatherings of world leaders.

The first test could be the July summit of Group of Eight leading industrialized nations: If Putin goes alone or accompanies Medvedev, that could signal his reluctance to relinquish control.

Russia had two rulers _ a diarchy _ in the 17th century, when the first Romanov czar, Mikhail, served along with his father, Patriarch Filaret. In the early 1920s, Josef Stalin briefly shared power with Vladimir Lenin, the Bolshevik leader and founder of the Soviet state.

Putin has already shown signs of discomfort with his new role as subordinate to his protege.

When asked at his last news conference in February whether he would put the new president's portrait on his office wall, Putin answered dryly that he doesn't need to make such displays of loyalty.

Some officials who know Medvedev say privately that he is tougher than his appearance and demeanor may suggest and could show more resolve after his inauguration.

Medvedev has taken a liberal and pro-business posture during the campaign, avoiding Putin's harsh anti-Western rhetoric. But critics point out that he helped engineer Putin's crackdown on political and media freedoms as one-time Kremlin chief of staff.

He also spearheaded the Kremlin's concept of making Russia an "energy superpower" as chairman of Gazprom state gas monopoly, strong-arming former Soviet neighbors and expanding Russia's control of Europe's energy supplies.

While most expect Medvedev to play second fiddle to Putin, the vast powers of the Russian presidency may tempt him to step out of his mentor's shadow.

Russian history shows that rulers often like to get rid of those who backed their ascent to power. Boris Berezovsky, who backed Putin's rise to power, fled abroad to escape money-laundering charges several months after his election.

Medvedev is the first Russian leader to succeed his predecessor according to a constitutional timetable; Putin became acting president first after Russia's first President Boris Yeltsin stepped down early, and only later won election.

But Medvedev's election was not a wide-open contest either.

Liberal opposition leaders Garry Kasparov and Mikhail Kasyanov were barred from running on technicalities, and voters across Russia say they were being urged, cajoled and pressured to vote in an effort to ensure that Medvedev scored a major victory.

Kasparov held his own protest against the election Sunday near Red Square. Escorted by a dozen riot police, he carried a plastic shopping bag that read: "I am not participating in this farce."

Polling stations offered enticements to voters: discounted food, office supplies, tickets to concerts. The enticements echoed the practices of the Soviet era, when hard-to-get items were available during carefully staged elections.

In a post-Soviet touch, some polling stations were set up in shopping malls.

The head of an independent Russian election monitoring group, Golos, said her organization was receiving a steady stream of complaints and reports of irregularities, including blatant attempts to influence voters and voters being "bought off."

"Most of problems appear to be occurring at the local level" in the provinces, where there is little scrutiny, Liliya Shabanova said.

___

Associated Press writers Mike Eckel, Mansur Mirovalev, Maria Danilova and Peter Leonard in Moscow contributed to this report.

NOTICE BOARD

* Ottawa Supper Clubs - Contact Janet Graham, Nephrology Unit, Ottawa Hospital, jgraham@ottawahospital.on.ca

* September 15-18, 2007. European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) 36th International Conference, Florence, Italy. Website: www.edtna-erca.org

* October 15, 2007. Kidney Foundation of Canada. Deadline for Allied Health Research Grants. Contact: Coordinator, Research Grants and Awards, e-mail: research@kidney.ca. Website: www.kidney.ca

* October 25-28, 2007. CANNT 39th National Symposium. Winnipeg Convention Centre - Winnipeg Delta Hotel, Winnipeg, Manitoba. Conference Planner: Heather Reid: e-mail: hreid@innovccca. Website: www.cannt.ca

* October 25, 2007 (opening of CANNT 2007 conference). Canadian Technical Certification Exam. For information, contact OACETT, Camilla Poliah, at (416) 621- 9621; e-mail: cpoliah@oacett.org. Website: www.oacett.org. Note: deadline for application for this exam is September 10, 2007.

* March 2-4, 2008. The 28th Annual Dialysis Conference. Rosen Shingle Creek Resort, Orlando, Florida. Website: www.muhealth.org/^dialysis/

* March 15, 2008. Kidney Foundation of Canada. Deadline for Allied Health Fellowships and Scholarships. Contact: Coordinator, Research Grants and Awards, (800) 361-7494, ext. 232; e-mail: research@kidney.ca. Website: www.kidney.ca

* April 27-30, 2008. American Nephrology Nurses Association (ANNA) 39th National Symposium, Philadelphia Marriott & PA Convention Center, Philadelphia, PA. Contact the ANNA National Office, (888) 600-2662; e-mail: anna@ajj.com. Website: www.annanurse.org

8 Fatah Policemen in Gaza Fighting

GAZA CITY, Gaza Strip - Hamas gunmen riddled a Fatah police jeep with gunfire at close range Tuesday, killing eight policemen in the most ruthless round yet of factional fighting, pushing the Palestinian unity government closer to collapse.

Gunmen in black ski masks took up positions in the streets and terrified residents huddled in their homes. Israel, too, was briefly drawn into the battle.

"I don't know when it's going to end and what the future will bring," said Salman Abu Arafeh, 42, a Gaza City interior decorator who was pinned down by gunfire in his apartment for hours, along with his wife and two children. A total of 15 people were killed in Tuesday's fighting.

An Egyptian mediator said a truce was reached late Tuesday - the third in as many nights. The others have collapsed within hours. Around midnight, a car carrying Egyptian officials with Hamas and Fatah representatives came under fire, Hamas officials said, and an Egyptian diplomat was slightly wounded.

Hamas gunmen stormed the home of a top Fatah official early Wednesday in Gaza City, killing five bodyguards inside, Palestinians security officials said. Hamas gunmen fired mortars at the house of Fatah security chief Rashid Abu Shbak before storming it and planting pipe bombs inside, the officials said. Abu Shbak and his family were not home at the time of the attack.

The renewed clashes Wednesday included mortars fired at the presidential compound of Palestinian President Mahmoud Abbas of Fatah. No one was wounded in this attack.

On Tuesday, Abbas called for the immediate implementation of a security plan that would put all rival forces under one command. However, his call is unlikely to be heeded: The fighting made it clear the Hamas-Fatah power struggle was never really resolved, despite formation of the unity government in March.

Gaza's turmoil further weakened hopes for a resumption of Israeli-Palestinian peace talks, despite a new push by the Arab world to bring the sides to the table, based on an offer of Arab recognition of Israel in exchange for an Israeli withdrawal from all lands it occupied in the 1967 Middle East War.

Israel has expressed major reservations, but Prime Minister Ehud Olmert told Jordan's King Abdullah on Tuesday that he's ready to meet with Arab leaders in Israel or anywhere else to talk about the idea. Abdullah, in turn, asked Olmert to set a timetable for reaching a peace deal.

Negotiations, however, are inconceivable if the Palestinians descend into a protracted civil war.

This week's fighting was the worst since Hamas and Fatah agreed to share power in February. In all, at least 28 people have been killed and dozens wounded. Among the injured was a 10-year-old girl caught in the crossfire late Tuesday and critically wounded by a gunshot to the head, Palestinian rescue workers said.

In the deadliest battle, Hamas gunmen fired rockets, rocket-propelled grenades and mortars early Tuesday at a training base for Fatah forces guarding the Karni cargo crossing with Israel. U.S. security experts had helped set up the base to improve security at Karni.

After the initial attack, Hamas fired on Fatah reinforcements rushing to the scene, and one of the jeeps carrying Fatah fighters veered off the road and crashed. Hamas gunmen surrounded the vehicle and riddled it with gunfire, said one witness, who works in a nearby factory.

"It was unbelievable. May God help us," said the man, who gave only his first name, Jamil, out of fear for his safety.

Eight men were killed, hospital officials said. Fatah security men also came under fire as they tried to move the bodies away from the overturned jeep.

Two Israeli helicopter gunships and three tanks moved toward the area, and Hamas fighters quickly withdrew. At one point, a major in the Palestinian Presidential Guard was killed by Israeli army fire as he tried to leave the crossing, security officials said.

Before sundown, Hamas said it fired rockets at Sderot, an Israeli town near Gaza in retaliation for the Israeli attack. Residents counted more than 20 rockets. One rocket hit a house, seriously wounding an Israeli woman. It was the first time in three weeks that Hamas has claimed responsibility for a rocket barrage.

Israeli Defense Minister Amir Peretz summoned army commanders for late-night consultations. Earlier, defense officials said Israel would not be dragged into the fighting.

However, Israel closed Karni, the only route for cargo into Gaza. The closure means Gaza will soon run out of fuel for its power plant and electricity to most of the strip could be shut down by Wednesday, said Abdel Karim Abdeen, head of the Palestinian Energy Authority.

The current fighting had many of the elements of previous Hamas-Fatah clashes: combatants kidnapped scores of rivals, set up roadblocks to search cars, took over rooftops of high-rises and often fired randomly in crowded residential areas.

Around Abbas' seaside compound in Gaza City, security forces searched cars and inspected motorists' ID cards. They gave those with beards - a possible sign of Hamas support - an extra close look.

Both sides have become more ruthless this time, with Fatah accused of an execution-style killing of two Hamas supporters Sunday and Hamas ambushing the Fatah jeep Tuesday. This might make it more difficult to negotiate a cease-fire and revive the coalition.

At the core of the fighting is the unresolved power struggle between Hamas, which won parliamentary elections last year, and Abbas' Fatah, which has dominated Palestinian politics for four decades. Squeezed by an international aid boycott, Hamas realized it could not govern alone and brought Fatah into the government. But the two sides never worked out their differences, particularly over security.

While the power-sharing deal largely halted factional fighting for three months, both sides continued to smuggle weapons through tunnels under the Egypt-Gaza border, preparing for the next round.

The spark for the new fighting was deployment of 3,000 Fatah-allied members of the security forces in Gaza City last week, over Hamas' objections. Hamas also has bristled at Abbas' appointment of former Gaza strongman Mohammed Dahlan as his national security adviser.

"Palestinian society is now similar to Lebanese society - always in civil war or on the verge of civil war," said analyst Hillel Frisch of Israel's Bar-Ilan University.

"It's going to be cyclical: both sides know the tremendous costs, so they try to contain it, but the problem is simply left unresolved, and is probably unresolvable," he said.

Both sides accused each other of waging a carefully orchestrated campaign to destroy the other.

The National Security, a force loyal to Abbas, said Hamas is leading a military coup against the Palestinian security establishment. A Hamas spokesman, Abdel Latif Kanuah, said Fatah is involved in a U.S.-backed plot to overthrow Hamas, referring to U.S. backing for Abbas' elite forces, the Presidential Guards.

Despite the unity government's shortcomings - and its failure to end the international embargo imposed on Hamas - it's unlikely Abbas will dissolve it and call early elections. Hamas would consider that an attempt to steal its election victory and likely oppose it violently.

---

Karin Laub contributed to this report from Ramallah, West Bank.

Phillip Adler

Graveside services for Phillip Adler, 56, the former owner of twonorthwest suburban men's clothing stores, will be held at 12:30 p.m.today at Shalom Memorial Park, Rand Rd. and Illinois 53, Palatine.

Mr. Adler, who died Saturday in Burbank, Calif., after a longillness, owned Alan B. Men's Wear stores in Buffalo Grove and HanoverPark for 15 years.

Before that, he managed Bertal's Women's Wear at Randolph andWashington.

He closed the shops in the early 1980s, moved to Sherman Oaks,Calif., and went into the men's retail clothing business in LosAngeles.

Mr. Adler, a former Des Plaines resident, began his career as astockboy for Turner Bros., a men's clothing store at Roosevelt andHalsted. He was a salesman when he left to join Bertal's.

Mr. Adler served in the Army from 1954 to 1956.

Survivors include his wife, Ilene; two sons, Barry and Alan; adaughter, Randi Kaden; a brother, Seymour, and four grandchildren.

Ohio House candidate sued for sexual harassment

CLEVELAND (AP) — A Cleveland woman has sued a Republican U.S. House candidate in Ohio, alleging he propositioned her and groped her after she tried to volunteer for his campaign.

The 39-year-old woman said in a lawsuit filed Thursday in Cuyahoga (ky-uh-HOH'-guh) County court that Tom Ganley offered her a $100 bill to buy lingerie and encouraged her to join him and his friends at a condominium.

The lawsuit alleges Ganley, a car salesman, tried to force himself on the woman during an August 2009 meeting in his car dealership office.

Ganley is trying to unseat Democratic incumbent U.S. Rep. Betty Sutton in a closely watched race nationally.

Messages were left Friday for Ganley at his campaign headquarters and for two Ganley attorneys. Attorney Steven Dever told The Plain Dealer the charges were extortion and motivated by politics.

His campaign says in a statement that Ganley is known as an upstanding citizen and businessman.

___

Information from: The Plain Dealer, http://www.cleveland.com

Branford Marsalis plays Debussy's Rhapsody with the Chicago Symphony Orchestra

Internationally famous alto saxophonist Branford Marsalis returns to Chicago to perform as a soloist with the Chicago Symphony Orchestra Debussy's Rhapsody for Alto Saxophone and Orchestra and Copland's Clarinet Concerto on soprano saxophone Friday at 8 p.m. and again Tuesday at 7:30 p.m. Conducted by David Robertson. Robertson will also lead the CSO in Faure's Pelleas and Melisande and Adams' Harmonielehre, this phase of the concert will be held at Orchestra Hall, located at 220 S. Michigan Ave.

Sunday, the concert will be repeated at the Wharton Center for Performing Arts at Michigan State University, in East Lansing, Mich. with Dvorak's Symphony No. 9 in E Minor, Opus 95 (From the New World).

A native of Santa Monica, Calif, Robertson is the musical director of the Saint Louis Symphony Orchestra and the principal guest conductor of London's BBC Symphony Orchestra. He frequently conducts symphonies throughout the world including the CSO, the San Francisco and Boston symphony orchestras, the Los Angeles Philharmonic, the Royal Concrete Orchestra and the Bayerischer Rundfunk Symphony Orchestra.

Marsalis is an artist whose talent enables him to perform several instruments and various genres of music. He is also the founder of the Marsalis Music record label. His brothers are Wynton, Delfeayo, Jason, Kinyatta Mboya and Ellis III, who is a poet, photographer and network engineer based in Baltimore.

Branford began his professional career with Art Blakey's big band, Clark Terry and Blakey's Jazz Messengers. He joined Wynton's ensemble, but left to play in Sting's backup band. During the second half of the '80s, Branford fronted his own ensemble. He also served as musical director of the Tonight Show, worked briefly with the Grateful Dead and toured in one of Miles Davis' last bands.

[Author Affiliation]

by Earl Calloway

Defender Staff Writer

Obituaries: Obit

Rebecca Lynn Allen

Rebecca Lynn "Becky" Allen, 44, of St. Albans passed away Sunday,April 29, 2007, at CAMC Memorial Hospital, Charleston.

Becky was a phlebotomist for six years at Holzer Clinic in SouthCharleston and a 19-year resident of St. Albans. She was a member ofEternal Light Church of God and was a witness for Jesus Christ whowas loved by everyone.

She was preceded in death by her mother, Betty Boggs, and sister,Ellen Tudor.

She is survived by her husband, Elvis Wayne Allen; daughter, KaylaNicole Allen at home; son, Joshua Wayne Allen of St. Albans; andfather and stepmother, George and Nancy Young of South Charleston.She is also survived by her sisters, Suzanne and her husband, HankSigmon, of South Charleston, Julia and Charles Kidd of Charleston andJennifer Athey of South Charleston; her brothers, James Young ofSouth Charleston and George Young of Pinch; brother-in-law, Ed Tudorof Alum Creek; her grandchildren, Chasity and Kayla Smith; severalnieces and nephews; and a host of friends.

The funeral service will be 11 a.m. Wednesday, May 2, at Bartlett-Chapman Funeral Home, St. Albans, with Bishop Robert Smith, Dr. JamesC. Abner and Brother Hank Sigmon officiating. Entombment will followin Cunningham Memorial Park, St. Albans.

Friends may call from 6 to 8 p.m. Tuesday at the funeral home.

Online condolences may also be made by visitingwww.bartlettchapmanfuneralhome.com.

Bartlett-Chapman Funeral Home, 409 Sixth Ave., St. Albans, is incharge of arrangements.

Murrel Brannon

Murrel Brannon, 95, of Forest Hill, Md., formerly of Spencer, diedApril 27, 2007, at the Forest Hill Health and Rehabilitation Center.

Born in Calhoun County, she was a daughter of the late Price andStella Ross Jarvis.

Mrs. Brannon formerly worked at Spencer Manufacturing. She movedto Daytona Beach, Fla., in 1967, where she and her husband owned andoperated the Imperial Motel. In 1990, they moved to Abingdon, Md., tobe closer to family.

Mrs. Brannon is survived by one son, Paul, and his wife, Jean, ofDillsburg, Pa. Also surviving are two daughters, Enona Phipps and herhusband, Dean, of Fallston, Md., and Karen Rapp and her husband,Carlos, of North East, Md. She was preceded in death by a daughter,Willa Mae Brannon.

Grandchildren surviving include Lisa Wilson of Rising Sun, Md.,Christie Louthan of Abingdon, Md., Lori Snyder of Bel Air, Md., andDavid Brannon of Philadelphia, Pa. She also had six great-grandchildren. She was preceded in death by a grandson, Thomas Craverof Fallston, Md.

Mrs. Brannon was also preceded in death by several brothers andsisters.

A memorial service will be held May 1, at 10 a.m. at the EventideCemetery in Spencer with the Rev. John Smith officiating.

Taylor-Vandale Funeral Home, Spencer, is in charge of thearrangements.

Ronald Brooks

Ronald Brooks, 54, of Rand died April 24, 2007. Preston FuneralHome, Charleston, is in charge of arrangements.

Michael G. Davis

Michael G. Davis, 45 of Stollings died April 30, 2007. Servicewill be 1 p.m. Thursday, May 3, at Honaker Funeral Home, Logan.Friends may call from 6 to 9 p.m. Wednesday. Burial will follow inHighland Memory Gardens, Godby.

James L. DiBenedetto

James L. DiBenedetto, 88, formerly of Aliquippa, Pa., passed awayinto the loving arms of our Lord on Saturday, April 28, 2007. He wasa member of Christ the King Church in Dunbar.

In addition to his parents, preceding him in death was his belovedwife, Alice E. Ciccone DiBenedetto; two brothers; and two sisters.

Surviving are four children and their spouses, Donna and AnthonyKulfan of Cranberry Township, Pa., James F. and Christine DiBenedettoof Aliquippa, Pa., Dennis V. and Barbara DiBenedetto of Petersburg,W.Va., and Celeste R. and Richard Peggs of St. Albans, W.Va.;grandchildren, Anthony and Jackie K Kulfan, James and AmyDiBenedetto, Amanda, Jeremy, and Dan DiBenedetto, and Micah Peggs;and a great-grandson, Mitchell Kulfan.

Friends will be received from 2 to 4 and 6 to 8 p.m. Tuesday andWednesday at Anthony Mastrofrancesco Funeral Home, Inc., 21st andMcMinn Streets, Aliquippa, Pa., telephone 724-375-0496, where aservice will be held at 9:45 a.m. on Thursday, May 3, at the funeralhome, followed by a Mass of Christian Burial at 10:15 a.m. at SaintTitus Catholic Church, Aliquippa, Pa. Interment will follow inSylvania Hills Memorial Park, Daughtery Township, Pa.

A Memorial Mass to celebrate Jim's life will be held at 7 p.m.Friday, May 4, 2007, at Christ the King Church, Dunbar, W.Va.

Tommy Paul DiToto

Tommy Paul DiToto, 42, of Walton died April 28, 2007. Service willbe 3 p.m. Wednesday, May 2, at Taylor-Vandale Funeral Home, Spencer.Friends may call one hour prior to service. Burial will be in LooneyCemetery, Walton.

Hazel M. Dingess

Hazel Dingess, 93, of Sarasota, Fla., formerly of West Logan, diedApril 9, 2007.

Services were conducted at Toale Brothers Gulf Gate Chapel andburial was at Sarasota Memorial Park.

Survivors include a daughter, Sue Profit of Poulsbo, Wash., and ason, Bill F. Dingess of Charleston.

She was a beloved grandmother of Todd Dingess of Hurricane,Kristin Dingess of Sugar Grove, Jeffrey Holleran of Atlanta, Ga.,Christopher Holleran of San Francisco, Calif.; and four great-grandchildren.

Mrs. Dingess was preceded in death by her husband, J.E. "Ed", herinfant son, Willis, and her daughter, Shirley.

She was a devoted member of the Bee Ridge Baptist Church familyfor the past 35 years. She will be remembered by her family andextended church family with great love.

Sign the guestbook at heraldtribune.com.

Marietta E. Farmer

Marietta E. Farmer, 76, of Grandview died April 28, 2007. Servicewill be 1 p.m. Wednesday, May 2, at High Lawn Funeral Chapel, OakHill. Friends may call from 6 to 8 p.m. Tuesday.

Kathryn E. Faudree

Kathryn Elizabeth Faudree, 80, of Point Pleasant died April 29,2007. Service will be 2 p.m. Wednesday, May 2, at Crow-HussellFuneral Home, Point Pleasant. Friends may call one hour prior toservice. Burial will be in Lone Oak Cemetery, Point Pleasant.

Anna Ayres Ganoe

Anna Ayres Ganoe, 89, of Bozoo died April 29, 2007. Service willbe 11 a.m. Wednesday, May 2, at Broyles-Shrewsbury Funeral Home,Peterstown. Friends may call from 5:30 to 8:30 p.m. Tuesday. Burialwill be in Peterstown Cemetery.

Dorothy Lea Godbey

Dorothy Lea Godbey, 75, of Richwood died April 28, 2007. Servicewill be 2 p.m. Wednesday, May 2, at Simons-Coleman Funeral Home,Richwood. Friends may call from 6 to 8 p.m. Tuesday. Burial will bein West Virginia Memorial Gardens, Calvin.

Mary Graham

Mary Graham, 82, of Charleston died April 29, 2007. PrestonFuneral Home, Charleston, is in charge of arrangements.

Jamsie Eugene Hinkle

Jamsie Eugene Hinkle, 82, of Beaver, formerly of Beckley, diedApril 28, 2007. Service will be 1 p.m. Wednesday, May 2, at BlueRidge Funeral Home, Beckley. Friends may call from 6 to 9 p.m.Tuesday. Entombment will be in Blue Ridge Memorial Gardens.

Charles W. Hypes

Charles W. Hypes, 84, of Lookout died April 29, 2007. Service willbe 1 p.m. Wednesday, May 2, at Wallace & Wallace Funeral Home,Ansted. Friends may call from 6 to 8 p.m. Tuesday. Burial will be inHigh Lawn Memorial Park, Oak Hill.

Martha Mae Martin

Martha Mae Martin, 76, of Dunbar, died Feb. 4, 2007. Gravesideservice will be held at 11 a.m., Tuesday, May 1, at Grandview

Memorial Park, Dunbar. Arrangements are in the care of KellerFuneral Home, Dunbar.

Helen Marie Moore

Helen Marie Teel Moore, 69, of Charleston went to be with theLord, after an extended illness on Sunday, April 29, 2007, surroundedby her loving family and friends.

She was a member of Cathedral of Prayer Southern Baptist Churchsince 1966.

Mrs. Moore is survived by her loving husband of 47 years, Ed;sons, Eddie and wife, Betty, Ricky, Jimmy and wife, Jannette, andBill, all of Charleston; daughter, Sara Hudnall and husband, Clark;two grandchildren, Angela Marie and Clark Ray Hudnall; brothers,Richard Teel and Carl Teel, both of Charleston; sisters, Irene Nelsonof South Charleston, Reba Toothman of Exeter, Neb., and RosieHumphrys of St. Albans; stepbrother, Clifford Jenkins of Spencer;stepsister, Helen Jean Morris of Charleston; and a host of otherfamily members and friends.

The family would like to extend a special thank you to the doctorsand staff of Dr. Schiano's office, and the nurses of the Third Floorat CAMC Women & Children's Hospital and the nurses of HospiceCare.

Funeral services will be held at 1 p.m. Wednesday, May 2, atCathedral of Prayer Southern Baptist Church with Pastor Kevin Norvellofficiating. Burial will follow in Cunningham Memorial Park, St.Albans.

Friends may call from 6 to 9 p.m. Tuesday at Keller Funeral Home,Dunbar.

In lieu of flowers, the family suggests donations be made toHospiceCare, 1143 Dunbar Avenue, Dunbar, WV 25064, or to, Cathedralof Prayer Southern Baptist Church, 2324 Pennsylvania Avenue,Charleston, WV 25302.

M. Eleanor Nester

M. Eleanor Nester, 74, of Spencer died April 28, 2007. Servicewill be 11 a.m. Wednesday, May 2, at Taylor-Vandale Funeral Home,Spencer. Friends may call from 6 to 8 p.m. Tuesday. Burial will be inClover Cemetery, Clover.

Betty Butler Pfahler

Betty Delores Crouse Butler Pfahler of Charleston entered intoHeaven, on Sunday, April 29, 2007, at 10 p.m. in CAMC MemorialHospital with her family around her.

She was preceded in death by her husband, Otis Butler; five infantchildren; father, William Lawrence Crouse; mother, Bertha RebaBarnette; stepbrothers and sisters.

Betty is survived by her brother, Billy Crouse and Sue; sons, OtisJr. and Sheila, William Ray and Carla, Shawn Eugene Butler;daughters, Betty Ann Yates and Jim, Reba Lynn Butler, JeannieBurdette and Jeff Jernigan; nine grandchildren; and 13 great-grandchildren.

Funeral service will be held at 2 p.m., Thursday, May 3, at KellerFuneral Home, Dunbar. Burial will follow in Butler Cemetery, Bomont.

Friends may call from 6 to 8 p.m., Wednesday, May 2, at KellerFuneral Home, Dunbar.

Phyllis Gunter Phillips

Phyllis Jean Gunter Phillips, 88, died April 28, 2007, at herMaryland home after a short illness.

She was born in Charleston, W.Va., Feb. 22, 1919, daughter ofIsaac and Carrie Keiffer Gunter. She lived with her husband, Elbertin Charleston/St. Albans/Nitro communities until 1986. They lived inFlorida until she moved to Maryland the past two years. She was alongtime member of Highlawn Presbyterian Church in St. Albans, andwas ordained as an Elder in 1974.

Phyllis is survived by her three children, Jean Jones of Columbus,Ohio, Frank Phillips of Leonardtown, Md., and Kathy West ofGreenville, S.C.; seven grandchildren; and eight great-grandchildren.

She was preceded in death by her husband and three sisters.

A service will be held at Highlawn Presbyterian Church at 11 a.m.on Saturday, May 5. Interment will be at Cunningham Memorial Park,St. Albans. In lieu of flowers, please make donations to the HighlawnPresbyterian Church.

Robert Reynolds

Robert Reynolds, 66, of Elkview, formerly of St. Albans, diedApril 29, 2007. Leonard Johnson Funeral Home, Marmet, is in charge ofarrangements.

Norva K. Robinson Jr.

Norva Kenneth Robinson Jr., 59, of Widen died April 29, 2007.Service will be 1 p.m. Wednesday, May 2, at Greene-Robertson FuneralHome, Sutton. Friends may call on ehour prior to service. Burial willbe in the Robinson family cemetery, Widen.

Carl Ray Shafer

Carl Ray Shafer, 86, of Pinch went home to be with the Lord onSunday, April 29, 2007, at his residence.

He was a longtime pipeliner and a retired welder from Union Local798. Throughout his life, he resided in Kanawha County.

Surviving: his loving wife of 67 years, Emma Alice Harris Shafer;sons, Michael Ray Shafer of Venice, Calif., and Donal Phillip Shaferand wife, Carol Jean, of Pinch; daughter, Nancy Shafer Stein andhusband, Steven, of Silver Spring, Md.; four grandchildren and eightgreat-grandchildren.

Service will be 1 p.m. Thursday, May 3, at the Hafer Funeral HomeChapel with Dan Forwood officiating. Burial will follow in ClendeninMemorial Park, Clendenin.

Friends may call from 6 to 8 p.m. Wednesday at the funeral home.

Hafer Funeral Home, Elkview, is in charge of arrangements.

Lonnie V. Sheppard

Lonnie V. Sheppard, 96, of Delbarton died April 29, 2007. Servicewill be 1 p.m. Wednesday, May 2, at Sheppard Cemetery, LowerSheppards Town. Friends may call Wednesday from 10 a.m. to noon atHonaker Funeral Home, Logan.

Franklin Glen Smith

Franklin Glen Smith, 74, of St. Albans passed away Sunday, April29, 2007, at Thomas Memorial Hospital, South Charleston.

Born February 15, 1933, in Kermit, he was a son of the late Walterand Nell Patrick Smith. He was also preceded in death by hisbrothers, Jack and Harry Smith, and uncle, Bill Patrick.

He graduated from Concord College in 1954 and was a varsitybasketball player for all four years. Franklin was a teacher/coach atKermit High School from 1954-1960; Springhill Jr. High School from1960- 1976; and McKinley Jr. High School from 1976-1988. His recordas coach was 424-104. After he retired, he taught two years ofphysical education at St. Francis School in St. Albans. Mr. Smith wasan author of a poetry book titled "Tunes from the Tug," which waspublished in 2006. He was also a member of Highlawn PresbyterianChurch, St. Albans.

He is survived by his wife of 47 years, Shelby Grim Smith;daughters and sons-in-law, Jeanie Elyse and Rande Robinson ofHickory, N.C., and Renee and Tommy Harper of Nitro; aunt, AlmaPatrick of Morehead, Ky.; and grandchildren, Rainer Robinson andRachael Renee Robinson, both of Hickory, N.C.

Funeral service will be held at 2 p.m. Wednesday, May 2, atBartlett-Chapman Funeral Home, 409 Sixth Ave., St. Albans, with theRev. Kristi S. Moore officiating. Entombment will follow inCunningham Memorial Park, St. Albans.

Friends may call from 6 to 8 p.m. Tuesday at the funeral home.

In lieu of flowers, the family suggests that donations be made toHighlawn Presbyterian Church, 2501 Washington Avenue, St. Albans, WV25177, or the American Diabetes Association, 1221 Ohio Ave., Dunbar,WV 25064.

Online condolences may be made atwww.bartlettchapmanfuneralhome.com.

Hale C. Stewart

Hale C. Stewart, 87, of Point Pleasant died April 30, 2007.Private graveside service will be Wednesday, May 2, in KirklandMemorial Gardens. There will be no visitation. Wilcoxen Funeral Home,Point Pleasant, is in charge of arrangements.

Grady Wilson Tucker II

Grady Wilson Tucker II, 60, of White Sulphur Springs died April27, 2007. A private family service will be held at a later date.Wallace & Wallace Funeral Home, Lewisburg, is in charge ofarrangements.

Serum procalcitonin, interleukin-6, soluble intercellular adhesin molecule-1 and IgG to short-chain exocellular lipoteichoic acid as predictors of infection in total joint prosthesis revision

ABSTRACT

The diagnosis of prosthetic joint infection and its differentiation from aseptic loosening remains problematic. The definitive laboratory diagnostic test is the recovery of identical infectious agents from multiple intraoperative tissue samples; however, interpretation of positive cultures is often complex as infection is frequently associated with low numbers of commensal microorganisms, in particular the coagulase-negative staphylococci (CNS). In this investigation, the value of serum procalcitonin (PCT), interleukin-6 (IL-6) and soluble intercellular adhesion molecule-1 (sICAM-1) as predictors of infection in revision hip replacement surgery is assessed. Furthermore, the diagnostic value of serum IgG to short-chain exocellular lipoteichoic acid (sce-LTA) is assessed in patients with infection due to CNS. Presurgical levels of conventional serum markers of infection including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell count (WBC) is also established. Forty-six patients undergoing revision hip surgery were recruited with a presumptive clinical diagnosis of either septic (16 patients) or aseptic loosening (30 patients). The diagnosis was confirmed microbiologically and levels of serum markers were determined. Serum levels of IL-6 and sICAM-1 were significantly raised in patients with septic loosening (P=0.001 and P=0.0002, respectively). Serum IgG to sce-LTA was elevated in three out of four patients with infection due to CNS. In contrast, PCT was not found to be of value in differentiating septic and aseptic loosening. Furthermore, CRP, ESR and WBC were significantly higher (P=0.0001, P=0.0001 and P=0.003, respectively) in patients with septic loosening. Serum levels of IL-6, sICAM-1 and IgG to sce-LTA may provide additional information to facilitate the diagnosis of prosthetic joint infection.

KEY WORDS: Biological markers.

Diagnosis.

Hip prosthesis.

Infection.

Reoperation.

Introduction

The clinical and laboratory diagnosis of septic prosthetic joint loosening and its differentiation from aseptic loosening is complex as currently used diagnostic tests lack sensitivity and specificity and underlying rheumatological disease can lead to periprosthetic inflammatory changes in tissue.12 Furthermore, interpretation of positive microbiological cultures from samples taken prior to or during surgery is often difficult because infection is frequently associated with low numbers of commensal microorganisms, particularly skin organisms including coagulase-negative staphylococci (CNS) and Propionibacterium acnes; insufficient or inappropriate intraoperative samples may be taken during surgery; and microbial contamination during sample collection or processing may occur.2-4

To improve the microbiological diagnosis of septic loosening, Atkins et al.5 undertook a prospective study to assess the significance of positive cultures and number of positive samples in reliably diagnosing infection. The study demonstrates that recovery of indistinguishable microorganisms from multiple intraoperative samples is highly predictive of infection. This has been used as the definitive test for the diagnosis of septic loosening in the present study.

The host response to bacterial infection results in the release of a wide range of inflammatory mediators, some of which may be used to facilitate the diagnosis of infection"6 or interpretation of complex positive microbiological cultures. Within the past decade, a large number of serological markers have been suggested as sensitive and specific indicators of bacterial infection.6-16 Levels of serum markers including procalcitonin (PCT)6-8 interleukin-6 (IL-6)9-11 and human soluble intercellular adhesion molecule-1 (sICAM-1)10 have been evaluated and used to facilitate diagnosis of infection and/or sepsis. Furthermore, serum IgG antibodies to short-chain exocellular lipoteichoic acid (sceLTA; previously termed lipid S)123 produced by CNS have been shown to be a valuable diagnostic marker in patients with intravascular device-related infection15,16 and septic loosening12 due to CNS.

The aim of the present study is to establish whether or not serum levels of PCT, IL-6 and sICAM-1 in patients with welldefined septic and aseptic loosening can facilitate a differential diagnosis and offer useful additional information alongside conventional predictors (i.e., C-reactive protein [CRP], erythrocyte sedimentation rate [ESR] and white blood cell count [WBC]). Furthermore, the potential value of serum IgG to sce-LTA as a marker for septic loosening due to CNS is also assessed.

Materials and methods

Patient recruitment

A prospective case-control study of 46 patients undergoing revision hip surgery under a single surgeon was conducted. Ethical committee approval was obtained prior to commencement of the study. Patients were recruited following informed consent. Strict inclusion criteria were adopted and any patient who had a history of possible infection remote from the hip within the previous six months was excluded from the study. Patients with co-morbidities including psoriasis, inflammatory bowel disease and malignancy were also excluded.

Preoperative clinical evaluation of each patient was undertaken. Preoperative anteroposterior and true lateral radiographs of the pelvis were also obtained. In addition, CRP ESR and WBC were determined seven to 21 days prior to surgery.

Surgery was performed by a single surgeon in an operating suite with vertical laminar airflow. Based on results of presurgical patient assessment and intraoperative clinical findings, patients were given a presumptive clinical diagnosis of septic or aseptic loosening.

Preoperative serum markers

Preoperative results of CRP ESR and WBC were determined by standard laboratory methods.

Intraoperative tissue samples and blood collection

Patients receiving antibiotics had their treatment stopped two weeks prior to surgery. Immediately prior to surgery, 5-mL blood was obtained from each patient for estimation of serum levels of PCT, IL-6, sICAM-1 and IgG to sce-LTA. A standard set of clinical samples5 for microbial culture was taken during surgery and comprised a swab of hip joint fluid, femoral tissue, capsular tissue, acetabular tissue, bone and/or cement, and the prosthetic hip.

Microbiological culture

Clinical samples were processed using standard microbiology methods. Briefly, 5-mL sterile phosphate buffered saline (PBS) was added to each of the acetabular, capsular, femoral tissue and bone/cement samples together with 10 sterile glass beads and were vortex-mixed for 2 min. Aliquot samples were then inoculated on two blood agar plates and one chocolate agar plate. One blood agar plate was incubated in 5% CO1 and the other anaerobically. The chocolate plate was incubated in 5% CO2. All plates were incubated at 37� C for up to seven days. Aliquot samples were also inoculated in Robertson's cooked meat broth and incubated at 37� C. Broths that became turbid were subcultured, as described previously. Broths showing no turbidity had a terminal subculture after five-days' incubation. The hip prosthesis was cultured by removing clinical debris from the device (premoistened with sterile saline) with a sterile scalpel and then culturing, as described previously.

Microorganisms recovered from clinical samples were identified by standard microbiological methods. Strain similarity of isolates recovered from multiple samples was based on phenotypic characteristics including biotype and antibiogram as determined by British Society for Antimicrobial Chemotherapy (BSAC) methodology.17 A definitive diagnosis of septic or aseptic loosening was established using criteria including presurgical imaging data, elevated presurgical serum CRP and/or ESR, positive microbiology cultures yielding indistinguishable microorganisms from two or more clinical samples.

Serum levels of PCT, IL-6 and sICAM-1

Serum levels of PCT, IL-6 and sICAM-1 at the time of surgery were determined using commercially available kits in accordance with the manufacturers' instructions (PCT, B.R.A.H.M.S PCT-Q, Hennigsdorf, Germany; IL-6 and sICAM-1, R&D Systems Europe, UK).

Serum IgG to sce-LTA

Serum IgG to sce-LTA was determined by enzyme-linked immunosorbent assay (ELISA), as previously described by Worthington et al.15

Diagnostic parameters of serum markers

The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of serum markers demonstrating the potential to facilitate diagnosis of septic loosening were determined. Routinely used cut-off values of 10 mg/L and 30 mm/h were applied for CRP and ESR, respectively. Diagnostic parameters for IL-6 and sICAM-1 were established over a series of cut-off points and the best predictors of septic loosening determined.

Statistical analysis

The Mann-Whitney U test was used to determine the significance of differences between levels of serum markers in patients with septic and aseptic loosening. Serum values of CRP, ESR, WBC, IL-6 and sICAM-1 were expressed as the median. All tests were two-sided and P<0.05 was considered significant.

Results

Patient demographics

Forty-six patients (25 male, 21 female; mean age: 72 years [range: 50-90]) requiring revision hip surgery due to prosthetic joint loosening were recruited to the study. Based on presurgical patient assessment, a presumptive clinical diagnosis was made by the same surgeon. Thirty (65%) patients were diagnosed clinically as having aseptic loosening of their hip prosthesis, while 16 (35%) were suspected of having septic loosening.

Patients with aseptic loosening

Results of microbiological culture of intraoperative tissue samples from the 30 patients with a clinical diagnosis of aseptic loosening are shown in Table 1. Nineteen (63%) generated sterile cultures while 11 (37%) yielded microorganisms from their intraoperative samples. Of the 11 patients yielding positive cultures, nine (82%) yielded only one positive culture from six intraoperative samples. The remaining two (18%) patients yielded three or more positive samples out of six intraoperative samples, all of which grew heavily mixed microorganisms. As initial criteria to confirm infection were based on the criteria of Atkins et al.,5 these mixed positive culture results were regarded as sample contamination and therefore non-significant. All 11 patients with positive microbiology were followed up for evidence of infection for a mean of 33 months. None re-presented with signs of infection. As they had undergone direct exchange revision surgery, this provides further evidence to support the correct classification as aseptic loosening. This cohort of patients was then investigated further for serum levels of PCT, IL-6, sICAM-1.

Patients with septic loosening

Sixteen patients with a clinical diagnosis of septic loosening based on presurgical patient assessment yielded identical microorganisms (based on phenotypic characteristics) from two or more samples (Table 2). Further evaluation of these patients for serum levels of PCT, IL-6, sICAM-1 was undertaken.

Presurgical results of CRP and ESR, and WBC

Presurgical results for CRP, ESR and WBC are shown in Table 3. There was a significant difference in levels of CRP (P<0.0001), ESR (P<0.0001) and WBC (P=0.03) between patients with septic and aseptic loosening.

Serum levels of PCT, IL-6, sICAM-1 and IgG to sce-LTA

Serum levels of PCT, IL-6, sICAM-1 and IgG to sce-LTA in patients with septic loosening are given in Table 2.

Procalcitonin

All patients with aseptic loosening had non-detectable serum levels of PCT (<0.5 ng/mL). Fifteen (94%) out of 16 patients with septic loosening had serum levels <0.5 ng/mL. One patient who yielded a pure culture of Proteus mirabilis from all six intraoperative samples had an elevated serum level >2.0 ng/mL. Based on these results, the diagnostic parameters of PCT as a serum marker for diagnosis of septic loosening were not determined.

Interleukin-6

The median serum concentration of IL-6 in patients with aseptic loosening was 2 pg/mL (range: 0-114), while the median in those patients with septic loosening was 24 pg/mL (range: 5-288). There was a significantly higher serum IL-6 concentration in patients with septic loosening of the hip prosthesis (P=0.0001).

Soluble intercellular adhesion molecule-1

The median serum sICAM-1 concentration in patients with aseptic loosening was 180 ng/mL (range: 104-434), while the median in those patients with septic loosening was 330 ng/mL (range: 136-1050). There was a significantly higher serum sICAM-1 concentration in patients with septic loosening of the hip prosthesis (P=0.0002).

Diagnostic parameters of CRP, ESR, IL-6 and sICAM-1

The sensitivity, specificity, PPV, NPV and accuracy of CRP, ESR, IL-6 and sICAM-1 for the diagnosis of septic loosening are shown in Table 4. Cut-off values of 9 pg/mL and 250 ng/mL for IL-6 and sICAM-1, respectively, demonstrate the optimum sensitivity and specificity. Nineteen (63%) out of 30 patients with aseptic loosening had serum levels of IL-6 and sICAM-1 below the optimum cut-off points, while 13 (81%) out of 16 patients with septic loosening had elevated serum levels of IL-6 and sICAM-1.

IgG to sce-LTA

No patient with aseptic loosening of their hip prosthesis had a detectable serum IgG to sce-LTA level. No patient with septic loosening caused by microorganisms other than CNS recovered from intraoperative samples had an elevated serum IgG to sce-LTA level. No patients with up to two positive intraoperative samples yielding identical strains of CNS had an elevated serum IgG to sce-LTA level. Four (25%) patients with septic loosening of their hip prosthesis yielded identical strains of CNS from three or more intraoperative samples and three (75%) of these patients had elevated serum IgG to sce-LTA levels (mean: 4250 EIU; range: 4000-6800). One patient had a pure culture of CNS recovered from three out of six intraoperative tissue samples, while single strains of CNS were recovered from five out of six samples from the remaining two patients.

Discussion

Accurate distinction between septic and aseptic loosening of joint prostheses is complex but important as the revision plan and patient management differs in each case.12 Routine tests currently used to facilitate the diagnosis are nonspecific and lack sensitivity. Furthermore, confirmatory microbiological culture of intraoperative tissue samples frequently yields positive results that are difficult to interpret. In a search for additional predictors of septic loosening to support current diagnostic methods, this study investigated the potential serum markers PCT, IL-6, sICAM-1 and IgG to sce-LTA in patients with well-defined septic or aseptic loosening.25

Procalcitonin is a 13 kDa polypeptide that has frequently been reported to facilitate the diagnosis of systemic bacterial infection."18 In the present study, serum PCT did not discriminate between infectious and non-infectious causes of prosthetic hip loosening. Serum PCT concentrations in healthy individuals are reported to be <0.1 ng/mL, with little or no rise in patients with viral or localised infections, or infections without systemic manifestation.18 Indeed, the most potent stimulus for PCT induction is systemic bacterial infection.19 Previous studies have reported serum PCT levels to be elevated in the range 6-53 ng/mL in patients with severe systemic infection,18 0.5-5240 ng/mL in patients with severe sepsis20 and 0.3-1.5 ng/mL in patients with localised infection.18 The low serum PCT levels detected in the study patients reported here are therefore not entirely surprising and do not rule out a localised infection.

It is well accepted that pathogen-associated molecular patterns (PAMPs), including LTA and sce-LTA, induce the immune and inflammatory response by binding to specific cellular receptors.21 Serum levels of the inflammatory markers IL-6 and sICAM-1 in the study patients with septic loosening were significantly raised, suggesting that these serum markers may offer a useful adjunct to current tests, and provide supporting clinical information to facilitate a diagnosis. Furthermore, the diagnostic parameters of IL-6 and sICAM-1 compared favourably with other markers currently used to discriminate septic and aseptic loosening.

Interleukin-6 is considered to be one of the three major pro-inflammatory cytokines produced during inflammation; however, it is not a specific marker for bacterial infection as levels are often elevated after physical trauma.1822 While the normal range of serum IL-6 in adults is 0.2-4.5 pg/mL, cutoff ranges vary considerably between studies.9,23,24 Applying a cut-off level of 9 pg/mL in this study yielded sensitivity, specificity, PPV, NPV and accuracy of 81%, 77%, 65%, 50% and 78%, respectively. In a recent study undertaken by Di Cesare et al." elevated serum IL-6 levels correlated positively with periprosthetic infection, generating diagnostic sensitivity and specificity of 100% and 95%, respectively. These results support the current findings and further advocate the use of serum IL-6 as a potential diagnostic marker of periprosthetic infection.

Intercellular adhesion molecule-1 is an integral membrane protein that is critical for leucocyte extravasation into inflamed tissue, the level of which is up-regulated during inflammation by a variety of cytokines. In bone, ICAM-I is expressed at the surface of the osetoblasts.25 Interestingly, sICAM-1, which is present in serum, cerebrospinal fluid and bronchoalveolar lavage, and arises from cleavage of ICAM-I, has been relatively understudied as a predictor of infection compared with many inflammatory markers. The results presented here demonstrate that sICAM-1 level is significantly raised in patients with septic loosening of their prosthetic hip compared to those with mechanical loosening. Soluble ICAM-I, if used in addition to, and in combination with, IL-6 may therefore serve as a valuable serological marker to discriminate septic and aseptic loosening of prosthetic joints. Applying a cut-off figure of 250 ng/mL, sensitivity, specificity, PPV, NPV and accuracy of 94%, 74%, 65%, 65% and 80%, respectively, were achieved.

Microorganisms most commonly associated with septic loosening of prosthetic joints are CNS, in particular Staphylococcus epidermidis, and account for approximately half of the cases.2 Serum markers which not only predict infection but give an indication to this aetiological agent may therefore facilitate both diagnosis and potentially influence patient management. Serum IgG antibody to sce-LTA has been shown to be of diagnostic value in patients with infections due to CNS including prosthetic joint infection.121415 Surprisingly, in this study only four (25%) patients had septic loosening due to CNS, which limited the analysis of the value of sce-LTA in predicting septic loosening due to these microorganisms. However, of these four patients with well-defined septic loosening due to CNS (i.e., recovered from three or more intraoperative samples5) three (75%) had elevated serum IgG to sce-LTA levels (Table 2) and supports previous findings.12

Based on the results of this study, serum levels of IL-6, sICAM-1 and sce-LTA may predict infection in patients with prosthetic hip loosening and provide useful adjuncts to current diagnostic markers. As a serum sample for CRp ESR and WBC is obtained routinely from patients as a part of presurgical assessment, serum levels of IL-6, sICAM-1 and IgG to sce-LTA could also be established at this stage of patient management, providing supporting diagnostic clinical information. Prospective studies of larger patient populations are required to assess further the clinical value of these serum markers, and perhaps additional serum markers, in aiding the diagnosis of septic loosening of prosthetic hips.

[Reference]

References

1 Trampuz A, Osmon DR, Hanssen AD, Steckelberg JM, Patel R. Molecular and antibiofilm approaches to prosthetic joint infection. Clin Orthop Relat Res 2003; 414: 69-88.

2 Trampuz A, Zimmerli W. Prosthetic joint infections: update in diagnosis and treatment. Swiss Med Wkly 2005; 135: 243-51.

3 Trampuz A, Piper KE, Hanssen AD et al. Sonication of explanted prosthetic components in bags for diagnosis of prosthetic joint infection is associated with risk of contamination. J Clin Microbiol 2006; 44: 628-31.

4 Tunney MM, Patrick S, Gorman SP et al. Improved detection of infection in hip replacements. A currently underestimated problem. J Bone Joint Surg Br 1998; 80 (4): 568-72.

5 Atkins BL, Athanasou N, Deeks JJ et al. Prospective evaluation of criteria for microbiological diagnosis of prosthetic joint infection at revision arthroplasty. The OSIRIS Collaborative Study Group. J Clin Microbiol 1998; 10: 2932-9.

6 Pihusch M, Pihusch R, Fraunberger P et al. Evaluation of C-reactive protein, interleukin-6 and procalcitonin levels in allogenic hematopoietic stem cell recipients. Eur J Haematol 2006; 76: 93-101.

7 Butbul-Aviel, Koren A, Halevy R, Sakran W. Procalcitonin as a diagnostic aid in osteomyelitis and septic arthritis. Pediatr Emerg Care 2005; 21: 828-32.

8 Clec'h C, Fosse JP Karoubi P et al. Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock. Crit Care Med 2006; 34: 102-7.

9 Magudumana MO, Ballot DE, Cooper PA et al. Serial interleukin 6 measurements in the early diagnosis of neonatal sepsis. J Trop Pediatr 2000; 46: 267-71.

10 Dollner H, Vatten L, Austgulen R. Early diagnostic markers for neonatal sepsis: comparing C-reactive protein, interleukin-6, soluble rumour necrosis factor receptors and soluble adhesion molecules. J Clin Epidemiol 2001; 54: 1251-7.

11 Di Cesare PE, Chang E, Preston CF, Liu CJ. Serum interleukin-6 as a marker of periprosthetic infection following total hip and knee arthroplasty. ] Bone Joint Surg Am 2005; 87: 1921-7.

12 Rafiq M, Worthington T, Tebbs SE et al. Serological detection of Gram-positive bacterial infection around prostheses. J Bone Joint Surg Br 2000; 82 (8): 1156-61.

13 Lambert PA, Worthington T, Tebbs SE, Elliott TS. Lipid S, a novel Staphylococcus epidermidis exocellular antigen with potential for the serodiagnosis of infections. FEMS Immunol Med Microbiol 2000; 29 (3): 195-202.

14 Elliott T, Worthington T, Lambert E Antibody response to staphylococcal slime and lipoteichoic acid. Lancet 2002; 360 (9349): 1977.

15 Worthington T, Lambert FA, Traube A, Elliott TSA. Rapid ELISA for the diagnosis of intravascular catheter-related sepsis caused by coagulase-negative staphylococci. J Clin Pathol 2002; 55 (1): 41-3.

16 Elliott TS, Tebbs SE, Moss HA, Worthington T, Spare MK, Faroqui MH, Lambert PAA. Novel serological test for the diagnosis of central venous catheter-associated sepsis. J Infect 2000; 40 (3): 262-6.

17 Andrews JM. BSAC standardised disc susceptibility testing method. J Antimicrob Chemother 2005; 56: 60-76.

18 Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993; 341: 515-8.

19 Dandona P, Nix D, Wilson MF et al. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab 1994; 79: 1605-8.

20 Gramm H-J, Dollinger P, Beier W. Procalcitonin - a new marker of host inflammatory response. Longitudinal studies in patients with sepsis and peritonitis. Chir Gastroenterol 1995; 11: 51-4.

21 Jones KJ, Perris AD, Vernallis AB, Worthington T, Lambert PA, Elliott TSJ. Induction of inflammatory cytokines and nitric oxide in J774.2 cells and murine macrophages by lipoteichoic acid and related cell wall antigens from Staphylococcus epidermidis. J Med Microbiol 2005; 54: 315-21.

22 Selburg O, Hecker H, Martin M, Klos A, Bautsch W, Kohl J. Discrimination of sepsis and systemic inflammatory response syndrome by determination of circulating plasma concentrations of procalcitonin, protein complement 3a and interleukin 6. Crii Care Med 2000; 28: 2793-8.

23 Nomura S, Kagawa H, Ozaki Y, Nagahama M, Yoshimura C, Fukuhara S. Relationship between platelet activation and cytokines in systemic inflammatory response syndrome patients with haematological malignancies. Thromb Res 1999; 95: 205-13.

24 Dollner H, Vatten L, Austgulen R. Early diagnostic markers for neonatal sepsis. Comparing C-reactive protein, interleukin-6, soluble tumour necrosis factor receptors and soluble adhesion molecules. J Clin Epidemiol 2001; 12: 1251-7.

25 Lavigne P, Benderdour M, Shi Q, Lajeunesse D, Fernandes JC. Involvement of ICAM-I in bone metabolism: a potential target in the treatment of bone diseases? Expert Opin Biol Ther 2005; 5: 313-20.

[Author Affiliation]

T. WORTHlNGTON*, D. DUNLOP[double dagger], A. CASEY[dagger], P. LAMBERT*, J. LUSCOMBE[double dagger] and T. ELLIOTT[dagger]

* School of Life and Health Sciences, Aston University; [dagger] Clinical Microbiology and Infection Control, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston; and [double dagger] Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK

Accepted: 2 March 2010

[Author Affiliation]

Correspondence to: Tony Worthington

Email: t.worthington@aston.ac.uk

Ted Turner gives $80M to UN fund for Nigeria work

ABUJA, Nigeria (AP) — Media mogul Ted Turner has announced that he will give $80 million to the United Nations to fight childhood polio and measles in the West African nation.

Speaking in Nigeria's capital, Abuja, on Monday night, Turner said his contribution will "finish the job on polio" in the nation of 150 million people.

Roughly $60 million of his donation will go toward buying polio vaccines, while the remaining $20 million will go toward fighting measles.

Turner's donation will be handled by the United Nations Foundation.

A billionaire philanthropist, Turner founded CNN in 1980.

Organization offers seminar on youth smoking prevention

Adults interested in helping youth stop smoking are invited to afree, one-day training Sept. 24 in Dunbar.

The American Lung Association of West Virginia will sponsor theNot-On-Tobacco (N-O-T) program, developed for the American LungAssociation at the West Virginia University Prevention ResearchCenter.

Of the teens who participate in the program, 22 percent are smoke-free six months later, results show. The program has four objectives -to help teens stop smoking, to reduce the number of cigarettes theysmoke, to increase a healthful lifestyle and to improve lifemanagement skills.

For more information or to register, call program manager TonyRichards at 342-6600 or e-mail tony@alawv.org.

World Bank president starts Africa tour

World Bank President Robert Zoellick began a weeklong tour of Africa Sunday with a visit to Mauritania, where international donors want to encourage equitable growth in one of the continent's newest oil producers.

The desert nation of 3 million on the edge of the Sahara desert in northwest Africa held elections last year that cemented a transition to democratic rule after a military junta overthrew a widely unpopular dictator. Oil was discovered here in 2006, boosting growth from around 5 percent to 11 percent, the World Bank said.

Zoellick's trip is aimed at "providing a more tailored level of support to the country's development priorities," the bank said in a statement, adding that donors were exploring "solutions for more inclusive and equitable growth that provides adequate access to basic services and opportunities for the poor."

Residents of some oil-rich nations in Africa _ Nigeria is a prime example _ have remained deeply poor despite their oil wealth, often because of corruption and mismanagement.

Zoellick will travel Tuesday to Liberia, and then Ethiopia for the upcoming African Union summit before ending his trip Feb. 4 in Mozambique.

In Mauritania, Zoellick will meet President Sidi Ould Cheikh Abdallahi as well as the prime minister and members of Parliament.

Oil prices soar after Energy Department report

Oil prices soared Wednesday as the dollar fell and the Energy Department issued a mixed report on the nation's fuel inventories. At the pump, gas prices rose to a new record over $4.05 a gallon.

The department's Energy Information Administration said oil inventories fell more than expected last week, and that gave oil a kick upward. But prices eased back to their pre-report levels as traders read further into the EIA's release and found that supplies of fuel such as gasoline and heating oil rose and demand fell.

Light, sweet crude spiked up nearly $5.50 to $136.80 a barrel soon after the report's release, then retreated to trade up $3.06 at $134.37 a barrel on the New York Mercantile Exchange.

The dollar's travails again sent oil prices rising. The euro bought $1.5539, up from $1.5449 Tuesday. Oil prices have closely tracked dollar moves; prices rose sharply last week when the dollar fell, then retreated more than $7 earlier this week as the dollar gained ground.

"It's been hand in hand with what the dollar's been doing," said James Cordier, president of Tampa, Fla.-based trading firms Liberty Trading Group and OptionSellers.com.

Many investors buy commodities such as oil as a hedge against inflation when the dollar falls. Also, a weaker greenback makes oil less expensive to investors dealing in other currencies. Many analysts believe the dollar's protracted decline is the primary reason oil prices have doubled over the past year.

The EIA said oil inventories fell by 4.6 million barrels last week. Analysts surveyed by energy research firm Platts expected a much smaller decline of about 1.4 million barrels.

But other elements of the report were considered bearish for prices, and pulled oil off its earlier highs. Supplies of gasoline and distillate fuels such as diesel and heating oil both rose last week, and demand for gasoline fell by 1.3 percent.

Retail gas prices, meanwhile, rose to another record Wednesday, rising 0.9 cent overnight to a national average of $4.052, according to a survey of stations by AAA and the Oil Price Information Service. Prices continue rising, despite falling demand, because the price of oil keeps moving higher.

While oil prices have slipped some from last week's trading record of $139.12 a barrel, analysts say gas prices still have some catching up to do, and could rise another nickel or so. Of course, if oil futures blast past that record and reach new highs, gas prices will likely rise even higher.

Also supporting oil prices Wednesday was Royal Dutch Shell PLC's decision to extend force majeure on some Nigerian oil shipments, a legal declaration that means the company can't meet contractual obligations to supply some customers. The company first made the declaration following a militant attack in April.

Alexander to target housing

Labour leader-elect Wendy Alexander has said affordable housingis an area where her party must find more solutions.

Questions on this had featured largely in her "listening andlearning" campaign around Scotland, prior to her formal adoption asleader on September 14.

Asked if she had encountered any surprises in the tour, she said:"The significance of the housing issue.

"You can't miss that - it's about affordable home ownership.

"We need to think much more deeply about solutions to that."

Ms Alexander was speaking before the latest appearance at theircampaign tour in Glasgow.

Lawmaker: Withhold US money to force UN changes

WASHINGTON (AP) — The U.S. ambassador to the United Nations on Thursday rejected House Republican demands to withhold American dollars from the world body to force changes, arguing such a move would undermine U.S. interests.

Testifying to Congress for a second straight day, Susan Rice faced tough questions from lawmakers frustrated with the United Nations' spending practices, attempts at reform and criticism of Israel by its Human Rights Council.

Rep. Ileana Ros-Lehtinen, the Republican chairwoman of the House Foreign Affairs Committee, insisted that the only solution was for the United States to withhold its payments. Ros-Lehtinen also plans to introduce legislation next week that would make U.S. payments voluntary.

"Almost every productive U.S. effort at reforming the U.N. has been based on withholding our contributions unless and until needed reforms are implemented," the lawmaker said, citing a similar move in the 1990s under legislation sponsored by two senators.

Rice said Republican and Democratic administrations have found such a practice does not work.

"It is counter to our interests to use withholding of dues as a means of trying to obtain our policy objectives," Rice said. "It's counterproductive and the record shows it."

Across the Capitol, U.N. Secretary-General Ban Ki-moon said the world body is doing what it can to reduce its budget and said he has instructed his senior advisers to come with a 3 percent cut.

At the same time, "We need to have robust financial support from the United States," he said after meeting with the top members of the Senate Foreign Relations Committee.

The U.S. is the largest single contributor to the U.N., responsible for 22 percent of the U.N.'s regular budget and 27 percent of the money for peacekeeping operations.

The Obama administration is seeking $3.54 billion for the United Nations and other international agencies, and peacekeeping efforts in the fiscal year beginning Oct. 1.

Several Republicans on the committee echoed Ros-Lehtinen's complaints and said a nation facing a $1.6 trillion deficit cannot afford to spend on the United Nations.

Rep. Dana Rohrbacher, a Republican, offered a fresh argument.

"The United Nations is being used as a vehicle to see how global government would function," he said. "If there's anything that would convince us we should not be moving toward global government, it is the folly of the United Nations."

That drew a quick retort from Democratic Rep. Gerry Connolly, who called Rohrbacher's comments "rehashed right-wing claptrap."

Democrats on the panel argued that withholding funds would diminish the U.S. leverage. The committee's top Democrat, Rep. Howard Berman, pointed out that when the U.S. withheld funds in the 1990s, the United States lost its seat on a critical U.N. budget panel.

He said such a step " would severely hinder our ability to pursue U.S. foreign policy and national security interests, support our allies and achieve the reforms" that both Republicans and Democrats seek.

____

Associated Press writer Desmond Butler contributed to this report.

News in Brief

KENDALL COUNTY

PLANO MAN KILLED BY COPS AFTER HIT-RUN

A Plano man was was shot to death by police Friday night after fleeing a hit-and-run crash, firing shots at police and stealing and crashing a squad car, according to the Kendall County Sheriff's Office.

The incident began at 8:38 p.m. in unincorporated Kendall County, when Bjorn S. Roland, 40, fled the scene of a hit-and-run crash on foot, authorities said.

They said Roland fired a handgun at a deputy who was searching for him.

When the deputy got out of his car to take cover, Roland stole the squad car, drove away and struck a Plano Police squad car, authorities said.

Roland fled again, but then he got out of the squad car and threatened officers at the scene, the sheriff's office said. Police then shot and killed Roland.

Illinois State Police were investigating.

KENDALL COUNTY

NEWARK MAN DIES IN SCUFFLE

A man who set his truck on fire at a car show and then went back into the burning truck to grab a knife and use it to attack a man was killed after suffering head injuries while being subdued by witnesses, the Kendall County Sheriff's Office said.

Witnesses told sheriff's police that Ricke Lewis Van Riper, 55, arrived at the car show in Newark, about 60 miles southwest of Chicago, and began arguing with his estranged wife.

Van Riper then poured gasoline on his own truck and set it on fire, the sheriff's office said.

Van Riper then entered the burning truck to get several knives, which he threw at a man, and then he attacked him, witnesses told police.

Other people at the car show subdued Van Riper, but he suffered head injuries and died, authorities said.

An autopsy is scheduled for today.

Phillips Interviews for Cowboys Job

IRVING, Texas - San Diego defensive coordinator Wade Phillips interviewed Friday with the Dallas Cowboys about replacing retired head coach Bill Parcells.

Phillips, the former head coach at Denver and Buffalo who also had interim stints in New Orleans and Atlanta, said he had a "very encompassing talk" with Cowboys owner and general manager Jerry Jones. Phillips has a 48-39 coaching record.

"I'm going to go on my record," Phillips said. "I've won as a head coach, been in the playoffs three out of the five years I've been a head coach. ... I have a lot of experience; I've been 30 years in the league, 25 as either a head coach or coordinator."

Jones also plans to talk to San Francisco offensive coordinator Norv Turner, a former head coach for Washington and Oakland, and New Orleans defensive coordinator Gary Gibbs. Both are former Dallas assistants.

Gibbs was scheduled to interview Saturday. Turner is coaching at the Senior Bowl on Saturday, and is expected to interview Sunday.

While Phillips didn't get a timetable from Jones about when a decision would be made, Phillips doesn't expect it to be a long time.

"I don't think it will be a long drawn out process," Phillips said. "That's what I've been told."

Phillips has been with the Chargers for three seasons. He was 16-17 with one playoff loss as head coach in Denver (1993-94), and 29-21 with two playoff losses in Buffalo (1998-2000).

On Thursday, the Cowboys added Jason Garrett to their coaching staff in an unspecified role, but said he would remain a candidate for the head coaching job.

The team said Garrett's responsibilities and title wouldn't be determined until Parcells' replacement was hired, but he's expected to be offensive coordinator if he's not head coach.

Garrett, the backup to Hall of Fame quarterback Troy Aikman for two Super Bowl titles in Dallas from 1993-99, was quarterbacks coach in Miami the last two seasons - his only coaching experience.

Phillips said he met with Garrett and Parcells while at Valley Ranch.

"I know Jason," Phillips said. "I think he's a bright young mind that's going to do well in this league. He's one of those rising stars."

Jones interviewed three of Parcells' assistant coaches Tuesday: assistant head coach Tony Sparano, receivers coach Todd Haley and secondary coach Todd Bowles, who is a minority coach. Haley became the Arizona Cardinals' offensive coordinator Thursday.

Parcells retired Monday after going 34-32 with two playoff losses in four seasons with the Cowboys, ending a 19-season career that included two Super Bowl titles with the New York Giants.

Turner was the Cowboys' offensive coordinator and quarterbacks coach from 1991-93, when they won consecutive Super Bowls with Aikman, Emmitt Smith and Michael Irvin. Turner had a 58-82-1 record as head coach in Washington (1994-00) and Oakland (2004-05).

Gibbs was head coach at Oklahoma for six seasons after replacing Barry Switzer in 1989. When Sean Payton left Parcells' staff to become New Orleans' head coach last year, he took Gibbs with him to run the defense.