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From: [email protected] (David Dodell)
Subject: HICN610 Medical News Part 3/4
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University of Arizona
Tucson, Arizona
Suggested Reading
Tan SL, Royston P, Campbell S, Jacobs HS, Betts J, Mason B, Edwards RG (1992).
Cumulative conception and Livebirth rates after in-vitro fertilization. Lancet
339:1390-1394.
For further information, call:
Physicians' Resource Line
1-800-328-5868
in Tucson:
694-5868
HICNet Medical Newsletter Page 28
Volume 6, Number 10 April 20, 1993
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Articles
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
LOW LEVELS OF AIRBORNE PARTICLES LINKED
TO SERIOUS ASTHMA ATTACKS
American Lung Association
A new study published by the American Lung Association has shown that
surprisingly low concentrations of airborne particles can send people with
asthma rushing to emergency rooms for treatment.
The Seattle-based study showed that roughly one in eight emergency visits
for asthma in that city was linked to exposure to particulate air pollution.
The actual exposure levels recorded in the study were far below those deemed
unsafe under federal air quality laws.
"People with asthma have inflamed airways, and airborne particles tend to
exacerbate that inflammation," said Joel Schwartz, Ph.D., of the Environmental
Protection Agency, who was the lead author of the study. "When people are on
the threshold of having, a serious asthma attack, particles can push them over
the edge."
The Seattle Study correlated 13 months of asthma emergency room visits
with daily levels of PM,,,. or particulate matter with an aerodynamic diameter
of 10 microns or less. These finer particles are considered hazardous because
they are small enough penetrate into the lung. Cities are considered out of
compliance with clean air laws if the 24-hour average concentration of PM10
exceeds 150 micrograms per cubic millimeter of air.
In Seattle however, a link between fine particles and asthma was found at
levels as low as 30 micrograms. The authors concluded that for every 30
microgram increase in the four-day average of PM10, the odds of someone with
asthma needing emergency treatment increased by 12 percent.
The findings were published in the April American Review of Respiratory
Disease, an official journal of the American Thoracic Society, the Lung
Association's medical section.
The study is the latest in a series of recent reports to suggest that
particulate matter is a greatly under appreciated health threat. A 1992 study
by Dr. Schwartz and Douglas Dockery, Ph.D., of Harvard found that particles
may be causing roughly 60,000 premature deaths each year in the United States.
Other studies have linked particulate matter to increased respiratory symptoms
and bronchitis in children.
"Government officials and the media are still very focused on ozone,"
says Dr. Schwartz. "But more and more research is showing that particles are
bad actors as well." One problem in setting, standards for particulate
air pollution is that PMIO is difficult to study. Unlike other regulated
pollutants such as ozone and carbon monoxide, particulate matter is a complex
and varying mixture of substances, including carbon, hydrocarbons, dust, and
HICNet Medical Newsletter Page 29
Volume 6, Number 10 April 20, 1993
acid aerosols.
"Researchers can't Put people in exposure chambers to study the effects
of particulate air pollution," says Dr. Schwartz. "We have no way of
duplicating the typical urban mix of particles. " Consequently, most of what
is known about particulates has been learned through population-based research
like the Seattle study.
Given that the EPA's current priority is to review the ozone and sulfur
dioxide standards, the agency is unlikely to reexamine the PM10 standard any
time soon. Until changes are made, there appears to be little people with
asthma can do to protect themselves from airborne particles.
"In some areas, you can get reports on air quality, but the reports only
cover the pollutant that is closest to violating its standard, and that's
rarely particulate matter," says Dr. Schwartz. "However, PM10 doesn't have
to be near its violation range to be unhealthy."
HICNet Medical Newsletter Page 30
Volume 6, Number 10 April 20, 1993
NIH Consensus Development Conference on Melanoma
The National Institutes of Health Consensus Development Conference on
Diagnosis and Treatment of Early Melanoma brought together experts in
dermatology, pathology, epidemiology, public education, surveillance
techniques, and potential new technologies as well as other health care
professionals and the public to address (1) the clinical and histological
characteristics of early melanoma; (2) the appropriate diagnosis, management,
and followup of patients with early melanoma; (3) the role of dysplastic nevi
and their significance; and (4) the role of education and screening in
preventing melanoma morbidity and mortality. Following 2 days of
presentations by experts and discussion by the audience, a consensus panel
weighed the scientific evidence and prepared their consensus statement.
Among their findings, the panel recommended that (1) melanoma in situ is a
distinct entity effectively treated surgically with 0.5 centimeter margins;
(2) thin invasive melanoma, less than 1 millimeter thick, has the potential
for long-term survival in more than 90 percent of patients after surgical
excision with a 1 centimeter margin; (3) elective lymph node dissections and
extensive staging evaluations are not recommended in early melanoma; (4)
patients with early melanoma are at low risk for relapse but may be at high
risk for development of subsequent melanomas and should be followed closely;
(5) some family members of patients with melanoma are at increased risk for
melanoma and should be enrolled in surveillance programs; and (6) education
and screening programs have the potential to decrease morbidity and mortality
from melanoma.
A copy of the full text of the consensus panel's statement is available by
calling the NIH Office of Medical Applications of Research at (301) 496-1143
or by writing to: Office of Medical Applications of Research, National
Institutes of Health, Federal Building, Room 618, Bethesda, MD 20892.
HICNet Medical Newsletter Page 31
Volume 6, Number 10 April 20, 1993
NCI-Designated Cancer Centers
The Cancer Centers Program is comprised of 55 NCI-designated Cancer Centers
actively engaged in multidisciplinary research efforts to reduce cancer
incidence, morbidity, and mortality. Within the program, there are four types
of cancer centers: basic science cancer centers (14), which engage primarily
in basic cancer research; clinical cancer centers (12), which focus on
clinical research; "comprehensive" cancer centers (28), which emphasize a
multidisciplinary approach to cancer research, patient care, and community
outreach; and consortium cancer centers (1), which specialize in cancer
prevention and control research.
Although some cancer centers existed in the late 1960s and the 1970s, it was
the National Cancer Act of 1971 that authorized the establishment of 15 new
cancer centers, as well as continuing support for existing ones. The passage
of the act also dramatically transformed the centers' structure and broadened
the scope of their mission to include all aspects of basic, clinical, and
cancer control research. Over the next two decades, the centers' program grew
progressively.
In 1990, there were 19 comprehensive cancer centers in the nation. Today,
there are 28 of these institutions, all of which meet specific NCI criteria
for comprehensive status.
To attain recognition from the NCI as a comprehensive cancer center, an
institution must pass rigorous peer review. Under guidelines newly
established in 1990, the eight criteria for "comprehensiveness" include the
requirement that a center have a strong core of basic laboratory research in
several scientific fields, such as biology and molecular genetics, a strong
program of clinical research, and an ability to transfer research findings
into clinical practice.
Moreover, five of the criteria for comprehensive status go significantly
beyond that required for attaining a Cancer Center Support Grant (also
referred to as a P30 or core grant), the mechanism of choice for supporting
the infrastructure of a cancer center's operations. These criteria encompass
strong participation in NCI-designated high-priority clinical trials,
significant levels of cancer prevention and control research, and important
outreach and educational activities--all of which are funded by a variety of
sources.
The other types of cancer centers also have special characteristics and
capabilities for organizing new programs of research that can exploit
important new findings or address timely research questions.
HICNet Medical Newsletter Page 32
Volume 6, Number 10 April 20, 1993
Of the 55 NCI-designated Cancer Centers, 14 are of the basic science type.
These centers engage almost entirely in basic research, although some centers
engage in collaborative research with outside clinical research investigators
and in cooperative projects with industry to generate medical applications
from new discoveries in the laboratory.
Clinical cancer centers, in contrast, focus on both basic research and
clinical research within the same institutional framework, and frequently
incorporate nearby affiliated clinical research institutions into their
overall research programs. There are 12 such centers today.
Finally, consortium cancer centers, of which there is one, are uniquely
structured and concentrate on clinical research and cancer prevention and
control research. These centers interface with state and local public health
departments for the purpose of achieving the transfer of effective prevention
and control techniques from their research findings to those institutions
responsible for implementing population-wide public health programs.
Consortium centers also are heavily engaged in collaborations with
institutions that conduct clinical trial research and coordinate community
hospitals within a network of cooperating institutions in clinical trials.
Together, the 55 NCI-Designated Cancer Centers continue to work toward
creating new and innovative approaches to cancer research, and through
interdisciplinary efforts, to effectively move this research from the
laboratory into clinical trials and into clinical practice.
Comprehensive Cancer Centers (Internet addresses are given where available)
University of Alabama at Birmingham Comprehensive Cancer Center
Basic Health Sciences Building, Room 108
1918 University Boulevard
Birmingham, Alabama 35294
(205) 934-6612
University of Arizona Cancer Center
1501 North Campbell Avenue
Tucson, Arizona 85724
(602) 626-6372
Internet: [email protected]
Jonsson Comprehensive Cancer Center
University of California at Los Angeles
200 Medical Plaza
Los Angeles, California 90027
(213) 206-0278
HICNet Medical Newsletter Page 33
Volume 6, Number 10 April 20, 1993
Internet: [email protected]
Kenneth T. Norris Jr. Comprehensive Cancer Center
University of Southern California
1441 Eastlake Avenue
Los Angeles, California 90033-0804
(213) 226-2370
Yale University Comprehensive Cancer Center
333 Cedar Street
New Haven, Connecticut 06510
(203) 785-6338
Lombardi Cancer Research Center
Georgetown University Medical Center
3800 Reservoir Road, N.W.
Washington, D.C. 20007
(202) 687-2192
Sylvester Comprehensive Cancer Center
University of Miami Medical School
1475 Northwest 12th Avenue
Miami, Florida 33136
(305) 548-4800
Internet: [email protected]
Johns Hopkins Oncology Center
600 North Wolfe Street
Baltimore, Maryland 21205
(410) 955-8638
Dana-Farber Cancer Institute
44 Binney Street
Boston, Massachusetts 02115
(617) 732-3214
Internet: [email protected]
Meyer L. Prentis Comprehensive Cancer Center of Metropolitan
Detroit
110 East Warren Avenue
Detroit, Michigan 48201
(313) 745-4329
Internet: cummings%[email protected]
University of Michigan Cancer Center
HICNet Medical Newsletter Page 34
Volume 6, Number 10 April 20, 1993
101 Simpson Drive
Ann Arbor, Michigan 48109-0752
(313) 936-9583
BITNET: [email protected]
Mayo Comprehensive Cancer Center
200 First Street Southwest
Rochester, Minnesota 55905
(507) 284-3413
Norris Cotton Cancer Center
Dartmouth-Hitchcock Medical Center
One Medical Center Drive
Lebanon, New Hampshire 03756
(603) 646-5505
BITNET: [email protected]
Roswell Park Cancer Institute
Elm and Carlton Streets
Buffalo, New York 14263
(716) 845-4400
Columbia University Comprehensive Cancer Center
College of Physicians and Surgeons
630 West 168th Street
New York, New York 10032
(212) 305-6905
Internet: [email protected]
Memorial Sloan-Kettering Cancer Center
1275 York Avenue
New York, New York 10021
(800) 525-2225
Kaplan Cancer Center
New York University Medical Center
462 First Avenue
New York, New York 10016-9103
(212) 263-6485
UNC Lineberger Comprehensive Cancer Center
University of North Carolina School of Medicine
Chapel Hill, North Carolina 27599
(919) 966-4431
HICNet Medical Newsletter Page 35
Volume 6, Number 10 April 20, 1993
Duke Comprehensive Cancer Center
P.O. Box 3814
Durham, North Carolina 27710
(919) 286-5515
Cancer Center of Wake Forest University at the Bowman Gray School
of Medicine
300 South Hawthorne Road
Winston-Salem, North Carolina 27103
(919) 748-4354
Internet: [email protected]
Ohio State University Comprehensive Cancer Center
300 West 10th Avenue
Columbus, Ohio 43210
(614) 293-5485
Internet: [email protected]
Fox Chase Cancer Center
7701 Burholme Avenue
Philadelphia, Pennsylvania 19111
(215) 728-2570
Internet: [email protected]
University of Pennsylvania Cancer Center
3400 Spruce Street
Philadelphia, Pennsylvania 19104
(215) 662-6364
Pittsburgh Cancer Institute
200 Meyran Avenue
Pittsburgh, Pennsylvania 15213-2592
(800) 537-4063
The University of Texas M.D. Anderson Cancer Center
1515 Holcombe Boulevard
Houston, Texas 77030
(713) 792-3245
Vermont Cancer Center
University of Vermont
1 South Prospect Street
Burlington, Vermont 05401
(802) 656-4580
HICNet Medical Newsletter Page 36
Volume 6, Number 10 April 20, 1993
Fred Hutchinson Cancer Research Center
1124 Columbia Street
Seattle, Washington 98104
(206) 667-4675
Internet: [email protected]
University of Wisconsin Comprehensive Cancer Center
600 Highland Avenue
Madison, Wisconsin 53792
(608) 263-8600
BITNET: [email protected]
Clinical Cancer Centers
University of California at San Diego Cancer Center
225 Dickinson Street
San Diego, California 92103
(619) 543-6178
Internet: [email protected]
City of Hope National Medical Center
Beckman Research Institute
1500 East Duarte Road
Duarte, California 91010
(818) 359-8111 ext. 2292
University of Colorado Cancer Center
4200 East 9th Avenue, Box B188
Denver, Colorado 80262
(303) 270-7235
University of Chicago Cancer Research Center
5841 South Maryland Avenue, Box 444
Chicago, Illinois 60637
(312) 702-6180
Internet: [email protected]
Albert Einstein College of Medicine
1300 Morris Park Avenue
Bronx, New York 10461
(212) 920-4826
HICNet Medical Newsletter Page 37
Volume 6, Number 10 April 20, 1993
University of Rochester Cancer Center
601 Elmwood Avenue, Box 704
Rochester, New York 14642
(716) 275-4911
Internet: [email protected]
Ireland Cancer Center Case Western Reserve University
University Hospitals of Cleveland
2074 Abington Road
Cleveland, Ohio 44106
(216) 844-5432
Roger Williams Cancer Center
Brown University
825 Chalkstone Avenue
Providence, Rhode Island 02908
(401) 456-2071
St. Jude Children's Research Hospital
332 North Lauderdale Street
Memphis, Tennessee 38101-0318
(901) 522-0306
Internet: [email protected]
Institute for Cancer Research and Care
4450 Medical Drive
San Antonio, Texas 78229
(512) 616-5580
Utah Regional Cancer Center
University of Utah Health Sciences Center
50 North Medical Drive, Room 2C110
Salt Lake City, Utah 84132
(801) 581-4048
BITNET: [email protected]
Massey Cancer Center
Medical College of Virginia
Virginia Commonwealth University
1200 East Broad Street
Richmond, Virginia 23298
(804) 786-9641
Consortia
HICNet Medical Newsletter Page 38
Volume 6, Number 10 April 20, 1993
Drew-Meharry-Morehouse Consortium Cancer Center
1005 D.B. Todd Boulevard
Nashville, Tennessee 37208
(615) 327-6927
HICNet Medical Newsletter Page 39
Volume 6, Number 10 April 20, 1993
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General Announcments
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
THE UCI MEDICAL EDUCATION SOFTWARE REPOSITORY
This is to announce the establishment of an FTP site at the University of
California, for the collection of shareware, public-domain software and other
information relating to Medical Education.
Specifically, we are interested in establishing this site as a clearinghouse
for personally developed software that has been developed for local medical
education programs. We welcome all contributions that may be shared with
other users.
To connect to the UCI Medical Education Software Repository, ftp to:
FTP.UCI.EDU
The Repository currently offers both MSDOS and Macintosh software, and we hope
to support other operating systems (UNIX, MUMPS, AMIGA?).
Uploads are welcome. We actively solicit information and software which you
have personaly developed or have found useful in your local medical education
efforts, either as an instructor or student.
Once you have connected to the site via FTP, cd (change directory) to either
the med-ed/mac/incoming or the med-ed/msdos/incoming directories, change the
mode to binary and "send" or "put" your files. Note that you won't be able to
see the files with the "ls" or "dir" commands. Please compress your files as
appropriate to the operating system (ZIP for MSDOS; Compactor or something
similar for Macintosh) to save disk space.
After uploading, please send email to Steve Clancy ([email protected]) (for
MSDOS) or Albert Saisho ([email protected]) (for MAC) describing the file(s) you
have uploaded and any other information we might need to describe it.
Note that we can only accept software or information that has been designated
as shareware, public-domain or that may otherwise be distributed freely.
Please do not upload commercial software! Doing so may jeopardize the
existence of this FTP site.
If you wish to upload software for other operating systems, please contact
either Steve Clancy, M.L.S. or Albert Saisho, M.D. at the addresses above.
HICNet Medical Newsletter Page 40
Volume 6, Number 10 April 20, 1993
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AIDS News Summaries
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
AIDS Daily Summary
The Centers for Disease Control and Prevention (CDC) National AIDS
Clearinghouse makes available the following information as a public service
only. Providing this information does not constitute endorsement by the CDC,
the CDC Clearinghouse, or any other organization. Reproduction of this text
is encouraged; however, copies may not be sold. Copyright 1993, Information,
Inc., Bethesda, MD
==================================================================
April 12, 1993
==================================================================
"NIH Set to Test Multiple AIDS Vaccines" Reuters (04/08/93) (Frank,
Jacqueline)
Washington--The Clinton administration will permit the National
Institutes of Health to test multiple AIDS vaccines instead of only allowing
the Army to test a single vaccine, administration sources said Thursday. The
decision ends the controversy between Army AIDS researchers who had hoped to
test a vaccine made by MicroGeneSys Inc. and the National Institutes of
Health, which contended that multiple vaccines should be tested. Health and
Human Services Secretary Donna Shalala said a final announcement on the
therapeutic vaccine trials was expected to be made last Friday. Companies
including Genentech Inc., Chiron Corp., and Immuno AG have already told NIH
that they are prepared to participate in the vaccine tests. The testing is
intended to demonstrate whether AIDS vaccines are effective in thwarting the
replication of HIV in patients already infected. Shalala refuted last week's
reports that the Clinton administration had decided the Army's test of the
MicroGeneSys VaxSyn should proceed without tests of others at the same time.
"The report was inaccurate, and I expect there to be some announcement in the
next 24 hours about that particular AIDS research project," said Shalala.
Administration sources subsequently confirmed that NIH director Dr. Bernadine
Healy and Food and Drug Administration Commissioner David Kessler had
convinced the White House that multiple vaccines should be tested
simultaneously. But MicroGeneSys president Frank Volvovitz said a test of
multiple vaccines could triple the cost of the trial and delay it by two
years.
==================================================================
HICNet Medical Newsletter Page 41
Volume 6, Number 10 April 20, 1993
"The Limits of AZT's Impact on HIV" U.S. News & World Report (04/12/93) Vol.
114, No. 14, P. 18
AZT has become the most widely used drug to fight AIDS since it was
approved by the Food and Drug Administration in 1987. Burroughs Wellcome,
the manufacturer of AZT, made $338 million last year alone from sales of the
drug. However, a team of European researchers recently reported that
although HIV-positive patients taking AZT demonstrated a slightly lower risk
of developing AIDS within the first year of treatment, that benefit
disappeared two years later. The Lancet published preliminary findings of
the three-year study, which could give more reason for critics to argue the
drug's cost, side effects, and general efficacy. Even though U.S.
researchers concede the study was more comprehensive than American trials,
many argue the European researchers' suggestion that HIV-positive patients
experience little improvement in their illness before the development of
AIDS symptoms. In addition, researchers have long been familiar with the
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