> **Environmental Agents Service**
>
> **Conference Call, Eastern Time, 1:00 -- 1:50pm**
>
> **November 1, 2005**

**Donald Rosenblum**: Greetings from VA Central Office, Washington, DC.

Welcome to Environmental Agents Service (131) conference call. I am
Donald J. Rosenblum, Deputy Director, Environmental Agents Service or
EAS. With me today are Dr. Mark Brown, John Kraemer, and Michelle
Foster, all from the EAS, and Dr. Clare Mahan from the Environmental
Epidemiology Service (EES). As you may recall, Dr. Brown missed the last
call, and we are glad to have him back. Helen Malaskiewicz couldn't join
us as she is currently flying to Austin, TX for a security summit
meeting. Dr. Neil Otchin of our larger office (Public Health and
Environmental Hazards) is here to respond to any medical issues that may
be raised. In addition, Dr. Nikhil Munshi who is Chairing the Mupliple
Myeloma project will be joining us by telephone -- since he is in Boston
\--with a report on his work. Dr. Munshi informed me this morning that
his colleague Bruce Holmberg may also be joining us by telephone.

Our most recent quarterly conference call was held on August 2, 2005.
Today's call is the last call for calendar year. Officials in
Martinsburg have approved the same schedule of calls for calendar year
2006. Calls will again be conducted on the first Tuesday in February,
May, August and November. That is February 7, May 2, August 1, and
November 7, 2006. Each call will start at 1pm Eastern Time and last 50
minutes. Our access code will remain 15095. As usual, we have a series
of VACO and other presentations followed by an opportunity for listeners
to ask questions, make comments, etc. Once again, we request that you
hold any questions/comments until that part of the call. Please mute or
turn off the telephone speaker until you are asking a question or making
a comment. Thank you for your cooperation.

Now I will turn the microphone over to our Director, Dr. Mark Brown.

**MBrown**: **Conference Call Contest**

Let's begin with this EAS Conference Call Contest results.

If you recall from last time the contest question was "Name at least one
important environmental hazard for Operation Iraqi Freedom or Operation
Enduring Freedom that you can find information about at our web site
www.va.gov/EnvironAgents."

It should be obvious that we really would like everyone to take a look
at what's available on our web site.

We've put together a lot of basic information on environmental and other
health issues related to service in Iraq or Afghanistan, and we think
this information should be helpful in responding to health care needs of
combat veterans coming back from these deployments.

So, Don, do we have a winner this time?

**DRosenblum**

Yes, we do! The winner of the August 2005 EAS contest is Ms. Karen
Barnes from VAMC Cincinnati, OH, whose correct answer to the question
was selected at random by Tiffany Anzalone, our 2005 HACU summer intern.

**MBrown**

Congratulations, Karen! For winning Karen will receive a \$20 gift
certificate to the VA Canteen Service!

For today's EAS conference call contest (get out your pencils and
paper), the question is: "Name the four veteran newsletters we put out,
each focusing on a specific groups of veterans (naming the four groups
of veterans these newsletters are written for is also an acceptable
answer)."

And, if you think that you know the answer to this EAS conference call
contest question, send it to Don Rosenblum at <rosdon@hq.med.va.gov>.

We'll announce the winner on our next conference call, and the winner
will receive a \$20 gift certificate for the Veterans Canteen Service.

Please have your entries here within one week, and immediate past
winners not eligible.

And as always, we welcome your question and comments -- we realize that
you may be hearing about new issues and concerns from new OIF and OEF
veterans before anyone else, and we'd very much like to hear from you
about these issues!

Also, if you have any suggestions for future topics that we can cover in
future conference calls, please email them to me at
<mbrown1@hq.med.va.gov>, or to Don.

**MBrown** We have a lot of topics to cover today.

**Announcements and Commentary**

**No new Congressional activity this quarter.**

**IOM Agent Orange update and Gulf War report sent to VA Medical Center
libraries**.

**Khamisiyah Brain Cancer Study**. You may recall that on our previous
EAS Conference Call we talked about the recent scientific study that
reported an increased risk for brain cancer among US Army 1991 Gulf War
veterans who may have been exposed to low levels of chemical warfare
nerve agents during March 1991 weapons demolitions at Khamisiyah, Iraq.

Although researchers found no difference in overall death rates or
overall death rates from cancer, they did report that exposed veterans
were about twice as likely to have died from brain cancer when compared
to unexposed veterans. Specifically, they found 12 excess brain cancer
deaths among the 100,487 exposed veterans over a 9-year period.

I'd like to update that story today by telling you that the Department
of Defense has begun sending letters to the more than 100,000 veterans
of the 1991 Gulf War who were estimated to have been exposed to low
levels of sarin at Khamisiyah, informing them about the results of this
new study.

Although VA has no special authority to provide treatment for veterans
coming to VA in response to DoD's letter, veterans from the 1991 Gulf
War are eligible and may be offered a Gulf War Registry examination
without charge, available at any VA Medical Center.

The new Information Letter, along with a copy of DoD's letter and
accompanying fact sheet, are available at
[www.va.gov/EnvironAgents](http://www.va.gov/EnvironAgents).

**New Mortality Study on Veterans of the 1991 Gulf War**. Next, I'd like
to briefly describe an article that just appeared in the International
Journal of Epidemiology, with the title "Long-term mortality amongst
Gulf War Veterans: is there a relationship with experiences during
deployment and subsequent morbidity?"

The abstract for this publication is available on line at
http://ije.oxfordjournals.org/cgi/content/abstract/dyi205v1?ct

This study looked at mortality and causes of mortality among British
veterans 13 years after deployment to the 1991 Gulf War. They also
looked at the issue of excess non-disease-related deaths, that is, from
accidents, among these veterans. This is a problem seen after virtually
every deployment since World War II, where an initial spike in mortality
is seen from accidents in the first few years following the deployment.

Researchers also wanted to see if there was a relationship between any
experiences reported during or after the 1991 Gulf War, including
post-war reported symptoms, and later mortality experience.

Participants were 53,462 British Gulf War Veterans, who were compared to
non-deployed military personnel matched for age-group, sex, rank,
service and level of fitness. Their mortality was followed through June
2004.

Researchers reported finding no differences, 13 years after the end of
the Gulf War, in the overall mortality experience of British Gulf War
veterans. This essentially duplicates results from similar mortality
studies done by VA on U.S. veterans of the 1991 Gulf War.

They also found that an initial excess in non-disease-related deaths
disappeared after the initial 7 years. This is essentially the same
thing that has been seen among U.S. veterans of this war, as well as
among veterans of all U.S. combat deployments, since World War II.

Researchers also found that the overall experiences reported by British
veterans during their deployment to the Gulf did not influence
subsequent risk of dying. Similarly, reports in various health surveys
by veterans of their health status also did not affect future mortality
risk.

They did report two non-significant increases in mortality risk: An
association between death from disease and self-reported depleted
uranium exposure, and an association between non-disease-related death
and self-reported handling of pesticides. However, the authors caution
that these non-statistically significant results need to be considered
in light of the number of possible associations examined and other
potential biases, even though they may be biologically plausible.

As always, we will keep you posted on results from this and other
similar studies.

Next we will have a presentation from Dr. Munshi regarding Multiple
Myeloma.

**Nikhil C. Munshi and Bruce Holmberg: Multiple Myeloma Project.**

Dr. Munshi provided the following information regarding Multiple Myeloma
and the multiple myeloma project approved by Secreta**ry** Nicholson.

What is multiple myeloma? Multiple myeloma, the second most common
hematologic or blood cancer, affects cells important for immune function
called the plasma cells. Myeloma cells grow in the bone marrow and crowd
out normal cells that may affect normal blood cells including reducing
the white cells (and increasing the risk of infection), reducing the red
cells (causing anemia). It produces proteins which can make blood thick
and affect the bone by destroying the bone structure. This, in turn,
causes other serious medical issues such as kidney failure and immune
system dysfunction.

Who gets multiple myeloma? Multiple myeloma represents one percent of
all cancer diagnosis and two percent of all cancer deaths. Approximately
50,000 people in the United States are living with multiple myeloma and
an estimated 14,600 new cases are diagnosed each year. Although the peak
age of onset of multiple myeloma is 65 to 70 years of age, recent
statistics suggest that incidence is increasing and at an earlier age.
Despite recent advances in the treatment of myeloma with significantly
improved five-year survival rates, about 11, 000 people die from myeloma
each year.

How does all this relate to VA? VA Medical Centers have approximately
10-12% of all cases. The prevalence of myeloma in the Veteran population
is higher than general population as veterans predominantly comprise a
male population which is has twice the risk of developing the disease
compared to women. Additionally, myeloma occurs more frequently at older
age and the average age of Veteran patients is above 50 years of age --
much higher than the general population. Other complications such as
smoking, substance abuse, and exposure to radiation and toxic agents
i.e. Agent Orange, increases the risk as well. In May, we have initiated
a multiple myeloma pilot program that includes three components: patient
education, provider education, and collaborative research across the
various VA hospital centers.

How does this relate to Agent Orange? Based on clinical research,
multiple myeloma, similar to other lymphoid cancers is one of the
diseases on VA's Agent Orange list of presumptive disabilities. In
simple terms, this means that if you served in Vietnam between 1962 and
1975, VA presumes you were exposed to Agent Orange. And if you are in
this category and you are diagnosed with multiple myeloma, federal law
presumes your multiple myeloma is related with that exposure. This
so-called \"presumptive policy\" simplifies the process of receiving
compensation for these diseases since VA foregoes the normal
requirements of proving that an illness began or was worsened during
military service. Veterans who served in Vietnam during the war are also
eligible for a complete physical examination. If a VA physician suspects
a disease might be related to Agent Orange, VA will provide free medical
care. Retiree veterans are eligible for VA disability compensation and
their own service's Combat Related Special Compensation (CRSC).

How is multiple myeloma diagnosed? One of the most difficult challenges
to diagnosing myeloma is that the disease presents itself with no
symptoms or as potentially other conditions. Two readily identifiable
symptoms are anemia and bone pain/fracture. But both of these symptoms
sometimes result in misdiagnosis and patients may go
undiagnosed/misdiagnosed for significant periods of time. Below is a
summary of common symptoms:

-   Kidney problems. Symptoms can present as loss of appetite, fatigue,
    muscle weakness, restlessness, difficulty in thinking or confusion,
    constipation, increased thirst, increased urine production, and
    nausea and vomiting.

-   Pain. Pain in the lower back, ribs, or long bones.

-   Manifestations of anemia including fatigue, weakness, shortness of
    breath and sleepiness.

-   Recurrent infection because of decreased immune function.

-   Lytic lesions and tumors in patient's bones; otherwise unexplained
    fractures.

Multiple myeloma is most readily diagnosed by a blood test called a
serum protein electrophoresis, or SPEP for short. It is not a routine
test, so that it must be specifically ordered if the provider suspects
myeloma. This test may show a marker called an M-spike, which suggests
the presence of cancerous myeloma cells. A bone marrow biopsy and x-rays
of entire skeleton usually follows to confirm the presence of multiple
myeloma.

How and why is the disease classified? There are several ways to
classify the disease and they are listed below. Disease classification
helps to determine treatment options.

-   MGUS. MGUS may be a pre-cursor to myeloma. It is observed and not
    treated.

-   Asymptomatic myeloma: Smoldering myeloma and indolent myeloma --
    these are early stages of myeloma which are not treated with
    specific therapy. Management includes essentially close follow up of
    the disease and bisphosphonates.

-   Symptomatic myeloma: Stage II and III. Treatment is immediate and
    may include targeted therapies, chemotherapy, and stem cell
    transplants.

How is multiple myeloma treated? Myeloma treatment has changed radically
in the last several years with the emergence of what have become known
as targeted therapies. Whereas chemotherapy, the once standard myeloma
treatment, attacks the entire body as well as the cancer cells, targeted
therapies attack either the cancer cells directly or the environment in
which they grow and live. The first of these new treatments was really
an old drug called thalidomide. It was withdrawn in the 1960s for
causing birth defects. However, recently it has been found to be highly
successful in myeloma, especially when combined with dexamethasone, a
powerful steroid. Its use in myeloma however, is carefully controlled to
guard against pregnancy-related complications. Other new treatments
include Velcade and Revlimid. Revlimid is a derivative of thalidomide in
the final phases of FDA clinical trials and is expected to be approved
soon. In addition there are a number of other new therapies either in
trial now or being considered for trials. Stem cell transplants, both
autologous (one's own stem cells) and allogenic (a donor's stem cells)
are also effective treatments for some people. Additionally, almost all
myeloma patients are given periodic infusions of a bisphosphonates, a
drug that strengthens bone structure and appears to help suppress
bone-related complications in myeloma.

What is the VA's Myeloma Initiative? In May, Bruce Holmberg, an Agent
Orange related myeloma patient and Dr. Nikhil Munshi, a VA hematologist
who specializes in myeloma treatment and research, met with Secretary
Nicholson to propose that VA use multiple myeloma as a pilot program to
do three things:

-   Educate VA patients on the disease, emerging treatments, and
    clinical trial opportunities

-   Educate providers on the disease, emerging treatments, and clinical
    trial opportunities

-   Establish a collaborative research program within the VA to combine
    the efforts of various centers so that the resulting research has
    direct and near term benefit to the patients. This effort will also
    allow patients to enroll in clinical trials for treatment options
    that might not otherwise be available

Watch for educational efforts online on the VA web site and in VA
clinics where myeloma patients are treated.

**Status of EES Studies' Updated CMahan**

> EAS Conference Call 11/1/2005: EES Research Update
>
> I will describe three new VA Merit Review research projects which
> focus on the health of US military and veteran populations who were
> potentially exposed to environmental or occupational hazards during
> their military service. These new research studies are now underway, a
> project coordinator/statistician having been hired for each study
> during the past quarter.
>
> One research project is entitled, "Post War Mortality from
> Neurological Diseases in Gulf Veterans, 1991-2004." -- This study
> addresses the question of whether or not the 1991 Gulf War veterans
> are at increased mortality risk or at increased risk of death due to
> any specific cause, especially neurological diseases such as ALS
> (amyotrophic lateral sclerosis) Lou Gehrig's disease, MS (multiple
> sclerosis), or brain cancer. There is persistent concern that Gulf War
> veterans may be at increased risk for adverse health outcomes,
> including neurological disorders, as a result of their Gulf War
> service. One method of assessing health consequences of the 1991 Gulf
> War is to compare Gulf War veteran mortality to that of non-Gulf War
> veterans. Should Gulf War veterans be at increased risk for a disease
> with a short survival time, then one might expect to find an excess of
> deaths from that disease among Gulf War veterans. Although this
> mortality study cannot address directly the prevalence of neurological
> diseases among Gulf War veterans, the cause-specific mortality rate
> could serve as a surrogate measure for an incidence of the diseases
> with a short survival time, such as ALS or brain cancer. Thus, the
> primary objectives of the study are: 1) to determine the overall and
> cause specific mortality risk of 621,902 Gulf War veterans through
> December 2004, and 2) to assess demographic, military and in-theater
> exposure characteristics associated with the risk of deaths from ALS,
> MS, or brain cancer.
>
> The second research project addresses the question of whether or not
> there is an excess cancer risk associated with the 1991 Gulf War and
> is entitled, "Estimates of Cancer Prevalence in Gulf Veterans Using
> State Registries". The specific objectives of the study are: 1) to
> assess and compare the prevalence, distribution, and characteristics
> of cancer among 621,902 Gulf veterans to 746,248 non-Gulf War
> veterans, and 2) to assess demographic, military, and in-theater
> exposure characteristics associated with the cancer.
>
> A cause-specific mortality study of Gulf War era veterans to date has
> not suggested excess deaths due to cancer in aggregate or any specific
> type of cancer. However, since many cancers are not fatal with a short
> survival time, the mortality study results may present only a partial
> answer to the question. A population-based survey may capture
> prevalent cases; however, a very large sample size (over 100,000) is
> necessary due to relative rarity of disease among the study
> population. To overcome some of these limitations, we have proposed to
> use the existing state cancer registries. Over ¾ of states in the
> United States maintain a cancer registry and are certified by the
> North American Association of Central Cancer Registries (NAACCR) for
> good quality and reliability. We plan to identify Gulf War and
> non-Gulf War veterans with a diagnosis of cancer from 1991 to 2002
> through record linkage of the VA databases of the population of Gulf
> and non-Gulf veterans with files of certain state cancer registries. A
> computer software program will be run at each registry under the
> supervision of designated cancer registry personnel at the registry.
> To preserve protected health information of the veterans, the output
> file will be de-identified at the end of the matching process at each
> registry. Thus, to ensure privacy, only factors related to the type of
> cancer and military and demographic characteristics are retained in
> the record for statistical analysis. At the present time, we are
> contacting each state for the required specific forms, preparing
> documents for submission to each state, along with our study protocol,
> for review by each state's IRB.
>
> This research project is being conducted in collaboration with
> colleagues from George Washington University School of Public Health
> and Health Services, Department of Epidemiology and Biostatistics.
>
> A third research project is entitled, "Evaluation of Dr. Stellman\'s
> Herbicide Exposure Reconstruction Model". The primary objective of the
> study is to assess the validity and utility of the model proposed by
> Dr. Stellman and her Columbia University research team. That team
> developed a method by which Vietnam veterans' opportunity for exposure
> to various herbicides can be estimated on the basis of historical
> reconstruction of relevant military records and a geographic
> information system (GIS). This is a quantitative description of an
> individual's proximity in time and space to the known herbicide
> spraying in Vietnam during the Vietnam War. Their most sophisticated
> model takes into account three factors: (1) quantity of herbicide
> sprayed, (2) a veteran's distance from spray path, and (3) residence
> time at an exposed location. Although the model developed by the
> Columbia team seems intuitive and reasonable for assessing the
> relative opportunity for herbicide exposure in Vietnam among Vietnam
> veterans, the [validity of]{.underline} [the model]{.underline} should
> be evaluated; this is our task. We will assess the validity and
> utility of the model by using the databases already collected for
> previous Vietnam veterans' health studies, and evaluate its
> application in epidemiologic studies of Vietnam veterans by applying
> the model to: (1) the Agent Orange Registry of 240,000 Vietnam
> veterans, (2) Marine Corps Vietnam Veterans, and (3) Women Vietnam
> Veterans.
>
> The first two of these projects are being funded through the special
> (2004) solicitation for Gulf War veterans' health research. The third
> new research project was submitted at the request of VA's ORD and
> funded.
>
> Since the previous conference call, several manuscripts in which EES
> has been involved have been published or accepted for publication in
> peer reviewed journals.

a\. Published

-   **Bullman TA, Mahan CM**, **Kang HK**, Page WF. Mortality in US Army
    Gulf War veterans exposed to 1991 Khamisiyah chemical munitions
    destruction. *American Journal of Public Health*, [2005;
    95:1382-1388.]{.mark}

-   Hooper TI, DeBakey SF, Lincoln A, **Kang HK**, Cowan DN, Gackstetter
    GD. Leveraging existing databases to study vehicle crashes in combat
    occupational cohort: epidemiologic methods. *Am J Ind Med*
    2005;48:118-127.

-   **Kang HK**, Hyams KC. Mental health care needs among recent war
    veterans. *N Engl J Med* 2005; 352:1289

-   Eisen SA, **Kang HK**, Murphy FM, et al. Gulf War veterans' health:
    a comprehensive medical evaluation of a population based cohort.
    *Annals Internal Med* [2005;142:881-890]{.mark}.

-   **Mahan CM,** Page WF, **Bullman TA**, **Kang, HK**. Health effects
    in Army Gulf War veterans possibly exposed to chemical munitions
    destruction at Khamisiyah, Iraq: Part I. Morbidity associated with
    potential exposure. *Military Medicine*, 2005; 170:935-944.

-   Page WF, **Mahan CM, Kang HK, Bullman TA.** Health effects in Army
    Gulf War veterans possibly exposed to chemical munitions destruction
    at Khamisiyah, Iraq: Part II. Morbidity associated with notification
    of potential exposure. *Military Medicine*, 2005; 170:945-951.

b.  Accepted/In Press

-   **Kang HK**, **Bullman TA,** Taylor JW.  Risk of selected
    cardiovascular diseases and posttraumatic stress disorder among
    former World War II Prisoners of War.  *Annals of Epidemiology*, in
    press.

-   Blanchard MS, Eisen SA, Alpern R, Karlinsky J, Toomey R, Reda DJ,
    Murphy FM, Jackson LW, **Kang HK**. Chronic multisymptom illness
    complex in Gulf War I veterans 10 years later. *Am J Epidemiol*
    2005, accepted for publication.

-   Eisen SA, Karlinsky J, Jackson LW, Blanchard M, **Kang HK**, Murphy
    FM, Alpern R, et al. Spouse of Gulf War I veterans: medical
    evaluation of a U.S. cohort. *Military Medicine* 2005, accepted for
    publication.

-   Lincoln AE, Hooper TI, **Kang HK** et al. Motor vehicle fatalities
    among Gulf War era veterans: characteristics, mechanisms and
    circumstances. *Traffic Injury Prevention*, accepted for
    publication.

-   Lincoln AE, Helmer DA, Schneiderman AI, Li M, Copeland HL, Prisco
    MK, Wallin MT, **Kang HK**, Natelson BH. The War-Related Illness and
    Injury Study Centers: A resource for deployment-related health
    concerns. *Military Medicine*, accepted for publication.

> This completes my report for today. Thank you.
>
> **Registry Updates and Related Administrative Issues HMalaskiewicz and
> M Foster**
>
> An early and well-deserved thank you to the EH Coordinator working
> group that have been and are providing excellent reviews and edits to
> 20-module web-based training program EH Coordinators contracted out to
> a firm called Broken Wings Flying with guidance and oversight of the
> National Project Manager, Anne Stechmann, Employee Education Service,
> Minneapolis and Dave Roberts, EES New Media Producer. The date for
> completing this program is March 20, 2006. We will keep you informed
> of our progress.
>
> EAS and AAC are currently revising the User's Guide for the EAS
> website for entering registry data. Included in this guide will be
> instructions for accessing the database and entering data for all
> registry programs. New registry Worksheets (originally identified as
> code sheets) will be available for EH Clinicians and Coordinators
> interviewing veterans and entering data.
>
> This is a response to the following question that might be of interest
> to all EH Coordinators:
>
> Q: Is a veteran who served in the Gulf War (also applies
>
> to Agent Orange and Ionizing Radiation Registry)
>
> who has an "Other Than Honorable (OTH)"
>
> discharge from service, eligible for a
>
> registry examination:

A.  The requirement of M-1, Part 1, Chapter 4, para 4.37, or appropriate
    Handbook and Directive apply to veterans with other than honorable
    discharges applying for registry exams. You will need to contact
    your VARO to determine if the OTH is a bar to benefits. If a
    determination is rendered that it is not a bar, the veteran would be
    eligible on the same basis as any other eligible veteran.

> **OUTREACH DRosenblum**

I have some brief comments on outreach efforts since our last call.

> 1\. We have been deluged with readers' surveys from the Agent Orange
> review newsletter , dated April 2005. It has been estimated that we
> have received about 700 responses to date. Based on previous readers
> surveys we anticipated a response of 75-125 readers. The responses
> have been overwhelmingly positive, with readers calling the newsletter
> outstanding, very informative, first class, well written, great, very
> good, comprehensive, and excellent. Many readers commented "keep up
> the good work."
>
> 2\. Also since the August 2^nd^ call, the August issue of the Ionizing
> Radiation review was printed and widely distributed throughout the VA
> system and to other interested parties. This is the third issue of
> this publication.
>
> 3\. Last week the fourth issue of operation IRAQ Freedom/Enduring
> Freedom review newsletter was sent to the printers. You should be
> receiving it later this month.
>
> 4\. The next issue of the Agent Orange Review Newsletter has gone to
> our publication office and should go the printers later this month.
>
> 5\. We are making good progress on the next issue of the internet only
> gulf war review newsletter and expect to have it posted on the
> internet next month. I gave Dr. Brown the first draft this morning.
> The May 2005 edition of this newsletter has been posted. That was the
> first issue of one of our newsletters prepared exclusively for the
> internet.
>
> 6\. I am happy to report that an article has been prepared and
> approved for publication in the VANguard about these four newsletters.
> HACU summer Intern Tiffany Anzalone prepared this article with
> assistance of Matt Bristol of the VANguard staff. It's quite an
> article. I think you will enjoy it.

7\. We been doing some cleaning in our office. We have surplus copies of
the following newsletters: OIF/OEF review (April 2005), Gulf War Review
(October 2004), and Ionizing Radiation Review (August 2005). We also
have a number of posters on Agent Orange, Gulf War, and Ionizing
Radiation. We would be happy to send this material to you for use in our
outreach efforts.

Now it's time for your questions and comments.

Thank you for your participation in today's call. Don't forget to send
the answers to today conference call content within a week.

REMINDER: Next call is in 14 weeks on Tuesday, February 7, 2006 , August
1, 2006, November 1, 2006 at 1 pm Eastern

Adjournment