------------- cut here ----------------- 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    ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::                                    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:  syd@azcc.arizona.edu   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:  rick@jccc.medsch.ucla.edu   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:  hlam@mednet.med.miami.edu   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:  Kristie_Stevenson@macmailgw.dfci.harvard.edu   Meyer L. Prentis Comprehensive Cancer Center of Metropolitan Detroit 110 East Warren Avenue Detroit, Michigan 48201 (313) 745-4329 Internet:  cummings%oncvx1.dnet@rocdec.roc.wayne.edu   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:  kallie.bila.michels@um.cc.umich.edu   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:  edward.bresnick@dartmouth.edu   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:  janie@cuccfa.ccc.columbia.edu   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:  ccwfumail@phs.bgsm.wfu.edu   Ohio State University Comprehensive Cancer Center 300 West 10th Avenue Columbus, Ohio 43210 (614) 293-5485 Internet:  dyoung@magnus.acs.ohio-state.edu   Fox Chase Cancer Center 7701 Burholme Avenue Philadelphia, Pennsylvania 19111 (215) 728-2570 Internet:  s_davis@fccc.edu   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:  sedmonds@cclink.fhcrc.org   University of Wisconsin Comprehensive Cancer Center 600 Highland Avenue Madison, Wisconsin 53792 (608) 263-8600 BITNET:  carbone@uwccc.biostat.wisc.edu       Clinical Cancer Centers     University of California at San Diego Cancer Center 225 Dickinson Street San Diego, California 92103 (619) 543-6178 Internet:  dedavis@ucsd.edu   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:  judith@delphi.bsd.uchicago.edu   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:  rickb@wotan.medicine.rochester.edu   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:  meyer@mbcf.stjude.org   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:  hogan@cc.utah.edu   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    ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::                              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 (slclancy@uci.edu) (for  MSDOS) or Albert Saisho (saisho@uci.edu) (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    ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::                               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  --------- end of part 3 ------------