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On November 5, a team of fourteen people, including LDA president Pat Smith, representatives of several LDA affiliates as well as doctors and researchers traveled to Washington, DC, to meet with Health & Human Services Secretary Tommy Thompson's staff, culminating weeks of organizing by the LDA. The team spent almost three hours presenting to HHS and highranking officials from the Atlanta and Fort Collins CDC and the National Institutes of Health, who were present either in person or through video teleconferencing. Pat Smith introduced the session with statistics about Lyme disease, saying it is the most prevalent vector borne disease in the US. After the CDC criteria were revamped in 1996, the number of reported cases decreased, at least on paper. The CDC estimates the reported cases represent about 1 10 of true cases. From 2001 to 2002 the numbers increased 40%, from 17, 000 to 23, 000 cases, but there was no media attention given to this astonishing and serious development, according to Smith. The CDC criteria fit only a small subset of patients. The characteristic erythema migrans occurs in less than 50% of cases and the vaccine study showed that 81% of people with no erythema migrans would not have been confirmed using CDC criteria, Smith said. She explained that people are not being diagnosed early because doctors are using the CDC criteria for clinical diagnosis, and this results in a possibly correctable problem becoming chronic and incurable. Smith described how doctors were being prosecuted for overdiagnosis and overtreatment by their state medical boards, eliciting Page 32 surprise from HHS staffer Laura Laller, who questioned why a licensing board would care if a doctor were treating a disease. Alluding to the relative dearth of national resources being allocated to Lyme disease, Smith stated that the CDC journal Emerging Infectious Diseases had published 9 articles and 2 letters on Lyme disease during the same time period that it had pub. Staysafetm closures should be tested for use with specific containers, liquids and oral syringe tips to confirm fit and compatibility and to ensure optimal performance. Pittsfield Mass. ; . Citizens. Septuagenarian dinner. Albany, New York, J. Munsell. 1870 Report of the speeches, poem and other proceedings at a dinner given June 30, 1870. By the citizens of Pittsfield, Mass., to their townsmen who had reached the age of 70 years. Official report.; 48 p.; 23 cm. Reel: 135, No. 2444 Pittsinger, Eliza A. Poem. San Francisco, C.A. Calhoun ; . 1862 In Society of California Pioneers, San Francisco. Ceremonies at the laying of the corner stone of the new Pioneer Hall .; p. [10]-11 ; . Reel: 162, No. 2895 Place, Edward R. Woman; a poem written for the fair held by the ladies of the Park Street Congregation, May, 1841. Portland. 1841 24 p. Reel: 106, No. 1816 Plato, Ann. Essays; including biographies and miscellaneous pieces, in prose and poetry. Hartford, Printed for the author. 1841 3 p.l., [xvii]-xx, [19]-122 p.; 15 cm. Reel: 106, No. 1818 Play-Room poetry by S. S. New York, M.W. Dodd. 1846 vi, [7]-128 p.; 24 cm. Reel: 107, No. 1819 The Plays and poems of L. New York, Delisser & Procter. 1859 2 v.; Contents.--v. 1. Eva, a tragic poem in one scene.--A tragic poem in three acts.--Ballads, etc.-v.2. Morning, noon and night.; V. 1 is "in three parts". V. 2 has "Part II" on spine. Reel: 135, No. 2445 A Plea for the church festivals: a poem by A. J. Mercersburg, Pa., P.A. Rice. 1850 16 p. Reel: 106, No. 1817 Pleasant stories in rhyme, for good boys and girls. New York, P.J. Cozans. [185-?] 63, [1] p.; illus.; 15 cm.; Uncle Philip's library, no. 4 ; . Reel: 107, No. 1819.1 Pleasants, Joseph, Mrs. Cinderella; The widow of Nain, and the Resurrection of Lazarus, in rhyme. Philadelphia. 1864 Composed for the benefit of the Sanitary fair.; 16 p.; 19 cm.; "60 copies privately printed.". Reel: 135, No. 2446 Pleasants, Julia, 1827?-1886. Apheila; and other poems. New York, C. Scribner. 1854 By two cousins of the South, Miss Julia Pleasants and Thomas Bibb Bradley.; viii, 13-272 p.; 18.5 cm. Reel: 136, No. 2447 Pleasing instructor. Northampton, J. Metcalf. 1840 8 p.; illus.; 8 cm. Reel: 107, No. 1820 A Pleasing toy. [New York, S. Wood & sons]. [1819.] 27 p.; illus. Reel: 52, No. 1520 Pleasure and profit. Providence, George P. Daniels. 1845 [14 p]; col. illus.; 17 cm. Reel: 107, No. 1821 The Pleasures of religion: a poem. New York. 1832 72 p.; 15 cm. Reel: 107, No. 1822 Plumb, David. Man: a poem, delivered at the commencement of the Wesleyan university, August 5, 1840. Lowell, Mass., L. Huntress. 1840 16 p.; 17 cm. Reel: 107, No. 1823 Plumb, David. The slaveholders' rebellion. [New York]. [1865] [10] p. Reel: 136, No. 2448 Plumer, William, 1789-1854. Lyrica sacra; or, War-songs and ballads from the Old Testament. Boston, W. Grosby and H.P. Nichols. 1846 x p., 1 l., 68 p.; 18.5 cm. Reel: 107, No. 1824 Plumer, William, 1789-1854. Manhood, or Scenes from the past. Boston. 1843 148 p. Reel: 107, No. 1825 Plumer, William, 1789-1854. Ruth, a pastoral poem of Bethlehem. Boston, Ticknor, Reed and Fields. 1852 Ephratah.; iv, [5]-37 p.; 20.5 cm. Reel: 136, No. 2449 Plumer, William, 1789-1854. Youth, or Scenes from the past; and other poems. Boston, C.C. Little and J. Brown. 1841 x, [11]-144 p.; 20.5 cm. Reel: 107, No. 1826.

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Physician guidelines can be developed for prevention, diagnosis, and treatment in biological and chemical attacks, distributing these on CD-ROM to the nation's physicians. Our AMA could co-host a national and perhaps annual ; conference on bioterrorism with HHS, seeking outside funding to establish the conference Secretariat at the AMA. Regional conferences offering continuing medical education for physicians could be developed and produced, with outside funding. Medical specialty societies will be an important resource, and could offer their own sessions at society meetings on relevant topics. Experts in emergency planning, medical response, infectious disease, and other topics in disaster bioterrorism would be recruited for these seminars. A "speakers kit" will be developed for hospital grand rounds presentations and state medical society meetings, and distributed through the Federation. The AMA will provide distance learning links to Uniformed Services University of the Health Sciences curriculum modules, and arrange CME credit through or the AMA for those who use these modules. National and state-level meetings could be used as a platform for discussion of physician intervention and opportunities for the medical community to enhance its responsiveness to disaster situations. Sessions on disaster response initiatives will be included on the National Leadership Conference agenda, the Presidents' Forum and other Federation meetings. The AMA will explore activities in patient education with groups such as the National Council for Patient Information and Education, medical specialty societies, pharmacists and the pharmaceutical industry, and consumer groups. Distribution of brochures on potential threats such as anthrax and other biological weapons could be distributed through supermarkets and pharmacies, for example INSULIN, EXERCISE, AND HYPOXIA all stimulate glucose transport in skeletal muscle by causing movement of the GLUT4 isoform of the glucose transporter from intracellular sites to the cell surface 17 ; . Under normal conditions, i.e., in the absence of insulin resistance, the increase in glucose transport induced by the and sirolimus!

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