ATW1H%ASUACAD.BITNET@oac.ucla.edu (Dr David Dodell) (09/05/89)
--- begin part 3 of 5 cut here --- common rabid domestic animal, rabies vaccination programs should target cats as well as dogs. Delaware, New Mexico, Alaska, Connecticut, and South Carolina reported the greatest relative increases in animal rabies in 1988. The increase in Delaware was due to continuing transmission among raccoons in one county that was initially affected by the mid-Atlantic epizootic in 1987. New Mexico had an increase in rabid skunks in several counties; this increase was possibly associated with an increase in the skunk population. Similarly, Alaska's increase was a result of periodic increases in rabid red foxes and fox populations in several areas. Connecticut's large percentage increase, however, was attributable to expected fluctuations in small numbers. In South Carolina, some of the increase was a result of a 29% increase in testing, possibly due to a new public-education campaign. Other increases reported by Florida, Georgia, and Pennsylvania were attributed to the spread of raccoon rabies in those states. The mid-Atlantic outbreak began two decades after the southeastern epizootic (Figure 19) (1). Although the number of rabid raccoons in the mid- Atlantic epizootic has decreased steadily since 1983, the number of affected counties increases each year. In 1988, the sharp increase of rabid raccoons from the southeastern epizootic represented the largest relative increase (50%) in 10 years and may indicate further spread of this epizootic after several years of relative equilibrium. Further spread of the mid-Atlantic epizootic to highly populated areas of eastern Pennsylvania, Delaware, and New Jersey, where raccoons commonly live in close proximity to people, may result in large numbers of persons exposed to rabies. In 1987, the Delmarva Rabies Initiative, a cooperative of state and federal health, wildlife, and agriculture agencies, established a zone of immune raccoons by vaccinating raccoons along the Chesapeake and Delaware Canal to protect animal populations in the southern part of the Delmarva Peninsula. In 1988, two rabid raccoons were trapped within the zone, for the first time demonstrating that the epizootic had reached this area; however, no rabid animals were found south of the zone. Transmission of rabies from one domestic animal to another rarely occurs in the United States. Dog-to-dog transmission may or may not be occurring in the two Texas counties. Nevertheless, this epizootic emphasizes the importance of maintaining high vaccination levels. Monoclonal antibody analysis of rabies virus isolates from domestic animals have demonstrated that most domestic animals are infected by bites from the dominant terrestrial wildlife reservoir in the area (2). The similar distribution of rabid domestic animals to skunks and raccoons suggests that skunks are the main source of rabies for domestic animals in the North Central and South Central states and that raccoons are the primary source in the Middle Atlantic and South Atlantic states. In addition, the distribution of rabid animals by month suggests that skunks are the primary source of rabies in cattle. The seasonal peaks of rabies in skunks, raccoons, and bats may reflect increased activity (e.g., during the mating season), increased likelihood of detection because of increased contact with people, or both. The two cases of imported canine rabies emphasize the need to educate Health InfoCom Network News Page 20 Volume 2, Number 32 September 4, 1989 travelers of the risk of canine rabies in developing countries. Persons traveling to developing countries should use great caution when importing pets from these countries. References 1. Jenkins SR, Winkler WG. Descriptive epidemiology from an epizootic of raccoon rabies in the middle Atlantic states, 1982-1983. Am J Epidemiol 1987;126:429-37. 2. Smith JS, Baer GM. Epizootiology of rabies: the Americas. In: Campbell JB, Charlton KM, eds. Developments in veterinary virology: rabies. Boston: Kluwer Academic Publishers, 1988:267-99. 3. CDC. Rabies Surveillance, United States, 1987. In: CDC Surveillance Summaries, September 1988. MMWR 1988;37(No. SS-4):1-17. 4. Fishbein DB, Arcangeli S. Rabies prevention in primary care: a four-step approach. Postgrad Med 1987;82:83-95. 5. World Health Organization. World survey of rabies XXII (for years 1984- 1985). Geneva: World Health Organization, Division of Communicable Diseases, Veterinary Public Health Unit, 1987. 6. Zoonosis Control Division. Rabies in Texas. Zoonosis Update, February 1989:1-2. 7. CDC. Imported dog and cat rabies--New Hampshire, California. MMWR 1988;37:559-60. 8. Helmick CG. The epidemiology of human rabies postexposure prophylaxis, 1980-1981. JAMA 1983;250:1990-6. Health InfoCom Network News Page 21 Volume 2, Number 32 September 4, 1989 =============================================================================== Dental News =============================================================================== Dental News from the American Dental Association ------ A new videotape and self-help manual entitled "Infection Control in the Dental Environment" is available. A videotape series and training manual, "Infection Control in the Dental Environment: A Video Training Manual," is the result of the collaboration of the Department of Veterans Affairs working with the ADA, the Centers for Disease Control, the Food and Drug Administration and the National Institute of Dental Research. The infection control training program includes a three-tape video series and a study manual designed to help dentists educate their staff to use infection control techniques for all patients. Step-by-step suggestions for setting up an office infection control regimen for commonly performed dental procedures are featured on the tapes. The five organizations that produced the program reviewed the scripts and rough cuts of the videotapes at each stage of production to ensure not only that the information included was correct, but that it also agreed with the agencies' own policies on infection copntrol. The program was designed to complement existing materials on infection control the agencies have already provided to dentists. Funding from CDC, FDA and NIDR awill enable distribution of the program to state and local dental societies; dental schools; dental hygiene, assisting and laboratory technician training programs; state and local health directors; and all VA facilities throughout the country. How to order Individual copies of the program can be purchased for dental offices, clinics or hospitals for $75, depending on sales tax regulations in each state. Prices are higher for non-ADA-members. To order the videotapes and training manual, contact the ADA's saleable materials department, WATS ext. 2639. Special care groups need coordination A host of government-supported and private-sector programs and activities exist designed to boost access to dental care for special patients. These diverse groups have had success in bringing oral health care to traditionally underserved populations -- the poor, elderly, physically and mentally handicapped and others. What they lack, though, is a coordinated effort clearly focused on common goals, according to Dr. Lawrence Meskin, speaking at the first National Conference on Special Care Issues in Dentistry. The Federation of Special Care Organizations -- composed of the American Association of Hospital Dentists, the Academy f Dentistry for the Handicapped and the American Society of Geriatric Dentistry -- will join the ADA's Council on Community Health, Hospital, Institutional and Medical Affairs to develop a strategic plan to coordinate activities to address the needs of the special patient. Dr. Meskin told conference members that a commitment to focus on universal goals is mandatory for success. He urged planners to seek the counsel of outside experts to develop the strategic plan. Health InfoCom Network News Page 22 Volume 2, Number 32 September 4, 1989 Other speakers at the conference recommended the development of coalitions on the national and grassroots levels and stressed care in the place of residence, in addition to improved public health education geared to the special patient. Patients don't want to be treated by a doctor with AIDS Most Americans said they would look for a new doctor if they found out their family physician was infected with the AIDS virus, according to a recent survey. A team of researchers at the University of California at San Francisco interviewed 2,000 Americans nationwide, seeking opinions about HIV infection, the cause of AIDS. Fifty-six percent of those called said they would change physicians if they learned their doctor had HIV infection and 25 percent said they'd switch from a doctor they believed was treating patients with HIV infection. The latter finding is especially disturbing, because the need for physicians from all specialties to provide care to AIDS patients is growing. Some doctors are reluctant to treat HIV patients for fear it will hurt their regular practice. If healthy people shun doctors who merely treat HIV- infected patients, it could add to the growing burden of providing medical care for AIDS patients, the researchers concluded. Interestingly, many people who said they would leave the practice of a physician infected with HIV also said they know the virus wouldn't be transmitted through contact in the doctor's office. Even though knowledge about AIDS is growing and most people understand that the infection doesn't spread through casual contact, survey results demonstrate the need for more public education about AIDS. Glove shortage abating The acute national shortage of medical gloves, which increased sharply in l987 with stringent infection control measures, has abated, according to the American Association of Hospital Dentists. Foreign and domestic suppliers have increased their manufacturing output to meet the escalating demand. However, purchasers are complaining that the quality of many gloves has substantially deteriorated. As a result, the federal government has initiated a regulatory process that will lead to its testing batches of nonsterile patient examination gloves and possibly seizing those that prove defective. It is feared that this impending quality control crackdown by the Food and Drug Administration (FDA) will rekindle the shortage. As of April l3, the FDA is revoking exemptions that applied to examination gloves regarding filing of premarket notifications and compliance with current good manufacturing practice regulations. These exemptions were granted in l980 because no adverse experiences had been related to patient examination gloves. Also, the role of gloves as a protective barrier against HIV transmission was not the public health concern it is today, and the risks associated with glove failure were not as well understood. Manufacturers now will be required to include descriptions of product testing, methodology, the standard employed in making the gloves, as well as the "acceptable quality level." The FDA may reconsider reinstituting the exemptions if, over time, the agency finds that gloves are meeting safety and effectiveness criteria. Health InfoCom Network News Page 23 Volume 2, Number 32 September 4, 1989 Oral complications of cancer therapy The oral cavity is frequently a common site of complications resulting from cancer therapies. At a National Institutes of Health (NIH) conference held in April, discussions focused on the most effective means of limiting oral complications by pretherapy interventions as well as strategies for the management of acute and chronic complications arising during cancer therapy. The consensus development panel, consisting of representatives from medicine, dentistry and nursing, evaluated scientific evidence presented by experts in the management of cancer patients. Pretherapy intervention There is evidence that pre-existing oral pathoses unrelated to cancer or therapy may increase the risk of oral complications. Therefore, a comprehensive pre- treatment dental evaluation should be performed before the initiation of cancer therapy. Pretreatment strategies include evaluation, treatment of pre-existing dental disease, prevention of oral mucosal infections, interventions to modify salivary gland dysfunction and prevention of mucositis, among others. During cancer therapy Oral complications occurring during treatment include mucosal inflammation and ulceration, oral candidiasis, bacterial and viral infections and mucosal bleeding. There is currently no single agent completely effective in preventing therapy-related mucositis. Patients at risk for oral herpes simplex virus may benefit from the use of either oral or intravenous acyclovir. Topical forms of therapy for oral candidiasis include nystatin and clotrimazole. Severe thrombocytopenia may predispose patients to bleeding from routine mechanical oral hygiene procedures. In these patients, dental plaque can be managed effectively by daily mouth rinsing with a chlorhexidine solution. Following cancer therapy Management of chronic xerostomia involves a combination of strategies, including continuous maintenance of effective oral hygiene to reduce the proliferation of oral pathogens, use of water or artificial saliva to keep the mouth moist, and stimulation of residual salivary parenchyma to produce more saliva. In the event that dental extraction is required following radiation, meticulous surgical technique and antibiotic prophylaxis are necessary. Directions for the future Emphasis must be placed on devising accurate, quantifiable and reproducible criteria for assessing the oral complications of cancer therapy, as well as establishing large-scale databases to determine incidence, prevalence and risk factors for oral complications. The panel felt that the therapeutic team should be multidisciplinary and sensitive to patients' emotional and physical needs. Through coordination of committed members of the dental, medical and nursing professional, many research goals can be reached. Danes get free dental check-ups More than one million edentulous Danes will be offered free oral examinations this fall, as part of the Danish Dental Association's contribution to the campaign "Europe Against Cancer." A publicity campaign has been launched and patient leaflets are being distributed at clinics throughout Denmark. At a number of conferences and exhibitions, the Associaiton is seeking to draw patients' attention to the Health InfoCom Network News Page 24 Volume 2, Number 32 September 4, 1989 risk of oral cancer. In the future, the education of dental students in Denmark will feature a greater emphasis on prevention and early diagnosis of oral cancer. Dentsply supports 'glasnost' Dentsply and the All-Union Scientific Industrial Association Stomatologia of the USSR formed a joint venture for the production of dental products within the USSR, the first venture of its kind in the dental industry. The joint venture will lead to the production of several dental products within the Soviet Union and the sale of those products within the USSR and other countries. The new enterprise will initially produce modern composite restorative materials. The products will be manufactured in Kharkov, USSR, in an existing facility, which will be equipped with modern, state-of-the art production equipment and quality control laboratories. In addition, Dentsply will establish educational centers in major Russian cities to train Soviet dentists and dental laboratory technicians in the use of the new products. The company noted that there are approximately l20,000 stomatologists (dentists) and 40,000 dental laboratory technicians in the USSR serving a population estimated at 280 million. Civil war trivia Thanks to Dr. Peter H. Jacobsohn, associate editor of the Wisconsin Dental Association Journal, for the following: During the American Civil War, desertion by soldiers was commonplace. Men left the battlefield in large numbers and just went home. Self-mutilation to avoid the draft or to be discharged from front line duty was a problem seen by both military recruiters and regimental surgeons. The destruction of anterior teeth was a common method used to avoid the draft or to be transferred to non-combatant status. The war weapon used by the average soldier of the day was a single-shot, muzzle-loading musket or rifle. It required 11 separate steps to load and fire. The first step was to tear open a paper cartridge with the incisor teeth. Anyone unable to do so because these teeth were absent was unable to serve as a front line infantryman. In an effort to discourage the practice of dental mutilation, the following announcement from the War Department appeared in local newspapers of the time: "Those drafted persons who have knocked out their front teeth to procure exemption are informed that they will be accepted in the Cavalry, where front teeth are not needed to bite off cartridges." o American Druggist, a publication for the nation's pharmacists, reported the most commonly dispensed prescription drugs in retail pharmacies for l988: l. Amoxil Infections 2. Lanoxin Arrythmia/congestive heart failure 3. Xanax Anxiety 4. Zantac Ulcers 5. Premarin Menopause 6. Dyazide Hypertension 7. Tagamet Ulcers Health InfoCom Network News Page 25 Volume 2, Number 32 September 4, 1989 8. Tenormin Hypertension/Angina 9. Naprosyn Pain/Arthritis l0. Cardizem Angina Health InfoCom Network News Page 26 Volume 2, Number 32 September 4, 1989 =============================================================================== Columns =============================================================================== Black Bag BBS ======================= Current as of 8/25/89 The following list is a list of medical, fire/EMS, science, alcohol, AIDS and disABILITY related bulletin board systems. All have been checked within the last twenty five days. You are granted the right to distribute the list in electronic form as long as it remains unaltered. Please remember how much time and effort goes into this and abide by this simple yet unenforceable request. Please excuse the fact that it is one month late..... I needed a break from the modem. Please take the time to read the comments at the end of the list. Enjoy, Edward Del Grosso M.D. Black Bag BBS (150/140) 302-731-1998 CIS : 71565,1532 Genie : E. DELGROSSO Name Number Baud Codes LastCall ======================================================================== ***** ALASKA ***** Alaska EMS 907-789-1694 2400 8N1 F 8/14/89 ***** ARIZONA ***** St.Joseph Hospital (114/15) 602-235-9653 2400 8N1 * 8/14/89 Eye Net (114/14) 602-941-3747 2400 8N1 * O 8/25/89 ***** CALIFORNIA ***** LifeLine 213-398-5433 2400 8N1 * L CALAN 8/25/89 Legacy 213-652-7537 1200 8N1 * CALAN 8/14/89 Shrink Tank 408-257-8131 2400 8N1 * P CASJO 8/14/89 Non Smokers BBS 408-298-4277 2400 8N1 * CASJO 8/14/89 MacScience BBS (143/36) 408-866-4933 2400 8N1 * S CASJO 8/25/89 Recovery II (125/9) 415-223-1119 2400 8N1 * L CAOAK 8/14/89 Cowtown Lafayette 415-284-1872 2400 8N1 * S CAOAK 8/14/89 Chemist's Comport (125/190) 415-359-6036 9600 8N1 * C CASFA 8/20/89 Children's Hospital 415-428-3039 1200 8N1 * CAOAK 8/14/89 Compuchem 415-487-0310 2400 8N1 * X CAPAL GONE California State EMS 415-499-7891 2400 8N1 * F CASFA 8/14/89 AIDS Info BBS 415-626-1246 2400 8N1 * A CASFA 8/14/89 Disabled Children 415-642-7387 300 8N1 * D CAOAK 8/20/89 OASIS (Over Eaters) 415-658-5397 2400 8N1 * CAOAK 8/20/89 Nightingale (10/475) 415-731-2422 2400 8N1 * R CASFA 8/14/89 Friends of Bill W. 415-833-1780 300 8N1 L 8/25/89 Cowtown Berkeley 415-841-1411 2400 8N1 * S CAOAK 8/25/89 Health InfoCom Network News Page 27 Volume 2, Number 32 September 4, 1989 Baytalk 415-864-6430 1200 8N1 * D CASFA 8/14/89 Digex SDCS Disabled 619-454-8078 1200 8N1 * D CASDI 8/14/89 Medical Management 619-532-9183 2400 8N1 * CASDI 8/14/89 Balboa Naval Hospital BBS 619-532-8022 2400 8N1 * CASDI 8/14/89 Survival Forum (125/7) 707-545-0746 2400 8N1 F 8/14/89 911 EMS 707-664-1639 2400 8N1 F 8/14/89 COMP SEA 714-865-8586 2400 8N1 8/25/89 12 & 12 Anonymous BBS. 714-539-8644 2400 8N1 * A CASAN 8/14/89 Beckman Inst (103/524) 714-773-8818 2400 8N1 * X CASAN 8/14/89 LLUMC Medical Lib (10/211) 714-824-4328 2400 8N1 * CACOL 8/14/89 WellSpring 714-856-7996 2400 8N1 * CASAN 8/14/89 WellSpring Node 2 714-856-5087 1200 8N1 * CASAN 8/15/89 Calif Self Help 714-952-2110 2400 8N1 * P CASAN 8/14/89 Nine Lives 805-836-8531 2400 8N1 8/14/89 The ARB Research Bulletin 916-324-6997 2400 8N1 * CASAC 8/14/89 Project Disable (119/500) 916-343-3742 2400 8N1 D GONE RBBS BioMed 916-362-4298 1200 8N1 * B CASAC 8/14/89 CompuHelp 916-786-3923 1200 8N1 D 8/14/89 ***** COLORADO ***** Nurse Link (104/52) 303-270-4936 2400 8N1 * R 8/14/89 P2 B2 S (104/51) 303-329-3337 2400 8N1 * P 8/14/89 The Watch Desk (104/66) 303-450-0822 2400 8N1 * F 8/14/89 Med Link (104/444) 303-499-1022 2400 8N1 * 8/14/89 Deaf Net BBS 303-989-9245 1200 8N1 * D 8/14/89 SCI LINE (128/48) 719-578-9127 2400 8N1 S 8/14/89 Fire Net Leader (128/16) 719-591-7415 2400 8N1 F 8/14/89 ***** CONNECTICUT ***** Handicap News (141/420) 203-337-1607 1200 8N1 D 8/14/89 Hippocampus (141/205) 203-481-7475 2400 8N1 8/14/89 Dr. Fido (141/315) 203-937-2686 2400 8N1 8/14/89 ***** DELAWARE ***** Black Bag BBS (150/101) 302-731-1998 2400 8N1 Call-ALWAYS ***** DISTRICT OF COLUMBIA ***** Science Line 2 202-265-4496 2400 8N1 * S 8/14/89 American Otolaryngology 202-289-7338 2400 8N1 * 8/14/89 Science Line 202-328-5853 2400 8N1 * S 8/15/89 APGO 202-466-2893 2400 8N1 * G GONE ACOG 202-479-0005 2400 8N1 * G 8/14/89 Synapse (109/110) 202-543-9176 2400 8N1 D 8/14/89 American Inst of Bio. Sci. 202-628-2427 2400 8N1 * Q 8/14/89 Science Resources (NSF) 202-634-1764 2400 8N1 * S 8/14/89 State and Local EMS 202-646-2887 2400 8N1 * F 8/14/89 The Steps of DC (109/133) 202-659-5270 1200 8N1 * L 8/14/89 PIE 202-872-9141 2400 8N1 * P 8/14/89 ShanErin (109/20) 202-941-8291 2400 8N1 * 8/24/89 Health InfoCom Network News Page 28 Volume 2, Number 32 September 4, 1989 ***** FLORIDA ***** Medical Software Ex (135/3) 305-325-8709 2400 8N1 * 8/14/89 CG Medterm (135/8) 305-444-5615 2400 8N1 * GONE The Way Out (135/35) 305-445-6917 2400 8N1 * L 8/12/89 Metro Fire (135/14) 305-596-8611 2400 8N1 * F 8/12/89 Epics Division (135/9) 305-883-6892 2400 8N1 * X 8/14/89 The Firehouse BBS (135/53) 305-948-4382 2400 8N1 * F 8/14/89 UCF Health Topics (363/507) 407-281-5522 2400 8N1 8/14/89 Nurses Corner (363/15) 407-299-4762 2400 8N1 R 8/14/89 The Pharmacy BBS 407-363-1143 2400 8N1 M 8/15/89 Med Net 407-433-3977 2400 8N1 8/14/89 The Firehouse BBS (3609/8) 407-439-0341 2400 8N1 F 8/14/89 Central Florida Psych 407-645-1658 1200 8N1 P 8/14/89 Central Florida TDD Info 407-657-7011 1200 8N1 D 8/14/89 Entropy 813-264-6344 2400 8N1 * S 8/20/89 MACNET/MEDNET 813-377-7032 2400 8N1 8/14/89 APCO National RBBS 904-423-1312 2400 8N1 F 8/15/89 Medlink (3600/3) 904-431-1575 2400 8N1 8/15/89 Naval Hospital 904-452-6613 2400 8N1 GONE ***** GEORGIA ***** Psychology OnLine 404-252-8810 2400 8N1 * P 8/15/89 Atlanta Medical Forum 404-351-9757 2400 8N1 * 8/20/89 CDC Aids Info Line 404-377-9563 2400 8N1 * A 8/14/89 CEAM 404-546-3402 2400 8N1 F 8/14/89 Middle GA Med.For (133/210) 912-477-8741 2400 8N1 8/14/89 ******* HAWAII ****** HAWAII EMS BBS 808-261-4268 2400 8N1 F GONE ***** ILLINOIS ***** Check Source (233/13) 217-244-6954 2400 8N1 S 8/25/89 Sig Bio (233/4) 217-333-9660 2400 8N1 S 8/14/89 RBBS Biomed 312-227-7455 1200 8N1 * B 8/20/89 COPH 2 (115/778) 312-286-0608 2400 8N1 * D 8/14/89 ENA BBS 312-649-0490 2400 8N1 * R 8/14/89 Cope (115/777) 312-790-0187 2400 8N1 * D 8/14/89 Hazardous Management 312-972-3275 2400 8N1 * F 8/14/89 T.I.E. 312-945-5575 2400 8N1 * S 8/25/89 ***** INDIANA ***** Testing Station 317-846-8917 2400 8N1 P 8/14/89 ***** IOWA ***** Anesthesiology BBS 319-353-6528 2400 8N1 N 8/14/89 Great Plains Hemophilia 319-356-1632 1200 8N1 8/14/89 ***** KANSAS ***** Health InfoCom Network News Page 29 Volume 2, Number 32 September 4, 1989 Doc Talk 913-588-1998 2400 8N1 * 8/14/89 ***** KENTUCKY ***** Operating Room 502-245-3516 2400 8N1 8/14/89 Fido Racer (11/301) 502-762-3140 2400 8N1 D 8/14/89 Science Spoken Here 606-233-5413 1200 8N1 S 8/14/89 ***** LOUISIANA ***** VICE (396/8) 504-286-7294 2400 8N1 D 8/15/89 Health Text 504-456-9440 2400 8N1 8/14/89 Tulane Med Center AIDS 504-584-1654 2400 8N1 A 8/14/89 Tulane Medical Center 504-588-5743 2400 8N1 8/14/89 The Fire Scene (390/2) 504-641-4789 2400 8N1 F 8/15/89 LA Medsig 504-737-8173 2400 8N1 8/14/89 ***** MAINE ***** Maine EMS 207-289-5336 1200 8N1 F 8/14/89 National Assoc. EMS 207-326-8800 2400 8N1 F 8/14/89 ***** MARYLAND ***** The Firefighter Sig 301-229-9570 2400 8N1 * F 8/25/89 MIEMSS 301-328-3842 1200 8N1 F 8/14/89 Maryland Med Sig (261/1039) 301-332-7386 2400 8N1 8/20/89 Fusion Connection 301-353-6167 2400 8N1 * S 8/14/89 IMEEC 301-433-4833 1200 8N1 X 8/20/89 Science Lab 301-444-0551 2400 8N1 S 8/15/89 AAPT Physics Teachers 301-454-2086 2400 8N1 * S 8/20/89 Maryland Fire (261/1047) 301-536-1935 2400 8N1 F 8/25/89 EPA Superfund and Hazard 301-589-8366 2400 8N1 * F 8/14/89 HEX TDD 301-593-7033 300 8N1 * D 8/14/89 HEX 301-593-7357 1200 8N1 * D 8/14/89 Nerve Center (261/1000) 301-655-4708 2400 8N1 D 8/14/89 --- end part 3 of 5 cut here ---