10 People, 5 Corporations Indicted For Operating Fraud Ring in Hollis, Queens Superintendent of Insurance Gregory V. Serio and Attorney General Eliot Spitzer today announced the indictment of 10 individuals and five corporations accused of operating an insurance fraud ring out of SZ Medical, a clinic in Hollis, Queens. The defendants include nine health care providers and are alleged to have fraudulently billed an insurance carrier for months of treatment and extensive testing, including medical evaluations, diagnostics tests, physical therapy, chiropractic treatment and acupuncture. Gregory V. Serio, Superintendent of Insurance, said, "It’s particularly disturbing that this fraud ring was comprised of doctors and health care providers, professionals who are here to protect us and not betray the public’s trust by defrauding our insurance system. Thanks to our strong partnership with Attorney General Spitzer, these people have been exposed and this case will help us build more momentum in the fight against fraud." "This case demonstrates the sustained and coordinated effort required to combat the pervasive nature of auto insurance fraud," Attorney General Spitzer said. "My office will continue to work with the State Insurance Department, law enforcement, and industry officials to bring these cases. While we are making progress, there is still an extraordinary amount of work yet to do." Under the State's no-fault auto insurance law, insurance carriers reimburse medical facilities for services provided to persons injured in motor vehicle accidents. It is alleged that the defendants submitted fraudulent claims to a no-fault insurance carrier for services never provided or for services that were not medically necessary. The charges stem from a long-term investigation of SZ Medical which began in Spring, 2003. According to the indictment, the defendants fraudulently billed an insurance carrier for months of treatment and extensive testing, including medical evaluations, diagnostics tests, physical therapy, chiropractic treatment and acupuncture. The indictment charges that fraudulent claims were submitted by three medical doctors, Sergey Zavilyansky, 48, of Brooklyn; Gary Friedman, 51, of Manhattan; and Lee Craig Nagourney, 52, of Brooklyn. Zavilyansky is the owner of SZ Medical. All three are charged with fabricating medical diagnoses and submitting claims for services not provided or not medically warranted. The indictment additionally charges the following defendants with fraudulent claim submissions: Stanley Frankel, 69, of Manhattan, a dentist; Michael Ferrato, 56, of Suffolk County, a psychologist; Juby Uralil, 26, of Queens County, a physical therapist; Joel Santos, 34, of Queens County, a physical therapist; Peter Pramberger, 51, of Suffolk County, a chiropractor; and Ji Yong Kim, 39, an acupuncturist. The indictment also charges that defendant Nelson Bloom, 57, of Brooklyn, a paralegal, held himself out as a licensed attorney and directed a no-fault patient to undergo medical tests and attend the clinic for several months, without regard to medical need, in an effort to increase the potential settlement of a bodily injury claim. Five corporations are also charged in the indictment: SZ Medical, P.C.; Almaz Medical Services, P.C., owned by physician-defendant Lee Craig Nagourney; Ferrato Psychological Services, P.C., owned by psychologist-defendant Michael Ferrato; Life Chiropractic P.C., owned by defendant Peter Pramberger; and Somun Acupuncture, P.C., owned by acupuncturist-defendant Ji Yong Kim. The defendants are facing charges of Insurance Fraud in the Third Degree, a D felony; Insurance Fraud in the Fourth Degree, an E felony; Falsifying Business Records in the First Degree, an E felony; Insurance Fraud in the Fifth Degree, an A misdemeanor, Attempted Grand Larceny in the Fourth Degree, an A misdemeanor; Practicing or Appearing as an Attorney-At-Law Without Being Admitted and Registered, an A misdemeanor; Conspiracy to Commit Grand Larceny in the Fourth Degree, an A misdemeanor; and Attempted Petit Larceny, a B misdemeanor. New York is aggressive in its fight against insurance fraud. To report suspected incidents of insurance fraud call 1-888-FRAUD-NY (1-888-372-8369). It should be noted that an arrest is merely an accusation and that a defendant is presumed innocent until proven guilty.

ARLINGTON, Va., Aug. 12 -- For the first time in the history of the Olympic Games two doctors of chiropractic will serve on the official U.S. Olympic Team medical staff, an elite group of health care providers selected by the U.S. Olympic Committee (USOC) to treat U.S. Olympiads. Drs. Marc Jaffe of Summit, N.J., and Ira Shapiro of Old Bridge, N.J., will join 44 other medical professionals serving the U.S. Olympic Team at the Summer Games in Athens, Greece. Since 1980, there has been only one doctor of chiropractic (DC) included on the medical staff of each U.S. Summer Olympic Team, and 2002 was the first year that a DC served on the U.S. Winter Olympic Team's medical staff. However, increasing athlete demand for chiropractic care has persuaded the USOC to boost the amount of available care at the 2004 Summer Games. "It is a true testament to the value of chiropractic care to be recognized by the U.S. Olympic Committee. It is with great pleasure that ACA's members have served athletes in past Olympics, and with two doctors of chiropractic on staff for this summer's games, we can be assured that our athletes have the best health care available," said American Chiropractic Association (ACA) President Donald J. Krippendorf, DC. During the games, medical staff will be available to the athletes at practice and during competition. Some of the staff will also work with athletes at the USOC's medical clinic in the Athlete's Village. "It's the athlete who realizes the benefit [of chiropractic care]. That's why we're in the Olympic movement," explained Dr. Shapiro. "We fit in perfectly with everything that goes on there." Athletes have long understood the value of chiropractic care as a means to maintain their health and improve their competitiveness. In the past, U.S. athletes sought out chiropractic care on the side because they strongly believed in its effectiveness to alleviate pain at the source and to condition their bodies for peak performance. Additionally, with increased scrutiny surrounding the use of performance-enhancing drugs, athletes are turning to safe, drug-free health care whenever possible. Athletes outside of the Olympics rely on chiropractic care, too. Both Drs. Jaffe and Shapiro have dedicated much of their professional lives to treating the nation's finest athletes. Dr. Jaffe has served as an attending chiropractor for events such as the U.S. Track and Field Championships, the U.S. Weightlifting Championships, the U.S. Triathlon Championships and the New York City Marathon. Furthermore, he is a consultant to the Rutgers University football team and is listed as a treating chiropractor in a manual distributed by the NFL to players for the New York Giants and New York Jets. Dr. Shapiro has an equally illustrious list of credentials that include service as an attending physician at the Gatorade Ironman Triathlon World Championship, the U.S. Figure Skating Championships and the World Championship of Freestyle Wrestling. However, previous experience does not ensure a berth on the U.S. Olympic medical staff. Both doctors were required to complete a rigorous evaluation of their clinical skills and of their abilities to work as a team with Olympic athletes and other medical staff. With the growing popularity of complementary and alternative medicine, chiropractic care has become increasingly integrated with other, more traditional medical treatments. The USOC medical team uses a similar approach by creating a group of providers who work cooperatively to maximize the athletes' health and well-being. "We have a tremendous collaborative working relationship with the other health care professionals," observed Dr. Shapiro -- who adds that there is a saying that the chiropractor is the busiest person around at USOC medical facilities. Chiropractic has been practiced in the United States for more than 100 years, and each year, millions of Americans trust their health to one of the nation's 60,000 doctors of chiropractic. To read research studies about the effectiveness of chiropractic care, visit ACA's website at:

(Issued by Palmer Marketing Department on Friday, July 30, 2004. At its July 2004 semi-annual meeting, the Commission on Accreditation (COA) of the Council on Chiropractic Education (CCE), the chiropractic colleges' specialized accrediting body, met with representatives of the Palmer College of Chiropractic (PCC) Doctor of Chiropractic degree program in a progress review meeting to discuss PCC's requests for substantive change to include Palmer Florida as a branch campus of PCC and the implementation of the Mastery Curriculum at the Florida campus. Following that meeting, the COA met in executive session and reached a consensus decision to extend accreditation to include the Palmer College of Chiropractic Florida (PCCF) site. As of this notice, PCCF will be included in (but not limited to) the regular accreditation cycle for PCC. As such, the Doctor of Chiropractic degree program of Palmer College of Chiropractic Florida is accredited by the Commission on Accreditation of the Council on Chiropractic Education (8049 North 85th Way, Scottsdale, Arizona 85258-4321. Tel: 480-443-8877). In discussing the accreditation, Douglas E. Hoyle, Ph.D., who oversees all accreditation, planning and institutional effectiveness activities, said, "The administration at Palmer has worked diligently for close to the past three years to have this event happen, which is a once in a lifetime event in the history of this college. We are very proud of the effort that has gone into this project, the patience of the students at PCCF while we obtained it, and the belief the faculty had in us while we pursued accreditation." In addition to the actions of the Commission on Accreditation of the Council on Chiropractic Education, Palmer Florida is licensed in the state of Florida by the Florida Commission on Independent Education (License number 2648), and is recognized as an accredited branch campus of Palmer College of Chiropractic by the Higher Learning Commission of Palmer's regional accrediting agency, the North Central Association of Colleges and Schools (30 North LaSalle Street, Suite 2400, Chicago, Illinois 60602-2504 Tel: 800-621-7440).

A chiropractor, licensed or legally authorized by the state or jurisdiction of service, may provide treatment only in the form of manual spinal manipulation to correct a subluxation (provided such treatment is legal in the state where it is performed). Specifically, Medicare defines chiropractors, based on §18601(r) of the Act, as physicians with respect to treatment by means of manual manipulation of the spine (to correct a subluxation) which he is legally authorized to perform by the state or jurisdiction in which treatment is provided. The following article addresses the ordering of X-rays for chiropractic patients. Read more in the Member's Only News Section. If you are not a member, join the NYSCA today and obtain access to the full story above.

Little Progress Seen Since 1999 IOM Report on Medical Errors Lakewood, CO – An average of 195,000 people in the U.S. died due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002, according to a new study of 37 million patient records that was released today by HealthGrades, the healthcare quality company. The HealthGrades Patient Safety in American Hospitals study is the first to look at the mortality and economic impact of medical errors and injuries that occurred during Medicare hospital admissions nationwide from 2000 to 2002. The HealthGrades study applied the mortality and economic impact models developed by Dr. Chunliu Zhan and Dr. Marlene R. Miller in a research study published in the Journal of the American Medical Association (JAMA) in October of 2003. The Zhan and Miller study supported the Institute of Medicine’s (IOM) 1999 report conclusion, which found that medical errors caused up to 98,000 deaths annually and should be considered a national epidemic. The HealthGrades study finds nearly double the number of deaths from medical errors found by the 1999 IOM report “To Err is Human,” with an associated cost of more than $6 billion per year. Whereas the IOM study extrapolated national findings based on data from three states, and the Zhan and Miller study looked at 7.5 million patient records from 28 states over one year, HealthGrades looked at three years of Medicare data in all 50 states and D.C. This Medicare population represented approximately 45 percent of all hospital admissions (excluding obstetric patients) in the U.S. from 2000 to 2002. “The HealthGrades study shows that the IOM report may have underestimated the number of deaths due to medical errors, and, moreover, that there is little evidence that patient safety has improved in the last five years,” said Dr. Samantha Collier, HealthGrades’ vice president of medical affairs. “The equivalent of 390 jumbo jets full of people are dying each year due to likely preventable, in-hospital medical errors, making this one of the leading killers in the U.S.” HealthGrades examined 16 of the 20 patient-safety indicators defined by the Agency for Healthcare Research and Quality (AHRQ) – from bedsores to post-operative sepsis – omitting four obstetrics-related incidents not represented in the Medicare data used in the study. Of these sixteen, the mortality associated with two, failure to rescue and death in low risk hospital admissions, accounted for the majority of deaths that were associated with these patient safety incidents. These two categories of patients were not evaluated in the IOM or JAMA analyses, accounting for the variation in the number of annual deaths attributable to medical errors. However, the magnitude of the problem is evident in all three studies. “If we could focus our efforts on just four key areas – failure to rescue, bed sores, postoperative sepsis, and postoperative pulmonary embolism – and reduce these incidents by just 20 percent, we could save 39,000 people from dying every year,” said Dr. Collier. The HealthGrades study was released in conjunction with the company’s first annual Distinguished Hospital Award for Patient SafetyTM, which honors hospitals with the best records of patient safety. Eighty-eight hospitals in 23 states were given the award for having the nation’s lowest patient-safety incidence rates. A list of winners can be found at http://www.healthgrades.com. Study Highlights

ABSTRACT Dietary niacin and the risk of incident Alzheimer’s disease and of cognitive decline M C Morris, D A Evans, J L Bienias, P A Scherr, C C Tangney, L E Hebert, D A Bennett, R S Wilson and N Aggarwal Background: Dementia can be caused by severe niacin insufficiency, but it is unknown whether variation in intake of niacin in the usual diet is linked to neurodegenerative decline. We examined whether dietary intake of niacin was associated with incident Alzheimer’s disease (AD) and cognitive decline in a large, prospective study. Methods: This study was conducted in 1993–2002 in a geographically defined Chicago community of 6158 residents aged 65 years and older. Nutrient intake was determined by food frequency questionnaire. Four cognitive tests were administered to all study participants at 3 year intervals in a 6 year follow up. A total of 3718 participants had dietary data and at least two cognitive assessments for analyses of cognitive change over a median 5.5 years. Clinical evaluations were performed on a stratified random sample of 815 participants initially unaffected by AD, and 131 participants were diagnosed with 4 year incident AD by standardised criteria. Results: Energy adjusted niacin intake had a protective effect on development of AD and cognitive decline. In a logistic regression model, relative risks (95% confidence intervals) for incident AD from lowest to highest quintiles of total niacin intake were: 1.0 (referent) 0.3 (0.1 to 0.6), 0.3 (0.1 to 0.7), 0.6 (0.3 to 1.3), and 0.3 (0.1 to 0.7) adjusted for age, sex, race, education, and ApoE e4 status. Niacin intake from foods was also inversely associated with AD (p for linear trend = 0.002 in the adjusted model). In an adjusted random effects model, higher food intake of niacin was associated with a slower annual rate of cognitive decline, by 0.019 standardised units (SU) per natural log increase in intake (mg) (p = 0.05). Stronger associations were observed in analyses that excluded participants with a history of cardiovascular disease (ß = 0.028 SU/year; p = 0.008), those with low baseline cognitive scores (ß = 0.023 SU/year; p = 0.02), or those with fewer than 12 years’ education (ß = 0.035 SU/year; p = 0.002) Conclusion: Dietary niacin may protect against AD and age related cognitive decline. SOURCE: Morris, M.C. Journal of Neurology, Neurosurgery, and Psychiatry, August 2004; vol 75: pp 1093-1099.

The New York State Court of Appeals’ June 10, 2004 decision in Belmonte v. Snashall affirmed the New York State Workers’ Compensation Board regulations regarding independent medical examinations, specifically the definition of “board certified” contained in the regulations. The regulations define the term “board certified” as a “physician or surgeon who is certified by a specialty board that is recognized by the American Board of Medical Specialties or the American Osteopathic Association.” Please be advised that because the physicians listed below do not currently satisfy the “board certified” requirement in the regulations as they are not certified by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA), their temporary authorizations to perform independent medical exams have been revoked, effective July 1, 2004. Reports of examination conducted through June 30, 2004 are permitted and the physicians entitled to payment. In addition, testimony and/or depositions concerning independent medical examinations conducted through June 30, 2004 may be provided. Revoked Independent Medical Examinations Authorizations Dominic John Belmonte, MD Donald J. Cally, MD Barry Constantine, MD Arthur Dinoff, MD Harvey Fishman, MD William J. Kilgus, MD Jose R. Lopez-Reymundi, MD Lawrence E. Miller, DO James W. Nelson, MD Jay Alan Rosenblum, MD Librada M. Santos, MD Any questions regarding this matter should be referred to the Office of General Counsel at 518-486-7676. David P. Wehner Chairman

Arlington, VA – For the first time in history, a doctor of chiropractic graduated from a military hospital residency program -- when Joanna Hudec, DC, completed a fellowship in integrative medicine at the National Naval Medical Center (NNMC) in Bethesda, MD on June 18, 2004. Hudec’s history-making graduation is seen by many as one of the clearest signs to date that the chiropractic profession works well with the medical community. Known as “the President’s hospital” because it is the site at which sitting U.S. presidents and other dignitaries receive care, NNMC is considered the “flagship of naval medicine.” The hospital also is the National Capital Region Resource for homeland defense. Most importantly, NNMC keeps the uniformed services mission ready and provides care to their families. “For chiropractic care to be integrated into a program within the most hallowed halls of medicine is an unparalleled step for this profession,” said American Chiropractic Association (ACA) President Donald J. Krippendorf, DC. “The ACA sincerely thanks Dr. Hudec for the shining example she has set for chiropractic.” U.S. Surgeon General Dr. Richard Carmona not only attended the graduation ceremony -- which included about 355 medical interns, residents and fellows -- but also congratulated Dr. Hudec for her efforts and thanked NNMC attending physician William Morgan, DC for the time he spent as the program director of this residency. Additionally, the commanding officers of both NNMC and Walter Reed Army Medical Center thanked Dr. Hudec for her outstanding work. At a dinner following the ceremony, Texas Chiropractic College (TCC) President Richard Brassard, DC, presented Dr. Hudec with a diploma certifying her completion of TCC’s Postdoctoral Fellowship in Integrative Medicine. Dr. Hudec began her 12-month fellowship at NNMC in April of 2003. Recognizing the need for doctors of chiropractic to be trained to work in an integrative hospital environment, TCC Director of Research James Giordano, PhD, and Dr. Morgan envisioned and then implemented the fellowship program, which is expected to become an ongoing, annual program. Dr. Hudec, an ACA member, called the founding of the fellowship program “just the beginning of the advancement of chiropractic into the military.” “In establishing this fellowship program, Texas Chiropractic College has made a very real contribution to our profession’s ongoing efforts toward integration into both the military health care system and our nation’s hospital system,” said Dr. Krippendorf. During her fellowship program, Dr. Hudec established a chiropractic clinic for the medical students at the Uniformed Services University of the Health Sciences (USUHS), also located in Bethesda, MD. That clinic is believed to be the only chiropractic clinic ever established within a medical school. A major goal of the military hospital chiropractic fellowship program is to provide a qualified pool of doctors of chiropractic to serve the needs of civilian, Department of Veterans Affairs (DVA) and Department of Defense (DOD) hospital-based chiropractic clinics.

Abstract Background: Although the effectiveness of manipulative therapy for treating back and neck pain has been demonstrated, the validity of many of the procedures used to detect joint dysfunction has not been confirmed. Practitioners of manual medicine frequently employ motion palpation as a diagnostic tool, despite conflicting evidence regarding its utility and reliability. The introduction of various spinal models with artificially introduced 'fixations' as an attempt to introduce a 'gold standard' has met with frustration and frequent mechanical failure. Because direct comparison against a 'gold standard' allows the validity, specificity and sensitivity of a test to be calculated, the identification of a realistic 'gold standard' against which motion palpation can be evaluated is essential. The objective of this study was to introduce a new, realistic, 'gold standard', the congenital block vertebra (CBV) to assess the validity of motion palpation in detecting a true fixation. Methods: Twenty fourth year chiropractic students examined the cervical spines of three subjects with single level congenital block vertebrae, using two commonly employed motion palpation tests. The examiners, who were blinded to the presence of congenital block vertebrae, were asked to identify the most hypomobile segment(s). The congenital block segments included two subjects with fusion at the C2– 3 level and one with fusion at C5-6. Exclusion criteria included subjects who were frankly symptomatic, had moderate or severe degenerative changes in their cervical spines, or displayed signs of cervical instability. Spinal levels were marked on the subject's skin overlying the facet joints from C1 to C7 bilaterally and the motion segments were then marked alphabetically with 'A' corresponding to C1-2. Kappa coefficients (K) were calculated to determine the validity of motion palpation to detect the congenitally fused segments as the 'most hypomobile' segments. Sensitivity and specificity of the diagnostic procedure were also calculated. Results: Kappa coefficients (K) showed substantial overall agreement for identification of the segment of greatest hypomobility (K = 0.65), with substantial (K = 0.76) and moderate (K = 0.46) agreement for hypomobility at C2-3 and C5-6 respectively. Sensitivity ranged from 55% at the C5-6 CBV to 78% at the C2-3 level. Specificity of the procedure was high (91 – 98%). Conclusion: This study indicates that relatively inexperienced examiners are capable of correctly identifying inter-segmental fixations (CBV) in the cervical spine using 2 commonly employed motion palpation tests. The use of a 'gold standard' (CBV) in this study and the substantial agreement achieved lends support to the validity of motion palpation in detecting major spinal fixations in the cervical spine. BMC Musculoskeletal Disorders 2004, 5:19 - Published: 15 June 2004

ABSTRACT Effect of Dextromethorphan, Diphenhydramine, and Placebo on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents Objectives. To determine whether the commonly used over-the-counter medications dextromethorphan and diphenhydramine are superior to placebo for the treatment of nocturnal cough and sleep difficulty associated with upper respiratory infections and to determine whether parents have improved sleep quality when their children receive the medications when compared with placebo. Methods. Parents of 100 children with upper respiratory infections were questioned to assess the frequency, severity, and bothersome nature of the nocturnal cough. Their answers were recorded on 2 consecutive days, initially on the day of presentation, when no medication had been given the previous evening, and then again on the subsequent day, when either medication or placebo was given before bedtime. Sleep quality for both the child and the parent were also assessed for both nights. Results. For the entire cohort, all outcomes were significantly improved on the second night of the study when either medication or placebo was given. However, neither diphenhydramine nor dextromethorphan produced a superior benefit when compared with placebo for any of the outcomes studied. Insomnia was reported more frequently in those who were given dextromethorphan, and drowsiness was reported more commonly in those who were given diphenhydramine. Conclusions. Diphenhydramine and dextromethorphan are not superior to placebo in providing nocturnal symptom relief for children with cough and sleep difficulty as a result of an upper respiratory infection. Furthermore, the medications given to children do not result in improved quality of sleep for their parents when compared with placebo. Each clinician should consider these findings, the potential for adverse effects, and the individual and cumulative costs of the drugs before recommending them to families. Ian M. Paul, MD, MSc, Katharine E. Yoder, Kathryn R. Crowell, MD, Michele L. Shaffer, PhD, Heidi S. McMillan, MD, Lisa C. Carlson, MD, Deborah A. Dilworth, RN and Cheston M. Berlin, Jr., MD Pediatrics 2004; 114: e85-e90.

Centers for Disease Control and Prevention (CDC) released study on the use of complementary and alternative medicine (CAM) in U.S. The study involved more then 31,000 U.S. adults and appears to be one of the most comprehensive to date. To view the study click on the link below:

ABSTRACT Objective: We hypothesized that primary care physicians (PCPs) specializing in a nonpharmaceutical/nonsurgical approach as their primary modality and utilizing a variety of complementary/alternative medicine (CAM) techniques integrated with allopathic medicine would have superior clinical and cost outcomes compared with PCPs utilizing conventional medicine alone. Design: Incurred claims and stratified randomized patient surveys were analyzed for clinical outcomes, cost offsets, and member satisfaction compared with normative values. Comparative blinded data, using nonrandomized matched comparison groups, was analyzed for age/sex demographics and disease profiles to examine sample bias. Setting: An integrative medicine independent provider association (IPA) contracted with a National Committee for Quality Assurance (NCQA)-accredited health maintenance organization (HMO) in metropolitan Chicago. Subjects: All members enrolled with the integrative medicine IPA from January 1, 1999 through December 31, 2002. Results: Analysis of clinical and cost outcomes on 21,743 member months over a 4-year period demonstrated decreases of 43.0% in hospital admissions per 1000, 58.4% hospital days per 1000, 43.2% outpatient surgeries and procedures per 1000, and 51.8% pharmaceutical cost reductions when compared with normative conventional medicine IPA performance for the same HMO product in the same geography over the same time frame. Conclusion: In the limited population studied, PCPs utilizing an integrative medical approach emphasizing a variety of CAM therapies had substantially improved clinical outcomes and cost offsets compared with PCPs utilizing conventional medicine alone. While certainly promising, these initial results may not be consistent on a larger and more diverse population. Sarnat RL, Winterstein J. Journal of Manipulative and Physiological Therapeutics. June 2004; Vol. 27, No. 5.

WASHINGTON -- Veterans can receive chiropractic care at 26 selected Department of Veterans Affairs (VA) facilities beginning this fall, Secretary of Veterans Affairs Anthony J. Principi announced today. VA will hire or contract with doctors of chiropractic to provide the care. In consultation with VA primary care providers, doctors of chiropractic will offer patient evaluations and chiropractic care for neuromusculoskeletal conditions. "Today, VA makes another significant improvement to the world-class health care we provide for eligible veterans," said Principi. "Veterans who will benefit from chiropractic services will now have the opportunity to receive chiropractic care to restore them to good health." Locations where chiropractic care will be provided include Togus, Maine; West Haven and Newington, Conn.; Buffalo and the Bronx, N.Y.; Butler, Pa.; Martinsburg, W.Va.; Columbia, S.C.; Augusta, Ga.; Tampa and Miami, Fla.; Mountain Home, Tenn.; Columbus, Ohio; Danville, Ill.; Iron Mountain, Mich.; Kansas City, Kan.; Jackson, Miss.; San Antonio, Temple, and Dallas, Texas; Albuquerque, N.M.; Fort Harrison, Mont.; Seattle, Wash.; Sacramento and Los Angeles, Calif.; and Sioux Falls, S.D. Eligible veterans in areas distant from these locations will also be able to receive chiropractic care through VA's outpatient fee-basis program after a referral by their primary care provider, and prior authorization by the department. VA was authorized to offer chiropractic care and services under the provisions of section 204 of Public Law 107-135, the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001. Chiropractors seeking employment or to provide contract services to veterans should call the Human Resources office of any of the above facilities. Some VA positions may be advertised at:

Effective June 26, 2004, the New York State Workers’ Compensation Board is rescinding the designation of Northeast Medical Evaluation and Diagnostic Services, P.C. as an entity registered to derive income from independent medical examinations in workers’ compensation cases. This rescission is made pursuant to Section 13-n of the Workers’ Compensation Law and 12 NYCRR 300.2 (e). This rescission is permanent. The entity’s address is: Northeast Medical Evaluation and Diagnostic Services, P.C. 900 Merchants Concourse Westbury, New York 11590 On the effective date of this rescission, the entity named above is permanently prohibited from deriving income from independent medical examinations in workers’ compensation cases. Examinations conducted prior to June 26, 2004 are valid. Any questions regarding this matter should be referred to the Office of General Counsel at 518-486-7676. David P. Wehner Chairman

ABSTRACT The goal of this review is to evaluate the efficacy of commonly available dietary supplements in the treatment of hypertension, using the average blood pressure reduction achieved with the implementation of lifestyle modifications as a standard. For this reason, the authors focus on the antihypertensive potential of these agents rather than pharmacology, pharmacokinetics, adverse effects, or supplement ñ drug interactions. For the purpose of this review, dietary supplements are defined as exhibiting some evidence of benefit if a systolic blood pressure reduction of 9.0 mm Hg or greater and/or a diastolic blood pressure reduction of 5.0 mm Hg or greater has been observed in previously published, peer-reviewed trials. These defining limits are based on the average blood pressure reduction associated with the implementation of certain lifestyle modifications. Agents with some evidence of benefit include coenzyme Q10, fish oil, garlic, vitamin C, and L-arginine. J Clin Hypertens (2004) 6;5:242-248

ABSTRACT Objective: To investigate whether, there is an association between consumption of fruit and vegetables and dietary antioxidants and the risk of developing inflammatory polyarthritis (IP). Methods: In a prospective, population based, nested case-control study of residents of Norfolk, UK, men and women aged 45–74 years were recruited, between 1993 and 1997 through general practice age-sex registers to the Norfolk arm of the European Prospective Investigation of Cancer (EPIC-Norfolk). Dietary intake was assessed at baseline using 7 day diet diaries. Seventy three participants who went on to develop IP between 1993 and 2001 and were registered by the Norfolk Arthritis Register (NOAR) were identified. Incident cases of IP, assessed by general practitioners, fulfilled the criteria of two or more swollen joints, persisting for a minimum of 4 weeks. Each case of IP was matched for age and sex with two controls free of IP. Results: Lower intakes of fruit and vegetables, and vitamin C were associated with an increased risk of developing IP. Those in the lowest category of vitamin C intake, compared with the highest, increased their risk of developing IP more than threefold, adjusted odds ratio (OR) with 95% confidence intervals (CI) 3.3 (95% CI 1.4 to 7.9). Weak inverse associations between vitamin E and ß-carotene intake and IP risk were found. Conclusion: Patients with IP (cases) consumed less fruit and vitamin C than matched controls, which appeared to increase their risk of developing IP. The mechanism for this effect is uncertain. Thus similar studies are necessary to confirm these results. Annals of the Rheumatic Diseases 2004;63:843-847

SALT LAKE CITY, - Dynatronics Corporation today announced the U.S. Food and Drug Administration has given marketing clearance for the company's new Solaris D890 low-power laser probe. The laser treats muscle and joint pain, including the pain and stiffness associated with arthritis. The Solaris D890 is the second probe designed for use as an accessory to the company's popular new Solaris Series products. The probe is expected to be ready for shipment within 30 to 60 days. "We are thrilled with the FDA's decision to allow us to begin marketing this laser probe," stated Kelvyn H. Cullimore Jr., president of Dynatronics. "Our first attempt to obtain approval for a laser probe was over 20 years ago. That makes this clearance even more satisfying." According to Larry K. Beardall, Dynatronics' executive vice president of marketing and sales, "The new D890 probe will expand the foundation of success our Solaris product line has already achieved. With two decades of clinical research behind them, lasers have been of keen interest to the medical community and have found many applications in medical settings. Hundreds of people around the country have already benefited from light therapy. The results have been remarkable." More information regarding this technology is available at:

CHESTERFIELD, Mo., June 7, 2004 – Logan College of Chiropractic President Dr. George Goodman, D.C. has announced the official opening of a new $4 million state-of-the-art learning and research center that will provide a valuable educational tool to students and healthcare professionals in the St. Louis area. The new Logan Learning Resources Center will be dedicated at ceremonies beginning at 5 p.m., Thursday, June 10, on the school’s campus at 1851 Schoettler Road, in Chesterfield. Area dignitaries and other public officials are expected to attend. “We are extremely proud of our new center because it represents Logan’s commitment to providing its students with a state-of-the-art library and research facility, and exemplifies the generosity and vision of those who help to make it possible,” Dr. Goodman said. The center and library will provide a wide range of books, video, audio, and computer facilities for Logan’s 1,100 students, and also will be available for use by other St. Louis-area college and high school students, teachers, and chiropractors. “St. Louis is nationally recognized as one of the nation’s leading healthcare and research destinations, and we hope this facility will be viewed as a valuable addition to the area’s health and educational facilities,” Dr. Goodman added. The new center houses a library, computer lab that has 75 workstations with Internet access, and a state-of-the-art distance learning facility with a variety of multimedia capabilities. It also contains a collection of approximately 12,000 books, 260 trade and professional journals with 32,000 issues, 1,100 video recordings, and more than 400 audio learning tapes. Because Logan specializes in health and chiropractic education, the center has an extensive collection of human skulls, skeletons, and other bones, along with artificial anatomical models, available for anatomy and human science studies. Bob Snyders, the center’s director, said the facility has a significant concentration of books and other learning tools that focus on anatomy, biology, life sciences, and other health-related topics. “We hope college, university, and high school students throughout the St. Louis area, that might be considering a career in healthcare, research, or related fields of study, will take advantage of the specialized materials available at the new Logan Learning Resources Center,” Snyders said. Group and individual study facilities are available, including separate rooms furnished with computers and media equipment, he added. Logan College is a member of the Missouri Bibliographic Information User System (MOBIUS), a network of more than 50 college and university libraries throughout Missouri that enables students around the state to have Internet access to the online card catalogs of the other member libraries. Snyders said that students, faculty, and staff from any MOBIUS library may borrow books from any of the other MOBIUS libraries. This can be done online or in person. Books requested online are delivered via a statewide courier service, and generally arrive within three business days. Logan is a nonprofit institution of higher education founded in 1935 in St. Louis. The school is the largest chiropractic college in Missouri and the second largest chiropractic college or university in the nation. The college offers Bachelor of Science degrees in human biology and life sciences, as well as the Doctor of Chiropractic degree. Logan also provides healthcare for patients in the greater St. Louis metropolitan area through eight local health centers in St. Louis City, St. Louis County, and St. Charles County. Chiropractic is the third largest profession of healthcare delivery in the world (behind only medicine and dentistry), and more than 26 million Americans seek treatment from doctors of chiropractic each year. State-of-the-Art Facility Is Available to Area Students, Healthcare Professionals

Abstract: Purpose: Delineating between functional and mechanical instability in those with chronic ankle dysfunction is a challenging task. Current methods of assessing ankle ligamentous laxity are subjective in nature and limit our ability to identify the site and extent of instability; therefore, a need exists for objective laxity measurements. The purpose of this study was to determine whether subjects with self-reported, functional ankle instability (FAI) demonstrated increased mechanical laxity when tested with instrumented arthrometry and stress radiography. Methods: Both ankles were tested in 51 subjects with self-reported unilateral FAI. An instrumented ankle arthrometer measured ankle-subtalar joint motion for total anteroposterior (AP) displacement (mm) during loading at 125 N and total inversion-eversion (I-E) rotation (degrees of ROM) during loading at 4 N[middle dot]m. The Telos GA-II/E device provided either anterior or lateral stress (15 kp) while fluoroscopic radiographs were recorded for anterior displacement (mm) and talar tilt (degrees). Results: The arthrometry measurements of anterior and total AP displacement and the radiographic measurements of anterior displacement were greater (P < 0.05) in the FAI ankles when compared with the uninjured ankles. There were no differences in total I-E rotation, inversion rotation, or talar tilt between ankles when analyzed with either measurement technique. Conclusion: The ability to objectively measure mechanical instability in the functionally unstable ankle is important to understanding the nature and cause of the instability. Ankle arthrometry and stress radiographic measurements are objective assessment tools for mechanical laxity. Despite finding greater laxity in the functionally unstable ankle, the clinical significance of the observed displacement remains unanswered. Further research is needed to determine the amount of laxity that constitutes mechanical instability and how this relates to FAI. Medicine & Science in Sports & Exercise. 36(5):760-766, May 2004. © 2004 American College of Sports Medicine

ABSTRACT Rhinoviruses are major causes of morbidity in patients with respiratory diseases; however, their modes of transmission are controversial. We investigated detection of airborne rhinovirus in office environments by polymerase chain reaction technology and related detection to outdoor air supply rates. We sampled air from 9 A.M. to 5 P.M. each workday, with each sample run for 1 work week. We directly extracted RNA from the filters for nested reverse transcriptase–polymerase chain reaction analysis of rhinovirus. Nasal lavage samples from building occupants with upper respiratory infections were also collected. Indoor carbon dioxide (CO2) concentrations were recorded every 10 minutes as a surrogate for outdoor air supply. To increase the range of CO2 concentrations, we adjusted the outdoor air supply rates every 3 months. Generalized additive models demonstrated an association between the probability of detecting airborne rhinovirus and a weekly average CO2 concentration greater than approximately 100 ppm, after controlling for covariates. In addition, one rhinovirus from a nasal lavage contained an identical nucleic acid sequence similar to that in the building air collected during the same week. These results suggest that occupants in buildings with low outdoor air supply may have an increased risk of exposure to infectious droplet nuclei emanating from a fellow building occupant.