Asthma many children may not grow out of it as has previously been assumed

Many children may not simply ‘grow out’ of asthma when they become teenagers, as has previously been widely assumed, according to a US study.

Doctors at the University of Arizona studied 781 children in the ‘Tucson Respiratory cohort’ – a group of children born at approximately the same time whose respiratory health has been tracked from birth by researchers.

They found that wheezing symptoms continued during adolescence in over half of the children who had asthma diagnosed before puberty. ‘Our findings challenge the commonly held view that asthma usually remits during adolescence,’ said Dr Stefano Guerra, who led the research. ‘Only 42% of children with asthma reported no wheezing in the first four years after the onset of puberty.’

Looking more closely at their results, the researchers found that obesity and the age at which puberty starts may play a part in determining whether a child ‘grows out’ of asthma or not in their teen years. Among the children who continued to experience asthma symptoms as adolescents, a disproportionate amount were overweight or had been younger to enter puberty. Being obese doubled the likelihood of a child having persistent asthma, said the scientists. ‘These findings expand our understanding of the relationship between obesity and asthma,’ said Dr Guerra.

‘This study reminds us that we shouldn’t assume that a child’s asthma will disappear as they grow up, but the link between asthma and obesity may not be quite so simple,’ said Kate Webb, Senior Policy & Information Officer at Asthma UK.

‘Asthma isn’t limited to overweight children,’ she added. ‘It would be interesting to know whether the teenagers in this study are obese as a result of their condition, which may be due to less exercise, or whether their obesity has caused their asthma,’ she added.

The research was published in the American Journal of Respiratory and Critical Care Medicine.

For advice and information on asthma, call the Asthma UK Adviceline (08457 01 02 03) or email an asthma nurse specialist.


Contact Lens Wearers Seek Relief From Spring Allergies

For millions of Americans, the arrival of Spring brings with it ocular allergy symptoms such as itching, tearing, and redness. Ocular allergies affect 1 in every 5 individuals and are among the most common reasons that people consult various health care professionals for advice on possible treatment and management. It is estimated that 50 percent of individuals with seasonal and indoor allergies also experience some degree of eye allergies.1,2

While eye allergy symptoms are a year-round problem for many, about 67 percent of allergy sufferers, say that Spring is the time of year when eye allergy symptoms are worst, according to a recent survey conducted by the Asthma & Allergy Foundation of America (AAFA), the leading patient advocacy organization for people with asthma and allergies. For respondents who wear contact lenses, Spring is particularly frustrating as nearly half (45%) say that their eye-related allergy problems often prevent them from wearing their contacts, and one in ten (12%) admits to having to stopped wearing their contacts because of allergies.

The majority of respondents report that they wear their lenses two weeks, one month or longer. In a recent study presented at the 87th annual meeting of The American Academy of Optometry, researchers reported that only about one-third (36%) of wearers of contact lenses prescribed for monthly replacement said that they replaced their lenses as prescribed. Over half (55%) replaced them within five weeks, 23 percent at eight weeks or more, and 14 percent at ten weeks or more.3

“As contact lenses age, they accumulate deposits that may impact the ocular surface,” explains Paul Karpecki, O.D., F.A.A.O., Clinical Director, Koffler Vision Group, Lexington, Kentucky. “Factor in the research that shows these patients are not being compliant with their wearing and replacement schedule, and it’s no surprise that many are experiencing ocular discomfort and distress. Certain care systems contain preservatives which may further exacerbate discomfort for some allergy sufferers.”

According to Dr. Karpecki, the use of one-day lenses can help minimize the discomfort of the contact lens-allergy combination. One study found that 67 percent of ocular allergy sufferers who switched to one-day lenses reported improved comfort while only 18 percent of those who simply replaced their conventional two-week daily wear soft contact lenses reported improvement.4

“Studies have shown that one-day contacts, such as 1???day acuvue® MOIST® Brand Contact Lenses can be a healthy and more comfortable option for any lens wearer, including those with eye allergies,” he explains. “By putting in a clean, fresh lens every day, one-day contacts minimize the potential for accumulation of allergens and irritants that can often accumulate with repeated use of the same pair of lenses.”

To help allergy sufferers better understand and manage their condition, AAFA offers a free educational brochure titled “Eye Health and Allergies.” The brochure, which also includes smart allergy season strategies for contact lens wearers, can be viewed or downloaded at aafa/eyeallergies. The brochure, along with a free trial-pair certificate* for 1???day acuvue® MOIST® Brand, is also available at acuvue/seasons.

ACUVUE® Brand Contact Lenses are indicated for vision correction. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. Lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness or other eye problems. Consult the package insert for complete information. Complete information is also available from VISTAKON®, Division of Johnson & Johnson Vision Care, Inc., by calling 1-800-843-2020 or by visiting acuvue.

Clinical research has shown when worn on a daily disposable basis, 1???DAY ACUVUE® Brand Contact Lenses and other daily disposable etafilcon A contact lenses such as 1???DAY ACUVUE® MOIST® Brand Contact Lenses may provide improved comfort for many patients suffering from mild discomfort and/or itching associated with allergies during contact lens wear compared to lenses replaced at intervals of greater than 2 weeks.

*Professional exam and fitting fees not included. Valid only while supplies last.

1 Katelaris CH, Bielory L. Evidence-based study design in ocular allergy trials. Curr Opin Allergy Clin Immunol. 2008;8(5):484-488.

2Bassett C. Ocular Allergies. Asthma & Allergy Advocate. Summer 2007. American Academy of Allergy Asthma & Immunology Web site. aaaai/patients/advocate/~. Accessed November 3, 2008.

3 Hickson-Curran, Sheila, Chou, Patricia, Gardere, Jill, “Longer Prescribed Replacement Intervals leads to More Stretching of Frequent Replacement Contact Lenses”, presented at American Academy of Optometry Meeting, November 2009

4 “Hayes, VY, Schnider, CM and Veys, J. “An evaluation of 1-day disposable contact lens wear in a population of allergy sufferers,” CL & Ant Eye, 26 (2003) 85-93

ACUVUE® and 1???DAY ACUVUE® MOIST® are trademarks of Johnson & Johnson Vision Care, Inc.

The Asthma and Allergy Foundation of America

New Therapy For Asthma Is A Breath Of Fresh Air

Glucocorticoids, the treatment of choice for many people with asthma, boost production of the molecule IL-10, which helps decrease airway inflammation. However, some asthmatic patients are resistant to glucocorticoid therapy because their T cells do not produce IL-10 in response to these steroids. In a study appearing online on December 8 in advance of print publication in the January 2006 issue of the Journal of Clinical Investigation, Catherine Hawrylowicz and colleagues from King’s College London investigate IL-10-producing T cells in the context of human allergic and asthmatic disease.

The authors show that pre-treatment of patient T cells with IL-10 and vitamin D3 can overcome this defect and greatly enhance glucocorticoid-induced IL-10 synthesis by T cells from asthmatic patients who were resistant to glucocorticoid therapy. These manipulations increase IL-10 production to levels comparable to those observed in patients who do respond well to therapy. IL-10 increases glucocorticoid receptor expression, and the authors propose that this is the mechanism by which IL-10 overcomes the glucocorticoid-resistant patient defect in IL-10 synthesis. Therefore, this population of IL-10-producing T cells may help treat human allergic diseases and reverse glucocorticoid resistance in asthma.

TITLE: Reversing the defective induction of IL-10-secreting regulatory T cells in glucocorticoid-resistant asthma patients

View the PDF of this article at:

Brooke Grindlinger
Journal of Clinical Investigation – Dec 8th

UNICEF: Children And Women Displaced By Conflict In Pakistan Need Urgent And Ongoing Support

UNICEF is deeply concerned about the condition of thousands of children who have been displaced by conflict, or who remain in affected areas, in north-western Pakistan. Nearly 50 per cent of the estimated 2 million displaced are children, many of whom are in urgent need of health and educational services, nutritional support, access to clean water and sanitation as well as protection. Their situation has been compounded by the harsh summer temperatures.

UNICEF is especially concerned that some 700,000 children are due to start the new school year in September in 3,700 schools that are currently occupied by 150,000 IDPs. If these schools are not vacated and rehabilitated soon, the education of all these children will be interrupted. Some of these children could even drop out of the education system permanently.

The speed and magnitude of the crisis has stretched the capacity of the government, host communities and humanitarian actors to the limit. Though fighting is reported to have subsided in Swat and Buner, IDPs continue to seek refuge in camps and communities in northern parts of North West Frontier Province (NWFP) and new displacements are being recorded into southern parts of the province due to military operations in South Waziristan.

“In Pakistan we face a unique humanitarian challenge, since the vast majority of the displaced are seeking shelter in host communities which are far more difficult to reach with basic services than in the camps,” said UNICEF’s Director of Emergency Programmes, Louis-Georges Arsenault.

While basic needs are being met in camps, the situation is critical for the vast majority of IDPs living in host communities. In the thousands of school buildings that have been converted into IDP shelters and other spontaneous camps that have sprung up throughout parts of NWFP to cope with the influx of people from conflict-affected areas, children and families are living in cramped conditions with limited to negligible access to safe drinking water and sanitation – and are difficult to reach with basic hygiene materials and education to decrease the likelihood of water borne diseases. At equal risk are host communities who are shouldering the burden with limited resources and fragile infrastructure in the aftermath of food prices spikes that took root in 2007.

UNICEF is working closely with the government of Pakistan and other partners to provide services and information to displaced children and women. To prevent the outbreak of diseases, over 200,000 children have been vaccinated against measles and 230,000 people receive safe drinking water and hygiene education in IDP camps and communities. To date, 47,400 children and 20,400 mothers have been screened for malnutrition, and the 11,000 moderately malnourished have received care within their own communities. While malnutrition rates are presently low, the vulnerability of the population requires sustained support to prevent the situation from deteriorating rapidly.

The Pakistan Humanitarian Response Plan, revised in May to cope with new displacements caused by the military operations in Swat and Buner, has so far raised less than a third of the $543 million required to support 1.7 million IDPs for six months. As part of the Appeal, UNICEF requested $52 million. To date $22.5 million has been received from donors and is in hand -and another $9.3 million has been pledged.

“Without sufficient funding, it will be impossible to ensure that thousands of children and families affected by the conflict have the services and support they require in the time of their greatest need. Equally important is support to the host communities who are struggling to cope with their new found burden,” said Arsenault.


Presented At CHEST 2009 – New Pediatric Lung Health Research

Children With Asthma May Benefit From Reduction in Daily Steroids

Children with status asthmaticus, those who experience prolonged and serious asthma attacks, may safely be able to reduce their daily corticosteroid dose. Researchers from Kosair Children’s Hospital in Kentucky conducted before and after chart reviews of 292 patients younger than 18 years who were hospitalized with status asthmaticus. Eligible patients had received methylprednisolone, prednisolone, or prednisone. Steroid dosing for group 1 (152 patients) was 1 mg/kg/dose every 6 hours (maximum of 240 mg/day) and 0.5 to 1 mg/kg/dose every 12 hours (maximum of 60 mg/day) for group 2 (141 patients). The average length of hospital stay for was 2.01 days for group 1 and 1.98 days for group 2, suggesting there was no effect on length of stay. Researchers conclude that decreasing the daily dose of systemic corticosteroids for status asthmaticus does not affect the length of hospital stay.

High-Dose Inhaled Albuterol Associated With Metabolic Acidosis

Patients with severe acute asthma may be at a higher risk of developing metabolic acidosis, an excess of acid in the blood. In a retrospective analysis, researchers from Yale School of Medicine reviewed demographic and physiologic data of 201 pediatric patients (younger than18 years) admitted to the pediatric ICU with a diagnosis of severe acute asthma. Results showed that heart rate and respiratory rate were higher in patients receiving high-dose albuterol (>10 mg/h), and 14 patients (33 percent) developed metabolic acidosis. In addition, 13 patients (43.3 percent) receiving high-dose albuterol developed metabolic acidosis compared with one patient (8.3 percent) receiving low-dose (

Swine Dust Inhalation Alters Lung Cilia Function

Cilia, tiny hair-like structures on the lung’s lining, propel mucus
up and out of the lung using a synchronised back-and-forth wave-like
motion. Excess mucus is created when an irritant, like bacteria or
dust, enters the lung.

It is vital to a person’s health that the cilia effectively move the
irritant-carrying mucus out of the lung. Interestingly, some
irritants are known to make the cilia beat faster and some make the
cilia beat more slowly.

Swine confinement workers suffer from many lung ailments. Based on
what is known about other irritants, Todd A. Wyatt (University of
Nebraska Medical Center, USA) and his colleagues hypothesised that
dust from a swine confinement facility would affect the cilia and
their ability to move mucus.

Using a cultured ciliated cell model, the authors of this study
conclude that swine confinement facility dust does indeed affect
cilia and its ability to clear mucus.

Exposing epithelial cells to swine confinement facility dust
initially causes a slight increase in the speed at which the cilia
beat. However, when a substance known to make the cilia beat faster
under normal circumstances is added to dust-treated cells, the cilia
do not beat faster.

Upon mechanistic inspection, the American team finds that both nitric
oxide and interleukin-8 found in the dust regulated these cilia effects.

These studies may provide a basis for the chronic inhalation injuries
observed in some agricultural workers exposed to organic dusts.

Title of original article-

Exposure to hog barn dust alters airway epithelial ciliary beating

The European Respiratory Journal is the peer-reviewed scientific publication of the European Respiratory Society (more than 8,000 specialists in lung diseases and respiratory medicine in Europe, the United States and Australia).

European Respiratory Journal

Four University Of Montreal Discoveries To Be Commercialized By Univalor And Cognitive Sensing Inc.

Cutting-edge technologies are about to enter the marketplace, thanks to a new partnership between Gestion Univalor, Limited Partnership (Univalor) and Cognitive Sensing Inc. (CSI), a privately owned technology company based in Montreal.

Univalor, which commercializes discoveries from the Universit?© de Montr?©al and its affiliated institutions, and CSI have announced the signature of a license agreement giving CSI exclusive worldwide rights to develop, manufacture and market four scientifically proven products developed by Jocelyn Faubert, a professor at the Universit?© de Montr?©al School of Optometry and CSI’s chief science officer.

Among the most anticipated products to emanate from Professor Faubert’s lab is a portable sports simulator that allows athletes to improve their game and reaction time. Another technology opens doors to the early detection, measurement and treatment of concussions and conditions such as Alzheimer’s and autism.

“We are impressed by the quality of the research generated by Prof. Jocelyn Faubert and his team. Technologies created in his lab present exciting market opportunities in the medical, sports and rejuvenation markets,” says Jean Castonguay, chief executive officer of CSI and a seasoned entrepreneur. “CSI has already entered into agreements with Industry leaders to validate the first applications of these technologies”.

Adds Marc Leroux, CEO of Univalor: “We are delighted to associate these Universit?© de Montr?©al technologies with CSI and their experienced management team. We look forward to a lasting relationship.”

Patented technologies: Scientific validation of Prof. Faubert’s technologies was established in numerous peer-reviewed journals such as Brain and Psychological Science. His creations are currently being tested at several centers; the first are set for commercial validation in January 2010. Under the licensing agreement, CSI will provide financial support for patent protection in various territories in addition to other payments. The patented technologies include:
MPI (Mild Perceptual Impairment Device): An apparatus to diagnose and monitor brain trauma, concussions, Alzheimer’s disease and other neurobiological conditions.

3D-MOT (3D Multiple Object Tracking): A device to enhance sports performance, as well as assess, train and improve perception in people of all ages.

MSRS (Multisensory Stochastic Resonance Stimulation): A technology to improve sense and balance via auditory and visual stimulation.

Noisy Bits: Software to improve image quality in standard displays and projectors by generating continuous luminance.

Source: Sylvain-Jacques Desjardins

University of Montreal

Current And Emerging Therapies Have No Advantage Over Enbrel In Reducing The Signs And Symptoms Of Rheumatoid Arthritis

Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that surveyed rheumatologists say that a therapy’s effect on reducing the signs and symptoms of rheumatoid arthritis at one year is the attribute that most influences their prescribing decisions in treating the disease. Clinical data and the opinions of interviewed thought leaders indicate that current and emerging therapies have no advantage in this attribute over Amgen/Wyeth/Takeda’s Enbrel (etanercept), the market sales-leading agent.

The new report entitled Rheumatoid Arthritis: A Novel Oral Therapy Must Satisfy Physicians’ High Expectations for Efficacy to Tap Significant Market Opportunity finds that an oral disease-modifying drug with a novel mechanism of action that is priced 20 percent lower than etanercept plus methotrexate would earn a 25 percent patient share in the United States and a 20 percent patient share in Europe, according to surveyed U.S. and European rheumatologists.

Decision Resources’ proprietary clinical gold standard in 2008 for rheumatoid arthritis was Enbrel, most notably because of its superior efficacy in inhibiting/slowing structural damage progression at one and two years compared with other agents in the market. Following its approval for the indication, which is likely to occur in 2010, Centocor/Schering-Plough/Mitsubishi Tanabe/Janssen’s Simponi (golimumab) will earn Decision Resources’ gold standard for rheumatoid arthritis in 2012. Although Simponi’s overall efficacy, safety and tolerability do not match that of Enbrel, its advantages in delivery differentiate it from Enbrel.

“Simponi ranks higher than Enbrel on the measures of dosage formulation and dosage frequency,” said Decision Resources Analyst Dancella Fernandes, Ph.D. “Simponi offers an alternative formulation and once-monthly dosing compared with Enbrel’s once- to twice-weekly dosing. By differentiating itself with improved delivery features, Simponi separates itself in a market crowded with drugs boasting similar efficacy and safety profiles.”

About the Report

Rheumatoid Arthritis: A Novel Oral Therapy Must Satisfy Physicians’ High Expectations for Efficacy to Tap Significant Market Opportunity is a DecisionBase 2009 report. DecisionBase 2009 is a decision-support tool that provides in-depth analysis of unmet need, physician expectations of new therapies and commercial dynamics to help pharmaceutical companies optimize their investments in drug development.

The report can be purchased by contacting Decision Resources. Members of the media may request an interview with an analyst.

About Decision Resources

Decision Resources (decisionresources) is a world leader in market research publications, advisory services and consulting designed to help clients shape strategy, allocate resources and master their chosen markets. Decision Resources is a Decision Resources, Inc. company.

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Please visit Decision Resources, Inc. at DecisionResourcesInc.

All company, brand, or product names contained in this document may be trademarks or registered trademarks of their respective holders.

Decision Resources

View drug information on Enbrel; Simponi.

Exercise Milo – Rehearsing London’s Health Response, UK

The Health Protection Agency, on behalf of the Department of Health and in conjunction with NHS London, will be holding Exercise Milo to train London’s Emergency Services and prepare and exercise their health-led response to potential major incidents.

The event will be held at the ExCeL London conference centre and at the Homerton Hospital on June 29 2010.

This field exercise will involve a variety of participants (known as ‘players’) ranging from NHS London to the Metropolitan Police and Amputees in Action. The scenario for the exercise involves a chemical incident at a major sporting event for disabled athletes. Exercise Milo was created specifically to include disabled people, something that has never been tested this widely before.

Some 600 people in total will be involved in the exercise: 150 of them players from the emergency services, 120 volunteer casualties, 150 controlling and evaluating staff as well as staff volunteers at the Homerton Hospital

“Exercise Milo provides an excellent opportunity for London to rehearse its planned response to a major incident in the capital,” said Andy Wapling, Head of Emergency Preparedness, NHS London. “Nothing on this scale has been attempted before, with the rehearsed decontamination of both disabled and able bodied casualties and all of London’s emergency services providing their response to the incident. NHS London are looking forward to learning from the day and will be able to share this good practice across the NHS and with other partner agencies to continue to ensure that London is prepared”.

As part of its remit and on behalf of the Department of Health, the HPA Emergency Response Department leads a series of exercises across England to enable the NHS to improve health preparedness to a range of potential incidents, including natural hazards, Chemical, Biological, Radiological and Nuclear (CBRN) events and new or re-emerging threats. This includes one or more annual field exercises.

“A multiagency planning group has helped to plan this exercise over many months,” said Gillian Dacey, HPA Exercise Manager. “Exercise Milo has been set up to give emergency response participants the opportunity to train and evaluate their skillset, and to take vital learning points, from a safe environment.”

Health Protection Agency

Growing Warnings About Asthma Drug Added To By Experts

University of Iowa asthma experts are trying to ensure that an asthma drug combination is prescribed only when truly necessary.

The long-acting asthma drug salmeterol used in combination with an inhaled corticosteroid can dangerously worsen asthma for a small subgroup of people with the condition.

In a letter published in the Aug. 24 issue of the New England Journal of Medicine (NEJM), the UI physicians reported two cases representing the few patients for whom the combination can make asthma more severe or even fatal.

“For most patients whose asthma cannot be controlled with a low-dose inhaled steroid, adding salmeterol to the steroid provides increased benefits. So there’s no question this can be a useful combination drug for many individuals,” said Miles Weinberger, M.D., professor of pediatrics in the University of Iowa Roy J. and Lucille A. Carver College of Medicine.

“However, some patients are receiving the combination drug but don’t actually need it, and there is at least a small subgroup of patients for whom previous research showed the salmeterol-steroid combination has a very negative, rather than beneficial, effect,” said Weinberger, who also directs the UI Division of Pediatric Allergy and Pulmonary Diseases.

Advair, made by GlaxoSmithKine, contains salmeterol in addition to an inhaled corticosteroid and is extensively marketed, Weinberger said. It is one of the most commonly prescribed maintenance asthma medications in the United States and is meant to be used by patients on a regular, preventive basis, not to treat sudden asthma attacks.

“We do not want to unduly alarm people, but instead help spread the word that patients should talk with their physicians if they are using Advair, or another inhaled asthma medication that contains salmeterol and feel that it worsens symptoms instead of making them better,” Weinberger said.

The UI physicians’ letter follows up a related editorial published December 2005 in the NEJM by Fernando Martinez, M.D., a leading asthma expert. The letter also helps illustrate findings reported this year in a large, population-based study in the United States that is consistent with a previous study in England.

The U.S. study showed a very small, but statistically significant, increased risk of asthma-related deaths — 13 among 13,000 individuals who received salmeterol but only three among another 13,000 individuals who received a placebo during a 28-week treatment period. Other studies have suggested that some people have a genetic variation that causes them to respond negatively to the class of medications that includes salmeterol, Weinberger said.

The concern about salmeterol and a related medication, formoterol, led the U.S. Food and Drug Administration this year to add a “black box” warning to products containing these medications.

The warning is appropriate, Weinberger said, but many people, including health care professionals, remain unaware of the problem. To raise awareness, Weinberger and Mutasim Abu-Hasan, M.D., UI clinical associate professor of pediatrics, documented two cases they saw at the UI that showed the risk of these medications.

Each of the two patients had life-threatening problems related to salmeterol use. When the patients switched to a different asthma medication, their asthma was successfully managed.

Weinberger emphasized that people currently taking asthma medication that contains salmeterol should continue taking it until they consult their physicians.

“For many patients, adding salmeterol to an inhaled corticosteroid provides additional clinical benefit. Patients should contact their physicians if they notice their response to a ‘rescue’ inhaler such as albuterol is lessened when they’re taking salmeterol as part of a regular maintenance medication,” he said.

Weinberger said that many primary care physicians, partly in response to heavy drug marketing, immediately start patients on the combination drug instead of first trying the inhaled steroid alone.

“We want to build on Dr. Martinez’s recommendation and encourage primary care physicians to start asthma patients on just the inhaled steroid as a regular maintenance medication and then add the salmeterol by using a combination product only if the person’s asthma symptoms are not adequately controlled,” Weinberger said.

Nearly 20 percent of all children have some degree of asthma. At least 6 percent of adults have asthma, as well.

It is not currently possible to test each patient with asthma to see if he or she has genetic risk factors for a bad reaction to Advair. The genetic testing is not commercially available, and all the genetic variations that could contribute to the problem are not yet known.

Individuals or physicians with general questions about the drug warning may contact Weinberger at miles-weinbergeruiowa.

STORY SOURCE: University of Iowa Health Science Relations, 5137 Westlawn, Iowa City, Iowa 52242-1178

ASTHMA EXPERT CONTACT: Dr. Miles Weinberger: miles-weinbergeruiowa.

PHOTOS: Abu-Hasan: uihealthcare/depts/med/pediatrics/pedsmds/abuhasan.html

Weinberger: uihealthcare/depts/med/pediatrics/pedsmds/weinberger.html

Contact: Becky Soglin

University of Iowa