2 15 38 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young. For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 039 Folder The folder containing the original item. 0892 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Mantel, Nathan Date A point or period of time associated with an event in the lifecycle of the resource March 26 1979 Title A name given to the resource Typescript: An Evaluation of the Statistical Methods Used in EPA's "Report of Assessment of a Field Investigation of Six-year Spontaneous Abortion Rates in Three Oregon Areas in Relation to Forest 2, 4, 5 -T Spray Practices" (the Alsea II Report) Subject The topic of the resource Oregon health effects herbicide regulation study criticism ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/4f904ee6bde921600602aec66129b9c8.pdf 2d917d2fec3f208acdd6536c4758daf5 PDF Text Text Item ID Number 01708 Author LeVois, Maurice E. Corporate Author RBPOrt/ArtlClB TltlO Typescript: [Update on study protocol], September 20, 1982 Journal/Book Title Year 000 ° Month/Day Color a Number of Images 3 Descriptor Notes Monday, June 11, 2001 Page 1709 of 1793 �1. On 5 March 1982, the AOWG Science Panel approved a 4 December 1981 DOD/AAQTF conceg<t. _jaaper on cohort selection. Scecifically, what the Science Panel approved was the genera1 jprinicj, ple of selecting battalion, and then company size, military units for exposrue analysis, assigning the company A/O exposure score to each member of that company. If an individual was reported absent on a day when his company received an exposure, that individual's exposure score would be reduced accordingly. This is a departure from the approach suggested by UCLA, in which individual subjects were to be drawn at random and exposure scores developed for each subject individually. 2. On 5 March 1982, the Science Panel states: "The Science Panel will oversee this cohort selection process." The 4 December 1981 DOD/AAOTF concept gaper was clearly not a scientifically rigorous methodological protocol. AOWG approval of that document should not have been construed as a signal to proceed with the actual selection of subjects without first developing a step-by-step protocol with the assistance of the Science Panel and othe qualified scientists. 3. On 10 June 1982, the VA submitted to the AOWG Science ' Panel a memorandum (attached) concerning AAOTF cohort selection activities. That memo alerted members of the �Science Panel to the fact that inappropriate and unapproved decisions concerning cohort composition, exposure criteria, and selection methods had been made independently by DOD/AAOTF. It was the VA's belief that, if the AAOTF proceeded to select subjects as they proposed, their efforts would produce unusable cohorts and no useful data on the feasibility of conducting the larger study. 4. Between 4 December 1981 and 10 June 1982, meetings were held on the topics of Agent Orange exposure and cohort selelction and some important progress occured. °It was generally agreed that a third cohort, roughly comparable to the two Vietnam cohorts could be assembled, if that were called for by the final study design. °A general AAOTP cohort data automation contract was developed by AAOTF. It should be noted that general functional capabilities, not specific data elements, were approved by the VA. °A Ranch Hand mission time/distance exposure matrix was developed. "Methods of equating the different modes of exposure were proposed. Work on this problem continues. "The AAOTF proceeded with work on an augmented "services" herbicide application record. This work also continues. The AAOTF was never asked by the AOWG or the VA to halt work on the documentation of herbicide use in Vietnam. This informiWon is essential to any cohort selelction process. �°On 8 April 1982, a letter was sent from VA Administrator Nimmo to Secretary Weinberger addressing the need for the support and cooperation of both agencies in this research effort, (attached) *J °0n 8 April 1982, a memo was sent by Secretary Scheiker to A Secretary Weinberger, (attached) That memo recommended that DOD assume responsibility for cohort selection in support of the VA study. "On 26 April 1982, Secretary Weinberger issued a tasking memo to the Secretaries of Army, Navy and Air Force authorizing full DOD support of this effort, (attached) "The AOWG Science Panel created a subcommittee to 1. develop an acceptable Agent Orange exposure index 2. develop a cohort selection protocol for the AAOTF. °On 8 September 1982, the Chairman of the Science Panel forwarded to DOD a draft protocol for cohort selection for DOD approval. 5. The AOWG and the VA can not provide the kind of continuous scientific supervision which is required for proper cohort selection. It has become clear that this important, complex and costly effort cannot be adequately supervised by a physiologist. The AAOTF should obtain the assistance of a qualified epidemiologist and/or biostatistician before proceeding with their cohort selection pilot work. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young. For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 063 Folder The folder containing the original item. 1708 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource LeVois, Maurice E. Title A name given to the resource Typescript: [Update on study protocol], September 20, 1982 Subject The topic of the resource Agent Orange Exposure Study AAOTF study criticism AOWG ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/a0107319411c24ad329c9d98088573fa.pdf 820d6cf7d3fcdfe7926cdec1149874c5 PDF Text Text Item ID Number °1695 Author LeVois, Maurice E. Corporate Author Roport/Artldo Title Memorandum: Agent Orange Research Predecisional Memorandum, from Maurice E. LeVois to Administrator, July 29, 1982 Journal/Book TltlB Year 000 ° Month/Day Color r] Number of unages 2 Descriptor Notes Monday, June 11,2001 Page 1696 of 1793 �Veterans Administration Director, Agent Orange Research and Education Office (001E) July 29, 1982 Administrator Slll : " Agent Orange Research Prcdec is iona 1 Memorandum ].. The Ayent Orange epidemiology research protocol has been reviewed and approved, in general terms, by the White House Agent Orange Working Group (AOWG) Science Panel, the Congressional Office of Technology Assessment (OTA), and the VA Advisory Committee on HeaJth~Related Effects of Herbicides. Although some differences remain among the recommendations made by these committees, all three of these review groups support tte idea of including a third cohort to evaluate the effect of the "Vietnam experience" on the health of veterans. vi 2. The AOWG strongly endorses the three cohort research design as an effective means of evaluating the health effects of both the Vietnam experience and of exposure to Agent Orange. 3. The three cohort research design may have far reaching implications: a) A third cohort will increase the cost of the study by nearly 50%; b) A throe cohort study design will increase the total number of hypotheses to be tested and, therefore, will increase the probability of finding both real and chance effects; c) Specific risk factors or exposures will be impossible to identify in the "Vietnam experience" portion of the study. Flealtii problems found to be associated with Vietnam service niay require further research to identify causation and establish the relative increase in risk for each health problem; d) For the purpose of compensation, the assumption of exposure to a general health risk factor by anyone who served in Vietnam, without requiring documentation of a specific exposure, may include very large numbers of veterans. This also applies to the process of compensation based upon Agent. Orange results; *•) If common health problems are found to te weakly associated with Agent Orange or service in Vietnam (i.e. only a slight increase in relative risk) then the VA may want to consider an "attributed risk" formulation for compensating veterans. 4. It is your decision whether or not the VA will conduct a study of three or only of two cohorts, Public Taw 97-72 states that you "may" broaden the scop} of the study to look at the general health effects of service in Vietnam, You rrwy also limit the focus of the study to the Agent Orange issue. �'there are a nurnter o£ options available to you: a) Broaden the .scop:; of the study by including a third cohort as the AQWG recommends. This option appears to be consistent with the wishes of the veterans" service organizations and the Congress; b) Limit the scope of the study to the health effects of Agent Orange exposure and study only two cohorts. The U.C.L.A. authors of the research protocol recommend this option on scientific grounds, but do not present: a strong argument for their position; c) Proceed with plans for a pilot study contract based upon three cohorts. If the National Academy of Sciences (NAS) ^review group recommends against the three cohort design drop the third group and re-negotiate the pilot study contract; d) Proceed as in c) atovc. If NAS agrees that a three cohort study is appropriate, then the pilot study can be used to evaluate the feasibility of the three cohort design. Participation rates may be lowest for the third, non-Vietnam, cohort. If. fewer titan 70% of the potential subjects in that group participate in the pilot study, the third group may have to be dropped from the final design for statistical reasons; e) Ask the VA Advisory Committee on Health-Related Effects of Herbicides and the VA Policy Coordinating Committee (PCC) to consider the three cohort design issue and provide you with their independent recommendations. MAURICE E. r.EVOlS Director, Agent Orange Research and Education Office � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young. For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 063 Folder The folder containing the original item. 1695 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource LeVois, Maurice E. Title A name given to the resource Memorandum: Agent Orange Research Predecisional Memorandum, from Maurice E. LeVois to Administrator, July 29, 1982 Subject The topic of the resource Agent Orange Exposure Study AOWG study criticism study protocol ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young. For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 067 Folder The folder containing the original item. 1827 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Klerman, Gerald L. Title A name given to the resource Memorandum with cover letter: to James Hagans, Jr. from Gerald Klerman, with subject Evaluation of Psychiatric Section of Revised VETS Project, August 22, 1984. Subject The topic of the resource Vietnam Experience Twin Study study criticism ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/df8d66e51c40779e9d002e14c30e9caf.pdf a7bbaebbe750a995b0af55bc3d939eb6 PDF Text Text Item ID Number 01735 Author Keller, Carl A. Corporate Author RODOrt/ArtlOlO TitlO Typescript: Review of Vietnam Veterans Mortality Study, September 14,1987 Journal/Book Title oooo Month/Day Color Number of Images n 1 Doscripton Notes Monday, June 11, 2001 Page 1786 of 1793 �REVIEW OF VIETNAM VETERANS MORTALITY STUDY A study of proportionate mortality among U.S. Army and Marine veterans who served between July 4, 1965 and March 1, 1973 and died before March 1, 1982 was reported by the Veterans Administration. The study included 19708 Army and 4527 Marine veterans who had served in Vietnam and 22904 Army and 3781 Marine veterans who had not served in Southeast Asia during tis period. The study included a random sample of about one-third of the potentially elligible veterans who had died during this period. The selection of study subjects and recovery of information on them appears to have been unbiased and appropriate. The major findings from this study included a statistically significant excess of accidental and drug related deaths and paucity of suicides among Army veterans who had served in Vietnam compared to those who had not served in Southeast Asia. In addition, there was a statistically significant excess of lung cancer and non-Hodgkins lymphoma among Marine veterans who had served in Vietnam compared to those who had not. Several other findings were not mentioned in either the conclusions nor in the narrative, but are evident in the tables. These include a statisically significant decrease in mortality due to genitourinary diseases and cancer of the extra-cranial nervous system among Army Vietnam veterans. In addition, there appears to have been a signifcant decrease in cancer deaths among enlisted Army veterans with only one tour of duty in Vietnam, and among similar Marine veterans before 1975. There was also a significant increase in accidental poisonings among enlisted Marine Vietnam veterans dying before 1975. The authors computed Standardized Proportionate Mortality Ratios (SPMR) and tested with the Chi-Square statistic (not presented in the tables). According to the reference used to justify this procedure (ref # 13), Professor Monson suggests using the Poisson approximation of the variance of the expected deaths, i.e., that the expected number of deaths approximates the variance. If this procedure is applied to the information which can be deduced from the observed number of deaths and the SPMR as given in the tables, several additional SPMRs appear to be statistically significant. These include an excess of all cancer deaths among Marine veterans who served in Vietnam, particularly single tour enlisted Marines after 1975. Other possibly significant findings would include a decrease in deaths due to infectious diseases and diseases of the blood, an increase in deaths due to musculoskeletal and connective tissue diseases, and a decrease in deaths from thyroid cancer and non-Hodgkins lymphoma among Army Vietnam veterans. While there is no way to determine which statistical procedures are "correct", these results indicate that more significant findings are available in these data than have been dicussed in the manuscript. While this does not make it any easier to interpret the results, it does serve to point out the selective nature of the findings which have been emphasized in the manuscript. In particular, the inclusion of one-seventh of the abstract and considerable dicussion in the narrative to Agent Orange is misleading. Other possible explanations for the findings should receive relatively more emphasis. Carl A. Keller, Ph.D. Epidemiologist, NIEHS � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young. For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 066 Folder The folder containing the original item. 1785 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Keller, Carl A. Title A name given to the resource Typescript: Review of Vietnam Veterans Mortality Study, September 14, 1987 Subject The topic of the resource VA Mortality Study mortality trends study criticism cancer risk assessment ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young. For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 066 Folder The folder containing the original item. 1779 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Kang, Han K. Title A name given to the resource Letter: from Han K. Kang to Bruce B. Dan, May 19, 1987 Subject The topic of the resource VA Mortality Study study protocol study criticism ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young. For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 066 Folder The folder containing the original item. 1778 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Kang, Han K. Title A name given to the resource Letter: from Han K. Kang to Bruce B. Dan, May 14, 1987 Subject The topic of the resource VA Mortality Study study protocol study criticism ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/3274dbae34e5de29e5c13b745ec55253.pdf 327ada61ba22f79e99d99f056952068b PDF Text Text Item ID Number 01353 Houk, Vernon N. Corporate Author Report/ArtidO TltlO Memorandum: to Ronald W. Hart, Chairman, Science Panel, Agent Orange Workinh Group (AOWG), from Vernon N. Houk, Assistant Surgeon General, with subject Protocol for Women's Vietnam Veterans Health Study, September 10,1987 Journal/Book Title Year 000 ° Month/Day Color D Number of Images 4 DOSCrlptOn NOtBS Memo discusses concerns that Houk has about the study protocol. He wants the concerns addressed before he will be willing to support conduct of the study. Wednesday, July 11, 2001 Page 1854 of 1870 �DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Centers for Disease Control Memorandum Date .September 10, 1987 From Director Center for Environmental Health and Injury Control Subject Protocol for Women's Vietnam Veterans Health Study To Ronald W. Hart, Ph.D., Chairman, Science Panel Agent Orange Working Group We have reviewed the Women's Vietnam Veterans Health Study Protocol submitted by the Hew England Research Institute, Inc. We have serious concerns about this submission which we have listed below. Until these concerns are adequately addressed, I cannot support conduct of the proposed study. Detailed below are comments on the protocol for the Women's Veteran Health Study. A. Cohor^ Selection 1. Unlike the Vietnam Experience Study, there are differences between the exposed group and the comparison groups in variables other than experience in Vietnam. The presence of such differences increases potential confounding and complicates the analyses. Would it be more satisfactory to limit the scope of the study and the selection of a comparison group (e.g., Limit, the study to army cases and controls) to address the most important hypotheses rather than try to do too much? 2. It is not clear how the VA developed its list of 5000 Army Vietnam veterans—how complete is this list? How complete are the lists of Vietnam veterans in the other services? 3. The sampling frame for the non-Vietnam veterans is not clearly described. 4. How valid is their proposed capture-recapture method as a method of documenting the completeness of the cohorts. 5. What duty stations will women veterans for Cohort B come from? Will the Air Force sample of nurses be large enough for separate comparisons? 6. pages 2-3: What does matched on occupation mean and how will this be possible? 7. Consideration might be given to increasing the number of controls (per case) in the overall study, especially in some of the proposed substudies (e.g., reproductive health). �Page 2 - Ronald W. Hart, Ph.D. B. Reproductive Health 1. The expectation is to find major birth defects in 1% of offspring; a more appropriate expectation is 2-3%. It would be wise to compile a list of specific defects which are to be considered "major" before the study begins. 2. Cases are defined as women who have had a baby with a defect or "two or more spontaneous abortions not clearly attributable to an identified cause." They propose excluding those with an 1 "unequivocal karyotypic abnormality", and those with a uterine abnormality. Exclusion of women who themselves have a tcaryotypic abnormality seems reasonable, but it is unlikely that any will be found in the sample. If the reference implies that aborted fetuses that have a karyotypic abnormality will be excluded, this is not reasonable. An abortion associated with a chromosomal anomaly is a health outcome worth considering in the study. In general, more details are needed on why certain diseases/conditions are being excluded. 3. Spontaneous abortions will be difficult to validate since they are frequently not medically documented. 4. It is stated that women with diethylstilbesterol (DBS) exposure would be kept in the sample. We would suggest exclusion since they are excluding spontaneous abortions associated with uterine abnormality, and DES exposed women have a higher rate of abortion, usually from uterine abnormality. 5. We would suggest matching controls on age at the last abnormal pregnancy, rather than the first. Spontaneous abortion is strongly related to age and a woman's pregnancies may be separated by many years. 6. At the time this study will be done, most women Vietnam veterans will be 40 or more years of age. Therefore the evaluation of prolonged amenorrhea should probably be deleted from the study. 7. A definition of fertility/infertility is needed. C. PsycholoRical/KeuropsychoIoRical TestinR 1. The proposal to use the CDC Vietnam Experience Study (VES) neuropsychological battery is inappropriate. That battery was designed to assess primarily neuropsychological deficits which might be expected from exposure to a toxin (e.g. TCDD). The battery also included some assessment of psychological and neuropsychological problems that might be related to stress. �Page 3 - Ronald W. Hart, Ph.D. This latter component is not included (as far as we can tell) in the present protocol. Since TCDD exposure is unlikely to have been a major problem for most nurses in Vietnam, it would probably be better to give greater emphasis to long-term psychological stress faced by these veterans while in Vietnam. This would mean that the proposed battery should include some measures of stress which have been well validated and accepted in psychological research. ' In addition, greater emphasis should be given to depression, anxiety, and alcohol and drug use, which are possible sequelae of stress. Also, consideration should be given to including the Minnesota Multiphasic Personality Inventory (MMPI), and more of the Diagnostic Interview Schedule (DIS) than just the Post Traumatic Stress Disorder (PTSD) section. 2. Another concern in the psychological area is the testing in the home of the participant. The VES battery was designed to be administered in a standard testing environment by trained technicians under close supervision. Quality control and standardization will be difficult in the proposed setting. 3. The rationale for measurement of TCDD levels in the PTSD substudy needs further clarification/justification. 4. With respect to the psychological area in general, we suggest that advice be sought from experts in psychology/psychiatry to evaluate the proposed psychological test battery. In addition, staffing for the study should include a qualified psychologist or psychiatrist. D. Serum. Dioxin (TCDD) Measurement 1. The whole issue of Agent Orange exposure assessment/TCDD testing becomes questionable now that the results of CDC's Validation Study are known. If TCDD testing is to be done, is a whole unit of blood necessary—if willing to accept some cut-off level (e.g. 20 ppt) less blood may be required. Also, if TCDD testing is to be done, consideration should be given to using a sample of Vietnam and non-Vietnam veterans—based on the results of a sample, a decision could be made about testing other participants. 2. Serum TCDD measurements are to be used as the measure of exposure for both the Reproductive Outcomes Study and the Post Traumatic Stress Disorder Study. Apparently about 550 serum analyses will be needed for these two studies combined. The current proposal does not involve flying the participants to a centralized collection center but rather using local Red Cross Centers on contract. These approximately 550 women will be located all over �Page 4 - Ronald U. Hart, Ph.D. the United States and the Red Cross is not even present in every state, so obtaining the samples solely in this manner will not be possible. A very large number (>100) of Red Cross contracts will be involved to obtain blood on persons near a Red Cross Center under the current plan. The use of at least regional Red Cross Centers would be a marked improvement and the quality of sample acquisition would be significantly higher if only a few (even one) Red Cross Center(s) were used. 3. T|he cost of the serum 2,3,7,8-TCDD measurement should be noted to be $1000 apiece. Currently the protocol states that EHLS is the only lab in the U.S. that can perform the measurements, but clearance for such measurements at EHLS has not been obtained. Similarly, has the American Red Cross been approached as to their willingness to participate in this study? E. Operational and Other Issues 1. The protocol anticipates a fair amount of dependence on both interviews and military records. What are the limitations of these data in terms of the questions addressed (e.g., ascertainment of spontaneous abortions by history)?. 2. The authors do not provide information on how they propose to address the issue of name changes in female veterans and the difficulties this might cause in locating these veterans. 3. The operational aspects of the pediatric examination component are not clearly described. Has the Ranch Hand Study been successful in this area? What end points will be looked at and analyzed? 4. The choice of conditions to be validated might be expanded to include same conditions which have been suggested to be associated with TCDD exposure—e.g. skin conditions (chloracne, hyperpigmentation, etc.), liver disorders including prophyria, peripheral neuropathy, immunologic deficits. 5. Quality control of the physical and routine laboratory examinations must be assured. 6. Has adequate effort been made to insure that the medical records and pathology slides will be reviewed in a blinded manner? 7. What efforts are being made to insure quality assurance and quality control of hormone blood testing? Vernon H. Houk, M.D. Assistant Surgeon General � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young. For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 069 Folder The folder containing the original item. 1853 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Houk, Vernon N. Title A name given to the resource Memorandum: to Ronald W. Hart, Chairman, Science Panel, Agent Orange Working Group (AOWG), from Vernon N. Houk, Assistant Surgeon General, with subject Protocol for Women's Vietnam Veterans Health Study, September 10, 1987 Subject The topic of the resource Women Vietnam Veterans Health Study study criticism study protocol dioxin ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/0397ef45f6a5749c72a829b6264147b2.pdf e95d695e5c8772b844e37ed1186077ad PDF Text Text Item ID Number 01734 Author Houk, Vernon N. Corporate Author RepOrt/ArtiClB TltlO Memorandum: Review of VA Mortality Study, from Vernon N. Houk to Ronald W. Hart, September 11, 1987 Journal/Book Title Year 000 ° Month/Day Color D Number of unaoos 2 Desorlpton Notes Monday, June 11, 2001 Page 1785 of 1793 �DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Centers for Disease Control Memorandum Date From .September 11, 1987 Director Center for Environmental Health and Injury Control Review of VA Mortality Study Subject To Ronald W. Hart, Ph.D. Director National Center for Toxicological Research i The Veterans Administration (VA) has conducted a proportionate mortality study (PMR) of 24,235 deaths among U.S. Army and U.S. Marine male veterans who served in Vietnam and 26,685 deaths among male veterans of the same two services who did not serve anywhere in Southeast Asia. All deaths were identified from the VA BIRLS file and occurred between July 4, 1965, and March 1, 1982. These deceased veterans had to have served in the military sometime between July 4, 1965, and March 1, 1973. Career and non-career, officers, and enlisted men, as well as reservists, were included. In-service deaths occurring before 1974 and men dying from war-related injuries were excluded. In service deaths after 1973 were included. Within the group of Vietnam veterans, the fraction of all deaths attributable to a particular cause was computed and compared to the corresponding proportion for non-Vietnam veterans. The comparison was done using the proportionate mortality ratio (PMR) technique in which age at death, race, and branch of service were taken into account. There was no adjustment for calendar year of death or rank. Altogether, PMRs were computed for 18 major cause of death groupings and for 23 specific cancer sites. We will address our concerns in data collection, data analysis, and interpretation. Data Collection. Are the BIRLS tapes truly at least 94 percent complete? From the CDC Mortality Study which used multiple sources of mortality we found that BIRLS was less complete. Data Analysis. Why do the authors emphasize only the statistically significant positive findings? Why were not the significant decreases in deaths from genitourinary diseases (Table 3) and the decrease in deaths *. from all cancers for one-tour of duty veterans (Table 5) not discussed? The lack of association between service in be reevaluated in light of the CDC finding in the first 5 years after discharge. CDC discharge rather than year of death. This Vietnam and suicide needs to that they were increased only used the time period since subject was repeatedly brought �Page 2 - Ronald W. Hart, Ph.D. up with the VA prior to completion of their analysis. The CDC study would indicate that grouping by 10 year periods would minimize the effect. The findings for lung cancer and NHL in Marine Vietnam veterans are provocative, although similar observations were not made in other studies of Vietnam veterans. The absence of unusual mortality from soft-tissue cancers is consistent with some previous studies but at variance with others. Because so many statistical tests were done on the data set, these ^apparent findings could be due to chance. It would be helpful to see a more detailed analysis in which mortality from these cancer sites is examined by calendar year in Vietnam, rank, MOS, and principal duty. These additional analyses would help in deciding whether some factor related to the Vietnam experience is responsible for the apparent association. Interpretation. The authors suggest that these were major differences in the findings of previous studies cited, but there are in fact few major differences in the findings. Referenced studies were not critically discussed. There has never been, for example, an association demonstrated between lung cancer and phenoxy herbicides except in the Zack Study (Ref. 29) where 3.6 cases were expected and 6 were found in those exposed to 2,4,5-T. Those authors state that they cannot evaluate trends in lung cancer deaths as they relate to occupation because of "limitation in the data." As noted above, it is not surprising to encounter the small number of statistical departures from expected mortality seen in this study. These could easily have arisen by chance alone. This study, as originally designed, cannot conclusively clarify mortality risks for Vietnam veterans, let alone elucidate possible causative factors within, or outside of, the Vietnam experience. Reasons include lack of a defined population-at-risk, incomplete ascertainment of deaths, and absence of "exposure" data on individual veterans. This PMR study appears to be well executed in mechanics. However, the presentation and discussion of the results do not provide the necessary caution in interpretation and allow the uninitiated to make causal inferences where they do not exist. Vernon N. Houk, M.D. Assistant Surgeon General � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young. For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 066 Folder The folder containing the original item. 1784 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Houk, Vernon N. Title A name given to the resource Memorandum: Review of VA Mortality Study, from Vernon N. Houk to Ronald W. Hart, September 11, 1987 Subject The topic of the resource VA Mortality Study BIRLS study criticism cancer risk assessment ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young. For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 036 Folder The folder containing the original item. 0758 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Holden, Constance Source A related resource from which the described resource is derived Science Date A point or period of time associated with an event in the lifecycle of the resource December 4 1981 Title A name given to the resource Reviewers Pan Agent Orange Study Plan Subject The topic of the resource AOWG VA veteran health and hygiene study criticism ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young. For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 048 Folder The folder containing the original item. 1247 Series The series number of the original item. Series III Subseries II Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Hill, Sir Austin Bradford Source A related resource from which the described resource is derived Proceedings of the Royal Society of Medicine Date A point or period of time associated with an event in the lifecycle of the resource 1965 Title A name given to the resource The Environment and Disease: Association or Causation? Subject The topic of the resource human exposure study criticism ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young. For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 063 Folder The folder containing the original item. 1705 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Flynn, Peter A. Jerome G. Bricker Title A name given to the resource Letter: from Peter A. Flynn and Jerome G. Bricker to Vernon Houk, [nd] Subject The topic of the resource Agent Orange Exposure Study study criticism AAOTF study protocol ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/99ce5314cd52c9e588a3a52f8c3ae102.pdf 89fec2c94c996592c00243a2d2b682c8 PDF Text Text Item ID Number 01694 Author F| nn Peter A y ' - Corporate Author Report/Article Titlfl Memorandum: VA Pilot Study Cohort Selection by the Army Agent Orange Task Force (AAOTF), from Peter A. Flynnto Chairman, White House Agent Orange Working Group, July 19, 1982 Journal/Book Title Year °00° Month/Day Color ' Number of Images 2 Descrlpton Notes Monday, June 11, 2001 Page 1695 of 1793 �JUL 1982 MEMORANDUM FOR CHAIRMAN, WHITE HOUSE AGENT ORANGE WORKING GROUP SOBJBCTj VA Pilot Study Cohort Selection by the Arny Agent Orange Ta»k Forc« (AAOTP) As you know, wh«n th« AOWG gave the VA the go~ah«ad to proceed with their pilot epideialo logical study, we in DoD coiaraitted ourselves to the AOWG to »e«tiny th«a January 1, 1903, date by which the VA estimated it would ne«d naraaa for the study. This date waa passed to the AAOYF and, as they had agreed in advance, they began to work immediately. That date was felt to be a reasonable on« with the programed personnel on board, in frtw K«antiB@, we had secured additional active duty personnel frota th<? Air Force, Navy and Marine Corps as we had said we would. The approach to the records u@«d by the AAOTF was basted on decisions of the Science Panel of th« AOWC and sora« announced asauraptions on our part whore there were no fira guidelineo. Discussions over the last month have made it apparent that there remain serious unresolved issues with regard to the 0CLA protocol in both its scop« and focus and in regard to ao£t« aspects of cohort selection. While the AAOT7 has been making excellent progress, th«re is now a substantial likelihood that the cohort selection process may not fully meet the VA's desires which ar« still being articulated by the VA. Accordingly, I have directed the AAOl'F to suspend its pilot study cohort selection activities until such ti»« as the aforementioned issues are resolved and the AAOTf can b« given clear and confirmed narching orders. We and th« AAOTF stand ready to assist those individuals and groups who are working with the protocol, particularly in those areas where thft records have a direct bearing on what is possible in tho way of data extraction. When definite new directions arcs aade available, we will, of course, immediately resua« the selection process for the pilot study. It is clear that the January 1, 1983, date can no longer be aet« A new date will have to be set depending on when we corasence work and the scope of the required records work. �As a matter of incidental interest, the AACTF lias briefed tm> National Academy of Science review personnel as requested by the VA. We continue to stand ready to be of all possible assistance with this important study. S16HIB P«t«r A, Plynn Captain, J1C, QSN Director for Professional Servicoo cc; Mr. R. Christian, AAOTF Dr. Vernon Houk, CDC, Science Panel Cbairwan Dr. Carl Keller, Research Panel Chairman HAFile/Reading/Chron/HRMChron COORDINATJOH; Plynn/dcs/16Jul82/0788d Dr. Bricker � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young. For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 063 Folder The folder containing the original item. 1694 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Flynn, Peter A. Title A name given to the resource Memorandum: VA Pilot Study Cohort Selection by the Army Agent Orange Task Force (AAOTF), from Peter A. Flynn to Chairman, White House Agent Orange Working Group, July 19, 1982 Subject The topic of the resource Agent Orange Exposure Study AOWG study criticism study protocol ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/063bb16d96e7401f4e4643efa67413a3.pdf 91410704d340733b48e2ed1c52d0fb24 PDF Text Text Item ID Number 01731 Author Fingerhut, Marilyn Corporate Author RdpOrt/ArtiClO TltlB Typescript: Comments on "Proportionate Mortality Study of Army and Marine Corp Veterans of the Vietnam War" by P. Breslin et al., Septembers, 1987 Journal/Book Title Year 000 ° Month/Day Color Number of Images D 1 Descrlpton Notes Monday, June 11, 2001 Page 1782 of 1793 �Comments on "Proportionate Mortality Study of Army and Marine Corp Veterans of the Vietnam War" by P. Breslin et_ al. Marilyn Fingerhut September 6, 1987 Use of BIRLS for a PMR study is reasonable. Structure of PMR study is reasonable: Random sample of complete file of BIRLS, with Vietnam exposure confirmed; death certificates obtained (96.9% followup), adequate size (at least for Army). PMR studies are usually used to generate, not test hypotheses. The article appropriately recommends further work to evaluate etiological factors. The media reports have not conveyed this information. The problem at hand results from the timing of the release of the article, and the inclusion of a sentence in the Abstract (inappropriately) referring to Agent Orange exposure. The structure of the study is appropriate; the scientific weakness of the article lies in the analysis and interpretation of the results. The authors can revise the article for submission to a journal. The weakness of the article results from 1) the absence of data evaluating elevations in other smoking related diseases in the Marines, 2) absence of latency evaluations for the malignancy outcomes, 3) lack of data evaluating the adequacy of the marine comparison group, and 4) inadequate evaluation of the limitations of the PMR study design. No evaluation of latency is presented for lymphoma or lung outcomes. Service was '64-'73, deaths were '65-'82. The article does not evaluate the relationship of time of exposure to time of death. No data are provided to show whether other circulatory or respiratory deaths were elevated in army and marines for conditions associated with smoking. It is unclear whether the cancer outcomes were obtained in the overall PMR, or in a separate Proportionate Cancer Mortality Ratio (PCMR). The results for deaths from external causes and accidental poisonings are consistent with other studies of veterans and point out problems for veterans following this war. The nonVietnam comparison group for the Army is large, so the numbers can be expected to be stable; the same may not be true for the marines. It would have been helpful if, 1) the authors had carefully presented data to show that the marine Vietnam vs. nonVietnam populations were truly comparable, and 2) the authors had provided a table showing the expected numbers for each cause of death if the national population had been used as the comparison. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young. For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 066 Folder The folder containing the original item. 1781 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Fingerhut, Marilyn Title A name given to the resource Typescript: Comments on "Proportionate Mortality Study of Army and Marine Corp Veterans of the Vietnam War" by P. Breslin et al., September 6, 1987 Subject The topic of the resource VA Mortality Study BIRLS study criticism cancer risk assessment ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young. For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 063 Folder The folder containing the original item. 1701 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Fein, George Title A name given to the resource Letter: from George Fein to Barclay M. Shepard, August 16, 1982 Subject The topic of the resource Agent Orange Exposure Study study protocol cohort study study criticism ao_seriesIII