Beware the normal angiogram.

Purulent pericarditis is now rare due to the widespread use of antibiotics. However, it is associated with significant morbidity and mortality, and non-specific symptoms and signs can make diagnosis difficult. We report a patient who presented with left-sided chest pain, mild fever and ST segment elevation on electrocardiography, who required prolonged organ support in the intensive care unit. This lesson highlights the diagnostic difficulties and management challenges that this condition can present.

First measurement of the form factors in the decays D0 → ρ- e+ ν(e) and D+ → ρ0 e+ ν(e).

The beauty to up quark coupling constant |V(ub)| can be extracted from B → ρ e+ ν(e) combined with the form factors for D → K* e+ ν(e) and B → V ℓ+ ℓ- and D → ρ e+ ν(e). Using the entire CLEO-c ψ(3770) → DD event sample, corresponding to an integrated luminosity of 818 pb(-1) and approximately 5.4×10(6) DD events, we measure the form factors for the decays D0 → ρ- e+ ν(e) and D+ → ρ0 e+ ν(e) for the first time and the branching fractions with improved precision. A four-dimensional unbinned maximum likelihood fit determines the form factor ratios to be V(0)/A1(0)=1.48±0.15±0.05 and A2(0)/A1(0)=0.83±0.11±0.04. Assuming Cabibbo-Kobayashi-Maskawa unitarity, the known D meson lifetimes, and our measured branching fractions we obtain the form factor normalizations A1(0), A2(0), and V(0). We also present a measurement of the branching fraction for D+ → ω e+ ν(e) with improved precision.

Peripartum infection with Streptococcus uberis but not coagulase-negative staphylococci reduced milk production in primiparous cows.

The effect of an intramammary infection (IMI) at calving on the milk yield of heifers during their first 200 d in milk (DIM) was estimated by comparing monozygotic twins, where one member had a naturally occurring IMI detected at the first milking after calving and the other twin did not. Data collected weekly over a full lactation for 29 twin pairs were used to estimate the effects of a peri-calving Streptococcus uberis IMI on milk yield and composition. Data for 19 twin pairs were used to estimate the effects of pericalving coagulase-negative staphylococci (CNS) IMI. A heifer with a Strep. uberis IMI produced 200 kg (7%) less milk during the first 200 d of lactation compared with her uninfected twin, with significant differences evident throughout the 200-d period. Similar milk losses were recorded for heifers that developed CM or remained subclinical. An elevated milk SCC for infected heifers was only apparent for the first month (d 2-30), although SCC tended to remain high during the second (d 31-60) and third (d 61-90) months. Milk protein concentrations were greater in the Strep. uberis-infected twin over the 200-d period, whereas fat and lactose concentrations showed little change. An IMI caused by Strep. uberis was associated with a lower milk yield, whereas an IMI by CNS was not, despite CNS-infected twins having a higher SCC than their uninfected twin for the first 30 d of lactation.

Observation of the h(c)(1P) Using e+ e- collisions above the DD threshold.

Using 586 pb(-1) of e+ e- collision data at E(c.m.) = 4170 MeV, produced at the Cornell Electron Storage Ring collider and collected with the CLEO-c detector, we observe the process e+ e- → π+ π- h(c)(1P). We measure its cross section to be 15.6±2.3±1.9±3.0 pb, where the third error is due to the external uncertainty on the branching fraction of ψ(2S) → π0 h(c)(1P), which we use for normalization. We also find evidence for e+ e- → ηh(c)(1P) at 4170 MeV at the 3σ level and see hints of a rise in the e+ e- → π+ π- h(c)(1P) cross section at 4260 MeV.

4-Hydroxy-3-nitrophenylglyoxal. A chromophoric reagent for arginyl residues in proteins.

The chromophoric reagent, 4-hydroxy-3-nitrophenylglyoxal, is highly selective for the modification of arginine in aqueous solution at pH 7--9. The reagent also inactivates creatine kinase (ATP:creatine N-phosphotransferase, EC 2.7.3.2) in a manner analogous to that reported with phenylglyoxal.

Retinal projections in the native cat, Dasyurus viverrinus.

Retinal projections were examined in the native cat, Dasyurus viverrinus using Fink-Heimer material and autoradiography. We found six regions in the brain which receive retinal projections. These are (1) the dorsal lateral geniculate nucleus (2) the ventral lateral geniculate nucleus (3) the lateral posterior nucleus (4) the pretectum (5) the superior colliculus, and (6) the accessory optic system. We did not examine the hypothalamus. The accessory optic system and the lateral posterior nucleus receive a contralateral retinal projection only and the other four regions receive a bilateral retinal projection. There is extensive binocular overlap in the dorsal lateral geniculate nucleus. On the side contralateral to an eye injection of 3H leucine our autoradiographs show four contralateral layers which fill most of the nucleus. Three of these layers, 3, 4 and 5, also receive input from the opsilateral eye. Layer 1 which lies adjacent to the optic tract receives only contralateral retinal input. Layer 2 receives a direct retinal input only from the ipsilateral eye. The ipsilateral projection to the dorsal lateral geniculate nucleus forms a fairly continuous patch which is not divided into separate layers. The ipsilateral retinal input is located in the dorsal part of the lateral geniculate nucleus. The ventral quarter of the nucleus only receives a contralateral retinal input and therefore represents the monocular part of the visual field.

Retinal projections in the Tasmanian devil, Sarcophilus harrisii.

Retinal projections were mapped in Tasmanian devils which had one eye injected with 3H-proline. The retinal fibers terminate in seven regions in the brain. These are (1) dorsal lateral geniculate nucleus (LGNd), (2) ventral lateral geniculate nucleus, (3) lateral posterior nucleus, (4) pretectum, (5) superior colliculus, (6) hypothalamus and (7) accessory optic system. The pattern of retinal input to six of these regions is similar to that seen in other marsupials. The pattern of retinal projections to the LGNd, while basically similar to that observed in other polyprotodont marsupials, is much simpler than that seen in the related native cat, Dasyurus viverrinus. The LGNd of Sarcophilus presents the simplest cytoarchitectural organisation of any marsupial examined so far. Each LGNd receives overlapping projections from both eyes. Suggestions of an intermittent lamination are seen in the LGNd contralateral to an eye injection of 3H-proline. On the ipsilateral side there are two patches of label, a large lateral patch and a smaller medial patch, both of which occupy areas receiving contralateral input. The monocular segment, occupying the ventral 40% of the nucleus, is more extensive than has been reported in any other polyprotodont marsupial.

Retinal projections in the ringtailed possum Pseudocheirus peregrinus.

The retinal projections in the ringtailed possum, Pseudocheirus peregrinus were determined using Fink-Heimer material and autoradiography. At least seven regions in the brain receive retinal projections. These are (1) the suprachiasmatic nucleus of the hypothalamus (2) the dorsal lateral geniculate nucleus (3) the ventral lateral geniculate nucleus (4) the lateral posterior nucleus (5) the pretectum (6) the superior colliculus, and (7) the accessory optic system. The accessory optic system and lateral posterior nucleus receive a contralateral retinal projection only and the other five regions receive a bilateral retinal projection. The dorsal lateral geniculate nucleus consists of two parts: an outer alpha division of closely packed cells and an inner beta division containing loosely scattered cells. There are no cell layers apparent within the alpha division in Nissl sections. The autoradiographs and Fink-Heimer material reveal four concealed laminae within the alpha division. Lamina 1, which is adjacent to the optic tract and lamina 3 receive a predominantly contralateral input. Laminae 2 and 4 receive a predominantly ipsilateral input. The beta segment contains a fifth lamina which receives contralateral retinal input.

Postnatal development of retinal projections in the brushtailed possum, Trichosurus vulpecula.

The postnatal development of retinal projections was studied in the brushtailed possum, Trichosurus vulpecula. [3H]proline was injected into one eye of 13 young possums aged 24-84 days in order to trace retinal pathways. The dorsal lateral geniculate nucleus (LGNd) can be identified in Nissl material at 19 days but not at 9-10 days. By 40 days some cytoarchitectural lamination of the LGNd is apparent and by 71 days the adult pattern of cell layers is present. At 24 days retinal fibers occupy by lateral part of the LGNd on both sides of the brain. By 38-40 days the retinal fibers fill be contralateral LGNd and the binocular part of the ipsilateral LGNd and there is a beginning of the segregation of retinal fibers into left and right eye territories. By 49-50 days a partial segregation is achieved, and complete segregation by 71 days. At 9-10 days the superior colliculus is not differentiated into layers and there is a thick zone of cell proliferation around the ventricle. By 23 days the superior colliculus has well-defined cell layers and there is still some indication of cell proliferation around the ventricle. By 40 days, the superior colliculus shows little evidence of cell proliferation. At 24 days retinal fibers fill the superficial layers of the contralateral optic tectum and are lightly distributed through the superficial layers of the rostral half of the ipsilateral tectum. By 38 days the ipsilateral retinal input is restricted to the deeper layers of the tectum. These results show that the adult pattern of retinal projections to the LGNd and optic tectum develops a number of weeks before eye opening occurs (at 90-120 days).

Annual update of how each state stands on legislative issues affecting advanced nursing practice.

The change from a free-for-service system to a system run by managed-care organizations has caused dramatic shifts in where and how health care is delivered. Within the managed-care systems, administrators need to show a good bottom line. Rapid restructuring of the system and the need for profit create many potential consequences (e.g., APNs squeezed out of participation on some provider panels; previously unattractive poor patients are now attractive because they can provide an ongoing revenue base; the use of more unlicensed personnel to provide patient services). Private businesses and the federal government like managed-care health care systems as an answer to the out-of-control escalating costs of health care. Managed care is likely to stay with us for a long while. Because political force comes from money and there is plenty of that in health care insurance corporations, managed care is likely to be with us for a long time. Regulations and control of these managed-care systems will probably be difficult. However, though big business has the money, APNs have the feet, hands and patience to seek further regulation of these huge corporations (e.g., antidiscrimination language to prevent exclusion from provider panels). With the reality of managed care, MDs are no longer in control of the health care system. The AMA's recent attempt to control other providers is tantamount to one ship officer attempting to control another on the Titanic's (i.e., fee-for-service system's) last evening. In a few states, fee-for-service is still predominant, but the majority of states are rapidly moving into megaconglomerate, finance-driven managed care run by business administrators. Things are getting so complex in today's world of corporate takeovers, managed-care megaconglomerates, and power-brokering politics that it is easy to understand why millions of Americans drown themselves in relatively simplistic good-versus-evil entertainment dramas. Huge changes in how the system operates have happened this year while the nation was busy following the Simpson trial. But NPs and other APNs must be very vigilant. We must ensure a place in this new system. Our patients and the nation need us!