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.

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!

Listeria monocytogenes--threat to a safe food supply: a review.

Listeria monocytogenes can cause circling disease, encephalitis, meningitis, septicemia, and mastitis in dairy cattle. Shedding of the pathogen from the udder or contamination from the environment can lead to presence of L. monocytogenes in raw milk. Surveys indicate the pathogen is in about 4% of US raw milks. Although HTST pasteurization commonly inactivates L. monocytogenes, evidence suggests that under unusual circumstances minimal survival is possible. The pathogen grows well in liquid dairy products at 4 to 35 degrees C and achieves higher populations in chocolate than in unflavored milks. When present in cheese milk, growth of L. monocytogenes may be retarded but not stopped by lactic starter cultures. The pathogen is concentrated in the curd with only a small fraction of cells in milk appearing in whey. Once in curd, the behavior of the pathogen ranges from growth (feta cheese making) to death of most but not all cells (cottage cheese making). During ripening of cheese, the numbers of L. monocytogenes decrease gradually (as in Cheddar or Colby cheese), decrease precipitously early during ripening, and then stabilize (as in blue cheese) or increase markedly (as in Camembert cheese). Consumption of foods containing L. monocytogenes can lead to listeriosis in susceptible humans (adults with a compromised immune system), pregnant women, and infants). In large outbreaks of human listeriosis, mortality rates of ca. 30% are common.