A study of two-body strong interactions of elementary particles Final technical report, 27 Jan. 1969 - 1 May 1970

Two-body strong interactions of elementary particles including kaons, pions, hyperons, and proton

Projective equivalence of ideals in Noetherian integral domains

Let I be a nonzero proper ideal in a Noetherian integral domain R. In this paper we establish the existence of a finite separable integral extension domain A of R and a positive integer m such that all the Rees integers of IA are equal to m. Moreover, if R has altitude one, then all the Rees integers of J = Rad(IA) are equal to one and the ideals J^m and IA have the same integral closure. Thus Rad(IA) = J is a projectively full radical ideal that is projectively equivalent to IA. In particular, if R is Dedekind, then there exists a Dedekind domain A having the following properties: (i) A is a finite separable integral extension of R; and (ii) there exists a radical ideal J of A and a positive integer m such that IA = J^m.Comment: 20 page

Post-Modern Jurisprudence - Finally (Maybe)

A new book from Ronald Dworkin is more than a publication by an eminent legal philosopher; it is a signal for jurisprudential reflection, reassessment and wood-shedding

Immigration and Naturalization Service v. Chadha: A Legislative House of Cards Tumbles

In Immigration and Naturalization Service v. Chadha,\u27 decided June 23, 1983, the United States Supreme Court held unconstitutional an exercise by Congress of a legislative veto provision under section 244(c)(2) of the Immigration and Nationality Ac

Cyclic derivatives of Tris (hydroxymethyl) aminomethane : monourethans and ureas

The purpose of the work reported in this thesis was to study the chemistry of tris(hydroxymethyl)aminomethane (A), H2Nc(cH20H) 3, a beta-hydroxy amine

Spilt milk: an unusual cause of bilateral chylothorax

We report a case of bilateral chylothorax without evidence of chylous fistula in a 62-year-old man following total laryngectomy and bilateral selective neck dissection for laryngeal cancer. Chylous fistulae, a well-known complication of neck dissection, occurs following 1% to 2% of these surgeries. On rare occasions, the chyle leak may communicate with the pleural space, resulting in chylothorax. This is a rare but potentially life-threatening complication. Bilateral chylothorax following neck dissection is even rarer, with less than 25 cases reported in the literature. Early diagnosis is essential to prevent complications. Physicians should have a high index of suspicion, especially when the postoperative effusions do not respond to diuretics. Though no evidence-based treatment guidelines exist, expert opinion recommends conservative management as first-line therapy. Our patient was effectively treated by conservative management. We postulate a mechanism whereby bilateral chylothorax occurred in our patient without a chylous fistula

Clinical vignette: Tension pneumothorax complicating septic pulmonary emboli

Case Presentation: A 40 year old female was referred from the local jail with a tension pneumothorax. She had a long history of intravenous (IV) heroin and cocaine use followed by a 2-year history of sobriety. She had resumed intravenous heroin use 3 weeks before admission and soon thereafter developed fever and chills. She was incarcerated 7 days before admission. Five days before admission she developed progressive dyspnea and left-sided pleuritic chest pain. On arrival in the emergency department, she was found to be febrile (39.0 deg C), tachycardic (121 beats/min), tachypneic (34 breaths/min), and hypoxemic. Leukocyte count was 12,100 cells/mcL. A chest x-ray showed a large left tension pneumothorax with mediastinal shift and a moderate left sided pleural effusion. After placement of a left-sided chest tube, computerized tomography revealed multifocal peripheral cavitary nodules suggestive of septic emboli. Per the radiology report, the etiology of the pneumothorax was compatible with bronchopleural fistula, suspected to be due to a peripheral cavitary nodule in the anteromedial left lower lobe. A transthoracic echocardiogram revealed a large tricuspid valve vegetation measuring 0.95 x 1.47cm. Blood cultures grew methicillin-sensitive Staphylococcus aureus. She was treated with nafcillin. Her initial hospital course included respiratory failure requiring mechanical ventilation and development of a right-sided pneumothorax requiring placement of an additional chest tube. Serial chest x-rays showed improvement of the cavitary lesions and resolution of the bilateral pneumothoraces. She was eventually transferred to a skilled nursing facility to complete a six week course of nafcillin. At the time of discharge, she was without leukocytosis and no longer required supplemental oxygen. Discussion: Pnemothorax is an uncommon complication of pneumonia; it may be seen with Pneumocystis jiroveci, tuberculosis, or necrotizing bacterial pneumonia. Pneumothorax associated with septic pulmonary emboli is a very rare complication of Staphyloccus aureus bacteremia. The pathophysiology is presumed to be erosion of a embolic bacterial cavitary lesion into a bronchus with creation of a bronchopulmonary fistula. Conclusions: Septic pulmonary embolus is a severe complication of staphylococcal bacteremia and right-sided endocarditis that may be seen in IV drug users. On rare occasion, it may be associated with pneumothorax. This infection is often associated with prolonged morbidity and increased mortalit

Successful recruiting by an academic hospitalist section

Statement of Problem: Because of changes in resident staffing, our academic hospitalist Section required a 50% increase (from 12 to 18 FTE) in faculty members in one year. Thus, we undertook an intensive recruiting effort that spanned 9 months. Innovation Objectives: In a cost effective way, to attract and screen a large number of applicants for a position with our Section of academic hospital medicine. Program Description: In January and October, we advertised in national journals and on websites. We responded to over 100 inquiries with a standardized email describing our program, and with an invitation to formally apply by providing a letter of intent, current curriculum vitae, and three professional references. Over a 9 month period, we received formal applications from 68 physicians (53 were currently completing their residency, and 15 were practicing hospitalists). 5 were from our own residents, and 4 were from local hospitalists who had completed some training with us. These 68 applications and/or letters of reference were reviewed by our Hiring Committee. Using pre-established screening criteria, 26 of 68 (38%) applicants were judged competitive. Using standardized interviewing tools, Hiring Committee members interviewed by telephone 24 of these competitive candidates and their references. Of these, 18 were invited for an on-site visit. Findings to Date: Almost all of the invited candidates (16/18) visited our department for a one or two day visit which included face-to-face interviews, rounding, and social events. 12 of these 16 candidates (and 6 of 8 local candidates) were offered a position, and 5 accepted. Four of these had completed their residency in the past year. 3/5 (60%) of the successfully recruited faculty members had done some training at our institution. The recruiting cost included $6,431 for advertising and$14,292 for candidate visits; and required weekly meetings by our Hiring Committee. Key Lessons Learned: Using pre-established screening criteria and standardized telephone interviews, we targeted those candidates which we felt we were most likely to successfully recruit, and invited them for on-site interviews. We ultimately offered a job to 75% and hired 30% of those who completed an on-site visit. Over half of our successful recruits were from local candidates. The cost of our recruiting was $4,145 per successfully recruited physicia

Clinical vignette: Burkitts lymphoma mimicking ovarian cancer\u27

Case presentation: A 50 year-old Asian woman presented with four days of abdominal discomfort and progressive distention. She had no significant past medical history and did not consume alcohol. Her physical examination was remarkable for normal vital signs and a distended, non-tender abdomen with a fluid wave but without hepatosplenomegaly. Complete blood count and liver tests were normal. Abdominal ultrasound revealed ascites and an echogenic liver consistent with hepatic steatosis or cirrhosis, which was initially suspected. Viral hepatitis studies, human immunodeficiency virus antibody, ceruloplasmin, anti mitochondrial antibody, alpha-1 antitrypsin, anti-smith antibody and antinuclear antibodies were negative. CA-125 was markedly elevated at 301 U/ml (normal \u3c 22). Transvaginal ultrasonography revealed normal ovaries. Ascitic fluid examination revealed 42,900 total nucleated cells/cu mm of which 88 % were mononuclear cells, 5 % neutrophils and 7 % lymphocytes. Further analysis of showed abnormal B-cells expressing CD 19, CD 20, CD 10, FMC 7, and CD 45; FISH analysis showed MYC/IgH fusion associated with translocation of t (8;14) (q24;q32) characteristic of Burkitts lymphoma. Her serum LDH was 910 U/L (normal 82 — 310). Serum uric acid was normal. Computerized tomographic scanning failed to reveal hepatic or pulmonary involvement. Bone marrow biopsy and lumbar puncture were both negative for Burkitt\u27s involvement. She was treated with cyclophosphamide, vincristine, doxorubicin dexamethaosone, rituximab and methotrexate. Discussion: This woman presented with malignant ascites, the most common cause of which is ovarian cancer. This was initially assumed to be the diagnosis because of her elevated CA-125. The correct diagnosis was established by careful pathologic evaluation of ascitic fluid, showing monomorphic medium sized cells with basophilic cytoplasm and a high proliferation fraction with Ki-67 fraction approaching 100%. Translocation of the cmyc gene on chromosome 8 is characteristic of Burkitt\u27s lymphoma. Burkitt\u27s lymphoma is rare, constituting less than 1% of B-cell lymphomas. It is more common in males and usually presents with masses and tumor lysis syndrome. Less commonly it may present with ascites. This form may have a rapidly progressive course with bowel obstruction and/or gastrointestinal bleeding. We are aware of only one previous case of Burkitt\u27s lymphoma presenting with ascites and an elevated CA-125. Conclusions: This case illustrates a rare cause of malignant ascites, masquerading as ovarian cancer. Careful cytologic analysis of ascetic fluid cells led to the correct diagnosis.\u2