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Splenic rupture is a well-described complication of babesiosis but is rarely associated with anaplasmosis.We report a case of a 37-year-old man with no significant past medical history who presented with malaise, myalgias, arthralgias and severe left upper quadrant pain. He was found to have splenic rupture secondary to infection by Anaplasma phagocytophilum. He reported a single tick bite the week prior to onset of his symptoms. On presentation, he was found to have left upper quadrant abdominal tenderness, pancytopenia, and splenomegaly with evidence of splenic rupture and hemoperitoneum on contrasted computed tomography. Blood smear did not demonstrate intraerythrocytic parasites or morulae. His hemoperitoneum was treated conservatively and he was empirically treated for babesiosis. Diagnosis was confirmed by a positive serum PCR for Anaplasma phagocytophilum.This case study adds to the small number of prior case reports and provides evidence for anaplasmosis-associated splenic rupture.

This article focuses on the Connections goal of the National Standards—i.e., on the integration of interdisciplinary content and language skills. Although content has always played some role in foreign language courses, the complexities of “connections” to academic content are far from being realized in the current foreign language teaching and learning environment. Consequently, this article proposes a developmental model for content-oriented instruction that moves students from familiar to unfamiliar academic and cultural content while also taking into account their language level at each stage. In the process, the article offers suggestions on how to avoid the “sudden jumps” in difficulty, characteristic of language and literature courses both in high school and college, which lead to so much student/teacher frustration as well as to often dramatic drops in enrollment from level to level.

A little more than four decades ago, in August 1971, the Twentieth Nobel Symposium was convened in Göteborg, Sweden, to address the rising tide of concern about adverse human impacts on the ocean. Although the discussion transcended disciplinary boundaries, the symposium focus was nevertheless on a single theme: The Changing Chemistry of the Ocean. Some 20 years of accelerated industrialization, energy production and consumption, and nuclear proliferation—fortunately, it seems—had been followed by another 20 years of advances in environmental trace metal and radiochemical analytical chemistry. Although the great technological advances in high-performance liquid chromatography and mass spectrometry that would throw open the doors of marine organic geochemistry were still yet to come, the art of environmental trace organic analysis was also making major advances in accuracy and precision, especially with regard to the identification and quantification of pesticide residues. Thanks to this newfound analytical capability, by the time of the symposium, blue-water ocean chemists worldwide were able to see more in seawater than the classic components of sea salt, macronutrients, and dissolved oxygen. The other substances they found always fascinated—and sometimes alarmed—them.

This article will discuss judicial involvement in Colorado prison health care, the interactions between Colorado State government and the United States District Court for the District of Colorado, and the effect that such judicial involvement has had on the status of overall prison health care in Colorado.

a ripple effect on state programs. In Colorado, the prie c) mary effect was a unanimous effort to "keep out the Feds." It was in this spirit, during the 1977 legislative session, that House Bill 1582 passed with bipartisan and hospital support. House Bill 1582 created the Colorado Hospital Commission, with broad powers to control both revenues and rates of increase in hospital costs. It also mandated a system of prospective budgeting, which represented a radical departure from the norm established by the Medicare program in 1966 of retrospective, cost-based reimbursement. In essence, the new system required that budget and revenue levels be set prior to the start of any hospital fiscal year, rather than simply reimbursing the hospitals for whatever they happened to spend. The new law met the demands and expectations of almost all segments of society. It dealt with the political concerns of the legislature that something be done to appease their constituents about skyrocketing hospital costs. It met the sociocultural concerns of the public-at-large in that an industry that had gone unchecked might finally be brought "into line." The bill also treated the ethical concerns of all involved in that they had reached an equitable compromise solution for dealing with a problem, albeit for widely differing reasons. It was in this spirit that regulation of hospital costs began in Colorado. The Commission commenced in October 1977. Within a year, the spirit of cooperation experienced during the passage of H.B. 1582 had disintegrated. By the end of the 1979 legislative session, Senate Bill 38 passed, dissolving the Commission as of March 1, 1980. Realizing that the Com

To the Editor. —Although most hazards of hydralazine hydrochloride therapy are well known, including clinical signs and symptoms resembling lupus erythematosus, the drug continues to be used therapeutically because of its ability to lower BP by a direct effect on peripheral vascular resistance. Among its less well-recognized side effects is serious hepatitis in sensitive individuals. We report herein such a case, where histologic evidence of granulomatous hepatitis was found. Report of a Case. —A 51-year-old woman was admitted to the hospital on March 24, 1982, with nausea, fever to 2.2 °C, and dark urine that contained bile. She had begun receiving 2.5 mg/day of metolazone in January and 20 to 80 mg/day of nadolol in February. On March 2, therapy was begun with 25 mg twice daily of hydralazine hydrochloride. Ten days later, the patient began experiencing malaise, with nausea and vomiting following during the next week. Ampicillin sodium, given

Providing quality services to any traveller requires constant efforts to ensure that tourist destinations, products, and services are accessible to all people, regardless of their health condition, physical limitations, gender, origin, age. This entails a collaborative process among all the interested parties: administrators, tourist agencies, tour operators, and end users, who expressing their points of view can objectively contribute to reach shared and effective solutions. A single visit destination can involve many factors, including access to information: the project A Region for All, promoted by Promoturismo FVG in collaboration with CRAD FVG and the University of Trieste, focused on this issue. Promoturismo FVG is a semi-public destination management organization. Its mission is to develop the regional tourism system collaborating with all the active subjects to improve the promotion and to optimize the resources by concentrating the efforts. The organization pursues its objectives by planning and organizing the offer through specific tourism products. In 2016 a mapping process has been started to investigate the usability of the relevant services to tourists / visitors with special needs along the itinerary of eight tourist centers of the Friuli Venezia Giulia region. To date, more than 200 facilities (bars, restaurants, pharmacies, cash machines…) have been detected. The paper will present the development of the work conducted by TrIAL - Trieste Inclusionamp; Accessibility Lab at Department of Engineering and Architecture within the University of Trieste for the management of the mapping process. On the strength of the mapping experience developed during the previous project LabAc (Laboratory of Accessibility) for the Province of Trieste and the project Trieste for All for the Municipality of Trieste (from 2013 to 2016), the research group has adopted and set a series of digital tools, has identified specific indicators and has focused on an efficient return of data to Promoturismo FVG. The overall project is still ongoing: collected data have not yet been published by the organization. Overall monitoring and evaluation activities are still lacking and will be part of a future phase of research.