Relationships among endogenous ouabain, alpha-adducin polymorphisms and renal sodium handling in primary hypertension.

OBJECTIVE: The basolateral Na pump drives renotubular reabsorption. In cultured renal cells, mutant adducins, as well as sub-nanomolar ouabain concentrations, stimulate the Na-K pump. METHODS: To determine whether these factors interact and affect Na handling and blood pressure (BP) in vivo, we studied 155 untreated hypertensive patients subdivided on the basis of their plasma endogenous ouabain or alpha-adducin genotype (ADD1 Gly460Trp-rs4961). RESULTS: Under basal conditions, proximal tubular reabsorption and plasma Na were higher in patients with mutated Trp ADD1 or increased endogenous ouabain (P = 0.002 and 0.05, respectively). BPs were higher in the high plasma endogenous ouabain group (P = 0.001). Following volume loading, the increment in BP (7.73 vs. 4.81 mmHg) and the slopes of the relationship between BP and Na excretion were greater [0.017 +/- 0.002 vs. 0.009 +/- 0.003 mmHg/(muEq min)] in ADD1 Trp vs. ADD1 Gly carriers (P < 0.05). BP changes were similar, whereas the slopes of the relationship between BP and Na excretion were lower [0.016 +/- 0.003 vs. 0.008 +/- 0.002 mmHg/(muEq min)] in patients with low vs. high endogenous ouabain (P < 0.05). In patients with high endogenous ouabain, volume loading increased the BP in the ADD1 Trp group but not in the Gly group (P < 0.05). Thus, patients with ADD1 Trp alleles are sensitive to salt and tubular Na reabsorption remains elevated after volume expansion. CONCLUSION: With saline loading, BP changes are similar in high and low endogenous ouabain patients, whereas tubular Na reabsorption increases in the high endogenous ouabain group. Saline loading unmasks differences in renal Na handling in patients with mutant adducin or high endogenous ouabain and exposes an interaction of endogenous ouabain and Trp alleles on BP.

Predictors of functional recovery in patients admitted to geriatric postacute rehabilitation.

OBJECTIVE: To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation. DESIGN: Observational study. SETTING: Postacute rehabilitation facility. PARTICIPANTS: Patients (N=2754) aged ≥65 years admitted over a 4-year period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement. RESULTS: Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16-1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01-1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31-1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15-1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19-23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13-2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67-2.93; P<.001, respectively). CONCLUSIONS: Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome.

Prolonged fluconazole exposure leads to a shift to Candida species with decreased susceptibility in breakthrough candidemia: prospective survey of the Fungal Infection Network of Switzerland

Objectives: To compare the clinical characteristics, species distribution and antifungal susceptibility of Candida bloodstream isolates (BSI) in breakthrough (BTC) vs. non-breakthrough candidemia (NBTC) and to study the effect of prolonged vs. short fluconazole (F) exposure in BTC.Methods: Candida BSI were prospectively collected during 2004- 2006 from 27 hospitals (seven university, 20 affiliated) of the FUNGINOS network. Susceptibility to F, voriconazole (V) and caspofungin (C) was tested in the FUNGINOS mycology reference laboratory by microtitre broth dilution method with the Sensititre YeastOneTM test panel. Clinical data were collected using standardized CRFs. BTC was defined as occurring during antifungal treatment/prophylaxis of at least three days duration prior to the candidemia. Susceptibility of BSI was defined according to 2010/2011 CLSI clinical breakpoints.Results: Out of 567 candidemia episodes, 550 Candida BSI were available. Of these, 43 (7.6%) were from BTC (37/43, 86% were isolated after F exposure). 38 BTC (88.4%) and 315 NBTC (55.6%) occurred in university hospitals (P < 0.001). The majority of patients developing BTC were immunocompromised: higher proportions of haematological malignancies (62.8% in BTC vs. 47.1% in NBTC, P < 0.001), neutropenia (37.2% vs. 11.8%, P < 0.001), acute GvHD (14% vs. 0.2%, P < 0.001), immunosuppressive drugs (74.4% vs. 7.8%, P < 0.001), and mucositis (32.6% vs. 2.3%, P < 0.001) were observed. Other differences between BTC and NBTC were higher proportions of patients with central venous catheters in the 2 weeks preceding candidemia (95.3% vs. 83.4%, P = 0.047) and receiving total parenteral nutrition (62.8% vs. 35.9%, P < 0.001), but a lower proportion of patients treated with gastric proton pump inhibitors (23.3% vs. 72.1%, P < 0.001). Overall mortality of BTC and NBTC was not different (34.9% vs. 31.7%, P = 0.73), while a trend to higher attributable mortality in BTC was found (13.9% vs. 6.9%, P = 0.12). Species identification showed a majority of C. albicans in both groups (51.2% in BTC vs. 62.9% in NBTC, P = 0.26), followed by C. glabrata (18.6% vs. 18.5%), C. tropicalis (2.3% vs. 6.3%) and C. parapsilosis (7.0% vs. 4.7%). Significantly more C. krusei were detected in BTC versus NBTC (11.6% vs. 1.6%, P = 0.002). The geometric mean MIC for F, V and C between BTC and NBTC isolates was not significantly different. However, in BTC there was a significant association between duration of F exposure and the Candida spp.: >10 days of F was associated with a significant shift from susceptible Candida spp. (C. albicans, C. parapsilosis, C. tropicalis, C. famata) to non-susceptible species (C. glabrata, C. krusei, C. norvegensis). Among 21 BTC episodes occurring after £10 days of F, 19% of the isolates were non-susceptible, in contrast to 68.7% in 16 BTC episodes occurring after >10 days of F (P = 0.003).Conclusions: Breakthrough candidemia occurred more often in immunocompromised hosts. Fluconazole administered for >10 days was associated with a shift to non-susceptible Candida spp.. Length of fluconazole exposure should be taken into consideration for the choice of empirical antifungal treatment.

1102-001 Twelve Mile Lake Final Report

Twelve-Mile Lake is an 800-acre man-made lake in central Union County. The watershed has 13,964 land acres that are used by farmers for row crops and pasture. This lake is used as a water supply source for the City of Creston and the Southern Iowa Rural Water Association. In total approximately 40,000 people are affected by this project. Developed over 20 years ago, the lake and fishery was renovated and restocked and much of the shoreline was riprapped about six years ago. During its history, extensive watershed efforts have been ongoing. However, as farmland for cropland has become more valuable and demand has increased, hilly land once used for dairy farming, grazing, and CRP has been put into row crop production. Consequently, sediment loss has become an increasing issue for farmers, conservation professionals, and the Creston Waterworks Department, which owns the water treatment facility at the lake. In 2011, the Creston Water Board received a WIRB grant to implement a sedimentation structure at the north end of the main channel flowing into the lake. The WIRB funds were used for land acquisition, with the IDNR actually constructing the facility. This report depicts work performed as part of the WIRB project.

1003-001 Williamson Pond Final Report

Williamson Pond is a 26-acre publicly owned lake located about 2 miles east of the town of Williamson, in Lucas County. It has a watershed area of 1,499 acres. It has been managed since 1976 by the Lucas County Conservation Board (while still under state ownership) for fishing, boating, hunting, picnicking and other passive uses. Designated uses are Class AI, primary contact, and Class B (LW) aquatic life. Williamson Pond is on the 2004 EPA 303(d) List of Impaired Waters. A Total Maximum Daily Load (TMDL) for turbidity and nutrients at Williamson Pond was prepared by IDNR in 2005 and approved by EPA in 2006. The TMDL set reduction targets for both suspended sediment and phosphorus. The Williamson Pond Watershed Management Plan has provided the local work group and partners with information to develop and implement strategies to improve and protect water quality. These strategies are based on a three phase approach that will ultimately lead the removal of Williamson Pond from the Impaired Waters List. The goals identified in this proposal (Phase I) will reduce sediment and phosphorus delivery by 453 tons and 589 pounds annually. The Lucas County SWCD has and will continue to provide leadership on the Williamson Pond Project and has secured the partnerships necessary to address water quality problems and hired a part-time project coordinator to manage, implement, and oversee all activities pertaining to this proposal.

1109-003 Coe Creek Watershed Final Report

The city of Elliott has had an increase in nitrate levels in their community water supply located in the Coe Creek Watershed. They have been working with the IDNR Source Water Protection (SWP) Programs to conduct site investigations and have formed a SWP Planning Team. This Team has been reviewing the investigation findings, formed an action plan and studied different Best Management Practices (BMPs). After considering the BMPs the SWP Team made a recommendation to the Elliott City Council which included native grass seeding and a shallow water wetland. The Team also held an informational meeting for the citizens of Elliott. The goal of this meeting was to inform and educate the public of the Team findings and BMPs. The Elliott City Council approved the restoration of a shallow wetland with a native grass buffer. This whole project is 27 acres and includes a shallow water wetland with native grass buffer. This would be a long term method to reduce nitrates in the city wells. Elliott is partnering with the Natural Resources Conservation Service, Montgomery County Soil and Water Conservation District, Pheasants Forever, the Montgomery County Conservation Board, US Fish and Wildlife Service and the Montgomery County Board of Supervisors in the restoration of the shallow water wetland and native grass buffer.

09006-003 Bear Creek Watershed Final Report

Bear Creek is an impaired warm water fishery designated as class B(LR) by the Iowa DNR and is on 303 impaired waters list for fish kills and ammonia. Bear Creek is located in eastern Delaware County. This project is designed to improve the water quality of Bear Creek by educating the landowners, operators and watershed community about the importance of this water resource. The goal of the Bear Creek Watershed Project is to improve the water quality of Bear Creek by reducing the amounts of ammoniated manure discharge, fecal coliform bacteria, sediment, nitrogen, and phosphorous. The Bear Creek Watershed Project has been a watershed project since July 2004, first as a Demo project FY 2004-2005 and then full time WSPF/319 project FY06-09. Fish kills have not occurred in 2008-2009. Sediment delivery has decreased in the Bear Creek Watershed by 5,328 tons per year. The objectives of this watershed project will be to improve Livestock Waste Storage, to improve Livestock Waste Usage, to decrease Sediment Losses, and to improve Education & Area Outreach. This project will install 2 manure storage structures (EQIP/project funded), 19 ac of CRP waterways, 12 ac of project waterways, 17 ac of CRP filter strips along stream, 12 water and sediment control basins, 18,000 ft of terraces, 350 ac of new notill planting, and 3,700 ft of streambank protection.

1008-003 White Oak Watershed Final Report

Whit Oak Lake was listed on the 2008 Section 303(d) List if impaired waters in four categories. The first phase of the project has already helped to affect approximately 60% of the watershed. There has been an estimated sediment reduction of 609 tons per year with phase one. The structure being planned for the South end of the lake, (phase two) will affect nearly all of the remaining 40%. If we can accomplish similar results, we can expect a sediment reduction of approximately 273 tons additional per year. We have been working with the Mahaska County NRCS office, Snyder & Associates (engineers) and private landowners in the watershed to make this project a reality.

06001-001 Norfolk Creek Watershed Final Report

This project would target Norfolk Creek Subwatershed for land treatment practices. The Norfolk Creek Subwatershed is 14,035 acres located southwest of Waukon. The landscape is characterized by rugged karst topography and is marked with hundreds of sinkholes, providing direct drainage into the water table, affecting wells, springs, and community water sources. The surface groundwater runoff from this karst landscape eventually flows into the Yellow River. The potential point and non-point pollution sources are complicated and expensive to resolve. Extensive water quality monitoring has been completed on Norfolk Creek and has tested high in many parameters. We hope that with the upland treatment included in this grant request, terraces, grade stabilization structures, sediment control basins, and livestock manure management systems, these will improve. Continued water quality sampling will monitor this. This application has been reviewed and approved by the Allamakee County Soil and Water Conservation District Commissioners.

07011-003 Keg Creek Watershed Final Report

Mills County proposes to reduce the identified impairment of the watershed, Keg Creek, by eliminating one of the main reasons for the impairment - non-conforming, on-site septic tanks that allow effluent to drain into the creek from the unincorporated community of Mineola. This has been identified by the county as a major priority. Therefore, the county proposes to construct a collection system and lagoon treatment facility, which would eliminate effluent from draining into Keg Creek. Regional Water will own, operate, and manage the collection and treatment systems in Mineola for Mills County.

07003-001 Clear Lake Watershed Final Report

Clear Lake, Iowa's third largest natural lake, is a premier natural resource and popular recreational destination in north central Iowa. Despite the lake's already strong recreational use, water quality concerns have not allowed the lake to reach its full potential. Clear Lake is listed on Iowa's 2004 303(d) Impaired Waters List due to excessive levels of phosphorus, bacteria, and turbidity. Urban storm water runoff from the 8,600 acre watershed is a significant contributor to Clear Lake's impairment. Local communities have been working towards the goal of making improvements at all 30 storm water outlets that have a drainage area of five acres or more and have a cost effective solution. Many improvements have already been made, and now there are only seven storm water outlet sites remaining that still need protection in order to meet the goal. The storm water improvements have been very effective in reducing contaminants in urban runoff, achieving reduction levels in the 50-80% range. The proposed Clear Lake Storm Water Improvement Project will address the remaining seven outlet sites and take place over three years. The first year will consist of performing engineering and design of storm water best management practices (BMPs) at the seven outlet sites to determine if a cost effective solution exists for each. Years two and three will consist of installing two storm water improvements each year to implement the most cost effective BMPs at a minimum of four of the seven sites. The grant request addresses one of the main priorities of the Iowa Watershed Improvement Grant: storm water runoff.

06004-003 Big Sioux River Watershed Final Report

Controlling and managing manure-contaminated runoff is a responsibility of every livestock producer. The minimum requirement of all confined feeding operations in Iowa, regardless of size, is to settle solids. Two separate watershed assessments conducted in 2003-2004 by the Lyon SWCD of 141 feedlot sites indicated only 29% have solid settling basins in place. Regulating agencies generally recommend a holding pond followed by irrigation land application which require large capital investments, specialized machinery and additional management skill sets. Producers are looking for more cost-effective alternatives for controlling feedlot runoff and regulating agencies need to know these alternatives will protect the environment.

05007-003 Hewitt Creek Watershed Final Report

The goal of this project is to help residents of the Hewitt Creek watershed identify themselves as a watershed community and use cost-effective approaches to control non-point source nutrient and sediment contaminants according to collective science-based environmental goals. The project will tap the low-cost, high-return human resources of local knowledge and resident leadership for economical and sustainable solutions. A watershed council will implement an incentive program to engage their watershed community in locally-acceptable practices and performance (outcome) measures for environmental stewardship that have reasonable cost and are linked with accountable crop and livestock management decisions. The Iowa and Dubuque County Farm Bureau have supported one year of management practice incentives. The performance incentive program will take this effort to the next level, to focus on outcomes.

05002-001 Little Pony Creek Watershed Final Report

Farmers Creek is a moderately flowing stream that winds through seventeen miles of central Jackson County, encompassing a watershed area of 30,590 acres. Due to nutrient loading and sedimentation, the stream was placed on Iowa’s 303(d) List of Impaired Waters in 2002. A three year grant project was initiated in January 2005 to reduce both sediment delivery and phosphorus levels by 40% in critical areas along the stream corridor. Over thirty-five BMP’s were started in the first nine months of this project. Funding through WIRB is being requested specifically for streambank stabilization and protection projects not covered by other cost-share programs. Innovative project designs and techniques will be installed and act as demonstration sites. Projects may include jetties, weirs, cedar revetments, cattle crossings, and fencing. To assist in excluding cattle from the stream, watering systems such as slingpumps, pasture pumps, or water rams will be installed, in conjunction with filter strips and riparian buffers.

1204-003 North Fork Maquoketa Watershed Final Report

The Headwaters North Fork Maquoketa River Project encompasses the Hewitt Creek, Bear Creek, and the Coffee Creek-North Fork Maquoketa subwatersheds. These three.sub-watersheds have intensive livestock agriculture production with manures applied generously on the landscape. Approximately 85% of the watershed area is cropland. Although livestock operations are not permitted to discharge waste directly into surface waters, the mishandling and over-application of animal waste and fertilizer have impacted water quality. Each of the subwatersheds has a strong locally led effort, concentrating significant efforts on monitoring, education, and conservation practice adoption. The original MRBI application was accepted by USDA with funding being extended to producers through FY14. A large component of this effort was the IJOBS funds awarded by IDALS to support the Project Coordinator for the first two years of this project. As previous funding for the support of the Project Coordinator has been exhausted, the local partners identified WIRB as a potential replacement funding source. The goal of the existing MRBI effort, in being consistent with this WIRB application, will help landowners and operators in the three selected watersheds voluntarily implement conservation systems that reduce nutrient loss; protect, restore, and enhance wetlands; maintain agricultural productivity; improve wildlife habitat; and achieve other objectives, such as flood reduction.