Iowa Department of Transportation Major Items - Preliminary Quantity Report, February 17, 2015; With Addendums

Weekly letting report.

The global activator GacA of Pseudomonas aeruginosa PAO positively controls the production of the autoinducer N-butyryl-homoserine lactone and the formation of the virulence factors pyocyanin, cyanide, and lipase.

The global activator GacA, a highly conserved response regulator in Gram-negative bacteria, is required for the production of exoenzymes and secondary metabolites in Pseudomonas spp. The gacA gene of Pseudomonas aeruginosa PAO1 was isolated and its role in cell-density-dependent gene expression was characterized. Mutational inactivation of gacA resulted in delayed and reduced formation of the cell-density signal N-butyryl-L-homoserine lactone (BHL), of the cognate transcriptional activator RhIR (VsmR), and of the transcriptional activator LasR, which is known to positively regulate RhIR expression. Amplification of gacA on a multicopy plasmid caused precocious and enhanced production of BHL, RhIR and LasR. In parallel, the gacA gene dosage markedly influenced the BHL/RhIR-dependent formation of the cytotoxic compounds pyocyanin and cyanide and the exoenzyme lipase. However, the concentrations of another known cell-density signal of P. aeruginosa, N-oxododecanoyl-L-homoserine lactone, did not always match BHL concentrations. A model accounting for these observations places GacA function upstream of LasR and RhIR in the complex, cell-density-dependent signal-transduction pathway regulating several exoproducts and virulence factors of P. aeruginosa via BHL.

Late side-effects after curative intent radiotherapy: Identification of hypersensitive patients for personalized strategy.

Radiation therapy undeniably enhances local control and thus improves overall survival in cancer patients. However, some long-term cancer survivors (less than 10%) develop severe late radio-induced toxicities altering their quality of life. Therefore, there is a need to identify patients who are sensitive to those toxicities and who could benefit from adapted care. In this review, we address all available techniques aiming to detect patients' hyper-radiosensitivity and present the scientific rationales these techniques are based on.

Cost-effectiveness of surgery in low- and middle-income countries: a systematic review.

BACKGROUND: There is increasing interest in provision of essential surgical care as part of public health policy in low- and middle-income countries (LMIC). Relatively simple interventions have been shown to prevent death and disability. We reviewed the published literature to examine the cost-effectiveness of simple surgical interventions which could be made available at any district hospital, and compared these to standard public health interventions. METHODS: PubMed and EMBASE were searched using single and combinations of the search terms "disability adjusted life year" (DALY), "quality adjusted life year," "cost-effectiveness," and "surgery." Articles were included if they detailed the cost-effectiveness of a surgical intervention of relevance to a LMIC, which could be made available at any district hospital. Suitable articles with both cost and effectiveness data were identified and, where possible, data were extrapolated to enable comparison across studies. RESULTS: Twenty-seven articles met our inclusion criteria, representing 64 LMIC over 16 years of study. Interventions that were found to be cost-effective included cataract surgery (cost/DALY averted range US$5.06-$106.00), elective inguinal hernia repair (cost/DALY averted range US$12.88-$78.18), male circumcision (cost/DALY averted range US$7.38-$319.29), emergency cesarean section (cost/DALY averted range US$18-$3,462.00), and cleft lip and palate repair (cost/DALY averted range US$15.44-$96.04). A small district hospital with basic surgical services was also found to be highly cost-effective (cost/DALY averted 1 US$0.93), as were larger hospitals offering emergency and trauma surgery (cost/DALY averted US$32.78-$223.00). This compares favorably with other standard public health interventions, such as oral rehydration therapy (US$1,062.00), vitamin A supplementation (US$6.00-$12.00), breast feeding promotion (US$930.00), and highly active anti-retroviral therapy for HIV (US$922.00). CONCLUSIONS: Simple surgical interventions that are life-saving and disability-preventing should be considered as part of public health policy in LMIC. We recommend an investment in surgical care and its integration with other public health measures at the district hospital level, rather than investment in single disease strategies.

Changes in nuclear 3,5,3'-triiodothyronine receptor expression in rat dorsal root ganglia and sciatic nerve during development: comparison with regeneration.

The action of the thyroid hormones on responsive cells in the peripheral nervous system requires the presence of nuclear triiodothyronine receptors (NT3R). These nuclear receptors, including both the alpha and beta subtypes of NT3R, were visualized by immunocytochemistry with the specific 2B3 monoclonal antibody. In the dorsal root ganglia (DRG) of rat embryos, NT3R immunoreactivity was first discretely revealed in a few neurons at embryonic day 14 (E14), then strongly expressed by all neurons at E17 and during the first postnatal week; all DRG neurons continued to possess clear NT3R immunostaining, which faded slightly with age. The peripheral glial cells in the DRG displayed a short-lived NT3R immunoreaction, starting at E17 and disappearing from the satellite and Schwann cells by postnatal days 3 and 7 respectively. In the developing sciatic nerve, Schwann cells also exhibited transient NT3R immunoreactivity restricted to a short period ranging from E17 to postnatal day 10; the NT3R immunostaining of the Schwann cells vanished proximodistally along the sciatic nerve, so that the Schwann cells rapidly became free of detectable NT3R immunostaining. However, after the transection or crushing of an adult sciatic nerve, the NT3R immunoreactivity reappeared in the Schwann cells adjacent to the lesion by 2 days, then along the distal segment in which the axons were degenerating, and finally disappeared by 45 days, when the regenerating axons were allowed to re-occupy the distal segment.(ABSTRACT TRUNCATED AT 250 WORDS)

La lombalgie aiguë en médecine de premier recours [Acute low back pain in general practice medicine].

The practioner's first concern is knowing how to single out from the immense majority of situations susceptible to a favourable spontaneous evolution those patients with a bad prognostic necessitating reference to a specialist. We present in this paper the clinical steps designed to meet this challenge and a reminder of certain principles of patient diagnosis and care.

Fecal calprotectin more accurately reflects endoscopic activity of ulcerative colitis than the Lichtiger Index, CRP, and blood leukocytes

Background: Thus far, the correlation of noninvasive markers with endoscopic activity in ulcerative colitis (UC) according to the modified Baron Index is unknown. We aimed to evaluate the correlation between endoscopic activity and fecal calprotectin (FC), C-reactive protein (CRP), blood leukocytes, and the Lichtiger Index (clinical score). Methods: UC patients undergoing complete colonoscopy were prospectively enrolled and scored clinically and endoscopically in an independent fashion. Fecal and blood samples were analyzed in UC patients and controls. Results: We enrolled 228 UC patients and 52 controls. Endoscopic disease activity correlated best with FC (Spearman's rank correlation coefficient r = 0.821), followed by the Lichtiger Index (r = 0.682), CRP (r = 0.556), and leukocytes (r = 0.401). FC was the only marker discriminating between different grades of endoscopic activity (grade 0, 20}11 mg/g; grade 1, 44}34 mg/g; grade 2, 111}74 mg/g; grade 3, 330}332 mg/g; grade 4, 659}319 mg/g; P = 0.0018 for discriminating grade 0 vs. 1 and P < 0.001 for discriminating all other grades). FC had the highest overall accuracy (91%) to detect endoscopically active disease (modified Baron Index _2), followed by the Lichtiger Index of _4 (77%), CRP larger than 5 mg/L (69%) and blood leukocytosis (58%). Conclusions: FC better correlated with the endoscopic disease activity than clinical activity, CRP, and blood leukocytes. The strong correlation with endoscopic disease activity suggests that FC represents a useful biomarker for noninvasive monitoring of disease activity in UC patients.

Planning for Water Quality, July 2012

The following document serves two purposes. First, the Environmental Protection Agency (EPA) requires a state to develop an approved Non-point Source Management Plan (NPSMP or Plan) that encompasses the nine key elements, described in full in Appendix A, to be eligible for federal Clean Water Act Section 319 funding. Second, the Plan serves as a representation of Iowa’s vision, goals, objectives and potential action steps to reduce non-point source pollution and improve water quality over the next five to ten years. This plan is not intended to be, nor should it be, limited to the Department of Natural Resources or Iowa’s Section 319 Program, but rather reflects the collective efforts and intents of the core partners and stakeholder groups that worked together to develop the goals identified herein and programmatic means of achieving those goals.

1022-013 Dry Run Creek Watershed Final Report

The Dry Run Creek Watershed received a biological impairment in 2002 after sampling conducted by the Department of Natural Resources revealed a lack in the diversity and abundance of aquatic life along a 2.8 mile reach of stream along the Southwest Branch. Among the primary stressors identified were hydrologic change, increased stormsewer inputs, lack of available habitat, and sedimentation. Goals put forth by the Watershed Management Plan and the preliminary Total Maximum Daily Load (TMDL) study center around the reduction in storm sewer inputs. The goal set forth by the TMDL is the reduction of connected impervious surface (CIS) to 10% in each of the creek’s subwatersheds as a surrogate for other stressors. Grant funding is being sought for the construction of two bioretention cells and a green roof to treat the first flush of runoff from a new 400 unit student housing structure and connected parking surfaces totaling 5.16 acres. In addition, a monitoring program will continue to be coordinated through a partnership with the Department of Natural Resources IOWATER program and locally led volunteer efforts which will allow us to track the progress of the watershed. Funding for administration, outreach, and assessment will be provided through existing 319 grants. Implementation of these practices will occur in phases over the course of a two year period.

06033-015 Fox River Watershed Final Report

With WIRB funding the Fox River Ecosystem Development board will install prioritized practices identified by assessments within the impaired segment of Fox River that currently will not be funded by Iowa Section 319 or Watershed Protection Funds. The FRED board is also asking for funding for a three year position for continuing assessment, planning, and technical assistance. Through various funding sources local work groups have been able to address some of the critical and high priority areas. But, as further assessments are made, commitment, and need expressed from landowners grow, the FRED board and SWCD districts in both Iowa and Missouri are committed not only to seek funding to continue water quality efforts for more practices but also enhance and protect existing practices and investments that protect our water quality and economic viability in both states.

1118-007 Lake Hendricks Watershed Final Report

Lake Hendricks is a 54 acre man-made lake that is encompassed by a 1,209 acre watershed. Lake Hendricks is currently on the 303(d) Impaired Waters List for algae and pH impairments due to an abundance of algae growth caused by nutrients being delivered to the lake via 11 separate tile lines draining adjoining cropland areas. In 2009, a Watershed Management Plan was developed in partnership with IDALS and the IDNR 319 programs and $256,500 was awarded to address the nutrient and sediment loading of the lake. Over the past three years a total of $251,000 were spent to implement one grade stabilization structure, two sediment basins, two bioreactors, 700 feet of streambank stabilization, 30.7 acres oftimber stand improvement, and 39.4 acres of Conservation Reserve Program (CRP). A proposed wetland structure and three sediment basins are scheduled to be constructed in the fall of 2011. Current water monitoring data is showing an average of 54% Nitrate (N) loading reductions as a result of the installed BMPs. The District feels further reductions are possible by addressing nutrient management issues in the cropland areas, stabilizing additional streambanks, and improving the surrounding woodland areas. The goal is to reduce N loading by an additional 20% and sediment loading by 50 tlac/yr. The resulting collaborative effort may lead to the future de-listing of Lake Hendricks from the 303(d) Impaired Waters List.

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.