Connections, Fall 2001

Newsletter for Iowa Department of Transportation, Office of Public Transit

Connections, Winter 2001-2002

Newsletter for Iowa Department of Transportation, Office of Public Transit

Connections, Spring 2001

Newsletter for Iowa Department of Transportation, Office of Public Transit

Connections, Summer 2001

Newsletter for Iowa Department of Transportation, Office of Public Transit

2006-2010 Iowa Transportation Improvement Program

This document provides the planned investments in Iowa's transportation system for the five-year period of 2006-2010. It encompasses aviation, railroads, rivers, trails, state parks and institutional roads, roadways, and public transit.

Theorizing institutional changes: understanding decentralization and federalization in Brazil, Spain and South Africa

In light of the existing theories about institutional change, this paper seeks to advance a common framework to understand the unfolding of decentralization and federalization in three countries: Brazil, Spain, and South Africa. Although in different continents, these three countries witnessed processes after their respective transitions to democracy that transferred administrative and fiscal authority to their regions (decentralization) and vertically distributed political and institutional capacity (federalization). This paper attempts to explain how institutional changes prompted a shift of power and authority towards regional governments by looking at internal sources of change within the intergovernmental arena in the three countries. This analysis is organized around two propositions: that once countries transit to democracy under all-encompassing constitutions there are high incentives for institutional change, and that under a bargained intergovernmental interaction among political actors subnational political elites are able to advance their interests incrementally. In short, through a common framework this paper will explain the evolving dynamics of intergovernmental dynamics in three countries.

Usefulness of methadone plasma concentration measurement in patients receiving nevirapine or efavirenz.

Objective: To determine methadone plasma trough and peak concentrations in patients presenting opiate withdrawal symptoms after introduction of nevirapine or efavirenz. To describe the disappearance of these symptoms after methadone titration based on plasma concentrations rather than on the symptoms. Methods: Nine patients undergoing highly active antiretroviral therapy (HAART) and either nevirapine or efavirenz treatment were monitored daily for opiate withdrawal in a specialized drug addiction center. Methadone dose was titrated daily, and plasma concentrations were measured. The data are retrospective (case series). Results: Several patients complained of symptoms such as nausea, vomiting, accelerated intestinal transit, or insomnia. Even after methadone titration based on clinical symptoms, patients and health-care providers trained in infectious disease did not classify these as withdrawal symptoms and considered them as the side effects of HAART or anxiety. Methadone plasma trough concentration showed low levels of (R)- and (R,S)-methadone. Further methadone dose adjustment according to plasma level resulted in the disappearance of these withdrawal symptoms. The daily methadone dose was split when the peak/trough (R)-methadone ratio was more than 2. Conclusions: When introducing efavirenz or nevirapine to patients undergoing methadone treatment, withdrawal symptoms should be monitored, especially those such as insomnia, vomiting, or nausea. Methadone plasma trough and peak measurements can be of value in preventing unnecessary side effects of HAART.

2007-2011 Iowa Transportation Improvement Program

This document was prepared by the Iowa Department of Transportation to inform Iowans of planned investments in the state's transportation system over the next five years.

Laparoscopic and open colorectal surgery in everyday practice : retrospective study

Résumé Introduction: La plupart des études disponibles sur la chirurgie colorectale par laparoscopie concernent des patients hautement sélectionnés. Le but de cette étude est d'analyser les résultats à court et à long terme de l'ensemble des patients traités dans un service de chirurgie générale. Méthodes: Il s'agit d'une analyse rétrospective d'un registre prospectif interne au service, dans lequel tous les patients consécutifs opérés pour la première fois du colon et du rectum entre mars 1993 et décembre 1997 ont été enregistrés. Les informations concernant le suivi ont été collectées par questionnaire. Résultats: Un total de 187 patients ont été opérés par laparoscopie et 215 patients par chirurgie ouverte durant la période d'étude. Les informations concernant le suivi ont pu être collectées dans 95% des cas avec une évolution de 1-107 mois (médiane 59 mois), respectivement de 1-104 mois (médiane 53 mois). Une conversion fut nécessaire dans 28 cas (15%) mais ceux-ci restent inclus dans le groupe laparoscopie pour l'analyse par intention de traitement. Dans le groupe laparoscopie, les opérations ont duré plus longtemps (205 vs 150 min, p<0.001) mais l'hospitalisation a été plus courte (8 vs 13 jours, p<0.001). La reprise du transit a été plus rapide après laparoscopie, mais uniquement après intervention sur le colon gauche (3 vs 4 jours, p<0.01). Cependant, la sélection préopératoire (nombre plus élevé d'urgences et de patients avec un risque anesthésiologique élevé dans le groupe de la chirurgie ouverte) a été favorable à la laparoscopie. Le taux de complications (global ainsi que pour chaque complication chirurgicale) a été similaire dans les deux groupes, avec un taux global de 20% environ. Conclusions: Malgré une sélection favorable des cas, uniquement très peu d'avantages à la laparoscopie sur la chirurgie ouverte ont pu être observés. Abstract Background: Most studies available on laparoscopic colorectal surgery focus on highly selected patient groups. The aim of the present study was to review short- and long-term outcome of everyday patients treated in a general surgery department. Methods: Retrospective review was carried out of a prospective database of all consecutive patients having undergone primary laparoscopic (LAP) or open colorectal surgery between March 1993 and December 1997. Follow-up data were completed via questionnaire. Results: A total of 187 patients underwent LAP resection and 215 patients underwent open surgery. Follow up was complete in 95% with a median of 59 months (range, 1-107 months) and 53 months (range, 1-104 months), respectively. There were 28 conversions (15%) in the LAP group and these remained in the LAP group in an intention-to-treat analysis. The LAP operations lasted significantly longer for all types of resections (205 vs 150 min, P<0.001) and hospital stay was shorter (8 vs 13 days, P<0.001). Recovery of intestinal function was faster in the LAP group, but only after left-sided procedures (3 vs 4days, P<0.01). However, preoperative patient selection (more emergency operations and patients with higher American Society of Anesthesiologists (ASA) score in the open group) had a major influence on these elements and favours the LAP group. Surprisingly, the overall surgical complication rate (including long-term complications such as wound hernia) was 20% in both groups with rates of individual complications also being comparable in both groups. Conclusion: Despite a patient selection favourable to the laparoscopy group, only little advantage in postoperative outcome could be shown for the minimally invasive over the open approach in the everyday patient.

2009-2013 Iowa Transportation Improvement Program

The Iowa Transportation Improvement Program (Program) is published to inform Iowans of planned investments in our state's transportation system. The Iowa Transportation Commission (Commission) and Iowa Department of Transportation (Iowa DOT) are committed to programming those investments in a fiscally responsible manner. Iowa's transportation system is multi-modal; therefore, the Program encompasses investments in aviation, transit, railroads, trails, and highways. A major component of the Program is the highway section. The FY2009-2013 highway section is financially balanced and was developed to achieve several objectives. The Commission's primary highway investment objective is the safety, maintenance and preservation of Iowa's existing highway system. The Commission has allocated an annual average of $321 million to achieve this objective. This includes $185 million in 2009 and $170 million annually in years 2010-2013 for preserving the interstate system. It includes $114 million in 2009, $100 million in 2010 and $90 million annually in years 2011-2013 for non-interstate pavement preservation. It includes $38 million annually in 2009 and 2010, and $35 million annually in years 2011-2013 for non-interstate bridges. In addition, $15 million annually is allocated for safety projects. However, due to increasing construction costs, flattened revenues and overall highway systems needs, the Commission acknowledges that insufficient funds are being invested in the maintenance and preservation of the existing highway system. Another objective involves investing in projects that have received funding from the federal transportation act and/or subsequent federal transportation appropriation acts. In particular, funding is being used where it will complete a project, corridor or useable segment of a larger project. As an investment goal, the Commission also wishes to advance highway projects that address the state's highway capacity and economic development needs. Projects that address these needs and were included for completion in the previous program have been advanced into this year's Program to maintain their scheduled completion. This program also includes a small number of other projects that generally either represent a final phase of a partially programmed project or an additional segment of a partially completed corridor. The TIME-21 bill, Senate File 2420, signed by Governor Chet Culver on April 22, provides additional funding to cities, counties and the Iowa DOT for road improvements. This will result in additional revenue to the Primary Road Fund beginning in the second half of FY2009 and gradually increase over time. The additional funding will be included in future highway programming objectives and proposals and is not reflected in this highway program. The Iowa DOT and Commission appreciate the public's involvement in the state's transportation planning process. Comments received personally, by letter, or through participation in the Commission's regular meetings or public input meetings held around the state each year are invaluable in providing guidance for the future of Iowa's transportation system. It should be noted that this document is a planning guide. It does not represent a binding commitment or obligation of the Commission or Iowa DOT, and is subject to change. You are invited to visit the Iowa DOT's Web site at iowadot.gov for additional and regular updates about the department's programs and activities.

Colonic movements in healthy subjects as monitored by a Magnet Tracking System.

The Magnet Tracking System (MTS) is a minimally-invasive technique of continuous evaluation of gastrointestinal motility. In this study, MTS was used to analyse colonic propulsive dynamics and compare the transit of a magnetic pill with that of standard radio-opaque markers. MTS monitors the progress in real time of a magnetic pill through the gut. Ten men and 10 women with regular daily bowel movements swallowed this pill and 10 radio-opaque markers at 8 pm. Five hours of recordings were conducted during 2 following mornings. Origin, direction, amplitude and velocity of movements were analysed relative to space-time plots of the pill trajectory. Abdominal radiographs were taken to compare the progress of both pill and markers. The magnetic pill lay idle for 90% of its sojourn in the colon; its total retrograde displacement accounted for only 20% of its overall movement. Analysis of these movements showed a bimodal distribution of velocities: around 1.5 and 50 cm min(-1), the latter being responsible for 2/3 of distance traversed. There were more movements overall and more mass movements in males. Net hourly forward progress was greater in the left than right colon, and greater in males. The position of the magnetic pill correlated well with the advancement of markers. MTS showed patterns and propulsion dynamics of colonic segments with as yet unmet precision. Detailed analysis of slow and fast patterns of colonic progress makes it possible to specify the motility of colonic segments, and any variability in gender. Such analysis opens up promising avenues in studies of motility disorders.

D-serine increases adult hippocampal neurogenesis.

Adult hippocampal neurogenesis results in the continuous formation of new neurons and is a process of brain plasticity involved in learning and memory. The neurogenic niche regulates the stem cell proliferation and the differentiation and survival of new neurons and a major contributor to the neurogenic niche are astrocytes. Among the molecules secreted by astrocytes, D-serine is an important gliotransmitter and is a co-agonist of the glutamate, N-methyl-D-aspartate (NMDA) receptor. D-serine has been shown to enhance the proliferation of neural stem cells in vitro, but its effect on adult neurogenesis in vivo is unknown. Here, we tested the effect of exogenous administration of D-serine on adult neurogenesis in the mouse dentate gyrus. We found that 1 week of treatment with D-serine increased cell proliferation in vivo and in vitro and increased the density of neural stem cells and transit amplifying progenitors. Furthermore, D-serine increased the survival of newborn neurons. Together, these results indicate that D-serine treatment resulted in the improvement of several steps of adult neurogenesis in vivo.

Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis--the role of routine abdominal drainage.

Complicated acute appendicitis is still associated with an increased morbidity. If laparoscopy has been accepted as a valid approach, some questions remain concerning intra-abdominal abscess formation. Routine prophylactic drainage of the abdomen has been proposed. However, this practice remains a matter of debate, poorly validated in the literature. With the present study, we investigated the impact of drainage in laparoscopic appendectomy for complicated appendicitis. This is a case match study of consecutive patients operated on by laparoscopy in a single institution. One hundred and thirty patients operated for complicated appendicitis (local peritonitis without perforation, with perforation, or with periappendicular abscess) with prophylactic intraperitoneal drainage were matched one by one to 130 patients operated without drainage. Uncomplicated appendicitis and generalized peritonitis were excluded. Primary endpoint was surgical complications and secondary endpoints were transit recovery time and length of hospital stay. Patients without drain had significantly less overall complications (7.7% vs. 18.5%, p = 0.01). Moreover, the absence of drainage was of significant benefit for transit recovery time (2.5 vs. 3.5 days, p = 0.0068) and length of hospital stay (4.2 vs. 7.3 days, p < 0.0001). No benefits were observed for prophylactic drainage of the abdominal cavity during emergency laparoscopic treatment of complicated appendicitis. For this reason, this practice may be abandoned.

Discovering Historic Iowa Transportation Milestones, February 1999

In studying and forming an understanding of Iowa’s transportation history, we must surely develop a reverence for the lifestyles which preceded ours. Achieving a greater understanding of our past, we are better prepared to plan our future as we say farewell to the 20th century and move forward into the 21st. In the words of Oliver Wendell Holmes: “I believe the greatest thing in this world is not so much where we stand as in what direction we are moving... and the further backward you can look, the farther forward you can see.” To help Iowans gain a better understanding of our state’s rich transportation past, the Iowa Department of Transportation has produced a collection of materials including this booklet, the 1999-2000 Iowa Transportation Map, a video entitled A History of Iowa’s Rivers, Roads, Rails and Runways, and a traveling photo exhibit. In addition, Iowa is fortunate to have many local organizations, and the state-owned museum and historic sites, working to preserve the history of our state. Listed in the back section of this booklet are the addresses and descriptions of many sites that offer visitors an opportunity to see a wide range of transportation- related artifacts. The information and photographs are organized in time sequence. However, you will note that many of the transportation eras overlap. The booklet begins with Iowa’s pre-settlement era and concludes with the historic highway and transit program that was signed into law by President Clinton in 1998. As you can imagine, condensing this much Iowa history into a booklet-sized resource was a monumental challenge. Making selections and abbreviating the information resulted in some difficult editorial choices. However, we hope this publication will inspire readers to learn more about our rich, rewarding past and to visit and experience some of Iowa’s historic sites.

Investing in Iowa’s Highways, May 29, 2009

The Iowa Transportation Commission (Commission) and Iowa Department of Transportation (Iowa DOT) develop Iowa’s Five-Year Transportation Improvement Program (Five-Year Program) to inform Iowans of planned investments in our state’s multi-modal transportation system. The Five-Year Program is typically updated and approved each year in June. The Five-Year Program encompasses investments in aviation, transit, railroads, trails, and highways. This brochure describes the programming process used by the Commission and Iowa DOT to develop the highway section of the Five-Year Program.