Hemodynamic effects of sodium bicarbonate in critically ill neonates.

OBJECTIVE: To analyze the cardiovascular effects of sodium bicarbonate in neonates with metabolic acidosis. DESIGN: Prospective, open, non-randomized, before-after intervention study with hemodynamic measurements performed before and 1, 5, 10, 20, and 30 min after bicarbonate administration. SETTING: Neonatal intensive care unit, tertiary care center. PATIENTS: Sequential sample of 16 paralysed and mechanically ventilated newborn infants with a metabolic acidosis (pH < 7.25 in premature and < 7.30 in term infants, base deficit > -8). INTERVENTION: An 8.4% sodium bicarbonate solution diluted 1:1 with water (final osmolality of 1000 mOsm/l) was administered in two equal portions at a rate of 0.5 mmol/min. The dose in mmol was calculated using the formula "base deficit x body weight (kg) x 1/3 x 1/2". MEASUREMENTS AND RESULTS: Sodium bicarbonate induced a significant but transient rise in pulsed Doppler cardiac output (CO) (+27.7%), aortic blood flow velocity (+15.3%), systolic blood pressure (BP) (+9.3%), (+14.6%), transcutaneous carbon dioxide pressure (PtcCO2) (+11.8%), and transcutaneous oxygen pressure (PtcO2) (+8%). In spite of the PaCO2 elevation, pH significantly improved (from a mean of 7.24 to 7.30), and the base deficit decreased (-39.3%). Calculated systemic vascular resistance (SVR) (-10.7%) and diastolic BP (-11.7%) decreased significantly, while PaO2 and heart rate (HR) did not change. Central venous pressure (CVP) (+6.5%) increased only slightly. By 30 min after bicarbonate administration all hemodynamic parameters, with the exception of the diastolic BP, had returned to baseline. CONCLUSION: Sodium bicarbonate in neonates with metabolic acidosis induces an increase in contractility and a reduction in afterload.

Field Evaluation of Cold In-Place Recycling of Asphalt Concrete, HR-303, 1993

The average thickness of the existing asphalt cement concrete (ACC) along route E66 in Tama County was 156 mm (6.13 in.). The rehabilitation strategy called for widening the base using the top 75 mm (3 in.) of the existing ACC by a recycling process involving cold milling and mixing with additional emulsion/rejuvenator. The material was then placed into a widening trench and compacted to match the level of the milled surface. The project had the following results: (1) Cold recycled ACC pavement provided adequate pavement structure for a low volume road; (2) Premature cracking of the ACC in the widened pavement area was caused by compaction of the mix over a saturated subgrade; and (3) Considerably less transverse and longitudinal cracking was observed with 75 mm (3 in.) of cold recycled ACC and a 50 mm (2 in.) hot mix ACC overlay than with a conventional hot mix overlay with no cold recycling. More research should be done on efficient construction procedures and incorporating longer test sections for proper evaluation.

Reduction of Concrete Deterioration by Ettringite Using Crystal Growth Inhibition Techniques, TR-431, 2001

Many researchers have concluded that secondary or delayed ettringite is responsible for serious premature deterioration of concrete highways. In some poorly performing Iowa concretes, ettringite is the most common secondary mineral but its role in premature deterioration is uncertain since some researchers still maintain that secondary ettringite does not itself cause deterioration. The current research project was designed to determine experimentally if it is possible to reduce secondary ettringite formation in concrete by treating the concrete with commercial crystallization inhibitor chemicals. The hypothesis is such that if the amount of ettringite is reduced, there will also be a concomitant reduction of concrete expansion and cracking. If both ettringite formation and deterioration are simultaneously reduced, then the case for ettringite induced expansion/cracking is strengthened. The experiment used four commercial inhibitors - two phosphonates, a polyacrylic acid, and a phosphate ester. Concrete blocks were subjected to continuous immersion, wet/dry and freeze/thaw cycling in sodium sulfate solutions and in sulfate solutions containing an inhibitor. The two phosphonate inhibitors, Dequest 2060 and Dequest 2010, manufactured by Monsanto Co., were effective in reducing ettringite nucleation and growth in concrete. Two other inhibitors, Good-rite K752 and Wayhib S were somewhat effective, but less so than the two phosphonates. Rapid experiments with solution growth inhibition of ettringite without the presence of concrete phases were used to explore the mechanisms of inhibition of this mineral. Reduction of new ettringite formation in concrete blocks also reduced expansion and cracking of the blocks. This relationship clearly links concrete expansion with this mineral - a conclusion that some research workers have disputed despite theoretical arguments for such a relationship and despite numerous observations of ettringite mineralization in prematurely deteriorated concrete highways. Secondary ettringite nucleation and growth must cause concrete expansion because the only known effect of the inhibitor chemicals is to reduce crystal nucleation and growth, and the inhibitors cannot in any other way be responsible for the reduction in expansion. The mechanism of operation of the inhibitors on ettringite reduction is not entirely clear but the solution growth experiments show that they prevent crystallization of a soluble ettringite precursor gel. The present study shows that ettringite growth alone is not responsible for expansion cracking because the experiments showed that most expansion occurs under wet/dry cycling, less under freeze/thaw cycling, and least under continuous soaking conditions. It was concluded from the different amounts of damage that water absorption by newly-formed, minute ettringite crystals is responsible for part of the observed expansion under wet/dry conditions, and that reduction of freeze resistance by ettringite filling of air-entrainment voids is also important in freeze/thaw environments.

Permeability of Granular Subbase Materials, MLR-90-4, 1991

The purpose of this research was to evaluate the materials Iowa uses as a granular subbase and to determine if it provides adequate drainage. Numerous laboratory and in-situ tests were conducted on the materials currently being used in Iowa. The follow conclusions can be made based on the test results: 1. The crushed concrete that is used as a subbase material has a relatively low permeability compared to many other materials used by other states. 2. Further research and tests are needed to find the necessary parameters for crushed concrete to make sure it is providing its optimum drainage and preventing premature damage of the pavement. 3. We have definitely made improvements in drainage in the past few months, but there are many areas that we can improve on that will increase the permeability of this material and insure that the pavement system is safe from premature damage due to water. The current gradation specification for granular subbase material at the start of this study was: Sieve # % Passing 1” 100 #8 10-35 #50 0-15 #200 0-6

Expansive Mineral Growth and Concrete Deterioration, HR-384, 1997

A significant question is: What role does newly-formed expansive mineral growth play in the premature deterioration of concrete? These minerals (ettringite and brucite) are formed in cement paste as a result of chemical reactions involving cement and coarse/fine aggregate. Petrographic observations and SEM/EDAX analysis were conducted in order to determine chemical and mineralogical changes in the aggregate and cement paste of samples taken from Iowa concrete highways that showed premature deterioration. Mechanisms involved in deterioration were investigated. A second objective was to investigate whether deicer solutions exacerbate the formation of expansive minerals and concrete deterioration. Magnesium in deicer solutions causes the most severe paste deterioration by forming non-cementitious magnesium silicate hydrate and brucite. Chloride in deicer solutions promotes decalcification of paste and alters ettringite to chloroaluminate. Calcium magnesium acetate (CMA) and magnesium acetate (Mg-acetate) produce the most deleterious effects on concrete, with calcium acetate (Ca-acetate) being much less severe.

Evaluation of Carbonate Aggregate Using X-Ray Analysis, HR-266, 1989

Iowa has more than 13,000 miles of portland cement concrete (PCC) pavement. Some pavements have performed well for over 50 years, while others have been removed or overlaid due to the premature deterioration of joints and cracks. Some of the premature deterioration is classical D-cracking, which is attributed to a critically saturated aggregate pore system (freeze-thaw damage). However, some of the premature deterioration is related to adverse chemical reactivity involving carbonate coarse aggregate. The objective of this paper is to demonstrate the value of a chemical analysis of carbonate aggregate using X-ray equipment to identify good or poor quality. At least 1.5% dolomite is necessary in a carbonate aggregate to produce a discernible dolomite peak. The shift of the maximum-intensity X-ray diffraction dolomite d-spacing can be used to predict poor performance of a carbonate aggregate in PCC. A limestone aggregate with a low percentage of strontium (less than 0.013) and phosphorus (less than 0.010) would be expected to give good performance in PCC pavement. Poor performance in PCC pavement is expected from limestone aggregates with higher percentages (above 0.05) of strontium.

Oferta formativa en terapias alternativas y complementarias para la asistencia al parto

Las terapias complementarias y alternativas (TCA) son las intervenciones y prácticas que no forman parte del sistema sanitario convencional. En la obstetricia, su uso es cada día más frecuente. Para asesorar a las gestantes es necesario tener unos conocimientos adecuados al respecto. El objetivo de este estudio es conocer la oferta formativa de las matronas en TCA para la atención al parto mediante una revisión bibliográfica y la consulta de fuentes documentales. El actual programa de formación no las contempla y su aprendizaje depende de motivaciones personales. Existe poca información al respecto. Para recomendarlas y utilizarlas con eficacia y seguridad, es necesario dedicar más recursos a la investigación e incorporarlas en los planes convencionales de estudio.

Cardiovascular effects in patrol officers are associated with fine particulate matter from brake wear and engine emissions

Background: Exposure to fine particulate matter air pollutants (PM2.5) affects heart rate variability parameters, and levels of serum proteins associated with inflammation, hemostasis and thrombosis. This study investigated sources potentially responsible for cardiovascular and hematological effects in highway patrol troopers. Results: Nine healthy young non-smoking male troopers working from 3 PM to midnight were studied on four consecutive days during their shift and the following night. Sources of in-vehicle PM2.5 were identified with variance-maximizing rotational principal factor analysis of PM2.5-components and associated pollutants. Two source models were calculated. Sources of in-vehicle PM2.5 identified were 1) crustal material, 2) wear of steel automotive components, 3) gasoline combustion, 4) speed-changing traffic with engine emissions and brake wear. In one model, sources 1 and 2 collapsed to a single source. Source factors scores were compared to cardiac and blood parameters measured ten and fifteen hours, respectively, after each shift. The "speed-change" factor was significantly associated with mean heart cycle length (MCL, +7% per standard deviation increase in the factor score), heart rate variability (+16%), supraventricular ectopic beats (+39%), % neutrophils (+7%), % lymphocytes (-10%), red blood cell volume MCV (+1%), von Willebrand Factor (+9%), blood urea nitrogen (+7%), and protein C (-11%). The "crustal" factor (but not the "collapsed" source) was associated with MCL (+3%) and serum uric acid concentrations (+5%). Controlling for potential confounders had little influence on the effect estimates. Conclusion: PM2.5 originating from speed-changing traffic modulates the autonomic control of the heart rhythm, increases the frequency of premature supraventricular beats and elicits proinflammatory and pro-thrombotic responses in healthy young men. [Authors]

Innovative Leak Test for Pavement Joint Seals, Progress Report, HR-318, 1993

Premature failure of concrete pavement contraction joint seals is an ongoing and costly problem for the Iowa Department of Transportation. Several joint seal test sections consisting of variations in sawing methods, joint cleaning techniques, sealant installation, and sealant types have been established over the past few years. Laboratory analysis and field inspections were done as a part of the tests, and core samples were taken for laboratory adhesion pull tests. Such methods often cover specifically small areas and may not expose hidden failures. Some tests are also labor-intensive and destructive, especially that of coring. An innovative, nondestructive, broad coverage joint seal tester that yields quick results has been designed and developed for evaluation of pavement joint seal performance. The Iowa vacuum joint seal tester (IA-VAC) applies a low vacuum above a joint seal that has been spray-covered with a foaming water solution. Any unsealed area or leak that exists along the joint will become quickly and clearly visible by the development of bubbles at the leak point. By analyzing the results from the IA-VAC tests, information on the number and types of leaks can be obtained; such information will help identify the source of the problem and direct efforts toward a solution.

Asphalt Cement Concrete Longitudinal Joint Adhesive Crafco PN 34524 (Iowa DOT New Product C-98-7), HR-2084, 2000

The joint between two lanes of asphalt pavement is often the first area of a roadway which shows signs of deterioration and requires maintenance. As the final lift of hot asphalt is being placed in a construction project, it is being forced p against the adjoining lane of cold asphalt, forming the longitudinal joint. The mating of the two lanes, to form a high quality seal, is often not fully successful and later results in premature stripping or raveling as water enters the unsealed joint. The application of a hot poured rubberized asphaltic joint sealant along the joint face in the final stage of construction should help to form a watertight joint seal. A new product, especially formulated for the longitudinal joint in asphalt pavements was proposed to improve joint sealing. The following describes the experimental application of the new product, Crafco, PN 34524.

Oferta formativa en terapias alternativas y complementarias para la asistencia al parto

Las terapias complementarias y alternativas (TCA) son las intervenciones y prácticas que no forman parte del sistema sanitario convencional. En la obstetricia, su uso es cada día más frecuente. Para asesorar a las gestantes es necesario tener unos conocimientos adecuados al respecto. El objetivo de este estudio es conocer la oferta formativa de las matronas en TCA para la atención al parto mediante una revisión bibliográfica y la consulta de fuentes documentales. El actual programa de formación no las contempla y su aprendizaje depende de motivaciones personales. Existe poca información al respecto. Para recomendarlas y utilizarlas con eficacia y seguridad, es necesario dedicar más recursos a la investigación e incorporarlas en los planes convencionales de estudio.

Freeze-Thaw Durability of Concretes with and without Class C Fly Ash, MLR-94-9 Phase I, 1997

The freeze-thaw resistance of concretes was studied. Nine concrete mixes, made with five cements and cement-Class C fly ash combinations, were exposed to freeze-thaw cycling following 110 to 222 days of moist curing. Prior to the freeze-thaw cycling, the specimens were examined by a low-vacuum scanning electron microscope (SEM) for their microstructure. The influence of a wet/dry treatment was also studied. Infilling of ettringite in entrained air voids was observed in the concretes tested. The extent of the infilling depends on the period of moist curing as well as the wet/dry treatment. The concretes with 15% Class C fly ash replacement show more infilling in their air voids. It was found that the influence of the infilling on the freeze-thaw durability relates to the air spacing factor. The greater the spacing factor, the more expansion under the freeze-thaw cycling. The infilling seems to decrease effective air content and to increase effective spacing factor. The infilling also implies that the filled air voids are water-accessible. These might lead to concrete more vulnerable to the freeze-thaw attack. By combining the above results with field observations, one may conclude that the freeze-thaw damage is a factor related to premature deterioration of portland cement concrete pavements in Iowa.

Fast Track Portland Cement Concrete Pavement, HR-538, 1997

In 1987, 1.5 km (0.935 mi.) of Spruce Hill Drive in Bettendorf, Iowa was reconstructed. It is an arteriel street with commercial usage on both termini with single family residential dwellings along most of the project. A portland cement concrete (PCC) pavement design was selected, but a 14 day curing period would have been an undue hardship on the residents and commercial businesses. An Iowa DOT Class F fast track concrete was used so the roadway could be used in 7 to 10 days. The Class F concrete with fly ash was relatively sticky and exhibited early stiffening problems and substantial difficulty in obtaining the target entrained air content of 6.5%. These problems were never completely resolved on the project. Annual visual field reviews were conducted through 1996. In November 1991, severe premature distress was identified on the westbound two lanes of the full width replacement. The most deteriorated section in a sag vertical, 152 m (500 ft.) of the westbound roadway, was replaced in 1996. Premature distress has been identified on a dozen other conventional PCC Iowa pavements constructed between 1983 and 1989, so the deterioration may not be related to the fact that it was fast track pavement.

Hormonothérapie dans le cancer du sein: efficacité et effets adverses [Endocrine therapy in breast cancer: efficacy and adverse events].

Endocrine therapy remains a mainstay in the treatment of endocrine-sensitive breast cancer. In the adjuvant setting, 5 years of endocrine therapy significantly reduces recurrence rate and mortality. Tamoxifen is the molecule of choice for premenopausal women, whereas for postmenopausal women aromatase inhibitors are currently part of the standard treatment. Endocrine therapy can induce side effects, which can affect patient's quality of life and lead to premature treatment interruption. Identification and adequately addressing these side effects is fundamental to maintain good treatment compliance and therefore improve breast cancer specific outcome.

A Different Perspective for Investigation of PCC Pavement Deterioration, HR-2074, 1995

Portland Cement Concrete (PCC) pavement has served the State of Iowa well for many years. The oldest Iowa pavement was placed in LeMars in 1904. Beginning in 1931, many miles of PCC pavement were built to "get out of the mud". Many of these early pavements provided good performance without deterioration for more than 50 years. In the late 1950s, Iowa was faced with severe PCC pavement deterioration called D cracking. Research identified the cause of this deterioration as crushed limestone containing a bad pore system. Selective quarrying and ledge control has alleviated this problem. In 1990, cracking deterioration was identified on a three-year-old pavement on US 20 in central Iowa. The coarse aggregate was a crushed limestone with an excellent history of performance in PCC pavement. Examination of cores showed very few cracks through the coarse aggregate particles. The cracks were predominately confined to the matrix. The deterioration was identified as alkali-silica reactivity (ASR) by a consultant. To investigate the cause of the deterioration, the Iowa DOT and Iowa State University jointly purchased a high resolution, low vacuum Hitachi Scanning Electron Microscope (SEM) with an energy dispersion detector. Subsequent evaluation identified no concentration of silica gel (silicon-Si), but did identify substantial amounts of sulfur-S and aluminum-AL (assumed to be ettringite) in the air voids. Some of these voids have cracks radiating from them leading us to conclude that the ettringite filled voids were a center of pressure causing the crack. The ettringite in the voids, after being subjected to sodium chloride (NaCl), initially swells and then dissolves. This low vacuum SEM research of PCC pavement deterioration supports the following conclusions: (1) A low vacuum SEM and an energy dispersion detector are very important for proper evaluation of PCC pavement deterioration; (2) There are instances today where PCC pavement deterioration is mistakenly identified as ASR; (3) Ettringite initially expands when subjected to NaCl; and the ettringite filled voids are a center-of-pressure that cracks the PCC; and (4) The deterioration of some current premature PCC pavement distress locations is caused by factors related to the formation of excessive ettringite.