Infrastructure Annual Status Report, January 2010

Per legislative requirement, attached is the Iowa Department of Transportation’s summary of project status for infrastructure projects that have been appropriated revenue from various funds including Rebuild Iowa Infrastructure, Health Restricted Capitals, Bridge Safety, Revenue Bonds Capitals, and Revenue Bonds Capitals II. In addition, we have included status reports for the FY11 passenger rail appropriation from the Underground Storage Tank Fund and the FY2010 Commercial Service Vertical Infrastructure appropriation from the General Fund.

Water Heating, 2011

Although there are many ways to cut you water heating bills, the all fall into two broad categories: reducing the amount of hot water you use and making your water heating system more efficient. Fortunately, there are several strategies that can help you consume less energy and save money - and still meet you hot water needs without sacrificing comfort or practicality. The booklet was designed to answer common questions about hot water systems and to provide you with the information necessary to make informed decision about a wide variety of topics, ranging from repairing hot water faucet leaks an insulation water supply pipes to installing low-flow shower heads and tuning you your existing water heather. You'll also find details on what to consider when it's time to go comparison shopping for a new water heater-including an evaluation of the alternatives to the common gas or electric storage tank unit that's found in the majority of homes in Iowa and across the country.

Isolated limb perfusion: distinct tourniquet and tumor necrosis factor effects on the early hemodynamic response.

HYPOTHESIS: Recent evidence indicates that tumor response rates after isolated limb perfusion (ILP) are improved when tumor necrosis factor (TNF) is added to the locoregional perfusion of high doses of chemotherapy. Other factors, related to the patient or the ILP procedure, may interfere with the specific role of TNF in the early hemodynamic response after ILP with TNF and high-dose chemotherapy. DESIGN: Case-control study. SETTING: Tertiary care university hospital. PATIENTS: Thirty-eight patients with a locoregionally advanced tumor of a limb treated by ILP with TNF and high-dose chemotherapy (TNF group) were compared with 31 similar patients treated by ILP with high-dose chemotherapy alone (non-TNF group). INTERVENTIONS: Swan-Ganz catheter hemodynamic recordings, patients' treatment data collection, and TNF and interleukin 6 plasma level measurements at regular intervals during the first 36 hours following ILP. MAIN OUTCOME MEASURES: Hemodynamic profile and total fluid and catecholamine administration. RESULTS: In the TNF group, significant changes were observed (P<.006): the mean arterial pressure and the systemic vascular resistance index decreased, and the temperature, heart rate, and cardiac index increased. These hemodynamic alterations started when the ILP tourniquet was released (ie, when or shortly after the systemic TNF levels were the highest). The minimal mean arterial pressure, the minimal systemic vascular resistance index, the maximal cardiac index, the intensive care unit stay, and the interleukin 6 maximal systemic levels were significantly (P<.001 for all) correlated to the log(10) of the systemic TNF level. In the non-TNF group, only a brief decrease in the blood pressure following tourniquet release and an increase in the temperature and in the heart rate were statistically significant (P<.006). Despite significantly more fluid and catecholamine administration in the TNF group, the mean arterial pressure and the systemic vascular resistance index were significantly (P<.001) lower than in the non-TNF group. CONCLUSIONS: Release of the tourniquet induces a blood pressure decrease that lasts less than 1 hour in the absence of TNF and that is distinct from the septic shock-like hemodynamic profile following TNF administration. The systemic TNF levels are correlated to this hemodynamic response, which can be observed even at low TNF levels.

Copeptin as a diagnostic biomarker for sepsis-related deaths.

Copeptin has been shown to increase in patients with sepsis, severe sepsis and septic shock. In the study herein described, copeptin was measured in a series of sepsis-related fatalities and control cases that underwent medico-legal investigations. No age-dependent differences in copeptin levels in either sepsis or control cases were observed. No correlation between copeptin concentrations and postmortem interval was identified in either group. Copeptin levels were significantly higher in sepsis cases. Moreover, copeptin concentrations in septic cases correlated with procalcitonin, C-reactive protein and interleukin 6 values. These preliminary findings seem to indicate that copeptin can be reliably measured in biological samples collected during postmortem investigations. These results also suggest that hemodynamic instability associated with sepsis and septic shock can be characterized by copeptin measurement also in the forensic casework.

Infection after total ankle replacement : A 5-year retrospective analysis of 92 implanted ankle prostheses (2004-2008).

Objectives: Total ankle replacement (TAR) is increasingly used for treatment of primary or posttraumatic arthritis of the ankle joint, if joint movement is intended to be preserved. Data on characteristics and treatment of ankle prosthetic joint infection (PJI) is limited and no validated therapeutic algorithm exist. Therefore, we analyzed all infections, which occurred in a cohort of implanted ankle prostheses during a 5-year-period.Methods: Between 06/2004 and 12/2008, all patients with an implanted ankle prosthesis at our institution were retrospectively reviewed. All patients were operated by the same surgical team. Ankle PJI was defined as visible purulence, acute inflammation on histopathology, sinus tract, or microbial growth in periprosthetic tissue or sonication fluid of the removed prosthesis. The surgery on the infected ankle prosthesis and the follow-up were performed by the surgical team, who implanted the prosthesis. A specialized septic team consisting of an orthopaedic surgeon and infectious diseases consultant were included in the treatment.Results: During the study period, 92 total ankle prostheses were implanted in 90 patients (mean age 61 years, range 28-80 years). 78 patients had posttraumatic arthritis, 11 rheumatoid arthritis and 3 other degenerative disorder. Ankle PJI occurred in 3 of 92 TAR (3.3%), occurring 1, 2 and 24 months after implantation; the causative organisms were Enterobacter cloacae, Streptococcus pyogenes and Staphylococcus epidermidis, respectively. The ankle prosthesis was removed in all infected patients, including debridement of the surrounding tissue was debrided and insertion of an antibiotic loaded spacer. Provisional arthrodesis was performed by external fixation in two patients and by plaster cast in one. A definitive ankle arthrodesis with a retrograde nail was performed 6 to 8 weeks after prosthesis removal. One patient needed a flap coverage. All 3 patients received intravenous antibiotic treatment for 2 weeks, followed by oral antibiotics for 4-6 weeks. At follow-up visit up to 18 months after start of treatment, all patients were without clinical or laboratory signs of infection.Conclusions: The infection incidence after TAR was 3.3%, which is slightly higher than reported after hip (<1%) or knee arthroplasty (<2%). A two-step approach consisting of removal of the infected prosthesis, combined with local and systemic antibiotic treatment, followed by definitive ankle arthrodesis shows good results. Larger patient cohort and longer follow-up evaluation is needed to define the optimal treatment approach for ankle PJI.

Endocan measurement for the postmortem diagnosis of sepsis

The vascular endothelium has been shown to play a pivotal role in the pathophysiology of sepsis through the expression of surface proteins and secretion of soluble mediators. Endocan (endothelial cell-specific molecule-1), a 50-kDa dermatan sulfate proteoglycan, is expressed by endothelial cells in lung and kidney and can be detected at low levels in the serum of healthy subjects. Increased concentrations were described in patients with sepsis, severe sepsis and septic shock compared to healthy individuals, with serum concentrations related to the severity of illness. In the present study, we investigated endocan, procalcitonin and C-reactive protein in postmortem serum from femoral blood in a series of sepsis-related fatalities and control individuals who underwent medicolegal investigations. Endocan was also measured in pericardial fluid. Two study groups were prospectively formed, a sepsis-related fatalities group and a control group. The sepsis-related fatalities group consisted of sixteen forensic autopsy cases with documented clinical diagnosis of sepsis in vivo. The control group consisted of sixteen forensic autopsy cases with various noninfectious causes of death. Postmortem serum endocan concentrations were significantly higher in the sepsis group, with values ranging from 0.519ng/ml to 6.756ng/ml. In the control group, endocan levels were undetectable in eleven out of sixteen cases. The results of the data analysis revealed similar endocan concentrations in the pericardial fluid of both studied groups. Endocan can be considered a suitable biological parameter for the detection of sepsis-related deaths in forensic pathology routine.

Response of Iowa Pavements to a Tracked Agricultural Vehicle, HR-1075, Phase II, 2000

The overall objective of the work summarized in this report and in the interim report was to study the effects of targeted implement-of-husbandry loads. This report is to complement phase I of this work, which was summarized in the interim report, entitled Response of Iowa Pavements to Heavy Agricultural Loads (December 1999). The response of newly constructed Portland cement concrete (PCC) and asphalt cement concrete (ACC) pavements under semitruck, single-axle single-tire grain wagon, single-axle dual-tire grain wagon, tandem and tridem tank wagons were summarized in the interim report. Phase II of this project, presented herein, was to complete the study in terms of how tracked agricultural vehicles relate to the reference 20,000-pound single-axle semi-truck. In this report the response of these two pavements under a tracked grain wagon is documented.

Response of Iowa Pavements to Heavy Agricultural Loads, HR-1075, 1999

Iowa's county road system includes several thousands of miles of paved roads which consist of Portland cement concrete (PCC) surfaces, asphalt cement concrete (ACC) surfaces, and combinations of thin surface treatments such as seal coats and slurries. These pavements are relatively thin pavements when compared to the state road system and therefore are more susceptible to damage from heavy loads for which they were not designed. As the size of the average farm in Iowa has increased, so have the size and weights of implements of husbandry. These implements typically have fewer axles than a truck hauling the same weight would be required to have; in other words, some farm implements have significantly higher axle weights than would be legal for semi-trailers. Since stresses induced in pavements are related to a vehicle's axle weight, concerns have been raised among county and state engineers regarding the possible damage to roadway surfaces that could result from some of these large implements of husbandry. Implements of husbandry on Iowa's highway system have traditionally not been required to comply with posted weight embargo on bridges or with regulations regarding axle-weight limitations on roadways. In 1999, with House File 651, the Iowa General Assembly initiated a phased program of weight restrictions for implements of husbandry. To help county and state engineers and the Iowa legislature understand the effects of implements of husbandry on Iowa's county roads, the following study was conducted. The study investigated the effects of variously configured grain carts, tank wagons, and fence-line feeders on Iowa's roadways, as well as the possible mitigating effects of flotation tires and tracks on the transfer of axle weights to the roadway. The study was accomplished by conducting limited experimental and analytical research under static loading conditions

Effect of soil interacting herbicides on soybean nodulation in Balcarce, Argentina

Two trials were performed in Balcarce, Argentina (37° 45' LS; 58° 18' LW) during 1993-94, to assess the effect of eight herbicides applied individually or in tank mixtures, on nodule number, nodule dry weight, seed yield and N percent in seed in soybean Asgrow 3205, inoculated with Bradyrhizobium japonicum CB 1809. Individual herbicides and doses in kg ha-1 of a.i. were metribuzin (0.48), acetochlor (0.90), metolachlor (1), flumioxazin (0.075), trifluralin (0.96), imazaquin (0.20), imazethapyr (0.10) and chlorimuron ethyl (0.0125). The mixtures were metribuzin+acetochlor (0.48+0.9), flumioxazin+acetochlor (0.075+0.9), imazaquin+acetochlor (0.2+0.9), metribuzin+metolachlor (0.48+1.92), and flumioxazin+ metolachlor (0.075+1.92). A control treatment without herbicides was included. Both trials were laid out as randomized complete blocks with four replicates, on a loam illitic thermic petrocalcic Paleudoll, 5.7% organic matter (OM), 25% clay, 30.4 cmol kg-1 CEC. Nodules were sampled at V2 (second node), V6 (sixth node) and R5 (beginning seed) growth stages. Herbicides did not significantly affect the beginning of nodulation or nodule number and mass at R5, not either grain yield or N accumulation. This indicates lack of interference between soil interacting herbicides and N fixation in the high organic matter, loam soils of SE Buenos Aires province, even though a tendency in less number and dry weight of nodules was evident at the two latter growth stages.

Perforation colique néonatale focale spontanée en dehors de la grande prématurité : rare et potentiellement insidieuse [Focal spontaneous colic perforation in term or near-term neonates: rare and potentially insidious].

Two cases of neonatal focal spontaneous colic perforations are reported. The 1st infant, born at 36 3/7 weeks gestational age, presented on day 3 with crying, abdominal distension, and liquid stools. Clinical examination showed a slightly irritable hypothermic (35.7 °C) infant with a distended abdomen and few bowel sounds. Blood tests were normal apart from an elevated C-reactive protein level (59 mg/l). The abdomen x-ray was erroneously considered normal. The infant's condition remained stable for nearly 3 days. After reviewing the initial x-ray, pneumoperitoneum was suspected and confirmed by a cross-table lateral abdominal x-ray. The infant was started on antibiotics and operated. Macroscopically, the entire gut was normal apart from a focal sigmoid perforation, which was stitched. A transmural colic biopsy revealed focal vascular dilation but was negative for necrotising enterocolitis or Hirschsprung disease. The infant recovered quickly. She is now a healthy, normal 3-year-old. The 2nd infant, born at 38 5/7 weeks gestational age, presented between day 1 and 2 with clinical signs of infection associated with slowly progressive ileus. The chest and abdomen x-ray was mistakenly considered normal. Frank septicemia developed. After reviewing the initial x-ray, pneumoperitoneum was suspected and confirmed by a cross-table lateral abdominal x-ray. The infant was operated. Macroscopically, the small intestine was normal, the ascending and transverse colons were dilated, and the descending and sigmoid colons were narrow. Three cecal perforations were discovered and stitched. An ileostomy and multiple colic biopsies were also performed. The postoperative course was complicated by persistent septic ileus due to descending and sigmoid colon leaks, which led to colic resections with end-to-end anastomosis. Rectal aspiration biopsies were also performed. At 1 month of age, the infant was discharged from the hospital. The ileostomy was closed in two steps at 2 and 5 months of age. A normal sweat test excluded cystic fibrosis. All colic and rectal biopsies revealed nonspecific inflammatory signs and excluded necrotizing enterocolitis and Hirschsprung disease. Nonspecific irregular thinning of muscularis mucosae and muscularis propria were observed in the two resected colic segments. The boy is now a healthy 7-year-old. The incidence of neonatal focal spontaneous colic perforations at term or close to term is unknown but probably very rare. Our department is the neonatal referral center for approximately 14,000 annual births. In the last 10 years (2000-2009), out of 5115 neonatal admissions in our unit, only ten cases have presented a neonatal spontaneous intestinal perforation, seven of ten in very-low-birth-weight infants and three of ten in term or near-term neonates (one with Hirschsprung disease and the two cases reported herein). In the same period, 108 infants suffered from necrotizing enterocolitis, seven of 108 were term infants and 6 out of 7 had a congenital heart disease. The medical literature is poor on the subject of focal spontaneous colic perforations at term; no risk factor is described. The most specific clinical sign seems to be the abdominal distension. The presence of pneumoperitoneum on an abdominal x-ray is the most sensitive paraclinical sign. In case of an intestinal perforation, surgery must be performed quickly. The vital prognosis seems to be good. The objective of this study was to draw pediatricians' attention to focal spontaneous colic perforations in term or close to term newborns. In the cases reported, the diagnostic delays could have been prevented if the entity - with its radiological manifestation - had been well known.

Determination of Asphalt Content and Characteristics of Bituminous Paving Mixtures, MLR-88-11, 1988

Due to the hazardous nature of chemical asphalt extraction agents, nuclear gauges have become an increasingly popular method of determining the asphalt content of a bituminous mix. This report details the results of comparisons made between intended, tank stick, extracted, and nuclear asphalt content determinations. A total of 315 sets of comparisons were made on samples that represented 110 individual mix designs and 99 paving projects. All samples were taken from 1987 construction projects. In addition to the comparisons made, seventeen asphalt cement samples were recovered for determination of penetration and viscosity. Results were compared to similar tests performed on the asphalt assurance samples in an attempt to determine the amount of asphalt hardening that can be expected due to the hot mix process. Conclusions of the report are: 1. Compared to the reflux extraction procedure, nuclear asphalt content gauges determine asphalt content of bituminous mixes with much greater accuracy and comparable precision. 2. As a means for determining asphalt content, the nuclear procedure should be used as an alternate to chemical extractions whenever possible. 3. Based on penetration and viscosity results, softer grade asphalts undergo a greater degree 'of hardening due to hot mix processing than do harder grades, and asphalt viscosity changes caused by the mixing process are subject to much more variability than are changes in penetration. 4. Based on changes in penetration and viscosity, the Thin Film Oven Test provides a reasonable means of estimating how much asphalt hardening can be anticipated due to exposure to the hot mix processing environment.

Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome.

BACKGROUND: Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II. METHODS: EPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days. RESULTS: Of the 7,087 infected patients, 1,392 (19.6%) had an abdominal infection on the study day (60% male, mean age 62 ± 16 years, SAPS II score 39 ± 16, SOFA score 7.6 ± 4.6). Microbiological cultures were positive in 931 (67%) patients, most commonly Gram-negative bacteria (48.0%). Antibiotics were administered to 1366 (98.1%) patients. Patients who had been in the ICU for ≤ 2 days prior to the study day had more Escherichia coli, methicillin-sensitive Staphylococcus aureus and anaerobic isolates, and fewer enterococci than patients who had been in the ICU longer. ICU and hospital mortality rates were 29.4% and 36.3%, respectively. ICU mortality was higher in patients with abdominal infections than in those with other infections (29.4% vs. 24.4%, p < 0.001). In multivariable analysis, hematological malignancy, mechanical ventilation, cirrhosis, need for renal replacement therapy and SAPS II score were independently associated with increased mortality. CONCLUSIONS: The characteristics, microbiology and antibiotic treatment of abdominal infections in critically ill patients are diverse. Mortality in patients with isolated abdominal infections was higher than in those who had other infections.

Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study.

BACKGROUND: Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking. METHODS: In this multinational, prospective, observational cohort study within the International Collaboration on Endocarditis, 2759 consecutive patients were enrolled from June 15, 2000, to December 1, 2005; 1056 patients with IE 65 years or older were compared with 1703 patients younger than 65 years. Risk factors, predisposing conditions, origin, clinical features, course, and outcome of IE were comprehensively analyzed. RESULTS: Elderly patients reported more frequently a hospitalization or an invasive procedure before IE onset. Diabetes mellitus and genitourinary and gastrointestinal cancer were the major predisposing conditions. Blood culture yield was higher among elderly patients with IE. The leading causative organism was Staphylococcus aureus, with a higher rate of methicillin resistance. Streptococcus bovis and enterococci were also significantly more prevalent. The clinical presentation of elderly patients with IE was remarkable for lower rates of embolism, immune-mediated phenomena, or septic complications. At both echocardiography and surgery, fewer vegetations and more abscesses were found, and the gain in the diagnostic yield of transesophageal echocardiography was significantly larger. Significantly fewer elderly patients underwent cardiac surgery (38.9% vs 53.5%; P < .001). Elderly patients with IE showed a higher rate of in-hospital death (24.9% vs 12.8%; P < .001), and age older than 65 years was an independent predictor of mortality. CONCLUSIONS: In this large prospective study, increasing age emerges as a major determinant of the clinical characteristics of IE. Lower rates of surgical treatment and high mortality are the most prominent features of elderly patients with IE. Efforts should be made to prevent health care-associated acquisition and improve outcomes in this major subgroup of patients with IE.

Fertilização com boro e zinco no solo em complementação à aplicação via foliar em laranjeira Pêra

As deficiências de boro (B) e zinco (Zn) são as mais freqüentes na citricultura brasileira e há escassez de conhecimento sobre critérios de diagnóstico e manejo desses nutrientes nessa cultura. A aplicação foliar tem sido a forma tradicional de fornecimento desses nutrientes, a despeito da baixa redistribuição na planta cítrica. O objetivo deste trabalho foi avaliar a eficiência da aplicação complementar de B e Zn no solo em comparação com a aplicação via foliar e estabelecer curvas de calibração de análises de solo e de folhas com a produtividade da laranjeira Pêra. Os tratamentos foram arranjados em delineamento fatorial 4², com três repetições. Foram aplicadas no solo as doses anuais de 0, 2, 4 e 6 kg ha-1 de B (ácido bórico) e Zn (sulfato de zinco), em complemento à adubação foliar. A produção de frutos aumentou significativamente com a aplicação de B no solo até a dose de 4 kg ha-1, enquanto a aplicação de Zn no solo mostrou-se pouco eficiente. As doses de B afetaram a qualidade dos frutos. A produtividade máxima foi obtida com teor de B no solo de 1,0 mg dm-3, e na folha de cerca de 300 mg kg-1. A aplicação foliar de B, apesar de evitar os sintomas típicos de deficiência, não otimizou a produtividade e a qualidade dos frutos, enquanto a aplicação foliar de Zn mostrou-se eficiente. Curvas de calibração de análises de solo e de folhas mostraram a necessidade de rever as classes de interpretação desses micronutrientes na citricultura.