Postmortem pump-driven reperfusion of the vascular system of porcine lungs: towards a new model for surgical training.

PURPOSE: The objective of this experiment is to establish a continuous postmortem circulation in the vascular system of porcine lungs and to evaluate the pulmonary distribution of the perfusate. This research is performed in the bigger scope of a revascularization project of Thiel embalmed specimens. This technique enables teaching anatomy, practicing surgical procedures and doing research under lifelike circumstances. METHODS: After cannulation of the pulmonary trunk and the left atrium, the vascular system was flushed with paraffinum perliquidum (PP) through a heart-lung machine. A continuous circulation was then established using red PP, during which perfusion parameters were measured. The distribution of contrast-containing PP in the pulmonary circulation was visualized on computed tomography. Finally, the amount of leak from the vascular system was calculated. RESULTS: A reperfusion of the vascular system was initiated for 37 min. The flow rate ranged between 80 and 130 ml/min throughout the experiment with acceptable perfusion pressures (range: 37-78 mm Hg). Computed tomography imaging and 3D reconstruction revealed a diffuse vascular distribution of PP and a decreasing vascularization ratio in cranial direction. A self-limiting leak (i.e. 66.8% of the circulating volume) towards the tracheobronchial tree due to vessel rupture was also measured. CONCLUSIONS: PP enables circulation in an isolated porcine lung model with an acceptable pressure-flow relationship resulting in an excellent recruitment of the vascular system. Despite these promising results, rupture of vessel walls may cause leaks. Further exploration of the perfusion capacities of PP in other organs is necessary. Eventually, this could lead to the development of reperfused Thiel embalmed human bodies, which have several applications.

Geosynthetic Reinforced Soil for Low-Volume Bridge Abutments, January 2012

This report presents a review of literature on geosynthetic reinforced soil (GRS) bridge abutments, and test results and analysis from two field demonstration projects (Bridge 1 and Bridge 2) conducted in Buchanan County, Iowa, to evaluate the feasibility and cost effectiveness of the use of GRS bridge abutments on low-volume roads (LVRs). The two projects included GRS abutment substructures and railroad flat car (RRFC) bridge superstructures. The construction costs varied from $43k to $49k, which was about 50 to 60% lower than the expected costs for building a conventional bridge. Settlement monitoring at both bridges indicated maximum settlements ≤1 in. and differential settlements ≤ 0.2 in transversely at each abutment, during the monitoring phase. Laboratory testing on GRS fill material, field testing, and in ground instrumentation, abutment settlement monitoring, and bridge live load (LL) testing were conducted on Bridge 2. Laboratory test results indicated that shear strength parameters and permanent deformation behavior of granular fill material improved when reinforced with geosynthetic, due to lateral restraint effect at the soilgeosynthetic interface. Bridge LL testing under static loads indicated maximum deflections close to 0.9 in and non-uniform deflections transversely across the bridge due to poor load transfer between RRFCs. The ratio of horizontal to vertical stresses in the GRS fill was low (< 0.25), indicating low lateral stress on the soil surrounding GRS fill material. Bearing capacity analysis at Bridge 2 indicated lower than recommended factor of safety (FS) values due to low ultimate reinforcement strength of the geosynthetic material used in this study and a relatively weak underlying foundation layer. Global stability analysis of the GRS abutment structure revealed a lower FS than recommended against sliding failure along the interface of the GRS fill material and the underlying weak foundation layer. Design and construction recommendations to help improve the stability and performance of the GRS abutment structures on future projects, and recommendations for future research are provided in this report.

Glial and axonal body fluid biomarkers are related to infarct volume, severity, and outcome.

Body fluid biomarkers of central nervous system damage may help improve the prognostic and diagnostic accuracy in ischemic stroke. We studied 53 patients. Stroke severity and outcome was rated using the National Institutes of Health Stroke Scale and modified Rankin scale. Ferritin, S100B, and NfH were measured in cerebrospinal fluid (CSF) and serum. Infarct volume was calculated from T2W images. CSF S100B (median 1.00 ng/mL) and CSF ferritin (10.0 ng/mL) levels were elevated in patients with stroke compared with control subjects (0.62 ng/mL, P < .0001; 2.34 ng/mL, P < .0001). Serum S100B (0.09 ng/mL) was higher in patients with stroke compared with control subjects (0.01 ng/mL). CSF S100B levels were higher in patients with a cardioembolic stroke (2.88 ng/mL) than in those with small-vessel disease (0.89 ng/mL, P < .05). CSF S100B levels correlated with the National Institutes of Health Stroke Scale score on admission (R = 0.56, P < .01) and the stroke volume (R = 0.44, P = .01). CSF S100B and NfH-SMI35 levels correlated with outcome on the modified Rankin scale. CSF S100B levels were related to stroke severity and infarct volume and highest in cardioembolic stroke.

Signing on Very Low Volume Rurd Roads Iowa DOT Project HR-262, July, 1984

Research was undertaken to define an appropriate level of use of traffic control devices on rural secondary roads that carry very low traffic volumes. The goal of this research was to improve the safety and efficiency of travel on the rural secondary road system. This goal was to be accomplished by providing County Engineers with guidance concerning the cost-effective use of traffic control devices on very low volume rural roads. A further objective was to define the range of traffic volumes on the roads for which the recommendations would be appropriate. Little previous research has been directed toward roads that carry very low traffic volumes. Consequently, the factual input for this research was developed by conducting an inventory of the signs and markings actually in use on 2,069 miles of rural road in Iowa. Most of these roads carried 15 or fewer vehicles per day. Additional input was provided by a survey of the opinions of County Engineers and Supervisors in Iowa. Data from both the inventory and the opinion survey indicated a considerable lack of uniformity in the application of signs on very low volume rural roads. The number of warning signs installed varied from 0.24 per mile to 3.85 per mile in the 21 counties in which the inventory was carried out. The use of specific signs not only varied quite widely among counties but also indicated a lack of uniform application within counties. County officials generally favored varying the elaborateness of signing depending upon the type of surface and the volume of traffic on different roads. Less elaborate signing would be installed on an unpaved road than on a paved road. A concensus opinion was that roads carrying fewer than 25 vehicles per day should have fewer signs than roads carrying higher volumes. Although roads carrying 0 to 24 vehicles per day constituted over 24% of the total rural secondary system, they carried less than 3% of the total travel on that system. Virtually all of these roads are classified as area service roads and would thus be expected to carry only short trips primarily by local motorists. Consequently, it was concluded that the need for warning signs rarely can be demonstrated on unpaved rural roads with traffic volumes of fewer than 25 vehicles per day. It is recommended that each county designate a portion of its roads as an Area Service Level B system. All road segments with very low traffic volumes should be considered for inclusion in this system. Roads included in this system may receive a lesser level of maintenance and a reduced level of signing. The county is also afforded protection from liability arising from accidents occurring on roads designated as part of an Area Service Level B system. A uniform absence of warning signs on roads of this nature is not expected to have any discernible effect on the safety or quality of service on these very low volume roads. The resources conserved may be expended more effectively to upgrade maintenance and traffic control on roads carrying higher volumes where the beneficial effect on highway safety and service will be much more consequential.

16-OR: Investigation of Sharp Trauma and Gunshot Cases Using Post-mortem CT-Angiography

Investigation of violent death, especially cases of sharp trauma and gunshot, is an important part of medico-legal investigations. Beside the execution of a conventional autopsy, the performance of a post-mortem Multi-Detector Computed Tomography (MDCT)-scan has become a highly appreciated tool. In order to investigate also the vascular system, post-mortem CT-angiography has been introduced. The most studied and widespread technique is the Multi-phase post-mortem CT-angiography (MPMCTA). Its sensitivity to detect vascular lesions is even superior to conventional autopsy. The application of MPMCTA for cases of gunshot and sharp-trauma is therefore an obvious choice, as vascular lesions are common in such victims. In most cases of sharp trauma and in several cases of gunshots, death can be attributed to exsanguinations. MPMCTA is able to detect the exact source of bleeding and also to visualize trajectories, which are of most importance in these cases. The reconstructed images allow to clearly visualizing the trajectory in a way that is easily comprehensible for not medically trained legal professionals. The sensitivity of MPMCTA for soft tissue and organ lesions approximately matches the sensitivity of conventional autopsy. However, special care, experience and effective use of the imaging software is necessary for performing the reconstructions of the trajectory. Large volume consuming haemorrhages and shift of inner organs are sources of errors and misinterpretations. This presentation shall give an overview about the advantages and limitations of the use of MPMCTA for investigating cases of gunshot and sharp-trauma.

Evaluation of Rumble Stripes on Low-Volume Rural Roads in Iowa—Phase II Final Report, November 2011

Single-vehicle run-off-road crashes are the most common crash type on rural two-lane Iowa roads. Rumble strips have proven effective in mitigating these crashes, but the strips are commonly installed in paved shoulders on higher-volume roads that are owned by the State of Iowa. Lower-volume paved rural roads owned by local agencies do not commonly feature paved shoulders but frequently experience run-off-road crashes. This project involved installing rumble stripes, which are a combination of conventional rumble strips with a painted edge line placed on the surface of the milled area, along the edge of the travel lanes, but at a narrow width to avoid possible intrusion into the normal vehicle travel paths. The research described in this report was part of a project funded by the Federal Highway Administration, Iowa Highway Research Board, and Iowa Department of Transportation to evaluate the effectiveness of edge-line rumble strips in Iowa. The project evaluated the effectiveness of rumble stripes in reducing run-off-road crashes and in improving the longevity and wet-weather visibility of edge-line markings. This project consisted of two phases. The first phase was to select pilot study locations, select a set of test sites, install rumble stripes, summarize lessons learned during installation, and provide a preliminary assessment of the rumble stripes’ performance. The purpose of this report was to document results from Phase II. A before and after crash analysis was conducted to assess whether use of the treatment had resulted in fewer crashes. However, due to low sample size, results of the analysis were inconclusive. Lateral position was also evaluated before and after installation of the treatment to determine whether vehicles engaged in better lane keeping. Pavement marking wear was also assessed.

Precast Concrete Elements for Accelerated Bridge Construction Final Report, Volume 1-1. Laboratory Testing of Precast Substructure Components: Boone County Bridge, January 2009

In July 2006, construction began on an accelerated bridge project in Boone County, Iowa that was composed of precast substructure elements and an innovative, precast deck panel system. The superstructure system consisted of full-depth deck panels that were prestressed in the transverse direction, and after installation on the prestressed concrete girders, post-tensioned in the longitudinal direction. Prior to construction, laboratory tests were completed on the precast abutment and pier cap elements. The substructure testing was to determine the punching shear strength of the elements. Post-tensioning testing and verification of the precast deck system was performed in the field. The forces in the tendons provided by the contractor were verified and losses due to the post-tensioning operation were measured. The stress (strain) distribution in the deck panels due to the post-tensioning was also measured and analyzed. The entire construction process for this bridge system was documented. Representatives from the Boone County Engineers Office, the prime contractor, precast fabricator, and researchers from Iowa State University provided feedback and suggestions for improving the constructability of this design.

Precast Concrete Elements for Accelerated Bridge Construction Final Report Volume 2. Laboratory Testing, Field Testing, and Evaluation of a Precast Concrete Bridge: Madison County Bridge, January 2009

The importance of rapid construction technologies has been recognized by the Federal Highway Administration (FHWA) and the Iowa DOT Office of Bridges and Structures. Recognizing this a two-lane single-span precast box girder bridge was constructed in 2007 over a stream. The bridge’s precast elements included precast cap beams and precast box girders. Precast element fabrication and bridge construction were observed, two precast box girders were tested in the laboratory, and the completed bridge was field tested in 2007 and 2008.

Precast Concrete Elements for Accelerated Bridge Construction Final Report Volume 3. Laboratory Testing, Field Testing, and Evaluation of a Precast Concrete Bridge: Black Hawk County,v January 2009

The importance of rapid construction technologies has been recognized by the Federal Highway Administration (FHWA) and the Iowa DOT Office of Bridges and Structures. Black Hawk County (BHC) has developed a precast modified beam-in-slab bridge (PMBISB) system for use with accelerated construction. A typical PMBISB is comprised of five to six precast MBISB panels and is used on low volume roads, on short spans, and is installed and fabricated by county forces. Precast abutment caps and a precast abutment backwall were also developed by BHC for use with the PMBISB. The objective of the research was to gain knowledge of the global behavior of the bridge system in the field, to quantify the strength and behavior of the individual precast components, and to develop a more time efficient panel-to-panel field connection. Precast components tested in the laboratory include two precast abutment caps, three different types of deck panel connections, and a precast abutment backwall. The abutment caps and backwall were tested for behavior and strength. The three panel-to-panel connections were tested in the lab for strength and were evaluated based on cost and constructability. Two PMBISB were tested in the field to determine stresses, lateral distribution characteristics, and overall global behavior.

Development of LRFD Procedures for Bridge Pile Foundations in Iowa: Volume I: An Electronic Database for PIle LOad Tests, September 2011

• Examine current pile design and construction procedures used by the Iowa Department of Transportation (DOT). • Recommend changes and improvements to these procedures that are consistent with available pile load test data, soils information, and bridge design practice recommended by the Load and Resistance Factor Design (LRFD) approach.

Development of LRFD Procedures for Bridge Pile Foundations in Iowa: Volume II: Field Testing of Steel Piles in Clay, Sand, and Mixed Soils and Data Analysis, September 2011

In response to the mandate on Load and Resistance Factor Design (LRFD) implementations by the Federal Highway Administration (FHWA) on all new bridge projects initiated after October 1, 2007, the Iowa Highway Research Board (IHRB) sponsored these research projects to develop regional LRFD recommendations. The LRFD development was performed using the Iowa Department of Transportation (DOT) Pile Load Test database (PILOT). To increase the data points for LRFD development, develop LRFD recommendations for dynamic methods, and validate the results ofLRFD calibration, 10 full-scale field tests on the most commonly used steel H-piles (e.g., HP 10 x 42) were conducted throughout Iowa. Detailed in situ soil investigations were carried out, push-in pressure cells were installed, and laboratory soil tests were performed. Pile responses during driving, at the end of driving (EOD), and at re-strikes were monitored using the Pile Driving Analyzer (PDA), following with the CAse Pile Wave Analysis Program (CAPWAP) analysis. The hammer blow counts were recorded for Wave Equation Analysis Program (WEAP) and dynamic formulas. Static load tests (SLTs) were performed and the pile capacities were determined based on the Davisson’s criteria. The extensive experimental research studies generated important data for analytical and computational investigations. The SLT measured loaddisplacements were compared with the simulated results obtained using a model of the TZPILE program and using the modified borehole shear test method. Two analytical pile setup quantification methods, in terms of soil properties, were developed and validated. A new calibration procedure was developed to incorporate pile setup into LRFD.

Automatic selection of tidal volume, respiratory frequency and minute ventilation in intubated ICU patients as start up procedure for closed-loop controlled ventilation.

OBJECTIVE: Before a patient can be connected to a mechanical ventilator, the controls of the apparatus need to be set up appropriately. Today, this is done by the intensive care professional. With the advent of closed loop controlled mechanical ventilation, methods will be needed to select appropriate start up settings automatically. The objective of our study was to test such a computerized method which could eventually be used as a start-up procedure (first 5-10 minutes of ventilation) for closed-loop controlled ventilation. DESIGN: Prospective Study. SETTINGS: ICU's in two adult and one children's hospital. PATIENTS: 25 critically ill adult patients (age > or = 15 y) and 17 critically ill children selected at random were studied. INTERVENTIONS: To stimulate 'initial connection', the patients were disconnected from their ventilator and transiently connected to a modified Hamilton AMADEUS ventilator for maximally one minute. During that time they were ventilated with a fixed and standardized breath pattern (Test Breaths) based on pressure controlled synchronized intermittent mandatory ventilation (PCSIMV). MEASUREMENTS AND MAIN RESULTS: Measurements of airway flow, airway pressure and instantaneous CO2 concentration using a mainstream CO2 analyzer were made at the mouth during application of the Test-Breaths. Test-Breaths were analyzed in terms of tidal volume, expiratory time constant and series dead space. Using this data an initial ventilation pattern consisting of respiratory frequency and tidal volume was calculated. This ventilation pattern was compared to the one measured prior to the onset of the study using a two-tailed paired t-test. Additionally, it was compared to a conventional method for setting up ventilators. The computer-proposed ventilation pattern did not differ significantly from the actual pattern (p > 0.05), while the conventional method did. However the scatter was large and in 6 cases deviations in the minute ventilation of more than 50% were observed. CONCLUSIONS: The analysis of standardized Test Breaths allows automatic determination of an initial ventilation pattern for intubated ICU patients. While this pattern does not seem to be superior to the one chosen by the conventional method, it is derived fully automatically and without need for manual patient data entry such as weight or height. This makes the method potentially useful as a start up procedure for closed-loop controlled ventilation.

Noctes atticae. Volume 1 / . Ex editione Jacobi Gronovii, cum notis et interpretatione in usum Delphini, variis lectionibus, notis variorum, recensu editionum et codicum et indice locupletissimo, accurate recensitae. Auli Gellii

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