Hyponatremia and short-term outcomes in patients with acute pulmonary embolism

BACKGROUND: Hyponatremia, a marker of neurohormonal activation, is associated with poor outcomes in acute cardiorespiratory diseases such as myocardial infarction, right and left ventricular heart failure, and pneumonia. The prognostic value of hyponatremia in patients with acute pulmonary embolism (PE) is unknown. We sought to assess whether hyponatremia at presentation was associated with mortality and hospital readmission in patients hospitalized with PE. METHODS: We studied patient discharges with a primary diagnosis of PE from 185 acute care hospitals in Pennsylvania (1/2000-11/2002). We defined hyponatremia as a serum sodium level ≤135 mmol/l, measured at the time of patient presentation. The study outcomes were 30-day all-cause mortality and hospital readmission. We used random-intercept logistic regression to examine the association between hyponatremia and mortality. We adjusted for baseline patient (race, insurance, severity of illness using the Pulmonary Embolism Severity Index) and hospital characteristics (region, hospital size and teaching status). We used the same approach to examine the association between hyponatremia and readmission among patients who were discharged alive. RESULTS: Among 13,728 patient discharges with PE, 2907 (21.1%) had hyponatremia at the time of presentation. Patients with hyponatremia were older (P<0.001) and more likely to have a history of cancer (P<0.001), heart failure (P<0.001), or chronic lung disease (P=0.002) than patients without hyponatremia. Patients with hyponatremia had a higher unadjusted cumulative 30-day mortality (15.2% vs 8.0%;P<0.001) and readmission rate (15.9% vs 11.8%; P< 0.001) than patients without hyponatremia (Figure). After adjustment for race, insurance, severity of illness, and hospital factors, hyponatremia was associated with a significantly greater odds of death (OR 1.71, 95% CI: 1.50-1.95) and hospital readmission (OR 1.29, 95% CI: 1.14-1.46). CONCLUSIONS: In this large, statewide sample of unselected patients with acute PE, hyponatremia was relatively common and was an independent predictor of short-term mortality and hospital readmission. Given that sodium is a low-cost, easily available laboratory parameter, it may be potentially useful in risk-stratifying patients with PE.

An Investigation of Emulsion Stabilized Limestone Screenings, HR-309, 1994

A significant amount of waste limestone screenings is produced during aggregate production. This waste material cannot be used in highway construction because it does not meet current highway specifications. The purpose of this research was to determine if a waste limestone screenings/emulsion mix could be used to construct a base capable of supporting local traffic. A 1.27 mile (2.04 km) section of roadway in Linn County was selected for this research. The road was divided into seven sections. Six of the sections were used to test 4 in. (100 mm) and 6 in. (150 mm) compacted base thicknesses containing 2.5%, 3.5%, and 4.5% residual asphalt contents. The seventh section was a control section containing untreated waste limestone screenings. This research on emulsion stabilized limestone screenings supports the following conclusions: (1) A low maintenance roadway can be produced using a seal coat surface on 6 in. (150 mm) of stabilized limestone screenings with 4.5% asphalt cement; (2) A 6 in. (150 mm) emulsion stabilized base with less than 3.5% asphalt cement does not produce a satisfactory low cost maintenance roadway; (3) A 4 in. (100 mm) emulsion stabilized base does not produce a satisfactory low cost maintenance roadway; and (4) A 2 in. (50 mm) asphalt concrete surface would be necessary on many roads to provide a low maintenance roadway using emulsion stabilized limestone screenings.

On the spot damage detection methodology for highway bridges (tech transfer summary)

The objective of this work was to develop a low-cost portable damage detection tool to assess and predict damage areas in highway bridges. The proposed tool was based on standard vibration-based damage identification (VBDI) techniques but was extended to a new approach based on operational traffic load. The methodology was tested using numerical simulations, laboratory experiments, and field testing.

Roadway Lighting on Secondary Roads in Iowa, HR-251, 1984

There are approximately 800 installations of destination lighting at secondary road intersections in Iowa. Approximately 90% of these have only a single luminaire. The other installations have two luminaires. No warrants currently exist for justifying the use of this type of lighting. Previous research has examined the safety benefits from full lighting of rural intersections that generally serve substantially higher traffic volumes than secondary road intersections in Iowa. However, the safety benefit of destination lighting at intersections carrying relatively low volumes has not been the subject of previous research. The research reported here, sponsored by the Iowa Department of Transportation, was undertaken to identify locations where destination lighting could be expected to improve highway safety. If destination lighting were shown to reduce accident frequency, warrants for its use on secondary roads could be developed. An inventory of secondary road lighting installations in Iowa was assembled. From this inventory, two samples were constituted that would permit two separate comparisons of the accident experience with and without destination lighting. Before and after comparisons were made for the same locations if accident records were available for at least one full year both preceding and following the installation of destination lighting. Accident records for this purpose were available from a statewide computerized record system covering the period from 1977 through 1982. The accident experience at locations having destination lighting installed before 1978 was compared with a sample of comparable locations not having destination lighting. The sample of secondary road intersections used for the before and after comparison included 91 locations. The sample of continuously lighted locations included 102 intersections. Accident experience at these locations was compared with the experience at 102 intersections that were not lighted. The intersections included in these samples averaged only 0.31 accidents per year. The accident rate at secondary road intersections that had destination lighting did not differ significantly from the accident rate at intersections that were not lighted. This conclusion was derived from both comparisons, the before and after experience and the comparison of experience at intersections that were continuously lighted with that at unlighted locations. Furthermore, no significant differences were noted between lighted and unlighted locations in the proportion of accidents that occurred at night. The distribution of accidents by type also did not differ between unlighted intersections and those having destination lighting. It was not possible to formulate warrants for destination lighting since analyses directed toward identifying specific characteristics of an intersection that could be correlated with highway safety did not yield any useful relationships. However, it was noted that the average damages for night accidents that occurred at lighted intersections were lower than for accidents at unlighted intersections. Even in the absence of a more definitive demonstration of beneficial effects, destination lighting is perceived by officials in most of the counties having such installations as yielding desirable effects and is recognized as helpful to motorists in performing the guidance function in driving. Given this benefit and a relatively low cost (an average of $74 per year for one luminaire), and given that the subjective criteria that have been used in the past to justify the installation of destination lighting have led to a high degree of public acceptance and satisfaction, it is recommended that the same subjective criteria continue to be used in lieu of definitive warrants.

Applications of MALDI-TOF mass spectrometry in clinical diagnostic microbiology.

Until recently, microbial identification in clinical diagnostic laboratories has mainly relied on conventional phenotypic and gene sequencing identification techniques. The development of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) devices has revolutionized the routine identification of microorganisms in clinical microbiology laboratories by introducing an easy, rapid, high throughput, low-cost, and efficient identification technique. This technology has been adapted to the constraint of clinical diagnostic laboratories and has the potential to replace and/or complement conventional identification techniques for both bacterial and fungal strains. Using standardized procedures, the resolution of MALDI-TOF MS allows accurate identification at the species level of most Gram-positive and Gram-negative bacterial strains with the exception of a few difficult strains that require more attention and further development of the method. Similarly, the routine identification by MALDI-TOF MS of yeast isolates is reliable and much quicker than conventional techniques. Recent studies have shown that MALDI-TOF MS has also the potential to accurately identify filamentous fungi and dermatophytes, providing that specific standardized procedures are established for these microorganisms. Moreover, MALDI-TOF MS has been used successfully for microbial typing and identification at the subspecies level, demonstrating that this technology is a potential efficient tool for epidemiological studies and for taxonomical classification.

Control of Concrete Deterioration Due to Trace Compounds in Deicers, Phase II, HR-299, 1989

This report presents results of research on ways to reduce the detrimental effects of sulfate-tainted rock salt deicers on portland cement concrete used for highway pavements. Repetitious experiments on the influence of fly ash on the mortar phase of concrete showed significant improvement in resistance to deicing brines is possible. Fifteen to twenty percent by weight of fly ash replacement for portland cement was found to provide optimum improvement. Fly ashes from five sources were evaluated and all were found to be equally beneficial. Preliminary results indicate the type of coarse aggregate also plays an important role in terms of concrete resistance to freeze-thaw in deicing brines. This was particularly true for a porous ferroan dolomite thought to be capable of reaction with the brine. In this case fly ash improved the concrete, but not enough for satisfactory performance. An intermediate response was with a porous limestone where undesirable results were observed without fly ash and adequate performance was realized when 15% fly ash was added. The best combination for making deicer-resistant concrete was found to be with a non-porous limestone. Performance in brines was found to be adequate without fly ash, but better when fly ash was included. Consideration was given to treating existing hardened concrete made with poor aggregate and no fly ash to extend pavement life in the presence of deicers, particularly at joints. Sodium silicate was found to improve freeze-thaw resistance of mortar and is a good candidate for field usage because of its low cost and ease of handling.

The value of adding mirror therapy for upper limb motor recovery of subacute stroke patients: a randomized controlled trial.

BACKGROUND: Upper limb paresis remains a relevant challenge in stroke rehabilitation. AIM: To evaluate if adding mirror therapy (MT) to conventional therapy (CT) can improve motor recovery of the upper limb in subacute stroke patients. DESIGN: Prospective, single-center, single-blind, randomised, controlled trial. SETTING: Subacute stroke patients referred to a Physical and Rehabilitation Medicine Unit between October 2009 and August 2011. POPULATION: Twenty-six subacute stroke patients (time from stroke <4 weeks) with upper limb paresis (Motricity Index â0/00¤ 77). METHODS: Patients were randomly allocated to the MT (N.=13) or to the CT group (N.=13). Both followed a comprehensive rehabilitative treatment. In addition, MT Group had 30 minutes of MT while the CT group had 30 minutes of sham therapy. Action Research Arm Test (ARAT) was the primary outcome measures. Motricity Index (MI) and the Functional Independence Measure (FIM) were the secondary outcome measures. RESULTS: After one month of treatment patients of both groups showed statistically significant improvements in all the variables measured (P<0.05). Moreover patients of the MT group had greater improvements in the ARAT, MI and FIM values compared to CT group (P<0.01, Glass's Î" Effect Size: 1.18). No relevant adverse event was recorded during the study. CONCLUSION: MT is a promising and easy method to improve motor recovery of the upper limb in subacute stroke patients. CLINICAL REHABILITATION IMPACT: While MT use has been advocated for acute patients with no or negligible motor function, it can be usefully extended to patients who show partial motor recovery. The easiness of implementation, the low cost and the acceptability makes this therapy an useful tool in stroke rehabilitation.

A Feasibility Study on Embedded Micro-Electromechanical Sensors and Systems (MEMS) for Monitoring Highway Structures, TR-575, 2011

Micro-electromechanical systems (MEMS) provide vast improvements over existing sensing methods in the context of structural health monitoring (SHM) of highway infrastructure systems, including improved system reliability, improved longevity and enhanced system performance, improved safety against natural hazards and vibrations, and a reduction in life cycle cost in both operating and maintaining the infrastructure. Advancements in MEMS technology and wireless sensor networks provide opportunities for long-term continuous, real-time structural health monitoring of pavements and bridges at low cost within the context of sustainable infrastructure systems. The primary objective of this research was to investigate the use of MEMS in highway structures for health monitoring purposes. This study focused on investigating the use of MEMS and their potential applications in concrete through a comprehensive literature review, a vendor survey, and a laboratory study, as well as a small-scale field study. Based on the comprehensive literature review and vendor survey, the latest information available on off-the-shelf MEMS devices, as well as research prototypes, for bridge, pavement, and traffic applications were synthesized. A commercially-available wireless concrete monitoring system based on radio-frequency identification (RFID) technology and off-the-shelf temperature and humidity sensors were tested under controlled laboratory and field conditions. The test results validated the ability of the RFID wireless concrete monitoring system in accurately measuring the temperature both inside the laboratory and in the field under severe weather conditions. In consultation with the project technical advisory committee (TAC), the most relevant MEMS-based transportation infrastructure research applications to explore in the future were also highlighted and summarized.

An Investigation of Portland Cement Concrete Utilizing 70% Class V Aggregate and 30% Calcareous Coarse Aggregate, R-255, 1973

The main sources of coarse aggregate for secondary slip form paving in Southwest Iowa exhibit undesirable "D" cracking. "D" cracking is a discoloration of the concrete caused by fine, hairline cracks. These cracks are caused by the freezing and thawing of moisture inside the coarse aggregate. The cracks are often hour glass shaped, are parallel to each other, and occur along saw joints. The B-4, a typical secondary mix, utilizes 50% fine aggregate and 50% coarse aggregate. It has been proposed that a concrete mix with less coarse aggregate and more fine aggregate might impede this type of deterioration. The Nebraska Standard 47B Mix, a 70% fine aggregate, and 30% coarse aggregate mix, as used by Nebraska Department of Roads produces concrete with ultimate strengths in excess of 4500 psi but because of the higher cost of cement (it is a six bag per cubic yard mix) is not competitive with our present secondary mixes. The sands of Southwest Iowa generally have poorer mortar strengths than the average Iowa Sand. Class V Aggregate also found in Southwest Iowa has a coarser sand fraction, therefore it has a better mortar strength, but exhibits an acidic reaction and therefore must be·used with limestone. This illustrates the need to find a mix for use in Southwest Iowa that possesses adequate strength and satisfactory durability at a low cost. The purpose of this study is to determine a concrete mix with an acceptable cement content which will produce physical properties similar to that of our present secondary paving mixes.

Studies on Soil-Aggregate-Sodium Chloride Stabilized Roads in Franklin County, Iowa, HR-33

This investigation was conducted to study the performance characteristics of low cost roadway surfaces of soil-aggregate-sodium chloride mixtures. Many roads have been successfully stabilized with sodium chloride. However, little information is available on either the properties of the road materials or the effects of sodium chloride on the materials. The performance of some of the sodium chloride stabilized roads in Franklin County, Iowa, and the performance of some near-by nonchemically treated roads has been studied. The study of sodium chloride stabilized roads was restricted to the roads in which the binder soil used in construction came from the same source. The effects of sodium chloride on some of the engineering properties of the soil and soil-aggregate mixtures used were studied in the laboratory.

Evaluation of Control Structures for Stabilizing Degrading Stream Channels in Western Iowa, Phases II and III, HR-208A, 1985

Since the turn of the century, tributaries to the Missouri River in western Iowa have entrenched their channels to as much as six times their original depth. This channel degradation is accompanied by widening as the channel side slopes become unstable and landslides occur. The deepening and widening of these streams have endangered about 25% of the highway bridges in 13 counties [Lohnes et al. 1980]. Grade stabilization structures have been recommended as the most effective remedial measure for stream degradation [Brice et al., 1978]. In western Iowa, within the last seven years, reinforced concrete grade stabilization structures have cost between $300,000 and $1,200,000. Recognizing that the high cost of these structures may be prohibitive in many situations, the Iowa Department of Transportation (Iowa DOT) sponsored a study at Iowa State University (ISU) to find low-cost alternative structures. This was Phase I of the stream degradation study. Analytical and laboratory work led to the conclusion that alternative construction materials such as gabions and soil-cement might result in more economical structures [Lohnes et al. 1980]. The ISU study also recommended that six experimental structures be built and their performance evaluated. Phase II involved the design of the demonstration structures, and Phase III included monitoring and evaluating their performance.

Treating Iowa's Marginal Aggregates and Soils by Foamix Process, HR-212, 1980

Quality granular materials suitable for building all-weather roads are not uniformly distributed throughout the state of Iowa. For this reason the Iowa Highway Research Board has sponsored a number of research programs for the purpose of developing new and effective methods for making use of whatever materials are locally available. This need is ever more pressing today due to the decreasing availability of road funds and quality materials, and the increasing costs of energy and all types of binder materials. In the 1950s, Professor L. H. Csanyi of Iowa State University had demonstrated both in the laboratory and in the field, in Iowa and in a number of foreign countries, the effectiveness of preparing low cost mixes by stabilizing ungraded local aggregates such as gravel, sand and loess with asphalt cements using the foamed asphalt process. In this process controlled foam was produced by introducing saturated steam at about 40 psi into heated asphalt cement at about 25 psi through a specially designed and properly adjusted nozzle. The reduced viscosity and the increased volume and surface energy in the foamed asphalt allowed intimate coating and mixing of cold, wet aggregates or soils. Through the use of asphalt cements in a foamed state, materials normally considered unsuitable could be used in the preparation of mixes for stabilized bases and surfaces for low traffic road construction. By attaching the desired number of foam nozzles, the foamed asphalt can be used in conjunction with any type of mixing plant, either stationary or mobile, batch or continuous, central plant or in-place soil stabilization.

State Forest Nursery 2013-2014 Seedling Catalog, 2013

The State Forest Nursery welcomes the opportunity to help you with your tree planting needs. Our goal is to provide low cost, native seedlings in order to help make your tree planting successful and affordable. We strive to produce the best stock in the industry, and our staff will do everything they can to help you achieve your planting goals. We want your tree planting to be successful, so please let us know how we can help! You can contact us www.iowatreeplanting.com By planting trees today you will leave a legacy for your children and grandchildren, as well as a legacy for your home state, its people and its habitat. Let us help you leave your mark on the state you love- your children and grandchildren will thank you!

Surface Improvement and Dust Palliation of Unpaved Secondary Roads and Streets, Progress Report, HR-151, 1971

A combined study of dust control and low-cost surface improvements of soil and aggregate materials for immediate (and intermediate) use as a treated surface course is being conducted in three concurrent phases: (1) laboratory screening of various additives thought to have potential for long-lasting dust palliation, soil-additive strength, durability, and additive retention potential; (2) test road construction, using those additives from the screening studies that indicate promise for performance and serviceability; and (3) observation and tests of constructed sections for evaluation of the additive's contribution to performance and serviceability as well as relationship to initial costs. A brief review is presented of the problem, some methods of measuring it, previously adopted approaches to it, project field tests and a portion of the results thus far, and portions of the laboratory work accomplished in the screening studies.

RFID Tags for Detecting Concrete Degradation in Bridge Decks, RB08-011, 2013

Steel reinforcing bar (rebar) corrosion due to chlorine ingress is the primary degradation mechanism for bridge decks. In areas where rock salt is used as a de-icing agent, salt water seeps into the concrete through cracks, causing corrosion of the rebar and potentially leading to catastrophic failure if not repaired. This project explores the use of radio frequency identification (RFID) tags as low-cost corrosion sensors. RFID tags, when embedded in concrete, will fail due to corrosion in the same manner as rebar after prolonged exposure to salt water. In addition, the presence of salt water interferes with the ability to detect the tags, providing a secondary mechanism by which this method can work. During this project, a fieldable RFID equipment setup was constructed and tested. In addition to a number of laboratory experiments to validate the underlying principles, RFID tags were embedded and tested in several actual bridge decks. Two major challenges were addressed in this project: issues associated with tags not functioning due to being in close proximity to rebar and issues associated with portland concrete coming in direct contact with the tags causing a detuning effect and preventing the tags from operating properly. Both issues were investigated thoroughly. The first issue was determined to be a problem only if the tags are placed in close proximity to rebar. The second issue was resolved by encapsulating the tag. Two materials, polyurethane spray foam and extruded polystyrene, were identified as providing good performance after testing, both in the lab and in the field.