President Barack Obama holds a baby in the air while talking with patrons during a stop for lunch at The Coupe in Washington, D.C., Jan. 10, 2014.
The Dragon Boat Festival
The Dragon Boat Festival or Chinese Zongzi Festival (literally Duanwu Festival in Chinese) is one of the most important traditional festivals in China and falls on the 5th day of the 5th lunar month in Chinese calendar every year. According the legend, the festival has been celebrated for over 2,000 years.
The Dragon Boat Festival has a wide influence in the world. The festival customs and traditions has spreaded to South Korea, Japan, Singapore, Vietnam, Malaysia, the United States, Germany, Britain and some other countries and places. In September 2009, UNESCO officially approved its inclusion in the representative list of intangible cultural heritage of mankind, so the Dragon Boat Festival became the first Chinese festival to be included in world heritage list.
Led by Athens and Sparta, the Greek city-states were engaged in a great war with the Persian Empire at the beginning of the fifth century B.C. In 498 B.C., Greek forces sacked the Persian city of Sardis. In 490 B.C., the Persian king sent a naval expedition across the Aegean to attack Athenian troops in the Battle of Marathon. Despite a resounding Athenian victory there, the Persians did not give up. In 480 B.C., the new Persian king sent a massive army across the Hellespont to Thermopylae, where 60,000 Persian troops defeated 5,000 Greeks in the Battle of Thermopylae, where King Leonidas of Sparta was famously killed. The year after that, however, the Greeks defeated the Persians for good at the Battle of Salamis.
Did you know? The first democracy originated in classical Greece. The Greek word demokratia means "rule by the people."
Veracruz continues to be a very important part of Mexico’s economy. The state is rich in natural resources and represents approximately 35 percent of Mexico’s water supply. In addition, Veracruz has four deep-water ports and two international airports. An important source of iron and copper, Veracruz also produces such non-metallic minerals as sulfur, silica, feldspar, calcium, kaolin and marble.
Farms in the region around Jalapa grow most of the state’s coffee beans. The state has a robust agricultural economy, and long-standing industrial centers at Córdoba, Orizaba and Rio Blanco produce abundant textile materials.
With a pleasant climate, good cuisine and archaeological sites, the port of Veracruz is a favorite seaside resort for Mexican and foreign tourists. The city, advantageously situated along the Gulf of Mexico, has become a preferred port for exports to the United States, Latin America and Europe. In fact, 75 percent of all port activity in Mexico takes place in Veracruz. The chief exports of the state are coffee, fresh fruits, fertilizers, sugar, fish and crustaceans.
Carlos Felipe Pena was a Major League Baseball player for the Texas Rangers (2001), Oakland Athletics (2002), Detroit Tigers (2002-2005), Boston Red Sox (2006), Tampa Bay Rays (2007-2010, 2012), Chicago Cubs (2011), Houston Astros (2013) and Kansas City Royals (2013).
On May 27, 2004, Carlos Pena went six-for-six in a game, the fifth Detroit Tigers player to do so, and the first since Damion Easley, on August 8, 2001. Pena batted in the eighth spot in the batting order and his six hits were the most from the eighth spot since Wilbert Robinson collected seven hits on June 10, 1892!
Carlos Pena | 2008 Bowman Baseball Card (#60) | Baseball Almanac Collection
Did you know that when Carlos Pena won a Gold Glove Award for First Basemen in 2008, it was the first one ever won - at any position - by a Tampa Bay Rays player? Did you know a year earlier, in 2007, Pena won a Silver Slugger Award (best batting average by any American League first baseman), which was also the first one ever won by a Rays player?
Since 1949, the Syracuse Law Review has published legal articles, notes, commentaries, and case summaries for the legal community.
The Law Review has enjoyed working with notable authors and speakers, including:
Nathan Roscoe Pound, Dean of Harvard Law School from 1916 to 1936
Possibilities of Law for World Stability, 2 Syracuse L. Rev. __ (1950)
Joseph Biden Jr., 47th Vice President of the United States and 1968 graduate of the Syracuse University College of Law
Who Needs the Legislative Veto?, 35 Syracuse L. Rev. 685 (1984)
Clarence Thomas, Associate Justice of the Supreme Court of the United States
1991 Commencement Address to the Syracuse University College of Law
Judge Stewart Hancock Jr., Former Associate Judge, New York Court of Appeals
Municipal Liability Through a Judge's Eyes, 44 Syracuse L. Rev. 925 (1993)
Janet Reno, Former Attorney General of the United States (1993-2001)
1998 Commencement Address to the Syracuse University College of Law
Daan Braveman, Dean of the Syracuse University College of Law (1994-2002), Current President of Nazareth College
Chadha: The Supreme Court as Umpire in Separation of Powers Disputes, 35 Syracuse L. Rev. 735 (1984)
Below is an article originally published in 2000 to commemorate the Law Review's 50th year. The article was written by the 1999-2000 editorial staff of the Law Review and details the history journal.
Syracuse Law Review
Copyright (c) 2000 Syracuse Law Review
Law is the most highly developed of the agencies of social control. It is a need of society to maintain and secure social interests against anti-social self assertion of individuals. But it is a need of the individual also, although he is likely to think only of a need to restrain his neighbor . . . . [law] is a body of norms or models of decision as an authoritative guide to conduct, to judicial decisions and administrative determinations, and as advice to those seeking counsel as to their rights and duties.
--Roscoe Pound, Possibilities of Law for World Stability. 
Advisory counsel must, of course, read a great deal. He must read critically all the court opinions--minority as well as majority opinions. He must keep up with current events through the newspapers and journals and books that contribute significantly to thinking on economics and politics.
-- Julius Henry Cohen, On Advice of Counsel.
In 1949, $2 bought a subscription to the Syracuse Law Review. The new bi-annual law journal offered leading articles and current commentary by members of the judiciary, practicing lawyers, and law teachers and students. The new law review delved into topics of interest and importance to the legal profession and recent developments discussing noteworthy recent cases. Among the 14 leading articles in Volume 1 were articles on judicial rule-making, civil investigations by the Federal Bureau of Investigation, law and equity and legal thinking. Our authors in the inaugural volume included J. Edgar Hoover, the legendary director of the FBI and Roscoe Pound, the noted author and dean of Harvard Law *1192 School.
A subscription form bore the statement that the books were “prepared by students of the College of Law, Syracuse University.”
The advertisement’s declaration echoed the sentiment of Dean Paul Shipman Andrews who commented on the Syracuse Law Review’s founding as a “creditable addition” to the crowded field of legal scholarship. The Dean, in his foreword, also expressed gratitude to the Syracuse University community, alumni and the college of law students who “performed the arduous task of creating the Review.” Dean Andrews continued:
Of one thing the Review is confident: that it will constitute a worthwhile tool for the better training of the student body (all of whom may submit notes or comments in competition for the privilege of publication) in the skills of legal writing and research. This is perhaps the primary objective of the Syracuse Law Review.
The field may have been crowded, and growing, but the time had arrived for the Syracuse Law Review. The new law review was forged to provide Syracuse College of Law students with the unique and immensely valuable experience of publishing a law review while thrusting the Syracuse name into the world of legal scholarship.
The faithful members of the Syracuse Law Review fulfilled Dean Andrews’ prophesy over the past five decades as they researched, wrote and edited this publication. Likewise, the Syracuse Law Review has fulfilled its duties as a creditable source of legal scholarship for practicing attorneys, academics and Syracuse law students who earned their way onto this Review.
This law review has met the needs of our readers by chronicling and reporting recent developments in the law on the state, national and global levels. Over the years, scholars’ articles have proposed changes and improvements to the law. To date, even the United States Supreme Court referred to this publication, citing the Review in 11 different court opinions.
Likewise, the Syracuse Law Review has contributed to scholarship and served as a record of the events at Syracuse College of Law and the university itself by sponsoring symposia, publishing commencement speeches, distinguished service awards and the dedication of new buildings.
One of our most influential contributions to legal scholarship came in 1962 when the Syracuse Law Review inherited the honor of publishing the Annual Survey of New York Law. In his foreword, Dean Ralph E. Kharas paid tribute to the other law schools in New York state and graciously accepted the torch from the New York University Law Review which had published the Annual Survey since 1947. The Annual Survey, he wrote: “has made a substantial contribution to the Empire State lawyers in their task of keeping up with the law.”
Over the years, the judges of the New York Court of Appeals regarded the Survey as a useful record and reflection of the nation’s common law tradition. The Survey chronicled developments with state-wide, national and international implications, marked the law’s progression and served as an annual “report card” for New York’s courts and judges.
In his foreword to the 1992 Survey, Judge Joseph W. Bellacosa, wrote:
This Syracuse Law Review Survey of New York Law for 1992 is a fine way station in that journey towards the destination of better understanding and achievement of the ideal. It focuses the reader’s eye and mind on a connected, comprehensive examination of seemingly disparate strands of justice, as actually delivered for better or for worse. This annual assessment educates the reader and renders an accounting of, and to the judiciary. The goal of this search, somewhat like Diogenes, is to grope for and discover an improved rule of law and a fairer system for delivering justice during ensuing *1196 years.
Publishing the annual Survey generated praise on the law review’s 20th anniversary in 1969. United States Attorney General John N. Mitchell wrote a letter congratulating the law review on its 20th anniversary, specifically referring to the annual survey as “helpful to practicing attorneys, judges and scholars who are interested in following the development of law in our state.”
In 1969, the editors of volume 20 published a prototypical example of an ideal law review linking the past with the future. Volume 20 included an article written by Osmond Fraenkel, who also wrote for the first edition. As they looked back to the founders, who exemplified the high level of academic merit to found this Review, the editors looked forward as well. Those editors sent a message to future editors: “During the next twenty years, we hope the Syracuse Law Review will continue to explore the legal frontier . . . .”
Those editors stepped toward the legal frontier with two visionary articles: one involving employment discrimination the other space law. The space law article, written by Syracuse Law Professor George J. Alexander was the outgrowth of a Syracuse University study conducted under a grant from the National Aeronautics and Space Administration (NASA) and was presented at the XIth International Colloquium on Space Law.
*1197 At a time when the international space race escalated and men walked on the moon, the article addressed many of the legal implications associated with space exploration including property rights in space and on Earth, national security in outer space, liability for disasters, NASA’s jurisdiction, and workplace safety for astronauts.
Professor Alexander concluded his piece:
The domestic legal problems facing the United States’ space program are, admittedly, not problems of grand proportions but they are real and serious nonetheless. What’s more, they will not patiently await studied answers once the contingencies manifest themselves. If answers are to be better than makeshift, they should come soon. We at the Syracuse project hope we can be involved in finding them.
Volume 20 exemplified the purpose of this law review by balancing legal history with a vision of the future legal landscape.
Editorial boards over the years provided exemplary models and worthy successors. For example, in 1960, with Volume 12, the editorial board took the step to transform the law review into a quarterly publication. After a two-year effort, in 1984, Volume 35, became the first Syracuse Law Review published using computerized word processing *1198 technology. The editor’s note stated that the use of the new technology would allow the staff to publish a timelier book with greater editorial control. Computers permitted the editors to publish more pages and incorporate late changes, additions and corrections. The technology enabled the editors to better serve our readers and subscribers.
In 1989, on the law review’s 40th anniversary, the editors referenced the profound and complex changes in the legal world since Volume 1. Despite the emergence of new legal frontiers in a world transformed by technology, the editors proclaimed that the Syracuse Law Review’s mission remained constant: to provide a forum for exploring developments in statutory and common law while identify problems and proposing solutions.
Today, Volume 50 is born in a world of instantaneous change. Business, political, social and technological forces alter the world on a minute-by-minute basis. Laws and regulation must conform and shape those forces at an equally instantaneous pace. Legal scholarship must also keep pace, yet remain a refuge for accurate information and innovative propositions. The Syracuse Law Review has and will meet those goals.
Like our predecessors in Volume 20, this book seeks to mesh the past, present and future. This book highlights several areas of legal development over the years as perceived by a panel with close ties to the Syracuse Law Review, our alumni.
Even as legal observers note the explosion of specialized law journals and critics foretell of the demise of the general interest law journal, the Syracuse Law Review will continue. Our articles contribute to the legal landscape while our student notes provide burgeoning legal scholars with the unique opportunity to hone legal research and writing skills while contributing to the legal community.
Technology and computers have had a tremendous impact on the legal publishing world. The Syracuse Law Review has kept pace with these changes and will continue to do so. The means of conveyance may change, but the information and scholarship under the Syracuse Law Review banner will continue.
Christian Stephen Yelich is an active Major League Baseball player for the Miami Marlins (2013-2017) and Milwaukee Brewers (2018-today). In his second big league season, Yelich won a Gold Glove, the first Marlins outfielder to ever receive the honor!
On August 29, 2018, Christian Yelich hit for the cycle against the Cincinnati Reds, collecting six-hits in six at-bats. Nineteen days later, on September 17, Yeli hit for the cycle again, the fourth player in Major League history to collect two cycles in the same season, the first to record them both against the same opponent in the same season!
Christian Yelich was the fourth Milwaukee Brewers player to go 6-for-6 in a game. The previous three joined this elite club in the listed seasons, see how many you can guess 1973 (Answer), 1993 (Answer), 2013 (Answer).
Christian Yelich homered on Opening Day in 2019, then continued to homer during the next three consecutive games. He was the sixth playing in Major League history to homer in his team's first four games, joining Willie Mays (1971), Mark McGwire (1998), Nelson Cruz (2011), Chris Davis (2013) and Trevor Story (2016).
Yeli didn't homer in the fifth game, but he did homer once more during the month, setting a new National League record for home runs hit during the month of March (4). [Home Runs in a Month Records]
If you find this type of "free" data useful please consider making a donation to Baseball Almanac : a privately run / non-commercial site in need of financial assistance.
Materials and methods
The study was conducted at the intensive care unit of the non-surgical emergency department of the Medical University of Vienna, a tertiary care facility. It was approved by the local ethics committee and all participants gave written informed consent. The study population was recently described: 15 Sixty patients were enrolled over a period of 1 year: 20 consecutive patients with HE and two different control groups comprising 20 consecutive patients with HU and 20 normotensive patients, who attended the emergency department for other reasons: gastritis (n=2), back pain (n=8), needlestick injury (n=1), follow-up after needlestick injury (n=8), electric shock (n=1).
The BP of patients was measured within the scope of intermediate or intensive care with an automated device (Hewlett-Packard, Palo Alto, CA USA).
HE was defined as critical elevation of BP (systolic BP >179 mm Hg and/or diastolic BP>109 mm Hg) with target organ dysfunction (that is, acute pulmonary oedema, coronary ischaemia, hypertensive encephalopathy, cerebral infarction, intracerebral haemorrhage, aortic dissection or acute renal failure, defined by the RIFLE criteria). 16, 17 HU was defined as severe elevation in BP (s. above) without evidence of target organ deterioration. 17 Twenty normotensives (that is, no history of hypertension or intake of antihypertensive drugs, a BP <130/85 mm Hg measured twice with standard equipment by a physician or trained nurse after 5 min of resting in sitting position, who had no history of severe chronic disease, diabetes mellitus, pre-existent cardiovascular disease, cancer, acute infectious disease or other relevant medical illness and a normal physical examination) served as controls.
Exclusion criteria were refusal or inability to give informed consent, preeclampsia and eclampsia, 17 clinical pattern and additional laboratory signs of acute inflammatory disease (that is, initial elevation of C-reactive protein >10 mg l −1 or fibrinogen >4.5 g l −1 ) and known, either by self-report or medical records, chronic kidney disease (CKD) stage 3B or higher.
Blood was sampled directly after admission at the emergency department before any relevant intervention. All routine laboratory and diagnostic/therapeutic interventions were performed as appropriate and under the discretion of the attending physician. The final diagnosis of HE/HU was confirmed by a second independent physician, blinded to the initial clinical diagnosis, after discharge of the patient on the basis of chart review.
Blood samples were drawn into sterile evacuated tubes (Vacutainer, BD, NJ, USA) containing EDTA or citrate. Analyses of creatinine and BUN were carried out by routine laboratory examinations (Beckman Coulter, Krefeld, FRG). Samples for cystatin C and NGAL measurements were immediately centrifuged at 3000 × g for 15 min and then stored as 0.5 ml aliquots at −80 °C until batch analysis.
Cystatin C and NGAL were measured by enzyme-linked immunosorbent assays (ELISA) according to the manufacturer’s instructions. For the cystatin C ELISA (R&D Systems, MN, USA) the limit of detection was 0.102 ng ml −1 , intra-assay precision was 3.1–6.6% and inter-assay precision was 5–7%. For the NGAL ELISA (BioPorto, Gentofte, Denmark), the limit of detection was 1.6 pg ml −1 , intra-assay variation was 2.8–4.5% and inter-assay variation was 4.4–4.6%.
Estimated glomerular filtration rate (eGFR) was calculated using the CKD epidemiology collaboration equations. 18
As data on NGAL levels in hypertensive patients are scarce, a sample size calculation was based on a previous publication presenting creatinine levels in hypertensive patients. 19 Assuming a common s.d. of 0.3 mg dl −1 a sample size of 19 was adequate to detect a 32% higher creatinine level (primary outcome variable) in HE as compared with controls or HU ((1-β) of 0.8 for P<0.05).
Continuous data are given as median and quartile range and categorical data as frequencies and percentages. Testing for normal distribution is difficult in sample sizes <25. Thus, in order to obtain conservative results, nonparametric tests were used. The Kruskal–Wallis ANOVA and the Mann–Whitney U-test were applied for the comparison of continuous variables between groups. Dichotomous variables were compared with the χ 2 -test or Fisher’s exact test as appropriate. The Spearman rank correlation test was used to correlate renal function parameters in patients with HE (SPSS 16.0, SPSS Inc., Chicago, IL, USA). Although the measured renal function parameters are interdependent, we applied the Bonferroni–Holm procedure to account for multiple comparisons of the four biomarkers. 20
States with the most dangerous bridges
From rural covered passes to modern engineering marvels, bridges overcome natural obstacles and expedite transportation. Yet many of the bridges that people drive on every day are in rough shape. According to one transportation group, more than one in 10 of the country's bridges are in need of serious repair or replacement.
In many states, the situation is more dire. Nearly a quarter of the bridges in Pennsylvania are structurally deficient, the highest of all states, according to Transportation for America, a grassroots organization advocating updated transportation infrastructure. Based on the group's report, "The Fix We're In For: The State of Our Nation's Bridges 2013," these are the 10 states with the most dangerous bridges.
The states on this list tend to have older bridges — their bridges' average age is older than the average age of all bridges nationwide of 43 years. In Pennsylvania, the states with the most dangerous bridges, the average age is 54, higher than all but four others.
David Goldberg, communications director with Transportation for America and a co-author of the report explained that a large number of U.S. bridges were part of the transportation projects initiated shortly after World War II. "A lot of these bridges were born with the baby boomers." He said. "Like the baby boomers, they are nearing retirement age." Transportation for America projects that in 10 years, one in four bridges in the country will be at least 65 years old.
For most states, gasoline taxes are one of the most important sources of funding for bridge construction and repair. Not surprisingly, many of the states with structurally deficient bridges have lower gas tax rates than other states. For instance, Oklahoma charges just 17 cents a gallon in taxes, lower than all but four other states. Meanwhile, Missouri charges 17.3 cents, lower than all but five other states. Both states are on this list.
But higher gas tax rates may not be sufficient to improve bridges in some states, Goldberg noted. Considering the number of bridges that need to be maintained, sparsely populated states simply do not have enough people filling up their tanks to bring in the revenue needed to rebuild or replace structurally unsound bridges. Such is the case in North Dakota and South Dakota, the fourth and fifth most sparsely populated states in the country, respectively.
Winter weather can also wreak havoc on infrastructure. Bridges tend to receive the most damage during the wintertime, Goldberg said, and states in the Northeast tend to have harsher winters. Of the 10 states on this list, four — Pennsylvania, Rhode Island, New Hampshire and Maine — are located in the Northeast. North and South Dakota also have very harsh winters.
Some of these states are heading in the right direction in terms of repairing bridges. The number of bridges in Missouri deemed structurally inadequate declined by more than 15% since 2011. The state has worked over the past several years to repair bridges through the $685 million Safe & Sound Bridge Improvement Program. In addition, both Pennsylvania and Maine have reduced the number of structurally deficient bridges by more than 8%.
Based on information from Transportation for America's report, "The Fix We're In For: The State of Our Nation's Bridges 2013," 24/7 Wall St. identified the 10 states with the highest percentage of bridges that are deemed structurally deficient. Transportation for America labels bridges structurally deficient if they "require significant maintenance, rehabilitation or replacement." Most of the information is as of 2013, with the exception of data from Tennessee and New Hampshire, which is from 2012. Transportation for America also provided the data regarding the average age of bridges, traffic over bridges and bridge information by county. Data on current excise taxes by state came from the Tax Foundation, while population density information as of 2011 was from the U.S. Census Bureau.
These are the states with the most dangerous bridges.
> Pct. of bridges structurally deficient: 14.5%
> Number of bridges structurally deficient: 3,502 (4th most)
> Average bridge age: 43 years (21st highest)
> State gas tax: 17.3 cents (6th lowest)
Since 2011, Missouri may have made more strides fixing its bridges than almost any other state in the nation. Although 3,502 of its 24,072 bridges are structurally deficient, this is actually 640 fewer than in 2011. In St. Louis County, just 3.9% of the 865 bridges received a subpar grade. Those 58 bridges in need of repair carry an average of 789,000 vehicles per day. However, the bridges in many other parts of Missouri remain in a serious state of disrepair. In five counties, more than 30% of the bridges are structurally deficient.
> Pct. of bridges structurally deficient: 14.8%
> Number of bridges structurally deficient: 356 (11th fewest)
> Average bridge age: 50 years (8th highest)
> State gas tax: 31.5 cents (16th highest)
Maine has 2,400 bridges, 356 of which are considered structurally unsound. The state is one of just eight where the average age of all its bridges is at least 50 years old. Despite still having among the highest percentage of problematic bridges, Maine has moved in the right direction in terms of repairs. As many as 33 bridges have been repaired in the state since 2011, reducing the number of structurally deficient bridges by 8.5%. This is among the better improvements of all states.
8. New Hampshire
> Pct. of bridges structurally deficient: 14.9%
> Number of bridges structurally deficient: 362 (13th fewest)
> Average bridge age: 52 years (6th highest)
> State gas tax: 19.6 cents (10th lowest)
Although it has just 2,429 bridges, less than all but a half a dozen other states, New Hampshire may soon need to spend a considerable sum on their upgrade and repairs. Nearly 15% of its bridges have been judged to be in poor condition. The average age of all bridges in the state is 52 years, while the average age of its structurally deficient bridges is close to 74 years. By both measures, the state's bridges are among the oldest in the nation. Of the bridges in need of maintenance, rehabilitation or replacement across New Hampshire, 50 were built before 1900.
7. North Dakota
> Pct. of bridges structurally deficient: 16.8%
> Number of bridges structurally deficient: 746 (23rd fewest)
> Average bridge age: 45 years (15th highest)
> State gas tax: 23.0 cents (20th lowest)
The number of structurally deficient bridges in North Dakota has increased by 2.6% since 2011, among the biggest increases in the country. While North Dakota has a high percentage of problematic bridges, just over 95,000 vehicles travel over them every day, lower traffic than any other state in the country. Although many states are able to fund repairs through state and federal gasoline taxes, Goldberg notes that states such as North Dakota have trouble repairing roads and bridges with this money due to the low volume of travelers in the state.
> Pct. of bridges structurally deficient: 18.0%
> Number of bridges structurally deficient: 2,778 (6th most)
> Average bridge age: 44 years (17h highest)
> State gas tax: 25.5 cents (24th highest)
Nebraska, the 14th least populous state in the country, has 2,778 defective bridges, more than all but five other states. By comparison, California, by far the most populous state in the nation, has just 2,978 deficient bridges. In recent years, very few bridges have been repaired, maintained or rehabilitated in Nebraska, with the number of structurally deficient bridges falling by just 42 since 2011. But not all parts of Nebraska suffer from this problem. Five counties in the state did not have a single defective bridge. In Douglas County, where Omaha is located, just 2% of daily bridge traffic travels over such bridges.
5. South Dakota
> Pct. of bridges structurally deficient: 20.6%
> Number of bridges structurally deficient: 1,208 (20th most)
> Average bridge age: 46 years (13th highest)
> State gas tax: 24.0 cents (23rd lowest)
South Dakota is one of just five states where more than 20% of the bridges are in need of maintenance. The average age of a bridge in the state is 46 years old. While this is far from the oldest of all states, it is higher than the 43 years average across the country. South Dakota's less-than-stellar bridges are not used too often — the average traffic on South Dakota's bridges is slightly more than 354,000 vehicles a day, lower than all but four other states.
> Pct. of bridges structurally deficient: 20.7%
> Number of bridges structurally deficient: 156 (6th fewest)
> Average bridge age: 55 years (4th highest)
> State gas tax: 33.0 cents (13th highest)
Rhode Island has just 754 bridges, the fewest of any state. Despite the limited amount, nearly 21% of the bridges are structurally deficient. And although Rhode Island is geographically small, each day more than 1.8 million vehicles use Providence County bridges that are in need of maintenance, rehabilitation or repair. In all, more than 2.6 million vehicles use potentially problematic bridges on an average day. This is more traffic on structurally deficient bridges than many, much more populous states, including Florida.
> Pct. of bridges structurally deficient: 21.2%
> Number of bridges structurally deficient: 5,191 (3rd most)
> Average bridge age: 44 years (17th highest)
> State gas tax: 22.0 cents (18th lowest)
Iowa is one of just three states where more than 5,000 bridges are structurally deficient. In three of the state's counties — Adams, Davis and Ringgold — more than 40% of the bridges are deficient, while in Lucas and Van Buren counties nearly 40% of the bridges are defective. The average age of all bridges and the average age of deficient bridges are both higher than the national averages. Members of the Iowa legislature attempted to raise the gasoline tax earlier this year to divert some of the revenue to maintenance projects through the state's road fund. However, the legislation died because of Republican opposition.
> Pct. of bridges structurally deficient: 22.6%
> Number of bridges structurally deficient: 5,382 (2nd most)
> Average bridge age: 46 years (13th highest)
> State gas tax: 17.0 cents (5th lowest)
None of the 10 states with a high percentage of deficient bridges has progressed less in repairing its bridges since 2011 than Oklahoma. In fact, the situation in Oklahoma further deteriorated. As many as 77 more bridges are deemed deficient now than were two years ago. More than 7.7 million vehicles use unsound bridges daily. In Tulsa County, 16.6% of daily bridge traffic is on bridges that need repairs or improvements. This amounts to an average of 7.2 million vehicles a day.
> Pct. of bridges structurally deficient: 24.5%
> Number of bridges structurally deficient: 5,543 (the most)
> Average bridge age: 54 years (5th highest)
> State gas tax: 32.3 cents (15th highest)
No state has a higher percentage of deficient bridges than Pennsylvania. Goldberg points out that the state has made a significant effort to improve its bridges in recent years. In three counties — McKean, Schuylkill and Potter — more than 40% of the bridges are structurally deficient. The average age of all bridges in Pennsylvania is 54 years, higher than all but four other states. Although Pennsylvania still has more bridges in need of serious maintenance or replacement than any other state in the country, it has reduced the number of these problematic bridges by 500 since 2011, more than any other state except for Missouri. The Pennsylvania legislature is currently debating legislation that would increase the state's transportation funding by 50%.
24/7 Wall St. is a USA TODAY content partner offering financial news and commentary. Its content is produced independently of USA TODAY.
A Rare Localization of Actinomycosis Mimicking Ulcerative Malignancy
Actinomycosis is a chronic, suppurative, and granulomatous process caused by Actinomycetes, saprophytic bacteria normally residing in the oral cavity. It can involve any organ, but the cervicofacial disease is the most frequent. Pharyngolayngeal involvement is rare and usually occurs secondary to the oral or cervical disease. There are few cases of primary pharyngolaringeal actinomycosis described in the literature. A rare case of pharyngeal actinomycosis mimicking an ulcerative malignancy in a 63-year-old man is reported. The patient was treated successfully with long-term antibiotic therapy. The clinical and pathological features and the aspects of diagnosis and treatment of cervicofacial actinomycosis are discussed.
Actinomycosis is an uncommon bacterial infection characterized by a chronic, suppurative, and granulomatous process due to Actinomycetes. They are usually saprophytic bacteria of the oral cavity and the digest tract, but sometimes can lead to local and diffuse infections. The infection is caused by a mixture of microbes with a predominance of the Actinomyces israelii, a gram-positive anaerobic bacillus. Five species of Actinomycetes have been identified: israelii, bovis, naeslundii, viscous, and odontolyticus. All these species are normal flora of the oral cavity with exception of bovis .
In 1938 Cope first classified actinomycosis into 3 different forms: cervicofacial, pulmonothoracic, and abdominopelvic, respectively, 50%, 30%, and 20% of cases . The predisposing factors are represented by debilitating conditions such as malignancy, diabetes, and immunosuppression . Cervicofacial actinomycosis is also more frequent in people with poor oral hygiene and oral mucosal trauma. The fifth decade of life is the most affected, and there is a little male prevalence. Actinomycosis located at the cervicofacial district classically presents a slowly growing, firm, painless, and possibly suppurating submandibular mass, but it can also present a rapidly progressive, painful, and fluctuant infection anywhere in the neck or face associated with fever and leukocytosis. Racial predisposition or geographic factors are unknown.
Actinomycosis is an insidious disease, and its propensity to mimic different pathologies, such as tuberculosis or carcinoma, is well known. CT and MR are aspecific for diagnosis, but they can help in defining the localization and the extension of the lesion . The certain diagnosis is based on cytology (FNAC) and/or biopsy . We report a rare case of pharyngeal actinomycosis mimicking an ulcerative malignancy.
2. Case Report
A 63-year-old man, non smoker, affected by diabetes mellitus and ischemic heart disease, complained of episodes of hemoptoe. He did not refer to dyspnoea or fever, and no previous surgery in the head and neck region was reported. Our examination of the oral cavity was normal, and there were no dental pathologies. Fiber optic laryngoscopic evaluation revealed an ulcerative lesion on the right pharyngoepiglottic ligament, homolateral vallecula, and right pyriform sinus (Figure 1).Diagnostic suggestion appeared to be a neoplastic process. Clinical evaluation of the neck did not show lymphadenopathy or skin alteration. Routine blood test evidenced only mild anemia (12,1 mg/dL), and chest X-ray was normal. Neck ultrasound was negative for cervical lymphadenopathies. MR confirmed the presence of an irregular tissue thickening with moderate contrast enhancement on the right pharyngoepiglottic ligament and homolateral pyriform sinus, but the radiologic findings were not specific (Figure 2). In microlaryngoscopy under general anaesthesia, a biopsy of the lesion was performed for histological diagnosis. Histologically a necrotizing granulomatous reaction with central aggregates of neutrophils, forming microabscesses, was observed. Some bacterial colonies were situated inside the neutrophilic collections and they formed characteristic structures that have been called “sulfur granules” (Figure 3). The internal bacteria were also stained with the PAS procedure (Figure 4).
After histologic diagnosis of actinomycosis, oral antibiotic therapy was administered with a regimen of amoxicillin 500 mg 3 times a day. It was planned to continue this for 3 months. MR after 1 month revealed a reduction of the lesion. Fiber optic laryngoscopic evaluation and MR performed after 3 months showed no evidence of disease.
Actinomyces are normal inhabitants of the human oral cavity that cannot penetrate healthy tissue, so mucosal breakdown is a predisposing factor for infection. It is very important to investigate if the patient has any risk factors to suspect actinomicosis such as poor oral hygiene, malignancies, diabetes, and immunosuppression [6, 7]. In the present case, the patient denied any clinical history of oromaxillofacial trauma, but he was affected by diabetes, that is correlatable with a debilitating condition. The fifth decade of life is the most affected, and there is a little male prevalence. Racial predisposition or geographic factors are unknown . Actinomycosis of the cervicofacial district usually occurs as a firm mass in submandibular region associated with surrounding hardening or erythema, with slowly growing, painless, and possibly suppurating mass, but it can also present a rapidly progressive fluctuant mass, painful, associated with fever and leukocytosis . Clinically, the absence of lymphadenopathy in the presence of marked induration may differentiate actinomycosis from other diseases such as tubercclosis, syphilis, and sarcoma. In our case the neck ultrasound and the MR did not show cervical lymphadenopathy. Actinomycosis is an insidious disease and its propensity to mimic different pathologies, such as tuberculosis or carcinoma, is well known. CT and MR are aspecific for diagnosis, and they can help in defining site and extension of the lesion . A recent radiologic study evidences the importance of imaging to show the extension of a pharyngeal actinomycosis to the adjacent neck space crossing fascial plane . The invasion of the fascial plane can be related to the bacterial infection spreading without respect for anatomical structures or lymphatic drainage. This infiltrative nature can be correlated with proteolytic enzymes released by Actinomycetes. Typically most lesions appear as not well-defined, infiltrative, soft-tissue masses with an inflammatory reaction.
In our case the MR showed an irregular and undefined tissue thickening with moderate contrast enhancement on the right pharyngoepiglottic ligament and homolateral pyriform sinus, but these radiologic findings were not specific.
The certain diagnosis is based on cytology (FNAC) and/or biopsy . In our case the site of the lesion needed a biopsy in microlaryngoscopy under general anaesthesia.
The histological examination revealed characteristic sulfur granules on a hematoxylin-eosin-stained section. These are rounded or elongated, deep purple aggregates composed of filamentous organisms. The sulfur granules often have eosinophilic club-shaped ends and are often encrusted with protein in the Splendore-Hoeppli phenomenon.
Pharyngeal actinomycosis is a rare localization. Actinomycosis shows a wide variety of symptoms and a characteristic ability to mimic many other diseases. Because of its peculiarity it can be considered a “great pretender” . Only 10% of Actinomyces infections are correctly diagnosed on initial presentation . In the past, surgery has been used both to diagnose and to treat this pathology with its removal. Nowadays with the advent of FNAC, the diagnosis has become easier and less invasive. The biopsy can be performed to obtain the correct diagnosis when multiple FNACs are not diagnostic or the site of the lesion is impossible to reach, as in our case. Moreover the surgical treatment is necessary when complications associated with actinomycosis, such as an abscess to be drained, occur. The main therapeutic treatment is administration of antibiotics, and penicillin is the drug of choice. Erythromycin and tetracycline can be used in patients allergic to penicillin . The antibiotic therapy must be administered in high dosage over a prolonged period because of the tendency of the disease to recur.
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