Traumatic Brain Injury in Iowa: An Analysis of Core Surveillance Data 2006-2008, July 15, 2011

Termed the “silent epidemic”, traumatic brain injury is the most debilitating outcome of injury characterized by the irreversibility of its damages, long-term effects on quality of life, and healthcare costs. The latest data available from the Centers for Disease Control and Prevention (CDC) estimate that nationally 50,000 people with traumatic brain injury (TBI) die each year; three times as many are hospitalized and more than twenty times as many are released from emergency room departments (ED) (CDC, 2008)1. The purpose of this report is to describe the epidemiology of TBI in Iowa to help guide policy and programming. TBI is a result of an external force which transfers energy to the brain. Stroke is caused by a disruption of blood flow in the brain that leads to brain injury. Though stroke is recognized as the 3rd leading cause of death nationally2, and is an injury that affects the brain it does not meet the definition a traumatic brain injury and is not included in this report.

Traumatic Brain Injury in Iowa Inpatient Hospital Data, 2003-2005

According to the Centers for Disease Control and Prevention, unintentional injury is the fifth leading cause of death for all age groups and the first leading cause of death for people from 1 to 44 years of age in the United States, while homicide remains the 2nd leading cause of death for 15 to 24 years old (CDC, 2006). In 2004, there were approximately 144,000 deaths due to unintentional injuries in the US; 53% of which represent people over 45 years of age (CDC, 2004). With 20,322 suicidal deaths and 13,170 homicidal deaths, intentional injury deaths affect mostly people under 45 years old. On average, there are 1,150 unintentional deaths per year in Iowa. In 2004, 37% of unintentional deaths were due to motor vehicle accidents (MTVCC) occurring across all age ranges and 30% were due to falls involving persons over 65 years of age 82% of the time (IDPH Health Stat Div., 2004). The most debilitating outcome of injury is traumatic brain injury, which is characterized by the irreversibility of its damages, long-term effects on quality of life, and healthcare costs. The latest data available from the CDC estimated that, nationally, 50,000 traumatic brain injured (TBI) people die each year; three times as many are hospitalized and more than twenty times as many are released from emergency room (ER) departments (CDC, 2006). Besides the TBI registry, brain injury data is also captured through three other data sources: 1) death certificates; 2) hospital inpatient data; and, 3) hospital outpatient data. The inpatient and outpatient hospital data are managed by the Iowa Hospital Association, which provides to Iowa Department of Public Health the hospital data without personal identifiers. (The hospitals send reports to the Agency of Health Care Research and Quality, which developed the Health Care Utilization Project and its product, the National Inpatient Sample).

Traumatic Brain Injury in Iowa: Iowa Brain Injury Resource Network Outcome Evaluation 2007-2009, August 2011

Termed the “silent epidemic,” traumatic brain injury (TBI) is the most debilitating outcome of injury, and is characterized by the irreversibility of its damages, long-term effects on quality of life and healthcare costs. The latest data available from the CDC estimate that nationally, 52,000 people die each year from TBI2. In Iowa, TBI is a major public health problem. The numbers and rates of hospitalizations and emergency department (ED) visits due to TBIs are steadily increasing. From 2006 to 2008, there were on average 545 injury deaths per year. Among the injured Iowans, TBI constituted nearly 30 percent (545) of all injury deaths, ten percent (1,591) of people hospitalized and seven percent (17,696) of ED visitors. 3 The state of Iowa has been supporting secondary prevention services to TBI survivors for several years. An Iowa organization that has made a significant effort in assisting TBI survivors is the Brain Injury Association of Iowa (BIAIA). The BIAIA administers the IBIRN program in cooperation with the Iowa Department of Public Health (IDPH) through HRSA TBI Implementation grant funding and state appropriations.

Use of Incentive/Disincentive Contracting to Mitigate Work Zone Traffic Impacts, 2012

Incentive/disincentive clauses (I/D) are designed to award payments to contractors if they complete work ahead of schedule and to deduct payments if they exceed the completion time. A previously unanswered question is, “Did the costs of the actual work zone impacts that were avoided justify the incentives paid?” This report answers that question affirmatively based on an evaluation of 20 I/D projects in Missouri from 2008 to 2011. Road user costs (RUC) were used to quantify work zone impacts and included travel delays, vehicle operating costs, and crash costs. These were computed using work zone traffic conditions for partial-closure projects and detour volumes and routes for full-closure projects. Conditions during construction were compared to after construction. Crash costs were computed using Highway Safety Manual methodology. Safety Performance Functions produced annual crash frequencies that were translated into crash cost savings. In considering an average project, the percentage of RUC savings was around 13% of the total contract amount, or $444,389 of $3,464,620. The net RUC savings produced was around $7.2 million after subtracting the approximately $1.7 million paid in incentives. In other words, for every dollar paid in incentives, approximately 5.3 dollars of RUC savings resulted. I/D provisions were very successful in saving RUC for projects with full-closure, projects in urban areas, and emergency projects. Rural, non-emergency projects successfully saved RUC but not at the same level as other projects. The I/D contracts were also compared to all Missouri Department of Transportation contracts for the same time period. The results show that I/D projects had a higher on-time completion percentage and a higher number of bids per call than average projects. But I/D projects resulted in 4.52% higher deviation from programmed costs and possibly more changes made after the award. A survey of state transportation departments and contractors showed that both agreed to the same issues that affect the success of I/D contracts. Legal analysis suggests that liquidated damages is preferred to disincentives, since enforceability of disincentives may be an issue. Overall, in terms of work zone impact mitigation, I/D contracts are very effective at a relatively low cost.

Western Iowa Missouri River Flooding -- Geo-Infrastructure Damage Assessment, Repair and Mitigation Strategies, TR-638, 2013

The 2011 Missouri River flooding caused significant damage to many geo-infrastructure systems including levees, bridge abutments/foundations, paved and unpaved roadways, culverts, and embankment slopes in western Iowa. The flooding resulted in closures of several interchanges along Interstate 29 and of more than 100 miles of secondary roads in western Iowa, causing severe inconvenience to residents and losses to local businesses. The main goals of this research project were to assist county and city engineers by deploying and using advanced technologies to rapidly assess the damage to geo-infrastructure and develop effective repair and mitigation strategies and solutions for use during future flood events in Iowa. The research team visited selected sites in western Iowa to conduct field reconnaissance, in situ testing on bridge abutment backfills that were affected by floods, flooded and non-flooded secondary roadways, and culverts. In situ testing was conducted shortly after the flood waters receded, and several months after flooding to evaluate recovery and performance. Tests included falling weight deflectometer, dynamic cone penetrometer, three-dimensional (3D) laser scanning, ground penetrating radar, and hand auger soil sampling. Field results indicated significant differences in roadway support characteristics between flooded and non-flooded areas. Support characteristics in some flooded areas recovered over time, while others did not. Voids were detected in culvert and bridge abutment backfill materials shortly after flooding and several months after flooding. A catalog of field assessment techniques and 20 potential repair/mitigation solutions are provided in this report. A flow chart relating the damages observed, assessment techniques, and potential repair/mitigation solutions is provided. These options are discussed for paved/unpaved roads, culverts, and bridge abutments, and are applicable for both primary and secondary roadways.

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.

Stream Stabilization in Western Iowa, HR-352, 1994

Stream channel erosion in the deep loess soils region of western Iowa causes severe damage along hundreds of miles of streams in twenty-two counties. The goal of this project was to develop information, systems, and procedures for use in making resource allocation decisions related to the protection of transportation facilities and farmland from damages caused by stream channel erosion. Section one of this report provides an introduction. Section two presents an assessment of stream channel conditions from aerial and field reconnaissance conducted in 1993 and 1994 and a classification of the streams based on a six stage model of stream channel evolution. A Geographic Information System is discussed that has been developed to store and analyze data on the stream conditions and affected infrastructure and assist in the planning of stabilization measures. Section three presents an evaluation of two methods for predicting the extent of channel degradation. Section four presents an estimate of costs associated with damages from stream channel erosion since the time of channelization until 1992. Damage to highway bridges represent the highest costs associated with channel erosion, followed by railroad bridges and right-of-way; loss of agricultural land represents the third highest cost. An estimate of costs associated with future channel erosion on western Iowa streams is also presented in section four. Section four also presents a procedure to estimate the benefits and costs of implementing stream stabilization measures. The final section of this report, section five, presents information on the development of the organizational structure and administrative procedures which are being used to plan, coordinate, and implement stream stabilization projects and programs in western Iowa.

Construction and Maintenance Practices to Minimize the Potential Liability of Counties for Roads in Rural Subdivisions, HR-221, 1981

In an earlier research project, HR-204, the magnitude and nature of highway related tort claims against counties in Iowa were investigated. However, virtually all of the claims identified in that research resulted from incidents that occurred in areas with predominantly agricultural land use. With recent increases in the rural non-farm population, many traditionally urban problems are also appearing in built-up areas under county jurisdiction. This trend is expected to continue so that counties must anticipate a change in the nature of the tort claims they will encounter. Problems that heretofore have been unique to cities may become commonplace in areas for which counties are responsible. The research reported here has been directed toward an investigation of those problems in rural subdivisions that lead to claims growing out of the provision of highway services by counties. Lacking a sufficient database among counties for the types of tort claims of interest in this research, a survey was sent to 259 cities in Iowa in order to identify highway related problems leading to those claims. The survey covered claims during a five year period from 1975 to 1980. Over one-third of the claims reported were based on alleged street defects. Another 34 percent of the claims contained allegations of damages due to backup of sanitary sewers or defects in sidewalks. By expanding the sample from the 164 cities that responded to the survey, it was estimated that a total of $49,000,000 in claims had been submitted to all 259 cities. Over 34% of this amount resulted from alleged defects in the use of traffic signs, signals, and markings. Another 42% arose from claims of defects in streets and sidewalks. Payments in settlement of claims were about 13.4% of the amount asked for those claims closed during the period covered by the survey. About $9,000,000 in claims was pending on June 30, 1980 according to the information furnished. Officials from 23 cities were interviewed to provide information on measures to overcome the problems leading to tort claims. On the basis of this information, actions have been proposed that can be undertaken by counties to reduce the potential for highway-related claims resulting from their responsibilities in rural subdivisions and unincorporated communities. Suggested actions include the eight recommendations contained in the final report for the previous research under HR-204. In addition, six recommendations resulted from this research, as follows: 1. Counties should adopt county subdivision ordinances. 2. A reasonable policy concerning sidewalks should be adopted. 3. Counties should establish and implement a system for setting road maintenance priorities. 4. Counties should establish and implement a procedure for controlling construction or maintenance activities within the highway right of way. 5. Counties should establish and implement a system to record complaints that are received relating to highway maintenance and to assure timely correction of defective conditions leading to such complaints. 6. Counties should establish and implement a procedure to ensure timely advice of highway defects for which notice is not otherwise received.

Aging Watch, December 20, 2013, Vol. 13, no. 14

Aging Watch is provided in the spirit of information and education. The opinions expressed by the contributors do not necessarily reflect those of the Department or its programs. The Department shall not be liable for any damages that may result from errors or omissions in information distributed in this publication. Aging Watch will be published regularly during the legislative session and monthly in the interim by the Iowa Department on Aging. “Aging Watch.” The Department is providing this update to better inform you about policy affecting older Iowans. In addition to policy updates from the statehouse and the nation’s capitol, you’ll learn about Department programs and changes affecting the landscape. As you’ll learn reading this and future editions, big changes are coming for the Iowa Aging Network. Over the next year the Department will be reducing the number of local Area Agencies on Aging, as required by legislative action. Not surprisingly, this is a major change for everyone.

Aging Watch, February 24, 2014, Vol. 14, no. 12

Aging Watch is provided in the spirit of information and education. The opinions expressed by the contributors do not necessarily reflect those of the Department or its programs. The Department shall not be liable for any damages that may result from errors or omissions in information distributed in this publication. Aging Watch will be published regularly during the legislative session and monthly in the interim by the Iowa Department on Aging. “Aging Watch.” The Department is providing this update to better inform you about policy affecting older Iowans. In addition to policy updates from the statehouse and the nation’s capitol, you’ll learn about Department programs and changes affecting the landscape. As you’ll learn reading this and future editions, big changes are coming for the Iowa Aging Network. Over the next year the Department will be reducing the number of local Area Agencies on Aging, as required by legislative action. Not surprisingly, this is a major change for everyone.

Aging Watch, January 24, 2014, Vol. 14, no. 1

Aging Watch is provided in the spirit of information and education. The opinions expressed by the contributors do not necessarily reflect those of the Department or its programs. The Department shall not be liable for any damages that may result from errors or omissions in information distributed in this publication. Aging Watch will be published regularly during the legislative session and monthly in the interim by the Iowa Department on Aging. “Aging Watch.” The Department is providing this update to better inform you about policy affecting older Iowans. In addition to policy updates from the statehouse and the nation’s capitol, you’ll learn about Department programs and changes affecting the landscape. As you’ll learn reading this and future editions, big changes are coming for the Iowa Aging Network. Over the next year the Department will be reducing the number of local Area Agencies on Aging, as required by legislative action. Not surprisingly, this is a major change for everyone.

Aging Watch, June 11, 2013, Vol. 13, no. 12

Aging Watch is provided in the spirit of information and education. The opinions expressed by the contributors do not necessarily reflect those of the Department or its programs. The Department shall not be liable for any damages that may result from errors or omissions in information distributed in this publication. Aging Watch will be published regularly during the legislative session and monthly in the interim by the Iowa Department on Aging. “Aging Watch.” The Department is providing this update to better inform you about policy affecting older Iowans. In addition to policy updates from the statehouse and the nation’s capitol, you’ll learn about Department programs and changes affecting the landscape. As you’ll learn reading this and future editions, big changes are coming for the Iowa Aging Network. Over the next year the Department will be reducing the number of local Area Agencies on Aging, as required by legislative action. Not surprisingly, this is a major change for everyone.

Aging Watch, June 28, 2013, Vol. 13, no. 13

Aging Watch is provided in the spirit of information and education. The opinions expressed by the contributors do not necessarily reflect those of the Department or its programs. The Department shall not be liable for any damages that may result from errors or omissions in information distributed in this publication. Aging Watch will be published regularly during the legislative session and monthly in the interim by the Iowa Department on Aging. “Aging Watch.” The Department is providing this update to better inform you about policy affecting older Iowans. In addition to policy updates from the statehouse and the nation’s capitol, you’ll learn about Department programs and changes affecting the landscape. As you’ll learn reading this and future editions, big changes are coming for the Iowa Aging Network. Over the next year the Department will be reducing the number of local Area Agencies on Aging, as required by legislative action. Not surprisingly, this is a major change for everyone.

Aging Watch, March 10, 2014, Vol. 14, no. 13

Aging Watch is provided in the spirit of information and education. The opinions expressed by the contributors do not necessarily reflect those of the Department or its programs. The Department shall not be liable for any damages that may result from errors or omissions in information distributed in this publication. Aging Watch will be published regularly during the legislative session and monthly in the interim by the Iowa Department on Aging. “Aging Watch.” The Department is providing this update to better inform you about policy affecting older Iowans. In addition to policy updates from the statehouse and the nation’s capitol, you’ll learn about Department programs and changes affecting the landscape. As you’ll learn reading this and future editions, big changes are coming for the Iowa Aging Network. Over the next year the Department will be reducing the number of local Area Agencies on Aging, as required by legislative action. Not surprisingly, this is a major change for everyone.

Aging Watch: Supplement Brief, May 1, 2012, Vol. 12, no. 2

Aging Watch is provided in the spirit of information and education. The opinions expressed by the contributors do not necessarily reflect those of the Department or its programs. The Department shall not be liable for any damages that may result from errors or omissions in information distributed in this publication. Aging Watch will be published regularly during the legislative session and monthly in the interim by the Iowa Department on Aging. “Aging Watch.” The Department is providing this update to better inform you about policy affecting older Iowans. In addition to policy updates from the statehouse and the nation’s capitol, you’ll learn about Department programs and changes affecting the landscape. As you’ll learn reading this and future editions, big changes are coming for the Iowa Aging Network. Over the next year the Department will be reducing the number of local Area Agencies on Aging, as required by legislative action. Not surprisingly, this is a major change for everyone.