Annual Report, Fiscal Years 2004 - 2006

DAS was established on July 1, 2003, by consolidating the departments of General Services, Information Technology, Personnel, and the Accounting Bureau of the Department of Revenue and Finance. In introducing our new department, you outlined four goals of this consolidation: 1. Improve service to customers, 2. Save money, 3. Streamline, and 4. Enhance resource flexibility for state government managers. Launch of the new department signaled more than just the consolidation of state government infrastructure providers. It also marked the first large-scale rollout of entrepreneurial management, a business model characterized by a customer-focused approach to delivering services in a competitive marketplace. In entrepreneurial management organizations, business decisions are motivated by the desire to meet customer needs and by rewards or consequences for financial performance. We’re pleased to provide this Annual Report for your review and trust you will agree that entrepreneurial management in state government is a viable working concept and remains a valuable asset to Iowans.

How are "teaching the teachers" courses in evidence based medicine evaluated? A systematic review.

BACKGROUND: Teaching of evidence-based medicine (EBM) has become widespread in medical education. Teaching the teachers (TTT) courses address the increased teaching demand and the need to improve effectiveness of EBM teaching. We conducted a systematic review of assessment tools for EBM TTT courses.To summarise and appraise existing assessment methods for teaching the teachers courses in EBM by a systematic review. METHODS: We searched PubMed, BioMed, EmBase, Cochrane and Eric databases without language restrictions and included articles that assessed its participants. Study selection and data extraction were conducted independently by two reviewers. RESULTS: Of 1230 potentially relevant studies, five papers met the selection criteria. There were no specific assessment tools for evaluating effectiveness of EBM TTT courses. Some of the material available might be useful in initiating the development of such an assessment tool. CONCLUSION: There is a need for the development of educationally sound assessment tools for teaching the teachers courses in EBM, without which it would be impossible to ascertain if such courses have the desired effect.

Identifying the gap between need and intervention for alcohol use disorders in Europe.

AIMS: A literature review of existing research on the prevalence of alcohol use disorders (AUDs) and availability of alcohol interventions in Europe was conducted. The review also explored what is known about the gap between need and provision of alcohol interventions in Europe. METHODS: The review search strategy included: (i) descriptive studies of alcohol intervention systems in Europe; (ii) studies of alcohol service provision in Europe; and (iii) studies of prevalence of AUD and alcohol needs assessment in Europe. RESULTS: Europe has a relatively high level of alcohol consumption and the resulting disabilities are the highest in the world. Most research on implementation of alcohol interventions in Europe has been restricted to screening and brief interventions. Alcohol needs assessment methodology has been developed but has not been applied in comparative studies across countries in Europe. CONCLUSIONS: This review points to key gaps in knowledge related to alcohol interventions in Europe. There is a lack of comparative data on variations in alcohol treatment systems across European countries and there is also a lack of comparative data on the prevalence of alcohol use disorders across European countries and the relative gap between need and access to treatment. The forthcoming Alcohol Measures for Public Health Research Alliance (AMPHORA) research project work package on 'Early identification and treatment' aims to address these gaps.

Pla de màrqueting per al llançament d'un nou producte en el mercat dels motors elèctrics per a bancs de proves

Ningú no dubte ja del canvi de mentalitat que s’ha produït en els darrers anys en els compradors pel què fa al mercat de l’automòbil. La seguretat i el respecte per el medi ambient, són actualment dos dels factors claus que el consumidor té en compte a l’hora de comprar un vehicle. D’altra banda en els darrers anys la Unió Europea, ha fixat tota una sèrie normatives per tal de reduir les emissions nocives a l’atmosfera. Així doncs, més seguretat i menys emissions, signifiquen vehicles que incorporin components i sistemas cada cop més sofisticats, els quals, a la vegada, necessiten de bancs d’assaig i equips de test per tal de ser validats. Aquest fet ha provocat una revolució dins dels sistemes de test per a vehicles, per als quals han augmentat enormement les exigències en quan a precisions i repetibilitat per tal d’intentar reproduir, amb la màxima fiabilitat possible, les condicions de treball que hauran de suportar els components durant el seu ús real. Les característiques dels motors elèctrics, resulten ideals per a accionar aquest tipus d’aplicacions, ja que permeten un control del parell molt acurat i una repetibilitat quasi perfecte enfront d’altres sistemas utilitzats fins no fa massa temps. Aquesta demanda creixent d’aquest tipus de màquines elèctriques, obra una nova oportunitat de negoci per a les empreses fabricants de motors elèctrics. L’objectiu principal d’aquest treball és identificar i satisfer les necessitats dels clients, dins d’un mercat industrial concret: el mercat dels motors elèctrics per a bancs de proves de components per a la indústria de l’automoció. La fita és doncs la de proporcionar les eines necessàries per tal de que una empresa, fabricant de motors elèctrics de velocitat variable, pugui realitzar el disseny, desenvolupament i llançament comercial d’un nou tipus de motor, específicament pensat per aquest mercat, amb les màximes garanties d’èxit. Com a principal conclusió, el treball argumenta que el nou producte representa una oportunitat de negoci força atractiva i rendible per a l’empresa, i permetrà diversificar la oferta de la companyia cap a un nou sector fins ara no explotat.

Iowa Aviation Plan, 2004-2024

The Iowa Department of Transportation (DOT), working closely with the Federal Aviation Administration (FAA), strives to ensure that Iowa’s system of public airports is positioned to meet the needs of businesses, residents, and visitors to our state. Airports must be accessible and positioned to safely meet different levels of aviation activity. In partnership with the FAA and various cities, counties, and airport authorities, the Iowa DOT helps to direct the systematic development of public airports. This report is a summary of a more comprehensive technical report that outlines a strategic plan for improving the performance of airports in Iowa over the next 20 years. More information on the technical report and on individual reports prepared for each of the public airports can be obtained from the Iowa DOT, Office of Aviation website at www.iawings.com. The Iowa Aviation System Plan provides the Iowa DOT with an important tool to monitor the ability of airports to meet customer needs. The plan also provides a means to measure the effects of investment on the performance of the Iowa Aviation System. Over the next 20 years, federal, state, local, and private funding will be needed to ensure that the aviation system meets goals established in this study. It is estimated that at least $821 million will be needed over the next 20 years if airports in Iowa are to respond to objectives set by the system plan. In future years, the plan will enable the Iowa DOT to measure system performance. By tracking key indicators for the airport system, it will be possible for the Iowa DOT and the FAA to formulate strategies for responding to Iowa’s air transportation needs. The Iowa Aviation System Plan provides a guide for the state and its communities to ensure that the vision established for the Iowa Aviation System can be achieved.

Iowa Aviation Plan, 2004-2024

The Iowa Department of Transportation (DOT), working closely with the Federal Aviation Administration (FAA), strives to ensure that Iowa’s system of public airports is positioned to meet the needs of businesses, residents, and visitors to our state. Airports must be accessible and positioned to safely meet different levels of aviation activity. In partnership with the FAA and various cities, counties, and airport authorities, the Iowa DOT helps to direct the systematic development of public airports. This report is a summary of a more comprehensive technical report that outlines a strategic plan for improving the performance of airports in Iowa over the next 20 years. More information on the technical report and on individual reports prepared for each of the public airports can be obtained from the Iowa DOT, Office of Aviation website at www.iawings.com. The Iowa Aviation System Plan provides the Iowa DOT with an important tool to monitor the ability of airports to meet customer needs. The plan also provides a means to measure the effects of investment on the performance of the Iowa Aviation System. Over the next 20 years, federal, state, local, and private funding will be needed to ensure that the aviation system meets goals established in this study. It is estimated that at least $821 million will be needed over the next 20 years if airports in Iowa are to respond to objectives set by the system plan. In future years, the plan will enable the Iowa DOT to measure system performance. By tracking key indicators for the airport system, it will be possible for the Iowa DOT and the FAA to formulate strategies for responding to Iowa’s air transportation needs. The Iowa Aviation System Plan provides a guide for the state and its communities to ensure that the vision established for the Iowa Aviation System can be achieved.

Les besoins des personnes vivant avec le VIH/sida en Suisse

[Table des matières] 1. Zusammenfassung. 2. Introduction et contexte de l'étude. 3. Méthode. 4. Besoins des personnes vivant avec le VIH/sida, amis et partenaires. 5. Etudes donnant des indications sur certaines catégories de besoins des personnes séropositives. 5.1.Programme national VIH/sida de 1999 à 2003. 5. 2. Test de dépistage du VIH. 5.3. Prophylaxie post exposition VIH (PEP). 5.4. La sexualité des personnes vivant avec le VIH/sida. 5.5. Discriminations institutionnelles à l'encontre des personnes vivant avec le VIH en Suisse. 5.6. Evaluation de la stratégie de prévention du sida en Suisse sur mandat de l'Office fédéral de la santé publique : sixième rapport de synthèse. 5.7. Activité de prévention du sida des médecins de premier recours, le counselling pré-test. 5.8. Comparaison 1989/1997 : est-ce que l'amélioration du traitement médical se répercute aussi sur la perception des patients de leur maladie ? 5.9. Histoires individuelles avec le VIH, bien-être psychophysique, coping, charge psychosociale. 5.10. Etude médico-ethnologique sur la prise en charge et les choix thérapeutiques. 5.11. Qualité des soins d'un service ambulatoire spécialisé dans le suivi des patients infectés par le VIH, le point de vue des patients. 5.12. Prévention de la transmission du VIH dans les prisons suisses : analyse secondaire sur la base de la littérature disponible. 5. 13. Recommandations. 5.14. Formation VIH/sida 1989-1999. 5.15. Etude sur les nouveaux traitements du VIH/sida dans la perspective des patients. 5.16. Projet SESAM. 5.17. Etude : Evaluation du site HivNet. 5.18. Etudes relatives à la paupérisation des personnes vivant avec le VIH. 5.19. Travail, revenu et pauvreté chez les personnes vivant avec le VIH/sida de la "Swiss Cohort Study". 5.20. Séropositivité, sida et les assurances sociales. 5.21. Politiques et pratqieus cantonales en matière de prévention VIH/sida et d'éducation sexuelle à l'école. 5.22. Données épidémiologiques sur le VIH/sida issues du système de surveillance. 5.23. Données descriptives issues de la Swiss HIV Cohort Study. 6. Tableau récapitulatif : conclusions et recommandations.

Iowa Aviation System Plan, 2004-2024

The Iowa Department of Transportation (DOT), working closely with the Federal Aviation Administration (FAA), strives to ensure that Iowa’s system of public airports is positioned to meet the needs of businesses, residents, and visitors to our state. Airports must be accessible and positioned to safely meet different levels of aviation activity. In partnership with the FAA and various cities, counties, and airport authorities, the Iowa DOT helps to direct the systematic development of public airports. This report is a summary of a more comprehensive technical report that outlines a strategic plan for improving the performance of airports in Iowa over the next 20 years. More information on the technical report and on individual reports prepared for each of the public airports can be obtained from the Iowa DOT, Office of Aviation website at www.iawings.com. The Iowa Aviation System Plan provides the Iowa DOT with an important tool to monitor the ability of airports to meet customer needs. The plan also provides a means to measure the effects of investment on the performance of the Iowa Aviation System. Over the next 20 years, federal, state, local, and private funding will be needed to ensure that the aviation system meets goals established in this study. It is estimated that at least $821 million will be needed over the next 20 years if airports in Iowa are to respond to objectives set by the system plan. In future years, the plan will enable the Iowa DOT to measure system performance. By tracking key indicators for the airport system, it will be possible for the Iowa DOT and the FAA to formulate strategies for responding to Iowa’s air transportation needs. The Iowa Aviation System Plan provides a guide for the state and its communities to ensure that the vision established for the Iowa Aviation System can be achieved.

La médecine ambulatoire youth-friendly. [Youth-friendly outpatient care].

Ambulatory pediatric and family medicine takes care of adolescent patients, most of whom regularly consult a physician. Consultations with young people involve issues specifically related to their age. Regarding health care systems and physicians, adolescents' expectations vary from those of adults, not so much in terms of the issues discussed but in terms of the priorities that they give to them. Confidential interviews are not always proposed but are highly appreciated, as are certain personal qualities on the part of the caregivers such as honesty, respect, and friendliness. Finally, easy access to care together with the continuity of care are essential. Prevention of risk behaviors by screening and health education is clearly insufficient. This issue could be approached during the consultation through a psychosocial history. This is a good opportunity to discuss sensitive issues that adolescents seldom bring up themselves. More systematic prevention would probably decrease youth morbidity and mortality, which are both closely related to risk behaviors. To meet these expectations and special health care needs, the World Health Organization has developed the concept of youth-friendly health services. This concept can be applied in both a specialized adolescence center and a pediatric or family practice. Youth-friendly services are still rarely evaluated but seem to bring a clear benefit in terms of patient satisfaction and access to care.

Iowa Plan for Brain Injury, 2007-2010

Traumatic Brain Injury (TBI) impacts the lives of thousands of Iowans every year. TBI has been described as the “Silent Epidemic” because so often the scars are not visible to others. The affects of brain injury are cognitive, emotional, social, and can result in physical disability. In addition to the overwhelming challenges individuals with brain injury experience, families also face many difficulties in dealing with their loved one’s injury, and in navigating a service delivery system that can be confusing and frustrating. In 1998, the Iowa Department of Public Health (IDPH) conducted a comprehensive statewide needs assessment of brain injury in Iowa. This assessment led to the development of the first Iowa Plan for Brain Injury, “Coming Into Focus.” An updated state plan, the Iowa Plan for Brain Injuries 2002 – 2005, was developed, which reported on progress of the previous state plan, and outlined gaps in service delivery in Iowa. Four areas of focus were identified by the State Plan for Brain Injuries Task Force that included: 1) Expanding the Iowa Brain Injury Resource Network (IBIRN); 2) Promoting a Legislative and Policy Agenda, While Increasing Legislative Strength; 3) Enhancing Data Collection; and, 4) Increasing Funding. The IDPH utilized “Coming Into Focus” as the framework for an application to the federal TBI State Grant Program, which has resulted in more than $900,000 for plan implementation. Iowa continues to receive grant dollars through the TBI State Grant Program, which focuses on increasing capacity to serve Iowans with brain injury and their families. Highlighting the success of this grant project, in 2007 the IDPH received the federal TBI Program’s “Impacting Systems Change” Award. The Iowa Brain Injury Resource Network (IBIRN) is the product of nine years of TBI State Grant Program funding. The IBIRN was developed to ensure that Iowans got the information and support they needed after a loved one sustained a TBI. It consists of a hospital and service provider pre-discharge information and service linkage process, a resource facilitation program, a peer-to-peer volunteer support network, and a service provider training and technical assistance program. Currently over 90 public and private partners work with the IDPH and the Brain Injury Association of Iowa (BIA-IA) to administer the IBIRN system and ensure that families have a relevant and reliable location to turn for information and support. Further success was accomplished in 2006 when the Iowa legislature created the Brain Injury Services Program within the IDPH. This program consists of four components focusing on increasing access to services and improving the effectiveness of services available to individuals with TBI and their families, including: 1) HCBS Brain Injury Waiver-Eligible Component; 2) Cost Share Component; 3) Neuro-Resource Facilitation; and, 4) Enhanced Training. The Iowa legislature appropriated $2.4 million to the Brain Injury Services Program in state fiscal year (SFY) 2007, and increased that amount to $3.9 million in SFY 2008. The Cost Share Component models the HCBS Brain Injury Waiver menu of services but is available for Iowans who do not qualify functionally or financially for the Waiver. In addition, the Neuro-Resource Facilitation program links individuals with brain injury and their families to needed supports and services. The Iowa Plan for Brain Injury highlights the continued need for serving individuals with brain injury and their families. Additionally, the Plan outlines the paths of prevention and services, which will expand the current system and direct efforts into the future.

Challenges to the implementation of behavioural survellance for HIV/STI in Europe

Background: Well-conducted behavioural surveillance (BS) is essential for policy planning and evaluation. Data should be comparable across countries. In 2008, the European Centre for Disease Prevention and Control (ECDC) began a programme to support Member States in the implementation of BS for Second Generation Surveillance. Methods: Data from a mapping exercise on current BS activities in EU/EFTA countries led to recommendations for establishing national BS systems and international coordination, and the definition of a set of core and transversal (UNGASS-Dublin compatible) indicators for BS in the general and eight specific populations. A toolkit for establishing BS has been developed and a BS needs-assessment survey has been launched in 30 countries. Tools for BS self-assessment and planning are currently being tested during interactive workshops with country representatives. Results: The mapping exercise revealed extreme diversity between countries. Around half had established a BS system, but this did not always correspond to the epidemiological situation. Challenges to implementation and harmonisation at all levels emerged from survey findings and workshop feedback. These include: absence of synergy between biological and behavioural surveillance and of actors having an overall view of all system elements; lack of awareness of the relevance of BS and of coordination between agencies; insufficient use of available data; financial constraints; poor sustainability, data quality and access to certain key populations; unfavourable legislative environments. Conclusions: There is widespread need in the region not only for technical support but also for BS advocacy: BS remains the neglected partner of second generation surveillance and requires increased political support and capacity-building in order to become effective. Dissemination of validated tools for BS, developed in interaction with country experts, proves feasible and acceptable.

Feasibility of Cooperative Development of Wetland Mitigation Projects, TR-526, 2006

The Iowa Department of Transportation (Iowa DOT) currently performs wetland mitigation on a project-by-project basis. At the same time, other agencies like the Iowa Department of Natural Resources and Natural Resource Conservation Service are performing wetland restoration projects, and counties and cities may be mitigating wetland losses as well. This project examined the feasibility of developing cooperative wetland mitigation projects in order to utilize state and local resources more efficiently to benefit both Iowa and local communities. The project accomplished the following objectives: (1) Identified and characterized cooperative wetland mitigation programs nationwide; (2) Developed a needs assessment through a survey of state, county, and large city agencies in Iowa to describe wetland mitigation programs and determine challenges with mitigation and program improvements, including long-term risks associated with maintenance and monitoring programs; (3) Surveyed state, county, and city agencies and organizations to identify resources available for developing cooperative mitigation projects and procedures; (4) Developed a conceptual framework for cooperative wetland mitigation.