2013-2018 Highway Program Summary, 2012

The Iowa Transportation Commission (Commission) and the Iowa Department of Transportation (DOT) develop Iowa’s Five Year Highway Program (Program) to inform you of planned investments in our state’s primary and interstate highway system. This brochure summarizes the FY 2013-2017 Program. $2.6 billion is forecast for highway right of way and construction. The Program is updated and approved in June of each year. A large part of funding available for highway programming comes from the federal government. Accurately estimating future federal funding levels is dependent on having a multiyear federal transportation authorization bill in place. The most recent authorization, Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU), expired September 30, 2009, and to date it has been extended nine times because a new authorization has not yet been enacted. The current extension will expire June 30, 2012.

AMCHP Issue Brief: Environmental Scan: State Title V Program Response to Autism Spectrum Disorder and Other Developmental Disabilities, December 2009

The increasing incidence of children identified and diagnosed with Autism Spectrum Disorders (ASD) and other developmental disabilities (DD) poses a major challenge to Title V and other programs as they try to meet the diverse and sometimes complex needs of these children. However, those state that have initiated coordinated efforts to meet the needs of these children cross systems have had the opportunity to form and/or strengthen relationships with new partners. In addition, these coordinated efforts will allow states to develop new policies, programs and financing mechanisms addressing the health of children with ASD, which may also strengthen the system of care for all Children and Youth with Special Health Care Needs.

Transplantation hépatique : introduction en Suisse d'un nouveau système d'allocation des organes [Liver transplantation: new organ allocation system in Switzerland]

This article describes the new organ allocation system for liver transplantation introduced in Switzerland on July 1, 2007. In its newly adopted transplantation law, Switzerland chose the MELD score (Model for end-stage liver disease), based on three laboratory values: total bilirubin, serum creatinine and INR. Advantages and limitations of the MELD score are discussed. Finally the West Switzerland joint liver transplantation program is briefly introduced. Cet article décrit le nouveau système d'allocation des organes pour la transplantation hépatique, qui a été introduit en Suisse depuis le 1er juillet 2007. En se dotant d'une nouvelle loi sur la transplantation en 2007, la Suisse a en effet opté pour le score MELD (Model for end-stage liver disease), c'est-à-dire un score calculable à partir de trois valeurs de laboratoire : bilirubine totale, créatinine et INR. Les avantages du MELD, mais aussi quelques inconvénients potentiels, sont brièvement décrits. Afin de clarifier le parcours du patient pour lequel une évaluation prétransplantation hépatique spécialisée est indiquée, une brève description du programme romand de transplantation hépatique est présentée.

SIMSAFADIM-CLASTIC: A new approach to mathematical 3D forward simulation modelling for terrigenous and carbonate marine sedimentation

Most sedimentary modelling programs developed in recent years focus on either terrigenous or carbonate marine sedimentation. Nevertheless, only a few programs have attempted to consider mixed terrigenous-carbonate sedimentation, and most of these are two-dimensional, which is a major restriction since geological processes take place in 3D. This paper presents the basic concepts of a new 3D mathematical forward simulation model for clastic sediments, which was developed from SIMSAFADIM, a previous 3D carbonate sedimentation model. The new extended model, SIMSAFADIM-CLASTIC, simulates processes of autochthonous marine carbonate production and accumulation, together with clastic transport and sedimentation in three dimensions of both carbonate and terrigenous sediments. Other models and modelling strategies may also provide realistic and efficient tools for prediction of stratigraphic architecture and facies distribution of sedimentary deposits. However, SIMSAFADIM-CLASTIC becomes an innovative model that attempts to simulate different sediment types using a process-based approach, therefore being a useful tool for 3D prediction of stratigraphic architecture and facies distribution in sedimentary basins. This model is applied to the neogene Vallès-Penedès half-graben (western Mediterranean, NE Spain) to show the capacity of the program when applied to a realistic geologic situation involving interactions between terrigenous clastics and carbonate sediments.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

A LC-tandem MS assay for the simultaneous measurement of new antiretroviral agents: Raltegravir, maraviroc, darunavir, and etravirine.

Raltegravir (RAL), maraviroc (MVC), darunavir (DRV), and etravirine (ETV) are new antiretroviral agents with significant potential for drug interactions. This work describes a sensitive and accurate liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the determination of plasma drug levels. Single-step extraction of RAL, MVC, DRV, ETV and RTV from plasma (100 microl) is performed by protein precipitation using 600 microl of acetonitrile, after the addition of 100 microl darunavir-d(9) (DRV-d(9)) at 1000 ng/ml in MeOH/H(2)O 50/50 as internal standard (I.S.). The mixture is vortexed, sonicated for 10 min, vortex-mixed again and centrifuged. An aliquot of supernatant (150 microl) is diluted 1:1 with a mixture of 20 mM ammonium acetate/MeOH 40/60 and 10 microl is injected onto a 2.1 x 50 mm Waters Atlantis-dC18 3 microm analytical column. Chromatographic separations are performed using a gradient program with 2 mM ammonium acetate containing 0.1% formic acid and acetonitrile with 0.1% formic acid. Analytes quantification is performed by electrospray ionisation-triple quadrupole mass spectrometry using the selected reaction monitoring detection in the positive mode. The method has been validated over the clinically relevant concentrations ranging from 12.5 to 5000 ng/ml, 2.5 to 1000 ng/ml, 25 to 10,000 ng/ml, 10 to 4000 ng/ml, and 5 to 2000 ng/ml for RAL, MRV, DRV, ETV and RTV, respectively. The extraction recovery for all antiretroviral drugs is always above 91%. The method is precise, with mean inter-day CV% within 5.1-9.8%, and accurate (range of inter-day deviation from nominal values -3.3 to +5.1%). In addition our method enables the simultaneous assessment of raltegravir-glucuronide. This is the first analytical method allowing the simultaneous assay of antiretroviral agents targeted to four different steps of HIV replication. The proposed method is suitable for the Therapeutic Drug Monitoring Service of these new regimen combinations administered as salvage therapy to patients having experienced treatment failure, and for whom exposure, tolerance and adherence assessments are critical.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

Use of Longitudinal Subdrains in the 3R Program, Final Report, HR-509, 1981

Construction of the interstate highway system began in 1956. This U.S. network of highway consists of more than 41,000 miles with 790 miles in Iowa. There have been many benefits of the controlled access roadway, but probably the most significant is the improved safety for the motorist. In Iowa, we have always endeavored to utilize quality locally available materials in our construction using the most economical or cost effective methods. Obviously when the effort is to build a cost effective system, there will be some portions of the network that will not perform as well as expected. In the design of our interstate, the main consideration for base construction under the pavement was structural capacity. The material was dense graded with the aim of supporting the pavement and distributing the load as it is transferred to the underlying grade. The drainage characteristic of the base was apparently not given adequate consideration. On jointed portland cement concrete (pcc) pavement, the water that is trapped immediately beneath the pavement causes severe problems. The traffic causes rapid movement of the water resulting in the hydraulic pressures or "pumping" (movement and redeposit of base fine material) resulting in faulting between individual slabs. Recognizing the need for maintaining this large national highway network, the Federal Highway Administration has initiated a funding program for resurfacing, restoration and rehabilitation (3R). Many miles of the system are more than 20 years old and in need of major maintenance. This new 3R Program necessitated a complete inventory of the Iowa interstate system to establish priorities and to identify those sections in need of immediate remedial treatments.

2015-2019 Iowa Transportation Improvement Program

This document describes planned investments in Iowa's multimodal transportation system including aviation, transit, railroads, trails, and highways. A large part of funding available for highway programming comes from the federal government. Accurately estimating future federal funding levels is dependent on having a multiyear federal transportation authorization bill in place and having a sustainable and solvent federal Highway Trust Fund. The most recent federal authorization, Moving Ahead for Progress in the 21st Century (MAP-21), will expire September 30, 2014. At the same time that MAP-21 expires and absent Congressional action, the federal Highway Trust Fund will no longer be able to provide funding at current levels resulting in the full elimination of federal highway funding for new projects in federal fiscal year 2015. These two issues provide funding uncertainty with this program in fiscal years 2015 and beyond.

Issue review : projected impact of elimination of the Federal Family Education Loan Program.

The federal Health Care and Education Reconciliation Act of 2010 ended the Federal Family Education Loan Program, or FFELP, and no new FFELP loans will be issued after June 30, 2010. The Iowa College Student Aid Commission received approximately 14 million dollars of its 14.7 million dollar fiscal year 2010 administrative budget from the various fees associated with the FFELP program and services. With the cessation of FFELP loans, the commission project's revenues will decline, as the currently existing FFELP loans are paid off, beginning with a 2.7 million dollar decline in fiscal year 2011. This issue review examines the prison system fiscal year 2010 budget, including receipts and expenditures, average annual costs, personnel and inmate assaults.

Iowa Local Technical Assistance Program 2010 Summary Report and 2011 Continuation Funding Proposal, HR-296, 2010

This document includes a summary of the initiatives and activities that are ongoing or have been completed by the Iowa Local Technical Assistance Program (LTAP) in 2010. It also contains a request for the 2011 continuation of LTAP funding. A brief history of Iowa LTAP is below. In addition, its mission/vision and objectives are noted and an explanation of the new organization used for this report is provided. The remainder of this document includes a description of the Iowa LTAP operations in 2010 and 2011. More specifically, staffing changes and several major initiatives are presented. This is then followed by a discussion of task-by-task 2010 outcomes and proposed 2011 activities.

2016-2020 Iowa Transportation Improvement Program

This document describes planned investments in Iowa’s multimodal transportation system including aviation, transit, railroads, trails, and highways. This five-year program documents $3.2 billion of highway and bridge construction projects on the primary road system using federal and state funding. Of that funding, a little over $500 million is available due to the passage of Senate File 257 in February 2015. As required by Senate File 257, this program includes a list of the critical highway and bridge projects funded with the additional revenue. As with other recent programs, there continues to be uncertainty in federal funding for roads and bridges. The most recent federal authorization, Moving Ahead for Progress in the 21st Century (MAP-21), will expire July 31, 2015. At the same time that MAP-21 expires and absent Congressional action, the federal Highway Trust Fund will no longer be able to provide funding at current levels. This could result in reduced federal funding reimbursement for projects already underway and/or full elimination of federal highway funding for new projects in federal fiscal year 2016. These two issues provide funding uncertainty with this program in fiscal year 2016 and beyond.

Antiretroviral adherence program in HIV patients: a feasibility study in the Swiss HIV Cohort Study.

Objective To evaluate the feasibility of a comprehensive, interdisciplinary adherence program aimed at HIV patients. Setting Two centers of the Swiss HIV Cohort Study: Lausanne and Basel. Method 6-month, pilot, quasi-experimental, 2-arm design (control and intervention). Patients starting a first or second combined antiretroviral therapy line were invited to participate in the study. Patients entering the intervention arm were proposed a multifactorial intervention along with an electronic drug monitor. It consisted of a maximum of six 30-min sessions with the interventionist coinciding with routine HIV check-up. The sessions relied on individualized semi-structured motivational interviews. Patients in the control arm used directly blinded EDM and did not participate in motivational interviews. Main outcome measures Rate of patients' acceptance to take part in the HIV-adherence program and rate of patients' retention in this program assessed in both intervention and control groups. Persistence, execution and adherence. Results The study was feasible in one center but not in the other one. Hence, the control group previously planned in Basel was recruited in Lausanne. Inclusion rate was 84% (n = 21) in the intervention versus 52% (n = 11) in the control group (P = 0.027). Retention rate was 91% in the intervention versus 82% in the control group (P = ns). Regarding adherence, execution was high in both groups (97 vs. 95%). Interestingly, the statistical model showed that adherence decreased more quickly in the control versus the intervention group (interaction group × time P < 0.0001). Conclusion The encountered difficulties rely on the implementation, i.e., on the program and the health care system levels rather than on the patient level. Implementation needs to be evaluated further; to be feasible a new adherence program needs to fit into the daily routine of the centre and has to be supported by all trained healthcare providers. However, this study shows that patients' adherence behavior evolved differently in both groups; it decreased more quickly over time in the control than in the intervention group. RCTs are eventually needed to assess the clinical impact of such an adherence program and to verify whether skilled pharmacists can ensure continuity of care for HIV outpatients.

2009 Regional Ambient Fish Tissue Monitoring Program Summary of Analyses

To supplement other environmental monitoring programs and to protect the health of people consuming fish from waters within this state, the state of Iowa conducts fish tissue monitoring. Since 1980, the Iowa Department of Natural Resources (IDNR), the United States Environmental Protection Agency Region VII (U.S. EPA), and the University of Iowa Hygienic Laboratory (UHL) have cooperatively conducted annual statewide collections and analyses of fish for toxic contaminants. Beginning in 1983, this monitoring effort became known as the Regional Ambient Fish Tissue Monitoring Program (RAFT). Currently, the RAFT program is the only statewide fish contaminant-monitoring program in Iowa. Historically, the data generated from the RAFT program have enabled IDNR to document temporal changes in contaminant levels and to identify Iowa lakes and rivers where high levels of contaminants in fish potentially threaten the health of fish-consuming Iowans (see IDNR 2006). The Iowa RAFT monitoring program incorporates four different types of monitoring sites: 1) status, 2) trend, 3) random and 4) follow-up. New for 2009 was the one-time inclusion of snapping turtle tissue as part of the Iowa RAFT sampling program.