Endeavors Update, Iowa Medicaid Enterprise, September 2011

The Iowa Medicaid Enterprise (IME) is an endeavor, started in 2005, to unite State staff with “best of breed” contractors into a performance-based model for administration of the Medicaid program.

Endeavors Update, Iowa Medicaid Enterprise, October 2011

The Iowa Medicaid Enterprise (IME) is an endeavor, started in 2005, to unite State staff with “best of breed” contractors into a performance-based model for administration of the Medicaid program.

Endeavors Update, Iowa Medicaid Enterprise, November 2011

The Iowa Medicaid Enterprise (IME) is an endeavor, started in 2005, to unite State staff with “best of breed” contractors into a performance-based model for administration of the Medicaid program.

Endeavors Update, Iowa Medicaid Enterprise, December 2011

The Iowa Medicaid Enterprise (IME) is an endeavor, started in 2005, to unite State staff with “best of breed” contractors into a performance-based model for administration of the Medicaid program.

Endeavors Update, Iowa Medicaid Enterprise, January 2012

The Iowa Medicaid Enterprise (IME) is an endeavor, started in 2005, to unite State staff with “best of breed” contractors into a performance-based model for administration of the Medicaid program.

09008-005 Hewitt Creek Final Report

The primary goal of the Hewitt Creek watershed council is to have Hewitt-Hickory Creek removed from the Iowa impaired waters (303d) list. Hewitt Creek watershed, a livestock dense 23,005 acre sub-watershed of the Maquoketa River Basin, is 91.2% agricultural and 7.5% woodland. Since 2005, sixty-seven percent of 84 watershed farm operations participated in an organized watershed improvement effort using a performance­ based watershed management approach, reducing annual sediment delivery to the stream by 4,000 tons. Watershed residents realize that water quality improvement efforts require a long-term commitment in order to meet their watershed improvement goals and seek funding for an additional five years to continue their successful watershed improvement project. Cooperators will be provided incentives for improved environmental performance, along with incentives and technical support to address feedlot runoff issues and sub-surface nitrate-nitrogen loss. The Phosphorus Index, Soil Conditioning Index and cornstalk nitrate test will be used by producers as measures of performance to refine nutrient and soil loss management and to determine effective alternatives to reduce nutrient and sediment delivery. Twenty-five livestock operations will improve feedlot runoff control systems and five sub-surface bioreactors will be installed to reduce nitrate delivery from priority tile-drained fields. The Hewitt Creek council will seek additional cost-share funding for high-cost feedlot runoff control structures, sediment control basins and stream bank stabilization projects.

Endeavors Update, Iowa Medicaid Enterprise, February 2012

The Iowa Medicaid Enterprise (IME) is an endeavor, started in 2005, to unite State staff with “best of breed” contractors into a performance-based model for administration of the Medicaid program.

Endeavors Update, Iowa Medicaid Enterprise, April 2012

The Iowa Medicaid Enterprise (IME) is an endeavor, started in 2005, to unite State staff with “best of breed” contractors into a performance-based model for administration of the Medicaid program.

Endeavors Update, Iowa Medicaid Enterprise, May 2012

The Iowa Medicaid Enterprise (IME) is an endeavor, started in 2005, to unite State staff with “best of breed” contractors into a performance-based model for administration of the Medicaid program.

Endeavors Update, Iowa Medicaid Enterprise, July 2012

The Iowa Medicaid Enterprise (IME) is an endeavor, started in 2005, to unite State staff with “best of breed” contractors into a performance-based model for administration of the Medicaid program.

06012-006 Lime Creek NPS Project Final Report

Lime Creek is a sub-watershed of the Cedar River above; approximately 25 miles from Cedar Rapids. The lower half of the stream is on the Iowa 2004 Section 303(d) impaired waters list. Monitoring by the Cedar River Watershed Monitoring Coalition documents that Lime Creek delivers above average amounts of nitrate+ nitrite-N, ammonia-Nand total phosphorus (above the 901 percentile) compared to other Cedar River sub-watersheds. The Cedar Rapids water utility is concerned about increasing delivery of nitrate+nitrate to the Cedar River, which provides drinking water for about 125,000 people in the area. A group of local citizens has formed the Lime Creek watershed council with the goal of reducing pollutant delivery to the creek and promoting sustainable, watershed-wide action by producers, urban and rural residents for improved environmental management. The council has established a performance-based program that rewards cooperators for improvement in research-based test and index scores which directly measure environmental impact of BMPs. The Iowa Com Growers Association is funding the performance rewards. The Watershed Coalition is contributing in-kind monitoring. Council and performance cooperators participate primarily with commitment of their own resources. WIRB funds will be used to increase program cooperators and for staff support. In addition to improvement of water quality in Lime Creek, the project will establish baseline values for arket-based a pro ch to valuing pollutant reduction by intensive livestock operations in eastern Iowa.

06014-007 Lower Coldwater-Palmer Creek Watershed Final Report

Lower Coldwater and Palmer Creeks in Butler and Floyd counties are subwatersheds of the Cedar River, which provides drinking water to Cedar Rapids, IA. The increasing concentration of nitrate+nitrate in the river is of concern to the Cedar Rapids water utility, and IDNR snapshot monitoring shows Coldwater and Palmer to be significant potential sources (above the 90th percentile for subwatersheds monitored). Both creeks are also on the Iowa Section 303(d) list of impaired waters (aquatic life). Citizens of these predominantly agricultural watersheds organized the Coldwater-Palmer Watershed Improvement Association to deal proactively with nonpoint source pollutants from crop and livestock operations through a performance-based environmental management program. The locally-adapted program implemented by the Coldwater-Palmer watershed council rewards participants for environmental accomplishments - soil quality improvement and nutrient source reduction as measured by accepted, scientifically-based tests and models. Most of the locally­appropriate BMPs used to improve performance are undertaken voluntarily at participants' initiative. WIRB funds will be combined with funding from the Iowa Com Growers Association and significant in-kind support from the Cedar River Watershed Monitoring Coalition, Iowa State University Extension and other partners. The project will result in sustainable reduction in nutrient loading achieved with voluntary participation of a majority of watershed farm operators.

Early auditory processing

ABSTRACT (English)An accurate processing of the order between sensory events at the millisecond time scale is crucial for both sensori-motor and cognitive functions. Temporal order judgment (TOJ) tasks, is the ability of discriminating the order of presentation of several stimuli presented in a rapid succession. The aim of the present thesis is to further investigate the spatio-temporal brain mechanisms supporting TOJ. In three studies we focus on the dependency of TOJ accuracy on the brain states preceding the presentation of TOJ stimuli, the neural correlates of accurate vs. inaccurate TOJ and whether and how TOJ performance can be improved with training.In "Pre-stimulus beta oscillations within left posterior sylvian regions impact auditory temporal order judgment accuracy" (Bernasconi et al., 2011), we investigated if the brain activity immediately preceding the presentation of the stimuli modulates TOJ performance. By contrasting the electrophysiological activity before the stimulus presentation as a function of TOJ accuracy we observed a stronger pre-stimulus beta (20Hz) oscillatory activity within the left posterior sylvian region (PSR) before accurate than inaccurate TOJ trials.In "Interhemispheric coupling between the posterior sylvian regions impacts successful auditory temporal order judgment" (Bernasconi et al., 2010a), and "Plastic brain mechanisms for attaining auditory temporal order judgment proficiency" (Bernasconi et al., 2010b), we investigated the spatio-temporal brain dynamics underlying auditory TOJ. In both studies we observed a topographic modulation as a function of TOJ performance at ~40ms after the onset of the first sound, indicating the engagement of distinct configurations of intracranial generators. Source estimations in the first study revealed a bilateral PSR activity for both accurate and inaccurate TOJ trials. Moreover, activity within left, but not right, PSR correlated with TOJ performance. Source estimations in the second study revealed a training-induced left lateralization of the initial bilateral (i.e. PSR) brain response. Moreover, the activity within the left PSR region correlated with TOJ performance.Based on these results, we suggest that a "temporal stamp" is established within left PSR on the first sound within the pair at early stages (i.e. ~40ms) of cortical processes, but is critically modulated by inputs from right PSR (Bernasconi et al., 2010a; b). The "temporal stamp" on the first sound may be established via a sensory gating or prior entry mechanism.Behavioral and brain responses to identical stimuli can vary due to attention modulation, vary with experimental and task parameters or "internal noise". In a fourth experiment (Bernasconi et al., 2011b) we investigated where and when "neural noise" manifest during the stimulus processing. Contrasting the AEPs of identical sound perceived as High vs. Low pitch, a topographic modulation occurred at ca. 100ms after the onset of the sound. Source estimation revealed activity within regions compatible with pitch discrimination. Thus, we provided neurophysiological evidence for the variation in perception induced by "neural noise".ABSTRACT (French)Un traitement précis de l'ordre des événements sensoriels sur une échelle de temps de milliseconde est crucial pour les fonctions sensori-motrices et cognitives. Les tâches de jugement d'ordre temporel (JOT), consistant à présenter plusieurs stimuli en succession rapide, sont traditionnellement employées pour étudier les mécanismes neuronaux soutenant le traitement d'informations sensorielles qui varient rapidement. Le but de cette thèse est d'étudier le mécanisme cérébral soutenant JOT. Dans les trois études présentées nous nous sommes concentrés sur les états du cerveau précédant la présentation des stimuli de JOT, les bases neurales pour un JOT correct vs. incorrect et sur la possibilité et les moyens d'améliorer l'exécution du JOT grâce à un entraînement.Dans "Pre-stimulus beta oscillations within left posterior sylvian regions impact auditory temporal order judgment accuracy" (Bernasconi et al., 2011),, nous nous sommes intéressé à savoir si l'activité oscillatoire du cerveau au pré-stimulus modulait la performance du JOT. Nous avons contrasté l'activité électrophysiologique en fonction de la performance TOJ, mesurant une activité oscillatoire beta au pré-stimulus plus fort dans la région sylvian postérieure gauche (PSR) liée à un JOT correct.Dans "Interhemispheric coupling between the posterior sylvian regions impacts successful auditory temporal order judgment" (Bernasconi et al., 2010a), et "Plastic brain mechanisms for attaining auditory temporal order judgment proficiency" (Bernasconi et al., 2010b), nous avons étudié la dynamique spatio-temporelle dans le cerveau impliqué dans le traitement du JOT auditif. Dans ses deux études, nous avons observé une modulation topographique à ~40ms après le début du premier son, en fonction de la performance JOT, indiquant l'engagement des configurations de générateurs intra- crâniens distincts. La localisation de source dans la première étude indique une activité bilatérale de PSR pour des JOT corrects vs. incorrects. Par ailleurs, l'activité dans PSR gauche, mais pas dans le droit, est corrélée avec la performance du JOT. La localisation de source dans la deuxième étude indiquait une latéralisation gauche induite par l'entraînement d'une réponse initialement bilatérale du cerveau. D'ailleurs, l'activité dans la région PSR gauche corrèlait avec la performance de TOJ.Basé sur ces résultats, nous proposons qu'un « timbre-temporel » soit établi très tôt (c.-à-d. à ~40ms) sur le premier son par le PSR gauche, mais module par l'activité du PSR droite (Bernasconi et al., 2010a ; b). « Le timbre- temporel » sur le premier son peut être établi par le mécanisme neuronal de type « sensory gating » ou « prior entry ».Les réponses comportementales et du cerveau aux stimuli identiques peut varier du à des modulations d'attention ou à des variations dans les paramètres des tâches ou au bruit interne du cerveau. Dans une quatrième expérience (Bernasconi et al. 2011B), nous avons étudié où et quand le »bruit neuronal« se manifeste pendant le traitement des stimuli. En contrastant les AEPs de sons identiques perçus comme aigus vs. grave, nous avons mesuré une modulation topographique à env. 100ms après l'apparition du son. L'estimation de source a révélé une activité dans les régions compatibles avec la discrimination de fréquences. Ainsi, nous avons fourni des preuves neurophysiologiques de la variation de la perception induite par le «bruit neuronal».

Task-induced deactivation from rest extends beyond the default mode brain network

Activity decreases, or deactivations, of midline and parietal cortical brain regions are routinely observed in human functional neuroimaging studies that compare periods of task-based cognitive performance with passive states, such as rest. It is now widely held that such task-induced deactivations index a highly organized"default-mode network" (DMN): a large-scale brain system whose discovery has had broad implications in the study of human brain function and behavior. In this work, we show that common task-induced deactivations from rest also occur outside of the DMN as a function of increased task demand. Fifty healthy adult subjects performed two distinct functional magnetic resonance imaging tasks that were designed to reliably map deactivations from a resting baseline. As primary findings, increases in task demand consistently modulated the regional anatomy of DMN deactivation. At high levels of task demand, robust deactivation was observed in non-DMN regions, most notably, the posterior insular cortex. Deactivation of this region was directly implicated in a performance-based analysis of experienced task difficulty. Together, these findings suggest that task-induced deactivations from rest are not limited to the DMN and extend to brain regions typically associated with integrative sensory and interoceptive processes.

Puutavarakaupan jakelun nykytila ja kehittäminen pääkaupunkiseudulla

Työn tavoitteena oli kartoittaa kohdeyrityksen pääkaupunkiseudun puu- ja rakennustarvikekaupan jakelun nykytila ja kehittää toimipisteille uusi ja yhtenäinen jakelun toimintamalli. Ensin selvitettiin jakelun nykytila haastattelemalla kuljetuksista vastaavia henkilöitä. Kirjallisuudesta saadun tiedon avulla haettiin vaihtoehtoja uuden jakelumallin luomiselle. Yrityksen tietojärjestelmästä haettiin tietoa toteutuneista kuljetuskustannuksista ja -tapahtumista. Tutkimuksessa selvitettiin myös kuljetuskustannukset ja -tuotot. Tällä hetkellä yritys tekee jakelussa tappiota eli kuljetuskustannukset ovat asiakkailta perittyjä kuljetustuottoja suuremmat. Jokaisessa toimipisteessä kuljetukset hoidetaan itsenäisesti eikä yhteistä järjestelmää ole käytössä. Tästä aiheutuu päällekkäisiä ja turhia ajoja pääkaupunkiseudun alueella, mikä voitaisiin välttää yhteisellä toimintamallilla. Työssä luotiin erilaisia malleja ja niitä verrattiin nykytilanteeseen. Mallien paremmuuden arviointiin käytettiin kannattavuutta ja ulkoista tehokkuutta. Toimintavaihtoehdoiksi nousi kolme eri mallia. Vaihtoehtoina olivat toimipisteiden yhtenäinen malli, jossa ohjaus olisi joko omassa hallinnassa tai ulkoistettu, ja kolmantena vaihtoehtona olisi koko jakelun ulkoistaminen. Malleja varten kartoitettiin eri ohjelmistoja ja ulkoistuspalveluja tarjoavia yrityksiä, jotka olisivat yrityksen tarpeisiin soveltuvia. Toimenpide-ehdotuksina ja suosituksina esitetään yhteiseen jakelujärjestelmään siirtymistä sekä siirtymistä jakelun hinnoittelussa suoriteperusteiseen hinnoitteluun. Tulevaisuudessa jakelun tietoja tulisi kerätä ja tiedon karttuessa laatia suoriteperusteiset hinnoittelutaulukot kuljetuksille. Myös myyjille ja kuljetusvastaaville tarvitaan yhtenäiset toimintaohjeet tilausten muutoksista, kuljetusten hinnoittelusta ja toimituksista.