Iowa's Rural Alzheimer's Demonstration Project, July 1, 2004 - June 31, 2007

The Iowa Department of Elder Affairs, in collaboration with the Iowa Department of Elder Affairs (IDEA) and the University of Iowa College of Nursing (UI CON), has been engaged in developing and evaluating community based services for persons with dementia in the state of Iowa over the past 7 years under two grants form the Administration on Aging. In the current grant period, the involved agencies have completed a collaborative effort aimed to increase the capacity of Adult Day Health and Respite (ADR) providers in serving persons with dementia. Adult day services and respite care were identified by participants in the initial grant through various processes and service providers as important components of caring for persons with dementia and that there was a gap of these services in the state. Therefore, adult day and respite services were chosen as a target for the second AoA grant. The focus, in particular, was to enhance capacity to care for persons with later stages of the disease and those in rural settings as well as to begin to develop services that are more responsive to emerging minority populations. The process of the grant provided the state with a rich amount of information about the status of Iowa’s Adult Day Service providers in general and in regard to provision of dementia specific services, as well as valuable insights into the capability of rural communities to serve persons with dementia and their caregivers at home. Final Performance Report

Summary Report for the Iowa Alzheimer's Task Force 2007 from the Iowa Alzheimer's Disease Demonstration Projects

The Iowa Department of Elder Affairs, in collaboration with the University of Iowa College of Nursing, has been engaged in developing and evaluating community based services for persons with dementia in the state of Iowa over the past 7 years under a grant form the Administration on Aging. This grant tested out several models of care (dementia nurse care manager, memory loss nurse specialist, “People Living Alone Need Support” (PLANS), varying models of respite care), surveyed agencies and service providers in regard to how they provide services for persons with dementia, and provided training to case management, community college instructors, adult day service providers and other related services providers including assisted living and nursing home facilities.

Patients's satisfaction concerning postoperative analgesia after caesarean section: a comparison of 4 alternative analgesic regimen

Introduction: Different routes of postoperative analgesia may be used after cesarean section: systemic, spinal or epidural [1]. Although the efficacy of these alternative analgesic regimen has already been studied [2, 3], very few studies have compared patients' satisfaction between them. Methodology: After ethical committee acceptation, 100 ASA 1 patients scheduled for an elective cesarean section were randomized in 4 groups. After a standardized spinal anesthesia (hyperbaric bupivacaine 10 mg and fentanyl 20 μg), each group had a different postoperative analgesic regimen: - Group 1: oral paracetamol 4x1 g/24 h, oral ibuprofene 3x600 mg/24 h and subcutaneous morphine on need (0.1 mg/kg 6x/24 h) - Group 2: intrathecal morphine (100 μg) and then same as Group 1 - Group 3: oral paracetamol 4x1 g/24 h, oral ibuprofene 3x600 mg/24 h and PCEA with fentanyl 5 μg/ml epidural solution - Group 4: oral paracetamol 4x1g/24 h, oral ibuprofene 3x600 mg/ 24 h and PCEA with bupivacaine 0.1% and fentanyl 2 μg/ml epidural solution After 48 hours, a specific satisfaction questionnaire was given to all patients which permitted to obtain 2 different scores concerning postoperative analgesia: a global satisfaction score (0-10) and a detailed satisfaction score (5 questions scored 0-10 with a summative score of 0-50). Both scores, expressed as mean ± SD, were compared between the 4 groups with a Kruskall-Wallis test and between each group with a Mann-Whitney test. A P-value <0.05 was considered significant. Results: Satisfaction scores Gr. 1 (n = 25) Gr. 2 (n = 25) Gr. 3 (n = 25) Gr. 4 (n = 25) P-value global (0-10) 8.2 ± 1.2 9.0 ± 1.0 7.8 ± 2.1 6.5 ± 2.5 0.0006 detailed (0-50) 40 ± 6 43 ± 5 38 ± 6 34 ± 8 0.0002 Conclusion: Satisfaction scores were significantly better in patients who received a systemic postoperative analgesia only (Groups 1 and 2) compared to patients who received systemic and epidural postoperative analgesia (Groups 3 and 4). The best scores were achieved with the combination of intrathecal morphine and multimodal systemic analgesia (Group 2) which allowed early ambulation without significant pain. Patients treated with postoperative epidural analgesia with combined local anesthetics and opioids (Group 4) obtained the worse scores (more restrictive nursing with less mobility, frequent asymmetrical block with insufficient analgesia on one side and motor block on the other)

Development of a control alternative for the citrus fruit borer, Ecdytolopha aurantiana (Lepidoptera, Tortricidae): from basic research to the grower

All research steps, developed from 1995 to 2000, to synthesize the sex pheromone of Ecdytolopha aurantiana (Lima, 1927) are described, in order to monitoring this pest that causes losses in the order of 50 million dollars per year to citriculture in the State of São Paulo. The basic researches conducted are described, including the development of an artificial diet for the insect, the study of its temperature and humidity requirements, behavioral studies, and synthesis of the male-attracting substance up to the formulation and distribution of the pheromone to the grower, by means of its commercialization. It is a case of success, at a cost of 50 thousand dollars, involving inter- and multidisciplinary researches, which can be adopted to other insect pests in the country.

Improving Transition Outcomes: Community Demonstration Prototypes

Information on the Council Bluffs Youth Connections, Henry County Transition Partners, and CASE (Career And Self Awareness) community demonstration prototypes.

Improving Transition Outcomes: Announcement of Community Demonstration Prototypes

Announcement of the Improving Transition Outcomes Community Demonstration Prototypes with general information for each.

Improving Transition Outcomes: Announcement of Community Demonstration Prototypes #2

Announcement of the Improving Transition Outcomes Community Demonstration Prototypes with general information for each.

Improving Transition Outcomes: CASE (Career And Self Awareness) Prototype: Conference Demonstration

Promotional article recognizing a CASE (Career And Self Awareness) conference demonstration.

Locação: Critérios de decisão e de reconhecimento

Uma empresa pode alcançar bons resultados, se os gestores da mesma optarem pela melhor fonte de financiamento. Na qualidade de alternativa de financiamento, a locação financeira tem vindo a apresentar níveis de crescimentos bastante expressivas, tendo já sido adoptado por grande parte do tecido empresarial internacional, como meio privilegiado de financiamento de médio e longo prazo. Desta forma, o presente trabalho desenvolve o tema: “ Locação: Critérios de Decisão e de Reconhecimento”, focalizando na locação financeira enquanto alternativa de financiamento. Tendo como objectivo, demonstrar a utilização ou não da locação financeira como meio de financiamento e de apresentar os critérios para fundamentar tal decisão, foi feito um inquérito a algumas empresas no mercado em São Vicente. A apreciação das respostas obtidas e análise do inquérito levou à conclusão de que a locação financeira é uma actividade relativamente recente, sendo pouca explorada pelo tecido empresarial. O trabalho explora ainda uma dimensão contabilística das locações, relacionada com os processos de mensuração e reconhecimento no balanço e nas demonstrações de resultados. Para além disso, este trabalho vai mais adiante com um estudo de caso, utilizando como instrumento um contrato de locação financeira, para averiguar na prática qual o tratamento contabilístico atribuído a este tipo de contrato pelos intervenientes no contrato. O estudo de caso foi feito com base em documentos facultados por uma das empresas inquiridas no mercado em São Vicente, da qual por exigência da mesma garantimos a confidencialidade, utilizando assim um nome fictício “Alfa, S.A.”. Esperamos que este estudo exploratório seja útil e que contribua para o aumento do conhecimento teórico e prático sobre as locações, a todos os interessados nesta matéria. A company can get good results, if their managers, opt for the best financing source. In the quality of financing alternative, the financial lease has been demonstrating, growth levels quite expressive, having already been adopted for great part of the international business fabric, as a privilege way of financing of medium and long period. On this way, the present work develops the theme: “Lease: Criteria of decision and of the recognition” focusing in the financial lease while financing alternative. The goal is to demonstrate the use of the financial lease as a way of financing and of presenting the criteria to base such decision, it was made an inquiry to some companies in São Vicente market. The appreciation of the obtained answers and the analyzes of such inquiry took the conclusion that the financial lease is an activity relatively recent, being little explored by the business fabric. This work explores also a accountant dimension of the related leases with the mensuration processes and of recognition of the swinging and in the demonstration of results. Besides, this work is going further on with a case study, using as instrument a contract of financial lease to inquire in practice which is the accounting treatment attributed to this type of contract by the intervening in the contact. The study case was done with base in documents allowed by one of the companies inquired in São Vicente, of which we guaranteed the confidentiality for demand of the same, using as a fictitious the name “Alfa, S.A.” We hoped that this exploratory study is useful and that it contributes to the increase of the theoretical knowledge and practice on the leases, to all the interested in this matter.

Revue des arthroplasties totales de la hanche et du genou infectées--à propos de 28 cas [Review of infected total arthroplasties of the hip and knee--apropos of 28 cases]

This study is a long-term analysis of a group of patients with infected arthroplasties of the hip or the knee. We identified 28 patients with an infected arthroplasty (22 hips, 6 knees) documented by bacterial culture or on direct examination. At the time of diagnosis and on follow-up (a mean of 46 months after treatment) we evaluated the clinical picture, the radiological appearances of the articulation and the biological parameters. 19/28 patients showed a typical clinical picture, whereas in 9 others the picture was more doubtful. The treatments were 14 two-stage replacements of the arthroplasties, 7 simple resections, 5 conservative treatments and 2 one-stage replacements. On follow-up, 25 patients were considered as cured of their infection and 3 as failures. From a functional viewpoint, 9 patients showed no limitation, whereas 19 were limited in the daily activity. Half of the patients had no pain. Radiology showed that 20/26 evaluated patients had no signs of recurrence. Paraclinical examinations are important in the diagnosis of persistent low grade infections, particularly the demonstration of bacteria by pre-surgical sampling (fine needle aspiration, culture from draining sinuses). In spite of the cure of infection, the functional and painful sequellae are often considerable. As a result of our experience, we recommend a two-stage surgical procedure. Only when the general condition of the patient is poor, or when the infection is not under control, would we envisage an alternative procedure (arthrodesis, girdelstone, conservative).

A new alternative method for testing skin irritation using a human skin model: a pilot study.

Studies assessing skin irritation to chemicals have traditionally used laboratory animals; however, such methods are questionable regarding their relevance for humans. New in vitro methods have been validated, such as the reconstructed human epidermis (RHE) model (Episkin®, Epiderm®). The comparison (accuracy) with in vivo results such as the 4-h human patch test (HPT) is 76% at best (Epiderm®). There is a need to develop an in vitro method that better simulates the anatomo-pathological changes encountered in vivo. To develop an in vitro method to determine skin irritation using human viable skin through histopathology, and compare the results of 4 tested substances to the main in vitro methods and in vivo animal method (Draize test). Human skin removed during surgery was dermatomed and mounted on an in vitro flow-through diffusion cell system. Ten chemicals with known non-irritant (heptylbutyrate, hexylsalicylate, butylmethacrylate, isoproturon, bentazon, DEHP and methylisothiazolinone (MI)) and irritant properties (folpet, 1-bromohexane and methylchloroisothiazolinone (MCI/MI)), a negative control (sodiumchloride) and a positive control (sodiumlaurylsulphate) were applied. The skin was exposed at least for 4h. Histopathology was performed to investigate irritation signs (spongiosis, necrosis, vacuolization). We obtained 100% accuracy with the HPT model; 75% with the RHE models and 50% with the Draize test for 4 tested substances. The coefficients of variation (CV) between our three test batches were <0.1, showing good reproducibility. Furthermore, we reported objectively histopathological irritation signs (irritation scale): strong (folpet), significant (1-bromohexane), slight (MCI/MI at 750/250ppm) and none (isoproturon, bentazon, DEHP and MI). This new in vitro test method presented effective results for the tested chemicals. It should be further validated using a greater number of substances; and tested in different laboratories in order to suitably evaluate reproducibility.

First observation of alternative food usage (extrafloral nectar) by the assassin bug Atopozelus opsimus (Hemiptera, Reduviidae)

Assassin bugs (Reduviidae) are voracious insects that prey on other arthropods. Recent evidences have pointed out that these predators also feed on plant derived substances in rare opportunities. The present study describes the feeding behavior of the reduviid Atopozelus opsimus on extrafloral nectaries of Inga vera (Fabaceae) in a Neotropical savanna area. It was investigated if the insects feed more frequently of extrafloral nectar or prey, and if individuals of different stages of development vary according to feeding behavior. Notably, the results suggest that the diet of all instars and adults consist mainly of extrafloral nectar (N = 1013), in detriment of captured prey ingestion (N = 18). Also, there was no variation on feeding behavior and life stage.