Improving Safety for Slow Moving Vehicles on Iowa's High-Speed Rural Roadways, TR-572, 2009

Among the variety of road users and vehicle types that travel on U.S. public roadways, slow moving vehicles (SMVs) present unique safety and operations issues. SMVs include vehicles that do not maintain a constant speed of 25 mph, such as large farm equipment, construction vehicles, or horse-drawn buggies. Though the number of crashes involving SMVs is relatively small, SMV crashes tend to be severe. Additionally, SMVs can be encountered regularly on non-Interstate/non-expressway public roadways, but motorists may not be accustomed to these vehicles. This project was designed to improve transportation safety for SMVs on Iowa’s public roadway system. This report includes a literature review that shows various SMV statistics and laws across the United States, a crash study based on three years of Iowa SMV crash data, and recommendations from the SMV community.

Troponin-based risk stratification of patients with acute nonmassive pulmonary embolism: systematic review and metaanalysis.

BACKGROUND: Controversy exists regarding the usefulness of troponin testing for the risk stratification of patients with acute pulmonary embolism (PE). We conducted an updated systematic review and a metaanalysis of troponin-based risk stratification of normotensive patients with acute symptomatic PE. The sources of our data were publications listed in Medline and Embase from 1980 through April 2008 and a review of cited references in those publications. METHODS: We included all studies that estimated the relation between troponin levels and the incidence of all-cause mortality in normotensive patients with acute symptomatic PE. Two reviewers independently abstracted data and assessed study quality. From the literature search, 596 publications were screened. Nine studies that consisted of 1,366 normotensive patients with acute symptomatic PE were deemed eligible. Pooled results showed that elevated troponin levels were associated with a 4.26-fold increased odds of overall mortality (95% CI, 2.13 to 8.50; heterogeneity chi(2) = 12.64; degrees of freedom = 8; p = 0.125). Summary receiver operating characteristic curve analysis showed a relationship between the sensitivity and specificity of troponin levels to predict overall mortality (Spearman rank correlation coefficient = 0.68; p = 0.046). Pooled likelihood ratios (LRs) were not extreme (negative LR, 0.59 [95% CI, 0.39 to 0.88]; positive LR, 2.26 [95% CI, 1.66 to 3.07]). The Begg rank correlation method did not detect evidence of publication bias. CONCLUSIONS: The results of this metaanalysis indicate that elevated troponin levels do not adequately discern normotensive patients with acute symptomatic PE who are at high risk for death from those who are at low risk for death.

Iowa Child Advocacy Board Annual Report, 2009

The Iowa Child Advocacy Board (ICAB) is an independent board composed of nine members appointed by the Governor of Iowa and confirmed by the Iowa Senate. ICAB establishes policies and procedures for two volunteer child advocacy programs: the Court Appointed Special Advocate (CASA) program and the Iowa Citizen Foster Care Review Boards programs.

What impact do systemically administrated bisphosphonates have on oral implant therapy? A systematic review.

OBJECTIVES: The aim of this systematic review is to evaluate, analysing the dental literature, whether: * Patients on intravenous (IV) or oral bisphosphonates (BPs) can receive oral implant therapy and what could be the risk of developing bisphosphonate-related osteonecrosis of the jaw (BRONJ)? * Osseointegrated implants could be affected by BP therapy. MATERIAL AND METHODS: A Medline search was conducted and all publications fulfilling the inclusion and exclusion criteria from 1966 until December 2008 were included in the review. Moreover, the Cochrane Data Base of Systematic Reviews, and the Cochrane Central Register of Controlled Trials and EMBASE (from 1980 to December 2008) were searched for English-language articles published between 1966 and 2008. Literature search was completed by a hand research accessing the references cited in all identified publications. RESULTS: The literature search rendered only one prospective and three retrospective studies. The prospective controlled non-randomized clinical study followed patients with and without BP medication up to 36 months after implant therapy. The patients in the experimental group had been on oral BPs before implant therapy for periods ranging between 1 and 4 years. None of the patients developed BRONJ and implant outcome was not affected by the BP medication. The three selected retrospective studies (two case-controls and one case series) yielded very similar results. All have followed patients on oral BPs after implant therapy, with follow-up ranging between 2 and 4 years. BRONJ was never reported and implant survival rates ranged between 95% and 100%. The literature search on BRONJ including guidelines and recommendations found 59 papers, from which six were retrieved. Among the guidelines, there is a consensus on contraindicating implants in cancer patients under IV-BPs and not contraindicating dental implants in patients under oral-BPs for osteoporosis. CONCLUSIONS: From the analysis of the one prospective and the three retrospective series (217 patients), the placement of an implant may be considered a safe procedure in patients taking oral BPs for <5 years with regard to the occurrence of BRONJ since in these studies no BRONJ has been reported. Moreover, the intake of oral-BPs did not influence short-term (1-4 years) implant survival rates.

Annual Infrastructure Report 2009, January 25, 2010

Major maintenance; health, safety, loss of use; and Americans with Disabilities Act deficiencies at the Capitol Complex and statewide for twelve agencies and divisions participating in the Vertical Infrastructure Program in collaboration with the Governor's Vertical Infrastructure Advisory Committee, including the Department of Administrative Services; the Department of Commerce, Alcoholic Beverages Division; the Department of Corrections; the Department of Cultural Affairs; the Department of Education, including Iowa Public Television and Iowa Vocational Rehabilitation Services; the Department of Human Services; Iowa Law Enforcement Academy; the Department of Public Safety; Terrace Hill; Iowa Veterans Home and Iowa Workforce Development. The advisory committee meets on a monthly basis to review the progress of the work and to make recommendations on procedures and priorities. Additional information on major maintenance projects is available in the advisory committee's Tenth Annual Report to the Governor, dated December 15, 2008.

Efficacity of in-hospital multidimensional interventions of secondary prevention after acute coronary syndrome : a systematic review and meta-analysis

RAPPORT DE SYNTHÈSE : Contexte Les programmes de prévention cardiovasculaire secondaire après un événement coronarien aigu ont pu démontrer leur efficacité dans le contexte des soins ambulatoires. L'hospitalisation pour une maladie aiguë peut être considérée comme un «instant charnière», particulièrement adapté à un changement de comportement de santé et où des interventions de prévention secondaire, telle l'éducation du patient, pourraient être particulièrement efficaces. De plus, la prescription de médicaments de prévention cardiovasculaire durant l'hospitalisation semble augmenter la proportion des patients traités selon les recommandations sur le long terme. Récemment, plusieurs études ont évalué l'efficacité de programmes de prévention ayant pour but l'éducation des patients et/ou une augmentation du taux de prescription de médicaments prouvés efficaces par les médecins en charge. L'article faisant l'objet du travail de thèse synthétise la littérature existante concernant l'efficacité en termes de mortalité des interventions multidimensionnelles de prévention cardiovasculaire après un syndrome coronarien aigu, débutées à l'hôpital, centrées sur le patient et ciblant plusieurs facteurs de risque cardiovasculaire. MÉTHODE ET RÉSULTATS : En utilisant une stratégie de recherche définie à l'avance, nous avons inclus des essais cliniques avec groupe contrôle et des études avant-après, débutées à l'hôpital et qui incluaient des résultats cliniques de suivi en terme de mortalité, de taux de réadmission et/ou de récidive de syndrome coronarien aigu. Nous avons catégorisé les études selon qu'elles ciblaient les patients (par exemple une intervention d'éducation aux patients par des infirmières), les soignants (par exemple des cours destinés aux médecins-assistants pour leur enseigner comment prodiguer des interventions éducatives) ou le système de soins (par exemple la mise en place d'itinéraires cliniques au niveau de l'institution). Globalement, les interventions rapportées dans les 14 études répondant aux critères montraient une réduction du risque relatif (RR) de mortalité après un an (RR= 0.79; 95% intervalle de confiance (IC), 0.69-0.92; n=37'585). Cependant, le bénéfice semblait dépendre du type d'étude et du niveau d'intervention. Les études avant-après suggéraient une réduction du risque de mortalité (RR, 0.77; 95% IC, 0.66-0.90; n=3680 décès), tandis que le RR était de 0.96 (95% IC, 0.64-1.44; n=99 décès) pour les études cliniques contrôlées. Seules les études avant-après et les études ciblant les soignants et le système, en plus de cibler les patients, semblaient montrer un bénéfice en termes de mortalité à une année. CONCLUSIONS ET PERSPECTIVES : Les preuves d'efficacité des interventions de prévention secondaires débutées à l'hôpital, ciblant le patient, sont prometteuses, mais pas définitives. En effet, seules les études avant-après montrent un bénéfice en termes de mortalité. Les recherches futures dans ce domaine devraient tester formellement quels éléments des interventions amènent le plus de bénéfices pour les patients.

Publication bias in animal research: a systematic review protocol.

BACKGROUND: Systematic reviews and meta-analyses of pre-clinical studies, in vivo animal experiments in particular, can influence clinical care. Publication bias is one of the major threats of validity in systematic reviews and meta-analyses. Previous empirical studies suggested that systematic reviews and meta-analyses have become more prevalent until 2010 and found evidence for compromised methodological rigor with a trend towards improvement. We aim to comprehensively summarize and update the evidence base on systematic reviews and meta-analyses of animal studies, their methodological quality and assessment of publication bias in particular. METHODS/DESIGN: The objectives of this systematic review are as follows: âeuro¢To investigate the epidemiology of published systematic reviews of animal studies until present. âeuro¢To examine methodological features of systematic reviews and meta-analyses of animal studies with special attention to the assessment of publication bias. âeuro¢To investigate the influence of systematic reviews of animal studies on clinical research by examining citations of the systematic reviews by clinical studies. Eligible studies for this systematic review constitute systematic reviews and meta-analyses that summarize in vivo animal experiments with the purpose of reviewing animal evidence to inform human health. We will exclude genome-wide association studies and animal experiments with the main purpose to learn more about fundamental biology, physical functioning or behavior. In addition to the inclusion of systematic reviews and meta-analyses identified by other empirical studies, we will systematically search Ovid Medline, Embase, ToxNet, and ScienceDirect from 2009 to January 2013 for further eligible studies without language restrictions. Two reviewers working independently will assess titles, abstracts, and full texts for eligibility and extract relevant data from included studies. Data reporting will involve a descriptive summary of meta-analyses and systematic reviews. DISCUSSION: Results are expected to be publicly available later in 2013 and may form the basis for recommendations to improve the quality of systematic reviews and meta-analyses of animal studies and their use with respect to clinical care.

Clinicopathological features of eyelid skin tumors. A retrospective study of 5504 cases and review of literature.

Eyelid tumors are the most common neoplasm in daily ophthalmology practice and encompass a wide variety of benign and malignant tumors. In this retrospective study, we report the clinical and histological features of 5504 eyelid skin tumors diagnosed at the Laboratory of Ophthalmopathology of the Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland, between January 1989 and December 2007. Benign tumors largely predominated over malignant ones, representing 84% of cases in this series, and the 5 most frequent subtypes were squamous cell papilloma (26%), seborrheic keratosis (21%), melanocytic nevus (20%), hidrocystoma (8%), and xanthoma/xanthelasma (6%). Basal cell carcinoma was the most frequent malignant tumor (86%), followed by squamous cell carcinoma (7%) and sebaceous carcinoma (3%). For several tumor subtypes, there was a poor correlation between clinical and histological diagnosis, stressing the numerous pitfalls in the diagnosis of eyelid tumors. We further discuss our results with reference to previously published series.

Effectiveness of Dynamic Messaging on Driver Behavior for Late Merge Lane Road Closures, 2009

Efforts to improve safety and traffic flow through merge areas on high volume/high speed roadways have included early merge and late merge concepts and several studies of the effectiveness of these concepts, many using Intelligent Transportation Systems for implementation. The Iowa Department of Transportation (Iowa DOT) planned to employ a system of dynamic message signs (DMS) to enhance standard temporary traffic control for lane closures and traffic merges at two bridge construction projects in western Iowa (Adair County and Cass County counties) on I-80 during the 2008 construction season. To evaluate the DMS system’s effectiveness for impacting driver merging actions, the Iowa DOT contracted with Iowa State University’s Center for Transportation Research and Education to perform the evaluation and make recommendations for future use of this system based on the results. Data were collected over four weekends, beginning August 1–4 and ending October 16–20, 2008. Two weekends yielded sufficient data for evaluation, one of transition traffic flow and the other with a period of congestion. For both of these periods, a statistical review of collected data did not indicate a significant impact on driver merging actions when the DMS messaging was activated as compared to free flow conditions with no messaging. Collection of relevant project data proved to be problematic for several reasons. In addition to personnel safety issues associated with the placement and retrieval of counting devices on a high speed roadway, unsatisfactory equipment performance and insufficient congestion to activate the DMS messaging hampered efforts. A review of the data that was collected revealed different results taken by the tube counters compared to the older model plate counters. Although variations were not significant from a practical standpoint, a statistical evaluation showed that the data, including volumes, speeds, and classifications from the two sources were not comparable at a 95% level of confidence. Comparison of data from the Iowa DOT’s automated traffic recorders (ATRs) in the area also suggested variations in results from these data collection systems. Additional comparison studies were recommended.

Electronic Construction Collaboration - Phase 1, 2009

Bridge construction projects are becoming increasingly complex as the demand for context-sensitive solutions, aesthetic designs, and accelerated bridge construction becomes more prevalent. In addition, the Iowa Department of Transportation (Iowa DOT) is entering a phase of design and construction of large border bridges, such as the I-80 (let 2008 for $56 million) and US 34 bridges over the Missouri River and I-74 over the Mississippi River. Compared to typical construction projects, these bridges generate more contractor Requests for Information (RFIs), Value Engineering (VE) proposals, Requests for Changes (RFCs), and shop drawings. Management of these submittals is a significant challenge for Resident Construction Engineers (RCEs) and other Iowa DOT staff. In addition, some submittals require cross-departmental and project consultant reviews. Commercially available software exists for managing submittals and project collaboration teams; in-house solutions may also be possible. Implementation is intended to speed construction submittal review time, reduce incidence of delay claims, and free up Iowa DOT staff from project management administrative tasks. Researchers from Iowa State University working with the Iowa DOT conducted a multi-pronged approach to indentify a web-based collaboration solution for Iowa DOT bridge projects. An investigation was launched to determine the functional needs of the Iowa DOT. Commercially available software programs were also evaluated to find what functionality is currently available. A Request for Proposals (RFP) was written to select a commercial web-based collaboration solution for pilot testing. In the second phase of research, a solution will be selected and implemented on two pilot projects. Lessons learned from these pilot projects will assist the Iowa DOT in developing and implementing a long-term solution to improve the management of Iowa DOT bridge projects.

Road Safety Audit for County Road X-37, from the Intersection of G-62 to the East Corporate Limits of Columbus City in Louisa County, Iowa, 2009

A road safety audit was conducted for a 7.75 mile section of County Road X-37 in Louisa County, Iowa. In 2006, the average annual daily traffic on this roadway was found to be 680 vehicles per day. Using crash data from 2001 to 2007, the Iowa Department of Transportation (Iowa DOT) has identified this roadway as being in the highest 5% of local rural roads in Iowa for single-vehicle runoff- road crashes. Considering these safety data, the Louisa County Engineer requested that a road safety audit be conducted to identify areas of safety concerns and recommend low-cost mitigation to address those concerns. Staff and officials from the Iowa DOT, Governor’s Traffic Safety Bureau, Federal Highway Administration, Institute for Transportation, and local law enforcement and transportation agencies met to review crash data and discuss potential safety improvements to this segment of X-37. This report outlines the findings and recommendations of the road safety audit team to address the safety concerns on this X-37 corridor and explain several selected mitigation strategies.

Road Safety Audit for County Road W-55 in Washington County, Iowa, 2009

A road safety audit was conducted for a seven-mile section of County Road W-55 in Washington County, Iowa. In 2006, the average annual daily traffic on this roadway was found to be 1,290 vehicles per day. Using crash data from 2001 to 2007, the Iowa Department of Transportation (Iowa DOT) has identified this roadway as being in the top 5% of Iowa secondary rural roads with the highest density of serious (fatal and major injury) crashes for single-vehicle run-off-road incidents. Considering these safety data, the Washington County Engineer requested that a road safety audit be conducted to identify areas with safety concerns and to recommend low-cost mitigation to address those concerns. Staff and officials from the Iowa DOT, Iowa State Patrol, Governor’s Traffic Safety Bureau, Federal Highway Administration, Institute for Transportation, and local law enforcement and transportation agencies met to review crash data and discuss potential safety improvements to this segment of W-55. This report outlines the findings and recommendations of the road safety audit team to address the safety concerns on this W-55 corridor and explain several selected mitigation strategies.

Road Safety Audit for I-380 through the Cities of Cedar Rapids and Hiawatha in Linn County, Iowa, 2009

Interstate 380 (I-380) through Cedar Rapids and Hiawatha, Iowa, is a multilane divided urban freeway that was constructed in 1976 to the Cedar River and in 1981 from that point northerly. Traffic volumes vary from 47,000 to 83,500 vehicles per day, with about 8%–15% trucks and buses. Based on concern for the high number of crash incidents, particularly serious crashes, and increased traffic volumes on this roadway, the City of Cedar Rapids and the Iowa Department of Transportation (Iowa DOT) District 6 Office requested that a road safety audit be conducted for this roadway section. Representatives from the Iowa DOT, Federal Highway Administration, Center for Transportation Research and Education, local law enforcement, local government, and area businesses met to review crash data and discuss potential safety improvements to this segment of I-380. This report outlines the findings and recommendations of the road safety audit team for addressing the safety concerns on this I-380 corridor and explains several selected mitigation strategies.

Review of CT features of saprophytic aspergillosis (Aspergilloma) and correlation with final diagnosis : P21

Purpose: 1. To review Ct features suggestive of saprophytic aspergillosis (aspergilloma) and to correlate them with the final pathological results. 2. To illustrate the wide range of differential diagnosis. Methods and materials: The electronic database of our department from 1995 to 2007 revealed CT reports of 48 patients that had been considered very suggestive of aspergilloma. Two radiologists with 6 and 12 years experience in thoracic radiology jointly reviewed the corresponding CT features including ancillary findings and the underlying lung diseases and correlated them with the final pathological diagnosis. Results: Forty patients could be included in the study (12 women, mean age 52), while in 8 patients there was no adequate clinical follow-up. In 17 patients the diagnosis "mycetoma" due to aspergillus fumigatus infection was confirmed, either by surgery, biopsy or bronchoscopy. In 23 patients, differential diagnoses were found, such as cavitating bronchial carcinoma (n = 7), bacterial abscess (n = 3), typical (n = 2) and atypical (n = 2) tuberculosis, as well as inflammatory changes due to mucoviscidosis (n = 1), Wegener's disease (n = 1) or chronic obstructive pulmonary disease (n = 3). Fibromyxoide hamartoma, lung infarction and bronchomucocele were responsible for the typical CT feature in one patient each. Conclusion: 1. The typical CT feature suggesting mycetoma is softtissue proliferation within a pre-existing wall-thickened lung cavity, oten even considered "pathognomonic". However, this diagnosis was finally confirmed by surgery or laboratory findings in less than 50% of patients only. 2. Since differential diagnoses are very large, not only including cavitating lung cancer and tuberculosis, the individual underlying lung disease needs strongly being taken into account often giving the best clue for the correct diagnosis.

Efficacy and safety of aripiprazole in the treatment of bipolar disorder: a systematic review.

Abstract BACKGROUND: The current article is a systematic review concerning the efficacy and safety of aripiprazole in the treatment of bipolar disorder. METHODS: A systematic Medline and repositories search concerning the usefulness of aripiprazole in bipolar disorder was performed, with the combination of the words 'aripiprazole' and 'bipolar'. RESULTS: The search returned 184 articles and was last updated on 15 April 2009. An additional search included repositories of clinical trials and previous systematic reviews specifically in order to trace unpublished trials. There were seven placebo-controlled randomised controlled trials (RCTs), six with comparator studies and one with add-on studies. They assessed the usefulness of aripiprazole in acute mania, acute bipolar depression and during the maintenance phase in comparison to placebo, lithium or haloperidol. CONCLUSION: Aripiprazole appears effective for the treatment and prophylaxis against mania. The data on bipolar depression are so far negative, however there is a need for further study at lower dosages. The most frequent adverse effects are extrapyramidal signs and symptoms, especially akathisia, without any significant weight gain, hyperprolactinaemia or laboratory test changes.