Report on a special investigation of the Eastern Iowa Center for Problem Gambling for the period May 1, 2007 through April 30, 2009

Report on a special investigation of the Eastern Iowa Center for Problem Gambling for the period May 1, 2007 through April 30, 2009

Report on the Iowa Department of Human Services – Central Distribution Center for the year ended June 30, 2010

Report on the Iowa Department of Human Services – Central Distribution Center for the year ended June 30, 2010

Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease a systematic review and meta-analysis of comparative studies.

OBJECTIVES: The purpose of this study was to determine whether thoracic endovascular aortic repair (TEVAR) reduces death and morbidity compared with open surgical repair for descending thoracic aortic disease. BACKGROUND: The role of TEVAR versus open surgery remains unclear. Metaregression can be used to maximally inform adoption of new technologies by utilizing evidence from existing trials. METHODS: Data from comparative studies of TEVAR versus open repair of the descending aorta were combined through meta-analysis. Metaregression was performed to account for baseline risk factor imbalances, study design, and thoracic pathology. Due to significant heterogeneity, registry data were analyzed separately from comparative studies. RESULTS: Forty-two nonrandomized studies involving 5,888 patients were included (38 comparative studies, 4 registries). Patient characteristics were balanced except for age, as TEVAR patients were usually older than open surgery patients (p = 0.001). Registry data suggested overall perioperative complications were reduced. In comparative studies, all-cause mortality at 30 days (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.33 to 0.59) and paraplegia (OR: 0.42, 95% CI: 0.28 to 0.63) were reduced for TEVAR versus open surgery. In addition, cardiac complications, transfusions, reoperation for bleeding, renal dysfunction, pneumonia, and length of stay were reduced. There was no significant difference in stroke, myocardial infarction, aortic reintervention, and mortality beyond 1 year. Metaregression to adjust for age imbalance, study design, and pathology did not materially change the results. CONCLUSIONS: Current data from nonrandomized studies suggest that TEVAR may reduce early death, paraplegia, renal insufficiency, transfusions, reoperation for bleeding, cardiac complications, pneumonia, and length of stay compared with open surgery. Sustained benefits on survival have not been proven.

Special investigation of the Glenwood Resource Center Client Activity Clearing Account for the period January 1, 2009 through June 30, 2010

Special investigation of the Glenwood Resource Center Client Activity Clearing Account for the period January 1, 2009 through June 30, 2010

Healthcare utilization of elderly persons hospitalized after a noninjurious fall in a Swiss academic medical center.

OBJECTIVES: To determine the risk of hospital readmission, nursing home admission, and death, as well as health services utilization over a 6-month follow-up, in community-dwelling elderly persons hospitalized after a noninjurious fall. DESIGN: Prospective cohort study with 6-month follow-up. SETTING: Swiss academic medical center. PARTICIPANTS: Six hundred ninety persons aged 75 and older hospitalized through the emergency department. MEASUREMENTS: Data on demographics and medical, physical, social, and mental status were collected upon admission. Follow-up data were collected from the state centralized billing system (hospital and nursing home admission) and proxies (death). RESULTS: Seventy patients (10%) were hospitalized after a noninjurious fall. Fallers had shorter hospital stays (median 4 vs 8 days, P<.001) and were more frequently discharged to rehabilitation or respite care than nonfallers. During follow-up, fallers were more likely to be institutionalized (adjusted hazard ratio=1.82, 95% confidence interval=1.03-3.19, P=.04) independent of comorbidity and functional and mental status. Overall institutional costs (averaged per day of follow-up) were similar for both groups ($138.5 vs $148.7, P=.66), but fallers had lower hospital costs and significantly higher rehabilitation and long-term care costs ($55.5 vs $24.1, P<.001), even after adjustment for comorbidity, living situation, and functional and cognitive status. CONCLUSION: Elderly patients hospitalized after a noninjurious fall were twice as likely to be institutionalized as those admitted for other medical conditions and had higher intermediate and long-term care services utilization during follow-up, independent of functional and health status. These results provide direction for interventions needed to delay or prevent institutionalization and reduce subsequent costs.

Agreed-upon procedures report on the Iowa State Center Business Office of Iowa State University of Science and Technology for the year ended June 30, 2011

Agreed-upon procedures report on the Iowa State Center Business Office of Iowa State University of Science and Technology for the year ended June 30, 2011

Handbook of Simplified Practice for Traffic Studies, November 2002

The Iowa Highway Research Board has identified the development of a simplified handbook of transportation studies as a high priority for the state of Iowa. The Center for Transportation Research and Education (CTRE) at Iowa State University was chosen to develop such a handbook. A well-executed, well-documented study is critical in the decision-making process for many transportation-related projects and in reporting to elected officials and members of the community. As more research is conducted in the area of transportation, study procedures in many cases have become more complex. It is often difficult for local jurisdictions with limited staff, training, experience, and time availability to perform these studies. The most commonly used publication for traffic studies is geared toward transportation professionals and professional engineers. That defining document, Manual of Transportation Studies (Institute of Transportation Engineers, 2000), is over 500 pages and includes several dozen types of transportation studies. Many of the transportation studies described in the manual are rarely (if ever) used by local jurisdictions. Further, those studies that are frequently used are at times very complex and possibly very costly to perform exactly as described. Local jurisdictions without the staff expertise to understand and apply the manual’s various studies have a need for a simplified handbook of procedures to perform common traffic studies themselves or properly define a scope of work to hire a consultant to perform the studies. This handbook describes simplified procedures that are easy to apply and are written for all potential users (civil engineers and traffic engineers, public works mangers, city managers and attorneys, and the general public).

Eight years experience from a skeletal dysplasia referral center in a tertiary hospital in Southern India: A model for the diagnosis and treatment of rare diseases in a developing country.

We report on a series of 514 consecutive diagnoses of skeletal dysplasia made over an 8-year period at a tertiary hospital in Kerala, India. The most common diagnostic groups were dysostosis multiplex group (n = 73) followed by FGFR3 (n = 49) and osteogenesis imperfecta and decreased bone density group (n = 41). Molecular confirmation was obtained in 109 cases. Clinical and radiographic evaluation was obtained in close diagnostic collaboration with expert groups abroad through Internet communication for difficult cases. This has allowed for targeted biochemical and molecular studies leading to the correct identification of rare or novel conditions, which has not only helped affected families by allowing for improved genetic counseling and prenatal diagnosis but also resulted in several scientific contributions. We conclude that (1) the spectrum of genetic bone disease in Kerala, India, is similar to that of other parts of the world, but recessive entities may be more frequent because of widespread consanguinity; (2) prenatal detection of skeletal dysplasias remains relatively rare because of limited access to expert prenatal ultrasound facilities; (3) because of the low accessibility to molecular tests, precise clinical-radiographic phenotyping remains the mainstay of diagnosis and counseling and of gatekeeping to efficient laboratory testing; (4) good phenotyping allows, a significant contribution to the recognition and characterization of novel entities. We suggest that the tight collaboration between a local reference center with dedicated personnel and expert diagnostic networks may be a proficient model to bring current diagnostics to developing countries. © 2014 Wiley Periodicals, Inc.

Report on the Iowa Department of Human Services – Central Distribution Center for the year ended June 30, 2011

Report on the Iowa Department of Human Services – Central Distribution Center for the year ended June 30, 2011

Report on the Iowa Department of Human Services – Central Distribution Center for the year ended June 30, 2012

Report on the Iowa Department of Human Services – Central Distribution Center for the year ended June 30, 2012

Desarrollo de la ciudadanía intercultural en Sant Quintí de Mediona a través de redes comunitarias

Con este artículo, se propone profundizar en la realidad de una localidad de menos de 3.000 habitantes con un porcentaje de población inmigrante extranjera de más del 10%, se trata de un estudio de caso llevado a cabo en Sant Quintí de Mediona, desde un modelo dinámico de ciudadanía intercultural, incidiendo especialmente en los procesos de acogida y de integración de la población inmigrante y potenciando unas condiciones óptimas para la convivencia. El estudio de estas condiciones ha exigido una evaluación diagnóstica para conocer las características de la población y del proceso migratorio, primeras políticas desarrolladas para la acogida de la población inmigrante y el punto de vista de los participantes en todo este proceso así como la disposición de las entidades que componen la red comunitaria para abrirse a la población recién llegada. Se ha recogido toda esta información a través del estudio documental, entrevistas a informantes claves, grupos de discusión y una encuesta a las entidades existentes en la población seleccionada. Desde el análisis de datos, este estudio diagnóstico, incluye las necesidades de cambio estructural, de nuevas relaciones de convivencia y de formación para toda la población y para colectivos determinados. Una vez presentadas las conclusiones, se ofrece una propuesta de desarrollo de un Plan de ciudadanía intercultural orientado a la convivencia para poblaciones multiculturales, que puede hacerse extensivo a poblaciones parecidas a la estudiada, contemplando el papel de las redes comunitarias como un elemento básico para su desarrollo.

Desarrollo de la ciudadanía intercultural en Sant Quintí de Mediona a través de redes comunitarias

Con este artículo, se propone profundizar en la realidad de una localidad de menos de 3.000 habitantes con un porcentaje de población inmigrante extranjera de más del 10%, se trata de un estudio de caso llevado a cabo en Sant Quintí de Mediona, desde un modelo dinámico de ciudadanía intercultural, incidiendo especialmente en los procesos de acogida y de integración de la población inmigrante y potenciando unas condiciones óptimas para la convivencia. El estudio de estas condiciones ha exigido una evaluación diagnóstica para conocer las características de la población y del proceso migratorio, primeras políticas desarrolladas para la acogida de la población inmigrante y el punto de vista de los participantes en todo este proceso así como la disposición de las entidades que componen la red comunitaria para abrirse a la población recién llegada. Se ha recogido toda esta información a través del estudio documental, entrevistas a informantes claves, grupos de discusión y una encuesta a las entidades existentes en la población seleccionada. Desde el análisis de datos, este estudio diagnóstico, incluye las necesidades de cambio estructural, de nuevas relaciones de convivencia y de formación para toda la población y para colectivos determinados. Una vez presentadas las conclusiones, se ofrece una propuesta de desarrollo de un Plan de ciudadanía intercultural orientado a la convivencia para poblaciones multiculturales, que puede hacerse extensivo a poblaciones parecidas a la estudiada, contemplando el papel de las redes comunitarias como un elemento básico para su desarrollo.

IMRT credentialing for prospective trials using institutional virtual phantoms: results of a joint European Organization for the Research and Treatment of Cancer and Radiological Physics Center project.

BACKGROUND AND PURPOSE: Intensity-modulated radiotherapy (IMRT) credentialing for a EORTC study was performed using an anthropomorphic head phantom from the Radiological Physics Center (RPC; RPCPH). Institutions were retrospectively requested to irradiate their institutional phantom (INSTPH) using the same treatment plan in the framework of a Virtual Phantom Project (VPP) for IMRT credentialing. MATERIALS AND METHODS: CT data set of the institutional phantom and measured 2D dose matrices were requested from centers and sent to a dedicated secure EORTC uploader. Data from the RPCPH and INSTPH were thereafter centrally analyzed and inter-compared by the QA team using commercially available software (RIT; ver.5.2; Colorado Springs, USA). RESULTS: Eighteen institutions participated to the VPP. The measurements of 6 (33%) institutions could not be analyzed centrally. All other centers passed both the VPP and the RPC ±7%/4 mm credentialing criteria. At the 5%/5 mm gamma criteria (90% of pixels passing), 11(92%) as compared to 12 (100%) centers pass the credentialing process with RPCPH and INSTPH (p = 0.29), respectively. The corresponding pass rate for the 3%/3 mm gamma criteria (90% of pixels passing) was 2 (17%) and 9 (75%; p = 0.01), respectively. CONCLUSIONS: IMRT dosimetry gamma evaluations in a single plane for a H&N prospective trial using the INSTPH measurements showed agreement at the gamma index criteria of ±5%/5 mm (90% of pixels passing) for a small number of VPP measurements. Using more stringent, criteria, the RPCPH and INSTPH comparison showed disagreement. More data is warranted and urgently required within the framework of prospective studies.

Expérience de dix ans de réanimation chirurgicale d'un centre hospitalier universitaire. Détermination d'un critère d'identification des patients à risque de décéder de coagulopathie irréversible [10 years experience in surgical resuscitation at a university hospital center. Determination of a criterion for identifying patients at risk for fatal irreversible coagulopathy]

The authors evaluated ten years of surgical reanimation in the University Centre of Lausanne (CHUV). Irreversible coagulopathy (IC) is the predominant cause of death for the polytraumatized patient. Acidosis, hypothermy, and coagulation troubles are crucial elements of this coagulopathy. The authors looked for a criterion allowing the identification of dying of IC. In a retrospective study, laboratory results of pH, TP, PTT, thrombocyte count and the need for blood transfusion units were checked for each major step of the primary evaluation and treatment of the polytraumatized patients. These results were considered as critical according to criteria of the literature (30). The authors conclude that the apparation of a third critical value may be useful to identify the polytraumatized patient at risk of dying of IC status. This criterion may also guide the trauma team in selecting a damage control surgical approach (DCS). This criterion was then introduced into an algorithm involving the Emergency Department, the operating room and the Intensive Care Unit. This criterion is a new tool to address the patient at the crucial moment to the appropriate hospital structure.

Report on the Iowa Department of Human Services – Central Distribution Center for the year ended June 30, 2013

Report on the Iowa Department of Human Services – Central Distribution Center for the year ended June 30, 2013