Business Sphere, Vol. 18, no.4

As the nation’s leading producer of ethanol and biodiesel, Iowa is building upon its national reputation as an innovative renewable fuel and energy leader by aggressively pursuing more wind energy production. We invite you to take a closer look at Iowa as we harness the winds of renewable energy

Iowa Workforce Monthly, April 2009, Issue 4

Highlights: *The Siouxland Tri-State Region is currently taking interest surveys for a potential wind energy company. .....pg. 2 * Over twenty businesses participated in a job fair last month in Red Oak....pg. 3 * Over 70 employers from across southwestern Iowa attended a seminar hosted by the SW Iowa division of the Employers Council of Iowa....pg. 3

2010 Annual Report of the Iowa Utilities Board

The IUB Annual Report contains summaries for IUB dockets that were active during the calendar year as well as IUB background information, IUB work section highlights, descriptions of IUB court cases and participation in federal proceedings, listings of IUB assessments to jurisdictional utilities, and the IUB fiscal year budget.

2011 Annual Report of the Iowa Utilities Board

The IUB Annual Report contains summaries for IUB dockets that were active during the calendar year as well as IUB background information, IUB work section highlights, descriptions of IUB court cases and participation in federal proceedings, listings of IUB assessments to jurisdictional utilities, and the IUB fiscal year budget.

2011 Annual Report of the Iowa Utilities Board

The IUB Annual Report contains summaries for IUB dockets that were active during the calendar year as well as IUB background information, IUB work section highlights, descriptions of IUB court cases and participation in federal proceedings, listings of IUB assessments to jurisdictional utilities, and the IUB fiscal year budget.

2012 Annual Report of the Iowa Utilities Board

The IUB Annual Report contains summaries for IUB dockets that were active during the calendar year as well as IUB background information, IUB work section highlights, descriptions of IUB court cases and participation in federal proceedings, listings of IUB assessments to jurisdictional utilities, and the IUB fiscal year budget.

Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group.

New evidence shows that older adults need more dietary protein than do younger adults to support good health, promote recovery from illness, and maintain functionality. Older people need to make up for age-related changes in protein metabolism, such as high splanchnic extraction and declining anabolic responses to ingested protein. They also need more protein to offset inflammatory and catabolic conditions associated with chronic and acute diseases that occur commonly with aging. With the goal of developing updated, evidence-based recommendations for optimal protein intake by older people, the European Union Geriatric Medicine Society (EUGMS), in cooperation with other scientific organizations, appointed an international study group to review dietary protein needs with aging (PROT-AGE Study Group). To help older people (>65 years) maintain and regain lean body mass and function, the PROT-AGE study group recommends average daily intake at least in the range of 1.0 to 1.2 g protein per kilogram of body weight per day. Both endurance- and resistance-type exercises are recommended at individualized levels that are safe and tolerated, and higher protein intake (ie, ≥1.2 g/kg body weight/d) is advised for those who are exercising and otherwise active. Most older adults who have acute or chronic diseases need even more dietary protein (ie, 1.2-1.5 g/kg body weight/d). Older people with severe kidney disease (ie, estimated GFR <30 mL/min/1.73m(2)), but who are not on dialysis, are an exception to this rule; these individuals may need to limit protein intake. Protein quality, timing of ingestion, and intake of other nutritional supplements may be relevant, but evidence is not yet sufficient to support specific recommendations. Older people are vulnerable to losses in physical function capacity, and such losses predict loss of independence, falls, and even mortality. Thus, future studies aimed at pinpointing optimal protein intake in specific populations of older people need to include measures of physical function.

Fallers in postacute rehabilitation have worse functional recovery and increased health services use.

OBJECTIVES: To determine characteristics associated with single and multiple fallers during postacute rehabilitation and to investigate the relationship among falls, rehabilitation outcomes, and health services use. DESIGN: Retrospective cohort study. SETTING: Geriatric postacute rehabilitation hospital. PARTICIPANTS: Patients (n = 4026) consecutively admitted over a 5-year period (2003-2007). MEASUREMENTS: All falls during hospitalization were prospectively recorded. Collected patients' characteristics included health, functional, cognitive, and affective status data. Length of stay and discharge destination were retrieved from the administrative database. RESULTS: During rehabilitation stay, 11.4% (458/4026) of patients fell once and an additional 6.3% (253/4026) fell several times. Compared with nonfallers, fallers were older and more frequently men. They were globally frailer, with lower Barthel score and more comorbidities, cognitive impairment, and depressive symptoms. In multivariate analyses, compared with 1-time fallers, multiple fallers were more likely to have lower Barthel score (adjOR: 2.45, 95% CI: 1.48-4.07; P = .001), cognitive impairment (adjOR: 1.43, 95% CI: 1.04-1.96; P = .026), and to have been admitted from a medicine ward (adjOR: 1.55, 95% CI: 1.03-2.32; P = .035). Odds of poor functional recovery and institutionalization at discharge, as well as length of stay, increased incrementally from nonfallers to 1-time and to multiple fallers. CONCLUSION: In these patients admitted to postacute rehabilitation, the proportion of fallers and multiple fallers was high. Multiple fallers were particularly at risk of poor functional recovery and increased health services use. Specific fall prevention programs targeting high-risk patients with cognitive impairment and low functional status should be developed in further studies.

Pharmacological treatment of behavioral and psychological symptoms of dementia (BPSD) in nursing homes: development of practice recommendations in a Swiss canton

OBJECTIVES: In 2002, the canton of Fribourg, Switzerland, implemented a coordinated pharmaceutical care service in nursing homes to promote rational drug use. In the context of this service, a project was conducted to develop recommendations for the pharmacological management of behavioral and psychological symptoms of dementia (BPSD) in nursing home residents. DESIGN AND METHODS: Selected evidence-based guidelines and meta-analysis sources related to the management of depression, insomnia, and agitation in dementia patients were systematically searched and evaluated. Evidence and controversies regarding the pharmacological treatment of the most common BPSD symptoms were reviewed, and treatment algorithms were developed. RESULTS: Ten evidence-based guidelines and meta-analyses for BPSD management were identified, with none specifically addressing issues related to nursing home residents. Based on this literature, recommendations were developed for the practice of pharmacological management of depression, sleep disturbances, and agitation in nursing home residents. For depression, SSRIs are considered the first choice if an antidepressant is required. No clear evidence has been found for sleep disturbances; the underlying conditions need to be investigated closely before the introduction of any drug therapy. Many drugs have been investigated for the treatment of agitation, and if necessary, antipsychotics could be used, although they have significant side effects. Several areas of uncertainty were identified, such as the current controversy about typical and atypical antipsychotic use or the appropriateness of cholinesterase inhibitors for controlling agitation. Treatment algorithms were presented to general practitioners, pharmacists, and medical directors of nursing homes in the canton of Fribourg, and will now be implemented progressively, using educational sessions, pharmaceutical counseling, and monitoring. CONCLUSION: Based on existing evidence-based studies, recommendations were developed for the practice of pharmacological management of depression, sleep disturbances, and agitation in nursing home residents. It should be further studied whether these algorithms implemented through pharmaceutical care services will improve psychotropic drug prescriptions and prevent drug-related problems in nursing home residents

2013 Annual Report of the Iowa Utilities Board

The IUB Annual Report contains summaries for IUB dockets that were active during the calendar year as well as IUB background information, IUB work section highlights, descriptions of IUB court cases and participation in federal proceedings, listings of IUB assessments to jurisdictional utilities, and the IUB fiscal year budget.

New diagnoses of dementia among older patients admitted to postacute care.

Objectives: To determine the prevalence of dementia and the proportion of undiagnosed dementia in elderly patients admitted to postacute care, and to identify patients' characteristics associated with undiagnosed dementia. Design: Cross-sectional study. Setting: Academic postacute rehabilitation facility in Lausanne, Switzerland. Participants: Patients (N = 1764) aged 70 years and older. Measurements: Data on socio-demographic, medical, functional, and affective status were collected upon admission. Data on cognitive performance (Mini-Mental State Exam [MMSE]), and cognition-related discharge diagnoses were abstracted through a structured review of discharge summaries. Results: Overall, 24.1% (425/1764) patients had a diagnosis of dementia, most frequently secondary to Alzheimer's disease (260/425, 61.2%). Among dementia cases, 70.8% (301/425) were newly diagnosed during postacute stay. This proportion was lower among patients referred from internal medicine than from orthopedic/surgery services (65.8% versus 74.8%, P = .042). Compared to patients with already diagnosed dementia, those newly diagnosed were older, lived alone more frequently, and had better functional status and MMSE score at admission (all P < .05). In multivariate analysis, previously undetected dementia remained associated with older age (OR = 2.4 for age 85 years and older, 95% CI 1.5-4.0, P = .001) and normal MMSE at admission (OR = 5.9, 95% CI 2.7-12.7, P < .001). Conclusion: Dementia was present in almost a fourth of elderly patients referred to postacute care, but was diagnosed in less than a third before admission. Oldest old patients appear especially at risk for underrecognition. These results emphasize the high diagnostic yield of systematic cognitive assessment in the postacute care setting to improve these patients' management and quality of life.

2014 Annual Report of the Iowa Utilities Board

The IUB Annual Report contains summaries for IUB dockets that were active during the calendar year as well as IUB background information, IUB work section highlights, descriptions of IUB court cases and participation in federal proceedings, listings of IUB assessments to jurisdictional utilities, and the IUB fiscal year budget.

Laitteen elinkaaritietoon perustuvien asiakasarvopohjaisten palveluiden kehittäminen

Työssä tutkitaan asiakasarvopohjaisten elinkaaritietoon perustuvien palveluiden kehittämistä. Tavoitteena on löytää asiakasarvo tuulivoimaliiketoiminnassa, selvittää mitä palveluja voidaan tuottaa elinkaaritietoon pohjautuen ja millainen kehitysprosessi palveluille ABB:n ympäristössä voidaan kuvata. Tutkimusongelmaa on tarkasteltuLCB-tutkimusprojektin tulosten ja kirjallisuuden pohjalta. Teoriat voidaan jakaa kolmeen osaan, asiakasarvoon, dataan ja kehitysprosessiin. Ensimmäisessä osassa keskitytään tarjoaman muutokseen, rooleihin liiketoimintaverkostossa ja asiakasarvon laskennalliseen määritykseen. Toisessa osassa keskitytään datan palveluksi jalostamiseen ja kolmannessa palvelun kehitysprosessin tutkimiseen. Tutkimustuloksia on verifioitu case-tutkimuksen avulla ja erästä asiakasta on lähestytty case-tapauksena haastattelun avulla. Asiakas on profiloitu haastattelun perusteella tavoitteena löytää asiakasarvo ja kiinnostus uusia palveluja kohtaan. Uusia palveluita on kehitetty sekä eksplisiittisen että hiljaisen tiedon pohjalta. Näiden pohjalta on luotu toimivia palvelukonsepteja ja ideointivaiheen kehitysprosessi on dokumentoitu. Työstä on tehty kaksi eri versiota, joista tämä on suppeampi.