Veterans counseling program : status report on the implementation of Iowa Code 35.12, Veterans Counseling & Outreach Program, 2008

This report gives an overview, background and progress on the implementation of the Veterans Counseling Program established pursuant to Iowa Code 35.12, as enacted by 2007 Iowa Acts, House FIle 817.

From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest.

OBJECTIVES: Therapeutic hypothermia has been recommended for postcardiac arrest coma due to ventricular fibrillation. However, no studies have evaluated whether therapeutic hypothermia could be effectively implemented in intensive care practice and whether it would improve the outcome of all comatose patients with cardiac arrest, including those with shock or with cardiac arrest due to nonventricular fibrillation rhythms. DESIGN: Retrospective study. SETTING: Fourteen-bed medical intensive care unit in a university hospital. PATIENTS: Patients were 109 comatose patients with out-of-hospital cardiac arrest due to ventricular fibrillation and nonventricular fibrillation rhythms (asystole/pulseless electrical activity). INTERVENTIONS: We analyzed 55 consecutive patients (June 2002 to December 2004) treated with therapeutic hypothermia (to a central target temperature of 33 degrees C, using external cooling). Fifty-four consecutive patients (June 1999 to May 2002) treated with standard resuscitation served as controls. Efficacy, safety, and outcome at hospital discharge were assessed. Good outcome was defined as Glasgow-Pittsburgh Cerebral Performance category 1 or 2. MEASUREMENTS AND MAIN RESULTS: In patients treated with therapeutic hypothermia, the median time to reach the target temperature was 5 hrs, with a progressive reduction over the 18 months of data collection. Therapeutic hypothermia had a major positive impact on the outcome of patients with cardiac arrest due to ventricular fibrillation (good outcome in 24 of 43 patients [55.8%] of the therapeutic hypothermia group vs. 11 of 43 patients [25.6%] of the standard resuscitation group, p = .004). The benefit of therapeutic hypothermia was also maintained in patients with shock (good outcome in five of 17 patients of the therapeutic hypothermia group vs. zero of 14 of the standard resuscitation group, p = .027). The outcome after cardiac arrest due to nonventricular fibrillation rhythms was poor and did not differ significantly between the two groups. Therapeutic hypothermia was of particular benefit in patients with short duration of cardiac arrest (<30 mins). CONCLUSIONS: Therapeutic hypothermia for the treatment of postcardiac arrest coma can be successfully implemented in intensive care practice with a major benefit on patient outcome, which appeared to be related to the type and the duration of initial cardiac arrest and seemed maintained in patients with shock.

Paper 5: Surveillance of multiple congenital anomalies: implementation of a computer algorithm in European registers for classification of cases.

BACKGROUND: Surveillance of multiple congenital anomalies is considered to be more sensitive for the detection of new teratogens than surveillance of all or isolated congenital anomalies. Current literature proposes the manual review of all cases for classification into isolated or multiple congenital anomalies. METHODS: Multiple anomalies were defined as two or more major congenital anomalies, excluding sequences and syndromes. A computer algorithm for classification of major congenital anomaly cases in the EUROCAT database according to International Classification of Diseases (ICD)v10 codes was programmed, further developed, and implemented for 1 year's data (2004) from 25 registries. The group of cases classified with potential multiple congenital anomalies were manually reviewed by three geneticists to reach a final agreement of classification as "multiple congenital anomaly" cases. RESULTS: A total of 17,733 cases with major congenital anomalies were reported giving an overall prevalence of major congenital anomalies at 2.17%. The computer algorithm classified 10.5% of all cases as "potentially multiple congenital anomalies". After manual review of these cases, 7% were agreed to have true multiple congenital anomalies. Furthermore, the algorithm classified 15% of all cases as having chromosomal anomalies, 2% as monogenic syndromes, and 76% as isolated congenital anomalies. The proportion of multiple anomalies varies by congenital anomaly subgroup with up to 35% of cases with bilateral renal agenesis. CONCLUSIONS: The implementation of the EUROCAT computer algorithm is a feasible, efficient, and transparent way to improve classification of congenital anomalies for surveillance and research.

Review of Inconsistencies Between SUDAS and Iowa DOT Specifications Phase II: Implementation of Recommendations into SUDAS Specifications, TR-565, 2008

The current version of the SUDAS Specifications will be revised to accommodate the DOT’s utilization of SUDAS. The revisions to the SUDAS Specifications will be based upon the recommendations from Phase 1. In some instances, the recommendations will require reorganization of portions of the SUDAS Specifications. Upon incorporation of the Phase 1 recommendations, each applicable Division of the SUDAS Specifications will be updated into the active-imperative style, utilizing the 3- part specification format currently utilized by SUDAS.

Review of Inconsistencies Between SUDAS and Iowa DOT Specifications Phase II: Implementation of Recommendations into SUDAS Specifications, TR-565, Synopsis, 2008

The current version of the SUDAS Specifications will be revised to accommodate the DOT’s utilization of SUDAS. The revisions to the SUDAS Specifications will be based upon the recommendations from Phase 1. In some instances, the recommendations will require reorganization of portions of the SUDAS Specifications. Upon incorporation of the Phase 1 recommendations, each applicable Division of the SUDAS Specifications will be updated into the active-imperative style, utilizing the 3- part specification format currently utilized by SUDAS.

Review of Inconsistencies Between SUDAS and Iowa DOT Specifications Phase III: Continued Implementation of Recommendations into SUDAS Specifications, TR-607, 2010

The objective of the Phase 3 project was to re-write the identified sections of the SUDAS specifications into the imperative mood, consistent with the format utilized during the Phase 2 project and other work completed by SUDAS staff. Figures for the identified sections were updated to match the new SUDAS format, similar to the Iowa DOT Standard Road Plans. While the Iowa DOT does not intend to incorporate all of the following sections into their specification book, consistency with the Iowa DOT specifications was strived for wherever possible. Maintaining consistency between the specifications simplifies design, bidding, and construction.

Implementation of the Federal Highway Administration Final Rule on Work Zone Safety and Mobility, 2007

The Federal Highway Administration published the final rule updating 23 CFR 630 Subpart J in September 2004. The revised rule requires agencies using federal funding to address both safety and mobility in planning and construction of roadway improvements. The Iowa Department of Transportation (Iowa DOT) requested the assistance of the Center for Transportation and Research in developing guidance for a policy and procedures to comply with the final rule. This report describes an in-depth examination of current Iowa DOT project development processes for all types of improvements, including maintenance, as well as a detailed characterization of work zone impact considerations throughout project completion. To comply with both the letter and perceived intent of the final rule on safety and mobility, the report features a suggested work zone policy statement and suggested revisions in the Iowa DOT project development processes, including a definition of the key element: significant projects.

Patient doses in CT examinations in Switzerland: implementation of national diagnostic reference levels.

Diagnostic reference levels (DRLs) were established for 21 indication-based CT examinations for adults in Switzerland. One hundred and seventy-nine of 225 computed tomography (CT) scanners operated in hospitals and private radiology institutes were audited on-site and patient doses were collected. For each CT scanner, a correction factor was calculated expressing the deviation of the measured weighted computed tomography dose index (CTDI) to the nominal weighted CTDI as displayed on the workstation. Patient doses were corrected by this factor providing a realistic basis for establishing national DRLs. Results showed large variations in doses between different radiology departments in Switzerland, especially for examinations of the petrous bone, pelvis, lower limbs and heart. This indicates that the concept of DRLs has not yet been correctly applied for CT examinations in clinical routine. A close collaboration of all stakeholders is mandatory to assure an effective radiation protection of patients. On-site audits will be intensified to further establish the concept of DRLs in Switzerland.

La dépression majeure en hôpital général: adaptation et mise en oeuvre de recommandations pour la pratique clinique [Major depression in the general hospital: adaptation and implementation of guidelines]

Major depression IMD) is highly prevalent in the general hospital and adds a considerable burden to affected patients, but remains under detected and under treated. In an attempt to improve this situation, existing guidelines on MD were retrieved, systematically evaluated with the instrument AGREE (Appraisal of guidelines for research and evaluation), and adapted to the needs of the general hospital. These guidelines were made available on intranet, and actively implemented in two wards, where their impact on clinical practice was evaluated.

Implementation of population balances in simulation of gas-liquid reactors using a CFD-PBM coupled approach

In bubbly flow simulations, bubble size distribution is an important factor in determination of hydrodynamics. Beside hydrodynamics, it is crucial in the prediction of interfacial area available for mass transfer and in the prediction of reaction rate in gas-liquid reactors such as bubble columns. Solution of population balance equations is a method which can help to model the size distribution by considering continuous bubble coalescence and breakage. Therefore, in Computational Fluid Dynamic simulations it is necessary to couple CFD and Population Balance Model (CFD-PBM) to get reliable distribution. In the current work a CFD-PBM coupled model is implemented as FORTRAN subroutines in ANSYS CFX 10 and it has been tested for bubbly flow. This model uses the idea of Multi Phase Multi Size Group approach which was previously presented by Sha et al. (2006) [18]. The current CFD-PBM coupled method considers inhomogeneous flow field for different bubble size groups in the Eulerian multi-dispersed phase systems. Considering different velocity field for bubbles can give the advantageof more accurate solution of hydrodynamics. It is also an improved method for prediction of bubble size distribution in multiphase flow compared to available commercial packages.

Implementation of the Rijndael-AES algorithm on a Sage-Math worksheet

La principal motivació d'aquest treball ha estat implementar l'algoritme Rijndael-AES en un full Sage-math, paquet de software matemàtic de lliure distribució i en actual desenvolupament, aprofitant les seves eines i funcionalitats integrades.

Implementation of Signaling Gateway between Telephone Network and the Internet

Tässä diplomityössä perehdytään verkkoelementiltä, joka yhdistää H.323, MEGACO- ja ISUP-protokollia käyttävät tietoliikenneverkot toisiinsa, vaadittaviin ominaisuuksiin ja toiminnallisuuksiin. Tyypillisesti tällaista toiminnallisuutta tarvitaan IP- ja PSTN-verkkojen yhdistämisessä. Tarkastelu aloitetaan kuvaamalla PSTN-verkon signalointi ja rakenne, jatketaan kuvaamalla internet-protokollia käyttävä verkkoympäristö ja lopuksi perehdytään verkkoelementiltä vaadittaviin toiminnallisuuksiin, jotta PSTN ja MEGACO-pohjaiset verkot toimivat yhteen. Työn käytännöllisenä osuutena kuvataan osa viestisekvenssikaavioista, joita verkkoelementti toteuttaa puuttumatta kuitenkaan eri protokollien toimintaan viestien parametrien tasolla.